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/ 
OBSERVATIONS
3 % ^
/
 \
SOME OF THE PHYSICAL, CHEMICAL, PHYSIOLOGICAL
        AM) PATHOLOGICAL PHENOMENA
MALARIAL    FEVER
          JOSEPH JONES, A.M., M.D.,
PROFESSOR OF MEDICAL CHEMISTRY IN THE MEDICAL COLLEGE OF GEORGIA, AT AUGUSTA.
            EXTRACTED FROM THE
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION.


          PHILADELPHIA:
COLLINS, PRINTER, 105 JAYNE STREET.
                1859. 
WCF





  1859
fitm Alt. 500%  7)0- Lj- 
INTRODUCTION.
  These " Observations  on some of the Phenomena of Malarial
Fever," form the first of a series of observations which the author
is conducting upon the fevers of the North American Continent.
  The first three chapters are devoted to the consideration of the
nature and extent of Pathological Investigations, and are intended
as a general introduction to the whole series of investigations.
  No one  is more painfully alive to the imperfections of these
incomplete observations than the author; and if they should result
in inducing a single young man to enter this  field, with correct
views and the right spirit, he will feel that he  has  been rewarded
for his labors. 
 
CONTENTS.
Introduction...........p_ 3


                              CHAPTER   I.

                   RELATIONS OF MAX TO THE EXTERIOR UNIVERSE.
Relations of astronomical, terrestrial, physical, chemical,  and physiological phenomena—
  The character and extent of physiological and pathological investigations established by
  the relations of man to the exterior universe  ......     pp. 7—49

                             CHAPTER   II.

THE EXTENT, OBJECTS, AND IMPERFECTIONS OF PATHOLOGICAL INVESTIGATIONS.
                                                                       pp. 50—To

                             CHAPTER  III.

                                    THE BLOOD.
Imperfect state of our knowledge of this fluid—Imperfections in the methods of analysis—
  Importance  and difficulty of establishing  a standard formula of the composition of the
  blood in health—The composition of the blood varies not only with the class, but with
  each species of animals, and corresponds with the development of the organs and appa-
  ratus ;  illustrated by the development of the blood and organs of invertebrate and
  vertebrate animals—Standard of Lehmann, and of  Becquerel and Rodier—Importance
  of determining the changes of the blood during thirst and starvation—Importance and
  difficulty of determining the  amount of blood in the  system   .    .     .    pp.75—87

                             CHAPTER  IV.

                    CHANGES  OF  THE BLOOD IN MALARIAL FEVER.

Difficulties of the investigation—Color of the blood and serum in malarial fever—Specific
  gravities and coagulation of the blood in  malarial fever and other  diseases—Fibrin
  decreases  in malarial fever—Formation of heart-clots in congestive fever during life—
  Occurrence of heart-clots in other diseases—Conditions most favorable to the  deposition
  of fibrinous concretions—Symptoms  and diagnosis of fibrinous concretions in the heart
  and bloodvessels—Perilous effects resulting from the detachment of fibrinous concretions
  Imperfect state of knowledge, with reference to the formation of fibrinous concretions in
  the living body—Cause of the coagulation of the blood unknown—Principles of treatment
  best adapted to prevent the  formation of fibrinous concretions in malarial fever—Phy-
  sical and chemical changes of the constituents of the blood in malarial  fever—Illustra-
  tive cases—Relations of the cerebro-spinal and sympathetic nervous  systems to the
  changes of the blood and organs  in malarial fever—Gangrenous  erosion  of cheek follow-
  ing  malarial fever—Comparison  of the changes of the blood in malarial fever with the 
6
CONTENTS.
  changes in marsh cachexia—Mechanical dropsy—Acute dropsy—Cachectic  dropsies—
  Alterations of the colored blood-corpuscles in malarial fever—Principles  of treatment
  suggested by the changes of the blood in  malarial fever—Effects of bloodletting—Of
  excessive purgation—Of  nutritious diet and  stimulants—Of phosphates—Of pepsin—
  Determination of the place of the destruction of the colored blood-corpuscles in malarial
  fever—Constitution of the blood in various diseases, in typhoid, typhus, and ephemeral
  fevers—In smallpox,  scarlatina, measles,  scurvy, erysipelas,  cholera, phthisis, scrofula,
  carcinoma, Bright's disease, chlorosis, anemia, rheumatism, puerperal fever, pneumonia,
  peritonitis, angina tonsillaris,  bronchitis, carditis, pericarditis, inflammation of brain,
  glanders, lead-poisoning—The  colored blood-corpuscles are more  uniformly and  rapidly
  destroyed in severe cases of malarial fever than in any other acute disease—Diminution
  of fibrin in malarial fever corresponds to the severity  of the disease—Discussion of the
  question, Do these changes of the blood precede,  or succeed,  or are they simultaneously
  with, the aberration  of the physical, chemical, vital, and nervous phenomena, denomi-
  nated fever?   ............pp. 88—216


                             CHAPTER  V.

CHANGES OF THE ORGANS, AND TISSUES, AND  APPARATUS  OF THE BODIES  OF  THOSE
  WHO HAVE DIED WITH THE DIFFERENT TYPES OF  MALARIAL FEVER, INTERMITTENT,
  REMITTENT, AND CONGESTIVE--COMPARISON  OF THESE CHANGES WITH  THE  PHENO-
  MENA  OF  MALARIAL FEVER AND WITH  SIMILAR CHANGES IN OTHER DISEASES, AND
  WITH THE  ORGANS, TISSUES, AND APPARATUS OF MEN AND ANIMALS IN THE NORMAL
  CONDITION.
Exterior—Muscular  system—Cerebro-spinal  nervous  system—Dura   mater,  arachnoid
  membrane, pia mater, cerebrum, cerebellum, medulla oblongata, ventricles of brain
  —Cerebro-spinal  fluid—Nervous  phenomena  of  malarial fever   compared  with post-
  mortem examinations—Causes of aberrated nervous  phenomena in malarial  fever—
  Theory expressing the  relations of the physical, chemical, and nervous phenomena  of
  malarial fever—Malarial fever  paroxysmal,  not because the action of the cerebro-spinal
  or of the sympathetic nervous  system  is paroxysmal—Explanation of the paroxysmal
  character of malarial  fever—Lungs—Heart—Alimentary canal—Tongue—Stomach—
  Intestinal canal—Liver—Weight of liver in malarial fever—Post-mortem examinations
  illustrating the changes of the color of the liver in malarial fever—Effects of previous
  pathological alterations upon the color—Changes of the color of the blood in  the liver of
  malarial  fever—Sources  of  the change of color  in the  liver during malarial  fever—
  Character of the bile  in malarial fever—The liver of those cases which died in the active
  stages  of malarial fever contained animal starch, whilst hepatic sugar was absent—Points
  of difference  between the malarial fever and  yellow  fever  liver—Spleen, pathological
  alterations of, in malarial fever—Pancreas—Kidneys     ....   pp. 216__271


                             CHAPTER  VI.

CIRCULATION, RESPIRATION, TEMPERATURE, STATE OF THE SKIN, TONGUE, AND CHANGES
  OF THE URINE IN INTERMITTENT, REMITTENT, AND CONGESTIVF FEVER__PRINCIPLES
  OF TREATMENT  BASED  UPON THESE OBSERVATIONS--ILLUSTRATED  BY  NUMEROUS
  CASES.

Importance of determining the pulse, respiration, temperature, and changes of the urine
  in health and disease—Variations of the pulse, respiration, and temperature  of different
  individuals and races—Intermittent fever—Cold stage—Illustrative cases__Phenomena
  of hot stage  and  period of intermission—Illustrative cases—Appearance of tongue__
  Characters of urine—Phenomena of remittent and congestive fever, with numerous illus-
  trative cases—Comparative view of the phenomena of intermittent,  remittent and con-
  gestive fevers............pp. 271—407 
OBSERVATIONS ON  SOME OF  THE PHYSICAL, CHE-
     MICAL,  PHYSIOLOGICAL,  AND  PATHOLOGICAL
     PHENOMENA OF MALARIAL FEYER.
                      CHAPTEE  I.

RELATIONS OF MAN TO THE EXTERIOR UNIVERSE—RELATIONS OF ASTRONO-
  MICAL, TERRESTRIAL, PHYSICAL, CHEMICAL, AND PHYSIOLOGICAL PHENO-
  MENA—THE CHARACTER AND EXTENT OF PHYSIOLOGICAL AND PATHOLO-
  GICAL INVESTIGATIONS  ESTABLISHED  BY THE RELATIONS OF MAN TO THE
  EXTERIOR UNIVERSE.

  The object of this chapter is to sketch the mutual relations of
celestial and terrestrial bodies and animated beings, and demon-
strate—that the existence of man is absolutely dependent upon the
relations of the component  members of the universe—that a single
alteration  in the chain  of phenomena would  destroy the conditions
necessary  for the existence  and manifestation of the phenomena of
man—that the forces of man are all resultants of the forces of the
sun and fixed stars, which  keep up a never  ending circulation and
change of matter upon the surface  of our globe—that man cannot
create or annihilate force any more  than he can create or annihilate
matter—that the great law of the Indestructibility of  Force, of
Action, and  Reaction, applies to all the  phenomena of man—that
man is a type of the universe, and comprehends within himself all
phenomena,  astronomical,  physical, chemical, physiological,  and
psychological—that the  knowledge of the  structure,  phenomena,
and relations of man includes a knowledge  of all science, whether
relating to matter or  mind.  The  end of the whole investigation
will be the establishment of the true character and extent of phy-
siological and pathological investigations.
  In this inquiry we will examine first the general or simple phe-
nomena, and lastly the particular or complex.
  There are certain phenomena, as  gravity, which affect all bodies,
and  at the same time  appear to be wholly  independent, in  their 
8
OBSERVATIONS ON
 existence and manifestation, of all  other phenomena.  These phe-
 nomena have been called1 general or simple, because  they appear
 to  be not only independent in their  own  existence of all  other
 phenomena, but they form the foundation of the manifestation and
 conditions of the existence of all other phenomena.
   We have another class of phenomena which are confined to cer-
 tain forms of matter, and whose existence and manifestation depend
 upon definite circumstances and  the pre-existence  of  the  general
 phenomena.  These phenomena are called complex or particular.
 Thus the law of gravity, which (so far  as our means of observation
 extend) affects  every molecule of matter throughout the universe,
 is an instance of a general phenomenon;  whilst physiological  phe-
 nomena, which  are manifested by only a comparatively small  num-
 ber of bodies, are instances of complex or particular phenomena.
  General phenomena are wholly  independent of the particular
 or complicated; whilst the particular or complicated are dependent
 upon the general, and cannot exist without them.  Thus, we cannot
 conceive of matter without weight,  but we do conceive and know
 of the existence of matter in a state of perfect freedom from the
 manifestation of physiological phenomena.  It is evident that  if we
 wish to understand  the complex phenomena, we must  analyze the
 component phenomena, and examine first the most general, which
 form the foundations of  the existence and  manifestation of the
 restricted or complex.
  Man  stands upon  the  summit  of a  pyramid, the foundation  of
 which is the inorganic  world, and the materials composing this
 pyramid consist:  first, of plants in various stages of development,
 the simple extending  downwards, the more complicated extending
 upwards, diminishing in  numbers as they increase  in complexity
 and, secondly, of animals  in various  stages of development, increas-
 ing in complexity and diminishing in numbers as they  extend
 upwards.  To understand the  physical and physiological constitu-
 tion of man, we must commence  at the base of the pyramid and
 examine successively  all the elements, with their properties forces
 and constitution—we must examine the relations of the individual
 elements to each other and to the  universe.

  1 That the true principles of  the classification of the phenomena of the universe
 were recognized by the ancients, as well  as by the moderns, is demonstrated by
the fact that the historical development and classification of the sciences correspond
with the logical classification.  The principles of classification and the relations of
the  sciences have been discussed in a masterly manner by Auguste Comte  in his
 Positive Philosophy. 
MALARIAL  FEVER.
9
  Upon the present occasion we can do nothing more than present
a general outline of this immense subject, for  the complete know-
ledge  of the intellectual  and  moral  constitution  of  man alone
requires the knowledge of the relations of the moral and intel-
lectual faculties of man to the material  structures by  which they
are surrounded—requires  the knowledge of the relations of  the
moral and intellectual faculties to  the  physical,  chemical, vital,
muscular, and  nervous forces—requires  the  knowledge of  the
nature, origin, and development of all science—requires the know-
ledge  of the constitution, and phenomena, and progress of  the
moral and intellectual faculties as revealed in all history, scientific,
civil, and religious, past and present.
   If it be admitted that the art of medicine will attain to the rank
of a science only when its relations with all the branches of know-
ledge are recognized and demonstrated, it must also  be admitted
that the present attempt to establish a standard for physiological
and pathological investigations  by  the  presentation  of a  general
view of the relations of man to the exterior universe, incomplete
and imperfect though it be, is an effort in the right direction.
   In the survey of the universe all  natural  phenomena have been
 divided into two great classes, celestial and terrestrial.
   Astronomical phenomena  affect all  bodies, whether  they  belong
 to this world or to the universe, and at the same time they may be
 said to be independent of all others.  All bodies attract each other,
 in direct proportion to their masses, and  in inverse proportion to
 the squares of their distances—this law, which is the sublimest of
 all generalizations, and the foundation of the science of astronomy,
 affects all  bodies,  inorganic and organic, inanimate and animate.
 The researches of astronomers are constantly enlarging our con-
 ceptions of the wide reign of the law of gravity.  In  every one of
 those wonderful binary systems of stars,1 which have been suffi-

   1 The number of double stars (those both optically and physically double)
 observed by Sir William Herschel (1776—1804) ; by Otto Struve in Pulkowa
 (from 1813 to 1842) ; by Sir John Herschel (from 1819 to 1838) ; by Bessel; by
 Argelander at Abo (1827—1835) ; by Encke and Galle at Berlin. (1836 and 1839) ;
 by Preuss and Otto Struve in Pulkowa (since the catalogue of 1837) ; by Madler
 in Dopart; by Mitchell in Cincinnati, U. S.; and by several other astronomers-
 may be estimated, with some certainty, at 6,000.  The number of the double stars,
 the elements of whose orbits it has been possible  to determine, is stated at present
 to be  16. History of the Royal Society, vol. iii., 1757, p. 225. An Inquiry into
 the Probable Parallax and Magnitude of the Fixed Stars, from the Quantity of Light
 which they afford us, by the Rev. John Mitchell, Philos. Trans., vol. lvii. pp. 234
        2 
10
OBSERVATIONS  ON
ciently examined, the two systems are found to obey unswervingly
Kepler's two laws, from which, by Newton's process, we infer that
these  grand orbs  are held together  by the force of gravity.   The
vast ocean  of space and matter  under the  dominion of the force
of gravity,  even  supposing it to be limited  to these double  suns,
revolving around their common  centres  of gravity, is  beyond  all
comprehension, for  the  light from  many of these  systems has to
travel years and even centuries1 before reaching our globe.  A faint
—261.  Outlines  of Astronomy, by Sir John F. W. Herschel, Philadelphia, 1855,
p. 475.  Popular  Astronomy, by Francis Arago, London, 1855, pp. 288—317.  The
Architecture of the Heavens, by J. P. Nichol, LL. D., London, 1851, pp. 165—268.
Cosmos, a Sketch of a Physical Description of the Universe, by Alexander Von
Humboldt, trans, by  E. C. Otte, London, 1851, vol. i. pp. 136—139, vol. iii. pp.
271—289.
  1  Nichol's Architecture of the Heavens, p. 13.
          Distances of the various orders of stars from our solar sphere.
                                                        Number of years
                                                        occupied by light
                                                       in traversing those
                                                           distances.
                                                             19.6
Apparent magnitudes.
 Distances of the exterior
limit of the various orders
 expressed in radii of the
     earth's orbit.
1,246,000
 33.3
 49.7
 69.0
 96.6
137.9
224.5
386.3
586.7
                                        2,111,000
                                        3,151,000
                                        4,375,000
                                        6,121,000
                                        8,746,000
                                       14,230,000
                                       24,490,000
                                       37,200,000
  According to astronomers the light of the most distant stars requires not merely
centuries, but thousands of years to reach our globe.  Our conception of the extent
of the reign of the law of gravity is farther widened when we consider not only
the immense  distances of the stars from  our earth, but also the immense orbits
described by these double stars  around  their common  centre of gravity, and
especially the immense periods of time required for the completion of a single
revolution.
  The following table, illustrating the periods of  revolution of these double stars,
has been selected from Madler's extensive  list:—
                                                       Period of revolution
          Stars.                                              in years.
210 Herculis					131
£ Bootis .					435
49 Cephi					466
t Hydrse					584
1 Leonis					561
42 Ceti					696
1 Cassiopeise, 1 pair					1,065
" 2 pair					2,785
y Leonis					1,342
 
MALARIAL  FEVER.
11
eonception of the immensity of the distance may be formed, when we
reflect that light passes over 191,515 English  miles in one second.
The grand march of our sun, with his attendant planets, through
the great ocean of space, at the annual rate of  154,185,000 miles,1
around a distant unknown centre, supports  still more strongly the
conclusion, that all the particles of  matter  in  the universe  are mu-
tually related.  Without this fixed relation of  all the individual
and component molecules of the universe,  matter could not exist
in  its present condition.  Destroy the mutual attraction of bodies,
and the essential conditions for  the existence of the universe will
be destroyed.  The existence of this law is independent of all others,
and of every form, property, and  affection of matter; whilst all the
properties and affections of the various forms of matter, inorganic
or organic, depend ultimately upon the existence of this fixed rela-
tion of the molecules of matter.  If our sun  with his planets were
blotted out of existence, this fixed relation of the remaining mole-
cules  of matter  would not be  destroyed.   If sun after sun, and
system after system, were blotted out of existence, it is reasonable
 to believe that this law would  not be destroyed as  long as  two
 atoms of  matter  remained.
    The atoms of  matter are bound together by a force which  acts
 only at insensible distances, called the force of cohesion.  It has
 been  announced  by some philosophers that the force of cohesion is
 nothing more than the force of gravity, acting between the indivi-
 dual atoms of bodies, at exceedingly small distances.   Be this as it
			'eriod of revolution
Stars. in years.			
y Ceti ...... 1,478			
a. Piscium			2,928
f Coronae			3,542
^ Cassiopeiae			5,468
Polaris			6,069
£ Ursae Majoris .			7,659
y Andromedae .			10,376
  The periods occupied by the motions of sun around sun are exceedingly various,
some occupying but a brief and rapid cycle of fifteen or sixteen years, and others
occupying thousands ; whilst in others the  changes are so slow that they are
almost imperceptible, and betoken circuits of immense spaciousness and duration.
  1 J. F. W. Herschel's Outlines of Astronomy, p. 494.  Arago's Popular Astro-
nomy, p. 363.  Bessel in Schum, Jahrb. fiir 1839, s. 51.  Arago in  the Annuaire,
1842, pp. 388—399.  Argelander, On the Proper Motion of the Solar System, 1837,
s. 43.  Otto Struve in the Bull, de 1'Acad. de St. Petersb., 1842, t. x., No. 9, pp.
137—139.  Nichol's Architecture of the Heavens, p. 242.  Humboldt's Cosmos,
vol. i. p. 134. 
12
OBSERVATIONS  ON
 may, it is evident that if matter be deprived of these two forces
 of cohesion and gravitation, its properties of form, color, porosity,
 compressibility, dilatability,  and elasticity, would cease to  exist,
 and  the manifestation of its peculiar affections or motions, as heat,
 light, electricity, and  magnetism, would be impossible.   Without
 these properties of matter no organized plant or  animal could exist
 in any portion of the universe, constructed upon the same plan with
 those of our globe.
  When we turn our eyes from a general survey of the universe
 to our own system, we discover that its present state depends abso-
 lutely upon the mutual relations of its component parts.
  Mathematicians, reasoning  upon the  necessary results of the law
 of gravity in producing mutual disturbances in the motions of  the
 planetary bodies, came to the  conclusion that our system contained
 within itself the elements  of its  destruction.  They thought that
 they  could  demonstrate that derangement  must ensue  from  the
 mutual action of the heavenly bodies upon each other—they thought
 that  they could calculate its progress with the  utmost exactness,
 and  predict the time when the whole  system would be  destroyed
 by the action of the law of gravity, which, when first discovered,
 appeared to be the great principle of  motion and  stability.  The
fallacies of these calculations  and falsity of these prophecies have
 been exposed by the sublime discoveries of Lagrange and Laplace,
 which have shown that the relative  distances, sizes, orbits, and
 periods of revolution of the planets are so nicely adjusted that  the
 mutual perturbations  counterbalance  each  other, so that, amidst
 numberless  conflicting, disturbing, destructive  influences, unity,
 harmony, and stability result.
  The order and harmony of our system give unmistakable evidence
 of the working of one great  omnipotent mind.  The plan  of each
 planet is the. type  of the  whole  system.   Thus,  all  the  planets
 revolve around the sun in the same direction, from west  to east,
 which is the direction of the rotation of the sun on his axis;  all
 the planets rotate on their axes also in the  same direction, all  the
 satellites move around the primaries  in the same  direction, and
 almost all the planets and satellites move around the sun in nearly
 the planes of the sun's equator. From these arrangements it results
 that  they all have the succession of day and night, and vicissitudes
 of the seasons.  As far as the observations of  astronomers have
 extended, it appears that the planets are constructed and arranged
 upon the same plan with our  earth.  The surface of one is diversi- 
MALARIAL FEVER.
13
fied with mountains, valleys, and plains—another is surrounded by
an atmosphere apparently having analogous motions (trade-winds)
to those of our own atmosphere—the surface of the red colored
Mars is  divided into  green seas and red continents, and as  his
winter advances a white color spreads over his northern regions,
and as summer approaches this whiteness disappears, thus showing
that a fluid exists upon his surface, which, like water, is congealed
by  cold, and  dissipated by heat—and many  of them have  their
satellites, which, like  our  own  moon, rule  the  night.  It is  not
reasonable  to  suppose that  the  blazing sun should shine by day,
and the gentle satellites by night, upon mere dead masses of matter
moving forever silently and fruitlessly through space.  These  beau-
tiful  arrangements force upon us the belief that the members of
our solar  system are inhabited  by beings,  which, probably, from
the very arrangements themselves, are analogous to those inhabiting
our globe.1   If they be inhabited  by similar beings,  the existence
of these inhabitants must depend absolutely upon the mutual rela-
tions of the component members of the system.
   The truth  of this  assertion  is  evident when  we  consider  the
relations of the organized beings inhabiting our globe to the size,
density, and structure of  the earth, and to its relations  with  the
sun and all other members of our  system.
   The plants and animals of our globe have all been constructed
 with exact reference to its structure, its mass, its power of gravity,
 and  the forces of the sun  and sister planets.  If the mass,  and
 density, and force of gravity of our earth were increased, the density
 of the atmosphere would  be  correspondingly increased, and  the
 respiration and circulation of animals and plants would be greatly
 interfered with, if  not completely arrested—the rise of the sap in
 plants, which  is due to the physical force of endosmose, which in
 this case acts antagonistically to gravity, would be counterbalanced
 and  completely checked, and the  elaboration of the sap, and  the
 nutrition and growth of plants, absolutely prevented—the  muscular
 strength of animals would be inadequate to the continued support
 and  active movement of their bodies; the  swiftest animals would
 crawl like sloths;  and the once active and energetic  lords of crea-
 tion, instead  of directing  and  controlling  the  powers of nature,

   1 " Discourses on the Christian Revelation viewed in connection with the  Modern
 Astronomy," by Thomas Chalmers. "The Plurality of Worlds." "More  Worlds
 than One," by Sir David Brewster. " The Unity of Worlds and of Nature," by the
 Rev. Baden Powell. 
14
OBSERVATIONS  ON
would drag out miserable existences, moving as  if under heavy
burdens, exhausted by the slightest mechanical effort.  On the other
hand, if the mass  and force of gravity of our planet were greatly
diminished,  the atmosphere  would  be correspondingly  rarified—
the respiration, and circulation, and  nutrition of animals and plants
disturbed—the development  of their physical and chemical forces
retarded and disturbed,  and  their situation and  motions rendered
unstable.1
   The  relations of the  moon with  our  earth are of the most im-
portant  character.  Her influence  is not  confined  to ruling the
night, lighting the mariner  and  traveller,  and  exciting  joy in the
hearts of all by her soft and silvery beams.   The  weight of the
moon and her distance from  the earth have been appointed by the
great Architect with exact reference to the size and density of our
globe, its distance from  the  sun, its relations with  other planets,
and the constitution of its atmosphere and  crust, and the structure,
forces, and wants  of  plants and animals.2
   The distance of the earth  from the sun  has been arranged  with
exact reference to the structure of the surface, and the constitution
and preservation  of its  organized  beings.   Were the distance of
the earth from the sun  increased or diminished, or  the inclination
of the plane of its  orbit increased, or the  nearly circular  orbit
rendered as  eccentric as the orbit  of a comet, the  alternations of
seasons, the  climate, and  constitution  of  many bodies  upon the

   1 " Astronomy and  General  Physics considered with reference to Natural  Theo-
logy," by Rev. William Whewell, D. D.
   2 If the moon had been placed much nearer the earth, or had been much  larger
than it is, the  tides  of the oceans would  have run so high that large tracts of
land would have been uninhabitable, and  navigation rendered dangerous,  if  not
impossible.
   We may form some idea of the  influence of the moon upon this earth, by con-
 sidering the fact, that, owing to its proximity to the earth, the agency of the moon
 in producing tides in  the waters of the  oceans, and  in  the atmosphere, is from 2^
 to 2^ times greater than that of the sun.
   The rise of the tide not only aids greatly navigation, by its repeated flow into
 numerous harbors, rivers, and creeks, which would, on account of their shallow-
 ness, be  useless for  the purpose  of navigation, but it also diffuses the  saline
 ingredients of the oceans, washed from  the strata at their sides and bottom, and
 from the continents through  which the  rivers flow, and thus maintains the  purity
 and uniformity of the waters.  Without this perpetual agitation, it is probable
 that the waters of the oceans would become unfit for animal and vegetable life.
   The attraction of the sun  and moon  produces corresponding tides in the great
 ocean of gaseous matter surrounding our globe.  These motions in the atmosphere
 must, without doubt, exert decided influences upon  organized beings. 
MALARIAL  FEVER.
15
surface of our  globe,  would be  greatly altered, and  the chemistry
of organized beings deranged.   The sun is a  great  centre of che-
mical as well  as of physical  influences, and should  he be  blotted
out of existence, or if the intensity of these chemical and physical
influences be lessened or increased, either  by an actual diminution
or by a  change  of  the distance from the  sun  to the  earth, not  a
vegetable or  animal could exist upon this  globe, because the sun's
heat and chemical  influences are  absolutely indispensable to the
growth and existence of plants.   If  vegetation  be destroyed, as a
necessary consequence  all animal  life, with its chemical composi-
tions and decompositions, must cease,  because animals,  whether
herbivorous,  or  carnivorous, or omnivorous, derive  the  materials
for the nutrition of their structures, and  the development of the
> forces which work their machinery, ultimately  from vegetables.
    The sun, and all the countless fixed stars of the material universe,
 are the sources of the  heat which  preserves matter  in its  present
 conditions upon  the face  of our globe,  and supplies the essential
 conditions for the existence of organized beings.1

   1 The states of matter, solid, fluid, and  gaseous, are relative and not absolute.
 The existence of matter in one or the other of these states depends upon the forces
 acting upon the atoms.  The atoms of matter are not in immediate contact with
 each other.  The distance of the atoms from each other, and the  stability of the
 matter which they form, depend upon the action of two antagonistic forces, cohesion
 and heat.   Heat corresponds to the repulsive centrifugal force, and cohesion to
 gravitation, the attractive centripetal force.  According to  this  view a particle of
 matter is a type of our solar system; it is composed of smaller bodies, held  in
 definite positions and accomplishing definite movements by two apparently antago-
 nistic forces.  In the solid state the attractive cohesive force is  stronger than the
 repulsive force of heat. In the fluid state, whilst the attractive force preponderates
 over the repulsive, the two are more nearly balanced, and the polarity of the particles
 is overcome, and they are  movable in all directions, and transmit forces equally
 in all directions.   In the gaseous state the repulsive force, heat, is stronger than
 the attractive cohesive force, and the particles have lost their polarity.  The exist-
 ence, then, of matter in one or the other of these states depends upon the tempera-
 ture.   As far as our means of observation extend it may be asserted that all the
 various forms of matter may be made to assume these states  successively by a
 variation of the temperature.   Thus, the metals are solids at ordinary tempera-
 tures.  When heat is applied they become fluid, and if the heat be continued they   *
 become gaseous.  Many of the gases have  been reduced first to fluids, and secondly
 to solids, under a reduction of temperature and increased pressure.
    One of the essential conditions of all animals and vegetables is that they possess
 a  large amount of fluid.   Without this  fluid the  important acts of circulation,
 nutrition, secretion, and excretion, and the preservation  of a definite form during
 unceasing chemical compositions and decompositions, could not be maintained.
 If animals and vegetables be deprived of fluid, all motions amongst the individual
 molecules must cease. 
16
OBSERVATIONS  ON
      The fixed stars, although analogous  to our sun, are at  so great
   distances that it seems unreasonable to  attribute to them any influ-
   ence over  the changes  going  on upon the surface  of our globe.
   When, however, we consider that scarcely a line can be projected
   into  space  from  any point  upon  our  globe  without eventually
   striking one of these suns—when we consider  that  in some places
   many thousands appear  to be gathered into a space no greater than
   that occupied by the  disk of the full moon, it  will be no longer a
   matter of surprise that they should exert a decided influence upon
   the temperature of our globe.
      M. Pouillet,1 from an  elaborate series of experiments upon solar
   and stellar  heat, finished in 1838, drew the following  remarkable
   conclusions:—
      1.  That  the actual  temperature of space in which the earth and
   planets move lies between —175° and —283° Fahr.
      2.  That the sun supplies the  earth annually with as much heat as
   would melt a layer of ice 100 feet thick, covering the entire globe.
      3.  That the fixed stars supply as much heat as would melt a layer
   of ice 85 feet thick, covering the whole globe.
      According to this calculation, the solar  heat  alone constitutes
   only two-thirds of the entire quantity of heat supplied to the earth,
   to repair its losses by radiation into space.   If this calculation  be
   true,2 it is evident  that  if the  heat  supplied by the  fixed  stars  be

     1 Memoir on the Solar Heat, on the Radiating and Absorbing Powers of the
   Atmospheric Air, and on the Temperature of Space, by M. Pouillet, Member of the
   Royal Academy of Sciences of Paris, Professor of Natural Philosophy in the Faculty
   of Sciences, &c.  Comptes Rendus des Seances de l'Academie des Sciences, July 9,
   1838.   See Translation in Taylor's Scientific Memoirs, 1846, vol. iv., article  iii.
   pp. 44—90.
     2 Whether these conclusions of Pouillet be true or false, they are sustained by
   the researches of the best observers, in that they agree in assigning to the regions
   of space a definite  temperature.  Thus, Fourier,* from a  careful series of investi-
   gations, estimates the temperature of space at from —58° to —76° ; Arago,f from
   polar observations, at —70°,  and Pictet at —76° ; Saigey, from 367 observations
   made by Humboldt in the chain of the Andes and  in Mexico, at —85°, and from
   thermometrical measurements at Mount Blanc and during the aeronautic ascent of
*  Gay-Lussac, at —107 ; Sir John HerschelJ at —132, and Poisson§ at only 8°. 6.
     * Thgorie Analytique de la Chaleur, 1822, p. ix.  (Annales de Chimie et de Physique, torn, iii.,
   1816, p. 350; torn, iv., 1817, p. 128; torn, vi., 1817, p. 259; torn, xiii., 1820, p. 418.)
     f Arago, Sur la temperature du pole et des espaces celestes, Annuaire du Bureau des Long, pour
   1825, p. 189, et pour 1834, p. 192 ; also Saigey,  Physique du Globe, 1S32, pp. 60—76.
     + Edinburgh Review, vol. 87, 1848, p. 223.
     § Poisson, Th6orie Mathematique de la Chaleur (§ 196, p. 436, § 200, p. 447, and § 228, p. 521, § 227,
   p. 520).  See Analysis of the Mathematical Theory of Heat, by S. D. Poisson, in Taylor's Scientific
   Memoirs, vol. i., article vi., 1837, p. 122. 
MALARIAL FEVER.                    17
withdrawn, the physical structure of the surface of our globe would
be changed, the greatest portion of the ocean would become a crys-
talline mass, and all animals and plants would be destroyed.
  These  results of  Pouillet,  considered in  connection with  the
grand march of our sun, with his attendant planets, through space,
throw much light upon  those wonderful  geological revolutions
which show that regions now covered with ice and snow were once
covered with  the rank vegetation of the tropics.  It has been sup-
posed with reason  that our system, in its majestic travels through
the great ocean of space, has swept into the blazing heat and light
of some  of those  splendid suns.   At  such a period there would
have been a grand illumination and distribution of heat from pole
to pole, and  the icebergs, and  glaciers, and snow of polar regions
would be succeeded by the luxuriant vegetation of the tropics.
   It is evident that  if the rays of the sun  and stars possessed no
heat, or  if the distance  from the earth to  the  sun was greatly
increased, or the stellar radiation greatly diminished, all  the various
forms of matter would be reduced  to  one form, the  solid, and as
a necessary  consequence all  vegetable and animal life would be
destroyed.  The solid state is as essential to the existence of organ-
ized beings as the fluid  state.  If the distance from the earth to
the  sun was greatly diminished, the  heat would be correspondingly
increased, and all solid bodies would be reduced to fluids, and, if
the  heat be sufficiently intense, to  gases—the whole structure of
organized beings would be deranged, because the solid materials,
which give individuality to the structures, the organs, tissues,  and
apparatus of plants and animals, would be transformed into unstable
fluids.
   All the motions in  the atmosphere, and  in the water, and upon
the  land, are resultants of the combined actions of the  sun and fixed
stars, and the forces of matter composing the globe.  An alteration
of the intensity or direction of one or the other class  of forces,  will
necessarily be attended by a corresponding alteration of the struc-
tures and motions of inorganic and organic bodies.1

   1 The truth of these propositions can be readily established by the consideration
of the most important properties and motions of the gases, fluids, and solids of our
globe, and  their relations to animated beings.             *:
   The atmosphere, like  all gases, is capable  of indefinite  expansion  under a
diminution of pressure or increase of heat, and of indefinite contraction under an
increase of pressure or diminution of heat. It is perfectly elastic, and the particles 
18
OBSERVATIONS ON
   Upon the property of bodies to expand when under the influence
of heat, and to contract when deprived of heat; and upon the pro-
perty of light gases  and fluids to ascend through the more dense;
upon the rapidity and direction of the earth's revolution on its axis;
and upon the structure of the earth's surface (the relations of land
and water with reference to the  absorption  and radiation of heat),
depend the motions in the atmosphere called the trade-winds and land
and sea-breezes, and the corresponding currents in the ocean.  If the
atmosphere and ocean had  been so constituted that currents were
not excited by heat, they would have been  stagnant, motionless—
the cool  sea-breezes, loaded with  moisture, which  in  the heat of
summer revive the  drooping vegetation, and at all seasons of the
year  waft the mariner's ship along, would never have existed—
the trade-winds, the great movers of commerce, would have been
unknown—mankind would have been confined to the continent on
which they were created, because the ocean would have been stag-
nant, without current, and navigation would have been impossible
—the surface of our globe would have been  a barren desert, sup-
porting trees only along the borders of the  ocean.
   The existence of animated beings is absolutely dependent upon
the constitution and mutual relations of the  atmosphere and watery
vapor,  and the supply of a definite amount  of heat.  The evapora-
tion of water continuously from the whole surface  of  the oceans,
lakes, rivers, continents, and islands,  and  the distribution  of  the
watery vapor through the atmosphere, require an immense expendi-
ture of mechanical force.1

are self-repellent as long as  they are acted upon by the mechanical force, heat.
The repellent force of the atoms of the atmosphere  and of all gases is nothing
more nor less than the heat of the sun.   Just in proportion as this is removed the
particles obey the attractive force and approach each  other, and it is probable that
if all the heat was removed the atmosphere and all gases would become as solid
as the framework of the continents and mountains.
   1 The spaces between the atoms of the atmosphere  are devoid of matter, and are
freely penetrable by the' atoms of other gases. When gases come in contact, a
process of rapid diffusion through the pores of each other takes place, and a uni-
form mixture is established.  Water, when changed  from the fluid to the gaseous
state, possesses all the properties of a gas, and rapidly diffuses itself through the
vacant spaces between the atoms of the atmosphere.  The amount of the watery
vapor varies with the intensity of the repellent force, heat.  ■ As long as the repel-
lent force, heat, acts with sufficient intensity to overcome the attractive force  of
the earth, the watery vapor  will manifest all the properties of the atmosphere.
The force which excites a motion in the atmosphere will excite a corresponding
motion in the watery vapor.  As the existence of the watery vapor depends upon 
MALARIAL  FEVER.
19
  The sun and the fixed  stars are  the sources of the  heat or
mechanical force  which  keeps  up a  never-ending  circulation of
water throughout the atmosphere and over the surface of our globe.
Some idea of the agency of heat in the phenomena of our globe
may be formed by taking the water which falls upon its surface as
an evidence of its mechanical power.  If we take 60 inches as the
average  annual amount of  water which falls in the form of rain,
dew, hail, and snow, upon the surface of  the earth, and 900 feet as
the average height from which it falls, then the work of the falling
water would equal 452 horse-powers upon each square  mile of the
earth's surface, and the work accomplished upon the whole surface
of  the  earth would equal  the  enormous  sum of 90,880,000,000
horse-powers.   If the united powers of all the steam engines of all
the nations of the  earth be estimated at seven millions of horse-
powers, then the work accomplished by the solar and stellar heat, in
merely evaporating and elevating the water from the surface of our
globe, would be 12,982 times greater than that which could be accom-
plished by all  the steam-engines of the  world, supposing  them to
work continually day and night.   The immense volumes of water
flowing in the rivers of the  earth existed first in the ocean, then in
the atmosphere in the form of vapor.  The mechanical power of the
water flowing in these  rivers may be taken as an index  of the force
which raised the water from the  surface of the  ocean, and trans-
ported it  across  immense continents.  It has been calculated that
the waters of the  river Niagara,  during their passage  over the
cataracts and falls,  exert a  mechanical power equal to  12J million
horse-powers.   The mechanical power of the Niagara Eiver alone,
is greater than that of all  the steam-engines of  the world.   The

the supply of a definite amount of heat, it is evident that its existence is  condi-
tional, limited, whilst that of the atmosphere is stable, unconditioned,  during all
the changes of temperature with which man is conversant.  Whenever the repel-
lent force is so diminished that it is unable to overcome the attractive force be-
tween the atoms, the vapor is transformed  into water, and is deposited in the form
of rain, dew, mist, snow, and hail.
  The conversion of water into vapor is accomplished by the expenditure of an
immense amount of heat, which may be stated in round numbers to be one thou-
sand degrees.  This heat has no effect upon the thermometer, because it has been
transformed into mechanical force, and is occupied in keeping asunder the atoms
of water.  By the law of inertia  that force is  indestructible, and by the law that
action and reaction are always equal, this heat will be given out again when the
particles approach each other.  This being the case, we may say with  truth that
water requires for its evaporation an immense expenditure of mechanical force. 
20
OBSERVATIONS ON
 Niagara, in comparison  with  the  Mississippi, Amazon,  La Plata,
 Yenisei, Yang-Tse,  Nile, Hoan-Ho,  and many others,  is only  a
 modest, medium sized river.  After we have calculated the immense
 mechanical power of the mighty volumes of water flowing in  the
 fountains, brooks, torrents, streams, and rivers of the earth, we have
 formed but an imperfect idea of the effects upon our globe of  the
 two great forces, gravitation and heat, which influence all heavenly
 bodies, and work throughout the  entire  universe, for, according to
 the calculation of Pouillet, forty per cent, of heat is absorbed during
 its passage through the atmosphere, and  immense quantities  are
 expended in expanding and maintaining currents in the  ocean and
 atmosphere.
   The water elevated by heat, during its descent upon  the earth,
 and passage back to the  oceans from whence it came, dissolves and
 wears down  the solid mountains and continents.  The solid rocks
 are  disintegrated, the  mineral matters  are dissolved, stones and
 masses of rock are loosened from hill-sides, even the very mountain
 peaks are  undermined by the trickling  water, and  every fountain,
 every brook,  every  mountain torrent, and every river  transport
 these  materials,  and gradually fill  up  the  lakes,  and  seas, and
 oceans, and build up immense deltas  and islands.  This everlasting
 round of the waters, carried  on  by heat and gravitation, prepares
 the  surface of the barren  rocks for  the habitation of plants and
 animals, and tends to level every mountain and fill up  every  de-
 pression upon our globe.
   The structure of the crust of our  globe gives unmistakable
 evidence that in its early history it was a molten mass.  When  the
 surface cooled  it was composed of nothing but rocks and water,  a
 dead barren mass, studded with volcanoes and lofty rocks.   Geology
 teaches that at this time no plant or animal existed upon our globe.
 It wTas necessary that the solid barren rocks should be disintegrated,
 worn away, the inequalities of the surface filled up, and the crust
 of the earth covered by a loose, pulverized  soil, suitable for the
 habitation of plants  and animals.  This  was  accomplished by the
 circulation  of the water and air, under the action of heat and gravi-
 tation, which at the present day preserves the purity of  the ocean
 and  atmosphere, waters  the thirsty  earth,  supplies the  most im-
 portant elements of the structures of plants and animals, and clothes
 the surface of the earth  with  a luxuriant vegetation, which elabo-
 rates the materials for the formation and maintenance of all animals,
from the simple animalcule to the complicated organism of man. 
MALARIAL FEVER.
21
   The immense mountain  ranges and table lands, which influence,
 to a great extent, the climate of continents, and exert an effect upon
 the structure, and growth,  and  distribution  of plants and animals,
 and determine, in a great measure, the habits, occupations, and dis-
 eases of man, have all been elevated by those forces, which rocked
 our earth  in  its cradle,  raised up  the mountains, brought low the
 valleys, heaved  up  immense  continents, and divided the sea from
 the  main  land.1
   To the superficial observer, the  angry  strife between  the  great
 forces of heat and gravitation—the blazing volcanoes, belching forth
 burning lava, and  deluging the fertile valleys and plains with  a
 fier}'-  flood—the earthquakes, rocking  the  globe,  fracturing and
 rolling  up its  strata, heaving up immense  continents  from  the
 ocean's  bed, removing the pillars of broad tracts of land and plung-
 ing them  far into the bosom of the earth, would appear to be under
 the  guidance only of blind, mad fate, chained and struggling in the
 fiery bowels of the earth.  It is, however, true that even this fiery

   1 The irresistible energy of the force of heat is displayed  by the discharges  of
 gas, steam,  mud, and melted  lava from the craters of volcanoes, and by the earth-
 quakes which have caused our globe to tremble from pole to pole.  On the 19th  of
 November, 1822, an earthquake was  felt along the eastern coast of South America,
 for the space of 1200 miles from north to south. The whole country, from the foot
 of the Andes to a great distance under the sea, was elevated from two to seven
 feet.  One hundred  thousand square miles of land, an extent of country almost
 equal to the States of Georgia and Alabama, was elevated, at the lowest calculation,
 three feet.  According to the estimate of  Sir Charles  Lyell, the thickness of the
 rock between the surface of Chili and the subterranean foci of volcanic action may
 have been many miles in depth.  If the thickness be estimated at two miles, then
 the mass  elevated three feet was 200,000 cubic miles,  and equalled in weight 363
 million pyramids.
  The discharge of mud in one year by the river Ganges equals the weight of sixty
 pyramids.  It would require  17£ centuries before this  river could bear down from
 the continent into the sea a  mass equal to that gained by the South American
 continent during a single earthquake.
  In the great eruption of Skaptara Jokul, in Iceland, the volcano threw out a tor-
 rent of lava, which flowed down the sides of the mountain into the Skaptara River,
completely dried it  up, and not  only filled the channel of the river, which was
between high  rocks, and in many places from 400 to 600 feet in depth, but over-
flowed  to a  great extent the surrounding  country, expanded over wide alluvial
plains, and formed broad, burning lakes, fifteen miles in breadth, and one hundred
feet in depth.  The streams of lava were ninety miles in length, and from seven to
fifteen in breadth, and from 100 to 600 feet in depth. If we add to this the pumice,
sand, and ashes scattered not  only over the whole island, but  to a distance of 300
miles around, in such abundance  as to destroy the fisheries in the neighboring sea,
the whole  amount of matter ejected by the volcano would be millions of cubic yards. 
22
OBSERVATIONS  ON
strife is  under the guidance  of  an intelligence who brings unity
out of diversity and discord, harmony and order out of contending
forces and elements, life  and  fertility out of fire and  destruction.
Every earthquake which in past or present times has fractured and
dislocated the  solid strata of the earth, elevated the bed of  the
ocean, or depressed the  level of  the  continents—every volcano
which has poured forth the liquid contents of the interior of  the
earth—every flood which  has swept over the  ancient continents,
has contributed more or less to the formation of a suitable soil for
the maintenance of plants and animals, and the development of the
human race.
  The forms,  arrangements,  and distributions  of the terrestrial
masses, although the results of the action of the forces of heat and
gravitation, reveal a great design.
  Every form of matter is definitely related to every other form
of matter upon the face of the globe; and the combination of these
various relations, and actions, and reactions of terrestrial masses
form  the essential condition  for the manifestation of the great
designs of the Creator.
  It is a universal law that all the component parts of the universe
do  not have in themselves  the entire  aim  or reason of  their
existence.
  The history of nations has  been, in a great measure, determined
by the agency of heat and  gravity upon matter.   As man is com-
posed of inorganic elements, and governed by all the laws, physical,
chemical, and astronomical, which govern the exterior world, it
follows as a necessary consequence that  the peculiar constitution
and  relations of  the inorganic elements of the crust of our globe
must affect the physical  and  mental endowments of man.   The
solid portion of our globe is constructed for man just as the body
is made for the soul.  The physical and mental development of the
different races of mankind  has depended, in great measure, upon
the mutual relations of the solid and fluid  portions of our globe.
This has been demonstrated by a comparison of the physical  cha-
racters of the great continents  of our globe with the physical social
and intellectual development of their inhabitants.1

  1 "The continent of Africa is without any great rivers, peninsulas, and bays. It
is concentrated upon itself, and nowhere lets into its bosom the waters of the sea.
  " Africa  has a sea-coast of only 14,000 geographical miles, whilst it covers an
area of 8,720,000 square miles.
  " Africa  has only one mile of coast for 623 miles of surface. It is like a body 
MALARIAL  FEVER.
23
   The chemist, by decomposing, analyzing, and comparing together
the different forms of inorganic  and organic  matter, has  demon-
strated that the innumerable forms of matter, rocks, and  minerals,
plants and  animals of all colors and  shapes, result from the com-
binations of sixty-two simple bodies, which cannot be resolved into
any other elements.  These elementary bodies unite with each other
in definite quantities  by volume and weight, and each body has its
own  combining weight, which, together with the  manifestation of
the physical forces  during chemical combination, appear to  depend
upon  the size and arrangement of  the ultimate atoms.
   During the union of these elementary bodies the physical forces,
heat, light,  and electricity, are  manifested  in amount exactly cor-
responding  to  the number  and  arrangement of the  elementary
bodies combining.   Whilst  each  separate  substance has its  own
color, form, density,  gravity, cohesion, elasticity,  and its relations

without arms.  Its relations with other continents are few and imperfect.  It closes
itself against every influence from without.
   " Without large rivers, without harbors and bays, without peninsulas, it offers but
few facilities for commerce, the great  medium of the interchange of the  thoughts
of nations.
   " The intellect of the African, like the physical constitution of the continent on
which he lives, is shut  up to itself; it is circumscribed by definite boundaries ; it
is incapable of active relations with surrounding intellects.
   " Of  all the  continents, Eurdpe is the one whose forms of contour are most varied.
Its principal mass is deeply cut in all parts by the ocean and by inland seas, and
seems almost  on the point of resolving itself into peninsulas.  These peninsulas
themselves, as Greece, Scandinavia, repeat to infinity the phenomena of articulation
and indentation of coasts which are  characteristic  of the entire continent.  The
inland seas, and the portions of the ocean its outer limits inclose, form nearly half
its surface.  The line of its shores is thus carried to the extent of 17,200 miles, an
enormous proportion compared with its small size ; for it is 3,200 miles more than
the sea-coast of Africa,  which is, nevertheless, three times greater.
   "Europe enjoys one mile of coast for every 156 square miles of surface.  Thus,
it is the continent most open to the sea  for foreign connections, and at  the same
time it is the  richest in local and independent districts.
   " In  Europe we find the  greatest number of independent organized kingdoms, the
greatest variety of interests, and the  most continued and rapid intercourse.   For
2,000 years Asia has lost  the sceptre of power and civilization, and Europe stands
unquestionably the first of the civilizing continents.  Nowhere on the  surface of
our planet has the mind of man risen to a  sublimer height; nowhere has man
known so well how to subdue nature  and make her the instrument of  his intel-
ligence.
   " The nations of Europe, including the Anglo-American branch, represent not
only the highest intellectual growth which the human race has attained at any
epoch,  but they rule already every part of the globe, and are preparing to  push
their conquests farther still."—"The Earth and Man," by Arnold Guyot,  p. 30. 
24
OBSERVATIONS ON
to heat, electricity, magnetism,  light, and chemical affinity, still
these properties, and  the manifestation of these physical and che-
mical phenomena, are similar in  all bodies, differing in degree and
not in kind.
   In view of the recent discoveries of science, with reference to the
equivalents of the  physical forces, we believe that we are justified
in asserting that an equivalent of force is always given out during
the  combination of the  elementary  bodies corresponding  to that
required to separate those bodies from their compounds (overcome
the force which  united the dissimilar elements), whether that force
be exerted in the laboratory of the chemist by heat or by electricity,
or by bringing other chemical affinities into play;  or in the labora-
tories of plants  and animals, or  in the great  laboratory of nature,
by the  action of the heat and chemical forces of the sun.
   In the exertion of every force in the universe,  whether between
the  great worlds and systems of worlds, or between the atoms of
matter, inorganic and organized, whatever be the  origin, character,
or intensity  of  that force,  the great mechanical  law holds good.
Action and reaction are equal. The  physical and chemical motions,
or affections, or forces of matter, mechanical motion, heat, chemical
affinity, and electricity, are correlative;  that is, they can mutually
excite,  or be converted into each other.1   Whatever hypothesis we

   1 In the cells of  the galvanic battery we have a chemical action developing a
physical force or motion (electricity), which may be propagated from particle to
particle of an insulated wire, of any length ; and if the wires propagating the elec-
trical excitement be dipped in water or  any compound fluid, a chemical action will
be developed, the extent of which will  correspond with the chemical action going
on in the cells of the battery.
   If the bodies separated from each other by the electrical excitement be united,
an equivalent of force will be given out corresponding  to the force required to
produce their separation.  The force generated during their union may be applied
to the expansion of the water in the boiler of a steam-engine, and thus accomplish
mechanical effects.  Here we have chemical action developing electricity, and this
in turn developing chemical action, and the union of the products of that chemical
action giving out  an  amount of  force equivalent to that developed during  the
chemical changes in the cells of the battery.
   If the wires conducting the electrical excitement, instead of being immersed in
 a fluid, be united by a metal which is a bad conductor (or, in other words, retards
 the  passage of the electrical excitement), heat will be developed in amount cor-
 responding to the retardation of the electrical excitement.
   The development of heat by friction is considered by philosophers as the con-
 version of motion of masses into motion of the component atoms.  In the electrical
 machine we have the development or excitation of electricity by ordinary impeded 
MALARIAL FEVER.
25
adopt, whether of actual conversion, or of excitement of the different
forces—the  law of action  and reaction holds good as far as the
researches of philosophers have extended, because if there be not
an actual conversion of one force into another, it is always true
that the force exciting is diminished in an amount corresponding to
the excitement of the  second force.   The direction of a force may
be changed, it  may be subdivided and directed  in  so many direc-
tions, and assume so many different  modes of force or motion, as to
escape our observation, or it may  be held in abeyance by opposing
force, just as  the action of the steel spring is counterbalanced by
the force of gravity of a weight;  but it can no more be destroyed
than  matter.
   The  three  great fundamental  laws of  motion established  by
Kepler, Galileo, and Newton :—
   1.  A body at rest cannot of itself begin to move;  and a body in
motion cannot change its velocity nor its direction of motion with-
out the action of  some extraneous cause;  any body  impelled by  a
single force will move in a right line and with uniform velocity.
   2.  Independence or coexistence of motions leading to the com-
position of forces.
   3.  Constant equality of action  and  reaction;  one body moving
another body loses precisely as much  motion, in proportion to its
mass, as the body moved gains;  although applied by them to me-
chanical motions alone, are applicable to all the motions and forces,
astronomical or terrestrial, of the masses or atoms of inanimate and
animate bodies.
   The establishment of the truth  of these laws for all motions and
forces,  however excited, is necessarily followed by  the admission
that,  as far as the powers of finite beings extend, force is indestructi-
ble.  The store of force with which the Creator has endowed mat-
ter can neither be added to nor detracted from  by man, any more
than  he can add to or detract  from the store of matter.  Without
this mutual relation of all the different forces, without the conserva-
tion of force,  the universe would not be maintained in its present
condition.

motion.  Electricity may be generated also by the revolution of the keeper of a
magnet around the poles of the magnet.
  The action of the steam-engine, and of the locomotive apparatus of every animal,
demonstrates the correlation of chemical affinity, heat, and mechanical force.
        3 
26
OBSERVATIONS ON
   The application of these laws to physical  and chemical pheno-
mena, and  the  establishment of this wide generalization, has not
been the work of one mind alone,  but of many minds, in different
countries, often working entirely independent of each other.  The
human mind, from the earliest periods, endeavored to explain the
origin and order of  the universe, and discover  some general prin-
ciple or  origin of all things.   The early students of nature, the
founders of the ancient schools of philosophy, endeavored to divine,
at a single  glance, the whole import of the book of nature,  and dis-
cover the origin and principle of the universe.  The ancient Hin-
doos, Sabians, Chinese, Persians, and Egyptians worshipped deities
which were resolvable into the powers of nature, and were mytho-
logical personalities of the sun or solar fire.  Thales, Parmenides,
Archelaus, Democritus, Pythagoras, Hippocrates, and many other
ancient  philosophers, maintained the existence of an omnipresent
fiery asther, as the efficient and primary cause of motion throughout
the universe, by the  energy of which matter was reduced  to order
from chaos, and life infused and maintained in plants and  animals.
Notwithstanding the dimness and vagueness of  these cosmogonies,
which were better suited to the dim magnificence of poetry than to
exact science, the human  mind at the present  day adopts a view
of the physical universe which, if more exact, is certainly not more
grand.
   Whilst the ancient  philosophers  failed to establish the exact
relations of phenomena, because they neglected to a  great extent
experiment and analysis of phenomena, and did not form definite
and distinct ideas for each class of  facts, still their  general systems
and cosmogonies were based upon observation of nature, and were
partial expressions of great philosophic laws.   Thus the reference
of all motion and of all life  to the light and  heat  of  the sun, was
without doubt founded upon the actual observation of the relations
of the sun  to plants and animals, and corresponds to the teachings
of modern science, that  the  Creator has  constituted the  sun the
source of motion, sensation, and life upon our globe.
   Modern  science differs from ancient philosophy, in that it pene-
trates beyond general views, decomposes  the  phenomena into  its
component facts, and points out the separate forces of the sun and
terrestrial  masses, and the relations of these forces, to each other
and to the  different forms of matter, inanimate and animate.
   In the history  of the correlation of the physical forces,  we have 
MALARIAL FEVER.
27
a history of the origin and development of the  different depart-
ments of physical and chemical science.
  In mechanics and astronomy, the establishment by Archimedes
of the doctrine of the lever and some  important  properties of the
centre of gravity, and the fundamental propositions of hydrostatics
—the observation of the most striking phenomena—the formation
of the notion of a year and month, and the fixation of the year and
month and of the seasons—the invention of lunisolar years—the
observation of the most general phenomena presented by the con-
stellations and planets—the distribution of the places and motions
of the heavenly bodies by means of a celestial sphere with imaginary
lines drawn upon it—the promulgation of the doctrine of the globu-
lar form of the  earth by Anaximander, and the  demonstration  of
this doctrine by Aristotle—the erection of the dial by Anaximenes
and Anaximander—the attempt of Aristarchus to measure the dis-
tance of the sun as compared with that of the moon—the establish-
ment of the theory of epicycles and eccentrics by Hipparchus—the
exposition of the theory of epicycles and  eccentrics  and of the
observations and calculations which  were employed in order  to
apply this theory to the sun, moon, and planets, and the discovery  of
evection by Ptolemy—the formal  promulgation of the heliocentric
theory  by Copernicus — the application  of  the  telescope  to the
examination of  the heavenly bodies, the discovery of the satellites
of Jupiter and  of  the  ring of Saturn, and  the verification  of the
 Copernican theory with regard to the motion of  Venus-by Galileo
 —the establishment by Kepler of numerical and  geometrical laws
 connecting the distances, times, forces and velocities of the bodies
 which revolve about the  central  sun—the  revival of the idea of
pressure and the demonstration of the equilibrium of oblique forces,
which includes  the principle of the  composition of statical forces
by Stevinus—the establishment of the first  law of motion (a body
acted on by one force will move forever in  a straight  line with
uniform velocity), the  application in mechanical science  of the
 notion of accelerating force, the establishment of the second law of
 motion (curvilinear motions), and of  the  principle of virtual velo-
 cities, and  of the third law of motion, by Galileo—the confirmation
 of the laws of falling bodies, by the experiments  and reasonings of
 Gassendi, Fermat, Riccioli, and Grimaldi—the labors, experiments,
 reasonings  and generalizations of Bacon, Descartes, Castelli, Huy-
 ghens,  Hooke,  Halley,  Mersenne, Bernoulli, Hermann, Leibnitz,
 Euler, Clairaut, D'Alembert, Lagrange, Gassendi,  Borelli, and other 
 ^o                   OBSERVATIONS ON

 philosophers: all prepared  the way for the development of those
 facts and fixed relations or laws, which formed the great Newtonian
 induction  of  universal gravitation, expressive  of  the  truth that
 every particle of matter in  all times, places, and circumstances is
' definitely related to every other particle of matter in the universe,
 by one common law of attraction, which must be  pronounced, in
 whatever light  it  be viewed,  whether in the  immensity  of  the
 knowledge and  labor which it involved, or the extent and bearing
 of the truth which it discloses, as the greatest scientific discovery,
 as a  law which in  generality  and  profundity  and magnificence
 stands without a rival  and without even  a  comparison.   Whilst
 the facts which  most nearly concerned Newton in the  establish-
 ment of the law of gravitation,  were the facts of the planetary
 motions  as established  by Kepler, and of the moon's  motions as
 given by Tycho  Brahe and Horrox, it is nevertheless true that the
 facts  included in this law had been accumulating  from the very
foundation of astronomy, because it included every fact, discovery,
and law, and included in one vast  magnificent generalization the
immense detail of astronomical science.
   In  optics,  the experiments,  labors and reasonings  of Seneca,
Ptolemy, Archimedes, Euclid,  Alhazen, Yitello, Snell,  Gregory,
Descartes, De Dominis, Newton, Huyghens, Grimaldi, Biot, Arago,
Hooke, Young, Fresnel, Brewster, and others, have  resulted in the
establishment  of the undulatory  theory, which in its  simplicity
and universality bears the same relation to optics that  the law of
gravitation bears to astronomy.   Whether we consider light as an
undulation of a  thin all-pervading ether,  or of ordinary matter,
the conclusion is the  same, that it is a peculiar  kind of  motion or
mode of force, and  as such  bears a definite relation to the other
modes of force.  Thus Professor Faraday has  established the exist-
ence of a relation between light and magnetism, and the relations
of heat and light have been observed and studied by many inves-
tigators,  and modern investigations have demonstrated that  an
intimate relation  exists between light and chemical affinity.
   In acoustics, the labors and discoveries of Pythagoras Mersenne
Newton, Taylor,  Bernoulli, D'Alembert, Euler, Lagrange, Laplace
Poisson,  and others,  have established the undulating  theory of
sound.  According  to this theory sound  is a vibration or motion
of ordinary matter,  the character of which is  dependent upon the
number and arrangement of  the atoms. 
MALARIAL FEVER.
29
   In thermotics the theory of Bacon,1 Locke,2 and others, that heat
is  motion,  has been  confirmed,  enlarged,  and  extended to  the
varied phenomena  of heat, by  the  experiments, observations, and
reasoning of  Rumford,3  Davy,4  Leslie,5 Dulong,6 Clausius,7 Mayer,8
Magnus,9 Holtzmann, Regnault,10 Eankine, Thompson, Joule,11 and
others.12

   • " From the  instances taken collectively, as well  as singly, the nature whose
limit is heat appears to be motion. *  * p. 161.
   " What we have said with regard  to motion must be thus understood when
taken as the genus of heat; it must not be thought that heat generates motion, or
motion heat (though in some respects this be true) ; but the very essence of heat,
or the substantial self of  heat, is motion and nothing else, limited, however, by
certain differences," p.  165.
   " The form or true definition of heat (considered relatively to the universe  and
not  to the sense) is briefly  thus :  heat is an expansive motion restrained,  and
striving to exert itself in the smaller particles.   The expansion is modified by its
tendency to rise through expanding towards the exterior; and the effort is modified
by its not being  sluggish, but active and somewhat violent.  With regard to the
operative definition, the matter is the same.  If you  are able to  excite a dilatory
or expansive motion in any material body, and so to repress that motion and force
it on itself as not  to allow the expansion to proceed equally, but only to be partially
exerted and partially repressed, you will, beyond all doubt, produce heat; without
any consideration whether the body be of earth (or elementary,  as they term it),
or "imbued with celestial influence, luminous or opaque, or dense, locally expanded,
or contained within the bounds of its first dimensions, verging to dissolution, or
remaining fixed,  animal, vegetable, or mineral, water, or oil, or air, or any other
 substance whatever susceptible of such motion.   Sensible heat is the same, but
 considered relatively  to the senses," p. 171.— Novum Organum,  or True  Sugges-
 tions for the Interpretation of Nature, by Francis Lord Verulam.  London, William
 Pickering, 1850.
   2 " Heat is a very brisk agitation  of the insensible parts of the object, which
 produces in us that sensation, from whence we denominate the object hot;  so what
 in our own sensation is heat, in the object is nothing but motion."—John Locke.
   s The first approximate numerical determination of the connection between heat
 and mechanical  force  (the  mechanical equivalent of heat) was  made by Count
 Rumford.  His experiments had for their object the determination of the  relation
 existing between the force and time expended in boring a brass cylinder,  and the
 amount  of heat developed by the friction.
   " It appears to me," Count Rumford remarks,  " entirely difficult, if not quite
 impossible to  form any direct idea  of anything capable of being  excited  and
 communicated in the  manner the  heat was excited and communicated in these
 experiments, except it be motion."   One of the most  important points in his
 account of these experiments, is the  estimate of the quantity of  mechanical force
 required to produce a  certain amount of heat.  According to Count Rumford, the
 heat required to  raise  a pound of water lo F.  is equivalent to a force represented
 by 1034 foot-pounds.   This estimate is too high, because no account was taken of
 the heat dissipated during  the experiment.-" An Inquiry concerning the Power 
30
OBSERVATIONS  ON
of Heat which is excited  by Friction," by Count Rumford,  Phil.  Trans., vol.
lxxxviii., 1798; Phil.  Trans, abridged, vol. xviii. p. 286.
  4 Sir Humphrey Davy communicated a paper to Dr. Beddoe's West County Con-
tributions, entitled " Researches  on Heat, Light, and  Respiration," in which he
confirmed the views of Count Rumford, by melting two pieces of ice, rubbed against
each other in the vacuum of an air-pump, which was kept below the freezing point.
From this experiment  Davy drew the inference that "the immediate cause of the
phenomena of heat is motion, and the laws of its communication the same as the
laws of the communication of motion."—See Elements of Chemical Philosophy, p. 94.
  5 Experimental Inquiry into the Nature and Propagation of Heat.  London, 1804.
  6 The researches of Dulong on  the specific heat of elastic  fluids established the
fact that " equal volumes of all the elastic fluids taken at the same temperature
and under the same pressure, being compressed or dilated  suddenly to the same
fraction of their volume, disengage or absorb the same absolute quantity of heat."
Mimoires de VAcade'mie des  Sciences, t. x. p. 188.  This law, established by the
researches of Dulong, is of  the  greatest  importance in  the development of the
theory of heat, because it proves that the calorific effect is under certain conditions
proportional to the force expended.
  7 " Ueber die bewegende Kraft der Warme,"  Pogg. Ann. lxxix. 394. TJeber die
Art der Bewegung welche wir Warme nennen, von R. Clausius, Pogg. Ann. c. 353.
On the Application of  the Mechanical Theory of Heat to  the Steam-Engine, by R.
Clausius.  The American Journal of  Science  and Arts, vol. xxii. p. 360;  vol.
xxxii. p. 25.
  8 Experiment on the Evolution of Heat  by  Fluid Friction.   Annalen of Wcehler
and Liebig, May, 1842.
  9 " Experiments on the Expansive Force of Steam," Poggendorff's Annalen, No.  2,
for 1844; see Trans, in Taylor's Scientific Memoirs, vol. iv. p. 218.  On the Force
Requisite for the Production of Vapors, ibid., No. 2.
   10  " On the Elastic Forces of Aqueous Vapor," Annales de Chimie et de Physique,
July, 1844;  Taylor's Scientific Memoirs, vol. iv. p. 559.  Hygrometrical Researches,
Comptes Rendus, t. xx. pp. 1127 and 1220, April,  1845.  Taylor's  Scientific Me-
moirs, vol. iv. p. 606.   Phil. Mag., vol. xx. p. 111.
   11  In 1843, Joule showed that the heat evolved by magneto-electricity is propor-
tional to the force absorbed; and that  the force of the electro-magnetic engine is
derived from the force of chemical affinity in the battery, a force which otherwise
would be evolved as heat; from these facts he announced that the quantity of heat
capable of increasing the temperature  of a  pound of water by lO F. equals and
may be converted into a mechanical force capable of raising  838  pounds to the
perpendicular height of one foot.—Phil. Mag., vol.  xxiii. p. 441.
   In a subsequent paper, read before the Royal Society in 1844, Joule showed that
the heat absorbed and evolved by the rarification and condensation of air is pro-
portional to the force  evolved and absorbed in these operations ; and the quanti-
tative relation between force and heat, deduced from these experiments, is almost
identical with that derived  from the electro-magnetic experiments.—Phil. Mag.,
vol. xxvi. pp. 375—379.
   In 1843, Joule announced that heat is evolved by the passage of  water throuo-h
narrow tubes.—Phil. Mag., vol. xxiii. p.  442;  xxvii. p. 205 ; xxxi. p. 173.
   In an article "On the  Mechanical Equivalent of  Heat," published in the Philo-
sophical Transactions of the Royal Society, part 1,1850, p. 61, Joule announced as
the results of an  extended series of experiments :— 
MALARIAL  FEVER.
31
  Volta's immortal discovery demonstrated the  relation between
electrical and chemical phenomena; the decomposition of water by
Nicholson, in 1800, revealed the chemical energy of electricity, and
constituted  the  starting  point  of electro-chemical  research; the
brilliant discoveries of Davy1 demonstrated  the  close relation, if
not the  identity of chemical affinity and electricity;  the labors of
Becquerel established  the  synthetical influence of electricity; the
profound and  extensive researches of  Faraday,2 following up the

  1. That the quantity of heat produced by the friction of bodies, whether solid or
liquid, is always proportional to  the quantity of  force expended.
  2. That the quantity of heat capable of increasing the temperature of a pound
of water (weighed in vacuo, taken at between 55 and 60°) by lO F. requires for its
evolution the expenditure of a  mechanical force represented by the fall of 772
pounds through the space of one foot.
  12 Memoirs on the Free Transmission of Radiant Heat through different Solid and
Liquid Bodies, by M. Melloni, Taylor's Scientific Memoirs, vol. i. pp. 1—74, p. 325,
p. 388.  The Mathematical Theory of Heat, by S. D. Poisson, Annales de Chimie
et de Physique, vol. lix. p. 71, et seq.  See Analysis, in Taylor's Scientific Memoirs,
vol. i. p. 122.  Memoir on the Motive Power of Heat, by E. Clapeyron, Taylor's
Scientific Memoirs, vol. i. p. 347.
  Kupffer, by comparing the expansion which a metal wire suffers  by heat with
the elongation produced by stretching it with a given weight, found that the heat
necessary to raise a pound of water 1° F. is equivalent to 661 foot-pounds.  Phil.
Mag. [4], xli. 393.  Kronig  on the " Fundamental Principles of a Theory of Gases,"
Pogg. Ann., xcix. 315.  "Investigations on  Radiant Heat," by H. Knoblauch,
Taylor's  Scientific Memoirs, vol. v. 188—383.  " On the  Heat and Elasticity of
Gases and Vapors, and on the Principles of the Theory of  Steam-Engines, by C.
Holtzmann, Manheim, 1845.  See also Taylor's Scientific Memoirs, vol. iv. p. 189.
  1  In September, 1800, Sir Humphrey Davy published his  first paper, describing
experiments similar to those of Nicholson and Carlisle on the decomposition of
water.—Nicholson's Journal, 4to. iv. 275.
  In  1802, Davy conjectured that in all cases of chemical  decomposition the
elements might be related to each other as electrically positive and negative, and
in 18^6 ne  attempted the solution  of this  question, and after referring  to his
experiments of 1800, 1801, and 1802, and to a number of new facts, which showed
that oxygen, alkalies, and acids, and oxidizable and noble metals, were in electrical
relations of positive and negative, he drew the conclusion, " that the combinations
and decompositions by electricity were referable to the law of electrical attractions
and repulsions," and advanced the  hypothesis "that chemical and  electrical
attractions were produced by the  same cause, acting in the one case on particles,
in the other on masses ; and that the same property, under different modifications,
was the cause of all the phenomena exhibited by different voltaic combinations."
—Phil.  Trans., 1826,  p. 389.
  2  "On the Induction of Electric Currents; the Evolution of Electricity from
Magnetism ; a New Electrical Condition of Matter; Arago's Magnetic Phenomena,"
Phil. Trans., 1831.  " Terrestrial Magneto-Electric Induction ; Force and Direction 
32
OBSERVATIONS ON
discoveries of Oersted, Davy, Arago, and Schweigger, demonstrated
the identity of the chemical, electrical, and magnetic forces, and led
this great  philosopher to advance  the idea that  the so-called  im-
ponderable bodies are merely the  exponents  of different forms of
force.
   The researches of Petit,1 in 1722, on the effect  of light upon the
crystallization of saltpetre and sal-ammoniac, and  the analysis of
the action and demonstration of the chemical influences of the rays
of light, by Charles William  Scheele,2 confirmed and extended by
the  researches of Senebier,3  Count Rumford,4 Meese,5 Priestley,6

of Magneto-Electric Induction," Bakerian Lecture, Jan. 12,  1831.  Identity of
Electricities derived from different Sources ; Relation by Measure of Common and
Voltaic Electricity, 1833.  Electro-Chemical Decomposition, 1833 and 1834.   Na-
ture of the Electric Force or Forces ; Relation of the Electric  and Magnetic' Forces ;
the Current  its  Forces, 1838.  On  the Source of Power in the Voltaic Pile, 1840.
On the Electricity Evolved by the Friction of Water and  Steam against other Bodies,
1840.   On the Magnetization of Light and the Illumination of Magnetic Lines of
Force, 1845.   On New Magnetic Actions, and on the Magnetic Condition of all Mat-
ter, 1845.  On the Crystalline  Polarity of  Bismuth (and other bodies), and on its
relation to the Magnetic form of Force, 1850.   On the possible relation of Gravity
and Electricity, 1850.  On the Magnetic and Diamagnetic Condition of Bodies, 1850.
  For these and many other papers by Professor Michael  Faraday, see  Philoso-
phical Transactions for 1831—1852.  These papers have been collected and pub-
lished in three  volumes—vol. i., 1849, sec. ed. ;  vol. ii., 1844, first ed.;  vol. iii.,
1855.   In his Bakerian  Lecture for 1845, Professor Farraday stated his  views of
the relations of the forms of force, thus :—
  " I have long held an opinion, almost amounting to conviction, in common with
many other lovers of natural knowledge, that the various forms under which the
forces of matter are made manifest have one common origin;  or, in other words,
are so directly related and mutually dependent that  they  are convertible, as it
were, into one another, and possess equivalents of power in their action. In modern
times  the proofs of their convertibility have been accumulated to a very consider-
able extent, and a commencement made  of the determination of the equivalent
forces."
  1 " Sur la Vegetation des Sels," Mem. de Paris, 1722.
  2 Scheele, Traite de l'Air et du Feu.
  3 Senebier sur la Lumiere, torn. iii. p. 199.
  4 " On the Propagation of Heat in Fluids," Phil. Trans.  " An Inquiry concerning
the Chemical Properties that have been attributed to Light," Phil. Trans., 1798.
  5 B. C. Meese, in 1775, first published experiments upon the influence  of light
on plants.
  6 In 1779, Dr. Priestley determined the problem of vegetable respiration, and
showed that carbonic acid was absorbed by the plant, that under the influence of
light it was decomposed and its oxygen liberated.   Experiments and Observations
on Different Kinds of Airs and other Branches of Natural Philosophy, Birmingham
1790.   See also Senebier, Experiences sur l'Action de  la Lumiere  Solaire dans la
Vegetation, Paris, 1788. 
MALARIAL  FEVER.
33
Ingenhousz,1  Saussure,2   Ritter,3  Wollaston,4  Young,5  Yogel,6
Herschel,7 Seebeck,8 Gay-Lussac, Thenard,  Berard, Wedgwood,9
Niepce, Daguerre,10 and Draper,11 have  resulted in the  establish-
ment of the complex nature of the sunbeam, and the demonstration
of the  relations  of light,  heat, chemical  affinity, and  animal  and
vegetable life.
   The  names which  we  have mentioned  by no  means  form a
complete  list  of those who  have assisted,  by their observations,
experiments, reasonings,  and  teachings, in  the  establishment  and
promulgation of the doctrine of the mutual relations of the physical
and chemical forces.
   In 1808, Oken12 affirmed that "light could be nothing but a polar
tension of the aether, evoked by a certain body in antagonism with
the planets;  and that the  heat was none other than the motion of
this  aether;" and in his " Physiophilosophy"13 not only points  out,

   1 "Experiences sur les Vegetaux," Phil. Trans., 1782.
   2 " Recherches Chimiques sur la Vegetation," Annales de Chimie, vol. i.
   3 Gehlen, Journal der Chem., vol. vi.
   4 Philosophical Transactions, 1802, p. 379.
   B Phil. Trans., 1804.
   6 Annales de Chimie, vol. lxxv.
   7 Transactions of the Royal Society of London, 1800.
   s Philosophical Magazine, vol. vii., 2d ser., p. 462.
   9 An Account of a Method of Copying Paintings upon  Glass, and of making
Profiles  by the Agency of Light upon Nitrate of Silver, with Observations, by H.
Davy, 1802.
   10 History and Practice of Photogenic Drawing, by M. Daguerre, translated from
the original by  T. S. Memes, LL. D.  London, 1839.
   " Philos. Mag., Sept., 1841.
   12 Erste Ideen Zur Theorie des Lichts, der Finsterniss der Farden und der Warme,
Jena, bey Frommann, 1808.
   13 " Magnetism and electrism are correlated, as iron and sulphur, as gravity and
light, as centre  and periphery.  The same spirit, which, when ruling in the dark,
exhibits itself as magnetic, is manifested when it has  attained  to light in sulphur
as  electrical.   Magnetism is only  the electrical identified. We may, therefore,
speak of idiomagnetic metals as well as idioelectric bodies.  Magnetism, therefore,
stands in opposition to electrism ; they mutually change  or annihilate each other.
p. 167. * * Chemism is related  to magnetism as salt is to metal, as the sedi-
mentary to the primary periods.  The whole sedimentary period is a product of
chemism, as the whole primary period is the product of magnetism." * *
  Magnetism and chemism are thus the creating agents for the solid nucleus of
the earth, and through both it is completed.  The process of  earth formation is
magneto-electrism.  Regarding the earth as an entire crystal, magnetism is the
determinant of its polar axis and polar radii, while chemism is the same in respect
to its integral parts.  All terrestrial action is an interchange of these two functions
or souls, which  are none other than the living gravity, and the living light upon 
34
OBSERVATIONS  ON
but bases much of his theory of the  evolution  and  order  of the
world upon the mutual relations of gravity, light, electricity, mag-
netism, heat, and chemical action.
  Carnot, in 1824, in his researches upon heat, attempted to  esta-
blish the relations of the physical forces.
  Lardner Yanuxem1 (an American), in the year 1827, published a
work, in which he affirmed that caloric, light, electricity, and mag-
netism are convertible one into another, and are but different states
of one kind of  repulsive matter.
  In 1833, Dr. Metcalfe, in an  essay  entitled  a "New  Theory of
Terrestrial Magnetism"2 (subsequently  expanded3 into his  magnifi-
cent work on caloric),  traced the most  striking analogies of caloric
and electricity,  and endeavored  to show that they are radically the
same subtle, imponderable, and  all-pervading element, and that its
unequal distribution through nature is the  cause of all the various
forces  and  attractions  of  ponderable  matter with which man is
acquainted.

the planet.  The electricity, like the heat, only maintains them in eternal tension
or extension.
  Chemism is the process  of space, density, quiescent heat, therefore  the latent
heat, or the temperature, must change in every chemical process.
  Chemism is related to magnetism as heat to gravity, to electricity like as to
light.
  Crystallization is point, magnetism line, electrism  surface, chemism cube.  Ele-
ments of Physiophilosophy, by Lorenz Oken, M. D. ; translated for the Ray Society
from the German, by Alfred Tulk, pp. 176—177.  London, 1847.
  Coleridge maintained that electricity, galvanism, and magnetism, are the funda-
mental principles  of action in nature, and that " a power acting exclusively in
length is (wherever it be  found) magnetism; that  a power which  acts  both in
length and breadth, and only in length and breadth, is (wherever  it be found)
electricity;  and, finally, that a power which,  together with length and  breadth,
includes  depth likewise, is  (wherever it be found) constructive  agency."—Hints
towards the Formation of a more  Comprehensive Theory of Life, by S.  T. Coleridge.
Philadelphia, 1848.
  1  An Essay on the Ultimate  Principles of Chemistry, Natural Philosophy, and
Physiology, by Lardner Vanuxem.  Philadelphia, 1827.
  2 " Caloric, electricity, and galvanism have  hitherto constituted a separate and
distinct triad of imponderables, perfectly incomprehensible ; all the phenomena of
wllich are quite intelligible, if we refer them to the agency of one grand,  primary,
universal element," p. 27.
  3 This article was extended,  published in a series of articles in the  Knicker-
bocker Magazine for 1834—5, and finally expanded into that great work, which
will ever remain as one of the noblest monuments of American learning  and phi-
losophy. Caloric, its Mechanical, Chemical, and Vital Agencies in the Phenomena
of Nature, by Samuel L. Metcalfe, M. D.  London: William Pickering, 1843. 
MALARIAL  FEVER.
35
  Dr.  Samuel  Jackson,1 in  his  Introductory Lecture for  1837,
asserted that " physical phenomena,  according to the class to which
they belong, are referred to a few simple  laws, as  gravity, caloric,
affinity, galvanism, electro-magnetism, all  of which, it  can now be
scarcely doubted, are manifestations of one great force." This learned
teacher  and philosopher has for  one quarter of a century taught
from his chair in  the University of Pennsylvania, not  only the
correlation of the physical forces, but also  the  mutual connection
of the vital and physical forces, and demonstrated before thousands
of  medical students and physicians "that the same  causes  and
actions  which  in inorganic  bodies constitute physics, in organic
bodies constitute physiology, or, as  it may be more aptly termed,
organic physics."
   Mr. Grove,2 in a Lecture delivered at the London Institution, on
the 19th  of  January, 1842, showed  that "light,  heat, electricity,
magnetism, motion, and chemical affinity, are all convertible mate-
rial affections; assuming any one as a cause, one of the others will
be the effect.   Thus, heat may be said  to produce electricity, elec-
tricity to produce heat; magnetism to produce electricity, electricity
magnetism; and so of the rest."
   In  this same  year,  J. R. Mayer,3 of  Heilbronn, saw truly  and
expressed  correctly this general  law;  and in  1843, Colding  pre-
sented  a  memoir  to  the Academy of Copenhagen, in which  the
same  law found utterance.
   Dr. H. Helmholtz4  read before  the Society of Berlin, July, 1847,

   1 In the  year 1849, in a paper read at  the meeting of the American Medical
 Association, held in Boston, Dr. Jackson  announced the correlation of animal
 mechanic force and heat.
   For  a  condensed statement of the views of this  philosopher, see his valuable
 " Introductory Essay on the Human Organism  and its Forces, with Remarks on
 Dr. Lehmann's Doctrine of Vital Forces," by Samuel Jackson, M. D., Professor of
 the Institutes of Medicine in the University of Pennsylvania.—Lehmann's Manual
 of Chemical Physiology, translated by J. Cheston Morris.  Philadelphia, 1856.
   2 The Correlation of Physical Forces, by W. R. Grove, first ed., 1846 ; third ed.,
 1855, London.
   3 Organic Movements in their Relations to Material Changes, 1845.  See also
 Trastour's pamphlet—Caloric, Origin, Matter, and  Law  of  the Universe,  1847.
 " Identities of Light and Heat, of Caloric and Electricity," by Dr. C. C. Cooper, 1857,
 British and Foreign Medical Review, article 18, Oct., 1844. Carpenter's Principles
 of General and Comparative Physiology, 1841, p. 167.  "On the Mutual Relations
 of the Vital and Physical Forces," by William B. Carpenter, M.D., Phil. Trans.,
 June 20, 1850, part ii. p. 727.
   4 " On the Conservation of Force, a Physical Memoir," by Dr. H. Helmholtz (read
 before the Physical Society of Berlin, July 23, 1847, Berlin, by Reimer), see trans. 
36
OBSERVATIONS  ON
a most profound, elaborate, and philosophic memoir on the " Con-
servation of Force," based upon two maxims:—
   1.  "That it is not possible, by any conditions whatever of natural
bodies, to derive an unlimited amount of mechanical force.
   2.  "All  actions in  nature can be ultimately referred to  alter-
nate  attractive or repulsive forces,  the intensity of which depends
solely upon the distances  between  the points by which the forces
are exerted."
   In this valuable memoir, Dr. Helmholtz refers natural phenomena
back to unchangeable  attractive and repulsive forces, whose inten-
sity depends solely upon the distance; and  establishes, by copious
illustrations  and  mathematical demonstrations, the interaction and
indestructibility of the forces of nature.1
   Organized animated bodies are composed of inorganic elements,
and are  governed by  all the  laws and phenomena of  inorganic
bodies, and  are  absolutely  dependent2  for  their existence  upon

in Taylor's Scientific Memoirs, vol. vi. pp. 114—162. " On the Interaction of Natural
Forces," by H. Helmholtz, Professor in the University of Bonn, translated by John
Tyndall, Phil. Mag., fourth series, vol. ii. p. 487.  See also the American Journal
of Science and Art, vol. xxiv., September, 1857, pp. 189—216.
  1 See also " Observations and Experiments on the Theory of the Identity of the
Agents which produce Light and Radiant Heat," by M. Melloni, Annales de Chimie
et de Physique, vol. i. p. 418. Taylor's Scientific  Memoirs, vol. i. p. 388.  " On the
Chemical Effects of  Electric Currents of Low Degree in  Crystallization," by M.
Becquerel,  Becquerel's Traite de  Electricite et  du  Magnetisme,  vol. iii. p. 287.
" On the Application of Electro-Magnetism to the Movement of Machines," by M. H.
Jacobi, Potsdam, 1835, Taylor's Scientific Memoirs, vol. i. p. 503; vol. ii. p. 1.
" Experiments of Joule determining the Relations of Heat and Electricity," Phil.
Mag., vol. xix. p. 275 ; to Chemical  Affinity, vol. xx. p.  Ill; vol. xxiii. p. 441.
" The Galvanic Circuit Investigated Mathematically," by Dr. G. S. Ohm, Taylor's
Scientific Memoirs, vol. ii.  p. 401.  "General Propositions relating to Attractive
and Repulsive Forces acting in Inverse Ratio of the Square of the Distance," by C.
F. Gauss, trans, in Taylor's Scientific  Memoirs, vol. iii. p. 153. " On the Relation
of Magnetism to Diamagnetism," by M. Pliicker, Poggen. Ann., Oct., 1847 ;  trans.
in Taylor's Scientific Memoirs,  vol. v. p. 376.  " On the Measurement of Electro-
Dynamic Forces," by W. Weber, Poggen. Ann., January, 1848 ; Taylor's Scientific
Memoirs, vol. v. p. 489.  "  On the Mechanical Equivalent of an Electric Discharge,
and the Heating of the Conducting Wire which  accompanies it," by R. Clausius,
Pogg. Ann., 1852; Taylor's Scientific Memoirs, vol. vi. p.  1.  "On the Work per-
formed and  the Heat generated in a Conductor by a Stationary Current," by R.
Clausius, Pog. An., vol. lxxxvii. p. 415 ; Taylor's  Scientific Memoirs, vol. vi. p. 200.
Philosophy of the Mechanics of Nature, by Z. Allen, New York, 1852.
   2 Inorganic bodies are wholly independent of the  organic, are  less complex in
structure, their phenomena are more simple, and the laws of their existence more
universal.  Thus, the bodies oxygen and  carbon are widely diffused throughout
nature, and  their existence is wholly independent of that of any other bodies. 
MALARIAL FEVER.                    37
inorganic bodies;  they have, however, a new set of phenomena,
dependent upon the  vital force; and in  animals we have another
set of phenomena, dependent upon the existence of the  nervous
system and intellectual faculties; and in man we  have another set
of phenomena, dependent upon the combination of the intellectual
and moral faculties.
   Inorganic bodies, with their properties, form the necessary con-
ditions for the existence of plants and animals, just as the properties
of cohesion and gravitation form the essential conditions for the
existence of the universe, in its present arrangement; the pheno-
mena  of living beings, plants and  animals, are, therefore, more
complicated and  less general than those of inorganic inanimate
bodies;  and  it  is evident that to understand the phenomena of
living beings, and their relations with the universe, we must com-
prehend the phenomena and relations of all inorganic bodies.
   The relative proportions of the inorganic elements entering into
the constitution of plants and animals, correspond, in a measure,
to the relative quantities of these  elements in the exterior world.
Whilst  the majority  of  the sixty-two  simple bodies,  with  their
compounds, exist  only in  small quantities, and enter into but few
combinations, and exert but little influence upon the phenomena
of organized bodies,  the elements composing the great mass of our
globe are the  very elements  which are essential to the formation of
the structures and manifestation of the forces of  animated beings.
   Water, which  covers two-thirds of the surface of our  globe,
and is distributed throughout the atmosphere and  soil, exists in
similar  proportions in the structures of plants and animals.   We
have  seen that water is  the great medium of chemical change in
the inorganic  world—that under the action  of heat and gravita-
tion, a great circulation of water is carried on through the atmo-
sphere, and over  the surface of the  continents and  islands, which
disintegrates and wears down the solid rocks, dissolves and washes
away the  impurities  of the  atmosphere and land.  An analogous
lesser circulation of water, whose existence depends upon the great
circulation in  the inorganic world, is carried on unceasingly through
the textures of plants and  animals; and water in  the organized
world, as  in the inorganic, is the great medium of change, and the

Plants and animals are composed in large measure of these two bodies, in com-
bination with hydrogen and nitrogen.  Without these elements, with their peculiar
properties and arrangements, plants and animals could not exist. 
38
OBSERVATIONS ON
great agent in the removal  of disintegrated, chemically altered,
offending substances.  The amount of water required annually for
the circulation through the textures, the distribution of the nutri-
tive materials, and the removal of the waste, useless products of the
billion inhabitants of the earth, is, at the lowest calculation, 1,500
billion pounds;  while  3,000  billion pounds are required for the
accomplishment of similar offices in the animal kingdom;  and the
vegetable  kingdom, at the lowest  calculation, requires  annually
9,288,000,000,000,000 pounds, or 4,644 billion tons of water.
  Eight-ninths of all the water,  one-fifth  of the great  ocean of
gaseous matter, and from one-half to two-thirds of the solid crust
of our globe, are composed of oxygen, in combination with hydro-
gen, silicum, aluminum,  calcium, sodium, potassium, magnesium,
iron, and carbon.  In  the  inorganic world oxygen is the great
purifier of earth, air, and sea—the great element of combustion—
the great element of chemical  change—which, excited by the forces
of the sun, works unceasingly.  Oxygen constitutes from two-thirds
to four-fifths of the structures of plants and animals, and immense
quantities are used in the chemical changes of the elements during
the construction and disintegration of the tissues and the develop-
ment of the forces; the human race alone annually consumes 800
billion pounds of oxygen, in  addition to the 1,322 billion pounds
contained in the water circulating annually through the textures.
The oxygen enters into combination with the elements of the food,
and  of the  tissues and organs—during these ceaseless  chemical
changes the integrity of the  structures  and the individuality of
animals are preserved, and  the forces which work their machinery
generated.   The structures of plants and  animals  are composed
chiefly of three gases and one solid; they are dependent,  however,
upon the soil for certain salts  of lime, soda, potassa, silica, and iron.
These salts,  although existing in  small amount, are absolutely ne-
cessary for  the existence of plants and  animals; every soil which
does not contain  these salts  in an  available form for plants  will
not support the higher species necessary for the elaboration from
inorganic matter, of compounds necessary  for the structures, and
chemical changes  and development of the forces of the most hio-hly
developed animals.  The absence of a single inorganic constituent
from the food of man and the higher animals, will be attended by
derangement of the structures, aberration of the forces, and, finally
death.  The researches of chemists, physiologists, and pathologists, 
MALARIAL FEVER.                   39
have shown  that more than  two-thirds of the sixty-two simple
elements, with their various compounds, so far from entering into
the constitution of plants and  animals, are  dangerous  poisons,
capable, in the smallest quantities, of producing death.  This com-
parison of the mineral constituents of plants and animals with the
constituents of  the  crust of our globe, develops such a close corre-
spondence that  the  conviction  is forced upon us, that not one of the
essential constituents  of  the crust of our globe could be  altered,
either  in quantity,  distribution, or chemical relations, without the
destruction  of  animals  and vegetables.  What  would  have been
the result if arsenic had been as widely distributed as iron ?  What
would have  been the result if the chlorine of the sea-water and
crust of our globe  had  been united with mercury  instead  of with
sodium?  Nor is this all;  the very scarcity and poisonous proper-
ties of these substances have exerted  great influences  upon the
development of certain  arts and sciences.
   Whilst inorganic bodies form the structures of plants and animals
and retain all their physical and chemical properties and relations,
whilst the circulation of matter in the organized world is carried on
by the same forces as in the  exterior inorganic world, and whilst
there is no creation of matter  or of force in  the bodies of animated
beings, it is, nevertheless, true that living beings have a new set of
phenomena,  and that their structures  and phenomena are more
complicated and less general than those of  inorganic bodies.
   Without entering into an enumeration of all the distinctions be-
tween inorganic bodies and animated beings, it may be stated that
inorganic bodies are homogeneous  in structure, and would remain
forever at rest and unchanged, physically  and chemically, unless
acted  upon  by extraneous forces, and in inorganic compounds the
biniary arrangement is pursued;  whilst,  on the  other hand,  all
vegetables, from the simple cell to the most highly developed, and
all animals, from  the simple cell  animalcule to  the complicated
organism of man, have  arisen from cells, and are composed of cells
variously developed and grouped, so as to form organs, and systems
of organs, and  apparatus, capable of accomplishing definite results,
when  moved by the proper chemical and  physical forces, and in
organic  compounds, four bodies, carbon,  hydrogen, oxygen, and
nitrogen, unite in  varying proportions, forming an endless series
of compounds.
    Amidst the  unceasing chemical and physical changes of the ma-
terials of organized beings, individuality of form is preserved and 
40
OBSERVATIONS  ON
unity of action maintained.  The  development of a definite form
from  a  formless  mass, and  the  preservation of that form amidst
unceasing chemical and physical changes, is the great characteristic
of organized beings.
  As no force or  combination of forces  in the inorganic world can
accomplish the development of  a form from a formless mass, and
the preservation of that form amidst  unceasing chemical changes,
the human mind,  reasoning upon the axiom that every effect must
have a cause, refers these effects to a special cause, called the vital
force.  It is true  that no one has ever seen  this force.  We know
it only by its  effects.  The  same thing is  true of all forces.  No
one has ever seen the force (the cause of the phenomena) of heat,
light, electricity, or magnetism.   We do not observe forces, but we
infer their existence from their effects.  The conclusion, then, that
animals and  plants are endowed with a force which inorganic bodies
do not possess is  logical.  We can come to no other conclusion if
we reason in accordance with the structure  of our minds.  If it be
true that the human mind  is the work, and even the reflection of
the image of the  Creator, who is himself Truth, we are confident
that whenever our minds reason in rigid  accordance with all the
known facts, and  their own structure, they  must obtain the truth.
  In  this view of the relations of  organized and inorganic bodies,
we do not attribute to the vital force  any power to  produce either
chemical, or physical, or nervous forces.  Its power is limited to a
direction of  the forces of matter, so that a  form is developed from
formless matter, maintained, and definite results accomplished, and
unity of action preserved.   All  the movements in plants and ani-
mals  depend ultimately upon the  chemical changes and physical
properties of their elements, and  upon the forces of the sun.  With-
out these forces the vital principle can accomplish nothing.
  According to this view the action of the vital principle, like that
of the intelligence, is limited to a  guidance and direction of the
forces with which the Creator has endowed all matter.  The action
of the vital principle upon matter, like that of the intelligence, does
not consist either in a creation of matter, or in  a direct  movement
of matter independent of the forces  of matter, but in the  mere
guidance and application  of the forces  of  matter, so that  definite
forms are developed from  formless  matter, and  definite results
accomplished.
  According to this view the vital principle and the intelligence
cannot create force any more than  they can create matter.  Their 
MALARIAL FEVER.                   41
influence is limited to an excitement and application of the forces
of matter.  We judge of  the influence of one just as we judge of
the influence of the other.  The complicated  machine points to
the existence of an intelligence distinct from  matter, which has so
applied the  forces of one portion of matter  that another portion
has been moulded into definite shapes, and formed into definite
apparatuses, capable of accomplishing definite results,  when acted
upon  by forces generated  and  applied in the right manner.   We
infer the existence of the intellect by the  results of its application
of the forces of matter.  In precisely the same manner do  we infer
the existence of the vital principle.
   The vital principle directs the forces resulting from the chemical
changes of one part of matter, in such manner that surrounding
matter is fashioned, moulded into definite forms and apparatuses,
destined to accomplish definite  results.  This  apparatus cannot
be worked by the  vital  principle  independent of chemical action,
any more  than a watch will run or any machine  accomplish
various mechanical effects without a supply of exterior force, or a
steam-engine accomplish  mechanical  effects  without the  develop-
ment of force by the chemical changes of matter, which has been
elevated into  a state of force  (placed in  a state capable of under-
going chemical change) by the forces of the sun.
   In  the living animals  the  forces resulting  from the chemical
changes  are expended under the direction of the vital  principle to
accomplish:—
   1. The preparation and elevation of new materials into the place
of that which has  been  chemically altered during the development
of the forces.
   2. The removal of the  products  of the chemical changes, which
are no longer fit to form the organized structures, and are no longer
capable of undergoing the changes  necessary for the development
of the forces.
   3. The working of the apparatus which distributes the elements
of secretion,  and  excretion, and  force, expels the excretions  and
moves the body.
   In the living animal the rapidity of the chemical changes which
develop the forces  of the machinery, depend,  first, upon the supply
and distribution of materials  capable  of  entering into the consti-
tution  of the organs, tissues,  and apparatus; secondly, upon the
supply and distribution of materials capable of undergoing chemical
change within  and around the machinery, and  thus generate the
       4 
42
OBSERVATIONS ON
forces in positions advantageous for their application ; thirdly, upon
the replacement of the chemically altered matter which once formed
part  of the  apparatus (machinery) by new matter;  fourthly, upon
the removal of the products of chemical change, which  derange
chemical action—first,  by  occupying positions in  the  apparatus
which  should be occupied  by matter  in  a state of force,  and not
by matter which has lost the  amount of force  originally received
from the sun; secondly, by inducing  chemical changes in wrong
positions in parts of the organism where  the forces  resulting from
their chemical changes cannot be applied; and, thirdly, by a direct
poisonous effect upon the organs, tissues, and  apparatus, especially
upon the nervous system, which keeps up a communication between
all parts of the system, and  controls, in a  great measure, the distri-
bution of the elements of  nutrition and  chemical change, by con-
trolling the  action  of the  respiratory and circulatory  apparatus.
The supply  and distribution of the materials of nutrition and che
mical change depend, first,  upon the perfection and action of the
vegetable  kingdom, and, secondly,  upon the perfection  and action
of the  animal,  digestive, circulatory, and  respiratory  apparatus,
related and co-ordinated by the nervous system.
  The study of the animal  kingdom as a whole demonstrates that
the perfection and action of the respiratory and circulatory systems
may be taken as an index  of not  only the physical and chemical
changes of the organized fluids and solids, but also of the develop-
ment and perfection of the  organs,  and tissues, and  apparatus, and
of the  activity and intelligence of  animals.
  The action of the respiratory and circulatory apparatus, the co-
ordination of this action with the action and wants of the muscular
and nervous systems, and  of all the  organs, and tissues,  and ap-
paratus, is guided by the nervous  system, in which a special  force
is generated—excited and guided by nervous  force, but not carried
on by  nervous force, independent of chemical change.
  Chemical  change in the organs and  apparatus,  and chemical
change in the nervous systems, is the  source not only of heat, but
of muscular and nervous force, and of all the forces generated in
the animal economy.
  All  the acts  called vital, and nervous, and muscular, by many
physiologists, such as the contraction of the muscles, and the trans-
mission of impressions to  and from the  nervous sensitive centres
along  the nerves,  are due  to  the  chemical changes of  those ele-
ments  which have been separated from oxygen, and elevated into 
MALARIAL  FEVER.
43
a state of force (capable of chemical change) by the forces of the
sun, acting through special organs in the vegetable kingdom. There
is a change of force in direction and mode of action, but there is no
creation of force.
  The generation  of any force—vital, nervous, chemical, or phy-
sical,  in  the animal economy, independent  of antecedent force,
would destroy the great  law upon which the stability of the uni-
verse rests,  that force  is indestructible—would destroy the great
law that action and reaction are equal.
  The vital  force does not create any force, however feeble;  but,
like the intellect, merely employs the forces with which the Creator
has endowed matter, just as a master-workman  employs the forces
of men to act upon matter and construct an edifice.  If the vital
force be not analogous to intelligence, how does  it come that all
the organs  and apparatus are developed upon a definite plan,
adapted by structure and conformation to the medium  in which the
animal lives, and to all the physical forces?
  The difference between vegetables and animals, and between the
different  species of each kingdom, depends not  upon differences of
forces, or of the elements of  their structures, but upon  the differ-
ence of the  development of the apparatus  by which  the  physical
and chemical forces are applied.  Thus, vegetables are fixed to the
soil, and  their structures  are  all arranged, for the  accomplishment
of a definite purpose—the application of the forces of the sun to
the grouping of the atoms of  inorganic matter, and the products of
the disintegration of the tissues of animals, in such a manner that
they may not only form  the  tissues  and organs of plants and  ani-
mals, but also that they may  be capable of undergoing change,  and
of giving back the same amount  of force which they had received
from the sun.
  The arrangement of the atoms of the structures of  animals,  and
the forces resulting from the chemical changes  of these  atoms, are
resultants of the forces of the sun, acting through special organs of
plants, and  guided by the vital force  of  plants, so as  to overcome
the chemical affinities of certain elements, separate  them, place
them in a situation where they can again  undergo chemical change,
and  give out the  force originally expended  by the sun  in over-
coming their chemical affinities.
  All matter upon the face of our globe tends continually to come
to rest.   This tendency is  due to several causes, as the action of
gravity, the limited amount of force with which  matter is endowed, 
44
OBSERVATIONS ON
 and the continued radiation of heat into space, and the loss of the
 forces of the elements by radiation during their chemical union.
 Without a continued supply of force all motion would cease, both
 in the inorganic and organic worlds.
   The great force which moves  the crude  sap of plants from the
 roots to the  leaves, from cell  to cell, in opposition to the force of
 gravity, is endosmose, which is itself dependent  upon chemical
 actions, and the varying densities of the contents of the cells,  both
 of which depend ultimately upon the forces  of the sun.  After the
 inorganic elements and  moisture have been supplied, the luxuri
 ance and perfection of plants depend upon the intensity of the
 forces of  the sun.
   The truth of this proposition may be established by a reference
 to the distribution of plants  upon the surface of  our globe, and
 upon mountains, which rise to a great  height in tropical countries.
   Whilst in equinoctial  and tropical countries, where a sufficient
 supply of moisture combines with the  influence of  heat  and light,
 vegetation appears in all its  magnitude and glory;  on the other
 hand, in polar regions, and  upon the summits of lofty mountains,
 all the more complicated forms  of vegetable existence disappear,
 and lichens and microscopic plants  take the place  of the majestic
 forests and impenetrable jungle.  In the tropics the lowest orders
 of plants are comparatively rare; whilst  in  the polar regions, and
 upon the summits  of mountains, they form almost the entire vege-
 tation.
   The strength and activity of animals depend upon the develop-
 ment of the apparatus by which the elements for chemical change
 are distributed, and the forces resulting from  these chemical changes
 applied, and a free communication between the different systems of
 organs kept up. The development of the apparatus depends upon
 the directive influence of the vital force.
   The truth of these propositions may  be clearly demonstrated by
 a comparison of the phenomena and anatomical structures of the
 different species, genera, orders, and classes of animals.  Thus the
 sluggish, feeble, cold-blooded animal is such, not from any pecu-
 liarity  of  the  elements  or forces of its structures, but  from the
 imperfect  development of the structures and apparatus  by which
 the elements of chemical change are  distributed, and  the forces
resulting from  these changes  applied.   The forces of an  animal
with imperfectly developed lungs and circulatory  apparatus are
necessarily feeble, because the apparatus for the introduction and 
MALARIAL FEVER.                   45
distribution of the  great agent of chemical change (oxygen) are
defective in their action.
  In the animal, as  in the plant, and as in the universe, there is no
creation of force independent of the  Creator.  The geographical
distribution of plants, and the relations of animals to the forces of
the sun (surrounding temperature), demonstrate conclusively this
proposition.   The independence of higher animals of surrounding
cold (absence  of heat or force) is due  solely to the  fact that they
can receive and distribute rapidly the materials  necessary for the
development of the  physical, chemical, and nervous forces.  As the
external temperature diminishes, the internal chemical changes cor-
respondingly  increase.  If, however, the external heat diminishes
to a point at  which the heat  lost by radiation from the surface of
the body of the living being is  greater than  that  developed  by
the greatest  possible combustion, the warm-blooded animal will
be reduced to the condition of a sluggish cold-blooded animal,  and
finally lose all motion and life.  The distinction, then, between cold
and warm-blooded animals, drawn from their temperature and  cor-
responding forces, is relative and not absolute.
  As far, then, as the knowledge of man extends, the  great law of the
indestructibility of force, and the great law that action and reaction are
equal, are applicable  to all phenomena, inorganic and organic.
  Physical and chemical forces  exist independently of the vital
force;  the vital force, on the contrary, cannot exist and manifest
its peculiar effects without  matter and the physical and chemical
forces;  the acts of development, nutrition, secretion, and excretion,
and propagation, which  are  peculiar to plants  and animals, are
resultants of the action of the physical and chemical forces upon
matter,  under the guidance of the vital force, which is incorporated
with and  presides over every molecule of living  organized  matter,
and directs all  its  physical and  chemical changes,  so that amidst
innumerable  and unceasing  changes  the  individuality of every
organ, apparatus, and animal is preserved.
  As the germination and development of vegetables and animals, and
the maintenance of their life actions, depend essentially upon the proper-
ties of matter, upon the relations of matter to the sun  and fixed stars,
and upon  the correlation of the vital, chemical, and physical forces, it
is evident  that the study of complicated, highly developed plants  and
animals involves the consideration of their origin, development, structure,
and relations to exterior bodies—involves the consideration of the chemical
and physical properties of the elements, and  combination of elements 
46
OBSERVATIONS ON
entering into their constitution, and the relations of the constituents of
their bodies to the surrounding  medium—involves  the  consideration of
the relations of the vital, chemical, and physical forces, and intellectual
and moral faculties—involves the consideration of the relations of ani-
mated beings to the forces and arrangements of the sun, and planets, and
fixed stars.
   The history of the origin, development, and distribution of plants
and animals, as  revealed by the records upon the solid rocks; the
geographical distribution of the  plants upon  the  surface of our
globe at the present time; the geographical distribution of animals,
and the relations of animated existence to the  surrounding medium
and external forces as revealed in the correspondence of the internal
structures and forces with the arrangements and chemical relations
of the elements  and the rapidity of the chemical changes, demon-
strate that the most simply constructed plants and animals are more
widely distributed over the surface of our globe, and the conditions
of their existence more general and less complicated than  the more
highly developed plants and animals;  demonstrate  that as we rise
in the scale of animal and vegetable existence, the phenomena of
life become more complex and  less  general, and the conditions of
their existence more complicated and restricted.1

   1 The truth of these propositions may be illustrated in a forcible manner by the
relation of vegetable and animal existence to the distribution of the forces of the
sun upon the surface of  our globe.  Thus, as a general rule, after the inorganic
elements and moisture have been supplied, the luxuriance and perfection of plants
depend upon the intensity of the forces of the  sun.  The more complicated and
perfect the vegetable structures, the closer is their dependence upon the proper sup-
ply and balance of the  physical forces.   The converse of this proposition is also
true.  The truth of these propositions may be established by references to the
distribution of plants upon the surface of our  globe, and upon mountains which
rise to a great height in tropical countries.  Whilst, in equinoctial countries, where
a  sufficient  supply  of moisture combines with  the influence of heat  and light,
vegetation appears in all its magnitude and glory; on the other hand, in polar
regions, and upon the summits of lofty mountains, all the more complicated forms
of vegetable existence disappear, and lichens and microscopic plants take the place
of majestic forests and  impenetrable jungles.  In the tropics the lowest orders of
plants are comparatively rare, whilst in  polar  regions  and  upon  the  summits of
mountains they form almost the entire vegetation.  The plants which first form
upon barren rocks, and lava  streams, and  coral islands, are those of the most
simple organization.  The simply organized lichens covering the bald-granite rocks
are familiar to every resident of a  primitive region.  Along the  sides of Etna
Ischia, Vesuvius, and other volcanoes, lava streams are seen stretching in  all
directions, which have flowed down like rivers.  These lava streams are of different
ages, and many of them were formed within the memory of man. An investigation 
MALARIAL FEVER.
47
   An  examination  of  the  origin,  development,  structure,  and
 relations  of  all  vegetables  and  animals,  commencing with  the

 of these lava streams affords an opportunity of determining the gradual distribution
 of vegetables.   Some are still naked, others have only a few plants scattered here
 and there in hollows and crevices, and in others the decaying plants are forming
 a soil.  According to the observations of Prof. J. F. Schow, the plants which first
 settle upon the naked lava, and form a soil for the more complex, are especially
 those  lower  and simply organized plants, called lichens.  Certain succulent and
 fleshy plants, as the Indian fig (opuntia vulgaris), which are nourished chiefly by
 the carbonic acid and aqueous vapor of the open air, absorbed by the stem and
, leaves, are also amongst the earliest inhabitants of the lava streams. Geology also
 teaches that the lower orders of plants appeared first upon our globe.
   As the luxuriance and perfection of plants depend upon the temperature of the
 surrounding medium, and the intensity of the forces of the  sun;  so also the per-
 fection of the nervous system, and of all the organs and apparatus, and the activity
 and intelligence of animals, correspond, in a great measure, to the rapidity of the
 physical and chemical changes going on in the molecules of their bodies,  and to
 the relations of the physical, and chemical, and vital forces, and to the temperature
 which they are able to maintain, regardless of that of the surrounding medium.
   As the chemical changes become feeble, and the temperature of animals descends
 and becomes dependent upon that of the surrounding medium, they become more
 simple in  their organization and  mode of life, the conditions of their existence
 become less  restricted, and they resemble closely the simple forms of vegetables,
 and in the twilight of existence we can  scarcely distinguish between the  lowest
 forms of plants and animals.
   If we examine the relations of the physical and chemical agents to the animal
 kingdom, we will find  that the most  simply constructed animals, many of which
 are devoid of a nervous  system and special organs of sense, as the infusoria, are,
 as in the case of the simply organized plants, the most widely distributed over the
 face of our globe, and are at the same time  far  less dependent for their existence
 upon the temperature  of the surrounding medium.
   Infusoria occur in immense numbers in every situation:  in stagnant pools, in
 marshes, in  mud of rivers, in peat earth, twenty feet below the  surface;  in the
 structures and  fluids of living animals and vegetables, in putrefying organic matter,
 in the bed and waters  of the ocean, in snow, in ice, and in boiling springs.
   Sir John Ross, in the  year  1840, picked  up some brash ice of a brown  yellow
 color in the Arctic regions, not far from Mount Erebus, which was supposed  to con-
 tain aluminous matter, ejected in fine ashes from the volcano.  Specimens were
 brought home in sealed glass vessels, and forwarded to M. Ehrenberg.
   This microscopist found the coloring matter to consist of myriads of infusoria,
 almost the whole of which reached Berlin in 1844, in a  living state.  Here  we see
 that these  microscopical  animals, after having been frozen and  thawed out, lived
 without food for four years.   Certain species of these animalcules have been found
 living and propagating in boiling springs, and some of them have been observed to
 recover after drying in vacuo along with chloride of calcium and sulphuric acid for
 twenty-eight days, and after exposure to a heat of 248°.  The infusorial animals
 were created at an early geologic period, and a  large number of the fossil species,
 which  compose the  polirschifer and semi-opal  of Bilin, are found at  the present
 time living and propagating in the seas and oceans.  The infusoria form a chain 
48
OBSERVATIONS  ON
simplest, and  ending with the  most  complicated,  leads us  to the
summit of the pyramid  upon which stands  man—governed by all
the  astronomical and chemical and  physical  laws  of inorganic
bodies, and comprehending within himself all organic nature—
arising in common with  plants and  animals, from the organic cell,
and like  them, passing through  various stages of development—
endowed in common with all vegetables  and animals, with  vital
force—possessing in  common with all animals, and  in contradis-
tinction to vegetables, a  nervous system endowed with special sen-
sibilities, relating the intellectual faculties to the  exterior  world,
and relating the  various  organs and  apparatus to each other, in
such a manner that, amidst  an  innumerable  number of complex
actions,  unity and harmony result—an organism composed of  in-
organic  elements, prepared  and  grouped into definite  compounds

connecting the organic life of distant ages of the earth, and demonstrating conclu-
sively that the distribution of animals, and the power to survive physical changes,
depends upon their development.
  The simpler the structures, the feebler the vital, nervous, and physical forces,
the less complicated the conditions of existence.  The gelatinous medusae (gelly
fishes) occur in such vast numbers in the cold Greenland sea, that they impart an
olive green color  to the sea, rendering the water dark and opaque, in comparison
with the ordinary cerulean hue.  Cold-blooded vertebrate animals, although more
highly organized than  invertebrate animals,  still  show  remarkable  powers of
enduring extremes of heat and cold without death.  Fish may be frozen and again
thawed out without a destruction of life.   The rapidity with which the absence
of heat is attended with loss  of sensibility and death, is directly proportional to
the development and perfection of vertebrate animals.
  The relations between the  physical, chemical, and vital forces are  strikingly
exhibited in certain cold and warm-blooded  animals,  which become torpid or
hybernate during the winter season.  In this state all the chemical and physical
actions are of the most sluggish character.  The heart scarcely beats, the frequency
and force of the action of the heart and flow of the circulation is greatly diminished
if not entirely stopped.  The  amount of carbonic acid  thrown off from the lungs is
greatly diminished, and all the chemical and physical changes of the elements of
the tissues, and fluids, and organs of these animals are retarded.  If the tempera-
ture of a warm-blooded animal be reduced, in like manner all its physical, chemical
and vital actions will be depressed, and the active  animal will be reduced  to the
condition of a sluggish cold-blooded animal, and death will rapidly ensue.  There
is, however, this  great difference between the cold and warm-blooded animal__the
conditions of the existence of  the latter are far more restricted than those of the
former.  The chemical changes of the cold-blooded animal are  slow, and  it can
exist without food for weeks and months, whilst a few days' starvation is fatal to
the warm-blooded animal.  These facts demonstrate conclusively that  the condi-
tions and phenomena of life  are complicated and restricted,  in exact accordance
with the development and perfection of the organs and tissues of animals, and the
rapidity of the chemical and physical changes  of the molecules of their bodies. 
MALARIAL FEVER.                    49
in the vegetable kingdom, by the combined actions  of the vital
principle, and the physical and chemical forces of matter  and the
sun;  perfect in  its  mechanical structure, and in the arrangement
of its parts, with the size of its organs, the strength of its muscles
and  bones, and  the vigor of  its forces, constructed and arranged
with exact reference to the force of gravity, the size of our globe,
and  its relations with the sun, and  all other worlds  in the uni-
verse—worked  by  forces, always  the  resultants  of the  chemical
changes of those substances which, in the vegetable kingdom, have
been elevated into a state of  force, by the action of the sun upon
matter in  the vegetable  laboratory—worked by  forces to which
the  great laws of mechanics  apply—possessing intellectual facul-
ties, capable of  receiving impressions from the motions of exterior
bodies, and of exciting the forces by which  they are surrounded, and
directing them so as to act upon exterior matter, and overcome all
the barriers  and obstacles of nature,  not by a suspension or altera-
tion of her laws, but by peculiar applications of those forces  and
laws—endowed with moral faculties which  distinguish him from
every other form of matter, and every other being upon our globe—
revolving  with the earth and  planets around the sun, and  with the
whole system, moving through the great  ocean of space, around a
distant unknown  centre—with an  existence like that of  plants
and animals dependent upon the length of the day and of the year,
and  of  the  seasons, which are dependent  upon  the adjustments
of the solar system ; dependent upon the constitution of terrestrial
bodies, and their relations with celestial bodies.
   Man,  then, is a type of the universe.
   If a single one of the nice adjustments and relations of the com-
ponent members  of the solar system  were materially altered, or
even if the relations of the solar system with the  exterior universe
 were materially altered, derangement  of  the structures, and  final
destruction of the  human race must  follow.
   To understand the phenomena of man in  health and in disease, and
his  relations to the  universe, we must  comprehend the phenomena and
 mutual relations of all animate and  inanimate bodies, terrestrial and
 celestial. 
50
OBSERVATIONS ON
                     CHAPTER II.

      THE EXTENT, OBJECTS, AND IMPERFECTIONS OF PATHOLOGICAL
                       INVESTIGATIONS.

  In the preceding chapter we  endeavored to sketch the general
relations of man to the exterior  universe, and demonstrate  the
extent and complexity of his phenomena.
  If man be related to celestial and terrestrial bodies—if the ex-
istence of man  be  dependent upon the adjustments of the solar
system,  the seasons, the  climate, the action of the  vegetable king-
dom, the soil, and upon the great circulation.of matter, kept up by
the forces of the sun—if the  derangement of only  one link in  this
complicated chain of phenomena would result in the destruction of
the human race—if the phenomena of man in health be thus com-
plicated, how much more complicated must be the phenomena of
disease,  when the constitution of the  complex solids and fluids of
man may be altered in many ways, and the relations  between the
physical, chemical, vital, and nervous forces, and  intellectual  and
moral faculties may be correspondingly deranged.
  In view of the immensity  and complexity of physiological  and
pathological phenomena; in  view of the fact, that  no single man,
even during a long lifetime, is capable of investigating thoroughly
the phenomena  presented by only one  disease, the  investigator
should always state clearly his views of the extent and  bearing of
physiological and  pathological  phenomena, and define the scope
and bounds, and methods  of his investigations, and candidly ac-
knowledge their omissions and imperfections.
  We will now proceed, in a condensed and brief manner, to point
out the  sources of disease.
  1. Astronomical changes are attended by corresponding changes
in the phenomena of man.  The changes of the day, and month,
and year, and seasons are attended by corresponding changes in
the constitution and phenomena of man.  Not only would derange-
ment of the adjustments of the  solar  system be attended by corre-
sponding derangements in the little world of man,  but his diseases, 
MALARIAL FEVER.
51
arising from whatever cause or causes, must be influenced by these
changes. As the sun with his attendant planets are progressing con-
tinuously through space, it is not unreasonable to suppose that the
phenomena of man might be modified by the properties and forces
of the regions of space through which the  solar system  travels.
That  a resisting medium does exist in space, to which  the trans-
mission of luminous and thermic vibrations  may be referred, has
been  conclusively demonstrated by astronomers in the  case of
Encke's comet.   What the matter is composing this resisting me-
dium, and whether this  matter is uniform, or varies with  the dif-
ferent regions of space, and whether it exerts any influence upon
the phenomena of man, are questions worthy of a solution.
   Geology teaches that the climate  of this earth has been altered
during different periods  of past times, and  that causes have in past
times destroyed whole races of plants and animals.  Whether these
causes were astronomical or  terrestrial, it is nevertheless true that
similar causes may be the sources of disease.
   2.  The surrounding medium may be physically and chemically
altered, either by an excess  or  deficiency  of  its ordinary  ingredi-
ents,  or by an excess or deficiency of  the forces by which  it is cir-
culated.
   Whilst it is true that the amount of force  annually received by the
earth from the sun is a fixed  quantity, it is nevertheless true that,
owing to the peculiar constitution of  the atmosphere, the nice adjust-
ment of its forces (the  ease with which one mode of force may be
converted into another, as heat into electricity, and vice versa), its
relations to moisture, its relation to the distribution of the forces of
the sun, and its  relations to the  distribution of the  solid and fluid
masses of the earth; the climate is subject  to variations which can-
not be predicted, and are not uniform.  Corresponding disturbances
are produced in the phenomena of man.  The truth of  this propo-
sition is conclusively demonstrated by the relations of certain dis-
eases, as pleurisy and pneumonia, to the weather. And even when
diseases are not directly produced by the disturbances of the struc-
ture and forces of the surrounding medium, it is nevertheless true
that the course and phenomena of disease  are modified, to a great
extent, by meteorological phenomena.  The value of the determina-
tion of these  relations in the investigation of the origin, progress
and treatment of disease, cannot be  over-estimated.
   3.  As the compounds composing  the body of man have  all been
formed by the vegetable kingdom, from the inorganic elements, it 
52
OBSERVATIONS ON
follows that any deficiency of the necessary elements of the soil
would be attended  by deficiencies in the constitution and by com-
position of the food, elaborated by the vegetable kingdom, and by
corresponding disturbances of the constitution and  phenomena of
man.  Corresponding changes in the constitution and phenomena
of plants may be induced by meteorological phenomena.  Hence,
in the investigation of the origin  and phenomena of disease, it is
necessary to determine the chemical and  physical constitution of
the soil, and its relations to the vegetable kingdom.
   4. The salts of the blood, which are absolutely necessary for its
healthy constitution, are obtained in part from  the water  daily
introduced into the system.   These salts may exist in deficiency
or excess; and other abnormal noxious, saline and organic matters
may exist in the water.  Each of these causes  may be a source of
disease.  Hence the  necessity in  pathological  investigations of a
careful examination of the water.
   5. Any one of the normal constituents of the body of man may
be deranged, and occupy different relations to each one of the other
constituents.   As  these constituents are numerous, the resulting
derangements may be correspondingly numerous.  The forms of
this class of diseases may be as numerous as the different positions
which the elements may be made to assume towards each other.
   6. Any one of the elements of his body may be in excess or de-
ficiency, and the  diseases may be as numerous  as the elements
themselves, and at the same  time, totally different from the dis-
eases arising from an alteration in the relative position of the ele-
ments.
   7. Foreign morbific agents may be introduced into  the  fluids
and solids, which will excite abnormal changes in  the solids and
fluids.   The generation of these  morbific agents will depend, in
great measure, upon the relations of climate and soil, and  water
and organic matter, and the forces of the sun.   The number of dis-
eases of this  class will correspond to the number of distinct mor-
bific agents.
   Combinations of these morbific  agents  may produce  still more
numerous and complicated diseases.
   8. As the  matter  composing the human body  is fashioned into
definite organs  and tissues destined to accomplish definite results
and combined into apparatuses, definitely related  to each  other
it is evident that the disturbance of the mutual relations of any one
of these organs and tissues  and  apparatus must, to a greater or 
MALARIAL FEVER.
53
lesser extent, produce corresponding disturbances in the component
members of the human organism.
  9. The Creator has associated the vital force with a definite con-
stitution of matter.   Whatever interferes with this constitution,
interferes with the action of the vital force.  Whatever interferes
with the vital force, necessarily disturbs its relations with the phy-
sical, chemical, and nervous forces.  If the  balance  of the forces,
their correlation be  disturbed, the chemical actions between the
elements may not only be deranged  in kind, but also in degree,
and the generation of the physical forces which work the machinery,
and the manifestation of the nervous, intellectual and moral pheno-
mena, correspondingly altered.
  10. The development and structure of the vegetable kingdom—
the development and structure and actions of the most simply con-
structed animals—the appearance of  the nervous system in the
animal  kingdom, and  in the  foetus of the higher animals, subse-
quently to the grouping of the atoms of formless matter into defi-
nite forms and  apparatuses — the formation of the digestive and
circulatory apparatus, before the formation of nervous cells and
nervous systems,  demonstrate  unequivocally,  conclusively, and
absolutely, that development, nutrition, and the direction  of the
forces  of  matter  to  the fashioning of another part are under the
guidance  of  the vital principle—demonstrate unequivocally, con-
clusively and absolutely, that the nervous  system is itself developed
and its perfection maintained under the guidance of the vital prin-
ciple.   Hence diseases may  arise independently of the nervous
system.  Hence we  may have chemical and physical changes  of
the elements of all the organs and systems of organs, incompatible
with the existence of the vital force in that altered matter.
  Whilst we admit  these propositions, we  must at the same time
bear in mind the true offices of the nervous system.  The nervous
system  is  the last and best work of the forces of matter directed by
the vital force, and is destined to form the medium of communica-
tion between the intellectual faculties and the exterior world; and
is destined to connect together and influence the various organs and
apparatuses; and is  destined  to regulate  secretion and  excretion,
and the consequent development of force; and is destined to excite
and control the actions of the dynamic muscular apparatus, not by
the possession and emission of  a peculiar force generated de novo,
but rather by a modification of physical force generated by the
mutual chemical reactions of  the blood and nervous systems. 
54
OBSERVATIONS  ON
  That the nervous force is not capable of itself of carrying on the
acts  of nutrition, secretion and excretion, is conclusively  demon-
strated by the fact that plants, and the simply constructed animals,
which are devoid of a nervous system, are  capable of carrying on
the offices of generation, development, digestion, assimilation, nutri-
tion, secretion, excretion, and of preserving a definite form amidst
unceasing chemical changes.   Many of the  simply organized ani-
mals, although without a  nervous system, still possess sensation
and voluntary motion.  The nervous system appears only when the
parts of the machinery are complicated,  and  need special means
of communication.
  The development and perfection  of the  nervous system corre-
spond  exactly to the  development, perfection and  complication  of
the organs and apparatus.   This fact is true of the animal kingdom,
in its successive degrees of development, and also of the successive
stages of the development of the solids and fluids of each individual
highly organized animal.  Physical and chemical actions take place
in a  similar  manner in all  animals, simple or complex;  they  differ
only in intensity.   The higher the  animal, the more complicated
its parts, the  more  rapid  the chemical changes, and  consequent
generation of the forces, and the  greater is the necessity for  some
special apparatus which will  bring all the complex organs and
apparatus and actions into harmonious relation.
  Unless the actions of different organs can be  telegraphed  (so to
speak) to each  other, confusion  in a complicated organism will
necessarily result.  Thus, if the amount of blood circulating through
any  organ and the chemical actions are too great, how can they  be
regulated without some medium of communication, and some means
of regulating the chemical  and physical actions.
  The observations and experiments of  Rufus  Ephesus,1 Galen,2
Piccolhomini,3 Riolan,4 Plempius,5 "Wills,6 Chirac, Winslow, Bohn,7
Duverney, Vieussens,8 Schrader, Valsalva, Morgagni, Baglivi, Con-

  1 Appellationes, Part. Hum. Corp.  Grace. Parisiis, 1554, p. 32.
  2 Galeni Opera. Venetiis, apud Juntas, 1576, de Hippocr. et Plat, decretus, lib.
ii. cap. vi. p. 238.
  3 Anatomicae Praelectiones Archang. Piccolhomini, Romae, 1586.
  4 Opera Anatomica. Lutetiae Parisiorum, 1649.
  5 Fundamenta Medicinae. Lovanii, 1644.
  6 Opera Omnia, edente Balsio.  1682, torn. i.  Nervorum Descriptio.
  7 Circulus Anatom. Physiol. Lipsiae, 1697.
  8 Treatise on the Heart, Toulouse,  1715. 
MALARIAL  FEVER.
55
ter,  Berger,1  Ens  Sinac,  Huermann,  Haller,2  Brunn,3 Molinelli,
Petit,4  Fontana,5  Cruikshank,  Haighton,  Meyer, Bichat,6 Dupuy-
tren, Dumas,7  Bainville, Provincal,8  Yesalius,  Columbus Riolan,9
Bidloo,10 Muralto, Chirac, Courten, Drelincourt,11 Martin,12 Emmet,
Portal,  Prochaska,13  Winslow,14  Le  Gallois,15  Philip, Lobstein,16
Reid,17 Krimer, Arnemann, Longet,18  Brodie,19  Chossat,20  McCart-
ney,21 Nasse,22 Bernard,23 Hall,24 Brown-Se'quard,25 and others, have
demonstrated that to  the nervous system is delegated this property
of regulating  the action of the  organs and  apparatus,  and  thus
regulating the amount of oxygen and blood supplied to the organs
and tissues and apparatus.
   The blood supplying the nutritive elements of the  tissues and
organs, and the materials for the secretions and development of the

   1  Physiologia Medica, Francofurti, 1737.
   2  Memoires sur les parties sensibles et irritables, torn. i.
   3  Commentarii de rebus in Scient. Nat. et Medic. Lipsiae, torn. iv.
   4  Memoires de l'Academie des Sciences, an. 1727.
   5  Traite sur le Venin de la Vipere.
   6  Recherch. Phys. sur la Vie et la Mort, Insere dans la Biblioth. Medic, torn.
xvii. p. 1.  Physiological Researches on Life and Death, by Xavier Bichat, trans.
by F. Gold, London.
   7  Journal General de Medecine, par M. Sedillot, torn, xxxiii.
   8  Bulletin des Sciences Medicales.
   9  Encheididium Anatom.  Parisiis, 1658.  Opera Anatomi.
   10  Exercitationes Anatom.  Chirurg.  Lugd. Batav., 1708.
   11  Experimenta Anatom.  Lugd. Batav., 1681.
   12 Essais et Observ. de  Medecine de la Societe d'Edimbourg. Paris, 1742.
   13  Opera Minora.  Viennae,  1800, torn. ii.
   14  Exposition Anatom. Traite" des Nerfs.
   15  Experiments on the Principle of Life, and Particularly on the Principle of the
Motions of the Heart, and the Seat of this Principle, by M. Le Gallois.   Translated
by N. C. and J. G. Nancrede, Philadelphia, 1813.
   16  Structure, Functions and Diseases of the Human Sympathetic Nerve, by John
Fred. Lobstein.  Translated  by Joseph Pancoast, M. D., Philad., 1831.
   17  "An Experimental Investigation into the  Functions of the Eighth Pair of
Nerves," by John Reid, M. D. Edinburgh Medical and Surgical Journal, 1838.
   18  Traite de Physiologie, Paris, 1850, t. ii.
   19  Medico-Chirurg. Trans., 1837, vol. xx. p. 132.
   a0  Mem. sur l'influence du syst. nerv.  sur la chal. anim. These de Paris, No. 126,
1820.
   21  Treatise on Inflammation, 1838, p. 13.
   22  Untersuchungen zur Physiol, und Pathol., 1839, vii.
   23 Gaz. Medic,  de Paris, vol. vii. No. 14.
   24  Phil. Trans., 1833.  On the  Diseases and Derangements of the Nervous Sys-
tem, by Marshall Hall, M. D., London, 1841.
   25  Experimental Researches applied to Physiology and Pathology, by E. Brown-
Sequard, New York, 1853. 
56
OBSERVATIONS  ON
forces, and oxygen being the active  agent in all the  chemical ac-
tions of the bodies, it is evident that whatever disturbs the consti-
tution of the nervous system, necessarily disturbs the functions of
the apparatus and organs, and  produces corresponding alterations
in their secretions and excretions.
   As the integrity of the nervous system depends upon the in-
tegrity of the blood, in like manner whatever alters the constitu-
tion of that  fluid will produce aberrated action in the nervous
system, and in turn, this disturbance may extend itself indefinitely.
   Disease, then, whether arising in the organs, or in the  blood, or
originally in the nervous system, will always be  attended by aber-
rated nervous action.  The most  prominent symptoms of disease
will be manifested by the nervous system.
   The value of the phenomena manifested by the nervous system
during febrile diseases, has been  recognized by no one more fully
than Professor Henry F. Campbell,1 M. D., in his able and elaborate
classification of fever by the nervous  phenomena.
   In all our investigations into the causes and effects of disease, we
should always  remember the distinction between the offices  and
phenomena of the two systems of nerves, the cerebro-spinal  and
sympathetic.
   Long before Haller,  the intellectual  functions, sensation,  and
voluntary motions, had  been distinguished from those which are
exercised without our knowledge, and over which our will  has no
command, such as  circulation, nutrition, and secretion.  The former
were distinguished under the name of external animal functions,
and the latter under the name of internal natural  functions,  and
both orders of functions were known to  be equally under the  con-
trol of the nervous power.  Willis2 asserted the distinction between
the nerves destined  to voluntary motions and those which preside
over the internal  natural functions which are independent of the
will.  He placed the origin of the nerves of the external  animal
functions in the cerebrum, and that of  the nerves of  the internal
natural functions  in the cerebellum, and contended that if the
motions of the heart as well as  the  other vital functions  do not

  1 Report on the  Nervous System in Febrile Diseases, and the  classification of
Fevers by the Nervous System, by Henry Fraser Campbell, A. M., M. D., Professor
of Anatomy in the Medical College of Georgia, at Augusta.  Transactions of the
American Medical Association, 1858.
  2 Tho. Willis opera omnia, edente Ger. Balsio.  Amstelodami, 1682.  Tom. i. de
Cerebri Anatome, cap. xv. 
MALARIAL FEVER.
57
undergo any interruption, it is because the action of the cerebellum
continues without ceasing;  whilst  on the contrary the voluntary
motions require repose, because  the  action of the brain is inter-
mittent.
  Boerhaave1 adopted the opinions of Willis, and in the  action of
the heart, in addition to nervous action, he admits two other causes
of its motions,  and their  harmony: the action of the blood of the
coronary arteries upon the  fibres of the  heart, and of the venous
blood in the internal surfaces of the cavities of the heart.  Recent
experiments2 have rendered this opinion  of Boerhaave more  than
probable.
  In 1752, Haller  published  his experiments upon irritability,
which tended  to establish  the existence of an internal  life inde-
pendent of the nervous power, and demonstrated that the cause of
animal motion  resided in  the muscular fibre itself.  The opinion is
now gaining ground with physiologists that the contraction of the
muscles  and all animal motions result from the chemical changes
of the elements of the muscles and blood.   Haller admitted that
whilst the irritability of  the muscles is  the  cause of all  animal
motions, it  cannot produce them without a stimulus, and that the
nervous power is the natural stimulus of all those which are sub-
mitted to the  will, whilst  the involuntary muscles acknowledge
stimuli of various  sorts, which, are appropriate to their functions,
and wholly abstracted from the nervous power.   According to
Haller, the blood  is  the  natural stimulus of the irritability of the
heart; and  alimentary substances the natural stimuli of  the intes-
tinal canal: and the  motions of these organs  are not  submitted to
the will because they are  independent of the nervous power.  This
theory of Haller,  although  imperfect, and in some  respects errone-
ous, nevertheless expressed great truths  which are now being de-
monstrated.  Careful experiments  demonstrate that Haller was in
error when he asserted the independence of the heart and the intes-
tines of the  nervous system; and Prochaska,3 in 1784, admitted the
nervous power as one of  the conditions necessary to the manifesta-
tion of irritability, and accounted for the fact that the motions of
the heart were  not  stopped by the entire suppression of all  com-
munication  between the brain  and the heart, by the abandonment

  1 Her. Boerhaave Inst. Medicae,  § 409.  Vanswieten in Aphorismis, &c.  Lugduni
Batav., 1745.  Tom. ii.
  2 Brown-Sequard.
  s Commentatio de Functionibus Systematis Nervosi, 1784.
       5 
58
OBSERVATIONS ON
of the then generally received opinion that the brain was the centre
and only source of the nervous power, and by the adoption of the
opinion that the nervous power is produced in the whole extent of
the nervous system, even in the smallest nerves, and that it can
exist independently of the brain, for a certain time.
   Willis1 and Vieussens2 acknowledged the  general  relations of
the sympathetic system with the cerebro-spinal, and considered the
sympathetic as the  medium by which the  sympathetic relation is
rendered so remarkable between the cerebrum and  the viscera of
the middle  and lower parts of the abdomen, and noticed  the im-
portant physiological and pathological facts that not only do the
various conditions of the brain affect the viscera, but the affections
of the viscera affect the brain as well as the mind itself.
   The observations and  researches of Winslow,3 Girardi,4 Fontana,4
Jacobson,5 Lobstein,6 Ribes,7 Killian,8 Laumonier,9 Cloquet,10 Scarpa,
Hasse, and  others,  established the structure and  distribution  and
communications  of the sympathetic  system  of  nerves, and  laid
the foundations for the philosophical generalizations of the physio-
logical and pathological  phenomena.
   Scarpa demonstrated by actual experiments, that the sympathetic
system receives  nerves  from all  parts of the nervous system, the
brain and  spinal marrow, and  that all the viscera receive nerves
composed of many  separate filaments from different sources.
   Wiirtzel  divided all the ganglia of the sympathetic system into
three orders, the cerebral,  spinal, and  vegetative, and  affirmed
that they differed essentially from each other in their structure, and
in their behavior under the action of chemical agents.
   Prochaska distinguished the nerves of motion from those of sen-
sation, and affirmed that the heart cannot contract itself, unless the
impression of the stimulus  upon its cavities is transmitted to the
ganglions of the system  of  vegetative  life, through  the  nerves of

   1 Nervorum Descriptio et Usus. Cap. xxvi. Opera Omnia.  Genevae, 1695, tome i.
   B Neurograph. Univers., lib. 3 de Nervis, cap. v.
  3 Exposition Anatomique, Traite des Nerfs.
   4 Journal de Medecine, Chir. et Pharm., par Bacher, torn, xciii.
  5 Acta regiae Societatis Hafniensis Medicae, vol. v.  Hafniae.
  6 Structure, Functions, and Diseases of the Sympathetic Nerve, by J. F. Lob-
stein.  Trans, by J. Pancoast.  Phila., 1831.
   7 Dictionnaire des Sciences Medicales, torn. lvi.
   8 Anatomische Untersuchung uber das Neunte Hirnnervenpaar, Pesth, 1822.
   9 Journal de Medecine, Chirurgie et Pharmacie, par Bacher, torn, xciii.
  10 Traite d'Anatomie Descriptive, torn. ii. 
MALARIAL FEVER.
59
sensation, and thence reflected to  the fibres of the  heart, through
the nerves of motion.   Whilst admitting the  connection  of the
sympathetic system  with the  action of the heart, he is  confused
and uncertain in his account  of  the functions of  the ganglions,
which he appeared to consider as knots and ligatures, tight enough
to intercept all communication in the calm and quiet state, but not
sufficiently tight to  prevent the action of the nervous force, gene-
rated in the brain during the agitation of the passions.  He asserted
that it is through the nerves of the eighth pair that the effect of
the passions is felt upon the heart.
   In common with Winslow, Wintrel, Johnstone, and others, Pro-
chaska believed that the ganglia of the  sympathetic system were
so  many little  brains capable  of  supplying the necessary nervous
force to the viscera.
   Bichat  acknowledged an  animal  and  organic life  distinct from
each  other, and affirmed that the system  of ganglions (sympathetic
system) belonged entirely to the organic life, and that the cerebral
system belonged entirely to the animal.
   Whilst Bichat understood the influence of the several parts of
the  nervous systems, he  failed to  recognize  their mutual  connec-
tions.  The mutual  relations of these systems were established by
the exact and philosophical experiments  of Le Gallois.1

  1 In his work, which was pronounced by Humboldt, Halle, and Percy, the com-
missioners of the French Institute to whom it was referred, " the most important
physiological work that had been produced since the  learned experiments of
Haller—the most unexampled work in physiology, every part of which is so con-
nected and so dependent upon each other, that to arrive at the perfect explana-
tion of a fact, it is necessary to reascend to all those by which the author had
arrived at it; and that  no one deduction can be denied, without denying all the
preceding ones, or raising a doubt respecting those which follow."  Le Gallois, by
an extensive series of experiments, arrived at the following conclusions :—
  " Life is  produced by an impression of the arterial blood made upon the brain
and medulla spinalis, or by a principle resulting from this impression.
  " The prolongation of life depends upon the continual renewal of this impression.
The property of the principle in question to survive wounds, and a very consider-
able destruction of the  rest of the body, provided its peculiar  seat has not been
injured, affords a ready criterion for  determining in what part of the nervous ap-
paratus the primum mobile of such a function resides.  For whenever, by destroy-
ing a certain portion either of the brain or of the spinal marrow, you cause the
cessation of a function suddenly, and before the known period when it would cease
naturally, you may be assured that this function  depends upon the part that has
been destroyed.  It was in this manner that I discovered that the primum mobile
of respiration had its seat in that part of the medulla oblongata which gives rise
to the nerves of the eighth pair; and it is by pursuing this mode, that one might, 
60
OBSERVATIONS  ON
    The results  of the experiments  of Le  Gallois  were  confirmed
 and extended by the minute, elaborated, and extensive anatomical,

 to a certain degree, discover the use of certain parts of the brain, so much the ob-
 ject of speculation, but  hitherto only defined in systems  produced by a lively
 imagination. . .
   " It is this impression, this  principle formed in the brain and spinal marrow,
 which, under the name of nervous power, and through the medium of the nerves,
 animates all the rest of the body, and presides over all its functions.
   " The heart derives all its powers from this principle, as do all the other parts,
 the sensation and motion with which they are endowed, with this difference, that
 the heart derives its power from every point of the spinal marrow, without excep-
 tion, whilst every part of the body is only animated by a portion of that medulla
 (by that which is supplied with nerves) ; a difference which may serve to explain
 the intensity of the power of the heart, and its uninterrupted continuance, from         *.
 the moment of conception, till the hour of death.
   " From the great sympathetic nerve, the heart receives its  principal nervous fila-
 ments ; and it is only through that nerve, that it can receive its energy from every
 point of the spinal marrow.  The great sympathetic must, therefore, have its origin
 in this medulla ; and thence the numerous questions that have been raised on the
 origin of this nerve, namely, whether it proceeds from the brain or from the spinal
 marrow; or, as Bichat pretends, whether those different portions are  only branches
 communicating from the ganglions, which this author considers as so many smaller
 brains, forming a distinct nervous system, independent of the brain and the spinal
 marrow.  All these questions, hitherto inexplicable in anatomy, are completely de-
 termined by experiments. . .
  "From the same  principle, we can no longer admit the assertion of Bichat,
 though pretty generally adopted, that there is in the  same individual two distinct
 lives, one animal, the  other organic ; that the brain is the only centre of animal
 life ; and that the heart, independent of the brain  and of the nervous power, is the
 centre of life.
  " It must, however, be observed, that there is a real and a very important dis-
 tinction to be made between the organs that receive their nerves from the great
 sympathetic, and those which receive theirs immediately from the medulla ob-
 longata and spinal marrow.
  " The former receive their principle of action from the whole nervous power;
 their functions are not submitted to the will; they are exercised in every instant
 of life, and, at most, suffer only remissions.
  " The latter, on the contrary, have their principle of  action in a limited portion
 of the nervous power ; their functions are submitted to the will; they are tempo-
 rary, and can only be repeated after complete intermissions of longer or shorter
 duration.
  " This distinction  comprises nearly the same organs as that of the two lives ; but
it is evident that it rests upon a basis entirely different, since the organs of organic
life, which,  in the system of the two lives, is considered as independent  of the brain
 and of the spinal marrow, are precisely those which receive the most powerful in-
fluence from it.
  " Numerous  anatomical, physiological, and pathological  facts can only be con-
ceived and accounted for by this distinction.   For instance, it is known that cer-
tain pains in the bowels cause debility, prostration of strength, and great disorder 
MALARIAL FEVER.
61
 physiological, and pathological researches of Lobstein,1 who antici-
 pated many of the results of recent experiments and research.

 throughout the animal economy.  This fact, which is unaccountable in the system
 Of the two lives, is readily understood, from the moment we reflect that the  intes-
 tines derive their principle of action from all parts of the nervous power, through the
 great sympathetic, from which they receive  their nerves ;  and that consequently,
 their affections ought to react immediately upon every part of this same power."
   " Experiments on the Principle of Life, and particularly on the Principle of the
 Motions of the Heart, and of the Seat of the Principle," by M. Le Gallois, M. D. P.
 Translated by N. C. and J. G. Nancrede, M. D., Philadelphia, 1813, pp. 142-148.
   1 The following quotations from the elaborate work of Lobstein upon the Struc-
 ture,  Function, and Diseases of the Sympathetic  Nerve embody the most important
 results and generalizations established by this author, and illustrate in a forcible
 manner the relations between the cerebro-spinal and sympathetic  systems.  The
 author sums up in the following manner the theories of Reil and others :—
   " The cerebral nervous system is formed differently from that of the sympathetic
 system.  The branches of the former  converge from the  periphery of the body
 towards the cerebrum, and are inserted into it by their roots, as the roots of vege-
 tables are in the soil; that system, therefore, has but one centre, which is in the
 encephalon.   The latter, on the contrary, is not collected into any centre ; it has
 no focus of action, but exercises its functions over a wide surface.
   " The sympathetic system connects the organs together in three different modes.
 1. It forms  networks around the vessels, which embrace the  arteries with their
 slender and minute branchlets (as the ivy clasps the stem of a tree), and  pene-
 trates with them to the organs.  These networks are known under the name  of
 plexuses, twelve of which are enumerated, appertaining to different parts. * * *
 2. These plexuses are connected to  the brain  and medulla spinalis by branches
 which Reil  calls conductors.  * * *  3.  These branches,  the conductors of the
 plexuses, appear to form a perfect connection between the  animal  and vegetable
 systems ; every commotion which the lower viscera  suffer would be conveyed to
 the sensorium commune, and vice versa—the will would exercise a perfect control
 over the organs of the thorax and abdomen, were not these movements intercepted
 by enlargements in the conductors called ganglia."—pp. 72, 73.
   " When the two nervous systems by which the animal is rendered more perfect
 are considered physiologically, each may be  esteemed a  sphere  of activity in
 which the vital actions are differently performed.  In the animal sphere (that is,
 in the cerebrum, the medulla spinalis, and their nerves) the determination of the
 will  and senses, when transferred to the common sensorium, become impressions
 instanter, and, as it were, at a single impulse.  In the vegetative sphere the nerv-
 ous energy is slowly, steadily, but obscurely, dispersed into the organs.  These are
 connected together, act according to their peculiar laws, and compose a system
 separate from the animal sphere, over which  appropriate laws preside.   This sys-
tem also possesses the faculty of perception—namely, it receives impressions, and
reacts upon them; but this perception abides in its own region, and is not commu-
nicated  to the  brain.   In a healthy state, the system of ganglia exerts no manifold
influence upon the cerebral system, from which it is divided by the separatory or
isolating apparatus, the series of ganglia in the sympathetic nerve.   But the case
is different in a state  of disease, for when the vital energy is increased in the com-
municating nerves of the plexuses, the condition of the ganglia is changed ;  they 
62
OBSERVATIONS  ON
transmit impressions which the extremities of the nerves in the viscera receive,
and become conductors, whilst before they were non-conductors or isolators.
—pp. 74, 75.
  " In the foetus none but the sympathetic nerve is in vigorous  action; it exists
previous to the secretory and nutrient organs ; it sustains the energy of the heart;
and breaks in sometimes upon the cerebral sphere, and determines those  automatic
motions which the infant, when closed in the uterus, performs with its muscles.
Acephalous foetuses, destitute of cerebral and spinal medulla, and hence wanting
the nervous centre from which emanates the principle of muscular contractions,
perform, nevertheless, muscular movements which can be in no other way excited
than by the vital influence of the sympathetic nerve, which is joined by an anas-
tomosis with the spinal nerves."—p. 77.
  " During the extra-uterine life of man, when there exists some immediate internal
sense inherent to the stomach, this nerve forms a remarkable intercourse between
the cerebrum and the viscera of the thorax and abdomen, as is proved by number-
less phenomena.  Then,  as in the embryo and foetus, it governs the  system of
capillary vessels, and directs the functions of  assimilation and nutrition, through
the influence of the vital plastic power, which Broussais calls vital chemistry." * *
-p.  77.
  After this general statement of the  theories broached and  facts established by
others, Lobstein proceeds to give the results of his own investigations.
  " No one will certainly deny that there exists in animals a certain central influ-
ence with which the duration of life  is intimately connected.  No one will deny
that  this  central influence is  inherent, not to the osseous, vascular, or muscular
systems, or nutrient organs, but to that initial  system which is  nobler than  the
rest,  and involves the first character of animality, and after removal of which all
power perishes—viz., the  nervous system."—p. 77.
  After a careful examination of the origin and development of the nervous sys-
tem in the animal kingdom, he concludes—
  " 1. That there is a nervous system in the invertebrate animals which is marked
with ganglia.  2.  That in the lowest order of these animals the first nervous mass
found belongs to a nutrient organ.  3. That other tubercles are speedily added in
animals  a little superior in the scale, which are  not dissimilar to the cerebral
system.
  " In animals of a superior order the motorial and sensorial ganglia of the organs
are inflated,  as it were, into  one system, the cerebral, in which the  gangliform
figure disappears; so, on the  other hand, the organs  employed  in  nutrition are
formed into a peculiar system in which the primitive arrangement and form of the
nerves remain, and which (as in the lowest class of animals) closely surround the
intestinal canal with their branches.
  "According to a corollary of the greatest  importance, there exists  a relation
between the sympathetic nerve and the par vagum—to wit, that  one  may  take
upon it the functions  of the other; for in the inferior vertebrated animals the par
vagum appears to be more prolific in branches distributed to the intestines, as the
sympathetic  nerve is less ; and it is  found that  in some vertebrated animals no
sympathetic nerve exists at all, and in which its  functions are performed by the
par vagum only.  Whence it follows that the par vagum should be classed under
the same law as the sympathetic itself, with the nerves  of vegetative life. In fine
in all orders of animals  the  sympathetic  nerve is always found, in regard to its
development, to correspond with the pre-existing vascular apparatus; which proves
that it owes its delicate construction to the wants of the vessels. 
MALARIAL  FEVER.
63
  " A nervous system which exists in the lowest scale of animals is peculiar to the
nutrient organs, and performs especial  functions of its own, which, prior to the
appearance of the brain, constituted a nervous centre, and which, when the cere-
bral centre is formed in animals, is inter-connected only, and never composes with
it one undivided apparatus, but always retains its pristine form and habit—that
such a system is endowed with the greatest functional importance is self-evident."
—p. 81.
  "As to the forces, the branches of the sympathetic  nerve  are  undoubtedly en-
dowed with the same power as nerves in general; that is, from the vital principle
by which tone, strength, and energy are  maintained in the organs over which they
preside. It does not seem improbable that the ganglia which diversify the trunk
ought to be considered as the laboratories of that principle, which the internal or
egredient branches conduct to the viscera, and of the nature of which  we are
entirely unacquainted.   In the cerebral voluntary nerves, as well as in the sym-
pathetic nerve, the nervous principle traverses in both directions ; to wit, from the
trunk into the branches, and again from the branches  into the trunk."—p. 82.
  " But the branches of the sympathetic belong principally to the arteries which
they envelop, while the finest filaments which follow the arterial branches into the
organs  are terminated in the external coat.  Hence it  is manifest that the vessels
are primitively constituted under the  government of the nerves, and that  from
them the force and energy are borrowed with which they operate in the functions
of nutrition and secretion."—p. 83.
  " From all that has been hitherto produced, we are at liberty to conclude that
there is no essential difference between  the sympathetic nerve and the encephalic
mass and spinal nerves, but that the two nervous  systems are so far distinct that
both are peculiarly situated according  to the different conditions in which they
exist in the body.
  " In the  anatomical part of this treatise it was first demonstrated that the trunk,
branches, and filaments of the sympathetic  nerve have the same structure as the
cerebral and spinal nerves, the same plexiform division, and, when examined with
the microscope, the same composition ;  to wit, medulla and neurilemma.  On the
other hand, I know, from attentive observation, that the sympathetic nerve trans-
mits the impressions it receives to the  common sensorium in the same manner as
the cerebral  and spinal nerves.  Thus  an irritant  afflicting  the primse viae is per-
ceived immediately by the brain, as the following demonstrates : 1.  The tormina
occurring in  various diseases.  2. A calculus  lodging in the  biliary ducts, the
pelvis of the kidneys, or the ureters.  3. An irritant near the hepatic plexus, from
which an animal was seen to  suffer by  Haller.  4.  The galvanic agent producing
intense peristaltic motion, and secretion of the intestinal fluid, according to the
experiments of Grapengeiser."—p. 87.
  " The sympathetic nerve presides over the function of nutrition, not only be-
cause it imparts many nerves to the chylopoietic organs, and sustains their energy
and influence, but  because it is also distributed to the arteries, which carry the
nutrient blood.
  " Let us suppose the nervous power  destroyed in the abdominal plexuses ; the
tone of the stomach, gastric, and intestinal digestion, and the functions of the liver
and spleen would be impaired.
  " That this indeed may take place, is taught by numberless instances of mental
disease, which, when thrown upon the  solar plexus, suddenly disturbs the whole
function of digestion.
   " The abnormal action of the abdominal nerves  exercises  an  influence over the 
64
OBSERVATIONS  ON
organs, in regions very distant from each other, from which it is manifest that the
functions of assimilation and nutrition are under its subjection.  Recently one of
my intimate friends, who is about thirty years of age, after being suddenly terri-
fied by the burning of his house, had his hair to turn white in the course of a few
days.  Was it not the mental suffering he  experienced, which, by the unanimous
consent of physiologists, deranges the abdominal nerves, that in this case produced
the change by disordering the force and functions  of  these  nerves ? and did not
this disordered action affect the nutrition of the capillaries 1
  " Physiologists have long since acknowledged the great influence  of the nerves
over the  capillary and nutrient vessels.   Thus, if it is enhanced, the action of the
latter is increased ; if diminished, weakened; if utterly deficient, destroyed; hence
it is as they are maintained to supply this office, that they have not  any control
beyond it.  Is it  not then evident, that when the nerves are injured, nutrition
would be frequently destroyed ?  The experiments of Dupuy upon horses, in which
the superior cervical ganglia were  cut away from either side,  furnish good proof of
this ; contraction of the pupil, redness of the conjunctiva (phenomena since  ob-
served by F. Petit), emaciation of the whole body, cedema of the feet, and an uni-
versal cutaneous inflammation followed the operation."—pp. 89, 90.
   " What I have said of nutrition in general, holds good in  the secretions of  the
fluids, because the same mechanism supports  secretion."—p. 91.
   " As we are considering  physiological and pathological phenomena, we will ask
if there be any ignorant that the  secretion of the fluids in the glands may be in-
creased by the effects of the imagination alone.
   " Who can deny that the maternal milk, the bland  and sweet nutriment of in-
fants, has been suddenly  changed by mental affections  to  an atrocious poison ?
No other instruments  certainly exist but the nerves, by whose aid  the  psycholo-
gical irritant can act upon the  organs.
   " The  sympathetic nerve governs the action of the heart and the circulation of
the blood.
   "The  cardiac  nerves have the  same relation to the fibres of the heart, as the
 cerebral and spinal nerves with the voluntary muscles."—pp.  92-93.
   " The sympathetic nerve forms an admirable chain of connection between the
 principal organs of the human body."  This proved anatomically and psychologi-
 cally and pathologically.   "The sympathetic action is by no means circumscribed
 to the cavity of the abdomen; on the contrary, it spreads  itself wider, and con-
 nects the separate parts of the body in close union with itself.
   " Most of the phenomena, indeed, may be considered as consensual, in which the sym-
 pathy is proved to arise from the connection  and interlacing of  the nerves.  1st. Titil-
 lation of the nose produces sneezing, because the nasal nerves of the  spheno-palatine
 ganglion are  connected through the medium of the deep-seated  and superficial vidian
 nerves,  with the  sympathetic; from which the  diaphragmatic plexus  arises,  which  is
 joined by anastomosis of the phrenic nerve.  2d.  An intense light also  excites sneezing,
 for the impression being perceived by the retina, and transferred instantly to the ciliary
  nerves, is  conveyed to the sympathetic, and by the nasal branch, and the remaining nasal
  nerves of the fifth pair.  3d.  The anastomosis of this nerve (sympathetic) with the fifth
 pair, accounts for the  gritting  of the teeth, and itching of the nose, in  the verminose
  diseases  of children; renal calculi, or nephritis, produce  vomiting, or other  disorders
  of the stomach, whilst the  stimulating cause, if confined to the bladder, rarely excites
  gastric  derangement.  For the nervous  communications are  more conspicuous and
  more numerous between the kidneys and stomach, than between the stomach and
  urinary bladder.   5.  The observations of celebrated practitioners instruct us, that 
MALARIAL  FEVER.                       65
many laboring under diseases of the abdominal viscera, suffer cloudiness of vision
that the retina is also drawn into consent."—pp. 96, 97.
   " But the medium through which the  connection of the nerves is chiefly made, is the
par vagum, the principal anastomoses of which with the intercostal nerve, in the neck,
thorax, and abdomen, form many plexuses, upon which the action of the sympathetic nerve
depends,  and through the medium of which, chiefly, that admirable intercourse exists be-
tween the head and abdomen, known to physicians in all ages."—p. 97'.
   " In this respect the fascia  communicans of Wrisberg is of great importance, and
which, in my judgment, might be more aptly named, the great abdomino-cephalic
anastomotic branch, for by it the  animal life is connected with  the nutrient or
vegetative, so that the  mutations of  one may be immediately felt within the do-
mains of the other, perceived by the mind, and vice versa. I shall allege some
cases of  abdominal  disease in the  third section of this work, in which this sym-
pathy is sufficiently manifest in the morbid state."—p. 98.
   " The route by which the descending or ascending impression goes and returns,
is none  other than the abdominal fascia, or the abdomino-cephalic anastomotic
branch.   This alone, and uninterrupted by ganglia,  forms the immediate inter-
course between the cerebrum and abdomen."—p. 99.
   " In reflecting  upon  the nature  of intermittent fevers, I  have thought that it
might, perhaps, be found in  the  disorder and perverted action of the abdominal
nervous  system, and there appear, indeed, to be sufficient grounds to render this
opinion probable."  * * *—p. 121.
   " The paroxysms of intermittent fever are tied down to a regular  rhythmus, in
consequence of their being radicated in the nervous system, upon which nature has
impressed a law, according to which  they must perform their functions periodi-
cally."—pp. 121, 122.
   " Each nervous system, therefore,  is obnoxious to its  own  diseases.  But the
mode in which the cerebral and  spinal nerves, and the nerves of the abdominal
plexuses and ganglia are affected by disease, is the same.  As in the various kinds
of convulsions, epilepsy, tetanus, etc., there is disorder in  the voluntary nerves,
even when no organic lesion can be discovered in them ;  so the nerves of the tho-
racic and abdominal viscera  may be affected without  any alteration perceptible to
the senses.   As the perverted action  of the cephalic brain  is reflected with great
force upon the abdominal  brain, so in turn does the  latter react upon and over-
whelm the former;  and finally as the cerebral system, when it is stupefied, as it
were, by the violence of disease, destroys life, in like  manner, I believe, an analo-
gous effect takes place in certain diseases in the solar plexus."—p. 122.  Connection
of the sympathetic and  cerebro-spinal systems, illustrated by numerous patholo-
gical conditions.  Effect of blow upon  epigastrium, p. 122.  Effects of the recession
of miliary exanthemata  in producing abdominal paralysis or apoplexy, hemicrania
excited by hypochondria and hysteria, p. 122.   Relations of affections of the head
to the state of the ganglionic  system and the bowels, pp. 124, 125.  Explanation of
delirium and of the action  of cathartics in modifying  the  phenomena of fever, pp.
122, 125-6.  " Sympathy between the teeth and abdominal nerves," p. 127.
   " The perverted action  of the brain is by no  means circumscribed to  the cavity of the
cranium; it is extended to distant regions of the body, whence organic diseases are pro-
duced.
  "After lesions of the brain there is undoubtedlg a dynamic  disorder of the nervous
apparatus of the liver, antecedent to the inflammation and suppuration of that organ.
Various hypotheses have been invented to explain the connection between  the brain and
hepatic system, none of which have yet been at all satisfactory.   I may with better rea- 
66
OBSERVATIONS  ON
   The physiological and  pathological relations of the sympathetic
and  cerebro-spinal nervous  systems  have  also   been  subjects  of
elaborate investigation, by Dr. Samuel Jackson,1 Professor  of the
Institutes of Medicine  in  the University of Pennsylvania.

son, refer it to a communication of the right par vagum with the solar plexus, by which
the cerebrum is connected to the right semilunar ganglion, from whence emanate directly
the posterior nerves."—pp. 131, 132.
  Lobstein illustrated the  relations of the sympathetic and  cerebral system of
nerves, and also the connection of the nervous system with diseases, by numerous
pathological facts.  The notes added by Dr. Joseph Pancoast also contain interest-
 ing corroborative facts.
   " A Treatise on the Structure, Functions, and Diseases of the Human  Sympa-
thetic Nerve," by John Fred. Lobstein.  Translated from the Latin, with notes, by
Joseph Pancoast, M. D., Philadelphia, 1831.
   1 The following quotations from his work  on the Principles of Medicine, pub-
lished more than a quarter of a century ago, will show that his views are profound
expressions  of those relations of the nervous  system which  are just now being
recognized by the profession:—
   " Considerations, based on the anatomical structure, lead  to the following infer-
ences as to the functions of the ganglionic system:—
   a.  " It is not independent of the cerebro-spinal nervous system, but derives its
nervous activity from its connection with that system.
   b. " It is connected throughout its whole extent by the numerous nervous fila-
ments passing from one ganglion to another, and uniting together the  different
plexuses.
   c.  " The organs of the head, neck, thorax, and abdomen, with the genital organs,
which receive nervous filaments from this  system, are placed in a communion of
 actions and impressions, which are transmitted from one  to  the other, and it is
 thus  the principal instrument of the sympathies between those organs.
   d.  "Supplying the thoracic  and abdominal  viscera and genital  organs with
 nerves, and communicating with the cerebro-spinal nervous system, it is  the me-
 dium of communication between these organs and the nervous system of relation.
   e.  " Supplying the abdominal and thoracic  viscera and genital  organs with
 numerous nerves, this system must be the chief agent in maintaining the exercise
 of their functions.
   /.  " From  the quantity of nerves which it distributes to the arteries, the close-
 ness  with which these vessels are invested with those nervous filaments, and which
 are lost in their coats, it must exercise an active agency over their circulation, and
 in this manner influence the secretions and nutrition.
   g.  "The  muscles that receive nervous filaments  from  this  system have this
 peculiarity, that they act  without  volition, or  even consciousness.  They  must,
 consequently, receive the nervous stimulation for this purpose from the ganglionic
 system."—p. 37.
   " From physiological and pathological facts we derive a confirmation  of these
 principles, and obtain additional light in arriving at a knowledge of the functions
 of this system."  *  *  *—p. 37.
   " The ganglionic system furnishing the principal nervous supply to the surfaces
 where are seated the instinctive wants of the organism, we have in the above facts : 
MALARIAL  FEVER.
67
1st, that the ganglionic system is the nervous apparatus of the instincts and inter-
nal senses ; 2d, that it communicates to the nervous system of animal life or rela-
tion the wants of the economy; and 3d, is capable  of compelling that system to
command the acts necessary to supply these wants.
  " The interrogation of pathological phenomena will furnish additional elucida-
tion to this subject.
  " Irritations excited in the mucous tissue of the stomach and small intestines by
the impressions of irritating agents, will excite irritations in the brain, and some-
times spinal marrow.
  " The acute inflammations of the gastro-intestinal mucous tissue rarely, it may be
asserted never, fail to occasion cerebral  or spinal inflammation.  Hence, they are
invariably  attended with headache  and  delirium, pains in  the back, and often
neuralgic pains in  the extremities ;  they frequently occasion coma, apoplexy, hy-
drocephalus, convulsions, and paralysis.  The chronic inflammations of the same
tissue are  also productive of chronic inflammations of the cerebral organs, and
hence we find mania, monomania, catalepsy, and hysteria, are frequently connected
with that state of the digestive organs.   The connection between the cerebro-spinal
organs and the mucous tissue of the stomach and small intestines, by which the
actions of the one are transmitted to the other, is most probably effected through
the nerves of the ganglionic system, and the inosculation of the solar plexus with
the par vagum."   *  *  *—p. 40.
  " None of the viscera that are placed under the influence of the ganglionic system
of nerves, exercise so decisive  and prominent an action over the cerebro-spinal
nervous organs as the stomach and small  intestines, especially the stomach.
  " With less promptness and less constancy the other organs  in this connection
respond to the morbid  irritation of the gastric  mucous surface.  An example is
afforded in acute gastritis, in which the eye is  always injected with blood, the
fauces and tongue  are arid and inflamed, the lungs often partake of the disorder,
and respiration is  impaired or deranged.  The liver, the kidneys,  the genital
organs, all display more or less of disturbance in their functions, corresponding to
the degree of the  gastric disease.  The acute irritation of these organs are attended,
in a like mode, with disorder and disturbance of the stomach and its functions.
Thus, inflammation of the kidneys, uterus, liver,  and sometimes of the eye, is
productive of an  irritable state of the stomach, exciting nausea and vomiting.
  " The above pathological phenomena exhibit: first, a close connection between
the stomach and  the brain, by which they mutually reflect their irritations on each
other;  and second, that the different organs to which the ganglionic system sends
nerves  possess a free communion in their  actions, which is most extensive and
active between those  organs most abundantly supplied with nerves.
  " The ganglionic  system, from these facts, would appear to be the medium of the
sympathies that bind together the viscera of the splanchnic cavities—the cranium,
thorax, abdomen, and the genital organs."  *  *  *—pp. 40-42.
  " While it cannot be doubted that the organs of the moral faculties and passions
are situated in the  brain, neither can it be denied that the viscera are not entirely
passive in their exercise.
  " What is the exact part they perform, it is not easy to divine; but every one is
conscious of sensations of a peculiar kind, having either a pleasurable or painful
character, experienced in the epigastrium, in the chest, and sometimes in other
parts, while under  the influence of moral emotions of an agreeable or  distressing
nature.
  " The participation of different organs of the thoracic and abdominal viscera in 
68
OBSERVATIONS ON
 the actions which constitute the passions, is evidenced in the secretion of tears, or
 weeping in sorrow;  sobbing in grief;  the tremulous voice, or its total loss, with
 tremors  of the muscular  system in fear; laughter in joy;  gaping in  ennui; the
 injected eye ;  hurried breathing and quickened action of the heart in violent anger
 and rage, when uncombined with apprehensions ; and in the gastric stricture expe-
 rienced  in the preceding  painful emotions, as also in hatred, jealousy, &c, with
 often the copious secretion of bile.
   "These  effects most distinctly indicate the extension of the cerebral actions,
 roused by the  passions or affective faculties to the physical organs of the economy.
   " These organs, on the other hand, are observed to hold  a decided  power over
 the exercise of the passions, and to control their  elicitation.
   " A state of  inflammatory excitement or irritation in those organs opposes the
 gentle visceral excitement of the pleasurable passions, and they can be no longer
 experienced.   When the stomach and thoracic organs are inflamed, it is not pos-
 sible, even in  those whose natural disposition inclines them to gayety, to excite
 feelings of that character or to provoke laughter.  Joy, hope, and all the animating
 moral impressions, are dissipated, and the mind is plunged into gloom,  depression,
 and despair.   The chronic irritation of the digestive viscera is the most common
 cause of melancholy and hypochondriasis.  Irritations of the digestive apparatus
 are often directed on the cerebral organs, and, by exciting irritation in them, carry
 a positive influence into the development of the passions.  Thus irritations in the
 stomach metamorphose frequently the temper and character; the gentle and mild
 become peevish and irritable, the gay morose, the fearful bold, the coward courage-
 ous, the merciful cruel.  The irritations occasioned by ardent spirits in the stomach
 and brain give rise to the frequent quarrels and disputes about trifles when this
 pernicious habit is indulged, and the man who when sober is an affectionate hus-
 band, a tender parent, a faithful friend, when under the influence of intoxication
 is  converted into a savage, unfeeling brute ; he is borne away by the most terrible
 and furious emotions ; he  is no longer master of  his actions, and  is scarcely con-
 scious of the excesses he perpetrates."   *  *  *—pp. 193, 194.
   " Sympathy is the medium connecting the organic actions of the different organs,
 and consists in the transmission to a remote organ, and the repetition in that organ,
 of the same mode of action which had been previously excited in some other organ.
 One organ is in this manner an exciter or stimulant to the actions of other organs,
 and concurs by this means to the maintenance of the vital  activity of the whole
 organism.  *  *   *
   " The improvement of physiological knowledge, by determining in a more precise
 manner the offices of the different tissues  and organs, renders it  certain that the
 nervous apparatus  alone is capable of producing the phenomena to which the term
 sympathy is applicable."  *  *  *—p. 590.
   " In the  senses we have  the positive demonstration of the transmission of im-
pression  from  one  organ to another distant organ.   *  *  *  A reciprocity and
 identity of action, it is apparent, prevails between the organs of the senses on the
 external  surface, the recipients of external impressions, and the internal cerebral
 organs ; an action  excited  in the one being transmitted to and repeated in the
 other.  * * *  In this example of the senses we have presented a series of phe-
 nomena corresponding exactly with those  constituting the sympathies—an action
excited in one  organ transmitted to and reiterated in another.
   " Illustrations of  a yet stronger character are  furnished by the phenomena of the
nervous  apparatus, exemplifying in a more vivid light the character and mode of
production of the sympathies. 
MALARIAL  FEVER.
69
     " A mental impression, an idea, the excitation of a moral emotion, excites or
   modifies the movements of the capillary circulation, or disturbs the regular func-
   tion of some important organ.  The deep  suffusion of the mantling blood in the
   face of the modest female, the eloquent language of the unuttered thought, is a
   striking exemplification of the influence of cerebral excitement over the capillary
   circulation.  The effects of the passions on the heart, so frequently disturbed in
   its mode of action by moral emotions ;  the disorders of the biliary secretion, and
   derangement of the digestive action of  the stomach, induced by profound mental
   operations, are strong evidences  of the transport  of impressions  by the nervous
   system.   A still more impressive  example is  found in the erotic ideas in dreams,
   so  stimulating the genital organs as  to provoke in them the actual sensations of
   the venereal act, and the ejaculation of the seminal liquor.
     " In these examples  is manifested an excitement transmitted by nervous com-
   munication from one organ, in which it is developed, to another organ, to which it
   is transported, and to which it is  imparted."  *  * *—p. 592.
     " The power of transmission is  common to all the nervous apparatus, and is the
   means connecting its different portions.  But for the transmission of the excitement
   of the organic actions a specific nervous apparatus is provided; it is the ganglionic
   system, or the sympathetic—the nervous system of the viscera and organic life.
   By the arrangement and distribution of this system a nervous apparatus  is pro-
   vided, independent  of,  yet most intimately  connected with, the cerebro-spinal
   nervous  system.   It is  endowed  with the  same force, nervous activity, fluid, or
   whatever name it may be known by.  It possesses an analogous mechanism;
   nervous  organs or centres  (the ganglia), nervous cords  of communication or of
   transmission, and receptive expansions in the viscera.  Its actions and influences
   are in a similar mode—impressions received, excitement of nervous activity, and
   transmission of excitement; and it exercises a controlling and governing influence
   over all the splanchnic viscera, to which it  is distributed, similar to that excited
   by the cerebro-spinal apparatus over  the organs of locomotion, expression, sensa-
   tion, the intellectual and moral faculties."  *  *  *—pp. 592, 593.
    " The two important centres which have been indicated as existing in the nerv-
   ous system are immediately  connected to each  other, and by this connection the
   two apparatuses  are placed in communication, and direct relations established
   between them.  This communication is established by the eighth pair, par vagum,
   or pneumogastric.   Arising from  the medulla oblongata, it sends  branches to the
   ganglia of the neck  and thorax, but is  principally expended in anastomoses with
   the solar plexus  and semilunar ganglia; so that it may be either described as
   proceeding from these ganglia and terminating in the medulla oblongata, or, arising
   from this last, it terminates in the ganglia.
    " The communication  formed by the par vagum or  pneumogastric between the
   centres—the medulla oblongata and semilunar ganglia—establishes the intimate re-
   lation and immediate connection uniting the two apparatuses of the nervous organs
  —the cerebro-spinal  and ganglionic or organic.  By this connection impressions
   are mutually reflected from the one apparatus into the other ; and consequently
  the impressions of the viscera, especially those of the  abdomen, which  have no
  direct communication with  the brain, reach that organ, while those viscera expe-
   rience themselves modifications from the influence of cerebral excitement,"  *  * *
, —pp. 594, 595.
    " In the  natural state of the organism the  correlation  and mutual play of the
   organs on each other, through the medium of  the nervous system, and by the
   radiation of its ingenerated nervous activity, are not characterized by features so 
70
OBSERVATIONS  ON
   The experiments  of  M.  Claude  Bernard,1 E.  Brown-Sequard,2
 and others,  and the  researches  of Henry  F. Campbell3, Marshall

 striking as  to be readily  seized on and established.   They nevertheless do exist,
 and are what is to be understood properly of the synergia of writers.   In the
 pathological state the evidences of this mode of connection and influence are too
 apparent to be  misunderstood.  The  pathological phenomena are,  however,  no
 more than an  exaggeration of the  physiological phenomena.   When an organ, in
 a state of active irritation or  acute inflammation, acts on  another  and distant
 organ, affects it in the same manner, communicates its own condition, it is not that
 a connection is  established which did  not before prevail, or a mode of action and
 influence is  brought into play which previously had no existence.  The connection
 was  already there ;  the action and influence already had being;  and as from this
 natural or physiological connection and influence the  organs harmonize and corre-
 spond to each  other in health, so from the same cause are they participants of the
 same condition in disease.  It is from this natural, fixed connection andinfluence
 that an organ pathologically excited, generating in itself, by the nervous elements
 of its structure, an  excess of nervous activity, becomes a morbid  or  pathological
 excitant to  the  other organs embraced in the range of its  nervous circle, or with
 which it is in most intimate nervous connection."  *  *  *—pp. 599, 600.
   After making extensive application of these physiological principles to the treat-
 ment of disease, Dr. Samuel Jackson institutes a profound analysis of the pheno-
 mena of fever, and  closes  his work  in  the following words, which reveal his high
 appreciation of the value of the knowledge of the relations of the nervous systems
 and organs :—
   " The study  of the connections of the organs, functional and sympathetic, is the
 complement of all physiological researches and the fulfilment of pathological in-
 vestigations.  The more profoundly they are examined, and the more  clearly they
 are understood, with the greater facility will the production of morbid phenomena
 be comprehended, the mysteries that involve the pathological state be penetrated,
 and  the perplexities proceeding from the complications and diversities of disease
 be unravelled.   Let them never be forgotten by the practitioner when he stands
 by the bedside of the sick.   This knowledge is the rock on which he must build,
 would he erect a system of treatment at once rational, safe, and efficient."*—p. 619.
   1 Leyons de Physiologie  Experimental Appliquee a la Medecine.   Par M. Claude
 Bernard.  Paris.
   2 Experimental Researches  applied to Physiology and Pathology.  By E. Brown-
 Sequard.  New York, 1853.
   Experimental  and Clinical Researches on the Physiology and Pathology of the
 Spinal Cord. Richmond, 1855.
   3 An Essay on the Influence  of Dentition in  producing Disease. By Henry F.
 Campbell, M. D., Demonstrator of Anatomy in the Medical  College of Georgia.
 Southern Medical and Surgical Journal  (new series), vol. vi., June,  1850,  p. 321.
   Transactions of the American Medical Association, vol. vi.
   An Inquiry into the Nature of Typhoidal Fevers.  Transactions of the American
Medical Association, 1853.
  Excito-Secretory System of Nerves. Transactions of the American Medical Asso-

  * The Principles of Medicine, founded on the Structure and Functions of the Organism. By Samuel
Jackson, M. D., Assistant to the Professor of the Institutes of Medicine and Clinical Medicine in the
University of Pennsylvania, &c. &c. Philadelphia, 1832. 
MALARIAL FEVER.
71
Hall,1 and others, have still further extended the knowledge of the
mutual relations of  the  sympathetic  and cerebro-spinal nervous
systems.  But, after all that has been achieved by a host of devoted
laborers, we have but the mere  outlines of this vast subject, and
our knowledge  relates almost entirely to the most general and
superficial phenomena.
  The true relations of  the nervous  system  to disease must be
based not only upon  the relations of the sympathetic system to the
organs, and to circulation, respiration, secretion, excretion, and nu-
trition ; and of  the cerebro-spinal system to motion and sensation;
and of the  sympathetic system to the cerebro-spinal  system; but
also upon the relations of the intellectual faculties to the nervous
system, and through  the nervous  system to circulation, respiration,
secretion, nutrition, and excretion.   If the  views promulgated by
Prochaska  and  Gall be true, that  each faculty of the intellect is
connected with  a special portion of the brain as the organic, mate-
rial condition of  the associated faculty, then  aberration of  those
faculties would point to organic or functional alterations of the
corresponding portions of the brain, just as an aberration or loss
of sensation would point  to the functional or structural alterations
of the nervous apparatus devoted to the reception and transmission
of sensational impressions; just  as an aberration or cessation  of
respiration would point to  a structural or functional alteration
existing either  in the nerves or in the  apparatus of respiration.
Whether the views of Prochaska and Gall, and of their followers,
the phrenologists, be true or false, it would be nevertheless true
that if the  action of the  intellect, when manifested by motions  or
sensations or consciousness,  is always attended by  chemical and
physical  changes of the  nervous structures, then  aberrated  intel-
lectual action would point to organic or functional changes in the
nervous system. As in the case of aberrated motion and sensation,
and of secretion  and  excretion, circulation  and  respiration,  the
causes of the aberration may lie entirely without the nervous sys-
tem, in chemical and physical changes of the blood, induced by the
catalytic action of morbific agents,  so also in the case of aberrated
intellectual action it  may arise from chemical and physical changes

ciation, 1857.  Also, Essays on the Secretory and Excito-Secretory System of Nerves.
By H. F. Campbell, M. D., Professor of Anatomy in the Medical College of Georgia,
at Augusta, &c. Philadelphia, 1857.
   1 London Lancet (Amer. ed.), March, 1857. 
72
OBSERVATIONS ON
 in the  blood  arresting or altering the normal chemical changes of
 the organs of the intellect.
   In all investigations into the causes  and effects  of disease, the
 pathologist should remember that the origin of the disease may be
 connected with derangements in the constituents of the blood and of
 all the organs, independent altogether of the nervous system. Thus
 in malarial fever the poison, whatever  it be, destroys the blood-
 corpuscles, destroys the ferment in  the blood which converts the
 animal starch elaborated in the liver into grape sugar, and produces
 profound alterations in the structures, blood, and secretions of the
 liver and spleen.  Now,  in  the beginning, these effects may take
 place entirely independent of any alteration in the nervous system.
 In this  case the nervous system will be secondarily affected, and its
 action seriously disturbed, and this disturbance will give rise to a
 distinct set of phenomena;  but it is  evident that the cause and
 origin of the disease lies back of this disturbance.
   The study of the physician does not cease with these phenomena.
   Whilst in the physical universe and in the structures of animated
 beings the phenomena are connected by determinate, definite rela-
 tions, in the moral world  there is a disturbing element acting con-
 trary to all harmony.  The history of the world presents a mournful
 picture of a strife between two great antagonistic principles of good
 and of evil.  Every individual that  is born into this world forms
 a fresh battle-field for the conflict of these principles.  In his pre-
 sent state,  man resembles the ruins of  a  majestic temple;  those
 columns, though marred and broken, still retain enough of beauty
 and symmetry to remind us of its former grandeur; the inscription
 upon  the wall  of the  innermost chamber, although covered with
 the damp and  decay  of ages, still points to a hand divine.  The
 pleasant sentient emotions excited in the nervous system by bene-
 volent actions  and the strict adherence to truth, prove  that the
 cultivation of the virtuous affections is  favorable to health.  While
 on the other hand, the irritation, weakness, and morbid excitability
 of the nervous  system produced  by the  indulgence of  the evil
 passions, envy, jealousy, and revenge—the haggard countenance,
 the withered, blasted  form of vice—prove that  the  indulo-ence of
the principle of moral evil injures and wastes the body; prove
 that the intellectual and moral faculties act upon the material body
by which they are environed; prove that  the material  body may
be rendered unfit for  the normal exercise of  the moral and intel- 
MALARIAL FEVER.                   73
lectual faculties; prove that the knowledge of the physician should
extend  not  merely to the  physical, chemical, physiological, and
pathological phenomena of the body, but should embrace the struc-
ture of  the intellectual and moral  faculties,  and  their relations to
the material body by  which they are environed.
  It is evident, then,  that the complete investigation of the origin,
causes, effects, and treatment of disease demands an examination of
the relations of man, during  health and disease, to astronomical
phenomena;  demands an examination of the relations of man to
the distribution of the terrestrial masses, to the soil, climate, and
waters,  not only at the present time, but in the past history of the
relations of man to  astronomical and terrestrial phenomena; de-
mands an examination of the structure and relations and alterations
of the solids and fluids of all the  organs  and systems of organs,
and apparatuses, and tissues, and blood, and secretions, and excre-
tions; demands an examination  of all  the physical and  chemical
changes, and the  relations of the physical, chemical, vital, and
nervous forces; demands  an  examination of the relations of the
physiological and pathological alterations of the nervous system to
secretion, excretion, sensation, motion, and intellectual and moral
actions.
   The  pathologist and physiologist must necessarily be appalled
by the  immensity of the subject of his investigations;  and he is
inevitably disappointed by the imperfections of human knowledge,
and by the  imperfections of  the instruments  and methods of in-
vestigation.  Thus, in attempting to account  for the different mani-
festations of only one disease, we have  not,  in the present state of
science, access to  the most valuable data, such as the relations of
astronomical, terrestrial, physiological, and pathological phenomena,
and in  the vast majority of the  subjects of disease the effects of
original constitutions, previous habits, and previous disease cannot
be determined and eliminated from the general mass of results.  It
is probable that the  course of severe diseases is always modified
by the  constitution, diet, occupation, and previous habits, whether
virtuous or  vicious,  temperate  or  intemperate,  and by previous
diseases, and by the  relations of the individual  and his ancestors
to  the  soil and climate.  Thus we know that in a body of strong,
healthy men, exposed to  precisely  the  same sources of malarious
disease, we may have manifestations of disease from a slight febrile
excitement, scarcely deviating from the condition of health, down
        6 
74
OBSERVATIONS ON
 to the most malignant type, commonly called congestive fever.   If
 all have been alike exposed upon the same small ship, to the same
 poison, whence this difference?  The difficulty and  complexity of
 this problem, arising about a handful of mariners, may be compre-
 hended when we state that, amongst many other things, its solution
 would demand a knowledge of the previous history of the physical,
 chemical, physiological, and moral influences of  soil, climate, and
 disease upon the ancestors, and even upon the races; would demand
 a knowledge of all hereditary tendencies, peculiarities of tempera-
 ment, and idiosyncrasy; would demand a knowledge of the relative
 activity and perfection of the individual organs and apparatus, and
 of the relations of these to each other; would demand a knowledge
 of the relations of the vital force to the matter of each organ and
 tissue and apparatus, and to the morbific agent or agents; would
 demand a  knowledge of the action and reaction of the morbific
 matter upon the different forms of organized structure, and the
 consequent derangement of the physical, nervous, intellectual, and
 moral phenomena;  would demand a knowledge of the relations of
 chemical action to  the development of the physical  and nervous
 forces, and the action of the intellectual and moral faculties;  would
 demand a knowledge of the correlations of the physical, vital, nerv-
 ous, intellectual, and moral phenomena; would demand a knowledge
 of the relations between physiological phenomena and the pheno-
 mena of the exterior universe.  Every candid man will admit that
 the solution of such a  problem is impossible at  the present time,
 because the facts are wanting;  and  they will  long  be wanting,
 owing to the extreme complexity of the phenomena.
   The imperfections of physiological and pathological investiga-
 tions are placed in a clear light when we reflect that physiologists
 and pathologists scarcely recognize the relations between the phy-
 sical, chemical, vital, and nervous forces;  are not  acquainted with
 many chemical changes going on in the  body; know little or no-
 thing about the origin and offices of  some of the most important
 constituents of the  blood, that  great source of the  materials  of
 structure and chemical  change; dispute  about the offices of the
 spleen, supra-renal capsules, thymus and thyroid glands; and  pos-
 sess no absolutely accurate method of analyzing  the  blood  or  of
 determining the amount and character of the products thrown off
from the lungs and skin.
  Whilst, therefore, we assert that the knowledge of pathological 
MALARIAL FEVER.
75
phenomena necessarily includes a knowledge of the relations of all
the phenomena of the universe, and  affirm that the dignity and
glory of  a science should depend upon the multitude and com-
plexity of its phenomena—whilst we express the hope that the day
will come when the science of medicine shall be founded upon the
immovable basis of inductive philosophy, and the world be com-
pelled to recognize the truth that the solution of the problems of
medicine  requires a higher exercise of the reasoning faculties than
the solution of the most complicated and difficult problems in phy-
sical and chemical science, a higher exercise of the reasoning facul-
ties than the solution of even the grandest problems of astronomy
—we would acknowledge that these physiological and pathological
investigations which we are about to present are imperfect in many
respects, and are merely beginnings in the right  direction.
  I shall be satisfied if they demonstrate the impossibility  of the
successful investigation of even the most  striking phenomena  of
disease by  a single individual, and lead to unity and concert  of
action amongst investigators.
                      CHAPTEK III.

                            THE BLOOD.

Imperfect state of our knowledge of this fluid—Imperfections in our methods of
  analysis—Importance and difficulty of establishing a standard formula of the
  constitution of the blood in health—The composition of the blood varies, not
  only with the class, but with each species of animals, and corresponds with the
  development of the organs and apparatuses, illustrated by development of the
  blood and organs of invertebrate and vertebrate animals—Standard of Lehmann,
  and of Becquerel and Rodier—Importance of establishing the changes of the
  blood during thirst and starvation—Importance and difficulty of determining the
  amount of blood in the system.

  In the  present  state of  physiological and  pathological science,
the investigation of the changes of the  blood in health and in dis-
ease is attended by great labor and numerous difficulties; and from
the complexity of the substances, the number and delicacy and com-
plexity of the  chemical changes of these  substances, and from the 
76
OBSERVATIONS ON
numerous obscure and  complex  relations  of these  substances  of
the blood with  the  surrounding organs and tissues,  and from the
great imperfection of the methods  and instruments of investigation,
absolute  accuracy is impossible.  In view  of the great labor and
numerous difficulties and imperfections and absolute  failures neces-
sarily arising from  the great complexity  of the  substances and
phenomena, and from imperfections in the  modes and instruments
of investigation, and from the partial and  imperfect nature of all
the results of investigation thus far recorded, the profession is com-
pelled to view with consideration even approximations to the truth.
These statements are dictated neither by a spirit of  exaggeration,
nor by a desire to avoid criticism or to  crave  indulgence.   They
are true,  because  important questions with  reference  to the origin
and offices of the most important  constituents of the blood remain
unsettled and involved in obscurity.
  Whilst the physiological chemist knows that  the elements of the
blood are ultimately derived from  the inorganic world (one portion
directly and the other secondarily  through the vegetable kingdom);
whilst  the chemist is able to investigate all the combinations and
relations of these inorganic bodies  out  of the living  organism;
whilst  the physicist  can demonstrate the correlation  and establish
the mechanical equivalents  of  the forces generated  during  these
chemical changes; while the physiologist can describe  the general
process of digestion,  and  the general superficial  changes of the
inorganic and  organic materials during their preparation for the
blood and structures; whilst the  physiological  chemist can isolate
many of the constituents of the blood, and of the secretions formed
from the blood; whilst  the physiological chemist can isolate many
of the  substances resulting from the metamorphoses  of the tissues
and blood, and form plausible hypotheses with reference to the
relations of these chemical changes to secretion, nutrition, and the
development of the forces—still, the knowledge of the physiological
chemist is incomplete, because numerous  chemical  changes have
never been investigated, and his  knowledge does  not  cover suffi-
cient ground to allow the  analysis, comparison, and generalization
of all the physical, chemical, and physiological actions, or the de-
termination of  the origin,  development,  and metamorphoses, and
physical, chemical, and physiological relations of  each substance
or the determination of those  fixed  relations or laws  by  which it
would  be possible, not only to explain the correlation of the physi-
cal, chemical, vital, and nervous forces, but also predict with abso- 
MALARIAL  FEVER.
77
lute  certainty the effects of disturbances  in the chemical changes
and in the development and mutual relations of the forces.
  The imperfection  of physiological and pathological  science is
placed in a clear light when we  consider that the  cause  of  the
coagulation of the blood, the most striking and apparently  simple
phenomenon presented by this fluid, is still undetermined, notwith-
standing the researches of Hewson, Hey, Prater, Hunter, Fordyce,
Langish, Thackrah,  Scudamore, Briicke, and Bichardson ;  when
we consider that the mode of origin and offices of fibrin are still
matters of dispute, Zimmerman, Simon, and Inman considering it
as an excretory product, of no further  use in the animal economy,
destined to be still  further  metamorphosed, and  finally cast off,
whilst Paget, Carpenter, and other physiologists regard it  as the
most perfect of the  nutritious products  destined to enter into the
constitution of the organs and tissues;  when  we consider that the
mode  and place of origin, and  the offices, and the mode and place
of death and disintegration  and excretion of the colored  blood-
corpuscles are still  subjects  of dispute and investigation with the
best physiological chemists; when we consider  that the mode of
the formation of the secretions from the  blood, and the connection
of the nervous system with secretion, nutrition, and excretion, are
undetermined, and  are now engaging  the  attention of the best
minds of the profession; when we consider that the series  of che-
mical  changes which the elements  undergo during  the nutrition of
the  organs  and  tissues, and during the development of the forces,
are very imperfectly understood, if not wholly unknown; when we
consider that the physical and chemical relations of the elements of
the  living body to the vast  majority of  poisonous compounds are
unknown;  when we consider that physiological and pathological
knowledge  extends  merely to  the time  and place, and results of
change, and not absolutely to the nature of the changes themselves;
when  we consider that no definite opinions prevail with reference
to the relations of the physical, chemical, and  nervous forces and
phenomena with the  vital and intellectual and moral principles.
Should these imperfections in physiological and pathological science
cause  indolence  and indifference ?  Should the complexity of the
phenomena, and the imperfections  in the instruments and modes of
analysis, lead the honest inquirer after  truth to abandon  the in-
vestigation in despair ?
   The honest attempts to  unravel complicated  phenomena, by
 honest and truth loving  minds who are not afraid or  ashamed to 
78
OBSERVATIONS ON
point out their failures, and the imperfections of their modes of
investigation, and who ardently desire to incite others to investiga-
tion, and who would cheerfully destroy with their own hands every
erroneous statement or hypothesis or theory which they have pro-
mulgated, have been and will often be characterized  by the  para-
sites and vultures of the medical profession, as failures, yea, even
as dishonest failures, simply because they yield only negative results,
or fail to elicit the whole truth.
  In judging of the value of original  investigations,  we should at
all times bear in mind the fact, that the development of all sciences
has been the slow result of the labors of many minds, and that the
rapidity of the development of each branch of  knowledge has been
in exact proportion to the  complexity of  the phenomena.   Thus
mathematics, and astronomy and mechanics, which deal with the
most simple and general phenomena, were  the first developed, and
are  now the most perfect of all sciences.   As man stands upon a
pyramid, the  foundation of  which is the inorganic world, and the
materials  composing this pyramid, consisting first  of plants  in
various  stages of development, the  simpler extending downwards,
the  more complicated extending upwards, diminishing in numbers
as they increase in complexity; and secondly of animals in various
stages of development,  increasing in complexity and diminishing
in numbers as they extend upwards; and as the existence of man
is absolutely dependent upon the relations of the component mem-
bers of the universe; and as the forces of man are all the resultants
of the action of the same forces of the sun which keep up a never
ending  circulation and change of the  matter  upon the surface of
our globe; and as the development and action and life of man and
of all organized beings depend upon the forces not only of our sun
but also of the fixed stars, it is  evident that he is  a type of the
universe and comprehends within himself all phenomena, astrono-
mical, physical, chemical, physiological and psychological, and that
his  phenomena are  exceedingly complex,  and  require for  their
complete solution the most laborious investigations and the most
exalted  exercise of the reasoning faculties.  Notwithstanding, that
from the complexity of the phenomena and the difficulties of the
investigations, the progress of physiology and pathology must be
slow; the observer, so far from being discouraged, should be ani-
mated  to vigorous and prolonged effort, remembering  that every
honest  physiological and pathological investigation must  be pro-
ductive of good, even if its results be only  negative.  Negative 
MALARIAL FEVER.
79
results are  always valuable, because  they assist  in defining  the
bounds of knowledge,  and in determining the extent of man's
power over the phenomena  of nature, which depends absolutely
upon his knowledge of the properties, forces, and relations and
laws of matter.


  Importance and Difficulty of Establishing a Standard Formula of
              the Constitution of the Blood in Health.
  The blood is composed of so many and such different materials,
and is liable to so many variations from causes entirely compatible
with health, that the establishment of  a reliable standard to which
the changes of the blood in disease may be referred, is difficult if
not impossible, and requires nice discrimination, laborious investi-
gation, and wide generalization.
  The blood is composed not alone of the elements of nutrition and
secretion and force, it receives  also the products of the disintegra-
tion of the tissues and organs, and the products resulting from  the
chemical changes of the elements  used in working the apparatus,
and in maintaining a definite temperature.
  The elements of the blood may be furnished from the food and
atmosphere alone, through the stomach, lungs, and skin;  but  the
blood as blood, is the resultant of  the  elaboration of many organs,
and of the chemical changes of all the  organs  and tissues.
  The blood is not only distributed by innumerable channels
through  every recess of the body;  the  blood is not  only the source
of all the elements of structure; the blood not only furnishes  the
materials for all  the secretions and  excretions, and  for all  the
chemical changes—but the blood is in  turn affected  by the physical
and  chemical changes of every vessel,  of every  nerve, of every
organ and texture of the body.  It is evident, then, that the con-
stitution of the  blood will depend upon the food;  upon the vigor
and  perfection of the organs of digestion,  respiration, circulation,
and secretion and excretion;  upon the  vigor and perfection of  the
nervous  system, and of all the organs and apparatus; and  upon
the correlation of the physical,  vital, and nervous forces.
  The character of the blood, then, will vary with the animal; with
the organ and tissue through which  it  is circulating; with the age,
sex, temperament, race,  diet, previous  habits, occupation, and pre-
vious diseases; with the soil and  climate; and with  the  relative
states of  activity of the forces. 
80
OBSERVATIONS  ON
   The constitution of the  blood varies not only with the class but with
each species of animals, and corresponds with the development and per-
fection of the organs and apparatus.
   Thus, in the lowest forms of the protozoa, which resemble simple
cells  provided with vibratile cilia?, we  find no circulatory system;
no fluid separated from  the albuminous fluid which permeates the
structures, to  which the name blood  may be applied;  no special
organs; and  no nervous system.   In  the  higher members of this
group we discover the first rudiments of a circulatory system, and
an attempt at the interchange of the fluids from  different parts of
the body.  All  the stomatoda have contractile pulsatory cavities
situated in the denser and outer layers of the parenchyma of  the
body.   During their expansion  these cavities become filled  with a
clear, transparent, colorless liquid, which disappears entirely during
the contraction.   No bloodvessels communicate with these cavities,
and  no special walls have been discovered surrounding them; and
the fluid which they contain, although analogous to blood, contains
no corpuscles.  By these simple means, corresponding to the struc-
ture of these animals, the fluids of the body are prevented from
stagnation, and  a free interchange of the nutritive elements  pro-
moted.
   In the polypi—inarticulate fleshy bodies, having a simple visceral
cavity, with a single opening at the  centre above, without intestines,
without glands separated from the walls of the visceral cavity, with
no distinction of sex, and an imperfectly developed nervous system
in the highest, and none whatever in  the lowest—the circulatory
system is  rudimentary,  and the fluid which  it distributes nothing
but  the digested  matters  of  the visceral cavity mixed with sea-
water.  This  circulatory fluid contains  a few spherical corpuscles,
apparently albuminous, and a few  oil-globules.   According to  Dr.
T. Williams,1 a few of  these corpuscles appear  to be nucleated,
others  appear to contain  secondary  cells, and  others again  are
charged with  minute granules.   The  fluid is incapable  of  coagu-
lation, and contains albumen in very small amount.
   In the  highest species of the acalephse the  nervous  system is
more developed than that of  the polyps, and the blood and circu-
latory system show a corresponding degree of development.  The
transparent gelatinous bodies of these animals  are traversed  by

   1 Memoir on the Blood-proper  and Chylaqueous Fluid of Invertebrate Animals,
by Dr. T. Williams, Philos. Transact., 1852;  Brit, and For. Med.-Chir.  Review'
vol. xii. p. 484. 
MALARIAL FEVER.
81
canals, which receive  water from  the stomach or directly from
without,  and being lined with ciliaa effect a constant renewal of the
water, and thus perform  the office of a respiratory system.  These
aquiferous canals  are  surrounded by vessels which have exceed-
ingly thin walls, and  are  without  ciliated  epithelium and longi-
tudinal and circular fibres, and which open directly by large tubes
into the  alimentary canal.   In some species,  according to Will,
these sanguiferous vessels contain a greenish fluid,  with spheroidal
and slightly elongated red corpuscles with large nuclei;  in others
the corpuscles are  brown, and in others again they are of a greenish
color.  There is no regular circulation,  the blood being  shifted
hither and thither by the irregular contractions of  the body.  The
blood of the acalephae, although like that of the polyps, the direct
product  of  digestion  mixed with sea-water, is of a higher type,
because  its corpuscles are larger, contain more granules and  oil-
globules, and their cell-membranes are more distinct.
  The higher members of the echinodermata have a distinct circu-
latory system separated from  the alimentary  canal, composed of
arterial and nervous trunks, between which, in some species, there
is an organ analogous to a heart.  The echinodermata is the only
class amongst the radiata in  which a proper circulation  of  the
nutritive fluid takes place, and this is attended with a correspond-
ing development of the nervous and  muscular systems and  organs
of  secretion.  It is in this class  that we first find the liver in its
rudimentary state, however, consisting of simple  caeca, opening
into the  digestive cavity.  According to Dr. T. Williams, the cor-
puscles resemble  spherules,  composed of hard  and very minute
granules of coagulated albumen, without any detectable nucleus or
cell-wall,  or oily  particles,  and are  readily broken up  into their
individual molecules.
  In the spiunculida, the highest order of this class, the corpuscles
are more highly developed, being flat and irregularly oblong, having
small, bright, highly refractive nuclei.
  As the great object of  these observations is to show that  the
constitution of the blood depends upon the development and per-
fection of the organs, and apparatus, and nervous system, and place
in a clear light the great difficulty and complexity of  the problem
to establish a definite standard to which diseased blood may  be
referred,  we will pass  over the remaining  classes of the inverte-
brata, and notice  only the  highest  division of the mollusca,  the
cephalopoda. 
82
OBSERVATIONS ON
  The nervous system of the cephalopoda is highly developed,
having a central portion resembling the brain of the vertebrata, in
the extraordinary increase of its ganglionic substance, and in being
contained in a cartilaginous cranium.  They have a well-developed
muscular system, and the rudiments of an internal skeleton, and all
the organs, except the spleen, which  are found in  the vertebrata.
They have organs of sense corresponding in  perfection with the
development of the  nervous system; digestive apparatus compli-
cated in  structure; salivary glands highly developed; a pancreas
present  in some species; the liver present in all, and consisting of
a compact glandular mass, with  distinct excretory ducts;  kidneys
also  present.  The circulatory and respiratory systems exhibit a
development, and the blood shows an elaboration corresponding to
the perfection of the organs and apparatuses  of  the cephalopoda.
It coagulates  spontaneously upon standing,  and  the  number of
corpuscles is greatly increased.  They inclose numerous  granules,
thus resembling the colorless  corpuscles of the vertebrata.  The
majority of  the blood-corpuscles are colorless; some few, scattered
here and there, have a violet hue.

  Blood of Vertebrate Animals.—In the amphioxus, or branchiostoma
(Lancelot), the most  simply constructed of vertebrate animals, the
circulatory system resembles closely that of some of the Annelida,
as the Eunice, in its  division and the distribution  of numerous
pulsatile dilatations upon the different vascular trunks.  The respi-
ratory system is  formed upon an  equally degraded type.  The
branchial  apparatus  is  placed  in  the same cavity in which are
lodged the liver, kidneys, generative apparatus, and greater portion
of the intestinal canal,  thus resembling closely the invertebrata.
The  nervous and organic systems are correspondingly simple in
structure.  The canal which  incloses  the  spinal  column presents
anteriorly no cranial expansion, but the spinal cord extends from
one extremity to the other.  The liver is reduced to its rudimen-
tary condition, a greenish glandular layer lining a portion of the
intestines, and the spleen is absent.  Accompanying these simple
undeveloped organs and feeble forces we find colorless blood, rich
in water and poor in solid constituents.  In the blood of this animal
we  find only  colorless  corpuscles.  This is remarkable when we
remember that the spleen also is absent.  Colored corpuscles and
a well developed spleen mark the  more highly organized fishes. 
MALARIAL FEVER.
83
We can assert that as far as our researches and experiments upon
fishes have extended, the number of the colored blood-corpuscles,
and the elaboration of the  blood, and the rapidity of the develop-
ment, and the energy of the forces, correspond to the development
and perfection of the organs.   Thus, in  the Garfish (Lepisosteous
osseus), which, in addition  to branchial apparatus, has a capacious
lung (opening by a short trachea and extending nearly the whole
length of the abdominal cavity), we find a greater number of colored
blood-corpuscles, and more  active and vigorous forces.  The Gar is
a destructive and active pirate, and consequently needs great mus-
cular  power to outstrip and capture  the  swift inhabitants of the
watery elements.   Without the simultaneous  development of the
colored blood-corpuscles, and  of the  organs  and  apparatus,  this
would be impossible.  We might demonstrate these propositions
by numerous  examples obtained by our own  laborious investiga-
tions, but these will suffice to establish the truth of our propositions
with reference to the class  of fishes.
   In  the  class of reptiles  we  find  a similar  development of the
blood, corresponding to the development of the organs and nervous
system, and the activity of the forces and intelligence.  Thus, the
blood of the doubtful reptiles, as the Congo Snake of our southern
swamps and  ricefields (Amphiuma means), and  the  Hellbender
(Menopoma Aileganiensis), is thin, deficient  in  blood-corpuscles,
and far less highly developed than  the  blood of the Alligator, or
Chelonians.
   In Birds and  Mammalia we find a great  increase  of  colored
corpuscles, not only in quantity, but also in  numbers.  The  size
of the  corpuscles are greatly diminished.  The character of the
blood varies in the different species, and even with the same; but
the facts  are  as yet wanting which would enable us to introduce
these elements with accuracy  in the calculations destined to the
establishment of a typical formula, to which the  changes  of the
blood in disease may be referred.
   The following  table, drawn  up by Lehmann1 from his own ana-
lyses, and from the experiments and deductions of Schmidt, presents
a comparison of the quantitative relations of the principal elements
of the blood-cells and intercellular fluid:—

   1 Lehmann's Physiological Chemistry, English ed., vol. ii. p. 160; American
ed., vol. i. p. 546. 
84
OBSERVATIONS ON
1000 Parts of Moist Blood-Corpuscles
  contain—
Water.....688.00
Solid constituents .     .    .  312.00
Specific gravity
Hsematin
Globulin and cell-membrane
Fat     ....
Extractive matters .
Mineral substances  (without
  iron)  ....
Chlorine
Sulphuric acid
Phosphoric acid
Potassium
Sodium .
Oxygen .
Phosphate of lime .
Phosphate of magnesia
1088.50

  16.75
 282.22
   2.31
   2.60

   8.12

   1.686
   0.066
   1.134
   3.328
   1.052
   0.667
   0.114
   0.073
1000 Parts  of  Liquor Sanguinis  Con-
  tain—
Water   .
Solid constituents .
902.90
 97.10
Specific gravity
Fibrin   .
Albumen
Fat     .
Extractive matters .
Mineral substances
Chlorine
Sulphuric acid
Phosphoric acid
Potassium
Sodium .
Oxygen .
Phosphate of lime
Phosphate of magnesia
1028.00

   4.05
  78.84
   1.72
   3.94
   8.55
3.644
0.115
0.191
0.323
3.341
0.403
0.311
0.222
   The following  are the  physiological limits  of the  variations of
the constituents of the blood, as  established by the researches of
MM. Becquerel1 and Eodier:—
                         In  1000 Parts of Blood—
    The Water may vary  ....     from  760.000  to  800.000
      "  Specific gravity of  the blood may vary   "   1055.     " 1063.
      «  Globules      .    .    .    "    "     "    120.000  «  150.000
      "  Fibrin
      "  Solid matters of the serum
      " Cholesterine
      " Animal soap
      " Serolin
      " Chloride of sodium
      " Soluble salts  .
      " Phosphates
                         In 1000 Parts of Serum—
     The Specific gravity of the serum may vary  from  1027.    to 1032.
      " Water of the serum .    .    "   "     "    880.000  "   900.000
      " Solid matters                "   "     "    100.000  "   120.000
      " Albumen                   "   "     "      70.000  "    90.000

   The following is  the  typical formula of  the constitution  of the
 blood in health, adopted  by MM. Becquerel2 and Rodier:—
2.000	u	3.500
90.000	ii	105.000
0.075	d	0.150
1.000	ii	2.000
0.010	k	0.030
2.000	a	5.000
1.500	it	4.000
0.500	a	1.000
1  Pathological Chemistry of MM. Becquerel and Rodier, English ed., p. 90.
2  Loc. cit., p. 81. 
MALARIAL FEVER.
85
Analysis of 1000 Parts of Blood.
opeumo gravity 01 u±e muuu . Water.....	J.UOU.UUU 781.600
Globules ....	135.000
Albumen ....	70.000
	2.500
Fatty matters, extractive mat-	
ters, and free salts	10.000
Phosphates ....	0.550
	0.350
  Analysis of 1000 Parts of Serum.
Specific gravity of serum   . 1028.000
Water.....908.000
Albumen    .    .    .   .80.000
Extractive matters and free
  salts.....12.000
  Notwithstanding the results of these laborious investigations, we
must  acknowledge that the establishment of an absolute standard,
expressing the constitution of the blood in health, is impracticable,
if not impossible.  In the first place, we must not only establish a
formula for each class and  species of animal, and  for the human
race generally, but we must establish a formula for each tempera-
ment, and  for each race and  nation, under every conceivable cir-
cumstance of soil, climate, and occupation.
  Another important field of investigation is the  changes  of the
constituents of the blood during thirst and starvation.
  In  almost all the forms  and grades of fevers the patients are
deprived of food, either by the physician or by the condition of the
digestive apparatus.   Accompanying  this condition we have rapid
chemical changes, and often perverted nutrition.  The constituents
of the blood may be divided into two great classes, the nutritive
and force  elements.  From  the chemical changes of these two
classes arises a third class, called the excrementitious.  Now, both
classes of matter, the force elements and the nutritive elements, are
consumed, chemically altered, and converted into excrementitious
offending compounds  during starvation.  In  like manner both
classes  are converted into  excrementitious  compounds in  fever
Now, to determine definitely what changes  are due to fever, we
must  first  determine what  are  due to starvation;  that is,  to the
consumption of  the blood during nutrition, and the  generation of
the forces by which the machinery is worked.  This can only  be
accomplished  by  determining the  changes  of  the blood during
starvation, and the forces and products  resulting from  these che-
mical changes.   A standard will thus  be established, to which the
changes in fever may be referred.  In fever we have a pathological
state  (abnormal changes)  superadded to those normally existing.
We can never have accurate  pathological knowledge until we de-
termine the physiological changes.  Another difficulty meets us: 
86
OBSERVATIONS ON
The  elements of the  blood are liable to variations,  not only of
quality, but also of quantity.  We must determine, not merely the
relative variations, but also the quantitative.  By  analyzing the
phenomena carefully, and attributing  to each its just  position, we
may eliminate  the elements of the problem only to a  probable
issue, we may determine the character of the changes and of the
morbific agent; but the absolute amount of these changes will be
unknown, without some method of  determining the amount of
blood in the system.   Here, then, is a  great and serious  difficulty
in the establishment of an absolute  standard of comparison.  We
have no accurate means of determining the amount of  blood circu-
lating through the system. It is evident that obscurity on this
point introduces obscurity  everywhere, and impairs the  value of
every standard we may erect.  The  truth  of this  proposition is
established by looking at the great discrepancies which have pre-
vailed among physiologists, with regard to the amount  of blood
contained  in the bodies of warm-blooded  animals.   Blumenbach
estimated  the quantity in an adult man at 8.5 to 11 pounds, Reil
at 44, Haller computed it at 28 to 30, Borelli 20, Young 40, Du-
mas  25, Fletcher 30, Ancell 30.  M.  Valentin,  by his method of
injecting water, arrived at  the following results.   The  numbers
represent  the relation existing between the quantity of blood and
the weight of the body—
     Large dogs (the mean of four experiments), as .   .    .  1 :  4.5
     A lean, debilitated sheep, as......1 :  5.02
     Cats, female (the mean of two experiments), as    .    .  1 :  5.78
     A large female rabbit, as.......1 :  6.20
From these data he estimates the amount of human blood to be—
     Male sex, as.........1 :  4.36
     Female sex, as.........1 :  4.93
  This would give in  a man weighing 150 lbs. 30 lbs.  of blood,
and in a female weighing 130 lbs. 26 lbs.   Lehman determined the
amount  of blood in the bodies of two criminals, who were decapi-
tated, to be from 17.5 to nearly 19 lbs., or  one-eighth the weight
of their bodies.  My  own  observations have established the fact,
that the  amount of blood varies with the different classes of animals
and corresponds with  the rapidity of  the chemical changes of the
blood and tissues, and with the physical, vital, and nervous forces.
These investigations have established that the blood is more abun-
dant in  warm than in cold-blooded animals. These facts are  im-
portant  in their bearing upon the phenomena of health and disease. 
MALARIAL FEVER.
87
When we have a large supply of blood, and a rapid distribution of
blood, then we will have a rapid generation of force.
  In  the present state of science we possess no method of deter-
mining absolutely the amount of blood existing in the animal body.
Whilst we might determine the amount of blood contained in the
large  bloodvessels, it would  be utterly impossible to determine the
amount in the capillaries, because the quantity lost after fatal he-
morrhage is  no criterion whatever, and the latter  portions drawn
are also  mixed  with the fluids of the  organs and tissues.   Our
knowledge on this  subject is vague, and may be summed up in a
few sentences.  The young are said to have more blood than adults
and the aged, and lean  persons are said to have more blood  than
very  fat persons.  As in certain diseases there is a rapid destruc-
tion and  perversion of the elements of the blood, and as it appears
that  these chemical changes  are destined to fulfil certain salutary
offices, as the  destruction of  peculiar  poisons, it is evident that an
increase or diminution of the blood, even within the limits of health,
must  modify not only the course of diseases, but also the action of
remedial  agents.  The  determination  of an absolute standard is
farther impossible, because  in the  piesent state  of science  the
methods   of  analysis  are not  strictly accurate.  We  have no
absolutely accurate method of determining the  colored  blood-
corpuscles.
   We have stated these difficulties, not with the design of casting
doubt and discredit upon physiological and  pathological science,
but rather with  the design of pointing out the great complexity of
the phenomena, and defining the bouuds of knowledge, and induc-
ing caution both in investigation and  in the generalization of the
results of observation and experiment. 
88
OBSERVATIONS ON
                      CHAPTER  IV.

             CHANGES OF THE BLOOD IN MALARIAL FEVER.

Color of the blood and serum in malarial fever and other diseases—Specific gravity
  and coagulation of the blood in malarial fever and other diseases—Fibrin de-
  creases in malarial fever—Formation of heart-clots in congestive fever during
  life—Cause of the coagulation of the blood unknown—Chemical changes of the
  blood in malarial fever compared with the changes of the blood in other diseases
  —Blood-corpuscles are destroyed during malarial fever, and during the slow
  action of the poison, unattended with fever—Principles of treatment founded
  upon these changes—Time when these changes of the blood commence.

  It is important that we should  in  the first place determine the
extent and bearing of our means of investigation, and of our know-
ledge.
  In  the present state of physiological and  pathological  science,
and methods of investigation, our knowledge of the changes of the
blood  during disease  is  limited to an  examination of the venous
blood of the extremities,  or of the surface of the trunk.   We have
no  means  of investigating the changes of the blood in different
organs and tissues during the different stages  of disease.
  The changes  of the blood in the different organs  can  only be
determined by an  examination of the blood  remaining in those
organs after death.  The information  yielded by an  examination
of the blood of the extremities and surface of the trunk during life,
and of the blood remaining in the  organs  after death, must be
imperfect, because  we can only superficially determine the com-
position  of the blood at different stages of  the  disease, and are
wholly unable to determine  its changes in different organs and
tissues, and apparatus, and are limited  to  an examination of the
blood in the organs only  after a fatal termination, and must, there-
fore, remain without the facts which would enable us  to determine
definitely the  various  steps of  the chemical changes, and the phy-
sical, chemical, physiological, and toxicological action of the resulting
compounds.  The examination of the blood after death must always
yield imperfect and unsatisfactory information, even with reference
to the  effects of the morbific  agents upon the blood, immediately 
MALARIAL FEVER.
89
preceding death, because in the hours of death, when the circulation
and respiration are impeded, and the  temperature diminished, and
the nervous  and vital influences enfeebled, many physical and
chemical changes of the blood may result from the disturbances of
the circulation and respiration, and from the alterations of the pro-
cess of endosmose, and from  the chemical changes of the organs
and  tissues through which the blood  passes, entirely independent
of the actions of the morbific  agents.
  In an examination  of this  kind it  would be necessary first to
establish a standard formula  of the  constitution  of the blood in
each  organ, and tissue, and apparatus, by an examination of the
blood after death, in the organs, and tissues, and apparatuses of
those who had died  in perfect health, and also during starvation.
In the preceding chapter we demonstrated that  the constitution of
the blood varied with  each animal, and in the human race varied
with temperament, age, previous habits, diet, occupation, and pre-
vious diseases  and race ; and  hence concluded that it was difficult
if not impossible, to establish a universal typical formula of venous
blood.  It is evident, therefore, that the difficulties of  establishing
typical formulas of the constitution  of the  blood in  the various
organs, and tissues, and apparatuses, would be increased a thousand
fold.
   Besides  these difficulties, the poison or poisons which produce
the changes of the blood in malarial fever  have never been isolated,
and we know nothing whatever concerning its physical, chemical,
physiological, and pathological relations  with the  elements of the
blood, and nervous system, and organs, and tissues by  direct expe-
riment.  We can only infer them from the changes going on during
the  progress of the  disease.   So complicated are the  phenomena,
and so imperfect our knowledge of malarial fever, that we are un-
able to answer such important questions as these:  Does the poison
act by catalysis, by its. mere presence in the blood, inducing a series
of chemical changes, which result in the alteration and destruction
of the elements of the blood?  or does  it undergo chemical changes
itself, and  during these chemical changes generate from  its own
elements, and from those of the blood, substances capable of pre-
venting and arresting the secretions of the organs, and of interfering
with the nutrition and chemical actions of the muscular  and nervous
systems, and causing aberrated muscular and nervous actions ?  Are
the acceleration and disturbance of the circulation and respiration,
and the aberration of the nervous and  muscular phenomena, due to
       7 
90
OBSERVATIONS ON
the direct action of the poison in the blood upon the muscular and
nervous elements, or to the action of the altered constituents of the
blood?  Are the changes  in the secretions of the liver due to the
direct action of the poison upon the secretory structures, or to the
action of the altered constituents of the blood supplied for secretion,
or to the action of the poison of the altered constituents of the blood,
upon that portion of the nervous system which influences the secre-
tion of the liver ?
  In attempting to answer these questions, we can reason analogi-
cally, but not definitely and absolutely.  The  great difficulty is,
that we have not as yet been able to  isolate the  poison.  If we
could isolate the poison, we would be  able to watch its action, in
combination with the actions of external  agents, and compare  its
action with that of other known poisons upon  the living  system,
under definite conditions.  The relations of cause and effect could
thus be determined,  and the operation of the  agents determined
with a precision corresponding to the  perfection of the modes of
investigation.
  If the physical and chemical properties of a poison be known,
and  if it can be isolated  and weighed,  a definite quantity may be
introduced  into the animal body, and by carefully-devised  experi-
ments the physiologist can determine the channels through which
the poison  is absorbed into the blood, and  its effects upon  the tis-
sues with which it comes  in contact, and its chemical and physical
relations to the  elements  of the  blood, and the influence of the
changes produced by it in the elements  of the blood, upon the
organs and tissues, and upon  the  development and  correlation of
the  physical, and vital,  and  nervous  forces;  and  by carefully-
devised experiments the physiologist can determine whether the
action of the poison be confined to one or more organs, and whether
the derangement of the chemical  actions in these  organs may not
be  the  cause of the  subsequent  phenomena; and  by careful ana-
lyses of the excretions of the  kidneys, intestines, skin, and luno-Sj
he can determine in what state  the  poison is thrown off;  he can
determine whether it  has  acted by its simple presence, or whether
it has itself entered into the round of chemical change, and  been
either altered or  destroyed; and  by a  comparison  of the products
of the metamorphoses of the elements  of the living body with the
alterations  produced in the  poison, and in the constituents of the
blood, he can form  some  definite, if not absolutely correct idea of 
MALARIAL FEVER.
91
the series of chemical changes  leading to  the alterations of the
various secretions and excretions, and of the elements of the blood;
and by carefully-devised experiments the physiologist and patho-
logist may also  determine the relations of remedial agent to the
poison.   Upon the results of such experiments and investigations,
a true, absolute system of pathology and therapeutics can alone be
based.
  It is evident that the perfect knowledge of all diseases will never
be obtained, until the physician is able to isolate the special poisons,
and determine their  physical, chemical, physiological, and patho-
logical relations.   In the case of malarial fever, although analogical
reasoning leaves no  doubt in the  mind that it is caused by the
action of a special poison; still  we are compelled to admit that up
to the present time this poison jiias not only never been isolated,
but that we  possess  no known tests for its presence, except the
peculiar class of phenomena induced by it in the  living organism.
We are compelled to admit that as we cannot isolate, weigh, and
experiment with the malarial  poison, we  cannot with certainty
trace  the channels of its introduction into the blood, neither can we
follow it through the course of the circulation, and determine its
physical, chemical,  and  physiological relations to  the elements  of
the blood, and secretions, and organs, and muscular and nervous
systems; nor can we tell  the form  and mode in which it is elimi-
nated from the body.
   Notwithstanding these  imperfections of our knowledge, we can
derive valuable information from the study of the symptoms, and
of the changes of the blood, and secretions and excretions, and of
the organs and  apparatuses, and from a comparison of these with
the analogous actions of those poisonous agents which can be iso-
lated, weighed, and experimented with.

   Color of the Blood and Serum in Malarial Fever.—In severe cases
of malarial fever I have observed that the blood presents, when first
abstracted, a dark  purple  almost black color, and after exposure
to the atmosphere the change from  the venous to  the arterial hue
upon  the surface of the clot is always slower than in normal blood,
and in very severe cases it changes to a cherry-red color, and not
to the bright red assumed by the surface of healthy venous blood.
  The blood found in the large veins after death always presented
a deep purple and  black color,  and changed slowly to the arterial 
92
OBSERVATIONS ON
hue upon  the surface when  exposed to the oxygen of the atmo-
sphere.
   The blood  of  the liver  presented  a dirty  brownish  red and
purplish red color, which did not change to the arterial hue when
exposed  to the oxygen of the  atmosphere.  The  relations  of the
coloring  matter of the blood to  the oxygen of the atmosphere were
noted  in sixteen malarial  fever livers, and in each instance the
result  was  the same—no change of color.
   The blood of the enlarged, softened, slate-colored spleen of mala-
rial fever, as far as my observations extend, presents reddish brown,
and  purplish brown, and purplish  red colors,  which  remain un-
changed during exposure to the oxygen of the atmosphere.
   The serum during  the active stages of the severest forms of mala-
rial fever was always, whether obtained from the surface of blisters,
or from the blood of the capillaries, or from that of  the veins and.
arteries, during life or after death, of a bright golden yellow color.
I have demonstrated  in several  cases that this coloring was due, in
part at least, to the coloring matter of the bile.  Whether  this
change in the color of the serum be entirely due to the presence of
the coloring matters of the  bile, or to the presence  of the products
resulting from the decomposition of the colored blood-corpuscles,
or to the simple increase  of the  normal  coloring matter of the
serum, has  not as yet been determined.

   Specific Gravity of the Blood and Serum.—The  specific gravities of
both the  blood and serum are diminished during the active stages
of malarial  fever, and during the slow action of the  malarial poison.
The following  table will  give a comparative view  of the variation
of the specific gravities of the  blood in malarial  fever and other
diseases:— 
MALARIAL FEVER.
93
Specific Gravities of the Blood and Serum in Various Diseases.
OBSERVERS.		DISEASES.		REMARKS.				Id-H C 3 S*	.a P<boo 1027.0 to 1033.0
								2? u u-i p. too GO	
Becquerel & Rodier		Healthy Standard j		Established by the examination of ) the blood of 22 healthy persons 1				1055.0 to 1063.0	
" "		" " . .		Mean in the healthy male				1060.0	1028.0
" "		u ii		Mean in the healthy female				1057.0	1027.0
Nasse ....		n n							
Zimmerman		u ii							
Joseph Jones		Malarial Fever		Mean of 9 examinations of 9 men . Maxima of ditto .... Minima of ditto .... Seaman; intermittent fever of 12 d'ys Irish laborer; int. fever of 5 weeks Ditto, ditto of 6 weeks Seaman; severe remit, fev. 16th day Ditto, ditto, 10th day Remittent and typhoid fever, 11th d'y Remittent fever .... Intermittent terminating in congest-				1038.3 1042.4 1030.5 1042.0 1034.0 1030.5 1042.0 1042.4 1035.0 1042.4	1021.3 1023.6 1018.0 1018.0 1021.3 1022.5 1021.3 1021.0
				ive fever, 2 months				1036.6	1023.6
" . .		" " •. .		Congestive fever ....				1040.0	1022.0
Becquerel & Rodier		Marsh Cachexy induced							
		by Malarial Poison		Mean of 5 cases ....				1036.7	1021.2
u n		" "		Maxima of ditto ....				1040.5	1024.1
n n		n u		Minima of ditto ....				1033.8	1016.4
n u		Typhoid Fever . . .		Mean of 17 first bleedings				1054.1	1026.0
n ii		" "...		Mean of 6 second bleedings				1051.4	1024.8
Guenaud de Mussy									
& M. Rodier		Typhus Fever . . .		Mean of 6 cases ....				1047.9	1020.8
u n		" " ...		Maxima of ditto ....				1055.5	1024.1
it n		" " ...		Minima of ditto ....				1041.2	1020.0
Becquerel & Rodier		Ephemeral Fever . .		Mean of 8 cases .... In a man 30 years of age, bled on				1056.8	1025.5
				day of death . . . . .				1074.1	1042.2
u ii		Acute Scurvy . . .		Man 48 years of age, 6 weeks .				1050.3	1025.5
u n		Chronic Scurvy . .		Man 32 years of age, 15 months				1060.3	1026.2
n ii				Mean of 10 cases of symptomatic					
				ansemia......				1049.9	1026.8
i i				Mean of 6 cases, females Maxima of ditto				1046.3 1055 2 1035.2 1048.2	1026.1 1032.2 1025.0 1023.5
		n		Minima of ditto Mean of 15 cases					
		Acute Briqht's Disease							
n ii		Cachectic Dropsies .		Mean of 16 cases				1039.6	1022.6
u ii		Phlegmasia generally						1055.4	1027.0
ii ii		Acute Bronchitis . .						1056.7	1027.4
n n		Pleurisy.....						1055.0	1026.0
n n		Pneumonia ....						1052.6	1025.0
„		Acute Rheumatism						10.35.5	1025.0
   As far as the  observations (which are  not only reliable, but
present a condensed view of the most important results  thus  far
recorded) presented in this table extend, they demonstrate that the
specific gravity, or, in  other words, the solid  matters of the blood
are more rapidly and decidedly diminished in malarial fever than
in any other disease.

   Coagulation of the Blood.—In severe cases of malarial fever I have
always  observed that  the  clot is voluminous, and much  less con-
sistent than the clot of normal blood, or of the blood of the phleg-
masias, and that the contraction of the fibrin is much less,  and as a 
94
OBSERVATIONS  ON
necessary consequence the amount of the serum forced  out is much
less than in normal and in  inflammatory blood.
   That the large size of the clot  is  due neither  to an increase of
globules, nor to an increase of fibrin, is conclusively  demonstrated
by the following  tables:—

       Table of the  Blood-Corpuscles in 1000 parts of Healthy and
                                Malarial Blood.
The blood-corpuscles in healthy blood may vary from    .    \

Mean of 9 examinations of the blood of 9 cases of malarial fever
Maxima of ditto.....
Minima of ditto.....
Seaman ; intermittent fever of 12 days
Irish laborer; intermittent fever of 5 weeks
Ditto, ditto of 6 weeks  ....
Seaman ; severe remittent fever, 16th day
Ditto, ditto, 10th day    ....
Remittent and typhoid fevers
Remittent fever terminating in congestive fever, 2 weeks
Congestive fever........
  Moist
blood-cor-
 puscles.
480.000
  to
600.000
331.397
431.508
207.948
413.732
293.620
207.948
401.764
431.508
262.448
309.936
317.748
343.872
 Water
 of moist
blood-cor-
 puscles.
360.000
  to
450.000
248.548
323.631
155.861
310.219
220.215
155.861
306.823
323.631
196.836
232.452
23S.217
258.804
  Solid
 matters
 of moist
blood-cor-
 puscles.
120.000
  to
150.000
 82.849
107.320
 51.812
100.431
 70.411
 51.812
100.409
107.320
 62.703
 73 655
 76.000
 84.400
Table of the Fibrin in 1000 parts of Healthy and Diseased Blood.
OBSERVERS.
Andral & Gavarret
Becquerel & Rodier
Joseph Jones
Becquerel & Rodier



Andral & Gavarret


M. H. Guenaud de
 Mussy & M. Rodier


Andral & Gavarret
Becquerel & Rodier
Andral & Gavarret
5 Standard of Health

Malarial Fever
Marsh  Cachexy induced
 by the Malarial Poison
Typhoid Fever
Typhus Ffver


Smallpox  .  .
Ephemeral Fever
Scarlatina
Measles
REMARKS.
In healthy blood the fibrin may vary \
  from......1
Mean of 9 cases of malarial fever
Maximum of ditto.....
Minimum of ditto.....
Intermittent fever of 12 days
Ditto of 5 weeks.....
Ditto of 6 weeks.....
Remittent fever of 16 days  .
Ditto of 10 days.....
Remittent and typhoid fevers of 11 days
Remittent fever of 2 weeks .
Congestive fever.....
Ditto......
Mean of 5 cases
Maximum of ditto .
Minimum of ditto .
Mean of 41 analyses
Maximum of ditto
Minimum of ditto .
Mean of 6 cases
Maximum of ditto
Minimum of ditto
Mean of 5 cases
Maximum of ditto
Minimum of ditto ,
Mean of 8 cases
Mean of 4 cases
Maximum of ditto
Minimum of ditto
Mean of 7 cases
Maximum of ditto
Minimum of ditto
2 000
 to
3.500
2.018
2.938
0.877
1.900
2.540
1.925
2.938
1.433
2.380
2.710
0.877
1.450
3.390
4.270
2.360
2.600
4.200
0.900
2.466
3.900
1.200
2 400
4.400
1.100
2.SO0
4 350
6.800
3.100
2.742
3.400
2.400 
MALARIAL  FEVER.
95
Table of Fibrin in Blood—Continued.
OBSERVERS.
Becquerel & Rodier
Popp.....
Andral & Gavarret
Wittstock  .  .   .
Simon.....
Becquerel & Rodier

Andral & Gavarret
Becquerel & Rodier
Glover  . .  .
Heller  . .  .
Becquerel & Rodier
Andral & Gavarret
Becquerel & Rodier
Andral & Gavarret
Becquerel & Rodier
Andral & Gavarret
Becquerel & Rodier
Andral & Gavarret

Becquerel & Rodier
Acute Scurvy.....

Chronic Scurvy  ....

Erysipelas......



Cholera  ......



Phthisis......



Scrofula  ......
Carcinoma......
Bright's Disease, Acute


Bright's Disease, Chronic
Chlorosis......
Anaemia.......


Acute Rheumatism .  .  .
Chronic Rheumatism
Puerperal Fever
Pneumonia ....


Pleuritis ....


Angina Tonsillaris
Acute Bronchitis
Phlegmasia generally
Acute Bronchitis  .  .
Pleurisy.....
Pneumonia.....

Articular Rheumatism
REMARKS.
Man aged 48 years, sick 42 days
Man aged 21 years, sick 30 days
Man aged 32, sick 455 days
Man aged 23, sick 552 days
Man aged 33 years
Mean of 8 analyses
Maximum of ditto
Minimum of ditto
1 case
Ditto
Man, day of death
Ditto
Mean of 21 cases
Maximum of ditto
Minimum of ditto
Mean of 16 cases
Mean of 8 cases, males
Mean of 7 cases
Mean of 15 cases
Maximum of ditto
Minimum of ditto
Mean of 13 cases
Mean of 6 cases
Mean of 10 cases
Maximum of ditto
Minimum of ditto
Mean of 43 cases
Maximum of ditto
Minimum of ditto
Meun of 10 cases
Mean of 4 cases
Mean of 58 analyses
Maximum of ditto
Minimum of ditto
Mean
Maximum
Minimum
Mean of 5 cases
Mean of 6 cases
Maximum of ditto
Minimum of ditto
Mean of 4 cases
Maximum of 6 cases
Minimum of ditto
Mean of numerous observations
Ditto, ditto
Ditto, ditto
Ditto, ditto, 1st bleeding
Ditto, ditto, 2d bleeding
Ditto, ditto
 2.500
 2.200
 1.850
 1.320
 6.600
 5.676
 7.300
 3.600
11.000
11.000
 1.8S0
 6.500
 4.400
 5.900
 2.100
 4.800
 3.130
 4.945
 2.990
 3.760
 1.650
 4.340
 4.200
 3 720
 5.820
 1 620
 6.700
10.200
 2.800
 3.800
 6.760
 7.300
10.500
 4 000
 4.656
 5 900
 3.800
 6.100
 5.550
 7.200
 3.800
 4.800
 9.300
 5.700
 5.800
 4.800
 6.100
 7.400
 6.800
 5.800
   This  table  demonstrates:  first,  that  the  fibrin  is  diminished
greatly in severe cases of malarial fever; second,  that the diminu-
tion  of  this  element of the blood is  characteristic not  only of
malarial  fever, but of  all fevers (Andral and Gavarret),  whilst  its
increase, on the other  hand, is  characteristic  of the phlegmasia?
(Hunter).
   As a general rule, the  diminution of the fibrin in malarial, as in
the pyrexiae  generally, corresponds to the  severity of the disease,
provided there be  no inflammatory complication.
   As far as my observations extend, the diminution and  alteration
of the  physical  properties of  the  fibrin  in malarial  fever, to any
great extent, was always accompanied  by congestions  of the spleen, 
96
OBSERVATIONS ON
liver, and brain, and serious.cerebral disturbances.  Whether these
phenomena  stand  in  the  relation  of cause and  effect, cannot be
determined  simply by their association  in a single disease, or in a
class of diseases, independent of an investigation of the offices and
relations of  fibrin  in health and in disease.
  These facts, with reference to the decrease of fibrin in malarial
fever, are invested  with interest and importance, in their agreement
with the results of the investigations of  Andral and Gavarret, and
Becquerel and Eodier, in the changes of  the blood in typhoid fever,
and of Guenaud de Mussy and Eodier, in typhus fever.
  The fibrin is not  only diminished in malarial fever,  but it is altered
in its properties and in its  relations to the other elements of the  blood,
and to the bloodvessels.
  We will  illustrate  this  proposition by the following  cases and
post-mortem  examinations:—

  Case illustrating the Physical Changes of the  Fibrin, and the
          Formation of Heart-Clots in Malarial Fever.

  Irishman—age 26; height 5 feet 11 inches; weight 170 pounds;
black hair; black eyes;  full, dark-brown  beard  and  mustache.
Limbs full and round, chest broad, and  well developed.  Has been
in America (New York) nine years, and in Savannah three months.
During this time he has followed the occupation of  a baker.
  Sept. 11,  12  o'clock M., 1857.  Has just  entered  the  Savannah
hospital with remittent fever.  Pulse accelerated but feeble, and his
complexion shows the effects of malarial fever.  Says that he has
been sick for one  week, and has been living near the depot of the
Albany and Gulf  Eailroad, in a low, malarious situation.  Under
the action of sulphate of  quinia and stimulants, the febrile  excite-
ment disappeared  in the course of four days ; the patient, however,
was left in a very  feeble condition; complained of great weakness,
his pulse was feeble, the action of the intellect sluggish, and he had
a peculiarly disagreeable smell, which was not permanently removed,
either by water or by a change of clothing.
   Under the action  of tonics,  he recovered sufficiently to walk
about the yard; but continued, however, weak, low-spirited, and
indisposed to action.
   27th.  Complained of torpor of  the  bowels.   A  mild cathartic
was administered.
   28th.  Has a cough.  The wind  has been from the northeast for 
malarial fever.
97
some time, and the weather has been cold and damp, and epidemic
catarrh is prevailing.  About two-thirds of the hundred patients
now in the hospital are suffering with the influenza.
  This patient was up and about the wards, assisting and nursing
the patients all  day. He  was up  and about  when I  went the
rounds of the wards  at 9 o'clock P. M.  Shortly after this he com-
plained of great oppression of the lungs,  difficulty of breathing,
and loss of muscular power.
  29th, 9 o'clock  A. M.  During the night took  a sudden and
remarkable change for the worse.
  Eespiration spasmodic, and  sounds as if the air-cells, bronchial
tubes and trachea contained large quantities of fluid, and is attended
with a loud  rattling  sound in  the throat.   The churning, rattling,
gurgling,  crackling sounds of the lungs and trachea are very loud,
and can be distinctly heard over the upper wards of the hospital.
Muscular power completely exhausted; lies upon his back, and is
unable  to turn  upon either side.   Surface  of extremities cold;
surface of trunk cool, several degrees below the normal standard.
The temperature of  the extremities does not differ essentially from
that of the surrounding medium.  The expression of his eyes and
countenance, and his efforts to  converse,  show  that he  is intelli-
gent ; he  is, however, entirely unable to articulate or expectorate.
   Sinapisms were applied to the extremities, epigastric region and
chest, and stimulants were administered freely.   These did not pro-
duce any beneficial effects—did not arouse the circulation, and did
not increase the animal temperature, because the supply of oxygen
necessary for the chemical changes which generated the physical,
muscular, and nervous forces, was cut off.  The mustards scarcely
reddened  the skin, even after the application of several hours.
   The patient continued in this state, with a gradual diminution of
power, until  1 o'clock A. M. the  next morning, when the painful
respiratory sounds were hushed in death.

                autopsy eight hours after death.

  Exterior.—Body in good condition, not emaciated;  limbs full
and round;  muscles  of trunk  and extremities  covered by a thick
layer of fat;  face  and hands sallow and sunburnt; surface  of the
skin which had been covered by the clothes, fair.
  Head.—Dura mater presented the usual appearance.  Arachnoid 
98
OBSERVATIONS  ON
 membrane transparent and healthy, bloodvessels of pia mater filled
 with blood.
   When the dura mater was removed, an ulcer in the substance of
 the  brain was  discovered, occupying a position near the  centre of
 the superior surface of  the left hemisphere of the cerebrum.   This
 ulcer was three-fourths of an inch in length, half an inch in breadth,
 and  one-eighth of  an inch in depth.  The  walls were thickened
 and  much  harder than the surrounding brain.  The bloodvessels
 of the surrounding pia mater and brain were congested with blood,
 and  a small quantity of bloody serum  was effused  between the
 arachnoid  and pia mater in the immediate neighborhood of the
 ulcer, but  nowhere else.  The appearance  of the ulcer, and the
 congestion of the bloodvessels around, by no means accounted for
 the death of the patient.  The thickened walls, the absence of pus,
 and  the sound  state of the structures  of the brain around, show not
 only that the ulcer was of long standing, but also that it was rapidly
 healing.  The  existence of this ulcer will account, in part, for the
 dull, lethargic state of  the intellectual  faculties,  but  not for the
 death of the patient.
   The ventricles of the brain contained  a small quantity of clear
 serum.
   The structures of the brain presented the usual consistence and
 appearance.
   Chest.—Heart normal in size; the right ventricle contained a large
 light yellow fibrinous clot, attached  to the  chordas tendineaa and
 carneae columnae, and extended  through the  auriculo-ventricular
 opening  into the  auricle.  This  clot was  firm in texture, and
 weighed  one  ounce.  The left ventricle contained  a  small  light
 yellow clot;  the aorta also contained a small, flattened, ribbon-like,
 light yellow clot.   These clots were  evidently formed previous to
 death, when the circulation was exceedingly feeble.
   Lungs.—The lungs were greatly inflated, and did not collapse in the
 slightest degree when air was  admitted into  the pleura.   They were
 congested with  blood, and resembled in appearance  liver;  and  when
 handled they were remarkably heavy, and felt more like liver than  lungs.
 When cut,  the air-cells, and large and small bronchial tubes, were found
filled with serous fluid, and numerous  fine bubbles of air.   When the
 lungs were squeezed, pints of this serous fluid flowed out.   In  many
 portions of  the lungs the serous fluid was clear ; in others it was reddish.
 The  fluid resembled serum in all respects,  and was not mucus.  Here
 then, we have the cause of the death of this patient.   He was drowned. 
malarial fever.
99
  Abdominal Cavity.—Stomach pale and perfectly healthy in appear-
ance ; intestinal canal, from the stomach to the anus, pale and healthy
in appearance.
  Liver.—The normal reddish-brown color of the liver was changed
in most parts to a mixture of light bronze and light olive, and in
several places resembled the normal color.  In two circular spots,
about three inches in diameter, the liver was of a dark-bluish slate
color, like that of a recent case of malarial fever.  The cut surface
of the liver approached more nearly to the normal color than the
exterior.  The blood of the liver, after exposure to the atmosphere,
assumed a red arterial color.  It is evident from this examination
that the structures of the liver were recovering from the effects of
the malarial fever, and that the organ  was regaining its normal
color.
  Spleen.—Slate-colored, enlarged, and  softened.  The pulp of the
spleen presented a dark purplish-brown color, which did not change
to the red arterial color as rapidly as the pulp of healthy spleens;
the change of color, however, was much greater than that of the
pulp of the spleen  in  recent cases of malarial fever.   This organ,
like the liver, appeared to be recovering from the effects of mala-
rial fever.
  Kidneys.—Healthy.
  We believe that we have now all the facts necessary for a rational
explanation of the phenomena presented by this case.
  The malarious  poison and  its effects had  produced profound
alterations in the blood and capillaries, liver and spleen, and pri-
marily by its direct action, or secondarily  by the action of  the
altered products in the blood, affected the sympathetic and cerebro-
spinal nervous systems.  The patient, although weak and lethargic
on  account of these pathological alterations and the ulcer upon the
brain, was, nevertheless, in a fair way of recovery;  the alimentary
canal had  resumed its healthy actions,  and the liver  and spleen
were fast recovering, and he  was gaining strength daily.  We can,
in view of these facts, safely assert  that if no other  disease had
occurred, the  lesion of the left hemisphere of the brain,  and  the
effects of the malarial poison, would not have proved fatal.
  In this state  of slow convalescence  the patient  was suddenly
seized with the  prevailing influenza.  The mucous membrane of
the bronchial tubes and air-cells was irritated.  The irritation of
the mucous membrane was followed by congestion of the blood-
vessels and capillaries of  the lungs.   The capillaries were  in an 
100
OBSERVATIONS ON
enfeebled state; the fibrin of the blood was diminished in quantity,
and altered in physical and chemical properties;  the colored blood-
corpuscles were diminished in number, and physically and chemi-
cally altered; the solid matters of the blood were diminished ; and
the physical and chemical relations between the individual consti-
tuents of the blood and  the  capillaries were  disturbed.   Healthy
limited  inflammation  was impossible.  Diffused inflammation  of
all the structures of the lungs resulted; the serous portion of the
blood poured into the  air-cells, bronchial tubes, and trachea; the
supply of oxygen was in a  great  measure cut off;  the chemical
changes of the solids and fluids in a corresponding degree checked;
the physical forces, heat and electricity, and the nervous force, de-
veloped by these  chemical changes, were,  as a necessary conse-
quence,  correspondingly diminished.
  The immediate cause of the death of this patient was a depriva-
tion  of  oxygen and the  retention of the carbonic  acid gas.  We
may  say with truth that he was drowned.

Case illustrating the Changes of the Fibrin, and  the Formation
              of Heart-Clots in Malarial Fever.

  Irishman—laborer and boatman;  age 30; height 6 feet;  weight
150 lbs.; tall, spare frame, light hair, blue eyes; pale, sallow com-
plexion.  Has been running  on flatboats and rafts, up and down
the Savannah Eiver, between  Savannah and Augusta, for  the last
twelve months.   Habits irregular;  addicted  to  the use of ardent
spirits.  Says that his constitution has suffered much  from  the
exposure to the hot sun and  night air on the river, and also from
the intemperate use of ardent spirits.
  September 20,  1857.   "A flat, laden with  wood, which he was
bringing to the city, was sunk in shoal water."  He was all day in
the water, up to his waist, fishing out the wood; and at night had
a chill, followed by fever.  The fever went off before morning, and
on the next day he was employed again in the water.  The chill
returned at night, and was followed by high fever.  Has been sick
from this time to the  present time, September  27th, without any
medical attendance.
  Pulse 106; respiration accelerated, labored; skin hot and dry
countenance distressed; has a haggard, anxious look; complains
of great thirst, of pains in his back and bones, and of great exhaus-
tion.  His pulse, although rapid, is feeble, and his forces appear to 
malarial fever.
101
be completely exhausted.   His fever remitted slightly on the next
day, but returned on  the 29th inst.  Under the action of large
doses of sulphate  of quinia, and stimulants, sinapisms, snakeroot-
tea, and milk-punch, and wine-whey, and brandy and arrowroot,
the febrile excitement subsided, the urine regained its normal hue,
and on  the 4th inst. his pulse was 70, and respiration  18;  tempera-
ture normal, and function of skin normal; and although apparently
very weak, the patient was able to be up and about the ward.
  During this attack the saliva was acid, and the urine copious;
from  20,000  to 25,000 grains  were excreted daily.  The specific
gravity was correspondingly low, from 1012 to 1014.  The abundant
discharge of  urine was due to the  large  quantities of water which
his thirst led him to take, and also to the diuretic  action of the
infusion of snakeroot.  Throughout the attack his pulse was feeble
and his forces greatly exhausted, and he required close attention,
and the free administration of stimulants.
   October 5th. This  morning escaped clandestinely  from the
hospital.
   8th.  Has returned.   Pulse  120; skin  hot and dry; respiration
accelerated, labored; complains of great pain  in the back of his
head and neck; these parts are swollen, and painful upon pressure.
 R.—Cold water dressing to back of head and neck.
   9th.  His head has been shaved, and the tissues  above the occi-
pital bone, and above  the  left temporal and  parietal bones, are
swollen, and  the skin looks black, and is ulcerated in several places.
The swelling extends down along the neck, and reaches  the supe-
rior portion  of the left shoulder.  To the finger the  swollen parts
feel as  if there was a collection of fluid  beneath the skin.  Says
that he is suffering  intense pain; countenance distressed and hag-
gard; pulse 128; skin  hot and dry; respiration  thoracic, labored,
accelerated.
   10th. Pulse 160,  feeble;  skin hot; respiration  spasmodic and
labored.  In addition to the intense  pain in the back of his neck
and left side  of the head, he complains of intense pain in his chest.
The pain in  the chest cuts short the  respiration, and  renders it
spasmodic.   His countenance  is expressive of great agony and
terror.
   11th. Pulse 140, rapid  and very feeble; respiration 24, labored,
thoracic, spasmodic.  The pain in his chest  is intense;  he groans
and cries at every breath, and the  expression of his countenance is
indicative of  great agony, terror,  and horror.   Was  restless and 
102                  observations on
delirious during  the night, and during his delirious visions spoke
and acted as if he was engaged in mortal combat.  Has no hope of
himself, and refuses all medicine.  The  back of his neck and side
of head is much  swollen, and when pressed with the hand there is
a distinct fluctuation.  Hoping that discharge of the pus, or fluid,
would  afford relief, a free crucial incision was  made at the most
prominent part of the swelling.   Nothing but blood issued.  The
hemorrhage  was  so great, that  it was necessary to  check it  by the
application to the wound of a compress, saturated with the tincture
of muriate of iron.
  12th. During  the night was delirious; would rip out the most
terrible oaths, and cry out that  the devils  were after  him, had
beaten him  severely, and were endeavoring  to  throw him  out of
the windows.  At other times he would  speak and act as if  he had
been in mortal  combat,  and was  wreaking  vengeance upon an
imaginary antagonist.  These  actions excited the suspicion  that
the injury on the back and side of the  head was  received  from a
blow.
  The patient died at one o'clock A. M. this morning.

                AUTOPSY NINE HOURS AFTER DEATH.

  Exterior.—Body much emaciated; back and left side of neck
much swollen.  The  inferior  surface of the  trunk and  neck pre-
sented a mottled appearance,  from the  settling of the blood by
gravitation during the last hours, when  the circulation was feeble.
On the right leg there were the marks of an  extensive ulcer upon
the skin covering the tibia; the cicatrix presented a purplish, angry
color.  When incisions were made into the  swollen  parts of his
neck, and  back  and side of head, the spaces between  the muscles,
the meshes of the fibrous tissue surrounding  and  connecting toge-
ther the muscles and the fibrous tissue of the skin, were found to
be completely filled and distended with golden-colored serum.
  Head.—Dura mater healthy.   Arachnoid membrane transparent
throughout its entire extent over  the hemispheres of the brain.  At
the base of the brain it was slightly opalescent.
  Bloodvessels of pia mater not more filled with blood than usual.
  The cortical and medullary substances of  the cerebrum, and of
the cerebellum, and the structures of the pons Varolii, the medulla
oblongata, and  superior portion of the spinal  marrow,  appeared
natural in consistence and color. 
malarial fever.                  103
  Ventricles of brain contained f 3iv of golden colored serum.
  The superior longitudinal  sinus of the dura mater contained a
golden-yellow elongated clot, the diameter of which was about one
half that of the longitudinal  sinus.
   Chest—Heart somewhat enlarged.   Pericardium contained f I] of
golden  serum.  All the cavities of  the  heart  contained  golden-
colored clots.  The right auricle had a large golden-colored clot,
which was attached to the carneas columnae and chordae tendineae
of the auriculo-ventricular valves.  The aorta, carotids, and pulmo-
nary arteries contained elongated golden-colored clots, having dia-
meters nearly equal to those of the arteries.  All these clots were
firm and elastic.
   Lungs.—^he lungs did not collapse when the cavity of the chest
was  opened.  Exterior surface of  the  pleura  covering  the lungs
and lining the walls of the thorax was covered with soft coagulable
lymph of  a golden-yellow color.  Adhesions were numerous, but
 as yet not strong, on account of the soft, fresh condition of the
 coagulable lymph, which  was evidently  but recently effused, pro-
 bably within the last seventy hours.  This inflammation of the pleura
 accounts for  the severe pain in the  chest during life.  The lungs
 were much congested with blood,  and when cut they resembled
 liver.  The bronchial tubes and air-cells  contained much  serum.
 This serous fluid poured in  large quantities from the cut surface.
    The anterior  surface of the middle lobule of the right lung had
  a dark blackish-red spot, about one inch in diameter, which resem-
  bled at first sight a wound  from a  sharp instrument.  An examin-
  ation of the exterior of the chest, and interior surface of the ribs,
  showed  neither  wound  nor fracture of the ribs.  When  closely
  examined, this portion of the lung was found to be more congested
  and solidified than the surrounding portions, and would in all pro-
  bability, if the patient had  survived, been the seat of an abscess.
    Abdominal Cavity.  Alimentary  Canal.-The stomach,  although
  enormously distended with gas, was pale and  healthy in  appear-
  ance • small intestines also  pale and healthy, to the naked eye.
    Liver of a light bronze color.  The color is lighter than that of
  the liver in the  active stages of malarial  fever, but resembles the
  color of a liver which was recovering from the effects of malarial
  fever  Cut surface of a light bronze color, and not of such a deep
   and decided bronze as the liver of the active stages of malarial
   fever   The right lobe of  the liver had upon  its under  surface a
   slate-colored spot three inches in diameter, which resembled in all 
104
observations  on
respects  the liver of a  recent case.  When an incision was made
across this spot, the cut surface presented for one-sixth of an inch
the true malarial hue; below this it approached  more nearly the
normal hue.   The structures of the liver did not appear  to  be
softened.
  Spleen.—Much enlarged, of a dark-slate color, and although much
softer than a normal spleen, it was much harder than a spleen of a
recent case of malarial fever. Weight 31 ounces.  This organ, like
the liver, appeared to be just recovering from the effects of malarial
fever.  Kidneys  appeared to be somewhat enlarged;  the calices>
infundibula and  pelvis  of the kidney contained a  fluid resembling
pus.
  The following  appears  to be the cause and  history of this last
attack:—
  The patient left the hospital  when  he was  in an  exceedingly
feeble condition, after a  severe  attack of remittent fever.   It  is
probable that he indulged his taste for ardent  spirits,  for the day
on  which he left the hospital was election day.  The wind  was
from the northeast, and  the weather damp and cool, with occasional
scuds of rain and mist.   Exposure to this cool damp  wind, fresh
from  the ocean, and the low grounds and swamps of Georgia and
South Carolina, not only during  the day but probably during the
night also, in a state of  intoxication, induced  a  severe attack  of
pleuro-pneumonia.
  The swelling on the back of his head was due either to a blow
or to inflammation in the  cellular tissue and muscles analogous  to
the inflammation of the lungs, and probably arising from the same
cause.
   The large amount of serum effused into  the bronchial tubes—the large
amount  of golden-colored serum effused into the  cellular  tissue of the
neck and head—and the large golden, fibrous clots in the heart and arte-
ries—the settling of the blood in the most dependent parts of the body—
the appearance of the cicatrix, and the inflamed spot in the lungs, all
indicated disturbances in the constitution of theflbrin, and of the relations
between this element and the other elements of the blood to each other and
to the bloodvessels and capillaries.
  The occurrence of the fibrous clots in the heart  and bloodvessels
during malarial fever, demands a careful investigation.
  As far as my observations extend, the formation of heart-clots during
life is very common in malarial fever.
   In fifteen  post-mortem  examinations  I. found heart-clots in ten 
malarial  fever.
105
cases, and of the  remaining five, one was  a case of typhoid fever
combined with remittent fever, another was a case of malarial fever
of long standing,  where the  patient died of exhaustion, and in the
remaining three no special examination for heart-clots was insti-
tuted.   The following cases, in addition to the two  just reported,
will illustrate the  symptoms  attending the formation and existence
of these heart-clots:—

Fatal Case of Congestive Fever, terminating suddenly—Fibrin-
  ous Concretions in the  Heart and Pulmonary Bloodvessels, and
  Aorta.

  Irish laborer; height 5 feet 10 inches, weight 150 pounds; black
hair, black eyes, dark complexion, resembles an Arab in  appear-
ance ; person, dirty and filthy.
  Sept. 2d, 1857,  12 o'clock  M. Has been  sick, on the bay, for ten
days, with  an abscess in  the palm of his  hand; previous to this
he had been working on the river bank.
  When first brought (this morning) into the hospital, he appeared
stupid,  and  urinated in the bed.   After  the administration  of a
hot bath, and  the lancing of his  hand, he was aroused, and  now
appears to be entirely restored to the exercise of his intellect.
Seems to be-very weak, and complains of no pain, or trouble any-
where, except in the palm  of his hand.  Skin not warmer than
usual; tongue dry, red, and glazed, and harsh and rough to the
touch;  pulse 82.
  Continued sensible, and apparently convalescent, and complained
of nothing, and manifested no striking phenomena until Sept. 3d,
3| o'clock P. M.
  At this hour I was  summoned  hastily, and found  this  patient
insensible,  with his mouth  open and  groaning loudly at every
breath.  His groans sounded very much like the barking of a dog.
Countenance distressed, anxious, and expressive of great  agony;
tendons twitching violently;  teeth coated with sordes;  tongue dry,
red and glazed, and harsh to the feeling. Eespiration 40, thoracic,
panting; pulse 104.  Temperature of hand 103° F.   Skin hot, dry,
and rough.  When the attempt is made to arouse him, by violent
shaking and loud  talking, he mutters incoherently.   Great tender-
ness upon pressure of epigastrium; cries out whenever this region
is pressed.   Cups to the temples and back of neck, a large blister
over the epigastric region—sinapisms  to the extremities, stimu-
       8 
106
observations on
lants and sulphate of quinia, all failed  to  arouse this  patient, and
he died twenty hours after this observation.
  There was but little change in the symptoms, with the exception
of an increase in the  frequency of the respiration and pulse.

               autopsy  three hours after death.
  Head.—When the skull-cap was removed, the  dura mater pre-
sented  the usual appearance.  Serous effusion had taken place be-
tween  the dura mater and membranes, and surface of the brain.
fliij of bloody serum flowed from  the base of the brain, and there
had been an effusion of golden-colored serum between the arach-
noid and pia mater.   Bloodvessels of pia mater filled with blood.
Bloodvessels at the base of the brain, and upon the medulla oblon-
gata and spinal cord, more  engorged with blood  than those upon
the superior portions of the brain.  This was, without doubt, due
solely  to the effect of gravity.   The substance of the brain pos-
sessed  the usual consistency, and appeared to the  naked eye to be
normal in structure.
   Chest.—Lungs normal; trachea filled with froth.
  Heart, normal.   The right auricle contained a  large golden-co-
lored clot, which filled almost the  entire cavity.  The left auricle
contained several small yellow clots.
  The right ventricle contained several small clots of blood, which
resembled, in all respects, coagulated blood.
  The main trunk  of the pulmonary  arteries contained a long,
flattened, ribbon-like, yellow clot, which extended not only through
the large trunk, but  divided and sent off branches to  each branch
of  the pulmonary artery;  and then  again  subdivided and sent
branches off to the  minor  branches of the arteries.   When the
main clot in the pulmonary artery was gently pulled,  the branches
were draWn out twelve  inches  in  length, and at their extremities
were not much larger than a fine silk thread.  The clot was almost
entirely free from red corpuscles, of a  yellow color, firm, and elas-
tic in structure, and in appearance  resembled an organized product.
   A similar ribbon-like, yellow, elastic clot, extended  through the
whole length of the  aorta.   The blood  in the vena cava was coagu-
lated,  but the  coagulum was like that of ordinary blood, and much
less firm than the  clots of the right auricle, pulmonary arteries and
aorta.
   Abdominal Cavity.—The liver presented  the true malarial hue-
contained no grape sugar, but an abundance of hepatic starch; and 
MALARIAL FEVER.
107
its blood  did not change to the arterial  hue when  exposed to the
atmosphere.  The spleen was enlarged, softened, and of the slate-
color of malarial fever.
  Stomach, intestines and kidneys normal.
  The autopsy demonstrated this to be a case of malarial fever.

Case of Congestive Fever illustrating the Formation of  Fibrin-
          ous COAGULA IN THE HEART AND BLOODVESSELS.

  Irish seaman, aged 24; light hair, light blue eyes, fair complex-
ion; height 5 feet 7  inches;  stout, well built, weight 150 pounds.
  Oct. 12th, 1857, 12 o'clock M.   Entered the hospital two hours
ago.  Now, he is out of his head, and can  give no history of his
case.  A  companion states that he  has been watching at night on
board a brig, lying in the river, below the ship-yard, along the low
marshy shore of  the Savannah Eiver,  and  that he  was taken sick
with chill and fever one week ago, but did not, until two  nights
ago, discontinue watching at night.   Habits intemperate.
  Pulse 137, rapid and feeble; respiration 32; skin, hot and dry.
Tip  of tongue clean, and of  a bright red color—the  remaining por-
tion of the tongue is coated with yellow fur.  The tongue is dry
and harsh to the  touch, and feels, when the fingers are passed over
it, like sand-paper.   The patient mutters  to himself  continually,
half-formed sentences and imperfect words.   Continues to mutter
in the same incoherent manner, notwithstanding strenuous efforts
to arouse and  attract his attention.  About one hour ago his ex-
tremities  felt cooler, and his pulse was more feeble  than it is now;
mustards  were applied to the extremities—they increased the tem-
perature and rendered the pulse  somewhat fuller, and aroused his
intellect for a moment, but  he  again relapsed into  the state of de-
lirium.
  Mustards to the epigastrium and extremities, cut cups  to  the
temples and back of neck, stimulants  and sulphate of quinia and
purgatives, failed to  arouse the intellect, and  at 8 o'clock P. M.,
the  patient lay in a profound stupor, with full  rapid  respiration
and  full rapid  pulse.  Pulse 124, and has increased  in force and
volume under the action of  the stimulants and sulphate of quinia.
Skin hot  and dry; tongue  presents the same dry and rough ap-
pearance.  B.—Continue the stimulants and sulphate of quinia, and
apply blisters to  the back of the neck and over epigastric region.
  13th, 11 o'clock A. M.  The cut cups to the head, the sinapisms 
108
observations on
upon the extremities, the blisters upon the back of the neck and
epigastric region, and the diffusible stimulants and cathartic have
failed to  arouse this  patient, and he  now lies in a comatose state,
and passes his urine and feces in the bed.   The nurse states that
during the  night, he was much more restless than at the present
time, and it was  necessary to give constant  attention  that  he did
not fall out of the bed.  The medicine has operated freely, and the
blister  has  drawn well.  The serum from the blistered  surface is
of a golden color.
  Eespiration 30, stertorous.  The patient lies  in a  stupor, with
his eyes  shut and mouth open, and  emits a suppressed groan, or
whine, at every  breath—his appearance, and the sounds which he
emits, are similar to those of the patient described in the preceding
case.   These  groans appear to be entirely involuntary, and depend
upon the state of the organ of voice, and the  mode  in which the
air passes through it.
   Pulse  144, feeble.  The  sounds of the heart  cannot  be distin-
guished—they are both united into  one, and the heart makes a
short, quick,  thumping sound.  The  number of the thumps of the
heart corresponds to the pulse, 144  to the  minute.   Temperature
of atmosphere 77° F.; temperature of hand 103°.5, temperature in
axilla 104°.5. Skin hot and dry;  teeth coated  with sordes.  Can-
not get a sight of his tongue, as his teeth are tightly closed, and he
is entirely insensible.
   I have just applied  mustards to  his extremities—they do not
arouse him—after remaining on one hour they scarcely redden the
surface.
   9 P.M. Profound coma;  respiration thirty-two, spasmodic; pulse
is gone;  heart merely flutters; head  and trunk warm, extremities
cold.  Have  again applied  mustards  to the extremities, and admin-
istered diffusible stimulants, but they do not produce the slightest
effect,  and he will die in the course of one hour.
   The patient died half an hour after this observation.

                AUTOPSY TWELVE HOURS AFTER DEATH.
   Body in good condition, apparently not  at  all reduced;  limbs
 full and round, muscular, well developed;  complexion fair, with a
 slight tinge  of yellow; skin of the dependent portions  slightly
 darker than  that of the superior portions of the  body; rigor mortis
 remarkably  strong; it  required all  the force that I could exert to
 straighten his arms, and they would return back to the bent posi- 
MALARIAL FEVER.
109
tion with considerable force; after the right arm had been straight-
ened out at right angles to the body, and while I was standing
between the arm and  the body, engaged in opening his abdomen
and thorax, I felt the pressure of a hand and arm upon my back—
this was the hand of the dead man,  which  had slowly returned to
its former position by the contraction of the muscles.
  Head.—Dura mater normal in appearance; the longitudinal sinus
of the dura mater contained an elongated, fattened, ribbon-like, fibrinous
clot, which was free from colored blood-corpuscles, and of a yellow color.
This, without doubt,  was formed before death.   Arachnoid membrane
opalescent, pearl colored in many places;  bloodvessels  of pia mater
filled with  blood.   The substance  of the brain  appeared  to  be
normal in color and texture, as far as an examination with the
naked eye extended; it was  perhaps a little softer than usual, but
this may have been due to  post-mortem changes, and at any rate
would not account for the symptoms during life; ventricles of the
brain contained  no serum; bloodvessels of medulla oblongata and
superior portions of  spinal cord not congested with blood.
   Chest.—Exterior surface of the heart adherent at all points  to the
pericardium.  There was no free space between the heart and the
pericardium, hence no  fluid lubricated  the heart.  If this  lesion
was the result of inflammation, it is  certain that the inflammation
had nothing  whatever  to do with  the present  attack of  fever.
Muscles of  the heart paler than  usual.   The right auricle and ven-
tricle contained a  yellow clot, free from colored  blood-corpuscles,  which
was attached to the columnar carneoz, and chordoz tendineai of the right
ventricle, and extended through the auricuto-ventricular opening into the
auricle.  This clot sent off a  large branch into the pulmonary artery.
This branch of the yellow fibrinous clot, which almost completely filled
up  the pulmonary artery, subdivided and sent branches  down the right
and left pulmonary arteries, and these branches again divided and sub-
divided  into numerous branches, the smallest of which were not  larger
than fine threads.   These fibrinous threads passed deep into the  blood-
vessels of  the lungs, probably almost to the commencement of the  capil-
laries.   The left ventricle contained a similar yellow fibrinous formation
almost entirely free from colored blood-corpuscles, which was attached at
one  extremity to the columnoe carnece, and chordae tendinece, and extending
through the auriculo-ventricular opening into the  auricle, subdivided
into  branches, which passed up the pulmonary veins, and subdivided
into numerous smaller branches which  occupied the smaller divisions of
the  pulmonary veins.   These fibrinous bodies of the pulmonary veins 
110
OBSERVATIONS  ON
and arteries were very elastic—iviih care they could be drawn out of the
smaller branches of the  pulmonary  veins and arteries, four and six
inches  in  length, without breaking, notwithstanding that  the smallest
branches  were very delicate.   The aorta contained a similar clot.  All
these clots were of a bright yellow color, almost entirely free from  colored
blood-corpuscles,  and presented  almost an organized appearance, and
were, without doubt, formed long before death.
  The large  nervous trunks  were  distended with partially coagu-
lated  black blood; the heart, arteries,  and pulmonary veins con-
tained little or no blood.
  When the black blood from the large venous trunks was exposed
to the atmosphere, it assumed slowly and imperfectly the arterial
hue.  The blood appeared to  have been collected in the capillaries
and veins.  If the chemical changes between the colored  blood-
corpuscles and liquor sanguinis, and between the blood-corpuscles
and the  capillaries, and  the structures  and fluids surrounding the
capillaries, be arrested, as a necessary consequence the circulation
of the colored  blood-corpuscles through the  capillaries must be
greatly interfered with.
  Lungs.—Normal in appearance and structure; lower (dependent)
portions congested with blood.  This was due  to the action of gravi-
tation.  The trachea, bronchial tubes, and air-cells contained much
froth.
  Abdominal  Cavity.—The mucous membrane of  the stomach pre-
sented to the  naked eye no marks of inflammation or pathological
alteration.
  The mucous membrane of the small intestines presented a darker
color, the bloodvessels appeared to be more  congested  with  blood
than usual, but there were no  marks of inflammation, and the con-
gested state of the vessels appeared  to be entirely due to the  action
of the cathartic.
  Liver.—The liver presented a much darker color upon its exterior
than normal,  but not the dark slate color of cases of malarial fever
of longer standing.  When incisions were made  into the liver, the
cut surface was  different in appearance from  that of the healthy
liver,  and  approached the bronze  color of  malarial fever.   The
color of the cut  surface, however, was several  shades lighter than
that of malarial fever of longer standing. On the under surface of
the right lobe were several spots of the dark  slate  color peculiar
to malarial fever.  The liver-cells presented  the  usual appearance. 
MALARIAL  FEVER.
Ill
In some cases they, as well as the tissues around, appeared to con-
tain more oil-globules than usual.
  The liver contained animal starch without a trace of grape sugar.
  Spleen enlarged, softened, disorganized, and of a dark slate ma-
larial  color; when pressed gently between the fingers, the trabeculae
could be felt giving way.  After  eight hours' exposure to the atmo-
sphere, small streaks, inclining to an arterial hue, appeared upon
the cut surface of the spleen, and probably  were due to the change
in the blood which issued from the divided vessels.
  The dark  effused  blood of the spleen  was found  under the
microscope to consist of colored  and colorless corpuscles and dark
granules;  some of the colored corpuscles were swollen, and altered
in shape.   The alteration was by no means universal  or remark-
ably great.
  Kidneys.—This subject had but one  kidney; this corresponded
to the right kidney.   The inferior surface of the kidney presented
a dark slate-colored spot, two inches in diameter;  the color of the
spot resembled in all respects the slate color of the malarial fever
liver.  When an incision was made into the substance of the kid-
ney, through this slate-colored  spot, the cut  surface presented a
bronze color to the depth  of about one-sixth of an inch.  The
bronze color gradually shaded into the normal color of the kidney.
With the exception of this slate-colored spot, the color of the kid-
ney was normal.
  After a careful examination of the  symptoms and the patholo-
gical  alterations presented by these two cases of congestive fever,
it appears that, with the exception  of the  heart-clots, we do not
discover any  pathological changes of the cerebro-spinal nervous
system, and of the organs, which of  themselves would  account for
the sudden severity of the symptoms, or the death of the patient.
  As far as an examination with the eye extended, we did not dis-
cover  in the brain any structural alterations  sufficient to account
for the sudden and alarming symptoms of delirium and coma.  We
should not, however, in the present state of chemical, physiological,
and pathological science,  decide dogmatically  a question of such
importance, for  we are wholly  ignorant of the chemical, physio-
logical, and pathological  relations  of  the  malarial poison to the
nervous elements.   It is evident that a thorough knowledge of the
phenomena of malarial fever demands, amongst many other things,
a thorough knowledge not only of  the  appearance and chemical
constitution of the structures of the cerebro-spinal and sympathetic 
112
OBSERVATIONS  ON
nervous systems, but also a thorough  knowledge  of the physical,
chemical, and pathological  alterations of  these structures,  when
acted on by morbific agents.
  Whatever were the alterations  of the nervous elements in this
case, it was  evident that they could not be  reached  by the most
energetic and vigorous treatment.  It was impossible to arouse the
action  of the brain, notwithstanding that  there was no inflamma-
tion, and only that congestion of the blood  in the capillaries which
resulted from the feeble action of the circulatory apparatus,  the
disturbance  of the relations of the blood and  capillaries, and  the
alterations of the constituents of  the blood.
  We do not think that the condition  of the spleen in these cases
was  sufficient to cause death, because we  have seen  cases where
sudden  death occurred from other diseases  during convalescence
from malarial fever, in which the  spleen was apparently in a worse
condition.
  The  same remark applies to the alterations of the liver; as  far as
our examination extended, they do not appear to have been suffi-
cient to cause death.
  The  stomach  and intestinal canal presented no special patholo-
gical alterations.   The slate-colored  spot upon the  kidney was
interesting, especially in its bearing upon  a  similar change in the
color of the liver, but it was not sufficient  to account for even one
of the symptoms.
  Can  we, then, from this analysis of the pathological phenomena,
infer that the immediate cause of death did not exist in the patho-
logical alterations of the organs and tissues, but in the disturbances
of the general and capillary circulation, and  especially of the func-
tion of the  lungs, by the fibrinous coagula  in the cavities of the
heart and in the bloodvessels.
  It is  important that we should, before  deciding this question, consider
the occurrence of these coagula in other diseases,  and the attendant phe-
nomena.
  Various  opinions have prevailed with reference to the fibrous
concretions  found in the  heart and bloodvessels  after death, and
almost up to the present time a  dispute has been carried on con-
cerning the time of  their formation,  some  contending that they
were formed during  life,  and others  that  they were  formed after
death.   Apart from the evidence afforded  by the lamellated struc-
ture of these bodies,  their freedom from colored blood-corpuscles
and the absence of colored blood in the surrounding cavities of the 
MALARIAL  FEVER.                   113
heart and bloodvessels, we  find scattered through the records of
medicine numerous  facts,  established  by independent observers,
demonstrating in the clearest manner the formation of these con-
cretions before death.
  Hewson1 found in  the right ventricle  of the heart of a dog, which
had been  killed eight hours after receiving a large wound  in his
neck (the wound had during this time  inflamed considerably), a
large whitish polypus, under which was  a little  blood, still fluid,
which coagulated after exposure to the air.
  Baillie,2 Morgagni,3 and Albinus4 have  described the obliteration
of  veins by the formation of coagula during life.  Mr. A. Burns5
found in the right auricle of a human  heart a large, dense, lamel-
lated polypus  (fibrinous concretion), which was so firmly attached
to  the rough surface of the musculi pectinati as to allow the  whole
mass of the heart, and a considerable portion of the lungs, to be
suspended by it. Mr. J. Stewart6 has described a heart which con-
tained  fibrinous concretions in the right auricle  and in both ven-
tricles.   Mr. Burns  reports  a case in  which a polypus more than
one inch long was  attached so firmly to the septum of the heart
that the ventricle was torn before the polypus could be torn from
its  attachment.   He also affirms that in  the centre of this polypus
 an abscess was found which discharged  a teaspoonful of perfectly
 formed purulent matter.
    Wardrop7 and Cruwell8 have recorded similar phenomena.
    Graham,9 Stenzel,10 Meckel,'1 Stoerk,12and others, have described
 laminated fibrinous  coagula in  the  aorta, and Baillie13 found two
 coagula, laminated like the walls of the  sac of an aneurism, firmly
 attached to the inside of the carotid arteries.
    M. Petit  and O'Halloran have observed  that  the bloodvessels

   1 An Experimental Inquiry into the Properties of the Blood.  By William Hew-
 son. London, 1771.  P. 49.
   2 Trans, of  A. Soc, vol. i. p. 129.            3 Annot. Academ., lib. 7, c. 2.
   * Epist. 36, art. 10.  Op. Path., p. 6, sec. 8.    6 Diseases of the Heart, p. 197.
   6 Edinb. Med. and Surg. Journ., for 1817.
   7 Baillie's Works, vol. ii. p. 20.  A. Burns on  the Diseases of the Heart.
   8 De Cordis et Vasorum Osteogenesi in Quatrogenaria Observata.  Halae, 1765.
   9 Med.-Chir. Transactions, vol. v. p. 297.
   10 Dissertatio de Steatomatibus Aortse.
   " M6m. de PAcad. R. de Berlin, 1756.
   12 Med.-Chir. Transactions, vol. v. p. 287.
   '» Transactions of the Society for the Improvement  of Medical and  Surgical
 Knowledge, vol. i.  p. 191. 
114                    OBSERVATIONS  ON
 immediately above, and in sphacelated parts, are filled with fibrous
 concretions.
   Mr. Martial,1 in 1694, in amputating  the legs of a poor woman
 affected with gangrene, found that  no  hemorrhage followed  the
 amputation  of the first leg, and that in like manner no hemorrhage
 would have followed the amputation of the second leg, had not the
 surgeon, after cutting off the  limb, pulled  out from  the  extremity
 of  the  artery a  round, firm, and white clot, about three inches in
 length, which had been pushed a little beyond the cut extremity of
 the artery by the force of the column of blood.
   M. Baron,2 Virchow, and Mr. Paget3 first directed the attention
 of  pathologists to the frequency and danger of  obstructions in the
 pulmonary artery.
   Crampton, Louis,  Bougen, Desault, Duncan, and others, have
 recorded cases of the obstruction of the  larger bloodvessels by
 fibrinous coagula, and Dr. Eeid,'  Hodgson,5 Andral,6 Tiedemann,7
 Otto,8 Lobstein,9 Cloquet,10 Carsewell,11 Langstaff,12 and others, have
 recorded cases of, and discussed the origin and  mode of  formation
 of  phlebolites.
   Dr. Benjamin Ward Eichardson,13 after  the careful examination
 of the condition of the blood after death in 543 cases, occurring in
 man and in  the  inferior animals, including, in the human subjects,

  1  Memoirs of the Royal Academy for the year 1732.
  2  Recherches et Obs. sur la Coagulation du Sang dans PArtere Pulmonaire et ses
 Effets, Arch. Gen. de Med., sec. iii. t. ii.
  3  Paget on Obs. of Pulmonary Artery, Med.-Chir. Soc. Trans., London, vol. xxvii.
 pp.  162 and 280; see also Professor Simpson's Obstetrical Works, vol. ii. p. 34.
  4  Pathological Researches, 1848, p. 395.
  5  Treatise of Diseases of Arteries, p. 521.
  6  Anatomie Pathologique, t. ii. p. 412.
  7  Journal Comp. du Diction, des Sciences Med., t. iii.
  s  Path. Anat. Trans., by South.
  9  Anat. Pathol.
  10  Path. Chirurgical.
  11  Cyclop, of  Practical Medicine, art Veins.
  12  London Medico-Chirurgical Transactions, vol. viii. p. 287.
  13  " The Fibrinous Constituent  in Relation to Disease," by B. W.  Richardson
 Medical Times  and Gazette* Feb. 12, 1853.  Ranking's Abstract of Med. Sci., June'
 1853, p. 76, Am. ed.  " Diagnosis of Fibrinous Concretions in the Heart," by B. W.'
 Richardson, Assoc. Med. Journal, April 13,1855.  Ranking's Abstract  of Med. Sci.
 June, 1855, No. xxi. p. 73, Am. ed.   " The Cause of the Coagulation of the Blood'
the  Astley Cooper Prize  Essay for 1856," by Benjamin Ward Richardson, M. D.'
London, 1858.  " On the Diagnosis of Fibrinous Concretions in the Heart in certain
cases of Inflammatory Croup," by B. W. Richardson, Med. Times and Gaz., March
8, 1S."6.  Ranking's Abst. Med. Sci., No. xxiii., Jan.—June, 1836, p. 76, Am. ed. 
MALARIAL FEVER.
115
deaths from  sudden syncope, epilepsy,  apoplexy, enteritis, croup,
pneumonia, bronchitis, bronchorrhcea, phthisis, mesenteric disease,
purpura, acute rheumatism, dropsy following scarlet fever, cyanosis,
haemoptysis, failure of the heart from fatty change, cancer, aneurism
of the aorta, atheromatous and ossific disease of the aorta, adhesion
and  ossification of the pericardium,  simple  starvation,  cirrhosis,
degeneration of the heart from drunkenness, hydrocephalus, lateral
compression of the chest, ulceration and stricture of the oesophagus,
icterus, general dropsy from  mitral  disease, dilatation of  the right
side  of the heart, senile decay, and hanging—including, in  the
human foetus, deaths in the sixth, seventh, eighth, and ninth months
of development, and  soon  after delivery, from various causes,  me-
chanical and morbific—including, in  pigs, sheep, oxen, dogs, cats,
rabbits, guinea-pigs, and birds, deaths from hemorrhage,  intestinal
obstruction, poisoning from narcotic gases, chloroform, ether, smoke
of puff-ball, carbonic acid, tobacco-smoke, antimoniuretted hydrogen,
and  prussic  acid,  poisoning  by solid opium, salts of ammonia, po-
tassa, and antimony, strangulation, drowning, electric shock, simple
exposure to  cold, peritoneal dropsy naturally and artificially pro-
duced, shock from blows on the head, extraction of the kidney, and
inhalation of oxygen and chloroform, decided that  the arguments
were conclusive for the formation, in certain conditions of the blood,
and  of the circulation and respiration, of fibrinous masses previous
to death.
   Dr. Eichardson, not content with these extensive observations,
demonstrated,  by well-devised  and  conclusive  experiments, that
fibrinous concretions can be artificially produced in animals during
life,  by the introduction into the blood of those substances which
disturb the  circulation and  respiration, and the relations of the
constituents of the blood to each other, and to the  capillaries, and
to the processes of secretion, nutrition, and excretion.
   The hearts of the living animals were opened, and  the fibrinous
concretions withdrawn whilst the organs were still pulsating.1

   The Conditions  most favorable to the Deposition of Fibrinous
                          Concretions.

   The experiments and observations of numerous pathologists and
physiologists have shown that the leading conditions for the depo-
sition of fibrinous concretions in the circulatory apparatus during

         1 "The Cause of the Coagulation of the Blood," pp. 60-140. 
116
OBSERVATIONS  ON
life, are actual and relative increase of the fibrin of the blood and
impeded circulation.
  The positive increase of fibrin, which occurs in diseases of the acute
inflammatory class, is frequently attended by a deposition  of  that
portion of the fibrin which can be no longer held in solution by the
blood, and thus cause death.   In  twenty-three cases of death from
acute inflammation of the respiratory  organs, and  which ended
fatally in the first stages by rapid sinking, Dr. Eichardson1 found
in every case a fibrinous concretion, which  he considered  as  due,
in great part, to the excess of  fibrin in the blood.
  This observer substantiated  this view  by a series of experiments
upon the  inhalation  of oxygen,  which Dr. Gairdner had  shown
would increase the quantity  of fibrin in the  blood.  After  con-
tinuing the inhalation of oxygen for a considerable length of time,
all the  symptoms of fibrinous deposition were produced,  and an
examination  of the living heart  showed the presence of the  con-
cretion.
  When the  other elements of the blood are diminished, whilst the
fibrin remains in  normal amount, when compared to the previous
quantities  of the  constituents  and volume  of the blood, but rela-
tively increased to the altered proportions, the fibrin may be de-
posited.  This kind of separation has  been  observed to occur after
profuse purging, or after profuse colliquative sweating, and  in cases
of cholera, and in the last stages of phthisis  pulmonalis, and  in
anemic conditions of the blood.
  Disturbances in the circulation arising from simple failure of the
heart, appear to be frequently  attended by the deposition of fibrin-
ous concretions.
  This  tendency  is marked in all  cases of slow death, when the
action of  the heart is enfeebled, and  the struggle for life is  pro-
longed, irrespective of the amount of  the fibrin, whether increased
or diminished, as in  typhus and malarial fevers, and in purpura,
and old age, and in debilitated states induced by ardent spirits and
dissipation, and exposure and privations.
  The deposition of fibrin in the circulation may  result from other
causes far  more obscure and difficult of  demonstration and investi-
gation than  those just enumerated.   Thus, it  has been observed
that these  concretions are more common in some seasons  than  in
others.  This fact would seem to indicate an atmospheric cause,  or
1 Loc. cit., p. 69. 
malarial fever.
117
 certain revolutions in the human system, and  in  diseases.  This
 fact shows  the impropriety of drawing wide and absolute  conclu-
 sions from a single series of investigations on the relative frequency
 of the formation of these bodies in different diseases.
   The presence of certain foreign bodies in the blood may  lead to
 the deposition of fibrin, as Gaspard  and Lee conclusively demon-
 strated, by  the  injection of pus into the blood of living animals;
 whilst,  on the  other  hand, the experiments of Magendie demon-
 strated that the injection of putrefying substances may produce
 the opposite condition—permanent fluidity of the blood.
   Alterations in the constitution of the walls of the capillaries and
 bloodvessels and heart may produce the deposition of fibrin, and
 even the coagulation of the blood, as has been conclusively demon-
 strated by the experiments of Hewson,1  Thackrah,2  Sir  Astley
 Cooper,3 and Briicke.4
   The normal reaction of the blood is alkaline, and it is a well es-
 tablished fact  that the alkalies  are solvents of fibrin—in fact, the
 theory proposed and  ably advocated by Dr. Eichardson,5 ascribes
 the solution of the fibrin in the  blood, to the presence of ammonia;
 if, then, the alkalies of the blood be neutralized by an acid gene-
 rated by  morbific  processes  within the blood, or absorbed from
 without, then we would expect the deposition of the fibrin.   Now,
 in malarial fever, in which these concretions are common, the secre-
 tions of the mouth and the urine are intensely acid.   I do not feel
 warranted, however, in propounding this as even a hypothesis, as I
 have found the blood in severe malarial fever alkaline, whilst the
 secretions of the mouth and urine changed the  litmus blue  to red,
 as  rapidly and decidedly as a  strong  solution of sulphuric acid.
 The degrees of alkalinity of the blood  of malarial fever are, how-
 ever, worthy of careful investigation.

  1  An Experimental Inquiry into the  Properties of the Blood, with Remarks on
 some of its Morbid Appearances. William Hewson: London, 1771.  Experiments
 xxii. to xxvii., pp. 82-88.
  2  An Inquiry into the Nature and Properties of the Blood in Health and in Dis-
ease, by Charles Turner Thackrah; first ed., London, 1819; second ed., London,
1837, pp. 77-83.
  3  As quoted by Mr. Thackrah in his Inquiry on the Blood, second ed., 1834, pp.
83-85.
  4 An Essay on the Cause of the Coagulation of the Blood, by E. Briicke, M. D.,
British and Foreign Medico-Chirurgical Review, No. xxxvii., January, 1857, p. 141,
Am. ed.
_ 5 Cause of the Coagulation of the Blood, pp. 229,330. 
118
OBSERVATIONS ON
    Symptoms and Diagnosis of Fibrinous Concretions in the
                   Heart and Bloodvessels.
  In  order that the connection of these  heart-clots with the phe-
nomena of malarial fever may be placed in the strongest light, we
will illustrate this branch of our subject, not by our own observa-
tions, but by those of a far more able and experienced observer and
experimenter.
  Dr. Benjamin Ward Eichardson thus  describes the  symptoms
and diagnosis of fibrinous concretions in the heart, in  his  model
work on the cause of the coagulation of the blood :—
  "The symptoms  produced by fibrinous deposition in  the heart,
are strikingly characteristic when  they are once understood.   But
as they are commonly superadded to other symptoms, and appear
at the acme or near the end of a disease, they occasion  great  per-
plexity to all who  are not prepared to read them off, and whose
attentions are bent to some more local  mischief, by which the dis-
ease  perchance  is misnamed, rather  than to the grand changes
which are occurring in the body as a whole.
  "Whatever be the disease, the  effects of a fibrinous  deposition
are in the main the same, according to the  manner in  which the
deposit itself is laid down.  In other words, the symptoms depend
on the position,  form and  character of the  deposit, less than on
the pre-existing malady.   Whenever  fibrinous  deposition takes
place  in the heart during the course of a disease, the pure symp-
toms  of  the disease are lost or masked  by the new  symptoms
which are set up, and which  take to  themselves a general  repre-
sentative position.
  "The advantages  which I have had for tracing out the symptoms
produced by concretion, and for confirming, by dissection, the diag-
nosis  instituted, have been  confined mainly  to cases where  active
inflammatory mischief (hyperinosis) has been the forerunning dis-
order.  I write, therefore, from these sources of natural information.
  "All symptoms of acute inflammatory diseases are attended with
some  risk of fibrinous deposition. Taking  the  majority of such
cases, the risk is certainly small; but it is present in each case, and
what  renders the risk more serious is, that such  risk or tendency
to deposition cannot be measured by the local  indications of in-
flammatory mischief in  any  given case, nor yet by the general
symptoms which accompany the local.  The  symptoms  of concre- 
MALARIAL FEVER.
119
tion may intervene in the mildest, as well as in the  severest cases.
They may creep on  insidiously;  they may take effect in a sudden
and unexpected outbreak.  The  following is an outline of a case
in which the symptoms are unexpected.  I  write as I have seen,
and as others have seen.  A patient is suffering from an acute in-
flammatory  attack.  The local mischief, be it pneumonia, bron-
chitis, erysipelas, peritonitis, rheumatism, is not in itself such as to
cause  immediate alarm.   The  symptoms go on from visit to visit,
and the patient is left on one of these occasions, not apparently in
imminent danger.   Unexpectedly there is  a sudden call for the
practitioner.  He goes, and in the universal change  that has oc-
curred, he reads off the death  signals.  The man will sink.  The
fact, as it is written in the patient, is not to be described in words,
but is easily learned from experience; it is written in the face of
the sick  man, in the restlessness,  in the  expression altogether.
Whoever knows disease, knows at once, without further comment,
what I mean.  It is my business to show how far this finale of in-
flammatory disorders results from fibrinous deposit, and to indicate
how the symptoms, when  studied in  detail, yield the diagnosis of
concretion.
   " If my observation of the last symptoms, and of the pathology
of the cases thus referred to, be correct, the origin of the symptoms
is connected with obstruction on the right side of the heart in the
majority of instances.  The obstruction may be on  the left side;
but the occurrence is comparatively rare, and  the symptoms them-
selves are modified in detail by the  difference in the point of ob-
struction.  Taken generally, the symptoms of fibrinous obstruction
on the right side are those which might be anticipated, on & priori
 physiological reasoning, as necessarily incident to  obstruction of
blood-making  towards the pulmonic circuit.  They are the symp-
toms  of arrest  in  the nutrition  and  life of the body.  They are
characterized primarily by a peculiar and  distressing dyspnoea.
 This occurs, not because the respiration is checked,  for the respira-
 tory murmur may be audible  enough, but because  the current of
 blood to the lungs is in part cut  off.   As an addendum, emphysema
 of the lungs, especially in children, results;  and the physical signs
 of this lesion are often a valuable corroboration of  the presence of
 concretion of the right side.  The dyspnoea depends  on the deficiency
 in the supply of blood to the lungs and the  nervous centres.   The left
 side of the heart being imperfectly supplied with blood, the arterial cir-
 culation is weakened; the pulse is small and intermittent; the surface 
120
OBSERVATIONS ON
 of the  body is cold,  and generally white as marble;  but, as there is
 stagnation of blood in the venous circuit,  the more  vascular parts, as
 the lips and centre of the cheeks, are often of a leaden hue.  There is
 general muscular prostration; and, as the brain is not  supplied normally
 with blood, the muscles are not under the control of the will, but are in
 a  continued restless  motion.  The mind loses its power ; the acts of
 excretion are performed involuntarily; and death sets in, the gasping
 respiration outliving  the paralyzed and obstructed heart.
   "The symptoms thus portrayed are applicable to cases in which
 they last for several hours; in such examples the concretion is
 either  lodged in the right auricle, or is being laid  down as a tube
 in the infundibulum  and pulmonary artery, or is commencing at
 the extremities of  the  pulmonary circulation.   But  other cases
 occur,  where the course of the  symptoms is suddenly cut short.
 There  may have been some slight premonitory symptoms, but  the
 suddenness of the end is the great fact.  The patient, previously
 exhausted, is rising in bed, or making some muscular movement or
 strain,  when  suddenly he reclines or falls, breathless, faint, feebly
 convulsed,  dead. I have met  with two illustrations  of  this  last
 event.   The  cause  in both cases was the same, and the  cause is
 ordinarily the  same; the pulmonary artery is suddenly blocked
 up with a  fibrin cylinder.  In  each of these cases, observed  by
 myself, this cylinder has been hollow, and had conveyed  a stream
 of blood like a tube.   Its base had commenced in the infundibu-
 lum ; its apex had ascended into the pulmonary artery.  The con-
 cretion had been suddenly torn from its attachments,  and carried
 up into  the artery.   In its centre was  a  column  of  red clotted
 blood;  externally  it was  encased  in a  thin layer of blood,  the
 result of a  rush of  blood past the concretion after its detachment.
   " Once more, there  are instances where the symptoms are unusu-
 ally prolonged.  In one instance which I observed, the symptoms
 of dyspnoea extended over many days, and anasarca supervened as
 a result of the obstruction.  The concretion in this instance com-
 menced in the auricula,  where it had a firm attachment, and sent a
 prolongation downwards into the ventricle.  In the case supplied by
Dr. Sayer the symptoms of dyspnoea extended over many months-
and Mr. H. Lee has recorded an  instance  in which a similar exten-
sion of symptoms occurred.
  " When the concretion is deposited on the left side of the heart
the ventricle, the infundibulum, and the  ascending  portion of  the
aorta are the most  common positions.  The symptoms which cha- 
MALARIAL FEVER.
121
racterize the presence of concretion here situated are different in
many respects from the preceding.  There is a tumultuous action
of the heart, a  symptom which is strikingly indicative that the
deposit is on the left side.  There is congestion of the lungs and suffo-
cative dyspnoea, with expectoration, sometimes mixed with blood.   The
surface of the body  is of a leaden color, and the body is cold.   The
muscular perturbation lapses into powerful convulsions, and coma pre-
cedes dissolution.   These symptoms  may extend over may hours.
  " But,  as in the preceding class of cases, the symptoms may also
occur in  a sudden manner.  The patient, in moving or  making a
straining effort,  suddenly falls back, is seized with  a violent con-
vulsive fit, and  so  expires.   I once saw these symptoms and this
sudden form of  death  in  an old lady, who had previously suffered
from  no other symptoms than a slight attack of cold.  In rising
from  bed, she fell, as  I have  described, and died before  medical
assistance could be obtained.  In this case  the  concretion  had
formed as a hollow cylinder  in the infundibulum of the left ven-
tricle, had become dislodged, and  had been carried into the aorta,
which it entirely occluded.
  "Again, the symptoms of the concretion may extend over a long
period.  The  concretion  may, as I have shown, become organized.
In  such case the symptoms are those of valvular obstruction on
the left side.  Such cases often end suddenly at last.  Cases may
be met with in  which concretions  exist on both sides of the heart
at the same time.   In such instances, unless the concretion on the
right side be small, or placed out of the direct course of the circu-
lation, the symptoms  partake of the characters which  belong to
deposition in the right cavities.
  " The pre-existence of disease of  the heart, either acute or chronic,
favors materially the deposition of fibrin.  We have seen in acute
endocarditis how this obtains.  It is easy to see, and cases abundant
are on record for illustration, to what extent dilatation of the heart,
feebleness of its walls, or induration of its valves, favors the forma-
tion of concretion.
  " I have often been asked whether there are no reliable physical
diagnostic signs of concretion.  I think not.   There are sometimes
abnormal sounds, but  it is difficult to distinguish these from mur-
murs, the results of valvular lesion.  The tumultuous action of
the heart, taken with  the general  symptoms, is always a valuable
diagnostic mark of concretion of the  left side;  but this is  com-
patible with other diseased conditions.  The weak, irregular action
       9 
122
OBSERVATIONS ON
is, with the general symptoms, always a valuable diagnostic  sign
in concretion of the right side; but it is equally compatible with
other causes.  In some cases, where the concretion  interferes with
the action  of either the  auriculo-ventricular or semilunar valves,
there is  a muffled character with  the sounds, dependent on  the
obstacle to the play of the valves  by  the tension of which  the
sound  is produced.  But  as it is scarcely ever the fact that both
sets of auriculo-ventricular valves, or both sets of  semilunars, are
affected simultaneously by concretion, loss of either sound is of
rare occurrence.  In short, the only physical signs of moment are,
feebleness of action, tumultuous action, or occasionally a peculiar
rumbling, fidgety, jog-trot motion, with which the  two sounds are
heard in natural sequence as  regards each other, but irregularly
and  lispingly.   The diagnosis  must  therefore rest upon the general
symptoms, rather than on the physical.   The nature of the case must
be considered.   All acute sthenic  inflammations form  favorable
pre-existing conditions; pneumonia foremost of all.  The puerperal
state is second to none in this particular,  and the symptoms of
concretion  are  often as insidious as they  are sudden.   I do  not
speak here of puerperal phlebitis, and of deposits in the veins,  but
of cases where there has been no outward sign, either during preg-
nancy  or  after parturition, and where the woman suddenly  suc-
cumbs, without  any preliminary  indication of acute disease.   In
these instances, unattended with pre-existing changes in the venous
trunks, or evidence of inflammatory lesion, we can only, in  the
present state of our knowledge, assign as a cause of the deposition
excess of fibrin in the  blood, arising from absorption of the thick-
ened uterine walls,  or suppressed lacteal secretion, or neutrality or
deficiency of the fibrin solvent.  I  have more than once seen a
sharp inflammatory attack, without  direct evidence of organic in-
flammation, end fatally by the deposition of concretion.   Many
cases of so-called "simple inflammatory,"  or  perhaps "continued
fever," are of this character.   After death it  is found that there
has been an inflammatory affection of some organ, but that such
affection has not been  diagnosed.  In these examples the spleen is
often the organ which has suffered the local lesion,  but the  symp-
toms have not been sufficient to be readily detected  durino- life.
  " By some observers, who admit  that the fibrinous deposit may
be formed before death, an argument is sometimes  used  that such
concretions are always formed in  the last  hours of existence  and
that they are  rather the sequences  of the dying  state  than its 
MALARIAL FEVER.
123
precursors and final  cause.  To some  extent  this argument has
weight; for there  are cases certainly in which these concretions
are found, where the inference is fair that death would have occur-
red though the concretion had not existed.  On the other side
various instances have been given, where both the symptoms and
the pathology show that the concretion  was the inevitable cause of
dissolution.  In other words, the  patient would not  have died if
the concretion had not been formed.  Moreover, in all cases where
the deposit occurs this is clear, that in the majority of cases  it is
the final seal and bond to the death claim.
   " The question may be asked, Of what good is this knowledge
concerning concretions in the  heart?   Why be anxious to learn
the existence of a cause of death, which, by its irremediability, may
be considered death itself?  I answer, great good.   I  am not with-
out hope  that the day may come when  science shall  show us how
the dissolution of  these concretions may in some cases be effected;
for I have seen them  partly dissolved as an effect of alkaline treat-
ment.
   "But irrespective of this matter, the correct diagnosis of concre-
tion is a guide to prognosis, and is a guide against many forms of
meddlesome and mischievous, because useless, practice.   Take two
examples: In the latter stages of inflammations, bleeding is noto-
riously bad practice.   The reason is obvious; and I  regret to say
I  have seen the evil  too obviously and practically explained.   In
these cases, the tendency of the disease is  towards fibrinous depo-
sition ;  and the tendency of hemorrhage is towards the same event.
Therefore, as the practitioner bleeds, the balance of the blood-con-
stituents,  already  disturbed, is  disturbed  the more;  all that  was
wanting to secure deposition is secured;  the circulation is enfeebled,
and the proportion of water and fibrin  is increased.  The deposit
forms, and the patient sinks.  In one instance of pneumonia I saw
the fatal symptoms of concretion on the right side follow the free
abstraction of blood,  as clearly as  the symptoms of narcotism can
ever be observed to succeed upon the administration  of  an  opiate.
For the same reason, in  the latter stages of acute  inflammatory
affections, it is equally dangerous to carry the depressing system
by medicines to an extreme, or  to produce too free an elimination
from  the  body; of all medicines,  in such  stages,  purgatives  and
opiates should be alike avoided.  Lastly, the correct diagnosis of
concretion in the heart may prevent unnecessary surgical interference,
and explain the reason why some measures, conducted on the most 
124
OBSERVATIONS  ON
scientific surgical  principles, miss their intended object.  This  is
strikingly illustrated  in  the disease, true inflammatory croup.  In
this affection, as I have proved by repeated inspections, concretions
definitely formed from blood in motion, and long before death, are
often found in the  heart after death has occurred.  Further, I have
been able in this  disease to trace the  symptoms of concretion as
clearly as I had previously traced the special, local, or inflamma-
tory symptoms of the disorder.  Thus, in croup there may be death
from one of  two sources: from the obstruction in  the larynx—
asphyxia; from the obstruction in the heart—syncope; or from the
combination of these.  If, then,  the  symptoms are clearly those of
pure asphyxia, dependent obviously  on the obstruction in the air-
passages, the  operation of tracheotomy is the  grand remedy.  But
if the stethoscope tells that the air enters the  lungs with moderate
freedom at each inspiration; if  indications of emphysema are pre-
sent ;  if the symptoms are those of  obstruction at the heart—syn-
cope—then is the operation of tracheotomy as useless as would be
that of phlebotomy for removing a solid plug  from the windpipe."1
  A careful comparison develops a close resemblance between the
symptoms of concretions of fibrin in the heart and bloodvessels,
and many of the symptoms of the cases of congestive malarial fever
now recorded.
  In view of the rapid,  feeble, intermittent pulse; disturbed, full,
panting respiration; rapid,  feeble, fluttering  action of the heart;
cold extremities, exhaustion of the muscular forces, stupor, wan-
dering of the intellect, inability  to control the muscles, and acts of
excretion;  in view of the sudden onset of all these symptoms in
malarial  fever; in  view  of the  size and  structure of the coagula
found in the  heart and bloodvessels after death, in the cases pre-
senting these symptoms ; in view of the close  correspondence of
these symptoms with those characteristic of the deposition of fibrin
in the heart  and bloodvessels; in  view of the observations and
experiments  of Baillie,2  Morgagni,3 Albinus,4 Burns,5 Hewson6
Gould, Templeman, Haller, Stewart,7 Graham,8 Chisholm,9 Ward-

  1 Cause of the Coagulation of the Blood, pp. 423-434. The Italics are our own.
  2 Trans, of A. Soc, vol. i.               3 Annot. Academ., lib. vii.  c. 2.
  4 Epist. 36, art. 10.                     5 Diseases of the Heart.
  6 An Experimental Inquiry into the Properties of the  Blood, 1771.
  7 Ed. Med. and Surg. Journal for 1817.
  8 Med.-Chirurg. Transactions, vol. v. p. 297.
  9 An Epidemic Polypus in Granada in 1790. 
                        MALARIAL  FEVER.                    125

rop,1 Cruwell,2  Stenzel,3  Petit, Martial,4 Baron,5 Virchow,6 Bouil-
laud,7 Meigs,8 Davy,9  Fuller, Simon,10 Simpson,11  Paget,12 Crisp,13
Kirkes,14 Wagner,15 Eokitansky,16 Eichardson,17 and others, we are
justified  in asserting  that the fibrinous  element of the blood  may
be deposited in the heart and bloodvessels during life in malarial
fever, and  not only give  rise to a  distinct  set of  phenomena, but
cause death in  cases which otherwise would not  have terminated
fatally.
   The evil effects of the deposition of fibrin in the bloodvessels are
by no means confined  to the period  attending and immediately suc-
ceeding their formation.   These fibrinous bodies, wherever formed,
and whatever be  their situation, are full of peril, and  may remain
so long after the circumstances which gave rise to them have passed
away.   The observations of Dr. Wm. Senhouse Kirkes18 have de-
monstrated that the large masses may at any time be detached from
the points  to which they  were originally attached (the  valves of the
heart and  bloodvessels, or the carnese columnae, or chordae  tendi-

   1 Baillie's  Works, vol. ii. p. 20.
   2 De Cordis et Vasorum Osteogeneses in Quatrogenario Observata ; Halse, 1767.
   3 Dissertationes de Steatomatibus Aortse.
   4 Memoirs  of the Royal Academy for the year 1732.
   s Recherches et Obs. sur la Coagulation du Sang dans PArtere Pulmonaire, et ses
Effets ; Arch. Gen. de Med., sec. 14, t. ii.
   6 On Plug  Formations and Obstructions in the Bloodvessels ; Handbuch der Spe-
ciallen Pathologie und Therapie; Erlangen, 1854, Erstes Bande.
   7 Traite Clinique des Malades da Cceur, Apendice, tome ii., Paris, 1835.
   8 Philadelphia Medical Examiner, No. 51, 1849.
   9 Physiological and Anatomical Researches, London, 1839.
   10 Animal  Chemistry, 1843.            u Obstetrical Works.
   12 On Obstructions of the Branches of the Pulmonary Artery, Med.-Chir. Trans.,
vol. xxvi., 1844.
   13 On the Structure, Diseases, and Injuries of the Bloodvessels,  1847.
   14 On some of the  Principal Effects  resulting from Detachment of  Fibrinous
Deposits from the  Interior of  the Heart, and their Mixture with  the Circulating
Fluid, Lancet, June 5, 1852; Ranking's Abstract,  1852.
   15 Elements of Physiology.              l6 Manual of Pathological Anatomy.
   17 Cause of the Coagulation of the Blood, 1858.  The Fibrinous Constituents of
the Blood in  relation to Disease, Medical Times and Gazette, Feb. 12, 1853.  Diag-
nosis of Fibrinous Concretions in the Heart, Assoc. Med. Journal, April 13, 1855.
See also Turner, Thackrah on  the Blood, 1819.  An Essay on the Cause of the
Coagulation of the Blood, by E. Briicke, British  and Foreign  Medico-Chirurgical
Review, No. xxxvi., Jan., 1857, p.  141, Am. ed.
   18 On some of the Principal Effects resulting from Detachment of Fibrinous
Deposits from the Interior of  the Heart, and their Mixture with  the Circulating
Fluid, London Lancet, June 5, 1852. 
126
OBSERVATIONS ON
 neae of the  heart), and  conveyed with the circulating blood until
 arrested within some arterial channel, which might thus become
 completely plugged  up, and  the  supply of blood  to an  important
 part be suddenly cut off, from which serious  if not fatal  results
 would ensue; or smaller masses  might be  detached, and pass on
 into arteries of much less size, or  even into the capillaries, and pro-
 duce stagnation and  coagulation of the blood, and all the attendant
 changes and phenomena; or the masses of fibrin may soften, break
 up, and discharge the finely granular material resulting from their
 disintegration into  the circulating blood,  and contaminating  the
 fluid, might  excite  symptoms very  similar to those observed  in
 phlebitis, typhus, and other  analogous blood-diseases.  The parts
 of the vascular system to which these detached masses of fibrin
 would be transmitted, will depend upon the parts of the circulatory
 system from which they are  detached; thus, if detached from  the
 left  heart, they would pass  into  the aorta  and its branches, and
 produce various disturbances in  the nutrition, secretion, and func-
 tions of the organs; and if detached from the right heart, the lungs
 would become the primary,  if not the exclusive, seat of their ulti-
 mate deposition.
  We will  hereafter record cases  presenting  certain symptoms,
 which  might be referred to the detachment of these fibrinous con-
 cretions, and their subsequent lodgment in different organs.
  In affirming that death may be, and is often produced in mala-
 rial fever by the deposition of fibrinous concretions, we do not for
 one moment  lose sight of the fact that the great questions after all
 to be settled are:  What produced this state of things, favorable to
 the  formation of these  concretions ?   What are the chemical and
 physical changes of the blood and of the bloodvessels ?  What are
 the  causes of the disturbance of the action of the heart and capil-
lary circulation, which precede and determine the deposition of the
fibrin of the blood ?
  The correct answer of these  questions  involves the complete
 knowledge of the physical and chemical relations of fibrin  to the
elements of  the blood,  and  to the  bloodvessels and  surrounding
tissues; involves the complete knowledge of the origin and offices
of fibrin in  physiological and pathological conditions;  involves a
 knowledge of the physical, chemical,  physiological, and patholo-
gical relations of morbific agents, not only to the fibrin, but to all
the  constituents of the blood, and to the containing vessels and to
the  organs, and tissues, and apparatus.  The impossibility of answer- 
MALARIAL FEVER.
127
ing these important questions is immediately seen, when we review
the whole controversy concerning the cause of the coagulation of
the blood, the knowledge of which should  form the starting-point
in the attempt to solve these difficulties.
   We  are  actuated by no  disparaging or captious spirit when we
assert that, notwithstanding the laborious investigations of Hewson,
Thackrah, Eichardson, and Briicke, we have no theory which will
explain satisfactorily and thoroughly the coagulation of the blood
under all circumstances; when we assert that the  theories thus far
proposed are expressions rather of necessary and attending circum-
stances for the manifestation of the phenomena of coagulation, than
of the true causes;  when we assert that notwithstanding the obser-
vations and  reasonings  of Mulder, Paget,  Simon, Carpenter, Vir-
chow, Briicke, and others, the origin, offices, and  ultimate changes
of fibrin are  still matters of dispute, and are questions to be deter-
mined by future observation and experiment.
   If we adopt the hypothesis of Dr. Eichardson,  that the fibrin of
the blood is held in solution by ammonia, and that the coagulation
of the fibrin  is due to the escape of the ammonia, the most import-
ant questions, in a physiological, as well  as in a pathological point
of view, with reference to the true causes of the coagulation of the
blood, remain unsettled.
   It has  not as yet  been determined what are the  physical and
chemical  properties  upon  which these relations of fibrin and am-
monia are dependent; the  origin and variations in quantity of the
ammonia in different physiological and pathological states,  and its
relations  to  the other constituents of the  blood, have been only
barely indicated, and not determined; and  no hypothesis yet pro-
pounded explains the phenomenon of the more rapid coagulation of
blood in a dead than  in a living heart or bloodvessel;  and no series
of experiments  have yet settled definitely and absolutely the ques-
tion, whether fibrin exists as fibrin in the blood, or is formed by a
chemical change at the time of coagulation.
   If we adopt the  hypothesis that fibrin is held in solution in the
living body  by  nervous and vital influences, and that its coagula-
tion is due to the  abstraction  of nervous and vital  influence, the
questions immediately arise, What are nervous and vital influences?
How are they produced? What are their relations to fibrin?
   If we adopt the hypothesis of Dr.  Eichardson, that the primary
and essential part of the process of coagulation consists in the evo-
lution of a volatile principle, and that the volatile principle  thus 
128
OBSERVATIONS ON
eliminated  from  blood, is ammonia, the questions immediately
arise: Does this ammonia which holds the fibrin in solution, de-
crease in the latter stages of malarial fever, and in the latter stages
of all those diseases in which fibrinous concretions are formed be-
fore death ? What are the causes of the decrease of ammonia ? What
are the disturbances  in the chemical  changes of the living organ-
ism, which  lead to this decrease of ammonia ?
  If we adopt  the hypothesis,  supported by the experiments of
Hewson,  Thackrah, Cooper, Briicke, and  others, that the solution
of fibrin  in the living body is  dependent upon its  relations  with
the walls of the containing heart and  bloodvessels, the  main ques-
tion to be settled is, What are these relations, and upon what are
they dependent, and how may they be disturbed?
  If we adopt  the hypothesis so ably advocated  by Briicke, that
the fibrin exists not  as fibrin, but as a soluble albuminate, and is
formed at the moment of coagulation, at  the expense of a portion
of the  albumen of the blood, by a change in its atomic constitu-
tion, and that these changes are prevented during life by an influ-
ence exerted by the coats of the living bloodvessels: the cause and
character of these chemical changes of the albumen, and the cause
and character  of the influence of the coats of the living blood-
vessels upon the blood, are still unknown.
  If, with Zimmerman, wre think that the coagulation of fibrin is
nearly allied to the process of fermentation, which may be regarded
in the light of  an oxidizing process,  and is brought about by  a
kind of putrefaction  occurring  in some of the constituents of the
blood, after its removal from  the body, the questions are still un-
answered :  What is this oxidizing process ?  Why does it not take
place in the circulating blood,  which is not deficient in oxygen ?
What  is this  peculiar kind of putrefaction, and what previous
chemical changes does it involve ? What is the nature of the putre-
factive process which leads to the deposition of fibrin in the living
heart and bloodvessels in malarial fever, and other diseases ?
  If we combine the  truths of all the  hypotheses of the coagulation
of the blood thus far  propounded, we will have the same  number
of important questions to be determined.
  If we say that the formation of fibrinous concretions in malarial
fever is due to impeded circulation;  while we express a valuable
fact,  leading to the development of important principles of treat-
ment, we do not, by any means,  explain the phenomena of the
deposition  of fibrin,  but only state one  of the favorable  circum- 
MALARIAL FEVER.
129
stances, and besides the important questions which we have pro-
pounded with  reference to every hypothesis of coagulation, thus
far advanced, the question still remains:  What produced the retard-
ation of the circulation ?  If the retardation of the circulation was
due to the effects of the  malarial poison, what are those effects?
where, when,  and how did the poison act?  Did the poison  act
alone upon the structures of the  circulatory  apparatus?  or did
the poison act  primarily upon the blood, and through the  altered
constituents of the blood upon  the  nutrition and development of
the forces of the circulatory apparatus? or  did the poison  in the
altered  products of the blood act  upon one or both the nervous
systems, and through them produce such irregularity and feeble-
ness in the circulatory apparatus, as led to the deposit of fibrinous
concretions.
   Notwithstanding that the facts now recorded  are not sufficiently
numerous, to warrant the  assertion that fibrinous concretions are
formed previous to death, in every  case of malarial fever; not-
withstanding that  the causes  of the formation of these clots are ob-
scure, complicated, and unknown; notwithstanding that the causes of
death may not be connected with those which lead to the deposition
of fibrin in the living vessels; we may, nevertheless, assert that the
knowledge that these concretions  may  and do form in many cases
of malarial fever,  and produce a fatal termination in  cases which
would not otherwise have thus terminated,  is of the utmost value
to practitioners of medicine in the South and Southwest, where the
severest grades of malarial fever prevail.

 Principles of Treatment best adapted to prevent the Formation
     of Fibrinous Concretions in the Heart and Bloodvessels.
   When the pulse is rapid  and feeble, beating from  120  to 160
times in a  minute, and feeling like the  vibrations of a delicate sil-
ver thread ; when  the heart thumps, feebly, and spasmodically, and
rapidly against the walls of  the thorax; when the respiration  is
full, panting, labored, varying from 30 to 50 in the minute ; when
the skin is hot,  and parched, and rough, or bathed in a cold clammy
sweat; when the temperature of the extremities is far below that of
the trunk, which by no means corresponds with the increased efforts
at the introduction of oxygen ; when the circulation of the blood
in the capillaries  of  the extremities  is almost entirely  checked ;
when the  chemical changes of the solids and fluids are in a great
measure arrested, and perverted,  and the development of the nerv- 
130                   OBSERVATIONS  ON

ous and physical forces arrested, and their correlation disturbed ;
when the altered  blood stagnates  in the  capillaries of the brain,
and the intellect is either abnormally excited or depressed ;  when
the altered blood stagnates in the capillaries of the tongue and sto-
mach, and the brilliant red, dry, rough tongue, is but a fit index
of the consuming  thirst of the restless patient tossing from side to
side, and  pleading for a drop of water; we  have  all the disturb-
ances necessary for the formation of fibrinous concretions, and the
treatment must be energetic and prompt.
   The torpid nervous centres must be aroused;  the feeble general and
capillary circulations  must be aroused; oxygen  must be rapidly intro-
duced, and correspondingly rapidly distributed through all parts  of the
system;  the chemical changes by which the muscular and nervous forces
and heat are developed and maintained, must be excited and maintained
with energy, by the rapid distribution of the elements of chemical change ;
the products resulting from these chemical changes, and from the changes
induced in the constituents of the blood and organs, by the malarial poi-
son, must  be removed.
   Those remedies  should be employed, which excite the general and ca-
pillary circulation; promote the introduction and distribution of oxy-
gen ;  increase the  chemical changes,  and excite  the development  of the
muscular  and nervous forces.
   Sulphate of Quinia and diffusible stimulants, Brandy and Carbon-
ate of Ammonia, should be freely and promptly administered, and
sinapisms freely applied.
   Bottles of hot water, or better still, the hot bath, should be used
to impart heat, and  stimulate the capillary circulation, and relieve
the engorgement of  the large organs.
   Brandy and Eed  Pepper may be applied to the surface with ad-
vantage.
   The Sulphate of Quinia  may be administered to adults in doses
of 5 to 30 grains, every one, two, or three hours,  according  to the
urgency of the symptoms, up to from  30 to  80 grains during the
twenty-four hours.   The  best  method  of administering the Sul-
phate of  Quinia, is  dissolved in a  weak solution of citric or acetic
acids, or  in lemon-juice.  It is  much more readily and rapidly ab-
sorbed, in the soluble form.  If the stomach rejects the Sulphate of
Quinia, it should be  administered in solution with  starch, by the
rectum.
   Every practitioner of medicine in the Southern and Southwestern
districts of the United States who has employed the Sulphate of 
MALARIAL FEVER.
131
Quinia in large doses, is aware  of  the  surprising rapidity with
which, in many cases, the most alarming symptoms of congestive
fever will be dissipated by the action of sulphate of quinia in large
doses.  The patient will frequently be snatched from the very jaws
of death, and be blessed with a recovery as rapid as his attack.  In
such cases, we must conclude that the action of Sulphate of Quinia
alone is able to prevent the formation of fibrinous concretions.
  The  Sulphate of Quinia prevents the deposition of fibrin in the
blood,  by its direct action upon the sympathetic and cerebro-spinal
nervous systems, or by its excitement of the general and capillary
circulations, either directly, or through the  nervous system, or by
its relations to the chemical changes of  the elements of the blood
and  malarial poison, or by its action in all these  modes combined.
  Diffusible stimulants should be administered  because they  act
more rapidly in exciting the nervous systems and in arousing  the
circulation, than  the sulphate of quinia.
  If the formation of fibrinous bodies in the heart and bloodvessels
be common in malarial fever, and if the statement of Dr. Benjamin
Ward Eichardson, of London, that the fibrin is held in solution in
the liquor sanguinis of the living bloodvessels by Ammonia be true,
and if, as we shall hereafter demonstrate by numerous facts and cases,
the action of the malarial poison is depressing, and not inflammatory,
then Carbonate of Ammonia should be administered freely in mala-
rial  fever.  It should be administered freely  in  congestive fever
when  there is a feeble, rapid action of the heart, and diminished,
aberrated forces, because it excites the general and capillary circu-
lation ; excites the chemical  changes in  the capillaries, necessary
for the development of the muscular and nervous forces; arouses
the  sympathetic  and  cerebro-spinal nervous  systems;  promotes
secretion and excretion; and furnishes the volatile  alkali to  the
blood, which holds the fibrin  in  solution.
   We do not for one moment advocate the Carbonate of Ammonia
as a substitute for Sulphate of Quinia.  The Carbonate of Ammonia
does not cure the disease.    The Carbonate of Ammonia  merely
arouses the system, prevents  a distressing  and fatal  accident, and
prolongs life until the Sulphate of Quinia can act.  Stimulants and
sinapisms also arouse the nervous system and circulation, and lead
to an  increased  supply and  distribution of the  great element of
chemical change  (oxygen), and  thus furnish  the conditions of an
increased  development  of  the  physical, chemical, muscular,  and
nervous forces; but they cannot cure the disease, they cannot di- 
132
OBSERVATIONS  ON
rectly remove, or chemically alter,  or destroy the poison ; they
cannot, then, take the place of the Sulphate of  Quinia.
   To prevent the formation of fibrinous concretions in malarial
fever, we must administer the Sulphate of Quinia in full doses, in
conjunction with the Carbonate of Ammonia,  stimulants, and  the
free use of sinapisms and the hot bath.
   This course of treatment maybe instituted regardless of the dry, red
tongue, tender epigastrium, and wandering and torpid intellect, and
distracting pains in the head.  I have observed in numerous cases,
that under the free use of stimulants, sinapisms, and large doses of
the Sulphate of Quinia, the dry, harsh,  hard, red, glazed tongue be
came  moist, soft, and pale;  the pulse diminished in  frequency, and
increased in fulness; the dry, harsh skin rendered moist; the cold
clammy skin restored to its  normal state;  the relations between
the circulation in the trunk and extremities restored; the correla-
tion between the physical, chemical, vital and  nervous  forces re-
stored;  and  the  wild  delirium succeeded  by calm intelligence.
Whilst  on the other hand, in  more cases than one, I have seen
active purgation, and the administration of alterative doses of Calo-
mel, convert cases of ordinary intermittent and remittent fever into
the dangerous congestive type,  resulting in the formation of  heart
clots and speedy death.   When stimulants and  Sulphate  of Quinia
have been withheld, I have seen the patient die from complete  ex-
haustion of the  nervous and vital powers  consequent  upon  the
action of  the malarial poison,  either  directly  upon the  nervous
ganglia of the sympathetic system, presiding over  the circulation
and respiration,  or by disturbances of the  relations existing  be-
tween the sympathetic and cerebro-spinal nervous systems; or pri-
marily upon the cerebro-spinal system and sympathetic  system
simultaneously;  or by such changes in the  elements of the blood
(especially of the blood-corpuscles), as resulted in the perversion of
the nutrition of the nervous ganglia; or by the  generation of com-
pounds in the blood, and in the secretions of the liver, spleen and
alimentary canal, which acted as poisons upon the sympathetic and
cerebro-spinal nervous systems; or by the simultaneous action of
the poison in all these different  modes. 
MALARIAL  FEVER.
133
    Physical and Chemical Changes of the Constituents of the
                    Blood in Malarial Fever.
  The method of analysis1 employed in these investigations is simi-
lar  in many respects to that  employed by  MM.  Becquerel and
Eodier, Bowman, and others.
  In the present state of physiological and pathological chemistry,
objections may be  alleged  against every method of analyzing the
blood, thus far proposed.
  All physiological chemists have failed to ascertain with absolute ac-
curacy the amount of solid matter in the serum of 1000 parts of blood;
and there is no method by which the colored  blood-corpuscles can
be  separated from the surrounding liquor sanguinis, and the che-
mical constitution  and relative proportions determined with abso-
lute accuracy.   It  is evident, therefore, that  when  we attempt to
calculate the  moist  blood-corpuscles by the formula of C.  Schmidt,
whatever error entered into the calculation of the solid matters of
the moist  blood-corpuscles,  will be increased fourfold, whilst the
error in the calculation of the constituents of the liquor sanguinis
will increase, not only in a direct ratio to the  errors in the calcula-
tion of the blood-corpuscles and solid matters  of the serum of 1000
parts of blood, but also in a definite ratio to the actual increase or
decrease of the moist blood-corpuscles.  That error  exists in this
method of analysis, is rendered evident when  we calculate the con-
stituents of 1000 parts of liquor sanguinis from the data  obtained
by subtracting the moist blood-corpuscles from 1000 parts  of blood,
and considering the remainder  liquor sanguinis.   The results thus
obtained, do not correspond with those obtained from  actual analy-
sis of 1000 parts of liquor sanguinis.  To render this error evident,

  1 Pathological Chemistry, by MM. Becquerel and Rodier.  Translated by S. T.
Speer, M. D.  London, 1857, p. 19 et seq.  Bowman's Medical Chemistry, pp. 145-
194.  Philadelphia, 1850.  Simon's Chemistry of Man, p. 142. Philadelphia, 184G
Lehmann's Physiological Chemistry. Trans, by G. E. Day.  Cavendish Society pubs.,
vol.  ii. pp. 153-280.  London, 1851-1854.   See also American ed., edited by Prof.
Rogers, vol. i. pp.  541-648.  Manual of Blood and Urine, by Griffith,  Reese, and
Markwick.  Philadelphia, 1848.  Physical, Chemical, and Physiological Investiga-
tions upon the Vital Phenomena, Structure, and Offices of the Solids and  Fluids
of Animals, by Joseph Jones (American Journal of Medical Sciences, July, 1858, p.
46).  Investigations, Chemical and Physiological, relative to certain American Ver-
tebrata, by Joseph Jones.  Smithsonian Contributions to Knowledge, 1856.  An-
leitung zur Qualitativen und Quantitativen Zoochemischen Analyse, von E. von
Goriip Besanez.  Nurnberg, 1854. 
134
OBSERVATIONS  ON
I have in the succeeding analyses, stated the actual analysis of 1000
parts of liquor sanguinis, and that calculated from the constitution
of the  liquor sanguinis determined in 1000 parts of blood, by the
subtraction  of the moist blood-corpuscles.  The former, by actual
experiment, is  always marked (1); the latter, by calculation, is
always marked (2).
  A perfect method of analyzing the blood will never be obtained,
until it be possible to obtain the moist, colored, and colorless blood-
corpuscles entirely free from the intercellular fluid, and without the
loss of any of their constituents, or the introduction of any foreign
bodies.  As yet the method first applied by Figuier, and improved
by Dumas  and Hofe, the method  of F. Simon, and the method of
direct  measurement and enumeration of the blood-corpuscles in a
definite portion  of blood, and, in fact, every method thus far pro-
posed,  is imperfect, and they have one and all failed to -yield abso-
lutely accurate results.
  Whilst these failures should lead to caution, and the  extension
of experiments and investigations, they should by no means lead
to the entire distrust and abandonment and condemnation of these
observations ; they should lead to an appreciation of the difficulties
of the  investigation, and of the exceeding complexity of the fluid
substances  to be examined; they should lead to an appreciation of
the causes  of the  differences in the  results obtained  by different
observers.   When those parasites  and vultures of the medical pro-
fession who  make their  living,  in a  great measure, by  rehashing
old objections, original neither with themselves nor their  race, shall
enter laboratories  in sickly countries, reeking with the fumes of
urine, blood, and brains, and demonstrate by actual experiment, the
truth of their objections, and the feasibility of their plans of reform
and improved investigation, they  will be  in a position at least to
criticize, if not to  propose something better.  The following  table
will illustrate the changes of the blood in malarial fever:— 
Table illustrating the Changes and Composition of Venous Blood in Malarial Fever.
			1	2	3	4	5	6	7	8	9
			1012	1034	1030.5	1042.0	1042.4	1035.0	1042.4	1036.6	1040.0
			1018		1021.3	1022.5	1021.3	1021.0		1023.6	1022.0
Water—											
In 1000 parts of blood......			S30.509	850.888	877.553	831.294	827.901	860.976	839.589 ■	840.511	833.449
" serum......			929.287	920 820	927.757	927.853	928.370	923.786	912.779	913 950	912.386
(1) " liquor sanguinis ....			927.194	918.072	925.725	924.664	926 937	921.233	909.839	912.665	910.798
(2) " " ...			887.328	892.859	911.124	887.265	887.034	900.473	879.813	882.723	875.813
Solid Matters—											
In 1000 parts of blood......			169.491	149.112	122.447	168.706	172.099	139.024	160.411	159.4S9	106.551
" serum ....			70.713	79 180	72.243	72.147	71.630	76.214	87.221	86.050	87.614
(1) " liquor sanguinis .			72.806	SI.928	74.275	75.336 •	73.297	78.767	90.169	86.978	89.203
(2) " "			112.672	107.424	88.876	112.735	112.965	99.527	120.187	117.277	124 187
In serum of 1000 parts of blood			64.158	73.167	68.435	64.464	62.789	71.032	80.227	79.135	SO. 033
Fixed Saline Constituents—											
In 1000 parts of blood......			7. "(32	7.692	3.316	4.310	4.041	7.317	7.500	5.796	6.314
(1) " liquor sanguinis ....			5.332	5.120	3 328	3.299	4.015	5.480	4.066	2.647	6.620
(2) " " ... " solid matters of blood			8.245	6.696	3.965	4.885	6.246	6.489	5 405	3.498	8.759
			44.439	51.586	27.083	25.906	23.202	52.631	46.754	36.341	37.909
(1) " " liquor sanguinis			77.931	64.648	45.901	45.576	56.338	71.902	46 387	30.178	75.558
" " blood-corpuscles			2S.500	40.351	3.240	14.047	4.5S4	42.751	51.046	42.914	6.595
" moist blood-corpuscles			7.2.5S	10.087	0 841	3.511	1.119	10.649	12.131	10.728	1.64S
In blood-corpuscles of 1000 parts of blood .			3.002	2.962	0.175	1.432	0.490	2.795	3.770	3.409	0 567
In serum of 1000 parts of blood ....			4.530	4.730	3.141	2.938	3.551	4.522	3.730	2.387	5.747
1000 parts of Blood contained—											
			413.732	293.620	207.948	407.764	431.508	262.448	309.936	317.748	313.872
Water of moist blood-corpuscles .			310.219	220 215	155.861	306.823	323.631	196.836	232.452	238.271	258.804
Organic matters of moist blood-corpuscles			100.431	70.411	51.812	100 409	107.320	62 703	73.655	76.000	84.400
Mineral matters of moist blood-corpuscles			3.002	2.962	0.175	1.432	0.490	2.795	3 770	3.409	0.567
			586.268	706.380	792.052	592.236	568.492	737.552	690.064	682.252	656.128
Water of liquor sanguinis			520.210	630.705	721.692	525.471	504.270	664.140	607.124	602 240	574.646
Organic matters.....			58.328	68.405	65.194	61.500	59.210	66.400	76.387	76 708	74.185
Mineral matters.....			4.760	4.730	3.141	2.301	3.551	4.522	3.730	2.387	5.747
				2.540	1.925	2.938	1.433	2.380	2.710	0.877	1.450
1000 parts of Moist Blood-corpuscles contained—											
			749.996	750.000	749.519	750.000	750.000	750.000	750.224	749.873	752.646
Organic residue......			242.746	239.S03	249.154	246.468	248 709	239.296	237.645	239.284	245 239
				10.087	0.841	3.511	1.119	10.649	12.131	10.728	1.648
 
136
OBSERVATIONS ON
   The blood in No. 1 was abstracted from  a stout, muscular Eng-
 lish seaman, who had been exposed to the malarial poison in Jack-
 sonville, Florida, and in Savannah.
   Before the commencement of the bloodletting the skin was hot
 and dry, face flushed  and red, respiration thoracic, pulse 106, tem-
 perature of hand 105, temperature under  the tongue 106.  The
 pulse was full, and the respiration deep and rapid.  There was  a
 rapid introduction and distribution of oxygen, and a corresponding
 increase of temperature, denoting an increase of chemical change.
 The patient complained of great pain in the head.
   The  patient  appeared to be  alarmed by the preparations for
 bloodletting, and  when I appeared with the specific gravity bottles,
 beaker-glasses, and capsules to receive the blood, he  fell back (he
 was standing) into the arms of the assistant, and in a few moments
 before the lancet  was applied the perspiration stood in large drops
 upon his face and hands.   During the bleeding he perspired  freely,
 and fainted before fix were abstracted.  The pulse and respiration
 were diminished  in frequency and force, and the patient fell into a
 profound slumber, during which his clothes were saturated  with a
 profuse perspiration.  The temperature in the course of three hours
 was reduced to the normal standard, and the pulse and respiration
 diminished in frequency and force.
   This case yielded readily to the action of sulphate of quinia, and
 was discharged three days after this observation.
   The fact  that  the  mere preparations for bleeding caused the
 patient "to break out into a profuse perspiration," may be accounted
 for in two ways.  Either the cerebro-spinal system acted upon the
 sympathetic nervous system, and  thus  influenced the circulation
 respiration, and skin, and  through the circulation and respiration
 the chemical changes; or the sweating stage was nigh at hand  and
 the bleeding was the occasion and not the cause of its  appearance.
   In this case, the true  explanation, which we will endeavor to
 substantiate hereafter by  numerous facts, appears to be that the
 malarial poison excites the sympathetic and cerebro-spinal nervous
 systems,  either by a direct action upon  the nervous apparatus or
 by an indirect action, by inducing chemical changes in the  blood
 especially in the blood-corpuscles, the altered products of which act
as excitants to the nervous systems.  Through the agency of these
 two  systems, especially of  the sympathetic, the respiration and cir-
culation are increased in frequency and force.  In other words the 
MALARIAL  FEVER.
137
elements and conditions of chemical change are rapidly supplied to
all  parts of  the  body; hence  the  heat  of fever.  During  these
changes the poison is drawn into  the round, altered, and rendered
no longer an  irritant to the nervous system.   The same thing may
be true of  the altered, offending compounds of the  blood; during
these chemical changes they may be broken up and thrown off, or
so altered  as to  be  no longer excitants to the  nervous systems.
The nervous systems, when these offending compounds are removed,
no longer excite  the respiration and circulation.  Another reason
why nervous action may be diminished periodically, is found in  the
chemical changes  going on in the nervous apparatus itself.  If nerv-
ous force result from chemical change, and if the amount of nervous
force corresponds to the chemical changes of a definite amount of
matter placed in  a definite position, then vigorous nervous action
must always be attended by rapid alteration of the elements of the
nervous system, and by a correspondingly rapid exhaustion of nerv-
ous force, and the action then would cease for the same reason that
the action of an engine ceases when all the fuel is consumed.  These
views are substantiated by the fact, that  in  malarial fever a high
temperature is almost invariably attended by a remission or  inter-
mission,  and  is a favorable symptom; whilst the want of a high
temperature,  as in congestive fever, is  always a  dangerous symp-
tom, signifying profound alterations in the nervous  system, and in
the muscular structures of the heart.
  The blood  of this  patient presented  a  dark, almost black  color,
which, upon the surface of the clot, changed to a bright red arterial
hue after two hours' exposure to the atmosphere.  The coagulation
appeared to be a  little slower than usual.  The color of the serum
was light golden.  The color was not of the bright, deep golden
yellow, which, as  far  as my experience extends, is  the invariable
color of  the serum in the severer cases of malarial fever.
  This patient had been sick  but five or six days, and the fever
was intermittent  and of a mild type, and the changes of the  blood
were correspondingly small.  The blood-corpuscles, and albumen,
and  fibrin  were slightly diminished;  the extractive and coloring
matters were slightly increased, and the mineral matters were nor-
mal in amount.
  The blood in No. 2 was abstracted from  a thin,  sallow, anemic
French laborer, who had been living and working in a low  mias-
matic situation on Thunderbolt road, and had been sick with chill
       10 
138
OBSERVATIONS ON
and  fever for five weeks, without  any medical attendance.   The
effects of the miasmatic fever were well  marked  in  the  reduced
flesh, feeble forces,  sallow anemic complexion, and pale lips and
gums, and in the neuralgic pains of the head.
  The pulse and respiration during the intermissions were normal,
whilst the respiration was slightly increased, and the temperature
of the trunk  and extremities slightly diminished.
  The blood coagulated in  the usual  time,  and the clot was firm.
After standing four days in  a stoppered bottle, in the heat of sum-
mer, the clot  appeared firm, undecomposed, and the serum clear.
The  blood of a patient who was suffering from the  effects of remit-
tent  fever and severe salivation, placed by the side of this, in the
same time, and under the  same  circumstances, had  its clot com-
pletely disintegrated, and commenced to putrefy.
  This  analysis confirms the statement that the malarial poison
(either directly or indirectly) destroys the colored blood-corpuscles.
They are diminished one half, the dried corpuscles being  only
73.405, and the moist corpuscles 293.620 ; whilst in health the dried
corpuscles generally average 135.000, and  the moist  corpuscles
540.000.  The fibrin  and mineral  matters  existed  in  the usual
proportion.
  The blood which furnished  the analysis No. 3 was drawn from the
arm  of  a thin, sallow, anemic  Irish laborer, who had been  living
and making bricks in a low miasmatic situation, and had  suffered
with  chill and fever for six weeks.  Flesh  reduced; complexion
sallow,  anemic;  lips, gums, and  tongue  pale.  This  patient is
exhausted by slight exertions, and  complains  of great  weakness.
Inferior  extremities slightly cedematous.  The pulse, respiration
and  temperature were variable;  sometimes  above and at others
below the normal temperature.
	Sept. 16th.	Sept. 17th.' Sept. 18th.		Sept. 19th	Sept. 20th
Respiration .... Temperature of atmosphere . " of hand " under tongue	88 24 87.5° F. 100.5 101.25	72 20 86° F. 90 98	72 20 88.0° F. 98.5 99.5	76 24 89° F. 98 99	96 24 83 3F. 100 102
  The reduction of the nervous and physical forces was attended
by a reduction in the solid constituents of the urine.
  Thus, upon Sept. 17th, 16,027 grains of light-colored urine were 
MALARIAL FEVER.
139
excreted during  the twenty-hours,  which contained only 68.432
grains of solid matters, composed of 42.681 grains of urea, 1.280
of uric acid, 18.776 grains of extractive and coloring matters, and
5.696 of  mineral matters.  Under the action of sulphate of quinia,
and infusion of Virginia  snakeroot, the solid matters of the urine
increased rapidly in amount, and soon corresponded to the normal
amount.
  The blood of this patient was watery in appearance, and coagu-
lated slowly.
  Eeaction decidedly alkaline.
  After standing twenty hours the clot contracted but little, and it
was soft, possessing  but little consistency.  In  the specific gravity
bottle the colored blood-corpuscles gravitated towards the bottom,
and left above a transparent, light yellow clot.
  Serum of a light yellow color.
  This examination of the blood shows, that the continued action
of the malarial poison had reduced the colored blood-corpuscles to
51.987 dried,  or 207.948  moist, which is only a little more than
one-third of the normal standard.
  The fixed saline constituents of the colored blood-corpuscles were
not only correspondingly, but  absolutely diminished in amount,
whilst the  fixed saline constituents of the liquor  sanguinis were
normal in amount.
  Notwithstanding the formation of the buffy coat, the fibrin was
diminished, as well as the colored blood-corpuscles.
  The blood in No.  4 was abstracted from the arm of a muscular,
well-built English seaman, who had  been  exposed to the malarious
influence when sleeping  aboard his vessel, lying in the Altamaha
river, opposite the town of Darien, and when running up and down
the Savannah river, from its mouth to the city of Savannah, in a
steam tug.
  The fever was preceded  by  a  chill, and  was of the  remittent
type.  The symptoms were indicative of great danger—tongue red,
dry, harsh,  and rough; skin  hot, dry, and harsh; pulse accele-
rated; respiration panting, thoracic, and greatly accelerated; thirst
intense ;  expression  of countenance anxious;  intellect  dull  and
often wandering;  urine high colored, concentrated, and rich in
coloring matters and  urea.  The dry, red, glazed tongue; the dry
skin ; the panting, accelerated  respiration, and the wandering in-
tellect, were dangerous symptoms, indicating  the  decided action 
140
OBSERVATIONS ON
of the poison  upon the cerebro-spinal and  sympathetic nervous
systems, and upon the circulatory and respiratory apparatus.  The
elevated temperature, and high-colored urine, rich in solid matters,
v/ere, on  the other hand, favorable symptoms, because they indi-
cated the existence of chemical actions which would  result in the
modification of the malarial poison, and the destruction of the nox-
ious compounds formed in the blood.  The following table  will
illustrate the prominent symptoms:—  _ 
Sept. 10 " 11 " 11 " 12 « 12 " 13 " 13 " 14 " 15 " 15 " 16 " 16 " 17 " 18 " 19 " 20 " 22	a
7 P.M. 11 A. M. 7 P.M. 12 M. 9 P.M. 11 A. M. 6 P.M. 1 P. M. 10 A. M. 7 P. M. 12 M. 8 P.M. 11 A. M. 12 M. 12 M. 12 M. 12 M.	• O "9
Tongue c coated and dr; Tongue c rough ; intellec ious. Tongue— portion skin m Tongue c red at' Tongue norma Do Tongue s yellow norma' Do Do Do Do Do Do Do Do Do Do	CO > n o -3 o K Ii r o M n a -r3 co 5 3 »
ry, red, s with blacl r; intellec ry, red, a skin dry, t dull; co tip clean a coated v. Dist and h leaner an ip and edg moist, sti do lightly co fur, soft a do do do do do do do do do do	
uperior portioD i fur; skin hot t dull. ud glazed, feels larsh, and hot; untenance anx-nd red, superior rith dark fur; 3t. d moister, still es; skin moist. 1 redder than do. ated with light nd moist; skin do. do. do. do. do. do. do. do. do. do.	
*v. 4- *. *- *. *. *- o> ot a m -j -j 50 » co *_. 4-4. 4.^ Ol-J O CD ©tO © © O CO ©	Pulse.
to to to £ w to- to to to to 9 to to to 71*. S» i T T ife to- 4- 4- 4- CO ^ -J 4- CD wCO W w 4- 4- °° OS tO OS 4- ©	Respiration.
80.1° 82.0 81.0 83.0 83.0 85.0 87.0 84.0 87.0 87.0 87.0 84.5 86 0 88.5 84.0	Temperature of atmosphere.
CO ffi(0<OtDtDCOtO(0 COCO© © © © -^•-40S03CJ1^J054^CO .-J CO © 4- W W	Temperature of hand.
©'©to©co©©b© © ►"■ m o to © GO©Oi©©©©CJi© ©050. © «i ©	
105.c0 105.0 104.8 102.5 101.5 100 0 102.0 99.0 99.0 99.0 99.0 99.0 99 0 99.0 99.12	Temperature un-der tongue.
1020.0 1019.6 1019.3 1020.0 1024.0 1022.0 1025.0 1016.5 1018.2 1022.2 1020.0 1018.0 1010.0 1008.0	Specific gravity of urine.
Grains. 12240 15294 20383 19418 8038 13652 6490 9720 13940 15903 24240 32320 23300	Urine excreted during 24 hrs.
Grains. 11428 14294 19240 8584 13186 6057 9238 13023	Water excreted during 24 hrs.
Grains. 811 999 1142 452 465 432 481 916	Solid matters ex-creted during 24 hours.
Grains. 523 669 790 679 267 140 212 203 197	Urea excreted during 24 hrs.
Grains. 4.80 4 35 7.45 10.79 5.07 16.66 3.79 8.95 9.11	Uric acid for 24 hours.
Grains. 253 270 185 147 252 169 214 449	Extractive and coloring mat-ters excreted in 24 hours.
O to t-1 -1 .... CJi O 4^ CO* W 4*. • • • O O W g= • • • • CD W 03 tl H Oi •• - CD 4- © !^* P	Fixed saline con-stituents in the urine excreted in 24 hours.
•aaAaj ivmvTVM 
142
OBSERVATIONS OX
  The blood of this patient was abstracted upon the lb'th day after
the commencement of the  attack of remittent fever, and  during
convalescence.
  The blood coagulated in the usual time, and the clot was firm.
During the coagulation, the blood-corpuscles settled, and left above
a transparent clot, about gth of an inch in depth, and of a light
yellow color.   Color of serum, light yellow.  This analysis  shows
that the dried organic  residue, and especially the fixed saline con-
stituents of the colored blood-corpuscles, have diminished.
  The moist blood-corpuscles are less than the normal number, by
near 100 parts in the 1000 parts of blood.  The fixed saline con-
stituents of the colored blood-corpuscles were less than one-half
the normal amount.
  This patient was treated with large doses of sulphate of quinia,
stimulants, and nutritive diet; and this mode of treatment, combined
with the vigorous chemical actions, as indicated  by the high tem-
perature, were, without doubt, the causes  which,  preserved, to  a
great extent, the integrity of the blood.
  The blood in No. 5 was abstracted from a young Scotch seaman,
aged fourteen years, with light hair, blue eyes, florid complexion,
and sanguine nervous temperament.  This patient had been much
exposed to the sun and the night air, upon the light-ship lying at
the mouth of the Savannah River.
  During the height of the fever the face was as red as scarlet; the
tongue dry, red, and rough; tip and middle clean, and  of a bright
red color;  posterior portion coated with dry yellow fur; surface as
dry and harsh as a rough  board;  lay in a stupor, it was  almost
impossible to arouse him;  manifested great tenderness of epigas-
trium; pressure here causes him to cry out.  The following table
will illustrate the condition of the  pulse, respiration, temperature,
skin, tongue, and intellect:— 
MALARIAL FEVER.
143
				a o	O	o CO	m P		0> a	
Date.	Hour OF DAY.	State of Tongue, Skin, and Intellect.			S-3	p ? S T3	C3 *> cs M	si &3	p-o a; o a>	Charac-ters of
			<D	s.		£•«	S"S	5 p	- o	the Urine.
						a «	a 2	a> Cm	ag	
			P		« OS	o J3	» p	p. o		
			Ph	M	Eh	Eh	Eh	CO	-^	
Sept. 16	7 P. M.	Skin of face as red as scar-	100	24	88.0°	102.00°	103.25c	Grs.		
1S57,		let, skin of body in a pro-fuse perspiration; tongue rough and perfectly dry; intellect in a stupor; can-not be aroused.								
" 17	11 A. M.	Skin and tongue moistand relaxed; intellect clear.	86	18	87.0	100.25	101.00	1008.2	12078	Light orange color.
" 18	12 M.	Tongue coated with yel-low fur, much dryer than normal; intellect wan-dering.	98	32	87.5	103.00	104.00	1010.0		Light straw color; urea and uric acid dimi-nished.
" 18	8 P.M.	Tongue bright red, dry,	90	26 8;		102.25	103.25			
		rough, and harsh ; lies in								
		a profound stupor.								
" 19	11 A.M.	Tongue moist, red at tip and edges, and coated with white fur; intellect bright.						1004.0		Light orange color.
" 20	12 M.	Tongue moist; intellect clear.						1001.0	30013	Light yellow color.
" 21	1P.M.	Tongue moist and pale; intellect continues clear.	66	18 83.0		98.00	100.00	1006.0	10000	Deep orange color.
" 22	12 M.	Tongue, skin, and intel-lect normal.	65	18 84.5		98.00	99.50	1004.0	20800	Normal in color.
" 22	7 P.M.		57	16 81.0		98.00	99.05	1003.0	21063	Light colored.
  The pulse throughout was much feebler than in " healthy cases"
of malarial fever.  It is worthy of note, that the urine excreted dur-
ing the delirious state was light colored, and of low specific gravity.
  In this case, as in the preceding one, we cast aside the  advice of
many of the older writers, and  administered the sulphate  of quinia
and stimulants  freely in  the first stages of the disease, regardless
of the glowing  parched tongue,  tenderness upon pressure of the
epigastrium, severe headache, high fever, rapid pulse, thoracic  full
respiration, hot,  dry skin, and wandering intellect. Under the action
of sulphate of quinia, cut cups, stimulants, and sinapisms, the dry,
red tongue became moist,  clean, and pale; the circulation  and
respiration abated in force and frequency, the dry, harsh  skin  was
covered  with perspiration,  the  intellect returned  to  its normal
actions, and all the symptoms subsided.
  In the present case, sinapisms,  blisters, cut cups, and purgatives,
diminished the  apparant  congestion of the brain temporarily, but
not permanently.   Stimulants  and sulphate of quinia, so far from
increasing the cerebral disturbance, diminished it permanently,  and
relieved the intellectual faculties.  Under their action, the red, dry,
rough tongue became pale,  moist, and soft—under their action, the
circulation and respiration were  equalized, and diminished in fre- 
144
OBSERVATIONS ON
quency; the temperature was diminished, and the intellect restored
to its normal exercise.
  The  blood was drawn on the 10th day after the  commencement
of the malarial fever, during convalescence.
  The  clot appeared to be softer than normal.
  Serum of a light yellow color.
  The  chemical examination of the blood  showed that the organic
matters of the colored blood-corpuscles were diminished slightly,
whilst  the mineral  matters  were greatly  diminished.  The fibrin
was considerably below the normal  standard, and  appeared to be
softer than normal.   The organic matters of the serum were some-
what below the normal standard.
   When we consider that this patient was  in a state of almost com-
plete starvation, during the height of the disease, it is evident that
the malarial poison  acted but slightly upon the constituents of the
blood.   The  malarial poison appeared to act almost  entirely upon
the brain  and nervous system.  During the height of the disease,
I  had  no hopes  whatever of his recovery, so alarming were the
cerebral symptoms.  Long after the pulse and respiration, skin and
digestive functions were restored to their normal actions, the patient
was scarcely able to stand or walk, on  account of  the condition of
the  brain.  His first efforts at walking resembled those of an in-
fant, just  learning to stand and walk alone.  This was  not due to
the loss of muscular power, for there had  been but a slight reduc-
tion of the size of the muscles.  It was due rather to the  disordered
state of the cerebro-spinal and sympathetic nervous systems.  The
action of  the malarial  poison upon  the brain and  nervous system
was, without doubt, greatly increased by peculiarities of constitu-
tion, irregularities of habit, and continued exposure  to the  hot sun
on the light-ship.
   I was afterwards informed that this boy was in the habit of using
ardent  spirits freely.  It is  probable that one or all these causes
may have predisposed the brain and nervous systems to derange-
ment,  and interfered with  the healthy action of  the organs, and
converted a light attack  into a severe and dangerous disease.
   It is probable that the dose of malaria was small, and aside from
these  circumstances, would  have produced only  a mild  disease.
We are led to this conclusion by the fact that its effects upon the
blood  and excretions were comparatively  slight.
   The blood marked No. 6 was drawn from the arm of an Ameri-
can seaman, six hours before death.  This patient  had been run- 
MALARIAL  FEVER.
145
ning up and  down  the  Savannah River in a  steam  tug, and  was
attacked with chill and fever, which assumed the  remittent type after
four days'  recurrence of the chill.   During his sickness, the disease
bore a blended likeness to  both remittent  and typhoid fevers, and
after death the  organs  exhibited the  existence  simultaneously of
both diseases.
   The following table will give a condensed view of the symptoms:—
 Hour
of DAY.
State of Tongue, Skin,
   and Intellect.
Characters of Urine.
Aug. 7 11 A. M,
 1857,
8 9 A. M
8 11 A. M.
9 11 A. M,
6 P. M.
10 9 A. M.
10 11 A. M.
11 10 A. M.
Skin hot, but in a profuse
 perspiration ; tongue coated
 with light yellow fur ; res-
 piration hurried, thoracic ;
 chest heaving; intellectstu-
 pid, torpid ; it is difficult to
 arouse  him, and  then  his
 answers  are  incoherent;
 bowels loose.
Skin hot and dry; continues
 stupid; bowels loose.
Skin moist; body has a pecu
 liar offensive smell; breath
 offensive ; stools very offen
 sive ; intellect  stupid;  low
 muttering delirium.
All symptoms much worse ;
 passes his urine and feces in
 bed;  has a pustular erup-
 tion over the surface of the
 trunk and limbs ; surface of
 blister red and  raw ;  the
 stools dark colored and fetid.
No improvement of  symp-
 toms ; tongue  dry ;  blister
 dry and red; boweis loose ;
 skin  not so warm; pulse
 weaker.
Continues to grow worse,
81.0°
103.0°
104° Urine clear, limpid, and of a
     deep orange color.
12 83
Do.
Almost entirely insensible ;
 lies with  mouth and eyes
 open; his elbows, shoulders,
 and hips,  upon which the
 weight of his body has rest-
 ed,  are of a dark purple
 color, and the skin is com-
 mencing to slough at those
 parts most exposed ; tongue
 dry and rough ;  teeth coat-
 ed with sordes.

Died.
Urine reddish orange, sp. gr.
 1013; 1000 parts contained—
 water 957.282, solid matters
 42.618, urea 7.108, uric acid
 0.394, extractive and color-
 ing matters  32.570, fixed
 salts 2.621.
Urine  of a bright reddish-
 brown color, cloudy, with
 epithelial  cells  from  the
 mucous membrane, blad-
 der and urethra, and with
 mucous  corpuscles  and
 spermatozoa.
Urine of a bright red color,
 sp. gr. 1012.6; contains albu-
 men; reaction strongly acid.
Urine bright red color ; after
 standing 12 hours, a heavy
 deposit  of triple phosphate
 fell; contains albumen.
Urine a  shade higher than
 normal; reaction acid ; sp.
 gr. 1013.2;  after 12  hours,
 let fall alight yellow deposit
 of triple phosphate, urate
 of soda, and spermatozoa;
 1000 parts contained—water
 961.112, solid matters 38.888,
 urea 12.304, uric acid 0 592,
 extractive and color'g mat-
 ters 22.259, fixed saline con
 stituents 3.333.
Urine, passed just  before
 death, normal in color; sp.
 gr. 1011.3; reaction acid;
 1000 parts contained—water
 972.728, solid matters 27.272,
 urea 5.228, uric acid 0.158,
 extractive and color'g mat-
 ters 18.543, fixed saline con-
 stituents 3.030. 
146
OBSERVATIONS ON
  The body was examined four hours after  death.  The exterior
was of a universal sallow color.
  The muscles were full and well-developed,  and appeared to have
lost but little flesh during the progress of the disease.
  The membranes of the brain presented a normal appearance, and
the substance was firm, and not more congested with blood than
normal.
  The appearance of the structure and condition of the brain, and
its bloodvessels, and  membranes, did not correspond to the condi-
tion of softening which the cerebral symptoms led us to expect.
  The brain was not examined microscopically,  and there may
have  been  minute changes in the delicate structures,  chemical or
physical, which escaped the observation of the naked eye.  This is
possible, but not  probable.  It is hardly probable that profound
alterations could take place in so delicate an organ as the brain,
without some changes in  its color or consistence, palpable to  the
naked eye.
  Heart and lungs normal.
  The liver presented the true malarial hue; slate-colored upon
the exterior, and dark bronze in the interior.
  The bile  was of  a greenish-black opaque color when  seen in
mass, and of a  gamboge-yellow color when spread out  in  thin
layers.  The structures of the liver presented the usual consistence.
The liver-cells, under the microscope, appeared to be a shade darker
than usual;  but presented the usual shape and appearance.
  No trace of grape-sugar was discovered in  the liver.   The blood
of the liver was dark, and did not change to  the arterial hue when
exposed to the oxygen of the atmosphere.
  The filtered  decoction of the liver presented a bright golden
color, similar in  all respects to the color  of  the  serum of  the
blood.
  The spleen was slate-colored, enlarged, and  softened.  The tissues
gave way readily under gentle pressure.   The dark, reddish-brown
pulp of the spleen consisted of numerous colored and colorless  cor-
puscles, and did not change to the  arterial hue when exposed to
the oxygen of the atmosphere.
  The mucous  membrane of the stomach was colored yellow with
bile, and the bloodvessels were filled with blood, and several spots
of the mucous membrane were more engorged with blood than the
rest of the surface;  but to the naked eye there was no softening or 
MALARIAL FEVER.
147
marks of inflammation, and no pathological alterations beyond the
mere  stasis of the blood in the capillaries.
  The color of the intestines, externally and internally, was darker
than usual.  The small intestines contained fecal matters, epithelial
cells,  mucous corpuscles, and mucus colored yellow by bile.  Blood-
vessels of the mucous  membrane of the small and large intestines
injected with  blood.   The mucous membrane was most  injected
with  blood, and presented a purplish color  in the  last  eight  feet
of the inferior portion of the  ileum, and  the  engorgement of the
bloodvessels was greatest  in the  immediate region of the ileo-ca?cal
valve.
  The solitary glands  were numerous, enlarged, elevated, and  dis-
tinct, and of a brown color.  When the intestines were  held up to
the light, bloodvessels engorged with blood were seen  passing to
each  gland.  The bloodvessels supplying the solitary and Peyer's
glands were more engorged with blood than those supplying the
mucous  membrane generally.   These solitary glands were most
numerous  in  the neighborhood  of the  ileo-coecal valve, and were
found scattered over the superior portion of the colon, and over
the caecum, and  over eight feet of the  inferior portion of the ileum.
  Peyer's glands were enlarged  and elevated.   These  glands were
of various  sizes, from one quarter of an inch to three inches in
length, and from a quarter of an inch to half an inch in breadth.
They occurred at intervals of from one  to two inches  from each
other, and extended from the ileo-caecal valve, along the mucous
membrane  of the ileum, for  about  nine feet.  The  bloodvessels
around these glands were engorged with  blood.  This part of the
mucous  membrane of the  ileum, studied with  the  solitary  and
Peyer's glands, was far more injected  with blood than  the stomach,
jejunum, or superior portion of the ileum.  Although these glands
were enlarged, elevated,  and injected with blood, still they could
not by any means be compared to the condition of these glands in
an advanced stage of typhoid fever.
  From  this examination we are now able to present a condensed
statement of the prominent symptoms and alterations of the solids
and fluids.
  The pulse wa3 feeble, and varied from  104 to 132  beats in the
minute;  the respiration was hurried, thoracic, and varied from 36
to 47 in the minute; the temperature  under the tongue varied from
104°  F. to 105°; the temperature of the extremities varied from
103°  to 104°; the temperature of both the  trunk and extremities 
148
OBSERVATIONS ON
was  remarkably uniform; the state of the skin varied, sometimes
dry,  and at others bathed in perspiration;  the tongue was dry and
coated with  fur; and  towards the termination of the  disease, the
tongue and teeth were coated with sordes.  It is evident from these
facts that there was no distinct remission of the febrile excitement.
  The urine was copious; of low specific gravity;  of higher color
than normal in the earlier stages of the disease; but twenty hours
before death  it changed  back to  its normal color.   The  urine
contained small quantities of albumen.  The urea was diminished
relatively to the extractive  matters;  we cannot  say absolutely,
because the whole  amount of urine excreted was not determined.
The  extractive matters were  increased relatively to the other con-
stituents of the urine.  The uric acid was normal in amount.
  The blood exhibited profound alterations; the dried colored cor-
puscles were only 65.612, and the moist colored corpuscles 262.448,
in the thousand parts; many of the colored corpuscles were altered
in shape and appearance, and had  in a great measure lost the power
of changing from the venous to the arterial color, and many of them
united together and formed rolls, as in the blood of inflammation;
the color of the venous blood, when first abstracted, was dark pur-
ple, almost purple, and after  exposure  to the oxygen of the atmo-
sphere the surface  of the clot changed to a cherry-red color, and
not to the bright red color assumed by the surface of healthy venous
blood when exposed to the atmosphere; the serum was of a golden
color, and low specific gravity;  the albumen was diminished, whilst
the extractive matters of the serum were increased; the mineral
matters of both the  blood-corpuscles  and liquor  sanguinis were
diminished relatively, but not absolutely; that is, their diminution
corresponded with,  but did not exceed the diminution of the other
elements of the blood.
  The pustular eruption, the offensive smell, the stasis of the blood
in the parts of the  body exposed  to pressure, and the  tendency of
these parts to slough, all  indicated alterations  in the constitution
of the blood, and derangement of  the capillary circulation.
  The loss  of muscular power, exhaustion,  stupidity,  coma, low
muttering  delirium,  insensibility to  pain,  all indicated  derange-
ment of the cerebro-spinal system.
  The alterations in the actions of the capillary and  general circu-
lations, and of  the respiration ;  the  profound  alterations  in the
blood ;  the alterations of the secretions and  excretions, and of the
structures of the liver and spleen, and of Peyer's, and of the soli- 
MALARIAL  FEVER.
149
tary glands of the intestines, were all indicative of derangements of
the sympathetic system of nerves.
  Our knowledge of the early symptoms, and pathological changes
of this case, do not permit an arbitrary decision as  to which system
of nerves  was affected  primarily.   The fact that the post-mortem
examination  revealed (to the  naked eye) no prominent lesions of
these two systems of nerves, would seem to indicate that the poison
or poisons acted primarily upon the blood, destroying and altering
the blood-corpuscles, the active agents in the elaboration  of the
elements of the secretions, and of the muscular and nervous sys-
tems.   When the proper chemical changes  in  the  blood  were
altered, when the  compounds  for the secretions and nutrition of
the nervous system were  altered, or not elaborated, then  both the
cerebro-spinal and  sympathetic systems, manifested aberrated ac-
tion.  As  the circulation and respiration, and the secretions and
excretions, and  the action and integrity of the organs  depend, in
great measure, upon the integrity of the nervous system, it is evi-
dent that  the derangement of  the cerebro-spinal and sympathetic
systems, through the derangement of the blood and secretions and
excretions, would in turn act in concert with the  disturbing agent
or  agents, and  thus still greater derangements of the solids and
fluids would be produced.
   The opinion of Hoffmann, Boerhaave, Cullen, Selle, Tode, Thorer,
Stoll, J. C. Frank, Fodere, Clutterbuck, Alibert, Payer, Nepple, and
others, whicn referred  fevers  to a lesion of  the  nervous system,
was  adopted and  extensively  applied by Maillot,1 in his original,
elaborate,  and  invaluable work  on  malarial  fever.   M. Maillot
looked upon  the cerebro-spinal axis as the point of departure of
the  series of morbid  actions  constituting periodical  fever, and
affirmed that an acute  irritation or hyperaemia of the great nerv-
ous centres existed during the active stages of malarial fever.  In
this country, my colleagues, Professors Lewis D.  Ford2 and L. A.

  1  Traite des Fievres ou Irritations  Cerebro-Spinales Intermittentes dApres des
Observations recueillies en France, en Corse, et en Afrique.  Par F. C. Maillot.
Paris, 1836.
  2  " It thus appears that of these forty cases of intermitting  and remitting fever,
this tenderness on pressure of some portion of the  spinal column was present in
all but four cases of remitting fever, and in two cases of intermittent; of these,
however, one was arrested by a blister to the spine, without other means used but
dieting, and the other was modified materially in its character in like manner."
*  *  *_p. 354.
  "Another question naturally presents itself: What is the force and value of this 
150
OBSERVATIONS  ON
Dugas,1 simultaneously with  the appearance of the work of Maillot,
maintained that the phenomena of intermitting and remitting fevers

symptom? whence this uneasiness? what does its existence indicate?  Certainly
not that the skin at these particular points is sore and tender.   I have examined
carefully, to verify this fact, by taking it up between the  thumb and finger, and
compressing it with more force than was applied by the direct pressure;  uniformly
receiving the assurance of the patient that the uneasiness was of a different cha-
racter from that produced by pressure upon the bone.   But if this might be the
cause of pain in the method by pressure,  it cannot be in that by percussion ; for
it is well known  to those who make use of mediate percussion  that  it  may be
employed freely even upon a  blistered surface, without producing pain.   It as
certainly does not indicate that the bone itself is tender and diseased;  for we can-
not conceive why pressure  upon a diseased bone  should be followed by  sighing,
coughing, increased oppression of the prsecordia, nausea, and faintness.  It is as
unsatisfactory, for the same reasons, to attribute this  symptom directly to a dis-
eased state of the ligaments of the vertebrae.
  " Having thus excluded these three parts from any participation in the production
of this phenomenon, we next inquire, Can it proceed from a diseased state of the
dura mater lining the bony channel ?  We answer unhesitatingly that  the symp-
toms above referred to, developed in  distant organs by the examination, cannot
arise directly from an inflammation or any degree  of irritation of the dura mater,
for  reasons assigned already ;  but we can conceive very readily how the  dura
mater, being in a swollen state, might produce such symptoms by compressing the
origin of nerves supplying these distant organs when an unusual degree of motion
is communicated to the vertebras by percussion. But we perceive that this unusual
motion of the vertebra would  produce the same  degree of  pressure if the  dura
mater were in its normal state, and the substance of the  cord itself enlarged.  We
therefore must necessarily adopt the conclusion that this phenomenon indicates
a diseased  state either of the  medullary substance of the spinal cord, or of its
investing membranes.  I  am not prepared to infer from these few cases that this
local affection of the spine always exists,  nor that it is the primary irritation upon
which these fevers depend ; but if subsequent observations shall  establish the
uniform existence of this  spinal irritation at the  commencement of intermitting
and remitting fevers, it will confirm the opinion, now almost universally held by
the profession, of the local origin of all fevers, and the equally universal  persuasion
that this location  is in some part of the nervous system."—pp. 357-359.*
  1 " When, fresh from the benches of the school of organic medicine, I was called
on to examine and to treat cases of ' bilious fever,' I instinctively interrogated in
succession every organ of the body, in search of the seat of the disease, or, in other
words, of the cause of so much constitutional disturbance.  In some cases  despite
all my investigations, no trace  of disordered function (the best evidence of a dis-
eased organ) could be detected elsewhere than in the stomach; in others the bowels
were alone distempered ;  other sets evinced the disturbance to be located in the
liver, in the brain, or in more than one of the principal viscera.  The bilious modi-
fication implied by the name of the affection, though very frequently manifest

  * Remarks on the  Pathology and Treatment of Intermittent and Remittent Fevers, with Case
By Lewis D. Ford, M. D., Professor of Chemistry in the Medical College of Georgia.  Southern Medi-
cal and Surgical Journal, vol. i. No. 6, November,  1836, pp. 335-360. 
MALARIAL  FEVER.
151
depend  upon  lesions of the  cerebro-spinal  nervous system;  and,
at  the  present  day,  my  colleague, Professor  Henry  F. Camp-

was often entirely wanting.   Yet each of these cases presented  certain  characters
peculiar  to all.   Their onset was always marked by loss of muscular power, by
pains in various parts of the muscular system of animal life, &c. ; their early
stage by intermittency, or decided remissions; their duration and termination pre-
sented a strong analogy ; in short, it was evident that although modified by the
affection of some special organ, all these cases were under the predominance of an
original and common affection.  The seat of this original  and common affection
cannot be mistaken if we adhere to the principle already alluded to, that of regard-
ing vitiated function as the  best indication of diseased organs.  If an organ be
healthy, its function must necessarily  be normal; consequently, if a function be
abnormal, the organ presiding over it cannot be in a physiological condition.  I
am aware that it will be urged that certain secretions may  be vitiated by an
altered condition of the fluid whence  they are  derived, without disease of the
secerning organs. For example, the urine may present various aspects, according
to the substances taken into the circulation, or the composition of the bile may
depend on that of the  blood.   But this cannot affect our position, for the condition
of the blood itself depends entirely on that of the organs which form it, and of
those whose office it is to eliminate its impurities.  If it remains impure, the cause
must be found in the vitiated action of  the emunctories.
   " But, whether these principles of diagnosis  be admitted or not, it is presumed
that no one would, on reflection, refer the morbid condition of the contractility and
sensibility of  the muscular system to any other locality than the nervous centres.
We have already stated the earliest symptoms of our fevers to be lassitude, loss of
muscular power, and pains in the muscles of animal life ; also, that intermittency,
more or less  complete, always marks their early  stage.  We are, therefore, led to
the conclusion that the nervous system  is the original and common seat of this class
of affections.   I  trust that I will not be misunderstood; the term  original being
here used expressly to indicate that these fevers subsequently undergo serious modi-
fications, from the supervention of other derangements.  It is to these complica-
tions we must look for the explanation of the various forms assumed by the fevers
misnamed bilious, so  that the  proper  definition of them  should  be an original
affection of the nervous centres,  subsequently  complicated by  phlogosis  of some  other
organ or organs, which secondary disorder may either gain the ascendency of the primary,
or merely mask and modify it."  *  *  *—pp. 388, 389.
   " We have  already  stated  that neither of the  above complicating phlegmasia^
alone or unattended with spinal disease, could produce  the phenomena common to
all the forms of our  ' bilious  fevers,' and we have furthermore stated the primary
lesion to be that of the nervous centre, or, in other words, of the spinal cord.  If
the primary affection remain  uncomplicated, then we have a disease of the mildest
form known, one which retains its peculiar characteristics, its paroxysmal form,
and its periodicity.  In short, we have  a plain case of  ague and fever, such as we
daily see."  *  *  *—p. 393.
   "The action of quinine will always be  most happily seconded by revulsive appli-
cations to the spine, which is frequently found painful on pressure or percussion.
Indeed these will alone, in many instances, be found sufficient to arrest the disease.
For evidence of this very decided  effect I would  refer  to the interesting and able 
152
OBSERVATIONS  ON
bell,1 advocates  a similar theory.   On  the  other  hand, Professor
John Fred. Lobstein2 and  James  Copland3 have  ably  and  elabo-
rately advocated the more probable theory that the malarial poison
affects primarily and especially the sympathetic nervous system.

paper published by Professor Ford in the sixth  number of the Southern Medical
and Surgical Journal."—p. 394.*
   1 "As in the nervous system we recognize two grand departments—viz., 1st, the
cerebro-spinal system, all the normal actions of which are  subject  to cessations
and interruptions ;  and, 2dly, the ganglionic system, all the normal  actions of
which are of a continuous and  uninterrupted character—so in the manifestations
of febrile  diseases do we distinctly recognize two grand distinguishing  character-
istics  respectively typefying the normal actions of these two systems of nerves ;
thus a character of  paroxysm obtains in certain cases, while a character of con-
tinuousness as plainly marks the others.  Again, as  in the cerebro-spinal system
we find that its normal action pertains almost exclusively to sensation and to
motion, with only  a secondary  and comparatively  somewhat remote  influence
(which we have termed excito-secretory)  upon nutrition and  secretion, while in
the normal action of the ganglionic system the entire function is known to be to
preside over nutrition and the secretions, so in paroxysmal fevers do we find intense
pain, modified sensation, and symptoms allying them to neuralgic and convulsive
diseases very prominent, while in continued fevers modified nutrition and altered
secretion are the marked and most prominent characteristics.  We would there-
fore announce, as our classification of  febrile diseases,  two grand divisions of fevers
corresponding with  the two grand divisions of the nervous system, thus:—
  " 1. Cerebro-spinal fevers.  All paroxysmal.  The secretions and nutrition second-
arily affected.
  " 2. Ganglionic fevers.   All continued.   The secretions and nutrition primarily
affected.
  " Under the head of cerebro-spinal fevers we would place the whole  family of
paroxysmal fevers, whatever type they may assume, and also the various forms of
neuralgia, which are nearly  always intermittent, as  well as  the sthenic forms of
traumatic fever, together with the fever accompanying simple pharyngitis, pneu-
monitis, dysentery,  and many other diseases of malarious districts."!
  The late Dr. Milton Antony published, in the  year 1837, an interesting article
upon spinal irritation, from which we select the following passages :__
  " Because spinal irritation is, indeed, the true cause of the most conspicuous
phenomena, as is evident on the soundest principles of physiology, and proved by
their  correction  by its  removal,  it  so captivated the thoughts,  not sufficiently
chastised  by time and experience, as (although itself an effect) to be considered
the primary and efficient cause  of all, to the neglect of all  concomitant or ante-
cedent phenomena,  and even its own etiology.  Inquiry, I say, stops here  at the

  * Remarks on the Pathology and Treatment of Bilions Fever.  Read before the Medical Society of
Angnsta, by L. A. Dugas, M. D., Professor of Anatomy in the Medical College of Georgia  Southern
Medical and Surgical Journal, vol. ii. No. 7, February, 1838, pp. 387-397
  t Classification of Febrile Diseases by their Relation to the Nervous System  By Henry F Cam
bell, M. D., Professor of  Anatomy in the Medical College of Georgia.  Southern Medical and Surgical
Journal, vol. xiv. No. 1, January, 1853, pp. 13-18.   See  also Transactions of the American Medical
Association, 1858. 
MALARIAL  FEVER.
153
detection of the fact of spinal irritation, satisfied that here is the real, here the
first, independent, and sole cause.  The indication of its removal,  and that alone,
is, therefore, plainly drawn from the premises.  And so strongly does the spell hold
its sway over the rational mind that, although no evidence of the fact of spinal irri-
tation can  be  apprehended, it is still believed so  intimately connected with the
other phenomena in relation of cause as  to have its existence  inferred from these.
  " Here are the errors I would expose.  * * *   To  the inquiring mind  I say this
local phenomenon, so clearly and beautifully displayed, cannot fail to reveal another
truth.  Could this spinal irritation have occurred without having its own peculiar
and appropriate cause ?  Certainly not, as there is no  effect without competent
causation.   If, then, it have a cause, is it abiding ?  Or  has it been momentary,
and, therefore, left only its effects to be corrected ?   If the former, surely nothing
can justify the neglect of such abiding cause of any train of phenomena when our
object is the  removal of that train.  As well might we expect to heal a wound
whilst  the thorn which caused it continues  to rankle there.   Our experience
justifies the belief that  spinal irritation generally, though not always, is dependent
upon an abiding cause, for we have often detected such cases  and removed  them,
correcting  thereby their effects without any prescription for these." * * *—pp. 581,
582.
   " We find an intermitting fever attended with some degree of  irritation  about
the spinal  marrow.  As spinal irritation seldom, if ever, exists idiopathically, shall
we not rather look to it as  an index pointing  to other disorder ?  In this case  an
inquiry is  necessary into the pathological condition of the general system,  or the
various organs, under the existence of an intermitting fever.  And here we find
that the liver and the spleen sometimes are laboring under an obstructing torpor,
which  prevents  that  free  transmission of blood through them which the great
portal system demands.  This is a fact that we know to exist; and if we did not,
it is susceptible of plain proof.
   " Now, suppose a given quantity of blood in  the system at the  moment of con-
sideration as twenty-four pounds, and  that one-twelfth, or  two  pounds, passes
the portal system, whilst  the  other twenty-two do the other circulation.  The
abdominal fulness evinces the  obstruction.   If, now, we allow  any obstructing
cause in the route of the portal circulation, the liver is  the only  organ where  we
may suppose it located.  Let us  suppose that this obstruction is such as to  trans-
mit only half the quantity of blood in a given time.  The unavoidable consequence
and proximate effect  of this must be an increased fulness of the portal vessels.
This accomplished to its utmost, and the next consequent must be their refusal to
imbibe or  receive more than  half their natural quantity in a given time, or one
instead of two pounds, and consequently, if the health were perfect in the former
state, there is, to say nothing about the quantity of blood, a redundance of  about
four  per cent.  Following  this  inquiry, we perceive, therefore, local phenomena,
and especially in non-resisting parts, and consequently a cause of irritation or of
oppression." * * *—p. 585.
   "In all these cases, therefore, we are bound to direct attention to the first seat of
the obstruction and  irritation.  Let the partisan in  medical  doctrines have his
choice  of  the horns  of  the dilemma, still is he bound to look to it as a cause,
whether it be the local irritation alone acting through the medium of the nerves,
or merely  the effect of the sanguine plethora, already prescribed.  And in case of
the combination of both, he must look to the removal of the obstruction to circula-
         11 
154
OBSERVATIONS  ON
 tion, as well as the subduction of irritation in the primarily obstructed and irritated
 part."*—p. 586.
   2  " In reflecting upon the nature of intermittent fevers, I have thought that it
 might, perhaps, be found in the disorder and perverted action of the abdominal
 nervous system, and there appear, indeed, to be sufficient grounds to render this
 opinion probable : 1st.  The cases of this disease are very rare in which the functions
 of the abdominal organs continue vigorous and entirely unaffected.  2d. The com-
 mencement of the paroxysms is often marked with vomiting.  3d. We experience
 daily that this disease is mitigated, and very often  entirely removed, by the use of
 cathartics.  4th. A single emetic, when given previously, sometimes suppresses the
 paroxysm, and not unusually removes the whole disease  ; from which it appears
 that this remedy makes an impression upon the solar plexus of an opposite nature
 to that which had produced the fever.  5th. When the disease is either left to itself
 or maltreated, congestions are produced ;n the abdominal viscera, induration of the
 liver, intumescence of the spleen, etc., and the general morbid state is  changed into
 a topical affection.  This metamorphosis appears to me to prove that the morbid
 action prevails at first in all  the plexuses, and afterwards migrates from one  to
 another ; for it is first apparently disseminated in  the whole territory of  the gan-
 glionic system before it runs with impetus into a single plexus, which is commonly
 the splenic; and as the vessels are under the influence of the nerves, it cannot be
 otherwise than that congestions should thus be produced in the vessels.  6th. The
 paroxysms of intermittent fever are tied down to  a regular rhythmus, in conse-
 quence  of their being  radicated  in  the  nervous  system, upon which nature has
 impressed a law according to which they must perform their functions periodically.
  " Each nervous  system, therefore, is obnoxious  to its  own diseases.  But the
 mode in which the cerebral and spinal nerves and the nerves  of the abdominal
plexuses and ganglia are affected by disease is the same.  As in  the various kinds
 of convulsions, epilepsy, tetanus, etc., there  is disorder in the  voluntary nerves,
even when no organic lesion can be discovered in them ; so the nerves of the tho-
racic and abdominal viscera may be affected without any  alteration perceptible  to
the senses.  As the perverted action of the cephalic brain is reflected with great
force upon the abdominal brain, so, in turn, does the latter react upon and over-
 whelm the former.  And, finally, as the cerebral system, when it is stupefied, as it
were, by the violence of disease, destroys life, in like manner, I  believe, an analo-
 gous effect takes place  in certain diseases in the solar plexus, "f
  3 The articles on Fevers in Dr. Copland's Medical Dictionary are the most elabo-
rate, learned, and philosophical with which I am acquainted, and correspond with
the other articles in his gigantic work, which will ever stand a noble monument  of
industry, energy, perseverance, learning, and philosophy. *The following quotations
 will present a bare outline of his views :—
  "The doctrine that the causes of fever first affect the cerebro-spinal nervous system
is invalidated by the following considerations : a. This system either does not send
nerves or it supplies  but few nerves, and  those  often indirectly, to the organs
especially or essentially affected in  idiopathic fevers, as  the heart, bloodvessels
secreting viscera, lungs, &c.  b. That the chief avenues to this system open to the
invasion of the exciting causes are the organs of sense and the cutaneous surface.
  * Remarks on Spinal Irritation, by M. Antony, M. D., Professor of Obstetrics in the Medical Col-
lege of Georgia.  Southern Medical and Surgical Journal, vol. i. Nos. 9 and 10, March 1837
680-587.                                                               '    '
  t A Treatise on the Structure, Functions, and Diseases of the Human Sympathetic Nerve  by John
Fred. Lobstein. Translated by Joseph Pancoast, M. D.  Philadelphia, 1831, pp. 121 122. 
                           MALARIAL  FEVER.                       155

Of these, the sense of smell is the principal.  Although this sense  is evidently
impressed by several of these causes when acting intensely, and admitting that the
brain is somewhat affected in consequence, still the effect produced in this quarter
seems inadequate to explain the chief, and far less the whole, of the early pheno-
mena,  c.  In some instances the intense operation of the effluvia generating fever
has produced its effects almost instantly, and even caused death itself with equal
rapidity, a result which the total annihilation of the cerebral functions could not
produce, but which would necessarily follow the interruption or suppression of the
influence transmitted to the heart and lungs by the nervous system of organic life.
d. The generation of  fever within the  body itself  cannot be explained upon the
supposition that the cerebro-spinal nervous system is primarily and solely, or even
chiefly, concerned  in the production of the disease, but may be readily solved by
means of the nervous system of organic life, if we  take into consideration its func-
tions and structural relations, especially with the  vascular system, the circulating
fluids, and the excreting viscera,  e. The early lesions, whether of function  or of
organization, characterizing  the first as well as the advanced periods of fever, can-
not  be accounted  for by assigning the  cerebro-spinal  nervous system as the
primary seat of the disease ; for, 1st. As this system cannot influence the action of
the  heart  and  the  state of the vessels, excepting through the medium of the
organic nervous system,  and this only to  a very limited  extent, changes in it do
not explain the alterations  of vascular action, and still  less the vitiation of the
blood.   2d. As it does not control animal heat, so  it cannot induce those remark-
able extremes and morbid states of temperature distinguishing the malady.   3d.
As it does not supply nor materially influence secreting surfaces and glands, so it
cannot give rise to those early changes of function  which  they present, nor to those
lesions of structure which they often subsequently experience.  4th. As it does not
materially affect the actions of assimilation and nutrition, so it cannot occasion the
remarkable changes  they present in fevers.  And, 5th.  As it does not present
aberrations of function, in the slighter and simpler states of fever, equal in degree
to those manifested  by the  viscera, chiefly supplied by the nerves of  organic life ;.
and as, when such aberrations supervene  in a remarkable manner, they are gene-
rally consequent upon those of the organic nerves and vascular systems, and of the
blood itself, so that the primary impression made upon it must be much  less
energetic than is  supposed by those who support the  present doctrine, although I
may grant  that it partakes, in  some  measure, or in  some forms of  fever, of the
morbid impression especially and principally made upon  the  nervous system of
organic life, and extended to the organs which it actuates."
   " That the efficient  agents  of fever act primarily and chiefly upon the organic or
ganglionic nervous system  is evident from what has been now adduced, and is farther
proved by the  following facts and inferences : a.  The intimate connection of this
system with the organs of  circulation, respiration, assimilation, and secretion, on
the one hand, and with the cerebro-spinal nervous system on the other, and the
influence exerted by it over their functions in health, are sufficient to show that
morbid impressions made upon it must necessarily affect all the organs and  parts
with which it is  related,  b.  The functions  primarily disordered in fever, and chiefly
affected  in its  course, are precisely those which  are  especially  subjected to. the
influence of this system.   As we cannot, consistently with our knowledge of the
animal actions in health and in disease, infer that a grave and  permanent disorder
of any one function can exist,  unless either the influence that  actuates  it is
impaired, excited, or  otherwise altered, or the structure of the  organ, which, is the
instrument of the  function, is more or less  affected; we  are necessarily led to 
156  '
OBSERVATIONS ON
  Still a fourth theory may be advanced to account for the changes;
that the poison or poisons acted primarily upon one or both the
grand portions of the nervous systems,  and the cerebro-spinal and
sympathetic systems, singly or combined, in turn  altered the ac-
tions of the organs  and  apparatus, and the secretions  and excre-
tions, and chemical and physical  actions over which they presided.
  We will discuss these  questions  more fully hereafter, when we
consider the nervous phenomena.
  Before,  however, dismissing the  subject, we would state that in
the present state of medical science, we cannot decide dogmatically
upon the  truth  of these  theories, because  the ultimate  facts are
wanting.
  What is the poison or  poisons which we have  assumed to exist,
and act upon the organs and tissues, and solids and fluids ?
  What is the relation of these substances, physically, chemically,
physiologically and  pathologically to  the cerebro-spinal  and sym-
pathetic systems, to the blood-corpuscles and elements of the blood,
organic and mineral, and to the  organs, tissues, and secretions and
excretions?
  In other  words, what  physical, chemical, physiological and pa-
thological changes, are they capable of producing in  the  solids and
fluids of the human body, and what effects would  these changes
have upon the development  and  action of  the vital  and nervous
forces?
inquire  as to which of  these  sources the disorder is  to be imputed.  Having
inferred from the nature and extent of the disorder, from the causes in which it
arose, and the suddenness and manner of its  occurrence, as well as  from various
other circumstances, that it does not consist of lesion of structure, we are,  there-
fore, compelled to adopt the former alternative, and, from the kind of disorder, to
infer the manner  in which the influence actuating the  organ is affected.   Thus,
observing that respiration, circulation, secretion, and animal heat are primarily
and especially disordered at the commencement of fever, and that various other
morbid phenomena are consequently produced, and finding no structural or local
change to account for the affection, we refer it to the state of the influence  which
actuates these functions. Anatomical and physiological evidence concur in show-
ing that the nervous system of organic life is chiefly concerned in the production
of those functions ; and, therefore, it may be  inferred that this system  is first
impressed by the causes of the disease."*
 * A Dictionary of Practical Medicine, comprising General Pathology, the Nature and Treatment of
Diseases, Morbid Structures, and the Disorders especially incident to Climates, to the Sex, and to the
different Epochs of Life, &c, by James Copland, M. D., F. R. S., &c. Edited with additions by
Charles A. Lee, A. M., M. D., &c , in three volumes.  New York, Harper & Brothers, 1855.  Vol. I.,
article Fever, pp. 1064,1065 ; also pp. 1038-1084. Intermittent fever, pp. 1085-1100.  Remittent fever,
pp  1100-1122. Hectic, Continued, Infiammatory, Bilo-gastric, Synchoid, Typhoid, and Typhus fevers,
pp. 1123-1230.  Article Disease, pp. 641-689. 
MALARIAL FEVER.
157
  Until these questions are definitely answered, our opinions must
be speculative,  and not absolute, and the results of our analogical
reasoning must be expressed as hypotheses and not as laws.
  The destruction of the colored  corpuscles; the golden color of
the serum; the slate color  of the  liver upon the exterior, and
bronzed color in the interior; the  color of the bile; the absence of
grape-sugar from the structures of the liver; the slate color of the
spleen, and the disorganized  state  of its tissues, and the inability of
its  pulp  to  change from the dark reddish-brown  to the  arterial
color, gave decided evidence that this was a case of malarial fever.
  There  were, however,  other symptoms and other lesions, which
indicated that  there  was something besides malarial fever.   The
cerebral  and nervous symptoms;  the continued febrile excitement
without  intermission; the loose state of the bowels; the unusual
action of a  small dose of castor  oil; the enlarged and congested
glands of Peyer,  and solitary glands of the intestines, indicated
the presence of typhoid fever.  The history of the case (the recent
attack of remittent  fever), and the fact that the glands of Peyer
showed the marks of recent, only partially developed inflamma-
tion, and pathological changes, and not the changes produced by
typhoid fever of long standing, lead us to the  conclusion that the
remittent fever preceded, or was, at least,  simultaneous with the
appearance of the typhoid fever.
   The blood in No. 7 was  abstracted from an Irish laborer, who
had been reduced  by an attack  of remittent fever, diarrhoea, and
salivation, from 200 pounds to 100.  At the time of  this  analysis,
he  was suffering with foul ulcers  in his mouth, and  over the sur-
face of the body, especially upon the  back;  and his body had  a
most disgusting nauseous smell.   Complexion sallow and anemic;
and forces completely worn out with pain and loss of sleep.
   Blood  coagulated slowly.  In  the  specific-gravity  bottle, the
colored corpuscles  settled to the  bottom,  leaving  above a  clear
golden-yellow clot.
   In a small, shallow porcelain  capsule, the superior central por-
tions of the clot  appeared transparent for several  lines in depth.
A  portion of the blood  was  set aside in a glass vessel.  In twelve
hours the clot  commenced to disintegrate and liberate its colored
blood-corpuscles, and in  twenty-four hours  the blood gave forth a
putrid smell, and  the serum was  filled with the liberated  colored
corpuscles presenting the appearance  of blood.   A specimen of
blood drawn at the same time from a  patient who had recovered 
158
OBSERVATIONS ON
from an attack of intermittent fever three weeks before, was placed
in the same room, in a similar bottle, by the side of this specimen.
The clot, serum, and odor of this remained unaltered for fifty hours.
  Serum of a golden-yellow color.  The colored  blood-corpuscles
were diminished nearly one-half, and  the fibrin  was slightly in-
creased.  The golden color of the serum, and the foul ulcers, and
the readiness with  which the blood underwent  putrefaction, all
pointed to alterations in the constituents of the blood and nutritive
fluids.  Stimulants, tonics, and alteratives produced  but  little ap-
parent effect.
  The patient continued dull, stupid, anxious, distressed, and feeble.
His body continued to exhale the disgusting stench.
  Four days after bleeding, his left arm swelled enormously.
  Eleven days after the abstraction of the blood, he took a sudden
and remarkable change for the worse.
  Lay in a stupor, with mouth and eyes open, with  every tendon
and muscle of his body twitching and  jumping violently.  Eespi-
ration 42, labored,  thoracic, spasmodic like that of a  man during a
severe chill.  At every inspiration and expiration, emits a sound
like the hoarse bark of a thirsty and starved dog.   The muscles of
the face contract and relax, and contort in every possible  manner,
making the most awful grimaces.  During these contortions of the
muscles of  the face, every expression of ridicule, sarcasm, joy, pain,
agony, malice, revenge, and hatred, are depicted in  rapid  succes-
sion.   The jerking of the muscles appear to be paroxysmal;  they
are very  violent  for a few moments, and  then moderate for a few
moments.  The patients in this large hospital ward, state that they
were kept awake during the whole night, by his barking and shak-
ing.   Pulse 144, feeble.  It was very difficult to count the beats of
the pulse, on account of the  violent twitchings of the tendons of
the forearm.   Temperature of trunk and extremities,  several de-
grees above  the normal standard.  Skin covered  with  clammy
sweat, which resembles bloody serum,  and stains his clothes and
bed just as bloody  serum would do.  Odor of his body intolerable.
Passes his feces and urine in bed.  This  patient continued in this
condition for three days, and finally died.  Unfortunately, no post-
mortem examination was performed, on account of the earnest en-
treaties of his superstitious friends.
  This second attack was, in all  probability, either a relapse, or a
fresh attack of malarial fever.
  This case illustrates in a forcible  manner the effects of the ma- 
MALARIAL FEVER.
159
larial poison in  altering the constitution of the blood, and of the
organs and  tissues, and in causing aberration of the muscular and
nervous, and physical and vital forces.
   The blood in No. 8 was drawn from the arm of a German butcher,
who had suffered for two months with chill and fever, without any
medical  attendance, and who  entered  the  hospital in a comatose
condition, reduced  in flesh from  180 pounds to 110  pounds, with
feeble forces.
   Complexion sallow, anemic; nervous and muscular forces very
feeble.  Pulse 120, feeble.  Respiration 24, labored.  Tongue per-
fectly dry, and rough. Skin dry and rough over all parts of the body.
Although revived and  partially relieved by sinapisms, stimulants,
and sulphate of quinia, the malarial poison had induced such pro-
found alterations in the blood  and organs, that the effects were
 followed by the most distressing suffering, and finally death.
   The blood drawn shortly  after his entrance  into the hospital,
 whilst he was in this comatose condition, coagulated rather slowly.
 In one  specimen, the  coagulation  was remarkably  slow, and the
 blood-corpuscles gravitated towards the bottom of the vessel, and
 left above a clear, golden-colored clot.  The transparent portion of
 the clot was about one-fourth of an inch in thickness.  Serum of a
 deep golden color, reaction alkaline.
    The fibrin was greatly deficient.  The deficiency of the fibrin in
 the  blood  was further demonstrated  by the fact that the blood
 oozed from the  cut-cups upon the temples for eighteen hours, and
 it was finally necessary to check the flow  by cold affusions.
    The colored blood-corpuscles were  greatly diminished; the dried
 corpuscles being 79.434, and the moist corpuscles 317.748.   The
 fixed saline constituents were correspondingly reduced in amount.
 The albumen was also diminished.
    It is worthy of note that, in the different forms of malarial fever,
  the serum is alkaline, whilst the  saliva and  urine are intensely
  acid.
    The following table will illustrate the prominent symptoms:— 
160
OBSERVATIONS  ON
Date.


1857.
Sept. 28

  "  29

  "  29

  "  30

 Oct. 1

  «   2
 Hour
of DAY.
 7 P. M.

11 A. M.

 7 P. M.

24. P. M.

 2 P. M.

 2 P.M.
2£ P. M.


 2 P.M.
2 P.M.

4 P. M.
4 P. M

4 P. M
State of Skin, Tosgce, Intellect, &c.
o  t ~  -C
Lies in a stupor; tongue dry and rough ; skin dry
  and rough.
Intellect brighter, but still very dull; tongue slightly
  coated with yellow fur and dry.
Pulse very feeble, feels like the vibrations of a deli-
  cate silver thread ; tongue and skin dry and rough.
Tongue moister and softer; surface of blister  red,
  raw, and dry; urine bright red, sp. gr. 1016.
Restless and stupid ; tongue dry and  rough; teeth
  coated with sordes.
Intellect more active, but still dull; patient has a
  disagreeable smell;  tongue coated with brownish-
  yellow fur,  and harsh, dry, and rough ;  the inci-
  sion in the arm where he was bled has not healed,
  limpid serum issues from it; side of head swollen
  and painful.
Tongue moist and soft; arm in which he was bled
  greatly swollen, veins of surface filled with blood;
  swelling of  arm due to pressure.
Swelling of arm and upon left side of face continues
  to increase; blister purplish red, with  dry  raw
  surface ; boils and ulcers are appearing upon dif-
  ferent parts of the  body ; tongue red, dry,  and
  glazed at tip ; root covered with brownish-yellow
  fur.
Swelling of arm stationary; swelling upon side of
  face continues to increase.
Skin hot and dry ; complains greatly of his head
  carotid  arteries throbbing violently; since the
  commencement of the inflammation, the pulse has
  been fuller  and stronger.
When the arm is bent, much serum issues from the
  lancet wound ; surface of blister red and raw, and
  shows no disposition to heal.
Abscess upon side of head has been lanced; it dis
  charged much pus.
Skin hot and  dry; tongue dry and rough ; abscess in
  angle of jaw continues to discharge much pus and
  masses of cellular tissue ; arm looks badly ;  skin
  of arm greenish yellow.
Surface of blister has commenced to suppurate, and
  discharges  unhealthy offensive pus; the ulcers
  upon various parts of the body steadily increase
  in size,  and, like the blister, discharge offensive
  matter.
The arm looks dreadfully ; skin over biceps muscle
  black and  gangrenous; bowels loose;  digestion
  bad
The skin over the entire region of the biceps has
  Bloughed away, and left the red quivering muscles;
  no hemorrhage ; body emits a disgusting stench.
Continues to grow worse ;  impossible to  give any
  idea of his distressing, offensive, and disgusting
  situation!
Died October 22d.
95.12°
70
100 00

101.00
94.5°
104.0
104.5
   In this report of the symptoms of this patient, we have a demon-
stration  of the powerful  effects of the  malarial  poison when  un-
checked.   We see that a few days after his entrance into the hos-
pital, a large abscess formed upon  the side of his head, in the region
of the ear,  and joint  and  angle  of  the inferior  maxillary  bone.
Notwithstanding  that  this  abscess  was  lanced, the  pus formed  an
entrance  into  the  external meatus auditorius.   Large masses  of
cellular tissue and muscles  sloughed away, and  the angle and supe- 
MALARIAL FEVER.
161
 nor portion of the inferior maxillary bone were almost completely
 stripped of flesh.   The  abscess compelled  him  to  lie upon the
 opposite side of his body, and finally the  skin over the biceps
 muscle changed to a black color, and sloughed off in a single night,
 leaving the red  quivering  muscles entirely exposed.  The biceps
 muscle sloughed  entirely  off from its lower attachment.
   After death, his  liver presented a color a shade lighter than the
 slate color of the  malarial  fever liver, and  in many parts it was
 regaining its normal hue.  Spleen  enlarged; surface covered  with
 effused coagulable lymph, and  bound to the liver and diaphragm
 by bands of  coagulable  lymph.   A  large  quantity of pus  of a
 greenish-yellow color issued from the anterior border of the spleen.
 Whether the abscess  had opened  and discharged this pus before
 death, or whether the abscess was accidentally ruptured during the
 opening of the chest  and abdomen, I was  unable  to determine.
 The structure  of the  spleen felt firm, and  very unlike the  soft,
 yielding structure  of  the spleen of the active stages of malarial
 fever.   When cut, many  portions of the spleen resembled the cut
 surface of a dark, bronzed malarial liver.  The pulp of these  por-
 tions was not soft, and did not pour out like the pulp of the spleen
 of the active stages of malarial  fever.   The liver-like substance of
 the spleen was found to consist, under the  microscope, of fibrous
 tissue  and numerous colored corpuscles and flakes,  composed  of
 granules resembling the dark-colored flakes of black-vomit.   These
 flakes  were, without doubt, composed of altered colored corpuscles.
 The colorless corpuscles of  this portion of the spleen appeared to
 be  more numerous than  normal.  This dark liver-like substance
 appears to be nothing more  than the pulp and effused blood of the
 spleen, from which  the serum has in a great measure been removed,
 and in which alterations of the blood-corpuscles have taken place,
 and  fibrous tissue  formed.,  After many hours'  exposure to the
 oxygen of the atmosphere, the color of this portion  of the spleen
 remained unchanged.
  In addition to the abscess opening upon the surface of the spleen
 attached to the liver, the substance of the spleen contained numerous
other abscesses  of various sizes (the three largest were of the  size
of a bullet, and the smallest of  the size of an English pea), filled
with thick greenish-yellow pus.   Portions of the  spleen especially
surrounding the abscesses, were altered into a cheese-like substance.
Under the microscope, these cheese-like portions  consisted almost 
162
OBSERVATIONS ON
entirely of pus corpuscles and large cells, containing granules and
other smaller  cells, thus resembling cancer-cells;  and also black
masses composed of granules (probably altered colored corpuscles),
like those from the denser portions of the spleen;  and also nume-
rous oil-globules.  The bodies resembling cancer-cells were not
numerous.  The pus issuing from the large abscess resembled ordi-
nary pus under the microscope, and contained a few of those pecu-
liar cancer-like cells.
  The bile presented a brownish-yellow opaque color when seen in
mass, and a gamboge-yellow in thin layers.  The bile  contained
numerous irregularly-shaped yellow masses of various sizes, from
an English pea  to a grain of sand.  These yellow masses, which
were soft and readily crushed between  the  fingers, formed about
two-fifths of the contents of the gall-bladder, and were found, under
the microscope, to consist of numerous cells from the mucous mem-
brane of the  gallbladder, and a yellow amorphous matter.  The
cystic duct appeared to be  choked up  with  these cells and  this
yellow matter.
  The stomach,  and  small and large intestines were greatly con-
tracted.  The  mucous membrane of the stomach presented an ap-
pearance resembling that  of chronic inflammation.  The exterior
of the large and small intestines  was  of a  purplish  color.  The
mucous membrane did  not  appear to the naked eye to be altered
in structure.   The glands of Peyer were enlarged and distinct;
some of them were several inches in length.  They were paler than
usual, and did not  present the appearance of active inflammation.
The lymphatics of the mesentery were much enlarged.
  This case demonstrates that the action of the malarial poison is
chiefly through the sympathetic nervous system, and that its effects,
even after the direct action  is checked, result in a further perver-
sion  of the blood, and  organs, and tissues.   Whilst the cerebro-
spinal nervous system  had recovered in a great measure from the
effects  of the  poison,  and sensation, and motion,  and intelligence
were restored,  the pathological alterations of the spleen and aliment-
ary canal, and of the liver and blood, continued.
  Many, if not all, the nervous affections and neuralgias occurring
after attacks of malarial fever, or after the long-continued action of
the malarial poison,  in  miasmatical situations, are connected with
the altered state  of the blood, and organs, and secretions.
  Alterations  of the  solids, similar to the one just recorded  have
been observed by Dr. Samuel Jackson, of Northumberland  Pa. 
MALARIAL FEVER.
163
  The following cases  of gangrsenopsis, or gangrenous erosion  of
the cheek, following malarial fever, are quoted from his interesting
article,  published  thirty-two years ago,  in the American  Medical
Recorder:—
  "Case 1. Mary, aged six years, daughter of John Eisely, of Sun-
bury, was  seized, in September, 1822, with an epidemic remittent
fever, which, in a few days, and before they obtained  medical aid,
had resolved itself into the intermittent form.  I was  called about
the tenth day of her disease, when one side of her face was greatly
swelled, pale, and shining; eyelids of the same side so cedematous
as to close the eye  entirely; lips, and particularly the upper one,
tumefied;  saliva streaming from her  mouth; breath highly offen-
sive.
  My first impression was that she was affected with mercury; but
they  assured me, as indeed they always  did afterwards, that she
had taken  no other medicine than the common purging salts, which
they had given without medical advice.
  Upon opening  the mouth, I found on the inside of the tumefied
cheek a patch of gangrene, about as large as  a crown piece, and
without anything like a line of separation.  It exhibited a singular
ash-color, approaching to whiteness;  but it was  plainly the  sub-
stance of the cheek, which was dead and disorganized to a consider-
able depth.  The teeth were  all fast, the gums  sound  and  not the
least sore on pressure,  nor did her breath smell precisely like that
of a salivated patient.  This affection had begun two or three days
before, and had been steadily increasing.   The disease was totally
unknown to me; but  the mere indications of cure were not  sup-
posed  to  be at all  mysterious, though I am far from certain  of
having fallen on the most successful means of fulfilling them.
  An  epispastic was applied to the cheek; the mouth  was very
frequently washed with a succession of gargles,  strong  alum-water,
Huxham's  tinct., diluted muriat. acid;  and bark, wine, elixir  vit.,
and tonic diet were given as freely as the patient  could bear them.
The  intermittent was  checked at once, and  the patient's health
began to improve before the swelling of the cheek subsided in the
least,  or any line of separation could be seen.  The tonic medicines
and diet were continued, and another blister drawn as soon as the
first healed.
  But the state of the cheek meliorated slowly, and I was particu-
larly struck with the obstinacy of the swelling, and the inability  of 
164
OBSERVATIONS ON
the system to form a line of separation.  At the 20th day from the
time I was  called the  slough came away, leaving  a healthy ulcer,
which had nearly penetrated  the cheek.  The teeth and gums were
not the least affected at any period of the disease.
  Case 2. About the same time, George Gaus, of Sunbury, called
me to visit his family, three of whom were ill of intermittent fever
and dysentery.
  His daughter, about four  or five years old, had  also the cheek
disease, precisely similar to that of  the above child, unless  that
there was very little, if any discharge of saliva.
  The father assured  me that she had  not taken one particle of
mercury  in any form ; nor can I possibly believe  that either he or
Eisely deceived  me, or  that they were  deceived themselves;  nor,
indeed, ought this cause of itself to have excited any inquiries con-
cerning this mineral, since  it was not attended with any  flow of
saliva; and, moreover, as in the above  case, the  teeth and gums
were in a healthy state.  Her dysentery  was cured with large doses
of calomel, jalap, and other purgatives; and at the same time a
sufficient quantity of bark was  given to check the fever.  During
this  time, probably, not less than a  hundred  and  fifty grains of
calomel were given, notwithstanding the state of the cheek.
  For the gangrene she was  treated precisely as Eisely's daughter.
She  soon recovered her health, but with a frightful ulcer, which,
however,  did not quite penetrate the cheek.
  How the ulcers in these two cases healed I know not, as I was
soon taken  with the epidemic myself, and confined  for  several
weeks.   I went to see these  patients  since writing  the above;
Eisely's daughter is dead; but the other  is a blooming girl, without
the least deformity.  It is not probable that these sphacelations
could have been arrested without medical aid, though it must be
confessed that their character  appeared to be rather indolent and
obstinate, than inflammatory and phagedenic.   They gave me no
uneasiness  at the time, but  subsequent experience has convinced
me that  had the debilitation of the  primary diseases proceeded a
few days longer, the  patients  might have been brought into the
utmost danger.
   Case 3. This  occurred September, 1823, in a child of  Hannah
Smith, of Northumberland.
   He was a robust boy of three years old, who had  been taken
with epidemic remittent fever, for which he was treated with vene- 
MALARIAL FEVER.
165
section, cathartics, antimonials, cold water to the head, and probably
with something more that I cannot now recollect.  He appeared to
be going  on well till the tenth day, when he was taken with an
incessant agitation of all his limbs, his brain and mind at the same
time apparently  quite unaffected.  An epispastic was  applied to
each limb, and nauseating  doses of tartar emetic, conjoined with
laudanum, were given every hour, with the hope of obtaining both
an antispasmodic and diaphoretic effect; the exact dose I do  not
recollect.
  This troublesome symptom subsided in  about forty-eight hours,
when the dreadful disease of which we are treating was observed
in the cheek.  Its prima fades is so peculiar that we  recognized it
in one moment as the same disease we had seen before in the two
preceding cases;  a swelling and hardness of one cheek, with  the
upper  lip slightly tumid, led us at once to suspect the existence of
mischief  within;  nor were  we disappointed.  A little cineritious
spot, or rather tumor, was seen behind the opening of the Stenonian
duct, without any symptom of inflammation near it, or in any part
of the mouth.  As we were alive to the operations of mercury, it
was not a little gratifying to find the teeth  and gums apparently
quite sound, and  not the least sore on pressure; and  also that  the
saliva was not increased, nor the breath offensive.
  The fever continued, and therefore general tonics were not admis-
sible.  A blister  was drawn on the cheek, and the mouth washed
frequently with a strong solution of alum.  At this time the swell-
ing was very moderate, and the mortification confined  to a point.
But  the  face swelled rapidly on that side, and the gangrene pro-
ceeded without giving any hopes of a line of separation.
  In two  days, the pulse became soft and slow, and, the fever being
now arrested, we forthwith used tonic diet,  bark,  and elixir vit.,
with the bark poultice to the face.  The mouth was washed alter-
nately with Huxham's tincture and muriatic acid, diluted with four
times its weight of water, and the sphacelated part was circumscribed
twice a day with  the nitrate of mercury, according to the plan of
Mr. Kirkland, until it was fairly ascertained  to be  utterly useless.
The  disease continued its deadly  progress till the poor child was
relieved of life, about the twenty-fifth day of  the gangrene.
  During all this  time, he suffered very little, if any,  pain, and he
had a ravenous appetite till the last two or three days, though much
poisonous matter  must have been continually passing into the sto- 
166
OBSERVATIONS ON
mach.  In  fact, we were greatly surprised to find him living so
long, when we consider the  deleterious  effects of mortification on
the general system;  which, in this case, we did nothing to counter-
act, after we found it impossible to preserve a tolerable visage.
  One side of this poor child's face was  literally destroyed as high
as the frontal sinus;  the teeth, maxillary, malar, palate, nasal, and
orbitar bones  were  cast off or  were picked  away by the patient.
One whole side  of the  face, including the mouth, chin, nose, and
one eye were eaten away—a horrible sight, which even to name is
a revolting duty.  Yet, even in this deplorable state of things, many
parts of the face put  on signs of healing, and, as the patient had a
good appetite, we felt no little alarm lest he might continue to live
in this deplorable condition.
  This child had  taken some purges  of calomel, jalap, and scam-
mony, in composition, all which operated  freely.   The breath was
not that of a salivated patient; there was no flow of saliva, as in
the first case, nor did he take any calomel which was not combined
with the above mentioned active cathartics.
  We gave him large doses of laudanum, in order that he might
sleep away in comfort the remainder of his life, and that the mother
might attend to the rest of her family, all of whom were sick ; and
it is a little surprising that,  towards  the last, he would take more
than half an ounce in twenty-four hours, without procuring more
than ordinary sleep.
  Case 4. In August, 1825, we saw a case exactly similar to this
in the town of Milton, twelve miles above us.   It was in a boy four
or five years old, the son of one Miller, who still resides  in that
borough.
  The patient had been treated for bilious fever, and had, like the
little Smith, taken purges containing calomel; and like him, too,
nearly the whole  face was eaten away, after the sphacelation had
lasted several weeks.   We believe that no calomel was given which
had not been combined  with more active  cathartics; but we have
no means of getting  at the exact history of the case.
  Case 5.  This was  the  next that came under my own care, and,
horribile dictu, it was  in  my own child.
  This  little girl, less  than two years old,  was debilitated by  a
variety of diseases in too rapid succession; an attack  of  habitual
intermittent, cynanche  tonsillaris, measles,  inflammation  of  the
lungs, influenza, and finally her intermittent again; all which con- 
                     MALARIAL FEVER.                  167

fined  her about ten weeks,  and had  nearly  brought her to the
grave.
  When she was in a state of extreme weakness, we observed one
side of her  face a little  swelled.  I recognized the  tumor at once,
and heard, with the utmost dismay, the little  sufferer say, 'Cheek,
cheek!' while at the same time she put her  hand to the affected
part.  On opening her mouth, I found the characteristic gangrene;
but it was not larger than a dime  piece, and was nearly circum-
scribed with a healthy periphery.  Her catenation of maladies hav-
ing ended  in her old intermittent, we were ready  to give quinine
and tonic diet.
   This  case was attended with an odor of the  breath altogether
peculiar and indescribable.  Only one dose of calomel  had been
given as a purge, and there was no affection whatever of the teeth
and gums, nor any flow of saliva."
   Dr. Samuel Jackson  gives other cases of this remarkable affec-
tion, and  proves  that  the affection was not  due to  the action of
mercury.
    " That rule of philosophizing, therefore, which  refers the same
 phenomena  to the same  cause, excludes calomel as a direct  agent
 in gangraenopsis.
    All the cases that we have seen were preceded by bilious fever,
 a  disease  that generally  has a tendency to spend its violence in
 some particular part;  and, therefore, if any irritation, and particu-
 larly one that debilitates, should attract and fix the morbific influ-
 ence, a mortification may be the consequence.
    In one case of  this fever, we  knew blisters to  mortify, and in
 several  instances we have known a lingering sphacelation  of the
 soft parts  covering the lumbar vertebras.
    Upon this principle, then, can  mercury have an indirect agency
 in the gangraenopsis ?
    It is well known that children cannot be easily salivated;  but it
 is not reasonable to suppose that mercury has, even in them, its
 specific tendency to the jaws; and, if so, may it not  predispose these
 parts to this fatal gangrene,  and create that morbific attraction that
 brings upon them the whole  weight of general disease?   Pars
 Mens trahit is a maxim in medicine as true as  any of the Newtonian
 Principia, and is of wonderful  efficacy in explaining the mysteries
 of morbid catenations.
    For our own part, we believe that mercury has no direct agency 
168
OBSERVATIONS  ON
in gangraenopsis.   It may possibly irritate and predispose the part,
and thus establish a catenation of morbid attraction, and so may
any other local  and debilitating irritation.  Upon this principle,
we have supposed  that the disease may arise from any injury done
to the part, while  the system is pervaded by a sphacelating influ-
ence, as no doubt it is in many  cases of fever."1
   The blood in No. 9 was abstracted from a young American sea-
man—aged 21 years—with a moderately well-developed muscular
system, who had been exposed to the malarious influence in  the
Savannah River, when sleeping  on the deck  of  the ship in  the
open air.  The ship was  lying  along the low marshy shore below
the city.   This patient was brought into the hospital in a comatose
condition, with rapid, feeble pulse, and rapid respiration, with  no
corresponding elevation  of  temperature.   This  patient lay in this
comatose condition, passing his urine  and feces for several days,
until aroused  by cut-cups,  sinapisms,  stimulants, and sulphate of
quinia.
   The blood was obtained,  whilst he was  in this  condition, three
days after his entrance into the hospital, and six days  after  the
commencment of the attack.
   Blood coagulated more slowly than usual.
   Serum of a deep golden color.  Nitric acid showed that this color
was due to the presence of bile.  Reaction of serum alkaline.
   The colored blood-corpuscles were greatly diminished; the dried
corpuscles being 85.968, and the moist 343.872, in 1000 parts of
blood.   The fixed saline constituents of the colored blood-corpus-
cles were greatly diminished in amount, whilst  those of the liquor
sanguinis were increased.
   The fibrin was diminished in amount.
   The following table will present a condensed view of the promi-
nent symptoms:—

  1 "On the Gangraenopsis, or Gangrenous Erosion of the Cheek,"  by  Samuel
Jackson, M. D., of Northumberland, Pa. American Medical Recorder, 1827, vol.
xii. pp. 66-96. 
MALARIAL  FEVER.                           169
 Hor/R
OF DAT.
Sep. 26
7 P. M.
11 A. M
State of Skin, Tongue, Intellect, &c.
29
7i P. M.
2 P. M.
Oct.  1
IP. M.
1P.M.
1P.M.
2 P. M.
IP. M
3 P.M.
! 2J P. M.

  2 P.M.
Tongue dryer than normal; coated with
 yellow fur;  complexion sallow ; has fe-
 ver, is very  weak and dull.
Comatose; passes urine and excrements
 in bed.
Restored to the temporary and partial use
 of his intellect by a blister.
The action of the blister has been only tem-
 porary ;  pulse is so feeble that it is with
 difficulty counted; tongue coated with
 yellow fur,  dry and rough.
Lies in a stupor, with mouth and eyes
 partially open ; teeth coated with sordes;
 tongue coated with black and light yellow
 fur, perfectly dry and rough; surface of
 blister red and raw.
Stimulants and sulphate of quinia have
 aroused  him, and excited the chemical
 changes  ; is still very weak,  and has a
 great tendency to sleep ; skin of head and
 trunk feels  a little warmer than normal,
 and is slightly moist; tongue presents the
 same dry, coated, rough appearance ;  re-
 action of saliva decidedly acid.
 Intellect clear, and there is less tendency
 to sleep; tongue is still very  dry, rough,
 and black in the centre ; it appears, how-
 ever, softer; reaction of saliva decidedly
 acid.
 Tongue moister, softer,  and cleaner ; says
 that he feels better, and is hungry; com-
 plexion  sallow, anemic.

 The expression of countenance is better,
  and the surface of the blister looks much
  better;  tongue still coated  with dark-
  brown fur, but moister and softer;  the
  sordes around the teeth and the disagree
  able smell  are rapidly disappearing;  ab
  domen tumid;  was able to walk across
  the ward.
 Has taken a change for the worse; inclined
  to stupor;  goes to sleep whilst convers-
  ing ; countenance anxious and distressed;
  bowels costive ; during the last four days,
  has taken 100 grs. of sulphate of quinia.
 Anxious expression of countenance ; bow-
  els  costive; abdomen  tumid ;  tongue a
  little softer and cleaner, but still much
  dryer, harder, and rougher than normal;
  there is still an almost complete cessation
  of the secretions of  the mouth.
 Tongue clean, and much moister and soft-
  er; the moisture, however, varies greatly;
  pulse very  weak, feels like the vibrations
  of a spider's thread;  greatly exhausted
  by the action of a purgative administered
  the night before.
 Under the action of stimulants  has  im-
  proved,  and looks better; tongue softer
  and  moister than it has been during his
  sickness ; pulse stronger, but still watery
  and  feeble.
 Complains of great weakness; pulse feeble
  and  watery ; bowels inactive and tumid.
 Complains of great weakness; his sallow
  complexion, anemic lips and gums, feeble
  pulse, and  feeble forces, demonstrate that
  his feelings are founded upon the effects
  of the  malarial poison.   Applied large
  mustards to the extremities, and admin-
  istered  stimulants; in 10 minutes after
  the  application, the temperature of  his
  extremities had risen 6° (from 86° to 92°),
  and his pulse had become much fuller,
  and increased 8 beats (from 92 to 100).  In
  half an hour after the application of the
  mustards,  the temperature  of his extre-
  mities  had risen 16° and remained  sta-
  tionary.
 Half an  hour afterwards, the temperature
   still continued elevated.
33
80°
as
S a
18
15
92
77.0
16
98.75
101°
16
73.0
71.0
Characters of
    Urine.
97.0
97.25

86.0
92.0
102.0
102.0
High colored; sp.
 gr.  1016;  uric
 acid in 1000 p'ts
 0.59.

Deep orange co-
 lor; sp.gr. 1016;
 uric acid in 1000
 parts 0.659.
Orange colored;
 sp.gr. 1016; uric
 acid in 1000 p'ts
 0.511; deposited
 a heavy light-
 yellow  deposit
 after standing.

Light orange co-
 lor; sp.gr. 10015;
 uric acid in 1000
 parts 0.238.

Sp. gr. 1006 ; re-
 action alkaline
 after  standing
 24  hours;  uric
 acid in 1000 p'ts
 0.078.
102 5

103.0
103.0
103.2
1%
 
170
OBSERVATIONS ON
Date. 1857.	Hour OF DAY.	State of Skin, Tongue, Intellect, &c.	6 "a	0 O 'p. W	£ » 11	o u 0 aS	SB.	Characters of Urine.
Oct. 10 " 10 " 17	4 P.M.	Much better ; temperature of the extremi-ties corresponds with that of the trunk. Appetite good; tongue moist; convalescent. Able to walk about the hospital grounds; reaction of saliva very slightly acid.	100 16 76 14		69.5 67.0	1010 97.25	102.5 102.0	Deep orange co-lor; sp. gr. 1014; 12,168 grs. pass-ed in 24 hours, containing urea 209.520 gr", uric acid 12.60 grs.
  This case presents many points of exceeding interest, which will
be fully noticed hereafter under the proper heads.  It illustrates in
a striking manner, the effects of the malarial poison in producing
profound alterations in the blood and secretions, and demonstrates
that such changes are attended by aberrated nervous and physical
phenomena.
  Throughout this  case there was  a want of correspondence be-
tween the temperature of the trunk and  extremities.  The tempe-
rature of the extremities was often several degrees below the normal
standard, whilst the  temperature of the trunk was several degrees
above the standard of health. Accompanying this loss of animal
heat in  the extremities,  and exaltation  in  the  trunk,  there was
rapid, feeble pulse, normal respiration, dry, harsh skin, dry mouth,
feeble digestion, torpid bowels, sluggish intellect  and feeble forces.
These facts, taken in connection with the analysis of the blood,
show that the malarial poison has produced profound alterations in
the constituents of the blood, interfered with the formation of the
secretions, interfered with the chemical changes  of the blood and
nutritive fluids, interfered with the development  and correlation of
the physical, vital, and nervous forces.  The  dry, harsh tongue, the
scanty acid secretions of the mucous membrane of the mouth, the
torpor of  the bowels, the high  colored acid urine, the dry, harsh
skin, the feeble circulation in the capillaries  of the extremities, the
elevation of the temperature of the trunk, the loss of harmony be-
tween the  actions of the circulatory and respiratory  system  all
point to profound disturbances in the domain over which the sym-
pathetic system presides.   The sluggish intellect indicated derange-
ment of the cerebro-spinal system.  The feeble forces point to de-
rangements in both the sympathetic and cerebro-spinal systems.  A
careful comparison of the symptoms of this  patient with  those of 
MALARIAL FEVER.
171
 fatal cases, shows that this was a case of such great severity that
 any carelessness or neglect would have been attended  by a fatal
 termination.
   Notwithstanding the  administration  of  the most active tonics,
 and of the most nutritious diet, this patient exhibited, for a great
 length of time, the effects of the bilious  remittent fever, in his pale,
 sallow, anemic countenance, pale lips and gums, and tottering gate.
   The violent nature of the malarial fever, contracted by sleeping
 in the open air in the low marshy land  bordering our fresh water
 rivers, is forcibly illustrated by the subsequent history of the crew
 to which this patient belonged.
   I was  informed, upon reliable  authority, that one week after
 the admission of this patient into the hospital, his captain weighed
 anchor and sailed  for New York.  The crew consisted of the men
 whom he had compelled to sleep on board the vessel lying along
 the  low, marshy shore.  Several of the crew were  unwell at  the
 time of sailing.  Before getting well out to sea, the captain and the
 whole crew were taken  sick.   In a few  days, there was not a man
 with strength to navigate  the  ship.  Fortunately, a small  vessel
 perceived their signal  of distress,  and towed them into Darien.
 Before reaching this port, the captain and five out of seven of the
 crew, had died.  There were but two remaining of eight, and these
 were extremely ill.  The  severity of the disease, in this case, re-
 sembles the accounts of African fever.
   "We will now, from these  observations and others, present a gene-
 ralized statement of the  changes of the blood in malarial fever.
   1. The careful comparison of the table of the changes of the blood in
 malarial fever with the formula of the blood, established by laborious
 investigations,  reveals the  fact that the colored blood-corpuscles are di-
 minished during malarial fever.
   2. The careful comparison of these analyses with  each other, reveals
 the fact, that the extent and rapidity of the  diminution of the colored cor-
puscles, corresponds  to the severity and extent of the disease.
   A short but violent  attack of congestive or of remittent fever,
 in its  severer forms, will accomplish as  great a diminution of the
 colored blood-corpuscles, as a long attack of intermittent fever, or
 the prolonged action of the malarial poison.
   These statements are  borne out in the  main, by the researches
 of Andral and Gavarret, upon the blood in intermittent fever.   If
 their analyses be  compared  with  those just recorded,  it will be
 seen that whilst the blood-corpuscles are  diminished, the diminu- 
172
OBSERVATIONS  ON
tion is less than in the  blood of the severe cases recorded by my-
self.   When we consider that the climate was much more healthy,
and that the fevers examined by Andral and Gavarret were only
of the intermittent type, and in all  probability, much  lighter than
the intermittents of the marshes, swamps, and low-grounds, of the
southern States, which generate a malaria scarcely less deadly than
that of Africa, it is evident that the results of the investigations in
America upon malarial fever, agree with those of Europe.
  The following table presents the results obtained by Andral and
Gavarret, from  the examinations of the blood of six persons suffer-
ing with intermittent fever :—
Number of case.	Water in 1000 parts of blood.	Solid residue of 1000 parts of blood.	Moist Blood-Corpuscles.			Fibrin.	Solid residue of serum of 1000 parts of blood.
			Moist blood-corpuscles in 1000 parts of blood.	Water in moist blood-corpuscles of 1000 parts of blood.	Solid residue in moist blood-corpus-cles in 1000 p'ts of blood.		
1 2 3 4 5 6 Maxima Minima Mean	847.9 778.1 811.4	221.9 152.1 188.6	511.6 441.6 438.0 423.2 420.0 275.2 511.6 275.2 417.2	383.7 331.2 328.5 317.4 315.0 206.4 373.7 206.4 309.4	127.9 110.4 109.5 105.8 105.0 68.8 127.9 68.8 104.3	3.7 3.5 3.5 3.4 3.3 3.0 3.7 3.0 3.3	91.0 71.6 80.0
  MM. Leonard and Foley, of Algiers, concluded from their exami-
nations of the  blood in intermittent fever, that the proportion of
globules tends either to remain stationary or to  diminish.1
  MM. Becquerel and Eodier have demonstrated that in that pecu-
liar condition of the system called marsh cachexia, accompanied by
a remarkable decoloration of the skin, and not unfrequently by
dropsy, and produced  by the long-continued influence  of malaria,
there is the greatest decrease  of both the albumen and the  globules.
  The following table  presents  the  analyses of marsh  cachexia,
executed by MM. Becquerel  and  Rodier.

  1 Pathological Chemistry in its Application to the Practice of Medicine.  Trans-
lated from the French of MM. Becquerel and Rodier, by S. T. Speer, M. D.  London
1857, pp. 172-174. 
MALARIAL FEVER..                    173
Analysis op 1000 parts of Blood.
o*S'S
'O's'g g
oi a » g ,
-^ £ -^ si
&*>* I
* .2 i g >.
all S~ S.
B S e Si
oo"a'R
■rsi-g g
& **> g 2 .

B 3 2 a
I a O h
l H C3T3
gf Sg
■e£-gg
*TS'
bo bo rf 5

8a
hi
Specific gravity
Water   .....
Moist globules
Solid matters of moist globules
Water of moist globules .
Solid matters of serum .
Fibrin.....
1035.40
 869.34
 268.40
  67.10
 201.30
  61.10
   2.36
1040.00
 853.75
 407.48
 101.87
 305.61
  41.84
   2.54
1034.06
 869.71
 269.12
  67.28
 201.84
  59.88
   3.13
1033.85
 875.67
 224.88
  56.22
 168.66
  63.83
   4.27
1040.51
 846.31
 338.88
  87.22
 251.66
  62.32
   4.15
Analysis of 1000 parts of Serum.
Specific gravity
Water   ....
Albumen
Extractive matters and salts
1020.37	1016.40	1021.61	1024.15
936.40	953.29	930.03	926.75
55.68	37.26	50.20	60.20
7.92	9.45	13.72	13.05
1023.56
 922.98
  63.25
  13.77
  The  mean composition  of the blood in marsh cachexia may be
represented thus:—

 Analysis of 1000 Parts of Blood (Mean Composition of in five Cases of Marsh
Cachexia)—
Specific gravity  .
Water
Moist globules
Dried residue of globules
Water of globules
Solid matters of serum
Fibrin
1036.76
 962.38
 303.76
  75.94
 227.82
  57.79
   3.39
               Mean Composition of 1000 Parts of the Serum.
        Specific gravity........1021.22
        Water.........935.10
        Albumen.........53.32
        Extractive matters and salts.....11.58

  The  following interesting  remarks, with reference  to the cause
of the dropsy, are  made by MM. Becquerel and Eodier :—
  "The dropsy  has  been  attributed  to  the  mechanical  obstacle
afforded by  the  enlarged condition of the spleen,  so common  in
these cases.  We do not  deny the possibility of such  a sequence;
but it is certain that in many instances we fail  to discover such an
amount of splenic enlargement,  as would suffice  to  explain the
occurrence of an increasing and  general anasarca.   In only one  of 
174
■OBSERVATIONS ON
the preceding analyses of the blood in marsh cachexia, did we notice
a marked degree of splenic enlargement; it was, however, insuf-
ficient to account for the serous infiltration present."1
  We will in the next  place compare  the changes of the blood in
malarial fever, and in the state of marsh cachexia produced by the
continued action of the poison, with the changes of the blood in
the different forms of dropsy.
  The following tables present a resume" of  the valuable investiga-
tions of MM. Becquerel and Eodier:—
Mechanical Dropsy.
Analysis of 1000 parts op Blood.				
*	A female aged 65; anasarca, dependent on cancer of the stomach and pancreas.	A female aged 36; anasarca of the lower ex-tremities, due to an abdomi-nal tumor.	A female aged 2-t; ascites and anasarca, due to abdo-minal tumors.	A female aged 61 ; anasarca, dependent on cancer of the stomach.
Specific gravity Water..... Moist globules .... Solid matters of moist globules Water of moist globules . Solid matters of serum Fibrin .....	1057.01 802.79 424.92 106.23 318.69 80.20 1.78	1053.45 810.20 361.30 90.30 270.90 85.50 4.00	1060.75 828.30 360.08 90.02 270.04 86.03 5.55	1043.56 842.40 285.48 71.37 214.11 81.85 5.38
Analysis of 1000 parts of Serum.				
Specific gravity Water ..... Albumen ..... Extractive matters and salts	1032.51 900.00 73.26 26.74	1033.00 894.53 82.62 22.85	1028.73 905.83 76.74 17.33	1026.69 913.68 70. SO 15.68
  In the blood of mechanical  dropsy we have a decrease of the
globules;  but the diminution is less than that of the severest forms
of malarial fever, and in marsh cachexia.
  It is worthy of note that other causes than mechanical operated
in two  of these cases.   It is probable that the cancers, and the
peculiar state of the system favorable to the development of can-
cers, may have had much  to do  with the  pathological changes of
the blood.
  These cases, then, are not without  objections; nevertheless, the
objections only place in a still  stronger light the profound altera-
tions of the blood-corpuscles in malarial fever.
1 Pathological Chemistry, p. 172. 
MALARIAL FEVER.

    Acute Dropsy.
175
Analysis of 1000 parts of Blood.1				
Mean.			Maxima.	Minima.
Specific gravity Water ..... Moist globules .... Dried residue of moist globules Water of moist globules . Solid matters of serum Fibrin.....		1045.84 830.78 414.32 104.58 309.74 61.87 2.77	1053.30 539.52 134.88 404.64 65.62 4.10	1037.55 280.40 70.10 210.30 57.24 1.25
Analysis of 1000 parts of Serum.				
Specific gravity .... Water...... Albumen ...... Extractive matters and salts		1022.61 928.47 58.52 13.01	1024.28 63"l8 17.14	1020.05 51.12 7.74
   "The globules are less liable to decrease than in cachectic dropsy;
they, nevertheless, fell in one case to 70, and in another to 72.   In
three cases they were above 120 per 1000;  in  three others between
100 and 120;  and in five cases between 100 and 110.
   The  fibrin  underwent  a marked diminution in two cases only,
viz., between 1 and  2 per 1000; in  six cases it varied from  3 to 6,
while in three others it  rose above 3 per 1000.
   The  albumen of the serum was always diminished,  and in some
instances  this diminution was considerable; it ranged from 60 to
66 in four cases, and from 55 to 60 in six others, while in one case
it fell as low as  51.02.
   It is almost needless to add, that  the specific gravity of both the
blood and serum was always found to have fallen below the standard
of  health."

  1 The above table is drawn up from eleven analyses of the blood; nine of the
patients  were males and two  females.  In all, the disease set in rapidly under the
following circumstances: In one case, it followed a sudden suppression of the
catamenia from violent emotion; in a second, it occurred at the fifth month of
pregnancy, without any appreciable cause; in a third, it followed an attack of
scarlatina ; in four  other cases, it followed prolonged exposure to cold; in another,
it resulted from sleeping on the ground in the open air, during the month of June ;
lastly, in three cases, the cause was inappreciable.  In two of these latter, the
patients  were suffering from a relapse of the disease.   Of these eleven patients,
none entered the hospital before the fourth, or after the eleventh, day of the dis-
ease.  In six cases, dropsy was the only symptom; in two, it was accompanied by
fever; in two others, there was slight fever; while in another, there was vomiting,
coupled with a mild attack of jaundice. 
176
OBSERVATIONS ON
  From a careful historical analysis and examination of these cases,
Becquerel and  Eodier drew the conclusion that acute dropsy was
the result of albuminuria following congestion of the kidney.
  " Under the  influence of some cause or other, congestion of the
kidney is produced.  The congestion  is indicated, along with other
symptomatic phenomena, by the escape of a certain amount of albu-
men with the urine; this,  ere long, diminishes the natural propor-
tion of the albumen of the blood, and the latter condition  in its
turn gives rise to a greater or less degree of dropsy.  But the con-
gestion of the kidney is generally of much shorter duration than
the modification of the blood, and its consecutive dropsy; it  disap-
pears, therefore, long before  these latter  phenomena;  and  if  the
patients  are not examined until a certain time after  the onset of
the disease, they alone are observed, the escape of albumen with
the urine having altogether ceased."
  Now, with  reference to  the diminution of  the blood-corpuscles
and albumen in malarial  fever, we can state positively that it is
not due  to the  escape of albumen through the kidneys.  I have
examined specimens of urine in all  the  various forms and  stages
of malarial fever in many cases; but  never but once detected albu-
men in the urine, and that was in  the  case already reported of a
seaman  suffering with remittent  and  typhoid  fevers combined.
We know that  albumen does  appear  in the urine of typhoid  fever;
so this case forms no exception to the previous statement.
  The diminution of the blood-corpuscles and albumen  in malarial
fever  appear  to be due to  one or  both  of two causes.   Either  the
organs destined to elaborate and prepare  the  blood-corpuscles and
albumen do not perform their office with sufficient energy to replace
the constant destruction, or else the albumen  and blood-corpuscles
are destroyed during the  chemical changes  of fever, and by  the
catalytic action of the malarial poison. 
r         !^~        MALARIAL  FEVER.                   177

                       Cachectic Dropsies.1
Analysis of 1000 parts of Blood.								
	A man aged 60, weakened by want, and suffering from dropsy not referable to any appreciable organic cause.	A man aged 64, suffering privations of every kind, and laboring under cachec-tic dropsy.	»-H 2 * » o «s-<d <j a to a> © "■a S a eS o B g 2	A man aged 58, suffering from anemia and cachectic dropsy, following chronic diarrhoea.	bO , hi a s b •E.5 P. fi>*a © 53 .2 "O m a « K5 t. a •gl'g a £ a cj a eS § a "*" H%	A man laboring under can-cer of the stomach and general dropsy, the result of cancerous cachexia.	An anemic female with an incessant haemorrhoidal flux of three months' du-ration.	© © 'S3 rS P. *> O t. t. "S-e « 2 .2 o a8* 5 as a => 2 =3 © S
Specific gravity Water..... Moist globules Solid residue of moist globules Water of moist globules Solid matters of serum	1051.10 825.94 407.84 101.96 305.88 68.50 3 60	1031.05 876.82 259.84 64.96 194.88 65.04 318	1043.55 864.45 334.52 83.63 250.89 49.88 2.04	1043.82 847.28 363.36 90.84 272 52 59.87 2.01	1045.01 824.55 414 08 103.52 310.56 68.20 3.73	1034.13 879.54 216.80 54.20 162.60 63.83 2.42	1041.04 888.24 188.00 47.00 141.00 62.50 2.26	1039.66 939.85 306.68 76.67 230.01 60.48 3.00
Analysis of 1000 pakts of Serum.								
Specific gravity Water..... Albumen .... Extractive matters and salts	1025.10 923.50 65.43 11.07	1020.51 937.86 51.30 10.84	1027.75 946.55 45.61 7.84	1023.89 935.13 53.38 11.49	1023.35 923.63 64.05 12.35	1023.32 938.09 60.81 11.01	1023.03 923.00 61.40 15.60	1022 67 932.65 11.40 55.95
  A careful  examination and  comparison of these results, demon-
strate  that the destruction of the colored blood-corpuscles  in the
severest forms of malarial fever, and in the dropsical anemic con-
dition called  marsh cachexia, produced by the long-continued  action
of the  malarial poison, is greater  than in mechanical  and acute
dropsies, and equal to destruction of these important constituents
of the blood  in cachectic dropsies, resulting from repeated losses of
blood,  exhausting discharges from the bowels, long-continued expo-
sure and privations, hunger and thirst, and from that peculiar state
of the system sometimes manifested in those suffering from cancers.
  These investigations establish, without the shadow of a doubt,
the fact that  the malarial poison, or the peculiar train of chemical
changes which it excites, destroys the gland-cells of the blood.
  This fact is further sustained  by the greater abundance of iron
in the urine of malarial fever than in that of health.  This increase
of iron in the urine corresponds to the destruction of the colored
blood-corpuscles, and the elimination of the products resulting from
their physical and chemical changes.
  3. Our researches show that the fixed saline constituents of the blood
corpuscles are often diminished in malarial fever.

        1 Becquerel & Rodier's Pathological Chemistry, pp. 167-178. 
178
OBSERVATIONS  ON
  Numerous examinations of the urine in different stages of mala-
rial fever, have convinced me that the proportion of phosphates are
increased  after an attack of malarial fever.   If the urine excreted
during convalescence be set  aside for a few hours, it will rapidly
change from the acid to the alkaline reaction, and a heavy deposit
of prismatic (most  generally) and stellate crystals of triple phos-
phate, and light-yellow granules, and acicular crystals of urate of
ammonia, will be thrown  down.  So abundant are the crystals of
the phosphates in the urine of convalescence, that if, after standing
until the reaction is decidedly alkaline, it  be held in  the sunshine,
thousands of these crystals of the triple phosphate will be seen, like
small spangles of silver.  It  is probable that a  portion of these
phosphates, at least, has been derived from the dead,  disintegrated,
chemically altered, colored blood-corpuscles.
  The bearing of these facts upon pathological  and  therapeutical
science, is placed in a clear light by a consideration of the pheno-
mena and offices of the colored blood-corpuscles.
  The specific gravity of the colored  blood-corpuscle varies with
the quantity of hsematin which they contain, and with the state of
concentration  or dilution of its contents.  The density of the fluid
contents will depend upon the character and rapidity of the mutual
interchanges  of the cellular fluid of the blood-corpuscles and the
surrounding liquor sanguinis.  Constant action and reaction are kept
up between these two great elements of the blood.  Each corpuscle
is a cell, resembling  in its nutrition, growth, and general structure
the active agents in the formation, elaboration, and separation of
all secretions and excretions.   Their cell-walls possess the property
of separating  from the surrounding  medium certain organic and
mineral compounds.   If  a blood-corpuscle  be placed in water,  it
swells up and finally bursts.   If it  be placed in a solution denser
than  its internal contents, they pass  out more rapidly than the
exterior solution passes  in, and the cell-wall swells up.  The same
physical laws of endosmose  are  at work in the animal economy.
A mutual action and reaction is incessantly carried on between the
interior contents of the  blood-corpuscles and the exterior  liquor
sanguinis.  Whenever water or liquids of low specific gravity are
introduced into the circulatory system they dilute the serum, and
immediately there is an endosmose of the less dense fluid into the
denser contents of the corpuscles.   Whenever water is  withheld
the liquor sanguinis continually loses this element by evaporation
from  the  surface of  the  lungs and skin,  and by the action of the 
MALARIAL FEVER.
179
kidneys becomes denser than  the contents of the corpuscles, and
exosmose takes place into the surrounding medium.  The cell-wall
modifies the physical and chemical properties of every molecule of
liquor sanguinis that passes through its structure.
  In  pathological conditions the cell-wall may be altered in che-
mical and physical condition.  This alteration will necessarily be
attended by disturbance of the physical and chemical relations of
the exterior liquor sanguinis to the interior cellular fluid.
  In pathological conditions (as we have just demonstrated in ma-
larial fever) any one or all the mineral and organic constituents of
the blood-corpuscles may be  altered physically and chemically.
These alterations will be attended  by corresponding alterations in
the minute actions and reactions of the liquor sanguinis and cellular
fluid.
  In  pathological conditions, any one or all the constituents of the
liquor sanguinis may be altered, physically  and  chemically, and
exist either in deficiency or excess;  or some new constituent may
be introduced.
  These alterations  may interfere with the physical and chemical
alterations of the blood-corpuscles;  and  may even prevent  the
development and nutrition of the blood-corpuscles; may be attended
by  a perversion of all the chemical and physical actions, and final
death of the blood-corpuscles.
  These views are borne  out  by the fact, that whilst  in healthy
human  blood  the density  of the  blood-corpuscles varies in  man
from  1088.5 to  1088.9, and in  woman from 1088.0  to  1088.6, in
diseases the density is not confined  to these limits; for in cholera
Schmidt found that the specific gravity of the blood-corpuscles was
increased to 1102.5,  or even to  1102.7; whilst in dysentery it was
diminished to  1085.5, in albuminuria to 1085.5, and in dropsies to
1081.9.
  Any  alteration in  the constituents of the blood  corpuscles must
alone, independently of any  actual destruction,  produce disturbances
in the muscular and nervous systems.  The truth of this assertion
is evident, when we  reflect that one of the most  important  results
demonstrated  by the researches which we recorded in  a  former
chapter, was that the development of the muscular and nervous
systems was always attended by an increase of colored  corpuscles
in the animal kingdom.
  The researches of C. Schmidt have shown that the fluid contents
of  the blood-corpuscles contain, in addition  to peculiar organic 
180
OBSERVATIONS  ON
matters, a preponderance of the phosphates and potash salts; whilst
the liquor sanguinis contains the chloride of sodium in large amount,
with a little chloride of potassium and phosphate of soda.
   In the blood-cells the fatty acids and globulin are combined both
with potash and soda; whilst in the plasma  the organic materials
are combined only  with soda.
   The researches of Liebig, confirmed  by those of Schmidt, have
shown that the fluid contained in the tubules of muscles is like that
of the blood-corpuscles, exceedingly  rich in the phosphates and pot-
ash salts.  The phosphates also exist in large amount in the brain.
   These facts not only show that the blood-corpuscles may separate
and elaborate from the liquor sanguinis those organic and inor-
ganic compounds which  constitute the most  important part of  the
structures of the muscles and brain,  but they  also show that altera-
tion or destruction  of the colored corpuscles  must be attended by
aberrated muscular and nervous action.   Numerous physiological
and pathological facts  might be brought forward to  support these
views.  They  not only throw light upon many of the phenomena of
malarial fever, especially those connected with the circulatory, muscular,
respiratory, and nervous systems, but they also indicate certain important
principles of treatment.

   (a.) Bloodletting should be avoided, as a general rule, in malarial fever.
   This principle applies to  general,  and not local bloodletting.
   I have used  local bloodletting (cut  cups) in  scores of  cases of
malarial fever, and always  with apparent benefit.  Over  the epi-
gastrium, it often arrests  obstinate vomiting, and over the  temples
and back of neck and over the  spine, it often relieves  distressing
pain.
   Local differs from general bloodletting in two essential  degrees.
   First, the quantity of  blood abstracted is much less, and second,
the number of colored blood-corpuscles is less in proportion to the
amount of blood abstracted in  local, than in general bloodletting.
The colored blood-corpuscles rush along in the centre of the  streams,
and in  general bloodletting they are lost more  rapidly than  the
other constituents of the blood.
   The  malarial  poison,  whatever it  be,  destroys rapidly  the
colored  blood-corpuscles.   Whatever,  therefore, diminishes  the
colored blood corpuscles, acts in concert with the malarial  poison.
   The malarial poison reduces rapidly the forces. 
MALARIAL FEVER.
181
  General bloodletting reduces rapidly the forces.  The two in this
particular, again act in concert.
  We would not for one moment  deny that  circumstances  may
arise, when  bloodletting would be  beneficial  in  malarial fever.
Whenever it is used, it should be borne in mind that it does not,
and  cannot  cure the  disease.   Its beneficial action is only tempo-
rary, and so far from curing the disease, the relief which it has tem-
porarily afforded  will vanish, if other  remedies, especially the sul-
phate of quinia, be not  used, and as a general  rule, without these
remedies, the patient will be in a much worse condition than if the
bloodletting  had  not been employed.
  In the use of bloodletting in malarial fever, we  should ever re-
member that the cerebral symptoms, the delirium and the torpor
of the  intellectual faculties, and the congestion of the  internal
organs, are not inflammatory; they are not due to an exaltation of
the functions, or to an irritation of the congested organs, but rather
to a loss of power in the circulatory apparatus, heart, arteries, capil-
laries, and veins, and  to disturbances of the  physical, chemical,
and nervous forces.
  The blood stagnates, and  accumulates in the capillaries of im-
portant organs, because the blood has been altered by the malarial
poison, and  the  changes which  it  induces ; because the relations
between the  blood and its containing vessels, especially the capilla-
ries, have been  disturbed; because the regular, normal  chemical
changes necessary for the development  of the  forces which work
the machinery, are not generated with sufficient energy, or if gene-
rated with even increased energy, they are not generated in the
right position and in the proper quantities, and the  correlation of
the  physical, chemical,  nervous and vital forces is thus deranged;
because the action of the sympathetic nervous system which accom-
panies the bloodvessels, and regulates the circulation, and respira-
tion, and secretion, and nutrition, and excretion, and relates them
to each other and to the cerebro-spinal system, has been disturbed
by  the direct and indirect action of the poison,  by the direct action
of the poison upon the sympathetic and cerebro-spinal nervous sys-
tems, or by  the relations of  the chemical changes induced, or the
products generated in the constituents of the blood, by the malarial
poison, to the sympathetic and cerebro-spinal nervous systems.
  We will  ilustrate these principles of  treatment by a single case
of congestive fever, selected from a multitude,  every one  substan-
tiating these statements. 
182
OBSERVATIONS ON
   Case Illustrating the Effects of Bloodletting  in Malarial Fever.—
German,  aged 27; height 5 feet 9 inches;  weight  160 pounds;
brown hair, blue eyes, florid complexion; thick-set, stout and mus-
cular ; thick,  short neck; person filthy ;  habits intemperate.
  Last winter and spring he was in the hospital with a large ulcer
upon  the leg.   Has  been  working  for  three weeks in a  mala-
rious locality, near Lover's Lane, on Thunderbolt road.  Has been
much exposed to the  hot sun and cold night air.
  August 21st,  1  o'clock P. M.,  1857.  Entered the Savannah Hos-
pital yesterday  afternoon, at 4 o'clock P. M.  The nurse states that
during the night he  appeared  to  be out of  his head, and would
frequently start out of bed with a loud shout.   Complained bitterly
of his head.  Had two  convulsions  during  the  night, one at 12
P. M., and the other at 2 A. M.
  Now, 1 o'clock  P. M., this patient appears to be suffering intense
agony in  his  head, and  has a hot fever.  Both hands are clasped
around his head, and he tosses violently about in his bed.   Every
breath is  accompanied with a deep groan, and an exclamation about
the pain in his head.   He is unable to give a coherent answer.
  Applied immediately  four cut-cups to his  head (two to back of
neck, and two to  temples);  also  a  large mustard  plaster over his
epigastrium, and one to  each leg.  Abstracted f^xviij of blood in
the standing  posture,  until  he fell back  upon the bed, completely
exhausted.
  The loss of blood was attended with almost immediate relief of
the pain in his  head.  The burning heat of the head  and skin was
almost immediately diminished, and the dry and  parched skin was
soon covered with perspiration.
  The pulse and respiration were diminished in frequency.
  Respiration, 39 ; pulse, 92.  Temperature of atmosphere, 80° F.;
temp, of  hand,  89; temp, under tongue, 97.
  The temperature under the tongue is 3°, and the temperature of
the extremities  is 9° below the normal standard.  The temperature
was not  ascertained  by the thermometer before the  abstraction
of  blood, owing  to  the great  suffering and restlessness  of  the
patient, but judging  by the sense  of touch, it is evident that the
temperature has diminished rapidly since the abstraction of blood.
The wild and restless glances of his eye, and the violent tossing of
his body, have  ceased, the pain in his head has almost entirely dis-
appeared, his intellect is calm, and he converses rationally. Tono-ue
thickly coated with yellow and black fur, tip and edges clean and of 
MALARIAL FEVER.
183
a scarlet color.  Previous to the bleeding, the tongue was dry, rough,
and where  the  fur was  absent, glazed; now it is more  moist, but
still much dryer than normal.
  He is now able to give an account of his case, and states that the
fever came on three days ago, with a chill, and pain in  the head ;
and that it has  continued  unabated, up to the present time.   Says
that he 'took blue pills and oil yesterday morning, before entering
the hospital, which operated freely.  Complains of great thirst.
  R.—Citrate of  potassa  3j; bicarbonate  of  potassa  5j;  water
f^xxviij.  Sig.—Drink  ad libitum.
  22d, 12 o'clock M.  Head  is well.  Has not complained of his
head  since the abstraction of blood.   Superior portion of  tongue
coated with thick, dry, yellow fur, inclining to black in  the centre.
Tip of tongue clean, bright red,  dry and glazed.  Complains of an
unquenchable thirst.  Lies quietly.
  Respiration 52, hurried, labored, thoracic, striking the attention
of the most casual observer.
  Pulse, 112 ; respiration, 52.  Temperature of atmosphere,  81° F.;
temp, of hand, 99; temp, under tongue, 104.
  Skin  of trunk feels hot to the hand.  Epigastrium very tender
under pressure.
   R.—Blister six inches  by six inches over  epigastric  region.
R.—Calomel gr. v;  rhubarb gr. viij.  Mix.  Gruel  and flaxseed
tea.
   23d, 12  o'clock M.  Says that his  head  is much better,  and he
feels  perfectly well.
   Blister has drawn ; serum from the blistered surface of a golden
color.  Medicine  operated four  times;  evacuations  small.   The
tongue presents the  same appearance.  Tenderness  of epigastrium
greatly diminished.
   Pulse, 72;  respiration  34, thoracic, labored.  Temperature of
atmosphere, 78° F.;  temp, of hand, 89;  temp, under tongue,  96 to
96.5; skin feels cool.
   The temperature under the tongue  is 3°, and the  temperature of
the hand 8° below the normal  standard.  There is great want of
co-ordination between  the circulation,  respiration, and chemical
changes.   R.—Calomel gr. xij;  James'  powder (pulvis antimonii
compositus) gr. xxij.  Mix and  divide into six  powders, and ad-
minister one powder every three hours, in a tablespoonful of snake-
root tea.   Sponge skin with salt dissolved in dilute alcohol.  Diet,
gruel and gum-water. 
184
OBSERVATIONS ON
   24th, 9£ o'clock A. M.   The nurse states that he has been rest-
less during the night,  and apparently out of his  head.   Several
times  he sprang  out  of the bed with a loud shout.  At one
time he  insisted  that he was  perfectly well, and affirmed that he
was going down to the hotel to get a cup of coffee, some boiled
eggs, and a good drink of brandy.  Now, his  respiration is spas-
modic, 40 to the minute.  Pulse cannot be felt.  Have administered
brandy, but he is unable to swallow, or to articulate.  He died fifteen
minutes  after this observation.  His death struggles were  severe
and distressing.  Deep  and violent  inspirations  and expirations;
mouth filled with froth which was scattered in every direction, with
the violent expirations.
   The examination  of  the  body  four  hours  after death, demon-
strated, that whilst the blood was congested, stagnated in the capil-
laries and veins of the brain, and lower dependent portions of the
lungs and skin, and  organs, and muscles generally,  and of  the in-
testines,  there were no marks of inflammation.
   The slate-colored  liver;  the dark greenish-brown bile; the ab-
sence of grape sugar, and the presence of animal starch in the liver;
the slate-colored, enlarged, engorged,  softened, spleen; demonstrated
that this was a case of malarial fever; the rapid, feeble pulse; rapid,
labored respiration; and depressed temperature of the trunk and
extremities, marked this case, as belonging to that type of malarial
fever called congestive fever.
   After the abstraction  of blood, there was no  correspondence be-
tween  the  circulation, respiration, and  chemical  changes.   Before
the abstraction of blood, there was a rapid pulse; rapid,  full, tho-
racic, labored  respiration, and dry, hot  skin, and dry,  red tongue,
accompanied by violent pain in the  head.  After the abstraction
of blood, and the application of mustards, there was a slight reduc-
tion of the temperature of the trunk and extremities ; the  tempera-
ture of the extremities was reduced  9° below  that of  health ; the
pain in the head vanished; the tongue became a little more moist,
but none the less  red.
   To a casual observer, the disease would  appear, in a  great mea-
sure, to  have been  conquered by the  abstraction of blood- the
symptoms, however, were only moderated.   The  congested  blood-
vessels of the brain were  relieved, and  the pain arisino1 from the
chemical changes, and stagnation, and engorgement  of the altered
blood in the bloodvessels and capillaries of this delicate organ  was
correspondingly diminished.  The temperature of the  trunk rose 
MALARIAL FEVER.
185
5° above the normal standard, on the next day, whilst that of the
extremities just reached the normal standard.  This increase was
attended by a far greater acceleration of the respiration and circu-
lation than was necessary in health,  to produce  this increased
chemical change.  We shall show, in a subsequent chapter, that if
the functions of the organs and apparatus be properly performed,
a full,  rapid and vigorous circulation and respiration, must  be
attended by the rapid absorption and distribution of oxygen, and
corresponding rapid chemical changes.
  In this case we had the rapid circulation and respiration, but a
deficiency of corresponding chemical change, and hence conclude
that the malarial poison  has acted, either by inducing directly such
changes in  the blood as to prevent its absorption of oxygen, or to
prevent the rapid action of  the oxygen absorbed, or by interfering
with the metamorphoses of  the solids and fluids of the organs, and
tissues, and nutritive fluids, or by a direct  action upon  the  struc-
tures or nerves of the heart,  thus deranging the circulation of the
blood, and through it  all the chemical changes  of nutrition, secre-
tion, excretion, and the  development of the forces, or by a  direct
action upon the nervous centres of the sympathetic nervous system,
which preside over and relate to the circulation and respiration, and
through them the chemical changes in the lungs, and  heart, and
bloodvessels, and capillaries, and organs, and tissues, and cerebro-
spinal nervous system.
  The  rapid but feeble action of the heart; the rapid  but feeble
pulse;  the  depressed temperature of the trunk and extremities;
the dry red tongue; the acid, light-colored urine; the feeble gene-
ral  and capillary circulation gradually overcome by the action  of
gravity; the gradual settling of the blood previous to death in the
bloodvessels of  the most dependent  parts  of all the organs and
tissues; the alterations  of the blood-corpuscles of  the  liver and
spleen; the alterations in the color and  constitution of the bile;
the destruction of the special ferment in the blood which converts
the animal starch into grape-sugar;  demonstrated that the malarial
poison had acted chiefly upon the sympathetic nervous system, and
produced  profound alterations in the structure of  the nutritive
fluids, and correspondingly interfered with  the  chemical changes,
the  development of the forces, and the formation of  the secretions
and excretions.
  The theory then suggested, and most strongly supported by the
case, is, that the malarial  poison acted primarily and simultaneously
       13 
186
OBSERVATIONS ON
upon  the blood, and spleen,  and liver, and sympathetic nervous
system, and secondarily upon  the cerebro-spinal nervous system.
We shall show presently that the blood in fevers is altered before
the manifestation of aberrated cerebrospinal nervous action.  The
same  thing may be established with reference to the organs.  We
shall also show that the symptoms and aberrated phenomena mani-
fested by  the sympathetic nervous system precede those  of the
cerebro-spinal system.  Nevertheless, in the present state of medical
science; whilst  we are ignorant of the  chemical and physical pro-
perties and relations of the malarial poison; whilst  we are  unable
to observe the first aberrations of sympathetic  and  cerebro-spinal
nervous phenomena, manifested  either  in an excess or deficiency
of secretion, and nutrition, and chemical change, or in a disturb-
ance of the mutual relations of the two systems to each other, and
to the respiration  and  circulation, and  to the organs and tissues;
the interests  and extent of science forbid the dogmatic location of
the origin of malarial fever in one system of nerves or the other,
or in both, exclusive of the  blood, or in  the  blood and  organs
exclusive of the two nervous  systems.
  The treatment of this case  was radically defective.  The blood-
letting was proper as a means of relieving the brain, but not as a
remedy applied alone, to combat the action of the malarial  poison.
The bloodletting relieved the  brain, but the poison went on acting,
altering the chemical relations of the  elements of the blood, and
liver,  and spleen, more rapidly than ever.   Here we have the cere-
bro-spinal  difficulty apparently relieved; whilst the war is raging
in the domain over which the sympathetic system is said especially
to preside.  There was  a  calm,  but it  was the  calm of conquest;
the calm of exhausted  nature.  The  mighty foe carried forward
the work  of destruction without noise or confusion,  because  all
opposition  was levelled, all resistance subdued.  This state of things
demanded prompt  and vigorous action on the part of the physician.
Those remedies should have been administered  which  would have
aroused the  capillary  circulation;  aroused the sympathetic and
cerebro-spinal nervous  systems, and accelerated  the absorption, and
distribution, and action of oxygen, and  the chemical changes of the
nutritive fluids, and organs, and tissues, which  are  the sources of
all the forces which work  the  machinery, and  without which we
can have the manifestation of no vital  phenomena.  Brandy, Sul-
phate of Quinia in  large doses, and Carbonate of Ammonia, should
have  been promptly and freely administered, and sinapisms applied. 
MALARIAL FEVER.
187
   (b.)  Active and excessive purgation  should be avoided in malarial
fever.
   We should avoid excessive  purgation in  malarial fever, for the
same reasons that general and  excessive bloodletting should be
avoided.
   In malarial fever the blood-corpuscles are altered and destroyed
to  a great extent, and the fibrin and albumen  are in a  measure
altered in quality and quantity.  These alterations are attended by
aberration and exhaustion of the  forces, and although the alteration
and destruction of the constituents of the blood  may appear small,
still they are sufficient to produce serious alterations in the secre-
tions, and excretions,  and  serious disturbances in the forces.  It is
an established fact that excessive purgation exhausts the forces and
diminishes the volume of blood.  Excessive purgation, then, acts
in concert with the malarial poison.
   Judiciously used, purgatives are of essential service in all those
cases of malarial  fever where there is  a  dry  hot skin, dry red
tongue, moderately accelerated full bounding pulse, and moderately
accelerated respiration, and  high temperature in the  trunk and in
the extremities.  In such cases our plan has been to administer to
an adult from eight to ten grains of  calomel in  combination with
seven  grains of sulphate of quinia, and follow with castor oil in four
hours, and commence  with five grains of sulphate of quinia as soon
as the purgative has operated once or twice freely, and continue five
grains every three hours up to twenty-five or forty grains, according
to the  symptoms of the case.  I have in scores of cases seen  the
hot dry skin become relaxed and moist, and  the dry  harsh tongue
become soft and moist, and the  restlessness and  pain in the  head
vanish, under  the  action of the calomel and sulphate of quinia.  I
have in scores of  cases seen the most obstinate paroxysms  yield
without any return to the vigorous  administration of the  sulphate
of quinia after the bowels have been opened, the skin relaxed,  the
secretions of the mouth and liver promoted, and the portal system
unloaded.
   On the other  hand, I have seen simple cases  of remittent fever,
converted into the congestive type, by the injudicious administra-
tion of purgatives, and  the neglect  of sulphate of quinia, stimu-
lants and sinapisms.  The efficacy  of this  mode  of  treatment, as
well as the true indications and methods for the employment of
purgatives, will be fully  discussed  and illustrated by cases in a
subsequent chapter. 
188
OBSERVATIONS ON
   (c.) Support the strength, during the severe attacks of malarial fever,
with nutritious diet and stimulants.
   If the action of .the malarial poison be depressing and not in-
flammatory;  if the action of the malarial poison be destructive and
not exciting, then nutritious diet and stimulants are indicated.
   I have administered milk punch, wine whey, beef  soup, mutton
soup, and soft-boiled eggs, with positive benefit in all the forms of
malarial fever.   The  advantage of this mode of treatment is espe-
cially evident in  congestive fever,  and in  the severer forms  of
remittent fever, and in convalescence from all the various forms of
malarial fever.
   The nutritious diet supplies the  elements of the  blood which
have  been destroyed, and the stimulants  arouse the  nervous sys-
tems, and through them excite the  action of the circulatory and
respiratory systems,  and promote the introduction  and distribu-
tion of the elements of nutrition and secretion, and of the chemical
changes by which the forces  are generated, and also  preserve the
elements of the blood and tissues from too rapid chemical change,
by taking their places and themselves undergoing those chemical
changes which are necessary for the development of the physical
forces which works the machinery.
   We should never  be deterred by the cerebral symptoms in ma-
larial fever from the  use  of stimulants.  They are due to the stag
nation and congestion of the altered blood in the capillaries of the
brain, as much,  if not far  more than  to  the direct  action of the
malarial poison.  Hence, whatever will quicken the circulation and
remove this, congestion  and stagnation  will promote the normal
action of the brain   and nervous  system.   Under  the action  of
stimulants and sulphate of quinia, I have seen the delirious subject,
with parched skin, tongue, and lips,  become  quiet  and rational,
with relaxed moist skin  and mucous membrane.  The efficacy of
this mode of treatment will be illustrated more fully hereafter.

   (d.) Administer the salts which are  deficient in the  colored blood-cor-
puscles, as soon as the destruction of the colored blood-corpuscles has been
arrested, and the malarial poison removed or diminished.
   I have derived great benefit from the administration of the Phos-
phates of Iron, Lime, Soda, and Potassa, in the  stage of convalescence
from malarial fever. 
MALARIAL  FEVER.
189
  (e.) If after the active stages of malarial fever the digestive functions
are enfeebled, pepsin should be administered.
  Cases  of neglected  or  badly  treated malarial fever frequently
run into what is commonly called the typhoid  state, in which the
digestion is enfeebled and perverted, the liver deranged, the spleen
disorganized and  in  many cases  degenerated, the blood-corpuscles
diminished and altered,  and  the whole constitution of the blood
profoundly altered.  In these cases we have employed pepsin  with
benefit.  If the gastric juice does not perform its offices, the active
and essential principle of the gastric juice should be supplied.  If
pepsin and an acid be supplied, digestion will take place in a weak,
diseased stomach as well as in the  healthy stomach.  The truth of
this  assertion  has been  established by the experiments  of Dr. L.
Corvisart,1 of Paris, to whom the profession is indebted for the in-
troduction of pepsin into the practice of medicine. Andral, Longet,2
Rilliet, Barthez,3 Grisolle, Herard, Vogel, Schiff, Josi, Lecointe,4 Bal-
lard,5 Bertholet,"  Cahagnet,7  Parise,8 Huet,9 Chambers,10  Nelson,11
and  others,12  have testified to the  efficacy and value of pepsin in
various diseases.
  1 " Dyspepsie et  Consomption—Usage de la Pepsine." By Dr. L. Corvisart.  Paris,
1854.  "Recherches ayant pour but, d'administrer aux Malades que  ne digerent
point des Aliments tours  digeres par le Sue Gastrique des Animaux;" Comptes
Rendus, Aug. 16, 1852—Sept. 6,1852.  "Etudes sur les Aliments et Nutriments—
Nouvelle Methode  pour le Traitement des Malades dont l'Estomac ne digere point;"
L'Union Medicale, 1854, p. 17.
  2 In typhoid fever. Bulletin Gen. de Therap., torn, xlvii. p. 320.
  » " Sur l'Apepsie (un absence de digestion) chez les Enfans, et sur le  Traitement
de cette Maladie par la Pepsine;" L'Union Medicale, Jan. 12, 1856.
  4 " Observation  d'un Cas de Consomption ultimo, traitee par la Poudre  Nutri-
mentive;" Bulletin Gen. de Therap., torn. xlix. p. 268.
  5 Artificial Digestion as a Remedy in Dyspepsia, Apepsia, and their Results.  By
Edward Ballard, M. D.  London, 1857.   This valuable work contains the method
of preparing pepsin, and also reports of numerous cases of disordered digestion
successfully treated with pepsin by Dr. Ballard and other practitioners of medicine.
  6 In dyspepsia of a year's duration.
  7 In dyspepsia and vomiting of several years' duration.
  6 In dyspepsia of early pregnancy.
  9 Gastralgia of several years' duration.
  10 "Practical Lectures on the Management of Digestion in  Disease," by T.  K.
Chambers, M. D. ; London Lancet, Aug. 1857, p. 101, Sept. 1857, p. 180, Am. ed.
  J' " On Mellitic Diabetes, in reference to its Treatment by Rennet or Liquor Pepti-
cus Pr«p.,"  by David Nelson, M. D.; London Lancet, Aug. 1857, p. 118, Am. ed.
  '2 "Rennet in Diabetes Mellitus,"  by Dr. James Gray ; Glasgow Medical Journal,
Oct. 1856.  See also American Journal of the Medical Sciences, Jan. 1857, p. 25.
" Case of Diabetes Mellitus, treated by Joseph Jones, M. D. ;" Southern Medical
 and Surgical Journal, May, 1858. 
190
OBSERVATIONS ON
  When pepsin can be obtained pure  from the apothecaries,  or
when the physician has time  to  prepare it himself, the poudres
nutrimentives of Corvisart is by far the most elegant and portable
preparation.   Chambers1 and others2 have shown that much of the
pepsin now sold possesses  but feeble  transforming powers, and it
is important  that the physician should be able to prepare it when
needed.  The following are  the directions given  by M. Boudalt3
for the preparation of the medicine: "Take a  sufficient number of
rennet bags  (the fourth stomach  of the  ruminants), open and re-
verse them,  and  wash  them under a  thin stream of cold  water;
scrape off the mucous membrane, reduce it to a pulp, and macerate
it in  distilled water for twelve hours; filter;  add to the liquor a
sufficient quantity of acetate of lead, and, after separating the pre-
cipitate, pass through it a current of sulphuretted hydrogen; filter
again; evaporate  at a low  temperature  to the consistence  of a
syrup, which is mixed intimately with starch, pulverized, and dried
at a temperature of 100° Cent.  In this state the gentle application
of heat will reduce it to a dry  mass, readily reducible to a powder
of uniform efficacy."
  The power of the pepsin thus obtained varies, and  before the use
of a specimen we  should first test its transforming power.  The
standard dose is that quantity of the powder which, when acidu-
lated  with three drops of lactic acid, and added to fifteen grammes
(225 grains)  of water,  would transform  (digest) six grammes (90
grains) of fresh fibrin, finely cut up, and kept in a bottle, at a tem-
perature of 40° Cent.,  for  twelve hours, with occasional shaking.
The average  dose  of the "poudre nutrimentive"  is fifteen  grains.
It may be taken dry or in  solution,  in  unfermented bread, or in
a spoonful of soup, or  in sweetened water.  It should always  be
taken with, or at the commencement  of, the meal on which  it  is
to act.
  The following mode, adopted and  recommended  by  Dr. James
Gray," for  the preparation of  rennet,  is  far less complicated and

  1 "Experiments upon Artificial Digestion,"  by T. K. Chambers, M. D.; London
Lancet, Aug. 1857, p. 133, Am. ed.
  2 "Experiments upon the Action of Pepsin," by Edward H. Sieveking ; Medical
Times and Gazette, April 4,  1857.  See also American Journal of the Medical Sci-
ences, July, 1857, p. 212.
  3 Ballard on  Artificial Digestion, p. 10. See also " Memoire sur le Principe Di-
gestif, les Preparations Nutrimentives, et les  Moyens propres a reconnaitre et a
mesurer leur Action;"  Acad. Imp. de Med., Seance du 14 Fevrier, 1854.
  4 Glasgow Medical Journal, Oct., 1856.  See abstract of paper in American Journ.
of Med. Sciences, Jan., 1857, p. 215. 
MALARIAL FEVER.
191
tedious, and at the same time yields a valuable preparation of
pepsin:—
   "The stomach of a calf (and the younger it is the better) is gently
washed with water, taking care not to injure the mucous membrane;
it  is then salted, tied up, and allowed  to dry.  After this it is cut
in small pieces, macerated in a pint  and a half or two pints of
water, according to the size of the stomach, for four days or longer
in winter, shaking it at intervals;  the  fluid is then poured off and
bottled, and to test its power a spoonful may be added to a  pint of
warm  milk, which, if  it curdles, it is now fit for  use.  A little
spirits, or decoction of sparrow-grass, may  be  added to make it
keep.  The dose of rennet thus prepared  is a tablespoonful, three,
four, or six times a day, about  half an hour after  each  meal, and
during the process of digestion,  followed shortly after by an alkali,
to neutralize the lactic acid formed.  That which I  recommend is
the alkaline tribasic phosphate of soda; but the carbonate of potash
will answer very well, either  alone or combined with  the tincture
of nux vomica, in five or ten drop  doses."
   The stomach of the pig may also be employed.   It may be pre-
pared  in the way recommended  by Dr. Gray in the preparation of
rennet, or it may be cut in thin slices and treated with vinegar, and
the digested mass added to mutton  or beef soup.
   Pepsin is not  the only substance concerned in the digestion of
albumen and flesh.
   The connective tissues and muscular fibres are disintegrated and
softened, but never completely dissolved by the gastric juice.  The
ultimate fibrillar of muscles, which  have escaped the action of the
gastric juice, pass into the small intestines, and are there digested
by the pancreatic juice.
   Whenever,  then, meat passes entirely through  the alimentary
canal without  being dissolved, we conclude not only that the  pepsin
is  deficient,  but also that the pancreatic juice has lost its power of
digesting the ultimate fibrillae of the muscles, which have escaped
the action of the gastric juice.
   Whenever the ultimate fibrillar alone are discharged by the rec-
tum, we must conclude that the pancreatic juice, and not the  gastric
juice, is at fault.  In distinguishing derangements of the pancreatic
from the gastric  digestion, the microscope, applied  to the matters
thrown off from the rectum, is absolutely necessary.
   As far as my observations extend, the  pancreas is less affected 
192
OBSERVATIONS  ON
during the process of malarial fever, than the liver, spleen, or sto-
mach and intestinal canal.  Notwithstanding these negative results,
it is important that we should know the value of treatment in de-
rangements of the pancreatic digestion.
  M. L. Corvisart1 communicated  to  the  Imperial Academy of
Sciences, April 6, 1857, a memoir "On the Power of the Pancreas
to Digest Azotized  Food," in which he  not only  confirmed the
assertion of Purkinge and Pappenheim, that the secretion of the
pancreas is  endowed, like the gastric juice, with  the  property of
dissolving  azotized  food;  and demonstrated that  the  pancreatic
juice in disintegrating albuminoid elements effects in them a trans-
formation identical or analogous to that which  the stomach  pro-
duces ;  but also showed that the pancreatic juice acts only on  those
portions of the food which have  escaped the action of the gastric
juice, and at the same time has no effect upon the digested products
of the stomach.
  When separated, the  pancreatic and gastric fluids exercise their
functions in  full, and, when  mingled in their pure state, the two
digestions are arrested.   The two ferments, pepsin and pancreatin,
destroy each other.
  In the alimentary canal,  this  is  prevented, 1st. By the pylorus
which separates the  two ferments.   2d. By the gastric digestion
during  which  the pepsin  is destroyed.   3d. By the  bile which
destroys in its course the activity of the pancreatin.
  It is  evident, therefore, that  the  pancreatin,  or  the  pancreatic
juice, so far from assisting digestion, would  retard  it.   M. S. Cor-
visart states that  he had  failed to  receive  any benefit from the
administration of  pancreatin for the relief  of derangement of the
digestion in the intestinal canal.
  My own limited experience with pancreatin sustains the  state-
ments of M. S. Corvisart.
  It is  evident, therefore, that in the present state of  science we
are  unable  to  reach, by medicines, the derangements of the pan-
creatic  digestion of flesh.  Nevertheless, the  determination of the
relative frequency, extent, and effects of derangements of the pan-
creatic  digestion, is of great value.   As far as  my observations
extend, these derangements are exceedingly rare in malarial fever.

  1 Moniteur des Hopitaux, April 21,1857.  See also American Journal of Medical
Sciences, July, 1857, p. 206. 
MALARIAL FEVER.
193
  (f.) The excretion of the products resulting from the dead disintegrated
blood-corpuscles should be promoted by diuretics and depurants.
  The necessity for the removal of these products is indicated by
the fact that the urine in congestive fever is deficient in the com-
pounds resulting from the chemical changes of the blood and tissues;
whilst in intermittent  and remittent fevers, in which the elevation
of temperature and the chemical changes correspond to the accele-
ration of the respiration and circulation, the urine is loaded with
the matters resulting from the chemical  changes of  the blood, and
organs, and tissues, and apparatuses.
  The Sulphate of Quinia appears not only to exert a direct effect
upon the actions of the sympathetic and cerebro-spinal systems,
and upon the action of the heart and capillary circulation, but it
also promotes the removal  of the  products  of the  metamorphoses
of the tissues.
  The infusion of Virginia  Snakeroot is valuable as a stimulant
and diuretic.
  The Bicarbonate, Citrate, and Acetate of Potassa, and the Carbo-
nate and Acetate of Soda, are valuable depurants, both in the active
stages and in convalescence.

  (g.) The liver and spleen should be roused  to action if torpid, and
their perverted secretions thrown off, and their  normal relations to the
blood re-established.
  In addition  to the  depurants just mentioned, we may employ
the various preparations of iodine, especially the iodide of quinia;
and, in some cases, the preparations of mercury  in small doses.
  I have witnessed  the beneficial action  of the iodide of  quinia,
both upon myself and upon others; and, as  far as my experience
extends, it appears  to act more powerfully upon the kidneys, and
depurate  the blood more thoroughly,  and restore  the stomach,
liver, and spleen more rapidly to  the exercise of the normal func-
tions, than either of those substances uncombined.   The iodide of
quinia is worthy of the examination of the profession.
  The citrate of iron combined with the  sulphate of quinia and the
carbonate of soda, dissolved in the infusion of quassia, appear not
only to assist in the restoration of the colored blood-corpuscles, and
depuration  of the blood, but  they  also appear to exert decided
beneficial influences  upon the liver and spleen. 
194
OBSERVATIONS  ON
  The next points of interest are the determination of the place of the de-
struction of the colored blood-corpuscles, and the discussion of the question
whether their disappearance be entirely due to  the cessation of their birth.
  Do they diminish simply because  new  ones do not take their
place ?
  With reference to the place  of the destruction of  the colored
blood-corpuscles, it may  be affirmed that they undergo important
alterations in the spleen  and liver, during  the active stages of ma-
larial fever.   In  examinations of the organs after death from all
the forms of malarial fever, intermittent,  remittent, and congestive,
I have observed that the  dark blood of the spleen and liver does not
change to the  arterial hue when exposed to  the  oxygen  of the
atmosphere.
  After death from phthisis, cirrhosis of the liver, organic disease
of the circulatory apparatus, apoplexy, and mechanical injuries, so
far  as my observations  extend,  the  blood of the spleen and liver
always changes to the arterial hue upon exposure to the action of
the oxygen of the atmosphere. Chemical examinations of the blood
of the liver during  health have shown  that the blood-corpuscles
are more numerous in the blood passing out of this  organ than in
the portal blood.
  The colored blood-corpuscles appear  to originate to a  certain
extent in the liver, and  undergo certain  important  chemical and
physical changes in this  organ.
  In  malarial  fever, important  changes take  place  in the blood
passing through the liver; many of the colored blood-corpuscles
are destroyed,  and the  coloring matters  infiltrate  the structures,
and, together with the altered bile, impart  the slate color  to  the
exterior, and the bronze color to the interior, of the  malarial fever
liver.  In some cases the coloring matter derived from the disin-
tegrated  blood-corpuscles, exists in the form of granules  in  the
tissues of the liver.  These granules, however, are  by no  means
necessary to the slate and bronze color.
  I have discovered a  similar change of  color in the kidneys of
several patients, which presented several spots  upon their  surface
of a  dark slate  color without,  and bronze  color  within.   If the
blood-corpuscles were destroyed in  the  capillaries of  the kidney
then  the destruction was circumscribed,  and the peculiar colorino-
matter resulting from the changes of the coloring matters of the
blood, infiltrated only those parts of the kidney adjoining the blood-
vessels and  capillaries in which they were  destroyed. 
MALARIAL FEVER.
195
  This curious phenomenon has been also witnessed in the livers of
patients who had died suddenly in the earliest stages of malarial
fever.  In  these cases the greater portion of the livers  have pre-
sented a color  but a few shades deeper than the Spanish brown;
whilst one  or more spots were found presenting the  true malarial
slate  and bronze color.   These facts illustrate  two points.   First,
they show  that the destruction of the colored blood-corpuscles in
the liver commences at an early day in the liver; and second, that
this destruction in some cases, at least, is confined at first to circum-
scribed portions of the liver.
  Whilst the facts as yet accumulated  are too few to warrant any
very  general or dogmatic assertions,  they certainly incline  our
minds to the belief that  the destruction of the colored  blood-cor-
puscles in the liver  are dependent  upon the  disturbance of the
relations of the liver  to the blood, rather than to the destruction of
the colored  blood-corpuscles in the capillaries and bloodvessels,
independent of the action of the liver, simply by the direct action
of the malarial poison.   The changes of the blood in the liver are
not confined to the destruction of the colored blood-corpuscles.

   Animal starch accumulates in the malarial fever liver; whilst grape
sugar, as far as my observations extend, is absent.
   I have made numerous post-mortem examinations in all the forms
of  malarial fever, and tested the livers carefully for animal starch
and grape sugar.   The result was the  same in every instance;  an
abundance of animal starch without a trace of grape sugar.  When
the malarial fever livers were washed, and small particles spread
upon a glass-slide, and treated with tincture of iodine, and viewed
under the microscope, numerous beautiful blue and purple masses
of this animal  starch, colored by the iodine, could be seen.  When
the fibrous capsules of the livers were  torn off  from  the surface of
the liver, and spread upon a glass-slide, and treated with tincture
of iodine, these blue masses were seen scattered amongst the meshes
of the fibrous tissue.  The livers were set aside and examined after
intervals of twelve hours.  The last examination was made thirty-
six hours after the first.  At every examination the result was the
same; an abundance of animal starch, and no grape sugar.
   These facts are important, not only in  their bearing upon mala-
rial fever,  but  also in their bearing upon other diseases.  M. CI.
Bernard has demonstrated that the  transformation of glycogenic
hepatic matter  (animal starch), formed by the liver, into  glucose, is 
196
OBSERVATIONS  ON
the result of the action of a special ferment, which is formed and
exists in  the blood, independent of the liver.   From these facts it
is probable that in malarial fever this ferment is destroyed; whilst
the liver still possesses the power of transforming the nitrogenized
and non-nitrogenized elements into animal starch.

   The blood and blood-corpuscles undergo remarkable alterations in the
spleen during malarial fever.
   Upon the exterior the malarial spleen presents a dark slate color,
resembling the color of the malarial liver.  When  held in the hand
the malarial spleen feels like a bag of soft mud.   The capsule  and
trabeculae break upon the slightest pressure, and  the fingers will
often plunge into the organ, even during the most careful hand-
ling. *
   The reddish-brown mud (pulp) of the malarial spleen consists
almost entirely of colored corpuscles in various stages of alteration
and disintegration.
   With the microscope I have found that in many cases, especially
those of long-standing, the mud of the spleen  contained  numerous
granules of a reddish-black color.   These black granules were fre-
quently conglomerated together, forming dark flakes, like the coffee-
ground  sediment of the black vomit of yellow  fever,  and were
without doubt altered colored blood-corpuscles.   In many spleens
the colored blood-corpuscles have presented swollen, and distorted,
and irregular forms.   I have found this alteration of the spleen in
all cases and in all periods of malarial fever.  In one case, in which
the patient died  in thirty  hours after the commencement of the
attack, the spleen presented the same enlarged  and softened condi-
tion ;  whilst the liver presented only spots of the slate and bronze
color.
  When we reflect that the malarial fever spleens often weigh one,
and two, and three or more pounds, and that their principal weight
is due to the presence of colored blood-corpuscles;  when we further
reflect that the whole amount of blood existing in the  body of a
grown man is about twenty pounds, and  that not more than nine
pounds of this exist in the form of moist colored blood-corpuscles, it
is evident  that the spleen in malarial fever forms a grand sepulchre
for the  colored  blood-corpuscles.   We will show in  the chapter
upon  the  changes of the organs  and apparatus in malarial fever,
where these subjects will be more fully discussed,  that the mud of
the spleen is not reabsorbed to any great extent. 
MALARIAL FEVER.
197
  We have before discussed the alterations of the fibrin, and the
changes of the color of the serum; it remains now to state that the
albumen is diminished in  malarial fever; whilst the extractive
matters of the serum are increased.
  Professor Cozzi has also shown that the cholesterin was increased
in the blood; whilst the phosphates, and  fat,  and albumen were
diminished.  Whether the cholesterin was derived from the bile or
from the brain, or from both, has not been  determined.
  We will now compare the changes of the blood in malarial fever
with those of other diseases.
  The following table, constructed from a minute and  laborious
examination, and calculation, and  classification of the  most im-
portant researches upon the changes of  the blood in disease, will
give a condensed resume of this department  of pathological che-
mistry:— 
				Constitution		,/a			e Blood in V		arious	Diseases.						
						>			n °	1000 PARTS OF BLOOD CONTAINED—								
												Moist Blood-Corpuscles.						
OBSERVERS.	DISEASES.			REMARKS		o			3 1		Solid				Albu-	Solid matters	Fixed saline	
																		
						d.2			s *	Water.	matters.	Moist		Solid matters.	men.	of	constitu-	Fibrin.
									oS O 3 125			blood cor puscles.	Water.			serum.	ents.	
Becquerel & Rodier	Typhoid Fever			Mean		11			1	801.0	199.0	498.0	373.5	124.5	64.4		6.744	2.3
	n			Mean		11			2	814.5	185.5	454.0	310.5	113.5	62.0		6.555	1.3
Andral & Gavarret	n				"f				5 1	756.3	243.7	581.2	435.9	145.3		961		2.3
	ii								7 2	769.7	230.3	543.2	407.4	135.8		92.4		2.1
	„			Case 1	[				8 3 0 4	785.2 798.6	214.8 201.4	504.8 464.8	378.6 348.6	126.2 116.2		86.8 83.9		1.6 1.3
.1 <i	u							n	5 5	827.4	272.6	366.8	275.1	91.7		79.9		1.0
it <<	n				(				7 1	766.5	233.5	574.4	430.8	143 6		87.4		2.5
" "	I			Case 2	1 f			"	9 2 12 3 8 1	777.6 782.1 767.6	222.4 217.9 232.4	544.8 538.0 557 2	408.6 403.5 417.9	136.2 134.5 139.3		82.5 79.8 8S.1		3.7 3.6 5.0
i< u	n			Case 3	I			"	0 2	777.3	222.7	518.8	389.1	129.7		87.6		5.7
n ii	u				1			]	1 3	7S2.4	217.6	508.4	381.3	127.1		85.5		6.0
u <i	n				L				4 4	791.7	208.3	494.4	370.8	123.6		80.7		4.0
n n	<i				f 4				9 1	769.5	230.5	598.4	448.8	149.6		77.3		3.6
n u	n							]	0 2	784.7	215.3	501.2	375.9	125.3		87.1		2.9
n n	n			Case 1				.	2 3	804.3	195.7	494.8	371.1	123.7		69.7		23
!!	«				\				5 4 S3 5 9 1 0 2	831.1 815.5 810.3 816.2	168.9 154.5 189.7 183.8	412.0 318.4 409.6 420.0	309.0 238.8 307.2 315.0	103.0 79.6 102.4 105.0		64.0 71.2 83.9 79.8		1.9 37 3.4 35
	"			Case 5	\ {			J ]	2 3 7 4	825 6 ■836.8	174.4 163.2	375 6 345.2	271.7 259.9	93.9 86.3		78 2 75.2		2.3 1.7
n n	i<								!4 5	847.8	152.2	304.0	228.0	76.0		74 6		2.1
ii u	u			Case 6					1 1	S19.7	ISO. 3	372.4	278.3	93.1		86.3		09
n n	n			Case 7					5 1	752.9	247.1	586.7	440.0	146.7		98.0		2.4
u ii	n			Maxima .		41				S62.3	243.7	598.4	448 8	149.6		98.0		4.2
ii n	ii			Minima .		41				756.3	137.7	266.8	200.1	66.7		66.8		0.9
n ii	n			Mean		41				796 0	2010	464.0	348.0	116.0		77.9		2.6
Lecanu . . .	n					2				805.2	194.8	460.0	345.0	115.0		79.0		
	u					1				792.3	207.6	419.2	314.4	104.8	S0.33			2.01
Popp	u			Maxima .		8				827.0	208 5	531.2	398.4	132.8		86.1		5 00
	n			Minima .		8				791 5	173.0	369.6	277.0	92.4		71.3		1.71
u	ii			Mean		8				S06.2		418.8	336.6	112.2		77 7		3.26
M. H. Guenaiid de	Typhi's Fever			Male, Case 1					! i	755. S	211 2	5S6.0	439.5	146.5		75.4		2.3
Mussy&M. Rodier				Male, Case 2						BU.2	1S5.8	451.0	311.5	113.5		71.1		1.2
CO
co 
		Constitution of (he Blood in Various						Diseases—Continued									
				> p	o3	bo a ■3	1000 PARTS OF BLOOD CONTAINED—										
									Moist Blood-Corpuscles.					Solid	Fixed		
OBSERVERS.	DISEASES. Typhus Feveu		REMARKS.	£i	5 O S3							Albu-men.		matters of serum.	saline constitu-ents.		
				o ° a c.2		o d	Water.	Solid matters.	Moist blood cor-puscles.	Water.	Solid matters.						Fibrin.
M. H. Guenaud de			Male, Case 3 .				799.0	201.0	452.4	314.3	138.1			60.1 72.0			2.8 3.9 2.5 2.1
Mnssy & M. Rodier			Male, Case 4 .				826.9	173.1	388.0	291.0	97.0						
	"		Female, Case 5 Female, Case 6				800.7 830.6	199.3 169.4	507.2 382.4	3S0.4 2S6.8	126.8 95.6			70.0 71.7			
Becquerel & Rodier	Ephemeral Fever ( N>NTI NUEJ) Fevej	(Simple i)		8			781.6	218.4	569.6	427.2	142.4	65	.7		5.8		2.8
Andral & Gavarret	Smai.i.-1'ox		(			i	771.5	228.5	482.4	361.8	120.6			101.5			4.3 2.9
						2	7S0.8	219.2	440.8	330.6	110.2			106.1			
u n	u		)			3	820.2	179.8	378.4	283.8	94.6			82.1			3 2
11 it	u		r			1	791.3	208.7	457.2	342.9	114.3			91 4			3.0
n ii	,i					2	803.9	196.1	370.4	277.8	92.6			100.3			3.2
!! "	" !		Case 2 . . <			3 4	811.8 817.3	1S8.2 182.7	353.6 348.0	265.2 261.0	88.4 87.0			96.8 92.4			3.0 3.3
11 11	,,		<	%.		1	781.4	218.6	511.6	383.7	127.9			88 1			2.6
11 11	,,		Case 3 . . 1			2	792.0	208.0	497.6	372.2	124.4			80.1			35
11 II	(i		^			1	796.0	204.0	506.0	379.5	126.5			76.4			4.1
11 tl	,i		Case 4 . . <			2	792.7	207.3	499.6	374.7	124.9			80.4			2.0
11 11	n		Case 5			1	805.0	195.0	395.2	296.4	98.8			92 3			2.9
.1 II	Scarlatina		S			1	761.5	238.5	584.0	438.0	146.0			89.4			3.1
It 11			Case 1 . . i			2	782.6	217 4	497.2	372.9	124.3			89.1			4.0
II 11	n		Case 2			1	776.3	223.7	544.4	408.3	136.1			84.1			3.5
II 11	n		Case 3			1	798.3	201.7	448.8	336.6	112.2			82.7			6.8
Lecanu .	u						776.5	223.5	578.0	433.5	144.5			78.9			
	ii						770.4	229.6	587.8	441.0	146.8			82 7			
Andral & Gavarret	Measles		Case 1 Case 2			1 1	760.2 766.9	239.8 233.1	586 4 563.6	439.8 422.7	146.6 140.9			90.6 89.2			2.6 3.0
ti ti	n		Case 3			1	781.6	218.4	548.4	411.3	137.1			78.7			2.6
ii it	n		Case 4 . . j			1	786.7	213.3	550.0	412.5	137.5			73.4			2.5
u ti	,,					2	795.8	204.2	526.4	394.8	131.6			70.1			2.7
it ti	u					1	792.1	207.9	474.4	355.8	118.6			86.9			2.4
ti n	,(		Case 5 . . j			2	823.8	176.8	373.2	279.9	93.3			80.1			3.4
Becquerel & Rodier	"		Man, Case 1 . j			1 2			5S4.4 506.4	438.3 379 8	146.1 126.6						2.8 3.8
u n	Acute Scurvy		Man aged 48 .		42		786.8	213.2	571.2	428.4	142.8			eV.88			2.5
n n			Man aged 21 .		30		783.7	216.3	500.2	375.0	125.0			89.00			2.2
i< ti	Chronic Scurvy		Man aged 32 .		455		763.5	236.5	611.6	458.7	152.9			81.69			1.S5
 
			Constitution of the Blood in									Various Diseases—Continued.										
							u at		C3			a		1000 PARTS OF		BLOOD	CONTAINED—					
												3		Moist Blood-Corpuscles.					„			
OBSERVERS.	DISEASES.					REMARKS.	ja		-3			a g Water.							Solid	Fixed		
													Solid				Albu-		matters	saline		
							° a		o				matters.	Moist		Solid matters.	men.		of	constitu-		Fibrin.
												0 5		blood cor puscles.	Water.				serum.'	ents.		
Becquerel & Rodier	Chronic Scurvy					Man aged 23, be-																
						fore treatment			552			765.9	231.1	704.8	528.6	176.2			56.59			1 32
11 n	" ...					After treatment			612			778.0	222.0	542.8	407.1	135.7			84.02			1.14
Busk	J u											849.9 835.9 846.2	150.1 164.1 153.8	191.2 289.2 242.8	143.4 206.9 182.1	47.8 72.3 60.7	84.0 76.6 74.2			9.5 11.5 10.9		6.5 4.5 5.9
popp ; ! \	Erysipelas .					Male aged 33 .						807.9	192.1	511.2	383.4	127.8	57.6					6.6
Andral & Gavarret						Case 1 . \			'2			1 826.6	173.4	303.6	227.7	75.9			83.2	7.3		7.0
	"								3			2 836.0	164.0	257.6	193 2	64.4			87.3	6.2		6 1
11 u	"					Case 2 . . j			2			1 799.2	200.8	433.6	325 2	108.4			78 9	6.8		6.7
n n	"								3			2 806.2	193 8	407.6	305.7	101.9			78.2	6.4		7.3
it u						Case 3			3			1 831.2	168.8	294.4	220.8	73.6			83.0	7.2		5.0
• i n						Case 4 . . j			5			1 788.7	211.3	476.4	357.3	119.1			80.7	6.8		4.7
	"								8			2 7969	203.1	442.8	332.1	110.7			80.5	6.9		5.0
ti	"					Case 5			3			1 762 9	230.4	557.6	418.2	139.4			80.2	7.2		3.6
Holler .	"											762.4	237.5	566.8	425.1	141.7			90.4			5.45
Wittstock	Cholera											740.0	260.0	597.6	473.2	124.4	110.02			14.1		11.00
^iipou	.'<'											750.5 740 0	249.4 260.0	434.0 497.6	325.5 373.2	108.5 124.4	114.1 110.4			10.6 14.1		2.47 11.00
Becquerel & Rodier	"					Man, day of death						722.5	277.4	758.4	568.8	189.6	51.8		sb'.o			1.88
it ti	"					u ii						753.9	215.0	640.8	480.6	160.2	69 39		89.3			6.50
Popp	Phthisis					Male aged 22 . Male aged 22 . Male aged 22 . Male aged 24 . Female aged 26 Male aged 27 . Male aged 36 .						806.2 818.0 786 9 802.2 791.5 771.1 819.0	193.8 182.0 213.1 197.8 208.5 228.9 181.0	495.2 378.8 502.0 323.6 502.4 606.4 306.4	371.4 284.1 376.5 242.7 376.8 454.8 229.8	123.8 94.7 125.5 80.9 125.6 151.6 76.6			6.5.5 81.5 85.9 110.6 80.5 75.7 100.9			4.06 5.16 I.864 6.10 2.30 2.12 3.29
" ...	"				Male aged 40 .							806.0	194.0	415.6	311.8	103.8			82.7			7.43
" ...	"					Male aged 39 .						845.8	151.2	274.0	205.5	68.5			80.2			5.30
Becquerel & Rodier	«;						16 16 16					1 794.8 2 799.8 3 821.0	205.2 200 2 179.0	500.0 490.8 414.0	375.0 367.2 310 5	125.0 122.7 103.5	66.2 65.0 62.0					4.80 420 3.60
Andral & Gavarret	"					Maxima .	21					845.8	225 0	48S.4	366.3	122.1			105.4			5.90
	"				i Minima		21					775.0	154.2	306.8	230.1	76.7			65.1			2.10
„, " "	"				I Mean		21					809.7	190.2	402 0	301.5	100.5			85.3			4.40
Glover .	SCROFUIA					Male .		■				816.4	1S3.6	400.0	300.0	100.0			73.9	5.4		4.30
to
o
o 
					(	'Onstitulion of the				Blood in					Variout
										>		<£			b
															
h-'										M		®			3
^	OBSERVERS.			DISEASES.			REMARKS.			J2 O 6.2		o			-i Water. £ 5
	Glover .			Scrofula ....			Male .								803.4
	"			"			Male .								790 0
	"			"			Male .								798.0
	"			"			Male .								776.1
	"			"			Male .								806.0
	"			"			Male .								764.0
	"			"			Mean								791.9
	"			"			Female								785.4
	"			"			Female								824.2
	"			"			Female								783.7
	"			"			Mean								796.1
	Heller			Carcinoma											832.4 864.0 852.6 859.5 820.0 809.9 853.7
	Becq	uerel & Rodiei		Bright's Disease, Acute			Case 1 . . j Case 2 . A Maxima . Minima			i l	"i				1 801.9 2 838.7 2 811.4 3 807.3
				u 11			Mean			15					'. 814.4
				Bright's Disease, Chronic .			Maxima . Minima Mean			13 13 13					'. 832.6
				Chlorosis ....											77S.2
				"											776.6
				"											783.1
				"			Maxima .			'6					
				"			Minima			6					
				"			Mean			6					'. S28.3
				Anemia .			Maxima Minima			10 10					
				"			Mean			10					'. 822.4
>• Diseases—Continued.
	1000 P	ARTS OF	BLOOD CONTAINED—					
	Moist Blood-Corpuscles.							
						Solid	Fixed	
Solid				Albu-		matters	saline	
matters.	Moist		Solid matters.	men.		of	constitu-	Fibrin.
	blood cor puscles.	Water.				serum. 81.4	ents.	
190.5	409.2	306.9	102.3				5.7	4.00
210.0	478.0	358.5	119.5			80.4	6.6	3.50
202.0	397.2	297.9	99.3			94.7	5.0	3.00
223.8	532.0	399.0	133.0			83.3	6.5	1.44
194.0	408.4	300 3	102.1			83.5	6.3	2.10
233 9	561.0	421.2	140.4			84.7	6.8	4.00
208.0	409.2	351.9	117.3			81.3	6.2	3.13
214.6	410.0	330.0	110.0			94.0	7.27	3.30
175.8	410.0	307.5	102.5			61.1	6.5	4.70
216.3	506.0	379.5	126.5			81.2	6.4	2.20
203.8	459.2	344.4	114.8			78.6	6.6	3.58
167.5	308.0	231 0	77.0			74.0		16.44
136.0	227.6	170.7	56.9			75.8		3.30
147.4	244.0	183.0	61.0			80.97		5 42
140.4	232 0	174.0	58.0			78.0		4.42
179.9	397.6	298.2	99.4			99.4		3.31
194.0	416.0	302.0	104.0			81.9		5.10
146.2	242.0	181.5	60.5			77.6		8.12
198.1	516.0	387.0	129.0			66.4		2.70
161.1	388.4	291.3	97.1			61.4		2.80
188.6	515.2	386.4	128.8			5.3.5		4.30
192.7	492.4	369.3	123.1			64.4		5.20
	586.0	439.5	146.5			76.53		3.76
	342.0	256.5	85.5			55.15		1.65
185.6	468.8	351.6	117.2			65.3		2.99
	546.4	409.8	136.6			78/8		6.50
	209.2	146.9	52.3			55.5		2.59
167.4	432.0	324.0	108.0			63.9		4.34
221.8	567.2	425.4	141.8			78.2		1.80
223.4	556.4	417.3	139.1			80.9		3.24
216.9	553.2	414.9	138 3			75.7		2.73
	436.4	327.3	109.1			92.8		5.01
	181.2	135.9	45.3			74 1		3.06
17l'.5	344.8	258.6	86.2			80.2		4.20
	436.0	327.0	109.0			88.1		5.82
	327.2	235.4	81.8			69.2		1.62
177.6	400.4	300.3	100.1			73.7		3.72
 
					Constitution of the Blood it									Various	Diseases—Continued							
									cS >		c3			Sj		1000 PARTS OF BLOOD CONTAINED—						
														3		Moist Blood-Corpuscles.				Solid matters	Fixed saline	
OBSERVERS.		DISEASES.					REMARKS.		o		■3			a	Solid				Albu-			
																						
									© 3 6.2		O			h Water. 0	matters.	Moist		Solid matters.	men.	of	constitu-	Fibrin.
													;	0 5		blood-cor-puscles.	Water.			serum.	ents.	
Popp		Simple Rheumatic Fever					Male aged 24 .							772 9	227.1	566.8	425.1	141.7		82.1		3.17
		u n					Male aged 26 .							798.4	201.6	429.8	322.1	107.7		89.8		4 02
"		n u					Male aged 46 .							791.4	208.6	472.0	354.0	118.0		88.5		1.93
11		Feb. Arthritic Rheumatism					Female aged 20 j							1 801.4	198.6	400.8	300.4	100.2		86 4		11.89
«		n n												2 816.1	1S3.9	308.4	231.3	77.1		93.7		12.97
ti		n n					Female aged 20 \							1 802.3	197.7	463.6	347.7	115.9		75.9		5.76
it		ii n												2 822.8	177.2	346.0	259.5	86.5	..	82.6		8.92
ii		u ti					C							1 790.4	209.6	461.9	345.9	115.3		82.8		11.40
,"		,\ "					Male aged 22 . <							2 817.2 3 830.7	182.8 169.3	394 4 368.1	295.8 276.0	98.6 92.0		76.1 67.9		7.91 9.25
it		n n					Female aged 19							859.7	140.3	236.4	177.3	59.1		67.7		13.34
11		n it					Male aged 40 .							789.8	210.2	472.8	354.6	118.2		84.9		7.06
it		u ti					Male aged 24							785.6	214.4	481.2	360.9	120.3		85.7		8.21
Andral & Gavarret		Acute Rheumatism					Maxima .		■43					839.6	160.4	520.0	390.0	130.0		104.8		10.20
ii u		ii .i					Minima .		43					771.6	228.4	2S0 4	210.3	70.1		76.9		2.80
u ii		it it					Mean		43					S05.4	194.6	404.0	303.0	101.0		86.0		6.70
		Chronic Rheumatism					Maxima . Minima . Mean		10 10 10					826.8 741.1 782.7	259 9 173.2 217.3	517.2 296.0 432.8	362.9 222.0 324.6	154.3 74.0 108.2		102.0 77.1 95.2		5.10 2.60 3.80
Becquerel & Rodier		Puerperal Fever					Mean		4					791.0	209.0	563.6	422.7	140.9	..	61.2		6.76
Heller .		ii n												833.8	165.1	332.0	254.5	77.5		77.4	6!6o	5.16
Andral & Gavarret		Pneumonia									'2			1 818.0	182.0	445.2	333.9	111.3		66.7		4.00
u ti		• '					Case 1 . . -j				3			2 818.5	181.5	430.8	323.1	107.7		6S.3		5.50
ti ti		n									5			3 820.9	179.1	404.4	303.3	101.1		71.5		6.50
it ti		ii					I				7			4 834.4	165.6	332.8	249.6	83.2		73.4		9.00
ti ii		ii					f				3			1 773.0	227.0	551.2	413.4	137.8		84.0		5.20
u n		ii					Case 2 . . -\				4			2 782.3	217.7	502.0	376.5	125.5		84.9		7.30
ii n		ii									5			3 795.0	205.0	469.6	352.2	117.4		80.7		6.90
it n		ii					I				6			4 800.4	199.6	446.0	334.5	111.5		80.6		8.00
ti it		»									4			1 781.5	218.5	519.2	389.4	129.8		83.2		5.50
it u		"					Case 3 . . }				5 9			2 788.3 3 823.9	211.7 176.1	465 2 382. S	348.9 287.1	116.3 95.7		88.6 74.0		6.80 6.40
u it		ii					Maxima .							S3 4.4	229.5	551.2	413.4	137.8		95 2		10.50
n ii		n					Minima .							770.5	165.6	332 8	249.6	83.2		66.7		4.00
n ii		ii					Moan							799.0	201.0	456.4	342.3	114.1		81.0		7 30
Becquerel & Rodier		'i					Mean		5					1 S01.1	199.0	490.0	367.5	122.5	61.1			7.40
	"	"					Mean			5				2 80S.0	192.0	455.6	341.7	113.9	59.7			6.30
to
o
to 
Constitution of the Blood in Various Diseases—Continued
				REMARKS.	>serva-isease. eedings.				1000 PARTS OF		BLOOD CONTAINED—					
									Moist Blood Corpuscles.			Albu-	Solid matters	Fixed saline		
OBSERVERS.	DISEASES.				o "° 5			Solid								Fibrin.
					-*h w a T^		Water.	matters.	Moist		Solid matters.	men.	of	constitu-		
					= a	*.			alood cor	Water.			serum.	ents.		
					O 'rH C3 C?				puscles.							
Andral & Gavarret	Pleuritis ....			Case 1 . . \		1 2	802.6 807.6	197.4 192.4	429.6 410.0	322.2 307.5	107.4 102.5		85.0 84.9			5.0 50 3.9 5.8 3.4 4.2 5.9 5.0 6.1 5.5 5.4
11 11				( i		X	783 5	216.5	515.2	386.4	128.8		83.8			
11 n				Case 2 . . ]		' 2	780.3	219.7	475.6	336.7	118 9		95 0			
"				( Case 3 . . ] Mean		1	783.0	217.0	541.6	406.2	135.4		78.1			
"						2	798.5	201.5	496.8	372 6	124.2		73.1			
Becquerel & Rodier Andral & Gavarret	Peritonitis						774.2 845.6 798.6 787.2	225.8 154.4 201.4 212.8	510.8 273.2 481.6 491.2	383.1 204.3 361.2 30S.4	127.7 68.3 120.4 122.8	65.4	92.2 81.1 815 83.4			
																
					5											
				r		1	822.9	177 1	353.2	204.9	88 3					
!!	»			Case 2 . . ]		! 2 3 1	831.6 851.0	168.4 149.0	294.4 242.0	220.8 189.5	73.6 60.5		89 5 84.9			5.3 3.6
" "				V			789.4	210.6	480.0	360.0	120.0		86.8			3.8
"	» :			Case 3 . . <		.! 2 3 4 1 5 2 6 1 2 1 3 2 !! i 2	802.7 813.5	197.3 186.5	438.0 401.2	328.5 300.9	109.5 100.3		83.1 80.1			4.7 6.1
i" u	Angina Tonsillar	s		Case 1 . ]			782.6 793.6	217.4 206.4	444.0 421.2	333.0 315.9	111.0 105.3		100.3 93.9			6.1 7.2
" ii	ii ii			Case 2 <			777.9 819.5	222.1 180.5	504.0 360.0	378.0 270.0	126.0 90.0		90.7 8S.1			5.4 4.4 6.4 4.8 3.5 7.3
**				Case 3 . . ]			830.2	169.8	318.0	238.5	79.5		83.9			
Becquerel & Rodier	Acute Bronchitis			( Males, mean . Females, mean t	'4 4		793.7 803.4 763.3 793.6	206.3 196.6 236.7	516.8 451.2 595.2	387.6 335.9 446.4	129.2 115 3 148.8	64.9 68.8 80.6				
Andral & Gavarret	"			Case 1 . ]				206.4	440 8	330.6	110.2	86.9				9.3
.t it				I			821.0	178.9	405.2	303.9	101.3		77.5			
Lecanu .	Carditis						880.4 807.2 847.4	119.5 192.7 154.8	167.6 385.2 276.0	125.7 28S.8 207.0	41.9 96.3 69.0		77.6 96.3 85.8			
Becquerel & Rodier	Pericarditis .					3	831.0 817.0	169.0 153.0	420.0 312.0	315.0 234.0	105.0 78.0	53.0 60.4				2.3 34
Popp	Inflammation of Brain			Case 1 . . ]		!! 1 2	811.2 797.5	188.8 203.5	421.6 454.0	316.2 340.5	105.4 113.5		76.8 82.4			6.4 6.3
** ...	•			t i		!! 1 2	823.5	176.5	428 8	321.6	107.2		62.8			6.37
" ...	Glanders ....			Case 1 . . ]			822.0	178.0	457.6	343.2	114.4		53.0			10.48
" : .' :	Lead Poisoning			(			822.5	177.5	338.0	253.5	84.5		86.7			6.13
 
204
OBSERVATIONS  ON
  The comparison of the  character, progress, and duration of the
diseases in those cases from which these observations were derived
(so far as the records extended), with the character, progress, and
duration of the cases of malarial fever observed and recorded by
ourselves, and the comparison of the  results of the chemical ex-
amination of the blood in various diseases (allowing due weight to
the different methods employed  by different observers)  with the
results of our chemical examination of the blood in malarial fever,
have forced upon my mind the conclusion that, so far as these obser-
vations extend, the colored blood-corpuscles  are more  uniformly and
rapidly destroyed in severe cases of malarial fever than in  any other
acute disease.
  We would state, distinctly and unequivocally, that this statement
applies only to those results of investigation  which are now before
the profession.
  This department of pathological chemistry may, with  truth, be
said to be in  the imperfect and undeveloped state  of the embryo.
We know little or nothing definitely concerning the changes of the
blood in yellow fever, and in the  states induced by numerous poi-
sons;   and our  knowledge,  in  almost  every instance, extends no
further than the destruction, or undefined alteration, of one or the
other constituent, and does not penetrate beyond the  exterior phy-
sical and  chemical changes, and reveal the relations of the sub-
stances destroyed or altered to the poisons, or substances  resulting
from the action of the poisons.
  When not merely the facts of the destruction or alteration of the
constituents of the blood in all diseases have been determined, but
also the causes of their destruction and alterations, and the methods
and results, chemical, physical, physiological,  and pathological, have
been definitely determined; then, and  not till then, will it  be pos-
sible  to draw broad  lines of  distinction  between diseases, based
upon  the chemical, and physical, and physiological, and pathological
alterations of the blood.  Nevertheless, the first step in the right
direction  is to perceive and appreciate the extent and bearing of
the established facts, even though they be imperfect, and  superfi-
cial, and meagre.
  In  comparing these results, it should be  remembered that the
individuals whose blood I examined were, as a general  rule, stout,
athletic seamen and  laborers,  who had never before  been attacked
by the malarial fever, and who had been exposed but a short time
to the malarial poison. 
MALARIAL FEVER.
205
   This table further shows that in certain states of the system—as
the cancerous and cachectic, and in such as are  induced by long
starvation, and exposure, and improper habits, and by hemorrhages,
scurvy, and Bright's disease—the blood-corpuscles are greatly dimi-
nished.  These results do  not invalidate the conclusion that blood-
corpuscles are most rapidly destroyed in severe attacks of malarial
fever, because the  destruction accomplished by the slow action of
the causes, inducing these states of  the system required months or
even years, whilst  an equal or even greater destruction may take
place in a few days or weeks in malarial fever.
   We affirm, and our affirmation is borne out by the results here
recorded, that the colored  blood-corpuscles are diminished during
the progress  of all acute diseases.  Andral & Gavarret have shown
that the idea which they promulgated in their  earliest researches,
that the blood-corpuscles  are increased  in the earlier stages of
typhoid  fever, was erroneous, and  arose from the fact that  this
disease most frequently attacks those whose blood is rich in colored
blood-corpuscles.   The suspension of  the process  of digestion, and
the perversion and partial suspension of secretion and nutrition,
and the rapid chemical changes  and corresponding rapid metamor-
phosis of matter—the universal attendants, or rather phenomena,
of acute diseases, must necessarily be attended by a destruction, to
a greater  or  less extent, according to the severity of the disease,
of one or all the constituents  of the  fluid which supplies  the  ele-
ments for secretion, nutrition, and chemical change.
   These causes produce destruction of the colored blood-corpuscles in all
acute diseases; but in malarial fever we have an increased destruction
ivhich cannot be referred to these causes.
   We have before  shown that the blood-corpuscles suffer profound
alterations in the liver and spleen during the active stages of mala-
rial fever; and, in attempting to account  for the different degrees
of destruction of the colored blood-corpuscles in different diseases,
this fact leads us to institute an examination and comparison of the
lesions of these organs in different diseases.
  In typhoid fever, the spleen is almost always more or less altered
in appearance.  Its volume is augmented, in  many cases, to three
or four times the natural  size,  and the  parenchyma reduced to a
soft pulpy mass.  The cases  of  typhoid fever in which the size of
the spleen is most  augmented, and the tissues  most  softened and
broken down, are  those which  terminate  most  rapidly.   In forty-
six examinations of the bodies of those who had died with typhoid 
206
OBSERVATIONS ON
fever,  Louis found  this organ  in its natural condition only  four
times.   This enlargement and softening of the spleen appear to be'
in typhoid, as well as in malarial fever, the result, not of inflamma-
tion, but of congestion.   Whether this  congestion be the  result of
disturbances in the circulatory apparatus  and nervous system and
contiguous organs, or of the direct action of the malarial or typhoid
poisons upon the spleen, will  be  more fully discussed hereafter, and
do not bear directly upon the question now under consideration.
  This source of the destruction  of the colored blood-corpuscles exists,
then, in both typhoid  and malarial fevers.   The  enlargement of the
spleen, however,  is  greater in malarial fever.   Whilst, therefore
there should be a destruction of colored  blood-corpuscles in the
spleen  in both typhoid and malarial fevers, this  destruction should
be somewhat greater in the malarial spleen.
  We  will next compare the  lesions of the liver in these  diseases.
So far  as pathological investigations (which, it must be confessed,
have been confined almost exclusively to  the mere physical altera-
tions of this organ, the color  and consistence) extend, nothing has
been discovered in the condition or secretion of the liver  peculiar
to typhoid fever.
  According to  Andral, the liver almost constantly  presents a
healthy appearance.
  Louis1 found slight softening  in about  one-half of the  cases  of
typhoid fever examined by  him.   It is probable that the softening
of the liver in these cases resulted from commencing decomposition.
  Pathological  investigations, then, indicate  that the blood-cor-
puscles are not destroyed in the  liver of typhoid fever,  as  they are
in this organ during malarial  fever.
  Here, then, is a marked difference between typhoid and malarial fever,
and the cause why the destruction of the colored blood-corpuscles is more
rapid in the latter than in the former.
  Dr. Gerhard,2 in his observations upon  typhus  fever, states  that
the  spleen was of the normal aspect in one-half the cases; in the
other half it was softened, but not enlarged; and in one  case out
of five or six, enlarged and softened.
  Dr. Jenner examined the spleen in thirty-four subjects above the

  1 Anatomical, Pathological, and  Therapeutical  Researches upon the  Disease
known under the names of Gastro-Enteritis, Putrid Adynamic, Ataxic and Typhoid
Fever, by P. Ch. A. Louis, 2 vols.  Paris, 1829.
  2 Am. Journ. of Med. Sci., Feb. 1837 
MALARIAL FEVER.
207
age of fifteen, who died  before the termination of the fourth week
of the disease, and found the average weight to be seven ounces and
five drachms.
   According  to the observations of  Dr. John Eeid, the weight  of
normal spleens ranges from 2187 to 3062 grains.  It is evident that
in these cases, reported by Dr. Jenner, the spleen was but slightly,
if at all, enlarged.
   Dr. John Home examined after death one hundred and one cases
of typhus fever, and found that the spleen was generally larger than
usual, soft, and in some cases almost diffluent.  In one instance this
organ weighed eleven, and in another fourteen, ounces.
   These observations, together with those of many other investi-
gators,  demonstrate that the lesions  of the spleen are neither con-
stant nor of  any great extent.  In some cases of typhus fever the
liver has been found engorged with dark  fluid blood, in others
spotted with ecchymosis, and in  many cases it was  the seat of  no
appreciable lesion.
   All observers agree that one of the most  striking facts in the
pathological anatomy of typhus fever, is  the  absence  of any con-
stant and characteristic lesions.  The most uniform and important
alteration  appears to be that of the blood, which is manifested not
only in its appearance,  physical  properties, and chemical constitu-
tion, but also in the rapidity  with which  the  color of  the  skin
changes after death, and the  body  undergoes decomposition, and
the frequent  occurrence  of cold abscesses in various parts of the
body after an attack of  typhus fever.
   If there be no destruction of the blood-corpuscles, independent of  the
 liver and spleen in typhus fever, or  if the destruction of  the blood-
corpuscles  in the bloodvessels and capillaries, independent of the spleen
and liver, be not more rapid in typhus than in typhoid and malarial
fever, then the destruction of the colored blood-corpuscles should be less
rapid in typhus fever than in typhoid and malarial fever.  The obser-
 vations thus far recorded do not  enable us to settle this question
 definitely, for the patients from whom the  blood was abstracted (the
 analyses of which are recorded in the table) were hospital patients,
 natives of Ireland, whose disease appeared (from the accounts of the
 authors) to have  been aggravated by previous  want.  We know
 that this fever most frequently attacks those whose constitutions
 have been worn  down, and their solids  and fluids, especially the
 blood deranged by foul air and poor diet. 
203
OBSERVATIONS  ON
   In malarial fever, and in fevers generally, theflbrin is rarely increased,
 and either remains within the limits of health, or is diminished, and, as
far as my observations extend, the diminution of fibrin corresponds ivith
 the severity of the disease.
   This  fact corresponds with the results established by Andral in
 his splendid researches upon the blood.
   The distinction  between the alterations of the blood in the py-
 rexias and phlegmasia} is thus pointed out by Andral:—
   "In my first memoir upon  the alterations of the blood I have
 proved  that the fibrin never augments in the  pyrexia?, supposing
 them divested of all phlegmasial complication ; that it often remains
 in normal quantity, and that sometimes it diminishes  to a point at
 which we do not find it in  any other acute disease. I  have shown
 that the pustules of variola,  and  the dothinenteric plaques of typhoid
 fever do not have  the power of increasing the cipher of fibrin; and
 finally I have shown  that with all the possible proportions of the
 globules, whether  they were very abundant, or whether they have
 become  very rare,  a pyrexia could equally arise with all  its varie-
 ties of form and gravity.   But  is it indifferently, and as it were by
 chance,  that the fibrin shows itself in the pyrexias, either in normal
 quantity, or in a proportion infinitely more feeble than in  the phy-
 siological condition?  No,  without doubt, and with regard to this,
 very clear general  principles may be laid down.
   "At every period of clinical observation, and upon whatever point
 of view  the observer was placed, it has been recognized that amongst
 the pyrexias there  were some unattended by  any grave symptoms,
 which marched naturally towards a favorable  termination; while
 there were others which, either at their commencement, or during
 their course, were  accompanied by accidents of such a  nature, that
 it seemed as though the forces which rule the organism were either
 vanquished, or  profoundly  disordered  to such  an  extent  that  the
 extinction of life  must be  the consequence;  and  at the same time
 it was found that in such cases the blood presented an altogether
peculiar appearance; it was observed  that as it became  less con-
sistent, it seemed to tend towards a sort of dissolution.
  "Admitted at all periods, but differently explained according to
the prevailing theories, this condition, which  may develop itself in
any pyrexia, and towards  which several  seem to tend naturally,
has been called, turn by turn, putrid, adynamic, and typhoid state •
it has its greatest development in the typhus fevers,  properly so
called;  it is in some sort inherent in them; it  is, as it were, their 
MALARIAL FEVER.
209
essence.   The pyrexia, now called typhoid fever, presents  it in a
slight degree from the invasion, and the grave cases of this disease
are its marked representation.   It does  not ordinarily exist in the
eruptive fevers, but  it often complicates them, and constitutes one
of their  dangers.  Finally, in  addition to the pyrexiae, with well-
marked  characters,  and which have  a fully  developed place in
nosological  systems, there are  others  to which no name has been
given, which may yet present in a high degree the different symp-
toms to which the ancients attached the idea of the  putrid  state.
This is because there may exist in effect, in all the pyrexiae, a com-
mon alteration of which the blood is the seat, and whose existence
constantly coincides with the appearance of those phenomena always
the same, attributed by vitalism to adynamia, by solidism to relax-
ation of the fibre, and by humorism to putridity of the  humors.
   "This alteration of the blood consists of a diminution of its fibrin.
It is consequently an alteration the inverse of that which betrays
in the blood the phlegmasial condition."  *  *  *
   " Since the  diminution of the fibrin  does not exist necessarily in
any pyrexia, it is perfectly clear that  it is not in this  alteration of
the blood that we should place the point of departure  of this class
of diseases.  But what seems to me incontestable is, that the specific
cause which gives them  birth acts upon  the blood in such a way
that it tends to destroy its spontaneously coagulable matter, while
the cause which produces the  phlegmasias tends, on the contrary,
to create in that fluid a fresh  proportion  of that matter.  If this
cause act with slight energy, or if the economy resist it, the destruc-
tion of  the fibrin is not  accomplished.   If, on the contrary, the
cause  continue to act with all its intensity, and the forces of the
organism be in fault, the  destruction of the  fibrin will  commence
either at the very beginning of the disease—which is very rare—
or at a certain period after its commencement. All  this  applies
itself equally well both to typhoid fever, and to the eruptive fevers.
   "For  me, there is in all these cases a true intoxication; if it be
slight, its effect must, to be sure, always exist, but it is  not appre-
ciable; if the intoxication be stronger, the effect which it has pro-
duced upon the blood becomes visible, and is marked, in that fluid,
by a diminution of the fibrin.
   "Whilst,  then, we establish,  in certain forms of typhoid fever or
scarlatina, that alteration of the blood which consists in a tendency
to the destruction of its spontaneously coagulable  matter, we  no
more attain by this means the true cause of the disease, than we do 
210
OBSERVATIONS ON
 by studying the alterations of which the tegurnentary membranes
 are the seat.  But, as these alterations of the mucous membrane
 or of the skin, once produced, bear their part in the production of
 symptoms, just so does the peculiar alteration of the  blood which
 may then arise bear its part."1
   With this quotation, confirmatory in a great measure of our own
 views, we close the examination of the nature and extent of the
 changes of the blood in malarial fever; not  because  we have by
 any means exhausted the subject, or even pointed out the full bear-
 ing of  all the facts  established by  our own investigations,  but
 because we are disinclined  to pursue a subject so imperfectly inves-
 tigated  and developed;  because we wish to avoid  unprofitable dis-
 cussions, which may be  overturned by the first  investigator who
 shall  penetrate beneath the surface, or may lead to the adoption of
 erroneous principles of practice.  We candidly confess that the un-
 known  vastly exceeds the known, and that the great body of facts
 in this branch of pathological chemistry, are only surface facts, re-
 lating to the  most superficial, exterior phenomena, and not to the
 relations and causes of phenomena.
   After we  have established  that the blood-corpuscles, and  the
 fibrin, and the saline matters of the blood in malarial fever, or in
 any other fever, have been destroyed  or altered, questions of great
 importance immediately arise.  How are  they destroyed?   Are
 they destroyed by an  actual, direct physical and chemical  action of
 a special poison, or by the suspension of the functions  of the organ
 or organs in which  they  are born, or by the chemical and physical
 changes of the liquor sanguinis in which  they float?   What  are
 the physical and chemical changes which the elements  of the blood
 and organs and apparatuses undergo,  under the action of morbific
 agents ?
   The imperfection of pathological chemistry is strikingly shown
 in the state of our knowledge with reference to  the  fixed saline
 constituents of the blood-corpuscles  and liquor  sanguinis.  Not-
 withstanding the brilliant researches of Becquerel,  Eodier, and
 others, we still need, amongst many other things, a comprehensive
 and laborious investigation of the changes of the saline  constituents
 of the blood-corpuscles and liquor sanguinis.  It is not sufficient
 that the saline constituents  of the entire blood, or of the liquor san-

  ' An Essay on the Blood in Diseases, by G. Andral.  Translated by J. F. Mei°-s
M. D., and Alfred Stille, M. D.  Philadelphia, 1844. 
MALARIAL FEVER.
211
guinis, should be examined.  The advancement of medical science
demands that the relations between the fixed saline constituents of
the blood-corpuscles and liquor  sanguinis  should be determined-
demands that the variations and  relations of the  fixed saline con-
stituents of every element of the blood  should be determined in
health and in disease.

  An important question now presents itself.
  Do these changes of the blood precede, or succeed, or are they simul-
taneous with,  the aberration of the physical, chemical,  vital, and nervous
phenomena denominated fever f
  This question can be settled only by an appeal to nature.  I have
resided almost all my life in a malarious district, in  the southern part
of Georgia, and speak from observation.
  It is known  to practitioners in malarious districts, that the con-
stitution is sometimes undermined  silently  by the malarial poison,
without the manifestation of febrile phenomena sufficiently marked
to attract the attention  of the patient or his friends.   It  is further
known to the practitioners in our  southern States, that the phleg-
masiae, especially pneumonia and pleurisy, and even the irritative
fever succeeding amputations and severe wounds, will assume the
intermittent, remittent,  and even  congestive types  of malarial fever.
That these types of inflammatory fevers are due to a state of the
system permanently induced  by the malarial poison, and also to
the direct action of the poison during the inflammatory disease, is
conclusively demonstrated by the  mode of treatment  most suc-
cessful in these districts, and  by the comparison  of  the  results of
this practice with that of healthy, non-malarious districts.
  It is an  established fact, that bleeding  and  active purgation will
not be borne in the pneumonia and pleurisy of malarious districts
as well as in these diseases occurring in the primitive, non-malarious,
middle regions of Georgia and other States.  It is an established
rule  with  many practitioners in the  malarious  districts of our
southern States, to avoid large bleedings and active purgation in
pneumonia and pleurisy, whilst  the reverse  rule has prevailed in
non-malarious  districts, having the same climate and relations to
heat and moisture.
  It is known  that the sulphate of quinia may be  used with the
greatest benefit and  success in  the  treatment of pneumonia and
pleurisy, and of the phlegmasia} generally, and even of the irritative
fever following amputations and severe  wounds,  in  malarious dis- 
212                   OBSERVATIONS ON
tricts;  whilst no such beneficial effects attend the use of this remedy
in these diseases occurring in non-malarious districts.
   These facts demonstrate that  the malarial poison is capable of altering
the constitution of the solids and fluids, and modifying and altering the
type  and progress,  phenomena and effects, of diseases, even when no
symptoms  of aberrated  physical, chemical, vital, and  nervous actions
were manifested, sufficient to attract the attention.
   The author has carefully noted the antecedents of three attacks
of malarial  fever  in his  own person,  occurring within eighteen
months, and separated from  each  other by  intervals of perfect
health.  The first was an attack of  bilious  remittent fever, con-
tracted in a malarious district, during repeated exposure to the
night air at  late hours  of the  night,  and aggravated by exposure to
the hot sun  in the early part  of August.
   For two weeks before the supervention of fever, the complexion
assumed a sallow appearance evident to observers.  The only un-
usual sensations at this time were  those of irritability and excite*
ment of the nervous system.   In  this  state, there  appeared to be
an increase rather than a diminution of mental and  physical force,
and I was surprised to find the strength sufficient for twelve hours
of hard labor in the conduction of  pathological, physiological, and
chemical investigations, and hospital practice, notwithstanding that
the rest at night was exceedingly imperfect.   Several days before
the commencement  of the fever, the bowels were  deranged; the
discharges were copious  and frequent, and appeared to contain
much altered bile, resembling that so often found in the gall-bladder
of the malarial liver after death.   Notwithstanding the superven-
tion  of this affection of the bowels,  I was able to continue for three
days, during the usual time  (twelve  hours daily), pathological in-
vestigations  and hospital  practice.  The fever which followed was
high; full rapid  pulse,  full moderately-accelerated respiration, high
temperature, dry skin,  dry tongue,  high-colored urine, and, at one
time, aberration of the intellect, preceded by intense pain in the
head, and cold extremities.
   The fever yielded readily to the action of the sulphate of quinia
and,  shortly after its removal, I recommenced my labors; and  not-
withstanding frequent  exposure to the  night  air at all hours, per-
fect health was  enjoyed for two months, at the end of which time
I was troubled by periodical headaches,  attended with derangement
of digestion, the generation of much acid in the stomach, and hio-h-
colored urine, and, at  times,  with slight exacerbation of the pulse 
MALARIAL FEVER.
213
and slight increase of temperature.  There was never any chill, nor
anything approaching  to  a chill, either at the commencement or
during the continuance of these periodical disturbances of the sys-
tem, which returned every seven, nine, eleven, or fifteen days, and
lasted from twelve to forty hours.   The headaches  appeared to be
often relieved, and  always benefited, by the free  administration of
the bicarbonate of potassa.  It was frequently noticed  that uric
acid and urate of soda were deposited in the urine excreted'just
after the disappearance of the headache.
   During the winter, I took up my residence in the town of Athens,
situated upon the granite  and gneiss hills  of middle Georgia.   The
town and environs of Athens are without a single source of malaria,
and its bills of mortality, and the appearance of its  inhabitants,
and the exemption of the students attending the University of
Georgia from disease, show that it is one of the healthiest localities
in the world.
   In this  healthy locality,  contrary to expectation, the headache
increased in severity,  and  the  strength  of  the  muscular system
diminished, and the nervous system became more excitable, and
the person lost flesh.
   Up to the first of March, six months from the commencement of
the periodical disturbances of the system, I had never been inca-
pacitated a single day  for the regular discharge of  rny professorial
duties and investigations.   At this time, after unusual anxiety and
fatigue, a chill came on, in the evening of the  day previous to the
anticipated headache.   During  this chill  the pulse was rapid, but
feeble, the respiration was  accelerated, full, and labored, the mus-
cles trembled and  shook, and the temperature of  the extremities
was many degrees below the  normal standard, whilst the tempera-
ture of the  trunk was elevated several  degrees above  the usual
point of health.  As we shall hereafter show, these were the phe-
nomena of a true malarial chill.
   The succeeding hot  stage was well marked by a full, rapid pulse,
rapid respiration, and  corresponding equalization and elevation of
the temperature of the trunk and  extremities, and by suppression
of the  secretions of  the  mucous membrane  of the tongue and
mouth, loss of appetite, derangement  of  digestion, severe  pain in
the  head, and high-colored, strongly acid  urine.
   Thinking  that it was not only improbable, but impossible, that
chill and fever could  arise in Athens, and failing to infer the con-
nection of the periodic disturbances with the operation of malaria 
214
OBSERVATIONS  ON
(because, up to the present time, they had never been attended by
a well-marked chill and febrile excitement), I neglected to use the
sulphate of quinia.  After the intermission of one week, the chill
and fever returned with increased violence.   The free  administra-
tion  of the sulphate  of quinia  after this paroxysm, prevented a
subsequent return, and, with the disappearance of the chill  and
fever, the headaches vanished, and I have been free from them to
the present time, one  year.
  Several of  the students who had  resided  in malarious districts,
previous to their  residence in Athens, were  attacked  with inter-
mittent fever, which, previous to the attack, appeared to have de-
stroyed, to a  considerable extent, the colored blood-corpuscles.  I
examined these cases, and inquired into their previous history
carefully, and am  convinced that they were  genuine cases of mala-
rial fever, induced by the action of a poison which had been  re-
ceived into the system months previous to their residence  in  this
healthy climate and locality.  The third  attack from which I suf-
fered, was contracted during a visit to the swamps of  Georgia, in
the month of September.  Although much more severe than the
two  which I have  recorded, the  preceding symptoms did  not
differ essentially from those of the first attack, with the exception,
that there was no affection of the bowels preceding the fever.
  These cases demonstrate conclusively thai the malarial poison can exist
in the system, and induce slow alterations  in the blood, without the ap-
pearance of those phenomena characteristic  of fever, and without any
marked aberration of nervous action.
  Many other facts might be brought forward to support this state-
ment.   Thus the serum of the blistered surfaces, in all the  stages
from the beginning to the end of severe cases of malarial fever, has
always (as far as my  observations extend)  presented a golden-yel-
low color. Post-mortem  examinations have revealed the fact that
the livers of those  residing in malarious districts  have presented the
peculiar slate and bronze color, although the patients had, at no
previous time,  manifested the phenomena of fever.  The spleen of
a large stout man, who was seized suddenly with coma whilst  ex-
posed to the malarial influence on the Savannah Eiver, and who died
after forty-three hours' sickness, was enlarged, softened, and of a slate
color;  the liver was changed  to the  slate and bronze color in seve-
ral places, and the bile was concentrated and of a brownish-black
color, with greenish reflections,  and poured like molasses.  Under
the microscope the colored corpuscles of the splenic mud appeared 
MALARIAL FEVER.
215
swollen and altered;  the solitary glands of the intestines were en-
larged ; and the heart contained a fibrous clot.   In this case the
changes were at least simultaneous with the manifest disturbances
of the physical, chemical, vital, and nervous phenomena.
   Dr. Stevens1 ascertained that in the marsh fevers, both of America
and of the West Indies, the blood is diseased before the attack;  it
was found to be dark in color, and evidently deranged in its phy-
sical  properties; its serum, instead of being translucent,  presented
a  muddy  or  brown color, and sometimes  an  oily  appearance.
During this altered state of the blood, previous to  its effects  upon
the nervous system,  by which  alone  the  patient would  be aware
that the healthy functions of the body were disturbed, the tem-
perature of the body would frequently be reduced several  degrees
below the normal standard, and the pulse becomes less frequent.   It
has been asserted  that the  seasoning fever of the West Indies (en-
demic yellow fever) is preceded  by a morbid condition of the blood.
   Dr. Ch. W. Ball2 observed that whilst the fainting fever of Persia
was at its  height in Teheran, the blood, even of  those not sensibly
attacked, presented a dark, dusky, reddish-brown color, very dif-
ferent from that of healthy venous blood;  and that  in general the
serum did not  separate from the clot.
   Dr. John Mitchell,3 of Virginia, Salvagnoli, Dr. Archer,4 of Nor-
folk, and Dr. Porter, of Baltimore, and others, have recorded similar
observations with reference to  the changes of the blood previous
to the manifestation of aberrated nervous  action.
   Dr. Potter,*  in the fever which prevailed in Baltimore in 1800,
demonstrated this fact conclusively by the following examinations:
" To ascertain  the appearance of the blood in good health, I drew
it from five persons who had  lived, during the whole season, in the
infected parts of the city, who were in  every external appearance
and inward feeling in perfect health.   The appearance of the blood
could not  be distinguished from that of those who labored under
the  most  inveterate  grades of the disease.  A  young gentleman
having returned from the western part of Pennsylvania on the 10th
of September in good health, I drew a few ounces of blood from a
vein  on that day; it discovered no  deviation from that of other

   1 Stevens  on the Blood, pp. 214-219.
   2 British and Foreign Med. Rev., xvi. p.  521.
   3 Medical  and Philos. Register, vol. iv. p. 188.
   4 History of the Yellow Fever of Norfolk in 1821, Med. Recorder, vol. v. p. 68.
   5 A Memoir on Contagion, p. 54. 
216
OBSERVATIONS ON
healthy persons.   He remained in my family till the 26th of the
month, and on that day I repeated  the  bloodletting.  The serum
had  assumed  a deep  yellow hue, and a copious precipitate of red
globules had fallen to the bottom of the receiving vessel."
                       CHAPTEE  V.

CHANGES OF THE ORGANS, AND TISSUES, AND APPARATUS OF THE BODIES OF
  THOSE WHO HAVE DIED WITH THE DIFFERENT TYPES OF MALARIAL FEVER,
  INTERMITTENT,  REMITTENT,  AND CONGESTIVE—COMPARISON OF THESE
  CHANGES WITH THE PHENOMENA OF MALARIAL FEVER, AND WITH SIMILAR
  CHANGES IN OTHER DISEASES, AND WITH THE ORGANS, TISSUES, AND AP-
  PARATUS OF MEN AND ANIMALS IN THE NORMAL CONDITION.

Exterior skin—Muscular system.   Head—dura-mater, arachnoid membrane, pia-
  mater, cerebrum, cerebellum, medulla oblongata, ventricles of brain, &c. Nervous
  phenomena of fever, compared with post-mortem examinations.  Chest—Lungs,
  heart.  Alimentary and intestinal  canal—Mouth, tongue, oesophagus, stomach,
  duodenum, jejunum,  ileum,  colon, rectum, glands of Peyer, solitary glands.
  Liver—Slate  and bronze color  of liver ;  changes of blood of liver; malarial
  liver contains animal starch, but no hepatic sugar; bile. Spleen—Slate color of
  spleen; pulp of  spleen;  alterations of structure.  Kidneys—Supra-renal  cap-
  sules.  Bladder.

  The following observations are based upon a  careful examination
and comparison of the symptoms of three hundred cases of malarial
fever; fifteen post-mortem examinations of the bodies of those who
had died from  the  different types of malarial fever, intermittent,
remittent, and congestive; numerous examinations of the bodies of
those who had died from various diseases, as phthisis pulmonalis,
pneumonia,  pleurisy,  dysentery, diarrhoea, cirrhosis of the liver,
fatty degeneration of the liver,  dropsy, hemorrhage,  apoplexy, can-
cer, intemperance, scarlet  fever, diabetes, Bright's  disease, enlarge-
ment of the lymphatic glands, typhoid fever, and yellow fever, and
upon the careful dissection  and  microscopical  examination of  the
organs, tissues,  and apparatus  of several  hundred fishes, reptiles,
birds, and mammalia.
  Exterior.—In  the severe cases of malarial fever, which terminate
in a short time,  the  muscular system,  and the fat surrounding  the
muscles, did  not appear  reduced to any great extent.  In cases of 
MALARIAL FEVER.
217
long standing, especially those which had been neglected, there was
great loss of flesh and fat, and  the  body and limbs presented an
emaciated appearance, unless the tissues were infiltrated with serum.
As a general rule the cadaverous rigidity was well marked.
   In many cases the surface presented a sallow hue; and in one
violent case of congestive fever, several hours before death, as the
patient lay in a profound stupor, the whole surface assumed a golden
yellow color, similar to that of the serum which issued from a blis-
tered surface over his epigastrium.
   In the majority of cases, the color of the skin of the  superior
parts, after  death, presented  a pale,  bloodless appearance; whilst
the  skin of  the  inferior (depeudent) portions presented a mottled
purplish color.   This dark purplish color of the dependent parts
gradually diminished towards the superior uppermost parts of the
body in the recumbent posture, and  appeared in every instance to
have been due to the gradual settling of the blood in the capillaries of
the most dependent parts towards the close of life, when the general
and capillary circulations were feeble. For this  reason the lips and
gums were almost always pale, and  almost white.  The lungs, and
liver, and kidneys, and intestines, and stomach, and brain  in many,
if not in every case, presented similar evidences of the gradual set-
tling of the blood in the vessels and capillaries of the most depend-
ent parts towards the close of life, when the feeble circulation was
readily overcome by the force of gravitation.  If stimulants and
sinapisms had been  freely used in the last hours, the settling of the
blood in the most dependent parts was not so marked.

                 Cerebro-Spinal Nervous System.
   As far as my observations have extended, in malarial  fever the
dura mater  was always normal—the arachnoid membrane  pearl-
colored, opalescent in some  cases, in others perfectly transparent
and normal in appearance—the bloodvessels of the pia mater con-
gested with  blood, but always without any marks of inflammation;
subarachnoid fluid  in almost all cases clear, and transparent, and
in one or two cases  colored by the presence of colored corpuscles;
in severe  cases of a golden color; the amount  varied in different
cases, sometimes exceeding, but most generally falling short of the
usual  amount—the  bloodvessels of  the  brain generally filled with
blood —structures of the brain  appeared in  almost every case
 normal,  altered  neither  in consistency nor appearance; blood was
 effused upon the brain in only two instances.
       15 
218
OBSERVATIONS  ON
   The opalescent pearl color of the arachnoid membrane in spots,
was of little diagnostic value, because it was by no means uniform.
In like manner, the variations in the amount of the subarachnoid
fluid and cerebro-spinal fluid was of little diagnostic value, because
its chief use is mechanical, and Magendie has shown that it  can be
rapidly secreted and  rapidly absorbed without any disturbance of
the functions  of the  brain; and further, that even in  the normal
condition  it varies  greatly in amount, from  two drachms to  two
ounces; and Cotunnius, the original discoverer of this  fluid, states
that in experiments upon the bodies of twenty adults, the amount
of this fluid varied  from four to five ounces.
   In  asserting that the  structures  of the  brain in malarial fever
were, as a general rule, altered neither in consistence nor in appear-
ance, we do so only upon the evidence afforded by sight and  touch;
we do therefore by no means affirm  this  to be a  fact established
upon  an immutable  basis.  How difficult is it to prove  the mode of
action of the malarial poison  upon the nervous system, especially
when  it may act in a manner analogous to that of certain violent
poisons, which we know will occasion almost instantaneous  death,
without producing a single pathological alteration  recognizable by
the most delicate chemical tests, or the most rigid microscopical
examination.  We  know that some substances, as  chloroform, will
produce sudden death, in some cases, where there is no assignable
cause, either in the structures or forces of the patient, or  in the
pathological alterations  produced,  or in  its  accustomed action.
This peculiar  action is said to be due to  the idiosyncrasy  of the
patient.  May not the fatal action of the malarial poison be due,  in
some  cases, to the  idiosyncrasy of the patient?   The  question is,
What is an idiosyncrasy ?  No one has ever demonstrated whether
these  peculiarities of  constitution depend  upon the physical and
chemical structures  and relations of the solids and fluids, or upon
the relations of the  physical, chemical, vital, nervous, and muscular
forces, or upon both  sets of relations combined.  We  must admit
that to determine accurately  the alterations of the nervous appa-
ratus, under the action of various morbific and remedial agents  it
is absolutely necessary that the structures of  the different parts of
the nervous apparatus should be submitted to a rigid chemical and
microscopical  analysis.   Numberless  insuperable difficulties lie  in
the way of complete  microscopical and chemical  analyses.   It is
impossible to obtain the substances for analysis until several hours
after death, and, in substances so liable to change, important  altera- 
MALARIAL FEVER.
219
tions may take place, even in this short time.  It is impossible to
separate the blood entirely from the nervous elements; and the
presence of a varying amount of blood, of varying constitution,
would of itself be sufficient to vitiate the results of  every analysis
which  had for its object the determination of the chemical changes
induced by  a most  subtle poison.   Notwithstanding this imperfect
state of  pathological  science;  notwithstanding that we have  no
facts to warrant the assertion that the malarial poison acts prima-
rily or exclusively upon  one system  of nerves  or  the other;  we
should, nevertheless, analyze the phenomena as far as our means of
analysis extend, and use all the well established facts to the extent
of their bearing and significance.   We will proceed to do this.
   As far as my observations extend, the pathological alterations of
the structures of the brain and spinal marrow do not correspond to
the symptoms during life.  The most universal phenomenon appears
to be the stagnation and  accumulation of the blood  in the blood-
vessels and capillaries of  the brain  and pia mater.   This accumu-
lation of the blood  in the  vessels of the brain and pia mater appears
to be due neither to inflammation nor to irritation, but simply to a
stagnation of the blood, similar to the stagnation and accumulation
of the blood in the vessels of the large organs.
   This view is conclusively sustained by the results of treatment.
In numerous cases I have seen the wildest delirium  calmed,  the
intellect aroused into full vigor from the most profound coma, and
the most alarming  cerebral symptoms vanish under the free use of
stimulants  and sinapisms, with or without the sulphate of quinia.
When the sulphate of quinia was withheld, the effects of the stimu-
lants and sinapisms would be but temporary;  whilst, when it was
administered  in  sufficient quantities, the  restoration  of the  intel-
lectual functions and the removal of the cerebral symptoms were
permanent.  Now, is this the action of stimulants or of sulphate of
quinia upon  an irritated or inflamed brain ?   These facts  alone
demonstrate conclusively that the cerebro-spinal system is not the seat of
irritation or inflammation in malarial fever, if we limit irritation and
inflammation to the  meaning universally adopted; and that if irritation
and inflammation of the cerebro-spinal system do arise in the progress of
malarial fever, they are by no means universal phenomena dependent
upon the dfinite and universal action of the malarial poison.
   To  what, then, must we refer  the aberrated nervous phenomena
of malarial fever?   Whilst we cannot answer  this  question  fully
and absolutely in the present imperfect, undeveloped state of phy- 
220
OBSERVATIONS  ON
siology and pathology, we  can point out and demonstrate three
distinct causes:  1st, the alterations of the blood; 2d, the disturb-
ances of the general and capillary circulations;  and  3d, the direct
depressing effects of the malarial poison upon  the  nervous appa-
ratus.
   1st.  The Altered Blood.—We have shown in the preceding chapter
that the colored blood-corpuscles are not only greatly and rapidly
diminished in malarial fever, but that they often lose the  saline
constituents.   W.e  have  every reason to believe that the blood-
corpuscles, taken collectively, perform the  offices of an  immense
gland for  the  elaboration of the materials for the nutrition of the
muscular and nervous  systems.   We have further shown that the
coloring matters of the serum are increased, and the coloring mat-
ters of  the bile retained, in the  blood of malarial  fever.  And I
shall hereafter show that  the constitution of the  urine is greatly
altered in the severest  forms of malarial fever, and that some of its
most important constituents are either not formed at  all,  or,  if
formed, are not eliminated.   We have also shown that the fibrin  is
altered both in quantity and in quality.
   Here, then, we have  profound alterations of the blood which must
induce corresponding  disturbances in the muscular and nervous
systems, and in all the organs and tissues which derive their nutri-
tion from the blood.  Here, then, we have profound  alterations in
the constituents of the blood which must produce  corresponding
disturbances in  the general  and capillary circulations, and in the
chemical changes in the capillaries and  surrounding tissues upon
which depend  the capillary circulation, and, in fact, the development
and maintenance of all the forces—physical, muscular, and nervous.
   As a general rule,  the  general  and  capillary  circulations are
greatly disturbed in congestive fever.  These disturbances are mani-
fested in the quick, thumping action of the heart, the small, feeble,
rapid pulse, the panting, full respiration, the want of correspond-
ence between  the temperatures of the  trunk and extremities the
aberration of the physical, chemical,  muscular, and nervous pheno-
mena, and in the stagnation  of the blood  in the different organs and
tissues.   The stagnation of the blood in the organs, tissues  and
apparatus, is due to disturbances in  the  sympathetic and cerebro-
spinal system,  disturbances in the general circulation, disturbances
in the quantities and qualities of  the constituents of the blood  and
arrest or perversion of the chemical changes of the capillaries.  It
is  well established  that the  circulation of the blood through the 
MALARIAL FEVER.
221
capillaries depends upon the relations, quantitative and qualitative,
physical and chemical, of the  individual constituents of the blood
to each other, and to the capillaries and the surrounding tissues,
and that disturbances of their relations will be attended by arrest
of the capillary circulation, and stagnation and congestion of the
blood, notwithstanding that the general  circulatory apparatus may
receive a sufficient supply of nervous  force, and perform its offices
with sufficient vigor.
   When the  general circulation is impeded,  either by the direct
action of the malarial poison* or of the altered blood upon the fibres
of the heart, or by the withdrawal or perversion of the nervous
force supplied by the  sympathetic  nervous  system,  or  by the
cerebro-spinal nervous system, through the  sympathetic, conse-
quent upon the action  of the  altered  blood,  or of the malarial
poison, or of both: it follows, as a  necessary consequence, that the
introduction and distribution of oxygen will be  retarded, and the
chemical changes in the capillaries  will be impeded, and the blood
will stagnate and accumulate in the capillaries.
   We have before demonstrated that  chemical change is necessary
for the  development of muscular  and nervous force, and  for the
manifestation of intellectual phenomena.  Whenever, therefore, the
normal chemical actions of the blood are disturbed, aberrated nerv-
ous  action, both  in the cerebrospinal  and  sympathetic nervous
systems, must result.
   We have a striking confirmation of these views in the mode of
origin and  progress of the  phenomena called chill in  malarial fever.
   The poison, as we have before demonstrated in the chapter on the blood,
first alters the constitution of the blood, and interferes with the actions and
secretions of those organs which elaborate the blood, before producing any
perceptible changes in the phenomena of either the sympathetic or cerebro-
spinal nervous systems; this alteration  of the blood progresses until a
point is reached,  where either such compounds  are generated in the cycle
of chemical  changes, induced by the malarial  poison, or the constituents
of the blood, especially the colored blood-corpuscles and fibrin, become so
altered that  disturbances are produced in the chemical changes by which
the capillary circulation is maintained, and as a  necessary consequence
the action of the heart, which depends, as all other muscular actions do,
upon the chemical changes in the capillaries, is impeded, and the  blood
gradually stagnates  in  the  capillaries, and accumulates in  the  large
bloodvessels  of the trunk and internal  organs, and the temperature of the
extremities, due to the chemical changes of the blood in the capillaries and 
222
OBSERVATIONS  ON
the surrounding tissues, sinks far below the normal standard; this arrest
of the capillary circulation  in  the  extremities, and probably also in the
lungs, is attended by the retention of the products of excretion, as carbonic
acid,  and the matters  thrown off from the skin and kidneys ; these excre-
mentitious offending  matters, together with  the products resulting from
the perverted chemical changes, due in part to the reduction of the  tem-
perature of the extremities many  degrees below  the normal  standard,
stimulate the sympathetic and cerebro-spinal nervous system;  the sensa-
tion of cold is felt, attended by twitching and jumping of the muscles,
entirely beyond  the control of the will, because they  are due to aberrated
muscular and nervous action, arising from disturbances in the capillary
circulation, and from the action of the perverted  elements of the  blood;
the respiration  is aroused, more oxygen is introduced, and the  tempera-
ture of the trunk elevated, provided the alterations in the  constitution of
the blood have not proceeded too far, or the nervous system been so over-
whelmed, either by  the action of the altered products, or of the malarial
poison, that they cannot respond to the excitation produced  by the altered
and retained productions ;  the elevation of the temperature of the trunk
is attended by a more rapid circulation of the blood in the capillaries of
the heart and of the  nervous centres, and consequently by  a more rapid
and powerful action  of the heart and generation of nervous force; the
oxygen is introduced  and distributed with greater rapidity, the chemical
changes  in  the capillaries are  again  excited, the capillary circulation is
first restored in  the trunk  and then  in the extremities, the  elevation of
temperature becomes general, and we have the phenomena called fever.
   During the active chemical changes of fever, the malarial poison and
the altered products of the  blood are drawn  into the round of chemical
change, physically and chemically altered,  and  are finally thrown off
from the lungs, skin, kidneys,  and intestinal canal.   After the removal
of these offending products,  the excitants of the  sympathetic and cerebro-
spinal nervous system, after the system has  been purified,  as if by fire;
then the nervous system returns back to  the  normal exercise of its func-
tions ; the force and frequency  of the heart diminish; the panting, full
respiration subsides into the calm regularity of health; the temperature
both in the trunk and in the extremities, returns to the normal standard
and we have what  is  called the remission of fever.
   If remedies have been  applied which affect the permanent alteration
and destruction, and removal of the  malarial poison, there is no return
of  the chill, succeeded by fever.
   If, on the other hand, the poison has not thus been removed the same
round of phenomena is repeated, the  blood is  again altered, the capil- 
MALARIAL FEVER.
223
lary circulation is again retarded, and the whole round of phenomena is
repeated.
  If these views  be correct,  it is evident  that  malarial fever is
paroxysmal, not because the action of the cerebro-spinal or of  the
sympathetic system is paroxysmal, but because the relations of the
malarial  poison to the  constituents of the blood  and organs and
apparatuses are such,  and the relations  to the chemical changes
necessary to the development of the physical, muscular, and nerv-
ous forces are such, that a definite series of actions and of chemical
changes are established, which result in the removal of the offending
products; but not always of the primary, disturbing element, the
poison, which will again excite another round of the same class of
actions—a paroxysm.
  The theory here advocated  is based upon thousands of observa-
tions upon the pulse, respiration, temperature, physical and chemical
changes  of the solids and fluids during all the stages of fever and
after death, and is consistent  with every  fact and observation re-
corded in this essay.  It is important, because it does not call in
the aid of occult qualities of the nervous  system, or the assistance
of the unknown vis-medicatrix naturae;  because it expresses an
analysis  of the phenomena, at the same time that it indicates the ■
true principles of the treatment of malarial fever; and it  is espe-
cially important, because  it  points out the  relative position and
importance of the phenomena, and the true direction of scientific
investigation.
  Without multiplying at this time facts,  we would simply adduce
the phenomena of congestive  fever, as conclusive demonstration of
the truth of this theory, or, rather, expression of the relations of
the phenomena of fever.   In  congestive fever, where the nervous
system is overwhelmed, and does  not respond to the action of  the
altered compounds,  no  elevation  of temperature is produced, the
chemical changes are perverted and  retarded, and the temperature
sinks both in the trunk and in the extremities, the altered products
remain, and death is inevitably the result, unless those remedies
can be applied which will arouse the sympathetic and cerebro-spinal
systems;  arouse  the action of the  heart;  arouse the chemical
changes  in the capillaries, and lead to a  vigorous development of
the physical, chemical, muscular, and nervous forces, and result in
the elimination of the altered  products and the poison.
  The following pathological observations  will  substantiate  the 
224
OBSERVATIONS ON
assertions, with reference  to the alterations of the nervous struc-
tures during malarial fever:—

   Case of intermittent fever occurring in  the latter stages  of phthisis
pulmonalis.
   When the skullcap  was removed, about f^ij  of  subarachnoid
and cerebro-spinal fluid, colored red by the blood which escaped
from the vessels divided during the removal of the skullcap, flowed
from the base of the brain.
   Dura mater normal.
   Arachnoid membrane slightly opalescent in several spots, espe-
cially in  the neighborhood of the large bloodvessels; the greater
part of this membrane, however, was transparent and  normal in
appearance.
   Subarachnoid fluid moderately abundant.
   Bloodvessels  of pia  mater filled  with blood.  There were  no
marks of inflammation  either in the pia mater or in the  arachnoid
membrane.
   The ventricles of the brain contained  small quantities of serum.
   The cortical  and  medullary substances, the  cerebellum, pons
Varolii, the medulla oblongata, and the spinal marrow, appeared
natural  to the naked eye.  The structures did  not  appear to  be
softened or materially altered.

   Case of remittent and  typhoid fevers combined.
   Several days  before the fatal termination, the cerebral  symptoms
were well marked.  The patient lay in a stupor, with mouth and
eyes open, and passed his  urine and feces in bed; and  it was im-
possible  to arouse him, even  by the most violent shaking.  The
examination of the blood, on the day previous to death, showed
that it had undergone profound alterations.
   Dura-mater perfectly natural; arachnoid  membrane  opalescent
(pearl colored) in  most  parts.   There were different degrees of this
opalescency, from almost perfect transparency to semi-translucency.
This change was especially evident in the neighborhood of the
large bloodvessels, and in those portions  of the arachnoid which
covered the depressions between the convolutions.  Bloodvessels
of pia-mater somewhat more distended with blood than usual-  but
not so much, however, as to  account for the cerebral  symptoms
during life.  Substance of brain firm, and not more cono-ested with
blood than normal.  The appearance of the structure  and condition 
MALARIAL FEVER.
225
 of  the  brain, and its bloodvessels and membranes, did  not corre-
 spond  to the condition of congestion, effusion, or softening, which
 the cerebral symptoms led us to expect.  The brain was not exa-
 mined  microscopically or chemically,  and there may have been
 minute chemical and physical changes in its delicate structures,
 which escaped the observation of the naked eye.   This is possible,
 but not probable; for we can hardly suppose that profound altera-
 tions in the structure of so delicate an organ as the brain, without
 some changes in the color or consistence palpable to the naked eye.
 The cerebro-spinal phenomena during life appear to have been the
 result of disturbances in the  circulation" and constitution  of  the
 blood, and of the action of  the poison or its products in the blood
 upon the ganglionic cells and commissures.

   Case  of an Irish baker, attacked during convalescence from remittent
fever  with influenza, and drowned  by  the  effusion  of serum  into the
 bronchial tubes and air-cells.
  Dura mater presented the usual appearance; arachnoid mem-
 brane transparent;  bloodvessels of pia  mater  filled with  blood.
 When the dura mater was  removed, an ulcer in the substance of
 the brain was discovered, occupying a position near the centre of
 the superior surface  of the left hemisphere of the cerebrum.  This
 ulcer was three-fourths of an inch in length and half  an inch  in
 breadth, and  about  one-eighth of an inch in depth.   The walls
 were  thickened and much harder than the surrounding brain. The
 bloodvessels of the surrounding pia mater and brain were congested
 with  blood, and there was an effusion of a small quantity of bloody
 serum  between the  arachnoid and pia mater, in  the  immediate
 neighborhood of the  ulcer,  but nowhere else.  The appearance of
 the ulcer, and the congestion  of  the  bloodvessels around,  by  no
 means accounted for the  death of the patient.  The ulcer appeared
 to be of long standing, and was in the process of healing.  During
 the attack of malarial fever, and during convalescence, the patient
 was dull, lethargic,  and  indisposed to exert his mind or body.
 The existence of this ulcer  will account for these  phenomena, but
not for the death of the patient, which was due to the rapid pouring
out of the altered liquor sanguinis of the blood into the air-cells and
bronchial tubes.  The cerebral symptoms after this calamity were
not different from those which would occur in impeded respiration
and circulation, when the distribution of the oxygen and the removal
of the carbonic acid were retarded.  The ventricles of the brain 
226
OBSERVATIONS  ON
contained the usual amount of clear fluid, and  the  structures of
the brain presented the usual consistence and appearance.

   Case of Irish laborer, attacked with pleuro-pneumonia,  during conva-
lescence from remittent fever.
   During the attack of remittent fever,  which was severe,  the
cerebral  symptoms  were absent.   During the  attack  of pleuro-
pneumonia which  supervened immediately upon the  remittent
fever, the cerebral symptoms were well marked ;  great excitement
and frequent aberrations of  the intellectual faculties.
   Dura mater healthy;  arachnoid membrane transparent through-
out its extent over  the hemispheres of the brain.  At the base of
the brain it  was slightly opalescent.  Bloodvessels of pia mater
not more filled with blood than usual.  The cortical and medullary
substances of the cerebrum  and cerebellum, the  pons Varolii, the
medulla  oblongata,  and  superior  portion  of the spinal marrow,
appeared natural in consistence and color; ventricles of the brain
contained f5iv of golden-colored serum.  The superior longitudinal
sinus of the dura mater  contained a golden-yellow elongated  clot,
the diameter of which was about one-half that of the longitudinal
sinus.

   Case of an Irish laborer, who was attacked in the early stages of
convalescence from intermittent fever, with an eruptive disease resembling
the severest form of lichen agrius.
   This patient had been exposed to the malarial influence in a  low,
damp, marshy situation.  The eruption was  very thick  upon  the
face, neck and chest; in these regions, and  especially  upon  the
face, the  papulas  were very numerous,  prominent, of a  vivid  red
color, and in  many places closely aggregated into large clusters, of
irregular form and size.  Numerous vesicles and pustules, contain-
ing sero-purulent fluid, were mingled with the papulae.   From the
clusters of papulae, vesicles and pustules, an ichorous  or sero-puru-
lent fluid issued, and desiccated into yellow  crusts.  In some places,
from the thickening of the  skin, the density of the crust, and the
depth of the fissures, the disease  might have been  mistaken for
psoriasis.  On the legs the eruption was much thinner, and resem-
bled lichen tropicus (prickly heat).  The vesicles and pustules were
so large and numerous, that across  the ward the eruption  resembled
smallpox.  Under treatment,  the discharge of sero-purulent fluid
ceased, the  pustules and vesicles dried up, and the symptom  ora- 
MALARIAL FEVER.
227
dually disappeared, but the patient continued weak  and feeble and
lethargic.   Twelve days after his entrance into the hospital with
the eruption, he was seized with a strong convulsion, which lasted
about ten  minutes, and was succeeded by stupor.  Four hours after
the convulsion, could not be aroused by the loudest interrogations
and the most violent shaking.  The left arm  was drawn across the
breast, and appeared paralyzed.  It  required considerable force to
straighten  it, and when released it would fly back  to  its  former
position, like a steel spring.   The left leg was also paralyzed, and
in like manner returned when  removed from its  position.   The
patient remained in this state forty-eight hours, and then died.
  When the skullcap was removed, about f^vj of blood flowed
from  the  base of the brain.  Dura  mater normal in appearance;
arachnoid  membrane slightly pearl  colored, opalescent in  several
places; bloodvessels of pia mater,  especially at  the base of the
brain, filled with blood.  Much blood and bloody serum were effused
between the dura mater and arachnoid membrane.  Cerebellum and
pons Varolii of a blood-red color upon the exterior.  The ventricles
of the brain were almost entirely filled with serum.   The structure
of the brain  appeared to be  somewhat  softer than usual, and the
bloodvessels were  filled with blood, and distinct.   Bloodvessels of
medulla oblongata and  superior portion of spinal cord filled and
distended  with blood.  Much bloody serum was effused around the
spinal cord.  No clots were found  in the blood and serum  effused
around the brain.  The liver and spleen bore the  marks of the
effects of  malarial fever; they were, however, recovering.  It is
impossible to determine positively the cause of this sudden effusion
of blood and serum upon the brain.  Were the softening of the
nervous structures and alterations of the capillaries the results of
the malarial poison ? or were they the results of  the action of the
cause, whatever it  was, which produced the eruption ?

   Case of  remittent fever, occurring in an Irish baker, of feeble consti-
tution,  during exposure and dissipation.  This  patient died without
any treatment, except the administration of a purgative.
  Dura mater and arachnoid membrane normal; bloodvessels of
pia mater  contained  more blood than usual, but  there were no
marks of inflammation;  f5J of clear serous fluid  escaped from the
spaces between the dura mater and  arachnoid membrane, and be-
tween the arachnoid membrane and pia mater. 
228
OBSERVATIONS  ON
   Case of remittent fever  converted into congestive fever, by excessive
 purgation,  and neglect of stimulation and the sulphate of quinia.
   Towards the close of life the intellect was sluggish, but perfectly
 clear when aroused.  Throughout the attack there were no  well-
 marked cerebral symptoms.   Brain examined twelve hours after death.
   Dura mater unusually thick and  firm, and adherent in several
 places  to the arachnoid membrane.   The thickening of the dura
 mater and the adhesions were of long standing, and were not con-
 nected with this attack of malarial fever.  Bloodvessels of the dura
 mater  filled  with  blood; arachnoid membrane opalescent,  pearl
 colored, and  in many places adherent to the pia mater.  These
 adhesions,  like those between the dura mater and  arachnoid  mem-
 brane, were apparently of long standing.  Between the arachnoid
 membrane and pia  mater bloody serum was effused, thus imparting
 to these membranes (especially the inferior portions from the gravi-
 tation of the blood) a red appearance.  Bloodvessels of pia mater
 were filled with blood.   The bloodvessels of those portions of the
 pia mater which extended into the ventricles of the brain were also
 engorged with blood. The ventricles of the brain contained a  small
 quantity of clear serum.  Structure of cerebrum  appeared to be
 somewhat softer than normal.  This softening may have been the
 result of post-mortem decomposition.  Bloodvessels  in  the  sub-
 stance of the  brain distinct and  more engorged with blood  than
 usual.  Structure of  cerebellum, medulla oblongata, and superior
 portion of spinal cord presented the usual appearance and tenacity.
 The bloodvessels of the  spinal cord appeared to be more congested
 with blood than usual.

   Case of congestive fever, aggravated and shortened by bleeding and
purgatives,  and allowed to  run its  course unchecked, by the neglect of
 stimulants and sulphate of quinia.
  Before the  abstraction of blood  the  cerebral  symptoms  were
 urgent.  The patient appeared to suffer intense agony in his head;
 both hands were clasped around his head ;  he tossed violently about
 his bed; every breath was  accompanied  with a deep  groan, and
 an exclamation about the pain  in his head; and he was unable to
 give a coherent answer.   Cut-cups to the temples  and  back of the
 neck, general  bloodletting,  and sinapisms, relieved the  cerebral
 symptoms.  Stimulants  and sulphate of quinia were not  adminis-
 tered, and the  cerebral symptoms returned with much less violence 
MALARIAL FEVER.
229
and at the end of fifty hours the patient died.   When the skullcap
was removed, four hours after death, f 3ij of blood flowed from the
base of the brain, and appeared to have come, in great measure,
from a rupture in  one of the sinuses of the dura mater.
   Arachnoid  membrane opalescent, pearl colored.  A small quan-
tity of yellow serum was effused between the arachnoid membrane
and pia  mater. Bloodvessels of pia mater engorged with blood.
Substance of brain appeared to be softer  than usual.   Upon the
cut surface were seen the cut extremities of numerous bloodvessels
filled  with blood.   The lateral ventricles of the brain were nearly
filled with golden  serum.  Bloodvessels of that portion  of the pia
mater  which  enters the ventricles engorged with blood.  Blood-
vessels at the  base of the brain and superior portion of the medulla
oblongata greatly distended with  blood.  The bloodvessels at the
base aud dependent portions of the brain were more distended with
blood than those of the superior portions of the brain.  There were
no marks of  inflammation anywhere, and the congestion of the
blood in the bloodvessels appeared to be due to its stagnation from
disturbances of the general and capillary circulations, produced by
the altered blood and the formation of heart clots and fibrinous
concretions in the pulmonary arteries and veins.

   Case of congestive fever ;  death  resulting, in great measure, from the
formation of fibrinous concretions in the heart and bloodvessels.
   The cerebral symptoms appeared suddenly, and were of the most
marked  and decided character.   The patient  was taken suddenly
with coma, and lay with his mouth and eyes open, perfectly insen-
sible, and emitting at  every breath a sharp, quick groan, like the
barking  of a  dog.  When the  skullcap was  removed, three hours
after death, fSiij of bloody serum flowed from the base of the brain.
The admixture of blood with the cerebro-spinal fluid appeared to
have been due entirely to the wounding of bloodvessels during the
removal of the skullcap. The arachnoid membrane was but slightly
opalescent; in most places it was perfectly transparent.  The fluid
effused between the arachnoid  membrane and pia mater, and into
the ventricles  of the brain,  presented the golden color of  the serum
of the blood.  Bloodvessels of pia mater filled with blood.  Blood-
vessels at the base  of the brain, and upon the medulla oblongata and
spinal cord, more engorged with  blood than those upon the superior
portions of the brain.   This was, without doubt, due solely to the 
230
OBSERVATIONS  ON
effect of gravity.   The substance of the brain  possessed the usual
consistency, and appeared  to the naked eye to be normal in struc-
ture.

   Case of congestive fever.
   Stout seaman, sick only  four days.  On  the  second  day became
comatose, and continued  insensible, passing his urine  and feces in
bed until death.   The treatment was defective  in energy.   Stimu-
lants and sulphate of quinia were not used with sufficient freedom
and frequency.  Brain examined twenty hours after death.
   Dura mater and arachnoid membrane presented a healthy appear-
ance.   The subarachnoid fluid was of a reddish color.  The ventri-
cles of the brain were almost completely filled with a reddish fluid.
Bloodvessels of  pia  mater  congested with blood.  Bloodvessels of
the superior portions of the brain less congested with blood than
those of  the inferior portions.   The substance of the brain pre-
sented nothing abnormal  to the naked eye, or to the touch.

   Case of remittent fever, neglected for ten days, terminating in conges-
tive fever.
   Four days before death cerebral symptoms  well marked; great
torpor of the intellect when stimulants  were withheld, and when
freely  administered  unusual excitement, attended with aberration
and inCoherency.  Brain examined twelve hours  after death.
   Dura mater normal; arachnoid membrane opalescent, pearl colored
in many spots; subarachnoid fluid in normal quantity; bloodvessels
of pia mater filled with blood ; substance of brain firm, and  altered
neither in consistency nor in appearance.  Bloodvessels of the sub-
stance of the  brain  not more distinct  than normal;  ventricles of
brain, and the space  around the medulla oblongata and spinal cord,
filled with light yellow fluid.   When  the  medulla oblongata, and
superior  portion of the spinal cord were removed, the serum flowed
in (the shoulders being slightly depressed), and filled  the vertebral
canal.

   Case of congestive fever; fibrinous concretion in the heart and blood-
vessels, cerebral  symptoms  severe, coma,  and complete  insensibility.
Brain examined twelve hours after death.
   The longitudinal sinus of the dura mater contained an elongated,
flattened, ribbon-like, fibrinous clot, which  was free from colored
blood-corpuscles, and of  a light yellow color.  This was, without 
MALARIAL FEVER.
231
doubt, formed before death.  Arachnoid membrane opalescent, pearl
colored in many places.  Bloodvessels of pia mater filled with blood.
Substance of brain appeared to be normal in color and texture, as
far  as an examination with the naked eye  extended; it was, per-
haps, a little softer than usual; but this may have been due to post-
mortem changes, and at  any rate would not account for the symp-
toms during life.   Bloodvessels of medulla oblongata and superior
portion of spinal cord not congested with blood.

  Case of congestive fever.  Death occurred forty-three hours  after the
commencement of the attack, which commenced suddenly, with vomiting,
cold extremities,  complete prostration, and delirium.
  When the skullcap was removed, twenty-four hours after  death,
fsiij blood flowed from the base of  the brain, which contained no
coagula, and appeared to have been effused before death. Arachnoid
membrane opalescent in  a few spots.   Bloodvessels  of pia mater
filled with blood.  The  sub-arachnoid fluid was of a bloody red
color.  Bloodvessels at the base of the brain, and surrounding the
medulla oblongata and superior  portion  of the spinal  cord, were
filled with blood.  The substance of the brain was normal in con-
sistence and appearance.

                             Chest.
  The lungs, in uncomplicated malarial fever, presented  no abnor-
mal appearance, except  the accumulation of the blood in the most
dependent parts, which resembled in  all  respects and were due to
the same causes as the accumulation of the blood in the vessels of
the most dependent  parts of all the organs and tissues.
  The heart  presented no uniform pathological alterations which
could be referred to malarial fever.   In  the  hearts of drunkards,
fatty degeneration was frequently observed; but this was an effect
of  the alcohol, and not of the malarial poison.  In some cases the
heart was paler and softer than usual; these did not appear to be
uniform alterations.

                      Alimentary Canal.
  During the severe forms  of  malarial fever, the secretions of the
mouth were, as an  almost universal rule,  suppressed;  and  the
tongue,  when  not coated with fur, presented a bright  red, dry,
rough surface,  with  enlarged papillae.  The bright red color of the
tongue was due to the stagnation of the blood and the accumulation 
232
OBSERVATIONS  ON
of the blood-corpuscles in the capillaries.  In numerous instances
I have observed the dry, harsh, hard tongue become soft and moist
under the action of stimulants and sulphate of quinia.   This sup-
pression of secretion and congestion  of the  bloodvessels of  the
tongue  and mucous membrane of  the  mouth,  was the result  of de-
rangements in the capillary circulation, induced by altered blood,
by the disturbed circulation, and  by aberrated nervous force sup-
plied by the sympathetic system, and not of inflammation or  irrita-
tion.   We consider the glowing, red, dry tongue  of remittent and con-
gestive fever as a valuable index of the condition of the capillary circu-
lation in other parts of the body.  It does not by any means indicate an
inflamed or even irritated state of the stomach.  In several cases, which
presented throughout their course  dry, red tongues, as hard and as
rough as boards, attended with great tenderness of the epigastrium,
the stomach presented after death a normal appearance, without any
marks of inflammation, or even of irritation.

                 STOMACH AND INTESTINAL CANAL.
  The pathological alterations of the stomach, observed after death,
did not correspond  to the severity  of the  symptoms, the vomiting,
and pain upon pressure, during the progress of the fever.   The in-
jection of the bloodvessels, and the mottled, purplish, brownish-red
color after death, appeared  to be  indicative, not of inflammation,
but rather of stagnation and accumulation of the blood in the capil-
laries,, consequent upon the disturbance of the relations of the blood
to the capillaries.  The distressing vomiting, so often a troublesome
symptom in malarial fever, appeared to depend upon the contact of
the altered bile (the stomach was frequently found discolored with
bile), and the  irritation of the nervous  centres which  supply the
stomach with nervous force  by  the  altered blood  and  by  the
malarial poison.
  In cases  where  there  has been  chronic inflammation of  the
stomach before  the appearance of the fever, and  in cases of long
standing, where the solids  and fluids were permanently altered,
decided alterations of structure were found in the stomach.  It may
be asserted, however, that  there is no constant and characteristic
lesion of the stomach in malarial fever, which would distinguish it
from other fevers.
  These remarks apply also to the small intestines.  The mucous
membrane frequently  presented  a  purplish,  irregularly injected,
mottled  appearance, especially after the administration of purga- 
MALARIAL FEVER.
233
tives; and it  was frequently observed that the injection  of  the
bloodvessels was  greatest in the dependent portions of the intes-
tines.  In several cases, Brunner's glands in the duodenum were
enlarged and distinct.   The solitary glands of the small intestines
appeared in many cases enlarged and distinct.   Peyer's glands, in
all  the cases except one which was characterized  by true typhoid
symptoms, were uniformly free from any well-marked morbid altera-
tion.  In some cases they were distinct and well  defined in their
outline, and presented a  honey-comb surface  dotted with dark
points; but they were always free from  marks of inflammation,  and
even of irritation, and in their pale white color contrasted strongly
with the surrounding  mucous membranes, discolored  with bile,
and often irregularly injected with blood.
   These statements will now be illustrated by the following post-
mortem examinations:—

   Case  of intermittent fever  occurring in the latter stages of  phthisis
pulmonalis.   Autopsy twelve hours after death.
   Stomach  small, contracted; small intestines  and colon  inflated
with air.  Mucous membrane of stomach of a purplish-red color in
spots,  presenting a mottled  appearance.  Bloodvessels upon  the
exterior filled with blood.  The small intestines contained fecal
matters colored by bile.  Mucous membrane of the small intestines
of a dark-purplish and  reddish-yellow hue. Bloodvessels upon the
exterior and  through  the structures of the intestines were filled
with dark blood.  Glands of Peyer normal, not enlarged nor  con-
gested.  Brunner's glands did not attract attention.

   Case of remittent and typhoid fevers combined.  Autopsy four hours
after death.
   Internal  surface of the stomach, colored yellow with bile.   As
far as the unaided eye  could  ascertain, the mucous membrane was
continuous and  unaltered in  structure.   The bloodvessels of the
mucous membrane were filled with blood, and several spots were
more engorged with blood than the rest of the  surface, presenting
an ecchymosed appearance.  The mere stagnation of the blood in
the vessels and capillaries of the mucous  membrane is not signifi-
cant of alterations in the structures, or of inflammation, or even of
irritation.  To the naked eye there were no pathological alterations
 in the structures of the stomach.
   The  color of the intestines, externally and internally, was darker
        16 
234
OBSERVATIONS ON
than usual; the small intestines contained fecal  matters, epithelial
cells, mucus-corpuscles, and mucus colored yellow with bile. Blood-
vessels of the mucous membrane of the  small and large intestines
injected with blood.  The mucous  membrane was most injected
with blood, and presented a purplish color, in the last eight feet of
the inferior portion of the ileum.  This engorgement of the blood-
vessels was greatest in the immediate region of the ileo-caecal valve.
The solitary  glands were  numerous, enlarged,  elevated  and dis-
tinct, and of  a brown color.  When the  intestines were held  up to
the light, bloodvessels engorged with blood, were seen passing to
each gland.   The bloodvessels  supplying the solitary and Peyer's
glands were  more engorged with blood than those supplying the
mucous membrane  generally.   These solitary glands  were  most
numerous in the neighborhood of the ileo-caecal valve, and  were
found scattered over the superior portion of the colon; and over
the caecum, and over eight feet of the inferior portion of the ileum.
  Peyer's glands were enlarged and elevated.   These glands were
of various sizes, from one-quarter of an inch to half an inch  in
breadth.   They occurred at intervals of from  one to two inches
from each other, and extended from the ileo-caecal valve, along the
mucous membrane of the ileum, for about nine feet.  The blood-
vessels around these glands were engorged with blood.  This part
of the  mucous membrane of the ileum,  studded with the solitary
and Peyer's glands, was far more injected with blood than the sto-
mach, jejunum, or superior portion of the ileum.  Although  these
glands were  enlarged, elevated, and  injected with blood, still they
could not, by any means be compared to the condition  of  these
glands, in an advanced stage of typhoid fever.
  That this  case was one  of typhoid fever was demonstrated  by
the great susceptibility of the intestinal canal to the action of small
doses of purgatives, the continued elevation  of the temperature,
and rapid action of the pulse  without any remission, the appear-
ance of albumen in the urine,  and the  low muttering delirium;
that it was also a case of remittent fever was demonstrated by the
slate or bronzed liver, the alteration in the blood, and the  disor-
ganized enlarged spleen.

   Case of an Irish baker, attacked during convalescence from remittent
fever, with influenza, and drowned by the effusion of serum into the
bronchial tubes and air-cells.   Autopsy eight hours after death.
   Stomach, pale  and perfectly healthy  in  appearance. Intestinal
canal, from the stomach  to the anus, pale and healthy in appearance. 
MALARIAL FEVER.                  235
   Case of Irish  laborer, attacked with pleuro-pneumonia during con-
valescence from remittent fever.   Autopsy nine hours after death.
  Stomach enormously distended with gas. Mucous membrane pale
and healthy in appearance.   Small intestines and colon healthy in
appearance to the naked eye.

   Case of  an Irish laborer who was attacked in the early stages of con-
valescence from intermittent fever, with an eruptive disease resembling
the severest form of lichen agrius, and who died suddenly from effusion
of blood upon the base of the brain.  Autopsy five hours after death.
   Bloodvessels  upon the exterior of the stomach filled with black
blood.  Internal mucous membrane generally of a reddish and
pinkish color, and in many spots where the congestion was greater,
the color  was much deeper.   Brunner's glands  in the duodenum,
and Lieberkiihn's follicles, in  the pyloric extremity of the  stomach,
and  in the pylorus and duodenum, appeared to be enlarged, and
gave  to the mucous membrane a mammillated appearance.
   Mucous membrane of the small intestines of a reddish color, with
bloodvessels filled  with blood, especially at the superior portion.
The  glands  of  Peyer, in the inferior  portion of  the ileum, espe-
cially in the region of the ileo-cascal valve, were enlarged.  Solitary
glands in the superior portion of the colon also enlarged.   Mucous
membrane of the stomach and intestines was colored yellow by the
bile.   The small intestines contained much offensive gas, tenacious
mucus, and fecal matters colored  yellow by the bile.  The colon
was distended with offensive  gas.

   Case of a house  painter, who during convalescence from a severe
attack of malarial fever was seized with convulsions, and died comatose.
Autopsy five hours after death.
   Stomach and small  and large intestines presented a healthy ap-
pearance.

   Case of German butcher, who, after suffering with chill and fever for
two months without  any medical attendance, was seized with  congestive
fever.  Autopsy four hours after death.
   He was relieved from congestive fever, but the alterations of the
organs and tissues and  blood had been so profound, that notwith-
standing  the use of alteratives, sulphate of  quinia, stimulants, and
nutritious diet, he died twenty-three days after the attack of con-
gestive fever.  Previous to death  the  digestion was imperfect and
the bowels loose. 
236
OBSERVATIONS ON
   The stomach  and small and large intestines were greatly con-
tracted.  Bloodvessels of mesentery, omentum, and exterior surface
of stomach, and small and large intestines, engorged with black
blood.  The mucous  membrane of the stomach  presented an ap-
pearance resembling that of chronic inflammation.  The  exterior
of the large and small intestines was of a purplish color.  The
mucous membrane  of the small  intestines  did not appear to  be
altered in structure.  Glands of Peyer, enlarged and distinct;  some
of them were several inches in length.  The glands of Peyer,  how-
ever,  did not present the appearance of active inflammation,  as in
typhoid fever.   They were even  paler than usual.  The solitary
glands did  not attract attention.  The lymphatics of the mesentery
were  much enlarged.
   It is worthy of note that in this case, which  assumed a low ty-
phoid type, the glands of Peyer were not inflamed.

   Case of remittent fever, occurring in an Irish laborer of feeble consti-
tution, during exposure and dissipation.   This patient died without any
treatment except the administration of a gentle purgative.  Autopsy four
hours  after death.
   The mucous  membrane of the  stomach presented  the  usual
healthy appearance.   The mucous membrane of  the small intes-
tines  appeared to be healthy.  Glands of Peyer large and distinct,
but pale, and without any marks of congestion  or  inflammation.
Several of  these glands were three inches in length.   The solitary
glands, especially in the region of the ileo-caecal valve, were en-
larged and  prominent.   They were about  the  size of millet-seed,
and of a reddish-brown color.

   Case of remittent fever, converted into congestive fever by excessive
purgation and neglect of stimulation and the sulphate of quinia.  Au-
topsy  twelve hours after death.
   The stomach  contained no  fluid or gas; bloodvessels upon the
exterior  filled with  blood; mucous  membrane  of  stomach of a
dark  purplish color.   The color of the mucous  membrane was not
uniform; it was much deeper in some spots than in others, thus
presenting  a mottled appearance.  The compound muciparous fol-
licles  (Brunner's glands) of the stomach and duodenum were pro-
minent and enlarged.
   Bloodvessels of the superior and inferior portions of the intes-
tinal canal  appeared to be more engorged with blood than those of 
MALARIAL FEVER.
237
the middle portions. The mucous membrane of the small intestines
was covered by a layer of mucus and fecal matter, colored yellow
by the bile.
   The solitary  glands in the inferior portion of the ileum, and
especially in the region of the ileo-caecal valve, were enlarged and
distinct.   The glands  of Peyer were distinct, but not enlarged or
inflamed.

   Case of congestive fever, aggravated and shortened by bleeding and
purgatives, and allowed to run its course unchecked, by  the neglect of
stimulants and sulphate of quinia.   Autopsy four hours after death.
   Mucous  membrane of stomach corrugated and of a purplish
color, varying  in intensity in  different spots.  The stomach con-
tained eight fluidounces of a dark greenish-black fluid, which re-
sembled, upon  a general  view,  the  black  vomit of yellow fever.
Under the microscope this  fluid was found to contain numerous
mucus-corpuscles, epithelial cells of the mucous  membrane, and
gastric  glands,  peptic cells, and dark granules.   These various
bodies were of  a greenish and yellow color under the microscope.
The action of nitric acid demonstrated that the  color was due to
the presence of bile.  The color of  a  mass of this fluid from the
stomach, like that of the bile from the gall-bladder, was of a dark
blackish-green color, whilst  the  thin layers, like those of the bile,
were of a yellow color.  I was  unable to distinguish any colored
corpuscles, notwithstanding  the  close resemblance to  black  vomit.
The granules did not  resemble altered blood-corpuscles.
   The color of the mucous  membrane of the small intestines was
darker  than usual, and the surface  was covered with mucus-cor-
puscles and epithelium, colored yellow by bile.
   Bloodvessels of the ileum, especially in the region of the ileo-
caecal valve, engorged with blood.   Neither  the  glands of Peyer
nor the solitary glands were enlarged.  Bloodvessels of colon filled
with blood. Exterior surface of rectum diversified by numerous
ecchymosed spots of a bright arterial hue.

   Case of congestive fever.  Death resulting in great measure from the
formation of fibrinous  coagula in the heart and bloodvessels.   Great
tenderness upon pressure  of epigastrium.  Autopsy  three hours after
death.
   Stomach distended  with gas.  Mucous membrane discolored by 
238
OBSERVATIONS ON
yellow bile, and diversified with punctated spots of a brilliant red
color.
  Small  intestines contained  bile and feces, which were extraordi-
narily  offensive.  The calomel and oil administered previous to
death had commenced to operate.   When  the feces  and epithelial
cells, colored  yellow by bile, were  scraped off, the mucous mem-
brane presented the normal appearance. The glands of Peyer were
remarkably large and distinct; several of them were three inches
in length;  their surfaces were pale, and  exhibited no  marks of
inflammation.

  Case of congestive fever.   Stout seaman, sick only four  days.   On
the second day became comatose, and  continued  insensible, passing  his
urine and feces in bed until death.   Autopsy  twenty hours after death.
  The mucous membrane of the alimentary canal, from the oeso-
phagus to  the  anus, presented the  normal color,  and showed  no
signs whatever of congestion or inflammation.

  Case of remittent fever, neglected for ten days, terminating in conges-
tive fever.  Tongue red, dry, and hard.  Autopsy twelve hours after
death.
  Bloodvessels upon the exterior of the stomach filled with blood.
The  mucous  membrane bore  no marks of inflammation, and was
not more congested with blood than usual.
  The exterior and  mucous  membrane of the  jejunum  presented
the usual appearance.  There was no unusual appearance, either of
congestion, irritation, or inflammation.   The mucous membrane of
the ileum, especially at the lower portion, was more congested with
blood,  and of a darker color than usual.  The intestinal canal,
through  its entire  length,  was  empty.  The  mucous  membrane
presented a yellow appearance, probably  due  to  the presence of
bile.
  The solitary glands of the ileum,  especially in the neighborhood
of the ileo-caecal valve, were numerous, enlarged, elevated, distinct,
and of a brown color.  When  the  intestines were held  up to  the
light, the bloodvessels filled  with blood could be distinctly seen
sending off branches to  each gland.   The glands of Peyer were
large, distinct, and elevated.  Several of these glands in the lower
portion of the ileum were  three inches in length.   These  glands,
however, were not inflamed, as in typhoid  fever, and presented  the
usual pale appearance. 
MALARIAL FEVER.
239
   Case  of congestive fever.  Fibrinous concretions  in  the  heart and
bloodvessels ; cerebral symptoms severe ; coma and complete insensibility;
tongue red, dry, rough, and hard.  Autopsy twelve hours after death.
   Exterior  surface of stomach and  intestines pale.   Bloodvessels
of omentum and  mesentery were filled with black blood.   The
stomach contained a yellow, mucus-like fluid.  The mucous mem-
brane of  the stomach was dyed  yellow by the bile.   With the
exception of this  discoloration, the  mucous  membrane of the sto-
mach appeared to be normal.  There were no marks of  inflamma-
tion.  The  small  intestines  contained large quantities  of yellow
mucoid matter, mixed with soft fecal matters.  When carefully and
completely washed under a  gentle stream of water,  the free edges
of the valvulae conniventes presented a bright red and bistre color,
which diminished  in intensity towards the attached portion.   The
whole surface of the  mucous membrane of the small and large in-
testines was of a darker color, and  indicated much more congestion
than  usual.  I do not consider the congestion of the bloodvessels
of the mucous membrane as a pathological alteration, due either to
the primary or secondary effects of the  malarial poison, because at
the time of his death the  patient was under the action of a cathartic.
Cathartics, as far as my experiments upon  animals have extended,
produce engorgement of the vessels of the  mucous  membrane of
the intestines.  Glands of Peyer and solitary glands not enlarged
or inflamed.

   Case of congestive fever.  Death occurring forty-three hours after the
commencement of the disease, which was ushered in suddenly with vomit-
ing, cold extremities, complete prostration, and delirium,. Autopsy twenty-
four hours after death.
   The mucous membrane of the stomach presented two well-defined
portions;  the mucous membrane of the lesser  curvature of the
stomach was  pale and normal in appearance; the mucous mem-
brane of the  greater curvature and pyloric extremity, and of the
pylorus, was of a purplish color, and ecchymosed in crimson spots.
The bloodvessels of the greater curvature and of the  pylorus were
congested with blood.  Mucous membrane of the superior portion
of the jejunum congested with blood;  valvulae conniventes,  espe-
cially at the edges, ecchymosed in spots, of a purple and scarlet
color.  Mucous membrane of the lower portion of the ileum greatly
congested with blood.   Peyer's glands somewhat enlarged,  more
distinct and elevated than  usual,  but pale and  not congested and 
240
OBSERVATIONS  ON
inflamed as in typhoid fever.  Solitary glands enlarged and distinct.
Mucous membrane of colon greatly congested with blood.

                            Liver.
  The size of this organ, the complexity and delicacy of its struc-
tures, and the extent and variety and importance of its offices, all
demonstrate  the value  and necessity of careful microscopical and
chemical examinations  of its structures, blood  and  products, in
pathological conditions.  The necessity of these careful  examina-
tions is placed' in a stronger and clearer light every time that the
bounds of pathological and physiological  science are enlarged.
  Modern research has  confirmed the ancient idea that the liver is
the fabricator of the blood.  M. CI. Bernard1 has demonstrated that
the liver is a great starch and sugar  manufactory, that it possesses
the power  of converting cane  sugar  into  hepatic  sugar, and of
changing the albuminose received  from  the alimentary canal
through the portal circulation, into the albumen of the blood.
  Weber3 has  shown  that there is an  extensive  generation of
colored blood-corpuscles in the liver of  the  embryo,  and in the
liver of the frog in the spring of the year, when the sexual organs
are highly developed, and when  the lymphatic system is in a highly
active state.
  Kolliker3 and  Bernard4 have confirmed these observations, and it
is now known that there are both a destruction and a regeneration
and formation of the colored and colorless corpuscles in the liver.
  Thackrah, Simon, Lehman and Bernard  have shown that the
fibrin is altered both in quantity and quality, during its passage
through the liver.
  According to Simon and Lehmann, the fats are diminished in the
blood passing through the liver.
  The extractive  matters, according  to  several observers, are in-
creased in  hepatic blood, whilst the  albumen, salts, and  iron are
diminished.
  These facts, and many others as well  established, indicate  that
the complete examination of the liver in physiological and  patho-
logical  conditions, requires a careful analysis and comparison of

  1 " Lectures on the Function of the Liver," L'Union Medicale, 1850.
  2 Henle and Pfeufer's Zeitschrift, 1846.
  3 Kolliker iiber die Blutkbrperchen der Menschlichen Embryo und die Entwick-
elung der Blutkorperchen der Saggethieren.
  4 Bernard and Robin on the Blood;  translated by W. T. Atlee, M. D., Philada.
1854, p. 106. 
                       MALARIAL  FEVER.                    241

the blood in the portal system before its entrance into the liver,
and of that in  hepatic  veins, which has traversed  the liver-
requires a careful analysis of the venous blood  in other parts of
the system, and a comparison  of the venous, portal,  and hepatic
blood—requires a careful chemical analysis, quantitative and quali-
tative, of the starch and sugar and bile and other matters separated
or  elaborated  from  the  blood  by the liver—requires  a  complete
chemical analysis of the  contents of the capillaries,  and of the
biliary tubes and cells, and of  the walls  of these capillaries, tubes
and cells—requires a complete microscopical examination of all the
structures of the liver.  Not even one single division of these sepa-
rate  subjects of inquiry can, in the present state of  physiological
and  pathological  science,  be executed with absolute accuracy, and
the majority  are  so complex  and  difficult of  investigation, that
even the attempt has never been made.
   Besides the difficulties necessarily attending the procuring of the
 blood from  the portal and hepatic veins; the value of the analyses
 must be in a great measure vitiated, and the conclusions based upon
 them rendered  doubtful in the extreme, by the changes  in the cir-
 culation and  in the chemical constitution of the blood during the
 last  moments, independent entirely of the original changes resulting
 from the action of the poison.
    The difficulty of correct microscopical examination of the liver,
 is strikingly shown by the differences of opinion amongst the most
 distinguished  anatomists, with reference to the connection of the
 liver-cells with the hepatic ducts.
    Kiernan,1 Schroder Vander  Kolk,2 Krukenberg,3 Weber,4 Eet-
 zius,5 Theile,6  Backer,7  Leidy,8  and Beale,9 have advocated the

    » "The Anatomy and Physiology of the Liver," by Francis Kiernan, Philoso-
 phical Transactions, 1833.
    2 In Backer's Essay, " De Structura Subtilori Hepatis Sani et Morbosi."
    3 Gerlach's Gewebelhre, ii. Auflage,p. 329. Untersuchungen ueber den feineren
 Bau der Menschichen Leber, in Mull. Archiv., st. 318.
    « Annot. Anat. et Physiolog., prol. vi., vii., viii., Lips.   Zusatze zu seinen Un-
 tersuchungen iiber den Bau der Leber in Berichte der K. Sachs. Ger. d. Wissench
 zu Leipzig, st. 151.  Programmatar Collecta, Fasc. ii. Lips.
    6 Uber den Bau der Leber, Mull. Archiv. ii. p. 141.
    6 Art. Leber, in R. Wagner's Handw. der Phys. ii. st. 308.
    ' De Structura Subtiliori Hepatis Sani et  Morbosi,  Dis Inaug. Trajecti  ad
  Rhenum.                                                      T .,
    " " Researches into the Comparative Structure of the Liver," by Joseph Leidy,
  American Journal of the Medical Sciences, January, 1848, p. 18.
    9  On Some Points in the Anatomy of the Liver of Man and Vertebrate Animals,
  by Lionel S. Beale, M. D.  London, 1856. 
242
OBSERVATIONS  ON
existence of a  tubular basement membrane, continuous  with the
ducts, within which lie the liver-cells.
   Kolliker1 describes the hepatic cells as so arranged in the lobules
as to form a  network, by the simple apposition of the flat surfaces,
without the  assistance of any foreign connecting, intermediate, or
investing coat.  Not a trace of biliary ducts is to be observed in
this network, and it is impossible to make out any connection be-
tween the biliary ducts and hepatic-cell network, which is undoubt-
edly the secreting portion of the liver.
   Dr. Handfield Jones2 asserts  that the  ducts terminate  in  blind
extremities on  reaching the lobule, instead  of forming a plexus
within it, and that the chief agents in the secretion of the bile are
the cells  lining these  ducts, and not the cells lining  the lobular
substance.
   Dr. H.  D. Schmidt,3 of Philadelphia, one of the latest and most
accurate observers on the minute anatomy of the liver, states as the
results of his observations upon  fresh and injected livers, that " two
capillary  networks, each independent of the other, exist in  the
lobule of the liver; the  one, commencing at the periphery of the
lobule, from  the smallest branches of the portal vein and hepatic
artery, and ending in  the centre in  those of the hepatic vein, is
destined for the circulation of the blood brought there by the portal
vein  and hepatic  artery; the other, commencing  independently in
the centre of the lobule,  near the intralobular vein  (branch of the
hepatic vein), and ending in the smallest branches  of the hepatic
duct, is most probably destined to  carry off the  secretion  of the
cells.  The cells lie  within the meshes of these two networks; but
seem to be especially held in their position  by their adhesion  to
the network destined to secretion."
   These facts show the necessity for careful and laborious research,
and the importance  of having a large number of careful, conscien-

  1 Manual of Human Microscopical Anatomy, by A. Kolliker.  Translated by G.
Busk and T. Huxley.  Philadelphia, 1854, p. 532 et seq.
  2 C. Handfield Jones, " On the Secretory Apparatus of the Liver;" Philosophical
Transactions, 1846, p.  473.  " On the Structure and Development of the Liver;"
Phil. Trans., 1849, 1. p. 109. "Further Inquiries on the Structure, Development,
and Functions of the Liver;" Phil. Trans., 1853, part i. pp. 1-29.
  3 American Journal of the Medical Sciences, Jan., 1859, vol. xxxvii.,N. S. p. 22.
In this article Dr. Schmidt describes valuable apparatus for microscopical investi-
gation, invented and constructed by himself.  The use of such delicate and accu-
rate apparatus will, without doubt, greatly facilitate and add much accuracy to
microscopical examinations of the liver. 
MALARIAL FEVER.
243
tious investigators engaged in this field.  The accuracy and value
of pathological investigation depend upon the state of anatomy
and physiology.  If anatomists  and physiologists are not  agreed
with reference to the minute anatomy of the liver, and the mode of
formation and  offices  of its secretions, how can the pathologist
arrive at accurate and  definite conclusions when he has to investi-
gate not only the complex anatomical structures and  secretions,
but also examine the  morbid, physical, and chemical alterations,
and if possible discover the character  and mode of action of  the
morbific agent or agents?
  Notwithstanding that much time and labor were expended in
microscopical and chemical examinations of the  liver in  malarial
fever, yellow fever, and in other diseases; and notwithstanding that
several  facts, which appear to possess some pathological value, were
discovered ; still, the knowledge thus far acquired extends only to
the most general  and superficial phenomena, and the whole subject
is open  for investigation, and presents to investigators an inviting
and almost entirely new and untrodden field.  The imperfect results
of my labors are now presented with the  hope that others of  far
more learning and  ability may be excited  to enter  the  same field,
and not only prove the truth or falsity of the observations recorded,
but also remove  the obscurity and absolute  ignorance which now
exist with reference to the cause and character of the pathological
changes  of  all  the organs, and establish such a body of scientific
facts as shall lead to the careful  determination of the pathological
alterations and  relations of all diseases.
Weight of the Liver in Malarial Fever.
	Avoirdupois pounds.	Avoirdupois ounces.	Troy grains.
Weight of healthy liver; mean of 82 obser-vations on males..... Ditto; mean of 36 observations on females Weight of liver in intermittent fever " remittent and typhoid fevers " lichen agrius during con-valescence from remit-tent fever . " remittent fever " congestive fever . "' congestive fever . " congestive fever .	J 3 to 4 3 to 4 3 lbs. 4\ ozs. 3 lbs. 11^ ozs. 5 " 3 " 4 " 3 " 5 " 0 " 5 " 3 " 4 " 3^ "	48-58 40-50 52£ 59£ 83 67 80 83 67i	( 13000 \ to ( 25375 f17500 1 to (21875 22968 25642 36312 29312 35000 36312 29416
 
244
OBSERVATIONS  ON
   According to the researches of Dr. John Reid, the liver weighed
in 43 cases out of 82 between 43 and 58 ounces in the adult male;
and in  17 cases  out  of  36 its weight in the adult female ranged
between 40 and 50 ounces.
   It may, then, in general terms be stated  that the weight of the
liver in health varies from three to four pounds, according to the
quantity of blood which it may contain at the time it is examined.
   The comparison of these results with  the  weight of the  liver in
the different forms of malarial fever, shows  that the weight of the
liver is increased in malarial fever.
   We would naturally  expect  this  increase of weight from  the
stagnation and accumulation of blood in the capillaries and blood-
vessels of the liver in  malarial fever.  In all such examinations it
should ever be remembered that the weight of the liver varies con-
siderably in  health, according  to the amount of blood which it
contains.

             Color of the Liver in Malarial Fever.
   My observations upon the  color of the liver, agree in the main
with those of Dr. Thomas Stewardson,1 of Philadelphia.
   This  distinguished pathologist first pointed out the fact that the
color of the  liver in malarial fever  is changed from the  normal
reddish-brown to a slaty or bronze, or mixture of bronze and olive.
The knowledge of this  peculiar change of  the color of the liver
during  malarial fever  is  exceedingly valuable  as  a means of  dis-
tinguishing malarial fever from yellow,  typhoid,  typhus,  and all
other fevers.
   The observations of Dr.  Thomas Stewardson,  have been con-
firmed by those of Dr. Wm. T. Howard,2 in the Baltimore Alms-
house, of Dr. Swett,3 in the New York Hospital, of Drs. Anderson"
and Frick, in  the  Baltimore Almshouse and  Infirmary,  and of
Dr. Eichard  Arnold,5 in the  Savannah Marine Hospital and Poor
House.

  1  Stewardson, " On Remittent Fever," American Journal Med. Sciences, April,
1841, New Series, vol. i. p. 289.  Elliotson's and Stewardson's  Practice of Medi-
cine, p. 338.
  2  Communicated by Dr. Stewardson, Am. Journ. Med. Sciences, 1845.
  3  Swett " On Pathol, of Remittent Fever," Am. Journ. Med. Sciences, 1845.
  4 Published by Dr. Alfred Stille,  Am. Journ. Med. Sciences, April, 1846.
  3  " An Essay upon the Relation of Bilious and Yellow Fever, prepared at the re-
quest of, and read before the Medical Society of Georgia, April, 1856," by Richard
D. Arnold, M. D.  Southern Medical and Surgical Journal, vol. xii. p. 515. 
                      MALARIAL FEVER.                   245

  In  all the  different  forms of malarial fever, intermittent, re-
mittent, and congestive, which had continued longer than five days,
and in which there had been no  previous structural alterations of
the liver, as cirrhosis or fatty degeneration, I found  the exterior to
be of a slate color, and the interior of a bronze color.  In  a case
of remittent and typhoid fever, the liver presented  the true mala-
rial slate color upon the  exterior, and the bronze  color in the in-
terior.
  In cases of  death from  other causes, during  convalescence from
malarial fever, the  color of the liver, both upon the  exterior and
within was not so deep,  and presented various shades, from the
slate, to dark  Spanish brown.  The change in the color appears to
be  very persistent. I  have,  in  several  cases,  observed that the
liver retained  shades of light slate and light  bronze, several weeks
after the relief of the attack of malarial fever.
  The liver of  a  stout American seaman, who had  died  from  a
severe attack  of congestive fever, of only three and a half days'
duration, presented upon  the exterior, a color only a shade darker
than  usual, with the exception  of two slate-colored  spots.  The
largest of  these slate-colored spots, was  four inches  in diameter,
and was situated upon the anterior surface of the right lobe, whilst
the smallest was situated upon  the  posterior  surface, of the left
lobe.   When  an incision was made into the structures of the liver,
through these spots, the substance presented a bronze color for the
depth of a quarter of an inch.  In all other parts of the liver, the cut
surface presented a color only a shade deeper than normal.
  In  a case of congestive  fever of the  most sudden onset and rapid
progress,  which was ushered in by  vomiting, complete  exhaus-
tion of the muscular and nervous forces, and  profound coma;  a
large portion of  the surface of the liver presented the healthy Span-
ish-brown  color, and when cut, the substance presented the usual
healthy color,  whilst the other portions presented a mottled appear-
ance of Spanish-brown and dark purple, and the bloodvessels of
these parts appeared to be  engorged  with blood.   The  right lobe
of the liver had  upon its under surface a spot about two inches in
diameter, of a dark slate (malarial color).  When an  incision was
made through this  portion of the liver, it presented for the depth
of about one-fourth of an inch, the true bronze color.
  Numerous incisions were made into the liver in all directions, so
as to  expose its  substance fully to view; portions were found, ap-
proaching in color the  bronze hue of the malarial fever liver;  the 
246
OBSERVATIONS  ON
great mass of the liver, however, resembled  more nearly that of a
healthy liver  engorged with blood.   Portions from different parts
of the liver were examined under the microscope.
   The liver cells, from the slate-colored and  bronzed portions, did
not differ in  appearance  under the microscope, from those of the
normal colored, or from those of the mottled portions.
   The colored corpuscles appeared to be more altered in form in
the bronzed portions, than in the normal colored portions.  The
alterations, however, even in the bronzed portions, were small and
by no means universal, but confined to a few, and after all, the differ-
ence may have been imaginary.  The  determination of comparative
alterations of this kind is  not so easy  as at first sight appears.
   Did not discover any of those dark granules in the bronze por-
tion, which  have been said to impart  the  peculiar color to the ma-
larial liver.   The liver cells  did not appear under the  microscope
to have been altered in any manner.

  Effects of Previous Pathological Alterations upon the Color
                of the Liver, in Malarial Fever.
   In  making examinations of the different organs  after death, and in
attempting to determine definitely the changes of color, we should always
determine, if possible, the condition of the liver previous to the disease.
   There are two affections of the  liver which  are attended with
profound alterations of the structures, and always modify the color
characteristic of malarial fever.
   The liver of an Irishman, who died  in the latter stages of phthisis
pulmonalis,  from intermittent fever, presented a purplish-red color,
notwithstanding the  presence of the  disease  long enough to have
produced the decided slate and bronzed color.  The structure was
unusually firm; it required considerable force to tear it asunder.  It
cut toughly under the knife, and the  lobules  started out  from  the
cut surface,  as if they had been bound down.  The fibrous capsule
surrounding the  exterior of the liver, forming  a sheath for  the
larger vessels  lying in the portal canals,  was thickened.   The in-
dividual  lobules of the liver were surrounded with fibrous tissue.
Here  then we  have the explanation of the variation of the color of
the liver from that characteristic of malarial fever.
  The lobules of the liver have  been  described  by Malpi<rhi  ]

        1 Malpighi, De Viscerum, Structura Bologna.  London, 1699. 
                       malarial fever.                   247

Kiernan,1 Miiller,2 Leidy,3 and  others, as isolated from  each other,
and each invested  with a layer of areolar or fibrous tissue.  In the
pig, in which these lobules were first noticed, and in  the Polar bear
according to Miiller, and in  the Octodon Cummingii, according to
Hyrtl,4 the lobules are invested by fibrous tissue, but in the liver
of the human subject, and in that of vertebrate animals generally,
the lobules  are not separated  from each other  by a fibrous parti-
tion, and there is  no areolar or fibrous tissue  or prolongation of
Glisson's capsule between them or in their interior.
  Vogel, Henle,5 Bowman,6 and Beale,7 have failed  to detect  any
fibrous tissue in the interlobular fissures of the normal human liver.
  In cirrhosis of the liver, on the other hand, there is a  remarkable
development of fibrous tissue in the parenchyma of  the liver;  and
the individual secreting segments become prominent or even firm
isolated lobules.
  The  increase of fibrous  tissue in the liver of this subject  was
manifest to the eye, and especially when the liver was subjected to
the action of a stream of water, and gently mashed between the
fingers.  The softer  parts were washed  out  and the fibrous tissue
remained.   The character of this was determined by microscopical
examination.  The portions of the liver surrounded by the indu-
rated fibrous tissue appeared to be but  little altered, and could be
readily scraped away.
  The cirrhosed condition of the liver was not the result of mala-
rial fever, for the microscopical  examination showed that the fibrous
tissue was abundant and  well formed.   The whole structure of the
liver could  not have been  pervaded with fibrous tissue  in a few
days.   It is reasonable to conclude with Dr. Budd,8 that  the re-

  1  "The Anatomy and Physiology of the Liver," by Francis  Kiernan, Philoso-
phical Transactions of the Royal Society of London, 1833, p. 714.
  2 Miiller, De Glandularum Secernent Struct. Penit, Berlin, 1830.  Elements of
Physiology, by J. Miiller, M. D., translated by Wm. Baly, M. D.  London, 1840 ;
vol. i. p. 493.
  3 "Researches into the Comparative Structure of the Liver," by  Joseph Leidy,
M. D.  American Journal of the Medical Sciences, New Series, vol. xv., 1848, p. 18.
  4 Hyrtl, Lehrbuch der Anatomie des Menchen., 1850.
  6 Hufeland's Journal, 1838, p. 8.
  6 Article " Mucous Membrane " in Todd's Cyclopaedia of Anatomy and Physiology,
by W. Bowman, vol.  iii. p. 497.   The Physiological Anatomy and Physiology of
Man, by Todd and Bowman.  Philadelphia, 1857, p. 773.
  7 On Some Points in the Anatomy  of the Liver of Man and Vertebrated Ani-
mals, by  Lionel S. Beale, M. D. London, 1856, pp. 13, 16, 19, 72.
  8 On Diseases of the Liver, by George Budd, M. D.  London, 1857, p. 143. 
248
OBSERVATIONS ON
markable changes in cirrhosis, are  mainly the consequences of ad-
hesive inflammation in the areolar tissue about the small twigs of
the portal vein, and in  the  areolar tissue of the  portal canals, by
which serous fluid and coagulable lymph are poured out.  In this
stage  the liver may be enlarged.  The serous part of the effusion
is  next  absorbed,  the lymph contracts, becomes converted  into
dense fibrous  tissue, which  divides the lobular  substance of the
liver into well defined masses, and gives great density and tough-
ness to  the organ.   Finally, this  fibrous tissue compresses the
small  twigs of the  portal vein and the small gall-ducts,  and thus
impeding the escape of the bile and the flow of blood induces  great
atrophy of the original hepatic tissue, and causes  by a deprivation
of blood and  the  admixture of  this dirty white fibrous tissue,
marked  changes  in  the  color of the liver.   If these views of Dr.
Budd be correct, it is evident that this condition of the liver could
not have resulted from an attack of malarial fever, which had com-
menced  only twelve days before death.
  This patient was an Irish laborer.  This class are addicted to the
free use of ardent spirits, and the true cause of this cirrhosed con-
dition of the liver  was the action of  the  alcohol in the portal
blood, absorbed directly from the stomach  and intestines upon the
bloodvessels and secreting apparatus of  the  liver.  We know that
this form of disease is most frequent in large manufacturing towns,
among the  poorer  classes, who drink  large quantities of ardent
spirits.  All the  cirrhosed livers which I have had an opportunity
of examining, have been taken from the bodies of those who have
been  accustomed to the free  use of spirits.  So common and well
known  is this cause,  that  cirrhosis is familiarly termed by the
English practitioners, gin-drinker's liver.
  The color of the liver of this patient was very different from that
generally presented in cirrhosis.   Upon the inferior surface of the
liver,  there was a small portion of a dark slate, inclining  to bronze
color, resembling the color of the malarial fever liver, and forming
a striking contrast with the surrounding purplish red color.
  In  cirrhosis, owing to the  admixture of fibrous tissue and the
impediment to the  circulation of the blood, and the passage of the
bile, and the compression of the capillaries and secreting apparatus,
the normal dull-reddish  brown color of the liver is altered some-
times to a bright  canary yellow, sometimes to a  brownish or
greenish, and occasionally to a reddish color.  A section of the 
MALARIAL FEVER.
249
liver upon a general view presents the grayish and yellow color of
impure beeswax.
  In  this case, owing  to  the  pathological conditions  of cirrhosis,
the admixture of fibrous tissue, impediment of the circulation of the
blood, and flow of bile, and the compression of the capillaries and
secretory apparatus, the color of  the liver was not so marked as in
those cases of malarial fever in which the liver was normal before
the introduction of the malarial poison.
  Allowing due weight to the pathological changes of cirrhosis, it
is evident that the change in  the color of the  liver was similar, in
all respects, to the slate and bronze color of livers which were nor-
mal before the onset of the malarial fever.
   The liver of a house painter, who died suddenly during convales-
cence from a severe attack of malarial fever, presented upon a general
view, a light  slate  color, with purplish and  brownish reflections.
Upon nearer inspection, it presented a  mottled appearance, many
of the lobules presented the yellow color of cirrhosis.  The cut
surface presented upon a general view a light bronze  and pur-
plish yellow color.   Upon close inspection, the yellow lobules were
distinctly visible.   Structure of the liver unusually firm, it re-
quired great force to tear it.  The  yellow color of  many of the
lobules and the large admixture  of dense fibrous tissue prove that
this liver was in a cirrhosed condition  previous to the attack of
malarial fever.  The yellow color of the cirrhosis was  masked very
much by the characteristic effects of the malarial poison.
   In the case of a  German barkeeper, who died with  congestive fever
after  seven days1 sickness, the  liver presented a singular mottled
appearance;  at a distance, it presented a light bronzed color; upon
nearer inspection the lobules were found to be distinct, elevated,
and of a light  bronze color, whilst the spaces between the lobules
inclined  to a slate color.  There  were several spots, varying from
two inches  to half an  inch in diameter, of a uniform slate color.
The structure of the liver was unusually firm, it required consider-
able force to tear  it asunder, it  cut toughly under  the knife, and
the lobules started  out from the cut surface  as if they had been
bound down.  The fibrous capsule surrounding the exterior of the
liver, and forming a thick sheath for the large vessels lying in the
portal canals, was thickened, and the individual lobules of the liver
were  surrounded with fibrous tissue.
   These  facts, which  were demonstrated, not only by the touch
and naked eye, but also by the  microscope, showed that this liver
       17 
250
OBSERVATIONS  ON
 was in a cirrhosed condition.  Cirrhosis of the liver in this case
 was not caused by the action of the malarial poison, but in all pro-
 bability by the habitual use of ardent spirits.   This patient was a
 barkeeper.   Men in this occupation are, as a general rule, addicted
 to the free use of ardent spirits.  The liquors drank in this country,
 at the hotels and bar-rooms, contain much alcohol, which  acts upon
 the secreting structures of the liver, and upon the bloodvessels, and
 excites adhesive inflammation in the areolar tissue, about the small
 twigs  of the portal vein, and  in the  areolar tissue of the  portal
 canals, by which serous fluid and coagulable lymph are thrown out.
   Under the microscope, the substance of the liver contained many
 dark-looking masses resembling the altered blood-corpuscles of the
 spleen, and the black granules  and flakes  of black vomit.   These
 dark masses were not sufficiently numerous to produce any marked
 effect upon  the color of the orgau.   When the fibrous capsule was
 torn off, it presented a light slate color, and yet, when  magnified
 and  carefully examined, but few of these dark masses were seen in
 the meshes.
   The structures of the liver and the liver-cells contained numerous
 oil-globules.  These oil-globules existed in sufficient  numbers to
 induce the belief that the liver  was in  a state not only of  cirrhosis,
 but also of  fatty degeneration.
   The mottled appearance of the liver, and  the want of that decided
 slate and bronze color characteristic of malarial fever, were due not
 to any peculiar effects of the  malarial poison, but rather  to the
 pathological conditions of cirrhosis  and fatty degeneration. Allow-
 ing due weight to  these pathological changes, it is evident that the
 change in the color of the liver was similar in all respects to the
 slate or bronze color of livers which were  normal before  the onset
 of the malarial fever.
  These facts show the importance, in all pathological  investiga-
 tions of the physical and chemical changes of the organs  after
 death,  of determining definitely the previous diseases and habits of
 the patients.   AVithout such  examinations the most erroneous con-
 clusions might be drawn with reference to  the nature of  the struc-
 tural alterations of the different organs, especially of  the liver
 during disease.
  The length of the disease should always be  accurately ascer-
tained.  Yvre know that the malarial poison is in many cases either
 from peculiarities of constitution, or changes in the forces induced
by bad habits and previous diseases; or from the amount and con- 
MALARIAL FEVER.
251
centration of the dose; or from the extent  and importance of the
offices  of  the organ upon  which its  force appears to be mainly
expended; exceedingly rapid and violent in  its action—death in
some cases occurring in 40 hours after the  appearance of the first
symptoms.  If the patients thus suddenly attacked have  never
been exposed previously to the malarial  poison, we should not
expect to find the  characteristic alterations in the color and struc-
tures of the liver and spleen as well marked as in cases of longer
standing, for all morbific changes attended with physical changes
of structure and color are attended by definite chemical changes,
and in most cases  are absolutely dependent upon such changes,
either in the blood or in the nervous systems or in the structures
of the organs; and as every chemical change  requires time for its
production and completion, so must every pathological change have
time for its  production and completion.  The  pathological altera-
tions of the organs would be most decidedly manifested, even after
apparent sudden attacks in those who have resided for some time
previous in  the malarious district, for in two instances on record,
the bronzed liver was found a year and more after the patient had
suffered from remittent fever, and, in the interval these persons had
enjoyed good health.
  In localities like Savannah, Charleston, New Orleans, and Mobile,  -
where  the yellow fever has prevailed as an epidemic, it would be
exceedingly important and interesting  to determine the effects of
previous attacks of yellow fever  upon the  structures and color of
the liver, and the characters of the alterations  presented in a sub-
sequent attack of  malarial fever.   Judging by  the extent  and
character of the alterations of the liver in  yellow fever, we would
say that they were as persistent as those of malarial fever, and that
they would, like the alterations of cirrhosis and fatty degeneration,
mask the characteristic color  of the malarial  liver.   These facts
demonstrate the extent and complexity of pathological phenomena
and the number of the  sources of uncertainty and  error in  patho-
logical investigations.

Changes of the Color of the Blood in the Liver of Malarial Fever.
  The blood of the liver in  malarial fever presents a dark brownish-
red and dark purplish-red color, often  inclining to black, and does
not change to the  arterial hue when exposed to the atmosphere.
If the patient  dies within  two days of the commencement of the
disease, there may  be  a  change  in portions  of the blood  issuing 
252
OBSERVATIONS ON
 from the cut surface, to the arterial hue.   This change takes place
 also in  the blood of the livers, taken from patients who have died
 from other diseases, during convalescence from malarial fever.

   Sources of the Change of Color in the Liver during Malarial
                              Fever.
    The change in the color of the liver during malarial fever is due to
 changes  in  the amount, and physical and chemical constitution of the
 blood in the capillaries of the liver, and to the physical and chemical
 changes  in the bile, and the contents of the secretory apparatus.
   Dr. A. Clarke1 has announced that the hue peculiar to the malarial
 liver " is produced  by an infinite number of colored microscopical
 particles of irregular shape and size, totally different from anything
 that enters  into the  constitution of the healthy liver; that these
 colored  particles are  scattered irregularly through the hepatic tis-
 sue, are seen to occupy the  secreting cells of the organ, and even
 the nuclei of these cells;  that tbey  vary  in hue from red or orange
 to an opaque, jet black, though  much the greater number  are of
 a  semi-transparent  dark-brown  color; and that, in shape, the  red
 and dark-brown particles  are, some beautifully  crystallized, some
 in  globular  dots and grains; while the  black,  often  in globular
 grains, are also seen in friable, semi-crystalline scales, some of them
 almost large enough to be  seen by the naked eye.   The nature of
 this coloring  matter must be sought among the  chemical transfor-
 mations  of hematin, or coloring  principle of the blood.  The belief
 is expressed that in the remittent fever, as in many other diseased
 states, the hematin is readily yielded by the blood, and, passing into
 the liver substance, there meets with some unknown agent,  which
 changes  its chemical  constitution, and converts it into the forms
 and colors here described."
   With  reference to the extent and character of his investigations,
 Dr. Clarke states in  a  note appended to the first volume of Dr. La
 Eoche's learned work on yellow fever:  " The hospital with which I
 am connected, though a very large one, does not receive many cases
 of this disease, and within the paved and  sewered districts  of this
 island  it is virtually extinct.  In the last seven  years, I may have
 witnessed seven post-mortem examinations, and though I have not

  1 The History, Diagnosis and Treatment of the Fevers of the United States, by
 Elisha Bartlett, M. D. Edited by A. Clarke, M. D. Philada. 1856, pp. 370, 371.  Yel-
low Fever  considered in its Historical, Pathological, Etiological and Therapeutical
Relations, by R. La Roche, M. D.  Philadelphia, 1855, vol i. pp. 610-615. 
MALARIAL FEVER.
253
kept notes of them, I can trust my recollection  to  assert that I
have seen no instance in which one of the recognized hues did not
exist.
  "Portions of the liver in each one of these cases have been studied
with the aid of the microscope, and in all, the coloring matter here
called hematoidin has been found abundant, and in each case, as
far as could be judged, the quantity was nicely proportioned to the
intensity of the abnormal color."—p.  614.
  The careful microscopical examination of the  livers of fifteen
cases of intermittent, remittent and congestive fever, has convinced
me that whilst  the red and dark-brown and black granules  do
occur in some cases of malarial fever, they are absent in the livers
of others which do not differ in color  from those in wdiich they are
present.  I have  seen the slate and bronze color of the liver as well
marked in the liver when these dark  masses were absent, as in the
liver when they were most abundant.  Careful microscopic exami-
nations of the slate and bronze colored spots in the livers of those who
had died suddenly with malarial fever, and of the  slate and bronzed
colored spots sometimes found upon the kidneys  in malarial fever,
demonstrated that this hue was just as decidedly marked  when
there was an entire absence of the peculiar dark masses.
  That the peculiar color of the liver is due in a  great measure to
changes in the coloring matter (hsematin) of the blood, is indicated
by the fact that the blood from the capillaries of the liver will not
ehange from the dark reddish-brown and  purplish color to the
arterial hue. It is probable that the altered coloring matter, result-
ing from the destroyed disintegrated  blood-corpuscles, or from the
blood-corpuscles  acted  on  by the  malarial poison without actual
disintegration, escapes and permeates  the surrounding tissues, and
imparts the peculiar color of the liver.
  The color of the  liver remains  the same, whether the coloring
matter  be retained in solution, or is precipitated,  forming the dark
granules.
  The peculiar hue appears to be also due to the  altered  color
of the bile.  In all the cases of malarial fever which I have thus
far examined, I have found the  bile to be of high specific gravity,
thick, concentrated,  and of a greenish-black color when seen in
mass, and of a gamboge yellow  when spread in thin layers.   The
liver cells under the microscope presented a light greenish-yellow
color, as if they also were infiltrated with the altered coloring matters.
In some cases the liver-cells contained  fewer oil-globules, and  the 
254
OBSERVATIONS  ON
cell-walls looked thinner than usual; in other cases they resembled
closely the healthy cells.
  The peculiar color of the malarial liver can,  to a certain extent,
be extracted by boiling water.
  In  almost every case I found the filtered decoction of malarial
fever  livers, to be of a brownish-yellow color, whilst the decoction
of yellow fever livers is of a  bright golden color, whilst that of
normal livers is of  a  light yellow.   These observations, however,
should be repeated  upon  an extensive scale, before we can  decide
upon  the characteristic color of the decoctions of the liver in dif-
ferent diseases.
  After the altered coloring matters of the blood and bile have in-
filtrated the structures of the liver, they will sometimes remain for
a considerable length of time  without being absorbed, and it may
communicate the peculiar bronzed color to the liver, long after the
restoration of its normal  functions, and  the disappearance  of the
malarial fever.  I have observed, however, that the intensity of the
color  of the liver bears a marked relation to the time of convales-
cence ; as convalescence advances, the color diminishes.

          Characters of  the  Bile in Malarial Fever.
  The gall-bladder, in fifteen cases of the different forms of mala-
rial fever, was filled with bile, which had, in the majority of cases,
the consistency of molasses, and presented  a  greenish-black, with
yellowish and reddish reflections when seen in mass, and of a gam-
boge-yellow when spread in thin layers.  In every case the mucous
membrane of the small intestines were colored yellow by the bile
throughout almost the entire extent, and  in many cases the mucous
membrane of the stomach was in like manner discolored with. bile.
The characters of the bile vomited during life, corresponded to that
found in the gall-bladder after death.
  In  a case of congestive fever of only forty-three  hours' duration, the
specific gravity of the bile was 1042.5, and viewed in mass it pre-
sented a brownish-black  color  with greenish  reflections, and re-
sembled, upon  a  general view, a saturated  tincture of iodine.  It
poured like  molasses, being thick and ropy.   Upon close  inspec-
tion,  the bile was found to contain numerous flakes of a green color,
which, under the microscope, were found to  consist of the con-
glomerated cells of  the  mucous membrane  of the  gall-bladder. 
MALARIAL FEVER.
255
When spread out in thin layers, the bile presented a gamboge-yel-
low color.
  In a case of malarial fever of eleven weeks, which had been en-
tirely without treatment during the first  eight weeks, and which
ended in extensive  disorganization of the blood, muscular system,
and spleen, the  gall-bladder was filled with  bile of a  brownish-
yellow opaque color, when seen in mass, and of a gamboge-yellow
in thin  layers.   The bile  contained  numerous, irregularly-shaped,
yellow masses of various sizes, from an English pea to  a grain of
sand.   These yellow masses formed about two-fifths of the contents
of the gall-bladder. These masses were soft, and  readily crushed
between the  fingers.  Under  the microscope, they were found to
consist of numerous cells from the mucous  membrane of the gall-
bladder, and a yellow amorphous matter.   The bile-duct appeared
to be completely stopped up with these cells, and this yellow amor-
phous matter. The specific gravity of this specimen of bile was 1036.
  In the case of the house painter who died suddenly during con-
valescence from a  severe attack of remittent fever, the bile pre-
sented a brownish-yellow  color in mass,  and a  gamboge-yellow
color  in thin layers.  It was  tenacious like mucus; in  fact, it re-
sembled closely  colored mucus, specific gravity 1022.5.

  The liver of those cases which died in the active stages
of  malarial  fever  contained animal  starch  (glucogenic
matter, Bernard); whilst hepatic sugar was entirely absent.
  The liver of every fatal case of malarial fever was carefully tested
for animal starch and grape sugar, and the results never varied ; in
intermittent, remittent, and congestive fevers, animal starch  (glu-
cogene) was always present, while grape sugar  was always absent.
  In many cases when the fibrous capsules of  the livers were torn
off, partially dried,  and treated with tincture of iodine, the cellular
tissue was not  altered by the  tincture of iodine, but whenever a
particle of liver adhered to the fibrous tissue, these purple and blue
masses could be  detected with the microscope.   In cirrhosed livers
the fibrous tissue of the liver generally, and of the  portal canals,
were found to be completely infiltrated  with this animal starch.
When single cells of the malarial liver were treated  with tincture
of iodine, I was not  able to demonstrate satisfactorily, whether they
contained animal starch.  When, however, a number of them in
mass were  treated with tincture of  iodine, the characteristic  blue
color was produced. 
256
OBSERVATIONS ON
  In several cases the hepatic ducts were isolated and treated with
tincture of iodine, and carefully examined under the microscope;
in some cases the ducts were dotted with blue particles, whilst the
other portions  were simply changed  to the color  of the  iodine,
and in other cases long portions of the hepatic ducts were changed
to a bright blue color.  These facts  show that  the  hepatic ducts
sometimes contain animal starch.
  From chemical examinations of the livers of the different forms
of malarial fever, from the summer of 1856 to the present  time, I
have obtained similar results.  In  many cases the livers were set
aside, and examined  after intervals of twelve  hours; the last exa-
minations were made thirty-six hours after the first; and at every
examination the result was the same—the presence of animal starch,
without a trace of grape sugar.
  The mere presence of starch in the liver  is not peculiar to mala-
rial fever; it is not a pathological condition.
  In the month  of September, 1856, I had an opportunity of exa-
mining chemically the  liver of a  patient, who had been under the
care of my friend and former colleague, Dr. J. B. Eead.  This pa-
tient had black  vomit, and all the symptoms of yellow fever, and
the liver presented  the yellow boxwood color peculiar to this dis-
ease.  Chemical  examination gave decided evidence of the presence
of animal starch in thestructure of the liver.  The liver of a yellow
fever  patient brought  from Norfolk  by Dr. J. B. Eead presented
a similar appearance, and also yielded animal starch.  I have de-
tected this substance in the human liver, in  normal condition after
sudden death from  diseases of the circulatory apparatus, and apo-
plexy, and phthisis, and  in abnormal  states, as  cirrhosis, fatty de-
generation, and cirrhosis  and fatty degeneration combined.
  I have examined  the livers of numerous vertebrate animals, in-
jected and uninjected, and in every instance animal starch has been
found.
  Whether  the elaboration of this product is confined specially to
any one of the anatomical elements of the  liver, I have not as yet
been able to determine with certainty, for  it has been found in the
fibrous tissue of the portal canals, in the hepatic ducts, and in seve-
ral cases, in the lower  animals, in the secreting cells.  We would
naturally infer that  it was formed in  and  by the secreting  cells of
the liver, and was deposited in other positions by endosmosis. The
exact point at  which it is converted into grape sugar is unknown.
Bernard has shown that this change is due to the action of a special 
malarial  fever.                   257
ferment contained in the blood.  Experiments have shown that the
liver-cells contain grape sugar as well as the hepatic veins.  If the
starch is formed in the secreting  cells, and grape sugar is formed
in them also, then the special ferment of the blood must be absorbed
by the secreting cells.  A portion of the animal starch  may be ab-
sorbed by the hepatic veins, and be acted  upon by the ferment only
partially if in large quantities, and finally  be deposited in the organs
and tissues.
   This view is partially sustained  by the  fact that this substance is
not confined to the liver; for I have found it in considerable abund-
ance in malarial fever spleens, and in normal spleens  taken  from
patients who had died from cirrhosis and fatty degeneration of the
liver combined, and in one case where the patient (an aged negro
man) had died suddenly from apoplexy.   A carbo hydrate, similar
in  its composition and properties  to vegetable cellulose,  has  been
found in some  of the  lower animals.  C Schmidt1 discovered cel-
lulose in  the mantle of phallusia mammillaris  (one  of the mollusca),
and Lowig3 and Kolliker have  discovered it in  the outer tube of
salpas, in the leathery mantle of the cynthiae, and in the  cartilagi-
nous capsule of the simple ascidise.  The researches of Odier,3 Las-
saigne,4 Payen,5 Children,6 and Danniel,and especially of C. Schmidt,7
have shown  that a body  closely  resembling cellulose (vegetable
fibre), which C. Schmidt regards as composed of a carbo-hydrate,
and of a nitrogenous body having the composition of the  muscular
fibre of insects, forms the true skeleton of all  insects and Crustacea.
This substance, called  chitin, constitutes not only the external ske-
leton, the scales, and hairs of insects, but it also forms their tracheae,
and even one of the layers of the intestinal canal.  Cellulose, or
animal  starch, has been  discovered by Eudolph Virchow,8 in the
brain, and in some of  the higher nerves of sense.   These observa-

  1  Zu Vergl. Physiol, der Wirbellosen Thiere, 1845, S. 62.  See also " Contribu-
tions to the Comparative Physiology of the Invertebrate Animals, being a Physio-
logico-Chemical Investigation," by Dr. Carl. Schmidt; Taylor's Scientific Memoirs,
vol. v. part xviii., 1852, p. 34.
  2 Ann. de Scienc. Nat., 3d series, torn. v. pp. 193-232.
  3 Memoire de la Societe d'Histoire Naturelle, torn. i. p. 29 et seq.
  4 Comptes Rendus, torn. xvi. p. 1087; Journ. de Chim. Med., 1-9,  p.  379.
  6 Comptes Rendus, torn.  xvii. p. 227.
  6 Todd's Cyclopaedia of Anatomy and Physiology, vol. ii. p. 882.
  7 Zur Vergleichend, Physiol, der Wirbellosen, Thiere. 1845, S. 32-69 ; trans, in
Taylor's Sci. Memoirs, vol. v., 1852, pp. 14-28.
  8 Virchow's Archiv., b. vii., h. i., p. 135. 
258
OBSERVATIONS ON
tions were subsequently confirmed  by those of George Busk.  In
1853, Virchow1 announced the discovery of corpuscles, presenting
the same reaction as the corpora amylacea of the brain, in the Mal-
phighian corpuscles of  diseased human  spleens, in the condition
termed  waxy spleen.  Virchow, Bennet,  and Carter, have also
pointed out the  existence of a peculiar amyloid substance in the
liver, in some chronic forms of disease, as waxy or fatty degenera-
tion.  At a meeting of the Academy of Sciences, March 23, 1857,
M. CI. Bernard announced "that the livers of dogs, fed exclusively
on meat, possess the property of forming a glucogenic substance,
analogous to vegetable starch, and alike susceptible of an ultimate
transformation into sugar, passing through  the intermediate condi-
tion of dextrine."   Sanson,  Longet, Bouley, Poggiale, Parry, and
others, have recorded similar facts with reference to the occurrence
of a substance having very much the same chemical constitution
and properties of starch in the liver, and the results of the experi-
ments and researches of Bernard and these observers prove that in
herbivorous animals this substance  may be found  in other organs
besides the liver.
  The presence of animal starch, and the absence of hepatic sugar,
in malarial fever, would seem to indicate that the  special  ferment
in the blood which transforms animal starch into glucose, had been
destroyed, whilst the power to manufacture starch from both nitro-
genized and non-nitrogenized materials was exercised  by the liver,
and hence  the absence of glucose, and the  accumulation of gluco-
gene.

Some of the Points of Difference  between the Malarial Fever
                   and Yellow  Fever Liver.
  The liver of yellow fever, as far as my observations extend, and
according to the observations of Louis and many other observers,
is of a bright yellow  color.   It  is probable that this color, as in
the case of that of the malarial liver, varies with the length of the
attack, and the effects  of previous diseases.  Thus Dr.  Samuel
Jackson, of Philadelphia, found the  livers in cases which had died
suddenly in the early stages, engorged with dark blood.
  As far as my observation extends,  the decoction of the yellow
fever liver is of a  bright golden color, whilst that of  the malarial
1 Journal of Microscopical Science, No. vi. p. 101. 
MALARIAL FEVER.
259
fever is  of a brownish yellow.   The  golden color of the yellow
fever liver can be extracted both by alcohol and water.
  The yellow fever liver is much firmer  and harder than that of
malarial fever, contains much less blood and  is much less readily
acted upon by liquor potassae and acids.   Liquor  potassae readily
dissolves the malarial fever liver, and the decoction presents  the
appearance of venous blood, while no such effect  is produced by
the action of this substance  upon the yellow fever liver.

                             Spleen.
  The  complexity and difficulty of pathological inquiries  are
again illustrated, by the different views which prevail with refe-
rence to the  offices of the spleen.   Whilst Gerlach, Virchow, and
Bennet,  consider the  spleen as  the birthplace of the  colored cor-
puscles,  Kolliker, Ecker, Beclard  and Gray, consider it the organ
in which the blood-corpuscles die and  are disintegrated.
   The difficulty of settling this  question definitely, is increased by
the equivocal and  uncertain results of comparative anatomical in-
vestigations, and of physiological experiments.   If the function of
the  spleen be that of the formation and destruction of the  blood-
corpuscles, it is reasonable to suppose that  it should be much larger
in warm than in cold-blooded animals, because the number of the
blood-corpuscles is greater, and all the changes of the elements of
the fluids  and solids  much more  rapid in the former than  in  the
latter*  To determine this point, I ascertained accurately the weights
of the bodies and spleens of cold and warm-blooded animals.1
   The following table presents a condensed view of the results, the
accuracy of which I have confirmed again  and again, by numerous
dissections and comparison  of the spleen in  the different classes of
animals.
            Comparative Weights of the Spleens of Animals.
                                                      Number of times
                                                       the weight of
                              Fishes.                     its spleen.
Weight of the body of Trygon sabina (Stingray), female
      "      "     Trygon sabina (Stingray), foetus
      "      "     Zygsena malleus (Hammerhead Shark)
      "      "     Zygaena malleus (Hammerhead Shark)
      "      "     Lepisosteus osseus (Garfish)
      "      "     Lepisosteus osseus (Garfish)
 292
1016
 601
 443
 587
 599
  ' " Investigations, Chemical and Physiological, relative to certain American Ver-
tebrata," by Joseph Jones, M. D., Smithsonian Contributions to knowledge, July,
1856, pp. 116-122. 
260
OBSERVATIONS  ON
   Comparative  Weight of the Spleens of Animals—Continued.
                                                         Number of times
                                                           the weight of
                                                            its spleen.
                             Reptiles.
Weight of the body of Rana catesbiana (Bullfrog)     .     .    •  2279
       "      "      Heterodon niger (Black Viper) .     .    . 25666
       "      "      Psammophis  fiagelliformis  (Coachwhip
                       Snake).......6426
       "      "      Coluber guttatus (Corn Snake) .     .    .9600
       "      "      Coluber constrictor (Black Snake)    .    .  7285
       "      "      Crotalus adamanteus (Rattlesnake)  .    . 15450
       "      "      Alligator Mississippiensis (Aligator), male   1319
       "      "      Alligator Mississippiensis (Aligator), female   798
       "      "      Chelonia caretta (Loggerhead Turtle)    .  2201
       "      "      Chelonura serpentina (Snapping Turtle)  .   800
       "      "      Emys terrapin (Salt-water Terrapin) .    .  7958
       "      "      Emys reticulata (Chicken Terrapin)  .    .   965
       "      "      Emys serrata  (Yellow-bellied Terrapin)   .  1618
       "      "      Emys serrata  (Yellow-bellied Terrapin)   .  1125
       "      "      Testudo polyphemus (Gopher)  .     .    .  2575
       "      "      Testudo polyphemus (Gopher)  .     .    .  3600

                              Birds.
Weight of the body of Meleagris gallopavo (Wild Turkey), female  1538
              "      Meleagris gallopavo (Wild Turkey), female  2625
                     Picus erythrocephalus (Red-headed Wood-
                       pecker)  .......2120
       "      "      Tantalus loculator (Wood Ibis)      .    .  3579
       "      "      Tantalus loculator (Wood Ibis)      .    .  2044
       "      "      Syrnium nebulosum (Barred Owl)    .    .  1470
       "      "      Cathartes atratus (Black Buzzard)    .    .  122S

                             Mammals.
Weight of the body of Didelphis Virginianus (Opossum)    .    .   418
       "      "      Common Sheep......590
              "      Sciurus Carolinensis (Gray Squirrel)     .   682
                     Sciurus capistratus (Fox Squirrel    .    .   919
                     Cervus Virginianus (Foetus of  Deer)  .    .   283
       "      "      Cervus  Virginianus (Foetus of Deer) .    .   350
       "      "      Mus rattus (Rat just born)     .     .    .   498
       "      "      Mus rattus (Rat just born)     .     ,    .   505
       "      "      Mus rattus (Rat half grown)   .     .    .   506
       "      "      Lepus sylvaticus (Common Rabbit)  .    .  1494
       "      "      Procyon lotor  (Raccoon), female     .    .   343
       "      "      Procyon lotor  (Raccoon), female     .    .    292
       "      "      Procyon lotor  (Raccoon), female     .    .    391
       "      "      Procyon lotor  (Raccoon just born)    .    .   156
       "      "      Pointer Dog, male.....577
       "      "      Common Cat,  female.....522 
MALARIAL FEVER.
261
   These tables show that the spleen is smallest in birds and ophi-
dians, and largest in fishes and mammals.
   The temperature of  birds is high, their blood-corpuscles numer-
ous, their life actions vigorous, and  the physical  and  chemical
changes of the elements  of their fluids and solids correspondingly
rapid.  In fishes, circulation and respiration are sluggish, the blood-
corpuscles few in numbers, the temperature low, the metamorphosis
of the elements of their structure slow, and the intellect and all the
life actions correspondingly feeble.  If the function  of the spleen
be  the  construction, destruction, and  elaboration of some of the
important elements of the blood, why is it so small and insignificant
in birds, and of such great relative magnitude in many cold-blooded
animals?
   Is it possible that an organ, which, in many ophidians, chelonians,
and birds, weighs only a few grains, or a  small fraction of a grain,
can exert any important  influence upon the physical properties and
chemical constitution of  the blood?  Do not these facts show con-
clusively  that we do not understand the functions of the spleen?
   Mr. Gray1 supposes that one office of the Malpighian corpuscles
is to store up nutritive matter when there  is a surplus of alimentary
materials, to*be restored  again  to the blood when there is a defici-
ency of these elements.   It is, however, difficult to  conceive how
nutritive  matter of any importance could  be stored up in  the Mal-
pighian corpuscles  of organs weighing a few grains, or only frac-
tions of a grain.  The amount accumulated in such organs would
be  microscopic in its character, and not much more  than the hun-
dredth part of a grain.   Even in warm-blooded animals, the amount
of  albuminous compounds contained in the Malpighian corpuscles
of  the spleen is insignificant, and unworthy of notice,  when com-
pared with that contained in the circulatory apparatus, the capacious
reservoir  of the nutritive materials.  The circulatory apparatus
of an  adult man contains about twenty pounds of blood, whilst the
Malpighian corpuscles of the spleen are capable of containing only
a few grains.  Would nature  construct  an  organ,  an important
office  of which  would be to store up a few grains of nutritive
matter, whilst the circulatory system contains more than ten thou-
sand times the amount?
  My observations  show that  the  increase of the  spleen during
active nutrition noticed by Mr.  Gray in cats, rabbits and rats, is by

  1 The Structure and Use of the Spleen, by Henry Gray, F. R. S.  London, 1854. 
262
OBSERVATIONS ON
no means a universal phenomena in the animal economy.  The
spleens of ophidians and saurians and chelonians did not diminish
in weight more rapidly than the other organs and tissues, and the
spleens of salt-water terrapins {emys terrapin), and of yellow-bellied
terrapins (emys serrata), which had been  starved and deprived of
water for a great length of time, and then transferred to a tub of
water and abundantly supplied with vegetable food, did not exhibit
any increase in  weight.  I have also observed, in  numerous in-
stances, that the spleen of cold-blooded animals does not act as a
diverticulum for any surplus water or nutritive materials in the
circulatory  apparatus.   The spleens of many carnivorous chelo-
nians, whose circulatory apparatus was  so filled with blood, conse-
quent upon a change of diet, that aqueous  albumino-saline effusions
took place into the cellular tissue, and all the cavities presented no
increase in size or weight.  The spleens  of ophidians, which are
voracious and swallow  large masses of  flesh, were  not enlarged,
notwithstanding the  large amount of nutritive substances which
were received into their circulatory apparatus.
  That the  spleen is an organ of subordinate importance in the
animal economy, will be shown by the following facts:  It is ab-
sent from all invertebrate animals without exception".  It  is also
absent from the  amphioxus, the connecting link  between fishes
and the higher forms of the mollusca.
  The spleen  of birds and  reptiles is too small  to exert  an im-
portant influence in the animal economy.   Its size  corresponds in
no manner  with the number of colored blood-corpuscles, or the
rapidity of the composition and decomposition of the organic and
inorganic elements of the solids  and fluids of animals.
  The function  of the  spleen is not essential to the  maintenance
of life, for it  has been excised by numerous observers, without
the death of the animal, or any manifest alterations in the blood or
organs, or any diminution of the forces.
  On the other hand, that the spleen has some important office to
perform  in the animal economy, is shown by the fact that in the
amphioxus and  invertebrate animals, which are devoid of spleens,
the blood-corpuscles are colorless.  The occurrence of the spleen is
accompanied by a change in the color of  the blood.   The question
immediately arises, has the spleen anything to do with the produc-
tion of the red blood-corpuscles of vertebrate animals ? The blood
of the invertebrata, with its corpuscles, exists before the formation
of any special organs;  and the same fact  is noticed in the develop- 
MALARIAL FEVER.
263
ment  of the foetus  of warm-blooded animals; a vascular system
circulating a fluid containing colored blood-corpuscles exists before
the formation of any special organs; and hence it is probable that
the spleen has little to do with the formation of the corpuscles and
the production of their red color.  This question cannot, however,
be settled by  an appeal to comparative anatomy,  or  by extirpa-
tion of the spleen,  because it is more than  probable that other
organs possess the  power of performing the  offices of the spleen
when  it is absent.
  Besides these facts in  comparative anatomy,  the microscopical
examinations of the pulp of the spleen by Oesterlen, Eemak, Hand-
field  Jones, Kolliker, Ecker, Beclard, and Gray,  and the  com-
parative analysis of the blood entering in  the spleen,  and of that
passing out of these organs, render it highly probable, if not abso-
lutely certain,  that one of the most important offices of the spleen
is the destruction of the colored  blood-corpuscles.
  As, therefore, our knowledge  of the functions of the spleen  is
not as extensive or  as definite as the requirements  of exact science
demand, we should  exercise caution in the construction of theories,
with reference to the effect of pathological alterations of the spleen
in diseases.

          Weight of the Spleen  in Malarial Fever.
  The following table confirms the statements of numerous observ-
ers, that the spleen  is enlarged in malarial fever.
Weight of the Spleen in Malarial Fever.
	Avoirdupois		Avoirdupois	Troy
	pounds.		ounces.	grain 8.
				f 3062
Weight of the spleen in its normal condition				\ to ( 2187
Case of intermittent fever in latter stages of				
phthisis .....			14}	6343
" remittent and typhoid fever .	1 lb.	2 ozs.	18	7920
" remittent fever ....	1 "	15 "	31	13562
" remittent fever ....	1 "	13 "	29	12687
Two years after attack of remittent fever .	1 "	14.V "	30 .y	13343
Case of remittent fever ....	1 "	2]-"	18}	8093
" congestive fever ....			13}	5895
" congestive fever ....	1 "	13 "	29	12687
" congestive fever ....	1 "	1}"	17}	7562
  This table  shows that in seven cases of malarial fever, terminat-
ing in the active stages, the spleen was enlarged;  the enlargement, 
264
OBSERVATIONS ON
 however, was not so great as in those cases exposed to a longer
 action of the malarial poison.   In such cases the spleen is often
 greatly enlarged, and can be often felt during life as a hard mass oc^
 cupying a considerable portion of the abdominal cavity.   Cases are
 recorded where  the spleen  has been said to weigh twenty pounds.
   I have found  the spleen  of those who died  in the active stages of
 malarial fever, not only enlarged, but softened, and filled  with dark
 brownish-purple, and brownish-red mud.
   The  malarial spleen presents  upon  the exterior,  a dark slate
 color;  and the  trabecular  and  capsule appear to be completely
 altered  in structure;  so much  altered in many  cases, that  the
 slightest touch is sufficient  to rupture them.   I have seen the struc-
 tures of the spleen in malarial fever so  much disorganized, that in
 attempting, even in the most careful manner, to remove this organ
 from the  abdominal cavity, the trabeculae  have given way under
 a slight pressure, and the fingers plunged into its soft substance.
   The  dark  brownish-purple mud (pulp and extravasated blood)
 of the spleen is  composed,  in great measure,  of colored blood-cor-
 puscles, altered  in various  degrees, according to the length of  the
 attack, and which have lost the power of changing to the arterial
 hue when  exposed to the  oxygen  of the atmosphere.   In many
 cases, especially those of long standing, the pulp and  extravasated
 blood (mud), of the spleen abounds  in dark  reddish-brown, and
 reddish-black granules and  conglomerated granules, resembling  the
 dark particles found in the malarial liver, and in the  sediment of
 the black-vomit of yellow fever.  Similar bodies, but apparently
 in less  abundance, are found in normal spleens.  In cases which
 have terminated fatally, after only a short illness of two or three
 days, these bodies resulting from the disintegration of the colored
 blood-corpuscles, were not  so numerous as in cases of longer dura-
 tion, and in some very recent cases, they were not more numerous
 than in  the spleen of health.  We will  now illustrate the changes
 of the spleen in malarial fever, by cases  of varying duration.
  In a case of malarial fever of  the congestive type, of only forty-three
hours' duration, the spleen was slate-colored, softened, and  enlarged •
not as much softened and altered, however, as in cases of malarial
fever of longer standing.   The mud of the spleen was of a dark
purplish hue, and appeared to  be in transition to the color and
state of the mud  of the spleens of malarial fever of longer duration.
After exposure for a few hours to the oxygen of the atmosphere, a
large portion of  the mud of the spleen assumed a color approach- 
MALARIAL FEVER.
265
ing the arterial hue; much  brighter than the mud of the spleens
upon which malarial fever had exerted its full effects, and some-
what darker than the bright arterial hue, assumed  by the splenic
pulp  of healthy normal spleens.  When the mud  was spread in
thin layers upon a glass slide, the change of color was much more
rapid.  Under  the microscope, the splenic mud appeared to consist
almost  entirely of colored  corpuscles, many  of  which  appeared
swollen and altered in  appearance.   After careful'  examination, I
was unable to find those conglomerations of black granules, resem-
bling the black sediment of black vomit, which were discovered in
the spleens of malarial fever of longer standing.
   The spleen  of a  stout Irish  seaman, who died from an attack of
congestive fever, fifty hours after the first appearance of disease,  was
enlarged,  softened, disorganized,  and of a dark  slate-color;  and
when pressed  gently between  the fingers, the trabecular could be
felt giving way.  The cut surface presented a dark, purplish-brown
color; from the cut  surface issued a dark, purplish-brown  mud.
After eight hours' exposure to the atmosphere small  streaks, in-
clining  to an  arterial hue, appeared upon  the cut  surface of the
spleen,  and  probably were due to the change in the blood which
issued from the divided vessels.  These streaks of splenic mud, in-
clining  to the arterial hue, occupied but an inappreciable fraction
of the  whole  surface.  When  the dark mud (effused  blood)  was
examined under the  microscope, it was found  to consist chiefly of
colored and colorless corpuscles, and the cells peculiar to the spleen.
Some of the colored corpuscles were swollen and altered in shape;
the alteration was by no means universal or remarkably great.  This
spleen contained, as usual in malarial fever, animal starch.
   The  spleen  of an American  seaman, who died of  congestive fever
seventy  hours after the first appearance of disease, was  enlarged, soft-
ened, and of the dark slate-color usual in malarial  fever. When
the mud of  the spleen was exposed  to  the  atmosphere, a part re-
tained the dark-purplish and reddish-brown color;  whilst another
smaller  portion changed to an arterial hue.  The difference between
these two portions of the splenic mud were  clearly seen when  a
section of the organ was exposed for several hours to the  action of
the atmosphere. The other portion  of  the mud of the  spleen  did
not change its color.  This phenomenon was, without doubt, due to
the fact that the blood had been but recently effused into the spleen.
The portions first effused had lost the power of changing to the arte-
rial hue; whilst those last effused had not entirely lost this power.
      18 
266
OBSERVATIONS  ON
   The spleen of an Irish laborer, who died suddenly  in a congestive
chill, which had been preceded for three or four days by an  apparently
mild attack of intermittent fever, was slate-colored, enlarged, softened,
and  disorganized, and could not be removed from  the  abdominal
cavity without rtfpture of its capsule and trabeculae.  The capsule
and  trabeculae appeared to be  so  altered in structure that the
slightest touch was sufficient to rupture them.  After careful wash-
ing under a stream of cold water the trabeculae, as  usual in mala-
rial fever, presented a red color.   The mud  of the spleen  was of
a  dark-reddish  and  purplish-brown color,  and  consisted  princi-
pally of colored blood-corpuscles,  which  did not  change  to the
arterial hue during fifty hours' exposure to the oxygen of the atmo-
sphere.  The mud and fibrous  tissue of the  trabeculae  and blood-
vessels of this spleen contained animal starch.
   The spleen of a  large, stout German laborer,  who died of congestive
fever, supervening  upon  an  attack of malarial fever of  four  days'
continuance, was enlarged and disorganized,  and presented  a dark
slate-color.   To the touch  the  spleen felt like a sack  filled with
a viscid  fluid.  The capsule was  torn upon the  slightest exertion
of force.  Whilst gently lifting the spleen, to  sever  its attachments
and  lift it out of the abdominal cavity, the capsule was torn off for
the space of several inches, and my fingers, which grasped the organ,
plunged through the  disorganized trabeculae  and pulp.   When the
spleen was  laid upon the table  and pressed, the mud  within was
forced into other portions, and the indentation remained,  thus show-
ing that the cells of the spleen communicated freely with  each other.
The spleen was filled with  a  substance resembling purplish-black
mud.  This splenic mud was very thick, and dried rapidly when
spread upon glass slides. Under the microscope, this was found to
consist principally of colored blood-corpuscles. Many of the colored
blood corpuscles presented  an altered appearance.  In  some cases
the color appeared darker  than normal.   Many of the corpuscles
were  swollen;  whilst others were  corrugated.  That the  colored
corpuscles  had undergone  some change  was conclusively  demon-
strated by the fact, that  the color of this  splenic mud did not alter
 during thirty-six hours'  exposure to the oxygen of the atmosphere.
 The splenic mud also contained numerous dark  granules and gra-
 nular masses.  The number of colorless corpuscles were apparently
 diminished.  This diminution was in all probability relative and
 not absolute; they appeared to be diminished relatively  to the
 immense number of  colored blood-corpuscles. 
MALARIAL FEVER.
267
   The spleen of an  Irish seaman, who died ten days after  the onset
of remittent and congestive fever, was of a dark slate-color, and  en-
larged,  softened, and the capsule and trabecular gave way when
pressed gently between the fingers.  When first removed,  the mud
of the spleen coagulated very slightly; the coagulum  possessed no
consistency and no permanence.  When the pulp and  extravasated
blood of the spleen were examined under the microscope, it was
found to consist of colored and colorless blood-corpuscles, and  nu-
merous dark,  black granules.   These  granules  were  frequently
conglomerated together, forming dark  flakes, like the coffee-ground
sediment of the black vomit of yellow fever.  Many of the colored
corpuscles appeared swollen.
   The spleen of an Irish laborer, who died two weeks after an attack of
intermittent fever from congestion of the brain, was enlarged, softened,
and of  a light slate-color.   The pulp  of  the spleen was of a pur-
plish and  reddish-brown color,  and changed  to  the arterial hue
upon exposure to the atmosphere.
   The  spleen of an  Irish baker, ivho died during  convalescence from
remittent fever during an attack of pleuro-pneumonia, was slate-colored,
enlarged, and softened.  The pulp of the  spleen was firmer than
that of recent cases of  malarial fever, and  although it changed  to
the arterial hue more slowly than the pulp of  healthy spleens,  the
change of color was much greater than  that of the pulp  of  the
spleen in the active stages of malarial fever.
   The  spleen of  a house painter ivho had died in convulsions, three
weeks after an attack of remittent fever, was enlarged and softer than
normal, but much harder than  usual  iu the active stages of mala-
rial fever.  The  cut  surface presented  a compact,  dark  brown
almost  black appearance.  Numerous small white bodies, about
the size of millet-seed, were found scattered through the pulp of the
spleen.   I had never before seen the splenic corpuscles so numerous,
large, and distinct.  The exterior of the spleen was of a slate color.
The compact nature of the pulp of this organ shows that it was
recovering from the effects  of malarial fever.
   The  spleen of the German butcher, who suffered with intermittent
fever two  months, without medical treatment, and whose  disease  at the
end of this lime assumed the  congestive type, and although relieved of
the  immediate effects  of the malarial  poison, fell a  victim, after
three weeks of the most intense and  loathsome suffering, to  the
complete disorganization of the solids and fluids  resulting from
the pathological alterations induced by the malarial poison during 
268
OBSERVATIONS ON
 the  period  when it  pursued its course unchecked; presented pro-
 found alterations.   This organ was enlarged; surface covered with
 effused coagulable lymph, and bound  to the liver  and diaphragm
 by bands of  coagulable  lymph.  A large  quantity  of pus, of a
 greenish-yellow color, issued from the anterior border of the spleen,
 which was firmly attached to  the liver.  Whether the abscess had
 opened and discharged the pus before death,  or whether the abscess
 was accidentally ruptured  during  the opening of the chest and
 abdomen, I was unable  to determine.
   The structure of the spleen felt firm, very unlike the soft yielding
 structure of the spleen of the active stages of  malarial fever.  When
 cut,  many  portions of the spleen  resembled a dark  bronzed and
 slate colored liver.   The pulp  of these portions was  not soft, and
 did not pour out like the pulp of the spleen of the active stages of
 malarial fever.
   The liver-like substance of the spleen was found to consist under
 the microscope of fibrous tissue, and numerous colored corpuscles
 and  flakes,  composed of granules  resembling the dark  colored
 flakes of the black vomit of yellow fever.   These flakes were with-
 out doubt derived from  the  coloring matter  of the  colored blood-
 corpuscles.  The colorless corpuscles of this portion of the spleen
 appeared to be more numerous than usual.  This  dark liver-like
 substance appeared to be nothing more than  the extravasated blood
 and the pulp of the  spleen,  effused and altered during the active
 stages of the fever, from which the serum has in a great measure
 been removed, and in which alterations of  the colored corpuscles
 have taken place, and fibrous tissue formed.   After several hours'
 exposure to the oxygen  of the atmosphere, the color of this portion
 of the spleen was not altered.  In addition to the abscess  opening
 upon the surface of the  spleen  attached to the liver, the substance
 of the  spleen contained  numerous smaller  abscesses of  various
 sizes (two or three of the largest were of the size of a bullet, and
 the smallest of the size of an English pea), filled with  thick greenish-
 yellow pus.  Portions  of the spleen,  especially  surrounding the
 abscesses, were altered  into a  cheese-like substance.  Under the
 microscope, these cheese like portions consisted almost entirely  of
 pus-corpuscles, and  large cells containing granules  and other
smaller cells ; and also black masses composed of granules, and also
numerous oil-globules.   The large  mother cells, resembling cancer-
cells, were not numerous.  The pus issuing from  the large abscess 
MALARIAL FEVER.
269
 resembled ordinary pus  under the microscope, and contain a few
 of these peculiar cancer-like cells.
   The spleen of an American, who died from the formation  of heart-
 clots, consequent upon structural disease of the heart and liver, and who
 had suffered with an attack of malarial fever two years previous to his
 death, whilst residing upon the Ogeechee Eiver, in a low, miasmatic
 situation, was enlarged and indurated, and presented a purplish-red
 color.  When pressed in the hand, it felt dense and firm.  When
 cut or torn,  the color and structure  resembled  that of healthy
 spleens in all respects, except that it had a much larger quantity
 of fibrous tissue.  The pulp of the spleen absorbed oxygen readily
 when exposed to the atmosphere, and changed to a bright scarlet
 color.  The  pulp of the spleen presented nothing peculiar under
 the microscope.  Did not discover those black flakes and granules
 which were  so  abundant  in the  spleen  of the patient previously
 described.  This spleen contained animal starch.
   It is reasonable to suppose that the enlargement and induration
 of this spleen were the effects of the previous attack of  malarial
 fever.  During the active stages of the fever the spleen was en-
 gorged with blood, softened,  and the trabecular in many places
 ruptured.  When  the action of the malarial poison ceased, the
 serum of the extravasated  blood was removed, and the ruptured
 trabecular repaired, and numerous bands of fibrous tissue formed
 throughout its  substance.   Finally  the  colored  corpuscles of the
 extravasated blood were disintegrated and removed.
   These cases demonstrate that the alterations of the spleen occur amongst
 the first pathological effects of the malarial poison.
   The gradual enlargement of the spleen in the bodies of those inhabit-
 ing malarious districts,  without any distinctly marked febrile symptoms,
 shows that these alterations of the spleen, may precede  the active symp-
 toms, and those disturbances of the nervous system attending the cold
 and hot stages of malarial fever.
   These cases demonstrate that the alterations  of the  spleen  in
 malarial fever are of the most decided and serious character.  The
 spleen might be readily ruptured, either  by violent exercise or by
 blows, or  even by rough handling, during the active stages of ma-
 larial fever.
   An immense number of colored blood corpuscles are destroyed in the
 spleen during the active stages of malarial fever.   The effused colored
 corpuscles are gradually disintegrated; their  harmatin appears  as
dark granular masses, which are  gradually altered physically and 
270
OBSERVATIONS  ON
chemically, passing through several shades of color, and are finally
eliminated.   The  serum of the  effused  blood  is  also  removed ;
fibrous  bands or trabecular are formed through the extravasated
blood, the capsule is thickened, and gradually the  organ becomes
firm and assumes its normal structure and offices.
  The cause of the peculiar pathological alterations of the spleen
in malarial fever  appears  to depend upon the alterations of the
blood and circulation, which produced  similar congestions in the
brain and liver, and upon the peculiar  anatomical  structures of
the spleen.  We have before shown that the fibrin  of the  blood  is
diminished and altered in malarial fever, and  that  the relations
between the  general and capillary circulations, and between the
constituents of the  blood  and the  walls of the vessels,  are  dis-
turbed,  and  that  the chemical  changes upon which  the  capillary
circulation depends are perverted and diminished,  and that the
action of the heart is greatly disturbed.  Here, then, we have causes
sufficient to account for the stagnation of the blood in the import-
ant organs of the trunk, and especially in the spleen, on  account
of its anatomical  relations  to the  other organs of the  abdomen, the
absence of valves in the splenic veins, and their  communication
with the  intercellular  spaces of  the spleen-pulp.   Mr. Gray has
shown that many of the capillary vessels are not directly continu-
ous with the veins, but that the  blood, in passing from one set of
vessels  to the other, traverses  intercellular  spaces in the spleen-
pulp, and that the veins  in many cases commence  in intercellular
spaces.
  If these views are correct, it follows  as a necessary consequence that
the pathological alterations of the spleen in malarial fever are not the
result of inflammatory action.
  The red color of the trabecular, after  the  pulp has been washed
out, has nothing  to do with inflammation, and is the result of the
action of the coloring matter of the disintegrated blood-corpuscles,
and is analogous  in all respects to the staining of the endocardium
and large vessels  by imbibition of harmatin, in  many diseases en-
tirely unaccompanied by inflammation.

                           Pancreas.

  We have been  unable to detect any alteration  in the pancreas
peculiar to malarial fever. 
MALARIAL FEVER.
271
                           Kidneys.
  In several cases of malarial fever, and in two which had yielded
suddenly in the earliest stages, the kidneys presented slate-colored
spots, which presented a bronze color upon section to the depth of
one-fourth to  one-eighth of an inch.  Microscopical examination
demonstrated  that the black granules were  not present in these
bronzed  portions, and that the structures of the kidney were not
altered in any recognizable manner.   We have in a previous chap-
ter considered the  bearing  of this fact upon the slate and bronze
color of the liver.
                     CHAPTER  VI.

CIRCULATION, RESPIRATION, TEMPERATURE, STATE OF THE SKIN, TONGUE,
  and changes of the urine in intermittent, remittent, and conges-
  tive fever.

     Principles of Treatment based upon these Observations.

  The complete investigation of pathological phenomena demands
the accurate  determination of the  amounts and chemical relations
of all  the  materials entering into the diseased body, and of the
transformations through which these  materials pass, and of the
amounts eliminated, and of the chemical and physical forma and
conditions  under which they are eliminated;  demands the accurate
determination of the chemical changes of the constituents of the
organs, tissues, apparatus, and  blood, and of  the forms and condi-
tions under which they are eliminated.
  The pathologist has no  means  of determining  the character of
the chemical  changes going on in the living body during the dif-
ferent stages  of disease.
  The pathologist is limited to an examination of the forces  deve-
loped by these changes, and of those products resulting from these
changes, which are eliminated and cast off from the body.
  Although it is impossible in the present state of science to deter- 
272
OBSERVATIONS ON
mine accurately the amounts of the muscular and nervous forces,
and of heat generated during the stages of diseases, still an exami-
nation of the mutual relations and disturbances  of these forces
during the progress of disease, yields invaluable information bear-
ing upon the nature and treatment of diseases.   The  amount of
force generated in the living body, no matter in what peculiar form
or mode  of force it appears, always stands in direct relation with
the amount of matter chemically altered.  The great laws of action
and reaction, and of the indestructibility of force, apply, as we have
before demonstrated, to all  the forces which work the animal  ma-
chinery.
  We have instituted, and are still prosecuting, a series  of experi-
ments,  the object of which is the demonstration that  all  the forces
of animals, physical, chemical, muscular, and  nervous, are derived
from the  chemical changes of the elements entering into their bodies
as food, and forming their structures.
  The following observations  demonstrate, as far as they extend,
that  the  forces  of animals are developed by  a chemical change of
the elements,  and are proportional to the  amount of chemical
change:— 
MALARIAL  FEVER.
273
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274
OBSERVATIONS  ON
  These observations, which I have extended to numerous other
warm and cold-blooded animals, and to man, together with an exa-
mination of the structure and development of the circulatory and
respiratory apparatuses of the animal1 kingdom, support  the fol-
lowing conclusions:—
  The intellect, temperature, nervous, and muscular forces, and
organic development of animals, are in proportion to the rapidity
of the changes of the elements.  In warm-blooded animals, which
are endowed with intellect of a high order, and possess great nerv-
ous and muscular force, and correspondingly developed organs, the
changes in their elements are incessant.  When starved they lose
weight rapidly.  In cold-blooded animals, the temperature of which
is often below the surrounding medium, and whose nervous system
and  intellect are feebly developed, the changes in their elements
are correspondingly slow.  The cur dog lost in  six days and  four-
teen hours one-third  of its original weight; whilst the chelonians
lived from thirty to sixty days without losing  more than from one-
fourth to one-thirteenth of their original weight.  The loss in the
former was from six  to fifteen times more rapid than in the latter.
The loss of weight at the time of  death was  very nearly equal  in
warm and  cold-blooded  animals.   The maintenance  of the short,
vigorous life of the former required as large a supply of organic
and  inorganic materials  as  the prolonged existence of the latter.
What the warm-blooded animal gained in intensity and power, it
lost in duration.
  The length of the life of an animal during starvation and thirst,
is proportional to the rapidity of the changes of its elements, and,
as a necessary consequence, stands  in direct relation to its tempera-
ture, intellect, and organic development.  Warm-blooded  animals
wasted more  rapidly,  lived more energetically,  and died in a cor-
respondingly shorter  time than cold-blooded animals.  Amongst
cold-blooded  animals  the chelonians, which  were  most active  in
their movements,  and whose nervous system was most  excited,
lived during a time corresponding with their increased nervous and
muscular exertions.   The female  terrapins, whose ovaries and ovi-
ducts were filled with  hard and soft eggs, lost from 3y5s to 3^3 of

  1 For numerous experiments on this subject, see the author's investigations,
published by the Smithsonian Institution—"Investigations, Chemical  and Phy-
siological, Relative to Certain American  Vertebrata,"  by Joseph Jones, M. D. ;
Smithsonian Contributions to Knowledge, 1856. 
MALARIAL FEVER.
275
their weight hourly, and died in the course of twenty-five or thirty-
five days; while the females which had deposited their eggs, and
the males, which were free from these anxieties, wasted only one-
half as much per hour—^gg to -g'g^ of their whole weight—and
lived twice the length of time—from fifty to seventy days.
  As the acts of life are carried on in the same general manner in
all animals, and as each species and individual has its own peculiar,
intellectual,  and physical endowments, it follows, as a necessary
consequence, that each species and individual, whether belonging
to the animal kingdom or to the  human race, must have its own
amount of chemical change, which develops the forces.   The forces
developed  by these  chemical changes are  dependent upon the
amount of matter chemically altered,  and the position and manner
in which it is altered.  Here  is a wide and important field for in-
vestigation, as yet almost entirely untrodden.
   These facts, although imperfect, are sufficient to demonstrate the
necessity in every pathological investigation,  of determining the
amount  of matter chemically altered and thrown off, and the cha-
racters of the  matters thus eliminated.   This can only be accom-
plished by the determination of the amounts and characters of the
matters  thrown off from the lungs, skin, kidneys and bowels.  We
 know that it is almost impossible,  with the present instruments and
 methods of investigation, to  determine accurately, the  changes in
 quantity of carbonic acid gas thrown off from the lungs under dif-
 ferent circumstances of health, during long periods of time, and the
 difficulties are greatly increased when we attempt to determine the
 quantity and characters of the excretions of the skin.   Any obser-
 vations  with the present instruments  and methods of investigations
 upon the amounts of matter thrown off  from  the lungs and  skin,
 for long periods-during different diseases, must be unsatisfactory if
 not absolutely impracticable.  Happily the pathologist can examine
 the urine which reflects as in a mirror, the changes going on in the
 body, and can determine the relations and changes of the animal
 temperature, circulation, and respiration.
    We hope to demonstrate hereafter, by numerous careful  obser-
 vations, that the determination of the relations of the  circulation,
 respiration, and temperature in diseases, is of the greatest import-
 ance  in enabling the practitioner of medicine to understand the
 nature and  treatment of diseases, and predict  with a great  degree
 of certainty, their course and termination.  Thus, whenever, as in
 congestive fever, there  is  a  want of correspondence  between the 
276
OBSERVATIONS ON
circulation,  respiration, temperature, and chemical changes, the
patient is always in danger.  A patient with a rapid feeble pulse,
and rapid thoracic respiration and low temperature (sluggish chemi-
cal changes), is always in  great  danger.   A full  moderately rapid
pulse, and moderately rapid and full  respiration, and correspond-
ingly high  temperature, are always favorable  symptoms, provided
there be no complications, as congestion of the brain.  The severity
of malarial fever is by no means proportional to the height of the
fever (animal  temperature).   As  a general  rule, the higher the
fever (temperature), the more readily does the attack yield to treat-
ment, and the  less serious  the  effects.   High  temperature signifies
active chemical  changes, and  an effort on the  part  of  nature  to
break up and consume the poison, and a power of resistance.  It is
the want of a high temperature which  is the most dangerous symp-
tom in malarial fever.
  It is necessary that we  should in the first place establish stand-
ards of the action of the respiratory and circulatory apparatus and
of the animal temperature of the  different parts of the body  in
health, to which the changes in disease may be referred.
  The following observations  are valuable, because they were  all
taken with the same instrument, in the same hospital, and under  as
similar circumstances as I could devise.  In their determination I
used every precaution necessary to accuracy:— 
MALARIAL FEVER.
277
Table showing the Variations of the Pulse, Respiration, and Temperature
                     of Different Individuals.
						a	o	e
					a	0 <u	a> 0	O 0 - bO 0 a
			REMARKS, &c.		"5	S"!	t«	t2
6 to IS	EC			"3 PL,	'S.		is E-i~	If
	M.	July 15	Healthy, active young man; American ; student of	78	20	82.1°	99.0°	99.5°
			medicine; sanguine temperament; standing pos-					
			ture, after exercise.					
20	M.	July 15	Healthy young American physician ; sanguine tem-perament; standing posture, after exercise.	68	20	S2.0	98.0	99.5
12	M.		Negro boy, healthy and active; erect posture, after exercise.	88	21	82.0	97.0	99.5
21	M.		Healthy, active young man ; lying in bed just after waking in the morning.	76	15	45.0	95.0	98.0
22	M.	Oct. 5	Seaman ; during convalescence from intermit, fever.	62	21	70.0	96.0	99.33
27	M.		English seaman ; recumbent posture.	64	16	78.0	9S.0	99.0
25	M.		Irish seaman ; recumbent posture.	60	17	83.0	97.0	98.8
25	M.		Seaman; recumbent posture; during convalescence from remittent fever.	44	22	S4.0	97.8	99.12
14	M.		Irish seaman; recumbent posture.	57	16	81.0	98.0	99.5
4-t	M.		Baker and cook; right arm and leg somewhat pa-ralyzed. Stout American seaman.			82.0	99.0	100.2
26	31.	Sept. 25		62	14	76.0	98.0	99.25
2ij	31.	Oct. 8	Do. do. .	48	14	73.0	97.0	99.5
2:i	31.	Oct. 9	Do. do.	43	15	72.0	96.5	99.75
20	31.		English seaman; shortly after recovering from an attack of intermittent fever.	72	17	84.5	98.7	99.9
30	31.	July 6	American seaman; slight paralysis of one hand, but otherwise healthy.			88.0	96.5	99.0
30	M.	July 9	Do. do. do.			81.0	97.5	99.0
27	M.	July 6	Portuguese sailor; suffering from injury of spine; health otherwise good.			79.0	98.5	99.0
27	M.	July 9	Do. do. do.			83.0	98.0	99.0
50	M.	July 7	Stout English seaman.			S4.5	96.0	99.7
20	31.	July 9	Do. do.	60	16	81.5	98.0	98.9
48	M.	July 1	American; stout, well built; suffering with partial paralysis of right side; health otherwise good.			82.5	96.5	99.2
21	M.		Irish laborer.			82.0	98.0	99.25
30	M.	July 8	Irish laborer; paralysis of right leg from blow, but otherwise healthy.			80.0	98.0	99.5
18	F.	July 15	Stout Irish woman; subject to fits of partial insanity; apparently in perfect health.	84		79.0	92.0	98.0
30	F.	Aug. 7	American woman ; superior portion of body in per-fect health ; chest and arms well developed ; lower extremities atrophied ; general health good.			80.5	97.5	100.1
45	M.	Oct. 19	American seaman in erect posture, after walking.	20	60	71.5	96.0	99.0
  The following tables are drawn up from  the observations of Dr.
John Davy, whose elaborate and valuable researches afford the best
materials for the establishment of the limits of the variations of the
pulse, respiration,  and temperature in health:— 
278
OBSERVATIONS ON
Variation of Temperature during 24 hours.  Jlean of Daily Observa-
  tions for one year in England and one year in Barbadoes.   By John
  Davy,  M. D.1
3Iean Temp, under Tongue.				Pulse.		Respirations.			Temperature of Room.		
7-8 A 31.	3-4 ! 12 P. M. P. 31.		7-8 A. 31.	3-4 P. M.	12 P. 31.	A. 31.	3-4 P. 31.	12 P. SI.	7-8 A. M.	3-4 P. 31.	12 P. 31.
98.74° ; 98.52° 97.92°			57.6	55.2	5i. 7	15.6 15.4 15.2			50.9°	54.7°	62.0°
Ix Barbadoes—											
31ean Temp, under Tongue.				Pulse.		Respirations.			Temperature or Room.		
6-7 A. M.	12-2 P. 31.	9-11 P. M.	6-7 A. M.	12-2 P. 31.	9-11 P. 31.	6-7 A. 31.	12-2 P. 31.	9-11 P. 31.	6-7 A. M.	12-2 P. 31.	9-11 P. M.
98.07°	98.9° 1 99.0°		54.4	56.0	60.3	14.4	15.4	15.0	76.7°	83.6°	79.0°
Variations of Temperature during different Seasons of the Year.
                   By John Davy, M. D.a
		Mean temp.				Blean temp.	
Month.		under					
		tongue.				tongue.	room.
1845				1847			
July ....		98.43°	76.00°	January . . .		98.60°	77.70°
August .		98.30	80.60	February .		98.53	80.26
September		98.60	81.20	March . .		98.60	77.40
October		98.56	81.46	April		98.53	78.00
November .		98.46	80.56	October		98.66	80.83
December .		98.40	77.90	November .		98.56	79.66
				December .		98.36	77.36
1816				1848			
January		98.63	78.16	January		98.60	77.06
February .		98.60	77.88	February .		98.53	77.73
April		98.46	80.00	March . .		98.60	78.40
May . .		98.66	81.50	April . .		98.60	78.26
June		98.66	81.56	May . .		98.66	81.46
July . .		98.36	81.00	June . .		98.60	80.86
August . .		98.70	81.60	July . .		98.36	80.46
September		98.40	81.36	August . .		98 76	81.56
October		98.73	81.50	September		98.76	82.26
November .		98.60	80.60	October		98.76	81.50
December .		98.63	77.96	November .		98.60	79.83
				Mean entire series		98.54	79.75
1 Phil. Trans., part ii. 1850, p. 437.
2 Ibid. 
MALARIAL FEVER.                   279
Table showing  the Variable Temperature of Man.  Drawn  up from
  Observations  on Seven Healthy Men, during a Voyage from England
  to Ceylon.  By John Davy, M. D.
Age.	Temperature under tongue. March 10th. Temp, of air, 78°.	Temperature under tongue. March 2d. Temp, of air, 79.5°.	Temperature under tongue. April 4th. Temp. iof air, 80°.	Temperature under tongue. May 5th. Temp, of air, 30°.
24	99.00°	100.00°	99.50°	98.50°
28	99.50	99.50	99.50	
25	98.75	98.50	99.75	98.25
17	99.00	99.00	100.00	
25	99.00	99.00	99.50	98.00
20	98.00	99.50	100.00	98.75
28	98.75	99.00	99.50	98.25
 
tO
00
o
Table showing the Variations of the Temperature of different Races of Men.   By John Davy, M. D.1
Hottentots. Cape of Good Hope, Slay 24, 1816. Tern, air, 60°.	SlNGALESE. Island of Cey-lon, Sept. 34th. Tem. of air, 79°.			Albinos (Sin-oalese). Ceylon, Sept. 14ih. Tem. of air, 79°.			Half Caste Singalese Children. Ceylon, Oct. 12th, 6-7 A. A. Temp, of air, 78°.				Vaidas. Kandy, Sept. 12th. Temp, of air, 73°.				Africans. Servants in military hospital at Kandy. Dec. 17th. Temp, of air, 74°.				Malays. Kandy, March 18th. Temp, of air, 81°.				Sepoys. Kandy, May 18th. Temp, of air, 80°.				English Sol'rs. Kaudv, 3Iav 20th. Tem. of air, 75''.		
Temperature under tongue.	X c	60	<D 0 (- 60 0 a gS §.« S 0 CD 3 E-i	HI	o5 60 <	01 e> 0 t- 60 0 0 «S B a	w	60 <1	<d » =1 t. 60 0 a gS	g a	O0	60 <	a 0 fc. 60 3 C •S3 Ii E-i rf	ga El""	-J:	cd 60 <	cd 3 h 60 3 a S 3 £"-c S	3 '3 g« E-i'"	y c a.	cd 60	a; CD 3 k- 60 3 s ? 3 p<3 si	CD Eh'"	02	CD 60	CD CD 0 t- 60 3 a I"	CD g 3 Eh""	v.	60 <	CD CD 0 <- 60 0 a #2 Ii
o 98.0 96.5 96.5 97.75 99.5	F. F. M. M. M. M.	50 4 29 8 40 25	0 101.0 101.5 1010 101.5 100.0 100.0	F. F. F. M.	5 12 23 27	o 101.5 101.5 101.75 101.0	F. F. F. M. M. M.	12 14 17 14 10 14	o 100.5 100.1 100.0 102.0 101.5 100.0	o 98.5 100.0 99.5 99.0	M. 31. M.	60 30 35	o 98.0 98.0 98.5	o 95.0 96.0 96.0	M.	23 35 25 34 28	o 9S.5 98.5 99.0 99.5 99.5	0 98.0 98.0 98.0 98.0 98.0	M. M. 31. M.	17 35 22 18	o 98.5 99.5 99.0 98.5	0 98.5 97.5 98.0 97.5	M. 31. M. M. 31. 31.	25 19 26 22 38 20	o 98.5 99.0 98.5 98.0 100.0 98.0	O 98.0 96.0 97.0 95.0 97.0 97.0	M. 31. M. M. M. 31.	21 99 27 36 28 34	o 98.75 98.5 99.0 99.25 99.0 99.5
1 Researches, Physiological and Anatomical, vol. i. p. 169. 
MALARIAL FEVER.
281
Table of Observations onfthe Temperature of the Insane in the Winter
           and Summer o/1838.  By John Davy, M. D.1
Age.	Species of	Winter.		Summer.	
					
	insanity.		Temperature		Temperature
		State of health.	under tongue.	State of health.	under tongue.
55	Amentia	Pretty good	100.0°	Pretty good	101.0°
63	Mania	Good	100.0	Good	101.5
49	Mania	Good	100.0	Good	101.0
31	Amentia	Rather feeble	99.0	Feeble	101.0
41	Mania	Good	98.0	Good	101.0
42	Amentia	Good	99.0	Good	100.5
50	Amentia	Slightly ailing	102.0	Good	99.5 ■
62	Amentia	Good	98.0	Good	100.5
69	Amentia	Feeble	100.0	Feeble	101.0
51	Amentia	Pretty good	99.0	Moderate	100.0
34	Amentia	Pretty good	100.0	Moderate	101.0
53	Amentia	Good	99.0	Good	101.0
37	Mania	Good	99.0	Good	100.0
41	Mania		101.0	Obscure dis-ease of lungs	104.5
41	Amentia	Pretty good	99.0	Good	100.0
64	Mania	Good	101.0	Good	101.0
45	Amentia	Pretty good	100.5	Moderate	101.0
29	Amentia	Indifferent	99.0	Indifferent	99.0
57	Mania	Good	99.0	Good	100.0
61	Melancholia	Good	100.5	Good	101.0
40	Amentia	Good	100.0	Good	101.0
61	Amentia	Good	98.0	Good	100.0
47	Amentia	Good	101.0	Good	101.0
27	Amentia	Good	98.0	Good	100.0
  Before  proceeding to record the results of our investigations, it
is necessary that I should state the methods by which the tempera-
tures, pulse and respiration were determined, and the difficulties and
imperfections of the investigation of the changes of the urine.
  The pulse and respirations in the following investigations were,
unless stated otherwise, always determined in the recumbent posture.
  All the temperatures recorded were determined by the same in-
strument,  which was carefully constructed, and  was upon  compa-
rison  with standard instruments found to be accurate.
  The thermometer was always allowed to remain under the tongue,
in the hand, or in the armpit, for some time after it was  station-
ary, and all the observations were taken and recorded at the bed-
side, under my own hand and eye.  The greatest care was exercised
in determining the temperature; the patients were in all cases, un-
less stated otherwise, lying quietly in bed, and protected from all
currents of air.
          1 Physiological and Anatomical Researches, vol. i. p. 204.
      19 
282
OBSERVATIONS ON
  The importance of attending to these circumstances, is strikingly
illustrated by the following experiments which I performed  upon
myself.
  Athens, Jan. 23d, 6 o'cock A. M.   Lying in bed, just after wak-
ing from sleep.  Pulse, 76; respirations, 15.  Temperature of air of
chamber, 45° F.; temp, of exterior air, 28;  temp, of hand, 95;
temp, under tongue, 98.   Dressed myself and took a walk of two
miles over several hills, in thirty minutes.  The ground was frozen
and  covered with frost.  During  the walk, my hands were bare
and freely exposed to the  atmosphere.   At first, the sensation of
cold was unpleasant, but towards the end of the walk, reaction ap-
peared to take place, and they felt much warmer. Pulse, 90; respi-
rations, 20. Temperature of atmosphere, 30° F.;  temp, of hand, 78;
temp, of axilla, 98.
  During the walk, the pulse had  gained 14, and the respiration 5,
to the minute.   The temperature in the hand had fallen 17°, whilst
that in the axilla had remained stationary.  The respiration in bed
was gentle and regular.  The  respiration after walking in the cold
was accelerated, full and vigorous.  Here we see that  a diminution
of the temperature  upon the  exterior  was attended by  a corre-
sponding change in the movements of the circulatory and respira-
tory systems.  They became more active in order to receive  and
distribute more rapidly the oxygen, and remove with corresponding
rapidity the increased products of the increased chemical changes.
  It is also worthy of note that the increased circulation and respi-
ration were  not attended with a rise of temperature, because the
radiation of heat from the surface of the body more than balanced
the increased generation  of heat consequent upon the increased
chemical change.
  I took breakfast, and then walked three miles over several hills,
in forty  minutes.  My hands  were kept in the overcoat pocket
during the walk.  At the  end of  the walk, the following  were the
results observed:  Pulse, 88; respirations, 26.  Temperature of
atmosphere, 45° F.; temp, of  hand,  97 ;  temp, under tongue, 98.5.
  January 24th, 4 o'clock P. M.  After sitting and writing  for
several hours in a cold room, without fire, my right hand, which
was freely exposed moving over the paper,  felt very cold  and stiff.
Pulse, 76; respirations, 16.  Temperature of atmosphere, 48°; temp.
of right  hand, 75; temp, in axilla, 98.5.  In  this experiment  the
right hand lost 22° in the course of  two hours.
  These  experiments demonstrated conclusively the absolute neces- 
MALARIAL FEVER.
283
sity of adhering rigidly to  a  uniform method of ascertaining the
pulse, respiration and temperature in health and  in disease.
  In  comparative investigations, the truth will not be obtained
without the most scrupulous and unremitting attention to the posi-
tion of the patient, and all the surrounding circumstances.
  Before presenting the results of numerous analyses of the urine
in the different forms of  malarial fever, we would candidly  ac-
knowledge the sources of error in determining the amount of urine
excreted during any stated  period, as twenty-four hours.
  When the bowels are frequently moved, it is  almost impossible
to ascertain, even approximately, the amount of  urine excreted.
  When the patient is delirious, and passes his urine and feces in the
bed, it is impossible to ascertain either the amount or character of
the urine.   Even when the bowels are not moved, and the patient
retains his faculties and a considerable amount of strength, it often
happens that,  during the night, the nurse will neglect to attend to
the passage and preservation of the excretions in  the proper vessels.
It often happens, from a combination of these circumstances, that
the urine of the most fatal,  important and interesting cases, escapes
our examination.  These difficulties in hospital  investigations can-
not readily be overcome, and  will often invalidate the conclusions
drawn from individual cases.
  Our duty, then, is to obtain as wide an induction of facta as pos-
sible, and thus eliminate or equalize, as far as possible, the errors,
and draw  our conclusions  not  so  much  from individual cases  as
from the whole assemblage of facts.
  From our  copious notes on  more than  two hundred cases of
malarial fever, we have determined to present a condensed state-
ment of only those  facts which present  points  of  interest  to  the
physiologist,  pathologist and practitioner of medicine, and will
often refrain fr6m noticing the full bearing of these facts, because
our limits  would not allow  of extended discussions.
  Our limits will not permit  us to enter into a  minute account of
the method of analyzing the  urine.   In view of  the  numerous ex-
cellent treatises, accessible to  all, this would involve an unnecessary
consumption of space and time.
  The urea1 was separated in the form of the  nitrate, and every

  1 Lehmann's Physiological Chemistry, Eng. ed., vol. i. p.  159 ; Am. ed., vol. i. p.
149.  Mitscherlich in Annalen der Physik und Chemie, Von Poggendorff, bd. 31, s.
303.  " Kidneys  and Urine," by J. J. Berzelius, translated by Boyle and Learning,
M. D.  Phila., 1843, pp. 66-83.   " Handbook of Chemistry," by Leopold Gmelin, 
284
OBSERVATIONS  ON
care was taken to secure  accuracy in  the results.  The amount of
the constituents  in  all these analyses, from the causes previously
stated, will be underrated and never overrated.
   The urine was always  analyzed a short  time  after  its passage.
This  precaution  is necessary in a warm  moist climate  like that of
Savannah.  In the heat of summer, the urea is often, especially in
the urine of convalescence, rapidly decomposed into carbonate of
ammonia.  In  one  case  of malarial  fever,  where the  patient was
suffering with a stricture and irritation of the  bladder, every trace
of urea disappeared from the urine in twelve hours.
   I  have endeavored scrupulously to  exclude from these papers

translated by H. Watts,  Cav. Soc. pub.  London, 1852, vol. vii. p. 363.  Simon's
Chemistry of Man.  Phila., 1846, p. 397. Becquerel and Rodier's Pathological
Chemistry, translated by Speer.  London, 1857.  See also for the general analysis
of the urine, "Anleitung zur qualitativen und quantitiitiven Zoochemischen Ana-
lyse."  Von E. Von Gorup Besanez.  Niirnberg, 1854.  " Anleitung zur qualitativen
und quantitativen Analyse des Hams." Von Carl Neubauer. Wiesbaden, 1854.
Heintz, Lehrbuch der Zoochemie.   Berlin, 1853.  Schlossberger, Lehrbuch der or-
ganischen Chemie, mit  besonderer Rucksicht  auf Physiologie  und Pathologic
Stuttgart, 1854.  Robin et Verdeil, Traite de Chimie Anatomique et Physiologique,
ou des Principes immediats Normaux et Morbides  que Constituent le Corps de
l'Homme et de Mammiferes, 3 vols.  Paris, 1853.  "A Course of Practical Chem-
istry," arranged for the use of Medical students, by Wm. Ordling, M. D.  London,
1859.   "Bird on Urinary Deposit."  Phila., 1854.   Bowman's Medical Chemistry.
Phila., 1855.
  For Liebig's valuable Memoir " On Certain Urea Compounds, and a new method
of determining the Chloride of  Sodium and the Urea in  the Urine," see Ann. der
Chem. und Pharm., vol. lxxxv., pp. 289-328.   See translation of  this Memoir in
vol. vi. of the Quarterly  Journal of the Chemical Society.  Limpricht, "On the In-
fluence of Allantoin ou the determination of Urea, by the method of Liebig," Ann.
der Chem. und Pharm., vol. Ixxxvii. p. 99.  Kletzinsky, "On the Comparison of
the Values of the Different Methods of Determining the Quantity of Urea," Heller's
Archiv. fur Chem. und Mikrosk., p. 252.  Jahrgang, 1853.
  "A new Method of Determining the Amount of  Urea," by Dr. E.  Davy.  Phila.
Mag., June, 1854 ;  Medico-Chir. Rev., Oct., 1854.   " The Detection and Estimation
of Urea," by Ragsky, Ranking's Abstract of Med. Sciences, 1845.  Part  ii. p. 90.
Beitrage zur Kenntniss der Urinabsonderung bei gesunden, schwangern und kran-
ken Personen.   Inaugural Abhandlung von Friedr. Mosler.   Giessen, 1853.  Kli-
nische Untersuchungen iiber den Stoflwechsel bei gesunden und kranken Menschen
iiberhaupt, und  durch den Urin insbesondere. Von  Prof. J. Vogel.  GOttingen,
1853.   "Studien zur Uroligie."  Von Dr. F. Fr. Bencke  (Archiv.  des Vereins fur
gemeinschaftliche Arbeiten, Band i., Hefte 3, 4).  Gbttingen, 1853.
  Beitrage Zu Kenntniss der Urinabsonderung bei gesunden Inaugural  Abhand-
lung von Aug. Winter.  Geissen, 1852.
  " A  Treatise on the Pathology of the Urine," by I. L. W. Thudichum M. D.
London,1858.
  Beale's Archives of Medicine, No. 1, pp. 34-42;  No. 2, pp. 142-147. 
MALARIAL FEVER.
285
every analysis, the  result of which was  influenced by changes in
the urine, subsequent to its excretion  by the  kidneys.   Uric acid
was determined in the usual manner.  The inorganic fixed saline
matters were determined according to the method of M. Lecanu.


                 I. INTERMITTENT FEVER.

                          Cold Stage.
   Proposition I.  During the cold stage (chill) there is a rapid, feeble
pulse, full, rapid respiration, and a hot trunk and cold extremities.
   During the  rapid thoracic  respiration  oxygen  is supplied in
abundance, and enters into the blood, which is confined during the
cold stage almost entirely  to  the trunk and large organs.   The
amount of oxygen received, and the elevation of the temperature
of the trunk,  will depend  upon  the  capillary circulation  of the
lungs and large organs of the trunk, and upon the action of the
heart.

   Proposition II. During  the cold stage the temperature of the extre-
mities is reduced far below that of the trunk, and even below the standard
of health, because the circulation of the blood in the  bloodvessels and
capillaries is feeble.
   The surface of the trunk and extremities presents a mottled pur-
plish color  during the cold stage, because, the supply of oxygen
being greatly diminished, the change from the venous to the  arte-
rial hue  does not take place.
   The shivering and twitching of the  muscles during the chill are
excited in a manner analogous  to  the shivering produced by
exposure to cold.   When the temperature of the extremities  is
rapidly reduced by rapid radiation, the capillary circulation becomes
feeble, the surface presents a wrinkled and often bluish appearance,
the blood is  not furnished in sufficient quantities to supply the ele-
ments of nutrition and chemical change in the muscles and nerves,
the chemical actions of both the muscles  and nerves are diminished
and perverted, and, as a necessary consequence,  this diminution
and perversion of chemical change is attended by  aberrated mus-
cular and nervous action.
   The phenomena of diminished capillary circulation, and corre-
sponding diminution in  the  supply of nutritive materials, and ele-
ments of chemical change,  and reduction  of  temperature, may be 
286
OBSERVATIONS on
also  produced by derangement of the general circulation and de-
rangements  of the  sympathetic nervous  system.   In  both cases
the cause of the diminished temperature in the extremities would
be due to feeble  capillary circulation.  In both  cases the cause of
the aberrated muscular and  nervous phenomena would be due to
diminished and perverted chemical changes.
  That the  chemical changes are perverted during  this state of
reduction  of animal temperature and diminution of  capillary cir-
culation is conclusively demonstrated by the fact that  in congestive
fever, where we have, as it were, a permanent reduction of tempera-
ture, and arrest of capillary circulation, and diminution of chemical
change, both in the trunk and in  the extremities,  the products
resulting from these perverted chemical changes are far different
both  from  those of health and those of fever, when the  system
reacts.

  Proposition III.  The diminution of the capillary circulation and
reduction of the  temperature of the  extremities precede the aberrated
nervous and muscular phenomena denominated chill.
  This fact  corresponds to the changes in the  blood, and demon-
strates conclusively that  the first phenomena of the cold stage are con-
nected with the sympathetic nervous system.

   Proposition  IV. The higher the  temperature  of the trunk during
the cold stage, the more rapid will be the equalization of  the circulation
and temperature.

   These propositions are sustained by the following cases:—
   (a.) Seaman, aged 55; height 5 feet 4 inches; small, spare man.
Has been in the hospital several months, suffering with an affection
of the eyes.  This case of intermittent fever originated in the hos-
pital.
   Chill came on one hour ago; he is still shaking violently, and his
lips and hands look  blue.  Pulse 100, feeble, small.  Eespiration
 36 to 50, varies with each  quarter of a minute; irregular, thoracic,
labored.  Temperature of atmosphere, 71.5° F.;  temp, of hand, 92°;
 temp, under tongue, 104°.
   (b.) Seaman, aged 38; height 5 feet 8 inches ; light hair, blue eyes,
 sallow complexion; looks as if his liver was out  of order.  Says
 that he has had chills off and on from the 16th of July to  the pre-
 sent time, October  12.  His first attack of intermittent fever was 
malarial fever.                  287
contracted  in  the swamps of the Peedee Eiver, South Carolina.
Tongue clean  and pale;  lips pale, anaemic.  This patient presents
the true malarial hue, and his blood is deficient in colored corpus-
cles.  In the  present attack of intermittent fever he has a  chill
every day.
   October  12.  This  morning had a chill, followed  by hot fever.
During the febrile excitement his pulse was 108 and his respiration
32 to the minute.  As soon  as the fever remitted, twentv grains of
sulphate of quinia were administered.  The  sulphate of  quinia de-
layed the chill.  It did not appear at the regular hour on the  13th
inst., but came on at 4 o'clock P.M. on the 14th inst.  At this time
I  commenced  the examination about fifteen  minutes after the  com-
mencement of the chill.
   Lips  and fingers pale, and of a bluish color;  extremities  cold,
whilst the  trunk  is hot to the touch.  Patient is shaking all  over.
Pulse 92, feeble;  respiration 32, full and labored.  Temperature of
atmosphere, 77.5° F.; temp, of hand, 91°; temp, under tongue, 103°.
   A small amount of urine was excreted  at the  close of the cold
stage and  commencement of the general elevation of temperature
(equalization of the actions of the general and capillary circulation),
which had a  normal color.   Specific gravity, 1023.  Eeaction de-
cidedly acid.   One  thousand parts  contained—urea 21.825, uric
acid 1.467, fixed  saline constituents 7.436.
   During  the sweating stage, the reaction of his skin was neutral;
as a general rule, I have found it to be acid  in the various forms of
malarial fever.  Eeaction of saliva, as usual, acid.
   October 15, 1859.  Complete intermission  of fever.  Pulse 80,
fuller;  respiration 20, regular.  Temperature of atmosphere, 71.5°
F.; temp,  of  hand, 96°; temp, under tongue, 98°.
   (c.) Frenchman, aged 45 ;  brown hair and eyes ; height 5 feet 7
inches; weight 130 pounds.   Thin, spare man.  Had an attack of
intermittent fever, commencing  September 15.
   This case was  treated  in  the  Savannah Poor-house, and yielded
to the  ordinary  remedies, and  the patient  was  discharged in the
course of ten  days.  He  returned to a miasmatic situation, and was
again attacked with intermittent fever.
   Entered the hospital  and poor-house October  7, and  stated that
for the last four days he had had "dumb  ague," which came  on
every day at the same  hour (11 o'clock A. M.), and lasted two
hours.  A purgative, followed by  twenty-five grains  of sulphate of 
288
OBSERVATIONS ON
quinia, was administered.   This delayed the "dumb  ague" until
October 9, 3| o'clock P. M. (twenty-eight hours).
  Examination commenced half an hour after the commencement
of the " dumb ague."   Lips and fingers purplish;  extremities cold;
head'and trunk warm.  Complains greatly of the  sensation of cold,
but shakes far less than in the former cases recorded.  Pulse 92, so
feeble that it is with difficulty felt, and with still  greater difficulty
counted.  The vibrations of  the  pulse resemble those  of  a fine
thread.  Eespiration  accelerated and irregular.  Temperature of
atmosphere, 75° F.; temp, of hand, 83 ; temp, under tongue, 101.5,
  6| o'clock P. M.  Eeaction has taken place,   and  he now has
fever.  Pulse 96, much fuller than during the chill,  but weaker
than in a frank  open case.   Temperature of atmosphere, 70°F.;
temp, of hand, 101.75; temp,  under tongue, 102.75.   In this case,
which was far  more serious than  the preceding  cases, we observe
that the temperature of the trunk was not so much elevated during
the chill, nor during the subsequent reaction.
  The urine indicated serious disturbances; it was of a high color
and specific gravity, and correspondingly rich in  urea  and extrac-
tive matters.  The uric acid was slightly increased.
  Oct. 10th.  Intermission of fever.   Temperature of  atmosphere,
70° F.; temp, of hand, 97.5 ;  temp, under tongue, 98.5.
  (d.) Irishman;  black hair;  black eyes;  height  5  feet 10 inches;
weight 130 lbs.  In health florid complexion.  Has been suffering
with intermittent fever for four days; chills have been slight.  The
present chill (Sept.  23d, 1857)  is slight.  Temperature of atmo-
sphere, 79° F.; temp, of hand, 90; temp, under tongue, 102.
  (e.) Seaman: Englishman;  brown hair;  brown  eyes; florid com-
plexion in health, now his complexion is anaemic; weight 146 lbs.;
age 25; height 5 feet 6 inches.  Sept. 10th. Entered the Savannah
Marine Hospital, with bilious remittent fever, and  from this date
until the 19th  inst. was extremely ill.  This patient recovered so
as to be able to walk about the hospital yard.   Notwithstanding
the administration of  tonics  and iron, his complexion was  pale,
anaemic, and he complained of a severe and continued pain in his
head.
   On the 4th of October, he was  taken with severe chill, followed
by high fever.  This returned every day.
   Oct. 6th.  The chill has been  on him one hour, and the hot stao-e
is just coming on.  Pulse 110, feebler than  after the  complete re-
action, but stronger than during the lowest depression of the cold 
MALARIAL FEVER.
289
stage.  Respirations irregular,  thoracic,  panting, from 40 to 50.
Muscles  trembling violently.  Temperature of atmosphere, 70°F.;
temp, of hand, 97; temp, under tongue, 104.
  (/.) Irish laborer; stout, well formed man; sanguine temperament;
light  hair; blue eyes; florid complexion;  height 5 feet 9 inches;
weight 190 lbs.  This is his second attack of chill and fever this
season.
  Sept. 18th, 11 A. M.   Chill is now just going off.  Pulse, 112;
respiration,  28.   Temperature  of  atmosphere,  90.5° F.; temp,  of
hand, 100; temp, under tongue, 104.
  19th, 2 P.M.   Apyrexia complete.  Pulse, 68;  respiration, 24.
Temperature of atmosphere, 91° F.; temp, of hand, 97.5; temp, under
tongue, 99.
  Eecovered from  this attack.  Commenced work upon a steam-
tug, and slept on board in the Savannah Eiver, at night.  Eeturned
to the hospital with a third attack of intermittent fever.
  Oct. 2d, 2 P. M.  Has a chill, and is  shaking violently.  Pulse
120, in sitting posture.  Eespiration 22, in sitting posture.   Tempe-
rature of atmosphere, 79° F.;  temp, of hand, 89;  temp, under
tongue, 102.25.
  3d, 2 P. M.   Has high fever. Pulse, 100; respirations  26, full.
Temperature of atmosphere, 77.5° F.; temp, of hand, 105; temp.
under tongue, 106.
  Oct. 4th, 2 P. M.   Apyrexia complete.  Pulse, 58 ; respiration,
20.  Temperature of atmosphere, 76° F.; temp, of hand, 96.5; temp.
under tongue, 98.5.
  (g.) Seaman: Age 22; height 5 feet 4 inches; weight 140 lbs.;
black hair and florid complexion; sanguine, nervous temperament;
native of New York.
  Sept. 29th, 1857.   Entered the Savannah Marine Hospital, with
intermittent fever.  Has never been sick before in his life.  Has
been in Savannah two weeks, and  this is his first visit.  Says that
he was taken  sick, four days ago,  with chill, vomiting, and pains
in all  his bones, and has had a chill every day since, commencing
regularly at 12 o'clock  M.  Had a chill this day, commencing  a
few minutes after 12 o'clock M.  Says that he took three blue pills
and castor oil,  night before last.  This medicine operated twice.
  7 o'clock P. M.  Has fever, and complains of pains in his joints.
Slight tenderness upon pressure  of epigastrium.   Tongue clean,
moist, red at tip and edges; papillae enlarged and of a bright red
color.  Eeaction of saliva decidedly acid.   Pulse, 120; respiration 
290
observations  on
32, full, thoracic.   Temperature  of atmosphere, 79° F.;  temp, of
hand, 103.33;  temp, under tongue, 106.
   R.—Calomel gr. xij; sulphate of quinia gr. vij.  Mix and adminis-
ter immediately, and follow with  castor oil in four hours.  As soon
as fever remits, give sulphate of  quinia gr. v, every three hours, up
to gr. xxv.  During fever, give  soda powders (pulveres efferves-
centes tartarizati).  Diet, gruel and flaxseed  tea.
   30th,  1 o'clock  P. M.   Medicine operated freely, and says that
he is much better, but  complains of weakness.  Tongue presents
the same appearance;  skin cool and relaxed; face not  so much
flushed.  Pulse 70,  regular; respiration 22, regular and gentle.
Temperature of atmosphere, 68° F.; temp, of hand, 92 ; temp, under
tongue,  99.5.  Here we see, that  although the pulse and  respiration
are more rapid than in health, the temperature  of the trunk is nor-
mal, whilst the temperature of the extremities is 6° below the nor-
mal standard, and there is no shaking of the muscles.
   Color of  the urine, light orange, sp. gr. 1009.  Eeaction decidedly
acid.  Uric acid in grs.  23,220 of urine passed during  the last 18
hours, gr. 1.0035.   Uric acid in  grs. 30,952  of  urine calculated for
24 hours, gr. 1.3376.  Up  to this time, 1 o'clock P. M., has taken
20 grs. of the sulphate  of quinia, and the  marked diminution of
the uric acid may be connected with the action of this medicine.
   5 o'clock P. M.  Half an hour ago was taken with chill and vomit-
ing.   Now the chill appears to be subsiding, the  shaking and con-
traction  of the muscles are diminishing.  Extremities cool, whilst
the head and trunk are pungent to the hand.   Pulse 108, feeble,
respiration 30, full, labored, panting.  Temperature of atmosphere,
74° F.;  temp, of  hand,  91; temp, under tongue, 105.5.  In  three
hours and  a half the pulse has increased 38 beats in the minute;
the respirations have increased 8 in the minute; the temperature of
the extremities has diminished, whilst that of the  trunk has  in-
creased 6°.   The  comparison of this observation with the preceding one
three  hours ago, demonstrates the  truth of the 3c? proposition, viz:  the
diminution  of  the  capillary circulation, and reduction of  the tempera-
ture of the extremities, precedes  the aberrated nervous and muscular
phenomena, denominated chill.
   8| o'clock P. M.  Three hours and a half after  the  observation
upon the chill, the relations between the temperature of the  trunk
and extremities have been restored, and the shaking and shivering
of the muscles, and the sensation of cold,  have  vanished.  Pulse
108, fuller and stronger;  respiration 32, not so full and  labored as 
malarial fever.
291
during the chill, but still much fuller and more labored than during
health.  Temperature of atmosphere, 73° F.; temp, of hand, 103.5;
temp, under the tongue, 105.
  Specific gravity of urine excreted during the cold stage and com-
mencement of the hot stage, 1020.  Color normal.  Eeaction  de-
cidedly acid.  Uric acid in 5100 grs. of urine excreted during 8 hours,
grs. 2.  Uric acid in 15,300 grs. of urine calculated for 24 hours,
grs. 6.  The uric acid has  increased in  amount  during  the chill
and commencement of the fever, when compared with the former
specimens of urine; it is, however, still below the standard of health.
If the diminution of the amount of uric acid be due to the action of
the sulphate of quinia, it shows that this action of this  remedy
pointed out by Eanke,1 is not necessarily  attended by a disappear-
ance of the chill.
  Oct. 1st, 11 o'clock A. M.  Apyrexia;  says he is better and  has
no pain  except a slight headache, and was in a perspiration all
night.  Fever intermittent at 12 P. M.  Skin cool.  Pulse, 76;  res-
piration 23.  Temperature of atmosphere,  70° F.; temp, of hand, 95;
temp, under tongue, 98.5.  Has taken 15 grs. of sulphate of quinia
since the intermission of the fever.
  (h.) Englishman, entered the Savannah  Marine Hospital, Oct. 9th,
1857; age  27.  Has been  in America thirteen years.  Height  5
feet 10 inches; weight 145 lbs.; muscular system well developed;
sanguine temperament; occupation,  steward on ship; has been in
Savannah three weeks.  Says that he was  taken  yesterday at 12
o'clock M. with cold feelings and headache.  The chilly feelings
lasted four  hours, and were succeeded by fever, which continued
until 4 o'clock this morning.  Two and a half hours  after the sub-
sidence of the fever (8J o'clock A. M.) he shook violently.  This
chill  was followed by fever.
  Now, 8 o'clock P. M., fever is subsiding.   Pulse 98, full but soft.
Temperature of atmosphere, 72° F.;  temp, of hand,  102.5; temp.
under the tongue, 103.  Tongue moist; skin in a profuse perspira-
tion ;  says  that he  took last evening a dose of salts and cream of
tartar, which operated twice this morning.   B.—When fever goes
off, give sulphate of quinia, grs. v, every three hours up to grs. xx.
  Oct. 10th, 12 o'clock M.   There was a complete intermission of
the fever about 2 o'clock this morning.   At this time the sulphate
of quinia was commenced, and he has taken gr. xv.
1 Medical Times and Gazette, May 30,1857, p. 540. 
292
observations on
Amount of urine passed during the last 16 hours  .    •  6144  grs.
      "      "      hourly    "    "      .       321.5  "
Calculated amount of urine for 24 hours    .    •    •  9216   "
	In 6144 grains of urine (16 hours).	In 9216 grains of urine calculated for 24 hours.	In 1000 parts of urine.
Uric acid .... Fixed saline constituents	226.980 grs. 0.600 " 40.200 "	340.470 grs. 0.900 " 60.100 "	36.943 0.097 6.542
   Sp. gr. of urine 1024—clear; no deposit; light red color.   Ee-
 action decidedly acid.  After standing 12 hours  no deposit; after
 standing 36 hours, a very slight light yellow deposit; after standing
 60 hours  the  surface was covered with a  pellicle, which, under a
 magnifying power of 210 diameters, was found to consist of small
 oval cells,  about the size of human blood-corpuscles.   There were
 also other elongated elliptical cells, the short diameters  of which did
 not differ from those of the globular cells.  Many of the elongated
 cells had a vibratory motion.   The deposit at the bottom consisted
 of these globular elliptical  acicular cells, and a  few crystals of
 triple phosphate.  That these  cells were organized bodies was de-
 monstrated by the action of chemical reagents under the microscope.
 Not a trace of uric acid was found in the pellicle and  deposit.
   12| o'clock P.M.   A  chill is just coming  on.   The thermometer
placed in his hand, indicated 91.5° F.  Simultaneously with  the in-
 crease  in the sensations of cold, it commenced to descend, and in fifteen
 minutes stood at  87.5°, 10J degrees below the normal standard.   In
fifteen minutes his hand lost 4°, and simultaneous with this loss of tem-
perature in the extremities, the sensation of cold increased.  He feels very
 cold, but does not  shake.  The extremities feel cold, whilst  the surface of
 the head and trunk feels hot and pungent.  When the bulb of the ther-
 mometer was simply placed between the skin and flannel shirt, and gently
pressed against the surface of the chest, it commenced to rise rapidly, and
 in a few moments indicated 103° F, and when placed in  the armpit, it
 rose rapidly to  107° F.  Pulse 100, not so full as during fever, but
 small, feeble, and threaded.   Respirations 26, full and labored.   Tem-
perature of atmosphere, 68.5° F;  temp.ofhand, 87.5°; temp, of axilla,
 107°.   Tongue pointed, but  moist,  and not much redder than usual
 Skin dry, with  a purplish mottled appearance as if the circulation in the
 capillaries  was retarded.   Says  that he has dull " wandering  pains
 around his loins up to his chest."   Complains of great thirst.  His sto-
 mach is so irritable that I could not ascertain the temperature under his 
malarial  fever.
293
tongue.   I made seven unsuccessful attempts.  At every trial the contact
of the bulb of the thermometer with the base of tfie tongue excited violent
retching and vomiting.  I applied a sinapism over the region of the
spinal column, eighteen inches in  length, and three inches in breadth,
also one over the epigastrium, and administered stimulants.  In half an
hour after their application, the mustards  and stimulants assisted in
arousing the capillary circulation in  the extremities.  His surface does
not present the mottled appearance; the heat  has, in a great measure,
returned to his extremities;  the cold sensations have disappeared, and he
"feels warm all over."  The temperature of his hand is now 99°, whilst
the temperature in the axilla is still 107°.  In half an hour  the  tem-
perature of  the extremities has risen  11.5°.   The temperature of the
hand does not correspond fully with  that of the trunk, and reaction is
not yet fully established.
   Has just passed clear  limpid straw-colored  urine.  Sp.  gr. 1003.
Amount of urine voided, 7021 grs.
	7021 grains of urine contained.	1000 parts of urine contained.
Fixed saline constituents	Grains. 39.551 0.420 9.800	5.650 0.059 1.395
   Nitrate of urea remarkably silky and white.
   Microscopical Examination.—The  urine  was placed in a  closely
stoppered bottle, and set aside for sixty hours.   At the end of this
time there was a pellicle over the surface, and a small light-yellow
deposit.  The pellicle consisted entirely of the globular, elliptical,
and vibrating cells, observed in  the  former specimen.  The deposit
also consisted of these  cells,  and a few beautifully formed,  pris-
matic  crystals  of triple  phosphate.  This specimen 6f urine was
interesting, because it was passed at the close of a chill, and was
probably excreted by the kidneys during the existence of the cold
stage.   It was much lighter in color than that passed during fever;
in fact it resembled the urine of hysterical women, in its light  color
and low specific gravity.

   Phenomena during the Hot Stage and Period op Intermission.
   Proposition V. The higher the temperature of the trunk during the
cold stage, and of the extremities and trunk during the subsequent hot
stage (stage of equalization of  the circulation and chemical action), the
t 
294
observations  on
milder and shorter will be the attack, as a general rule, provided there
be no complication, as congestion of the brain.
  Whenever, as in congestive fever, there is a want of correspond-
ence  between the circulation, respiration and  chemical  changes,
the patient is always in danger.   A patient with  a  rapid feeble
pulse, and rapid thoracic respiration and low temperature (sluggish
chemical changes), is always in great danger.  In cases of malig-
nant (congestive) malarial fever there is, as  far as my  observations
extend, a want of co-ordination between the actions of the circula-
tory and respiratory systems, and the rapidity and character of the
chemical  changes.   The  heart attempts to propel the blood; it
beats rapidly  (flutters 140  to 160 times in the  minute), but  the
blood does not flow readily through the capillaries, because  the
chemical  changes  are in a great measure  arrested, and in many
cases perverted.  On  the other hand,  the bounding, full, accelerated
pulse; the full, heaving, accelerated respiration, and correspond-
ingly high temperature, are always favorable symptoms, provided
there be no complication, as obstinate vomiting, or cerebral symp-
toms.   The severity of the  fever is by no means proportional to the
height of the fever (animal  temperature), for, as a general rule, the
higher the fever (temperature), the more readily does the attack yield to
treatment, and the less serious the effects.
  A  high temperature, then, in intermittent fever, is a favorable
symptom.
  Whether the high  temperature signifies  an effort on the part of
nature  to  break up, chemically alter, destroy,  and throw off,  the
malarial poison; or whether the  high temperature be significant
of nothing more than vigorous, vital, nervous, physical,  and chemi-
cal forces; nevertheless the determination of the correlation of the
respiration, circulation, and temperature, affords the most valuable
information to the medical practitioner.

   Proposition VI. In malarial fever there is a  close relation between
the state of the skin, pulse, respiration, and temperature of the extremi-
ties and trunk.
   A rapid, full pulse, hurried, full respiration,  and dry skin, were
attended  with a corresponding elevation of temperature.  If the
functions of the organs and apparatus be properly  performed,  a
full, and rapid, vigorous circulation and respiration, must be at-
tended by the rapid  absorption of oxygen, and exhalation of  car-
» 
MALARIAL fever.
295
bonic acid gas, and  correspondingly rapid chemical changes, and
development of heat.
  A slow pulse, and  respiration, and moist skin, was always accom-
panied with a reduction of temperature.
  During the intermission of the fever, the slow pulse, and respira-
tion, and moist, relaxed skin, were attended with a reduction of the
temperature, in many cases, below the standard of health.
  The questions immediately arise: Is the intermission of the fever
due to the restoration of the functions of the sudoriparous  glands,
which collectively expose a surface of tubing 1,570,000 inches, or
nearly 28 miles in length ?  Is the morbific agent or agents, which
have disturbed the chemical actions and correlation of the forces,
eliminated by these  glands?
   If  the intermission is due to the restoration of the functions of
the sudoriparous glands, what excited them to action?
   Is  the  phenomena connected with the nervous system alone, or
with chemical and physical changes of the morbific agents, and of
the blood, and secretions, and excretions?
   If the  reduction of temperature be not dependent upon the re-
storation of the functions of the sudoriparous glands, what retarded
the chemical actions by which the physical forces are generated?
   If the  chemical actions developing an unusual amount of heat
 were excited by the introduction  of foreign elements, may not the
 foreign elements themselves have entered into these chemical  ac-
 tions, and been so altered that  they have been for a time rendered
 inert?
    That a special end is accomplished in  malarial  fever by an eleva-
 tion  of  temperature, is  proved by  the  fact that the cases which
 manifest the highest temperatures, are, as a general rule, attended
 with little or no danger; whilst in those cases, as congestive fever,
 where there is a depression of temperature, the  danger is  always
 imminent.
    It is true  that the sudoriparous glands have much to do with the
 regulation of the temperature, for the water which they eliminate
 from the blood  during its evaporation, abstracts one thousand de-
 grees of heat from the surface of the body and the surrounding
 atmosphere.  The heat is  expended in the mechanical action of
 keeping asunder the particles of  water, and is hence insensible to
 the thermometer.   The experiments of Dr. Southwood Smith,1 at
' Philosophy of Health, vol. ii. pp. 391-396. 
296
OBSERVATIONS  ON
the Phoenix Gas Works, and of MM. Berger, Delaroche,1 Fordyce,
Blagden,2 and others,3 have shown that when animals and man were
subjected to great external degrees of heat, the temperature of the
body was regulated by the evaporation from the surface of the skin
and lungs.  When the air was dry, individuals were able to endure,
for a considerable length of time, a temperature of from 250 to 350
degrees, without  injurious  effects, and without any great  elevation
of temperature.  The loss of water from  the surface of the body
was correspondingly great, and by its evaporation  maintained the
temperature of the interior at the normal standard.   If,  however,
this evaporation be  interfered  with,  by  saturating the  air with
aqueous vapor, the temperature rose rapidly, and  the  individuals
died in a short time.
   The determination  of the fact that the  sudoriparous glands can,
to a certain extent, regulate  the temperature of the  surface, does
not by any means prove that the  remission or intermission of ma-
larial fever is due to the restoration of the function of these glands.
In congestive fever, when  these  glands are  active, and the whole
surface is bathed in  perspiration, the malarial poison  is far more
active than  in remittent and intermittent fevers, attended  with a
rapid, bounding pulse,  and rapid, full  respiration,  and high tem-
perature, and hot, dry skin.

  1 Experiences sur les Effets qu'une forte Chaleur produit sur l'Economie, Paris,
1805 ; and Journal de Physique, tomes lxxi. et lxxiii.
  2 Philosophical Transactions, 1775.
  3 " Magendie's Experiments upon the Influence of Hot Air on Animal Life ;" Am.
Journ. Med. Sciences, Jan., 1845, p.  183.  M. Constantine James, "On the Effects
of the Hot Moist Air of the Baths or Stoves of Nero, at Pozzuoli;" Gazette Medicale,
27th Avril, 1844.  W. F. Edwards, " On Animal Heat;" Cyclopaedia of Anatomy and
Physiology, vol. ii. pp. 649-684. John Davy, "On Animal Temperature," Phil.
Trans., 1814; Edinburgh  Philosophical Journal, Jan., 1826 ; see also Researches,
Physiological and Anatomical, by John Davy, London, 1839, vol.  i. pp. 141-248.
Experiments of Tillet and Duhamel, " Experiments on the Servants of a Baker, at
Rochefoucault, in Angoumois;"  Mem. Acad.  Scien.,  pour 1764,  p. 186 et  seq.
Experiments of Dobson at  Liverpool; Phil. Trans, for 1775, p. 463  et seq.  " Obser-
vations on the Effects of High Temperatures," by Bell, of Manchester ;  Manchester
Memoirs, vol. i. p. 1 et  seq.   Currie " On the Application of  Water at Different
Temperatures;" Phil. Trans, for 1792, p. 199 et seq.   Experiments of Delaroche,
Journ. Phys., t. lxiii. p. 207.  Nicholson's Journ., vol. xvii. p. 142, 215.  Journ.
Phys., t. lxxi. p. 289, and t. lxxvii. p. 1.  Lavoisier on  Transpiration, Mem. Acad.
pour 1790.  John Reid on Respiration, Cyclopsed. of  Anatomy and Physiology,
vol. iv. pp. 325-368. 
MALARIAL FEVER.                  297
        Appearances op the Tongue in Intermittent Fever.

   In almost every case the papillae  of the tongue were enlarged,
 and of a bright, red color.  In the mildest cases the tongue was
 only slightly coated with white and  light yellow fur, and the tip
 and edges were redder  than normal.  In the severest cases the tip
 and edges of the tongue assumed a bright-red color, and the tongue
 was much dryer than  in  the milder cases, and the reaction of the
 saliva more intensely acid.  The fur of the tongue in many cases
 was thick, and  of a brownish-yellow color.   The reaction of the
 saliva was always acid  during  the active stages,  and the  intensity
 of the acid seemed  to correspond, in a measure,  to the severity of
 the disease.


         Characters op the Urine in Intermittent Fever.

   In the  mildest cases the characters of  the  urine did not differ
 very essentially from those of health.
   As a general rule the amount of urine excreted  during the active
 stages, and during the earliest period of intermission, when the
 temperature of the trunk and extremities  sinks below the normal
 standard, was less than that of health.  During convalescence, espe-
 cially under the action of depurants, the amount of urine  excreted
 was greatly increased.
   These statements cannot be  applied rigidly to all cases, for the
 urine is  affected by so many varied  external  and internal condi-
 tions, that the amount excreted exhibits great  fluctuations, even in
 health.   No two observers agree with reference to the amount ex-
 creted in definite periods.
  Thus,  Lecanu, from  the  examinations  of the  urine of sixteen
 individuals, living upon mixed food, estimated that the amount of
 urine discharged in twenty-four hours ranged  from 8085 grains to
 34,973 grains.
  Becquerel  found that the mean daily quantity passed  by  four
 men was  19,511 grains, and that by four women was 21,130 grains.
 Lehmann, from experiments instituted upon himself,  estimated the
 quantity  discharged daily  at from 13,829 grains to 22,299 grains.
  According to the valuable experiments of Dr. William A. Ham-
 mond, instituted upon himself, the  amount of urine excreted under
a mixed  diet ranged from  19,684 grains  to 22,756 grains, with a
       20 
298
OBSERVATIONS  ON
 mean of 20,898 grains;  under a diet of albumen, from 12,325  to
 21,592, with a mean of 17,738;  under a diet of starch, from 14,339
 to 23,352, with a mean of 18,427 grains; and under a diet of gum,
 from 20,516 to 23,721 grains, with a mean of 21,538 grains.
   The  only accurate  method of determining  whether or not the
 urine be increased or diminished is  to refer it to the  standard  of
 health  in the individual examined.   In hospital practice this is  in
 the majority of  cases impossible, and we are  compelled to be con-
 tent with approximate results.
   The density of the urine was slightly increased  in the majority  of
 cases during the active  stages,  and in  others it remained at the
 standard of health,  and  in  others, again, it  varied within  wide
 limits.
   The color of the urine varied from  deep yellow and the normal
 yellow  color to  light red.  During  the active  stages deep orange
 was the most common color.
   The intensity of the color was greatest during the active stages,
 and diminished during convalescence.
   During the active  stages of intermittent fever  the urine always
 contains more free acid than in  health.  It will  retain the acid re-
 action for several days, even  in the heat  of summer.
   When the fever intermits, and the skin is soft and relaxed, and
 the patient is convalescent, the urine then  excreted rapidly under-
 goes decomposition, and  in a few hours the reaction changes  from
 acid to  alkaline.  I believe this to be one of the most certain signs
 of convalescence in  malarial fever.   The  acidity of the urine in
 malarial fever is in  proportion  to the severity of the attack; it  is
 more intense in  remittent that in intermittent fever, and still more
 intense  in congestive fever than in intermittent and remittent fever.
   The urea was increased during the active stages above the stand-
 ard of starvation.  During the active stages the patients took  little
 or no nourishment, and  the  urine  excreted  during  these periods
 should  be compared with that excreted during starvation  and re-
 pose, and not with that of health.  Unfortunately the standard of
 the urine during starvation varies with each individual, and  as  it
 is  impossible to establish a standard previous to the attack in the
 great majority of hospital patients,  we can only establish approxi-
 mate results.
  In the majority of the cases the URIC acid was diminished,  both
 with and without the action  of the sulphate of quinia during the
active stages, when the pulse was full  and rapid, and the  respira- 
MALARIAL FEVER.
299
tion full and accelerated, and the temperature elevated.   In almost
every case, as the fever declined, the uric acid increased above the
standard of health, both with and. without the action  of  the sul-
phate of quinia.
  From the microscopical examination  of several hundred speci-
mens of urine excreted during the different forms of malarial fever,
I found it, as a general rule, to be true that, in the mode of treatment
which I adopted, the uric acid appears in much larger quantities in
the urine of convalescence than  in that excreted during fever, even
when the sulphate of quinia had been  withheld, or  sparingly ad-
ministered.
  The majority of specimens of urine excreted  during fever, which
were set aside and  examined under the microscope, at successive
intervals, gave no deposits of  the crystals  or salts  of uric acid,
whilst   specimens  of the urine  of convalescence very soon gave
evidence of the presence of uric acid, by letting fall  deposits of
urate of soda and  ammonia.
  As far as my observations extend, it may be stated, as a general
rule, that the  phosphates are more abundant in the stage of conva-
lescence than  during the active  stages.
  The deposits so common during convalescence consist chiefly of
urates  of soda and ammonia, and the phosphates most generally
in the form of the triple phosphate.
  The chief reason why the deposit of the phosphates is more fre-
quent in the intermission than  in the active stages is because the
urine in the  active stage of convalescence is far less acid, and far
more readily  decomposed and rendered  alkaline  by  the ammonia
resulting from the decomposition of the urea, than  the urine  of
fever.
  These facts explain the nature of the so-called critical discharges
of malarial  fever.   The urine excreted  during fever is generally
deficient in uric acid and the  earthy salts,  whilst its acidity and
power  of resisting decomposition is greatly increased,  and it will
remain  for a  great length of time without undergoing  decomposi-
tion.  The urine of convalescence, on the other  hand, is rich  in
uric acid and  the earthy and  alkaline salts, and readily undergoes
decomposition.  The deposit of the urates of soda and  ammonia,
and the precipitation of the triple phosphate by the ammonia gene-
rated during  decomposition of  the urea, form the so-called critical
discharges.  As a  general rule,  the urine excreted during  the hot
stage of intermittent  fever is poorer in uric  acid than the urine of 
300
OBSERVATIONS  ON
remittent fever; and I have known cases in which, during  fever,
the uric acid disappeared almost entirely.   In several cases of con-
gestive fever the urine contained only traces of uric acid, and in
one case, which terminated fatally, the disappearance of the uric
acid was attended with the disappearance of the urea.  Dr. Eanke1
states, in his article upon  the  physiological action  of sulphate of
quinia, that, according to all observers, there is in ague an increase
of uric acid.  My observations do not correspond with this  asser-
tion, if it is intended to apply to the active stages of intermittent,
remittent, and congestive fevers.  The fact that uric acid increases
during convalescence from malarial fever demonstrates conclusively
that the  diminution of the amount of uric acid by sulphate of
quinia is an attending circumstance, and not necessarily one of the
beneficial remedial modes of the action of this medicine.
  As a  general rule, the extractive  and coloring matters are
less abundant during  the  active  stage of  intermittent fever  than
during the first period  of  the intermission.  They are either not
formed in  such abundance, or if formed,  are partially consumed
during the active chemical  changes of fever.
  The nitrate of urea formed from the urine excreted during the
active  stages of  intermittent fever  is silvery  white,  whilst  the
nitrate of urea formed from the urine excreted during the  inter-
mission is dark, discolored, and the crystals are not so well formed.
The former kind of urine, when evaporated and concentrated, gene-
rally has a yellowish or brownish color, whilst the concentrated
urine of the intermission assumes the color of a very strong decoc-
tion of over-parched coffee.  The depressed state of the forces con-
sequent upon the continued action of the malarial poison is,  as far
as my observations extend, attended by a marked  diminution of
the solid constituents of the urine.
  These propositions and  statements will be illustrated by the fol-
lowing cases:—
1 Medical Times and Gazette, May 30, 1858, p. 537. 
TABLE  I.
Observation.—(h.) Seaman; native of New York; age 22;  height 5 feet 4 inches; weight  140 lbs. ; black hair, florid complexion ; handsome,
    intelligent countenance; sanguine nervous temperament.   Has never been siok before ; has been in Savannah two weeks, and this is his
    first visit; has slept on board the ship lying in the Savannah River.   Was taken sick four days ago, and has had a chill every day since
    at 12 o'clock M.;  had a chill this day commencing a few minutes after 12 o'clock M.   Says that he  took  three blue pills  and castor oil
    night before last; this medicine operated twice.
Date.	Hour OP DAT.	Medicine.	State of Skin.	CD ~0	d o P.	o 0 O)	o 0 H*1	■0 a 0 P 3 « . CD 0 P. to S a H	0 •0 a> 0	13 CD g r0 O •3-d « -H 0CN * S	CD © J;	Urine excreted in Hours.		V 05 « CD P< CO	2 oj P	° u a§ . * a w ■a « "S2 03 .« -fl I 5 Si "3 "3.2	0 CD c » J a S g T3-3J3 £ <a~n 03 t> IN g'g-2 o ° *	^6 v o . ■2 13 J3 W O	Color and Microscopical Examination of Urine.
Sept. 29 " 30 " 30 " 30 Oct. 1 " 2 " 3 " 4 " 5	7 P. M. IP. M. 5 P. M. 8 P. M 11 A. M. 11 A. M 11 A. M 11 A. M. 11 A. M	Calomel gr. xij, sulp. qui. gr. vij, castor oil in 4 hrs., sulph. qui. gr. xxv. Spirit of mindererus. Sulph. quinia gr. xx. Sulph. quinia gr. v. Calomel gr. vj, sulph. qui. gr. vj, castor oil in 4 hrs., sulph. qui. gr. xv. Snakeroot tea and sul-phate of quinia. Quassia and soda. Quassia and soda.	Hot, dry Cool, relaxed Chill Hot, dry Cool, moist Warm and moist Cool and moist Normal Normal	120 70 108 108 76 84 62 60 62	32 22 30 32 23 32 20 20 21	79.0° 68.0 74.0 73.0 70.0 74.0 74.0 72.5 70.0	103.33° 92.00 91.00 103.50 95.00 100.50 96.00 96.00 96.00	106.0° 99.5 105.5 105.0 98.5 102.0 98.5 99..3 99.3	Grs. 28320 24309 15810 18180 20520 30450	Grs. 3.0035 9.3000 8.1000 15.000	Grs. 1290 118*0 1014 658 757 855 1268	Grs. 23220 5100 19209 15810 18180 20520 30150	18 '8 15 21 24 24 24	1009.5 1020.0 1011.0 1020.0 1010.0 1018.0 1015.0	Grs. 1.0035 2.0000 9.3000 8.1000 15.000	Grs. 30952 15300 30734	Grs. 1.3376 6.0000	60 60 60 20 20	Light orange; af-ter 50 hours, no deposit of urates or phosphates. Normal color; no deposit. A shade higher " than normal. Deposit of urates and phosphates. Light yellow; phosphates and urates precipi-tated. Color normal; de-posit. Color normal; de-posit.
 
o
to
                                                          TABLE II.

Observation.—(t.) American seaman; age 16 ;  weight 125 lbs.; light hair, blue eyes, florid complexion ; sanguine temperament.  From U. S.
    cutter which has been lying at the 'ship-yard in the low lands east of the city.   Four nights ago, he slept on the Savannah River m an
    open boat- has not felt well since, and thinks that  this was the cause of his sickness.  The next morning felt badly; had pains in his
    bones and'back, but no chill.   These unoomfortable feelings were followed by fever, which  intermitted yesterday.  This morning had a
    slight chill, followed by fever.
										a	0			
								O	o		■3			
								<d ©	CD	a> .	+2			
											CD			
							o	H ^		£ s		3	L. .	Color and Reaction
Date.	Hour OF DAY.	Medicine.	State	of Skin.	State of Tongue.	<D	o3 'p.	ag.	03 u B 03			II	ca '£ '3 s ■d *-.	of Urine.
														
						fc	w	H	£*	Eh	P	P	co	
											Grs.	Grs.		
Oct. 5	11 A. M.	Cal gr. viij, castor oil in 4 hours, cit. potassa mix-ture, sulphate of quinia,	Hot, dry		Red, dry, rough	120	40	72°	105.75°	106.00°		••		Light orange color.
" 6	Ii P. M	gr. xv. Sulphate of quinia, gr. v.	Moist, soft,	and relaxed	Moist, soft, and clean	64	20	73	94.50	99.00			1022	Reaction strongly acid in
" 7 " S " 9	1J- P. M. 2 P. M. 12 M.	Snakeroot tea, quassia, and soda. Quassia and soda. Quassia and soda.	Normal Normal Normal		Normal Normal Normal	62 52 52	20 2t 24	72 73 73	94.73 98.20 98.20	99.20 99 50 99.50	8210 8721 15912	313.3 363.3 663.8	1030 1026 1024	Reaction alkaline in 16 hours ; heavy deposit.
 
                                                            TABLE  III.

Observation.-^.) Englishman; age 27 ;  height 5 feet 10 inches ;  weight 145 lbs.; muscular system well developedj™J^^^™&
    occupation, steward on ship.   Has been in Savannah three weeks.  Says that he was taken yesterday, at 12  ° clocf ^  fg ™£?£m
    ings and headache.  The chilly feelings  lasted four hours, and were succeeded by fever which cont nued until 4-c^ock th,emoi■    g
    Four and a half hours after the subsidence of the  fever (8$ o'clock A.  M.), he shook violently.  This chill was followed by lever wi
    is now subsiding.
Date
Oct. 9
 Hour
of DAY.
10 12 M.
10  i P. M
11
Sulph. of qui
 gr. XX.
         Spirit  of  min-
          dererus and
          sinapisms
   IP. M
   7 P. M.jSulph.  of qui.
          gr. xx.
  10 P. M. Snakeroot tea
12 11 A. M. Quassia & soda
13 10 A. M
14|   ..
State of
 Skin.
Warm and
 moist
Cool, moist
Cool, moist
Normal
Normal
£ £
0 CD
aS
72.0'
69.0
67.0

0.2
"°-0
— CD
 99.0
102.0
K a
CD o
OS A


PM
287S2
16320
Grs.
18290 365.9
O CN

» 0
Grs.  Grs.
115.2
6144
7021
 5075

 9144
15120
13662
16320
1024
1003
1015

1016
1008
1012
1020
	T3
	
	O
	03
OS	V
	
	
p	P
Grs.	Grs.
226.0	0.600
39.0	0 420
99.4	0.2*30
157.0	3.150
101.8	2.023
488.0	9.600
•0 0
40.2
 9.8
28.5

40.5
 29.7
115.2
	c'13 0S o o>	L*		,
		a		i>£ ■
		■0		8g"
CD	S 3 . oi X CO	*	u 0	2 S S
* ^	•0 w a CD CD 0 C5.2^	0 J 03 9	jOcN	r- CO-f
11 p~	art-*1 g 0 CM	cS^S	u"2	■o 3,2 CD -^ *-
	^ o.S	£<»	,T CD	■- SO O
Grs.	Grs.	Grs.	Grs.	Grs.
321	9216	310.0	0.90	60.10
760	20300	397.7	1.00	ni'oo
590	14630	251 4	5.01	61.80
1680	40219			
942	21859	162.9	3.21	47.52
680				
CO
o
Cm 
o
H-*
                                                           TABLE  IV.

Observation.—^.) American seaman, native of Maine ; weight 140 lbs.;  height 5 feet 8 inches;  age 19 ; li«ht hair and blue eyes ;  fair com-
    plexion.  Has been m Savannah three weeks.  Was taken with chill, followed by fever, yesterday at 12 o'clock M.;  had another chill this
    morning at 4 o'clock.   Oct. 10th, 11 o'olock A. M.  Has a high fever now, and complains of pains in his head and bones.  Skin very hot but
    moist;_ pulse 112 ;  respiration thoracic, labored ; tongue slightly coated with fur.  $.—Calomel, gr. x; sulph. of quinia, gr. vi.   Mix 'and
    administer immediately, and follow with castor oil in four hours.   I}.—Soda powders.                                           '
																
						o						9 £	a t	n n	a 9 -	
						*►.	a				a o	2 J3 2-H	$■*	S -	a g-a	
Date.	Hour of Day.	Medicine.	State of Skin and Tongue.	CD "3 Pi	0 o '2, o W	> d to V . <a « 'C a P. 0 OB	o^ a-2 0S. o u a *	0 o a	£ p	"2 '3 (3 P	<D a O u Si "	SJ5 03 b -e<2 £ « co a in "OS'S	03^ •0,0 CD*-gs o	cSTS I"S g a S * o ^l	Is-T3 CO '*-tp»J g«5 * o'm	Reaction, Color, &c. of Urine.
							Grs.		Grs.	Grs.	Grs.	Grs.		Grs.	Grs	
Oct. 10 " 11 " 12	7 P. M. 1 P. M. 11 A. M.	Sulph. of quinia, gr. x. Sulph. of quinia, gr. x. Quassia & soda	Skin hot, but moist; fever con-tinues unabated. Skin cool and moist; papillae of tongue red and enlarged, tongue soft, moist, and slight-ly coated with white fur. Skin cool and moist; tongue clean.	74 72	26 20	1022 1027 1023	9198 3580	10 7	222.5 132.0	3.96 1.75	87.30 21.70	22075 12177	534.0 452.7	9.50 5.99	209.5 74.3	Clear orange color; still acid, with no deposit after 70 hrs. Reaotion ohanged from acid to alkaline in 36 hours, and de-posit of triple phosphate and urate of soda thrown down. Reddish-orange color; reao-
																tion acid at end of 50 hours,
" 12 1 8 P. M. Quassia & soda			Skin soft and normal.	64	16	1020	5100									and no deposit. Straw-colored. Normal.
" 13 11 A. M. Quassia & soda I 1			Normal.				5120	25		2.75	46.00	8192		4.40	73.6	
																
 
			----------------------------1
CO	Date.	CO 4-03to»-'i-'00<o<ococo-4-aOiai	Date.
>4-03tOt-'l-,OOCOCOCDODM-^c3iOi			
y > g ^d > |ti^ Jti t> ."d > Jti > ^ ^ kk' kkkgkkkkkkag	Hour OF DAT.	^ S tOB? H^Ooo«ffi-JOO>H *d > g nj > N> ^ > ^ r* ^ r* ^ -^ kk' kkk^skkgsgsa	o * a B a
Oi M HJ tOM tO — 03 . . . 030iOi>-J03H--JGO. . . y	Urea.	. . Oi OS -J Oi Oi -4 -J CO -J O CO tO HJ . • O -J (+* CO CO Oi Oi CO CO CO CO O CO 1	Pulse.
O O O O (^-rf^ *• 03 Oi			
Grs. 1.000 3.240 4.320 0.720 4.440 1.000 2.300 4.200 4.720 5.400	Uric acid.	to • - to to i-1 to i-1 to to hj i-i to to • IT . • O tOCOO CO tOO CCGC H- CO- 03	Respiration.
Grs. 54.4 272.3 ' 126.4 215.9 690.0	Extractive and coloring mat-ters.	go-^icogo-4co**j-j~3coco co 03GctOOCO~JOtOiCitOO. o* '. . b^'o oooooooo' o Oil ooooooooo o	Temperature of atmosphere.
03 *s Kt^SS ti ,-, CO ►—' fcOtOOitO<#.UJ to; '. '. 'y'. '. '. '*• bi to to '• '• '• S o co o o o 03 r o o O O O Oi	Fixed saline constituents.	96.00° 100.00 103.75 98.50 93.00 97.75 97.50 96 50 97.00 97.00 97.83 97.00	Temperature of hand.
Grs. 6803 20903 16335 13745 18405 7661 13601 10722 13139 5768	Calculated am't of urine for 24 hours.	101.5° 104.0 105.0 100.5 104.5 99 5 99.8 98.0 98.9 98.2 99.0 99.8	Temperature under tongue.
Grs. 6405 19856 15570 13015	Calculated am't of water for 24 hours.	Grs. 14776 18351 15291 15298; 11240 10209 12250 11254 8194 16962 25335	Am't of urine excreted dur-ing 24 hours.
Grs. 397.9 1047.0 765.0 729.0	Calculated am't of solid mat-ters for 24 hrs.	Grs. 6J5 764 628 637 468 425 510 468 341 706 1055	Am't of urine excreted hourly.
Grs. 217.7 477 0 302.5 356.0 340.0 94.5 169.0 205.6	Calculated am't of urea for 24 hours.	Grs. 14015 174.03 14017 23971	Water excreted during 24 hrs.
Grs. 2.666 5.540 11.507 1.080 13.320 1.500 6.131 6.300 15.104 7.619	Calculated am't of uric acid for 24 hours.	Grs. 760 898 773 1363	Solid matters excreted dur-ing 24 hours.
Grs. 144.9 466.0 337.0 324.0	Calculated am't of extractive and col'ng mat-ters for 24 hrs.	o, BMMMosau . . . n 1 Urea excreted 2: : : §§c»oSS3' • • • 3 1 dnring24hrs.	
Grs. 32.610 96.150 113.700 48.600 61.792	Calculated am't of fixed saline constituents for 24 hrs.	Grs. 4.240 7.560 5.040 5.160 5.400 3.300 6.500 8.920 10.120	Uric acid ex-creted during 24 hours.
CO CD CO CD X> CO rf*.! ! ! ! I ! I tt* o« en *- co, . en os 03 o r—' os	Water in 1000 parts of urine.	Grs. 326 398 341 552	Extractive and coloring mat-ters excreted during 24 hrs. Fixed saline constituents excreted dur-ing 24 hrs.
63.9 58.5 50.0 46 8 53.0 54.5	Solid matters in 1000 parts of urine.	o Mcoa Q Oi.......CUt GO 00 " \ . . 1	
		o o bo "o ?	
34.90 31.90 22.80 18.50 25.90 18.40 12.30 12.30 19.49 19.90	Urea in 1000 parts of urine.	Grs. 2552 12224 6127 9163 6135 5107 5102 7148 4106 4088 31669	Am't of urine excreted in Hours.
0.705 0.391 0.265 0.705 0.078 0.723 0.196 0.450 0.587 1.149 1.320	Uric acid in 1000 parts of urine.	o* -j ~* oi co os co oi co *. co; ; ;	
21.270 21.350 22.283 20.600 23.500 22.400	Extractive and coloring mat-ters in 1000 parts of urine.		
		020.SO 018.70 021.20 018.20 022.00 L021.50 020.40 021.20 L026.50 1022.15 102*1.60	Specific gra-vity.
6.976 4.780 4.600 6.962 3.539 5.037 12.100	Fixed saline constituents in 1000 parts of urine.	Grs. 2402 11613 5S30 8677 29965	Water.
Grs. 283 566 680 572 766 468 566 446 534 240 706 1055	Am't of urine excreted hourly.	Grs. 149.3 616.2 2S6.9 486.5 1703.0	Solid matters.
908
•aaAa^ iviavivn 
TABLE VI.
CO
o
oa
Observation.—(m.)  Frenchman;  age 45; weight 120 lbs.; thin and spare; nervous temperament;  complexion pale.   Has been in Savannah
    three weeks ;  has been acting, as nurse in the hospital two weeks.  Sept. 15th, 12 o'clock M. Was taken with a  chill at 8 o'clock A. M.,
    attended with vomiting, and followed with high fever.  Urine passed during the height and decline of the fever, orange colored, and dimi-
    nished in amount.
Date.	Hour OF DAY.	Skin, Medicine, Color of Urine, &c.	OS "3	d o P. OS K	o sg. EH*	o CD t. 0 U CO _J a aj cd j EH	u CD •0 0 0 CD 5 * 6 CD 0 P. to S a EH	0 a t» 0 o> "S S CD 'E 0. a CO	Amount of urine excreted in Hours.		c4 CD	"5 C3	0 0 0 CD a ri . •o d CD S E »	O . s-" "0 L. g § 03 fl	0 ■0 CD "3 0 0 e> £-*	■0 3 . O CO w 0 COIN CJ Pi "E<2	•its CG <» 0 2 s s» CD W fc. OS J3 " " + TJOM SSg
Sept. 16 " 17 " 18 " 19 Oct. 7 " 9 " 9 " 10 " 12	12 M. 12 M. 12 M. 12 M. 3* P. M. 3| P. M. 6i. P. M. 11 A. M. 11 A. M.	Apyrexia ; skin cool. Apyrexia; skin cool. Apyrexia; skin cool. Convalescent. Continued to improve and was dis-charged September 23d. Has returned ; has had chill every day since the 5th inst., at 11 o'clock A. M. ; calomel, gr. xij, sulphate of quinia, gr. xxv. The chill has returned; pulse very feeble, with difficulty counted ; re-spiration irregular; lips and fingers blue. Hot stage; pulse much fuller. Febrile excitement has almost entire-ly subsided; sulph. of quinia, gr. xxv ; urine high colored, like new Madeira wine. Pulse, skin, and tongue normal; con-valescent.	92 96		88.0° 89.5 75.0 70.0 70.0	93.5° 96.5 83.0 101.8 97.5	99! 0° 98.0 101.5 102.5 98.5	1021.5 1021.7 1023.0 1022.0 1022.0	Grs. 4086 6641 6610 7530 86S7 15330	24 21 21 24 15 24	Grs. 252.2 136.1 342.1 349.2	Grs. 0.400 2.275 13.840 5.950 11.250	Grs. 28.0 76.5	Grs. 4086 6641 6640 7530 13899 15330	Grs. 252.2 136.1 517.3 319.2	Grs. 0.400 2.275 13.810 9.*520 11.250	Grs. 44.8 , 76.5
 
                                                                   TABLE VII.

OBSERVATioN.-(n.)  Irish laborer; age 40 ; height 5 feet 8 inches; weight 145 lbs.;  brown hair, gray eyes, and sallow complexion.   Was  in
     the hospital ten days ago with intermittent fever.   Was discharged, but has returned, August 17th, at 1Z o clocK m.
 Hor/R
OF DAT.
Poxse, Tongue, Skin, <fcc.
Aug. 17

    18



    18

    19
12 M.

12 M.
 8 P. M

12 M.
Intermission.  Skin cool and moist; tongue
  slightly furred.
Fever has returned; complains of great
  thirst, and pain in head; tongue coated
  in the middle with yellow fur,  red at
  tip and sides ;  skin dry.
Skin softer, but still very hot; fever con
  tinues.
Skin cool; tongue covered with yellowish
  fur.

Slight febrile excitement.
 60

100
104

 70
CD CD

0 CD
90°
p<2
106°

106°
101
 98
1005

1014
1017
1009
CD M
a 0

05
o o-P
a H3
Grs.
3000

2000
11120
14126
a trace

 1.20
Character op Urine.
Amount of urine excreted during fever in
  six hours, 7035 grains.


Urine  excreted during fever, clear and
  light colored.
Amount of urine passed in seven hours of
  the intermission, 6089 grains ; uric acid
  0.48 grains.
High color.
Heavy deposit of prismatic crystals of
  triple phosphate.
►
W
M

F


<

w 
                                                        TABLE  VIII.

Observation.—(o.) Irishman; age 18 ; brown hair and brown eyes ; height 5 feet 6 inches ; weight 125 lbs.; well-developed chest.  Occupation,
    barkeeper in a sailors' boarding-house on the bay.   Five days ago,  attended a boat-race  at Thunderbolt, and  slept for two nights in an
    open boat.  The second morning, after waking, felt badly and vomited.
						CD		u													iOjl .i			
									o								o .		o	° s	O.Si o M to			
						A		0								0								
							o	0	.•s	u					"2 ^ a cd	V	B'l,	el,	a is	QCN	-_, O HJ - O rf a »s a «-*		a 0 O o "o O	
Date.	c4 O u 0 O W	Medicine.	State of Skin and Tongue.	CD-'S	0 o u 'p.	a o a CD Eh	0	0 2 CD CD 0 P< M a ° go Eh~	cd ti CO. CD *3 p CD *Sh P. 0 W	°.2 'S'S o $ as < *	0 O	u CD	oi	12 a u w	1 a o tie 03 0 W	0 ■00 CD Z	£& w CD 0 0 cd 3	cdcN T3 -^ <2 * t. "3 2 ~ cd cd Ej o	03 -H T3CN 2 ^i £& "a ca O CD CO 3 o	o5 g oi'S gS	Calculated a extr'veand matters for Calculated a fixed saline tuents for 2			Deposits in Uiune.
										Grs.		Grs.	Grs.	Grs.	Grs.	Grs.	Grs.	Grs.	Grs.	Grs.	Grs.	Grs.		
Sept. 11			Tongue slightly	116	30	80u	102.5°	103.0°																
	P. M. xij, castor		furred ; skin																					
		oil in 4	warm.																					
		hrs., sulp.																						
		qui. gr. x.																						
" 12	12	Sulp. qui.	Skin cool; tongue	84	24	83	98.5	99.0	1018.0	7126	16	6766.0	203.70	trace	110.3	45.8	10689	10149 3C		trace	165 5	68.70	Deep	
	M.	gr. x.	slightly coated with white fur.																				orange red	edly acid after 60 hours, and
" 12	8* P.M.		Skin hot; tongue slightly furred.	100	24	82	102.5	103.9	1022.0	6138	8						18414						Deep orange inclin-ing to red Deep	No deposit.
" 13	11	Sulp. qui.	Tongue moist;	98	26	82	102.2	103.0	1020.0	7154	15						11446							No deposit.
	A.M.	gr. xx.	skin hot.																				orange	
" 13	5\			90 28		85	101.0	102.9	1022.0	4092	7						14029						Deep	No deposit.
	P.M.																						orange red Light	
" 14	1	....	Tongue slightly	65	24	85	96.0	98.0	1021.0	10210	20						12252							Reaction still
	P.M.		coated with white fur; skin moist and cool.																				orange	very acid; no deposit.
" 15	10	Quassia &	Pulse, skin, and						10197	11726	20	11291.3	161.04	8.624	204.2 60.4		14071	13550	200.01	16.35	237.1	72.77	Light	
	A.M.	soda.	respiration nor-mal; up and walking about the hospital grounds.																				orange	urine changed from acid to alkaline in 12 hours, and let fall a heavy, shin'g deposit of triple phos-phate ; the crystals were numerous and
																								beautiful.
OS
o
OO 
                                    TABLE IX.

Observation.—(p.) Pulse, respiration, temperature, and character of
urine in intermittent fever.
											o CD £	o			H. CD <N .5 a			
CD											0 CD	0	0 a	03				
o	CD	ho "cd	3	Date.		Hour OF DAY	Medicine.	State of Skin and Tonoue.	CD	"p.	St M a!	Q.H3 0 ° S co	"S3	bog ca n	0"O ° g g 6 x 2	!2	Color of Urine.	Deposits in Urine.
© —	to <	*	a						0	CD	EH«	CD r. Eh^	es	P. O CO		5		
	Yrs. Lbs.		Ft. In.												Grs.	Grs.		
				Sept	18	11 A. M.	Sulph. qui. gr. xx.	Chill is just going off.	112	28 90.5°		100.0°	104.0°					Reaction strongly acid.
				"	19	2 P. M.		Skin cool and moist.	68	21J91.0		97.5	99.0	1008	18144	2.88	A shade	No deposit.
																	higher than	
																	normal.	
				Oct.	2	2 P. M.	Cal. gr. xij, sulph.	Lips and hands purple;	120	22 79.0		89.0	102 25					Do.
						qui. gr. vij.		violent chill.		s								
				"	3	2J P. M. Sulp. qui. gr. xxv.		Skin hot and dry; tongue	100	2677.6		105.0	106.0					Do.
p	25	192	5 8£-					red at tip, but moist and soft. Skiu cool; pulse full and										
				<i	4	2 P. M.			58	20	76.0	96.5	98.5	1008	14112		Deep orange	Do.
								soft.									color.	
				"	5			Skin cool and normal.						1016	15290		Reddish orange.	Do.
				"	15	2 P. M.		Skin hot; high fever.						1002	35070 12 hrs.	trace		Do.
				Aug	12 14	2 P. M.	Comp. blue pill and castor oil. Sulph. qui. gr. xv.	Face red ; skin hot. Tongue red at tip, furred and pointed.	112 112	40	88.0	101.0	106.0					Reaction strongly acid ; no deposit after 60 hours. Do. do.
				"	15		Sulph. qui. gr. xv.	Skin cool, moist, and re-laxed.	92 26		88.0	98.0	99.7					Do. do.
				"	16			Skin hot and moist.	112'..					1020				Do. do.
q	18	150	5 9 -	'<	17			Skin cool and moist.	82i24		S6.0	99.0	ioo.'o					Do. do.
				"	18			Skin warm and soft.	96	36	86.0	99.0	102.75	1020			High color-ed. Shade of Ma-	Do. do.
				«	18	8 P. M.		in profuse perspiration.	90									Do. do.
																	deira wine.	
				"	19				76 23		89.0		99.0	1021			Do.	Heavy deposit of urate of soda and triple phosphate.
					20				72 26 1		85.0		98.0	1020			Do.	Do. do.
CO
o 
OBSERVATIONS
ON
					-J	o 2			■ - (1
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•puBq jo 9iniB.i9draax	0 0 CO 0	0 CO 0	0 cd Oi	000 CM CO oi O Oi Oi	q co" 0	O O CO O Oi 0	00 CO		q d	O Ci	.00 . ■ CM oi • O Ci
■a.igqdsouij'B jo 9.iniijjadniax	0 GO	0 CO	0 CO	OOO CO rH O OO GO OO	q	0 q cd -h GO 00	q cd		0 CM CO	q	. 'O CO • d h oi
■noii'BJidsaa;	1 «"> CM	CO CO	CM	-H rH 00 CM CM CN	CM	r-> CO CM CM	-* CM	rH		0 CO	OCtCH CO CM CM CM
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■asua jo -o(j I 
MALAEIAL FEVER.
311
   Case (m.) illustrating the diminution of the constituents of the urine,
when the forces have been reduced by the continued action of  the mala-
ria I poison.
   Irish laborer; light-brown hair, brown eyes; has been in America
seven years, and in Savannah three years;  age 22, medium height.
Has been  living and making bricks in a low, miasmatic  situation.
Says that  he has suffered with chill and fever for six weeks.  Com-
plexion sallow and anaemic; lips, gums, and tongue pale.   He is
exhausted by slight exertions, and complains of great weakness.
   Sept. 16th, 12J o'clock P.M.  Pulse, 88; respirations,24.  Tem-
perature of atmosphere, 87° F.; temp, of hand, 100.5; temp, under
tongue, 101.25.
   17th, Hi o'clock P.M.  Pulse, 72;  respirations, 20.  Tempe-
rature of  atmosphere, 86° F.; temp, of hand, 90°; temp, under
tongue, 98°. Has just awoke from sleep, and is in a profuse perspi-
ration.
	16,027 grains of urine, excreted in 21 hours (sp. gr. 1001.7), clear and limpid, contained	1000 parts of urine contained
Extractive and coloring matters Fixed saline constituents	Grains. 15,958.568 68.432 42.680 1.280 18.776 5.696	995.730 4.270 2.664 0.074 1.171 0.356
  The reduction of the nervous and  physical forces was attended
by a reduction in the amounts of the solid constituents of the urine.
U— Infusion of Virginia Snakeroot Oxvj ; brandy fSvj ; sulph. of
quinia gr. xv.—Mix.   Take a wineglassful five times a day.  R.—
Citrate of iron gr. iv, three times a day.
  17th, 12 M.  Pulse, 72;  respirations, 20.  Temperature of at-
mosphere, 88° F.;  temp, of hand, 98.5°; temp, under tongue, 99.5°.
Amount of urine excreted during the last twenty-four hours under
the action of the diuretic and  tonics, 14,645 grs.;  sp. gr., 1010.
Urea  in 14,645 grs.  of urine, 196.910;  uric acid  in  14,645 grs.
of urine, 7.975; urea in 1000 parts of urine, 12.445; uric acid in
1000  parts of  urine,  0.544.  The infusion of snakeroot, and sul-
phate of quinia and  citrate  of iron, have produced an increase of
the solid constituents of the  urine. 
312
OBSERVATIONS  OX
   Case (v.) illustrating  the diminution of the constituents  of the urine
when the forces have been reduced by the continued action of the malarial
poison.
   German laborer, age  30;  height 5  feet  5  inches; weight,  in
health, 112 pounds;  light  hair,  blue  eyes; small,  delicate man.
Has been in the United States three years, and in Savannah three
months.   Has  been "keeping store" on  the river,  near the rice
mill.   Was taken sick with chill and fever two months ago.  Com-
plexion, anaemic.  Complains  of great weakness.   Lips, gums, and
tongue pale;  tongue coated with white fur.
   10th, 11 o'clock A. M.  Says that he had a chill yesterday.
   R.—Sulph. of quinia gr. v, every three hours, up to gr. xv.
   11th, 12 o'clock M.  Skin cool; in a profuse perspiration.  Pulse
76, respirations, 19.  Temperature of atmosphere,  85° F.; temp, of
hand, 94°; temp, under tongue, 98.  Color of urine a shade higher
than normal.   Sp. gr. 1014.5.
	5072 grains of	7157 grains of	
	urine, excreted	urine, calculated	1000 parts of
	in 17 hours,	for 21 hours,	urine contaiued
	contained	contained	
	Grains.	Grains.	
Water.....	4886.160	6895.783	963.462
Solid matters ....	185.340	261.514	36.538
Urea.....	65.475	92.385	12.907
Uric acid .....	2.750	3.880	0.552
Extractive and coloring matters	102.485	144.607	20.225
Fixed saline constituents .	14.631	20.642	2.884
  In this case, as in the preceding, we see that the depressed state
of the forces consequent upon  the action of the malarial  poison,
was attended by a marked diminution of the solid constituents of
the urine.
  12th,  12i o'clock P. M.   Pulse, 72 ; respirations, 19.  Tempera-
ture  of  atmosphere, 84° F.; temp, of hand, 97.25°;  temp, under
tongue,  99.9°.  Sp. gr. of urine,  1011.3.  After sixteen  hours a
copious  deposit of urate of soda and triple phosphate.'
	13,652 grains of urine, excreted in 24 hours, contained	1000 parts of urine contained
Water....... Extractive and coloring matters Fixed saline constituents	Grains. 13,242.437 409.563 209.520 19.710 158.4^5 20.265	970.000 30.000 15.316 1.443 11.676 1.567
 
MALARIAL FEVER.
313
  Under the action of the sulphate of quinia, the  urea, uric acid,
extractive and coloring matters, have been increased in amount.
                   II. REMITTENT FEVER.

  PROPOSITION VII. The phenomena  of the cold stage, preceding the
hot stage of remittent fever, are similar to those of the cold stage of inter-
mittent fever.
  During the cold stage of remittent fever, there is a rapid, feeble
pulse, full rapid respiration, and  hot trunk, and cold extremities.
The temperature of the extremities is reduced far below that of the
trunk, and even below the standard of health.  The diminution of
the capillary circulation and reduction  of temperature of the extremi-
ties precede the aberrated nervous and muscular phenomena, denominated
chill.  The  higher the temperature  of the trunk, during the cold
stage, the more rapid will be the equalization of the circulation and
temperature;  the higher the temperature of the trunk during the
cold stage, and of the extremities and trunk during the subsequent
hot  stage  (stage  of equalization of the  circulation  and chemical
action), the milder and shorter will  be the  attack,  if judiciously
treated, provided there be no complication, as congestion  of the
brain, or obstinate vomiting; whenever there is  a want  of cor-
respondence  between  the circulation, respiration, and  chemical
changes, the patient is in danger.

  PROPOSITION VIII. As far as my  observation extends, the most inu
portant difference between the cold stage of remittent, and that of inter-
mittent  fever, is a difference of degree and not of kind; the phenomena
of the cold stage of remittent fever are more protracted than those of in-
termittent fever; the sympathetic system is not so rapidly aroused, and
the circulation in the capillaries of the  extremities is not so rapidly re-
stored in remittent, as in intermittent fever.
  We have before shown that the alterations of the blood are more
profound in remittent than in intermittent fever, and that in both
diseases the alterations in the blood precede  the disturbances  of the cir-
culation and respiration and action of the sympathetic nervous system;
it follows then, as a necessary consequence, that the phenomena of
the  cold  stage should be more prolonged in remittent than  in
intermittent fever.
        21 
314
OBSERVATIONS ON
  Proposition IX.  In remittent as in intermittent fever the increase of
the  action of the pulse and respiration is attended by an elevation of
temperature, and the  elevation of temperature corresponds more accu-
rately with the increased actions of the circulatory and respiratory sys-
tems in intermittent than in remittent fever—that is, the pulse and
respiration are more accelerated in remittent fever, whilst the temperature
does not rise higher than that of intermittent fever.
  The explanation of this phenomenon lies  in  the fact that the
blood  is most altered in  remittent fever, and that the chemical
changes  of  the  capillaries are  most disturbed, and probably the
power of the blood to absorb oxygen, or the  force of the circula-
tion in the capillaries of the lungs, more  diminished in remittent
than in intermittent  fever.

  Proposition X. The elevation of  the temperature is more persistent
in remittent than in intermittent fever.
  The alterations of  the blood induced by the malarial poison are
greater, and the effects upon the liver, spleen, sympathetic and cere-
bro-spinal nervous systems, and upon the heart, are greater than in
intermittent  fever, and hence more vigorous  chemical changes  are
needed for the alteration and elimination of these altered offending
products.

  Proposition XI.   The  pain  upon pressure  of  the epigastrium is
more acute, and the vomiting more obstinate, and the cerebral symptoms
more common and dangerous, in remittent than in intermittent fever.

  Proposition XII. The secretions of the mouth are  more completely
checked, and  the  tongue is drier, redder, and  rougher to the feeling, in
remittent than in intermittent fever.
  In the active stages of remittent fever, the tongue, in many cases,
especially if it be tb;e first attack of fever, presents, upon those por-
tions which are clean, a brilliant scarlet color, and dry, glazed sur-
face ; the papillae are enlarged;  the fur which frequently coats the
tongue is of a yellowish and brownish-yellow, and sometimes black,
color, and almost always dry; the tongue, in many cases, feels, when
the finger is passed  over it, as  dry and as rough and harsh as the
surface of a rough board.

   Proposition XIII. The glowing  tongue of remittent fever is not an
index of inflammation.
   It indicates arrest or disturbance of circulation in the capillaries 
MALARIAL FEVER.
315
of the superficial parts of the tongue.  The secretions of the mucous
membrane have been checked; the moisture is evaporated by the
elevated temperature; the circulation in  the superficial capillaries
is  thus retarded, and they become filled with colored blood-corpus-
cles, which give the bright color to the tongue.

   Proposition XIV. The secretions of the salivary glands and mucous
membrane of the mouth are not only more diminished, but they are also
more perverted in remittent  than in intermittent fever.  The acidity of
the saliva is greatest in remittent fever.
   The solution of the question, What checked the secretions of the
salivary glands and mucous membrane of the mouth? involves the
consideration of the relations of the malarial  poison to the salivary
glands  and mucous membrane of the mouth;  involves  the  con-
sideration of the relations of the altered products of the blood,
resulting from the action of the malarial poison, to the salivary
glands  and mucous membrane of the mouth;  involves  the  con-
sideration of the relations of the  malarial poison  and altered ele-
ments  of the blood to that portion  of the nervous system which
presides over the circulation and secretion of the salivary glands
and mucous membrane of the mouth.

   Proposition XV.  The coma, delirium, and severe pain in the head
so often present in  the severe cases of remittent fever, are, as a general
rule, not indicative of  inflammation of the brain, but of the stagnation
of the blood and perversion of the chemical changes in the capillaries of
the brain, and of the action of the altered blood upon  the nervous ele-
ments, and of the direct action of the malarial poison upon the nervous
structures.
   The  truth of this  proposition  is  established by the effects  of
stimulants and sulphate of quinia  in the severest forms of remittent
fever.
   In numerous cases, I have seen, under the free administration of
stimulants and sulphate of quinia, the dry, red, glowing,  parched,
hard, rough tongue, become moist, clean, and pale; the tenderness
upon pressure of the epigastrium disappear; the circulation  and
respiration abate  in force and frequency; the dry, harsh,  hot skin
become  soft, relaxed, cool, and covered with perspiration; the se-
verest headache relieved; and the dulness, and even profound coma
and wild delirium, of the intellectual  faculties vanish, and the brain
restored to the exercise of its normal functions. 
316
observations on
  Proposition XVI. The changes of the urine in remittent fever are
the same in kind, but different in degree from those of intermittent fever.
  As a general rule, the amount of urine excreted during the active
stages, and during the  earliest period of intermission, when  the
temperature of the trunk and extremities sinks below the normal
standard,  is less than that of health; and during convalescence
(especially under the action of depurants) the amount of urine  ex-
creted is greatly increased.
  The color  of the urine is much deeper in remittent than  in inter-
mittent fever, and varies from deep orange to deep red and reddish
brown, and in some cases almost black.  The intensity of the color
is greatest during  the active stages, and diminishes during conva-
lescence.
  The acidity of the urine is greater in remittent than in intermittent
fever.  The urine excreted during the active  stages is far more
acid than  that of convalescence or of health, and retains its acidity
and resists decomposition much longer.  When the fever intermits
and the cause  of the disease is removed, and the patient is conva-
lescent, the urine  then excreted rapidly undergoes decomposition,
and in a few hours the reaction changes from acid to  alkaline, and
the phosphates, which, as in intermittent fever, are most abundant
in the urine of convalescence, are thrown down  in the  form of
beautiful  silvery,  shining crystals, which resemble, when held in
the sunlight, particles of shining silver.
  The increased temperature and correspondingly increased chemi-
cal changes of the active stages of remittent fever were attended by
an increase of the urea, not only above the normal standard,
during rest and a deprivation of food, but also  above the  standard
of active health, and far above the standard  of  intermittent fever.
When the temperature  falls  below the normal standard in  the
earliest stages of convalescence of remittent  fever, the  urea, as in
the similar changes in intermittent fever, decreases in amount.
  In the  majority of the cases, the uric acid was diminished both
with and  without  the action of the sulphate of quinia,  during the
active stages of remittent fever, when the pulse was full and rapid,
and the respiration full and accelerated, and the temperature  ele-
vated.
  In almost every case of remittent fever, as the fever declined, the
uric acid  increased above  the standard  of health  both with and
without the action of the sulphate of quinia. 
malarial  fever.
317
  The formation of deposits of  the urates of  soda and
ammonia and of the triple phosphates (critical discharges) in the
urine of remittent fever is similar in all respects, takes place at
analogous periods of  the disease, and  is due to the same causes as
that of intermittent fever.
  The coloring and extractive matters were  diminished during
the active stages and  increased during the subsidence of the fever.
In several hundred examinations of the urine of the different forms
of malarial fever,  albumen was found  in only one case, which was
complicated with  typhoid fever.  This fact  is  important in its
bearing upon typhoid and yellow fever.
  These propositions will now be supported and  illustrated by the
following cases:— 
                                                          TABLE X.
Observation.—(w.)  English seaman ; age 25 ; weight 140 ; height 5 feet 6 inches ; black hair, florid complexion.  Sailed from N. Y. to Danen ;
    remained in Darien five days, during which time he slept on board the vessel lying in the Altamaha River ; sailed from Darien, and arrived
    in Savannah twelve days ago.  During the day, has been running on a steam-tug up and down the Savannah Eiver, from its mouth to
    the city, and has slept during  the night on the bay.  Was taken with chill September 6th, at 10 o'clock A. M.   This was a severe attack;
    the cerebral symptoms were well marked.   The stupor, and the  dry red tongue, and harsh  dry skin, and the disturbances of the sympa-
    thetic system and of the respiration and circulation, were relieved by the free administration of stimulants and sulphate of quinia.
Date.	Hour of day.	Medicines.	State of Tongue.	State of Skin.	Ah	a o 'p.	Cm o 0 Ql 11	o V 0 u O.-0 aS (1; -H Eh^1	CO a> => fc. 60 O 0 3S « u a 0 g*	Am't of urine excreted dur-ing Hours.		a 0 0-0 » %	cfl *s cfl 'u •J3 0 P. 0 CO		a 'o CO
Sept. 10 " 11 " 11 " 12 " 12 " 13 " 13 « 14 " 15 " 15 " 16 " 16 " 16 " 17 " 18 " 19 " 20 " 22	7 P. M. 11 A. M. 7 P. M. 12 M. 9 P.M. 11 A. M. 6 P. M. IP. M. 10 A. M. 7 P. M. 12 M. 12 M. 8 P. M. 11 A. M. 12 M. 12 M. 12 M. 12 M.	Sulphate of quinia gr. xx, soda powders. Soda powders, sulphate of quinia gr. x. Calomel gr. xij, castor oil in 4 hrs., sulph. qui. gr. xl. Sulphate of quinia gr. xv, snakeroot tea fjxvj, table-spoonful every 4 hours. Brandy, sulphate of quinia, and snakeroot tea. Do. do. Do. do. Quas. & soda, snakeroot tea. Do. do. Do. do. Quas. & soda, snakeroot tea. Do. do.	Dry, red; superior portion coated with black fur. Dry, red, and glazed ; feels rough. Tip clean and red; supe-rior portion coated with dark fur. Cleaner and moist; still red at tip and edges. Moist; still redder than normal. Do. do. Slightly coated with yel-low fur. Normal. Do. Do. Do. Normal. Do.	Dry, hot. Dry, harsh, hot. Moist, hot. Moist. Normal. Do. Do. Do. Normal. Do.	90 88 90 70 70 52 60 58 50 47 46 47 44 44 44 44	48 34-40 40-44 26-36 53 48 26-32 28 24 27 20-26 28 24 24 24 22	80.0° 82.0 81.0 83.0 83.0 85.0 87.0 84.0 87.0 87.0 87.0 84.5 86.0 88.5 84.0	103.00° 103.25 104.00 100.75 99! 16 97.00 99.00 94.50 96.00 97.00 95' 90 96.00 96.25 97.00 97'. 80	105.00° 105.00 104.80 102.50 10l'.50 100.00 102.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.12	Grs. 8160 5098 13258 15285 203S3 15375 6607 5121 4599 9720 4080 8712 15903 24240 32320 23300	16 8 24 17 24 19 20 9 17 24 8 15 24 24 24 24	Grs. 510 637 552 899 849 809 330 569 270 40.3 510 514 662 1010 1346 929	1020.0 1019.6 1019.8 1019.0 1019.3 1020.0 1024.0 1022.0 1025.0 1016.5 1018.2 1022.2 1020.0 1018.0 101b.o 1008.0	Grs. 7618 4761 12383 14475 19240 6230 4946 4292 9238 8139	Grs. 541 333 874 899 1142 376 174 306 481 572
 
Sept. 10 " 11 " 11 " 12 " 12 " 13 " 13 " 14 " 15 " 15 " 16 " 16 " 16 " 17 " 18 " 19 " 20 " 22	fa
7 P. M. 11 A. M. 7 P. M. 12 M. 9 P. M. 11 A. M. 6 P. M. 1 P. M. 10 A. M. 7 P. M. 12 M. 12 M. 8 P. M. 11 A. M. 12 M. 12 M. 12 M. 12 M.	K • o
Grs. 349 223 672 567 790 538 222 52 150 203 123	Urea.
, C< Oi 00 tO 02 >*- 00 -J 3-. 4- I-1 CO ffl	Uric acid.
• • • b> "en • co ^-or to i-o en • • • '*. © o> '*. to • 3 Cl CO CJ» O 0< tO Oi CHOOiOi © .	
....to., tow M. . . . M to i-'.ffl . ...CD. t—tOCOfcO. . . ! 00 CO CJ» CO OSi-j M rf-© 4-CO OtOiOOO CD pa	Extractive and coloring matters.
....<-•. . . . MM . O . . . : oa; oicototoco, ; ; o*.wh to! *i m co to © oa en oo o oo oo © «	Fixed saline con-stituents.
Grs. 12240 15294 21567 8038 13662 6490 12240 13940	Calculated amount of urine for 24 hours.
Grs. 11428 14294 20435 7584 13186 6057 13023	Calculated amount of water for 24 hours.
.... co- . 4-a-4-• • ... t-i. co oo. :? .... h-i . . co o> Oi • . ... CO* CO m. s OS tO Cil tO M CD M .	Calculated amount of solid matters for 24 hours.
Grs. 523 669 800 679 267 140 212 197	Calculated amount of urea for 24 hours.
. CO. _ CO Oi O O OO rf^ rfk Q	Calculated amount of uric acid for 24 hours.
.... M. . -J Oi © <I * • . . tb-« w OD • J5 M CO OS ~JI CO OS Ci © .	
Grs. 253 270 134 147 252 169 449	Calculated amount of extractive and coloring matters for 24 hours.
.... c. . ,&.o<co*.. ■ . . co* en eo« :r •••'»•■ OiiHli. • . . ~j. h- © • 3	Calculated amount of fixed saline constituents for 24 hours.
High colored, like new Ma-deira wine. Do. do. Brownish red. Orange colored. Do. do. Do. do. Deep orange. Orange. Light orange. Nearly normal. Normal. Do. Do. Do. Do.	o o o w o •4 a 2 3 n
.......j—11—' k-' h-" i—* m ■ • -a«a<j -a. .......tO Oi Oi Ot o» »• . ooo o •	Length of time re-quired for the change from the acid to alkaline.
4 g~» BO«?o"	« n V o CO 3 B a
hours, a very small of prismatic crystals ) phosphate. and urate of soda. do. do. ly heavy deposit of losphate, and urate and ammonia. do. posit.	
1-3



IT"
Q
o
"aaAa^ itihvith 
320
OBSERVATIONS ON
   Observation.-—(x.)  Irish seaman; age  21;  height 5 feet 4 inches;
weight 125 pounds; brown hair, brown  eyes, sallow complexion.
Has been in Savannah three weeks, and has been sick three days.
This is his first trip to Savannah during the summer season.
   Oct. 12,12 M.  Complains of great weakness and pain in his back
and bones; says that he had no chill and no fever during the three
days of indisposition previous to his entrance into  the  hospital.
Pulse 80, full.
   R.—Sulph. of quinia gr. v every three hours up to gr. xv.
   13th, 12 M.  Did not rest well last night.  Complains of pain in
his head and bones.  Had a chill two  hours ago.  Tongue clean,
red, dry, and  rough; papillae enlarged.   Some tenderness of epi-
gastrium.  Skin  hot and dry.  Pulse,  118; respirations 24 to 2(5,
irregular, thoracic.
   R.—Calomel gr. x.  Follow with castor oil in four hours.
   R.—After fever remits give sulphate  of quinia gr. v every three
hours up to gr. xx.
   14th, 12 M.  Medicine acted twice.  Tongue clean and very red.
Patient is not so  restless; complains of  great weakness; has taken
gr. xx of sulphate of quinia.  Temperature  of skin normal.
   R.—Brandy f^viij ; sulph. of quinia gr. xv; infusion of Virginia
snakeroot flviij.—Mix.   Tablespoonful every four hours.
   15th, 12 M.  Had an increase of fever yesterday afternoon, which
was accompanied with severe pain in his head and bones.
   Now he  is restless and nervous;  countenance uneasy, anxious.
All his motions are indicative of restless, uneasy, anxious feeling;
complains of great thirst;  tongue as red as scarlet, at 9 o'clock
this morning it  was dry and glazed,  at the present time (three
hours afterwards) it is a little moister and softer; lips  dry, red,
and rough.  Epigastrium tender upon  pressure; trunk and head
very hot; extremities only moderately  warm.  Complains of pain
in  the small  of the back,  and  in the  knees and bones  of his
legs.  Pulse 106, feeble; respirations 30  to 34, irregular, labored,
thoracic, panting.  Temperature  of atmosphere, 74°  F.;  temp, of
hand, 101°; temp,  on  axilla, 105°.  The temperature under  the
tongue could not  be taken on account of his restlessness.  There is
a  great want of co-ordination between the  circulation, respiration,
and temperature of the extremities.  The capillary circulation  and
chemical changes are impeded.   Eeaction of saliva, acid.
   R.—Four cut  cups  to epigastrium.  Four cut  cups  over  the
lumbar regions and spine. 
MALARIAL FEVER.
321
  R.—Sinapisms to the extremities.
  Urine high-colored, of a deep brownish-red color.  Sp. gr., 1028;
reaction decidedly acid.
Amount of urine passed during the last 30 hours .    .  15,430 grs.
                  "      "     24  «   .    .  12,344 "
      "      "      hourly     "     "           515 «
	15,430 grains of	12,344 grains of	
	urine, passed	urine, passed	1000 parts of urine
	during 30 hours,	during 24 hours,	contained
	contained	contained	
	Grains.	Grains.	
Urea .....	727.500	582.000	47.178
Uric acid ....	9.300	7.440	0.603
Fixed saline constituents	75.000	60.000	4.863
  7| o'clock P. M.  Lies in a stupor, muttering to himself, and is
with great difficulty aroused.  When aroused, answers incoherently
and says that he feels very well.  Temperature of extremities below
the normal standard, cool; temperature of head and trunk normal;
tongue of a bright red color; great tenderness of epigastrium ; pres-
sure here  arouses him more quickly than violent  shaking.  Pulse
100, feeble;  respirations, 32.
  R.—Two cut cups to each temple.   R.—Blister over the  epigas-
trium,  6 inches by 4 inches, and another to the back of the neck,
4 inches by 5.   R.—Apply sinapisms to extremities.  R.—Brandy
and infusion of Virginia snakeroot, and spirit of mindererus, f^ss;
of each alternately every half hour, until  reaction is established.
R.—Sulph. of quinia, gr. v, every three hours up to gr. xlv.
     Amount of urine passed during the last 7£ hours  .    .  4,072 grs.
            "     "     hourly     "     "          543 "
     Calculated amount of urine for 24 hours    .    .    .  13,030 "
  Sp.gr. of urine 1018; high colored and strongly acid. After stand-
ing 70 hours there  was no deposit, and the reaction was still de-
cidedly acid.
	4072 grains of urine, passed during 7£ hours, contained	13,030 grains of urine, calculated for 24 hours, contained	1000 parts of urine contained
Urea..... Uric acid ....	Grains. 151.320 1.888	Grains. 483.224 6.036	37.161 0.461
  Oct. 16th, 9 o'clock A. M.  Much  better; intellect clear.  The
cups, blisters, and stimulants, and sulphate of quinia, have restored
the capillary circulation to its normal state. 
322
OBSERVATIONS  ON
  12 J o'clock P. M.  Continues to improve;  urine high-colored, of
a deep orange-red; reaction strongly acid; after  standing fifteen
hours, a slight deposit of mucus-corpuscles; and after one hundred
hours, a small light yellow deposit of  mucus-corpuscles, urate of
ammonia and vegetable cells.  The presence of the mucus-corpus-
cles in the urine is due to the absorption and action of the cantha-
radin upon the mucous membrane of the genito-urinary apparatus.
In several cases of severe remittent fever, I have discovered, after
the action of blisters, numerous spermatozoa in the urine.   Sp. gr.
of urine, 1021.
	11,231 grains of urine, passed during the last 16 hours, contained	16,746 grains of urine, calculated for 24 hours, contained	15,303 grains of urine, excreted during 24 hours, contained	1000 parts of urine contained
Urea .... Uric acid Fixed saline constituents	Grains. 357.445 5.500 53.900	Grains. 535.667 8.250 80.850	Grains. 508.760 7.380 64.680	31.820 0.489 4.799
   Amount of urine passed during the last 16 hours,    .    .  11,231 grs.
         "     "      hourly     "     "...    702  "
   Calculated amount of urine for 24 hours,   ....  16,746  "
   Actual amount of urine excreted during the last 24 hours,  .  15,303  "
           "     "     "    hourly     "      "    .    637  "
  3 o'clock P. M.  Skin dry but  soft.   Has taken  xlv grs. of sul-
phate of quinia.  This has not yet exerted its characteristic effects
upon the skin.  Tongue red but moist and soft;  blisters have drawn
well.  Serum from blistered  surfaces  of a golden color; patient
complains of difficulty  in passing his urine.   This is due to the
absorption and action  upon the mucous membrane of the bladder
and urethra, of the cantharidin absorbed from the blistered sur-
faces.  Pulse, 84; respiration, 16.  Temperature  of  atmosphere,
69.5° F.; temp, of hand, 99° ; temp, under tongue, 99.5°.   R.—Sul-
phate of quinia, gr. v, every three hours, up  to gr. xv.  R.—Con-
tinue spirit of mindererus, and brandy, and  snakeroot tea, f^ss of
each alternately every two hours.  Diet, mutton soup and arrow-
root.
  17th, 12 M.  Continues to improve; tongue red, but  clean and
soft.  Pulse 70; respiration 16.   Temperature of atmosphere, 67°
F.; temp, of hand, 97.33°; temp, under tongue, 98.5°.   Color of
urine deep  red, reaction decidedly acid.   Sp.  gr. 1022.   Eeaction
of saliva strongly  acid. 
MALARIAL FEVER.                  323
Amount of urine passed during the last 24 hours  .    .  8176 grs.
      "     "      hourly     "     »          382 "
	8176 grains of urine, excreted during 24 hours, contained	1000 parts of urine contained
Fixed saline constituents	Grains. 185.240 4.400 40.000	22.578 0.538 4.892 --------_
  The reduction of the temperature, and of the action of the respi-
ratory and circulatory system, has been attended by a correspond-
ing diminution of the constituents of the urine.
  18th. Continues to improve;  "feels quite well, with the excep-
tion of great weakness."  His appetite  has returned; tongue clean,
moist, and soft,  and not so red.  Pulse 72; respiration 18.
  R.—Continue brandy and infusion of Virginia snakeroot.
  Color of urine orange, much lighter; reaction in  twenty hours,
decidedly alkaline.  Sp. gr. 1020.  Heavy light yellow deposit, after
standing twenty hours, of urate of soda and triple phosphate.
      Amount of urine passed during the last 24 hours  .    . 20,400 grs.
           "      "      hourly    "     "     .    .    850  "
  Diet, soft-boiled eggs, milk punch, arrowroot,  and mutton soup.
  18th, 12 M. Skin, pulse, and respiration normal.  Urine orange
colored.   Sp. gr. 1020.  Eeaction  alkaline in twelve hours; heavy
light yellow deposit in twelve hours.
      Amount of urine excreted during the last 24 hours    . 15,300 grs.
           "      "      hourly    "     "     .        637  "
  20th.
Amount of urine passed during the last 24 hours .    .  17,374 grs.
      «      «     hourly     "  '   "    .        724 "
	17,374 grains of urine, passed during 24 hours, contained	1000 parts of urine contained
Fixed saline constituents	Grains. 11.730 93.500	0.675 5.381
  Sp. gr. of urine 1022.  Eeaction alkaline in twelve hours; orange
color.  After standing twenty-four hours, a  light yellow deposit of
triple phosphate and urate of soda were thrown down.
  21st, 9 A. M. The patient is dressed, and has been walking about
the hospital grounds.  His pale, sallow complexion and feeble gait 
324                  OBSERVATIONS ON

show the effects of the malarial  fever.  Urine  of a light orange
color, only a shade darker than normal.  Sp. gr. 1024.   Eeaction,
just after its deposition,  acid;  in ten  hours afterwards, alkaline.
This change gave evidence of the formation of ammonia, and was
attended by the formation of crystals,  presenting,  when  the  urine
was held in the sun, a sparkling appearance, like particles of silver.
Under the microscope these crystals were found to be well formed,
prysmatic crystals  of triple  phosphate.  The  microscope also re-
vealed a few crystals and globular masses of the urates of soda and
ammonia.
	9234 grains of	18,468 grains of	
	urine, excreted	urine, calculated	1000 parts of urine
	during 12 hours,	for 24 hours,	contained
	contained	contained	
	Grains.	Grains.	
Urea.....	229.599	458.198	25.128
Uric acid ....	7.740	15.480	0.935
Fixed saline constituents	91.800	183.600	9.941
     Amount of urine passed during 12 hours    .    .    .   9,234 grs.
           "      "     hourly    «      ...    769 "
     Calculated amount for 24 hours.....18,468 "
  The following table will present the relations of the pulse, respi-
ration, and urine:— 
TABLE XI.
Date.	Hour OF DAY.	CD 0 Ph	0 O cj u 'p. eg K	CM o o oi 0 <D p.S al	O » 0 N a£	0 0 O . bI CO o p.-" as	o cd eg o p.3 03	Amount of urine excreted in Hours.		si	5 cd *w S3	0 0 w co 0 . 1~ _ & •0 0 a> -u	0 0 0 a> "3 S3 S -Jo-. 0 0 WHH	0 0 a3 "««2 ■g o3 . 0 w"	1! a<2 cS-2 *-2 „; 5 2 0 '*'" %	Calculated amount of fixed saline constituents for 24 hours.	Color op Urine.	Reaction, Deposits in Urine, &c.
Oct. 13 " 15 " 15 " 15 " 16 " 16 " 17 " 18 " 19 " 20 " 21	12 M. 12 M. 12 M. 7i P. M. 12JP.M. 12* P.M. 12 M. 12 M. 12 M. 12 M. 9 A. M.	118 106 100 84 70 72 Normal Normal Normal	24-26 30-40 32 16 16 16 Normal Normal Normal	74.0° 69.5 67.0	ioi'.o° 99.0 97.33 Normal Normal Normal	105.0° 99*.5 98.5 Normal Normal Normal	1028 1018 1021 1021 1022 1020 1020 1022 1024	Grs. 15430 12344 4072 11231 15313 8176 20400 15300 17374 9234	30 24 7i-16 24 24 24 24 24 12	Grs. 72V! 50 582.00 151.32 357.44 508.70 185.20 229.50	Grs. 9.300 7.440 1.888 5.500 7.380 4.400 11.V30 7.740	Grs. 75.00 60.00 53.90 64.65 40.00 93.'50 91.80	Grs. 13030 16746 18468	Grs. 483.22 535.60 458.10	Grs. 6.036 8.250 15.480	Grs. 80'.850 183.600	Deep brownish red color. Do. Deep orange. Deep red. Orange. Do. Light orange. Very light orange, almost normal color.	No deposit after 110 hours. Do. do. After 15 hours, a small deposit of mucus-cor-puscles ; after 100 hrs., small deposit of vege-tative cells and urate of soda. Heavy deposit of urate of soda and triple phos-phate, and alkaline re-action after 20 hours. Do. do. Reaction alkaline in 12 hours; heavy deposit. Reaction changed from acid to alkaline in 10 hours; heavy deposit of urate of soda, and ammonia, and triple phosphate.
Ol 
326
OBSERVATIONS ON
  Observation.—(?/.) Irish seaman, aged 38; weight 160 lbs.; height
5 feet 6 inches; stout, muscular man;  first trip to Savannah.   Has
been in Savannah ten days, during which time he has worked on
a ship lying along the  shore of the river, and has slept on  Bay
Street at night.
  Oct. 14, 2 P. M. "Was taken sick four days ago, with pain in his
head and in all his bones, accompanied with fever, which has  con-
tinued unabated up to the present time.  Has had no chill.  Took
a dose of calomel three days ago, which acted freely.  Now his  face
is much flushed; skin hot  and dry; head very hot; complains
greatly of pain in his head; eyes look heavy and stupid; tongue
bright red and dry; voice  hoarse  and guttural;  says that he has
been vomiting, and can retain nothing upon his stomach.  R.—Cut
cups to each temple, and  two  to back of neck, and four over the
region of the stomach.
  If the cut cups do not relieve the vomiting, administer a table-
spoonful of equal parts of milk, lime-water, and the aqueous solu-
tion of the acetate of morphia.
  15th, 11 A.M.  Says that he feels better; the cut cups over the
temples and back of neck relieved the pain in  his  head, and the
cut cups over the region of the stomach checked the  vomiting.
Face is not so much flushed; tongue still very red, dry, and rough ;
no tenderness  upon pressure of epigastrium, although the state of
his  tongue would  lead us to look for it; skin soft  and not so hot.
This morning  at  3 A. M.  the  fever  remitted with perspiration.
Pulse, 76; respiration, 20.  Has taken xxvj grains of sulphate  of
quinia.  R.—Neutral mixture;  drink ad libitum.
  8 o'clock P.  M.   Has been vomiting this evening.  This was ar-
rested  by milk and lime-water, and acetate of morphia.  Tip  of
tongue  for three-fourths  of an inch clean, dry, glazed, and  of a
brilliant red color—the remainder of the  tongue is coated  with
brownish-yellow fur, which is dry and harsh to the feeling;  face
flushed and hot; skin, upon all parts of the body, hot, pungent, and
dry; no tenderness upon pressure of epigastrium.  The calomel has
acted several times, and is still acting.  Pulse, 94;  respiration, 26.
R.—Soda powders.  Urine high colored, like new Madeira wine.
  16th, 1 o'clock P. M. Did not rest during the night; was tossing
about,  and getting up out of the bed every few moments, and was
and is now tormented by unquenchable thirst; appears to be  com-
pletely exhausted.  Tip of tongue clean, dry, scarlet-colored, glazed,
shining—posterior portion (base) of tongue coated with brown and 
MALARIAL FEVER.                  327
black fur, dry, harsh, and as rough as sand-paper.  The under sur-
face of the tongue is dry, glazed, and shining.   There is  no more
moisture in his tongue, and in the walls of the mouth, than if they
were made of glass.   Skin hot, dry, and harsh to the feeling.
  The temperature under the tongue cannot be taken, on account
of the dry condition of the lips and tongue.  Bowels are loose__
stools watery and yellow; no pain upon  pressure of epigastrium.
Complains of no pain anywhere.  There is a  great tendency to
stupor.
  Although  his tongue is glowing red, and his face is flushed, and
there is an inclination to stupor, still I will administer sulphate of
quinia and stimulants, because he is exhausted, and the appearance
of the mucous membrane of his mouth and tongue is indicative, not
of inflammation, but of derangement of the capillary circulation, and
of alterations in the nervous  system and blood.
   R.—Brandy flviij; infusion  of Virginia snakeroot f^viij; sul-
phate  of quinia gr. xv.—Mix.   f^j every hour.   R.—Spirit of
mindererus f^j  every hour.   R.—Mustards  to  extremities.  R.—
Sulphate of quinia gr. v; camphor gr. ij.—Mix.  Every three hours.
R.—Soda powders.
      Amount  of urine passed during the last 17 hours  .    . 10,210 grs.
           "     "      hourly    "    "            600 "
      Calculated amount of urine for 24 hours    .   .    . 14,406 "
   Sp. gr. 1020.  Eeaction decidedly acid; urine high colored, like
new  Madeira wine.  No deposit after thirty hours; after sixty
hours, a slight deposit of mucous corpuscles and triple phosphate.
Crystals of nitrate of urea, silvery and well formed.  Hydrochloric
acid showed  the presence of  coloring matters in large amount.
	10,210 grains of urine, excreted during 17 hours, contained	14,406 grains of urine, calculated for 24 hours, contained	1000 parts of urine contained
Urea..... Uric acid . . . . Fixed saline constituents	Grains. 320.980 0.200 30.000	Grains. 452.581 0.382 40.330	32.305 0.019 2.938
  17th, 11 o'clock A. M.  Much better.  Tip of tongue clean—supe-
rior portion  coated with fur;  tongue moister, softer, and not so red
as on  yesterday; face  much  less flushed; the burning thirst has
almost entirely disappeared;  has no pain anywhere, and says that
he has an appetite; no tenderness of epigastrium.   Has taken grs.
xxx of the  sulphate of quinia since 1 o'clock P.M., October 16th. 
328                  OBSERVATIONS ON
Pulse, 68;  respiration, 18.   Pulse much fuller;  respiration more
regular and soft.  Temperature of atmosphere 68° F.; temperature
of hand 98°; temp, under tongue 98°.5.
  Here we see, that under the action of the sulphate of quinia and
stimulants, his respiration  has become regular;  his pulse  slower
and fuller; his burning thirst diminished; his glowing tongue and
flushed face paler; his parched mouth moister; his intellect brighter;
his exhausted forces more active; and all the secretions and func-
tions more regular.  Urine high colored.  Decided acid  reaction.
Sp. gr. 1022.  No deposit after standing thirty hours. After eighty
hours a small light-yellow deposit of triple phosphate and urate of
soda.
     Amount of urine excreted during the last 24 hours    .  12,264  grs.
           "      "       hourly    "     "            511   "
	12,264 grains of urine, passed during 24 hours, contained	1000 parts of urine contained
Fixed saline constituents	Grains. 315.250 5.200 34.800	30.846 0.440 2.846
  R.—Continue camphor  and sulphate of quinia, and brandy and
snakeroot tea.  Diet, milk-punch, wine-whey, arrowroot, and mut-
ton soup.
  18th,  12 o'clock M. Eested well during the night; had no fever,
and his skin was in a good  perspiration.   The great  thirst has
entirely disappeared.  Tongue  still redder than normal, but moist
and soft, and the  yellow fur coating the posterior portion is break-
ing up  and cleaning  off;  skin moist, and  normal  in temperature
and feeling.  Pulse and respiration normal.  Dressed himself, and
has been walking in the  ward.   Urine of a deep orange color,
several  shades  lighter than that voided yesterday.  Sp. gr. 1019.
Eeaction slightly acid.
     Amount of urine passed during the last 24 hours .   . 12,737 grs.
           "      "     hourly    "    "    .       614  "
  R— Continue  brandy and  snakeroot tea,  tablespoonful every
three  hours.  Diet, soft-boiled  eggs, milk  punch,  mutton soup,
arrowroot,  and  rice.
  19th.  Dressed,  and walked about the  ward.
  20th.  Walked about one mile into town; says that he feels well •
urine orange color. Sp. gr. 1020.   After standing twelve hours, a 
                     MALARIAL FEVER.                  329

heavy light-yellow deposit of triple phosphate and urate of soda.
1000 parts of urine contained uric acid 0.607.  Fixed saline consti-
tuents 3.529.
  21st.  Says that he took a slight cold yesterday, during the walk
into the city; urine orange color.  Sp. gr. 1019.
     Amount of urine passed during the last 17 hours .    .  13,247 grs.
           "        "   hourly   "      "            770 "
     Calculated amount of urine for 24 hours    .    .    .  19,495  "
•	13,247 grains of urine, excreted during 17 hours, contained	19,595 grains of urine, calculated for 24 hours, contained	1000 parts of urine contained
Urea..... Uric acid .... Fixed saline constituents	Grains. 181.568 6.110 96.900	Grains. 290.508 9.770 154.040	12.992 0.461 7.199
  This patient  had no return of fever, and was discharged a few
days subsequently.  This case sustains not only the conclusions,
but also the treatment of the two preceding cases of remittent fever.
Six Cases from the same Small Yessel, illustrating the Injurious
  Effects of the Use of Calomel, and the neglect of Stimulants
  and Sulphate of Quinia in Remittent Fever ;  the Relations of
  the Pulse and Respiration and Temperature in Malarial Fever ;
  the Effects of  Stimulants and  Sulphate of Quinia upon the
  severe Cerebral Symptoms ;  the Depressing Influences of the
  Malarial Poison;  and the Diversity of the  Manifestation of
  its Effects ^n Men living in  the same Small Vessels, and ex-
  posed, IN AN EQUAL MANNER, TO THE MALARIAL INFLUENCE.

   Observation.—(x 1.) American seaman from U. S. cutter; age, 24;
height, 5 feet 10 inches; weight, 150 pounds; brown hair, brown
eyes.  This is his first summer in Savannah.   Has been employed
as a sailor on the  United States revenue cutter, which has been
cruising during the summer, up and down the  Savannah Eiver.
  Ten days ago, the  cutter was struck by lightning and was placed
in the dry dock, at  the ship yard, on the river, east of the city.
This ship yard is located on the Savannah  Eiver, about five hun-
dred yards from the eastern boundary of the city in a malarious
district which was formerly under  the rice (wet)  culture; now the
surrounding lowlands are protected from overflows by dams, and
are under dry culture.   The banks of the river, at this locality, are
      22 
830
OBSERVATIONS ON
coated with mud composed in large measure of animal  and vege-
table  matters; the banks and  bottom of the canal, in which the
ships  are  floated  at  high water, also contain large quantities of
similar mud.  The crew of the cutter slept on board one night after
she was placed in dry dock.  The crew consisted of ten healthy
seamen, and out of this number six were taken sick in the course
of ten days.  Whilst the cutter continued in the stream the men
were healthy, but as  soon as they were exposed to the exhalations
of the mud, and low  grounds, they were taken sick.
   September 24,1857. Has just entered the hospital, and says that
he had a slight chill yesterday, followed by fever.  Tongue coajed
with brownish-yellow dry fur.  Pulse, rapid; intellect, dull.  Says
that his bowels have  not been moved for several days.
   R.—Calomel gr. xv; castor oil in four hours.
   25th.  Medicine acted' freely.   Has fever.  Tongue still coated
with fur, but a little  more moist.   The  fur shows a disposition to
come  off in patches.   Pulse, accelerated; intellect continues dull.
   R.—Sulph. of  quinia gr.  v,  every three  hours,  up to gr. xv.
Soda powders.
   26th.  Has been passing his feces in bed, and lies in a comatose
condition.
   R.—Cut-cups to back of head.   R.—Sinapisms  to. extremities;
blisters  to back of neck and  epigastric region.  R.—Infusion of
snakeroot, and sulphate of quinia.   R.—Calomel gr. xxiv; opium
gr. ij.—Mix.  Divide into twelve pills, and  administer  one every
two hours.
   27th.  Continues comatose.  Pulse 106,  small and  feeble.  The
blisters  drew finely.   The blisters and sinapisms failed to arouse this
patient, and he died this afternoon at 1 o'clock P. 31.

              AUTOPSY TWENTY HOURS AFTER DEATH.
   Exterior.—Full; limbs  round;  subject  apparently not  at  all
emaciated; skin of the superior (uppermost)  portions of the body
presented  the usual appearance, whilst the skin of the inferior (de-
pendent) parts presented a mottled,  purplish  appearance.  This
was due to the settling of the blood under the action of  gravity.
   Head.—Dura mater presented the usual appearance.
   Arachnoid membrane not opalescent, but presented  the usual
transparency.  Bloody serum was effused between the  arachnoid
membrane and pia mater.
   Bloodvessels of pia mater congested with blood. 
MALARIAL FEVER.
331
  Ventricles of brain, almost completely filled with reddish serum.
Bloodvessels of the superior portions of the brain, more congested
with blood than those of the inferior portions.
  Substance of the brain presented the usual appearance and con-
sistency, considering the length of time since death.
   Chest.—Heart and lungs normal.
  Abdomen—Liver.—Color of the exterior appeared to  be normal
(perhaps  a  shade darker than usual), with  the  exception of two
slate-colored spots.  The largest of these slate-colored spots was
four inches  in diameter, and situated  upon the anterior surface of
the right lobe, whilst the smallest was situated upon the  posterior
surface of the left lobe.  When an incision was made into the sur-
face of the  liver, through these spots, the structures  presented  a
bronze color for  the depth of a quarter of an inch. In  all other
parts of the liver, the cut  surface  presented a color only a shade
deeper than normal.
   Spleen, enlarged, softened, and of a dark slate color.
   When the mud of the spleen was  exposed to  the atmosphere, a
part retained the dark-purplish and reddish-brown color, whilst
another smaller portion changed  to an arterial  hue.   The differ-
ence between these two  portions  of the splenic mud were clearly
seen when a section of the organ was exposed for several hours to
the action of the atmosphere. The other portion of  the mud of the
spleen did  not change its  color.  It is probable that this  pheno-
 menon was due  to the fact, that the blood had been but recently
effused into the spleen.   The portions first effused had lost the
 power of changing to  the arterial hue, whilst those last effused had
 not lost this power.
   Kidneys, normal.
   Alimentary Canal.—The mucous membrane of the alimentary
 canal, from the oesophagus  to the anus, presented the normal color,
 and showed no signs whatever of congestion or inflammation.

                           CONCLUSIONa
   (1.)  This case  illustrates the rapid  and powerful action of the
 malarial poison.
   (2.)  The brain and  its membranes appeared to be normal, with
 the exception of the serous effusion which was  entirely inade-
 quate  to account for  the  cerebral  disturbance during  life;  the
 liver, with the exception of the small spots, appeared to be normal
 in structure; the affection of the spleen was recent; and the ali- 
332
OBSERVATIONS  ON
 mentary canal, from the mouth to the anus, bore no marks of in-
 flammation, and yet this strong, hearty young man fell a victim to
 the malarial poison.
   The malarial poison appeared  to act in this case, directly upon
 the nervous centres of the cerebro-spinal and sympathetic nervous
 systems.
   (3.)  The treatment of this  case was radically defective—it was
 wanting in energy.  The effects of the disease were those of exhaustion,
 and not of inflammation and excitement.   The chemical changes of the
 elements were interfered  with, and the  relations of  the forces, as a
 necessary consequence, disturbed.  The manifest indication was to stimu-
 late the exhausted nervous system, and excite those chemical changes by
 which the forces are generated, which work the animal machinery.
   The blisters  and sinapisms, and cut-cups, and  small doses of
 sulphate of quinia, were right, as far as they went.   The last doses
 of calomel were decidedly wrong, and worse than useless; they
 simply  worked in  conjunction with the malarial  poison.   Large
 doses of brandy, carbonate of ammonia -and sulphate  of  quinia,
 should have been administered promptly and energetically, in con-
junction with the  blisters  and  sinapisms.   The  following case,
 which resembled this one in all respects, will illustrate, in a forcible
 manner, these conclusions:—
   Observation.—(x 2.) Seamen from the United States revenue cut-
 ter, and a shipmate of the previous case; and the remarks which
 were made with reference to the history of that case, apply also to
 the present one.  Age 26 ; light hair, blue eyes, florid complexion;
 height, 5 feet 11 inches;  weight, 160  lbs.  This is his first sum-
 mer in these regions.
   September 25, 1857. Has been  sick two days; says that  he was
 suffering with a thick eruption of prickly-heat.   This disappeared
 suddenly and then the fever appeared.  Has fever now.
   R.—Calomel gr. xv; castor oil in four hours.
   26th. Medicine acted freely;  heat of  skin much less;  tongue
 heavily coated with yellow fur, tip and edges very red; intellect
 dull;  appears to articulate with difficulty.
   R.—Sulph. of quinia, gr. v  every three hours, up to gr. xv.  In-
 fusion of Virginia snakeroot.
   27th. Intellect still dull;  tongue presented the same coated ap-
 pearance.   Pulse 83.
   R.—Calomel gr. x; sulph. of quinia gr. v.  Mix and  administer
 immediately. 
MALARIAL FEVER.                  333
   28th, 10 o'clock A. M.   Was delirious during the night, and it
was necessary to use much force to keep him in bed. Appears to be
much worse this morning, and  continues delirious; tongue, heavily
coated and very red at tip and edges.  Pulse, 86.  No pain upon
pressure of epigastrium.
   R.—Blister to epigastrium and back of  neck.  R.—Calomel gr.
xxiv;  opium  gr. ij.—Mix.  Divide  into twelve powders, and ad-
minister one every two hours.
   7 o'clock P. M.   Appears to be very weak  and stupid.  When
aroused by shaking, whines and mutters incoherently.   Pulse, 82 ;
respiration, 20;  skin dry; tongue presented the same  appearance.
It is evident that  unless the calomel be abandoned, and a more vigorous
method of treatment adopted, this patient will die just as the previous
case.
   R.—Two cut-cups to each temple; sinapisms to extremities. R.—
Brandy  fIviij ;  infusion  of  Virginia snakeroot f^viij ;  sulphate
of quinia gr. xv.  Mix and administer a tablespoonful every half
hour.  R.—Sulph. of quinia gr. v every three  hours  up to gr. xx.
   29th, 11 o'clock A. M.   The stimulants  and sulphate of quinia
have been productive of much  good.  Tongue, although very red,
and dryer and rougher than normal, is moister and  softer than it
was yesterday.  During the night, slept soundly, and this morning
his skin relaxed and was bathed in a copious perspiration. Intellect
clearer.  Pulse,  78; respirations, 15.   Temperature of  atmosphere
80° F.;  temp, of hand, 99.  Has taken during  the  last eighteen
hours,  forty grains of sulphate of quinia.  R.—Give 20 more grains
of sulphate of quinia during the next 20 hours, and continue the
brandy and infusion of Virginia  snakeroot, tablespoonful  every
hour.  Diet, beef-soup and tea.
   7 o'clock P. M.  Continues to improve, and says that he is much
better.  The  blisters  have drawn and discharged  golden colored
serum.   Intellect more active,  but still much  duller than usual.
Tongue red, dry and harsh, feels like  sand-paper—superior portion
coated with yellow fur; face much flushed;  reaction  of saliva de-
cidedly acid;  urine high  colored.  Pulse, 80; respirations, 16.
Temperature of  atmosphere, 78.5° F.; temp, of hand, 100.33.
   R.—Mustard to extremities.   Stop sulphate of quinia. Continue
brandy and infusion of Virginia snakeroot.   Diet, milk punch, and
brandy and arrowroot.
  30th.  Says that he is much better.  Pulse, 79 ; respirations, 16.
Temperature  of atmosphere, 70° F.;  temp,  of  hand, 97.5; temp. 
334                  OBSERVATIONS ON

under tongue, 100.   Tongue still very red, but more moist.   Skin
dry; reaction of saliva acid.
  Urine, of a bright red color, and decided acid  reaction—sp. gr.
1022.  Uric acid in 1000 parts, 0.538.
  R.—Continue stimulants and nutritious diet.
  Oct. 1st, 11 o'clock A. M.  Eested well during the night, and
continues to improve.  Complains of great weakness.   Tongue
much softer.  Pulse, 70; respirations, 14.  Temperature of atmo-
sphere, 71° F.; temp, of hand, 98; temp, under tongue, 99.5.  Urine
only a shade higher colored than normal, reaction acid—sp. gr. 1010.
Uric acid in 1000 parts,  0.0099.
  R.—Continue brandy and infusion of snakeroot tea. Administer
15 grs. of the sulphate of quinia during the next fifteen hours.
  2d, 11 o'clock A. M.  Surface of blister red  and raw; tongue
cleaning off; papillae enlarged and distinct; bowels torpid.  Pulse
60;  respirations 13, slow and full. It is probable that the frequency
of the respiration is diminished by the blistered surface.  Temper-
ature of atmosphere, 76° F.;  temp, of hand, 97.75;  temp,  under
tongue, 99.5.
  R.—Continue stimulants and nutritious diet,  milk punch and
mutton  soup.
  Urine, of a bright red color, sp. gr. 1020—turbid after standing
several  hours. Amount passed during the last twenty-four hours,
13,260 grs.
  3d, 11 o'clock A. M.   Pulse, 62; respiration, 14.   Temperature
of atmosphere, 76° F.;  temp,  of hand, 98°; temp, under tongue,
99.25°.   Eeaction of saliva acid;  urine  of a deep orange color—
heavy, light-yellow deposit after standing a few  hours.  The acid
has  greatly  diminished—reaction  alkaline after standing  a  few
hours.   Amount passed during the last  twenty-four hours,  15,330
grs.; sp. gr. 1022.   Uric acid in  15,330  grs. of urine, 10.5  grs.
Uric acid in 1000 parts of urine, 0.684.  Bowels have not been
moved for four days.
   R.—Calomel gr. viij ;  sulph. of quinia gr. v.   Castor oil in four
hours.   Continue stimulants and infusion of snakeroot.
   4th. Dressed and walking about the ward.  Tongue moist and
soft, and only a little redder at the tip than usual.  Pulse, 60; res-
piration, 12.   Blister  raw, and slow in healing.   Urine  orange
colored, reaction slightly acid, when first voided, but rapidly changes
to the alkaline, and lets fall  a heavy deposit after standing a few
hours. 
MALARIAL FEVER.
335
  R.—Quassia and soda.  Full diet.
  5th. Urine, orange colored;  sp. gr, 1024.   Heavy deposit—reac-
tion of saliva very slightly acid.
  8th. Entirely  restored  to health.   Pulse, 48;  respiration,  14.
Temperature of atmosphere, 73° F.; temp, of hand, 97° ; temp, under
tongue, 99.5°.

                          CONCLUSIONS.
  (1.) Although the pulse of this patient, at first sight, did not ap-
pear to have been much accelerated, when compared with the pulse
in other cases of malarial fever, still it was greatly accelerated.  The
pulse was  unusually slow in health, only 48 to the minute.  The
respiration was  also very slow in  health, 14 to the minute.  The
temperature of the surface was not greatly elevated.
  (2.) Aside from the  cerebral symptoms, there was  nothing to
alarm the practitioner, except the state of the tongue.  The promi-
nent  symptoms, as in the previous  fatal case, from the same vessel,
were connected  with the brain.
   (3.) Active purgation and alterative doses of calomel, so far from
benefiting, were, as was conclusively demonstrated, by careful exa-
minations  and analyses of all his  symptoms, working  in conjunc-
tion with the malarial poison, and rapidly bringing on a fatal ter-
mination.   Stimulants, blisters, sinapisms, and large doses of sul-
phate of quinia, administered without any regard to the state of
the tongue and brain, so far from  increasing the  cerebral disturb-
ance, diminished it rapidly.  Under the vigorous use of these active
remedies,  the dry, red tongue became  moist, soft, and pale—the
pulse was diminished  in  frequency,  and became fuller—the dry
skin became moist, and the delirium entirely disappeared.
    These facts demonstrate conclusively that the action of the  malarial
poison in this case was that of depression and not of inflammation.
    Observation.—(x 3.) American seaman from United States revenue
 cutter; companion of  the two  former cases.  Taken sick at the
 same time.  Age 23; brown hair, dark eyes, florid complexion;
 height 5  feet 7. inches; weight  155 lbs.; large chest, and  stout
 muscular  limbs.
    September 25th,  1857.  Was  taken  sick two  days ago.^  His
 attack commenced with a prolonged chilly feeling, followed in the
 course of  six hours with fever.  Has  fever now.
    R.—Calomel gr. x;  sulphate of quinia gr. v.
    26th. Medicine operated freely.   Complains of pain  in his head. 
336
OBSERVATIONS ON
 Tongue coated with fur;  pain upon pressure  of  epigastrium.
 Pulse 88.
   R.—Apply sinapism over epigastric region; and administer infu-
 sion of red pepper.
   27th. Much better; febrile excitement much less.  Complains of
 slight pains in his bones and bowels.
   R.—Sulph. of quinia gr. v, every three  hours, up to gr. xv; in-
 fusion of Virginia snakeroot.
   28th. Has no fever.   Give fifteen more grains of sulph. of quinia.
   29th, 11 o'clock A. M.  Much better.
   7 o'clock P. M.  Within the  last two hours has taken a change
 for the worse.  Intellect wandering.   Complains  of great pain in
 his head.   Pulse 92, feeble; respiration, 32.  Eeaction of  saliva
 intensely  acid.  The secretions  of the mucous membrane of the
 mouth are almost entirely dried up, and it is with difficulty that
 sufficient saliva is obtained to moisten the litmus paper.  Tongue,
 where the fur is  absent, very red—it is dry, harsh, and rough to
 the  touch.  Pain  upon  pressure of the epigastrium.   Head and
 trunk hot, and extremities cool.
   R.—Sinapisms to extremities and epigastric region ;  cut-cups to
 temples and back of  head.
   R.—Sulphate of quinia gr. vij, every  three  hours, up to gr. xl.
 Administer brandy and infusion of Virginia snakeroot, freely.  Diet,
 brandy and arrowroot.
   30th, 11  o'clock  A. M.  The mustards and  stimulants have
 aroused the intellect, and rendered the dry, parched tongue moist,
 and diminished the frequency of the pulse and respiration.   Pulse
 68, rather feeble;  respirations,  22.   Temperature of  atmosphere,
 80°  F.; temp, of hand,  95.5°;  temp,  under  tongue,  97°.  Skin
 slightly moist, and cool  to  the touch; face much flushed ; surface
 of head cool, although from its congested,  florid, red  appearance,
 we would  judge it to be  hot. The temperature of the trunk and
 extremities is below the normal standard, notwithstanding that
the pulse  and respiration are much more rapid than in health.
During the night he was delirious, and it was difficult to keep him
in bed.
  The blood from the cut-cups  appeared to be normal under the
microscope, and showed no signs of inflammation.
  R— Continue stimulants and sulph. of quinia. Diet, milk punch,
brandy, and arrowroot.
  October 1st, 11 o'clock A. M.   Continues to improve under the 
MALARIAL FEVER.
337
action of the stimulants and  sulphate of quinia.  Tongue moister
and  softer.   Pulse  66, rather feeble; respirations,  20.  Tempera-
ture of atmosphere, 71.5° F.; temp, of hand, 95°; temp,  under
tongue, 97.15°.  Complains of weakness.   Eested well during the
night, and has had no pain in his head since the application of the
cut cups.  Urine orange-colored; sp. gr. 1013.
  R.—Continue stimulants and nutritious diet.
  2d, 12 o'clock M.  Tongue moist and clean, redder than normal.
Pulse 62, regular, full and soft;  respirations, 20.  Temperature of
atmosphere, 76.5° F.; temp, of hand, 98°; temp, under tongue, 99°.
Eeaction of saliva, decidedly acid.  Urine, orange-colored and clear,
reaction decidedly acid; sp.  gr. 1014.  Amount excreted during
the last twenty-four hours, grs. 21,210.
  R.—Continue.  Full diet.
  3d. Face not so much flushed.  Tongue clean, moist, soft, and
approaching the usual color.  Eespirations,  19.  Temperature of
atmosphere, 76.5°  F.; temp,  of  hand, 96.5°; temp, under tongue,
98.8°.   Eeaction of saliva decidedly acid.
  Color of urine, reddish-orange;  after standing several hours, let
fall a light yellow deposit; sp. gr. 1017.
  R.—Continue stimulants and infusion of Virginia snakeroot tea.
  4th, 12 o'clock M.  Up, and  walking about the ward.  Urine,
orange colored;  the  change from the  acid to the  alkaline reaction
took place in the course of a few hours, and a heavy deposit was
thrown down.  Amount  of urine passed during the  last twenty-
four hours, 15,270 grs.;  sp.  gr. 1018.   Pulse  54, slow and full;
respirations, 14.
  It.—Quassia and soda.
  5th, 11 o'clock A. M.   Tongue, pulse, respiration and  skin nor-
mal.  Color of urine, light orange; sp. gr. 1020; reaction of saliva,
acid.
  9th.  Entirely restored  to  health.  Pulse,  43; respirations, 15.
Temperature  of atmosphere, 72° F.;  temp, of  hand, 96.5°; temp.
under tongue, 99.75°.
   Observation.—(x 4.) Irish seaman from  United States  revenue
cutter, age 19 ; height 5 feet  7£ inches; weight  145  pounds; light-
brown hair, gray eyes, fair complexion.
  Oct. 4th. Was taken sick four days ago ; his attack was two days
later than that of his companions.  Has had no chill, but has suf-
fered with pain and dizziness in  the head;  face flushed.  Pulse,
100;  respirations,  20.  Tongue coated with yellow fur, tip  and 
338
OBSERVATIONS  ON
edges red;  papillae enlarged.  No tenderness of epigastrium.  Skin
hot.
  R.—Calomel gr. xij;  sulph. of quinia gr. vj.  Mix, and admin-
ister immediately, and follow  with castor oil in  four hours.  As
soon as the medicine has commenced to act, give  sulph. of quinia
gr. v every three hours up to gr. xx.
  5th. Much better.   Head relieved.   Skin in a profuse perspira-
tion.  Eeaction of sweat and  saliva decidedly acid.  Pulse, 104.
Skin  hot, but moist, and relaxed.  Eespirations 24, full, thoracic.
No tenderness upon pressure of epigastrium.  Tongue  redder and
dryer than normal.   Medicine operated four times.  Has taken
thirty grains of sulphate of quinia.
  R.—As soon as fever remits, give brandy and infusion of Vir-
ginia  snakeroot.
  6th. Continues to improve.   Pulse, 96.   Skin warm, but  moist.
Continue stimulants.
  The febrile excitement subsided and there was no return, and
this patient was discharged a few days  afterwards.
   Observations.—(x 5, 6.) Two  stout, athletic young seamen, from
the United  States revenue cutter, who contracted their  sickness
simultaneously with the four seamen just mentioned.
  One suffered with a slight attack of intermittent fever, and re-
mained in the hospital only a few days.
  The other suffered also with intermittent fever, but of a severer
type.
  In this case, the chill was well  marked, by a hot trunk and cold
extremities, and great disturbance of the sympathetic and cerebro-
spinal nervous systems; and  in  the succeeding stage  of febrile
excitement, the pulse was full and strong, the respiration accele-
rated  and the animal temperature correspondingly elevated; and in
the intermission there was a marked subsidence of the febrile ex-
citement.
  At  first sight, the severe  chill—the full, bounding  pulse—the
thoracic  respiration, and the  hot and  parched  skin, would  excite
the belief that the patient was  in danger.  Such an opinion would
have  been  erroneous,  for these  phenomena signified powers of
resistance.
  This case yielded far more readily to the action of the sulph. of
quinia than the former cases from  the cutter. 
malarial fever.
339
Conclusions drawn from an Examination, Analysis, and Comparison
  of these Six Cases of Malarial Fever, occurring in the Crew of
  the United States Revenue Cutter.
  (1.) Whilst the revenue cutter was cruising about the  mouth of
the  Savannah  Eiver, the  crew remained healthy;  but as soon as
they were exposed to the exhalations of the low grounds  and
marshes, they were attacked by malarial fever.  This fact demon-
strates that a special cause resided in a special  locality, capable of
producing a special disease.
  (2.)  There was a remarkable uniformity in  the symptoms of four
out  of the six  young men from the cutter who were attacked with
fever.
   In these cases, the  malarial poison appeared to act either directly
or secondarily, powerfully upon the nervous centres of the sympa-
thetic  and cerebro-spinal systems.
   The action of the malarial poison was depressing, rather than inflam-
matory.   Whatever diminished the forces, acted in conjunction with the
malarial poison.   Whatever stimulated the  nervous system, excited the
action  of the heart, excited the capillary circulation, excited and increased
the chemical changes of the nutritive fluids and organs and tissues,  acted
directly antagonistic to the action and effects of the malarial poison.
   (3.) A rapid feeble pulse, rapid respiration and low temperature,
 and wandering  intellect,  are always  dangerous symptoms, which
 signify a perversion of  the  functions, an interference with the
 normal chemical actions, which generate the forces, and  an uncon-
 ditional surrender to the fatal poison.
   (4.) A rapid, full pulse, accelerated respiration, and a correspond-
 ing development of heat, are favorable symptoms, and  signify an
 effort on the part of nature to get rid of the poison.  The fever  is
 not the disease—it is an effect of  the action of the malarial poison upon
 the living organism, and signifies a power of resistance.
   (5.) The differences in the  symptoms of  these  cases show that
 men living on the same small vessel, and exposed  in an equal  man-
 ner, will not suffer alike.   The effects of the poison will  depend, in
 great measure, upon the nature of their vital and physical endow-
 ments. 
340
OBSERVATIONS ON
                  III.  CONGESTIVE  FEVER.

              Pernicious Fever.—Malignant Fever.
   These terms do not designate distinct diseases, but peculiar mani-
 festations of one disease, malarial fever.
   The  complete prostration of the vital and physical forces; the
 reduction of animal temperature both in the trunk and in the ex-
 tremities; the cold, clammy sweat; the rapid, feeble pulse; the rapid
 thumping action of the heart, and the  sudden intervention of the
 most alarming  cerebral symptoms, may occur gradually or  sud-
 denly in either intermittent or remittent fever, and may be induced
 by several distinct causes acting singly  or in  combination.

   Proposition XVII.  The malarial poison may produce such pro-
found alterations in the blood, and such profound impressions upon the
 sympathetic and cerebro-spinal systems, and upon the fibres of the heart,
 that both the  capillary circulation and the general circulation will  be
 greatly  deranged, the  chemical changes in the  capillaries and organs
from which  the  nervous and muscular forces are developed,  arrested,
 and the temperature of the trunk diminished.

   Proposition XVIII. The malarial poison  may produce such de-
 rangements in the blood and its containing  vessels, that fibrinous coagula
 will be formed in the heart and large bloodvessels, and produce suddenly
 and without previous warning, the phenomena denominated congestive.
   We have before illustrated  this proposition  by several striking
 cases of fibrinous concretions in the  heart and large bloodvessels
 during life.

   Proposition XIX. The action of drastic purgatives or of an emetic
 or profuse bloodletting, may act in conjunction with the  malarial poison
 and induce the phenomena denominated congestive, pernicious or malig-
 nant.

   Proposition XX.  As far  as  my  observations  extend,  there  is
 always  a want of co-ordination between the actions of the circulation and
 respiration and animal temperature in congestive fever.
   The  respirations are accelerated, full,  and often panting and heav-
 ing, varying from 30 to 50 in the minute; the pulse beats from 120 to 
MALARIAL FEVER.
341
160, and feels like a delicate thread, or is so small that it cannot be
counted; the heart thumps irregularly and spasmodically against
the walls of the chest, as in some cases of narcotic poisoning;  the
circulation in the capillaries  is arrested;  the  temperature of  the
trunk, notwithstanding the full and rapid respiration, sinks below
the normal standard ; the temperature of the extremities sinks far
below the normal standard, and the surface is  covered with a cold
clammy  sweat.

   Proposition XXI.  The phenomena of congestive fever differ from
those of the cold stage of intermittent and remittent fever in the want of
elevation of the temperature of the trunk.
   This distinction is most important as a diagnostic and prognostic
sign.

   Proposition XXII. The phenomena of congestive fever are due to
depression of the fever, and  not to excitation, and should be treated ac-
cordingly.
   The characters of the urine are not so readily determined in congestive
fever, on account of the restlessness, and often  delirium of the patients.
   In some cases it is increased and of a light color.   The color of
the urine does not, as in remittent and congestive fever, correspond
with the severity of the disease.  The changes  in the urine during
congestive fever  point to profound disturbances in the chemical
changes of the  capillaries. In a case which  we shall  relate, the
characters of the urine were completely  altered.
   The following cases will illustrate some of  the phenomena  and
some of the principles of treatment of congestive fever.
   In presenting  these cases, the author  would again disclaim  any
attempt to present all the various phenomena of malarial fever.

Case illustrating the Changes of the Blood in Malarial Fever,
   and the Disturbances of the Pulse and Respiration in Congestive
   Fever, and the Effects of Stimulants 'and Sulphate of Quinia.
   American seaman: native of Boston; age 21; weight 150; height
5  feet 10 inches; dark brown hair, brown eyes; muscular system,
moderately well developed.  This is  his  first trip  to  Savannah.
Has been in Savannah ten days.  During  this  time has been sleep-
ing at night on the deck of the ship in the open air.  The captain
compelled all  his men to sleep on board the ship, which was lying
at the saw-mill, opposite  the  low marshy  shore.  Was  taken  sick 
342
OBSERVATIONS on
four days ago.  The crew consisted of eight; four of the crew slept
on deck, and the same number in the cabin.  The former are now
sick, whilst the latter are well.
  September 26th, 1857.  Tongue dryer than normal, and coated
with yellow fur; complexion sallow.   Pain upon pressure  of epi-
gastrium.   Has some fever, and appears to be very weak.
  R.—Sinapism over epigastric region.
  R.—Sulphate of quinia gr. v, every three hours, up to gr. xv.
  27th.  Has taken a change for the worse.   Has been passing his
water in bed, and is in a comatose state.  When the epigastrium is
pressed  exhibits signs of pain. Pulse and respiration accelerated.
  R.—Blister over epigastric region,  and sinapisms to extremities.
  R.—James'  powder  (Pulvis Antimonii Compositus) gr.  xxij;
calomel gr. xij; opium gr. ij.—Mix.  Divide into  twelve  powders
and administer one every two hours.
  28th,  11 o'clock A. M.  The blister  has aroused the nervous
system,  and the patient is restored to the use of his reason.
  R.—Continue calomel and opium.
  R.—Neutral mixture.
  7 o'clock P. M.   The action of the blister has been only  tempo-
rary, and the patient is now stupid, almost comatose.  Pulse, 120.
Respiration, 22.  Pulse is so feeble that it is with difficulty counted.
Tongue coated with yellow fur, dry and rough.  The surface feels
harsh, like the surface of a board.   It is evident that the stimulant
effect of the blister has vanished, and that the calomel is exerting
no beneficial effect.
  R.—Sinapisms to extremities.
  R.—Brandy flviij;  infusion of  Virginia snakeroot flviij; sul-
phate of quinia gr. xv.—Mix.  Administer Ij every half hour.
  R.—Sulph. of quinia gr. v every three hours, up to gr. xx.
  29th,  11 o'clock A. M.  Lies in  a stupor, with mouth and eyes
partially open.  When aroused by shaking, answers sluggishly and
in a few moments relapses into a stupor.   Teeth coated with  sordes.
Tongue coated with black and light yellow fur, with swollen edges,
indented by the teeth; perfectly dry and rough. The surface of the
tongue is transversed by several deep cracks.  Surface of blister red
raw and dry.  The  serum which issued from the blister  was of a
golden color.  This patient emits a  disagreeable nauseous smell.
Has taken 40 grs. of sulph. of quinia.
  R.—Continue brandy,  infusion  of  Virginia  snakeroot,  and sul-
phate of quinia. 
MALARIAL  FEVER.
          2 o'clock P. M.   Examination of Blood.
Blood coagulated slowly.
Serum of a deep golden color.
Nitric acid showed that this color was due to the presence of
Reaction of serum, alkaline.
Specific gravity of blood       ....
   "        "     serum      ....
bile.
                                Water.
   In 1000 parts of blood
       "     "    serum
(1)    "     "    liquor sanguinis  .
(2)    "     "       "       "

                             Solid Matters.
   In 1000 parts of blood
       "     "     serum
(1)    "     "     liquor sanguinis
(2)    "     "       "       "
   In serum of 1000 parts of blood

                        Fixed Saline Constituents.
   In 1000 parts of blood
        "      "    serum
 (2)     "      "    liquor sanguinis  .
        "     "    dried blood-corpuscles
        "     "    moist blood-corpuscles
        "      "    dried residue of blood
        »      n      «      «     serum
    In serum of 1000 parts of blood
1000 parts of Blood contained-
    Water
                                 ( Dried organic residue
    Dried blood-corpuscles  85.9681 p.xed galine constituentg

    Fibrin      ...•••
    Albumen, extractive and color- ( Dried organic residue
      ing matters      .    80.033 ( Fixed saline constituents

1000 parts of Blood contained—
                                   {Water
                                   Dried organic residue   .
                                   Fixed saline constituents
                                   Water   .
                                   Albumen, extractive and
                          656.128 ■{   coloring matters
                                   Fixed saline constituents
                                  w Fibrin   .
Liquor sanguinis
1000 parts of Moist Blood-Corpuscles contained—
    Water      .
    Dried organic residue
    Fixed saline constituents  .
.   1040
.   1022

833.449
912.386
910.798
875.813


166.551
 87.614
 89.203
124.187
 80.033


   6.314
   6.620
   8.759
   6.595
   1.648
 37.909
 75.558
   5.747


 833.449
  84.400
   0.567
   1.450
  74.186
   5.747


 258.804
  84.400
   0.567
 574.646

  74.185
   5.747
   1.450


 752.646
 245.239
   1.648 
344
OBSERVATIONS  ON
(1) 1000 parts of Liquor Sanguinis contained—
     Water.......910.797
     Albumen, extractive and coloring matters .     .      •    80.996
     Fixed saline constituents  .....     1.587
     Fibrin.......6.620
(2) 1000 parts of Liquor Sanguinis contained—
     Water    .......   875.813
     Albumen, extractive and coloring matters      .      .   113.064
     Fixed saline constituents  .     .     .     •      •     8.758
     Fibrin.......2.209
  7^ o'clock P. M.   The stimulants and  sulphate  of quinia have
excited the chemical changes and aroused the nervous system, and
the patient is now restored to the  exercise of his intellect.  He is
still, however,  very weak,  and has a  great  tendency to sleep.
Pulse, 98; respiration 18, full.  Temperature of atmosphere, 80° F.;
temp, of hand, 98°.   Skin of head and trunk feels a little warmer
than normal, and is slightly moist.  Tongue presents the same dry,
coated, rough appearance.   Eeaction of saliva decidedly acid.
  R.—Mustard to extremities.   Continue brandy, infusion of  Vir-
ginia snakeroot, and sulphate of quinia. Diet: milk punch, brandy,
and arrowroot.
  30th, 2 o'clock P. M.  His  intellect is clear, and  there  is less
tendency  to sleep, and he appears to be decidedly better.  Pulse
80, much  fuller;  respiration, 14.   Temperature of atmosphere, 71°
F.; temp, of hand, 97°.   Tongue is still very dry, rough, and black
in the centre; it  appears, however, when pressed with the finger, to
be somewhat softer.
  Urine passed this morning high colored.  Urine passed  during
the night several shades lighter, and of the usual color.  Eeaction
decidedly acid.   Specific gravity  of urine  passed this morning,
1016.  Owing  to the weakness of the patient, the whole  amount
was not collected.  Amount of uric acid in 1000 parts of urine,
0.59.  Eeaction of saliva, acid.
   R.—Continue stimulants, sulphate of quinia, and nutritious diet.
   October 1, 1 o'clock P. M. Says that he feels better, and  is  hun-
gry.  Pulse, 90; respiration, 20.   Temperature of atmosphere, 73°
F.; temp, of hand, 98.75°; temp, under tongue, 101°. Complexion
very sallow.   Tongue slightly moister, cleaner, and softer.
   Urine of a deep orange color, clear, and limpid;  reaction acid;
sp. gr., 1016.   Uric acid in 1000 parts of urine, 0.659.
   2d, 1 o'clock P. M.  The expression of the countenance is better,
and the surface  of  the blister looks much better.   Tongue still 
MALARIAL FEVER.
345
coated with dark-brown fur, but moister and softer.  The sordes
around his teeth, and the disagreeable smell, are rapidly disappear-
ing.  Abdomen tumid.  Pulse, 88; respiration,  18.  Temperature
of atmosphere, 77° F.; temp, of hand, 102°.  Was able to get up
and walk across the ward this morning.
  R.—Continue brandy and snakeroot tea, and sulphate of quinia;
tablespoonful every three hours.
  Urine orange colored; sp. gr., 1016.  Uric acid in 1000 parts of
urine, 0.511.  Eeaction of saliva decidedly acid.   As in the former
examinations, there was scarcely  sufficient saliva to moisten the
test paper."
  3d, 1 o'clock P. M. Has apparently taken a change for the worse.
Inclined to stupor; goes to sleep  whilst conversing; countenance
anxious and distressed.  This inclination to stupor may be the
effect of the brandy and sulphate  of quinia.  During the last four
days has taken about one hundred grains of the sulphate of quinia.
  R.—Stop stimulants and sulphate of quinia.
  Pulse, 94; respiration, 18.  Temperature of atmosphere, 77° F.;
temp, of hand, 102.5°.  Bowels are costive.
  R.—Citrate of magnesia and soda powders.
  Urine of yesterday deposited a heavy light-yellow deposit. Urine
just passed light orange colored, limpid; reaction acid; sp. gr., 1006.
Uric acid in 1000 parts of urine, 02.38.
  4th, 2 o'clock P.  M.  Medicine operated slightly.  Pulse, 94.
  R.—Infusion of Virginia snakeroot.
  R.—Tincture of  muriate of iron nix, three times a day.
  5th, 2 o'clock P. M.  Anxious expression of countenance; bowels
costive; abdomen tumid.   Tongue a little softer and cleaner, but
still much drier, harder, and rougher than normal.  Notwithstand-
ing the slight improvement  of his  strength, there is still an almost
complete absence of the secretions  of the mucous membrane of the
mouth.   Pulse, 90;  respiration, 15.  Temperature of atmosphere,
74° F.;  temp,  of hand,  96°; temp, under tongue, 103°.
  The temperature  of the extremities is two degrees below, whilst
the temperature of  the  trunk is four degrees above, that of health.
Accompanying this loss of animal heat in the extremities, and ex-
altation in the trunk, there is a rapid, feeble pulse, normal respira-
tion, dry,  harsh  skin, dry mouth,  feeble digestion, torpid bowels,
sluggish intellect, and feeble forces.  These facts, taken in connec-
tion with  the  analysis of the blood, show that the malarial poison
has produced profound  alterations  in the constituents of the blood,
       23 
346
OBSERVATIONS ON
 interfered with the formation of the secretions, interfered with the
 chemical changes of the blood and nutritive fluids, interfered  with
 the development and correlation of the physical, vital, and nervous
 forces.
   The dry, harsh tongue; the scanty, acid secretions of the mucous
 membrane of the mouth; the torpor of the bowels; the high-colored,
 acid urine;  the dry, harsh skin; the feeble circulation in the capil-
 laries of the extremities; the  elevation of the  temperature of the
 trunk;  the loss of harmony between the actions of the circulatory
 and respiratory systems—all point to profound  disturbances in the
 domain over which the sympathetic system presides. The sluggish
 intellect indicates derangement of the cerebro-spinal system.   The
 feeble forces point  to derangements in both the sympathetic and
 cerebro-spinal systems.
   The fact  that the temperature of the  extremities is  but two de-
 grees below the normal standard, whilst that of the trunk is several
 degrees above the  normal  standard, affords evidence that the  che-
 mical changes of the organs,  tissues, and blood are  sufficient in
 quantity to work the machinery with the accustomed vigor.   But
 the machinery is not worked with the accustomed vigor; the  pa-
 tient is weak, and unable to accomplish any mechanical effort at all
 corresponding to the chemical changes of the elements and solids.
 The forces are generated, but they are not properly applied, or they
 are not  properly related to each other, or they are not generated in
 the right position or in the proper apparatus. If muscular force is
 generated by the chemical changes of the elements composing the
 muscular tissue,  and if the nervous force is generated  by the  che-
 mical changes of the elements composing the nervous and muscular
 systems, if the transmission of the nervous excitement is dependent
 upon chemical changes in the elements of the nerves along which
 the excitement passes,  it is  evident that whatever interferes with
 those chemical changes  must be attended by either an exaltation
 or depression or aberration of  muscular and nervous force.  If the
 colored  blood-corpuscles, taken collectively, be  an immense gland
 which elaborates the materials for  the nutrition and development
 of the  forces of  the muscular  and nervous systems, then their de-
 struction by the  malarial poison would in  great  measure account
for the disturbances in the muscular and nervous systems.
  Important questions present themselves: Do the disturbances in
the sympathetic  and cerebro-spinal  systems arise from a direct
action of the malarial poison upon one or the other of these  sys- 
MALARIAL FEVER.
347
terns?   Do the alterations in the secretions and excretions, and in
the amount and  character of the  chemical changes and physical
forces, depend upon the direct action of the  malarial poison upon
the organs, elaborating the secretions and separating the excretions,
and preparing the materials destined to form the elements of the
tissues and undergo those chemical changes, by which all the forces
are generated ? Or, do the alterations of the  secretions and  excre-
tions depend upon  alterations of the blood, which is the great re-
servoir of materials for chemical  change and  nutrition ?  Or, do
they depend upon a deficiency, or  excess, or perversion, of nervous
influence, which  is supposed  to influence secretion ?   A correct
solution of  these problems  is  impossible, in the present state of
medical science, because the ultimate facts are wanting.
   Specific gravity of urine, 1006; reaction alkaline after standing
twenty-four  hours.  Amount of uric acid in 1000  parts of  urine,
0.078.
   R.—Stop  tincture  of  muriate  of iron immediately.   At 10
o'clock P. M. this night (twelve hours afterwards) administer calo-
mel gr. x, followed by castor  oil in four hours.  If  he is weakened
by the action of  the medicine, administer stimulants freely.
   6th, 1 o'clock P. M.  Medicine operated four times, and has pro-
duced great exhaustion.   Tongue  clean and  much moister and
softer;  the  moisture of the tongue,  however, varies greatly.  This
morning at  10 o'clock A. M. it was moist and soft; at 12 o'clock
M. it was almost  entirely dry, and  now it is moist.  Pulse 100, very
weak;  feels like the vibrations of.  a spider's  thread.   It requires
time  and care to find the  pulse,  and much  more time  and care to
ascertain correctly its number of vibrations.   It  appears  that  I
have made a mistake in giving the calomel and oil.  His system is
so much exhausted that it is doubtful whether  it will rally.
   R.—Brandy and infusion of Virginia snakeroot;  milk punch.
   R.—Compound tincture  of gentian  f5j; compound  tincture of
bark f3j.  Mix, and administer three times a day in a wineglassful
of infusion of snakeroot.
   R.—Chlorate of potassa  5j 5  water fjviij.   Dissolve, and  admi-
nister during  the  twenty-four  hours.  Diet, mutton soup,  boiled
rice, brandy, arrowroot, and milk  punch.
   7th, 3 o'clock  P. M. Looks better.  The  anxious expression of
his countenance is  removed, his intellect is brighter, and his spirits
better.   Tongue  softer and moister than it  has been  during the
sickness.  Pulse  92, watery and feeble, but  stronger than yester- 
348
OBSERVATIONS ON
day ; respirations, 13.   Temperature of atmosphere, 70.5° F.; ternp.
of hand, 97°; temp, under tongue, 103°.
   R.—Continue medicine and diet.
   R.—Spirits of turpentine, 10 drops, four times a day.
   8th, 21  o'clock P. M.  Says that he feels very weak.  Tongue
moister and softer.  Pulse 96, feeble and watery; respirations, 16.
Temperature of atmosphere, 72.5° F.; temp, of hand, 97.25° ; temp.
under tongue, 102.5°.  Has  not had a  movement of  the  bowels
since the action of the calomel.
   R.—Phosphate of soda 3iij ; water fgv.  Dissolve, and administer
in two doses.  Continue tonics, stimulants, and nutritious diet.
   9th, 2 o'clock P. M. Complains of great weakness.   His sallow
complexion, anemic lips and gums, feeble pulse, and feeble forces,
demonstrate that  his  feelings  are founded  in  the  effects  of the
malarial poison.  Pulse, 92;  respirations, 16.  Temperature of at-
mosphere, 73° F.; temp, of hand, 86°; temp, under tongue, 103°.
The  hand in which the thermometer was placed  was carefully sur-
rounded with the non-conducting blanket.  Notwithstanding this
favorable arrangement for the accumulation and manifestation of ani-
mal heat, the thermometer during the period of one hour indicated a
temperature of 86°, which is twelve degrees below the normal stand-
ard.  The temperature of his trunk, on the other hand, is four degrees
above the  normal  standard and seventeen degrees above that of the
extremities. Here we  have a disturbance of the temperature ana-
logous to that of the well-marked chill of malarial fever, and  yet the
patient does not complain of trie sensation of cold, and there  is no
shivering of the muscles, and  the respiration is normal in frequency,
a,nd the violent action of the respiratory muscles characteristic of
a  well-marked  chill is absent.   The feeble pulse,  on the other
hand, attended with elevation of the temperature of the trunk and
depression of the  temperature of the extremities, corresponds with
the phenomena of a well-marked  chill, and indicates  deficient
circulation of  blood and arrest of chemical action  in the capil-
laries of the extremities, and,  at  the same  time, accumulation of
blood and increase  of chemical  change in the capillaries  and
bloodvessels of the large organs of the trunk.  The increased heat
of the  trunk during the cold stage may arise,  in part, from the
chemical changes  in the blood corpuscles, resulting in their destruc-
tion, and in the liver,  resulting in the alterations of its secretions
and nutritive fluids.  The heat thus  generated by the  destruction
of the blood-corpuscles, by the alterations of the other elements of 
MALARIAL FEVER.
349
the blood, and by the alterations of the secretions and nutritive
fluids of the liver, induced  by  the  presence  of  an extraneous
poisonous body, would be generated in the wrong position, and by
a wrong collocation, action, and reaction  of elements, and would, so
far from adding to  the forces, produce derangement and interfere
with the carefully-adjusted  balance of the forces.   It is  a well-
established  truth  in physiology that vital phenomena  are mani-
fested by matter having a definite chemical and physical constitu-
tion, and whatever alters  the  arrangement of the matter destroys
the essential conditions of the manifestation of the vital phenomena.
The study and investigation of man  should be, not what are  the
essences of the physical, chemical, and  vital forces, but what  are
the essential conditions and laws of their existence and  manifesta-
tion.
   Whilst the low temperature of the extremities, accompanied by
a feeble rapid pulse, is a very dangerous symptom, still  the condi-
tion of  the patient would  be much worse if the temperature of  the
trunk corresponded with  that of the extremities.  A definite tem-
perature of the trunk is absolutely essential to the maintenance of
life in man.   An elevation or depression of the  temperature of the
great organs of the  trunk, of only a few degrees, is attended with
death ;  because this fixed temperature is one of the essential condi-
tions for the conduction of those chemical processes  by which the
forces are generated; and by which, under the guidance of the vital
principle, poisonous compounds are removed and new matter ele-
vated into a state of force, and rendered suitable for the habitation of
the vital principle, by the action  of the forces of the sun through
the  apparatus of  the vegetable kingdom, is  introduced into  the
position of that chemically  altered  and removed;  and by which
that constitution of  matter is  preserved, which is indispensable for
the existence of the vital principle, and the manifestation  of vital
phenomena, by the correlation of the chemical and physical forces,
acting under the guidance of the vital principle, upon and  through
special  apparatus.   Whilst even a moderate elevation or  depression
of the  temperature of the great organs of the trunk is necessarily
attended by the generation  of abnormal compounds, or  by a com-
plete arrest of the chemical and physical and nervous actions;  the
elevation or depression, even to a great extent,  of the temperature
of the  extremities  is not, on  the other hand,  attended by such
serious consequences, because these parts of the body are destined
to act  as mere servants to the spiritual  nature,  as  mere organs of 
350
OBSERVATIONS ON
locomotion and mechanical action, and not as chemical laboratories
for the preparation of the nutritive elements, and of the matters
destined  for the development of the  forces.  Nevertheless, as the
forces which work the muscular system are developed by the chemi-
cal changes of the structures of the muscles, and of the compounds
and elements of the surrounding blood; and as the excitement and
transmission of the nervous force to the  muscular system is the
result of the chemical changes of the  elements of the nerves (and
probably of the muscles), it  is evident that a reduction  or eleva-
tion  to any great  extent, of the temperature  of the extremities,
must also, but in a much smaller degree,  interfere with the chemi-
cal changes going on in those muscles and with  the correlation of
the chemical, physical, and nervous forces.
  The  development  of the muscular  and nervous forces depends  upon
the constitution of the muscular and nervous apparatus, and a free sup-
ply of oxygen {the great agent  of chemical change), and of the nutritive
and force-generating elements of the blood.  In the case before us, the
muscular and nervous systems appear to be normal in constitution,
whilst  the blood and oxygen are wanting.
  To restore the action of the muscular and nervous systems, and
prevent the generation of noxious compounds  by the reduction of
temperature, we must restore the circulation of blood, and the dis-
tribution of oxygen.   Acting upon these  principles, I endeavored
to arouse the circulatory, respiratory,  and nervous systems, by
sinapisms.
  Applied large mustard plasters to the extremities.
  In ten minutes after the application of the mustard, the tempera-
ture  of his extremities had risen six degrees (from 86° to 92°), and
his pulse had become  fuller, and  increased eight beats  (from  92
to 100 beats).
  In half an hour after  the application of the mustards, the tem-
perature of the extremities had risen sixteen degrees, from 86° to
102°, and the pulse had increased 12 beats to the minute.  During
these changes the respiration  and the temperature of the trunk have
remained uniform.   The elevation  of  the temperature from 86° to
92°,  during the first  ten  minutes, was more rapid than the subse-
quent  elevation during the succeeding twenty minutes, from 92° to
102°.  After reaching this temperature, the thermometer  indicated
a stationary temperature both in the  hand and  under the tongue,
and at 8 o'clock P. M., five hours after these observations, the  pulse 
MALARIAL FEVER.                  351
was 94; respiration 16.   Temperature of atmosphere, 70° F.; temp.
of hand, 102°;  temp, under tongue, 103°.
  Here we see that although  the frequency of the pulse has been
reduced, and it has returned back to within two beats  of  what it
was when the temperature of the hand was only 86°, still the tem-
perature of the hand is 102°.  The pulse  has increased in volume,
and  hence the  increased elevation  of temperature is  due to the
increased circulation of blood.  It is evident that the action of the
mustard has not been evanescent.  The  following table will ex-
hibit in a clear light the changes induced by the revulsives.
	Before the application of the sinapisms.	10 minutes after the application of the sinapisms.	30 minutes after,5 hours after the the application application of of the sinapisms, the sinapisms.	
Pulse Respiration Temp, of atmosphere Temp, of hand . Temp, under tongue .	92 16 73° 86 103	100 16 73° 92 103	104 16 72° 102 103.2	94 16 71° 102 103
  The restoration of the circulation and chemical changes in the
capillaries of the extremities, was attended by a  subsidence of the
twitching of the tendons, by a disappearance, in a great measure,
of the feelings of exhaustion, by an increase of the secretions of the
mucous membrane of  the  mouth, tongue, and fauces, and by an
increase of muscular and nervous force.
  The patient says that the mustards have made him feel much
stronger.
  In this experiment the volatile, stimulant oil of mustard, has not
simply called forth the nervous  force existing in  the system, but
has produced a  permanent exaltation of the nervous and physical
forces.
  This was accomplished by the stimulant principle of the mustard,
and its distribution, by the bloodvessels, to  all  parts of the sym-
pathetic  and cerebro-spinal nervous systems.  The  action of the
heart was thus  increased, and the  absorption and distribution of
oxygen, promoted by an acceleration of the general  and capillary
circulation.
  Before the action of the stimulant, the chemical changes in the
capillaries of the extremities were slow and  small, because the cir-
culation in the capillaries of the extremities was sluggish, and the
amount of oyxgen and blood supplied to the muscles and nerves of
the extremities,  insufficient to sustain vigorous chemical changes.
  When the circulation was aroused, the chemical actions in the 
352
OBSERVATIONS ON
extremities were correspondingly increased, because the elements
of these changes were presented in  abundance, and with rapidity.
As the muscular and nervous forces depend upon chemical change,
the excitation of the chemical changes were necessarily attended by
an increase of muscular and nervous force.
  Thus, the increased supply and distribution of the elements of
chemical change, led to an increase  of nervous and  physical force,
and this nervous and physical force, in turn, led to a still farther
excitement of the machinery devoted to  the absorption and dis-
tribution of the oxygen, the  great  element  of  chemical change.
Hence, the excitement was permanent.
  R.—Carbonate of ammonia gr. x,  every  four hours.
  R.—Oil of turpentine "Ix, every  three  hours.  Continue stimu-
lants,  tonics, and nutritious diet.
  10th.  Much better.  Temperature of the extremities corresponds
with that of the trunk.
  Urine has a strong smell of turpentine.  Amount passed during
the last  eighteen hours, 12,168 grains; sp. gr. 1014.  Deep orange
color,  inclining  to red;  reaction decidedly acid.   Slight turbidity,
but no  deposit.  12,168 grs. of urine passed  during twenty-four
hours contained urea,  209.520 grs.;  uric acid,  12.60 grs.   1000
parts of urine contained urea, 17,212 ; uric acid, 1,035.
  4 o'clock  P. M.  Appetite good; tongue  moist.  Pulse, 100;
much  stronger than yesterday, before the application of the mus-
tards.   Eespiration,  16.   Temperature  of atmosphere, 69.5° F.;
temp,  of hand, 101.° ; temp, under tongue, 102.5°.
  Urine high colored,  reddish-brown; sp. gr., 1016; reaction de-
cidedly  acid,  clear, limpid.  Amount passed  during the last five
hours, 4,562 grs.
  R.—Continue.
  11th.  Continues to improve.  Is able to walk about the ward.
  E.—Citrate of  iron gr. ij ; sulph.  of quinia gr. iij.— Mix.  Ad-
minister three times a day.
  R.—Continue stimulants, tonics, and nutritious diet, oysters, soft
boiled eggs, milk punch, &c.
  17th.  Has continued  to improve, and is  now able to walk in the
hospital grounds.   He is still, however, pale, sallow, and  very weak.
Pulse  76, full and strong; perspiration, 14. Temperature of atmo-
sphere, 67° F.;  temp, of hand, 97.25°; temp, under  tongue, 100.°;
reaction of saliva very slightly acid.  During his sickness it has
been decidedly  acid. 
MALARIAL FEVER.
353
  I have  been informed, upon reliable authority, that one week
after the admission of this patient into the hospital, his captain
weighed anchor and sailed for New York.   The crew consisted of
the men whom he had compelled to sleep on board the vessel, lying
along the  low, marshy shore.  Several of the crew were unwell at
the time of sailing.  Before getting well out  to sea, the captain and
the whole crew were  taken sick.  In a few days there was not a
man with  strength to navigate the  ship.  Fortunately,  a small
vessel  perceived  their signals  of  distress, and  towed  them into
Darien.  Before reaching  this  port,  the captain and five out of
seven of the crew had  died.  There  were but two  remaining of
eight, and these were extremely ill.   The severity of the disease,
in this  case, resembles the  accounts of African  fever.  From  the
report of  this case, which came under our own observation, it is
evideut that any carelessness or neglect would have been attended
by a fatal termination.  Notwithstanding the administration of the
most active tonics, and of the most nutritious diet, this patient ex-
hibited for a great length of time the effects of the bilious remittent
fever, in his pale, sallow, anemic countenance, pale lips and gums,
and tottering gait.

  Case illustrating the Pulse, Respiration, and Animal Tempera-
    ture,  and the Effects of Purgatives, in Congestive Fever.
   American seaman;  height 5  feet 9 inches;  weight 160 pounds;
stout,  well  built; large  chest, brown hair, bronzed complexion,
bilious  temperament;  age 45. Has been in Savannah three weeks.
Was  taken with  a  chill  October 8, at 12 o'clock M., which lasted
one hour, and was followed by fever,  which  continued, without re-
mission, for eight hours.  On the 9th inst. (the next day) had no chill.
   October 10, 1857, 1J  o'clock P. M.  Entered  the  hospital  this
morning at 10 o'clock.   At 12 o'clock M. the chill came on.  The
chill was  well marked;  rapid, small pulse; rapid thoracic respira-
tion • shivering, quivering muscles; high temperature of the trunk,
and low temperature of the extremities.  The chill lasted one hour
and twenty  minutes.   Now (1£ o'clock P.  M.) the  shivering  has
ceased, and the circulation in the  capillaries is more vigorous,  and
the difference between the temperature of the trunk and extremities
less.  Pulse 130, full; respiration 46, thoracic.  Temperature of at-
mosphere, 68.5° F.; temp, of hand, 100°; temp, under tongue, 106°.
The difference of temperature between the  trunk and extremities 
354
OBSERVATIONS ON
shows that the relation between the general and capillary circula-
tions has not as yet been completely established.
  Tongue perfectly dry, and feels rough under the finger, like sand-
paper.  Those  portions which are not coated by yellow fur are of a
bright red color. Pressure over epigastric region causes some pain.
Has pain in his chest, and a very bad cough.  Says that he has
suffered with a cough  for one  month, and three weeks  ago "spit
blood."  Complains of "pain in his bones."  Has taken no medicine.
  R.—Calomel gr. xij; sulphate of quinia gr. vj.  Mix,  and admi-
nister immediately, and follow with castor oil in four hours.
  R.—Neutral mixture. As soon as fever remits, give gr. v of the
sulphate  of quinia every three hours, up to gr. xxv.
  8 o'clock P.  M.  Febrile  excitement is declining.  Skin in a good
perspiration.  Has no pain anywhere, and is  very comfortable.
  R.—Commence with sulphate of quinia immediately.
  11th, 11 o'clock  A.M.   Severe vomiting commenced  last night
at 11 o'clock P.M., and has  continued unchecked up  to 4 o'clock
A. M., when the nurse administered a mixture of milk, lime-water,
and acetate of morphia, which has in a great measure  checked the
vomiting.  Twenty-six grains of the sulphate of quinia  have been
administered since 8 o'clock P. M.; only eleven grains  have been
retained.   Says that the calomel and oil  operated powerfully, and
he was upon the night-chair almost the  whole  night.  The discharges
appear to have been serous fluid colored with bile. Says that he has
always been greatly affected  by cathartics; even the smallest doses
have produced violent  purgation, followed by great exhaustion.   I
was not  aware of  this  idiosyncrasy when the  medicine  was admi-
nistered.   Now his extremities  are covered with a cold, clammy
sweat, and  he  is completely exhausted.   During the action of the
medicine he was almost senseless from the great prostration conse-
quent upon the violent purgation and  vomiting.  Pulse, 94; respi-
ration, 22.  Temperature  of atmosphere, 71° F.;  temp, of hand,
79°; temp, under tongue, 97°.
  The temperature of the extremities is nineteen degrees below the
normal  standard, whilst the  temperature of the trunk is only two
degrees below that of health.  The pulse is accelerated  thirty-four
beats to  the minute;  the respiration is but slightly accelerated.
The temperature of the extremities and trunk does not correspond
to the increased action of  the circulation and respiration.
  This remarkable reduction of the temperature  of the extremities
and trunk is attended by a complete prostration  of the forces. 
                      malarial  fever.                  355

  The respiration is sufficiently rapid and full to introduce  large
quantities of the great element of change—oxygen; and the action
of the heart is sufficiently rapid, but not sufficiently powerful, to
distribute the elements of nutrition  and chemical change in the
capillaries of the extremities.   The pulse is feeble, and the circu-
lation  in the capillaries of the extremities exceedingly sluggish.
Here we have a condition of the extremities resembling that of a
well-marked chill.  The elevation of the temperature of the trunk,
and  the shivering and quivering of  the muscles, characteristic of
the well-marked  chill, however,  are  absent.  The temperature of
the trunk is absolutely lower than that of health, notwithstanding
the acceleration of the respiration and  circulation.  This disturb-
ance  of chemical action,  this disturbance of the physical forces,
this  prostration of the nervous and muscular systems, are, without
doubt, due to the simultaneous actions of the purgative and  mala-
rial poison.   Here we have an instance of vomiting and purgation
producing  such a disturbance of circulation, respiration, and che-
mical action, and such a prostration of the muscular and nervous
systems, that a simple case of intermittent fever is converted into
what is ordinarily called congestive fever.
  The phenomena of this patient,  during  the  febrile  excitement,
were such as warranted the administration of calomel.
  Administered stimulants and sulphate of quinia.  His  stomach
is so irritable  that it will not retain  these  medicines.   Sinapisms
have been applied to the extremities; bottles of hot water  applied
to feet and legs.  The mustards have been very slow in their action,
producing but little or no coloration of  the skin  after  the lapse of
half an hour.  They  remained  on for three-quarters  of  an  hour
before the skin was decidedly reddened.  After  the action of the
mustards for three-quarters of an hour, the temperature of his  hand
is 88°, and that under the tongue 97.75°.  The temperature of the
extremities  has risen nine degrees, whilst that of the  trunk has
risen only three-fourths of a  degree.  The action of the stimulant
principle of the mustard  has  been  to excite the general and  capil-
lary circulation, through  the  sympathetic  nervous system.  This
excitement  has been attended by a more rapid distribution of the
elements of nutrition and chemical change.  These increased chemi-
cal changes  have been attended by an increased  generation of the
physical, muscular, and nervous forces.   The increase of chemical
change, and the increase of physical force, are attended  by a rectifi-
cation of the aberrated phenomena of  the sympathetic and cerebro- 
356                  OBSERVATIONS ON

spinal  nervous systems.  The restlessness, the feeling of complete
exhaustion and prostration,  and the  vomiting,  have in a great
measure disappeared.  The stomach is now able to retain stimu-
lants and sulphate of quinia.
  R.—Continue sulphate of quinia gr.  v, every three hours, up to
gr. xl.   If the stomach  rejects  the  sulphate of quinia, administer
ten grains by the rectum, combined with starch and tincture of
opium, every  three hours.  Continue  stimulants and  infusion of
Virginia snakeroot.
  Urine of a brownish-red color; sp. gr. 1014; reaction decidedly
acid, even after standing forty-eight hours.  When treated  with
hydrochloric acid, the urine was changed to an almost black color.
After standing forty-eight hours there  was no deposit.  Uric acid
in 1000 parts of urine, 0.0197.   It  was impossible, on account of
the severe purgation, to  determine the  whole amount of  urine ex-
creted.
  12th, 12 o'clock M.  Says that he rested well during the night,
and feels better, but is still very weak.   Has vomited three times
this morning.   The cold, clammy feeling  of  his skin has disap-
peared, and  the patient appears to be decidedly better.   Tongue
red at tip, and pointed ;  papilla? enlarged and distinct.  Pulse 100,
much fuller and stronger than during  the  state of prostration.
Respirations 30,  quick,  but  gentle; does not resemble the full,
labored, thoracic respiration  of many cases  of  congestive fever.
Temperature of atmosphere, 74° F.; temp, of hand, 100.75°; temp.
under  tongue,  101.20°.   This  observation demonstrates that the
increased  distribution of blood and oxygen has been attended by
a decided  elevation of temperature.  Whenever  there is an imper-
fect capillary circulation, whenever there is a deficiency of the ele-
ments of nutrition and  chemical change, then will we  have feeble
forces and aberration of muscular and nervous action. The tempe-
rature, the muscular force and the nervous force, depend absolutely
upon the chemical changes of the elements of the living organism,
which have been elevated into a state of force, by the action of the
forces of the sun  upon special apparatus, or rather upon a great
laboratory, the vegetable kingdom.
  The rapidity of the chemical changes, which develop the forces
of the  machinery, depends first, upon the supply and distribution
of materials  capable of entering into the constitution of the organs
tissues, and apparatus; secondly, upon  the supply and distribution
of materials capable of undergoing chemical change,  within  and 
MALARIAL FEVER.
357
around  the  machinery, and thus generate the forces in positions
advantageous for their application ;  thirdly, upon the replacement
of the chemically altered  matter which once  formed part of the
apparatus (machinery), by new matter;  fourthly, upon the removal
of the products of chemical change, which derange chemical action,
first, by occupying positions in the apparatus which should.be oc-
cupied by matter in a state of force, and not  by matter which has
lost the amount of force originally received from the sun; secondly,
by inducing chemical changes in the wrong position in parts of the
organism, where the forces resulting from these chemical changes
cannot be applied; and, thirdly, by  a direct  poisonous  effect upon
the organs,  tissues, and apparatus, especially upon the nervous sys-
tem, which  keeps up  a communication between all  parts of the
system, and controls,  in a  great  measure, the distribution of the
elements  of nutrition and  chemical change, by  controlling the
action of the respiratory and circulatory apparatus.
   The supply  and distribution of the  materials of nutrition and
chemical  change depend, first, upon the perfection and action of
the vegetable  apparatus, and secondly, upon the  perfection and
action of the animal digestive, circulatory, and respiratory appa-
ratus, related and co-ordinated by the nervous system.
   The  study of the  animal  kingdom,  as a whole,  demonstrates
that the perfection and action of the respiratory  and  circulatory
systems may be taken as an index of, nut only the  physical and
chemical  changes of the organized fluids and solids, but also of the
development and perfection of the  organs, and tissues, and appa-
ratus, and of the activity and  intelligence of  animals.  The action
of the respiratory and circulatory apparatus, and the co-ordination of
this action  with the action and wants of the muscular and  nervous
systems, and of all these  organs, and tissues, and apparatus, are
guided by the  nervous system in which a special force is generated;
excited and guided by nervous force, but not carried on by nervous
force, independent of chemical  change.  Chemical change in the
organs and apparatus, and  chemical change in the  nervous system,
is the source not only of heat, but of muscular and nervous force,
and of all the forces generated in the animal economy.
   The generation of any force—vital, nervous, chemical, or physical—in
 the animal  economy, independent of antecedent force, would destroy the
great law upon which the stability of the universe rests,  that force is inde-
structible—would destroy the great law that action and reaction are equal.
   All the forces in the animal economy are generated by chemical 
358
OBSERVATIONS  ON
 action.   The  various  organs and  apparatus are simply  arrange-
 ments for the  preparation of materials suitable for chemical change,
 and for the application of the forces generated by chemical change.
   According to this view, the action of the vital force, like that  of the in-
 telligence, is limited to a guidance and direction of the forces with which
 the Creator has endowed all matter.  The action of the vital principle
 upon matter,  like that of the intelligence, does not consist, either
 in a creation of matter or in a direct movement of matter, independent of
 the forces of matter, but in the mere guidance  and application, of the
 forces of matter, so that definite forms are developed from  formless
 matter,  and definite results accomplished.
   Accordiny to this view, the vital principle and the  intelligence, cannot
 create force, any more than they can create matter.   Their influence is
 limited  to an excitement and application of the forces of matter.
   We judge of  the influence of one just as we judge of the influ-
 ence of  the other.  The complicated machine points to the exist-
 ence of  an  intelligence distinct from matter, which  has  so applied
 the forces of one portion of matter, that another  portion has been
 moulded into definite shapes and formed into definite  apparatus,
 capable of accomplishing definite results when acted upon by forces
 generated and applied in the right manner.  We infer the existence
 of the intellect by the results  of its application of the forces of
 matter.   In precisely  the same manner do we infer the existence
 of the vital principle.  The vital principle directs the forces, result-
 ing from the  chemical changes of one part of  matter,  in such a
 manner  that surrounding matter is fashioned, moulded into defi-
 nite forms  and apparatus, destined to accomplish definite results.
 This apparatus cannot be worked by the vital principle, independ-
 ent  of chemical change, any more  than a watch  will run, or any
 machine will accomplish various mechanical  effects,  without a sup-
 ply  of  exterior  force, or a steam  engine accomplish mechanical
 effects, without the  development of force by the  chemical  changes
 of matter, which has been elevated  into a state of force  (placed in
 a state  capable of undergoing chemical change) by the forces of
 the sun.
  The development and structure  of the vegetable kingdom, the
 development and structure and actions  of the most simply con-
 structed animals, the  appearance of the nervous system in the
 animal  kingdom  and  in the foetus of the higher animals subse-
 quently  to  the grouping of the atoms  of  formless matter  into
 definite   forms and  apparatus, before the formation of nerve-cells
and  nervous  systems,  demonstrate  unequivocally,  conclusively, 
MALARIAL FEVER.                   359
and absolutely,  that development,  nutrition and  the  direction of
the forces of one part of matter, to  the fashioning  of another part,
are under the  guidance of the vital principle; demonstrate une-
quivocally, conclusively, and absolutely, that the  nervous system
itself is developed and its perfection maintained under the guidance
of the vital principle.  The nervous system  is the last and  best
work of the forces of matter  directed  by  the vital force,  and is
destined  to connect together and influence  the various organs and
apparatus, and  is destined to regulate secretion and  excretion, and
the consequent development of force; and is destined to excite and
control the actions of the dynamic  muscular apparatus, not by the
possession and  emission of  a peculiar force generated de novo,  but
rather by a modification of physical force generated by the mutual
chemical reactions of the elements of the blood and nervous system.
The truth of this  proposition  is conclusively  demonstrated  by the
fact that an arrest of chemical action is immediately attended by an
arrest of nervous and muscular force.
   During the last twenty-four hours, has  taken  and  retained  25
grs. of the  sulphate  of quinia.  R.—Continue stimulants.  Diet,
wine whey and arrowroot.
   Urine orange-colored ; sp. gr. 1020 ; reaction decidedly acid, and
remained so longer than sixty hours.  After standing fifty hours
there was a slight deposit of epithelial cells, mucous corpuscles and
cylindrical casts of the tubuli uriniferi.  Amount of urine collected
during the last twenty-four hours,  6120 grs.  The patient affirms
that this was the whole amount passed during the last twenty-four
hours.  When  the urine wras  evaporated to  the  consistence of a
syrup  and treated with nitric acid, there was a powerful efferves-
cence, and the  urine  assumed  a dirty-brownish yellow color, and
the nitrate of urea presented a  brownish-black Color, and imperfect
crystallization.   When  the urine was concentrated by  evaporation
it  assumed a brownish-black  color.  When  the  unconcentrated
urine  was  treated with  hydrochloric  acid,  it assumed a dark-
mahogany,  almost black color.  The solid matters of the urine
appeared to consist principally of the coloring matters.
	6120 grains of urine, collected during 21 hours, contained	1000 parts of urine contained
Fixed saline constituents	Grains. 41.960 0.060 43.S<;0	6.822 0.009 7.156
 
360
OBSERVATIONS ON
   This examination of the urine shows that during the reduction of the
temperature of the body and exhaustion of  the forces,  the urine was
excreted in  less amount, and altered in quality.  Here we  have a demon-
stration of  the previous propositions,  that animal temperature and mus-
cular and nervous force are the results of chemical change, and that the
reduction of temperature is attended by the generation of chemical com-
pounds different from  those of health, and that the malarial poison acts
by inducing chemical changes  in the elements of the blood and organs,
different from the chemical changes of health.
   The fact that the chemical changes of the nutritive and force elements
in the capillaries of the muscles and  nerves and bones of  the extremities
and surface of the trunk and head  were very small, and the fact that the
blood was congested in the bloodvessels of the trunk, render it probable
that the peculiar coloring matter of the urine was derived from the dis-
integrated blood-corpuscles.
   8 o'clock P. M.  Says  that  he feels very weak.  Has been vo-
miting  bile.  Three  hours ago six cut cups were applied over the
epigastric  region, without  any  arrest of the  vomiting.  Tongue
very red at tip, and the surface is dry and  rough, like sand-paper.
The patient appears to be completely prostrated.  Pulse 104.
   R.—Apply a blister, six iuches by six inches, immediately over the
epigastric region, and as soon as it blisters, if the vomiting is not ar-
rested, remove the cuticle, and  sprinkle over the raw surface one
grain of the acetate of morphia.  Stop all stimulants and adminis-
ter internally small fragments  of ice and milk and  lime-water and
acetate of  morphia.
   Urine, orange colored ; sp. gr.  1016.   Amount passed during
the last eight hours, 10,160 grs.;  calculated  amount of urine  for
twenty-four  hours, 30,480 grs.;  reaction decidedly acid.  Here we
have a decided increase of the urine..
   13th, 1 o'clock P. M.  Says that  he feels  much  better.  Pulse  86,
fuller and  stronger;  respirations 28.  Temperature of atmosphere,
76° F.; temp, of hand, 91° ;  temp,  under tongue, 98.5.  Surface of
the body in a profuse perspiration, which feels  cold  to the hand.
The temperature of the extremities  does not correspond with the
increased circulation  and respiration.   The  blister has drawn well,
and the serum is of a light-yellow color, and  not the golden color
of many cases of remittent and congestive fever.  The blister and
the acetate of morphia and ice have completely arrested the obsti-
nate and violent vomiting. 
MALARIAL FEVER.
361
  R.—Sulphate  of quinia  gr. xv;  tincture  of  opium  "Ixx:
starch f siv.   Mix  and administer immediately as an  enema, and
repeat in the course of four hours.  Diet, arrowroot and chicken
soup.
  Amount of urine passed during the last fifteen hours 8112 grs.
Color only a shade darker than normal; sp. gr. 1014; reaction de-
cidedly  acid after standing thirty hours.  No deposit after standing
thirty hours.
	8112 grains of urine, excreted during 15 hours, contained	12,979 grains of urine, calculated for 21 hours, contained	1000 parts of urine contained
Urea..... Uric acid .... Fixed saline constituents	Grains. 159.080 2.000 16.800	Grains. 254.528 3.200 26.880	19.594 0.256 2.071
   During the last three days the patient  has been able to retain
little or no nourishment, so that this is the urine of starvation.
   14th, 11 o'clock A. M. Much better; dressed and walking about
the ward.   Pulse 72, full and  strong;  respirations, 22.   Tempera-
ture of atmosphere, 78.5° F.;  temp, of hand, 96.75°; temp, under
tongue, 98°.  Skin feels normal.  The cold, clammy sweat has dis-
appeared.   Tongue  clean, but redder than normal.  Although the
vomiting has almost  entirely disappeared, still  the  stomach  is
unable to retain  the sulphate of quinia.
   R.—Eepeat the enema of sulph. of quinia. Diet, wine whey, soft
boiled eggs, and  arrowroot.
   15th. Continues to improve.   Pulse, 64; respirations, 24.  Tem-
perature of atmosphere, 74° F.; temp, of hand, 97.75° ; temp, under
tongue, 98.33°.   Tongue still  quite red, but moist and soft.   The
amount of urine has greatly increased.   During  the last twenty
hours  has passed 30,360 grains of light-yellow urine, which rapidly
changes from the acid to the alkaline reaction, and lets fall a yellow
deposit.
     Sp. gr. of the  urine passed during the night  .   .   .  1010 grs.
        «       "         this morning  ....  1014
     Amount of uric acid passed during the last 10 hours   .    28
   This is at the rate of sixty-seven grains of uric acid during the twenty-
four hours.  This examination confirms the  statement previously made
and substantiated in  former cases, that, as a general rule, the uric acid
is either normal in amount or diminished in the active stages of malarial
fever, and increases during convalescence.  As in the present case, this
       24 
362
OBSERVATIONS  ON
increase of the uric acid may take place even whilst the patient is under
the influence of sulphate of quinia.
  R.—Infusion of Virginia snakeroot and sulph. of quinia.   Diet,
oyster soup, wine whey, and arrowroot.
  16th, 1 o'clock P.M.  Still very weak, but continues to improve.
Tongue not so red, moister and softer.  Eeaction of saliva alkaline;
up to this time it has been decidedly acid.  Pulse, 56; respirations,
22.   Temperature  of atmosphere, 71.5° F.;  temp, of hand,  96°;
temp, under tongue,  98.75°.
  Urine,  light straw colored; becomes alkaline and throws down a
light-yellow deposit,  after standing a few hours.   Amount passed
during the  last twenty-four hours, 29,000 grains; sp. gr. of the
urine passed  during the evening and  night, 1010; sp. gr. of the
urine passed this morning, 1005;  1000  parts of the  urine passed
this morning contained, urea 8.686; uric acid, a trace, a few small
crystals;  fixed saline constituents, 1.990.   This  examination shows
that the elimination of uric acid  has ceased in the course of a few
hours.
  17th. Has been walking about the hospital grounds. Pulse, 60 ;
respirations, 26.  Temperature of atmosphere, 64° F.; temp.ofhand,
94.75°; temp, under  tongue, 99°.   The  exercise will account for
the acceleration of the pulse and  respiration, and the free exposure
of the hands to the cool morning air will account for the  slight
diminution of temperature.  Eeaction of saliva, acid.  The acidity,
however, was not so intense as in  the paroxysms.  Yesterday the
reaction  of the saliva was  alkaline.  During the  active  stages of
malarial  fever the saliva, according to  my observations, is always
decidedly acid, whilst during convalescence it is generally alkaline,
but may  vary from  alkaline to slightly acid.  This change in the
intensity  of the acidity of the saliva corresponds, in a  general way,
with the  diminution  of acid in the  urine.
  R.—Quassia and soda.  Full, nutritious diet.
  Amount of urine passed during the last twenty-four hours, 21,000
grains; urine passed during the last afternoon, evening, and night,
orange-colored; sp. gr., 1014.  After standing a few  hours the re-
action changed  from the acid  to the alkaline, and a  heavy, light-
yellow deposit was thrown down.  Urine passed this morning of
a light straw  color; sp. gr., 1004.
  19th. Says that he feels as well as he ever did in his life.   Has
been walking about  the hospital grounds.  Pulse, 60; respirations,
24.  Tongue, skin, and temperature normal. Blister almost entirely 
MALARIAL  FEVER.
363
healed.  This  patient had no  return of fever, and was discharged
from the hospital a few days after this observation.


Case illustrating the Effects of Purgatives in Malarial Fever—
  the Relations of  the Pulse, Respiration and Temperature of
  Trunk and Extremities in Congestive Fever—the Formation of
  Heart Clots in  the Latter Stages of Congestive Fever.   The
  Chemical Constitution of the Urine.  The Chemical and Physi-
  cal and Pathological Changes of the Organs.

  Irishman, age 28,  height 5 feet 7 inches, weight 140 lbs.;  dark
brown hair, brown  eyes, dark complexion.   Has been in Savannah
nine months.  Engineer on  steam-tug running up  and down the
Savannah Eiver.   One  month ago was discharged from the steam-
tug, and commenced "day labor," along the wharves, and at the
saw-mill.  Habits intemperate.  Has been sick one week.  Says that
" three days ago he took a large dose of castor oil, which  operated
ten times.  On the following day took three blue pills, and yester-
day took another dose of castor oil, which has been operating  up to
the present time."
  August 24th, 1857,1 o'clock P.M.  Has just entered the hospital.
Skin cool.   Tongue coated with yellow fur.  Pulse 120.  Complains
of great weakness.  R.—Sulphate of quinia gr. xv; infusion of Vir-
ginia snakeroot f3xvj.—Mix.  flij every two hours.  Diet, gruel.
  25tb, 12 o'clock M.  Complains of great pain in his back.   Sur-
face of trunk and extremities  cool.  Tongue dry at  tip and centre,
and coated with yellow  fur.  No tenderness upon pressure of
epigastrium.  Bowels loose.
  R._Stop sulph. of quinia and infusion of Virginia snakeroot.
R.__Calomel gr. xij ; James's  powder (pulvis antimonii compositus)
gr.  xxij; mix and divide  into six powders.  Administer one pow-
der every three hours.    If the extremities continue cool, apply
mustards
  26th, 12 o'clock  M.  During  the  afternoon of  yesterday was
very  feeble, and at one  time was almost pulseless.  The nurse
administered brandy.  This induced reaction.  Now skin of trunk
and extremities cool  and moist.   Complexion pale, sallow; lips and
gums very pale.   Tongue coated with yellow fur, and dry at tip.
Pulse small and weak—so feeble that it is with di'Ticulty that it can
be  felt at all.   Pulse, 120 ; respiration, 22.   Temperature of hand,
95.5° F. 
364
OBSERVATIONS  ON
  R.—Burnt brandy and infusion of Virginia snakeroot.  Apply
sinapisms to extremities.  Diet, arrowroot and brandy.
  8 o'clock P. M.  Pulse a little stronger, but still very weak,  112.
Surface of trunk and extremities  warmer.   Tongue cleaning off
towards  the  tip; the  clean portion is  very red, dry, and  glazed.
Has no pain, and rests quietly.  Appears to'be very  weak.
  R.—Continue brandy and infusion of Virginia snakeroot.
  27th, 12  o'clock  M.   Pulse 120, larger  in  volume, but  still
very  feeble,  and with.difficulty counted;  respiration,  24.   Skin
a little warmer.  Temperature of atmosphere, 87.5° F.; temp, of
hand, 98°; temp, under  tongue, 98.5°.   There is a  great want  of
co-ordination between the actions of the circulatory and respiratory
systems.   Says that  he is very weak.  His  appearance is  that  of
complete exhaustion.  Superior portion of tongue coated with dry
yellow fur.  A lozenge-shaped space of the surface of the tongue,
extending for one inch from the tip to the centre, is clean and  of a
brilliant red color.   Teeth coated with sordes.  Hands and tongue
tremulous.  Says that he feels very weak. Has no pain anywhere,
and lies quiet.
  R.—Stop the calomel and James's powder.  R.—Sulph. of quinia
gr. ij, every two hours, up to gr.xv.  Continue brandy and infusion
of snakeroot.
  Urine orange colored,  several shades  higher than  in health, but
much less highly, colored than usual in severe cases of malarial
fever.   Eeaction slightly acid, sp. gr. 1009, contained as usual  in
uncomplicated cases of malarial fever, no albumen, and no grape sugar.
Amount of urine collected during the last twenty-four hours, grs.
16,144.   The nurse  states that this is the whole amount that has
been passed.
16,141 grains of urine, ,„„„   .  ,
excretid in 24 hours, 100° Partts.of ,unne
    contained        contained
Water.....
Solid matters ....
Urea   .....
Uric acid    ....

Extractive and coloring matters
Fixed saline constituents
Grains.	
15,745.336	975.306
398.664	24.674
170.610	10.499
trace, scarcely	a trace
visible	
203.683	12.560
24.161	1.496
  7 o'clock P. M.  Much worse.  Pulse 140, feeble;  respiration 40,
labored, panting.  Extremities feel cold.  Temperature of hand, 90°.
Eestless, groans and  sighs frequently.   Inclined  to stupor.  Intel- 
MALARIAL FEVER.
365
lect sluggish; when aroused appears to be sensible, but  articulates
with great difficulty.  The heart  appears merely to flutter; the
sounds  are so rapid and feeble that they are counted with difficulty.
The circulation in the capillaries is  sluggish and feeble.  The tem-
perature, the index of the chemical changes of the elements of the
solids and fluids, is below the normal standard, and does not corres-
pond with  the frequency of the circulation and respiration.  No
pain upon  pressure of  epigastrium.  Asks for water continually,
and complains of much thirst.  The nurse has just raised him up
to administer brandy; he groans  and  tosses about the bed, and
makes several ineffectual efforts  to rise;  in  a few moments he is
quiet and apparently asleep.
   This patient died thirty minutes after this observation.

              AUTOPSY twelve hours after death.
   Exterior.—Body muscular, with well-developed limbs and promi-
nent chest;  trunk and limbs round, and not emaciated.   Adipose
matter  not  wasted.  Color of muscles when the integument was
removed, red and normal.  Color of the skin of  the superior  parts
of the corpse, pale, bloodless; color of the skin of the inferior  parts
of the corpse, of a dark purple.  This dark purple color gradually
diminished towards the superior parts of the body, and appeared
to have been due to the gradual settling of the blood in the capil-
laries of the most  dependent  parts towards the close of life, when
the general and capillary circulations were feeble.  Lips and gums
very pale, almost white.   Teeth loaded with sordes.
   Head.—Dura mater unusually thick and firm, and adherent in
several  places to the arachnoid membrane.   The thickening of the
dura mater and the adhesions were  of long standing,  and were not
connected with this attack of malarial  fever.  Bloodvessels of the
dura mater filled  with blood.
   Arachnoid membrane  opalescent, pearl colored, and in  many
places  adherent  to the pia mater.  These adhesions,  like those
between the dura mater and arachnoid  membrane, were apparently
of long standing.   Between the arachnoid membrane and pia mater,
bloody serum was effused, thus imparting to these membranes (es-
pecially the inferior portions  from the gravitation of the  blood) a
red appearance.
   Bloodvessels of pia mater were  filled with blood.  The blood-
vessels  of those portions  of the pia mater  which extended into
the  ventricles  of  the  brain,  were also  engorged  with blood. 
366
OBSERVATIONS ON
The  ventricles  of  the  brain  contained a small quantity of clear
serum.
  Structure of cerebrum appeared to be softer than normal. This
softening  may  have been the result of  partial decomposition.
Bloodvessels in the substance of the brain, distinct, and more  en-
gorged with blood than usual.
  Structure of cerebellum, medulla oblongata and superior portion
of spinal cord,  appeared  to  be  normal.    Bloodvessels of spinal
cord appeared to be more congested with blood than usual.
   Chest.—Heart  normal  in structure; contained  several clots of
blood, which from their ragged appearance, light-yellow color,  and
freedom  from  colored  blood-corpuscles, must have been  formed
before death.  Long, fibrous  coagula  were  found  in the aorta  and
vena cava.
   Lungs.—Old adhesions in several places, numerous small tubercles
were scattered throughout the tissues of the lungs.  The tubercles did
not appear to have suppurated.   During his sickness this  patient
showed no signs, either in appearance or in action, of the existence
of these tubercles.
   Superior portions of the lungs (leaving out of view the tubercles)
were normal in color and density.  The inferior portions were en-
gorged  with blood, and the most dependent portions were almost
black from the great engorgement of the  bloodvessels and capil-
laries, and when cut resembled in  appearance  and density portions
 of liver.   The accumulation of blood in the lower portions of the
lungs was due to  the action  of gravity, during the feeble state  of
 the circulation previous  to death.  The chemical changes of the
 elements of the blood  and organs  and tissues  had been greatly di-
 minished,  previously to death; the physical forces resulting  from
 these chemical changes which propelled the circulatory apparatus,
 and worked all the machinery, were correspondingly diminishedj
 and the blood gradually obeyed the physical law  of gravity, which
 although constantly acting during health, was counterbalanced by
 the physical forces developed by the chemical changes of  the ele-
 ments of the organism.
   Abdomen.—Liver normal in size, and of a slate color externally,
 and  of a  dark bronze color internally.   Substance firm.  "When
 pressed, the dark  yellow, greenish bile flowed out in  small quanti-
 ties  from  the  cut ends of the hepatic ducts.  Bloodvessels of the
 liver appeared to  contain more than the normal quantity of blood.
 Blood  of  liver dark  purplish-brown, and did not change to the 
MALARIAL  FEVER.
367
arterial hue when exposed to the action of the oxygen of the atmo-
sphere.
  The liver contained animal starch, but no hepatic sugar.
  Under the microscope the cells of the liver appeared  normal,
with the exception that many of them contained more oil-globules
than usual.
  The gall-bladder was filled with bile, which was of a dark brown-
ish-green when seen  in mass, and of a gamboge color  when viewed
in thin layers.  The surface of the gall-bladder was of this gamboge
color, from the endosmosis of the bile, probably after death.
  Spleen enlarged; color  dark slate, two shades darker than  the
liver.  Tissues of spleen softened; partially disorganized.   When
the organ was pressed gently between  the  fingers it was  evident
that the tissues gave way.
  Mud of spleen of a dark purplish-brown color.  This dark color
was not altered, notwithstanding that it was exposed to the action
of the atmosphere for twenty-four hours.  When first removed, the
mud  of the spleen coagulated  slightly.   The  coagulum, however,
possessed  no consistency, and was readily  dissolved.  When  the
mud  of the  spleen  (pulp and  extravasated blood) was examined
under the microscope, it was found to consist of colored and color-
less blood-corpuscles and  numerous  granules of a black color.
These black  granules  were frequently  conglomerated together,
forming dark flakes  like the  coffee-ground  sediment  of the black
vomit of yellow fever.  Many of the colored  corpuscles appeared
to  be swollen.   The colorless corpuscles  appeared  to be  more
numerous than normal.
  Alimentary  Canal.—Stomach contained no fluid  or gas; blood-
vessels upon the exterior filled with blood.   Mucous  membrane of
stomach of a dark purplish color.  The color of the mucous mem-
brane was not uniform; it was  much deeper in some  spots than in
others, thus presenting a mottled appearance.
  The compound muciparous follicles (Brunner's  glands) of  the
stomach and duodenum were prominent and enlarged.
  Bloodvessels of the superior and inferior portions of the intestinal
canal appeared to be more engorged with blood than those of  the
middle portions.  The mucous membrane of the small intestine was
covered by a  layer of mucus and fecal matter, colored yellow by
the bile.
  The solitary  glands  in  the  inferior portion of the ileum,  and 
368
OBSERVATIONS  ON
especially in  the  region of the ileo-csecal valve, were enlarged and
distinct.
  The glands of Peyer were distinct, but not enlarged or inflamed.
  The serous membrane of the intestines bore the marks of an old
inflammation. The serous membrane was thickened, and organized
bands of coagulable lymph in many places  bound  the large  and
small intestines together and to the walls of  the abdominal cavity.
This inflammation  had nothing whatever to do with the present
attack.
  Kidneys normal in size and structure.  Blood had settled in the
vessels and capillaries of the inferior dependent portions.  Color of
superior portions of kidneys normal; color of inferior dependent portions
almost as dark as  the slate-colored liver.
  The bloodvessels and capillaries of the cellular tissue of the pos-
terior dependent  walls of the abdominal cavity were  engorged with
blood, whilst those of the upper  anterior and  lateral  walls were
almost devoid of blood.  This was due to  the action of gravity
upon the enfeebled circulation.
  The facts which we have presented  show  that the capillary cir-
culation  had been greatly  enfeebled  in  every organ  and  tissue
previous to  death, and the blood necessarily accumulated in the
most dependent bloodvessels and capillaries.   This view is  farther
confirmed by the fact that the vena cava contained but  little blood.
  The bladder contained 5000 grains of light-colored urine.
  Eeaction acid;  sp. gr., 1008.7.
  After standing forty-eight hours no deposit  was thrown down.
This was also true of the former specimen of urine.
	5000 grains of urine contained	1000 parts of urine contained
Extractive and coloring matters Fixed saline constituents	Grains. 4863.140 136.860 38.945 0.240 88.005 9.120	972.628 27.372 7.789 0.048 17.601 1.824
                          CONCLUSIONS.
  (1.) The slate-colored liver,  the  dark greenish-brown bile, the
absence of grape sugar and the  presence of animal starch in the
liver—the  slate-colored,  enlarged, engorged, softened spleen—de-
monstrated that this was a case of malarial fever. 
MALARIAL FEVER.
369
  (2.) The rapid and feeble action of the heart; the rapid and feeble
pulse;  the depressed temperature  of the  trunk and extremities;
the dry, red tongue; the complete exhaustion of the muscular and
nervous force;  the acid, light-colored urine; the feeble general and
capillary circulation, gradually overcome by the action of gravity;
the gradual  settling of the blood previous to  death in the blood-
vessels of the most  dependent parts of all the organs and tissues;
the alterations of the blood-corpuscles of the liver and spleen;  the
alterations in the color  and constitution of the bile; the destruction
of the special ferment  in the blood which converted  the animal
starch  into  grape sugar—demonstrated that the malarial poison
had not only interfered with the action of the cerebro-spinal sys-
tem, but had also affected the sympathetic  system, and produced
profound alterations in  the structure of the nutritive fluids, and cor-
respondingly interfered with the chemical changes, the development
of the forces, and the formation of the secretions and excretions.
   (3.)  The rapid exhaustion of the forces was, without doubt, due,
in  a great  measure, to the severe purgation to which this patient
had been subjected previous to his entrance  into the hospital,  and
to his  previous intemperate habits, and to the presence of tubercles
in the lungs. The administration of large  doses of purgative medi-
cines (castor oil and blue pill), without any sulphate of quinia,  and
without any stimulants,  converted an ordinary case  of  malarial
fever into a congestive malarial fever.   The term congestive, as
applied to this case, means nothing more than a state of exhaustion,
inability  to resist the  action  of the  malarial poison, inability to
react.
   (4.)  The  plan of treatment in this  case  was correct in principle,
but radically deficient  in energy.   Stimulants were  administered,
but not in sufficient quantities.  Sinapisms were used, but not often
enough, nor large enough, nor long  enough.  Sulphate  of quinia
was administered, but too infrequently and in too small doses to be
efficient, and much valuable  time was wasted.  This case demanded
prompt and vigorous action.  Large doses of the sulphate of quinia
and the most diffusible and powerful stimulants should have been
promptly and frequently  administered, and the extremities should
have been repeatedly covered with sinapisms. 
370
OBSERVATIONS ON
Case illustrating the Action of Purgatives in Malarial Fever.
  Principles  which should govern the Administration of Purga-
  tives in Malarial Fever.

  English seaman; height 5 feet 7|  inches; weight 145  pounds;
black hair, brown eyes, dark complexion; age 46;  well-built, mus-
cular man.  First  trip to  Savannah.  Has  been in this port three
weeks, and during this time has slept on board ship.
  October 13, 1857, 11 o'clock A.M.  Says that he was taken sick
two days ago, with pain in his head and bones, and loss of appetite.
Last night, between 8 and 9 o'clock P. M., had a chill, which lasted
for one hour, and was succeeded by fever, which remitted this morn-
ing with  a profuse perspiration.   Tongue pale and clean.  Bowels
have not been moved for three days.
  R.—Calomel  gr. xij; sulphate of quinia gr.  vj.—Mix.   Admi-
nister immediately, and follow with  castor oil in four  hours.  As
soonas the  medicine has  operated once, give gr. v of the sulphate
of quinia every three hours, up to gr.  xx.
  13th, 11 o'clock A.M. The medicine operated freely.  Has taken
twenty-six grains of the sulphate of quinia.   The patient  is weak
and stupid.   Pays no attention  to inquiries, even when the voice
is greatly elevated.   When aroused by violent shaking,  answers
incoherently, and in a few moments relapses into a stupor.  Great
tenderness upon pressure of epigastric region; pressure here arouses
him, and he cries  out.  Pulse 120, very feeble;  so feeble that it is
with difficulty that it can be felt, and with still greater difficulty
that its number of beats to the minute can be ascertained;  respira-
tion 40, thoracic, labored.   Tongue coated with yellow fur, moist,
and soft.   Skin warm and moist; in a perspiration.
  Administered  f.?ij of a mixture of equal parts of brandy and
infusion of Virginia  snakeroot.  As soon as the fluids  entered the
stomach they were ejected again, with great violence, over the table
and the  neighboring  bed.   The  brandy and infusion of snakeroot
had mingled with the contents of the stomach, and were of a green
color.  The  act of vomiting was performed, apparently, without
any effort.  There was no retching  previous to the ejection of the
fluids.  They came up in a stream.
  R.—Mustards  to extremities and interior surface of  thighs and
a blister six inches by five over the epigastric region.
  R.—Lime-water f3ij; milk fsij; solution of acetate  of  morphia 
MALARIAL FEVER.                  371
f5j — Mix.  Administer immediately, and repeat every half hour
until his stomach is settled.  As soon as the stomach will retain
this mixture, administer sulphate of  quinia, brandy, and infusion
of Virginia snakeroot, freely.
  8 o'clock P. M. More sensible than this morning, but weak and
restless.   Breathing not so  accelerated  and labored.   Pulse 120,
still very feeble.   Blister is drawing.
  R.—Sulphate of quinia gr. v every three hours, up to gr. xxx.
  If his stomach rejects this, give the following injection:—
  R.—Sulphate of quinia  gr. x; starch f 3ij;  tincture of opium
"Ixv.—Mix.  Eepeat every three hours  until forty grains of the
sulphate of quinia have been administered.  Administer brandy,
infusion  of Virginia snakeroot, and spirit of mindererus, freely.
  14th, 11 o'clock A.M.   Says that  he is  much better.  Intellect
clear;  answers coherently.  He is much  more quiet.   Blister  has
drawn well; serum golden colored.   Pulse 96, much stronger and
more regular,  but still feeble;  respiration, 24.  Tongue soft and
moist; superior portion coated with  white  fur.   Under the action
of sulphate of  quinia and  stimulants the pulse has diminished in
frequency and increased in volume,  and the  respiration  has dimi-
nished in  frequency, and  the spasmodic actions of the respiratory
muscles  have ceased, and the nervous system has been aroused, and
the dull  intellect has resumed its  normal actions.   If stimulants had
been withheld, it is highly probable that  this patient would have died
from complete exhaustion  of the nervous and vital powers, conse-
quent upon the action of  the malarial poison, either directly upon
the nervous ganglia of the sympathetic system presiding over the
respiration  and circulation;  or by such changes in the elements of
the blood  (especially of the blood-corpuscles) as resulted in the
perversion  of the nutritive  elements of the nervous  ganglia, or in
the generation of compounds in  the  blood  and in the secretions of
the liver, spleen, and  alimentary canal, which acted as poisons upon
the  sympathetic and  cerebro-spinal  nervous systems, or "by the
simultaneous action of  the poison in  all these different ways.
   R.—Continue brandy and infusion of Virginia snakeroot.   Stop
sulphate of quinia.  Diet,  milk punch and arrowroot.
   15th,  11  o'clock A. M.   Continues to improve.  Has  no pain
anywhere.  Tip of tongue  clean and redder than normal; posterior
portion  coated with patches of black fur.  Pulse, 88 ;  respiration,
16.  Temperature of trunk normal;  reaction  of saliva neutral.
   R.—Continue stimulants and nutritious diet. 
372
OBSERVATIONS  ON
  8 o'clock P. M.  Continues to improve. Up to the present time,
owing to the  action of the  medicine, the congestive chill, delirium
and  weakness, it has been  impossible  to obtain  any urine  for
analysis.  Urine passed this afternoon  orange colored.  Amount
passed during the last twenty-four  hours, 5050 grs.;  calculated
amount for twenty-four hours, 15,510; sp. gr.,  1010; reaction acid.
	5050 grains of urine, excreted during 8 hours, contained	15,150 grains of urine, calculated for 21 hours, contained	1000 parts of urine contained
Urea ..... Uric acid .... Fixed saline constituents	Grains. 129.495 3.250 8.500	Grains. 338.395 9.750 25.500	25.642 0.643 1.683
  16th, 11 o'clock A. M.  Continues to  improve.  Tongue soft,
moist and  normal in  appearance.  Eeaction  of  saliva decidedly
acid.  His  appetite is good.   Pulse,  84;  respiration,  15.   Urine
passed during the night, of  a deep  orange  color; sp. gr. 1014.
Eeaction when first  voided acid, after the lapse  of fifteen  hours
slightly alkaline.   Simultaneously with the change from acid to
alkaline, there was the formation of  numerous well formed pris-
matic crystals of triple phosphate.  When the urine was held in
the sunlight,  these crystals sparkled like particles  of silver.
  1000 parts of Urine contained—
     Urea    .......    24.761
     Uric acid  .......     0.029
     Fixed saline constituents .....     1.773
  R.:—Continue brandy and infusion of  Virginia snakeroot and
nutritious diet.
  R.—Quassia and soda.
  17th. Greatly improved; dressed and walking about the hospital
yard.  Pulse, 72.  Tongue, skin,  respiration and temperature, nor-
mal.  Complains of nothing but weakness.
  The* captain  of the  vessel  to which this  seaman belonged has
just informed me that his crew consisted of eight men and a woman
(the cook).  Four of the men  and the cook slept aboard  the ship
lying in the Savannah Eiver.    Every one was  taken sick with
malarial fever, aud entered the  hospital.   Of the four seamen who
slept  ashore, two  were  taken  sick; their attacks, however, were
much lighter than those who slept on board the ship. 
malarial fever.                  373
                          conclusions.

Principles which should govern the Administration of Purgatives
                      in Malarial Fever.
  (1.) This case illustrates the necessity of watching  the action of
purgatives in malarial fever.
  I have treated numerous cases of malarial fever, both with  and
without purgatives, and from a careful comparison of the results of
the different modes of treatment, have found that the disease yields
much sooner to the action of the sulphate of quinia, after the action
of a purgative.  The purgative which I have  almost  invariably
employed at the commencement of the disease, is calomel.  It was
administered in doses from vij to xij grains, conjoined with from v
to vij grains of the sulphate of quinia.  The liver and portal circu-
lation, and perhaps the  spleen to a certain extent, are relieved by
the action of the purgative, and the  sulphate of  quinia is absorbed
much more readily and  rapidly.  The sulphate of quinia appears
to affect the head much less after the action of a purgative.  I have
frequently observed, that in both intermittent and remittent fever,
the action of calomel  on the alimentary canal, and liver, especially
when accompanied by, and followed with large doses of sulphate
of quinia, was attended with relaxation of the  hard dry skin, in-
crease of the secretions of the  dry  red mucous membrane of the
tongue and mouth, and relief of the  cerebral symptoms.
   The purgative by no means cures the disease.  The purgative simply
excites the alimentary canal to eliminate and throw off offending
matters, and relieves the congestion of important organs, and thus
equalizes the  circulation, promotes secretion, and secondarily re-
lieves some of  the nervous phenomena.  If the patient was left thus
without farther treatment, the malarial poison would still continue
its work unchecked.  The purgative "prepares  the system" for the
action of  sulphate of quinia and stimulants.
   In the  administration of purgatives  in  malarial fever, however,
the practitioner should always bear in mind the important fact,
that there are  certain cases,  as the present one, and  others already
recorded, in which purgatives will produce in conjunction with the
malarial  poison, sudden  and dangerous depression of  the system.
It  is important that the practitioner  should  study carefully the
indications for and against the employment of purgatives.
   I will state  my experience in the following propositions:— 
374
OBSERVATIONS ON
  (a.)  Whenever there is a full, rapid, bounding pulse, rapid respira-
tion and corresponding chemical change and development of heat; whether
the tongue be red or pale, dry or moist; whether the skin be dry or moist;
ichether the intellect be clear or clouded, a moderate dose of calomel, espe-
cially if it be mixed with sulphate of quinia, will prove highly beneficial,
and expedite the subsequent action of the sulphate of quinia, and hasten
the termination of the disease.
  (b.)  Whenever there is a feeble, rapid pulse, and rapid, thoracic respi-
ration, and no corresponding elevation of temperature (in many cases a
great  depression), with or without a dry, red tongue,  with a  dry,  harsh
skin, or with a cold clammy sweat, with or without cerebral disturbance,
with or without restlessness, purgatives should be rigidly avoided.
  (c.)  Whenever there is  a  marked want of co-ordination  between  the
actions of  the circulatory and  respiratory systems,  and the chemical
changes and consequent development of the physical and nervous forces,
purgatives should be avoided.
  (d.)  If purgatives be administered, without being followed with
sulphate of quinia, they act in  conjunction with the malarial poison,
by diminishing  the amount of the blood and depressing the forces.
  (e.)  If purgatives be administered repeatedly  with or  without
sulphate of quinia, they may convert a case of simple intermittent
or remittent fever, into one of congestive fever.
  (/.)  The best purgative is calomel.
  (g.)  The proper time for  the administration of the purgative, is
at the  commencement of the disease.
  (h.)  After the free  evacuation of  the intestinal canal, the purga-
tive should not  be repeated.
  (i.)   The  action of the purgative in  all cases  of malarial fever
should be  carefully watched, and if there is  any depression of  the
forces, stimulants and sulphate of  quinia should be immediately
and liberally administered, and sinapisms or blisters applied.  Car-
bonate of ammonia is one of the  most valuable stimulants in these
cases; sulphate  of  quinia should  always be combined with  the
purgative.
  (2.) The  tongue did  not  present  the dry, harsh, red appearance,
so common in these  severe cases.
  I have observed  that the  dry, red tongue, is more common in
the first  than in the second or succeeding attacks  of malarial fever.
This  patient  stated  that he had  a  severe attack of fever, several
years  ago,  on the  coast of  Africa, at the  mouth  of  the   river
Sierra Leone.  Says that  this attack was similar to the present 
MALARIAL FEVER.
375
one.  He was out of his head, and  no hopes were entertained of
his recovery.  The fever was of a malignant type.   The crew of the
ship was composed of eight strong active men, and out of this num-
ber, six died.  It  is highly probable that the disease was malarial
fever.  It is reasonable to suppose that this severe attack of malig-
nant malarial fever left a permanent impress upon his constitution,
and influenced the symptoms of the present attack.
   In attempting to account for the different manifestations of dis-
ease, we have not, in the present state of science, access to all the
data, such as original constitution, previous habits  and previous
diseases.
   It is probable that the course of severe diseases is  always modi-
fied by  the  constitution, diet,  occupation,  and  previous  habits,
whether virtuous or vicious, temperate or intemperate, and by pre-
vious diseases, and by the relations of the individual and his an-
cestors to the climate  and soil.  We know that in a body of strong
healthy men, exposed to precisely the same sources  of malarial
disease, we may have  manifestations of disease, from a slight febrile
excitement, scarcely deviating from the condition  of health, down
to the most malignant type,  commonly called congestive fever.
   If all  have been alike exposed upon the same small ship, to the
same poison,  whence this difference ?
   The difficulty and  complexity of this problem may be compre-
hended  when we  state  that,  amongst  other things,  its solution
would demand a knowledge  of the previous history of the physical,
chemical, physiological, and moral influences of soil and climate,
and disease upon  the ancestors, and even upon the races;  would
demand  a knowledge of all hereditary tendencies, peculiarities  of
temperament and  idiosyncrasy;  would demand a knowledge  of
the relative activity and  perfection of the individual  organs and
apparatus, and of  the relations of  these  to each other; would de-
mand a knowledge of the relations of the vital  force  to the  matter
of each organ, and tissue, and  apparatus, and to the morbific agent
or agents; would  demand a knowledge of the action and reaction
of the morbific matter upon  the different forms of organized struc-
ture, and the consequent derangement of the physical, nervous, in-
tellectual, and moral  phenomena;  would demand a knowledge of
the relations of chemical action to the development of the physical
and nervous forces, and the action of the intellectual and moral facul-
ties; would demand a knowledge of the correlations of the physical,
vital, nervous, intellectual, and moral phenomena; would demand 
376
OBSERVATIONS ON
a knowledge of the relations between physiological phenomena and
the phenomena of the exterior  universe.   Every candid man will
admit that the solution of such  a problem is impossible at the pre-
sent time, because the facts are wanting.   And they will be long
wanting, owing to the extreme complexity of the phenomena.
  A thorough knowledge of pathological phenomena, necessarily includes
a knowledge of the relations of all  the phenomena  of the universe.   The
dignity and  glory of a science  should certainly depend upon the
multitude and complexity of its phenomena.  We hope, however,
that the day will come when the science of medicine shall be founded
upon the immovable basis of  inductive philosophy, and the world
be  compelled to recognize the truth, that the solution of the pro-
blems of medicine requires a higher exercise of the reasoning facul-
ties than the solution of the  most complicated and  difficult pro-
blems in physical and chemical science; a  higher exercise of the
reasoning faculties than the solution of even the grandest problems
of astronomy.

Case of Congestive Fever, illustrating the Effects of the Mala-
  rial Poison upon the  Nervous System,  Muscular  System  and
  Organs; the Physical and Chemical Changes of the Urine ;  and
  also the Formation of Heart-Clots.  Treatment of Congestive
  Fever.

  Observation.—German ; age, 40; height, 5 feet 9 inches; weight,
150 lbs.; black hair,  black eyes; sallow complexion; occupation,
bar-keeper.
  October 16, 1857, 8 o'clock  P. M.  Has just  entered the hospital.
Is unable to give coherent answers, and is either stupid or unable
to speak the English language. His companion  states that  this
patient has been in Savannah for two months, and has been  sick
with chill and fever for two weeks.   He is exceedingly weak, and
his intellect wanders.   Pulse 112, rather feeble.
  R.—Calomel gr. xij ;  sulphate of quinia  gr. vj.—Mix.    Ad-
minister and follow with castor oil in four hours.
  R.—As soon as the  calomel has acted  once, commence  with
sulph. of quinia, gr. v every three hours up  to gr. xx.
  17th,  11 A.M.  When I saw this patient  last  night, I supposed
that this stupidity and  difficulty of speech were due,  in a great
measure, to the fact that he was  a foreigner, imperfectly acquainted
with our language.  A careful examination this morning, however, 
MALARIAL FEVER.
377
shows that the difficulty of speech and torpor of intellect are de-
pendent upon the effects of the malarial poison (either directly or
indirectly) upon the brain.   When questioned, endeavors to con-
verse ; commences sentences, but is unable to finish them.  Pulse
124, very  feeble;  respiration,  28; tongue, dry, hard, and rough,
and coated with dry, brownish-yellow fur.   The tongue feels very
hard and  rough.   There is not moisture enough in his  mouth to
produce any sensible effect upon a bit of paper pressed against the
tongue.  Skin warm and dry.  The  temperature of the skin cor-
responds with the feebleness of the pulse, but not to its frequency,
and not to the frequency of respiration.   Says that he feels well.
   R.—Mustards to extremities.  Cut cups to temples and back of
neck.  R.—Administer freely,  brandy, infusion of Virginia snake-
root, spirit of mindererus, and sulphate of quinia.
   8 o'clock P. M.  The cut cups  and mustards aroused him for a
short time, but he has relapsed into the state of  partial stupor, in
spite  of the action of the sulphate of quinia and stimulants.
   R.—Continue stimulants,  infusion of Virginia snakeroot, and
sulphate of quinia.
   18th, 11 o'clock A. M.   No  improvement.  Tongue very red at
edges and tip, which are free from fur.   Surface  of tongue  coated
with dry,  yellow fur, and presents the same dry, rough feeling and
appearance.  Teeth  coated with sordes.   The pulse is so rapid and
feeble that it is almost impossible to  ascertain accurately its num-
ber of beats.  It  feels like the  delicate pulsations  of a minute
capillary  filled with water.  The pulsations  cease, as soon  as the
slightest pressure is made.   Pulse, 155  to minute.  The heart
merely thumps (flutters).   The two sounds are merged into one, and
cannot be  distinguished.  The sounds of the heart correspond in
number to the beating of the pulse, 155 to  minute.  The corres-
pondence of the two was  examined not only by separate calculation,
but also by applying the  ear over the region of the chest, and the
hand  over the pulse at  the  wrist.   Eespiration  34, spasmodic.
Skin  covered with cold, clammy sweat.  Extremities are at least
20 degrees below the normal standard.  Trunk and  head feel cold;
their  temperature several  degrees below the normal standard.
   The action of the heart  is  feeble; the  capillary circulation is
exceedingly feeble and sluggish.  The distribution of the nutritive
and force  elements is correspondingly retarded, and, as a necessary
consequence, the chemical changes are diminished and altered both
in quantity and kind.
       25 
373
OBSERVATIONS  ON
  The patient is  very restless, tosses  about the  bed, and is with
the greatest difficulty  retained in bed.   Passes his water and feces
in bed.  Intellect wandering; talks incoherently.  Says that he is
perfectly well, and wishes nothing but water.   When aroused, his
eye looks bright, and there is no expression of pain or  uneasiness
upon  his countenance.
  During the last thirty-six hours has taken fifty grains of  the
sulphate of quinia, together with large quantities of stimulants.
Mustards have been frequently applied.  The effect of these reme-
dies appears to be only palliative.  They have produced no  per-
manent beneficial effect.  Whenever the mustards and  stimulants
were withheld, the forces decreased rapidly, and the patient would
relapse almost into a profound stupor.  The action of the mustards
was very slow on account of the  sluggish capillary circulation.
  R.—Continue stimulants.  Apply bottles of hot water to the ex-
tremities.   Administer 10 grains of the sulphate of quinia imme-
diately, and repeat every three hours.  R.—Blister to back of neck.
  9£ o'clock P. M.  The mustards and stimulants aroused him, and
at 6 o'clock P. M. this evening his pulse was fuller, his tongue was
moister, his intellect  clearer, and  the restlessness had,  in a great
measure, disappeared.  The patient, during the momentary absence
of the nurse, got out of bed and attempted to walk across the floor,
to the bucket of water at the other end of the ward.  He had not
proceeded more than  five steps, before he fell upon the floor, com-
pletely  exhausted.   Almost  immediately his pulse became more
frequent and feeble,  in fact, almost entirely disappeared, and his
extremities  became much colder.  Mustards  were again applied,
and stimulants administered.  Under the action of these, his  cir-
culation, both general and capillary, was increased somewhat in
force, and his exhausted forces revived.
   Now his pulse is 135, and his  respiration 32.  The sordes on the
teeth, which were this morning perfectly dry, are moister; the tongue
is moister;  the pulse is fuller (although still exceedingly feeble and
flickering), than it was this morning.
   There is an unnatural brilliancy about his  eye, and  excitement
about his intellect.   He converses freely for the first  time;  says
that he feels perfectly well, and  wishes to go immediately home to
the hotel and take the place of the bar-keeper, who he says is sick.
Complains bitterly of being confined to bed, when nothing is the
matter  with him, and he feels as strong and as well as he ever did
in  his life.   Has been  quarrelling with the  nurse, and  threatens 
MALARIAL FEVER.                  379
vengeance, because he confines him to bed and will not allow him
to dress himself and go and drink  freely of water.  Complains
greatly of thirst;  keeps his eye  fixed  on the vessel containing
water, notwithstanding that he is liberally supplied.   Has vomited
several times.  The blister is acting, and  the serum is of a golden
color.  Has taken 30 grs. of the sulphate of quinia since 11  o'clock
this morning.
   Has just passed urine.  It is perfectly clear, and amber-colored.
The color of the urine is in striking contrast to that of patients who are
able to resist the effects of the malarial poison to the extent of the produc-
tion of the febrile excitement.   When the constitution is able to cope with
the malarial poison, we have a rapid pulse, rapid respiration, high tem-
perature, rapid chemical change,  and high-colored  concentrated urine.
Specific gravity of urine,  1015.3.   Eeaction strongly acid.  The
urine changed the litmus blue paper  to as bright a red as a strong
mineral acid.  The rapidity of the change also corresponded to the
action  of a powerful acid.  After  standing  70 hours the reaction
was  still decidedly acid, and there was  no deposit  of any  kind.
When  the  urine was evaporated, the residue was a  dark reddish-
brown  viscous mass, resembling  tar.   After prolonged, tedious,
and  careful  evaporation, it was found to be  impossible to reduce
it to a solid state.   When the  urine, concentrated to the  consist-
ence of a syrup, was treated with nitric  acid, there was a slight
effervescence,  and  a few crystals  appeared.  These  crystals were
transparent, and resembled  rather crystals of saltpetre than the
silvery crystals of nitrate of urea.   After  standing for  a short
time these  crystals  disappeared, and did not again appear even
when the fluid was concentrated by evaporation.  If these crystals
 were nitrate of urea, the whole amount existing  in  1000 grs.  of
urine must  have  been less  than 2 grs.  In  a fluidounce  of urine
not more than a trace of uric acid could be detected after careful
examination.  Under the microscope a few small crystals could be
detected which were invisible to the naked eye.
   1000 parts of Urine contained—
Solid matters	. . • •	34.482
Water .	.	965.518
Urea	.	a trace
Uric acid	.	a trace
Extractive, coloring,	and organic matters	24.805
Fixed saline constituents, principally phosphates		9.655
The fixed saline constituents were principally the phosphates. 
380
OBSERVATIONS ON
  A short  time after this observation the excitement and restless-
ness of this patient disappeared, and he went into a profound sleep
and died at 1 o'clock A. M.

               autopsy twelve hours after death.
  Exterior.—Limbs  and trunks round and full, and apparently in
full flesh.   The skin  over the whole  surface except the  face pre-
sented a fair white color.  There was no settling of  the  blood in
the capillaries of the most dependent portions of the skin producing
the mottled appearance previously noticed.  This may be due to
the fact that the  patient was under the action of stimulants at the
time of death.
  Head.—Dura mater,  normal.  Arachnoid membrane opalescent
(pearl colored)  in many spots.  Serum was  effused between the
arachnoid membrane and  pia mater.  Bloodvessels of pia mater,
filled with  blood.  Substance of brain was firm,  and was  altered
neither in  consistency nor  in  appearance.   Bloodvessels of the
substance of the brain  not more distinct than normal.  Ventricles
of the brain were almost entirely filled with light-yellow serum.
Light-yellow serum was effused around the medulla oblongata, and
superior portion of spinal cord.  The effused serum  appeared to
fill completely the spaces between the spinal cord and its membranes
and the surrounding  vertebral cavity.  When the medulla oblon-
gata and superior portion of the spinal cord were removed, the
serum flowed in (the shoulders being slightly depressed)  and filled
the vertebral canal.
  Chest.—Lungs normal.  Bloodvessels  of the dependent portions
engorged with blood.
  Heart normal in size and structure.  The ventricles and auricles
contained  clots.  Portions of these  clots were free  from  colored
corpuscles  and presented the yellow color of whipped fibrin.  Sur-
rounding, and attached to these, were ordinary coagula  of blood.
The vena  cava, and all the large venous trunks  in the abdominal
cavity, were filled with dark, almost black coagulated blood.
  Abdominal Cavity.—Liver, somewhat enlarged;  and presented a
singular mottled appearance.  At a  distance it presented  a lio-ht
bronzed color.  Upon nearer inspection, the lobules were found to
be distinct, elevated,  and of  a light-bronze color, whilst the  spaces
between the lobules inclined to a slate color.  There were several
spots varying from two inches to half an inch in diameter of a uni- 
MALARIAL FEVER.                  381
form slate color.  The structure of the liver was unusually firm; it
required considerable force to tear it asunder; it cut toughly under
the knife, and  the  lobules started out  from the cut surface  as if
they had been bound down.   The fibrous capsule  surrounding the
exterior of the liver and forming a sheath for the  large vessels
lying in the portal canals was thickened, and the individual lobules
of the liver  were  surrounded with  fibrous tissue.  These  facts,
which were demonstrated not only by the touch and naked eye, but
also by the microscope, show that this liver was in a cirrhosed con-
dition.   Cirrhosis of the liver in  this case was not caused by the
action of the  malarial poison, but in all probability, by the habitual
use of ardent spirits.
   This  patient was a barkeeper.   Men  in this occupation are, as a
general rule, addicted to the free use of ardent spirits.   The liquors
drank in this country at the hotels and bar-rooms contain much
alcohol, which acts upon the secreting  structures  of the liver  and
upon the bloodvessels, and  excites  adhesive inflammation in the
areolar tissue of the small twigs of the portal vein, and in the areo-
lar tissue of the portal canals, by which  serous fluid and coagulable
lymph  are thrown out.  Under the microscope, the substance of
the  liver contained  many  dark looking masses,  resembling the
altered  blood-corpuscles of the spleen, and the black granules  and
flakes of black vomit.  These dark masses were not  sufficiently
numerous to have any marked effect upon the organ.  When the
fibrous capsule was  torn off it presented a light slate color, and yet
when magnified  and carefully examined, but few of  these dark
masses  were  seen, in the meshes.   The  structures  of the liver,  and
the  liver-cells, contained numerous  oil-globules.  These oil-glo-
bules existed in sufficient numbers to induce the belief that the
liver was in a state,  not only of cirrhosis, but also of fatty degene-
ration.   The bloodvessels of the liver were filled with dark blood,
which did not change  to the arterial hue upon  exposure to the
atmosphere.
   The mottled appearance of the liver, and the want of that decided
slate and bronze color characteristic of malarial fever, were due not
to any peculiarity of the effects of the  malarial poison, but rather
to the pathological conditions of cirrhosis and fatty degeneration.
Allowing due weight to these pathological  changes, it is evident
that the change in the color of the liver was similar in all respects
to the slate, or bronze color of livers, which were normal before the
onset of the  malarial fever.   The change in the color of the liver 
382
OBSERVATIONS  ON
during malarial fever is due to changes in the amount, and physical
and chemical constitution of the blood in the capillaries of the liver,
and to the physical and chemical changes in  the bile and the con-
tents of the secretory apparatus,  and not to the deposition of black
granules in  the structures of the liver.  I have seen the slate and
bronze color as well marked in  the liver when these dark  masses
were absent,  as in  the liver where they were most abundant.  The
peculiar color of the liver is due, in a great measure, to changes in
the coloring matter (baematin) of the blood.   The  blood will not
change to the arterial hue when exposed to the atmosphere.   This
altered coloring matter resulting from the destroyed disintegrated
blood-corpuscles,  or from the  blood-corpuscles acted  on by the
malarial poison, without actual disintegration, escapes and permeates
the surrounding tissues and  imparts the peculiar color to the liver.
The color is also due to the  altered color of the bile.
  In all the cases of malarial fever which I have thus far examined,
I have found  the bile to be  of high specific gravity, thick, concen-
trated, and of a greenish black color, when seen in  mass, and of a
gamboge yellow when spread in  thin layers.  The altered bile also
infiltrates the surrounding tissues and gives  this peculiar color to
the liver.  This peculiar color can be to a certain extent abstracted
from  the liver by boiling with water.  I have always  found the
filtered  decoction  of malarial fever livers to be of  a  brownish-
yellow color,  whilst the decoction  of yellow fever livers is of a
bright golden color, whilst that of  normal livers is of a light-
yellow.   After the altered coloring matters of the  blood and bile
have infiltrated the structures of the liver, they will sometimes  re-
main  for a considerable length of time without being absorbed, and
communicate the peculiar bronzed color to the liver long after the
restoration of its  normal functions, and the  disappearance  of the
malarial fever. I have observed, however, that the  intensity of the
color of the liver bears a marked relation to the time of convales-
cence; as convalescence advanced the color diminished in depth.
  The liver contained animal starch.   Several of the  hepatic ducts
were isolated and treated with tincture of iodine  and carefully ob-
served under  the  microscope.  Their color, with the exception of
a few small  spots, was simply changed to  that of the tincture of
iodine.   In  these  spots, the color was  changed to a bright blue.
In other cases of malarial fever, I have seen long  portions of the
hepatic ducts changed  to a bright blue color under the action of the 
MALARIAL  FEVER.                  383
tincture of iodine.  These facts would show that they do sometimes
contain animal starch.
  The gall-bladder was filled with concentrated bile of the consist-
ency of molasses, and of the color (when seen  in mass) of a satu-
rated solution of iodine.  When spread  in  thin layers the bile
presented a gamboge color.
  Spleen enlarged.  It was at least three times the normal size.
The structures of the  spleen were s<f much disorganized, that in
attempting to remove it from the abdominal cavity, the capsule and
trabeculae gave  way under  a  slight pressure, and the fingers
plunged  into its  soft substance.  Dark brownish purple, almost
black mud flowed from the rupture.  After thirty-six hours' expos-
ure to the atmosphere, the color of the mud of the spleen remained
unchanged.
  Under the microscope, the mud of the spleen  contained a great
number of dark, reddish-brown  and reddish-black  granules, and
conglomerations of granules.  These  granules and  black masses,
composed of conglomerated granules, resembled the bodies found
in the liver, and also the black sediment of  the black vomit of yel-
low fever.
  Similar granules and masses  have been observed in normal
spleens.   They appear, however, to be most abundant in the mala-
rial fever spleens of long standing. In cases which have terminated
fatally after only a short illness of only two or three days, I have
observed  that these granules were not so numerous as in cases of
longer duration, and in some very recent cases they were not more
numerous than in the spleen of  health.  These  masses appear to
be derived from the disintegrating blood-corpuscles.
  Alimentary and Intestinal Canal.  Stomach.—Bloodvessels  upon
its exterior filled with blood.  Mucous membrane bore no marks
of inflammation, and was not more congested with blood than usual.
The exterior and mucous membrane of the jejunum presented the
usual appearance.  There was no unusual appearance either of con-
gestion, irritation, or inflammation.  The mucous membrane of the
ileum, especially at the  lower portion, was more congested, and of
a darker color than  usual.
  The intestinal  canal  throughout its entire  length  was empty.
The mucous membrane presented a yellowish appearance, probably
due to the presence of bile.
  The solitary glands of the ileum especially in the  neighborhood
of the ileo-csecal valve, were numerous, enlarged, elevated, distinct, 
384
OBSERVATIONS  ON
and of a brown color.  When the intestines were held  up to the
light, the bloodvessels filled with blood could be distinctly seen send-
ing off branches to each gland.  The glands of Peyer were large, dis-
tinct, and elevated.  Several of these glands in the lower portion
of the ileum, were three inches in length.  These glands, however,
were not inflamed, as in typhoid fever,  but  presented  the usual
pale appearance.
  Kidneys.—Each kidney had upon its inferior surface a spot about
one  inch in diameter, of a slate color, resembling, in all respects,
the color of the  exterior of the malarial fever liver and  spleen.
When  these portions of  the  kidney were cut, they presented  a
bronzed  color for the depth of one-eighth of an inch.   Microsco-
pical examination showed the absence from  these  portions of the
liver of those granules, and brownish-red  and reddish-black masses,
so abundant in the spleen and liver.  Microscopical examination
showed that the excretory structures of the kidney were not altered
in these discolored portions.
  These  facts sustain the  assertion  that  I have previously made
that the color of the liver in malarial fever does depend upon the
diffusion through its  substance of  dark granules and  granular
masses.   The bladder  was empty. The scrotum was reddened, and
appeared to be blistered  and excoriated.  This was due to the ac-
tion of the intensely acid urine.

                          conclusions.
  1.  This  case corresponds to the congestive fever  of  American
writers.  The prominent symptoms  of this case were rapid, full
pulse;  rapid, thoracic respiration; relaxed skin, with  cold clammy
sweat;   sluggish  capillary  circulation;  deficient and  perverted
chemical action; reduced temperature; deranged physical, muscu-
lar, and nervous forces; and aberrated intellectual action.
  2. The rapid, feeble, action of the heart; the rapid,  feeble pulse;
the almost entire arrest of the circulation and chemical changes in
the capillaries, were attended by a reduction of temperature, and
loss of muscular  and nervous force,  and aberration of the  actions
of the sympathetic and  cerebro spinal  nervous  systems.  These
disturbances of the chemical changes, and physical, muscular  and
nervous  forces were  reflected  in the urine.   The  appearance and
chemical constitution of the urine were strikingly different from the  urine
of those cases of intermittent and remittent fevers where the action of the 
MALARIAL FEVER.
385
poison is attended by an excitement of the general and capillary circula-
tion  and of the respiration, and corresponding rapid chemical changes,
and  high temperature.  In those cases of malarial fever where there
is a  rapid, full  pulse; moderately accelerated respiration;  rapid
introduction and distribution of oxygen and corresponding high
temperature, the urine is invariably high-colored, concentrated, and
rich in solid matters.
   If we examine the analyses of the urine of those cases of inter-
mittent and remittent fever, which have been previously recorded;
and, at the same time, bear in mind the  fact  that  the  urine was
excreted during the summer season, and  during starvation; it  is
evident that during the  febrile excitement the urea is greatly in-
creased.
   When the febrile excitement (rapid distribution of oxygen, and
rapid chemical  change, and high temperature) subsides, the urea
 and other solid constituents of the urine decrease.
   After  the establishment  of  convalescence, when the patient  is
 able to take food freely, the solid constituents of the urine again
 rise, notwithstanding that  the temperature  is  the same, or a  few
 degrees above that of the intermission.  The urea during convales-
 cence  is probably derived partly from the food, and partly from
 the  metamorphoses  of the tissues.   In  this case, on the other hand,
 the arrest of the circulation and chemical changes of the capillaries, and
 the  reduction of  temperature, was attended by a complete alteration  of
 the physical and chemical constitution of the products resulting from the
 metamorphoses of the blood,  organs, and tissues.   The urea and uric
 acid were absent, the acid of the urine was greatly increased, and the
 physical properties of the  urine altered.
   Whether the disappearance of the urea and  uric acid resulted
 from the arrest of the metamorphoses of the muscular tissue, or of
 the  blood-corpuscles and  nitrogenized elements of the  blood;  or
 from the disturbance of the normal chemical changes, by the intro-
 duction of the malarial poison, amongst the substances undergoing
 chemical change; or from  the primary action of the malarial poison
 upon the sympathetic and cerebro-spinal nervous systems, and the
 perversion of the chemical changes of the organized elements, by
 the consequent aberrated  nervous action ; cannot be definitely an-
 swered in the present state of  chemical, physical, physiological and
 pathological science, because the fundamental facts are wanting.
    Whilst it is known that urea and uric acid are  products of the
 chemical changes of the nitrogenized  elements, still it has not as 
386
OBSERVATIONS  ON
yet been definitely settled whether urea and  uric acid1 result from
the metamorphoses of the blood-corpuscles, or of some one special
nitrogenized constituent of the  blood, or of  the  muscular tissue:
or  from all these sources.
   The chemical, physical, physiological and pathological  properties
and relations of the malarial poison are unknown.  What relations,
chemical, physical, physiological  and pathological,  do  the meta-
morphoses of the  organized bodies which result in  the  formation
of  urea and  uric acid, and of the  extractive and coloring matters,
bear to the metamorphoses  induced by the malarial poison ?   It is
impossible to give any answer  to  this  important  question, which
lies at the foundation of the solution of the problem.
   Neither would the answer of this important  fundamental ques-
tion clear up the difficulty,  for we  have here  complicated pheno-

  1  The following observations are interesting in their bearings upon  the origin of
uric acid.  I kept a large Indigo snake (coluber couperi) in a cold, dry room, during
the winter season,  without food and drink.  This serpent remained in a partially
torpid state for three months.  He was never entirely without the power of motion,
and would, when aroused, show considerable power.  At the end of this time the
serpent died.  When the heart was exposed after death, its surface was covered with
a chalky granular  substance, which was demonstrated both by microscopical and
chemical analysis,  to be the urate of ammonia.  The external surface of the aorta
and its largest branches were in like manner covered with the urate of ammonia.
When the substance of the heart was cut, numerous particles of the urate of am-
monia were found along the course of the bloodvessels and amongst the muscular
fibres.  Numerous  particles of the urate of ammonia were also discovered amongst
the fibres of the muscular coat of the aorta and its largest branches.  When a
portion of the muscle of the heart, or of the muscular coat of the aorta was treated
with acetic or hydrochloric acid under the microscope, thousands of small lozenge-
shaped crystals of  uric acid were discovered lying around the muscular fibrillse.
The urate of ammonia was deposited in no other organ or tissue except the heart
and the aorta, and its largest branches.  The following appears to be the explanation
of this singular phenomenon:  The heart was the only portion of the muscular
system in continual action during the season of hybernation.  Muscular force is
developed by chemical change. The heart, therefore, was the only portion of the
muscular system undergoing chemical change.   The blood was concentrated, defi-
cient in water.   There was not sufficient water to dissolve the urate  of ammonia
resulting from the chemical changes of the blood and muscles of the heart, by which
the muscular force was developed.  The urate of ammonia consequently remained
just where it was formed.  This observation not only points to the origin of uric acid
and ammonia in the animal economy, but also demonstrates that the muscular force is
developed during the chemical changes of the elements, of the blood and  muscles.  If
these conclusions be  legitimate, true and universal, it follows as a necessary consequence
that any alteration in amount or kind of the chemical changes of the blood  and muscular
tissue, must be attended by corresponding alterations in the amount and kind of the
products resulting from those chemical changes. 
MALARIAL FEVER.                  387
mena and numerous complicated actions  and reactions.  So com-
plicated and involved are the  phenomena that the solution of one
necessarily demands the solution of all.
  Such questions as these demand an answer:—
  What is the  chemical, physical, physiological and pathological
relations of the malarial poison to the sympathetic and cerebro-
spinal nervous systems ?
  What is the effect of derangement of the sympathetic nervous sys-
tem upon secretion and excretion, in fact upon all chemical changes
of the elements of the human organism ?
  Will the derangement of  the  secretions and excretions  differ
with different poisons, when the actions of those poisons are limited
simply to the sympathetic nervous system f
  What is the effect of derangement of the sympathetic nervous sys-
tem upon the cerebro-spinal nervous system ?
  Can the sympathetic nervous system induce alterations in the actions
of the organs and tissues, in the secretions  and excretions, inde-
pendent entirely of any direct action, but by communicating or re-
flecting its aberrated action to the cerebro-spinal nervous system?
  What is the  effect  of derangement of the cerebro-spinal nervous
system, upon secretion and excretion, in fact upon all the chemical
changes of the elements of the human organism ?
  Will the derangements of the secretions  and excretions  differ
with  different poisons, when the actions of those poisons are limited
simply to the cerebro-spinal nervous system?
  What is the effect of derangement of the cerebro-spinal nervous
system, upon the sympathetic nervous system ?
  Can the cerebro-spinal nervous system induce alterations in the
actions of the organs and tissues, in the  secretions  and excretions,
independent entirely of any direct action,  but  by communicating
or reflecting its  aberrated action to the cerebro-spinal nervous system.
  Would the phenomena of nervous and muscular action and of
secretion and excretion, vary, if the action of the poison or poisons
were primarily upon the blood, rendering it unsuited to the healthy
action of the cerebro-spinal and sympathetic nervous systems and
of the muscular system, rendering it unsuitable for the formation
of the secretions and excretions?
  Notwithstanding the absence of the facts necessary for the abso-
lute solution of  these complicated phenomena, and problems, still
the  present  observations, that  arrest  of  capillary  circulation and
chemical  change, due to the action of  the  malarial poison, was 
388
OBSERVATIONS ON
attended by a reduction of the temperature, aberrated muscular and
nervous  action, and a marked alteration  of the properties of the
urine,  are of great  interest  in their bearing  upon the  treatment
of congestive fever.
  3. In the treatment of that form of malarial  fever called congest-
ive fever, those remedies should be employed, which excite the
general  and capillary  circulation, promote the introduction and
distribution of oxygen, increase  the chemical  changes, and excite
the development of the  muscular and nervous forces.   Sulphate of
quinia and diffusible stimulants, brandy, and carbonate of ammonia
should be freely and promptly administered, and sinapisms freely
applied.   Bottles of hot water, or, better still, the hot  water bath,
should be used to impart  heat and stimulate the capillary circula-
tion, and  relieve  the engorgement of the large organs.  Brandy
and red  pepper may be  applied to the  surface with advantage.
The sulphate of quinia may be administered in doses of 15 to 30
grains every one, two, or three hours, according to the urgency of the
symptoms, up to from 30 to 100 grains during the twenty-four hours.
The best method of administering the sulphate of quinia is dissolved
in a weak solution of citric acid or in lemon juice.  It is perfectly
soluble in this,  and is much more readily absorbed when in this
soluble  form.  If the stomach  rejects the  sulphate of  quinia, it
should be administered in solution with starch, by  the  rectum.
These stimulants will in  many cases be the means of prolonging
life until the sulphate of quinia can be absorbed and act.  Whilst
therefore the stimulants do not cure the disease, they often preserve
life by supporting the patient until  the sulphate of quinia can act.
  The carbonate of ammonia is peculiarly valuable in  that form of
malarial fever where there is  a rapid feeble pulse and corresponding
rapid feeble  action of the heart.  The observations which I  have
recorded in the previous numbers of this journal prove that heart-
clots are almost always formed previously to death from malarial
fever.  It is  probable that cases often occur  where the sudden and
distressing symptoms are due in a great measure to the  formation
of these  heart-clots during life.1  The feeble  action of  the heart,

  1  The following observations of Dr.  Chisholm are exceedingly interesting in
their bearings upon the preceding investigations upon the formation  of fibrinous
concretions in the heart and bloodvessels, during malarial fever:—
       "A Short Account of the Epidemic Polypus at Grenada, in 1790.
  "The situation  in which  this singular disease  appeared is rather peculiarly
circumstanced. The foreground is the sea, perfectly open, with an extensive and 
MALARIAL FEVER.
389
and the sluggish  circulation of  the blood, are very  favorable to
the formation of these heart-clots.   The free administration of the

burning beach of sand ;  on the left is a hill of considerable and steep ascent, the
base sides of which, in conjunction with the reflecting surface of the sea, produce
in dry seasons an immense degree of heat; on the right the view is limited by a
mountain of great  height  and magnitude; the background is a marsh extending
from the sea to the mountains, and formed chiefly by water rushing from a narrow
stony ravine, and dammed up by a beach rendered  impenetrable by the  surge:
from this marsh vapors of a very deleterious nature continually exhale, and this
was particularly observable in the month of October of this year, on account of the
trees and brushwood, which hitherto had covered it, being  cut away in order to
drain the marsh.   Immediately behind the marsh the ravine begins, and runs
back between the hill and mountain, in the form of a funnel, gradually rising for
upwards of a mile.  Through this ravine  there is a continual current of wind of
an uncommon degree of coolness.  The negro houses of the plantation are built on
the left, chiefly on its slope, and towards the edge of the marsh.  The negroes were
consequently at once exposed to excessive heat, a cold chilling current of air, and
the miasma of the marsh.   Their diet was chiefly composed of vegetable food.
They had been employed immediately before the appearance of the disease in
question, in clearing the surface of the marsh, and in holing land for the reception
of cane plants.  Like all other negroes placed in similar situations (marshy), they
were much given to the destructive habit of eating a species of pipe-clay, very
abundant in Grenada.
   " The disease made its appearance on the plantation Grand-mal, about the end of
September or beginning of October ; was most prevalent towards  the close  of the
latter month, and disappeared totally in November.   The whole number of sick
might have been forty, of whom seven died.   Its commencement was marked by
no distinguishing symptom ; but soon after, the patient complained of pain at the
pit of the stomach and in the head, and difficult respiration.  These pains were
attended with a dry skin, small  quick  pulse, and slight frequent dry cough. No
febrile heat accompanied these  symptoms; on the contrary, the surface  was at
this period remarkably cool; but a heaviness and dulness of eye, a  melancholy or
depression of spirits, and features strongly expressive of anxiety  were constant
attendants.  The state of the patient was thus characterized for three days.  At
the expiration of that period, the pulse became  extremely quick, 120 to 140, and
 intermitted, attended with a penetrating pungent heat, which produced a pricking
 sensation on the hand of the person feeling the pulse.  But this state of the pulse
 and heat, as well as the  pains, anxiety, and other distressing symptoms, now also
 intermitted, or rather the disease  assumed something like an intermittent form,
 the intermission of it may be so called, continuing eight or nine hours.   During
 the paroxysm, the  struggle for breath, the aggravation of all the  other symptoms,
 and the very quick, interrupted, and evidently visible, as well as audible palpita-
 tion of the heart, produced a scene of uncommon horror.  The paroxysm was suc-
 ceeded by a cold clammy sweat, and a  state of approaching syncope.   The  second
 paroxysm generally put a period to the existence of the patient.   The disease was
 also distinguished  during this latter stage, and even for some time  previous to its
 commencement, by a constant or almost constant disagreeable clammy sweat over-
 spreading the face, the upper extremities and the body as low down as the scrobi-
 culus cordis, all below remaining arid  and parched in a most remarkable degree. 
390
OBSERVATIONS  ON
 carbonate of ammonia, in  congestive fever, will fulfil two  indica-
 tions : 1st, stimulation; 2d, prevention of the formation of fibrinous
 clots in  the heart and large bloodvessels.

 The disease seemed sometimes inclined to terminate by metastasis ;  one instance
 of this was remarkable, wherein a spontaneous absorption of the lymph deposited
 in the heart, and a deposition of it in the left arm and left thigh took place.   The
 patient, in this case, after laboring under all the symptoms peculiar to the disease
 before the  intermittent period, found himself all at once, and without an evident
 cause, relieved of them; but he perceived at the same instant an excruciating pain
 a little above the elbow, and nearly about the middle of the thigh.  He continued
 ever after absolutely free of all the symptoms of the polypus ;  but they were suc-
 ceeded by a large abscess in the parts in which he felt the pain.  That in the arm
 disappeared gradually, but the other became  so large as  to occupy the whole of
 the under part of the  thigh.  The cure was effected by passing a seton  through
 the whole length of the tumor; by the use of two dozen of Madeira wine, a large
 quantity of bark, and a calomel pill, with opium three times a day.  The audible-
 ness of palpitation may be considered as exaggeration; but in one instance par-
 ticularly,  the  gentleman (Mr.  M'Sween) to whom the negroes belonged, heard
 distinctly the palpitation, although in an adjoining room.
  " What mode of practice did so extraordinary a train of symptoms indicate ?  I
 could fix on none till dissection instructed me.   Having no suspicion of the heart
 being the seat of this uncommon malady, I did not examine that organ in the two
 first bodies I opened; but finding all the other viscera, and the brain in a state of
 health, I found myself still unable to account for the extraordinary symptoms the
 patients had been afflicted with.  At length, on opening the third body, I examined
 the heart, and discovered what I conceived might be considered the cause and
 seat of the disease.  In the right ventricle of the heart I found a polypus which
 extended considerably into the pulmonary artery.  On extracting it, it measured
 exactly two feet and two inches  in length ; and the body of it contained, in  the
 ventricle, two inches in breadth.  In the fourth body there was a very large poly-
 pus in the right and left ventricle, besides one in the right auricle.  The hearts of
 the fifth, sixth, and seventh, were circumstanced precisely similar; and in the
 five, except one where the lungs  were morbidly affected, no other morbid appear-
 ance of any description could be perceived.  Did these extraordinary circumstances
justify the appellation—epidemic polypus ?
  "After a variety of ineffectual attempts to cure this disease, I determined on the
 following, and  found it  successful: From the consideration of the circumstances
 contributing to the production of the disease, so far as they were discovered ; of
 the features of the disease itself;  and of the morbid changes observed in the dead
 bodies ;  it may be fair to conolude, that a laxity of fibre, a want of due  cohesion
 in the mass of blood, and a consequent deposition and  accumulation of coagu-
 lable lymph in the cavities of the heart, where the various valves and  columnae
 favor such accumulation, produced polypi, an interruption, and at length a total
 stop to the circulation.  Having this view of the disease, it was  manifest that such
 means as  might prevent  deposition and accumulation of coagulable lymph  or
 destroy it, should it have happened, in the first instance ; and afterwards restore
tone to the fibre, would cure the disease.   The action of mercury on the absorbent
 system I had for some time been acquainted with, and its probable efficacy in that
way here, readily occurred to me. My mode of treatment, therefore was this: 
MALARIAL FEVER.
391
  4. The failure of this mode of treatment to prevent a fatal termi-
nation  in  this  case  was  due to several causes.   The disease  had
been allowed  to progress without any opposition for at  least ten
days before this plan of treatment was instituted.  During this time
such profound  alterations of the blood, spleen, and liver had taken
place,  and  the chemical  changes so perverted and the  correlation
of the  physical, vital, nervous, and muscular forces, so  disturbed,
that no plan of treatment, however vigorous,  however  appropriate,
could  arrest the progress of the disease.
   The symptoms  were without doubt aggravated by the cirrhosed
condition  of the  liver.  The alterations of the color of the blood
and of the secretions of  the liver  in  malarial fever, point  to  pro-
found  alterations.   The cirrhosed condition  of the  liver would
necessarily increase these morbid effects.   The cirrhosed  condition
of  the liver also  points  to the  former intemperate habits of the
patient, and  the effects of  these upon the constitution, no doubt
influenced materially the course of the disease.  As far as my  ob-
servations  upon malarial fever extend,  I can assert that this disease
most frequently proves  fatal in  those  who  have been  addicted  to  the
intemperate use of ardent spirits, and  especially in those in whom a
cirrhosed condition of the liver has been induced by the free use of ardent
spirits.  This statement  is worthy of  the attentive examination and
consideration of the profession.
   It is probable that  the fibrinous clots found  in  the  heart  were
formed some time before death, and if they did not determine, they
at  least hastened  the fatal termination.
   5. In  this  case the  marked reduction of the temperature of the

 The moment I could  distinguish the disease, I bled, in order to render circulation
 through the lungs and  heart less difficult and obstructed.  This evacuation was
 never repeated without great  caution, and the most evident necessity.  After this
 I gave calomel in doses of five grains, guarded with opium, every fourth hour, and
 continued it until salivation was excited.  Under this treatment I lost not a single
 patient, the  fatal  terminations having taken place before  I could  carry it fully
 into execution.
   "A pneumatic physician would probably refer all to the  hydrocarbonate of the
 marshy exhalations, and attribute the cure to the oxygen disengaged from the
 mercury, assisted by the stimulus of the metal. Whether such might be correct
 reasoning or not, I am certainly induced to consider the history taken  altogether
 as an illustration of  the theory of the curative action  of mercury in the system ;
 and as such I have  judged it worthy of the reader's notice."  (An Essay on the
 Malignant Pestilential Fever introduced into the West Indian Islands from Boullam,
 on the Coast of Guinea, as  it appeared in  1793, 1794, 1795, and  1796.   By C.
 Chisholm, M. D.  London, 1801, vol ii.  Appendix No. 6, pp. 454—460.) 
392
OBSERVATIONS ON
 trunk and extremities was unattended by the shivering and sensa-
 tions of cold characteristic of the chill of intermittent and remittent
 fever.
   The observations which I have recorded have established that in
 the chill of intermittent and remittent fever the temperature of the
 trunk is actually elevated several degrees above the normal stand-
 ard, whilst the temperature of the  extremities is depressed many
 degrees below the normal standard.  In this state of things we find
 a feeble pulse, feeble  circulation of the  blood in the  capillaries of
 the extremities, diminished chemical action in the capillaries of the
 extremities, accumulation of blood in the large organs of the trunk,
 and increased chemical change in the blood and large organs of the
 trunk.  This state of things is attended by shivering of the muscles
 and a sensation of cold, just as a  similar reduction of  the tempera-
 ture of the extremities in cold weather would be attended by shiver-
 ing of the muscles and a sensation of cold.
   On the other hand, in that form of malarial fever called congestive
fever, where the temperature of both the trunk and extremities is
 depressed, the patient often complains of no sensation of cold, and,
 in some instances, even says that  he feels perfectly  well, and there
 is no shivering of the muscles.   Here we find a feeble general and
 capillary  circulation  and an arrest and perversion  of chemical
 action, both in the trunk and in the extremities.
   Whence this difference?
   Without attempting to decide dogmatically upon the solution of
 these complicated phenomena, we would simply state  that in con-
 gestive fever the  chemical changes in all  parts of the body  are so
 diminished  and  perverted, and the correlation  of the forces  so
 disturbed, that the muscular system ceases to indicate by shivering
 and aberrated action,  and the nervous system ceases to indicate by
 the  sensation of cold, the depression of temperature consequent
 upon the arrest of capillary circulation and chemical change.   As
 muscular and nervous force,  and  even  sensation, depend upon
 chemical  change, it is but reasonable to suppose  that a marked
 perversion and diminution of chemical change should  be attended
 by an arrest of muscular and nervous action, and even of sensation.
 In congestive fever, whether from peculiarities of constitution or
 from the overwhelming  amount  of the poison introduced, those
 chemical changes are  not excited, which result in the  breaking up
 and removal of the malarial poison.
   The febrile excitement following the chill  of intermittent  and 
MALARIAL FEVER.
393
remittent fever, appears to be due to the equalization of the general
and capillary circulations; and to the distribution through the blood-
vessels and  capillaries of all parts of the body, of  the substances
undergoing  active chemical changes, developing high temperature,
which during the chill were confined to the trunk.
  The equalization  of the capillary and general  circulations is,
without doubt, dependent  in great measure, primarily, upon the
action of  the sympathetic  nervous system; and, perhaps, may be
secondarily  and  remotely  affected  by  the action of the cerebro-
spinal nervous system.  We say dependent in great measure, but
not absolutely,  and entirely, upon the sympathetic nervous system;
because the malarial  poison may  act, in addition to the modes
already pointed out, directly upon the fibres of the heart, and thus
influence  circulation,  and   through it  respiration, and chemical
change, and temperature, and muscular and nervous force, and the
manifestation of intellectual phenomena, independently altogether,
of any direct and primary action upon either  the  sympathetic or
cerebro-spinal nervous systems.
  It  is highly probable that,  during the febrile excitement, the
malarial poison is drawn into the round of chemical changes, and
so altered, that its action is for a time  suspended.  Hence the in-
termission,  or remission.
   The fever, then, is  a favorable symptom, and the want of fever, a
most unfavorable symptom; and if these views be true, the paroxysms
of malarial  fever are due to the alterations and  partial destruction
of the poison during the active chemical changes of the febrile ex-
citement.
  The manifest duty of  the physician in congestive fever (if  these
views, which have been suggested by the results of actual observa-
tion and experiment, be. correct), is  to  administer  those remedies
which will  excite the general and capillary circulations—excite
chemical change—excite fever, and arouse into vigorous action the
sympathetic nervous system, and destroy, or counteract, or paralyze
the action, or eliminate the malarial poison.

Case illustrating the Power  and Rapidity of  the Action of the
  Malarial Poison  in Congestive Fever and Changes of Blood in
  the Liver and  Spleen.
  American seaman;  age 25;  height 5 feet 9 inches; weight 150
pounds; dark complexion, dark-brown  hair, brown eyes.
       26 
394                  OBSERVATIONS  ON
  October 19, 1857, 8 o'clock P. M.  This patient entered the hos-
pital three hours ago, at 5 o'clock P. M., in an almost  insensible
condition.  Now  he  is aroused with great difficulty and answers
incoherently. Extremities cold. Pulse 80, feeble.  Head  and trunk
cooler than  normal.   Tongue  by the gas light appears clean, soft,
and normal in color.
  R.—Cut cups to each temple and back  of neck.
  R— Mustards to extremities and over epigastric region.
  R.—Sulphate of quinia gr. v;  camphor gr.  ij.  Mix, and admi-
nister every three hours until fifty grains of the sulphate of quinia
have been taken.
  B.—Spirit of  mindererus,  brandy, and  infusion of  snakeroot
foss of each, alternately every half hour.
  20th,  9 o'clock A. M. Lies in a  profound coma.  This  came on a
short time after the first  observation yesterday evening.  The cut
cups aroused him partially for a few moments, but he soon relapsed.
Mustards have been applied to the extremities and epigastric region
three times during the night; they failed to rouse the brain;  they
excited  the capillary  circulation and  induced  an elevation of  tem-
perature, but did not restore reason.  The stimulants also failed to
arouse the intellect.   Whenever the mustards were removed  and
the stimulants withheld  his surface became   cool and  the pulse
diminished in volume.  It  is evident, then, that the mustards and
stimulants excite  the general and  capillary circulation, and  induce
an elevation of temperature, but they do  not arrest the disease.
During the night has passed his urine and feces in bed.  Pulse 140,
full.   The sounds of the heart are not distinct; they cannot be dis-
tinguished, but  sound to the ear like one sound.  The beating of
the heart-sounds stronger even than in health.  The sounds of the
heart correspond in frequency to  the beat of the  pulse,  140 to the
minute.  Respirations 40, spasmodic.  Temperature of atmosphere,
70° F.;  temp, of hand, 104°; temp,  in axilla,  104.5°.   Great  ten-
derness of epigastrium.  Whilst  neither  shaking nor  loud  talking
will arouse him,  pressure upon the epigastrium causes him  to emit
a short  cry.  The epigastrium and region of the  liver feel to the
hand warmer than the head or any other part of the  body.  Com-
plexion very sallow.   I administered gr.  xxx of sulphate of quinia
in foij of  brandy.  It was with great difficulty that  the  spoon was
forced between his clenched teeth.  The  dose  had not been swal-
lowed more than  a  few  moments before it was  ejected violently,
apparently without any effort or consciousness on the part of the 
MALARIAL FEVER.
395
patient.  This dose was again repeated, and his trunk and extremi-
ties covered with mustards, and bottles of hot water applied to the
feet, without producing the slightest good effects.   This patient died
one hour and a half after these observations.

             AUTOPSY TWENTY-FOUR HOURS AFTER DEATH.

   Body not emaciated ; apparently in full flesh.  Has the marks of
a large ulcer over the superior portion of the sternum.  Skin  of
the dependent parts of the body of a purplish hue.   The discolora-
tion of the skin commences about  the middle of  the  body and
gradually increases downwards, until the most dependent portions
are of a deep purple color.
   Head.—When the skullcap  was  removed, much blood  flowed
out.   Arachnoid membrane opalescent, in  a few spots.  Blood-
vessels of pia mater filled with blood.  Bloody serum was effused
between the arachnoid and pia mater.   Bloodvessels at the base of
the brain  and  surrounding the medulla oblongata and superior
portion of the  spinal cord, congested with  blood.  Blood was ef-
fused upon the  base of the brain.   This blood was fluid, and con-
tained no coagula.  The substance of  the  brain was normal  in
consistence and appearance.
   Chest.—Heart, normal; right auricle and  ventricle  contained  a
small  clot, left  heart empty.   Lungs, normal; dependent portions
congested with  blood. Bloodvessels of superior portions  almost
entirely  free of  blood.
   Abdomen—Liver.—A large  portion of the surface of the liver
presented  the  healthy Spanish brown color, and,  when cut, the
substance presented the usual healthy color.   Other portions, how-
ever, presented  a mottled appearance of Spanish  brown and dark
purple, and the  bloodvessels of these parts appeared to be engorged
with blood.  The right lobe of the liver had  upon  its under surface
a spot about two inches in diameter, of a dark slate (malarial) color.
 When an incision was made through this portion  of the liver, it
presented  for the depth  of about one-fourth of an inch, the true
bronze color.   Numerous incisions were made into the liver in all
directions, so as to  expose its substance fully to view; portions
were found approaching  in  color the bronze hue of the malarial
 fever liver; the great mass of the liver, however, resembled more
 nearly that of a healthy liver, engorged with  blood.  Portions from
 different parts  of the liver were examined  under the microscope. 
396
OBSERVATIONS ON
 The liver cells from the slate colored and bronzed portions did not
 differ in appearance, under the microscope, from those of the nor-
 mal colored, or from  those of the mottled portions.  The colored
 corpuscles appeared to be more altered in form in  the bronzed
 portions than in the  normal colored portions.  The alterations,
 however, even in the bronze portions, were small and  by no means
 universal, but confined comparatively to a few, and,  after all, the
 difference may have been imaginary.  The determination of com-
 parative alterations of this kind is  not so easy as at first sight
 appears. Did not discover any of those dark granules in the bronze
 portion, which have been said to impart the peculiar color  to the
 liver.  From the cut surface of the liver, much black blood issued,
 which assumed, upon exposure to the atmosphere, the arterial hue.
 The liver-cells did not appear to  be altered in any manner.
   Gall-bladder, filled with  bile.   Specific gravity of  bile, 1042.5.
 Viewed  in mass, the  bile was  of a brownish-black  color, with
 greenish reflections, and  resembled, upon a general view, a satu-
 rated tincture of iodine.  It resembled, and poured  like  molasses,
 being thick and  ropy.  Upon close inspection, the bile was  found
 to contain  numerous  flakes  of  a green color, which, under  the
 microscope, were found to consist of the conglomerated cells of the
 mucous membrane of the gall-bladder.   When spread out in thin
 layers, the bile presented  a gamboge,  yellow color.
  Pancreas, normal.
  Spleen, slate colored, softened and enlarged ; not as  much softened
and altered, however, as in cases  of malarial fever of longer stand-
ing.   The mud of the spleen was of a dark purplish hue, and ap-
peared to be in transition to the color and state of the mud of the
spleens of malarial fever of longer duration.  After  exposure for a
few hours to the oxygen  of the atmosphere, a large  portion of  the
mud of  the spleen assumed a color approaching the arterial hue,
much brighter than the  mud of the  spleens upon which malarial
fever had exerted its full effects, and somewhat darker  than  the
bright arterial hue assumed by the splenic mud  of healthy, normal
spleens.  When  the splenic mud was spread in  thin layers upon a
glass slide,  the change of color was much more rapid.  Under the
microscope, the splenic mud appeared to consist almost entirely of
colored corpuscles, many  of which appeared swollen and altered in
appearance.   After careful examination, I was unable to find  those
conglomerations  of black granules, resembling the black  sediment
of black vomit, which were discovered in other malarial spleens. 
„,:^
                      MALARIAL  FEVER.                  397

  Kidneys, normal. Bladder contracted ; contained no urine.  Scro-
tum red, and apparently scalded.   This was due most probably to
the acrid urine,   I have  observed this effect of the urine upon the
scrotum in many cases of malarial fever of the severest types.
  Alimentary and Intestinal Canal.—The mucous membrane of the
stomach  presented two well-defined portions:  the mucous mem-
brane of the lesser curvature of  the stomach was pale and normal
in appearance; the mucous membrane of the greater curvature and
pyloric extremity, and of  the pylorus, was  of a purplish color, and
ecchymosed in crimson spots.   The bloodvessels of  the greater
curvature and of the pylorus were congested with blood.  Mucous
membrane of the  superior portion of the jejunum congested with
blood.  Valvulae conniventes, especially at the edges, ecchymosed
in spots of a purple and  scarlet  color.  Mucous membrane of the
lower portion of  the ileum greatly congested with blood.  Peyer's
glands somewhat enlarged, more distinct and elevated than usual,
but pale, and not congested and inflamed as in typhoid fever.  Soli-
tary glands enlarged and distinct.   Mucous membrane of colon
greatly congested with blood.

                          CONCLUSIONS.
  1. The slight alteration of the  color of the liver; the change of
the blood  of the liver  to the arterial hue upon exposure to the
atmosphere;  the  change of the splenic  mud to the arterial hue-
all prove that this patient had died very soon after the commence-
ment of the  malarial fever.   As we have seen, the patient  was
unable to answer any inquiries with reference to the history of his
case.   So convinced was I that this was a case of only one or  two
days' standing, that I sought out  the captain of the vessel to  which
this patient belonged, and made minute inquiries.   The captain
stated that this man was the cook on the vessel.   One month ago,
whilst the vessel  was lying in the Santee Eiver of South Carolina,
this patient was taken with a fit.  This was  relieved in a few hours,
and was  not  followed by  fever; and the patient appeared to suffer
no ill effects, and resumed his duties.   Two weeks ago the captain
brought  his vessel to Savannah.   This patient has been sleeping
on board the ship at night up to  the  time  of his entrance into the
hospital.  He was well, active, and attentive to his duties, up to
5 o'clock P. M.,  October  18, when he  was suddenly seized with
vomiting, cold extremities, complete prostration, and delirium.  He 
398
OBSERVATIONS  ON
had cooked dinner this day, and was attending to his duties at the
time of this sudden attack.  He had, however, "a singular  look
out of his eyes," which attracted the attention of the captain, and led
him to inquire if he was well; the patient answered yes, and com-
plained of nothing.  Whilst sick on board the ship, he complained
of no pain; and, before  the complete loss of reason, said  that he
felt well.  The next day, the 19th inst., he was sent to the hospital
at 5 o'clock P. M.   I saw him for the  first time at  8 o'clock P. M.
He died at 12 o'clock M. the next day.   This patient, then, died after
forty-three hours' sickness.
   2. The general and capillary circulations were easily aroused by
stimulants; the temperature of the body, under the action of stimu-
lants, was elevated above the normal standard ; there was  a corre-
lation between the temperature of the  trunk and extremities; the
chemical changes appeared to be  amply sufficient for the develop-
ment of the muscular and nervous forces; and the liver and spleen
had  undergone  comparatively but slight alterations.   The  most
prominent apparent cause of death was the effusion of blood  upon
the base  of  the  brain.  The fit which occurred one month ago
points to a previous derangement of the cerebro-spinal system.
   AVas the effusion of blood upon the brain the result of the action
of the  malarial poison  alone, or the result of the action of the
malarial poison upon the delicate structures of the  brain already
altered by previous disease?  It is impossible to decide these ques-
tions positively, but all our observations upon malarial fever would
lead us to accept the latter supposition.  We regard the action of
the malarial  poison as depressing, and not inflammatory.  Cerebral
disturbances in malarial fever appear to be due—first, to the direct
action  of the malarial poison and of the altered  blood upon the
 nervous  structures;  and, secondly, to the stagnation  and  accumu-
 lation of blood in the capillaries and bloodvessels of the brain, due
 to the diminished action of the  heart, arrest and perversion of che-
 mical change in the blood of the capillaries, and loss of power in
 the capillaries themselves.  If by previous disease, arising of itself,
 or induced by the intemperate use of ardent  spirits, the capillaries
 and bloodvessels of the brain and its membranes lose their tonicity,
 elasticity, and coherency, the simple stagnation and accumulation
 of blood may  be attended by a rupture of the  altered vessels
 without any inflammatory action.  A strong confirmation of these
 views  is the fact that the vigorous administration of the most active
 stimulants, conjoined with sulphate of  qu:nia, is the  most efficient 
MALARIAL FEVER.
399
mode of preventing, arresting, and relieving the coma and delirium
of malarial fever.   If the action of the  poison was inflammatory,
this  would not  be the case.  The preceding case shows  that we
may have symptoms of inflammation of the brain in malarial fever,
without a single pathological alteration after death, cognizable to
the unaided senses.
   We say cognizable to  the unaided senses,  because the thorough
knowledge of the nature of malarial fever demands, amongst many
other things, a  thorough knowledge, not only of the  appearance
and  chemical constitution of the structures of the cerebro-spinal
and  sympathetic nervous systems, but  also a thorough knowledge
of the physical, chemical,  and  pathological alterations of these
structures when acted upon by morbific agents.
   We are  actuated by no disparaging  spirit, when we assert that
in the present  state of chemical, physiological,  and  pathological
science, we are wholly ignorant of the chemical, physiological, and
pathological  relations of the malarial  poison to  the  nervous ele-
ments.
   In those cases in which the cause of  death was  not found in the
pathological  alterations of the organs and tissues,  the question im-
mediately arises, what destroyed life ?
   In the present state of medical science we can offer suppositions,
but  we can  give no decided answer.   How difficult would it be to
prove or disprove, that the malarial poison produced  death by its direct
action upon the nervous system, in a manner analogous to  the action of
some of the  violent alkaloid and  metallic poisons?   We know that
some substances, as chloroform, will produce sudden death in some
cases, when  there  is no assignable cause either in the structures
and forces of the patient, or in the pathological alterations pro-
duced.
   This peculiar action is said to be due to the idiosyncrasy of the
patient.  May not the fatal action of the malarial  poison be due in
some cases to the idiosyncrasy of the patient ?  Has any one ever
determined upon what an idiosyncrasy depends ?
   3.  A comparison of the autopsy of this case with that of previous
cases shows that in the first stages of malarial fever the  liver is first
engorged with blood, and the slate and  bronze color is not at first
universal, but confined  to  definite portions.  It  is an interesting
fact that in the present case the solitary glands were found enlarged
even at this  early stage of the disease.   The mucous membrane of
the stomach  and intestines presented marks  of congestion, if not of 
400
OBSERVATIONS on
inflammation.  This  condition of the mucous membrane is by no
means characteristic of malarial fever, even when there is great
tenderness  upon pressure of the epigastrium.  Tenderness here
may be due rather to the state of the spleen and liver.  The obser-
vation which we made upon previous cases is also true with regard
to this, that the slate and bronze  color of the liver is not due to
the formation and distribution through the liver of peculiar dark-
colored granules.
  4. Although the stimulants and sulphate of quinia did not cure
the disease, still they aroused the capillary and general circulation,
and induced the chemical changes.


  The following Tables, drawn up after the  Careful Examina-
tion of Three Hundred Cases of Malarial Fever, will present a
Comparative View of some of the most striking  Phenomena of the
Different Forms of Malarial Fever :— 
INTERMITTENT  FEVER.
COLD  STAGE  (CHILL).
Date.
Hour OF
  DAY.
State op Intellect, Skin, Tongue, Pclse,
           Respiration, &c.
		O	0	oi
05 ■3 P4	0 "p.	o> <£ 0 03 SSg-Ii	0> U 0 Is N EH""	0) 0 a3 »0
70	22	68.0°	92.0°	99.5°
108	30	74.0	91.0	10.5.5
100	26	68.0	91.5	107.0
100	26	68.0	87.5	107.0
92	32	77.5	91.0	103.0
100	36-50	71.5	92.0	104.0
		79.0	90.0	102.0
120	22	79.0	89.0	102.25
Characters of Urine.
Sept. 30
 "   30
Oct.  10
  5 P.
12£P.
1 P. M.
Intellect clear; tongue clean, moist, red at tip and
  edges; papillae enlarged, and of a bright red color;
  skin  cool and relaxed ; pulse feeble; saliva acid.
Extremities cold ; head and trunk hot; pulse feeble.
Tongue pointed, but moist, and not much redder
  than usual; skin of extremities cold, of head and
  trunk hot, and presents a purplish  mottled  ap-
  pearance ; pulse small and feeble; saliva acid.
        Do.           do.           do.
Lips and fingers pale, and of a bluish color; extre-
  mities cold, whilst the trunk is hot;  pulse  small
  and feeble.
Shaking violently ; lips and hands look blue; pulse
  small,  feeble, and rapid; respiration full,  pant-
  ing, and irregular.
        Do.           do.           do.
         Do.           do.           do.
Light orange color; sp. gr. 1010; reaction strongly
  acid; no deposit after standing 70 hours.

        Do.           do.           do.
Urine excreted during the chill clear and limpid, of
  a light straw color; sp. gr. 1003; reaction strongly
  acid; slight deposit of triple phosphate after 60
  hours.
        Do.           do.           do.
Urine excreted during the chill normal in color ; sp
  gr. 1023.
HOT STAGE (FEVER).
   1
11
Oct.   fi
Sept. 17
Oct.   3
Aug. 18
Pain in bones of legs; slight tenderness of epigas-
  trium ;  tongue clean, moist, red at tip and edges;
  papillse red and enlarged; skin hot and dry; saliva
  acid; pulse full.
        Do.           do.           do.
Fever subsiding; pulse full, but soft; tongue moist;
  skin in a profuse perspiration.
Skin hot and dry.
Skin hot, dry, and pungent to the hand; lips parched
  and dry;  tongue dry and red; no tenderness of
  epigastrium ; pulse full, strong, and bounding.
Chill just going off.
Tongue red at tip, but moist and soft; skiu hot and
  dry; saliva acid; pulse full and bounding; com-
  plains of pain in head.
Great thirst, and paiu in head and back; tongue
  coated in the middle with yellowish fur, pointed
  and red at the  sides and tip; skin hot and dry;
  pulse full and strong.
120	32	79.0°	103.3°	106.0°
108 98	32	73.0 72.0	103 5 102.5	105.0 103.0
100 120	26 40	67.0 72.0	102.0 105.75	107.0 106.0
112 100	28 26	90.0 77.0	100.0 105.0	104.0 106.0
100	36	90.0	106.0	106.0
Color of urine light orange;  sp. gr. 1011; reaction
  strongly acid; no deposit after 60 hours.
Color of urine normal;  sp. gr. 1020; strongly acid.
Orange colored; sp. gr. 1025; clear; reaction strong-
  ly acid; no deposit after 60 hours.
Specific gravity 1015.
Light orange color ; sp. gr. 1022; reaction strongly
  acid; no deposit.
Urine of a deep orange color, and docidcd acid  re
  action; sp. gr. 100S. 
INTERMITTENT FEVER—Continued.
HOT STAGE (FEVER)—Continued.									
d « o	Date.	Hour of DAT.	State of Intellect, Skin, Tongue, Pulse, Respiration, &c.		0 O ca 'p.	cm O la as	O P 0 0> «-«	d 0 0 ll	Characters of Urine.
d				0	OJ	S*	g*	05 a	
f	Sept. 11		Tongue slightly furred, not redder than normal; no	116	30	80.0°	102.5°	103.0°	Deep orange ; sp. gr. 1018; reaction strongly acid;
,21			tenderness of epigastrium ; pulse full.						no deposit after 70 hours.
	" 12		Tongue moist and slightly furred; reaction of saliva	100	24	82.0	102.1	103.9	Orange colored; sp. gr. 1022.
I			acid ; skin hot.						
13	" 7		Skin warm and moist; tongue slightly coated; no pain upon pressure of epigastrium.	108	24	82.0	103.7	105.0	Deep orange colored; sp. gr. 1020.8 ; after standing 39 hours, small deposit of urate of soda.
14			Sk)n hot and dry; pulse full; saliva acid.	108	28	85.0	104.0	105.0	
15	Oct.' 3		Skin hot and dry; tongue red at tip, but moist and soft; pulse full and strong.	100	26	77.6	105.0	106.0	Reaction strongly acid; no deposit after standing several days.
16	July 8		Skin hot and dry; tongne dry; papillae enlarged; tongue covered with thick yellow fur.	88		82.0	105.0	106.0	Deep orange color ; after standing several days, slight deposit of mucus and vegetable cells.
INTERMISSION.									
-	Sept. 30	1P.M.	Skin cool and relaxed ; pulse soft; tongue clean and moist, red at tip and edges ; papillae enlarged, and of a bright red color; reaction of saliva decidedly acid. This intermission was followed by high fever.	70	22	68.0°	92.0°	99.5°	Reaction of urine strongly acid; sp. gr. 1008; after standing 48 hours, a light deposit of vegetable cells, but no salts ; orange colored.
17-	Oct. 3		Tongue clean and moist, only a shade redder than	62	20	74.0	96.0	98.5	Urine normal in color ; sp. gr. 1010; reaction slightly
			normal; papillae still enlarged and distinct; saliva						acid ; in 20 hours changed to alkaline, and threw
			acid.						down a heavy deposit of phosphates and urate of soda. Color normal; sp. gr. 1018; changed from acid to
	" 4		Tongue clean, moist, and soft; papillae only a shade	60	20	72.0	96.0	99.5	
			redder than normal; saliva acid.						alkaline in 8 hours, and let fall a heavy precipi-tate of urates and phosphates.
18	" 13		Tongue and skin normal; saliva slightly acid; dur-ing the height of the fever, it was intensely acid. High fever three days ago.	68	16	78.0	98.0	99.0	Sp. gr. 1012; color normal; alkaline reaction, and heavy deposit of phosphates and urates in 12 hours.
f	" 7		Tongue clean and normal. Two days ago, had high	64	20	73.0	94.5	99.0	Normal color; sp. gr. 1030; reaction alkaline in 16
J			fever.						hours, and heavy light-yellow deposit of urates
									and phosphates.
[	" 8		Do. do. do.	52	24	73.0	98.2	99.5	Alkaline reaction, and heavy deposit in 14 hours.
20	Aug. 21		Two days before, had high fever. Tongue and skin moist. Had fever on the preceding day. Tongue and skin	72	17.5	80.0	96.0	98.0	Sp. gr. 1009 ; alkaline, and heavy deposit in 16 hrs.
21	Sept. 14			65	24	85.0	96.0	98.0	Sp. gr. 1021; alkaline, and heavy deposit in 20 hrs.
			moist.						
 
REMITTENT FEVER.
COLD  STAGE (CHILL).
Date,
 Hour
of DAY,
State of Intellect, Skin, Tongue, Pulse,
           Respiration, &c.
				
		o		©
				o> a
	0 o	<- s	&.	t. 60
			2	0 0
		2 &	cS	-8S
				
d	'&	aS	ag	II
Ph	«	S*	£*	E-i P
92		75.0°	83.0°	101.5°
110	45	70.0	97.0	104.0
Characters of Urine.
Oct.   9
Pulse very feeble, resembles the vibrations of a fine
  thread, with  difficulty counted;  respiration  acceler-
  ated and irregular ; lips and fingers blue;  reaction of
  saliva intensely acid;  extremities cold;  tongue dry
  and red.
Respiration rapid, thoracic, panting;  extremities cold;
  tongue dry, red, and rough ; saliva strongly acid.
High colored, like new Madeira wine; sp. gr. 1022;
  strongly acid ; amount of iron increased ; no deposit
  after 60 hours.
High colored, dark brownish red ; strongly acid ; sp.
  gr. 1020; iron increased; no deposit after 70 hours.
HOT STAGE  (FEVER).
r	Sept. 10	7 P. M.
24-	" 11	11 A. M.
25	" 11 Oct. 15	7 P. M 12 M.
26		
	Sept. 16	7 P. M.
27-		
	" 18	12 M.
' I		
Tongue pointed and red at tip and edges, superior por-
  tion coated with black fur, dry and rough; skin hot,
  dry, and rough ; great thirst, and pain in head ; reac-
  tion of saliva strongly acid ;  pulse full.
Tongue red,  dry, and glazed ; skin dry, hot, and harsh ;
  no pain of epigastrium;  intellect dull; face as red as
  scarlet.
          Do.            do.           do.
Lips and tongue dry, red, and rough ; epigastrium very
  tender upon pressure ; skin dry and hot; pulse rather
  feeble ; respiration full and irregular ; intellect dull ;
  saliva strongly acid.
Intellect torpid ; aroused with difficulty ; apex of tongue,
  for about  half an inch,  clean, red, and dry ; the re-
  mainder of  the tongue  is coated with rough,  dry,
  brownish-black and yellow fur ; no tenderness of epi-
  gastrium; skin hot, dry, and rough.
Face as red as scarlet;  lies in  a stupor; skin in a pro-
  fuse perspiration : tip and middle of tongue clean, and
  of a bright red color; root of tongue coated with yel-
  low fur"; tongue rough  and perfectly dry ; when the
  finger is'passed over the tongue, it feels as dry and as
  rough as a board ; great  tenderness upon pressure of
  epigastrium.
Tongue preseuts the same appearance; continues in a
  stupor; pulse feeble.
90	48	80.0°	103.0°	105.0°
88	34-40	82.0	103.2	105.0
90 106	40-44 30-40	81.0 74.0	104.0 101.0	104.8 105.0
90	30	74.0	105.0	106 0
100	24	88.0	102.0	103.2
98	32	87.0	103.0	104.0
High colored, like new Madeira wine; sp. gr. 1020
  iron increased.
Reaction strongly acid ; after standing 48 hours, threw
  down a small deposit of regularly-formed crystals
  of triple phosphates.
          Do.          do.          do.
Urine high colored, of a deep brownish red color;  sp
  gr. 1028 ;  strongly acid.
Deep orange color;  strongly acid; sp. gr. 1020; no
  deposit after 60 hours ; still acid.
Unusual secretion of urine; the amount much larger
  than usual in remittent fever; specific gravity cor-
  respondingly diminished;  orange  colored; sp. gr.
  100S ; strongly acid; no deposit.
Light straw colored; sp. gr. 1010; reaction strongly
  acid. 
REMITTENT  FEVER—Continued.
HOT STAGE (FEVER)—Continued.
Date.
 Hour
of DAY
State of Intellect, Skin, Tongue, Pulse,
           Respiration, &c.
				
		o	o	03
		o> ©		o> 3
	a	0 0>	3	t. 60
		a-a	o3	•S2
d "3	'3.	N	ag	H
	pa	£«	g*	£*
112	38	81.0°	103.0°	104.0°
132	47	80.0	104.0	105.0
Characters of Urine.
Aug.  7

  "   11
11 A. M.

10 A. M.
Skin hot, but in a profuse perspiration; tongue coated
  with yellow fur, dry and rough ; lies in a stupor.
Continues stupid, and' almost insensible; passes urine
  and feces in bed;  body has a peculiar, disagreeable
  smell;  tongue coated and dry.
Reddish-orange colored ; sp. gr. 1013; reaction strongly
  acid.
Urine normal in color ; sp. gr. 1011.3.
REMISSION.
' Sept. 12	12 M.
" 12	9 P. M.
" 13	11 A. M.
" 14	IP. M.
" Oct. 16	
" 16	12 M.
Tongue very red, but softer and moister than during the
  fever ; the dry, yellow, and brown fur has commenced
  to clean off; slight tenderness of epigastrium.
Skin moist and relaxed;  tongue softer and not so red ;
  pulse regular and soft.
Tongue continues to improve.

Tongue and skin normal.

Intellect restored ; tongue red, but soft and moist; skin
  dry, but soft;  saliva strongly acid.
Tongue moister and  softer, not so red as in fever; pos-
  terior portion still coated with brownish-yellow fur.
70	26-36	83.0°	100.7°	102.5°
70	53	83.0	99 1	101.5
52	48	85.0	97.0	100.0
58	28	87.0	99.0	102.0
84	16	69.5	99.0	99.5
75	20	70.0	101.3	101.5
Urine high colored, brownish-red ;  sp. gr. 1019; reac-
  tion decidedly acid ; after 4S hours, small deposit of
  vegetable cells, urate of soda, and triple phosphate.
Brownish-red ; sp. gr. 1020; strongly acid.

Orange colored ; sp. gr. 1024; reaction alkaline; heavy
  deposit of the urates and phosphates in 15 hours.
Orange colored ; sp. gr. 1025; reaction alkaline; heavy
  deposit of urates and phosphates in 15 hours.
Deep orange  red;  strongly acid;  after standing 13
  hours, slight deposit of mucus corpuscles ; after 100
  hours, small light yellow deposit of mucus  corpus-
  cles, urate of ammonia, and vegetable cells.
Bright red color ; sp. gr. 1020; after standing 15 hours,
  slight deposit of urates and phosphates.
INTERMISSION.
, f	Sept. 16
	" 17
32-	" 18
33 34 3.3	" 19 " 22 Oct. 17 ' " 17 « 8
36.
          8 P. M.;Skin cool, moist and relaxed ;  tongue soft and moist.
                j   but slightly redder than normal.
         11 A. M.           Do.           do.           do.

         12 M.   i Pulse, skin, and tongue normal.

         12 M.              Do.           do.           do.
         12 M.   |           Do.           do.           do.
         12 M.   jTongue red, but clean and soft;  saliva acid.
         11 P. M.jTip of tongue  clean, superior portion coated with fur.
                Tongue soft and moist; saliva acid.
Sept. 30 111 A. M. Tongue red, but soft; intellect restored.
Oct.   1 11 A. M.i           Do.           do.           do.
47	28	87.0°	95.9°
44	24	84.0	96.0
44	24	86.0	96.2
44	24	88.0	97.0
44	24	84.0	97.8
70	16	67.0	97.3
68	18	68.0	98.0
54	18	uS.O	9l>.0
68	22	80.0	9.3.5
66	20	71.0	95.0
99.0°  Shade higher colored than normal; after 12 hrs., heavy
     ]   deposit of urates and phosphates ; sp. gr. 1019.
99.0   Reaction alkaline in 16 hours, with heavy deposit of
        urates and phosphates ; sp. gr. 1018.
99.0   Color normal;  great increase of uric acid ; in 8 hours,
        heavy deposit of urates and phosphates; sp. gr. 1020.
99.0             Do.           do.          do.
99.1             Do.           do.          do.
98.5   Deep red color ; sp. gr. 1022.
99.5   Deep orange color; sp. gr.  1022.
99.0   Only a shade higher than normal; sp.  gr. 1020.
97.0
97.1   Orange colored ;  sp. gr.  1013. 
Hour of
  day.
State of Intellect, Skin, Tonuue, Pulse,
            Respiration, &c.
Oct.  17


 "   18
38hj	
	Aug. 21
39.	" 22 " 23 " 26
40-	
	" 27
	' Sept. 29
41-	Sept. 30 Oct. 1 " 4 " 5 " 10
11 A. M.


11 A. M.
9£ P. M.
 1 P. M.
1 P. M.
12 M.
12 M.
12 M.
12 M.
 7 P. M.
11 A. M.
 7 P.M.
2J P. M.
 2 P. M.
 2 P. M.
 2 P. M.
 4 P. M.
Intellect wandering; tongue dry, hard, and rough, and
  coated with dry, brownish-yellow fur;  pulse very
  feeble ; skin cool upon trunk and extremities.
Intellect wandering ; tongue continues still as dry and
  as rough as a board ; pulse exceedingly feeble ; trunk
  and head cold; skin covered with cold, clammy sweat;
  saliva strongly acid; respiration spasmodic;  teeth
  coated with sordes.
           Do.            do.            do.
Tongue perfectly dry and  rough, feels like sand-paper;
  bright red color.
Severe vomiting and purgation ; skin of head and ex-
  tremities bathed in cold clammy sweat.

Severe pain in head ; tongue thickly coated with yellow
  and  black  fur, tip and  edges clean, and  of a scarlet
  color; dry and rough.
           Do.            do.            do.
           Do.            do.            do.
Pulse very feeble; skin of trunk and head cool; tongue
  dry, rough, and coated.


           Do.            do.            do.
           Do.            do.            do.
Tongue slightly coated with yellow fur, dry and harsh
  to the feeling; intellect stupid ;  pulse very feeble,
  with difficulty counted.
           Do.            do.            do.
           Do.            do.            do.
Restless and stupid ; tongue the same.
           Do.            do.
Restless and stupid ; skin hot, dry, and rough.
           Do.            do.            do.
]VER.
68.5°

71.0


80.0
81.0
78.0
71.0
87.0
83.0
80 0
73.0
79.0
76.0
73.0
70.0
100.0°

 79.0
99.0
89.0
95.5
98.0
90.0
95.1
 91.0
 88.5
100.5
100.0
103.7
a 0
g*
Characters of Urine.
106.0°

 97.0
104.0
 96.0
 98.0
98.5
97.0
97.0
96.0
94.5
104.0
104.5
Clear amber colored; sp. gr. 1015;  reaction
  strongly acid ;  after standing 60 hours, the
  reaction was still decidedly acid.
The urine contained no urea, and no uric acid
After 90 hours, no deposit.
Urine light colored ; sp. gr. 1020; urea and uric
  acid greatly  diminished; reaction strongly
  acid.
Urine orange  colored, several shades  higher
  than in health, but much less highly colored
  than usual in severe cases of malarial fever
  sp. gr. 1009 ; contained no uric acid.
        Do.          do.         do.
        Do.          do.         do.
Bright red color;  sp. gr. 1016 ; strongly acid.
        Do.          do.          do.
        Do.          do.          do.
        Do.          do.          do.
        Do.          do.          do.
        Do.          do.          do. 
CONGESTIVE FEVER—Conitnued.
d cd o d	Date.	Hour of day.	State op Intellect, Skin, Tongue, Pulse, Respiration, &c.	d "3	a 0 "5 u 'p. 0>	O CD <n *~ t-, 8 % l!	CM O © 0 eg	v 0 0 0 32 |S a^ .3	Characters of Urine.
42-43 r "1 45J	Sept. 3 Sept. 4 5 " 6 Oct. 12 " 13 Sept. 3 " 3 " 3	12 M. 3£ P. M. 12 M. 10 A. M. 10 A. M. 12 M. 11 A. M 12 M. 3 P. M. 7 P. M.	Tongue red, dry, and rough; skin of extremities and trunk cold. Lies with mouth and eyes open, and is insensible; skin in a profuse perspiration. Skin covered with a clammy sweat, resembling bloody serum ; passes urine and feces in bed. Lies in a stupor, and emits a barking sound; muscles of body twitching violently. Do. do. do. Lies in a profound stupor; great tenderness of epigas-trium ; skin dry and rough. Intellect wandering; pulse feeble; tip of tongue clean and of a bright red color, the remaining portion coated with yellow fur, dry, rough, and harsh as sand-paper. Do. do. do. Intellect wandering; delirious and violent; tongue coated and dry; pulse feeble; respiration thoracic; skin dry. Do. skin in a profuse perspiration. Do. do. do.	140 128 106 144 140 140 137 144 140 130 120	28 33 26 42 38 40 32 30 36 36 32	75.0° 78.0 81.0 79.0 80.0 700 77.0 75.0 80.0 76.0	94.5° 101.0 100.0 103.0 105.0 104.0 103.5 1020 98.0 94.0	99.0° 102.0 101.0 104.0 106.0 104.5 104.5 104.0 99.0 98.0	1 V Could not be determined on account of rest-) lessness and stupor of the patients.
 
MALARIAL FEVER.
407
  The next subjects which demand investigation are—
  1. The  comparison of the circulation, respiration, temperature,
and chemical  changes of the solids and fluids, especially of the
urine in malarial fever, with similar phenomena in health, and in
all other diseases.
  2. The  action of the medicines employed in the treatment of
malarial fever.
  3. The  comparison of the methods and results  of treatment in
malarial fever with those of other diseases.
  4. Nature of the causes of malarial fever.
  5. Relations of malarial fever to soil, water, atmosphere,  and
climate.
  The discussion of each one  of these divisions would occupy as
much  space as the preceding  imperfect investigation  and must,
therefore, be deferred to a future time.
  In concluding  these " Observations on some  of  the Phenomena
of Malarial Fever" (which have been the result of three years' labor
and study, upon more than three hundred cases  of the  different
forms of malarial fever, in Savannah, in Liberty County, in Athens,
and in Augusta), we would again admit that they are incomplete
—in fact, nothing more than beginnings in the right direction—
and again express the hope that  the statements, and relations, and
laws  deduced from these observations, will be  tested by careful,
conscientious  observers; the errors eliminated, the imperfections
removed, the  results  enlarged, and the positive knowledge of the
phenomena of malarial fever, and of all fevers, established by ob-
servation, experiment, and reason. 
 
INDEX.
  Alimentary Canal.
    Pathological changes of in malarial fever,

    Changes in the secretions  of the  mouth
      during malarial fever, 231.
    Appearance  of the  tongue in  malarial
      fever. 232.
    Pathological alterations of the stomach in
      malarial fever, 232.
        of the intestinal canal,  232.
    Post-mortem examinations illustrating the
      pathological alterations of the stomach
      and intestines in malarial fever, 233—
      240.

 Arachnoid Membrane.
    Pathological alterations in malarial fever,
      218.
    Illustrative post-mortem  examinations,
      224—231.

 Astronomical Phenomena.
   Affect all bodies, 9.
   Gravity, 9.
   Binary stars,  and the revolution of  our
     sun  around a distant centre, illustra-
     tions of the wide reign of the  law of
     gravity, 9—11.
   Stability of the solar system, 12.
   Order and harmony of the planetary sys-
     tem, 12.
   Relations of plants  and animals to  the
     force of gravity,  and the  size of our
     globe, 13.
   Relations of the moon  to the earth, with
     its plants and animals, 14.
   Heat of the sun and fixed stars, 16.
   Researches of Pouillet upon  heat of fixed
     stars, 16.
   Relations of the fixed stars to the motions
     upon the  earth, and to the existence of
     plants and animals, 17—20.
Acalephae, blood of, 80.
Andral,  on the  changes of the blood  in
  typhoid fever, 198;  in smallpox,  199;  in
  measles, 199; in erysipelas, 200; in phthi-
  sis, 200; in acute rheumatism, 202;  in
  pleuritis, 203; in peritonitis, 203; in bron-
  chitis, 203.
------on the distinctions between the altera-
  tions  of the blood  in the pyrexiae  and
  phlegmasise, 208—210.

         27
Anemia, changes of blood in, 201.
Antony, Dr.  MUton,  on spinal irritation.
  152.                                  '
Arnold, Dr. Richard D., on the color of the
  liver in malarial fever, 244.
                   B

Blood, 75—216.
  Imperfect state of our knowledge, 75.
  Importance and  difficulty of establishing
    a standard  formula of the constitution
    of the blood in health, 79.
  The constitution of the  blood  varies not
    only with the class, but with each spe-
    cies of animals,  and corresponds with
    the development and perfection of the
    organs and apparatus, 80.
  Blood of Protozoa, 80.
          Polypi, 80.
          Acalephae, 80.
          Echinodermata, 81.
          Cephalopoda, 82.
          Amphioxus, 82.
          Garfish  (lepisosteous  osseus),
            83.
          Reptiles, 83.
          Birds and mammalia,  83.
 Chemical constitution of moist blood cor-
   puscles, 84.
 Chemical constitution of liquor sanguinis,
   84.
 Importance  of establishing the  typical
   formula of the blood in starvation, 85.
 Difficulties of establishing the amount of
   blood in health and disease, 86.
 Estimates of the amount of blood in the
   human system by Blumenbach, Haller,
   Borelli,  Young, Dumas, Fletcher, An-
   cell, Valentine, and Lehmann, and by
   the author, 86.
 Changes of the blood in malarial  fever,
   88, 216.
 Difficulties of investigations upon the blood
     in disease,  88.
 Color of the blood and serum in malarial
   fever, 91.
 Specific gravity of the blood and  serum
   in various  diseases,  as  determined by
   Becquerel, Rodier, Nasse, Zimmerman,
   Guenaud de Mussy, and Joseph Jones,
   93.
 Coagulation of the blood, 93. 
410
INDEX.
Blo o D—continued.
  Table of blood-corpuscles in 1,000 parts
    of healthy and malarial blood, 94.
  Fibrin in healthy and diseased blood, as
    determined by Andral, Gavarret, Bec-
    querel,  Rodier,   Guenaud de  Mussy,
    Popp, Wittstock, Simon, Glover, Heller,
    and Joseph Jones, 94, 95.
  Cases illustrating the physical changes of
    the fibrin, and the formation of heart
    clots in malarial fever, 96—112.
  Observations  of  Hewson,  Baillie, Mor-
    gagni, Albinus,  Burns, Stewart, War-
    drop, Cruwell, Graham, Stenzel, Meckel,
    Stoerk, Petit, O'Halloran, Martial,  Ba-
    ron, Virchow, Paget, Crampton,  Louis,
    Bougen, Desault, Duncan, Reid, Hodg-
    son, Andral, Tiedemann, Otto, Lobstein,
    Cloquet,  Carsewell,  Langstaff, and  Ri-
    chardson, on the formation of fibrinous
    concretions during life, 113—115.
  Conditions most favorable to the deposi-
    tion of fibrinous concretions, 115—117.
  Observations  of  Gairdner,   Richardson,
    Gaspard, Lee, Hewson, Thackrah, Coo-
    per, and Briicke, upon the coagulation
    of the blood, 116,  117.
  Symptoms and  diagnosis of fibrinous con
    cretions in the heart and bloodvessels,
    118—124.
  Observations of Dr. Wm. Senhouse Kirkes
    upon  the effects of detachment of fibrin-
    ous concretions during life, 125.
  Discussion of the  causes of the formation
    of fibrinous  concretions in  the heart
    and bloodvessels in malarial fever,  126
    —129.
  Principles of treatment best adapted to
    prevent the formation of fibrinous con-
    cretions in the heart and bloodvessels,
    129—132.
  Method of analyzing the blood, 133.
  Table illustrating the composition  of ven-
    ous blood in  malarial fever, 135.
  History of the  cases which furnished the
    blood for analyses, 136—171.  '
  Comparison of their results with the typi-
     cal formula of the blood in health  and
     disease, 171—211.
  Colored blood-corpuscles are diminished
     during malarial fevers, and the extent
     and rapidity of the diminution  corre-
     spond to the severity and  extent of the
     disease, 171.
  Researches of  Andral and Gavarret upon
     the blood of intermittent fever,  172.
  Composition of the blood in marsh cach-
     exia, according to Becquerel & Rodier,
     173.
  Composition of the blood in mechanical
     dropsy, 174.
  Composition of the blood in acute dropsy,
     175.
   Composition of the blood in cachectic drop-
     sies,  177.
   The fixed saline constituents of the col-
     ored blood-corpuscles are diminished in
     malarial fever, 177.
   The iron of the disintegrated blood-corpus-
     cles  appears in the urine, 178.
lood—continued.
Physiological,  pathological,  and  thera-
  peutical bearing of the changes of the
  blood-corpuscles in malarial fevers,  178
  —193.
Researches of  Schmidt upon the specific
  gravity of the  colored blood-corpuscles
  in various diseases, 179.
Relations of the  colored blood-corpuscles
  to the muscular and  nervous  system,
  179.
Principles of treatment,  based upon  the
  changes of the blood in malarial fever,
  180—193.
Injurious  effects of bloodletting in mala-
  rial fever, 180—186.
Active and excessive purgation should be
  avoided in malarial fever, 187.
Importance of nutritious diet, and of the
  phosphates and iron,  188.
Principles which should govern the admin-
  istration of  pepsin  in malarial fever,
  189.
The excretion of the products  resulting
  from the dead disintegrated blood-cor-
  puscles should be promoted by diuretics
  and depurants, and the liver and spleen
  should be roused to throw off their  per-
  verted secretions, 193.
Place of the destruction  of the  colored
  corpuscles in malarial fever, 194.
Animal  starch accumulates in the malarial
  liver;  whilst  grape  sugar  is  absent,
  195.
Alterations of the blood, and especially of
  the blood-corpuscles in the spleen during
  malarial fever, 196.
 Comparison of the changes of the blood
   in malarial  fever,  with the changes of
   the blood in typhoid fever, typhus fever,
   ephemeral fever, smallpox, scarlatina,
   measles, acute scurvy, chronic  scurvy,
   erysipelas, cholera,  phthisis, scrofula,
   carcinoma,  Bright's disease,  chlorosis,
   anemia,  simple rheumatic fever, febrile
   arthritic rheumatism, rheumatism, puer-
   peral  fever,  pneumonia,  pleuritis, peri-
   tonitis,  angina tonsillaris,  acute bron-
   chitis, carditis,  pericarditis, inflamma-
   tion of brain, glanders,  and lead poi-
   soning, 198—203.
 The colored blood-corpuscles are more uni-
   formly  and  rapidly destroyed in mala-
   rial fever than  in any other acute  dis-
   ease,  204—207.
 Comparison of the changes of  the blood
   and organs in malarial  fever, with the
   changes of the blood and organs in ty-
   phoid and typhus fevers,  205—207.
 The diminution of fibrin in malarial fever
   corresponds  with the severity of  the
   disease, 208
 Observations of Andral upon the diminution
   of fibrin in fevers, 208—210.
 Discussion  of  the question,  do  these
   changes of the blood  precede or suc-
   ceed, or are they simultaneous with, the
   aberration  of the  physical,  chemical,
   vital, and nervous  phenomena  denomi-
   nated fever, 211—216. 
INDEX.
411
Blood—continued.
  Bleeding should be employed with caution
    in malarious districts, 211.
  Sulphate of quinia beneficial in pneumo-
    nia and pleurisy,  and irritative fevers
    following amputations, occurring in ma-
    larious  countries, 211.
  Observations of the author upon three at-
    tacks of malarial fever, occurring in his
    own person, 212—214.
  Observations  of  Drs.  Stevens,  Ball,
    Mitchell, Salvagnoli,  Archer, Porter,
    and Potter,  upon  the changes of the
    blood   preceding   the  phenomena  of
    fever, 215, 216.

Brain.
  Pathological  alterations  of in malarial
    fever, 217—231.
Cases of  malarial  fever, illustrating  the
      formation of heart-clots, 96—112.
    illustrating the changes of the blood in
      malarial fever, 136—171.
    illustrating the effects of bloodletting in
      malarial fever, 182.
   . illustrating  the  period  at  which  the
      changes in the blood commence, 212.
    illustrating the pathological alterations
      of the  organs,  224—231,  233—240,
      245, 264—270.
    illustrating the phenomena of intermit-
      tent, remittent, and congestive fevers,
      286—293, 301—313, 320—407.

Cerebro-Spinal Nervous System, 217—
    231.
  Not the seat in malarial fever of any uni-
    form irritation or inflammation, 219.
  Discussion of the causes of the aberrated
    nervous  phenomena of malarial  fever,
    220.
  Theory  expressing the relations  of  the
    physical, chemical, and nervous  pheno-
    mena of malarial fever, 221.
  Malarial fever paroxysmal not because the
    action of the cerebro-spinal or  of the
    sympathetic  nervous system is  parox-
    ysmal, 223.
  Explanation of the paroxysmal character
    of malarial fever, 221—223.
  Post-mortem examinations of the cerebro-
    spinal nervous  system in the various
    forms of malarial fever, 224—231.

Chemical Changes.
  Importance of determining the amounts
    and character in various disease, 271—
    276.
  Index of temperature, 271—276.
  Chemical changes of blood, 88—216.
                    liver, 195, 240.
                     spleen, 196, 259.
                     intermittent  fever,
                       285.
                     remittent fever, 312.
                     congestive fever, 352.
Cellulose.
  Investigations of C. Schmidt, Lowig, Kol-
    liker, Odier,  Lassaigne,  Payen,  Chil-
    dren, Danniel, Virchow, Busk, Bennet,
    and Carter, upon, 257.
Chlorosis, changes of blood in, 201.
Cholera, changes of blood in, 200.
Carditis, changes of blood in, 203.
Campbell, Prof. H.  F., on nervous svstem,
  152.                            J
Copland, Dr. James, on the relations of the
  cerebro-spinal and sympathetic nervous
  systems to fever, 155,  156.


Circulation.
  Relations of,  to respiration, temperature,
    state of  skin, and changes of urine in
    intermittent, remittent,  and congestive
    fever, 271—407.
  Importance of its determination, 275.
  Table  showing the variations of in differ-
    ent individuals,  277.
  Effects of changes of temperature on, 282.
  Condition of, in the cold stage of intermit-
    tent fever,  285—293.
  In the hot  stage, and period of intermis-
    sion, 293—312.
  Cases and tables illustrating the  changes of
    the  circulation in  intermittent, remit-
    tent, and congestive fevers, 301—407.

Correlation of the Physical and Vital
    Forces, 24—48.
  History of the establishment of the cor-
    relation of the physical forces, 26—36.
  Views of the Hindoos, Sabians, Chinese,
    Persians,  and  Egyptians,  of Thales,
    Parmenides,  Archelaus,  Democritus,
    Pythagoras, Hippocrates, and other an-
    cient philosophers, 26.
  Labors,  experiments,  reasonings,  and
    generalizations  in  astronomy, of Ar-
    chimedes, Anaximander, Aristotle, An-
    aximenes, Aristarchus, Hipparchus, Pto-
    lemy,  Copernicus,  Kepler,   Stevinus,
    Galileo,  Gassendi,  Fermat,   Riccioli,
    Grimaldi,  Bacon,  Descartes, Castelli,
    Huyghens, Hooke, Halley,  Mersenne,
    Bernoulli,  Hermann, Leibnitz, Euler,
    Clairaut, D'Alembert, Lagrange,  Gas-
    sendi, Borelli,  and Newton, 27, 28;
    in acoustics, of  Pythagoras,   Mersenne,
    Newton, Taylor, Bernoulli, D'Alembert,
    Euler, Lagrange, Laplace, Poisson, 28;
    in thermotics, of Bacon, Locke,  Rum-
    ford, Davy,  Leslie, Dulong,  Clausius,
    Mayer, Magnus, Holtzmann,  Regnault,
    Rankine,  Thompson,  Joule,  29;  in
    optics, of Seneca, Ptolemy, Archimedes,
    Euclid, Alhazen, Vitello, Snell,  Greg-
    ory,  Descartes,  De Dominis, Newton,
    Huyghens,  Grimaldi,   Biot,  Arago,
    Hooke, Young,  Fresnel, Brewster, 30 ;
    of Volta, Nicholson, Davy,  Becquerel,
    Faraday, Oersted,  Arago, Schweigger,
    31—32;  of  Petit, Scheele,   Senebier,
    Rumford, Meese, Priestley, Ingenhousz,
    Saussure,  Ritter,  Wollaston, Young,
    Vogel, Herschel, Seebeck, Gay-Lussac, 
412
INDEX.
Correlation of the Physical and Vital
  Forc e s—continued.
    Thenard, Berard, Wedgwood,  Niepce,
    Daguerre, Draper, 32 ; of Oken, 33 ; of
    Carnot, Vanuxem, Metcalfe, 34; of Dr.
    Samuel Jackson, 35;  of Grove, Mayer,
    Helmholtz, 35—36.
                   D

Dugas, Prof.  L. A., on the pathology and
  treatment of bilious fever, 150—152.
  Dura mater, normal in malarial fever, 217.
  Post-mortem appearances, 224—231.
                   £

Erysipelas, changes of blood in, 200.
Earthquakes, illustrating the irresistible en-
  ergy of the  force of heat, 21;  of  South
  America, calculations of Sir Charles  Lyell,
  21.
Exterior, 216.
                    F

Fever.
  Intermittent, 93, 95, 135,139, 285—313.
    Cold stage, 285—293.
    Hot stage, 293.
    Intermission, 293—313.
    Character, urine in, 297—313.
    Pulse, respiration, and temperature in,
      285—313.
  Remittent  fever,   changes  of urine in,
    313.
. Congestive fever, pulse, respiration, tem-
    perature, and urine, 342—407.
  Illustrative  cases,  96,  136—170,  286—
    407.
  Typhus fever, changes of blood in, 198.
  Typhoid fever, changes of blood in, 198.
  Ephemeral fever,  changes  of blood in,
    199.
  Opinions of Hoffmann, Boerhaave, Cullen,
    Selle, Tode, Thorer, Stoll, J. C. Frank,
    Fodere,  Clutterbuck,  Alibert, Rayer,
    Nepple,  Ford,  Dugas, Campbell, An-
    tony,  Copland, and Maillot  on  fever,
    149—156.

Fibrinous  Concretions,  96—132.
  Cases illustrating  the formation of fibrin-
    ous concretions in malarial fever, 96—
    112
  Symptoms of, 118.
  Principles  of treatment  best  adapted to
    prevent  the formation of, 129.
  Observations  of Hewson,  Baillie,  Mor-
    gagni, Albinus,  Burns, Stewart, Ward-
    rop, Cruwell, Graham,  Stenzel, Meckel,
    Stoerk, Baillie,  Petit, O'Halloran, Mar-
    tial, Baron, Virchow, Paget, Crampton,
    Louis, Bougen, Desault, Duncan, Reid,
    Hodgson,  Andral,  Tiedemann,  Otto,
    Lobstein, Cloquet, Carsewell, Langstaff,
Fibrinous Concretions—continued.
    Richardson,  Thackrah,  Cooper,  and
    Briicke upon the formation of fibrinous
    concretions during life, 113—125.
Ford, Prof. Lewis D., on intermitting and
  remitting fever, 149—150.
Frank, J. C, on fever, 149.
                   G

Galileo, 25.
Gangraenopsis, or  gangrenous  erosion  of
  cheek, 163—168.
Gerhard, Dr., observations on typhus fever,
  206.
Gavarret on typhoid fever, 198.
Guenaud de Mussy, on typhus fever, 198.
Gavarret, on smallpox, 199 ; on erysipelas,
  200 ; on phthisis, 200 ;  on acute rheumat-
  ism, 202; on  pleuritis, 203 ; on perito-
  nitis, 203; on bronchitis, 203.
Glover, on the changes of the blood in scro-
  fula, 200—201.
Glanders, changes of blood in, 203.
Grape sugar, absence of,  in the malarial fe-
  ver liver, 195;  255—258.
                   H

Heart.
  Fibrinous concretions of, 96—132.
  Principles of treatment best adapted  to
    prevent the formation of fibrinous con-
    cretions in the heart and  bloodvessels,
    129.
  Symptoms of fibrinous  concretions in the
    heart, 118—124.
  Investigations  of  Dr.  Benjamin  Ward
    Richardson upon the formation of fibri-
    nous concretions in the heart, 114,  115 ;
    118—124.
  Observations of Gairdner, Lee, Gaspard,
    Hewson, Thackrah, Cooper, and Briicke,
    upon the formation of fibrinous concre-
    tions in the heart during life, 116, 117.
  Cases illustrating the formation of heart-
    clots in malarial fever, 96—112.
  Pathological alterations  of,  in malarial
    fever, 231.
                   I

Intermittent Fever, 285—312.
  Cold stage, 285—293.
  Changes of blood in, 135—139.
  Changes of urine in, 288—293, 297—312.
  Hot stage and phenomena of intermission
    393—312.
  Relations  between state of skin,  pulse
    respiration, and temperature in. 294__'.
    296.                          '
  Theories  of Dr. Ford,  Dugas, Campbell,
    Lobstein, and Copland, 149—156.
  Skin, pulse, respiration, and temperature
    285—312.
  Illustrative cases, 286—293, 301__314.
  Critical discharges in, 299. 
INDEX.                                413
Intermittent Fever—cotttinued.
  Character of deposits in urine, 178, 297,
    301.
Iodide of quinia useful as a depurant in the
    latter stages of malarial fever, 193.

Intestines.
  Pathological changes of, in malarial fever,
    232—240.
  Illustrative post-mortem examination, 233
    —240.
  Peyer's glands not enlarged  in malarial
    fever, 233.
  Illustrative cases, 233—240.
   Brunner's glands, 233.
   Illustrative cases, 233—240.
Jackson, Prof. Samuel, of the University of
    Pennsylvania, on the correlation of the
    physical and  vital forces, 35 ;  on the
    relations of the cerebro-spinal and sym-
    pathetic nervous systems, 66—70.
Jackson, Dr.  Samuel, of Northumberland,
    Pa., on gangraenopsis,  or  gangrenous
    erosion of the cheek, 163—168.
Jenner on typhus fever, 206.
Liver—continued.
  Observations of Dr. Thomas Stewardson,
    William  T.  Howard,  Swett, Anderson,
    Frick, and  Richard Arnold, upon the
    color of the liver in malarial fever, 244
    —254.
  Post-mortem examinations, 245.
  Effects of previous pathological alterations
    upon the  color of the liver in malarial
    fever, 246—251.
  Effects  of pre-existing cirrhosis upon the
    color of  the liver in malarial fever, 246
    —250.
  Changes in the color of the blood in the
    liver of malarial fever, 251—252.
  Sources of the changes of color in the liver
    during malarial fever, 252—254.
  A nimal starch present in the malarial liver,
    whilst hepatic sugar is absent, 255—258.
   Animal starch present in the yellow fever
    liver, 256.
   Occurrence of cellulose and of chitin in the
     animal kingdom, 257.
   Some of the points of difference  between
     the  malarial  fever,  and  yellow fever
    liver, 258—259.
 Liebig on the fluid contained in the tubules
     of muscles, 180.
 Lecanu on typhoid fever, 198; on scarlatina,
     199 ; on carditis,  203.
 Lead-poisoning, changes of blood in, 203.
Kidneys.
  Pathological  alterations of,  in malarial
    fever, 194,  271.
  Slate and bronze-colored spots upon, 194
    —195, 271.
Kepler, 10, 25.
Kolliker on the structure of the liver, 240,
  242.
Lagrange and Laplace, discoveries of, prov-
  ing the stability of the solar system, 12.
Lungs.
  Pathological
    231.
changes  in  malarial fever,
M
Mars, character of its surface, 13.
Moon, its  relations to plants and animals,
    14.
Man,  relations to the exterior universe, 7—
    49.
Miiller on structure of liver, 247.
Maillot on cerebro-spinal fevers, 149.
Liver.
  Cirrhosis of, 247.
  Color of, in malarial fever, 244.
  Color of, in yellow fever, 256.
  Chemical changes of blood in,  194, 195.
  Accumulation of animal  starch, and ab-
    sence of grape sugar in malarial fever,
    195.
  Observations of Malpighi, Kiernan, Miil-
    ler,  Leidy,  Vogel,  Henle, Bowman,
    Beale, Budd, and Reid, on the liver,
    241.
  The liver, the fabricator of the blood, re-
    searches of M. Cl. Bernard, Weber, Kol-
    liker, Thackrah, Simon, and Lehmann,
    240.                             .  ,
  Difficulties of  pathological,  anatomical,
    and physiological examinations  of the
    liver, 240—243.
  Weight of the liver in malarial fever, m.
  Color of the liver in malarial fever, 244—
    254.
                                        27*
Malarial Fevers.
  Changes of blood in, 88—216.
  Changes of the liver in, 194, 240—259.
  Researches of Dr.  Thomas Stewardson,
    Howard, Swett,  Anderson, Frick,  and
    Arnold, on the color of the liver in ma-
    larial fever, 244, 245.
  Changes of the pulse, respiration, tempe-
    rature, and urine in, 271—407.
  Cases of, 96—112, 135—171, 286—407.
N
Nervous  System, 56—70, 149—156, 217—
    231.
  Investigations of  Willis, 56;  of Boer-
    haave,  57; of  Haller,  57;  of Pro-
    chaska, 57 ; of  Willis and  Vieussens,
    58;   of  Winslow,  Girardi,  Fontana,
    Jacobson,  Lobstein,   Ribes,  Killian,
    Laumonier, Cloquet,   Scarpa,  Hasse,
    58; of Prochaska,  58, 59;  of  Bichat, 
)EX.
 414                               INE


 Nervous System—continued.
     59;  of Le Gallois, 59 ; of Lobstein, 61;
     of Dr.  Samuel Jackson,  66—68;   of
     Claude Bernard, Brown-Sequard, Camp-
     bell, and Hall, 68.
  Relations of the cerebro-spinal and sym-
     pathetic nervous systems to disease, 66
     —71, 149—156, 217—231.
  Relations of the  nervous  system to the
     intellectual and moral faculties in dis-
     ease, 72.
 Newton,  25, 28.

                   P

 Pancreas.
  No pathological alterations of, in malarial
     fever, 270.

 Pancreatine,
  Observations  of M. L. Corvisart on, 192.

 Pathological Investigations, 50—75.
  Sources of disease, 50—53.
  Relations of astronomical changes to dis-
     ease, 50.
  Relations of  climate, soil, and water,  to
     disease, 51, 52.
  Offices of the nervous system and relations
    to disease, 53—71.
  Observations, experiments, and researches
    of Ephesus, Galen, Piccolhomini,  Rio-
    Ian, Plempius, Wills, Chirac, Winslow,
    Bohn, Duverney, Vieussens, Valsalva,
    Morgagni,  Baglivi,  Conter,   Berger,
    Sinac, Huermann, Haller, Brunn, Mo-
    linelli,  Petit,  Fontana,  Cruikshank,
    Haighton,  Meyer, Bichat,  Dupuytren,
    Dumas, Bainville, Provincal, Vesalius,
    Columbus   Riolan,   Bidloo, Muralto,
    Chirac, Courten, Drelincourt,  Martin,
    Emmet, Portal,  Prochaska, Winslow,
    Le  Gallois,  Philip,  Lobstein,  Reid,
    Krimer, Arnemann,  Longet,  Brodie,
    Chossat, McCartney, Nasse, Bernard,
    Hall, Brown-Sequard, Campbell, Jack-
    son,  Prochaska, and  others, upon the
    physiology and pathology of the cerebro-
    spinal and sympathetic nervous systems,
    54—71.
  Experiments of Le Gallois upon the rela-
    tions of the cerebro-spinal and sympa-
    thetic nervous systems, 59.
  Physiological and  pathological researches
    of Lobstein upon the cerebro-spinal and
    sympathetic nervous systems, 61.
  Researches  of Dr. Samuel Jackson upon
    the physiological and pathological rela-
    tions  of the sympathetic and cerebro-
    spinal nervous systems, 66.
  Relations of  the  intellectual and moral
    faculties to disease, 71, 72.
  Extent and imperfections of pathological
    investigations, 73.

Pathological  Changes of  the Organs
    and Tissues in Malarial Fever, 424.
  Exterior, 216.
  Muscular system, 217.
  Head, 217.
Pathological  Changes of the Organs
    and  Tissues  in  Malarial  Fever—
    continued.
  Dura mater, 217.
  Arachnoid membrane, 217.
  Pia mater, 217.
  Cerebrum, 218.
  Cerebrellum, 218.
  Medulla oblongata, 218.
  Ventricles of brain,  217.
  Nervous phenomena of malarial fever com-
    pared with  post-mortem examinations,
    219—231.
  Chest, 231.
  Lungs,  231.
  Heart, 231.
  Alimentary canal, 231—240.
  Mouth, 231.
  Tongue, 231.
  Oesophagus, 232.
  Stomach, 232.
  Duodenum, 232.
  Jejunum, 232.
  Ileum, 232.
  Glands of Peyer, 233, 234.
  Solitary glands, 233.
  Liver, 240—259.
  Slate and bronze color of liver, 244.
  Changes of blood of  liver, 240.
  Malarial liver contains  animal starch, but
    no hepatic sugar, 255.
  Bile, 254.
  Spleen, 259—270.
  Slate color of spleen, 264.
  Pulp of spleen, 264—270.
  Kidneys, 271.
  Cerebro-spinal nervous system,  217—231;
    Cerebro-spinal nervous system not the
    seat, in malarial fever, of any uniform
    irritation or inflammation, 219 ; discus-
    sion of the causes  of the aberrated phe-
    nomena of malarial fever, 220.
  Theory  expressing  the relations  of the
    physical, chemical, and nervous pheno-
    mena of malarial fever, 221.
  Malarial fever paroxysmal, not because
    the action of the  cerebro-spinal, or of
    the sympathetic nervous  system is pa-
    roxysmal, 223.
  Explanation of the paroxysmal  character
    of malarial fever,  221—223.
  Post-mortem examinations of the cerebro-
    spinal nervous  system in the various
    forms of malarial  fever, 224—231.
  Lungs, 231.
  Heart, 231.
  Alimentary canal, 231—240 ;  changes in
    the secretions of the  mouth during ma-
    larial fever, 231.
  Appearance of the tongue in malarial
    fever,  232; stomach,  232.
  Intestinal canal, 232.
  Post-mortem examinations illustrating the
    pathological changes of the stomach and
    intestines in malarial fever,  233__240 •
    liver, 240—259.
  The liver the fabricator of the blood ; re-
    searches of  M. Cl.  Bernard, Weber
    Kolliker, Thackrah,  Simon,  and  Leh-
    mann, 240. 
INDEX.
415
Pathological  Changes of  the  Organs
    and Tissues in Malarial Fever—
    continued.
  Difficulties  of pathological, anatomical,
    and physiological examinations of the
    liver, 240—243.
  Difficulty of correct microscopical exami-
    nation of the liver, illustrated  by the
    differences of opinion of Kiernan, Schro-
    der Vander Kolk, Krukenberg, Weber,
    Retzius, Theile,  Backer,  Leidy, Beale,
    Kolliker,  Handfield Jones,  and H.  D.
    Schmidt,  241, 242.
  Weight of the liver in malarial fever, 243;
    color of  the  liver in malarial  fever,
    244—254; observations of Drs.  Thomas
    Stewardson, Wm. T.  Howard, Swett,
    Anderson, Frick, and Richard  Arnold,
    upon the  color of the liver in malarial
    fever, 244, 245.
  Post-mortem  examinations,  illustrating
    the changes of color, 245.
  Effects of previous  pathological alterations
    upon the color of the liver, in malarial
    fever, 246—251.
  Effects of pre-existing cirrhosis upon the
    color of the liver  in malarial fever;
    observations ofMalpighi, Kiernan, Miil-
    ler, Leidy, Hyrtl, Vogel,  Henle, Bow-
    man, and  Beale, upon the fibrous tissue
    of the liver; observations of Dr. Budd
    upon the nature  of cirrhosis of the liver,
    246—248; cases  illustrating the effects
    of pre-existing cirrhosis upon the color
    of the liver in  malarial fever,  246—
    250.
  Changes of the color of the blood in the
    liver of malarial fever, 251, 252.
  Sources of the  change  of color in the liver
    during malarial fever, 252—254 ; obser-
    vations of Dr. Clarke on,  252;  charac-
    ters  of the bile in malarial  fever, 254,
    255; the liver of those cases  which died
    in the active  stages of malarial fever,
    contained  animal starch, whilst  hepatic
    sugar was  absent, 255—258.
  Animal starch  present in the yellow fever
    liver, 256  ; researches of C. Schmidt,
    Lowig, and  Kolliker, upon  the  occur-
    rence of cellulose in the  animal  king-
    dom, 257;  researches of Odier, Las-
    saigne, Payen, Children,  Danniel, and
    Schmidt, upon the occurrence of chitin
    in the animal kingdom, 257.
  Discovery of cellulose  in the  brain and
    nerves of sense,  by  Rudolph Virchow,
    257;  observations of Busk, Virchow,
    Bennet, Carter, Bernard,  Sanson, Lon-
    get, Bouley,  Poggiale, and Parry, upon
    cellulose and animal starch, 258.
  Some of the  points of difference between
    the  malarial fever  and  yellow  fever
    liver, 258,  259.
  Spleen, pathological alterations of, in ma-
    larial fever, 259—270.
 Difficulty of determining the  offices of the
   spleen, 259—263 ; comparative weights
    of the spleens of animals, 259; observa-
    tions of Gray on  Malpighian  corpuscles
Pathological Changes  of the Organs
    and Tissues in Malarial Fever—
    continued.
    of the spleen, 261; weight of the spleen
    in malarial fever, 263.
  Cases illustrating the pathological altera-
    tions of the  spleen in  malarial fever,
    264—270.
  Pancreas, 270.
  Kidneys, 271.
Pepsin, administration of, in malarial fever,
    189—191 ; employment  in various  dis-
    eases,  189; method of its preparation,
    190.
Pia Mater, pathological  alterations of, in
    malarial fever, 216.

Pulse,  271—407.
  Effects of exercise in cold air upon,  282.
  Intermittent fever, 285—314.
  Remittent fever, 314.
  Congestive fever, 314.
  Table  showing  its variations  in different
    individuals,  277;  variations  during
    twenty-four hours, 278 ;  variations dur-
    ing exercise, 282; cold  stage of inter-
    mittent fever, 285—293  ; hot stage and
    period of intermission, 293—312; in
    remittent and congestive fevers, 314—
    407.
Purgation, excessive, should be avoided in
  malarial fever, 187.
Popp, on the  changes of blood in typhoid
  fever,  198;  in  phthisis, 200; in  simple
  rheumatic fever, 202; in inflammation of
  brain, 203 ; in glanders, 203;  in lead  poi-
  soning, 203.
                   R.

Relations of Man to the Exterior Uni-
    verse, 7—49.
  Wide reign of the law of gravity, 9.
  Binary  system of stars  illustrating the
    unity  of forces in the universe, 9.
  Uniformity  in the forces of the universe
    illustrated by the  extent  of the orbits,
    and the periods of revolutions of the
    binary systems of  stars, 10.
  Mutual relations of  the component mem-
    bers of the universe, and the wide reign
    of the law of gravity illustrated by the
    grand march of  our sun and planets
    through space, 11.
  Law of gravity absolutely essential to the
    existence of the universe in its present
    condition, 11.
  Phenomenon  of gravity, independent of
    all other  properties and phenomena of
    matter, 11.
  Cohesion and gravitation necessary pro-
    perties of matter as now constituted, 12.
  The present state  of our solar system de-
    pends  upon the  relations of its compo-
    nent parts, 12.
  Stability of the  solar system—discoveries
    of Lagrange and Laplace, 12. 
416
INDEX.
Relations of Man to the Exterior Uni-  1
    verse—continued.
  Uniformity of the construction, motions,
    and arrangements of the planets, 12.
  Relations of organized beings to the size
    and structure of our  globe, and to its
    relations with the sun and moon, and
    planets and fixed stars, 13.
  Dependence of  organized beings upon the
    relations  of  the moon to our  earth,
    14.
  Existence of organized beings dependent
    upon the distanoe of the earth from the
    sun, 15.
  States of matter, solid, fluid, and gaseous,
    dependent upon the forces acting upon
    the atoms;  the distance of the atoms
    from each other, and the stability of the
    matter which they form, depend upon
    the action of two  antagonistic  forces,
    cohesion and heat, 15.
  Sun and  fixed stars, the sources of the
    heat which maintains  the matter of our
    globe in its present conditions, 15.
  Heat supplied  to  our earth by the fixed
    stars, 16.
  The fixed stars supply as much heat, ac-
    cording  to  Pouillet,  as would melt  a
    layer of ice,  85 feet thick, covering the
    whole globe, 16.
  The solar heat constitutes only two-thirds
    of the entire quantity of heat supplied
    to the earth, 16.
   Geological changes explained by the heat
    of the  fixed stars, and the motion of
    our system through the ocean of space,
    17.
   Motions in the atmosphere and  crust of
     our globe due to the  forces of the sun
    and fixed stars,  17.
   Constitution,  properties, and  motions of
    the atmosphere, trade-winds, land and
    sea-breezes,  18.
   Dependence of organized beings upon these
    motions of the  atmosphere, excited  by
     the forces of the sun and fixed stars,
     19.
   Relations of the atmosphere to moisture,
     19.
   Latent heat, an instance of the conversion
     of heat  into mechanical  force ;  illus-
     trates the law that action and  reaction
     are equal, and  that force is indestruc-
     tible, 19.
   Force of the  heat of the sun expended in
     evaporation expressed in horse power,
     19.
   Work  accomplished by the heat  of the
     sun in evaporation upon  the whole sur-
     face of the earth, 19.
   This work of the sun compared with that
     accomplished  by the steam-engines of
     the world,  19.
   Effects of the heat  of the sun, illustrated
     by the power of Niagara Falls, 19.
   Effects of the everlasting circulation of air
      and water carried on by the forces of
     the sun upon the continents, solid rocks,
      and mountains of the earth, 20.
ELATIONS OF MAN TO THE EXTERIOR UNI-
  VERSE —continued.
Relations of organized beings to this ever-
  lasting round of the waters and  atmo-
  sphere, 20.
Our globe originally in a state of fusion,
  20.
Disintegration  of the solid barren  rocks,
  and the preparation of a soil  suitable
  for the habitation of plants and animals,
  effected by the circulation of water and
  air, under the action of heat and gravi-
  tation, 20.
Irresistible energy of the force of heat dis-
  played in the discharges of gas, steam,
  mud, and melted lava  from the craters
  of volcanoes, 21.
Illustrated  by the earthquake in  South
  America,  in  November, 1822;  calcula-
  tions of Sir Charles Lyell; the effects of
  the earthquake compared with the dis-
  charge of mud in one year by the river
  Ganges;  great eruption of  Skaptara
  Jokul, in  Iceland; the fiery strife in the
  bowels of the earth, under the guidance
  of intelligence, 21.
Every  earthquake  and  every flood  has
  contributed to the formation of a suit-
  able  soil for  the  maintenance of plants
   and  animals,  and the development of
  the human race, 22.
Every form of matter is definitely related
   to every other form of matter, and the
   arrangements and  distribution  of  the
   terrestrial masses, although the  results
   of the action of the forces of heat  and
   gravitation,  reveal a great design, 22.
 The combination of these various relations
   and actions, and reactions of terrestrial
   masses,  form the essential conditions
   of the existence of plants and animals,
   22.
 The history  of nations  has, in  a great
   measure, been determined by the agen-
   cies  of heat and  gravitation upon mat-
   ter ; the  effects of the arrangement and
   structure of terrestrial masses upon the
   development and progress of intelligence
   and knowledge,  and science, illustrated
   by a comparison  of the four continents
   —Africa, Europe, Asia,  and  America,
   23.
 Bodies composing our globe  divided  into
   two classes, inorganic and organic,  36.
 Inorganic  bodies  necessary for the exist-
    ence of  living  beings;  phenomena of
    plants and animals more complicated
    and less  general than those of inorganic
    bodies, 36.
 Elementary bodies—development of heat,
    light, and  electricity during the union
    of these elements, 23.
  The manifestation of physical and chemi-
    cal phenomena are similar in all bodies,
    differing in degree and not in kind, 23.'
  Just as much force  is always given out
    during the combination of the element-
    ary bodies  as was required to separate
    those bodies from  their compounds 
INDEX.
417
Relations op Man to the Exterior Uni-
    verse—continued.
    (overcome  the force which united the
    dissimilar elements), whether that force
    be  exerted in the laboratory  of the
    chemist,  by heat, or by electricity, or
    by  bringing  other chemical affinities
    into play, or in the great laboratory of
    nature by the action of the heat, elec-
    tricity, and chemical forces of the sun,
    24.
  In the exertion of even force in the uni-
    verse, whether between the great worlds
    or systems of worlds, or between the
    atoms of matter, whatever be the origin,
    character, or intensity of that force, the
    great law of Newton holds good—action
    and reaction are equal, 25.
  Correlation of the physical forces, 24, 25.
  Conversion of heat into ordinary motion,
    25.
  Conversion of ordinary motion into heat.
    24.
  Correlation  of the physical  forces illus-
    trated by experiments with the galvanic
    battery;   chemical action  developing
    electricity ;  and this in turn developing
    chemical action;  and the union of the
    products of that chemical action giving
    out the original amount of force  de-
    veloped during the chemical changes in
    the cells of the battery, 24.
  Conversion of heat into electricity, and of
    electricity into heat, 24.
  Force indestructible, 25.
  We may change the  direction of forces,
    but we can no more destroy force than
    we can annihilate matter, 25.
  The three great fundamental laws of mo-
    tion discovered by Kepler, Galileo, and
    Newton: 1. A body at  rest cannot of
    itself begin to move ;  and a body in
    motion cannot change its velocity nor
    its direction of motion without the ac-
    tion  of some  extraneous cause.   Any
    body impelled by a single force will
    move in a right line, and with uniform
    velocity.   2. Independence or coexist-
    ence of motions, leading to the compo-
    sition of forces.  3. Constant equality
    of action and reaction.   One body mov-
    ing another loses precisely as much mo-
    tion, in proportion to its mass,  as the
    body moved  gains ; although  applied
    by them alone to mechanical motions,
    are applicable to all the various motions,
    astronomical  or terrestrial, of inani-
    mate and animate bodies, 25.
  The establishment of these laws is neces ■
    sarily followed by the admission  that
    force is  indestructible.   The  store  of
    force with which the Creator has en-
    dowed matter can neither be added to
    nor detracted from by man, 25.
  Without this mutual  relation of all the
    different forces, without  this  conserva-
    tion of force, the universe could not be
    maintained in  its present conditions,
    25.
 Relations op Man to the Exterior Uni-
     verse—continued.
   History of the correlation of the physical
     forces, 26—36.
   Plants and animals composed of inorganic
     elements, 37.
   The relative proportions of these elements
     entering into the constitution of plants
     and animals  correspond  in a  great
     measure to the relative  quantities  of
     these elements in the exterior world, 37.
   The number of elements composing the
     great mass of the crust of our globe is
     very small, 37.
   Distribution and amount of water on our
     globe,  37.
   Circulation of water through the struc-
     tures of plants and animals  analogous
     to the  grand circulation of water in the
     surrounding  atmosphere,  and over the
     surface of the earth, 38.
   Water in the organized world, as in the
     inorganic, is  the  great  medium  of
     change, and the great agent  in the  re-
     moval of disintegrated, chemically al-
     tered,  offending substances, 38, 39.
   Amount  of water annually required for
     the circulation through the textures, the
     distribution of the nutritive  materials,
     and the removal of the waste products
     of the  billion inhabitants  of  the earth,
     38.
   Amount  of oxygen consumed by animals
     and vegetables, 38.
   Offices of oxygen in the animal economy,
     38.
   Relations of animated beings to inorganic
     matter, 39.
   Vital force, 40—45.
   Discussion of the nature and relations  of
     the vital principle to the physical, chem-
     ical, and nervous forces, 40—49.
   Without  the physical forces,  the  vital
     principle can  accomplish nothing, 40.
   The vital principle acts in a manner ana-
     logous  to the  intelligence,  40.
   The laws of physics apply to all the physical
     and chemical changes of vegetables and
     animals, 345.
   General view of the phenomena of man.
    47—49.

Respiration.
  Variations of respiration in different indi-
    viduals, 277.
  Method of determining, 281.
  Effects of exercise in cold air upon, 282.
  Variations of, in intermittent, remittent,
    and congestive fevers, 285—407.
                   S.
Skin.
  Relations of in malarial fever to the pulse,
    respiration, and temperature of extremi-
    ties and trunk, 294—297.

Spleen, 196, 259—270.
  Pathological  alterations  of, in malarial
    fever, 259—270. 
418
INDEX.
Spleen—continued.
  Difficulty of determining the offices of the
    spleen, 259—263.
  Comparative weights of the spleens of ani-
    mals, 259.
  Weight of the spleen in malarial fever, 263
  Cases illustrating the pathological altera-
    tions of  the spleen in malarial fever,
    264—270.
Scarlatina, changes of blood in, 199.
Smallpox,  changes  of blood in, 199.
Scurvy, changes of blood.in, 199, 200.
Scrofula, changes of blood in, 200, 201.
Stevens on the changes of the  blood in the
  marsh fevers of America and West In-
  dies, 215.
Starch, animal, occurrence  in  the malarial
  fever, 195, 255—258.
Researches of M. Cl. Bernard upon,  195.
Schmidt on the occurrence of cellulose in
  the mollusca, 257.
Stewardson, observations on the pathologi-
  cal changes of the liver in malarial fever,
  244.

Stomach.
  Pathological alterations in malarial fever,
    232, 233—240.
Swett on the  color of the liver in malarial
  fever, 244.
Tables.
  Composition of 1000 parts of moist blood-
    corpuscles, 84.
  Composition of 1000  parts of liquor san-
    guinis, 84.
  Composition of 1000 parts of blood, 84.
  Composition of 1000  parts of  serum, 84.
  Specific gravities of the blood and serum
    in various diseases, 93.
  Blood-corpuscles in 1000 parts of healthy
    and malarial blood, 94.
  Fibrin in 1000  parts of healthy and  dis-
    eased blood, 94, 95.
  Chemical  changes  and  composition  of
    venous blood in malarial fever, 135.
  Pulse,  respiration, and temperature, in
    case of intermittent fever, 138.
  Tongue, skin, pulse, respiration, tempera-
    ture, and urine, in  remittent fever,  141,
    143; in remittent  and typhoid fevers,
    145 ; in congestive fever, 160,  169.
  Composition of blood in intermittent fever
    according to Andral,  172.
  Composition of blood in marsh  cachexia,
    according to Becquerel and Rodier, 172;
    in mechanical  dropsy,  174;  in acute
    dropsy, 175 ;   in  cachectic  dropsies,
    177.
  Constitution of the blood  in various  dis-
    eases, 198—203.
  Weight of the spleen in malarial fever,
    263.
  Weight of the spleen in various animals,
    259.
  Weight of the liver in malarial fever,  243.
Tables—continued.
  Table showing the loss  of  weight and
    amounts of urine excreted  by cold and
    warm blooded animals deprived of food
    and drink, 273.
  Table showing the  variations of the pulse,
    respiration, and temperature of different
    individuals and races, 277—280.
  Tables of the  variations of temperature
    during 24 hours, and  during different
    seasons of the years, 278, 279.
  Variable temperature of man, 277—281.
  Variations of the temperature of different
    races, 280.
  Temperature of the insane, 281.
  Phenomena  of intermittent fever,  301—
    310.
  Phenomena of remittent fever; cold stage,
    hot stage,  and intermission of intermit-
    tent fever;  cold  stage, hot stage, remis-
    sion and intermission  of remittent fe-
    ver ;  pulse,  respiration, temperature,
    tongue, skin, intellect, and urine,  in
    congestive fever, 316—407.

Temperature, 271—407.
  Variations of temperature in different in-
    dividuals, 277—281.
  Variations of temperature during 24 hours,
    and during different seasons of the year,
    278.
  Observations  of Dr. John Davy on tem-
    perature, 278—281.
  Variations of the temperature of different
    raees, 280.
  Temperature of the insane, 281.
  Method of determining the temperature,
    281.
  Effects  of the temperature  of the sur-
    rounding medium, and of exposure to
    cold air upon, 272.
  Changes of,  in malarial fever, 271—407.
  Importance  of determining the relations
    of, to the pulse and respiration, 275.
  Tables showing its variations in different
    individuals, 277—281.
  Importance of attending to the surround-
    ing temperature in the determination of
    animal temperature, 282, 283.
  Temperature in intermittent fever, cold
    stage,  285—293; hot stage and  period
    of intermission,  293; in remittent and
    congestive fevers, 217—407.

Tongue.
  Appearance in malarial fever, 232,  297.
U
Urine.
  Importance  of examining the  chemical
    constitution, 271.
  Method of analyzing, 283.
  Works treating of the urine, 283, 284.
  Method of separating urea, 283.
  Method of separating uric acid,  284.
  Changes of, in intermittent, remittent, and
    congestive fevers, 271—407. 
INDEX.                                419
Urine—continued.
  Table  showing  the amount excreted by
    cold and warm-blooded animals, 273.
  Relations to temperature and muscular and
    nervous force, 274—276.
  Difficulties  of  determining the  amounts
    excreted during disease, 283.
  Method of analyzing the urine—references
    to the  best  treatises upon  the  urine,
    283—285.
  Characters of, during cold stage  of inter-
    mittent fever, 287—293.
  Hot stage and stages of intermission, 297
    —312.
  Urea,  changes in intermittent' fever, 297
    —312.
  Uric acid, changes in intermittent fever,
    297—312.
  Characters of urine in  remittent and con-
    gestive fevers, 317—407.
                   W

Water,  relations to  plants  and  animals,
  19, 29; power of, 19 ; circulation of car-
  ried on by the heat of the sun, 19.
Wittstock, on the changes of the blood in cho-
  lera, 200.
Weights of the liver in malarial fever, 343.
Weights of the spleen in malarial fever, 263.
Weights of the  spleen in various  animals,
  259.
Wurtzel on the nervous system, 58.
                   Y

Yellow fever, color of liver in, 256.
  Color of decoction of liver, 258.
  Pathological  differences  from malarial
    fever, 258. 
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