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the great head local disease, it would be difficult to point out the organ primarily affected.
I think I have now pretty dearly made out that a disease may be general, though we have no direct evidence of each particular organ being deranged; and if, from this enumeration of symptoms, it appears to be so, by investigating as much as we are able the phenomena of febrile disease, its mode of acting on the body, and the means by which it is removed, perhaps we shall be still more confirmed in that opinion. In doing this, however, I shall confine myself, for the sake of brevity, to the consideration of one or two of the febrile diseases; for the same reasoning that will apply to one will be applicable to another. .And here it may be proper to observe, that though the author professed in the beginning of his work to demonstrate in a future part of it that the Febres and Exanthemata of Cullen's first class Pyrexiae, were decidedly local diseases, he has entirelyomitted to prove his assertion, resting satisfied with his intention. Perhaps it might be easier to prove that idiopathic fever is a general disease; but I will take Peripneumony a* an instance of what I consider a general disease. It begins with the usual symptoms of fever, and the pyrexia is often present several hours before pain is felt in the chest, or cough is excited, the pulse being frequent and strong ; cough, dyspnoea, and pains in the side and thorax, shortly succeed; the expectoration is often streaked with blood; but sometimes, particularly in the beginning, the cough is dry. These are the leading symptoms, varying, of course, in different constitutions, habits of life, age, and season. ,
The causes of this complaint are chierly the vicissitudes of heat and cold experienced in the winter or spring.seasons. But millions of people at these seasons of the year are daily exposed to every cause of peripneumony without being subject to the complaint. Now I contend that, was it a local affection, were the lungs independent of the system, performing their functions unaided and uninfluenced by any other organs, they would, when exposed to the exciting cause, at all times be liable to the disease in question ; but they are not. They are immediately connected with the whole system by nerves, blood-vessels, and absorbents; and before they can be affected as they are in peripneumony, the whole system must be subjected to some change or action, which, if not morbid, is so nearly allied to.it, that I cannot distinguish between the two states. Who are principally the subjects of acute peripneumony? Not the feeble; not those of a spare habit and lax fibre": it is the robust, the strong, the tree-livers, men from twenty.five or thirty, to forty years of age.
Whenever Whenever the quantity of blood is increased by excess in eating or drinking, by indolence and inactivity, and a general fulness of the vascular system is present; or where its velocity is much accelerated by great exertion in running, or labor; in such a state, particularly where there is a disposition to plethora, and which, in spite of Dr. Clutterbuck's objections, I consider as a sthenic or inflammatory diathesis; in such a state, I say, the causes of peripneumony, viz. the vicissitudes of heat and cold being applied, the symptoms may appear pretty much in the order before stated. The whole system is undergoing morbid action, and the lungs are merely affected as forming part of that system; and I can assign no reason why the disease, under similar circumstances, might not have been acute rheumatism, as well as peripneumony; the two affections are frequently blended together. A strong proof of the system, in either case, being generally affected, is, that the pain frequently moves to different parts; nor does it entirely cease till the general affection of the system is removed. This brings us to the cure; which is so well known to depend entirely upon remedies acting on the whole system, that it scarcelj' merits notice in this place. Large and repeated general bleeding, and purgatives, not administered so much with the view of merely evacuating the intestines, as to lower the inflammatory state of the system, to effect which every means within the power of medicine is indicated; and when this is happily accomplished, the effect ceases ; the patient has nothing to contend with but debility, and perhaps in some cases cough may remain a little longer. If blisters are used, they are merely considered as adjuncts, and as such unquestionably are serviceable. The cough also must be attended to.
In a general disease, requiring general treatment, there may be parts of the system more affected than some other parts, and which, independent of the remedies given to act on the system generally, demand some particular applications, for the more speedy relief of the patients. But a general disease can only be cured by remedies which act universally on the system.
If the preceding observations are correct, I think it may fairly be laid down as a general proposition, that where local affections, or organs undergoing morbid action, are preceded by universal indisposition, the disease may in all Oases be regarded as a general disease, to be cured only by general treatment.
To enumerate more instances of general disease, would occupy too much space in your Journal: I shall now, therefore, merely attempt to show what is meant by a local
disease; disease; and offer some remarks upon the importance of discriminating between the two affections. The first characteristic difference between local and general disease, is, that the latter is always preceded by predisposition, the former never; without predisposition there can be no general disease. Thus we occasionally meet with instances where the small-pox cannot be communicated, and it is very properly stated that in such cases there is no predisposition; again, the cow-pox will in general be found to destroy this predisposition. A local disease may be produced by wounds, acrid substances occasioning erosion of parts, in short, whatever produces solution of continuity. This is the simplest species, and belongs to the province of the surgeon. When, * however, organs highly sensible become affected, and inflammation is produced, the symptoms are often violent and dangerous; and perhaps it was from considering some cases of this kind which induced Dr. Clutterbuck to regard every disease as local. In gastritis or inflammation of the stomach, a patient immediately preceding the attack is in perfect health; he accidentally or purposely swallows some highly stimulating matter, as corrosive subhmate, pins, ground glass, ardent spirit, &c. &c. and inflammation of the organ speedily ensues; and from the high sensibility of* the part, the system becomes generally affected; but this is. evidently secondarily. In enteritis, or inflammation of the intestines, the same; and so it is with every acutely sensible organ where matter sufficiently offending is applied. In organs less sensible, or where the exciting cause is less potent, the morbid action is slow, and for a long time confined to the part first affected; thus we often meet with, diseases of some of the glands which have existed for months without producing any constitutional disease whatever.
Perhaps a great source of error in the consideration of local and general disease, is, that the same organ is often diseased and its functions -deranged very similarly in both cases; this is particularly observable in the stomach, an organ extremely subject to disturbance in its functions. In almost every general disease it is affected from the very beginning, or at least its interrupted action is one of the leading symptoms. Again, it is very frequently primarily affected, and subjected to chronic complaints, which, had the cause applied been sufficiently strong, would have been acute.
To discriminate then between local and general disease is essential to the practitioner. It gives confidence to his practice, and enables him more correctly to form his judgment, and estimate the probable result of the case. When a gene
No. 175. B b ral
val disease is very speedily accompauied by urgent local affections, usually before we see our patient, it is surely of some, consequence to be aware that notwithstanding the violence of the local symptoms, and the distress experienced from the suffering of parts, it is the general state of the system to which we are to direct our chief attention, and apply otir remedies. Again we are called in when the whole constitution is suffering from the disease of some organ; and unless from our acuteness of perception, and the previous history of the attack, we discover the real nature of the complaint, we act completely in the dark •, and consequently prescribe with the feebleness of timidity, or the temerity of ignorance.
■ I therefore regard the division of diseases into general and local, as being highly momentous and essentially useful, whilst it strictly accords with nature. What can the advocate of the. opposite side of the question gain by his discovery i Though he does consider every disease in its origin to be local, when he conies to treat diseases which are now regarded as general from their commencement, he must prescribe as if treating a general disease; and he loses a very powerful assistant to his judgment, and I fear will be much more liable to error and misconception.
, Having now very hastily and imperfectly stated what occurred to me upon the sobject immediately after perusing Dr. Clutterbuck's work on fever, I cannot conclude without noticing two arguments upon which lie chiefly depends iu support of his hypothesis. Though he regards the phlegmasia; as local diseases, because tliey are often present without any general disorder of the system, he is fully aware that they are often preceded by febrile action and general indisposition; such cases he contends are cases of proper fever, complicated with topical inflammation; but proper fever, he also contends, is topical inflammation of the brain; therefore, peripneumony must be inflammation of the brain, combined with topical affection of the lungs. So also, cynanclie tonsillaris, measles, &c. being preceded by fever, must be regarded as inflammation of the brain, with topical affection of the throat, &c. Thus the very explanation of his doctrine confutes itself. The only other opinion which I sljull trouble you with commenting upon, is, in my apprehension, a very mischievous one, and contrary to truth. The author, in his zeal for establishing the locality of disease, will not admit any general asthenic state of the system; or,, if.it is present, he contends that it is a consequence of some topical complaint, or diseased state of some particular organ, and by giving what are termed strengthening remedies, we
., increase increase the complaint by exciting greater action in the morbid part. Unquestionably in some instances this is true: but surely the author must have seen numerous cases 6f illness where the whole, constitution appears to be sinking under debility; where there is extreme languor, feebleness, watit of vigor, and general depression; where, in short, the universal frame seems on tlie verge of dissolution ; and where, except general pains in the extremities, back, loins, &c. indeed over all the frame, (which is frequently the case fn extreme debility,) no local affection whatever is cither com, plained of or discovered. And how is this state removed, but by the very means which the learned doctor so decidedly condemns? by stimulant and tonic remedies, nutritious diejt, pure air, and by every method which affords to the system a grateful and pleasant stimulus.
Having thus freely offered my sentiments upon this interesting subject of inquiry, I hope it will be considered that J have intended nothing personal in my remarks. It is tho doctrine merely which I wished to discuss, and I am truly happy in being able to offer a public tribute of my respect for the worthy author, with some of whose opinions 1 have had occasion to differ; whatever may be our sentiments of his peculiar theory, the work in which it is developed contains much valuable information and ingenious disquisition; and no man capable of understanding it, can rise from its perusal without being benefited by his labor.
For the Medical and Physical Journal.
^memorial, by Dr. Henperson, addressed to the Committee who undertook the Investigation D/ank Moore's Case.
"AVING understood that Ann Moore lias, within these few days, given her consent to a repetition of the ^watching of her person, I would beg leave to call the atten* tioa
* At the time we stated, at page 79 of this Journal, our opinion of the observations made by Dr. Henderson in his pamphlet, being the means of bringing out a complete detection of Ann Moore, we did it on the publicity of the circumstance, not having then received any private intimation of a contrary fact. If we have been in an error in this particular, we acknowledge an obligation to Mr. Webster. Our great wish is to lay before the public as much of clear and incontrovertible fact as possible. As an opinion, however, our former asser-i lion has not lost its weight, for we still think that the investigation
* b 2 and;