M. M. Venesection has been recommended by some writers on the first day,

where the inflammation was supposed to be attended with sufficient arterial

strength, which might perhaps sometimes happen, as the bubo seems to be a

suppuration; but the carbuncle, or anthrax, is a gangrene of the part, and

shews the greatest debility of circulation. Whence all the means before

enumerated in this genus of diseases to support the powers of life are to

be administered. Currents of cold air, cold water, ice, externally on the

hot parts of the skin.

The methods of preventing the spreading of this disease have been much

canvassed, and seem to consist in preventing all congregations of the

people, as in churches, or play-houses; and to remove the sick into tents

on some airy common by the side of a river, and supply them with fresh

food, both animal and vegetable, with beer and wine in proper quantities,

and to encourage those who can, daily to wash both their clothes and

themselves.

The _pestis vaccina_, or disease amongst the cows, which afflicted this

island about half a century ago, seems to have been a contagious fever with

great arterial debility; as in some of them in the latter stage of the

disease, an emphysema could often be felt in some parts, which evinced a

considerable progress of gangrene beneath the skin. In the sensitive

inirritated fevers of these animals, I suppose about sixty grains of opium,

with two ounces of extract of oak-bark, every six hours, would supply them

with an efficacious medicine; to which might be added thirty grains of

vitriol of iron, if any tendency to bloody urine should appear, to which

this animal is liable. The method of preventing the infection from

spreading, if it should ever again gain access to this island, would be

immediately to obtain an order from government to prevent any cattle from

being removed, which were found within five miles of the place supposed to

be infected, for a few days; till the certainty of the existence of the

pestilence could be ascertained, by a committee of medical people. As soon

as this was ascertained, all the cattle within five miles of the place

should be immediately slaughtered, and consumed within the circumscribed

district; and their hides put into lime-water before proper inspectors.

14. _Pemphigus_ is a contagious disease attended with bladdery eruptions

appearing on the second or third day, as large as filberts, which, remain

many days, and then effuse a thin ichor. It seems to be either of a mild

kind with sensitive fever only, of which I have seen two instances, or with

irritated, or with inirritated fever, as appears from the observations of

M. Salabert. See Medical Comment, by Dr. Duncan, Decad. II. Vol. VI.

15. _Varicella._ Chicken-pox is accompanied with sensitive fever, pustules

break out after a mild fever like the small-pox, seldom suppurate, and

generally terminate in scales without scars. I once saw a lady, who

miscarryed during this disease, though all her children had it as slightly

as usual. It sometimes leaves scars or marks on the skin. This disease has

been mistaken for the small-pox, and inoculated for it; and then the

small-pox has been supposed to happen twice to the same person. See Trans.

of the College London. It is probable that the pemphigus and urticaria, as

well as this disease, have formerly been diseases of more danger; which the

habit of innumerable generations may have rendered mild, and will in

process of time annihilate. In the same manner as the small-pox, venereal

disease, and rickets, seem to become milder or less in quantity every half

century. While at the same time it is not improbable, that other new

diseases may arise, and for a season thin mankind!

16. _Urticaria._ Nettle-rash begins with mild sensitive fever, which is

sometimes scarcely perceptible. Hence this eruption has been thought of two

sorts, one with and the other without fever. On the second day red spots,

like parts stung with nettles, are seen; which almost vanish during the

day, and recur in the evening with the fever, succeeded in a few days by

very minute scales. See Trans. of the College, London.

17. _Aphtha._ Thrush. It has been doubted, whether aphtha or thrush, which

consists of ulcers in the mouth, should be enumerated amongst febrile

diseases; and whether these ulcers are always symptomatic, or the

consequence rather than the cause of the fevers which attend them. The

tongue becomes rather swelled; its colour and that of the fauces purplish;

sloughs or ulcers appear first on the throat and edges of the tongue, and

at length over the whole mouth. These sloughs are whitish, sometimes

distinct, often coalescing, and remain an uncertain time. Cullen. I shall

concisely mention four cases of aphtha, but do not pretend to determine

whether they were all of them symptomatic or original diseases.

_Aphtha sensitiva._ A lady during pregnancy was frequently seized with

ulcers on her tongue and cheeks, or other parts of the mouth, without much

apparent fever; which continued two or three weeks, and returned almost

every month. The thrush in the mouths of young children seems to be a

similar disease. These ulcers resemble those produced in the sea-scurvy,

and have probably for their cause an increased action of the secerning

system from increased sensation, with a decreased action of the absorbent

system from decreased irritation. See Class I. 2. 1. 15.

M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently

into the mouth in very small quantity. See Class II. 1. 3. 1.

_Aphtha irritata._ Inflammatory aphtha. A case of this kind is related

under the title of suppurative rheumatism. Class IV. 1. 2. 16.

_Aphtha inirritata._ Sloughs or ulcers of the mouth, attended with

sensitive fever with great arterial debility. They seem to spread downwards

from the throat into the stomach, and probably through the whole intestinal

canal, beginning their course with cardialgia, and terminating it with

tenesmus; and might perhaps be called an erysipelas of this mucous

membrane.

M. M. Cool air. A small blister on the back. Bark. Wine. Opium in small

repeated quantities. Soap neutralizes the gastric acid without

effervescence, and thus relieves the pain of cardialgia, where the stomach

is affected. Milk also destroys a part of this acid. Infusion of sage

leaves two ounces, almond soap from five grains to ten, with sugar and

cream, is generally both agreeable and useful to these patients. See I. 2.

4. 5.

Where the stomach may be supposed to be excoriated by poisons containing

acid, as sublimate of mercury or arsenic; or if it be otherwise inflamed,

or very sensible to the stimulus of the gastric acid; or where it abounds

with acid of any kind, as in cardialgia; the exhibition of soap is perhaps

a preferable manner of giving alcali than any other, as it decomposes in

the stomach without effervescence; while the caustic alcali is too acrid to

be administered in such cases, and the mild alcali produces carbonic gas.

If a drop of acid of vitriol be put on cap paper, it will be long before it

destroys the paper; but if a drop of mild alcali be added, a sudden

effervescence arises, and the paper is instantly destroyed by the escape of

the fixed air; in the same manner as lumps of solid lime are broken into

powder by the escape of the steam produced from the water, which is poured

on them. This shews why a succession of acid and of alcaline caustics

sooner destroys a part, than either of them applied separately.

18. _Dysenteria._ Bloody-flux is attended with sensitive fever generally

with arterial debility; with frequent mucous or bloody stools; which

contain contagious matter produced by the membranes of the intestines; the

alimentary excrement being nevertheless retained; with griping pains and

tenesmus.

M. M. Emetics. Antimonials. Peruvian bark. Opium and calomel of each a

grain every night. Bolus armeniae. Earth of alum. Chalk. Calcined

hartshorn. Mucilage. Bee's wax mixt with yolk of egg. Cerated glass of

antimony. Warm bath. Flannel clothing next to the skin. Large clysters with

opium. With ipecacuanha, with smoke of tobacco? Two dysenteric patients in

the same ward of the infirmary at Edinburgh quarrelled, and whipped each

other with horsewhips a long time, and were both much better after it,

owing perhaps to the exertion of so much of the sensorial power of

volition; which, like real insanity, added excitement to the whole system.

The prevention of this contagion must consist principally in ventilation

and cleanliness; hence the patients should be removed into cottages distant

from each other, or into tents; and their faeces buried as soon as may be;

or conveyed into a running stream; and themselves should be washed with

cold or warm water after every evacuation. For the contagious matter

consists in the mucous or purulent discharge from the membrane which lines

the intestines; and not from the febrile perspiration, or breath of the

patients. For the fever is only the consequence and not the cause of

contagion; as appears from Genus the Fifth of this Order, where contagion

exists without fever.

19. _Gastritis superficialis._ Superficial inflammation of the stomach. An

erysipelatous inflammation of the stomach is mentioned by Dr. Cullen from

his own observations; which is distinguished from the inflammatory

gastritis by less pain, and fever, and by an erysipelatous redness about

the fauces. Does this disease belong to aphtha?

20. _Enteritis superficialis._ Superficial inflammation of the bowels is

also mentioned by Dr. Cullen from his own observation under the name of

enteritis erythematica; and is said to be attended with less pain and

fever, without vomiting, and with diarrhoea. May not this disease be

referred to aphtha, or to dysentery?

* * * * *

ORDO I.

_Increased Sensation._

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands,

without Fever._

Where inflammation is produced in a small part, which has not great natural

sensibility, the additional sensation does not produce an increased action

of the arterial system; that is, the associated motions which are employed

in the circulation of the blood, those for instance of the heart, arteries,

glands, capillaries, and their correspondent veins, are not thrown into

increased action by so small an addition of the sensorial power of

sensation. But when parts, which naturally possess more sensibility, become

inflamed, the quantity of the sensorial power of sensation becomes so much

increased, as to affect the associated motions belonging to the

circulation, occasioning them to proceed with greater frequency; that is, a

fever is induced. This is well exemplified in the internal and superficial

paronychia, one of which is attended with great pain and fever, and the

other with little pain and no fever. See Class II. 1. 2. 19. and II. 1. 4.

5.

From hence it appears, that the sensitive fever is an accidental

consequence of the topical phlegmon, or inflammation, and not a cause of

it; that it is often injurious, but never salutary; and should therefore

always be extinguished, as soon as may be, either by the lancet and

cathartics, and diluents, and cold air, when it is of the irritated kind;

or by the bark, opium, cool air, and nutrientia, when it is of the

inirritated kind.

SPECIES.

1. _Ophthalmia superficialis._ As the membranes, which cover the eye, are

excluded from the air about one third part of the twenty-four hours; and

are moistened by perpetual nictitation during the other sixteen; they may

be considered as internal membranes; and from the analogy of their

inflammation to that of other internal membranes, it is arranged under this

genus; whilst the tonsillitis is esteemed an inflammation of an external

membrane, because currents of air are perpetually passing both day and

night over the fauces.

The superficial ophthalmy has generally been esteemed a symptom of

scrophula, when it recurs frequently in young persons; but is probably only

a concomitant of that disease, as a symptom of general debility;

ramifications of new red vessels, and of enlarged old ones, are spread over

the white part of the eye; and it is attended with less heat, less pain,

and less intolerance of light than the ophthalmia interna, described in

Class II. 1. 2. 2. It occurs in those of feeble circulation, especially

children of a scrophulous tendency, and seems to arise from a previous

torpor of the vessels of the tunica albuginea from their being exposed to

cold air; and from this torpor being more liable to occur in habits, which

are naturally inirritable; and therefore more readily fall into quiescence

by a smaller deduction of the stimulus of heat, than would affect stronger

or more irritable habits; the consequence of this torpor is increased

action, which produces pain in the eye, and that induces inflammation by

the acquisition of the additional sensorial power of sensation.

_Ophthalmia lymphatica_ is a kind of anasarca of the tunica adnata; in this

the vessels over the sclerotica, or white part of the eye, rise

considerably above the cornea, which they surround, are less red than in

the ophthalmia superficialis, and appear to be swelled by an accumulation

of lymph rather than of blood; it is probably owing to the temporary

obstruction of a branch of the lymphatic system.

M. M. If the pain be great, venesection by leeches on the temple, or

cutting the temporal artery, and one purge with three or four grains of

calomel should be premised. Then the Peruvian bark twice a day. Opium from

a quarter to half a grain twice a day for some weeks. Bathe the eye

frequently with cold water alone, or with cold water, to a pint of which is

added half an ounce of salt. White vitriol six grains dissolved in one

ounce of water; a drop or two to be put between the eyelids twice a day.

Take very small electric sparks from the eyes every day for a fortnight.

Bathe the whole head with salt and water made warm every night for some

months. Send such children to a school near the sea for the convenience of

sea-bathing for many months annually; such schools are to be found in or

near Liverpool.

When a child is afflicted with an inflamed eye of this kind, he should

always sit with his back to the window or candle; but it is generally not

necessary to cover it, or if the uneasy sensation of light makes this

proper, the cover should stand off from the eye, so as not much to exclude

the cool air from it. As covering an eye unnecessarily is liable to make

that eye weaker than the other, from its not being sufficiently used, and

thence to produce a squinting for ever afterwards.

Nevertheless, when the pain is great, a poultice must be applied to keep

the eyes moist, or a piece of oiled silk bound lightly over them. Or thus,

boil an egg till it is hard, cut it longitudinally into two hemispheres,

take out the yolk, sew the backs of the two hollow hemispheres of the white

to a ribbon, and bind them over the eyes every night on going to bed;

which, if nicely fitted on, will keep the eyes moist without any

disagreeable pressure. See Class I. 1. 3. 14.

_Ophthalmia equina._ An inflammation of this kind is liable to affect the

eyes of horses; one cause of which is owing to a silly custom of cutting

the hair out of horses' ears; by which they are not only liable to take

cold at the ear, but grass seeds are liable to fall into their ears from

the high racks in stables; and in both cases the eye becomes inflamed by

sympathy. I once directed the temporal artery of a horse to be opened, who

had frequent returns of an inflamed eye; and I believed it was of essential

service to him; it is probable that the artery was afterwards contracted in

the wounded part, and that thence less blood was derived to the eye: the

haemorrhage was stopped by two persons alternately keeping their fingers on

the orifice, and afterwards by a long bandage of broad tape.

2. _Pterigion._ Eye-wing. A spot of inflammation sometimes begins on the

inside of the lower eyelid, or on the tunica albuginea, and spreads an

intertexture of red vessels from it, as from a center, which extend on the

white part of the eye, and have the appearance of the wing of a fly, from

whence its name.

M. M. Cut the ramifications of vessels again and again with the point of a

lancet close to the center of inflammation.

3. _Tarsitis palpebrarum._ Inflammation of the edges of the eyelids. This

is a disease of the glands, which produce the hairs of the eye-lashes, and

is frequently the cause of their falling off. After this inflammation a

hard scar-like ridge is left on the edge of the eyelid, which scratches and

inflames the eyeball, and becomes a very troublesome disease.

The Turkish ladies are said to colour the edge of the eyelash with crude

antimony in very fine powder, which not only gives lustre to the eye, as a

diamond set on a black soil, but may prevent extraneous light from being

reflected from these edges into the eye, and thus serve the purpose of the

black feathers about the eyes of swans, described in Sect. XXXIX. 5. 1. and

may also prevent the edges of the eyelids from being inflamed by the

frequent stimulus of tears on them. Black lead in fine powder might be

better for all these purposes than antimony, and might be put on with a

camel's hair brush.

M. M. Mercurial ointment smeared at night on the edges of the eyelids.

Burnt alum sixty grains, hog's grease half an ounce, well rubbed into an

ointment to be smeared on them in the night. Cold water frequently in the

day. See Class II. 1. 1. 8.

4. _Hordeolum._ Stye. This inflammation begins either on or near the edges

of the eyelids, or in the loose skin of them, and is sometimes very slow

either in coming to suppuration or in dispersing. The skin beneath the

lower eyelid is the most frequent seat of this tumor, which sometimes never

suppurates at all, but becomes an incysted tumor: for as this skin is very

loose for the purpose of admitting great motion to the eyelid, the

absorbent power of the veins seems particularly weak in this part; whence

when any person is weakened by fatigue or otherwise, a darker shade of

colour is seen beneath the eyes; which is owing to a less energetic action

of the absorbent terminations of the veins, whence the currents of dark or

venous blood are delayed in them. This dark shade beneath the eyes, when it

is permanent, is a symptom of habitual debility, or inirritability of the

circulating system. See Class I. 2. 2. 2.

M. M. Smear the tumors with mercurial ointment, moisten them frequently

with ether. To promote their suppuration they may be wounded with a lancet,

or slit down the middle, or they may be cut out. A caustic leaves a large

scar.

5. _Paronychia superficialis._ Whitlow. An inflammation about the roots of

the nail beneath the skin, which suppurates without fever, and sometimes

destroys the nail; which is however gradually reproduced. This kind of

abscess, though not itself dangerous, has given opportunity for the

inoculation of venereal matter in the hands of accoucheurs, and of putrid

matter from the dissection of diseased bodies; and has thus been the cause

of disease and death. When putrid matter has been thus absorbed from a dead

body, a livid line from the finger to the swelled gland in the axilla is

said to be visible; which shews the inflammation of the absorbent vessel

along its whole course to the lymphatic gland; and death has generally been

the consequence.

M. M. In the common paronychia a poultice is generally sufficient. In the

absorption of putrid matter rub the whole hand and arm with mercurial

ointment three or four times a day, or perpetually. Could the swelled

axillary gland be exsected? In the absorption of venereal matter the usual

methods of cure in syphilis must be administered, as in Class II. 1. 5. 2.

6. _Gutta rosea._ The rosy drop on the face is of three kinds. First, the

_gutta rosea hepatica_, or the red pimples on the faces of drunkards, which

are probably a kind of crisis, or vicarious inflammation, which succeeds,

or prevents, a torpor of the membranes of the liver. This and the

succeeding species properly belong to Class IV. 1. 2. 14.

Secondly, the pimpled face in consequence of drinking cold water, or eating

cold turnips, or other insipid food, when much heated with exercise; which

probably arises from the sympathy between the skin of the face and the

stomach; and may be called the _gutta rosea stomatica_. Which is

distinguished from the former by the habits of the patient in respect to

drinking; by the colour of the eruptions being less deep; and by the

patient continuing generally to be troubled with some degree of apepsia.

See Class I. 3. 1. 3. I knew a lady, who had long been afflicted with pain

about the region of the stomach; and, on drinking half a pint of vinegar,

as a medicine, she had a breaking out commenced on her face; which

remained, and she became free from the pain about the stomach. Was this a

stomachic, or an hepatic disease?

Thirdly, there is a red face, which consists of smaller pimples than those

above mentioned; and which is less liable to suppurate; and which seems to

be hereditary, or at least has no apparent cause like those above

mentioned; which may be termed _gutta rosea hereditaria_, or puncta rosea.

Mrs. S. had a pimpled face, which I believe arose from potation of ale. She

applied alum in a poultice to it, and had soon a paralytic stroke, which

disabled her on one side, and terminated in her death.

Mrs. L. had a red pimpled face, which seemed to have been derived from her

mother, who had probably acquired it by vinous potation; she applied a

quack remedy to it, which I believe was a solution of lead, and was seized

with epileptic fits, which terminated in palsy, and destroyed her. This

shews the danger of using white paint on the face, which is called bismuth,

but is in reality white lead or cerussa.

Mr. Y---- had acquired the gutta rosea on his nose, and applied a saturnine

solution on it for a few nights, and was then seized with paralysis on one

side of his face; which however he gradually recovered, and has since

acquired the gutta rosea on other parts of his face.

These fatal effects were probably caused by the disagreeable sensation of

an inflamed liver, which used before to be relieved of the sympathetic

action and consequent inflammation of the skin of the face, which was now

prevented by the stronger stimulus of the application of calx of lead. The

manner in which disagreeable sensations induce epilepsy and palsy is

treated of in Class III. In some cases where habitual discharges, or

eruptions, or ulcers are stopped, a torpor of the system may follow, owing

to the want of the accustomed quantity of sensation or irritation. See

Class I. 1. 2. 9. and II. 1. 5. 6. In both these situations some other

stimulus should be used to supply the place of that which is taken away;

which may either be perpetual, as an issue; or periodical, as a cathartic

repeated once a fortnight or month.

Miss W. an elegant young lady of about twenty, applied a mercurial lotion

to her face, which was covered with very small red points; which seemed to

have been not acquired by any known or avoidable means; she was seized with

inflammation of her liver, and after repeated bleeding and cathartics

recovered, and in a few weeks the eruption appeared as before.

M. M. Five grains of calomel once a month, with a cathartic, five grains of

rhubarb and a quarter of a grain of emetic tartar every night for many

weeks. With this preparation mercurial plasters, made without turpentine,

and applied every night, and taken off every morning, will sometimes

succeed, and may be used with safety. But blistering the face all over the

eruption, beginning with a part, succeeds better than any other means, as I

have more than once experienced.--Something like this is mentioned in the

Letters of Lady Mary Wortley Montague, who blistered her face with balsam

of Mecca.

Mrs. F. had for many years had a disagreeably looking eruption on her chin,

after a cathartic with calomel, she was advised to blister her whole chin;

on the healing of the blister a few eruptions again appeared, which ceased

on the application of a second blister. She took rhubarb five grains, and

emetic tartar a quarter of a grain every night for many weeks.

Miss L. a young lady about eighteen, had tried variety of advice for

pimples over the greatest part of her face in vain. She took the above

medicines internally, and blistered her face by degrees all over and became

quite beautiful. A spot or two now and then appeared, and on this account

she frequently slept with parts of her face covered with mercurial plaster,

made without turpentine, which was held on by a pasteboard mask, and taken

off in the mornings; if any part of the plaster adhered, a little butter or

oil destroyed the adhesion.

7. _Odontitis._ Inflammatory tooth-ach is occasioned by inflammation of the

membranes of the tooth, or a caries of the bone itself. The gum sometimes

suppurates, otherwise a swelling of the cheek succeeds by association, and

thus the violence of the pain in the membranes of the tooth is relieved,

and frequently cured; and when this happens the disease properly belongs to

Class IV. as it so far resembles the translations of morbid actions in the

gout and rheumatism.

At other times the tooth dies without caries, especially in people about

sixty years of age, or before; and then it stimulates its involving

membrane, like any other extraneous substance. The membrane then becomes

inflamed and thickened, occasioning some pain, and the tooth rises upwards

above the rest, and is gradually pushed out whole and undecayed; on its

rising up a pus-like mucus is seen discharged from the gum, which surrounds

it; and the gum seems to have left the tooth, as the fangs or roots of it

are in part naked.

M. M. Where the tooth is sound it can only be saved by evacuations by

venesection, and a cathartic; and after its operation two grains of opium,

a blister may also be used behind the ear, and ether applied to the cheek

externally. In slighter cases two grains of opium with or without as much

camphor may be held in the mouth, and suffered to dissolve near the

affected tooth, and be gradually swallowed. See Class I. 2. 4. 12.

Odontalgia may be distinguished from otitis by the application of cold

water to the affected tooth; for as the pain of common tooth-ach is owing

to torpor, whatever decreases stimulus adds to the torpor and consequent

pain; whereas the pain of an inflamed tooth being ceased by the increased

action of the membranes of it is in some measure alleviated by the

application of cold.

8. _Otitis._ Inflammation and consequent suppuration of some membranes of

the internal ear frequently occur in children, who sleep in cold rooms, or

near a cold wall, without a night-cap. If the bones are affected, they come

out in a long process of time, and the child remains deaf of that ear. But

in this case there is generally a fever attends this inflammation; and it

then belongs to another genus.

M. M. A warmer night-cap. Warmish water should be gently syringed into the

ear to keep it clean twice a day; and if it does not heal in a week, a

little spirit of wine should be added; first about a fourth part, and it

should be gradually increased to half rectified spirit and half water: if

it continues long to discharge matter with a very putrid smell, the bones

are injured, and will in time find their exit, during which time the ear

should be kept clean by filling it with a weaker mixture of spirit of wine

and water; or a solution of alum in water; which may be poured into the

ear, as the head is inclined, and shook out again by turning the head, two

or three times morning and evening. See Class II. 1. 4. 10.

9. _Fistula lacrymalis._ The lacrymal sack, with its puncta lacrymalia and

nasal duct, are liable to be destroyed by suppuration without fever; the

tears then run over the eyelids, and inflame the edges of them, and the

cheeks, by their perpetual moisture, and saline acrimony.

M. M. By a nice surgical operation a new aperture is to be made from the

internal corner of the eye into the nostril, and a silver tube introduced,

which supplies the defect by admitting the tears to pass again into the

nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has

improved this operation.

10. _Fistula in ano._ A mucous discharge from the anus, called by some

white piles, or matter from a suppurated pile, has been mistaken for the

matter from a concealed fistula. A bit of cotton wool applied to the

fundament to receive the matter, and renewed twice a day for a week or two,

should always be used before examination with the probe. The probe of an

unskilful empyric sometimes does more harm in the loose cellular membrane

of these parts than the original ulcer, by making a fistula he did not

find. The cure of a fistula in ano of those, who have been much addicted to

drinking spirituous liquor, or who have a tendency to pulmonary

consumption, is frequently of dangerous consequence, and is succeeded by

ulcers of the lungs, and death.

M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a

day; the pepper-corns should be cut each into two or three pieces. The late

Dr. Monro of Edinburgh asserted in his lectures, that he had known a

fistula in ano cured by injecting first a mixture of rectified spirit of

wine and water; and by gradually increasing the strength of it, till the

patient could bear rectified spirit alone; by the daily use of which at

length the sides of the fistula became callous, and ceased to discharge,

though the cavity was left. A French surgeon has lately affirmed, that a

wire of lead put in at the external opening of the ulcer, and brought

through the rectum, and twisted together, will gradually wear itself

through the gut, and thus effect a cure without much pain. The ends of the

leaden wire must be twisted more and more as it becomes loose. Or, lastly,

it must be laid open by the knife.

11. _Fistula urethrae._ Where a stricture of the urethra exists, from

whatever cause, the patient, in forcing the stream of urine through the

structure, distends the urethra behind it; which after a time is liable to

burst, and to become perforated; and some of the urine is pushed into the

cellular membrane, occasioning fistulas, which sometimes have large

surfaces producing much matter, which is pressed out at the time of making

water, and has been mistaken for a catarrh of the bladder; these fistulas

sometimes acquire an external opening in the perinaeum, and part of the

urine is discharged that way.

Can this matter be distinguished from mucus of the bladder by the criterion

delivered in Class II. 1. 6. 6?

M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The

latter may be had at No. 37, Red-lion street, Holborn, London. The former

are easily made, by moistening the catgut, and keeping it stretched till

dry, and then rounding one end with a pen-knife. The use of a warm bath

every day for near an hour, at the heat of 94 or 96 degrees, for two or

three months, I knew to be uncommonly successful in one case; the extensive

fistulas completely healing. The patient should introduce a bougie always

before he makes water, and endeavour to make it as slowly as possible. See

Class I. 2. 3. 24.

12. _Hepatitis chronica._ Chronical inflammation of the liver. A collection

of matter in the liver has frequently been found on dissection, which was

not suspected in the living subject. Though there may have been no certain

signs of such a collection of matter, owing to the insensibility of the

internal parts of this viscus; which has thus neither been attended with

pain, nor induced any fever; yet there may be in some cases reason to

suspect the existence of such an abscess; either from a sense of fulness in

the right hypochondre, or from transient pains sometimes felt there, or

from pain on pressure, or from lying on the left side, and sometimes from a

degree of sensitive fever attending it.

Dr. Saunders suspects the acute hepatitis to exist in the inflammation of

the hepatic artery, and the chronical one in that of the vena portarum.

Treatise on the Liver. Robinson. London.

13. _Scrophula suppurans._ Suppurating scrophula. The indolent tumors of

the lymphatic glands are liable, after a long time, to regain their

sensibility; and then, owing to their former torpor, an increased action of

the vessels, beyond what is natural, with inflammation, is the consequence

of their new life, and suppuration succeeds. This cure of scrophula

generally happens about puberty, when a new energy pervades the whole

system, and unfolds the glands and organs of reproduction.

M. M. See Class I. 2. 3. 21. Where scrophulous ulcers about the neck are

difficult to heal, Dr. Beddoes was informed, in Ireland, that an empyric

had had some success by inflaming them by an application of wood sorrel,

oxalis acetosella, the leaves of which are bruised in a mortar, and applied

on the ulcers for two or three days, and then some more lenient application

is used.

A poor boy, about twelve years old, had a large scrophulous ulcer on one

side of the chest beneath the clavicle, and another under his jaw; he was

directed, about three weeks ago, to procure a pound of dry oak-bark from

the tanners, and to reduce it to fine powder, and to add to it one ounce of

white lead in fine powder, and to cover the ulcers daily with it, keeping

it on by brown paper and a bandage. He came to me a few minutes ago, to

shew me that both the ulcers are quite healed. The constant application of

linen rags, moistened with a solution of an ounce of sugar of lead in a

pint of water, I think I have seen equally efficacious.

14. _Scorbutus suppurans._ In the sea-scurvy there exists an inactivity of

venous absorption, whence vibices and petechiae, and sometimes ulcers. As

the column of blood pressing on the of origins of the veins of the lower

extremities, when the body is erect, opposes the ascent of the blood in

them, they are more frequently liable to become enlarged, and to produce

varixes, or vibices, or, lastly, ulcers about the legs, than on the upper

parts of the body. The exposure to cold is believed to be another cause of

ulcers on the extremities; as happens to many of the poor in winter at

Lisbon, who sleep in the open air, without stockings, on the steps of their

churches or palaces. See Class I. 2. 1. 15.

M. M. A bandage spread with plaster to cover the whole limb tight. Rags

dipped in a solution of sugar of lead. A warm flannel stocking or roller.

White lead and oak bark, both in fine powder. Horizontal rest.

15. _Scirrhus suppurans._ When a scirrhus affects any gland of no great

extent or sensibility, it is, after a long period of time, liable to

suppurate without inducing fever, like the indolent tumors of the

conglobate or lymphatic glands above mentioned; whence collections of

matter are often found after death both in men and other animals; as in the

liver of swine, which have been fed with the grounds of fermented mixtures

in the distilleries. Another termination of scirrhus is in cancer, as

described below. See Class I. 2. 3. 22.

16. _Carcinoma._ Cancer. When a schirrous tumor regains its sensibility by

nature, or by any accidental hurt, new vessels shoot amongst the yet

insensible parts of it, and a new secretion takes place of a very injurious

material. This cancerous matter is absorbed, and induces swelling of the

neighbouring lymphatic glands; which also become schirrous, and afterwards

cancerous.

This cancerous matter does not seem to acquire its malignant or contagious

quality, till the cancer becomes an open ulcer; and the matter secreted in

it is thus exposed to the air. Then it evidently becomes contagious,

because it not only produces hectic fever, like common matter in ulcers

open to the air; but it also, as it becomes absorbed, swells the lymphatic

glands in its vicinity; as those of the axilla, when the open cancer is on

the breast. See Class II. 1. 3.

Hence exsection before the cancer is open is generally a cure; but after

the matter has been exposed to the air, it is seldom of service; as the

neighbouring lymphatic glands are already infected. I have observed some of

these patients after the operation to have had diseased livers, which might

either have previously existed, or have been produced by the fear or

anxiety attending the operation.

Erosion with arsenic, after the cancer is become an open ulcer, has

generally no better effect than exsection, but has been successful before

ulceration. The best manner of using arsenic, is by mixing one grain with a

dram of lapis calaminaris, and strewing on the cancer some of the powder

every day, till the whole is destroyed.

Cancers on the face are said to arise from the periosteum, and that unless

this be destroyed by the knife, or by caustics, the cancer certainly

recurs. After the cancer becomes an open ulcer of some extent, a purulent

fever supervenes, as from other open ulcers, and gradually destroys the

patient. See Class II. 1. 6. 13.

Two very interesting cases have been lately published by Dr. Ewart, of

Bath, in which carbonic acid gas, or fixed air, was kept constantly in

contact with the open cancerous ulcers of the breast; which then healed

like other common ulcers. This is rather to be ascribed to the exclusion of

oxygen, than to any specific virtue in the carbonic acid. As in common

ulcers the matter does not induce hectic fever, till it has been exposed to

the air, and then probably united with oxygen.

The manner of applying the fixed air, is by including the cancer in one

half or hemisphere of a large bladder; the edges are made to adhere to the

skin by adhesive plaster, or perhaps a mixture of one part of honey with

about twenty parts of carpenter's glue might better suit some tender skins.

The bladder is then kept constantly filled with carbonic acid gas, by means

of a pipe in the neck of it; and the matter let out at a small aperture

beneath.

17. _Arthrocele._ Swelling of the joints seems to have its remote cause in

the softness of the bones, for they could not swell unless they were

previously softened, see Class I. 2. 2. 14. The epiphyses, or ends of the

bones, being naturally of a looser texture, are most liable to this

disease, and perhaps the cartilages and capsular ligaments may also become

inflamed and swelled along with the heads of the bones. This malady is

liable to distort the fingers and knees, and is usually called gout or

rheumatism; the former of which is liable to disable the fingers by

chalk-stones, and thence to have somewhat a similar appearance. But the

arthrocele, or swelling of the joints, affects people who have not been

intemperate in the use of fermented or spirituous liquors; or who have not

previously had a regular gout in their feet; and in both these

circumstances differs from the gout. Nor does it accord with the

inflammatory rheumatism, as it is not attended with fever, and because the

tumors of the joints never entirely subside. The pain or sensibility, which

the bones acquire, when they are inflamed, may be owing to the new vessels,

which shoot in them in their soft state, as well as to the distention of

the old ones.

M. M. Half a grain of opium twice a day, gradually increased to a grain,

but not further, for many months. Thirty grains of powder of bark twice a

day for many months. Ten grains of bone-ashes, or calcined hartshorn, twice

a day, with decoction of madder? Soda phosphorata?

18. _Arthropuosis._ Joint-evil. This differs from the former, as that never

suppurates; these ulcers of the joints are generally esteemed to arise from

scrophula; but as scrophula is a disease of the lymphatic or absorbent

system, and this consists in the suppuration of the membranes, or glands,

or cartilages about the joints, there does not seem a sufficient analogy to

authorize their arrangement under the same name.

The white swelling of the knee, when it suppurates, comes under this

species, with variety of other ulcers attended with carious bones.

19. _Caries ossium._ A caries of the bones may be termed a suppuration of

them; it differs from the above, as it generally is occasioned by some

external injury, as in decaying teeth; or by venereal virus, as in nodes on

the tibia; or by other matter derived to the bone in malignant fevers; and

is not confined to the ends of them.

The separation of the dead bone from the living is a work of some time. See

Sect. XXXIII. 3. 1.

* * * * *

ORDO I.

_Increased Sensation._

GENUS V.

_With the Production of new Vessels by external Membranes or Glands,

without Fever._

The ulcers, or eruptions, which are formed on the external skin, or on the

mouth or throat, or on the air-cells of the lungs, or on the intestines,

all of which are more or less exposed to the contact of the atmospheric

air, which we breathe, and which in some proportion we swallow with our

food and saliva; or to the contact of the inflammable air, or hydrogen,

which is set at liberty by the putrefying aliment in the intestines, or by

putrefying matter in large abscesses; all of them produce contagious

matter; which, on being inoculated into the skin of another person, will

produce fever, or a similar disease.

In some cases even the matter formed beneath the skin becomes in some

degree contagious, at least so much so as to produce fever of the hectic or

malignant kind, as soon as it has pierced through the skin, and has thus

gained access to some kind of air; as the fresh puss of a common abscess;

or the putrid pus of an abscess, which has been long confined; or of

cancerous ulcers.

From this analogy there is reason to suspect, that the matter of all

contagious diseases, whether with or without fever, is not infectious till

it has acquired something from the air; which, by oxygenating the secreted

matter, may probably produce a new acid. And secondly, that in hectic fever

a part of the purulent matter is absorbed; or acts on the surface of the

ulcer; as variolous matter affects the inoculated part of the arm. And that

hectic fever is therefore caused by the matter of an open ulcer; and not by

the sensation in the ulcer independent of the aerated pus, which lies on

it. Which may account for the venereal matter from buboes not giving the

infection, according to the experiments of the late Mr. Hunter, and for

some other phenomena of contagion. See Variola discreta, Class II. 1. 3. 9.

SPECIES.

1. _Gonorrhoea venerea._ A pus-like contagious material discharged from the

urethra after impure cohabitation, with smarting or heat on making water;

which begins at the external extremity of the urethra, to which the

contagious matter is applied, and where it has access to the air.

M. M. In this state of the venereal disease once venesection, with mild

cathartics of senna and manna, with mucilage, as almond emulsion, and gum

arabic, taken for two or three weeks, absolve the cure. Is camphor of use

to relieve the ardor urinae? Do balsams increase or lessen the heat of

urine? Neutral salts certainly increase the smarting in making water, by

increasing the acrimony of the urine.

Can the discharge from the urethra be soon stopped by saturnine injections,

or mercurial ones, or with solution of blue vitriol, at first very dilute,

and gradually made stronger? And at the same time lest the syphilis, or

general disease, should supervene, the patient might take a quarter of a

grain of corrosive sublimate of mercury twice a day, as directed below?

2. _Syphilis._ Venereal disease. The contagion shews itself in ulcers on

the part first inoculated, as chancres; ulcers on the tonsils succeed, with

eruption on the skin, especially about the roots of the hair; afterwards on

other parts of the skin, terminating in dry scabs; and lastly, with pain

and swelling of the bones.

The corona veneris, or crown of Venus, consists of the eruptions at the

roots of the hair appearing most round the forehead; which is occasioned by

this part being more exposed to the air; which we observed, at the

beginning of this genus, either produces or increases the virulence of

contagious matter. But it is difficult to conceive from this history, why

the throat should be first affected; as it cannot be supposed, that the

disease is so often taken by the saliva, like the small-pox, though this

may sometimes occur, perhaps very often. The connection between the

genitals in men and the throat, is treated of in Class IV. 1. 2. 7.

Hydrophobia.

M. M. A quarter of a grain of corrosive sublimate of mercury, taken thrice

a day for five or six weeks, made into a pill with breadcrumbs, or

dissolved in a spoonful of brandy and water, is a very efficacious and

almost certain cure. When it does not succeed, it is owing either to the

drug being bad, or to its having precipitated from the brandy, or from its

being spoiled in the pill by long keeping. Opium contributes much to

expedite the cure both of the simple gonorrhoea, and of venereal ulcers, by

increasing absorption both from the mucous membrane, and from the surface

of ulcers.

3. _Lepra._ Leprosy. Leprosy of the Greeks. The skin is rough with white

branny scales, which are full of chinks; often moist beneath, and itching.

The scales on the head or arms of some drinking people are a disease of

this kind. The perspirable matter designed for the purpose of lubricating

the external skin is secreted in this disease in a too viscid state, owing

to the inflammation of the subcutaneous vessels; and, as the absorbents act

too strongly at the same time, a viscid mucus is left adhering to the

surface of the skin.

In the leprosy of the Jews, described in the thirteenth and fourteenth

chapters of Leviticus, the depression of the sore beneath the surface of

the skin, and the hairs in it becoming white, seem to have been the

principal circumstances, which the priest was directed to attend to for the

purpose of ascertaining the disease.

M. M. Essence of antimony from 20 drops to 100 twice or thrice a day, with

half a pint of decoction of elm-bark; or tincture of cantharides from 20 to

60 drops four times a day; or sublimate of mercury, with much diluting

fluid. Acid of vitriol? Perhaps the cure chiefly depends on much dilution

with water, from two to four pints a day, in which elm-bark, or pine-buds,

or juniper-tops, may be boiled. Bath or Buxton water drank in large

quantities. Warm bath. Oil-skin bound on the part to confine the

perspirable matter. Ointment of tar and suet; or poultice for two or three

days, and then cerate with lapis calaminaris. Diet of raisins and bread.

Abstinence from wine, beer, and all spirits.

4. _Elephantiasis._ Leprosy of the Arabs. A contagious disease; the skin is

thickened, wrinkled, rough, unctuous, destitute of hair, without any

sensation of touch in the extremities of the limbs; the face deformed with

tubercles; the voice hoarse, and with a nasal tone. Cullen.

5. _Framboesia._ Yaws is said to be contagious and hereditary. It

principally affects the negroes in the West Indies. Edinb. Essays, Vol. VI.

6. _Psora._ Itch. A contagious prurient eruption. There are two kinds of

itch, that which appears between the fingers, and under the joints of the

knees and elbows; and that which seldom is seen in these places, but all

over the other parts of the body. The latter is seldom thought to be the

itch, as it does not easily infect even a bedfellow, and resists the usual

means of cure by brimstone.

If the itch be cured too hastily by rubbing mercurial or arsenical

preparations over the whole body, or on too great a part of it, many bad

symptoms are produced; as weakness of digestion, with pale bloated

countenance, and tendency to dropsy. I have twice seen St. Vitus's dance

occur from the use of a mercurial girdle; and once a swelled liver. I have

also seen a swelled spleen and swelled legs from the external use of

arsenic in the cure of the itch. And very numerous and large phlegmons

commonly succeed the too hasty cure of it by other means.

There does not appear a strict analogy between the hasty cure of the itch,

and the retrocession of the pustles in the secondary fever of the

small-pox; because in that the absorption of the matter is evinced by the

swelling of the face and hands, as the pustles recede, as explained in

Class II. 1. 3. 9. Variola discreta. And a fever is produced by this

absorption; neither of which happen, when the pustles of the itch are

destroyed by mercury or arsenic.

Nor can these inconveniences, which occur on the too hasty cure of the

itch, be explained by those which follow the cure of some kinds of gutta

rosea, Class II. 1. 4. 6. as in those the eruptions on the face were an

associated disease with inflammation of the liver or stomach, which they

were accustomed to relieve; whereas the itch is not known to have had any

previous catenation with other diseases.

In the itch there exists not only great irritation in the production of the

pustles, but great sensation is caused by their acrimony afterwards;

insomuch that the pain of itching, without the interrupted smarting

occasioned by scratching, would be intolerable. This great excitement of

the two sensorial powers of irritation and sensation is so great, when the

pustles are diffused over the whole surface of the body, that a torpor

succeeds the sudden ceasing of it; which affects those parts of the system,

which were most catenated with the new motions of the skin, as the stomach,

whence indigestion and flatulency; or which are generally most liable to

fall into torpor, as the numerous glands, which form the liver. Whence the

diseases consequent to the hasty cure of the itch are diseases of debility,

as tumid viscera, oedematous swellings, and St. Vitus's dance, which is a

debility of association. In the same manner indigestion, with green

evacuations, are said to follow an injudicious application of cerussa to

stop too hastily the exsudation behind the ears of children, Class I. 1. 2.

9. And dropsies are liable to succeed the cure of old ulcers of the legs,

which have long stimulated the system.

M. M. The size of a large pea, of an ointment consisting of one part of

white precipitate of mercury to six parts of hogs' lard well triturated

together, to be rubbed on a part of the body every night, and washed off

with soap and water next morning, till every part is cleared; with lac

sulphuris twenty grains to be taken every morning inwardly. Warm saline

bath, with white vitriol in it. Flowers of sulphur mixed with thick gruel,

with hogs fat. With either of which the body may be smeared all over.

7. _Psora ebriorum._ Elderly people, who have been much addicted to

spirituous drinks, as beer, wine, or alcohol, are liable to an eruption all

over their bodies; which is attended with very afflicting itching, and

which they probably propagate from one part of their bodies to another with

their own nails by scratching themselves. I saw fatal effects in one such

patient, by a too extensive use of a solution of lead; the eruption

disappeared, he became dropsical, and died; I suppose from the too suddenly

ceasing of the great stimulus caused by the eruptions over the whole skin,

as in the preceding article.

M. M. The patient should gradually accustom himself to half his usual

quantity of vinous potation. The warm bath, with one pound of salt to every

three gallons. Mercurial ointments on small parts of the skin at a time. A

grain of opium at night instead of the usual potation of wine or beer.

8. _Herpes._ Herpes consists of gregarious spreading excoriations, which

are succeeded by branny scales or scabs. In this disease there appears to

be a deficient absorption of the subcutaneous mucus, as well as

inflammation and increased secretion of it. For the fluid not only

excoriates the parts in its vicinity by its acrimony, but is very saline to

the taste, as some of these patients have assured me; I believe this kind

of eruption, as well as the tinea, and perhaps all other cutaneous

eruption, is liable to be inoculated in other parts of the body by the

finger-nails of the patients in scratching themselves.

It is liable to affect the hands, and to return at distant periods; and is

probably a secondary disease, as well as the zona ignea, or shingles,

described below.

M. M. Poultice the eruption with bread and milk, or raw carrots grated, for

two or three whole days, to dilute or receive the discharged fluid, and

abate the inflammation; then cover the parts with fresh cerate mixed with

lapis calaminaris. On the parts not excoriated mercurial ointment, made of

one part of white calx of mercury and six of hogs' fat. Internally, after

venesection, gentle repeated cathartics. Lastly, the bark. Acid of vitriol.

Bolus Armeniae, or testacia. Antimonials. Decoction of interior bark of

elm.

9. _Zona ignea._ Shingles. This eruption has been thought a species of

herpes by some writers, and by others a species of erysipelas. Yellow or

livid vesicles appear, producing a corrosive ichor, which is sometimes

attended with a degree of fever. It is said to infest sometimes the thorax

and ribs, but its most general situation is on the small of the back, over

one kidney, extending forward over the course of one of the ureters.

There is reason to suspect, that this also is a secondary or sympathetic

disease, as well as the preceding one; but future observations are

required, before it can be removed to the fourth class, or diseases of

association. In three patients I have been induced to believe, that the

eruption on the loins was a translation of inflammation from the external

membrane of the kidney to the skin. They had, for a day or two before the

appearance of the eruption, complained of a dull pain on the region of one

kidney, but without vomiting; by which it was distinguished from nephritis

interna, or gravel; and without pain down the outside of the thigh, by

which it was distinguished from sciatica. In other situations the shingles

may sympathize with other internal membranes, as in a case published by Dr.

Russel (De Tabe Glandulari), where the retrocession of the shingles was

succeeded by a serious dyspnaea.

M. M. Venesection, if the pulse is strong. Calomel three or four grains,

very mild repeated cathartics. Poultice for a few days, then cerate of

lapis calaminaris, as in herpes. A grain of emetic tartar dissolved in a

pint of water, and taken so as to empty the stomach and intestines, is said

much to hasten the cure; compresses soaked in a saturnine solution are

recommended externally on the eruption; and cerate where there are

ulcerations. Desanet's Surgical Journal, Vol. II. p. 378. If this be a

vicarious disease, it should continue half a lunation; lest, on its

ceasing, the bad habits of motion of the primary disease should not have

been so perfectly dissevered, but that they may recur.

10. _Annulus repens._ Ring-worm. A prurient eruption formed in a circle,

affecting children, and would seem to be the work of insects, according to

the theory of Linnaeus, who ascribes the itch and dysentery to microscopic

animalcula. These animalcula are probably the effect, and not the cause, of

these eruptions; as they are to be seen in all putrescent animal fluids.

The annular propagation of the ring-worm, and its continuing to enlarge its

periphery, is well accounted for by the acrimony of the ichor or saline

fluid eroding the skin in its vicinity.

M. M. Cover the eruption daily with ink. With white mercurial ointment, as

described above in herpes. With solution of white vitriol ten grains to an

ounce. These metallic calces stimulate the absorbents into stronger action,

whence the fluid has its saline part reabsorbed, and that before it has

access to the air, which probably adds to its acrimony by oxygenating it,

and thus, producing a new acid.

11. _Tinea._ Scald head. This contagious eruption affects the roots of the

hair, and is generally most virulent around the edges of the hair on the

back part of the head; as the corona veneris appears most on the edges of

the hair on the forepart of the head; for in these parts the eruption about

the roots of the hair is most exposed to the external air, by which its

acrimony or noxious quality is increased.

The absorption of the matter thus oxygenated swells the lymphatics of the

neck by its stimulus, occasioning many little hard lumps beneath the seat

of the eruption; when this happens, the sooner it is cured the better, lest

the larger lymphatics of the neck should become affected.

M. M. The art of curing these eruptions consists, first, in abating the

inflammation, and consequent secretion of a noxious material. Secondly, to

prevent its access to the air, which so much increases its acrimony. And

thirdly, to promote the absorption of it, before it has been exposed to the

air; for these purposes venesection once, and gentle cathartics, which

promote absorption by emptying the blood-vessels. Next poultices and

fomentations, with warm water, abate inflammation by diluting the saline

acrimony of the secreted fluid, and abating the painful sensation.

Afterwards cerate joined with some metallic calx, as of zinc or lead, or

solution of lead, mercury, or copper, or iron, which may stimulate the

absorbent system into stronger action.

Cover the shaved head with tar and suet, and a bladder; this, by keeping

the air from the secreted fluid, much contributes to its mildness, and the

stimulus of the tar increases its absorption. See the three preceding

species of this genus.

12. _Crusta lactea._ Milk-crust is a milder disease than tinea, affecting

the face as well as the hairy scalp of very young children. It is not

infectious, nor liable to swell the lymphatics in its vicinity like the

tinea.

M. M. Cover the eruption with cerate made with lapis calaminaris, to be

renewed every day. Mix one grain of emetic tartar with forty grains of

chalk, and divide into eight papers, one to be taken twice a day, or with

magnesia alba, if stools are wanted. The child should be kept cool and much

in the air.

13. _Trichoma._ Plica polonica. A contagious disease, in which the hair is

said to become alive and bleed, forming inextricable knots or plaits of

great length, like the fabled head of Medusa, with intolerable pain, so as

to confine the sufferer on his bed for years.

* * * * *

ORDO I.

_Increased Sensation._

GENUS VI.

_With Fever consequent to the Production of new Vessels or Fluids._

SPECIES.

1. _Febris sensitiva._ Sensitive fever, when unmixed with either irritative

or inirritative fever, may be distinguished from either of them by the less

comparative diminution of muscular strength; or in other words, from its

being attended with less diminution of the sensorial power of irritation.

An example of unmixed sensitive fever may generally be taken from the

pulmonary consumption; in this disease patients are seen to walk about with

ease, and to do all the common offices of life for weeks, and even months,

with a pulse of 120 strokes in a minute; while in other fevers, whether

irritated or inirritated, with a pulse of this frequency, the patient

generally lies upon the bed, and exerts no muscular efforts without

difficulty.

The cause of this curious phenomenon is thus to be understood; in the

sensitive fever a new sensorial power, viz. that of sensation, is

superadded to that of irritation; which in other fevers alone carries on

the increased circulation. Whence the power of irritation is not much more

exhausted than in health; and those muscular motions, which are produced in

consequence of it, as those which are exerted in keeping the body upright

in walking, riding, and in the performance of many customary actions, are

little impaired. For an account of the irritated sensitive fever, see Class

II. 1. 2. 1.; for the inirritated sensitive fever, Class II. 1. 3. 1. IV.

2. 4. 11.

2. _Febris a pure clauso._ Fever from inclosed matter is generally of the

irritated sensitive kind, and continues for many weeks, and even months,

after the abscess is formed; but is distinguished from the fever from

aerated matter in open ulcers, because there are seldom any night-sweats,

or colliquative diarrhoea in this, as in the latter. The pulse is also

harder, and requires occasional venesection, and cathartics, to abate the

inflammatory fever; which is liable to increase again every three or four

days, till at length, unless the matter has an exit, it destroys the

patient. In this fever the matter, not having been exposed to the air, has

not acquired oxygenation; in which a new acid, or some other noxious

property, is produced; which acts like contagion on the constitution

inducing fever-fits, called hectic fever, which terminate with sweats or

diarrhoea; whereas the matter in the closed abscess is either not absorbed,

or does not so affect the circulation as to produce diurnal or hectic

fever-fits; but the stimulus of the abscess excites so much sensation as to

induce perpetual pyrexia, or inflammatory fever, without such marked

remissions. Nevertheless there sometimes is no fever produced, when the

matter is lodged in a part of little sensibility, as in the liver; yet a

white pus-like sediment in those cases exists I believe generally in the

urine, with occasional wandering pains about the region of the liver or

chest.

3. _Vomica._ An abscess in the lungs is sometimes produced after

peripneumony, the cough and shortness of breath continue in less degree,

with difficulty in lying on the well side, and with sensitive irritated

fever, as explained in the preceding article.

The occasional increase of fever, with hard pulse and sizy blood, in these

patients, is probably owing to the inflammation of the walls of the vomica;

as it is attended with difficulty of breathing, and requires venesection.

Mr. B----, a child about seven years old, lived about five weeks in this

situation, with a pulse from 150 to 170 in a minute, without sweats, or

diarrhoea, or sediment in his water, except mucus occasionally; and took

sufficient nourishment during the whole time. The blood taken was always

covered with a strong cupped size, and on his death three or four pints of

matter were found in one side of the chest; which had probably, but lately,

been effused from a vomica. This child was frequently induced to swing,

both in a reciprocating and in a rotatory swing, without any apparent

absorption of matter; in both these swings he expressed pleasure, and did

not appear to be vertiginous.

M. M. Repeated emetics. Digitalis? Perseverance in rotatory swinging. See

Class II. 1. 6. 7.

Mr. I. had laboured some months under a vomica after a peripneumony, he was

at length taken with a catarrh, which was in some degree endemic in March

1795, which occasioned him to sneeze much, during which a copious

haemorrhage from the lungs occurred, and he spit up at the same time half a

pint of very fetid matter, and recovered. Hence errhines may be

occasionally used with advantage.

4. _Empyema._ When the matter from an abscess in the lungs finds its way

into the cavity of the chest, it is called an empyema. A servant man, after

a violent peripneumony, was seized with symptoms of empyema, and it was

determined, after some time, to perform the operation; this was explained

to him, and the usual means were employed by his friends to encourage him,

"by advising him not to be afraid." By which good advice he conceived so

much fear, that he ran away early next morning, and returned in about a

week quite well. Did the great fear promote the absorption of the matter,

like the sickness occasioned by digitalis? Fear renders the external skin

pale; by this continued decrease of the action of the absorbents of the

skin might not those of the lungs be excited into greater activity? and

thus produce increased pulmonary absorption by reverse sympathy, as it

produces pale urine, and even stools, by direct sympathy?

M.M. Digitalis?

5. _Febris Mesenterica._ Fever from matter formed in the mesentery is

probably more frequent than is suspected. It commences with pain in the

bowels, with irritated sensitive fever; and continues many weeks, and even

months, requiring occasional venesection, and mild cathartics; till at

length the continuance of the pyrexia, or inflammatory fever, destroys the

patient. This is an affection of the lymphatic glands, and properly belongs

to scrophula; but as the matter is not exposed to the air, no hectic fever,

properly so called, is induced.

6. _Febris a pure aerato._ Fever from aerated matter. A great collection of

matter often continues a long time, and is sometimes totally absorbed, even

from venereal buboes, without producing any disorder in the arterial

system. At length, if it becomes putrid by its delay, and one part of the

matter thus becomes aerated by the air given out by the other part; or if

the ulcer has been opened, so that any part of it has been exposed to the

air for but one day, a hectic fever is produced. Whence the utility arises

of opening large abscesses by setons, as in that case little or no hectic

fever is induced; because the matter is squeezed out by the side of the

spongy threads of cotton, and little or no air is admitted; or by tapping

the abscess with a trocar, as mentioned in ischias, Class II. 1. 2. 18.

In this fever the pulse is about 120 in a minute, and its access is

generally in an evening, and sometimes about noon also, with sweats or

purging towards morning, or urine with pus-like sediment; and the patients

bear this fever better than any other with so quick a pulse; and lastly,

when all the matter from a concealed ulcer is absorbed, or when an open

ulcer is healed, the hectic fever ceases. Here the absorbed matter is

supposed to produce the fever, and the diarrhoea, sweats, or copious muddy

urine, to be simply the consequence of increased secretion, and not to

consist of the purulent matter, which was supposed to be absorbed from the

ulcer. See Sudor calidus, Class I. 1. 2. 3.

The action of the air on ulcers, as we have already shewn, increases the

acrimony of the purulent matter, and even converts it into a weaker kind of

contagious matter; that is, to a material inducing fever. This was ascribed

to the union of the azotic part of the atmosphere with the effused pus in

Sect. XXVIII. 2. but by contemplating more numerous facts and analogies, I

am now induced to believe, that it is by the union of oxygen with it;

first, because oxygen so greedily unites with other animal substances, as

the blood, that it will pass through a moist bladder to combine with it,

according to the experiment of Dr. Priestley. Secondly, because the poisons

of venomous creatures are supposed to be acids of different kinds, and are

probably formed by the contact of air after their secretion. And lastly,

because the contagious matter from other ulcers, as in itch, or small-pox,

are formed on external membranes, and are probably combinations of animal

matter and oxygen, producing other new acids; but further experiments must

determine this question.

It was thought a subject of consequence by the Aesculapian Society at

Edinburgh, to find a criterion which should distinguish pus from mucus, for

the purpose of more certainly discovering the presence of ulcers in

pulmonary diseases, or in the urinary passages. For this purpose that

society offered their first gold medal, which was conferred on the late Mr.

Charles Darwin, in the year 1778, for his experiments on this subject. From

which he deduces the following conclusions:

"1. Pus and mucus are both soluble in the vitriolic acid, though in

very different proportions, pus being much the less soluble.

2. The addition of water to either of these compounds decomposes it;

the mucus thus separated, either swims on the mixture, or forms large

flocci in it; whereas the pus falls to the bottom, and forms on

agitation a uniform turbid mixture.

3. Pus is diffusible through a diluted vitriolic acid, though mucus is

not; the same occurs with water, or a solution of sea salt.

4. Nitrous acid dissolves both pus and mucus; water added to the

solution of pus produces a precipitate; and the fluid above becomes

clear and green; while water and the solution of mucus form a dirty

coloured fluid.

5. Alkaline lixivium dissolves (though sometimes with difficulty)

mucus, and generally pus.

6. Water precipitates pus from such a solution, but does not mucus.

7. Where alkaline lixivium does not dissolve pus, it still

distinguishes it from mucus; as it then prevents its diffusion through

water.

8. Coagulable lymph is neither soluble in diluted nor concentrated

vitriolic acid.

9. Water produces no change on a solution of serum in alkaline

lixivium, until after long standing, and then only a very slight

sediment appears.

10. Corrosive sublimate coagulates mucus, but does not pus.

From the above experiments it appears, that strong vitriolic acid and

water, diluted vitriolic acid, and caustic alkaline lixivium and water

will serve to distinguish pus from mucus; that the vitriolic acid can

separate it from coagulable lymph, and alkaline lixivium from serum.

And hence, when a person has any expectorated material, the composition

of which he wishes to ascertain, let him dissolve it in vitriolic acid,

and in caustic alkaline lixivium; and then add pure water to both

solutions: and if there is a fair precipitation in each, he may be

assured that some pus is present. If in neither a precipitation occurs,

it is a certain test, that the material is entirely mucus. If the

material cannot be made to dissolve in alkaline lixivium by time and

trituration, we have also reason to believe that it is pus."

Experiments on Pus and Mucus. Cadell. London.

7. _Phthisis pulmonalis._ In pulmonary consumption the fever is generally

supposed to be the consequence of the stimulus of absorbed matter

circulating in the blood-vessels, and not simply of its stimulus on their

extremities in the surface of the ulcers; as mentioned in Class II. 1. 5.

and Class II. 1. 3. 9. The ulcers are probably sometimes occasioned by the

putrid acrimony of effused blood remaining in the air-cells of the lungs

after an haemoptoe. See Class I. 2. 1. 9. The remote cause of consumption

is ingeniously ascribed by Dr. Beddoes to the hyper-oxygenation of the

blood, as mentioned Section XXVIII. 2.

As the patients liable to consumption are of the inirritable temperament,

as appears by the large pupils of their eyes; there is reason to believe,

that the haemoptoe is immediately occasioned by the deficient absorption of

the blood at the extremities of the bronchial vein; and that one difficulty

of healing the ulcers is occasioned by the deficient absorption of the

fluids effused into them. See Sect. XXX. 1. and 2.

The difficulty of healing pulmonary ulcers may be owing, as its remote

cause, to the incessant motion of all the parts of the lungs; whence no

scab, or indurated mucus, can be formed so as to adhere on them. Whence

these naked ulcers are perpetually exposed to the action of the air on

their surfaces, converting their mild purulent matter into a contagious

ichor; which not only prevents them from healing, but by its action on

their circumferences, like the matter of itch or tinea, contributes to

spread them wider. See the preceding article, and Sect. XXXIII. 2. 7. where

the pulmonary phthisis is supposed to be infectious.

This acidifying principle is found in all the metallic calces, as in lapis

calaminaris, which is a calciform ore of zinc; and in cerussa, which is a

calx of lead; two materials which are powerful in healing excoriations, and

ulcers, in a short time by their external application. How then does it

happen, that the oxygen in the atmosphere should prevent pulmonary ulcers

from healing, and even induce them to spread wider; and yet in its

combination with metals, it should facilitate their healing? The healing of

ulcers consists in promoting the absorption of the fluids effused into

them, as treated of in Section XXXIII. 3. 2. Oxygen in combination with

metals, when applied in certain quantity, produces this effect by its

stimulus; and the metallic oxydes not being decomposed by their contact

with animal matter, no new acid, or contagious material, is produced. So

that the combined oxygen, when applied to an ulcer, simply I suppose

promotes absorption in it, like the application of other materials of the

articles sorbentia or incitantia, if applied externally; as opium, bark,

alum. But in the pulmonary ulcers, which cannot protect themselves from the

air by forming a scab, the uncombined oxygen of the atmosphere unites with

the purulent matter, converting it into a contagious ichor; which by

infection, not by erosion, enlarges the ulcers, as in the itch or tinea;

which might hence, according to Dr. Beddoes's ingenious theory of

consumption, be induced to heal, if exposed to an atmosphere deprived of a

part of its oxygen. This I hope future experiments will confirm, and that

the pneumatic medicine will alleviate the evils of mankind in many other,

as well as in this most fatal malady.

M. M. First, the respiration of air lowered by an additional quantity of

azote, or mixed with some proportion of hydrogen, or of carbonic acid air,

may be tried; as described in a late publication of Dr. Beddoes on the

medicinal use of factitious airs. Johnson, London. Or lastly, by breathing

a mixture of one tenth part of hydro-carbonate mixed with common air,

according to the discovery of Mr. Watt, which has a double advantage in

these cases, of diluting the oxygen of the atmospheric air, and inducing

sickness, which increases pulmonary absorption, as mentioned below. An

atmosphere diluted with fixed air (carbonic acid) might be readily procured

by setting tubs of new wort, or fermenting beer, in the parlour and

lodging-room of the patient. For it is not acids floating in the air, but

the oxygen or acidifying principle, which injures or enlarges pulmonary

ulcers by combining with the purulent matter.

Another easy method of adding carbonic acid gas to the air of a room, would

be by means of an apparatus invented by Mr. Watt, and sold by Bolton and

Watt at Birmingham, as described in Dr. Beddoes' Treatise on Pneumatic

Medicine. Johnson, London. It consists of an iron pot, with an arm

projecting, and a method of letting water drop by slow degrees on chalk,

which is to be put into the iron pot, and exposed to a moderate degree of

heat over a common fire. By occasionally adding more and more chalk,

carbonic acid gas might be carried through a tin pipe from the arm of the

iron pot to any part of the room near the patient, or from an adjoining

room. In the same manner a diffusion of solution of flowers of zinc might

be produced and breathed by the patient, and would be likely much to

contribute to the healing of pulmonary ulcers; as observed by Mr. Watt. See

the treatise above mentioned.

Breathing over the vapour of caustic volatile alkali might easily be

managed for many hours in a day; which might neutralize the acid poison

formed on pulmonary ulcers by the contact of oxygen, and thus prevent its

deleterious quality, as other acids become less caustic, when they are

formed into neutral salts with alkalis. The volatile salt should be put

into a tin canister, with two pipes like horns from the top of it, one to

suck the air from, and the other to admit it.

[Illustration]

Secondly, the external ulcers in scrophulous habits are pale and flabby,

and naturally disinclined to heal, the deposition of fluids in them being

greater than the absorption; these ulcers have their appearance immediately

changed by the external application of metallic calxes, and the medicines

of the article Sorbentia, such as cerussa and the bark in fine powder, see

Class I. 2. 3. 21. and are generally healed in a short time by these means.

Induced by these observations, I wished to try the external application of

such powders to ulcers in the lungs, and constructed a box with a

circulating brush in it, as described in the annexed plate; into this box

two ounces of fine powder of Peruvian bark were put, and two drams of

cerussa in fine powder; on whirling the central brush, part of this was

raised into a cloud of powder, and the patient, applying his mouth to one

of the tin pipes rising out of the box, inhaled this powder twice a day

into his lungs. I observed it did not produce any cough or uneasiness. This

patient was in the last stage of consumption, and was soon tired of the

experiment, nor have I had such patients as I wished for the repetition of

it. Perhaps a fine powder of manganese, or of the flowers of zinc, or of

lapis calaminaris, might be thus applied to ulcers of the lungs with

greater advantage? Perhaps air impregnated with flowers of zinc in their

most comminuted state, might be a better way of applying this powder to the

lungs, as discovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine.

Johnson.

Thirdly, as the healing of an ulcer consists in producing a tendency to

absorption on its surface greater than the deposition on it; see Sect.

XXXIII. 3. 2. other modes of increasing pulmonary absorption, which are

perhaps more manageable than the preceding ones, may be had recourse to;

such as by producing frequent nausea or sickness. See Sect. XXIX. 5. 1. and

Art. IV. 2. The great and sudden absorption of fluid from the lungs in the

anasarca pulmonum by the sickness induced by the exhibition of digitalis,

astonishes those who have not before attended to it, by emptying the

swelled limbs, and removing the difficulty of breathing in a few hours.

The most manageable method of using digitalis is by making a saturated

tincture of it, by infusing two ounces of the powder of the leaves in a

mixture of four ounces of rectified spirit of wine, and four ounces of

water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are

to be taken twice in the morning part of the day, and to be so managed as

not to induce violent sickness. If sickness nevertheless comes on, the

patient must for a day or two omit the medicine; and then begin it again in

reduced doses.

Mr. ----, a young man about twenty, with dark eyes, and large pupils, who

had every symptom of pulmonary ulcers, I believed to have been cured by

digitalis, and published the case in the Transactions of the College, Vol.

III. But about two years afterwards I heard that he relapsed and died. Mr.

L----, a corpulent man, who had for some weeks laboured under a cough with

great expectoration, with quick pulse, and difficulty of breathing, soon

recovered by the use of digitalis taken twice a day; and though this case

might probably be a peripneumonia notha, or catarrh, it is here related as

shewing the power of pulmonary absorption excited by the use of this drug.

Another method of inducing sickness, and pulmonary absorption in

consequence, is by sailing on the sea; by which many consumptive patients

have been said to have received their cure; which has been erroneously

ascribed to sea-air, instead of sea-sickness; whence many have been sent to

breathe the sea-air on the coasts, who might have done better in higher

situations, where the air probably contains less oxygen gas, which is the

heaviest part of it. See a Letter from Dr. T. C. below.

A third method of inducing sickness, and consequent pulmonary absorption,

is by the vertigo occasioned by swinging; which has lately been introduced

into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed

that by swinging the hectic pulse became slower, which is explained in

Class IV. 2. 1. 10. The usual way of reciprocating swinging, like the

oscillations of a pendulum, produces a degree of vertigo in those, who are

unused to it; but to give it greater effect, the patient should be placed

in a chair suspended from the ceiling by two parallel cords in contact with

each other, the chair should then be forcibly revolved 20 or 40 times one

way, and suffered to return spontaneously; which induces a degree of

sickness in most adult people, and is well worthy an exact and pertinacious

trial, for an hour or two, three or four times a day for a month.

The common means of promoting absorption in ulcers, and of thickening the

matter in consequence, by taking the bark and opium internally, or by

metallic salts, as of mercury, steel, zinc, and copper, in small

quantities, have been repeatedly used in pulmonary consumption; and may

have relieved some of the symptoms. As mercury cures venereal ulcers, and

as pulmonary ulcers resemble them in their not having a disposition to

heal, and in their tendency to enlarge themselves, there were hopes, from

analogy, that it might have succeeded. Would a solution of gold in aqua

regia be worth trying? When vinegar is applied to the lips, it renders them

instantly pale, by promoting the venous absorption; if the whole skin was

moistened with warmish vinegar, would this promote venous absorption in the

lungs by their sympathy with the skin? The very abstemious diet on milk and

vegetables alone is frequently injurious. Flesh-meat once a day, with small

wine and water, or small beer, is preferable. Half a grain of opium twice a

day, or a grain, I believe to be of great use at the commencement of the

disease, as appears from the subsequent case.

Miss ----, a delicate young lady, of a consumptive family, when she was

about eighteen, had frequent cough, with quick pulse, a pain of her side,

and the general appearances of a beginning consumption. She took about five

drops of laudanum twice a day in a saline draught, which was increased

gradually to ten. In a few weeks she recovered, was afterwards married,

bore three or four children, and then became consumptive and died.

The following case of hereditary consumption is related by a physician of

great ability and very extensive practice; and, as it is his own case,

abounds with much nice observation and useful knowledge; and, as it has

been attended with a favourable event, may give consolation to many, who

are in a similar situation; and shews that Sydenham's recommendation of

riding as a cure for consumption is not so totally ineffectual, as is now

commonly believed.

"J. C. aged 27, with black hair, and a ruddy complexion, was subject to

cough from the age of puberty, and occasionally to spitting of blood.

His maternal grandfather died of consumption under thirty years of age,

and his mother fell a victim to this disease, with which she had long

been threatened, in her 43d year, and immediately after she ceased to

have children. In the severe winter of 1783-4, he was much afflicted

with cough; and being exposed to intense cold, in the month of February

he was seized with peripneumony. The disease was violent and dangerous,

and after repeated bleedings as well as blisterings, which he supported

with difficulty, in about six weeks he was able to leave his bed. At

this time the cough was severe, and the expectoration difficult. A

fixed pain remained on the left side, where an issue was inserted;

regular hectic came on every day about an hour after noon, and every

night heat and restlessness took place, succeeded towards morning by

general perspiration.

The patient, having formerly been subject to ague, was struck with the

resemblance of the febrile paroxysm, with what he had experienced under

that disease, and was willing to flatter himself it might be of the

same nature. He therefore took bark in the interval of fever, but with

an increase of his cough, and this requiring venesection, the blood was

found highly inflammatory. The vast quantity of blood which he had lost

from time to time, produced a disposition to fainting, when he resumed

the upright posture, and he was therefore obliged to remain almost

constantly in a recumbent position. Attempting to ride out in a

carriage, he was surprised to find that he could sit upright for a

considerable time, while in motion, without inconvenience, though, on

stopping the carriage, the disposition to fainting returned.

At this time, having prolonged his ride beyond the usual length, he one

day got into an uneven road at the usual period of the recurrence of

the hectic paroxysms, and that day he missed it altogether. This

circumstance led him to ride out daily in a carriage at the time the

febrile accession might be expected, and sometimes by this means it was

prevented, sometimes deferred, and almost always mitigated.

This experience determined him to undertake a journey of some length,

and Bristol being, as is usual in such cases, recommended, he set out

on the 19th of April, and arrived there on the 2d of May. During the

greater part of this journey (of 175 miles) his cough was severe, and

being obliged to be bled three different times on the road, he was no

longer able to sit upright, but at very short intervals, and was

obliged to lie at length in the diagonal of a coach. The hectic

paroxysms were not interrupted during the journey, but they were

irregular and indistinct, and the salutary effects of exercise, or

rather of gestation, were impressed on the patient's mind.

At Bristol he stayed a month, but reaped no benefit. The weather was

dry and the roads dusty; the water insipid and inert. He attempted to

ride on horseback on the downs, but was not able to bear the fatigue

for a distance of more than a hundred yards. The necessity of frequent

bleedings kept down his strength, and his hectic paroxysms continued,

though less severe. At this time, suspecting that his cough was

irritated by the west-winds bearing the vapour from the sea, he

resolved to try the effects of an inland situation, and set off for

Matlock in Derbyshire.

During the journey he did not find the improvement he expected, but the

nightly perspirations began to diminish; and the extraordinary fatigue

he experienced proceeded evidently from his travelling in a

post-chaise, where he could not indulge in a recumbent position. The

weather at Bristol had been hot, and the earth arid and dusty. At

Matlock, during the month of June 1784, there was almost a perpetual

drizzle, the soil was wet, and the air moist and cold. Here, however,

the patient's cough began to abate, and at intervals he found an

opportunity of riding more or less on horseback. From two or three

hundred yards at a time, he got to ride a mile without stopping; and at

length he was able to sit on horseback during a ride from Mason's Bath

to the village of Matlock along the Derwent, and round on the opposite

banks, by the works of Mr. Arkwright, back to the house whence he

started, a distance of five miles. On dismounting, however, he was

seized with diliquium, and soon after the strength he had recovered was

lost by an attack of the haemorrhoids of the most painful kind, and

requiring much loss of blood from the parts affected.

On reflection, it appeared that the only benefit received by the

patient was during motion, and continued motion could better be

obtained in the course of a journey than during his residence at any

particular place. This, and other circumstances of a private but

painful nature, determined him to set out from Matlock on a journey to

Scotland. The weather was now much improved, and during the journey he

recruited his strength. Though as yet he could not sit upright at rest

for half an hour together without a disposition to giddiness, dimness

of sight, and deliquium, he was able to sit upright under the motion of

a post-chaise during a journey of from 40 to 70 miles daily, and his

appetite began to improve. Still his cough continued, and his hectic

flushings, though the chills were much abated and very irregular.

The salutary effects of motion being now more striking than ever, he

purchased a horse admirably adapted to a valetudinarian in

Dumfriesshire, and being now able to sit on horseback for an hour

together, he rode out several times a day. He fixed his residence for a

few weeks at Moffat, a village at the foot of the mountains whence the

Tweed, the Clyde, and the Annan, descend in different directions; a

situation inland, dry, and healthy, and elevated about three hundred

feet above the surface of the sea. Here his strength recovered daily,

and he began to eat animal food, which for several months before he had

not tasted. Persevering in exercise on horseback, he gradually

increased the length of his rides, according to his strength, from four

to twenty miles a day; and returning on horseback to Lancashire by the

lakes of Cumberland, he arrived at Liverpool on the first of September,

having rode the last day of his journey forty miles.

The two inferences of most importance to be drawn from this narrative,

are, first, the extraordinary benefit derived from gestation in a

carriage, and still more the mixture of gestation and exercise on

horseback, in arresting or mitigating the hectic paroxysm; and

secondly, that in the florid consumption, as Dr. Beddoes terms it, an

elevated and inland air is in certain circumstances peculiarly

salutary; while an atmosphere loaded with the spray of the sea is

irritating and noxious. The benefit derived in this case from exercise

on horseback, may lead us to doubt whether Sydenham's praise of this

remedy be as much exaggerated as it has of late been supposed. Since

the publication of Dr. C. Smyth on the effects of swinging in lowering

the pulse in the hectic paroxysm, the subject of this narrative has

repeated his experiments in a great variety of cases, and has confirmed

them. He has also repeatedly seen the hectic paroxysm prevented, or cut

short, by external ablution of the naked body with tepid water.

So much was his power of digestion impaired or vitiated by the immense

evacuations, and the long continued debility he underwent, that after

the cough was removed, and indeed for several years after the period

mentioned, he never could eat animal food without heat and flushing,

with frequent pulse and extreme drowsiness. If this drowsiness was

encouraged, the fever ran high, and he awoke from disturbed sleep,

wearied and depressed. If it was resolutely resisted by gentle

exercise, it went off in about an hour, as well as the increased

frequency of the pulse. This agitation was however such as to

incapacitate him during the afternoon for study of any kind. The same

effects did not follow a meal of milk and vegetables, but under this

diet his strength did not recruit; whereas after the use of animal food

it recovered rapidly, notwithstanding the inconvenience already

mentioned. For this inconvenience he at last found a remedy in the use

of coffee immediately after dinner, recommended to him by his friend

Dr. Percival. At first this remedy operated like a charm, but by

frequent use, and indeed by abuse, it no longer possesses its original

efficacy.

Dr. Falconer, in his Dissertation on the Influence of the Passions and

Affections of the Mind on Health and Disease, supposes that the

cheerfulness which attends hectic fever, the ever-springing hope, which

brightens the gloom of the consumptive patient, increases the diseased

actions, and hastens his doom. And hence he is led to enquire, whether

the influence of fear might not be substituted in such cases to that of

hope with advantage to the patient? This question I shall not presume

to answer, but it leads me to say something of the state of the mind in

the case just related.

The patient, being a physician, was not ignorant of his danger, which,

some melancholy circumstances served to impress on his mind. It has

already been mentioned, that his mother and grandfather died of this

disease. It may be added, that in the year preceding that on which he

himself was attacked, a sister of his was carried off by consumption in

her 17th year; that in the same winter in which he fell ill, two other

sisters were seized with the same fatal disorder, to which one of them

fell a victim during his residence at Bristol, and that the hope of

bidding a last adieu to the other was the immediate cause of his

journey to Scotland, a hope which, alas! was indulged in vain. The day

on which he reached the end of his journey, her remains were committed

to the dust! It may be conjectured from these circumstances, that

whatever benefit may be derived from the apprehension of death, must in

this case have been obtained. The expectation of this issue was indeed

for some time so fixed that it ceased to produce much agitation; in

conformity to that general law of our nature, by which almost all men

submit with composure to a fate that is foreseen, and that appears

inevitable. As however the progress of disease and debility seemed to

be arrested, the hope and the love of life revived, and produced, from

time to time, the observations and the exertions already mentioned.

Wine and beer were rigorously abstained from during six months of the

above history; and all the blood which was taken was even to the last

buffy." Feb. 3, 1795.

8. _Febris scrophulosa._ The hectic fever occasioned by ulcers of the

lymphatic glands, when exposed to the air, does not differ from that

attending pulmonary consumption, being accompanied with night-sweats and

occasional diarrhoea.

M. M. The bark. Opium internally. Externally cerussa and bark in fine

powder. Bandage. Sea-bathing. See Class I. 2. 3. 21. and II. 1. 4. 13.

9. _Febris ischiadica._ A hectic fever from an open ulcer between the

muscles of the pelvis, which differs not from the preceding. If the matter

in this situation lodges till part of it, I suppose, becomes putrid, and

aerates the other part; or till it becomes absorbed from some other

circumstance; a similar hectic fever is produced, with night-sweats, or

diarrhoea.

Mrs. ----, after a lying in, had pain on one side of her loins, which

extended to the internal part of the thigh on the same side. No fluctuation

of matter could be felt; she became hectic with copious night-sweats, and

occasional diarrhoea, for four or five weeks; and recovered by, I suppose,

the total absorption of the matter, and the reunion of the walls of the

abscess. See Class II. 1. 2. 18.

10. _Febris Arthropuodica._ Fever from the matter of diseased joints. Does

the matter from suppurating bones, which generally has a very putrid smell,

produce hectic fever, or typhus? See Class II. 1. 4. 16.

11. _Febris a pure contagioso._ Fever from contagious pus. When the

contagious matters have been produced on the external habit, and in process

of time become absorbed, a fever is produced in consequence of this

reabsorption; which differs with the previous irritability or

inirritability, as well as with the sensibility of the patient.

12. _Febris variolosa secundaria._ Secondary fever of small-pox. In the

distinct small-pox the fever is of the sensitive irritated or inflammatory

kind; in the confluent small-pox it is of the sensitive inirritated kind,

or typhus gravior. In both of them the swelling of the face, when the

matter there begins to be absorbed, and of the hands, when the matter there

begins to be absorbed, shew, that it stimulates the capillary vessels or

glands, occasioning an increased secretion greater than the absorbents can

take up, like the action of the cantharides in a blister; now as the

application of a blister on the skin frequently occasions the strangury,

which shews, that some part of the cantharides is absorbed; there is reason

to conclude, that a part of the matter of small-pox is absorbed, and thus

produces the secondary fever. See Class II. 1. 3. 9. And not simply by its

stimulus on the surface of the ulcers beneath the scabs. The exsudation of

a yellow fluid from beneath the confluent eruptions on the face before the

height is spoken of in Class II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from

that of open ulcers, as it is only aerated through the elevated cuticle;

and secondly, because there is not a constant supply of fresh matter, when

that already in the pustules is exhausted, either by absorption, or by

evaporation, or by its induration into a scab. Might not the covering the

face assiduously and exactly with plasters, as with cerate of calamy, or

with minium plaster, by precluding the air from the pustules, prevent their

contracting a contagious, or acescent, or fever-producing power? and the

secondary fever be thus prevented entirely. If the matter in those pustules

on the face in the confluent small-pox were thus prevented from

oxygenation, it is highly probable, both from this theory, and from the

facts before mentioned, that the matter would not erode the skin beneath

them, and by these means no marks or scars would succeed.

13. _Febris carcinomatosa._ Fever from the matter of cancer. In a late

publication the pain is said to be relieved, and the fever cured, and the

cancer eradicated, by the application of carbonic acid gas, or fixed air.

See Class II. 1. 4. 16.

14. _Febris venerea._ From the absorption of the matter from venereal

ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. _Febris a sanie putrida._ Fever from putrid sanies. When parts of the

body are destroyed by external violence, as a bruise, or by mortification,

a putrefaction soon succeeds; as they are kept in that degree of warmth and

moisture by their adhesion to the living parts of the body, which most

forwards that process. Thus the sloughs of mortified parts of the tonsils

give fetor to the breath in some fevers; the matter from putrefying teeth,

or other suppurating bones, is particularly offensive; and even the scurf,

which adheres to the tongue, frequently acquires a bitter taste from its

incipient putridity. This material differs from those before mentioned, as

its deleterious property depends on a chemical rather than an animal

process.

16. _Febris puerpera._ Puerperal fever. It appears from some late

dissections, which have been published, of those women who have died of the

puerperal fever, that matter has been formed in the omentum, and found in

the cavity of the abdomen, with some blood or sanies. These parts are

supposed to have been injured by the exertions accompanying labour; and as

matter in this viscus may have been produced without much pain, this

disease is not attended with arterial strength and hard full pulse like the

inflammation of the uterus; and as the fever is of the inirritative or

typhus kind, there is reason to believe, that the previous exhaustion of

the patient during labour may contribute to its production; as well as the

absorption of a material not purulent but putrid; which is formed by the

delay of extravasated or dead matter produced by the bruises of the

omentum, or other viscera, in the efforts of parturition, rather than by

purulent matter, the consequence of suppuration. The pulse is generally

about 120 when in bed and in the morning; and is increased to 134, or more,

when the patient sits up, or in the evening paroxysm. The pulse of all very

weak patients increases in frequency when they sit up; because the

expenditure of sensorial power necessary to preserve an erect posture

deducts so much from their general strength; and hence the pulse becomes

weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very

large and repeated quantities of the bark, by preventing sufficient food

from being taken, as bread, and wine, and water, I have thought has much

injured the patient; for the bark is not here given as in intermittent

fevers to prevent the paroxysm, but simply to strengthen the patient by

increasing the power of digestion. About two ounces of decoction of bark,

with four drops of laudanum, and a dram of sweet spirit of vitriol, once in

six hours, and a glass of wine between those times, with panada, or other

food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air,

so as to sound on striking them with the fingers, the case is always

dangerous, generally hopeless; which is more so in proportion to the

quickness of the pulse. Where the bowels are distended two drops of oil of

cinnamon should be given in the panada three or four times a day.

17. _Febris a sphacelo._ Fever from mortification. This fever from

absorption of putrid matter is of the inirritative or typhus kind. See the

preceding article.

M. M. Opium and the bark are frequently given in too great quantity, so as

to induce consequent debility, and to oppress the power of digestion.

* * * * *

ORDO I.

_Increased Sensation._

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

1. _Delirium febrile._ Paraphrosyne. The ideas in delirium consist of those

excited by the sensation of pleasure or pain, which precedes them, and the

trains of other ideas associated with these, and not of those excited by

external irritations or by voluntary exertion. Hence the patients do not

know the room which they inhabit, or the people who surround them; nor have

they any voluntary exertion, where the delirium is complete; so that their

efforts in walking about a room or rising from their bed are unsteady, and

produced by their catenations with the immediate affections of pleasure or

pain. See Section XXXIII. 1. 4.

By the above circumstances it is distinguished from madness, in which the

patients well know the persons of their acquaintance, and the place where

they are; and perform all the voluntary actions with steadiness and

determination. See Sect. XXXIV. 2. 2.

Delirium is sometimes less complete, and then a new face and louder voice

stimulate the patient to attend to them for a few moments; and then they

relapse again into perfect delirium. At other times a delirium affects but

one sense, and the person thinks he sees things which do not exist; and is

at the same time sensible to the questions which are asked him, and to the

taste of the food which is offered to him.

This partial delirium is termed an hallucination of the disordered organ;

and may probably arise from the origin of one nerve of sense being more

liable to inflammation than the others; that is, an exuberance of the

sensorial power of sensation may affect it; which is therefore thrown into

action by slighter sensitive catenations, without being obedient to

external stimulus, or to the power of volition.

The perpetual flow of ideas in delirium is owing to the same circumstance,

as of those in our dreams; namely, to the defect or paralysis of the

voluntary power; as in hemiplagia, when one side of the body is paralytic,

and thus expends less of the sensorial power, the limbs on the other side

are in constant motion from the exuberance of it. Whence less sensorial

power is exhausted in delirium, than at other times, as well as in sleep;

and hence in fevers with great debility, it is perhaps, as well as the

stupor, rather a favourable circumstance; and when removed by numerous

blisters, the death of the patient often follows the recovery of his

understanding. See Class I. 2. 5. 6. and I. 2. 5. 10.

Delirium in diseases from inirritability is sometimes preceded by a

propensity to surprise. See Class I. 1. 5. 11.

M. M. Fomentations of the shaved head for an hour repeatedly. A blister on

the head. Rising from bed. Wine and opium, and sometimes venesection in

small quantity by cupping, if the strength of the arterial system will

allow it.

2. _Delirium maniacale._ Maniacal delirium. There is another kind of

delirium, described in Sect. XXXIII. 1. 4. which has the increase of

pleasureable or painful sensation for its cause, without any diminution of

the other sensorial powers; but as this excites the patient to the exertion

of voluntary actions, for the purpose of obtaining the object of his

pleasureable ideas, or avoiding the object of his painful ones, such as

perpetual prayer, when it is of the religious kind, it belongs to the

insanities described in Class III. 1. 2. 1, and is more properly termed

hallucinatio maniacalis.

3. _Dilirium ebrietatis._ The drunken delirium is in nothing different from

the delirium attending fevers except in its cause, as from alcohol, or

other poisons. When it is attended with an apoplectic stupor, the pulse is

generally low; and venesection I believe sometimes destroys those, who

would otherwise have recovered in a few hours.

M. M. Diluting liquids. An emetic.

4. _Somnium._ Dreams constitute the most complete kind of delirium. As in

these no external irritations are attended to, and the power of volition is

entirely suspended; so that the sensations of pleasure and pain, with their

associations, alone excite the endless trains of our sleeping ideas; as

explained in Sect. XVIII. on Sleep.

5. _Hallucinatio visus._ Deception of sight. These visual hallucinations

are perpetual in our dreams; and sometimes precede general delirium in

fevers; and sometimes belong to reverie, and to insanity. See Class III. 1.

2. 1. and 2. and must be treated accordingly.

Other kinds of visual hallucinations occur by moon-light; when objects are

not seen so distinctly as to produce the usual ideas associated with them,

but appear to us exactly as they are seen. Thus the trunk of a tree appears

a flat surface, instead of a cylinder as by day, and we are deceived and

alarmed by seeing things as they really are seen. See Berkley on Vision.

6. _Hallucinatio auditus._ Auricular deception frequently occurs in dreams,

and sometimes precedes general delirium in fevers; and sometimes belongs to

vertigo, and to reverie, and to insanity. See Sect. XX. 7. and Class III.

1. 2. 1. and 2.

7. _Rubor a calore._ The blush from heat is occasioned by the increased

action of the cutaneous vessels in consequence of the increased sensation

of heat. See Class I. 1. 2. 1. and 3.

8. _Rubor jucunditatis._ The blush of joy is owing to the increased action

of the capillary arteries, along with that of every moving vessel in the

body, from the increase of pleasurable sensation.

9. _Priapismus amatorius._ Amatorial priapism. The blood is poured into the

cells of the corpora cavernosa much faster than it can be reabsorbed by the

vena penis, owing in this case to the pleasurable sensation of love

increasing the arterial action. See Class I. 1. 4. 6.

10. _Distentio mamularum._ The teats of female animals, when they give

suck, become rigid and erected, in the same manner as in the last article,

from the pleasurable sensation of the love of the mother to her offspring.

Whence the teat may properly be called an organ of sense. The nipples of

men do the same when rubbed with the hand. See Class I. 1. 4. 7.

* * * * *

ORDO II.

_Decreased Sensation._

GENUS I.

_Of the General System._

SPECIES.

1. _Stultitia insensibilis._ Folly from insensibility. The pleasure or pain

generated in the system is not sufficient to promote the usual activity

either of the sensual or muscular fibres.

2. _Taedium vitae._ Ennui. Irksomeness of life. The pain of laziness has

been thought by some philosophers to be that principle of action, which has

excited all our industry, and distinguished mankind from the brutes of the

field. It is certain that, where the ennui exists, it is relieved by the

exertions of our minds or bodies, as all other painful sensations are

relieved; but it depends much upon our early habits, whether we become

patient of laziness, or inclined to activity, during the remainder of our

lives, as other animals do not appear to be affected with this malady;

which is perhaps left owing to deficiency of pleasurable sensation, than to

the superabundancy of voluntary power, which occasions pain in the muscles

by its accumulation; as appears from the perpetual motions of a squirrel

confined in a cage.

3. _Paresis sensitiva._ Weakness of the whole system from insensibility.

* * * * *

ORDO II.

_Decreased Sensation._

GENUS II.

_Of Particular Organs._

SPECIES.

1. _Anorexia._ Want of appetite. Some elderly people, and those debilitated

by fermented liquors, are liable to lose their appetite for animal food;

which is probably in part owing to the deficiency of gastric acid, as well

as to the general decay of the system: elderly people will go on years

without animal food; but inebriates soon sink, when their digestion becomes

so far impaired. Want of appetite is sometimes produced by the putrid

matter from many decaying teeth being perpetually mixed with the saliva,

and thence affecting the organ of taste, and greatly injuring the

digestion.

M. M. Fine charcoal powder diffused in warm water held in the mouth

frequently in a day, as in Class I. 2. 4. 12. or solution of alum in water.

Extract the decayed teeth. An emetic. A blister. Chalybeates. Vitriolic

acid. Bile of an ox inspissated, and made into pills; 20 grains to be taken

before dinner and supper. Opium half a grain twice a day.

All the strength we possess is ultimately derived from the food, which we

are able to digest; whence a total debility of the system frequently

follows the want of appetite, and of the power of digestion. Some young

ladies I have observed to fall into this general debility, so as but just

to be able to walk about; which I have sometimes ascribed to their

voluntary fasting, when they believed themselves too plump; and who have

thus lost both their health and beauty by too great abstinence, which could

never be restored.

I have seen other cases of what may be termed anorexia epileptica, in which

a total loss of appetite, and of the power of digestion, suddenly occurred

along with epileptic fits. Miss B. a girl about eighteen, apparently very

healthy, and rather plump, was seized with fits, which were at first called

hysterical; they occurred at the end of menstruation, and returned very

frequently with total loss of appetite. She was relieved by venesection,

blisters, and opiates; her strength diminished, and after some returns of

the fits, she took to her bed, and has survived 15 or 20 years; she has in

general eaten half a potato a day, and seldom speaks, but retains her

senses, and had many years occasional returns of convulsion. I have seen

two similar cases, where the anorexia, or want of appetite, was in less

degree; and but just so much food could be digested, as supplied them with

sufficient strength to keep from the bed or sofa for half the day. As well

as I can recollect, all these patients were attended with weak pulse, and

cold pale skin; and received benefit by opium, from a quarter of a grain to

a grain four times a day. See Class III. 1. 1. 7. and III. 1. 2. 1. and

III. 1. 2. 20.

2. _Adipsia._ Want of thirst. Several of the inferior people, as farmers

wives, have a habit of not drinking with their dinner at all, or only take

a spoonful or two of ale after it. I have frequently observed these to

labour under bad digestion, and debility in consequence; which I have

ascribed to the too great stimulus of solid food undiluted, destroying in

process of time the irritability of the stomach.

3. _Impotentia_ (agenesia). Impotency much seldomer happens to the male sex

than sterility to the female sex. Sometimes a temporary impotence occurs

from bashfulness, or the interference of some voluntary exertion in the

production of an effect, which should be performed alone by pleasurable

sensation.

One, who was soon to be married to a lady of superior condition to his own,

expressed fear of not succeeding on the wedding night; he was advised to

take a grain of opium before he went to bed, and to accustom himself to

sleep with a woman previously, but not to enjoy her, to take off his

bashfulness; which succeeded to his wish.

M. M. Chalybeates. Opium. Bark. Tincture of cantharides.

4. _Sterilitas._ Barrenness. One of the ancient medical writers asserts,

that the female sex become pregnant with most certainty at or near the time

of menstruation. This is not improbable, since these monthly periods seem

to referable the monthly venereal orgasm of some female quadrupeds, which

become pregnant at those times only; and hence the computation of pregnancy

is not often erroneous, though taken from the last menstruation. See