This is a sufficient and an interesting proof that this illustrious
physician saw the importance of making the analysis in question; it
shews also, that his ingenuity suggested probably the best mode of
conducting it which a philosopher sitting in his study could devise; and
the only proper mode of conducting it the circumstances of his age and
country did not place within his reach. Accordingly his success did not
equal his labour: for out of the three phenomena which he fixes upon as
those that are common to all the varieties of the disease there is not
one which is invariably found in any type of it; while in innumerable
cases the combination of the three is not found. Shivering does not
occur in some of the worst forms of the malady; and where it does, it is
confined to the commencement of the attack, or to that of its
exacerbations. The pulse, instead of being always more frequent than
natural, in some of the most formidable aspects assumed by the disease,
has been observed to be as low as forty or even thirty in the minute,
and, from the beginning to the termination of the attack, the heat in
some cases is below the natural standard, as it generally is in the
commencement of the cold stage.
To the catalogue of Boerhaave, Cullen makes the following
additions:—“languor, lassitude and other signs of debility, together
with derangement of the functions, particularly a want of vigor in the
limbs without any primary local affection.” This extension of the
catalogue adds in no respect to the excellence of the generalization. It
has all the vices which a definition can possess. The characters are not
present in all cases; the very opposite are strikingly prominent in
many, while the last, “without any primary local affection,” has so
direct a tendency to mislead the mind, and positively to prevent it from
observing the real phenomena of the disease, that it may well be
questioned, whether the introduction of this single phrase into the
definition of fever, has not been the occasion of far more practical
mischief than has been compensated by any good that has been
accomplished, or ever can be accomplished by all the rest of the
nosology.
In the last attempt to improve the definition of fever with which I am
acquainted, Dr. Wilson Philip says, “If we lay aside Dr. Cullen’s term
pyrexia, (which it must be borne in mind is precisely Boerhaave’s brief
catalogue) we shall considerably lessen the difficulty of giving such a
definition of idiopathic fevers as shall apply to all cases. They may be
defined as follows. Languor, lassitude, and other signs of debility,
followed by a frequent pulse, and increased heat, without any primary
local affection.”[18] Inasmuch as this definition contains fewer words
than that proposed by Cullen, it may be liable to fewer objections, but
it is less faulty only because it is shorter.
Public-domain text, read in full here on John Shaqi.
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