The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • Elliotson, John, 1791-1868.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    and are called acute. Oiher diseases last for a long time—perhaps coming on slowly; but whether they come on slowly or suddenly, if they last for a long time, they are called chronic. Acute diseases, however, will sometimes, instead of ter- minating in health or death, become chronic;—that is, become less violent in degree, and go on for a length of time. Diseases, therefore, are to be considered acute or chronic according to their duration. Active and Passive Diseases.—Diseases are also considered, by some, accord- ing as they are active or passive;—that is to say, according as they are attended with a degree of violence or excitement of the system, or no excitement at all. Some persons (indeed a large number) use the terms '« active and passive, and acute and chronic synonymously; but this is an error which ought particularly to be guarded against. It does not follow because a disease is acute,—that is to say, exists for a short time, and then terminates,—that it is necessarily attended by violent symp- toms; nor does it follow, because it lasts for a length of time, that these symptoms should not be active. This is illustrated, every day, in the case of rheumatism. It is daily spoken of as acute or chronic, and active or passive;—the term acute being used indifferently with active and chronic with passive. In the chronic form of the affection, therefore, a person would not think at first of apply- ing those remedies which, in an acute attack, would be beneficial;—taking it for granted that, as the disease is chronic, there is no violence; but that a slowness of mis- chief is going on, and that the remedies for the active acute state are improper. But we see, every day, cases of rheumatism which, although they have lasted for six or twelve months, or even longer, are still attended with all the symptoms of an acute disease;—that is, attended by heat of the parts, if not by quickness of pulse; and if blood be taken away, it appears buffed. It would, therefore, be a serious error to consider active and passive as synonymous terms with acute and chronic; because, in acute diseases, the word acute refers simply to their short duration; and, in chronic diseases, the word chronic simply to their long duration; whereas the word active refers to the violent disturbance going on in the system or part, and the word passive to slow changes,—changes not of a violent description. A chronic disease may be active; and an acute affection may be passive. A person with an acute affection may lose all his powers, and the whole functions of the bodv may go on in the most languid way. Therefore acute and chronic are one kind of state, active and passive are another. An acute affection cannot be chronic, but it may be passive; and a chronic affection cannot be acute, but it may be active. Continued, Remittent, and Intermittent Diseases.—Diseases differ, also, accord- ing to their uniformity of duration. Some continue with uniform tenor during their whole course,—without any very great deviation from the beginning to the end; these are called continued. Others, again, undergo a very great remission at regular periods, or at least pretty regular periods;—the symptoms not going off entirely till the disease ceases altogether, but undergoing such a relaxation of severity at such periods, as to acquire a character from this circumstance;—when they are called ''remittent. While others, again, will cease entirely from time to time (generally, too, at stated times), and recur again at certain intervals, so long as the person is affected with them; these are called intermittent. These varieties are particularly seen in the case of fever. Fever may hold a pretty uniform course;— never ceasing at all, or particularly diminishing, during the twenty-four hours, till its close; anil then we call it continued fever. It mav last for a dav, a week, or several weeks. In other cases, there is a sudden diminution in the degree of heat, violence of pulse, thirst, and all the other symptoms, at a certain period in the twenty-four hours, and perhaps at longer intervals; but they do not cease entirely: such is the character of remittent fever. Others, again, cease entirely. The patient will be attacked at a certain hour, be ill a certain number of hours; and then recover perfectly, with the exception perhaps of languor: the disease then receives the name of intermittent fever. Continuent and Periodical Diseases.—Many persons speak of continued