ORDO II.

_Decreased Irritation._

GENUS I.

_With decreased Action of the Sanguiferous System._

The reader should be here apprized, that the words strength and debility,

when applied to animal motions, may properly express the quantity of

resistance such motions may overcome; but that, when they are applied to

mean the susceptibility or insusceptibility of animal fibres to motion,

they become metaphorical terms; as in Sect. XII. 2. 1. and would be better

expressed by the words activity and inactivity.

There are three sources of animal inactivity; first, the defect of the

natural quantity of stimulus on those fibres, which have been accustomed to

perpetual stimulus; as the arterial and secerning systems. When their

accustomed stimulus is for a while intermitted, as when snow is applied to

the skin of the hands, an accumulation of sensorial power is produced; and

then a degree of stimulus, as of heat, somewhat greater than that at

present applied, though much less than the natural quantity, excites the

vessels of the skin into violent action. We must observe, that a deficiency

of stimulus in those fibres, which are not subject to perpetual stimulus,

as the locomotive muscles, is not succeeded by accumulation of sensorial

power; these therefore are more liable to become permanently inactive after

a diminution of stimulus; as in strokes of the palsy, this may be called

inactivity from defect of stimulus.

2. A second source of animal inactivity exists, when the sensorial power in

any part of the system has been previously exhausted by violent stimuli; as

the eyes after long exposure to great light; or the stomach, to repeated

spirituous potation; this may be termed inactivity from exhaustion of

sensorial power. See Sect. XII. 2. 1.

3. But there is a third source of inactivity owing to the deficient

production of sensorial power in the brain; and hence stimuli stronger than

natural are required to produce the accustomed motions of the arterial

system; in this case there is no accumulation of sensorial power produced;

as in the inactivity owing to defect of stimulus; nor any previous

exhaustion of it, as in the inactivity owing to excess of stimulus.

This third kind of inactivity causes many of the diseases of this genus;

which are therefore in general to be remedied by such medicines as promote

a greater production of sensorial power in the brain; as the incitantia,

consisting of wine, beer, and opium, in small repeated quantities; and

secondly of such as simply stimulate the arterial and glandular system into

their natural actions; as small repeated blisters, spices, and essential

oils. And lastly the sorbentia, which contribute to supply the more

permanent strength of the system, by promoting the absorption of

nourishment from the stomach, and intestines; and of the superfluous fluid,

which attends the secretions.

SPECIES.

1. _Febris inirritativa._ Inirritative fever. This is the typhus mitior, or

nervous fever of some writers; it is attended with weak pulse without

inflammation, or symptoms of putridity, as they have been called. When the

production of sensorial power in the brain is less than usual, the pulse

becomes quick as well as weak; and the heart sometimes trembles like the

limbs of old age, or of enfeebled drunkards; and when this force of the

contractions of the heart and arteries is diminished, the blood is pushed

on with less energy, as well as in less quantity, and thence its stimulus

on their sides is diminished in a duplicate ratio. In compressions of the

brain, as in apoplexy, the pulse becomes slower and fuller; for in that

disease, as in natural sleep, the irritative motions of the heart and

arteries are not diminished, volition alone is suspended or destroyed.

If the absorption of the terminations of the veins is not equally impaired

with the force of the heart and arteries, the blood is taken up by the

veins the instant it arrives at their extremities; the capillary vessels

are left empty, and there is less resistance to the current of the blood

from the arteries; hence the pulse becomes empty, as well as weak and

quick; the veins of the skin are fuller than the arteries of it; and its

appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1.

When this pulse persists many hours, it constitutes the febris

inirritativa, or typhus, or nervous fever, of some writers; it is attended

with little heat, the urine is generally of a natural colour, though in

less quantity; with great prostration of strength, and much disturbance of

the faculties of the mind. Its immediate cause seems to be a deficient

secretion of the sensorial power from the inaction of the brain; hence

almost the whole of the sensorial power is expended in the performance of

the motions necessary to life, and little of it can be spared for the

voluntary actions of the locomotive muscles, or organs of sense, see Class

I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some

other part of the body; as of the spleen, when a tumour is felt on the left

side, as in some intermittents; or of the kidnies, when the urine continues

pale and in small quantity. Does the revivescence of these affected parts,

or their torpor, recurring at intervals, form the paroxysms of these

fevers? and their permanent revivescence establish the cure? See Class IV.

2. 1. 19.

M. M. Wine and opium in small quantities repeated every three hours

alternately; small repeated blisters; warm but fresh air; sorbentia;

nutrientia; transfusion of blood. Small electric shocks passed through the

brain in all directions. Oxygene air?

2. _Paresis inirritativa._ Inirritative debility. A defective action of the

irritative motions without increase of the frequency of the pulse. It

continues three or four weeks like a fever, and then either terminates in

health, or the patient sinks into one kind of apoplexy, and perishes. Many

symptoms, which attend inirritative fevers, accompany this disease, as cold

hands and feet at periodic times, scurf on the tongue, want of appetite,

muddy urine, with pains of the head, and sometimes vertigo, and vomiting.

This disease differs from the inirritative fever by the pulse not being

more frequent than in health. The want of appetite and of digestion is a

principal symptom, and probably is the cause of the universal debility,

which may be occasioned by the want of nourishment. The vertigo is a

symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine

is owing to increased absorption from the bladder in consequence of the

diminished cutaneous and cellular absorption, as in anasarca, explained in

Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of

that part of the system; the foul tongue is owing to an increased

absorption of the thinner part of the mucus in consequence of the general

deficiency of fluid, which should be absorbed by the skin and stomach. The

sickness is owing to decreased action of the stomach, which is probably the

primary disease, and is connected with the vertigo.

M. M. An emetic. Calomel, grains iv. once or twice. Then a blister.

Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small

quantities, repeated alternately every three hours. Small electric

percussions through the stomach.

3. _Somnus interruptus._ Interrupted sleep. In some fevers, where the

inirritability is very great, when the patient falls asleep, the pulse in a

few minutes becomes irregular, and the patient awakes in great disorder,

and fear of dying, refusing to sleep again from the terror of this uneasy

sensation. In this extreme debility there is reason to believe, that some

voluntary power during our waking hours is employed to aid the irritative

stimuli in carrying on the circulation of the blood through the lungs; in

the same manner as we use voluntary exertions, when we listen to weak

sounds, or wish to view an object by a small light; in sleep volition is

suspended, and the deficient irritation alone is not sufficient to carry on

the pulmonary circulation. This explanation seems the most probable one,

because in cases of apoplexy the irritative motions of the arterial system

do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13.

M. M. Opium in very small doses, as three drops of laudanum. A person

should watch the patient, and awaken him frequently; or he should measure

the time between slumber and slumber by a stop-watch, and awaken the

patient a little before he would otherwise awake; or he should keep his

finger on the pulse, and should forcibly awaken him, as soon as it becomes

irregular, before the disorder of the circulation becomes so great as to

disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2.

4. _Syncope._ Fainting consists in the decreased action of the arterial

system; which is sometimes occasioned by defect of the stimulus of

distention, as after venesection, or tapping for the dropsy. At other times

it arises from great emotions of the mind, as in sudden joy or grief. In

these cases the whole sensorial power is exerted on these interesting

ideas, and becomes exhausted. Thus during great surprise or fear the heart

stops for a time, and then proceeds with throbbing and agitation; and

sometimes the vital motions become so deranged, as never to recover their

natural successive action; as when children have been frightened into

convulsions. See Sect. XII. 7. 1.

Miss ----, a young lady of Stafford, in travelling in a chaise was so

affected by seeing the fall of a horse and postillion, in going down a

hill, though the carriage was not overturned, that she fainted away, and

then became convulsed, and never spoke afterwards; though she lived about

three days in successive convulsions and stupor.

5. _Haemorrhagia venosa._ A bleeding from the capillaries arising from

defect of venous absorption, as in some of those fevers commonly termed

putrid. When the blood stagnates in the cellular membrane, it produces

petechiae from this torpor or paralysis of the absorbent mouths of the

veins. It must be observed, that those people who have diseased livers, are

more liable to this kind of haemorrhages, as well as to the haemorrhagia

arteriosa; the former, because patients with diseased livers are more

subject to paralytic complaints in general, as to hemiplegia, and to

dropsy, which is a paralysis of the lymphatics; and the latter is probably

owing to the delay of the circulation in the vena porta by the torpor of

this hepatic vessel, when the liver is not much enlarged; and to its

pressure on the vena cava, when it is much enlarged.

M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel

dissolved in spirit of wine externally. Flour.

6. _Haemorrhois cruenta._ In the bleeding piles the capillary vessels of

the rectum become distended and painful from the defect of the venous

absorption of the part, and at length burst; or the mucous glands are so

dilated as to give a passage to the blood; it is said to observe lunar

periods.

M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia.

External compression by applying lint, sponge, or cotton. Internal

compression by applying a bit of candle smeared with mercurial ointment.

Strangulate the tumid piles with a silk string. Cut them off. See Class I.

2. 3. 22.

Mrs. ---- had for twelve or fifteen years, at intervals of a year or less,

a bleeding from the rectum without pain; which however stopped

spontaneously after she became weakened, or by the use of injections of

brandy and water. Lately the bleeding continued above two months, in the

quantity of many ounces a day, till she became pale and feeble to an

alarming degree. Injections of solutions of lead, of bark and salt of

steel, and of turpentine, with some internal astringents, and opiates, were

used in vain. An injection of the smoke of tobacco, with ten grains of

opium mixed with the tobacco, was used, but without effect the two first

times on account of the imperfection of the machine; on the third time it

produced great sickness, and vertigo, and nearly a fainting fit; from which

time the blood entirely stopped. Was this owing to a fungous excrescence in

the rectum; or to a blood-vessel being burst from the difficulty of the

blood passing through the vena porta from some hepatic obstruction, and

which had continued to bleed so long? Was it stopped at last by the

fainting fit? or by the stimulus of the tobacco?

7. _Haemorrhagia renum._ Haemorrhage from the kidnies, when attended with

no pain, is owing to defect of venous absorption in the kidney. When

attended with pain on motion, it is owing to a bit of gravel in the ureter

or pelvis of the kidney; which is a much more frequent disease than the

former. See Sect. XXVII. 1.

M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate;

cold immersion up to the navel, the upper part of the body being kept

cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent

liquids. Cool dress. Cool bed-room.

Cows are much subject to bloody urine, called foul water by the farmers; in

this disease about sixty grains of opium with or without as much rust of

iron, given twice a day, in a ball mixed with flour and water, or dissolved

in warm water, or warm ale, is, I believe, an efficacious remedy, to which

however should be added about two quarts of barley or oats twice a day, and

a cover at night, if the weather be cold.

8. _Haemorrhagia Hepatis._ Haemorrhage from the liver. It sometimes happens

in those, who have the gutta rosea, or paralytic affections owing to

diseased livers induced by the potation of fermented liquors, that a great

discharge of black viscid blood occasionally comes away by stool, and

sometimes by vomiting: this the ancients called Melancholia, black bile. If

it was bile, a small quantity of it would become yellow or green on

dilution with warm water, which was not the case in one experiment which I

tried; it must remain some time in the intestines from its black colour,

when it passes downwards, and probably comes from the bile-ducts, and is

often a fatal symptom. When it is evacuated by vomiting it is less

dangerous, because it shews greater remaining irritability of the

intestinal canal, and is sometimes salutary to those who have diseased

livers.

M. M. An emetic. Rhubarb, steel, wine, bark.

9. _Haemoptoe venosa._ Venous haemoptoe frequently attends the beginning of

the hereditary consumptions of dark-eyed people; and in others, whose lungs

have too little irritability. These spittings of blood are generally in

very small quantity, as a tea-spoonful; and return at first periodically,

as about once a month; and are less dangerous in the female than in the

male sex; as in the former they are often relieved by the natural periods

of the menses. Many of these patients are attacked with this pulmonary

haemorrhage in their first sleep; because in feeble people the power of

volition is necessary, besides that of irritation, to carry on respiration

perfectly; but, as volition is suspended during sleep, a part of the blood

is delayed in the vessels of the lungs, and in consequence effused, and the

patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II.

1. 6. 6. III. 2. 1. 10.

M. M. Wake the patient every two or three hours by an alarum clock. Give

half a grain of opium at going to bed, or twice a day. Onions, garlic,

slight chalybeates. Issues. Leeches applied once a fortnight or month to

the hemorrhoidal veins to produce a new habit. Emetics after each period of

haemoptoe, to promote expectoration, and dislodge any effused blood, which

might by remaining in the lungs produce ulcers by its putridity. A hard

bed, to prevent too sound sleep. A periodical emetic or cathartic once a

fortnight.

10. _Palpitatio cordis._ The palpitation of the heart frequently attends

the haemoptoe above mentioned; and consists in an ineffectual exertion of

the heart to push forwards its contents in due time, and with due force.

The remote cause is frequently some impediment to the general circulation;

as the torpor of the capillaries in cold paroxysms of fever, or great

adhesions of the lungs. At other times it arises from the debility of the

action of the heart owing to the deficient sensorial power of irritation or

of association, as at the approach of death.

In both these cases of weak exertion the heart feels large to the touch, as

it does not completely empty itself at each contraction; and on that

account contracts more frequently, as described in Sect. XXXII. 2. 2.

Another kind of palpitation may sometimes arise from the retrograde motions

of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.

11. _Menorrhagia._ Continued flow of the catamenia. The monthly effusion of

blood from the uterus or vagina is owing to a torpor of the veins of those

membranes in consequence of the defect of venereal stimulus; and in this

respect resembles the mucus discharged in the periodical venereal orgasm of

the female quadrupeds, which are secluded from the males. The menorrhagia,

or continued flow of this discharge, is owing to a continued defect of the

venous absorption of the membranes of the uterus or vagina. See Class IV.

2. 4. 7.

M. M. Venesection in small quantity. A cathartic. Then opium, a grain every

night. Steel. Bark. A blister. Topical aspersion with cold water, or cold

vinegar.

12. _Dysmenorrhagia._ A difficulty of menstruation attended with pain. In

this complaint the torpor of the uterine vessels, which precedes

menstruation, is by sympathy accompanied with a torpor of the lumbar

membranes, and consequent pain; and frequently with cold extremities, and

general debility. The small quantity and difficulty of the discharge is

owing to arterial inactivity, as in chlorosis. Whence it happens, that

chalybeate medicines are of efficacy both to stop or prevent too great

menstruation, and to promote or increase deficient menstruation; as the

former is owing to inirritability of the veins, and the latter of the

arteries of the uterus. See Article IV. 2. 6. in the Materia Medica.

M. M. Opium, steel, pediluvium. Warm bath.

13. _Lochia nimia._ Too great discharge after delivery. In that unnatural

practice of some hasty accoucheurs of introducing the hand into the uterus

immediately after the delivery of the child, and forcibly bringing away the

placenta, it frequently happens, that a part of it is left behind; and the

uterus, not having power to exclude so small a portion of it, is prevented

from complete contraction, and a great haemorrhage ensues. In this

circumstance a bandage with a thick compress on the lower part of the

belly, by appressing the sides of the uterus on the remaining part of the

placenta, is likely to check the haemorrhage, like the application of a

pledget of any soft substance on a bleeding vessel.

In other cases the lochia continues too long, or in too great quantity,

owing to the deficiency of venous absorption.

M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark.

Clothes dipped in cold vinegar and applied externally. Bandages on the

limbs to keep more blood in them for a time have been recommended.

14. _Abortio spontanea._ Some delicate ladies are perpetually liable to

spontaneous abortion, before the third, or after the seventh, month of

gestation. From some of these patients I have learnt, that they have

awakened with a slight degree of difficult respiration, so as to induce

them to rise hastily up in bed; and have hence suspected, that this was a

tendency to a kind of asthma, owing to a deficient absorption of blood in

the extremities of the pulmonary or bronchial veins; and have concluded

from thence, that there was generally a deficiency of venous absorption;

and that this was the occasion of their frequent abortion. Which is further

countenanced, where a great sanguinary discharge precedes or follows the

exclusion of the fetus.

M. M. Opium, bark, chalybeates in small quantity. Change to a warmer

climate. I have directed with success in four cases half a grain of opium

twice a day for a fortnight, and then a whole grain twice a day during the

whole gestation. One of these patients took besides twenty grains of

Peruvian bark for several weeks. By these means being exactly and regularly

persisted in, a new habit became established, and the usual miscarriages

were prevented.

Miscarriages more frequently happen from eruptive fevers, and from

rheumatic ones, than from other inflammatory diseases. I saw a most violent

pleurisy and hepatitis cured by repeated venesection about a week or ten

days before parturition; yet another lady whom I attended, miscarried at

the end of the chicken pox, with which her children were at the same time

affected. Miscarriages towards the termination of the small pox are very

frequent, yet there have been a few instances of children, who have been

born with the eruption on them. The blood in the small pox will not

inoculate that disease, if taken before the commencement of the secondary

fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is

not yet formed, but after it has been oxygenated through the cuticle in the

pustules, it becomes contagious; and if it be then absorbed, as in the

secondary fever, the blood of the mother may become contagious, and infect

the child. The same mode of reasoning is applicable to the chicken pox. See

Class IV. 3. 1. 7.

15. _Scorbutus._ Sea-scurvy is caused by salt diet, the perpetual stimulus

of which debilitates the venous and absorbent systems. Hence the blood is

imperfectly taken up by the veins from the capillaries, whence brown and

black spots appear upon the skin without fever. The limbs become livid and

edematous, and lastly ulcers are produced from deficient absorption. See

Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of

the lungs, see Sect. XXVII. 2.

M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar.

Wine. Steel. Bark. Sorbentia. Opium?

16. _Vibices._ Extravasations of blood become black from their being

secluded from the air. The extravasation of blood in bruises, or in some

fevers, or after death in some patients, especially in the parts which were

exposed to pressure, is owing to the fine terminations of the veins having

been mechanically compressed so as to prevent their absorbing the blood

from the capillaries, or to their inactivity from disease. The blood when

extravasated undergoes a chemical change before it is sufficiently fluid to

be taken up by the lymphatic absorbents, and in that process changes its

colour to green and then yellow.

17. _Petechiae._ Purple spots. These attend fevers with great venous

inirritability, and are probably formed by the inability of a single

termination of a vein, whence the corresponding capillary becomes ruptured,

and effuses the blood into the cellular membrane round the inert

termination of the vein. This is generally esteemed a sign of the putrid

state of the blood, or that state contrary to the inflammatory one. As it

attends some inflammatory diseases which are attended with great

inirritability, as in the confluent small pox. But it also attends the

scurvy, where no fever exists, and it therefore simply announces the

inactivity of the terminations of some veins; and is thence indeed a bad

symptom in fevers, as a mark of approaching inactivity of the whole

sanguiferous system, or death. The blue colour of some children's arms or

faces in very cold weather is owing in like manner to the torpor of the

absorbent terminations of the veins, whence the blood is accumulated in

them, and sometimes bursts them.

* * * * *

ORDO II.

_Decreased Irritation._

GENUS II.

_Decreased Action of the Secerning System._

These are always attended with decrease of partial, or of general heat; for

as the heat of animal bodies is the consequence of their various

secretions, and is perpetually passing away into the ambient air, or other

bodies in contact with them; when these secretions become diminished, or

cease, the heat of the part or of the whole is soon diminished, or ceases

along with them.

SPECIES.

1. _Frigus febrile._ Febrile coldness. There is reason to believe, that the

beginning of many fever-fits originates in the quiescence of some part of

the absorbent system, especially where they have been owing to external

cold; but that, where the coldness of the body is not owing to a diminution

of external heat, it arises from the inaction of some part of the secerning

system. Hence some parts of the body are hot whilst other parts are cold;

which I suppose gave occasion to error in Martyn's Experiments; where he

says, that the body is as hot in the cold paroxysms of fevers as at other

times.

After the sensorial power has been much diminished by great preceding

activity of the system, as by long continued external heat, or violent

exercise, a sudden exposure to much cold produces a torpor both greater in

degree and over a greater portion of the system, by subtracting their

accustomed stimulus from parts already much deprived of their irritability.

Dr. Franklin in a letter to M. Duberge, the French translator of his works,

mentions an instance of four young men, who bathed in a cold spring after a

day's harvest work; of whom two died on the spot, a third on the next

morning, and the other survived with difficulty. Hence it would appear,

that those, who have to travel in intensely cold weather, will sooner

perish, who have previously heated themselves much with drams, than those

who have only the stimulus of natural food; of which I have heard one well

attested instance. See Article VII. 2. 3. Class III. 2. 1. 17.

_Frigus chronicum._ Permanent coldness. Coldness of the extremities,

without fever, with dry pale skin, is a symptom of general debility, owing

to the decreased action of the arterial system, and of the capillary

vessels; whence the perspirable matter is secreted in less quantity, and in

consequence the skin is less warm. This coldness is observable at the

extremities of the limbs, ears, and nose, more than in any other parts: as

a larger surface is here exposed to the contact of the air, or clothes, and

thence the heat is more hastily carried away.

The pain, which accompanies the coldness of the skin, is owing to the

deficient exertion of the subcutaneous vessels, and probably to the

accumulation of sensorial power in the extremities of their nerves. See

Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1.

M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes.

Fire. Joy. Anger.

2. _Pallor fugitivus._ The fugitive paleness, which accompanies the

coldness of the extremities, is owing to a less quantity of blood passing

through the capillaries of the skin in a given time; where the absorbent

power of the veins is at the same time much diminished, a part of the blood

lingers at their junction with the capillary arteries, and a bluish tinge

is mixed with the paleness; as is seen in the loose skin under the

eye-lids, and is always a mark of temporary debility. See Class II. 1. 4.

4. Where the paleness of the skin is owing to the deficiency of red

globules in the blood, it is joined with a yellowish tinge; which is the

colour of the serum, with which the blood then abounds, as in chlorosis,

and in torpor or paralysis of the liver, and is often mistaken for a

superabundance of bile.

A permanent paleness of the skin is owing to the coalescence of the minute

arteries, as in old age. See Class I. 2. 2. 9. There is another source of

paleness from the increased absorption of the terminations of the veins, as

when vinegar is applied to the lips. See Sect. XXVII. 1. and another from

the retrograde motions of the capillaries and fine extremities of the

arteries. See Class II. 3. 1. 1.

M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.

3. _Pus parcius._ Diminished pus. Dryness of ulcers. In the cold fits of

fever all the secretions are diminished, whether natural or artificial, as

their quantity depends on the actions of the glands or capillaries, which

then share in the universal inaction of the system. Hence the dryness of

issues and blisters in great debility, and before the approach of death, is

owing to deficient secretion, and not to increased absorption.

M. M. Opium, wine in very small quantities, Peruvian bark.

4. _Mucus parcior._ Diminished mucus. Dryness of the mouth and nostrils.

This also occurs in the cold fits of intermittents. In these cases I have

also found the tongue cold to the touch of the finger, and the breath to

the back of one's hand, when opposed to it, which are very inauspicious

symptoms, and generally fatal. In fevers with inirritability it is

generally esteemed a good symptom, when the nostrils and tongue become

moist after having been previously dry; as it shews an increased action of

the mucous glands of those membranes, which were before torpid. And the

contrary to this is the facies Hippocratica, or countenance so well

described by Hippocrates, which is pale, cold, and shrunk; all which are

owing to the inactivity of the secerning vessels, the paleness from there

being less red blood passing through the capillaries, the coldness of the

skin from there being less secretion of perspirable matter, and the shrunk

appearance from there being less mucus secreted into the cells of the

cellular membrane. See Class IV. 2. 4. 11.

M. M. Blisters. Incitantia.

5. _Urina parcior pallida._ Paucity of pale urine, as in the cold fits of

intermittents; it appears in some nervous fevers throughout the whole

disease, and seems to proceed from a palsy of the kidnies; which probably

was the cause of the fever, as the fever sometimes ceases, when that

symptom is removed: hence the straw-coloured urine in this fever is so far

salutary, as it shews the unimpaired action of the kidnies.

M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides

internally.

6. _Torpor hepaticus._ Paucity of bile from a partial inaction of the

liver; hence the bombycinous colour of the skin, grey stools, urine not

yellow, indigestion, debility, followed by tympany, dropsy, and death.

This paralysis or inirritability of the liver often destroys those who have

been long habituated to much fermented liquor, and have suddenly omitted

the use of it. It also destroys plumbers, and house-painters, and in them

seems a substitute for the colica saturnina. See Sect. XXX.

M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment

rubbed on the region of the liver. Rhubarb, three or four grains, with

opium half a grain to a grain twice a day. Equitation, warm bath for half

an hour everyday.

7. _Torpor Pancreatis._ Torpor of the pancreas. I saw what I conjectured to

be a tumour of the pancreas with indigestion, and which terminated in the

death of the patient. He had been for many years a great consumer of

tobacco, insomuch that he chewed that noxious drug all the morning, and

smoaked it all the afternoon. As the secretion from the pancreas resembles

saliva in its general appearance, and probably in its office of assisting

digestion, by preventing the fermentation of the aliment; as would appear

by the experiments of Pringle and Macbride; there is reason to suspect,

that a sympathy may exist between the salivary and pancreatic glands; and

that the perpetual stimulus of the former by tobacco might in process of

time injure the latter. See Tobacco, Article III. 2. 2.

8. _Torpor renis._ Inirritability or paralysis of the kidnies is probably

frequently mistaken for gravel in them. Several, who have lived rather

intemperately in respect to fermented or spirituous liquors, become

suddenly seized about the age of sixty, or later, with a total stoppage of

urine; though they have previously had no symptoms of gravel. In these

cases there is no water in the bladder; as is known by the introduction of

the catheter, of which those made of elastic gum are said to be preferable

to metallic ones; or it may generally be known by the shape of the abdomen,

either by the eye or hand. Bougies and catheters of elastic gum are sold at

N^o 37, Red Lion-street, Holborn, London.

M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1.

3. 9. When no gravel has been previously observed, and the patient has been

a wine-drinker rather than an ale-drinker, the case is generally owing to

inirritability of the tubuli uriniferi, and is frequently fatal. See Class

I. 2. 4. 20.

9. _Punctae mucosae vultus._ Mucous spots on the face. These are owing to

the inactivity of the excretory ducts of the mucous glands; the thinner

part of this secretion exhales, and the remainder becomes inspissated, and

lodges in the duct; the extremity of which becomes black by exposure to the

air.

M. M. They may be pressed out by the finger-nails. Warm water. Ether

frequently applied. Blister on the part?

10. _Maculae cutis fulvae._ Morphew or freckles. Tawny blotches on the skin

of the face and arms of elderly people, and frequently on their legs after

slight erysipelas. The freckles on the face of younger people, who have red

hair, seem to be a similar production, and seem all to be caused by the

coalescence of the minute arteries or capillaries of the part. In a scar

after a wound the integument is only opake; but in these blotches, which

are called morphew and freckles, the small vessels seem to have become

inactive with some of the serum of the blood stagnating in them, from

whence their colour. See Class III. 1. 2. 12.

M. M. Warm bathing. A blister on the part?

11. _Canities._ Grey hair. In the injection of the vessels of animals for

the purposes of anatomical preparations, the colour of the injected fluid

will not pass into many very minute vessels; which nevertheless uncoloured

water, or spirits, or quicksilver will permeate. The same occurs in the

filtration of some coloured fluids through paper, or very fine sand, where

the colouring matter is not perfectly dissolved, but only diffused through

the liquid. This has led some to imagine, that the cause of the whiteness

of the hair in elderly people may arise from the diminution, or greater

tenuity, of the glandular vessels, which secrete the mucus, which hardens

into hair; and that the same difference of the tenuity of the secerning

vessels may possibly make the difference of colour of the silk from

different silk-worms, which is of all shades from yellow to white.

But as the secreted fluids are not the consequence of mechanical

filtration, but of animal selection; we must look out for another cause,

which must be found in the decreasing activity of the glands, as we advance

in life; and which affects many of our other secretions as well as that of

the mucus, which forms the hair. Hence grey hairs are produced on the faces

of horses by whatever injures the glands at their roots, as by corrosive

blisters; and frequently on the human subject by external injuries on the

head; and sometimes by fevers. And as the grey colour of hair consists in

its want of transparency, like water converted into snow; there is reason

to suppose, that a defect of secreted moisture simply may be the cause of

this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13.

M. M. Whatever prevents the inirritability and insensibility of the system,

that is, whatever prevents the approach of old age, will so far counteract

the production of grey hairs, which is a symptom of it. For this purpose in

people, who are not corpulent, and perhaps in those who are so, the warm

bath twice or thrice a week is particularly serviceable. See Sect. XXXIX.

5. 1. on the colours of animals, and Class I. 1. 2. 15.

12. _Callus._ The callous skin on the hands and feet of laborious people is

owing to the extreme vessels coalescing from the perpetual pressure they

are exposed to.

As we advance in life, the finer arteries lose their power of action, and

their sides grow together; hence the paleness of the skins of elderly

people, and the loss of that bloom, which is owing to the numerous fine

arteries, and the transparency of the skin, that encloses them.

M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a

pumice stone. Cover the part with oiled silk to prevent the evaporation of

the perspirable matter, and thus to keep it moist.

13. _Cataracta_ is an opacity of the crystalline lens of the eye. It is a

disease of light-coloured eyes, as the gutta serena is of dark ones. On

cutting off with scissars the cornea of a calf's eye, and holding it in the

palm of one's hand, so as to gain a proper light, the artery, which

supplies nutriment to the crystalline humour, is easily and beautifully

seen; as it rises from the centre of the optic nerve through the vitreous

humour to the crystalline. It is this point, where the artery enters the

eye through the cineritious part of the optic nerve, (which is in part near

the middle of the nerve,) which is without sensibility to light; as is

shewn by fixing three papers, each of them about half an inch in diameter,

against a wall about a foot distant from each other, about the height of

the eye; and then looking at the middle one, with one eye, and retreating

till you lose sight of one of the external papers. Now as the animal grows

older, the artery becomes less visible, and perhaps carries only a

transparent fluid, and at length in some subjects I suppose ceases to be

pervious; then it follows, that the crystalline lens, losing some fluid,

and gaining none, becomes dry, and in consequence opake; for the same

reason, that wet or oiled paper is more transparent than when it is dry, as

explained in Class I. 1. 4. 1. The want of moisture in the cornea of old

people, when the exhalation becomes greater than the supply, is the cause

of its want of transparency; and which like the crystalline gains rather a

milky opacity. The same analogy may be used to explain the whiteness of the

hair of old people, which loses its pellucidity along with its moisture.

See Class I. 2. 2. 11.

M. M. Small electric shocks through the eye. A quarter of a grain of

corrosive sublimate of mercury dissolved in brandy, or taken in a pill,

twice a day for six weeks. Couching by depression, or by extraction. The

former of these operations is much to be preferred to the latter, though

the latter is at this time so fashionable, that a surgeon is almost

compelled to use it, lest he should not be thought an expert operator. For

depressing the cataract is attended with no pain, no danger, no

confinement, and may be as readily repeated, if the crystalline should rise

again to the centre of the eye. The extraction of the cataract is attended

with considerable pain, with long confinement, generally with fever, always

with inflammation, and frequently with irreparable injury to the iris, and

consequent danger to the whole eye. Yet has this operation of extraction

been trumpeted into universal fashion for no other reason but because it is

difficult to perform, and therefore keeps the business in the hands of a

few empyrics, who receive larger rewards, regardless of the hazard, which

is encountered by the flattered patient.

A friend of mine returned yesterday from London after an absence of many

weeks; he had a cataract in a proper state for the operation, and in spite

of my earnest exhortation to the contrary, was prevailed upon to have it

extracted rather than depressed. He was confined to his bed three weeks

after the operation, and is now returned with the iris adhering on one side

so as to make an oblong aperture; and which is nearly, if not totally,

without contraction, and thus greatly impedes the little vision, which he

possesses. Whereas I saw some patients couched by depression many years ago

by a then celebrated empyric, Chevalier Taylor, who were not confined above

a day or two, that the eye might gradually be accustomed to light, and who

saw as well as by extraction, perhaps better, without either pain, or

inflammation, or any hazard of losing the eye.

As the inflammation of the iris is probably owing to forcing the

crystalline through the aperture of it in the operation of extracting it,

could it not be done more safely by making the opening behind the iris and

ciliary process into the vitreous humour? but the operation would still be

more painful, more dangerous, and not more useful than that by depressing

it.

14. _Innutritio ossium._ Innutrition of the bones. Not only the blood

effused in vibices and petechiae, or from bruises, as well as the blood and

new vessels in inflamed parts, are reabsorbed by the increased action of

the lymphatics; but the harder materials, which constitute the fangs of the

first set of teeth, and the ends of exfoliating bones, and sometimes the

matter of chalk-stones in the gout, the coagulable lymph, which is

deposited on the lungs, or on the muscles after inflammation of those

parts, and which frequently produces difficulty of breathing, and the pains

of chronic rheumatism, and lastly the earthy part of the living bones are

dissolved and absorbed by the increased actions of this system of vessels.

See Sect. XXXIII. 3. 1.

The earthy part of bones in this disease of the innutrition of them seems

to suffer a solution, and reabsorption; while the secerning vessels do not

supply a sufficient quantity of calcareous earth and phosphoric acid, which

constitute the substance of bones. As calcareous earth abounds every where,

is the want of phosphoric acid the remote cause? One cause of this malady

is given in the Philosophic Transactions, where the patient had been

accustomed to drink large quantities of vinegar. Two cases are described by

Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous

earth, and afterwards of bone-ashes, and of decoction of madder, and also

of sublimate of mercury, were given without effect. All the bones became

soft, many of them broke, and the patient seemed to die from the want of

being able to distend her chest owing to the softness of the ribs.

M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined

hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or

such as is found in all limestone or marly countries. The calcareous earth

in these waters might possibly be carried to the bones, as madder is known

to colour them. Warm bath. Volatile or fixed alcali as a lotion on the

spine, or essential oils.

The innutrition of the bones is often first to be perceived by the

difficulty of breathing and palpitation of the heart on walking a little

faster than usual, which I suppose is owing to the softness of the ends of

the ribs adjoining to the sternum; on which account they do not perfectly

distend the chest, when they are raised by the pectoral and intercostal

muscles with greater force than usual. After this the spine becomes curved

both by the softness of its vertebrae, and for the purpose of making room

for the disturbed heart. See Species 16 of this genus.

As these patients are pale and weak, there would seem to be a deficiency of

oxygene in their blood, and in consequence a deficiency of phosphoric acid;

which is probably produced by oxygene in the act of respiration.

Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to

arise from the prevalence of vegetable or acetous acid, which is known to

soften bones out of the body. Mr. Dettaen seems to have espoused a similar

opinion, and both of them in consequence give alcalies and testacea. If

this theory was just, the soft bones of such patients should shew evident

marks of such acidity after death; which I believe has not been observed.

Nor is it analogous to other animal facts, that nutritious fluids secreted

by the finest vessels of the body should be so little animalized, as to

retain acetous or vegetable acidity.

The success attending the following case in so short a time as a fortnight

I ascribed principally to the use of the warm bath; in which the patient

continued for full half an hour every night, in the degree of heat, which

was most grateful to her sensation, which might be I suppose about 94. Miss

----, about ten years of age, and very tall and thin, has laboured under

palpitation of her heart, and difficult breathing on the least exercise,

with occasional violent dry cough, for a year or more, with dry lips,

little appetite either for food or drink, and dry skin, with cold

extremities. She has at times been occasionally worse, and been relieved in

some degree by the bark. She began to bend forwards, and to lift up her

shoulders. The former seemed owing to a beginning curvature of the spine,

the latter was probably caused to facilitate her difficult respiration.

M. M. She used the warm bath, as above related; which by its warmth might

increase the irritability of the smallest series of vessels, and by

supplying more moisture to the blood might probably tend to carry further

the materials, which form calcareous or bony particles, or to convey them

in more dilute solution. She took twice a day twenty grains of extract of

bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of

calcined hartshorn mixed into a powder with ten drops of laudanum; with

flesh food both to dinner and supper; and port wine and water instead of

the small beer, she had been accustomed to; she lay on a sofa frequently in

a day, and occasionally used a neck-swing.

15. _Rachitis._ Rickets. The head is large, protuberant chiefly on the

forepart. The smaller joints are swelled; the ribs depressed; the belly

tumid, with other parts emaciated. This disease from the innutrition or

softness of the bones arose about two centuries ago; seems to have been

half a century in an increasing or spreading state; continued about half a

century at its height, or greatest diffusion; and is now nearly vanished:

which gives reason to hope, that the small-pox, measles, and venereal

disease, which are all of modern production, and have already become

milder, may in process of time vanish from the earth, and perhaps be

succeeded by new ones! See the preceding species.

16. _Spinae distortio._ Distortion of the spine is another disease

originating from the innutrition or softness of the bones. I once saw a

child about six years old with palpitation of heart, and quickness of

respiration, which began to have a curvature of the spine; I then doubted,

whether the palpitation and quick respiration were the cause or consequence

of the curvature of the spine; suspecting either that nature had bent the

spine outwards to give room to the enlarged heart; or that the malformation

of the chest had compressed and impeded the movements of the heart. But a

few weeks ago on attending a young lady about ten years old, whose spine

had lately began to be distorted, with very great difficulty and quickness

of respiration, and alarming palpitation of the heart, I convinced myself,

that the palpitation and difficult respiration were the effect of the

change of the cavity of the chest from the distortion of the spine; and

that the whole was therefore a disease of the innutrition or softness of

the bones.

For on directing her to lie down much in the day, and to take the bark, the

distortion became less, and the palpitation and quick respiration became

less at the same time. After this observation a neck-swing was directed,

and she took the bark, madder, and bone-ashes; and she continues to amend

both in her shape and health.

Delicate young ladies are very liable to become awry at many boarding

schools. This is occasioned principally by their being obliged too long to

preserve an erect attitude, by sitting on forms many hours together. To

prevent this the school-seats should have either backs, on which they may

occasionally rest themselves; or desks before them, on which they may

occasionally lean. This is a thing of greater consequence than may appear

to those, who have not attended to it.

When the least tendency to become awry is observed, they should be advised

to lie down on a bed or sofa for an hour in the middle of the day for many

months; which generally prevents the increase of this deformity by taking

off for a time the pressure on the spine of the back, and it at the same

time tends to make them grow taller. Young persons, when nicely measured,

are found to be half an inch higher in a morning than at night; as is well

known to those, who inlist very young men for soldiers. This is owing to

the cartilages between the bones of the back becoming compressed by the

weight of the head and shoulders on them during the day. It is the same

pressure which produces curvatures and distortions of the spine in growing

children, where the bones are softer than usual; and which may thus be

relieved by an horizontal posture for an hour in the middle of the day, or

by being frequently allowed to lean on a chair, or to play on the ground on

a carpet.

Young ladies should also be directed, where two sleep in a bed, to change

every night, or every week, their sides of the bed; which will prevent

their tendency to sleep always on the same side; which is not only liable

to produce crookedness, but also to occasion diseases by the internal parts

being so long kept in uniform contact as to grow together. For the same

reason they should not be allowed to sit always on the same side of the

fire or window, because they will then be inclined too frequently to bend

themselves to one side.

Another great cause of injury to the shape of young ladies is from the

pressure of stays, or other tight bandages, which at the same time cause

other diseases by changing the form or situation of the internal parts. If

a hard part of the stays, even a knot of the thread, with which they are

sewed together, is pressed hard upon one side more than the other, the

child bends from the side most painful, and thus occasions a curvature of

the spine. To counteract this effect such stays, as have fewest hard parts,

and especially such as can be daily or weekly turned, are preferable to

others.

[Illustration]

Where frequent lying down on a sofa in the day-time, and swinging

frequently for a short time by the hands or head, with loose dress, do not

relieve a beginning distortion of the back; recourse may be had to a chair

with stuffed moveable arms for the purpose of suspending the weight of the

body by cushions under the arm-pits, like resting on crutches, or like the

leading strings of infants. From the top of the back of the same chair a

curved steel bar may also project to suspend the body occasionally, or in

part by the head, like the swing above mentioned. The use of this chair is

more efficacious in straightening the spine, than simply lying down

horizontally; as it not only takes off the pressure of the head and

shoulders from the spine, but at the same time the inferior parts of the

body contribute to draw the spine straight by their weight; or lastly,

recourse may be had to a spinal machine first described in the Memoires of

the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and

since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road,

London, which suspends the head, and places the weight of it on the hips.

This machine is capable of improvement by joints in the bar at the back of

it, to permit the body to bend forwards without diminishing the extension

of the spine.

The objections of this machine of M. Vacher, which is made by Mr. Jones,

are first, that it is worn in the day-time, and has a very unsightly

appearance. Mr. Jones has endeavoured to remedy this, by taking away the

curved bar over the head, and substituting in its place a forked bar,

rising up behind each ear, with webs fastened to it, which pass under the

chin and occiput. But this is not an improvement, but a deterioration of M.

Vacher's machine, as it prevents the head from turning with facility to

either side. Another objection is, that its being worn, when the muscles of

the back are in action, it is rather calculated to prevent the curvature of

the spine from becoming greater, than to extend the spine, and diminish its

curvature.

[Illustration]

For this latter purpose I have made a steel bow, as described in the

annexed plate, which receives the head longitudinally from the forehead to

the occiput; having a fork furnished with a web to sustain the chin, and

another to sustain the occiput. The summit of the bow is fixed by a swivel

to the board going behind the head of the bed above the pillow. The bed is

to be inclined from the head to the feet about twelve or sixteen inches.

Hence the patient would be constantly sliding down during sleep, unless

supported by this bow, with webbed forks, covered also with fur, placed

beneath the chin, and beneath the occiput. There are also proper webs lined

with fur for the hands to take hold off occasionally, and also to go under

the arms. By these means I should hope great advantage from gradually

extending the spine during the inactivity of the muscles of the back; and

that it may be done without disturbing the sleep of the patient, and if

this should happen, the bow is made to open by a joint at the summit of it,

so as to be instantly disengaged from the neck by the hand of the wearer.

This bow I have not yet had opportunity to make use of, but it may be had

from Mr. Harrison, whitesmith, Bridge-gate, Derby.

It will be from hence easily perceived, that all other methods of confining

or directing the growth of young people should be used with great skill;

such as back-boards, or bandages, or stocks for the feet; and that their

application should not be continued too long at a time, lest worse

consequences should ensue, than the deformity they were designed to remove.

To this may be added, that the stiff erect attitude taught by some modern

dancing masters does not contribute to the grace of person, but rather

militates against it; as is well seen in one of the prints in Hogarth's

Analysis of Beauty; and is exemplifyed by the easy grace of some of the

ancient statues, as of the Venus de Medici, and the Antinous, and in the

works of some modern artists, as in a beautiful print of Hebe feeding an

Eagle, painted by Hamilton, and engraved by Eginton, and many of the

figures of Angelica Kauffman.

Where the bone of one of the vertebrae of the back has been swelled on both

sides of it, so as to become protuberant, issues near the swelled part have

been found of great service, as mentioned in Species 18 of this genus. This

has induced me to propose in curvatures of the spine, to put an issue on

the outside of the curve, where it could be certainly ascertained, as the

bones on the convex side of the curve must be enlarged; in one case I

thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general

constitution is of service; as the use of the cold bath in the summer

months. This however requires some restriction both in respect to the

degree of coldness of the bath, the time of continuing in it, and the

season of the year. Common springs, which are of forty-eight degrees of

heat, are too cold for tender constitutions, whether of children or adults,

and frequently do them great and irreparable injury. The coldness of river

water in the summer months, which is about sixty-eight degrees, or that of

Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are

much to be preferred. The time of continuing in the bath should be but a

minute or two, or not so long as to occasion a trembling of the limbs from

cold. In respect to the season of the year, delicate children should

certainly only bathe in the summer months; as the going frequently into the

cold air in winter will answer all the purposes of the cold bath.

17. _Claudicatio coxaria._ Lameness of the hip. A nodding of the thigh-bone

is said to be produced in feeble children by the softness of the neck or

upper part of that bone beneath the cartilage; which is naturally bent, and

in this disease bends more downwards, or nods, by the pressure of the body;

and thus renders one leg apparently shorter than the other. In other cases

the end of the bone is protruded out of its socket, by inflammation or

enlargement of the cartilages or ligaments of the joint, so that it rests

on some part of the edge of the acetabulum, which in time becomes filled

up. When the legs are straight, as in standing erect, there is no

verticillary motion in the knee-joint; all the motion then in turning out

the toes further than nature designed, must be obtained by straining in

some degree this head of the thigh-bone, or the acetabulum, or cavity, in

which it moves. This has induced me to believe, that this misfortune of the

nodding of the head by the bone, or partial dislocation of it, by which one

leg becomes shorter than the other, is sometimes occasioned by making very

young children stand in what are called stocks; that is with their heels

together, and their toes quite out. Whence the socket of the thigh-bone

becomes inflamed and painful, or the neck of the bone is bent downward and

outwards.

In this case there is no expectation of recovering the straightness of the

end of the bone; but these patients are liable to another misfortune, that

is, to acquire afterwards a distortion of the spine; for as one leg is

shorter than the other, they sink on that side, and in consequence bend the

upper part of their bodies, as their shoulders, the contrary way, to

balance themselves; and then again the neck is bent back again towards the

lame side, to preserve the head perpendicular; and thus the figure becomes

quite distorted like the letter S, owing originally to the deficiency of

the length of one limb. The only way to prevent this curvature of the spine

is for the child to wear a high-heeled shoe or patten on the lame foot, so

as to support that side on the same level with the other, and thus to

prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle

in walking; but nevertheless, when she stands or sits, she sinks down

towards her right side, and turns out that toe more than the other. Hence,

both as she sits and stands, she bends her body to the right; whence her

head would hang a little over her right shoulder; but to replace this

perpendicularly, she lifts up her left shoulder and contracts the muscles

on that side of the neck; which are therefore become thicker and stronger

by their continued action; but there is not yet any very perceptible

distortion of the spine.

As her right toe is turned outward rather more than natural, this shews the

disease to be in the hip-joint; because, when the limb is stretched out,

the toe cannot turn horizontally in the least without moving the end of the

thigh-bone; although when the knee is bent, the toe can be turned through

one third or half of a circle by the rotation of the tibia and fibula of

the leg round each other. Hence if children are set in stocks with their

heels touching each other as they sit, and are then made to rise up, till

they stand erect, the socket or head of the thigh-bone becomes injured,

especially in those children, whose bones are soft; and a shortness of that

limb succeeds either by the bending of the neck of the thigh-bone, or by

its getting out of the acetabulum; and a consequent rising of one shoulder,

and a curvature of the spine is produced from so distant a cause.

M. M. An elastic cushion made of curled hair should be placed under the

affected hip, whenever she sits; or should be fitted to the part by means

of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying

down in the day, should be occasionally used to prevent or remove any

curvature of the spine. The rest as in Species 13 and 15 of this genus.

18. _Spina protuberans._ Protuberant spine. One of the bones of the spine

swells, and rises above the rest. This is not an uncommon disease, and

belongs to the innutrition of the bones, as the bone must become soft

before it swells; which softness is owing to defect of the secretion of

phosphorated calcareous earth. The swelling of the bone compresses a part

of the brain, called the spinal marrow, within the cavity of the

back-bones; and in consequence the lower limbs become paralytic, attended

sometimes with difficulty of emptying the bladder and rectum.

M. M. Issues put on each side of the prominent bone are of great effect, I

suppose, by their stimulus; which excites into action more of the sensorial

powers of irritation and sensation, and thus gives greater activity to the

vascular system in their vicinity. The methods recommended in distortion of

the spine are also to be attended to.

19. _Spina bifida._ Divided spine, called also Hydrorachitis, as well as

the Hydrocephalus externus, are probably owing in part to a defect of

ossification of the spine and cranium; and that the collection of fluid

beneath them may originate from the general debility of the system; which

affects both the secerning, and absorbent vessels.

A curious circumstance, which is affirmed to attend the spina bifida, is,

that on compressing the tumor with the hand gently, the whole brain becomes

affected, and the patient falls asleep. I suppose the same must happen on

compressing the hydrocephalus externus? See Sect. XVIII. 20.

20. _Ossis palati defectus._ A defect of the bone of the palate, which

frequently accompanies a division of the upper lip, occurs before nativity;

and is owing to the deficient action of the secerning system, from whence

the extremities are not completed. From a similar cause I have seen the

point of the tongue deficient, and one joint of the two least fingers, and

of the two least toes, in the same infant; who was otherwise a fine girl.

See Sect. XXXIX. 4. 4.

The operation for the hare-lip is described by many surgical writers; but

there is a person in London, who makes very ingenious artificial palates;

which prevents that defect of speech, which attends this malformation. This

factitious palate consists of a thin plate of silver of the shape and form

of the roof of the mouth; from the front edge to the back edge of this

silver plate four or five holes are made in a straight line large enough

for a needle to pass through them; on the back of it is then sewed a piece

of sponge; which when expanded with moisture is nearly as large as the

silver plate. This sponge is slipped through the division of the bone of

the palate, so as to lie above it, while the silver plate covers the

aperture beneath, and is suspended by the expanding sponge. This is removed

every night and washed, and returned into its place in the morning; on this

account it is convenient to have five or six of them, for the sake of

cleanliness. I have been more particular in describing this invention, as I

do not know the name, or place of residence, of the maker.

* * * * *

ORDO II.

_Decreased Irritation._

GENUS III.

_The Decreased Action of the Absorbent System._

Some decrease of heat attends these diseases, though in a less degree than

those of the last genus, because the absorbent system of glands do not

generate so much heat in their healthy state of action as the secerning

system of glands, as explained in Class I. 1. 3.

SPECIES.

1. _Mucus faucium frigidus._ Cold mucus from the throat. Much mucus, of

rather a saline taste, and less inspissated than usual, is evacuated from

the fauces by hawking, owing to the deficient absorption of the thinner

parts of it. This becomes a habit in some elderly people, who are

continually spitting it out of their mouths; and has probably been brought

on by taking snuff, or smoking tobacco; which by frequently stimulating the

fauces have at length rendered the absorbent vessels less excitable by the

natural stimulus of the saline part of the secretion, which ought to be

reabsorbed, as soon as secreted.

M. M. A few grains of powder of bark frequently put into the mouth, and

gradually diffused over the fauces. A gargle of barley water.

2. _Sudor frigidus._ The cold dampness of the hands of some people is

caused by the deficient absorption of perspirable matter; the clammy or

viscid feel of it is owing to the mucous part being left upon the skin. The

coldness is produced both by the decreased action of the absorbent system,

and by the evaporation of a greater quantity of the perspirable matter into

the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quantity of volatile

alcali in water.

3. _Catarrhus frigidus._ The thin discharge from the nostrils in cold

weather. The absorbent vessels become torpid by the diminution of external

heat, sooner than the secerning ones, which are longer kept warm by the

circulating blood, from which they select the fluid they secrete; whereas

the absorbent vessels of the nostrils drink up their fluids, namely the

thin and saline part of the mucus, after it has been cooled by the

atmosphere. Hence the absorbents ceasing to act, and the secerning vessels

continuing some time longer to pour out the mucus, a copious thin discharge

is produced, which trickles down the nostrils in cold weather. This

discharge is so acrid as to inflame the upper lip; which is owing to the

neutral salts, with which it abounds, not being reabsorbed; so the tears in

the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7.

4. _Expectoratio frigida._ Cold expectoration. Where the pulmonary

absorption is deficient, an habitual cough is produced, and a frequent

expectoration of thin saline mucus; as is often seen in old enfeebled

people. Though the stimulus of the saline fluid, which attends all

secretions, is not sufficient to excite the languid absorbent vessels to

imbibe it; yet this saline part, together with the increased quantity of

the whole of the secreted mucus, stimulates the branches of the bronchia,

so as to induce an almost incessant cough to discharge it from the lungs. A

single grain of opium, or any other stimulant drug, as a wine-posset with

spirit of hartshorn, will cure this cold cough, and the cold catarrh of the

preceding article, like a charm, by stimulating the torpid mouths of the

absorbents into action. Which has given rise to an indiscriminate and

frequently pernicious use of the warm regimen in coughs and catarrhs of the

warm or inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes the absorption of

the more fluid and saline parts, and in consequence thickens the mucus, and

abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali.

5. _Urina uberior pallida._ On being exposed naked to cold air, or

sprinkled with cold water, a quantity of pale urine is soon discharged; for

the absorbents of the bladder become torpid by their sympathy with those of

the skin; which are rendered quiescent by the diminution of external heat;

but the kidnies continue to secrete the urine, and as no part of it is

absorbed, it becomes copious and pale. This happens from a similar cause in

cold fits of agues; and in less degree to many debilitated constitutions,

whose extremities are generally cold and pale. The great quantity of limpid

water in hysteric cases, and in diabaetes, belongs to Class I. 3. 1. 10. I.

3. 2. 6.

M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in

cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire.

6. _Diarrhoea frigida._ Liquid stools are produced by exposing the body

naked to cold air, or sprinkling it with cold water, for the same reason as

the last article.

But this disease is sometimes of a dangerous nature; the intestinal

absorption being so impaired, that the aliment is said to come away

undiminished in quantity, and almost unchanged by the powers of digestion,

and is then called lientery.

The mucus of the rectum sometimes comes away like pellucid hartshorn jelly,

and liquefies by heat like that, towards the end of inirritative fevers,

which is owing to the thinner part of the mucus not being absorbed, and

thus resembles the catarrh of some old people.

M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold

weather. Clysters with opium. Friction on the bowels morning and night.

Equitation twice a day.

7. _Fluor albus frigidus._ Cold fluor albus. In weak constitutions, where

this discharge is pellucid and thin, it must proceed from want of

absorption of the mucous membrane of the vagina, or uterus, and not from an

increased secretion. This I suspect to be the most frequent kind of fluor

albus; the former one described at Class I. 1. 2. 11. attends menstruation,

or is a discharge instead of it, and thus resembles the venereal orgasm of

female quadrupeds. The discharge in this latter kind being more saline, is

liable to excoriate the part, and thus produce smarting in making water; in

its great degree it is difficult to cure.

M. M. Increase the evacuation by stool and by perspiration, by taking

rhubarb every night, about six or ten grains with one grain of opium for

some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters,

chalybeates, friction over the whole skin with flannel morning and night.

Partial cold bath, by sprinkling the loins and thighs, or sponging them

with cold water. Mucilage, as isinglass boiled in milk; blanc mange,

hartshorn jelly, are recommended by some. Tincture of cantharides sometimes

seems of service given from ten to twenty drops or more, three or four

times a day. A large plaster of burgundy pitch and armenian bole, so as to

cover the loins and lower part of the belly, is said to have sometimes

succeeded by increasing absorption by its compression in the manner of a

bandage. A solution of metallic salts, as white vitriol, sixty grains to a

pint; or an infusion of oak-bark may be injected into the vagina. Cold

bath.

8. _Gonorrhoea frigida._ Cold gleet. Where the gleet is thin and pellucid,

it must arise from the want of absorption of the membranes of the urethra,

rather than from an increased secretion from them. This I suppose to be a

more common disease than that mentioned at Class I. 1. 2. 10.

M. M. Metallic injections, partial cold bath, internal method as in the

fluor albus above described. Balsam of copaiva. Tincture of cantharides.

9. _Hepatis tumor._ The liver becomes enlarged from defect of the

absorption of mucus from its cells, as in anasarca, especially in feeble

children; at the same time less bile is secreted from the torpid

circulation in the vena portae. And as the absorbents, which resume the

thinner parts of the bile from the gall-bladder and hepatic ducts, are also

torpid or quiescent, the bile is more dilute, as well as in less quantity.

From the obstruction of the passage of the blood through the compressed

vena porta these patients have tumid bellies, and pale bloated

countenances; their paleness is probably owing to the deficiency of the

quantity of red globules in the blood in consequence of the inert state of

the bile.

These symptoms in children are generally attended with worms, the dilute

bile and the weak digestion not destroying them. In sleep I have seen

fleuke-worms in the gall-ducts themselves among the dilute bile; which

gall-ducts they eat through, and then produce ulcers, and the hectic fever,

called the rot. See Class I. 1. 4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron-filings are specific in this

disease in children, and the worms are destroyed by the returning acrimony

and quantity of the bile. A blister on the region of the liver. Sorbentia,

as worm-seed, santonicum. Columbo. Bark.

10. _Chlorosis._ When the defect of the due action of both the absorbent

and secerning vessels of the liver affects women, and is attended with

obstruction of the catamenia, it is called chlorosis; and is cured by the

exhibition of steel, which restores by its specific stimulus the absorbent

power of the liver; and the menstruation, which was obstructed in

consequence of debility, recurs.

Indigestion, owing to torpor of the stomach, and a consequent too great

acidity of its contents, attend this disease; whence a desire of eating

chalk, or marl. Sometimes a great quantity of pale urine is discharged in a

morning, which is owing to the inaction of the absorbents, which are

distributed on the neck of the bladder, during sleep. The swelling of the

ankles, which frequently attends chlorosis, is another effect of deficient

action of the absorbent system; and the pale countenance is occasioned by

the deficient quantity of red globules of blood, caused by the deficient

quantity or acrimony of the bile, and consequent weakness of the

circulation. The pulse is so quick in some cases of chlorosis, that, when

attended with an accidental cough, it may be mistaken for pulmonary

consumption. This quick pulse is owing to the debility of the heart from

the want of stimulus occasioned by the deficiency of the quantity, and

acrimony of the blood.

M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all

over the body and limbs night and morning. Rhubarb five grains, opium half

a grain, every night. Flesh diet, with small beer, or wine and water. The

disease continues some months, but at length subsides by the treatment

above described. A bath of about eighty degrees, as Buxton Bath, is of

service; a colder bath may do great injury.

11. _Hydrocele._ Dropsy of the vagina testis. Dropsies have been divided

into the incysted and the diffused, meaning those of the cellular membrane,

the cells of which communicate with each other like a sponge, and those of

any other cavity of the body. The collections of mucous fluids in the

various cells and cavities of the body arise from the torpor of the

absorbent vessels of those parts. It is probable, that in dropsies attended

with great thirst the cutaneous absorbents become paralytic first; and then

from the great thirst, which is thus occasioned by the want of atmospheric

moisture, the absorption of the fat ensues; as in fevers attended with

great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some

have believed, that the cellular and adipose membranes are different ones;

as no fat is ever deposited in the eye-lids or scrotum, both which places

are very liable to be distended with the mucilaginous fluid of the

anasarca, and with air in Emphysema. Sometimes a gradual absorption of the

accumulated fluid takes place, and the thinner parts being taken up, there

remains a more viscid fluid, or almost a solid in the part, as in some

swelled legs, which can not easily be indented by the pressure of the

finger, and are called scorbutic. Sometimes the paralysis of the absorbents

is completely removed, and the whole is again taken up into the

circulation.

The Hydrocele is known by a tumor of the scrotum, which is without pain,

gradually produced, with fluctuation, and a degree of pellucidity, when a

candle is held behind it; it is the most simple incysted dropsy, as it is

not in general complicated with other diseases, as ascites with schirrous

liver, and hydrocephalus internus, with general debility. The cure of this

disease is effected by different ways; it consists in discharging the water

by an external aperture; and by so far inflaming the cyst and testicle,

that they afterwards grow together, and thus prevent in future any

secretion or effusion of mucus; the disease is thus cured, not by the

revivescence of the absorbent power of the lymphatics, but by the

prevention of secretion by the adhesion of the vagina to the testis. This I

believe is performed with less pain, and is more certainly manageable by

tapping, or discharging the fluid by means of a trocar, and after the

evacuation of it to fill the cyst with a mixture of wine and water for a

few minutes till the necessary degree of stimulus is produced, and then to

withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by

Dr. Duncan, for 1793.

12. _Hydrocephalus internus_, or dropsy of the ventricles of the brain, is

fatal to many children, and some adults. When this disease is less in

quantity, it probably produces a fever, termed a nervous fever, and which

is sometimes called a worm fever, according to the opinion of Dr.

Gilchrist, in the Scots Medical essays. This fever is attended with great

inirritability, as appears from the dilated pupils of the eyes, in which it

corresponds with the dropsy of the brain. And the latter disease has its

paroxysms of quick pulse, and in that respect corresponds with other fevers

with inirritability.

The hydrocephalus internus is distinguished from apoplexy by its being

attended with fever, and from nervous fever by the paroxysms being very

irregular, with perfect intermissions many times in a day. In nervous fever

the pain of the head generally affects the middle of the forehead; in

hydrocephalus internus it is generally on one side of the head. One of the

earliest criterions is the patient being uneasy on raising his head from

the pillow, and wishing to lie down again immediately; which I suppose is

owing to the pressure of the water on the larger trunks of the

blood-vessels entering the cavity being more intolerable than on the

smaller ones; for if the larger trunks are compressed, it must

inconvenience the branches also; but if some of the small branches are

compressed only, the trunks are not so immediately incommoded.

Blisters on the head, and mercurial ointment externally, with calomel

internally, are principally recommended in this fatal disease. When the

patient cannot bear to be raised up in bed without great uneasiness, it is

a bad symptom. So I believe is deafness, which is commonly mistaken for

stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of

either eye, or the squinting is very apparent, or the pupils of both eyes

much dilated, it is generally fatal. As by stimulating one branch of

lymphatics into inverted motion, another branch is liable to absorb its

fluid more hastily; suppose strong errhines, as common tobacco snuff to

children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed

with ten or fifteen grains of sugar, was gradually blown up the nostrils?

See Class I. 3. 2. 1. I have tried common snuff upon two children in this

disease; one could not be made to sneeze, and the other was too near death

to receive advantage. When the mercurial preparations have produced

salivation, I believe they may have been of service, but I doubt their good

effect otherwise. In one child I tried the tincture of Digitalis; but it

was given with too timid a hand, and too late in the disease, to determine

its effects. See Sect. XXIX. 5. 9.

As all the above remedies generally fail of success, I think frequent,

almost hourly, shocks of electricity from very small charges might be

passed through the head in all directions with probability of good event.

And the use of the trephine, where the affected side can be distinguished.

See Strabismus, Class I. 2. 5. 4. When one eye is affected, does the

disease exist in the ventricule of that side?

13. _Ascites._ The dropsy of the cavity of the abdomen is known by a tense

swelling of the belly; which does not sound on being struck like the

tympany; and in which a fluctuation can be readily perceived by applying

one hand expanded on one side, and striking the tumour on the other.

Effusions of water into large cavities, as into that of the abdomen or

thorax, or into the ventricules of the brain or pericardium, are more

difficult to be reabsorbed, than the effusion of fluids into the cellular

membrane; because one part of this extensive sponge-like system of cells,

which connects all the solid parts of the body, may have its power of

absorption impaired, at the same time that some other part of it may still

retain that power, or perhaps possess it in an increased degree; and as all

these cells communicate with each other, the fluid, which abounds in one

part of it, can be transferred to another, and thus be reabsorbed into the

circulation.

In the ascites, cream of tartar has sometimes been attended with success; a

dram or two drams are given every hour in a morning till it operates, and

is to be repeated for several days; but the operation of tapping is

generally applied to at last. Dr. Sims, in the Memoirs of the Medical

Society of London, Vol. III. has lately proposed, what he believes to be a

more successful method of performing this operation, by making a puncture

with a lancet in the scar of the navel, and leaving it to discharge itself

gradually for several days, without introducing a canula, which he thinks

injurious both on account of the too sudden emission of the fluid, and the

danger of wounding or stimulating the viscera. This operation I have twice

known performed with less inconvenience, and I believe with more benefit to

the patient, than the common method.

After the patient has been tapped, some have tried injections into the

cavity of the abdomen, but hitherto I believe with ill event. Nor are

experiments of this kind very promising of success. First because the

patients are generally much debilitated, most frequently by spirituous

potation, and have generally a disease of the liver, or of other viscera.

And secondly, because the quantity of inflammation, necessary to prevent

future secretion of mucus into the cavity of the abdomen, by uniting the

peritoneum with the intestines or mesentery, as happens in the cure of the

hydrocele, would I suppose generally destroy the patient, either

immediately, or by the consequence of such adhesions.

This however is not the case in respect to the dropsy of the ovarium, or in

the hydrocele.

14. _Hydrops thoracis._ The dropsy of the chest commences with loss of

flesh, cold extremities, pale countenance, high coloured urine in small

quantity, and general debility, like many other dropsies. The patient next

complains of numbness in the arms, especially when elevated, with pain and

difficulty of swallowing, and an absolute impossibility of lying down for a

few minutes, or with sudden starting from sleep, with great difficulty of

breathing and palpitation of his heart.

The numbness of the arms is probably owing more frequently to the increased

action of the pectoral muscles in respiration, whence they are less at

liberty to perform other offices, than to the connexion of nerves mentioned

in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the

compression of the oesophagus by the lymph in the chest; and the

impossibility of breathing in an horizontal posture originates from this,

that if any parts of the lungs must be rendered useless, the inability of

the extremities of them must be less inconvenient to respiration; since if

the upper parts or larger trunks of the air-vessels should be rendered

useless by the compression of the accumulated lymph, the air could not gain

admittance to the other parts, and the animal must immediately perish.

If the pericardium is the principal seat of the disease, the pulse is quick

and irregular. If only the cavity of the thorax is hydropic, the pulse is

not quick nor irregular.

If one side is more affected than the other, the patient leans most that

way, and has more numbness in that arm.

The hydrops thoracis is distinguished from the anasarca pulmonum, as the

patient in the former cannot lie down half a minute; in the latter the

difficulty of breathing, which occasions him to rise up, comes on more

gradually; as the transition of the lymph in the cellular membranes from

one part to another of it is slower, than that of the effused lymph in the

cavity of the chest.

The hydrops thoracis is often complicated with fits of convulsive

breathing; and then it produces a disease for the time very similar to the

common periodic asthma, which is perhaps owing to a temporary anasarca of

the lungs; or to an impaired venous absorption in them. These exacerbations

of difficult breathing are attended with cold extremities, cold breath,

cold tongue, upright posture with the mouth open, and a desire of cold air,

and a quick, weak, intermittent pulse, and contracted hands.

These exacerbations recur sometimes every two or three hours, and are

relieved by opium, a grain every hour for two or three doses, with ether

about a dram in cold water; and seem to be a convulsion of the muscles of

respiration induced by the pain of the dyspnea. As in Class III. 1. 1. 9.

M. M. A grain of dried squill, and a quarter of a grain of blue vitriol

every hour for six or eight hours, unless it vomit or purge. A grain of

opium. Blisters. Calomel three grains every third day, with infusion of

senna. Bark. Chalybeates. Puncture in the side.

Can the fluctuation in the chest be heard by applying the ear to the side,

as Hippocrates asserts? Can it be felt by the hand or by the patient before

the disease is too great to admit of cure by the paracentesis? Does this

dropsy of the chest often come on after peripneumony? Is it ever cured by

making the patient sick by tincture of digitalis? Could it be cured, if on

one side only, by the operation of puncture between the ribs, and

afterwards by inflaming the cavity by the admission of air for a time, like

the cure of the hydrocele; the pleura afterwards adhering wholly to that

lobe of the lungs, so as to prevent any future effusion of mucus?

15. _Hydrops ovarii._ Dropsy of the ovary is another incysted dropsy, which

seldom admits of cure. It is distinguished from ascites by the tumour and

pain, especially at the beginning, occupying one side, and the fluctuation

being less distinctly perceptible. When it happens to young subjects it is

less liable to be mistaken for ascites. It affects women of all ages,

either married or virgins; and is produced by cold, fear, hunger, bad food,

and other debilitating causes. I saw an elegant young lady, who was shortly

to have been married to a sensible man, with great prospect of happiness;

who, on being overturned in a chaise in the night, and obliged to walk two

or three miles in wet, cold, and darkness, became much indisposed, and

gradually afflicted with a swelling and pain on one side of the abdomen;

which terminated in a dropsy of the ovary, and destroyed her in two or

three years. Another young woman I recollect seeing, who was about

seventeen, and being of the very inferior class of people, seemed to have

been much weakened by the hardship of a cold floor, and little or no bed,

with bad food; and who to these evils had to bear the unceasing obloquy of

her neighbours, and the persecution of parish officers.

The following is abstracted from a letter of my friend Mr. Power, surgeon,

at Bosworth in Leicestershire, on examining the body of an elderly lady who

died of this disease, March 29, 1793. "On opening the abdomen I found a

large cyst attached to the left ovarium by an elastic neck as thick as the

little finger, and so callous as not to admit of being separated by

scissars without considerable difficulty. The substance of the cyst had an

appearance much resembling the gravid uterus near the full period of

gestation, and was as thick. It had no attachment to the peritonaeum, or

any of the viscera, except by the hard callous neck I have mentioned; so

that the blood must with difficulty have been circulated through it for

some time. Its texture was extremely tender, being easily perforated with

the finger, was of a livid red colour, and evidently in a sphacelated

state. It contained about two gallons of a fluid of the colour of port

wine, without any greater tenacity. It has fallen to my lot to have opened

two other patients, whose deaths were occasioned by incysted dropsy of the

ovarium. In one of these the ovarium was much enlarged with eight or ten

cysts on its surface, but there was no adhesion formed by any of the cysts

to any other part; nor had the ovarium formed any adhesion with the

peritonaeum, though in a very diseased state. In the other the disease was

more simple, being only one cyst, without any attachment but to the

ovarium.

"As the ovarium is a part not necessary to life, and dropsies of this

kind are so generally fatal in the end, I think I shall be induced,

notwithstanding the hazard attending wounds, which penetrate the cavity

of the abdomen, to propose the extirpation of the diseased part in the

first case, which occurs to me, in which I can with precision say, that

the ovarium is the seat of the disease, and the patient in other

respects tolerably healthy; as the cavity of the abdomen is often

opened in other cases without bad consequences."

An argument, which might further countenance the operation thus proposed by

Mr. Power, might be taken from the disease frequently affecting young

persons; from its being generally in these subjects local and primary; and

not like the ascites, produced or accompanied with other diseased viscera;

and lastly, as it is performed in adult quadrupeds, as old sows, with

safety, though by awkward operators.

16. _Anasarca pulmonum._ The dropsy of the cellular membrane of the lungs

is usually connected with that of the other parts of the system. As the

cells of the whole cellular membrane communicate with each other, the

mucaginous fluid, which remains in any part of it for want of due

absorption, sinks down to the most depending cells; hence the legs swell,

though the cause of the disease, the deficiency of absorption, may be in

other parts of the system. The lungs however are an exception to this,

since they are suspended in the cavity of the thorax, and have in

consequence a depending part of their own.

The anasarca of the lungs is known by the difficulty of respiration

accompanied with swelled legs, and with a very irregular pulse. This last

circumstance has generally been ascribed to a dropsy at the same time

existing in the pericardium, but is more probably owing to the difficult

passage of the blood through the lungs; because I found on dissection, in

one instance, that the most irregular pulse, which I ever attended to, was

owing to very extensive adhesions of the lungs; insomuch that one lobe

intirely adhered to the pleura; and secondly, because this kind of dropsy

of the lungs is so certainly removed for a time along with the anasarca of

the limbs by the use of digitalis.

This medicine, as well as emetic tartar, or squill, when given so as to

produce sickness, or nausea, or perhaps even without producing either in

any perceptible degree, by affecting the lymphatics of the stomach, so as

either to invert their motion, or to weaken them, increases by reverse

sympathy the action, and consequent absorbent power of these lymphatics,

which open into the cellular membrane. But as those medicines seldom

succeed in producing an absorption of those fluids, which stagnate in the

larger cavities of the body, as in the abdomen, or chest, and do generally

succeed in this difficulty of breathing with irregular pulse above

described, I conclude that it is not owing to an effusion of lymph into the

pericardium, but simply to an anasarca of the lungs.

M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar

(antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain

twice a day. Raisin wine and water, or other wine and water, is preferred

to the spirit and water, which these patients have generally been

accustomed to.

The usual cause of anasarca is from a diseased liver, and hence it most

frequently attends those, who have drank much fermented or spirituous

liquors; but I suspect that there is another cause of anasarca, which

originates from the brain; and which is more certainly fatal than that,

which originates from a diseased liver. These patients, where the anasarca

originates from, or commences in, the brain, have not other symptoms of

diseased liver; have less difficulty of breathing at the beginning; and

hold themselves more upright in their chair, and in walking. In this kind

of dropsy I suspect the digitalis has less or no effect; as it particularly

increases the absorption from the lungs.

17. _Obesitas._ Corpulency may be called an anasarca or dropsy of fat,

since it must be owing to an analogous cause; that is, to the deficient

absorption of fat compared to the quantity secreted into the cells which

contain it. See Class II. 1. 1. 4.

The method of getting free from too much fat without any injury to the

constitution, consists, first, in putting on a proper bandage on the belly,

so that it can be tightened or relaxed with ease, as a tightish under

waistcoat, with a double row of buttons. This is to compress the bowels and

increase their absorption, and it thus removes one principal cause of

corpulency, which is the looseness of the skin. Secondly, he should omit

one entire meal, as supper; by this long abstinence from food the absorbent

system will act on the mucus and fat with greater energy. Thirdly, he

should drink as little as he can with ease to his sensations; since, if the

absorbents of the stomach and bowels supply the blood with much, or perhaps

too much, aqueous fluid, the absorbents of the cellular membrane will act

with less energy. Fourthly, he should use much salt or salted meat, which

will increase the perspiration and make him thirsty; and if he bears this

thirst, the absorption of his fat will be greatly increased, as appears in

fevers and dropsies with thirst; this I believe to be more efficacious than

soap. Fifthly, he may use aerated alcaline water for his drink, which may

be supposed to render the fat more fluid,--or he may take soap in large

quantities, which will be decomposed in the stomach. Sixthly, short rest,

and constant exercise.

18. _Splenis tumor._ Swellings of the spleen, or in its vicinity, are

frequently perceived by the hand in intermittents, which are called

Ague-cakes, and seem owing to a deficiency of absorption in the affected

part.

Mr. Y----, a young man about twenty-five years of age, who lived

intemperately, was seized with an obstinate intermittent, which had become

a continued fever with strong pulse, attended with daily remission. A large

hard tumour on the left side, on the region of the spleen, but extending

much more downward, was so distinctly perceptible, that one seemed to get

one's fingers under the edge of it, much like the feel of the brawn or

shield on a boar's shoulder. He was repeatedly bled, and purged with

calomel, had an emetic, and a blister on the part, without diminishing the

tumour; after some time he took the Peruvian bark, and slight doses of

chalybeates, and thus became free from the fever, and went to Bath for

several weeks, but the tumour remained. This tumour I examined every four

or five years for above thirty years. His countenance was pale, and towards

the end of his life he suffered much from ulcers on his legs, and died

about sixty, of general debility; like many others, who live intemperately

in respect to the ingurgitation of fermented or spirituous liquors.

As this tumour commenced in the cold fit of an intermittent fever, and was

not attended with pain, and continued so long without endangering his life,

there is reason to believe it was simply occasioned by deficient

absorption, and not by more energetic action of the vessels which

constitute the spleen. See Class II. 1. 2. 13.

M. M. Venesection. Emetic, cathartic with calomel; then sorbentia,

chalybeates, Peruvian bark.

19. _Genu tumor albus._ White swelling of the knee, is owing to deficient

absorption of the lymphatics of the membranes including the joint, or

capsular ligaments, and sometimes perhaps of the gland which secretes the

synovia; and the ends of the bones are probably affected in consequence.

I saw an instance, where a caustic had been applied by an empiric on a

large white swelling of the knee, and was told, that a fluid had been

discharged from the joint, which became anchylosed, and healed without loss

of the limb.

M. M. Repeated blisters on the part early in the disease are said to cure

it by promoting absorption; saturnine solutions externally are recommended.

Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with

the hand.

20. _Bronchocele._ Swelled throat. An enlargement of the thyroid glands,

said to be frequent in mountainous countries, where river water is drank,

which has its source from dissolving snows. This idea is a very ancient

one, but perhaps not on that account to be the more depended upon, as

authors copy one another. Tumidum guttur quis miratur in alpibus, seems to

have been a proverb in the time of Juvenal. The inferior people of Derby

are much subject to this disease, but whether more so than other populous

towns, I can not determine; certain it is, that they chiefly drink the

water of the Derwent, which arises in a mountainous country, and is very

frequently blackened as it passes through the morasses near its source; and

is generally of a darker colour, and attended with a whiter foam, than the

Trent, into which it falls; the greater quantity and whiteness of its froth

I suppose may be owing to the viscidity communicated to it by the colouring

matter. The lower parts of the town of Derby might be easily supplied with

spring water from St. Alkmond's well; or the whole of it from the abundant

springs near Bowbridge: the water from which might be conveyed to the town

in hollow bricks, or clay-pipes, at no very great expence, and might be

received into frequent reservoirs with pumps to them; or laid into the

houses.

M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage

into lozenges, and permitted to dissolve slowly under the tongue twice a

day, is asserted to cure in a few months; perhaps other animal charcoal, as

candle-snuffs, might do the same.

I have directed in the early state of this disease a mixture of common salt

and water to be held in the mouth, particularly under the tongue, for a few

minutes, four or six times a day for many weeks, which has sometimes

succeeded, the salt and water is then spit out again, or in part swallowed.

Externally vinegar of squills has been applied, or a mercurial plaster, or

fomentations of acetated ammoniac; or ether. Some empirics have applied

caustics on the bronchocele, and sometimes, I have been told, with success;

which should certainly be used where there is danger of suffocation from

the bulk of it. One case I saw, and one I was well informed of, where the

bronchocele was cured by burnt sponge, and a hectic fever supervened with

colliquative sweats; but I do not know the final event of either of them.

De Haen affirms the cure of bronchocele to be effected by flowers of zinc,

calcined egg-shells, and scarlet cloth burnt together in a close crucible,

which was tried with success, as he assured me, by a late lamented

physician, my friend, Dr. Small of Birmingham; who to the cultivation of

modern sciences added the integrity of ancient manners; who in clearness of

head, and benevolence of heart, had few equals, perhaps no superiors.

21. _Scrophula._ King's evil is known by tumours of the lymphatic glands,

particularly of the neck. The upper lip, and division of the nostrils is

swelled, with a florid countenance, a smooth skin, and a tumid abdomen.

Cullen. The absorbed fluids in their course to the veins in the scrophula

are arrested in the lymphatic or conglobate glands; which swell, and after

a great length of time, inflame and suppurate. Materials of a peculiar

kind, as the variolous and venereal matter, when absorbed in a wound,

produce this torpor, and consequent inflammation of those lymphatic glands,

where they first arrive, as in the axilla and groin. There is reason to

suspect, that the tonsils frequently become inflamed, and suppurate from

the matter absorbed from carious teeth; and I saw a young lady, who had

both the axillary glands swelled, and which suppurated; which was believed

to have been caused by her wearing a pair of new green gloves for one day,

when she had perspired much, and was much exhausted and fatigued by

walking; the gloves were probably dyed in a solution of verditer.

These indolent tumours of the lymphatic glands, which constitute the

scrophula, originate from the inirritability of those glands; which

therefore sooner fall into torpor after having been stimulated too

violently by some poisonous material; as the muscles of enfeebled people

sooner become fatigued, and cease to act, when exerted, than those of

stronger ones. On the same account these scrophulous glands are much longer

in acquiring increase of motion, after having been stimulated into

inactivity, and either remain years in a state of indolence, or suppurate

with difficulty, and sometimes only partially.

The difference between scrophulous tumours, and those before described,

consists in this; that in those either glands of different kinds were

diseased, or the mouths only of the lymphatic glands were become torpid;

whereas in scrophula the conglobate glands themselves become tumid, and

generally suppurate after a great length of time, when they acquire new

sensibility. See Sect. XXXIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by passing

electric shocks through them every day for two or three weeks, as I have

witnessed. It is probable, that the alternate application of snow or iced

water to them, till they become painfully cold, and then of warm flannel or

warm water, frequently repeated, might restore their irritability by

accumulation of sensorial power; and thence either facilitate their

dispersion, or occasion them to suppurate. See Class II. 1. 4. 13.

This disease is very frequent amongst the children of the poor in large

towns, who are in general ill fed, ill lodged, and ill clothed; and who are

further weakened by eating much salt with their scanty meal of insipid

vegetable food, which is seldom of better quality than water gruel, with a

little coarse bread in it. See diarrhoea of infants, Class I. 1. 2. 5.

Scrophulous ulcers are difficult to heal, which is owing to the deficiency

of absorption on their pale and flabby surfaces, and to the general

inirritability of the system. See Class I. 1. 3. 13.

M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium,

from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture

of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing

in salt and water, one pound to three gallons, made warm. The application

of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in

fine powder one part, mixed together and applied on the ulcers in dry

powder, by means of lint and a bandage, to be renewed every day. Or very

fine powder of calamy alone, lapis calaminaris. If powder of manganese?

22. _Schirrus._ After the absorbent veins of a gland cease to perform their

office, if the secerning arteries of it continue to act some time longer,

the fluids are pushed forwards, and stagnate in the receptacles or

capillary vessels of the gland; and the thinner part of them only being

resumed by the absorbent system of the gland, a hard tumour gradually

succeeds; which continues like a lifeless mass, till from some accidental

violence it gains sensibility, and produces cancer, or suppurates. Of this

kind are the schirrous glands of the breasts, of the lungs, of the

mesentery, and the scrophulous tumours about the neck and the bronchocele.

Another seat of schirrus is in the membranous parts of the system, as of

the rectum intestinum, the urethra, the gula or throat; and of this kind is

the verucca or wart, and the clavus pedum, or corns on the toes. A wen

sometimes arises on the back of the neck, and sometimes between the

shoulders; and by distending the tendinous fascia produces great and

perpetual pain.

M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation.

Electric shocks through the tumour. An issue into the substance of the wen.

Opium. Ether externally.

23. _Schirrus recti intestini._ Schirrus of the rectum. A schirrus

frequently affects a canal, and by contracting its diameter becomes a

painful and deplorable disease. The canals thus obstructed are the rectum,

the urethra, the throat, the gall-ducts, and probably the excretory ducts

of the lymphatics, and of other glands.

The schirrus of the rectum is known by the patient having pain in the part,

and being only able to part with liquid feces, and by the introduction of

the finger; the swelled part of the intestine is sometimes protruded

downwards, and hangs like a valve, smooth and hard to the touch, with an

aperture in the centre of it. See a paper on this subject by J. Sherwin.

Memoirs of a London Medical Society, Vol. II. p. 9.

M. M. To take but little solid food. Aperient medicines. Introduce a candle

smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of

laudanum. Introduce a leathern canula, or gut, and then either a wooden

maundril, or blow it up with air, so as to distend the contracted part as

much as the patient can bear. Or spread mercurial plaster on thick soft

leather, and roll it up with the plaster outwards to any thickness and

length, which can be easily introduced and worn; or two or three such

pieces may be introduced after each other. The same may be used to compress

bleeding internal piles. See Class I. 2. 1. 6.

24. _Schirrus urethrae._ Schirrus of the urethra. The passage becomes

contracted by the thickened membrane, and the urine is forced through with

great difficulty, and is thence liable to distend the canal behind the

stricture; till at length an aperture is made, and the urine forces its way

into the cellular membrane, making large sinuses. This situation sometimes

continues many months, or even years, and so much matter is evacuated after

making water, or at the same time, by the action of the muscles in the

vicinity of the sinuses, that it has been mistaken for an increased

secretion from the bladder, and has been erroneously termed a catarrh of

the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs.

M. M. Distend the part gradually by catgut bougies, which by their

compression will at the same time diminish the thickness of the membrane,

or by bougies of elastic gum, or of horn boiled soft. The patient should

gain the habit of making water slowly, which is a matter of the utmost

consequence, as it prevents the distention, and consequent rupture, of that

part of the urethra, which is between the stricture and the neck of the

bladder.

When there occurs an external ulcer in the perinaeum, and the urine is in

part discharged that way, the disease can not be mistaken. Otherwise from

the quantity of matter, it is generally supposed to come from the bladder,

or prostate gland; and the urine, which escapes from the ruptured urethra,

mines its way amongst the muscles and membranes, and the patient dies

tabid, owing to the want of an external orifice to discharge the matter.

See Class II. 1. 4. 11.

25. _Schirrus oesophagi._ A schirrus of the throat contracts the passage so

as to render the swallowing of solids impracticable, and of liquids

difficult. It affects patients of all ages, but is probably most frequently

produced by swallowing hard angular substances, when people have lost their

teeth; by which this membrane is over distended, or torn, or otherwise

injured.

M. M. Put milk into a bladder tied to a canula or catheter; introduce it

past the stricture, and press it into the stomach. Distend the stricture

gradually by a sponge-tent fastened to the end of whale-bone, or by a plug

of wax, or a spermaceti candle, about two inches long; which might be

introduced, and left there with a string only fixed to it to hang out of

the mouth, to keep it in its place, and to retract it by occasionally; for

which purpose the string must be put through a catheter or hollow probang,

when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and

then distend it by blowing wind into it. The swallowing a bullet with a

string put through it, to retract it on the exhibition of an emetic, has

also been proposed. Externally mercurial ointment has been much

recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth.

Transfusion of blood into a vein three or four ounces a day? See Class III.

1. 1. 15.

I directed a young woman about twenty-two years of age, to be fed with new

milk put into a bladder, which was tied to a catheter, and introduced

beyond the stricture in her throat; after a few days her spirits sunk, and

she refused to use it further, and died. Above thirty years ago I proposed

to an old gentleman, whose throat was entirely impervious, to supply him

with a few ounces of blood daily from an ass, or from the human animal, who

is still more patient and tractable, in the following manner. To fix a

silver pipe about an inch long to each extremity of a chicken's gut, the

part between the two silver ends to be measured by filling it with warm

water; to put one end into the vein of a person hired for that purpose, so

as to receive the blood returning from the extremity; and when the gut was

quite full, and the blood running through the other silver end, to

introduce that end into the vein of the patient upwards towards the heart,

so as to admit no air along with the blood. And lastly, to support the gut

and silver ends on a water plate, filled with water of ninety-eight degrees

of heat, and to measure how many ounces of blood was introduced by passing

the finger, so as to compress the gut, from the receiving pipe to the

delivering pipe; and thence to determine how many gut-fulls were given from

the healthy person to the patient. See Class IV. 2. 4. 11. Mr. ----

considered a day on this proposal, and then another day, and at length

answered, that "he now found himself near the house of death; and that if

he could return, he was now too old to have much enjoyment of life; and

therefore he wished rather to proceed to the end of that journey, which he

was now so near, and which he must at all events soon go, than return for

so short a time." He lived but a few days afterwards, and seemed quite

careless and easy about the matter.

26. _Lacteorum inirritabilitas._ Inirritability of the lacteals is

described in Sect. XXVIII. under the name of paralysis of the lacteals; but

as the word paralysis has generally been applied to the disobedience of the

muscles to the power of volition, the name is here changed to

inirritability of the lacteals, as more characteristic of the disease.

27. _Lymphaticorum inirritabilitas._ The inirritability of the cellular and

cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Class I. 2.

3. 16. The inirritability of the cutaneous lymphatics generally accompanies

anasarca, and is the cause of the great thirst in that malady. At the same

time the cellular lymphatics act with greater energy, owing to the greater

derivation of sensorial power to them in consequence of the less

expenditure of it by the cutaneous ones; and hence they absorb the fat, and

mucus, and also the thinner parts of the urine. Whence the great emaciation

of the body, the muddy sediment, and the small quantity of water in this

kind of dropsy.

* * * * *

ORDO II.

_Decreased Irritation._

GENUS IV.

_With Decreased Actions of other Cavities and Membranes._

Many of the diseases of this genus are attended with pain, and with cold

extremities, both which cease on the exhibition of wine or opium; which

shews, that they originate from deficient action of the affected organ.

These pains are called nervous or spasmodic, are not attended with fever,

but are frequently succeeded by convulsions and madness; both which belong

to the class of volition. Some of them return at periods, and when these

can be ascertained, a much less quantity of opium will prevent them, than

is necessary to cure them, when they are begun; as the vessels are then

torpid and inirritable from the want of sensorial power, till by their

inaction it becomes again accumulated.

Our organs of sense properly so called are not liable to pain from the

absence of their appropriated stimuli, as from darkness or silence; but the

other senses, which may be more properly called appetites, as those by

which we perceive heat, hunger, thirst, lust, want of fresh air, are

affected with pain from the defect or absence of their accustomed stimuli,

as well as with pleasure by the possession of them; it is probable that

some of our glands, whose sense or appetite requires or receives something

from the circulating blood, as the pancreas, liver, testes, prostate gland,

may be affected with aching or pain, when they cannot acquire their

appropriated fluid.

Wherever this defect of stimulus occurs, a torpor or inaction of the organ

ensues, as in the capillaries of the skin, when exposed to cold; and in the

glands, which secrete the gastric juice, when we are hungry. This torpor

however, and concomitant pain, which is at first owing to defect of

stimulus, is afterwards induced by other associations or catenations, and

constitutes the beginning of ague fits.

It must be further observed, that in the diseases of pain without fever,

the pain is frequently not felt in the part where the cause of the disease

resides; but is induced by sympathy with a distant part, whose irritability

or sensibility is greater or less than its own. Thus a stone at the neck of

the bladder, if its stimulus is not very great, only induces the pain of

strangury at the glans penis. If its stimulus be greater, it then induces

pain at the neck of the bladder. The concretions of bile, which are

protruded into the neck of the gall-bladder, when the disease is not very

great, produce pain at the other extremity of the bile-duct, which enters

the duodenum immediately under the pit of the stomach; but, when the

disease is great from the largeness of the bile-stone, the pain is felt in

the region of the liver at the neck of the gall-bladder.

It appears from hence, that the pains enumerated in this genus are

consequences of the inactivity of the organ; and, as they do not occasion

other diseases, should be classed according to their proximate cause, which

is defective irritation; there are nevertheless other pains from defect of

stimulus, which produce convulsions, and belong to Class III. 1. 1.; and

others, which produce pains of some distant part by association, and belong

to Class IV. 2. 2.

SPECIES.

1. _Sitis._ Thirst. The senses of thirst and of hunger seem to have this

connection, that the former is situated at the upper end, and the latter at

the lower end of the same canal. One about the pharinx, where the

oesophagus opens into the mouth, and the other about the cardia ventriculi,

where it opens into the stomach. The extremities of other canals have been

shewn to possess correspondent sensibilities, or irritabilities, as the two

ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4.