bougie; if from cantharides give half a pint of warm water every ten
minutes. Mucilage of gum arabic and tragacanth.
The natural evacuation of the urine is a process similar to this, except
that the muscular fibres of the bladder, and the muscles of the abdomen,
which act in concert with them by the combined powers of sensation and of
association, are, in the former case of strangury, excited into action by
painful sensation; and in the latter by a sensation, which may almost be
termed pleasurable, as it relieves us from a previous uneasy one.
The ejectio feminis is another process in some respects similar to
strangury, as belonging to the same sensible canal of the urethra, and by
exciting into action the accelerator muscles; but in the strangury these
muscles are excited into action by painful sensation, and in the ejection
of the semen by pleasureable sensation.
12. _Parturitio._ Parturition is not a disease, it is a natural process,
but is more frequently unfortunate in high life than amongst the middle
class of females; which may be owing partly to fear, with which the priests
of LUCINA are liable to inspire the ladies of fashion to induce them to lie
in in town; and partly to the bad air of London, to which they purposely
resort.
There are however other causes, which render parturition more dangerous to
the ladies of high life; such as their greater general debility from
neglect of energetic exercise, their inexperience of the variations of cold
and heat, and their seclusion from fresh air. To which must be added, that
great source of the destruction of female grace and beauty, as well as of
female health, the tight stays, and other bandages, with which they are
generally tortured in their early years by the active folly of their
friends, which by displacing many of the viscera impedes their actions, and
by compressing them together produces adhesions of one part to another, and
affects even the form and aperture of the bones of the pelvis, through
which the nascent child must be protruded.
As parturition is a natural, not a morbid process, no medicine should be
given, where there is no appearance of disease. The absurd custom of giving
a powerful opiate without indication to all women, as soon as they are
delivered, is, I make no doubt, frequently attended with injurious, and
sometimes with fatal consequences. See Class II. 1. 2. 16.
Another thing very injurious to the child, is the tying and cutting the
navel-string too soon; which should always be left till the child has not
only repeatedly breathed, but till all pulsation in the cord ceases. As
otherwise the child is much weaker than it ought to be; a part of the blood
being left in the placenta, which ought to have been in the child; and at
the same time the placenta does not so naturally collapse, and withdraw
itself from the sides of the uterus, and is not therefore removed with so
much safety and certainty. The folly of giving rue or rhubarb to new-born
children, and the danger of feeding them with gruel instead of milk, is
spoken of in Class I. 1. 2. 5. and II. 1. 2. 16.
* * * * *
ORDO I.
_Increased Sensation._
GENUS II.
_With the Production of new Vessels by internal Membranes or Glands, with
Fever._
In the first class of diseases two kinds of fevers were described, one from
excess, and the other from defect of irritation; and were in consequence
termed irritative, and inirritative fevers. In this second class of
diseases another kind of fever occurs, which is caused by excess of
sensation, and termed in consequence Sensitive Fever. But there is no fever
from defect of sensation, because the circulation is carried on in health
without our consciousness, that is, without any sensation attending it.
But as excess of sensation may exist with excess or defect of irritation,
two other kinds of fever arise from a combination of sensitive fever with
the irritative, and inirritative ones. Making five kinds in all.
1. Irritative fever, described in Class I. 1. 1. 1.
2. Inirritative fever. Class I. 2. 1. 1.
3. Sensitive fever. Class II. 1. 6. 1.
4. Sensitive irritated fever. Class II. 1. 2. 1.
5. Sensitive inirritated fever. Class II. 1. 3. 1.
As the sensitive irritated fever attends all the diseases enumerated under
the genus about to be described, it is placed at the head of it. And as the
sensitive inirritated fever accompanies the greatest number of the species
enumerated under the third genus of this order, it is placed at the head of
them. And as the sensitive fever attends the diseases of the sixth genus,
it is placed at the head of them. But as every febrile paroxysm consists of
disordered tribes or trains of associated motions, it may be doubted,
whether they ought not all to have been placed in the fourth class, amongst
the diseases of association. See Class IV. 2. 4. 11.
All the subsequent species of this genus are attended with sensitive
irritated fever; there are nevertheless some superficial inflammations,
which affect the same situations without much fever, as the scrophulous
ophthalmy and spurious peripneumony, which belong to other genera.
Inflammation is uniformly attended with the production or secretion of new
fibres constituting new vessels; this therefore may be esteemed its
essential character, or the criterion of its existence. The extension of
the old vessels seems rather a consequence than a cause of the germination,
or pullulation, of these new ones; for the old vessels may be enlarged, and
excited with unusual energy, without any production of new ones, as in the
blush of shame or of anger.
When these new vessels are formed, if they are not reabsorbed into the
circulation, they secrete a new fluid called purulent matter; which
generally opens itself a passage on the external skin, and produces an
ulcer, which either gradually heals, or spreads, and is the cause of hectic
fever; or they secrete contagious matter, which has the property of
exciting the same kind of inflammation, and of producing the same kind of
contagious matter, when inserted by inoculation into the skin of other
persons. These contagious matters form ulcers, which either heal
spontaneously, or by art; or continue to spread, and destroy the patient,
by other kinds of hectic fever.
In this genus there is an increase of the sensorial power of irritation as
well as of sensation; whence great arterial energy is produced, and the
pulse becomes strong and full, as well as quick; and the coats of the
arteries feel hard under the finger, being themselves thickened and
distended by inflammation. The blood drawn, especially at the second
bleeding, is covered with a tough size; which is probably the mucus from
the inflamed internal surface of the arteries, increased in quantity, and
more coagulable than in its natural state; the thinner part being more
perfectly absorbed by the increased action of the inflamed absorbents. See
Sect. XXXIII. 2. 2. This is rendered more probable, because the hard feel
of the pulse, and the abundance of coagulable lymph commence, exist, and
cease together.
Great heat is produced from the new chemical combinations arising in the
secretion of new fibres, and great pain from the distention of old ones, or
from their increased action. The increased quantity of sensation from a
topical inflammation or phlegmon is the immediate cause of the febris
sensitiva irritata, or inflammatory fever; as when it arises from the pain
of pleurisy, or paronychia; but generally an irritative fever precedes this
topical inflammation, which occurs during the hot fit of it; and then the
irritative fever is changed into a sensitive irritated fever, by the
additional cause of the sensorial power of sensation besides that of
irritation.
SPECIES.
1. _Febris sensitiva irritata._ Sensitive irritated fever, or inflammatory
fever. Phlegmasia. A strong full pulse, with inflammation of the coats of
the arteries, constitutes this disease. It originates from some topical
inflammation, which, if the fever is not subdued, terminates in
suppuration; and differs from irritative fever in respect to the painful
sensation which accompanies it. For as pleasurable sensation is the cause
of the growth of the new vessels, and distention of the old ones, in the
natural enlargement of the body during our infancy; so a painful sensation
is the cause of the unnatural production of new vessels, and enlargement of
old ones in inflammatory diseases.
When matter is thus formed in any internal viscus, or in the cellular
membrane, as in the lungs or liver; so long as this abscess remains without
admission of air, this inflammatory fever is liable to continue, receiving
only temporary relief by bleeding or emetics, or cathartics; till the
patient, after a month, or two, or three, expires. But, if air be admitted
to these internal abscesses, this kind of fever is changed into a hectic
fever in a single day. It also sometimes happens, that when the abscess
remains unopened to the air, if the matter has become putrid, that hectic
fever supervenes, with colliquative sweats, or diarrhoea; the matter in
both cases is sometimes absorbed, and the sides of the abscess grow
together again without an external aperture. See Class II. 1. 4. 1. and 2.
Another termination of inflammation is in gangrene, but this belongs to the
inflammation of the external skin; as the production of purulent matter
belongs to inflammation of the internal or mucous membranes. Thus when the
external skin is the seat of inflammation, as in erythema, or erysipelas,
and produces sensitive irritated fever, no collection of purulent matter
can be formed; but a material oozes out, and lies upon the surface, like
that in the confluent small-pox, and the cuticle at length peels off, or
gangrene supervenes. It must be noted, that these kinds of inflammation can
exist together; and some parts of the cellular membrane may suppurate at
the same time that the external skin is affected with erythema, or
erysipelas.
M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath?
See Sect. XII. 6.
The increased arterial action in this sensitive irritated fever is not
simply owing to the increased irritability of the arterial system, or to
the stimulus of the distention of the vessels, but also to the increased
acrimony or pungency of the blood; which has now so far changed its nature
as to become more fluid, more dense, and to be loaded with coagulable
lymph. Hence it becomes necessary not only to lessen the quantity of blood
by venesection and by cathartics, but also to dilute its acrimony, or
pungency, by the introduction of aqueous and mucilaginous fluids, such as
barley water, cream and water, sugar and water, weak broths; to which may
be added so much of some vegetable essential oil, as may render them
grateful to the stomach, and thus promote their absorption, as by infusing
parsley or cellery and turneps in the broth; or by balm, mint, or sage
teas.
The following species of this genus only distinguish the situation of the
part previously inflamed, and which is the remote cause of the sensitive
irritated, or inflammatory fever, which attends it.
2. _Ophthalmia interna._ Inflammation of the eye is attended with the
production of new vessels, which spread over the tunica adjunctiva, and
over the cornea; these new vessels are easily seen, as they lie on a white
ground, and give ocular demonstration of their production in inflammation.
When this inflammation of the cornea suppurates, it is liable to leave
little ulcers, which may be seen beneath the surface in the form of little
excavations; and as these heal, they are liable to be covered with an opake
scar. This scar, in some months or years, is liable to wear away, and
become transparent, without the assistance of any polishing powder, as of
very finely levigated glass, as some have recommended. But when the cornea
is affected through all its thickness, the return of its transparency
becomes hopeless. See Class I. 1. 3. 14.
In violent degrees of ophthalmy the internal parts, as the retina, optic
artery, iris, ciliary process, become inflamed, as well as the external
ones; hence the least light admitted to the eye occasions intolerable pain.
This curious circumstance cannot be owing to the action of light on the
inflamed vessels of the cornea; it therefore shews, that the extremity of
the optic nerve or retina is also rendered more exquisitely sensible to
light, by partaking of the inflammation; and I have been told, that red
colours are in these cases sometimes painfully perceived even in perfect
darkness. This shews that the retina is excited into motion by the stimulus
of light; and that, when it is inflamed, these motions give great pain,
like those of other inflamed parts, as the muscles, or membranes. And
secondly, that the ideas of colours consist in the motions of the retina;
which ideas occasion pain, when the extremity of the moving nerve is
inflamed.
M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the
eye with cold water by means of a rag. Cool airy room. Darkness. When the
inflammation begins to decline, white vitriol gr. vi. in an ounce of water
is more efficacious to moisten the eye than solutions of lead. Tincture of
opium diluted. New vessels from the inflamed tunica adnata frequently
spread like a fly's wing upon the transparent cornea, which is then called
Pterigium. To stop the growth of this, the principal vessels should be cut
through with a lancet. When the inflammation begins to decline, after due
evacuation any stimulating material put into the eye increases the
absorption, which soon removes the new red vessels; which has given rise to
a hundred famous eye-waters, and eye-doctors; if these stimulating
materials are used too soon, the inflammation is increased by them. See
Sect. XXXII. 2. 10.
There is another ophthalmia, which attends weak children, and is generally
esteemed a symptom of scrophula, as described in Class II. 1. 4. 1. and
another, which is of venereal origin, mentioned in Class II. 1. 5. 2. both
which may be termed ophthalmia superficialis.
3. _Phrenitis._ Inflammation of the brain is attended with intolerance of
light and sound; which shews, that the extremities of the nerves of those
senses are at the same time inflamed; it is also attended with great pain
of the head, with watchfulness, and furious delirium. The violent efforts,
these patients are said sometimes to exert, are owing to the increased
secretion of sensorial power in the brain; as all other inflamed glands
have a greater circulation of blood passing through them, and a greater
secretion in consequence of their peculiar fluids, as in the hepatitis much
more bile is generated.
M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water
for hours together. Or with warm water. Cool airy room. Afterwards cupping
on the occiput. Leeches to the temples. When the patient is weakened a
blister on the head, and after further exhaustion five or six drops of
tincture of opium.
4. _Peripneumonia._ Inflammation of the lungs. The pulse is not always
hard, sometimes soft; which is probably owing to a degree of sickness or
inaction of the stomach; with dull pain of the chest; respiration
constantly difficult, sometimes with erect posture; the face bloated and
purplish; cough generally with moist expectoration, often stained with
blood.
When the difficulty of respiration is very great, the patient is not able
to cough; in this situation, after copious bleeding, the cough is liable to
return, and is so far a favourable symptom, as it shews some abatement of
the inflammation.
A peripneumony frequently occurs in the chin-cough, and destroys the
patient, except immediate recourse be had to the lancet, or to four or five
leeches; when blood cannot be otherwise taken.
The peripneumony is very fatal to young children, especially as I believe
it is frequently mistaken for a spasmodic asthma, or for the croup, or
cynanche trachealis of Cullen. Both which, however, when they occur,
require immediate venesection by the lancet or by leeches, as well as the
peripneumony.
The croup is an inflammation of the upper part, and the peripneumony of the
lower part of the same organ, viz. the trachea or windpipe. See Class I. 1.
3. 4. But as the inflammation is seldom I suppose confined to the upper
part of the trachea only, but exists at the same time in other parts of the
lungs, and as no inflammation of the tonsils is generally perceptible, the
uncouth name of cynanche trachealis should be changed for _peripneumonia
trachialis_. The method of cure consists in immediate and repeated
bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in
subtepid water, and in breathing over the steam of warm water, with or
without a little vinegar in it. And lastly, by keeping the child raised
high in bed.
Inflammation of the lungs is also liable to occur in the measles, and must
be attacked by venesection at any time of the disease; otherwise either a
present death, or an incurable consumption, is the consequence.
The peripneumony is frequently combined with inflammation of the pleura,
and sometimes with that of the diaphragm; either of these may generally be
distinguished, not only by the pain which attends inflammation of these
membranes, but by inspecting the naked chest, and observing whether the
patient breathes more by elevating the ribs, or by depressing the
diaphragm.
A crisis happens in children about the sixth day with much pale urine,
which must be waited for after evacuations have been used, as far as can be
done with safety; in this situation the warm bath twice a day, and small
blisters repeatedly in succession, are of peculiar service.
After the termination of peripneumony a collection of coagulable lymph is
frequently left in the cavity of the chest unabsorbed; or a common anasarca
of the lungs occurs from the present inaction of the absorbent vessels,
which had previously been excited too violently. This difficulty of
breathing is cured or relieved by the exhibition of digitalis. See Art. IV.
2. 8.
M. M. The lancet is the anchor of hope in this disease; which must be
repeated four or five times, or as often as the fever and difficulty of
breathing increase, which is generally in the evening; antimonials,
diluents, repeated small blisters about the chest, mucilage, pediluvium,
warm bath. Is a decoction of seneka-root of use? Do not neutral salts
increase the tendency to cough by their stimulus, as they increase the heat
of urine in gonorrhoea? Children in every kind of difficult breathing, from
whatever cause, should be kept as upright in bed as may be, and continually
watched; since, if they slip down, they are liable to be immediately
suffocated. After the patient is greatly debilitated, so that no further
evacuation can be admitted, and the difficult breathing and cough continue,
I have given four or five drops of tincture of opium, that is, about a
quarter of a grain of solid opium, with great advantage, and I believe in
several cases I have saved the patient. A greater quantity of opium in this
state of debility cannot be used without hazarding the life of the person.
This small quantity of an opiate should be given about six in the evening,
or before the access of the evening paroxysm, and repeated three or four
nights, or longer.
There is a peripneumony with weak pulse, which may be termed _peripneumonia
inirritata_, as described in Sect. XXVII. 2. which belongs to this place.
See also Superficial Peripneumony, Class II. 1. 3. 7.
5. _Pleuritis._ Pleurisy. Inflammation of the pleura, with hard pulse, pain
chiefly of the side, pungent, particularly increased during inspiration;
lying on either side uneasy, the cough very painful, dry at the beginning,
afterwards moist, often bloody.
One cause of pleurisy is probably a previous adhesion of the lungs to a
part of the pleura, which envelops them. This in many cases has been
produced in infancy, by suffering children to lie too long on one side. Or
by placing them uniformly on one side of a fire, or window, to which they
will be liable always to bend themselves.
When matter is produced during peripneumony or pleurisy in one side of the
chest, so long as it is a concealed vomica, the fever continues, if the
disease be great, for many weeks, and even months; and requires occasional
venesection, till the patient sinks under the inflammatory or sensitive
irritated fever. But if air be admitted, by a part of the abscess opening
itself a way into the air-vessels of the lungs, a hectic fever, with
colliquitive sweats or diarrhoea, supervenes, and frequently destroys the
patient; or the abscess heals the lungs adhering to the pleura.
M. M. The lancet must be used copiously, and repeated as often as the pain
and difficult respiration increase. A blister on the pained part.
Antimonial preparations. Diluents. Cool air. Do neutral salts increase the
tendency to cough? Pediluvium or semicupium frequently repeated.
6. _Diaphragmitis._ Inflammation of the diaphragm. Pain round the lower
ribs as if girt with a cord. Difficult respiration performed only by
elevating the ribs and in an erect posture. The corners of the mouth
frequently retracted into a disagreeable smile, called risus Sardonicus.
Those animals, which are furnished with clavicles, or collar-bones, not
only use their foremost feet as hands, as men, monkies, cats, mice,
squirrels, &c. but elevate their ribs in respiration as well as depress the
diaphragm for the purpose of enlarging the cavity of the chest. Hence an
inflammation of the diaphragm is sudden death to those animals, as horses
and dogs, which can only breaths by depressing the diaphragm; and is I
suppose the cause of the sudden death of horses that are over-worked;
whereas, in the human animal, when the diaphragm is inflamed, so as to
render its motions impossible from the pain they occasion, respiration can
be carried on, though in a less perfect manner, by the intercostal muscles
in the elevation of the ribs. In pleurisy the ribs are kept motionless, and
the respiration is performed by the diaphragm, as may be readily seen on
inspecting the naked chest, and which is generally a bad symptom; in the
diaphragmitis the ribs are alternately elevated, and depressed, but the
lower part of the belly is not seen to move.
M. M. As in pleurisy and peripneumony. When the patient becomes delirious,
and smiles disagreeably by intervals, and is become so weak, that
evacuations by the lancet could be used no further, and I have almost
despaired of my patient, I have found in two or three instances, that about
five or six drops of tinct. thebaic, given an hour before the evening
exacerbation, has had the happiest effect, and cured the patient in this
case, as well as in common peripneumony; it must be repeated two or three
evenings, see Class II. 1. 2. 4. as the exacerbation of the fever and
difficult respiration and delirium generally increase towards night.
The stimulus of this small quantity of opium on a patient previously so
much debilitated, acts by increasing the exertion of the absorbent vessels,
in the same manner as a solution of opium, or any other stimulant, put on
an inflamed eye after the vessels are previously emptied by evacuations,
stimulates the absorbent system, so as to cause the remaining new vessels
to be immediately reabsorbed. Which same stimulants would have increased
the inflammation, if they had been applied before the evacuations. See
Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full
of blood, the absorbents cannot act so powerfully, as the progress of their
contents is opposed by the previous fulness of the blood-vessels; whence
stimulants in that case increase the action of the secerning system more
than of the absorbent one; but after copious evacuation this resistance to
the progress of the absorbed fluids is removed; and when stimulants are
then applied, they increase the action of the absorbent system more than
that of the secerning one. Hence opium given in the commencement of
inflammatory diseases destroys the patient; and cures them, if given in
very small doses at the end of inflammatory diseases.
7. _Carditis._ Inflammation of the heart is attended with unequal
intermitting pulse, palpitation, pain in the middle of the sternum, and
constant vomiting. It cannot certainly be distinguished from peripneumony,
and is perhaps always combined with it.
8. _Peritonitis._ Inflammation of the peritonaeum is known by pain all over
the abdomen, which is increased on erecting the body. It has probably most
frequently a rheumatic origin. See Class II. 1. 2. 17.
9. _Mesenteritis._ Inflammation of the mesentery is attended with pains
like colic, and with curdled or chyle-like stools. It is a very frequent
and dangerous disease, as the production of matter more readily takes place
in it than in any other viscus. The consequence of which, after a hard
labour, is probably the puerperal fever, and in scrophulous habits a fatal
purulent fever, or hopeless consumption.
M. M. Venesection. Warm bath. Emollient clysters.
10. _Gastritis._ In inflammation of the stomach the pulse is generally
soft, probably occasioned by the sickness which attends it. The pain and
heat of the stomach is increased by whatever is swallowed, with immediate
rejection of it. Hiccough.
This disease may be occasioned by acrid or indigestible matters taken into
the stomach, which may chemically or mechanically injure its interior coat.
There is however a slighter species of inflammation of this viscus, and
perhaps of all others, which is unattended by much fever; and which is
sometimes induced by drinking cold water, or eating cold insipid food, as
raw turnips, when the person has been much heated and fatigued by exercise.
For when the sensorial power has been diminished by great exertion, and the
stomach has become less irritable by having been previously stimulated by
much heat, it sooner becomes quiescent by the application of cold. In
consequence of this slight inflammation of the stomach an eruption of the
face frequently ensues by the sensitive association of this viscus with the
skin, which is called a surfeit. See Class IV. 1. 2. 13. and II. 1. 4. 6.
and II. 1. 3. 19.
M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See
Class II. 1. 3. 17.
11. _Enteritis._ Inflammation of the bowels is often attended with soft
pulse, probably owing to the concomitant sickness; which prevents sometimes
the early use of the lancet, to the destruction of the patient. At other
times it is attended with strong and full pulse like other inflammations of
internal membranes. Can the seat of the disease being higher or lower in
the intestinal canal, that is, above or below the valve of the colon,
produce this difference of pulse by the greater sympathy of one part of the
bowels with the stomach than another? In enteritis with strong pulse the
pain is great about the navel, with vomiting, and the greatest difficulty
in procuring a stool. In the other, the pain and fever is less, without
vomiting, and with diarrhoea. Whence it appears, that the enteritis with
hard quick pulse differs from Ileus, described in Class I. 3. 1. 6. only in
the existence of fever in the former and not the latter, the other symptoms
generally corresponding; and, secondly, that the enteritis with softer
quick pulse, differs from the cholera described in Class I. 3. 1. 5. only
in the existence of fever in the former, and not the latter, the other
symptoms being in general similar. See Class II. 1. 3. 20.
Inflammation of the bowels sometimes is owing to extraneous indigestible
substances, as plum-stones, especially of the damasin, which has sharp
ends. Sometimes to an introsusception of one part of the intestine into
another, and very frequently to a strangulated hernia or rupture. In
respect to the first, I knew an instance where a damasin stone, after a
long period of time, found its way out of the body near the groin. I knew
another child, who vomited some damasin stones, which had lain for near
twenty hours, and given great pain about the navel, by the exhibition of an
emetic given in repeated doses for about an hour. The swallowing of
plum-stones in large quantities, and even of cherry-stones, is annually
fatal to many children. In respect to the introsusception and hernia, see
Ileus, Class I. 3. 1. 6.
M. M. Repeated venesection. Calomel from ten to twenty grains given in
small pills as in Ileus; these means used early in the disease generally
succeed. After these evacuations a blister contributes to stop the
vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will
frequently stay in the stomach. Glauber's salt dissolved in pepper-mint
water given by repeated spoonfuls.
When the patient is much reduced, opium in very small doses may be given,
as a quarter of a grain, as recommended in pleurisy. If the pain suddenly
ceases, and the patient continues to vomit up whatever is given him, it is
generally fatal; as it indicates, that a mortification of the bowel is
already formed. Some authors have advised to join cathartic medicines with
an opiate in inflammation of the bowels, as recommended in colica
saturnina. This may succeed in slighter cases, but is a dangerous practice
in general; since, if the obstruction be not removed by the evacuation, the
stimulus of the opium is liable to increase the action of the vessels, and
produce mortification of the bowel, as I think I have seen more than once.
12. _Hepatitis._ Inflammation of the liver is attended with strong quick
pulse; tension and pain of the right side; often pungent as in pleurisy,
oftner dull. A pain is said to affect the clavicle, and top of the right
shoulder; with difficulty in lying on the left side; difficult respiration;
dry cough; vomiting; hiccough.
There is another hepatitis mentioned by authors, in which the fever, and
other symptoms, are wanting, or are less violent; as described in Class II.
1. 4. 12. and which is probably sometimes relieved by eruptions of the
face; as in those who are habituated to the intemperate use of fermented
liquors.
M. M. Hepatic inflammation is very liable to terminate in suppuration, and
the patient is destroyed by the continuance of a fever with sizy blood, but
without night-sweats, or diarrhoea, as in other unopened abscesses. Whence
copious and repeated venesection is required early in the disease, with
repeated doses of calomel, and cathartics. Warm bath. Towards the end of
the disease small doses of opium before the evening paroxysms, and lastly
the Peruvian bark, and chalybeate wine, at first in small doses, as 20
drops twice a day, and afterwards, if necessary, in larger. See Art. IV. 2.
6.
Mrs. C. a lady in the last month of her pregnancy, was seized with violent
hepatitis, with symptoms both of peripneumony and of pleurisy, for it
seldom happens in violent inflammations, that one viscus alone is affected;
she wanted then about a fortnight of her delivery, and after frequent
venesection, with gentle cathartics, with fomentation or warm bath, she
recovered and was safely delivered, and both herself and child did well.
Rheumatic and eruptive fevers are more liable to induce abortion.
13. _Splenitis._ Inflammation of the spleen commences with tension, heat,
and tumour of the left side, and with pain, which is increased by pressure.
A case is described in Class I. 2. 3. 18. where a tumid spleen, attended
with fever, terminated in schirrus of that viscus.
14. _Nephritis._ Inflammation of the kidney seems to be of two kinds; each
of them attended with different symptoms, and different modes of
termination. One of them I suppose to be an inflammation of the external
membrane of the kidney, arising from general causes of inflammation, and
accompanied with pain in the loins without vomiting; and the other to
consist in an inflammation of the interior parts of the kidney, occasioned
by the stimulus of gravel in the pelvis of it, which is attended with
perpetual vomiting, with pain along the course of the ureter, and
retraction of the testis on that side, or numbness of the thigh.
The former of these kinds of nephritis is distinguished from lumbago by its
situation being more exactly on the region of the kidney, and by its not
being extended beyond that part; after three or four days I believe this
inflammation is liable to change place; and that a herpes or erysipelas,
called zona, or shingles, breaks out about the loins in its stead; at other
times it is cured by a cathartic with calomel, with or without previous
venesection.
The other kind of nephritis, or inflammation of the interior part of the
kidney, generally arises from the pain occasioned by the stimulus of a
stone entering the ureter from the pelvis of the kidney; and, which ceases
when the stone is protruded forwards into the bladder; or when it is
returned into the pelvis of the kidney by the retrograde action of the
ureter. The kidney is nevertheless inflamed more frequently, though in a
less degree, from other causes; especially from the intemperate
ingurgitation of ale, or other fermented or spirituous liquors. This less
degree of inflammation is the cause of gravel, as that before mentioned is
the effect of it. The mucus secreted to lubricate the internal surface of
the uriniferous tubes of the kidney becomes secreted in greater quantity,
when these vessels are inflamed; and, as the correspondent absorbent
vessels act more energetically at the same time, the absorption of its more
fluid parts is more powerfully effected; on both these accounts the mucus
becomes both changed in quality and more indurated. And in this manner
stones are produced on almost every mucous membrane of the body; as in the
lungs, bowels, and even in the pericordium, as some writers have affirmed.
See Class I. 1. 3. 9.
M. M. Venesection. Ten grains of calomel given in small pills, then
infusion of sena with oil. Warm bath. Then opium a grain and half. See
Class I. 1. 3. 9. for a further account of the method of cure.
15. _Cystitis._ Inflammation of the bladder is attended with tumor and pain
of the lower part of the belly; with difficult and painful micturition; and
tenesmus. It generally is produced by the existence of a large stone in the
bladder, when in a great degree; or is produced by common causes, when in a
slighter degree.
The stone in the bladder is generally formed in the kidney, and passing
down the ureter into the bladder becomes there gradually increased in size;
and this most frequently by the apposition of concentric spheres, as may be
seen by sawing some of the harder calculi through the middle, and polishing
one surface. These new concretions superinduced on the nucleus, which
descended from the kidney, as described in Class I. 1. 3. 9. and in the
preceding article of this genus, is not owing to the microcosmic salt,
which is often seen to adhere to the sides of chamber-pots, as this is
soluble in warm water, but to the mucus of the bladder, as it rolls along
the internal surface of it. Now when the bladder is slightly inflamed, this
mucus of its internal surface is secreted in greater quantity, and is more
indurated by the absorption of its more liquid part at the instant of
secretion, as explained in Class I. 1. 3. 9. and II. 1. 2. 14. and thus the
stimulus and pain of a stone in the bladder contributes to its enlargement
by inflaming the interior coat of it.
M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See Class I. 1.
3. 9.
16. _Hysteritis._ Inflammation of the womb is accompanied with heat,
tension, tumor, and pain of the lower belly. The os uteri painful to the
touch. Vomiting. This disease is generally produced by improper management
in the delivery of pregnant women. I knew an unfortunate case, where the
placenta was left till the next day; and then an unskilful accoucheur
introduced his hand, and forcibly tore it away; the consequence was a most
violent inflammatory fever, with hard throbbing pulse, great pain, very
sizy blood, and the death of the patient. Some accoucheurs have had a
practice of introducing their hand into the uterus immediately after the
birth of the child, to take away the placenta; which they said was to save
time. Many women I believe have been victims to this unnatural practice.
Others have received injury, where inflammation has been beginning, by the
universal practice of giving a large dose of opium immediately on delivery,
without any indication of its propriety; which, though a proper and useful
medicine, where the patient is too feeble, when given in a small dose, as
10 drops of tincture of opium, or half a grain of solid opium, must do a
proportionate injury, when it is given improperly; and as delivery is a
natural process, it is certainly more wise to give no medicines, except
there be some morbid symptom, which requires it; and which has only been
introduced into custom by the ill-employed activity of the Priests or
Priestesses of LUCINA; like the concomitant nonsense of cramming rue or
rheubarb into the mouth of the unfortunate young stranger, who is thus soon
made to experience the evils of life. See Class II. 1. 1. 12. and I. 1. 2.
5. Just so some over-wise beldames force young ducks and turkeys, as soon
as they are hatched, to swallow a peppercorn.
M. M. Venesection repeatedly; diluents; fomentation; the patient should be
frequently raised up in bed for a short time, to give opportunity of
discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera.
17. _Lumbago sensitiva._ Sensitive lumbago. When the extensive membranes,
or ligaments, which cover the muscles of the back are torpid, as in the
cold paroxysm of ague, they are attended with pain in consequence of the
inaction of the vessels, which compose them. When this inaction continues
without a consequent renewal or increase of activity, the disease becomes
chronical, and forms the lumbago frigida, or irritativa, described in Class
I. 2. 4. 16. But when this cold fit or torpor of these membranes, or
ligaments or muscles of the back, is succeeded by a hot fit, and consequent
inflammation, a violent inflammatory fever, with great pain, occurs,
preventing the erect posture of the body; and the affected part is liable
to suppurate, in which case a very dangerous ulcer is formed, and a part of
one of the vertebrae is generally found carious, and the patient sinks
after a long time under the hectic fever occasioned by the aerated or
oxygenated matter.
This disease bears no greater analogy to rheumatism than the inflammation
of the pleura, or any other membranous inflammation; and has therefore
unjustly been arranged under that name. It is distinguished from nephritis,
as it is seldom attended with vomiting, I suppose never, except the ureter
happens to be inflamed at the same time.
The pain sometimes extends on the outside of the thigh from the hip to the
ankle, heel, or toes, and is then called sciatica; and has been thought to
consist in an inflammation of the theca, or covering of the sciatic nerve,
as the pain sometimes so exactly attends the principal branches of that
nerve. See Class I. 2. 4. 15. 16.
M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm
bath; poultice on the back, consisting of camomile flowers, turpentine,
soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs
from the torpor of the muscles, which had previously been too much excited,
frequently occurs at the end of this disease; in this case electricity, and
issues on each side of the lumber vertebrae, are recommended. See Class I.
2. 4. 16.
18. _Ischias._ The ischias consists of inflammatory fever, with great pain
about the pelvis, the os coccigis, and the heads of the thigh-bones,
preventing the patient from walking or standing erect, with increase of
pain on going to stool. This malady, as well as the preceding, has been
ascribed to rheumatism; with which it seems to bear no greater analogy,
than the inflammations of any other membranes.
The patients are left feeble, and sometimes lame after this disease; which
is also sometimes accompanied with great flow of urine, owing to the
defective absorption of its aqueous parts; and with consequent thirst
occasioned by the want of so much fluid being returned into the
circulation; a lodgment of faeces in the rectum sometimes occurs after this
complaint from the lessened sensibility of it. See Class I. 2. 4. 15.
M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with
camomile flowers, turpentine, soap, and opium; afterwards the bark. See
Class I. 1. 3. 5.
When this inflammation terminates in suppuration the matter generally can
be felt to fluctuate in the groin, or near the top of the thigh. In this
circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire,
proposes to tap the abscess by means of a trocar, and thus as often as
necessary to discharge the matter without admitting the air. Might a weak
injection of wine and water, as in the hydrocele, be used with great
caution to inflame the walls of the abscess, and cause them to unite? See
Class II. 1. 6. 9.
19. _Paronychia interna._ Inflammation beneath the finger-nail. The pain
occasioned by the inflammatory action and tumor of parts bound down between
the nail on one side and the bone on the other, neither of which will
yield, is said to occasion so much pain as to produce immediate delirium,
and even death, except the parts are divided by a deep incision; which must
pass quite through the periosteum, as the inflammation is said generally to
exist beneath it. This disease is thus resembled by the process of toothing
in young children; where an extraneous body lodged beneath the periosteum
induces pain and fever, and sometimes delirium, and requires to be set at
liberty, by the lancet.
* * * * *
ORDO I.
_Increased Sensation._
GENUS III.
_With the Production of new Vessels by external Membranes or Glands with
Fever._
The diseases of this genus are perhaps all productive of contagious matter;
or which becomes so by its exposure to the air, either through the cuticle,
or by immediate contact with it; such are the matters of the small-pox and
measles. The purulent matter formed on parts covered from the air by
thicker membranes or muscles, as in the preceding genus, does not induce
fever, and cannot therefore be called contagious; but it acquires this
property of producing fever in a few hours, after the abscess has been
opened, so as to admit the air to its surface, and may then be said to
consist of contagious miasmata. This kind of contagious matter only induces
fever, but does not produce other matter with properties similar to its
own; and in this respect it differs from the contagious miasmata of
small-pox or measles, but resembles those which have their origin in
crowded jails; for these produce fever only, which frequently destroys the
patient; but do not produce other matters similar to themselves; as appears
from none of those, who died of the jail-fever, caught at the famous black
assizes at Oxford, at the beginning of this century, having infected their
physicians or attendants.
If indeed the matter has continued so long as to become putrid, and thus to
have given out air from a part of it, it acquires the power of producing
fever; in the same manner as if the ulcer had been opened, and exposed to
the common air; instances of which are not unfrequent. And from these
circumstances it seems probable, that the matters secreted by the new
vessels formed in all kinds of phlegmons, or pustles, are not contagious,
till they have acquired something from the atmosphere, or from the gas
produced by putrefaction; which will account for some phenomena in the lues
venerea, cancer, and of other contagious secretions on the skin without
fever, to be mentioned hereafter. See Class II. 1. 4. 14.
The theory of contagion has been perplexed by comparing it with fermenting
liquors; but the contagious material is shewn in Section XXXIII. to be
produced like other secreted matters by certain animal motions of the
terminations of the vessels. Hence a new kind of gland is formed at the
terminations of the vessels in the eruptions of the small-pox; the animal
motions of which produce from the blood variolous matter; as other glands
produce bile or saliva. Now if some of this matter is introduced beneath
the cuticle of a healthy person, or enters the circulation, and excites the
extremities of the blood-vessels into those kinds of diseased motions, by
which it was itself produced, either by irritation or association, these
diseased motions of the extremities of the vessels will produce other
similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion
seems to be propagated two ways; one, by the stimulus of contagious matter
applied to the part, which by an unknown law of nature excites the
stimulated vessels to produce a similar matter; as in venereal ulcers,
which thus continue to spread; or as when variolous matter is inserted
beneath the cuticle; or when it is supposed to be absorbed, and diffused
over the body mixed with the blood, and applied in that manner to the
cutaneous glands. The other way, by which contagion seems to be diffused,
is by some distant parts sympathizing or imitating the motions of the part
first affected; as the stomach and skin in the eruptions of the inoculated
small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3.
In some of the diseases of this genus the pulse is strong, full, and hard,
constituting the sensitive irritated fever, as described in the preceding
genus; as in one kind of erysipelas, which requires repeated venesection.
In others the arterial action is sometimes moderate, so as to constitute
the sensitive fever, as in the inoculated small-pox; where the action of
the arteries is neither increased by the sensorial power of irritation, as
in the sensitive irritated fever; nor decreased by the defect of that
power, as in the sensitive inirritated fever. But in the greatest number of
the diseases of this genus the arterial action is greatly diminished in
respect to strength, and consequently the frequency of pulsation is
proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing
to the deficiency of the sensorial power of irritation joined with the
increase of that of sensation, and thus constitutes the sensitive
inirritated fever; as in Scarlatina with gangrenous tonsils.
From this great debility of the action of the arteries, there appears to be
less of the coagulable lymph or mucus secreted on their internal surfaces;
whence there is not only a defect of that buff or size upon the blood,
which is seen on the surface of that, which is drawn in the sensitive
irritated fever; but the blood, as it cools, when it has been drawn into a
bason, scarcely coagulates; and is said to be dissolved, and is by some
supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3.
where the truth of this idea is controverted. But in the fevers of both
this genus and the preceding one great heat is produced from the chemical
combinations in the secretions of new vessels and fluids, and pain or
uneasiness from the distention of the old ones; till towards the
termination of the disease sensation ceases, as well as irritation, with
the mortification of the affected parts, and the death of the patient.
Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the
diseases of external membranes, because they are exposed either to the
atmospheric air, which is breathed, and swallowed with our food and saliva;
or they are exposed to the inflammable air; or hydrogen, which is generated
in the intestines; both which contribute to produce or promote the
contagious quality of these fluids; as mentioned in Class II. 1. 5.
It is not speaking accurate language, if we say, that in the diseases of
this genus the fever is contagious; since it is the material produced by
the external membranes, which is contagious, after it has been exposed to
air; while the fever is the consequence of this contagious matter, and not
the cause of it. As appears from the inoculated small-pox, in which the
fever does not commence, till after suppuration has taken place in the
inoculated arm, and from the diseases of the fifth genus of this order,
where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18.
SPECIES.
1. _Febris sensitiva inirritata._ Sensitive inirritated fever. Typhus
gravior. Putrid malignant fever. Jail fever. The immediate cause of this
disease is the increase of the sensorial power of sensation, joined with
the decrease of the sensorial power of irritation; that is, it consists in
the febris sensitiva joined with the febris inirritativa of Class I. 2. 1.
1. as the febris sensitiva irritata of the preceding genus consists of the
febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In
both which the word irritata, and inirritata, are designed to express more
or less irritation than the natural quantity; and the same when applied to
some of the diseases of this genus.
This fever is frequently accompanied with topical inflammation, which is
liable, if the arterial strength is not supported, to end in sphacelus; and
as mortified parts, such as sloughs of the throat, if they adhere to living
parts, soon become putrid from the warmth and moisture of their situation;
these fevers have been termed putrid, and have been thought to owe their
cause to what is only their consequence. In hot climates this fever is
frequently induced by the exhalations of stagnating lakes or marshes, which
abound with animal substances; but which in colder countries produce fevers
with debility only, as the quartan ague, without inflammation.
The sensitive inirritated, or malignant, fever is also frequently produced
by the putrid exhalations and stagnant air in prisons; but perhaps most
frequently by contact or near approach of the persons, who have resided in
them. These causes of malignant fevers contributed to produce, and to
support for a while, the septic and antiseptic theory of them; see Sect.
XXXIII. 1. 3. The vibices or bruises, and petechiae or purples, were
believed to be owing to the dissolved state of the blood by its incipient
putrefaction; but hydrostatical experiments have been made, which shew the
sizy blood of the patient in sensitive irritated or inflammatory fever,
with strong pulse, is more fluid, while it is warm, than this uncoagulable
blood taken in this sensitive inirritated, or malignant fever; from whence
it is inferred, that these petechiae, and vibices, are owing to the
deficient power of absorption in the terminations of the veins, See Class
I. 2. 1. 5.
This sensitive inirritated fever, or typhus gravior, is distinguished from
the inirritative fever, or typhus mitior, in the early stages of it, by the
colour of the skin; which in the latter is paler, with less heat, owing to
the less violent action of the capillaries; in this it is higher coloured,
and hotter, from the greater energy of the capillary action in the
production of new vessels. In the more advanced state petechiae, and the
production of contagious matter from inflamed membranes, as the aphthae of
the mouth, or ulcers of the throat, distinguishes this fever from the
former. Delirium, and dilated pupils of the eyes, are more frequent in
nervous fevers; and stupor with deafness more frequent attendants on
malignant fevers. See Class I. 2. 5. 6.
There is another criterion discernible by the touch of an experienced
finger; and that is, the coat of the artery in inflammatory fevers, both
those attended with strength of pulsation, and these with weak pulsation,
feels harder, or more like a cord; for the coats of the arteries in these
fevers are themselves inflamed, and are consequently turgid with blood, and
thence are less easily compressed, though their pulsations are nevertheless
weak: when the artery is large or full with an inflamed coat, it is called
hard; and when small or empty with an inflamed coat, it is called sharp, by
many writers.
M. M. The indications of cure consist, 1. In procuring a regurgitation of
any offensive material, which may be lodged in the long mouths of the
lacteals or lymphatics, or in their tumid glands. 2. To excite the system
into necessary action by the repeated exhibition of nutrientia, sorbentia,
and incitantia; and to preserve the due evacuation of the bowels. 3. To
prevent any unnecessary expenditure of sensorial power. 4. To prevent the
formation of ulcers, or to promote the absorption in them, for the purpose
of healing them.
1. One ounce of wine of ipecacuanha, or about ten grains of the powder,
should be given as an emetic. After a few hours three or four grains of
calomel should be given in a little mucilage, or conserve. Where something
swallowed into the stomach is the cause of the fever, it is liable to be
arrested by the lymphatic glands, as the matter of the small-pox inoculated
in the arm is liable to be stopped by the axillary lymphatic gland; in this
situation it may continue a day or two, or longer, and may be regurgitated
during the operation of an emetic or cathartic into the stomach or bowel,
as evidently happens on the exhibition of calomel, as explained in Sect.
XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if
indicated by the hardness and fulness of the pulse, will very frequently
remove fevers, if exhibited on the first, second, or even third day.
2. Wine and opium, in small doses repeated frequently, but so that not the
least degree of intoxication follows, for in that case a greater degree of
debility is produced from the expenditure of sensorial power in unnecessary
motions. Many weak patients have been thus stimulated to death. See Sect.
XII. 7. 8. The Peruvian bark should be given also in repeated doses in such
quantity only as may strengthen digestion, not impede it. For these
purposes two ounces of wine, or of ale, or cyder, should be given every six
hours; and two ounces of decoction of bark, with two drachms of the
tincture of bark, and six drops of tincture of opium, should be given also
every six hours alternately; that is, each of them four times in
twenty-four hours. As much rhubarb as may induce a daily evacuation, should
be given to remove the colluvies of indigested materials from the bowels;
which might otherwise increase the distress of the patient by the air it
gives out in putrefaction, or by producing a diarrhoea by its acrimony; the
putridity of the evacuations are in consequence of the total inability of
the digestive powers; and their delay in the intestines, to the inactivity
of that canal in respect to its peristaltic motions.
The quantities of wine or beer and opium, and bark, above mentioned, may be
increased by degrees, if the patient seems refreshed by them; and if the
pulse becomes slower on their exhibition; but this with caution, as I have
seen irrecoverable mischief done by greater quantities both of opium, wine,
and bark, in this kind of fever; in which their use is to strengthen the
digestion of the weak patient, rather than to stop the paroxysms of fever;
but when they are administered in intermittents, much larger quantities are
necessary.
The stimulus of small blisters applied in succession, one every three or
four days, when the patient becomes weak, is of great service by
strengthening digestion, and by preventing the coldness of the extremities,
owing to the sympathy of the skin with the stomach, and of one part of the
skin with another.
In respect to nutriment, the patient should be supplied with wine and
water, with toasted bread, and sugar or spice in it; or with sago with
wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with
cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish,
or whatever is grateful to the palate of the sick person, in small quantity
repeated frequently; with small beer, cyder and water, or wine and water,
for drink, which may be acidulated with acid of vitriol in small
quantities.
3. All unnecessary motions are to be checked, or prevented. Hence
horizontal posture, obscure room, silence, cool air. All the parts of the
skin, which feel too hot to the hand, should be exposed to a current of
cool air, or bathed with cold water, whether there are eruptions on it or
not. Wash the patient twice a day with cold vinegar and water, or cold salt
and water, or cold water alone, by means of a sponge. If some parts are too
cold, as the extremities, while other parts are too hot, as the face or
breast, cover the cold parts with flannel, and cool the hot parts by a
current of cool air, or bathing them as above.
4. For the healing of ulcers, if in the mouth, solution of alum in water
about 40 grains to an ounce, or of blue vitriol in water, one grain or two
to an ounce may be used to touch them with three or four times a day. Of
these perhaps a solution of alum is to be preferred, as it instantly takes
away the stench from ulcers I suppose by combining with the volatile alcali
which attends it. For this purpose a solution of alum of an ounce to a pint
of water should be frequently injected by means of a syringe into the
mouth. If there are ulcers on the external skin, fine powder of bark seven
parts, and cerusia in fine powder one part, should be mixed, and applied
dry on the sore, and kept on by lint, and a bandage.
As sloughs in the mouth are frequently produced by the previous dryness of
the membranes, which line it, this dryness should be prevented by
frequently moistening them, which may be effected by injection with a
syringe, or by a moist sponge, or lastly in the following manner. Place a
glass of wine and water, or of milk and sugar, on a table by the bedside, a
little above the level of the mouth of the patient; then, having previously
moistened a long piece of narrow listing, or cloth, or flannel, with the
same liquor, leave one end of it in the glass, and introduce the other into
the mouth of the patient; which will thus be supplied with a constant
oozing of the fluid through the cloth, which acts as a capillary syphon.
The viscid phlegm, which adheres to the tongue, should be coagulated by
some austere acid, as by lemon-juice evaporated to half its quantity, or by
crab-juice; and then it may be scraped off by a knife, or rubbed off by
flannel, or a sage leaf dipped in vinegar, or in salt and water.
2. _Erysipelas_, St. Anthony's fire, may be divided into three kinds, which
differ in their method of cure, the irritated, the inirritated, and the
sensitive erysipelas.
_Erysipelas irritatum_ is attended with increase of irritation besides
increase of sensation; that is, with strong, hard, and full pulse, which
requires frequent venesection, like other inflammations with arterial
strength. It is distinguished from the phlegmonic inflammations of the last
genus by its situation on the external habit, and by the redness, heat, and
tumour not being distinctly circumscribed; so that the eye or finger cannot
exactly trace the extent of them.
When the external skin is the seat of inflammation, and produces sensitive
irritated fever, no collection of matter is formed, as when a phlegmon is
situated in the cellular membrane beneath the skin; but the cuticle rises
as beneath a blister-plaster, and becomes ruptured; and a yellow material
oozes out, and becomes inspissated, and lies upon its surface; as is seen
in this kind of erysipelas, and in the confluent small-pox; or if the new
vessels are reabsorbed the cuticle peels off in scales. This difference of
the termination of erysipelatous and phlegmonic inflammation seems to be
owing in part to the less distensibility of the cuticle than of the
cellular membrane, and in part to the ready exhalation of the thinner parts
of the secreted fluids through its pores.
This erysipelas is generally preceded by a fever for two or three days
before the eruption, which is liable to appear in some places, as it
declines in others; and seems frequently to arise from a previous scratch
or injury of the skin; and is attended sometimes with inflammation of the
cellular membrane beneath the skin; whence a real phlegmon and collection
of matter becomes joined to the erysipelas, and either occasions or
increases the irritated fever, which attends it.
There is a greater sympathy between the external skin and the meninges of
the brain, than between the cellular membrane and those meninges; whence
erysipelas is more liable to be preceded or attended, or succeeded, by
delirium than internal phlegmons. I except the mumps, or parotitis,
described below; which is properly an external gland, as its excretory duct
opens into the air. When pain of the head or delirium precedes the
cutaneous eruption of the face, there is some reason to believe, that the
primary disease is a torpor of the meninges of the brain; and that the
succeeding violent action is transferred to the skin of the face by
sensitive association; and that a similar sympathy occurs between some
internal membranes and the skin over them, when erysipelas appears on other
parts of the body. If this circumstance should be supported by further
evidence, this disease should be removed into Class IV. along with the
rheumatism and gout. See Class IV. 1. 2. 17.
This supposed retropulsion of erysipelas on the brain from the frequent
appearance of delirium, has prevented the free use of the lancet early in
this disease to the destruction of many; as it has prevented the subduing
of the general inflammation, and thus has in the end produced the
particular one on the brain. Mr. B----, a delicate gentleman about sixty,
had an erysipelas beginning near one ear, and extending by degrees over the
whole head, with hard, full, and strong pulse; blood was taken from him
four or five times in considerable quantity, with gentle cathartics, with
calomel, diluents, and cool air, and he recovered without any signs of
delirium, or inflammation of the meninges of the brain. Mr. W----, a strong
corpulent man of inferior life, had erysipelas over his whole head, with
strong hard pulse: he was not evacuated early in the disease through the
timidity of his apothecary, and died delirious. Mrs. F---- had erysipelas
on the face, without either strong or weak pulse; that is, with sensitive
fever alone, without superabundance or deficiency of irritation; and
recovered without any but natural evacuations. From these three cases of
erysipelas on the head it appears, that the evacuations by the lancet must
be used with courage, where the degree of inflammation requires it; but not
where this degree of inflammation is small, nor in the erysipelas attended
with inirritation, as described below.
M. M. Venesection repeated according to the degree of inflammation. An
emetic. Calomel three grains every other night. Cool air. Diluents, emetic
tartar in small doses, as a quarter of a grain every six hours. Tea, weak
broth, gruel, lemonade, neutral salts. See Sect. XII. 6.
Such external applications as carry away the heat of the skin may be of
service, as cold water, cold flour, snow, ether. Because these applications
impede the exertions of the secerning vessels, which are now in too great
action; but any applications of the stimulant kind, as solutions of lead,
iron, copper, or of alum, used early in the disease, must be injurious; as
they stimulate the secerning vessels, as well as the absorbent vessels,
into greater action; exactly as occurs when stimulant eye-waters are used
too soon in ophthalmy. See Class II. 1. 2. 2. But as the cuticle peels off
in this case after the inflammation ceases, it differs from ophthalmy; and
stimulant applications are not indicated at all, except where symptoms of
gangrene appear. For as a new cuticle is formed under the old one, as under
a blister, the serous fluid between them is a defence to the new cuticle,
and should dry into a scab by exhalation rather than be reabsorbed. Hence
we see how greasy or oily applications, and even how moist ones, are
injurious in erysipelas; because they prevent the exhalation of the serous
effusion between the old and new cuticle, and thus retard the formation of
the latter.
_Erysipelas inirritatum_ differs from the former in its being attended with
weak pulse, and other symptoms of sensitive inirritated fever. The feet and
legs are particularly liable to this erysipelas, which precedes or attends
the sphacelus or mortification of those parts. A great and long coldness
first affects the limb, and the erysipelas on the skin seems to occur in
consequence of the previous torpor of the interior membranes. As this
generally attends old age, it becomes more dangerous in proportion to the
age, and also to the habitual intemperance of the patient in respect to the
use of fermented or spirituous liquor.
When the former kind, or irritated erysipelas, continues long, the patient
becomes so weakened as to be liable to all the symptoms of this inirritated
erysipelas; especially where the meninges of the brain are primarily
affected. As in that case, after two or three efforts have been made to
remove the returning periods of torpor of the meninges to the external
skin, those meninges become inflamed themselves, and the patient sinks
under the disease; in a manner similar to that in old gouty patients, where
the torpor of the liver or stomach is relieved by association of the
inflammation of the membranes of the feet, and then of other joints, and
lastly the power of association ceasing to act, but the excess of sensation
continuing, the liver or stomach remains torpid, or become themselves
inflamed, and the patient is destroyed.
M. M. Where there exists a beginning gangrene of the extremities, the
Peruvian bark, and wine, and opium, are to be given in large quantities; so
as to strengthen the patient, but not to intoxicate, or to impede his
digestion of aliment, as mentioned in the first species of this genus.
Class II. 1. 2. 1. But where the brain is inflamed or oppressed, which is
known either by delirium, with quick pulse; or by stupor, and slow
respiration with slow pulse; other means must be applied. Such as, first, a
fomentation on the head with warm water, with or without aromatic herbs, or
salt in it, should be continued for an hour or two at a time, and
frequently repeated. A blister may also be applied on the head, and the
fomentation nevertheless occasionally repeated. Internally very gentle
stimulants, as camphor one grain or two in infusion of valerian. Wine and
water or small beer, weak broth. An enema. Six grains of rhubarb and one of
calomel. Afterwards five drops of tincture of opium, which may be repeated
every six hours, if it seems of service. Might the head be bathed for a
minute with cold water? or with ether? or vinegar?
_Erysipelas sensitivum_ is a third species, differing only in the kind of
fever which attends it, which is simply inflammatory, or sensitive, without
either excess of irritation, as in the first variety; or the defect of
irritation, as in the second variety: all these kinds of erysipelas are
liable to return by periods in some people, who have passed the middle of
life, as at periods of a lunation, or two lunations, or at the equinoxes.
When these periods of erysipelas happen to women, they seem to supply the
place of the receding catamenia; when to men, I have sometimes believed
them to be associated with a torpor of the liver; as they generally occur
in those who have drank vinous spirit excessively, though not
approbriously; and that hence they supply the place of periodical piles, or
gout, or gutta rosea.
M. M. As the fever requires no management, the disease takes its progress
safely, like a moderate paroxysm of the gout; but in this case, as in some
of the former, the erysipelas does not appear to be a primary disease, and
should perhaps be removed to the Class of Association.
3. _Tonsillitis._ Inflammation of the tonsils. The uncouth term Cynanche
has been used for diseases so dissimilar, that I have divided them into
Tonsillitis and Parotitis; and hope to be excused for adding a Greek
termination to a Latin word, as one of those languages may justly be
considered as a dialect of the other. By tonsillitis the inflammation of
the tonsils is principally to be understood; but as all inflammations
generally spread further than the part first affected; so, when the summit
of the windpipe is also much inflamed, it may be termed tonsillitis
trachealis, or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and when the
summit of the gullet is much inflamed along with the tonsil, it may be
called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus
X. p. 92. The inflammation of the tonsils may be divided into three kinds,
which require different methods of cure.
_Tonsillitis interna._ Inflammation of the internal tonsil. When the
swelling is so considerable as to produce difficulty of breathing, the size
of the tonsil should be diminished by cutting it with a proper lancet,
which may either give exit to the matter it contains, or may make it less
by discharging a part of the blood. This kind of angina is frequently
attended with irritated fever besides the sensitive one, which accompanies
all inflammation, and sometimes requires venesection. An emetic should be
given early in the disease, as by its inducing the retrograde action of the
vessels about the fauces during the nausea it occasions, it may eliminate
the very cause of the inflammation; which may have been taken up by the
absorbents, and still continue in the mouths of the lymphatics or their
glands. The patient should then be induced to swallow some aperient liquid,
an infusion of senna, so as to induce three or four evacuations. Gargles of
all kinds are rather hurtful, as the action of using them is liable to give
pain to the inflamed parts; but the patients find great relief from
frequently holding warm water in their mouths, and putting it out again, or
by syringing warm water into the mouth, as this acts like a warm bath or
fomentation to the inflamed part. Lastly, some mild stimulant, as a weak
solution of salt and water, or of white vitriol and water, may be used to
wash the fauces with in the decline of the disease, to expedite the
absorption of the new vessels, if necessary, as recommended in ophthalmy.
_Tonsillitis superficialis._ Inflammation of the surface of the tonsils. As
the tonsils and parts in their vicinity are covered with a membrane, which,
though exposed to currents of air, is nevertheless constantly kept moist by
mucus and saliva, and is liable to diseases of its surface like other
mucous membranes, as well as to suppuration of the internal substance of
the gland; the inflammation of its surface is succeeded by small elevated
pustules with matter in them, which soon disappears, and the parts either
readily heal, or ulcers covered with sloughs are left on the surface.
This disease is generally attended with only sensitive fever, and therefore
is of no danger, and may be distinguished with great certainty from the
dangerous inflammation or gangrene of the tonsils at the height of the
small-pox, or scarlet fever, by its not being attended with other symptoms
of those diseases. One emetic and a gentle cathartic is generally
sufficient; and the frequent swallowing of weak broth, or gruel, both
without salt in them, relieves the patient, and absolves the cure. When
these tumours of the tonsils frequently return I have sometimes suspected
them to originate from the absorption of putrid matter from decaying teeth.
See Class I. 2. 3. 21. and II. 2. 2. 1.
_Tonsillitis inirritata._ Inflammation of the tonsils with sensitive
inirritated fever is a symptom only of contagious fever, whether attended
with scarlet eruption, or with confluent small-pox, or otherwise. The
matter of contagion is generally diffused, not dissolved in the air; and as
this is breathed over the mucaginous surface of the tonsils, the contagious
atoms are liable to be arrested by the tonsil; which therefore becomes the
nest of the future disease, like the inflamed circle round the inoculated
puncture of the arm in supposititious small-pox. This swelling is liable to
suffocate the patient in small-pox, and to become gangrenous in scarlet
fever, and some other contagious fevers, which have been received in this
manner. The existence of inflammation of the tonsil previous to the scarlet
eruption, as the arm inflames in the inoculated small-pox, and suppurates
before the variolous eruption, should be a criterion of the scarlet fever
being taken in this manner.
M. M. All the means which strengthen the patient, as in the sensitive
inirritated fever, Class II. 1. 2. 1. As it is liable to continue a whole
lunation or more, great attention should be used to nourish the patient
with acidulous and vinous panada, broth with vegetables boiled in it,
sugar, cream, beer; all which given frequently will contribute much to
moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm
water and wine, or acid of lemon, should be frequently applied to the
tonsils by means of a syringe, or by means of a capillary syphon, as
described in Class II. 1. 3. 1. A slight solution of blue vitriol, as two
grains to an ounce, or a solution of sugar of lead of about six grains to
an ounce, may be of service; especially the latter, applied to the edges of
the sloughs, drop by drop by means of a small glass tube, or small
crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to
the end of either of which a drop will conveniently hang by capillary
attraction; as solutions of lead evidently impede the progress of
erysipelas on the exterior skin, when it is attended with feeble pulse. Yet
a solution of alum injected frequently by a syringe is perhaps to be
preferred, as it immediately removes the fetor of the breath, which must
much injure the patient by its being perpetually received into the lungs by
respiration.
4. _Parotitis._ Mumps, or branks, is a contagious inflammation of the
parotis and maxillary glands, and has generally been classed under the word
Cynanche or Angina, to which it bears no analogy. It divides itself into
two kinds, which differ in the degree of fever which attends them, and in
the method of cure.
_Parotitis suppurans._ The suppurating mumps is to be distinguished by the
acuteness of the pain, and the sensitive, irritated, or inflammatory fever,
which attends it.
M. M. Venesection. Cathartic with calomel three or four grains repeatedly.
Cool air, diluents. This antiphlogistic treatment is to be continued no
longer than is necessary to relieve the violence of the pain, as the
disease is attended with contagion, and must run through a certain time,
like other fevers with contagion.
_Parotitis mutabilis._ Mutable parotitis. A sensitive fever only, or a
sensitive irritated fever, generally attends this kind. And when the tumor
of the parotis and maxillary glands subsides, a new swelling occurs in some
distant part of the system; as happens to the hands and feet, at the
commencement of the secondary fever of the small-pox, when the tumor of the
face subsides. This new swelling in the parotitis mutabilis is liable to
affect the testes in men, and form a painful tumor, which should be
prevented from suppuration by very cautious means, if the violence of the
pain threaten such a termination; as by bathing the part with coldish water
for a time, venesection, a cathartic; or by a blister on the perinaeum, or
scrotum, or a poultice.
When women are affected with this complaint, after the swelling of the
parotis and maxillary glands subsides, a tumor with pain is liable to
affect their breasts; which, however, I have never seen terminate in
suppuration.
On the retrocession of the tumor of the testes above described, and I
suppose of that of the breasts in women, a delirium of the calm kind is
very liable to occur; which in some cases has been the first symptom which
has alarmed the friends of the patient; and it has thence been difficult to
discover the cause of it without much inquiry; the previous symptoms having
been so slight as not to have occasioned any complaints. In this delirium,
if the pulse will bear it, venesection should be used, and three or four
grains of calomel, with fomentation of the head with warm water for an hour
together every three or four hours.
Though this disease generally terminates favourably, considering the
numbers attacked by it, when it is epidemic, yet it is dangerous at other
times in every part of its progress. Sometimes the parotis or maxillary
glands suppurate, producing ulcers which are difficult to cure, and
frequently destroy the patient, where there was a previous scrophulous
tendency. The testis in men is also liable to suppurate with great pain,
long confinement, and much danger; and lastly the affection of the brain is
fatal to many.
Mr. W. W. had a swelled throat, which after a few days subsided. He became
delirious or stupid, in which state he was dying when I saw him; and his
friends ascribed his death to a coup de soleil, which he was said to have
received some months before, when he was abroad.
Mr. A. B. had a swelling of the throat, which after a few days subsided.
When I saw him he had great stupor, with slow breathing, and partial
delirium. On fomenting his head with warm water for an hour these symptoms
of stupor were greatly lessened, and his oppressed breathing gradually
ceased, and he recovered in one day.
Mr. C. D. I found walking about the house in a calm delirium without
stupor; and not without much inquiry of his friends could get the previous
history of the disease; which had been attended with parotitis, and swelled
testis, previous to the delirium. A few ounces of blood were taken away, a
gentle cathartic was directed, and his head fomented with warm water for an
hour, with a small blister on the back, and he recovered in two or three
days.
Mr. D. D. came down from London in the coach alone, so that no previous
history could be obtained. He was walking about the house in a calm
delirium, but could give no sensible answers to any thing which was
proposed to him. His pulse was weak and quick. Cordials, a blister, the
bark, were in vain exhibited, and he died in two or three days.
Mr. F. F. came from London in the same manner in the coach. He was mildly
delirious with considerable stupor, and moderate pulse, and could give no
account of himself. He continued in a kind of cataleptic stupor, so that he
would remain for hours in any posture he was placed, either in his chair,
or in bed; and did not attempt to speak for about a fortnight; and then
gradually recovered. These two last cases are not related as being
certainly owing to parotitis, but as they might probably have that origin.
The parotitis suppurans, or mumps with irritated fever, is at times
epidemic among cats, and may be called _parotitis felina_; as I have reason
to believe from the swellings under the jaws, which frequently suppurate,
and are very fatal to those animals. In the village of Haywood, in
Staffordshire, I remember a whole breed of Persian cats, with long white
hair, was destroyed by this malady, along with almost all the common cats
of the neighbourhood; and as the parotitis or mumps had not long before
prevailed amongst human beings in that part of the country, I recollect
being inclined to believe, that the cats received the infection from
mankind; though in all other contagious diseases, except the rabies canina
can be so called, no different genera of animals naturally communicate
infection to each other; and I am informed, that vain efforts have been
made to communicate the small-pox and measles to some quadrupeds by
inoculation. A disease of the head and neck destroyed almost all the cats
in Westphalia. Savage, Nosol. Class X. Art. 30. 8.
5. _Catarrhus sensitivus_ consists of an inflammation of the membrane,
which lines the nostrils and fauces. It is attended with sensitive fever
alone, and is cured by the steam of warm water externally, and by diluents
internally, with moderate venesection and gentle cathartics. This may be
termed catarrhus sensitivus, to distinguish it from the catarrhus
contagiosus, and is in common language called a violent cold in the head;
it differs from the catarrhus calidus, or warm catarrh, of Class I. 1. 2.
7. in the production of new vessels, or inflammation of the membrane, and
the consequent more purulent appearance of the discharge.
Raucedo catarrhalis, or catarrhal hoarseness, is a frequent symptom of this
disease, and is occasioned by the pain or soreness which attends the
thickened and inflamed membranes of the larynx; which prevents the muscles
of vocallity from sufficiently contracting the aperture of it. It ceases
with the inflammation, or may be relieved by the steam of warm water alone,
or of water and vinegar, or of water and ether. See Paralytic Hoarseness,
Class III. 2. 1. 4.
6. _Catarrhus contagiosus._ This malady attacks so many at the same time,
and spreads gradually over so great an extent of country, that there can be
no doubt but that it is disseminated by the atmosphere. In the year 1782
the sun was for many weeks obscured by a dry fog, and appeared red as
through a common mist. The material, which thus rendered the air muddy,
probably caused the epidemic catarrh, which prevailed in that year, and
which began far in the north, and extended itself over all Europe. See
Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294,
note; and was supposed to have been thrown out of a volcano, which much
displaced the country of Iceland.
In many instances there was reason to believe, that this disease became
contagious, as well as epidemic; that is, that one person might receive it
from another, as well as by the general unsalutary influence of the
atmosphere. This is difficult to comprehend, but may be conceived by
considering the increase of contagious matter in the small-pox. In that
disease one particle of contagious matter stimulates the skin of the arm in
inoculation into morbid action so as to produce a thousand particles
similar to itself; the same thing occurs in catarrh, a few deleterious
atoms stimulate the mucous membrane of the nostrils into morbid actions,
which produce a thousand other particles similar to themselves. These
contagious particles diffused in the air must have consisted of animal
matter, otherwise how could an animal body by being stimulated by them
produce similar particles? Could they then have had a volcanic origin, or
must they not rather have been blown from putrid marshes full of animal
matter? But the greatest part of the solid earth has been made from animal
and vegetable recrements, which may be dispersed by volcanos.--Future
discoveries must answer these questions.
As the sensitive fever attending these epidemic catarrhs is seldom either
much irritated or inirritated, venesection is not always either clearly
indicated or forbid; but as those who have died of these catarrhs have
generally had inflamed livers, with consequent suppuration in them,
venesection is adviseable, wherever the cough and fever are greater than
common, so as to render the use of the lancet in the least dubious. And in
some cases a second bleeding was necessary, and a mild cathartic or two
with four grains of calomel; with mucilaginous subacid diluents; and warm
steam occasionally to alleviate the cough, finished the cure.
The catarrhus contagiosus is a frequent disease amongst horses and dogs; it
seems first to be disseminated amongst these animals by miasmata diffused
in the atmosphere, because so many of them receive it at the same time; and
afterwards to be communicable from one horse or dog to another by
contagion, as above described. These epidemic or contagious catarrhs more
frequently occur amongst dogs and horses than amongst men; which is
probably owing to the greater extension and sensibility of the mucous
membrane, which covers the organ of smell, and is diffused over their wide
nostrils, and their large maxillary and frontal cavities. And to this
circumstance may be ascribed the greater fatality of it to these animals.
In respect to horses, I suspect the fever at the beginning to be of the
sensitive, irritated, or inflammatory kind, because there is so great a
discharge of purulent mucus; and that therefore they will bear once
bleeding early in the disease; and also one mild purgative, consisting of
about half an ounce of aloe, and as much white hard soap, mixed together.
They should be turned out to grass both day and night for the benefit of
pure air, unless the weather be too cold (and in that case they should be
kept in an open airy stable, without being tied), that they may hang down
their heads to facilitate the discharge of the mucus from their nostrils.
Grass should be offered them, or other fresh vegetables, as carrots and
potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or
cold water frequently in a day. When symptoms of debility appear, which may
be known by the coldness of the ears or other extremities, or when sloughs
can be seen on the membrane which lines the nostrils, a drink consisting of
a pint of ale with half an ounce of tincture of opium in it, given every
six hours, is likely to be of great utility.
In dogs I believe the catarrh is generally joined with symptoms of debility
early in the disease. These animals should be permitted to go about in the
open air, and should have constant access to fresh water. The use of being
as much as may be in the air is evident, because all the air which they
breathe passes twice over the putrid sloughs of the mortified parts of the
membrane which lines the nostrils, and the maxillary and frontal cavities;
that is, both during inspiration and expiration; and must therefore be
loaded with contagious particles. Fresh new milk, and fresh broth, should
be given them very frequently, and they should be suffered to go amongst
the grass, which they sometimes eat for the purpose of an emetic; and if
possible should have access to a running stream of water. As the contagious
mucus of the nostrils, both of these animals and of horses, generally drops
into the water they attempt to drink. Bits of raw flesh, if the dog will
eat them, are preferred to cooked meat; and from five to ten drops of
tincture of opium may be given with advantage, when symptoms of debility
are evident, according to the size of the dog, every six hours. If sloughs
can be seen in the nostrils, they should be moistened twice a day, both in
horses and dogs, with a solution of sugar of lead, or of alum, by means of
a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be
made by dissolving half an ounce of sugar of lead in a pint of water.
Ancient philosophers seem to have believed, that the contagious miasmata in
their warm climates affected horses and dogs previous to mankind. If those
contagious particles were supposed to be diffused amongst the heavy
inflammable air, or carbonated hydrogen, of putrid marshes, as these
animals hold their heads down lower to the ground, they may be supposed to
have received them sooner than men. And though men and quadrupeds might
receive a disease from the same source of marsh-putrefaction, they might
not afterwards be able to infect each other, though they might infect other
animals of the same genus; as the new contagious matter generated in their
own bodies might not be precisely similar to that received; as happened in
the jail-fever at Oxford, where those who took the contagion and died, did
not infect others.
On mules and dogs the infection first began,
And, last, the vengeful arrows fix'd on man.
POPE'S Homer's Iliad, I.
7. _Peripneumonia superficialis._ The superficial or spurious peripneumony
consists in an inflammation of the membrane, which lines the bronchia, and
bears the same analogy to the true peripneumony, as the inflammations of
other membranes do to that of the parenchyma, or substantial parts of the
viscus, which they surround. It affects elderly people, and frequently
occasions their death; and exists at the end of the true peripneumony, or
along with it; when the lancet has not been used sufficiently to cure by
reabsorbing the inflamed parts, or what is termed by resolution.
M. M. Diluents, mucilage, antimonials, warmish air constantly changed,
venesection once, perhaps twice, if the pulse will bear it. Oily volatile
draughts. Balsams? Neutral salts increase the tendency to cough. Blisters
in succession about the chest. Warm bath. Mild purgatives. Very weak
chicken broth without salt in it. Boiled onions. One grain of calomel every
night for a week. From five drops to ten of tincture of opium at six every
night, when the patient becomes weak. Digitalis? See Class II. 1. 6. 7.
8. _Pertussis._ Tussis convulsiva. Chin-cough resembles peripneumonia
superficialis in its consisting in an inflammation of the membrane which
lines the air-vessels of the lungs; but differs in the circumstance of its
being contagious; and is on that account of very long duration; as the
whole of the lungs are probably not infected at the same time, but the
contagious inflammation continues gradually to creep on the membrane. It
may in this respect be compared to the ulcers in the pulmonary consumption;
but it differs in this, that in chin-cough some branches of the bronchia
heal, as others become inflamed.
This complaint is not usually classed amongst febrile disorders, but a
sensitive fever may generally be perceived to attend it during some part of
the day, especially in weak patients. And a peripneumony very frequently
supervenes, and destroys great numbers of children, except the lancet or
four or six leeches be immediately and repeatedly used. When the child has
permanent difficulty of breathing, which continues between the coughing
fits: unless blood be taken from it, it dies in two, three, or four days of
the inflammation of the lungs. During this permanent difficulty of
breathing the hooping-cough abates, or quite ceases, and returns again
after once or twice bleeding; which is then a good symptom, as the child
now possessing the power to cough shews the difficulty of breathing to be
abated. I dwell longer upon this, because many lose their lives from the
difficulty there is in bleeding young children; where the apothecary is old
or clumsy, or is not furnished with a very sharp and fine-pointed lancet.
In this distressing situation the application of four leeches to one of the
child's legs, the wounds made by which should continue to bleed an hour or
two, is a succedaneum; and saves the patient, if repeated once or twice
according to the difficulty of the respiration.
The chin-cough seems to resemble the gonorrhoea venerea in several
circumstances. They are both received by infection, are both diseases of
the mucous membrane, are both generally cured in four or six weeks without
medicine. If ulcers in the cellular membrane under the mucous membrane
occur, they are of a phagedenic kind, and destroy the patient in both
diseases, if no medicine be administered.
Hence the cure should be similar in both these diseases; first general
evacuations and diluents, then, after a week or two, I have believed the
following pills of great advantage. The dose for a child of about three
years old was one sixth part of a grain of calomel, one sixth part of a
grain of opium, and two grains of rhubarb, to be taken twice a day.
The opium promotes absorption from the mucous membrane, and hence
contributes to heal it. The mercury prevents ulcers from being formed under
the mucous membrane, or cures them, as in the lues venerea; and the rhubarb
is necessary to keep the bowels open.
M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air.
Tincture of cantharides, or repeated blisters; afterwards opiates in small
doses, and the bark. Warm bath frequently used. The steam of warm water
with a little vinegar in it may be inhaled twice a day. Could the breathing
of carbonic acid gas mixed with atmospheric air be of service? Copious
venesection, when a difficulty of breathing continues between the fits of
coughing; otherwise the cough and the expectoration cease, and the patient
is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis
pulmonalis in a few weeks terminates in death. Where the cough continues
after some weeks without much of the hooping, and a sensitive fever daily
supervenes, so as to resemble hectic fever from ulcers of the lungs; change
of air for a week or fortnight acts as a charm, and restores the patient
beyond the hopes of the physician.
Young children should lie with their heads and shoulders raised; and should
be constantly watched day and night; that when the cough occurs, they may
be held up easily, so as to stand upon their feet bending a little
forwards; or nicely supported in that posture which they seem to put
themselves into. A bow of whalebone, about the size of the bow of a key, is
very useful to extract the phlegm out of the mouths of infants at the time
of their coughing; as an handkerchief, if applied at the time of their
quick inspirations after long holding their breath, is dangerous, and may
suffocate the patient in an instant, as I believe has sometimes happened.
9. _Variola discreta._ The small-pox is well divided by Sydenham into
distinct and confluent. The former consists of distinct pustules, which
appear on the fourth day of the fever, are circumscribed and turgid; the
fever ceasing when the eruption is complete. Head-ach, pain in the loins,
vomiting frequently, and convulsive fits sometimes, precede the eruption.
The distinct small-pox is attended with sensitive fever only, when very
mild, as in most inoculated patients; or with sensitive irritated fever,
when the disease is greater: the danger in this kind of small-pox is owing
either to the tumor and soreness of the throat about the height, or eighth
day of the eruption; or to the violence of the secondary fever. For, first,
as the natural disease is generally taken by particles of the dust of the
contagious matter dried and floating in the air, these are liable to be
arrested by the mucus about the throat and tonsils in their passage to the
lungs, or to the stomach, when they are previously mixed with saliva in the
mouth. Hence the throat inflames like the arm in inoculated patients; and
this increasing, as the disease advances, destroys the patient about the
height.
Secondly, all those upon the face and head come out about the same time,
namely, about one day before those on the hands, and two before those in
the trunk; and thence, when the head is very full, a danger arises from the
secondary fever, which is a purulent, not a variolous fever; for as the
matter from all these of the face and head is reabsorbed at the same time,
the patient is destroyed by the violence of this purulent fever; which in
the distinct small-pox can only be abated by venesection and cathartics;
but in the confluent small-pox requires cordials and opiates, as it is
attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10.
When the pustules on the face recede, the face swells; and when those of
the hands recede, the hands swell; and the same of the feet in succession.
These swellings seem to be owing to the absorption of variolous matter,
which by its stimulus excites the cutaneous vessels to secrete more lymph,
or serum, or mucus, exactly as happens by the stimulus of a blister. Now,
as a blister sometimes produces strangury many hours after it has risen; it
is plain, that a part of the cantharides is absorbed, and carried to the
neck of the bladder; whether it enters the circulation, or is carried
thither by retrograde movements of the urinary branch of lymphatics; and by
parity of reasoning the variolous matter is absorbed, and swells the face
and hands by its stimulus.
_Variola confluens._ The confluent small-pox consists of numerous pustules,
which appear on the third day of the fever, flow together, are irregularly
circumscribed, flaccid, and little elevated; the fever continuing after the
eruption is complete; convulsions do not precede this kind of small-pox,
and are so far to be esteemed a favourable symptom.
The confluent small-pox is attended with sensitive inirritated fever, or
inflammation with arterial debility; whence the danger of this disease is
owing to the general tendency to gangrene, with petechiae, or purple spots,
and haemorrhages; besides the two sources of danger from the tumor of the
throat about the height, or eleventh day of the eruption, and the purulent
fever after that time; which are generally much more to be dreaded in this
than in the distinct small-pox described above.
M. M. The method of treatment must vary with the degree and kind of fever.
Venesection may be used in the distinct small-pox early in the disease,
according to the strength or hardness of the pulse; and perhaps on the
first day of the confluent small-pox, and even of the plague, before the
sensorial power is exhausted by the violence of the arterial action? Cold
air, and even washing or bathing in cold water, is a powerful means in
perhaps all eruptive diseases attended with fever; as the quantity of
eruption depends on the quantity of the fever, and the activity of the
cutaneous vessels; which may be judged of by the heat produced on the skin;
and which latter is immediately abated by exposure to external cold.
Mercurial purges, as three grains of calomel repeated every day during the
eruptive fever, so as to induce three or four stools, contribute to abate
inflammation; and is believed by some to have a specific effect on the
variolous, as it is supposed to have on the venereal contagion.
It has been said, that opening the pock and taking out the matter has not
abated the secondary fever; but as I had conceived, that the pits, or marks
left after the small-pox, were owing to the acrimony of the matter beneath
the hard scabs, which not being able to exhale eroded the skin, and
produced ulcers, I directed the faces of two patients in the confluent
small-pox to be covered with cerate early in the disease, which was daily
renewed; and I was induced to think, that they had much less of the
secondary fever, and were so little marked, that one of them, who was a
young lady, almost entirely preserved her beauty. Perhaps mercurial
plasters, or cerates, made without turpentine in them, might have been more
efficacious, in preventing the marks, and especially if applied early in
the disease, even on the first day of the eruption, and renewed daily. For
it appears from the experiments of Van Woensel, that calomel or sublimate
corrosive, triturated with variolous matter, incapacitates it from giving
the disease by inoculation. Calomel or sublimate given as an alterative for
ten days before inoculation, and till the eruptive fever commences, is said
with certainty to render the disease mild by the same author. Exper. on
Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.
_Variola inoculata._ The world is much indebted to the great discoverer of
the good effects of inoculation, whose name is unknown; and our own country
to Lady Wortley Montague for its introduction into this part of Europe. By
inserting the variolous contagion into the arm, it is not received by the
tonsils, as generally happens, I suppose, in the natural small-pox; whence
there is no dangerous swelling of the throat, and as the pustules are
generally few and distinct, there is seldom any secondary fever; whence
those two sources of danger are precluded; hence when the throat in
inoculated small-pox is much inflamed and swelled, there is reason to
believe, that the disease had been previously taken by the tonsils in the
natural way.--Which also, I suppose, has generally happened, where the
confluent kind of small-pox has occurred on inoculation.
I have known two instances, and have heard of others, where the natural
small-pox began fourteen days after the contagion had been received; one of
these instances was of a countryman, who went to a market town many miles
from his home, where he saw a person in the small-pox, and on returning the
fever commenced that day fortnight: the other was of a child, whom the
ignorant mother carried to another child ill of the small-pox, on purpose
to communicate the disease to it; and the variolous fever began on the
fourteenth day from that time. So that in both these cases fever commenced
in half a lunation after the contagion was received. In the inoculated
small-pox the fever generally commences on the seventh day, or after a
quarter of a lunation; and on this circumstance probably depends the
greater mildness of the latter. The reason of which is difficult to
comprehend; but supposing the facts to be generally as above related, the
slower progress of the contagion indicates a greater inirritability of the
system, and in consequence a tendency to malignant rather than to
inflammatory fever. This difference of the time between the reception of
the infection and the fever in the natural and artificial small-pox may
nevertheless depend on its being inserted into a different series of
vessels; or to some unknown effect of lunar periods. It is a subject of
great curiosity, and deserves further investigation.
When the inoculated small-pox is given under all the most favourable
circumstances I believe less than one in a thousand miscarry, which may be
ascribed to some unavoidable accident, such as the patient having
previously received the infection, or being about to be ill of some other
disease. Those which have lately miscarried under inoculation, as far as
has come to my knowledge, have been chiefly children at the breast; for in
these the habit of living in the air has been confirmed by so short a time,
that it is much easier destroyed, than when these habits of life have been
established by more frequent repetition. See Sect. XVII. 3. Thus it appears
from the bills of mortality kept in the great cities of London, Paris, and
Vienna, that out of every thousand children above three hundred and fifty
die under two years old. (Kirkpatrick on Inoculation.) Whence a strong
reason against our hazarding inoculation before that age is passed,
especially in crowded towns; except where the vicinity of the natural
contagion renders it necessary, or the convenience of inoculating a whole
family at a time; as it then becomes better to venture the less favourable
circumstances of the age of the patient, or the chance of the pain from
toothing, than to risk the infection in the natural way.
The most favourable method consists in, first, for a week before
inoculation, restraining the patients from all kinds of fermented or
spirituous liquor, and from animal food; and by giving them from one grain
to three or four of calomel every other day for three times. But if the
patients be in any the least danger of taking the natural infection, the
inoculation had better be immediately performed, and this abstinence then
began; and two or three gentle purges with calomel should be given, one
immediately, and on alternate days. These cathartics should not induce more
than two or three stools. I have seen two instances of a confluent
small-pox in inoculation following a violent purging induced by too large a
dose of calomel.
Secondly, the matter used for inoculation should be in a small quantity,
and warm, and fluid. Hence it is best when it can be recently taken from a
patient in the disease; or otherwise it may be diluted with part of a drop
of warm water, since its fluidity is likely to occasion its immediate
absorption; and the wound should be made as small and superficial as
possible, as otherwise ulcers have been supposed sometimes to ensue with
subaxillary abscesses. Add to this, that the making two punctures either on
the same, or one on each arm, secures the success of the operation in
respect to communicating the infection.
Thirdly, at the time of the fever or eruption the application of cool air
to those parts of the skin, which are too warm, or appear red, or are
covered with what is termed a rash, should be used freely, as well as
during the whole disease. And at the same time, if the feet or hands are
colder than natural, these should be covered with flannel. See Class IV. 2.
2. 10.
10. _Rubeola irritata, morbilli._ The measles commence with sneezing, red
eyes, dry hoarse cough, and is attended with sensitive irritated fever. On
the fourth day, or a little later, small thick eruptions appear, scarcely
eminent above the skin, and, after three days, changing into very small
branny scales.
As the contagious material of the small-pox may be supposed to be diffused
in the air like a fine dry powder, and mixing with the saliva in the mouth
to infect the tonsils in its passage to the stomach; so the contagious
material of the measles may be supposed to be more completely dissolved in
the air, and thus to impart its poison to the membrane of the nostrils,
which covers the sense of smell; whence a catarrh with sneezing ushers in
the fever; the termination of the nasal duct of the lacrymal sac is subject
to the same stimulus and inflammation, and affects by sympathy the lacrymal
glands, occasioning a great flow of tears. See Sect. XVI. 8. And the
redness of the eye and eyelids is produced in consequence of the tears
being in so great quantity, that the saline part of them is not entirely
reabsorbed. See Sect. XXIV. 2. 8.
The contagion of the measles, if it be taken a sufficient time before
inoculation, so that the eruption may commence before the variolous fever
comes on, stops the progress of the small-pox in the inoculated wound, and
delays it till the measle-fever has finished its career. See Sect. XXXIII.
2. 9.
The measles are usually attended with inflammatory fever with strong pulse,
and bear the lancet in every stage of the disease. In the early periods of
it, venesection renders the fever and cough less; and, if any symptoms of
peripneumony occur, is repeatedly necessary; and at the decline of the
disease, if a cough be left after the eruption has ceased, and the
subsequent branny scales are falling off, venesection should be immediately
used; which prevents the danger of consumption. At this time also change of
air is of material consequence, and often removes the cough like a charm,
as mentioned in a similar situation at the end of the chin-cough.
_Rubeola inirritata._ Measles with inirritated fever, or with weak pulse,
has been spoken of by some writers. See London Med. Observ. Vol. IV. Art.
XI. It has also been said to have been attended with sore throat. Edinb.
Essays, Vol. V. Art. II. Could the scarlet fever have been mistaken for the
measles? or might one of them have succeeded the other, as in the measles
and small-pox mentioned in Sect. XXXIII. 2. 9.?
From what has been said, it is probable that inoculation might disarm the
measles as much as the small-pox, by preventing the catarrh, and frequent
pulmonary inflammation, which attends this disease; both of which are
probably the consequence of the immediate application of the contagious
miasmata to these membranes. Some attempts have been made, but a difficulty
seems to arise in giving the disease; the blood, I conjecture, would not
infect, nor the tears; perhaps the mucous discharge from the nostrils might
succeed; or a drop of warm water put on the eruptions, and scraped off
again with the edge of a lancet; or if the branny scales were collected,
and moistened with a little warm water? Further experiments on this subject
would be worthy the public attention.
11. _Scarlatina mitis._ The scarlet fever exists with all degrees of
virulence, from a flea-bite to the plague. The infectious material of this
disease, like that of the small-pox, I suppose to be diffused, not
dissolved, in the air; on which account I suspect, that it requires a much
nearer approach to the sick, for a well person to receive the infection,
than in the measles; the contagion of which I believe to be more volatile,
or diffusible in the atmosphere. But as the contagious miasmata of
small-pox and scarlet fever are supposed to be more fixed, they may remain
for a longer time in clothes or furniture; as a thread dipped in variolous
matter has given the disease by inoculation after having been exposed many
days to the air, and after having been kept many months in a phial. This
also accounts for the slow or sporadic progress of the scarlet fever, as it
infects others at but a very small distance from the sick; and does not
produce a quantity of pus-like matter, like the small-pox, which can adhere
to the clothes of the attendants, and when dried is liable to be shook off
in the form of powder, and thus propagate the infection.
This contagious powder of the small-pox, and of the scarlet fever, becomes
mixed with saliva in the mouth, and is thus carried to the tonsils, the
mucus of which arrests some particles of this deleterious material; while
other parts of it are carried into the stomach, and are probably decomposed
by the power of digestion; as seems to happen to the venom of the viper,
when taken into the stomach. Our perception of bad tastes in our mouths, at
the same time that we perceive disagreeable odours to our nostrils, when we
inhale very bad air, occasions us to spit out our saliva; and thus, in some
instances, to preserve ourselves from infection. This has been supposed to
originate from the sympathy between the organs of taste and smell; but any
one who goes into a sick room close shut up, or into a crowded
assembly-room, or tea-room, which is not sufficiently ventilated, may
easily mix the bad air with the saliva on his tongue so as to taste it; as
I have myself frequently attended to.
Hence it appears that these heavy infectious matters are more liable to mix
with the saliva, and inflame the tonsils, and that either before or at the
commencement of the fever; and this is what generally happens in the
scarlet fever, always I suppose in the malignant kind, and very frequently
in the mild kind. But as this infection may be taken by other means, as by
the skin, it also happens in the most mild kind, that there is no
inflammation of the tonsils at all; in the same manner as there is
generally no inflammation of the tonsils in the inoculated small-pox.
In the mild scarlatina on the fourth day of the fever the face swells a
little, at the same time a florid redness appears on various parts of the
skin, in large blotches, at length coalescing, and after three days
changing into branny scales.
M. M. Cool air. Fruit. Lemonade. Milk and water.
_Scarlatina maligna._ The malignant scarlet fever begins with inflamed
tonsils; which are succeeded by dark drab coloured sloughs three or five
lines in diameter, flat, or beneath the surrounding surface; and which
conceal beneath them spreading gangrenous ulcers. The swellings of the
tonsils are sensible to the eye and touch externally, and have an elastic
rather than an oedematous feel, like parts in the vicinity of gangrenes.
The pulse is very quick and weak, with delirium, and the patient generally
dies in a few days; or if he recovers, it is by slow degrees, and attended
with anasarca.
M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated
doses. Small successive blisters, if the extremities are cooler than
natural. Cool air on the hot parts of the skin, the cool extremities being
at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies.
Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the
contagious matter, and then with a sponge filled with vinegar, with or
without sugar of lead dissolved in it, about six grains to an ounce; or
with a very little blue vitriol dissolved in it, as a grain to an ounce;
but nothing so instantaneously corrects the putrid smell of ulcers as a
solution of alum; about half an ounce to a pint of water, which should be a
little warmish, and injected into the fauces gently by means of a syringe.
These should be repeated frequently in a day, if it can be done easily, and
without fatigue to the child. A little powder of bark taken frequently into
the mouth, as a grain or two, that it may mix with the saliva, and thus
frequently stimulate the dying tonsils. Could a warm bath made of decoction
of bark, or a cold fomentation with it, be of service? Could oxygene gas
mixed with common air stimulate the languid system? Small electric shocks
through the tonsils every hour? ether frequently applied externally to the
swelled tonsils?
As this disease is attended with the greatest degree of debility, and as
stimulant medicines, if given in quantity, so as to produce more than
natural warmth, contribute to expend the already too much exhausted
sensorial power; it appears, that there is nothing so necessary to be
nicely attended to, as to prevent any unnecessary motions of the system;
this is best accomplished by the application of cold to those parts of the
skin, which are in the least too hot. And secondly, that the exhibition of
the bark in such quantity, as not to oppress the stomach and injure
digestion, is next to be attended to, as not being liable to increase the
actions of the system beyond their natural quantity; and that opium and
wine should be given with the greatest caution, in very small repeated
quantity, and so managed as to prevent, if possible, the cold fits of
fever; which probably occur twice in 25 hours, obeying the lunations like
the tides, as mentioned in Sect. XXXII. 6. that is, I suppose, the cold
periods, and consequent exacerbations of fever, in this malignant
scarlatina, occur twice in a lunar day; which is about ten minutes less
than 25 hours; so that if the commencement of one cold fit be marked, the
commencement of the next may be expected, if not disturbed by the
exhibition of wine or opium, or the application of blisters, to occur in
about twelve hours and a half from the commencement of the former; or if
not prevented by large doses of the bark.
No one could do an act more beneficial to society, or glorious to himself,
than by teaching mankind how to inoculate this fatal disease; and thus to
deprive it of its malignity. Matter might be taken from the ulcers in the
throat, which would probably convey the contagion. Or warm water might be
put on the eruption, and scraped off again by the edge of a lancet. These
experiments could be attended with no danger, and should be tried for the
public benefit, and the honour of medical science.
12. _Miliaria._ Miliary fever. An eruption produced by the warmth, and more
particularly by the stimulus of the points of the wool in flannel or
blankets applied to the skin, has been frequently observed; which, by cool
dress, and bed-clothes without flannel, has soon ceased. See Class I. 1. 2.
3. This, which maybe called _miliaria sudatoria_, has been confounded with
other miliary fevers, and has made the existence of the latter doubted. Two
kinds of eruptions I have seen formerly attended with fever, but did not
sufficiently mark their progress, which I conceived to be miliary
eruptions, one with arterial strength, or with sensitive irritated fever,
and the other with arterial debility, or with sensitive inirritated fever.
In the former of these, or _miliaria irritata_, the eruptions were distinct
and larger than the small-pox, and the fever was not subdued without two or
three venesections, and repeated cathartics with calomel.
The latter, or _miliaria inirritata_, was attended with great arterial
debility; and during the course of the fever pellucid points appeared
within the skin, particularly on the soft parts of the fingers. And, in one
patient, whom I esteemed near her end, I well recollect to have observed
round pellucid globules, like what are often seen on vines in hot-houses,
no larger than the smallest pins' heads, adhere to her neck and bosom;
which were hard to the touch, but were easily rubbed off. These diseases,
if they are allied, do not differ more than the kinds of small-pox; but
require many further observations.
The eruption so often seen on children in the cradle, and called by the
nurses red-gum, and which is attended with some degree of fever, I suspect
to be produced by too great warmth, and the contact of flannel next their
tender skins, like the miliaria sudatoria; and like that requires cool air,
cool clothes, and linen next their skin.
13. _Pestis._ The plague, like other diseases of this class, seems to be
sometimes mild, and sometimes malignant; according to the testimony of
different writers. It is said to be attended with inflammation, with the
greatest arterial debility, and to be very contagious, attended at an
uncertain time of the fever with buboes and carbuncles. Some authors
affirm, that the contagion of the plague may be repeatedly received, so as
to produce the disease; but as this is contrary to the general analogy of
all contagious diseases, which are attended with fever, and which cure
themselves spontaneously; there is reason to suspect, that where it has
been supposed to have been repeatedly received, that some other fever with
arterial debility has been mistaken for it, as has probably universally
been the case, when the small-pox has been said to have been twice
experienced.