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Title: Zoonomia, Vol. II

Or, the Laws of Organic Life

Author: Erasmus Darwin

Release Date: December 23, 2008 [eBook #27600]

Language: English

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ZOONOMIA;

OR,

THE LAWS

OF

ORGANIC LIFE.

VOL. II.

By ERASMUS DARWIN, M.D. F.R.S.

AUTHOR OF THE BOTANIC GARDEN.

LONDON:
PRINTED FOR. J. JOHNSON, IN ST. PAUL'S CHURCH-YARD.
1796.

Entered at Stationers' Hall.

ZOONOMIA;

OR,

THE LAWS OF ORGANIC LIFE.

PART II.

CONTAINING

A CATALOGUE OF DISEASES

DISTRIBUTED INTO

NATURAL CLASSES ACCORDING TO THEIR PROXIMATE CAUSES,

WITH THEIR

SUBSEQUENT ORDERS, GENERA, AND SPECIES,

AND WITH

THEIR METHODS OF CURE.

Hæc, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa ut sint et fixa, quæ dixero; sed ut Homunculus unus e multis probabiliora conjecturâ sequens.—Cic. Tusc. Disp. l. 1. 9.

PREFACE.

All diseases originate in the exuberance, deficiency, or retrograde action, of the faculties of the sensorium, as their proximate cause; and consist in the disordered motions of the fibres of the body, as the proximate effect of the exertions of those disordered faculties.

The sensorium possesses four distinct powers, or faculties, which are occasionally exerted, and produce all the motions of the fibrous parts of the body; these are the faculties of producing fibrous motions in consequence of irritation which is excited by external bodies; in consequence of sensation which is excited by pleasure or pain; in consequence of volition which is excited by desire or aversion; and in consequence of association which is excited by other fibrous motions. We are hence supplied with four natural classes of diseases derived from their proximate causes; which we shall term those of irritation, those of sensation, those of volition, and those of association.

In the subsequent classification of diseases I have not adhered to the methods of any of those, who have preceded me; the principal of whom are the great names of Sauvages and Cullen; but have nevertheless availed myself, as much as I could, of their definitions and distinctions.

The essential characteristic of a disease consists in its proximate cause, as is well observed by Doctor Cullen, in his Nosologia Methodica, T. ii. Prolegom. p. xxix. Similitudo quidem morborum in similitudine causæ eorum proximæ, qualiscunque sit, reverâ consistit. I have taken the proximate cause for the classic character. The characters of the orders are taken from the excess, or deficiency, or retrograde action, or other properties of the proximate cause. The genus is generally derived from the proximate effect. And the species generally from the locality of the disease in the system.

Many species in this system are termed genera in the systems of other writers; and the species of those writers are in consequence here termed varieties. Thus in Dr. Cullen's Nosologia the variola or small-pox is termed a genus, and the distinct and confluent kinds are termed species. But as the infection from the distinct kind frequently produces the confluent kind, and that of the confluent kind frequently produces the distinct; it would seem more analogous to botanical arrangement, which these nosologists profess to imitate, to call the distinct and confluent small-pox varieties than species. Because the species of plants in botanical systems propagate others similar to themselves; which does not uniformly occur in such vegetable productions as are termed varieties.

In some other genera of nosologists the species have no analogy to each other, either in respect to their proximate cause, or to their proximate effect, though they may he somewhat similar in less essential properties; thus the thin and saline discharge from the nostrils on going into the cold air of a frosty morning, which is owing to the deficient action of the absorbent vessels of the nostrils, is one species; and the viscid mucus discharged from the secerning vessels of the same membrane, when inflamed, is another species of the same genus, Catarrhus. Which bear no analogy either in respect to their immediate cause or to their immediate effect.

The uses of the method here offered to the public of classing diseases according to their proximate causes are, first, more distinctly to understand their nature by comparing their essential properties. Secondly, to facilitate the knowledge of the methods of cure; since in natural classification of diseases the species of each genus, and indeed the genera of each order, a few perhaps excepted, require the same general medical treatment. And lastly, to discover the nature and the name of any disease previously unknown to the physician; which I am persuaded will be more readily and more certainly done by this natural system, than by the artificial classifications already published.

The common names of diseases are not well adapted to any kind of classification, and least of all to this from their proximate causes. Some of their names in common language are taken from the remote cause, as worms, stone of the bladder; others from the remote effect, as diarrhœa, salivation, hydrocephalus; others from some accidental symptom of the disease, as tooth-ach, head-ach, heart-burn; in which the pain is only a concomitant circumstance of the excess or deficiency of fibrous actions, and not the cause of them. Others again are taken from the deformity occasioned in consequence of the unnatural fibrous motions, which constitute diseases, as tumours, eruptions, extenuations; all these therefore improperly give names to diseases; and some difficulty is thus occasioned to the reader in endeavouring to discover to what class such disorders belong.

Another difficulty attending the names of diseases is, that one name frequently includes more than one disease, either existing at the same time or in succession. Thus the pain of the bowels from worms is caused by the increased action of the membrane from the stimulus of those animals; but the convulsions, which sometimes succeed these pains in children, are caused by the consequent volition, and belong to another class.

To discover under what class any disease should be arranged, we must first investigate the proximate cause; thus the pain of the tooth-ach is not the cause of any diseased motions, but the effect; the tooth-ach therefore does not belong to the class of Sensation. As the pain is caused by increased or decreased action of the membranes of the tooth, and these actions are owing to the increase or decrease of irritation, the disease is to be placed in the class of irritation.

To discover the order it must be inquired, whether the pain be owing to increased or defective motion of the pained membrane; which is known by the concomitant heat or coldness of the part. In tooth-ach without inflammation there is generally a coldness attends the cheek in its vicinity; as may be perceived by the hand of the patient himself, compared with the opposite cheek. Hence odontalgia is found to belong to the order of decreased irritation. The genus and species must be found by inspecting the synopsis of the second order of the class of Irritation. See Class I. 2. 4. 12.

This may be further elucidated by considering the natural operation of parturition; the pain is occasioned by the increased action or distention of the vessels of the uterus, in consequence of the stimulus of the fetus; and is therefore caused by increased irritation; but the action of the abdominal muscles in its exclusion are caused by the pain, and belong to the class of increased sensation. See Class II. 1. 1. 12. Hence the difficulty of determining, under what class of diseases parturition should be arranged, consists in there being two kinds of diseased actions comprehended under one word; which have each their different proximate cause.

In Sect. XXXIX. 8. 4. and in Class II. 1. 1. 1. we have endeavoured to give names to four links of animal causation, which conveniently apply to the classification of diseases; thus in common nictitation, or winking with the eyes without our attention to it, the increased irritation is the proximate cause; the stimulus of the air on the dry cornea is the remote cause; the closing of the eyelid is the proximate effect; and the diffusion of tears over the eye-ball is the remote effect. In some cases two more links of causation may be introduced; one of them may be termed the pre-remote cause; as the warmth or motion of the atmosphere, which causes greater exhalation from the cornea. And the other the post-remote effect; as the renewed pellucidity of the cornea; and thus six links of causation may be expressed in words.

But if amid these remote links of animal causation any of the four powers or faculties of the sensorium be introduced, the reasoning is not just according to the method here proposed; for these powers of the sensorium are always the proximate causes of the contractions of animal fibres; and therefore in true language cannot be termed their remote causes. From this criterion it may always be determined, whether more diseases than one are comprehended under one name; a circumstance which has much impeded the investigation of the causes, and cures of diseases.

Thus the term fever, is generally given to a collection of morbid symptoms; which are indeed so many distinct diseases, that sometimes appear together, and sometimes separately; hence it has no determinate meaning, except it signifies simply a quick pulse, which continues for some hours; in which sense it is here used.

In naming diseases I have endeavoured to avoid the affectation of making new compound Greek words, where others equally expressive could be procured: as a short periphrasis is easier to be understood, and less burthensome to the memory.

In the Methodus Medendi, which is marked by M.M. at the end of many of the species of diseases, the words incitantia, sorbentia, torpentia, &c. refer to the subsequent articles of the Materia Medica, explaining the operations of medicines.

The remote causes of many diseases, their periods, and many circumstances concerning them, are treated of in the preceding volume; the descriptions of many of them, which I have omitted for the sake of brevity, may be seen in the Nosologia Methodica of Sauvages, and in the Synopsis Nosologiæ of Dr. Cullen, and in the authors to which they refer.

In this arduous undertaking the author solicits the candour of the critical reader; as he cannot but foresee, that many errors will be discovered, many additional species will require to be inserted; and others to be transplanted, or erased. If he could expend another forty years in the practice of medicine, he makes no doubt, but that he could bring this work nearer perfection, and thence render it more worthy the attention of philosophers.——As it is, he is induced to hope, that some advantages will be derived from it to the science of medicine, and consequent utility to the public, and leaves the completion of his plan to the industry of future generations.

ZOONOMIA.

PART II.

CLASSES OF DISEASES.

The Orders and Genera of the First Class of Diseases.

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

Increased Irritation.

GENERA.

ORDO II.

Decreased Irritation.

GENERA.

ORDO III.

Retrograde Irritative Motions.

GENERA.

The Orders, Genera, and Species, of the First Class of Diseases.

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

Increased Irritation.

GENUS I.

With Increased Actions of the Sanguiferous System.

SPECIES.

GENUS II.

With Increased Actions of the Secerning System.

SPECIES.

GENUS III.

With increased Actions of the Absorbent System.

SPECIES.

GENUS IV.

With increased Actions of other Cavities and Membranes.

SPECIES.

GENUS V.

With increased Actions of the Organs of Sense.

SPECIES.

ORDO II.

Decreased Irritation.

GENUS I.

With decreased Actions of the Sanguiferous System.

SPECIES.

GENUS II.

With decreased Actions of the Secerning System.

SPECIES.

GENUS III.

With decreased Actions of the Absorbent System.

SPECIES.

GENUS IV.

With decreased Actions of other Cavities and Membranes.

SPECIES.

GENUS V.

With decreased Actions of the Organs of Sense.

SPECIES.

ORDO III.

Retrograde Irritative Motions.

GENUS I.

Of the Alimentary Canal.

SPECIES.

GENUS II.

Of the Absorbent System.

SPECIES.

GENUS III.

Of the Sanguiferous System.

SPECIES.

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

Increased Irritation.

GENUS I.

With increased Actions of the Sanguiferous System.

The irritability of the whole, or of part, of our system is perpetually changing; these vicissitudes of irritability and of inirritability are believed to depend on the accumulation or exhaustion of the sensorial power, as their proximate cause; and on the difference of the present stimulus, and of that which we had previously been accustomed to, as their remote cause. Thus a smaller degree of heat produces pain and inflammation in our hands, after they have been for a time immersed in snow; which is owing to the accumulation of sensorial power in the moving fibres of the cutaneous vessels during their previous quiescence, when they were benumbed with cold. And we feel ourselves cold in the usual temperature of the atmosphere on coming out of a warm room; which is owing to the exhaustion of sensorial power in the moving fibres of the vessels of the skin by their previous increased activity, into which they were excited by unusual heat.

Hence the cold fits of fever are the occasion of the succeeding hot ones; and the hot fits contribute to occasion in their turn the succeeding cold ones. And though the increase of stimulus, as of heat, exercise, or distention, will produce an increased action of the stimulated fibres; in the same manner as it is produced by the increased irritability which was occasioned by a previous defect of stimulus; yet as the excesses of irritation from the stimulus of external things are more easily avoided than the deficiencies of it; the diseases of this country, except those which are the consequences of drunkenness, or of immoderate exercise, more frequently begin with torpor than with orgasm; that is, with inactivity of some parts, or of the whole of the system, and consequent coldness, than with increased activity, and consequent heat.

If the hot fit be the consequence of the cold one, it may be asked if they are proportionate to each other: it is probable that they are, where no part is destroyed by the cold fit, as in mortification or death. But we have no measure to distinguish this, except the time of their duration; whereas the extent of the torpor over a greater or less part of the system, which occasions the cold fit; or of the exertion which occasions the hot one; as well as the degree of such torpor or exertion, are perhaps more material than the time of their duration. Besides this some muscles are less liable to accumulate sensorial power during their torpor, than others, as the locomotive muscles compared with the capillary arteries; on all which accounts a long cold fit may often be followed by a short hot one.

SPECIES.

1. Febris irritativa. Irritative fever. This is the synocha of some writers, it is attended with strong pulse without inflammation; and in this circumstance differs from the febris inirritativa of Class I. 2. 1. 1. which is attended with weak pulse without inflammation. The increased frequency of the pulsation of the heart and arteries constitutes fever; during the cold fit these pulsations are always weak, as the energy of action is then decreased throughout the whole system; and therefore the general arterial strength cannot be determined by the touch, till the cold part of the paroxysm ceases. This determination is sometimes attended with difficulty; as strong and weak are only comparative degrees of the greater or less resistance of the pulsation of the artery to the compression of the finger. But the greater or less frequency of the pulsations affords a collateral evidence in those cases, where the degree of strength is not very distinguishable, which may assist our judgment concerning it. Since a moderately strong pulse, when the patient is in a recumbent posture, and not hurried in mind, seldom exceeds 120 strokes in a minute; whereas a weak one often exceeds 130 in a recumbent posture, and 150 in an erect one, in those fevers, which are termed nervous or putrid. See Sect. XII. 1. 4.

The increased frequency of the pulsation of the heart and arteries, as it is occasioned either by excess or defect of stimulus, or of sensorial power, exists both in the cold and hot fits of fever; but when the cold fit ceases, and the pulse becomes strong and full as well as quick, in consequence of the increased irritability of the heart and arteries, it constitutes the irritative fever, or synocha. It is attended with considerable heat during the paroxysm, and generally terminates in a quarter of a lunation, without any disturbance of the faculties of the mind. See Class IV. 1. 1. 8.

M. M. Venesection. Emetics. Cathartics. Cool the patient in the hot fit, and warm him in the cold one. Rest. Torpentia.

2. Ebrietas. Drunkenness. By the stimulus of wine or opium the whole arterial system, as well as every other part of the moving system, is excited into increased action. All the secretions, and with them the production of sensorial power itself in the brain, seem to be for a time increased, with an additional quantity of heat, and of pleasureable sensation. See Sect. XXI. on this subject. This explains, why at the commencement of the warm paroxysm of some fevers the patient is in greater spirits, or vivacity; because, as in drunkenness, the irritative motions are all increased, and a greater production of sensation is the consequence, which when in a certain degree, is pleasureable, as in the diurnal fever of weak people. Sect. XXXVI. 3. 1.

3. Hæmorrhagia arteriosa. Arterial hæmorrhage. Bleeding with a quick, strong, and full pulse. The hæmorrhages from the lungs, and from the nose, are the most frequent of these; but it sometimes happens, that a small artery but half divided, or the puncture of a leech, will continue to bleed pertinaciously.

M. M. Venesection. Cathartic with calomel. Divide the wounded artery. Bind sponge on the puncture. If coffee or charcoal internally? If air with less oxygen?

4. Hæmoptoe arteriosa. Spitting of arterial blood. Blood spit up from the lungs is florid, because it has just been exposed to the influence of the air in its passage through the extremities of the pulmonary artery; it is frothy, from the admixture of air with it in the bronchia. The patients frequently vomit at the same time from the disagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is rejected from the stomach.

Sometimes an hæmoptoe for several successive days returns in gouty persons without danger, and seems to supply the place of the gouty paroxysms. Is not the liver always diseased previous to the hæmoptoe, as in several other hæmorrhages? See Class I. 2. 1. 9.

M. M. Venesection, a purge, a blister, diluents, torpentia; and afterwards sorbentia, as the bark, the acid of vitriol, and opium. An emetic is said to stop a pulmonary hæmorrhage, which it may effect, as sickness decreases the circulation, as is very evident in the great sickness sometimes produced by too large a dose of digitalis purpurea.

Dr. Rush says, a table spoonful or two of common salt is successful in hæmoptoe; this may be owing to its stimulating the absorbent systems, both the lymphatic, and the venous. Should the patient respire air with less oxygen? or be made sick by whirling round in a chair suspended by a rope? One immersion in cold water, or a sudden sprinkling all over with cold water, would probably stop a pulmonary hæmorrhage. See Sect. XXVII. 1.

5. Hæmorrhagia narium. Epistaxis. Bleeding at the nose in elderly subjects most frequently attends those, whose livers are enlarged or inflamed by the too frequent use of fermented liquors.

In boys it occurs perhaps simply from redundancy of blood; and in young girls sometimes precedes the approach of the catamenia; and then it shews a disposition contrary to chlorosis; which arises from a deficiency of red blood.

M. M. It is stopped by plunging the head into cold water, with powdered salt hastily dissolved in it; or sometimes by lint strewed over with wheat flour put up the nostrils; or by a solution of steel in brandy applied to the vessel by means of lint. The cure in other respects as in hæmoptoe; when the bleeding recurs at certain periods, after venesection, and evacuation by calomel, and a blister, the bark and steel must be given, as in intermittent fevers. See Section XXVII. 1.

ORDO I.

Increased Irritation.

GENUS II.

With increased Actions of the Secerning System.

These are always attended with increase of partial or of general heat; for the secreted fluids are not simply separated from the blood, but are new combinations; as they did not previously exist as such in the blood vessels. But all new combinations give out heat chemically; hence the origin of animal heat, which is always increased in proportion to the secretion of the part affected, or to the general quantity of the secretions. Nevertheless there is reason to believe, that as we have a sense purposely to distinguish the presence of greater or less quantities of heat, as mentioned in Sect. XIV. 6. so we may have certain minute glands for the secretion of this fluid, as the brain is believed to secrete the sensorial power, which would more easily account for the instantaneous production of the blush of shame, and of anger. This subject deserves further investigation.

SPECIES.

1. Calor febrilis. The heat in fevers arises from the increase of some secretion, either of the natural fluids, as in irritative fevers; or of new fluids, as in infectious fevers; or of new vessels, as in inflammatory fevers. The pain of heat is a consequence of the increased extension or contraction of the fibres exposed to so great a stimulus. See Class I. 1. 5. 6.

2. Rubor febrilis. Febrile redness. When the cold fit of fever terminates, and the pulsations of the heart and arteries become strong as well as quick from the increase of their irritability after their late quiescence, the blood is impelled forwards into the fine extremities of the arteries, and the anastomozing capillaries, quicker than the extremities of the veins can absorb and return it to the heart. Hence the pulse at the wrist becomes full, as well as quick and strong, and the skin glows with arterial blood, and the veins become empty and less visible.

In elderly people the force of the heart and arteries becomes less, while the absorbent power of the veins remains the same; whence the capillary vessels part with the blood, as soon as it is received, and the skin in consequence becomes paler; it is also probable, that in more advanced life some of the finer branches of the arteries coalesce, and become impervious, and thus add to the opacity of the skin.

3. Sudor calidus. Warm sweat may be divided into four varieties, according to their remote causes. First, the perspirable matter is secreted in as great quantity during the hot fit of fever, as towards the end of it, when the sweat is seen upon the skin. But during the hot fit the cutaneous absorbents act also with increased energy, and the exhalation is likewise increased by the greater heat of the skin; and hence it does not appear in drops on the surface, but is in part reabsorbed, and in part dissipated in the atmosphere. But as the mouths of the cutaneous absorbents are exposed to the cool air or bedclothes; whilst those of the capillary glands, which secrete the perspirable matter, are exposed to the warmth of the circulating blood; the former, as soon as the fever-fit begins to decline, lose their increased action first; and hence the absorption of the sweat is diminished, whilst the increased secretion of it continues for some hours afterwards, which occasions it to stand in drops upon the skin.

As the skin becomes cooler, the evaporation of the perspirable matter becomes less, as well as the absorption of it. And hence the dissipation of aqueous fluid from the body, and the consequent thirst, are perhaps greater during the hot fit, than during the subsequent sweat. For the sweats do not occur, according to Dr. Alexander's experiments, till the skin is cooled from 112 to 108 degrees of heat; that is, till the paroxysm begins to decline. From this it appears, that the sweats are not critical to the hot fit, any more than the hot fit can be called critical to the cold one; but simply, that they are the natural consequence of the decline of the hot fit, commencing with the decreased action of the absorbent system, and the decreased evaporation from the skin. And from hence it may be concluded, that a fever-fit is not in general an effort of nature to restore health, as Sydenham considered it, but a necessary consequence of the previous torpor; and that the causes of fevers would be less detrimental, if the fever itself could be prevented from existing; as appears in the cool treatment of the small-pox.

It must be noted that the profuse sweats on the skin are more frequent at the decline of fever-fits than the copious urine, or loose stools, which are mentioned below; as the cutaneous absorbents, being exposed to the cool air, lose their increased action sooner than the urinary or intestinal absorbents; which open into the warm cavities of the bladder and intestines; but which are nevertheless often affected by their sympathy with the cutaneous absorbents. Hence few fevers terminate without a moisture of the skin; whence arose the fatal practice of forcing sweats by the external warmth of air or bedclothes in fevers; for external warmth increases the action of the cutaneous capillaries more than that of the other secerning vessels; because the latter are habituated to 98 degrees of heat, the internal warmth of the body; whereas the cutaneous capillaries being nearer the surface are habitually kept cooler by the contact of the external air. Sweats thus produced by heat in confined rooms are still more detrimental; as the air becomes then not only deprived of a part of its oxygene by frequent respiration, but is loaded with animal effluvia as well as with moisture, till it can receive no more; and in consequence, while the cutaneous secretion stands upon the skin in drops for want of exhalation, the lungs are exposed to an insalubrious atmosphere.

I do not deny, that sweating may be so managed as to be serviceable in preventing the return of the cold paroxysm of fevers; like the warm bath, or any other permanent stimulus, as wine, or opium, or the bark. For this purpose it should be continued till past the time of the expected cold fit, supported by moderate doses of wine-whey, with spirit of hartshorn, and moderate degrees of warmth. Its salutary effect, when thus managed, was probably one cause of its having been so much attended to; and the fetid smell, which when profuse is liable to accompany it, gave occasion to the belief, that the supposed material cause of the disease was thus eliminated from the circulation.

When too great external heat is applied, the system is weakened by excess of action, and the torpor which causes the cold paroxysm recurs sooner and more violently. For though some stimuli, as of opium and alcohol, at the same time that they exhaust the sensorial power by promoting increase of fibrous action, may also increase the production or secretion of it in the brain, yet experience teaches us, that the exhaustion far out-balances the increased production, as is evinced by the general debility, which succeeds intoxication.

In respect to the fetor attending copious continued sweats, it is owing to the animalized part of this fluid being kept in that degree of warmth, which most favours putrefaction, and not suffered to exhale into the atmosphere. Broth, or other animal mucus, kept in similar circumstances, would in the same time acquire a putrid smell; yet has this error frequently produced miliary eruptions, and increased every kind of inflammatory or sensitive fever.

The ease, which the patient experiences during sweating, if it be not produced by much external heat, is similar to that of the warm bath; which by its stimulus applied to the cutaneous vessels, which are generally cooler than the internal parts of the system, excites them into greater action; and pleasureable sensation is the consequence of these increased actions of the vessels of the skin. From considering all these circumstances, it appears that it is not the evacuation by sweats, but the continued stimulus, which causes and supports those sweats, which is serviceable in preventing the returns of fever-fits. And that sweats too long continued, or induced by too great stimulus of warmth, clothes, or medicines, greatly injure the patient by increasing inflammation, or by exhausting the sensorial power. See Class I. 1. 2. 14.

Secondly, The sweats produced by exercise or labour are of the warm kind; as they originate from the increased action of the capillaries of the skin, owing to their being more powerfully stimulated by the greater velocity of the blood, and by a greater quantity of it passing through them in a given time. For the blood during violent exercise is carried forwards by the action of the muscles faster in the arteries, than it can be taken up by the veins; as appears by the redness of the skin. And from the consequent sweats, it is evinced, that the secretory vessels of the skin during exercise pour out the perspirable matter faster, than the mouths of the absorbent vessels can drink it up. Which mouths are not exposed to the increased muscular action, or to the stimulus of the increased velocity and quantity of the blood, but to the cool air.

Thirdly, the increased secretion of perspirable matter occasioned by the stimulus of external heat belongs likewise to this place; as it is caused by the increased motions of the capillary vessels; which thus separate from the blood more perspirable matter, than the mouths of their correspondent absorbent vessels can take up; though these also are stimulated by external heat into more energetic action. If the air be stationary, as in a small room, or bed with closed curtains, the sweat stands in drops on the skin for want of a quicker exhalation proportioned to the quicker secretion.

A fourth variety of warm perspiration is that occasioned by stimulating drugs, of which opium and alcohol are the most powerful; and next to these the spices, volatile alkali, and neutral salts, especially sea salt; that much of the aqueous part of the blood is dissipated by the use of these drugs, is evinced by the great thirst, which occurs a few hours after the use of them. See Art. III. 2. 12. and Art. III. 2. 1.

We may from hence understand, that the increase of this secretion of perspirable matter by artificial means, must be followed by debility and emaciation. When this is done by taking much salt, or salted meat, the sea-scurvy is produced; which consists in the inirritability of the bibulous terminations of the veins arising from the capillaries; see Class I. 2. 1. 14. The scrophula, or inirritability of the lymphatic glands, seems also to be occasionally induced by an excess in eating salt added to food of bad nourishment. See Class I. 2. 3. 21. If an excess of perspiration is induced by warm or stimulant clothing, as by wearing flannel in contact with the skin in the summer months, a perpetual febricula is excited, both by the preventing the access of cool air to the skin, and by perpetually goading it by the numerous and hard points of the ends of the wool; which when applied to the tender skins of young children, frequently produce the red gum, as it is called; and in grown people, either an erysipelas, or a miliary eruption, attended with fever. See Class II. 1. 3. 12.

Shirts made of cotton or calico stimulate the skin too much by the points of the fibres, though less than flannel; whence cotton handkerchiefs make the nose sore by frequent use. The fibres of cotton are, I suppose, ten times shorter than those of flax, and the number of points in consequence twenty times the number; and though the manufacturers singe their calicoes on a red-hot iron cylinder, yet I have more than once seen an erysipelas induced or increased by the stimulus of calico, as well as of flannel.

The increase of perspiration by heat either of clothes, or of fire, contributes much to emaciate the body; as is well known to jockeys, who, when they are a stone or two too heavy for riding, find the quickest way to lessen their weight is by sweating themselves between blankets in a warm room; but this likewise is a practice by no means to be recommended, as it weakens the system by the excess of so general a stimulus, brings on a premature old age, and shortens the span of life; as may be further deduced from the quick maturity, and shortness of the lives, of the inhabitants of Hindostan, and other tropical climates.

M. Buffon made a curious experiment to shew this circumstance. He took a numerous brood of the butterflies of silkworms, some hundreds of which left their eggs on the same day and hour; these he divided into two parcels; and placing one parcel in the south window, and the other in the north window of his house, he observed, that those in the colder situation lived many days longer than those in the warmer one. From these observations it appears, that the wearing of flannel clothing next the skin, which is now so much in fashion, however useful it may be in the winter to those, who have cold extremities, bad digestions, or habitual coughs, must greatly debilitate them, if worn in the warm months, producing fevers, eruptions, and premature old age. See Sect. XXXVII. 5. Class I. 1. 2. 14. Art. III. 2. 1.

4. Urina uberior colorata. Copious coloured urine. Towards the end of fever-fits a large quantity of high coloured urine is voided, the kidneys continuing to act strongly, after the increased action of the absorbents of the bladder is somewhat diminished. If the absorbents continue also to act strongly, the urine is higher coloured, and so loaded as to deposit, when cool, an earthy sediment, erroneously thought to be the material cause of the disease; but is simply owing to the secretion of the kidnies being great from their increased action; and the thinner parts of it being absorbed by the increased action of the lymphatics, which are spread very thick on the neck of the bladder; for the urine, as well as perhaps all the other secreted fluids, is produced from the kidnies in a very dilute state; as appears in those, who from the stimulus of a stone, or other cause, evacuate their urine too frequently; which is then pale from its not having remained in the bladder long enough for the more aqueous part to have been reabsorbed. The general use of this urinary absorption to the animal œconomy is evinced from the urinary bladders of fish, which would otherwise be unnecessary. High coloured urine in large quantity shews only, that the secreting vessels of the kidnies, and the absorbents of the bladder, have acted with greater energy. When there is much earthy sediment, it shews, that the absorbents have acted proportionally stronger, and have consequently left the urine in a less dilute state. In this urine the transparent sediment or cloud is mucous; the opake sediment is probably coagulable lymph from the blood changed by an animal or chemical process. The floating scum is oil. The angular concretions to the sides of the pot, formed as the urine cools, is microcosmic salt. Does the adhesive blue matter on the sides of the glass, or the blue circle on it at the edge of the upper surface of the urine, consist of Prussian blue?

5. Diarrhœa calida. Warm diarrhœa. This species may be divided into three varieties deduced from their remote causes, under the names of diarrhœa febrilis, diarrhœa crapulosa, and diarrhœa infantum. The febrile diarrhœa appears at the end of fever-fits, and is erroneously called critical, like the copious urine, and the sweats; whereas it arises from the increased action of those secerning organs, which pour their fluids into the intestinal canal (as the liver, pancreas, and mucous glands), continuing longer than the increased action of the intestinal absorbents. In this diarrhœa there is no appearance of curdled chyle in the stools, as occurs in cholera. I. 3. 1. 5.

The diarrhœa crapulosa, or diarrhœa from indigestion, occurs when too great a quantity of food or liquid has been taken; which not being compleatly digested, stimulates the intestines like any other extraneous acrid material; and thus produces an increase of the secretions into them of mucus, pancreatic juice, and bile. When the contents of the bowels are still more stimulant, as when drastic purges, or very putrescent diet, have been taken, a cholera is induced. See Sect. XXIX. 4.

The diarrhœa infantum, or diarrhœa of infants, is generally owing to too great acidity in their bowels. Milk is found curdled in the stomachs of all animals, old as well as young, and even of carnivorous ones, as of hawks. (Spallanzani.) And it is the gastric juice of the calf, which is employed to curdle milk in the process of making cheese. Milk is the natural food for children, and must curdle in their stomachs previous to digestion; and as this curdling of the milk destroys a part of the acid juices of the stomach, there is no reason for discontinuing the use of it, though it is occasionally ejected in a curdled state. A child of a week old, which had been taken from the breast of its dying mother, and had by some uncommon error been suffered to take no food but water-gruel, became sick and griped in twenty-four hours, and was convulsed on the second day, and died on the third! When all young quadrupeds, as well as children, have this natural food of milk prepared for them, the analogy is so strong in favour of its salubrity, that a person should have powerful testimony indeed of its disagreeing, before he advises the discontinuance of the use of it to young children in health, and much more so in sickness. The farmers lose many of their calves, which are brought up by gruel, or gruel and old milk; and among the poor children of Derby, who are thus fed, hundreds are starved into the scrophula, and either perish, or live in a state of wretched debility.

When young children are brought up without a breast, they should for the first two months have no food but new milk; since the addition of any kind of bread or flour is liable to ferment, and produce too much acidity; as appears by the consequent diarrhœa with green dejections and gripes; the colour is owing to a mixture of acid with the natural quantity of bile, and the pain to its stimulus. And they should never be fed as they lie upon their backs, as in that posture they are necessitated to swallow all that is put into their mouths; but when they are fed, as they are sitting up, or raised up, when they have had enough, they can permit the rest to run out of their mouths. This circumstance is of great importance to the health of those children, who are reared by the spoon, since if too much food is given them, indigestion, and gripes, and diarrhœa, is the consequence; and if too little, they become emaciated; and of this exact quantity their own palates judge the best.

M. M. In this last case of the diarrhœa of children, the food should be new milk, which by curdling destroys part of the acid, which coagulates it. Chalk about four grains every six hours, with one drop of spirit of hartshorn, and half a drop of laudanum. But a blister about the size of a shilling is of the greatest service by restoring the power of digestion. See Article III. 2. 1. in the subsequent Materia Medica.

6. Salivatio calida. Warm salivation. Increased secretion of saliva. This may be effected either by stimulating the mouth of the gland by mercury taken internally; or by stimulating the excretory duct of the gland by pyrethrum, or tobacco; or simply by the movement of the muscles, which lie over the gland, as in masticating any tasteless substance, as a lock of wool, or mastic.

In about the middle of nervous fevers a great spitting of saliva sometimes occurs, which has been thought critical; but as it continues sometimes two or even three weeks without the relief of the patient, it may be concluded to arise from some accidental circumstance, perhaps not unsimilar to the hysteric ptyalisms mentioned in Class I. 3. 2. 2. See Sect. XXIV.

M. M. Cool air, diluents, warm bath, evacuations.

7. Catharrhus calidus. Warm catarrh. Consists in an increased secretion of mucus from the nostrils without inflammation. This disease, which is called a cold in the head, is frequently produced by cold air acting for some time on the membranes, which line the nostrils, as it passes to the lungs in respiration. Whence a torpor of the action of the mucous glands is first introduced, as in I. 2. 3. 3. and an orgasm or increased action succeeds in consequence. Afterwards this orgasm and torpor are liable to alternate with each other for some time like the cold and hot fits of ague, attended with deficient or exuberant secretion of mucus in the nostrils.

At other times it arises from reverse sympathy with some extensive parts of the skin, which have been exposed too long to cold, as of the head, or feet. In consequence of the torpor of these cutaneous capillaries those of the mucous membrane of the nostrils act with greater energy by reverse sympathy; and thence secrete more mucus from the blood. At the same time the absorbents, acting also with greater energy by their reverse sympathy with those of some distant part of the skin, absorb the thinner parts of the mucus more hastily; whence the mucus is both thicker and in greater quantity. Other curious circumstances attend this disease; the membrane becomes at times so thickened by its increased action in secreting the mucus, that the patient cannot breathe through his nostrils. In this situation if he warms his whole skin suddenly by fire or bed-clothes, or by drinking warm tea, the increased action of the membrane ceases by its reverse sympathy with the skin; or by the retraction of the sensorial power to other parts of the system; and the patient can breathe again through the nostrils. The same sometimes occurs for a time on going into the cold air by the deduction of heat from the mucous membrane, and its consequent inactivity or torpor. Similar to this when the face and breast have been very hot and red, previous to the eruption of the small-pox by inoculation, and that even when exposed to cool air, I have observed the feet have been cold; till on covering them with warm flannel, as the feet have become warm, the face has cooled. See Sect. XXXV. 1. 3. Class II. 1. 3. 5. IV. 2. 2. 10. IV. 1. 1. 5.

M. M. Evacuations, abstinence, oil externally on the nose, warm diluent fluids, warm shoes, warm night-cap.

8. Expectoratio calida. Warm expectoration consists of the increased secretion of mucus from the membrane, which lines the bronchiæ, or air-cells of the lungs, without inflammation. This increased mucus is ejected by the action of coughing, and is called a cold, and resembles the catarrh of the preceding article; with which it is frequently combined.

M. M. Inhale the steam of warm water, evacuations, warm bath, afterwards opium, sorbentia.

9. Exsudatio pone aures. A discharge behind the ears. This chiefly affects children, and is a morbid secretion; as appears from its fetor; for if it was owing to defect of absorption, it would be saline, and not fetid; if a morbid action has continued a considerable time, it should not be stopped too suddenly; since in that case some other morbid action is liable to succeed in its stead. Thus children are believed to have had cholics, or even convulsions, consequent to the too sudden healing of these morbid effusions behind their ears. The rationale of this is to be explained from a medical fact, which I have frequently observed; and that is, that a blister on the back greatly strengthens the power of digestion, and removes the heart-burn in adults, and green stools in children. The stimulus of the blister produces sensation in the vessels of the skin; with this additional sensorial power these vessels act more strongly; and with these the vessels of the internal membranes of the stomach and bowels act with greater energy from their direct sympathy with them. Now the acrid discharge behind the ears of children produces sensation on that part of the skin, and so far acts as a small blister. When this is suddenly stopped, a debility of the digestive power of the stomach succeeds from the want of this accustomed stimulus, with flatulency, green stools, gripes, and sometimes consequent convulsions. See Class II. 1. 5. 6. and II. 1. 4. 6.

M. M. If the matter be absorbed, and produces swelling of the lymphatics of the neck, it should be cured as soon as possible by dusting the part with white lead, cerussa, in very fine powder; and to prevent any ill consequence an issue should be kept for about a month in the arm; or a purgative medicine should be taken, every other day for three or four times, which should consist of a grain of calomel, and three or four grains of rhubarb, and as much chalk. If there be no appearance of absorption, it is better only to keep the parts clean by washing them with warm water morning and evening; or putting fuller's earth on them; especially till the time of toothing is past. The tinea, or scald head, and a leprous eruption, which often appears behind the ears, are different diseases.

10. Gonorrhea calida. Warm gleet. Increased discharge of mucus from the urethra or prostrate gland without venereal desire, or venereal infection. See Class I. 2. 3. 8.

M. M. Cantharides, balsams, rhubarb, blister in perinæum, cold bath, injections of metallic salts, flannel shirt, change of the form of the accustomed chair or saddle of the patient.

11. Fluor albus calidus. Warm fluor albus. Increased secretion of mucus in the vagina or uterus without venereal desire or venereal infection. It is distinguished from the fluor albus frigidus by the increased sense of warmth in the part, and by the greater opacity or spissitude of the material discharged; as the thinner parts are reabsorbed by the increased action of the absorbents, along with the saline part, whence no smarting or excoriation attends it.

M. M. Mucilage, as isinglass, hartshorn jelly, gum arabic. Ten grains of rhubarb every night. Callico or flannel shift, opium, balsams. See Class I. 2. 3. 7.

12. Hæmorrhois alba. White piles. An increased discharge of mucus from the rectum frequently mistaken for matter; is said to continue a few weeks, and recur like the bleeding piles; and to obey lunar influence. See Class I. 2. 1. 6.

M. M. Abstinence from vinous spirit. Balsam of copaiva. Spice swallowed in large fragments, as ten or fifteen black pepper-corns cut in half, and taken after dinner and supper. Ward's paste, consisting of black pepper and the powdered root of Helenium Enula.

13. Serum e vesicatorio. Discharge from a blister. The excretory ducts of glands terminate in membranes, and are endued with great irritability, and many of them with sensibility; the latter perhaps in consequence of their facility of being excitable into great action; instances of this are the terminations of the gall-duct in the duodenum, and of the salivary and lachrymal glands in the mouth and eye; which produce a greater secretion of their adapted fluids, when the ends of their excretory ducts are stimulated.

The external skin consists of the excretory ducts of the capillaries, with the mouths of the absorbents; when these are stimulated by the application of cantharides, or by a slice of the fresh root of bryonia alba bound on it, the capillary glands pour an increased quantity of fluid upon the skin by their increased action; and the absorbent vessels imbibe a greater quantity of the more fluid and saline part of it; whence a thick mucous or serous fluid is deposited between the skin and cuticle.

14. Perspiratio fœtida. Fetid perspiration. The uses of the perspirable matter are to keep the skin soft and pliant, for the purposes of its easier flexibility during the activity of our limbs in locomotion, and for the preservation of the accuracy of the sense of touch, which is diffused under the whole surface of it to guard us against the injuries of external bodies; in the same manner as the secretion of tears is designed to preserve the cornea of the eye moist, and in consequence transparent; yet has this cutaneous mucus been believed by many to be an excrement; and I know not how many fanciful theories have been built on its supposed obstruction. Such as the origin of catarrhs, coughs, inflammations, erysypelas, and herpes.

To all these it may be sufficient to answer, that the antient Grecians oiled themselves all over; that some nations have painted themselves all over, as the Picts of this island; that the Hottentots smear themselves all over with grease. And lastly, that many of our own heads at this day are covered with the flour of wheat and the fat of hogs, according to the tyranny of a filthy and wasteful fashion, and all this without inconvenience. To this must be added the strict analogy between the use of the perspirable matter and the mucous fluids, which are poured for similar purposes upon all the internal membranes of the body; and besides its being in its natural state inodorous; which is not so with the other excretions of feces, or of urine.

In some constitutions the perspirable matter of the lungs acquires a disagreeable odour; in others the axilla, and in others the feet, emit disgustful effluvia; like the secretions of those glands, which have been called odoriferæ; as those, which contain the castor in the beaver, and those within the rectum of dogs, the mucus of which has been supposed to guard them against the great costiveness, which they are liable to in hot summers; and which has been thought to occasion canine madness, but which, like their white excrement, is more probably owing to the deficient secretion of bile. Whether these odoriferous particles attend the perspirable matter in consequence of the increased action of the capillary glands, and can properly be called excrementitous; that is, whether any thing is eliminated, which could be hurtful if retained; or whether they may only contain some of the essential oil of the animal; like the smell, which adheres to one's hand on stroking the hides of some dogs; or like the effluvia, which is left upon the ground, from the feet of men and other creatures; and is perceptible by the nicer organs of the dogs, which hunt them, may admit of doubt.

M. M. Wash the parts twice a day with soap and water; with lime water; cover the feet with oiled silk socks, which must be washed night and morning. Cover them with charcoal recently made red hot, and beaten into fine powder and sifted, as soon as cold, and kept well corked in a bottle, to be warned off and renewed twice a day. Internally rhubarb grains vi. or viii. every night, so as to procure a stool or two extraordinary every day, and thus by increasing one evacuation to decrease another. Cool dress, diluting liquids?

15. Crines novi. New hairs. The black points on the faces of some people consist of mucus, which is become viscid, and which adheres in the excretory ducts of the glands of the skin; as described in Class I. 2. 2. 9. and which may be pressed out by the fingers, and resembles little worms. Similar to this would seem the fabrication of silk, and of cobweb by the silk worm and spider; which is a secreted matter pressed through holes, which are the excretory ducts of glands. And it is probable, that the production of hair on many parts of the body, and at different periods of life, may be effected by a similar process; and more especially as every hair may be considered as a slender flexible horn, and is an appendage of the skin. See Sect. XXXIX. 3. 2. Now as there is a sensitive sympathy between the glands, which secrete the semen, and the throat, as appears in the mumps; see Hydrophobia, Class IV. 1. 2. 7. and Parotitis, Class IV. 1. 2. 19. The growth of the beard at puberty seems to be caused by the greater action of the cutaneous glands about the chin and pubes in consequence of their sympathy with those of the testes. But this does not occur to the female sex at their time of puberty, because the sensitive sympathy in them seems to exist between the submaxillary glands, and the pectoral ones; which secrete the milk, and afford pleasure both by that secretion, and by the erection of the mamulæ, or nipples; and by delivering the milk into the mouth of the child; this sensitive sympathy of the pectoral and submaxillary glands in women is also observable in the Parotitis, or mumps, as above referred to.

When hairs grow on the face or arms so as to be disagreeable, they may be thus readily removed without pain or any ill consequence. Warm the ends of a pair of nippers or forceps, and stick on them a little rosin, or burgundy pitch; by these means each single hair may be taken fast hold of; and if it be then plucked off slowly, it gives pain; but if plucked off suddenly, it gives no pain at all; because the vis inertiæ of the part of the skin, to which it adheres, is not overcome; and it is not in consequence separated from the cellular membrane under it. Some of the hairs may return, which are thus plucked off, or others may be induced to grow near them; but in a little time they may be thus safely destroyed; which is much to be preferred to the methods said to be used in Turkey to eradicate hair; such as a mixture of orpiment and quick lime; or of liver of sulphur in solution; which injure the skin, if they are not very nicely managed; and the hair is liable to grow again as after shaving; or to become white, if the roots of it have been much inflamed by the causticity of the application. See Class I. 2. 2. 11. on grey hairs.

ORDO I.

Increased Irritation.

GENUS III.

With increased Actions of the Absorbent System.

These are not attended with so great increase of heat as in the former genus, because the fluids probably undergo less chemical change in the glands of the absorbent system; nor are the glands of the absorbent vessels so numerous or so extensive as those of the secerning ones. Yet that some heat is produced by the increased action of the absorbents appears from the greater general warmth of the skin and extremities of feeble patients after the exhibition of the peruvian bark, and other medicines of the article Sorbentia.

SPECIES.

1. Lingua arida. Dry tongue occurs in those fevers, where the expired air is warmer than natural; and happens to all those, who sleep with their mouths open; the currents of air in respiration increasing the evaporation. There is also a dryness in the mouth from the increased action of the absorbent vessels, when a sloe or a crab-apple are masticated; and after the perforation has been much increased by eating salt or spice, or after other copious secretions; as after drunkenness, cathartics, or fever fits, the mucus of the mouth becomes viscid, and in small quantity, from the increased absorption, adhering to the tongue like a white slough. In the diabætes, where the thirst is very great, this slough adheres more pertinaciously, and becomes black or brown, being coloured after a few days by our aliment or drink. The inspissated mucus on the tongue of those, who sleep with their mouths open, is sometimes reddened as if mixed with blood, and sometimes a little blood follows the expuition of it from the fauces owing to its great adhesion. When this mucus adheres long to the papillæ of the tongue, the saliva, which it contains in its interstices, like a sponge, is liable to become putrid, and to acquire a bitter taste, like other putrid animal substances; which is generally mistaken for an indication of the presence of bile.

M. M. Warm subacid liquids. See Class I. 2. 5. 8.

2. Fauces aridæ. Dry throat. The expuition of a frothy mucus with great and perpetual hawking occurs in hydrophobia, and is very distressing to the patient; which may be owing to the increased irritability or sensibility of the upper part of the œsophagus, which will not permit any fluid to rest on it.

It affects some people after intoxication, when the lungs remain slightly inflamed, and by the greater heat of the air in expiration the mucus becomes too hastily evaporated, and is expectorated with difficulty in the state of white froth.

I knew a person, who for twenty years always waked with his tongue and throat quite dry; so that he was necessitated to take a spoonful of water, as soon as he awoke; otherwise a little blood always followed the forcible expuition of the indurated mucus from his fauces. See Class II. 1. 3. 17.

M. M. Steel-springs fixed to the night-cap so as to suspend the lower jaw and keep it closed; or springs of elastic gum. Or a pot of water suspended over the bed, with a piece of list, or woollen cloth, depending from it, and held in the mouth; which will act like a syphon, and slowly supply moisture, or barley water should be frequently syringed into the mouth of the patient.

3. Nares aridi. Dry nostrils with the mucus hardening upon their internal surface, so as to cover them with a kind of skin or scale, owing to the increased action of the absorbents of this membrane; or to the too great dryness of the air, which passes into the lungs; or too great heat of it in its expiration.

When air is so dry as to lose its transparency; as when a tremulous motion of it can be seen over corn fields in a hot summer's day; or when a dry mist, or want of transparency of the air, is visible in very hot weather; the sense of smell is at the same time imperfect from the dryness of the membrane, beneath which it is spread.

4. Expectoratio solida. Solid expectoration. The mucus of the lungs becomes hardened by the increased absorption, so that it adheres and forms a kind of lining in the air-cells, and is sometimes spit up in the form of branching vessels, which are called polypi of the lungs. See Transact. of the College, London. There is a rattling or weezing of the breath, but it is not at first attended with inflammation.

The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polyposa of Michaelis, if they differ from the peripneumony of infants, seem to belong to this genus. When the difficulty of respiration is great, venesection is immediately necessary, and then an emetic, and a blister. And the child should be kept nearly upright in bed as much as may be. See Tonsillitis, Class II. 1. 3. 3.

M. M. Diluents, emetics, essence of antimony, fœtid gums, onions, warm bath for half an hour every day for a month. Inhaling the steam of water, with or without volatile alcali. Soap.

5. Constipatio alvi. Costiveness from increased action of the intestinal absorbents. The feces are hardened in lumps called scybala; which are sometimes obliged to be extracted from the rectum with a kind of marrow spoon. This is said to have happened from the patient having taken much rust of iron. The mucus is also hardened so as to line the intestines, and to come away in skins, rolled up as they pass along, so as to resemble worms, for which they are frequently mistaken; and sometimes it is evacuated in still larger pieces, so as to counterfeit the form of the intestines, and has been mistaken for a portion of them. Balls of this kind, nearly as heavy as marble, and considerably hard, from two inches to five in diameter, are frequently found in the bowels of horses. Similar balls found in goats have been called Bezoar.

M. M. Cathartics, Diluents, fruit, oil, soap, sulphur, warm bath. Sprinkling with cold water, cool clothing. See Class I. 2. 4. 18.

6. Cutis arida. Dry skin. This dry skin is not attended with coldness as in the beginning of fever-fits. Where this cutaneous absorption is great, and the secreted material upon it viscid, as on the hairy scalp, the skin becomes covered with hardened mucus; which adheres so as not to be easily removed, as the scurf on the head; but is not attended with inflammation like the Tinea, or Lepra. The moisture, which appears on the skin beneath resinous or oily plasters, or which is seen to adhere to such plasters, is owing to their preventing the exhalation of the perspirable matter, and not to their increasing the production of it, as some have idly imagined.

M. M. Warm bathing, oil externally, oil-skin gloves, resinous plasters. Wax.

7. Urina parca colorata. Diminished urine, which is high coloured, and deposits an earthy sediment, when cold, is owing to the great action of the urinary absorbents. See Class I. 1. 2. 4. In some dropsies the cutaneous absorbents are paralytic, as well as those opening into the cellular membrane; and hence, no moisture being acquired from the atmosphere, or from the cellular membrane, great thirst is excited; and great absorption from all parts, where the absorbents are still capable of action. Hence the urine is in very small quantity, and of deep colour, with copious sediment; and the kidneys are erroneously blamed for not doing their office; stimulant diuretic medicines are given in vain; and very frequently the unhappy patient is restrained from quenching his thirst, and dies a martyr to false theory.

M. M. Diluent liquids, and warm bathing, are the natural cure of this symptom; but it generally attends those dropsies, which are seldom curable; as they are owing to a paralysis both of the cutaneous and cellular lymphatics.

8. Calculus felleus. Gall-stone. From the too hasty absorption of the thinner parts of the bile, the remainder is left too viscid, and crystallizes into lumps; which, if too large to pass, obstruct the ductus choledochus, producing pain at the pit of the stomach, and jaundice. When the indurated bile is not harder than a boiled pea, it may pass through the bile-duct with difficulty by changing its form; and thus gives those pains, which have been called spasms of the stomach; and yet these viscid lumps of bile may afterwards dissolve, and not be visible among the feces.

In two instances I have seen from thirty to fifty gall-stones voided after taking an oil vomit as below. They were about the size of peas, and distinguishable when dry by their being inflammable like bad wax, when put into the flame of a candle. For other causes of jaundice, see Class I. 2. 4. 19.

M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. Unboiled acrid vegetables, as lettice, cabbage, mustard, and cresses. When in violent pain, four ounces of oil of olives, or of almonds, should be swallowed; and as much more in a quarter of an hour, whether it stays or not. The patient should lie on the circumference of a large barrel, first on one side, and then on the other. Electric shocks through the gall-duct. Factitious Selter's water made by dissolving one dram of Sal Soda in a pint of water; to half a pint of which made luke-warm add ten drops of marine acid; to be drank as soon as mixed, twice a day for some months. Opium must be used to quiet the pain, if the oil does not succeed, as two grains, and another grain in half an hour if necessary. See Class IV. 2. 2. 4.

9. Calculus renis. Stone of the kidney. The pain in the loins and along the course of the ureter from a stone is attended with retraction of the testicle in men, and numbness on the inside of the thigh in women. It is distinguished from the lumbago or sciatica, as these latter are seldom attended with vomiting, and have pain on the outside of the thigh, sometimes quite down to the ankle or heel. See Herpes and Nephritis.

Where the absorption of the thinner parts of the secretion takes place too hastily in the kidnies, the hardened mucus, and consequent calculous concretions, sometimes totally stop up the tubuli uriniferi; and no urine is secreted. Of this many die, who have drank much vinous spirit, and some of them recover by voiding a quantity of white mucus, like chalk and water; and others by voiding a great quantity of sand, or small calculi. This hardened mucus frequently becomes the nucleus of a stone in the bladder. The salts of the urine, called microcosmic salt, are often mistaken for gravel, but are distinguishable both by their angles of crystallization, their adhesion to the sides or bottom of the pot, and by their not being formed till the urine cools. Whereas the particles of gravel are generally without angles, and always drop to the bottom of the vessel, immediately as the water is voided.

Though the proximate cause of the formation of the calculous concretions of the kidneys, and of chalk-stones in the gout, and of the insoluble concretions of coagulable lymph, which are found on membranes, which have been inflamed in peripneumony, or rheumatism, consists in the too great action of the absorbent vessels of those parts; yet the remote cause in these cases is probably owing to the inflammation of the membranes; which at that time are believed to secrete a material more liable to coagulate or concrete, than they would otherwise produce by increased action alone without the production of new vessels, which constitutes inflammation. As defined in Class II. 1. 2.

The fluids secreted from the mucous membranes of animals are of various kinds and consistencies. Hair, silk, scales, horns, fingernails, are owing to natural processes. Gall-stones, stones found in the intestines of horses, scurf of the skin in leprosy, stones of the kidnies and bladder, the callus from the inflamed periosteum, which unites broken bones, the calcareous cement, which repairs the injured shells of snails, the calcareous crust on the eggs of birds, the annually renewed shells of crabs, are all instances of productions from mucous membranes, afterwards indurated by absorption of their thinner parts.

All these concretions contain phosphoric acid, mucus, and calcareous earth in different proportions; and are probably so far analogous in respect to their component parts as well as their mode of formation. Some calcareous earth has been discovered after putrefaction in the coagulable lymph of animals. Fordyce's Elements of Practice. A little calcareous earth was detected by Scheel or Bergman in the calculus of the bladder with much phosphoric acid, and a great quantity of phosphoric acid is shewn to exist in oyster-shells by their becoming luminous on exposing them a while to the sun's light after calcination; as in the experiments of Wilson. Botanic Garden, P. 1. Canto 1. l. 182, note. The exchange of which phosphoric acid for carbonic acid, or fixed air, converts shells into limestone, producing mountains of marble, or calcareous strata.

Now as the hard lumps of calcareous matter, termed crabs' eyes, which are found in the stomachs of those animals previous to the annual renewal of their shells, are redissolved, probably by their gastric acid, and again deposited for that purpose; may it not be concluded, that the stone of the bladder might be dissolved by the gastric juice of fish of prey, as of crabs, or pike; or of voracious young birds, as young rooks or hawks, or even of calves? Could not these experiments be tried by collecting the gastric juice by putting bits of sponge down the throats of young crows, and retracting them by a string in the manner of Spallanzani? or putting pieces of calculus down the throat of a living crow, or pike, and observing if they become digested? and lastly could not gastric juice, if it should appear to be a solvent, be injected and born in the bladder without injury by means of catheters of elastic resin, or caoutchouc?

M. M. Diluents. Cool dress. Frequent change of posture. Frequent horizontal rest in the day. Bathe the loins every morning with a sponge and cold water. Aerated alcaline water internally. Abstinence from all fermented or spirituous liquors. Whatever increases perspiration injures these patients, as it dissipates the aqueous particles, which ought to dilute the urine. When the constitution begins to produce gravel, it may I believe be certainly prevented by a total abstinence from fermented or spirituous liquors; by drinking much aqueous fluids; as toast and water, tea, milk and water, lemonade; and lastly by thin clothing, and sleeping on a hardish bed, that the patient may not lie too long on one side. See Class IV. 2. 2. 2. There is reason to believe, that the daily use of opium contributes to produce gravel in the kidnies by increasing absorption, when they are inflamed; in the same manner as is done by fermented or spirituous liquor. See Class I. 3. 2. 11.

When the kidnies are so obstructed with gravel, that no urine passes into the bladder; which is known by the external appearance of the lower part of the abdomen, which, when the bladder is full, seems as if contracted by a cord between the navel and the bladder; and by the tension on the region of the bladder distinguishable by the touch; or by the introduction of the catheter; the following methods of cure are frequently successful. Venesection to six or eight ounces, ten grains of calomel, and an infusion of senna with salts and oil, every three hours, till stools are procured. Then an emetic. After the patient has been thus evacuated, a blister on the loins should be used; and from ten to twenty electric shocks should be passed through the kidnies, as large as can be easily borne, once or twice a day. Along with this method the warm bath should be used for an hour once or twice a day. After repeated evacuations a clyster, consisting of two drams of turpentine dissolved by yolk of egg, and sixty drops of tincture of opium, should be used at night, and repeated, with cathartic medicines interposed, every night, or alternate nights. Aerated solution of alcali should be taken internally, and balsam of copaiva, three or four times a day. Some of these patients recover after having made no water for nine or ten days.

If a stone sticks in the ureter with incessant vomiting, ten grains of calomel must be given in small pills as above; and some hours afterwards infusion of senna and salts and oil, if it can be made to stay on the stomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, consisting of two grains of opium. If this does not succeed, ten or twenty electric shocks through the kidney should be tried, and the purgative repeated, and afterwards the opiate. The patient should be frequently put into the warm bath for an hour at a time. Eighty or an hundred drops of laudanum given in a glyster, with two drams of turpentine, is to be preferred to the two grains given by the stomach as above, when the pain and vomiting are very urgent.

10. Calculus vesicæ. Stone of the bladder. The nucleus, or kernel, of these concretions is always formed in the kidney, as above described; and passing down the ureter into the bladder, is there perpetually increased by the mucus and salts secreted from the arterial system, or by the mucus of the bladder, disposed in concentric strata. The stones found in the bowels of horses are also formed on a nucleus, and consist of concentric spheres; as appears in sawing them through the middle. But as these are formed by the indurated mucus of the intestines alone without the urinary salts, it is probable a difference would be found on their analysis.

As the stones of the bladder are of various degrees of hardness, and probably differ from each other in the proportions at least of their component parts; when a patient, who labours under this afflicting disease, voids any small bits of gravel; these should be kept in warm solutions of caustic alcali, or of mild alcali well aerated; and if they dissolve in these solutions, it would afford greater hopes, that that which remains in the bladder, might be affected by these medicines taken by the stomach, or injected into the bladder.

To prevent the increase of a stone in the bladder much diluent drink should be taken; as half a pint of water warmed to about eighty degrees, three or four times a day: which will not only prevent the growth of it, by preventing any microcosmic salts from being precipitated from the urine, and by keeping the mucus suspended in it; but will also diminish the stone already formed, by softening, and washing away its surface. To this must be added cool dress, and cool bed-clothes, as directed above in the calculus renis.

When the stone is pushed against or into the neck of the bladder, great pain is produced; this may sometimes be relieved by the introduction of a bougie to push the stone back into the fundus of the bladder. Sometimes by change of posture, or by an opiate either taken into the stomach, or by a clyster.

A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and well saturated with carbonic acid (fixed air), by means of Dr. Nooth's glass-apparatus, and drank every day, or twice a day, is the most efficacious internal medicine yet discovered, which can be easily taken without any general injury to the constitution. An aerated alcaline water of this kind is sold under the name of factitious Seltzer water, by J. Schweppe, at N^o 8, King's-street, Holborn, London; which I am told is better prepared than can be easily done in the usual glass-vessels, probably by employing a greater pressure in wooden ones.

Lythotomy is the last recourse. Will the gastric juice of animals dissolve calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and water in the act of fermentation with yest, dissolve any kind of animal concretions?

11. Calculus arthriticus. Gout-stones are formed on inflamed membranes, like those of the kidnies above described, by the too hasty absorption of the thinner and saline parts of the mucus. Similar concretions have been produced in the lungs, and even in the pericardium; and it is probable, that the ossification, as it is called, of the minute arteries, which is said to attend old age, and to precede some mortifications of the extremities, may be a process of this kind.

As gout-stones lie near the surface, it is probable, that ether, frequently applied in their early state, might render them so liquid as to permit their reabsorption; which the stimulus of the ether might at the same time encourage.

12. Rheumatismus chronicus. Chronic rheumatism. After the acute rheumatism some inspissated mucus, or material similar to chalk-stones of the gout, which was secreted on the inflamed membrane, is probably left, owing to the too hasty absorption of the thinner and saline part of it; and by lying on the fascia, which covers some of the muscles, pains them, when they move and rub against it, like any extraneous material.

The pain of the shoulder, which attends inflammations of the upper membrane of the liver, and the pains of the arms, which attend asthma dolorificum, or dropsy of the pericardium, are distinguished from the chronic rheumatism, as in the latter the pain only occurs on moving the affected muscles.

M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so as to compress the part. Cover the part with flannel. With oiled silk. Rub it with common oil frequently. With ether. A blister. A warmer climate. Venesection. A grain of calomel and a grain of opium for ten successive nights. The Peruvian bark.

13. Cicatrix vulnerum. The scar after wounds. In the healing of ulcers the matter is first thickened by increasing the absorption in them; and then lessened, till all the matter is absorbed, which is brought by the arteries, instead of being deposed in the ulcer.

M. M. This is promoted by bandage, by the sorbentia externally, as powder of bark, white lead; solution of sugar of lead. And by the sorbentia internally after evacuations. See Sect. XXXIII. 3. 2.

In those ulcers, which are made by the contact of external fire, the violent action of the fibres, which occasions the pain, is liable to continue, after the external heat is withdrawn. This should be relieved by external cold, as of snow, salt and water recently mixed, ether, or spirits of wine suffered to evaporate on the part.

The cicatrix of an ulcer generally proceeds from the edges of it; but in large ones frequently from the middle, or commences in several places at the same time; which probably contributes to the unevenness of large scars.

14. Corneæ obfuscatio. Opacity of the cornea. There are few people, who have passed the middle of life, who have not at some time suffered some slight scratches or injuries of the cornea, which by not healing with a perfectly smooth surface, occasion some refractions of light, which may be conveniently seen in the following manner: fill a tea-saucer with cream and tea, or with milk, and holding it to your lips, as if going to drink it, the imperfections of the cornea will appear like lines or blotches on the surface of the fluid, with a less white appearance than that surface. Those blemishes of the eye are distinguished from the muscæ volitantes described in Class I. 2. 5. 3. by their being invariably seen at any time, when you look for them.

Ulcers may frequently be seen on the cornea after ophthalmy, like little pits or indentations beneath the surface of it: in this case no external application should be used, lest the scar should be left uneven; but the cure should be confined to the internal use of thirty grains of bark twice a day, and from five to ten drops of laudanum at night, with five grains of rhubarb, if necessary.

After ulcers of the cornea, which have been large, the inequalities and opacity of the cicatrix obscures the sight; in this case could not a small piece of the cornea be cut out by a kind of trephine about the size of a thick bristle, or a small crow-quill, and would it not heal with a transparent scar? This experiment is worth trying, and might be done by a piece of hollow steel wire with a sharp edge, through which might be introduced a pointed steel screw; the screw to be introduced through the opake cornea to hold it up, and press it against the cutting edge of the hollow wire or cylinder; if the scar should heal without losing its transparency, many blind people might be made to see tolerably well by this slight and not painful operation. An experiment I wish strongly to recommend to some ingenious surgeon or oculist.

ORDO I.

Increased Irritation.

GENUS IV.

With increased Actions of other Cavities and Membranes.

SPECIES.

1. Nictitatio irritativa. Winking of the eyes is performed every minute without our attention, for the purpose of cleaning and moistening the eye-ball; as further spoken of in Class II. 1. 1. 8. When the cornea becomes too dry, it becomes at the same time less transparent; which is owing to the pores of it being then too large, so that the particles of light are refracted by the edges of each pore, instead of passing through it; in the same manner as light is refracted by passing near the edge of a knife. When these pores are filled with water, the cornea becomes again transparent. This want of transparency of the cornea is visible sometimes in dying people, owing to their inirritability, and consequent neglect of nictitation.

The increase of transparency by filling the pores with fluid is seen by soaking white paper in oil; which from an opake body becomes very transparent, and accounts for a curious atmospheric phenomenon; when there exists a dry mist in a morning so as to render distant objects less distinct, it is a sign of a dry day; when distant objects are seen very distinct, it is a sign of rain. See Botan. Garden, Part I. add. note xxv. The particles of air are probably larger than those of water, as water will pass through leather and paper, which will confine air; hence when the atmosphere is much deprived of moisture, the pores of the dry air are so large, that the rays of light are refracted by their edges instead of passing through them. But when as much moisture is added as can be perfectly dissolved, the air becomes transparent; and opake again, when a part of this moisture collects into small spherules previous to its precipitation. This also accounts for the want of transparency of the air, which is seen in tremulous motions over corn-fields on hot summer-days, or over brick-kilns, after the flame is extinguished, while the furnace still remains hot.

2. Deglutitio irritativa. The deglutition of our saliva is performed frequently without our attention, and is then an irritative action in consequence of the stimulus of it in the mouth. Or perhaps sometimes for the purpose of diffusing a part of it over the dry membranes of the fauces and pharinx; in the same manner as tears are diffused over the cornea of the eye by the act of nictitation to clean or moisten it.

3. Respiratio et Tussis irritativæ. In the acts of respiration and of coughing there is an increased motion of the air-cells of the lungs owing to some stimulating cause, as described above in Class I. 1. 2. 8. and I. 1. 3. 4. and which are frequently performed without our attention or consciousness, and are then irritative actions; and thus differ from those described in Class II. 1. 1. 2. and 5. To these increased actions of the air-cells are superadded those of the intercostal muscles and diaphragm by irritative association. When any unnatural stimulus acts so violently on the organs of respiration as to induce pain, the sensorial power of sensation becomes added to that of irritation, and inflammation of the membranes of them is a general consequence.

4. Exclusio bilis. The exclusion of the bile from the gall-bladder, and its derivation into the duodenum, is an irritative action in consequence of the stimulus of the aliment on the extremity of the biliary duct, which terminates in the intestine. The increased secretion of tears is occasioned in a similar manner by any stimulating material in the eyes; which affects the excretory ducts of the lacrymal glands. A pain of the external membrane of the eye sometimes attends any unusual stimulus of it, then the sensorial power of sensation becomes added to that of irritation, and a superficial inflammation is induced.

5. Dentitio. Toothing. The pain of toothing often begins much earlier than is suspected; and is liable to produce convulsions; which are sometimes relieved, when the gum swells, and becomes inflamed; at other times a diarrhœa supervenes, which is generally esteemed a favourable circumstance, and seems to prevent the convulsions by supplying another means of relieving the pain of dentition by irritative exertion; and a consequent temporary exhaustion of sensorial power. See Class I. 1. 2. 5. Sect. XXXV. 2. 1.

The convulsions from toothing generally commence long before the appearance of the teeth; but as the two middle incisors of the lower jaw generally appear first, and then those of the upper, it is adviseable to lance the gums over these longitudinally in respect to the jaw-bones, and quite down to the periosteum, and through it.

As the convulsions attending the commencement of toothing are not only dangerous to life in their greatest degree, but are liable to induce stupor or insensibility by their continuance even in a less degree, the most efficacious means should be used to cure them.

M. M. Lance the gum of the expected teeth quite through the periosteum longitudinally. Venesection by the lancet or by two or three leeches. One grain of calomel as a purge. Tincture of jalap, five or six drops in water every three hours til it purges, to be repeated daily. After evacuations a small blister on the back or behind the ears. And lastly, two or three drops of laudanum according to the age of the child. Warm bath. See Class III. 1. 1. 5. and 6.

6. Priapismus chronicus. I have seen two cases, where an erection of the penis, as hard as horn, continued two or three weeks without any venereal desires, but not without some pain; the easiest attitude of the patients was lying upon their backs with their knees up. At length the corpus cavernosum urethræ became soft, and in another day or two the whole subsided. In one of them a bougie was introduced, hoping to remove some bit of gravel from the caput gallinaginis, camphor, warm bathing, opium, lime-water, cold aspersion, bleeding in the veins of the penis, were tried in vain. One of them had been a free drinker, had much gutta rosacea on his face, and died suddenly a few months after his recovery from this complaint. Was it a paralysis of the terminations of the veins, which absorb the blood from the tumid penis? or from the stimulus of indurated semen in the seminal vessels? In the latter case some venereal desires should have attended. Class III. 1. 2. 16.

The priapismus, which occurs to vigorous people in a morning before they awake, has been called the signum salutis, or banner of health, and is occasioned by the increase of our irritability or sensibility during sleep, as explained in Sect. XVIII. 15.

7. Distentio mamularum. The distention of the nipples of lactescent women is at first owing to the stimulus of the milk. See Sect. XIV. 8. and Sect. XVI. 5. See Class II. 1. 7. 10.

8. Descensus uteri. This is a very frequent complaint after bad labours, the fundus uteri becomes inverted and descends like the prolapsus ani.

M. M. All the usual pessaries are very inconvenient and ineffectual. A piece of soft sponge about two inches diameter introduced into the vagina gives great ease to these patients, and supports the uterus; it should have a string put through it to retract it by.

There are also pessaries now made of elastic gum, which are said to be easily worn, and to be convenient, from their having a perforation in their centre.

9. Prolapsus ani. The lower part of the rectum becomes inverted, and descends after every stool chiefly in children; and thus stimulates the sphincter ani like any other extraneous body.

M. M. It should be dusted over with very fine powder of gum sandarach, and then replaced. Astringent fomentations; as an infusion of oak-bark, or a slight solution of alum. Horizontal rest frequently in the day.

10. Lumbricus. Round worm. The round worm is suspected in children when the belly is tumid, and the countenance bloated and pale, with swelling of the upper lip. The generation of these worms is promoted by the too dilute state of the bile, as is evident in the fleuke-worm found in the biliary ducts and substance of the liver in sheep; and in water-rats, in the livers of which last animals they were lately detected in large numbers by Dr. Capelle. Transactions of the college at Philadelphia, v. i.

Now as the dilute state of the bile depends on the deficiency of the absorption of its thinner parts, it appears, that the tumid belly, and bloated countenance, and swelled upper lip, are a concomitant circumstance attending the general inactivity of the absorbent system; which is therefore to be esteemed the remote cause of the generation of worms.

The simplicity of the structure of worms probably enables them to exist in more various temperatures of heat; and their being endued with life prevents them from being destroyed by digestion in the stomach, probably in the same manner as the powers of life prevent the fermentation and putrefaction of the stomach itself. Hence I conclude, that worms are originally taken into our alimentary canal from without; as I believe similar worms of all kinds are to be found out of the body.

M. M. The round worm is destroyed by a cathartic with four or six grains of calomel; and afterwards by giving six or eight grains of filings of iron twice a day for a fortnight. See Hepatis tumor, Class I. 2. 3. 9. As worms are liable to come away in fevers, whether of the hectic or putrid kind, could they be removed by purulent matter, or rotten egg, or putrid flesh, since in those fevers from the enfeebled action of the intestines the fæces become highly putrid?

11. Tænia. Tape-worm consists of a chain of animals extending from the stomach to the anus. See Sect. XXXIX. 2. 3. It frequently exists in cats, rats, and geese, and probably in many other animals.

The worms of this genus possess a wonderful power of retaining life. Two of them, which were voided by a pointer dog in consequence of violent purgatives, each of which were several feet in length, had boiling water poured on them in a bason; which seemed not much to inconvenience them. When the water was cool, they were taken out and put into gin or whiskey of the strongest kind, in which their life and activity continued unimpaired; and they were at length killed by adding to the spirit a quantity of corrosive sublimate. Medic. Comment. for 1791, p. 370.

The tape-worm is cured by an amalgama of tin and quicksilver, such as is used on the back of looking-glasses; an ounce should be taken every two hours, till a pound is taken; and then a brisk cathartic of Glauber's salt two ounces, and common salts one ounce, dissolved in two wine pints of water, half a pint to be taken every hour till it purges. The worm extends from the stomach to the anus, and the amalgama tears it from the intestine by mechanical pressure, acting upon it the whole way. Electric shocks through the duodenum greatly assists the operation. Large doses of tin in powder. Iron filings in large doses. The powder of fern-root seems to be of no use, as recommended by M. Noufflier.

12. Ascarides. Thread-worms. These worms are said to be more frequent in some parts of this kingdom than in others, as near the fens of Lincolnshire. Do they escape from the body and become flies, like the bott-worm in horses? Do they crawl from one child to another in the same bed? Are they acquired from flies or worms, which are seen in putrid necessary houses, as these worms as well as the tapeworms, are probably acquired from without? this may account for their re-appearance a few weeks or months after they have been destroyed; or can this happen from the eggs or parts of them remaining?

Ascarides appear to be of two kinds, the common small ones like a thread; which has a very sharp head, as appears in the microscope; and which is so tender, that the cold air soon renders it motionless; and a larger kind above an inch long, and nearly as thick as a very small crow-quill, and which is very hard in respect to its texture, and very tenacious of life. One of these last was brought to me, and was immediately immersed in a strong solution of sugar of lead, and lived in it a very long time without apparent inconvenience.

M. M. Ascarides are said to be weakened by twenty grains of cinnabar and five of rhubarb taken every night, but not to be cured by this process. As these worms are found only in the rectum, variety of clysters have been recommended. I was informed of a case, where solutions of mercurial ointment were used as a clyster every night for a month without success. Clysters of Harrowgate water are recomended, either of the natural, or of the factitious, as described below, which might have a greater proportion of liver of sulphur in it. As the cold air soon destroys them, after they are voided, could clysters of iced water be used with advantage? or of spirit of wine and water? or of ether and water? Might not a piece of candle, about an inch long, or two such pieces, smeared with mercurial ointment, and introduced into the anus at night, or twice a day, be effectual by compressing their nidus, as well as by the poison of the mercury.

The clysters should be large in quantity, that they may pass high in the rectum, as two drams of tobacco boiled a minute in a pint of water. Or perhaps what might be still more efficacious and less inconvenient, the smoke of tobacco injected by a proper apparatus every night, or alternate nights, for six or eight weeks. This was long since recommended, I think by Mr. Turner of Liverpool; and the reason it has not succeeded, I believe to have been owing to the imperfections of the joints of the common apparatus for injecting the smoke of tobacco, so that it did not pass into the intestine, though it was supposed to do so, as I once observed. The smoke should be received from the apparatus into a large bladder; and it may then be certainly injected like the common clyster with sufficient force; otherwise oiled leathers should be nicely put round the joints of the machine; and a wet cloth round the injecting pipe to prevent the return of the smoke by the sides of it. Clysters of carbonated hydrogen gas, or of other factitious airs, might be tried.

Harrowgate water taken into the stomach, so as to induce six or seven stools every morning, for four or six weeks, is perhaps the most efficacious method in common use. A factitious Harrowgate water may be made probably of greater efficacy than the natural, by dissolving one ounce of marine salt, (called bay salt) and half an ounce of magnesia Glauber's salt, (called Epsom salt, or bitter purging salt) in twenty-eight ounces of water. A quarter or half a pint of this is to be taken every hour, or two hours in the morning, till it operates, with a tea-spoonful of a solution of liver of sulphur, which is to be made by putting an ounce of hepar sulphuris into half a pint of water. See Class IV. 1. 2. 9.

13. Dracunculus. A thin worm brought from the coast of Guinea. It is found in the interstices of the muscles, and is many yards long; it makes a small ulcer; which is cured by extracting an inch of the worm a day, and wrapping the extracted part slowly round a bit of tobacco pipe till next day, so as not to break it. I have twice seen long worms, like a thick horse-hair, in water in July in this country, which appeared hard and jointed.

14. Morpiones. Crab-lice. The excrement of this animal stains the linen, and appears like diluted blood.

M. M. Spirit of wine. Mercurial ointment, shaving the part. Oil destroys other insects, if they be quite covered with it, as the ticks on dogs, and would probably therefore destroy these. Its manner of operation is by stopping up or filling their spiracula, or breathing pores; a few drops of oil poured on a wasp, so as to cover it, destroys it in a few seconds.

15. Pediculi. Lice. There is said to be a disease, in which these animals are propagated in indestructible numbers, so as to destroy the patient.

M. M. Cleanliness, mercurial ointment, stavis acria in powder, or the tincture of it in spirit of wine. Spirit of wine alone? Bath of oil?

ORDO I.

Increased Irritation.

GENUS V.

With Increased Actions of the Organs of Sense.

SPECIES.

1. Visus acrior. Acuter sight. There have been instances of people, who could see better in the gloom of the evening, than in the stronger light of the day; like owls, and bats, and many quadrupeds, and flying insects. When the eye is inflamed, great light becomes eminently painful, owing to the increased irritative motions of the retina, and the consequent increased sensation. Thus when the eye is dazzled with sudden light, the pain is not owing to the motion of the iris; for it is the contraction of the iris, which relieves the pain from sudden light; but to the too violent contractions of the moving fibres, which constitute the extremities of the optic nerve.

2. Auditus acrior. The irritative ideas of hearing are so increased in energy as to excite our attention. This happens in some diseases of the epileptic kind, and in some fevers. Hence the whispering of the currents of air in a room, the respiration of the company, and noises before unperceived, become troublesome; and sounds louder than usual, or unexpected, produce starting, and convulsions.

M. M. Put oil of almonds into the ears. Stop the meatus auditorius with cotton wool. Set the feet of the patient's bed on cushions, or suspend it by cords from the ceiling.

3. Olfactus acrior. The irritative ideas of smell from the increased action of the olfactive nerve excite our attention. Hence common odours are disagreeable; and are perceived from variety of objects, which were before thought inodorous. These are commonly believed to be hallucinations of the sense.

M. M. Snuff starch up the nostrils.

4. Gustus acrior. The irritative ideas of taste, as of our own saliva, and even of the atmospheric air, excite our attention; and common tastes are disagreeably strong.

M. M. Water. Mucilage. Vegetable acids. Scrape the tongue clean. Rub it with a sage-leaf and vinegar.

5. Tactus acrior. The irritative ideas of the nerves of touch excite our attention: hence our own pressure on the parts, we rest upon, becomes uneasy with universal soreness.

M. M. Soft feather-bed. Combed wool put under the patients, which rolls under them, as they turn, and thus prevents their friction against the sheets. Drawers of soft leather. Plasters of cerate with calamy.

6. Sensus caloris acrior. Acuter sense of heat occurs in some diseases, and that even when the perceptible heat does not appear greater than natural to the hand of another person. See Class I. 1. 2. See Sect. XIV. 8. All the above increased actions of our organs of sense separately or jointly accompany some fevers, and some epileptic diseases; the patients complaining of the perception of the least light, noises in their ears, bad smells in the room, and bad tastes in their mouths, with soreness, numbness, and other uneasy feels, and with disagreeable sensations of general or partial heat.

7. Sensus extensionis acrior. Acuter sense of extension. The sense of extension was spoken of in Sect. XIV. 7. and XXXII. 4. The defect of distention in the arterial system is accompanied with faintness; and its excess with sensations of fulness, or weight, or pressure. This however refers only to the vascular muscles, which are distended by their appropriated fluids; but the longitudinal muscles are also affected by different quantities of extension, and become violently painful by the excess of it.

These pains of muscles and of membranes are generally divided into acute and dull pains. The former are generally owing to increase of extension, as in pricking the skin with a needle; and the latter generally to defect of extension, as in cold head-aches; but if the edge of a knife, or point of a pin, be gradually pressed against the fibres of muscles or membranes, there would seem to be three states or stages of this extension of the fibres; which have acquired names according to the degree or kind of sensation produced by the extension of them; these are 1. titillation or tickling. 2. itching, and the 3. smarting; as described below. See Sect. XIV. 9.

8. Titillatio. Tickling is a pleasureable pain of the sense of extension above mentioned, and therefore excites laughter; as described in Sect. XXXIV. 1. 4. The tickling of the nostrils, which precedes the efforts of sneezing, is owing to the increased irritation occasioned by external stimulus; and is attended with a pleasureable sensation in consequence of the increased action of the part. When this action is exerted in a greater degree, the sensation becomes painful, and the convulsion of sneezing ensues; as the pain in tickling the soles of the feet of children is relieved by laughter.

A lady after a bruise on her nose by a fall was affected with incessant sneezing, and relieved by snuffing starch up her nostrils. Perpetual sneezings in the measles, and in catarrhs from cold, are owing to the stimulus of the saline part of the mucous effusion on the membrane of the nostrils. See Class II. 1. 1. 3.

9. Pruritus. Itching seems to be a greater degree of titillation, and to be owing to the stimulus of some acrid material, as the matter of the itch; or of the herpes on the scrotum, and about the anus; or from those universal eruptions, which attend some elderly people, who have drank much vinous spirit. It occurs also, when inflammations are declining, as in the healing of blisters, or in the cure of ophthalmia, as the action of the vessels is yet so great as to produce sensation; which, like the titillations that occasion laughter, is perpetually changing from pleasure to pain.

When the natural efforts of scratching do not relieve the pain of itching, it sometimes increases so as to induce convulsions and madness. As in the furor uterinus, and satyriasis, and in the sphincter ani and scrotum. See Class II. 1. 4. 14. IV. 2. 2. 6.

M. M. Warm bath. Fomentation. Alcohol externally. Poultice. Oiled silk. Mercurial ointments on small surfaces at once. See Class II. 1. 4. 12. Solutions of lead on small surfaces at once.

10. Dolor urens. Smarting follows the edge of a knife in making a wound, and seems to be owing to the distention of a part of a fibre, till it breaks. A smarting of the skin is liable to affect the scars left by herpes or shingles; and the callous parts of the bottoms of the feet; and around the bases of corns on the toes; and frequently extends after sciatica along the outside of the thigh, and of the leg, and part of the foot. All these may be owing to the stimulus of extension, by blood or serum being forced into vessels nearly coalesced.

M. M. Emplastrum de minio put like a bandage on the part. Warm fomentation. Oil and camphor rubbed on the part. Oil-silk covering. A blister on the part. Ether, or alcohol, suffered to evaporate on the part.

11. Consternatio. Surprise. As our eyes acquaint us at the same time with less than half of the objects, which surround us, we have learned to confide much in the organ of hearing to warn us of approaching dangers. Hence it happens, that if any sound strikes us, which we cannot immediately account for, our fears are instantly alarmed. Thus in great debility of body, the loud clapping of a door, or the fall of a fire-shovel, produces alarm, and sometimes even convulsions; the same occurs from unexpected sights, and in the dark from unexpected objects of touch.

In these cases the irritability is less than natural, though it is erroneously supposed to be greater; and the mind is busied in exciting a train of ideas inattentive to external objects; when this train of ideas is dissevered by any unexpected stimulus, surprise is excited; as explained in Sect. XVII. 3. 7. and XVIII. 17. then as the sensibility in these cases is greater, fear becomes superadded to the surprise; and convulsions in consequence of the pain of fear. See Sect. XIX. 2.

The proximate cause of surprise is the increased irritation induced by some violent stimulus, which dissevers our usual trains of ideas; but in diseases of inirritability the frequent starting or surprise from sounds not uncommon, but rather louder than usual, as the clapping of a door, shews, that the attention of the patient to a train of sensitive ideas was previously stronger than natural, and indicates an incipient delirium; which is therefore worth attending to in febrile diseases.

ORDO II.

Decreased Irritation.

GENUS I.

With decreased Action of the Sanguiferous System.

The reader should be here apprized, that the words strength and debility, when applied to animal motions, may properly express the quantity of resistance such motions may overcome; but that, when they are applied to mean the susceptibility or insusceptibility of animal fibres to motion, they become metaphorical terms; as in Sect. XII. 2. 1. and would be better expressed by the words activity and inactivity.

There are three sources of animal inactivity; first, the defect of the natural quantity of stimulus on those fibres, which have been accustomed to perpetual stimulus; as the arterial and secerning systems. When their accustomed stimulus is for a while intermitted, as when snow is applied to the skin of the hands, an accumulation of sensorial power is produced; and then a degree of stimulus, as of heat, somewhat greater than that at present applied, though much less than the natural quantity, excites the vessels of the skin into violent action. We must observe, that a deficiency of stimulus in those fibres, which are not subject to perpetual stimulus, as the locomotive muscles, is not succeeded by accumulation of sensorial power; these therefore are more liable to become permanently inactive after a diminution of stimulus; as in strokes of the palsy, this may be called inactivity from defect of stimulus.

2. A second source of animal inactivity exists, when the sensorial power in any part of the system has been previously exhausted by violent stimuli; as the eyes after long exposure to great light; or the stomach, to repeated spirituous potation; this may be termed inactivity from exhaustion of sensorial power. See Sect. XII. 2. 1.

3. But there is a third source of inactivity owing to the deficient production of sensorial power in the brain; and hence stimuli stronger than natural are required to produce the accustomed motions of the arterial system; in this case there is no accumulation of sensorial power produced; as in the inactivity owing to defect of stimulus; nor any previous exhaustion of it, as in the inactivity owing to excess of stimulus.

This third kind of inactivity causes many of the diseases of this genus; which are therefore in general to be remedied by such medicines as promote a greater production of sensorial power in the brain; as the incitantia, consisting of wine, beer, and opium, in small repeated quantities; and secondly of such as simply stimulate the arterial and glandular system into their natural actions; as small repeated blisters, spices, and essential oils. And lastly the sorbentia, which contribute to supply the more permanent strength of the system, by promoting the absorption of nourishment from the stomach, and intestines; and of the superfluous fluid, which attends the secretions.

SPECIES.

1. Febris inirritativa. Inirritative fever. This is the typhus mitior, or nervous fever of some writers; it is attended with weak pulse without inflammation, or symptoms of putridity, as they have been called. When the production of sensorial power in the brain is less than usual, the pulse becomes quick as well as weak; and the heart sometimes trembles like the limbs of old age, or of enfeebled drunkards; and when this force of the contractions of the heart and arteries is diminished, the blood is pushed on with less energy, as well as in less quantity, and thence its stimulus on their sides is diminished in a duplicate ratio. In compressions of the brain, as in apoplexy, the pulse becomes slower and fuller; for in that disease, as in natural sleep, the irritative motions of the heart and arteries are not diminished, volition alone is suspended or destroyed.

If the absorption of the terminations of the veins is not equally impaired with the force of the heart and arteries, the blood is taken up by the veins the instant it arrives at their extremities; the capillary vessels are left empty, and there is less resistance to the current of the blood from the arteries; hence the pulse becomes empty, as well as weak and quick; the veins of the skin are fuller than the arteries of it; and its appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1.

When this pulse persists many hours, it constitutes the febris inirritativa, or typhus, or nervous fever, of some writers; it is attended with little heat, the urine is generally of a natural colour, though in less quantity; with great prostration of strength, and much disturbance of the faculties of the mind. Its immediate cause seems to be a deficient secretion of the sensorial power from the inaction of the brain; hence almost the whole of the sensorial power is expended in the performance of the motions necessary to life, and little of it can be spared for the voluntary actions of the locomotive muscles, or organs of sense, see Class I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some other part of the body; as of the spleen, when a tumour is felt on the left side, as in some intermittents; or of the kidnies, when the urine continues pale and in small quantity. Does the revivescence of these affected parts, or their torpor, recurring at intervals, form the paroxysms of these fevers? and their permanent revivescence establish the cure? See Class IV. 2. 1. 19.

M. M. Wine and opium in small quantities repeated every three hours alternately; small repeated blisters; warm but fresh air; sorbentia; nutrientia; transfusion of blood. Small electric shocks passed through the brain in all directions. Oxygene air?

2. Paresis inirritativa. Inirritative debility. A defective action of the irritative motions without increase of the frequency of the pulse. It continues three or four weeks like a fever, and then either terminates in health, or the patient sinks into one kind of apoplexy, and perishes. Many symptoms, which attend inirritative fevers, accompany this disease, as cold hands and feet at periodic times, scurf on the tongue, want of appetite, muddy urine, with pains of the head, and sometimes vertigo, and vomiting.

This disease differs from the inirritative fever by the pulse not being more frequent than in health. The want of appetite and of digestion is a principal symptom, and probably is the cause of the universal debility, which may be occasioned by the want of nourishment. The vertigo is a symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine is owing to increased absorption from the bladder in consequence of the diminished cutaneous and cellular absorption, as in anasarca, explained in Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of that part of the system; the foul tongue is owing to an increased absorption of the thinner part of the mucus in consequence of the general deficiency of fluid, which should be absorbed by the skin and stomach. The sickness is owing to decreased action of the stomach, which is probably the primary disease, and is connected with the vertigo.

M. M. An emetic. Calomel, grains iv. once or twice. Then a blister. Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small quantities, repeated alternately every three hours. Small electric percussions through the stomach.

3. Somnus interruptus. Interrupted sleep. In some fevers, where the inirritability is very great, when the patient falls asleep, the pulse in a few minutes becomes irregular, and the patient awakes in great disorder, and fear of dying, refusing to sleep again from the terror of this uneasy sensation. In this extreme debility there is reason to believe, that some voluntary power during our waking hours is employed to aid the irritative stimuli in carrying on the circulation of the blood through the lungs; in the same manner as we use voluntary exertions, when we listen to weak sounds, or wish to view an object by a small light; in sleep volition is suspended, and the deficient irritation alone is not sufficient to carry on the pulmonary circulation. This explanation seems the most probable one, because in cases of apoplexy the irritative motions of the arterial system do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13.

M. M. Opium in very small doses, as three drops of laudanum. A person should watch the patient, and awaken him frequently; or he should measure the time between slumber and slumber by a stop-watch, and awaken the patient a little before he would otherwise awake; or he should keep his finger on the pulse, and should forcibly awaken him, as soon as it becomes irregular, before the disorder of the circulation becomes so great as to disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2.

4. Syncope. Fainting consists in the decreased action of the arterial system; which is sometimes occasioned by defect of the stimulus of distention, as after venesection, or tapping for the dropsy. At other times it arises from great emotions of the mind, as in sudden joy or grief. In these cases the whole sensorial power is exerted on these interesting ideas, and becomes exhausted. Thus during great surprise or fear the heart stops for a time, and then proceeds with throbbing and agitation; and sometimes the vital motions become so deranged, as never to recover their natural successive action; as when children have been frightened into convulsions. See Sect. XII. 7. 1.

Miss ——, a young lady of Stafford, in travelling in a chaise was so affected by seeing the fall of a horse and postillion, in going down a hill, though the carriage was not overturned, that she fainted away, and then became convulsed, and never spoke afterwards; though she lived about three days in successive convulsions and stupor.

5. Hæmorrhagia venosa. A bleeding from the capillaries arising from defect of venous absorption, as in some of those fevers commonly termed putrid. When the blood stagnates in the cellular membrane, it produces petechiæ from this torpor or paralysis of the absorbent mouths of the veins. It must be observed, that those people who have diseased livers, are more liable to this kind of hæmorrhages, as well as to the hæmorrhagia arteriosa; the former, because patients with diseased livers are more subject to paralytic complaints in general, as to hemiplegia, and to dropsy, which is a paralysis of the lymphatics; and the latter is probably owing to the delay of the circulation in the vena porta by the torpor of this hepatic vessel, when the liver is not much enlarged; and to its pressure on the vena cava, when it is much enlarged.

M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel dissolved in spirit of wine externally. Flour.

6. Hæmorrhois cruenta. In the bleeding piles the capillary vessels of the rectum become distended and painful from the defect of the venous absorption of the part, and at length burst; or the mucous glands are so dilated as to give a passage to the blood; it is said to observe lunar periods.

M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia. External compression by applying lint, sponge, or cotton. Internal compression by applying a bit of candle smeared with mercurial ointment. Strangulate the tumid piles with a silk string. Cut them off. See Class I. 2. 3. 22.

Mrs. —— had for twelve or fifteen years, at intervals of a year or less, a bleeding from the rectum without pain; which however stopped spontaneously after she became weakened, or by the use of injections of brandy and water. Lately the bleeding continued above two months, in the quantity of many ounces a day, till she became pale and feeble to an alarming degree. Injections of solutions of lead, of bark and salt of steel, and of turpentine, with some internal astringents, and opiates, were used in vain. An injection of the smoke of tobacco, with ten grains of opium mixed with the tobacco, was used, but without effect the two first times on account of the imperfection of the machine; on the third time it produced great sickness, and vertigo, and nearly a fainting fit; from which time the blood entirely stopped. Was this owing to a fungous excrescence in the rectum; or to a blood-vessel being burst from the difficulty of the blood passing through the vena porta from some hepatic obstruction, and which had continued to bleed so long? Was it stopped at last by the fainting fit? or by the stimulus of the tobacco?

7. Hæmorrhagia renum. Hæmorrhage from the kidnies, when attended with no pain, is owing to defect of venous absorption in the kidney. When attended with pain on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney; which is a much more frequent disease than the former. See Sect. XXVII. 1.

M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate; cold immersion up to the navel, the upper part of the body being kept cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent liquids. Cool dress. Cool bed-room.

Cows are much subject to bloody urine, called foul water by the farmers; in this disease about sixty grains of opium with or without as much rust of iron, given twice a day, in a ball mixed with flour and water, or dissolved in warm water, or warm ale, is, I believe, an efficacious remedy, to which however should be added about two quarts of barley or oats twice a day, and a cover at night, if the weather be cold.

8. Hæmorrhagia Hepatis. Hæmorrhage from the liver. It sometimes happens in those, who have the gutta rosea, or paralytic affections owing to diseased livers induced by the potation of fermented liquors, that a great discharge of black viscid blood occasionally comes away by stool, and sometimes by vomiting: this the ancients called Melancholia, black bile. If it was bile, a small quantity of it would become yellow or green on dilution with warm water, which was not the case in one experiment which I tried; it must remain some time in the intestines from its black colour, when it passes downwards, and probably comes from the bile-ducts, and is often a fatal symptom. When it is evacuated by vomiting it is less dangerous, because it shews greater remaining irritability of the intestinal canal, and is sometimes salutary to those who have diseased livers.

M. M. An emetic. Rhubarb, steel, wine, bark.

9. Hæmoptoe venosa. Venous hæmoptoe frequently attends the beginning of the hereditary consumptions of dark-eyed people; and in others, whose lungs have too little irritability. These spittings of blood are generally in very small quantity, as a tea-spoonful; and return at first periodically, as about once a month; and are less dangerous in the female than in the male sex; as in the former they are often relieved by the natural periods of the menses. Many of these patients are attacked with this pulmonary hæmorrhage in their first sleep; because in feeble people the power of volition is necessary, besides that of irritation, to carry on respiration perfectly; but, as volition is suspended during sleep, a part of the blood is delayed in the vessels of the lungs, and in consequence effused, and the patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II. 1. 6. 6. III. 2. 1. 10.

M. M. Wake the patient every two or three hours by an alarum clock. Give half a grain of opium at going to bed, or twice a day. Onions, garlic, slight chalybeates. Issues. Leeches applied once a fortnight or month to the hemorrhoidal veins to produce a new habit. Emetics after each period of hæmoptoe, to promote expectoration, and dislodge any effused blood, which might by remaining in the lungs produce ulcers by its putridity. A hard bed, to prevent too sound sleep. A periodical emetic or cathartic once a fortnight.

10. Palpitatio cordis. The palpitation of the heart frequently attends the hæmoptoe above mentioned; and consists in an ineffectual exertion of the heart to push forwards its contents in due time, and with due force. The remote cause is frequently some impediment to the general circulation; as the torpor of the capillaries in cold paroxysms of fever, or great adhesions of the lungs. At other times it arises from the debility of the action of the heart owing to the deficient sensorial power of irritation or of association, as at the approach of death.

In both these cases of weak exertion the heart feels large to the touch, as it does not completely empty itself at each contraction; and on that account contracts more frequently, as described in Sect. XXXII. 2. 2. Another kind of palpitation may sometimes arise from the retrograde motions of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.

11. Menorrhagia. Continued flow of the catamenia. The monthly effusion of blood from the uterus or vagina is owing to a torpor of the veins of those membranes in consequence of the defect of venereal stimulus; and in this respect resembles the mucus discharged in the periodical venereal orgasm of the female quadrupeds, which are secluded from the males. The menorrhagia, or continued flow of this discharge, is owing to a continued defect of the venous absorption of the membranes of the uterus or vagina. See Class IV. 2. 4. 7.

M. M. Venesection in small quantity. A cathartic. Then opium, a grain every night. Steel. Bark. A blister. Topical aspersion with cold water, or cold vinegar.

12. Dysmenorrhagia. A difficulty of menstruation attended with pain. In this complaint the torpor of the uterine vessels, which precedes menstruation, is by sympathy accompanied with a torpor of the lumbar membranes, and consequent pain; and frequently with cold extremities, and general debility. The small quantity and difficulty of the discharge is owing to arterial inactivity, as in chlorosis. Whence it happens, that chalybeate medicines are of efficacy both to stop or prevent too great menstruation, and to promote or increase deficient menstruation; as the former is owing to inirritability of the veins, and the latter of the arteries of the uterus. See Article IV. 2. 6. in the Materia Medica.

M. M. Opium, steel, pediluvium. Warm bath.

13. Lochia nimia. Too great discharge after delivery. In that unnatural practice of some hasty accoucheurs of introducing the hand into the uterus immediately after the delivery of the child, and forcibly bringing away the placenta, it frequently happens, that a part of it is left behind; and the uterus, not having power to exclude so small a portion of it, is prevented from complete contraction, and a great hæmorrhage ensues. In this circumstance a bandage with a thick compress on the lower part of the belly, by appressing the sides of the uterus on the remaining part of the placenta, is likely to check the hæmorrhage, like the application of a pledget of any soft substance on a bleeding vessel.

In other cases the lochia continues too long, or in too great quantity, owing to the deficiency of venous absorption.

M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark. Clothes dipped in cold vinegar and applied externally. Bandages on the limbs to keep more blood in them for a time have been recommended.

14. Abortio spontanea. Some delicate ladies are perpetually liable to spontaneous abortion, before the third, or after the seventh, month of gestation. From some of these patients I have learnt, that they have awakened with a slight degree of difficult respiration, so as to induce them to rise hastily up in bed; and have hence suspected, that this was a tendency to a kind of asthma, owing to a deficient absorption of blood in the extremities of the pulmonary or bronchial veins; and have concluded from thence, that there was generally a deficiency of venous absorption; and that this was the occasion of their frequent abortion. Which is further countenanced, where a great sanguinary discharge precedes or follows the exclusion of the fetus.

M. M. Opium, bark, chalybeates in small quantity. Change to a warmer climate. I have directed with success in four cases half a grain of opium twice a day for a fortnight, and then a whole grain twice a day during the whole gestation. One of these patients took besides twenty grains of Peruvian bark for several weeks. By these means being exactly and regularly persisted in, a new habit became established, and the usual miscarriages were prevented.

Miscarriages more frequently happen from eruptive fevers, and from rheumatic ones, than from other inflammatory diseases. I saw a most violent pleurisy and hepatitis cured by repeated venesection about a week or ten days before parturition; yet another lady whom I attended, miscarried at the end of the chicken pox, with which her children were at the same time affected. Miscarriages towards the termination of the small pox are very frequent, yet there have been a few instances of children, who have been born with the eruption on them. The blood in the small pox will not inoculate that disease, if taken before the commencement of the secondary fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is not yet formed, but after it has been oxygenated through the cuticle in the pustules, it becomes contagious; and if it be then absorbed, as in the secondary fever, the blood of the mother may become contagious, and infect the child. The same mode of reasoning is applicable to the chicken pox. See Class IV. 3. 1. 7.

15. Scorbutus. Sea-scurvy is caused by salt diet, the perpetual stimulus of which debilitates the venous and absorbent systems. Hence the blood is imperfectly taken up by the veins from the capillaries, whence brown and black spots appear upon the skin without fever. The limbs become livid and edematous, and lastly ulcers are produced from deficient absorption. See Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of the lungs, see Sect. XXVII. 2.

M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar. Wine. Steel. Bark. Sorbentia. Opium?

16. Vibices. Extravasations of blood become black from their being secluded from the air. The extravasation of blood in bruises, or in some fevers, or after death in some patients, especially in the parts which were exposed to pressure, is owing to the fine terminations of the veins having been mechanically compressed so as to prevent their absorbing the blood from the capillaries, or to their inactivity from disease. The blood when extravasated undergoes a chemical change before it is sufficiently fluid to be taken up by the lymphatic absorbents, and in that process changes its colour to green and then yellow.

17. Petechiæ. Purple spots. These attend fevers with great venous inirritability, and are probably formed by the inability of a single termination of a vein, whence the corresponding capillary becomes ruptured, and effuses the blood into the cellular membrane round the inert termination of the vein. This is generally esteemed a sign of the putrid state of the blood, or that state contrary to the inflammatory one. As it attends some inflammatory diseases which are attended with great inirritability, as in the confluent small pox. But it also attends the scurvy, where no fever exists, and it therefore simply announces the inactivity of the terminations of some veins; and is thence indeed a bad symptom in fevers, as a mark of approaching inactivity of the whole sanguiferous system, or death. The blue colour of some children's arms or faces in very cold weather is owing in like manner to the torpor of the absorbent terminations of the veins, whence the blood is accumulated in them, and sometimes bursts them.

ORDO II.

Decreased Irritation.

GENUS II.

Decreased Action of the Secerning System.

These are always attended with decrease of partial, or of general heat; for as the heat of animal bodies is the consequence of their various secretions, and is perpetually passing away into the ambient air, or other bodies in contact with them; when these secretions become diminished, or cease, the heat of the part or of the whole is soon diminished, or ceases along with them.

SPECIES.

1. Frigus febrile. Febrile coldness. There is reason to believe, that the beginning of many fever-fits originates in the quiescence of some part of the absorbent system, especially where they have been owing to external cold; but that, where the coldness of the body is not owing to a diminution of external heat, it arises from the inaction of some part of the secerning system. Hence some parts of the body are hot whilst other parts are cold; which I suppose gave occasion to error in Martyn's Experiments; where he says, that the body is as hot in the cold paroxysms of fevers as at other times.

After the sensorial power has been much diminished by great preceding activity of the system, as by long continued external heat, or violent exercise, a sudden exposure to much cold produces a torpor both greater in degree and over a greater portion of the system, by subtracting their accustomed stimulus from parts already much deprived of their irritability. Dr. Franklin in a letter to M. Duberge, the French translator of his works, mentions an instance of four young men, who bathed in a cold spring after a day's harvest work; of whom two died on the spot, a third on the next morning, and the other survived with difficulty. Hence it would appear, that those, who have to travel in intensely cold weather, will sooner perish, who have previously heated themselves much with drams, than those who have only the stimulus of natural food; of which I have heard one well attested instance. See Article VII. 2. 3. Class III. 2. 1. 17.

Frigus chronicum. Permanent coldness. Coldness of the extremities, without fever, with dry pale skin, is a symptom of general debility, owing to the decreased action of the arterial system, and of the capillary vessels; whence the perspirable matter is secreted in less quantity, and in consequence the skin is less warm. This coldness is observable at the extremities of the limbs, ears, and nose, more than in any other parts: as a larger surface is here exposed to the contact of the air, or clothes, and thence the heat is more hastily carried away.

The pain, which accompanies the coldness of the skin, is owing to the deficient exertion of the subcutaneous vessels, and probably to the accumulation of sensorial power in the extremities of their nerves. See Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1.

M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes. Fire. Joy. Anger.

2. Pallor fugitivus. The fugitive paleness, which accompanies the coldness of the extremities, is owing to a less quantity of blood passing through the capillaries of the skin in a given time; where the absorbent power of the veins is at the same time much diminished, a part of the blood lingers at their junction with the capillary arteries, and a bluish tinge is mixed with the paleness; as is seen in the loose skin under the eye-lids, and is always a mark of temporary debility. See Class II. 1. 4. 4. Where the paleness of the skin is owing to the deficiency of red globules in the blood, it is joined with a yellowish tinge; which is the colour of the serum, with which the blood then abounds, as in chlorosis, and in torpor or paralysis of the liver, and is often mistaken for a superabundance of bile.

A permanent paleness of the skin is owing to the coalescence of the minute arteries, as in old age. See Class I. 2. 2. 9. There is another source of paleness from the increased absorption of the terminations of the veins, as when vinegar is applied to the lips. See Sect. XXVII. 1. and another from the retrograde motions of the capillaries and fine extremities of the arteries. See Class II. 3. 1. 1.

M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.

3. Pus parcius. Diminished pus. Dryness of ulcers. In the cold fits of fever all the secretions are diminished, whether natural or artificial, as their quantity depends on the actions of the glands or capillaries, which then share in the universal inaction of the system. Hence the dryness of issues and blisters in great debility, and before the approach of death, is owing to deficient secretion, and not to increased absorption.

M. M. Opium, wine in very small quantities, Peruvian bark.

4. Mucus parcior. Diminished mucus. Dryness of the mouth and nostrils. This also occurs in the cold fits of intermittents. In these cases I have also found the tongue cold to the touch of the finger, and the breath to the back of one's hand, when opposed to it, which are very inauspicious symptoms, and generally fatal. In fevers with inirritability it is generally esteemed a good symptom, when the nostrils and tongue become moist after having been previously dry; as it shews an increased action of the mucous glands of those membranes, which were before torpid. And the contrary to this is the facies Hippocratica, or countenance so well described by Hippocrates, which is pale, cold, and shrunk; all which are owing to the inactivity of the secerning vessels, the paleness from there being less red blood passing through the capillaries, the coldness of the skin from there being less secretion of perspirable matter, and the shrunk appearance from there being less mucus secreted into the cells of the cellular membrane. See Class IV. 2. 4. 11.

M. M. Blisters. Incitantia.

5. Urina parcior pallida. Paucity of pale urine, as in the cold fits of intermittents; it appears in some nervous fevers throughout the whole disease, and seems to proceed from a palsy of the kidnies; which probably was the cause of the fever, as the fever sometimes ceases, when that symptom is removed: hence the straw-coloured urine in this fever is so far salutary, as it shews the unimpaired action of the kidnies.

M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides internally.

6. Torpor hepaticus. Paucity of bile from a partial inaction of the liver; hence the bombycinous colour of the skin, grey stools, urine not yellow, indigestion, debility, followed by tympany, dropsy, and death.

This paralysis or inirritability of the liver often destroys those who have been long habituated to much fermented liquor, and have suddenly omitted the use of it. It also destroys plumbers, and house-painters, and in them seems a substitute for the colica saturnina. See Sect. XXX.

M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment rubbed on the region of the liver. Rhubarb, three or four grains, with opium half a grain to a grain twice a day. Equitation, warm bath for half an hour everyday.

7. Torpor Pancreatis. Torpor of the pancreas. I saw what I conjectured to be a tumour of the pancreas with indigestion, and which terminated in the death of the patient. He had been for many years a great consumer of tobacco, insomuch that he chewed that noxious drug all the morning, and smoaked it all the afternoon. As the secretion from the pancreas resembles saliva in its general appearance, and probably in its office of assisting digestion, by preventing the fermentation of the aliment; as would appear by the experiments of Pringle and Macbride; there is reason to suspect, that a sympathy may exist between the salivary and pancreatic glands; and that the perpetual stimulus of the former by tobacco might in process of time injure the latter. See Tobacco, Article III. 2. 2.

8. Torpor renis. Inirritability or paralysis of the kidnies is probably frequently mistaken for gravel in them. Several, who have lived rather intemperately in respect to fermented or spirituous liquors, become suddenly seized about the age of sixty, or later, with a total stoppage of urine; though they have previously had no symptoms of gravel. In these cases there is no water in the bladder; as is known by the introduction of the catheter, of which those made of elastic gum are said to be preferable to metallic ones; or it may generally be known by the shape of the abdomen, either by the eye or hand. Bougies and catheters of elastic gum are sold at N^o 37, Red Lion-street, Holborn, London.

M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1. 3. 9. When no gravel has been previously observed, and the patient has been a wine-drinker rather than an ale-drinker, the case is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Class I. 2. 4. 20.

9. Punctæ mucosæ vultûs. Mucous spots on the face. These are owing to the inactivity of the excretory ducts of the mucous glands; the thinner part of this secretion exhales, and the remainder becomes inspissated, and lodges in the duct; the extremity of which becomes black by exposure to the air.

M. M. They may be pressed out by the finger-nails. Warm water. Ether frequently applied. Blister on the part?

10. Maculæ cutis fulvæ. Morphew or freckles. Tawny blotches on the skin of the face and arms of elderly people, and frequently on their legs after slight erysipelas. The freckles on the face of younger people, who have red hair, seem to be a similar production, and seem all to be caused by the coalescence of the minute arteries or capillaries of the part. In a scar after a wound the integument is only opake; but in these blotches, which are called morphew and freckles, the small vessels seem to have become inactive with some of the serum of the blood stagnating in them, from whence their colour. See Class III. 1. 2. 12.

M. M. Warm bathing. A blister on the part?

11. Canities. Grey hair. In the injection of the vessels of animals for the purposes of anatomical preparations, the colour of the injected fluid will not pass into many very minute vessels; which nevertheless uncoloured water, or spirits, or quicksilver will permeate. The same occurs in the filtration of some coloured fluids through paper, or very fine sand, where the colouring matter is not perfectly dissolved, but only diffused through the liquid. This has led some to imagine, that the cause of the whiteness of the hair in elderly people may arise from the diminution, or greater tenuity, of the glandular vessels, which secrete the mucus, which hardens into hair; and that the same difference of the tenuity of the secerning vessels may possibly make the difference of colour of the silk from different silk-worms, which is of all shades from yellow to white.

But as the secreted fluids are not the consequence of mechanical filtration, but of animal selection; we must look out for another cause, which must be found in the decreasing activity of the glands, as we advance in life; and which affects many of our other secretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horses by whatever injures the glands at their roots, as by corrosive blisters; and frequently on the human subject by external injuries on the head; and sometimes by fevers. And as the grey colour of hair consists in its want of transparency, like water converted into snow; there is reason to suppose, that a defect of secreted moisture simply may be the cause of this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13.

M. M. Whatever prevents the inirritability and insensibility of the system, that is, whatever prevents the approach of old age, will so far counteract the production of grey hairs, which is a symptom of it. For this purpose in people, who are not corpulent, and perhaps in those who are so, the warm bath twice or thrice a week is particularly serviceable. See Sect. XXXIX. 5. 1. on the colours of animals, and Class I. 1. 2. 15.

12. Callus. The callous skin on the hands and feet of laborious people is owing to the extreme vessels coalescing from the perpetual pressure they are exposed to.

As we advance in life, the finer arteries lose their power of action, and their sides grow together; hence the paleness of the skins of elderly people, and the loss of that bloom, which is owing to the numerous fine arteries, and the transparency of the skin, that encloses them.

M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a pumice stone. Cover the part with oiled silk to prevent the evaporation of the perspirable matter, and thus to keep it moist.

13. Cataracta is an opacity of the crystalline lens of the eye. It is a disease of light-coloured eyes, as the gutta serena is of dark ones. On cutting off with scissars the cornea of a calf's eye, and holding it in the palm of one's hand, so as to gain a proper light, the artery, which supplies nutriment to the crystalline humour, is easily and beautifully seen; as it rises from the centre of the optic nerve through the vitreous humour to the crystalline. It is this point, where the artery enters the eye through the cineritious part of the optic nerve, (which is in part near the middle of the nerve,) which is without sensibility to light; as is shewn by fixing three papers, each of them about half an inch in diameter, against a wall about a foot distant from each other, about the height of the eye; and then looking at the middle one, with one eye, and retreating till you lose sight of one of the external papers. Now as the animal grows older, the artery becomes less visible, and perhaps carries only a transparent fluid, and at length in some subjects I suppose ceases to be pervious; then it follows, that the crystalline lens, losing some fluid, and gaining none, becomes dry, and in consequence opake; for the same reason, that wet or oiled paper is more transparent than when it is dry, as explained in Class I. 1. 4. 1. The want of moisture in the cornea of old people, when the exhalation becomes greater than the supply, is the cause of its want of transparency; and which like the crystalline gains rather a milky opacity. The same analogy may be used to explain the whiteness of the hair of old people, which loses its pellucidity along with its moisture. See Class I. 2. 2. 11.

M. M. Small electric shocks through the eye. A quarter of a grain of corrosive sublimate of mercury dissolved in brandy, or taken in a pill, twice a day for six weeks. Couching by depression, or by extraction. The former of these operations is much to be preferred to the latter, though the latter is at this time so fashionable, that a surgeon is almost compelled to use it, lest he should not be thought an expert operator. For depressing the cataract is attended with no pain, no danger, no confinement, and may be as readily repeated, if the crystalline should rise again to the centre of the eye. The extraction of the cataract is attended with considerable pain, with long confinement, generally with fever, always with inflammation, and frequently with irreparable injury to the iris, and consequent danger to the whole eye. Yet has this operation of extraction been trumpeted into universal fashion for no other reason but because it is difficult to perform, and therefore keeps the business in the hands of a few empyrics, who receive larger rewards, regardless of the hazard, which is encountered by the flattered patient.

A friend of mine returned yesterday from London after an absence of many weeks; he had a cataract in a proper state for the operation, and in spite of my earnest exhortation to the contrary, was prevailed upon to have it extracted rather than depressed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one side so as to make an oblong aperture; and which is nearly, if not totally, without contraction, and thus greatly impedes the little vision, which he possesses. Whereas I saw some patients couched by depression many years ago by a then celebrated empyric, Chevalier Taylor, who were not confined above a day or two, that the eye might gradually be accustomed to light, and who saw as well as by extraction, perhaps better, without either pain, or inflammation, or any hazard of losing the eye.

As the inflammation of the iris is probably owing to forcing the crystalline through the aperture of it in the operation of extracting it, could it not be done more safely by making the opening behind the iris and ciliary process into the vitreous humour? but the operation would still be more painful, more dangerous, and not more useful than that by depressing it.

14. Innutritio ossium. Innutrition of the bones. Not only the blood effused in vibices and petechiæ, or from bruises, as well as the blood and new vessels in inflamed parts, are reabsorbed by the increased action of the lymphatics; but the harder materials, which constitute the fangs of the first set of teeth, and the ends of exfoliating bones, and sometimes the matter of chalk-stones in the gout, the coagulable lymph, which is deposited on the lungs, or on the muscles after inflammation of those parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatism, and lastly the earthy part of the living bones are dissolved and absorbed by the increased actions of this system of vessels. See Sect. XXXIII. 3. 1.

The earthy part of bones in this disease of the innutrition of them seems to suffer a solution, and reabsorption; while the secerning vessels do not supply a sufficient quantity of calcareous earth and phosphoric acid, which constitute the substance of bones. As calcareous earth abounds every where, is the want of phosphoric acid the remote cause? One cause of this malady is given in the Philosophic Transactions, where the patient had been accustomed to drink large quantities of vinegar. Two cases are described by Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous earth, and afterwards of bone-ashes, and of decoction of madder, and also of sublimate of mercury, were given without effect. All the bones became soft, many of them broke, and the patient seemed to die from the want of being able to distend her chest owing to the softness of the ribs.

M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or such as is found in all limestone or marly countries. The calcareous earth in these waters might possibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alcali as a lotion on the spine, or essential oils.

The innutrition of the bones is often first to be perceived by the difficulty of breathing and palpitation of the heart on walking a little faster than usual, which I suppose is owing to the softness of the ends of the ribs adjoining to the sternum; on which account they do not perfectly distend the chest, when they are raised by the pectoral and intercostal muscles with greater force than usual. After this the spine becomes curved both by the softness of its vertebræ, and for the purpose of making room for the disturbed heart. See Species 16 of this genus.

As these patients are pale and weak, there would seem to be a deficiency of oxygene in their blood, and in consequence a deficiency of phosphoric acid; which is probably produced by oxygene in the act of respiration.

Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to arise from the prevalence of vegetable or acetous acid, which is known to soften bones out of the body. Mr. Dettaen seems to have espoused a similar opinion, and both of them in consequence give alcalies and testacea. If this theory was just, the soft bones of such patients should shew evident marks of such acidity after death; which I believe has not been observed. Nor is it analogous to other animal facts, that nutritious fluids secreted by the finest vessels of the body should be so little animalized, as to retain acetous or vegetable acidity.

The success attending the following case in so short a time as a fortnight I ascribed principally to the use of the warm bath; in which the patient continued for full half an hour every night, in the degree of heat, which was most grateful to her sensation, which might be I suppose about 94. Miss ——, about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the least exercise, with occasional violent dry cough, for a year or more, with dry lips, little appetite either for food or drink, and dry skin, with cold extremities. She has at times been occasionally worse, and been relieved in some degree by the bark. She began to bend forwards, and to lift up her shoulders. The former seemed owing to a beginning curvature of the spine, the latter was probably caused to facilitate her difficult respiration.

M. M. She used the warm bath, as above related; which by its warmth might increase the irritability of the smallest series of vessels, and by supplying more moisture to the blood might probably tend to carry further the materials, which form calcareous or bony particles, or to convey them in more dilute solution. She took twice a day twenty grains of extract of bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of calcined hartshorn mixed into a powder with ten drops of laudanum; with flesh food both to dinner and supper; and port wine and water instead of the small beer, she had been accustomed to; she lay on a sofa frequently in a day, and occasionally used a neck-swing.

15. Rachitis. Rickets. The head is large, protuberant chiefly on the forepart. The smaller joints are swelled; the ribs depressed; the belly tumid, with other parts emaciated. This disease from the innutrition or softness of the bones arose about two centuries ago; seems to have been half a century in an increasing or spreading state; continued about half a century at its height, or greatest diffusion; and is now nearly vanished: which gives reason to hope, that the small-pox, measles, and venereal disease, which are all of modern production, and have already become milder, may in process of time vanish from the earth, and perhaps be succeeded by new ones! See the preceding species.

16. Spinæ distortio. Distortion of the spine is another disease originating from the innutrition or softness of the bones. I once saw a child about six years old with palpitation of heart, and quickness of respiration, which began to have a curvature of the spine; I then doubted, whether the palpitation and quick respiration were the cause or consequence of the curvature of the spine; suspecting either that nature had bent the spine outwards to give room to the enlarged heart; or that the malformation of the chest had compressed and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whose spine had lately began to be distorted, with very great difficulty and quickness of respiration, and alarming palpitation of the heart, I convinced myself, that the palpitation and difficult respiration were the effect of the change of the cavity of the chest from the distortion of the spine; and that the whole was therefore a disease of the innutrition or softness of the bones.

For on directing her to lie down much in the day, and to take the bark, the distortion became less, and the palpitation and quick respiration became less at the same time. After this observation a neck-swing was directed, and she took the bark, madder, and bone-ashes; and she continues to amend both in her shape and health.

Delicate young ladies are very liable to become awry at many boarding schools. This is occasioned principally by their being obliged too long to preserve an erect attitude, by sitting on forms many hours together. To prevent this the school-seats should have either backs, on which they may occasionally rest themselves; or desks before them, on which they may occasionally lean. This is a thing of greater consequence than may appear to those, who have not attended to it.

When the least tendency to become awry is observed, they should be advised to lie down on a bed or sofa for an hour in the middle of the day for many months; which generally prevents the increase of this deformity by taking off for a time the pressure on the spine of the back, and it at the same time tends to make them grow taller. Young persons, when nicely measured, are found to be half an inch higher in a morning than at night; as is well known to those, who inlist very young men for soldiers. This is owing to the cartilages between the bones of the back becoming compressed by the weight of the head and shoulders on them during the day. It is the same pressure which produces curvatures and distortions of the spine in growing children, where the bones are softer than usual; and which may thus be relieved by an horizontal posture for an hour in the middle of the day, or by being frequently allowed to lean on a chair, or to play on the ground on a carpet.

Young ladies should also be directed, where two sleep in a bed, to change every night, or every week, their sides of the bed; which will prevent their tendency to sleep always on the same side; which is not only liable to produce crookedness, but also to occasion diseases by the internal parts being so long kept in uniform contact as to grow together. For the same reason they should not be allowed to sit always on the same side of the fire or window, because they will then be inclined too frequently to bend themselves to one side.

Another great cause of injury to the shape of young ladies is from the pressure of stays, or other tight bandages, which at the same time cause other diseases by changing the form or situation of the internal parts. If a hard part of the stays, even a knot of the thread, with which they are sewed together, is pressed hard upon one side more than the other, the child bends from the side most painful, and thus occasions a curvature of the spine. To counteract this effect such stays, as have fewest hard parts, and especially such as can be daily or weekly turned, are preferable to others.

Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back; recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight; or lastly, recourse may be had to a spinal machine first described in the Memoires of the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road, London, which suspends the head, and places the weight of it on the hips. This machine is capable of improvement by joints in the bar at the back of it, to permit the body to bend forwards without diminishing the extension of the spine.

The objections of this machine of M. Vacher, which is made by Mr. Jones, are first, that it is worn in the day-time, and has a very unsightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and substituting in its place a forked bar, rising up behind each ear, with webs fastened to it, which pass under the chin and occiput. But this is not an improvement, but a deterioration of M. Vacher's machine, as it prevents the head from turning with facility to either side. Another objection is, that its being worn, when the muscles of the back are in action, it is rather calculated to prevent the curvature of the spine from becoming greater, than to extend the spine, and diminish its curvature.

For this latter purpose I have made a steel bow, as described in the annexed plate, which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches. Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput. There are also proper webs lined with fur for the hands to take hold off occasionally, and also to go under the arms. By these means I should hope great advantage from gradually extending the spine during the inactivity of the muscles of the back; and that it may be done without disturbing the sleep of the patient, and if this should happen, the bow is made to open by a joint at the summit of it, so as to be instantly disengaged from the neck by the hand of the wearer. This bow I have not yet had opportunity to make use of, but it may be had from Mr. Harrison, whitesmith, Bridge-gate, Derby.

It will be from hence easily perceived, that all other methods of confining or directing the growth of young people should be used with great skill; such as back-boards, or bandages, or stocks for the feet; and that their application should not be continued too long at a time, lest worse consequences should ensue, than the deformity they were designed to remove. To this may be added, that the stiff erect attitude taught by some modern dancing masters does not contribute to the grace of person, but rather militates against it; as is well seen in one of the prints in Hogarth's Analysis of Beauty; and is exemplifyed by the easy grace of some of the ancient statues, as of the Venus de Medici, and the Antinous, and in the works of some modern artists, as in a beautiful print of Hebe feeding an Eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman.

Where the bone of one of the vertebræ of the back has been swelled on both sides of it, so as to become protuberant, issues near the swelled part have been found of great service, as mentioned in Species 18 of this genus. This has induced me to propose in curvatures of the spine, to put an issue on the outside of the curve, where it could be certainly ascertained, as the bones on the convex side of the curve must be enlarged; in one case I thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general constitution is of service; as the use of the cold bath in the summer months. This however requires some restriction both in respect to the degree of coldness of the bath, the time of continuing in it, and the season of the year. Common springs, which are of forty-eight degrees of heat, are too cold for tender constitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldness of river water in the summer months, which is about sixty-eight degrees, or that of Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath should be but a minute or two, or not so long as to occasion a trembling of the limbs from cold. In respect to the season of the year, delicate children should certainly only bathe in the summer months; as the going frequently into the cold air in winter will answer all the purposes of the cold bath.

17. Claudicatio coxaria. Lameness of the hip. A nodding of the thigh-bone is said to be produced in feeble children by the softness of the neck or upper part of that bone beneath the cartilage; which is naturally bent, and in this disease bends more downwards, or nods, by the pressure of the body; and thus renders one leg apparently shorter than the other. In other cases the end of the bone is protruded out of its socket, by inflammation or enlargement of the cartilages or ligaments of the joint, so that it rests on some part of the edge of the acetabulum, which in time becomes filled up. When the legs are straight, as in standing erect, there is no verticillary motion in the knee-joint; all the motion then in turning out the toes further than nature designed, must be obtained by straining in some degree this head of the thigh-bone, or the acetabulum, or cavity, in which it moves. This has induced me to believe, that this misfortune of the nodding of the head by the bone, or partial dislocation of it, by which one leg becomes shorter than the other, is sometimes occasioned by making very young children stand in what are called stocks; that is with their heels together, and their toes quite out. Whence the socket of the thigh-bone becomes inflamed and painful, or the neck of the bone is bent downward and outwards.

In this case there is no expectation of recovering the straightness of the end of the bone; but these patients are liable to another misfortune, that is, to acquire afterwards a distortion of the spine; for as one leg is shorter than the other, they sink on that side, and in consequence bend the upper part of their bodies, as their shoulders, the contrary way, to balance themselves; and then again the neck is bent back again towards the lame side, to preserve the head perpendicular; and thus the figure becomes quite distorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the spine is for the child to wear a high-heeled shoe or patten on the lame foot, so as to support that side on the same level with the other, and thus to prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle in walking; but nevertheless, when she stands or sits, she sinks down towards her right side, and turns out that toe more than the other. Hence, both as she sits and stands, she bends her body to the right; whence her head would hang a little over her right shoulder; but to replace this perpendicularly, she lifts up her left shoulder and contracts the muscles on that side of the neck; which are therefore become thicker and stronger by their continued action; but there is not yet any very perceptible distortion of the spine.

As her right toe is turned outward rather more than natural, this shews the disease to be in the hip-joint; because, when the limb is stretched out, the toe cannot turn horizontally in the least without moving the end of the thigh-bone; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other. Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause.

M. M. An elastic cushion made of curled hair should be placed under the affected hip, whenever she sits; or should be fitted to the part by means of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying down in the day, should be occasionally used to prevent or remove any curvature of the spine. The rest as in Species 13 and 15 of this genus.

18. Spina protuberans. Protuberant spine. One of the bones of the spine swells, and rises above the rest. This is not an uncommon disease, and belongs to the innutrition of the bones, as the bone must become soft before it swells; which softness is owing to defect of the secretion of phosphorated calcareous earth. The swelling of the bone compresses a part of the brain, called the spinal marrow, within the cavity of the back-bones; and in consequence the lower limbs become paralytic, attended sometimes with difficulty of emptying the bladder and rectum.

M. M. Issues put on each side of the prominent bone are of great effect, I suppose, by their stimulus; which excites into action more of the sensorial powers of irritation and sensation, and thus gives greater activity to the vascular system in their vicinity. The methods recommended in distortion of the spine are also to be attended to.

19. Spina bifida. Divided spine, called also Hydrorachitis, as well as the Hydrocephalus externus, are probably owing in part to a defect of ossification of the spine and cranium; and that the collection of fluid beneath them may originate from the general debility of the system; which affects both the secerning, and absorbent vessels.

A curious circumstance, which is affirmed to attend the spina bifida, is, that on compressing the tumor with the hand gently, the whole brain becomes affected, and the patient falls asleep. I suppose the same must happen on compressing the hydrocephalus externus? See Sect. XVIII. 20.

20. Ossis palati defectus. A defect of the bone of the palate, which frequently accompanies a division of the upper lip, occurs before nativity; and is owing to the deficient action of the secerning system, from whence the extremities are not completed. From a similar cause I have seen the point of the tongue deficient, and one joint of the two least fingers, and of the two least toes, in the same infant; who was otherwise a fine girl. See Sect. XXXIX. 4. 4.

The operation for the hare-lip is described by many surgical writers; but there is a person in London, who makes very ingenious artificial palates; which prevents that defect of speech, which attends this malformation. This factitious palate consists of a thin plate of silver of the shape and form of the roof of the mouth; from the front edge to the back edge of this silver plate four or five holes are made in a straight line large enough for a needle to pass through them; on the back of it is then sewed a piece of sponge; which when expanded with moisture is nearly as large as the silver plate. This sponge is slipped through the division of the bone of the palate, so as to lie above it, while the silver plate covers the aperture beneath, and is suspended by the expanding sponge. This is removed every night and washed, and returned into its place in the morning; on this account it is convenient to have five or six of them, for the sake of cleanliness. I have been more particular in describing this invention, as I do not know the name, or place of residence, of the maker.

ORDO II.

Decreased Irritation.

GENUS III.

The Decreased Action of the Absorbent System.

Some decrease of heat attends these diseases, though in a less degree than those of the last genus, because the absorbent system of glands do not generate so much heat in their healthy state of action as the secerning system of glands, as explained in Class I. 1. 3.

SPECIES.

1. Mucus faucium frigidus. Cold mucus from the throat. Much mucus, of rather a saline taste, and less inspissated than usual, is evacuated from the fauces by hawking, owing to the deficient absorption of the thinner parts of it. This becomes a habit in some elderly people, who are continually spitting it out of their mouths; and has probably been brought on by taking snuff, or smoking tobacco; which by frequently stimulating the fauces have at length rendered the absorbent vessels less excitable by the natural stimulus of the saline part of the secretion, which ought to be reabsorbed, as soon as secreted.

M. M. A few grains of powder of bark frequently put into the mouth, and gradually diffused over the fauces. A gargle of barley water.

2. Sudor frigidus. The cold dampness of the hands of some people is caused by the deficient absorption of perspirable matter; the clammy or viscid feel of it is owing to the mucous part being left upon the skin. The coldness is produced both by the decreased action of the absorbent system, and by the evaporation of a greater quantity of the perspirable matter into the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quantity of volatile alcali in water.

3. Catarrhus frigidus. The thin discharge from the nostrils in cold weather. The absorbent vessels become torpid by the diminution of external heat, sooner than the secerning ones, which are longer kept warm by the circulating blood, from which they select the fluid they secrete; whereas the absorbent vessels of the nostrils drink up their fluids, namely the thin and saline part of the mucus, after it has been cooled by the atmosphere. Hence the absorbents ceasing to act, and the secerning vessels continuing some time longer to pour out the mucus, a copious thin discharge is produced, which trickles down the nostrils in cold weather. This discharge is so acrid as to inflame the upper lip; which is owing to the neutral salts, with which it abounds, not being reabsorbed; so the tears in the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7.

4. Expectoratio frigida. Cold expectoration. Where the pulmonary absorption is deficient, an habitual cough is produced, and a frequent expectoration of thin saline mucus; as is often seen in old enfeebled people. Though the stimulus of the saline fluid, which attends all secretions, is not sufficient to excite the languid absorbent vessels to imbibe it; yet this saline part, together with the increased quantity of the whole of the secreted mucus, stimulates the branches of the bronchia, so as to induce an almost incessant cough to discharge it from the lungs. A single grain of opium, or any other stimulant drug, as a wine-posset with spirit of hartshorn, will cure this cold cough, and the cold catarrh of the preceding article, like a charm, by stimulating the torpid mouths of the absorbents into action. Which has given rise to an indiscriminate and frequently pernicious use of the warm regimen in coughs and catarrhs of the warm or inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes the absorption of the more fluid and saline parts, and in consequence thickens the mucus, and abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali.

5. Urina uberior pallida. On being exposed naked to cold air, or sprinkled with cold water, a quantity of pale urine is soon discharged; for the absorbents of the bladder become torpid by their sympathy with those of the skin; which are rendered quiescent by the diminution of external heat; but the kidnies continue to secrete the urine, and as no part of it is absorbed, it becomes copious and pale. This happens from a similar cause in cold fits of agues; and in less degree to many debilitated constitutions, whose extremities are generally cold and pale. The great quantity of limpid water in hysteric cases, and in diabætes, belongs to Class I. 3. 1. 10. I. 3. 2. 6.

M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire.

6. Diarrhœa frigida. Liquid stools are produced by exposing the body naked to cold air, or sprinkling it with cold water, for the same reason as the last article.

But this disease is sometimes of a dangerous nature; the intestinal absorption being so impaired, that the aliment is said to come away undiminished in quantity, and almost unchanged by the powers of digestion, and is then called lientery.

The mucus of the rectum sometimes comes away like pellucid hartshorn jelly, and liquefies by heat like that, towards the end of inirritative fevers, which is owing to the thinner part of the mucus not being absorbed, and thus resembles the catarrh of some old people.

M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold weather. Clysters with opium. Friction on the bowels morning and night. Equitation twice a day.

7. Fluor albus frigidus. Cold fluor albus. In weak constitutions, where this discharge is pellucid and thin, it must proceed from want of absorption of the mucous membrane of the vagina, or uterus, and not from an increased secretion. This I suspect to be the most frequent kind of fluor albus; the former one described at Class I. 1. 2. 11. attends menstruation, or is a discharge instead of it, and thus resembles the venereal orgasm of female quadrupeds. The discharge in this latter kind being more saline, is liable to excoriate the part, and thus produce smarting in making water; in its great degree it is difficult to cure.

M. M. Increase the evacuation by stool and by perspiration, by taking rhubarb every night, about six or ten grains with one grain of opium for some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters, chalybeates, friction over the whole skin with flannel morning and night. Partial cold bath, by sprinkling the loins and thighs, or sponging them with cold water. Mucilage, as isinglass boiled in milk; blanc mange, hartshorn jelly, are recommended by some. Tincture of cantharides sometimes seems of service given from ten to twenty drops or more, three or four times a day. A large plaster of burgundy pitch and armenian bole, so as to cover the loins and lower part of the belly, is said to have sometimes succeeded by increasing absorption by its compression in the manner of a bandage. A solution of metallic salts, as white vitriol, sixty grains to a pint; or an infusion of oak-bark may be injected into the vagina. Cold bath.

8. Gonorrhœa frigida. Cold gleet. Where the gleet is thin and pellucid, it must arise from the want of absorption of the membranes of the urethra, rather than from an increased secretion from them. This I suppose to be a more common disease than that mentioned at Class I. 1. 2. 10.

M. M. Metallic injections, partial cold bath, internal method as in the fluor albus above described. Balsam of copaiva. Tincture of cantharides.

9. Hepatis tumor. The liver becomes enlarged from defect of the absorption of mucus from its cells, as in anasarca, especially in feeble children; at the same time less bile is secreted from the torpid circulation in the vena portæ. And as the absorbents, which resume the thinner parts of the bile from the gall-bladder and hepatic ducts, are also torpid or quiescent, the bile is more dilute, as well as in less quantity. From the obstruction of the passage of the blood through the compressed vena porta these patients have tumid bellies, and pale bloated countenances; their paleness is probably owing to the deficiency of the quantity of red globules in the blood in consequence of the inert state of the bile.

These symptoms in children are generally attended with worms, the dilute bile and the weak digestion not destroying them. In sleep I have seen fleuke-worms in the gall-ducts themselves among the dilute bile; which gall-ducts they eat through, and then produce ulcers, and the hectic fever, called the rot. See Class I. 1. 4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron-filings are specific in this disease in children, and the worms are destroyed by the returning acrimony and quantity of the bile. A blister on the region of the liver. Sorbentia, as worm-seed, santonicum. Columbo. Bark.

10. Chlorosis. When the defect of the due action of both the absorbent and secerning vessels of the liver affects women, and is attended with obstruction of the catamenia, it is called chlorosis; and is cured by the exhibition of steel, which restores by its specific stimulus the absorbent power of the liver; and the menstruation, which was obstructed in consequence of debility, recurs.

Indigestion, owing to torpor of the stomach, and a consequent too great acidity of its contents, attend this disease; whence a desire of eating chalk, or marl. Sometimes a great quantity of pale urine is discharged in a morning, which is owing to the inaction of the absorbents, which are distributed on the neck of the bladder, during sleep. The swelling of the ankles, which frequently attends chlorosis, is another effect of deficient action of the absorbent system; and the pale countenance is occasioned by the deficient quantity of red globules of blood, caused by the deficient quantity or acrimony of the bile, and consequent weakness of the circulation. The pulse is so quick in some cases of chlorosis, that, when attended with an accidental cough, it may be mistaken for pulmonary consumption. This quick pulse is owing to the debility of the heart from the want of stimulus occasioned by the deficiency of the quantity, and acrimony of the blood.

M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all over the body and limbs night and morning. Rhubarb five grains, opium half a grain, every night. Flesh diet, with small beer, or wine and water. The disease continues some months, but at length subsides by the treatment above described. A bath of about eighty degrees, as Buxton Bath, is of service; a colder bath may do great injury.

11. Hydrocele. Dropsy of the vagina testis. Dropsies have been divided into the incysted and the diffused, meaning those of the cellular membrane, the cells of which communicate with each other like a sponge, and those of any other cavity of the body. The collections of mucous fluids in the various cells and cavities of the body arise from the torpor of the absorbent vessels of those parts. It is probable, that in dropsies attended with great thirst the cutaneous absorbents become paralytic first; and then from the great thirst, which is thus occasioned by the want of atmospheric moisture, the absorption of the fat ensues; as in fevers attended with great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some have believed, that the cellular and adipose membranes are different ones; as no fat is ever deposited in the eye-lids or scrotum, both which places are very liable to be distended with the mucilaginous fluid of the anasarca, and with air in Emphysema. Sometimes a gradual absorption of the accumulated fluid takes place, and the thinner parts being taken up, there remains a more viscid fluid, or almost a solid in the part, as in some swelled legs, which can not easily be indented by the pressure of the finger, and are called scorbutic. Sometimes the paralysis of the absorbents is completely removed, and the whole is again taken up into the circulation.

The Hydrocele is known by a tumor of the scrotum, which is without pain, gradually produced, with fluctuation, and a degree of pellucidity, when a candle is held behind it; it is the most simple incysted dropsy, as it is not in general complicated with other diseases, as ascites with schirrous liver, and hydrocephalus internus, with general debility. The cure of this disease is effected by different ways; it consists in discharging the water by an external aperture; and by so far inflaming the cyst and testicle, that they afterwards grow together, and thus prevent in future any secretion or effusion of mucus; the disease is thus cured, not by the revivescence of the absorbent power of the lymphatics, but by the prevention of secretion by the adhesion of the vagina to the testis. This I believe is performed with less pain, and is more certainly manageable by tapping, or discharging the fluid by means of a trocar, and after the evacuation of it to fill the cyst with a mixture of wine and water for a few minutes till the necessary degree of stimulus is produced, and then to withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by Dr. Duncan, for 1793.

12. Hydrocephalus internus, or dropsy of the ventricles of the brain, is fatal to many children, and some adults. When this disease is less in quantity, it probably produces a fever, termed a nervous fever, and which is sometimes called a worm fever, according to the opinion of Dr. Gilchrist, in the Scots Medical essays. This fever is attended with great inirritability, as appears from the dilated pupils of the eyes, in which it corresponds with the dropsy of the brain. And the latter disease has its paroxysms of quick pulse, and in that respect corresponds with other fevers with inirritability.

The hydrocephalus internus is distinguished from apoplexy by its being attended with fever, and from nervous fever by the paroxysms being very irregular, with perfect intermissions many times in a day. In nervous fever the pain of the head generally affects the middle of the forehead; in hydrocephalus internus it is generally on one side of the head. One of the earliest criterions is the patient being uneasy on raising his head from the pillow, and wishing to lie down again immediately; which I suppose is owing to the pressure of the water on the larger trunks of the blood-vessels entering the cavity being more intolerable than on the smaller ones; for if the larger trunks are compressed, it must inconvenience the branches also; but if some of the small branches are compressed only, the trunks are not so immediately incommoded.

Blisters on the head, and mercurial ointment externally, with calomel internally, are principally recommended in this fatal disease. When the patient cannot bear to be raised up in bed without great uneasiness, it is a bad symptom. So I believe is deafness, which is commonly mistaken for stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the squinting is very apparent, or the pupils of both eyes much dilated, it is generally fatal. As by stimulating one branch of lymphatics into inverted motion, another branch is liable to absorb its fluid more hastily; suppose strong errhines, as common tobacco snuff to children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed with ten or fifteen grains of sugar, was gradually blown up the nostrils? See Class I. 3. 2. 1. I have tried common snuff upon two children in this disease; one could not be made to sneeze, and the other was too near death to receive advantage. When the mercurial preparations have produced salivation, I believe they may have been of service, but I doubt their good effect otherwise. In one child I tried the tincture of Digitalis; but it was given with too timid a hand, and too late in the disease, to determine its effects. See Sect. XXIX. 5. 9.

As all the above remedies generally fail of success, I think frequent, almost hourly, shocks of electricity from very small charges might be passed through the head in all directions with probability of good event. And the use of the trephine, where the affected side can be distinguished. See Strabismus, Class I. 2. 5. 4. When one eye is affected, does the disease exist in the ventricule of that side?

13. Ascites. The dropsy of the cavity of the abdomen is known by a tense swelling of the belly; which does not sound on being struck like the tympany; and in which a fluctuation can be readily perceived by applying one hand expanded on one side, and striking the tumour on the other.

Effusions of water into large cavities, as into that of the abdomen or thorax, or into the ventricules of the brain or pericardium, are more difficult to be reabsorbed, than the effusion of fluids into the cellular membrane; because one part of this extensive sponge-like system of cells, which connects all the solid parts of the body, may have its power of absorption impaired, at the same time that some other part of it may still retain that power, or perhaps possess it in an increased degree; and as all these cells communicate with each other, the fluid, which abounds in one part of it, can be transferred to another, and thus be reabsorbed into the circulation.

In the ascites, cream of tartar has sometimes been attended with success; a dram or two drams are given every hour in a morning till it operates, and is to be repeated for several days; but the operation of tapping is generally applied to at last. Dr. Sims, in the Memoirs of the Medical Society of London, Vol. III. has lately proposed, what he believes to be a more successful method of performing this operation, by making a puncture with a lancet in the scar of the navel, and leaving it to discharge itself gradually for several days, without introducing a canula, which he thinks injurious both on account of the too sudden emission of the fluid, and the danger of wounding or stimulating the viscera. This operation I have twice known performed with less inconvenience, and I believe with more benefit to the patient, than the common method.

After the patient has been tapped, some have tried injections into the cavity of the abdomen, but hitherto I believe with ill event. Nor are experiments of this kind very promising of success. First because the patients are generally much debilitated, most frequently by spirituous potation, and have generally a disease of the liver, or of other viscera. And secondly, because the quantity of inflammation, necessary to prevent future secretion of mucus into the cavity of the abdomen, by uniting the peritoneum with the intestines or mesentery, as happens in the cure of the hydrocele, would I suppose generally destroy the patient, either immediately, or by the consequence of such adhesions.

This however is not the case in respect to the dropsy of the ovarium, or in the hydrocele.

14. Hydrops thoracis. The dropsy of the chest commences with loss of flesh, cold extremities, pale countenance, high coloured urine in small quantity, and general debility, like many other dropsies. The patient next complains of numbness in the arms, especially when elevated, with pain and difficulty of swallowing, and an absolute impossibility of lying down for a few minutes, or with sudden starting from sleep, with great difficulty of breathing and palpitation of his heart.

The numbness of the arms is probably owing more frequently to the increased action of the pectoral muscles in respiration, whence they are less at liberty to perform other offices, than to the connexion of nerves mentioned in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the compression of the œsophagus by the lymph in the chest; and the impossibility of breathing in an horizontal posture originates from this, that if any parts of the lungs must be rendered useless, the inability of the extremities of them must be less inconvenient to respiration; since if the upper parts or larger trunks of the air-vessels should be rendered useless by the compression of the accumulated lymph, the air could not gain admittance to the other parts, and the animal must immediately perish.

If the pericardium is the principal seat of the disease, the pulse is quick and irregular. If only the cavity of the thorax is hydropic, the pulse is not quick nor irregular.

If one side is more affected than the other, the patient leans most that way, and has more numbness in that arm.

The hydrops thoracis is distinguished from the anasarca pulmonum, as the patient in the former cannot lie down half a minute; in the latter the difficulty of breathing, which occasions him to rise up, comes on more gradually; as the transition of the lymph in the cellular membranes from one part to another of it is slower, than that of the effused lymph in the cavity of the chest.

The hydrops thoracis is often complicated with fits of convulsive breathing; and then it produces a disease for the time very similar to the common periodic asthma, which is perhaps owing to a temporary anasarca of the lungs; or to an impaired venous absorption in them. These exacerbations of difficult breathing are attended with cold extremities, cold breath, cold tongue, upright posture with the mouth open, and a desire of cold air, and a quick, weak, intermittent pulse, and contracted hands.

These exacerbations recur sometimes every two or three hours, and are relieved by opium, a grain every hour for two or three doses, with ether about a dram in cold water; and seem to be a convulsion of the muscles of respiration induced by the pain of the dyspnea. As in Class III. 1. 1. 9.

M. M. A grain of dried squill, and a quarter of a grain of blue vitriol every hour for six or eight hours, unless it vomit or purge. A grain of opium. Blisters. Calomel three grains every third day, with infusion of senna. Bark. Chalybeates. Puncture in the side.

Can the fluctuation in the chest be heard by applying the ear to the side, as Hippocrates asserts? Can it be felt by the hand or by the patient before the disease is too great to admit of cure by the paracentesis? Does this dropsy of the chest often come on after peripneumony? Is it ever cured by making the patient sick by tincture of digitalis? Could it be cured, if on one side only, by the operation of puncture between the ribs, and afterwards by inflaming the cavity by the admission of air for a time, like the cure of the hydrocele; the pleura afterwards adhering wholly to that lobe of the lungs, so as to prevent any future effusion of mucus?

15. Hydrops ovarii. Dropsy of the ovary is another incysted dropsy, which seldom admits of cure. It is distinguished from ascites by the tumour and pain, especially at the beginning, occupying one side, and the fluctuation being less distinctly perceptible. When it happens to young subjects it is less liable to be mistaken for ascites. It affects women of all ages, either married or virgins; and is produced by cold, fear, hunger, bad food, and other debilitating causes. I saw an elegant young lady, who was shortly to have been married to a sensible man, with great prospect of happiness; who, on being overturned in a chaise in the night, and obliged to walk two or three miles in wet, cold, and darkness, became much indisposed, and gradually afflicted with a swelling and pain on one side of the abdomen; which terminated in a dropsy of the ovary, and destroyed her in two or three years. Another young woman I recollect seeing, who was about seventeen, and being of the very inferior class of people, seemed to have been much weakened by the hardship of a cold floor, and little or no bed, with bad food; and who to these evils had to bear the unceasing obloquy of her neighbours, and the persecution of parish officers.

The following is abstracted from a letter of my friend Mr. Power, surgeon, at Bosworth in Leicestershire, on examining the body of an elderly lady who died of this disease, March 29, 1793. "On opening the abdomen I found a large cyst attached to the left ovarium by an elastic neck as thick as the little finger, and so callous as not to admit of being separated by scissars without considerable difficulty. The substance of the cyst had an appearance much resembling the gravid uterus near the full period of gestation, and was as thick. It had no attachment to the peritonæum, or any of the viscera, except by the hard callous neck I have mentioned; so that the blood must with difficulty have been circulated through it for some time. Its texture was extremely tender, being easily perforated with the finger, was of a livid red colour, and evidently in a sphacelated state. It contained about two gallons of a fluid of the colour of port wine, without any greater tenacity. It has fallen to my lot to have opened two other patients, whose deaths were occasioned by incysted dropsy of the ovarium. In one of these the ovarium was much enlarged with eight or ten cysts on its surface, but there was no adhesion formed by any of the cysts to any other part; nor had the ovarium formed any adhesion with the peritonæum, though in a very diseased state. In the other the disease was more simple, being only one cyst, without any attachment but to the ovarium.

"As the ovarium is a part not necessary to life, and dropsies of this kind are so generally fatal in the end, I think I shall be induced, notwithstanding the hazard attending wounds, which penetrate the cavity of the abdomen, to propose the extirpation of the diseased part in the first case, which occurs to me, in which I can with precision say, that the ovarium is the seat of the disease, and the patient in other respects tolerably healthy; as the cavity of the abdomen is often opened in other cases without bad consequences."

An argument, which might further countenance the operation thus proposed by Mr. Power, might be taken from the disease frequently affecting young persons; from its being generally in these subjects local and primary; and not like the ascites, produced or accompanied with other diseased viscera; and lastly, as it is performed in adult quadrupeds, as old sows, with safety, though by awkward operators.

16. Anasarca pulmonum. The dropsy of the cellular membrane of the lungs is usually connected with that of the other parts of the system. As the cells of the whole cellular membrane communicate with each other, the mucaginous fluid, which remains in any part of it for want of due absorption, sinks down to the most depending cells; hence the legs swell, though the cause of the disease, the deficiency of absorption, may be in other parts of the system. The lungs however are an exception to this, since they are suspended in the cavity of the thorax, and have in consequence a depending part of their own.

The anasarca of the lungs is known by the difficulty of respiration accompanied with swelled legs, and with a very irregular pulse. This last circumstance has generally been ascribed to a dropsy at the same time existing in the pericardium, but is more probably owing to the difficult passage of the blood through the lungs; because I found on dissection, in one instance, that the most irregular pulse, which I ever attended to, was owing to very extensive adhesions of the lungs; insomuch that one lobe intirely adhered to the pleura; and secondly, because this kind of dropsy of the lungs is so certainly removed for a time along with the anasarca of the limbs by the use of digitalis.

This medicine, as well as emetic tartar, or squill, when given so as to produce sickness, or nausea, or perhaps even without producing either in any perceptible degree, by affecting the lymphatics of the stomach, so as either to invert their motion, or to weaken them, increases by reverse sympathy the action, and consequent absorbent power of these lymphatics, which open into the cellular membrane. But as those medicines seldom succeed in producing an absorption of those fluids, which stagnate in the larger cavities of the body, as in the abdomen, or chest, and do generally succeed in this difficulty of breathing with irregular pulse above described, I conclude that it is not owing to an effusion of lymph into the pericardium, but simply to an anasarca of the lungs.

M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar (antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain twice a day. Raisin wine and water, or other wine and water, is preferred to the spirit and water, which these patients have generally been accustomed to.

The usual cause of anasarca is from a diseased liver, and hence it most frequently attends those, who have drank much fermented or spirituous liquors; but I suspect that there is another cause of anasarca, which originates from the brain; and which is more certainly fatal than that, which originates from a diseased liver. These patients, where the anasarca originates from, or commences in, the brain, have not other symptoms of diseased liver; have less difficulty of breathing at the beginning; and hold themselves more upright in their chair, and in walking. In this kind of dropsy I suspect the digitalis has less or no effect; as it particularly increases the absorption from the lungs.

17. Obesitas. Corpulency may be called an anasarca or dropsy of fat, since it must be owing to an analogous cause; that is, to the deficient absorption of fat compared to the quantity secreted into the cells which contain it. See Class II. 1. 1. 4.

The method of getting free from too much fat without any injury to the constitution, consists, first, in putting on a proper bandage on the belly, so that it can be tightened or relaxed with ease, as a tightish under waistcoat, with a double row of buttons. This is to compress the bowels and increase their absorption, and it thus removes one principal cause of corpulency, which is the looseness of the skin. Secondly, he should omit one entire meal, as supper; by this long abstinence from food the absorbent system will act on the mucus and fat with greater energy. Thirdly, he should drink as little as he can with ease to his sensations; since, if the absorbents of the stomach and bowels supply the blood with much, or perhaps too much, aqueous fluid, the absorbents of the cellular membrane will act with less energy. Fourthly, he should use much salt or salted meat, which will increase the perspiration and make him thirsty; and if he bears this thirst, the absorption of his fat will be greatly increased, as appears in fevers and dropsies with thirst; this I believe to be more efficacious than soap. Fifthly, he may use aerated alcaline water for his drink, which may be supposed to render the fat more fluid,—or he may take soap in large quantities, which will be decomposed in the stomach. Sixthly, short rest, and constant exercise.

18. Splenis tumor. Swellings of the spleen, or in its vicinity, are frequently perceived by the hand in intermittents, which are called Ague-cakes, and seem owing to a deficiency of absorption in the affected part.

Mr. Y——, a young man about twenty-five years of age, who lived intemperately, was seized with an obstinate intermittent, which had become a continued fever with strong pulse, attended with daily remission. A large hard tumour on the left side, on the region of the spleen, but extending much more downward, was so distinctly perceptible, that one seemed to get one's fingers under the edge of it, much like the feel of the brawn or shield on a boar's shoulder. He was repeatedly bled, and purged with calomel, had an emetic, and a blister on the part, without diminishing the tumour; after some time he took the Peruvian bark, and slight doses of chalybeates, and thus became free from the fever, and went to Bath for several weeks, but the tumour remained. This tumour I examined every four or five years for above thirty years. His countenance was pale, and towards the end of his life he suffered much from ulcers on his legs, and died about sixty, of general debility; like many others, who live intemperately in respect to the ingurgitation of fermented or spirituous liquors.

As this tumour commenced in the cold fit of an intermittent fever, and was not attended with pain, and continued so long without endangering his life, there is reason to believe it was simply occasioned by deficient absorption, and not by more energetic action of the vessels which constitute the spleen. See Class II. 1. 2. 13.

M. M. Venesection. Emetic, cathartic with calomel; then sorbentia, chalybeates, Peruvian bark.

19. Genu tumor albus. White swelling of the knee, is owing to deficient absorption of the lymphatics of the membranes including the joint, or capsular ligaments, and sometimes perhaps of the gland which secretes the synovia; and the ends of the bones are probably affected in consequence.

I saw an instance, where a caustic had been applied by an empiric on a large white swelling of the knee, and was told, that a fluid had been discharged from the joint, which became anchylosed, and healed without loss of the limb.

M. M. Repeated blisters on the part early in the disease are said to cure it by promoting absorption; saturnine solutions externally are recommended. Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with the hand.

20. Bronchocele. Swelled throat. An enlargement of the thyroid glands, said to be frequent in mountainous countries, where river water is drank, which has its source from dissolving snows. This idea is a very ancient one, but perhaps not on that account to be the more depended upon, as authors copy one another. Tumidum guttur quis miratur in alpibus, seems to have been a proverb in the time of Juvenal. The inferior people of Derby are much subject to this disease, but whether more so than other populous towns, I can not determine; certain it is, that they chiefly drink the water of the Derwent, which arises in a mountainous country, and is very frequently blackened as it passes through the morasses near its source; and is generally of a darker colour, and attended with a whiter foam, than the Trent, into which it falls; the greater quantity and whiteness of its froth I suppose may be owing to the viscidity communicated to it by the colouring matter. The lower parts of the town of Derby might be easily supplied with spring water from St. Alkmond's well; or the whole of it from the abundant springs near Bowbridge: the water from which might be conveyed to the town in hollow bricks, or clay-pipes, at no very great expence, and might be received into frequent reservoirs with pumps to them; or laid into the houses.

M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage into lozenges, and permitted to dissolve slowly under the tongue twice a day, is asserted to cure in a few months; perhaps other animal charcoal, as candle-snuffs, might do the same.

I have directed in the early state of this disease a mixture of common salt and water to be held in the mouth, particularly under the tongue, for a few minutes, four or six times a day for many weeks, which has sometimes succeeded, the salt and water is then spit out again, or in part swallowed. Externally vinegar of squills has been applied, or a mercurial plaster, or fomentations of acetated ammoniac; or ether. Some empirics have applied caustics on the bronchocele, and sometimes, I have been told, with success; which should certainly be used where there is danger of suffocation from the bulk of it. One case I saw, and one I was well informed of, where the bronchocele was cured by burnt sponge, and a hectic fever supervened with colliquative sweats; but I do not know the final event of either of them.

De Haen affirms the cure of bronchocele to be effected by flowers of zinc, calcined egg-shells, and scarlet cloth burnt together in a close crucible, which was tried with success, as he assured me, by a late lamented physician, my friend, Dr. Small of Birmingham; who to the cultivation of modern sciences added the integrity of ancient manners; who in clearness of head, and benevolence of heart, had few equals, perhaps no superiors.

21. Scrophula. King's evil is known by tumours of the lymphatic glands, particularly of the neck. The upper lip, and division of the nostrils is swelled, with a florid countenance, a smooth skin, and a tumid abdomen. Cullen. The absorbed fluids in their course to the veins in the scrophula are arrested in the lymphatic or conglobate glands; which swell, and after a great length of time, inflame and suppurate. Materials of a peculiar kind, as the variolous and venereal matter, when absorbed in a wound, produce this torpor, and consequent inflammation of those lymphatic glands, where they first arrive, as in the axilla and groin. There is reason to suspect, that the tonsils frequently become inflamed, and suppurate from the matter absorbed from carious teeth; and I saw a young lady, who had both the axillary glands swelled, and which suppurated; which was believed to have been caused by her wearing a pair of new green gloves for one day, when she had perspired much, and was much exhausted and fatigued by walking; the gloves were probably dyed in a solution of verditer.

These indolent tumours of the lymphatic glands, which constitute the scrophula, originate from the inirritability of those glands; which therefore sooner fall into torpor after having been stimulated too violently by some poisonous material; as the muscles of enfeebled people sooner become fatigued, and cease to act, when exerted, than those of stronger ones. On the same account these scrophulous glands are much longer in acquiring increase of motion, after having been stimulated into inactivity, and either remain years in a state of indolence, or suppurate with difficulty, and sometimes only partially.

The difference between scrophulous tumours, and those before described, consists in this; that in those either glands of different kinds were diseased, or the mouths only of the lymphatic glands were become torpid; whereas in scrophula the conglobate glands themselves become tumid, and generally suppurate after a great length of time, when they acquire new sensibility. See Sect. XXXIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by passing electric shocks through them every day for two or three weeks, as I have witnessed. It is probable, that the alternate application of snow or iced water to them, till they become painfully cold, and then of warm flannel or warm water, frequently repeated, might restore their irritability by accumulation of sensorial power; and thence either facilitate their dispersion, or occasion them to suppurate. See Class II. 1. 4. 13.

This disease is very frequent amongst the children of the poor in large towns, who are in general ill fed, ill lodged, and ill clothed; and who are further weakened by eating much salt with their scanty meal of insipid vegetable food, which is seldom of better quality than water gruel, with a little coarse bread in it. See diarrhœa of infants, Class I. 1. 2. 5. Scrophulous ulcers are difficult to heal, which is owing to the deficiency of absorption on their pale and flabby surfaces, and to the general inirritability of the system. See Class I. 1. 3. 13.

M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium, from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing in salt and water, one pound to three gallons, made warm. The application of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in fine powder one part, mixed together and applied on the ulcers in dry powder, by means of lint and a bandage, to be renewed every day. Or very fine powder of calamy alone, lapis calaminaris. If powder of manganese?

22. Schirrus. After the absorbent veins of a gland cease to perform their office, if the secerning arteries of it continue to act some time longer, the fluids are pushed forwards, and stagnate in the receptacles or capillary vessels of the gland; and the thinner part of them only being resumed by the absorbent system of the gland, a hard tumour gradually succeeds; which continues like a lifeless mass, till from some accidental violence it gains sensibility, and produces cancer, or suppurates. Of this kind are the schirrous glands of the breasts, of the lungs, of the mesentery, and the scrophulous tumours about the neck and the bronchocele.

Another seat of schirrus is in the membranous parts of the system, as of the rectum intestinum, the urethra, the gula or throat; and of this kind is the verucca or wart, and the clavus pedum, or corns on the toes. A wen sometimes arises on the back of the neck, and sometimes between the shoulders; and by distending the tendinous fascia produces great and perpetual pain.

M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation. Electric shocks through the tumour. An issue into the substance of the wen. Opium. Ether externally.

23. Schirrus recti intestini. Schirrus of the rectum. A schirrus frequently affects a canal, and by contracting its diameter becomes a painful and deplorable disease. The canals thus obstructed are the rectum, the urethra, the throat, the gall-ducts, and probably the excretory ducts of the lymphatics, and of other glands.

The schirrus of the rectum is known by the patient having pain in the part, and being only able to part with liquid feces, and by the introduction of the finger; the swelled part of the intestine is sometimes protruded downwards, and hangs like a valve, smooth and hard to the touch, with an aperture in the centre of it. See a paper on this subject by J. Sherwin. Memoirs of a London Medical Society, Vol. II. p. 9.

M. M. To take but little solid food. Aperient medicines. Introduce a candle smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of laudanum. Introduce a leathern canula, or gut, and then either a wooden maundril, or blow it up with air, so as to distend the contracted part as much as the patient can bear. Or spread mercurial plaster on thick soft leather, and roll it up with the plaster outwards to any thickness and length, which can be easily introduced and worn; or two or three such pieces may be introduced after each other. The same may be used to compress bleeding internal piles. See Class I. 2. 1. 6.

24. Schirrus urethræ. Schirrus of the urethra. The passage becomes contracted by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to distend the canal behind the stricture; till at length an aperture is made, and the urine forces its way into the cellular membrane, making large sinuses. This situation sometimes continues many months, or even years, and so much matter is evacuated after making water, or at the same time, by the action of the muscles in the vicinity of the sinuses, that it has been mistaken for an increased secretion from the bladder, and has been erroneously termed a catarrh of the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs.

M. M. Distend the part gradually by catgut bougies, which by their compression will at the same time diminish the thickness of the membrane, or by bougies of elastic gum, or of horn boiled soft. The patient should gain the habit of making water slowly, which is a matter of the utmost consequence, as it prevents the distention, and consequent rupture, of that part of the urethra, which is between the stricture and the neck of the bladder.

When there occurs an external ulcer in the perinæum, and the urine is in part discharged that way, the disease can not be mistaken. Otherwise from the quantity of matter, it is generally supposed to come from the bladder, or prostate gland; and the urine, which escapes from the ruptured urethra, mines its way amongst the muscles and membranes, and the patient dies tabid, owing to the want of an external orifice to discharge the matter. See Class II. 1. 4. 11.

25. Schirrus œsophagi. A schirrus of the throat contracts the passage so as to render the swallowing of solids impracticable, and of liquids difficult. It affects patients of all ages, but is probably most frequently produced by swallowing hard angular substances, when people have lost their teeth; by which this membrane is over distended, or torn, or otherwise injured.

M. M. Put milk into a bladder tied to a canula or catheter; introduce it past the stricture, and press it into the stomach. Distend the stricture gradually by a sponge-tent fastened to the end of whale-bone, or by a plug of wax, or a spermaceti candle, about two inches long; which might be introduced, and left there with a string only fixed to it to hang out of the mouth, to keep it in its place, and to retract it by occasionally; for which purpose the string must be put through a catheter or hollow probang, when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and then distend it by blowing wind into it. The swallowing a bullet with a string put through it, to retract it on the exhibition of an emetic, has also been proposed. Externally mercurial ointment has been much recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth. Transfusion of blood into a vein three or four ounces a day? See Class III. 1. 1. 15.

I directed a young woman about twenty-two years of age, to be fed with new milk put into a bladder, which was tied to a catheter, and introduced beyond the stricture in her throat; after a few days her spirits sunk, and she refused to use it further, and died. Above thirty years ago I proposed to an old gentleman, whose throat was entirely impervious, to supply him with a few ounces of blood daily from an ass, or from the human animal, who is still more patient and tractable, in the following manner. To fix a silver pipe about an inch long to each extremity of a chicken's gut, the part between the two silver ends to be measured by filling it with warm water; to put one end into the vein of a person hired for that purpose, so as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other silver end, to introduce that end into the vein of the patient upwards towards the heart, so as to admit no air along with the blood. And lastly, to support the gut and silver ends on a water plate, filled with water of ninety-eight degrees of heat, and to measure how many ounces of blood was introduced by passing the finger, so as to compress the gut, from the receiving pipe to the delivering pipe; and thence to determine how many gut-fulls were given from the healthy person to the patient. See Class IV. 2. 4. 11. Mr. —— considered a day on this proposal, and then another day, and at length answered, that "he now found himself near the house of death; and that if he could return, he was now too old to have much enjoyment of life; and therefore he wished rather to proceed to the end of that journey, which he was now so near, and which he must at all events soon go, than return for so short a time." He lived but a few days afterwards, and seemed quite careless and easy about the matter.

26. Lacteorum inirritabilitas. Inirritability of the lacteals is described in Sect. XXVIII. under the name of paralysis of the lacteals; but as the word paralysis has generally been applied to the disobedience of the muscles to the power of volition, the name is here changed to inirritability of the lacteals, as more characteristic of the disease.

27. Lymphaticorum inirritabilitas. The inirritability of the cellular and cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Class I. 2. 3. 16. The inirritability of the cutaneous lymphatics generally accompanies anasarca, and is the cause of the great thirst in that malady. At the same time the cellular lymphatics act with greater energy, owing to the greater derivation of sensorial power to them in consequence of the less expenditure of it by the cutaneous ones; and hence they absorb the fat, and mucus, and also the thinner parts of the urine. Whence the great emaciation of the body, the muddy sediment, and the small quantity of water in this kind of dropsy.

ORDO II.

Decreased Irritation.

GENUS IV.

With Decreased Actions of other Cavities and Membranes.

Many of the diseases of this genus are attended with pain, and with cold extremities, both which cease on the exhibition of wine or opium; which shews, that they originate from deficient action of the affected organ. These pains are called nervous or spasmodic, are not attended with fever, but are frequently succeeded by convulsions and madness; both which belong to the class of volition. Some of them return at periods, and when these can be ascertained, a much less quantity of opium will prevent them, than is necessary to cure them, when they are begun; as the vessels are then torpid and inirritable from the want of sensorial power, till by their inaction it becomes again accumulated.

Our organs of sense properly so called are not liable to pain from the absence of their appropriated stimuli, as from darkness or silence; but the other senses, which may be more properly called appetites, as those by which we perceive heat, hunger, thirst, lust, want of fresh air, are affected with pain from the defect or absence of their accustomed stimuli, as well as with pleasure by the possession of them; it is probable that some of our glands, whose sense or appetite requires or receives something from the circulating blood, as the pancreas, liver, testes, prostate gland, may be affected with aching or pain, when they cannot acquire their appropriated fluid.

Wherever this defect of stimulus occurs, a torpor or inaction of the organ ensues, as in the capillaries of the skin, when exposed to cold; and in the glands, which secrete the gastric juice, when we are hungry. This torpor however, and concomitant pain, which is at first owing to defect of stimulus, is afterwards induced by other associations or catenations, and constitutes the beginning of ague fits.

It must be further observed, that in the diseases of pain without fever, the pain is frequently not felt in the part where the cause of the disease resides; but is induced by sympathy with a distant part, whose irritability or sensibility is greater or less than its own. Thus a stone at the neck of the bladder, if its stimulus is not very great, only induces the pain of strangury at the glans penis. If its stimulus be greater, it then induces pain at the neck of the bladder. The concretions of bile, which are protruded into the neck of the gall-bladder, when the disease is not very great, produce pain at the other extremity of the bile-duct, which enters the duodenum immediately under the pit of the stomach; but, when the disease is great from the largeness of the bile-stone, the pain is felt in the region of the liver at the neck of the gall-bladder.

It appears from hence, that the pains enumerated in this genus are consequences of the inactivity of the organ; and, as they do not occasion other diseases, should be classed according to their proximate cause, which is defective irritation; there are nevertheless other pains from defect of stimulus, which produce convulsions, and belong to Class III. 1. 1.; and others, which produce pains of some distant part by association, and belong to Class IV. 2. 2.

SPECIES.

1. Sitis. Thirst. The senses of thirst and of hunger seem to have this connection, that the former is situated at the upper end, and the latter at the lower end of the same canal. One about the pharinx, where the œsophagus opens into the mouth, and the other about the cardia ventriculi, where it opens into the stomach. The extremities of other canals have been shewn to possess correspondent sensibilities, or irritabilities, as the two ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4.

The membrane of the upper end of the gullet becomes torpid, and consequently painful, when there is a deficiency of aqueous fluid in the general system; it then wants its proper stimulus. In the same manner a want of the stimulus of more solid materials at the other end of the canal, which terminates in the stomach, produces hunger; as mentioned in Sect. XIV. 8. The proximate causes of both of them therefore consist in deficient irritation, when they are considered as pains; because these pains are in consequence of the inactivity of the organ, according to the fifth law of animal causation. Sect. IV. 5. But when they are considered as desires, namely of liquid or solid aliment, their proximate cause consists in the pain of them, according to the sixth law of animal causation. So the proximate cause of the pain of coldness is the inactivity of the organ, and perhaps the consequent accumulation of sensorial power in it; but the pain itself, or the consequent volition, is the proximate cause of the shuddering and gnashing the teeth in cold fits of intermittent fevers. See Class I. 2. 2. 1.

Thirst may be divided into two varieties alluding to the remote cause of each, and may be termed sitis calida, or warm thirst, and sitis frigida, or cold thirst. The remote cause of the former arises from the dissipation of the aqueous parts of our fluids by the increased secretion of perspirable matter, or other evacuations. And hence it occurs in hot fits of fever, and after taking much wine, opium, spice, salt, or other drugs of the Art. incitantia or secernentia. The thirst, which occurs about three hours after eating a couple of red herrings, to a person unaccustomed to salted meat, is of this kind; the increased action of the cutaneous vessels dissipates so much of our fluids by insensible perspiration, as to require above two quarts of water to restore the fluidity of the blood, and to wash the salt out of the system. See Art. III. 2. 1.

M. M. Cold water. Vegetable acids. Warm bath.

The remote cause of sitis frigida, or cold thirst, is owing to the inaction of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the blood is deprived of the great supply of moisture, which it ought to receive from the atmosphere, and from the cells of the cellular membrane, and from other cysts; this cause of thirst exists in dropsies, and in the cold fits of intermittents. The desire of fluids, like that of solids, is liable to acquire periods, and may therefore readily become diseased by indulgence in liquids grateful to the palate.

Of diseased thirst, the most common is either owing to defect of the action of the numerous absorbent vessels on the neck of the bladder, in which the patient makes much paleish water; or to the defective absorption of the skin and lungs, in which the patient makes but little water, and that high-coloured, and with sediment. In both the tongue and lips are liable to become very dry. The former in its greatest degree attends diabætes, and the latter anasarca.

M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water. Lemonade. Cyder.

2. Esuries. Hunger has been fancifully ascribed to the sides of the stomach rubbing against each other, and to the increased acidity of the gastric juice corroding the coats of it. If either of these were the cause of hunger, inflammation must occur, when they had continued some time; but, on the contrary, coldness and not heat are attendant on hunger; which evinces, that like thirst it is owing to the inactivity of the membrane, which is the seat of it; while the abundant nerves about the cardia ventriculi, and the pain of hunger being felt in that part, gives great reason to conclude, that it is there situated.

The sense of hunger as well as of thirst is liable to acquire habits in respect to the times of its returning painfulness, as well as in respect to the quantity required to satiate its appetency, and hence may become diseased by indulgence, as well as by want of its appropriate stimulus. Those who have been accustomed to distend their stomach by large quantities of animal and vegetable food, and much potation, find a want of distention, when the stomach is empty, which occasions faintness, and is mistaken for hunger, but which does not appear to be the same sensation. I was well informed, that a woman near Lichfield, who eat much animal and vegetable food for a wager, affirmed, that since distending her stomach so much, she had never felt herself satisfied with food; and had in general taken twice as much at a meal, as she had been accustomed to, before she eat so much for a wager.

3. Nausea sicca. Dry nausea. Consists in a quiescence or torpor of the mucous or salivary glands, and precedes their inverted motions, described in nausea humida, Class I. 3. 2. 3. In the same manner as sickness of the stomach is a quiescence of that organ preceding the action of vomiting, as explained in Sect. XXXV. 1. 3. This is sometimes induced by disagreeable drugs held in the mouth, at other times of disgustful ideas, and at other times by the association of these actions with those of the stomach; and thus according to its different proximate causes may belong to this, or to the second, or to the fourth class of diseases.

M. M. Lemonade. Tasteful food. A blister. Warm bath.

4. Ægritudo ventriculi. Sickness of stomach is produced by the quiescence or inactivity of that organ, as is explained in Sect. XXXV. 1. 3. It consists in the state between the usual peristaltic motions of that organ, in the digestion of our aliment, and the retrograde motions of it in vomiting; for it is evident, that the direct motions of it from the cardia to the pylorus must stop, before those in a contrary direction can commence. This sickness, like the nausea above described, is sometimes produced by disgustful ideas, as when nasty objects are seen, and nasty stories related, as well as by the exhaustion of the sensorial power by the stimulus of some emetic drugs, and by the defect of the production of it, as in enfeebled drunkards.

Sickness may likewise consist in the retrograde motions of the lymphatics of the stomach, which regurgitate into it the chyle or lymph, which they have lately absorbed, as in Class I. 3. 2. 3. It is probable, that these two kinds of sickness may be different sensations, though they have acquired but one name; as one of them attends hunger, and the other repletion; though either of them may possibly be induced by association with nauseous ideas.

M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the head in bed. See Sect. XXV. 16. Class IV. 1. 1. 2. and 3.

5. Cardialgia. Heartburn originates from the inactivity of the stomach, whence the aliment, instead of being subdued by digestion, and converted into chyle, runs into fermentation, producing acetous acid. Sometimes the gastric juice itself becomes so acid as to give pain to the upper orifice of the stomach; these acid contents of the stomach, on falling on a marble hearth, have been seen to produce an effervescence on it. The pain of heat at the upper end of the gullet, when any air is brought up from the fermenting contents of the stomach, is to be ascribed to the sympathy between these two extremities of the œsophagus rather than to the pungency of the carbonic gas, or fixed air; as the sensation in swallowing that kind of air in water is of a different kind. See Class I. 3. 1. 3. and IV. 2. 2. 5.

M. M. This disease arising from indigestion is often very pertinacious, and afflicting; and attended with emaciation of the body from want of sufficient chyle. As the saliva swallowed along with our food prevents its fermentation, as appears by the experiments of Pringle and Macbride, some find considerable relief by chewing parched wheat, or mastic, or a lock of wool, frequently in a day, when the pain occurs, and by swallowing the saliva thus effused; a temporary relief is often obtained from antiacids, as aerated alcaline water, Seltzer's water, calcareous earths, alcaline salts made into pills with soap, soap alone, tin, milk, bitters. More permanent use may be had from such drugs as check fermentation, as acid of vitriol; but still more permanent relief from such things as invigorate the digestion, as a blister on the back; a due quantity of vinous spirit and water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat made so tight as slightly to compress the bowels and stomach. A flannel shirt in winter, not in summer. A less quantity of potation of all kinds. Ten black pepper-corns swallowed after dinner. Half a grain of opium twice a day, or a grain. The food should consist of such things as do not easily ferment, as flesh, shell-fish, sea-biscuit, toasted cheese. I have seen toasted cheese brought up from the stomach 24 hours after it had been swallowed, without apparently having undergone any chemical change. See Class II. 1. 3. 17. and IV. 1. 2. 13.

6. Arthritis Ventriculi. Sickness of the stomach in gouty cases is frequently a consequence of the torpor or inflammation of the liver, and then it continues many days or weeks. But when the patient is seized with great pain at the stomach with the sensation of coldness, which they have called an ice-bolt, this is a primary affection of the stomach, and destroys the patient in a few hours, owing to the torpor or inaction of that viscus so important to life.

This primary gout of the stomach, as it is a torpor of that viscus, is attended with sensation of coldness, and with real defect of heat, in that part, and may thence be distinguished from the pain occasioned by the passage of a gall-stone into the duodenum, as well as by the weak pulse, and cold extremities; to which must be added, that it affects those only, who have been long afflicted with the gout, and much debilitated by its numerous attacks.

M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied externally to the stomach by hot cloths or fomentation.

7. Colica flatulenta. The flatulent colic arises from the too great distention of the bowel by air, and consequent pain. The cause of this disease is the inactivity or want of sufficiently powerful contraction of the coats of the bowel, to carry forwards the gas given up by the fermenting aliment. It is without fever, and generally attended with cold extremities.

It is distinguished, first, from the pain occasioned by the passage of a gall-stone, as that is felt at the pit of the stomach, and this nearer the navel. Secondly, it is distinguished from the colica saturnina, or colic from lead, as that arising from the torpor of the liver, or of some other viscus, is attended with greater coldness, and with an aching pain; whereas the flatulent cholic being owing to distention of the muscles of the bowel, the pain is more acute, and the coldness less. Thirdly, it is distinguished from inflammation of the bowels, or ileus, as perpetual vomiting and fever attend this. Fourthly, it is distinguished from cholera, because that is accompanied with both vomiting and diarrhœa. And lastly, from the colica epileptica, or hysteric colic, as that is liable to alternate with convulsion, and sometimes with insanity; and returns by periods.

M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain. Spice. Volatile alcali. Warm fomentation externally. Rhubarb.

8. Colica saturnina. Colic from lead. The pain is felt about the navel, is rather of an aching than acute kind at first, which increases after meals, and gradually becomes more permanent and more acute. It terminates in paralysis, frequently of the muscles of the arm, so that the hand hangs down, when the arm is extended horizontally. It is not attended with fever, or increase of heat. The seat of the disease is not well ascertained, it probably affects some part of the liver, as a pale bluish countenance and deficiency of bile sometimes attends or succeeds it, with consequent anasarca; but it seems to be caused immediately by a torpor of the intestine, whether this be a primary or secondary affection, as appears from the constipation of the bowels, which attends it; and is always produced in consequence of the great stimulus of lead previously used either internally for a length of time, or externally on a large surface.

A delicate young girl, daughter of a dairy farmer, who kept his milk in leaden cisterns, used to wipe off the cream from the edges of the lead with her finger; and frequently, as she was fond of cream, licked it from her finger. She was seized with the saturnine colic, and semi-paralytic wrists, and sunk from general debility.

A feeble woman about 40 years of age sprained her ancle, and bruised her leg and thigh; and applied by ill advice a solution of lead over the whole limb, as a fomentation and poultice for about a fortnight. She was then seized with the colica saturnina, lost the use of her wrists, and gradually sunk under a general debility.

M. M. First opium one or two grains, then a cathartic of senna, jalap, and oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A blister on the navel. Warm bath. The stimulus of the opium, by restoring to the bowel its natural irritability in this case of painful torpor, assists the action of the cathartic.

9. Tympanitis. Tympany consists in an elastic tumor of the abdomen, which sounds on being struck. It is generally attended with costiveness and emaciation. In one kind the air is said to exist in the bowels, in which case the tumor is less equal, and becomes less tense and painful on the evacuation of air. In the other kind the air exists in the cavity of the abdomen, and sometimes is in a few days exchanged for water, and the tympany becomes an ascites.

Air may be distinguished in the stomach of many people by the sound on striking it with the fingers, and comparing the sound with that of a similar percussion on other parts of the bowels; but towards the end of fevers, and especially in the puerperal fever, a distention of the abdomen by air is generally a fatal symptom, though the ease, and often cheerfulness, of the patient vainly flatters the attendants.

M. M. In the former case a clyster-pipe unarmed may be introduced, and left some time in the rectum, to take off the resistance of the sphincter, and thus discharge the air, as it is produced from the fermenting or putrefying aliment. For this purpose, in a disease somewhat similar in horses, a perforation is made into the rectum on one side of the sphincter; through which fistula the air, which is produced in such great excess from the quantity of vegetable food which they take, when their digestions are impaired, is perpetually evacuated. In both cases also, balsams, essential oil, spice, bandage on the abdomen, and, to prevent the fermentation of the aliment, acid of vitriol, saliva. See Class I. 2. 4. 5.

10. Hypochondriasis. The hypochondriac disease consists in indigestion and consequent flatulency, with anxiety or want of pleasureable sensation. When the action of the stomach and bowels is impaired, much gas becomes generated by the fermenting or putrescent aliment, and to this indigestion is catenated languor, coldness of the skin, and fear. For when the extremities are cold for too long a time in some weak constitutions, indigestion is produced by direct sympathy of the skin and the stomach, with consequent heart-burn, and flatulency. The same occurs if the skin be made cold by fear, as in riding over dangerous roads in winter, and hence conversely fear is produced by indigestion or torpor of the stomach by association.

This disease is confounded with the fear of death, which is an insanity, and therefore of a totally different nature. It is also confounded with the hysteric disease, which consists in the retrograde motions of the alimentary canal, and of some parts of the absorbent system.

The hypochondriasis, like chlorosis, is sometimes attended with very quick pulse; which the patient seems to bear so easily in these two maladies, that if an accidental cough attends them, they may be mistaken for pulmonary consumption; which is not owing primarily to the debility of the heart, but to its direct sympathy with the actions of the stomach.

M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain twice a day. Rhubarb six grains every night. Bark. Steel. Spice. Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No liquor stronger than small beer, or wine and water. Gentle exercise on horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4. 5.

11. Cephalæa. Head-ach frequently attends the cold paroxysm of intermittents; afflicts inebriates the day after intoxication; and many people who remain too long in the cold bath. In all which cases there is a general inaction of the whole system, and as these membranes about the head have been more exposed to the variations of heat and cold of the atmosphere, they are more liable to become affected so far as to produce sensation, than other membranes; which are usually covered either with clothes, or with muscles, as mentioned in Sect. XXXIII. 2. 10.

The promptitude of the membranes about the scalp to sympathize with those of other parts of the system is so great, that this cephalæa without fever, or quickness of pulse, is more frequently a secondary than a primary disease, and then belongs to Class IV. 2. 2. 7. The hemicrania, or partial head-ach, I believe to be almost always a disease from association; though it is not impossible, but a person may take cold on one side of the head only. As some people by sitting always on the same side of the fire in winter are liable to render one side more tender than the other, and in consequence more subject to pains, which have been erroneously termed rheumatic. See Class IV. 2. 2. 7. & 8.

M. M. The method of cure consists in rendering the habit more robust, by gentle constant exercise in the open air, flesh diet, small beer at meals with one glass of wine, regular hours of rest and rising, and of meals. The cloathing about the head should be warmer during sleep than in the day; because at that time people are more liable to take cold; that is, the membranous parts of it are more liable to become torpid. As explained in Sect. XVIII. 15. In respect to medicine, two drams of valerian root in powder three or four times a day are recommended by Fordyce. The bark. Steel in moderate quantities. An emetic. A blister. Opium, half a grain twice a day. Decayed teeth should be extracted, particularly such as either ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm bath of 94 or 98 degrees every day for half an hour during a month. See Class IV. 2. 2. 7. and 8.

A solution of arsenic, about the sixteenth part of a grain, is reported to have great effect in this disease. It should be taken thrice a day, if it produces no griping or sickness, for two or three weeks. A medicine of this kind is sold under the name of tasteless ague-drops; but a more certain method of ascertaining the quantity is delivered in the subsequent materia medica, Art. IV. 2. 6.

12. Odontalgia. Tooth-ach. The pain has been erroneously supposed, where there is no inflammation, to be owing to some acrid matter from a carious tooth stimulating the membrane of the alveolar process into violent action and consequent pain; but the effect seems to have been mistaken for the cause, and the decay of the tooth to have been occasioned by the torpor and consequent pain of the diseased membrane.

First, because the pain precedes the decay of the tooth in regard to time, and is liable to recur, frequently for years, without certainly being succeeded at last by a carious tooth, as I have repeatedly observed.

Secondly, because any stimulant drug, as pyrethrum, or oil of cloves, applied to the tooth, or ether applied externally to the cheek, so far from increasing the pain, as they would do if the pained membrane, already acted too strongly, that they frequently give immediate relief like a charm.

And thirdly, because the torpor, or deficient action of the membrane, which includes the diseased tooth, occasions the motions of the membranes most connected with it, as those of the cheek and temples, to act with less than their natural energy; and hence a coldness of the cheek is perceived easily by the hand of the patient, comparing it with the other cheek; and the pain of hemicrania is often produced in the temple of the affected side.

This coldness of the cheek in common tooth-ach evinces, that the pain is not then caused by inflammation; because in all inflammations so much heat is produced in the secretions of new vessels and fluids, as to give heat to the parts in vicinity. And hence, as soon as the gum swells and inflames along with the cheek, heat is produced, and the pain ceases, owing to the increased exertions of the torpid membrane, excited by the activity of the sensorial power of sensation; which previously existed in its passive state in the painful torpid membrane. See Odontitis, Class II. 1. 4. 7. and IV. 2. 2. 8.

M. M. If the painful tooth be found, venesection. Then a cathartic. Afterwards two grains of opium. Camphor and opium, one grain of each held in the mouth; or a drop or two of oil of cloves put on the painful tooth. Ether. If the tooth has a small hole in it, it should be widened within by an instrument, and then stopped with leaf-gold, or leaf-lead; but should be extracted, if much decayed. It is probable that half a small drop of a strong solution of arsenic, put carefully into the hollow of a decayed aching tooth, would destroy the nerve without giving any additional pain; but this experiment requires great caution, lest any of the solution should touch the tongue or gums.

Much cold or much heat are equally injurious to the teeth, which are endued with a fine sensation of this universal fluid. The best method of preserving them is by the daily use of a brush, which is not very hard, with warm water and fine charcoal dust. A lump of charcoal should be put a second time into the fire till it is red hot, as soon as it becomes cool the external ashes should be blown off, and it should be immediately reduced to fine powder in a mortar, and kept close stopped in a phial. It takes away the bad smell from decayed teeth, by washing the mouth with this powder diffused in water immediately. The putrid smell of decaying stumps of teeth may be destroyed for a time by washing the mouth with a weak solution of alum in water. If the calcareous crust upon the teeth adheres very firmly, a fine powder of pumice-stone may be used occasionally, or a tooth instrument.

Acid of sea-salt, much diluted, may be used; but this very rarely, and with the greatest caution, as in cleaning sea-shells. When the gums are spongy, they should be frequently pricked with a lancet. Should black spots in teeth be cut out? Does the enamel grow again when it has been perforated or abraded?

13. Otalgia. Ear-ach sometimes continues many days without apparent inflammation, and is then frequently removed by filling the ear with laudanum, or with ether; or even with warm oil, or warm water. See Class II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the consequence of association with a diseased tooth; in that case the ether should be applied to the cheek over the suspected tooth, or a grain of opium and as much camphor mixed together and applied to the suspected tooth. In this case the otalgia belongs to the fourth class of diseases.

14. Pleurodyne chronica. Chronical pain of the side. Pains of the membranous parts, which are not attended with fever, have acquired the general name of rheumatic; which should, nevertheless, be restricted to those pains which exist only when the parts are in motion, and which have been left after inflammation of them; as described in Class I. 1. 3. 12. The pain of the side here mentioned affects many ladies, and may possibly have been owing to the pressure of tight stays, which has weakened the action of the vessels composing some membranous part, as, like the cold head-ach, it is attended with present debility; in one patient, a boy about ten years old, it was attended with daily convulsions, and was supposed to have originated from worms. The disease is very frequent, and generally withstands the use of blisters on the part; but in some cases I have known it removed by electric shocks repeated every day for a fortnight through the affected side.

Pains of the side may be sometimes occasioned by the adhesion of the lungs to the pleura, after an inflammation of them; or to the adhesion of some abdominal viscera to their cavity, or to each other; which also are more liable to affect ladies from the unnatural and ungraceful pressure of tight stays, or by sitting or lying too long in one posture. But in these cases the pain should be more of the smarting, than of the dull kind.

M. M. Ether. A blister. A plaster of Burgundy pitch. An issue or seton on the part. Electric shocks. Friction on the part with oil and camphor. Loose dress. Frequent change of posture both in the day and night. Internally opium, valerian, bark.

15. Sciatica frigida. Cold sciatica. The pain along the course of the sciatic nerve, from the hip quite down to the top of the foot, when it is not attended with fever, is improperly termed either rheumatism or gout; as it occurs without inflammation, is attended with pain when the limb is at rest; and as the pain attends the course of the nerve, and not the course of the muscles, or of the fascia, which contains them. The theory of Cotunnius, who believed it to be a dropsy of the sheath of the nerve, which was compressed by the accumulated fluid, has not been confirmed by dissection. The disease seems to consist of a torpor of this sheath of the nerve, and the pain seems to be in consequence of this torpor. See Class II. 1. 2. 18.

M. M. Venesection. A cathartic. And then one grain of calomel and one of opium every night for ten successive nights. And a blister, at the same time, a little above the knee-joint on the outside of the thigh, where the sciatic nerve is not so deep seated. Warm bath. Cold bath. Cover the limb with oiled silk, or with a plaster-bandage of emplastrum de minio.

16. Lumbago frigida. Cold lumbago. When no fever or inflammation attends this pain of the loins, and the pain exists without motion, it belongs to this genus of diseases, and resembles the pain of the loins in the cold fit of ague. As these membranes are extensive, and more easily fall into quiescence, either by sympathy, or when they are primarily affected, this disease becomes very afflicting, and of great pertinacity. See Class II. 1. 2. 17.

M. M. Venesection. A cathartic. Issues on the loins. Adhesive plaster on the loins. Blister on the os sacrum. Warm bath. Cold bath. Remove to a warmer climate in the winter. Loose dress about the waist. Friction daily with oil and camphor.

17. Hysteralgia frigida. Cold pain of the uterus preceding or accompanying menstruation. It is attended with cold extremities, want of appetite, and other marks of general debility.

M. M. A clyster of half a pint of gruel, and 30 drops of laudanum; or a grain of opium and six grains of rhubarb every night. To sit over warm water, or go into a warm bath.

18. Proctalgia frigida. Cold pain at the bottom of the rectum previous to the tumor of the piles, which sometimes extends by sympathy to the loins; it seems to be similar to the pain at the beginning of menstruation, and is owing to the torpor or inirritability of the extremity of the alimentary canal, or to the obstruction of the blood in its passage through the liver, when that viscus is affected, and its consequent delay in the veins of the rectum, occasioning tumors of them, and dull sensations of pain.

M. M. Calomel. A cathartic. Spice. Clyster, with 30 drops of laudanum. Sitting over warm water. If chalybeates after evacuation? See Class I. 2. 3. 23. and I. 2. 1. 6.

19. Vesicæ felleæ inirritabilitas. The inirritability of the gall-bladder probably occasions one kind of icterus, or jaundice; which is owing to whatever obstructs the passage of bile into the duodenum. The jaundice of aged people, and which attends some fevers, is believed to be most frequently caused by an irritative palsy of the gall-bladder; on which account the bile is not pressed from the cyst by its contraction, as in a paralysis of the urinary bladder.

A thickening of the coats of the common bile-duct by inflammation or increased action of their vessels so as to prevent the passage of the bile into the intestine, in the same manner as the membrane, which lines the nostrils, becomes thickened in catarrh so as to prevent the passage of air through them, is probably another frequent cause of jaundice, especially of children; and generally ceases in about a fortnight, like a common catarrh, without the aid of medicine; which has given rise to the character, which charms have obtained in some countries for curing the jaundice of young people.

The spissitude of the bile is another cause of jaundice, as mentioned in Class I. 1. 3. 8. This also in children is a disease of little danger, as the gall-ducts are distensible, and will the easier admit of the exclusion of gall-stones; but becomes a more serious disease in proportion to the age of the patient, and his habits of life in respect to spirituous potation.

A fourth cause of jaundice is the compression of the bile-duct by the enlargement of an inflamed or schirrous liver; this attends those who have drank much spirituous liquor, and is generally succeeded by dropsy and death.

M. M. Repeated emetics. Mild cathartics. Warm bath. Electricity. Bitters. Then steel, which, when the pain and inflammation is removed by evacuations, acts like a charm in removing the remainder of the inflammation, and by promoting the absorption of the new vessels or fluids; like the application of any acrid eye-water at the end of ophthalmia; and thus the thickened coats of the bile-duct become reduced, or the enlargement of the liver lessened, and a free passage is again opened for the bile into the intestine. Ether with yolk of egg is recommended, as having a tendency to dissolve inspissated bile. And a decoction of madder is recommended for the same purpose; because the bile of animals, whose food was mixed with madder, was found always in a dilute state. Aerated alcaline water, or Seltzer's water. Raw cabbage, and other acrid vegetables, as water-cresses, mustard. Horses are said to be subject to inspissated bile, with yellow eyes, in the winter season, and to get well as soon as they feed on the spring grass.

The largest bile-stone I have seen was from a lady, who had parted with it some years before, and who had abstained above ten years from all kinds of vegetable diet to prevent, as she supposed, a colic of her stomach, which was probably a pain of the biliary duct; on resuming the use of some vegetable diet, she recovered a better state of health, and formed no new bilious concretions.

A strong aerated alcaline water is sold by J. Schweppe, No. 8, King's-street, Holborn. See Class I. 1. 3. 10.

20. Pelvis renalis inirritabilitas. Inirritability of the pelvis of the kidney. When the nucleus of a stone, whether it be inspissated mucus, or other matter, is formed in the extremity of any of the tubuli uriniferi, and being detached from thence falls into the pelvis of the kidney, it is liable to lodge there from the want of due irritability of the membrane; and in that situation increases by new appositions of indurated animal matter, in the same manner as the stone of the bladder. This is the general cause of hæmorrhage from the kidney; and of obtuse pain in it on exercise; or of acute pain, when the stone advances into the ureter. See Class I. 1. 3. 9.

ORDO II.

Decreased Irritation.

GENUS V.

Decreased Action of the Organs of Sense.

SPECIES.

1. Stultitia inirritabilis. Folly from inirritability. Dulness of perception. When the motions of the fibrous extremities of the nerves of sense are too weak to excite sensation with sufficient quickness and vigour. The irritative ideas are nevertheless performed, though perhaps in a feeble manner, as such people do not run against a post, or walk into a well. There are three other kinds of folly; that from deficient sensation, from deficient volition, and from deficient association, as will be mentioned in their places. In delirium, reverie, and sleep, the power of perception is abolished from other causes.

2. Visus imminutus. Diminished vision. In our approach to old age our vision becomes imperfect, not only from the form of the cornea, which becomes less convex, and from its decreased transparency mentioned in Class I. 2. 3. 26.; but also from the decreased irritability of the optic nerve. Thus, in the inirritative or nervous fever, the pupil of the eye becomes dilated; which in this, as well as in the dropsy of the brain, is generally a fatal symptom. A part of the cornea as well as a part of the albuginea in these fevers is frequently seen during sleep; which is owing to the inirritability of the retina to light, or to the general paresis of muscular action, and in consequence to the less contraction of the sphincter of the eye, if it may be so called, at that time.

There have been instances of some, who could not distinguish certain colours; and yet whose eyes, in other respects, were not imperfect. Philos. Transact. Which seems to have been owing to the want of irritability, or the inaptitude to action, of some classes of fibres which compose the retina. Other permanent defects depend on the diseased state of the external organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11.

3. Muscæ volitantes. Dark spots appearing before the eyes, and changing their apparent place with the motions of the eyes, are owing to a temporary defect of irritability of those parts of the retina, which have been lately exposed to more luminous objects than the other parts of it, as explained in Sect. XL. 2. Hence dark spots are seen on the bed-clothes by patients, when the optic nerve is become less irritable, as in fevers with great debility; and the patients are perpetually trying to pick them off with their fingers to discover what they are; for these parts of the retina of weak people are sooner exhausted by the stimulus of bright colours, and are longer in regaining their irritability.

Other kinds of ocular spectra, as the coloured ones, are also more liable to remain in the eyes of people debilitated by fevers, and to produce various hallucinations of sight. For after the contraction of a muscle, the fibres of it continue in the last situation, till some antagonist muscles are exerted to retract them; whence, when any one is much exhausted by exercise, or by want of sleep, or in fevers, it is easier to let the fibres of the retina remain in their last situation, after having been stimulated into contraction, than to exert any antagonist fibres to replace them.

As the optic nerves at their entrance into the eyes are each of them as thick as a crow-quill, it appears that a great quantity of sensorial power is expended during the day in the perpetual activity of our sense of vision, besides that used in the motions of the eye-balls and eyelids; as much I suppose as is expended in the motions of our arms, which are supplied with nerves of about the same diameters. From hence we may conclude, that the light should be kept from patients in fevers with debility, to prevent the unnecessary exhaustion of the sensorial power. And that on the same account their rooms should be kept silent as well as dark; that they should be at rest in an horizontal posture; and be cooled by a blast of cool air, or by washing them with cold water, whenever their skins are warmer than natural.

4. Strabismus. Squinting is generally owing to one eye being less perfect than the other; on which account the patient endeavours to hide the worst eye in the shadow of the nose, that his vision by the other may not be confused. Calves, which have an hydatide with insects inclosed in it in the frontal sinus on one side, turn towards the affected side; because the vision on that side, by the pressure of the hydatide, becomes less perfect; and the disease being recent, the animal turns round, expecting to get a more distinct view of objects.

In the hydrocephalus internus, where both eyes are not become insensible, the patient squints with only one eye, and views objects with the other, as in common strabismus. In this case it may be known on which side the disease exists, and that it does not exist on both sides of the brain; in such circumstances, as the patients I believe never recover as they are now treated, might it not be adviseable to perforate the cranium over the ventricule of the affected side? which might at least give room and stimulus to the affected part of the brain?

M. M. If the squinting has not been confirmed by long habit, and one eye be not much worse than the other, a piece of gauze stretched on a circle of whale-bone, to cover the best eye in such a manner as to reduce the distinctness of vision of this eye to a similar degree of imperfection with the other, should be worn some hours every day. Or the better eye should be totally darkened by a tin cup covered with black silk for some hours daily, by which means the better eye will be gradually weakened by the want of use, and the worse eye will be gradually strengthened by using it. Covering an inflamed eye in children for weeks together, is very liable to produce squinting, for the same reason.

5. Amaurosis. Gutta serena. Is a blindness from the inirritability of the optic nerve. It is generally esteemed a palsy of the nerve, but should rather be deemed the death of it, as paralysis has generally been applied to a deprivation only of voluntary power. This is a disease of dark eyes only, as the cataract is a disease of light eyes only. At the commencement of this disease, very minute electric shocks should be repeatedly passed through the eyes; such as may be produced by putting one edge of a piece of silver the size of a half-crown piece beneath the tongue, and one edge of a piece of zinc of a similar size between the upper lip and the gum, and then repeatedly bringing their exterior edges into contact, by which means very small electric sparks become visible in the eyes. See additional note at the end of the first volume, p. 567. and Sect. XIV. 5.

M. M. Minute electric shocks. A grain of opium, and a quarter of a grain of corrosive sublimate of mercury, twice a day for four or six weeks. Blister on the crown of the head.

6. Auditus imminutus. Diminished hearing. Deafness is a frequent symptom in those inflammatory or sensitive fevers with debility, which are generally called putrid; it attends the general stupor in those fevers, and is rather esteemed a salutary sign, as during this stupor there is less expenditure of sensorial power.

In fevers of debility without inflammation, called nervous fevers, I suspect deafness to be a bad symptom, arising like the dilated pupil from a partial paralysis of the nerve of sense. See Class IV. 2. 1. 15.

Nervous fevers are supposed by Dr. Gilchrist to originate from a congestion of serum or water in some part of the brain, as many of the symptoms are so similar to those of hydrocephalus internus, in which a fluid is accumulated in the ventricules of the brain; on this idea the inactivity of the optic or auditory nerves in these fevers may arise from the compression of the effused fluid; while the torpor attending putrid fever may depend on the meninges of the brain being thickened by inflammation, and thus compressing it; now the new vessels, or the blood, which thickens inflamed parts, is more frequently reabsorbed, than the effused fluid from a cavity; and hence the stupor in one case is less dangerous than in the other.

In inflammatory or sensitive fevers with debility, deafness may sometimes arise from a greater secretion and absorption of the ear-wax, which is very similar to the bile, and is liable to fill the meatus auditorius, when it is too viscid, as bile obstructs the gall-ducts.

M. M. In deafness without fever Dr. Darwin applied a cupping-glass on the ear with good effect, as described in Phil. Trans. Vol. LXIV. p. 348. Oil, ether, laudanum, dropped into the ears.

7. Olfactus imminutus. Inactivity of the sense of smell. From our habits of trusting to the art of cookery, and not examining our food by the smell as other animals do, our sense of smell is less perfect than theirs. See Sect. XVI. 5. Class IV. 2. 1. 16.

M. M. Mild errhines.

8. Gustus imminutus. Want of taste is very common in fevers, owing frequently to the dryness or scurf of the tongue, or external organ of that sense, rather than to any injury of the nerves of taste. See Class. I. 1. 3. 1. IV. 2. 1. 16.

M. M. Warm subacid liquids taken frequently.

9. Tactus imminutus. Numbness is frequently complained of in fevers, and in epilepsy, and the touch is sometimes impaired by the dryness of the cuticle of the fingers. See Class IV. 2. 1. 16.

When the sense of touch is impaired by the compression of the nerve, as in sitting long with one thigh crossed over the other, the limb appears larger, when we touch it with our hands, which is to be ascribed to the indistinctness of the sensation of touch, and may be explained in the same manner as the apparent largeness of objects seen through a mist. In this last case the minute parts of an object, as suppose of a distant boy, are seen less distinctly, and therefore we instantly conceive them to be further from the eye, and in consequence that the whole subtends a larger angle, and thus we believe the boy to be a man. So when any one's fingers are pressed on a benumbed limb, the sensation produced is less than it should be, judging from visible circumstances; we therefore conceive, that something intervened between the object and the sense, for it is felt as if a blanket was put between them; and that not being visibly the case, we judge that the limb is swelled.

The sense of touch is also liable to be deceived from the acquired habits of one part of it acting in the vicinity of another part of it. Thus if the middle finger be crossed over either of the fingers next to it, and a nut be felt by the two ends of the fingers so crossed at the same time, the nut appears as if it was two nuts. And lastly, the sense of touch is liable to be deceived by preconceived ideas; which we believe to be excited by external objects, even when we are awake. It has happened to me more than once, and I suppose to most others, to have put my hands into an empty bason standing in an obscure corner of a room to wash them, which I believed to contain cold water, and have instantly perceived a sensation of warmth, contrary to that which I expected to have felt.

In some paralytic affections, and in cold fits of ague, the sensation of touch has been much impaired, and yet that of heat has remained, See Sect. XIV. 6.

M. M. Friction alone, or with camphorated oil, warm bath. Ether. Volatile alcali and water. Internally spice, salt. Incitantia. Secernentia.

10. Stupor. The stupor, which occurs in fevers with debility, is generally esteemed a favourable symptom; which may arise from the less expenditure of sensorial power already existing in the brain and nerves, as mentioned in species 6 of this genus. But if we suppose, that there is a continued production of sensorial power, or an accumulation of it in the torpid parts of the system, which is not improbable, because such a production of it continues during sleep, to which stupor is much allied, there is still further reason for believing it to be a favourable symptom in inirritable fevers; and that much injury is often done by blisters and other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and XXXIII. 1. 4.

Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many other ingenious observations and deductions, relates a curious experiment on salmon, and other fish, and which he repeated upon eels with similar event.

"If a fish, immediately upon being taken out of the water, is stunned by a violent blow on the head, or by having the head crushed, the irritability and sweetness of the muscles will be preserved much longer, than if it had been allowed to die with the organs of sense entire. This is so well known to fishermen, that they put it in practice, in order to make them longer susceptible of the operation called crimping. A salmon is one of the fish least tenacious of life, insomuch, that it will lose all signs of life in less than half an hour after it is taken out of the water, if suffered to die without any farther injury; but if, immediately after being caught, it receives a violent blow on the head, the muscles will shew visible irritability for more than twelve hours afterwards."

Dr. Blane afterwards well remarks, that "in those disorders in which the exercise of the senses is in a great measure destroyed, or suspended, as in the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that the appetite and digestion are better than in health."

ORDO III.

Retrograde Irritative Motions.

GENUS I.

Of the Alimentary Canal.

The retrograde motions of our system originate either from defect of stimulus, or from defect of irritability. Thus sickness is often induced by hunger, which is a want of stimulus; and from ipecacuanha, in which last case it would seem, that the sickness was induced after the violence of the stimulus was abated, and the consequent torpor had succeeded. Hence spice, opium, or food relieves sickness.

The globus hystericus, salivation, diabætes, and other inversions of motion attending hysteric paroxysms, seem to depend on the want of irritability of those parts of the body, because they are attended with cold extremities, and general debility, and are relieved by wine, opium, steel, and flesh diet; that is, by any additional stimulus.

When the longitudinal muscles are fatigued by long action, or are habitually weaker than natural, the antagonist muscles replace the limb by stretching it in a contrary direction; and as these muscles have had their actions associated in synchronous tribes, their actions cease together. But as the hollow muscles propel the fluids, which they contain, by motions associated in trains; when one ring is fatigued from its too great debility, and brought into retrograde action; the next ring, and the next, from its association in train falls into retrograde action. Which continue so long as they are excited to act, like the tremors of the hands of infirm people, so long as they endeavour to act. Now as these hollow muscles are perpetually stimulated, these retrograde actions do not cease as the tremors of the longitudinal muscles, which are generally excited only by volition. Whence the retrograde motions of hollow muscles depend on two circumstances, in which they differ from the longitudinal muscles, namely, their motions being associated in trains, and their being subject to perpetual stimulus. For further elucidation of the cause of this curious source of diseases, see Sect. XXIX. 11. 5.

The fluids disgorged by the retrograde motions of the various vascular muscles may be distinguished, 1. From those, which are produced by secretion, by their not being attended by increase of heat, which always accompanies increased secretion. 2. They may be distinguished from those fluids, which are the consequence of deficient absorption, by their not possessing the saline acrimony, which those fluids possess; which inflames the skin or other membranes on which they fall; and which have a saline taste to the tongue. 3. They may be distinguished from those fluids, which are the consequence both of increased secretion and absorption, as these are attended with increase of warmth, and are inspissated by the abstraction of their aqueous parts. 4. Where chyle, or milk, are found in the feces or urine, or when other fluids, as matter, are translated from one part of the system to another, they have been the product of retrograde action of lymphatic or other canals. As explained in Sect. XXIX. 8.

SPECIES.

1. Ruminatio. In the rumination of horned cattle the retrograde motions of the œsophagus are visible to the eye, as they bring up the softened grass from their first stomach. The vegetable aliment in the first stomach of cattle, which have filled themselves too full of young clover, is liable to run into fermentation, and distend the stomach, so as to preclude its exit, and frequently to destroy the animal. To discharge this air the farmers frequently make an opening into the stomach of the animal with success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that of twenty cows in this situation two had died, and that he directed a pint of gin or whisky, mixed with an equal quantity of water, to be given to the other eighteen; all of which eructed immense quantities of air, and recovered.

There are histories of ruminating men, and who have taken pleasure in the act of chewing their food a second time. Philos. Transact.

2. Ructus. Eructation. An inverted motion of the stomach excluding through its upper valve an elastic vapour generated by the fermentation of the aliment; which proceeds so hastily, that the digestive power does not subdue it. This is sometimes acquired by habit, so that some people can eruct when they please, and as long as they please; and there is gas enough generated to supply them for this purpose; for by Dr. Hale's experiments, an apple, and many other kinds of aliment, give up above six hundred times their own bulk of an elastic gas in fermentation. When people voluntarily eject the fixable air from their stomachs, the fermentation of the aliment proceeds the faster; for stopping the vessels, which contain new wines, retards their fermentation, and opening them again accelerates it; hence where the digestion is impaired, and the stomach somewhat distended with air, it is better to restrain than to encourage eructations, except the quantity makes it necessary. When wine is confined in bottles the fermentation still proceeds slowly even for years, till all the sugar is converted into spirit; but in the process of digestion, the saccharine part is absorbed in the form of chyle by the bibulous mouths of the numerous lacteals, before it has time to run into the vinous fermentation.

3. Apepsia. Indigestion. Water-qualm. A few mouthfuls of the aliment are rejected at a time for some hours after meals. When the aliment has had time to ferment, and become acid, it produces cardialgia, or heart-burn. This disease is perhaps generally left after a slight inflammation of the stomach, called a surfeit, occasioned by drinking cold liquors, or eating cold vegetables, when heated with exercise. This inflammation of the stomach is frequently, I believe, at its commencement removed by a critical eruption on the face, which differs in its appearance as well as in its cause from the gutta rosea of drunkards, as the skin round the base of each eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with pain of the cardia ventriculi, and from its retrograde motions of a part of the stomach about the upper orifice of it. In the same manner as hysteria differs from hypochondriasis; the one consisting in the weakness and indigestion of the same portions of the alimentary canal, and the other in the inverted motions of some parts of it. This apepsia or water-qualm continues many years, even to old age; Mr. G—— of Lichfield suffered under this disease from his infancy; and, as he grew old, found relief only from repeated doses of opium.

M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder. Tin-powder.

4. Vomitus. An inverted order of the motions of the stomach and œsophagus with their absorbent vessels, by which their contents are evacuated. In the act of vomiting less sensorial power is employed than in the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1. 3. Whence after the operation of an emetic the digestion becomes stronger by an accumulation of sensorial power during its decreased action. This decreased action of the stomach may be either induced by want of stimulus, as in the sickness which attends hunger; or it may be induced by temporary want of irritability, as in cold fits of fever; or from habitual want of irritability, as the vomiting of enfeebled drunkards. Or lastly, by having been previously too violently stimulated by an emetic drug, as by ipecacuanha.

M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a while with the bed-clothes. Crude mercury. A poultice with opium or theriaca externally.

5. Cholera. When not only the stomach, as in the last article, but also the duodenum, and ilium, as low as the valve of the colon, have their motions inverted; and great quantities of bile are thus poured into the stomach; while at the same time some branches of the lacteals become retrograde, and disgorge their contents into the upper part of the alimentary canal; and other branches of them disgorge their contents into the lower parts of it beneath the valve of the colon; a vomiting and purging commence together, which is called cholera, as it is supposed to have its origin from increased secretion of bile; but I suppose more frequently arises from putrid food, or poisonous drugs, as in the case narrated in Sect. XXV. 13. where other circumstances of this disease are explained. See Class II. 1. 2. 11.

The cramps of the legs, which are liable to attend cholera, are explained in Class III. 1. 1. 14.

6. Ileus. Consists in the inverted motions of the whole intestinal canal, from the mouth to the anus; and of the lacteals and absorbents which arise from it. In this pitiable disease, through the valve of the colon, through the pylorus, the cardia, and the pharinx, are ejected, first, the contents of the stomach and intestines, with the excrement and even clysters themselves; then the fluid from the lacteals, which is now poured into the intestines by their retrograde motions, is thrown up by the mouth; and, lastly, every fluid, which is absorbed by the other lymphatic branches, from the cellular membrane, the skin, the bladder, and all other cavities of the body; and which is then poured into the stomach or intestines by the retrograde motions of the lacteals; all which supply that amazing quantity of fluid, which is in this disease continually ejected by vomiting. See Sect. XXV. 15. for a further explanation of this disease.

M. M. Copious venesection. Twenty grains of calomel in small pills, or one grain of aloe every hour till stools are procured. Blisters. Warm bath. Crude mercury. Clyster of ice-water. Smear the skin all over with grease, as mentioned in Sect. XXV. 15.

As this malady is occasioned sometimes by an introsusception of a part of the intestine into another part of it, especially in children, could holding them up by their heels for a second or two of time be of service after venesection? Or the exhibition of crude quicksilver two ounces every half hour, till a pound is taken, be particularly serviceable in this circumstance? Or could half a pound, or a pound, of crude mercury be injected as a clyster, the patient being elevated by the knees and thighs so as to have his head and shoulders much lower than his bottom, or even for a short time held up by the heels? Could this also be of advantage in strangulated hernia?

Where the disease is owing to strangulated hernia, the part should be sprinkled with cold water, or iced water, or salt and water recently mixed, or moistened with ether. In cases of strangulated hernia, could acupuncture, or puncture with a capillary trocar, be used with safety and advantage to give exit to air contained in the strangulated bowel? Or to stimulate it into action? It is not uncommon for bashful men to conceal their being afflicted with a small hernia, which is the cause of their death; this circumstance should therefore always be enquired into. Is the seat or cause of the ileus always below the valve of the colon, and that of the cholera above it? See Class II. 1. 2. 11.

7. Globus hystericus. Hysteric suffocation is the perception of a globe rolling round in the abdomen, and ascending to the stomach and throat, and there inducing strangulation. It consists of an ineffectual inversion of the motions of the œsophagus, and other parts of the alimentary canal; nothing being rejected from the stomach.

M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria, Class I. 3. 1. 10.

8. Vomendi conamen inane. An ineffectual effort to vomit. It frequently occurs, when the stomach is empty, and in some cases continues many hours; but as the lymphatics of the stomach are not inverted at the same time, there is no supply of materials to be ejected; it is sometimes a symptom of hysteria, but more frequently attends irregular epilepsies or reveries; which however may be distinguished by their violence of exertion, for the exertions of hysteric motions are feeble, as they are caused by debility; but those of epilepsies, as they are used to relieve pain, are of the most violent kind; insomuch that those who have once seen these ineffectual efforts to vomit in some epilepsies, can never again mistake them for symptoms of hysteria. See a case in Sect. XIX. 2.

M. M. Blister. Opium. Crude mercury.

9. Borborigmus. A gurgling of the bowels proceeds from a partial invertion of the peristaltic motions of them, by which the gas is brought into a superior part of the bowel, and bubbles through the descending fluid, like air rushing into a bottle as the water is poured out of it. This is sometimes a distressing symptom of the debility of the bowels joined with a partial inversion of their motions. I attended a young lady about sixteen, who was in other respects feeble, whose bowels almost incessantly made a gurgling noise so loud as to be heard at a considerable distance, and to attract the notice of all who were near her. As this noise never ceased a minute together for many hours in a day, it could not be produced by the uniform descent of water, and ascent of air through it, but there must have been alternately a retrograde movement of a part of the bowel, which must again have pushed up the water above the air; or which might raise a part of the bowel, in which the fluid was lodged, alternately above and below another portion of it; which might readily happen in some of the curvatures of the smaller intestines, the air in which might be moved backward and forward like the air-bubble in a glass-level.

M. M. Essential oil. Ten corns of black pepper swallowed whole after dinner, that its effect might be slower and more permanent; a small pipe occasionally introduced into the rectum to facilitate the escape of the air. Crude mercury. See Class I. 2. 4. 9.

10. Hysteria. The three last articles, together with the lymphatic diabætes, are the most common symptoms of the hysteric disease; to which sometimes is added the lymphatic salivation, and fits of syncope, or convulsion, with palpitation of the heart (which probably consists of retrograde motions of it), and a great fear of dying. Which last circumstance distinguishes these convulsions from the epileptic ones with greater certainty than any other single symptom. The pale copious urine, cold skin, palpitation, and trembling, are the symptoms excited by great fear. Hence in hysteric diseases, when these symptoms occur, the fear, which has been usually associated with them, recurs at the same time, as in hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1.

The convulsions which sometimes attend the hysteric disease, are exertions to relieve pain, either of some torpid, or of some retrograde organ; and in this respect they resemble epileptic convulsions, except that they are seldom so violent as entirely to produce insensibility to external stimuli; for these weaker pains cease before the total exhaustion of sensorial power is produced, and the patient sinks into imperfect syncope; whereas the true epilepsy generally terminates in temporary apoplexy, with perfect insensibility to external objects. These convulsions are less to be dreaded than the epileptic ones, as they do not originate from so permanent a cause.

The great discharge of pale urine in this disease is owing to the inverted motions of the lymphatics, which arise about the neck of the bladder, as described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the inverted motions of the salivary lymphatics.

Hysteria is distinguished from hypochondriasis, as in the latter there are no retrograde motions of the alimentary canal, but simply a debility or inirritability of it, with distention and flatulency. It is distinguished from apepsia and cardialgia by there being nothing ejected from the stomach by the retrograde motions of it, or of the œsophagus.

M. M. Opium. Camphor. Assafœtida. Castor, with sinapisms externally; to which must be added a clyster of cold water, or iced water; which, according to Mons. Pomme, relieves these hysteric symptoms instantaneously like a charm; which it may effect by checking the inverted motions of the intestinal canal by the torpor occasioned by cold; or one end of the intestinal canal may become strengthened, and regain its peristaltic motion by reverse sympathy, when the other end is rendered torpid by ice-water. (Pomme des Affections Vaporeuses, p. 25.) These remove the present symptoms; and bark, steel, exercise, coldish bath, prevent their returns. See Art. VI. 2. 1.

11. Hydrophobia. Dread of water occasioned by the bite of a mad dog, is a violent inversion of the motions of the œsophagus on the contact or even approach of water or other fluids. The pharinx seems to have acquired the sensibility of the larinx in this disease, and is as impatient to reject any fluid, which gets into it. Is not the cardia ventriculi the seat of this disease? As in cardialgia the pain is often felt in the pharinx, when the acid material stimulates the other end of the canal, which terminates in the stomach. As this fatal disease resembles tetanus, or locked jaw, in its tendency to convulsion from a distant wound, and affects some other parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1. 2. 7.

ORDO III.

Retrograde Irritative Motions.

GENUS II.

Of the Absorbent System.

SPECIES.

1. Catarrhus lymphaticus. Lymphatic catarrh. A periodical defluxion of a thin fluid from the nostrils, for a few hours, occasioned by the retrograde motions of their lymphatics; which may probably be supplied with fluid by the increased absorption of some other lymphatic branches in their vicinity. It is distinguished from that mucous discharge, which happens in frosty weather from decreased absorption, because it is less salt to the taste; and from an increased secretion of mucus, because it is neither so viscid, nor is attended with heat of the part. This complaint is liable to recur at diurnal periods, like an intermittent fever, for weeks and months together, with great sneezing and very copious discharge for an hour or two.

I have seen two of these cases, both of which occurred in delicate women, and seemed an appendage to other hysteric symptoms; whence I concluded, that the discharge was occasioned by the inverted motions of the lymphatics of the nostrils, like the pale urine in hysteric cases; and that they might receive this fluid from some other branches of lymphatic vessels opening into the frontal or maxillary cavities in their vicinity.

Could such a discharge be produced by strong errhines, and excite an absorption of the congestion of lymph in the dropsy of the brain?

2. Salivatio lymphatica. Lymphatic salivation. A copious expuition of a pellucid insipid fluid, occasioned by the retrograde motions of the lymphatics of the mouth. It is sometimes periodical, and often attends the hysteric disease, and nervous fevers; but is not accompanied with a saline taste, or with heat of the mouth, or nausea.

3. Nausea humida. Moist nausea consists in a discharge of fluid, owing to the retrograde motions of the lymphatics about the fauces, without increase of heat, or saline taste, together with some retrograde motions of the fauces or pharinx; along with this nausea a sickness generally precedes the act of vomiting; which may consist of a similar discharge of mucus or chyle into the stomach by the retrograde motions of the lymphatics or lacteals, which open into it. See Class I. 2. 4. 3. and I. 2. 4. 4.

M. M. Subacid liquids. Wine. Opium. A blister.

4. Diarrhœa lymphatica. Lymphatic diarrhœa. A quantity of mucus and lymph are poured into the intestines by the inverted motions of the intestinal lymphatics. The feces are less fetid and more liquid; and it sometimes portends the commencement of a diabætes, or dropsy, or their temporary relief. This lymphatic diarrhœa sometimes becomes chronical, in which the atmospheric moisture, absorbed by the cutaneous and pulmonary lymphatics, is poured into the intestines by the retrograde motions of the lacteals. See Section XXIX. 4. 6. where some cases of this kind are related.

5. Diarrhœa chylifera, cœliaca. Chyliferous diarrhœa. The chyle drank up by the lacteals of the upper intestines is poured into the lower ones by the retrograde motions of their lacteals, and appears in the dejections. This circumstance occurs at the beginning of diarrhœa crapulosa, where the patient has taken and digested more aliment than the system can conveniently receive, and thus eliminates a part of it; as appears when there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It differs from the lymphatic diarrhœa, as the chyliferous diabætes differs from the aqueous and mucaginous diabætes.

6. Diabætes. By the retrograde motions of the urinary lymphatics, an immense quantity of fluid is poured into the bladder. It is either termed chyliferous, or aqueous, or mucaginous, from the nature of the fluid brought into the bladder; and is either a temporary disease, as in hysteric women, in the beginning of intoxication, in worm cases, or in those exposed to cold damp air, or to great fear, or anxiety, or in the commencement of some dropsies; or it becomes chronical.

When the urinary lymphatics invert their motions, and pour their refluent contents into the bladder, some other branch of the absorbent system acts with greater energy to supply this fluid. If it is the intestinal branch, the chyliferous diabætes is produced: if it is the cutaneous or pulmonary branch, the aqueous diabætes is produced: and if the cellular or cystic branches, the mucaginous diabætes. In the two last the urine is pellucid, and contains no sugar.

In dropsies the fluid is sometimes absorbed, and poured into the bladder by the retrograde motions of the urinary lymphatics, as during the exhibition of digitalis. In the beginning of the dropsies of infirm gouty patients, I have frequently observed, that they make a large quantity of water for one night, which relieves them for several days. In these cases the patient previously feels a fulness about the precordia, with difficult respiration, and symptoms similar to those of hysteria. Perhaps a previous defect of absorption takes place in some part of the body in those hysteric cases, which are relieved by a copious discharge of pale urine. See Diabætes explained at large, Section XXIX. 4.

A discharge of blood sometimes attends the diabætes, which was occasionally a symptom of that disease in Mr. Brindley, the great navigable canal maker in this country. Which may be accounted for by the communication of a lymphatic branch with the gastric branch of the vena portarum, as discovered by J. F. Meckel. See Section XXVII. 2.

M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium. See Sect. XXIX. 4.

7. Sudor lymphaticus. Profuse sweats from the inverted motions of the cutaneous lymphatics, as in some fainting fits, and at the approach of death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These sweats are glutinous to the touch, and without increased heat of the skin; if the part is not covered, the skin becomes cold from the evaporation of the fluid. These sweats without heat sometimes occur in the act of vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R. Davis, which he cured by frequent application of lime. Though it is possible, that cold sweaty hands may also arise from the want of due absorption of the perspirable matter effused on them, and that the coldness may be owing to the greater evaporation in consequence.

The acid sweats described by Dr. Dobson, which he observed in a diabætic patient, and ascribes to the chyle effused on the skin, must be ascribed to the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6.

8. Sudor asthmaticus. The cold sweats in this disease only cover the head, arms, and breast, and are frequently exceedingly profuse. These sweats are owing to the inverted motions of the cutaneous lymphatics of the upper part of the body, and at the same time the increased absorption of the pulmonary absorbents: hence these sweats when profuse relieve the present fit of asthma. There is no other way to account for sweats appearing on the upper parts of the body only, but by the fluid having been absorbed by the lymphatic branch of the lungs, and effused on the skin by the retrograde movements of the cutaneous lymphatics; which join those of the lungs before they enter into the venous circulation. For if they were occasioned, as generally supposed, by the difficulty of the circulation of the blood through the lungs, the whole skin must be equally affected, both of the upper and lower parts of the body; for whatever could obstruct the circulation in the upper part of the venous system, must equally obstruct it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma these sweats do not occur; hence they may be distinguished; and might be called the hydropic asthma, and the epileptic asthma.

9. Translatio puris. Translation of matter from one part of the system to another can only be explained from its being absorbed by one branch of the lymphatic system, and deposited in a distant part by the retrograde motions of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these translations of matter are attended generally, I believe, with cold fits; for less heat is produced during the retrograde action of this part of the system, as no secretion in the lymphatic glands of the affected branches can exist at the same time. Do any ineffectual retrograde motions occasion the cold fits of agues? The time when the gout of the liver ceases, and the gout in the foot commences, is attended with a cold fit, as I have observed in two instances, which is difficult to explain, without supposing the new vessels, or the matter produced on the inflamed liver, to be absorbed, and either eliminated by some retrograde motion, or carried to the newly inflamed part? See Class IV. 1. 2. 15.

10. Translatio lactis. Translation of milk to the bowels in puerperal fevers can only be explained by the milk being absorbed by the pectoral branch of lymphatics, and carried to the bowels by the retrograde motions of the intestinal lymphatics or lacteals. See many instances of this in Sect. XXIX. 7. 4.

11. Translatio urinæ. Translation of urine. There is a curious case related in the Transaction of the College of Physicians at Philadelphia, Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine for many months; which could not be distinguished from that which was at other times drawn off by the catheter. After having taken much opium, she seems at length to have formed gravel, some of which was frequently brought up by vomiting. Dr. Senter ascribes this to the retrograde motions of the lymphatics of the stomach, and the increased ones of those of the bladder, and refers to those of Sect. XXIX. of this work; which section was first published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine.

The patient above described sometimes had a discharge of urine by the navel, and at other times by the rectum, and sometimes by urinous sweats.

ORDO III.

Retrograde Irritative Motions.

GENUS III.

Of the Sanguiferous System.

SPECIES.

1. Capillarium motus retrogressus. In microscopic experiments it is usual to see globules of blood regurgitate from the capillary vessels again and again, before they pass through them; and not only the mouths of the veins, which arise from these capillaries, are frequently seen by microscopes to regurgitate some particles of blood during the struggles of the animal; but a retrograde motion of the blood in the veins of these animals, from the very heart to the extremities of the limbs, is observable by intervals during the distresses of the dying creature. Haller, Elem. Phys. T. i. p. 216. See Section XXIX. 3. 8.

2. Palpitatio cordis. May not the ineffectual and weak unequal motions of the heart in hysteric cases be ascribed to the retrograde motions of it, which continue for a short time, or terminate in syncope? See Class IV. 3. 1. 6.

3. Anhelatio spasmodica. In some asthmas may not the difficulty of respiration arise from the inverted action of the finer branches of the bronchia, or of the pulmonary artery or vein, like those of the capillaries above described in No. 1. of this genus?

The Orders and Genera of the Second Class of Diseases.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENERA.

ORDO II.

Decreased Sensation.

GENERA.

ORDO III.

Retrograde Sensitive Motions.

GENERA.

The Orders, Genera, and Species, of the Second Class Of Diseases.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENUS I.

With Increased Action of the Muscles.

SPECIES.

GENUS II.

With the Production of new Vessels by internal Membranes or Glands, with Fever.

SPECIES.

GENUS III.

With the Production of new Vessels by external Membranes or Glands, with Fever.

SPECIES.

GENUS IV.

With the Production of new Vessels by internal Membranes or Glands, without Fever.

SPECIES.

GENUS V.

With the Production of new Vessels by external Membranes or Glands, without Fever.

SPECIES.

GENUS VI.

With Fever consequent to the Production of new Vessels or Fluids.

SPECIES.

GENUS VII.

With increased Action of the Organs of Sense.

SPECIES.

ORDO II.

Decreased Sensation.

GENUS I.

With decreased Action of the general System.

SPECIES.

GENUS II.

With decreased Actions of particular Organs.

SPECIES.

ORDO III.

Retrograde Sensitive Motions.

GENUS I.

Of Excretory Ducts.

SPECIES.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENUS I.

With Increased Action of the Muscles.

The actions belonging to this genus are those which are immediately excited by the sensations of pain or pleasure, but which are neither followed by inflammation, nor by convulsion. The former of which belong to the subsequent genera of this order, and the latter to the class of voluntary motions.

The criterion between the actions, which are the immediate consequence of painful sensation, and convulsive actions properly so called, consists in the former having a tendency to dislodge the stimulating cause, which induces the painful sensation; and the latter being exerted for the purpose of expending the sensorial power, and thus dulling or destroying the general sensation of the system. See Class III. 1.

There is a degree of heat produced in the affected part by these sensitive actions without inflammation, but in much less quantity than when attended by inflammation; as in the latter there is a production of new vessels. See Sect. XXXIII. 2. 3.

Some of the species of this genus cannot properly be termed diseases in their natural state, but become so by their defect or excess, and are here inserted to facilitate the explanation of the others.

SPECIES.

1. Deglutitio. Swallowing our food is immediately caused by the pleasureable sensation occasioned by its stimulus on the palate or fauces and is acquired long before the nativity of the animal. Afterwards the pain of hunger previously produces the various voluntary exertions to procure the proper material, but the actions of masticating and of swallowing it are effected by the sensorial power of sensation; which appears by their not being always controulable by the will, as when children in vain attempt to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food stimulates the palate, which is an organ of sense, into so much action, as to produce agreeable sensation; and the muscles subservient to deglutition are brought into action by the sensation thus produced. The pleasureable sensation is the proximate cause; the action of the fibres of the extremities of the nerves of taste is the remote cause; the sensorial power of irritation exciting these fibres of the nerves of taste into increased action is the pre-remote cause; the action of the muscles of deglutition is the proximate effect; the pushing the food into the stomach is the remote effect; and the nutrition of the body is the post-remote effect.

Though the muscles subservient to deglutition have their actions previously associated, so as to be excited into synchronous tribes or successive trains, either by volition, as when we swallow a disagreeable drug; or by sensation, as when we swallow agreeable food; or by irritation, as when we inattentively swallow our saliva; yet do all those three kinds of deglutition belong to the respective classes of volition, sensation, and irritation; because the first links of these tribes or trains of muscular action are excited by those sensorial powers, and the associated links, which accompany or succeed them, are excited by the combined powers either of volition, or of sensation, or of irritation, along with that of association.

2. Respiratio. Respiration is immediately caused by the sensorial power of sensation in consequence of the baneful want of vital air; and not from the accumulation of blood in the lungs, as that might be carried on by inhaling azote alone, without the oxygenous part of the atmosphere. The action of respiration is thus similar to that of swallowing our food to appease the pain of hunger; but the lungs being surrounded with air, their proper pabulum, no intermediate voluntary exertions are required, as in hunger, to obtain and prepare the wanted material.

Respiration is similar to slow combustion; the oxygenous part of the atmosphere is received through the moist membranes, which line the air-cells of the lungs, and uniting with the inflammable part of the blood generates an acid, probably the phosphoric acid; a portion of carbonic acid is likewise produced in this process; as appears by repeatedly breathing over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto I. l. 401. note.

3. Sternutatio. Sneezing consists of muscular actions produced by the sensorial faculty of sensation; and is an effort to dislodge, by means of air forcibly impelled through the nostrils, some material; which stimulates the membrane, which lines them, into too great action, and might thence injure the sense of smell which is diffused on it.

In this operation the too great action of the vessels of the membrane of the nostrils is the remote cause; the sensation thence induced is the proximate cause; and the muscular actions are the proximate effect.

This action of sneezing frequently precedes common respiration in new-born children, but I believe not always; as like the latter it cannot have been previously acquired in the uterus.

It is produced in some people by sudden light, as by looking up at the sky in a morning, when they come out of a gloomy bed-chamber. It then becomes an associate action, and belongs to Class IV. 1. 2. 2.

M. M. When it is exerted to excess it may be cured by snuffing starch up the nostrils. See Class I. 1. 2. 13.

4. Anhelitus. Panting. The quick and laborious breathing of running people, who are not accustomed to violent exercise, is occasioned by the too great conflux of blood to the lungs. As the sanguiferous system, as well as the absorbent system, is furnished in many parts of its course with valves, which in general prevent the retrograde movement of their contained fluids; and as all these vessels, in some part of their course, lie in contact with the muscles, which are brought into action in running, it follows that the blood must be accelerated by the intermitted swelling of the bellies of the muscles moving over them.

The difficulty of breathing, with which, very fat people are immediately affected on exercise, is owing to the pressure of the accumulated fat on the veins, arteries, and lymphatics; and which, by distending the skin, occasions it to act as a tight bandage on the whole surface of the body. Hence when the muscles are excited into quicker action, the progress of the blood in the veins, and of the lymph and chyle in the absorbent system, is urged on with much greater force, as under an artificial bandage on a limb, explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the circulation is instantly quickened to a great degree, and the difficulty of breathing is the consequence of a more rapid circulation through the lungs. The increased secretion of the perspirable matter is another consequence of this rapid circulation; fat people, when at rest, are believed to perspire less than others, which may be gathered from their generally having more liquid stools, more and paler urine, and to their frequently taking less food than many thin people; and lastly, from the perspiration of fat people being generally more inodorous than that of lean ones; but when corpulent people are put in motion, the sweat stands in drops on their skins, and they "lard the ground" as they run. The increase of heat of corpulent people on exercise, is another consequence of their more rapid circulation, and greater secretion. See Class I. 2. 3. 17.

Other causes of difficult or quick respiration will be treated of under Asthma, Pertussis, Peripneumony, Tonsillitis.

5. Tussis ebriorum. Sensitive cough is an exertion of the muscles used in expiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the lungs. As the saline part of the secreted mucus, when the absorption of it is impeded; or the too great viscidity of it, when the absorption is increased; or the too great quantity of the mucus, when the secretion is increased; or the inflammation of the membranes of the lungs; it is an effort to dislodge any of these extraneous materials.

Of this kind is the cough which attends free-drinkers after a debauch; it consists of many short efforts to cough, with a frequent expuition of half a tea-spoonful of frothy mucus, and is attended with considerable thirst. The thirst is occasioned by the previous dissipation of the aqueous parts of the blood by sensible or insensible perspiration; which was produced by the increased action of the cutaneous and pulmonary capillaries during the stimulus of the wine. In consequence of this an increased absorption commences to replace this moisture, and the skin and mouth become dry, and the pulmonary mucus becomes inspissated; which stimulates the bronchia, and is raised into froth by the successive currents of air in evacuating it. This production of froth is called by some free-drinkers "spitting sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid expectoration in some people succeeds the slightest degree of intoxication, of which it may be esteemed a criterion. See Class IV. 2. 1. 8.

As coughs are not always attended with pain, the muscular actions, which produce them, are sometimes excited by the sensorial faculty of irritation, as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic, as Class IV. 2. 1. 7.

M. M. Venesection, when the cough is attended with inflammation. Mucilages. Opium. Torpentia. Blister.

6. Singultus. Hiccough is an exertion of the muscles used in inspiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the cardia ventriculi, or upper orifice of the stomach. As when solid food is too hastily taken without sufficient dilution. And is an effort to dislodge that offensive material, and push it to some less sensible part of the stomach, or into the middle of the contained aliment.

At the end of fatal fevers it may arise from the acrimony of the undigested aliment, or from a part of the stomach being already dead, and by its weight or coldness affecting the surviving part with disagreeable sensation. The pain about the upper orifice of the stomach is the proximate cause, the too great or too little action of the fibres of this part of the stomach is the remote cause, the action of the muscles used in inspiration is the proximate effect, and the repercussion of the offending material is the remote effect.

Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of epilepsy or reverie, as in Sect. XIX. 2.

M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar, or on chalk. Opium. Blister. Emetic.

7. Asthma humorale. The humoral asthma probably consists in a temporary anasarca of the lungs, which may be owing to a temporary defect of lymphatic absorption. Its cause is nevertheless at present very obscure, since a temporary deficiency of venous absorption, at the extremities of the pulmonary or bronchial veins, might occasion a similar difficulty of respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that the lymph effused into the cavity of the chest might, by some additional heat during sleep, acquire an aerial form, and thus compress the lungs; and on this circumstance the relief, which these patients receive from cold air, would be readily accounted for.

The paroxysms attack the patient in his first sleep, when the circulation through the lungs in weak people wants the assistance of the voluntary power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less able to fulfil the whole of their duty. And part of the thin mucus, which is secreted into the air-cells, remains there unabsorbed, and occasions the difficult respiration, which awakes the patient. And the violent exertions of the muscles of respiration, which succeed, are excited by the pain of suffocation, for the purpose of pushing forwards the blood through the compressed capillaries, and to promote the absorption of the effused lymph.

In this the humoral differs from the convulsive asthma, treated of in Class III. 1. 1. 10. as in that there is probably no accumulated fluid to be absorbed; and the violent respiration is only an exertion for the purpose of relieving pain, either in the lungs or in some distant part, as in other convulsions, or epilepsy; and in this respect the fits of humoral and convulsive asthma essentially differ from each other, contrary to the opinion expressed without sufficient consideration in Sect. XVIII. 15.

The patients in the paroxysms both of humoral and convulsive asthma find relief from cold air, as they generally rise out of bed, and open the window, and put out their heads; for the lungs are not sensible to cold, and the sense of suffocation is somewhat relieved by there being more oxygen contained in a given quantity of cold fresh air, than in the warm confined air of a close bed-chamber.

I have seen humoral asthma terminate in confirmed anasarca, and destroy the patient, who had been an excessive drinker of spirituous potation. And M. Savage asserts, that this disease frequently terminates in diabetes; which seems to shew, that it is a temporary dropsy relieved by a great flow of urine. Add to this, that these paroxysms of the asthma are themselves relieved by profuse sweats of the upper parts of the body, as explained in Class I. 3. 2. 8. which would countenance the idea of their being occasioned by congestions of lymph in the lungs.

The congestion of lymph in the lungs from the defective absorption of it is probably the remote cause of humoral asthma; but the pain of suffocation is the immediate cause of the violent exertions in the paroxysms. And whether this congestion of lymph in the air-cells of the lungs increases during our sleep, as above suggested, or not; the pain of suffocation will be more and more distressing after some hours of sleep, as the sensibility to internal stimuli increases during that time, as described in Sect. XVIII. 15. For the same reason many epileptic fits, and paroxysms of the gout, occur during sleep.

In two gouty cases, complicated with jaundice, and pain, and sickness, the patients had each of them a shivering fit, like the commencement of an ague, to the great alarm of their friends; both which commenced in the night, I suppose during their sleep; and the consequence was a cessation of the jaundice, and pain about the stomach, and sickness; and instead of that the gout appeared in their extremities. In these cases I conjecture, that there was a metastasis not only of the diseased action from the membranes of the liver to those of the foot; but that some of the new vessels, or new fluids, which were previously produced in the inflamed liver, were translated to the feet during the cold fit, by the increased absorption of the hepatic lymphatics, and by the retrograde motions of those of the affected limbs.

This I think resembles in some respects a fit of humoral asthma, where stronger motions of the absorbent vessels of the lungs are excited, and retrograde ones of the correspondent cutaneous lymphatics; whence the violent sweats of the upper parts of the body only are produced; and for a time the patient becomes relieved by the metastasis and elimination of the offending material by sensitive exertion. For a further account of this intricate subject see Class III. 1. 1. 10.

M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed with water, with 10 drops of laudanum, to be repeated three or four times. Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a grain of opium at night, and two or three of aloes. A flannel shirt in winter, but not in summer. Issues. Digitalis?

In this species of asthma, there is great reason to believe, that the respiration of an atmosphere, with an increased proportion of oxygen, will prove of great advantage; some well-observed and well-attested cases of which are published by Dr. Beddoes; as this purer air invigorates the circulation, and the whole system in consequence, perhaps not only by its stimulus, but by its supplying the material from which the sensorial power is extracted or fabricated. In spasmodic asthma, on the contrary, Dr. Ferriar has found undoubted benefit from an atmosphere mixed with hydrogen. See Sect. XVIII. 15. and Class III. 1. 1. 10.

8. Nictitatio sensitiva. Winking of the eyes is performed every minute, without our attention, for the purpose of diffusing the tears over them, which are poured into the eye a little above the external corner of it, and which are afterwards absorbed by the lacrymal points above and below the internal corner of it. When this operation is performed without our attention, it is caused by the faculty of irritation, and belongs to Class I. 1. 4. 1. but when it is produced by a stronger stimulus of any extraneous material in the eye, so as to cause pain, the violent and frequent nictitation is caused by the faculty of sensation.

This disease is sometimes produced by the introversion of the edge of the lower eyelid, which bends the points of the hairs of the eyelash upon the ball of the eye, which perpetually stimulate it into painful sensation. This introversion of the eyelid is generally owing to a tumor of the cellular membrane below the edge of the eyelid, and though a very troublesome complaint may often be cured by the following simple means. A little common plaster spread on thin linen, about a quarter of an inch long, must be rolled up so as to be about the size of a crow-quill, this must be applied immediately below the eyelash on the outside of the eye; and must be kept on by another plaster over it. This will then act as a slight compression on the tumor under the eyelash, and will prevent the hairs from touching the eye-ball. In a week or two the compression will diminish the tumor it lies over, and cure this painful deformity.

9. Oscitatio et pandiculatio. Yawning and stretching of the limbs is produced either by a long inactivity of the muscles now brought into action, as sometimes happens after sleep, or after listening a long time to a dull narrative; or it is produced by a too long continued action of the antagonist muscles. In the former case there is an accumulation of sensorial power during the quiescence of the muscles now brought into action; which probably constitutes the pain or wearisomeness of a continued attitude. In the latter case there is an exhaustion of sensorial power in the muscles, which have lately been acting violently, and a consequent accumulation in the muscles, which are antagonists to them, and which were at rest.

These involuntary motions are often seen in paralytic limbs, which are at the same time completely disobedient to the will; and are frequently observable in very young children; and from thence we may conclude, that these motions are learnt before nativity; as puppies are seen to open their mouths before the membranes are broken. See Sect. XVI. 2.

Where these motions are observed in limbs otherwise paralytic, it is an indication that electric shocks may be employed with advantage, as the excitability of the limb by irritation is not extinct, though it be disobedient both to volition and sensation.

10. Tenesmus consists in violent and frequent ineffectual efforts to discharge the contents of the rectum, owing to pain of the sphincter. The pain is produced by indurated feces, or by some acrid material, as the acidity of indigested aliment; and the efforts are attended with mucus from the pained membrane. The feces must sometimes be taken away by the end of a marrow-spoon, as cathartics and even clyster will pass without removing them. It is sometimes caused by sympathy with the urethra, when there is a stone at the neck of the bladder. See Class II. 2. 2. 7. and IV. 1. 2. 8.

M. M. Fomentation, an enema with mucilage and laudanum.

The common exclusion of the feces from the rectum is a process similar to this, except that the muscles of the sphincter ani, and those of the abdomen, which act along with them by the combined powers of sensation and association, are in tenesmus excited by painful sensation, and in the latter by a sensation, which may in some instances be almost called pleasurable, as relieving us from a painful one in the exclusion of the feces.

11. Stranguria. Strangury consists in painful efforts to discharge the contents of the urinary bladder. It is generally owing to a stone in the sphincter of the bladder; or to the inflammation of the neck of it occasioned by cantharides. It is sometimes caused by sympathy with the piles; and then is liable in women to occasion convulsions, from the violence of the pain without inflammation. See Class IV. 2. 2. 2. and 3.

M. M. Fomentation clyster with oil and laudanum, push the stone back with a bougie; if from cantharides give half a pint of warm water every ten minutes. Mucilage of gum arabic and tragacanth.

The natural evacuation of the urine is a process similar to this, except that the muscular fibres of the bladder, and the muscles of the abdomen, which act in concert with them by the combined powers of sensation and of association, are, in the former case of strangury, excited into action by painful sensation; and in the latter by a sensation, which may almost be termed pleasurable, as it relieves us from a previous uneasy one.

The ejectio feminis is another process in some respects similar to strangury, as belonging to the same sensible canal of the urethra, and by exciting into action the accelerator muscles; but in the strangury these muscles are excited into action by painful sensation, and in the ejection of the semen by pleasureable sensation.

12. Parturitio. Parturition is not a disease, it is a natural process, but is more frequently unfortunate in high life than amongst the middle class of females; which may be owing partly to fear, with which the priests of Lucina are liable to inspire the ladies of fashion to induce them to lie in in town; and partly to the bad air of London, to which they purposely resort.

There are however other causes, which render parturition more dangerous to the ladies of high life; such as their greater general debility from neglect of energetic exercise, their inexperience of the variations of cold and heat, and their seclusion from fresh air. To which must be added, that great source of the destruction of female grace and beauty, as well as of female health, the tight stays, and other bandages, with which they are generally tortured in their early years by the active folly of their friends, which by displacing many of the viscera impedes their actions, and by compressing them together produces adhesions of one part to another, and affects even the form and aperture of the bones of the pelvis, through which the nascent child must be protruded.

As parturition is a natural, not a morbid process, no medicine should be given, where there is no appearance of disease. The absurd custom of giving a powerful opiate without indication to all women, as soon as they are delivered, is, I make no doubt, frequently attended with injurious, and sometimes with fatal consequences. See Class II. 1. 2. 16.

Another thing very injurious to the child, is the tying and cutting the navel-string too soon; which should always be left till the child has not only repeatedly breathed, but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be; a part of the blood being left in the placenta, which ought to have been in the child; and at the same time the placenta does not so naturally collapse, and withdraw itself from the sides of the uterus, and is not therefore removed with so much safety and certainty. The folly of giving rue or rhubarb to new-born children, and the danger of feeding them with gruel instead of milk, is spoken of in Class I. 1. 2. 5. and II. 1. 2. 16.

ORDO I.

Increased Sensation.

GENUS II.

With the Production of new Vessels by internal Membranes or Glands, with Fever.

In the first class of diseases two kinds of fevers were described, one from excess, and the other from defect of irritation; and were in consequence termed irritative, and inirritative fevers. In this second class of diseases another kind of fever occurs, which is caused by excess of sensation, and termed in consequence Sensitive Fever. But there is no fever from defect of sensation, because the circulation is carried on in health without our consciousness, that is, without any sensation attending it.

But as excess of sensation may exist with excess or defect of irritation, two other kinds of fever arise from a combination of sensitive fever with the irritative, and inirritative ones. Making five kinds in all.

1. Irritative fever, described in Class I. 1. 1. 1.

2. Inirritative fever. Class I. 2. 1. 1.

3. Sensitive fever. Class II. 1. 6. 1.

4. Sensitive irritated fever. Class II. 1. 2. 1.

5. Sensitive inirritated fever. Class II. 1. 3. 1.

As the sensitive irritated fever attends all the diseases enumerated under the genus about to be described, it is placed at the head of it. And as the sensitive inirritated fever accompanies the greatest number of the species enumerated under the third genus of this order, it is placed at the head of them. And as the sensitive fever attends the diseases of the sixth genus, it is placed at the head of them. But as every febrile paroxysm consists of disordered tribes or trains of associated motions, it may be doubted, whether they ought not all to have been placed in the fourth class, amongst the diseases of association. See Class IV. 2. 4. 11.

All the subsequent species of this genus are attended with sensitive irritated fever; there are nevertheless some superficial inflammations, which affect the same situations without much fever, as the scrophulous ophthalmy and spurious peripneumony, which belong to other genera.

Inflammation is uniformly attended with the production or secretion of new fibres constituting new vessels; this therefore may be esteemed its essential character, or the criterion of its existence. The extension of the old vessels seems rather a consequence than a cause of the germination, or pullulation, of these new ones; for the old vessels may be enlarged, and excited with unusual energy, without any production of new ones, as in the blush of shame or of anger.

When these new vessels are formed, if they are not reabsorbed into the circulation, they secrete a new fluid called purulent matter; which generally opens itself a passage on the external skin, and produces an ulcer, which either gradually heals, or spreads, and is the cause of hectic fever; or they secrete contagious matter, which has the property of exciting the same kind of inflammation, and of producing the same kind of contagious matter, when inserted by inoculation into the skin of other persons. These contagious matters form ulcers, which either heal spontaneously, or by art; or continue to spread, and destroy the patient, by other kinds of hectic fever.

In this genus there is an increase of the sensorial power of irritation as well as of sensation; whence great arterial energy is produced, and the pulse becomes strong and full, as well as quick; and the coats of the arteries feel hard under the finger, being themselves thickened and distended by inflammation. The blood drawn, especially at the second bleeding, is covered with a tough size; which is probably the mucus from the inflamed internal surface of the arteries, increased in quantity, and more coagulable than in its natural state; the thinner part being more perfectly absorbed by the increased action of the inflamed absorbents. See Sect. XXXIII. 2. 2. This is rendered more probable, because the hard feel of the pulse, and the abundance of coagulable lymph commence, exist, and cease together.

Great heat is produced from the new chemical combinations arising in the secretion of new fibres, and great pain from the distention of old ones, or from their increased action. The increased quantity of sensation from a topical inflammation or phlegmon is the immediate cause of the febris sensitiva irritata, or inflammatory fever; as when it arises from the pain of pleurisy, or paronychia; but generally an irritative fever precedes this topical inflammation, which occurs during the hot fit of it; and then the irritative fever is changed into a sensitive irritated fever, by the additional cause of the sensorial power of sensation besides that of irritation.

SPECIES.

1. Febris sensitiva irritata. Sensitive irritated fever, or inflammatory fever. Phlegmasia. A strong full pulse, with inflammation of the coats of the arteries, constitutes this disease. It originates from some topical inflammation, which, if the fever is not subdued, terminates in suppuration; and differs from irritative fever in respect to the painful sensation which accompanies it. For as pleasurable sensation is the cause of the growth of the new vessels, and distention of the old ones, in the natural enlargement of the body during our infancy; so a painful sensation is the cause of the unnatural production of new vessels, and enlargement of old ones in inflammatory diseases.

When matter is thus formed in any internal viscus, or in the cellular membrane, as in the lungs or liver; so long as this abscess remains without admission of air, this inflammatory fever is liable to continue, receiving only temporary relief by bleeding or emetics, or cathartics; till the patient, after a month, or two, or three, expires. But, if air be admitted to these internal abscesses, this kind of fever is changed into a hectic fever in a single day. It also sometimes happens, that when the abscess remains unopened to the air, if the matter has become putrid, that hectic fever supervenes, with colliquative sweats, or diarrhœa; the matter in both cases is sometimes absorbed, and the sides of the abscess grow together again without an external aperture. See Class II. 1. 4. 1. and 2. Another termination of inflammation is in gangrene, but this belongs to the inflammation of the external skin; as the production of purulent matter belongs to inflammation of the internal or mucous membranes. Thus when the external skin is the seat of inflammation, as in erythema, or erysipelas, and produces sensitive irritated fever, no collection of purulent matter can be formed; but a material oozes out, and lies upon the surface, like that in the confluent small-pox, and the cuticle at length peels off, or gangrene supervenes. It must be noted, that these kinds of inflammation can exist together; and some parts of the cellular membrane may suppurate at the same time that the external skin is affected with erythema, or erysipelas.

M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath? See Sect. XII. 6.

The increased arterial action in this sensitive irritated fever is not simply owing to the increased irritability of the arterial system, or to the stimulus of the distention of the vessels, but also to the increased acrimony or pungency of the blood; which has now so far changed its nature as to become more fluid, more dense, and to be loaded with coagulable lymph. Hence it becomes necessary not only to lessen the quantity of blood by venesection and by cathartics, but also to dilute its acrimony, or pungency, by the introduction of aqueous and mucilaginous fluids, such as barley water, cream and water, sugar and water, weak broths; to which may be added so much of some vegetable essential oil, as may render them grateful to the stomach, and thus promote their absorption, as by infusing parsley or cellery and turneps in the broth; or by balm, mint, or sage teas.

The following species of this genus only distinguish the situation of the part previously inflamed, and which is the remote cause of the sensitive irritated, or inflammatory fever, which attends it.

2. Ophthalmia interna. Inflammation of the eye is attended with the production of new vessels, which spread over the tunica adjunctiva, and over the cornea; these new vessels are easily seen, as they lie on a white ground, and give ocular demonstration of their production in inflammation. When this inflammation of the cornea suppurates, it is liable to leave little ulcers, which may be seen beneath the surface in the form of little excavations; and as these heal, they are liable to be covered with an opake scar. This scar, in some months or years, is liable to wear away, and become transparent, without the assistance of any polishing powder, as of very finely levigated glass, as some have recommended. But when the cornea is affected through all its thickness, the return of its transparency becomes hopeless. See Class I. 1. 3. 14.

In violent degrees of ophthalmy the internal parts, as the retina, optic artery, iris, ciliary process, become inflamed, as well as the external ones; hence the least light admitted to the eye occasions intolerable pain. This curious circumstance cannot be owing to the action of light on the inflamed vessels of the cornea; it therefore shews, that the extremity of the optic nerve or retina is also rendered more exquisitely sensible to light, by partaking of the inflammation; and I have been told, that red colours are in these cases sometimes painfully perceived even in perfect darkness. This shews that the retina is excited into motion by the stimulus of light; and that, when it is inflamed, these motions give great pain, like those of other inflamed parts, as the muscles, or membranes. And secondly, that the ideas of colours consist in the motions of the retina; which ideas occasion pain, when the extremity of the moving nerve is inflamed.

M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the eye with cold water by means of a rag. Cool airy room. Darkness. When the inflammation begins to decline, white vitriol gr. vi. in an ounce of water is more efficacious to moisten the eye than solutions of lead. Tincture of opium diluted. New vessels from the inflamed tunica adnata frequently spread like a fly's wing upon the transparent cornea, which is then called Pterigium. To stop the growth of this, the principal vessels should be cut through with a lancet. When the inflammation begins to decline, after due evacuation any stimulating material put into the eye increases the absorption, which soon removes the new red vessels; which has given rise to a hundred famous eye-waters, and eye-doctors; if these stimulating materials are used too soon, the inflammation is increased by them. See Sect. XXXII. 2. 10.

There is another ophthalmia, which attends weak children, and is generally esteemed a symptom of scrophula, as described in Class II. 1. 4. 1. and another, which is of venereal origin, mentioned in Class II. 1. 5. 2. both which may be termed ophthalmia superficialis.

3. Phrenitis. Inflammation of the brain is attended with intolerance of light and sound; which shews, that the extremities of the nerves of those senses are at the same time inflamed; it is also attended with great pain of the head, with watchfulness, and furious delirium. The violent efforts, these patients are said sometimes to exert, are owing to the increased secretion of sensorial power in the brain; as all other inflamed glands have a greater circulation of blood passing through them, and a greater secretion in consequence of their peculiar fluids, as in the hepatitis much more bile is generated.

M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water for hours together. Or with warm water. Cool airy room. Afterwards cupping on the occiput. Leeches to the temples. When the patient is weakened a blister on the head, and after further exhaustion five or six drops of tincture of opium.

4. Peripneumonia. Inflammation of the lungs. The pulse is not always hard, sometimes soft; which is probably owing to a degree of sickness or inaction of the stomach; with dull pain of the chest; respiration constantly difficult, sometimes with erect posture; the face bloated and purplish; cough generally with moist expectoration, often stained with blood.

When the difficulty of respiration is very great, the patient is not able to cough; in this situation, after copious bleeding, the cough is liable to return, and is so far a favourable symptom, as it shews some abatement of the inflammation.

A peripneumony frequently occurs in the chin-cough, and destroys the patient, except immediate recourse be had to the lancet, or to four or five leeches; when blood cannot be otherwise taken.

The peripneumony is very fatal to young children, especially as I believe it is frequently mistaken for a spasmodic asthma, or for the croup, or cynanche trachealis of Cullen. Both which, however, when they occur, require immediate venesection by the lancet or by leeches, as well as the peripneumony.

The croup is an inflammation of the upper part, and the peripneumony of the lower part of the same organ, viz. the trachea or windpipe. See Class I. 1. 3. 4. But as the inflammation is seldom I suppose confined to the upper part of the trachea only, but exists at the same time in other parts of the lungs, and as no inflammation of the tonsils is generally perceptible, the uncouth name of cynanche trachealis should be changed for peripneumonia trachialis. The method of cure consists in immediate and repeated bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in subtepid water, and in breathing over the steam of warm water, with or without a little vinegar in it. And lastly, by keeping the child raised high in bed.

Inflammation of the lungs is also liable to occur in the measles, and must be attacked by venesection at any time of the disease; otherwise either a present death, or an incurable consumption, is the consequence.

The peripneumony is frequently combined with inflammation of the pleura, and sometimes with that of the diaphragm; either of these may generally be distinguished, not only by the pain which attends inflammation of these membranes, but by inspecting the naked chest, and observing whether the patient breathes more by elevating the ribs, or by depressing the diaphragm.

A crisis happens in children about the sixth day with much pale urine, which must be waited for after evacuations have been used, as far as can be done with safety; in this situation the warm bath twice a day, and small blisters repeatedly in succession, are of peculiar service.

After the termination of peripneumony a collection of coagulable lymph is frequently left in the cavity of the chest unabsorbed; or a common anasarca of the lungs occurs from the present inaction of the absorbent vessels, which had previously been excited too violently. This difficulty of breathing is cured or relieved by the exhibition of digitalis. See Art. IV. 2. 8.

M. M. The lancet is the anchor of hope in this disease; which must be repeated four or five times, or as often as the fever and difficulty of breathing increase, which is generally in the evening; antimonials, diluents, repeated small blisters about the chest, mucilage, pediluvium, warm bath. Is a decoction of seneka-root of use? Do not neutral salts increase the tendency to cough by their stimulus, as they increase the heat of urine in gonorrhœa? Children in every kind of difficult breathing, from whatever cause, should be kept as upright in bed as may be, and continually watched; since, if they slip down, they are liable to be immediately suffocated. After the patient is greatly debilitated, so that no further evacuation can be admitted, and the difficult breathing and cough continue, I have given four or five drops of tincture of opium, that is, about a quarter of a grain of solid opium, with great advantage, and I believe in several cases I have saved the patient. A greater quantity of opium in this state of debility cannot be used without hazarding the life of the person. This small quantity of an opiate should be given about six in the evening, or before the access of the evening paroxysm, and repeated three or four nights, or longer.

There is a peripneumony with weak pulse, which may be termed peripneumonia inirritata, as described in Sect. XXVII. 2. which belongs to this place. See also Superficial Peripneumony, Class II. 1. 3. 7.

5. Pleuritis. Pleurisy. Inflammation of the pleura, with hard pulse, pain chiefly of the side, pungent, particularly increased during inspiration; lying on either side uneasy, the cough very painful, dry at the beginning, afterwards moist, often bloody.

One cause of pleurisy is probably a previous adhesion of the lungs to a part of the pleura, which envelops them. This in many cases has been produced in infancy, by suffering children to lie too long on one side. Or by placing them uniformly on one side of a fire, or window, to which they will be liable always to bend themselves.

When matter is produced during peripneumony or pleurisy in one side of the chest, so long as it is a concealed vomica, the fever continues, if the disease be great, for many weeks, and even months; and requires occasional venesection, till the patient sinks under the inflammatory or sensitive irritated fever. But if air be admitted, by a part of the abscess opening itself a way into the air-vessels of the lungs, a hectic fever, with colliquitive sweats or diarrhœa, supervenes, and frequently destroys the patient; or the abscess heals the lungs adhering to the pleura.

M. M. The lancet must be used copiously, and repeated as often as the pain and difficult respiration increase. A blister on the pained part. Antimonial preparations. Diluents. Cool air. Do neutral salts increase the tendency to cough? Pediluvium or semicupium frequently repeated.

6. Diaphragmitis. Inflammation of the diaphragm. Pain round the lower ribs as if girt with a cord. Difficult respiration performed only by elevating the ribs and in an erect posture. The corners of the mouth frequently retracted into a disagreeable smile, called risus Sardonicus.

Those animals, which are furnished with clavicles, or collar-bones, not only use their foremost feet as hands, as men, monkies, cats, mice, squirrels, &c. but elevate their ribs in respiration as well as depress the diaphragm for the purpose of enlarging the cavity of the chest. Hence an inflammation of the diaphragm is sudden death to those animals, as horses and dogs, which can only breaths by depressing the diaphragm; and is I suppose the cause of the sudden death of horses that are over-worked; whereas, in the human animal, when the diaphragm is inflamed, so as to render its motions impossible from the pain they occasion, respiration can be carried on, though in a less perfect manner, by the intercostal muscles in the elevation of the ribs. In pleurisy the ribs are kept motionless, and the respiration is performed by the diaphragm, as may be readily seen on inspecting the naked chest, and which is generally a bad symptom; in the diaphragmitis the ribs are alternately elevated, and depressed, but the lower part of the belly is not seen to move.

M. M. As in pleurisy and peripneumony. When the patient becomes delirious, and smiles disagreeably by intervals, and is become so weak, that evacuations by the lancet could be used no further, and I have almost despaired of my patient, I have found in two or three instances, that about five or six drops of tinct. thebaic, given an hour before the evening exacerbation, has had the happiest effect, and cured the patient in this case, as well as in common peripneumony; it must be repeated two or three evenings, see Class II. 1. 2. 4. as the exacerbation of the fever and difficult respiration and delirium generally increase towards night.

The stimulus of this small quantity of opium on a patient previously so much debilitated, acts by increasing the exertion of the absorbent vessels, in the same manner as a solution of opium, or any other stimulant, put on an inflamed eye after the vessels are previously emptied by evacuations, stimulates the absorbent system, so as to cause the remaining new vessels to be immediately reabsorbed. Which same stimulants would have increased the inflammation, if they had been applied before the evacuations. See Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full of blood, the absorbents cannot act so powerfully, as the progress of their contents is opposed by the previous fulness of the blood-vessels; whence stimulants in that case increase the action of the secerning system more than of the absorbent one; but after copious evacuation this resistance to the progress of the absorbed fluids is removed; and when stimulants are then applied, they increase the action of the absorbent system more than that of the secerning one. Hence opium given in the commencement of inflammatory diseases destroys the patient; and cures them, if given in very small doses at the end of inflammatory diseases.

7. Carditis. Inflammation of the heart is attended with unequal intermitting pulse, palpitation, pain in the middle of the sternum, and constant vomiting. It cannot certainly be distinguished from peripneumony, and is perhaps always combined with it.

8. Peritonitis. Inflammation of the peritonæum is known by pain all over the abdomen, which is increased on erecting the body. It has probably most frequently a rheumatic origin. See Class II. 1. 2. 17.

9. Mesenteritis. Inflammation of the mesentery is attended with pains like colic, and with curdled or chyle-like stools. It is a very frequent and dangerous disease, as the production of matter more readily takes place in it than in any other viscus. The consequence of which, after a hard labour, is probably the puerperal fever, and in scrophulous habits a fatal purulent fever, or hopeless consumption.

M. M. Venesection. Warm bath. Emollient clysters.

10. Gastritis. In inflammation of the stomach the pulse is generally soft, probably occasioned by the sickness which attends it. The pain and heat of the stomach is increased by whatever is swallowed, with immediate rejection of it. Hiccough.

This disease may be occasioned by acrid or indigestible matters taken into the stomach, which may chemically or mechanically injure its interior coat. There is however a slighter species of inflammation of this viscus, and perhaps of all others, which is unattended by much fever; and which is sometimes induced by drinking cold water, or eating cold insipid food, as raw turnips, when the person has been much heated and fatigued by exercise. For when the sensorial power has been diminished by great exertion, and the stomach has become less irritable by having been previously stimulated by much heat, it sooner becomes quiescent by the application of cold. In consequence of this slight inflammation of the stomach an eruption of the face frequently ensues by the sensitive association of this viscus with the skin, which is called a surfeit. See Class IV. 1. 2. 13. and II. 1. 4. 6. and II. 1. 3. 19.

M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See Class II. 1. 3. 17.

11. Enteritis. Inflammation of the bowels is often attended with soft pulse, probably owing to the concomitant sickness; which prevents sometimes the early use of the lancet, to the destruction of the patient. At other times it is attended with strong and full pulse like other inflammations of internal membranes. Can the seat of the disease being higher or lower in the intestinal canal, that is, above or below the valve of the colon, produce this difference of pulse by the greater sympathy of one part of the bowels with the stomach than another? In enteritis with strong pulse the pain is great about the navel, with vomiting, and the greatest difficulty in procuring a stool. In the other, the pain and fever is less, without vomiting, and with diarrhœa. Whence it appears, that the enteritis with hard quick pulse differs from Ileus, described in Class I. 3. 1. 6. only in the existence of fever in the former and not the latter, the other symptoms generally corresponding; and, secondly, that the enteritis with softer quick pulse, differs from the cholera described in Class I. 3. 1. 5. only in the existence of fever in the former, and not the latter, the other symptoms being in general similar. See Class II. 1. 3. 20.

Inflammation of the bowels sometimes is owing to extraneous indigestible substances, as plum-stones, especially of the damasin, which has sharp ends. Sometimes to an introsusception of one part of the intestine into another, and very frequently to a strangulated hernia or rupture. In respect to the first, I knew an instance where a damasin stone, after a long period of time, found its way out of the body near the groin. I knew another child, who vomited some damasin stones, which had lain for near twenty hours, and given great pain about the navel, by the exhibition of an emetic given in repeated doses for about an hour. The swallowing of plum-stones in large quantities, and even of cherry-stones, is annually fatal to many children. In respect to the introsusception and hernia, see Ileus, Class I. 3. 1. 6.

M. M. Repeated venesection. Calomel from ten to twenty grains given in small pills as in Ileus; these means used early in the disease generally succeed. After these evacuations a blister contributes to stop the vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will frequently stay in the stomach. Glauber's salt dissolved in pepper-mint water given by repeated spoonfuls.

When the patient is much reduced, opium in very small doses may be given, as a quarter of a grain, as recommended in pleurisy. If the pain suddenly ceases, and the patient continues to vomit up whatever is given him, it is generally fatal; as it indicates, that a mortification of the bowel is already formed. Some authors have advised to join cathartic medicines with an opiate in inflammation of the bowels, as recommended in colica saturnina. This may succeed in slighter cases, but is a dangerous practice in general; since, if the obstruction be not removed by the evacuation, the stimulus of the opium is liable to increase the action of the vessels, and produce mortification of the bowel, as I think I have seen more than once.

12. Hepatitis. Inflammation of the liver is attended with strong quick pulse; tension and pain of the right side; often pungent as in pleurisy, oftner dull. A pain is said to affect the clavicle, and top of the right shoulder; with difficulty in lying on the left side; difficult respiration; dry cough; vomiting; hiccough.

There is another hepatitis mentioned by authors, in which the fever, and other symptoms, are wanting, or are less violent; as described in Class II. 1. 4. 12. and which is probably sometimes relieved by eruptions of the face; as in those who are habituated to the intemperate use of fermented liquors.

M. M. Hepatic inflammation is very liable to terminate in suppuration, and the patient is destroyed by the continuance of a fever with sizy blood, but without night-sweats, or diarrhœa, as in other unopened abscesses. Whence copious and repeated venesection is required early in the disease, with repeated doses of calomel, and cathartics. Warm bath. Towards the end of the disease small doses of opium before the evening paroxysms, and lastly the Peruvian bark, and chalybeate wine, at first in small doses, as 20 drops twice a day, and afterwards, if necessary, in larger. See Art. IV. 2. 6.

Mrs. C. a lady in the last month of her pregnancy, was seized with violent hepatitis, with symptoms both of peripneumony and of pleurisy, for it seldom happens in violent inflammations, that one viscus alone is affected; she wanted then about a fortnight of her delivery, and after frequent venesection, with gentle cathartics, with fomentation or warm bath, she recovered and was safely delivered, and both herself and child did well. Rheumatic and eruptive fevers are more liable to induce abortion.

13. Splenitis. Inflammation of the spleen commences with tension, heat, and tumour of the left side, and with pain, which is increased by pressure. A case is described in Class I. 2. 3. 18. where a tumid spleen, attended with fever, terminated in schirrus of that viscus.

14. Nephritis. Inflammation of the kidney seems to be of two kinds; each of them attended with different symptoms, and different modes of termination. One of them I suppose to be an inflammation of the external membrane of the kidney, arising from general causes of inflammation, and accompanied with pain in the loins without vomiting; and the other to consist in an inflammation of the interior parts of the kidney, occasioned by the stimulus of gravel in the pelvis of it, which is attended with perpetual vomiting, with pain along the course of the ureter, and retraction of the testis on that side, or numbness of the thigh.

The former of these kinds of nephritis is distinguished from lumbago by its situation being more exactly on the region of the kidney, and by its not being extended beyond that part; after three or four days I believe this inflammation is liable to change place; and that a herpes or erysipelas, called zona, or shingles, breaks out about the loins in its stead; at other times it is cured by a cathartic with calomel, with or without previous venesection.

The other kind of nephritis, or inflammation of the interior part of the kidney, generally arises from the pain occasioned by the stimulus of a stone entering the ureter from the pelvis of the kidney; and, which ceases when the stone is protruded forwards into the bladder; or when it is returned into the pelvis of the kidney by the retrograde action of the ureter. The kidney is nevertheless inflamed more frequently, though in a less degree, from other causes; especially from the intemperate ingurgitation of ale, or other fermented or spirituous liquors. This less degree of inflammation is the cause of gravel, as that before mentioned is the effect of it. The mucus secreted to lubricate the internal surface of the uriniferous tubes of the kidney becomes secreted in greater quantity, when these vessels are inflamed; and, as the correspondent absorbent vessels act more energetically at the same time, the absorption of its more fluid parts is more powerfully effected; on both these accounts the mucus becomes both changed in quality and more indurated. And in this manner stones are produced on almost every mucous membrane of the body; as in the lungs, bowels, and even in the pericordium, as some writers have affirmed. See Class I. 1. 3. 9.

M. M. Venesection. Ten grains of calomel given in small pills, then infusion of sena with oil. Warm bath. Then opium a grain and half. See Class I. 1. 3. 9. for a further account of the method of cure.

15. Cystitis. Inflammation of the bladder is attended with tumor and pain of the lower part of the belly; with difficult and painful micturition; and tenesmus. It generally is produced by the existence of a large stone in the bladder, when in a great degree; or is produced by common causes, when in a slighter degree.

The stone in the bladder is generally formed in the kidney, and passing down the ureter into the bladder becomes there gradually increased in size; and this most frequently by the apposition of concentric spheres, as may be seen by sawing some of the harder calculi through the middle, and polishing one surface. These new concretions superinduced on the nucleus, which descended from the kidney, as described in Class I. 1. 3. 9. and in the preceding article of this genus, is not owing to the microcosmic salt, which is often seen to adhere to the sides of chamber-pots, as this is soluble in warm water, but to the mucus of the bladder, as it rolls along the internal surface of it. Now when the bladder is slightly inflamed, this mucus of its internal surface is secreted in greater quantity, and is more indurated by the absorption of its more liquid part at the instant of secretion, as explained in Class I. 1. 3. 9. and II. 1. 2. 14. and thus the stimulus and pain of a stone in the bladder contributes to its enlargement by inflaming the interior coat of it.

M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See Class I. 1. 3. 9.

16. Hysteritis. Inflammation of the womb is accompanied with heat, tension, tumor, and pain of the lower belly. The os uteri painful to the touch. Vomiting. This disease is generally produced by improper management in the delivery of pregnant women. I knew an unfortunate case, where the placenta was left till the next day; and then an unskilful accoucheur introduced his hand, and forcibly tore it away; the consequence was a most violent inflammatory fever, with hard throbbing pulse, great pain, very sizy blood, and the death of the patient. Some accoucheurs have had a practice of introducing their hand into the uterus immediately after the birth of the child, to take away the placenta; which they said was to save time. Many women I believe have been victims to this unnatural practice.

Others have received injury, where inflammation has been beginning, by the universal practice of giving a large dose of opium immediately on delivery, without any indication of its propriety; which, though a proper and useful medicine, where the patient is too feeble, when given in a small dose, as 10 drops of tincture of opium, or half a grain of solid opium, must do a proportionate injury, when it is given improperly; and as delivery is a natural process, it is certainly more wise to give no medicines, except there be some morbid symptom, which requires it; and which has only been introduced into custom by the ill-employed activity of the Priests or Priestesses of Lucina; like the concomitant nonsense of cramming rue or rheubarb into the mouth of the unfortunate young stranger, who is thus soon made to experience the evils of life. See Class II. 1. 1. 12. and I. 1. 2. 5. Just so some over-wise beldames force young ducks and turkeys, as soon as they are hatched, to swallow a peppercorn.

M. M. Venesection repeatedly; diluents; fomentation; the patient should be frequently raised up in bed for a short time, to give opportunity of discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera.

17. Lumbago sensitiva. Sensitive lumbago. When the extensive membranes, or ligaments, which cover the muscles of the back are torpid, as in the cold paroxysm of ague, they are attended with pain in consequence of the inaction of the vessels, which compose them. When this inaction continues without a consequent renewal or increase of activity, the disease becomes chronical, and forms the lumbago frigida, or irritativa, described in Class I. 2. 4. 16. But when this cold fit or torpor of these membranes, or ligaments or muscles of the back, is succeeded by a hot fit, and consequent inflammation, a violent inflammatory fever, with great pain, occurs, preventing the erect posture of the body; and the affected part is liable to suppurate, in which case a very dangerous ulcer is formed, and a part of one of the vertebrae is generally found carious, and the patient sinks after a long time under the hectic fever occasioned by the aerated or oxygenated matter.

This disease bears no greater analogy to rheumatism than the inflammation of the pleura, or any other membranous inflammation; and has therefore unjustly been arranged under that name. It is distinguished from nephritis, as it is seldom attended with vomiting, I suppose never, except the ureter happens to be inflamed at the same time.

The pain sometimes extends on the outside of the thigh from the hip to the ankle, heel, or toes, and is then called sciatica; and has been thought to consist in an inflammation of the theca, or covering of the sciatic nerve, as the pain sometimes so exactly attends the principal branches of that nerve. See Class I. 2. 4. 15. 16.

M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm bath; poultice on the back, consisting of camomile flowers, turpentine, soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs from the torpor of the muscles, which had previously been too much excited, frequently occurs at the end of this disease; in this case electricity, and issues on each side of the lumber vertebræ, are recommended. See Class I. 2. 4. 16.

18. Ischias. The ischias consists of inflammatory fever, with great pain about the pelvis, the os coccigis, and the heads of the thigh-bones, preventing the patient from walking or standing erect, with increase of pain on going to stool. This malady, as well as the preceding, has been ascribed to rheumatism; with which it seems to bear no greater analogy, than the inflammations of any other membranes.

The patients are left feeble, and sometimes lame after this disease; which is also sometimes accompanied with great flow of urine, owing to the defective absorption of its aqueous parts; and with consequent thirst occasioned by the want of so much fluid being returned into the circulation; a lodgment of fæces in the rectum sometimes occurs after this complaint from the lessened sensibility of it. See Class I. 2. 4. 15.

M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with camomile flowers, turpentine, soap, and opium; afterwards the bark. See Class I. 1. 3. 5.

When this inflammation terminates in suppuration the matter generally can be felt to fluctuate in the groin, or near the top of the thigh. In this circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire, proposes to tap the abscess by means of a trocar, and thus as often as necessary to discharge the matter without admitting the air. Might a weak injection of wine and water, as in the hydrocele, be used with great caution to inflame the walls of the abscess, and cause them to unite? See Class II. 1. 6. 9.

19. Paronychia interna. Inflammation beneath the finger-nail. The pain occasioned by the inflammatory action and tumor of parts bound down between the nail on one side and the bone on the other, neither of which will yield, is said to occasion so much pain as to produce immediate delirium, and even death, except the parts are divided by a deep incision; which must pass quite through the periosteum, as the inflammation is said generally to exist beneath it. This disease is thus resembled by the process of toothing in young children; where an extraneous body lodged beneath the periosteum induces pain and fever, and sometimes delirium, and requires to be set at liberty, by the lancet.

ORDO I.

Increased Sensation.

GENUS III.

With the Production of new Vessels by external Membranes or Glands with Fever.

The diseases of this genus are perhaps all productive of contagious matter; or which becomes so by its exposure to the air, either through the cuticle, or by immediate contact with it; such are the matters of the small-pox and measles. The purulent matter formed on parts covered from the air by thicker membranes or muscles, as in the preceding genus, does not induce fever, and cannot therefore be called contagious; but it acquires this property of producing fever in a few hours, after the abscess has been opened, so as to admit the air to its surface, and may then be said to consist of contagious miasmata. This kind of contagious matter only induces fever, but does not produce other matter with properties similar to its own; and in this respect it differs from the contagious miasmata of small-pox or measles, but resembles those which have their origin in crowded jails; for these produce fever only, which frequently destroys the patient; but do not produce other matters similar to themselves; as appears from none of those, who died of the jail-fever, caught at the famous black assizes at Oxford, at the beginning of this century, having infected their physicians or attendants.

If indeed the matter has continued so long as to become putrid, and thus to have given out air from a part of it, it acquires the power of producing fever; in the same manner as if the ulcer had been opened, and exposed to the common air; instances of which are not unfrequent. And from these circumstances it seems probable, that the matters secreted by the new vessels formed in all kinds of phlegmons, or pustles, are not contagious, till they have acquired something from the atmosphere, or from the gas produced by putrefaction; which will account for some phenomena in the lues venerea, cancer, and of other contagious secretions on the skin without fever, to be mentioned hereafter. See Class II. 1. 4. 14.

The theory of contagion has been perplexed by comparing it with fermenting liquors; but the contagious material is shewn in Section XXXIII. to be produced like other secreted matters by certain animal motions of the terminations of the vessels. Hence a new kind of gland is formed at the terminations of the vessels in the eruptions of the small-pox; the animal motions of which produce from the blood variolous matter; as other glands produce bile or saliva. Now if some of this matter is introduced beneath the cuticle of a healthy person, or enters the circulation, and excites the extremities of the blood-vessels into those kinds of diseased motions, by which it was itself produced, either by irritation or association, these diseased motions of the extremities of the vessels will produce other similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion seems to be propagated two ways; one, by the stimulus of contagious matter applied to the part, which by an unknown law of nature excites the stimulated vessels to produce a similar matter; as in venereal ulcers, which thus continue to spread; or as when variolous matter is inserted beneath the cuticle; or when it is supposed to be absorbed, and diffused over the body mixed with the blood, and applied in that manner to the cutaneous glands. The other way, by which contagion seems to be diffused, is by some distant parts sympathizing or imitating the motions of the part first affected; as the stomach and skin in the eruptions of the inoculated small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3.

In some of the diseases of this genus the pulse is strong, full, and hard, constituting the sensitive irritated fever, as described in the preceding genus; as in one kind of erysipelas, which requires repeated venesection. In others the arterial action is sometimes moderate, so as to constitute the sensitive fever, as in the inoculated small-pox; where the action of the arteries is neither increased by the sensorial power of irritation, as in the sensitive irritated fever; nor decreased by the defect of that power, as in the sensitive inirritated fever. But in the greatest number of the diseases of this genus the arterial action is greatly diminished in respect to strength, and consequently the frequency of pulsation is proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing to the deficiency of the sensorial power of irritation joined with the increase of that of sensation, and thus constitutes the sensitive inirritated fever; as in Scarlatina with gangrenous tonsils.

From this great debility of the action of the arteries, there appears to be less of the coagulable lymph or mucus secreted on their internal surfaces; whence there is not only a defect of that buff or size upon the blood, which is seen on the surface of that, which is drawn in the sensitive irritated fever; but the blood, as it cools, when it has been drawn into a bason, scarcely coagulates; and is said to be dissolved, and is by some supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3. where the truth of this idea is controverted. But in the fevers of both this genus and the preceding one great heat is produced from the chemical combinations in the secretions of new vessels and fluids, and pain or uneasiness from the distention of the old ones; till towards the termination of the disease sensation ceases, as well as irritation, with the mortification of the affected parts, and the death of the patient.

Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the diseases of external membranes, because they are exposed either to the atmospheric air, which is breathed, and swallowed with our food and saliva; or they are exposed to the inflammable air; or hydrogen, which is generated in the intestines; both which contribute to produce or promote the contagious quality of these fluids; as mentioned in Class II. 1. 5.

It is not speaking accurate language, if we say, that in the diseases of this genus the fever is contagious; since it is the material produced by the external membranes, which is contagious, after it has been exposed to air; while the fever is the consequence of this contagious matter, and not the cause of it. As appears from the inoculated small-pox, in which the fever does not commence, till after suppuration has taken place in the inoculated arm, and from the diseases of the fifth genus of this order, where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18.

SPECIES.

1. Febris sensitiva inirritata. Sensitive inirritated fever. Typhus gravior. Putrid malignant fever. Jail fever. The immediate cause of this disease is the increase of the sensorial power of sensation, joined with the decrease of the sensorial power of irritation; that is, it consists in the febris sensitiva joined with the febris inirritativa of Class I. 2. 1. 1. as the febris sensitiva irritata of the preceding genus consists of the febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In both which the word irritata, and inirritata, are designed to express more or less irritation than the natural quantity; and the same when applied to some of the diseases of this genus.

This fever is frequently accompanied with topical inflammation, which is liable, if the arterial strength is not supported, to end in sphacelus; and as mortified parts, such as sloughs of the throat, if they adhere to living parts, soon become putrid from the warmth and moisture of their situation; these fevers have been termed putrid, and have been thought to owe their cause to what is only their consequence. In hot climates this fever is frequently induced by the exhalations of stagnating lakes or marshes, which abound with animal substances; but which in colder countries produce fevers with debility only, as the quartan ague, without inflammation.

The sensitive inirritated, or malignant, fever is also frequently produced by the putrid exhalations and stagnant air in prisons; but perhaps most frequently by contact or near approach of the persons, who have resided in them. These causes of malignant fevers contributed to produce, and to support for a while, the septic and antiseptic theory of them; see Sect. XXXIII. 1. 3. The vibices or bruises, and petechiæ or purples, were believed to be owing to the dissolved state of the blood by its incipient putrefaction; but hydrostatical experiments have been made, which shew the sizy blood of the patient in sensitive irritated or inflammatory fever, with strong pulse, is more fluid, while it is warm, than this uncoagulable blood taken in this sensitive inirritated, or malignant fever; from whence it is inferred, that these petechiæ, and vibices, are owing to the deficient power of absorption in the terminations of the veins, See Class I. 2. 1. 5.

This sensitive inirritated fever, or typhus gravior, is distinguished from the inirritative fever, or typhus mitior, in the early stages of it, by the colour of the skin; which in the latter is paler, with less heat, owing to the less violent action of the capillaries; in this it is higher coloured, and hotter, from the greater energy of the capillary action in the production of new vessels. In the more advanced state petechiæ, and the production of contagious matter from inflamed membranes, as the aphthæ of the mouth, or ulcers of the throat, distinguishes this fever from the former. Delirium, and dilated pupils of the eyes, are more frequent in nervous fevers; and stupor with deafness more frequent attendants on malignant fevers. See Class I. 2. 5. 6.

There is another criterion discernible by the touch of an experienced finger; and that is, the coat of the artery in inflammatory fevers, both those attended with strength of pulsation, and these with weak pulsation, feels harder, or more like a cord; for the coats of the arteries in these fevers are themselves inflamed, and are consequently turgid with blood, and thence are less easily compressed, though their pulsations are nevertheless weak: when the artery is large or full with an inflamed coat, it is called hard; and when small or empty with an inflamed coat, it is called sharp, by many writers.

M. M. The indications of cure consist, 1. In procuring a regurgitation of any offensive material, which may be lodged in the long mouths of the lacteals or lymphatics, or in their tumid glands. 2. To excite the system into necessary action by the repeated exhibition of nutrientia, sorbentia, and incitantia; and to preserve the due evacuation of the bowels. 3. To prevent any unnecessary expenditure of sensorial power. 4. To prevent the formation of ulcers, or to promote the absorption in them, for the purpose of healing them.

1. One ounce of wine of ipecacuanha, or about ten grains of the powder, should be given as an emetic. After a few hours three or four grains of calomel should be given in a little mucilage, or conserve. Where something swallowed into the stomach is the cause of the fever, it is liable to be arrested by the lymphatic glands, as the matter of the small-pox inoculated in the arm is liable to be stopped by the axillary lymphatic gland; in this situation it may continue a day or two, or longer, and may be regurgitated during the operation of an emetic or cathartic into the stomach or bowel, as evidently happens on the exhibition of calomel, as explained in Sect. XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if indicated by the hardness and fulness of the pulse, will very frequently remove fevers, if exhibited on the first, second, or even third day.

2. Wine and opium, in small doses repeated frequently, but so that not the least degree of intoxication follows, for in that case a greater degree of debility is produced from the expenditure of sensorial power in unnecessary motions. Many weak patients have been thus stimulated to death. See Sect. XII. 7. 8. The Peruvian bark should be given also in repeated doses in such quantity only as may strengthen digestion, not impede it. For these purposes two ounces of wine, or of ale, or cyder, should be given every six hours; and two ounces of decoction of bark, with two drachms of the tincture of bark, and six drops of tincture of opium, should be given also every six hours alternately; that is, each of them four times in twenty-four hours. As much rhubarb as may induce a daily evacuation, should be given to remove the colluvies of indigested materials from the bowels; which might otherwise increase the distress of the patient by the air it gives out in putrefaction, or by producing a diarrhœa by its acrimony; the putridity of the evacuations are in consequence of the total inability of the digestive powers; and their delay in the intestines, to the inactivity of that canal in respect to its peristaltic motions.

The quantities of wine or beer and opium, and bark, above mentioned, may be increased by degrees, if the patient seems refreshed by them; and if the pulse becomes slower on their exhibition; but this with caution, as I have seen irrecoverable mischief done by greater quantities both of opium, wine, and bark, in this kind of fever; in which their use is to strengthen the digestion of the weak patient, rather than to stop the paroxysms of fever; but when they are administered in intermittents, much larger quantities are necessary.

The stimulus of small blisters applied in succession, one every three or four days, when the patient becomes weak, is of great service by strengthening digestion, and by preventing the coldness of the extremities, owing to the sympathy of the skin with the stomach, and of one part of the skin with another.

In respect to nutriment, the patient should be supplied with wine and water, with toasted bread, and sugar or spice in it; or with sago with wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish, or whatever is grateful to the palate of the sick person, in small quantity repeated frequently; with small beer, cyder and water, or wine and water, for drink, which may be acidulated with acid of vitriol in small quantities.

3. All unnecessary motions are to be checked, or prevented. Hence horizontal posture, obscure room, silence, cool air. All the parts of the skin, which feel too hot to the hand, should be exposed to a current of cool air, or bathed with cold water, whether there are eruptions on it or not. Wash the patient twice a day with cold vinegar and water, or cold salt and water, or cold water alone, by means of a sponge. If some parts are too cold, as the extremities, while other parts are too hot, as the face or breast, cover the cold parts with flannel, and cool the hot parts by a current of cool air, or bathing them as above.

4. For the healing of ulcers, if in the mouth, solution of alum in water about 40 grains to an ounce, or of blue vitriol in water, one grain or two to an ounce may be used to touch them with three or four times a day. Of these perhaps a solution of alum is to be preferred, as it instantly takes away the stench from ulcers I suppose by combining with the volatile alcali which attends it. For this purpose a solution of alum of an ounce to a pint of water should be frequently injected by means of a syringe into the mouth. If there are ulcers on the external skin, fine powder of bark seven parts, and cerusia in fine powder one part, should be mixed, and applied dry on the sore, and kept on by lint, and a bandage.

As sloughs in the mouth are frequently produced by the previous dryness of the membranes, which line it, this dryness should be prevented by frequently moistening them, which may be effected by injection with a syringe, or by a moist sponge, or lastly in the following manner. Place a glass of wine and water, or of milk and sugar, on a table by the bedside, a little above the level of the mouth of the patient; then, having previously moistened a long piece of narrow listing, or cloth, or flannel, with the same liquor, leave one end of it in the glass, and introduce the other into the mouth of the patient; which will thus be supplied with a constant oozing of the fluid through the cloth, which acts as a capillary syphon.

The viscid phlegm, which adheres to the tongue, should be coagulated by some austere acid, as by lemon-juice evaporated to half its quantity, or by crab-juice; and then it may be scraped off by a knife, or rubbed off by flannel, or a sage leaf dipped in vinegar, or in salt and water.

2. Erysipelas, St. Anthony's fire, may be divided into three kinds, which differ in their method of cure, the irritated, the inirritated, and the sensitive erysipelas.

Erysipelas irritatum is attended with increase of irritation besides increase of sensation; that is, with strong, hard, and full pulse, which requires frequent venesection, like other inflammations with arterial strength. It is distinguished from the phlegmonic inflammations of the last genus by its situation on the external habit, and by the redness, heat, and tumour not being distinctly circumscribed; so that the eye or finger cannot exactly trace the extent of them.

When the external skin is the seat of inflammation, and produces sensitive irritated fever, no collection of matter is formed, as when a phlegmon is situated in the cellular membrane beneath the skin; but the cuticle rises as beneath a blister-plaster, and becomes ruptured; and a yellow material oozes out, and becomes inspissated, and lies upon its surface; as is seen in this kind of erysipelas, and in the confluent small-pox; or if the new vessels are reabsorbed the cuticle peels off in scales. This difference of the termination of erysipelatous and phlegmonic inflammation seems to be owing in part to the less distensibility of the cuticle than of the cellular membrane, and in part to the ready exhalation of the thinner parts of the secreted fluids through its pores.

This erysipelas is generally preceded by a fever for two or three days before the eruption, which is liable to appear in some places, as it declines in others; and seems frequently to arise from a previous scratch or injury of the skin; and is attended sometimes with inflammation of the cellular membrane beneath the skin; whence a real phlegmon and collection of matter becomes joined to the erysipelas, and either occasions or increases the irritated fever, which attends it.

There is a greater sympathy between the external skin and the meninges of the brain, than between the cellular membrane and those meninges; whence erysipelas is more liable to be preceded or attended, or succeeded, by delirium than internal phlegmons. I except the mumps, or parotitis, described below; which is properly an external gland, as its excretory duct opens into the air. When pain of the head or delirium precedes the cutaneous eruption of the face, there is some reason to believe, that the primary disease is a torpor of the meninges of the brain; and that the succeeding violent action is transferred to the skin of the face by sensitive association; and that a similar sympathy occurs between some internal membranes and the skin over them, when erysipelas appears on other parts of the body. If this circumstance should be supported by further evidence, this disease should be removed into Class IV. along with the rheumatism and gout. See Class IV. 1. 2. 17.

This supposed retropulsion of erysipelas on the brain from the frequent appearance of delirium, has prevented the free use of the lancet early in this disease to the destruction of many; as it has prevented the subduing of the general inflammation, and thus has in the end produced the particular one on the brain. Mr. B——, a delicate gentleman about sixty, had an erysipelas beginning near one ear, and extending by degrees over the whole head, with hard, full, and strong pulse; blood was taken from him four or five times in considerable quantity, with gentle cathartics, with calomel, diluents, and cool air, and he recovered without any signs of delirium, or inflammation of the meninges of the brain. Mr. W——, a strong corpulent man of inferior life, had erysipelas over his whole head, with strong hard pulse: he was not evacuated early in the disease through the timidity of his apothecary, and died delirious. Mrs. F—— had erysipelas on the face, without either strong or weak pulse; that is, with sensitive fever alone, without superabundance or deficiency of irritation; and recovered without any but natural evacuations. From these three cases of erysipelas on the head it appears, that the evacuations by the lancet must be used with courage, where the degree of inflammation requires it; but not where this degree of inflammation is small, nor in the erysipelas attended with inirritation, as described below.

M. M. Venesection repeated according to the degree of inflammation. An emetic. Calomel three grains every other night. Cool air. Diluents, emetic tartar in small doses, as a quarter of a grain every six hours. Tea, weak broth, gruel, lemonade, neutral salts. See Sect. XII. 6.

Such external applications as carry away the heat of the skin may be of service, as cold water, cold flour, snow, ether. Because these applications impede the exertions of the secerning vessels, which are now in too great action; but any applications of the stimulant kind, as solutions of lead, iron, copper, or of alum, used early in the disease, must be injurious; as they stimulate the secerning vessels, as well as the absorbent vessels, into greater action; exactly as occurs when stimulant eye-waters are used too soon in ophthalmy. See Class II. 1. 2. 2. But as the cuticle peels off in this case after the inflammation ceases, it differs from ophthalmy; and stimulant applications are not indicated at all, except where symptoms of gangrene appear. For as a new cuticle is formed under the old one, as under a blister, the serous fluid between them is a defence to the new cuticle, and should dry into a scab by exhalation rather than be reabsorbed. Hence we see how greasy or oily applications, and even how moist ones, are injurious in erysipelas; because they prevent the exhalation of the serous effusion between the old and new cuticle, and thus retard the formation of the latter.

Erysipelas inirritatum differs from the former in its being attended with weak pulse, and other symptoms of sensitive inirritated fever. The feet and legs are particularly liable to this erysipelas, which precedes or attends the sphacelus or mortification of those parts. A great and long coldness first affects the limb, and the erysipelas on the skin seems to occur in consequence of the previous torpor of the interior membranes. As this generally attends old age, it becomes more dangerous in proportion to the age, and also to the habitual intemperance of the patient in respect to the use of fermented or spirituous liquor.

When the former kind, or irritated erysipelas, continues long, the patient becomes so weakened as to be liable to all the symptoms of this inirritated erysipelas; especially where the meninges of the brain are primarily affected. As in that case, after two or three efforts have been made to remove the returning periods of torpor of the meninges to the external skin, those meninges become inflamed themselves, and the patient sinks under the disease; in a manner similar to that in old gouty patients, where the torpor of the liver or stomach is relieved by association of the inflammation of the membranes of the feet, and then of other joints, and lastly the power of association ceasing to act, but the excess of sensation continuing, the liver or stomach remains torpid, or become themselves inflamed, and the patient is destroyed.

M. M. Where there exists a beginning gangrene of the extremities, the Peruvian bark, and wine, and opium, are to be given in large quantities; so as to strengthen the patient, but not to intoxicate, or to impede his digestion of aliment, as mentioned in the first species of this genus. Class II. 1. 2. 1. But where the brain is inflamed or oppressed, which is known either by delirium, with quick pulse; or by stupor, and slow respiration with slow pulse; other means must be applied. Such as, first, a fomentation on the head with warm water, with or without aromatic herbs, or salt in it, should be continued for an hour or two at a time, and frequently repeated. A blister may also be applied on the head, and the fomentation nevertheless occasionally repeated. Internally very gentle stimulants, as camphor one grain or two in infusion of valerian. Wine and water or small beer, weak broth. An enema. Six grains of rhubarb and one of calomel. Afterwards five drops of tincture of opium, which may be repeated every six hours, if it seems of service. Might the head be bathed for a minute with cold water? or with ether? or vinegar?

Erysipelas sensitivum is a third species, differing only in the kind of fever which attends it, which is simply inflammatory, or sensitive, without either excess of irritation, as in the first variety; or the defect of irritation, as in the second variety: all these kinds of erysipelas are liable to return by periods in some people, who have passed the middle of life, as at periods of a lunation, or two lunations, or at the equinoxes. When these periods of erysipelas happen to women, they seem to supply the place of the receding catamenia; when to men, I have sometimes believed them to be associated with a torpor of the liver; as they generally occur in those who have drank vinous spirit excessively, though not approbriously; and that hence they supply the place of periodical piles, or gout, or gutta rosea.

M. M. As the fever requires no management, the disease takes its progress safely, like a moderate paroxysm of the gout; but in this case, as in some of the former, the erysipelas does not appear to be a primary disease, and should perhaps be removed to the Class of Association.

3. Tonsillitis. Inflammation of the tonsils. The uncouth term Cynanche has been used for diseases so dissimilar, that I have divided them into Tonsillitis and Parotitis; and hope to be excused for adding a Greek termination to a Latin word, as one of those languages may justly be considered as a dialect of the other. By tonsillitis the inflammation of the tonsils is principally to be understood; but as all inflammations generally spread further than the part first affected; so, when the summit of the windpipe is also much inflamed, it may be termed tonsillitis trachealis, or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and when the summit of the gullet is much inflamed along with the tonsil, it may be called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus X. p. 92. The inflammation of the tonsils may be divided into three kinds, which require different methods of cure.

Tonsillitis interna. Inflammation of the internal tonsil. When the swelling is so considerable as to produce difficulty of breathing, the size of the tonsil should be diminished by cutting it with a proper lancet, which may either give exit to the matter it contains, or may make it less by discharging a part of the blood. This kind of angina is frequently attended with irritated fever besides the sensitive one, which accompanies all inflammation, and sometimes requires venesection. An emetic should be given early in the disease, as by its inducing the retrograde action of the vessels about the fauces during the nausea it occasions, it may eliminate the very cause of the inflammation; which may have been taken up by the absorbents, and still continue in the mouths of the lymphatics or their glands. The patient should then be induced to swallow some aperient liquid, an infusion of senna, so as to induce three or four evacuations. Gargles of all kinds are rather hurtful, as the action of using them is liable to give pain to the inflamed parts; but the patients find great relief from frequently holding warm water in their mouths, and putting it out again, or by syringing warm water into the mouth, as this acts like a warm bath or fomentation to the inflamed part. Lastly, some mild stimulant, as a weak solution of salt and water, or of white vitriol and water, may be used to wash the fauces with in the decline of the disease, to expedite the absorption of the new vessels, if necessary, as recommended in ophthalmy.

Tonsillitis superficialis. Inflammation of the surface of the tonsils. As the tonsils and parts in their vicinity are covered with a membrane, which, though exposed to currents of air, is nevertheless constantly kept moist by mucus and saliva, and is liable to diseases of its surface like other mucous membranes, as well as to suppuration of the internal substance of the gland; the inflammation of its surface is succeeded by small elevated pustules with matter in them, which soon disappears, and the parts either readily heal, or ulcers covered with sloughs are left on the surface.

This disease is generally attended with only sensitive fever, and therefore is of no danger, and may be distinguished with great certainty from the dangerous inflammation or gangrene of the tonsils at the height of the small-pox, or scarlet fever, by its not being attended with other symptoms of those diseases. One emetic and a gentle cathartic is generally sufficient; and the frequent swallowing of weak broth, or gruel, both without salt in them, relieves the patient, and absolves the cure. When these tumours of the tonsils frequently return I have sometimes suspected them to originate from the absorption of putrid matter from decaying teeth. See Class I. 2. 3. 21. and II. 2. 2. 1.

Tonsillitis inirritata. Inflammation of the tonsils with sensitive inirritated fever is a symptom only of contagious fever, whether attended with scarlet eruption, or with confluent small-pox, or otherwise. The matter of contagion is generally diffused, not dissolved in the air; and as this is breathed over the mucaginous surface of the tonsils, the contagious atoms are liable to be arrested by the tonsil; which therefore becomes the nest of the future disease, like the inflamed circle round the inoculated puncture of the arm in supposititious small-pox. This swelling is liable to suffocate the patient in small-pox, and to become gangrenous in scarlet fever, and some other contagious fevers, which have been received in this manner. The existence of inflammation of the tonsil previous to the scarlet eruption, as the arm inflames in the inoculated small-pox, and suppurates before the variolous eruption, should be a criterion of the scarlet fever being taken in this manner.

M. M. All the means which strengthen the patient, as in the sensitive inirritated fever, Class II. 1. 2. 1. As it is liable to continue a whole lunation or more, great attention should be used to nourish the patient with acidulous and vinous panada, broth with vegetables boiled in it, sugar, cream, beer; all which given frequently will contribute much to moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm water and wine, or acid of lemon, should be frequently applied to the tonsils by means of a syringe, or by means of a capillary syphon, as described in Class II. 1. 3. 1. A slight solution of blue vitriol, as two grains to an ounce, or a solution of sugar of lead of about six grains to an ounce, may be of service; especially the latter, applied to the edges of the sloughs, drop by drop by means of a small glass tube, or small crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to the end of either of which a drop will conveniently hang by capillary attraction; as solutions of lead evidently impede the progress of erysipelas on the exterior skin, when it is attended with feeble pulse. Yet a solution of alum injected frequently by a syringe is perhaps to be preferred, as it immediately removes the fetor of the breath, which must much injure the patient by its being perpetually received into the lungs by respiration.

4. Parotitis. Mumps, or branks, is a contagious inflammation of the parotis and maxillary glands, and has generally been classed under the word Cynanche or Angina, to which it bears no analogy. It divides itself into two kinds, which differ in the degree of fever which attends them, and in the method of cure.

Parotitis suppurans. The suppurating mumps is to be distinguished by the acuteness of the pain, and the sensitive, irritated, or inflammatory fever, which attends it.

M. M. Venesection. Cathartic with calomel three or four grains repeatedly. Cool air, diluents. This antiphlogistic treatment is to be continued no longer than is necessary to relieve the violence of the pain, as the disease is attended with contagion, and must run through a certain time, like other fevers with contagion.

Parotitis mutabilis. Mutable parotitis. A sensitive fever only, or a sensitive irritated fever, generally attends this kind. And when the tumor of the parotis and maxillary glands subsides, a new swelling occurs in some distant part of the system; as happens to the hands and feet, at the commencement of the secondary fever of the small-pox, when the tumor of the face subsides. This new swelling in the parotitis mutabilis is liable to affect the testes in men, and form a painful tumor, which should be prevented from suppuration by very cautious means, if the violence of the pain threaten such a termination; as by bathing the part with coldish water for a time, venesection, a cathartic; or by a blister on the perinæum, or scrotum, or a poultice.

When women are affected with this complaint, after the swelling of the parotis and maxillary glands subsides, a tumor with pain is liable to affect their breasts; which, however, I have never seen terminate in suppuration.

On the retrocession of the tumor of the testes above described, and I suppose of that of the breasts in women, a delirium of the calm kind is very liable to occur; which in some cases has been the first symptom which has alarmed the friends of the patient; and it has thence been difficult to discover the cause of it without much inquiry; the previous symptoms having been so slight as not to have occasioned any complaints. In this delirium, if the pulse will bear it, venesection should be used, and three or four grains of calomel, with fomentation of the head with warm water for an hour together every three or four hours.

Though this disease generally terminates favourably, considering the numbers attacked by it, when it is epidemic, yet it is dangerous at other times in every part of its progress. Sometimes the parotis or maxillary glands suppurate, producing ulcers which are difficult to cure, and frequently destroy the patient, where there was a previous scrophulous tendency. The testis in men is also liable to suppurate with great pain, long confinement, and much danger; and lastly the affection of the brain is fatal to many.

Mr. W. W. had a swelled throat, which after a few days subsided. He became delirious or stupid, in which state he was dying when I saw him; and his friends ascribed his death to a coup de soleil, which he was said to have received some months before, when he was abroad.

Mr. A. B. had a swelling of the throat, which after a few days subsided. When I saw him he had great stupor, with slow breathing, and partial delirium. On fomenting his head with warm water for an hour these symptoms of stupor were greatly lessened, and his oppressed breathing gradually ceased, and he recovered in one day.

Mr. C. D. I found walking about the house in a calm delirium without stupor; and not without much inquiry of his friends could get the previous history of the disease; which had been attended with parotitis, and swelled testis, previous to the delirium. A few ounces of blood were taken away, a gentle cathartic was directed, and his head fomented with warm water for an hour, with a small blister on the back, and he recovered in two or three days.

Mr. D. D. came down from London in the coach alone, so that no previous history could be obtained. He was walking about the house in a calm delirium, but could give no sensible answers to any thing which was proposed to him. His pulse was weak and quick. Cordials, a blister, the bark, were in vain exhibited, and he died in two or three days.

Mr. F. F. came from London in the same manner in the coach. He was mildly delirious with considerable stupor, and moderate pulse, and could give no account of himself. He continued in a kind of cataleptic stupor, so that he would remain for hours in any posture he was placed, either in his chair, or in bed; and did not attempt to speak for about a fortnight; and then gradually recovered. These two last cases are not related as being certainly owing to parotitis, but as they might probably have that origin.

The parotitis suppurans, or mumps with irritated fever, is at times epidemic among cats, and may be called parotitis felina; as I have reason to believe from the swellings under the jaws, which frequently suppurate, and are very fatal to those animals. In the village of Haywood, in Staffordshire, I remember a whole breed of Persian cats, with long white hair, was destroyed by this malady, along with almost all the common cats of the neighbourhood; and as the parotitis or mumps had not long before prevailed amongst human beings in that part of the country, I recollect being inclined to believe, that the cats received the infection from mankind; though in all other contagious diseases, except the rabies canina can be so called, no different genera of animals naturally communicate infection to each other; and I am informed, that vain efforts have been made to communicate the small-pox and measles to some quadrupeds by inoculation. A disease of the head and neck destroyed almost all the cats in Westphalia. Savage, Nosol. Class X. Art. 30. 8.

5. Catarrhus sensitivus consists of an inflammation of the membrane, which lines the nostrils and fauces. It is attended with sensitive fever alone, and is cured by the steam of warm water externally, and by diluents internally, with moderate venesection and gentle cathartics. This may be termed catarrhus sensitivus, to distinguish it from the catarrhus contagiosus, and is in common language called a violent cold in the head; it differs from the catarrhus calidus, or warm catarrh, of Class I. 1. 2. 7. in the production of new vessels, or inflammation of the membrane, and the consequent more purulent appearance of the discharge.

Raucedo catarrhalis, or catarrhal hoarseness, is a frequent symptom of this disease, and is occasioned by the pain or soreness which attends the thickened and inflamed membranes of the larynx; which prevents the muscles of vocallity from sufficiently contracting the aperture of it. It ceases with the inflammation, or may be relieved by the steam of warm water alone, or of water and vinegar, or of water and ether. See Paralytic Hoarseness, Class III. 2. 1. 4.

6. Catarrhus contagiosus. This malady attacks so many at the same time, and spreads gradually over so great an extent of country, that there can be no doubt but that it is disseminated by the atmosphere. In the year 1782 the sun was for many weeks obscured by a dry fog, and appeared red as through a common mist. The material, which thus rendered the air muddy, probably caused the epidemic catarrh, which prevailed in that year, and which began far in the north, and extended itself over all Europe. See Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294, note; and was supposed to have been thrown out of a volcano, which much displaced the country of Iceland.

In many instances there was reason to believe, that this disease became contagious, as well as epidemic; that is, that one person might receive it from another, as well as by the general unsalutary influence of the atmosphere. This is difficult to comprehend, but may be conceived by considering the increase of contagious matter in the small-pox. In that disease one particle of contagious matter stimulates the skin of the arm in inoculation into morbid action so as to produce a thousand particles similar to itself; the same thing occurs in catarrh, a few deleterious atoms stimulate the mucous membrane of the nostrils into morbid actions, which produce a thousand other particles similar to themselves. These contagious particles diffused in the air must have consisted of animal matter, otherwise how could an animal body by being stimulated by them produce similar particles? Could they then have had a volcanic origin, or must they not rather have been blown from putrid marshes full of animal matter? But the greatest part of the solid earth has been made from animal and vegetable recrements, which may be dispersed by volcanos.—Future discoveries must answer these questions.

As the sensitive fever attending these epidemic catarrhs is seldom either much irritated or inirritated, venesection is not always either clearly indicated or forbid; but as those who have died of these catarrhs have generally had inflamed livers, with consequent suppuration in them, venesection is adviseable, wherever the cough and fever are greater than common, so as to render the use of the lancet in the least dubious. And in some cases a second bleeding was necessary, and a mild cathartic or two with four grains of calomel; with mucilaginous subacid diluents; and warm steam occasionally to alleviate the cough, finished the cure.

The catarrhus contagiosus is a frequent disease amongst horses and dogs; it seems first to be disseminated amongst these animals by miasmata diffused in the atmosphere, because so many of them receive it at the same time; and afterwards to be communicable from one horse or dog to another by contagion, as above described. These epidemic or contagious catarrhs more frequently occur amongst dogs and horses than amongst men; which is probably owing to the greater extension and sensibility of the mucous membrane, which covers the organ of smell, and is diffused over their wide nostrils, and their large maxillary and frontal cavities. And to this circumstance may be ascribed the greater fatality of it to these animals.

In respect to horses, I suspect the fever at the beginning to be of the sensitive, irritated, or inflammatory kind, because there is so great a discharge of purulent mucus; and that therefore they will bear once bleeding early in the disease; and also one mild purgative, consisting of about half an ounce of aloe, and as much white hard soap, mixed together. They should be turned out to grass both day and night for the benefit of pure air, unless the weather be too cold (and in that case they should be kept in an open airy stable, without being tied), that they may hang down their heads to facilitate the discharge of the mucus from their nostrils. Grass should be offered them, or other fresh vegetables, as carrots and potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or cold water frequently in a day. When symptoms of debility appear, which may be known by the coldness of the ears or other extremities, or when sloughs can be seen on the membrane which lines the nostrils, a drink consisting of a pint of ale with half an ounce of tincture of opium in it, given every six hours, is likely to be of great utility.

In dogs I believe the catarrh is generally joined with symptoms of debility early in the disease. These animals should be permitted to go about in the open air, and should have constant access to fresh water. The use of being as much as may be in the air is evident, because all the air which they breathe passes twice over the putrid sloughs of the mortified parts of the membrane which lines the nostrils, and the maxillary and frontal cavities; that is, both during inspiration and expiration; and must therefore be loaded with contagious particles. Fresh new milk, and fresh broth, should be given them very frequently, and they should be suffered to go amongst the grass, which they sometimes eat for the purpose of an emetic; and if possible should have access to a running stream of water. As the contagious mucus of the nostrils, both of these animals and of horses, generally drops into the water they attempt to drink. Bits of raw flesh, if the dog will eat them, are preferred to cooked meat; and from five to ten drops of tincture of opium may be given with advantage, when symptoms of debility are evident, according to the size of the dog, every six hours. If sloughs can be seen in the nostrils, they should be moistened twice a day, both in horses and dogs, with a solution of sugar of lead, or of alum, by means of a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be made by dissolving half an ounce of sugar of lead in a pint of water.

Ancient philosophers seem to have believed, that the contagious miasmata in their warm climates affected horses and dogs previous to mankind. If those contagious particles were supposed to be diffused amongst the heavy inflammable air, or carbonated hydrogen, of putrid marshes, as these animals hold their heads down lower to the ground, they may be supposed to have received them sooner than men. And though men and quadrupeds might receive a disease from the same source of marsh-putrefaction, they might not afterwards be able to infect each other, though they might infect other animals of the same genus; as the new contagious matter generated in their own bodies might not be precisely similar to that received; as happened in the jail-fever at Oxford, where those who took the contagion and died, did not infect others.

7. Peripneumonia superficialis. The superficial or spurious peripneumony consists in an inflammation of the membrane, which lines the bronchia, and bears the same analogy to the true peripneumony, as the inflammations of other membranes do to that of the parenchyma, or substantial parts of the viscus, which they surround. It affects elderly people, and frequently occasions their death; and exists at the end of the true peripneumony, or along with it; when the lancet has not been used sufficiently to cure by reabsorbing the inflamed parts, or what is termed by resolution.

M. M. Diluents, mucilage, antimonials, warmish air constantly changed, venesection once, perhaps twice, if the pulse will bear it. Oily volatile draughts. Balsams? Neutral salts increase the tendency to cough. Blisters in succession about the chest. Warm bath. Mild purgatives. Very weak chicken broth without salt in it. Boiled onions. One grain of calomel every night for a week. From five drops to ten of tincture of opium at six every night, when the patient becomes weak. Digitalis? See Class II. 1. 6. 7.

8. Pertussis. Tussis convulsiva. Chin-cough resembles peripneumonia superficialis in its consisting in an inflammation of the membrane which lines the air-vessels of the lungs; but differs in the circumstance of its being contagious; and is on that account of very long duration; as the whole of the lungs are probably not infected at the same time, but the contagious inflammation continues gradually to creep on the membrane. It may in this respect be compared to the ulcers in the pulmonary consumption; but it differs in this, that in chin-cough some branches of the bronchia heal, as others become inflamed.

This complaint is not usually classed amongst febrile disorders, but a sensitive fever may generally be perceived to attend it during some part of the day, especially in weak patients. And a peripneumony very frequently supervenes, and destroys great numbers of children, except the lancet or four or six leeches be immediately and repeatedly used. When the child has permanent difficulty of breathing, which continues between the coughing fits: unless blood be taken from it, it dies in two, three, or four days of the inflammation of the lungs. During this permanent difficulty of breathing the hooping-cough abates, or quite ceases, and returns again after once or twice bleeding; which is then a good symptom, as the child now possessing the power to cough shews the difficulty of breathing to be abated. I dwell longer upon this, because many lose their lives from the difficulty there is in bleeding young children; where the apothecary is old or clumsy, or is not furnished with a very sharp and fine-pointed lancet. In this distressing situation the application of four leeches to one of the child's legs, the wounds made by which should continue to bleed an hour or two, is a succedaneum; and saves the patient, if repeated once or twice according to the difficulty of the respiration.

The chin-cough seems to resemble the gonorrhœa venerea in several circumstances. They are both received by infection, are both diseases of the mucous membrane, are both generally cured in four or six weeks without medicine. If ulcers in the cellular membrane under the mucous membrane occur, they are of a phagedenic kind, and destroy the patient in both diseases, if no medicine be administered.

Hence the cure should be similar in both these diseases; first general evacuations and diluents, then, after a week or two, I have believed the following pills of great advantage. The dose for a child of about three years old was one sixth part of a grain of calomel, one sixth part of a grain of opium, and two grains of rhubarb, to be taken twice a day.

The opium promotes absorption from the mucous membrane, and hence contributes to heal it. The mercury prevents ulcers from being formed under the mucous membrane, or cures them, as in the lues venerea; and the rhubarb is necessary to keep the bowels open.

M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air. Tincture of cantharides, or repeated blisters; afterwards opiates in small doses, and the bark. Warm bath frequently used. The steam of warm water with a little vinegar in it may be inhaled twice a day. Could the breathing of carbonic acid gas mixed with atmospheric air be of service? Copious venesection, when a difficulty of breathing continues between the fits of coughing; otherwise the cough and the expectoration cease, and the patient is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis pulmonalis in a few weeks terminates in death. Where the cough continues after some weeks without much of the hooping, and a sensitive fever daily supervenes, so as to resemble hectic fever from ulcers of the lungs; change of air for a week or fortnight acts as a charm, and restores the patient beyond the hopes of the physician.

Young children should lie with their heads and shoulders raised; and should be constantly watched day and night; that when the cough occurs, they may be held up easily, so as to stand upon their feet bending a little forwards; or nicely supported in that posture which they seem to put themselves into. A bow of whalebone, about the size of the bow of a key, is very useful to extract the phlegm out of the mouths of infants at the time of their coughing; as an handkerchief, if applied at the time of their quick inspirations after long holding their breath, is dangerous, and may suffocate the patient in an instant, as I believe has sometimes happened.

9. Variola discreta. The small-pox is well divided by Sydenham into distinct and confluent. The former consists of distinct pustules, which appear on the fourth day of the fever, are circumscribed and turgid; the fever ceasing when the eruption is complete. Head-ach, pain in the loins, vomiting frequently, and convulsive fits sometimes, precede the eruption.

The distinct small-pox is attended with sensitive fever only, when very mild, as in most inoculated patients; or with sensitive irritated fever, when the disease is greater: the danger in this kind of small-pox is owing either to the tumor and soreness of the throat about the height, or eighth day of the eruption; or to the violence of the secondary fever. For, first, as the natural disease is generally taken by particles of the dust of the contagious matter dried and floating in the air, these are liable to be arrested by the mucus about the throat and tonsils in their passage to the lungs, or to the stomach, when they are previously mixed with saliva in the mouth. Hence the throat inflames like the arm in inoculated patients; and this increasing, as the disease advances, destroys the patient about the height.

Secondly, all those upon the face and head come out about the same time, namely, about one day before those on the hands, and two before those in the trunk; and thence, when the head is very full, a danger arises from the secondary fever, which is a purulent, not a variolous fever; for as the matter from all these of the face and head is reabsorbed at the same time, the patient is destroyed by the violence of this purulent fever; which in the distinct small-pox can only be abated by venesection and cathartics; but in the confluent small-pox requires cordials and opiates, as it is attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10.

When the pustules on the face recede, the face swells; and when those of the hands recede, the hands swell; and the same of the feet in succession. These swellings seem to be owing to the absorption of variolous matter, which by its stimulus excites the cutaneous vessels to secrete more lymph, or serum, or mucus, exactly as happens by the stimulus of a blister. Now, as a blister sometimes produces strangury many hours after it has risen; it is plain, that a part of the cantharides is absorbed, and carried to the neck of the bladder; whether it enters the circulation, or is carried thither by retrograde movements of the urinary branch of lymphatics; and by parity of reasoning the variolous matter is absorbed, and swells the face and hands by its stimulus.

Variola confluens. The confluent small-pox consists of numerous pustules, which appear on the third day of the fever, flow together, are irregularly circumscribed, flaccid, and little elevated; the fever continuing after the eruption is complete; convulsions do not precede this kind of small-pox, and are so far to be esteemed a favourable symptom.

The confluent small-pox is attended with sensitive inirritated fever, or inflammation with arterial debility; whence the danger of this disease is owing to the general tendency to gangrene, with petechiæ, or purple spots, and hæmorrhages; besides the two sources of danger from the tumor of the throat about the height, or eleventh day of the eruption, and the purulent fever after that time; which are generally much more to be dreaded in this than in the distinct small-pox described above.

M. M. The method of treatment must vary with the degree and kind of fever. Venesection may be used in the distinct small-pox early in the disease, according to the strength or hardness of the pulse; and perhaps on the first day of the confluent small-pox, and even of the plague, before the sensorial power is exhausted by the violence of the arterial action? Cold air, and even washing or bathing in cold water, is a powerful means in perhaps all eruptive diseases attended with fever; as the quantity of eruption depends on the quantity of the fever, and the activity of the cutaneous vessels; which may be judged of by the heat produced on the skin; and which latter is immediately abated by exposure to external cold. Mercurial purges, as three grains of calomel repeated every day during the eruptive fever, so as to induce three or four stools, contribute to abate inflammation; and is believed by some to have a specific effect on the variolous, as it is supposed to have on the venereal contagion.

It has been said, that opening the pock and taking out the matter has not abated the secondary fever; but as I had conceived, that the pits, or marks left after the small-pox, were owing to the acrimony of the matter beneath the hard scabs, which not being able to exhale eroded the skin, and produced ulcers, I directed the faces of two patients in the confluent small-pox to be covered with cerate early in the disease, which was daily renewed; and I was induced to think, that they had much less of the secondary fever, and were so little marked, that one of them, who was a young lady, almost entirely preserved her beauty. Perhaps mercurial plasters, or cerates, made without turpentine in them, might have been more efficacious, in preventing the marks, and especially if applied early in the disease, even on the first day of the eruption, and renewed daily. For it appears from the experiments of Van Woensel, that calomel or sublimate corrosive, triturated with variolous matter, incapacitates it from giving the disease by inoculation. Calomel or sublimate given as an alterative for ten days before inoculation, and till the eruptive fever commences, is said with certainty to render the disease mild by the same author. Exper. on Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.

Variola inoculata. The world is much indebted to the great discoverer of the good effects of inoculation, whose name is unknown; and our own country to Lady Wortley Montague for its introduction into this part of Europe. By inserting the variolous contagion into the arm, it is not received by the tonsils, as generally happens, I suppose, in the natural small-pox; whence there is no dangerous swelling of the throat, and as the pustules are generally few and distinct, there is seldom any secondary fever; whence those two sources of danger are precluded; hence when the throat in inoculated small-pox is much inflamed and swelled, there is reason to believe, that the disease had been previously taken by the tonsils in the natural way.—Which also, I suppose, has generally happened, where the confluent kind of small-pox has occurred on inoculation.

I have known two instances, and have heard of others, where the natural small-pox began fourteen days after the contagion had been received; one of these instances was of a countryman, who went to a market town many miles from his home, where he saw a person in the small-pox, and on returning the fever commenced that day fortnight: the other was of a child, whom the ignorant mother carried to another child ill of the small-pox, on purpose to communicate the disease to it; and the variolous fever began on the fourteenth day from that time. So that in both these cases fever commenced in half a lunation after the contagion was received. In the inoculated small-pox the fever generally commences on the seventh day, or after a quarter of a lunation; and on this circumstance probably depends the greater mildness of the latter. The reason of which is difficult to comprehend; but supposing the facts to be generally as above related, the slower progress of the contagion indicates a greater inirritability of the system, and in consequence a tendency to malignant rather than to inflammatory fever. This difference of the time between the reception of the infection and the fever in the natural and artificial small-pox may nevertheless depend on its being inserted into a different series of vessels; or to some unknown effect of lunar periods. It is a subject of great curiosity, and deserves further investigation.

When the inoculated small-pox is given under all the most favourable circumstances I believe less than one in a thousand miscarry, which may be ascribed to some unavoidable accident, such as the patient having previously received the infection, or being about to be ill of some other disease. Those which have lately miscarried under inoculation, as far as has come to my knowledge, have been chiefly children at the breast; for in these the habit of living in the air has been confirmed by so short a time, that it is much easier destroyed, than when these habits of life have been established by more frequent repetition. See Sect. XVII. 3. Thus it appears from the bills of mortality kept in the great cities of London, Paris, and Vienna, that out of every thousand children above three hundred and fifty die under two years old. (Kirkpatrick on Inoculation.) Whence a strong reason against our hazarding inoculation before that age is passed, especially in crowded towns; except where the vicinity of the natural contagion renders it necessary, or the convenience of inoculating a whole family at a time; as it then becomes better to venture the less favourable circumstances of the age of the patient, or the chance of the pain from toothing, than to risk the infection in the natural way.

The most favourable method consists in, first, for a week before inoculation, restraining the patients from all kinds of fermented or spirituous liquor, and from animal food; and by giving them from one grain to three or four of calomel every other day for three times. But if the patients be in any the least danger of taking the natural infection, the inoculation had better be immediately performed, and this abstinence then began; and two or three gentle purges with calomel should be given, one immediately, and on alternate days. These cathartics should not induce more than two or three stools. I have seen two instances of a confluent small-pox in inoculation following a violent purging induced by too large a dose of calomel.

Secondly, the matter used for inoculation should be in a small quantity, and warm, and fluid. Hence it is best when it can be recently taken from a patient in the disease; or otherwise it may be diluted with part of a drop of warm water, since its fluidity is likely to occasion its immediate absorption; and the wound should be made as small and superficial as possible, as otherwise ulcers have been supposed sometimes to ensue with subaxillary abscesses. Add to this, that the making two punctures either on the same, or one on each arm, secures the success of the operation in respect to communicating the infection.

Thirdly, at the time of the fever or eruption the application of cool air to those parts of the skin, which are too warm, or appear red, or are covered with what is termed a rash, should be used freely, as well as during the whole disease. And at the same time, if the feet or hands are colder than natural, these should be covered with flannel. See Class IV. 2. 2. 10.

10. Rubeola irritata, morbilli. The measles commence with sneezing, red eyes, dry hoarse cough, and is attended with sensitive irritated fever. On the fourth day, or a little later, small thick eruptions appear, scarcely eminent above the skin, and, after three days, changing into very small branny scales.

As the contagious material of the small-pox may be supposed to be diffused in the air like a fine dry powder, and mixing with the saliva in the mouth to infect the tonsils in its passage to the stomach; so the contagious material of the measles may be supposed to be more completely dissolved in the air, and thus to impart its poison