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.