Principles of medicine : comprising general pathology and therapeutics, and a brief general view of etiology, nosology, semeiology, diagnosis, prognosis, and hygienics

Front matter

PRINCIPLES OF MEDICINE:

COMPRISING

GENERAL PATHOLOGY AND THERAPEUTICS,

Preface

More than a year has elapsed since the first edition of this work was out of print, and it has been the subject of continual regret on my part that my engagements have so long retarded the completion of the present. Some excuse for the delay will, I trust, be found in the very extensive additions which it contains, comprising the enunciation and application of most of the facts and established deductions made available to the science and art of medicine during the last few years. These additions pervade almost every portion of the work; but they preponderate in the following subjects : —

In Etiology, mechanical, chemical, and dietetic causes of disease, defective cleanliness, ventilation, and drainage. In Pathology, the tabular views of the elements of disease ; reflex action and sympathy ; elementary changes in the blood ; congestion ; determination of blood ; inflammation in its nature, manifold results, and modes of treatment ; degeneration of textures ; cacoplastic and aplastic deposits, and their treatment, with a notice of the action of the cod liver oil; and the whole chapter on Hygienics, comprisingyboc?, clothing, air, and temperature, exercise, mental occupation, sleep, and excretion.

In endeavoring to adapt the work to the rapid improvements in medical science, it is most satisfactory to be able to state that in very few instances has it been necessary to retract or supersede the inferences and views set forth in the first edition; on many subjects they have been confirmed and extended by recent researches to a degree that has not less surprised than convinced me of their truth ; as examples, I would mention the subjects Congestion, Dropsy, Determination of blood, Inflammation, and Deposits. I am quite aware that my views on some of these subjects are opposed to those held by several distinguished and estimable pathologists ; and the knowledge of this fact has led me to test them the more severely by all the experiments which physiology, clinical observation, and pathological research could supply; and the result of this scrutiny, in which I have been aided by several able fronds?

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PREFACE.

and pupils, has been a firmer and clearer conviction of their substantial truth. I would further add in favor of the views put forth on the above named subjects, that they, as it were spontaneously, point to remedial measures closely corresponding with those which the best experience has sanctioned, and they simplify and facilitate the indications of treatment in a manner that suggests more efficient modes of practice than could be obtained by blind experience.

It is in harmony with the statement just made, that whilst I feel grateful for the approbation with which this work has been honored by scientific men, both in this and in foreign countries, I am especially gratified by the favor with which it has been received by practitioners of great experience. This favorable reception, as well as the assistance which it has afforded me in my systematic course of lectures on practical medicine, leads me to believe that my attempts to combine science with art to place the practice of physic on a more rational basis, have not been altogether unsuccessful, and encourages me to hope that the present work may further contribute to the same desirable end.

I am fully aware of the existence of many defects in the accomplishment of this work, some of which might be amended by delaying its publication a little longer; but the objections to such delay outweigh the probable advantages; and I must trust to the leniency of my critics to excuse the errors of omission and commission, which it is very difficult to exclude in a volume that is at once elementary and yet embraces a most extensive range of subjects.

7, Holies Street, Cavendish Square, Feb. 19, 1848.

PREFACE

TO THE FIRST EDITION.

As an apology for the appearance of this publication, it may, I think, be stated to be generally acknowledged, that there is at present, no work which fully treats of the subject of General Pathology, and its application to practical medicine. The present attempt to supply the defect arose from my feeling the want of an elementary work on these subjects, by aid of which I could introduce to my pupils the science of practical medicine. With many excellent and elaborate treatises on the details of medicine, we have scarcely any which treat of those general principles in the nature and treatment of disease, which are really fundamental in the practice of medicine. Even the very able work of my distinguished friend, Prof. Alison, (to which the following pages owe much,) in the last edition, instead of some of these general principles, embraces some of these details of Special Pathology.

It maybe supposed, that in subjects comparatively so modern as those embraced in this work, little reference can be made to any but recent authors; and for a great portion of the facts and illustrations, I have drawn on my own experience in the continual observation of disease, during upwards of twenty years, in hospitals and private practice. Throughout this experience, I have alw T ays endeavored to keep in mind the bearings of physiology and pathology on practical medicine, and to render their advances useful, by their application to this art. Many original facts and opinions have been the result of this mode of study; and some of these will be found in the following pages. I cannot expect that they will speedily receive a general assent ; but I ask for them the test of clinical observation, from which they have been mainly derived.

It seems quite extraordinary that, notwithstanding the recent rapid improvements and comparative perfections of the contributory sciences, practical medicine should still halt in the domain of empiricism. A chief reason for the anomaly seems to be, that science and practice have been

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PREFACE.

rarely pursued by the same parties. Scientific men are not and cannot be practical, because they have had no experience ; and practitioners know little of science, and therefore derive little good from it. Instead of working together, these parties are at issue with each other. But it is high time to put an end to this feud. Philosophers must descend from their transcendental positions, to consider details of practice and purposes of utility. Those who would be practitioners must gain from science that knowledge and that method which render experience instructive and useful.

In the present effort towards the accomplishment of these objects, I am conscious of many deficiencies. Want of time has prevented me from treating some subjects as fully as they deserve, particularly those of the last chapter. In others, I have studied to be brief, to avoid perplexing the reader with much discussion or detail. For this reason, doubtful facts and a variety of conflicting opinions have been withheld ; and only the facts best ascertained and the views which seem most tenable have been given. By this eclectic method, I have succeeded in reducing a very extensive range of subjects within the compass of a moderate volume.

7, Holies Street, Cavendish Square, Sept. 22, 1843.

Contents

Preface - - - - - - - - Page v

PRINCIPLES OF MEDICINE.

Paragraph.

Section II. — Predisposing Causes of Disease - - p. 23 — 36 20 Classification of predisposing causes

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

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

24 habits generally. Long continued heat. Long continued cold. Habitual in- 25 — 28 temperance. Depressing passions. Excessive evacuations. Previous debili- 29, 30 tating diseases.

31, 32 II. Excitement, examples. III. Previous disease; operating by change of structure; 33 by persistence of cause. Examples.

34, 35 IV. Present disease or defective function.

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CONTENTS.

Paragraph.

36, 37 V. Hereditary constitution. VI. Temperaments. Definition and nature ; sanguine ; 38- — 41 phlegmatic; bilious; nervous. Diathesis. VII. Age, and its predispositions. 42 — 46 Infancy. Childhood. Puberty. Full-growth. Adult age. Old age; influ- 47 — 49 ences exemplified in vascular and nutritive functions. VIII. Sex. IX. Occur

50 potion.

Section III. — Exciting Causes of Disease p. 36 — 60

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

sification.

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.) Ingesta. Non- alimentary : examples ; action of salt in excess. Intoxicating

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

57 terations of food, impure water, medicines. Aliment, unfit in quality; a due

58 mixture requisite. Simple principles, such as fibrin, starch, gum, &c, insufficient. Bread the staff of life. Dr. Prout's views on aliments, sanctioned by

59 familiar experience. Extent of conversion of the elements of food by digestion. Dumas's views ; objections. Experiments of Petroz and Boussingault. Liebig's

60, 61 views. Effects of alimentary principles; albuminous, gelatinous, oleaginous, and saccharine, in defect, in excess, or bad in quality. Aliment, generally, in

62, 63 excess. Defective. Symptoms of inanition. Chossat's experiments on starvation.

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

65 exertion. Exhaustion from fatigue. Want of exercise.

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

tal exertion.

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 in

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

72 fective ventilation often insidious in its operation. Evil results, in dwellings

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

74, 75 (9.) Temperature and Changes. Effects of extreme heat or cold. Extensive burns, shock. Cold, applied generally. Experiments of Sir A. Cooper and Chossat.

76 Stimulating effects of heat. View of Liebig. Partial application of heat.

77 Sedative effects of cold. Intropulsion of blood. Effect on the arteries. Indi-

78 rect effects of cold. Chilblains. Warmth to be restored in benumbed parts

79 gradually. Mode in which cold excites internal disease. Dr. Alison's views: objections. It acts by deranging the circulation. Symptoms of "cold caught.'"

80 Means of diminishing susceptibility to cold. Cold bathing. Water cure.

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

Section IV. — Non-cognizabee Agents p. 60 — 67 Definition and division into Endemic, Epidemic, and Infectious

(I.) Endemic causes. Proofs of their existence. Sources. Malaria. Nature of malaria. Its properties. Sources of malaria. Its virulence in proportion to heat with moisture. Morbid effects of malaria. Periodicity of their attacks, cause of this. Kinds of malaria. Endemic disease from cognizable causes.

(II.) Epidemic causes. Proofs of their existence. Epidemic. Cognizable causes distinguished from non-cognizable. Epidemic constitutions or periods. Nature of epidemic influences. Dr. Prout's observations. Animalcule origin of epidemic diseases.

(III.) Infectious causes. Proofs of their existence. Modes of infection: by wounds; by contact; by aerial communications; by several modes. Difficulties of explaining infection. Analogy of fermentation ; of animal and vegetable generation ; examples. Parasitic view of infection confirmed by circumstances

83, 84

87, 88 89, 90 91

CONTENTS.

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Paragraph.

101 which promote and check it. Peculiarities of infectious diseases, of endemic

102 — 104 diseases, of epidemic diseases. Diseases propagated in several ways. Pesti- 105 lences. General operation of all these causes depressing, but may excite reac-

tion. Effect modified by the weather.

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

106 Disease composed of elements. Analogy with chemistry, &c. Primary ele-

107 ments of structure and function ; healthy and diseased. Primary elements

108 of disease. Alterations of these elements in degree, and in kind. Table of

109 primary elements of disease. Table of proximate elements of disease; in

110 excess, defect, and perversion. These elements are the especial objects of general pathology - - - - - p. 68 — 70

FUNCTIONAL DISEASES.— PRIMARY ELEMENTS.

Section I. — Diseased Irritability p. 73 — 76

111 Irritability. The distinctive property of muscular fibre. In excess. Varieties 112 — 114 in strength, in mobility, and in duration. Examples, causes. Remedial 115 measures.

116 — 118 Defective, in force, in mobility. Connection of irritability with nerves not essen-

119 tial. Remedial measures.

Section II. — Diseased Tonicity - - - p. 70 — 73

120 Tonicity; distinct from irritability; proved by different effects of heat and cold.

Long known empirically. 121, 122 Excessive. Examples : effect on pulse. Remedial measures. 123,124 Defective. Examples: retarded and dichrotous pulse. Remedial measures.

Section III. — DiseasedSensibility - - - p. 76 — 82

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

126 General. Excessive, from excitement, from disease, from temperament. Patho- 127,128 logical causes. Remedial measures. Inhalation of ether; mode of action.

Inhalation of chloroform, see Appendix. 129,130 Defective. Causes ; from disease, age, temperament. Remedies.

131 Perverted. Examples; causes. Remedies.

132 Local sensibility. Variations illustrated by experiment. Pathological causes. 133 — 136 Excessive, in orifices, in internal organs. Pain, and other varieties. Remedial 137, 138 measures. Defective. Paralysis of sensation. Remedies.

Section IV. — Diseased Voluntary Motion - p. 82> — 85 139 Division into general and partial

140, 141 General voluntary motion, in Excess: examples. Defective: examples. Per- 142 verted: examples.

143, 144 Partial, excessive, rare. Defective; pathological causes: examples. Remedies 145 — 147 for diseased voluntary motion ; excessive. Defective local. Perverted.

Section V. — Diseases of Reflex and Sympathetic Nervous Influence - - - - - p. 82 — 91

148,149 Natural reflex function: examples. Excessive, in involuntary muscles; ex- 150,151 amples. In voluntary muscles : examples. Convulsions ; centric and eccen-

152 trie. Partial, by reflected irritation. Irritation of involuntary muscles; the

153 spinal marrow the centre of reflexion. Pathological causes of inordinate excitomotion ; irritation of spinal marrow or its nerves; accumulation by rest; from action of opium, &c.

154 Defective reflex motion. In coma, asphyxia, sinking, &c. Remedial measures for

155 excessive. Narcotics, sedatives, stimulants, tonics. For defective. Stimulants; opium.

156, 157 Reflected or sympathetic sensations. Examples. Remedies.

XIV CONTENTS.

Paragraph.

Section VI. — Diseases of Secretion - - - p. 91 — {

158 Secretion due to a vital property, aided by chemical affinity; not to be ascribed to nervous influence.

159, 160 Changes due to altered supply of blood, or to nervous influence. Excessive.

161 — 164 Effects; forwards; examples; backwards. On the organ: examples. On the

165,166 blood: examples. Remedies. Depletion. Astringents. Alteratives.

167 — 169 Defective secretion. Causes. Effects: forwards; examples; backwards; on the

170,171 organ; examples. Suppression of excretions; extreme, moderate; in idiopathic

172, 173 and symptomatic fevers, and other diseases. Remedies, through the circula-

174, 175 tion. Special stimulants. Alteratives. Tonics. Substitutes for defective

176 — 178 secretion. Perverted secretion. Examples. Effects. Remedies.

Section VII. — Diseases of the Constituents of the Blood p. 99

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.

Diseases of bed Particles p. 99 — 106

182 — 184 Natural offices and proportions. Excess. Examples. Signs and effects. 185, 186 Defective. Examples, and effects. Alterations; in color; in shape and size; 187,188 breaking up. Arterial change ; cause. Mulder's notion. Mr. W. Jones' ob- 189,190 servations ; explanation. Mr. Gulliver's observations. Origin of red particles. 191 — 193 Causes of their decrease. Disorders of spleen and uterus. Remedies for excess, defect, and alteration.

Section VIII. — Fibrin and White Corpuscles p. 106 — 116

194 Nature of fibrin. Purposes. Structure, in washed clot, or lymph; composition.

195 Excess. Examples ; signs and effects. Increase of white globules. Buffy 196,197 coat present without excess of fibrin. Defect. Examples; fluidity of blood. 198 Causes. Effects ; hemorrhage, congestion, venous murmurs, &c.

199 — 201 Alterations in quality ; apparent from character of coagulum, which shows pro-

202 perties of self-coagulation, contraction, and separation. Self-coagulation; varie*

203,204 ties and causes. Contraction; varieties and causes. Separation; causes,

205, 206 varieties. Causes of the buffy coat. Appearances of coagulated blood.

207, 208 Large clot; small clot. Separated and cupped; mode of exhibiting these pro-

209, 210 perties. Source of fibrin, and formation of white globules. Increase by in-

211, 212 fiammation. Material of coagulable lymph. Varieties. Coagulation of fibrin

213 during life. Vegetation and polypi.

214,215 Remedies for excess of Fibrin. Blood-letting. Evacuants. Mr. Blake's experiments.

216 Diet. Remedies for defect; diet; regimen; stimulants; tonics; antiseptics.

217 — 219 Means of altering quality of fibrin; depletion; alteratives. Tonics; diet.

Section IX. — Albumen and other Animal Principles Dissolved in 220 Natural offices of albumen

221,222 Excess. Examples. Causes. Remedies. Defect. Examples. Effects. Remedies.

223, 224 Excess. Examples. Milky serum. Depends on the presence of unassimilated chyle. Cholesterine. Causes, Sources of fat. Causes of obesity. Remedies. Defect. Cause of atrophy.

Section XL— Saline Matter .... p. 119, 120

225 — 227 Excess. Thirst caused by salt. Defect: in yellow fever and malignant cholera.

Effect of saline injections. Use of salines in fevers. Defect of potash the cause of scurvy; See Appendix.

Section XIL— Water - - - - - p. 120, 121

228 — 230 Excess. Examples and effects. From too much drink. Defect. Examples. 231 Symptoms. Causes. Effects of cholera — of abstinence from liquids. Re-

medies for excess and defect. Water cure and dry diet.

CONTENTS.

XV

Section XIIT. — Changes in the blood by respiration - p. 121 — 126

232 — 234 Analysis of the changes. Excess. Examples in disease? Defect: the element

235,236 of asphyxia. Effect proportioned to suddenness as well as degree. Explana-

237 tion of this. Analysis of asphyxia. Classification of symptoms. Defect

238 gradually induced. Hybernation. Cyanosis: state of the functions; little

239 muscle and much fat ; with defective respiration. Emphysema. Remedies

240 for defect; Lowering functional activity. Treatment of asphyxia. Stimu- 241,242 lants. Warm bath. Promoting respiration. Other means of arterializing the 243 blood. Treatment of congestion of apncea. Diet in dyspnoea. Excess of 244 — 246 changes by respiration: in rheumatism? Respiration of oxygen gas. Effects

explained. Carbonic acid may asphyxiate independently of the exclusion of

247 oxygen. Liebig's theory of the action of hydrocyanic acid controverted.

Section XIV. — Changes in the Blood by Excretion - p. 127 — 129

248 Defective secretion of urine. Experiments of Prevost and Dumas, of Bernard

249 and Barreswil. Effects of diseased kidneys. Acute and chronic albuminuria.

250 Defective secretion of bile. Examples. Effects. Of perspiratory secretion ;

251 checked by cold. Vicarious action of skin and kidneys. Rheumatism;

252 materies morbi. Remedies to be directed to this element.

Section XV. — Changes in the Blood from the Transformation of

Chyle and of the Textures - - p. 129 — 134

Natural changes uncertain. Lithic acid diseases. Diet, &c. producing them. Operation of colchicum. Effects on the kidneys. Nephralgia, &c. Gout ; varieties, effects.

Formation of sugar in diabetes. Effects and treatment in gout and rheumatism contrasted. Production of urea in excess. Remedies. Obesity. Fatty degeneration.

Section XVI. — Changed Properties of the Blood from the presence of foreign matters - p. 134 — 136

259 The blood the seat of morbid poisons; proofs; and of germs of malignant disease.

260 Treatment of morbific matters in the blood.

253 254

256—258

Section I. — Anjemia - - - - p. 1 37 — 145 261 Explanation of proximate elements of disease

262 — 264 General anaemia. Nature, exciting causes, and symptoms. Physical signs.

265 — 267 Changes in the blood. Symptoms of excitement in anaemia. Explanation of

268,269 these symptoms. Symptoms of coma, &c. Cases and interpretation of natuie

270,271 of anaemic coma. Nutrition in anaemia. Fatal terminations. Remedial mea-

272 sures. Regimen and diet. Medicines. Venous murmurs.

273 Partial ancemia. Examples. Effects.

Section H. — Hyperemia or Excess of Blood. - - p. 145

274 Definition and nature. Classification of varieties.

Section III. — Plethora — General Excess of Blood - p. 146 — 150

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. 284 — 286 Remedial measures. Blood-letting: where unfit. In sthenic, other measures needed. In asthenic, tonics as well as evacuants.

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CONTENTS.

Paragraph.

Local Hyperemia. Excess of Blood in a part.

Section IV. — With Motion Diminished - - p. 15G — 165

287,288 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. From 291,292 over-distention. Examples. From intropulsive action of cold and malaria. 293, 294 Over excitement or inflammation. Examples and illustrations by microscope. 295,296 Stagnation in the vessels. From arrest of secretion or capillary circulation.

298 From imperfect respiration. (Power of the heart sufficient of itself to maintain the circulation. Dr. Sharpey's experiment. Microscopic examinations; fallacies. Objections to the supposition of spontaneous movement of the blood particles.) Observations of Mr. Erichsen. Obstruction to circulation in

299 asphyxia is from contraction of the small arteries. Atony of vessels impedes 300 — 302 transit of blood. Experiments to show the neutralization of force in the flaccid

vessels. Cause of long continuance of congestion. 303 Symptoms and effects of congestion. Effects on secretion explained. Production .

305, 306 of flux. Examples. Considerable congestion required to produce dropsy.

307 Amount of tension and quality of blood determine quality of effusion, liquid

308 and solid. Examples. Albuminuria referred to congestion of the kidney. 309, 310 Reasons. Congestion continuing causes hypertrophy of a peculiar kmd. 31 1, 312 Origin of granular disease and cirrhosis. Other instances. Effects of local congestion on the system.

313 Remedies for congestion. Removal of causes, venous obstruction and causes of

314,315 atony. Posture. Pressure. Friction. Exercise. Astringents and tonics; 316, 317 when inapplicable. Stimulant remedies; Operation shown by the microscope; 318 when hurtful. Depletion and other cvacuants. Heemostasis or counter con-

319,320 gestion. 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. 165 — 175

321,322 Examples in health and in disease. Determination to the head. Examples with

324,325 symptoms. Caused by stimuli. Physical cause of determination of blood.

326, 327 Enlargement of arteries proved, by experiment and microscope. Dr. Billing's

328,329 view. Cause of the enlargement, a loss of tonicity. Final cause of determina-

330 tion to supply more blood where wanted. Determination from intropulsion.

331 Subjects of determination. Determination may cause anaemia in other parts.

332 Determination affects large arteries.

333, 334 Symptoms and effects of determination of blood. Parts most subject to it. To the

335, 336 head. Explanation of its different effects in different cases. To the kidneys.

337 — 340 To the mucous membranes. To the skin. Other symptoms. Determination

341 if continued leads to hypertrophy.

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

344 — 346 dilated arteries. Cold. Astringents. Derivants. Posture. Evacuants.

Blood-letting; general and local; its effect seen by the microscope. Cases

347, 348 requiring blood letting. Remedies to relax the arterial system and quiet the

349 heart. Measures to equalize and strengthen the circulation. Tonics.

Section VI. — Results of Hyperemia - - - p. 175 — 195

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

351 Hemorrhage from plethora. Examples. Epistaxis, hematemesis, Sec, from con-

352 gestion of venous obstruction. Examples. Pulmonary, bronchial, gastric, &c.

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

360,361 Varieties of hemorrhage. Sthenic and asthenic defined. Symptoms. Molimen

362 hemorrhagicum : jerking pulse, how produced. Faintness; Reaction. Transi-

363,364 tion to inflammation. Examples. Local effects and symptoms. Passive

365 hemorrhage.

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

styptics.

Flux and Dropsy. From plethora. Examples. From congestion. Experiment of Lower. Examples in disease.

From weakness of the vessels. After excitement. Intropulsion of cold. From determination of blood. Examples; active flux; active dropsy. Flux and dropsy vicarious. Examples. Circumstances causing hyperemia to end in these results : in the vessels : in the blood. Combination of these circumstances in anaemia. Diseased blood from defective excretion, especially by the kidneys. Examples and proofs. Cause of anasarca after scarlatina. Dropsy and flux with albuminuria: why inflammatory: resemblance to rheumatism. Thinness of blood cause of asthenic dropsy. Dropsy from retention of water and excrementitious matter in the blood. Malnutrition. Proofs. Distinctive pathology of fluxes and dropsy. Causes of each. General treatment of flux and dropsy. Remedies for hyperaemia. Remedies for

malexcretion and malnutrition.

Treatment of fluxes. Removal of causes. Derivants. For sthenic flux ; evacuants and depletion ; not to be hastily checked. For asthenic flux ; astringents and tonics. Dry and tonic regimen.

Treatment of dropsy. Means to remove effusion and restore action of kidneys in sthenic dropsy. Means to improve the blood in asthenia. Recurrence of dropsy requires variation of remedies. Circumstances which indicate tapping or puncture. Cautions.

Section VII. — Local Hyperemia, Excess of Blood in a part, with Motion PARTLY INCREASED, PARTLY DIMINISHED INFLAMMATION

399,400 Inflammation not understood from its elements not being studied. Definition from nature ; from 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. Exam- 403, 404 pies. Indirect causes produce congestion. Causes mixed in operation. 405, 406 Checked hemorrhage and flux. Irritants operate primarily on the nerves.

407 But inflammation is sometimes excited without nervous irritation. Cause

408 essentially acts on vessels, producing sometimes determination first, sometimes congestion.

409 Phenomena and nature of inflammation. Difference from congestion; 410,411 from determination. Essential characters established: increase of blood,

with motion increased and diminished. Cause of the obstruction. Views 412, 413 of Cullen, W. Phillip, Hunter, Kaltenbrunner, and Alison, considered. Atony

414 of the vessels a partial cause of obstruction. Examples and experiments.

415 Another cause within the vessels: adhesion of white globules; their increase.

416 Description and production of white globules; Mr. Addison's observations;

417 Mr. Gulliver's. Appearance of frog's web after irritation. Adhesive property of white globules; those recently formed have no cell-wall. Share which the red corpuscles take in the obstruction. The presence and proper-

418 ties of white globules essential to inflammation. Conclusions as to the 419, 420 obstruction of inflammation. Effect of obstruction to expend force on the

421 arterial capillaries. This opposition of obstruction to force also the cause of destruction.

422 Effects of inflammation on vital properties ; on secretions.

423, 424 Effusions; general character; microscopic character. Exudation corpuscles.

Elementary solids of inflammatory effusions. Molecules. Granules. Fibrils. 425, 426 Exudation corpuscles. Pus globules. Tubercle. Mode of formation of

some of these. Variety in their plasticity and organizability. Other effects

427 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. Heat; cause; indica~ 431,432 tions. Swelling; causes; varieties from texture. Pain; causes. Degrees

1*

373—375

376—378 379

380—382

385 386 387

388, 389

392, 393 394

396, 397 398 xviii

CONTENTS.

Paragraph.

433, 434 and varieties and their causes. Other sensations. Effect of inflammation on 435, 436 contractility. On other functions and symptoms.

437 Constitutional symptoms. Inflammatory fever. Change in the blood. Cause

438, 439 of the increase of the fibrin and its contractile property. This not the sole cause of inflammatory fever. Pathology of inflammatory fever. Causes. 440, 441 Reaction, irritation, altered condition of the blood. Why some functions are

442 excited and others impaired. Symptoms of inflammatory fever. Its varie-

443 ties : high, low. Type of fever from cause or seat of inflammation. Ex-

444 planation of this. Remittent and intermittent fever. Apyrexia. Injury to blood in continued inflammation.

Nature and Symptoms of the Results on Terminations of Inflammation.

445, 446 Division. The results seldom occur singly. Resolution. Its nature. Modes 447, 448 of occurrence. Local symptoms. Constitutional symptoms of resolution.

Critical discharges. Lateritious sediments; cause; nature; reason of absence; &c.

449 Effusion (including adhesion). Not always a termination. History of effusions

450 in serous membranes. Coagulable lymph. Varieties. Euplastic. Mode of

451 organization. Formation of vessels. Views of Kiernan, Travers, Vogel, 452, 453 Liston. Cacoplastic lymph. Varieties and effects. Aplastic lymph. Causes 454, 455 of these low products. Effusions of mucous membranes. Interstitial deposit. 456, 457 Changes of mucus. Effusion in skin: varieties of cutaneous inflammation. 458,459 Effusion in cellular texture. In parenchymata. Symptoms of effusion.

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

tion between exudation corpuscles and pus. Alteration by acetic acid ; by

461 distilled water. Its want of cohesion. Explanation of this. Liquefaction of

462 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. Suppurative diathesis Examples. Mode in which they act. Pus in the

463 blood. Process of suppuration explained: death of tissues by pressure; liquefaction and absorption of all but pus globules. Varieties of suppuration.

464 Diffused. Abscess: pyogenic membrane: pointing. Opening and healing 465, 466 of abscesses. Granulations. Ulceration. Varieties. Causes. Softening of 467 textures. Suppuration a work of destruction, therefore depressing. Symp- 468,469 toms of suppuration. Local: constitutional: varieties caused by limitation,

470 or not, of suppuration. Purulent deposits. Nature and causes. No true absorption of pus. Pus frequently in the blood in severe inflammation.

471 Cachaamia usually precedes pyaemia. Depression from suppuration. Cause of rigors. Hectic fever. Varieties of pus ; laudable; ill conditioned.

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

475 grene; interrupted circulation; noxious agents. Local symptoms and effects

476 of gangrene. Varieties. Constitutional symptoms. Combinations and gradations of the results of inflammation.

Varieties of Inflammation.

477,478 Sthenic and asthenic; symptoms and results. Acute inflammation generally

479 sthenic; symptoms, duration, products. Subacute. Chronic; generally asthenic ; symptoms, duration, results. Cause of their variety.

480 Congestive inflammation; nature, symptoms, results.

481 Phlegmonous inflammation; nature; causes; type and symptoms.

482 Erythematic and erysipelatous; local symptoms and effects; fever; cause spe-

483 cific. Pyaemia. Pellicular; asthenic; symptoms; low fever. Plastic inflammation of mucous membranes. Aphthae of adults often attended by the

484 growth of a confervoid vegetable. Aphthae of children. Hemorrhagic inflammation; causes.

485 Scrofulous inflammation ; asthenic; peculiar symptoms. Microscopic characters

of scrofulous matter. Changes which it undergoes. Scrofulous diathesis ; its external marks ; symptoms and causes. Course and results of inflammation 486, 487 in scrofulous subjects. Condition of the blood. Gouty and rheumatic inflammations. Nature and causes. Gonorrheal inflammation; seat and effects. Syphilitic inflammation ; seat and effects.