Principles of medicine : an elementary view of the causes, nature, treatment, diagnosis and prognosis of disease

Preface

In this work the attempt is made to place the practice of Medicine on a footing somewhat corresponding with that of Physiology, Chemistry, and other sciences which equally depend on the accurate observation and rational arrangement of facts. If our knowledge of the healthy body, and of its parts and functions,, he exact, it ought to be our best guide in the study of the same parts and functions in a state of disease. Yet the habit has long prevailed, and even still has its avowed advocates, of regarding the phenomena of disease as a new and separate order of things, the character and laws of which are to be investigated by themselves, and without reference to the standard of health from which they deviate; as if diseases were independent entities, and as if the body under their influence ceased to possess the same structures and functions which it has in health. Happily, however, such irrational dogmas do not now find much favour with the members of our profession, who, in proportion as they become more enlightened by sound physiology, recognise in it, when combined with careful clinical and pathological observation, the best guide to the understanding and treatment of disease.

It must be admitted that there remain considerable doubt and obscurity in many subjects, both in Physiology and in Medicine, and the science of one and the art of the other must, therefore, still be acknowledged to be imperfect; but no one can dispassionately look back on the progress which has been made in both departments within the last thirty years, without being encouraged to hope for increasing precision in the science and greater success in the art.

For an additional proof of the existence of a growing interest and confidence in rational medicine, I may perhaps be excused in referring to the success of the former editions of this work. When first I communicated to my publisher my intention of bringing out a work on the Principles of Medicine, I was by no means encouraged by the intimation that books on that subject did not vi preface;

sell; but no sooner was it discovered that the " Principles" were essentially and intelligibly practical, than the demand for the work became sufficient to exhaust two editions, long before I could find time to replace them. Several editions have also appeared on the Continent and in America.

I have now to express my regret that the incessant engagements of my practice have so long delayed the appearance of this edition. In fact, it might have been deferred much longer, if I had not secured the valuable assistance of my friend and former pupil, Dr. R. J. Mann, who has contributed several articles on recent investigations in Physiology and Animal Chemistry, and has taken great pains in revising the composition of the whole work. To my friend, Mr. George Gulliver, I am also indebted for looking over the chapters on Diseases of the Blood and Inflammation, and for very important microscopic contributions on these subjects. Free reference has been made to various recent authors on Physiology and Pathology; but I would especially mention the works of Dr. Carpenter, Mr. Paget and Professor Rokitansky, as sources from which I have derived much valuable information.

It is right to mention that several of the early sheets of this work have been printed more than twelve months, which will account for the absence from them of reference to the most recent facts.

49 Upper Brook Street, August 8th, 1856.

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Contents

Preface Page iii

PRINCIPLES OF MEDICINE.

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Section II. — Predisposing Causes of Disease . . - .p. 40-— 52 20 Classification of predisposing causes

21, 22 I. Debilitating causes and their modes of operation. Imperfect nourishment.

23 Impure air. Excessive exertion of body or mind. Want of exercise, and

24 sedentary habits generally. Long continued heat. Long continued cold.

ViU

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25 — 28 Habitual intemperance. Depressing passions. Excessive evacuations.

29, 30 Previous debilitating diseases.

31, 32 II. Excitement, examples. III. Previous disease; operating by change of struc-

33 ture; by persistence of cause. Examples.

34, 3-5 IV. Present disease or defective function. Zymotic material in the body.

36, 37 V. Hereditary constitution. VI. Temperaments. Definition and nature; san-

38 — 41 guine; phlegmatic; bilious; nervous. Diathesis. VII. Age, and its predis-

42 — 46 positions. Infancy, Childhood. Puberty. Full-growth. Adult age. Old

47 — 49 age; influences exemplified in vascular and nutritive functions. VIII. Sex.

GO IX. Occupation.

Section III. — Exciting Causes op Disease . . . . . p. 52 — 95

51 Operation of exciting causes. Division into cognizable and non-cognizable.

Classification.

52 I. Cognizable Agents. (1.) Mechanical causes: examples of their physical

effects. Vital operation of severe injuries.

53 (2.) Chemical causes: extrinsic; intrinsic; modes of operation, as local irritants,

as corrosives, as septics, and as chemical alteratives; examples of their effects.

54,55 (3.) Ingesia. Non- alimentary : condiments; action of salt in excess. Intoxi-

56 eating liquors, use and abuse of. Delirium tremens ; principles of treatment.

57 Tea and coffee. Water. Adulterations of food, impure water, medicines,

58 Aliment, unfit in quality ; a clue mixture requisite. Simple principles, such as fibrin, starch, gum, &c. insufficient. Bread the staff of life. Dr. Prout's

59 views on aliments, sanctioned by familiar experience. Extent of conversion of the elements of food by digestion. Dumas' views; objections. Experi-

60, 61 nients of Petroz and Boussingault. Liebig's views. Effects of alimentary principles; albuminous, gelatinous, oleaginous, farinaceous, and saccharine.

62, 63 in defect, in excess, or bad in quality. Adaptation of food to climate, &c.

Action of oil, starch, sugar, vegetable acids, &c. Aliment generally, in excess. Defective. Symptoms of inanition. Chossat's experiments on starvation. Liability of the ill-fed to zymotic diseases.

64 (4.) Violent exertion, effect on the heart, brain, lungs, and other organs. Par-

65 tial exertion. Exhaustion from fatigue. Want of exercise.

66 (5.) Mental emotion. Strong. Slow emotion. Mental anxiety. Excessive

mental exertion. Wear and tear.

67 (6.) Excessive evacuation. Effects. Syncope, cerebral, and cardiac. Other

effects and resulting diseases.

68 (7.) Retention, Diminution, and Suppression of Evacuations, alvine, urine, bile, &c.

69 Lower degrees common in disease. Suppression of artificial discharges ; of cutaneous eruptions, &c.

70 (8.) Defective cleanliness, ventilation, and drainage. Their prevalence; modes

71 in which they excite disease. Filth, action on skin, &c. Filth in dwellings.

72 Defective ventilation often insidious in its operation. Evil results, in dwell-

73 ings and public buildings. Defective drainage; results of effluvia from cesspools. London sewers. Entrapped drains. Causes and consequences'.

74, 75 (9.) Temperature and changes. Effects of extreme heat or cold. Cold, applied generally and locally. Dr. James Arnott's method of applying cold. Power of the body to resist cold. Burns and scalds. Shock to the system. Ex-

76 periments of Sir A. Cooper and Chossat on cold. Stimulating effects of heat.

77 Partial application of heat. Coup de soleil. Sedative effects of cold. In-

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tropulsion of blood. Effect on the arteries. Indirect effects of cold. Chil-

78 Mains and frostbite. Warmth to be restored in benumbed parts, gradually.

79 Mode in which cold excites internal disease. Dr. Alison's views: objections. It acts by deranging the circulation, and chemical changes of the blood.

80 Symptoms of "cold caught." Railway draughts. Fogs. Ozone. Means of diminishing susceptibility to cold. Cold bathing. Water cure. Good

81 and bad effects. Effects of cold proportioned to previous state of the body. Atmospheric changes.

II. Non-cognizable Agents. — Zymotic poisons divided into Endemic, Epidemic, and Infectious.

82 (I.) Endemic Poisons. Proofs of their existence. Sources. Malaria. Na- 83, 84 ture of malaria. Its properties. Localities of malaria. Its virulence in

85 proportion to heat with moisture. Diseases caused by malaria. Periodi-

86 city of their attacks, causes of this. Kinds of malaria. Endemic diseases from cognizable causes.

87, 88 (II.) Epidemic Poisons. Proofs of their existence. Epidemic. Cognizable 89, 90 causes distinguished from non-cognizable. Epidemic constitutions or pe-

91 riods. Nature of epidemic influences. Dr. Prout's observations. Ani-

92 malcule origin of epidemic diseases ; Linnseus ; Sir H. Holland, &c. Ehrenberg's observations.

93, 94 (HI.) Infectious Poisons. Proofs of their existence. Modes of infection: by 95, 96 wounds; by contact; by aerial communication; by several modes. Difii-

97, 98 culties of explaining infection. Analogy of fermentation; of animal and

99, 100 vegetable generation ; examples. Parasitic view of infection confirmed by

101 circumstances which promote and check it. Character of cholera infec-

102 tion. Peculiarities of infectious diseases, of endemic diseases, of epidemic

103 diseases. Diseases propagated in several ways. Pestilences. General

104 operation of all these causes depressing, but may excite reaction. Effect

105 modified by the weather. Means of checking or counteracting zymotic poisons. Antiseptics. Stimulants. Tonics. Eliminants.

Chapter Ii.— Pathology (proper)— The Nature And Constitution Of Disease

106 Disease composed of elements. Knowledge of these essential to medical

science. Analogy with chemistry, &c. Primary elements of structure and

107 function; healthy and diseased. Primary elements of disease. Alterations

108 of these elements in degree, and in kind. Table of primary elements of

109 disease. Table of proximate elements of disease; in excess, defect, and

110 perversion. These elements are the especial objects of general pathology . . . . . . .p. 95—97

FUNCTIONAL DISEASES— PRIMARY ELEMENTS.

Section I. — Diseased Irritability . . p. 97 — 102

111 Irritability. The distinctive property of muscular fibre. Dependent on sup-

ply of blood. Structure of muscular fibre. 112 — 114 In excess. Varieties in strength, in mobility, and in duration. Examples. 115 Causes. Remedial measures.

116 — 118 Defective, in force, mobility. Examples. Connexion of irritability with 119 nerves not essential. Remedial measures.

X

121, 122 123, 124

127, 128

129, 130

133—136 137, 138

140,141 142

143, 144 145

146 147

148, 149 150, 151 152

154 155

156, 157

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Section II.— Diseased Tonicity . , . p. 102—105

Tonicity; description; function ; distinct from irritability ; as proved by different effects of heat and cold. Long recognised practically. Excessive. Examples; effect on pulse. Remedial measures. Sedatives. Cold:

Defective. Examples : atony, retarded and dichrotous pulse. Remedial measures. Tonics.

Elementary Nervous Functions. Dependent on supply of blood. Influenced by poisons ; mechanical irritation; heat, &c. Expenditure of nervous matter . . . . . p. 106 — 107

Section III. — Diseased Sensibility . . .p. 107 — 115

Sensibility referable to the nervous system, and divided into the centric and local.

General. Excessive, from excitement, from disease, from temperament. Pathological causes. Remedial measures. Narcotics. Tonics. Anassthesis by inhalation of chloroform and ether. Mode of action. Cautions.

Defective. Causes: from disease, age, temperament. Remedies.

Perverted. Examples; causes. Remedies.

Local sensibility. Variations illustrated by experiment. Pathological causes. Excessive, in orifices, in internal organs. Pain and other varieties. Remedial measures. Local anodynes. Benumbing cold. Defective. Paralysis of sensation. Remedies.

Section IV. — Diseased Voluntary Motion . . p. 115 — 120 Division into general and partial

General voluntary motion, in Excess : examples. Phrensy; Hysteria; tarantulism, &c. Defective: examples. Lethargy; catalepsy; hysteria, &c. Perverted: examples. Chorea; delirium tremens; shaking palsy, &c.

Partial, excessive. Tricks; fidgets. Defective; pathological causes: examples. Remedies for diseased voluntary motion. Excessive. Narcotics; calmants ; douche. Modes of action of these remedies. Remedies for defective volition. Stimulants. Mental excitement. Revulsives. Remedies for perverted volition. Narcotics; tonics. Eemedies for locally diseased volition. Electricity, &c.

Section V. — Diseases of Reflex and Sympathetic Nervous

Natural reSex function : examples. Excessive, in involuntary muscles : examples. In voluntary muscles : examples. Convulsions ; centric and eccentric. Partial, by reflected irritation; spasms; cramp, &c. Irritation of involuntary muscles ; the spinal marrow the centre of reflexion.

Pathological causes of inordinate excito-motion ; irritation of spinal marrow or its nerves; accumulation by rest; from action of opium, &c. Epileptic fits. Action of strychnia and other poisons. Tetanus. Hydrophobia.

Defective reflex motion. In coma, asphyxia, sinking, &c. Sleeplessness from exhaustion.

Remedial measures for excessive reflex action. Narcotics, nervous sedatives, stimulants, chloroform, tonics. For defective. Stimulants; opium.

Reflected or sympathetic sensations. Examples. Spinal and superficial sensibility ; involuntary reflex action; chorea. Remedies.

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Section VI. — Diseased Secretion . . .p. 130 — 140 Paragraph

158 Secretion clue to a vital property; aided by chemical affinity; not to be

ascribed to nervous influence. 159 — 161 Changes due to altered supply of blood, or to nervous influence. Excessive. 162 — 164 Effects : forwards; examples: backwards; on the organ ; examples. On the 165, 166 blood: examples. Relations of bile and urea. Remedies. Depletion and

other evacuations. Astringents. Alteratives. 167 — 169 Defective secretion. Causes. Effects: forwards; examples: backwards; on 170, 171 the organ; examples. Suppression of excretions; urasmia, choloemia, &c. ; 172, 173 extreme; moderate; in idiopathic and symptomatic fevers, gout, rheuma- 174, 175 tism, and other diseases. Remedies, through the circulation. Special 176 — 178 stimulants. Alteratives. Tonics. Substitutes for defective secretion.

Perverted secretion. Examples. Effects. Remedies.

Section VII. — Diseases of the Constituents of the Blood p. 140 179 Constituents of the blood, when altered, form elements of disease.

180, 181 Enumeration of constituents and modes of alteration. Chemical composition of the blood.

Disease of Red Particles .... p. 140 — 148

182 — 184 Natural offices, composition, and proportions. Excessive. Examples. Signs and effects.

185,186 Deficient. Examples and effects. Alterations; in colour; in shape and size ;

187,188 breaking up. Arterial change ; cause. Mulder's and Carpenter's notions.

189, 190 Mr. W. Jones' observations; explanation. Mr. Gulliver's observations.

191 — 193 Origin of red particles. Causes of their decrease. Spoilt blood. Disorders of spleen and uterus. Remedies for excess, defect, and alteration of red particles.

Section VIII. — Fibrin and White Corpuscles . . p. 148 — 161

194 Nature of fibrin. Structure in washed clot, or lymph ; circumstances inducing

195 fibrillation; composition; an oxy-protein. Purposes: materials of textures. White corpuscles. Excess of fibrin. Examples in inflammation. Signs and effects. Increase of white globules, at expense of red. Defi-

196, 197 ciency of fibrin. Examples; fluidity of blood, in fevers; in Gaspard's ex- 198 periments, &c. Causes. Effects : hemorrhage ; congestion, venous mur-

murs, &c. Magendie's experiments. 199 — 201 Alterations in quality : apparent from character of coagulum, which shows

202 properties of self-coagulation, contraction, and separation. Self-coagula-

203 tion ; varieties and causes ; its occurrence within the vessels. Contraction ; 294,205 varieties and causes; cupped blood. Separation; causes, varieties. Causes 206, 207 of the buffy coat. Appearances of coagulated blood. Large clot; small

208 clot. Separated and cupped ; mode of exhibiting these properties. Source

209 of fibrin, and formation of white globules. Increase by inflammation. Ma- • terial of coagulable lymph. Varieties. Coagulation of fibrin during life.

Vegetation and polypi. 210,211 Remedies for Excess of Fibrin. Blood-letting. Evacuants. Narcotics. Cod

oil. Mr. Blake's experiments. 212 Remedies for defect ; diet ; regimen ; stimulants ; tonics ; antiseptics ; oxydating

agents.

213 — 215 Means of altering quality of fibrin; depletion; alteratives; salines. Tonics; diet and regimen.

xii

Section XII.— Water . . . . .p. 168—170 228 Natural proportion

230 Excess. Examples and effects. From too much drink. Deficiency. Ex-

231 amples. Symptoms. Causes. Effects of cholera — of abstinence from liquids. Remedies for excess and defect. Water cure and dry diet. Drinking: use and abuse. Water increases waste of tissues.

Section XIII. — Changes in the Blood by Respiration . p. 170 — 175 232—234 Analysis of changes. Excess. Examples in disease? Inhalation of oxygen ;

effects.

235, 236 Defect: the element of asphyxia. Effect proportioned to suddenness as well

237 as degree. Explanation of this. Analysis of asphyxia. Classification of

238 symptoms. Defect gradually induced. Hybernation. Cyanosis : state of

239 the functions; little muscles and much fat; with defective respiration.

240 Emphysema. Remedies for defect; Lowering functional activity. Treat- 241,242 ment of asphyxia. Stimulants. Warm bath. Promoting respiration.

243 Other means of arterializing the blood. Treatment of congestion of apnoea.

244 Diet in dyspnoea.

Section XIV. — Changes in the Blood by Secretion . 175 — 182

245 . Defective secretion of urine. Experiments of Prevost and Dumas. Effects

246 of diseased kidneys. Views of Frerichs. Acute and chronic albuminuria. 249 Defective secretion of bile. Examples. Effects on blood, &c. Bilious

251 attacks. Perspiratory nature of secretion; checked by cold; effects. Vicarious action of skin and kidneys. Rheumatism ; increased acid in blood ; materies morbi. Remedies to be directed to this element.

252 Treatment of rheumatism: by nitre; lemon juice; the author's plan. Water

cure.

Section XV. — Changes in the Blood from the Transformation of Chyle and of the Textures of the Body . . 182 — 188

253 Natural changes imperfectly known. Gout and other lithic acid diseases.

254 Decay of textures. Causes: rich and too highly azotized food. Treatment of uraemia. Treatment of cholasmia; of bilious attack. Morbid effects of lithic acid on the kidneys. Nephralgia and nephritis. Gout in

223, 224

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various forms ; irregular ; regular ; sthenic ; asthenic ; chronic ; chalkstones of gout.

255 Diabetes. Sugar traced to the blood; formed in the liver. Sugar often pre-

sent in the urine of the aged and asthmatic.

256 Treatment of gout and diabetes, compared and contrasted. Treatment of

diabetes. Treatment of gout by alkaline eliminants. Cautions. Local treatment. Fit of gout. Gouty constitution. Gout in the stomach.

257 Azoturia, or excess of urea. Result of decay of texture. Remedies: repose;

stimulants; tonics; narcotics; tea and coffee.

258 Fatty transformation in the blood ; impairing nutrition. Fatty degeneration.

Section XVI. — Toxemia — Changed Properties of the Blood from the Presence of Foreign Noxious Matters . . 189 — 194

259 The blood the seat of morbid poisons; and of the virus of malignant disease ;

proofs. Examples of action of morbid poisons on the blood. Decomposing matter a nidus. Poisons of exanthemata ; of typhoid fever, &c. ; traced in operation, and with the reacting powers of the system causing the varieties of these diseases.

260 Treatment indicated by the operation of the poison, and subsequent reaction.

Remedies to counteract the poisons. To destroy or expel them. To regulate and sustain the functions.

Chapter Iii.— Proximate Elements Of Disease

Section L— Anemia ..... p. 195—206 261 Explanation of proximate elements of disease.

262 — 264 General angemia. Nature, exciting causes, and symptoms. Physical signs. 265 — 267 Changes in the blood. Symptoms of excitement in angemia. Explanation 268, 269 of these symptoms. Symptoms of coma, &c. Cases and interpretation of 270, 271 nature of anaemic coma. Nutrition in angemia. Predominance of nervous

272 symptoms. Fatal terminations. Extraordinary success of remedies in angemia. Iron and other tonics ; modes of exhibition. Regimen and diet. Treatment of nervous symptoms. Venous murmurs.

273 Partial anaemia. Examples. Effects: cause of gangrene; numbness;

wasting; degeneration. Treatment. General and Local.

Section II. — Hyperemia or Excess of Blood . . p. 206

274 Definition and nature. Classification of varieties.

Section III. — Plethora — General Excess of Blood p. 206 — 211

275 — 277 Origin of plethora. Subjects. Symptoms. Tendencies. Causes. Division 278, 279 into Sthenic and Asthenic. Symptoms of Sthenic. Subjects. Tendencies. 281 — 283 Asthenic. Symptoms. Subjects. Tendencies. Results. Fever. Gout. 28± — 286 Remedial measures. Bloodletting ; where unfit. In sthenic, other measures needed. In asthenic, tonics as well as evacuants and eliminants Diet and regimen.

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Local Hyperemia. Excess of Blood in 1 a tart.

Section IV. — With Motion diminished. Congestion p. 211 — 229

2S7, 288 Congestion analyzed. Its causes classed.

289 Congestion from venous obstruction. Examples, in health and in disease. Ex-

planation of congestion in emphysema.

290 Congestion from atony of the vessels. From general debility. Hypostatic. 291,292, From local debility ; over-distention. Examples. From intropulsive ac- 293, 294 tion of cold and malaria, From over-excitement or inflammation. Exain- 295, 296 pies and illustrations by microscope. Stagnation in the vessels. From 298 arrest of secretion or capillary circulation. Explained by Mr. Graham's law of "Osmotic force." From imperfect respiration. (Is the power of the heart sufficient of itself to maintain the circulation? Dr. Sharpey's experiments. Microscopic examinations; fallacies. Objections to the supposition of spontaneous movement of the blood particles. Dr. Carpenter's assumption of the existence of a motory power in the capillaries considered, and admitted as identical with Graham's "Osmotic force.") Observations of Mr. Erichsen. Obstruction to circulation in asphyxia, partly from contraction of the small arteries, but also by suspension of osmotic 299 force in capillaries. Atony of vessels also impedes transit of blood. Ex-

300 — 302 periments to show the neutralization of force in the flaccid vessels. Cause

of long continuance of congestion. 303 Symptoms and effects of congestion. 1. In congested part — Impaired func-

305, 306 tions. Effects on secretion explained. Production of flux. Examples.

307 Considerable congestion required to produce dropsy. Amount of tension

308 and quality of blood determine quality of effusion, liquid and solid. Ex- 309, 310 amples. Albuminuria referred to congestion of the kidney. Reasons. 311, 312 Congestion continuing causes hypertrophy of a peculiar kind. Origin of

granular disease and cirrhosis. Other instances. 2. Effects of local congestion on the system. Fit of ague deprives it of blood. Examples. Injury to blood. This congestion may cause cachsemia. 313 Remedies for congestion. Removal of causes, venous obstruction and causes

314, 315 of atony. Posture. Pressure. Friction. Exercise. Astringents and 310,317 tonics; when applicable. Stimulant remedies; Operations shown by the 31S microscope: when hurtful. Depletion and other evacuants. Hremostasis

319, 320 or counter congestion. Preceding remedies combined or alternated. Prevention of congestions by increasing tone.

Section V. — Local Hyperemia. Excess of Blood in a Part with Motion increased. Determination of Blood . . p. 229 — 240 321, 322 Examples in health and in disease. Determination to the head. Examples, 324, 325 with symptoms. The cause of various fits. Determinations caused by 326, 327 stimuli. Physical cause of determination of blood. Enlargement of ar- 328, 329 teries, proved by the author's microscopic experiments. Observations of

330 Mr. Paget and Mr. W. Jones. Cause of the enlargement, a loss of tonicity.

331 Influence of the nerves on the arterial tonicity. Experiments of Bernard

332 and W. Jones. Final cause of determination to supply more blood where wanted. Determination from intropulsion. Subjects of determination. Determination may cause anaemia in other parts. Determination affects any arteries.

333 Symptoms and effects of determination of blood. Parts most subject to it.

334 — 336 To the head. Explanation of its different effects in different cases. To

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337 — 340 the kidneys. To the mucous membranes. To the skin. Other symp-

341 toins. Determination if continued leads to hypertrophy.

342, 343 Remedies. Removal of causes. Means which promote the tonic contrac-

344, 345 tion of dilated arteries. Cold. Astringents. Sedatives which restore

346 contraction of vessels. Derivants. Posture. Evacuants. Blood-letting;

347, 34S general and local; its effect seen by the microscope. Cases requiring

349 blood-letting. Remedies to relax the arterial system and quiet the heart. Measures to equalize and strengthen the circulation. Tonics.

Section VI. — Results of Hyperemia .... p. 240 — 266

350 Hemorrhage, flux, and dropsy, results short of inflammation.

351 Hemorrhage from plethora. Examples. Epistaxis, haematemesis, &c,

352 from congestion of venous obstruction. Examples. Pulmonary, bronchial,

353 gastric, &c. From atony of vessels; from posture; from intropulsion of 354, 355 cold. Examples. From determination of 'blood. Examples. Epistaxis; 356 apoplexy; haematemesis. Additional element of hemorrhage in the vessels 357, 358 or in the blood. Blood-vessels diseased. Examples. Blood diseased. 359 Hemorrhagic diathesis. Mode in which blood is effused. By rupture or

through the pores ?

360, 361 Varieties of hemorrhage. Sthenic and asthenic defined. Symptoms. Mo- 362 limen hemorrhagicum; jerking pulse, how produced. Faintness ; Reaction.

363, 364 Transition to inflammation. Examples. Local effects and symptoms. 365 Passive hemorrhage.

366, 367 Treatment of hemorrhage. Remedies for hyperemia. Styptics. Cases re- 368,369 quiring a speedy check. Active or sthenic. Passive or asthenic. Me- 370 chanical means. Special styptics. Internal remedies. Tonics, purgatives,

and styptics. Action of styptics considered. 373 — 375 Flux and Dropsy. From -plethora. Examples. From congestion. Experiment of Lower. Examples in disease. 376 — 37S From weakness of the vessels. After excitement. Intropulsion of cold. 379 From determination of 'blood. Examples ; active flux; active dropsy. From

stimulants.

380 — 382 Flux and dropsy vicarious. Examples. Circumstances causing hyperemia 3S3 to end in these results: in the vessels : in the blood. Combination of these

384 circumstances in anaemia. Diseased blood from defective excretion, espe-

cially by the kidneys. Examples and proofs. Cause of anasarca after 3S5 scarlatina. Changes in the kidneys. Dropsy and flux with albuminuria :

386 why inflammatory: resemblance to rheumatism. Thinness of blood, cause

337 of asthenic dropsy. Dropsy from retention of water and excrementitious

388 matter in the blood. Malnutrition. Proofs. Distinctive pathology of

383 fluxes and dropsy. Causes of each.

390 General treatment of ' flnx and dropsy . Remedies for hyperemia. Remedies

391 for malexcretion and malnutrition.

392, 393 Treatment of faxes. Removal of causes. Derivants. For sthenic flux ;

394 evacuants and depletion; not to be hastily checked. For asthenic flux; astringents and tonics. Dry and tonic regimen.

395 Treatment of dropsy. Means to remove effusion and restore action of kid- 396, 337 neys in sthenic dropsy. Means to improve the blood in asthenic. Re- 398 currence of dropsy requires variation of remedies. Circumstances which

indicate tapping or puncture. Cautions. Means to prevent recurrence of dropsy. Pressure. Injection of iodine.

Xvi CONTENTS.

Section VII. — Local Hyperemia. Excess of Blood in a part, with Motion partly increased, partly diminished — Inflammation

Faragrapli.

399, 4U0 Inflammation not understood from its elements not being studied. Defini-

tion according to its nature; according to its signs.

401 Causes of Inflammation and their Mode of Operation. Predisposing;

weakness, or excitement. Exciting causes divided into local and general ;

402 direct and indirect. Local irritants; mechanical, chemical, and vital. 4 03 Examples. Poisons and other irritants in the blood. Predisposition to 404 catarrhs. Indirect causes produce congestion. Causes mixed in opera-

400, 406 tion. Checked hemorrhage and flux. Irritants operate primarily on the

407 nerves. But inflammation is excited without nervous irritation, and when

408 nerves are divided. Cause essentially acts on vessels, producing sometimes determination first, sometimes congestion.

409 Phenomena and Nature of Inflammation. Difference from congestion ;

410 from determination. Essential characters established; increase of blood,

411 with motion increased and diminished. Cause of the obstruction. Views

412 of Cullen, W. Phillip, Hunter, Kaltenbrunner, and Alison, considered.

413 Existence of congestion and determination proved. Atony of the vessels

414 one cause of obstruction. Examples and experiments. Another cause of

415 the blood: adhesion of white globules; their increase. Description and

416 production of white globules; Mr. Addison's observations; Mr. Gulliver's. Appearance of frog's web after irritation. Adhesive property of white glo-

417 bules ; those recently formed have no cell-wall. The presence and proper-

418 ties of white globules essential to inflammation. Variation in the osmotic force of the capillaries. Share which the red corpuscles take in the obstruction, questioned by Dr. Hughes Bennet, and Mr. Paget: affirmed by

419, 420 Mr. Gulliver. Conclusions as to the process of inflammation ; essentially

421 complex. Effect of obstruction to expend force on the arterial capillaries, and to modify the osmotic force and composition of the blood. This opposition of obstruction to force the cause, both of construction and of destruction of blood and tissue material.

422 Effects of inflammation on vital properties ; on secretions.

423 Effusions; liquid; solid; general character ; microscopic character. Exuda-

424 tion corpuscles. Elementary solids of inflammatory effusions. Molecules.

420, 426 Granules. Fibrils. Exudation corpuscles. Pus globules. Irregular pro-

ducts. Tubercle. Mode of formation of some of these. Variety in their

427 plasticity and organizability. Other effects of inflammation. Softening. Suppuration. Slough. Gangrene. Induration.

428 Symptoms and Effects of Inflammation. Divided into local and general.

429, 430 Local symptoms. "Redness; causes; varieties; changes; explained and ap- 431, 432 plied. Heat; cause; indications. Swelling; causes; varieties from tex- 433, 434 ture ; position, &c. Pain; causes. Degrees and varieties and their causes.

430, 436 Other sensations. Effects of inflammation on contractility. On other

functions and symptoms. 437 Constitutional symptoms. Inflammatory fever. Change in the blood.

438, 439 Cause of the increase of the fibrin and its contractile property. This not

the sole cause of inflammatory fever. Pathology of inflammatory fever. 440, 441 Causes. Reaction, irritation, altered condition of the blood. Why some

442 functions are excited and others impaired. Symptoms of inflammatory

443 fever. Its varieties: high, low. Type of fever from cause or seat of in-

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444 flammation. Explanation of this. Remittent and intermittent fever.

Apyrexia. Injury to blood in continued inflammation.

Nature and Symptoms of the Results or Terminations of Inflammation.

445,446 Division. The results seldom occur singly. Resolution. Its nature.

447,448 Modes of occurrence. Local symptoms. Constitutional symptoms of resolution. Critical discharges. Lateritious sediments in urine; cause; nature: reason of absence; reappearance of chlorides.

449 Tffnsion (including adhesion.) Not always a termination. History of ef-

450 fusions in serous membranes. Coagulable lymph. Varieties. Euplastic.

451 Mode of organization. Formation of vessels. Views of Kiernan, Travers, 452,4."3 Vogel, Liston. Cacoplastic lymph; corpuscular; (Paget) croupous (Ro- 454,455 kitansky.) Varieties and effects. Aplastic lymph. Causes of these low 456 products. Effusions of mucous membranes. Interstitial deposit. Changes 457,458 of mucus; purulent and fibrinous; stricture. Effusion in shin; varieties

of cutaneous inflammation exemplified in skin diseases. Effusion in cellu-

459 I ar texture. In parencltymata. Symptoms of effusion.

460 Suppuration and ulceration. Nature of pus. Microscopical characters.

Distinction between exudation corpuscles and pus. Alteration by acetic

461 acid; by distilled water. ■ Its want of cohesion. Explanation of this.

462 Liquefaction of tissues in suppuration. Chemical changes. Causes of suppuration. Circumstances tending to the conversion of the deutoxide of protein into the tritoxide. 1. Intensity and continuance of inflammation. 2. Access of air. 3. State of the blood; suppurative diathesis. Examples.

463 Mode in which they act. Observations of Mr. Paget. Pus in the blood. Process of suppuration explained; death of tissue by pressure; liquefaction and absorption of all but pus globules. Varieties of suppuration. Dif-

464 fused; Abscess: pyogenic membrane: pointing. Opening and healing of 465, 463 abscesses. Granulations. Ulceration. Varieties. Causes. Softening 467 of textures. Suppuration a work of destruction, therefore depressing. 468, 469 Symptoms of suppuration. Local : constitutional : varieties caused by limi-

470 tation, or not, of suppuration. Purulent deposits. Nature and causes. No true absorption of pus. Pus frequently in the blood in severe inflammation. Cachaemia usually precedes pyaemia. Depression from suppura-

471 tion. Cause of rigors. Hectic fever. Varieties of pus; laudable; ill-conditioned.

473,474 Gangrene. Process of sloughing; gangrene; and sphacelus. Causes of

475 gangrene; interrupted circulation ; noxious agents. Local symptoms and