consequently painful, when there is a deficiency of aqueous fluid in the
general system; it then wants its proper stimulus. In the same manner a
want of the stimulus of more solid materials at the other end of the canal,
which terminates in the stomach, produces hunger; as mentioned in Sect.
XIV. 8. The proximate causes of both of them therefore consist in deficient
irritation, when they are considered as pains; because these pains are in
consequence of the inactivity of the organ, according to the fifth law of
animal causation. Sect. IV. 5. But when they are considered as desires,
namely of liquid or solid aliment, their proximate cause consists in the
pain of them, according to the sixth law of animal causation. So the
proximate cause of the pain of coldness is the inactivity of the organ, and
perhaps the consequent accumulation of sensorial power in it; but the pain
itself, or the consequent volition, is the proximate cause of the
shuddering and gnashing the teeth in cold fits of intermittent fevers. See
Class I. 2. 2. 1.
Thirst may be divided into two varieties alluding to the remote cause of
each, and may be termed sitis calida, or warm thirst, and sitis frigida, or
cold thirst. The remote cause of the former arises from the dissipation of
the aqueous parts of our fluids by the increased secretion of perspirable
matter, or other evacuations. And hence it occurs in hot fits of fever, and
after taking much wine, opium, spice, salt, or other drugs of the Art.
incitantia or secernentia. The thirst, which occurs about three hours after
eating a couple of red herrings, to a person unaccustomed to salted meat,
is of this kind; the increased action of the cutaneous vessels dissipates
so much of our fluids by insensible perspiration, as to require above two
quarts of water to restore the fluidity of the blood, and to wash the salt
out of the system. See Art. III. 2. 1.
M. M. Cold water. Vegetable acids. Warm bath.
The remote cause of sitis frigida, or cold thirst, is owing to the inaction
of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the
blood is deprived of the great supply of moisture, which it ought to
receive from the atmosphere, and from the cells of the cellular membrane,
and from other cysts; this cause of thirst exists in dropsies, and in the
cold fits of intermittents. The desire of fluids, like that of solids, is
liable to acquire periods, and may therefore readily become diseased by
indulgence in liquids grateful to the palate.
Of diseased thirst, the most common is either owing to defect of the action
of the numerous absorbent vessels on the neck of the bladder, in which the
patient makes much paleish water; or to the defective absorption of the
skin and lungs, in which the patient makes but little water, and that
high-coloured, and with sediment. In both the tongue and lips are liable to
become very dry. The former in its greatest degree attends diabaetes, and
the latter anasarca.
M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water.
Lemonade. Cyder.
2. _Esuries._ Hunger has been fancifully ascribed to the sides of the
stomach rubbing against each other, and to the increased acidity of the
gastric juice corroding the coats of it. If either of these were the cause
of hunger, inflammation must occur, when they had continued some time; but,
on the contrary, coldness and not heat are attendant on hunger; which
evinces, that like thirst it is owing to the inactivity of the membrane,
which is the seat of it; while the abundant nerves about the cardia
ventriculi, and the pain of hunger being felt in that part, gives great
reason to conclude, that it is there situated.
The sense of hunger as well as of thirst is liable to acquire habits in
respect to the times of its returning painfulness, as well as in respect to
the quantity required to satiate its appetency, and hence may become
diseased by indulgence, as well as by want of its appropriate stimulus.
Those who have been accustomed to distend their stomach by large quantities
of animal and vegetable food, and much potation, find a want of distention,
when the stomach is empty, which occasions faintness, and is mistaken for
hunger, but which does not appear to be the same sensation. I was well
informed, that a woman near Lichfield, who eat much animal and vegetable
food for a wager, affirmed, that since distending her stomach so much, she
had never felt herself satisfied with food; and had in general taken twice
as much at a meal, as she had been accustomed to, before she eat so much
for a wager.
3. _Nausea sicca._ Dry nausea. Consists in a quiescence or torpor of the
mucous or salivary glands, and precedes their inverted motions, described
in nausea humida, Class I. 3. 2. 3. In the same manner as sickness of the
stomach is a quiescence of that organ preceding the action of vomiting, as
explained in Sect. XXXV. 1. 3. This is sometimes induced by disagreeable
drugs held in the mouth, at other times of disgustful ideas, and at other
times by the association of these actions with those of the stomach; and
thus according to its different proximate causes may belong to this, or to
the second, or to the fourth class of diseases.
M. M. Lemonade. Tasteful food. A blister. Warm bath.
4. _Aegritudo ventriculi._ Sickness of stomach is produced by the
quiescence or inactivity of that organ, as is explained in Sect. XXXV. 1.
3. It consists in the state between the usual peristaltic motions of that
organ, in the digestion of our aliment, and the retrograde motions of it in
vomiting; for it is evident, that the direct motions of it from the cardia
to the pylorus must stop, before those in a contrary direction can
commence. This sickness, like the nausea above described, is sometimes
produced by disgustful ideas, as when nasty objects are seen, and nasty
stories related, as well as by the exhaustion of the sensorial power by the
stimulus of some emetic drugs, and by the defect of the production of it,
as in enfeebled drunkards.
Sickness may likewise consist in the retrograde motions of the lymphatics
of the stomach, which regurgitate into it the chyle or lymph, which they
have lately absorbed, as in Class I. 3. 2. 3. It is probable, that these
two kinds of sickness may be different sensations, though they have
acquired but one name; as one of them attends hunger, and the other
repletion; though either of them may possibly be induced by association
with nauseous ideas.
M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the
head in bed. See Sect. XXV. 16. Class IV. 1. 1. 2. and 3.
5. _Cardialgia._ Heartburn originates from the inactivity of the stomach,
whence the aliment, instead of being subdued by digestion, and converted
into chyle, runs into fermentation, producing acetous acid. Sometimes the
gastric juice itself becomes so acid as to give pain to the upper orifice
of the stomach; these acid contents of the stomach, on falling on a marble
hearth, have been seen to produce an effervescence on it. The pain of heat
at the upper end of the gullet, when any air is brought up from the
fermenting contents of the stomach, is to be ascribed to the sympathy
between these two extremities of the oesophagus rather than to the pungency
of the carbonic gas, or fixed air; as the sensation in swallowing that kind
of air in water is of a different kind. See Class I. 3. 1. 3. and IV. 2. 2.
5.
M. M. This disease arising from indigestion is often very pertinacious, and
afflicting; and attended with emaciation of the body from want of
sufficient chyle. As the saliva swallowed along with our food prevents its
fermentation, as appears by the experiments of Pringle and Macbride, some
find considerable relief by chewing parched wheat, or mastic, or a lock of
wool, frequently in a day, when the pain occurs, and by swallowing the
saliva thus effused; a temporary relief is often obtained from antiacids,
as aerated alcaline water, Seltzer's water, calcareous earths, alcaline
salts made into pills with soap, soap alone, tin, milk, bitters. More
permanent use may be had from such drugs as check fermentation, as acid of
vitriol; but still more permanent relief from such things as invigorate the
digestion, as a blister on the back; a due quantity of vinous spirit and
water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat
made so tight as slightly to compress the bowels and stomach. A flannel
shirt in winter, not in summer. A less quantity of potation of all kinds.
Ten black pepper-corns swallowed after dinner. Half a grain of opium twice
a day, or a grain. The food should consist of such things as do not easily
ferment, as flesh, shell-fish, sea-biscuit, toasted cheese. I have seen
toasted cheese brought up from the stomach 24 hours after it had been
swallowed, without apparently having undergone any chemical change. See
Class II. 1. 3. 17. and IV. 1. 2. 13.
6. _Arthritis Ventriculi._ Sickness of the stomach in gouty cases is
frequently a consequence of the torpor or inflammation of the liver, and
then it continues many days or weeks. But when the patient is seized with
great pain at the stomach with the sensation of coldness, which they have
called an ice-bolt, this is a primary affection of the stomach, and
destroys the patient in a few hours, owing to the torpor or inaction of
that viscus so important to life.
This primary gout of the stomach, as it is a torpor of that viscus, is
attended with sensation of coldness, and with real defect of heat, in that
part, and may thence be distinguished from the pain occasioned by the
passage of a gall-stone into the duodenum, as well as by the weak pulse,
and cold extremities; to which must be added, that it affects those only,
who have been long afflicted with the gout, and much debilitated by its
numerous attacks.
M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied
externally to the stomach by hot cloths or fomentation.
7. _Colica flatulenta._ The flatulent colic arises from the too great
distention of the bowel by air, and consequent pain. The cause of this
disease is the inactivity or want of sufficiently powerful contraction of
the coats of the bowel, to carry forwards the gas given up by the
fermenting aliment. It is without fever, and generally attended with cold
extremities.
It is distinguished, first, from the pain occasioned by the passage of a
gall-stone, as that is felt at the pit of the stomach, and this nearer the
navel. Secondly, it is distinguished from the colica saturnina, or colic
from lead, as that arising from the torpor of the liver, or of some other
viscus, is attended with greater coldness, and with an aching pain; whereas
the flatulent cholic being owing to distention of the muscles of the bowel,
the pain is more acute, and the coldness less. Thirdly, it is distinguished
from inflammation of the bowels, or ileus, as perpetual vomiting and fever
attend this. Fourthly, it is distinguished from cholera, because that is
accompanied with both vomiting and diarrhoea. And lastly, from the colica
epileptica, or hysteric colic, as that is liable to alternate with
convulsion, and sometimes with insanity; and returns by periods.
M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain.
Spice. Volatile alcali. Warm fomentation externally. Rhubarb.
8. _Colica saturnina._ Colic from lead. The pain is felt about the navel,
is rather of an aching than acute kind at first, which increases after
meals, and gradually becomes more permanent and more acute. It terminates
in paralysis, frequently of the muscles of the arm, so that the hand hangs
down, when the arm is extended horizontally. It is not attended with fever,
or increase of heat. The seat of the disease is not well ascertained, it
probably affects some part of the liver, as a pale bluish countenance and
deficiency of bile sometimes attends or succeeds it, with consequent
anasarca; but it seems to be caused immediately by a torpor of the
intestine, whether this be a primary or secondary affection, as appears
from the constipation of the bowels, which attends it; and is always
produced in consequence of the great stimulus of lead previously used
either internally for a length of time, or externally on a large surface.
A delicate young girl, daughter of a dairy farmer, who kept his milk in
leaden cisterns, used to wipe off the cream from the edges of the lead with
her finger; and frequently, as she was fond of cream, licked it from her
finger. She was seized with the saturnine colic, and semi-paralytic wrists,
and sunk from general debility.
A feeble woman about 40 years of age sprained her ancle, and bruised her
leg and thigh; and applied by ill advice a solution of lead over the whole
limb, as a fomentation and poultice for about a fortnight. She was then
seized with the colica saturnina, lost the use of her wrists, and gradually
sunk under a general debility.
M. M. First opium one or two grains, then a cathartic of senna, jalap, and
oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A
blister on the navel. Warm bath. The stimulus of the opium, by restoring to
the bowel its natural irritability in this case of painful torpor, assists
the action of the cathartic.
9. _Tympanitis._ Tympany consists in an elastic tumor of the abdomen, which
sounds on being struck. It is generally attended with costiveness and
emaciation. In one kind the air is said to exist in the bowels, in which
case the tumor is less equal, and becomes less tense and painful on the
evacuation of air. In the other kind the air exists in the cavity of the
abdomen, and sometimes is in a few days exchanged for water, and the
tympany becomes an ascites.
Air may be distinguished in the stomach of many people by the sound on
striking it with the fingers, and comparing the sound with that of a
similar percussion on other parts of the bowels; but towards the end of
fevers, and especially in the puerperal fever, a distention of the abdomen
by air is generally a fatal symptom, though the ease, and often
cheerfulness, of the patient vainly flatters the attendants.
M. M. In the former case a clyster-pipe unarmed may be introduced, and left
some time in the rectum, to take off the resistance of the sphincter, and
thus discharge the air, as it is produced from the fermenting or putrefying
aliment. For this purpose, in a disease somewhat similar in horses, a
perforation is made into the rectum on one side of the sphincter; through
which fistula the air, which is produced in such great excess from the
quantity of vegetable food which they take, when their digestions are
impaired, is perpetually evacuated. In both cases also, balsams, essential
oil, spice, bandage on the abdomen, and, to prevent the fermentation of the
aliment, acid of vitriol, saliva. See Class I. 2. 4. 5.
10. _Hypochondriasis._ The hypochondriac disease consists in indigestion
and consequent flatulency, with anxiety or want of pleasureable sensation.
When the action of the stomach and bowels is impaired, much gas becomes
generated by the fermenting or putrescent aliment, and to this indigestion
is catenated languor, coldness of the skin, and fear. For when the
extremities are cold for too long a time in some weak constitutions,
indigestion is produced by direct sympathy of the skin and the stomach,
with consequent heart-burn, and flatulency. The same occurs if the skin be
made cold by fear, as in riding over dangerous roads in winter, and hence
conversely fear is produced by indigestion or torpor of the stomach by
association.
This disease is confounded with the fear of death, which is an insanity,
and therefore of a totally different nature. It is also confounded with the
hysteric disease, which consists in the retrograde motions of the
alimentary canal, and of some parts of the absorbent system.
The hypochondriasis, like chlorosis, is sometimes attended with very quick
pulse; which the patient seems to bear so easily in these two maladies,
that if an accidental cough attends them, they may be mistaken for
pulmonary consumption; which is not owing primarily to the debility of the
heart, but to its direct sympathy with the actions of the stomach.
M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain
twice a day. Rhubarb six grains every night. Bark. Steel. Spice.
Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No
liquor stronger than small beer, or wine and water. Gentle exercise on
horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4.
5.
11. _Cephalaea._ Head-ach frequently attends the cold paroxysm of
intermittents; afflicts inebriates the day after intoxication; and many
people who remain too long in the cold bath. In all which cases there is a
general inaction of the whole system, and as these membranes about the head
have been more exposed to the variations of heat and cold of the
atmosphere, they are more liable to become affected so far as to produce
sensation, than other membranes; which are usually covered either with
clothes, or with muscles, as mentioned in Sect. XXXIII. 2. 10.
The promptitude of the membranes about the scalp to sympathize with those
of other parts of the system is so great, that this cephalaea without
fever, or quickness of pulse, is more frequently a secondary than a primary
disease, and then belongs to Class IV. 2. 2. 7. The hemicrania, or partial
head-ach, I believe to be almost always a disease from association; though
it is not impossible, but a person may take cold on one side of the head
only. As some people by sitting always on the same side of the fire in
winter are liable to render one side more tender than the other, and in
consequence more subject to pains, which have been erroneously termed
rheumatic. See Class IV. 2. 2. 7. & 8.
M. M. The method of cure consists in rendering the habit more robust, by
gentle constant exercise in the open air, flesh diet, small beer at meals
with one glass of wine, regular hours of rest and rising, and of meals. The
cloathing about the head should be warmer during sleep than in the day;
because at that time people are more liable to take cold; that is, the
membranous parts of it are more liable to become torpid. As explained in
Sect. XVIII. 15. In respect to medicine, two drams of valerian root in
powder three or four times a day are recommended by Fordyce. The bark.
Steel in moderate quantities. An emetic. A blister. Opium, half a grain
twice a day. Decayed teeth should be extracted, particularly such as either
ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm
bath of 94 or 98 degrees every day for half an hour during a month. See
Class IV. 2. 2. 7. and 8.
A solution of arsenic, about the sixteenth part of a grain, is reported to
have great effect in this disease. It should be taken thrice a day, if it
produces no griping or sickness, for two or three weeks. A medicine of this
kind is sold under the name of tasteless ague-drops; but a more certain
method of ascertaining the quantity is delivered in the subsequent materia
medica, Art. IV. 2. 6.
12. _Odontalgia._ Tooth-ach. The pain has been erroneously supposed, where
there is no inflammation, to be owing to some acrid matter from a carious
tooth stimulating the membrane of the alveolar process into violent action
and consequent pain; but the effect seems to have been mistaken for the
cause, and the decay of the tooth to have been occasioned by the torpor and
consequent pain of the diseased membrane.
First, because the pain precedes the decay of the tooth in regard to time,
and is liable to recur, frequently for years, without certainly being
succeeded at last by a carious tooth, as I have repeatedly observed.
Secondly, because any stimulant drug, as pyrethrum, or oil of cloves,
applied to the tooth, or ether applied externally to the cheek, so far from
increasing the pain, as they would do if the pained membrane, already acted
too strongly, that they frequently give immediate relief like a charm.
And thirdly, because the torpor, or deficient action of the membrane, which
includes the diseased tooth, occasions the motions of the membranes most
connected with it, as those of the cheek and temples, to act with less than
their natural energy; and hence a coldness of the cheek is perceived easily
by the hand of the patient, comparing it with the other cheek; and the pain
of hemicrania is often produced in the temple of the affected side.
This coldness of the cheek in common tooth-ach evinces, that the pain is
not then caused by inflammation; because in all inflammations so much heat
is produced in the secretions of new vessels and fluids, as to give heat to
the parts in vicinity. And hence, as soon as the gum swells and inflames
along with the cheek, heat is produced, and the pain ceases, owing to the
increased exertions of the torpid membrane, excited by the activity of the
sensorial power of sensation; which previously existed in its passive state
in the painful torpid membrane. See Odontitis, Class II. 1. 4. 7. and IV.
2. 2. 8.
M. M. If the painful tooth be found, venesection. Then a cathartic.
Afterwards two grains of opium. Camphor and opium, one grain of each held
in the mouth; or a drop or two of oil of cloves put on the painful tooth.
Ether. If the tooth has a small hole in it, it should be widened within by
an instrument, and then stopped with leaf-gold, or leaf-lead; but should be
extracted, if much decayed. It is probable that half a small drop of a
strong solution of arsenic, put carefully into the hollow of a decayed
aching tooth, would destroy the nerve without giving any additional pain;
but this experiment requires great caution, lest any of the solution should
touch the tongue or gums.
Much cold or much heat are equally injurious to the teeth, which are endued
with a fine sensation of this universal fluid. The best method of
preserving them is by the daily use of a brush, which is not very hard,
with warm water and fine charcoal dust. A lump of charcoal should be put a
second time into the fire till it is red hot, as soon as it becomes cool
the external ashes should be blown off, and it should be immediately
reduced to fine powder in a mortar, and kept close stopped in a phial. It
takes away the bad smell from decayed teeth, by washing the mouth with this
powder diffused in water immediately. The putrid smell of decaying stumps
of teeth may be destroyed for a time by washing the mouth with a weak
solution of alum in water. If the calcareous crust upon the teeth adheres
very firmly, a fine powder of pumice-stone may be used occasionally, or a
tooth instrument.
Acid of sea-salt, much diluted, may be used; but this very rarely, and with
the greatest caution, as in cleaning sea-shells. When the gums are spongy,
they should be frequently pricked with a lancet. Should black spots in
teeth be cut out? Does the enamel grow again when it has been perforated or
abraded?
13. _Otalgia._ Ear-ach sometimes continues many days without apparent
inflammation, and is then frequently removed by filling the ear with
laudanum, or with ether; or even with warm oil, or warm water. See Class
II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the
consequence of association with a diseased tooth; in that case the ether
should be applied to the cheek over the suspected tooth, or a grain of
opium and as much camphor mixed together and applied to the suspected
tooth. In this case the otalgia belongs to the fourth class of diseases.
14. _Pleurodyne chronica._ Chronical pain of the side. Pains of the
membranous parts, which are not attended with fever, have acquired the
general name of rheumatic; which should, nevertheless, be restricted to
those pains which exist only when the parts are in motion, and which have
been left after inflammation of them; as described in Class I. 1. 3. 12.
The pain of the side here mentioned affects many ladies, and may possibly
have been owing to the pressure of tight stays, which has weakened the
action of the vessels composing some membranous part, as, like the cold
head-ach, it is attended with present debility; in one patient, a boy about
ten years old, it was attended with daily convulsions, and was supposed to
have originated from worms. The disease is very frequent, and generally
withstands the use of blisters on the part; but in some cases I have known
it removed by electric shocks repeated every day for a fortnight through
the affected side.
Pains of the side may be sometimes occasioned by the adhesion of the lungs
to the pleura, after an inflammation of them; or to the adhesion of some
abdominal viscera to their cavity, or to each other; which also are more
liable to affect ladies from the unnatural and ungraceful pressure of tight
stays, or by sitting or lying too long in one posture. But in these cases
the pain should be more of the smarting, than of the dull kind.
M. M. Ether. A blister. A plaster of Burgundy pitch. An issue or seton on
the part. Electric shocks. Friction on the part with oil and camphor. Loose
dress. Frequent change of posture both in the day and night. Internally
opium, valerian, bark.
15. _Sciatica frigida._ Cold sciatica. The pain along the course of the
sciatic nerve, from the hip quite down to the top of the foot, when it is
not attended with fever, is improperly termed either rheumatism or gout; as
it occurs without inflammation, is attended with pain when the limb is at
rest; and as the pain attends the course of the nerve, and not the course
of the muscles, or of the fascia, which contains them. The theory of
Cotunnius, who believed it to be a dropsy of the sheath of the nerve, which
was compressed by the accumulated fluid, has not been confirmed by
dissection. The disease seems to consist of a torpor of this sheath of the
nerve, and the pain seems to be in consequence of this torpor. See Class
II. 1. 2. 18.
M. M. Venesection. A cathartic. And then one grain of calomel and one of
opium every night for ten successive nights. And a blister, at the same
time, a little above the knee-joint on the outside of the thigh, where the
sciatic nerve is not so deep seated. Warm bath. Cold bath. Cover the limb
with oiled silk, or with a plaster-bandage of emplastrum de minio.
16. _Lumbago frigida._ Cold lumbago. When no fever or inflammation attends
this pain of the loins, and the pain exists without motion, it belongs to
this genus of diseases, and resembles the pain of the loins in the cold fit
of ague. As these membranes are extensive, and more easily fall into
quiescence, either by sympathy, or when they are primarily affected, this
disease becomes very afflicting, and of great pertinacity. See Class II. 1.
2. 17.
M. M. Venesection. A cathartic. Issues on the loins. Adhesive plaster on
the loins. Blister on the os sacrum. Warm bath. Cold bath. Remove to a
warmer climate in the winter. Loose dress about the waist. Friction daily
with oil and camphor.
17. _Hysteralgia frigida._ Cold pain of the uterus preceding or
accompanying menstruation. It is attended with cold extremities, want of
appetite, and other marks of general debility.
M. M. A clyster of half a pint of gruel, and 30 drops of laudanum; or a
grain of opium and six grains of rhubarb every night. To sit over warm
water, or go into a warm bath.
18. _Proctalgia frigida._ Cold pain at the bottom of the rectum previous to
the tumor of the piles, which sometimes extends by sympathy to the loins;
it seems to be similar to the pain at the beginning of menstruation, and is
owing to the torpor or inirritability of the extremity of the alimentary
canal, or to the obstruction of the blood in its passage through the liver,
when that viscus is affected, and its consequent delay in the veins of the
rectum, occasioning tumors of them, and dull sensations of pain.
M. M. Calomel. A cathartic. Spice. Clyster, with 30 drops of laudanum.
Sitting over warm water. If chalybeates after evacuation? See Class I. 2.
3. 23. and I. 2. 1. 6.
19. _Vesicae felleae inirritabilitas._ The inirritability of the
gall-bladder probably occasions one kind of _icterus_, or jaundice; which
is owing to whatever obstructs the passage of bile into the duodenum. The
jaundice of aged people, and which attends some fevers, is believed to be
most frequently caused by an irritative palsy of the gall-bladder; on which
account the bile is not pressed from the cyst by its contraction, as in a
paralysis of the urinary bladder.
A thickening of the coats of the common bile-duct by inflammation or
increased action of their vessels so as to prevent the passage of the bile
into the intestine, in the same manner as the membrane, which lines the
nostrils, becomes thickened in catarrh so as to prevent the passage of air
through them, is probably another frequent cause of jaundice, especially of
children; and generally ceases in about a fortnight, like a common catarrh,
without the aid of medicine; which has given rise to the character, which
charms have obtained in some countries for curing the jaundice of young
people.
The spissitude of the bile is another cause of jaundice, as mentioned in
Class I. 1. 3. 8. This also in children is a disease of little danger, as
the gall-ducts are distensible, and will the easier admit of the exclusion
of gall-stones; but becomes a more serious disease in proportion to the age
of the patient, and his habits of life in respect to spirituous potation.
A fourth cause of jaundice is the compression of the bile-duct by the
enlargement of an inflamed or schirrous liver; this attends those who have
drank much spirituous liquor, and is generally succeeded by dropsy and
death.
M. M. Repeated emetics. Mild cathartics. Warm bath. Electricity. Bitters.
Then steel, which, when the pain and inflammation is removed by
evacuations, acts like a charm in removing the remainder of the
inflammation, and by promoting the absorption of the new vessels or fluids;
like the application of any acrid eye-water at the end of ophthalmia; and
thus the thickened coats of the bile-duct become reduced, or the
enlargement of the liver lessened, and a free passage is again opened for
the bile into the intestine. Ether with yolk of egg is recommended, as
having a tendency to dissolve inspissated bile. And a decoction of madder
is recommended for the same purpose; because the bile of animals, whose
food was mixed with madder, was found always in a dilute state. Aerated
alcaline water, or Seltzer's water. Raw cabbage, and other acrid
vegetables, as water-cresses, mustard. Horses are said to be subject to
inspissated bile, with yellow eyes, in the winter season, and to get well
as soon as they feed on the spring grass.
The largest bile-stone I have seen was from a lady, who had parted with it
some years before, and who had abstained above ten years from all kinds of
vegetable diet to prevent, as she supposed, a colic of her stomach, which
was probably a pain of the biliary duct; on resuming the use of some
vegetable diet, she recovered a better state of health, and formed no new
bilious concretions.
A strong aerated alcaline water is sold by J. Schweppe, No. 8,
King's-street, Holborn. See Class I. 1. 3. 10.
20. _Pelvis renalis inirritabilitas._ Inirritability of the pelvis of the
kidney. When the nucleus of a stone, whether it be inspissated mucus, or
other matter, is formed in the extremity of any of the tubuli uriniferi,
and being detached from thence falls into the pelvis of the kidney, it is
liable to lodge there from the want of due irritability of the membrane;
and in that situation increases by new appositions of indurated animal
matter, in the same manner as the stone of the bladder. This is the general
cause of haemorrhage from the kidney; and of obtuse pain in it on exercise;
or of acute pain, when the stone advances into the ureter. See Class I. 1.
3. 9.
* * * * *
ORDO II.
_Decreased Irritation._
GENUS V.
_Decreased Action of the Organs of Sense._
SPECIES.
1. _Stultitia inirritabilis._ Folly from inirritability. Dulness of
perception. When the motions of the fibrous extremities of the nerves of
sense are too weak to excite sensation with sufficient quickness and
vigour. The irritative ideas are nevertheless performed, though perhaps in
a feeble manner, as such people do not run against a post, or walk into a
well. There are three other kinds of folly; that from deficient sensation,
from deficient volition, and from deficient association, as will be
mentioned in their places. In delirium, reverie, and sleep, the power of
perception is abolished from other causes.
2. _Visus imminutus._ Diminished vision. In our approach to old age our
vision becomes imperfect, not only from the form of the cornea, which
becomes less convex, and from its decreased transparency mentioned in Class
I. 2. 3. 26.; but also from the decreased irritability of the optic nerve.
Thus, in the inirritative or nervous fever, the pupil of the eye becomes
dilated; which in this, as well as in the dropsy of the brain, is generally
a fatal symptom. A part of the cornea as well as a part of the albuginea in
these fevers is frequently seen during sleep; which is owing to the
inirritability of the retina to light, or to the general paresis of
muscular action, and in consequence to the less contraction of the
sphincter of the eye, if it may be so called, at that time.
There have been instances of some, who could not distinguish certain
colours; and yet whose eyes, in other respects, were not imperfect. Philos.
Transact. Which seems to have been owing to the want of irritability, or
the inaptitude to action, of some classes of fibres which compose the
retina. Other permanent defects depend on the diseased state of the
external organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11.
3. _Muscae volitantes._ Dark spots appearing before the eyes, and changing
their apparent place with the motions of the eyes, are owing to a temporary
defect of irritability of those parts of the retina, which have been lately
exposed to more luminous objects than the other parts of it, as explained
in Sect. XL. 2. Hence dark spots are seen on the bed-clothes by patients,
when the optic nerve is become less irritable, as in fevers with great
debility; and the patients are perpetually trying to pick them off with
their fingers to discover what they are; for these parts of the retina of
weak people are sooner exhausted by the stimulus of bright colours, and are
longer in regaining their irritability.
Other kinds of ocular spectra, as the coloured ones, are also more liable
to remain in the eyes of people debilitated by fevers, and to produce
various hallucinations of sight. For after the contraction of a muscle, the
fibres of it continue in the last situation, till some antagonist muscles
are exerted to retract them; whence, when any one is much exhausted by
exercise, or by want of sleep, or in fevers, it is easier to let the fibres
of the retina remain in their last situation, after having been stimulated
into contraction, than to exert any antagonist fibres to replace them.
As the optic nerves at their entrance into the eyes are each of them as
thick as a crow-quill, it appears that a great quantity of sensorial power
is expended during the day in the perpetual activity of our sense of
vision, besides that used in the motions of the eye-balls and eyelids; as
much I suppose as is expended in the motions of our arms, which are
supplied with nerves of about the same diameters. From hence we may
conclude, that the light should be kept from patients in fevers with
debility, to prevent the unnecessary exhaustion of the sensorial power. And
that on the same account their rooms should be kept silent as well as dark;
that they should be at rest in an horizontal posture; and be cooled by a
blast of cool air, or by washing them with cold water, whenever their skins
are warmer than natural.
4. _Strabismus._ Squinting is generally owing to one eye being less perfect
than the other; on which account the patient endeavours to hide the worst
eye in the shadow of the nose, that his vision by the other may not be
confused. Calves, which have an hydatide with insects inclosed in it in the
frontal sinus on one side, turn towards the affected side; because the
vision on that side, by the pressure of the hydatide, becomes less perfect;
and the disease being recent, the animal turns round, expecting to get a
more distinct view of objects.
In the hydrocephalus internus, where both eyes are not become insensible,
the patient squints with only one eye, and views objects with the other, as
in common strabismus. In this case it may be known on which side the
disease exists, and that it does not exist on both sides of the brain; in
such circumstances, as the patients I believe never recover as they are now
treated, might it not be adviseable to perforate the cranium over the
ventricule of the affected side? which might at least give room and
stimulus to the affected part of the brain?
M. M. If the squinting has not been confirmed by long habit, and one eye be
not much worse than the other, a piece of gauze stretched on a circle of
whale-bone, to cover the best eye in such a manner as to reduce the
distinctness of vision of this eye to a similar degree of imperfection with
the other, should be worn some hours every day. Or the better eye should be
totally darkened by a tin cup covered with black silk for some hours daily,
by which means the better eye will be gradually weakened by the want of
use, and the worse eye will be gradually strengthened by using it. Covering
an inflamed eye in children for weeks together, is very liable to produce
squinting, for the same reason.
5. _Amaurosis._ Gutta serena. Is a blindness from the inirritability of the
optic nerve. It is generally esteemed a palsy of the nerve, but should
rather be deemed the death of it, as paralysis has generally been applied
to a deprivation only of voluntary power. This is a disease of dark eyes
only, as the cataract is a disease of light eyes only. At the commencement
of this disease, very minute electric shocks should be repeatedly passed
through the eyes; such as may be produced by putting one edge of a piece of
silver the size of a half-crown piece beneath the tongue, and one edge of a
piece of zinc of a similar size between the upper lip and the gum, and then
repeatedly bringing their exterior edges into contact, by which means very
small electric sparks become visible in the eyes. See additional note at
the end of the first volume, p. 567. and Sect. XIV. 5.
M. M. Minute electric shocks. A grain of opium, and a quarter of a grain of
corrosive sublimate of mercury, twice a day for four or six weeks. Blister
on the crown of the head.
6. _Auditus imminutus._ Diminished hearing. Deafness is a frequent symptom
in those inflammatory or sensitive fevers with debility, which are
generally called putrid; it attends the general stupor in those fevers, and
is rather esteemed a salutary sign, as during this stupor there is less
expenditure of sensorial power.
In fevers of debility without inflammation, called nervous fevers, I
suspect deafness to be a bad symptom, arising like the dilated pupil from a
partial paralysis of the nerve of sense. See Class IV. 2. 1. 15.
Nervous fevers are supposed by Dr. Gilchrist to originate from a congestion
of serum or water in some part of the brain, as many of the symptoms are so
similar to those of hydrocephalus internus, in which a fluid is accumulated
in the ventricules of the brain; on this idea the inactivity of the optic
or auditory nerves in these fevers may arise from the compression of the
effused fluid; while the torpor attending putrid fever may depend on the
meninges of the brain being thickened by inflammation, and thus compressing
it; now the new vessels, or the blood, which thickens inflamed parts, is
more frequently reabsorbed, than the effused fluid from a cavity; and hence
the stupor in one case is less dangerous than in the other.
In inflammatory or sensitive fevers with debility, deafness may sometimes
arise from a greater secretion and absorption of the ear-wax, which is very
similar to the bile, and is liable to fill the meatus auditorius, when it
is too viscid, as bile obstructs the gall-ducts.
M. M. In deafness without fever Dr. Darwin applied a cupping-glass on the
ear with good effect, as described in Phil. Trans. Vol. LXIV. p. 348. Oil,
ether, laudanum, dropped into the ears.
7. _Olfactus imminutus._ Inactivity of the sense of smell. From our habits
of trusting to the art of cookery, and not examining our food by the smell
as other animals do, our sense of smell is less perfect than theirs. See
Sect. XVI. 5. Class IV. 2. 1. 16.
M. M. Mild errhines.
8. _Gustus imminutus._ Want of taste is very common in fevers, owing
frequently to the dryness or scurf of the tongue, or external organ of that
sense, rather than to any injury of the nerves of taste. See Class. I. 1.
3. 1. IV. 2. 1. 16.
M. M. Warm subacid liquids taken frequently.
9. _Tactus imminutus._ Numbness is frequently complained of in fevers, and
in epilepsy, and the touch is sometimes impaired by the dryness of the
cuticle of the fingers. See Class IV. 2. 1. 16.
When the sense of touch is impaired by the compression of the nerve, as in
sitting long with one thigh crossed over the other, the limb appears
larger, when we touch it with our hands, which is to be ascribed to the
indistinctness of the sensation of touch, and may be explained in the same
manner as the apparent largeness of objects seen through a mist. In this
last case the minute parts of an object, as suppose of a distant boy, are
seen less distinctly, and therefore we instantly conceive them to be
further from the eye, and in consequence that the whole subtends a larger
angle, and thus we believe the boy to be a man. So when any one's fingers
are pressed on a benumbed limb, the sensation produced is less than it
should be, judging from visible circumstances; we therefore conceive, that
something intervened between the object and the sense, for it is felt as if
a blanket was put between them; and that not being visibly the case, we
judge that the limb is swelled.
The sense of touch is also liable to be deceived from the acquired habits
of one part of it acting in the vicinity of another part of it. Thus if the
middle finger be crossed over either of the fingers next to it, and a nut
be felt by the two ends of the fingers so crossed at the same time, the nut
appears as if it was two nuts. And lastly, the sense of touch is liable to
be deceived by preconceived ideas; which we believe to be excited by
external objects, even when we are awake. It has happened to me more than
once, and I suppose to most others, to have put my hands into an empty
bason standing in an obscure corner of a room to wash them, which I
believed to contain cold water, and have instantly perceived a sensation of
warmth, contrary to that which I expected to have felt.
In some paralytic affections, and in cold fits of ague, the sensation of
touch has been much impaired, and yet that of heat has remained, See Sect.
XIV. 6.
M. M. Friction alone, or with camphorated oil, warm bath. Ether. Volatile
alcali and water. Internally spice, salt. Incitantia. Secernentia.
10. _Stupor._ The stupor, which occurs in fevers with debility, is
generally esteemed a favourable symptom; which may arise from the less
expenditure of sensorial power already existing in the brain and nerves, as
mentioned in species 6 of this genus. But if we suppose, that there is a
continued production of sensorial power, or an accumulation of it in the
torpid parts of the system, which is not improbable, because such a
production of it continues during sleep, to which stupor is much allied,
there is still further reason for believing it to be a favourable symptom
in inirritable fevers; and that much injury is often done by blisters and
other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and
XXXIII. 1. 4.
Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many
other ingenious observations and deductions, relates a curious experiment
on salmon, and other fish, and which he repeated upon eels with similar
event.
"If a fish, immediately upon being taken out of the water, is stunned
by a violent blow on the head, or by having the head crushed, the
irritability and sweetness of the muscles will be preserved much
longer, than if it had been allowed to die with the organs of sense
entire. This is so well known to fishermen, that they put it in
practice, in order to make them longer susceptible of the operation
called _crimping_. A salmon is one of the fish least tenacious of life,
insomuch, that it will lose all signs of life in less than half an hour
after it is taken out of the water, if suffered to die without any
farther injury; but if, immediately after being caught, it receives a
violent blow on the head, the muscles will shew visible irritability
for more than twelve hours afterwards."
Dr. Blane afterwards well remarks, that "in those disorders in which the
exercise of the senses is in a great measure destroyed, or suspended, as in
the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that
the appetite and digestion are better than in health."
* * * * *
ORDO III.
_Retrograde Irritative Motions._
GENUS I.
_Of the Alimentary Canal._
The retrograde motions of our system originate either from defect of
stimulus, or from defect of irritability. Thus sickness is often induced by
hunger, which is a want of stimulus; and from ipecacuanha, in which last
case it would seem, that the sickness was induced after the violence of the
stimulus was abated, and the consequent torpor had succeeded. Hence spice,
opium, or food relieves sickness.
The globus hystericus, salivation, diabaetes, and other inversions of
motion attending hysteric paroxysms, seem to depend on the want of
irritability of those parts of the body, because they are attended with
cold extremities, and general debility, and are relieved by wine, opium,
steel, and flesh diet; that is, by any additional stimulus.
When the longitudinal muscles are fatigued by long action, or are
habitually weaker than natural, the antagonist muscles replace the limb by
stretching it in a contrary direction; and as these muscles have had their
actions associated in synchronous tribes, their actions cease together. But
as the hollow muscles propel the fluids, which they contain, by motions
associated in trains; when one ring is fatigued from its too great
debility, and brought into retrograde action; the next ring, and the next,
from its association in train falls into retrograde action. Which continue
so long as they are excited to act, like the tremors of the hands of infirm
people, so long as they endeavour to act. Now as these hollow muscles are
perpetually stimulated, these retrograde actions do not cease as the
tremors of the longitudinal muscles, which are generally excited only by
volition. Whence the retrograde motions of hollow muscles depend on two
circumstances, in which they differ from the longitudinal muscles, namely,
their motions being associated in trains, and their being subject to
perpetual stimulus. For further elucidation of the cause of this curious
source of diseases, see Sect. XXIX. 11. 5.
The fluids disgorged by the retrograde motions of the various vascular
muscles may be distinguished, 1. From those, which are produced by
secretion, by their not being attended by increase of heat, which always
accompanies increased secretion. 2. They may be distinguished from those
fluids, which are the consequence of deficient absorption, by their not
possessing the saline acrimony, which those fluids possess; which inflames
the skin or other membranes on which they fall; and which have a saline
taste to the tongue. 3. They may be distinguished from those fluids, which
are the consequence both of increased secretion and absorption, as these
are attended with increase of warmth, and are inspissated by the
abstraction of their aqueous parts. 4. Where chyle, or milk, are found in
the feces or urine, or when other fluids, as matter, are translated from
one part of the system to another, they have been the product of retrograde
action of lymphatic or other canals. As explained in Sect. XXIX. 8.
SPECIES.
1. _Ruminatio._ In the rumination of horned cattle the retrograde motions
of the oesophagus are visible to the eye, as they bring up the softened
grass from their first stomach. The vegetable aliment in the first stomach
of cattle, which have filled themselves too full of young clover, is liable
to run into fermentation, and distend the stomach, so as to preclude its
exit, and frequently to destroy the animal. To discharge this air the
farmers frequently make an opening into the stomach of the animal with
success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that
of twenty cows in this situation two had died, and that he directed a pint
of gin or whisky, mixed with an equal quantity of water, to be given to the
other eighteen; all of which eructed immense quantities of air, and
recovered.
There are histories of ruminating men, and who have taken pleasure in the
act of chewing their food a second time. Philos. Transact.
2. _Ructus._ Eructation. An inverted motion of the stomach excluding
through its upper valve an elastic vapour generated by the fermentation of
the aliment; which proceeds so hastily, that the digestive power does not
subdue it. This is sometimes acquired by habit, so that some people can
eruct when they please, and as long as they please; and there is gas enough
generated to supply them for this purpose; for by Dr. Hale's experiments,
an apple, and many other kinds of aliment, give up above six hundred times
their own bulk of an elastic gas in fermentation. When people voluntarily
eject the fixable air from their stomachs, the fermentation of the aliment
proceeds the faster; for stopping the vessels, which contain new wines,
retards their fermentation, and opening them again accelerates it; hence
where the digestion is impaired, and the stomach somewhat distended with
air, it is better to restrain than to encourage eructations, except the
quantity makes it necessary. When wine is confined in bottles the
fermentation still proceeds slowly even for years, till all the sugar is
converted into spirit; but in the process of digestion, the saccharine part
is absorbed in the form of chyle by the bibulous mouths of the numerous
lacteals, before it has time to run into the vinous fermentation.
3. _Apepsia._ Indigestion. Water-qualm. A few mouthfuls of the aliment are
rejected at a time for some hours after meals. When the aliment has had
time to ferment, and become acid, it produces cardialgia, or heart-burn.
This disease is perhaps generally left after a slight inflammation of the
stomach, called a surfeit, occasioned by drinking cold liquors, or eating
cold vegetables, when heated with exercise. This inflammation of the
stomach is frequently, I believe, at its commencement removed by a critical
eruption on the face, which differs in its appearance as well as in its
cause from the gutta rosea of drunkards, as the skin round the base of each
eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs
from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with
pain of the cardia ventriculi, and from its retrograde motions of a part of
the stomach about the upper orifice of it. In the same manner as hysteria
differs from hypochondriasis; the one consisting in the weakness and
indigestion of the same portions of the alimentary canal, and the other in
the inverted motions of some parts of it. This apepsia or water-qualm
continues many years, even to old age; Mr. G---- of Lichfield suffered
under this disease from his infancy; and, as he grew old, found relief only
from repeated doses of opium.
M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder.
Tin-powder.
4. _Vomitus._ An inverted order of the motions of the stomach and
oesophagus with their absorbent vessels, by which their contents are
evacuated. In the act of vomiting less sensorial power is employed than in
the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1.
3. Whence after the operation of an emetic the digestion becomes stronger
by an accumulation of sensorial power during its decreased action. This
decreased action of the stomach may be either induced by want of stimulus,
as in the sickness which attends hunger; or it may be induced by temporary
want of irritability, as in cold fits of fever; or from habitual want of
irritability, as the vomiting of enfeebled drunkards. Or lastly, by having
been previously too violently stimulated by an emetic drug, as by
ipecacuanha.
M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a
while with the bed-clothes. Crude mercury. A poultice with opium or
theriaca externally.
5. _Cholera._ When not only the stomach, as in the last article, but also
the duodenum, and ilium, as low as the valve of the colon, have their
motions inverted; and great quantities of bile are thus poured into the
stomach; while at the same time some branches of the lacteals become
retrograde, and disgorge their contents into the upper part of the
alimentary canal; and other branches of them disgorge their contents into
the lower parts of it beneath the valve of the colon; a vomiting and
purging commence together, which is called cholera, as it is supposed to
have its origin from increased secretion of bile; but I suppose more
frequently arises from putrid food, or poisonous drugs, as in the case
narrated in Sect. XXV. 13. where other circumstances of this disease are
explained. See Class II. 1. 2. 11.
The cramps of the legs, which are liable to attend cholera, are explained
in Class III. 1. 1. 14.
6. _Ileus._ Consists in the inverted motions of the whole intestinal canal,
from the mouth to the anus; and of the lacteals and absorbents which arise
from it. In this pitiable disease, through the valve of the colon, through
the pylorus, the cardia, and the pharinx, are ejected, first, the contents
of the stomach and intestines, with the excrement and even clysters
themselves; then the fluid from the lacteals, which is now poured into the
intestines by their retrograde motions, is thrown up by the mouth; and,
lastly, every fluid, which is absorbed by the other lymphatic branches,
from the cellular membrane, the skin, the bladder, and all other cavities
of the body; and which is then poured into the stomach or intestines by the
retrograde motions of the lacteals; all which supply that amazing quantity
of fluid, which is in this disease continually ejected by vomiting. See
Sect. XXV. 15. for a further explanation of this disease.
M. M. Copious venesection. Twenty grains of calomel in small pills, or one
grain of aloe every hour till stools are procured. Blisters. Warm bath.
Crude mercury. Clyster of ice-water. Smear the skin all over with grease,
as mentioned in Sect. XXV. 15.
As this malady is occasioned sometimes by an introsusception of a part of
the intestine into another part of it, especially in children, could
holding them up by their heels for a second or two of time be of service
after venesection? Or the exhibition of crude quicksilver two ounces every
half hour, till a pound is taken, be particularly serviceable in this
circumstance? Or could half a pound, or a pound, of crude mercury be
injected as a clyster, the patient being elevated by the knees and thighs
so as to have his head and shoulders much lower than his bottom, or even
for a short time held up by the heels? Could this also be of advantage in
strangulated hernia?
Where the disease is owing to strangulated hernia, the part should be
sprinkled with cold water, or iced water, or salt and water recently mixed,
or moistened with ether. In cases of strangulated hernia, could
acupuncture, or puncture with a capillary trocar, be used with safety and
advantage to give exit to air contained in the strangulated bowel? Or to
stimulate it into action? It is not uncommon for bashful men to conceal
their being afflicted with a small hernia, which is the cause of their
death; this circumstance should therefore always be enquired into. Is the
seat or cause of the ileus always below the valve of the colon, and that of
the cholera above it? See Class II. 1. 2. 11.
7. _Globus hystericus._ Hysteric suffocation is the perception of a globe
rolling round in the abdomen, and ascending to the stomach and throat, and
there inducing strangulation. It consists of an ineffectual inversion of
the motions of the oesophagus, and other parts of the alimentary canal;
nothing being rejected from the stomach.
M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria,
Class I. 3. 1. 10.
8. _Vomendi conamen inane._ An ineffectual effort to vomit. It frequently
occurs, when the stomach is empty, and in some cases continues many hours;
but as the lymphatics of the stomach are not inverted at the same time,
there is no supply of materials to be ejected; it is sometimes a symptom of
hysteria, but more frequently attends irregular epilepsies or reveries;
which however may be distinguished by their violence of exertion, for the
exertions of hysteric motions are feeble, as they are caused by debility;
but those of epilepsies, as they are used to relieve pain, are of the most
violent kind; insomuch that those who have once seen these ineffectual
efforts to vomit in some epilepsies, can never again mistake them for
symptoms of hysteria. See a case in Sect. XIX. 2.
M. M. Blister. Opium. Crude mercury.
9. _Borborigmus._ A gurgling of the bowels proceeds from a partial
invertion of the peristaltic motions of them, by which the gas is brought
into a superior part of the bowel, and bubbles through the descending
fluid, like air rushing into a bottle as the water is poured out of it.
This is sometimes a distressing symptom of the debility of the bowels
joined with a partial inversion of their motions. I attended a young lady
about sixteen, who was in other respects feeble, whose bowels almost
incessantly made a gurgling noise so loud as to be heard at a considerable
distance, and to attract the notice of all who were near her. As this noise
never ceased a minute together for many hours in a day, it could not be
produced by the uniform descent of water, and ascent of air through it, but
there must have been alternately a retrograde movement of a part of the
bowel, which must again have pushed up the water above the air; or which
might raise a part of the bowel, in which the fluid was lodged, alternately
above and below another portion of it; which might readily happen in some
of the curvatures of the smaller intestines, the air in which might be
moved backward and forward like the air-bubble in a glass-level.
M. M. Essential oil. Ten corns of black pepper swallowed whole after
dinner, that its effect might be slower and more permanent; a small pipe
occasionally introduced into the rectum to facilitate the escape of the
air. Crude mercury. See Class I. 2. 4. 9.
10. _Hysteria._ The three last articles, together with the lymphatic
diabaetes, are the most common symptoms of the hysteric disease; to which
sometimes is added the lymphatic salivation, and fits of syncope, or
convulsion, with palpitation of the heart (which probably consists of
retrograde motions of it), and a great fear of dying. Which last
circumstance distinguishes these convulsions from the epileptic ones with
greater certainty than any other single symptom. The pale copious urine,
cold skin, palpitation, and trembling, are the symptoms excited by great
fear. Hence in hysteric diseases, when these symptoms occur, the fear,
which has been usually associated with them, recurs at the same time, as in
hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1.
The convulsions which sometimes attend the hysteric disease, are exertions
to relieve pain, either of some torpid, or of some retrograde organ; and in
this respect they resemble epileptic convulsions, except that they are
seldom so violent as entirely to produce insensibility to external stimuli;
for these weaker pains cease before the total exhaustion of sensorial power
is produced, and the patient sinks into imperfect syncope; whereas the true
epilepsy generally terminates in temporary apoplexy, with perfect
insensibility to external objects. These convulsions are less to be dreaded
than the epileptic ones, as they do not originate from so permanent a
cause.
The great discharge of pale urine in this disease is owing to the inverted
motions of the lymphatics, which arise about the neck of the bladder, as
described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the
inverted motions of the salivary lymphatics.
Hysteria is distinguished from hypochondriasis, as in the latter there are
no retrograde motions of the alimentary canal, but simply a debility or
inirritability of it, with distention and flatulency. It is distinguished
from apepsia and cardialgia by there being nothing ejected from the stomach
by the retrograde motions of it, or of the oesophagus.
M. M. Opium. Camphor. Assafoetida. Castor, with sinapisms externally; to
which must be added a clyster of cold water, or iced water; which,
according to Mons. Pomme, relieves these hysteric symptoms instantaneously
like a charm; which it may effect by checking the inverted motions of the
intestinal canal by the torpor occasioned by cold; or one end of the
intestinal canal may become strengthened, and regain its peristaltic motion
by reverse sympathy, when the other end is rendered torpid by ice-water.
(Pomme des Affections Vaporeuses, p. 25.) These remove the present
symptoms; and bark, steel, exercise, coldish bath, prevent their returns.
See Art. VI. 2. 1.
11. _Hydrophobia._ Dread of water occasioned by the bite of a mad dog, is a
violent inversion of the motions of the oesophagus on the contact or even
approach of water or other fluids. The pharinx seems to have acquired the
sensibility of the larinx in this disease, and is as impatient to reject
any fluid, which gets into it. Is not the cardia ventriculi the seat of
this disease? As in cardialgia the pain is often felt in the pharinx, when
the acid material stimulates the other end of the canal, which terminates
in the stomach. As this fatal disease resembles tetanus, or locked jaw, in
its tendency to convulsion from a distant wound, and affects some other
parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1.
2. 7.
* * * * *
ORDO III.
_Retrograde Irritative Motions._
GENUS II.
_Of the Absorbent System._
SPECIES.
1. _Catarrhus lymphaticus._ Lymphatic catarrh. A periodical defluxion of a
thin fluid from the nostrils, for a few hours, occasioned by the retrograde
motions of their lymphatics; which may probably be supplied with fluid by
the increased absorption of some other lymphatic branches in their
vicinity. It is distinguished from that mucous discharge, which happens in
frosty weather from decreased absorption, because it is less salt to the
taste; and from an increased secretion of mucus, because it is neither so
viscid, nor is attended with heat of the part. This complaint is liable to
recur at diurnal periods, like an intermittent fever, for weeks and months
together, with great sneezing and very copious discharge for an hour or
two.
I have seen two of these cases, both of which occurred in delicate women,
and seemed an appendage to other hysteric symptoms; whence I concluded,
that the discharge was occasioned by the inverted motions of the lymphatics
of the nostrils, like the pale urine in hysteric cases; and that they might
receive this fluid from some other branches of lymphatic vessels opening
into the frontal or maxillary cavities in their vicinity.
Could such a discharge be produced by strong errhines, and excite an
absorption of the congestion of lymph in the dropsy of the brain?
2. _Salivatio lymphatica._ Lymphatic salivation. A copious expuition of a
pellucid insipid fluid, occasioned by the retrograde motions of the
lymphatics of the mouth. It is sometimes periodical, and often attends the
hysteric disease, and nervous fevers; but is not accompanied with a saline
taste, or with heat of the mouth, or nausea.
3. _Nausea humida._ Moist nausea consists in a discharge of fluid, owing to
the retrograde motions of the lymphatics about the fauces, without increase
of heat, or saline taste, together with some retrograde motions of the
fauces or pharinx; along with this nausea a sickness generally precedes the
act of vomiting; which may consist of a similar discharge of mucus or chyle
into the stomach by the retrograde motions of the lymphatics or lacteals,
which open into it. See Class I. 2. 4. 3. and I. 2. 4. 4.
M. M. Subacid liquids. Wine. Opium. A blister.
4. _Diarrhoea lymphatica._ Lymphatic diarrhoea. A quantity of mucus and
lymph are poured into the intestines by the inverted motions of the
intestinal lymphatics. The feces are less fetid and more liquid; and it
sometimes portends the commencement of a diabaetes, or dropsy, or their
temporary relief. This lymphatic diarrhoea sometimes becomes chronical, in
which the atmospheric moisture, absorbed by the cutaneous and pulmonary
lymphatics, is poured into the intestines by the retrograde motions of the
lacteals. See Section XXIX. 4. 6. where some cases of this kind are
related.
5. _Diarrhoea chylifera, coeliaca._ Chyliferous diarrhoea. The chyle drank
up by the lacteals of the upper intestines is poured into the lower ones by
the retrograde motions of their lacteals, and appears in the dejections.
This circumstance occurs at the beginning of diarrhoea crapulosa, where the
patient has taken and digested more aliment than the system can
conveniently receive, and thus eliminates a part of it; as appears when
there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It
differs from the lymphatic diarrhoea, as the chyliferous diabaetes differs
from the aqueous and mucaginous diabaetes.
6. _Diabaetes._ By the retrograde motions of the urinary lymphatics, an
immense quantity of fluid is poured into the bladder. It is either termed
chyliferous, or aqueous, or mucaginous, from the nature of the fluid
brought into the bladder; and is either a temporary disease, as in hysteric
women, in the beginning of intoxication, in worm cases, or in those exposed
to cold damp air, or to great fear, or anxiety, or in the commencement of
some dropsies; or it becomes chronical.
When the urinary lymphatics invert their motions, and pour their refluent
contents into the bladder, some other branch of the absorbent system acts
with greater energy to supply this fluid. If it is the intestinal branch,
the chyliferous diabaetes is produced: if it is the cutaneous or pulmonary
branch, the aqueous diabaetes is produced: and if the cellular or cystic
branches, the mucaginous diabaetes. In the two last the urine is pellucid,
and contains no sugar.
In dropsies the fluid is sometimes absorbed, and poured into the bladder by
the retrograde motions of the urinary lymphatics, as during the exhibition
of digitalis. In the beginning of the dropsies of infirm gouty patients, I
have frequently observed, that they make a large quantity of water for one
night, which relieves them for several days. In these cases the patient
previously feels a fulness about the precordia, with difficult respiration,
and symptoms similar to those of hysteria. Perhaps a previous defect of
absorption takes place in some part of the body in those hysteric cases,
which are relieved by a copious discharge of pale urine. See Diabaetes
explained at large, Section XXIX. 4.
A discharge of blood sometimes attends the diabaetes, which was
occasionally a symptom of that disease in Mr. Brindley, the great navigable
canal maker in this country. Which may be accounted for by the
communication of a lymphatic branch with the gastric branch of the vena
portarum, as discovered by J. F. Meckel. See Section XXVII. 2.
M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium.
See Sect. XXIX. 4.
7. _Sudor lymphaticus._ Profuse sweats from the inverted motions of the
cutaneous lymphatics, as in some fainting fits, and at the approach of
death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These
sweats are glutinous to the touch, and without increased heat of the skin;
if the part is not covered, the skin becomes cold from the evaporation of
the fluid. These sweats without heat sometimes occur in the act of
vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty
hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R.
Davis, which he cured by frequent application of lime. Though it is
possible, that cold sweaty hands may also arise from the want of due
absorption of the perspirable matter effused on them, and that the coldness
may be owing to the greater evaporation in consequence.
The acid sweats described by Dr. Dobson, which he observed in a diabaetic
patient, and ascribes to the chyle effused on the skin, must be ascribed to
the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6.
8. _Sudor asthmaticus._ The cold sweats in this disease only cover the
head, arms, and breast, and are frequently exceedingly profuse. These
sweats are owing to the inverted motions of the cutaneous lymphatics of the
upper part of the body, and at the same time the increased absorption of
the pulmonary absorbents: hence these sweats when profuse relieve the
present fit of asthma. There is no other way to account for sweats
appearing on the upper parts of the body only, but by the fluid having been
absorbed by the lymphatic branch of the lungs, and effused on the skin by
the retrograde movements of the cutaneous lymphatics; which join those of
the lungs before they enter into the venous circulation. For if they were
occasioned, as generally supposed, by the difficulty of the circulation of
the blood through the lungs, the whole skin must be equally affected, both
of the upper and lower parts of the body; for whatever could obstruct the
circulation in the upper part of the venous system, must equally obstruct
it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma
these sweats do not occur; hence they may be distinguished; and might be
called the hydropic asthma, and the epileptic asthma.
9. _Translatio puris._ Translation of matter from one part of the system to
another can only be explained from its being absorbed by one branch of the
lymphatic system, and deposited in a distant part by the retrograde motions
of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these
translations of matter are attended generally, I believe, with cold fits;
for less heat is produced during the retrograde action of this part of the
system, as no secretion in the lymphatic glands of the affected branches
can exist at the same time. Do any ineffectual retrograde motions occasion
the cold fits of agues? The time when the gout of the liver ceases, and the
gout in the foot commences, is attended with a cold fit, as I have observed
in two instances, which is difficult to explain, without supposing the new
vessels, or the matter produced on the inflamed liver, to be absorbed, and
either eliminated by some retrograde motion, or carried to the newly
inflamed part? See Class IV. 1. 2. 15.
10. _Translatio lactis._ Translation of milk to the bowels in puerperal
fevers can only be explained by the milk being absorbed by the pectoral
branch of lymphatics, and carried to the bowels by the retrograde motions
of the intestinal lymphatics or lacteals. See many instances of this in
Sect. XXIX. 7. 4.
11. _Translatio urinae._ Translation of urine. There is a curious case
related in the Transaction of the College of Physicians at Philadelphia,
Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine
for many months; which could not be distinguished from that which was at
other times drawn off by the catheter. After having taken much opium, she
seems at length to have formed gravel, some of which was frequently brought
up by vomiting. Dr. Senter ascribes this to the retrograde motions of the
lymphatics of the stomach, and the increased ones of those of the bladder,
and refers to those of Sect. XXIX. of this work; which section was first
published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine.
The patient above described sometimes had a discharge of urine by the
navel, and at other times by the rectum, and sometimes by urinous sweats.
* * * * *
ORDO III.
_Retrograde Irritative Motions._
GENUS III.
_Of the Sanguiferous System._
SPECIES.
1. _Capillarium motus retrogressus._ In microscopic experiments it is usual
to see globules of blood regurgitate from the capillary vessels again and
again, before they pass through them; and not only the mouths of the veins,
which arise from these capillaries, are frequently seen by microscopes to
regurgitate some particles of blood during the struggles of the animal; but
a retrograde motion of the blood in the veins of these animals, from the
very heart to the extremities of the limbs, is observable by intervals
during the distresses of the dying creature. Haller, Elem. Phys. T. i. p.
216. See Section XXIX. 3. 8.
2. _Palpitatio cordis._ May not the ineffectual and weak unequal motions of
the heart in hysteric cases be ascribed to the retrograde motions of it,
which continue for a short time, or terminate in syncope? See Class IV. 3.
1. 6.
3. _Anhelatio spasmodica._ In some asthmas may not the difficulty of
respiration arise from the inverted action of the finer branches of the
bronchia, or of the pulmonary artery or vein, like those of the capillaries
above described in No. 1. of this genus?
* * * * *
_The Orders and Genera of the Second Class of Diseases._
* * * * *
CLASS II.
DISEASES OF SENSATION.
ORDO I.
_Increased Sensation._
GENERA.
1. With increased action of the muscles.
2. With the production of new vessels by internal membranes or glands
with fever.
3. With the production of new vessels by external membranes or glands
with fever.
4. With the production of new vessels by internal membranes or glands
without fever.
5. With the production of new vessels by external membranes or glands
without fever.
6. With fever consequent to the production of new vessels or fluids.
7. With increased action of the organs of sense.
ORDO II.
_Decreased Sensation._
GENERA.
1. With decreased actions of the general system.
2. With decreased actions of particular organs.
ORDO III.
_Retrograde Sensitive Motions._
GENERA.
1. Of the excretory ducts.
* * * * *
_The Orders, Genera, and Species, of the Second Class Of Diseases._
* * * * *
CLASS II.
DISEASES OF SENSATION.
ORDO I.
_Increased Sensation._
GENUS I.
_With Increased Action of the Muscles._
SPECIES.
1. _Deglutitio._ Deglutition.
2. _Respiratio._ Respiration.
3. _Sternutatio._ Sneezing.
4. _Anhelitus._ Panting.
5. _Tussis ebriorum._ Cough of inebriates.
6. _Syngultus._ Hiccough.
7. _Asthma humorale._ Humoral asthma.
8. _Nictitatio sensitiva._ Winking from pain.
9. _Oscitatio et pandiculatio._ Yawning and stretching.
10. _Tenesmus._ Tenesmus.
11. _Stranguria._ Strangury.
12. _Parturitio._ Parturition.
GENUS II.
_With the Production of new Vessels by internal Membranes or Glands, with
Fever._
SPECIES.
1. _Febris sensitiva irritata._ Sensitive irritated fever.
2. _Ophthalmia interna._ Inflammation of the eye.
3. _Phrenitis._ ---- of the brain.
4. _Peripneumonia._ ---- of the lungs.
---- _trachealis._ ---- the croup.
5. _Pleuritis._ ---- of the pleura.
6. _Diaphragmitis._ ---- of the diaphragm.
7. _Carditis._ ---- of the heart.
8. _Peritonitis._ ---- of the peritoneum.
9. _Mesenteritis._ ---- of the mesentery.
10. _Gastritis._ ---- of the stomach.
11. _Enteritis._ ---- of the bowels.
12. _Hepatitis._ ---- of the liver.
13. _Splenitis._ ---- of the spleen.
14. _Nephritis._ ---- of the kidney.
15. _Cystitis._ ---- of the bladder.
16. _Hysteritis._ ---- of the womb.
17. _Lumbago sensitiva._ ---- of the loins.
18. _Ischias._ ---- of the pelvis.
19. _Paronychia interna._ ---- beneath the nails.
GENUS III.
_With the Production of new Vessels by external Membranes or Glands, with
Fever._
SPECIES.
1. _Febris sensitiva inirritata._ Sensitive inirritated fever.
2. _Erysipelas irritatum._ Erysipelas irritated.
_----inirritatum._ ---- inirritated.
---- _sensitivum._ ---- sensitive.
3. _Tonsillitis interna._ Angina internal.
---- _superficialis._ ---- superficial.
---- _inirritata._ ---- inirritated.
4. _Parotitis suppurans._ Mumps suppurative.
---- _mutabilis._ ---- mutable.
---- _felina._ ---- of cats.
5. _Catarrhus sensitivus._ Catarrh inflammatory.
6. ---- _contagiosus._ ---- contagious.
---- _equinus et caninus._ ---- among horses and dogs.
7. _Peripneumonia superficialis._ Superficial peripneumony.
8. _Pertussis._ Chin-cough.
9. _Variola discreta._ Small-pox distinct.
---- _confluens._ ---- confluent.
---- _inoculata._ ---- inoculated.
10. _Rubeola irritata._ Measles irritated.
---- _inirritata._ ---- inirritated.
11. _Scarlatina mitis._ Scarlet fever mild.
---- _maligna._ ---- malignant.
12. _Miliaria sudatoria._ Miliary fever sudatory.
---- _irritata._ ---- irritated.
---- _inirritata._ ---- inirritated.
13. _Pestis._ Plague.
---- _vaccina._ ---- of horned cattle.
14. _Pemphigus._ Bladdery fever.
15. _Varicella._ Chicken-pox.
16. _Urticaria._ Nettle rash.
17. _Aptha sensitiva._ Thrush sensitive.
---- _irritata._ ---- irritated.
---- _inirritata._ ---- inirritated.
18. _Dysenteria._ Bloody flux.
19. _Gastritis superficialis._ Superficial inflam. of the stomach.
20. _Enteritis superficialis._ ---- of the bowels.
GENUS IV.
_With the Production of new Vessels by internal Membranes or Glands,
without Fever._
SPECIES.
1. _Ophthalmia superficialis._ Ophthalmy superficial.
---- _lymphatica._ ---- lymphatic.
---- _equina._ ---- of horses.
2. _Pterigion._ Eye-wing.
3. _Tarsitis palpebrarum._ Red eyelids.
4. _Hordeolum._ Stye.
5. _Paronychia superficialis._ Whitlow.
6. _Gutta rosea hepatica._ Pimpled face hepatic.
---- _stomatica._ ---- stomatic.
---- _hereditaria._ ---- hereditary.
7. _Odontitis._ Inflamed tooth.
8. _Otitis._ ---- ear.
9. _Fistula lacrymalis._ Fistula lacrymalis.
10. _Fistula in ano._ Fistula in ano.
11. _Fistula urethrae._ Fistula urethrae.
12. _Hepatitis chronica._ Chronical hepatitis.
13. _Scrophula suppurans._ Suppurating scrophula.
14. _Scorbutus suppurans._ Suppurating scurvy.
15. _Schirrus suppurans._ Suppurating schirrus.
16. _Carcinoma._ Cancer.
17. _Arthrocele._ Swelling of the joints.
18. _Arthropuosis._ Suppuration of the joints.
19. _Caries ossium._ Caries of the bones.
GENUS V.
_With the Production of new Vessels by external Membranes or Glands,
without Fever._
SPECIES.
1. _Gonorrhoea venerea._ Clap.
2. _Syphilis._ Venereal disease.
3. _Lepra._ Leprosy.
4. _Elephantiasis._ Elephantiasis.
5. _Framboesia._ Framboesia.
6. _Psora._ Itch.
7. _Psora ebriorum._ Itch of drunkards.
8. _Herpes._ Herpes.
9. _Zona ignea._ Shingles.
10. _Annulus repens._ Ring-worm.
11. _Tinea capitis._ Scald-head.
12. _Crusta lactea._ Milk-crust.
13. _Trichoma._ Plica polonica.
GENUS VI.
_With Fever consequent to the Production of new Vessels or Fluids._
SPECIES.
1. _Febris sensitiva._ Sensitive fever.
2. ---- _a pure clauso._ Fever from concealed matter.
3. ---- _a vomica._ ---- from vomica.
4. ---- _ab empyemate._ ---- from empyema.
5. ---- _mesenterica._ ---- mesenteric.
6. ---- _a pure aerato._ ---- from aerated matter.
7. ---- _a phthisi._ ---- from consumption.
8. ---- _scrophulosa._ ---- scrophulous.
9. ---- _ischiadica._ ---- from ischias.
10. ---- _arthropuodica._ ---- from joint-evil.
11. ---- _a pure contagioso._ ---- from contagious matter.
12. ---- _variolosa secundaria._ ---- secondary of small-pox.
13. ---- _carcinomatosa._ ---- cancarous.
14. ---- _venerea._ ---- venereal.
15. ---- _a sanie contagiosa._ ---- from contagious sanies.
16. ---- _puerpera._ ---- puerperal.
17. ---- _a sphacelo._ ---- from sphacelus.
GENUS VII.
_With increased Action of the Organs of Sense._
SPECIES.
1. _Delirium febrile._ Delirium of fevers.
2. ---- _maniacale._ ---- maniacal.
3. ---- _ebrietatis._ ---- of drunkenness.
4. _Somnium._ Dreams.
5. _Hallucinatio visus._ Deception of sight.
6. ---- _auditus._ ---- of hearing.
7. _Rubor a calore._ Blush from heat.
8. ---- _jucunditatis._ ---- from joy.
9. _Priapismus amatorius._ Amorous priapism.
10. _Distentio mamularum._ Distention of the nipples.
ORDO II.
_Decreased Sensation._
GENUS I.
_With decreased Action of the general System._
SPECIES.
1. _Stultitia insensibilis._ Folly from insensibility.
2. _Taedium vitae._ Irksomeness of life.
3. _Paresis sensitiva._ Sensitive debility.
GENUS II.
_With decreased Actions of particular Organs._
SPECIES.
1. _Anorexia._ Want of appetite.
2. _Adipsia._ Want of thirst.
3. _Impotentia._ Impotence.
4. _Sterilitas._ Barrenness.
5. _Insensibilitas artuum._ Insensibility of the limbs.
6. _Dysuria insensitiva._ Insensibility of the bladder.
7. _Accumulatio alvina._ Accumulation of feces.
ORDO III.
_Retrograde Sensitive Motions._
GENUS I.
_Of Excretory Ducts._
SPECIES.
_Motus retrogressus_ Retrograde motion.
1. ---- _ureterum._ ---- of the ureters.
2. ---- _urethrae._ ---- of the urethra.
3. ---- _ductus choledoci._ ---- of the bile-duct.
* * * * *
CLASS II.
DISEASES OF SENSATION.
ORDO I.
_Increased Sensation._
GENUS I.
_With Increased Action of the Muscles._
The actions belonging to this genus are those which are immediately excited
by the sensations of pain or pleasure, but which are neither followed by
inflammation, nor by convulsion. The former of which belong to the
subsequent genera of this order, and the latter to the class of voluntary
motions.
The criterion between the actions, which are the immediate consequence of
painful sensation, and convulsive actions properly so called, consists in
the former having a tendency to dislodge the stimulating cause, which
induces the painful sensation; and the latter being exerted for the purpose
of expending the sensorial power, and thus dulling or destroying the
general sensation of the system. See Class III. 1.
There is a degree of heat produced in the affected part by these sensitive
actions without inflammation, but in much less quantity than when attended
by inflammation; as in the latter there is a production of new vessels. See
Sect. XXXIII. 2. 3.
Some of the species of this genus cannot properly be termed diseases in
their natural state, but become so by their defect or excess, and are here
inserted to facilitate the explanation of the others.
SPECIES.
1. _Deglutitio._ Swallowing our food is immediately caused by the
pleasureable sensation occasioned by its stimulus on the palate or fauces
and is acquired long before the nativity of the animal. Afterwards the pain
of hunger previously produces the various voluntary exertions to procure
the proper material, but the actions of masticating and of swallowing it
are effected by the sensorial power of sensation; which appears by their
not being always controulable by the will, as when children in vain attempt
to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food
stimulates the palate, which is an organ of sense, into so much action, as
to produce agreeable sensation; and the muscles subservient to deglutition
are brought into action by the sensation thus produced. The pleasureable
sensation is the proximate cause; the action of the fibres of the
extremities of the nerves of taste is the remote cause; the sensorial power
of irritation exciting these fibres of the nerves of taste into increased
action is the pre-remote cause; the action of the muscles of deglutition is
the proximate effect; the pushing the food into the stomach is the remote
effect; and the nutrition of the body is the post-remote effect.
Though the muscles subservient to deglutition have their actions previously
associated, so as to be excited into synchronous tribes or successive
trains, either by volition, as when we swallow a disagreeable drug; or by
sensation, as when we swallow agreeable food; or by irritation, as when we
inattentively swallow our saliva; yet do all those three kinds of
deglutition belong to the respective classes of volition, sensation, and
irritation; because the first links of these tribes or trains of muscular
action are excited by those sensorial powers, and the associated links,
which accompany or succeed them, are excited by the combined powers either
of volition, or of sensation, or of irritation, along with that of
association.
2. _Respiratio._ Respiration is immediately caused by the sensorial power
of sensation in consequence of the baneful want of vital air; and not from
the accumulation of blood in the lungs, as that might be carried on by
inhaling azote alone, without the oxygenous part of the atmosphere. The
action of respiration is thus similar to that of swallowing our food to
appease the pain of hunger; but the lungs being surrounded with air, their
proper pabulum, no intermediate voluntary exertions are required, as in
hunger, to obtain and prepare the wanted material.
Respiration is similar to slow combustion; the oxygenous part of the
atmosphere is received through the moist membranes, which line the
air-cells of the lungs, and uniting with the inflammable part of the blood
generates an acid, probably the phosphoric acid; a portion of carbonic acid
is likewise produced in this process; as appears by repeatedly breathing
over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto
I. l. 401. note.
3. _Sternutatio._ Sneezing consists of muscular actions produced by the
sensorial faculty of sensation; and is an effort to dislodge, by means of
air forcibly impelled through the nostrils, some material; which stimulates
the membrane, which lines them, into too great action, and might thence
injure the sense of smell which is diffused on it.
In this operation the too great action of the vessels of the membrane of
the nostrils is the remote cause; the sensation thence induced is the
proximate cause; and the muscular actions are the proximate effect.
This action of sneezing frequently precedes common respiration in new-born
children, but I believe not always; as like the latter it cannot have been
previously acquired in the uterus.
It is produced in some people by sudden light, as by looking up at the sky
in a morning, when they come out of a gloomy bed-chamber. It then becomes
an associate action, and belongs to Class IV. 1. 2. 2.
M. M. When it is exerted to excess it may be cured by snuffing starch up
the nostrils. See Class I. 1. 2. 13.
4. _Anhelitus._ Panting. The quick and laborious breathing of running
people, who are not accustomed to violent exercise, is occasioned by the
too great conflux of blood to the lungs. As the sanguiferous system, as
well as the absorbent system, is furnished in many parts of its course with
valves, which in general prevent the retrograde movement of their contained
fluids; and as all these vessels, in some part of their course, lie in
contact with the muscles, which are brought into action in running, it
follows that the blood must be accelerated by the intermitted swelling of
the bellies of the muscles moving over them.
The difficulty of breathing, with which, very fat people are immediately
affected on exercise, is owing to the pressure of the accumulated fat on
the veins, arteries, and lymphatics; and which, by distending the skin,
occasions it to act as a tight bandage on the whole surface of the body.
Hence when the muscles are excited into quicker action, the progress of the
blood in the veins, and of the lymph and chyle in the absorbent system, is
urged on with much greater force, as under an artificial bandage on a limb,
explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the
circulation is instantly quickened to a great degree, and the difficulty of
breathing is the consequence of a more rapid circulation through the lungs.
The increased secretion of the perspirable matter is another consequence of
this rapid circulation; fat people, when at rest, are believed to perspire
less than others, which may be gathered from their generally having more
liquid stools, more and paler urine, and to their frequently taking less
food than many thin people; and lastly, from the perspiration of fat people
being generally more inodorous than that of lean ones; but when corpulent
people are put in motion, the sweat stands in drops on their skins, and
they "lard the ground" as they run. The increase of heat of corpulent
people on exercise, is another consequence of their more rapid circulation,
and greater secretion. See Class I. 2. 3. 17.
Other causes of difficult or quick respiration will be treated of under
Asthma, Pertussis, Peripneumony, Tonsillitis.
5. _Tussis ebriorum._ Sensitive cough is an exertion of the muscles used in
expiration excited into more violent action by the sensorial power of
sensation, in consequence of something which too powerfully stimulates the
lungs. As the saline part of the secreted mucus, when the absorption of it
is impeded; or the too great viscidity of it, when the absorption is
increased; or the too great quantity of the mucus, when the secretion is
increased; or the inflammation of the membranes of the lungs; it is an
effort to dislodge any of these extraneous materials.
Of this kind is the cough which attends free-drinkers after a debauch; it
consists of many short efforts to cough, with a frequent expuition of half
a tea-spoonful of frothy mucus, and is attended with considerable thirst.
The thirst is occasioned by the previous dissipation of the aqueous parts
of the blood by sensible or insensible perspiration; which was produced by
the increased action of the cutaneous and pulmonary capillaries during the
stimulus of the wine. In consequence of this an increased absorption
commences to replace this moisture, and the skin and mouth become dry, and
the pulmonary mucus becomes inspissated; which stimulates the bronchia, and
is raised into froth by the successive currents of air in evacuating it.
This production of froth is called by some free-drinkers "spitting
sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid
expectoration in some people succeeds the slightest degree of intoxication,
of which it may be esteemed a criterion. See Class IV. 2. 1. 8.
As coughs are not always attended with pain, the muscular actions, which
produce them, are sometimes excited by the sensorial faculty of irritation,
as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also
sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic,
as Class IV. 2. 1. 7.
M. M. Venesection, when the cough is attended with inflammation. Mucilages.
Opium. Torpentia. Blister.
6. _Singultus._ Hiccough is an exertion of the muscles used in inspiration
excited into more violent action by the sensorial power of sensation, in
consequence of something which too powerfully stimulates the cardia
ventriculi, or upper orifice of the stomach. As when solid food is too
hastily taken without sufficient dilution. And is an effort to dislodge
that offensive material, and push it to some less sensible part of the
stomach, or into the middle of the contained aliment.
At the end of fatal fevers it may arise from the acrimony of the undigested
aliment, or from a part of the stomach being already dead, and by its
weight or coldness affecting the surviving part with disagreeable
sensation. The pain about the upper orifice of the stomach is the proximate
cause, the too great or too little action of the fibres of this part of the
stomach is the remote cause, the action of the muscles used in inspiration
is the proximate effect, and the repercussion of the offending material is
the remote effect.
Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the
kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of
epilepsy or reverie, as in Sect. XIX. 2.
M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar,
or on chalk. Opium. Blister. Emetic.
7. _Asthma humorale._ The humoral asthma probably consists in a temporary
anasarca of the lungs, which may be owing to a temporary defect of
lymphatic absorption. Its cause is nevertheless at present very obscure,
since a temporary deficiency of venous absorption, at the extremities of
the pulmonary or bronchial veins, might occasion a similar difficulty of
respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that
the lymph effused into the cavity of the chest might, by some additional
heat during sleep, acquire an aerial form, and thus compress the lungs; and
on this circumstance the relief, which these patients receive from cold
air, would be readily accounted for.
The paroxysms attack the patient in his first sleep, when the circulation
through the lungs in weak people wants the assistance of the voluntary
power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less
able to fulfil the whole of their duty. And part of the thin mucus, which
is secreted into the air-cells, remains there unabsorbed, and occasions the
difficult respiration, which awakes the patient. And the violent exertions
of the muscles of respiration, which succeed, are excited by the pain of
suffocation, for the purpose of pushing forwards the blood through the
compressed capillaries, and to promote the absorption of the effused lymph.
In this the humoral differs from the convulsive asthma, treated of in Class
III. 1. 1. 10. as in that there is probably no accumulated fluid to be
absorbed; and the violent respiration is only an exertion for the purpose
of relieving pain, either in the lungs or in some distant part, as in other
convulsions, or epilepsy; and in this respect the fits of humoral and
convulsive asthma essentially differ from each other, contrary to the
opinion expressed without sufficient consideration in Sect. XVIII. 15.
The patients in the paroxysms both of humoral and convulsive asthma find
relief from cold air, as they generally rise out of bed, and open the
window, and put out their heads; for the lungs are not sensible to cold,
and the sense of suffocation is somewhat relieved by there being more
oxygen contained in a given quantity of cold fresh air, than in the warm
confined air of a close bed-chamber.
I have seen humoral asthma terminate in confirmed anasarca, and destroy the
patient, who had been an excessive drinker of spirituous potation. And M.
Savage asserts, that this disease frequently terminates in diabetes; which
seems to shew, that it is a temporary dropsy relieved by a great flow of
urine. Add to this, that these paroxysms of the asthma are themselves
relieved by profuse sweats of the upper parts of the body, as explained in
Class I. 3. 2. 8. which would countenance the idea of their being
occasioned by congestions of lymph in the lungs.
The congestion of lymph in the lungs from the defective absorption of it is
probably the remote cause of humoral asthma; but the pain of suffocation is
the immediate cause of the violent exertions in the paroxysms. And whether
this congestion of lymph in the air-cells of the lungs increases during our
sleep, as above suggested, or not; the pain of suffocation will be more and
more distressing after some hours of sleep, as the sensibility to internal
stimuli increases during that time, as described in Sect. XVIII. 15. For
the same reason many epileptic fits, and paroxysms of the gout, occur
during sleep.
In two gouty cases, complicated with jaundice, and pain, and sickness, the
patients had each of them a shivering fit, like the commencement of an
ague, to the great alarm of their friends; both which commenced in the
night, I suppose during their sleep; and the consequence was a cessation of
the jaundice, and pain about the stomach, and sickness; and instead of that
the gout appeared in their extremities. In these cases I conjecture, that
there was a metastasis not only of the diseased action from the membranes
of the liver to those of the foot; but that some of the new vessels, or new
fluids, which were previously produced in the inflamed liver, were
translated to the feet during the cold fit, by the increased absorption of
the hepatic lymphatics, and by the retrograde motions of those of the
affected limbs.
This I think resembles in some respects a fit of humoral asthma, where
stronger motions of the absorbent vessels of the lungs are excited, and
retrograde ones of the correspondent cutaneous lymphatics; whence the
violent sweats of the upper parts of the body only are produced; and for a
time the patient becomes relieved by the metastasis and elimination of the
offending material by sensitive exertion. For a further account of this
intricate subject see Class III. 1. 1. 10.
M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed
with water, with 10 drops of laudanum, to be repeated three or four times.
Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a
grain of opium at night, and two or three of aloes. A flannel shirt in
winter, but not in summer. Issues. Digitalis?
In this species of asthma, there is great reason to believe, that the
respiration of an atmosphere, with an increased proportion of oxygen, will
prove of great advantage; some well-observed and well-attested cases of
which are published by Dr. Beddoes; as this purer air invigorates the
circulation, and the whole system in consequence, perhaps not only by its
stimulus, but by its supplying the material from which the sensorial power
is extracted or fabricated. In spasmodic asthma, on the contrary, Dr.
Ferriar has found undoubted benefit from an atmosphere mixed with hydrogen.
See Sect. XVIII. 15. and Class III. 1. 1. 10.
8. _Nictitatio sensitiva._ Winking of the eyes is performed every minute,
without our attention, for the purpose of diffusing the tears over them,
which are poured into the eye a little above the external corner of it, and
which are afterwards absorbed by the lacrymal points above and below the
internal corner of it. When this operation is performed without our
attention, it is caused by the faculty of irritation, and belongs to Class
I. 1. 4. 1. but when it is produced by a stronger stimulus of any
extraneous material in the eye, so as to cause pain, the violent and
frequent nictitation is caused by the faculty of sensation.
This disease is sometimes produced by the introversion of the edge of the
lower eyelid, which bends the points of the hairs of the eyelash upon the
ball of the eye, which perpetually stimulate it into painful sensation.
This introversion of the eyelid is generally owing to a tumor of the
cellular membrane below the edge of the eyelid, and though a very
troublesome complaint may often be cured by the following simple means. A
little common plaster spread on thin linen, about a quarter of an inch
long, must be rolled up so as to be about the size of a crow-quill, this
must be applied immediately below the eyelash on the outside of the eye;
and must be kept on by another plaster over it. This will then act as a
slight compression on the tumor under the eyelash, and will prevent the
hairs from touching the eye-ball. In a week or two the compression will
diminish the tumor it lies over, and cure this painful deformity.
9. _Oscitatio et pandiculatio._ Yawning and stretching of the limbs is
produced either by a long inactivity of the muscles now brought into
action, as sometimes happens after sleep, or after listening a long time to
a dull narrative; or it is produced by a too long continued action of the
antagonist muscles. In the former case there is an accumulation of
sensorial power during the quiescence of the muscles now brought into
action; which probably constitutes the pain or wearisomeness of a continued
attitude. In the latter case there is an exhaustion of sensorial power in
the muscles, which have lately been acting violently, and a consequent
accumulation in the muscles, which are antagonists to them, and which were
at rest.
These involuntary motions are often seen in paralytic limbs, which are at
the same time completely disobedient to the will; and are frequently
observable in very young children; and from thence we may conclude, that
these motions are learnt before nativity; as puppies are seen to open their
mouths before the membranes are broken. See Sect. XVI. 2.
Where these motions are observed in limbs otherwise paralytic, it is an
indication that electric shocks may be employed with advantage, as the
excitability of the limb by irritation is not extinct, though it be
disobedient both to volition and sensation.
10. _Tenesmus_ consists in violent and frequent ineffectual efforts to
discharge the contents of the rectum, owing to pain of the sphincter. The
pain is produced by indurated feces, or by some acrid material, as the
acidity of indigested aliment; and the efforts are attended with mucus from
the pained membrane. The feces must sometimes be taken away by the end of a
marrow-spoon, as cathartics and even clyster will pass without removing
them. It is sometimes caused by sympathy with the urethra, when there is a
stone at the neck of the bladder. See Class II. 2. 2. 7. and IV. 1. 2. 8.
M. M. Fomentation, an enema with mucilage and laudanum.
The common exclusion of the feces from the rectum is a process similar to
this, except that the muscles of the sphincter ani, and those of the
abdomen, which act along with them by the combined powers of sensation and
association, are in tenesmus excited by painful sensation, and in the
latter by a sensation, which may in some instances be almost called
pleasurable, as relieving us from a painful one in the exclusion of the
feces.
11. _Stranguria._ Strangury consists in painful efforts to discharge the
contents of the urinary bladder. It is generally owing to a stone in the
sphincter of the bladder; or to the inflammation of the neck of it
occasioned by cantharides. It is sometimes caused by sympathy with the
piles; and then is liable in women to occasion convulsions, from the
violence of the pain without inflammation. See Class IV. 2. 2. 2. and 3.