Volume 1

A system of medicine / by many writers ; edited by Thomas Clifford Allbutt.

Date:
1896-1899
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt. Source: Wellcome Collection.

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    temperature inco-ordinate with that of the surrounding medium may be detected during rapid changes of the tissues. A local disengagement of heat is a factor of inflammation rather than of fever, which latter term is more properly applied to the irregular propagation of heat waves in a system integrated by blood-vessels and nerves. There is a point where differentiation of fever from inflammation has not begun—where destruc- tive changes for lack of integrating machinery cannot maintain their balance by diffusing their vibrations; when component parts fight as individual members or clans, and not yet as a national regiment. In- flammation, then, is even a more general term than fever. Proceeding farther we find that fever forms part of a large group of maladies within which sub-groups are made according to more and more special differences. Broussais, deplorable as was his teaching on its therapeutical side, destroyed the idea of Fevers as several morbid entities : an immense service to nosology. We now know that cow-pox and small- pox, widely different as they superficially appear, must be classed together, because the processes in the cow and in men follow like initial causes; although, owing to differences in the media, they reach the surface in widely different forms. Within the memory of living physicians Mr. Hutchinson and others have impressed upon us that syphilis, widely eccentric in its superficial aspects, profoundly resembles such febrile diseases as scarlet fever and its kin, and is to be classified with these. The various phases of tuberculosis have still more recently been fitted into a serial order \yide art. Tuberculosis ], and the malady as a whole carried into th« same class as syphilis, small-pox, scarlet fever, leprosy, and so forth,—a class presenting the widest differences in the superficial features of its members. Tuberculosis and syphilis are now indeed recognised as the most exemplary instances of a nosological series of which we have cognisance. When we turn to consider the forms in which diseases present them- selves to the eye, we shall find that, even within the limits of the most definite kinds such as small-pox, no two cases are identical; and in'^kinds of more aberrant habit, such as syphilis, the unlikeness of cases is so marked that many of the various phases of this protean malady have been fitted into the series within the last few years. We must not suppose, indeed, that our observation of this series is even yet complete. For not only may corresponding members of two or more series of morbid phases differ in degree, but one or more members of the series may be absent — scarlatina may occur without rash, whooping-cough without whoop, angina pectoris without pain, migraine without headache, and so forth. Only by a study of genetic affinities can we dispose such cases in proper serial order; and some symptom groups, no doubt, are yet undistinguished, or if distinguished, are not yet placed in a series. The obscure series which we call gout may yet receive many more affections within its limits — attributions perhaps as unexpected as was that of pathologists' warts, when this deformity appeared in the series we call tuberculosis. Many skin diseases have yet to find their places in series of