MORPHOLOGY OF THE TEXTURES, W 509 affected, by the thickening of the areolar and fibrous exercised, inferring, as well as circumstances will textures involved, and the accompanying oedema, 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, produce repetitions of the attack, and prolong its times and stages. Unconformable products then appear in the affected textures, and pari passu with irregular or abnormal morphological phenomena, sthenic gout becomes asthenic. Phlebitis is an asthenic disease. The blood of pregnant women is well known to contain an unusual abundance of colourless cells and protoplasma, administering to the growth and preservation of the fœtus. When the infant is born, a new but natural channel is opened for these nutritive materials; the breasts experience a physiological and conservative inflammation a new nutritive energy and an increased vascularity are established in them, and a new product is formed for the sustenance of the child. But adverse external conditions, a contagious poison, and other causes, sometimes disturb these events, and a train of phenomena termed puerperal phlebitis ensue. The nutritive materials with which the blood is highly charge are unfitted for their office, their morphology is arrested or rendered retrograde, and they accumulate in the circulating fluid, upon the walls of the bloodvessels, and in the textures that have been irritated by the process of the labour; the milk is not at all or only very scantily secreted, and thus arises one of the most asthenic diseases to which the human structure is obnoxious. 177 particularizing the law, and then trying the truth of it by following out its consequences, and comparing them with facts; or, 3rd, by a process partaking of both these, and combining the advantages of both without their defects-viz., by assuming the laws we would discover, but so generally expressed, that they shall include an unlimited variety of particular laws;-following out the consequences of this assumption by the application of such general principles as the case admits; comparing them in succession with all the particular cases within our knowledge; and lastly, on this comparison, so modifying and restricting the general enunciation of our laws, as to make the results agree." Now, in the law of the morphology of animal structures to which I refer the phenomena of inflammatory and scrofulous diseases, the agents of the metamorphosis are not arbitrarily assumed. We know them to exist in nature. Their presence in normal growth is demonstrated by unequivocal signs, and they perform a part in phenomena analogous to those we would render an account of. The laws which regulate their action have been derived by examining the cases of scrofula and inflammation, in which we know them to be exercised, by inductive reasoning from experiments and observations purposely instituted in vegetable and embryo animal textures, and by comparing the assumed law with all the particular cases within our knowledge, on which comparison the results agree; so that if my conclusions are theoretical, the terms of a good theory have been fulfilled. Supposing it necessary to inquire further what the agents are, then both experiment and observation afford grounds for concluding that they are the active molecules so copiously distributed amongst the textural elements, and so abundant in the interior of the cells of both vegetable and animal structures; and the colourless cells of blood filled with these molecules remaining stationary, and undergoing changes upon the textures, is a vera causa, explaining how, in animal structures, and in the human body, these active molecules are transferred from the flowing nutritive current to the fixed solids. Experience suggests that possibly these conclusions may be deemed speculative and theoretical; but let the candid reader be reminded, that no department of human knowledge can assume a scientific form without a theory, and because hitherto physiological or medical theories have presented an unfavourable aspect, still we must not, on that account, relinquish the right use of theory, and repudiate the term. "In framing a theory," | says Sir John Herschel, “which shall render a rational account of any natural phenomenon, we have first to consider the agents on which it depends, or the causes to which we regard it as ultimately referrible. These agents are not to be arbitrarily assumed; they must be such as we have good inductive grounds to believe do exist in nature, and do perform a part in phenomena analagous to those we would render an account of, or 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 cause, in short, which we can not only show to exist and to act, but the laws of whose action we can derive independently, by direct induction, from experiments purposely instituted. We have next to consider the laws which regulate the action of these agents, and these we can only arrive at in three ways-1st, by examining all the cases in which we know them to be In bringing to a termination this inquiry into the laws of scrofulous diseases and inflammation in the lower structures, and in the growth of embryo-textures, it may be useful to review the facts, and recapitulate the conclusions grounded upon them. All living bodies grow and are sustained by an epigenesis or morphology,-that is to say, by a series of changes and transformations in matter effected in • "Preliminary Discourse," pp., 197, 199, &c. 510 closed cells, and consequent upon two necessary antecedents,- —a vital power or inherent disposition imparted from the parent to the offspring, and certain external conditions, in which are included food, air, water, and temperature. The lowest living beings are simple isolated-cells; the next in order are aggregates of slightly cohering-cells; then follow the structures, composed of coherent-cells; after which come the fibrous and cartilaginous textures; and lastly, bone or wood. And it is to be particularly observed as we ascend the scale of animated nature, that the additional later-formed or higher elements do not supersede, but are superadded to, the prior ones:-thus fibrous elements are superadded to the cellular; cartilaginous to the fibrous and cellular; and bone to the cartilaginous, the fibrous, and cellular, until in the human body we meet with all the varieties,-osseous, cartilaginous, fibrous, and coherent cellular textures, superadded to All these slightly coherent and incoherent cells. textures, and every organ in the human body, in their primary or embryo state, are groups of slightly cohering cells, from which, by an epigenesis and morphology, are formed coherent cellular textures, traversed by numerous vessels or channels, conveying a current of the primary forms,-incoherent cells; to these are subsequently added various fibrous elements, and lastly, cartilage and bone. ON A NEW AND SUCCESSFUL MODE OF By WILLIAM GILL, M.D., Physician to the Nottingham Dispensary, and Consulting Physician to the Union (Read before the Provincial Medical and Surgical Associa- At a period when fever, to an alarming extent, prevails in our great manufacturing towns, I have much pleasure in bringing before the consideration of the members of the Association, a new method of treatment of fever, which is generally applicable, and has proved very effective. Twenty-five cases of fever occurring in our Union Hospital, during the last two This remedy is months, have tested its power. capable, not only of controlling some of the most distressing symptoms of the typhoid state, but frequently of arresting its progress, both at the commencement, and at a more advanced stage of the disease. Still a more extended experience is required before its merits can be fully determined. It is said, that very lately, in Liverpool, no less than 10,000 people were at the same time suffering from typhus fever, accompanied with a considerable mortality. Its attacks were not limited to the poorer classes, as many of the Roman clergy, and several in the higher ranks, have fallen victims to its power. In London, Glasgow, Leeds, Huddersfield, and Manchester, and other large towns, the same type of fever exists. Should the constitution of the atmosphere, during the autumnal season, prove favourable to its dissemination, may we not expect its In Liverpool, The phenomena of inflammation observe the same order. The first steps of the process are indicated by an unusual accumulation of incoherent red and colour. less cells derived from the blood current, the latter of which remain stationary upon the affected texture, become slightly coherent, and discharge their proto-wide spread in an epidemical form? as in other large places, the introduction of typhus plasmatous contents, the conformable or unconformable was traceable to the vagrant Irish. Its rapid diffusion morphology of which determines the nature of the product and the sthenic or asthenic character of the may be easily accounted for, by their gregarious habits. Wherever they wander, a family of contagious disorders disorder. The products of a conformable metamorphosis 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 The appearance of phosis, whether irregular or retrograde, added to the famine from their native land. these unfortunates, especially the children, was wretched pre-existing textures constitute asthenic inflammation. in the extreme, and told an unerring tale of hunger and suffering. Very soon typhus fever broke out, and raged with considerable severity. The phenomena of scrofulous diseases also commence with an accumulation of incoherent cells from the same source, (the blood,) and it is by the products of the unconformable metamorphosis hindering their natural growth and supplanting the natural elements, that these diseases are produced. Holding the appointment of Honorary Physician to the Hospital, I had a fair opportunity of trying a 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 the Nottingham Union, is a building well adapted for 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 NEW MODE OF TREATING FEVER. be described, every new case was submitted to its influence-twenty-five in all. During the last three weeks only two fever-patients have been admitted. Before entering more immediately on the object of this paper, it will be right to describe, concisely, the general features of the prevalent fever. Occuring, as it chiefly did, amongst the half-starved Irish, we might naturally suppose it would be characterized by symptoms of a low typhoid character. In most cases the immediate cause of the attack was traceable to sleeping in crowded lodging houses, the usual abode of fever in our large cities; the proximate causes, doubtless, were over fatigue, and insufficient and unwholesome food. The term "hunger pestilence," has been aptly applied to the disease. A true typhoid gastro-enterite, was present in many of the patients, closely resembling what so frequently is observed in the Parisian hospitals. Whether the essentiality of the fever existed in the condition of the muco-alimentary membrane or not, it is not my intention here to discuss. This, how ever, I remarked, that so soon as the signs of gastroalimentary irritation were subdued, the signs of general fever subsided. Some two or three cases which I shall read, will corroborate this observation. In the generality of patients under my care, not only was the gastro-alimentary membrane affected, but also the muco-pulmonary, as evidenced by cough, shortness of respiration, and frequently universal sonorous râles, affecting the whole of the chest. In most of the Irish sick the skin was spotted with petechiæ, of different sizes and colours, chiefly developed on the abdomen and chest. This was not remarked amongst the English cases. There was no discharge of blood from the inner membranes. Edema of the lower extremities occurring early in the disease was generally a fatal symptom, though we had two cases of recovery in boys, who were universally anasarcous from the commencement. The disturbance of the sensorium was marked by low muttering delirium, sometimes wandering about the bed-room, constant picking at the bed-cloths, and subsultus tendinum. Some were affected with a heavy, comatose, and stupid state, from which they were with difficulty aroused, and when aroused, with difficulty were made to understand questions; they relapsed immediately into the same lethargic condition when left to themselves. This comatose condition often continued till convalescence was established, and in some even later. It seemed a perfect prostration of all mental energy, and was only relieved as the bodily powers regained their tone. In no one case did active delirium occur. The secretions from the bowels were thin, frequent, black, and offensive, and often attended with severe griping, but no bloody discharges. The function of the bladder in one or two individuals was suspended, and it was necessary twice daily to use the catheter. The usual period of the termination of the fever seemed to be from the 511 eighteenth to the twenty-first day, at which time the patients were left in a state of the greatest prostration. When the case terminated fatally, an unrousable unconscious coma closed the scene. The usual symptoms of fever were generally present,‚—as the hot dry skin; black tongue; urgent thirst; pulse varying from 90 to 130; insomnia; and pains in head, back, and limbs, &c. After this brief description of the general features of the disease, we will now proceed to the treatment. I am well aware that a great prejudice exists in the profession against the treatment to be advocated, partly because it is opposed to preconceived opinions, and chiefly from the unprofessional manner in which it has been ushered into notice. I feel certain, however, that I am addressing a body of gentlemen willing to receive truth for the sake of itself, not looking to the source from whence derived, but only to its sterling quality. With perfect confidence, therefore, I throw myself on the candour and liberality of my professional brethren, whilst I detail a treatment of fever, as yet untaught in the schools, and unrecognized by the profession. If future experience shall confirm my own, as to its curative properties, it will be a source of gratification to myself in having been the first to bring its merits before this enlightened Association. I believe that Dr. Currie, of Liverpool, was the first scientific English physician who enlisted cold water as an external remedial agent in the treatment of fevers. Successful as the practice was under his direction, how little has it been followed in later times! It is only within the last few years that the prejudice which existed against the internal and external use of water has begun to subside. Perhaps the prominence of the sanitary questions, and the many evils proved to arise from the want of a due supply of pure water, has had much to do in removing this groundless prejudice, and may have produced an undue re-action in its favour, causing it to be considered not only as necessary to a healthy condition, but as a curative agent of universal efficacy. Hence perhaps the public mind has been somewhat prepared to receive the hydropathic theory with much more favour than its intrinsic merits demand. An universal remedy will ever find many advocates, and in a numerous profession like ours, there are ever men to be found who, from selfish motives, will pander to this diseased taste of the public mind. We, as an Association, must ever protest against such exclusive theories as prevail in our days, being in our opinion unscientific, opposed to experience, and calculated to lead to incorrect views respecting the power of many known and valued medicinal agents. In making this protest against any exclusive theory for the cure of diseases, we must not rush into the opposite extreme, and from disbelief of their universal efficacy, deny their particular efficacy, when the touchstone of experience speaks to the contrary. in winter, it is necessary to have a good fire, and to have one blanket well warmed to apply around the body, so soon as removed from the wet sheet. Several cases of incipient fever have lost all tracesof disease after the first application. If the fever is not reduced, the next day the same plan must be repeated, keeping the patient in the wetted sheet from half an hour to one hour, according to the intensity of the symptoms, and in the blankets from one to two hours. This may be repeated every day till indications of a cool skin arise, then it must be immediately discontinued. During some period of this treatment, the tem The plan which I have adopted for the cure of fever has been a modification of Dr. Currie's. Instead of pouring buckets of cold water over the body, I have enveloped it in a wetted sheet, an instrument more effective than Currie's in reducing the temperature of the body, and producing a warm and comfortable perspiration, which did not uniformly follow his plan. The fear of evil consequences from this treatment is groundless. I give no opinion as to its utility except in cases of fever. Here, however, I can speak with confidence. When the skin is burning-hot, and the mouth and tongue parched, the application of a sheet, wrung out of cold water, and applied closely to the whole surface of 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 a most grateful feeling of refreshment, which is soon followed by a more or less warm perspiration. In young people this perspiration breaks out in from five to ten minutes after its application; in middle-aged people the period is longer. Many uncomfortable sensations are soon relieved by its use, such as the muscular pains in the back, thighs, and legs, and the sense of aching and weariness; the thirst often becomes less, and even the dry tongue sympathizes with the relaxing influence induced on the cutaneous surface. I have seen the low moaning delirium subside whilst under its use; and some patients who have not slept before, now doze, especially if the hair has viously been cut short, and a flannel night-cap wetted with vinegar and water been applied to the head. pre The simple plan I have followed has been this :On a flock bed I have placed from three to five blankets, superimposed over these a sheet wrung out of cold water, on which the patient, stripped, is placed, with legs outstretched, and arms to the side; the sheet is then drawn tightly around up to the neck, and inclosing the feet; first, one blanket, then another, and so on to the whole number, are tightly drawn over the sheet, so as to have the whole body well and closely packed. In this state the patient lies from a quarter of an hour to one or two hours, according to the object in view, and the effect produced. Some get tired at the end of half an hour, some can continue for one or two hours, and feel very comfortable. As soon as a gentle perspiration commences, a wine-glass full of water is given frequently. At the commencement of this treatment, in a case of fever, I have generally ordered its use for one hour; after that time the wet things are removed, and the sick person is placed in bed, well wrapped in three blankets, and allowed to perspire for three hours; afterwards, the blankets are to be carefully removed, one at a time, so as to allow the perspiration to subside gradually, and the patient is then placed in bed between the sheets. During the whole of this period, small quantities of water should be given. In the summer, during this process, a free ventilation may be allowed in the chamber; 78° in shade,) I have not found it advisable to keep the patient as long as two hours sweating in the blankets; from half an hour to one hour was sufficient. A longer period caused the pulse to be accelerated, instead of lowered, which latter is the usual effect of the treatment. In very hot weather, when a free perspiration has been induced at the commencement of the fever, I have adopted the following plan:-To wrap the sick person for half an hour in the wet sheet, covered lightly with one blanket; to be then washed all over with a towel wetted with tepid water, then rubbed dry, and placed in bed between the sheets. I have not found it necessary to make use of this treatment more than five times to the same individual; generally after the third or fourth application the skin becomes cooler, and the other signs of fever gradually subside. When the skin becomes cool, and the tongue less dry, I have instantly discontinued all water remedies, and given bark, wine, and broths, and it was surprising how soon convalescence and strength become established. During the whole course of the fever milk and water, or weak broths, were allowed, ad libitum. In one person, twice, in the course of the same day, owing to the intensity of the fever, it was found necessary to repeat the wet sheet, using it the second time for only half the period of the first; a comfortable night ensued. Without doubt this is a most effective mode of quickly reducing the temperature of the body; an equilibrium is soon established between the cold of the water and the heat of the body, and the patient becomes bathed in a natural vapour bath, as may be felt by placing the hand under the bed-clothes. Where the fever runs high, and the delirium is violent, the wet sheet may be safely applied for short periods, (two minutes,) several times in the course of the day. This will be found a more effectual mode of reducing the cerebral excitement, than any other means with which we are acquainted. This refrigerating plan, used for ten minutes, during an evening exacerbation, will often produce a few hours refreshing sleep. I must confess that I had great doubts as to the safety of this treatment, where the mucous membranes NEW MODE OF TREATING FEVER. of the bronchi and gastro-alimentary passages were complicated. Very soon my fears on this head were dissipated by the convincing evidence of experience; in fact, these proved the cases in which the decided benefit of the treatment was most marked. The quick and embarrassed respiration, dry cough, and sonorous râles, subsided quickly after one or two applications of the wet sheet; the cough became looser, the râles moister, and expectoration was established. 513 Supination in a lethargic state, and unconscious, unless violently aroused; the face purplish red; eyes bloodshot and pupil dilated; constantly picks at the bedclothes; subsultus tendinum; low muttering delirium ; the skin furnace-hot; tongue dry, shrivelled, black, and covered with sordes; diarrhœa; general tympanitis of abdomen, without much expressiou of pain when pressed, unless aroused, and then his face indicates the existence of pain; the urine and stools are not passed involuntarily; the abdomen and skin generally The same happy change also occurred where the covered with dark-coloured petechiae; the respiration gastro-alimentary membranes were disordered. Gene-hurried, forty-four in the minute, and the stethoscope rally the first wet sheet puts a stop to the diarrhoea, and soon afterwards pain and swelling disappeared. A confined state of the bowels was frequently the effect of the wet sheet, and it was found necessary in several of the patients to resort to small doses of castor oil. In three or four cases the symptoms of gastric and abdominal irritation or inflammation were so violent, as to have justified the employment of leeches, calomel, and opium; and indeed we know that depletion by leeches is the usual treatment followed in the Parisian hospitals, and yet by the simple means mentioned, in three days every bad symptom had vanished. A great saving is made to the patient's strength when we can dispense with the abstraction of blood. I am anxious to make this paper altogether practical, hence I will not enter into any theory respecting the modus operandi of the wet sheet. At some future time perhaps I may avail myself of our excellent Provincial Journal for such purpose. And now, before I read some cases, a most important question suggests itself. Is it possible to arrest the progress of typhus fever after once fairly established? I am well aware that individual experience, and the testimony of our best writers on the subject, answer this question in the negative. It is therefore with great diffidence I oppose my experience against this concurrent testimony. Facts are stubborn things, and can only be contradicted by proving their incorrectness. My limited experience distinctly shows that, fever in all its stages has been arrested. If a more lengthened trial of this treatment should corroborate this simple statement, a pleasing addition will be made to our stock of professional knowledge, which may prove of considerable advantage to suffering humanity. I think it right to add that many of the patients in the Union Hospital were occasionally visited by professional friends resident in Nottingham, and were daily seen by the House-Physician. I shall read a selection of cases in order that I may not unnecessarily occupy the valuable time of this meeting. CASE I. Michael Kane, aged 18, Irish vagrant, of vigorous constitution. He has been in the Union Hospital five days, under the care of Dr. Stiff, and taken salines. June 28th. The following is his present condition :— reveals universal bronchitic râles in the chest; pulse 130, weak and hurried. The treatment ordered was the application of the wetted sheet for one hour, blanket for two hours; the head to be shaved, and a flannel night-cap, wetted with vinegar and water, to be constantly applied. To have milk and water ad libitum. There evidently were clear signs of head, chest, and abdomen complication. The blood-shot eye and purple countenance, accompanying a nearly unconscious state, indicated a congestive condition of the brain. The stethoscope revealed a similar condition in the lungs, and the universal swelling of the abdomen, attended by diarrhoea, and by pain when the patient was partly sensible, added no little to cause a most unfavourable prognosis to be formed. June 29th. The aspect is better; has passed a better night; the picking at the bed-clothes and the low muttering delirium are quite subsided; the skin is cooler and rather inclined to moisture; the purging no longer continues, and there is less tympanitis; breathing and dry cough less troublesome; respiration not so frequent when lying quiet, but the slightest movement causes it to be accelerated; the râles moister; the man more intelligent when aroused, but still instantly falls into a doze when left to himself; the tongue not so black or dry; the pulse come down to 100, regular and soft. He sweated much both in the sheet and blankets. To repeat the wet sheet and blankets as before. 30th. Continues better in all respects. No further application of the wet sheet. July 1st. The man is convalescent; skin cool and moist; tongue has nearly lost all marks of dryness and blackness; urine free and paler coloured; bowels open once daily; intelligence nearly restored; pulse 90; the chest and abdominal complications rapidly subsiding; the patient asks for nourishing diet. have the bark, mutton broth, and bread and milk. To CASE II. Martin Glynn, Irish vagrant, aged 13, has been ill three days. June 9th. There is intense heat of skin, and flushing of the face, with pains in the head, bones, abdomen, back, and legs; great thirst; tongue deep red, and covered in the centre with a cream-coloured fur; great pain in epigastrium, and a tympanitic condition of the abdomen, with diarrhea; there exists slight cough, but no " |