community are exempted. We here associate together the inflammatory,
spasmodic, saturnine, bilious, flatulent, the infantile colick,
and other species. Colick is generally a temporary disease; and
with which some, much more than others, are afflicted at intervals.
Inflammation of the intestines ileus, volvulus, enteritis; generally
sudden assault of excruciating, fixed, and increasing pain, in some
degree affecting the whole abdomen, but more pungent about the navel;
with nausea, frequent vomiting of food and drink, and sometimes of
intestinal feculence; obstinate costiveness, severe gripes, eructation,
flatulence: the fever sometimes succeeding, sometimes preceding, the
local pain; and of which there are exacerbations and remissions, and
various gradations. The pulse at the beginning is not remarkably
full nor frequent, from which fatal mistakes and irremediable
procrastination, have often ensued in medical practice: the urine is in
small quantity, or suppressed. It is much more frequent in the narrow
than the wide part of the intestinal tube. In the rectum, constant
tenesmus, excretion of mucus; and in the male sex strangury are natural
consequences and symptoms. Inflammation or nephritick paroxisms in the
kidneys and ureters, with which it has been confounded, are hereafter
discriminated.
It is extremely dangerous and precipitate; frequently destroying in
a few days, sometimes in one day, and is seldom protracted beyond
nine. There is less danger in young than in old persons: abatement of
pain, cessation of nausea and vomiting, discharge of flatulence and of
feces, softer and freer pulse, are favourable symptoms: unfavourable
are, unconquerable costiveness, immoderate vomiting, tumid belly,
eructation, hiccup, cold extremities, gangrene; abscess rarely.
Inflammation is sometimes the effect, and not the original cause of
colick.
Under the spasmodick colick may be classed the colica pictonum,
saturnina, plumbeia, and dry belly-ach of the West Indies. The
symptoms, writhing pain in the abdomen, about the loins and back;
retraction of the navel towards the spine, dysury, ischury, or
strangury; costiveness with difficulty removed, and the feces in
conglobated lumps, vomiting, anxiety, depression of spirits. In the
saturnine the countenance is sometimes of a leaden colour, and there
is a saccharine taste on the tongue. This infests various classes of
artificers: sometimes terminating in chronic colick, in palsy of the
lower extremities, and in convulsions.
Bilious colick is accompanied with severe pain in the stomach and
intestines, nausea, sickness, vomiting of bile, costiveness, bitter
taste on the tongue, anxiety, dejection of spirits, dysury, often
flatulence. Its duration is short, but it is prone to return on any
intemperance or irregularity; sometimes it ends in jaundice. Flatulent
colick is distinguished by the pain being mobile, without much nausea
or vomiting, or hard pulse and thirst, or fever; by considerable
unusual distention of the abdomen, and flatulent explosion upwards
and downwards; and sometimes efforts to vomit until the flatulence is
ejected: respiration is also more or less interrupted.
The infant colick is very frequent, and infinitely more fatal in those
years than the London bills represent. Infants scream lamentably,
and cannot be appeased; they contract and draw up their legs to the
belly, are restless, sometimes costive; but often there is concomitant
diarrhœa and green feces, vomiting, flatulent explosion; and sometimes
the breath smells sour; in some the urine is suppressed; and many die
convulsed.
The predisposing and occasional _causes_ of colick, inflammatory,
spasmodick, bilious, and of most other species are, acrid matter of
aliment, medicines, poisons; acrid putrid bile; obstruction of the
intestinal tube by indurated feculence, hair-balls, cherry-stones,
calculi, steatome, volvulus, intusesception, contraction of the
intestines in some part; scirrhus, cancer, severe colick, spasm,
ruptures; wounds of the intestines; the aliments, pickles, condiments,
and luxuries of the table, cooked, prepared, or preserved in lead
or copper vessels not well tinned; the lead corroded from clayed
vessels used for domestick purposes; wine adulterated with lead; cyder
pressed in leaden cisterns; effluvia of lead to which painters and
some metallurgies are exposed; excess or acrimony of bile; broken
constitutions in tropical climates; acrid chyle; particular food or
drink; new fermented liquors; sudden suppression of perspiration; cold
wet feet; sudden passions of mind; flatulence and elastic air pent up;
muscular and nervous spasms; plethora menstrual, lacteal, hemorrhoidal,
scorbutick, rheumatick, arthritick, hysterick, nephritick; calculi
in the biliary ducts; epidemick; aneurism of the aorta; turgid
gall-bladder; spasm in the abdominal muscles, violent vomiting. In
infancy, corrupted meconium, crudity, and sour or adulterated milk;
suction to excess; acrid bile; the mother or nurse fasting too long
before the infant sucks; corrupted unwholesome milk of nurses; nurses
addicted to passion, to dram-drinking; insufficient exercise of the
infant; tight rollers round its abdomen; dentition; worms.
_Gall-Stones_, calculi cystici. We have no account of this disease in
ancient records. Until the beginning of the present century, it had
escaped the vigilance of medical observation. But it is now known, that
biliary concretions are, perhaps, not less frequent than those in the
urinary organs. Gall-stones infest more the adult, old, and sedentary;
and it is alledged, more females than males. The symptoms at first are
dubious, and are all to be weighed together in forming a diagnostick.
In attempting to descend throughout the gall-ducts, they excite direful
pain at the pit of the stomach and hepatick region, darting to the
back, with restlessness, anxiety, dyspnœa, jaundice-colour of the eyes,
costiveness, and commonly vomiting: the pain is aggravated by coughing
or sneezing, and sometimes ascends to the right shoulder and arm; but
the pulse and circulation are not accelerated.
In the expulsion of these calculi, there are usually reiterated
paroxisms, or exacerbations and remissions of pain. The continuance of
the paroxisms is from a few hours to days, weeks, or even months; but
the latter is rare; during which period either no stone is discharged,
or one or many stones are successively protruded. Their immediate
expulsion is accompanied with a sensation, as of something bursting in
that part, or of a fluid rushing into the intestines; and often some
tenderness is there left behind. The calculi vary in shape, colour,
consistence, size, and number; from a pea to a walnut, and from one to
dozens and scores. It is generally a tedious and chronic disease, and
may continue many years; often thro’ life. It is seldom immediately
dangerous, unless, as in nephritis, inflammation is kindled, or during
pregnancy. When chronic and inveterate, it may terminate in jaundice,
cachexy, dropsy. The symptoms of calculi in the gall-bladder are
obscure; such as weight, uneasiness, dull heavy pain at intervals,
sometimes temporary jaundice, cachexy, and diseases of the stomach.
The _causes_, hereditary, viscid, tenacious bile, sedentary life,
depressing passions, spirituous liquors; often ambiguous.
Whether any calculous concretions are formed in the pancreatick duct,
is yet unexplored by authors. The pancreatick fluid is nearly similar
to the saliva, which separates a tartarous sediment on the teeth.
_Jaundice_, icterus, morbus regius. Some of the eastern nations
have naturally this complexion. The mortality by jaundice is not
inconsiderable, amounting in the London bills, in the last thirty
years of the preceding century, to 2169; and in the present century
is doubled. The symptoms, heaviness and aversion to motion, itching
and dryness of the skin, yellowness of the tunica-conjunctiva of
the eyes, and also of the skin; the urine of a saffron-colour, and
tinging linen; objects appear yellow; there is thirst, bitter taste
in the tongue, bitter and yellow saliva, inappetency, indigestion,
costiveness, and frequently pale-coloured feces. Sometimes, though very
rarely, jaundice is local and not general. Jaundice may be critical,
symptomatick, idiopathick, periodick, chronick. From gall-stones it is
generally periodical; and such are prone to relapses. The prognosticks
are more favourable with natural sweats; in recent than in chronic; in
youth than in old age; in robust than in weak persons; in yellow than
mulatto tinge; and when not complicated with other dangerous diseases,
especially dropsy. Its duration and termination is various; from a few
days to weeks, and months.
The predisposing and occasional _causes_ are, sand, mucus, or
inspissated bile in the biliary ducts, especially the ductus communis;
tumors compressing the biliary ducts, or their concretion; scirrhous
duodenum; spasmodic, and flatulent colick obstructing the intestinal
orifice of the biliary ducts; violent passions of mind; strong emeticks
or purgatives; sudden refrigeration of the body; hepatic obstruction
and inflammation; languid circulation through the vena porta, sedentary
life; warm climates and broken constitutions; excess of bile and
re-absorption; cachexy; depraved state of the blood; symptomatick in
some intermittent and remittent fevers, pregnancy, scurvy, obstructed
spleen; venomous bites and stings. In infants, excess of bile and
meconium, or distention of the duodenum obstructing the biliary
excretory.
_Worms._ In assigning an adequate share of mortality to worms, the
London bills, probably, are defective. During the last thirty years
of the preceding century, they are rated at only fourteen hundred;
and continue decreasing throughout the present century. Perhaps a
portion of verminous mortality is confounded with colick and gripes,
or with hectic emaciation. Worms infest most in infancy and childhood;
but seldom until after ablactation; and then, probably, more of the
children of the necessitous than of the affluent. The principal species
of human worms are the rotunda, or lumbricalis, the tænia or lata, the
cucurbitina, and the ascarides: these are again, but with superfluous
subtility, subdivided by nosologists. The rotunda or lumbricalis,
has most resemblance to an earth-worm; it is forked at both ends,
but paler: in length various, from inches to feet: and often many
are entangled together in clusters. The tænia has some resemblance
to tape, consisting of numerous joints, or coherent links, about an
inch or more distant, and often many yards in length: this is most
frequent in the adult age. The ascarides are extremely numerous,
active, and minute, like fine needles, or the cuttings of white thread;
and generally burrow in the lower extremity of the intestinal tube of
children: the former species wallow through all parts of the alimentary
canal.
Verminous symptoms are numerous, various, and all extremely
ambiguous, unless worms are discharged with the feces: feculence in
the stomach and intestines may occasion all the other symptoms: such
as pale countenance; fugaceous flushing of the face and cheeks, and
circumscribed spots of redness; itching of the nose; swelling of the
upper lip and nose, and lower eye-lids; dilatation of the pupil;
grinding of the teeth; fetid breath, and eructation; flow of saliva;
irregular, impaired, or voracious appetite, nausea, vomiting, colick,
gripes and sudden screams from the violence of pain; tumid and enlarged
belly; costiveness, or diarrhœa and fetid stools; the urine sometimes
like milk; sudden startings in sleep, frightful dreams; palpitation
of the heart; dry hectic cough, atrophy; various nervous symptoms,
epilepsy, tetanus, convulsions. The ascarides excite irritation about
the anus, tenesmus, and dysury. These intestinal insects are often
most tormenting when the stomach and intestines are empty. Sometimes
they excite a symptomatick and slow fever, with hot skin, quick pulse,
thirst; and the children are then confined to bed. But without fever,
children pursue their usual amusements. The _causes_, improper diet
for these years, as cheese, farinaceous, legumens, fruits, saccharine,
putrid diet or unwholesome aliment, hereditary weak constitution, moist
air: the ova of the insects swallowed with the air, food, or drink.
_Hemorrhoides_, piles. Is a frequent and very universal disease in
both sexes, and most so during the adult stages and decline of life;
and by which the lives of many are incommoded and harassed. They are
distinguished into the blind and open, the external and internal; and
are temporary, periodical, and chronic. The blind piles denote small
imperforated lumps and tumors about the margin of the anus. Sometimes
the tumours and hemorrhage from the anus ensue without any previous
disease of the body; but generally some antecedent or accompanying
disorder is felt; such as vertigo, headach, pain of the back and loins,
oppression in the breast, colick, dysury, some fever and heat. The
approaching hemorrhage is with sense of fulness, heat, itching, and
pain about the anus, with tenesmus, costiveness, and conglobated feces;
and sometimes is preceded by a serous discharge, or this sometimes is
substituted for red blood. The quantity of sanguineous extravasation
is various in different persons, and in the same person at different
periods: from the internal vessels of the rectum it is more profuse
than from the external; and is generally during, or after the fecal
discharge: in other cases it is without fecal efforts, and then in
larger debilitating streams, but rarely immediately fatal. These
tumors, or sanguinous torrents, are almost always periodical, and at
various intervals. They are often salutary, if moderate, especially if
bad health preceded; and also as preservatives. In the decline of life,
when the hemorrhoidal flux has been frequent, but suddenly ceases, they
are in danger of apoplexy or palsy. On the other hand, in excess, it
may exhaust the body, injure the health, and terminate in dropsy or
consumption. Or sometimes hemorrhoidal tumours inflame, suppurate, and
form fistulas in ano.
The predisposing and occasional _causes_ hereditary; plethora, dense
blood, luxurious living, indolence and stimulating diet; intemperance,
especially in spirituous liquors; dried indigestible diet; suppression
of the menses, and their final cessation, and of other critical
evacuations; obstructions of the liver, spleen, of the mesenteric and
hemorrhoidal veins; reiterated and severe colick; abrasion of the
intestinal mucus; acrid purges; acrimony of the blood; costiveness,
and hardened feces; worms; sitting too long on the necessary, and
over-warm steams, or stoves; long sitting, riding, and compression of
the hemorrhoidal veins; diseases of the vagina, womb, and neck of the
bladder; prolapsus ani; pregnancy; rupture of the extremities of the
iliac arteries; effusion of blood into the cellular texture of the
intestines, near its extremity.
_Vomiting of Blood_, hematomosis, vomitus cruentus, is a very rare
disease. It is said to be more frequent in females than males; and
is an adult malady. The symptoms, weight, straitness, and anxiety
at the region of the stomach; nausea, cardialgy, efforts to vomit,
and discharge of blood without coughing: the colour depends upon the
time it has lain in the stomach, and is with various intermixtures of
food, bile, pituita: there is also great prostration of strength, and
proneness to faint. The quantity of this extravasation is various, from
ounces to pounds; and frequently some portion descends by the anus. It
is extremely dangerous, either immediately, or in its consequences.
If with fever and great force in the discharge, it may destroy in
a few paroxisms; or if chronic, may end in dropsy, consumption, or
diseases of the stomach and intestines. Slight eruptions have relieved
chronic maladies of the liver and spleen, hypochondriasm, hystericks,
and intermittents. From obstructed menses it is much less alarming.
The _causes_, obstructions of the liver, spleen, menses, hemorrhoids;
scirrhus of the stomach and liver, or spleen; suppression of habitual
discharges or evacuations, or old ulcers; dregs of intermittent fevers;
scorbutick; acrids and poisons swallowed, and violent efforts to vomit;
worms; violent passions; external injuries.
_Poisons._ By poisons conveyed through the mouth or wounds, very few of
the community are destroyed. The ancient Asiaticks, Greeks, and Romans,
were infected with the silly infatuation and apprehension of constantly
swallowing poison in their aliment. This was not an epidemical error
of the rabble, but had spread amongst their emperors and philosophers:
hence the pompous and absurd compositions of mithridate, theriac,
and other poisonous antidotes. None of the two hundred genera of the
quadruped creation, nor of birds, are poisonous; and very few of the
fish, or of the numerous insects and reptiles. Out of the many thousand
genera of the vegetable creation, the poisonous are comparatively
trifling: such are the napelli, apocyna, strammonium, solanum, laurus,
aconitum, manchinel, cicuta, opium, and a few others; some of which,
however, are powerful remedies. Of the mineral, the metals and
semi-metals, arsenick excepted, the preparations of lead, copper, and
mercury, are also amongst the potent remedies.
Of poisons, some corrode or burn, others are septic; and by far
the greatest number attack the vital principle, by either violent
irritation or torpidity: some have a more deadly malignity than others,
and are more speedily destructive. Most of the vegetable poisons excite
narcotic, stupifying, vertiginous, lethargic, convulsive, and emetic
symptoms, affecting the brain, external senses, heart, and stomach.
The minerals, as arsenick and corrosive sublimate, excite symptoms
of inflammation in the stomach, in the most violent degree; and both
copper and lead of spasmodic colick also. From their readier solution
in the stomach, the vegetable poisons, except by the symptoms, can
rarely be subjected to ocular detection; but by certain chymical
analysis, when in any considerable quantity, the mineral may be
discovered. Arsenick has a milky whiteness, is gritty and insipid; part
of it swims in water, like a pale film, the greatest part sinking to
the bottom undissolved: thrown on a red-hot iron plate, it does not
flame, but rises in thick white fumes, which have an offensive smell
of garlick, and cover cold iron held over them with thick flowers:
arsenick inclosed between two plates of copper, then put into the
fire and made red-hot, changes copper white. Copper is soluble in all
acids, and assumes a blue colour when corroded by any acid or saline
substance. Preparations of lead have a peculiar sweet taste; and wine
adulterated with lead is detected by any alkali, which renders the
mixture turbid, and precipitates the metal. These observations are a
part of medical jurisprudence; and we shall hereafter touch upon it,
under Female Abortion, and External Violence, especially injuries of
the head.
_Hydrophobia._ This disease may be classed with the mental, or
with poisons, and spasmodic affections of the superior part of the
alimentary canal. There are very few instances of this disease in
Britain: it is, notwithstanding, one of the modern hobgoblins, in which
we rival the folly of the ancients respecting alimentary poisons. It
should first be indisputably ascertained whether the dog, or other
animal, was mad or not: we have a thousand false alarms, forgeries,
and falsehoods in this respect. Dogs, especially puppies, are subject
to periodical short fits, in which they run about as if mad, barking
incessantly, and with a querulous angry voice. The symptoms of a mad
dog, as described by authors, are, he suddenly becomes mopish, peevish,
and morose; has an aversion to food and drink; an unusual look about
his eyes; he runs about disorderly, forgets his master; his voice
changes to a shrill bark; he suffers no one to approach, or to handle
him, but bites at those who attempt it; he deserts his own habitation,
running with his head and tail drooping; the tongue hangs out of his
mouth, covered with foam and slaver; other dogs fly from him with
horror; he attempts to bite all who fall in his way; he flies from
water and rivers, and at length falls down exhausted, and dies on the
third or fourth day after the first appearance of the disease. It is
also agreed, that canine madness is more general in hot climates, and
in the hottest summers of northern. But unfortunately hitherto, in
most cases, probably nineteen out of twenty, the mania of dogs has not
been incontrovertibly decided; as in cases even at the commencement,
when it is very dubious, dogs are very improperly and impolitickly
destroyed, instead of being confined in a place of security, to observe
whether the poison is fermenting in them. Hence, probably, much ideal
terror and horror; and boasted, though impotent, virtues of many vulgar
nostrums, panaceas, and antidotes.
In the human species, Hydrophobia, phrenitis latrans, rabies canina,
aquæ fugax, is described, for I never saw an instance of it, in
the following progressive train of symptoms; some days or weeks
after the bite and wound, heaviness, lassitude, disturbed sleep,
frightful dreams, restlessness, melancholy, pain in the wounded part;
exacerbation during the phases and changes of the moon; aversion to
food and drink, pain in the throat, difficulty or impracticability of
swallowing, fluids especially; and horror, or even convulsions, at the
sight of any fluid; in some, delirium; in others, the senses perfect.
There are some instances of recovery in the stages of hydrophobia. The
diseases from other venomous bites and stings are transferred to the
future class of external accidents.
_P. S._ In the preceding group of diseases may be included two, which
I had no opportunity to introduce sooner: these are costiveness, and
nasal hemorrhage. Costiveness, it is true, is frequently symptomatic
in many diseases, but is also idiopathic; and the suppression of this
excretory during several days, occasions vertigo, headach, disturbed
sleep, inappetency, indigestion, flatulence, colick, &c. The _causes_,
obstruction or constriction of the intestinal tube; faults in its
muscular fibres, diminution of irritability by age or disease; defect
of mucus, bile, especially cystic bile, its inertness; costive food
and drink, and medicines; too little drink; excessive discharge, by
perspiration or urine; indolence, and hard feces. Nasal hemorrhage
predominates principally in the adolescent age, and towards puberty and
manhood, and more amongst the male sex: the hemorrhage is generally
periodical at irregular intervals, usually from one nostril, and
slight, or in torrents: and there are instances on record of many
quarts of blood being discharged within a few days. After puberty it
commonly abates, and some years later ceases. The hemorrhage is very
seldom immediately fatal; and more dangerous diseases have followed
its rash suppression. The causes will be comprehended from those of
hemorrhages in general.
* * * * *