Chapter XXV: Not the Last Word (1)

As soon as he could decently leave his cousin at home, he did; and then he walked hastily down to the house in which Mrs. Rosewarne had taken rooms. Miss Rosewarne was not at home, the small maid-servant said. Was Mrs. Rosewarne? Yes; so he would see her.

He went up stairs, never thinking how his deep trouble about so insignificant an incident would strike a third person.

"Mrs. Rosewarne," he said right out, "I want you to tell me if Wenna wishes our acquaintance to end. Has she been speaking to you? Just now she passed me in the street as if she did not wish to see me again."

"Probably," said Mrs. Rosewarne, amused as well as surprised by the young man's impetuosity, "she did not see you then. Wenna often passes people so. Most likely she was thinking about other things, for she had another letter from Jamaica just before she went out."

"Oh, she has had another letter from Jamaica this morning?" Trelyon said, with an angry light appearing in his eyes. "That is it, is it?"

"I don't understand you," Mrs. Rosewarne was saying, when both of them heard Wenna enter below.

"Mrs. Rosewarne," he said with a sudden entreaty in his voice, "would you mind letting me see Wenna alone for a couple of minutes? I want to ask her if she is offended with me: you won't mind, will you?"

"Not in the least," she said, good-naturedly; and then she added, at the door, "Mind, Mr. Trelyon, Wenna is easily hurt. You must speak gently to her."

About a minute afterward Wenna, having laid her hat and shawl aside, came into the room. When she found Trelyon there alone, she almost shrank back, and her face paled somewhat: then she forced herself to go forward and shake hands with him, though her face still wore a frightened and constrained look.

"Wenna," he said, "don't go away: I want to speak to you for a minute. You are offended with me about something, and I want you to tell me why. If you wish our friendship to cease, say so, and I will obey you; but you must tell me why first."

"I am not offended with you, Mr. Trelyon," she said in a low and nervous voice. "Do not think that. But--but I think it will be better if you will let our friendship cease, as you say."

"Oh no," he said, "I will not in this fashion. You've got to tell me what is the matter first. Now remember this. Not very long ago you chose to quarrel with me about nothing--absolutely about nothing. You know quite well that I meant no harm to you by lending Mr. Roscorla that money, yet you must needs flare up and give it me as hot as you could, all for nothing. What could I do? Why, only wait until you saw what a mistake you had made."

"It was very wrong of me," she said: "I ask your forgiveness. But now it is quite different: I am not angry with you at all. I should like to remain your friend, and yet I think it better not. I--I cannot explain to you, Mr. Trelyon, and I am sure you won't ask me when I say so."

He looked at her for a moment, and then he said, gently and yet firmly, "Look here, Wenna. You think I am only a boy--that may or may not be--but I am going to talk reasonably to you for once. Come over to this chair by the window and sit down."

She followed him in passive obedience. She took the one chair, he the other.

"Perhaps I am only a boy," he said, "but I have knocked about a good deal, and I have kept my eyes as wide open as most folks. I suppose ill-natured people might say that as I had nothing to do at Eglosilyan, I wanted to have a flirtation with the only girl who was handy. I know better. Year after year I saw more and more of you, bit by bit, and that after I had been abroad or living in other places in England from time to time. I got to believe that I had never seen anywhere any girl or woman who was so honest as you are, and good in a dozen secret ways that needed a deal of discovering. I found out far more about you than you imagined. I heard of you in cottages that you never knew I was in; and everything I heard made me respect you more and more. Mind this, too. I had no sort of personal liking for the sort of thing you were doing. I don't admire beastly little rooms and poverty and sick people as appealing to a fine sentiment. There never was anything of the parson or the benevolent old lady about me. I would rather give half a crown to an impertinent little boy who had just whopped another boy bigger than himself than give a halfpenny tract to a sickly child in its mother's arms: that's original sin in me, I suppose. But all that squalid sort of work you were in only made the jewel shine the more. I used to think I should like to marry a very grand woman, who could be presented at court without a tremor, who would come into a drawing-room as if she was conferring a favor on the world at large; and I certainly never thought I should find the best and finest woman I had ever seen in back kitchens sewing pinafores for children. And then when I found her there, wasn't it natural I should put some store by her friendship? I suppose you didn't know what I thought of you, Wenna, because I kept chaffing you and Mabyn? I have told you something of it now; and now I want you to say whether you have a right to shunt me off like this, without a word of explanation."

She sat still, silent and nervous. The rude and impetuous eloquence of his speech, broken by many a hesitating stammer, had touched her. There was more thoughtfulness and tenderness in this wild lad than she had supposed.

"How can I explain?" she burst out suddenly. "I should cover myself with shame!"

"And what have you to be ashamed of?" he said with a stare. The distress she was obviously suffering was so great that he had almost a mind to take her at her word and leave the house without further ado.

Just at this moment, when he was considering what would be the most generous thing to do, she seemed to nerve herself to speak to him, and in a low and measured voice she said, "Yes, I will tell you. I have had a letter this morning from Mr. Roscorla. He asks me if it is true that you are paying me such attention that people notice it; and he asks me if that is how I keep my promise to him."

Something like a quiver of rage passed through the young man at this moment, but his teeth were kept firmly together. She did not look up to his face.

"That is not all. I must tell you that I was deeply shocked and grieved by this letter; but on looking back over the past six weeks I think a suspicious person might have been justified in complaining to Mr. Roscorla. And--and--and, Mr. Trelyon, did you see that dried flower in my Prayer-book last night?"

Her resolution was fast ebbing away: he could see that her hands were clasped piteously together.

"Yes, I did," he said boldly.

"And oh what could you have thought of me?" she cried in her distress. "Indeed, Mr. Trelyon, it was all a mistake. I did not keep the flower--I did not, indeed. And when I thought you had seen it I could have died for shame."

"And why?" he said in a way that made her lift up her startled eyes to his face. There was a strange look there, as of a man who had suddenly resolved to dare his fate, and yet was imploringly anxious as to the result. "For you have been frank with me, and so will I be with you. Why should you not have kept that flower? Yes, I sent it to you, and with all the purpose that such a thing could carry. Yes, you may be as angry as you please; only listen, Wenna. You don't love that man whom you are engaged to marry; you know in your heart that you do not believe in his love for you; and are you surprised that people should wish to have you break off an engagement that will only bring you misery?"

"Mr. Trelyon!"

"Wenna, one minute: you must hear me. Do with my offer what you like--only here it is: give me the power to break off this engagement, and I will. Give me the right to do that. Don't mind me in the matter. It is true I love you--there, I will say it again: there is nothing I think of from morning till night but my love for you--and if you would say that some time I might ask you to be my wife, you would give me more happiness than you could dream of. But I don't wish that now. I will remain your friend if you like, Wenna; only let me do this thing for you, and when you are free you can then say yes or no."

She rose, not proud and indignant, but weeping bitterly. "I have deserved this," she said, apparently overwhelmed with mortification and self-reproach. "I have earned this shame, and I must bear it. I do not blame you, Mr. Trelyon: it is I who have done this. How many weeks is it since the man left England to whom I promised to be faithful? and already--But this I can do, Mr. Trelyon: I will bid you good-bye now, and I will never see you again."

Her face was quite pale. She held out her hand.

"No," he said firmly. "We don't part like that, Wenna. First, let me say that you have nothing to accuse yourself of. You have done nothing and said nothing of which any man, however mean and suspicious, could complain. Perhaps I was too hasty in speaking of my love for you. In that case I've got to pay for my folly."

"And it is folly, Mr. Trelyon," she said passionately, and yet with nothing but tenderness in her face. "How could you have thought of marrying me? Why, the future that ought to lie before you is far more than you can imagine yet; and you would go and hamper it by marrying an innkeeper's daughter! It is folly indeed, and you will see that very soon. But--but I am very sorry all this has occurred: it is another grief to me that I have troubled you. I think I was born to bring grief to all my friends."

He was anxiously debating what he should do; and he needed all his wits at that moment, for his own feelings were strong within him, and clamoring for expression. Should he insist? Should he bear down all opposition? Happily, quieter counsels prevailed, for there was no mistake as to the absolute truthfulness of what the girl had said.

"Well, Wenna," he said, "I will do anything you like, only to remain your friend. Is that possible? Will you forgive all that I have said if I make you a promise not to repeat it, and never again to mention your engagement to Mr. Roscorla?"

"No, we must part now altogether," she said slowly. Then by haphazard she glanced up at his face for a moment, and there was a great sadness in her eyes. "It is a hard thing to part. Perhaps it will not be necessary that you should never come to see me. But we must not be friends as we have been, for I have my duty to do toward him."

"Then I may come to see you sometimes?"

She hesitated: "You may come to see my mother sometimes. And I will always think of you as a dear friend, whether I see you or not."

He went outside, and drew a long breath. "I had to keep a tight grip on the reins that time," he was thinking to himself--"a precious tight grip; but I did it."

He thought of the look there was in her eyes when she finally bid him goodbye. His face grew the happier as he thought of it. He was clearly not at all down-hearted about his rejection: on the contrary, he went and told his cousin Juliott that the little affair of the morning had been quite satisfactorily arranged, that Miss Wenna and he were very good friends again, and that it was quite a mistake to imagine that she was already married to Mr. Roscorla.

"Harry," said his cousin, "I strictly forbid you to mention that gentleman's name."

"Why, Jue?" he said.

"Because I will not listen to the bad language you invariably use whenever you speak of him; and you ought to remember that you are in a clergyman's house. I wonder Miss Rosewarne is not ashamed to have your acquaintance, but I dare say you amend your ways when you are in her presence. She'll have plenty to reform if ever she takes you for a husband."

"That's true enough, Jue," the young man said penitently. "I believe I'm a bad lot, but then look at the brilliant contrast which the future will present. You know that my old grandmother is always saying to me, 'Harry, you were born with as many manners as most folks, and you've used none; so you'll have a rare stock to come and go on when you begin.'"

[TO BE CONTINUED.]

FEVER.

At present all branches of Science possess an intrinsic interest for every intelligent man, but such elementary knowledge as enables its possessor to understand the explanations of the medical attendant has a double value. Over and over again I have heard the remark when some bold successful treatment was being discussed, "But you would not have dared to do that in private practice." The days of medical mystification are not yet entirely passed, but year by year the profession is assuredly losing that peculiar virtue of office which it formerly possessed in so eminent a degree. The doctor is no longer a dignified personage with gold-headed cane and powdered wig, mounting the mansion steps with stately tread, but a busy man in various garb, hurrying from house to house, studying the multitudinous problems of disease, and applying the fruits of such study to the relief of individual cases. No longer able to awe his patients into obedience, he must rely upon his moral and intellectual powers in controlling them. To enable any one to understand the explanations of physicians, and to protect himself, by discovery, against the impudent assumptions of quacks, some knowledge of medical truths and of the drift of modern medical thought is necessary. Every successful physician, no matter how independent he may be by nature, is necessarily more or less cramped by the prejudices of patients--prejudices which often a little primary instruction would have done away with.

Of all the diseased processes fever is one of the most frequent and one of the most serious in their results. A discussion, therefore, of its nature, the method of its production and of its relief, will, it may be hoped, engage the attention of the general reader.

If the hand be laid upon the skin of a person in a high fever the attention is at once attracted by the great heat, and if the bulb of a thermometer be placed under the tongue or in the armpit of the patient the mercury may indicate a temperature of 107°, 108°, 109°, or even 110° Fahrenheit, instead of 98° to 99° Fahrenheit, the normal temperature of the human body. It is a common belief that the skin in fever is always dry as well as hot, but this is a mistake, as intense fever may coexist with a reeking perspiration. During the fever the pulse is greatly increased in frequency, the head aches and throbs, and if the attack be very severe restlessness, sudden startings, irregular muscular twitchings, or even violent epileptiform convulsions and stupor, delirium or coma, indicate the disturbance of the nervous system.

These various symptoms are simply results of the excess of caloric, which excites universal irritation, and, if prolonged, destroys the tissues. This fact I have verified by three series of experiments, by the first of which it was shown that the general application of external heat so as to raise the bodily temperature produces all the phenomena of fever; by the second, that the local application of heat to the brain and to the heart causes the nervous and circulatory disturbances so universally seen in fever; and by the third that the abstraction of heat in fever is followed by immediate subsidence of the other symptoms.

If a small animal, such as a dog, cat or rabbit, be placed in a chamber heated by means of the sun's rays falling upon a slanting glass roof or by some artificial method to a temperature of considerably over one hundred degrees, a very constant series of phenomena is developed. The breathing becomes hurried and the pulse greatly quickened, whilst the restless movements of the body indicate nervous distress. After a time, if the exposure be continued, the symptoms are intensified, and restlessness passes into the weakness of partial paralysis; then suddenly or gradually, with or without convulsions, stupor sets in, deepening into coma, and death from arrested respiration is the final result. If the temperature of the animal be tested from time to time during the exposure, it will be found to rise steadily, and the severity of the symptoms will be directly, and in any one species constantly, proportional to the intensity of the bodily heat.

The nervous system of man apparently resists the action of heat, but in reality it does not do so. Man, it is true, is the only animal that can thrive almost equally amidst arctic snows and in tropical jungles. This is not, however, because his nervous system lacks sensitiveness, but because he has the power of heating or cooling his body in such a manner that its temperature is comparatively unaffected by that of the surrounding air. Man might be well defined as the naked sweating animal. In the north he strips the bear and the fox of their coat to keep him warm; in the south his own skin acts as a refrigerator. The dog has a few sweat-glands about the mouth--man has two millions densely covering his body. In the horse exposed to heat the hair soon becomes wet and matted, interfering very greatly with evaporation; in man the bare skin offers an excellent surface, from which the perspiration passes off almost as fast as formed. Evaporation, conversion of a liquid into a vapor, means a steady conversion of sensible heat into what was formerly called latent heat, but what we now know to be repulsive force: the heat-energy of the body is lost in driving the particles of sweat asunder in the form of vapor.

It is possible, however, to have a temperature which even a Hindoo cannot resist. When a man is exposed to such a heat his bodily temperature rises, and as it rises the symptoms of fever develop precisely as they do in the lower animals--sometimes slowly, sometimes suddenly--with disturbances of the respiration, circulation and innervation precisely similar to those already noticed as occurring in the dog, the cat and the rabbit. Sunstroke, or thermic fever, is generally believed to be instantaneous in its onset, but the wide experience of the English in India has shown that whilst in some cases it is thus sudden in its development, in others it is a slow process, and probably in almost all cases close observation would have revealed the existence of premonitions.

External heat, by producing an internal rise of temperature, may thus cause all the phenomena of fever. Of these phenomena the most prominent is disturbance of the nervous system and of the circulation. In order to determine whether the heat itself directly causes the nervous disturbance, or whether it produces it indirectly by causing changes in the blood, I applied caloric directly to the brains of animals. This was done by fitting a hog's bladder like a bonnet over the head and allowing hot water to run through it. It was found that stupor, coma, convulsions, and finally death from arrest of the respiration, were produced, sometimes gradually, sometimes suddenly, precisely as in the case of exposure of the animal in a hot chamber. Moreover, on opening the skull and plunging a thermometer into the cerebrum immediately after death or the supervention of unconsciousness, it was found that these phenomena were developed at the same brain-temperature when the heat was locally applied as when the animal was exposed in the hot box. Thus, if any given species in the hot box became unconscious when the temperature reached 110° Fahrenheit, this species also became unconscious when the locally-heated brain attained a temperature of 110°; or if death occurred by arrest of the respiration in the hot box at 114°, so did it when the locally-heated brain reached that point.

Dr. Lauder Brunton of England has performed a series of experiments upon the circulation parallel to those just narrated. Anæsthetizing animals and exposing the heart, he has found that the action of that organ is accelerated and weakened by the local application of heat, precisely as occurs in fever.

In order to test the effect of the withdrawal of heat, I have taken a rabbit out of the hot chamber, in which it lay upon its side totally unconscious, and plunged it into a bucket of cold water. The temperature of the water rose rapidly, whilst that of the rabbit fell even more rapidly. As soon as the bodily heat approached its normal intensity consciousness returned, and in a few moments the animal, which had just before been at the point of death, was running about the grass.

Some months since I had an opportunity of repeating this experiment upon a human being.

In acute inflammatory rheumatism it sometimes happens that the swelling and pain of the joints suddenly disappear, and the patient becomes comatose or wildly delirious. It has been customary to explain these symptoms as the result of the rheumatism leaving the joints and attacking the brain. Evidently, this being the case, the proper thing to do was to irritate the joints so as to draw the rheumatism back to them. This method was formerly practiced, and the almost invariable result was death in a few hours.

In most if not all of these frightful cases of sudden accession of severe nervous symptoms in rheumatism the temperature will be found, on testing it, to be exceedingly high--108°, 109° or even 110° Fahrenheit. If the views advocated in this paper be correct, it is not the rheumatism, but the intense bodily heat, which causes the severe symptoms, and finally death. The joints lose their sensitiveness, not because the disease has left them, but because the heat so overpowers the brain that it has lost its power of perception: the patient's leg might be cut off without his feeling it. In such a case the proper treatment is to take away the heat by plunging the patient into a cold bath. But can there be anything more shocking to the universal belief and prejudices than to put a patient dying of acute rheumatism into an almost ice-cold bath?

Last spring there was in my ward in the Philadelphia Hospital a stout young Irishman who had passed through an acute attack of inflammatory rheumatism, and was suffering from a sharp relapse. Entering the ward one day, I saw at once that the man was unconscious, and turning to the resident physician asked, "What is the matter with James?" "Nothing," was the reply: "I saw him an hour and a half ago, and he was doing very well, except that the fever was very high." "He is dying now, at any rate," was my rejoinder. On going to the bedside the patient was found perfectly unconscious, the skin dry and intensely hot, the affected joints pale and devoid of sensibility, the breathing irregular and jerking, the pulse 170 and scarcely perceptible, every muscle relaxed as in death, every power of perception abolished. A thermometer placed in the armpit registered 108-4/5° Fahrenheit.

Believing that the symptoms were due simply to this excessive temperature, I ordered the man to be at once stripped and put in a full bath drawn from the cold-water spigot. The temperature of this bath was found to be 60° Fahrenheit. In one minute and a half after the patient had been placed in the tub he recovered consciousness sufficiently to put out his tongue when told to do so in a loud, commanding tone. In three minutes he began to struggle to get out and to complain of the cold. In six minutes and a half he had become quite rational. He was now taken out, only partially wiped, laid upon an India-rubber blanket and covered with a single sheet, the temperature of the room being between 65° and 70°. Three minutes after this the temperature in the armpit was 94°, in the mouth 105-3/5°; five minutes later the mouth-thermometer marked 103°, and the pain and tenderness had reappeared in the affected joints. It would be out of place here to give further details as to his treatment. It is enough to state that, although owing to a misunderstanding of my orders, the man was left in a cool room for twelve hours upon the gum blanket, wet and covered only with a sheet--or possibly because he was so left--he recovered without a relapse or any bad symptoms.

The first case in which the cold-water treatment was practiced in the Philadelphia Hospital was that of a woman suffering from a desperate relapse of typhoid fever. She was semi-comatose, with a pulse of 150 and a temperature of 107° Fahrenheit: death was seemingly inevitable and imminent. As the bath-tubs were not convenient, the order was given that the woman be laid upon an India-rubber cloth, and be wrapped simply in a sheet constantly wet with water at a temperature as near 32° as practicable. The nurses, aghast, refused at first to carry out the order, but the physician's power being despotic, obedience was enforced. About three pints of whisky were given in the twenty-four hours, besides drugs, the whole treatment being successful.

It has been shown that excessive bodily heat is capable of producing the various symptoms of fever, and that its withdrawal is followed by the immediate relief of these symptoms; and since excessive heat is always present in fever, it is a logical deduction that it is the cause of fever symptoms; or, in other words, that it is the essential part of fever.

It must be borne in mind, however, that the term fever is here used in an abstract sense, to express a general diseased process, a bodily condition. _A_ fever is a very different thing from fever. We may have _a_ fever, such as typhoid, without the existence of fever. In a fever, the fever--_i.e._, the elevation of temperature--is only part of the disease, and great judgment and experience are often required to decide how much of the general symptoms is caused by the fever, and how much by the disease which is the cause of the fever.

The importance of high temperature having been recognized, it becomes a matter of the gravest scientific and practical interest to determine the method in which it is produced.

There are only two systems which bind the body together--namely, the circulation and the nervous system. As fever is usually a universal phenomenon, occurring simultaneously in every part of the body, it must be produced either through the nervous system or by a poison in the blood acting simultaneously on every tissue. Every physician knows, however, that there are cases of fever in which there has been no introduction of a poison into the blood: hence it follows that at least sometimes fever must be produced by the nervous system.

This being so, the study of the influence of the nervous system upon animal heat is naturally the next step in our investigation. Before making this step it may be well to call to mind the fact that chemical processes are usually accompanied either by the giving out or the withdrawal of heat. Thus, the chemical actions which result when ice and salt are mixed cause a withdrawal of heat, and a "freezing mixture" is formed. When a candle is burnt, the oxidation of its constituents, a chemical process, evolves heat. Oxidation is the great source of artificial heat, and animal heat is chiefly generated by the same process; in other words, animal heat is always the product of the chemical movements of the body, and these movements are almost exclusively of the character of oxidation. In the animal tissues a lessened oxidation is equivalent to a lessened heat-production, and _vise versâ_.

If a large nerve be exposed in one of the lower animals, and a galvanic current be sent through it for half a minute or more, the temperature of the animal falls very decidedly; and if the irritation be repeated several times at intervals, the diminution of the animal heat may amount to several degrees. Galvanization of a nerve affects very powerfully the circulation, and it has been believed that this derangement was the cause of the lessened chemical movements. But the alteration of the circulation is immediate, and ceases almost at once when the current is broken, whereas the fall of temperature comes on only after several minutes, then progressively increases, and persists for many minutes--it may be hours. The two phenomena being thus differently developed, it is impossible that they should have the relation of cause and effect, and the fall of temperature must be traced to a direct influence of the nervous system upon the chemical processes of the body.

This lowering of temperature under the influence of a powerful irritation of a nerve-trunk or of its minute branches, which everywhere pervade the tissues and spread out in the skin, is common to all species of mammals. If a rabbit be merely tied down tightly upon a table, the fall is perceptible, and if it be severely wounded, the temperature diminishes very greatly. It has long been known that severe burns are followed by a very great depression of the animal heat. Redard, a French physician, made during the late siege of Paris a most interesting series of observations upon the influence of severe gunshot wounds. He found that, entirely independent of any hæmorrhage which might have occurred, the temperature fell enormously, and in direct proportion to the gravity of the wound; so that by the aid of the thermometer he was able to predict whether a fatal issue would or would not occur in the course of a few hours.

We have found that both in man and the lower animals the nervous system is able to check the chemical movements of the body, but before we can decide how it does so facts not yet noticed must be looked at.

If the spinal cord of an animal be cut just below the origin of the nerves of respiration, an immediate fall of temperature occurs, and, if the animal be left in a cool room, persists until death ensues. If, however, the victim be put in a warm place, after a time the temperature begins to rise, and finally a most intense fever is developed. Parallel phenomena follow division of the spinal cord in man. Indeed, Sir Benjamin Brodie was first led to experiment upon animals by observing in 1837 an excessive fever follow in a patient a wound of the spinal cord.

I have already explained, in a former number of this Magazine,[2] the nature of the so-called vaso-motor nerves, which preside over the little circular muscles that run round and round in the coats of the blood-vessels. When they are excited, these muscles contract and the size of the arteries is diminished: when they are paralyzed, the arterial inner muscles relax and the vessels dilate. The vaso-motor nerves have their governing centre in that upper portion of the spinal cord which is within the skull, the so-called medulla oblongata. When the spinal cord is divided, the vessels are cut off from the influence of this vaso-motor centre, and at once dilate, profoundly affecting the blood-current by doing so.

The first fall of temperature which follows division of the cord is believed by most physiologists to be due to this dilatation of the vessels. Very probably the blood-stream, flowing sluggishly, does not give the normal amount of stimulus to the tissues, so that at first their chemical actions are lessened, and consequently less caloric than usual is generated in the body. Further, the blood moving slowly through the dilated vessels of the lungs and of the surface of the body, is cooled more completely than it should be; hence, unless the body is protected by being surrounded with warm air, no excessive accumulation of heat in it can occur, and therefore no fever can appear.

Assuming that this explanation of the primary lowering of the temperature after division of the cord be correct--and no better one has as yet been offered--what is the cause of the fever which afterward develops itself? As it occurs only when the animal is exposed to a somewhat elevated temperature, it has been thought by some to be due to the absorption of this external heat. This, however, is certainly not true, as is shown, to omit less decisive proofs, by the experiments of Naunyn and Quincke, who exposed animals for two days to a temperature of 90°, and at the end of that time, their bodily temperature not having risen, cut their spinal cords, after which intense fever was developed in a few hours without any change of atmosphere.

Section of the cord must therefore give rise to an increased chemical movement and heat-production in the body. As already stated, this section affects very greatly the circulation, but the fever is independent of such action. The upper end of the medulla oblongata is continuous with a nervous mass which joins the two brain hemispheres together, and hence is known as the _pons_ or bridge. If, instead of cutting the spinal cord, we separate the medulla oblongata from the pons, an _immediate_ rise of temperature occurs, and continues until death, whether the operation be performed in a cold or heated room.[3]

Cutting the medulla at its junction with the pons causes, then, an immediate and direct elevation of temperature, without disturbance of the circulation. What can this mean? Evidently, only one thing--namely, that by the division of the medulla there has been separated from the general tissues of the body a repressive force--a something which normally controls their chemical activity and the production in them of animal heat.

The existence of nerves whose function is to repress action is no new discovery in physiology. Readers of _Lippincott's Magazine_ may remember my description of the pneumogastrics or brake-nerves of the heart, whose duty it is to control the action of that viscus. Nerves which repress or inhibit action are spoken of in modern physiology as inhibitory. The experiments which have been adduced prove that there are nerves whose function it is to control the general vital chemical actions, and that the governing centre of these nerves is situated above the medulla oblongata. To this centre, whose exact location is unknown, the name of the _inhibitory heat-centre_ has been given.

The way in which galvanization of a nerve, violent injuries and excessive pain depress the temperature, independently of any action upon the circulation, is now evident. An impulse simply passes up the irritated or wounded nerve, and excites this inhibitory heat-centre to increased action, and the temperature falls because the chemical movements of the body are repressed.

The method in which fever is produced also becomes very evident when once the existence of an inhibitory heat-centre has been established. Any poison having the power to depress, and finally paralyze, this centre must, if it find entrance to the blood, produce fever. If the poison, from its inherent properties, or from its being in very small quantity, only diminishes the activity of the inhibitory heat-centre, the controlling influence is not entirely removed from the chemical movements of the body, and only slight fever results; but if the poison actually paralyzes the inhibitory nerves, a very great rise of temperature must rapidly follow the complete removal of the brake-power.

As an illustration we may consider the intense rheumatic fever, or the so-called "cerebral rheumatism," such as affected the young Irishman whose case has been narrated in the present article. Without any apparent reason the poison of rheumatism habitually attacks one joint on one day, and another joint on another day, and with as little apparent reason it occasionally falls of a sudden upon the inhibitory heat-centre, and actually paralyzes it. In a few minutes intense fever is developed, and the bodily temperature rapidly approaches nearer and nearer that line on the other side of which is death.

In many cases of fever, however, there is no poison in the blood; thus, the local irritation of a boil or other inflammation may cause what is well termed "irritative fever." The way in which this is produced is by an indirect, and not a direct, action upon the inhibitory heat-centre.

The casualties of the late war proved but too abundantly that a man may be wounded in one part of the body and suffer from paralysis of voluntary motion in another part. Thus, a soldier struck in the neck fell unconscious, and on awaking was astonished to find his right arm powerless at his side. This is the so-called "reflex paralysis." Very commonly the irritation of a nerve will give rise to an impulse which will travel up the nerve to a motor-centre, and so excite it that it shall send in turn an impulse down a second nerve to a distant muscle, and a spasm result. Sometimes, however, the impulse which travels to the nerve-centre is of such a character that, instead of exciting it to action, it deprives it of the power of action. In the former instance reflex motion, in the latter reflex paralysis, results.

We have seen that galvanization of a nerve may excite the inhibitory centre to activity, and the peculiar persistent irritation of a local inflammation may deprive the same centre of its power of action: in the one instance a reflex inhibitory heat-centre spasm--_i.e._, lowering of temperature--is produced, and in the other a reflex inhibitory heat-centre paralysis--_i.e._, fever--results.

It would be going too far at present to assert that all fever is produced in the way spoken of. There are certain drugs which lower the temperature in the fever that follows division of the cord and consequent paralysis of the heat-centre, and which must therefore act either upon the blood, or universally upon the tissues so as to diminish their-chemical movements. It is most probable, although not yet absolutely proved, that there are other substances which act directly upon the blood and tissues in such a way as to increase their chemical activities, and thereby cause fever.

The practical considerations in regard to the treatment of disease which naturally flow from the recent investigations of fever are very important and very obvious. This is especially true since it has been shown in Germany that under the influence of a continuous high bodily temperature, not intense enough at any time to compromise life, all the muscular tissues of the body undergo a peculiar granular degeneration. Many a typhoid-fever patient has undoubtedly died from the heart-muscle having undergone this change, when, if by artificial cooling the temperature of the body had been kept down, the alteration of the heart-structure would have been prevented, and death averted. It is obvious, also, that the old plan of thwarting the intentions of Nature, and depriving the fever-patient of the free use of cooling drinks, was practically a baneful cruelty. As the body is burning up in fever, it is also evident that to deprive it of sustenance is to aid in the production of fatal exhaustion. The burning will go on, whether food is given or not, so long as the tissues can serve as fuel. Of course no more food should be taken than the patient can digest, but every grain of digested food is so much added to the resources of the system, which is engaged, it may be, in a close and doubtful conflict with disease.

If it were possible, of course the best treatment for fever would be that which lessened the production of heat. Fortunately, we have some drugs--notably, quinine and alcohol--which do exert a decided influence upon the vital chemical movements, but, unfortunately, their power is limited. As we are therefore often unable to control heat-production, the best we can do is to abstract the caloric from the body whenever it becomes so excessive as to threaten serious results. To do this, all that is necessary is to put the patient in a cold bath, or wrap him in a sheet wet with ice-cold water, or lay him upon an ice-mattress, or surround him with coils of tubing through which cold water runs, or use some similar efficacious device. I do not wish to be misunderstood. External cold is not to be lightly employed: it is a powerful two-edged weapon, capable of cutting both ways--a weapon as injurious and destructive in the hands of the ignorant and inexperienced as it is efficient in the hands of those to whom study and experience have taught its skillful use.

To illustrate what cold water may effect when employed by intelligent and skillful physicians, I may be permitted to cite a few hospital statistics from Germany and Switzerland, the only countries where the so-called antipyretic treatment of continued fever has been efficiently carried out on a large scale. From 1850 to 1861 there were treated without cold water, at the hospital at Kiel, 330 cases of typhoid fever, with 51 deaths--a mortality of about 15-1/2 per cent.; from 1863 to 1866, 160 cases were treated with cold baths, with 5 deaths--a mortality of only 3-1/10 per cent. In the hospital of Bâle, from 1843 to 1864, there were 1718 cases without antipyretic treatment, with 469 deaths--a mortality of about 27-1/2 per cent; from September, 1866, to 1873, 1121 cases were treated antipyretically, with 92 deaths--a mortality of a little over 8 per cent. Assuredly, we may claim that this water-treatment in typhoid fever is one of the greatest gains of modern medicine since the discovery of anæsthesia.

Some of my readers may here say to themselves, "Why, this is hydropathy!" Not so. It is the legitimate, not the illegitimate, use of cold water. It is the use of it as a single weapon, not as the only weapon of the armory. It is the employment of it in a single affection, not as a cure for all diseases.

Perhaps, in concluding this essay, I may be pardoned one word of counsel to my lay audience. Any physician who proclaims himself a follower of any special doctrine, be he a hydropath, an electropath, an allopath, a homoeopath, or any other _path_, should be viewed with suspicion. Water, cold, heat, electricity, drugs, are all agents capable of being used advantageously in the treatment of disease. Above all men, the physician ought to have that teachable spirit which is the offspring of true humility. Knowing the grave responsibilities which he assumes, living almost beneath the shadow of that past whose life-imperiling mistakes are so plainly visible in the light of the present, he, of all men, should be ever seeking for new knowledge, gathering with equal zest the seeds of healing in the waste as well as in the cultivated places, amongst the lowest and most ignorant of the populace, as well as in far-famed schools of medicine.

H.C. WOOD, JR., M.D.

SONNET.

Young bride, that findest not a single star Shining to-night with longed for prophecy, Though snowy drifts are swelling near and far, They need not chill thy happy hope and thee. If blue had overarched the earth all day, And heaven were brilliant with its stars to-night, "A happy omen!" many a guest would say, And think that Fortune blessed the sacred rite. Be superstition far from thee, sweet soul: This snowy robe, in unison with thine, Nature will doff to-morrow, and the whole Of this white waste in spring-like freshness shine. If love be strong, then all adversity Will melt like snow, and life the greener be.

CHARLOTTE F. BATES.

SOME RECOLLECTIONS OF HIRAM POWERS.

There are--or were--many at Florence whose recollections of Hiram Powers stretch over the best part of a quarter of a century; and there are few men of whom it could with equal truth and accuracy be said that such recollections are wholly pleasant in their character to the survivors and honorable to the subject of them. He was in truth universally respected by people of all classes, and by Americans and English, as well as Italians, in the city of his adoption, and personally liked and esteemed by all who had the good fortune to be among his friends. Recollections such as these are, I say, the property of very many at Florence. But there is no one in that city--there _was_ during his life no one in that city, not even she who during a long life was a companion, friend, partner and helpmeet in every sense admirable for him--whose recollections went back to so early a period as mine did.

When I came to Florence with my mother in 1841, intending to make a home there for a few years, we found, with some surprise and much pleasure, Hiram Powers, with a wife and children, settled there as a sculptor. It was long since, in the course of the changes and chances of life, we had lost sight of him, but the meeting was none the less pleasurable to, I think I may say, both parties. It was at Cincinnati in 1829 that my mother and myself first knew him. My mother, who had long been an acquaintance of General La Fayette, became thus the intimate friend of his ward, Frances Wright. Fascinated by the talent, the brilliancy and the singular eloquence of that remarkable and highly-gifted woman, and at the same time anxious to find a career for one of her sons (not the well-known author of the present day, but another brother, long since dead), whose wishes and proclivities adapted him for a life of more activity and adventure than that of one of our home-abiding professions, my mother was persuaded by her to join her in a scheme which at that time was engaging all her singularly large powers of energy and enthusiasm, the object of which was to found at New Harmony--I think, though I am not sure whether Frances Wright's colony was not another, separate from that of New Harmony--an establishment which was in some way or other to contribute to the emancipation of the slaves, mainly, I imagine, by showing that under proper management they were not unfitted for freedom. The fate of that philanthropic scheme is too well known to make it necessary for me to rehearse the story of it here, imperfectly known to me as it is. The upshot was, that my mother and brother were induced to go to Cincinnati and attempt other plans, the final result of which was also a failure. I had had no share in these Transatlantic projects, being at the time a scholar at Winchester in the college of William of Wykeham. But between quitting Winchester, at the age of eighteen, and going to Oxford, I had a period of liberty of nearly a twelvemonth, the greater part of which I devoted to accompanying my father on a visit to Cincinnati. And there I became acquainted with Powers, a very few years only my senior, whom I found already the valued friend of my mother and brother.

He was at that time--I well remember the look of him--a tall, lanky, but remarkably handsome lad, somewhat awkward in person, but with a calm but at the same time intellectually expressive beauty of feature which marked him as one of Nature's noblemen. His eyes were the most noticeable point about him. They were magnificent--large, clear, well-opened, and expressive of calm thought and the working of the intellect rather than of shrewdness or passion. His manner, I remember, was marked by an exceeding simpleness, and a sort of innocent and dignified straightforwardness which much impressed me. Altogether, my acquaintance with him was a contribution of a new sort to the education of my mind. I had passed eight years in the acquisition of those things which an English "gentleman's education" is supposed to offer. These things (in the year 1829) consisted in a very fair knowledge of Latin and Greek. Unquestionably, the eight years which I had spent in learning those languages had brought with them other advantages and other teachings of an altogether priceless sort. But what they professedly had taught me, what I then considered as the net result of my eight years at school, was a competent knowledge of Latin and Greek, and nothing else. Now, here was a young man of my own age, or little more, about whose idiosyncrasy there was something especially _simpatico_ to me, as the Italians say--who knew nothing whatever of the only things which I knew, but knew a whole world of things of which I was profoundly ignorant. I was (of course) full of prejudices also--ecclesiastical prejudices, class prejudices, political prejudices, caste prejudices--all of which were as unintelligible to my new friend as they would have been to a red Indian. He was singularly free from prejudice of any kind--a sort of original, blank-paper mind, on which nothing had been written save what he had consciously written there himself as the result of his own observations of life. I knew other young Americans, and perceived and could have pointed out characteristics which distinguished them. But Powers was not like them. He seemed to me a sort of Adam, a fresh, new and original _man_, unclassable and unjudgable by any of the formulas or prejudices which served me as means of appreciating men. Despite all this--perhaps because of all this--we soon became great friends. I very shortly discovered that he was wholly and entirely truthful. His "yes" was _yes,_ his "no" was _no_; and not only that, but what is much rarer still, his "five" or "six" was not five and a quarter or six and a half, but _five_ or _six_. I remember in him then what I recognized after many, many years in later life, and what is often so amusing a characteristic in simple, upright and truthful minds--the notion that on occasion he could be deep enough to outwit the cunning of the unscrupulous, whereas his loyal unsuspiciousness of evil was such that he might have been cheated by the first shallow rogue who chose to exercise his vulpine craft against him.

When I reached Cincinnati I found him intimate with my brother, and a favorite with my mother, who had formed a high opinion both of his character and of his talents. The latter had already very markedly manifested themselves in that direction which finally decided his career in life. Yet there was little of that dreamy and enthusiastic worship for the abstract beautiful which is generally supposed to be the marking characteristic of the artistic temperament. But he had a wonderful faculty of executing with his hands whatever his mind had conceived, and a mind singularly active in invention and in devising means for the execution of a mechanical end. Had circumstances not made him a sculptor, he might have been--probably would have been--a successful inventor, mechanician or engineer. Throughout life he was an eminently and specially _practical_ man--a man whose tendency was not to dream, but to _do_. That artistic temperament, as it is generally called, which so often manifests itself in exactly the opposite direction--in a tendency to dream rather than to do, and to allow the pleasures of the ideal to incapacitate those who indulge in them for real work--was so little his that I have never known a more industrious and conscientious worker with his hands. And there was nothing to which he could not turn them, and that with a degree of skill that would often put to shame the attempts of members of the craft which he might be essaying for the first time.