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MORPHOLOGY OF THE TEXTURES,
affected, by the thickening of the areolar and fibrous' exercised, inferring, as well as circumstances will textures involved, and the accompanying õdema, and permit, the amount or intensity in each particular case, which is most important, by the part being restored to and then generalizing from them, and so arriving at the its natural state. But unfavourable conditions, intem- laws desired ; 2nd, by forming at once a bold hypothesis, perate modes of life, mental anxiety, and other causes, particularizing the law, and then trying the truth of it produce repetitions of the attack, and prolong its by following out its consequences, and comparing them times and stages. Unconformable products then with facts; or, 3rd, by a process partaking of both these, appear in the affected textures, and pari passu with and combining the advantages of both without their irregular or abnormal morphological phenomena, defects-viz., by assuming the laws we would discover, sthenic gout becomes asthenic.
but so generally expressed, that they shall include an Phlebitis is an asthenic disease. The blood of unlimited variety of particular laws;-following out the pregnant women is well known to contain an unusual consequences of this assumption by the application abundance of colourless cells and protoplasma, admi- of such general principles as the case admits ; nistering to the growth and preservation of the comparing them in succession with all the particular fætůs. When the infant is born, a new but natural cases within our knowledge, and lastly, on this comchannel is opened for these nutritive materials; the parison, so modifying and restricting the general breasts experience a physiological and conservative enunciation of our laws, as to make the results agree."* inflammation a new nutritive energy and an increased Now, in the law of the morphology of animal strucvascularity are established in them, and a new pro- tures to which I refer the phenomena of inflammatory duct is formed for the sustenance of the child. and scrofulous diseases, the agents of the metamore But adverse external conditions, a contagious poison, phosis are not arbitrarily assumed. We know thern and other causes, sometimes disturb these events, and to exist in nature. Their presence in normal growth a train of phenomena termed puerperal phlebitis ensue. ( is demonstrated by unequivocal signs, and they perform The nutritive materials with which the blood is highly a part in phenomena analogous to those we would charge are unfitted for their office, their morphology render an account of. The laws which regulate their is arrested or rendered retrograde, and they accumulate action have been derived by examining the cases of in the circulating Auid, upon the walls of the blood scrofula and inflammation, in which we know them vessels, and in the textures that have been irritated by to be exercised, by inductive reasoning from experia the process of the labour; the milk is not at all or only ments and observations purposely instituted in vegetable very scantily secreted, and thus arises one of the most and embryo animal textures, and by comparing the asthenic diseases to which the human structure is assumed law with all the particular cases within our obnoxious.
knowledge, on which comparison the results agree ; Experience suggests that possibly these conclusions so that if my conclusions are theoretical, the terms may be deemed speculative and theoretical; but let of a good theory have been fulfilled. Supposing it the candid reader be reminded, that no department of necessary to inquire further what the agents are, buman knowledge can assume a scientific form without then both experiment and observation afford grounds a theory, and because hitherto physiological or medical for concluding that they are the active molecules so theories bare presented an unfavourable aspect, still we copiously distributed amongst the textural elements, must not, on that account, relinquish the right use of and so abundant in the interior of the cells of both theory, and repudiate the term. “In framing a theory,” vegetable and animal structures; and the colourless says Sir John Herschel, “ which shall render a rational cells of blood filled with these molecules remaining account of any natural phenomenon, we have first to stationary, and undergoing changes upon the textures, consider the agents on which it depends, or the causes to is a vera causa, explaining how, in animal structures, which we regard it as ultimately referrible. These and in the human body, these active molecules are agents are not to be arbitrarily assumed ; they must be transferred from the flowing nutritive current to the such as we have good inductive grounds to believe do fixed solids. exist in nature, and do perform a part in phenomena! In bringing to a termination this inquiry into the analagous to those we would render an account of, or laws of scrofulous diseases and inflamm
laws of scrofulous diseases and inflammation in the such whose presence in the actual case can be demon human body, based upon the phenomena observed in strated by unequivocal signs. They must be veræ lower structures, and in the growth of embryo-textures, causa, in short, which we can not only show to exist it may be useful to review the facts, and recapitulate and to act, but the laws of whose action we can derive the conclusions grounded upon them. independently, by direct induction, from experiments All living bodies grow and are sustained by an purposely instituted. We have next to consider the epigenesis or morphology,--that is to say, by a series laws which regulate the action of these agents, and of changes and transformations in matter effected in these we can only arrive at in three ways-lst, byexamining all the cases in which we know them to be "Preliminary Discourse," pp, 197, 199, &c.
closed cells, and consequent upon two necessary ante- ON A NEW AND SUCCESSFUL MODE of cedents,-a vital power or inherent disposition imparted
TREATING FEVER. from the parent to the offspring, and certain external
By WILLIAM GILL, M.D., Physician to the Nottingham conditions, in which are included food, air, water; 'and
Dispensary, and Consulting Physician to the Union temperature. The lowest living beings are simple
Hospital, Nottingham. isolated-cells; the next in order are aggregates of (Read before the Provincial Medical and Surgical Associaslightly cohering cells ; then follow the structures, tion, at the Anniversary Meeting, at Derby, Thursday, composed of coherent-cells; after wbicb come the August 5th, 1817.) fibrous and cartilaginous textures ; and lastly, bone or At a period when fever, to an alarming extent, wood. And it is to be particularly observed as we prevails in our great manufacturing towns, I have ascend the scale of animated nature, that the additional much pleasure in bringing before the consideration later-formed or higher elements do not supersede, but of the members of the Association, a new method of are superadded to, the prior ones :—ibus fibrous elements treatment of fever, which is generally applicable, and are superadded to the cellular; cartilaginous to the has proved very effective. Twenty-five cases of fever fibrous and cellular; and bone to the cartilaginous, ) occurring in our Union Hospital, during the last two the fibrous, and cellular, until in the human body we months, have tested its power. This remedy is meet with all the varieties,-osseous, cartilaginous, capable, not only of controlling some of the most fibrous, and coherent cellular textures, superadded to distressing symptoms of the typhoid state, but frequently slightly coherent and incoherent cells. All these of arresting its progress, bo:h at the commencement, textures, and every organ in the human body, in their and at a more advanced stage of the disease. Still a primary or embryo state, are groups of slightly more extended experience is required before its merits cohering cells, from which, by an epigenesis and can be fully determined. It is said, that very lately, morphology, are formed coherent cellular textures, in Liverpool, no less than 10,000 people were at the traversed by numerous vessels or channels, conveying same time suffering from typhus fever, accompanied a current of the primary forms,-incoherent cells; to with a considerable mortality. Its attacks were not these are subsequently added various fibrous elements, limited to the poorer classes, as many of the Roman and lastly, cartilage and bone.
clergy, and several in the higher ranks, have fallen The phenomena of inflammation observe the same victims to its power. In London, Glasgow, Leeds, order. The first steps of the process are indicated by
Huddersfield, and Manchester, and other large towns, an unusual accumulation of incoherent red and colour. the same type of fever exists. Should the constitution less cells derived from the blood current, the latter of of the atmosphere, during the autumnal season, prove which remain stationary upon the affected texture, | favourable to its dissemination, may we pot expect its become slightly coherent, and discharge their proto wide spread in an epidemical form ? In Liverpool, plasmatous contents, the conformable or unconformable as in other large places, the introduction of typhus morphology of which determines the nature of the was traceable to the vagrant Irish. Its rapid diffusion product and the sthenic or asthenic character of the may be easily accounted for, by their gregarious habits. disorder. The products of a conformable metamor
Wherever they wander, a family of contagious disorders phosis added to the pre-existing natural elements,
is carried with them. Small-pox, measles, skin disconstitute sthenic, curable and conservative inflamma seases, and fever, were imported wholesale into the tion. The products of an unconformable metamor | Union Hospital, by the droves of Irish driven by phosis, whether irregular or retrograde, added to the famine from their native land. The appearance of pre-existing textures constitute asthenic inflammation. these unfortunates, especially the children, was wretcbed
The phenomena of scrofulous diseases also com. I in the extreme, and told an unerring tale of hunger mence with an accumulation of incoherent cells from and suffering. Very soon typhus ferer broke out, and the same source, (the blood,) and it is by the products | raged with considerable severity. of the unconformable metamorphosis hindering their
Holding the appointment of Honorary Physician natural growth and supplanting the natural elements,
to the Hospital, I had a fair opportunity of trying a that these diseases are produced.
method of cure, the success of which had frequently reached my ears whilst living in Germany. I think it proper to mention that the hospital, in connection with Ĩ the treatment of fever, the rooms being lofty, and well ventilated, and kept very clean, and readily admits of the classification of patients. The diet is wholesome and liberal, and an intelligent medical officer, Dr. Stiff, has the management of the in-door sick. After the commencement of the mode of treatment to
be described, every new case was submitted to its eighteenth to the twenty-first day, at which time infuence-twenty-fire in all. During the last three the patients were left in a state of the greatest prostraweeks only two ferer-patients have been admitted. tion. When the case terminated fatally, an ubrousable
Before entering more immediately on the object of unconscious coma closed the scene. The usual sympthis paper, it will be right to describe, concisely, the toms of fever were generally present, -as the hot dry general features of the prevalent fever. Occuring, as it skin; black tongue; urgent thirst ; pulse varying from chiefly did, amongst the half-starved Irish, we might 90 to 130; insomnia; and pains in head, back, and naturally suppose it would be characterized by symp. limbs, &c. After this brief description of the general toms of a low typhoid character. In most cases the features of the disease, we will now proceed to the immediate cause of the attack was traceable to sleeping treatment. in crowded lodging houses, the usual abode of fever in ' I am well aware that a great prejudice exists in the our large cities; the proximate causes, doubtless, were profession against the treatment to be advocated, partly over fatigue, and insufficient and upwholesome food. because it is opposed to preconceived opinions, and The term "hunger pestilence," has been aptly applied chiefly from the unprofessional manner in which it has to the disease. A true typhoid gastro-enterite, was been ushered into notice. I feel certain, however, that present in many of the patients, closely resembling I am addressing a body of gentlemen willlog to receive what so frequently is observed in the Parisian hospitals. truth for the sake of itself, not looking to the source Whether the essentiality of the fever existed in from whence derived, but only to its sterling quality. the condition of the muco-alimentary membrane or with perfect confidence, therefore, I throw myself on not, it is not my intention here to discuss. This, how the candour and liberality of my professional brethren, ever, I remarked, that so soon as the signs of gastroa whilst I detail a treatment of fever, as yet untaught in alimentary irritation were subdued, the signs of the schools, and unrecognized by the profession. If general fever subsided. Some two or three cases future experience shall confirm my own, as to its curawhich I shall read, will corroborate this observation. tive properties, it will be a source of gratification to In the generality of patients under my care, not only myself in having been the first to bring its merits was the gastro-alimentary membrane affected, but before this enlightened Association. also the muco-pulmonary, as evidenced by cough, I believe that Dr. Currie, of Liverpool, was the first shortness of respiration, and frequently universal / scientific English physician who enlisted cold water as sonorous râles, affecting the whole of the chest. In an external remedial agent in the treatment of fevers. most of the Irish sick the skin was spotted with Successful as the practice was under his direction, bow petechiæ, of different sizes and colours, chiefly de- little has it been followed in later times! It is only veloped on the abdomen and chest. This was not within the last few years that the prejudice which remarked amongst the English cases. There was no exisied against the internal and external use of water discharge of blood from the inner membranes. Edema has begun to subside. Perhaps the prominence of the of the lower extremities occurring early in the disease sanitary questions, and the many erils proved to arise was generally a fatal symptom, though we had two from the want of a due supply of pure water, has bad cases of recovery in boys, who were universally anasar. much to do in remoring this groundless prejudice, and cous from the cominencement. The disturbance of may have produced an undue re-action in its favour, the sensorium was marked by low muttering deliriuin, causing it to be considered not only as necessary to a sometimes wandering about the bed-room, constant healthy condition, but as a curative agent of universal picking at the bed-cloths, and subsultus tendinum. efficacy. Hence perhaps the public mind has been Some were affected with a heavy, comatose, and stupid somewhat prepared to receive the hydropathic theory state, from which they were with difficulty aroused, with much more favour than its intrinsic merits and when aroused, with difficulty were made to under demand. An universal remedy will ever find many stand questions; they relapsed immediately into the advocates, and in a numerous profession like ours, there same lethargic condition when left to themselves. This are ever men to be found who, from selfish motives, comatose condition often continued till convalescence will pander to this diseased taste of the public mind, was established, and in some even later. It seemed a We, as an Association, must erer protest against such perfect prostration of all mental energy, and was only exclusive theories as prevail in our days, being in our relieved as the bodily powers regained their tone. In opinion unscientific, opposed to experience, and calcu. Do one case did active delirium occur. The secretions lated to lead to incorrect views respecting the power of from the bowels were thin, frequent, black, and offer many known and valued medicinal agents. In making sive, and often attended with severe griping, but no this protest against any exclusive theory for the cure of bloody discharges. The function of the bladder in diseases, we must not rush into the opposite extreme, one or two individuals was suspended, and it was neces- and from disbelief of their universal efficacy, deny sary twice daily to use the catheter. The usual period their particular efficacy, when the touchstone of expeof the termination of the fever seemed to be from the rience speaks to the contrary.
The plan which I have adopted for the cure of fever in winter, it is necessary to have a good fire, and to has been a modification of Dr. Currie's. Instead of have one blanket well warmed to apply around the pouring buckets of cold water over the body, I have body, so soon as removed from the wet sheet. enveloped it in a wetted sheet, an instrument more Several cases of incipient fever have lost all traceseffective than Currie's in reducing the temperature of of disease after the first application. If the ferer the body, and producing a warm and comfortable per- is not reduced, the next day the same plan must be spiration, which did not uniformly follow his plan. The repeated, keeping the patient in the wetted sheet fear of evil consequences from this treatment is ground from half an hour to one hour, according to the less. I give no opinion as to its utility except in cases | intensity of the symptoms, and in the blankets of fever. Here, however, I can speak with confidence. froin one to two hours. This may be repeated every When the skin is burning-hot, and the mouth and day till indications of a cool skin arise, then it must tongue parched, the application of a sheet, wrung out be immediately discontinued. of cold water, and applied closely to the whole surface During, some period of this treatment, the temof the body, and evaporation prevented by the applica- perature of the atmosphere being very high, (75° to tion of three or four blankets placed over it, produces 78o in shade,) I have not found it adrisable to keep a most grateful feeling of refreshment, wbich is soon the patient as long as two hours sweating in the followed by a more or less warm perspiration. In blankets; from half an hour to one bour was sufficient. young people this perspiration breaks out in from five A longer period caused the pulse to be accelerated, to ten minutes after its application; in middle-aged instead of lowered, which latter is the usual effect people the period is longer. Many uncomfortable of the treatment. In very hot weather, when a free sensations are soon relieved by its use, such as the perspiration has been induced at the commencement muscular pains in the back, thighs, and legs, and the of the fever, I have adopted the following plan:--To sense of aching and weariness; the thirst often becomes wrap the sick person for half an hour in the wet sheet, less, and even the dry tongue sympathizes with the covered lightly with one blanket; to be then washed relaxing influence induced on the cutaneous surface. | all over with a towel wetted with tepid water, then I have seen the low moaning delirium subside rubbed dry, and placed in bed between the sheets. whilst under its use ; and some patients who have not I have not found it necessary to make use of this slept before, now doze, especially if the hair has pre- treatment more than five times to the same individual; viously been cut short, and a flannel night-cap wetted generally after the third or fourth application the skin with vinegar and water been applied to the bead. becomes cooler, and the other signs of fever gradually
The simple plan I have followed has been this :- subside. When the skin becomes cool, and the tongue On a flock bed I have placed from three to five less dry, I have instantly discontinued all water blankets, superimposed over these a sheet wrung out remedies, and given bark, wine, and broths, and it was of cold water, on which the patient, stripped, is placed, surprising how soon convalescence and strength become with legs outstretched, and arms to the side ; the sheet is established. During the whole course of the fever then drawn tightly around up to the neck, and inclosing milk and water, or weak broths, were allowed, ad the feet ; first, one blanket, then another, and so on libitum. In one person, twice, in the course of the to the whole number, are tightly drawn over the sheet, same day, owing to the intensity of the fever, it was
save the whole body well and closely packed. | found necessary to repeat the wet sheet, using it the In this state the patient lies from a quarter of an second time for only half the period of the first; & hour to one or two hours, according to the object in view, comfortable night ensued. and the effect produced. Some get tired at the end! Without doubt this is a most effective mode of of half an hour, soine can continue for one or two quickly reducing the temperature of the body; an hours, and feel very comfortable. As soon as a gentle equilibrium is soon established between the cold of the perspiration commences, a wine-glass full of water is water and the beat of the body, and the patient given frequently. At the commencement of this becomes bathed in a natural vapour bath, as may be treatment, in a case of fever, I bave generally ordered felt by placing the band under the bed-clothes. Where its use for one hour; after that time the wet things the fever runs high, and the delirium is violent, the are removed, and the sick person is placed in bed, well wet sheet may be safely applied for short periods, (two wrapped in three blankets, and allowed to perspire for minutes,) several times in the course of the day. This three hours; afterwards, the blankets are to be care- will be found a more effectual mode of reducing the fully removed, one at a time, so as to allow the perspira- cerebral excitement, than any other means with which tion to subside gradually, and the patient is then we are acquainted. This refrigerating plan, used for placed in bed between the sheets.
ten minutes, during an evening exacerbation, will During the whole of this period, sniall quantities of often produce a few hours refreshing sleep. vater should be given. In the summer, during this pro- I must confess that I had great doubts as to the cess, a free ventilation may be allowed in the chamber; safety of this treatment, where the mucous membranes
of the bronchi and gastro-alimentary passages were Supination in a'lethargic state, and unconscious, unless complicated. Very soon my fears on this lead were violently aroused; the face purplish red; eyes blood. dissipated by the convincing evidence of experience; shot' and pupil dilated; constantly picks at the bed in fact, these proved the cases in which the decided clothes ; subsultus tendinum; low niuttering delirium ; benefit of the treatment was most marked. The quick the skia furnace-hot; tongue dry, shrivelled, black, and embarrassed respiration, dry cough, and sonorous
and covered with sordes; diarrbæa; general tympanitis
of abdomen, without much expressiou of pain when rales, subsided quickly after one or two applications
pressed, uoless aroused, and then bis face indicates of the wet sheet; the cough became looser, the rales
the existence of paia ; the urine and stools are not moister, and expectoration was establisbed.
passed involuntarily ; the abdomen and skin generally The same happy change also occurred where the covered with dark-coloured petechiæ; the respiration gastro-alimentary membranes were disordered. Gene- burried, forty-four in the minute, and the stethoscope rally the first wet sheet puts a stop to the diarrhoea, and reveals universal bronchitic râles in the chest; pulse soon afterwards pain and swelling disappeared. A 130, weak and hurried. The treatment ordered was -confined state of the bowels was frequently the effect the application of the wetted sheet for one hour, of the wet sheet, and it was found necessary in several
blanket for two hours; the head to be shaved, and a
flannel night-cap, wetted with vinegar and water, to be of the patients to resort to small doses of castor oil.
constantly applied. To have milk and water ad libitum. In three or four cases the synoptoms of gastric and
There evidently were clear signs of head, chest, and abdominal irritation or inflammation were so violent, as
e so volent, as abdomen complication. The blood-shot eye and pur. to have justified the employment of leeches, calomel, l ple countenance, accompanying a nearly unconscious and opium ; and indeed we know that depletion by state, indicated a congestive condition of the brain. leecbes is the usual treatment followed in the Parisian The stethoscope revealed a similar condition in the hospitals, and yet by the simple means mentioned, in lungs, and the universal swelling of the abdomen, three days every bad symptom had vanished. A great attended by diarrhea, and by pain when the patient saving is made to the patient's strength when we can
was partly sensible, added no little to cause a most dispense with the abstraction of blood.
unfavourable prognosis to be formed.
June 29th. The aspect is better ; has passed a I am anxious to make this paper altogether prac
better night; the picking at the bed-clothes and the tical, hence I will not enter into ang theory respecting
low muttering delirium are quite subsided; the skin the modus operandi of the wet sheet. At some future is cooler and rather inclined to moisture ; the purging time perhaps I may avail myself of our excellent
no longer continues, and there is less tympanitis; Provincial Journal for such purpose.
breathing and dry cough less troublesome; respiration And now, before I read some cases, a most important not so frequent when lying quiet, but the slightest question suggests itself. Is it possible to arrest the movement causes it to be accelerated; the râles progress of typhus fever after once fairly established ?
moister; the man more intelligent when aroused, but I am well aware that individual experience, and the
still instantly falls into a doze when left to himself;
the tongue not so black or dry; the pulse come down testimony of our best writers on the subject, answer
to 100, regular and soft. He sweated much both in this question in the negative. It is therefore with great
the sheet and blankets. To repeat the wet sheet and diffidence I oppose my experience against this concur.
blankets as before. rent testimony. Facts are stubborn things, and can 30th. Continues better in all respects. No further only be contradicted by proving their incorrectness. I application of the wet sheet. My limited experience distinctly shows that, fever in July 1st. The man is convalescent; skin cool and all its stages has been arrested. If a more lengthened moist; tongue has nearly lost all parks of dryness and trial of this treatment should corroborate this simple blackness; urine free and paler coloured; bowels open statement, a pleasing addition will be made to our once daily ; intelligence nearly restored; pulse 90; stock of professional knowledge, which may prove of
the chest and abdominal complications rapidly subconsiderable advantage to suffering humanity. "I think
siding; the patient asks for nourishing diet. To
have the bark, mutton broth, and bread and milk. it right to add that many of the patients in the Union
July 4th. To bave meat daily. Hospital were occasionally visited by professional
5th. Is able to walk in the room. . friends resident in Nottingham, and were daily seen by 6th. Is down stairs in the yard and well. the House-Physician.
Case II. I shall read a selection of cases in order that I may Ma
Martin Glynn, Irish vagrant, aged 13, has been ill not" uodecessarily occupy the" valuable time of this three days. meeting.
June 9th. There is intense heat of skin, and flushing of . ; CASE I.
the face, with pains in the bead, bones, abdomen, back, Michael Kane, aged 18, Irish vagrant, of vigorous and legs; great thirst; tongue deep red, and covered constitution. He has been in the Union Hospital five in the centre with a cream-coloured fur; great pain in days, under the care of Dr. Stiff, and taken saliaes. epigastrium, and a tympanitic condition of the abdo.
June 28th. The following is his present condition :- med, with diarrhea ; there exists slight cough, but no