to administer opium for its relief, from an appre- | whom we have often quoted,-Sir B. Faulkner,hension of aggravating the stupor or comatose is equally sceptical as to its prophylactic powdisposition; but finding that this effect did not ers. On this point he remarks: "There are follow its employment, he used it in 1762 much so many instances of persons living in the closest more freely than he had done in former years, intercourse with the infected who escaped without and in general remarked that where he succeeded the use of oil, and so few well-attested cases of in stopping the looseness early in the disease, the persons having come into actual contact with pespatient became more alert and sensibly better. In tiferous matter who were protected by oil alone, the more advanced stage, however, we learn from that I cannot hesitate to conclude that the opinion the same writer, astringents and opiates rarely of its possessing any independent or certain prochecked or suppressed the diarrhoea. Inflamma- phylactic efficacy is destitute of foundation." (Op. tion of the intestines being one of the few patho- cit. p. 232.) Vaccination has been recommended logical appearances generally recorded by authors, as a means of prophylaxis. The last-quoted writhere can be little doubt that the diarrhoea which ter furnishes us with the following forcible arguaccompanies plague indicates some inflammatory ment against its claim to such a property. I affection of the bowels, and that local bleeding, took pains," says he, "to ascertain whether those from the integuments of the abdomen or anus, and who had recently been vaccinated were rendered perhaps subsequent blistering, would be found less susceptible; and I found that the instances of important auxiliaries in its treatment. its inefficacy were every where numerous, of which I may mention rather a striking one, which was communicated to me by a Maltese surgeon, who was much employed in the plague, namely, that of a numerous family who had been recently vaccinated, the whole fell sacrifices to the prevailing contagion, with the exception of the parents, who had never undergone the operation." (Op. cit. p. 233.) For the prophylactic means to be adopted, we beg to refer to the articles CONTAGION and DISINFECTION.

Coma and other affections of the brain it is customary to combat by means of blisters between the shoulders, to the nape of the neck, temples, and occiput. (Sir B. Faulkner, loc. cit. p. 241.) It is extremely probable that the dread of drawing blood, which is so general among those who treat this disease, is the reason why local bleeding is not conjoined with the counter-irritants to subdue the cerebral affection. From the symptoms we have detailed of the intellectual disorder in plague, there can be little doubt of its depending upon the same causes as that which accompanies other malignant fevers, and that the same method of treatment would be found applicable to both.

Certain remedies of the general febrile state, besides those already mentioned, have been tried by European practitioners in this disease. Cold affusion is thought by Sir B. Faulkner to present a considerable prospect of benefit if applied at the very commencement: this writer, however, it should be remarked, speaks from a very limited experience of its effects. Several writers speak favourably of mercury; some on merely speculative grounds; others from the analogy, real or presumed, between plague and other disorders in which they have observed that this mineral is useful;-Mr. Stafford from considerable experience. This gentleman declares that, when his regiment was infected, thirty or forty cases of axillary tumour recovered under its use, and he relates at length five severe cases of plague, of which three recovered under mercurial treatment. The mode of administering it was internally, in the form of calomel, and by inunction. The statements of this writer seem to show that the mineral may be serviceable in the treatment of the disease. (Cases by Mr. Stafford, quoted by Sir B. Faulkner, p. 245-253.)

Should the vital powers appear to be failing at any period of the disease, wine and cordials are administered, and many writers advise that they should be accompanied by tonic medicines, of which calumba, bark, and serpentaria are those most usu"sually resorted to.

Friction with oil has been praised as a means of curing the disease, by inducing diaphoresis, and likewise as a preservative from infection. The property of inducing diaphoresis it certainly pos-sesses; but its power of curing the disease is questioned by numerous authorities. A writer

The general plan of diet is the same as in other febrile disorders. Of preparations of animal food nothing stronger than chicken broth should be allowed; the rest ought to consist of preparations of farinaceous or leguminous vegetables, ripe fruits, and simple diluents, such as lemonade, toast-water, or tea.

[It is to be deplored, that all remedial agencies are too often ineffectual, owing to the malignity of the disease; and, accordingly, we are not so much surprised at the information given by Dr. Shapter, (Tweedie's Library of Medicine, 2d Amer. edit., i. 230, Philad. 1842,) that a recent observer, after five months' experimenting with all kinds of treatment, and all modifications of the disease, in about 1000 cases, arrived at the melancholy conclusion, that, although the medicines produced their wonted effects upon the organism, the malady neither ceased nor changed.]

The local treatment of buboes should be limited to the application of warm emollient poultices. By the older writers, who erroneously conceived that the suppuration of buboes was the cause, rather than the effect, of the abatement of the fever, various irritating measures were resorted to for accelerating the process, but sounder pathological views have occasioned them to be abandoned. When suppuration has taken place, the matter may be left to discharge itself spontaneously, or the lancet may be employed to give exit to it. Should the original aperture be too small, it should be dilated, as its narrowness is apt to give rise to sinuses. If the carbuncles require topical treat ment at all, it should be of the same simple nature as that of the buboes. Prior to the forming of the eschar, a mild poultice only is required: subsequently a slightly stimulating dressing, such as unguentum resine, or the same with oleum terebinthine, may be interposed between the tumour and the poultice. JOSEPH BROWN.

importance to be assured of the negative, it cannot but be deemed an important part of pathological science to trace the circumstances which generate a state of plethora, and the phenomena which indicate it, so as to be prepared both to recognise it when present, and to apply means suitable and adequate for its correction.

PLETHORA, λn@ópa, fulness; [Polyæmia | diseases, and actually gives rise to several; and of Andral.]-Before entering on the discussion to as, even in cases where it does not exist, it is of which this article is appropriated, the writer wishes to guard himself against a misconception that has at times been inconsiderately formed respecting the doctrines maintained in it. Though connected with the foundations of all pathology, they are by no means intended to represent the whole of it. Pathology regards living actions, which depend on organized structure, and this both derives its nutrient elements from the blood, and returns to it the effete matter which the nutrient deposits displace. This connection-subsisting without intermission so long as life endures—is so intimate, that whatever affects the condition of the blood must immediately concern the well-being of the whole frame; whence every approach to a correct pathology of the circulation must contribute to the establishment of sound principles, and improve medical science. But pathology embraces more than the mere lesions of the blood or of its circulatory apparatus; there is a nervous system as well as a vascular, which cannot be overlooked. We wish it, therefore, to be understood, that in the following doctrines of plethora we have not the slightest intention of establishing an exclusive pathology, or of claiming for the facts and reasonings adduced a higher importance than they intrinsically merit.

The term plethora but ill expresses the state of constitution which it is used to designate, yet it would be difficult to substitute one more correct and appropriate. Indeed, no concise term could convey the compound idea which requires to be represented, and which involves the conception not so much of the quantity of the circulating fluid, as of the relative proportions of its constituent parts. The term hyperæmia, as being of similar import, would not be preferable even if it were not otherwise appropriated. It is applied to denote local accumulations of blood arising from congestion or determination, in which the phenomenon results solely from the increased quantity of blood, without reference to its quality, and is consequently expressed with correctness by a term representing such excess.

Plethora, though inducing a morbid condition of the body, has not in general been designated a disease, nor treated of by practical writers, save in Connection with some special malady attendant on or derived from it. Linnæus has given it a place in his nosology in the class Deformes and order Decolores, and thus defines it: "Rubedo corporis a distensis vasis sanguineis, cum dyspnoea." Sagar also admits it in the class cachexia, and order Intumescentiæ, giving not only a definition but a description also: “Intumescentia universalis, proportionata et æquabilis ex abundantia sanguinis." Amystidis et ventris cultus, pulsus plenus aut suppressus, venarum amplitudo conspicua, æstus et gravitas totius corporis, respirandi difficultas, lassitudo spontanea, stupor artuum, somni turbati, partes epidelio tecte ruberrimæ, temperamentum sublaxum, sanguineum." The former of these would seem to denote rather special disease of the lungs, and the latter to characterize obesity. Neither is calculated to convey a clear or correct notion of the morbid condition which excess of blood occasions. As this condition is present in many VOL. III.-70

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Disease is considered to exist when there is any observable deviation from health in any of the functions or structures of the body. When the whole constitution is disturbed or depraved, without any part being prominently affected, the disease is said to be general or constitutional, and according to its character is called either febrile or cachectic. If any function or organ be particularly disturbed, a name is thence affixed; and if an organ or function suffer without apparent disturbance of the general health, the disease is pronounced local. On such views have classifications of diseases been formed, yet are they wholly wanting in that precision which the productions of a nosological arrangement should indisputably possess.

When morbid symptoms of any kind arise, it is necessary to consider not only the morbid lesions which immediately produce them, but also the deviations from health in which these morbid lesions themselves originate, tracing these back to the point where deviation from health first occurs. By such investigation only can the history of disease be rendered complete, or its true pathology be established.

It is easy to understand why the investigation of disease bas for the most part commenced with that period when a nosological malady is consi dered as formed. Until this period arrives medical aid is rarely sought for, the patient's consciousness of indisposition being aroused only when the functions of health become so impeded as to fail sensibly in their accustomed exercise. The accession is then referred in general to some exciting cause, real or imaginary, and is considered as having commenced at the time when the imputed cause was supposed to operate, a state of previous good health being assumed. Thus suddenness of accession has been regarded as a character of most acute diseases, and the period when the accession has been first observed has been regarded as iden. tical with the commencement of disease. Yet it may be doubted whether any disease, excepting such as results from a morbific poison, ever takes place suddenly or without previous derangement of general health, cognizable by its appropriate manifestations, and capable of being corrected so as to obviate the morbid accession to which it leads. If this can be demonstrated, it is clear that this introductory stage of disease is of the highest importance, as being that to which prophylactic treatment can be most beneficially directed, and also as forming a part of the ensuing disease essential to its complete history, and without a knowledge of which its intimate nature or the series of morbid changes never can be thoroughly understood.

In tracing the progress of plethora, and the derangements of function which it occasions, it is necessary to commence at that point where the

equable and temperate exercise of all the functions | appropriation of blood by the nutrient and other

secretions is languid and inefficient. As repletion, then, may take place under very different circumstances, so is its presence marked by different phenomena. Whenever it arises, one of two consequences is sure to result; either it excites the several functions, if sufficiently healthy and vigorous, to increased actions leading to its speedy ap

and unable at the moment to institute and support those increased actions by which the redundant matter is to be appropriated and expelled, then, oppressed by a labour to which they are unequal, they manifest a decline of even their ordinary power, and all the outward phenomena of debility are displayed. To discriminate this state from one of real debility arising from exhaustion of animal power, or from defective nutrition, is a matter of practical importance not inferior to any which medical science may be engaged in illus trating.

of life constitutes the state which we denominate health. By this means physiology becomes connected with pathology; the actual transition of health into disease is elucidated; and a light is thus shed on morbid processes which no other source of investigation can supply. When disease has made a certain advance, and continued a certain time, so complex are the derangements re-propriation and removal; or, if these be weakly sulting, that without some clue for unravelling their intricacies, an exposition of them is in vain attempted, and, as the history of physic abundantly shows, conclusions the most opposite may be arrived at in inquiries directed to the same end. This could not be the case if the several morbid changes, as occurring in the respective functions, were marked in their regular progression, so as to determine, when any one presented, what were its antecedents, what would be its consequents. Were this knowledge clearly possessed, each symptom of disease would be discriminated as belonging to a determinate train of morbid actions; and however obscured it might be by contingent or derivative disturbances, it would point out unequivocally the appropriate means of its own correction. With such accurate knowledge we should not see such ambiguity prevailing as that in certain maladies some practitioners enjoin bloodletting where others give opium and ammonia.

Almost all systematic and theoretical writers have left their inquiries incomplete; with each an important stage of the disease of which they respectively treat remains unexplained. This stage embraces the interval between the first deviation from a state of health, and the occurrence of the special lesion of which each has taken cognizance; and it is chiefly to this stage that we propose to direct attention in the following pages.

When redundancy of nutriment takes place in a healthy constitution, its earliest effects manifest what may be termed rather exuberance of health than a state of disease. The several functions of the body are more vigorously performed, the nutrition of its several structures is more abundant, and it acquires increase of bulk, especially if the habits of life are not of an activity capable of increasing excretion to a degree proportionate to the nutriment inordinately supplied. And if the excess be casual or inconsiderable, the self-adjusting powers of the body are amply sufficient to dispose of it so as to prevent the transition of healthy actions into diseased. If from extent or continuance the excess be such as to urge these powers beyond a certain point, then their conservative energies fail and irregular actions of various kinds take place, laying the foundation of a large proportion of the specific diseases to which the human body is liable. The general character of diseases so in

The constant unremitting exercise of the functions, the aggregate of which constitutes all that we know or can conceive of life, is attended with a physical expenditure which daily nutrition reduced is inflammatory. They are marked by a places. The nutritive matter taken into the stomach, and which forms the chief support of animal life, undergoes several successive changes in its passage through the body; it is digested, assimilated to the animal juices, deposited in the several structures for their appropriate nutrition, and finally, when no longer fit for supporting their healthy actions, is taken up by the absorbents and carried out of the system by appropriate excretories. It is obvious that there is a natural proportion between the ordinary waste of the body and the supply of fresh nutritive matter, and that if the latter be either too sparing or excessive, the functions of life must undergo some deviation from their healthy exercise.

Considerable variations are liable to occur in the quantity and quality of food which any individual consumes, in the assimilating processes by which what is taken into the stomach is animalized and fitted for repairing the waste of the system, and in the several secretions in which the blood is expended. If more food be assimilated than the ordinary waste of the body requires, a state of repletion must be the natural and inevitable result. But repletion may also take place under a moderate and even abstemious use of food, when, from sedentary habits, inactive life, or other cause,

quickened circulation, increased heat, and a more or less depraved state of the several functions. According to the predisposition of the system, hereditary or acquired, to the accidental weakness of particular parts, or to the casual excitement to which the body may be exposed, is the specific form of the ensuing disease determined. For this diseased condition the means of essential relief are, depletion and abstinence; the one to remove or abate the original cause of distemper,-the other to prevent its recurrence. There can be little doubt that the process of nature here referred to, though generative of what we term disease, is yet intrinsically sanative; its object being to dispose by increased energies of that which the ordinary powers are unable to appropriate and the continuance of which is inconsistent with their healthful exercise.

When repletion occurs in a habit of less natural vigour, the self-adjusting powers are not so successful in effecting early restoration, and inflam matory actions are more tardy in their accession. The interval which precedes the occurrence of morbidly increased actions is one of peculiar interest, because its phenomena are of an equivocal character, resembling in many respects those which belong to a very different state of the sys

sequent to and resulting from redundancy of nutritive matter in the blood, both absolute and relative.

changes so induced we pretend not wholly to explain, though many of them are readily intelligible; but the cognizable phenomena are sufficiently obvious to mark their connection and dependency, and thus to establish a rational theory of the course which nature pursues.

We have stated that absolute plethora is the parent of pure inflammation. If there be no plethora, inflammation will not be excited by slight causes; or if it be aroused through the operation Relief by increased nutrient secretion not sufof an exciting cause, it will be mild and easily ficing, a more general excitement seems now resubdued. The severity of inflammation, too, will, quired, the object of which may be to call into cæteris paribus, be proportionate to the degree of more vigorous exercise the several excretories; and plethora pre-existing. Previously to the occur- a state of generally increased or febrile action enrence of febrile or inflammatory action, there issues. The state of irregularity is obviously the always a sensible interval of disease marked by transition from the state of feebleness to that of evidences of diminished power in the arterial sys-permanently increased action or fever; and the tem, the oppressed and irregular actions of which end of the latter is to get rid of the original cause evince its inadequacy to carry on the circulation of disturbance. It is in proof of the correctness with its wonted vigour. The pulse, if examined, of these views that if in the stage of feebleness will be found low, oppressed, irregular; which depletion and abstinence be resorted to, the feeblestate passes progressively into one of permanently ness disappears, natural vigour is renewed, and increased action or fever. Multiplied observations health is restored, without any febrile action being have satisfied us both that the stage of disease here instituted; while if this state be treated with stimu mentioned precedes that of febrile action, and that lants and nutritive diet, febrile or inflammatory the morbid actions indicated by the pulse succeed action is sure to result. We wish here to observe each other in the order here announced; the first that in these remarks we use the term fever to being that of feebleness or overloaded power, the denote, not any of the specific diseases known by second of irregularity, and the third of perma- that name, but simple pyrexia, characterized by a nently quickened circulation. It has been already quick pulse, hot skin, and furred tongue, being stated how incipient plethora, when the redund- the constitutional state attendant on the ordinary ancy is no longer disposed of by the healthy action phlegmasiæ, and so generally, through a radical of the several organs of appropriation, and when inisconception, denominated symptomatic fever, these can no longer perform steadily the increased As the stage of feebleness is relievable by evacualabour, gives rise to the state of feebleness now tions and abstinence, so are those of irregular under discussion. To comprehend the nature of action and of febrile excitement to be remedied by these several changes is not difficult, it being rea- the same means; and if these be duly employed, dily explicable by reference to well-known laws any or all of these morbid conditions may be of vital action. promptly corrected without specific disease or local lesion of any kind ensuing. But if they be not employed, and more especially if, through miscon ception, stimulants be used and nutritive diet continued, then febrile action becomes more determinately aroused, and some specific disease of an inflammatory character is engendered; or else, if the constitution be, from natural inertness or the extent of labour to be performed, unequal to the effort necessary for generating a state of fever in inflammation, the general health progressively de

When redundancy of nutritive matter first occurs, its immediate effect is to promote more vigorous circulation, and to excite to increased actions the several capillaries, especially those engaged in nutrient secretion. The peculiar stimulus of the nutritive matter excites these actions; their end is to dispose of the redundancy by natural appropriation, and the effect on the frame in the first instance is only that of increased volume and exuberant health. But to all vital actions, and the degree to which they can be continuously sus-clines, the powers of life become enfeebled, and the tained, there is a limit; and when increased beyond this, they after a time become relaxed, sinking even below the natural standard. By incipient plethora increased actions are excited which at first differ from perfectly healthy actions only in degree. In time, however, and especially if the plethoric state be kept up by excessive nutriment, they become enfeebled and abate; then it is that the pulse, which antecedently was fuller and stronger than natural, first becomes low and oppressed. The disposal of redundancy by increased action of healthful processes proving inadequate, from inability of the vital powers to continue it, other efforts are now needed; and as these, though in their tendency corrective of what is amiss, no longer resemble the healthy actions, they must be considered as morbid; disease being the result of their institution. While we thus regard them, however, we should never lose sight of the corrective tendency which originally belongs to them, nor fail to profit by the curative indications which the efforts of nature point out. The minute

constitution finally sinks under some of the com. plicated forms of chronic disease. When, under the former of thèse results, active fever or inflammation occurs, it is in general speedily subjected to medical treatment; and as opinions vary but little respecting the measures to be pursued under such circumstances, while the urgency of disease requires them to be employed with proportionate vigour, it seldom happens that this stage of disease is improperly treated, at least so far as regards the use of evacuants. At this time the propriety and necessity of active treatment and of depletory practice are admitted on all sides; yet previously to the acute attack a deviation from a healthy state existed, which admitted of detection, and which as clearly indicated the propriety of some depletion, though it might not demand it so imperatively, nor require it to the same extent, as when the acute attack had supervened. Were this introductory stage relieved by adequate depletion and other suitable means, there can be little doubt that the accession of acute disease might