Zoonomia; Or, the Laws of Organic Life, Vol. II
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Title: Zoonomia; Or, the Laws of Organic Life, Vol. II
Author: Erasmus Darwin
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ZOONOMIA;
OR,
THE LAWS
OF
ORGANIC LIFE.
VOL. II.
_By ERASMUS DARWIN, M.D. F.R.S._
AUTHOR OF THE BOTANIC GARDEN.
Principio coelum, ac terras, camposque liquentes,
Lucentemque globum lunae, titaniaque astra,
Spiritus intus alit, totamque infusa per artus
Mens agitat molem, et magno se corpore miscet.--VIRG. Aen. vi.
Earth, on whose lap a thousand nations tread,
And Ocean, brooding his prolific bed,
Night's changeful orb, blue pole, and silvery zones,
Where other worlds encircle other suns,
One Mind inhabits, one diffusive Soul
Wields the large limbs, and mingles with the whole.
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.
* * * * *
Haec, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa ut
sint et fixa, quae dixero; sed ut Homunculus unus e multis probabiliora
conjectura 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 causae eorum
proximae, qualiscunque sit, revera 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 diarrhoea,
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 Nosologiae 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.
DERBY, _Jan._ 1, 1796.
* * * * *
ZOONOMIA.
PART II.
* * * * *
CLASSES OF DISEASES.
* * * * *
I. DISEASES OF IRRITATION.
II. DISEASES OF SENSATION.
III. DISEASES OF VOLITION.
IV. DISEASES OF ASSOCIATION.
* * * * *
_The Orders and Genera of the First Class of Diseases._
* * * * *
CLASS I.
DISEASES OF IRRITATION.
ORDO I.
_Increased Irritation._
GENERA.
1. With increased actions of the sanguiferous system.
2. With increased actions of the secerning system.
3. With increased actions of the absorbent system.
4. With increased actions of other cavities and membranes.
5. With increased actions of the organs of sense.
ORDO II.
_Decreased Irritation._
GENERA.
1. With decreased actions of the sanguiferous system.
2. With decreased actions of the secerning system.
3. With decreased actions of the absorbent system.
4. With decreased actions of other cavities and membranes.
5. With decreased actions of the organs of sense.
ORDO III.
_Retrograde Irritative Motions._
GENERA.
1. Of the alimentary canal.
2. Of the absorbent system.
3. Of the sanguiferous system.
* * * * *
_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.
1. _Febris irritativa._ Irritative fever.
2. _Ebrietas._ Drunkenness.
3. _Haemorrhagia arteriosa._ Arterial haemorrhage.
4. _Haemoptoe arteriosa._ Spitting of arterial blood.
5. _Haemorrhagia narium._ Bleeding from the nose.
GENUS II.
_With Increased Actions of the Secerning System._
SPECIES.
1. _Calor febrilis._ Febrile heat.
2. _Rubor febrilis._ Febrile redness.
3. _Sudor calidus._ Warm sweat.
---- _febrilis._ Sweat in fevers.
---- _a labore._ ---- from exercise.
---- _ab igne._ ---- from fire.
---- _a medicamentis._ ---- from medicines.
4. _Urina uberior colorata._ Copious coloured urine.
5. _Diarrhoea calida._ Warm diarrhoea.
---- _febrilis._ ---- from fever.
---- _crapulosa._ ---- from indigestion.
---- _infantum._ ---- of infants.
6. _Salivatio calida._ ---- salivation.
7. _Catarrhus calidus._ ---- catarrh.
8. _Expectoratio calida._ ---- expectoration.
9. _Exsudatio pone aures._ Discharge behind the ears.
10. _Gonorrhoea calida._ Warm gonorrhoea.
11. _Fluor albus calidus._ ---- fluor albus.
12. _Haemorrhois alba._ White piles.
13. _Serum e visicatorio._ Discharge from a blister.
14. _Perspiratio foetida._ Fetid perspiration.
15. _Crines novi._ New hairs.
GENUS III.
_With increased Actions of the Absorbent System._
SPECIES.
1. _Lingua arida._ Dry tongue.
2. _Fauces aridae._ Dry throat.
3. _Nares aridi._ Dry nostrils.
4. _Expectoratio solida._ Solid expectoration.
5. _Constipatio alvi._ Costiveness.
6. _Cutis arida._ Dry skin.
7. _Urina parcior colorata._ Diminished coloured urine.
8. _Calculus felleus et icterus._ Gall-stone and jaundice.
9. ---- _renis._ Stone of the kidney.
10. ---- _vesicae._ Stone of the bladder.
11. ---- _arthriticus._ Gout-stone.
12. _Rheumatismus chronicus._ Chronic rheumatism.
13. _Cicatrix vulnerum._ Healing of ulcers.
14. _Corneae obfuscatio._ Scar on the cornea.
GENUS IV.
_With increased Actions of other Cavities and Membranes._
SPECIES.
1. _Nictitatio irritativa._ Irritative nictitation.
2. _Deglutitio irritativa._ Irritative deglutition.
3. _Respiratio et tussis._ Respiration and cough.
4. _Exclusio bilis._ Exclusion of the bile.
5. _Dentitio._ Toothing.
6. _Priapismus._ Priapism.
7. _Distensio mamularum._ Distention of the nipples.
8. _Descensus uteri._ Descent of the uterus.
9. _Prolapsus ani._ Descent of the rectum.
10. _Lumbricus._ Round worm.
11. _Taenia._ Tape-worm.
12. _Ascarides._ Thread-worms.
13. _Dracunculus._ Guinea-worm.
14. _Morpiones._ Crab-lice.
15. _Pediculi._ Lice.
GENUS V.
_With increased Actions of the Organs of Sense._
SPECIES.
1. _Visus acrior._ Acuter sight.
2. _Auditus acrior._ ---- hearing.
3. _Olfactus acrior._ ---- smell.
4. _Gustus acrior._ ---- taste.
5. _Tactus acrior._ ---- touch.
6. _Sensus caloris acrior._ ---- sense of heat.
7. ---- _extensionis acrior._ ---- sense of extension.
8. _Titillatio._ Tickling.
9. _Pruritus._ Itching.
10. _Dolor urens._ Smarting.
11. _Consternatio._ Surprise.
ORDO II.
_Decreased Irritation._
GENUS I.
_With decreased Actions of the Sanguiferous System._
SPECIES.
1. _Febris inirritativa._ Inirritative fever.
2. _Paresis inirritativa._ ---- debility.
3. _Somnus interruptus._ Interrupted sleep.
4. _Syncope._ Fainting.
5. _Haemorrhagia venosa._ Venous haemorrhage.
6. _Haemorrhois cruenta._ Bleeding piles.
7. _Haemorrhagia renum._ ---- from the kidneys.
8. ---- _hepatis._ ---- from the liver.
9. _Haemoptoe venosa._ Spitting of venous blood.
10. _Palpitatio cordis._ Palpitation of the heart.
11. _Menorrhagia._ Exuberant menstruation.
12. _Dysmenorrhagia._ Deficient menstruation.
13. _Lochia nimia._ Too great lochia.
14. _Abortio spontanea._ Spontaneous abortion.
15. _Scorbutus._ Scurvy.
16. _Vibices._ Extravasations of blood.
17. _Petechiae._ Purple spots.
GENUS II.
_With decreased Actions of the Secerning System._
SPECIES.
1. _Frigus febrile._ Coldness in fevers.
---- _chronicum._ ---- permanent.
2. _Pallor fugitivus._ Paleness fugitive.
---- _permanens._ ---- permanent.
3. _Pus parcius._ Diminished pus.
4. _Mucus parcior._ Diminished mucus.
5. _Urina parcior pallida._ Pale diminished urine.
6. _Torpor hepaticus._ Torpor of the liver.
7. _Torpor pancreatis._ Torpor of the pancreas.
8. _Torpor renis._ Torpor of the kidney.
9. _Punctae mucosae vultus._ Mucous spots on the face.
10. _Maculae cutis fulvae._ Tawny blots on the skin.
11. _Canities._ Grey hairs.
12. _Callus._ Callus.
13. _Cataracta._ Cataract.
14. _Innutritio ossium._ Innutrition of the bones.
15. _Rachitis._ Rickets.
16. _Spina distortio._ Distortion of the spine.
17. _Claudicatio coxaria._ Lameness of the hip.
18. _Spina protuberans._ Protuberant spine.
19. _Spina bifida._ Divided spine.
20. _Defectus palati._ Defect of the palate.
GENUS III.
_With decreased Actions of the Absorbent System._
SPECIES.
1. _Mucus faucium frigidus._ Cold mucus from the throat.
2. _Sudor frigidus._ ---- sweat.
3. _Catarrhus frigidus._ ---- catarrh.
4. _Expectoratio frigida._ ---- expectoration.
5. _Urina uberior pallida._ Copious pale urine.
6. _Diarrhoea frigida._ Cold diarrhoea.
7. _Fluor albus frigidus._ ---- fluor albus.
8. _Gonorrhoea frigida._ ---- gonorrhoea.
9. _Hepatis tumor._ Swelling of the liver.
10. _Chlorosis._ Green sickness.
11. _Hydrocele._ Dropsy of the vagina testis.
12. _Hydrocephalus internus._ ---- of the brain.
13. _Ascites._ ---- of the belly.
14. _Hydrothorax._ ---- of the chest.
15. _Hydrops ovarii._ ---- of the ovary.
16. _Anasarca pulmonum._ ---- of the lungs.
17. _Obesitas._ Corpulency.
18. _Splenis tumor._ Swelling of the spleen.
19. _Genu tumor albus._ White swelling of the knee.
20. _Bronchocele._ Swelled throat.
21. _Scrophula._ King's evil.
22. _Schirrus._ Schirrus.
23. ---- _recti._ ---- of the rectum.
24. ---- _urethrae._ ---- of the urethra.
25. ---- _oesophagi._ ---- of the throat.
26. _Lacteorum inirritabilitas._ Inirritability of the lacteals.
27. _Lymphaticorum inirritabilitas._ Inirritability of the lymphatics.
GENUS IV.
_With decreased Actions of other Cavities and Membranes._
SPECIES.
1. _Sitis calida._ Thirst warm.
---- _frigida._ ---- cold.
2. _Esuries._ Hunger.
3. _Nausea sicca._ Dry Nausea.
4. _Aegritudo ventriculi._ Sickness of stomach.
5. _Cardialgia._ Heart-burn.
6. _Arthritis ventriculi._ Gout of the stomach.
7. _Colica flatulenta._ Flatulent colic.
8. _Colica saturnina._ Colic from lead.
9. _Tympanitis._ Tympany.
10. _Hypochondriasis._ Hypochondriacism.
11. _Cephalaea frigida._ Cold head-ach.
12. _Odontalgia._ Tooth-ach.
13. _Otalgia._ Ear-ach.
14. _Pleurodyne chronica._ Chronical pain of the side.
15. _Sciatica frigida._ Cold sciatica.
16. _Lumbago frigida._ ---- lumbago.
17. _Hysteralgia frigida._ ---- pain of the uterus.
18. _Proctalgia frigida._ ---- pain of the rectum.
19. _Vesicae felleae inirritibilitas_ Inirritability of the gall-bladder
_et icterus._ and jaundice.
GENUS V.
_With decreased Actions of the Organs of Sense._
SPECIES.
1. _Stultitia inirritabilis._ Folly from inirritability.
2. _Visus imminutus._ Impaired vision.
3. _Muscae volitantes._ Dark moving specks.
4. _Strabismus._ Squinting.
5. _Amaurosis._ Palsy of the optic nerve.
6. _Auditus imminutus._ Impaired hearing.
7. _Olfactus imminutus._ ---- smell.
8. _Gustus imminutus._ ---- taste.
9. _Tactus imminutus._ ---- touch.
10. _Stupor._ Stupor.
ORDO III.
_Retrograde Irritative Motions._
GENUS I.
_Of the Alimentary Canal._
SPECIES.
1. _Ruminatio._ Chewing the cud.
2. _Ructus._ Eructation.
3. _Apepsia._ Indigestion, water-qualm.
4. _Vomitus._ Vomiting.
5. _Cholera._ Cholera.
6. _Ileus._ Iliac passion.
7. _Globus hystericus._ Hysteric strangulation.
8. _Vomendi conamen inane._ Vain efforts to vomit.
9. _Borborigmus._ Gurgling of the bowels.
10. _Hysteria._ Hysteric disease.
11. _Hydrophobia._ Dread of water.
GENUS II.
_Of the Absorbent System._
SPECIES.
1. _Catarrhus lymphaticus._ Lymphatic catarrh.
2. _Salivatio lymphatica._ Lymphatic salivation.
3. _Nausea humida._ Moist nausea.
4. _Diarrhoea lymphatica._ Lymphatic flux.
5. _Diarrhoea chylifera._ Flux of chyle.
6. _Diabaetes._ Diabetes.
7. _Sudor lymphaticus._ Lymphatic sweat.
8. _Sudor asthmaticus._ Asthmatic sweat.
9. _Translatio puris._ Translation of matter.
10. ---- _lactis._ ---- of milk.
11. ---- _urinae._ ---- of urine.
GENUS III.
_Of the Sanguiferous System._
SPECIES.
1. _Capillarium motus retrogressus._ Retrograde motion of the
capillaries.
2. _Palpitatio cordis._ Palpitation of the heart.
3. _Anhelatio spasmodica._ Spasmodic panting.
* * * * *
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. _Haemorrhagia arteriosa._ Arterial haemorrhage. Bleeding with a quick,
strong, and full pulse. The haemorrhages 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. _Haemoptoe 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 haemoptoe 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 haemoptoe, as in several
other haemorrhages? 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 haemorrhage, 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
haemoptoe; 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 haemorrhage. See Sect. XXVII. 1.
5. _Haemorrhagia 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 haemoptoe;
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
oeconomy 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. _Diarrhoea calida._ Warm diarrhoea. This species may be divided into
three varieties deduced from their remote causes, under the names of
diarrhoea febrilis, diarrhoea crapulosa, and diarrhoea infantum. The
febrile diarrhoea 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 diarrhoea there is no appearance of curdled chyle in
the stools, as occurs in cholera. I. 3. 1. 5.
The _diarrhoea crapulosa_, or diarrhoea 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 _diarrhoea infantum_, or diarrhoea 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 diarrhoea 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 diarrhoea, 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 diarrhoea 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 bronchiae, 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 perinaeum, 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. _Haemorrhois 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 foetida._ 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 odoriferae; 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 mamulae, 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 inertiae 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
diabaetes, 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 papillae
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 aridae._ 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 oesophagus, 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, foetid 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 vesicae._ 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. _Corneae 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 muscae 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 irritativae._ 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 diarrhoea 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 urethrae 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
faeces become highly putrid?
11. _Taenia._ 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. _Haemorrhagia 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
petechiae 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 haemorrhages, as well as to the haemorrhagia
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. _Haemorrhois 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. _Haemorrhagia renum._ Haemorrhage 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. _Haemorrhagia Hepatis._ Haemorrhage 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. _Haemoptoe venosa._ Venous haemoptoe 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
haemorrhage 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
haemoptoe, 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 haemoptoe 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 haemorrhage 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 haemorrhage, 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. _Petechiae._ 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. _Punctae mucosae vultus._ 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. _Maculae cutis fulvae._ 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 petechiae, 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 vertebrae, 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. _Spinae 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.
[Illustration]
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.
[Illustration]
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 vertebrae 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 diabaetes, 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. _Diarrhoea 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. _Gonorrhoea 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 portae. 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 p
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