Physiological pyretology

Front matter

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Preface

To dissipate the prejudices entertained by some physicians against the application of pathological anatomy and physiology to the investigation of the seat and nature of fevers; to contribute to the dissemination of truths, the value of which can no longer be contested, since they have given rise to a more rational, and, what is of greater importance, a more efficacious treatment of these diseases; to show that, if the French medical doctrine is new, when considered as a system, it can, nevertheless, appeal in attestation of its truth to the authority of past ages, and even to the experience of its adversaries ; finally, to reduce within the limits of observation, principles which have been generalized with too much boldness. Such were the objects which I proposed to myself in the publication of this work, which first appeared in 1823.

This edition has received numerous additions, which principally refer to the anatomical researches recently made, with a view to throw light on the nature and seat of various fevers, to quarantines, and the epidemics of the Morea and Gibraltar. In consequence of the employment of a smaller type, the size of the volume has not been increased.

Having been induced by the continued favour of the public^ to believe that this work had not been devoid of utility, the only reward which a scientific author can iv PREFACE.

propose to himself, I undertook to publish a work of greater extent, in which I applied to pathology * in general, the method and principles by which I had conducted my researches on fevers.

I do not aspire to the celebrity of a reformer ; my object is simply to offer students and practitioners, who have not an opportunity of following the progress of medical discovery, a faithful exposition of the present state of the science of disease, in reference to diagnosis and treatment. The observations of the ancients and moderns have furnished the elements of this work, which is designed as an introduction to that attentive and profound study of the science and art of curing, which it is the duty of every physician to prosecute.

Paris, November 2,7th, 1830.

* Nosographie Organique ou Traite complet de Medicine. Paris, 1828, 1830, 4 vols, in 8vo.; chez J. B. Balliere.

Table Of Contents

Preface Page 3 — 4

Introduction. General principles of physiology and pathology. Sect. 1 . Of life and organization. Sect. 2. Of the human body. Sect. 3. Of organic action. Sect. 4. Of excitability. Sect. 5. Of organic action in the state of health. Sect. 6. Of organic action in the state of disease. Sect. 7. Of sur-excitation or irritation. Sect. 8. Of sub-excitation or astheny. Sect. 9. Of organic action considered with relation to therapeutics. - - Page 9 — 56

PHYSIOLOGICAL PYRETOLOGY.

Chapter I. Of Fevers In General

Hippocrates did not entertain the opinions since held on the subject of fevers. Symptomatic pyretology. The characteristic signs of fevers. Enumeration of the different fevers described by pyretologists. Type, duration and termination of fevers. Errors of the pyretological doctrines before Pinel. Service rendered to science by Pinel. The perfecting of nosographic pyretology to be ascribed to him. Necessity of commencing where he terminated, in treating of fevers. Object of the author and plan of the work. Principles of M. Broussais, in relation to the seat of diseases in general, and the nature and seat of fevers in particular. Arguments in favour of their adoption. Arguments against referring all fevers to gastro-enteritis. Opinion of the author on the seat of fevers. This work is not polemical. - - . Page 57 — 68

Chapter II. Of Inflammatory Fever

Synonym. Premonitory symptoms. Symptoms. Course, duration, complications and terminations. Varieties. Nature and seat. According to Pinel. According to M. Broussais; Tommasini; Reil; Bagard; Brown; J. P. Frank; M. Bouillaud; M. Gendrin; The Author. Causes; Synocha is not always a gastro-enteritis. Inflammatory fever arising from encephalic irritation; from car-

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dlac; gastric; bronchial; mammary; uterine; renal; vesical; cutaneous; articular: epidemic inflammatory fever of 1802. These diverse irritations combined, may determine symptoms of inflammatory fever.

Treatment of Inflammatory Fever.

Principles which should guide us in the treatment, founded upon the nature and seat of this disease. General indication. Of blood-letting". Answer to the objections against leeches. Of cupping; diet; drink; pediluvia; rubefacients; emetics and cathartics. The treatment should be the same in epidemic inflammatory fever. Are there cases in which the inflammatory fever should be abandoned to the efforts of nature. Treatment during convalescence. Treatment of complicated inflammatory fevers. - - - Page 69 — 107

Chapter III. Of Gastric Fever

Synonym. Precursory signs. Symptoms of gastric embarrassment. Of intestinal embarrassment. Of gastro-intestinal embarrassment. Of gastric fever. Course, duration, complications, and terminations of these affection. Of gastric inflammatoiy fever. Pathological anatomy. Symptoms of cholerar. Pathological anatomy. Nature of these affections, according to Galen; Tissot; Finke; Selle; Stoll; Frank; Brown; Fordyce, and Pinel. Nature and seat, according to MM. Tommasini and Broussais. Causes. Variety of gastric embarrassment, with which it is important to be acquainted. First variety of gastric fever; second variety; third variety; fourth variety. Relative frequency of these varieties. Encephalic symptoms in gastric fever. Pectoral symptoms in gastric fever. Of the pretended utility of vomiting, diarrhoea and a flux of urine in gastric fever. Prognosis. Pathological anatomy. In the horse.

Treatment of Gastric or Bilious Fever.

Of indigestion. Treatment of indigestion. Affinity between indigestion, gastric embarrassment and gastric fever. Treatment of gastric fever since Hippocrates. According to Tissot, Stoll and Pinel. Fundamental principles which should, at the present day, direct the treatment of gastric affections. Treatment of a slight irritation of the stomach. Of a more intense irritation, of the degree of irritation which constitutes the ardent fever of the ancients, or of inflammatoiy gastric fever. Of leeches, drinks, water. Quantity and temperature of drinks. Of diet. Of emulsions; fomentations; lavements; measures indicated by the signs of encephalic irritation. Course to be pursued when the irritation extends to the liver. Case in which an emetic is allowable. Stoll thought the patient should be prepared by blood-letting, for the operation of an emetic. What is meant by the salutary shock produced by an emetic? The melioration of the symptoms after an emetic, is generally only momentary. Purgatives. Treatment of diarrhoea. Of the irritations which supervene on that of the gastric mucous membrane, and complicate it Of anomalous bilious

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fevers described by Finke. Epidemic gastric fevers, require no other treatment than those which are sporadic. Purgatives during- convalescence. Means of preventing- relapses. Disadvantages of tonics. - - Page 108 — 138

Chapter IV. Of Mucous Fever

Synonym. Precursory signs. Symptoms. Of the presence of worms. Course duration, complication and terminations. Results of-autopsy according to Roe derer and Wagler; according" to Sarcone. Causes, nature and seat. Worms. Complicated mucous fever is not always solely the result of gastro-enteritis Complication. Treatment of mucous fever. General idea of mucous fever which should guide us in the treatment. Treatment recommended by Selle, Stoll and Frank; by Roederer and Wagler, and by Pinel. Therapeutic indications derived from its nature and seat. When the signs of gastro-intestinal irri tation are very prominent. When they are not very prominent. Opinion of Sarcone with regard to blood-letting: of Roederer. Emetics. Measures to be taken when the disease is prolonged; when there is diarrhoea, dysentery, 'or bronchial irritation. Page 139 — 160

Chapter V. Of Adynamic Fever

It is the creation of modem times. The opinions of Selle, Stoll, Cullen and Frank, with regard to putrid fevers. Character of the adynamic fever according to Pinel. Symptoms of this fever. Physiological analysis of all the symptoms. Conclusion. Causes to which this fever is attributed. Physiological analysis of the action of these causes. Quarin distinguishes five kinds of putrid fever. Experiments of MM. Gaspard and Magendie. Does astheny of the brain occur in adynamy? Precursory signs. The adynamic fever is not the result of weakness. First variety of this fever; second variety; third variety. Nature and seat^of adynamic fever: course, duration and termination. Unfavourable signs. Results of autopsy, according to Pinel; M. Prost; M. Broussais and the Author. Objections urged against the importance of organic alterations detected after adynamic fever. Answers to these objections. Result of the anatomical researches of M. Andral; of Laennec; of M. Ribes. Recent conclusions of M. Andral. Researches of M. Louis.

Treatment of Adynamic Fever.

It is seldom cured, especially when it is treated by tonics. Tonics and emetics are contra-indicated by the nature of this fever. The prescription of tonics in this fever, founded solely upon hypothesis. Botalli; Gui; Patin: Hecquet; Chirac; Baglivi; Van Swieten; Dehaen; Sydenham; Huxham and Stoll, were aware of the bad effects of these measures. Brown used them prodigally. MM. Rasori and Tommasini commenced a reform. It was in France that the problem of the nature of adynamic fever, was definitively solved, and from that period the treatment of these fevers has reposed upon a solid basis. Hy-

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gienic measures against the development of these fevers. Measures proper on some occasions, on the part of the government. Blood-letting- does not convert inflammatory into adynamic fever. Bad effects of emetics administered with a view to prevent adynamy. Adynamic fever uncommon in the establishments in which fever is treated by blood-letting. Good effects of the antiphlogistic treatment, witnessed by the author in the practice of M. Broussais. Proper course when adynamy has declared itself. When there still exist unequivocal symptoms of inflammation. When the symptoms of adynamy alone appear to remain. When we are called to a patient in whom the symptoms are said to have manifested themselves suddenly, or about whose case we can obtain no information. When the case is almost hopeless. If there are cases .in which tonics may be useful; these cases are rare, and they are exceptions to the general rule, and must not be considered as constituting this rule. Of tonics in convalescence. Attention to be paid to the skin in this disease. Of baths. Of sinapisms. Of blisters. Of the treatment of ulcerations. Of dryness of the mouth, and of drinks. Of constipation and lavements. Of meteorism and cold fomentations. Of hemorrhage and astringents. Of sweats. Attentions during convalescence. Treatment recommended by M. Louis. Page 161 — 237

Chapter VI. Of Ataxic Fever

Synonym. Course pursued by Selle and Pinel in establishing the order of ataxic fevers. Symptoms of ataxic fever. Nervous symptoms of those fevers. Division of those symptoms into two series. First series. Second series. Neither of these series indicate weakness. Signs of irritation of the arachnoid and encephalon, according to Lallemand. Result of the researches of MM. Bouillaud, Foville, Pinel Grandchamp, Lacrampe, Lousteau, Parent, and Martinet — Of M. Senn. Gastric symptoms of ataxic fever. They are the result of irritation. Their absence and inference to be drawn from it. Circulatory symptoms of ataxic fever. They do not prove that it is owing to weakness or ataxy. State of the skin in this fever. Of ataxy. Signs of ataxy according to Selle. Varieties of ataxic fever which it is important not to confound. First variety; second, third, fourth, fifth, sixth, seventh, eighth. Termination. Unfavourable signs. Results of autopsy. Nature and seat of ataxic fever according to the author. Causes of ataxic fever. Physiological analysis of the action of the causes. All ataxic fevers are not gastro-enterites. Definition of ataxic fever according to the author.

Treatment of Maxic Fever.

Danger of tonics in these fevers. Services rendered to medicine by M. Broussais. Indications to be fulfilled with a view to prevent ataxic fever, — to cure it; general method; blood-letting, in plethoric subjects, in subjects more nervous than sanguine, in subjects suffering from exhaustion. Tonics, emetics, cathartics. Modifications of the treatment in cerebral fever, in ataxic inflammatory fever; hi gastro-ataxic fever, in ataxic mucous fever, in slow nervous fever.

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Chapter VII. Of Typhus

Signification of this word according- to Hippocrates, Galen, Sauvages, Pringle, Cullen, Hildenbrand, Pinel. The latter has expressed two contradictory opinions with regard to the nature of typhus in his nosography. History of the typhus of Rochefort, described by Chirac. Results of autopsy. History of the typhus, described by Pringle. Results of autopsy. History of the typhus of Salpetriere, described by Pinel. Results of autopsy. General description of typhus, according to Hildenbrand. Of regular typhus. Description of irregular typhus. Results of autopsy, according to Hildenbrand. This author contradicts himself. Services rendered to science by Chirac, Pringle, Poissonnier Desperrieres, Pinel, and Hildenbrand. Inference drawn from a physiological analysis of their works. What typhus is, according to the author. Proofs of the truth of this opinion derived from the work of Hildenbrand. Opinion of M. Broussais on the nature and seat of typhus. According to him, typhus is not a disease sui generis. He has not dwelt sufficiently on the constancy of cerebral irritation in typhus. Typhus, according to Hildenbrand and Pinel, is a peculiar disease. This speciality is not demonstrated by pathological anatomy; it is not to be found in the symptoms or in the causes. The stupor does not prove it, nor the mode of propagation. How typhus, caused by miasmata, differs from sporadic typhus. Of petechia, of inflammation of the parotid gland, of phlegmon, of tumefaction of the inguinal glands; of gangrenous spots, and of carbuncles. What these symptoms indicate: how their appearance may be explained. Hildenbrand has properly remarked, that an absorption of miasmata is not essential to the production of typhus. To what distance can the miasmata and effluvia which generate typhus, be transported? Of the agents of its propagation. Of the causes of typhus other than miasmata. On what organ do the miasmata principally act? The skin is not the only organ to be guarded against their impression. Of the general measures to be employed with a view to prevent the development and propagation of typhus.

Treatment of Typhus.

Theoretical views of Chirac on the treatment of typhus: in what his method consisted. Precautions taken by him in the employment of blood-letting. He abused emetics and stimulants, and advised at the same time, to prevent with care the inflammation of the stomach and intestines, of the brain and liver. Method of Pringle in the treatment of typhus. It was vague, founded upon a defective theory, and not upon experience. Prejudices of Pringle against blood-letting. Poissonnier Desperrieres, only pursued the footsteps of Pringle. Method of Pinel in the treatment of typhus. Is it proper to administer tonics and emetics in the first twenty-four hours? How Hildenbrand treated himself when he had the typhus. How Pinel treated himself under similar circumstances. Singular confession of Hildenbrand. Method of Broussais in the treatment of typhus. Superiority of this method. Why bloodletting is of so little efficacy in typhus. - - - Page 272—313

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Chapter VIII. Of Yellow Fever

It Las been referred to every species of continued fever, with the exception of mucous fever. General description of the symptoms of this fever. Premonitory signs. First period, second period, third period. Duration. State of the intellectual faculties. Convalescence. Of the symptoms observed in yellow fever more frequently than in any other disease, and of those which constantly occur in this fever. Of the black matter; of icterus; of vomiting-; of epigastric pain: of pain in the head; of pain in the loins, and in the back of the neck. Do these symptoms authorize us to regard the yellow fever as a disease essentially different from even- other. Results of post mortem examinations in America; at Barcelona: at New Orleans. Important researches remain to be made with regard to this disease. Of the seat of yellow fever according 1 to M. Tommasini; according- to M. Bailly, according- to M. Francois; according- to M. Dubreuil; according to M. Broussais; according- to V. Coste. Origin of yellow fever. Of the importation of this disease. Opinion of Deveze; of M. Bailly. Opinion of Spanish physicians. Could it be propagated by an army marching through a country. Experiments proposed with a view to determine the mode of propagation of this disease. Places and seasons of its prevalence. Predisposing and occasional causes. If there is a miasm it cannot act except with a concurrence of these causes. History of the yellow fever at Port du Passage. Of the yellow fever at Gibraltar.

Treatment of Yellow Fever.

Conditions necessary to the avoidance of the disease in the country in which it prevails. Method of M. Bailly in the treatment of this fever. Mortality of this disease greater than that of typhus. How M. Bailly treated himself when he was attacked with the yellow fever. Of blood-letting in yellow fever. Method of M. Jourdan. Opinion of M. Jourdan. Opinion of M. Dupuytren.

Chapter IX. Of The Plague

Idea vulgarly attached to this word by many physicians of the present day. History of the plague of Nimeguen, described by Diemerbroeck. History of the plague of Marseilles, described by Bertrand. Results of autopsy. History of the plague of Russia, described by Samoilowitz. Results of autopsy. History of the plague of Egypt, described by M. Desgenettes. Results of autopsy. History of the plague of Noja, described by Vitangelo Morea. Results of autopsy. History of the plague of the Morea, by Bobillier. Nature and seat of the plague. Occult proximate cause of the plague. Whether the plague originated in Egypt.

Treatment of the Plague.

Prophylactic measures. Idea which has long influenced the treatment of the plague. Method of Bertrand. His opinion on blood-letting. Opinion of M.

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Desgenettes with regard to this operation. Local treatment of the plague, according to M. Larrey. Of friction with ice, recommended by Samo'ilowitz. Of friction with oil of olives. Profound views of Cullen. Precept of Diemerbroeck. Page 349-568

Chapter X. Of Quarantine

Of contagious diseases. Of importable diseases. Is all the good effected by quarantine which is ascribed to it? Answer with regard to plague, with regard to yellow fever, leprosy. Cholera morbus. Analysis of the instructions according tc which quarantine is prescribed. Vagueness of this instruction. Of patents. Of fumigations. Consequences of the quarantine regulations. How ships should be distinguished on their arrival in port. Necessity of a reform in the system of quarantine. Quarantine illusory in most cases.

Chapter XI. Of Intermittent Fever, And Particularly Of Benign Intermittent Fever

Pinel has rendered an important service to medicine, in classing each intermittent fever W'*" 1 . the continued fever whose symptoms it presents. Description of simple intermittent fever, according to Boerhaave and Stoll, or of intermittent fever in general. Different types of intermittent fever. Of the character of the paroxysms, according to the type. Of the apyrexia. Conversion of intermittents into each other. Termination. Division of these fevers, according to the season; according to then' severity. Division according to their symptoms, according to Pinel. Description of inflammatory intermittent fever; of gastric, of mucous, of adynamic, and of ataxic intermittents. Opinion of ML Broussais on the nature and seat of intermittents. Modification of this opinion by the author. Nature of intermittents. Influence of marsh miasmata. Whether the type of intermittents prove that they differ from continued fever. Hypothesis of Willis, of Deleboe, Borelli, Boerhaave, Stoll, Selle, and J. P. Frank. Opinion of Reil. Opinion of M. Roche. Reflections on this subject. The periodicity of fevers does not prove that they have their seats in the nervous system. Nature of intermittents, according to M. Guerin de Mamers. Their periodicity does not prove that they do not depend on inflammation.

Treatment of Intermittent Fevers, and especially of Benign Intermittent Fever.

Should we attempt the cure of them? Reasons for curing intermittents as quickly as possible. To what must we attribute the frequent unhappy consequences of the treatment? The first thing to be done is to change the circumstances of the patient. The morbid predisposition of the viscera should be cautiously considered. Method of the ancients. What means have taken the place of those employed by them. Conflicting opinions of Torti and Rammazzini with regard to bark. Why this remedy is preferred to all others, in the cure of intermittents. Treatment of simple intermittent, according to Frank. He has

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observed well, but explained badly. Treatment in the paroxysm, according to Stoll. Of inflammatory intermittents, according- to Stoll and others; according to Cullen: M. Broussais employs venesection and leeches. Advantages of this method, according to M. Duplan, If. Gassand, M. Gaste; according to the author. Treatment of gastric intermittents, according to Pinel. What the treatment should be at the present day. Treatment of mucous intermittents; of adynamic intermittents. Of arsenical preparations. Of bitters. Of the alkaloids of bark. Is the action of bark specific? How it cures intermittents. First fact; second fact; third fact Inference from these facts. How the excitation of the stomach, by the bark, prevents the development of intermittent fever. Of regimen in intermittent fever. Of the antiphlogistic means in the apyrexia. The irritation is not always intermittent. Of ligatures applied to the limbs in these fevers. Of blood-letting in the cold stage. Page 382—423

Chapter XII. Of Pernicious Intermittent Fevers

By what signs do we discover that intermittent fevers have assumed the pernicious character? Of the varieties of pernicious fever; of the cardialgic pernicious fever, atra-bilious, the choleric, the colic, the cephalalgic, the apoplectic, the delirious, the convulsive, the epileptic, the hydrophobic, aphonic, paralytic, amaurotic, peripneumonic, the pleuritic, dyspnaeic, asthmatic, catarrhal, syncopal, carditic, uterine, nephritic, cystic, rheumatic, arthritic, algid, diaphoretic, exanthematic, petechial, icteric. Ordinary type of pernicious intermittent fevers. Of the nature and seat of pernicious intermittents in general. Results of autopsic examination. How pernicious intermittents differ from benign. Opinion of F. Hoffman on the seat of intermittents; opinion of ML Alard; opinion of M. Bailly.

Treatment of Pernicious Intermittents.

They should never be left to their natural course. Course to be pursued when a benign intermittent begins to assume the pernicious character. When the apyrexia is complete. When the paroxysm is renewed. When the physician is called during a very short apyrexia. When the paroxysms are sub-intrant. When the paroxysms return after the administration of the bark. When the paroxysms return, but are of a more feeble character. When they do not return. Mode of aclministering bark in pernicious intermittents. When the fever is double tertian. Whether we can limit the bark to a small dose. What must be done when the irritation of the stomach is manifest. When deglutition is impossible. When called during the course of a paroxysm. When the symptoms indicate a violent irritation. Are there other indications to be fulfilled besides the administration of bark in pernicious intermittent fevers? Cold baths employed by Giannini. Every cause of irritation should be removed during the administration of the bark. What must be done when the bark decidedly exasperates the paroxysms. When the fever becomes continued. Dangers of the bark, pointed out by MM. Alibert and Broussais. Important distinction made by M. Broussais of two kinds of intermittent fevers.

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Action of bark in benign, or pernicious intermittent fevers. Compared to the action of this medicine in continued fevers. Action of bark in sub-intrant fevers. General idea of the action of bark in intermittent fevers. Doctrine of M. Tommasini on the Treatment of intermittent fevers. - Page 424 — 460

Chapter XIII. Of Erratic, Anomalous, Partial, And Masked Intermit

TENTS.

Of erratic intermittents, anomalous, partial. Of periodical diseases without fever. Of masked fevers. Analogy of masked fevers to intermittent fevers. All periodical diseases, with or without fever, have not their causes in the abdomen. Medicus liimself furnishes proof against his own opinion.

Chapter XIV. Of Remittent Fevers

Definition. Doctrine of Stoll with regard to remittent fever. Critique of this doctrine, by Pinel. Doctrine of Baumes on remittent fever. Symptoms before the paroxysm, in the paroxysm, after the paroxysm. Characters of pernicious remittent fever. Of the remission. Three sorts of remittent fever, according- to Baumes. Conclusion of the author. What remittent fevers are. Causes of these fevers. Opinion of Alexander, of Giannini, and of Ramel, with regard to the non-existence of miasmata — of Baumes — of the author. Results of autopsic examination, according to M. R. Thomas, according to Baumes. Conclusion. Type of remittent fevers. Inflammatory remittent fevers, bilious, mucous, adynamic, ataxic. Nature and seat of remittent fevers. Prognosis. Treatment of remittent fevers. Method of Pinel. Treatment of benign remittents, according to the author: during the remission, during the paroxysm. Treatment of pernicious fevers, according to the author. Objections to the method of Torti. The existence of remittent fevers proves the analogy of the nature and seat of continued and intermittent fevers. - - Page 465 — 477

Chapter XV. Of Chronic Fevers

How continued or intermittent acute fevers pass into the chronic state. Of the hectic fever, according to M. Broussais; of gastric hectic; pectoral hectic; genital hectic; hemorrhagic hectic; cutaneous hectic; moral hectic. Hectic fever is not always a gastro-enteritis. Causes of hectic fever. Termination of hectic fever. Of the hectic of pain, and the hectic of absorption. Results of autopsic examination.

Treatment of Hectic Fevers.

Whether bark should be prescribed in continued hectic fever. Whether we should endeavour to arrest the colliquative sweat. Distinction of hectic fevers

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into two varieties, the one with, and the other without, gastric irritation. Of chronic intermittent fevers. Of Splanchnic intermittent fevers. Results of autopsic examination. Inference from these results. The state of the gastrointestinal mucous membrane after these fevers have not been sufficiently insisted upon. Chronic intermittent fevers ultimately become gastric, when they have not been so from the beginning-. What principles should guide the practitioner when he is desirous of preventing obstructions. Treatment of obstructions when they are old, when they are recent. What is to be done when the chronic intermittent fever becomes continued. - Page 478 — 488

Chapter XVI

OF SIMPLE AND COMPLICATED FEVERS; OF ESSENTIAL OR PRI- " MITTVE FEVERS; OF SYMPTOMATIC OR SECONDARY FEVERS, AND OF HUMORAL FEVERS.

Nature of a simple fever; a complicated fever; an essential fever; a symptomatic fever; a primitive fever; a secondary fever. Complication of essential fevers. Of fevers which supervene in the course of another disease. All fevers are essential in one point of view. It is proper to distinguish primitive from secondary fevers. Of exanthematous fevers. Of fevers which accompany or precede internal inflammations, hemorrhages, and neurosis. Of traumatic fevers. All these fevers are not to be referred to gastro-enteritis as their cause. Results of these principles. Of humoral fevers. - - Page 489 — £96

Chapter XVII. Of Fever

What fever is, according to Galen: important remark of Avicenna and Fernel: according to Paracelsus; according to Van Helmont; according to Screta; according to Sydenham; according to Borelli; according to Bellini; according to Chirac; according to Stahl; according to F. Hoffman; according to Bordeu; according to Brown; according to Pinel. What we should understand at the present day by fever. Whether febrile irritation differs from inflammatory irritation. Whether the irritation which constitutes intermittent fevers differs from inflammation. Treatment of fever, according to Galen and his successors. Brown and Pinel have proscribed blood-letting. What remains to be done to complete the history of fevers. To perfect the treatment of fevers. Fortune of the physiological doctrine. - Page 497 — 504

Introduction

GENERAL PRINCIPLES

PHYSIOLOGY AtfD PATHOLOGY.

1. Of Life and Organization.

1. Life is the mode of existence and action peculiar to organized bodies.

2. Organized bodies are composed of parts, of which each acts in a special manner for its own preservation, and for that of the whole. The most simple appear to consist only of a kind of cellular membrane. At the head of the most complicated is Man.

2. Of the Huynan Body.

3. Man presents to the immediate action of the bodies which surround him, or which penetrate into his cavities, only an excitable absorbent and exhalent tissue.

4. The external portion of this tissue is in contact with the air and light, caloric, electricity — substances diss eriiii ted thitizh the 2:11:57 be re — ini :.:: ."".lis. :ii ::::•:: ':'::: : : 5 5 e 5 I: iiireheidi the skin, the conjunctiva, the membrane which invests the external auditory canal and the tympanum, the naso-buccal mucous membrane, and that which covers : 1 e : irii.5 : : 1 e 1 11 1 : 1 .

impression of die air, of die imponderable agents of sub- 511:1 zz'izz'.ti " ::h :':.- iiiihn: the ::::yi::-:itestiiii 1 :;: : is ne: 111:1 5iie::ed 1: :he 1111 ;: : nediiiei :ii 1 : 1.5:1.5. hi 115-5 :ver it 111 ihiih i; 1111:11:15:1:.: lie iinhii. ei: 1 :r :i nn:

d. These i"": 1:11:15 : :' 111 "ii:: thru lie sirihee 1 lie 1:1 ire 1:111.1 :ie ~::i the ether: iinates, the other comn e 11 Their structure is not every where the same, hut it does not vii" 511:1117 :i tie diieiei: 1111 the:: 1111: :: cast any doubt upon their analc 1

7. B esiies the 11111.5 11111 :i:i :i 11:15 which are better entitled to the name of internal, since they are never in contact with external agents in a state of health: these are the serous and synovial membranes; thin and diaphanous in structure, and intimately related in action to the mucous membranes, and still more so to die skin, the functions of which they partly suppi

8. In the interstices of all these membranes are found canals, which carry the chyle, the lymph, the black and red blood, called the chyliferous and the lymphatic vessels, and the blood-vessels, comprehending the veins and 1: ten.

9. In connexion with the blood-vessels are found, the heart, which receives from the body the black blood, and sends out to it the red blood ; and the lungs which receive the black blood from the heart and send to it the red. At the extremity of the arteries are the secretory organs, such as the cutaneous cryptai, the mucous follicles, and the glands, — organs which open on the surface of the mucous membranes or the skin, by canals carrying liquids, of which some are destined for assimilation and generation, and others are to be eliminated from the animal economy. The thymus gland, the capsular renales, and the spleen are also situated along the course of the blood-vessels, although their functions are not exactly understood.

10. Along the course of the lymphatic vessels are found the glands of the same name, the use of which is unknown, whatever may be the opinion of most physiologists on this subject. In like manner we find along the course of the chyliferous vessels the mesenteric glands, the use of which are equally unknown.