* * * * *
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.
* * * * *