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others who will say, upon my soul and body,there is no infection at all about colds.But what is called catching cold, is where

you are exposed to a stream of air; and ifthe wind blows upon some delicate persons,or if a little bit of a blast from the doorcomes upon them, 0 ! off they will go sneez-ing, and have a cold immediately. Well, Ihad caught a cold ; I had inflammatoryfever, acceleration of pulse, white tongue,and thirst; was bother-headed, could nei-ther read nor do any thing else, and all mymuscles ached most surprisingly. As Ididn’t know what to do with myself, I wentto the play; and when I got there, egad,my loins ached in a most horrible manner ;I was glad to get to a place where I couldlean to support myself, and then there wasno pain. Iheldup my arm, but the paininthedeltoid was intolerable, and down it droppedimmediately. Well, you know, all this is fol-lowed by sneezing, then by coughing, andthen by expectoration. Now, I say, can

you account for all this, that just a blast ofair blowing on one part of the skin, shouldso disturb the whole constitution 1 Can youaccount for it? To me the account seems

easy enough ; which is, that one part of the ’,skin being affected, the whole of the skinbecomes affected ; a sort of shivering andsuppression of secretion takes place ; andthen we have what I may call the electricityof the body, the nervous system, and themuscular system, all become disturbed, andthere is febrile excitement. Now a little ofJames’ powder, and throwing yourself into aperspiration, will take off these feelingspretty quickly. But this relates only to onekind of cold. People come into the hospitalwith their loins full of pains, saying, 0 myloins are very bad indeed; and if you letthem do as they please, they will remainthere for many months ; that is, if you allowthem to get up and use their muscles, thepains will continue ; but if you keep themin bed, they will soon entirely go away.

Now I have got over these muscles asfar’as I have gone, as briefly as I could,because I don’t like to be too minute withrespect to any object; and I am firmly per-suaded that it is a piece of affectation to de-scribe these muscles with accuracy, for theyhave not exactly the same attachments indifferent subjects ; it is the general view ofthe muscles on the back, which it is im-portant for you to learn ; and having learnedthat, you may afterwards learn more if youthink proper.

LECTURES

ON THE

Diseases of the Nervous System,BY

DR. CLUTTERBUCK.

LECTURE VII.

On Idiopathic Fever.

THE last form of acute inflammation ofthe brain to be noticed, is that termed idio-

pathiefever, by way of distinguishing it fromwhat is called symptomatic,fever, as producedby inflammation in general.Now the termfever, according to its natu-ral and obvious signification, expressesmerely a general increase of heat in thesystem, probably from the Latin verb fencre,to be hot, and analogous with the corre-

sponding term pyrexia from the Greek. Ac-cordingly, in common language, (and justlyin respect to the derivation of the word,)fever is a term applied to every state of sys-tem where the animal heat is morbidly in-creased. Now this, as you know, is thecase in almost all inflammations, whereverseated, provided they are of a certain de-gree of intensity and extent; hence, such afebrile state of system has been consideredas in most cases the mere effect of inflam-mation, and therefore called symptomaticfever, that is, fever symptomatic of inflam-mation, and of course a secondary affection.But it has also generally been supposed,that fever might exist as a primary affection,altogether independent of inflammation.This, it was alleged, is the case with thewhole tribe of continued, intermittent, and re-mittent fevl31’s ; as well as those termed specific.For although these were often found com-

bined with inflammation, this was supposedto be secondary and accidental only, and not

the primary or essential part of the disease.Now such fevers, in order to distinguishthem from symptomatic fever as resulting un-’ equivocally from inflammation, were calledby way of distinction, idiopathic fevers.f I shall endeavour to show you, that suchdistinction is unfounded ; and, as a general1 rule, that there are no idiopathicfevers, with-out inflammation as their cause : in short,

that fever in every form, or, in other words,every febrile state of system, that is, wherethe skin is preternaturally hot, the tonguefurred, and the pulse quickened (these beingthe leading symptoms of such state) is theresult of inflammation, and of this cause only._This I propose to prove to you, by detailing

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the history of what is called idiopathic fever, symptoms or appearances that present them.when you will find reason, I think, to ad- selves during life secondly, by examinatienmit, that this form of disease furnishes no in the way of dissection, after death. These

exception to the general rule I have just modes of investigation are both of them oflaid down. And you cannot but perceive considerable importance ; but the greatestthe importance of this, in a practical point weight is due to the former, or examina-of view. For if a febrile state of body, tion of symptoms ; because these, or somewhenever it occurs, is a secondary state of of them at least (the essential or pathoono.disease, an effect merely of inflammation, it monic) are always present; while there areought not to engage our sole or principal many diseases that leave few or no tracesattention in the cure ; but we should rather behind them after death. I must premiselook to the removal of the inflammation itself, here, that in an investigation of this kind,as the cause; for this being removed, the it is absolutely necessary to confine our at-effect will cease also ; which experience tention to the simplest form of the disease;shows to be the case. While the removal so as to exclude, for the time, all acciden-of the effect, the febrile state of system, is tal combination with other diseases. Suchnot necessarily followed by a cessation of combinations are exceedingly frequent inthe in,flammation; which may still pursue its fever; but they throw no light upon thecourse : and more than this, it is sometimes real or intrinsic nature of the disease,found, that the exciting a febrile state, or which, on the contrary, they rather tend toaggravating it when already present, by the obscure. This is a point that has been toouse of stimulants, is, in certain circumstances much neglected in most of the attemptsof inflammation, the most effectual means that have hitherto been made to establishof removing the disease. This, we shall the theory of fever : the accidental circum.find, applies to proper or idiopathic fever, as stances having been confounded with thosewell as to other inflammations. that are essential, and false conclusions

I may as well tell you at once, what are come to in consequence. In ordinary prac.the points I am desirous of establishing : tice, we find fever very often combined withthey are these then : 1st, That there is no inflammation in the chest, or in the abdomen,such thing as a fever, independent of local or other parts; all such cases are to beinflammation as its cause ; consequently, looked upon as complicated states of the dis-that what is called proper or idiopathic fever, ease, and which will be treated of hereafter.like all other febrile states of system, is At present, our attention must be directed

always the result of inflammation ; and that exclusively to fever in its simplest state.it no otherwise differs from a common case Now I think you will best understand theof inflammation of the lungs or any other subject, if I describe to you, as briefly 38 Iorgan, than in regard to the part where the can, a case of simple fever, such as it occursinflammation is seated. 2dly, That the pro- nine times in ten in this climate, where theper or primary seat of idiopathic fever is the comparative mildness of the symptoms inbrain, in the same way that the lungs are the beginning, and the slower progress ofthe seat of pneumonia, the liver of hepatitis, the disease altogether, give us ample timeand so of others ; the febrile symptoms, or for observation ; whereas, in hot climates,general disorder of system, being in each fever is so rapid in its progress, and socase secondary, or symptomatic of the local quickly fatal; and, at the same time, soinflammation. Thus, then, all febrile dis- generally complicated with other affections,orders, whether we call them symptomatic or particularly inflammation in some of the ah-idiopathic fevers, are compounded of a pri- dominal viscera, that it scarcely affords anmary topical inflammation ; and, as the ef- opportunity for investigating the intiinsicfect of this, a general disorder of system, nature of the disease.which, in Dr. Cullen’s Nosology, is termed Suppose, then, you are called to a patientpyrexia, or a febrile state of body. Accord- recently attacked with fever ; not yet so ill,ingly, we might make as many fevers as however, but that he is able to sit up. Youthere are organs which, when inflamed, are find him languid and feeble, both unwillingcapable of rousing the system into febrile and unable to make any considerable mus-action. In this way, we might have pulmo- cular exertion ; his countenance dull and’1Iic fever, cardiac fever, gastric fever, hepatic inexpressive ; complaining of pain in thefever, and so on ; while those febrile states head, with heat and throbbing of the arte-that are produced by inflammation of the ries of the head and neck, the throbbingbrain might, upon the same principle, be increased upon stooping, or by any suddentermed brain fever, corresponding with what exertion of mind or body ; incapable of ex-is called by physicians idiopathic fever; the erting the mental, no less than the bodil.11,primary seat and nature of which, I shall functions ; the skin hot and dry, either par-now endeavour to establish by proofs. tially or generally, but always with the headNow the seat and nature of a disease may hot, even though the extremities be cold, as

be aecertained in two ways : finst, by the they often are ; the tongue furred, but

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generally less white than in other diseases ; which never lasts above a few days, as itthe pulse weak, and soft to the feel; the either terminates in health within this pe-appetite lost, often with nausea; the sleep, riod, or degenerates gradually into the formimperfect or disturbed. of violent or malignant fever before described;Now by these few and simple charac- under these circumstances, Dr. Cullen calls

ters, you may always recognise a case of it synochus, as if it were a distinct species ofproper or idiopathic fever, even where the disease, instead of a mere variety, as is reallydisease is in its early stage, and slight in the case.

degree ; and where the disturbance in the These are all cases of simple fever, dif-brain is not so strongly marked, as it after- fering from one another merely in degree ;wards becomes. the difference depending upon foreign or

This is fever in its simplest and mildest accidental circumstances, not essential toform, such as is called by Huxham and other the disease. And it is in this simple stateauthors, the low nervousfever, the typhus mitior only, that its true nature and character canof Dr. Cullen.! be ascertained.

If you look at the disease in a more ad- Now I ask, whether the characters justvanced stage, and a more violent and aggra- mentioned, and which are all that are essen-vated form ; such as it appears under unfa- tial to the disease, do not point out thevourable circumstances, as confinement in brain as the part affected ? It is the headan impure and heated atmosphere, with neg- that is uniformly complained of as the seatlect of cleanliness and ventilation, or other of pain, except where the disease is so vio-mismanagement; you still find it present- lent, or far advanced, as to deprive the pa-ing the same essential characters, differing tient of his proper consciousness; then, in-from the former only in degree, but showing deed, he makes no complaint of pain in thestill more clearly the seat and nature of the head. The peculiar functions, again, thatdisease. The pain in the head, indeed, may are performed by the brain, the sensorial, asbe no longer complained of ; but this is we call them, that is, sensation, voluntaryowing to the want of consciousness, from motion, and intellect, are constantly disturbed,the greater disturbance that is taking place in greater or less degree; sometimes theyin the brain. The heat of head, throbbing are in too excited a state, sometimes theof arteries, and the flushing of the eyes and reverse ; but always disordered at the samecheeks, are greater. The sensorial or proper time. This disturbance of the sensorial func-functions of the brain, are more disordered, tions is in proportion to the violence andand in extreme cases nearly annihilated. danger of the case ; which proves that itThe heat of skin is intense ; the fur on makes an essential part of the character ofthe tongue has increased in thickness, and the disease. And when it is consideredbecome darker coloured, often to the de- further, that such disturbance makes no ne-gree of absolute blackness ; the pulse is cessary part of other diseases, however vio-soft, and easily compressible ; with other lent and dangerous they may be, (providedsymptoms that will be more minutely de- they are simple and uncombined) we seemscribed hereafter. This is the other ex- on these grounds to be warranted in refer-treme of simple fever differing from the for- ring fever essentially to the brain, as itsmer, or milder typhus, merely in degree. proper seat.

Accordingly, there are all the gradations It is true that fever is’frequently accom-possible between the two ; the one, by con- panied with other symptoms ; such as thosetinuance merely, especially if injudiciously of inflammation in the chest, or in the ab-treated, or neglected, readily passing into domen ; and it has been said that thesethe other. This is the form of fever called, occur as frequently as the symptoms offrom its violence, malignant; and, from the brain affection, and have as great a right,tendency to decomposition observed in the therefore, to be looked upon as essential tofluids, putrid fever; called also gaol, camp, the disease. This, however, is far fromhospital, or ship fever, from the situation being a true statement of the case. Thein which it has most frequently occurred : difference lies here ; that in proper or idio-the typhus gravior of Dr. Cullen. pathic fever, however complicated, the brainWhen fever occurs in young and vigorous affection is always present, though occa-

subjects, living in a pure air, and in the sionally much obscured by the predomi-spring season more especially ; and also nance of other symptoms; while the affec-when it arises from such simple causes as tion of other organs, is occasional and acci-exposure to cold, violent exercise, or tem- dental only. No simple case of pneumonia,porary excess ; the pulse becomes strong or peritonitis, or any other inflammation, ex-and full, the pain and throbbing of the head cept that of the brain itself, is attendedare unusually violent, and the heat of skin with the essential symptoms of idiupathicvery great, with a tendency to profuse fever. You will have the local pain, andsweating. This constitutes what is called the disturbed function of the part inflamed ;inflammatory fever, the synocha of Dr. Cullen, and you may have likewise a high state of

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.pyrexia, or general febrile action. But you ment in the bad air of a dissecting room, towill not observe the prostration of muscular wounds received in dissection, to excessivestrength, the delirious tendency, nor the application of mind, or other causes. Nowother sensorial disturbance ; nor the brown I have attended many of these patients, andtongue ; which are the distinguishing cha- I never found one who was not convinced,racters of proper fever, and which, where from his own feelings, that the brain wasthey do occur, in combination with other the principal seat of his disease, and thatinflammations, serve to show a complicated the arteries of the brain were in such a statestate of disease. of violent action, as could only be referred d

It is, perhaps, worth remarking here, to actual inflammation.that the pain in the head, which I men- This brings us, then, to the second headtioned as serving to mark the seat of dis- of proof, namely, dissection after death. Nowease in fever, often precedes for several this has been considered as affording evi-

days the general disorder, or febrile state dence that ought to be quite conclusive onof system ; it takes place, in fact, before the the subject. But you will easily see thatdisease is fully formed, and before, in strict- such an opinion is not maintainable, andness of language, it merits the title of fever that for different reasons. In the first place,while it (the pain in the head) often re- dissection can only show alterations of struc-mains after the fever has wholly gone off; ture, or states approaching to this ; but notor is renewed again by the most trivial disordered action, which is the primary and’causes that tend to excite or disturb the essential part of all disease. Alteration ofvascular action of the brain ; such as stoop- structure is only a consequence of disease,ing, or any sudden bodily exertion, or emo- and requires some time for its production ;tion of mind. commonly, several days at the least, andThese then are the grounds upon which often much longer. Now, if a disease

I found my opinion, in regard to the seat of should prove fatal before time is given forfever ; and that the disease consists in in- effecting such a change, it is plain that dis-:flammation of the organ, may with equal section would not serve our purpose. Hence

justice be inferred, from a comparison of you may understand, why the most violentthe symptoms with those of inflammation cases of fever, as well as of other inflamma.generally. You have only to apply the tions in the brain, leave the fewest traces ofsame tests that are employed in investigat- disease behind them. They prove fatal, be.ing other diseases, in order to arrive at this fore such change can be effected. Besidesconclusion. this, the appearances observed after death

If, for instance, you found a person com- are not necessarily those that existed duringplaining of pain in the chest; and if, as is life ; great changes take place in the dis-often the case, there was a sense of heat tribution of the blood at the time of death,and throbbing in the part; if respiration so as materially to affect the appearancewere observed to be disturbed in any way, of parts.as by cough, expectoration, or difficulty of The essence of disease, as I have beforebreathing; and, lastly, if along with these remarked, is disordered action; inflammationlocal symptoms you should find the skin itself is nothing more at first; change ofhot ; the tongue dry and coated; and the structure, when it occurs, is only a conse-pulse accelerated,-you would not hesitate quence, more or less remote, of this dis-

, to conclude, from such a combination of ordered action. Now inflammation alwayssymptoms, that the patient was labouring disturbs and deranges the function of theunder inflammation in the lungs. Now a part which it affects; and, when very vio-similar train of symptoms, denoting inflam- lent and extensive throughout the organ,mation in the brain, are always present in may interrupt it altogether. This may beidiopathic fever, in greater or less degree, instanced in the case of the kidney, as wellThere is head-ach, with increase of heat, as any other: violent inflammation of thisand generally throbbing of arteries within organ produces a total suppresion of urine:and about the head ; there is more or less and you cannot doubt that the same mayof disturbance of all the proper functions of occur with respect to the brain. Shouldthe brain ; and there is altogether the same such be the case, life might be very quicklyfebrile state of system, (pyre,,cia) that accom- destroyed, from the necessity of the func-panies other° inflammations. What infe- tions of this organ to existence; yet no re-Tence ought to be drawn from these circum- markable traces of the disease might bestances, I leave to yourselves to determine. found after death.I shall only remark further upon this point, That the structure of the brain is notthat it is the lot of a considerable number necessarily or materially altered, during theof medical students, during the period of course of even violent fever, may be verytheir residence in London, to become affect- safely inferred from this circumstance; thated with fever, and often in a severe and often, in the worst forms of the disease,dangerous. degree ; owing either to confine- where for many days together the sensorial

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fullttions have been nearly annihilated, a seen, indeed, much stronger marks of in-favourable turn takes place in the disease, flammation in the brain of persons dying ofby a kind of crisis, as it is called; and, in the simple fever, than is met with in manyspace of a few hours or little more, the brain cases of what is called phrenitis ; and thatis enabled to resume its functions ; free from where none but the ordinary symptoms ofdisease, though with diminished powers. fever appeared, without any of those thatThis could not possibly have been the case, are supposed to characterise the latter formif the structure had been materially changed; of inflammation of the brain. Now suchwhich serves to show that fever, like other being the case, we are led into this dilemma :diseases, is essentially a state of disordered either the inflammation, in those cases, wasaction, producing, as a necessary conse- the cause of the symptoms of fever present ;quence, a disordered state of functions ; or violent inflammation can exist in thewhile change of structure, if it occur at all, brain, without giving rise to any symptoms,is a remote effect, and by no means the that is, without producing any disturbancecause of the symptoms that appear during of functions: a position which, I imagine,life. few are prepared to support.But there is still another reason, why Before proceeding further, it may be use-

dissection often proves incompetent to the ful to draw a parallel between the threeelucidation of the nature of fever; namely, different forms of cerebral inflammationthe occasional complication of this with that have been mentioned; viz. hydroce-other diseases, the latter sometimes de- phalus, phrenitis, and idiopathic fever. This,stroying the patient, rather than the fever I expect, will facilitate your conception ofitself. Thus, in hot climates, inflammation the subject altogether.very frequently arises in the stomach, or Now with respect to names: the termsome other of the abdominal viscera, and hydrocephalus, or dropsy ol’the brain, is mani-kills the patient, where the fever itself festly improper, as it applies only to an ad-might not have done so. In this case, dis- vanced stage of the disease. The peculiarsection would be likely to show only the signs denoting such an accumulation of fluid,secondary diseases. So likewise in this cli- are observed only after the disease has sub-mate, during the course of a fever, it fre- sisted for some time; while the inflamma-quently happens that extensive inflamma- tory state, that in which the disease pri-tion arises in the mucous membrane of the marily and essentially consists, is apt to beintestinal canal, sometimes spontaneously, overlooked or misconceived. It shouldbut much more frequently, I believe, in- doubtless be called by some name denotingduced by the excessive use of calomel, and at once the seat and nature of the disease,other drastic purgatives. This secondary and that in its simplest form. The termaffection hastens’the death of the patient; meningitis, which has been used by some,and, in such cases, strong marks of inflam - though ill-sounding, appears sufficientlymation are found in the intestines after death. characteristic ; or the disease mightbedesig-This has led many to conclude, that an in- nated by the still more expressive languageflamed state of the mucous membrane makes of membranous inflammation of the brain. Thean essential part of the disease. If this term phrenitis is perhaps admissible, fromwere true, such a state of membrane ought the long and constant use that has beento be constantly met with ; but it is only made of it, to indicate that variety of cere-where symptoms of disordered action in the bral inflammation that is especially charac-intestines take place during life, that such terised by active delirium. But the term

appearances are found. fever is altogether objectionable, since itBut although the changes induced on the makes no distinction between a great num-

brain by fever, are not always or necessarily ber of diseases, to which different namesdiscoverable by dissection, you will find, in have been given, and which often call formost cases, upon a careful examination after considerable difference of treatment. It isdeath, sufficiently evident marks of inflam- further objectionable as alluding to a se-

mation having existed in the brain during condary state of disease ; while it leads tolife. I have myself, indeed, met with no in- the neglect of the primary affection out ofstance to the contrary, provided the patient which it arises. The epithet idiopathic,really died of the fever, and not from any that has been applied to fever, in order tosupervening disease, as is sometimes the distinguish it from other diseases that arecase. In proportion as greater attention is attended with a febrile state of system, ispaid to the subject, the proofs of inflamma- absolutely improper ; for it suggests an ideation existing in the brain, as the essential that is wholly groundless ; namely, thatcause of fever, multiply. The appearances, fever properly so called, is an original andhowever, are by no means peculiar to fever, universal disease, and not the result of anynor distinguishable from those produced by primary topical affection. But I have saidthe other forms of cerebral disease, and enough, I trust, to convince you that thiswhich have been already described. I have is not true ; but that what is called idiopathic

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fever, is primarily and essentially an inflam- toms of hydrocephalus make their appear.mation of the cerebral substance ; and there- ance ; that is, when serous accumulationhasfore might not unaptly be called cephalitis, a taken place. This result depends chieflyname that has been employed by some upon the age of the patient. In very youngnosologists, to express inflammation of the children, the tendency to serous accumula-substance of the brain, though it did not tion appears to be greater; or it may be,occur to them to include proper or idiopathic that the membranes in them are more dis-fever under this denomination. posed to inflammation, which, when it

The nature of the disease is the same, in arises, runs more rapidly through its course.all the three varieties mentioned. They all Whence it is, that inflammation of the brainconsist in inflammation, and differ merely and its membranes in infants, is rarely ob.as to the particular seat they occupy in the served to have the same protracted dura-brain. 1. Hydrocephalus is an affection of tion as in adults : the disease either provesthe membranes only ; analagous with pleuritis, quickly fatal, from the violence of the in-or peritonitis, or any other inflammation of flammation, and the consequent disturbanceserous membrane. In its simplest form, (of and interruption of the vital functions; orwhich there are many examples,) it is unat- it ends in serous accumulation; with a

tended with any disorder of the sensorial new train of symptoms, and under anewfunctions; though in most instances, per- denomination. In a word, hydrocephalushaps, the inflammation extends to the sub- in infants (supposing the inflammation tostance of the brain, so as to disturb more or extend, as in most cases it does, to theless its functions ; just as it happens with brain itself) is the same disease as fever inregard to the lungs ; where we meet with adults, and they require a similar mode ofmany more cases of what is called pleuro- treatment. Nor is it uncommon for hydro-peripnetimony, than of simple pleurisy. 2dly, In cephalus to exhibit signs of active and evenphrenitis, the disease is characterised by dis- furious delirium, (as far as this state can beorder of one of the sensorial functions; judged of in infants;) such as, in an adult,whence it must be considered as seated in would be called phrenitis. It is likewisethe brain itself ; not affecting, however, the common for inflammation of the brain set-whole organ, but confined to that part, ting out as rhrenitis, to subside at lengthwhatever it be, that is particularly connected into what is called the typhoid state of fever;with the mental function. Unhappily, our so that towards the end of the disease, thephysiology is not yet sufficiently advanced, sensorial functions are equally obliterated into enable us to assign this with any preci- both. In the course of ordinary idiopathicsion ; though there seems sufficient reason ,fever again, the delirium sometimes assnmesto believe, that the hemispheres are more the active form observed in phren;tis; thisespecially devoted to the operations of mind however is commonly of short duration, theor intellect. Sdly, In idiopathic fever, all delirium soon subsiding again into the lowthe sensorial functions, (sensation, voluntary or ordinary state. This occasional inter-motion, and mind,) are at once disturbed; change of symptoms is probably to be as-

though unequally in regard to each other, cribed to the casual shifting of the inflhIù-and in different degrees at different times, mation, from one part of the brain to ano-Hence it may be inferred, that fever, strictly ther ; or to the varying state of the inflam-so called, is an affection of the whole organ ; mation with regard to particular parts ofin which respect it differs from the other the organ, a circumstance common to in-forms of inflammation in the brain, which flammation wherever seated.are partial, and of limited extent; as we These differences in the characters of the

judge from the state of functions. different varieties of cerebral inflammation,It must appear, therefore, from what I are not satisfactorily elucidated by dissec-

ha-ve now said, that the different forms tion ; for the appearances observed are verymentioned of inflammation in the brain, are nearly the same in all. In recent cases,mere varieties, in the language of natural whether of hydrocephalus, phrenitis, or ici’io-

history, and not specifically different in na- pathic, fever, we meet with the same turgidityture, as they have generally been considered. of vessels, both on the surface and in theThis is further proved by their frequent in- medullary substance ; the same reddening,termixture, and their readily passing into and thickening, and opacity, of membranes;one another: so that, at times, it is difficult and more or less of serous accumulation.to say, to which variety any particular case So that it is quite impossible, from the ap-. belongs. Thus in hydrocephalus, the symp- pearances exhibited on dissection, to indi-toms at first are often undistinguishable from cate the particular form of the disease thatthose of ordinary fever; the inflammation existed during life. Such appearances areextending more or less to the substance of proofs only of the general nature of thethe brain, produces a corresponding disorder affection, as consisting in inflammation. Norof functions. Nor is it till an advanced pe- are they to be considered as the immediateriod of the disease, that the peculiar symp- cause of the symptoms i for these differ

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widely, where the apparent changes in the brain are the same : thus confirming whatI before stated to you, that the essence of disease is, in all cases, disordered action; a astate that, of course, cannot be discoveredafter death, and of which the morbid ap-pearances are only consequences, neither

necessary nor constant. This readily ac-counts also for a fact that has been some-times noticed ; namely, that the symptomspeculiar to each of those diseases, have beenobserved during life, where no adequatecause of them could be discovered by dissec-tion after death.

Lastly, I may remark to you, that themanner of attack and termination; the con-sequences ; the occasional causes ; and alsothe mode of treatment; are essentially thesame in the three varieties alluded to ; -,while, in all these respects, the analogywith inflammation in general, is perfectlymaintained.Sometimes, the attack is sudden and vio-

lent ; accompanied then, generally, withrigors, or a cold fit, as it is called. This issoon followed by increase of heat ; and thisagain by sweating, provided the patient isplaced in favourable circumstances. Atother times, the approach is gradual, and ialmost imperceptible ; many days often t

elapsing before the disease attracts notice. *

The general course of the disease after-wards, corresponds in a great measure withthe manner of attack. So that where this issudden and violent, the disease is equallyso, and runs rapidly through its course,

terminating in many instances in profusesweating. Whereas, when the approach isslow and gradual, the progress of the dis-ease is likewise slow ; the symptoms com-mencing mildly, gradually increase in vio-lence ; and the duration of the disease al-

together is longer, while it subsides by slowdegrees.The cmiseq?ietices of these different forms of

cerebral inflammation are essentially alike,and similar to those of inflammation in gene-ral. If the disease should continue beyond ,a certain period, it often ends in disorgani-sation of the parts concerned, in greater orless degree ; thus laying a foundation forchronic disease, with imperfection or dis-turbance of function, in all the various waysthat an organ so extensive and diversifiedin structure, is capable of. And thus are

produced the numerous tribe of nei-vous af-fections, which receive their denominationschiefly from the particular function that

suffers ; but which all consist essentially ina disordered state of one or more of thesensorial functions, as will hereafter appear.The exciting or occasional causes of hydro-

cephalus, phrenitis, and fever, are essentiallythe same. These different affections are allcapable of being produced by the common

causes of inflammation such as the takingcold, and mechanical injuries of the brain.This organ, likewise, being under the in-fluence of a greater variety of causes thanany other, is excited into inflammation bymany circumstances that have no effect onother parts. Thus fpH’tttMMsHqMCM, and variousnarcotic substances, when carried to excess,readily excite inflammation in the brain ;sometimes in the form of phrenitis, some-times that of fever. Mental emotions, like-wise, may induce one or the other of these,according to the nature of the cause, andthe susceptibility of the brain to be affectedby it. The different fefebrile contagions also,appear to induce inflammation of the brain,generally in the form of j’ever; the diseasein each case, however, being of a specific na-ture, and different from common inflamma-tion.

The treatment of all these varieties ofbrain affection, whether acute or chronic, isbest conducted upon the same general prin-ciples as govern us in the treatment of otherinflammations ; that is, according to thestate and stage of the disease, and the par-ticular circumstances of the patient: modi-fied, however, in scme degree by the pecu-liar nature of the organ affected ; a circum-stance that influences the treatment of alldiseases.

1 shall next explain to you the varietiesobserved in the character of idiopathic f’ever.But this must make the subject of a futurelecture.

FOREIGN DEPARTMENT.

Cases of congenital displacement of the heads ofthe Thigh Bones. Reported by BaronDiTruYTRE-.1, in the Repertoire for Octo-ber 1826.

" I HAVE had opportunities," says Dupuy-tren, in the Memoir before us, " of seeingpatients who, for several years, were con-fined to their beds, though labouring underno disease-though afflicted by no maladythat was remediable by art, their only ail-ment (if such it could be called) being anoriginal or congenital displacement of thethigh bone. I have seen others who hadbeen tortured by innumerable applicationsof leeches, blisters, cauteries, and moxa.I recollect, particularly, the case of a younggirl who, under the direction of a blind madwoman, had been subjected to the tormentof twenty-one cauterizations by moxa, ap-plied round the haunch, and all this bruta-lity was practised for a congenital displace-ment, and which was therefore not reme-diable by art."Moxa, as every one knows, is the uni.