diagnosticks of which it would be unpardonable to omit; because it
has often and fatally been either confounded with, and treated as
genuine pulmonick inflammation, or slighted as a catarrh. This is named
Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It
is most frequent in persons old, phlegmatick, fat, weak, emaciated,
subject to catarrh, addicted to fermented and spirituous liquors; and
in foggy weather and rainy winters. It appears in the same seasons
with genuine pulmonick inflammation, and with catarrh; that is, in
spring and autumn; and frequently under the veil of a violent catarrh.
The fever and heat are inconsiderable; the pulse not hard nor tense;
but there is straitness and difficulty of breathing, and load at the
breast, with anxiety and gasping for breath; urgent violent cough, with
some expectoration, and sometimes exciting vomiting; giddiness of the
head; rending headach; sometimes drowsiness. It is sometimes suddenly
and unexpectedly aggravated, and suffocates the patient.
The predisposing and occasional _causes_ of pulmonick inflammation are,
epidemick state of the air; sudden vicissitudes of the seasons and
weather from heat to cold; sudden suppression of perspiration, or of
pulmonary exhalation; inspiration of cold air; sudden exposure to keen
cold air, especially after breathing in a warm room, or drinking warm
liquors; cold liquors drank when the body is heated; intemperance and
sottishness, particularly in spirituous liquors; dry cold winds; strong
muscular exercise, or manual labour; repulsion of cutaneous eruption,
febrile or chronic; exsiccation of old ulcers; suppression of habitual
evacuation and eruption; translation to and deposition of morbid
matter on the lungs; consequence and dregs of small pox and measles;
symptomatick from some other diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary,
are very rare diseases. The symptoms of Carditis are severe fever; pain
and anxiety in the region of the heart; difficulty of breathing; cough;
irregular pulse; palpitation, syncope. Inflammation of the diaphragm,
paraphrenitis: the symptoms are, acute fever, intense pain in the
breast darting to the back, and increased by inspiration, coughing and
sneezing, and by natural exertion at stool and urine; restlessness,
anxiety, dry cough, quick convulsive breathing; sneezing, hiccup,
nausea, vomiting; compulsive painful grin on the countenance, delirium.
When it occurs, it is generally complicated with inflammation of the
adjacent organs, in either the thorax or the abdomen. As the heart
is the main spring of the blood’s circulation, and the diaphragm the
principal agent in respiration, it is evident that inflammation in
either must be extremely dangerous.
_Inflammation of the Liver_, hepatitis, acute and chronic. Both species
are much more frequent in tropical climates and warm regions, than
in northern and cold; and more so in the former during the hottest
seasons of the year. The sensibility of the liver being dull, its
inflammation is less painful than that of any other viscus. The
symptoms are, fever, pain in the right side under the false ribs, and
felt at the corresponding clavicle, scapula, and hand; sensation of
heat and heaviness in the hepatick region; difficulty of breathing,
more especially when the inflammation invests the superior convex part
of the liver; there is often dry cough; nausea, bilious vomiting, and
diarrhœa; the urine of a fiery or saffron-colour; and generally, but
not always, the eyes, countenance, and skin more or less of a jaundice
tinge; the pulse not remarkably disturbed; but thirst. Sometimes
hepatick inflammation is entangled with that of some contiguous organs
of the lungs or abdomen, and with their respective features. The acute
hepatitis, but not the chronic, is usually terminated in a few days,
at the utmost fourteen or twenty-one, by discussion, suppuration, or
gangrene. Critical resolution may be variously accompanied with bilious
diarrhœa and urine, nasal or hemorrhoidal hemorrhage, copious bilious
sweats. Suppuration is not an unfrequent termination: after which
many survive, but with difficult and slow recovery. The purulency may
be expurgated by absorption, by the biliary ducts, by erosion of the
abdominal muscles, or by an artificial opening when the abscess is
perceptible externally; and sometimes it erodes the diaphragm and lungs.
The predisposing and occasional _causes_ are, burning climates;
acrid viscid bile; the blood tenacious and glutinous in consistence;
calculi, steatome, worms in the biliary ducts; bilious vomiting; sudden
refrigeration of the body when heated, and obstructed perspiration;
thirst, and not sufficient dilution of the blood; intoxication and
abuse of spirituous liquors; poisons; external injuries; violent
exercise; passions of mind; inveterate hypochondriasm; translation of
purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ
is far more frequent. The Peritonitis is also an uncommon inflammatory
vagrant: it will be revived hereafter under Puerperal Fever.
_Inflammation of the stomach_, gastritis. Notwithstanding the incessant
irritation and distinction of this sensible organ, by innumerable
varieties of food and drink, yet its inflammation is a rare event. The
symptoms, acute fever; fixed burning pain and heat in the region of the
stomach, aggravated by pressure; frequent nausea and vomiting after
taking any nourishment; anxiety, restlessness; weak, hard, intermittent
pulse; frequently delirium; universal debility. It may prove fatal in
the space of a few days, or even of a few hours: there are different
gradations of severity and danger. The termination is by resolution,
suppuration, gangrene. The predisposing and occasional _causes_ are,
all the causes of topical inflammations in general; poisons swallowed;
cold water, ices, and fruits swallowed when the body is much heated;
repletion from food and gormandizing; crude and difficultly digested
nutriment; violent agitation of body or mind; external injuries: from
repelled gout very rarely.
The three succeeding genera of the phlogistick tribe, so far as
respects mere inflammation only, affect the external parts and
circumference of the body, and do not suppurate. In other respects
there is a distinct tripartite separation, both as to general outlines
and minuter shades.
_Erysipelas_, ignis sanct. antonii: gutta rosacea, zoster, zona,
herpes. Some trifling pillage by this disease is noticed in the
London bills. To adults it is most hostile. The symptoms are, more or
less fever; superficial inflammation of some portion of the skin and
cuticular membrane, with pain, tumefaction, burning heat, redness, and
pruriency, like that from nettles; and variously, in different persons,
assailing the face, the neck, the trunk, or one of the extremities:
the eruption seldom appears until after the commencement of the
febrile commotion; and often from a small point spreads gradually:
it never rises to any conical eminence, nor suppurates, but often
excites vesications; and if on the face and violent, blocks up the
eyelids: the pulse is frequently full and hard; and with the eruptive
expulsion the fever and heat do not cease. It is sometimes critical and
salutary: the favourable crisis is usually in a few days, or within
nine, by perspiration, urine, and desquamation of the inflamed cuticle;
and sometimes without any perceptible revulsion to the excretories.
Some have this cutaneous inflammation annually, or oftener, or at
wider intervals; and those once affected, are more obnoxious to its
returns. Presages of danger are, violent inflammation and intumescence
on the face, or sometimes even on the legs, particularly in old age,
or unsound constitutions; premature retrocession of the eruption;
pale colour; frequent return, and repetition of the inflammation;
delirium; coma; gangrene. On the legs it sometimes leaves behind a
chronic enlargement. The zoster and zona is a species of erysipelatous
inflammation, a hand’s breadth or more, affecting the breast, sides, or
abdomen, and various in length.
The predisposing and occasional _causes_ of Erysipelas are, epidemick
influence of the air; obstructed perspiration; sudden refrigeration
of the body when heated; plethora; suppressed evacuations, natural or
artificial; luxurious living and indolence; intemperance; spirituous
liquors in excess; poisons; unsound constitutions; contusions, wounds,
burns, punctured nerves, blisters, acrids; dregs of fevers; scorbutick;
lunar influence; passions of mind.
_Rheumatism, acute and chronic._ From the Chart of diseases we may
rank rheumatism as an inferior piratical foe amongst the morbid host;
or rather as a scourge and instrument of torture than of execution. In
the acute or chronic form, multitudes are molested by it, especially
in this island, and in northern regions: and more so in winter, in
spring, and autumn, and the interchanges of the seasons: it seldom
molests very young or aged persons: adults are most annoyed by it;
the male more than the female sex; the poor and indigent more than
the affluent; and those most who are exposed to the inclemency and
vicissitudes of the seasons and weather: hence, during war, soldiers
and sailors are much more afflicted with it than in peace.
In the acute rheumatism, fever may commence before or after the pain,
which variously and alternately seems to dilacerate different parts,
especially about the joints of the ancles, knees, hips, shoulders,
elbows, and wrists, sometimes the trunk; but rarely the small joints
of the toes or fingers: and commonly succeeded by swelling and redness
of the distracted joints, and with restlessness: at night the pains
are exasperated, and often suddenly abating in one joint, seize upon
another; thus harassing the body with a war of posts. In its diagnostic
train also are, hard quick pulse, sizy blood, inflammatory urine;
sweats sometimes copious, but not critical. Its continuance may be
one, two, or three weeks; by which time the fever, if not mismanaged,
abates with the pains: it very rarely terminates in suppuration, and in
this instance resembles erysipelas and gout. The crisis of the acute is
generally by sweats, cuticular efflorescence, nasal hemorrhage. It may
terminate inauspiciously in chronic pains, or in consumption: indeed,
emaciation is always a consequence.
Chronic rheumatism may occupy all the stations of the acute: in the
hips it is called ischias, morbus coxendicis, and sciatica: in the
loins, lumbago. In this there is no fever, redness, nor swelling,
only pain and often inability to move the affected joints; and this
aggravated by change of weather and cold. In the lumbago there is
direful pain about the loins, with difficulty in erecting the trunk;
but not, as in the nephritis, accompanied with nausea or vomiting,
nor pain of the ureters, testicles, or thighs. In the ischias there
is severe fixed pain about the hips, os sacrum, and pubis, and often
extending down the thigh and leg along the fascia aponeurotica; with
difficulty or incapacity of moving the thigh; and sometimes atrophy
of that extremity, or sciatic tabes. Chronic rheumatism may harass
months, years, with various degrees of severity and exacerbation, and
interludes of ease; and is often extremely obstinate and difficult to
be dislodged. In many instances also, we observe a contrariety and
dilemma whether to affix the name of chronic rheumatism or gout to
such pains. In general, rheumatic aches are not so periodical in their
returns; and in several other features the two diseases divaricate.
The predisposing and occasional _causes_ of acute and chronic
rheumatism, idiopathic and symptomatick, are, sudden suppression of
perspiration; sudden heats and colds; cold damp night air, beds,
houses, habitations, want of sufficient warm cloathing and fuel in
rigorous seasons, or during the interchanges of the seasons; wet
cloaths; exposure to heats and colds; sudden vicissitudes of heat
and cold; change of winds and weather; one part of the body exposed
to cold whilst the other part is heated; sleeping on damp ground;
plethora; impure blood; repelled eruption; suppressed evacuations;
habitual intoxication; intermittent; dregs of fever; arthritic;
hereditary; scorbutick; hysterical; venereal; noxious exhalation
from lead or mercury; excess of venery; tabes dorsalis; aneurism of
the descending aorta near the loins; lifting great weights; internal
abscess and scirrhus; abscess, and caries at the upper articulation of
the thigh-bone; sprains; luxation and fracture of its neck; diseases of
the coverings of the nerves, or of their medullary substance, or of the
muscular fibre.
_Gout_, arthritis, podagra; acute, chronic, regular, and irregular.
Here we have no foundation to accuse the elements, or the invisible
demons of disease: this malady either immediately, or by hereditary
descent, is too often the natural castigation and penance of
voluptuousness and sensuality. In the preceding century it was
confounded with sciatica in the London bills. During the present
century, there is a considerable increase in arthritic mortality; but,
compared to some other of the morbid host, it is a mere buccanier.
Arthritic piracy must solely be imputed to the assaults of chronic
gout, either gradually breaking down the fabrick, or storming some
of the internal organs essential to life. It attacks principally the
male sex; sometimes, but rarely, females; and of the latter those of
robust full habits, the viragines, luxurious, indolent, corpulent,
and generally after the final menstrual cessation: the majority, from
the peculiarity in the female constitution, and from superiority in
temperance, are exempt. It seldom attacks before middle age; generally
in the decline of life: the few exceptions of its earlier occurrence
are rare; and in them it is usually by co-operation of hereditary, and
of remote exciting causes: in adolescence, and before puberty, it would
be numbered amongst the medical miracles. It harasses most those of
robust, full, corpulent, large frame and temperament, the voracious,
gormandizing, affluent, and pampered; more of the patrician than the
plebeian orders; more of the literary and sedentary professions; and,
according to Sydenham, those of an acute genius and intellectual
eminence. The active and industrious orders of every community; those
who are exercised in daily corporeal labour, or who, from necessity,
design, custom, or religion, do not indulge to excess in animal food,
or in wine and fermented liquors, are seldom arthritick martyrs.
Compared to the number afflicted, very few die of gout; it has even
been by some considered as an omen of longevity: many, subject to it,
have reached the Mosaick goal. It has been alledged, to render men more
secure from other diseases; and in some few instances to expurgate and
renovate a disordered constitution. These observations, however, must
be restricted to regular gout only, and recurring at distant intervals.
That periodical local pain and inflammation called the regular
arthritic paroxism sometimes invades suddenly, without any warning; but
in general there are presages of its approach, one or two days, or even
weeks; by ceasing of usual moisture on the feet; coldness, numbness in
the feet and legs, enlargement of their veins, muscular cramps; general
torpor and languor; restlessness; headach; depression of spirits;
impaired appetite; flatulence, indigestion, cardialgy; costiveness.
But frequently one or two days preceding the paroxism, the appetite
is keener than usual. The regular and recent paroxism commonly invades
by nocturnal surprize in bed, with pain in one foot, usually the
ball of the great toe, accompanied with shivering, heat, and shortly
after, conspicuous glossy redness, tension, and spreading tumor.
The pain becomes often so intense as to be compared to premeditated
dislocation, or to a dog tearing the flesh and ligaments: and such is
the exquisite tenderness in the inflamed part and foot, as not to be
able to tolerate the slightest touch or even weight of the bed-cloaths.
In this way there are more or less diurnal remissions and exacerbations
of pain; which, after one, two, three, or four weeks, recedes gradually
and insensibly, together with the redness and swelling; leaving the
patient who had been chained to a bed or couch, in perfect health;
and soon after, the foot in the exercise of its former suppleness and
strength. Throughout the paroxism the corporeal agony renders the mind
more irritable and irascible: the urine is acrid, hot, turbid, and
fabulous; in many, the perspiration is fetid; and with both general
and local sweats, and desquamation of the inflamed cuticle, the
paroxism finally evaporates. In vigorous constitutions the paroxisms
are sooner terminated: indications of which are, sudden tumefaction,
throbbing pain, and frightful sleep. In recent gout the pain is more
severe than in chronic; the paroxisms shorter, with longer intervals;
and _vice versa_. Pustular eruptions on the foot sometimes carry off
the arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more
regular and distant; at intervals of three or four years, or longer:
by degrees the intervals are progressively reduced to two, to one; to
two paroxisms annually about the equinoxes and solstices, and during
the autumn, winter, and spring; at the same time the paroxisms are
protracted to two or three months. At length, in the chronic inveterate
stages of the disease the patient enjoys a very short respite; some
few of the enervated, perhaps only two or three months during the
summer: the pains in the extremities are then indeed less violent;
but the stomach is more disordered. In recent gout, one foot only is
assaulted; by degrees both feet, one after the other: and in the rooted
state of the disease it not only torments both feet in succession, but
capriciously deserts and re-attacks various parts; the ancle, knee,
elbow, wrist; darting often with electrical velocity and shocks through
the nerves and muscular fibres: thus, in a circle of torture and
litigious warfare, teazing the arthritick victim.
When either the inflammation of the joints has commenced in the usual
manner, but without an adequate degree of pain and inflammation,
or at least without continuing the usual time, and precipitately
recedes, some internal organ is exposed in its retreat and rebound.
Or when the arthritick fuel is occluded, and not ejected to the feet,
it will, according to the various parts and organs affected, excite
corresponding vibrations and symptoms in the natural, vital, and animal
functions; as inappetency, indigestion, nausea, vomiting, flatulence,
ventricular eructation, colick, diarrhœa, nephritis, and urinary
obstructions; difficult respiration, asthma, palpitation, fainting,
general debility, low spirits, hypochondriasm, cramps and spasms in the
muscles, apoplexy, palsy. In dubious cases from what source to derive
such irregular alarms and minatory explosion; if they happen about the
usual arthritic periods, and in such temperaments, their origin may be
suspected: and it is of the highest moment to know that they are rarely
of an inflammatory nature. After the disease has continued many years
with frequent reiterated paroxisms the joints do not soon recover,
but continue weak and stiff. In many cases, chalky and calculous
concretions are formed in the joints of the extremities, and in the
kidneys and urinary passages. Racked by those combined tortures, the
patient requires the auxiliary aid of stuffed chairs, flannel, and
crutches.
The predisposing and occasional _causes_ are hereditary; inactive
sedentary life, with luxurious living and gormandizing, especially on
animal food; intemperance in wine, spirituous or fermented liquors;
early or intemperate libations to Bacchus and Venus; unremitting
application to study or business; sedentary life; nocturnal
lucubrations; disturbed sleep, cares, misfortunes, vexation, depressing
passions; ceasing of usual exercise or labour; sudden transition
from an active to a sedentary life; coaches, dissipation, luxury,
effeminacy; sudden violent changes in diet; plethora; suppressed
evacuations; profuse evacuations; various causes of debility;
indigestion from quantity or quality of aliment.
_Of internal suppuration_ in the lungs, liver, stomach, intestines,
kidneys. Pulmonick suppuration, empyema, or vomica, may be predicted
from preceding inflammation, without considerable remissions, the
neglect of effectual remedies, and no signs of resolution by the
efforts of nature or art, and by remission of acute pain; the
difficulty of respiration and also cough continuing; with frequent
horrors and shivering, heat and hectic, weight and throbbing in the
side, laying on the diseased side painful; dyspnœa aggravated by a
recumbent posture; disagreeable taste in the tongue; thirst; fetid
breath; emaciation. It may burst in all the intervals between fourteen
and sixty days, and either relieves or suffocates, or is gradually
expectorated: and sometimes, after absorption, may be evacuated by
diarrhœa or urine: the purulent contents may also be discharged upon
the diaphragm, or between the pleura and intercostal muscles. Sometimes
there are several small abscesses; and too frequently the final
termination is ulceration and phthisis. Suppuration in the Liver is a
frequent consequence of previous inflammation, and is not altogether
so fatal as some other internal abscesses. Its symptoms are those in
common with internal formation of pus, horror and chilliness, hectic
heat, thirst, weight and load in that region, jaundice-colour of
the eyes. Sometimes the purulence erodes the external integuments;
sometimes the diaphragm, lungs, or stomach; sometimes is discharged
by the biliary ducts into the intestines, or absorbed and washed away
with the urine. Suppuration in the stomach and intestines is rare. In
the kidneys, the general symptoms, with purulent fetid urine: it may
also burst externally; or by slow ulceration and hectic, undermine the
constitution.
Of _Internal Gangrene_ in the lungs, stomach, intestines, kidneys,
liver. Pulmonick gangrene from inflammation, is predicted by sudden
cessation of pain, without any benign crisis: expectoration either
suppressed, or yellow, green, black, and fetid; hollow noise in the
breast during respiration; dejected countenance; red and heavy eyes;
foul and black tongue; quick, languid, and intermittent pulse; fetid
urine, stools, and sweat; hiccup; cold sweats; universal debility
and sinking of the vital powers. From the preceding symptoms, from
those enumerated under general febrile prognosticks, and from the
functions peculiar to the different diseased organs, internal gangrene
in whatsoever part may be comprehended; and a minute detail would be
superfluous.
* * * * *