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diff --git a/27600.txt b/27600.txt new file mode 100644 index 0000000..de7c73b --- /dev/null +++ b/27600.txt @@ -0,0 +1,25474 @@ +The Project Gutenberg eBook, Zoonomia, Vol. II, by Erasmus Darwin + + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + + + + +Title: Zoonomia, Vol. II + Or, the Laws of Organic Life + + +Author: Erasmus Darwin + + + +Release Date: December 23, 2008 [eBook #27600] + +Language: English + +Character set encoding: ISO-646-US (US-ASCII) + + +***START OF THE PROJECT GUTENBERG EBOOK ZOONOMIA, VOL. II*** + + +E-text prepared by Robert Shimmin, Greg Alethoup, Keith Edkins, and the +Project Gutenberg Online Distributed Proofreading Team +(https://www.pgdp.net) + + + +Note: Project Gutenberg also has an HTML version of this + file which includes the original illustrations. + See 27600-h.htm or 27600-h.zip: + (https://www.gutenberg.org/dirs/2/7/6/0/27600/27600-h/27600-h.htm) + or + (https://www.gutenberg.org/dirs/2/7/6/0/27600/27600-h.zip) + + +Transcriber's note + +A few typographical errors have been corrected: they are +listed at the end of the text. + + + + + +ZOONOMIA; + +OR, + +THE LAWS + +OF + +ORGANIC LIFE. + +VOL. II. + +_By ERASMUS DARWIN, M.D. F.R.S._ + +AUTHOR OF THE BOTANIC GARDEN. + + + + Principio coelum, ac terras, camposque liquentes, + Lucentemque globum lunae, titaniaque astra, + Spiritus intus alit, totamque infusa per artus + Mens agitat molem, et magno se corpore miscet.--VIRG. Aen. vi. + + Earth, on whose lap a thousand nations tread, + And Ocean, brooding his prolific bed, + Night's changeful orb, blue pole, and silvery zones, + Where other worlds encircle other suns, + One Mind inhabits, one diffusive Soul + Wields the large limbs, and mingles with the whole. + + + + + + + +London: +Printed for. J. Johnson, in St. Paul's Church-Yard. +1796. + +Entered at Stationers' Hall. + + + + +ZOONOMIA; + +OR, + +THE LAWS OF ORGANIC LIFE. + +PART II. + +CONTAINING + +A CATALOGUE OF DISEASES + +DISTRIBUTED INTO + +NATURAL CLASSES ACCORDING TO THEIR PROXIMATE CAUSES, + +WITH THEIR + +SUBSEQUENT ORDERS, GENERA, AND SPECIES, + +AND WITH + +THEIR METHODS OF CURE. + + * * * * * + + Haec, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa ut + sint et fixa, quae dixero; sed ut Homunculus unus e multis probabiliora + conjectura sequens.--CIC. TUSC. DISP. l. 1. 9. + + * * * * * + +PREFACE. + +All diseases originate in the exuberance, deficiency, or retrograde action, +of the faculties of the sensorium, as their proximate cause; and consist in +the disordered motions of the fibres of the body, as the proximate effect +of the exertions of those disordered faculties. + +The sensorium possesses four distinct powers, or faculties, which are +occasionally exerted, and produce all the motions of the fibrous parts of +the body; these are the faculties of producing fibrous motions in +consequence of irritation which is excited by external bodies; in +consequence of sensation which is excited by pleasure or pain; in +consequence of volition which is excited by desire or aversion; and in +consequence of association which is excited by other fibrous motions. We +are hence supplied with four natural classes of diseases derived from their +proximate causes; which we shall term those of irritation, those of +sensation, those of volition, and those of association. + +In the subsequent classification of diseases I have not adhered to the +methods of any of those, who have preceded me; the principal of whom are +the great names of Sauvages and Cullen; but have nevertheless availed +myself, as much as I could, of their definitions and distinctions. + +The essential characteristic of a disease consists in its proximate cause, +as is well observed by Doctor Cullen, in his Nosologia Methodica, T. ii. +Prolegom. p. xxix. Similitudo quidem morborum in similitudine causae eorum +proximae, qualiscunque sit, revera consistit. I have taken the proximate +cause for the classic character. The characters of the orders are taken +from the excess, or deficiency, or retrograde action, or other properties +of the proximate cause. The genus is generally derived from the proximate +effect. And the species generally from the locality of the disease in the +system. + +Many species in this system are termed genera in the systems of other +writers; and the species of those writers are in consequence here termed +varieties. Thus in Dr. Cullen's Nosologia the variola or small-pox is +termed a genus, and the distinct and confluent kinds are termed species. +But as the infection from the distinct kind frequently produces the +confluent kind, and that of the confluent kind frequently produces the +distinct; it would seem more analogous to botanical arrangement, which +these nosologists profess to imitate, to call the distinct and confluent +small-pox varieties than species. Because the species of plants in +botanical systems propagate others similar to themselves; which does not +uniformly occur in such vegetable productions as are termed varieties. + +In some other genera of nosologists the species have no analogy to each +other, either in respect to their proximate cause, or to their proximate +effect, though they may he somewhat similar in less essential properties; +thus the thin and saline discharge from the nostrils on going into the cold +air of a frosty morning, which is owing to the deficient action of the +absorbent vessels of the nostrils, is one species; and the viscid mucus +discharged from the secerning vessels of the same membrane, when inflamed, +is another species of the same genus, Catarrhus. Which bear no analogy +either in respect to their immediate cause or to their immediate effect. + +The uses of the method here offered to the public of classing diseases +according to their proximate causes are, first, more distinctly to +understand their nature by comparing their essential properties. Secondly, +to facilitate the knowledge of the methods of cure; since in natural +classification of diseases the species of each genus, and indeed the genera +of each order, a few perhaps excepted, require the same general medical +treatment. And lastly, to discover the nature and the name of any disease +previously unknown to the physician; which I am persuaded will be more +readily and more certainly done by this natural system, than by the +artificial classifications already published. + +The common names of diseases are not well adapted to any kind of +classification, and least of all to this from their proximate causes. Some +of their names in common language are taken from the remote cause, as +worms, stone of the bladder; others from the remote effect, as diarrhoea, +salivation, hydrocephalus; others from some accidental symptom of the +disease, as tooth-ach, head-ach, heart-burn; in which the pain is only a +concomitant circumstance of the excess or deficiency of fibrous actions, +and not the cause of them. Others again are taken from the deformity +occasioned in consequence of the unnatural fibrous motions, which +constitute diseases, as tumours, eruptions, extenuations; all these +therefore improperly give names to diseases; and some difficulty is thus +occasioned to the reader in endeavouring to discover to what class such +disorders belong. + +Another difficulty attending the names of diseases is, that one name +frequently includes more than one disease, either existing at the same time +or in succession. Thus the pain of the bowels from worms is caused by the +increased action of the membrane from the stimulus of those animals; but +the convulsions, which sometimes succeed these pains in children, are +caused by the consequent volition, and belong to another class. + +To discover under what class any disease should be arranged, we must first +investigate the proximate cause; thus the pain of the tooth-ach is not the +cause of any diseased motions, but the effect; the tooth-ach therefore does +not belong to the class of Sensation. As the pain is caused by increased or +decreased action of the membranes of the tooth, and these actions are owing +to the increase or decrease of irritation, the disease is to be placed in +the class of irritation. + +To discover the order it must be inquired, whether the pain be owing to +increased or defective motion of the pained membrane; which is known by the +concomitant heat or coldness of the part. In tooth-ach without inflammation +there is generally a coldness attends the cheek in its vicinity; as may be +perceived by the hand of the patient himself, compared with the opposite +cheek. Hence odontalgia is found to belong to the order of decreased +irritation. The genus and species must be found by inspecting the synopsis +of the second order of the class of Irritation. See Class I. 2. 4. 12. + +This may be further elucidated by considering the natural operation of +parturition; the pain is occasioned by the increased action or distention +of the vessels of the uterus, in consequence of the stimulus of the fetus; +and is therefore caused by increased irritation; but the action of the +abdominal muscles in its exclusion are caused by the pain, and belong to +the class of increased sensation. See Class II. 1. 1. 12. Hence the +difficulty of determining, under what class of diseases parturition should +be arranged, consists in there being two kinds of diseased actions +comprehended under one word; which have each their different proximate +cause. + +In Sect. XXXIX. 8. 4. and in Class II. 1. 1. 1. we have endeavoured to give +names to four links of animal causation, which conveniently apply to the +classification of diseases; thus in common nictitation, or winking with the +eyes without our attention to it, the increased irritation is the proximate +cause; the stimulus of the air on the dry cornea is the remote cause; the +closing of the eyelid is the proximate effect; and the diffusion of tears +over the eye-ball is the remote effect. In some cases two more links of +causation may be introduced; one of them may be termed the pre-remote +cause; as the warmth or motion of the atmosphere, which causes greater +exhalation from the cornea. And the other the post-remote effect; as the +renewed pellucidity of the cornea; and thus six links of causation may be +expressed in words. + +But if amid these remote links of animal causation any of the four powers +or faculties of the sensorium be introduced, the reasoning is not just +according to the method here proposed; for these powers of the sensorium +are always the proximate causes of the contractions of animal fibres; and +therefore in true language cannot be termed their remote causes. From this +criterion it may always be determined, whether more diseases than one are +comprehended under one name; a circumstance which has much impeded the +investigation of the causes, and cures of diseases. + +Thus the term fever, is generally given to a collection of morbid symptoms; +which are indeed so many distinct diseases, that sometimes appear together, +and sometimes separately; hence it has no determinate meaning, except it +signifies simply a quick pulse, which continues for some hours; in which +sense it is here used. + +In naming diseases I have endeavoured to avoid the affectation of making +new compound Greek words, where others equally expressive could be +procured: as a short periphrasis is easier to be understood, and less +burthensome to the memory. + +In the Methodus Medendi, which is marked by M.M. at the end of many of the +species of diseases, the words incitantia, sorbentia, torpentia, &c. refer +to the subsequent articles of the Materia Medica, explaining the operations +of medicines. + +The remote causes of many diseases, their periods, and many circumstances +concerning them, are treated of in the preceding volume; the descriptions +of many of them, which I have omitted for the sake of brevity, may be seen +in the Nosologia Methodica of Sauvages, and in the Synopsis Nosologiae of +Dr. Cullen, and in the authors to which they refer. + +In this arduous undertaking the author solicits the candour of the critical +reader; as he cannot but foresee, that many errors will be discovered, many +additional species will require to be inserted; and others to be +transplanted, or erased. If he could expend another forty years in the +practice of medicine, he makes no doubt, but that he could bring this work +nearer perfection, and thence render it more worthy the attention of +philosophers.----As it is, he is induced to hope, that some advantages will +be derived from it to the science of medicine, and consequent utility to +the public, and leaves the completion of his plan to the industry of future +generations. + + DERBY, _Jan._ 1, 1796. + + * * * * * + + +ZOONOMIA. + +PART II. + + * * * * * + +CLASSES OF DISEASES. + + * * * * * + + I. DISEASES OF IRRITATION. + + II. DISEASES OF SENSATION. + + III. DISEASES OF VOLITION. + + IV. DISEASES OF ASSOCIATION. + + * * * * * + + +_The Orders and Genera of the First Class of Diseases._ + + * * * * * + +CLASS I. + +DISEASES OF IRRITATION. + +ORDO I. + +_Increased Irritation._ + +GENERA. + + 1. With increased actions of the sanguiferous system. + 2. With increased actions of the secerning system. + 3. With increased actions of the absorbent system. + 4. With increased actions of other cavities and membranes. + 5. With increased actions of the organs of sense. + +ORDO II. + +_Decreased Irritation._ + +GENERA. + + 1. With decreased actions of the sanguiferous system. + 2. With decreased actions of the secerning system. + 3. With decreased actions of the absorbent system. + 4. With decreased actions of other cavities and membranes. + 5. With decreased actions of the organs of sense. + +ORDO III. + +_Retrograde Irritative Motions._ + +GENERA. + + 1. Of the alimentary canal. + 2. Of the absorbent system. + 3. Of the sanguiferous system. + + * * * * * + +_The Orders, Genera, and Species, of the First Class of Diseases._ + + * * * * * + +CLASS I. + +DISEASES OF IRRITATION. + +ORDO I. + +_Increased Irritation._ + +GENUS I. + +_With Increased Actions of the Sanguiferous System._ + +SPECIES. + + 1. _Febris irritativa._ Irritative fever. + 2. _Ebrietas._ Drunkenness. + 3. _Haemorrhagia arteriosa._ Arterial haemorrhage. + 4. _Haemoptoe arteriosa._ Spitting of arterial blood. + 5. _Haemorrhagia narium._ Bleeding from the nose. + +GENUS II. + +_With Increased Actions of the Secerning System._ + +SPECIES. + + 1. _Calor febrilis._ Febrile heat. + 2. _Rubor febrilis._ Febrile redness. + 3. _Sudor calidus._ Warm sweat. + ---- _febrilis._ Sweat in fevers. + ---- _a labore._ ---- from exercise. + ---- _ab igne._ ---- from fire. + ---- _a medicamentis._ ---- from medicines. + 4. _Urina uberior colorata._ Copious coloured urine. + 5. _Diarrhoea calida._ Warm diarrhoea. + ---- _febrilis._ ---- from fever. + ---- _crapulosa._ ---- from indigestion. + ---- _infantum._ ---- of infants. + 6. _Salivatio calida._ ---- salivation. + 7. _Catarrhus calidus._ ---- catarrh. + 8. _Expectoratio calida._ ---- expectoration. + 9. _Exsudatio pone aures._ Discharge behind the ears. + 10. _Gonorrhoea calida._ Warm gonorrhoea. + 11. _Fluor albus calidus._ ---- fluor albus. + 12. _Haemorrhois alba._ White piles. + 13. _Serum e visicatorio._ Discharge from a blister. + 14. _Perspiratio foetida._ Fetid perspiration. + 15. _Crines novi._ New hairs. + +GENUS III. + +_With increased Actions of the Absorbent System._ + +SPECIES. + + 1. _Lingua arida._ Dry tongue. + 2. _Fauces aridae._ Dry throat. + 3. _Nares aridi._ Dry nostrils. + 4. _Expectoratio solida._ Solid expectoration. + 5. _Constipatio alvi._ Costiveness. + 6. _Cutis arida._ Dry skin. + 7. _Urina parcior colorata._ Diminished coloured urine. + 8. _Calculus felleus et icterus._ Gall-stone and jaundice. + 9. ---- _renis._ Stone of the kidney. + 10. ---- _vesicae._ Stone of the bladder. + 11. ---- _arthriticus._ Gout-stone. + 12. _Rheumatismus chronicus._ Chronic rheumatism. + 13. _Cicatrix vulnerum._ Healing of ulcers. + 14. _Corneae obfuscatio._ Scar on the cornea. + +GENUS IV. + +_With increased Actions of other Cavities and Membranes._ + +SPECIES. + + 1. _Nictitatio irritativa._ Irritative nictitation. + 2. _Deglutitio irritativa._ Irritative deglutition. + 3. _Respiratio et tussis._ Respiration and cough. + 4. _Exclusio bilis._ Exclusion of the bile. + 5. _Dentitio._ Toothing. + 6. _Priapismus._ Priapism. + 7. _Distensio mamularum._ Distention of the nipples. + 8. _Descensus uteri._ Descent of the uterus. + 9. _Prolapsus ani._ Descent of the rectum. + 10. _Lumbricus._ Round worm. + 11. _Taenia._ Tape-worm. + 12. _Ascarides._ Thread-worms. + 13. _Dracunculus._ Guinea-worm. + 14. _Morpiones._ Crab-lice. + 15. _Pediculi._ Lice. + +GENUS V. + +_With increased Actions of the Organs of Sense._ + +SPECIES. + + 1. _Visus acrior._ Acuter sight. + 2. _Auditus acrior._ ---- hearing. + 3. _Olfactus acrior._ ---- smell. + 4. _Gustus acrior._ ---- taste. + 5. _Tactus acrior._ ---- touch. + 6. _Sensus caloris acrior._ ---- sense of heat. + 7. ---- _extensionis acrior._ ---- sense of extension. + 8. _Titillatio._ Tickling. + 9. _Pruritus._ Itching. + 10. _Dolor urens._ Smarting. + 11. _Consternatio._ Surprise. + +ORDO II. + +_Decreased Irritation._ + +GENUS I. + +_With decreased Actions of the Sanguiferous System._ + +SPECIES. + + 1. _Febris inirritativa._ Inirritative fever. + 2. _Paresis inirritativa._ ---- debility. + 3. _Somnus interruptus._ Interrupted sleep. + 4. _Syncope._ Fainting. + 5. _Haemorrhagia venosa._ Venous haemorrhage. + 6. _Haemorrhois cruenta._ Bleeding piles. + 7. _Haemorrhagia renum._ ---- from the kidneys. + 8. ---- _hepatis._ ---- from the liver. + 9. _Haemoptoe venosa._ Spitting of venous blood. + 10. _Palpitatio cordis._ Palpitation of the heart. + 11. _Menorrhagia._ Exuberant menstruation. + 12. _Dysmenorrhagia._ Deficient menstruation. + 13. _Lochia nimia._ Too great lochia. + 14. _Abortio spontanea._ Spontaneous abortion. + 15. _Scorbutus._ Scurvy. + 16. _Vibices._ Extravasations of blood. + 17. _Petechiae._ Purple spots. + +GENUS II. + +_With decreased Actions of the Secerning System._ + +SPECIES. + + 1. _Frigus febrile._ Coldness in fevers. + ---- _chronicum._ ---- permanent. + 2. _Pallor fugitivus._ Paleness fugitive. + ---- _permanens._ ---- permanent. + 3. _Pus parcius._ Diminished pus. + 4. _Mucus parcior._ Diminished mucus. + 5. _Urina parcior pallida._ Pale diminished urine. + 6. _Torpor hepaticus._ Torpor of the liver. + 7. _Torpor pancreatis._ Torpor of the pancreas. + 8. _Torpor renis._ Torpor of the kidney. + 9. _Punctae mucosae vultus._ Mucous spots on the face. + 10. _Maculae cutis fulvae._ Tawny blots on the skin. + 11. _Canities._ Grey hairs. + 12. _Callus._ Callus. + 13. _Cataracta._ Cataract. + 14. _Innutritio ossium._ Innutrition of the bones. + 15. _Rachitis._ Rickets. + 16. _Spina distortio._ Distortion of the spine. + 17. _Claudicatio coxaria._ Lameness of the hip. + 18. _Spina protuberans._ Protuberant spine. + 19. _Spina bifida._ Divided spine. + 20. _Defectus palati._ Defect of the palate. + +GENUS III. + +_With decreased Actions of the Absorbent System._ + +SPECIES. + + 1. _Mucus faucium frigidus._ Cold mucus from the throat. + 2. _Sudor frigidus._ ---- sweat. + 3. _Catarrhus frigidus._ ---- catarrh. + 4. _Expectoratio frigida._ ---- expectoration. + 5. _Urina uberior pallida._ Copious pale urine. + 6. _Diarrhoea frigida._ Cold diarrhoea. + 7. _Fluor albus frigidus._ ---- fluor albus. + 8. _Gonorrhoea frigida._ ---- gonorrhoea. + 9. _Hepatis tumor._ Swelling of the liver. + 10. _Chlorosis._ Green sickness. + 11. _Hydrocele._ Dropsy of the vagina testis. + 12. _Hydrocephalus internus._ ---- of the brain. + 13. _Ascites._ ---- of the belly. + 14. _Hydrothorax._ ---- of the chest. + 15. _Hydrops ovarii._ ---- of the ovary. + 16. _Anasarca pulmonum._ ---- of the lungs. + 17. _Obesitas._ Corpulency. + 18. _Splenis tumor._ Swelling of the spleen. + 19. _Genu tumor albus._ White swelling of the knee. + 20. _Bronchocele._ Swelled throat. + 21. _Scrophula._ King's evil. + 22. _Schirrus._ Schirrus. + 23. ---- _recti._ ---- of the rectum. + 24. ---- _urethrae._ ---- of the urethra. + 25. ---- _oesophagi._ ---- of the throat. + 26. _Lacteorum inirritabilitas._ Inirritability of the lacteals. + 27. _Lymphaticorum inirritabilitas._ Inirritability of the lymphatics. + +GENUS IV. + +_With decreased Actions of other Cavities and Membranes._ + +SPECIES. + + 1. _Sitis calida._ Thirst warm. + ---- _frigida._ ---- cold. + 2. _Esuries._ Hunger. + 3. _Nausea sicca._ Dry Nausea. + 4. _Aegritudo ventriculi._ Sickness of stomach. + 5. _Cardialgia._ Heart-burn. + 6. _Arthritis ventriculi._ Gout of the stomach. + 7. _Colica flatulenta._ Flatulent colic. + 8. _Colica saturnina._ Colic from lead. + 9. _Tympanitis._ Tympany. + 10. _Hypochondriasis._ Hypochondriacism. + 11. _Cephalaea frigida._ Cold head-ach. + 12. _Odontalgia._ Tooth-ach. + 13. _Otalgia._ Ear-ach. + 14. _Pleurodyne chronica._ Chronical pain of the side. + 15. _Sciatica frigida._ Cold sciatica. + 16. _Lumbago frigida._ ---- lumbago. + 17. _Hysteralgia frigida._ ---- pain of the uterus. + 18. _Proctalgia frigida._ ---- pain of the rectum. + 19. _Vesicae felleae inirritibilitas_ Inirritability of the gall-bladder + _et icterus._ and jaundice. + +GENUS V. + +_With decreased Actions of the Organs of Sense._ + +SPECIES. + + 1. _Stultitia inirritabilis._ Folly from inirritability. + 2. _Visus imminutus._ Impaired vision. + 3. _Muscae volitantes._ Dark moving specks. + 4. _Strabismus._ Squinting. + 5. _Amaurosis._ Palsy of the optic nerve. + 6. _Auditus imminutus._ Impaired hearing. + 7. _Olfactus imminutus._ ---- smell. + 8. _Gustus imminutus._ ---- taste. + 9. _Tactus imminutus._ ---- touch. + 10. _Stupor._ Stupor. + +ORDO III. + +_Retrograde Irritative Motions._ + +GENUS I. + +_Of the Alimentary Canal._ + +SPECIES. + + 1. _Ruminatio._ Chewing the cud. + 2. _Ructus._ Eructation. + 3. _Apepsia._ Indigestion, water-qualm. + 4. _Vomitus._ Vomiting. + 5. _Cholera._ Cholera. + 6. _Ileus._ Iliac passion. + 7. _Globus hystericus._ Hysteric strangulation. + 8. _Vomendi conamen inane._ Vain efforts to vomit. + 9. _Borborigmus._ Gurgling of the bowels. + 10. _Hysteria._ Hysteric disease. + 11. _Hydrophobia._ Dread of water. + +GENUS II. + +_Of the Absorbent System._ + +SPECIES. + + 1. _Catarrhus lymphaticus._ Lymphatic catarrh. + 2. _Salivatio lymphatica._ Lymphatic salivation. + 3. _Nausea humida._ Moist nausea. + 4. _Diarrhoea lymphatica._ Lymphatic flux. + 5. _Diarrhoea chylifera._ Flux of chyle. + 6. _Diabaetes._ Diabetes. + 7. _Sudor lymphaticus._ Lymphatic sweat. + 8. _Sudor asthmaticus._ Asthmatic sweat. + 9. _Translatio puris._ Translation of matter. + 10. ---- _lactis._ ---- of milk. + 11. ---- _urinae._ ---- of urine. + +GENUS III. + +_Of the Sanguiferous System._ + +SPECIES. + + 1. _Capillarium motus retrogressus._ Retrograde motion of the + capillaries. + 2. _Palpitatio cordis._ Palpitation of the heart. + 3. _Anhelatio spasmodica._ Spasmodic panting. + + * * * * * + +CLASS I. + +DISEASES OF IRRITATION. + +ORDO I. + +_Increased Irritation._ + +GENUS I. + +_With increased Actions of the Sanguiferous System._ + +The irritability of the whole, or of part, of our system is perpetually +changing; these vicissitudes of irritability and of inirritability are +believed to depend on the accumulation or exhaustion of the sensorial +power, as their proximate cause; and on the difference of the present +stimulus, and of that which we had previously been accustomed to, as their +remote cause. Thus a smaller degree of heat produces pain and inflammation +in our hands, after they have been for a time immersed in snow; which is +owing to the accumulation of sensorial power in the moving fibres of the +cutaneous vessels during their previous quiescence, when they were benumbed +with cold. And we feel ourselves cold in the usual temperature of the +atmosphere on coming out of a warm room; which is owing to the exhaustion +of sensorial power in the moving fibres of the vessels of the skin by their +previous increased activity, into which they were excited by unusual heat. + +Hence the cold fits of fever are the occasion of the succeeding hot ones; +and the hot fits contribute to occasion in their turn the succeeding cold +ones. And though the increase of stimulus, as of heat, exercise, or +distention, will produce an increased action of the stimulated fibres; in +the same manner as it is produced by the increased irritability which was +occasioned by a previous defect of stimulus; yet as the excesses of +irritation from the stimulus of external things are more easily avoided +than the deficiencies of it; the diseases of this country, except those +which are the consequences of drunkenness, or of immoderate exercise, more +frequently begin with torpor than with orgasm; that is, with inactivity of +some parts, or of the whole of the system, and consequent coldness, than +with increased activity, and consequent heat. + +If the hot fit be the consequence of the cold one, it may be asked if they +are proportionate to each other: it is probable that they are, where no +part is destroyed by the cold fit, as in mortification or death. But we +have no measure to distinguish this, except the time of their duration; +whereas the extent of the torpor over a greater or less part of the system, +which occasions the cold fit; or of the exertion which occasions the hot +one; as well as the degree of such torpor or exertion, are perhaps more +material than the time of their duration. Besides this some muscles are +less liable to accumulate sensorial power during their torpor, than others, +as the locomotive muscles compared with the capillary arteries; on all +which accounts a long cold fit may often be followed by a short hot one. + +SPECIES. + +1. _Febris irritativa._ Irritative fever. This is the synocha of some +writers, it is attended with strong pulse without inflammation; and in this +circumstance differs from the febris inirritativa of Class I. 2. 1. 1. +which is attended with weak pulse without inflammation. The increased +frequency of the pulsation of the heart and arteries constitutes fever; +during the cold fit these pulsations are always weak, as the energy of +action is then decreased throughout the whole system; and therefore the +general arterial strength cannot be determined by the touch, till the cold +part of the paroxysm ceases. This determination is sometimes attended with +difficulty; as strong and weak are only comparative degrees of the greater +or less resistance of the pulsation of the artery to the compression of the +finger. But the greater or less frequency of the pulsations affords a +collateral evidence in those cases, where the degree of strength is not +very distinguishable, which may assist our judgment concerning it. Since a +moderately strong pulse, when the patient is in a recumbent posture, and +not hurried in mind, seldom exceeds 120 strokes in a minute; whereas a weak +one often exceeds 130 in a recumbent posture, and 150 in an erect one, in +those fevers, which are termed nervous or putrid. See Sect. XII. 1. 4. + +The increased frequency of the pulsation of the heart and arteries, as it +is occasioned either by excess or defect of stimulus, or of sensorial +power, exists both in the cold and hot fits of fever; but when the cold fit +ceases, and the pulse becomes strong and full as well as quick, in +consequence of the increased irritability of the heart and arteries, it +constitutes the irritative fever, or synocha. It is attended with +considerable heat during the paroxysm, and generally terminates in a +quarter of a lunation, without any disturbance of the faculties of the +mind. See Class IV. 1. 1. 8. + +M. M. Venesection. Emetics. Cathartics. Cool the patient in the hot fit, +and warm him in the cold one. Rest. Torpentia. + +2. _Ebrietas._ Drunkenness. By the stimulus of wine or opium the whole +arterial system, as well as every other part of the moving system, is +excited into increased action. All the secretions, and with them the +production of sensorial power itself in the brain, seem to be for a time +increased, with an additional quantity of heat, and of pleasureable +sensation. See Sect. XXI. on this subject. This explains, why at the +commencement of the warm paroxysm of some fevers the patient is in greater +spirits, or vivacity; because, as in drunkenness, the irritative motions +are all increased, and a greater production of sensation is the +consequence, which when in a certain degree, is pleasureable, as in the +diurnal fever of weak people. Sect. XXXVI. 3. 1. + +3. _Haemorrhagia arteriosa._ Arterial haemorrhage. Bleeding with a quick, +strong, and full pulse. The haemorrhages from the lungs, and from the nose, +are the most frequent of these; but it sometimes happens, that a small +artery but half divided, or the puncture of a leech, will continue to bleed +pertinaciously. + +M. M. Venesection. Cathartic with calomel. Divide the wounded artery. Bind +sponge on the puncture. If coffee or charcoal internally? If air with less +oxygen? + +4. _Haemoptoe arteriosa._ Spitting of arterial blood. Blood spit up from +the lungs is florid, because it has just been exposed to the influence of +the air in its passage through the extremities of the pulmonary artery; it +is frothy, from the admixture of air with it in the bronchia. The patients +frequently vomit at the same time from the disagreeable titillation of +blood about the fauces; and are thence liable to believe, that the blood is +rejected from the stomach. + +Sometimes an haemoptoe for several successive days returns in gouty persons +without danger, and seems to supply the place of the gouty paroxysms. Is +not the liver always diseased previous to the haemoptoe, as in several +other haemorrhages? See Class I. 2. 1. 9. + +M. M. Venesection, a purge, a blister, diluents, torpentia; and afterwards +sorbentia, as the bark, the acid of vitriol, and opium. An emetic is said +to stop a pulmonary haemorrhage, which it may effect, as sickness decreases +the circulation, as is very evident in the great sickness sometimes +produced by too large a dose of digitalis purpurea. + +Dr. Rush says, a table spoonful or two of common salt is successful in +haemoptoe; this may be owing to its stimulating the absorbent systems, both +the lymphatic, and the venous. Should the patient respire air with less +oxygen? or be made sick by whirling round in a chair suspended by a rope? +One immersion in cold water, or a sudden sprinkling all over with cold +water, would probably stop a pulmonary haemorrhage. See Sect. XXVII. 1. + +5. _Haemorrhagia narium._ _Epistaxis_. Bleeding at the nose in elderly +subjects most frequently attends those, whose livers are enlarged or +inflamed by the too frequent use of fermented liquors. + +In boys it occurs perhaps simply from redundancy of blood; and in young +girls sometimes precedes the approach of the catamenia; and then it shews a +disposition contrary to chlorosis; which arises from a deficiency of red +blood. + +M. M. It is stopped by plunging the head into cold water, with powdered +salt hastily dissolved in it; or sometimes by lint strewed over with wheat +flour put up the nostrils; or by a solution of steel in brandy applied to +the vessel by means of lint. The cure in other respects as in haemoptoe; +when the bleeding recurs at certain periods, after venesection, and +evacuation by calomel, and a blister, the bark and steel must be given, as +in intermittent fevers. See Section XXVII. 1. + + * * * * * + +ORDO I. + +_Increased Irritation._ + +GENUS II. + +_With increased Actions of the Secerning System._ + +These are always attended with increase of partial or of general heat; for +the secreted fluids are not simply separated from the blood, but are new +combinations; as they did not previously exist as such in the blood +vessels. But all new combinations give out heat chemically; hence the +origin of animal heat, which is always increased in proportion to the +secretion of the part affected, or to the general quantity of the +secretions. Nevertheless there is reason to believe, that as we have a +sense purposely to distinguish the presence of greater or less quantities +of heat, as mentioned in Sect. XIV. 6. so we may have certain minute glands +for the secretion of this fluid, as the brain is believed to secrete the +sensorial power, which would more easily account for the instantaneous +production of the blush of shame, and of anger. This subject deserves +further investigation. + +SPECIES. + +1. _Calor febrilis._ The heat in fevers arises from the increase of some +secretion, either of the natural fluids, as in irritative fevers; or of new +fluids, as in infectious fevers; or of new vessels, as in inflammatory +fevers. The pain of heat is a consequence of the increased extension or +contraction of the fibres exposed to so great a stimulus. See CLASS I. 1. +5. 6. + +2. _Rubor febrilis._ Febrile redness. When the cold fit of fever +terminates, and the pulsations of the heart and arteries become strong as +well as quick from the increase of their irritability after their late +quiescence, the blood is impelled forwards into the fine extremities of the +arteries, and the anastomozing capillaries, quicker than the extremities of +the veins can absorb and return it to the heart. Hence the pulse at the +wrist becomes full, as well as quick and strong, and the skin glows with +arterial blood, and the veins become empty and less visible. + +In elderly people the force of the heart and arteries becomes less, while +the absorbent power of the veins remains the same; whence the capillary +vessels part with the blood, as soon as it is received, and the skin in +consequence becomes paler; it is also probable, that in more advanced life +some of the finer branches of the arteries coalesce, and become impervious, +and thus add to the opacity of the skin. + +3. _Sudor calidus._ Warm sweat may be divided into four varieties, +according to their remote causes. _First_, the perspirable matter is +secreted in as great quantity during the hot fit of fever, as towards the +end of it, when the sweat is seen upon the skin. But during the hot fit the +cutaneous absorbents act also with increased energy, and the exhalation is +likewise increased by the greater heat of the skin; and hence it does not +appear in drops on the surface, but is in part reabsorbed, and in part +dissipated in the atmosphere. But as the mouths of the cutaneous absorbents +are exposed to the cool air or bedclothes; whilst those of the capillary +glands, which secrete the perspirable matter, are exposed to the warmth of +the circulating blood; the former, as soon as the fever-fit begins to +decline, lose their increased action first; and hence the absorption of the +sweat is diminished, whilst the increased secretion of it continues for +some hours afterwards, which occasions it to stand in drops upon the skin. + +As the skin becomes cooler, the evaporation of the perspirable matter +becomes less, as well as the absorption of it. And hence the dissipation of +aqueous fluid from the body, and the consequent thirst, are perhaps greater +during the hot fit, than during the subsequent sweat. For the sweats do not +occur, according to Dr. Alexander's experiments, till the skin is cooled +from 112 to 108 degrees of heat; that is, till the paroxysm begins to +decline. From this it appears, that the sweats are not critical to the hot +fit, any more than the hot fit can be called critical to the cold one; but +simply, that they are the natural consequence of the decline of the hot +fit, commencing with the decreased action of the absorbent system, and the +decreased evaporation from the skin. And from hence it may be concluded, +that a fever-fit is not in general an effort of nature to restore health, +as Sydenham considered it, but a necessary consequence of the previous +torpor; and that the causes of fevers would be less detrimental, if the +fever itself could be prevented from existing; as appears in the cool +treatment of the small-pox. + +It must be noted that the profuse sweats on the skin are more frequent at +the decline of fever-fits than the copious urine, or loose stools, which +are mentioned below; as the cutaneous absorbents, being exposed to the cool +air, lose their increased action sooner than the urinary or intestinal +absorbents; which open into the warm cavities of the bladder and +intestines; but which are nevertheless often affected by their sympathy +with the cutaneous absorbents. Hence few fevers terminate without a +moisture of the skin; whence arose the fatal practice of forcing sweats by +the external warmth of air or bedclothes in fevers; for external warmth +increases the action of the cutaneous capillaries more than that of the +other secerning vessels; because the latter are habituated to 98 degrees of +heat, the internal warmth of the body; whereas the cutaneous capillaries +being nearer the surface are habitually kept cooler by the contact of the +external air. Sweats thus produced by heat in confined rooms are still more +detrimental; as the air becomes then not only deprived of a part of its +oxygene by frequent respiration, but is loaded with animal effluvia as well +as with moisture, till it can receive no more; and in consequence, while +the cutaneous secretion stands upon the skin in drops for want of +exhalation, the lungs are exposed to an insalubrious atmosphere. + +I do not deny, that sweating may be so managed as to be serviceable in +preventing the return of the cold paroxysm of fevers; like the warm bath, +or any other permanent stimulus, as wine, or opium, or the bark. For this +purpose it should be continued till past the time of the expected cold fit, +supported by moderate doses of wine-whey, with spirit of hartshorn, and +moderate degrees of warmth. Its salutary effect, when thus managed, was +probably one cause of its having been so much attended to; and the fetid +smell, which when profuse is liable to accompany it, gave occasion to the +belief, that the supposed material cause of the disease was thus eliminated +from the circulation. + +When too great external heat is applied, the system is weakened by excess +of action, and the torpor which causes the cold paroxysm recurs sooner and +more violently. For though some stimuli, as of opium and alcohol, at the +same time that they exhaust the sensorial power by promoting increase of +fibrous action, may also increase the production or secretion of it in the +brain, yet experience teaches us, that the exhaustion far out-balances the +increased production, as is evinced by the general debility, which succeeds +intoxication. + +In respect to the fetor attending copious continued sweats, it is owing to +the animalized part of this fluid being kept in that degree of warmth, +which most favours putrefaction, and not suffered to exhale into the +atmosphere. Broth, or other animal mucus, kept in similar circumstances, +would in the same time acquire a putrid smell; yet has this error +frequently produced miliary eruptions, and increased every kind of +inflammatory or sensitive fever. + +The ease, which the patient experiences during sweating, if it be not +produced by much external heat, is similar to that of the warm bath; which +by its stimulus applied to the cutaneous vessels, which are generally +cooler than the internal parts of the system, excites them into greater +action; and pleasureable sensation is the consequence of these increased +actions of the vessels of the skin. From considering all these +circumstances, it appears that it is not the evacuation by sweats, but the +continued stimulus, which causes and supports those sweats, which is +serviceable in preventing the returns of fever-fits. And that sweats too +long continued, or induced by too great stimulus of warmth, clothes, or +medicines, greatly injure the patient by increasing inflammation, or by +exhausting the sensorial power. See Class I. 1. 2. 14. + +_Secondly_, The sweats produced by exercise or labour are of the warm kind; +as they originate from the increased action of the capillaries of the skin, +owing to their being more powerfully stimulated by the greater velocity of +the blood, and by a greater quantity of it passing through them in a given +time. For the blood during violent exercise is carried forwards by the +action of the muscles faster in the arteries, than it can be taken up by +the veins; as appears by the redness of the skin. And from the consequent +sweats, it is evinced, that the secretory vessels of the skin during +exercise pour out the perspirable matter faster, than the mouths of the +absorbent vessels can drink it up. Which mouths are not exposed to the +increased muscular action, or to the stimulus of the increased velocity and +quantity of the blood, but to the cool air. + +_Thirdly_, the increased secretion of perspirable matter occasioned by the +stimulus of external heat belongs likewise to this place; as it is caused +by the increased motions of the capillary vessels; which thus separate from +the blood more perspirable matter, than the mouths of their correspondent +absorbent vessels can take up; though these also are stimulated by external +heat into more energetic action. If the air be stationary, as in a small +room, or bed with closed curtains, the sweat stands in drops on the skin +for want of a quicker exhalation proportioned to the quicker secretion. + +A _fourth_ variety of warm perspiration is that occasioned by stimulating +drugs, of which opium and alcohol are the most powerful; and next to these +the spices, volatile alkali, and neutral salts, especially sea salt; that +much of the aqueous part of the blood is dissipated by the use of these +drugs, is evinced by the great thirst, which occurs a few hours after the +use of them. See Art. III. 2. 12. and Art. III. 2. 1. + +We may from hence understand, that the increase of this secretion of +perspirable matter by artificial means, must be followed by debility and +emaciation. When this is done by taking much salt, or salted meat, the +sea-scurvy is produced; which consists in the inirritability of the +bibulous terminations of the veins arising from the capillaries; see Class +I. 2. 1. 14. The scrophula, or inirritability of the lymphatic glands, +seems also to be occasionally induced by an excess in eating salt added to +food of bad nourishment. See Class I. 2. 3. 21. If an excess of +perspiration is induced by warm or stimulant clothing, as by wearing +flannel in contact with the skin in the summer months, a perpetual +febricula is excited, both by the preventing the access of cool air to the +skin, and by perpetually goading it by the numerous and hard points of the +ends of the wool; which when applied to the tender skins of young children, +frequently produce the red gum, as it is called; and in grown people, +either an erysipelas, or a miliary eruption, attended with fever. See Class +II. 1. 3. 12. + +Shirts made of cotton or calico stimulate the skin too much by the points +of the fibres, though less than flannel; whence cotton handkerchiefs make +the nose sore by frequent use. The fibres of cotton are, I suppose, ten +times shorter than those of flax, and the number of points in consequence +twenty times the number; and though the manufacturers singe their calicoes +on a red-hot iron cylinder, yet I have more than once seen an erysipelas +induced or increased by the stimulus of calico, as well as of flannel. + +The increase of perspiration by heat either of clothes, or of fire, +contributes much to emaciate the body; as is well known to jockeys, who, +when they are a stone or two too heavy for riding, find the quickest way to +lessen their weight is by sweating themselves between blankets in a warm +room; but this likewise is a practice by no means to be recommended, as it +weakens the system by the excess of so general a stimulus, brings on a +premature old age, and shortens the span of life; as may be further deduced +from the quick maturity, and shortness of the lives, of the inhabitants of +Hindostan, and other tropical climates. + +M. Buffon made a curious experiment to shew this circumstance. He took a +numerous brood of the butterflies of silkworms, some hundreds of which left +their eggs on the same day and hour; these he divided into two parcels; and +placing one parcel in the south window, and the other in the north window +of his house, he observed, that those in the colder situation lived many +days longer than those in the warmer one. From these observations it +appears, that the wearing of flannel clothing next the skin, which is now +so much in fashion, however useful it may be in the winter to those, who +have cold extremities, bad digestions, or habitual coughs, must greatly +debilitate them, if worn in the warm months, producing fevers, eruptions, +and premature old age. See Sect. XXXVII. 5. Class I. 1. 2. 14. Art. III. 2. +1. + +4. _Urina uberior colorata._ Copious coloured urine. Towards the end of +fever-fits a large quantity of high coloured urine is voided, the kidneys +continuing to act strongly, after the increased action of the absorbents of +the bladder is somewhat diminished. If the absorbents continue also to act +strongly, the urine is higher coloured, and so loaded as to deposit, when +cool, an earthy sediment, erroneously thought to be the material cause of +the disease; but is simply owing to the secretion of the kidnies being +great from their increased action; and the thinner parts of it being +absorbed by the increased action of the lymphatics, which are spread very +thick on the neck of the bladder; for the urine, as well as perhaps all the +other secreted fluids, is produced from the kidnies in a very dilute state; +as appears in those, who from the stimulus of a stone, or other cause, +evacuate their urine too frequently; which is then pale from its not having +remained in the bladder long enough for the more aqueous part to have been +reabsorbed. The general use of this urinary absorption to the animal +oeconomy is evinced from the urinary bladders of fish, which would +otherwise be unnecessary. High coloured urine in large quantity shews only, +that the secreting vessels of the kidnies, and the absorbents of the +bladder, have acted with greater energy. When there is much earthy +sediment, it shews, that the absorbents have acted proportionally stronger, +and have consequently left the urine in a less dilute state. In this urine +the transparent sediment or cloud is mucous; the opake sediment is probably +coagulable lymph from the blood changed by an animal or chemical process. +The floating scum is oil. The angular concretions to the sides of the pot, +formed as the urine cools, is microcosmic salt. Does the adhesive blue +matter on the sides of the glass, or the blue circle on it at the edge of +the upper surface of the urine, consist of Prussian blue? + +5. _Diarrhoea calida._ Warm diarrhoea. This species may be divided into +three varieties deduced from their remote causes, under the names of +diarrhoea febrilis, diarrhoea crapulosa, and diarrhoea infantum. The +febrile diarrhoea appears at the end of fever-fits, and is erroneously +called critical, like the copious urine, and the sweats; whereas it arises +from the increased action of those secerning organs, which pour their +fluids into the intestinal canal (as the liver, pancreas, and mucous +glands), continuing longer than the increased action of the intestinal +absorbents. In this diarrhoea there is no appearance of curdled chyle in +the stools, as occurs in cholera. I. 3. 1. 5. + +The _diarrhoea crapulosa_, or diarrhoea from indigestion, occurs when too +great a quantity of food or liquid has been taken; which not being +compleatly digested, stimulates the intestines like any other extraneous +acrid material; and thus produces an increase of the secretions into them +of mucus, pancreatic juice, and bile. When the contents of the bowels are +still more stimulant, as when drastic purges, or very putrescent diet, have +been taken, a cholera is induced. See Sect. XXIX. 4. + +The _diarrhoea infantum_, or diarrhoea of infants, is generally owing to +too great acidity in their bowels. Milk is found curdled in the stomachs of +all animals, old as well as young, and even of carnivorous ones, as of +hawks. (Spallanzani.) And it is the gastric juice of the calf, which is +employed to curdle milk in the process of making cheese. Milk is the +natural food for children, and must curdle in their stomachs previous to +digestion; and as this curdling of the milk destroys a part of the acid +juices of the stomach, there is no reason for discontinuing the use of it, +though it is occasionally ejected in a curdled state. A child of a week +old, which had been taken from the breast of its dying mother, and had by +some uncommon error been suffered to take no food but water-gruel, became +sick and griped in twenty-four hours, and was convulsed on the second day, +and died on the third! When all young quadrupeds, as well as children, have +this natural food of milk prepared for them, the analogy is so strong in +favour of its salubrity, that a person should have powerful testimony +indeed of its disagreeing, before he advises the discontinuance of the use +of it to young children in health, and much more so in sickness. The +farmers lose many of their calves, which are brought up by gruel, or gruel +and old milk; and among the poor children of Derby, who are thus fed, +hundreds are starved into the scrophula, and either perish, or live in a +state of wretched debility. + +When young children are brought up without a breast, they should for the +first two months have no food but new milk; since the addition of any kind +of bread or flour is liable to ferment, and produce too much acidity; as +appears by the consequent diarrhoea with green dejections and gripes; the +colour is owing to a mixture of acid with the natural quantity of bile, and +the pain to its stimulus. And they should never be fed as they lie upon +their backs, as in that posture they are necessitated to swallow all that +is put into their mouths; but when they are fed, as they are sitting up, or +raised up, when they have had enough, they can permit the rest to run out +of their mouths. This circumstance is of great importance to the health of +those children, who are reared by the spoon, since if too much food is +given them, indigestion, and gripes, and diarrhoea, is the consequence; and +if too little, they become emaciated; and of this exact quantity their own +palates judge the best. + +M. M. In this last case of the diarrhoea of children, the food should be +new milk, which by curdling destroys part of the acid, which coagulates it. +Chalk about four grains every six hours, with one drop of spirit of +hartshorn, and half a drop of laudanum. But a blister about the size of a +shilling is of the greatest service by restoring the power of digestion. +See Article III. 2. 1. in the subsequent Materia Medica. + +6. _Salivatio calida._ Warm salivation. Increased secretion of saliva. This +may be effected either by stimulating the mouth of the gland by mercury +taken internally; or by stimulating the excretory duct of the gland by +pyrethrum, or tobacco; or simply by the movement of the muscles, which lie +over the gland, as in masticating any tasteless substance, as a lock of +wool, or mastic. + +In about the middle of nervous fevers a great spitting of saliva sometimes +occurs, which has been thought critical; but as it continues sometimes two +or even three weeks without the relief of the patient, it may be concluded +to arise from some accidental circumstance, perhaps not unsimilar to the +hysteric ptyalisms mentioned in Class I. 3. 2. 2. See Sect. XXIV. + +M. M. Cool air, diluents, warm bath, evacuations. + +7. _Catharrhus calidus._ Warm catarrh. Consists in an increased secretion +of mucus from the nostrils without inflammation. This disease, which is +called a cold in the head, is frequently produced by cold air acting for +some time on the membranes, which line the nostrils, as it passes to the +lungs in respiration. Whence a torpor of the action of the mucous glands is +first introduced, as in I. 2. 3. 3. and an orgasm or increased action +succeeds in consequence. Afterwards this orgasm and torpor are liable to +alternate with each other for some time like the cold and hot fits of ague, +attended with deficient or exuberant secretion of mucus in the nostrils. + +At other times it arises from reverse sympathy with some extensive parts of +the skin, which have been exposed too long to cold, as of the head, or +feet. In consequence of the torpor of these cutaneous capillaries those of +the mucous membrane of the nostrils act with greater energy by reverse +sympathy; and thence secrete more mucus from the blood. At the same time +the absorbents, acting also with greater energy by their reverse sympathy +with those of some distant part of the skin, absorb the thinner parts of +the mucus more hastily; whence the mucus is both thicker and in greater +quantity. Other curious circumstances attend this disease; the membrane +becomes at times so thickened by its increased action in secreting the +mucus, that the patient cannot breathe through his nostrils. In this +situation if he warms his whole skin suddenly by fire or bed-clothes, or by +drinking warm tea, the increased action of the membrane ceases by its +reverse sympathy with the skin; or by the retraction of the sensorial power +to other parts of the system; and the patient can breathe again through the +nostrils. The same sometimes occurs for a time on going into the cold air +by the deduction of heat from the mucous membrane, and its consequent +inactivity or torpor. Similar to this when the face and breast have been +very hot and red, previous to the eruption of the small-pox by inoculation, +and that even when exposed to cool air, I have observed the feet have been +cold; till on covering them with warm flannel, as the feet have become +warm, the face has cooled. See Sect. XXXV. 1. 3. Class II. 1. 3. 5. IV. 2. +2. 10. IV. 1. 1. 5. + +M. M. Evacuations, abstinence, oil externally on the nose, warm diluent +fluids, warm shoes, warm night-cap. + +8. _Expectoratio calida._ Warm expectoration consists of the increased +secretion of mucus from the membrane, which lines the bronchiae, or +air-cells of the lungs, without inflammation. This increased mucus is +ejected by the action of coughing, and is called a cold, and resembles the +catarrh of the preceding article; with which it is frequently combined. + +M. M. Inhale the steam of warm water, evacuations, warm bath, afterwards +opium, sorbentia. + +9. _Exsudatio pone aures._ A discharge behind the ears. This chiefly +affects children, and is a morbid secretion; as appears from its fetor; for +if it was owing to defect of absorption, it would be saline, and not fetid; +if a morbid action has continued a considerable time, it should not be +stopped too suddenly; since in that case some other morbid action is liable +to succeed in its stead. Thus children are believed to have had cholics, or +even convulsions, consequent to the too sudden healing of these morbid +effusions behind their ears. The rationale of this is to be explained from +a medical fact, which I have frequently observed; and that is, that a +blister on the back greatly strengthens the power of digestion, and removes +the heart-burn in adults, and green stools in children. The stimulus of the +blister produces sensation in the vessels of the skin; with this additional +sensorial power these vessels act more strongly; and with these the vessels +of the internal membranes of the stomach and bowels act with greater energy +from their direct sympathy with them. Now the acrid discharge behind the +ears of children produces sensation on that part of the skin, and so far +acts as a small blister. When this is suddenly stopped, a debility of the +digestive power of the stomach succeeds from the want of this accustomed +stimulus, with flatulency, green stools, gripes, and sometimes consequent +convulsions. See Class II. 1. 5. 6. and II. 1. 4. 6. + +M. M. If the matter be absorbed, and produces swelling of the lymphatics of +the neck, it should be cured as soon as possible by dusting the part with +white lead, cerussa, in very fine powder; and to prevent any ill +consequence an issue should be kept for about a month in the arm; or a +purgative medicine should be taken, every other day for three or four +times, which should consist of a grain of calomel, and three or four grains +of rhubarb, and as much chalk. If there be no appearance of absorption, it +is better only to keep the parts clean by washing them with warm water +morning and evening; or putting fuller's earth on them; especially till the +time of toothing is past. The tinea, or scald head, and a leprous eruption, +which often appears behind the ears, are different diseases. + +10. _Gonorrhea calida._ Warm gleet. Increased discharge of mucus from the +urethra or prostrate gland without venereal desire, or venereal infection. +See Class I. 2. 3. 8. + +M. M. Cantharides, balsams, rhubarb, blister in perinaeum, cold bath, +injections of metallic salts, flannel shirt, change of the form of the +accustomed chair or saddle of the patient. + +11. _Fluor albus calidus._ Warm fluor albus. Increased secretion of mucus +in the vagina or uterus without venereal desire or venereal infection. It +is distinguished from the fluor albus frigidus by the increased sense of +warmth in the part, and by the greater opacity or spissitude of the +material discharged; as the thinner parts are reabsorbed by the increased +action of the absorbents, along with the saline part, whence no smarting or +excoriation attends it. + +M. M. Mucilage, as isinglass, hartshorn jelly, gum arabic. Ten grains of +rhubarb every night. Callico or flannel shift, opium, balsams. See Class I. +2. 3. 7. + +12. _Haemorrhois alba._ White piles. An increased discharge of mucus from +the rectum frequently mistaken for matter; is said to continue a few weeks, +and recur like the bleeding piles; and to obey lunar influence. See Class +I. 2. 1. 6. + +M. M. Abstinence from vinous spirit. Balsam of copaiva. Spice swallowed in +large fragments, as ten or fifteen black pepper-corns cut in half, and +taken after dinner and supper. Ward's paste, consisting of black pepper and +the powdered root of Helenium Enula. + +13. _Serum e vesicatorio._ Discharge from a blister. The excretory ducts of +glands terminate in membranes, and are endued with great irritability, and +many of them with sensibility; the latter perhaps in consequence of their +facility of being excitable into great action; instances of this are the +terminations of the gall-duct in the duodenum, and of the salivary and +lachrymal glands in the mouth and eye; which produce a greater secretion of +their adapted fluids, when the ends of their excretory ducts are +stimulated. + +The external skin consists of the excretory ducts of the capillaries, with +the mouths of the absorbents; when these are stimulated by the application +of cantharides, or by a slice of the fresh root of bryonia alba bound on +it, the capillary glands pour an increased quantity of fluid upon the skin +by their increased action; and the absorbent vessels imbibe a greater +quantity of the more fluid and saline part of it; whence a thick mucous or +serous fluid is deposited between the skin and cuticle. + +14. _Perspiratio foetida._ Fetid perspiration. The uses of the perspirable +matter are to keep the skin soft and pliant, for the purposes of its easier +flexibility during the activity of our limbs in locomotion, and for the +preservation of the accuracy of the sense of touch, which is diffused under +the whole surface of it to guard us against the injuries of external +bodies; in the same manner as the secretion of tears is designed to +preserve the cornea of the eye moist, and in consequence transparent; yet +has this cutaneous mucus been believed by many to be an excrement; and I +know not how many fanciful theories have been built on its supposed +obstruction. Such as the origin of catarrhs, coughs, inflammations, +erysypelas, and herpes. + +To all these it may be sufficient to answer, that the antient Grecians +oiled themselves all over; that some nations have painted themselves all +over, as the Picts of this island; that the Hottentots smear themselves all +over with grease. And lastly, that many of our own heads at this day are +covered with the flour of wheat and the fat of hogs, according to the +tyranny of a filthy and wasteful fashion, and all this without +inconvenience. To this must be added the strict analogy between the use of +the perspirable matter and the mucous fluids, which are poured for similar +purposes upon all the internal membranes of the body; and besides its being +in its natural state inodorous; which is not so with the other excretions +of feces, or of urine. + +In some constitutions the perspirable matter of the lungs acquires a +disagreeable odour; in others the axilla, and in others the feet, emit +disgustful effluvia; like the secretions of those glands, which have been +called odoriferae; as those, which contain the castor in the beaver, and +those within the rectum of dogs, the mucus of which has been supposed to +guard them against the great costiveness, which they are liable to in hot +summers; and which has been thought to occasion canine madness, but which, +like their white excrement, is more probably owing to the deficient +secretion of bile. Whether these odoriferous particles attend the +perspirable matter in consequence of the increased action of the capillary +glands, and can properly be called excrementitous; that is, whether any +thing is eliminated, which could be hurtful if retained; or whether they +may only contain some of the essential oil of the animal; like the smell, +which adheres to one's hand on stroking the hides of some dogs; or like the +effluvia, which is left upon the ground, from the feet of men and other +creatures; and is perceptible by the nicer organs of the dogs, which hunt +them, may admit of doubt. + +M. M. Wash the parts twice a day with soap and water; with lime water; +cover the feet with oiled silk socks, which must be washed night and +morning. Cover them with charcoal recently made red hot, and beaten into +fine powder and sifted, as soon as cold, and kept well corked in a bottle, +to be warned off and renewed twice a day. Internally rhubarb grains vi. or +viii. every night, so as to procure a stool or two extraordinary every day, +and thus by increasing one evacuation to decrease another. Cool dress, +diluting liquids? + +15. _Crines novi._ New hairs. The black points on the faces of some people +consist of mucus, which is become viscid, and which adheres in the +excretory ducts of the glands of the skin; as described in Class I. 2. 2. +9. and which may be pressed out by the fingers, and resembles little worms. +Similar to this would seem the fabrication of silk, and of cobweb by the +silk worm and spider; which is a secreted matter pressed through holes, +which are the excretory ducts of glands. And it is probable, that the +production of hair on many parts of the body, and at different periods of +life, may be effected by a similar process; and more especially as every +hair may be considered as a slender flexible horn, and is an appendage of +the skin. See Sect. XXXIX. 3. 2. Now as there is a sensitive sympathy +between the glands, which secrete the semen, and the throat, as appears in +the mumps; see Hydrophobia, Class IV. 1. 2. 7. and Parotitis, Class IV. 1. +2. 19. The growth of the beard at puberty seems to be caused by the greater +action of the cutaneous glands about the chin and pubes in consequence of +their sympathy with those of the testes. But this does not occur to the +female sex at their time of puberty, because the sensitive sympathy in them +seems to exist between the submaxillary glands, and the pectoral ones; +which secrete the milk, and afford pleasure both by that secretion, and by +the erection of the mamulae, or nipples; and by delivering the milk into +the mouth of the child; this sensitive sympathy of the pectoral and +submaxillary glands in women is also observable in the Parotitis, or mumps, +as above referred to. + +When hairs grow on the face or arms so as to be disagreeable, they may be +thus readily removed without pain or any ill consequence. Warm the ends of +a pair of nippers or forceps, and stick on them a little rosin, or burgundy +pitch; by these means each single hair may be taken fast hold of; and if it +be then plucked off slowly, it gives pain; but if plucked off suddenly, it +gives no pain at all; because the vis inertiae of the part of the skin, to +which it adheres, is not overcome; and it is not in consequence separated +from the cellular membrane under it. Some of the hairs may return, which +are thus plucked off, or others may be induced to grow near them; but in a +little time they may be thus safely destroyed; which is much to be +preferred to the methods said to be used in Turkey to eradicate hair; such +as a mixture of orpiment and quick lime; or of liver of sulphur in +solution; which injure the skin, if they are not very nicely managed; and +the hair is liable to grow again as after shaving; or to become white, if +the roots of it have been much inflamed by the causticity of the +application. See Class I. 2. 2. 11. on grey hairs. + + * * * * * + +ORDO I. + +_Increased Irritation._ + +GENUS III. + +_With increased Actions of the Absorbent System._ + +These are not attended with so great increase of heat as in the former +genus, because the fluids probably undergo less chemical change in the +glands of the absorbent system; nor are the glands of the absorbent vessels +so numerous or so extensive as those of the secerning ones. Yet that some +heat is produced by the increased action of the absorbents appears from the +greater general warmth of the skin and extremities of feeble patients after +the exhibition of the peruvian bark, and other medicines of the article +Sorbentia. + +SPECIES. + +1. _Lingua arida._ Dry tongue occurs in those fevers, where the expired air +is warmer than natural; and happens to all those, who sleep with their +mouths open; the currents of air in respiration increasing the evaporation. +There is also a dryness in the mouth from the increased action of the +absorbent vessels, when a sloe or a crab-apple are masticated; and after +the perforation has been much increased by eating salt or spice, or after +other copious secretions; as after drunkenness, cathartics, or fever fits, +the mucus of the mouth becomes viscid, and in small quantity, from the +increased absorption, adhering to the tongue like a white slough. In the +diabaetes, where the thirst is very great, this slough adheres more +pertinaciously, and becomes black or brown, being coloured after a few days +by our aliment or drink. The inspissated mucus on the tongue of those, who +sleep with their mouths open, is sometimes reddened as if mixed with blood, +and sometimes a little blood follows the expuition of it from the fauces +owing to its great adhesion. When this mucus adheres long to the papillae +of the tongue, the saliva, which it contains in its interstices, like a +sponge, is liable to become putrid, and to acquire a bitter taste, like +other putrid animal substances; which is generally mistaken for an +indication of the presence of bile. + +M. M. Warm subacid liquids. See Class I. 2. 5. 8. + +2. _Fauces aridae._ Dry throat. The expuition of a frothy mucus with great +and perpetual hawking occurs in hydrophobia, and is very distressing to the +patient; which may be owing to the increased irritability or sensibility of +the upper part of the oesophagus, which will not permit any fluid to rest +on it. + +It affects some people after intoxication, when the lungs remain slightly +inflamed, and by the greater heat of the air in expiration the mucus +becomes too hastily evaporated, and is expectorated with difficulty in the +state of white froth. + +I knew a person, who for twenty years always waked with his tongue and +throat quite dry; so that he was necessitated to take a spoonful of water, +as soon as he awoke; otherwise a little blood always followed the forcible +expuition of the indurated mucus from his fauces. See Class II. 1. 3. 17. + +M. M. Steel-springs fixed to the night-cap so as to suspend the lower jaw +and keep it closed; or springs of elastic gum. Or a pot of water suspended +over the bed, with a piece of list, or woollen cloth, depending from it, +and held in the mouth; which will act like a syphon, and slowly supply +moisture, or barley water should be frequently syringed into the mouth of +the patient. + +3. _Nares aridi._ Dry nostrils with the mucus hardening upon their internal +surface, so as to cover them with a kind of skin or scale, owing to the +increased action of the absorbents of this membrane; or to the too great +dryness of the air, which passes into the lungs; or too great heat of it in +its expiration. + +When air is so dry as to lose its transparency; as when a tremulous motion +of it can be seen over corn fields in a hot summer's day; or when a dry +mist, or want of transparency of the air, is visible in very hot weather; +the sense of smell is at the same time imperfect from the dryness of the +membrane, beneath which it is spread. + +4. _Expectoratio solida._ Solid expectoration. The mucus of the lungs +becomes hardened by the increased absorption, so that it adheres and forms +a kind of lining in the air-cells, and is sometimes spit up in the form of +branching vessels, which are called polypi of the lungs. See Transact. of +the College, London. There is a rattling or weezing of the breath, but it +is not at first attended with inflammation. + +The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polyposa of +Michaelis, if they differ from the peripneumony of infants, seem to belong +to this genus. When the difficulty of respiration is great, venesection is +immediately necessary, and then an emetic, and a blister. And the child +should be kept nearly upright in bed as much as may be. See Tonsillitis, +Class II. 1. 3. 3. + +M. M. Diluents, emetics, essence of antimony, foetid gums, onions, warm +bath for half an hour every day for a month. Inhaling the steam of water, +with or without volatile alcali. Soap. + +5. _Constipatio alvi._ Costiveness from increased action of the intestinal +absorbents. The feces are hardened in lumps called scybala; which are +sometimes obliged to be extracted from the rectum with a kind of marrow +spoon. This is said to have happened from the patient having taken much +rust of iron. The mucus is also hardened so as to line the intestines, and +to come away in skins, rolled up as they pass along, so as to resemble +worms, for which they are frequently mistaken; and sometimes it is +evacuated in still larger pieces, so as to counterfeit the form of the +intestines, and has been mistaken for a portion of them. Balls of this +kind, nearly as heavy as marble, and considerably hard, from two inches to +five in diameter, are frequently found in the bowels of horses. Similar +balls found in goats have been called Bezoar. + +M. M. Cathartics, Diluents, fruit, oil, soap, sulphur, warm bath. +Sprinkling with cold water, cool clothing. See Class I. 2. 4. 18. + +6. _Cutis arida._ Dry skin. This dry skin is not attended with coldness as +in the beginning of fever-fits. Where this cutaneous absorption is great, +and the secreted material upon it viscid, as on the hairy scalp, the skin +becomes covered with hardened mucus; which adheres so as not to be easily +removed, as the scurf on the head; but is not attended with inflammation +like the Tinea, or Lepra. The moisture, which appears on the skin beneath +resinous or oily plasters, or which is seen to adhere to such plasters, is +owing to their preventing the exhalation of the perspirable matter, and not +to their increasing the production of it, as some have idly imagined. + +M. M. Warm bathing, oil externally, oil-skin gloves, resinous plasters. +Wax. + +7. _Urina parca colorata._ Diminished urine, which is high coloured, and +deposits an earthy sediment, when cold, is owing to the great action of the +urinary absorbents. See Class I. 1. 2. 4. In some dropsies the cutaneous +absorbents are paralytic, as well as those opening into the cellular +membrane; and hence, no moisture being acquired from the atmosphere, or +from the cellular membrane, great thirst is excited; and great absorption +from all parts, where the absorbents are still capable of action. Hence the +urine is in very small quantity, and of deep colour, with copious sediment; +and the kidneys are erroneously blamed for not doing their office; +stimulant diuretic medicines are given in vain; and very frequently the +unhappy patient is restrained from quenching his thirst, and dies a martyr +to false theory. + +M. M. Diluent liquids, and warm bathing, are the natural cure of this +symptom; but it generally attends those dropsies, which are seldom curable; +as they are owing to a paralysis both of the cutaneous and cellular +lymphatics. + +8. _Calculus felleus._ Gall-stone. From the too hasty absorption of the +thinner parts of the bile, the remainder is left too viscid, and +crystallizes into lumps; which, if too large to pass, obstruct the ductus +choledochus, producing pain at the pit of the stomach, and jaundice. When +the indurated bile is not harder than a boiled pea, it may pass through the +bile-duct with difficulty by changing its form; and thus gives those pains, +which have been called spasms of the stomach; and yet these viscid lumps of +bile may afterwards dissolve, and not be visible among the feces. + +In two instances I have seen from thirty to fifty gall-stones voided after +taking an oil vomit as below. They were about the size of peas, and +distinguishable when dry by their being inflammable like bad wax, when put +into the flame of a candle. For other causes of jaundice, see Class I. 2. +4. 19. + +M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. +Unboiled acrid vegetables, as lettice, cabbage, mustard, and cresses. When +in violent pain, four ounces of oil of olives, or of almonds, should be +swallowed; and as much more in a quarter of an hour, whether it stays or +not. The patient should lie on the circumference of a large barrel, first +on one side, and then on the other. Electric shocks through the gall-duct. +Factitious Selter's water made by dissolving one dram of Sal Soda in a pint +of water; to half a pint of which made luke-warm add ten drops of marine +acid; to be drank as soon as mixed, twice a day for some months. Opium must +be used to quiet the pain, if the oil does not succeed, as two grains, and +another grain in half an hour if necessary. See Class IV. 2. 2. 4. + +9. _Calculus renis._ Stone of the kidney. The pain in the loins and along +the course of the ureter from a stone is attended with retraction of the +testicle in men, and numbness on the inside of the thigh in women. It is +distinguished from the lumbago or sciatica, as these latter are seldom +attended with vomiting, and have pain on the outside of the thigh, +sometimes quite down to the ankle or heel. See Herpes and Nephritis. + +Where the absorption of the thinner parts of the secretion takes place too +hastily in the kidnies, the hardened mucus, and consequent calculous +concretions, sometimes totally stop up the tubuli uriniferi; and no urine +is secreted. Of this many die, who have drank much vinous spirit, and some +of them recover by voiding a quantity of white mucus, like chalk and water; +and others by voiding a great quantity of sand, or small calculi. This +hardened mucus frequently becomes the nucleus of a stone in the bladder. +The salts of the urine, called microcosmic salt, are often mistaken for +gravel, but are distinguishable both by their angles of crystallization, +their adhesion to the sides or bottom of the pot, and by their not being +formed till the urine cools. Whereas the particles of gravel are generally +without angles, and always drop to the bottom of the vessel, immediately as +the water is voided. + +Though the proximate cause of the formation of the calculous concretions of +the kidneys, and of chalk-stones in the gout, and of the insoluble +concretions of coagulable lymph, which are found on membranes, which have +been inflamed in peripneumony, or rheumatism, consists in the too great +action of the absorbent vessels of those parts; yet the remote cause in +these cases is probably owing to the inflammation of the membranes; which +at that time are believed to secrete a material more liable to coagulate or +concrete, than they would otherwise produce by increased action alone +without the production of new vessels, which constitutes inflammation. As +defined in Class II. 1. 2. + +The fluids secreted from the mucous membranes of animals are of various +kinds and consistencies. Hair, silk, scales, horns, fingernails, are owing +to natural processes. Gall-stones, stones found in the intestines of +horses, scurf of the skin in leprosy, stones of the kidnies and bladder, +the callus from the inflamed periosteum, which unites broken bones, the +calcareous cement, which repairs the injured shells of snails, the +calcareous crust on the eggs of birds, the annually renewed shells of +crabs, are all instances of productions from mucous membranes, afterwards +indurated by absorption of their thinner parts. + +All these concretions contain phosphoric acid, mucus, and calcareous earth +in different proportions; and are probably so far analogous in respect to +their component parts as well as their mode of formation. Some calcareous +earth has been discovered after putrefaction in the coagulable lymph of +animals. Fordyce's Elements of Practice. A little calcareous earth was +detected by Scheel or Bergman in the calculus of the bladder with much +phosphoric acid, and a great quantity of phosphoric acid is shewn to exist +in oyster-shells by their becoming luminous on exposing them a while to the +sun's light after calcination; as in the experiments of Wilson. Botanic +Garden, P. 1. Canto 1. l. 182, note. The exchange of which phosphoric acid +for carbonic acid, or fixed air, converts shells into limestone, producing +mountains of marble, or calcareous strata. + +Now as the hard lumps of calcareous matter, termed crabs' eyes, which are +found in the stomachs of those animals previous to the annual renewal of +their shells, are redissolved, probably by their gastric acid, and again +deposited for that purpose; may it not be concluded, that the stone of the +bladder might be dissolved by the gastric juice of fish of prey, as of +crabs, or pike; or of voracious young birds, as young rooks or hawks, or +even of calves? Could not these experiments be tried by collecting the +gastric juice by putting bits of sponge down the throats of young crows, +and retracting them by a string in the manner of Spallanzani? or putting +pieces of calculus down the throat of a living crow, or pike, and observing +if they become digested? and lastly could not gastric juice, if it should +appear to be a solvent, be injected and born in the bladder without injury +by means of catheters of elastic resin, or caoutchouc? + +M. M. Diluents. Cool dress. Frequent change of posture. Frequent horizontal +rest in the day. Bathe the loins every morning with a sponge and cold +water. Aerated alcaline water internally. Abstinence from all fermented or +spirituous liquors. Whatever increases perspiration injures these patients, +as it dissipates the aqueous particles, which ought to dilute the urine. +When the constitution begins to produce gravel, it may I believe be +certainly prevented by a total abstinence from fermented or spirituous +liquors; by drinking much aqueous fluids; as toast and water, tea, milk and +water, lemonade; and lastly by thin clothing, and sleeping on a hardish +bed, that the patient may not lie too long on one side. See Class IV. 2. 2. +2. There is reason to believe, that the daily use of opium contributes to +produce gravel in the kidnies by increasing absorption, when they are +inflamed; in the same manner as is done by fermented or spirituous liquor. +See Class I. 3. 2. 11. + +When the kidnies are so obstructed with gravel, that no urine passes into +the bladder; which is known by the external appearance of the lower part of +the abdomen, which, when the bladder is full, seems as if contracted by a +cord between the navel and the bladder; and by the tension on the region of +the bladder distinguishable by the touch; or by the introduction of the +catheter; the following methods of cure are frequently successful. +Venesection to six or eight ounces, ten grains of calomel, and an infusion +of senna with salts and oil, every three hours, till stools are procured. +Then an emetic. After the patient has been thus evacuated, a blister on the +loins should be used; and from ten to twenty electric shocks should be +passed through the kidnies, as large as can be easily borne, once or twice +a day. Along with this method the warm bath should be used for an hour once +or twice a day. After repeated evacuations a clyster, consisting of two +drams of turpentine dissolved by yolk of egg, and sixty drops of tincture +of opium, should be used at night, and repeated, with cathartic medicines +interposed, every night, or alternate nights. Aerated solution of alcali +should be taken internally, and balsam of copaiva, three or four times a +day. Some of these patients recover after having made no water for nine or +ten days. + +If a stone sticks in the ureter with incessant vomiting, ten grains of +calomel must be given in small pills as above; and some hours afterwards +infusion of senna and salts and oil, if it can be made to stay on the +stomach. And after the purge has operated four or five times, an opiate is +to be given, if the pain continues, consisting of two grains of opium. If +this does not succeed, ten or twenty electric shocks through the kidney +should be tried, and the purgative repeated, and afterwards the opiate. The +patient should be frequently put into the warm bath for an hour at a time. +Eighty or an hundred drops of laudanum given in a glyster, with two drams +of turpentine, is to be preferred to the two grains given by the stomach as +above, when the pain and vomiting are very urgent. + +10. _Calculus vesicae._ Stone of the bladder. The nucleus, or kernel, of +these concretions is always formed in the kidney, as above described; and +passing down the ureter into the bladder, is there perpetually increased by +the mucus and salts secreted from the arterial system, or by the mucus of +the bladder, disposed in concentric strata. The stones found in the bowels +of horses are also formed on a nucleus, and consist of concentric spheres; +as appears in sawing them through the middle. But as these are formed by +the indurated mucus of the intestines alone without the urinary salts, it +is probable a difference would be found on their analysis. + +As the stones of the bladder are of various degrees of hardness, and +probably differ from each other in the proportions at least of their +component parts; when a patient, who labours under this afflicting disease, +voids any small bits of gravel; these should be kept in warm solutions of +caustic alcali, or of mild alcali well aerated; and if they dissolve in +these solutions, it would afford greater hopes, that that which remains in +the bladder, might be affected by these medicines taken by the stomach, or +injected into the bladder. + +To prevent the increase of a stone in the bladder much diluent drink should +be taken; as half a pint of water warmed to about eighty degrees, three or +four times a day: which will not only prevent the growth of it, by +preventing any microcosmic salts from being precipitated from the urine, +and by keeping the mucus suspended in it; but will also diminish the stone +already formed, by softening, and washing away its surface. To this must be +added cool dress, and cool bed-clothes, as directed above in the calculus +renis. + +When the stone is pushed against or into the neck of the bladder, great +pain is produced; this may sometimes be relieved by the introduction of a +bougie to push the stone back into the fundus of the bladder. Sometimes by +change of posture, or by an opiate either taken into the stomach, or by a +clyster. + +A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and +well saturated with carbonic acid (fixed air), by means of Dr. Nooth's +glass-apparatus, and drank every day, or twice a day, is the most +efficacious internal medicine yet discovered, which can be easily taken +without any general injury to the constitution. An aerated alcaline water +of this kind is sold under the name of factitious Seltzer water, by J. +Schweppe, at N^o 8, King's-street, Holborn, London; which I am told is +better prepared than can be easily done in the usual glass-vessels, +probably by employing a greater pressure in wooden ones. + +Lythotomy is the last recourse. Will the gastric juice of animals dissolve +calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and +water in the act of fermentation with yest, dissolve any kind of animal +concretions? + +11. _Calculus arthriticus._ Gout-stones are formed on inflamed membranes, +like those of the kidnies above described, by the too hasty absorption of +the thinner and saline parts of the mucus. Similar concretions have been +produced in the lungs, and even in the pericardium; and it is probable, +that the ossification, as it is called, of the minute arteries, which is +said to attend old age, and to precede some mortifications of the +extremities, may be a process of this kind. + +As gout-stones lie near the surface, it is probable, that ether, frequently +applied in their early state, might render them so liquid as to permit +their reabsorption; which the stimulus of the ether might at the same time +encourage. + +12. _Rheumatismus chronicus._ Chronic rheumatism. After the acute +rheumatism some inspissated mucus, or material similar to chalk-stones of +the gout, which was secreted on the inflamed membrane, is probably left, +owing to the too hasty absorption of the thinner and saline part of it; and +by lying on the fascia, which covers some of the muscles, pains them, when +they move and rub against it, like any extraneous material. + +The pain of the shoulder, which attends inflammations of the upper membrane +of the liver, and the pains of the arms, which attend asthma dolorificum, +or dropsy of the pericardium, are distinguished from the chronic +rheumatism, as in the latter the pain only occurs on moving the affected +muscles. + +M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so +as to compress the part. Cover the part with flannel. With oiled silk. Rub +it with common oil frequently. With ether. A blister. A warmer climate. +Venesection. A grain of calomel and a grain of opium for ten successive +nights. The Peruvian bark. + +13. _Cicatrix vulnerum._ The scar after wounds. In the healing of ulcers +the matter is first thickened by increasing the absorption in them; and +then lessened, till all the matter is absorbed, which is brought by the +arteries, instead of being deposed in the ulcer. + +M. M. This is promoted by bandage, by the sorbentia externally, as powder +of bark, white lead; solution of sugar of lead. And by the sorbentia +internally after evacuations. See Sect. XXXIII. 3. 2. + +In those ulcers, which are made by the contact of external fire, the +violent action of the fibres, which occasions the pain, is liable to +continue, after the external heat is withdrawn. This should be relieved by +external cold, as of snow, salt and water recently mixed, ether, or spirits +of wine suffered to evaporate on the part. + +The cicatrix of an ulcer generally proceeds from the edges of it; but in +large ones frequently from the middle, or commences in several places at +the same time; which probably contributes to the unevenness of large scars. + +14. _Corneae obfuscatio._ Opacity of the cornea. There are few people, who +have passed the middle of life, who have not at some time suffered some +slight scratches or injuries of the cornea, which by not healing with a +perfectly smooth surface, occasion some refractions of light, which may be +conveniently seen in the following manner: fill a tea-saucer with cream and +tea, or with milk, and holding it to your lips, as if going to drink it, +the imperfections of the cornea will appear like lines or blotches on the +surface of the fluid, with a less white appearance than that surface. Those +blemishes of the eye are distinguished from the muscae volitantes described +in Class I. 2. 5. 3. by their being invariably seen at any time, when you +look for them. + +Ulcers may frequently be seen on the cornea after ophthalmy, like little +pits or indentations beneath the surface of it: in this case no external +application should be used, lest the scar should be left uneven; but the +cure should be confined to the internal use of thirty grains of bark twice +a day, and from five to ten drops of laudanum at night, with five grains of +rhubarb, if necessary. + +After ulcers of the cornea, which have been large, the inequalities and +opacity of the cicatrix obscures the sight; in this case could not a small +piece of the cornea be cut out by a kind of trephine about the size of a +thick bristle, or a small crow-quill, and would it not heal with a +transparent scar? This experiment is worth trying, and might be done by a +piece of hollow steel wire with a sharp edge, through which might be +introduced a pointed steel screw; the screw to be introduced through the +opake cornea to hold it up, and press it against the cutting edge of the +hollow wire or cylinder; if the scar should heal without losing its +transparency, many blind people might be made to see tolerably well by this +slight and not painful operation. An experiment I wish strongly to +recommend to some ingenious surgeon or oculist. + + * * * * * + +ORDO I. + +_Increased Irritation._ + +GENUS IV. + +_With increased Actions of other Cavities and Membranes._ + +SPECIES. + +1. _Nictitatio irritativa._ Winking of the eyes is performed every minute +without our attention, for the purpose of cleaning and moistening the +eye-ball; as further spoken of in Class II. 1. 1. 8. When the cornea +becomes too dry, it becomes at the same time less transparent; which is +owing to the pores of it being then too large, so that the particles of +light are refracted by the edges of each pore, instead of passing through +it; in the same manner as light is refracted by passing near the edge of a +knife. When these pores are filled with water, the cornea becomes again +transparent. This want of transparency of the cornea is visible sometimes +in dying people, owing to their inirritability, and consequent neglect of +nictitation. + +The increase of transparency by filling the pores with fluid is seen by +soaking white paper in oil; which from an opake body becomes very +transparent, and accounts for a curious atmospheric phenomenon; when there +exists a dry mist in a morning so as to render distant objects less +distinct, it is a sign of a dry day; when distant objects are seen very +distinct, it is a sign of rain. See Botan. Garden, Part I. add. note xxv. +The particles of air are probably larger than those of water, as water will +pass through leather and paper, which will confine air; hence when the +atmosphere is much deprived of moisture, the pores of the dry air are so +large, that the rays of light are refracted by their edges instead of +passing through them. But when as much moisture is added as can be +perfectly dissolved, the air becomes transparent; and opake again, when a +part of this moisture collects into small spherules previous to its +precipitation. This also accounts for the want of transparency of the air, +which is seen in tremulous motions over corn-fields on hot summer-days, or +over brick-kilns, after the flame is extinguished, while the furnace still +remains hot. + +2. _Deglutitio irritativa._ The deglutition of our saliva is performed +frequently without our attention, and is then an irritative action in +consequence of the stimulus of it in the mouth. Or perhaps sometimes for +the purpose of diffusing a part of it over the dry membranes of the fauces +and pharinx; in the same manner as tears are diffused over the cornea of +the eye by the act of nictitation to clean or moisten it. + +3. _Respiratio et Tussis irritativae._ In the acts of respiration and of +coughing there is an increased motion of the air-cells of the lungs owing +to some stimulating cause, as described above in Class I. 1. 2. 8. and I. +1. 3. 4. and which are frequently performed without our attention or +consciousness, and are then irritative actions; and thus differ from those +described in Class II. 1. 1. 2. and 5. To these increased actions of the +air-cells are superadded those of the intercostal muscles and diaphragm by +irritative association. When any unnatural stimulus acts so violently on +the organs of respiration as to induce pain, the sensorial power of +sensation becomes added to that of irritation, and inflammation of the +membranes of them is a general consequence. + +4. _Exclusio bilis._ The exclusion of the bile from the gall-bladder, and +its derivation into the duodenum, is an irritative action in consequence of +the stimulus of the aliment on the extremity of the biliary duct, which +terminates in the intestine. The increased secretion of tears is occasioned +in a similar manner by any stimulating material in the eyes; which affects +the excretory ducts of the lacrymal glands. A pain of the external membrane +of the eye sometimes attends any unusual stimulus of it, then the sensorial +power of sensation becomes added to that of irritation, and a superficial +inflammation is induced. + +5. _Dentitio._ Toothing. The pain of toothing often begins much earlier +than is suspected; and is liable to produce convulsions; which are +sometimes relieved, when the gum swells, and becomes inflamed; at other +times a diarrhoea supervenes, which is generally esteemed a favourable +circumstance, and seems to prevent the convulsions by supplying another +means of relieving the pain of dentition by irritative exertion; and a +consequent temporary exhaustion of sensorial power. See Class I. 1. 2. 5. +Sect. XXXV. 2. 1. + +The convulsions from toothing generally commence long before the appearance +of the teeth; but as the two middle incisors of the lower jaw generally +appear first, and then those of the upper, it is adviseable to lance the +gums over these longitudinally in respect to the jaw-bones, and quite down +to the periosteum, and through it. + +As the convulsions attending the commencement of toothing are not only +dangerous to life in their greatest degree, but are liable to induce stupor +or insensibility by their continuance even in a less degree, the most +efficacious means should be used to cure them. + +M. M. Lance the gum of the expected teeth quite through the periosteum +longitudinally. Venesection by the lancet or by two or three leeches. One +grain of calomel as a purge. Tincture of jalap, five or six drops in water +every three hours til it purges, to be repeated daily. After evacuations a +small blister on the back or behind the ears. And lastly, two or three +drops of laudanum according to the age of the child. Warm bath. See Class +III. 1. 1. 5. and 6. + +6. _Priapismus chronicus._ I have seen two cases, where an erection of the +penis, as hard as horn, continued two or three weeks without any venereal +desires, but not without some pain; the easiest attitude of the patients +was lying upon their backs with their knees up. At length the corpus +cavernosum urethrae became soft, and in another day or two the whole +subsided. In one of them a bougie was introduced, hoping to remove some bit +of gravel from the caput gallinaginis, camphor, warm bathing, opium, +lime-water, cold aspersion, bleeding in the veins of the penis, were tried +in vain. One of them had been a free drinker, had much gutta rosacea on his +face, and died suddenly a few months after his recovery from this +complaint. Was it a paralysis of the terminations of the veins, which +absorb the blood from the tumid penis? or from the stimulus of indurated +semen in the seminal vessels? In the latter case some venereal desires +should have attended. Class III. 1. 2. 16. + +The priapismus, which occurs to vigorous people in a morning before they +awake, has been called the signum salutis, or banner of health, and is +occasioned by the increase of our irritability or sensibility during sleep, +as explained in Sect. XVIII. 15. + +7. _Distentio mamularum._ The distention of the nipples of lactescent women +is at first owing to the stimulus of the milk. See Sect. XIV. 8. and Sect. +XVI. 5. See Class II. 1. 7. 10. + +8. _Descensus uteri._ This is a very frequent complaint after bad labours, +the fundus uteri becomes inverted and descends like the prolapsus ani. + +M. M. All the usual pessaries are very inconvenient and ineffectual. A +piece of soft sponge about two inches diameter introduced into the vagina +gives great ease to these patients, and supports the uterus; it should have +a string put through it to retract it by. + +There are also pessaries now made of elastic gum, which are said to be +easily worn, and to be convenient, from their having a perforation in their +centre. + +9. _Prolapsus ani._ The lower part of the rectum becomes inverted, and +descends after every stool chiefly in children; and thus stimulates the +sphincter ani like any other extraneous body. + +M. M. It should be dusted over with very fine powder of gum sandarach, and +then replaced. Astringent fomentations; as an infusion of oak-bark, or a +slight solution of alum. Horizontal rest frequently in the day. + +10. _Lumbricus._ Round worm. The round worm is suspected in children when +the belly is tumid, and the countenance bloated and pale, with swelling of +the upper lip. The generation of these worms is promoted by the too dilute +state of the bile, as is evident in the fleuke-worm found in the biliary +ducts and substance of the liver in sheep; and in water-rats, in the livers +of which last animals they were lately detected in large numbers by Dr. +Capelle. Transactions of the college at Philadelphia, v. i. + +Now as the dilute state of the bile depends on the deficiency of the +absorption of its thinner parts, it appears, that the tumid belly, and +bloated countenance, and swelled upper lip, are a concomitant circumstance +attending the general inactivity of the absorbent system; which is +therefore to be esteemed the remote cause of the generation of worms. + +The simplicity of the structure of worms probably enables them to exist in +more various temperatures of heat; and their being endued with life +prevents them from being destroyed by digestion in the stomach, probably in +the same manner as the powers of life prevent the fermentation and +putrefaction of the stomach itself. Hence I conclude, that worms are +originally taken into our alimentary canal from without; as I believe +similar worms of all kinds are to be found out of the body. + +M. M. The round worm is destroyed by a cathartic with four or six grains of +calomel; and afterwards by giving six or eight grains of filings of iron +twice a day for a fortnight. See Hepatis tumor, Class I. 2. 3. 9. As worms +are liable to come away in fevers, whether of the hectic or putrid kind, +could they be removed by purulent matter, or rotten egg, or putrid flesh, +since in those fevers from the enfeebled action of the intestines the +faeces become highly putrid? + +11. _Taenia._ Tape-worm consists of a chain of animals extending from the +stomach to the anus. See Sect. XXXIX. 2. 3. It frequently exists in cats, +rats, and geese, and probably in many other animals. + +The worms of this genus possess a wonderful power of retaining life. Two of +them, which were voided by a pointer dog in consequence of violent +purgatives, each of which were several feet in length, had boiling water +poured on them in a bason; which seemed not much to inconvenience them. +When the water was cool, they were taken out and put into gin or whiskey of +the strongest kind, in which their life and activity continued unimpaired; +and they were at length killed by adding to the spirit a quantity of +corrosive sublimate. Medic. Comment. for 1791, p. 370. + +The tape-worm is cured by an amalgama of tin and quicksilver, such as is +used on the back of looking-glasses; an ounce should be taken every two +hours, till a pound is taken; and then a brisk cathartic of Glauber's salt +two ounces, and common salts one ounce, dissolved in two wine pints of +water, half a pint to be taken every hour till it purges. The worm extends +from the stomach to the anus, and the amalgama tears it from the intestine +by mechanical pressure, acting upon it the whole way. Electric shocks +through the duodenum greatly assists the operation. Large doses of tin in +powder. Iron filings in large doses. The powder of fern-root seems to be of +no use, as recommended by M. Noufflier. + +12. _Ascarides._ Thread-worms. These worms are said to be more frequent in +some parts of this kingdom than in others, as near the fens of +Lincolnshire. Do they escape from the body and become flies, like the +bott-worm in horses? Do they crawl from one child to another in the same +bed? Are they acquired from flies or worms, which are seen in putrid +necessary houses, as these worms as well as the tapeworms, are probably +acquired from without? this may account for their re-appearance a few weeks +or months after they have been destroyed; or can this happen from the eggs +or parts of them remaining? + +Ascarides appear to be of two kinds, the common small ones like a thread; +which has a very sharp head, as appears in the microscope; and which is so +tender, that the cold air soon renders it motionless; and a larger kind +above an inch long, and nearly as thick as a very small crow-quill, and +which is very hard in respect to its texture, and very tenacious of life. +One of these last was brought to me, and was immediately immersed in a +strong solution of sugar of lead, and lived in it a very long time without +apparent inconvenience. + +M. M. Ascarides are said to be weakened by twenty grains of cinnabar and +five of rhubarb taken every night, but not to be cured by this process. As +these worms are found only in the rectum, variety of clysters have been +recommended. I was informed of a case, where solutions of mercurial +ointment were used as a clyster every night for a month without success. +Clysters of Harrowgate water are recomended, either of the natural, or of +the factitious, as described below, which might have a greater proportion +of liver of sulphur in it. As the cold air soon destroys them, after they +are voided, could clysters of iced water be used with advantage? or of +spirit of wine and water? or of ether and water? Might not a piece of +candle, about an inch long, or two such pieces, smeared with mercurial +ointment, and introduced into the anus at night, or twice a day, be +effectual by compressing their nidus, as well as by the poison of the +mercury. + +The clysters should be large in quantity, that they may pass high in the +rectum, as two drams of tobacco boiled a minute in a pint of water. Or +perhaps what might be still more efficacious and less inconvenient, the +smoke of tobacco injected by a proper apparatus every night, or alternate +nights, for six or eight weeks. This was long since recommended, I think by +Mr. Turner of Liverpool; and the reason it has not succeeded, I believe to +have been owing to the imperfections of the joints of the common apparatus +for injecting the smoke of tobacco, so that it did not pass into the +intestine, though it was supposed to do so, as I once observed. The smoke +should be received from the apparatus into a large bladder; and it may then +be certainly injected like the common clyster with sufficient force; +otherwise oiled leathers should be nicely put round the joints of the +machine; and a wet cloth round the injecting pipe to prevent the return of +the smoke by the sides of it. Clysters of carbonated hydrogen gas, or of +other factitious airs, might be tried. + +Harrowgate water taken into the stomach, so as to induce six or seven +stools every morning, for four or six weeks, is perhaps the most +efficacious method in common use. A factitious Harrowgate water may be made +probably of greater efficacy than the natural, by dissolving one ounce of +marine salt, (called bay salt) and half an ounce of magnesia Glauber's +salt, (called Epsom salt, or bitter purging salt) in twenty-eight ounces of +water. A quarter or half a pint of this is to be taken every hour, or two +hours in the morning, till it operates, with a tea-spoonful of a solution +of liver of sulphur, which is to be made by putting an ounce of hepar +sulphuris into half a pint of water. See Class IV. 1. 2. 9. + +13. _Dracunculus._ A thin worm brought from the coast of Guinea. It is +found in the interstices of the muscles, and is many yards long; it makes a +small ulcer; which is cured by extracting an inch of the worm a day, and +wrapping the extracted part slowly round a bit of tobacco pipe till next +day, so as not to break it. I have twice seen long worms, like a thick +horse-hair, in water in July in this country, which appeared hard and +jointed. + +14. _Morpiones._ Crab-lice. The excrement of this animal stains the linen, +and appears like diluted blood. + +M. M. Spirit of wine. Mercurial ointment, shaving the part. Oil destroys +other insects, if they be quite covered with it, as the ticks on dogs, and +would probably therefore destroy these. Its manner of operation is by +stopping up or filling their spiracula, or breathing pores; a few drops of +oil poured on a wasp, so as to cover it, destroys it in a few seconds. + +15. _Pediculi._ Lice. There is said to be a disease, in which these animals +are propagated in indestructible numbers, so as to destroy the patient. + +M. M. Cleanliness, mercurial ointment, stavis acria in powder, or the +tincture of it in spirit of wine. Spirit of wine alone? Bath of oil? + + * * * * * + +ORDO I. + +_Increased Irritation._ + +GENUS V. + +_With Increased Actions of the Organs of Sense._ + +SPECIES. + +1. _Visus acrior._ Acuter sight. There have been instances of people, who +could see better in the gloom of the evening, than in the stronger light of +the day; like owls, and bats, and many quadrupeds, and flying insects. When +the eye is inflamed, great light becomes eminently painful, owing to the +increased irritative motions of the retina, and the consequent increased +sensation. Thus when the eye is dazzled with sudden light, the pain is not +owing to the motion of the iris; for it is the contraction of the iris, +which relieves the pain from sudden light; but to the too violent +contractions of the moving fibres, which constitute the extremities of the +optic nerve. + +2. _Auditus acrior._ The irritative ideas of hearing are so increased in +energy as to excite our attention. This happens in some diseases of the +epileptic kind, and in some fevers. Hence the whispering of the currents of +air in a room, the respiration of the company, and noises before +unperceived, become troublesome; and sounds louder than usual, or +unexpected, produce starting, and convulsions. + +M. M. Put oil of almonds into the ears. Stop the meatus auditorius with +cotton wool. Set the feet of the patient's bed on cushions, or suspend it +by cords from the ceiling. + +3. _Olfactus acrior._ The irritative ideas of smell from the increased +action of the olfactive nerve excite our attention. Hence common odours are +disagreeable; and are perceived from variety of objects, which were before +thought inodorous. These are commonly believed to be hallucinations of the +sense. + +M. M. Snuff starch up the nostrils. + +4. _Gustus acrior._ The irritative ideas of taste, as of our own saliva, +and even of the atmospheric air, excite our attention; and common tastes +are disagreeably strong. + +M. M. Water. Mucilage. Vegetable acids. Scrape the tongue clean. Rub it +with a sage-leaf and vinegar. + +5. _Tactus acrior._ The irritative ideas of the nerves of touch excite our +attention: hence our own pressure on the parts, we rest upon, becomes +uneasy with universal soreness. + +M. M. Soft feather-bed. Combed wool put under the patients, which rolls +under them, as they turn, and thus prevents their friction against the +sheets. Drawers of soft leather. Plasters of cerate with calamy. + +6. _Sensus caloris acrior._ Acuter sense of heat occurs in some diseases, +and that even when the perceptible heat does not appear greater than +natural to the hand of another person. See Class I. 1. 2. See Sect. XIV. 8. +All the above increased actions of our organs of sense separately or +jointly accompany some fevers, and some epileptic diseases; the patients +complaining of the perception of the least light, noises in their ears, bad +smells in the room, and bad tastes in their mouths, with soreness, +numbness, and other uneasy feels, and with disagreeable sensations of +general or partial heat. + +7. _Sensus extensionis acrior._ Acuter sense of extension. The sense of +extension was spoken of in Sect. XIV. 7. and XXXII. 4. The defect of +distention in the arterial system is accompanied with faintness; and its +excess with sensations of fulness, or weight, or pressure. This however +refers only to the vascular muscles, which are distended by their +appropriated fluids; but the longitudinal muscles are also affected by +different quantities of extension, and become violently painful by the +excess of it. + +These pains of muscles and of membranes are generally divided into acute +and dull pains. The former are generally owing to increase of extension, as +in pricking the skin with a needle; and the latter generally to defect of +extension, as in cold head-aches; but if the edge of a knife, or point of a +pin, be gradually pressed against the fibres of muscles or membranes, there +would seem to be three states or stages of this extension of the fibres; +which have acquired names according to the degree or kind of sensation +produced by the extension of them; these are 1. titillation or tickling. 2. +itching, and the 3. smarting; as described below. See Sect. XIV. 9. + +8. _Titillatio._ Tickling is a pleasureable pain of the sense of extension +above mentioned, and therefore excites laughter; as described in Sect. +XXXIV. 1. 4. The tickling of the nostrils, which precedes the efforts of +sneezing, is owing to the increased irritation occasioned by external +stimulus; and is attended with a pleasureable sensation in consequence of +the increased action of the part. When this action is exerted in a greater +degree, the sensation becomes painful, and the convulsion of sneezing +ensues; as the pain in tickling the soles of the feet of children is +relieved by laughter. + +A lady after a bruise on her nose by a fall was affected with incessant +sneezing, and relieved by snuffing starch up her nostrils. Perpetual +sneezings in the measles, and in catarrhs from cold, are owing to the +stimulus of the saline part of the mucous effusion on the membrane of the +nostrils. See Class II. 1. 1. 3. + +9. _Pruritus._ Itching seems to be a greater degree of titillation, and to +be owing to the stimulus of some acrid material, as the matter of the itch; +or of the herpes on the scrotum, and about the anus; or from those +universal eruptions, which attend some elderly people, who have drank much +vinous spirit. It occurs also, when inflammations are declining, as in the +healing of blisters, or in the cure of ophthalmia, as the action of the +vessels is yet so great as to produce sensation; which, like the +titillations that occasion laughter, is perpetually changing from pleasure +to pain. + +When the natural efforts of scratching do not relieve the pain of itching, +it sometimes increases so as to induce convulsions and madness. As in the +furor uterinus, and satyriasis, and in the sphincter ani and scrotum. See +Class II. 1. 4. 14. IV. 2. 2. 6. + +M. M. Warm bath. Fomentation. Alcohol externally. Poultice. Oiled silk. +Mercurial ointments on small surfaces at once. See Class II. 1. 4. 12. +Solutions of lead on small surfaces at once. + +10. _Dolor urens._ Smarting follows the edge of a knife in making a wound, +and seems to be owing to the distention of a part of a fibre, till it +breaks. A smarting of the skin is liable to affect the scars left by herpes +or shingles; and the callous parts of the bottoms of the feet; and around +the bases of corns on the toes; and frequently extends after sciatica along +the outside of the thigh, and of the leg, and part of the foot. All these +may be owing to the stimulus of extension, by blood or serum being forced +into vessels nearly coalesced. + +M. M. Emplastrum de minio put like a bandage on the part. Warm fomentation. +Oil and camphor rubbed on the part. Oil-silk covering. A blister on the +part. Ether, or alcohol, suffered to evaporate on the part. + +11. _Consternatio._ Surprise. As our eyes acquaint us at the same time with +less than half of the objects, which surround us, we have learned to +confide much in the organ of hearing to warn us of approaching dangers. +Hence it happens, that if any sound strikes us, which we cannot immediately +account for, our fears are instantly alarmed. Thus in great debility of +body, the loud clapping of a door, or the fall of a fire-shovel, produces +alarm, and sometimes even convulsions; the same occurs from unexpected +sights, and in the dark from unexpected objects of touch. + +In these cases the irritability is less than natural, though it is +erroneously supposed to be greater; and the mind is busied in exciting a +train of ideas inattentive to external objects; when this train of ideas is +dissevered by any unexpected stimulus, surprise is excited; as explained in +Sect. XVII. 3. 7. and XVIII. 17. then as the sensibility in these cases is +greater, fear becomes superadded to the surprise; and convulsions in +consequence of the pain of fear. See Sect. XIX. 2. + +The proximate cause of surprise is the increased irritation induced by some +violent stimulus, which dissevers our usual trains of ideas; but in +diseases of inirritability the frequent starting or surprise from sounds +not uncommon, but rather louder than usual, as the clapping of a door, +shews, that the attention of the patient to a train of sensitive ideas was +previously stronger than natural, and indicates an incipient delirium; +which is therefore worth attending to in febrile diseases. + + * * * * * + +ORDO II. + +_Decreased Irritation._ + +GENUS I. + +_With decreased Action of the Sanguiferous System._ + +The reader should be here apprized, that the words strength and debility, +when applied to animal motions, may properly express the quantity of +resistance such motions may overcome; but that, when they are applied to +mean the susceptibility or insusceptibility of animal fibres to motion, +they become metaphorical terms; as in Sect. XII. 2. 1. and would be better +expressed by the words activity and inactivity. + +There are three sources of animal inactivity; first, the defect of the +natural quantity of stimulus on those fibres, which have been accustomed to +perpetual stimulus; as the arterial and secerning systems. When their +accustomed stimulus is for a while intermitted, as when snow is applied to +the skin of the hands, an accumulation of sensorial power is produced; and +then a degree of stimulus, as of heat, somewhat greater than that at +present applied, though much less than the natural quantity, excites the +vessels of the skin into violent action. We must observe, that a deficiency +of stimulus in those fibres, which are not subject to perpetual stimulus, +as the locomotive muscles, is not succeeded by accumulation of sensorial +power; these therefore are more liable to become permanently inactive after +a diminution of stimulus; as in strokes of the palsy, this may be called +inactivity from defect of stimulus. + +2. A second source of animal inactivity exists, when the sensorial power in +any part of the system has been previously exhausted by violent stimuli; as +the eyes after long exposure to great light; or the stomach, to repeated +spirituous potation; this may be termed inactivity from exhaustion of +sensorial power. See Sect. XII. 2. 1. + +3. But there is a third source of inactivity owing to the deficient +production of sensorial power in the brain; and hence stimuli stronger than +natural are required to produce the accustomed motions of the arterial +system; in this case there is no accumulation of sensorial power produced; +as in the inactivity owing to defect of stimulus; nor any previous +exhaustion of it, as in the inactivity owing to excess of stimulus. + +This third kind of inactivity causes many of the diseases of this genus; +which are therefore in general to be remedied by such medicines as promote +a greater production of sensorial power in the brain; as the incitantia, +consisting of wine, beer, and opium, in small repeated quantities; and +secondly of such as simply stimulate the arterial and glandular system into +their natural actions; as small repeated blisters, spices, and essential +oils. And lastly the sorbentia, which contribute to supply the more +permanent strength of the system, by promoting the absorption of +nourishment from the stomach, and intestines; and of the superfluous fluid, +which attends the secretions. + +SPECIES. + +1. _Febris inirritativa._ Inirritative fever. This is the typhus mitior, or +nervous fever of some writers; it is attended with weak pulse without +inflammation, or symptoms of putridity, as they have been called. When the +production of sensorial power in the brain is less than usual, the pulse +becomes quick as well as weak; and the heart sometimes trembles like the +limbs of old age, or of enfeebled drunkards; and when this force of the +contractions of the heart and arteries is diminished, the blood is pushed +on with less energy, as well as in less quantity, and thence its stimulus +on their sides is diminished in a duplicate ratio. In compressions of the +brain, as in apoplexy, the pulse becomes slower and fuller; for in that +disease, as in natural sleep, the irritative motions of the heart and +arteries are not diminished, volition alone is suspended or destroyed. + +If the absorption of the terminations of the veins is not equally impaired +with the force of the heart and arteries, the blood is taken up by the +veins the instant it arrives at their extremities; the capillary vessels +are left empty, and there is less resistance to the current of the blood +from the arteries; hence the pulse becomes empty, as well as weak and +quick; the veins of the skin are fuller than the arteries of it; and its +appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1. + +When this pulse persists many hours, it constitutes the febris +inirritativa, or typhus, or nervous fever, of some writers; it is attended +with little heat, the urine is generally of a natural colour, though in +less quantity; with great prostration of strength, and much disturbance of +the faculties of the mind. Its immediate cause seems to be a deficient +secretion of the sensorial power from the inaction of the brain; hence +almost the whole of the sensorial power is expended in the performance of +the motions necessary to life, and little of it can be spared for the +voluntary actions of the locomotive muscles, or organs of sense, see Class +I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some +other part of the body; as of the spleen, when a tumour is felt on the left +side, as in some intermittents; or of the kidnies, when the urine continues +pale and in small quantity. Does the revivescence of these affected parts, +or their torpor, recurring at intervals, form the paroxysms of these +fevers? and their permanent revivescence establish the cure? See Class IV. +2. 1. 19. + +M. M. Wine and opium in small quantities repeated every three hours +alternately; small repeated blisters; warm but fresh air; sorbentia; +nutrientia; transfusion of blood. Small electric shocks passed through the +brain in all directions. Oxygene air? + +2. _Paresis inirritativa._ Inirritative debility. A defective action of the +irritative motions without increase of the frequency of the pulse. It +continues three or four weeks like a fever, and then either terminates in +health, or the patient sinks into one kind of apoplexy, and perishes. Many +symptoms, which attend inirritative fevers, accompany this disease, as cold +hands and feet at periodic times, scurf on the tongue, want of appetite, +muddy urine, with pains of the head, and sometimes vertigo, and vomiting. + +This disease differs from the inirritative fever by the pulse not being +more frequent than in health. The want of appetite and of digestion is a +principal symptom, and probably is the cause of the universal debility, +which may be occasioned by the want of nourishment. The vertigo is a +symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine +is owing to increased absorption from the bladder in consequence of the +diminished cutaneous and cellular absorption, as in anasarca, explained in +Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of +that part of the system; the foul tongue is owing to an increased +absorption of the thinner part of the mucus in consequence of the general +deficiency of fluid, which should be absorbed by the skin and stomach. The +sickness is owing to decreased action of the stomach, which is probably the +primary disease, and is connected with the vertigo. + +M. M. An emetic. Calomel, grains iv. once or twice. Then a blister. +Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small +quantities, repeated alternately every three hours. Small electric +percussions through the stomach. + +3. _Somnus interruptus._ Interrupted sleep. In some fevers, where the +inirritability is very great, when the patient falls asleep, the pulse in a +few minutes becomes irregular, and the patient awakes in great disorder, +and fear of dying, refusing to sleep again from the terror of this uneasy +sensation. In this extreme debility there is reason to believe, that some +voluntary power during our waking hours is employed to aid the irritative +stimuli in carrying on the circulation of the blood through the lungs; in +the same manner as we use voluntary exertions, when we listen to weak +sounds, or wish to view an object by a small light; in sleep volition is +suspended, and the deficient irritation alone is not sufficient to carry on +the pulmonary circulation. This explanation seems the most probable one, +because in cases of apoplexy the irritative motions of the arterial system +do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13. + +M. M. Opium in very small doses, as three drops of laudanum. A person +should watch the patient, and awaken him frequently; or he should measure +the time between slumber and slumber by a stop-watch, and awaken the +patient a little before he would otherwise awake; or he should keep his +finger on the pulse, and should forcibly awaken him, as soon as it becomes +irregular, before the disorder of the circulation becomes so great as to +disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2. + +4. _Syncope._ Fainting consists in the decreased action of the arterial +system; which is sometimes occasioned by defect of the stimulus of +distention, as after venesection, or tapping for the dropsy. At other times +it arises from great emotions of the mind, as in sudden joy or grief. In +these cases the whole sensorial power is exerted on these interesting +ideas, and becomes exhausted. Thus during great surprise or fear the heart +stops for a time, and then proceeds with throbbing and agitation; and +sometimes the vital motions become so deranged, as never to recover their +natural successive action; as when children have been frightened into +convulsions. See Sect. XII. 7. 1. + +Miss ----, a young lady of Stafford, in travelling in a chaise was so +affected by seeing the fall of a horse and postillion, in going down a +hill, though the carriage was not overturned, that she fainted away, and +then became convulsed, and never spoke afterwards; though she lived about +three days in successive convulsions and stupor. + +5. _Haemorrhagia venosa._ A bleeding from the capillaries arising from +defect of venous absorption, as in some of those fevers commonly termed +putrid. When the blood stagnates in the cellular membrane, it produces +petechiae from this torpor or paralysis of the absorbent mouths of the +veins. It must be observed, that those people who have diseased livers, are +more liable to this kind of haemorrhages, as well as to the haemorrhagia +arteriosa; the former, because patients with diseased livers are more +subject to paralytic complaints in general, as to hemiplegia, and to +dropsy, which is a paralysis of the lymphatics; and the latter is probably +owing to the delay of the circulation in the vena porta by the torpor of +this hepatic vessel, when the liver is not much enlarged; and to its +pressure on the vena cava, when it is much enlarged. + +M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel +dissolved in spirit of wine externally. Flour. + +6. _Haemorrhois cruenta._ In the bleeding piles the capillary vessels of +the rectum become distended and painful from the defect of the venous +absorption of the part, and at length burst; or the mucous glands are so +dilated as to give a passage to the blood; it is said to observe lunar +periods. + +M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia. +External compression by applying lint, sponge, or cotton. Internal +compression by applying a bit of candle smeared with mercurial ointment. +Strangulate the tumid piles with a silk string. Cut them off. See Class I. +2. 3. 22. + +Mrs. ---- had for twelve or fifteen years, at intervals of a year or less, +a bleeding from the rectum without pain; which however stopped +spontaneously after she became weakened, or by the use of injections of +brandy and water. Lately the bleeding continued above two months, in the +quantity of many ounces a day, till she became pale and feeble to an +alarming degree. Injections of solutions of lead, of bark and salt of +steel, and of turpentine, with some internal astringents, and opiates, were +used in vain. An injection of the smoke of tobacco, with ten grains of +opium mixed with the tobacco, was used, but without effect the two first +times on account of the imperfection of the machine; on the third time it +produced great sickness, and vertigo, and nearly a fainting fit; from which +time the blood entirely stopped. Was this owing to a fungous excrescence in +the rectum; or to a blood-vessel being burst from the difficulty of the +blood passing through the vena porta from some hepatic obstruction, and +which had continued to bleed so long? Was it stopped at last by the +fainting fit? or by the stimulus of the tobacco? + +7. _Haemorrhagia renum._ Haemorrhage from the kidnies, when attended with +no pain, is owing to defect of venous absorption in the kidney. When +attended with pain on motion, it is owing to a bit of gravel in the ureter +or pelvis of the kidney; which is a much more frequent disease than the +former. See Sect. XXVII. 1. + +M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate; +cold immersion up to the navel, the upper part of the body being kept +cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent +liquids. Cool dress. Cool bed-room. + +Cows are much subject to bloody urine, called foul water by the farmers; in +this disease about sixty grains of opium with or without as much rust of +iron, given twice a day, in a ball mixed with flour and water, or dissolved +in warm water, or warm ale, is, I believe, an efficacious remedy, to which +however should be added about two quarts of barley or oats twice a day, and +a cover at night, if the weather be cold. + +8. _Haemorrhagia Hepatis._ Haemorrhage from the liver. It sometimes happens +in those, who have the gutta rosea, or paralytic affections owing to +diseased livers induced by the potation of fermented liquors, that a great +discharge of black viscid blood occasionally comes away by stool, and +sometimes by vomiting: this the ancients called Melancholia, black bile. If +it was bile, a small quantity of it would become yellow or green on +dilution with warm water, which was not the case in one experiment which I +tried; it must remain some time in the intestines from its black colour, +when it passes downwards, and probably comes from the bile-ducts, and is +often a fatal symptom. When it is evacuated by vomiting it is less +dangerous, because it shews greater remaining irritability of the +intestinal canal, and is sometimes salutary to those who have diseased +livers. + +M. M. An emetic. Rhubarb, steel, wine, bark. + +9. _Haemoptoe venosa._ Venous haemoptoe frequently attends the beginning of +the hereditary consumptions of dark-eyed people; and in others, whose lungs +have too little irritability. These spittings of blood are generally in +very small quantity, as a tea-spoonful; and return at first periodically, +as about once a month; and are less dangerous in the female than in the +male sex; as in the former they are often relieved by the natural periods +of the menses. Many of these patients are attacked with this pulmonary +haemorrhage in their first sleep; because in feeble people the power of +volition is necessary, besides that of irritation, to carry on respiration +perfectly; but, as volition is suspended during sleep, a part of the blood +is delayed in the vessels of the lungs, and in consequence effused, and the +patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II. +1. 6. 6. III. 2. 1. 10. + +M. M. Wake the patient every two or three hours by an alarum clock. Give +half a grain of opium at going to bed, or twice a day. Onions, garlic, +slight chalybeates. Issues. Leeches applied once a fortnight or month to +the hemorrhoidal veins to produce a new habit. Emetics after each period of +haemoptoe, to promote expectoration, and dislodge any effused blood, which +might by remaining in the lungs produce ulcers by its putridity. A hard +bed, to prevent too sound sleep. A periodical emetic or cathartic once a +fortnight. + +10. _Palpitatio cordis._ The palpitation of the heart frequently attends +the haemoptoe above mentioned; and consists in an ineffectual exertion of +the heart to push forwards its contents in due time, and with due force. +The remote cause is frequently some impediment to the general circulation; +as the torpor of the capillaries in cold paroxysms of fever, or great +adhesions of the lungs. At other times it arises from the debility of the +action of the heart owing to the deficient sensorial power of irritation or +of association, as at the approach of death. + +In both these cases of weak exertion the heart feels large to the touch, as +it does not completely empty itself at each contraction; and on that +account contracts more frequently, as described in Sect. XXXII. 2. 2. +Another kind of palpitation may sometimes arise from the retrograde motions +of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6. + +11. _Menorrhagia._ Continued flow of the catamenia. The monthly effusion of +blood from the uterus or vagina is owing to a torpor of the veins of those +membranes in consequence of the defect of venereal stimulus; and in this +respect resembles the mucus discharged in the periodical venereal orgasm of +the female quadrupeds, which are secluded from the males. The menorrhagia, +or continued flow of this discharge, is owing to a continued defect of the +venous absorption of the membranes of the uterus or vagina. See Class IV. +2. 4. 7. + +M. M. Venesection in small quantity. A cathartic. Then opium, a grain every +night. Steel. Bark. A blister. Topical aspersion with cold water, or cold +vinegar. + +12. _Dysmenorrhagia._ A difficulty of menstruation attended with pain. In +this complaint the torpor of the uterine vessels, which precedes +menstruation, is by sympathy accompanied with a torpor of the lumbar +membranes, and consequent pain; and frequently with cold extremities, and +general debility. The small quantity and difficulty of the discharge is +owing to arterial inactivity, as in chlorosis. Whence it happens, that +chalybeate medicines are of efficacy both to stop or prevent too great +menstruation, and to promote or increase deficient menstruation; as the +former is owing to inirritability of the veins, and the latter of the +arteries of the uterus. See Article IV. 2. 6. in the Materia Medica. + +M. M. Opium, steel, pediluvium. Warm bath. + +13. _Lochia nimia._ Too great discharge after delivery. In that unnatural +practice of some hasty accoucheurs of introducing the hand into the uterus +immediately after the delivery of the child, and forcibly bringing away the +placenta, it frequently happens, that a part of it is left behind; and the +uterus, not having power to exclude so small a portion of it, is prevented +from complete contraction, and a great haemorrhage ensues. In this +circumstance a bandage with a thick compress on the lower part of the +belly, by appressing the sides of the uterus on the remaining part of the +placenta, is likely to check the haemorrhage, like the application of a +pledget of any soft substance on a bleeding vessel. + +In other cases the lochia continues too long, or in too great quantity, +owing to the deficiency of venous absorption. + +M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark. +Clothes dipped in cold vinegar and applied externally. Bandages on the +limbs to keep more blood in them for a time have been recommended. + +14. _Abortio spontanea._ Some delicate ladies are perpetually liable to +spontaneous abortion, before the third, or after the seventh, month of +gestation. From some of these patients I have learnt, that they have +awakened with a slight degree of difficult respiration, so as to induce +them to rise hastily up in bed; and have hence suspected, that this was a +tendency to a kind of asthma, owing to a deficient absorption of blood in +the extremities of the pulmonary or bronchial veins; and have concluded +from thence, that there was generally a deficiency of venous absorption; +and that this was the occasion of their frequent abortion. Which is further +countenanced, where a great sanguinary discharge precedes or follows the +exclusion of the fetus. + +M. M. Opium, bark, chalybeates in small quantity. Change to a warmer +climate. I have directed with success in four cases half a grain of opium +twice a day for a fortnight, and then a whole grain twice a day during the +whole gestation. One of these patients took besides twenty grains of +Peruvian bark for several weeks. By these means being exactly and regularly +persisted in, a new habit became established, and the usual miscarriages +were prevented. + +Miscarriages more frequently happen from eruptive fevers, and from +rheumatic ones, than from other inflammatory diseases. I saw a most violent +pleurisy and hepatitis cured by repeated venesection about a week or ten +days before parturition; yet another lady whom I attended, miscarried at +the end of the chicken pox, with which her children were at the same time +affected. Miscarriages towards the termination of the small pox are very +frequent, yet there have been a few instances of children, who have been +born with the eruption on them. The blood in the small pox will not +inoculate that disease, if taken before the commencement of the secondary +fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is +not yet formed, but after it has been oxygenated through the cuticle in the +pustules, it becomes contagious; and if it be then absorbed, as in the +secondary fever, the blood of the mother may become contagious, and infect +the child. The same mode of reasoning is applicable to the chicken pox. See +Class IV. 3. 1. 7. + +15. _Scorbutus._ Sea-scurvy is caused by salt diet, the perpetual stimulus +of which debilitates the venous and absorbent systems. Hence the blood is +imperfectly taken up by the veins from the capillaries, whence brown and +black spots appear upon the skin without fever. The limbs become livid and +edematous, and lastly ulcers are produced from deficient absorption. See +Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of +the lungs, see Sect. XXVII. 2. + +M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar. +Wine. Steel. Bark. Sorbentia. Opium? + +16. _Vibices._ Extravasations of blood become black from their being +secluded from the air. The extravasation of blood in bruises, or in some +fevers, or after death in some patients, especially in the parts which were +exposed to pressure, is owing to the fine terminations of the veins having +been mechanically compressed so as to prevent their absorbing the blood +from the capillaries, or to their inactivity from disease. The blood when +extravasated undergoes a chemical change before it is sufficiently fluid to +be taken up by the lymphatic absorbents, and in that process changes its +colour to green and then yellow. + +17. _Petechiae._ Purple spots. These attend fevers with great venous +inirritability, and are probably formed by the inability of a single +termination of a vein, whence the corresponding capillary becomes ruptured, +and effuses the blood into the cellular membrane round the inert +termination of the vein. This is generally esteemed a sign of the putrid +state of the blood, or that state contrary to the inflammatory one. As it +attends some inflammatory diseases which are attended with great +inirritability, as in the confluent small pox. But it also attends the +scurvy, where no fever exists, and it therefore simply announces the +inactivity of the terminations of some veins; and is thence indeed a bad +symptom in fevers, as a mark of approaching inactivity of the whole +sanguiferous system, or death. The blue colour of some children's arms or +faces in very cold weather is owing in like manner to the torpor of the +absorbent terminations of the veins, whence the blood is accumulated in +them, and sometimes bursts them. + + * * * * * + +ORDO II. + +_Decreased Irritation._ + +GENUS II. + +_Decreased Action of the Secerning System._ + +These are always attended with decrease of partial, or of general heat; for +as the heat of animal bodies is the consequence of their various +secretions, and is perpetually passing away into the ambient air, or other +bodies in contact with them; when these secretions become diminished, or +cease, the heat of the part or of the whole is soon diminished, or ceases +along with them. + +SPECIES. + +1. _Frigus febrile._ Febrile coldness. There is reason to believe, that the +beginning of many fever-fits originates in the quiescence of some part of +the absorbent system, especially where they have been owing to external +cold; but that, where the coldness of the body is not owing to a diminution +of external heat, it arises from the inaction of some part of the secerning +system. Hence some parts of the body are hot whilst other parts are cold; +which I suppose gave occasion to error in Martyn's Experiments; where he +says, that the body is as hot in the cold paroxysms of fevers as at other +times. + +After the sensorial power has been much diminished by great preceding +activity of the system, as by long continued external heat, or violent +exercise, a sudden exposure to much cold produces a torpor both greater in +degree and over a greater portion of the system, by subtracting their +accustomed stimulus from parts already much deprived of their irritability. +Dr. Franklin in a letter to M. Duberge, the French translator of his works, +mentions an instance of four young men, who bathed in a cold spring after a +day's harvest work; of whom two died on the spot, a third on the next +morning, and the other survived with difficulty. Hence it would appear, +that those, who have to travel in intensely cold weather, will sooner +perish, who have previously heated themselves much with drams, than those +who have only the stimulus of natural food; of which I have heard one well +attested instance. See Article VII. 2. 3. Class III. 2. 1. 17. + +_Frigus chronicum._ Permanent coldness. Coldness of the extremities, +without fever, with dry pale skin, is a symptom of general debility, owing +to the decreased action of the arterial system, and of the capillary +vessels; whence the perspirable matter is secreted in less quantity, and in +consequence the skin is less warm. This coldness is observable at the +extremities of the limbs, ears, and nose, more than in any other parts: as +a larger surface is here exposed to the contact of the air, or clothes, and +thence the heat is more hastily carried away. + +The pain, which accompanies the coldness of the skin, is owing to the +deficient exertion of the subcutaneous vessels, and probably to the +accumulation of sensorial power in the extremities of their nerves. See +Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1. + +M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes. +Fire. Joy. Anger. + +2. _Pallor fugitivus._ The fugitive paleness, which accompanies the +coldness of the extremities, is owing to a less quantity of blood passing +through the capillaries of the skin in a given time; where the absorbent +power of the veins is at the same time much diminished, a part of the blood +lingers at their junction with the capillary arteries, and a bluish tinge +is mixed with the paleness; as is seen in the loose skin under the +eye-lids, and is always a mark of temporary debility. See Class II. 1. 4. +4. Where the paleness of the skin is owing to the deficiency of red +globules in the blood, it is joined with a yellowish tinge; which is the +colour of the serum, with which the blood then abounds, as in chlorosis, +and in torpor or paralysis of the liver, and is often mistaken for a +superabundance of bile. + +A permanent paleness of the skin is owing to the coalescence of the minute +arteries, as in old age. See Class I. 2. 2. 9. There is another source of +paleness from the increased absorption of the terminations of the veins, as +when vinegar is applied to the lips. See Sect. XXVII. 1. and another from +the retrograde motions of the capillaries and fine extremities of the +arteries. See Class II. 3. 1. 1. + +M. M. A blister, nutrientia, incitantia, exercise, oxygene gas. + +3. _Pus parcius._ Diminished pus. Dryness of ulcers. In the cold fits of +fever all the secretions are diminished, whether natural or artificial, as +their quantity depends on the actions of the glands or capillaries, which +then share in the universal inaction of the system. Hence the dryness of +issues and blisters in great debility, and before the approach of death, is +owing to deficient secretion, and not to increased absorption. + +M. M. Opium, wine in very small quantities, Peruvian bark. + +4. _Mucus parcior._ Diminished mucus. Dryness of the mouth and nostrils. +This also occurs in the cold fits of intermittents. In these cases I have +also found the tongue cold to the touch of the finger, and the breath to +the back of one's hand, when opposed to it, which are very inauspicious +symptoms, and generally fatal. In fevers with inirritability it is +generally esteemed a good symptom, when the nostrils and tongue become +moist after having been previously dry; as it shews an increased action of +the mucous glands of those membranes, which were before torpid. And the +contrary to this is the facies Hippocratica, or countenance so well +described by Hippocrates, which is pale, cold, and shrunk; all which are +owing to the inactivity of the secerning vessels, the paleness from there +being less red blood passing through the capillaries, the coldness of the +skin from there being less secretion of perspirable matter, and the shrunk +appearance from there being less mucus secreted into the cells of the +cellular membrane. See Class IV. 2. 4. 11. + +M. M. Blisters. Incitantia. + +5. _Urina parcior pallida._ Paucity of pale urine, as in the cold fits of +intermittents; it appears in some nervous fevers throughout the whole +disease, and seems to proceed from a palsy of the kidnies; which probably +was the cause of the fever, as the fever sometimes ceases, when that +symptom is removed: hence the straw-coloured urine in this fever is so far +salutary, as it shews the unimpaired action of the kidnies. + +M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides +internally. + +6. _Torpor hepaticus._ Paucity of bile from a partial inaction of the +liver; hence the bombycinous colour of the skin, grey stools, urine not +yellow, indigestion, debility, followed by tympany, dropsy, and death. + +This paralysis or inirritability of the liver often destroys those who have +been long habituated to much fermented liquor, and have suddenly omitted +the use of it. It also destroys plumbers, and house-painters, and in them +seems a substitute for the colica saturnina. See Sect. XXX. + +M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment +rubbed on the region of the liver. Rhubarb, three or four grains, with +opium half a grain to a grain twice a day. Equitation, warm bath for half +an hour everyday. + +7. _Torpor Pancreatis._ Torpor of the pancreas. I saw what I conjectured to +be a tumour of the pancreas with indigestion, and which terminated in the +death of the patient. He had been for many years a great consumer of +tobacco, insomuch that he chewed that noxious drug all the morning, and +smoaked it all the afternoon. As the secretion from the pancreas resembles +saliva in its general appearance, and probably in its office of assisting +digestion, by preventing the fermentation of the aliment; as would appear +by the experiments of Pringle and Macbride; there is reason to suspect, +that a sympathy may exist between the salivary and pancreatic glands; and +that the perpetual stimulus of the former by tobacco might in process of +time injure the latter. See Tobacco, Article III. 2. 2. + +8. _Torpor renis._ Inirritability or paralysis of the kidnies is probably +frequently mistaken for gravel in them. Several, who have lived rather +intemperately in respect to fermented or spirituous liquors, become +suddenly seized about the age of sixty, or later, with a total stoppage of +urine; though they have previously had no symptoms of gravel. In these +cases there is no water in the bladder; as is known by the introduction of +the catheter, of which those made of elastic gum are said to be preferable +to metallic ones; or it may generally be known by the shape of the abdomen, +either by the eye or hand. Bougies and catheters of elastic gum are sold at +N^o 37, Red Lion-street, Holborn, London. + +M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1. +3. 9. When no gravel has been previously observed, and the patient has been +a wine-drinker rather than an ale-drinker, the case is generally owing to +inirritability of the tubuli uriniferi, and is frequently fatal. See Class +I. 2. 4. 20. + +9. _Punctae mucosae vultus._ Mucous spots on the face. These are owing to +the inactivity of the excretory ducts of the mucous glands; the thinner +part of this secretion exhales, and the remainder becomes inspissated, and +lodges in the duct; the extremity of which becomes black by exposure to the +air. + +M. M. They may be pressed out by the finger-nails. Warm water. Ether +frequently applied. Blister on the part? + +10. _Maculae cutis fulvae._ Morphew or freckles. Tawny blotches on the skin +of the face and arms of elderly people, and frequently on their legs after +slight erysipelas. The freckles on the face of younger people, who have red +hair, seem to be a similar production, and seem all to be caused by the +coalescence of the minute arteries or capillaries of the part. In a scar +after a wound the integument is only opake; but in these blotches, which +are called morphew and freckles, the small vessels seem to have become +inactive with some of the serum of the blood stagnating in them, from +whence their colour. See Class III. 1. 2. 12. + +M. M. Warm bathing. A blister on the part? + +11. _Canities._ Grey hair. In the injection of the vessels of animals for +the purposes of anatomical preparations, the colour of the injected fluid +will not pass into many very minute vessels; which nevertheless uncoloured +water, or spirits, or quicksilver will permeate. The same occurs in the +filtration of some coloured fluids through paper, or very fine sand, where +the colouring matter is not perfectly dissolved, but only diffused through +the liquid. This has led some to imagine, that the cause of the whiteness +of the hair in elderly people may arise from the diminution, or greater +tenuity, of the glandular vessels, which secrete the mucus, which hardens +into hair; and that the same difference of the tenuity of the secerning +vessels may possibly make the difference of colour of the silk from +different silk-worms, which is of all shades from yellow to white. + +But as the secreted fluids are not the consequence of mechanical +filtration, but of animal selection; we must look out for another cause, +which must be found in the decreasing activity of the glands, as we advance +in life; and which affects many of our other secretions as well as that of +the mucus, which forms the hair. Hence grey hairs are produced on the faces +of horses by whatever injures the glands at their roots, as by corrosive +blisters; and frequently on the human subject by external injuries on the +head; and sometimes by fevers. And as the grey colour of hair consists in +its want of transparency, like water converted into snow; there is reason +to suppose, that a defect of secreted moisture simply may be the cause of +this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13. + +M. M. Whatever prevents the inirritability and insensibility of the system, +that is, whatever prevents the approach of old age, will so far counteract +the production of grey hairs, which is a symptom of it. For this purpose in +people, who are not corpulent, and perhaps in those who are so, the warm +bath twice or thrice a week is particularly serviceable. See Sect. XXXIX. +5. 1. on the colours of animals, and Class I. 1. 2. 15. + +12. _Callus._ The callous skin on the hands and feet of laborious people is +owing to the extreme vessels coalescing from the perpetual pressure they +are exposed to. + +As we advance in life, the finer arteries lose their power of action, and +their sides grow together; hence the paleness of the skins of elderly +people, and the loss of that bloom, which is owing to the numerous fine +arteries, and the transparency of the skin, that encloses them. + +M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a +pumice stone. Cover the part with oiled silk to prevent the evaporation of +the perspirable matter, and thus to keep it moist. + +13. _Cataracta_ is an opacity of the crystalline lens of the eye. It is a +disease of light-coloured eyes, as the gutta serena is of dark ones. On +cutting off with scissars the cornea of a calf's eye, and holding it in the +palm of one's hand, so as to gain a proper light, the artery, which +supplies nutriment to the crystalline humour, is easily and beautifully +seen; as it rises from the centre of the optic nerve through the vitreous +humour to the crystalline. It is this point, where the artery enters the +eye through the cineritious part of the optic nerve, (which is in part near +the middle of the nerve,) which is without sensibility to light; as is +shewn by fixing three papers, each of them about half an inch in diameter, +against a wall about a foot distant from each other, about the height of +the eye; and then looking at the middle one, with one eye, and retreating +till you lose sight of one of the external papers. Now as the animal grows +older, the artery becomes less visible, and perhaps carries only a +transparent fluid, and at length in some subjects I suppose ceases to be +pervious; then it follows, that the crystalline lens, losing some fluid, +and gaining none, becomes dry, and in consequence opake; for the same +reason, that wet or oiled paper is more transparent than when it is dry, as +explained in Class I. 1. 4. 1. The want of moisture in the cornea of old +people, when the exhalation becomes greater than the supply, is the cause +of its want of transparency; and which like the crystalline gains rather a +milky opacity. The same analogy may be used to explain the whiteness of the +hair of old people, which loses its pellucidity along with its moisture. +See Class I. 2. 2. 11. + +M. M. Small electric shocks through the eye. A quarter of a grain of +corrosive sublimate of mercury dissolved in brandy, or taken in a pill, +twice a day for six weeks. Couching by depression, or by extraction. The +former of these operations is much to be preferred to the latter, though +the latter is at this time so fashionable, that a surgeon is almost +compelled to use it, lest he should not be thought an expert operator. For +depressing the cataract is attended with no pain, no danger, no +confinement, and may be as readily repeated, if the crystalline should rise +again to the centre of the eye. The extraction of the cataract is attended +with considerable pain, with long confinement, generally with fever, always +with inflammation, and frequently with irreparable injury to the iris, and +consequent danger to the whole eye. Yet has this operation of extraction +been trumpeted into universal fashion for no other reason but because it is +difficult to perform, and therefore keeps the business in the hands of a +few empyrics, who receive larger rewards, regardless of the hazard, which +is encountered by the flattered patient. + +A friend of mine returned yesterday from London after an absence of many +weeks; he had a cataract in a proper state for the operation, and in spite +of my earnest exhortation to the contrary, was prevailed upon to have it +extracted rather than depressed. He was confined to his bed three weeks +after the operation, and is now returned with the iris adhering on one side +so as to make an oblong aperture; and which is nearly, if not totally, +without contraction, and thus greatly impedes the little vision, which he +possesses. Whereas I saw some patients couched by depression many years ago +by a then celebrated empyric, Chevalier Taylor, who were not confined above +a day or two, that the eye might gradually be accustomed to light, and who +saw as well as by extraction, perhaps better, without either pain, or +inflammation, or any hazard of losing the eye. + +As the inflammation of the iris is probably owing to forcing the +crystalline through the aperture of it in the operation of extracting it, +could it not be done more safely by making the opening behind the iris and +ciliary process into the vitreous humour? but the operation would still be +more painful, more dangerous, and not more useful than that by depressing +it. + +14. _Innutritio ossium._ Innutrition of the bones. Not only the blood +effused in vibices and petechiae, or from bruises, as well as the blood and +new vessels in inflamed parts, are reabsorbed by the increased action of +the lymphatics; but the harder materials, which constitute the fangs of the +first set of teeth, and the ends of exfoliating bones, and sometimes the +matter of chalk-stones in the gout, the coagulable lymph, which is +deposited on the lungs, or on the muscles after inflammation of those +parts, and which frequently produces difficulty of breathing, and the pains +of chronic rheumatism, and lastly the earthy part of the living bones are +dissolved and absorbed by the increased actions of this system of vessels. +See Sect. XXXIII. 3. 1. + +The earthy part of bones in this disease of the innutrition of them seems +to suffer a solution, and reabsorption; while the secerning vessels do not +supply a sufficient quantity of calcareous earth and phosphoric acid, which +constitute the substance of bones. As calcareous earth abounds every where, +is the want of phosphoric acid the remote cause? One cause of this malady +is given in the Philosophic Transactions, where the patient had been +accustomed to drink large quantities of vinegar. Two cases are described by +Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous +earth, and afterwards of bone-ashes, and of decoction of madder, and also +of sublimate of mercury, were given without effect. All the bones became +soft, many of them broke, and the patient seemed to die from the want of +being able to distend her chest owing to the softness of the ribs. + +M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined +hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or +such as is found in all limestone or marly countries. The calcareous earth +in these waters might possibly be carried to the bones, as madder is known +to colour them. Warm bath. Volatile or fixed alcali as a lotion on the +spine, or essential oils. + +The innutrition of the bones is often first to be perceived by the +difficulty of breathing and palpitation of the heart on walking a little +faster than usual, which I suppose is owing to the softness of the ends of +the ribs adjoining to the sternum; on which account they do not perfectly +distend the chest, when they are raised by the pectoral and intercostal +muscles with greater force than usual. After this the spine becomes curved +both by the softness of its vertebrae, and for the purpose of making room +for the disturbed heart. See Species 16 of this genus. + +As these patients are pale and weak, there would seem to be a deficiency of +oxygene in their blood, and in consequence a deficiency of phosphoric acid; +which is probably produced by oxygene in the act of respiration. + +Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to +arise from the prevalence of vegetable or acetous acid, which is known to +soften bones out of the body. Mr. Dettaen seems to have espoused a similar +opinion, and both of them in consequence give alcalies and testacea. If +this theory was just, the soft bones of such patients should shew evident +marks of such acidity after death; which I believe has not been observed. +Nor is it analogous to other animal facts, that nutritious fluids secreted +by the finest vessels of the body should be so little animalized, as to +retain acetous or vegetable acidity. + +The success attending the following case in so short a time as a fortnight +I ascribed principally to the use of the warm bath; in which the patient +continued for full half an hour every night, in the degree of heat, which +was most grateful to her sensation, which might be I suppose about 94. Miss +----, about ten years of age, and very tall and thin, has laboured under +palpitation of her heart, and difficult breathing on the least exercise, +with occasional violent dry cough, for a year or more, with dry lips, +little appetite either for food or drink, and dry skin, with cold +extremities. She has at times been occasionally worse, and been relieved in +some degree by the bark. She began to bend forwards, and to lift up her +shoulders. The former seemed owing to a beginning curvature of the spine, +the latter was probably caused to facilitate her difficult respiration. + +M. M. She used the warm bath, as above related; which by its warmth might +increase the irritability of the smallest series of vessels, and by +supplying more moisture to the blood might probably tend to carry further +the materials, which form calcareous or bony particles, or to convey them +in more dilute solution. She took twice a day twenty grains of extract of +bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of +calcined hartshorn mixed into a powder with ten drops of laudanum; with +flesh food both to dinner and supper; and port wine and water instead of +the small beer, she had been accustomed to; she lay on a sofa frequently in +a day, and occasionally used a neck-swing. + +15. _Rachitis._ Rickets. The head is large, protuberant chiefly on the +forepart. The smaller joints are swelled; the ribs depressed; the belly +tumid, with other parts emaciated. This disease from the innutrition or +softness of the bones arose about two centuries ago; seems to have been +half a century in an increasing or spreading state; continued about half a +century at its height, or greatest diffusion; and is now nearly vanished: +which gives reason to hope, that the small-pox, measles, and venereal +disease, which are all of modern production, and have already become +milder, may in process of time vanish from the earth, and perhaps be +succeeded by new ones! See the preceding species. + +16. _Spinae distortio._ Distortion of the spine is another disease +originating from the innutrition or softness of the bones. I once saw a +child about six years old with palpitation of heart, and quickness of +respiration, which began to have a curvature of the spine; I then doubted, +whether the palpitation and quick respiration were the cause or consequence +of the curvature of the spine; suspecting either that nature had bent the +spine outwards to give room to the enlarged heart; or that the malformation +of the chest had compressed and impeded the movements of the heart. But a +few weeks ago on attending a young lady about ten years old, whose spine +had lately began to be distorted, with very great difficulty and quickness +of respiration, and alarming palpitation of the heart, I convinced myself, +that the palpitation and difficult respiration were the effect of the +change of the cavity of the chest from the distortion of the spine; and +that the whole was therefore a disease of the innutrition or softness of +the bones. + +For on directing her to lie down much in the day, and to take the bark, the +distortion became less, and the palpitation and quick respiration became +less at the same time. After this observation a neck-swing was directed, +and she took the bark, madder, and bone-ashes; and she continues to amend +both in her shape and health. + +Delicate young ladies are very liable to become awry at many boarding +schools. This is occasioned principally by their being obliged too long to +preserve an erect attitude, by sitting on forms many hours together. To +prevent this the school-seats should have either backs, on which they may +occasionally rest themselves; or desks before them, on which they may +occasionally lean. This is a thing of greater consequence than may appear +to those, who have not attended to it. + +When the least tendency to become awry is observed, they should be advised +to lie down on a bed or sofa for an hour in the middle of the day for many +months; which generally prevents the increase of this deformity by taking +off for a time the pressure on the spine of the back, and it at the same +time tends to make them grow taller. Young persons, when nicely measured, +are found to be half an inch higher in a morning than at night; as is well +known to those, who inlist very young men for soldiers. This is owing to +the cartilages between the bones of the back becoming compressed by the +weight of the head and shoulders on them during the day. It is the same +pressure which produces curvatures and distortions of the spine in growing +children, where the bones are softer than usual; and which may thus be +relieved by an horizontal posture for an hour in the middle of the day, or +by being frequently allowed to lean on a chair, or to play on the ground on +a carpet. + +Young ladies should also be directed, where two sleep in a bed, to change +every night, or every week, their sides of the bed; which will prevent +their tendency to sleep always on the same side; which is not only liable +to produce crookedness, but also to occasion diseases by the internal parts +being so long kept in uniform contact as to grow together. For the same +reason they should not be allowed to sit always on the same side of the +fire or window, because they will then be inclined too frequently to bend +themselves to one side. + +Another great cause of injury to the shape of young ladies is from the +pressure of stays, or other tight bandages, which at the same time cause +other diseases by changing the form or situation of the internal parts. If +a hard part of the stays, even a knot of the thread, with which they are +sewed together, is pressed hard upon one side more than the other, the +child bends from the side most painful, and thus occasions a curvature of +the spine. To counteract this effect such stays, as have fewest hard parts, +and especially such as can be daily or weekly turned, are preferable to +others. + +[Illustration] + +Where frequent lying down on a sofa in the day-time, and swinging +frequently for a short time by the hands or head, with loose dress, do not +relieve a beginning distortion of the back; recourse may be had to a chair +with stuffed moveable arms for the purpose of suspending the weight of the +body by cushions under the arm-pits, like resting on crutches, or like the +leading strings of infants. From the top of the back of the same chair a +curved steel bar may also project to suspend the body occasionally, or in +part by the head, like the swing above mentioned. The use of this chair is +more efficacious in straightening the spine, than simply lying down +horizontally; as it not only takes off the pressure of the head and +shoulders from the spine, but at the same time the inferior parts of the +body contribute to draw the spine straight by their weight; or lastly, +recourse may be had to a spinal machine first described in the Memoires of +the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and +since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road, +London, which suspends the head, and places the weight of it on the hips. +This machine is capable of improvement by joints in the bar at the back of +it, to permit the body to bend forwards without diminishing the extension +of the spine. + +The objections of this machine of M. Vacher, which is made by Mr. Jones, +are first, that it is worn in the day-time, and has a very unsightly +appearance. Mr. Jones has endeavoured to remedy this, by taking away the +curved bar over the head, and substituting in its place a forked bar, +rising up behind each ear, with webs fastened to it, which pass under the +chin and occiput. But this is not an improvement, but a deterioration of M. +Vacher's machine, as it prevents the head from turning with facility to +either side. Another objection is, that its being worn, when the muscles of +the back are in action, it is rather calculated to prevent the curvature of +the spine from becoming greater, than to extend the spine, and diminish its +curvature. + +[Illustration] + +For this latter purpose I have made a steel bow, as described in the +annexed plate, which receives the head longitudinally from the forehead to +the occiput; having a fork furnished with a web to sustain the chin, and +another to sustain the occiput. The summit of the bow is fixed by a swivel +to the board going behind the head of the bed above the pillow. The bed is +to be inclined from the head to the feet about twelve or sixteen inches. +Hence the patient would be constantly sliding down during sleep, unless +supported by this bow, with webbed forks, covered also with fur, placed +beneath the chin, and beneath the occiput. There are also proper webs lined +with fur for the hands to take hold off occasionally, and also to go under +the arms. By these means I should hope great advantage from gradually +extending the spine during the inactivity of the muscles of the back; and +that it may be done without disturbing the sleep of the patient, and if +this should happen, the bow is made to open by a joint at the summit of it, +so as to be instantly disengaged from the neck by the hand of the wearer. +This bow I have not yet had opportunity to make use of, but it may be had +from Mr. Harrison, whitesmith, Bridge-gate, Derby. + +It will be from hence easily perceived, that all other methods of confining +or directing the growth of young people should be used with great skill; +such as back-boards, or bandages, or stocks for the feet; and that their +application should not be continued too long at a time, lest worse +consequences should ensue, than the deformity they were designed to remove. +To this may be added, that the stiff erect attitude taught by some modern +dancing masters does not contribute to the grace of person, but rather +militates against it; as is well seen in one of the prints in Hogarth's +Analysis of Beauty; and is exemplifyed by the easy grace of some of the +ancient statues, as of the Venus de Medici, and the Antinous, and in the +works of some modern artists, as in a beautiful print of Hebe feeding an +Eagle, painted by Hamilton, and engraved by Eginton, and many of the +figures of Angelica Kauffman. + +Where the bone of one of the vertebrae of the back has been swelled on both +sides of it, so as to become protuberant, issues near the swelled part have +been found of great service, as mentioned in Species 18 of this genus. This +has induced me to propose in curvatures of the spine, to put an issue on +the outside of the curve, where it could be certainly ascertained, as the +bones on the convex side of the curve must be enlarged; in one case I +thought this of service, and recommend the further trial of it. + +In the tendency to curvature of the spine, whatever strengthens the general +constitution is of service; as the use of the cold bath in the summer +months. This however requires some restriction both in respect to the +degree of coldness of the bath, the time of continuing in it, and the +season of the year. Common springs, which are of forty-eight degrees of +heat, are too cold for tender constitutions, whether of children or adults, +and frequently do them great and irreparable injury. The coldness of river +water in the summer months, which is about sixty-eight degrees, or that of +Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are +much to be preferred. The time of continuing in the bath should be but a +minute or two, or not so long as to occasion a trembling of the limbs from +cold. In respect to the season of the year, delicate children should +certainly only bathe in the summer months; as the going frequently into the +cold air in winter will answer all the purposes of the cold bath. + +17. _Claudicatio coxaria._ Lameness of the hip. A nodding of the thigh-bone +is said to be produced in feeble children by the softness of the neck or +upper part of that bone beneath the cartilage; which is naturally bent, and +in this disease bends more downwards, or nods, by the pressure of the body; +and thus renders one leg apparently shorter than the other. In other cases +the end of the bone is protruded out of its socket, by inflammation or +enlargement of the cartilages or ligaments of the joint, so that it rests +on some part of the edge of the acetabulum, which in time becomes filled +up. When the legs are straight, as in standing erect, there is no +verticillary motion in the knee-joint; all the motion then in turning out +the toes further than nature designed, must be obtained by straining in +some degree this head of the thigh-bone, or the acetabulum, or cavity, in +which it moves. This has induced me to believe, that this misfortune of the +nodding of the head by the bone, or partial dislocation of it, by which one +leg becomes shorter than the other, is sometimes occasioned by making very +young children stand in what are called stocks; that is with their heels +together, and their toes quite out. Whence the socket of the thigh-bone +becomes inflamed and painful, or the neck of the bone is bent downward and +outwards. + +In this case there is no expectation of recovering the straightness of the +end of the bone; but these patients are liable to another misfortune, that +is, to acquire afterwards a distortion of the spine; for as one leg is +shorter than the other, they sink on that side, and in consequence bend the +upper part of their bodies, as their shoulders, the contrary way, to +balance themselves; and then again the neck is bent back again towards the +lame side, to preserve the head perpendicular; and thus the figure becomes +quite distorted like the letter S, owing originally to the deficiency of +the length of one limb. The only way to prevent this curvature of the spine +is for the child to wear a high-heeled shoe or patten on the lame foot, so +as to support that side on the same level with the other, and thus to +prevent a greater deformity. + +I have this day seen a young lady about twelve, who does not limp or waddle +in walking; but nevertheless, when she stands or sits, she sinks down +towards her right side, and turns out that toe more than the other. Hence, +both as she sits and stands, she bends her body to the right; whence her +head would hang a little over her right shoulder; but to replace this +perpendicularly, she lifts up her left shoulder and contracts the muscles +on that side of the neck; which are therefore become thicker and stronger +by their continued action; but there is not yet any very perceptible +distortion of the spine. + +As her right toe is turned outward rather more than natural, this shews the +disease to be in the hip-joint; because, when the limb is stretched out, +the toe cannot turn horizontally in the least without moving the end of the +thigh-bone; although when the knee is bent, the toe can be turned through +one third or half of a circle by the rotation of the tibia and fibula of +the leg round each other. Hence if children are set in stocks with their +heels touching each other as they sit, and are then made to rise up, till +they stand erect, the socket or head of the thigh-bone becomes injured, +especially in those children, whose bones are soft; and a shortness of that +limb succeeds either by the bending of the neck of the thigh-bone, or by +its getting out of the acetabulum; and a consequent rising of one shoulder, +and a curvature of the spine is produced from so distant a cause. + +M. M. An elastic cushion made of curled hair should be placed under the +affected hip, whenever she sits; or should be fitted to the part by means +of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying +down in the day, should be occasionally used to prevent or remove any +curvature of the spine. The rest as in Species 13 and 15 of this genus. + +18. _Spina protuberans._ Protuberant spine. One of the bones of the spine +swells, and rises above the rest. This is not an uncommon disease, and +belongs to the innutrition of the bones, as the bone must become soft +before it swells; which softness is owing to defect of the secretion of +phosphorated calcareous earth. The swelling of the bone compresses a part +of the brain, called the spinal marrow, within the cavity of the +back-bones; and in consequence the lower limbs become paralytic, attended +sometimes with difficulty of emptying the bladder and rectum. + +M. M. Issues put on each side of the prominent bone are of great effect, I +suppose, by their stimulus; which excites into action more of the sensorial +powers of irritation and sensation, and thus gives greater activity to the +vascular system in their vicinity. The methods recommended in distortion of +the spine are also to be attended to. + +19. _Spina bifida._ Divided spine, called also Hydrorachitis, as well as +the Hydrocephalus externus, are probably owing in part to a defect of +ossification of the spine and cranium; and that the collection of fluid +beneath them may originate from the general debility of the system; which +affects both the secerning, and absorbent vessels. + +A curious circumstance, which is affirmed to attend the spina bifida, is, +that on compressing the tumor with the hand gently, the whole brain becomes +affected, and the patient falls asleep. I suppose the same must happen on +compressing the hydrocephalus externus? See Sect. XVIII. 20. + +20. _Ossis palati defectus._ A defect of the bone of the palate, which +frequently accompanies a division of the upper lip, occurs before nativity; +and is owing to the deficient action of the secerning system, from whence +the extremities are not completed. From a similar cause I have seen the +point of the tongue deficient, and one joint of the two least fingers, and +of the two least toes, in the same infant; who was otherwise a fine girl. +See Sect. XXXIX. 4. 4. + +The operation for the hare-lip is described by many surgical writers; but +there is a person in London, who makes very ingenious artificial palates; +which prevents that defect of speech, which attends this malformation. This +factitious palate consists of a thin plate of silver of the shape and form +of the roof of the mouth; from the front edge to the back edge of this +silver plate four or five holes are made in a straight line large enough +for a needle to pass through them; on the back of it is then sewed a piece +of sponge; which when expanded with moisture is nearly as large as the +silver plate. This sponge is slipped through the division of the bone of +the palate, so as to lie above it, while the silver plate covers the +aperture beneath, and is suspended by the expanding sponge. This is removed +every night and washed, and returned into its place in the morning; on this +account it is convenient to have five or six of them, for the sake of +cleanliness. I have been more particular in describing this invention, as I +do not know the name, or place of residence, of the maker. + + * * * * * + +ORDO II. + +_Decreased Irritation._ + +GENUS III. + +_The Decreased Action of the Absorbent System._ + +Some decrease of heat attends these diseases, though in a less degree than +those of the last genus, because the absorbent system of glands do not +generate so much heat in their healthy state of action as the secerning +system of glands, as explained in Class I. 1. 3. + +SPECIES. + +1. _Mucus faucium frigidus._ Cold mucus from the throat. Much mucus, of +rather a saline taste, and less inspissated than usual, is evacuated from +the fauces by hawking, owing to the deficient absorption of the thinner +parts of it. This becomes a habit in some elderly people, who are +continually spitting it out of their mouths; and has probably been brought +on by taking snuff, or smoking tobacco; which by frequently stimulating the +fauces have at length rendered the absorbent vessels less excitable by the +natural stimulus of the saline part of the secretion, which ought to be +reabsorbed, as soon as secreted. + +M. M. A few grains of powder of bark frequently put into the mouth, and +gradually diffused over the fauces. A gargle of barley water. + +2. _Sudor frigidus._ The cold dampness of the hands of some people is +caused by the deficient absorption of perspirable matter; the clammy or +viscid feel of it is owing to the mucous part being left upon the skin. The +coldness is produced both by the decreased action of the absorbent system, +and by the evaporation of a greater quantity of the perspirable matter into +the air, which ought to have been absorbed. + +M. M. Wash the hands in lime water, or with a small quantity of volatile +alcali in water. + +3. _Catarrhus frigidus._ The thin discharge from the nostrils in cold +weather. The absorbent vessels become torpid by the diminution of external +heat, sooner than the secerning ones, which are longer kept warm by the +circulating blood, from which they select the fluid they secrete; whereas +the absorbent vessels of the nostrils drink up their fluids, namely the +thin and saline part of the mucus, after it has been cooled by the +atmosphere. Hence the absorbents ceasing to act, and the secerning vessels +continuing some time longer to pour out the mucus, a copious thin discharge +is produced, which trickles down the nostrils in cold weather. This +discharge is so acrid as to inflame the upper lip; which is owing to the +neutral salts, with which it abounds, not being reabsorbed; so the tears in +the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7. + +4. _Expectoratio frigida._ Cold expectoration. Where the pulmonary +absorption is deficient, an habitual cough is produced, and a frequent +expectoration of thin saline mucus; as is often seen in old enfeebled +people. Though the stimulus of the saline fluid, which attends all +secretions, is not sufficient to excite the languid absorbent vessels to +imbibe it; yet this saline part, together with the increased quantity of +the whole of the secreted mucus, stimulates the branches of the bronchia, +so as to induce an almost incessant cough to discharge it from the lungs. A +single grain of opium, or any other stimulant drug, as a wine-posset with +spirit of hartshorn, will cure this cold cough, and the cold catarrh of the +preceding article, like a charm, by stimulating the torpid mouths of the +absorbents into action. Which has given rise to an indiscriminate and +frequently pernicious use of the warm regimen in coughs and catarrhs of the +warm or inflammatory kind, to the great injury of many. + +M. M. Half a grain of opium night and morning promotes the absorption of +the more fluid and saline parts, and in consequence thickens the mucus, and +abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali. + +5. _Urina uberior pallida._ On being exposed naked to cold air, or +sprinkled with cold water, a quantity of pale urine is soon discharged; for +the absorbents of the bladder become torpid by their sympathy with those of +the skin; which are rendered quiescent by the diminution of external heat; +but the kidnies continue to secrete the urine, and as no part of it is +absorbed, it becomes copious and pale. This happens from a similar cause in +cold fits of agues; and in less degree to many debilitated constitutions, +whose extremities are generally cold and pale. The great quantity of limpid +water in hysteric cases, and in diabaetes, belongs to Class I. 3. 1. 10. I. +3. 2. 6. + +M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in +cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire. + +6. _Diarrhoea frigida._ Liquid stools are produced by exposing the body +naked to cold air, or sprinkling it with cold water, for the same reason as +the last article. + +But this disease is sometimes of a dangerous nature; the intestinal +absorption being so impaired, that the aliment is said to come away +undiminished in quantity, and almost unchanged by the powers of digestion, +and is then called lientery. + +The mucus of the rectum sometimes comes away like pellucid hartshorn jelly, +and liquefies by heat like that, towards the end of inirritative fevers, +which is owing to the thinner part of the mucus not being absorbed, and +thus resembles the catarrh of some old people. + +M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold +weather. Clysters with opium. Friction on the bowels morning and night. +Equitation twice a day. + +7. _Fluor albus frigidus._ Cold fluor albus. In weak constitutions, where +this discharge is pellucid and thin, it must proceed from want of +absorption of the mucous membrane of the vagina, or uterus, and not from an +increased secretion. This I suspect to be the most frequent kind of fluor +albus; the former one described at Class I. 1. 2. 11. attends menstruation, +or is a discharge instead of it, and thus resembles the venereal orgasm of +female quadrupeds. The discharge in this latter kind being more saline, is +liable to excoriate the part, and thus produce smarting in making water; in +its great degree it is difficult to cure. + +M. M. Increase the evacuation by stool and by perspiration, by taking +rhubarb every night, about six or ten grains with one grain of opium for +some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters, +chalybeates, friction over the whole skin with flannel morning and night. +Partial cold bath, by sprinkling the loins and thighs, or sponging them +with cold water. Mucilage, as isinglass boiled in milk; blanc mange, +hartshorn jelly, are recommended by some. Tincture of cantharides sometimes +seems of service given from ten to twenty drops or more, three or four +times a day. A large plaster of burgundy pitch and armenian bole, so as to +cover the loins and lower part of the belly, is said to have sometimes +succeeded by increasing absorption by its compression in the manner of a +bandage. A solution of metallic salts, as white vitriol, sixty grains to a +pint; or an infusion of oak-bark may be injected into the vagina. Cold +bath. + +8. _Gonorrhoea frigida._ Cold gleet. Where the gleet is thin and pellucid, +it must arise from the want of absorption of the membranes of the urethra, +rather than from an increased secretion from them. This I suppose to be a +more common disease than that mentioned at Class I. 1. 2. 10. + +M. M. Metallic injections, partial cold bath, internal method as in the +fluor albus above described. Balsam of copaiva. Tincture of cantharides. + +9. _Hepatis tumor._ The liver becomes enlarged from defect of the +absorption of mucus from its cells, as in anasarca, especially in feeble +children; at the same time less bile is secreted from the torpid +circulation in the vena portae. And as the absorbents, which resume the +thinner parts of the bile from the gall-bladder and hepatic ducts, are also +torpid or quiescent, the bile is more dilute, as well as in less quantity. +From the obstruction of the passage of the blood through the compressed +vena porta these patients have tumid bellies, and pale bloated +countenances; their paleness is probably owing to the deficiency of the +quantity of red globules in the blood in consequence of the inert state of +the bile. + +These symptoms in children are generally attended with worms, the dilute +bile and the weak digestion not destroying them. In sleep I have seen +fleuke-worms in the gall-ducts themselves among the dilute bile; which +gall-ducts they eat through, and then produce ulcers, and the hectic fever, +called the rot. See Class I. 1. 4. 10. and Article IV. 2. 6. + +M. M. After a calomel purge, crude iron-filings are specific in this +disease in children, and the worms are destroyed by the returning acrimony +and quantity of the bile. A blister on the region of the liver. Sorbentia, +as worm-seed, santonicum. Columbo. Bark. + +10. _Chlorosis._ When the defect of the due action of both the absorbent +and secerning vessels of the liver affects women, and is attended with +obstruction of the catamenia, it is called chlorosis; and is cured by the +exhibition of steel, which restores by its specific stimulus the absorbent +power of the liver; and the menstruation, which was obstructed in +consequence of debility, recurs. + +Indigestion, owing to torpor of the stomach, and a consequent too great +acidity of its contents, attend this disease; whence a desire of eating +chalk, or marl. Sometimes a great quantity of pale urine is discharged in a +morning, which is owing to the inaction of the absorbents, which are +distributed on the neck of the bladder, during sleep. The swelling of the +ankles, which frequently attends chlorosis, is another effect of deficient +action of the absorbent system; and the pale countenance is occasioned by +the deficient quantity of red globules of blood, caused by the deficient +quantity or acrimony of the bile, and consequent weakness of the +circulation. The pulse is so quick in some cases of chlorosis, that, when +attended with an accidental cough, it may be mistaken for pulmonary +consumption. This quick pulse is owing to the debility of the heart from +the want of stimulus occasioned by the deficiency of the quantity, and +acrimony of the blood. + +M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all +over the body and limbs night and morning. Rhubarb five grains, opium half +a grain, every night. Flesh diet, with small beer, or wine and water. The +disease continues some months, but at length subsides by the treatment +above described. A bath of about eighty degrees, as Buxton Bath, is of +service; a colder bath may do great injury. + +11. _Hydrocele._ Dropsy of the vagina testis. Dropsies have been divided +into the incysted and the diffused, meaning those of the cellular membrane, +the cells of which communicate with each other like a sponge, and those of +any other cavity of the body. The collections of mucous fluids in the +various cells and cavities of the body arise from the torpor of the +absorbent vessels of those parts. It is probable, that in dropsies attended +with great thirst the cutaneous absorbents become paralytic first; and then +from the great thirst, which is thus occasioned by the want of atmospheric +moisture, the absorption of the fat ensues; as in fevers attended with +great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some +have believed, that the cellular and adipose membranes are different ones; +as no fat is ever deposited in the eye-lids or scrotum, both which places +are very liable to be distended with the mucilaginous fluid of the +anasarca, and with air in Emphysema. Sometimes a gradual absorption of the +accumulated fluid takes place, and the thinner parts being taken up, there +remains a more viscid fluid, or almost a solid in the part, as in some +swelled legs, which can not easily be indented by the pressure of the +finger, and are called scorbutic. Sometimes the paralysis of the absorbents +is completely removed, and the whole is again taken up into the +circulation. + +The Hydrocele is known by a tumor of the scrotum, which is without pain, +gradually produced, with fluctuation, and a degree of pellucidity, when a +candle is held behind it; it is the most simple incysted dropsy, as it is +not in general complicated with other diseases, as ascites with schirrous +liver, and hydrocephalus internus, with general debility. The cure of this +disease is effected by different ways; it consists in discharging the water +by an external aperture; and by so far inflaming the cyst and testicle, +that they afterwards grow together, and thus prevent in future any +secretion or effusion of mucus; the disease is thus cured, not by the +revivescence of the absorbent power of the lymphatics, but by the +prevention of secretion by the adhesion of the vagina to the testis. This I +believe is performed with less pain, and is more certainly manageable by +tapping, or discharging the fluid by means of a trocar, and after the +evacuation of it to fill the cyst with a mixture of wine and water for a +few minutes till the necessary degree of stimulus is produced, and then to +withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by +Dr. Duncan, for 1793. + +12. _Hydrocephalus internus_, or dropsy of the ventricles of the brain, is +fatal to many children, and some adults. When this disease is less in +quantity, it probably produces a fever, termed a nervous fever, and which +is sometimes called a worm fever, according to the opinion of Dr. +Gilchrist, in the Scots Medical essays. This fever is attended with great +inirritability, as appears from the dilated pupils of the eyes, in which it +corresponds with the dropsy of the brain. And the latter disease has its +paroxysms of quick pulse, and in that respect corresponds with other fevers +with inirritability. + +The hydrocephalus internus is distinguished from apoplexy by its being +attended with fever, and from nervous fever by the paroxysms being very +irregular, with perfect intermissions many times in a day. In nervous fever +the pain of the head generally affects the middle of the forehead; in +hydrocephalus internus it is generally on one side of the head. One of the +earliest criterions is the patient being uneasy on raising his head from +the pillow, and wishing to lie down again immediately; which I suppose is +owing to the pressure of the water on the larger trunks of the +blood-vessels entering the cavity being more intolerable than on the +smaller ones; for if the larger trunks are compressed, it must +inconvenience the branches also; but if some of the small branches are +compressed only, the trunks are not so immediately incommoded. + +Blisters on the head, and mercurial ointment externally, with calomel +internally, are principally recommended in this fatal disease. When the +patient cannot bear to be raised up in bed without great uneasiness, it is +a bad symptom. So I believe is deafness, which is commonly mistaken for +stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of +either eye, or the squinting is very apparent, or the pupils of both eyes +much dilated, it is generally fatal. As by stimulating one branch of +lymphatics into inverted motion, another branch is liable to absorb its +fluid more hastily; suppose strong errhines, as common tobacco snuff to +children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed +with ten or fifteen grains of sugar, was gradually blown up the nostrils? +See Class I. 3. 2. 1. I have tried common snuff upon two children in this +disease; one could not be made to sneeze, and the other was too near death +to receive advantage. When the mercurial preparations have produced +salivation, I believe they may have been of service, but I doubt their good +effect otherwise. In one child I tried the tincture of Digitalis; but it +was given with too timid a hand, and too late in the disease, to determine +its effects. See Sect. XXIX. 5. 9. + +As all the above remedies generally fail of success, I think frequent, +almost hourly, shocks of electricity from very small charges might be +passed through the head in all directions with probability of good event. +And the use of the trephine, where the affected side can be distinguished. +See Strabismus, Class I. 2. 5. 4. When one eye is affected, does the +disease exist in the ventricule of that side? + +13. _Ascites._ The dropsy of the cavity of the abdomen is known by a tense +swelling of the belly; which does not sound on being struck like the +tympany; and in which a fluctuation can be readily perceived by applying +one hand expanded on one side, and striking the tumour on the other. + +Effusions of water into large cavities, as into that of the abdomen or +thorax, or into the ventricules of the brain or pericardium, are more +difficult to be reabsorbed, than the effusion of fluids into the cellular +membrane; because one part of this extensive sponge-like system of cells, +which connects all the solid parts of the body, may have its power of +absorption impaired, at the same time that some other part of it may still +retain that power, or perhaps possess it in an increased degree; and as all +these cells communicate with each other, the fluid, which abounds in one +part of it, can be transferred to another, and thus be reabsorbed into the +circulation. + +In the ascites, cream of tartar has sometimes been attended with success; a +dram or two drams are given every hour in a morning till it operates, and +is to be repeated for several days; but the operation of tapping is +generally applied to at last. Dr. Sims, in the Memoirs of the Medical +Society of London, Vol. III. has lately proposed, what he believes to be a +more successful method of performing this operation, by making a puncture +with a lancet in the scar of the navel, and leaving it to discharge itself +gradually for several days, without introducing a canula, which he thinks +injurious both on account of the too sudden emission of the fluid, and the +danger of wounding or stimulating the viscera. This operation I have twice +known performed with less inconvenience, and I believe with more benefit to +the patient, than the common method. + +After the patient has been tapped, some have tried injections into the +cavity of the abdomen, but hitherto I believe with ill event. Nor are +experiments of this kind very promising of success. First because the +patients are generally much debilitated, most frequently by spirituous +potation, and have generally a disease of the liver, or of other viscera. +And secondly, because the quantity of inflammation, necessary to prevent +future secretion of mucus into the cavity of the abdomen, by uniting the +peritoneum with the intestines or mesentery, as happens in the cure of the +hydrocele, would I suppose generally destroy the patient, either +immediately, or by the consequence of such adhesions. + +This however is not the case in respect to the dropsy of the ovarium, or in +the hydrocele. + +14. _Hydrops thoracis._ The dropsy of the chest commences with loss of +flesh, cold extremities, pale countenance, high coloured urine in small +quantity, and general debility, like many other dropsies. The patient next +complains of numbness in the arms, especially when elevated, with pain and +difficulty of swallowing, and an absolute impossibility of lying down for a +few minutes, or with sudden starting from sleep, with great difficulty of +breathing and palpitation of his heart. + +The numbness of the arms is probably owing more frequently to the increased +action of the pectoral muscles in respiration, whence they are less at +liberty to perform other offices, than to the connexion of nerves mentioned +in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the +compression of the oesophagus by the lymph in the chest; and the +impossibility of breathing in an horizontal posture originates from this, +that if any parts of the lungs must be rendered useless, the inability of +the extremities of them must be less inconvenient to respiration; since if +the upper parts or larger trunks of the air-vessels should be rendered +useless by the compression of the accumulated lymph, the air could not gain +admittance to the other parts, and the animal must immediately perish. + +If the pericardium is the principal seat of the disease, the pulse is quick +and irregular. If only the cavity of the thorax is hydropic, the pulse is +not quick nor irregular. + +If one side is more affected than the other, the patient leans most that +way, and has more numbness in that arm. + +The hydrops thoracis is distinguished from the anasarca pulmonum, as the +patient in the former cannot lie down half a minute; in the latter the +difficulty of breathing, which occasions him to rise up, comes on more +gradually; as the transition of the lymph in the cellular membranes from +one part to another of it is slower, than that of the effused lymph in the +cavity of the chest. + +The hydrops thoracis is often complicated with fits of convulsive +breathing; and then it produces a disease for the time very similar to the +common periodic asthma, which is perhaps owing to a temporary anasarca of +the lungs; or to an impaired venous absorption in them. These exacerbations +of difficult breathing are attended with cold extremities, cold breath, +cold tongue, upright posture with the mouth open, and a desire of cold air, +and a quick, weak, intermittent pulse, and contracted hands. + +These exacerbations recur sometimes every two or three hours, and are +relieved by opium, a grain every hour for two or three doses, with ether +about a dram in cold water; and seem to be a convulsion of the muscles of +respiration induced by the pain of the dyspnea. As in Class III. 1. 1. 9. + +M. M. A grain of dried squill, and a quarter of a grain of blue vitriol +every hour for six or eight hours, unless it vomit or purge. A grain of +opium. Blisters. Calomel three grains every third day, with infusion of +senna. Bark. Chalybeates. Puncture in the side. + +Can the fluctuation in the chest be heard by applying the ear to the side, +as Hippocrates asserts? Can it be felt by the hand or by the patient before +the disease is too great to admit of cure by the paracentesis? Does this +dropsy of the chest often come on after peripneumony? Is it ever cured by +making the patient sick by tincture of digitalis? Could it be cured, if on +one side only, by the operation of puncture between the ribs, and +afterwards by inflaming the cavity by the admission of air for a time, like +the cure of the hydrocele; the pleura afterwards adhering wholly to that +lobe of the lungs, so as to prevent any future effusion of mucus? + +15. _Hydrops ovarii._ Dropsy of the ovary is another incysted dropsy, which +seldom admits of cure. It is distinguished from ascites by the tumour and +pain, especially at the beginning, occupying one side, and the fluctuation +being less distinctly perceptible. When it happens to young subjects it is +less liable to be mistaken for ascites. It affects women of all ages, +either married or virgins; and is produced by cold, fear, hunger, bad food, +and other debilitating causes. I saw an elegant young lady, who was shortly +to have been married to a sensible man, with great prospect of happiness; +who, on being overturned in a chaise in the night, and obliged to walk two +or three miles in wet, cold, and darkness, became much indisposed, and +gradually afflicted with a swelling and pain on one side of the abdomen; +which terminated in a dropsy of the ovary, and destroyed her in two or +three years. Another young woman I recollect seeing, who was about +seventeen, and being of the very inferior class of people, seemed to have +been much weakened by the hardship of a cold floor, and little or no bed, +with bad food; and who to these evils had to bear the unceasing obloquy of +her neighbours, and the persecution of parish officers. + +The following is abstracted from a letter of my friend Mr. Power, surgeon, +at Bosworth in Leicestershire, on examining the body of an elderly lady who +died of this disease, March 29, 1793. "On opening the abdomen I found a +large cyst attached to the left ovarium by an elastic neck as thick as the +little finger, and so callous as not to admit of being separated by +scissars without considerable difficulty. The substance of the cyst had an +appearance much resembling the gravid uterus near the full period of +gestation, and was as thick. It had no attachment to the peritonaeum, or +any of the viscera, except by the hard callous neck I have mentioned; so +that the blood must with difficulty have been circulated through it for +some time. Its texture was extremely tender, being easily perforated with +the finger, was of a livid red colour, and evidently in a sphacelated +state. It contained about two gallons of a fluid of the colour of port +wine, without any greater tenacity. It has fallen to my lot to have opened +two other patients, whose deaths were occasioned by incysted dropsy of the +ovarium. In one of these the ovarium was much enlarged with eight or ten +cysts on its surface, but there was no adhesion formed by any of the cysts +to any other part; nor had the ovarium formed any adhesion with the +peritonaeum, though in a very diseased state. In the other the disease was +more simple, being only one cyst, without any attachment but to the +ovarium. + + "As the ovarium is a part not necessary to life, and dropsies of this + kind are so generally fatal in the end, I think I shall be induced, + notwithstanding the hazard attending wounds, which penetrate the cavity + of the abdomen, to propose the extirpation of the diseased part in the + first case, which occurs to me, in which I can with precision say, that + the ovarium is the seat of the disease, and the patient in other + respects tolerably healthy; as the cavity of the abdomen is often + opened in other cases without bad consequences." + +An argument, which might further countenance the operation thus proposed by +Mr. Power, might be taken from the disease frequently affecting young +persons; from its being generally in these subjects local and primary; and +not like the ascites, produced or accompanied with other diseased viscera; +and lastly, as it is performed in adult quadrupeds, as old sows, with +safety, though by awkward operators. + +16. _Anasarca pulmonum._ The dropsy of the cellular membrane of the lungs +is usually connected with that of the other parts of the system. As the +cells of the whole cellular membrane communicate with each other, the +mucaginous fluid, which remains in any part of it for want of due +absorption, sinks down to the most depending cells; hence the legs swell, +though the cause of the disease, the deficiency of absorption, may be in +other parts of the system. The lungs however are an exception to this, +since they are suspended in the cavity of the thorax, and have in +consequence a depending part of their own. + +The anasarca of the lungs is known by the difficulty of respiration +accompanied with swelled legs, and with a very irregular pulse. This last +circumstance has generally been ascribed to a dropsy at the same time +existing in the pericardium, but is more probably owing to the difficult +passage of the blood through the lungs; because I found on dissection, in +one instance, that the most irregular pulse, which I ever attended to, was +owing to very extensive adhesions of the lungs; insomuch that one lobe +intirely adhered to the pleura; and secondly, because this kind of dropsy +of the lungs is so certainly removed for a time along with the anasarca of +the limbs by the use of digitalis. + +This medicine, as well as emetic tartar, or squill, when given so as to +produce sickness, or nausea, or perhaps even without producing either in +any perceptible degree, by affecting the lymphatics of the stomach, so as +either to invert their motion, or to weaken them, increases by reverse +sympathy the action, and consequent absorbent power of these lymphatics, +which open into the cellular membrane. But as those medicines seldom +succeed in producing an absorption of those fluids, which stagnate in the +larger cavities of the body, as in the abdomen, or chest, and do generally +succeed in this difficulty of breathing with irregular pulse above +described, I conclude that it is not owing to an effusion of lymph into the +pericardium, but simply to an anasarca of the lungs. + +M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar +(antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain +twice a day. Raisin wine and water, or other wine and water, is preferred +to the spirit and water, which these patients have generally been +accustomed to. + +The usual cause of anasarca is from a diseased liver, and hence it most +frequently attends those, who have drank much fermented or spirituous +liquors; but I suspect that there is another cause of anasarca, which +originates from the brain; and which is more certainly fatal than that, +which originates from a diseased liver. These patients, where the anasarca +originates from, or commences in, the brain, have not other symptoms of +diseased liver; have less difficulty of breathing at the beginning; and +hold themselves more upright in their chair, and in walking. In this kind +of dropsy I suspect the digitalis has less or no effect; as it particularly +increases the absorption from the lungs. + +17. _Obesitas._ Corpulency may be called an anasarca or dropsy of fat, +since it must be owing to an analogous cause; that is, to the deficient +absorption of fat compared to the quantity secreted into the cells which +contain it. See Class II. 1. 1. 4. + +The method of getting free from too much fat without any injury to the +constitution, consists, first, in putting on a proper bandage on the belly, +so that it can be tightened or relaxed with ease, as a tightish under +waistcoat, with a double row of buttons. This is to compress the bowels and +increase their absorption, and it thus removes one principal cause of +corpulency, which is the looseness of the skin. Secondly, he should omit +one entire meal, as supper; by this long abstinence from food the absorbent +system will act on the mucus and fat with greater energy. Thirdly, he +should drink as little as he can with ease to his sensations; since, if the +absorbents of the stomach and bowels supply the blood with much, or perhaps +too much, aqueous fluid, the absorbents of the cellular membrane will act +with less energy. Fourthly, he should use much salt or salted meat, which +will increase the perspiration and make him thirsty; and if he bears this +thirst, the absorption of his fat will be greatly increased, as appears in +fevers and dropsies with thirst; this I believe to be more efficacious than +soap. Fifthly, he may use aerated alcaline water for his drink, which may +be supposed to render the fat more fluid,--or he may take soap in large +quantities, which will be decomposed in the stomach. Sixthly, short rest, +and constant exercise. + +18. _Splenis tumor._ Swellings of the spleen, or in its vicinity, are +frequently perceived by the hand in intermittents, which are called +Ague-cakes, and seem owing to a deficiency of absorption in the affected +part. + +Mr. Y----, a young man about twenty-five years of age, who lived +intemperately, was seized with an obstinate intermittent, which had become +a continued fever with strong pulse, attended with daily remission. A large +hard tumour on the left side, on the region of the spleen, but extending +much more downward, was so distinctly perceptible, that one seemed to get +one's fingers under the edge of it, much like the feel of the brawn or +shield on a boar's shoulder. He was repeatedly bled, and purged with +calomel, had an emetic, and a blister on the part, without diminishing the +tumour; after some time he took the Peruvian bark, and slight doses of +chalybeates, and thus became free from the fever, and went to Bath for +several weeks, but the tumour remained. This tumour I examined every four +or five years for above thirty years. His countenance was pale, and towards +the end of his life he suffered much from ulcers on his legs, and died +about sixty, of general debility; like many others, who live intemperately +in respect to the ingurgitation of fermented or spirituous liquors. + +As this tumour commenced in the cold fit of an intermittent fever, and was +not attended with pain, and continued so long without endangering his life, +there is reason to believe it was simply occasioned by deficient +absorption, and not by more energetic action of the vessels which +constitute the spleen. See Class II. 1. 2. 13. + +M. M. Venesection. Emetic, cathartic with calomel; then sorbentia, +chalybeates, Peruvian bark. + +19. _Genu tumor albus._ White swelling of the knee, is owing to deficient +absorption of the lymphatics of the membranes including the joint, or +capsular ligaments, and sometimes perhaps of the gland which secretes the +synovia; and the ends of the bones are probably affected in consequence. + +I saw an instance, where a caustic had been applied by an empiric on a +large white swelling of the knee, and was told, that a fluid had been +discharged from the joint, which became anchylosed, and healed without loss +of the limb. + +M. M. Repeated blisters on the part early in the disease are said to cure +it by promoting absorption; saturnine solutions externally are recommended. +Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with +the hand. + +20. _Bronchocele._ Swelled throat. An enlargement of the thyroid glands, +said to be frequent in mountainous countries, where river water is drank, +which has its source from dissolving snows. This idea is a very ancient +one, but perhaps not on that account to be the more depended upon, as +authors copy one another. Tumidum guttur quis miratur in alpibus, seems to +have been a proverb in the time of Juvenal. The inferior people of Derby +are much subject to this disease, but whether more so than other populous +towns, I can not determine; certain it is, that they chiefly drink the +water of the Derwent, which arises in a mountainous country, and is very +frequently blackened as it passes through the morasses near its source; and +is generally of a darker colour, and attended with a whiter foam, than the +Trent, into which it falls; the greater quantity and whiteness of its froth +I suppose may be owing to the viscidity communicated to it by the colouring +matter. The lower parts of the town of Derby might be easily supplied with +spring water from St. Alkmond's well; or the whole of it from the abundant +springs near Bowbridge: the water from which might be conveyed to the town +in hollow bricks, or clay-pipes, at no very great expence, and might be +received into frequent reservoirs with pumps to them; or laid into the +houses. + +M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage +into lozenges, and permitted to dissolve slowly under the tongue twice a +day, is asserted to cure in a few months; perhaps other animal charcoal, as +candle-snuffs, might do the same. + +I have directed in the early state of this disease a mixture of common salt +and water to be held in the mouth, particularly under the tongue, for a few +minutes, four or six times a day for many weeks, which has sometimes +succeeded, the salt and water is then spit out again, or in part swallowed. +Externally vinegar of squills has been applied, or a mercurial plaster, or +fomentations of acetated ammoniac; or ether. Some empirics have applied +caustics on the bronchocele, and sometimes, I have been told, with success; +which should certainly be used where there is danger of suffocation from +the bulk of it. One case I saw, and one I was well informed of, where the +bronchocele was cured by burnt sponge, and a hectic fever supervened with +colliquative sweats; but I do not know the final event of either of them. + +De Haen affirms the cure of bronchocele to be effected by flowers of zinc, +calcined egg-shells, and scarlet cloth burnt together in a close crucible, +which was tried with success, as he assured me, by a late lamented +physician, my friend, Dr. Small of Birmingham; who to the cultivation of +modern sciences added the integrity of ancient manners; who in clearness of +head, and benevolence of heart, had few equals, perhaps no superiors. + +21. _Scrophula._ King's evil is known by tumours of the lymphatic glands, +particularly of the neck. The upper lip, and division of the nostrils is +swelled, with a florid countenance, a smooth skin, and a tumid abdomen. +Cullen. The absorbed fluids in their course to the veins in the scrophula +are arrested in the lymphatic or conglobate glands; which swell, and after +a great length of time, inflame and suppurate. Materials of a peculiar +kind, as the variolous and venereal matter, when absorbed in a wound, +produce this torpor, and consequent inflammation of those lymphatic glands, +where they first arrive, as in the axilla and groin. There is reason to +suspect, that the tonsils frequently become inflamed, and suppurate from +the matter absorbed from carious teeth; and I saw a young lady, who had +both the axillary glands swelled, and which suppurated; which was believed +to have been caused by her wearing a pair of new green gloves for one day, +when she had perspired much, and was much exhausted and fatigued by +walking; the gloves were probably dyed in a solution of verditer. + +These indolent tumours of the lymphatic glands, which constitute the +scrophula, originate from the inirritability of those glands; which +therefore sooner fall into torpor after having been stimulated too +violently by some poisonous material; as the muscles of enfeebled people +sooner become fatigued, and cease to act, when exerted, than those of +stronger ones. On the same account these scrophulous glands are much longer +in acquiring increase of motion, after having been stimulated into +inactivity, and either remain years in a state of indolence, or suppurate +with difficulty, and sometimes only partially. + +The difference between scrophulous tumours, and those before described, +consists in this; that in those either glands of different kinds were +diseased, or the mouths only of the lymphatic glands were become torpid; +whereas in scrophula the conglobate glands themselves become tumid, and +generally suppurate after a great length of time, when they acquire new +sensibility. See Sect. XXXIX. 4. 5. + +These indolent tumours may be brought to suppurate sometimes by passing +electric shocks through them every day for two or three weeks, as I have +witnessed. It is probable, that the alternate application of snow or iced +water to them, till they become painfully cold, and then of warm flannel or +warm water, frequently repeated, might restore their irritability by +accumulation of sensorial power; and thence either facilitate their +dispersion, or occasion them to suppurate. See Class II. 1. 4. 13. + +This disease is very frequent amongst the children of the poor in large +towns, who are in general ill fed, ill lodged, and ill clothed; and who are +further weakened by eating much salt with their scanty meal of insipid +vegetable food, which is seldom of better quality than water gruel, with a +little coarse bread in it. See diarrhoea of infants, Class I. 1. 2. 5. +Scrophulous ulcers are difficult to heal, which is owing to the deficiency +of absorption on their pale and flabby surfaces, and to the general +inirritability of the system. See Class I. 1. 3. 13. + +M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium, +from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture +of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing +in salt and water, one pound to three gallons, made warm. The application +of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in +fine powder one part, mixed together and applied on the ulcers in dry +powder, by means of lint and a bandage, to be renewed every day. Or very +fine powder of calamy alone, lapis calaminaris. If powder of manganese? + +22. _Schirrus._ After the absorbent veins of a gland cease to perform their +office, if the secerning arteries of it continue to act some time longer, +the fluids are pushed forwards, and stagnate in the receptacles or +capillary vessels of the gland; and the thinner part of them only being +resumed by the absorbent system of the gland, a hard tumour gradually +succeeds; which continues like a lifeless mass, till from some accidental +violence it gains sensibility, and produces cancer, or suppurates. Of this +kind are the schirrous glands of the breasts, of the lungs, of the +mesentery, and the scrophulous tumours about the neck and the bronchocele. + +Another seat of schirrus is in the membranous parts of the system, as of +the rectum intestinum, the urethra, the gula or throat; and of this kind is +the verucca or wart, and the clavus pedum, or corns on the toes. A wen +sometimes arises on the back of the neck, and sometimes between the +shoulders; and by distending the tendinous fascia produces great and +perpetual pain. + +M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation. +Electric shocks through the tumour. An issue into the substance of the wen. +Opium. Ether externally. + +23. _Schirrus recti intestini._ Schirrus of the rectum. A schirrus +frequently affects a canal, and by contracting its diameter becomes a +painful and deplorable disease. The canals thus obstructed are the rectum, +the urethra, the throat, the gall-ducts, and probably the excretory ducts +of the lymphatics, and of other glands. + +The schirrus of the rectum is known by the patient having pain in the part, +and being only able to part with liquid feces, and by the introduction of +the finger; the swelled part of the intestine is sometimes protruded +downwards, and hangs like a valve, smooth and hard to the touch, with an +aperture in the centre of it. See a paper on this subject by J. Sherwin. +Memoirs of a London Medical Society, Vol. II. p. 9. + +M. M. To take but little solid food. Aperient medicines. Introduce a candle +smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of +laudanum. Introduce a leathern canula, or gut, and then either a wooden +maundril, or blow it up with air, so as to distend the contracted part as +much as the patient can bear. Or spread mercurial plaster on thick soft +leather, and roll it up with the plaster outwards to any thickness and +length, which can be easily introduced and worn; or two or three such +pieces may be introduced after each other. The same may be used to compress +bleeding internal piles. See Class I. 2. 1. 6. + +24. _Schirrus urethrae._ Schirrus of the urethra. The passage becomes +contracted by the thickened membrane, and the urine is forced through with +great difficulty, and is thence liable to distend the canal behind the +stricture; till at length an aperture is made, and the urine forces its way +into the cellular membrane, making large sinuses. This situation sometimes +continues many months, or even years, and so much matter is evacuated after +making water, or at the same time, by the action of the muscles in the +vicinity of the sinuses, that it has been mistaken for an increased +secretion from the bladder, and has been erroneously termed a catarrh of +the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs. + +M. M. Distend the part gradually by catgut bougies, which by their +compression will at the same time diminish the thickness of the membrane, +or by bougies of elastic gum, or of horn boiled soft. The patient should +gain the habit of making water slowly, which is a matter of the utmost +consequence, as it prevents the distention, and consequent rupture, of that +part of the urethra, which is between the stricture and the neck of the +bladder. + +When there occurs an external ulcer in the perinaeum, and the urine is in +part discharged that way, the disease can not be mistaken. Otherwise from +the quantity of matter, it is generally supposed to come from the bladder, +or prostate gland; and the urine, which escapes from the ruptured urethra, +mines its way amongst the muscles and membranes, and the patient dies +tabid, owing to the want of an external orifice to discharge the matter. +See Class II. 1. 4. 11. + +25. _Schirrus oesophagi._ A schirrus of the throat contracts the passage so +as to render the swallowing of solids impracticable, and of liquids +difficult. It affects patients of all ages, but is probably most frequently +produced by swallowing hard angular substances, when people have lost their +teeth; by which this membrane is over distended, or torn, or otherwise +injured. + +M. M. Put milk into a bladder tied to a canula or catheter; introduce it +past the stricture, and press it into the stomach. Distend the stricture +gradually by a sponge-tent fastened to the end of whale-bone, or by a plug +of wax, or a spermaceti candle, about two inches long; which might be +introduced, and left there with a string only fixed to it to hang out of +the mouth, to keep it in its place, and to retract it by occasionally; for +which purpose the string must be put through a catheter or hollow probang, +when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and +then distend it by blowing wind into it. The swallowing a bullet with a +string put through it, to retract it on the exhibition of an emetic, has +also been proposed. Externally mercurial ointment has been much +recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth. +Transfusion of blood into a vein three or four ounces a day? See Class III. +1. 1. 15. + +I directed a young woman about twenty-two years of age, to be fed with new +milk put into a bladder, which was tied to a catheter, and introduced +beyond the stricture in her throat; after a few days her spirits sunk, and +she refused to use it further, and died. Above thirty years ago I proposed +to an old gentleman, whose throat was entirely impervious, to supply him +with a few ounces of blood daily from an ass, or from the human animal, who +is still more patient and tractable, in the following manner. To fix a +silver pipe about an inch long to each extremity of a chicken's gut, the +part between the two silver ends to be measured by filling it with warm +water; to put one end into the vein of a person hired for that purpose, so +as to receive the blood returning from the extremity; and when the gut was +quite full, and the blood running through the other silver end, to +introduce that end into the vein of the patient upwards towards the heart, +so as to admit no air along with the blood. And lastly, to support the gut +and silver ends on a water plate, filled with water of ninety-eight degrees +of heat, and to measure how many ounces of blood was introduced by passing +the finger, so as to compress the gut, from the receiving pipe to the +delivering pipe; and thence to determine how many gut-fulls were given from +the healthy person to the patient. See Class IV. 2. 4. 11. Mr. ---- +considered a day on this proposal, and then another day, and at length +answered, that "he now found himself near the house of death; and that if +he could return, he was now too old to have much enjoyment of life; and +therefore he wished rather to proceed to the end of that journey, which he +was now so near, and which he must at all events soon go, than return for +so short a time." He lived but a few days afterwards, and seemed quite +careless and easy about the matter. + +26. _Lacteorum inirritabilitas._ Inirritability of the lacteals is +described in Sect. XXVIII. under the name of paralysis of the lacteals; but +as the word paralysis has generally been applied to the disobedience of the +muscles to the power of volition, the name is here changed to +inirritability of the lacteals, as more characteristic of the disease. + +27. _Lymphaticorum inirritabilitas._ The inirritability of the cellular and +cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Class I. 2. +3. 16. The inirritability of the cutaneous lymphatics generally accompanies +anasarca, and is the cause of the great thirst in that malady. At the same +time the cellular lymphatics act with greater energy, owing to the greater +derivation of sensorial power to them in consequence of the less +expenditure of it by the cutaneous ones; and hence they absorb the fat, and +mucus, and also the thinner parts of the urine. Whence the great emaciation +of the body, the muddy sediment, and the small quantity of water in this +kind of dropsy. + + * * * * * + +ORDO II. + +_Decreased Irritation._ + +GENUS IV. + +_With Decreased Actions of other Cavities and Membranes._ + +Many of the diseases of this genus are attended with pain, and with cold +extremities, both which cease on the exhibition of wine or opium; which +shews, that they originate from deficient action of the affected organ. +These pains are called nervous or spasmodic, are not attended with fever, +but are frequently succeeded by convulsions and madness; both which belong +to the class of volition. Some of them return at periods, and when these +can be ascertained, a much less quantity of opium will prevent them, than +is necessary to cure them, when they are begun; as the vessels are then +torpid and inirritable from the want of sensorial power, till by their +inaction it becomes again accumulated. + +Our organs of sense properly so called are not liable to pain from the +absence of their appropriated stimuli, as from darkness or silence; but the +other senses, which may be more properly called appetites, as those by +which we perceive heat, hunger, thirst, lust, want of fresh air, are +affected with pain from the defect or absence of their accustomed stimuli, +as well as with pleasure by the possession of them; it is probable that +some of our glands, whose sense or appetite requires or receives something +from the circulating blood, as the pancreas, liver, testes, prostate gland, +may be affected with aching or pain, when they cannot acquire their +appropriated fluid. + +Wherever this defect of stimulus occurs, a torpor or inaction of the organ +ensues, as in the capillaries of the skin, when exposed to cold; and in the +glands, which secrete the gastric juice, when we are hungry. This torpor +however, and concomitant pain, which is at first owing to defect of +stimulus, is afterwards induced by other associations or catenations, and +constitutes the beginning of ague fits. + +It must be further observed, that in the diseases of pain without fever, +the pain is frequently not felt in the part where the cause of the disease +resides; but is induced by sympathy with a distant part, whose irritability +or sensibility is greater or less than its own. Thus a stone at the neck of +the bladder, if its stimulus is not very great, only induces the pain of +strangury at the glans penis. If its stimulus be greater, it then induces +pain at the neck of the bladder. The concretions of bile, which are +protruded into the neck of the gall-bladder, when the disease is not very +great, produce pain at the other extremity of the bile-duct, which enters +the duodenum immediately under the pit of the stomach; but, when the +disease is great from the largeness of the bile-stone, the pain is felt in +the region of the liver at the neck of the gall-bladder. + +It appears from hence, that the pains enumerated in this genus are +consequences of the inactivity of the organ; and, as they do not occasion +other diseases, should be classed according to their proximate cause, which +is defective irritation; there are nevertheless other pains from defect of +stimulus, which produce convulsions, and belong to Class III. 1. 1.; and +others, which produce pains of some distant part by association, and belong +to Class IV. 2. 2. + +SPECIES. + +1. _Sitis._ Thirst. The senses of thirst and of hunger seem to have this +connection, that the former is situated at the upper end, and the latter at +the lower end of the same canal. One about the pharinx, where the +oesophagus opens into the mouth, and the other about the cardia ventriculi, +where it opens into the stomach. The extremities of other canals have been +shewn to possess correspondent sensibilities, or irritabilities, as the two +ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4. + +The membrane of the upper end of the gullet becomes torpid, and +consequently painful, when there is a deficiency of aqueous fluid in the +general system; it then wants its proper stimulus. In the same manner a +want of the stimulus of more solid materials at the other end of the canal, +which terminates in the stomach, produces hunger; as mentioned in Sect. +XIV. 8. The proximate causes of both of them therefore consist in deficient +irritation, when they are considered as pains; because these pains are in +consequence of the inactivity of the organ, according to the fifth law of +animal causation. Sect. IV. 5. But when they are considered as desires, +namely of liquid or solid aliment, their proximate cause consists in the +pain of them, according to the sixth law of animal causation. So the +proximate cause of the pain of coldness is the inactivity of the organ, and +perhaps the consequent accumulation of sensorial power in it; but the pain +itself, or the consequent volition, is the proximate cause of the +shuddering and gnashing the teeth in cold fits of intermittent fevers. See +Class I. 2. 2. 1. + +Thirst may be divided into two varieties alluding to the remote cause of +each, and may be termed sitis calida, or warm thirst, and sitis frigida, or +cold thirst. The remote cause of the former arises from the dissipation of +the aqueous parts of our fluids by the increased secretion of perspirable +matter, or other evacuations. And hence it occurs in hot fits of fever, and +after taking much wine, opium, spice, salt, or other drugs of the Art. +incitantia or secernentia. The thirst, which occurs about three hours after +eating a couple of red herrings, to a person unaccustomed to salted meat, +is of this kind; the increased action of the cutaneous vessels dissipates +so much of our fluids by insensible perspiration, as to require above two +quarts of water to restore the fluidity of the blood, and to wash the salt +out of the system. See Art. III. 2. 1. + +M. M. Cold water. Vegetable acids. Warm bath. + +The remote cause of sitis frigida, or cold thirst, is owing to the inaction +of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the +blood is deprived of the great supply of moisture, which it ought to +receive from the atmosphere, and from the cells of the cellular membrane, +and from other cysts; this cause of thirst exists in dropsies, and in the +cold fits of intermittents. The desire of fluids, like that of solids, is +liable to acquire periods, and may therefore readily become diseased by +indulgence in liquids grateful to the palate. + +Of diseased thirst, the most common is either owing to defect of the action +of the numerous absorbent vessels on the neck of the bladder, in which the +patient makes much paleish water; or to the defective absorption of the +skin and lungs, in which the patient makes but little water, and that +high-coloured, and with sediment. In both the tongue and lips are liable to +become very dry. The former in its greatest degree attends diabaetes, and +the latter anasarca. + +M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water. +Lemonade. Cyder. + +2. _Esuries._ Hunger has been fancifully ascribed to the sides of the +stomach rubbing against each other, and to the increased acidity of the +gastric juice corroding the coats of it. If either of these were the cause +of hunger, inflammation must occur, when they had continued some time; but, +on the contrary, coldness and not heat are attendant on hunger; which +evinces, that like thirst it is owing to the inactivity of the membrane, +which is the seat of it; while the abundant nerves about the cardia +ventriculi, and the pain of hunger being felt in that part, gives great +reason to conclude, that it is there situated. + +The sense of hunger as well as of thirst is liable to acquire habits in +respect to the times of its returning painfulness, as well as in respect to +the quantity required to satiate its appetency, and hence may become +diseased by indulgence, as well as by want of its appropriate stimulus. +Those who have been accustomed to distend their stomach by large quantities +of animal and vegetable food, and much potation, find a want of distention, +when the stomach is empty, which occasions faintness, and is mistaken for +hunger, but which does not appear to be the same sensation. I was well +informed, that a woman near Lichfield, who eat much animal and vegetable +food for a wager, affirmed, that since distending her stomach so much, she +had never felt herself satisfied with food; and had in general taken twice +as much at a meal, as she had been accustomed to, before she eat so much +for a wager. + +3. _Nausea sicca._ Dry nausea. Consists in a quiescence or torpor of the +mucous or salivary glands, and precedes their inverted motions, described +in nausea humida, Class I. 3. 2. 3. In the same manner as sickness of the +stomach is a quiescence of that organ preceding the action of vomiting, as +explained in Sect. XXXV. 1. 3. This is sometimes induced by disagreeable +drugs held in the mouth, at other times of disgustful ideas, and at other +times by the association of these actions with those of the stomach; and +thus according to its different proximate causes may belong to this, or to +the second, or to the fourth class of diseases. + +M. M. Lemonade. Tasteful food. A blister. Warm bath. + +4. _Aegritudo ventriculi._ Sickness of stomach is produced by the +quiescence or inactivity of that organ, as is explained in Sect. XXXV. 1. +3. It consists in the state between the usual peristaltic motions of that +organ, in the digestion of our aliment, and the retrograde motions of it in +vomiting; for it is evident, that the direct motions of it from the cardia +to the pylorus must stop, before those in a contrary direction can +commence. This sickness, like the nausea above described, is sometimes +produced by disgustful ideas, as when nasty objects are seen, and nasty +stories related, as well as by the exhaustion of the sensorial power by the +stimulus of some emetic drugs, and by the defect of the production of it, +as in enfeebled drunkards. + +Sickness may likewise consist in the retrograde motions of the lymphatics +of the stomach, which regurgitate into it the chyle or lymph, which they +have lately absorbed, as in Class I. 3. 2. 3. It is probable, that these +two kinds of sickness may be different sensations, though they have +acquired but one name; as one of them attends hunger, and the other +repletion; though either of them may possibly be induced by association +with nauseous ideas. + +M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the +head in bed. See Sect. XXV. 16. Class IV. 1. 1. 2. and 3. + +5. _Cardialgia._ Heartburn originates from the inactivity of the stomach, +whence the aliment, instead of being subdued by digestion, and converted +into chyle, runs into fermentation, producing acetous acid. Sometimes the +gastric juice itself becomes so acid as to give pain to the upper orifice +of the stomach; these acid contents of the stomach, on falling on a marble +hearth, have been seen to produce an effervescence on it. The pain of heat +at the upper end of the gullet, when any air is brought up from the +fermenting contents of the stomach, is to be ascribed to the sympathy +between these two extremities of the oesophagus rather than to the pungency +of the carbonic gas, or fixed air; as the sensation in swallowing that kind +of air in water is of a different kind. See Class I. 3. 1. 3. and IV. 2. 2. +5. + +M. M. This disease arising from indigestion is often very pertinacious, and +afflicting; and attended with emaciation of the body from want of +sufficient chyle. As the saliva swallowed along with our food prevents its +fermentation, as appears by the experiments of Pringle and Macbride, some +find considerable relief by chewing parched wheat, or mastic, or a lock of +wool, frequently in a day, when the pain occurs, and by swallowing the +saliva thus effused; a temporary relief is often obtained from antiacids, +as aerated alcaline water, Seltzer's water, calcareous earths, alcaline +salts made into pills with soap, soap alone, tin, milk, bitters. More +permanent use may be had from such drugs as check fermentation, as acid of +vitriol; but still more permanent relief from such things as invigorate the +digestion, as a blister on the back; a due quantity of vinous spirit and +water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat +made so tight as slightly to compress the bowels and stomach. A flannel +shirt in winter, not in summer. A less quantity of potation of all kinds. +Ten black pepper-corns swallowed after dinner. Half a grain of opium twice +a day, or a grain. The food should consist of such things as do not easily +ferment, as flesh, shell-fish, sea-biscuit, toasted cheese. I have seen +toasted cheese brought up from the stomach 24 hours after it had been +swallowed, without apparently having undergone any chemical change. See +Class II. 1. 3. 17. and IV. 1. 2. 13. + +6. _Arthritis Ventriculi._ Sickness of the stomach in gouty cases is +frequently a consequence of the torpor or inflammation of the liver, and +then it continues many days or weeks. But when the patient is seized with +great pain at the stomach with the sensation of coldness, which they have +called an ice-bolt, this is a primary affection of the stomach, and +destroys the patient in a few hours, owing to the torpor or inaction of +that viscus so important to life. + +This primary gout of the stomach, as it is a torpor of that viscus, is +attended with sensation of coldness, and with real defect of heat, in that +part, and may thence be distinguished from the pain occasioned by the +passage of a gall-stone into the duodenum, as well as by the weak pulse, +and cold extremities; to which must be added, that it affects those only, +who have been long afflicted with the gout, and much debilitated by its +numerous attacks. + +M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied +externally to the stomach by hot cloths or fomentation. + +7. _Colica flatulenta._ The flatulent colic arises from the too great +distention of the bowel by air, and consequent pain. The cause of this +disease is the inactivity or want of sufficiently powerful contraction of +the coats of the bowel, to carry forwards the gas given up by the +fermenting aliment. It is without fever, and generally attended with cold +extremities. + +It is distinguished, first, from the pain occasioned by the passage of a +gall-stone, as that is felt at the pit of the stomach, and this nearer the +navel. Secondly, it is distinguished from the colica saturnina, or colic +from lead, as that arising from the torpor of the liver, or of some other +viscus, is attended with greater coldness, and with an aching pain; whereas +the flatulent cholic being owing to distention of the muscles of the bowel, +the pain is more acute, and the coldness less. Thirdly, it is distinguished +from inflammation of the bowels, or ileus, as perpetual vomiting and fever +attend this. Fourthly, it is distinguished from cholera, because that is +accompanied with both vomiting and diarrhoea. And lastly, from the colica +epileptica, or hysteric colic, as that is liable to alternate with +convulsion, and sometimes with insanity; and returns by periods. + +M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain. +Spice. Volatile alcali. Warm fomentation externally. Rhubarb. + +8. _Colica saturnina._ Colic from lead. The pain is felt about the navel, +is rather of an aching than acute kind at first, which increases after +meals, and gradually becomes more permanent and more acute. It terminates +in paralysis, frequently of the muscles of the arm, so that the hand hangs +down, when the arm is extended horizontally. It is not attended with fever, +or increase of heat. The seat of the disease is not well ascertained, it +probably affects some part of the liver, as a pale bluish countenance and +deficiency of bile sometimes attends or succeeds it, with consequent +anasarca; but it seems to be caused immediately by a torpor of the +intestine, whether this be a primary or secondary affection, as appears +from the constipation of the bowels, which attends it; and is always +produced in consequence of the great stimulus of lead previously used +either internally for a length of time, or externally on a large surface. + +A delicate young girl, daughter of a dairy farmer, who kept his milk in +leaden cisterns, used to wipe off the cream from the edges of the lead with +her finger; and frequently, as she was fond of cream, licked it from her +finger. She was seized with the saturnine colic, and semi-paralytic wrists, +and sunk from general debility. + +A feeble woman about 40 years of age sprained her ancle, and bruised her +leg and thigh; and applied by ill advice a solution of lead over the whole +limb, as a fomentation and poultice for about a fortnight. She was then +seized with the colica saturnina, lost the use of her wrists, and gradually +sunk under a general debility. + +M. M. First opium one or two grains, then a cathartic of senna, jalap, and +oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A +blister on the navel. Warm bath. The stimulus of the opium, by restoring to +the bowel its natural irritability in this case of painful torpor, assists +the action of the cathartic. + +9. _Tympanitis._ Tympany consists in an elastic tumor of the abdomen, which +sounds on being struck. It is generally attended with costiveness and +emaciation. In one kind the air is said to exist in the bowels, in which +case the tumor is less equal, and becomes less tense and painful on the +evacuation of air. In the other kind the air exists in the cavity of the +abdomen, and sometimes is in a few days exchanged for water, and the +tympany becomes an ascites. + +Air may be distinguished in the stomach of many people by the sound on +striking it with the fingers, and comparing the sound with that of a +similar percussion on other parts of the bowels; but towards the end of +fevers, and especially in the puerperal fever, a distention of the abdomen +by air is generally a fatal symptom, though the ease, and often +cheerfulness, of the patient vainly flatters the attendants. + +M. M. In the former case a clyster-pipe unarmed may be introduced, and left +some time in the rectum, to take off the resistance of the sphincter, and +thus discharge the air, as it is produced from the fermenting or putrefying +aliment. For this purpose, in a disease somewhat similar in horses, a +perforation is made into the rectum on one side of the sphincter; through +which fistula the air, which is produced in such great excess from the +quantity of vegetable food which they take, when their digestions are +impaired, is perpetually evacuated. In both cases also, balsams, essential +oil, spice, bandage on the abdomen, and, to prevent the fermentation of the +aliment, acid of vitriol, saliva. See Class I. 2. 4. 5. + +10. _Hypochondriasis._ The hypochondriac disease consists in indigestion +and consequent flatulency, with anxiety or want of pleasureable sensation. +When the action of the stomach and bowels is impaired, much gas becomes +generated by the fermenting or putrescent aliment, and to this indigestion +is catenated languor, coldness of the skin, and fear. For when the +extremities are cold for too long a time in some weak constitutions, +indigestion is produced by direct sympathy of the skin and the stomach, +with consequent heart-burn, and flatulency. The same occurs if the skin be +made cold by fear, as in riding over dangerous roads in winter, and hence +conversely fear is produced by indigestion or torpor of the stomach by +association. + +This disease is confounded with the fear of death, which is an insanity, +and therefore of a totally different nature. It is also confounded with the +hysteric disease, which consists in the retrograde motions of the +alimentary canal, and of some parts of the absorbent system. + +The hypochondriasis, like chlorosis, is sometimes attended with very quick +pulse; which the patient seems to bear so easily in these two maladies, +that if an accidental cough attends them, they may be mistaken for +pulmonary consumption; which is not owing primarily to the debility of the +heart, but to its direct sympathy with the actions of the stomach. + +M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain +twice a day. Rhubarb six grains every night. Bark. Steel. Spice. +Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No +liquor stronger than small beer, or wine and water. Gentle exercise on +horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4. +5. + +11. _Cephalaea._ Head-ach frequently attends the cold paroxysm of +intermittents; afflicts inebriates the day after intoxication; and many +people who remain too long in the cold bath. In all which cases there is a +general inaction of the whole system, and as these membranes about the head +have been more exposed to the variations of heat and cold of the +atmosphere, they are more liable to become affected so far as to produce +sensation, than other membranes; which are usually covered either with +clothes, or with muscles, as mentioned in Sect. XXXIII. 2. 10. + +The promptitude of the membranes about the scalp to sympathize with those +of other parts of the system is so great, that this cephalaea without +fever, or quickness of pulse, is more frequently a secondary than a primary +disease, and then belongs to Class IV. 2. 2. 7. The hemicrania, or partial +head-ach, I believe to be almost always a disease from association; though +it is not impossible, but a person may take cold on one side of the head +only. As some people by sitting always on the same side of the fire in +winter are liable to render one side more tender than the other, and in +consequence more subject to pains, which have been erroneously termed +rheumatic. See Class IV. 2. 2. 7. & 8. + +M. M. The method of cure consists in rendering the habit more robust, by +gentle constant exercise in the open air, flesh diet, small beer at meals +with one glass of wine, regular hours of rest and rising, and of meals. The +cloathing about the head should be warmer during sleep than in the day; +because at that time people are more liable to take cold; that is, the +membranous parts of it are more liable to become torpid. As explained in +Sect. XVIII. 15. In respect to medicine, two drams of valerian root in +powder three or four times a day are recommended by Fordyce. The bark. +Steel in moderate quantities. An emetic. A blister. Opium, half a grain +twice a day. Decayed teeth should be extracted, particularly such as either +ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm +bath of 94 or 98 degrees every day for half an hour during a month. See +Class IV. 2. 2. 7. and 8. + +A solution of arsenic, about the sixteenth part of a grain, is reported to +have great effect in this disease. It should be taken thrice a day, if it +produces no griping or sickness, for two or three weeks. A medicine of this +kind is sold under the name of tasteless ague-drops; but a more certain +method of ascertaining the quantity is delivered in the subsequent materia +medica, Art. IV. 2. 6. + +12. _Odontalgia._ Tooth-ach. The pain has been erroneously supposed, where +there is no inflammation, to be owing to some acrid matter from a carious +tooth stimulating the membrane of the alveolar process into violent action +and consequent pain; but the effect seems to have been mistaken for the +cause, and the decay of the tooth to have been occasioned by the torpor and +consequent pain of the diseased membrane. + +First, because the pain precedes the decay of the tooth in regard to time, +and is liable to recur, frequently for years, without certainly being +succeeded at last by a carious tooth, as I have repeatedly observed. + +Secondly, because any stimulant drug, as pyrethrum, or oil of cloves, +applied to the tooth, or ether applied externally to the cheek, so far from +increasing the pain, as they would do if the pained membrane, already acted +too strongly, that they frequently give immediate relief like a charm. + +And thirdly, because the torpor, or deficient action of the membrane, which +includes the diseased tooth, occasions the motions of the membranes most +connected with it, as those of the cheek and temples, to act with less than +their natural energy; and hence a coldness of the cheek is perceived easily +by the hand of the patient, comparing it with the other cheek; and the pain +of hemicrania is often produced in the temple of the affected side. + +This coldness of the cheek in common tooth-ach evinces, that the pain is +not then caused by inflammation; because in all inflammations so much heat +is produced in the secretions of new vessels and fluids, as to give heat to +the parts in vicinity. And hence, as soon as the gum swells and inflames +along with the cheek, heat is produced, and the pain ceases, owing to the +increased exertions of the torpid membrane, excited by the activity of the +sensorial power of sensation; which previously existed in its passive state +in the painful torpid membrane. See Odontitis, Class II. 1. 4. 7. and IV. +2. 2. 8. + +M. M. If the painful tooth be found, venesection. Then a cathartic. +Afterwards two grains of opium. Camphor and opium, one grain of each held +in the mouth; or a drop or two of oil of cloves put on the painful tooth. +Ether. If the tooth has a small hole in it, it should be widened within by +an instrument, and then stopped with leaf-gold, or leaf-lead; but should be +extracted, if much decayed. It is probable that half a small drop of a +strong solution of arsenic, put carefully into the hollow of a decayed +aching tooth, would destroy the nerve without giving any additional pain; +but this experiment requires great caution, lest any of the solution should +touch the tongue or gums. + +Much cold or much heat are equally injurious to the teeth, which are endued +with a fine sensation of this universal fluid. The best method of +preserving them is by the daily use of a brush, which is not very hard, +with warm water and fine charcoal dust. A lump of charcoal should be put a +second time into the fire till it is red hot, as soon as it becomes cool +the external ashes should be blown off, and it should be immediately +reduced to fine powder in a mortar, and kept close stopped in a phial. It +takes away the bad smell from decayed teeth, by washing the mouth with this +powder diffused in water immediately. The putrid smell of decaying stumps +of teeth may be destroyed for a time by washing the mouth with a weak +solution of alum in water. If the calcareous crust upon the teeth adheres +very firmly, a fine powder of pumice-stone may be used occasionally, or a +tooth instrument. + +Acid of sea-salt, much diluted, may be used; but this very rarely, and with +the greatest caution, as in cleaning sea-shells. When the gums are spongy, +they should be frequently pricked with a lancet. Should black spots in +teeth be cut out? Does the enamel grow again when it has been perforated or +abraded? + +13. _Otalgia._ Ear-ach sometimes continues many days without apparent +inflammation, and is then frequently removed by filling the ear with +laudanum, or with ether; or even with warm oil, or warm water. See Class +II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the +consequence of association with a diseased tooth; in that case the ether +should be applied to the cheek over the suspected tooth, or a grain of +opium and as much camphor mixed together and applied to the suspected +tooth. In this case the otalgia belongs to the fourth class of diseases. + +14. _Pleurodyne chronica._ Chronical pain of the side. Pains of the +membranous parts, which are not attended with fever, have acquired the +general name of rheumatic; which should, nevertheless, be restricted to +those pains which exist only when the parts are in motion, and which have +been left after inflammation of them; as described in Class I. 1. 3. 12. +The pain of the side here mentioned affects many ladies, and may possibly +have been owing to the pressure of tight stays, which has weakened the +action of the vessels composing some membranous part, as, like the cold +head-ach, it is attended with present debility; in one patient, a boy about +ten years old, it was attended with daily convulsions, and was supposed to +have originated from worms. The disease is very frequent, and generally +withstands the use of blisters on the part; but in some cases I have known +it removed by electric shocks repeated every day for a fortnight through +the affected side. + +Pains of the side may be sometimes occasioned by the adhesion of the lungs +to the pleura, after an inflammation of them; or to the adhesion of some +abdominal viscera to their cavity, or to each other; which also are more +liable to affect ladies from the unnatural and ungraceful pressure of tight +stays, or by sitting or lying too long in one posture. But in these cases +the pain should be more of the smarting, than of the dull kind. + +M. M. Ether. A blister. A plaster of Burgundy pitch. An issue or seton on +the part. Electric shocks. Friction on the part with oil and camphor. Loose +dress. Frequent change of posture both in the day and night. Internally +opium, valerian, bark. + +15. _Sciatica frigida._ Cold sciatica. The pain along the course of the +sciatic nerve, from the hip quite down to the top of the foot, when it is +not attended with fever, is improperly termed either rheumatism or gout; as +it occurs without inflammation, is attended with pain when the limb is at +rest; and as the pain attends the course of the nerve, and not the course +of the muscles, or of the fascia, which contains them. The theory of +Cotunnius, who believed it to be a dropsy of the sheath of the nerve, which +was compressed by the accumulated fluid, has not been confirmed by +dissection. The disease seems to consist of a torpor of this sheath of the +nerve, and the pain seems to be in consequence of this torpor. See Class +II. 1. 2. 18. + +M. M. Venesection. A cathartic. And then one grain of calomel and one of +opium every night for ten successive nights. And a blister, at the same +time, a little above the knee-joint on the outside of the thigh, where the +sciatic nerve is not so deep seated. Warm bath. Cold bath. Cover the limb +with oiled silk, or with a plaster-bandage of emplastrum de minio. + +16. _Lumbago frigida._ Cold lumbago. When no fever or inflammation attends +this pain of the loins, and the pain exists without motion, it belongs to +this genus of diseases, and resembles the pain of the loins in the cold fit +of ague. As these membranes are extensive, and more easily fall into +quiescence, either by sympathy, or when they are primarily affected, this +disease becomes very afflicting, and of great pertinacity. See Class II. 1. +2. 17. + +M. M. Venesection. A cathartic. Issues on the loins. Adhesive plaster on +the loins. Blister on the os sacrum. Warm bath. Cold bath. Remove to a +warmer climate in the winter. Loose dress about the waist. Friction daily +with oil and camphor. + +17. _Hysteralgia frigida._ Cold pain of the uterus preceding or +accompanying menstruation. It is attended with cold extremities, want of +appetite, and other marks of general debility. + +M. M. A clyster of half a pint of gruel, and 30 drops of laudanum; or a +grain of opium and six grains of rhubarb every night. To sit over warm +water, or go into a warm bath. + +18. _Proctalgia frigida._ Cold pain at the bottom of the rectum previous to +the tumor of the piles, which sometimes extends by sympathy to the loins; +it seems to be similar to the pain at the beginning of menstruation, and is +owing to the torpor or inirritability of the extremity of the alimentary +canal, or to the obstruction of the blood in its passage through the liver, +when that viscus is affected, and its consequent delay in the veins of the +rectum, occasioning tumors of them, and dull sensations of pain. + +M. M. Calomel. A cathartic. Spice. Clyster, with 30 drops of laudanum. +Sitting over warm water. If chalybeates after evacuation? See Class I. 2. +3. 23. and I. 2. 1. 6. + +19. _Vesicae felleae inirritabilitas._ The inirritability of the +gall-bladder probably occasions one kind of _icterus_, or jaundice; which +is owing to whatever obstructs the passage of bile into the duodenum. The +jaundice of aged people, and which attends some fevers, is believed to be +most frequently caused by an irritative palsy of the gall-bladder; on which +account the bile is not pressed from the cyst by its contraction, as in a +paralysis of the urinary bladder. + +A thickening of the coats of the common bile-duct by inflammation or +increased action of their vessels so as to prevent the passage of the bile +into the intestine, in the same manner as the membrane, which lines the +nostrils, becomes thickened in catarrh so as to prevent the passage of air +through them, is probably another frequent cause of jaundice, especially of +children; and generally ceases in about a fortnight, like a common catarrh, +without the aid of medicine; which has given rise to the character, which +charms have obtained in some countries for curing the jaundice of young +people. + +The spissitude of the bile is another cause of jaundice, as mentioned in +Class I. 1. 3. 8. This also in children is a disease of little danger, as +the gall-ducts are distensible, and will the easier admit of the exclusion +of gall-stones; but becomes a more serious disease in proportion to the age +of the patient, and his habits of life in respect to spirituous potation. + +A fourth cause of jaundice is the compression of the bile-duct by the +enlargement of an inflamed or schirrous liver; this attends those who have +drank much spirituous liquor, and is generally succeeded by dropsy and +death. + +M. M. Repeated emetics. Mild cathartics. Warm bath. Electricity. Bitters. +Then steel, which, when the pain and inflammation is removed by +evacuations, acts like a charm in removing the remainder of the +inflammation, and by promoting the absorption of the new vessels or fluids; +like the application of any acrid eye-water at the end of ophthalmia; and +thus the thickened coats of the bile-duct become reduced, or the +enlargement of the liver lessened, and a free passage is again opened for +the bile into the intestine. Ether with yolk of egg is recommended, as +having a tendency to dissolve inspissated bile. And a decoction of madder +is recommended for the same purpose; because the bile of animals, whose +food was mixed with madder, was found always in a dilute state. Aerated +alcaline water, or Seltzer's water. Raw cabbage, and other acrid +vegetables, as water-cresses, mustard. Horses are said to be subject to +inspissated bile, with yellow eyes, in the winter season, and to get well +as soon as they feed on the spring grass. + +The largest bile-stone I have seen was from a lady, who had parted with it +some years before, and who had abstained above ten years from all kinds of +vegetable diet to prevent, as she supposed, a colic of her stomach, which +was probably a pain of the biliary duct; on resuming the use of some +vegetable diet, she recovered a better state of health, and formed no new +bilious concretions. + +A strong aerated alcaline water is sold by J. Schweppe, No. 8, +King's-street, Holborn. See Class I. 1. 3. 10. + +20. _Pelvis renalis inirritabilitas._ Inirritability of the pelvis of the +kidney. When the nucleus of a stone, whether it be inspissated mucus, or +other matter, is formed in the extremity of any of the tubuli uriniferi, +and being detached from thence falls into the pelvis of the kidney, it is +liable to lodge there from the want of due irritability of the membrane; +and in that situation increases by new appositions of indurated animal +matter, in the same manner as the stone of the bladder. This is the general +cause of haemorrhage from the kidney; and of obtuse pain in it on exercise; +or of acute pain, when the stone advances into the ureter. See Class I. 1. +3. 9. + + * * * * * + +ORDO II. + +_Decreased Irritation._ + +GENUS V. + +_Decreased Action of the Organs of Sense._ + +SPECIES. + +1. _Stultitia inirritabilis._ Folly from inirritability. Dulness of +perception. When the motions of the fibrous extremities of the nerves of +sense are too weak to excite sensation with sufficient quickness and +vigour. The irritative ideas are nevertheless performed, though perhaps in +a feeble manner, as such people do not run against a post, or walk into a +well. There are three other kinds of folly; that from deficient sensation, +from deficient volition, and from deficient association, as will be +mentioned in their places. In delirium, reverie, and sleep, the power of +perception is abolished from other causes. + +2. _Visus imminutus._ Diminished vision. In our approach to old age our +vision becomes imperfect, not only from the form of the cornea, which +becomes less convex, and from its decreased transparency mentioned in Class +I. 2. 3. 26.; but also from the decreased irritability of the optic nerve. +Thus, in the inirritative or nervous fever, the pupil of the eye becomes +dilated; which in this, as well as in the dropsy of the brain, is generally +a fatal symptom. A part of the cornea as well as a part of the albuginea in +these fevers is frequently seen during sleep; which is owing to the +inirritability of the retina to light, or to the general paresis of +muscular action, and in consequence to the less contraction of the +sphincter of the eye, if it may be so called, at that time. + +There have been instances of some, who could not distinguish certain +colours; and yet whose eyes, in other respects, were not imperfect. Philos. +Transact. Which seems to have been owing to the want of irritability, or +the inaptitude to action, of some classes of fibres which compose the +retina. Other permanent defects depend on the diseased state of the +external organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11. + +3. _Muscae volitantes._ Dark spots appearing before the eyes, and changing +their apparent place with the motions of the eyes, are owing to a temporary +defect of irritability of those parts of the retina, which have been lately +exposed to more luminous objects than the other parts of it, as explained +in Sect. XL. 2. Hence dark spots are seen on the bed-clothes by patients, +when the optic nerve is become less irritable, as in fevers with great +debility; and the patients are perpetually trying to pick them off with +their fingers to discover what they are; for these parts of the retina of +weak people are sooner exhausted by the stimulus of bright colours, and are +longer in regaining their irritability. + +Other kinds of ocular spectra, as the coloured ones, are also more liable +to remain in the eyes of people debilitated by fevers, and to produce +various hallucinations of sight. For after the contraction of a muscle, the +fibres of it continue in the last situation, till some antagonist muscles +are exerted to retract them; whence, when any one is much exhausted by +exercise, or by want of sleep, or in fevers, it is easier to let the fibres +of the retina remain in their last situation, after having been stimulated +into contraction, than to exert any antagonist fibres to replace them. + +As the optic nerves at their entrance into the eyes are each of them as +thick as a crow-quill, it appears that a great quantity of sensorial power +is expended during the day in the perpetual activity of our sense of +vision, besides that used in the motions of the eye-balls and eyelids; as +much I suppose as is expended in the motions of our arms, which are +supplied with nerves of about the same diameters. From hence we may +conclude, that the light should be kept from patients in fevers with +debility, to prevent the unnecessary exhaustion of the sensorial power. And +that on the same account their rooms should be kept silent as well as dark; +that they should be at rest in an horizontal posture; and be cooled by a +blast of cool air, or by washing them with cold water, whenever their skins +are warmer than natural. + +4. _Strabismus._ Squinting is generally owing to one eye being less perfect +than the other; on which account the patient endeavours to hide the worst +eye in the shadow of the nose, that his vision by the other may not be +confused. Calves, which have an hydatide with insects inclosed in it in the +frontal sinus on one side, turn towards the affected side; because the +vision on that side, by the pressure of the hydatide, becomes less perfect; +and the disease being recent, the animal turns round, expecting to get a +more distinct view of objects. + +In the hydrocephalus internus, where both eyes are not become insensible, +the patient squints with only one eye, and views objects with the other, as +in common strabismus. In this case it may be known on which side the +disease exists, and that it does not exist on both sides of the brain; in +such circumstances, as the patients I believe never recover as they are now +treated, might it not be adviseable to perforate the cranium over the +ventricule of the affected side? which might at least give room and +stimulus to the affected part of the brain? + +M. M. If the squinting has not been confirmed by long habit, and one eye be +not much worse than the other, a piece of gauze stretched on a circle of +whale-bone, to cover the best eye in such a manner as to reduce the +distinctness of vision of this eye to a similar degree of imperfection with +the other, should be worn some hours every day. Or the better eye should be +totally darkened by a tin cup covered with black silk for some hours daily, +by which means the better eye will be gradually weakened by the want of +use, and the worse eye will be gradually strengthened by using it. Covering +an inflamed eye in children for weeks together, is very liable to produce +squinting, for the same reason. + +5. _Amaurosis._ Gutta serena. Is a blindness from the inirritability of the +optic nerve. It is generally esteemed a palsy of the nerve, but should +rather be deemed the death of it, as paralysis has generally been applied +to a deprivation only of voluntary power. This is a disease of dark eyes +only, as the cataract is a disease of light eyes only. At the commencement +of this disease, very minute electric shocks should be repeatedly passed +through the eyes; such as may be produced by putting one edge of a piece of +silver the size of a half-crown piece beneath the tongue, and one edge of a +piece of zinc of a similar size between the upper lip and the gum, and then +repeatedly bringing their exterior edges into contact, by which means very +small electric sparks become visible in the eyes. See additional note at +the end of the first volume, p. 567. and Sect. XIV. 5. + +M. M. Minute electric shocks. A grain of opium, and a quarter of a grain of +corrosive sublimate of mercury, twice a day for four or six weeks. Blister +on the crown of the head. + +6. _Auditus imminutus._ Diminished hearing. Deafness is a frequent symptom +in those inflammatory or sensitive fevers with debility, which are +generally called putrid; it attends the general stupor in those fevers, and +is rather esteemed a salutary sign, as during this stupor there is less +expenditure of sensorial power. + +In fevers of debility without inflammation, called nervous fevers, I +suspect deafness to be a bad symptom, arising like the dilated pupil from a +partial paralysis of the nerve of sense. See Class IV. 2. 1. 15. + +Nervous fevers are supposed by Dr. Gilchrist to originate from a congestion +of serum or water in some part of the brain, as many of the symptoms are so +similar to those of hydrocephalus internus, in which a fluid is accumulated +in the ventricules of the brain; on this idea the inactivity of the optic +or auditory nerves in these fevers may arise from the compression of the +effused fluid; while the torpor attending putrid fever may depend on the +meninges of the brain being thickened by inflammation, and thus compressing +it; now the new vessels, or the blood, which thickens inflamed parts, is +more frequently reabsorbed, than the effused fluid from a cavity; and hence +the stupor in one case is less dangerous than in the other. + +In inflammatory or sensitive fevers with debility, deafness may sometimes +arise from a greater secretion and absorption of the ear-wax, which is very +similar to the bile, and is liable to fill the meatus auditorius, when it +is too viscid, as bile obstructs the gall-ducts. + +M. M. In deafness without fever Dr. Darwin applied a cupping-glass on the +ear with good effect, as described in Phil. Trans. Vol. LXIV. p. 348. Oil, +ether, laudanum, dropped into the ears. + +7. _Olfactus imminutus._ Inactivity of the sense of smell. From our habits +of trusting to the art of cookery, and not examining our food by the smell +as other animals do, our sense of smell is less perfect than theirs. See +Sect. XVI. 5. Class IV. 2. 1. 16. + +M. M. Mild errhines. + +8. _Gustus imminutus._ Want of taste is very common in fevers, owing +frequently to the dryness or scurf of the tongue, or external organ of that +sense, rather than to any injury of the nerves of taste. See Class. I. 1. +3. 1. IV. 2. 1. 16. + +M. M. Warm subacid liquids taken frequently. + +9. _Tactus imminutus._ Numbness is frequently complained of in fevers, and +in epilepsy, and the touch is sometimes impaired by the dryness of the +cuticle of the fingers. See Class IV. 2. 1. 16. + +When the sense of touch is impaired by the compression of the nerve, as in +sitting long with one thigh crossed over the other, the limb appears +larger, when we touch it with our hands, which is to be ascribed to the +indistinctness of the sensation of touch, and may be explained in the same +manner as the apparent largeness of objects seen through a mist. In this +last case the minute parts of an object, as suppose of a distant boy, are +seen less distinctly, and therefore we instantly conceive them to be +further from the eye, and in consequence that the whole subtends a larger +angle, and thus we believe the boy to be a man. So when any one's fingers +are pressed on a benumbed limb, the sensation produced is less than it +should be, judging from visible circumstances; we therefore conceive, that +something intervened between the object and the sense, for it is felt as if +a blanket was put between them; and that not being visibly the case, we +judge that the limb is swelled. + +The sense of touch is also liable to be deceived from the acquired habits +of one part of it acting in the vicinity of another part of it. Thus if the +middle finger be crossed over either of the fingers next to it, and a nut +be felt by the two ends of the fingers so crossed at the same time, the nut +appears as if it was two nuts. And lastly, the sense of touch is liable to +be deceived by preconceived ideas; which we believe to be excited by +external objects, even when we are awake. It has happened to me more than +once, and I suppose to most others, to have put my hands into an empty +bason standing in an obscure corner of a room to wash them, which I +believed to contain cold water, and have instantly perceived a sensation of +warmth, contrary to that which I expected to have felt. + +In some paralytic affections, and in cold fits of ague, the sensation of +touch has been much impaired, and yet that of heat has remained, See Sect. +XIV. 6. + +M. M. Friction alone, or with camphorated oil, warm bath. Ether. Volatile +alcali and water. Internally spice, salt. Incitantia. Secernentia. + +10. _Stupor._ The stupor, which occurs in fevers with debility, is +generally esteemed a favourable symptom; which may arise from the less +expenditure of sensorial power already existing in the brain and nerves, as +mentioned in species 6 of this genus. But if we suppose, that there is a +continued production of sensorial power, or an accumulation of it in the +torpid parts of the system, which is not improbable, because such a +production of it continues during sleep, to which stupor is much allied, +there is still further reason for believing it to be a favourable symptom +in inirritable fevers; and that much injury is often done by blisters and +other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and +XXXIII. 1. 4. + +Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many +other ingenious observations and deductions, relates a curious experiment +on salmon, and other fish, and which he repeated upon eels with similar +event. + + "If a fish, immediately upon being taken out of the water, is stunned + by a violent blow on the head, or by having the head crushed, the + irritability and sweetness of the muscles will be preserved much + longer, than if it had been allowed to die with the organs of sense + entire. This is so well known to fishermen, that they put it in + practice, in order to make them longer susceptible of the operation + called _crimping_. A salmon is one of the fish least tenacious of life, + insomuch, that it will lose all signs of life in less than half an hour + after it is taken out of the water, if suffered to die without any + farther injury; but if, immediately after being caught, it receives a + violent blow on the head, the muscles will shew visible irritability + for more than twelve hours afterwards." + +Dr. Blane afterwards well remarks, that "in those disorders in which the +exercise of the senses is in a great measure destroyed, or suspended, as in +the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that +the appetite and digestion are better than in health." + + * * * * * + +ORDO III. + +_Retrograde Irritative Motions._ + +GENUS I. + +_Of the Alimentary Canal._ + +The retrograde motions of our system originate either from defect of +stimulus, or from defect of irritability. Thus sickness is often induced by +hunger, which is a want of stimulus; and from ipecacuanha, in which last +case it would seem, that the sickness was induced after the violence of the +stimulus was abated, and the consequent torpor had succeeded. Hence spice, +opium, or food relieves sickness. + +The globus hystericus, salivation, diabaetes, and other inversions of +motion attending hysteric paroxysms, seem to depend on the want of +irritability of those parts of the body, because they are attended with +cold extremities, and general debility, and are relieved by wine, opium, +steel, and flesh diet; that is, by any additional stimulus. + +When the longitudinal muscles are fatigued by long action, or are +habitually weaker than natural, the antagonist muscles replace the limb by +stretching it in a contrary direction; and as these muscles have had their +actions associated in synchronous tribes, their actions cease together. But +as the hollow muscles propel the fluids, which they contain, by motions +associated in trains; when one ring is fatigued from its too great +debility, and brought into retrograde action; the next ring, and the next, +from its association in train falls into retrograde action. Which continue +so long as they are excited to act, like the tremors of the hands of infirm +people, so long as they endeavour to act. Now as these hollow muscles are +perpetually stimulated, these retrograde actions do not cease as the +tremors of the longitudinal muscles, which are generally excited only by +volition. Whence the retrograde motions of hollow muscles depend on two +circumstances, in which they differ from the longitudinal muscles, namely, +their motions being associated in trains, and their being subject to +perpetual stimulus. For further elucidation of the cause of this curious +source of diseases, see Sect. XXIX. 11. 5. + +The fluids disgorged by the retrograde motions of the various vascular +muscles may be distinguished, 1. From those, which are produced by +secretion, by their not being attended by increase of heat, which always +accompanies increased secretion. 2. They may be distinguished from those +fluids, which are the consequence of deficient absorption, by their not +possessing the saline acrimony, which those fluids possess; which inflames +the skin or other membranes on which they fall; and which have a saline +taste to the tongue. 3. They may be distinguished from those fluids, which +are the consequence both of increased secretion and absorption, as these +are attended with increase of warmth, and are inspissated by the +abstraction of their aqueous parts. 4. Where chyle, or milk, are found in +the feces or urine, or when other fluids, as matter, are translated from +one part of the system to another, they have been the product of retrograde +action of lymphatic or other canals. As explained in Sect. XXIX. 8. + +SPECIES. + +1. _Ruminatio._ In the rumination of horned cattle the retrograde motions +of the oesophagus are visible to the eye, as they bring up the softened +grass from their first stomach. The vegetable aliment in the first stomach +of cattle, which have filled themselves too full of young clover, is liable +to run into fermentation, and distend the stomach, so as to preclude its +exit, and frequently to destroy the animal. To discharge this air the +farmers frequently make an opening into the stomach of the animal with +success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that +of twenty cows in this situation two had died, and that he directed a pint +of gin or whisky, mixed with an equal quantity of water, to be given to the +other eighteen; all of which eructed immense quantities of air, and +recovered. + +There are histories of ruminating men, and who have taken pleasure in the +act of chewing their food a second time. Philos. Transact. + +2. _Ructus._ Eructation. An inverted motion of the stomach excluding +through its upper valve an elastic vapour generated by the fermentation of +the aliment; which proceeds so hastily, that the digestive power does not +subdue it. This is sometimes acquired by habit, so that some people can +eruct when they please, and as long as they please; and there is gas enough +generated to supply them for this purpose; for by Dr. Hale's experiments, +an apple, and many other kinds of aliment, give up above six hundred times +their own bulk of an elastic gas in fermentation. When people voluntarily +eject the fixable air from their stomachs, the fermentation of the aliment +proceeds the faster; for stopping the vessels, which contain new wines, +retards their fermentation, and opening them again accelerates it; hence +where the digestion is impaired, and the stomach somewhat distended with +air, it is better to restrain than to encourage eructations, except the +quantity makes it necessary. When wine is confined in bottles the +fermentation still proceeds slowly even for years, till all the sugar is +converted into spirit; but in the process of digestion, the saccharine part +is absorbed in the form of chyle by the bibulous mouths of the numerous +lacteals, before it has time to run into the vinous fermentation. + +3. _Apepsia._ Indigestion. Water-qualm. A few mouthfuls of the aliment are +rejected at a time for some hours after meals. When the aliment has had +time to ferment, and become acid, it produces cardialgia, or heart-burn. +This disease is perhaps generally left after a slight inflammation of the +stomach, called a surfeit, occasioned by drinking cold liquors, or eating +cold vegetables, when heated with exercise. This inflammation of the +stomach is frequently, I believe, at its commencement removed by a critical +eruption on the face, which differs in its appearance as well as in its +cause from the gutta rosea of drunkards, as the skin round the base of each +eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs +from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with +pain of the cardia ventriculi, and from its retrograde motions of a part of +the stomach about the upper orifice of it. In the same manner as hysteria +differs from hypochondriasis; the one consisting in the weakness and +indigestion of the same portions of the alimentary canal, and the other in +the inverted motions of some parts of it. This apepsia or water-qualm +continues many years, even to old age; Mr. G---- of Lichfield suffered +under this disease from his infancy; and, as he grew old, found relief only +from repeated doses of opium. + +M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder. +Tin-powder. + +4. _Vomitus._ An inverted order of the motions of the stomach and +oesophagus with their absorbent vessels, by which their contents are +evacuated. In the act of vomiting less sensorial power is employed than in +the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1. +3. Whence after the operation of an emetic the digestion becomes stronger +by an accumulation of sensorial power during its decreased action. This +decreased action of the stomach may be either induced by want of stimulus, +as in the sickness which attends hunger; or it may be induced by temporary +want of irritability, as in cold fits of fever; or from habitual want of +irritability, as the vomiting of enfeebled drunkards. Or lastly, by having +been previously too violently stimulated by an emetic drug, as by +ipecacuanha. + +M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a +while with the bed-clothes. Crude mercury. A poultice with opium or +theriaca externally. + +5. _Cholera._ When not only the stomach, as in the last article, but also +the duodenum, and ilium, as low as the valve of the colon, have their +motions inverted; and great quantities of bile are thus poured into the +stomach; while at the same time some branches of the lacteals become +retrograde, and disgorge their contents into the upper part of the +alimentary canal; and other branches of them disgorge their contents into +the lower parts of it beneath the valve of the colon; a vomiting and +purging commence together, which is called cholera, as it is supposed to +have its origin from increased secretion of bile; but I suppose more +frequently arises from putrid food, or poisonous drugs, as in the case +narrated in Sect. XXV. 13. where other circumstances of this disease are +explained. See Class II. 1. 2. 11. + +The cramps of the legs, which are liable to attend cholera, are explained +in Class III. 1. 1. 14. + +6. _Ileus._ Consists in the inverted motions of the whole intestinal canal, +from the mouth to the anus; and of the lacteals and absorbents which arise +from it. In this pitiable disease, through the valve of the colon, through +the pylorus, the cardia, and the pharinx, are ejected, first, the contents +of the stomach and intestines, with the excrement and even clysters +themselves; then the fluid from the lacteals, which is now poured into the +intestines by their retrograde motions, is thrown up by the mouth; and, +lastly, every fluid, which is absorbed by the other lymphatic branches, +from the cellular membrane, the skin, the bladder, and all other cavities +of the body; and which is then poured into the stomach or intestines by the +retrograde motions of the lacteals; all which supply that amazing quantity +of fluid, which is in this disease continually ejected by vomiting. See +Sect. XXV. 15. for a further explanation of this disease. + +M. M. Copious venesection. Twenty grains of calomel in small pills, or one +grain of aloe every hour till stools are procured. Blisters. Warm bath. +Crude mercury. Clyster of ice-water. Smear the skin all over with grease, +as mentioned in Sect. XXV. 15. + +As this malady is occasioned sometimes by an introsusception of a part of +the intestine into another part of it, especially in children, could +holding them up by their heels for a second or two of time be of service +after venesection? Or the exhibition of crude quicksilver two ounces every +half hour, till a pound is taken, be particularly serviceable in this +circumstance? Or could half a pound, or a pound, of crude mercury be +injected as a clyster, the patient being elevated by the knees and thighs +so as to have his head and shoulders much lower than his bottom, or even +for a short time held up by the heels? Could this also be of advantage in +strangulated hernia? + +Where the disease is owing to strangulated hernia, the part should be +sprinkled with cold water, or iced water, or salt and water recently mixed, +or moistened with ether. In cases of strangulated hernia, could +acupuncture, or puncture with a capillary trocar, be used with safety and +advantage to give exit to air contained in the strangulated bowel? Or to +stimulate it into action? It is not uncommon for bashful men to conceal +their being afflicted with a small hernia, which is the cause of their +death; this circumstance should therefore always be enquired into. Is the +seat or cause of the ileus always below the valve of the colon, and that of +the cholera above it? See Class II. 1. 2. 11. + +7. _Globus hystericus._ Hysteric suffocation is the perception of a globe +rolling round in the abdomen, and ascending to the stomach and throat, and +there inducing strangulation. It consists of an ineffectual inversion of +the motions of the oesophagus, and other parts of the alimentary canal; +nothing being rejected from the stomach. + +M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria, +Class I. 3. 1. 10. + +8. _Vomendi conamen inane._ An ineffectual effort to vomit. It frequently +occurs, when the stomach is empty, and in some cases continues many hours; +but as the lymphatics of the stomach are not inverted at the same time, +there is no supply of materials to be ejected; it is sometimes a symptom of +hysteria, but more frequently attends irregular epilepsies or reveries; +which however may be distinguished by their violence of exertion, for the +exertions of hysteric motions are feeble, as they are caused by debility; +but those of epilepsies, as they are used to relieve pain, are of the most +violent kind; insomuch that those who have once seen these ineffectual +efforts to vomit in some epilepsies, can never again mistake them for +symptoms of hysteria. See a case in Sect. XIX. 2. + +M. M. Blister. Opium. Crude mercury. + +9. _Borborigmus._ A gurgling of the bowels proceeds from a partial +invertion of the peristaltic motions of them, by which the gas is brought +into a superior part of the bowel, and bubbles through the descending +fluid, like air rushing into a bottle as the water is poured out of it. +This is sometimes a distressing symptom of the debility of the bowels +joined with a partial inversion of their motions. I attended a young lady +about sixteen, who was in other respects feeble, whose bowels almost +incessantly made a gurgling noise so loud as to be heard at a considerable +distance, and to attract the notice of all who were near her. As this noise +never ceased a minute together for many hours in a day, it could not be +produced by the uniform descent of water, and ascent of air through it, but +there must have been alternately a retrograde movement of a part of the +bowel, which must again have pushed up the water above the air; or which +might raise a part of the bowel, in which the fluid was lodged, alternately +above and below another portion of it; which might readily happen in some +of the curvatures of the smaller intestines, the air in which might be +moved backward and forward like the air-bubble in a glass-level. + +M. M. Essential oil. Ten corns of black pepper swallowed whole after +dinner, that its effect might be slower and more permanent; a small pipe +occasionally introduced into the rectum to facilitate the escape of the +air. Crude mercury. See Class I. 2. 4. 9. + +10. _Hysteria._ The three last articles, together with the lymphatic +diabaetes, are the most common symptoms of the hysteric disease; to which +sometimes is added the lymphatic salivation, and fits of syncope, or +convulsion, with palpitation of the heart (which probably consists of +retrograde motions of it), and a great fear of dying. Which last +circumstance distinguishes these convulsions from the epileptic ones with +greater certainty than any other single symptom. The pale copious urine, +cold skin, palpitation, and trembling, are the symptoms excited by great +fear. Hence in hysteric diseases, when these symptoms occur, the fear, +which has been usually associated with them, recurs at the same time, as in +hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1. + +The convulsions which sometimes attend the hysteric disease, are exertions +to relieve pain, either of some torpid, or of some retrograde organ; and in +this respect they resemble epileptic convulsions, except that they are +seldom so violent as entirely to produce insensibility to external stimuli; +for these weaker pains cease before the total exhaustion of sensorial power +is produced, and the patient sinks into imperfect syncope; whereas the true +epilepsy generally terminates in temporary apoplexy, with perfect +insensibility to external objects. These convulsions are less to be dreaded +than the epileptic ones, as they do not originate from so permanent a +cause. + +The great discharge of pale urine in this disease is owing to the inverted +motions of the lymphatics, which arise about the neck of the bladder, as +described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the +inverted motions of the salivary lymphatics. + +Hysteria is distinguished from hypochondriasis, as in the latter there are +no retrograde motions of the alimentary canal, but simply a debility or +inirritability of it, with distention and flatulency. It is distinguished +from apepsia and cardialgia by there being nothing ejected from the stomach +by the retrograde motions of it, or of the oesophagus. + +M. M. Opium. Camphor. Assafoetida. Castor, with sinapisms externally; to +which must be added a clyster of cold water, or iced water; which, +according to Mons. Pomme, relieves these hysteric symptoms instantaneously +like a charm; which it may effect by checking the inverted motions of the +intestinal canal by the torpor occasioned by cold; or one end of the +intestinal canal may become strengthened, and regain its peristaltic motion +by reverse sympathy, when the other end is rendered torpid by ice-water. +(Pomme des Affections Vaporeuses, p. 25.) These remove the present +symptoms; and bark, steel, exercise, coldish bath, prevent their returns. +See Art. VI. 2. 1. + +11. _Hydrophobia._ Dread of water occasioned by the bite of a mad dog, is a +violent inversion of the motions of the oesophagus on the contact or even +approach of water or other fluids. The pharinx seems to have acquired the +sensibility of the larinx in this disease, and is as impatient to reject +any fluid, which gets into it. Is not the cardia ventriculi the seat of +this disease? As in cardialgia the pain is often felt in the pharinx, when +the acid material stimulates the other end of the canal, which terminates +in the stomach. As this fatal disease resembles tetanus, or locked jaw, in +its tendency to convulsion from a distant wound, and affects some other +parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1. +2. 7. + + * * * * * + +ORDO III. + +_Retrograde Irritative Motions._ + +GENUS II. + +_Of the Absorbent System._ + +SPECIES. + +1. _Catarrhus lymphaticus._ Lymphatic catarrh. A periodical defluxion of a +thin fluid from the nostrils, for a few hours, occasioned by the retrograde +motions of their lymphatics; which may probably be supplied with fluid by +the increased absorption of some other lymphatic branches in their +vicinity. It is distinguished from that mucous discharge, which happens in +frosty weather from decreased absorption, because it is less salt to the +taste; and from an increased secretion of mucus, because it is neither so +viscid, nor is attended with heat of the part. This complaint is liable to +recur at diurnal periods, like an intermittent fever, for weeks and months +together, with great sneezing and very copious discharge for an hour or +two. + +I have seen two of these cases, both of which occurred in delicate women, +and seemed an appendage to other hysteric symptoms; whence I concluded, +that the discharge was occasioned by the inverted motions of the lymphatics +of the nostrils, like the pale urine in hysteric cases; and that they might +receive this fluid from some other branches of lymphatic vessels opening +into the frontal or maxillary cavities in their vicinity. + +Could such a discharge be produced by strong errhines, and excite an +absorption of the congestion of lymph in the dropsy of the brain? + +2. _Salivatio lymphatica._ Lymphatic salivation. A copious expuition of a +pellucid insipid fluid, occasioned by the retrograde motions of the +lymphatics of the mouth. It is sometimes periodical, and often attends the +hysteric disease, and nervous fevers; but is not accompanied with a saline +taste, or with heat of the mouth, or nausea. + +3. _Nausea humida._ Moist nausea consists in a discharge of fluid, owing to +the retrograde motions of the lymphatics about the fauces, without increase +of heat, or saline taste, together with some retrograde motions of the +fauces or pharinx; along with this nausea a sickness generally precedes the +act of vomiting; which may consist of a similar discharge of mucus or chyle +into the stomach by the retrograde motions of the lymphatics or lacteals, +which open into it. See Class I. 2. 4. 3. and I. 2. 4. 4. + +M. M. Subacid liquids. Wine. Opium. A blister. + +4. _Diarrhoea lymphatica._ Lymphatic diarrhoea. A quantity of mucus and +lymph are poured into the intestines by the inverted motions of the +intestinal lymphatics. The feces are less fetid and more liquid; and it +sometimes portends the commencement of a diabaetes, or dropsy, or their +temporary relief. This lymphatic diarrhoea sometimes becomes chronical, in +which the atmospheric moisture, absorbed by the cutaneous and pulmonary +lymphatics, is poured into the intestines by the retrograde motions of the +lacteals. See Section XXIX. 4. 6. where some cases of this kind are +related. + +5. _Diarrhoea chylifera, coeliaca._ Chyliferous diarrhoea. The chyle drank +up by the lacteals of the upper intestines is poured into the lower ones by +the retrograde motions of their lacteals, and appears in the dejections. +This circumstance occurs at the beginning of diarrhoea crapulosa, where the +patient has taken and digested more aliment than the system can +conveniently receive, and thus eliminates a part of it; as appears when +there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It +differs from the lymphatic diarrhoea, as the chyliferous diabaetes differs +from the aqueous and mucaginous diabaetes. + +6. _Diabaetes._ By the retrograde motions of the urinary lymphatics, an +immense quantity of fluid is poured into the bladder. It is either termed +chyliferous, or aqueous, or mucaginous, from the nature of the fluid +brought into the bladder; and is either a temporary disease, as in hysteric +women, in the beginning of intoxication, in worm cases, or in those exposed +to cold damp air, or to great fear, or anxiety, or in the commencement of +some dropsies; or it becomes chronical. + +When the urinary lymphatics invert their motions, and pour their refluent +contents into the bladder, some other branch of the absorbent system acts +with greater energy to supply this fluid. If it is the intestinal branch, +the chyliferous diabaetes is produced: if it is the cutaneous or pulmonary +branch, the aqueous diabaetes is produced: and if the cellular or cystic +branches, the mucaginous diabaetes. In the two last the urine is pellucid, +and contains no sugar. + +In dropsies the fluid is sometimes absorbed, and poured into the bladder by +the retrograde motions of the urinary lymphatics, as during the exhibition +of digitalis. In the beginning of the dropsies of infirm gouty patients, I +have frequently observed, that they make a large quantity of water for one +night, which relieves them for several days. In these cases the patient +previously feels a fulness about the precordia, with difficult respiration, +and symptoms similar to those of hysteria. Perhaps a previous defect of +absorption takes place in some part of the body in those hysteric cases, +which are relieved by a copious discharge of pale urine. See Diabaetes +explained at large, Section XXIX. 4. + +A discharge of blood sometimes attends the diabaetes, which was +occasionally a symptom of that disease in Mr. Brindley, the great navigable +canal maker in this country. Which may be accounted for by the +communication of a lymphatic branch with the gastric branch of the vena +portarum, as discovered by J. F. Meckel. See Section XXVII. 2. + +M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium. +See Sect. XXIX. 4. + +7. _Sudor lymphaticus._ Profuse sweats from the inverted motions of the +cutaneous lymphatics, as in some fainting fits, and at the approach of +death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These +sweats are glutinous to the touch, and without increased heat of the skin; +if the part is not covered, the skin becomes cold from the evaporation of +the fluid. These sweats without heat sometimes occur in the act of +vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty +hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R. +Davis, which he cured by frequent application of lime. Though it is +possible, that cold sweaty hands may also arise from the want of due +absorption of the perspirable matter effused on them, and that the coldness +may be owing to the greater evaporation in consequence. + +The acid sweats described by Dr. Dobson, which he observed in a diabaetic +patient, and ascribes to the chyle effused on the skin, must be ascribed to +the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6. + +8. _Sudor asthmaticus._ The cold sweats in this disease only cover the +head, arms, and breast, and are frequently exceedingly profuse. These +sweats are owing to the inverted motions of the cutaneous lymphatics of the +upper part of the body, and at the same time the increased absorption of +the pulmonary absorbents: hence these sweats when profuse relieve the +present fit of asthma. There is no other way to account for sweats +appearing on the upper parts of the body only, but by the fluid having been +absorbed by the lymphatic branch of the lungs, and effused on the skin by +the retrograde movements of the cutaneous lymphatics; which join those of +the lungs before they enter into the venous circulation. For if they were +occasioned, as generally supposed, by the difficulty of the circulation of +the blood through the lungs, the whole skin must be equally affected, both +of the upper and lower parts of the body; for whatever could obstruct the +circulation in the upper part of the venous system, must equally obstruct +it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma +these sweats do not occur; hence they may be distinguished; and might be +called the hydropic asthma, and the epileptic asthma. + +9. _Translatio puris._ Translation of matter from one part of the system to +another can only be explained from its being absorbed by one branch of the +lymphatic system, and deposited in a distant part by the retrograde motions +of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these +translations of matter are attended generally, I believe, with cold fits; +for less heat is produced during the retrograde action of this part of the +system, as no secretion in the lymphatic glands of the affected branches +can exist at the same time. Do any ineffectual retrograde motions occasion +the cold fits of agues? The time when the gout of the liver ceases, and the +gout in the foot commences, is attended with a cold fit, as I have observed +in two instances, which is difficult to explain, without supposing the new +vessels, or the matter produced on the inflamed liver, to be absorbed, and +either eliminated by some retrograde motion, or carried to the newly +inflamed part? See Class IV. 1. 2. 15. + +10. _Translatio lactis._ Translation of milk to the bowels in puerperal +fevers can only be explained by the milk being absorbed by the pectoral +branch of lymphatics, and carried to the bowels by the retrograde motions +of the intestinal lymphatics or lacteals. See many instances of this in +Sect. XXIX. 7. 4. + +11. _Translatio urinae._ Translation of urine. There is a curious case +related in the Transaction of the College of Physicians at Philadelphia, +Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine +for many months; which could not be distinguished from that which was at +other times drawn off by the catheter. After having taken much opium, she +seems at length to have formed gravel, some of which was frequently brought +up by vomiting. Dr. Senter ascribes this to the retrograde motions of the +lymphatics of the stomach, and the increased ones of those of the bladder, +and refers to those of Sect. XXIX. of this work; which section was first +published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine. + +The patient above described sometimes had a discharge of urine by the +navel, and at other times by the rectum, and sometimes by urinous sweats. + + * * * * * + +ORDO III. + +_Retrograde Irritative Motions._ + +GENUS III. + +_Of the Sanguiferous System._ + +SPECIES. + +1. _Capillarium motus retrogressus._ In microscopic experiments it is usual +to see globules of blood regurgitate from the capillary vessels again and +again, before they pass through them; and not only the mouths of the veins, +which arise from these capillaries, are frequently seen by microscopes to +regurgitate some particles of blood during the struggles of the animal; but +a retrograde motion of the blood in the veins of these animals, from the +very heart to the extremities of the limbs, is observable by intervals +during the distresses of the dying creature. Haller, Elem. Phys. T. i. p. +216. See Section XXIX. 3. 8. + +2. _Palpitatio cordis._ May not the ineffectual and weak unequal motions of +the heart in hysteric cases be ascribed to the retrograde motions of it, +which continue for a short time, or terminate in syncope? See Class IV. 3. +1. 6. + +3. _Anhelatio spasmodica._ In some asthmas may not the difficulty of +respiration arise from the inverted action of the finer branches of the +bronchia, or of the pulmonary artery or vein, like those of the capillaries +above described in No. 1. of this genus? + + * * * * * + + +_The Orders and Genera of the Second Class of Diseases._ + + * * * * * + +CLASS II. + +DISEASES OF SENSATION. + +ORDO I. + +_Increased Sensation._ + +GENERA. + + 1. With increased action of the muscles. + 2. With the production of new vessels by internal membranes or glands + with fever. + 3. With the production of new vessels by external membranes or glands + with fever. + 4. With the production of new vessels by internal membranes or glands + without fever. + 5. With the production of new vessels by external membranes or glands + without fever. + 6. With fever consequent to the production of new vessels or fluids. + 7. With increased action of the organs of sense. + +ORDO II. + +_Decreased Sensation._ + +GENERA. + + 1. With decreased actions of the general system. + 2. With decreased actions of particular organs. + +ORDO III. + +_Retrograde Sensitive Motions._ + +GENERA. + + 1. Of the excretory ducts. + + * * * * * + +_The Orders, Genera, and Species, of the Second Class Of Diseases._ + + * * * * * + +CLASS II. + +DISEASES OF SENSATION. + +ORDO I. + +_Increased Sensation._ + +GENUS I. + +_With Increased Action of the Muscles._ + +SPECIES. + + 1. _Deglutitio._ Deglutition. + 2. _Respiratio._ Respiration. + 3. _Sternutatio._ Sneezing. + 4. _Anhelitus._ Panting. + 5. _Tussis ebriorum._ Cough of inebriates. + 6. _Syngultus._ Hiccough. + 7. _Asthma humorale._ Humoral asthma. + 8. _Nictitatio sensitiva._ Winking from pain. + 9. _Oscitatio et pandiculatio._ Yawning and stretching. + 10. _Tenesmus._ Tenesmus. + 11. _Stranguria._ Strangury. + 12. _Parturitio._ Parturition. + +GENUS II. + +_With the Production of new Vessels by internal Membranes or Glands, with +Fever._ + +SPECIES. + + 1. _Febris sensitiva irritata._ Sensitive irritated fever. + 2. _Ophthalmia interna._ Inflammation of the eye. + 3. _Phrenitis._ ---- of the brain. + 4. _Peripneumonia._ ---- of the lungs. + ---- _trachealis._ ---- the croup. + 5. _Pleuritis._ ---- of the pleura. + 6. _Diaphragmitis._ ---- of the diaphragm. + 7. _Carditis._ ---- of the heart. + 8. _Peritonitis._ ---- of the peritoneum. + 9. _Mesenteritis._ ---- of the mesentery. + 10. _Gastritis._ ---- of the stomach. + 11. _Enteritis._ ---- of the bowels. + 12. _Hepatitis._ ---- of the liver. + 13. _Splenitis._ ---- of the spleen. + 14. _Nephritis._ ---- of the kidney. + 15. _Cystitis._ ---- of the bladder. + 16. _Hysteritis._ ---- of the womb. + 17. _Lumbago sensitiva._ ---- of the loins. + 18. _Ischias._ ---- of the pelvis. + 19. _Paronychia interna._ ---- beneath the nails. + +GENUS III. + +_With the Production of new Vessels by external Membranes or Glands, with +Fever._ + +SPECIES. + + 1. _Febris sensitiva inirritata._ Sensitive inirritated fever. + 2. _Erysipelas irritatum._ Erysipelas irritated. + _----inirritatum._ ---- inirritated. + ---- _sensitivum._ ---- sensitive. + 3. _Tonsillitis interna._ Angina internal. + ---- _superficialis._ ---- superficial. + ---- _inirritata._ ---- inirritated. + 4. _Parotitis suppurans._ Mumps suppurative. + ---- _mutabilis._ ---- mutable. + ---- _felina._ ---- of cats. + 5. _Catarrhus sensitivus._ Catarrh inflammatory. + 6. ---- _contagiosus._ ---- contagious. + ---- _equinus et caninus._ ---- among horses and dogs. + 7. _Peripneumonia superficialis._ Superficial peripneumony. + 8. _Pertussis._ Chin-cough. + 9. _Variola discreta._ Small-pox distinct. + ---- _confluens._ ---- confluent. + ---- _inoculata._ ---- inoculated. + 10. _Rubeola irritata._ Measles irritated. + ---- _inirritata._ ---- inirritated. + 11. _Scarlatina mitis._ Scarlet fever mild. + ---- _maligna._ ---- malignant. + 12. _Miliaria sudatoria._ Miliary fever sudatory. + ---- _irritata._ ---- irritated. + ---- _inirritata._ ---- inirritated. + 13. _Pestis._ Plague. + ---- _vaccina._ ---- of horned cattle. + 14. _Pemphigus._ Bladdery fever. + 15. _Varicella._ Chicken-pox. + 16. _Urticaria._ Nettle rash. + 17. _Aptha sensitiva._ Thrush sensitive. + ---- _irritata._ ---- irritated. + ---- _inirritata._ ---- inirritated. + 18. _Dysenteria._ Bloody flux. + 19. _Gastritis superficialis._ Superficial inflam. of the stomach. + 20. _Enteritis superficialis._ ---- of the bowels. + +GENUS IV. + +_With the Production of new Vessels by internal Membranes or Glands, +without Fever._ + +SPECIES. + + 1. _Ophthalmia superficialis._ Ophthalmy superficial. + ---- _lymphatica._ ---- lymphatic. + ---- _equina._ ---- of horses. + 2. _Pterigion._ Eye-wing. + 3. _Tarsitis palpebrarum._ Red eyelids. + 4. _Hordeolum._ Stye. + 5. _Paronychia superficialis._ Whitlow. + 6. _Gutta rosea hepatica._ Pimpled face hepatic. + ---- _stomatica._ ---- stomatic. + ---- _hereditaria._ ---- hereditary. + 7. _Odontitis._ Inflamed tooth. + 8. _Otitis._ ---- ear. + 9. _Fistula lacrymalis._ Fistula lacrymalis. + 10. _Fistula in ano._ Fistula in ano. + 11. _Fistula urethrae._ Fistula urethrae. + 12. _Hepatitis chronica._ Chronical hepatitis. + 13. _Scrophula suppurans._ Suppurating scrophula. + 14. _Scorbutus suppurans._ Suppurating scurvy. + 15. _Schirrus suppurans._ Suppurating schirrus. + 16. _Carcinoma._ Cancer. + 17. _Arthrocele._ Swelling of the joints. + 18. _Arthropuosis._ Suppuration of the joints. + 19. _Caries ossium._ Caries of the bones. + +GENUS V. + +_With the Production of new Vessels by external Membranes or Glands, +without Fever._ + +SPECIES. + + 1. _Gonorrhoea venerea._ Clap. + 2. _Syphilis._ Venereal disease. + 3. _Lepra._ Leprosy. + 4. _Elephantiasis._ Elephantiasis. + 5. _Framboesia._ Framboesia. + 6. _Psora._ Itch. + 7. _Psora ebriorum._ Itch of drunkards. + 8. _Herpes._ Herpes. + 9. _Zona ignea._ Shingles. + 10. _Annulus repens._ Ring-worm. + 11. _Tinea capitis._ Scald-head. + 12. _Crusta lactea._ Milk-crust. + 13. _Trichoma._ Plica polonica. + +GENUS VI. + +_With Fever consequent to the Production of new Vessels or Fluids._ + +SPECIES. + + 1. _Febris sensitiva._ Sensitive fever. + 2. ---- _a pure clauso._ Fever from concealed matter. + 3. ---- _a vomica._ ---- from vomica. + 4. ---- _ab empyemate._ ---- from empyema. + 5. ---- _mesenterica._ ---- mesenteric. + 6. ---- _a pure aerato._ ---- from aerated matter. + 7. ---- _a phthisi._ ---- from consumption. + 8. ---- _scrophulosa._ ---- scrophulous. + 9. ---- _ischiadica._ ---- from ischias. + 10. ---- _arthropuodica._ ---- from joint-evil. + 11. ---- _a pure contagioso._ ---- from contagious matter. + 12. ---- _variolosa secundaria._ ---- secondary of small-pox. + 13. ---- _carcinomatosa._ ---- cancarous. + 14. ---- _venerea._ ---- venereal. + 15. ---- _a sanie contagiosa._ ---- from contagious sanies. + 16. ---- _puerpera._ ---- puerperal. + 17. ---- _a sphacelo._ ---- from sphacelus. + +GENUS VII. + +_With increased Action of the Organs of Sense._ + +SPECIES. + + 1. _Delirium febrile._ Delirium of fevers. + 2. ---- _maniacale._ ---- maniacal. + 3. ---- _ebrietatis._ ---- of drunkenness. + 4. _Somnium._ Dreams. + 5. _Hallucinatio visus._ Deception of sight. + 6. ---- _auditus._ ---- of hearing. + 7. _Rubor a calore._ Blush from heat. + 8. ---- _jucunditatis._ ---- from joy. + 9. _Priapismus amatorius._ Amorous priapism. + 10. _Distentio mamularum._ Distention of the nipples. + +ORDO II. + +_Decreased Sensation._ + +GENUS I. + +_With decreased Action of the general System._ + +SPECIES. + + 1. _Stultitia insensibilis._ Folly from insensibility. + 2. _Taedium vitae._ Irksomeness of life. + 3. _Paresis sensitiva._ Sensitive debility. + +GENUS II. + +_With decreased Actions of particular Organs._ + +SPECIES. + + 1. _Anorexia._ Want of appetite. + 2. _Adipsia._ Want of thirst. + 3. _Impotentia._ Impotence. + 4. _Sterilitas._ Barrenness. + 5. _Insensibilitas artuum._ Insensibility of the limbs. + 6. _Dysuria insensitiva._ Insensibility of the bladder. + 7. _Accumulatio alvina._ Accumulation of feces. + +ORDO III. + +_Retrograde Sensitive Motions._ + +GENUS I. + +_Of Excretory Ducts._ + +SPECIES. + + _Motus retrogressus_ Retrograde motion. + 1. ---- _ureterum._ ---- of the ureters. + 2. ---- _urethrae._ ---- of the urethra. + 3. ---- _ductus choledoci._ ---- of the bile-duct. + + * * * * * + +CLASS II. + +DISEASES OF SENSATION. + +ORDO I. + +_Increased Sensation._ + +GENUS I. + +_With Increased Action of the Muscles._ + +The actions belonging to this genus are those which are immediately excited +by the sensations of pain or pleasure, but which are neither followed by +inflammation, nor by convulsion. The former of which belong to the +subsequent genera of this order, and the latter to the class of voluntary +motions. + +The criterion between the actions, which are the immediate consequence of +painful sensation, and convulsive actions properly so called, consists in +the former having a tendency to dislodge the stimulating cause, which +induces the painful sensation; and the latter being exerted for the purpose +of expending the sensorial power, and thus dulling or destroying the +general sensation of the system. See Class III. 1. + +There is a degree of heat produced in the affected part by these sensitive +actions without inflammation, but in much less quantity than when attended +by inflammation; as in the latter there is a production of new vessels. See +Sect. XXXIII. 2. 3. + +Some of the species of this genus cannot properly be termed diseases in +their natural state, but become so by their defect or excess, and are here +inserted to facilitate the explanation of the others. + +SPECIES. + +1. _Deglutitio._ Swallowing our food is immediately caused by the +pleasureable sensation occasioned by its stimulus on the palate or fauces +and is acquired long before the nativity of the animal. Afterwards the pain +of hunger previously produces the various voluntary exertions to procure +the proper material, but the actions of masticating and of swallowing it +are effected by the sensorial power of sensation; which appears by their +not being always controulable by the will, as when children in vain attempt +to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food +stimulates the palate, which is an organ of sense, into so much action, as +to produce agreeable sensation; and the muscles subservient to deglutition +are brought into action by the sensation thus produced. The pleasureable +sensation is the proximate cause; the action of the fibres of the +extremities of the nerves of taste is the remote cause; the sensorial power +of irritation exciting these fibres of the nerves of taste into increased +action is the pre-remote cause; the action of the muscles of deglutition is +the proximate effect; the pushing the food into the stomach is the remote +effect; and the nutrition of the body is the post-remote effect. + +Though the muscles subservient to deglutition have their actions previously +associated, so as to be excited into synchronous tribes or successive +trains, either by volition, as when we swallow a disagreeable drug; or by +sensation, as when we swallow agreeable food; or by irritation, as when we +inattentively swallow our saliva; yet do all those three kinds of +deglutition belong to the respective classes of volition, sensation, and +irritation; because the first links of these tribes or trains of muscular +action are excited by those sensorial powers, and the associated links, +which accompany or succeed them, are excited by the combined powers either +of volition, or of sensation, or of irritation, along with that of +association. + +2. _Respiratio._ Respiration is immediately caused by the sensorial power +of sensation in consequence of the baneful want of vital air; and not from +the accumulation of blood in the lungs, as that might be carried on by +inhaling azote alone, without the oxygenous part of the atmosphere. The +action of respiration is thus similar to that of swallowing our food to +appease the pain of hunger; but the lungs being surrounded with air, their +proper pabulum, no intermediate voluntary exertions are required, as in +hunger, to obtain and prepare the wanted material. + +Respiration is similar to slow combustion; the oxygenous part of the +atmosphere is received through the moist membranes, which line the +air-cells of the lungs, and uniting with the inflammable part of the blood +generates an acid, probably the phosphoric acid; a portion of carbonic acid +is likewise produced in this process; as appears by repeatedly breathing +over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto +I. l. 401. note. + +3. _Sternutatio._ Sneezing consists of muscular actions produced by the +sensorial faculty of sensation; and is an effort to dislodge, by means of +air forcibly impelled through the nostrils, some material; which stimulates +the membrane, which lines them, into too great action, and might thence +injure the sense of smell which is diffused on it. + +In this operation the too great action of the vessels of the membrane of +the nostrils is the remote cause; the sensation thence induced is the +proximate cause; and the muscular actions are the proximate effect. + +This action of sneezing frequently precedes common respiration in new-born +children, but I believe not always; as like the latter it cannot have been +previously acquired in the uterus. + +It is produced in some people by sudden light, as by looking up at the sky +in a morning, when they come out of a gloomy bed-chamber. It then becomes +an associate action, and belongs to Class IV. 1. 2. 2. + +M. M. When it is exerted to excess it may be cured by snuffing starch up +the nostrils. See Class I. 1. 2. 13. + +4. _Anhelitus._ Panting. The quick and laborious breathing of running +people, who are not accustomed to violent exercise, is occasioned by the +too great conflux of blood to the lungs. As the sanguiferous system, as +well as the absorbent system, is furnished in many parts of its course with +valves, which in general prevent the retrograde movement of their contained +fluids; and as all these vessels, in some part of their course, lie in +contact with the muscles, which are brought into action in running, it +follows that the blood must be accelerated by the intermitted swelling of +the bellies of the muscles moving over them. + +The difficulty of breathing, with which, very fat people are immediately +affected on exercise, is owing to the pressure of the accumulated fat on +the veins, arteries, and lymphatics; and which, by distending the skin, +occasions it to act as a tight bandage on the whole surface of the body. +Hence when the muscles are excited into quicker action, the progress of the +blood in the veins, and of the lymph and chyle in the absorbent system, is +urged on with much greater force, as under an artificial bandage on a limb, +explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the +circulation is instantly quickened to a great degree, and the difficulty of +breathing is the consequence of a more rapid circulation through the lungs. +The increased secretion of the perspirable matter is another consequence of +this rapid circulation; fat people, when at rest, are believed to perspire +less than others, which may be gathered from their generally having more +liquid stools, more and paler urine, and to their frequently taking less +food than many thin people; and lastly, from the perspiration of fat people +being generally more inodorous than that of lean ones; but when corpulent +people are put in motion, the sweat stands in drops on their skins, and +they "lard the ground" as they run. The increase of heat of corpulent +people on exercise, is another consequence of their more rapid circulation, +and greater secretion. See Class I. 2. 3. 17. + +Other causes of difficult or quick respiration will be treated of under +Asthma, Pertussis, Peripneumony, Tonsillitis. + +5. _Tussis ebriorum._ Sensitive cough is an exertion of the muscles used in +expiration excited into more violent action by the sensorial power of +sensation, in consequence of something which too powerfully stimulates the +lungs. As the saline part of the secreted mucus, when the absorption of it +is impeded; or the too great viscidity of it, when the absorption is +increased; or the too great quantity of the mucus, when the secretion is +increased; or the inflammation of the membranes of the lungs; it is an +effort to dislodge any of these extraneous materials. + +Of this kind is the cough which attends free-drinkers after a debauch; it +consists of many short efforts to cough, with a frequent expuition of half +a tea-spoonful of frothy mucus, and is attended with considerable thirst. +The thirst is occasioned by the previous dissipation of the aqueous parts +of the blood by sensible or insensible perspiration; which was produced by +the increased action of the cutaneous and pulmonary capillaries during the +stimulus of the wine. In consequence of this an increased absorption +commences to replace this moisture, and the skin and mouth become dry, and +the pulmonary mucus becomes inspissated; which stimulates the bronchia, and +is raised into froth by the successive currents of air in evacuating it. +This production of froth is called by some free-drinkers "spitting +sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid +expectoration in some people succeeds the slightest degree of intoxication, +of which it may be esteemed a criterion. See Class IV. 2. 1. 8. + +As coughs are not always attended with pain, the muscular actions, which +produce them, are sometimes excited by the sensorial faculty of irritation, +as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also +sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic, +as Class IV. 2. 1. 7. + +M. M. Venesection, when the cough is attended with inflammation. Mucilages. +Opium. Torpentia. Blister. + +6. _Singultus._ Hiccough is an exertion of the muscles used in inspiration +excited into more violent action by the sensorial power of sensation, in +consequence of something which too powerfully stimulates the cardia +ventriculi, or upper orifice of the stomach. As when solid food is too +hastily taken without sufficient dilution. And is an effort to dislodge +that offensive material, and push it to some less sensible part of the +stomach, or into the middle of the contained aliment. + +At the end of fatal fevers it may arise from the acrimony of the undigested +aliment, or from a part of the stomach being already dead, and by its +weight or coldness affecting the surviving part with disagreeable +sensation. The pain about the upper orifice of the stomach is the proximate +cause, the too great or too little action of the fibres of this part of the +stomach is the remote cause, the action of the muscles used in inspiration +is the proximate effect, and the repercussion of the offending material is +the remote effect. + +Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the +kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of +epilepsy or reverie, as in Sect. XIX. 2. + +M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar, +or on chalk. Opium. Blister. Emetic. + +7. _Asthma humorale._ The humoral asthma probably consists in a temporary +anasarca of the lungs, which may be owing to a temporary defect of +lymphatic absorption. Its cause is nevertheless at present very obscure, +since a temporary deficiency of venous absorption, at the extremities of +the pulmonary or bronchial veins, might occasion a similar difficulty of +respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that +the lymph effused into the cavity of the chest might, by some additional +heat during sleep, acquire an aerial form, and thus compress the lungs; and +on this circumstance the relief, which these patients receive from cold +air, would be readily accounted for. + +The paroxysms attack the patient in his first sleep, when the circulation +through the lungs in weak people wants the assistance of the voluntary +power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less +able to fulfil the whole of their duty. And part of the thin mucus, which +is secreted into the air-cells, remains there unabsorbed, and occasions the +difficult respiration, which awakes the patient. And the violent exertions +of the muscles of respiration, which succeed, are excited by the pain of +suffocation, for the purpose of pushing forwards the blood through the +compressed capillaries, and to promote the absorption of the effused lymph. + +In this the humoral differs from the convulsive asthma, treated of in Class +III. 1. 1. 10. as in that there is probably no accumulated fluid to be +absorbed; and the violent respiration is only an exertion for the purpose +of relieving pain, either in the lungs or in some distant part, as in other +convulsions, or epilepsy; and in this respect the fits of humoral and +convulsive asthma essentially differ from each other, contrary to the +opinion expressed without sufficient consideration in Sect. XVIII. 15. + +The patients in the paroxysms both of humoral and convulsive asthma find +relief from cold air, as they generally rise out of bed, and open the +window, and put out their heads; for the lungs are not sensible to cold, +and the sense of suffocation is somewhat relieved by there being more +oxygen contained in a given quantity of cold fresh air, than in the warm +confined air of a close bed-chamber. + +I have seen humoral asthma terminate in confirmed anasarca, and destroy the +patient, who had been an excessive drinker of spirituous potation. And M. +Savage asserts, that this disease frequently terminates in diabetes; which +seems to shew, that it is a temporary dropsy relieved by a great flow of +urine. Add to this, that these paroxysms of the asthma are themselves +relieved by profuse sweats of the upper parts of the body, as explained in +Class I. 3. 2. 8. which would countenance the idea of their being +occasioned by congestions of lymph in the lungs. + +The congestion of lymph in the lungs from the defective absorption of it is +probably the remote cause of humoral asthma; but the pain of suffocation is +the immediate cause of the violent exertions in the paroxysms. And whether +this congestion of lymph in the air-cells of the lungs increases during our +sleep, as above suggested, or not; the pain of suffocation will be more and +more distressing after some hours of sleep, as the sensibility to internal +stimuli increases during that time, as described in Sect. XVIII. 15. For +the same reason many epileptic fits, and paroxysms of the gout, occur +during sleep. + +In two gouty cases, complicated with jaundice, and pain, and sickness, the +patients had each of them a shivering fit, like the commencement of an +ague, to the great alarm of their friends; both which commenced in the +night, I suppose during their sleep; and the consequence was a cessation of +the jaundice, and pain about the stomach, and sickness; and instead of that +the gout appeared in their extremities. In these cases I conjecture, that +there was a metastasis not only of the diseased action from the membranes +of the liver to those of the foot; but that some of the new vessels, or new +fluids, which were previously produced in the inflamed liver, were +translated to the feet during the cold fit, by the increased absorption of +the hepatic lymphatics, and by the retrograde motions of those of the +affected limbs. + +This I think resembles in some respects a fit of humoral asthma, where +stronger motions of the absorbent vessels of the lungs are excited, and +retrograde ones of the correspondent cutaneous lymphatics; whence the +violent sweats of the upper parts of the body only are produced; and for a +time the patient becomes relieved by the metastasis and elimination of the +offending material by sensitive exertion. For a further account of this +intricate subject see Class III. 1. 1. 10. + +M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed +with water, with 10 drops of laudanum, to be repeated three or four times. +Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a +grain of opium at night, and two or three of aloes. A flannel shirt in +winter, but not in summer. Issues. Digitalis? + +In this species of asthma, there is great reason to believe, that the +respiration of an atmosphere, with an increased proportion of oxygen, will +prove of great advantage; some well-observed and well-attested cases of +which are published by Dr. Beddoes; as this purer air invigorates the +circulation, and the whole system in consequence, perhaps not only by its +stimulus, but by its supplying the material from which the sensorial power +is extracted or fabricated. In spasmodic asthma, on the contrary, Dr. +Ferriar has found undoubted benefit from an atmosphere mixed with hydrogen. +See Sect. XVIII. 15. and Class III. 1. 1. 10. + +8. _Nictitatio sensitiva._ Winking of the eyes is performed every minute, +without our attention, for the purpose of diffusing the tears over them, +which are poured into the eye a little above the external corner of it, and +which are afterwards absorbed by the lacrymal points above and below the +internal corner of it. When this operation is performed without our +attention, it is caused by the faculty of irritation, and belongs to Class +I. 1. 4. 1. but when it is produced by a stronger stimulus of any +extraneous material in the eye, so as to cause pain, the violent and +frequent nictitation is caused by the faculty of sensation. + +This disease is sometimes produced by the introversion of the edge of the +lower eyelid, which bends the points of the hairs of the eyelash upon the +ball of the eye, which perpetually stimulate it into painful sensation. +This introversion of the eyelid is generally owing to a tumor of the +cellular membrane below the edge of the eyelid, and though a very +troublesome complaint may often be cured by the following simple means. A +little common plaster spread on thin linen, about a quarter of an inch +long, must be rolled up so as to be about the size of a crow-quill, this +must be applied immediately below the eyelash on the outside of the eye; +and must be kept on by another plaster over it. This will then act as a +slight compression on the tumor under the eyelash, and will prevent the +hairs from touching the eye-ball. In a week or two the compression will +diminish the tumor it lies over, and cure this painful deformity. + +9. _Oscitatio et pandiculatio._ Yawning and stretching of the limbs is +produced either by a long inactivity of the muscles now brought into +action, as sometimes happens after sleep, or after listening a long time to +a dull narrative; or it is produced by a too long continued action of the +antagonist muscles. In the former case there is an accumulation of +sensorial power during the quiescence of the muscles now brought into +action; which probably constitutes the pain or wearisomeness of a continued +attitude. In the latter case there is an exhaustion of sensorial power in +the muscles, which have lately been acting violently, and a consequent +accumulation in the muscles, which are antagonists to them, and which were +at rest. + +These involuntary motions are often seen in paralytic limbs, which are at +the same time completely disobedient to the will; and are frequently +observable in very young children; and from thence we may conclude, that +these motions are learnt before nativity; as puppies are seen to open their +mouths before the membranes are broken. See Sect. XVI. 2. + +Where these motions are observed in limbs otherwise paralytic, it is an +indication that electric shocks may be employed with advantage, as the +excitability of the limb by irritation is not extinct, though it be +disobedient both to volition and sensation. + +10. _Tenesmus_ consists in violent and frequent ineffectual efforts to +discharge the contents of the rectum, owing to pain of the sphincter. The +pain is produced by indurated feces, or by some acrid material, as the +acidity of indigested aliment; and the efforts are attended with mucus from +the pained membrane. The feces must sometimes be taken away by the end of a +marrow-spoon, as cathartics and even clyster will pass without removing +them. It is sometimes caused by sympathy with the urethra, when there is a +stone at the neck of the bladder. See Class II. 2. 2. 7. and IV. 1. 2. 8. + +M. M. Fomentation, an enema with mucilage and laudanum. + +The common exclusion of the feces from the rectum is a process similar to +this, except that the muscles of the sphincter ani, and those of the +abdomen, which act along with them by the combined powers of sensation and +association, are in tenesmus excited by painful sensation, and in the +latter by a sensation, which may in some instances be almost called +pleasurable, as relieving us from a painful one in the exclusion of the +feces. + +11. _Stranguria._ Strangury consists in painful efforts to discharge the +contents of the urinary bladder. It is generally owing to a stone in the +sphincter of the bladder; or to the inflammation of the neck of it +occasioned by cantharides. It is sometimes caused by sympathy with the +piles; and then is liable in women to occasion convulsions, from the +violence of the pain without inflammation. See Class IV. 2. 2. 2. and 3. + +M. M. Fomentation clyster with oil and laudanum, push the stone back with a +bougie; if from cantharides give half a pint of warm water every ten +minutes. Mucilage of gum arabic and tragacanth. + +The natural evacuation of the urine is a process similar to this, except +that the muscular fibres of the bladder, and the muscles of the abdomen, +which act in concert with them by the combined powers of sensation and of +association, are, in the former case of strangury, excited into action by +painful sensation; and in the latter by a sensation, which may almost be +termed pleasurable, as it relieves us from a previous uneasy one. + +The ejectio feminis is another process in some respects similar to +strangury, as belonging to the same sensible canal of the urethra, and by +exciting into action the accelerator muscles; but in the strangury these +muscles are excited into action by painful sensation, and in the ejection +of the semen by pleasureable sensation. + +12. _Parturitio._ Parturition is not a disease, it is a natural process, +but is more frequently unfortunate in high life than amongst the middle +class of females; which may be owing partly to fear, with which the priests +of LUCINA are liable to inspire the ladies of fashion to induce them to lie +in in town; and partly to the bad air of London, to which they purposely +resort. + +There are however other causes, which render parturition more dangerous to +the ladies of high life; such as their greater general debility from +neglect of energetic exercise, their inexperience of the variations of cold +and heat, and their seclusion from fresh air. To which must be added, that +great source of the destruction of female grace and beauty, as well as of +female health, the tight stays, and other bandages, with which they are +generally tortured in their early years by the active folly of their +friends, which by displacing many of the viscera impedes their actions, and +by compressing them together produces adhesions of one part to another, and +affects even the form and aperture of the bones of the pelvis, through +which the nascent child must be protruded. + +As parturition is a natural, not a morbid process, no medicine should be +given, where there is no appearance of disease. The absurd custom of giving +a powerful opiate without indication to all women, as soon as they are +delivered, is, I make no doubt, frequently attended with injurious, and +sometimes with fatal consequences. See Class II. 1. 2. 16. + +Another thing very injurious to the child, is the tying and cutting the +navel-string too soon; which should always be left till the child has not +only repeatedly breathed, but till all pulsation in the cord ceases. As +otherwise the child is much weaker than it ought to be; a part of the blood +being left in the placenta, which ought to have been in the child; and at +the same time the placenta does not so naturally collapse, and withdraw +itself from the sides of the uterus, and is not therefore removed with so +much safety and certainty. The folly of giving rue or rhubarb to new-born +children, and the danger of feeding them with gruel instead of milk, is +spoken of in Class I. 1. 2. 5. and II. 1. 2. 16. + + * * * * * + +ORDO I. + +_Increased Sensation._ + +GENUS II. + +_With the Production of new Vessels by internal Membranes or Glands, with +Fever._ + +In the first class of diseases two kinds of fevers were described, one from +excess, and the other from defect of irritation; and were in consequence +termed irritative, and inirritative fevers. In this second class of +diseases another kind of fever occurs, which is caused by excess of +sensation, and termed in consequence Sensitive Fever. But there is no fever +from defect of sensation, because the circulation is carried on in health +without our consciousness, that is, without any sensation attending it. + +But as excess of sensation may exist with excess or defect of irritation, +two other kinds of fever arise from a combination of sensitive fever with +the irritative, and inirritative ones. Making five kinds in all. + +1. Irritative fever, described in Class I. 1. 1. 1. + +2. Inirritative fever. Class I. 2. 1. 1. + +3. Sensitive fever. Class II. 1. 6. 1. + +4. Sensitive irritated fever. Class II. 1. 2. 1. + +5. Sensitive inirritated fever. Class II. 1. 3. 1. + +As the sensitive irritated fever attends all the diseases enumerated under +the genus about to be described, it is placed at the head of it. And as the +sensitive inirritated fever accompanies the greatest number of the species +enumerated under the third genus of this order, it is placed at the head of +them. And as the sensitive fever attends the diseases of the sixth genus, +it is placed at the head of them. But as every febrile paroxysm consists of +disordered tribes or trains of associated motions, it may be doubted, +whether they ought not all to have been placed in the fourth class, amongst +the diseases of association. See Class IV. 2. 4. 11. + +All the subsequent species of this genus are attended with sensitive +irritated fever; there are nevertheless some superficial inflammations, +which affect the same situations without much fever, as the scrophulous +ophthalmy and spurious peripneumony, which belong to other genera. + +Inflammation is uniformly attended with the production or secretion of new +fibres constituting new vessels; this therefore may be esteemed its +essential character, or the criterion of its existence. The extension of +the old vessels seems rather a consequence than a cause of the germination, +or pullulation, of these new ones; for the old vessels may be enlarged, and +excited with unusual energy, without any production of new ones, as in the +blush of shame or of anger. + +When these new vessels are formed, if they are not reabsorbed into the +circulation, they secrete a new fluid called purulent matter; which +generally opens itself a passage on the external skin, and produces an +ulcer, which either gradually heals, or spreads, and is the cause of hectic +fever; or they secrete contagious matter, which has the property of +exciting the same kind of inflammation, and of producing the same kind of +contagious matter, when inserted by inoculation into the skin of other +persons. These contagious matters form ulcers, which either heal +spontaneously, or by art; or continue to spread, and destroy the patient, +by other kinds of hectic fever. + +In this genus there is an increase of the sensorial power of irritation as +well as of sensation; whence great arterial energy is produced, and the +pulse becomes strong and full, as well as quick; and the coats of the +arteries feel hard under the finger, being themselves thickened and +distended by inflammation. The blood drawn, especially at the second +bleeding, is covered with a tough size; which is probably the mucus from +the inflamed internal surface of the arteries, increased in quantity, and +more coagulable than in its natural state; the thinner part being more +perfectly absorbed by the increased action of the inflamed absorbents. See +Sect. XXXIII. 2. 2. This is rendered more probable, because the hard feel +of the pulse, and the abundance of coagulable lymph commence, exist, and +cease together. + +Great heat is produced from the new chemical combinations arising in the +secretion of new fibres, and great pain from the distention of old ones, or +from their increased action. The increased quantity of sensation from a +topical inflammation or phlegmon is the immediate cause of the febris +sensitiva irritata, or inflammatory fever; as when it arises from the pain +of pleurisy, or paronychia; but generally an irritative fever precedes this +topical inflammation, which occurs during the hot fit of it; and then the +irritative fever is changed into a sensitive irritated fever, by the +additional cause of the sensorial power of sensation besides that of +irritation. + +SPECIES. + +1. _Febris sensitiva irritata._ Sensitive irritated fever, or inflammatory +fever. Phlegmasia. A strong full pulse, with inflammation of the coats of +the arteries, constitutes this disease. It originates from some topical +inflammation, which, if the fever is not subdued, terminates in +suppuration; and differs from irritative fever in respect to the painful +sensation which accompanies it. For as pleasurable sensation is the cause +of the growth of the new vessels, and distention of the old ones, in the +natural enlargement of the body during our infancy; so a painful sensation +is the cause of the unnatural production of new vessels, and enlargement of +old ones in inflammatory diseases. + +When matter is thus formed in any internal viscus, or in the cellular +membrane, as in the lungs or liver; so long as this abscess remains without +admission of air, this inflammatory fever is liable to continue, receiving +only temporary relief by bleeding or emetics, or cathartics; till the +patient, after a month, or two, or three, expires. But, if air be admitted +to these internal abscesses, this kind of fever is changed into a hectic +fever in a single day. It also sometimes happens, that when the abscess +remains unopened to the air, if the matter has become putrid, that hectic +fever supervenes, with colliquative sweats, or diarrhoea; the matter in +both cases is sometimes absorbed, and the sides of the abscess grow +together again without an external aperture. See Class II. 1. 4. 1. and 2. +Another termination of inflammation is in gangrene, but this belongs to the +inflammation of the external skin; as the production of purulent matter +belongs to inflammation of the internal or mucous membranes. Thus when the +external skin is the seat of inflammation, as in erythema, or erysipelas, +and produces sensitive irritated fever, no collection of purulent matter +can be formed; but a material oozes out, and lies upon the surface, like +that in the confluent small-pox, and the cuticle at length peels off, or +gangrene supervenes. It must be noted, that these kinds of inflammation can +exist together; and some parts of the cellular membrane may suppurate at +the same time that the external skin is affected with erythema, or +erysipelas. + +M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath? +See Sect. XII. 6. + +The increased arterial action in this sensitive irritated fever is not +simply owing to the increased irritability of the arterial system, or to +the stimulus of the distention of the vessels, but also to the increased +acrimony or pungency of the blood; which has now so far changed its nature +as to become more fluid, more dense, and to be loaded with coagulable +lymph. Hence it becomes necessary not only to lessen the quantity of blood +by venesection and by cathartics, but also to dilute its acrimony, or +pungency, by the introduction of aqueous and mucilaginous fluids, such as +barley water, cream and water, sugar and water, weak broths; to which may +be added so much of some vegetable essential oil, as may render them +grateful to the stomach, and thus promote their absorption, as by infusing +parsley or cellery and turneps in the broth; or by balm, mint, or sage +teas. + +The following species of this genus only distinguish the situation of the +part previously inflamed, and which is the remote cause of the sensitive +irritated, or inflammatory fever, which attends it. + +2. _Ophthalmia interna._ Inflammation of the eye is attended with the +production of new vessels, which spread over the tunica adjunctiva, and +over the cornea; these new vessels are easily seen, as they lie on a white +ground, and give ocular demonstration of their production in inflammation. +When this inflammation of the cornea suppurates, it is liable to leave +little ulcers, which may be seen beneath the surface in the form of little +excavations; and as these heal, they are liable to be covered with an opake +scar. This scar, in some months or years, is liable to wear away, and +become transparent, without the assistance of any polishing powder, as of +very finely levigated glass, as some have recommended. But when the cornea +is affected through all its thickness, the return of its transparency +becomes hopeless. See Class I. 1. 3. 14. + +In violent degrees of ophthalmy the internal parts, as the retina, optic +artery, iris, ciliary process, become inflamed, as well as the external +ones; hence the least light admitted to the eye occasions intolerable pain. +This curious circumstance cannot be owing to the action of light on the +inflamed vessels of the cornea; it therefore shews, that the extremity of +the optic nerve or retina is also rendered more exquisitely sensible to +light, by partaking of the inflammation; and I have been told, that red +colours are in these cases sometimes painfully perceived even in perfect +darkness. This shews that the retina is excited into motion by the stimulus +of light; and that, when it is inflamed, these motions give great pain, +like those of other inflamed parts, as the muscles, or membranes. And +secondly, that the ideas of colours consist in the motions of the retina; +which ideas occasion pain, when the extremity of the moving nerve is +inflamed. + +M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the +eye with cold water by means of a rag. Cool airy room. Darkness. When the +inflammation begins to decline, white vitriol gr. vi. in an ounce of water +is more efficacious to moisten the eye than solutions of lead. Tincture of +opium diluted. New vessels from the inflamed tunica adnata frequently +spread like a fly's wing upon the transparent cornea, which is then called +Pterigium. To stop the growth of this, the principal vessels should be cut +through with a lancet. When the inflammation begins to decline, after due +evacuation any stimulating material put into the eye increases the +absorption, which soon removes the new red vessels; which has given rise to +a hundred famous eye-waters, and eye-doctors; if these stimulating +materials are used too soon, the inflammation is increased by them. See +Sect. XXXII. 2. 10. + +There is another ophthalmia, which attends weak children, and is generally +esteemed a symptom of scrophula, as described in Class II. 1. 4. 1. and +another, which is of venereal origin, mentioned in Class II. 1. 5. 2. both +which may be termed ophthalmia superficialis. + +3. _Phrenitis._ Inflammation of the brain is attended with intolerance of +light and sound; which shews, that the extremities of the nerves of those +senses are at the same time inflamed; it is also attended with great pain +of the head, with watchfulness, and furious delirium. The violent efforts, +these patients are said sometimes to exert, are owing to the increased +secretion of sensorial power in the brain; as all other inflamed glands +have a greater circulation of blood passing through them, and a greater +secretion in consequence of their peculiar fluids, as in the hepatitis much +more bile is generated. + +M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water +for hours together. Or with warm water. Cool airy room. Afterwards cupping +on the occiput. Leeches to the temples. When the patient is weakened a +blister on the head, and after further exhaustion five or six drops of +tincture of opium. + +4. _Peripneumonia._ Inflammation of the lungs. The pulse is not always +hard, sometimes soft; which is probably owing to a degree of sickness or +inaction of the stomach; with dull pain of the chest; respiration +constantly difficult, sometimes with erect posture; the face bloated and +purplish; cough generally with moist expectoration, often stained with +blood. + +When the difficulty of respiration is very great, the patient is not able +to cough; in this situation, after copious bleeding, the cough is liable to +return, and is so far a favourable symptom, as it shews some abatement of +the inflammation. + +A peripneumony frequently occurs in the chin-cough, and destroys the +patient, except immediate recourse be had to the lancet, or to four or five +leeches; when blood cannot be otherwise taken. + +The peripneumony is very fatal to young children, especially as I believe +it is frequently mistaken for a spasmodic asthma, or for the croup, or +cynanche trachealis of Cullen. Both which, however, when they occur, +require immediate venesection by the lancet or by leeches, as well as the +peripneumony. + +The croup is an inflammation of the upper part, and the peripneumony of the +lower part of the same organ, viz. the trachea or windpipe. See Class I. 1. +3. 4. But as the inflammation is seldom I suppose confined to the upper +part of the trachea only, but exists at the same time in other parts of the +lungs, and as no inflammation of the tonsils is generally perceptible, the +uncouth name of cynanche trachealis should be changed for _peripneumonia +trachialis_. The method of cure consists in immediate and repeated +bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in +subtepid water, and in breathing over the steam of warm water, with or +without a little vinegar in it. And lastly, by keeping the child raised +high in bed. + +Inflammation of the lungs is also liable to occur in the measles, and must +be attacked by venesection at any time of the disease; otherwise either a +present death, or an incurable consumption, is the consequence. + +The peripneumony is frequently combined with inflammation of the pleura, +and sometimes with that of the diaphragm; either of these may generally be +distinguished, not only by the pain which attends inflammation of these +membranes, but by inspecting the naked chest, and observing whether the +patient breathes more by elevating the ribs, or by depressing the +diaphragm. + +A crisis happens in children about the sixth day with much pale urine, +which must be waited for after evacuations have been used, as far as can be +done with safety; in this situation the warm bath twice a day, and small +blisters repeatedly in succession, are of peculiar service. + +After the termination of peripneumony a collection of coagulable lymph is +frequently left in the cavity of the chest unabsorbed; or a common anasarca +of the lungs occurs from the present inaction of the absorbent vessels, +which had previously been excited too violently. This difficulty of +breathing is cured or relieved by the exhibition of digitalis. See Art. IV. +2. 8. + +M. M. The lancet is the anchor of hope in this disease; which must be +repeated four or five times, or as often as the fever and difficulty of +breathing increase, which is generally in the evening; antimonials, +diluents, repeated small blisters about the chest, mucilage, pediluvium, +warm bath. Is a decoction of seneka-root of use? Do not neutral salts +increase the tendency to cough by their stimulus, as they increase the heat +of urine in gonorrhoea? Children in every kind of difficult breathing, from +whatever cause, should be kept as upright in bed as may be, and continually +watched; since, if they slip down, they are liable to be immediately +suffocated. After the patient is greatly debilitated, so that no further +evacuation can be admitted, and the difficult breathing and cough continue, +I have given four or five drops of tincture of opium, that is, about a +quarter of a grain of solid opium, with great advantage, and I believe in +several cases I have saved the patient. A greater quantity of opium in this +state of debility cannot be used without hazarding the life of the person. +This small quantity of an opiate should be given about six in the evening, +or before the access of the evening paroxysm, and repeated three or four +nights, or longer. + +There is a peripneumony with weak pulse, which may be termed _peripneumonia +inirritata_, as described in Sect. XXVII. 2. which belongs to this place. +See also Superficial Peripneumony, Class II. 1. 3. 7. + +5. _Pleuritis._ Pleurisy. Inflammation of the pleura, with hard pulse, pain +chiefly of the side, pungent, particularly increased during inspiration; +lying on either side uneasy, the cough very painful, dry at the beginning, +afterwards moist, often bloody. + +One cause of pleurisy is probably a previous adhesion of the lungs to a +part of the pleura, which envelops them. This in many cases has been +produced in infancy, by suffering children to lie too long on one side. Or +by placing them uniformly on one side of a fire, or window, to which they +will be liable always to bend themselves. + +When matter is produced during peripneumony or pleurisy in one side of the +chest, so long as it is a concealed vomica, the fever continues, if the +disease be great, for many weeks, and even months; and requires occasional +venesection, till the patient sinks under the inflammatory or sensitive +irritated fever. But if air be admitted, by a part of the abscess opening +itself a way into the air-vessels of the lungs, a hectic fever, with +colliquitive sweats or diarrhoea, supervenes, and frequently destroys the +patient; or the abscess heals the lungs adhering to the pleura. + +M. M. The lancet must be used copiously, and repeated as often as the pain +and difficult respiration increase. A blister on the pained part. +Antimonial preparations. Diluents. Cool air. Do neutral salts increase the +tendency to cough? Pediluvium or semicupium frequently repeated. + +6. _Diaphragmitis._ Inflammation of the diaphragm. Pain round the lower +ribs as if girt with a cord. Difficult respiration performed only by +elevating the ribs and in an erect posture. The corners of the mouth +frequently retracted into a disagreeable smile, called risus Sardonicus. + +Those animals, which are furnished with clavicles, or collar-bones, not +only use their foremost feet as hands, as men, monkies, cats, mice, +squirrels, &c. but elevate their ribs in respiration as well as depress the +diaphragm for the purpose of enlarging the cavity of the chest. Hence an +inflammation of the diaphragm is sudden death to those animals, as horses +and dogs, which can only breaths by depressing the diaphragm; and is I +suppose the cause of the sudden death of horses that are over-worked; +whereas, in the human animal, when the diaphragm is inflamed, so as to +render its motions impossible from the pain they occasion, respiration can +be carried on, though in a less perfect manner, by the intercostal muscles +in the elevation of the ribs. In pleurisy the ribs are kept motionless, and +the respiration is performed by the diaphragm, as may be readily seen on +inspecting the naked chest, and which is generally a bad symptom; in the +diaphragmitis the ribs are alternately elevated, and depressed, but the +lower part of the belly is not seen to move. + +M. M. As in pleurisy and peripneumony. When the patient becomes delirious, +and smiles disagreeably by intervals, and is become so weak, that +evacuations by the lancet could be used no further, and I have almost +despaired of my patient, I have found in two or three instances, that about +five or six drops of tinct. thebaic, given an hour before the evening +exacerbation, has had the happiest effect, and cured the patient in this +case, as well as in common peripneumony; it must be repeated two or three +evenings, see Class II. 1. 2. 4. as the exacerbation of the fever and +difficult respiration and delirium generally increase towards night. + +The stimulus of this small quantity of opium on a patient previously so +much debilitated, acts by increasing the exertion of the absorbent vessels, +in the same manner as a solution of opium, or any other stimulant, put on +an inflamed eye after the vessels are previously emptied by evacuations, +stimulates the absorbent system, so as to cause the remaining new vessels +to be immediately reabsorbed. Which same stimulants would have increased +the inflammation, if they had been applied before the evacuations. See +Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full +of blood, the absorbents cannot act so powerfully, as the progress of their +contents is opposed by the previous fulness of the blood-vessels; whence +stimulants in that case increase the action of the secerning system more +than of the absorbent one; but after copious evacuation this resistance to +the progress of the absorbed fluids is removed; and when stimulants are +then applied, they increase the action of the absorbent system more than +that of the secerning one. Hence opium given in the commencement of +inflammatory diseases destroys the patient; and cures them, if given in +very small doses at the end of inflammatory diseases. + +7. _Carditis._ Inflammation of the heart is attended with unequal +intermitting pulse, palpitation, pain in the middle of the sternum, and +constant vomiting. It cannot certainly be distinguished from peripneumony, +and is perhaps always combined with it. + +8. _Peritonitis._ Inflammation of the peritonaeum is known by pain all over +the abdomen, which is increased on erecting the body. It has probably most +frequently a rheumatic origin. See Class II. 1. 2. 17. + +9. _Mesenteritis._ Inflammation of the mesentery is attended with pains +like colic, and with curdled or chyle-like stools. It is a very frequent +and dangerous disease, as the production of matter more readily takes place +in it than in any other viscus. The consequence of which, after a hard +labour, is probably the puerperal fever, and in scrophulous habits a fatal +purulent fever, or hopeless consumption. + +M. M. Venesection. Warm bath. Emollient clysters. + +10. _Gastritis._ In inflammation of the stomach the pulse is generally +soft, probably occasioned by the sickness which attends it. The pain and +heat of the stomach is increased by whatever is swallowed, with immediate +rejection of it. Hiccough. + +This disease may be occasioned by acrid or indigestible matters taken into +the stomach, which may chemically or mechanically injure its interior coat. +There is however a slighter species of inflammation of this viscus, and +perhaps of all others, which is unattended by much fever; and which is +sometimes induced by drinking cold water, or eating cold insipid food, as +raw turnips, when the person has been much heated and fatigued by exercise. +For when the sensorial power has been diminished by great exertion, and the +stomach has become less irritable by having been previously stimulated by +much heat, it sooner becomes quiescent by the application of cold. In +consequence of this slight inflammation of the stomach an eruption of the +face frequently ensues by the sensitive association of this viscus with the +skin, which is called a surfeit. See Class IV. 1. 2. 13. and II. 1. 4. 6. +and II. 1. 3. 19. + +M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See +Class II. 1. 3. 17. + +11. _Enteritis._ Inflammation of the bowels is often attended with soft +pulse, probably owing to the concomitant sickness; which prevents sometimes +the early use of the lancet, to the destruction of the patient. At other +times it is attended with strong and full pulse like other inflammations of +internal membranes. Can the seat of the disease being higher or lower in +the intestinal canal, that is, above or below the valve of the colon, +produce this difference of pulse by the greater sympathy of one part of the +bowels with the stomach than another? In enteritis with strong pulse the +pain is great about the navel, with vomiting, and the greatest difficulty +in procuring a stool. In the other, the pain and fever is less, without +vomiting, and with diarrhoea. Whence it appears, that the enteritis with +hard quick pulse differs from Ileus, described in Class I. 3. 1. 6. only in +the existence of fever in the former and not the latter, the other symptoms +generally corresponding; and, secondly, that the enteritis with softer +quick pulse, differs from the cholera described in Class I. 3. 1. 5. only +in the existence of fever in the former, and not the latter, the other +symptoms being in general similar. See Class II. 1. 3. 20. + +Inflammation of the bowels sometimes is owing to extraneous indigestible +substances, as plum-stones, especially of the damasin, which has sharp +ends. Sometimes to an introsusception of one part of the intestine into +another, and very frequently to a strangulated hernia or rupture. In +respect to the first, I knew an instance where a damasin stone, after a +long period of time, found its way out of the body near the groin. I knew +another child, who vomited some damasin stones, which had lain for near +twenty hours, and given great pain about the navel, by the exhibition of an +emetic given in repeated doses for about an hour. The swallowing of +plum-stones in large quantities, and even of cherry-stones, is annually +fatal to many children. In respect to the introsusception and hernia, see +Ileus, Class I. 3. 1. 6. + +M. M. Repeated venesection. Calomel from ten to twenty grains given in +small pills as in Ileus; these means used early in the disease generally +succeed. After these evacuations a blister contributes to stop the +vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will +frequently stay in the stomach. Glauber's salt dissolved in pepper-mint +water given by repeated spoonfuls. + +When the patient is much reduced, opium in very small doses may be given, +as a quarter of a grain, as recommended in pleurisy. If the pain suddenly +ceases, and the patient continues to vomit up whatever is given him, it is +generally fatal; as it indicates, that a mortification of the bowel is +already formed. Some authors have advised to join cathartic medicines with +an opiate in inflammation of the bowels, as recommended in colica +saturnina. This may succeed in slighter cases, but is a dangerous practice +in general; since, if the obstruction be not removed by the evacuation, the +stimulus of the opium is liable to increase the action of the vessels, and +produce mortification of the bowel, as I think I have seen more than once. + +12. _Hepatitis._ Inflammation of the liver is attended with strong quick +pulse; tension and pain of the right side; often pungent as in pleurisy, +oftner dull. A pain is said to affect the clavicle, and top of the right +shoulder; with difficulty in lying on the left side; difficult respiration; +dry cough; vomiting; hiccough. + +There is another hepatitis mentioned by authors, in which the fever, and +other symptoms, are wanting, or are less violent; as described in Class II. +1. 4. 12. and which is probably sometimes relieved by eruptions of the +face; as in those who are habituated to the intemperate use of fermented +liquors. + +M. M. Hepatic inflammation is very liable to terminate in suppuration, and +the patient is destroyed by the continuance of a fever with sizy blood, but +without night-sweats, or diarrhoea, as in other unopened abscesses. Whence +copious and repeated venesection is required early in the disease, with +repeated doses of calomel, and cathartics. Warm bath. Towards the end of +the disease small doses of opium before the evening paroxysms, and lastly +the Peruvian bark, and chalybeate wine, at first in small doses, as 20 +drops twice a day, and afterwards, if necessary, in larger. See Art. IV. 2. +6. + +Mrs. C. a lady in the last month of her pregnancy, was seized with violent +hepatitis, with symptoms both of peripneumony and of pleurisy, for it +seldom happens in violent inflammations, that one viscus alone is affected; +she wanted then about a fortnight of her delivery, and after frequent +venesection, with gentle cathartics, with fomentation or warm bath, she +recovered and was safely delivered, and both herself and child did well. +Rheumatic and eruptive fevers are more liable to induce abortion. + +13. _Splenitis._ Inflammation of the spleen commences with tension, heat, +and tumour of the left side, and with pain, which is increased by pressure. +A case is described in Class I. 2. 3. 18. where a tumid spleen, attended +with fever, terminated in schirrus of that viscus. + +14. _Nephritis._ Inflammation of the kidney seems to be of two kinds; each +of them attended with different symptoms, and different modes of +termination. One of them I suppose to be an inflammation of the external +membrane of the kidney, arising from general causes of inflammation, and +accompanied with pain in the loins without vomiting; and the other to +consist in an inflammation of the interior parts of the kidney, occasioned +by the stimulus of gravel in the pelvis of it, which is attended with +perpetual vomiting, with pain along the course of the ureter, and +retraction of the testis on that side, or numbness of the thigh. + +The former of these kinds of nephritis is distinguished from lumbago by its +situation being more exactly on the region of the kidney, and by its not +being extended beyond that part; after three or four days I believe this +inflammation is liable to change place; and that a herpes or erysipelas, +called zona, or shingles, breaks out about the loins in its stead; at other +times it is cured by a cathartic with calomel, with or without previous +venesection. + +The other kind of nephritis, or inflammation of the interior part of the +kidney, generally arises from the pain occasioned by the stimulus of a +stone entering the ureter from the pelvis of the kidney; and, which ceases +when the stone is protruded forwards into the bladder; or when it is +returned into the pelvis of the kidney by the retrograde action of the +ureter. The kidney is nevertheless inflamed more frequently, though in a +less degree, from other causes; especially from the intemperate +ingurgitation of ale, or other fermented or spirituous liquors. This less +degree of inflammation is the cause of gravel, as that before mentioned is +the effect of it. The mucus secreted to lubricate the internal surface of +the uriniferous tubes of the kidney becomes secreted in greater quantity, +when these vessels are inflamed; and, as the correspondent absorbent +vessels act more energetically at the same time, the absorption of its more +fluid parts is more powerfully effected; on both these accounts the mucus +becomes both changed in quality and more indurated. And in this manner +stones are produced on almost every mucous membrane of the body; as in the +lungs, bowels, and even in the pericordium, as some writers have affirmed. +See Class I. 1. 3. 9. + +M. M. Venesection. Ten grains of calomel given in small pills, then +infusion of sena with oil. Warm bath. Then opium a grain and half. See +Class I. 1. 3. 9. for a further account of the method of cure. + +15. _Cystitis._ Inflammation of the bladder is attended with tumor and pain +of the lower part of the belly; with difficult and painful micturition; and +tenesmus. It generally is produced by the existence of a large stone in the +bladder, when in a great degree; or is produced by common causes, when in a +slighter degree. + +The stone in the bladder is generally formed in the kidney, and passing +down the ureter into the bladder becomes there gradually increased in size; +and this most frequently by the apposition of concentric spheres, as may be +seen by sawing some of the harder calculi through the middle, and polishing +one surface. These new concretions superinduced on the nucleus, which +descended from the kidney, as described in Class I. 1. 3. 9. and in the +preceding article of this genus, is not owing to the microcosmic salt, +which is often seen to adhere to the sides of chamber-pots, as this is +soluble in warm water, but to the mucus of the bladder, as it rolls along +the internal surface of it. Now when the bladder is slightly inflamed, this +mucus of its internal surface is secreted in greater quantity, and is more +indurated by the absorption of its more liquid part at the instant of +secretion, as explained in Class I. 1. 3. 9. and II. 1. 2. 14. and thus the +stimulus and pain of a stone in the bladder contributes to its enlargement +by inflaming the interior coat of it. + +M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See Class I. 1. +3. 9. + +16. _Hysteritis._ Inflammation of the womb is accompanied with heat, +tension, tumor, and pain of the lower belly. The os uteri painful to the +touch. Vomiting. This disease is generally produced by improper management +in the delivery of pregnant women. I knew an unfortunate case, where the +placenta was left till the next day; and then an unskilful accoucheur +introduced his hand, and forcibly tore it away; the consequence was a most +violent inflammatory fever, with hard throbbing pulse, great pain, very +sizy blood, and the death of the patient. Some accoucheurs have had a +practice of introducing their hand into the uterus immediately after the +birth of the child, to take away the placenta; which they said was to save +time. Many women I believe have been victims to this unnatural practice. + +Others have received injury, where inflammation has been beginning, by the +universal practice of giving a large dose of opium immediately on delivery, +without any indication of its propriety; which, though a proper and useful +medicine, where the patient is too feeble, when given in a small dose, as +10 drops of tincture of opium, or half a grain of solid opium, must do a +proportionate injury, when it is given improperly; and as delivery is a +natural process, it is certainly more wise to give no medicines, except +there be some morbid symptom, which requires it; and which has only been +introduced into custom by the ill-employed activity of the Priests or +Priestesses of LUCINA; like the concomitant nonsense of cramming rue or +rheubarb into the mouth of the unfortunate young stranger, who is thus soon +made to experience the evils of life. See Class II. 1. 1. 12. and I. 1. 2. +5. Just so some over-wise beldames force young ducks and turkeys, as soon +as they are hatched, to swallow a peppercorn. + +M. M. Venesection repeatedly; diluents; fomentation; the patient should be +frequently raised up in bed for a short time, to give opportunity of +discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera. + +17. _Lumbago sensitiva._ Sensitive lumbago. When the extensive membranes, +or ligaments, which cover the muscles of the back are torpid, as in the +cold paroxysm of ague, they are attended with pain in consequence of the +inaction of the vessels, which compose them. When this inaction continues +without a consequent renewal or increase of activity, the disease becomes +chronical, and forms the lumbago frigida, or irritativa, described in Class +I. 2. 4. 16. But when this cold fit or torpor of these membranes, or +ligaments or muscles of the back, is succeeded by a hot fit, and consequent +inflammation, a violent inflammatory fever, with great pain, occurs, +preventing the erect posture of the body; and the affected part is liable +to suppurate, in which case a very dangerous ulcer is formed, and a part of +one of the vertebrae is generally found carious, and the patient sinks +after a long time under the hectic fever occasioned by the aerated or +oxygenated matter. + +This disease bears no greater analogy to rheumatism than the inflammation +of the pleura, or any other membranous inflammation; and has therefore +unjustly been arranged under that name. It is distinguished from nephritis, +as it is seldom attended with vomiting, I suppose never, except the ureter +happens to be inflamed at the same time. + +The pain sometimes extends on the outside of the thigh from the hip to the +ankle, heel, or toes, and is then called sciatica; and has been thought to +consist in an inflammation of the theca, or covering of the sciatic nerve, +as the pain sometimes so exactly attends the principal branches of that +nerve. See Class I. 2. 4. 15. 16. + +M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm +bath; poultice on the back, consisting of camomile flowers, turpentine, +soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs +from the torpor of the muscles, which had previously been too much excited, +frequently occurs at the end of this disease; in this case electricity, and +issues on each side of the lumber vertebrae, are recommended. See Class I. +2. 4. 16. + +18. _Ischias._ The ischias consists of inflammatory fever, with great pain +about the pelvis, the os coccigis, and the heads of the thigh-bones, +preventing the patient from walking or standing erect, with increase of +pain on going to stool. This malady, as well as the preceding, has been +ascribed to rheumatism; with which it seems to bear no greater analogy, +than the inflammations of any other membranes. + +The patients are left feeble, and sometimes lame after this disease; which +is also sometimes accompanied with great flow of urine, owing to the +defective absorption of its aqueous parts; and with consequent thirst +occasioned by the want of so much fluid being returned into the +circulation; a lodgment of faeces in the rectum sometimes occurs after this +complaint from the lessened sensibility of it. See Class I. 2. 4. 15. + +M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with +camomile flowers, turpentine, soap, and opium; afterwards the bark. See +Class I. 1. 3. 5. + +When this inflammation terminates in suppuration the matter generally can +be felt to fluctuate in the groin, or near the top of the thigh. In this +circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire, +proposes to tap the abscess by means of a trocar, and thus as often as +necessary to discharge the matter without admitting the air. Might a weak +injection of wine and water, as in the hydrocele, be used with great +caution to inflame the walls of the abscess, and cause them to unite? See +Class II. 1. 6. 9. + +19. _Paronychia interna._ Inflammation beneath the finger-nail. The pain +occasioned by the inflammatory action and tumor of parts bound down between +the nail on one side and the bone on the other, neither of which will +yield, is said to occasion so much pain as to produce immediate delirium, +and even death, except the parts are divided by a deep incision; which must +pass quite through the periosteum, as the inflammation is said generally to +exist beneath it. This disease is thus resembled by the process of toothing +in young children; where an extraneous body lodged beneath the periosteum +induces pain and fever, and sometimes delirium, and requires to be set at +liberty, by the lancet. + + * * * * * + +ORDO I. + +_Increased Sensation._ + +GENUS III. + +_With the Production of new Vessels by external Membranes or Glands with +Fever._ + +The diseases of this genus are perhaps all productive of contagious matter; +or which becomes so by its exposure to the air, either through the cuticle, +or by immediate contact with it; such are the matters of the small-pox and +measles. The purulent matter formed on parts covered from the air by +thicker membranes or muscles, as in the preceding genus, does not induce +fever, and cannot therefore be called contagious; but it acquires this +property of producing fever in a few hours, after the abscess has been +opened, so as to admit the air to its surface, and may then be said to +consist of contagious miasmata. This kind of contagious matter only induces +fever, but does not produce other matter with properties similar to its +own; and in this respect it differs from the contagious miasmata of +small-pox or measles, but resembles those which have their origin in +crowded jails; for these produce fever only, which frequently destroys the +patient; but do not produce other matters similar to themselves; as appears +from none of those, who died of the jail-fever, caught at the famous black +assizes at Oxford, at the beginning of this century, having infected their +physicians or attendants. + +If indeed the matter has continued so long as to become putrid, and thus to +have given out air from a part of it, it acquires the power of producing +fever; in the same manner as if the ulcer had been opened, and exposed to +the common air; instances of which are not unfrequent. And from these +circumstances it seems probable, that the matters secreted by the new +vessels formed in all kinds of phlegmons, or pustles, are not contagious, +till they have acquired something from the atmosphere, or from the gas +produced by putrefaction; which will account for some phenomena in the lues +venerea, cancer, and of other contagious secretions on the skin without +fever, to be mentioned hereafter. See Class II. 1. 4. 14. + +The theory of contagion has been perplexed by comparing it with fermenting +liquors; but the contagious material is shewn in Section XXXIII. to be +produced like other secreted matters by certain animal motions of the +terminations of the vessels. Hence a new kind of gland is formed at the +terminations of the vessels in the eruptions of the small-pox; the animal +motions of which produce from the blood variolous matter; as other glands +produce bile or saliva. Now if some of this matter is introduced beneath +the cuticle of a healthy person, or enters the circulation, and excites the +extremities of the blood-vessels into those kinds of diseased motions, by +which it was itself produced, either by irritation or association, these +diseased motions of the extremities of the vessels will produce other +similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion +seems to be propagated two ways; one, by the stimulus of contagious matter +applied to the part, which by an unknown law of nature excites the +stimulated vessels to produce a similar matter; as in venereal ulcers, +which thus continue to spread; or as when variolous matter is inserted +beneath the cuticle; or when it is supposed to be absorbed, and diffused +over the body mixed with the blood, and applied in that manner to the +cutaneous glands. The other way, by which contagion seems to be diffused, +is by some distant parts sympathizing or imitating the motions of the part +first affected; as the stomach and skin in the eruptions of the inoculated +small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3. + +In some of the diseases of this genus the pulse is strong, full, and hard, +constituting the sensitive irritated fever, as described in the preceding +genus; as in one kind of erysipelas, which requires repeated venesection. +In others the arterial action is sometimes moderate, so as to constitute +the sensitive fever, as in the inoculated small-pox; where the action of +the arteries is neither increased by the sensorial power of irritation, as +in the sensitive irritated fever; nor decreased by the defect of that +power, as in the sensitive inirritated fever. But in the greatest number of +the diseases of this genus the arterial action is greatly diminished in +respect to strength, and consequently the frequency of pulsation is +proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing +to the deficiency of the sensorial power of irritation joined with the +increase of that of sensation, and thus constitutes the sensitive +inirritated fever; as in Scarlatina with gangrenous tonsils. + +From this great debility of the action of the arteries, there appears to be +less of the coagulable lymph or mucus secreted on their internal surfaces; +whence there is not only a defect of that buff or size upon the blood, +which is seen on the surface of that, which is drawn in the sensitive +irritated fever; but the blood, as it cools, when it has been drawn into a +bason, scarcely coagulates; and is said to be dissolved, and is by some +supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3. +where the truth of this idea is controverted. But in the fevers of both +this genus and the preceding one great heat is produced from the chemical +combinations in the secretions of new vessels and fluids, and pain or +uneasiness from the distention of the old ones; till towards the +termination of the disease sensation ceases, as well as irritation, with +the mortification of the affected parts, and the death of the patient. + +Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the +diseases of external membranes, because they are exposed either to the +atmospheric air, which is breathed, and swallowed with our food and saliva; +or they are exposed to the inflammable air; or hydrogen, which is generated +in the intestines; both which contribute to produce or promote the +contagious quality of these fluids; as mentioned in Class II. 1. 5. + +It is not speaking accurate language, if we say, that in the diseases of +this genus the fever is contagious; since it is the material produced by +the external membranes, which is contagious, after it has been exposed to +air; while the fever is the consequence of this contagious matter, and not +the cause of it. As appears from the inoculated small-pox, in which the +fever does not commence, till after suppuration has taken place in the +inoculated arm, and from the diseases of the fifth genus of this order, +where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18. + +SPECIES. + +1. _Febris sensitiva inirritata._ Sensitive inirritated fever. Typhus +gravior. Putrid malignant fever. Jail fever. The immediate cause of this +disease is the increase of the sensorial power of sensation, joined with +the decrease of the sensorial power of irritation; that is, it consists in +the febris sensitiva joined with the febris inirritativa of Class I. 2. 1. +1. as the febris sensitiva irritata of the preceding genus consists of the +febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In +both which the word irritata, and inirritata, are designed to express more +or less irritation than the natural quantity; and the same when applied to +some of the diseases of this genus. + +This fever is frequently accompanied with topical inflammation, which is +liable, if the arterial strength is not supported, to end in sphacelus; and +as mortified parts, such as sloughs of the throat, if they adhere to living +parts, soon become putrid from the warmth and moisture of their situation; +these fevers have been termed putrid, and have been thought to owe their +cause to what is only their consequence. In hot climates this fever is +frequently induced by the exhalations of stagnating lakes or marshes, which +abound with animal substances; but which in colder countries produce fevers +with debility only, as the quartan ague, without inflammation. + +The sensitive inirritated, or malignant, fever is also frequently produced +by the putrid exhalations and stagnant air in prisons; but perhaps most +frequently by contact or near approach of the persons, who have resided in +them. These causes of malignant fevers contributed to produce, and to +support for a while, the septic and antiseptic theory of them; see Sect. +XXXIII. 1. 3. The vibices or bruises, and petechiae or purples, were +believed to be owing to the dissolved state of the blood by its incipient +putrefaction; but hydrostatical experiments have been made, which shew the +sizy blood of the patient in sensitive irritated or inflammatory fever, +with strong pulse, is more fluid, while it is warm, than this uncoagulable +blood taken in this sensitive inirritated, or malignant fever; from whence +it is inferred, that these petechiae, and vibices, are owing to the +deficient power of absorption in the terminations of the veins, See Class +I. 2. 1. 5. + +This sensitive inirritated fever, or typhus gravior, is distinguished from +the inirritative fever, or typhus mitior, in the early stages of it, by the +colour of the skin; which in the latter is paler, with less heat, owing to +the less violent action of the capillaries; in this it is higher coloured, +and hotter, from the greater energy of the capillary action in the +production of new vessels. In the more advanced state petechiae, and the +production of contagious matter from inflamed membranes, as the aphthae of +the mouth, or ulcers of the throat, distinguishes this fever from the +former. Delirium, and dilated pupils of the eyes, are more frequent in +nervous fevers; and stupor with deafness more frequent attendants on +malignant fevers. See Class I. 2. 5. 6. + +There is another criterion discernible by the touch of an experienced +finger; and that is, the coat of the artery in inflammatory fevers, both +those attended with strength of pulsation, and these with weak pulsation, +feels harder, or more like a cord; for the coats of the arteries in these +fevers are themselves inflamed, and are consequently turgid with blood, and +thence are less easily compressed, though their pulsations are nevertheless +weak: when the artery is large or full with an inflamed coat, it is called +hard; and when small or empty with an inflamed coat, it is called sharp, by +many writers. + +M. M. The indications of cure consist, 1. In procuring a regurgitation of +any offensive material, which may be lodged in the long mouths of the +lacteals or lymphatics, or in their tumid glands. 2. To excite the system +into necessary action by the repeated exhibition of nutrientia, sorbentia, +and incitantia; and to preserve the due evacuation of the bowels. 3. To +prevent any unnecessary expenditure of sensorial power. 4. To prevent the +formation of ulcers, or to promote the absorption in them, for the purpose +of healing them. + +1. One ounce of wine of ipecacuanha, or about ten grains of the powder, +should be given as an emetic. After a few hours three or four grains of +calomel should be given in a little mucilage, or conserve. Where something +swallowed into the stomach is the cause of the fever, it is liable to be +arrested by the lymphatic glands, as the matter of the small-pox inoculated +in the arm is liable to be stopped by the axillary lymphatic gland; in this +situation it may continue a day or two, or longer, and may be regurgitated +during the operation of an emetic or cathartic into the stomach or bowel, +as evidently happens on the exhibition of calomel, as explained in Sect. +XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if +indicated by the hardness and fulness of the pulse, will very frequently +remove fevers, if exhibited on the first, second, or even third day. + +2. Wine and opium, in small doses repeated frequently, but so that not the +least degree of intoxication follows, for in that case a greater degree of +debility is produced from the expenditure of sensorial power in unnecessary +motions. Many weak patients have been thus stimulated to death. See Sect. +XII. 7. 8. The Peruvian bark should be given also in repeated doses in such +quantity only as may strengthen digestion, not impede it. For these +purposes two ounces of wine, or of ale, or cyder, should be given every six +hours; and two ounces of decoction of bark, with two drachms of the +tincture of bark, and six drops of tincture of opium, should be given also +every six hours alternately; that is, each of them four times in +twenty-four hours. As much rhubarb as may induce a daily evacuation, should +be given to remove the colluvies of indigested materials from the bowels; +which might otherwise increase the distress of the patient by the air it +gives out in putrefaction, or by producing a diarrhoea by its acrimony; the +putridity of the evacuations are in consequence of the total inability of +the digestive powers; and their delay in the intestines, to the inactivity +of that canal in respect to its peristaltic motions. + +The quantities of wine or beer and opium, and bark, above mentioned, may be +increased by degrees, if the patient seems refreshed by them; and if the +pulse becomes slower on their exhibition; but this with caution, as I have +seen irrecoverable mischief done by greater quantities both of opium, wine, +and bark, in this kind of fever; in which their use is to strengthen the +digestion of the weak patient, rather than to stop the paroxysms of fever; +but when they are administered in intermittents, much larger quantities are +necessary. + +The stimulus of small blisters applied in succession, one every three or +four days, when the patient becomes weak, is of great service by +strengthening digestion, and by preventing the coldness of the extremities, +owing to the sympathy of the skin with the stomach, and of one part of the +skin with another. + +In respect to nutriment, the patient should be supplied with wine and +water, with toasted bread, and sugar or spice in it; or with sago with +wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with +cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish, +or whatever is grateful to the palate of the sick person, in small quantity +repeated frequently; with small beer, cyder and water, or wine and water, +for drink, which may be acidulated with acid of vitriol in small +quantities. + +3. All unnecessary motions are to be checked, or prevented. Hence +horizontal posture, obscure room, silence, cool air. All the parts of the +skin, which feel too hot to the hand, should be exposed to a current of +cool air, or bathed with cold water, whether there are eruptions on it or +not. Wash the patient twice a day with cold vinegar and water, or cold salt +and water, or cold water alone, by means of a sponge. If some parts are too +cold, as the extremities, while other parts are too hot, as the face or +breast, cover the cold parts with flannel, and cool the hot parts by a +current of cool air, or bathing them as above. + +4. For the healing of ulcers, if in the mouth, solution of alum in water +about 40 grains to an ounce, or of blue vitriol in water, one grain or two +to an ounce may be used to touch them with three or four times a day. Of +these perhaps a solution of alum is to be preferred, as it instantly takes +away the stench from ulcers I suppose by combining with the volatile alcali +which attends it. For this purpose a solution of alum of an ounce to a pint +of water should be frequently injected by means of a syringe into the +mouth. If there are ulcers on the external skin, fine powder of bark seven +parts, and cerusia in fine powder one part, should be mixed, and applied +dry on the sore, and kept on by lint, and a bandage. + +As sloughs in the mouth are frequently produced by the previous dryness of +the membranes, which line it, this dryness should be prevented by +frequently moistening them, which may be effected by injection with a +syringe, or by a moist sponge, or lastly in the following manner. Place a +glass of wine and water, or of milk and sugar, on a table by the bedside, a +little above the level of the mouth of the patient; then, having previously +moistened a long piece of narrow listing, or cloth, or flannel, with the +same liquor, leave one end of it in the glass, and introduce the other into +the mouth of the patient; which will thus be supplied with a constant +oozing of the fluid through the cloth, which acts as a capillary syphon. + +The viscid phlegm, which adheres to the tongue, should be coagulated by +some austere acid, as by lemon-juice evaporated to half its quantity, or by +crab-juice; and then it may be scraped off by a knife, or rubbed off by +flannel, or a sage leaf dipped in vinegar, or in salt and water. + +2. _Erysipelas_, St. Anthony's fire, may be divided into three kinds, which +differ in their method of cure, the irritated, the inirritated, and the +sensitive erysipelas. + +_Erysipelas irritatum_ is attended with increase of irritation besides +increase of sensation; that is, with strong, hard, and full pulse, which +requires frequent venesection, like other inflammations with arterial +strength. It is distinguished from the phlegmonic inflammations of the last +genus by its situation on the external habit, and by the redness, heat, and +tumour not being distinctly circumscribed; so that the eye or finger cannot +exactly trace the extent of them. + +When the external skin is the seat of inflammation, and produces sensitive +irritated fever, no collection of matter is formed, as when a phlegmon is +situated in the cellular membrane beneath the skin; but the cuticle rises +as beneath a blister-plaster, and becomes ruptured; and a yellow material +oozes out, and becomes inspissated, and lies upon its surface; as is seen +in this kind of erysipelas, and in the confluent small-pox; or if the new +vessels are reabsorbed the cuticle peels off in scales. This difference of +the termination of erysipelatous and phlegmonic inflammation seems to be +owing in part to the less distensibility of the cuticle than of the +cellular membrane, and in part to the ready exhalation of the thinner parts +of the secreted fluids through its pores. + +This erysipelas is generally preceded by a fever for two or three days +before the eruption, which is liable to appear in some places, as it +declines in others; and seems frequently to arise from a previous scratch +or injury of the skin; and is attended sometimes with inflammation of the +cellular membrane beneath the skin; whence a real phlegmon and collection +of matter becomes joined to the erysipelas, and either occasions or +increases the irritated fever, which attends it. + +There is a greater sympathy between the external skin and the meninges of +the brain, than between the cellular membrane and those meninges; whence +erysipelas is more liable to be preceded or attended, or succeeded, by +delirium than internal phlegmons. I except the mumps, or parotitis, +described below; which is properly an external gland, as its excretory duct +opens into the air. When pain of the head or delirium precedes the +cutaneous eruption of the face, there is some reason to believe, that the +primary disease is a torpor of the meninges of the brain; and that the +succeeding violent action is transferred to the skin of the face by +sensitive association; and that a similar sympathy occurs between some +internal membranes and the skin over them, when erysipelas appears on other +parts of the body. If this circumstance should be supported by further +evidence, this disease should be removed into Class IV. along with the +rheumatism and gout. See Class IV. 1. 2. 17. + +This supposed retropulsion of erysipelas on the brain from the frequent +appearance of delirium, has prevented the free use of the lancet early in +this disease to the destruction of many; as it has prevented the subduing +of the general inflammation, and thus has in the end produced the +particular one on the brain. Mr. B----, a delicate gentleman about sixty, +had an erysipelas beginning near one ear, and extending by degrees over the +whole head, with hard, full, and strong pulse; blood was taken from him +four or five times in considerable quantity, with gentle cathartics, with +calomel, diluents, and cool air, and he recovered without any signs of +delirium, or inflammation of the meninges of the brain. Mr. W----, a strong +corpulent man of inferior life, had erysipelas over his whole head, with +strong hard pulse: he was not evacuated early in the disease through the +timidity of his apothecary, and died delirious. Mrs. F---- had erysipelas +on the face, without either strong or weak pulse; that is, with sensitive +fever alone, without superabundance or deficiency of irritation; and +recovered without any but natural evacuations. From these three cases of +erysipelas on the head it appears, that the evacuations by the lancet must +be used with courage, where the degree of inflammation requires it; but not +where this degree of inflammation is small, nor in the erysipelas attended +with inirritation, as described below. + +M. M. Venesection repeated according to the degree of inflammation. An +emetic. Calomel three grains every other night. Cool air. Diluents, emetic +tartar in small doses, as a quarter of a grain every six hours. Tea, weak +broth, gruel, lemonade, neutral salts. See Sect. XII. 6. + +Such external applications as carry away the heat of the skin may be of +service, as cold water, cold flour, snow, ether. Because these applications +impede the exertions of the secerning vessels, which are now in too great +action; but any applications of the stimulant kind, as solutions of lead, +iron, copper, or of alum, used early in the disease, must be injurious; as +they stimulate the secerning vessels, as well as the absorbent vessels, +into greater action; exactly as occurs when stimulant eye-waters are used +too soon in ophthalmy. See Class II. 1. 2. 2. But as the cuticle peels off +in this case after the inflammation ceases, it differs from ophthalmy; and +stimulant applications are not indicated at all, except where symptoms of +gangrene appear. For as a new cuticle is formed under the old one, as under +a blister, the serous fluid between them is a defence to the new cuticle, +and should dry into a scab by exhalation rather than be reabsorbed. Hence +we see how greasy or oily applications, and even how moist ones, are +injurious in erysipelas; because they prevent the exhalation of the serous +effusion between the old and new cuticle, and thus retard the formation of +the latter. + +_Erysipelas inirritatum_ differs from the former in its being attended with +weak pulse, and other symptoms of sensitive inirritated fever. The feet and +legs are particularly liable to this erysipelas, which precedes or attends +the sphacelus or mortification of those parts. A great and long coldness +first affects the limb, and the erysipelas on the skin seems to occur in +consequence of the previous torpor of the interior membranes. As this +generally attends old age, it becomes more dangerous in proportion to the +age, and also to the habitual intemperance of the patient in respect to the +use of fermented or spirituous liquor. + +When the former kind, or irritated erysipelas, continues long, the patient +becomes so weakened as to be liable to all the symptoms of this inirritated +erysipelas; especially where the meninges of the brain are primarily +affected. As in that case, after two or three efforts have been made to +remove the returning periods of torpor of the meninges to the external +skin, those meninges become inflamed themselves, and the patient sinks +under the disease; in a manner similar to that in old gouty patients, where +the torpor of the liver or stomach is relieved by association of the +inflammation of the membranes of the feet, and then of other joints, and +lastly the power of association ceasing to act, but the excess of sensation +continuing, the liver or stomach remains torpid, or become themselves +inflamed, and the patient is destroyed. + +M. M. Where there exists a beginning gangrene of the extremities, the +Peruvian bark, and wine, and opium, are to be given in large quantities; so +as to strengthen the patient, but not to intoxicate, or to impede his +digestion of aliment, as mentioned in the first species of this genus. +Class II. 1. 2. 1. But where the brain is inflamed or oppressed, which is +known either by delirium, with quick pulse; or by stupor, and slow +respiration with slow pulse; other means must be applied. Such as, first, a +fomentation on the head with warm water, with or without aromatic herbs, or +salt in it, should be continued for an hour or two at a time, and +frequently repeated. A blister may also be applied on the head, and the +fomentation nevertheless occasionally repeated. Internally very gentle +stimulants, as camphor one grain or two in infusion of valerian. Wine and +water or small beer, weak broth. An enema. Six grains of rhubarb and one of +calomel. Afterwards five drops of tincture of opium, which may be repeated +every six hours, if it seems of service. Might the head be bathed for a +minute with cold water? or with ether? or vinegar? + +_Erysipelas sensitivum_ is a third species, differing only in the kind of +fever which attends it, which is simply inflammatory, or sensitive, without +either excess of irritation, as in the first variety; or the defect of +irritation, as in the second variety: all these kinds of erysipelas are +liable to return by periods in some people, who have passed the middle of +life, as at periods of a lunation, or two lunations, or at the equinoxes. +When these periods of erysipelas happen to women, they seem to supply the +place of the receding catamenia; when to men, I have sometimes believed +them to be associated with a torpor of the liver; as they generally occur +in those who have drank vinous spirit excessively, though not +approbriously; and that hence they supply the place of periodical piles, or +gout, or gutta rosea. + +M. M. As the fever requires no management, the disease takes its progress +safely, like a moderate paroxysm of the gout; but in this case, as in some +of the former, the erysipelas does not appear to be a primary disease, and +should perhaps be removed to the Class of Association. + +3. _Tonsillitis._ Inflammation of the tonsils. The uncouth term Cynanche +has been used for diseases so dissimilar, that I have divided them into +Tonsillitis and Parotitis; and hope to be excused for adding a Greek +termination to a Latin word, as one of those languages may justly be +considered as a dialect of the other. By tonsillitis the inflammation of +the tonsils is principally to be understood; but as all inflammations +generally spread further than the part first affected; so, when the summit +of the windpipe is also much inflamed, it may be termed tonsillitis +trachealis, or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and when the +summit of the gullet is much inflamed along with the tonsil, it may be +called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus +X. p. 92. The inflammation of the tonsils may be divided into three kinds, +which require different methods of cure. + +_Tonsillitis interna._ Inflammation of the internal tonsil. When the +swelling is so considerable as to produce difficulty of breathing, the size +of the tonsil should be diminished by cutting it with a proper lancet, +which may either give exit to the matter it contains, or may make it less +by discharging a part of the blood. This kind of angina is frequently +attended with irritated fever besides the sensitive one, which accompanies +all inflammation, and sometimes requires venesection. An emetic should be +given early in the disease, as by its inducing the retrograde action of the +vessels about the fauces during the nausea it occasions, it may eliminate +the very cause of the inflammation; which may have been taken up by the +absorbents, and still continue in the mouths of the lymphatics or their +glands. The patient should then be induced to swallow some aperient liquid, +an infusion of senna, so as to induce three or four evacuations. Gargles of +all kinds are rather hurtful, as the action of using them is liable to give +pain to the inflamed parts; but the patients find great relief from +frequently holding warm water in their mouths, and putting it out again, or +by syringing warm water into the mouth, as this acts like a warm bath or +fomentation to the inflamed part. Lastly, some mild stimulant, as a weak +solution of salt and water, or of white vitriol and water, may be used to +wash the fauces with in the decline of the disease, to expedite the +absorption of the new vessels, if necessary, as recommended in ophthalmy. + +_Tonsillitis superficialis._ Inflammation of the surface of the tonsils. As +the tonsils and parts in their vicinity are covered with a membrane, which, +though exposed to currents of air, is nevertheless constantly kept moist by +mucus and saliva, and is liable to diseases of its surface like other +mucous membranes, as well as to suppuration of the internal substance of +the gland; the inflammation of its surface is succeeded by small elevated +pustules with matter in them, which soon disappears, and the parts either +readily heal, or ulcers covered with sloughs are left on the surface. + +This disease is generally attended with only sensitive fever, and therefore +is of no danger, and may be distinguished with great certainty from the +dangerous inflammation or gangrene of the tonsils at the height of the +small-pox, or scarlet fever, by its not being attended with other symptoms +of those diseases. One emetic and a gentle cathartic is generally +sufficient; and the frequent swallowing of weak broth, or gruel, both +without salt in them, relieves the patient, and absolves the cure. When +these tumours of the tonsils frequently return I have sometimes suspected +them to originate from the absorption of putrid matter from decaying teeth. +See Class I. 2. 3. 21. and II. 2. 2. 1. + +_Tonsillitis inirritata._ Inflammation of the tonsils with sensitive +inirritated fever is a symptom only of contagious fever, whether attended +with scarlet eruption, or with confluent small-pox, or otherwise. The +matter of contagion is generally diffused, not dissolved in the air; and as +this is breathed over the mucaginous surface of the tonsils, the contagious +atoms are liable to be arrested by the tonsil; which therefore becomes the +nest of the future disease, like the inflamed circle round the inoculated +puncture of the arm in supposititious small-pox. This swelling is liable to +suffocate the patient in small-pox, and to become gangrenous in scarlet +fever, and some other contagious fevers, which have been received in this +manner. The existence of inflammation of the tonsil previous to the scarlet +eruption, as the arm inflames in the inoculated small-pox, and suppurates +before the variolous eruption, should be a criterion of the scarlet fever +being taken in this manner. + +M. M. All the means which strengthen the patient, as in the sensitive +inirritated fever, Class II. 1. 2. 1. As it is liable to continue a whole +lunation or more, great attention should be used to nourish the patient +with acidulous and vinous panada, broth with vegetables boiled in it, +sugar, cream, beer; all which given frequently will contribute much to +moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm +water and wine, or acid of lemon, should be frequently applied to the +tonsils by means of a syringe, or by means of a capillary syphon, as +described in Class II. 1. 3. 1. A slight solution of blue vitriol, as two +grains to an ounce, or a solution of sugar of lead of about six grains to +an ounce, may be of service; especially the latter, applied to the edges of +the sloughs, drop by drop by means of a small glass tube, or small +crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to +the end of either of which a drop will conveniently hang by capillary +attraction; as solutions of lead evidently impede the progress of +erysipelas on the exterior skin, when it is attended with feeble pulse. Yet +a solution of alum injected frequently by a syringe is perhaps to be +preferred, as it immediately removes the fetor of the breath, which must +much injure the patient by its being perpetually received into the lungs by +respiration. + +4. _Parotitis._ Mumps, or branks, is a contagious inflammation of the +parotis and maxillary glands, and has generally been classed under the word +Cynanche or Angina, to which it bears no analogy. It divides itself into +two kinds, which differ in the degree of fever which attends them, and in +the method of cure. + +_Parotitis suppurans._ The suppurating mumps is to be distinguished by the +acuteness of the pain, and the sensitive, irritated, or inflammatory fever, +which attends it. + +M. M. Venesection. Cathartic with calomel three or four grains repeatedly. +Cool air, diluents. This antiphlogistic treatment is to be continued no +longer than is necessary to relieve the violence of the pain, as the +disease is attended with contagion, and must run through a certain time, +like other fevers with contagion. + +_Parotitis mutabilis._ Mutable parotitis. A sensitive fever only, or a +sensitive irritated fever, generally attends this kind. And when the tumor +of the parotis and maxillary glands subsides, a new swelling occurs in some +distant part of the system; as happens to the hands and feet, at the +commencement of the secondary fever of the small-pox, when the tumor of the +face subsides. This new swelling in the parotitis mutabilis is liable to +affect the testes in men, and form a painful tumor, which should be +prevented from suppuration by very cautious means, if the violence of the +pain threaten such a termination; as by bathing the part with coldish water +for a time, venesection, a cathartic; or by a blister on the perinaeum, or +scrotum, or a poultice. + +When women are affected with this complaint, after the swelling of the +parotis and maxillary glands subsides, a tumor with pain is liable to +affect their breasts; which, however, I have never seen terminate in +suppuration. + +On the retrocession of the tumor of the testes above described, and I +suppose of that of the breasts in women, a delirium of the calm kind is +very liable to occur; which in some cases has been the first symptom which +has alarmed the friends of the patient; and it has thence been difficult to +discover the cause of it without much inquiry; the previous symptoms having +been so slight as not to have occasioned any complaints. In this delirium, +if the pulse will bear it, venesection should be used, and three or four +grains of calomel, with fomentation of the head with warm water for an hour +together every three or four hours. + +Though this disease generally terminates favourably, considering the +numbers attacked by it, when it is epidemic, yet it is dangerous at other +times in every part of its progress. Sometimes the parotis or maxillary +glands suppurate, producing ulcers which are difficult to cure, and +frequently destroy the patient, where there was a previous scrophulous +tendency. The testis in men is also liable to suppurate with great pain, +long confinement, and much danger; and lastly the affection of the brain is +fatal to many. + +Mr. W. W. had a swelled throat, which after a few days subsided. He became +delirious or stupid, in which state he was dying when I saw him; and his +friends ascribed his death to a coup de soleil, which he was said to have +received some months before, when he was abroad. + +Mr. A. B. had a swelling of the throat, which after a few days subsided. +When I saw him he had great stupor, with slow breathing, and partial +delirium. On fomenting his head with warm water for an hour these symptoms +of stupor were greatly lessened, and his oppressed breathing gradually +ceased, and he recovered in one day. + +Mr. C. D. I found walking about the house in a calm delirium without +stupor; and not without much inquiry of his friends could get the previous +history of the disease; which had been attended with parotitis, and swelled +testis, previous to the delirium. A few ounces of blood were taken away, a +gentle cathartic was directed, and his head fomented with warm water for an +hour, with a small blister on the back, and he recovered in two or three +days. + +Mr. D. D. came down from London in the coach alone, so that no previous +history could be obtained. He was walking about the house in a calm +delirium, but could give no sensible answers to any thing which was +proposed to him. His pulse was weak and quick. Cordials, a blister, the +bark, were in vain exhibited, and he died in two or three days. + +Mr. F. F. came from London in the same manner in the coach. He was mildly +delirious with considerable stupor, and moderate pulse, and could give no +account of himself. He continued in a kind of cataleptic stupor, so that he +would remain for hours in any posture he was placed, either in his chair, +or in bed; and did not attempt to speak for about a fortnight; and then +gradually recovered. These two last cases are not related as being +certainly owing to parotitis, but as they might probably have that origin. + +The parotitis suppurans, or mumps with irritated fever, is at times +epidemic among cats, and may be called _parotitis felina_; as I have reason +to believe from the swellings under the jaws, which frequently suppurate, +and are very fatal to those animals. In the village of Haywood, in +Staffordshire, I remember a whole breed of Persian cats, with long white +hair, was destroyed by this malady, along with almost all the common cats +of the neighbourhood; and as the parotitis or mumps had not long before +prevailed amongst human beings in that part of the country, I recollect +being inclined to believe, that the cats received the infection from +mankind; though in all other contagious diseases, except the rabies canina +can be so called, no different genera of animals naturally communicate +infection to each other; and I am informed, that vain efforts have been +made to communicate the small-pox and measles to some quadrupeds by +inoculation. A disease of the head and neck destroyed almost all the cats +in Westphalia. Savage, Nosol. Class X. Art. 30. 8. + +5. _Catarrhus sensitivus_ consists of an inflammation of the membrane, +which lines the nostrils and fauces. It is attended with sensitive fever +alone, and is cured by the steam of warm water externally, and by diluents +internally, with moderate venesection and gentle cathartics. This may be +termed catarrhus sensitivus, to distinguish it from the catarrhus +contagiosus, and is in common language called a violent cold in the head; +it differs from the catarrhus calidus, or warm catarrh, of Class I. 1. 2. +7. in the production of new vessels, or inflammation of the membrane, and +the consequent more purulent appearance of the discharge. + +Raucedo catarrhalis, or catarrhal hoarseness, is a frequent symptom of this +disease, and is occasioned by the pain or soreness which attends the +thickened and inflamed membranes of the larynx; which prevents the muscles +of vocallity from sufficiently contracting the aperture of it. It ceases +with the inflammation, or may be relieved by the steam of warm water alone, +or of water and vinegar, or of water and ether. See Paralytic Hoarseness, +Class III. 2. 1. 4. + +6. _Catarrhus contagiosus._ This malady attacks so many at the same time, +and spreads gradually over so great an extent of country, that there can be +no doubt but that it is disseminated by the atmosphere. In the year 1782 +the sun was for many weeks obscured by a dry fog, and appeared red as +through a common mist. The material, which thus rendered the air muddy, +probably caused the epidemic catarrh, which prevailed in that year, and +which began far in the north, and extended itself over all Europe. See +Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294, +note; and was supposed to have been thrown out of a volcano, which much +displaced the country of Iceland. + +In many instances there was reason to believe, that this disease became +contagious, as well as epidemic; that is, that one person might receive it +from another, as well as by the general unsalutary influence of the +atmosphere. This is difficult to comprehend, but may be conceived by +considering the increase of contagious matter in the small-pox. In that +disease one particle of contagious matter stimulates the skin of the arm in +inoculation into morbid action so as to produce a thousand particles +similar to itself; the same thing occurs in catarrh, a few deleterious +atoms stimulate the mucous membrane of the nostrils into morbid actions, +which produce a thousand other particles similar to themselves. These +contagious particles diffused in the air must have consisted of animal +matter, otherwise how could an animal body by being stimulated by them +produce similar particles? Could they then have had a volcanic origin, or +must they not rather have been blown from putrid marshes full of animal +matter? But the greatest part of the solid earth has been made from animal +and vegetable recrements, which may be dispersed by volcanos.--Future +discoveries must answer these questions. + +As the sensitive fever attending these epidemic catarrhs is seldom either +much irritated or inirritated, venesection is not always either clearly +indicated or forbid; but as those who have died of these catarrhs have +generally had inflamed livers, with consequent suppuration in them, +venesection is adviseable, wherever the cough and fever are greater than +common, so as to render the use of the lancet in the least dubious. And in +some cases a second bleeding was necessary, and a mild cathartic or two +with four grains of calomel; with mucilaginous subacid diluents; and warm +steam occasionally to alleviate the cough, finished the cure. + +The catarrhus contagiosus is a frequent disease amongst horses and dogs; it +seems first to be disseminated amongst these animals by miasmata diffused +in the atmosphere, because so many of them receive it at the same time; and +afterwards to be communicable from one horse or dog to another by +contagion, as above described. These epidemic or contagious catarrhs more +frequently occur amongst dogs and horses than amongst men; which is +probably owing to the greater extension and sensibility of the mucous +membrane, which covers the organ of smell, and is diffused over their wide +nostrils, and their large maxillary and frontal cavities. And to this +circumstance may be ascribed the greater fatality of it to these animals. + +In respect to horses, I suspect the fever at the beginning to be of the +sensitive, irritated, or inflammatory kind, because there is so great a +discharge of purulent mucus; and that therefore they will bear once +bleeding early in the disease; and also one mild purgative, consisting of +about half an ounce of aloe, and as much white hard soap, mixed together. +They should be turned out to grass both day and night for the benefit of +pure air, unless the weather be too cold (and in that case they should be +kept in an open airy stable, without being tied), that they may hang down +their heads to facilitate the discharge of the mucus from their nostrils. +Grass should be offered them, or other fresh vegetables, as carrots and +potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or +cold water frequently in a day. When symptoms of debility appear, which may +be known by the coldness of the ears or other extremities, or when sloughs +can be seen on the membrane which lines the nostrils, a drink consisting of +a pint of ale with half an ounce of tincture of opium in it, given every +six hours, is likely to be of great utility. + +In dogs I believe the catarrh is generally joined with symptoms of debility +early in the disease. These animals should be permitted to go about in the +open air, and should have constant access to fresh water. The use of being +as much as may be in the air is evident, because all the air which they +breathe passes twice over the putrid sloughs of the mortified parts of the +membrane which lines the nostrils, and the maxillary and frontal cavities; +that is, both during inspiration and expiration; and must therefore be +loaded with contagious particles. Fresh new milk, and fresh broth, should +be given them very frequently, and they should be suffered to go amongst +the grass, which they sometimes eat for the purpose of an emetic; and if +possible should have access to a running stream of water. As the contagious +mucus of the nostrils, both of these animals and of horses, generally drops +into the water they attempt to drink. Bits of raw flesh, if the dog will +eat them, are preferred to cooked meat; and from five to ten drops of +tincture of opium may be given with advantage, when symptoms of debility +are evident, according to the size of the dog, every six hours. If sloughs +can be seen in the nostrils, they should be moistened twice a day, both in +horses and dogs, with a solution of sugar of lead, or of alum, by means of +a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be +made by dissolving half an ounce of sugar of lead in a pint of water. + +Ancient philosophers seem to have believed, that the contagious miasmata in +their warm climates affected horses and dogs previous to mankind. If those +contagious particles were supposed to be diffused amongst the heavy +inflammable air, or carbonated hydrogen, of putrid marshes, as these +animals hold their heads down lower to the ground, they may be supposed to +have received them sooner than men. And though men and quadrupeds might +receive a disease from the same source of marsh-putrefaction, they might +not afterwards be able to infect each other, though they might infect other +animals of the same genus; as the new contagious matter generated in their +own bodies might not be precisely similar to that received; as happened in +the jail-fever at Oxford, where those who took the contagion and died, did +not infect others. + + On mules and dogs the infection first began, + And, last, the vengeful arrows fix'd on man. + POPE'S Homer's Iliad, I. + +7. _Peripneumonia superficialis._ The superficial or spurious peripneumony +consists in an inflammation of the membrane, which lines the bronchia, and +bears the same analogy to the true peripneumony, as the inflammations of +other membranes do to that of the parenchyma, or substantial parts of the +viscus, which they surround. It affects elderly people, and frequently +occasions their death; and exists at the end of the true peripneumony, or +along with it; when the lancet has not been used sufficiently to cure by +reabsorbing the inflamed parts, or what is termed by resolution. + +M. M. Diluents, mucilage, antimonials, warmish air constantly changed, +venesection once, perhaps twice, if the pulse will bear it. Oily volatile +draughts. Balsams? Neutral salts increase the tendency to cough. Blisters +in succession about the chest. Warm bath. Mild purgatives. Very weak +chicken broth without salt in it. Boiled onions. One grain of calomel every +night for a week. From five drops to ten of tincture of opium at six every +night, when the patient becomes weak. Digitalis? See Class II. 1. 6. 7. + +8. _Pertussis._ Tussis convulsiva. Chin-cough resembles peripneumonia +superficialis in its consisting in an inflammation of the membrane which +lines the air-vessels of the lungs; but differs in the circumstance of its +being contagious; and is on that account of very long duration; as the +whole of the lungs are probably not infected at the same time, but the +contagious inflammation continues gradually to creep on the membrane. It +may in this respect be compared to the ulcers in the pulmonary consumption; +but it differs in this, that in chin-cough some branches of the bronchia +heal, as others become inflamed. + +This complaint is not usually classed amongst febrile disorders, but a +sensitive fever may generally be perceived to attend it during some part of +the day, especially in weak patients. And a peripneumony very frequently +supervenes, and destroys great numbers of children, except the lancet or +four or six leeches be immediately and repeatedly used. When the child has +permanent difficulty of breathing, which continues between the coughing +fits: unless blood be taken from it, it dies in two, three, or four days of +the inflammation of the lungs. During this permanent difficulty of +breathing the hooping-cough abates, or quite ceases, and returns again +after once or twice bleeding; which is then a good symptom, as the child +now possessing the power to cough shews the difficulty of breathing to be +abated. I dwell longer upon this, because many lose their lives from the +difficulty there is in bleeding young children; where the apothecary is old +or clumsy, or is not furnished with a very sharp and fine-pointed lancet. +In this distressing situation the application of four leeches to one of the +child's legs, the wounds made by which should continue to bleed an hour or +two, is a succedaneum; and saves the patient, if repeated once or twice +according to the difficulty of the respiration. + +The chin-cough seems to resemble the gonorrhoea venerea in several +circumstances. They are both received by infection, are both diseases of +the mucous membrane, are both generally cured in four or six weeks without +medicine. If ulcers in the cellular membrane under the mucous membrane +occur, they are of a phagedenic kind, and destroy the patient in both +diseases, if no medicine be administered. + +Hence the cure should be similar in both these diseases; first general +evacuations and diluents, then, after a week or two, I have believed the +following pills of great advantage. The dose for a child of about three +years old was one sixth part of a grain of calomel, one sixth part of a +grain of opium, and two grains of rhubarb, to be taken twice a day. + +The opium promotes absorption from the mucous membrane, and hence +contributes to heal it. The mercury prevents ulcers from being formed under +the mucous membrane, or cures them, as in the lues venerea; and the rhubarb +is necessary to keep the bowels open. + +M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air. +Tincture of cantharides, or repeated blisters; afterwards opiates in small +doses, and the bark. Warm bath frequently used. The steam of warm water +with a little vinegar in it may be inhaled twice a day. Could the breathing +of carbonic acid gas mixed with atmospheric air be of service? Copious +venesection, when a difficulty of breathing continues between the fits of +coughing; otherwise the cough and the expectoration cease, and the patient +is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis +pulmonalis in a few weeks terminates in death. Where the cough continues +after some weeks without much of the hooping, and a sensitive fever daily +supervenes, so as to resemble hectic fever from ulcers of the lungs; change +of air for a week or fortnight acts as a charm, and restores the patient +beyond the hopes of the physician. + +Young children should lie with their heads and shoulders raised; and should +be constantly watched day and night; that when the cough occurs, they may +be held up easily, so as to stand upon their feet bending a little +forwards; or nicely supported in that posture which they seem to put +themselves into. A bow of whalebone, about the size of the bow of a key, is +very useful to extract the phlegm out of the mouths of infants at the time +of their coughing; as an handkerchief, if applied at the time of their +quick inspirations after long holding their breath, is dangerous, and may +suffocate the patient in an instant, as I believe has sometimes happened. + +9. _Variola discreta._ The small-pox is well divided by Sydenham into +distinct and confluent. The former consists of distinct pustules, which +appear on the fourth day of the fever, are circumscribed and turgid; the +fever ceasing when the eruption is complete. Head-ach, pain in the loins, +vomiting frequently, and convulsive fits sometimes, precede the eruption. + +The distinct small-pox is attended with sensitive fever only, when very +mild, as in most inoculated patients; or with sensitive irritated fever, +when the disease is greater: the danger in this kind of small-pox is owing +either to the tumor and soreness of the throat about the height, or eighth +day of the eruption; or to the violence of the secondary fever. For, first, +as the natural disease is generally taken by particles of the dust of the +contagious matter dried and floating in the air, these are liable to be +arrested by the mucus about the throat and tonsils in their passage to the +lungs, or to the stomach, when they are previously mixed with saliva in the +mouth. Hence the throat inflames like the arm in inoculated patients; and +this increasing, as the disease advances, destroys the patient about the +height. + +Secondly, all those upon the face and head come out about the same time, +namely, about one day before those on the hands, and two before those in +the trunk; and thence, when the head is very full, a danger arises from the +secondary fever, which is a purulent, not a variolous fever; for as the +matter from all these of the face and head is reabsorbed at the same time, +the patient is destroyed by the violence of this purulent fever; which in +the distinct small-pox can only be abated by venesection and cathartics; +but in the confluent small-pox requires cordials and opiates, as it is +attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10. + +When the pustules on the face recede, the face swells; and when those of +the hands recede, the hands swell; and the same of the feet in succession. +These swellings seem to be owing to the absorption of variolous matter, +which by its stimulus excites the cutaneous vessels to secrete more lymph, +or serum, or mucus, exactly as happens by the stimulus of a blister. Now, +as a blister sometimes produces strangury many hours after it has risen; it +is plain, that a part of the cantharides is absorbed, and carried to the +neck of the bladder; whether it enters the circulation, or is carried +thither by retrograde movements of the urinary branch of lymphatics; and by +parity of reasoning the variolous matter is absorbed, and swells the face +and hands by its stimulus. + +_Variola confluens._ The confluent small-pox consists of numerous pustules, +which appear on the third day of the fever, flow together, are irregularly +circumscribed, flaccid, and little elevated; the fever continuing after the +eruption is complete; convulsions do not precede this kind of small-pox, +and are so far to be esteemed a favourable symptom. + +The confluent small-pox is attended with sensitive inirritated fever, or +inflammation with arterial debility; whence the danger of this disease is +owing to the general tendency to gangrene, with petechiae, or purple spots, +and haemorrhages; besides the two sources of danger from the tumor of the +throat about the height, or eleventh day of the eruption, and the purulent +fever after that time; which are generally much more to be dreaded in this +than in the distinct small-pox described above. + +M. M. The method of treatment must vary with the degree and kind of fever. +Venesection may be used in the distinct small-pox early in the disease, +according to the strength or hardness of the pulse; and perhaps on the +first day of the confluent small-pox, and even of the plague, before the +sensorial power is exhausted by the violence of the arterial action? Cold +air, and even washing or bathing in cold water, is a powerful means in +perhaps all eruptive diseases attended with fever; as the quantity of +eruption depends on the quantity of the fever, and the activity of the +cutaneous vessels; which may be judged of by the heat produced on the skin; +and which latter is immediately abated by exposure to external cold. +Mercurial purges, as three grains of calomel repeated every day during the +eruptive fever, so as to induce three or four stools, contribute to abate +inflammation; and is believed by some to have a specific effect on the +variolous, as it is supposed to have on the venereal contagion. + +It has been said, that opening the pock and taking out the matter has not +abated the secondary fever; but as I had conceived, that the pits, or marks +left after the small-pox, were owing to the acrimony of the matter beneath +the hard scabs, which not being able to exhale eroded the skin, and +produced ulcers, I directed the faces of two patients in the confluent +small-pox to be covered with cerate early in the disease, which was daily +renewed; and I was induced to think, that they had much less of the +secondary fever, and were so little marked, that one of them, who was a +young lady, almost entirely preserved her beauty. Perhaps mercurial +plasters, or cerates, made without turpentine in them, might have been more +efficacious, in preventing the marks, and especially if applied early in +the disease, even on the first day of the eruption, and renewed daily. For +it appears from the experiments of Van Woensel, that calomel or sublimate +corrosive, triturated with variolous matter, incapacitates it from giving +the disease by inoculation. Calomel or sublimate given as an alterative for +ten days before inoculation, and till the eruptive fever commences, is said +with certainty to render the disease mild by the same author. Exper. on +Mercury by Van Woensel, translated by Dr. Fowle, Salisbury. + +_Variola inoculata._ The world is much indebted to the great discoverer of +the good effects of inoculation, whose name is unknown; and our own country +to Lady Wortley Montague for its introduction into this part of Europe. By +inserting the variolous contagion into the arm, it is not received by the +tonsils, as generally happens, I suppose, in the natural small-pox; whence +there is no dangerous swelling of the throat, and as the pustules are +generally few and distinct, there is seldom any secondary fever; whence +those two sources of danger are precluded; hence when the throat in +inoculated small-pox is much inflamed and swelled, there is reason to +believe, that the disease had been previously taken by the tonsils in the +natural way.--Which also, I suppose, has generally happened, where the +confluent kind of small-pox has occurred on inoculation. + +I have known two instances, and have heard of others, where the natural +small-pox began fourteen days after the contagion had been received; one of +these instances was of a countryman, who went to a market town many miles +from his home, where he saw a person in the small-pox, and on returning the +fever commenced that day fortnight: the other was of a child, whom the +ignorant mother carried to another child ill of the small-pox, on purpose +to communicate the disease to it; and the variolous fever began on the +fourteenth day from that time. So that in both these cases fever commenced +in half a lunation after the contagion was received. In the inoculated +small-pox the fever generally commences on the seventh day, or after a +quarter of a lunation; and on this circumstance probably depends the +greater mildness of the latter. The reason of which is difficult to +comprehend; but supposing the facts to be generally as above related, the +slower progress of the contagion indicates a greater inirritability of the +system, and in consequence a tendency to malignant rather than to +inflammatory fever. This difference of the time between the reception of +the infection and the fever in the natural and artificial small-pox may +nevertheless depend on its being inserted into a different series of +vessels; or to some unknown effect of lunar periods. It is a subject of +great curiosity, and deserves further investigation. + +When the inoculated small-pox is given under all the most favourable +circumstances I believe less than one in a thousand miscarry, which may be +ascribed to some unavoidable accident, such as the patient having +previously received the infection, or being about to be ill of some other +disease. Those which have lately miscarried under inoculation, as far as +has come to my knowledge, have been chiefly children at the breast; for in +these the habit of living in the air has been confirmed by so short a time, +that it is much easier destroyed, than when these habits of life have been +established by more frequent repetition. See Sect. XVII. 3. Thus it appears +from the bills of mortality kept in the great cities of London, Paris, and +Vienna, that out of every thousand children above three hundred and fifty +die under two years old. (Kirkpatrick on Inoculation.) Whence a strong +reason against our hazarding inoculation before that age is passed, +especially in crowded towns; except where the vicinity of the natural +contagion renders it necessary, or the convenience of inoculating a whole +family at a time; as it then becomes better to venture the less favourable +circumstances of the age of the patient, or the chance of the pain from +toothing, than to risk the infection in the natural way. + +The most favourable method consists in, first, for a week before +inoculation, restraining the patients from all kinds of fermented or +spirituous liquor, and from animal food; and by giving them from one grain +to three or four of calomel every other day for three times. But if the +patients be in any the least danger of taking the natural infection, the +inoculation had better be immediately performed, and this abstinence then +began; and two or three gentle purges with calomel should be given, one +immediately, and on alternate days. These cathartics should not induce more +than two or three stools. I have seen two instances of a confluent +small-pox in inoculation following a violent purging induced by too large a +dose of calomel. + +Secondly, the matter used for inoculation should be in a small quantity, +and warm, and fluid. Hence it is best when it can be recently taken from a +patient in the disease; or otherwise it may be diluted with part of a drop +of warm water, since its fluidity is likely to occasion its immediate +absorption; and the wound should be made as small and superficial as +possible, as otherwise ulcers have been supposed sometimes to ensue with +subaxillary abscesses. Add to this, that the making two punctures either on +the same, or one on each arm, secures the success of the operation in +respect to communicating the infection. + +Thirdly, at the time of the fever or eruption the application of cool air +to those parts of the skin, which are too warm, or appear red, or are +covered with what is termed a rash, should be used freely, as well as +during the whole disease. And at the same time, if the feet or hands are +colder than natural, these should be covered with flannel. See Class IV. 2. +2. 10. + +10. _Rubeola irritata, morbilli._ The measles commence with sneezing, red +eyes, dry hoarse cough, and is attended with sensitive irritated fever. On +the fourth day, or a little later, small thick eruptions appear, scarcely +eminent above the skin, and, after three days, changing into very small +branny scales. + +As the contagious material of the small-pox may be supposed to be diffused +in the air like a fine dry powder, and mixing with the saliva in the mouth +to infect the tonsils in its passage to the stomach; so the contagious +material of the measles may be supposed to be more completely dissolved in +the air, and thus to impart its poison to the membrane of the nostrils, +which covers the sense of smell; whence a catarrh with sneezing ushers in +the fever; the termination of the nasal duct of the lacrymal sac is subject +to the same stimulus and inflammation, and affects by sympathy the lacrymal +glands, occasioning a great flow of tears. See Sect. XVI. 8. And the +redness of the eye and eyelids is produced in consequence of the tears +being in so great quantity, that the saline part of them is not entirely +reabsorbed. See Sect. XXIV. 2. 8. + +The contagion of the measles, if it be taken a sufficient time before +inoculation, so that the eruption may commence before the variolous fever +comes on, stops the progress of the small-pox in the inoculated wound, and +delays it till the measle-fever has finished its career. See Sect. XXXIII. +2. 9. + +The measles are usually attended with inflammatory fever with strong pulse, +and bear the lancet in every stage of the disease. In the early periods of +it, venesection renders the fever and cough less; and, if any symptoms of +peripneumony occur, is repeatedly necessary; and at the decline of the +disease, if a cough be left after the eruption has ceased, and the +subsequent branny scales are falling off, venesection should be immediately +used; which prevents the danger of consumption. At this time also change of +air is of material consequence, and often removes the cough like a charm, +as mentioned in a similar situation at the end of the chin-cough. + +_Rubeola inirritata._ Measles with inirritated fever, or with weak pulse, +has been spoken of by some writers. See London Med. Observ. Vol. IV. Art. +XI. It has also been said to have been attended with sore throat. Edinb. +Essays, Vol. V. Art. II. Could the scarlet fever have been mistaken for the +measles? or might one of them have succeeded the other, as in the measles +and small-pox mentioned in Sect. XXXIII. 2. 9.? + +From what has been said, it is probable that inoculation might disarm the +measles as much as the small-pox, by preventing the catarrh, and frequent +pulmonary inflammation, which attends this disease; both of which are +probably the consequence of the immediate application of the contagious +miasmata to these membranes. Some attempts have been made, but a difficulty +seems to arise in giving the disease; the blood, I conjecture, would not +infect, nor the tears; perhaps the mucous discharge from the nostrils might +succeed; or a drop of warm water put on the eruptions, and scraped off +again with the edge of a lancet; or if the branny scales were collected, +and moistened with a little warm water? Further experiments on this subject +would be worthy the public attention. + +11. _Scarlatina mitis._ The scarlet fever exists with all degrees of +virulence, from a flea-bite to the plague. The infectious material of this +disease, like that of the small-pox, I suppose to be diffused, not +dissolved, in the air; on which account I suspect, that it requires a much +nearer approach to the sick, for a well person to receive the infection, +than in the measles; the contagion of which I believe to be more volatile, +or diffusible in the atmosphere. But as the contagious miasmata of +small-pox and scarlet fever are supposed to be more fixed, they may remain +for a longer time in clothes or furniture; as a thread dipped in variolous +matter has given the disease by inoculation after having been exposed many +days to the air, and after having been kept many months in a phial. This +also accounts for the slow or sporadic progress of the scarlet fever, as it +infects others at but a very small distance from the sick; and does not +produce a quantity of pus-like matter, like the small-pox, which can adhere +to the clothes of the attendants, and when dried is liable to be shook off +in the form of powder, and thus propagate the infection. + +This contagious powder of the small-pox, and of the scarlet fever, becomes +mixed with saliva in the mouth, and is thus carried to the tonsils, the +mucus of which arrests some particles of this deleterious material; while +other parts of it are carried into the stomach, and are probably decomposed +by the power of digestion; as seems to happen to the venom of the viper, +when taken into the stomach. Our perception of bad tastes in our mouths, at +the same time that we perceive disagreeable odours to our nostrils, when we +inhale very bad air, occasions us to spit out our saliva; and thus, in some +instances, to preserve ourselves from infection. This has been supposed to +originate from the sympathy between the organs of taste and smell; but any +one who goes into a sick room close shut up, or into a crowded +assembly-room, or tea-room, which is not sufficiently ventilated, may +easily mix the bad air with the saliva on his tongue so as to taste it; as +I have myself frequently attended to. + +Hence it appears that these heavy infectious matters are more liable to mix +with the saliva, and inflame the tonsils, and that either before or at the +commencement of the fever; and this is what generally happens in the +scarlet fever, always I suppose in the malignant kind, and very frequently +in the mild kind. But as this infection may be taken by other means, as by +the skin, it also happens in the most mild kind, that there is no +inflammation of the tonsils at all; in the same manner as there is +generally no inflammation of the tonsils in the inoculated small-pox. + +In the mild scarlatina on the fourth day of the fever the face swells a +little, at the same time a florid redness appears on various parts of the +skin, in large blotches, at length coalescing, and after three days +changing into branny scales. + +M. M. Cool air. Fruit. Lemonade. Milk and water. + +_Scarlatina maligna._ The malignant scarlet fever begins with inflamed +tonsils; which are succeeded by dark drab coloured sloughs three or five +lines in diameter, flat, or beneath the surrounding surface; and which +conceal beneath them spreading gangrenous ulcers. The swellings of the +tonsils are sensible to the eye and touch externally, and have an elastic +rather than an oedematous feel, like parts in the vicinity of gangrenes. +The pulse is very quick and weak, with delirium, and the patient generally +dies in a few days; or if he recovers, it is by slow degrees, and attended +with anasarca. + +M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated +doses. Small successive blisters, if the extremities are cooler than +natural. Cool air on the hot parts of the skin, the cool extremities being +at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies. +Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the +contagious matter, and then with a sponge filled with vinegar, with or +without sugar of lead dissolved in it, about six grains to an ounce; or +with a very little blue vitriol dissolved in it, as a grain to an ounce; +but nothing so instantaneously corrects the putrid smell of ulcers as a +solution of alum; about half an ounce to a pint of water, which should be a +little warmish, and injected into the fauces gently by means of a syringe. +These should be repeated frequently in a day, if it can be done easily, and +without fatigue to the child. A little powder of bark taken frequently into +the mouth, as a grain or two, that it may mix with the saliva, and thus +frequently stimulate the dying tonsils. Could a warm bath made of decoction +of bark, or a cold fomentation with it, be of service? Could oxygene gas +mixed with common air stimulate the languid system? Small electric shocks +through the tonsils every hour? ether frequently applied externally to the +swelled tonsils? + +As this disease is attended with the greatest degree of debility, and as +stimulant medicines, if given in quantity, so as to produce more than +natural warmth, contribute to expend the already too much exhausted +sensorial power; it appears, that there is nothing so necessary to be +nicely attended to, as to prevent any unnecessary motions of the system; +this is best accomplished by the application of cold to those parts of the +skin, which are in the least too hot. And secondly, that the exhibition of +the bark in such quantity, as not to oppress the stomach and injure +digestion, is next to be attended to, as not being liable to increase the +actions of the system beyond their natural quantity; and that opium and +wine should be given with the greatest caution, in very small repeated +quantity, and so managed as to prevent, if possible, the cold fits of +fever; which probably occur twice in 25 hours, obeying the lunations like +the tides, as mentioned in Sect. XXXII. 6. that is, I suppose, the cold +periods, and consequent exacerbations of fever, in this malignant +scarlatina, occur twice in a lunar day; which is about ten minutes less +than 25 hours; so that if the commencement of one cold fit be marked, the +commencement of the next may be expected, if not disturbed by the +exhibition of wine or opium, or the application of blisters, to occur in +about twelve hours and a half from the commencement of the former; or if +not prevented by large doses of the bark. + +No one could do an act more beneficial to society, or glorious to himself, +than by teaching mankind how to inoculate this fatal disease; and thus to +deprive it of its malignity. Matter might be taken from the ulcers in the +throat, which would probably convey the contagion. Or warm water might be +put on the eruption, and scraped off again by the edge of a lancet. These +experiments could be attended with no danger, and should be tried for the +public benefit, and the honour of medical science. + +12. _Miliaria._ Miliary fever. An eruption produced by the warmth, and more +particularly by the stimulus of the points of the wool in flannel or +blankets applied to the skin, has been frequently observed; which, by cool +dress, and bed-clothes without flannel, has soon ceased. See Class I. 1. 2. +3. This, which maybe called _miliaria sudatoria_, has been confounded with +other miliary fevers, and has made the existence of the latter doubted. Two +kinds of eruptions I have seen formerly attended with fever, but did not +sufficiently mark their progress, which I conceived to be miliary +eruptions, one with arterial strength, or with sensitive irritated fever, +and the other with arterial debility, or with sensitive inirritated fever. + +In the former of these, or _miliaria irritata_, the eruptions were distinct +and larger than the small-pox, and the fever was not subdued without two or +three venesections, and repeated cathartics with calomel. + +The latter, or _miliaria inirritata_, was attended with great arterial +debility; and during the course of the fever pellucid points appeared +within the skin, particularly on the soft parts of the fingers. And, in one +patient, whom I esteemed near her end, I well recollect to have observed +round pellucid globules, like what are often seen on vines in hot-houses, +no larger than the smallest pins' heads, adhere to her neck and bosom; +which were hard to the touch, but were easily rubbed off. These diseases, +if they are allied, do not differ more than the kinds of small-pox; but +require many further observations. + +The eruption so often seen on children in the cradle, and called by the +nurses red-gum, and which is attended with some degree of fever, I suspect +to be produced by too great warmth, and the contact of flannel next their +tender skins, like the miliaria sudatoria; and like that requires cool air, +cool clothes, and linen next their skin. + +13. _Pestis._ The plague, like other diseases of this class, seems to be +sometimes mild, and sometimes malignant; according to the testimony of +different writers. It is said to be attended with inflammation, with the +greatest arterial debility, and to be very contagious, attended at an +uncertain time of the fever with buboes and carbuncles. Some authors +affirm, that the contagion of the plague may be repeatedly received, so as +to produce the disease; but as this is contrary to the general analogy of +all contagious diseases, which are attended with fever, and which cure +themselves spontaneously; there is reason to suspect, that where it has +been supposed to have been repeatedly received, that some other fever with +arterial debility has been mistaken for it, as has probably universally +been the case, when the small-pox has been said to have been twice +experienced. + +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 +Section XXXVI. 2. 3. + +M. M. Opium a grain every night. Chalybeates in very small doses. Bark. +Sea-bathing. + +5. _Insensibilitas artuum._ As in some paralytic limbs. A great +insensibility sometimes accompanies the torpor of the skin in cold fits of +agues. Some parts have retained the sense of heat, but not the sense of +touch. See Sect. XVI. 6. + +M. M. Friction with flannel. A blister. Warmth. + +6. _Dysuria insensitiva._ Insensibility of the bladder. A difficulty or +total inability to make water attends some fevers with great debility, +owing to the insensibility or inirritability of the bladder. This is a +dangerous but not always a fatal symptom. + +M. M. Draw off the water with a catheter. Assist the patient in the +exclusion of it by compressing the lower parts of the abdomen with the +hands. Wine two ounces, Peruvian bark one dram in decoction, every three +hours alternately. Balsam of copaiva. Oil of almonds, with as much camphor +as can be dissolved in it, applied as a liniment rubbed on the region of +the bladder and perinaeum, and repeated every four hours, was used in this +disease with success by Mr. Latham. Med. Comment. 1791, p. 213. + +7. _Accumulatio alvina._ An accumulation of feces in the rectum, occasioned +by the torpor, or insensibility, of that bowel. But as liquids pass by +these accumulations, it differs from the constipatio alvi, which is owing +to too great absorption of the alimentary canal. + +Old milk, and especially when boiled, is liable to induce this kind of +costiveness in some grown persons; which is probably owing to their not +possessing sufficient gastric acid to curdle and digest it; for as both +these processes require gastric acid, it follows, that a greater quantity +of it is necessary, than in the digestion of other aliments, which do not +previously require being curdled. This ill digested milk not sufficiently +stimulating the rectum, remains till it becomes a too solid mass. On this +account milk seldom agrees with those, who are subject to piles, by +inducing costiveness and large stools. + +M. M. Extract the hardened scybala by means of a marrow-spoon; or by a +piece of wire, or of whale-bone bent into a bow, and introduced. Injections +of oil. Castor oil, or oil of almonds, taken by the mouth. A large clyster +of smoak of tobacco. Six grains of rhubarb taken every night for many +months. Aloes. An endeavour to establish a habit of evacuation at a certain +hour daily. See Class I. 1. 3. 5. + + * * * * * + +ORDO III. + +_Retrograde Sensitive Motions._ + +GENUS I. + +_Of Excretory Ducts._ + +The retrograde action of the oesophagus in ruminating animals, when they +bring up the food from their first stomach for the purpose of a second +mastication of it, may probably be caused by agreeable sensation; similar +to that which induces them to swallow it both before and after this second +mastication; and then this retrograde action, properly belongs to this +place, and is erroneously put at the head of the order of irritative +retrograde motions. Class I. 3. 1. 1. + +SPECIES. + +1. _Ureterum motus retrogressus._ When a stone has advanced into the ureter +from the pelvis of the kidney, it is sometimes liable to be returned by the +retrograde motion of that canal, and the patient obtains fallacious ease, +till the stone is again pushed into the ureter. + +2. _Urethrae motus retrogressus._ There have been instances of bougies +being carried up the urethra into the bladder most probably by an inverted +motion of this canal; for which some have undergone an operation similar to +that for the extraction of a stone. A case is related in some medical +publication, in which a catgut bougie was carried into the bladder, and +after remaining many weeks, was voided piece-meal in a semi-dissolved +state. Another case is related of a French officer, who used a leaden +bougie; which at length found its way into the bladder, and was, by +injecting crude mercury, amalgamated and voided. + +In the same manner the infection from a simple gonorrhoea is probably +carried further along the course of the urethra; and small stones +frequently descend some way into the urethra, and are again carried up into +the bladder by the inverted action of this canal. + +3. _Ductus choledochi motus retrogressus._ The concretions of bile, called +gall-stones, frequently enter the bile-duct, and give violent pain for some +hours; and return again into the gall-bladder, by the retrograde action of +this duct. May not oil be carried up this duct, when a gall-stone gives +great pain, by its retrograde spasmodic action? See Class I. 1. 3. 8. + +M. M. Opium a grain and half. + + * * * * * + + +_The Orders and Genera of the Third Class of Diseases._ + + * * * * * + +CLASS III. + +DISEASES OF VOLITION. + +ORDO I. + +_Increased Volition._ + +GENERA. + + 1. With increased actions of the muscles. + 2. With increased actions of the organs of sense. + +ORDO II. + +_Decreased Volition._ + +GENERA. + + 1. With decreased actions of the muscles. + 2. With decreased actions of the organs of sense. + + * * * * * + +_The Orders, Genera, and Species, of the Third Class of Diseases._ + + * * * * * + +CLASS III. + +DISEASES OF VOLITION. + +ORDO I. + +_Increased Volition._ + +GENUS I. + +_With Increased Actions of the Muscles._ + +SPECIES. + + 1. _Jactitatio._ Restlessness. + 2. _Tremor febrilis._ Febrile trembling. + 3. _Clamor._ Screaming. + 4. _Risus._ Laughter. + 5. _Convulsio._ Convulsion. + ---- _debilis._ ---- weak. + 6. ---- _dolorifica._ ---- painful. + 7. _Epilepsia._ Epilepsy. + 8. ---- _dolorifica._ ---- painful. + 9. _Somnambulismus._ Sleep-walking. + 10. _Asthma convulsivum._ Asthma convulsive. + 11. ---- _dolorificum._ ---- painful. + 12. _Stridor dentium._ Gnashing of the teeth. + 13. _Tetanus trismus._ Cramp of the jaw. + 14. ---- _dolorificus._ ---- painful. + 15. _Hydrophobia._ Dread of water. + +GENUS II. + +_With increased Actions of the Organs of Sense._ + +SPECIES. + + 1. _Mania mutabilis._ Mutable madness. + 2. _Studium inane._ Reverie. + 3. _Vigilia._ Watchfulness. + 4. _Erotomania._ Sentimental love. + 5. _Amor sui._ Vanity. + 6. _Nostalgia._ Desire of home. + 7. _Spes religiosa._ Superstitious hope. + 8. _Superbia stemmatis._ Pride of family. + 9. _Ambitio._ Ambition. + 10. _Maeror._ Grief. + 11. _Taedium vitae._ Irksomeness of life. + 12. _Desiderium pulchritudinis._ Loss of beauty. + 13. _Paupertatis timor._ Fear of poverty. + 14. _Lethi timor._ ---- of death. + 15. _Orci timor._ ---- of hell. + 16. _Satyriasis._ Lust. + 17. _Ira._ Anger. + 18. _Rabies._ Rage. + 19. _Citta._ Depraved appetite. + 20. _Cacositia._ Aversion to food. + 21. _Syphilis imaginaria._ Imaginary pox. + 22. _Psora imaginaria._ ---- itch. + 23. _Tabes imaginaria._ ---- tabes. + 24. _Sympathia aliena._ Pity. + 25. _Educatio heroica._ Heroic education. + +ORDO II. + +_Decreased Volition._ + +GENUS I. + +_With decreased Actions of the Muscles._ + +SPECIES. + + 1. _Lassitudo._ Fatigue. + 2. _Vacillatio senilis._ See-saw of old age. + 3. _Tremor senilis._ Tremor of old age. + 4. _Brachiorum paralysis._ Palsy of the arms. + 5. _Raucedo paralytica._ Paralytic hoarseness. + 6. _Vesicae urinariae paralysis._ Palsy of the bladder. + 7. _Recti paralysis._ Palsy of the rectum. + 8. _Paresis voluntaria._ Voluntary debility. + 9. _Catalepsis._ Catalepsy. + 10. _Hemiplegia._ Palsy of one side. + 11. _Paraplegia._ Palsy of the lower limbs. + 12. _Somnus._ Sleep. + 13. _Incubus._ Night-mare. + 14. _Lethargus._ Lethargy. + 15. _Syncope epileptica._ Epileptic fainting. + 16. _Apoplexia._ Apoplexy. + 17. _Mors a frigore._ Death from cold. + +GENUS II. + +_With decreased Actions of the Organs of Sense._ + +SPECIES. + + 1. _Recollectionis jactura._ Loss of recollection. + 2. _Stultitia voluntaria._ Voluntary folly. + 3. _Credulitas._ Credulity. + + * * * * * + +CLASS III. + +DISEASES OF VOLITION. + +ORDO I. + +_Increased Volition._ + +GENUS I. + +_Increased Actions of the Muscles._ + +We now step forward to consider the diseases of volition, that superior +faculty of the sensorium, which gives us the power of reason, and by its +facility of action distinguishes mankind from brute animals; which has +effected all that is great in the world, and superimposed the works of art +on the situations of nature. + +Pain is introduced into the system either by excess or defect of the action +of the part. (Sect. IV. 5.) Both which circumstances seem to originate from +the accumulation of sensorial power in the affected organ. Thus when the +skin is exposed to great cold, the activity of the cutaneous vessels is +diminished, and in consequence an accumulation of sensorial power obtains +in them, because they are usually excited into incessant motion by the +stimulus of heat, as explained in Sect. XII. 5. 2. Contrarywise, when the +vessels of the skin are exposed to great heat, an excess of sensorial power +is also produced in them, which is derived thither by the increase of +stimulus above what is natural. + +This accounts for the relief which is received in all kinds of pain by any +violent exertions of our muscles or organs of sense; which may thus be in +part ascribed to the exhaustion of the sensorial power by such exertions. +But this relief is in many cases so instantaneous, that it seems +nevertheless probable, that it is also in part owing to the different +manner of progression of the two sensorial powers of sensation and +volition; one of them commencing at some extremity of the sensorium, and +being propagated towards the central parts of it; and the other commencing +in the central parts of the sensorium, and being propagated towards the +extremities of it; as mentioned in Sect. XI. 2. 1. + +These violent voluntary exertions of our muscles or ideas to relieve the +sensation of pain constitute convulsions and madness; and are distinguished +from the muscular actions owing to increased sensation, as in sneezing, or +coughing, or parturition, or ejectio feminis, because they do not +contribute to dislodge the cause, but only to prevent the sensation of it. +In two cases of parturition, both of young women with their first child, I +have seen general convulsions occur from excess of voluntary exertion, as +above described, instead of the actions of particular muscles, which ought +to have been excited by sensation for the exclusion of the fetus. They both +became insensible, and died after some hours; from one of them the fetus +was extracted in vain. I have heard also of general convulsions being +excited instead of the actions of the musculi acceleratores in the ejectio +feminis, which terminated fatally. See Class III. 1. 1. 7. + +These violent exertions are most frequently excited in consequence of those +pains, which originate from defect of the action of the part. See Sect. +XXXIV. 1. and 2. The pains from excess and defect of the action of the part +are distinguishable from each other by the former being attended with +increase of heat in the pained part, or of the whole body; while the latter +not only exist without increase of heat in the pained part, but are +generally attended with coldness of the extremities of the body. + +As soon as these violent actions of our muscular or sensual fibres for the +purpose of relieving pain cease to be exerted, the pain recurs; whence the +reciprocal contraction and relaxation of the muscles in convulsion, and the +intervals of madness. Otherwise these violent exertions continue, till so +great a part of the sensorial power is exhausted, that no more of it is +excitable by the faculty of volition; and a temporary apoplexy succeeds, +with snoring as in profound sleep; which so generally terminates epileptic +fits. + +When these voluntary exertions become so connected with certain +disagreeable sensations, or with irritations, that the effort of the will +cannot restrain them, they can no longer in common language be termed +voluntary; but nevertheless belong to this class, as they are produced by +excess of volition, and may still not improperly be called depraved +voluntary actions. See Sect. XXXIV. 1. where many motions in common +language termed involuntary are shewn to depend on excess of volition. + +When these exertions from excess of volition, which in common language are +termed involuntary motions, either of mind or body, are perpetually exerted +in weak constitutions, the pulse becomes quick; which is occasioned by the +too great expenditure of the sensorial power in these unceasing modes of +activity. In the same manner as in very weak people in fevers, the pulse +sometimes increases in frequency to 140 strokes in a minute, when the +patients stand up or endeavour to walk; and subsides to 110, when they lie +down again in their beds. Whence it appears, that when a very quick pulse +accompanies convulsion or insanity, it simply indicates the weakness of the +patient; that is, that the expenditure of sensorial power is too great for +the supply of it. But if the strength of the patient is not previously +exhausted, the exertions of the muscles are attended with temporary +increase of circulation, the reciprocal swellings and elongations of their +bellies push forwards the arterial blood, and promote the absorption of the +venous blood; whence a temporary increase of secretion and of heat, and a +stronger pulse. + +SPECIES. + +1. _Jactitatio._ Restlessness. There is one kind of restlessness attending +fevers, which consists in a frequent change of posture to relieve the +uneasiness of the pressure of one part of the body upon another, when the +sensibility of the system, or of some parts of it, is increased by +inflammation, as in the lumbago; which may sometimes be distinguished in +its early stage by the incessant desire of the patient to turn himself in +bed. But there is another restlessness, which approaches towards writhing +or contortions of the body, which is a voluntary effort to relieve pain; +and may be esteemed a slighter kind of convulsion, not totally +unrestrainable by opposite or counteracting volitions. + +M. M. A blister. Opium. Warm bath. + +2. _Tremor febrilis._ Reciprocal convulsions of the subcutaneous muscles, +originating from the pain of the sense of heat, owing to defect of its +usual stimulus, and consequent accumulation of sensorial power in it. The +actual deficiency of heat may exist in one part of the body, and the pain +of cold be felt most vividly in some other part associated with it by +sensitive sympathy. So a chillness down the back is first attended to in +ague-fits, though the disease perhaps commences with the torpor and +consequent coldness of some internal viscus. But in whatever part of the +system the defect of heat exists, or the sensation of it, the convulsions +of the subcutaneous muscles exerted to relieve it are very general; and, if +the pain is still greater, a chattering of the teeth is added, the more +suddenly to exhaust the sensorial power, and because the teeth are very +sensible to cold. + +These convulsive motions are nevertheless restrainable by violent voluntary +counteraction; and as their intervals are owing to the pain of cold being +for a time relieved by their exertion, they may be compared to laughter, +except that there is no interval of pleasure preceding each moment of pain +in this as in the latter. + +M. M. See I. 2. 2. 1. + +3. _Clamor._ Screaming from pain. The talkative animals, as dogs, and +swine, and children, scream most, when they are in pain, and even from +fear; as they have used this kind of exertion from their birth most +frequently and most forcibly; and can therefore sooner exhaust the +accumulation of sensorial power in the affected muscular or sensual organs +by this mode of exertion; as described in Sect. XXXIV. 1. 3. This facility +of relieving pain by screaming is the source of laughter, as explained +below. + +4. _Risus._ The pleasurable sensations, which occasion laughter, are +perpetually passing into the bounds of pain; for pleasure and pain are +often produced by different degrees of the same stimulus; as warmth, light, +aromatic or volatile odours, become painful by their excess; and the +tickling on the soles of the feet in children is a painful sensation at the +very time it produces laughter. When the pleasurable ideas, which excite us +to laugh, pass into pain, we use some exertion, as a scream, to relieve the +pain, but soon stop it again, as we are unwilling to lose the pleasure; and +thus we repeatedly begin to scream, and stop again alternately. So that in +laughing there are three stages, first of pleasure, then pain, then an +exertion to relieve that pain. See Sect. XXXIV. 1. 3. + +Every one has been in a situation, where some ludicrous circumstance has +excited him to laugh; and at the same time a sense of decorum has forbid +the exertion of these interrupted screams; and then the pain has become so +violent, as to occasion him to use some other great action, as biting his +tongue, and pinching himself, in lieu of the reiterated screams which +constitute laughter. + +5. _Convulsio._ Convulsion. When the pains from defect or excess of motion +are more distressing than those already described, and are not relievable +by such partial exertions, as in screaming, or laughter, more general +convulsions occur; which vary perhaps according to the situation of the +pained part, or to some previous associations formed by the early habits of +life. When these convulsive motions bend the body forwards, they are termed +emprosthotonoi; when they bend it backward, they are termed opisthotonoi. +They frequently succeed each other, but the opisthotonoi are generally more +violent; as the muscles, which erect the body, and keep it erect, are +naturally in more constant and more forcible action than their antagonists. + +The causes of convulsion are very numerous, as from toothing in children, +from worms or acidity in their bowels, from eruption of the distinct +small-pox, and lastly, from breathing too long the air of an unventilated +bed-room. Sir G. Baker, in the Transactions of the College, described this +disease, and detected its cause; where many children in an orphan-house +were crowded together in one chamber without a chimney, and were almost all +of them affected with convulsion; in the hospital at Dublin, many died of +convulsions before the real cause was understood. See Dr. Beddoes's Guide +to Self-preservation. In a large family, which I attended, where many +female servants slept in one room, which they had contrived to render +inaccessible to every blast of air; I saw four who were thus seized with +convulsions, and who were believed to have been affected by sympathy from +the first who fell ill. They were removed into more airy apartments, but +were some weeks before they all regained their perfect health. + +Convulsion is distinguished from epilepsy, as the patient does not intirely +lose all perception during the paroxysm. Which only shews, that a less +exhaustion of sensorial power renders tolerable the pains which cause +convulsion, than those which cause epilepsy. The hysteric convulsions are +distinguished from those, owing to other causes, by the presence of the +expectation of death, which precedes and succeeds them, and generally by a +flow of pale urine; these convulsions do not constantly attend the hysteric +disease, but are occasionally superinduced by the disagreeable sensation +arising from the torpor or inversion of a part of the alimentary canal. +Whence the convulsion of laughter is frequently sufficient to restrain +these hysteric pains, which accounts for the fits of laughter frequently +attendant on this disease. + +M. M. To remove the peculiar pain which excites the convulsions. +Venesection. An emetic. A cathartic with calomel. Warm-bath. Opium in large +quantities, beginning with smaller ones. Mercurial frictions. Electricity. +Cold-bath in the paroxysm; or cold aspersion. See Memoirs of Med. Society, +Lon. V. 3. p. 147. a paper by Dr. Currie. + +_Convulsio debilis._ The convulsions of dying animals, as of those which +are bleeding to death in the slaughter-house, are an effort to relieve +painful sensation, either of the wound which occasions their death, or of +faintness from want of due distention of the blood-vessels. Similar to this +in a less degree is the subsultus tendinum, or starting of the tendons, in +fevers with debility; these actions of the muscles are too weak to move the +limb, but the belly of the acting muscles is seen to swell, and the tendon +to be stretched. These weak convulsions, as they are occasioned by the +disagreeable sensation of faintness from inanition, are symptoms of great +general debility, and thence frequently precede the general convulsions of +the act of dying. See a case of convulsion of a muscle of the arm, and of +the fore-arm, without moving the bones to which they were attached, Sect. +XVII. 1. 8. See twitchings of the face, Class IV. 1. 3. 2. + +6. _Convulsio dolorifica._ Raphania. Painful convulsion. In this disease +the muscles of the arms and legs are exerted to relieve the pains left +after the rheumatism in young and delicate people; it recurs once or twice +a-day, and has been mistaken for the chorea, or St. Vitus's dance; but +differs from it, as the undue motions in that disease only occur, when the +patient endeavours to exert the natural ones; are not attended with pain; +and cease, when he lies down without trying to move: the chorea, or dance +of St. Vitus, is often introduced by the itch, this by the rheumatism. + +It has also been improperly called nervous rheumatism; but is distinguished +from rheumatism, as the pains recur by periods once or twice a day; whereas +in the chronic rheumatism they only occur on moving the affected muscles. +And by the warmth of a bed the pains of the chronic rheumatism are +increased, as the muscles or membranes then become more sensible to the +stimulus of the extraneous mucaginous material deposited under them. +Whereas the pains of the raphania, or painful convulsion, commence with +coldness of the part, or of the extremities. See Rheumatismus chronicus, +Class I. 1. 3. 12. + +The pains which accompany the contractions of the muscles in this disease, +seem to arise from the too great violence of those contractions, as happens +in the cramp of the calf of the leg; from which they differ in those being +fixed, and these being reiterated contractions. Thus these convulsions are +generally of the lower limbs, and recur at periodical times from some +uneasy sensation from defect of action, like other periodic diseases; and +the convulsions of the limbs relieve the original uneasy painful sensation, +and then produce a greater pain from their own too vehement contractions. +There is however another way of accounting for these pains, when they +succeed the acute rheumatism; and that is by the coagulable lymph, which +may be left still unabsorbed on the membranes; and which may be in too +small quantity to affect them with pain in common muscular exertions, but +may produce great pain, when the bellies of the muscles swell to a larger +bulk in violent action. + +M. M. Venesection. Calomel. Opium. Bark. One grain of calomel and one of +opium for ten successive nights. A bandage spread with emplastrum de minio +put tight on the affected part. + +7. _Epilepsia_ is originally induced, like other convulsions, by a +voluntary exertion to relieve some pain. This pain is most frequently about +the pit of the stomach, or termination of the bile-duct; and in some cases +the torpor of the stomach, which probably occasioned the epileptic fits, +remains afterwards, and produces a chronical anorexia; of which a case is +related in Class II. 2. 2. 1. There are instances of its beginning in the +heel, of which a case is published by Dr. Short, in the Med. Essays, Edinb. +I once saw a child about ten years old, who frequently fell down in +convulsions, as she was running about in play; on examination a wart was +found on one ancle, which was ragged and inflamed; which was directed to be +cut off, and the fits never recurred. + +When epilepsy first commences, the patients are liable to utter one scream +before they fall down; afterwards the convulsions so immediately follow the +pain, which occasions them, that the patient does not recollect or seem +sensible of the preceding pain. Thus in laughter, when it is not excessive, +a person is not conscious of the pain, which so often recurs, and causes +the successive screams or exertions of laughter, which give a temporary +relief to it. + +Epileptic fits frequently recur in sleep from the increase of sensibility +at that time, explained in Sect. XVIII. 14. In two such cases, both of +young women, one grain of opium given at night, and continued many months, +had success; in one of them the opium was omitted twice at different times, +and the fit recurred on both the nights. In the more violent case, +described in Sect. XVIII. 15, opium had no effect. + +Epileptic fits generally commence with setting the teeth, by which means +the tongue is frequently wounded; and with rolling the eyeballs in every +kind of direction; for the muscles which suspend the jaw, as well as those +which move the eyes, are in perpetual motion during our waking hours; and +yet continue subservient to volition; hence their more facile and forcible +actions for the purpose of relieving pain by the exhaustion of sensorial +power. See Section XXXIV. 1. 4. + +Epileptic convulsions are not attended with the fear of death, as in the +hysteric disease, and the urine is of a straw colour. However it must be +noted, that the disagreeable sensations in hysteric diseases sometimes are +the cause of true epileptic convulsions, of syncope, and of madness. + +The pain, which occasions some fits of epilepsy, is felt for a time in a +distant part of the system, as in a toe or heel; and is said by the patient +gradually to ascend to the head, before the general convulsions commence. +This ascending sensation has been called aura epileptica, and is said to +have been prevented from affecting the head by a tight bandage round the +limb. In this malady the pain, probably of some torpid membrane, or +diseased tendon, is at first only so great as to induce slight spasms of +the muscular fibres in its vicinity; which slight spasms cease on the +numbness introduced by a tight bandage; when no bandage is applied, the +pain gradually increases, till generally convulsions are exerted to relieve +it. The course of a lymphatic, as when poisonous matter is absorbed; or of +a nerve, as in the sciatica, may, by the sympathy existing between their +extremities and origins, give an idea of the ascent of an aura or vapour. + +In difficult parturition it sometimes happens, that general convulsions are +excited to relieve the pain of labour, instead of the exertions of those +muscles of the abdomen and diaphragm, which ought to forward the exclusion +of the child. See Class III. 1. 1. That is, instead of the particular +muscular actions, which ought to be excited by sensation to remove the +offending cause, general convulsions are produced by the power of volition, +which still the pain, as in common epilepsy, without removing the cause; +and, as the parturition is not thus promoted, the convulsions continue, +till the sensorial power is totally exhausted, that is, till death. In +patients afflicted with epilepsy from other causes, I have seen the most +violent convulsions recur frequently during pregnancy without miscarriage, +as they did not tend to forward the exclusion of the fetus. + +M. M. Venesection. A large dose of opium. Delivery. + +The later in life epileptic fits are first experienced, the more dangerous +they may be esteemed in general; as in these cases the cause has generally +been acquired by the habits of the patient, or by the decay of some part, +and is thus probably in an increasing state. Whereas in children the +changes in the system, as they advance to puberty, sometimes removes the +cause. So in toothing, fits of convulsion with stupor frequently occur, and +cease when the tooth advances; but this is not to be expected in advanced +life. Sir ----, about sixty years of age, had only three teeth left in his +upper jaw, a canine tooth, and one on each side of it. He was seized with +epileptic fits, with pain commencing in these teeth. He was urged to have +them extracted, which he delayed too long, till the fits were become +habitual, and then had them extracted in vain, and in a few months sunk +under the disease. + +Mr. F----, who had lived intemperately, and had been occasionally affected +with the gout, was suddenly seized with epileptic fits; the convulsions +were succeeded by apoplectic snoring; from which he was, in about 20 +minutes, disturbed by fresh convulsions, and had continued in this +situation above four-and-twenty hours. About eight ounces of blood were +then taken from him; and after having observed, that the apoplectic's +torpor continued about 20 minutes, I directed him to be forcibly raised up +in bed, after he had thus lain about fifteen minutes, to gain an interval +between the termination of the sleep, and the renovation of convulsion. In +this interval he was induced to swallow forty drops of laudanum. Twenty +more were given him in the same manner in about half an hour, both which +evidently shortened the convulsion fits, and the consequent stupor; he then +took thirty more drops, which for the present removed the fits. He became +rather insane the next day, and after about three more days lost the +insanity, and recovered his usual state of health. + +The case mentioned in Sect. XXVII. 2. where the patient was left after +epileptic fits with a suffusion of blood beneath the tunica adjunctiva of +the eye, was in almost every respect similar to the preceding, and +submitted to the same treatment. Both of them suffered frequent relapses, +which were relieved by the same means, and at length perished, I believe, +by the epileptic fits. + +In those patients, who have not been subject to epilepsy before they have +arrived to about forty years of age, and who have been intemperate in +respect to spirituous potation, I have been induced to believe, that the +fits were occasioned by the pain of a diseased liver; and this became more +probable in one of the above subjects, who had used means to repel +eruptions on the face; and thus by some stimulant application had prevented +an inflammation taking place on the skin of the face instead of on some +part of the liver. Secondly, as in these cases insanity had repeatedly +occurred, which could not be traced from an hereditary source; there is +reason to believe, that this as well as the epileptic convulsions were +caused by spirituous potation; and that this therefore is the original +source both of epilepsy and of insanity in those families, which are +afflicted with them. This idea however brings some consolation with it; as +it may be inferred, that in a few sober generations these diseases may be +eradicated, which otherwise destroy the family. + +M. M. Venesection. Opium. Bark. Steel. Arsenic. Opium one grain twice a day +for years together. See the preceding article. + +8. _Epilepsia dolorifica._ Painful epilepsy. In the common epilepsy the +convulsions are immediately induced, as soon as the disagreeable sensation, +which causes them, commences; but in this the pain continues long with cold +extremities, gradually increasing for two or three hours, till at length +convulsions or madness come on; which terminate the daily paroxysm, and +cease themselves in a little time afterwards. + +This disease sometimes originates from a pain about the lower edge of the +liver, sometimes in the temple, and sometimes in the pudendum; it recurs +daily for five or six weeks, and then ceases for several months. The pain +is owing to defect of action, that is, to the accumulation of sensorial +power in the part, which probably sympathizes with some other part, as +explained in Sect. XXXV. 2. XII. 5. 3. and Class II. 1. 1. 11. and IV. 2. +2. 3. + +It is the most painful malady that human nature is liable to!--See Sect. +XXXIV. 1. 4. + +Mrs. C---- was seized every day about the same hour with violent pain on +the right side of her bowels about the situation of the lower edge of the +liver, without fever, which increased for an hour or two, till it became +totally intolerable. After violent screaming she fell into convulsions, +which terminated sometimes in fainting, with or without stertor, as in +common epilepsy; at other times a tempory insanity supervened; which +continued about half an hour, and the fit ceased. These paroxysms had +returned daily for two or three weeks, and were at length removed by large +doses of opium, like the fits of reverie or somnambulation. About half an +hour before the expected return of the fit three or four grains of opium +were exhibited, and then tincture of opium was given in warm brandy and +water about 20 or 30 drops every half hour, till the eyes became somewhat +inflamed, and the nose began to itch, and by the sharp movements of the +patient, or quick speech, an evident intoxication appeared; and then it +generally happened that the pain ceased. But the effects of this large dose +of opium was succeeded by perpetual sickness and efforts to vomit, with +great general debility all the succeeding day. + +The rationale of this temporary cure from the exhibition of opium and +vinous spirit depends on the great expenditure of sensorial power in the +increased actions of all the irritative motions, by the stimulus of such +large quantities of opium and vinous spirit; together with the production +of much sensation, and many movements of the organs of sense or ideas in +consequence of that sensation; and lastly, even the motions of the arterial +system become accelerated by this degree of intoxication, all which soon +exhausted so much sensorial power as to relieve the pain; which would +otherwise have caused convulsions or insanity, which are other means of +expending sensorial power. The general debility on the succeeding day, and +the particular debility of the stomach, attended in consequence with +sickness and frequent efforts to vomit, were occasioned by the system +having previously been so strongly stimulated, and those parts in +particular on which the opium and wine more immediately acted. This +sickness continued so many hours as to break the catenation of motions, +which had daily reproduced the paroxysm; and thus it generally happened, +that the whole disease ceased for some weeks or months from one great +intoxication, a circumstance not easily to be explained on any other +theory. + +The excess or defect of motion in any part of the system occasions the +production of pain in that part, as in Sect. XII. 1. 6. This defect or +excess of fibrous action is generally induced by excess or defect of the +stimulus of objects external to the moving organ. But there is another +source of excessive fibrous action, and consequent pain, which is from +excess of volition, which is liable to affect those muscles, that have weak +antagonists; as those which support the under jaw, and close the mouth in +biting, and those of the calf of the leg; which are thus liable to fixed or +painful contractions, as in trismus, or locked jaw, and in the cramp of the +calf of the leg; and perhaps in some colics, as in that of Japan: these +pains, from contraction arising from excess of volition in the part from +the want of the counteraction of antagonist muscles, may give occasional +cause to epileptic fits, and may be relieved in the same way, either by +exciting irritative and sensitive motions by the stimulus of opium and +wine; or by convulsions or insanity, as described above, which are only +different methods of exhausting the general quantity of sensorial power. + +Considering the great resemblance between this kind of painful epilepsy and +the colic of Japan, as described by Kemfer; and that that disease was said +to be cured by acupuncture, or the prick of a needle; I directed some very +thin steel needles to be made about three inches long, and of such a +temper, that they would bend double rather than break; and wrapped wax +thread over about half an inch of the blunt end for a handle. One of these +needles, when the pain occurred, was pushed about an inch into the painful +part, and the pain instantly ceased; but I was not certain, whether the +fear of the patient, or the stimulus of the puncture, occasioned the +cessation of pain; and as the paroxysm had continued some weeks, and was +then declining, the experiment was not tried again. The disease is said to +be very frequent in Japan, and its seat to be in the bowels, and that the +acupuncture eliminates the air, which is supposed to distend the bowel. But +though the aperture thus made is too small to admit of the eduction of air; +yet as the stimulus of so small a puncture may either excite a torpid part +into action, or cause a spasmodic one to cease to act; and lastly, as no +injury could be likely to ensue from so small a perforation, I should be +inclined at some future time to give this a fairer trial in similar +circumstances. + +Another thing worth trial at the commencement of this deplorable disease +would be electricity, by passing strong shocks through the painful part; +which, whether the pain was owing to the inaction of that part, or of some +other membrane associated with it, might stimulate them into exertion; or +into inactivity, if owing to fixed painful contraction. + +And lastly, the cold bath, or aspersions with cold water on the affected +part, according to the method of Dr. Currie in the Memoirs of a Med. Soc. +London, V. iii. p. 147, might produce great effect at the commencement of +the pain. Nevertheless opium duly administered, so as to precede the +expected paroxysm, and in such doses, given by degrees, as to induce +intoxication, is principally to be depended upon in this deplorable malady. +To which should be added, that if venesection can be previously performed, +even to but few ounces, the effect of the opium is much more certain; and +still more so, if there be time to premise a brisk cathartic, or even an +emetic. The effect of increased stimulus is so much greater after previous +defect of stimulus; and this is still of greater advantage where the cause +of the disease happens to consist in a material, which can be absorbed. See +Art. IV. 2. 8. + +M. M. Venesection. An emetic. A cathartic. Warm bath. Opium a grain every +half hour. Wine. Spirit of wine. If the patient becomes intoxicated by the +above means, the fit ceases, and violent vomitings and debility succeed on +the subsequent day, and prevent a return. Blisters or sinapisms on the +small of the leg, taken off when they give much pain, are of use in +slighter convulsions. Acupuncture. Electricity. Aspersion with cold water +on the painful part. + +9. _Somnambulismus._ Sleep-walking is a part of reverie, or studium inane, +described in Sect. XIX. In this malady the patients have only the general +appearance of being asleep in respect to their inattention to the stimulus +of external objects, but, like the epilepsies above described, it consists +in voluntary exertions to relieve pain. The muscles are subservient to the +will, as appears by the patient's walking about, and sometimes doing the +common offices of life. The ideas of the mind also are obedient to the +will, because their discourse is consistent, though they answer imaginary +questions. The irritative ideas of external objects continue in this +malady, because the patients do not run against the furniture of the room; +and when they apply their volition to their organs of sense, they become +sensible of the objects they attend to, but not otherwise, as general +sensation is destroyed by the violence of their voluntary exertions. At the +same time the sensations of pleasure in consequence of ideas excited by +volition are vividly experienced, and other ideas seem to be excited by +these pleasurable sensations, as appears in the case of Master A. Sect. +XXXIV. 3. 1. where a history of a hunting scene was voluntarily recalled, +with all the pleasurable ideas which attended it. In melancholy madness the +patient is employed in voluntarily exciting one idea, with those which are +connected with it by voluntary associations only, but not so violently as +to exclude the stimuli of external objects. In reverie variety of ideas are +occasionally excited by volition, and those which are connected with them +either by sensitive or voluntary associations, and that so violently as to +exclude the stimuli of external objects. These two situations of our +sensual motions, or ideas, resemble convulsion and epilepsy; as in the +former the stimulus of external objects is still perceived, but not in the +latter. Whence this disease, so far from being connected with sleep, though +it has by universal mistake acquired its name from it, arises from excess +of volition, and not from a suspension of it; and though, like other kinds +of epilepsy, it often attacks the patients in their sleep, yet those two, +whom I saw, were more frequently seized with it while awake, the +sleep-walking being a part of the reverie. See Sect. XIX. and XXXIV. 3. and +Class II. 1. 7. 4. and III. 1. 2. 18. + +M. M. Opium in large doses before the expected paroxysm. + +10. _Asthma convulsivum._ The fits of convulsive asthma return at periods, +and are attended with cold extremities, and so far resemble the access of +an intermittent fever; but, as the lungs are not sensible to the pain of +cold, a shivering does not succeed, but instead of it violent efforts of +respiration; which have no tendency, as in the humoral asthma, to dislodge +any offending material, but only to relieve the pain by exertion, like the +shuddering in the beginning of ague-fits, as explained Class III. 1. 1. 2. + +The insensibility of the lungs to cold is observable on going into frosty +air from a warm room; the hands and face become painfully cold, but no such +sensation is excited in the lungs; which is another argument in favour of +the existence of a peculiar set of nerves for the purpose of perceiving the +universal fluid matter of heat, in which all things are immersed. See Sect. +XIV. 6. Yet are the lungs nevertheless very sensible to the deficiency of +oxygen in the atmosphere, as all people experience, when they go into a +room crowded with company and candles, and complain, that it is so close, +they can scarcely breathe; and the same in some hot days in summer. + +There are two diseases, which bear the name of asthma. The first is the +torpor or inability of the minute vessels of the lungs, consisting of the +terminations of the pulmonary and bronchial arteries and veins, and their +attendant lymphatics; in this circumstance it resembles the difficulty of +breathing, which attends cold bathing. If this continues long, a congestion +of fluid in the air-cells succeeds, as the absorbent actions cease +completely before the secerning ones; as explained in Class I. 1. 2. 3. And +the coldness, which attends the inaction of these vessels, prevents the +usual quantity of exhalation. Some fits cease before this congestion takes +place, and in them no violent sweating nor any expuition of phlegm occurs. +This is the humoral asthma, described at Class II. 1. 1. 7. + +The second kind of asthma consists in the convulsive actions in consequence +of the disagreeable sensations thus induced; which in some fits of asthma +are very great, as appears in the violent efforts to raise the ribs, and to +depress the diaphragm, by lifting the shoulders. These, so long as they +contribute to remove the cause of the disease, are not properly +convulsions, but exertions immediately caused by sensation; but in this +kind of asthma they are only efforts to relieve pain, and are frequently +preceded by other epileptic convulsions. + +These two kinds of asthmas have so many resembling features, and are so +frequently intermixed, that it often requires great attention to +distinguish them; but as one of them is allied to anasarca, and the other +to epilepsy, we shall acquire a clearer idea of them by comparing them with +those disorders. A criterion of the humoral or hydropic asthma is, that it +is relieved by copious sweats about the head and breast, which are to be +ascribed to the sensitive exertions of the pulmonary vessels to relieve the +pain occasioned by the anasarcous congestion in the air-cells; and which is +effected by the increased absorption of the mucus, and its elimination by +the retrograde action of those lymphatics of the skin, whose branches +communicate with the pulmonary ones; and which partial sweats do not easily +admit of any other explanation. See Class I. 3. 2. 8. Another criterion of +it is, that it is generally attended with swelled legs, or other symptoms +of anasarca. A criterion of the convulsive asthma may be had from the +absence of these cold clammy sweats of the upper part of the body only, and +from the patient having occasionally been subject to convulsions of the +limbs, as in the common epilepsy. + +It may thus frequently happen, that in the humoral asthma some exertions of +the lungs may occur, which may not contribute to discharge the anasarcous +lymph, but may be efforts simply to relieve pain; besides those efforts, +which produce the increased absorption and elimination of it; and thus we +have a bodily disease resembling in this circumstance the reverie, in which +both sensitive and voluntary motions are at the same time, or in +succession, excited for the purpose of relieving pain. + +It may likewise sometimes happen, that the disagreeable sensation, +occasioned by the congestion of lymph in the air-cells in the humoral or +hydropic asthma, may induce voluntary convulsions of the respiratory organs +only to relieve the pain, without any sensitive actions of the pulmonary +absorbents to absorb and eliminate the congestion of serous fluid; and thus +the same cause may occasionally induce either the humoral or convulsive +asthma. + +The humoral asthma has but one remote cause, which is the torpor of the +pulmonary vessels, like that which occurs on going into the cold bath; or +the want of absorption of the pulmonary lymphatics to take up the lymph +effused into the air-cell. Whereas the convulsive asthma, like other +convulsions, or epilepsies, may be occasioned by pain in almost any remote +part of the system. But in some of the adult patients in this disease, as +in many epilepsies, I have suspected the remote cause to be a pain of the +liver, or of the biliary ducts. + +The asthmas, which have been induced in consequence of the recess of +eruptions, especially of the leprous kind, countenance this opinion. One +lady I knew, who for many years laboured under an asthma, which ceased on +her being afflicted with pain, swelling, and distortion of some of her +large joints, which were esteemed gouty, but perhaps erroneously. And a +young man, whom I saw yesterday, was seized with asthma on the +retrocession, or ceasing of eruptions on his face. + +The convulsive asthma, as well as the hydropic, are more liable to return +in hot weather; which may be occasioned by the less quantity of oxygen +existing in a given quantity of warm air, than of cold, which can be taken +into the lungs at one inspiration. They are both most liable to occur after +the first sleep, which is therefore a general criterion of asthma. The +cause of this is explained in Sect. XVIII. 15. and applies to both of them, +as our sensibility to internal uneasy sensation increases during sleep. + +When children are gaining teeth, long before they appear, the pain of the +gums often induces convulsions. This pain is relieved in some by sobbing +and screaming; but in others a laborious respiration is exerted to relieve +the pain; and this constitutes the true asthma convulsivum. In other +children again general convulsions, or epileptic paroxysms, are induced for +this purpose; which, like other epilepsies, become established by habit, +and recur before the irritation has time to produce the painful sensation, +which originally caused them. + +The asthma convulsivum is also sometimes induced by worms, or by acidity in +the stomachs of children, and by other painful sensations in adults; in +whom it is generally called nervous asthma, and is often joined with other +epileptic symptoms. + +This asthma is distinguished from the peripneumony, and from the croup, by +the presence of fever in the two latter. It is distinguished from the +humoral asthma, as in that the patients are more liable to run to the cold +air for relief, are more subject to cold extremities, and experience the +returns of it more frequently after their first sleep. It is distinguished +from the hydrops thoracis, as that has no intervals, and the patient sits +constantly upright, and the breath is colder; and, where the pericardium is +affected, the pulse is quick and unequal. See Hydrops Thoracis, I. 2. 3. +14. + +M. M. Venesection once. A cathartic with calomel once. Opium. Assafoetida. +Warm bath. If the cause can be detected, as in toothing or worms, it should +be removed. As this species of asthma is so liable to recur during sleep, +like epileptic fits, as mentioned in Section XVIII. 15. there was reason to +believe, that the respiration of an atmosphere mixed with hydrogen, or any +other innocuous air, which might dilute the oxygen, would be useful in +preventing the paroxysms by decreasing the sensibility of the system. This, +I am informed by Dr. Beddoes, has been used with decided success by Dr. +Ferriar. See Class II. 1. 1. 7. + +11. _Asthma dolorificum._ Angina pectoris. The painful asthma was first +described by Dr. Heberden in the Transactions of the College; its principal +symptoms consist in a pain about the middle of the sternum, or rather +lower, on every increase of pulmonary or muscular exertion, as in walking +faster than usual, or going quick up a hill, or even up stairs; with great +difficulty of breathing, so as to occasion the patient instantly to stop. A +pain in the arms about the insertion of the tendon of the pectoral muscle +generally attends, and a desire of resting by hanging on a door or branch +of a tree by the arms is sometimes observed. Which is explained in Class I. +2. 3. 14. and in Sect. XXIX. 5. 2. + +These patients generally die suddenly; and on examining the thorax no +certain cause, or seat, of the disease has been detected; some have +supposed the valves of the arteries, or of the heart, were imperfect; and +others that the accumulation of fat about this viscus or the lungs +obstructed their due action; but other observations do not accord with +these suppositions. + +Mr. W----, an elderly gentleman, was seized with asthma during the hot part +of last summer; he always waked from his first sleep with difficult +respiration, and pain in the middle of his sternum, and after about an hour +was enabled to sleep again. As this had returned for about a fortnight, it +appeared to me to be an asthma complicated with the disease, which Dr. +Heberden has called angina pectoris. It was treated by venesection, a +cathartic, and then by a grain of opium given at going to bed, with ether +and tincture of opium when the pain or asthma required, and lastly with the +bark, but was several days before it was perfectly subdued. + +This led me to conceive, that in this painful asthma the diaphragm, as well +as the other muscles of respiration, was thrown into convulsive action, and +that the fibres of this muscle not having proper antagonists, a painful +fixed spasm of it, like that of the muscles in the calf of the leg in the +cramp, might be the cause of death in the angina pectoris, which I have +thence arranged under the name of painful asthma, and leave for further +investigation. + +From the history of the case of the late much lamented John Hunter, and +from the appearances after death, the case seems to have been of this kind, +complicated with vertigo and consequent affection of the stomach. The +remote cause seems to have arisen from ossifications of the coronary +arteries; and the immediate cause of his death from fixed spasm of the +heart. Other histories and dissections are still required to put this +matter out of doubt; as it is possible, that either a fixed spasm of the +diaphragm, or of the heart, which are both furnished with but weak +antagonists, may occasion sudden death; and these may constitute two +distinct diseases. + +Four patients I have now in my recollection, all of whom I believed to +labour under the angina pectoris in a great degree; which have all +recovered, and have continued well three or four years by the use, as I +believe, of issues on the inside of each thigh; which were at first large +enough to contain two pease each, and afterwards but one. They took besides +some slight antimonial medicine for a while, and were reduced to half the +quantity or strength of their usual potation of fermented liquor. + +The use of femoral issues in angina pectoris was first recommended by Dr. +Macbride, physician at Dublin, Med. Observ. & Enquir. Vol. VI. And I was +further induced to make trial of them, not only because the means which I +had before used were inadequate, but from the ill effect I once observed +upon the lungs, which succeeded the cure of a small sore beneath the knee; +and argued conversely, that issues in the lower limbs might assist a +difficult respiration. + +Mrs. L----, about fifty, had a small sore place about the size of half a +pea on the inside of the leg a little below the knee. It had discharged a +pellucid fluid, which she called a ley-water, daily for fourteen years, +with a great deal of pain; on which account she applied to a surgeon, who, +by means of bandage and a saturnine application, soon healed the sore, +unheedful of the consequences. In less than two months after this I saw her +with great difficulty of breathing, which with universal anasarca soon +destroyed her. + +The theory of the double effect of issues, as above related, one in +relieving by their presence the asthma dolorificum, and the other in +producing by its cure an anasarca of the lungs, is not easy to explain. +Some similar effects from cutaneous eruptions and from blisters are +mentioned in Class I. 1. 2. 9. In these cases it seems probable, that the +pain occasioned by issues, and perhaps the absorption of a small quantity +of aerated purulent matter, stimulate the whole system into greater energy +of action, and thus prevent the torpor which is the beginning of so many +diseases. In confirmation of this effect of pain on the system, I remember +the case of a lady of an ingenious and active mind, who, for many of the +latter years of her life, was perpetually subject to great pains of her +head from decaying teeth. When all her teeth were gone, she became quite +low spirited, and melancholy in the popular sense of that word, and after a +year or two became universally dropsical and died. + +M. M. Issues in the thighs. Five grains of rhubarb, and one sixth of a +grain of emetic tartar every night for some months, with or without half a +grain of opium. No stronger liquor than small beer, or wine diluted with +twice its quantity of water. Since I wrote the above I have seen two cases +of hydrops thoracis, attended with pain in the left arm, so as to be +mistaken for asthma dolorificum, in which femoral issues, though applied +early in the disease, had no effect. + +12. _Stridor dentium._ The clattering of the teeth on going into cold +water, or in the beginning of ague-fits, is an exertion along with the +tremblings of the skin to relieve the pain of cold. The teeth and skin +being more sensible to cold than the more internal parts, and more exposed +to it, is the reason that the muscles, which serve them, are thrown into +exertion from the pain of cold rather than those of respiration, as in +screaming from more acute pain. Thus the poet, + + Put but your toes into cold water, + Your correspondent teeth will clatter. + PRIOR. + +In more acute pains the jaws are gnashed together with great vehemence, +insomuch that sometimes the teeth are said to have been broken by the +force. See Sect. XXXIV. 1. 3. In these cases something should be offered to +the patient to bite, as a towel, otherwise they are liable to tear their +own arms, or to bite their attendants, as I have witnessed in the painful +epilepsy. + +13. _Tetanus trismus._ Cramp. The tetanus consists of a fixed spasm of +almost all the muscles of the body; but the trismus, or locked jaw, is the +most frequent disease of this kind. It is generally believed to arise from +sympathy with an injured tendon. In one case where it occurred in +consequence of a broken ankle from a fall from a horse, it was preceded by +evident hydrophobia. Amputation was advised, but not submitted to; two +wounds were laid into one with scissors, but the patient died about the +seventh day from the accident. In this case the wounded tendon, like the +wounds from the bite of a mad dog, did not produce the hydrophobia, and +then the locked jaw, till several days after the accident. + +I twice witnessed the locked jaw from a pain beneath the sternum, about the +part where it is complained of in painful asthma, or angina pectoris, in +the same lady at some years distance of time. The last time it had +continued two days, and she wrote her mind, or expressed herself by signs. +On observing a broken tooth, which made a small aperture into her mouth, I +rolled up five grains of opium like a worm about an inch long, and +introducing it over the broken tooth, pushed it onward by means of a small +crow-quill; as it dissolved I observed she swallowed her saliva, and in +less than half an hour, she opened her mouth and conversed as usual. + +Men are taught to be ashamed of screaming from pain in their early years; +hence they are prone to exert the muscles of the jaws instead, which they +have learnt to exert frequently and violently from their infancy; whence +the locked jaw. This and the following spasm have no alternate relaxations, +like the preceding ones; which is perhaps owing, first, to the weakness of +their antagonist muscles, those which elevate the jaw being very strong for +the purpose of biting and masticating hard substances, and for supporting +the under jaw, with very weak antagonist muscles; and secondly, to their +not giving sufficient relief even for a moment to the pain, or its +preceding irritation, which excited them. + +M. M. Opium in very large quantities. Mercurial ointment used extensively. +Electricity. Cold bath. Dilate the wound, and fill it with lint moistened +with spirit of turpentine; which inflames the wound, and cures or prevents +the convulsions. See a case, Transact. of American Society, Vol. II. p. +227. + +Wine in large quantities in one case was more successful than opium; it +probably inflames more, which in this disease is desirable. Between two or +three ounces of bark, and from a quart to three pints of wine a day, +succeeded better than opium. Ib. + +14. _Tetanus dolorificus._ Painful cramp. This kind of spasm most +frequently attacks the calf of the leg, or muscles of the toes; it often +precedes paroxysms of gout, and appears towards the end of violent +diarrhoea, and from indigestion, or from acid diet. In these cases it seems +to sympathize with the bowels, but is also frequently produced by the pain +of external cold, and to the too great previous extension of the muscles, +whence some people get the cramp in the extensor muscles of the toes after +walking down hill, and of those of the calf of the leg after walking up a +steep eminence. For the reason why these cramps commence in sleep, see +Sect. XVIII. 15. + +The muscle in this disease contracts itself to relieve some smaller pain, +either from irritation or association, and then falls into great pain +itself, from the too great action of its own fibres. Hence any muscle, by +being too vehemently exerted, falls into cramp, as in swimming too forcibly +in water, which is painfully cold; and a secondary pain is then induced by +the too violent contraction of the muscle; though the pain, which was the +cause of the contraction, ceases. Which accounts for the continuance of the +contraction, and distinguishes this disease from other convulsions, which +are relaxed and exerted alternately. Hence whatever may be the cause of the +primary pain, which occasions the cramp of the calf of the leg, the +secondary one is relievable by standing up, and thus by the weight of the +body on the toes forcibly extending the contracted muscles. For the cause, +which induces these muscles of the calf of the leg to fall into more +violent contraction than other spasmodic muscles, proceeds from the +weakness of their antagonist muscles; as they are generally extended again +after action by the weight of the body on the balls of the toes. See the +preceding article. + +M. M. Rub the legs with camphor dissolved in oil, and let the patient wear +stockings in bed. If a foot-board be put at the bed's feet, and the bed be +so inclined, that he will rest a little with his toes against the +foot-board, that pressure is said to prevent the undue contractions of the +musculi gastrocnemii, which constitute the calf of the leg. In gouty +patients, or where the bowels are affected with acidity, half a grain of +opium, and six grains of rhubarb, and six of chalk, every night. Flesh-meat +to supper. A little very weak warm spirit and water may be taken for +present relief, when these cramps are very troublesome to weak or gouty +patients. + +15. _Hydrophobia._ Dread of water generally attending canine madness. I was +witness to a case, where this disease preceded the locked jaw from a wound +in the ankle, occasioned by a fall from a horse; as mentioned in the +preceding article. It came on about the sixth day after the accident; when +the patient attempted to swallow fluids, he became convulsed all over from +the pain of this attempt, and spurted them out of his mouth with violence. +It is also said to happen in some hysterical cases. Hence it seems rather +the immediate consequence of a pained tendon, than of a contagious poison. +And is so far analogous to tetanus, according with the opinions of Doctor +Rusch and Doctor Percival. + +In other respects, as it is produced by the saliva of an enraged animal +instilled into a wound, it would seem analogous to the poison of venomous +animals. And from the manner of its access so long after the bite, and of +its termination in a short time, it would seem to resemble the progress of +contagious fevers. See Sect. XXII. 3. 3. + +If the patient was bitten in a part, which could be totally cut away, as a +finger, even after the hydrophobia appears, it is probable it might cure +it; as I suspect the cause still remains in the wounded tendon, and not in +a diffused infection tainting the blood. Hence there are generally uneasy +sensations, as cold or numbness, in the old cicatrix, before the +hydrophobia commences. See a case in Medical Communications, Vol. II. p. +190. + +If the diseased tendon could be inflamed without cutting it out, as by +cupping, or caustic, or blister after cupping, and this in the old wound +long since healed, after the hydrophobia commences, might prevent the +spasms about the throat. As inflaming the teeth by the use of mercury is of +use in some kinds of hemicrania. Put spirit of turpentine on the wound, +wash it well. See Class I. 3. 1. 11. IV. 1. 2. 7. + +M. M. Wine, musk, oil, internally. Opium, mercurial ointment, used +extensively. Mercurial fumigation. Turpeth mineral. To salivate the patient +as soon as possible. Exsection or a caustic on the scar, even after the +appearance of hydrophobia. Put a tight bandage on the limb above the scar +of the old wound to benumb the pained tendon, however long the wound may +have been healed. Could a hollow catheter of elastic gum, caoutchouc, be +introduced into the oesophagus by the mouth or nostril, and liquid +nourishment be thus conveyed into the stomach? See Desault's Journal, Case +I. where, in an ulcer of the mouth, such a catheter was introduced by the +nostril, and kept in the oesophagus for a month, by which means the patient +was nourished and preserved. + +It is recommended by Dr. Bardsley to give oil internally by a similar +method contrived by Mr. John Hunter. He covered a probang with the skin of +a small eel, or the gut of a lamb or cat. It was tied up at one end above +and below the sponge, and a slit made above the upper ligature; to the +other end of the eel-skin or gut was fixed a bladder and pipe. The probang +thus covered was introduced into the stomach, and the liquid food or +medicine was put into the bladder and squeezed down through the eel-skin. +Mem. of Society at Manchester. See Class I. 2. 3. 25. + +Dr. Bardsley has endeavoured to prove, that dogs never experience the +hydrophobia, or canine madness, without having been previously bitten or +infected; and secondly, that the disease in this species of animal always +shews itself in five or six weeks; and concludes from hence, that this +dreadful malady might be annihilated by making all the dogs in Great +Britain perform a kind of quarantine, by shutting them up for a certain +number of weeks. Though the disease from the bite of the mad dog is perhaps +more analogous to those from the wounds inflicted by venomous animals than +to those from other contagious matter, yet these observations are well +worthy further attention; which the author promises. + + * * * * * + +ORDO I. + +_Increased Volition._ + +GENUS II. + +_With increased Actions of the Organs of Sense._ + +In every species of madness there is a peculiar idea either of desire or +aversion, which is perpetually excited in the mind with all its +connections. In some constitutions this is connected with pleasurable ideas +without the exertion of much muscular action, in others it produces violent +muscular action to gain or avoid the object of it, in others it is attended +with despair and inaction. Mania is the general word for the two former of +these, and melancholia for the latter; but the species of them are as +numerous as the desires and aversions of mankind. + +In the present age the pleasurable insanities are most frequently induced +by superstitious hopes of heaven, by sentimental love, and by personal +vanity. The furious insanities by pride, anger, revenge, suspicion. And the +melancholy ones by fear of poverty, fear of death, and fear of hell; with +innumerable others. + + Quicquid agunt homines, votum, timor, ira, voluptas, + Gaudia, discursus, nostri est farrago libelli. + JUVEN. I. 85. + +This idea, however, which induces madness or melancholy, is generally +untrue; that is, the object is a mistaken fact. As when a patient is +persuaded he has the itch, or venereal disease, of which he has no symptom, +and becomes mad from the pain this idea occasions. So that the object of +madness is generally a delirious idea, and thence cannot be conquered by +reason; because it continues to be excited by painful sensation, which is a +stronger stimulus than volition. Most frequently pain of body is the cause +of convulsion, which is often however exchanged for madness; and a painful +delirious idea is most frequently the cause of madness originally, but +sometimes of convulsion. Thus I have seen a young lady become convulsed +from a fright, and die in a few days; and a temporary madness frequently +terminates the paroxysms of the epilepsia dolorifica, and an insanity of +greater permanence is frequently induced by the pains or bruises of +parturition. + +Where the patient is debilitated a quick pulse sometimes attends insane +people, which is nevertheless generally only a symptom of the debility, +owing to the too great expenditure of sensorial power; or of the paucity of +its production, as in inirritative, or in sensitive inirritated fever. See +III. 1. 1. + +But nevertheless where the quick pulse is permanent, it shews the presence +of fever; and as the madness then generally arises from the disagreeable +sensations attending the fever, it is so far a good symptom; because when +the fever is cured, or ceases spontaneously, the insanity most frequently +vanishes at the same time. + +The stimulus of so much volition supports insane people under variety of +hardships, and contributes to the cure of diseases from debility, as +sometimes occurs towards the end of fevers. See Sect. XXXIV. 2. 5. And, on +the same account, they bear large doses of medicines to procure any +operation on them; as emetics, and cathartics, which, before they produce +their effect in inverting the motions of the stomach in vomiting, or of the +absorbents of the bowels in purging, must first weaken the natural actions +of those organs, as shewn in Sect. XXXV. 1. 3. + +From these considerations it appears, that the indications of cure must +consist in removing the cause of the pain, whether it arises from a +delirious idea, or from a real fact, or from bodily disease; or secondly, +if this cannot be done, by relieving the pain in consequence of such idea +or disease. The first is sometimes effected by presenting frequently in a +day contrary ideas to shew the fallacy, or the too great estimation, of the +painful ideas. 2dly. By change of place, and thus presenting the stimulus +of new objects, as a long journey. 3dly. By producing forgetfulness of the +idea or object, which causes their pain; by removing all things which recal +it to their minds; and avoiding all conversation on similar subjects. For I +suppose no disease of the mind is so perfectly cured by other means as by +forgetfulness. + +Secondly, the pain in consequence of the ideas or bodily diseases above +described is to be removed, first, by evacuations, as venesection, emetics, +and cathartics; and then by large doses of opium, or by the vertigo +occasioned by a circulating swing, or by a sea-voyage, which, as they +affect the organs of sense as well as evacuate the stomach, may contribute +to answer both indications of cure. + +Where maniacs are outrageous, there can be no doubt but coercion is +necessary; which may be done by means of a straight waistcoat; which +disarms them without hurting them; and by tying a handkerchief round their +ankles to prevent their escape. In others there can be no doubt, but that +confinement retards rather than promotes their cure; which is forwarded by +change of ideas in consequence of change of place and of objects, as by +travelling or sailing. + +The circumstances which render confinement necessary, are first, if the +lunatic is liable to injure others, which must be judged of by the outrage +he has already committed. 2dly. If he is likely to injure himself; this +also must be judged of by the despondency of his mind, if such exists. +3dly. If he cannot take care of his affairs. Where none of these +circumstances exist, there should be no confinement. For though the +mistaken idea continues to exist, yet if no actions are produced in +consequence of it, the patient cannot be called insane, he can only be +termed delirious. If every one, who possesses mistaken ideas, or who puts +false estimates on things, was liable to confinement, I know not who of my +readers might not tremble at the sight of a madhouse! + +The most convenient distribution of insanities will be into general, as +mania mutabilis, studium inane, and vigilia; and into partial insanities. +These last again may be subdivided into desires and aversions, many of +which are succeeded by pleasurable or painful ideas, by fury or dejection, +according to the degree or violence of their exertions. Hence the analogy +between the insanities of the mind, and the convulsions of the muscles +described in the preceding genus, is curiously exact. The convulsions +without stupor, are either just sufficient to obliterate the pain, which +occasions them; or are succeeded by greater pain, as in the convulsio +dolorifica. So the exertions in the mania mutabilis are either just +sufficient to allay the pain which occasions them, and the patient dwells +comparatively in a quiet state; or those exertions excite painful ideas, +which are succeeded by furious discourses, or outrageous actions. The +studium inane, or reverie, resembles epilepsy, in which there is no +sensibility to the stimuli of external objects. Vigilia, or watchfulness, +may be compared to the general writhing of the body; which is just a +sufficient exertion to relieve the pain which occasions it. Erotomania may +be compared to trismus, or other muscular fixed spasm, without much +subsequent pain; and maeror to cramp of the muscles of the leg, or other +fixed spasm with subsequent pain. All these coincidences contribute to +shew, as explained in Sect. III. 5, that our ideas are motions of the +immediate organs of sense obeying the same laws as our muscular motions. + +The violence of action accompanying insanity depends much on the education +of the person; those who have been proudly educated with unrestrained +passions, are liable to greater fury; and those, whose education has been +humble, to greater despondency. Where the delirious idea, above described, +produces pleasurable sensations, as in personal vanity or religious +enthusiasm; it is almost a pity to snatch them from their fool's paradise, +and reduce them again to the common lot of humanity; lest they should +complain of their cure, like the patient described in Horace, + + --------Pol! me occidistis, amici, + Non servastis, ait, cui sic extorta voluptas, + Et demptus per vim mentis gratissimus error! + +The disposition to insanity, as well as to convulsion, is believed to be +hereditary; and in consequence to be induced in those families from +slighter causes than in others. Convulsions have been shewn to have been +most frequently induced by pains owing to defect of stimulus, as the +shuddering from cold, and not from pains from excess of stimulus, which are +generally succeeded by inflammation. But insanities are on the contrary +generally induced by pains from excess of stimulus, as from the too violent +actions of our ideas, as in common anger, which is an insanity of short +duration; for insanities generally, though not always, arise from pains of +the organs of sense; but convulsions generally, though not always, from +pains of the membranes or glands. And it has been previously explained, +that though the membrane and glands, as the stomach and skin, receive great +pain from want of stimulus; yet that the organs of sense, as the eye and +ear, receive no pain from defect of stimulus. + +Hence it follows, that the constitutions most liable to convulsion, are +those which most readily become torpid in some part of the system, that is, +which possess less irritability; and that those most liable to insanity, +are such as have excess of sensibility; and lastly, that these two +circumstances generally exist in the same constitution; as explained in +Sect. XXXI. 2. on Temperaments. These observations explain why epilepsy and +insanity frequently succeed or reciprocate with each other, and why +inirritable habits, as scrophulous ones, are liable to insanity, of which I +have known some instances. + +In many cases however there is no appearance of the disposition to epilepsy +or insanity of the parent being transmitted to the progeny. First, where +the insanity has arisen from some violent disappointment, and not from +intemperance in the use of spirituous liquors. Secondly, where the parent +has acquired the insanity or epilepsy by habits of intoxication after the +procreation of his children. Which habits I suppose to be the general cause +of the disposition to insanity in this country. See Class III. 1. 1. 7. + +As the disposition to gout, dropsy, epilepsy, and insanity, appears to be +produced by the intemperate use of spirituous potation, and is in all of +them hereditary; it seems probable, that this disposition gradually +increases from generation to generation, in those families which continue +for many generations to be intemperate in this respect; till at length +these diseases are produced; that is, the irritability of the system +gradually is decreased by this powerful stimulus, and the sensibility at +the same time increased, as explained in Sect. XXXI. 1. and 2. This +disposition is communicated to the progeny, and becomes still increased, if +the same stimulus be continued, and so on by a third and fourth generation; +which accounts for the appearance of epilepsy in the children of some +families, where it was never known before to have existed, and could not be +ascribed to their own intemperance. A parity of reasoning shews, that a few +sober generations may gradually in the same manner restore a due degree of +irritability to the family, and decrease the excess of sensibility. + +From hence it would appear probable, that scrophula and dropsy are diseases +from inirritability; but that in epilepsy and insanity an excess of +sensibility is added, and the two faulty temperaments are thus conjoined. + +SPECIES. + +1. _Mania mutabilis._ Mutable madness. Where the patients are liable to +mistake ideas of sensation for those from irritation, that is, imaginations +for realities, if cured of one source of insanity, they are liable in a few +months to find another source in some new mistaken or imaginary idea, and +to act from this new idea. The idea belongs to delirium, when it is an +imaginary or mistaken one; but it is the voluntary actions exerted in +consequence of this mistaken idea, which constitute insanity. + +In this disease the patient is liable carefully to conceal the object of +his desire or aversion. But a constant inordinate suspicion of all people, +and a carelessness of cleanliness, and of decency, are generally +concomitants of madness. Their designs cannot be counteracted, till you can +investigate the delirious idea or object of their insanity; but as they are +generally timid, they are therefore less to be dreaded. + +Z. Z. called a young girl, one of his maid-servants, into the parlour, and, +with cocked pistols in his hands, ordered her to strip herself naked; he +then inspected her with some attention, and dismissed her untouched. Then +he stripped two of his male servants in the same manner, to the great +terror of the neighbourhood. After he was secured, with much difficulty he +was persuaded to tell me, that he had got the itch, and had examined some +of his servants to find out from whom he had received it; though at the +same time there was not a spot to be seen on his hands, or other parts. The +outrages in consequence of this false idea were in some measure to be +ascribed to the pride occasioned by unrestrained education, affluent +wealth, and dignified family. + +Madness is sometimes produced by bodily pain, particularly I believe of a +diseased liver, like convulsion and epilepsy; at other times it is caused +by very painful ideas occasioned by external circumstances, as of grief or +disappointment; but the most frequent cause of insanity arises from the +pain of some imaginary or mistaken idea; which may be termed hallucinatio +maniacalis. This hallucination of one of the senses is often produced in an +instant, and generally becomes gradually weakened in process of time, by +the perpetual stimulus of external objects, or by the successions of other +catenations of ideas, or by the operations of medicines; and when the +maniacal hallucination ceases, or is forgotten, the violent exertions +cease, which were in consequence of it, and the disease is cured. + +Mr. ----, a clergyman, about forty years of age, who was rather a weak man, +happened to be drinking wine in jocular company, and by accident swallowed +a part of the seal of a letter, which he had just then received; one of his +companions seeing him alarmed, cried out in humour, "It will seal your +bowels up." He became melancholy from that instant, and in a day or two +refused to swallow any kind of nourishment. On being pressed to give a +reason for this refusal, he answered, he knew nothing would pass through +him. A cathartic was given, which produced a great many evacuations, but he +still persisted, that nothing passed through him; and though he was +frightened into taking a little broth once or twice by threats, yet he soon +ceased intirely to swallow any thing, and died in consequence of this +insane idea. + +Miss ----, a sensible and ingenious lady, about thirty, said she had seen +an angel; who told her, that she need not eat, though all others were under +the necessity of supporting their earthly existence by food. After +fruitless persuasions to take food, she starved herself to death.--It was +proposed to send an angel of an higher order to tell her, that now she must +begin to eat and drink again; but it was not put into execution. + +Mrs. ----, a lady between forty and fifty years of age, imagined that she +heard a voice say to her one day, as she was at her toilet, "Repent, or you +will be damned." From that moment she became melancholy, and this +hallucination affected her in greater or less degree for about two years; +she then recovered perfectly, and is now a cheerful old woman. + +Mrs. ----, a farmer's wife, going up stairs to dress, found the curtains of +her bed drawn, and on undrawing them, she believed that she saw the corpse +of her sister, who was then ill at the distance of twenty miles, and became +from that time insane; and as her sister died about the time, she could not +be produced to counteract the insane hallucination, but she perfectly +recovered in a few months. + +Mrs. ----, a most elegant, beautiful, and accomplished lady, about +twenty-two years of age, had been married about two months to an elegant, +polished, and affluent young man, and it was well known to be a love-match +on both sides. She suddenly became melancholy, and yet not to so great a +degree, but that she could command herself to do the honours of her table +with grace and apparent ease. After many days intreaty, she at length told +me, that she thought her marrying her husband had made him unhappy; and +that this idea she could not efface from her mind day or night. I withstood +her being confined, as some had advised, and proposed a sea-voyage to her, +with expectation that the sickness, as well as change of objects, might +remove the insane hallucination, by introducing other energetic ideas; this +was not complied with, but she travelled about England with her friends and +her husband for many months, and at length perfectly recovered, and is now +I am informed in health and spirits. + +These cases are related to shew the utility of endeavouring to investigate +the maniacal idea, or hallucination; as it may not only acquaint us with +the probable designs of the patient, from whence may be deduced the +necessity of confinement; but also may some time lead to the most effectual +plan of cure. + +I received good information of the truth of the following case, which was +published a few years ago in the newspapers. A young farmer in +Warwickshire, finding his hedges broke, and the sticks carried away during +a frosty season, determined to watch for the thief. He lay many cold hours +under a hay-stack, and at length an old woman, like a witch in a play, +approached, and began to pull up the hedge; he waited till she had tied up +her bottle of sticks, and was carrying them off, that he might convict her +of the theft, and then springing from his concealment, he seized his prey +with violent threats. After some altercation, in which her load was left +upon the ground, she kneeled upon her bottle of sticks, and raising her +arms to heaven beneath the bright moon then at the full, spoke to the +farmer already shivering with cold, "Heaven grant, that thou never mayest +know again the blessing to be warm." He complained of cold all the next +day, and wore an upper coat, and in a few days another, and in a fortnight +took to his bed, always saying nothing made him warm, he covered himself +with very many blankets, and had a sieve over his face, as he lay; and from +this one insane idea he kept his bed above twenty years for fear of the +cold air, till at length he died. + +M. M. As mania arises from pain either of our muscles or organs of sense, +the arts of relieving pain must constitute the method of cure. See Sect. +XXXIV. 3. 4. Venesection. Vomits of from five grains to ten of emetic +tartar, repeated every third morning for three or four times; with solution +of gum-ammoniac, and soluble tartar, so as to purge gently every day. +Afterwards warm bath for two or three hours a day. Opium in large doses. +Bark. Steel. + +Dr. Binns gave two scruples (40 grains) of solid opium at a dose, and +twenty grains four hours afterwards; which restored the patient. Dr. +Brandreth gave 400 drops of laudanum to a maniac in the greatest possible +furor, and in a few hours he became calm and rational. Med. Comment for +1791, p. 384. + +_Prognostic._ + +The temporary quick pulse attending some maniacal cases is simply a symptom +of debility, and is the consequence of too great exertions; but a permanent +quick pulse shews the presence of fever, and is frequently a salutary sign; +because, if the life of the patient be safe, when the fever ceases, the +insanity generally vanishes along with it, as mentioned above. In this case +the kind of fever must direct the method of curing the insanity; which must +consist of moderate evacuations and diluents, if the pulse be strong; or by +nutrientia, bark, and small doses of opium, if the pulse be weak. + +Where the cause is of a temporary nature, as in puerperal insanity, there +is reason to hope, that the disease will cease, when the bruises, or other +painful sensations attending this state, are removed. In these cases the +child should be brought frequently to the mother, and applied to her +breast, if she will suffer it, and this whether she at first attends to it +or not; as by a few trials it frequently excites the storge, or maternal +affection, and removes the insanity, as I have witnessed. + +When the madness is occasioned by pain of the teeth, which I believe is no +uncommon case, these must be extracted; and the cure follows the extinction +of the pain. There is however some difficulty in detecting the delinquent +tooth in this case, as in hemicrania, unless by its apparent decay, or by +some previous information of its pain having been complained of; because +the pain of the tooth ceases, as soon as the exertions of insanity +commence. + +When a person becomes insane, who has a family of small children to solicit +his attention, the prognostic is very unfavourable; as it shews the +maniacal hallucination to be more powerful than those ideas which generally +interest us the most. + +2. _Studium inane._ Reverie consists of violent voluntary exertions of +ideas to relieve pain, with all the trains or tribes connected with them by +sensations or associations. It frequently alternates with epileptic +convulsions; with which it corresponds, in respect to the insensibility of +the mind to the stimuli of external objects, in the same manner as madness +corresponds with common convulsion, in the patient's possessing at the same +time a sensibility of the stimuli of external objects. + +Some have been reported to have been involved in reverie so perfectly, as +not to have been disturbed by the discharge of a cannon; and others to have +been insensible to torture, as the martyrs for religious opinions; but +these seem more properly to belong to particular insanities than to +reverie, like nostalgia and erotomania. + +Reverie is distinguished from madness as described above; and from +delirium, because the trains of ideas are kept consistent by the power of +volition, as the person reasons and deliberates in it. Somnambulismus is a +part of reverie, the latter consisting in the exertions of the locomotive +muscles, and the former of the exertions of the organs of sense; see Class +III. 1. 1. 9. and Sect. XIX. both which are mixed, or alternate with each +other, for the purpose of relieving pain. + +When the patients in reverie exert their volition on their organs of sense, +they can occasionally perceive the stimuli of external objects, as +explained in Sect. XIX. And in this case it resembles sometimes an +hallucination of the senses, as there is a mixture of fact and imagination +in their discourse; but may be thus distinguished: hallucinations of the +lenses are allied to delirium, and are attended generally with quick pulse, +and other symptoms of great debility; but reverie is without fever, and +generally alternates with convulsions; and so much intuitive analogy (see +Sect. XVII. 3. 7.) is retained in its paroxysms, as to preserve a +consistency in the trains of ideas. + +Miss G----, whose case is related in Sect. III. 5. 8. said, as I once sat +by her, "My head is fallen off, see it is rolled to that corner of the +room, and the little black dog is nibbling the nose off." On my walking to +the place which she looked at, and returning, and assuring her that her +nose was unhurt, she became pacified, though I was doubtful whether she +attended to me. See Class III. 1. 1. 9. and Class III. 1. 2. 2. + +M. M. Large doses of opium given before the expected paroxysm, as in +epilepsia dolorifica, Class III. 1. 1. 8. + +The hallucinatio studiosa, or false ideas in reverie, differ from maniacal +hallucinations above described, as no insane exertions succeed, and in the +patients whom I have seen they have always been totally forgotten, when the +paroxysm was over. + +Master ----, a school-boy about twelve years old, after he came out of a +convulsion fit and sat up in bed, said to me, "Don't you see my father +standing at the feet of the bed, he is come a long way on foot to see me." +I answered, no: "What colour is his coat!" He replied, "A drab colour." +"And what buttons?" "Metal ones," he answered, and added, "how sadly his +legs are swelled." In a few minutes he said, with apparent surprise, "He is +gone," and returned to his perfect mind. Other cases are related in Sect. +XIX. and XXXIV. 3. and in Class III. 1. 2. 2. with further observations on +this kind of hallucination; which however is not the cause of reverie, but +constitutes a part of it, the cause being generally some uneasy sensation +of the body. + +3. _Vigilia._ Watchfulness consists in the unceasing exertion of volition; +which is generally caused by some degree of pain either of mind or of body, +or from defect of the usual quantity of pleasurable sensation; hence if +those, who are accustomed to wine at night, take tea instead, they cannot +sleep. The same happens from want of solid food for supper, to those who +are accustomed to use it; as in these cases there is pain or defect of +pleasure in the stomach. + +Sometimes the anxiety about sleeping, that is the desire to sleep, prevents +sleep; which consists in an abolition of desire or will. This may so far be +compared to the impediment of speech described in Sect. XVII. 1. 10. as the +interference of the will prevents the effect desired. + +Another source of watchfulness may be from the too great secretion of +sensorial power in the brain, as in phrenzy, and as sometimes happens from +the exhibition of opium, and of wine; if the exhaustion of sensorial power +by the general actions of the system occasioned by the stimulus of these +drugs can be supposed to be less than the increased secretion of it. + +M. M. 1. Solid food to supper. Wine. Opium. Warm bath. 2. The patient +should be told that his want of sleep is of no consequence to his health. +3. Venesection by cupping. Abstinence from wine. 4. A blister by +stimulating the skin, and rhubarb by stimulating the bowels, will sometimes +induce sleep. Exercise. An uniform sound, as of a pausing drop of water, or +the murmur of bees. Other means are described in Sect. XVIII. 20. + +4. _Erotomania._ Sentimental love. Described in its excess by +romance-writers and poets. As the object of love is beauty, and as our +perception of beauty consists in a recognition by the sense of vision of +those objects, which have before inspired our love, by the pleasure they +have afforded to many of our senses (Sect. XVI. 6); and as brute animals +have less accuracy of their sense of vision than mankind (ib.); we see the +reason why this kind of love is not frequently observable in the brute +creation, except perhaps in some married birds, or in the affection of the +mother to her offspring. Men, who have not had leisure to cultivate their +taste for visible objects, and who have not read the works of poets and +romance-writers, are less liable to sentimental love; and as ladies are +educated rather with an idea of being chosen, than of choosing; there are +many men, and more women, who have not much of this insanity; and are +therefore more easily induced to marry for convenience or interest, or from +the flattery of one sex to the other. + +In its fortunate gratification sentimental love is supposed to supply the +purest source of human felicity; and from the suddenness with which many of +those patients, described in Species I. of this genus, were seized with the +maniacal hallucination, there is reason to believe, that the most violent +sentimental love may be acquired in a moment of time, as represented by +Shakespeare in the beginning of his Romeo and Juliet. + +Some have endeavoured to make a distinction between beauty and grace, and +have made them as it were rivals for the possession of the human heart; but +grace may be defined beauty in action; for a sleeping beauty cannot be +called graceful in whatever attitude she may recline; the muscles must be +in action to produce a graceful attitude, and the limbs to produce a +graceful motion. But though the object of love is beauty, yet the idea is +nevertheless much enhanced by the imagination of the lover; which appears +from this curious circumstance, that the lady of his passion seldom appears +so beautiful to the lover after a few months separation, as his ideas had +painted her in his absence; and there is, on that account, always a little +disappointment felt for a minute at their next interview from this +hallucination of his ideas. + +This passion of love produces reverie in its first state, which exertion +alleviates the pain of it, and by the assistance of hope converts it into +pleasure. Then the lover seeks solitude, lest this agreeable reverie should +be interrupted by external stimuli, as described by Virgil. + + Tantum inter densas, umbrosa cacumina, fagos + Assidue veniebat, ibi haec incondita solus + Montibus et sylvis studio jactabat inani. + +When the pain of love is so great, as not to be relieved by the exertions +of reverie, as above described; as when it is misplaced on an object, of +which the lover cannot possess himself; it may still be counteracted or +conquered by the stoic philosophy, which strips all things of their +ornaments, and inculcates "nil admirari." Of which lessons may be found in +the meditations of Marcus Antoninus. The maniacal idea is said in some +lovers to have been weakened by the action of other very energetic ideas; +such as have been occasioned by the death of his favourite child, or by the +burning of his house, or by his being shipwrecked. In those cases the +violence of the new idea for a while expends so much sensorial power as to +prevent the exertion of the maniacal one; and new catenations succeed. On +this theory the lover's leap, so celebrated by poets, might effect a cure, +if the patient escaped with life. + +The third stage of this disease I suppose is irremediable; when a lover has +previously been much encouraged, and at length meets with neglect or +disdain; the maniacal idea is so painful as not to be for a moment +relievable by the exertions of reverie, but is instantly followed by +furious or melancholy insanity; and suicide, or revenge, have frequently +been the consequence. As was lately exemplified in Mr. Hackman, who shot +Miss Ray in the lobby of the playhouse. So the poet describes the passion +of Dido, + + ----------Moriamur inultae?-- + At moriamur, ait,--sic, sic, juvat ire sub umbras! + +The story of Medaea seems to have been contrived by Ovid, who was a good +judge of the subject, to represent the savage madness occasioned by +ill-requited love. Thus the poet, + + Earth has no rage like love to hatred turn'd, + Nor hell a fury like a woman scorn'd. + DRYDEN. + +5. _Amor sui._ Vanity consists of an agreeable reverie, and is well +ridiculed in the story of Narcissus, who so long contemplated his own +beautiful image in the water, that he died from neglect of taking +sustenance. I once saw a handsome young man, who had been so much flattered +by his parents, that his vanity rose so near to insanity, that one might +discern by his perpetual attention to himself, and the difficulty with +which he arranged his conversation, that the idea of himself intruded +itself at every comma or pause of his discourse. In this degree vanity must +afford great pleasure to the possessor; and when it exists within moderate +bounds, may contribute much to the happiness of social life. + +My friend Mr. ---- once complained to me, that he was much troubled with +bashfulness in company, and believed that it arose from his want of +personal vanity; on this account he determined on a journey to Paris, when +Paris was the center of politeness; he there learnt to dress, to dance, and +to move his hands gracefully in conversation; and returned a most +consummate coxcomb. But after a very few years he relapsed into rusticity +of dress and manners. + +M. M. The cure of vanity may be attempted by excess of flattery, which will +at length appear ridiculous, or by its familiarity will cease to be +desired. I remember to have heard a story of a nobleman in the court of +France, when France had a court, who was so disagreeably vain in +conversation, that the king was pleased to direct his cure, which was thus +performed. Two gentlemen were directed always to attend him, one was to +stand behind his chair, and the other at a respectful distance before him; +whenever his lordship began to speak, one of them always pronounced, "Lord +Gallimaufre is going to say the best thing in the world." And, as soon as +his lordship had done speaking, the other attendant pronounced, "Lord +Gallimaufre has spoken the best thing in the world." Till in a few weeks +this noble lord was so disgusted with praise that he ceased to be vain; and +his majesty dismissed his keepers. + +6. _Nostalgia._ Maladie de Pais. Calenture. An unconquerable desire of +returning to one's native country, frequent in long voyages, in which the +patients become so insane as to throw themselves into the sea, mistaking it +for green fields or meadows. The Swiss are said to be particularly liable +to this disease, and when taken into foreign service frequently to desert +from this cause, and especially after hearing or singing a particular tune, +which was used in their village dances, in their native country, on which +account the playing or singing this tune was forbid by the punishment of +death. Zwingerus. + + Dear is that shed, to which his soul conforms, + And dear that hill, which lifts him to the storms. + GOLDSMITH. + +7. _Spes religiosa._ Superstitious hope. This maniacal hallucination in its +milder state produces, like sentimental love, an agreeable reverie; but +when joined with works of supererogation, it has occasioned many +enormities. In India devotees consign themselves by vows to most painful +and unceasing tortures, such as holding up their hands, till they cannot +retract them; hanging up by hooks put into the thick skin over their +shoulders, sitting upon sharp points, and other self torments. While in our +part of the globe fasting and mortification, as flagellation, has been +believed to please a merciful deity! The serenity, with which many have +suffered cruel martyrdoms, is to be ascribed to this powerful reverie. + +Mr. ----, a clergyman, formerly of this neighbourhood, began to bruise and +wound himself for the sake of religious mortification, and passed much time +in prayer, and continued whole nights alone in the church. As he had a wife +and family of small children, I believed the case to be incurable; as +otherwise the affection and employment in his family connections would have +opposed the beginning of this insanity. He was taken to a madhouse without +effect, and after he returned home, continued to beat and bruise himself, +and by this kind of mortification, and by sometimes long fasting, he at +length became emaciated and died. I once told him in conversation, that +"God was a merciful being, and could not delight in cruelty, but that I +supposed he worshipped the devil." He was struck with this idea, and +promised me not to beat himself for three days, and I believe kept his word +for one day. If this idea had been frequently forced on his mind, it might +probably have been of service. + +When these works of supererogation have been of a public nature, what +cruelties, murders, massacres, has not this insanity introduced into the +world!--A commander, who had been very active in leading and encouraging +the bloody deeds of St. Bartholomew's day at Paris, on confessing his sins +to a worthy ecclesiastic on his death-bed, was asked, "Have you nothing to +say about St. Bartholomew?" "On that day," he replied, "God Almighty was +obliged to me!"--The fear of hell is another insanity, which will be spoken +of below. + +8. _Superbia stemmatis._ Pride of family has frequently formed a maniacal +hallucination, which in its mild state has consisted in agreeable reverie, +but when it has been so painful as to demand homage from others, it has +frequently induced insane exertions. This insanity seems to have existed in +the flourishing state of Rome, as now all over Germany, and is attacked by +Juvenal with great severity, a small part of which I shall here give as a +method of cure. Sat. 8. + + Say, what avails the pedigree, that brings + Thy boasted line from heroes or from kings; + Though many a mighty lord, in parchment roll'd, + Name after name, thy coxcomb hands unfold; + Though wreathed patriots crowd thy marble halls, + Or steel-clad warriors frown along the walls; + While on broad canvas in the gilded frame + All virtues flourish, and all glories flame?-- + Say,--if ere noon with idiot laugh you lie + Wallowing in wine, or cog the dubious die, + Or act unshamed, by each indignant bust, + The midnight orgies of promiscuous lust!-- + Go, lead mankind to Virtue's holy shrine, + With morals mend them, and with arts refine, + Or lift, with golden characters unfurl'd, + The flag of peace, and still a warring world!-- + --So shall with pious hands immortal Fame + Wreathe all her laurels round thy honour'd name, + High o'er thy tomb with chissel bold engrave, + "THE TRULY NOBLE ARE THE GOOD AND BRAVE." + +9. _Ambitio._ Inordinate desire of fame. A carelessness about the opinions +of others is said by Xenophon to be the source of impudence; certainly a +proper regard for what others think of us frequently incites us to virtuous +actions, and deters us from vicious ones; and increases our happiness by +enlarging our sphere of sympathy, and by flattering our vanity. + + Abstract what others feel, what others think, + All pleasures sicken, and all glories sink. + POPE. + +When this reverie of ambition excites to conquer nations, or to enslave +them, it has been the source of innumerable wars, and the occasion of a +great devastation of mankind. Caesar is reported to have boasted, that he +had destroyed three millions of his enemies, and one million of his +friends. + +The works of Homer are supposed to have done great injury to mankind by +inspiring the love of military glory. Alexander was said to sleep with them +always on his pillow. How like a mad butcher amid a flock of sheep appears +the hero of the Iliad, in the following fine lines of Mr. Pope, which +conclude the twentieth book. + + His fiery coursers, as the chariot rolls, + Tread down whole ranks, and crush out heroes' souls; + Dash'd from their hoofs, as o'er the dead they fly, + Black bloody drops the smoaking chariot dye;-- + The spiky wheels through heaps of carnage tore, + And thick the groaning axles dropp'd with gore; + High o'er the scene of death ACHILLES stood, + All grim with dust, all horrible with blood; + Yet still insatiate, still with rage on flame, + Such is the lust of never-dying fame! + +The cure must be taken from moral writers. Woolaston says, Caesar conquered +Pompey; that is, a man whose name consisted of the letters C. a. e. s. a. +r. conquered a long time ago a man, whose name consisted of the letters P. +o. m. p. e. y. and that this is all that remains of either of them. Juvenal +also attacks this mode of insanity, Sat. X. 166. + + --I, demens, et saevas curre per alpes, + Ut pueris placeas, et declamatio fias! + +Which is thus translated by Dr. Johnson, + + And left a name, at which the world grew pale, + To point a moral, or adorn a tale! + +10. _Maeror._ Grief. A perpetual voluntary contemplation of all the +circumstances of some great loss, as of a favourite child. In general the +painful ideas gradually decrease in energy, and at length the recollection +becomes more tender and less painful. The letter of Sulpicius to Cicero on +the loss of his daughter is ingenious. The example of David on the loss of +his child is heroic. + +A widow lady was left in narrow circumstances with a boy and a girl, two +beautiful and lively children, the one six and the other seven years of +age; as her circumstances allowed her to keep but one maid-servant, these +two children were the sole attention, employment, and consolation of her +life; she fed them, dressed them, slept with them, and taught them herself; +they were both snatched from her by the gangrenous sore throat in one week: +so that she lost at once all that employed her, as well as all that was +dear to her. For the first three or four days after their death, when any +friend visited her, she sat upright, with her eyes wide open, without +shedding tears, and affected to speak of indifferent things. Afterwards she +began to weep much, and for some weeks talked to her friends of nothing +else but her dear children. But did not for many years, even to her dying +hour, get quite over a gloom, which was left upon her countenance. + +In violent grief, when tears flow, it is esteemed a good symptom; because +then the actions caused by sensitive association take the place of those +caused by volition; that is, they prevent the voluntary exertions of ideas, +or muscular actions, which constitute insanity. + +The sobbing and sighing attendant upon grief are not convulsive movements, +they are occasioned by the sensorial power being so expended on the painful +ideas, and their connections, that the person neglects to breathe for a +time, and then a violent sigh or sob is necessary to carry on the blood, +which oppresses the pulmonary vessels, which is then performed by deep or +quick inspirations, and laborious expirations. Sometimes nevertheless the +breath is probably for a while voluntarily held, as an effort to relieve +pain. The paleness and ill health occasioned by long grief is spoken of in +Class IV. 2. 1. 9. + +The melioration of grief by time, and its being at length even attended +with pleasure, depends on our retaining a distinct idea of the lost object, +and forgetting for a time the idea of the loss of it. This pleasure of +grief is beautifully described by Akenside. Pleasures of Imagination, Book +II. l. 680. + + ----------Ask the faithful youth, + Why the cold urn of her, whom long he loved, + So often fills his arms; so often draws + His lonely footsteps at the silent hour + To pay the mournful tribute of his tears? + Oh! he will tell thee, that the wealth of worlds + Should ne'er seduce his bosom to forego + That sacred hour; when, stealing from the noise + Of care and envy, sweet remembrance soothes + With Virtue's kindest looks his aching breast, + And turns his tears to rapture. + +M. M. Consolation is best supplied by the Christian doctrine of a happy +immortality. In the pagan religion the power of dying was the great +consolation in irremediable distress. Seneca says, "no one need be unhappy +unless by his own fault." And the author of Telemachus begins his work by +saying, that Calypso could not console herself for the loss of Ulysses, and +found herself unhappy in being immortal. In the first hours of grief the +methods of consolation used by uncle Toby, in Tristram Shandy, is probably +the best; "he sat down in an arm chair by the bed of his distressed friend, +and said nothing." + +11. _Taedium vitae._ The inanity of sublunary things has afforded a theme +to philosophers, moralists, and divines, from the earliest records of +antiquity; "Vanity of vanities!" says the preacher, "all is vanity!" Nor is +there any one, I suppose, who has passed the meridian of life, who has not +at some moments felt the nihility of all things. + +Weariness of life in its moderate degree has been esteemed a motive to +action by some philosophers. See Sect. XXXIV. 2. 3. But in those men, who +have run through the usual amusements of life early in respect to their +age; and who have not industry or ability to cultivate those sciences, +which afford a perpetual fund of novelty, and of consequent entertainment, +are liable to become tired of life, as they suppose there is nothing new to +be found in it, that can afford them pleasure; like Alexander, who is said +to have shed tears, because he had not another world to conquer. + +Mr. ----, a gentleman about fifty, of polished manners, who in a few months +afterwards destroyed himself, said to me one day, "a ride out in the +morning, and a warm parlour and a pack of cards in the afternoon, is all +that life affords." He was persuaded to have an issue on the top of his +head, as he complained of a dull head-ach, which being unskilfully managed, +destroyed the pericranium to the size of an inch in diameter; during the +time this took in healing, he was indignant about it, and endured life, but +soon afterwards shot himself. + +Mr. ----, a gentleman of Gray's Inn, some years ago was prevailed upon by +his friends to dismiss a mistress, by whom he had a child, but who was so +great a termagant and scold, that she was believed to use him very ill, and +even to beat him. He became melancholy in two days from the want of his +usual stimulus to action, and cut his throat on the third so completely, +that he died immediately. + +Mr. Anson, the brother to the late Lord Anson, related to me the following +anecdote of the death of Lord Sc----. His Lordship sent to see Mr. Anson on +the Monday preceding his death, and said, "You are the only friend I value +in the world, I determined therefore to acquaint you, that I am tired of +the insipidity of life, and intend to-morrow to leave it." Mr. Anson said, +after much conversation, that he was obliged to leave town till Friday, and +added, "As you profess a friendship for me, do me this last favour, I +entreat you, live till I return." Lord Sc---- believed this to be a pious +artifice to gain time, but nevertheless agreed, if he should return by four +o'clock on that day. Mr. Anson did not return till five, and found, by the +countenances of the domestics, that the deed was done. He went into his +chamber and found the corpse of his friend leaning over the arm of a great +chair, with the pistol on the ground by him, the ball of which had been +discharged into the roof of his mouth, and passed into his brain. + +Mr. ---- and Mr. ----, two young men, heirs to considerable fortunes, shot +themselves at the age of four or five and twenty, without their friends +being able to conjecture any cause for those rash actions. One of them I +had long known to express himself with dissatisfaction of the world; at +eighteen years of age he complained, that he could not entertain himself; +he tried to study the law at Cambridge, and afterwards went abroad for a +year or two by my advice; but returned dissatisfied with all things. As he +had had an eruption for some years on a part of his face, which he probably +endeavoured to remove by external applications; I was induced to ascribe +his perpetual ennui to the pain or disagreeable sensation of a diseased +liver. The other young gentleman shot himself in his bed-room, and I was +informed that there was found written on a scrap of paper on his table, "I +am impotent, and therefore not fit to live." From whence there was reason +to conclude, that this was the hallucinatio maniacalis, the delirious idea, +which caused him to destroy himself. The case therefore belongs to mania +mutabilis, and not to taedium vitae. + +M. M. Some restraint in exhausting the usual pleasures of the world early +in life. The agreeable cares of a matrimonial life. The cultivation of +science, as of chemistry, natural philosophy, natural history, which +supplies an inexhaustible source of pleasurable novelty, and relieves ennui +by the exertions it occasions. + +In many of these cases, whence irksomeness of life has been the ostensible +cause of suicide, there has probably existed a maniacal hallucination, a +painful idea, which the patient has concealed even to his dying hour; +except where the mania has evidently arisen from hereditary or acquired +disease of the membranous or glandular parts of the system. + +12. _Pulchritudinis desiderium._ The loss of beauty, either by disease, as +by the small-pox, or by age, as life advances, is sometimes painfully felt +by ladies, who have been much flattered on account of it. There is a +curious case of this kind related in Le Sage's Bachelor of Salamanca, which +is too nicely described to be totally imaginary. + +In this situation some ladies apply to what are termed cosmetics under +various names, which crowd the newspapers. Of these the white has destroyed +the health of thousands; a calx, or magistery, of bismuth is supposed to be +sold in the shops for this purpose; but it is either, I am informed, in +part or entirely white lead or cerussa. The pernicious effects of the +external use of those saturnine applications are spoken of in gutta rosea, +Class II. 1. 4. 6. The real calx of bismuth would probably have the same +ill effect. As the red paint is prepared from cochineal, which is an animal +body, less if any injury arises from its use, as it only lies on the skin +like other filth. + +The tan of the skin occasioned by the sun may be removed by lemon juice +evaporated by the fire to half its original quantity, or by diluted marine +acid; which cleans the cuticle, by eroding its surface, but requires much +caution in the application; the marine acid must be diluted with water, and +when put upon the hand or face, after a second of time, as soon as the tan +disappears, the part must be washed with a wet towel and much warm water. +Freckles lie too deep for this operation, nor are they in general +removeable by a blister, as I once experienced. See Class I. 2. 2. 9. + +It is probable, that those materials which stain silk, or ivory, might be +used to stain the cuticle, or hair, permanently; as they are all animal +substances. But I do not know, that any trials of this kind have been made +on the skin. I endeavoured in vain to whiten the back of my hand by marine +acid oxygenated by manganese, which so instantly whitens cotton. + +The cure therefore must be sought from moral writers, and the cultivation +of the graces of the mind, which are frequently a more valuable possession +than celebrated beauty. + +13. _Paupertatis timor._ The fear of poverty is one kind of avarice; it is +liable to affect people who have left off a profitable and active business; +as they are thus deprived of their usual exertions, and are liable to +observe the daily expenditure of money, without calculating the source from +whence it flows. It is also liable to occur with a sudden and unexpected +increase of fortune. Mr. ----, a surgeon, about fifty years of age, who was +always rather of a parsimonious disposition, had a large house, with a +fortune of forty thousand pounds, left him by a distant relation; and in a +few weeks became insane from the fear of poverty, lamenting that he should +die in a jail or workhouse. He had left off a laborious country business, +and the daily perception of profit in his books; he also now saw greater +expences going forwards in his new house, than he had been accustomed to +observe, and did not so distinctly see the source of supply; which seems to +have occasioned the maniacal hallucination.--This idea of approaching +poverty is a very frequent and very painful disease, so as to have induced +many to become suicides, who were in good circumstances; more perhaps than +any other maniacal hallucination, except the fear of hell. + +The covetousness of age is more liable to affect single men, than those who +have families; though an accumulation of wealth would seem to be more +desirable to the latter. But an old man in the former situation, has no +personal connections to induce him to open his purse; and having lost the +friends of his youth, and not easily acquiring new ones, feels himself +alone in the world; feels himself unprotected, as his strength declines, +and is thus led to depend for assistance on money, and on that account +wishes to accumulate it. Whereas the father of a family has not only those +connections, which demand the frequent expenditure of money, but feels a +consolation in the friendship of his children, when age may render their +good offices necessary to him. + +M. M. I have been well informed of a medical person in good circumstances +in London, who always carries an account of his affairs, as debtor and +creditor, in his pocket-book; and looks over it frequently in a day, when +this disease returns upon him; and thus, by counteracting the maniacal +hallucination, wisely prevents the increase of his insanity. Another +medical person, in London, is said to have cured himself of this disease by +studying mathematics with great attention; which exertions of the mind +relieved the pain of the maniacal hallucination. + +Many moral writers have stigmatised this insanity; the covetous, they say, +commit crimes and mortify themselves without hopes of reward; and thus +become miserable both in this world and the next. Thus Juvenal: + + Cum furor haud dubius, cum sit manifesta phrenitis, + Ut locuples moriaris, egenti vivere fato! + +The covetous man thought he gave good advice to the spendthrift, when he +said, "Live like me," who well answered him, + + ----------"Like you, Sir John? + "That I can do, when all I have is gone!" + POPE. + +14. _Lethi timor._ The fear of death perpetually employs the thoughts of +these patients; hence they are devising new medicines, and applying to +physicians and quacks without number. It is confounded with +hypochondriasis, Class I. 2. 4. 10. in popular conversation, but is in +reality an insanity. + +A young gentleman, whom I advised to go abroad as a cure for this disease, +assured me, that during the three years he was in Italy and France he never +passed a quarter of an hour without fearing he should die. But has now for +above twenty years experienced the contrary. + +The sufferers under this malady are generally at once discoverable by their +telling you, amidst an unconnected description of their complaints, that +they are nevertheless not afraid of dying. They are also easily led to +complain of pains in almost any part of the body, and are thus soon +discovered. + +M. M. As the maniacal hallucination has generally arisen in early infancy +from some dreadful account of the struggles and pain of dying, I have +sometimes observed, that these patients have received great consolation +from the instances I have related to them of people dying without pain. +Some of these, which I think curious, I shall concisely relate, as a part +of the method of cure. + +Mr. ----, an elderly gentleman, had sent for me one whole day before I +could attend him; on my arrival he said he was glad to see me, but that he +was now quite well, except that he was weak, but had had a pain in his +bowels the day before. He then lay in bed with his legs cold up to the +knees, his hands and arms cold, and his pulse scarcely discernible, and +died in about six hours. Mr. ----, another gentleman about sixty, lay in +the act of dying, with difficult respiration like groaning, but in a kind +of stupor or coma vigil, and every ten or twelve minutes, while I sat by +him, he waked, looked up, and said, "who is it groans so, I am sure there +is somebody dying in the room," and then sunk again into a kind of sleep. +From these two cases there appeared to be no pain in the act of dying, +which may afford consolation to all, but particularly to those who are +afflicted with the fear of death. + +15. _Orci timor._ The fear of hell. Many theatric preachers among the +Methodists successfully inspire this terror, and live comfortably upon the +folly of their hearers. In this kind of madness the poor patients +frequently commit suicide; although they believe they run headlong into the +hell, which they dread! Such is the power of oratory, and such the debility +of the human understanding! + +Those, who suffer under this insanity, are generally the most innocent and +harmless people; who are then liable to accuse themselves of the greatest +imaginary crimes, and have so much intellectual cowardice, that they dare +not reason about those things, which they are directed by their priests to +believe, however contradictory to human apprehension, or derogatory to the +great Creator of all things. The maniacal hallucination at length becomes +so painful, that the poor insane flies from life to become free from it. + +M. M. Where the intellectual cowardice is great, the voice of reason is +ineffectual; but that of ridicule may save many from those mad-making +doctors; though it is too weak to cure those, who are already hallucinated. +Foot's Farces are recommended for this purpose. + +16. _Satyriasis._ An ungovernable desire of venereal indulgence. The remote +cause is probably the stimulus of the semen; whence the phallus becomes +distended with blood by the arterial propulsion of it being more strongly +excited than the correspondent venous absorption. At the same time a new +sense is produced in the other termination of the urethra; which, like +itching, requires some exterior friction to facilitate the removal of the +cause of the maniacal actions, which may probably be increased in those +cases by some associated hallucinations of ideas. It differs from +priapismus chronicus in the desire of its appropriated object, which is not +experienced in the latter, Class I. 1. 4. 6. and from the priapismus +amatorius, Class II. 1. 7. 9. in the maniacal actions in consequence of +desire. The furor uterius, or nymphomania, is a similar disease. + +M. M. Venesection. Cathartics. Torpentia. Marriage. + +17. _Ira._ Anger is caused by the pain of offended pride. We are not angry +at breaking a bone, but become quite insane from the smallest stroke of a +whip from an inferior. Ira furor brevis. Anger is not only itself a +temporary madness, but is a frequent attendant on other insanities, and as, +whenever it appears, it distinguishes insanity from delirium, it is +generally a good sign in fevers with debility. + +An injury voluntarily inflicted on us by others excites our exertions of +self-defence or of revenge against the perpetrator of it; but anger does +not succeed in any great degree unless our pride is offended; this idea is +the maniacal hallucination, the pain of which sometimes produces such +violent and general exertions of our muscles and ideas, as to disappoint +the revenge we meditate, and vainly to exhaust our sensorial power. Hence +angry people, if not further excited by disagreeable language, are liable +in an hour or two to become humble, and sorry for their violence, and +willing to make greater concessions than required. + +M. M. Be silent, when you feel yourself angry. Never use loud oaths, +violent upbraidings, or strong expressions of countenance, or +gesticulations of the arms, or clenched fists; as these by their former +associations with anger will contribute to increase it. I have been told of +a sergeant or corporal, who began moderately to cane his soldiers, when +they were awkward in their exercise, but being addicted to swearing and +coarse language, he used soon to enrage himself by his own expressions of +anger, till toward the end he was liable to beat the delinquents +unmercifully. + +18. _Rabies._ Rage. A desire of biting others, most frequently attendant on +canine madness. Animals in great pain, as in the colica saturnina, are said +to bite the ground they lie upon, and even their own flesh. I have seen +patients bite the attendants, and even their own arms, in the epilepsia +dolorifica. It seems to be an exertion to relieve pain, as explained in +Sect. XXXIV. 1. 3. The dread of water in hydrophobia is occasioned by the +repeated painful attempts to swallow it, and is therefore not an essential +or original part of the disease called canine madness. See Class III. 1. 1. +15. + +There is a mania reported to exist in some parts of the east, in which a +man is said to run a muck; and these furious maniacs are believed to have +induced their calamity by unlucky gaming, and afterwards by taking large +quantities of opium; whence the pain of despair is joined with the energy +of drunkenness; they are then said to sally forth into the most populous +streets, and to wound and slay all they meet, till they receive their own +death, which they desire to procure without the greater guilt, as they +suppose, of suicide. + +M. M. When there appears a tendency to bite in the painful epilepsy, the +end of a rolled-up towel, or a wedge of soft wood, should be put into the +mouth of the patient. As a bullet is said sometimes to be given to a +soldier, who is to be severely flogged, that he may by biting it better +bear his punishment. + +19. _Citta._ A desire to swallow indigestible substances. I once saw a +young lady, about ten years of age, who filled her stomach with the earth +out of a flower-pot, and vomited it up with small stones, bits of wood, and +wings of infects amongst it. She had the bombycinous complexion, and looked +like a chlorotic patient, though so young; this generally proceeds from an +acid in the stomach. + +M. M. A vomit. Magnesia alba. Armenian bole. Rhubarb. Bark. Steel. A +blister. See Class I. 2. 4. 5. + +20. _Cacositia._ Aversion to food. This may arise, without disease of the +stomach, from connecting nauseous ideas to our usual food, as by calling a +ham a hog's a----. This madness is much inculcated by the stoic philosophy. +See Antoninus' Meditations. See two cases of patients who refused to take +nourishment, Class III. 1. 2. 1. + +Aversions to peculiar kinds of food are thus formed early in life by +association of some maniacal hallucination with them. I remember a child, +who on tasting the gristle of sturgeon, asked what gristle was? And being +told it was like the division of a man's nose, received an ideal +hallucination; and for twenty years afterwards could not be persuaded to +taste sturgeon. + +The great fear or aversion, which some people experience at the sight of +spiders, toads, crickets, and the like, have generally had a similar +origin. + +M. M. Associate agreeable ideas with those which disgust; as call a spider +ingenious, a frog clean and innocent; and repress all expressions of +disgust by the countenance, as such expressions contribute to preserve, or +even to increase, the energy of the ideas associated with them; as +mentioned above in Species 17. Ira. + +21. _Syphilis imaginaria._ The fear that they are infested with the +venereal disease, when they have only deserved it, is a very common +insanity amongst modest young men; and is not to be cured without applying +artfully to the mind; a little mercury must be given, and hopes of a cure +added weekly and gradually by interview or correspondence for six or eight +weeks. Many of these patients have been repeatedly salivated without curing +the mind! + +22. _Psora imaginaria._ I have twice seen an imaginary itch, and twice an +imaginary diabaetes, where there was not the least vestige of either of +those diseases, and once an imaginary deafness, where the patient heard +perfectly well. In all these cases the hallucinated idea is so powerfully +excited, that it is not to be changed suddenly by occular sensation, or +reason. Yet great perseverance in the frequently presenting contrary ideas +will sometimes slowly remove this hallucination, or in great length of time +oblivion, or forgetfulness, performs a cure, by other means in vain +attempted. + +23. _Tabes imaginaria._ This imaginary disease, or hallucination, is caused +by the supposed too great frequency of parting with the semen, and had long +imposed upon the physician as well as the patient, till Mr. John Hunter +first endeavoured to shew, that in general the morbid effects of this +pollution was in the imagination; and that those were only liable to those +effects in general, who had been terrified by the villainous books, which +pretend to prevent or to cure it, but which were purposely written to vend +some quack medicine. Most of those unhappy patients, whom I have seen, had +evidently great impression of fear and self-condemnation on their minds, +and might be led to make contradictory complaints in almost any part of the +body, and if their confessions could be depended on, had not used this +pollution to any great excess. + +M. M. 1. Assure them if the loss of the semen happens but twice a week, it +will not injure them. 2. Marry them. The last is a certain cure; whether +the disease be real or imaginary. Cold partial bath, and astringent +medicines frequently taken, only recal the mind to the disease, or to the +delinquency; and thence increase the imaginary effects and the real cause, +if such exists. Mr. ---- destroyed himself to get free from the pain of +fear of the supposed ill consequences of self-pollution, without any other +apparent disease; whose parents I had in vain advised to marry him, if +possible. + +24. _Sympathia aliena._ Pity. Our sympathy with the pleasures and pains of +others distinguishes men from other animals; and is probably the foundation +of what is termed our moral sense and the source of all our virtues. See +Sect. XXII. 3. 3. When our sympathy with those miseries of mankind, which +we cannot alleviate, rises to excess, the mind becomes its own tormentor; +and we add to the aggregate sum of human misery, which we ought to labour +to diminish; as in the following eloquent lamentation from Akenside's +Pleasures of Imagination, Book II. 1. 200. + + ----------------Dark, + As midnight storms, the scene of human things + Appear'd before me; deserts, burning sands, + Where the parch'd adder dies; the frozen south; + And desolation blasting all the west + With rapine and with murder. Tyrant power + Here sits enthroned in blood; the baleful charms + Of superstition there infect the skies, + And turn the sun to horror. Gracious Heaven! + What is the life of man? Or cannot these, + Not these portents thy awful will suffice? + That, propagated thus beyond their scope, + They rise to act their cruelties anew + In my afflicted bosom, thus decreed + The universal sensitive of pain, + The wretched heir of evils not its own! + +A poet of antiquity, whose name I do not recollect, is said to have written +a book describing the miseries of the world, and to have destroyed himself +at the conclusion of his task. This sympathy, with all sensitive beings, +has been carried so far by some individuals, and even by whole tribes, as +the Gentoos, as not only to restrain them from killing animals for their +support, but even to induce them to permit insects to prey upon their +bodies. Such is however the condition of mortality, that the first law of +nature is, "Eat or be eaten." We cannot long exist without the destruction +of other animal or vegetable beings, either in their mature or their +embryon state. Unless the fruits, which surround the seeds of some +vegetables, or the honey stolen from them by the bee, may be said to be an +exception to this assertion. See Botanic Garden, P. I. Cant. I. l. 278. +Note. Hence, from the necessity of our nature, we may be supposed to have a +right to kill those creatures, which we want to eat, or which want to eat +us. But to destroy even insects wantonly shews an unreflecting mind or a +depraved heart. + +Nevertheless mankind may be well divided into the selfish and the social; +that is, into those whose pleasures arise from gratifying their appetites, +and those whose pleasures arise from their sympathizing with others. And +according to the prevalence of these opposing propensities we value or +dislike the possessor of them. + +In conducting the education of young people, it is a nice matter to inspire +them with so much benevolent sympathy, or compassion, as may render them +good and amiable; and yet not so much as to make them unhappy at the sight +of incurable distress. We should endeavour to make them alive to sympathize +with all remediable evils, and at the same time to arm them with fortitude +to bear the sight of such irremediable evils, as the accidents of life must +frequently present before their eyes. About this I have treated more at +large in a plan for the conduct of a boarding school for ladies, which I +intend to publish in the course of the next year. + +25. _Educatio heroica._ From the kinds and degrees of insanities already +enumerated, the reader will probably recollect many more from his own +observation; he will perceive that all extraordinary exertions of voluntary +action in consequence of some false idea or hallucination, which strongly +affects us, may philosophically, though not popularly, be termed an +insanity; he will then be liable to divide these voluntary exertions into +disagreeable, pernicious, detestable, or into meritorious, delectable, and +even amiable, insanities. And will lastly be induced to conceive, that a +good education consists in the art of producing such happy hallucinations +of ideas, as may be followed by such voluntary exertions, as may be termed +meritorious or amiable insanities. + +The old man of the mountain in Syria, who governed a small nation of people +called Assassines, is recorded thus to have educated those of his army who +were designed to assassinate the princes with whom he was at war. A young +man of natural activity was chosen for the purpose, and thrown into a deep +sleep by opium mixed with his food; he was then carried into a garden made +to represent the paradise of Mahomet, with flowers of great beauty and +fragrance, fruits of delicious flavor, and beautiful houries beckoning him +into the shades. After a while, on being a second time stupified with +opium, the young enthusiast was reconveyed to his apartment; and on the +next day was assured by a priest, that he was designed for some great +exploit, and that by obeying the commands of their prince, immortal +happiness awaited him. + +Hence it is easy to collect how the first impressions made on us by +accidental circumstances in our infancy continue through life to bias our +affections, or mislead our judgments. One of my acquaintance can trace the +origin of his own energies of action from some such remote sources; which +justifies the observation of M. Rousseau, that the seeds of future virtues +or vices are oftener sown by the mother, than the tutor. + + * * * * * + +ORDO II. + +_Decreased Volition._ + +GENUS I. + +_With decreased Actions of the Muscles._ + +Our muscles become fatigued by long contraction, and cease for a time to be +excitable by the will; owing to exhaustion of the sensorial power, which +resides in them. After a short interval of relaxation the muscle regains +its power of voluntary contraction; which is probably occasioned by a new +supply of the spirit of animation. In weaker people these contractions +cease sooner, and therefore recur more frequently, and are attended with +shorter intervals of relaxation, as exemplified in the quickness of the +pulse in fevers with debility, and in the tremors of the hands of aged or +feeble people. + +After a common degree of exhaustion of the sensorial power in a muscle, it +becomes again gradually restored by the rest of the muscle; and even +accumulated in those muscles, which are most frequently used; as in those +which constitute the capillaries of the skin after having been rendered +torpid by cold. But in those muscles, which are generally obedient to +volition, as those of locomotion, though their usual quantity of sensorial +power is restored by their quiescence, or in sleep (for sleep affects these +parts of the system only), yet but little accumulation of it succeeds. And +this want of accumulation of the sensorial power in these muscles, which +are chiefly subservient to volition, explains to us one cause of their +greater tendency to paralytic affection. + +It must be observed, that those parts of the system, which have been for a +time quiescent from want of stimulus, as the vessels of the skin, when +exposed to cold, acquire an accumulation of sensorial power during their +inactivity; but this does not happen at all, or in much less quantity, from +their quiescence after great expenditure of sensorial power by a previous +excessive stimulus, as after intoxication. In this case the muscles or +organs of sense gradually acquire their natural quantity of sensorial +power, as after sleep; but not an accumulation or superabundance of it. And +by frequent repetitions of exhaustion by great stimulus, these vessels +cease to acquire their whole natural quantity of sensorial power; as in the +schirrous stomach, and schirrous liver, occasioned by the great and +frequent stimulus of vinous spirit; which may properly be termed irritative +paralysis of those parts of the system. + +In the same manner in common palsies the inaction of the paralytic muscle +seems not to be owing to defect of the stimulus of the will, but to +exhaustion of sensorial power. Whence it frequently follows great exertion, +as in Sect. XXXIV. 1. 7. Thus some parts of the system may cease to obey +the will, as in common paralysis; others may cease to be obedient to +sensation, as in the impotency of age; others to irritation, as in +schirrous viscera; and others to association, as in impediment of speech; +yet though all these may become inexcitable, or dead, in respect to that +kind of stimulus, which has previously exhausted them, whether of volition, +or sensation, or irritation, or association, they may still in many cases +be excited by the others. + +SPECIES. + +1. _Lassitudo._ Fatigue or weariness after much voluntary exertion. From +the too great expenditure of sensorial power the muscles are with +difficulty brought again into voluntary contraction; and seem to require a +greater quantity or energy of volition for this purpose. At the same time +they still remain obedient to the stimulus of agreeable sensation, as +appears in tired dancers finding a renovation of their aptitude to motion +on the acquisition of an agreeable partner; or from a tired child riding on +a gold-headed cane, as in Sect. XXXIV. 2. 6. These muscles are likewise +still obedient to the sensorial power of association, because the motions, +when thus excited, are performed in their designed directions, and are not +broken into variety of gesticulation, as in St. Vitus's dance. + +A lassitude likewise frequently occurs with yawning at the beginning of +ague-fits; where the production of sensorial power in the brain is less +than its expenditure. For in this case the torpor may either originate in +the brain, or the torpor of some distant parts of the system may by +sympathy affect the brain, though in a less proportionate degree than the +parts primarily affected. + +2. _Vacillatio senilis._ Some elderly people acquire a see-saw motion of +their bodies from one side to the other, as they sit, like the oscillation +of a pendulum. By these motions the muscles, which preserve the +perpendicularity of the body, are alternately quiescent, and exerted; and +are thus less liable to fatigue or exhaustion. This therefore resembles the +tremors of old people above mentioned, and not those spasmodic movements of +the face or limbs, which are called tricks, described in Class IV. 1. 3. 2. +which originate from excess of sensorial power, or from efforts to relieve +disagreeable sensation, and are afterwards continued by habit. + +3. _Tremor senilis._ Tremor of old age consists of a perpetual trembling of +the hands, or of the head, or of other muscles, when they are exerted; and +is erroneously called paralytic; and seems owing to the small quantity of +animal power residing in the muscular fibres. These tremors only exist when +the affected muscles are excited into action, as in lifting a glass to the +mouth, or in writing, or in keeping the body upright; and cease again, when +no voluntary exertion is attempted, as in lying down. Hence these tremors +evidently originate from the too quick exhaustion of the lessened quantity +of the spirit of animation. So many people tremble from fear or anger, when +too great a part of the sensorial power is exerted on the organs of sense, +so as to deprive the muscles, which support the body erect, of their due +quantity. + +4. _Brachiorum paralysis._ A numbness of the arms is a frequent symptom in +hydrops thoracis, as explained in Class I. 2. 3. 14. and in Sect. XXIX. 5. +2.; it also accompanies the asthma dolorificum, Class III. 1. 1. 11. and is +owing probably to the same cause in both. In the colica saturnina a +paralysis affects the wrists, as appears on the patient extending his arm +horizontally with the palm downwards, and is often attended with a tumor on +the carpal or metacarpal bones. See Class IV. 1. 2. 10. + +Mr. M----, a miner and well-sinker, about three years ago, lost the power +of contracting both his thumbs; the balls or muscles of the thumbs are much +emaciated, and remain paralytic. He ascribes his disease to immersing his +hands too long in cold water in the execution of his business. He says his +hands had frequently been much benumbed before, so that he could not +without difficulty clench them; but that they recovered their motion, as +soon as they began to glow, after he had dried and covered them. + +In this case there existed two injurious circumstances of different kinds; +one the violent and continued action of the muscles, which destroys by +exhausting the sensorial power; and the other, the application of cold, +which destroys by defect of stimulus. The cold seems to have contributed to +the paralysis by its long application, as well as the continued exertion; +but as during the torpor occasioned by the exposure to cold, if the degree +of it be not so great as to extinguish life, the sensorial power becomes +accumulated; there is reason to believe, that the exposing a paralytic limb +to the cold for a certain time, as by covering it with snow or iced water +for a few minutes, and then covering it with warm flannel, and this +frequently repeated, might, by accumulation of sensorial power, contribute +to restore it to a state of voluntary excitability. As this accumulation of +sensorial power, and consequent glow, seems, in the present case, several +times to have contributed to restore the numbness or inability of those +muscles, which at length became paralytic. See Class I. 2. 3. 21. + +M. M. Ether externally. Friction. Saline warm bath. Electricity. + +5. _Raucedo paralytica._ Paralytic hoarseness consists in the almost total +loss of voice, which sometimes continues for months, or even years, and is +occasioned by inability or paralysis of the recurrent nerves, which serve +the muscles of vocality, by opening or closing the larynx. The voice +generally returns suddenly, even so as to alarm the patient. A young lady, +who had many months been affected with almost a total loss of voice, and +had in vain tried variety of advice, recovered her voice in an instant, on +some alarm as she was dancing at an assembly. Was this owing to a greater +exertion of volition than usual? like the dumb young man, the son of +Croesus, who is related to have cried out, when he saw his father's life +endangered by the sword of his enemy, and to have continued to speak ever +afterwards. Two young ladies in this complaint seemed to be cured by +electric shocks passed through the larynx every day for a fortnight. See +Raucedo catarrhalis, Class II. 1. 3. 5. + +M. M. An emetic. Electric shocks. Mustard-seed, a large spoonful swallowed +whole, or a little bruised, every morning. Valerian. Burnt sponge. Blisters +on each side of the larynx. Sea-bathing. A gargle of decoction of seneca. +Friction. Frequent endeavours to shout and sing. + +6. _Vesicae urinariae paralysis._ Paralysis of the bladder is frequently a +symptom in inirritative fever; in this case the patient makes no water for +a day or two; and the tumor of the bladder distended with urine may be seen +by the shape of the abdomen, as if girt by a cord below the navel, or +distinguished by the hand. Many patients in this situation make no +complaint, and suffer great injury by the inattention of their attendants; +the water must be drawn off once or twice a day by means of a catheter, and +the region of the bladder gently pressed by the hand, whilst the patient be +kept in a sitting or erect posture. + +M. M. Bark. Wine. Opium, a quarter of a grain every six hours. Balsam of +copaiva or of Peru. Tincture of cantharides 20 drops twice a day, or +repeated small blisters. + +7. _Recti paralysis._ Palsy of the rectum. The rectum intestinum, like the +urinary bladder in the preceding article, possesses voluntary power of +motion; though these volitions are at times uncontrollable by the will, +when the acrimony of the contained feces, or their bulk, stimulate it to a +greater degree. Hence it happens, that this part is liable to lose its +voluntary power by paralysis, but is still liable to be stimulated into +action by the contained feces. This frequently occurs in fevers, and is a +bad sign as a symptom of general debility; and it is the sensibility of the +muscular fibres of this and of the urinary bladder remaining, after the +voluntarity has ceased, which occasions these two reservoirs so soon to +regain, as the fever ceases, their obedience to volition; because the +paralysis is thus shewn to be less complete in those cases than in common +hemiplegia; as in the latter the sense of touch, though perhaps not the +sense of pain, is generally destroyed in the paralytic limb. + +M. M. A sponge introduced within the sphincter ani to prevent the constant +discharge, which should have a string put through it, by which it may be +retracted. + +8. _Paresis voluntaria._ Indolence; or inaptitude to voluntary action. This +debility of the exertion of voluntary efforts prevents the accomplishment +of all great events in life. It often originates from a mistaken education, +in which pleasure or flattery is made the immediate motive of action, and +not future advantage; or what is termed duty. This observation is of great +value to those, who attend to the education of their own children. I have +seen one or two young married ladies of fortune, who perpetually became +uneasy, and believed themselves ill, a week after their arrival in the +country, and continued so uniformly during their stay; yet on their return +to London or Bath immediately lost all their complaints, and this +repeatedly; which I was led to ascribe to their being in their infancy +surrounded with menial attendants, who had flattered them into the +exertions they then used. And that in their riper years, they became torpid +for want of this stimulus, and could not amuse themselves by any voluntary +employment; but required ever after, either to be amused by other people, +or to be flattered into activity. This I suppose, in the other sex, to have +supplied one source of ennui and suicide. + +9. _Catalepsis_ is sometimes used for fixed spasmodic contractions or +tetanus, as described in Sect. XXXIV. 1. 5. and in Class III. 1. 1. 13. but +is properly simply an inaptitude to muscular motion, the limbs remaining in +any attitude in which they are placed. One patient, whom I saw in this +situation, had taken much mercury, and appeared universally torpid. He sat +in a chair in any posture he was put, and held a glass to his mouth for +many minutes without attempting to drink, or withdrawing his hand. He never +spoke, and it was at first necessary to compel him to drink broth; he +recovered in a few weeks without relapse. + +10. _Hemiplegia._ Palsy of one side consists in the total disobedience of +the affected muscles to the power of volition. As the voluntary motions are +not perpetually exerted, there is little sensorial power accumulated during +their quiescence, whence they are less liable to recover from torpor, and +are thus more frequently left paralytic, or disobedient to the power of +volition, though they are sometimes still alive to painful sensation, as to +the prick of a pin, and to heat; also to irritation, as in stretching and +yawning; or to electric shocks. Where the paralysis is complete the patient +seems gradually to learn to use his limbs over again by repeated efforts, +as in infancy; and, as time is required for this purpose, it becomes +difficult to know, whether the cure is owing to the effect of medicines, or +to the repeated efforts of the voluntary power. + +The dispute, whether the nerves decussate or cross each other before they +leave the cavities of the skull or spine, seems to be decided in the +affirmative by comparative anatomy; as the optic nerves of some fish have +been shewn evidently to cross each other; as seen by Haller, Elem. Physiol. +t. v. p. 349. Hence the application of blisters, or of ether, or of warm +fomentations, should be on the side of the head opposite to that of the +affected muscles. This subject should nevertheless be nicely determined, +before any one should trepan for the hydrocephalus internus, when the +disease is shewn to exist only on one side of the brain, by a squinting +affecting but one eye; as proposed in Class I. 2. 5. 4. Dr. Sommering has +shewn, that a true decussation of the optic nerves in the human subject +actually exists, Elem. of Physiology by Blumenbach, translated by C. +Caldwell, Philadelphia. This further appears probable from the oblique +direction and insertion of each optic nerve, into the side of the eye next +to the nose, in a direct line from the opposite side of the brain. + +The vomiting, which generally attends the attack of hemiplegia, is +mentioned in Sect. XX. 8. and is similar to that attending vertigo in +sea-sickness, and at the commencement of some fevers. Black stools +sometimes attend the commencement of hemiplegia, which is probably an +effusion of blood from the biliary duct, where the liver is previously +affected; or some blood may be derived to the intestines by its escaping +from the vena cava into the receptacle of chyle during the distress of the +paralytic attack; and may be conveyed from thence into the intestines by +the retrograde motions of the lacteals; as probably sometimes happens in +diabaetes. See Sect. XXVII. 2. Palsy of one side of the face is mentioned +in Class II. 1. 4. 6. Paralysis of the lacteals, of the liver, and of the +veins, which are described in Sect. XXVIII. XXX. and XXVII. do not belong +to this class, as they are not diseases of voluntary motions. + +M. M. The electric sparks and shocks, if used early in the disease, are +frequently of service. A purge of aloes, or calomel. A vomit. Blister. +Saline draughts. Then the bark. Mercurial ointment or sublimate, where the +liver is evidently diseased; or where the gutta rosea has previously +existed. Sudden alarm. Frequent voluntary efforts. Externally ether. +Volatile alcali. Fomentation on the head. Friction. When children, who have +suffered an hemiplegia, begin to use the affected arm, the other hand +should be tied up for half an hour three or four times a day; which obliges +them at their play to use more frequent voluntary efforts with the diseased +limb, and thus sooner to restore the dissevered associations of motion. + +Dr. J. Alderson has lately much recommended the leaves of rhus toxicodendon +(sumach), from one gr. to iv. of the dried powder to be taken three or four +times a day. Essay on Rhus Toxic. Johnson, London, 1793. But it is +difficult to know what medicine is of service, as the movements of the +muscles must be learned, as in infancy, by frequent efforts. + +11. _Paraplegia._ A palsy of the lower half of the body divided +horizontally. Animals may be conceived to have double bodies, one half in +general resembling so exactly the other, and being supplied with separate +sets of nerves; this gives rise to hemiplegia, or palsy of one half of the +body divided vertically; but the paraplegia, or palsy of the lower parts of +the system, depends on an injury of the spinal marrow, or that part of the +brain which is contained in the vertebrae of the back; by which all the +nerves situated below the injured part are deprived of their nutriment, or +precluded from doing their proper offices; and the muscles, to which they +are derived, are in consequence disobedient to the power of volition. + +This sometimes occurs from an external injury, as a fall from an eminence; +of which I saw a deplorable instance, where the bladder and rectum, as well +as the lower limbs, were deprived of so much of their powers of motion, as +depended on volition or sensation; but I suppose not of that part of it, +which depends on irritation. In the same manner as the voluntary muscles in +hemiplegia are sometimes brought into action by irritation, as in +stretching or pendiculation, described in Sect. VII. 1. 3. + +But the most frequent cause of paraplegia is from a protuberance of one of +the spinal vertebrae; which is owing to the innutrition or softness of +bones, described in Class I. 2. 2. 17. The cure of this deplorable disease +is frequently effected by the stimulus of an issue placed on each side of +the prominent spine, as first published by Mr. Pott. The other means +recommended in softness of bones should also be attended to; both in +respect to the internal medicines, and to the mechanical methods of +supporting, or extending the spine; which last, however, in this case +requires particular caution. + +12. _Somnus._ In sleep all voluntary power is suspended, see Sect. XVIII. +An unusual quantity of sleep is often produced by weakness. In this case +small doses of opium, wine, and bark, may be given with advantage. For the +periods of sleep, see Class IV. 2. 4. 1. + +The subsequent ingenious observations on the frequency of the pulse, which +sometimes occurs in sleep, are copied from a letter of Dr. Currie of +Liverpool to the author. + + "Though rest in general perhaps renders the healthy pulse slower, yet + under certain circumstances the contrary is the truth. A full meal + without wine or other strong liquor does not increase the frequency of + my pulse, while I sit upright, and have my attention engaged. But if I + take a recumbent posture after eating, my pulse becomes more frequent, + especially if my mind be vacant, and I become drowsy; and, if I + slumber, this increased frequency is more considerable with heat and + flushing. + + "This I apprehend to be a general truth. The observation may be + frequently made upon children; and the restless and feverish nights + experienced by many people after a full supper are, I believe, owing to + this cause. The supper occasions no inconvenience, whilst the person is + upright and awake; but, when he lies down and begins to sleep, + especially if he does not perspire, the symptoms above mentioned occur. + Which may be thus explained in part from your principles. When the + power of volition is abolished, the other sensorial actions are + increased. In ordinary sleep this does not occasion increased frequency + of the pulse; but where sleep takes place during the process of + digestion, the digestion itself goes on with increased rapidity. Heat + is excited in the system faster than it is expended; and operating on + the sensitive actions, it carries them beyond the limitation of + pleasure, producing, as is common in such cases, increased frequency of + pulse. + + "It is to be observed, that in speaking of the heat generated under + these circumstances, I do not allude to any chemical evolution of heat + from the food in the process of digestion. I doubt if this takes place + to any considerable degree, for I do not observe that the parts + incumbent on the stomach are increased in heat during the most hurried + digestion. It is on some parts of the surface, but more particularly on + the extremities of the body, that the increased heat excited by + digestion appears, and the heat thus produced arises, as it should + seem, from the sympathy between the stomach and the vessels of the + skin. The parts most affected are the palms of the hands and the soles + of the feet. Even there the thermometer seldom rises above 97 or 98 + degrees, a temperature not higher than that of the trunk of the body; + but three or four degrees higher than the common temperature of these + parts, and therefore producing an uneasy sensation of heat, a sensation + increased by the great sensibility of the parts affected. + + "That the increased heat excited by digestion in sleep is the cause of + the accompanying fever, seems to be confirmed by observing, that if an + increased expenditure of heat accompanies the increased generation of + it (as when perspiration on the extremities or surface attends this + kind of sleep) the frequent pulse and flushed countenance do not occur, + as I know by experiment. If, during the feverish sleep already + mentioned, I am awakened, and my attention engaged powerfully, my pulse + becomes almost immediately slower, and the fever gradually subsides." + +From these observations of Dr. Currie it appears, that, while in common +sleep the actions of the heart, arteries, and capillaries, are strengthened +by the accumulation of sensorial power during the suspension of voluntary +action, and the pulse in consequence becomes fuller and slower; in the +feverish sleep above described the actions of the heart, arteries, and +capillaries, are quickened as well as strengthened by their consent with +the increased actions of the stomach, as well as by the stimulus of the new +chyle introduced into the circulation. For the stomach, and all other parts +of the system, being more sensible and more irritable during sleep, Sect. +XVIII. 15. and probably more ready to act from association, are now exerted +with greater velocity as well as strength, constituting a temporary fever +of the sensitive irritated kind, resembling the fever excited by wine in +the beginning of intoxication; or in some people by a full meal in their +waking hours. Sect. XXXV. 1. + +On waking, this increased sensibility and irritability of the system ceases +by the renewed exertions of volition; in the same manner as more violent +exertions of volition destroy greater pains; and the pulse in consequence +subsides along with the increase of heat; if more violent efforts of +volition are exerted, the system becomes still less affected by sensation +or irritation. Hence the fever and vertigo of intoxication are lessened by +intense thinking, Sect. XXI. 8; and insane people are known to bear the +pain of cold and hunger better than others, Sect. XXXIV. 2. 5; and lastly, +if greater voluntary efforts exist, as in violent anger or violent +exercise, the whole system is thrown into more energetic action, and a +voluntary fever is induced, as appears by the red skin, quickened pulse, +and increase of heat; whence dropsies and fevers with debility are not +unfrequently removed by insanity. + +Hence the exertion of the voluntary power in its natural degree diminishes +the increased sensibility, and irritability, and probably the increased +associability, which occurs during sleep; and thus reduces the frequency of +the pulse in the feverish sleep after a full meal. In its more powerful +state of exertion, it diminishes or destroys sensations and irritations, +which are stronger than natural, as in intoxication, or which precede +convulsions, or insanity. In its still more powerful degree, the +superabundance of this sensorial power actuates and invigorates the whole +moving system, giving strength and frequency to the pulse, and an universal +glow both of colour and of heat, as in violent anger, or outrageous +insanities. + +If, in the feverish sleep above described, the skin becomes cooled by the +evaporation of much perspirable matter, or by the application of cooler +air, or thinner clothes, the actions of the cutaneous capillaries are +lessened by defect of the stimulus of heat, which counteracts the increase +of sensibility during sleep, and the pulsations of the heart and arteries +become slower from the lessened stimulus of the particles of blood thus +cooled in the cutaneous and pulmonary vessels. Hence the admission of cold +air, or ablution with subtepid or with cold water, in fevers with hot skin, +whether they be attended with arterial strength, or arterial debility, +renders the pulse slower; in the former case by diminishing the stimulus of +the blood, and in the latter by lessening the expenditure of sensorial +power. See Suppl. I. 8. and 15. + +13. _Incubus._ The night-mare is an imperfect sleep, where the desire of +locomotion is vehement, but the muscles do not obey the will; it is +attended with great uneasiness, a sense of suffocation, and frequently with +fear. It is caused by violent fatigue, or drunkenness, or indigestible +food, or lying on the back, or perhaps from many other kinds of uneasiness +in our sleep, which may originate either from the body or mind. + +Now as the action of respiration is partly voluntary, this complaint may be +owing to the irritability of the system being too small to carry on the +circulation of the blood through the lungs during sleep, when the voluntary +power is suspended. Whence the blood may accumulate in them, and a painful +oppression supervene; as in some haemorrhages of the lungs, which occur +during sleep; and in patients much debilitated by fevers. See Somnus +interruptus, Class I. 2. 1. 3. and I. 2. 1. 9. + +Great fatigue with a full supper and much wine, I have been well informed +by one patient, always produced this disease in himself to a great degree. +Now the general irritability of the system is much decreased by fatigue, as +it exhausts the sensorial power; and secondly, too much wine and +stimulating food will again diminish the irritability of some parts of the +system, by employing a part of the sensorial power, which is already too +small, in digesting a great quantity of aliment; and in increasing the +motions of the organs of sense in consequence of some degree of +intoxication, whence difficulty of breathing may occur from the +inirritability of the lungs, as in Class I. 2. 1. 3. + +M. M. To sleep on a hard bed with the head raised. Moderate supper. The +bark. By sleeping on a harder bed the patient will turn himself more +frequently, and not be liable to sleep too profoundly, or lie too long in +one posture. To be awakened frequently by an alarm clock. + +14. _Lethargus._ The lethargy is a slighter apoplexy. It is supposed to +originate from universal pressure on the brain, and is said to be produced +by compressing the spinal marrow, where there is a deficiency of the bone +in the spina bifida. See Sect. XVIII. 20. Whereas in the hydrocephalus +there is only a partial pressure of the brain; and probably in nervous +fevers with stupor the pressure on the brain may affect only the nerves of +the senses, which lie within the skull, and not those nerves of the medulla +oblongata, which principally contribute to move the heart and arteries; +whence in the lethargic or apoplectic stupor the pulse is slow as in sleep, +whereas in nervous fever the pulse is very quick and feeble, and generally +so in hydrocephalus. + +In cases of obstructed kidneys, whether owing to the tubuli uriniferi being +totally obstructed by calculous matter, or by their paralysis, a kind of +drowsiness or lethargy comes on about the eighth or ninth day, and the +patient gradually sinks. See Class I. 1. 3. 9. + +15. _Syncope epileptica_, is a temporary apoplexy, the pulse continuing in +its natural state, and the voluntary power suspended. This terminates the +paroxysms of epilepsy. + +When the animal power is much exhausted by the preceding convulsions, so +that the motions from sensation as well as those from volition are +suspended; in a quarter or half an hour the sensorial power becomes +restored, and if no pain, or irritation producing pain, recurs, the fit of +epilepsy ceases; if the pain recurs, or the irritation, which used to +produce it, a new fit of convulsion takes place, and is succeeded again by +a syncope. See Epilepsy, Class III. 1. 1. 7. + +16. _Apoplexia._ Apoplexy may be termed an universal palsy, or a permanent +sleep. In which, where the pulse is weak, copious bleeding must be +injurious; as is well observed by Dr. Heberden, Trans. of the College. + +Mr. ----, about 70 years of age, had an apoplectic seizure. His pulse was +strong and full. One of the temporal arteries was opened, and about ten +ounces of blood suddenly taken from it. He seemed to receive no benefit +from this operation; but gradually sunk, and lived but a day or two. + +If apoplexy arises from the pressure of blood extravasated on the brain, +one moderate venesection may be of service to prevent the further effusion +of blood; but copious venesection must be injurious by weakening the +patient; since the effused blood must have time, as in common vibices or +bruises, to undergo a chemico-animal process, so to change its nature as to +fit it for absorption; which may take two or three weeks, which time a +patient weakened by repeated venesection or arteriotomy may not survive. + +Mrs. ----, about 40 years old, had an apoplectic seizure after great +exertion from fear; she had lain about 24 hours without speech, or having +swallowed any liquid. She was then forcibly raised in bed, and a spoonful +of solution of aloes in wine put into her mouth, and the end of the spoon +withdrawn, that she might more easily swallow the liquid.--This was done +every hour, with broth, and wine and water intervening, till evacuations +were procured; which with other means had good effect, and she recovered, +except that a considerable degree of hemiplegia remained, and some +imperfection of her speech. + +Many people, who have taken so much vinous spirit as to acquire the +temporary apoplexy of intoxication, and are not improperly said to be +dead-drunk, have died after copious venesection, I suppose in consequence +of it. I once saw at a public meeting two gentlemen in the drunken +apoplexy; they were totally insensible with low pulse, on this account they +were directed not to lose blood, but to be laid on a bed with their heads +high, and to be turned every half hour; as soon as they could swallow, warm +tea was given them, which evacuated their stomachs, and they gradually +recovered, as people do from less degrees of intoxication. + +M. M. Cupping on the occiput. Venesection once in moderate quantity. Warm +fomentations long continued and frequently repeated on the shaved head. +Solution of aloes. Clysters with solution of aloe and oil of amber. A +blister on the spine. An emetic. Afterwards the bark, and small doses of +chalybeates. Small electric shocks through the head. Errhines. If small +doses of opium? + +17. _Mors a frigore._ Death from cold. The unfortunate travellers, who +almost every winter perish in the snow, are much exhausted by their efforts +to proceed on their journey, as well as benumbed by cold. And as much +greater exercise can be borne without fatigue in cold weather than in warm; +because the excessive motions of the cutaneous vessels are thus prevented, +and the consequent waste of sensorial power; it may be inferred, that the +fatigued traveller becomes paralytic from violent exertion as well as by +the application of cold. + +Great degrees of cold affect the motions of those vessels most, which have +been generally excited into action by irritation; for when the feet are +much benumbed by cold, and painful, and at the same time almost insensible +to the touch of external objects, the voluntary muscles retain their +motions, and we continue to walk on; the same happens to the fingers of +children in throwing snow-balls, the voluntary motions of the muscles +continue, though those of the cutaneous vessels are benumbed into +inactivity. + +Mr. Thompson, an elderly gentleman of Shrewsbury, was seized with +hemiplegia in the cold bath; which I suppose might be owing to some great +energy of exertion, as much as to the coldness of the water. As in the +instance given of Mr. Nairn, who, by the exertion to save his relation, +perished himself. See Sect. XXXIV. 1. 7. + +Whence I conclude, that though heat is a fluid necessary to muscular +motion, both perhaps by its stimulus, and by its keeping the minute +component parts of the ultimate fibrils of the muscles or organs of sense +at a proper distance from each other; yet that paralysis, properly so +called, is the consequence of exhaustion of sensorial power by exertion. +And that the accumulations of it during the torpor of the cutaneous vessels +by exposure to cold, or of some internal viscus in the cold fits of agues, +are frequently instrumental in recovering the use of paralytic limbs, or of +the motions of other paralytic parts of the system. See Spec. 4. of this +genus. + +Animal bodies resist the power of cold probably by their exertions in +consequence of the pain of cold, see Botan. Gard. V. 1. additional note +xii. But if these increased exertions be too violent, so as to exhaust the +sensorial power in producing unnecessary motions, the animal will probably +sooner perish. Thus a moderate quantity of wine or spirit repeated at +proper intervals of time might be of service to those, who are long exposed +to excessive cold, both by increasing the action of the capillary vessels, +and thus producing heat, and perhaps by increasing in some degree the +secretion of sensorial power in the brain. But the contrary must happen +when taken immoderately, and not at due intervals. A well attested history +was once related to me of two men, who set out on foot to travel in the +snow, one of whom drank two or three glasses of brandy before they began +their journey, the other contented himself with his usual diet and +potation; the former of whom perished in spite of any assistance his +companion could afford him; and the other performed his journey with +safety. In this case the sensorial power was exhausted by the unnecessary +motions of incipient intoxication by the stimulus of the brandy, as well as +by the exertions of walking; which so weakened the dram-drinker, that the +cold sooner destroyed him; that is, he had not power to produce sufficient +muscular or arterial action, and in consequence sufficient heat, to supply +the great expenditure of it. Hence the capillaries of the skin first cease +to act, and become pale and empty; next those which are immediately +associated with them, as the extremities of the pulmonary artery, as +happens on going into the cold bath. By the continued inaction of these +parts of the vascular system the blood becomes accumulated in the internal +arteries, and the brain is supposed to be affected by its compression; +because these patients are said to sleep, or to become apoplectic, before +they die. I overtook a fishman asleep on his panniers on a very cold frosty +night, but on waking him he did not appear to be in any degree of stupor. +See Class I. 2. 2. 1. + +When travellers are benighted in deep snow, they might frequently be saved +by covering themselves in it, except a small aperture for air; in which +situation the lives of hares, sheep, and other animals, are so often +preserved. The snow, both in respect to its component parts, and to the air +contained in its pores, is a bad conductor of heat, and will therefore well +keep out the external cold; and as the water, when part of it dissolves, is +attracted into the pores of the remainder of it, the situation of an animal +beneath it is perfectly dry; and, if he is in contact with the earth, he is +in a degree of heat between 48, the medium heat of the earth, and 32, the +freezing point; that is, in 40 degrees of heat, in which a man thus covered +will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone, +Barometz, and Muschus. If these facts were more generally understood, it +might annually save the lives of many. + +After any part of the vascular system of the body has been long exposed to +cold, the sensorial power is so much accumulated in it, that on coming into +a warm room the pain of hotach is produced, and inflammation, and +consequent mortification, owing to the great exertion of those vessels, +when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence +the propriety of applying but very low degrees of heat to limbs benumbed +with cold at first, as of snow in its state of dissolving, which is at 32 +degrees of heat, or of very cold water. A French writer has observed, that +if frozen apples be thawed gradually by covering them with thawing snow, or +immersing them in very cold water, that they do not lose their taste; if +this fact was well ascertained, it might teach us how to preserve other +ripe fruits in ice-houses for winter consumption. + + * * * * * + +ORDO II. + +_Decreased Volition._ + +GENUS II. + +_With decreased Actions of the Organs of Sense._ + +SPECIES. + +1. _Recollectionis jactura._ Loss of recollection. This is the defect of +memory in old people, who forget the actions of yesterday, being incapable +of voluntary recollection, and yet remember those of their youth, which by +frequent repetition are introduced by association or suggestion. This is +properly the paralysis of the mind; the organs of sense do not obey the +voluntary power; that is, our ideas cannot be recollected, or acted over +again by the will. + +After an apoplectic attack the patients, on beginning to recover, find +themselves most at a loss in recollecting proper names of persons or +places; as those words have not been so frequently associated with the +ideas they stand for, as the common words of a language. Mr. ----, a man of +strong mind, of a short necked family, many of whom had suffered by +apoplexy, after an apoplectic fit on his recovering the use of speech, +after repeated trials to remember the name of a person or place, applauded +himself, when he succeeded, with such a childish smile on the partial +return of his sagacity, as very much affected me.--Not long, alas! to +return; for another attack in a few weeks destroyed the whole. + +I saw a child after the small-pox, which was left in this situation; it was +lively, active, and even vigorous; but shewed that kind of surprise, which +novelty excites, at every object it viewed; and that as often as it viewed +it. I never heard the termination of the case. + +2. _Stultitia voluntaria._ Voluntary folly. The absence of voluntary power +and consequent incapacity to compare the ideas of present and future good. +Brute animals may be said to be in this situation, as they are in general +excited into action only by their present painful or pleasurable +sensations. Hence though they are liable to surprise, when their passing +trains of ideas are dissevered by violent stimuli; yet are they not +affected with wonder or astonishment at the novelty of objects; as they +possess but in a very inferior degree, that voluntary power of comparing +the present ideas with those previously acquired, which distinguishes +mankind; and is termed analogical reasoning, when deliberatively exerted; +and intuitive analogy, when used without our attention to it, and which +always preserves our hourly trains of ideas consistent with truth and +nature. See Sect. XVII. 3. 7. + +3. _Credulitas._ Credulity. Life is short, opportunities of knowledge rare; +our senses are fallacious, our reasonings uncertain, mankind therefore +struggles with perpetual error from the cradle to the coffin. He is +necessitated to correct experiment by analogy, and analogy by experiment; +and not always to rest satisfied in the belief of facts even with this +two-fold testimony, till future opportunities, or the observations of +others, concur in their support. + +Ignorance and credulity have ever been companions, and have misled and +enslaved mankind; philosophy has in all ages endeavoured to oppose their +progress, and to loosen the shackles they had imposed; philosophers have on +this account been called unbelievers: unbelievers of what? of the fictions +of fancy, of witchcraft, hobgobblins, apparitions, vampires, fairies; of +the influence of stars on human actions, miracles wrought by the bones of +saints, the flights of ominous birds, the predictions from the bowels of +dying animals, expounders of dreams, fortune-tellers, conjurors, modern +prophets, necromancy, cheiromancy, animal magnetism, with endless variety +of folly? These they have disbelieved and despised, but have ever bowed +their hoary heads to Truth and Nature. + +Mankind may be divided in respect to the facility of their belief or +conviction into two classes; those, who are ready to assent to single facts +from the evidence of their senses, or from the serious assertions of +others; and those, who require analogy to corroborate or authenticate them. + +Our first knowledge is acquired by our senses; but these are liable to +deceive us, and we learn to detect these deceptions by comparing the ideas +presented to us by one sense with those presented by another. Thus when we +first view a cylinder, it appears to the eye as a flat surface with +different shades on it, till we correct this idea by the sense of touch, +and find its surface to be circular; that is, having some parts gradually +receding further from the eye than others. So when a child, or a cat, or a +bird, first sees its own image in a looking-glass, it believes that another +animal exists before it, and detects this fallacy by going behind the glass +to examine, if another tangible animal really exists there. + +Another exuberant source of error consists in the false notions, which we +receive in our early years from the design or ignorance of our instructors, +which affect all our future reasoning by their perpetual intrusions; as +those habits of muscular actions of the face or limbs, which are called +tricks, when contracted in infancy continue to the end of our lives. + +A third great source of error is the vivacity of our ideas of imagination, +which perpetually intrude themselves by various associations, and compose +the farrago of our dreams; in which, by the suspension of volition, we are +precluded from comparing the ideas of one sense with those of another, or +the incongruity of their successions with the usual course of nature, and +thus to detect their fallacy. Which we do in our waking hours by a +perpetual voluntary exertion, a process of the mind above mentioned, which +we have termed intuitive analogy. Sect. XVII. 3. 7. + +This analogy presupposes an acquired knowledge of things, hence children +and ignorant people are the most credulous, as not possessing much +knowledge of the usual course of nature; and secondly, those are most +credulous, whose faculty of comparing ideas, or the voluntary exertion of +it, is slow or imperfect. Thus if the power of the magnetic needle of +turning towards the north, or the shock given by touching both sides of an +electrized coated jar, was related for the first time to a philosopher, and +to an ignorant person; the former would be less ready to believe them, than +the latter; as he would find nothing similar in nature to compare them to, +he would again and again repeat the experiment, before he would give it his +entire credence; till by these repetitions it would cease to be a single +fact, and would therefore gain the evidence of analogy. But the latter, as +having less knowledge of nature, and less facility of voluntary exertion, +would more readily believe the assertions of others, or a single fact, as +presented to his own observation. Of this kind are the bulk of mankind; +they continue throughout their lives in a state of childhood, and have thus +been the dupes of priests and politicians in all countries and in all ages +of the world. + +In regard to religious matters, there is an intellectual cowardice +instilled into the minds of the people from their infancy; which prevents +their inquiry: credulity is made an indispensable virtue; to inquire or +exert their reason in religious matters is denounced as sinful; and in the +catholic church is punished with more severe penances than moral crimes. +But in respect to our belief of the supposed medical facts, which are +published by variety of authors; many of whom are ignorant, and therefore +credulous; the golden rule of David Hume may be applied with great +advantage. "When two miraculous assertions oppose each other, believe the +less miraculous." Thus if a person is said to have received the small-pox a +second time, and to have gone through all the stages of it, one may thus +reason: twenty thousand people have been exposed to the variolous contagion +a second time without receiving the variolous fever, to every one who has +been said to have thus received it; it appears therefore less miraculous, +that the assertor of this supposed fact has been deceived, or wishes to +deceive, than that it has so happened contrary to the long experienced +order of nature. + +M. M. The method of cure is to increase our knowledge of the laws of +nature, and our habit of comparing whatever ideas are presented to us with +those known laws, and thus to counteract the fallacies of our senses, to +emancipate ourselves from the false impressions which we have imbibed in +our infancy, and to set the faculty of reason above that of imagination. + + * * * * * + + +_The Orders and Genera of the Fourth Class of Diseases._ + +CLASS IV. + +DISEASES OF ASSOCIATION. + +ORDO I. + +_Increased Associate Motions._ + +GENERA. + + 1. Catenated with irritative motions. + 2. Catenated with sensitive motions. + 3. Catenated with voluntary motions. + 4. Catenated with external influences. + +ORDO II. + +_Decreased Associate Motions._ + +GENERA. + + 1. Catenated with irritative motions. + 2. Catenated with sensitive motions. + 3. Catenated with voluntary motions. + 4. Catenated with external influences. + +ORDO III. + +_Retrograde Associate Motions._ + +GENERA. + + 1. Catenated with irritative motions. + 2. Catenated with sensitive motions. + 3. Catenated with voluntary motions. + 4. Catenated with external influences. + + * * * * * + +_The Orders, Genera, and Species, of the Fourth Class of Diseases._ + + * * * * * + +CLASS IV. + +DISEASES OF ASSOCIATION. + +ORDO I. + +_Increased Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motions._ + +SPECIES. + + 1. _Rubor vultus pransorum._ Flushing of the face after dinner. + 2. _Sudor stragulis immersorum._ Sweat from covering the face + in bed. + 3. _Cessatio aegritudinis cute_ Cure of sickness by stimulating + _excitata._ the skin. + 4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of + the skin. + 5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. + 6. _Absorptio cellularis aucta_ Cellular absorption increased by + _vomitu._ vomiting. + 7. _Syngultus nephriticus._ Nephritic hiccough. + 8. _Febris irritativa._ Irritative fever. + +GENUS II. + +_Catenated with Sensitive Motions._ + +SPECIES. + + 1. _Lacrymarum fluxus_ Sympathetic tears. + _sympatheticus._ + 2. _Sternutatio a lumine._ Sneezing from light. + 3. _Dolor dentium a Stridore._ Tooth-edge from grating sounds. + 4. _Risus sardonicus._ Sardonic smile. + 5. _Salivae fluxus cibo viso._ Flux of saliva at sight of food. + 6. _Tensio mamularum viso puerulo._ Tension of the nipples of lactescent + women at sight of the child. + 7. _Tensio penis in hydrophobia._ Tension of the penis in hydrophobia. + 8. _Tenesmus calculosus._ Tenesmus from stone. + 9. _Polypus narium ex ascaride._ Polypus of the nose from ascarides. + 10. _Crampus surarum in diarrhoea._ Cramp from diarrhoea. + 11. _Zona ignea nephritica._ Nephritic shingles. + 12. _Eruptio variolarum._ Eruption of small-pox. + 13. _Gutta rosea stomatica._ Stomatic rosy drop. + 14. ---- _hepatica._ Hepatic rosy drop. + 15. _Podagra._ Gout. + 16. _Rheumatismus._ Rheumatism. + 17. _Erysipelas._ Erysipelas. + 18. _Testium tumor in gonorrhoea._ Swelled testis in gonorrhoea. + 19. ---- _in parotitide._ ---- in mumps. + +GENUS III. + +_Catenated with Voluntary Motions._ + +SPECIES. + + 1. _Deglutitio invita._ Involuntary deglutition. + 2. _Nictitatio invita._ ---- nictitation. + 3. _Risus invitus._ ---- laughter. + 4. _Lusus digitorum invitus._ ---- actions with the fingers. + 5. _Unguium morsiuncula invita._ ---- biting the nails. + 6. _Vigilia invita._ ---- watchfulness. + +GENUS IV. + +_Catenated with External Influences._ + +SPECIES. + + 1. _Vita ovi._ Life of an egg. + 2. _Vita hiemi-dormientium._ Life of winter-sleepers. + 3. _Pullulatio arborum._ Budding of trees. + 4. _Orgasmatis venerei periodus._ Periods of venereal desire. + 5. _Brachii concussio electrica._ Electric shock through the arm. + 6. _Oxygenatio sanguinis._ Oxygenation of the blood. + 7. _Humectatio corporis._ Humectation of the body. + +ORDO II. + +_Decreased Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motions._ + +SPECIES. + + 1. _Cutis frigida pransorum._ Chillness after dinner. + 2. _Pallor urinae pransorum._ Pale urine after dinner. + 3. ---- _a frigore cutaneo._ ---- from cold skin. + 4. _Pallor ex aegritudine._ Paleness from sickness. + 5. _Dyspnoea a balneo frigido._ Shortness of breath from cold + bathing. + 6. _Dyspepsia a pedibus frigidis._ Indigestion from cold feet. + 7. _Tussis a pedibus frigidis._ Cough from cold feet. + 8. ---- _hepatica._ Liver-cough. + 9. ---- _arthritica._ Gout-cough. + 10. _Vertigo rotatoria._ Vertigo rotatory. + 11. ---- _visualis._ ---- visual. + 12. ---- _ebriosa._ ---- inebriate. + 13. ---- _febriculosa._ ---- feverish. + 14. ---- _cerebrosa._ ---- from the brain. + 15. _Murmur aurium vertiginosum._ Noise in the ears. + 16. _Tactus, gustus, olfactus_ Vertiginous touch, taste, smell. + _vertiginosi._ + 17. _Pulsus mollis a vomitione._ Soft pulse in vomiting. + 18. ---- _intermittens a ventriculo._ Intermittent pulse from the + stomach. + 19. _Febris inirritativa._ Inirritative fever. + +GENUS II. + +_Catenated with Sensitive Motions._ + +SPECIES. + + 1. _Torpor genae a dolore dentis._ Coldness of the cheek from tooth-ach. + 2. _Stranguria a dolore vesicae._ Strangury from pain of the bladder. + 3. ---- _convulsiva._ Convulsive strangury. + 4. _Dolor termini ductus_ Pain of the end of the bile-duct. + _choledochi._ + 5. _Dolor pharyngis ab acido_ Pain of the throat from gastric acid. + _gastrico._ + 6. _Pruritus narium a vermibus._ Itching of the nose from worms. + 7. _Cephalaea._ Head-ach. + 8. _Hemicrania et otalgia._ Partial head-ach, and ear-ach. + 9. _Dolor humeri in hepatitide._ Pain of shoulder in hepatitis. + 10. _Torpor pedum variola_ Cold feet in eruption of small-pox. + _erumpente._ + 11. _Testium dolor nephriticus._ Nephritic pain of testis. + 12. _Dolor digiti minimi_ Pain of little finger from sympathy. + _sympatheticus._ + 13. _Dolor brachii in hydrope_ Pain of the arm in dropsy of the + _pectoris._ chest. + 14. _Diarrhoea a dentitione._ Diarrhoea from toothing. + +GENUS III. + +_Catenated with Voluntary Motions._ + +SPECIES. + + 1. _Titubatio linguae._ Impediment of speech. + 2. _Chorea sancti viti._ St. Vitus' dance. + 3. _Risus._ Laughter. + 4. _Tremor ex ira._ Trembling from anger. + 5. _Rubor ex ira._ Redness from anger. + 6. ---- _criminati._ Blush of guilt. + 7. _Tarditas paralytica._ Slowness from palsy. + 8. ---- _senilis._ ---- of age. + +GENUS IV. + +_Catenated with External Influences._ + +SPECIES. + + 1. _Somni periodus._ Periods of sleep. + 2. _Studii inanis periodus._ ---- of reverie. + 3. _Hemicraniae periodus._ ---- of head-ach. + 4. _Epilepsiae dolorificae periodus._ ---- of painful epilepsy. + 5. _Convulsionis dolorificae periodus._ ---- of painful convulsion. + 6. _Tussis periodicae periodus._ ---- of periodic cough. + 7. _Catameniae periodus._ ---- of catamenia. + 8. _Haemorrhoidis periodus._ ---- of the piles. + 9. _Podagrae periodus._ ---- of the gout. + 10. _Erysipelatis periodus._ ---- of erysipelas. + 11. _Febrium periodus._ ---- of fevers. + +ORDO III. + +_Retrograde Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motions._ + +SPECIES. + + 1. _Diabaetes irritata._ Diabetes from irritation. + 2. _Sudor frigidus in asthmate._ Cold sweat in asthma. + 3. _Diabaetes a timore._ Diabetes from fear. + 4. _Diarrhoea a timore._ Diarrhoea from fear. + 5. _Pallor et tremor a timore._ Paleness and trembling from fear. + 6. _Palpitatio cordis a timore._ Palpitation of the heart from fear. + 7. _Abortio a timore._ Abortion from fear. + 8. _Hysteria a timore._ Hysterics from fear. + +GENUS II. + +_Catenated with Sensitive Motions._ + +SPECIES. + + 1. _Nausea idealis._ Nausea from ideas. + 2. ---- _a conceptu._ Nausea from conception. + 3. _Vomitio vertiginosa._ Vomiting from vertigo. + 4. ---- _a calculo in uretere._ ---- from stone in the ureter. + 5. ---- _ab insultu paralytico._ ---- from stroke of palsy. + 6. ---- _a titilatione faucium._ ---- from tickling the throat. + 7. ---- _cute sympathetica._ ---- from sympathy with the skin. + +GENUS III. + +_Catenated with Voluntary Motions._ + +SPECIES. + + 1. _Ruminatio._ Rumination. + 2. _Vomitio voluntaria._ Voluntary vomiting. + 3. _Eructatio voluntaria._ ---- eructation. + +GENUS IV. + +_Catenated with External Influences._ + +SPECIES. + + 1. _Catarrhus periodicus._ Periodical catarrh. + 2. _Tussis periodica._ Periodic cough. + 3. _Histeria a frigore._ Hysterics from cold. + 4. _Nausea pluvialis._ Sickness against rain. + + * * * * * + +CLASS IV. + +DISEASES OF ASSOCIATION. + +ORDO I. + +_Increased Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motion._ + +The importance of the subsequent class not only consists in its elucidating +all the sympathetic diseases, but in its opening _a road to the knowledge +of fever_. The difficulty and novelty of the subject must plead in excuse +for the present imperfect state of it. The reader is entreated previously +to attend to the following circumstances for the greater facility of +investigating their intricate connections; which I shall enumerate under +the following heads. + + A. Associate motions distinguished from catenations. + B. Associate motions of three kinds. + C. Associations affected by external influences. + D. Associations affected by other sensorial motions. + E. Associations catenated with sensation. + F. Direct and reverse sympathy. + G. Associations affected four ways. + H. Origin of associations. + I. Of the action of vomiting. + K. Tertian associations. + +A. _Associate Motions distinguished from Catenations._ + +Associate motions properly mean only those, which are caused by the +sensorial power of association. Whence it appears, that those fibrous +motions, which constitute the introductory link of an associate train of +motions, are excluded from this definition, as not being themselves caused +by the sensorial power of association, but by irritation, or sensation, or +volition. I shall give for example the flushing of the face after dinner; +the capillary vessels of the face increase their actions in consequence of +their catenation, not their association, with those of the stomach; which +latter are caused to act with greater energy by the irritation excited by +the stimulus of food. These capillaries of the face are associated with +each other reciprocally, as being all of them excited by the sensorial +power of association; but they are only catenated with those of the +stomach, which are not in this case associate motions but irritative ones. +The common use of the word association for almost every kind of connection +has rendered this subject difficult; from which inaccuracy I fear some +parts of this work are not exempt. + +B. _Associate Motions of three Kinds._ + +Those trains or tribes of associate motions, whose introductory link +consists of an irritative motion, are termed irritative associations; as +when the muscles of the eyelids close the eye in common nictitation. Those, +whose introductory link consists of a sensitive motion, are termed +sensitive associations; as when the pectoral and intercostal muscles act in +sneezing. And lastly, those, whose introductory link consists of a +voluntary motion, are termed voluntary associations; as when the muscles of +the lower limbs act in concert with those of the arm in fencing. + +C. _Associations affected by external Influences._ + +Circles of associate motions, as well as trains and tribes of them, are +liable to be affected by external influences, which consist of etherial +fluids, and which, by penetrating the system, act upon it perhaps rather as +a causa sine qua non of its movements, than directly as a stimulus; except +when they are accumulated in unusual quantity. We have a sense adapted to +the perception of the excess or defect of one of these fluids; I mean that +of elementary heat; in which all things are immersed. See Class IV. 1. 4. +7. But there are others of them, which as we have no power to evade their +influence, so we have no sense to perceive it; these are the solar, and +lunar, and terrestrial gravitation, in which also all things are immersed; +the electric aura, which pervades us, and is perpetually varying, See Class +IV. 1. 4. 5; the magnetic fluid, Class IV. 1. 4. 5; and lastly, the great +life-preserver oxygen gas, and the aqueous vapour of the atmosphere, see +Class IV. 1. 4. 6. and 7. and 2. + +Of these external influences those of heat, and of gravity, have diurnal +periods of increase and decrease; besides their greater periods of monthly +or annual variation. The manner in which they act by periodical increments +on the system, till some effect is produced, is spoken of in Sect. XXXII. +3. and 6. + +D. _Associations affected by other Sensorial Motions._ + +Circles and trains of associate motions are also liable to be affected by +their catenations with other sensorial powers, as of irritation, or +sensation, or volition; which other sensorial powers either thus simply +form some of the links of the catenation, or add to the energy of the +associated motions. Thus when vomiting is caused by the stimulus of a stone +in the ureter, the sensation of pain seems to be a link of the catenation +rather than an efficient cause of the vomiting. But when the capillary +vessels of the skin increase their action from the influence of external +heat, they are excited both by the stimulus of unusual heat, as well as by +the stimulus of the blood, and by their accustomed association with the +actions of the heart and arteries. And lastly, in the blush of anger the +sensorial power of volition is added to that of association, and +irritation, to excite the capillaries of the face with increased action. +See Class IV. 2. 3. 5. + +E. _Associations catenated with Sensation._ + +Pain frequently accompanies associate trains or circles of motion without +its being a cause, or a link, of them, but simply an attendant symptom; +though it frequently gives name to the disease, as head-ach. Thus in the +cramp of the calves of the legs in diarrhoea, the increased sensorial power +of association is the proximate cause; the preceding increased action of +the bowels is the remote cause; and the proximate effect is the violent +contractions of the musculi gastrocnemii; but the pain of these muscles is +only an attendant symptom, or a remote effect. See Sect. XVIII. 15. Other +sensitive associations are mentioned in Class IV. 1. 2. and IV. 1. 2. 15. + +Thus, if the flushing of the face above mentioned after dinner be called a +disease, the immediate or proximate cause is the increased power of +association, the remote cause is the increased irritative motions of the +stomach in consequence of the stimulus of food and wine. The disease or +proximate effect consists in the increased actions of the cutaneous vessels +of the face; and the sensation of heat, the existence of heat, and the red +colour, are attendants or symptoms, or remote effects, of the increased +actions of these cutaneous vessels. + +F. _Direct and reverse Sympathy._ + +The increased actions of the primary part of the trains of associated +motions are sometimes succeeded by increased actions of the secondary part +of the train; and sometimes by decreased actions of it. So likewise the +decreased actions of the primary part of a train of associate motions are +sometimes succeeded by decreased actions of the secondary part, and +sometimes by increased actions of it. The former of these situations is +called direct sympathy, and the latter reverse sympathy. In general I +believe, where the primary part of the train of associated motions is +exerted more than natural, it produces direct sympathy in strong people, +and reverse sympathy in weak ones, as a full meal makes some people hot, +and others chill. And where the primary part of the train is exerted less +than natural, it produces direct sympathy in weak people, and reverse +sympathy in strong ones, as on being exposed for a certain length of time +on horseback in a cold day gives indigestion and consequent heart-burn to +weak people, and strengthens the digestion, and induces consequent hunger +in strong ones. See Sect. XXXV. 1. + +This may perhaps be more easily understood, by considering strength and +weakness, when applied to animal bodies, as consisting in the quantity of +sensorial power residing in the contracting fibres, and the quantity of +stimulus applied, as shewn in Sect. XII. 2. 1. Now when defective stimulus, +within certain limits, is partially applied to parts subject to perpetual +motion, the expenditure of sensorial power is for a while lessened, but not +its general production in the brain, nor its derivation into the +weakly-stimulated part. Hence in strong people, or such whose fibres abound +with sensorial power, if the first tribe of an associate train of motions +be deprived in part of its accustomed stimulus, its action becomes +diminished; and the sensorial power becomes accumulated, and by its +superabundance, or overflowing as it were, increases the action of the +second tribe of the associate actions by reverse sympathy. As exposing the +warm skin for a moderate time to cold air increases the action of the +stomach, and thus strengthens the power of digestion. + +On the reverse, when additional stimulus within certain limits is partially +applied to parts, which are deficient in respect to the natural quantity of +sensorial power, the expenditure of sensorial power is increased, but in a +less degree than the increased production of it in the brain, or its +increased derivation into the strongly-stimulated organ. Hence in weak +people, or such whose fibres are deficient of sensorial power, if the first +tribe of an associate train of motions be subjected for a while to greater +stimulus than usual, a greater production of sensorial power, or a greater +derivation of it into the stimulated parts occurs; which by its excess, or +overflowing as it were, increases the actions of the second tribe of the +associate motions by direct sympathy. Thus when vomiting occurs with cold +extremities, a blister on the back in a few hours occasions universal +warmth of the skin, and stops the vomiting. And when a diarrhoea occurs +with pale skin and cold extremities, the pricking of the points of a +flannel shirt, worn next the skin, occasions universal warmth of it, and +checks or cures the diarrhoea. + +In some associate trains of action nevertheless reverse sympathies more +frequently occur than direct ones, and in others direct ones more +frequently than reverse ones. Thus in continued fever with debility there +appears to be a reverse sympathy between the capillary vessels of the +stomach and those of the skin; because there exists a total aversion to +solid food, and constant heat on the surface of the body. Yet these two +systems of vessels are at other times actuated by direct sympathy, as when +paleness attends sickness, or cold feet induces indigestion. This subject +requires to be further investigated, as it probably depends not only on the +present or previous plus or minus of the sensorial power of association, +but also on the introduction of other kinds of sensorial power, as in Class +IV. 1. 1. D; or the increased production of it in the brain, or the greater +mobility of one part of a train of actions than another. + +Thus when much food or wine is taken into the stomach, if there be no +superfluity of sensorial power in the system, that is, none to be spared +from the continual actions of it, a paleness and chillness succeeds for a +time; because now the expenditure of it by the increased actions of the +stomach is greater than the present production of it. In a little time +however the stimulus of the food and wine increases the production of +sensorial power in the brain, and this produces a superfluity of it in the +system; in consequence of which the skin now becomes warm and florid, which +was at first cold and pale; and thus the reverse sympathy is shortly +converted into a direct one; which is probably owing to the introduction of +a second sensorial power, that of pleasurable sensation. + +On the contrary, when an emetic drug produces sickness, the skin is at +first pale for a time by direct sympathy with the capillaries of the +stomach; but in a few minutes, by the accumulation of sensorial power in +the stomach during its less active state in sickness, the capillaries of +the skin, which are associated with those of the stomach, act with greater +energy by reverse sympathy, and a florid colour returns. Where the quantity +of action is diminished in the first part of a train of motions, whether by +previous diminution of sensorial power, or present diminution of stimulus, +the second part of the train becomes torpid by direct sympathy. And when +the quantity of action of the first part becomes increased by the +accumulation of sensorial power during its previous torpor, or by increase +of stimulus, the actions of the second part of it likewise become increased +by direct sympathy. + +In moderate hunger the skin is pale, as before dinner, and in moderate +sickness, as no great accumulation of sensorial power has commenced; but in +violent hunger, and in greater torpor of the stomach, as from contagious +matter, the accumulation of sensorial power becomes so great as to affect +the arterial and capillary system, and fever is produced in both cases. + +In contagious fevers with arterial debilities commencing with torpor of the +stomach, why is the action of the heart weakened, and that of the +capillaries increased? Is it because the mobility of the heart is less than +that of the stomach, and the mobility of the capillaries greater? Or is it +because the association between the muscular fibres of the stomach and +those of the heart have been uniformly associated by direct sympathy; and +the capillaries of the stomach and those of the skin have been more +frequently associated by reverse sympathy? + +Where the actions of the stomach have been previously exhausted by long +stimulus, as on the day after intoxication, little or no accumulation of +sensorial power occurs, during the torpor of the organ, beyond what is +required to replace the deficiency of it, and hence fever seldom follows +intoxication. And a repetition of the stimulus sometimes becomes necessary +even to induce its natural action, as in dram-drinkers. + +Where there has been no previous exhaustion of sensorial power, and the +primary link of associate motions is violently actuated by the sensorial +power of sensation, the secondary link is also violently actuated by direct +sympathy, as in inflammatory fevers. Where however the sensorial power of +the system is less than natural, the secondary link of associated motions +becomes torpid by reverse sympathy, as in the inoculated small-pox during +the eruption on the face the feet are frequently cold. + +G. _Associations affected four Ways._ + +Hence associated trains or circles of motions may be affected four +different ways. 1. By the greater or less energy of action of the first +link with which they are catenated, and from which they take their names; +as irritative, sensitive, or voluntary associations. 2. By being excited by +two or more sensorial powers at the same time, as by irritation and +association, as in the instance of the application of the stimulus of +increased external heat to the cutaneous capillaries. 3. By catenation with +other sensorial powers, as with pain or pleasure, which are in this case +not the proximate cause of motion, but which, by becoming a link of +catenation, excites the sensorial power of association into action; as the +pain at the neck of the gall-bladder occasioned by a gall-stone is +transferred to the other end of that canal, and becomes a link of +catenation between the action of the two extremities of it. 4. The +influence of ethereal fluids, as of heat and gravitation. To which last +perhaps might be added moisture and oxygen gas as constituting necessary +parts of the system, rather than stimuli to excite it into action. + +H. _The Origin of Associations._ + +Some trains or circles of associate motions must have been formed before +our nativity, as those of the heart, arteries, and capillaries; others have +been associated, as occasion required them, as the muscles of the diaphragm +and abdomen in vomiting; and others by perpetual habit, as those of the +stomach with the heart and arteries directly, as in weak pulse during +sickness; with the capillaries directly, as in the flushed skin after +dinner; and lastly, with the cellular absorbents reversely, as in the +increased absorption in anasarca during sickness; and with the irritative +motions of the organs of sense reversely, as in vertigo, or sea-sickness. +Some of these associations shall be here shortly described to facilitate +the investigation of others. + +First, other congeries of glands occupy but a particular part of the +system, or constitute a particular organ, as the liver, or kidneys; but +those glands, which secrete the mucus, and perspirable matter, which are +called capillaries, are of very great extent; they receive the blood from +the arteries, separate from it the mucus, which lines every cell, and +covers every cavity of body; and the perspirable matter, which softens and +lubricates the whole surface of the skin, and the more extensive surface of +the air-vessels, which compose the lungs. These are supplied with blood by +the perpetual action of the heart and arteries, and have therefore their +motions associated with the former, and with each other, by sympathy, which +is sometimes direct, and sometimes reverse. + +One branch of this association, the capillaries of the skin, are very +irritable by the increased quantities of cold and heat, another branch, +that of the lungs, has not the perception of cold and heat, but is liable +by direct sympathy to act in concert with the former, as in going into the +cold bath. And it is probable the capillaries of the internal membranes are +likewise directly affected by their sympathy with those of the skin, as +appears from the defect of secretion in ulcers during the cold fits of +agues. + +The motions of this extensive system of capillaries, thus associated by +direct sympathy, are also associated with those of the heart and arteries, +sometimes by reverse and sometimes by direct sympathy; and thus constitute +simple fever. The cold paroxysm of which consists in their torpor, and the +hot one in their orgasm, or increased activity. + +I. _Of the Action of Vomiting._ + +The manner, in which the stomach and the diaphragm and abdominal muscles +acquire their associate action in vomiting, requires some attention. It is +not probable, that this action of vomiting occurs before nativity; as the +uniform application of the nutritive liquor amnii to the mouth of the +foetus, and the uniform expenditure of its nourishment, would not seem to +give occasion to too great temporary repletion of the stomach; and would +preclude the deglutition of any improper material. After nativity the +stomach of the child may be occasionally too much distended with milk; as +previous hunger may induce it to overgorge itself; and by repeated efforts +the act of vomiting is learned, as a means of getting free from a +disagreeable sensation. Thus when any disgustful material, as a bitter +drug, is taken into the mouth; certain retrograde motions of the tongue and +lips are produced, for the purpose of putting the disagreeable material out +of the mouth again. + +When the stomach is disagreeably stimulated by the distention or acrimony +of the aliment, a similar effort to regurgitate it must occur; and by +repeated trials the action of the diaphragm and abdominal muscles by +squeezing the stomach assists its retrograde exertion to disgorge its +contents. In the same manner when a piece of gravel is pushed into the +urethra, or a piece of indurated bile into the neck of the gall-bladder, +after they have been in vain pressed forward by the usual motions of those +ducts, they return into the bladders of gall and urine by the retrograde +motions of them. + +That this is one mode, in which vomiting is induced, appears from the +instantaneous rejection from the stomach occasioned by some nauseous drug, +or from some nauseous idea; and lastly, from the voluntary power, which +some people have been said to have acquired, of emptying their stomachs, +much in the same manner as ruminating animals bring up the grass from their +first stomach. + +There are nevertheless many modes by which these inverted motions of the +stomach and oesophagus are induced, and which it is of consequence to +distinguish from each other. The first is the mode above described, where +an effort is made to dislodge something, which stimulates the stomach into +disagreeable sensation; and which is returned by repeated exertions; as +when a nauseous drug is taken into the mouth, or a bit of sand falls into +the eye, or a drop of water into the wind-pipe. In this the peristaltic +motions of the stomach are first stopped, and then reverted by painful +sensation; and the abdominal muscles and diaphragm by repeated efforts +become associated with them. Now as less sensorial power is expended on the +retrograde actions of the stomach, and of the lymphatics, which open their +mouths on its surface, than by their natural motions, an accumulation of +sensorial power in the fibres of the stomach follows the exhibition of an +emetic, and on that account an emetic will sometimes stop a spontaneous +vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and +Art. V. 2. 1. + +As bitters and metallic salts, exhibited in small doses, stimulate the +stomach into greater action, as appears by their increasing the power of +digestion, and yet become emetic, when given in larger doses; one might +suspect, that they became emetic by inducing debility, and consequent +retrograde actions of the stomach, by their previously exhausting the +sensorial power by their great stimulus; which might be effected in a +moment without producing pain, and in consequence without our perceiving +it. But on the contrary, there does not in general appear on the exhibition +of emetics to be any previous exhaustion of sensorial power; because there +is evidently an accumulation of it during the sickness, as appears from the +digestion being stronger afterwards; and from the increased action of the +cellular and cutaneous absorbents during its operation. See Art. V. 2. 1. + +Another mode, by which vomiting is induced, is owing to debility or +deficiency of sensorial power, from the previous exhaustion of it; as on +the day after intoxication, or which occurs in people enfeebled with the +gout, and in dropsy, and in some fevers with debility. In these, when the +vomiting ceases, there is no appearance of accumulation of sensorial power, +as the digestion still remains weak and imperfect. + +Another mode by which sickness or vomiting is induced, is by defect of +stimulus, as in great hunger; and in those, who have been habituated to +spice and spirit with their meals, who are liable to be sick after taking +food without these additional stimuli. Other means of inducing sickness by +vertigo, or by nauseous ideas, will be mentioned below. + +We shall only add, that the motions of the muscular fibres of the stomach +are associated with those of the heart and arteries by direct sympathy, as +appears by the weakness of the pulse during the exhibition of an emetic; +and that the absorbents of the stomach are associated with the cellular and +cutaneous absorbents by reverse sympathy, as is shewn by the great +absorption of the mucus of the cells in anasarca during sickness; at the +same time that the absorbents of the stomach invert their actions, and pour +the mucus and water thus absorbed into that viscus. + +In cold paroxysms of fever the stomach partakes of the general torpor, and +vomiting is induced by its debility, either by its association with the +torpid capillaries, or other torpid parts, or by its own torpor commencing +first, and causing the cold fit. The disordered motions of the stomach +frequently seem to be the cause or primary seat of fever, as where +contagious miasmata are swallowed with the saliva, and where fever is +produced by sea-sickness, which I once saw. Nevertheless a disorder of the +stomach does not always induce fever, as in that case it should constantly +attend indigestion, and vertigo, and sea-sickness; but is itself frequently +induced by association with the disordered movements of other parts of the +system, as when it arises from gravel in the ureter, or from a percussion +on the head. + +The connexion of the motions of the stomach with irritative ideas, or +motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus +it appears, that many circles of association are either directly or +reversely associated, or catenated, with this viscus; which will much +contribute to unfold some of the symptoms of fever. + +K. _Tertian Associations._ + +The third link of associate trains of motion is sometimes actuated by +reverse sympathy, with the second link, and that by reverse sympathy with +the first link; so that the first and third link may act by direct +sympathy, and the intermediate one by reverse sympathy. Of this instances +are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At +other times the tertian or quartan links of associate motions are actuated +by direct sympathy; and that sometimes forwards and sometimes backwards in +respect to the usual order of those trains of associate motions, as in +Class IV. 1. 2. 1. + +SPECIES. + +1. _Rubor vultus prandorum._ Flushing of the face after dinner is explained +in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes +florid from the association of the actions of the cutaneous arteries with +those of the stomach, because vinous spirit excites the fibres of the +stomach into more violent action than the stimulus of common food; and the +cutaneous capillaries of the face, from their more frequent exposure to the +vicissitudes of cold and heat, possess more mobility or irritability than +those of other parts of the skin, as further explained in Sect. XXXIII. 2. +10. Vinegar is liable to produce this flushing of the face, which probably +is owing to the quantity of vinous spirit it contains, as I believe the +unfermented vegetable acids do not produce this effect. In every kind of +blush the arterial blood is propelled into the capillaries faster than the +venous absorption can carry it forwards into the veins, in this respect +resembling the tensio phalli. + +Can the beginning vinous or acetous fermentation of the aliment in weak +stomachs contribute to this effect? or is it to be ascribed to the greater +power of association between the arteries of the face and the fibres of the +stomach in some people than in others? + +M. M. Eat and drink less at a time, and more frequently. Put 20 drops of +weak acid of vitriol into water to be drank at meals. Let the dress over +the stomach and bowels be loose. Use no fermented liquors, or vinegar, or +spice. + +2. _Sudor stragulis immersorum._ Sweat from being covered in bed. In the +commencement of an epidemic fever, in which the perpetual efforts to vomit +was a distressing symptom, Dr. Sydenham discovered, that if the patient's +head was for a short time covered over with the bed clothes, warmth was +produced, and a sweat broke out upon the skin, and the tendency to vomit +ceased. In this curious fact two trains of associated motions are excited +into increased action. First, the vessels of the lungs are known to have +their motion associated with those of the skin by the difficulty of +breathing on going into the cold bath, as described in Sect. XXXII. 3. 2. +Hence, when the vessels of the lungs become excited into stronger action, +by the bad air under the bed clothes, warmed and adulterated by frequent +breathing, those of the external skin soon become excited by their +association into more energetic action, and generate more heat along with a +greater secretion of perspirable matter. Secondly, the sympathy between the +stomach and skin is evident in variety of circumstances; thus the cold air +of frosty days applied to the skin for a short time increases the action of +the stomach by reverse sympathy, but decreases it if continued too long by +direct sympathy; so in the circumstance above mentioned the action of the +stomach is increased by direct sympathy with that of the skin; and the +tendency to vomit, which was owing to its diminished action, ceases. + +3. _Cessatio aegritudinis cute excitata._ The cure of sickness by +stimulating the skin. This is explained in the preceding article; and +further noticed in IV. 2. 2. 4. and in IV. 1. 1. f. + +Similar to these is the effect of a blister on the back in relieving +sickness, indigestion, and heart-burn; and, on the contrary, by these +symptoms being frequently induced by coldness of the extremities. The +blister stimulates the cutaneous vessels into greater action; whence warmth +and pain are produced at the same time, and the fibres of the stomach are +excited into greater action by their association with those of the skin. It +does not appear, that the concomitant pain of the blister causes the +increased energy of the stomach, because the motions of it are not greater +than natural; though it is sometimes difficult to determine, whether the +primary part of some associated trains be connected with irritative or +sensitive motions. + +In the same manner a flannel shirt, to one who has not been in the habit of +wearing one, stimulates the skin by its points, and thus stops vomiting in +some cases; and is particularly efficacious in checking some chronical +diarrhoeas, which are not attended with fever; for the absorbents of the +skin are thus stimulated into greater action, with which those of the +intestines consent by direct sympathy. + +This effect cannot be ascribed to the warmth alone of the flannel shirt, as +being a covering of loose texture, and confining air in its pores, like a +sponge, which air is known to be a bad conductor of heat, since in that +case its use should be equally efficacious, if it were worn over a linen +shirt; and an increased warmth of the room of the patient would be equally +serviceable. + +4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of the +skin. Every one has experienced the increase of his appetite after walking +in the cool air in frosty days; for there is at this time not only a saving +of sensorial power by the less exertion of the cutaneous vessels; but, as +these consent with those of the stomach and bowels, this saving of +sensorial power is transferred by reverse sympathy from the cutaneous +capillaries and absorbents to those of the stomach and intestines. + +Hence weak people should use the cold air of winter as a cold bath; that +is, they should stay in it but a short time at once, but should immerse +themselves in it many times a day. + +5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. This has been +already explained in Class I. 1. 2. 7. and is further described in Sect. +XXXV. 1. 3. In this disease the vessels of the membrane, which lines the +nostrils, are excited into greater action; when those of the skin, with +which they are associated, are excited into less action by the deficiency +of external heat, by reverse sympathy; and though the pain of cold attends +the torpor of the primary link of this association, yet the increased +motions of the membrane of the nostrils are associated with those of the +cutaneous vessels, and not with the pain of them, because no inflammation +follows. + +6. _Absorptio cellularis aucta vomitu._ In the act of vomiting the +irritative motions of the stomach are inverted, and of the absorbents, +which open their mouths into it; while the cutaneous, cellular, and +pulmonary absorbents are induced, by reverse sympathy with them, to act +with greater energy. This is seen in cases of anasarca, when long sickness +and vomiting are caused by squills, or antimonial salts, or most of all by +the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a +case, in which a large bubo, which was just ready to break, was absorbed in +a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus +accounted for; less sensorial power is expended during sickness by the +decreased action of the fibres of the stomach, and of its absorbents; as +shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and +there is in consequence a greater quantity of sensorial power for the +exertion of those motions, which are associated with the absorbents of the +stomach by reverse sympathy. + +The reverse sympathy between the lacteal and lymphatic branches of the +absorbent system have been produced by the one branch being less excited to +act, when the other supplies sufficient fluid or nutriment to the +sanguiferous vessels. Thus when the stomach is full, and the supply of +chyle and mucus and water is in sufficient quantity; the pulmonary, +cellular, and cutaneous lymphatics are not excited into action; whence the +urine is pale, and the skin moist, from the defect of absorption on those +surfaces. + +7. _Syngultus nephriticus._ When a stone irritates the ureter, and that +even without its being attended with pain or fever, sometimes a chronical +hiccough occurs, and continues for days and weeks, instead of sickness or +vomiting; which are the common symptoms. In this case the motions of the +stomach are decreased by their sympathy with those of the ureter, which are +increased by the stimulus of the stone in it; and the increased motions of +the diaphragm seem to exist in consequence of their association with the +stomach by a second reverse sympathy. This hiccough may nevertheless admit +of another explanation, and be supposed to be a convulsive exertion of the +diaphragm to relieve the disagreeable sensation of the stomach in +consequence of its disordered irritative associations; and in that case it +would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of +tertiary association. + +M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from +two to ten drops. Aerated alcaline water. Peruvian bark. + +8. _Febris irritativa._ Irritative fever, described in Class I. 1. 1. 1. +The diseases above explained in this genus are chiefly concerning the +sympathies of the absorbent system, or the alimentary canal, which are not +so much associated with the arterial system, as to throw it into disorder, +when they are slightly deranged; but when any great congeries of +conglomerate glands, which may be considered as the extremities of the +arterial system, are affected with torpor, the whole arterial system and +the heart sympathize with the torpid glands, and act with less energy; +which constitutes the cold fit of fever; which is therefore at first a +decreased action of the associate organ; but as this decrease of action is +only a temporary effect, and an increase of exertion both of the torpid +glands, and of the whole arterial system, soon follows; the hot fit of +irritative fever, or fever with strong pulse, properly belongs to this +class and genus of diseases. + + * * * * * + +ORDO I. + +_Increased Associate Motions._ + +GENUS II. + +_Catenated with Sensitive Motions._ + +The primary links of the associated actions of this genus are either +produced or attended by painful or pleasurable sensation. The secondary +links of the first ten species are attended with increased motions without +inflammation, those of the remainder are attended with inflammation. All +inflammations, which do not arise in the part which was previously torpid, +belong to this genus; as the gout, rheumatism, erysipelas. It is probable +many other inflammations may, by future observation, require to be +transplanted into this class. + +The circles of sensitive associate motions consist chiefly of the excretory +ducts of the capillaries and of the mouths of the absorbent vessels, which +constitute the membranes; and which have been induced into action at the +same time; or they consist of the terminations of canals; or of parts which +are endued with greater sensibility than those which form the first link of +the association. An instance of the first of those is the sympathy between +the membranes of the alveolar processes of the jaws, and the membranes +above or beneath the muscles about the temples in hemicrania. An instance +of the second is in the sympathy between the excretory duct of the lacrymal +gland, and the nasal duct of the lacrymal sack. And an instance of the +third is the sympathy between the membranes of the liver, and the skin of +the face in the gutta rosea of inebriates. + +SPECIES. + +1. _Lacrymarum fluxus sympatheticus._ A flow of tears from grief or joy. +When the termination of the duct of the lacrymal sac in the nostrils +becomes affected either by painful or pleasurable sensations, in +consequence of external stimulus, or by its association with agreeable or +disagreeable ideas, the motions of the lacrymal gland are at the same time +exerted with greater energy, and a profusion of tears succeeds by sensitive +association, as explained in Sect. XVI. 8. 2. + +In this case there exists a chain of associated actions, the secretion of +the lacrymal gland is increased by whatever stimulates the surface of the +eye, at the same time the increased abundance of tears stimulates the +puncta lacrymalia into greater action; and the fluid thus absorbed +stimulates the lacrymal sac, and its nasal duct in the nose into greater +action. In a contrary direction of this chain of association the present +increase of action is induced. First, the nasal duct of the lacrymal sac is +excited into increased action by some pleasurable or painful idea, as +described in Sect. XVI. 8. 2. 2d. The puncta lacrymalia or other +extremity of the lacrymal sac sympathizes with it (as the two ends of all +other canals sympathize with each other). 3d. With these increased +motions of the puncta lacrymalia those of the excretory duct of the +lacrymal gland are associated from their having so perpetually acted +together. And, lastly, with the increased actions of the excretory duct of +this gland are associated those of the other end of it by their frequently +acting together; in the same manner as the extremities of other canals are +associated; and thus a greater flow of tears is poured into the eye. + +When a flow of tears is produced in grief, it is believed to relieve the +violence of it, which is worthy a further inquiry. Painful sensations, when +great, excite the faculty of volition; and the person continues voluntarily +to call up or perform those ideas, which occasion the painful sensation; +that is, the afflicted person becomes so far insane or melancholy; but +tears are produced by the sensorial faculty of association, and shew that +the pain is so far relieved as not to excite the excessive power of +volition, or insanity, and are therefore a sign of the abatement of the +painful state of grief, rather than a cause of that abatement. See Class +III. 1. 2. 10. + +2. _Sternutatio a lumine._ Some persons sneeze from looking up at the light +sky in a morning after coming out of a dark bedroom. The olfactory nerves +are brought into too great action by their sympathy with the optic nerves, +or by their respective sympathies with some intervening parts, as probably +with the two extremities of the lacrymal sac; that is, with the puncta +lacrymalia and the nasal duct. See Class II. 1. 1. 3. + +3. _Dolor dentium Stridore._ Tooth-edge from grating sounds, and from the +touch of certain substances, and even from imagination alone, is described +and explained in Sect. XVI. 10. The increased actions of the alveolar +vessels or membranes are associated with the ideas, or sensual motions of +the auditory nerves in the first case; and of those of the sense of touch, +in the second case; and by imagination, or ideas exerted of painful +sensation alone, in the last. + +4. _Risus sardonicus._ A disagreeable smile attends inflammations of the +diaphragm arising from the associations of the reiterated exertions of that +muscle with those of the lips and cheeks in laughing. See Diaphragmitis, +Class II. 1. 2. 6. + +5. _Salivae fluxus cibo viso._ The flow of saliva into the mouths of hungry +animals at the sight or smell of food is seen in dogs standing round a +dinner-table. The increased actions of the salivary glands have been +usually produced by the stimulus of agreeable food on their excretory ducts +during the mastication of it; and with this increased action of their +excretory ducts the other terminations of those glands in the capillary +arteries have been excited into increased action by the mutual association +of the ends of canals; and at the same time the pleasurable ideas, or +sensual motions, of the sense of smell and of sight have accompanied this +increased secretion of saliva. Hence this chain of motions becomes +associated with those visual or olfactory ideas, or with the pleasure, +which produces or attends them. + +6. _Tensio mamularum viso puerulo._ The nipples of lactescent women are +liable to become turgid at the sight of their young offspring. The nipple +has generally been rendered turgid by the titillation of the lips or gums +of the child in giving suck; the visible idea of the child has thus +frequently accompanied this pleasurable sensation of parting with the milk, +and turgescence of the tubes, which constitute the nipple. Hence the visual +idea of the child, and the pleasure which attends it, become associated +with those increased arterial actions, which swell the cells of the mamula, +and extend its tubes; which is very similar to the tensio phalli visa +muliere nuda etiam in insomnio. + +7. _Tensio penis in hydrophobia._ An erection of the penis occurs in the +hydrophobia, and is a troublesome symptom, as observed by Coelius +Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an +unexplained sympathy between the sensations about the fauces and the penis. +In men the hair grows about both these parts, the voice changes, and the +neck thickens at puberty. In the mumps, when the swellings about the throat +subsides, the testicles are liable to swell. Venereal infection received by +the penis is very liable to affect the throat with ulcers. Violent coughs, +with soreness or rawness about the fauces are often attended with erection +of the penis; which is also said to happen to male animals, that are +hanged; which last circumstance has generally been ascribed to the +obstruction of the circulation of the blood, but is more probably +occasioned by the stimulus of the cord in compressing the throat; since if +it was owing to impeded circulation it ought equally to occur in drowning +animals. + +In men the throat becomes so thickened at the time of puberty, that a +measure of this is used to ascertain the payment of a poll-tax on males in +some of the islands of the Mediterranean, which commences at puberty; a +string is wrapped twice round the thinnest part of the neck, the ends of it +are then put into each corner of the mouth; and if, when thus held in the +teeth, it passes readily over the head, the subject is taxable. + +It is difficult to point out by what circumstance the sensitive motions of +the penis and of the throat and nose become associated; I can only observe, +that these parts are subjected to greater pleasurable sensations than any +other parts of the body; one being designed to preserve ourselves by the +pleasure attending the smell and deglutition of food, and the other to +ensure the propagation of our species; and may thus gain an association of +their sensitive motion by their being eminently sensible to pleasure. See +Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5. + +In the female sex this association between the face, throat, nose, and +pubis does not exist; whence no hair grows on their chins at the time of +puberty, nor does their voices change, or their necks thicken. This happens +probably from there being in them a more exquisite sensitive sympathy +between the pubis and the breasts. Hence their breasts swell at the time of +puberty, and secrete milk at the time of parturition. And in the parotitis, +or mumps, the breasts of women swell, when the tumor of the parotitis +subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts +possess an intermediate sympathy between the pubis and the throat; as they +are the seat of a passion, which men do not possess, that of suckling +children. + +8. _Tenesmus calculosus._ The sphincter of the rectum becomes painful or +inflamed from the association of its sensitive motions with those of the +sphincter of the bladder, when the latter is stimulated into violent pain +or inflammation by a stone. + +9. _Polypus narium ex ascaridibus?_ The stimulation of ascarides in the +rectum produces by sensitive sympathy an itching of the nose, as explained +in IV. 2. 2. 6; and in three children I have seen a polypus in the nose, +who were all affected with ascarides; to the perpetual stimulation of +which, and the consequent sensitive association, I was led to ascribe the +inflammation and thickening of the membrane of the nostrils. + +10. _Crampus surarum in cholera._ A cramp of the muscles of the legs occurs +in violent diarrhoea, or cholera, and from the use of too much acid diet in +gouty habits. This seems to sympathize with uneasy sensation in the bowels. +See Class III. 1. 1. 14. This association is not easily accounted for, but +is analogous in some degree to the paralysis of the muscles of the arms in +colica saturnina. It would seem, that the muscles of the legs in walking +get a sympathy with the lower parts of the intestines, and those of the +arms in variety of employment obtain a sympathy with the higher parts of +them. See Cholera and Ileus. + +11. _Zona ignea nephritica._ Nephritic shingles. The external skin about +the loins and sides of the belly I suppose to have greater mobility in +respect to sensitive association, than the external membrane of the kidney; +and that their motions are by some unknown means thus associated. When the +torpor or beginning inflammation of this membrane ceases, the external skin +becomes inflamed, in its stead, and a kind of herpes, called the shingles, +covers the loins and sides of the belly. See Class II. 1. 5. 9. + +12. _Eruptio variolarum._ After the inflammation of the inoculated arm has +spread for a quarter of a lunation, it affects the stomach by reverse +sympathy; that is, the actions of the stomach are associated with those of +the skin; and as much sensorial power is now exerted on the inflamed skin, +the other part of this sensitive association is deprived of its natural +share, and becomes torpid, or inverts its motions. After this torpor of the +stomach has continued a time, and much sensorial power is thus accumulated; +other parts of the skin, which are also associated with it, as that of the +face first, are thrown into partial inflammation; that is, the eruptions of +the small-pox appear on the face. + +For that the variolous matter affects the stomach previous to its eruption +on the skin appears from the sickness at the commencement of the fever; and +because, when the morbid motions affect the skin, those of the stomach +cease; as in the gout and erysipelas, mentioned below. The consent between +the stomach and the skin appears in variety of other diseases; and as they +both consist of surfaces, which absorb and secrete a quantity of moisture, +their motions must frequently be produced together or in succession; which +is the foundation of all the sympathies of animal motions, whether of the +irritative, sensitive, or voluntary kinds. + +Now as the skin, which covers the face, is exposed to greater variations of +heat and cold than any other part of the body; it probably possesses more +mobility to sensitive associations, not only than the stomach, but than any +other part of the skin; and is thence affected at the eruption of the +small-pox with violent action and consequent inflammation, by the +association of its motions with those of the stomach, a day before the +other parts of the skin; and becomes fuller of pustules, than any other +part of the body. See Class II. 1. 3. 9. + +It might be supposed, that the successive swelling of the hands, when the +face subsides, at the height of the small-pox, and of the feet, when the +hands subside, were governed by some unknown associations of those parts of +the system; but these successions of tumor and subsidence more evidently +depend on the times of the eruption of the pustules on those parts, as they +appear a day sooner on the face than on the hands, and a day sooner on the +hands than on the feet, owing to the greater comparative mobility of those +parts of the skin. + +13. _Gutta rosea stomatica._ Stomatic red face. On drinking cold water, or +cold milk, when heated with exercise, or on eating cold vegetables, as raw +turnips, many people in harvest-time have been afflicted with what has been +called a surfeit. The stomach becomes painful, with indigestion and +flatulency, and after a few days an eruption of the face appears, and +continues with some relief, but not with entire relief; as both the pimpled +face and indigestion are liable to continue even to old age. + +M. M. Venesection. A cathartic with calomel. Then half a grain of opium +twice a day for many weeks. If saturated solution of arsenic three or five +drops twice or thrice a day for a week? + +14. _Gutta rosea hepatica._ The rosy drop of the face of some drinking +people is produced like the gout described below, in consequence of an +inflamed liver. In these constitutions the skin of the face being exposed +to greater variation of heat and cold than the membranes of the liver, +possesses more mobility than those hepatic membranes; and hence by whatever +means these membranes are induced to sympathize, when this sensitive +association occurs, the cutaneous vessels of the face run into greater +degrees of those motions, which constitute inflammation, than previously +existed in the membranes of the liver; and then those motions of the liver +cease. See Class II. 1. 4. 6. + +An inflammation of the liver so frequently attends the great potation of +vinous spirit, there is reason to suspect, that this viscus itself becomes +inflamed by sensitive association with the stomach; or that, when one +termination of the bile-duct, which enters the duodenum is stimulated +violently, the other end may become inflamed by sensitive association. + +15. _Podagra._ The gout, except when it affects the liver or stomach, seems +always to be a secondary disease, and, like the rheumatism and erysipelas +mentioned below, begins with the torpor of some distant part of the system. + +The most frequent primary seat of the gout I suppose to be the liver, which +is probably affected with torpor not only previous to the annual paroxysms +of the gout, but to every change of its situation from one limb to another. +The reasons, which induce me to suspect the liver to be first affected, are +not only because the jaundice sometimes attends the commencement of gout, +as described in Sect. XXIV. 2. 8. but a pain also over the pit of the +stomach, which I suppose to be of the termination of the bile-duct in the +duodenum, and which is erroneously supposed to be the gout of the stomach, +with indigestion and flatulency, generally attends the commencement of the +inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In +the two cases, which I saw, of the gout in the limbs being preceded by +jaundice, there was a cold shivering fit attended the inflammation of the +foot, and a pain at the pit of the stomach; which ceased along with the +jaundice, as soon as the foot became inflamed. This led me to suspect, that +there was a torpor of the liver, and perhaps of the foot also, but +nevertheless the liver might also in this case be previously inflamed, as +observed in Sect. XXIV. 2. 8. + +Now as the membranes of the joints of the feet suffer greater variations of +heat and cold than the membranes of the liver, and are more habituated to +extension and contraction than other parts of the skin in their vicinity; I +suppose them to be more mobile, that is, more liable to run into extremes +of exertion or quiescence; and are thence more susceptible of inflammation, +than such parts as are less exposed to great variations of heat and cold, +or of extension and contraction. + +When a stone presses into the sphincter of the bladder, the glans penis is +affected with greater pain by sympathy, owing to its greater sensibility, +than the sphincter of the bladder; and when this pain commences, that of +the sphincter ceases, when the stone is not too large, or pushed too far +into the urethra. Thus when the membrane, which covers the ball of the +great toe, sympathizes with some membranous part of a torpid or inflamed +liver; this membrane of the toe falls into that kind of action, whether of +torpor or inflammation, with greater energy, than those actions excited in +the diseased liver; and when this new torpor or inflammation commences, +that with which it sympathises ceases; which I believe to be a general law +of associated inflammations. + +The paroxysms of the gout would seem to be catenated with solar influence, +both in respect to their larger annual periods, and to their diurnal +periods--See Sect. XXXVI. 3. 6.--as the former occur about the same season +of the year, and the latter commence about an hour before sun-rise; +nevertheless the annual periods may depend on the succession of great +vicissitudes of cold and heat, and the diurnal ones on our increased +sensibility to internal sensations during sleep, as in the fits of asthma, +and of some epilepsies. See Sect. XVIII. 15. + +In respect to the pre-remote cause or disposition to the gout, there can be +no doubt of its individually arising from the potation of fermented or +spirituous liquors in this country; whether opium produces the same effect +in the countries, where it is in daily use, I have never been well +informed. See Sect. XXI. 10, where this subject is treated of; to which I +have to add, that I have seen some, and heard of others, who have moderated +their paroxysms of gout, by diminishing the quantity of fermented liquors, +which they had been accustomed to; and others who, by a total abstinence +from fermented liquors, have entirely freed themselves from this +excruciating malady; which otherwise grows with our years, and curtails or +renders miserable the latter half, or third, of the lives of those, who are +subject to it. The remote cause is whatever induces temporary torpor or +weakness of the system; and the proximate cause is the inirritability, or +defective irritation, of some part of the system; whence torpor and +consequent inflammation. The great Sydenham saw the beneficial effects of +the abstinence from fermented liquors in preventing the gout, and adds, "if +an empiric could give small-beer only to gouty patients as a nostrum, and +persuade them not to drink any other spirituous fluids, that he might +rescue thousands from this disease, and acquire a fortune for his +ingenuity." Yet it is to be lamented, that this accurate observer of +diseases had not resolution to practise his own prescription, and thus to +have set an example to the world of the truth of his doctrine; but, on the +contrary, recommends Madeira, the strongest wine in common use, to be taken +in the fits of the gout, to the detriment of thousands; and is said himself +to have perished a martyr to the disease, which he knew how to subdue! + +As example has more forcible effect: than simple assertion, I shall now +concisely relate my own case, and that of one of my most respected friends. +E. D. was about forty years of age, when he was first seized with a fit of +the gout. The ball of his right great toe was very painful, and much +swelled and inflamed, which continued five or six days in spite of +venesection, a brisk cathartic with ten grains of calomel, and the +application of cold air and cold water to his foot. He then ceased to drink +ale or wine alone; confining himself to small beer, or wine diluted with +about thrice its quantity of water. In about a year he suffered two other +fits of the gout, in less violent degree. He then totally abstained from +all fermented liquors, not even tasting small-beer, or a drop of any kind +of wine; but eat plentifully of flesh-meat, and all kinds of vegetables, +and fruit, using for his drink at meals chiefly water alone, or lemonade, +or cream and water; with tea and coffee between them as usual. + +By this abstinence from fermented liquors he kept quite free from the gout +for fifteen or sixteen years; and then began to take small-beer mixed with +water occasionally, or wine and water, or perry and water, or cyder and +water; by which indulgence after a few months he had again a paroxysm of +gout, which continued about three days in the ball of his toe; which +occasioned him to return to his habit of drinking water, and has now for +above twenty years kept in perpetual health, except accidental colds from +the changes of the seasons. Before he abstained from fermented or +spirituous liquors, he was frequently subject to the piles, and to the +gravel, neither of which he has since experienced. + +In the following case the gout was established by longer habit and greater +violence, and therefore required more cautious treatment. The Rev. R. W. +was seized with the gout about the age of thirty-two, which increased so +rapidly that at the age of forty-one he was confined to his room seven +months in that year; he had some degree of lameness during the intervals, +with chalky swellings of his heels and elbows. As the disease had continued +so long and so violently, and the powers of his digestion were somewhat +weakened, he was advised not entirely to leave off all fermented liquors; +and as small-beer is of such various strength, he was advised to drink +exactly two wine glasses, about four ounces, of wine mixed with three or +four times its quantity of water, with or without lemon and sugar, for his +daily potation at dinner, and no other fermented liquor of any kind; and +was advised to eat flesh-meat with any kind of boiled vegetables, and +fruit, with or without spice. He has now scrupulously continued this +regimen for above five years, and has had an annual moderate gouty paroxysm +of a few weeks, instead of the confinement of so many months, with great +health and good spirits during the intervals. + +The following is a more particular account of the history of this case; +being part of a letter which Mr. Wilmot wrote on that subject at my +entreaty. + + "I entered into the army with an excellent constitution at the age of + fifteen. The corps I served in was distinguished by its regularity, + that is, the regular allowance of the mess was only one pint of wine + per man each day; unless we had company to dine with us; then, as was + the general custom of the time, the bottle circulated without limit. + This mode of living, though by no means considered as excess for men, + was certainly too great for a youth of my age. This style of living I + continued, when with the regiment, till the latter end of the year + 1769, when I had the misfortune to sleep in a damp bed at Sheffield on + a journey to York, but arrived there before I felt the ill effects of + it. I was then seized with a violent inflammatory rheumatism with great + inflammation of my eyes, and was attended by Dr. Dealtry; so violent + was the disorder, that I was bled for it eight times in less than a + fortnight; and was three months, before I could consider my health + perfectly re-established. Dr. Dealtry told me, that I should be subject + to similar attacks for many years; and that he had no doubt, from the + tendency he found in my habit to inflammation, that, when I was farther + advanced in life, I should change that complaint for the gout. He + predicted truly; for the three succeeding winters I had the same + complaint, but not so violently; the fourth winter I escaped, and + imputed my escape to the continuance of cold bathing during the whole + of that winter; after that I never escaped it, till I had a regular and + severe fit of the gout: after the first attack of rheumatic fever I was + more abstemious in my manner of living, though when in company I never + subjected myself to any great restraint. In the year 1774 I had quitted + the army, and being in a more retired situation, was seldom led into + any excess; in 1776 and 1777 I was in the habit of drinking a good deal + of wine very frequently, though not constantly. After that period till + the year 1781, I drank a larger quantity of wine regularly, but very + seldom to any degree of intoxication. I lived much at that time in the + society of some gentlemen, who usually drank nearly a bottle of wine + daily after dinner. I must here however observe, that at no part of my + life was I accustomed to drink wine in an evening, and very seldom + drank any thing more than a single half-pint glass of some sort of + spirits diluted with much water. Till the year 1781 I had always been + accustomed to use very violent and continued exercise on horseback; in + the winter months I pursued all field diversions, and in the summer + months I rode frequent and long journeys; and with this exercise was + liable to perspire to great excess; besides which I was subject to very + profuse night-sweats, and had frequently boils break out all over me, + especially in the spring and autumn; for which I took no medicine, + except a little flour of sulphur with cream of tartar in honey. + + "You will observe I bring every thing down to the date of 1781. In the + month of October in that year, when I was just entered into the + thirty-second year of my age, I had the first attack of gout; that fit + was very severe, and of many weeks continuance. I now determined upon a + more abstemious method of living, in respect to wine; and indeed the + society, in which I had before been accustomed to live, being + considerably changed, I had less frequent temptations to excess. From + this time I enjoyed the most perfect good state of health till August + 1784, when I had my second attack of gout. I never perfectly recovered + from this attack through the succeeding winter, and in March 1785 was + advised to try the Bath waters, and drank them under the direction of + one of the faculty of that place. I was there soon seized with a fever, + and a slight attack of gout in one knee. I should observe, that when I + set out from home, I was in a weak and low state, and unequal to much + fatigue; as appeared by my having a fainting fit one day on the road, + after having travelled only about fifty miles; in the course of the + summer I had two or three more slight attacks of gout of less + consequence, till the month of October; when I was afflicted with it + all over me in such a manner, as to be without the possibility of the + least degree of removal for some days; and was about two months without + being able to get into the air. This was the severest attack I had then + experienced; though I have since had several equally severe. In the + course of this summer I had a fall with my horse; and soon after it, + having discovered an enlargement on one elbow, I concluded I had hurt + it at that time; but in the course of this last attack having a similar + enlargement on the other elbow, I found my mistake, and that they were + collections of gouty matter; these increased to the size of pullet's + eggs, and continue in that state. I had soon after similar enlargements + on my heels; the right heel being severely bruised, I was under the + necessity of having it lanced, and a large quantity of chalky matter + was discharged from it; and have since that time frequently had chalky + matter taken from it, and sometimes small bits of apparently perfect + chalk. My right hand soon was afflicted in the same way, and I have + scarcely a joint on those fingers now in a natural state. My left hand + has escaped tolerably well. After this last attack (viz. October 1785), + I had two or three slight attacks before the month of June 1787, when I + had a very severe intermittent fever; from that time I continued very + well till the latter end of the year, when I began to feel the gout + about me very much, but was not confined by it. I was in this state + advised to try what is called the American Recipe (gum guaiacum and + nitre dissolved in spirits); it had apparently been of essential + service to a friend of mine, who from the inability to walk a mile for + some years, was believed to be restored by the use of this medicine to + a good state of health, so as to walk ten miles a day. In addition to + this medicine I drank, as my common beverage with my meals, spruce + beer. I had so high an opinion of this medicine in the gout, and of + spruce beer as an antiscorbutic, that I contemplated with much + satisfaction, and with very little doubt, the perfect restoration of my + health and strength; but I was miserably deceived; for in September + 1788 I was seized with the gout in a degree that none but arthritics, + and indeed but few of those, can easily conceive. From this time till + August 1789 I scarcely ever passed a comfortable day; seven months of + this time I had been confined, my health seemed much impaired, my + strength was diminished, and my appetite almost gone. In this state my + friends pressed me to consult you. I was unwilling for some time to do + it, as I had lost all hope of relief; however, when I had determined to + apply to you, I likewise determined to give up every prejudice of my + own respecting my case, and to adhere most strictly to your advice. On + the 20th of August 1789 I consulted you, on the 25th I entered upon the + regimen, which you prescribed, and which was as follows. + + "Drink no malt liquor on any account. Let your beverage at dinner + consist of two glasses of wine diluted with three half-pints of water. + On no account drink any more wine or spirituous liquors in the course + of the day; but, if you want more liquid, take cream and water, or milk + and water, or lemonade, with tea, coffee, chocolate. Use the warm bath + twice a week for half an hour before going to bed, at the degree of + heat which is most grateful to your sensations. Eat meat constantly at + dinner, and with it any kind of tender vegetables you please. Keep the + body open by two evacuations daily, if possible without medicine, if + not take the size of a nutmeg of lenitive electuary occasionally, or + five grains of rhubarb every night. Use no violent exercise, which may + subject yourself to sudden changes from heat to cold; but as much + moderate exercise as may be, without being much fatigued or starved + with cold. Take some supper every night; a small quantity of animal + food is preferred; but if your palate refuses this, take vegetable + food, as fruit pie, or milk; something should be eaten, as it might be + injurious to you to fast too long." To the whole of this I adhered most + scrupulously, and soon found my appetite improve, and with it my + strength and spirits. I had in December a fevere attack, and two or + three slight ones in the course of twelve months; but the improvement + in the general state of my health induced me to persevere. On the 18th + of August 1790 I had another severe attack, but it went off easier than + before, and I soon recovered sufficiently to go to Buxton, which you + advised me to, and from which I reaped great benefit; nevertheless on + the 29th of December I had a slight attack in comparison of some that I + had before experienced, and from that time I was free from gout, and + enjoyed my health perfectly well till the fourth week in October 1791; + from that till the third week in October 1792; from that till the third + week in October 1793; and from that till June 1794. From what happened + for the last three years I dreaded the month of October; but I escaped + then, and have enjoyed my health most perfectly ever since till within + the last week, that I have had a slight attack in one knee, which is + nearly gone, without any symptom to lead me to suppose that it will go + further. + + "I adhered to your advice most scrupulously for the first year; and in + regard to the not drinking malt liquor, and taking only the two glasses + of wine with water, I have never deviated but two days; and then the + first day I only drank one glass of ale and one glass of Champaigne; on + the second only one glass of Champaigne. With regard to the warm bath, + I only use it now when I have gouty symptoms upon me, and in such + situations I find it of infinite service; and in other respects I + continue to live according to your direction. + + "Many persons have laughed at the idea of my perseverance in a system, + which has not been able to _cure_ the gout after five years trial; but + such persons are either ignorant of what I before suffered, or totally + unacquainted with the nature of the disorder. Under the blessing of + Providence, by an adherence to your advice, I am reaping all the + benefit you flattered me I might expect from it, viz. my attacks less + frequent, my sufferings less acute, and an improvement in the general + state of my health. + + "I have been particular in this account of myself at your request, and + am, Sir, &c. + + MORLEY, near DERBY, + February 10th, 1795. + ROBERT WILMOT." + +There are situations nevertheless in which a paroxysm of gout has been +believed to be desirable, as relieving the patient from other disagreeable +diseases, or debilities, or sensations. Thus when the liver is torpid, a +perpetual uneasiness and depression of spirits occur; which a fit of gout +is supposed to cure by a metastasis of the disease. Others have acquired +epileptic fits, probably from the disagreeable sensation of a chronically +inflamed liver; which they suppose the pain and inflammation of gout would +relieve. When gouty patients become much debilitated by the progress of the +disease, they are liable to dropsy of the chest, which they suppose a fit +of the gout would relieve. But in all these cases the attempt to procure a +paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or +mineral waters, seldom succeeds; and the patients are obliged to apply to +other methods of relief adapted to their particular cases. In the two +former situations small repeated doses of calomel, or mercurial unction on +the region of the liver may succeed, by giving new activity to the vessels +of the liver, either to secrete or to absorb their adapted fluids, and thus +to remove the cause of the gout, rather than to promote a fit of it. In the +last case the tincture of digitalis, and afterwards the class of sorbentia, +must be applied to. + +M. M. In young strong patients the gout should be cured by venesection and +cathartics and diluents, with poultices externally. But it has a natural +crisis by producing calcareous matter on the inflamed membrane, and +therefore in old enfeebled people it is safest to wait for this crisis, +attending to the natural evacuations and the degree of fever; and in young +ones, where it is not attended with much fever, it is customary and popular +not to bleed, but only to keep the body open with aloes, to use gentle +sudorifics, as neutral salts, and to give the bark at the decline of the +fit; which is particularly useful where the patient is much debilitated. +See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17. + +When there is not much fever, and the patient is debilitated with age, or +the continuance of the disease, a moderate opiate, as twenty drops of +tincture of opium, or one grain of solid opium, may be taken every night +with advantage. Externally a paste made with double the quantity of yeast +is a good poultice; and booterkins made with oiled silk, as they confine +the perspirable matter, keep the part moist and supple, and thence relieve +the pain like poultices. + +The only safe way of moderating the disease is by an uniform and equal +diminution, or a total abstinence from fermented liquors, with the cautions +directed in Sect. XII. 7. 8. The continued use of strong bitters, as of +Portland's powder, or bark, has been frequently injurious, as spoken of in +the Materia Medica, Art. IV. 2. 11. + +One of my acquaintance, who was much afflicted with the gout, abstained for +about half a year from beer and wine; and not having resolution to persist, +returned to his former habits of potation in less quantity; and observed +that he was then for one winter stronger and freer from the gout than +usual. This however did not long continue, as the disease afterwards +returned with its usual or increased violence. This I think is a +circumstance not unlikely to occur, as opium has a greater effect after its +use has been a while intermitted; and the debility or torpor, which is the +cause of gout, is thus for a few months prevented by the greater +irritability of the system, acquired during the lessened use of fermented +liquor. + +For the same reason an ounce of spirituous tincture of guaiacum, or of +bark, is said to have for some time prevented returns of the gout; which +has afterwards, like all other great stimuli when long continued, been +succeeded by greater debility, and destroyed the patient. This seems to +have been exemplified in the case of the ingenious Dr. Bown, see Preface to +his Elementa Medicinae; he found temporary relief from the stimulus of +wine, regardless of its future effects. + +16. _Rheumatismus._ Acute rheumatism. There is reason to suspect, that +rheumatic inflammations, like the gouty ones, are not a primary disease; +but that they are the consequence of a translation of morbid action from +one part of the system to another. This idea is countenanced by the +frequent change of place of rheumatic-like gouty inflammations, and from +their attacking two similar parts at the same time, as both ankles and both +wrists, and these attacks being in succession to each other. Whereas it is +not probable that both feet or both hands should at the same time be +equally exposed to any external cause of the disease, as to cold or +moisture; and less so that these should occur in succession. Lastly, from +the inflammatory diathesis in this disease being more difficult to subdue, +and more dangerous in event, than other common inflammations, especially to +pregnant women, and in weak constitutions. + +From this idea of the rheumatism being not a primary disease, like the +gout, but a transferred morbid action owing to the previous torpor of some +other part of the system, we perceive why it attacks weak people with +greater pertinacity than strong ones; resisting or recurring again and +again after frequent evacuations, in a manner very different from primary +inflammations; because the cause is not removed, which is at a distance +from the seat of the inflammation. + +This also accounts for rheumatic inflammations so very rarely terminating +in suppuration, because like the gout the original cause is not in the +inflamed part, and therefore does not continue to act after the +inflammation commences. Instead of suppuration in this disease, as well as +in the gout, a quantity of mucus or coagulable lymph is formed on the +inflamed membrane; which in the gout changes into chalkstones, and in the +rheumatism is either reabsorbed, or lies on the membrane, producing pains +on motion long after the termination of the inflammation, which pains are +called chronic rheumatism. The membranes, which have thus been once or +repeatedly inflamed, become less mobile, or less liable to be affected by +sympathy, as appears by the gout affecting new parts, when the joints of +the foot have been frequently inflamed by it; hence as the cause of the +inflammation does not exist in the inflamed part, and as this part becomes +less liable to future attacks, it seldom suppurates. + +Secondly, when rheumatism affects the muscles of the chest, it produces +symptoms similar to pleurisy, but are distinguished from that by the +patient having previously suffered rheumatic affections in other parts, and +by the pertinacity or continuance of the inflammatory state of the patient, +this should be termed pleurodyne rheumatica. + +Thirdly, when rheumatic inflammation affects the bowels, it produces a +disease very different from enteritis, or common inflammation of the +bowels, and should be termed enteralgia rheumatica. The pain is less than +in enteritis, and the disease of longer continuance, with harder pulse, and +the blood equally sizy. It is attended with frequent dejections, with much +mucus, and previous griping pains, but without vomiting; and differs +perhaps from dysentery from its not being attended with bloody stools, and +not being infectious. + +Fourthly, there is another kind of rheumatism attended with debility, which +suppurates, and should be termed rheumatismus suppurans. It is generally +believed to be the gout, till suppuration takes place on the swelled joint; +and, as the patient sinks, there are sloughs formed over the whole mouth; +and he seems to be destroyed by inflammation or gangrene of the mucous +membranes. I have twice seen this disease in patients about sixty. Some +other diseases are erroneously called rheumatic, as hemicrania, and +odontalgia. See Sect. XXVI. 3. + +M.M. In the three former kinds venesection repeatedly. Cathartics. +Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark. +Opium with or without ipecacuanha; but not till the patient is considerably +weakened. Sweats forced early in the disease do injury. Opium given early +in the disease prolongs it. In the last kind, gentle stimulants, as wine +and water, mucilage, sorbentia. + +The following is a case of suppurative rheumatism. Mr. F----, about sixty, +was supposed to have the gout in his hand, which however suppurated, and it +was then called the suppurative rheumatism. He had lived rather +intemperately in respect to wine, and was now afflicted with a tendency to +inflammation of the mucous membranes. As he lay on the bed half resupine, +propped up with pillows, and also slept in that posture, his lower jaw +dropped by its own weight, when the voluntary power of the muscles was +suspended. The mucus of his mouth and throat became quite dry, and at +length was succeeded with sloughs; this was a most distressing circumstance +to him, and was in vain endeavoured to be relieved by supporting his jaw by +slender steel springs fixed to his night-cap, and by springs of elastic +gum. The sloughs spread and seemed to accelerate his death. See Class I. 1. +3. 2. + +17. _Erysipelas._ The erysipelas differs from the zona ignea, and other +species of herpes, in its being attended with fever, which is sometimes of +the sensitive irritated or inflammatory kind, with strong and full pulse; +and at other times with weak pulse and great inirritability, as when it +precedes or attends mortifications. See Class II. 1. 3. 2. + +Like the zona ignea above described, it seems to be a secondary disease, +having for its primary part the torpor or inflammation of some internal or +distant membrane, as appears from its so frequently attending wounds; +sometimes spreading from issues over the whole limb, or back, by sympathy +with a tendon or membrane, which is stimulated by the pease in them. In its +more violent degree I suppose that it sympathizes with some extensive +internal membranes, as of the liver, stomach, or brain. Another reason, +which countenances this idea, is, that the inflammation gradually changes +its situation, one part healing as another inflames; as happens in respect +to more distant parts in gout and rheumatism; and which seems to shew, that +the cause of the disease is not in the same place with the inflammation. +And thirdly, because the erysipelas of the face and head is liable to +affect the membranes of the brain; which were probably in these cases the +original or primary seat of the disease; and lastly, because the fits of +erysipelas, like those of the gout, are liable to return at certain annual +or monthly periods, as further treated of in Class II. 1. 3. 2. + +Many cases of erysipelas from wounds or bruises are related in Default's +Surgical Journal, Vol. II. in which poultices are said to do great injury, +as well as oily or fatty applications. Saturnine solutions were sometimes +used with advantage. A grain of emetic tartar given to clear the stomach +and bowels, is said to be of great service. + +18. _Testium tumor in gonorrhoea._ Mr. Hunter in his Treatise on the +Venereal Disease observes, that the tumor of the testes in gonorrhoea +arises from their sympathy with the inflammation of the urethra; and that +they are not similar to the actions arising from the application of +venereal matter, whether by absorption or otherwise; as they seldom or +never suppurate; and when suppuration happens, the matter produced is not +venereal. Treatise on Venereal Disease, p. 53. + +19. _Testium tumor in parotidite._ The sympathy between some parts about +the throat and the genitals has been treated of in Class IV. 1. 2. 7. The +swelling of the testes, when that of the parotis subsides, seems to arise +from the association of successive action; as the tension of the penis in +hydrophobia appears to arise from the previous synchronous associations of +the sensitive motions of these parts; but the manner of the production of +both these associations is yet very obscure. In women a swelling of the +breasts often succeeds the decline of the mumps by another wonderful +sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a +delirium succeeds the swelling of the parotis, or the subsequent ones of +the testes or breasts; which is sometimes fatal, and seems to arise from a +sympathy of successive action, and not of synchronous action, of the +membranes of the brain with those of the parotide glands. Sometimes a +stupor comes on instead of this delirium, which is relieved by fomenting +the shaved head for an hour or two. See Class II. 1. 3. 4. + + * * * * * + +ORDO I. + +_Increased Associate Motions._ + +GENUS III. + +_Catenated with Voluntary Motions_ + +SPECIES. + +1. _Deglutitio invita._ When any one is told not to swallow his saliva, and +that especially if his throat be a little sore, he finds a necessity of +immediately swallowing it; and this the more certainly, the more he +voluntarily endeavours not to do so. + +In this case the voluntary power exerted by our attention to the pharinx +renders it more sensible to irritation, and therefore occasions it to be +more frequently induced to swallow the saliva. Here the irritation induces +a volition to swallow it, which is more powerful than the desire not to +swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was +exerted on any of the senses, as of sight or taste, the objects of those +senses became perceived; but not otherwise. Sect. XIX. 6. This is a +troublesome symptom in some sore throats. + +M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth +frequently, as a fomentation to the inflamed throat. + +2. _Nictitatio invita._ Involuntary winking with the eye-lids, and +twitchings of the face, are originally induced by an endeavour to relieve +some disagreeable sensations about inflamed eyes, as the dazzling of light; +and afterwards these motions become catenated with other motions or +sensations, so as not to be governed by the will. Here the irritation first +produces a volition to wink, which by habit becomes stronger than the +anti-volition not to wink. + +This subject is rendered difficult from the common acceptation of the word, +volition, including previous deliberation, as well as the voluntary +exertion, which succeeds it. In the volitions here spoken of there is no +time for deliberation or choice of objects, but the voluntary act +immediately succeeds the sensation which excites it. + +M. M. Cover the affected parts with a sticking plaster or a blister. Pass a +fine needle and thread through a part of the skin over the muscle, which +moves, and attach the other end of the thread by a sticking plaster to a +distant part. An issue behind the ear. To practise daily by a looking-glass +to stop the motions with the hand. See the cure of a case of the leaping of +a muscle of the arm, Sect. XVII. 1. 8. See Convulsio debilis, Class III. 1. +1. 5. + +3. _Risus invitus._ Involuntary laughter. When the pleasure arising from +new combinations of words and ideas, as in puns; or of other circumstances, +which are so trivial, as to induce no voluntary exertion to compare or +consider their present importance or their future consequence; the pleasure +is liable to rise into pain; that is, the ideas or sensual motions become +exerted too violently for want of some antithetistic ideas; in the same +manner as those muscles, which have weak antagonists, as those of the calf +of the leg, are liable to fall into cramp or painful contraction. In this +situation a scream is begun to relieve this pain of ideas too violently +exerted, which is stopped again soon, as explained in Sect. XXXIV. 1. 4. +and Class III. 1. 1. 4. and IV. 2. 3. 3. + +The pain, into which this pleasure rises, which would excite the scream of +laughter, has been felt forcibly by every one; when they have been under +such circumstances, as have induced them to restrain it by a +counter-volition; till at length the increased associate motions produce so +much pain as to overcome the counter-volition, and the patient bursts out +into indecent laughter, contrary to his will in the common acceptation of +that word. + +4. _Lusus digitorum invitus._ An awkward playing with the fingers in +speaking in public. These habits are began through bashfulness, and seem +rather at first designed to engage the attention in part, and thus prevent +the disagreeable ideas of mauvaise hont; as timorous boys whistle, when +they are obliged to walk in the dark; and as it is sometimes necessary to +employ raw soldiers in perpetual manoeuvres, as they advance to the first +charge. + +5. _Unguium morsiuncula invita._ Biting the nails is a depraved habit +arising from similar causes as those of the last article. + +M. M. Dip the fingers in solution of aloes. + +6. _Vigilia invita._ Watchfulness, where the person wishes, and endeavours +to fall asleep, properly belongs to this place, as the wish or volition to +sleep prevents the desired effect; because sleep consists in an abolition +of volition. See Class III. 1. 2. 3. + + * * * * * + +ORDO I. + +_Increased Associate Motions._ + +GENUS IV. + +_Catenated with External Influences._ + +SPECIES. + +1. _Vita ovi._ Life of an egg. The eggs of fowls were shewn by Mr. J. +Hunter to resist the freezing process in their living state more +powerfully, than when they were killed by having the yolk and white shook +together. Philos. Trans. It may be asked, does the heat during the +incubation of eggs act as a stimulus exciting the living principle into +activity? Or does it act simply as a causa sine qua non, as an influence, +which penetrating the mass, removes the particles of it to a greater +distance from each other, so as to allow their movement over each other, in +the same manner as heat is conceived to produce the fluidity of water; not +by stimulus, but by its penetrating influence? Or may elementary heat in +its uncombined state be supposed to act only as an influence necessary to +life in its natural quantity; whence torpor and death follows the eduction +of it from the body; but in its increased state above what is natural, or +usual, that it acts as a stimulus; which we have a sense to perceive; and +which excites many parts of the system into unnatural action? See Class IV. +1. 1. C. + +2. _Vita hiemi-dormientium._ The torpor of insects, and birds, and +quadrupeds, during the cold season, has been called sleep; but I suppose it +must differ very much from that state of animal life, since not only all +voluntary power is suspended, but sensation and vascular motion has ceased, +and can only be restored by the influence of heat. There have been related +instances of snails, which have recovered life and motion on being put into +water after having experienced many years of torpidity, or apparent death, +in the cabinets of the curious. Here the water as well as the heat are +required not only as a stimulus, but as a causa sine qua non of fluidity +and motion, and consequent life. + +3. _Pullulatio arborum._ The annual revivescence of the buds of trees seems +not only to be owing to the influence of the returning warmth of the +spring, but also to be catenated with solar gravitation; because seeds and +roots and buds, which are analogous to the eggs of animals, put forth their +shoots by a less quantity of heat in spring, than they had undergone in the +latter part of autumn, which may however be ascribed to their previous +torpid state, and consequent accumulation of sensorial power, or +irritability; as explained in Botanic Garden, Part II. Cant. I. l. 322. +note. Other circumstances, which countenance the idea, that vegetation is +affected by solar gravitation, as well as by heat, may be observed in the +ripening of the seeds of plants both in those countries where the summers +are short, and in those where they are long. And by some flowers closing +their bells at noon, or soon after; and hence seem to sleep rather at solar +diurnal periods, than from the influence of cold, or the deficiency of +light. + +4. _Orgasmatis venerei periodus._ The venereal orgasm of birds and +quadrupeds commences or returns about the vernal or autumnal equinoxes, and +thence seems in respect to their great periods to be governed by solar +influence. But if this orgasm be disappointed of its object, it is said to +recur at about monthly periods, as observed in mares and bitches in this +respect resembling the female catamenia. See Sect. XXXVI. 2. 3. and Sect. +XVI. 13. + +5. _Brachii concussio electrica._ The movement of the arm, even of a +paralytic patient, when an electric shock is passed through it, is owing to +the stimulus of the excess of electricity. When a piece of zinc and silver, +each about the size of a crown-piece, are placed one under the upper lip, +and the other on the tongue, so as the outer edges may be brought into +contact, there is an appearance of light in the eyes, as often as the outer +edges of these metals are brought into contact or separated; which is +another instance of the stimulus of the passage of electric shocks through +the fibres of the organs of sense, as well as through the muscular fibres. +See Sect. XII. 1. 1. and first addit. note to Vol. I. of this work. But in +its natural state electricity seems only to act as an influence on animal +and vegetable bodies; of the salutary or injurious effects of which we have +yet no precise knowledge. + +Yet if regular journals were kept of the variations of atmospheric +electricity, it is probable some discoveries of its influence on our system +might in time be discovered. For this purpose a machine on the principle of +Mr. Bennet's electric doubler might be applied to the pendulum of a clock, +so as to manifest, and even to record the daily or hourly variations of +aerial electricity. Which has already been executed, and applied to the +pendulum of a Dutch wooden clock, by Mr. Bennet, curate of Wirksworth in +Derbyshire. + +Besides the variations of the degree or kind of atmospheric electricity, +some animals, and some men, seem to possess a greater power of accumulating +this fluid in themselves than others. Of which a famous history of a +Russian prince was lately published; who, during the clear and severe +frosts of that country, could not move himself in bed without luminous +corruscations. Such may have been the case of those people, who have been +related to have taken fire spontaneously, and to have been reduced to +ashes. The electric concussion from the gymnotus electricus, and torpedo, +are other instances of the power of the animal system to accumulate +electricity, as in these it is used as a weapon of defence, or for the +purpose of taking their prey. + +Some have believed that the accumulation or passage of the magnetic fluid +might affect the animal system, and have asserted that the application of a +large magnet to an aching tooth has quickly effected a cure. If this +experiment is again tried in odontalgia, or hemicrania, the painful +membrane of the tooth or head should be included between the south and +north poles of a horse-shoe magnet, or between the contrary poles of two +different magnets, that the magnetism may be accumulated on the torpid +part. + +6. _Oxygenatio sanguinis._ The variation of the quantity of oxygen gas +existing in the atmosphere must affect all breathing animals; in its excess +this too must be esteemed a stimulus; but in its natural quantity would +seem to act as an influence, or cause, without which, animal life cannot +exist even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic +infirmary, for the purpose of putting this and various other airs to the +test of experiment, will meet with public encouragement, and render +consumption, asthma, cancer, and many diseases conquerable, which at +present prey with unremitted devastation on all orders and ages of mankind. + +7. _Humectatio corporis._ Water, and probably the vapour of water dissolved +or diffused in the atmosphere, unites by mechanical attraction with the +unorganized cuticle, and softens and enlarges it; as may be seen in the +loose and wrinkled skin of the hands of washerwomen; the same probably +occurs to the mucous membrane of the lungs in moist weather; and by +thickening it increases the difficulty of respiration of some people, who +are said to be asthmatical. So far water may be said to act as an influx or +influence, but when it is taken up by the mouths of the absorbent system, +it must excite those mouths into action, and then acts as a stimulus. + +There appears from hence to be four methods by which animal bodies are +penetrated by external things. 1. By their stimulus, which induces the +absorbent vessels to imbibe them. 2. By mechanical attraction, as when +water softens the cuticle. 3. By chemical attraction, as when oxygen passes +through the membranes of the air-vessels of the lungs, and combines with +the blood. And lastly, by influx without mechanical attraction, chemical +combination, or animal absorption, as the universal fluids of heat, +gravitation, electricity, magnetism, and perhaps of other ethereal fluids +yet unknown. + + * * * * * + +ORDO II. + +_Decreased Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motions._ + +As irritative muscular motions are attended with pain, when they are +exerted too weakly, as well as when they are exerted too strongly; so +irritative ideas become attended with sensation, when they are exerted too +weakly, as well as when they are exerted too strongly. Which accounts for +these ideas being attended with sensation in the various kinds of vertigo +described below. + +There is great difficulty in tracing the immediate cause of the deficiences +of action of some links of the associations of irritative motions; first, +because the trains and tribes of motions, which compose these links, are so +widely extended as to embrace almost the whole animal system; and secondly, +because when the first link of an associated train of actions is exerted +with too great energy, the second link by reverse sympathy may be affected +with torpor. And then this second link may transmit, as it were, this +torpor to a third link, and at the same time regain its own energy of +action; and it is possible this third link may in like manner transmit its +torpor to a fourth, and thus regain its own natural quantity of motion. + +I shall endeavour to explain this by an example taken from sensitive +associated motions, as the origin of their disturbed actions is more easily +detected. This morning I saw an elderly person, who had gradually lost all +the teeth in his upper jaw, and all of the under except three of the +molares; the last of these was now loose, and occasionally painful; the +fangs of which were almost naked, the gums being much wasted both within +and without the jaw. He is a man of attentive observation, and assured me, +that he had again and again noticed, that, when a pain commenced in the +membranes of the alveolar process of the upper jaw opposite to the loose +tooth in the under one (which had frequently occurred for several days +past), the pain of the loose tooth ceased. And that, when the pain +afterwards extended to the ear and temple on that side, the pain in the +membranes of the upper jaw ceased. In this case the membranes of the +alveolar process of the upper jaw became torpid, and consequently painful, +by their reverse sympathy with the too violent actions of the inflamed +membranes of the loose tooth; and then by a secondary sympathy the +membranes about the ear and temple became torpid, and painful; and those of +the alveolar process of the upper jaw regained their natural quantity of +action, and ceased to be painful. A great many more nice and attentive +observations are wanted to elucidate these curious circumstances of +association, which will be found to be of the greatest importance in the +cure of many diseases, and lead us to the knowledge of fever. + +SPECIES. + +1. _Cutis frigida pransorum._ Chillness after dinner frequently attends +weak people, or those who have been exhausted by exercise; it arises from +the great expenditure of the sensorial power on the organs of digestion, +which are stimulated into violent action by the aliment; and the vessels of +the skin, which are associated with them, become in some measure torpid by +reverse sympathy; and a consequent chillness succeeds with less absorption +of atmospheric moisture. See the subsequent article. + +2. _Pallor urinae pransorum._ The paleness of urine after a full meal is an +instance of reverse association; where the secondary part of a train of +associate motions acts with less energy in consequence of the greater +exertions of the primary part. After dinner the absorbent vessels of the +stomach and intestines are stimulated into greater action, and drink up the +newly taken aliment; while those, which are spread in great number on the +neck of the bladder, absorb less of the aqueous part of the urine than +usual, which is therefore discharged in a more dilute state; and has been +termed crude by some medical writers, but it only indicates, that so great +a proportion of the sensorial power is expended on digestion and absorption +of the aliment, that other parts of the system act for a time with less +energy. See Class IV. I. 1. 6. + +3. _Pallor urinae a frigore cutaneo._ There is a temporary discharge of +pale water, and a diarrhoea, induced by exposing the skin to the cold air; +as is experienced by boys, who strip themselves before bathing. In this +case the mouths of the cutaneous lymphatics become torpid by the subduction +of their accustomed degree of heat, and those of the bladder and intestines +become torpid by direct sympathy; whence less of the thinner part of the +urinary secretion, and of the mucus of the intestines, is reabsorbed. See +Sect. XXIX. 4. 6. This effect of suddenly cooling the skin by the aspersion +of cold water has been used with success in costiveness, and has produced +evacuations, when other means have failed. When young infants are afflicted +with griping joined with costiveness, I have sometimes directed them to be +taken out of a warm bed, and carried about for a few minutes in a cool +room, with almost instant relief. + +4. _Pallor ex aegritudine._ When sickness of stomach first occurs, a +paleness of the skin attends it; which is owing to the association or +catenation between the capillaries of the stomach and the cutaneous ones; +which at first act by direct sympathy. But in a short time there commences +an accumulation of the sensorial power of association in the cutaneous +capillaries during their state of inactivity, and then the skin begins to +glow, and sweats break out, from the increased action of the cutaneous +glands or capillaries, which is now in reverse sympathy with those of the +stomach. So in continued fevers, when the stomach is totally torpid, which +is known by the total aversion to solid food, the cutaneous capillaries are +by reverse sympathy in a perpetual state of increased activity, as appears +from the heat of the skin. + +5. _Dyspnoea a balneo frigido._ The difficulty of breathing on going up to +the middle in cold water is owing to the irritative association or +catenation of the action of the extreme vessels of the lungs with those of +the skin. So that when the latter are rendered torpid or inactive by the +application of sudden cold, the former become inactive at the same time, +and retard the circulation of the blood through the lungs, for this +difficulty of breathing cannot be owing to the pressure of the water +impeding the circulation downwards, as it happens equally by a cold +shower-bath, and is soon conquered by habitual immersions. The capillaries +of the skin are rendered torpid by the subduction of the stimulus of heat, +and by the consequent diminution of the sensorial power of irritation. The +capillaries of the lungs are rendered torpid by the diminution of the +sensorial power of association, which is now excited in less quantity by +the lessened actions of the capillaries of the skin, with which they are +catenated. So that at this time both the cutaneous and pulmonary +capillaries are principally actuated, as far as they have any action, by +the stimulus of the blood. But in a short time the sensorial powers of +irritation, and of association, become accumulated, and very energetic +action of both these membranes succeed. Which thus resemble the cold and +hot fit of an intermittent fever. + +6. _Dyspepsia a pedibus frigidis._ When the feet are long cold, as in +riding in cold and wet weather, some people are very liable to indigestion +and consequent heart-burn. The irritative motions of the stomach become +torpid, and do their office of digestion imperfectly, in consequence of +their association with the torpid motions of the vessels of the +extremities. Fear, as it produces paleness and torpidity of the skin, +frequently occasions temporary indigestion in consequence of this +association of the vessels of the skin with those of the stomach; as riding +in very bad roads will give flatulency and indigestion to timorous people. + +A short exposure to cold air increases digestion, which is then owing to +the reverse sympathy between the capillary vessels of the skin, and of the +stomach. Hence when the body is exposed to cold air, within certain limits +of time and quantity of cold, a reverse sympathy of the stomach and the +skin first occurs, and afterwards a direct sympathy. In the former case the +expenditure of sensorial power by the skin being lessened, but not its +production in the brain; the second link of the association, viz. the +stomach, acquires a greater share of it. In the latter case, by the +continuation of the deficient stimulus of heat, the torpor becomes extended +to the brain itself, or to the trunks of the nerves; and universal +inactivity follows. + +7. _Tussis a pedibus frigidis._ On standing with the feet in thawing snow, +many people are liable to incessant coughing. From the torpidity of the +absorbent vessels of the lungs, in consequence of their irritative +associations with those of the skin, they cease to absorb the saline part +of the secreted mucus; and a cough is thus induced by the irritation of +this saline secretion; which is similar to that from the nostrils in frosty +weather, but differs in respect to its immediate cause; the former being +from association with a distant part, and the latter from defect of the +stimulus of heat on the nostrils themselves. See Catarrhus frigidus, Class +I. 2. 3. 3. + +8. _Tussis hepatica._ The cough of inebriates, which attends the +enlargement of the liver, or a chronical inflammation of its upper +membrane, is supposed to be produced by the inconvenience the diaphragm +suffers from the compression or heat of the liver. It differs however +essentially from that attending hepatitis, from its not being accompanied +with fever. And is perhaps rather owing to irritative association, or +reverse sympathy, between the lungs and the liver. As occurs in sheep, +which are liable to a perpetual dry cough, when the fleuk-worm is preying +on the substance of their livers. See Class II. 1. 1. 5. + +M. M. From half a grain to a grain of opium twice a day. A drachm of +mercurial ointment rubbed on the region of the liver every night for eight +or ten times. + +9. _Tussis arthritica._ Gout-cough. I have seen a cough, which twice +recurred at a few years distance in the same person, during his fits of the +gout, with such pertinacity and violence as to resist venesection, opiates, +bark, blisters, mucilages, and all the usual methods employed in coughs. It +was for a time supposed to be the hooping-cough, from the violence of the +action of coughing; it continued two or three weeks, the patient never +being able to sleep more than a few minutes at once during the whole time, +and being propped up in bed with pillows night and day. + +As no fever attended this violent cough, and but little expectoration, and +that of a thin and frothy kind, I suspected the membrane of the lungs to be +rather torpid than inflamed, and that the saline part of the mucus not +being absorbed stimulated them into perpetual exertion. And lastly, that +though the lungs are not sensible to cold and heat, and probably therefore +less mobile; yet, as they are nevertheless liable to consent with the +torpor of cold feet, as described in Species 6 of this Genus, I suspected +this torpor of the lungs to succeed the gout in the feet, or to act a +vicarious part for them. + +10. _Vertigo rotatoria._ In the vertigo from circumgyration the irritative +motions of vision are increased; which is evinced from the pleasure that +children receive on being rocked in a cradle, or by swinging on a rope. For +whenever sensation arises from the production of irritative motion with +less energy than natural, it is of the disagreeable kind, as from cold or +hunger; but when it arises from their production with greater energy than +natural, if it be confined within certain limits, it is of the pleasurable +kind, as by warmth or wine. With these increased irritative motions of +vision, I suppose those of the stomach are performed with greater energy by +direct sympathy; but when the rotatory motions, which produce this +agreeable vertigo, are continued too long, or are too violent, sickness of +the stomach follows; which is owing to the decreased action of that organ +from its reverse sympathy with the increased actions of the organ of +vision. For the expenditure of sensorial power by the organ of vision is +always very great, as appears by the size of the optic nerves; and is now +so much increased as to deprive the next link of association of its due +share. As mentioned in Article 6 of this Genus. + +In the same manner the undulations of water, or the motions of a ship, at +first give pleasure by increasing the irritative motions belonging to the +sense of vision; but produce sickness at length by expending on one part of +the associated train of irritative actions too much of that sensorial +power, which usually served the whole of it; whence some other parts of the +train acquire too little of it, and perform their actions in consequence +too feebly, and thence become attended with disagreeable sensation. + +It must also be observed, that when the irritative motions are stimulated +into unusual action, as in inebriation, they become succeeded by sensation, +either of the pleasurable or painful kind; and thus a new link is +introduced between the irritative motions thus excited, and those which +used to succeed them; whence the association is either dissevered or much +weakened, and thus the vomiting in sea-sickness occurs from the defect of +the power of association, rather than from the general deficiency of +sensorial power. + +When a blind man turns round, or when one, who is not blind, revolves in +the dark, a vertigo is produced belonging to the sense of touch. A blind +man balances himself by the sense of touch, which being a less perfect +means of determining small quantities of deviation from the perpendicular, +occasions him to walk more carefully upright than those, who balance +themselves by vision. When he revolves, the irritative associations of the +muscular motions, which were used to preserve his perpendicularity, become +disordered by their new modes of successive exertion; and he begins to +fall. For his feet now touch the floor in manners or directions different +from those they have been accustomed to; and in consequence he judges less +perfectly of the situation of the parts of the floor in respect to that of +his own body, and thus loses his perpendicular attitude. This may be +illustrated by the curious experiment of crossing one finger over the next +to it, and feeling of a nut or bullet with the ends of them. When, if the +eyes be closed, the nut or bullet appears to be two, from the deception of +the sense of touch. + +In this vertigo from gyration, both of the sense of sight, and of the sense +of touch, the primary link of the associated irritative motions is +increased in energy, and the secondary ones are increased at first by +direct sympathy; but after a time they become decreased by reverse sympathy +with the primary link, owing to the exhaustion of sensorial power in +general, or to the power of association in particular; because in the last +case, either pleasurable or painful sensation has been introduced between +the links of a train of irritative motions, and has dissevered, or much +enfeebled them. + +Dr. Smyth, in his Essay on Swinging in Pulmonary Consumption, has observed, +that swinging makes the pulse slower. Dr. Ewart of Bath confirmed this +observation both on himself and on Col. Cathcart, who was then hectic, and +that even on shipboard, where some degree of vertigo might be supposed +previously to exist. Dr. Currie of Liverpool not only confirmed this +observation frequently on himself, when he was also phthisical, but found +that equitation had a similar effect on him, uniformly retarding his pulse. +This curious circumstance cannot arise from the general effect of exercise, +or fatigue, as in those cases the pulse becomes weaker and quicker; it must +therefore be ascribed to a degree of vertigo, which attends all those modes +of motion, which we are not perpetually accustomed to. + +Dr. Currie has further observed, that "in cases of great debility the +voluntary muscular exertion requisite in a swing produces weariness, that +is, increases debility; and that in such instances he had frequently +noticed, that the diminution of the frequency of the pulse did not take +place, but the contrary." These circumstances may thus be accounted for. + +The links of association, which are effected in the vertigo occasioned by +unusual motion, are the irritative motions of the sense of vision, those of +the stomach, and those of the heart and arteries. When the irritative ideas +of vision are exerted with greater energy at the beginning of vertigo, a +degree of sensation is excited, which is of the pleasurable kind, as above +mentioned; whence the associated trains of irritative motions of the +stomach, and heart, and arteries, act at first with greater energy, both by +direct sympathy; and by the additional sensorial power of sensation. Whence +the pulse of a consumptive patient becomes stronger and consequently +slower. + +But if this vertigo becomes much greater in degree or duration, the first +link of this train of associated irritative motions expends too much of the +sensorial power, which was usually employed on the whole train; and the +motions of the stomach become in consequence exerted with less energy. This +appears, because in this degree of vertigo sickness supervenes, as in +sea-sickness, which has been shewn to be owing to less energetic action of +the stomach. And the motions of the heart and arteries then become weaker, +and in consequence more frequent, by their direct sympathy with the +lessened actions of the stomach. See Supplement, I. 12. and Class II. 1. 6. +7. The general weakness from fatigue is owing to a similar cause, that is, +to the too great expenditure of sensorial power in the increased actions of +one part of the system, and the consequent deficiency of it in other parts, +or in the whole. + +The abatement of the heat of the skin in hectic fever by swinging, is not +only owing to the increased ventilation of cool air, but to the reverse +sympathy of the motions of the cutaneous capillaries with those of the +heart and arteries; which occurs in all fevers with arterial debility, and +a hot or dry skin. Hence during moderate swinging the action of the heart +and arteries becomes stronger and slower, and the action of the +capillaries, which was before too great, as appeared by the heat of the +skin, now is lessened by their reverse sympathy with that of the heart and +arteries. See Supplement, I. 8. + +11. _Vertigo visualis._ Visual vertigo. The vertigo rotatoria described +above, was induced by the rotation or undulation of external objects, and +was attended with increased action of the primary link of the associated +motions belonging to vision, and with consequent pleasure. The vertigo +visualis is owing to less perfect vision, and is not accompanied with +pleasurable sensation. This frequently occurs in strokes of the palsy, and +is then succeeded by vomiting; it sometimes precedes epileptic fits, and +often attends those, whose sight begins to be impaired by age. + +In this vertigo the irritative ideas of the apparent motions of objects are +less distinct, and on that account are not succeeded by their usual +irritative associations of motion; but excite our attention. Whence the +objects appear to librate or circulate according to the motions of our +heads, which is called dizziness; and we lose the means of balancing +ourselves, or preserving our perpendicularity, by vision. So that in this +vertigo the motions of the associated organs are decreased by direct +sympathy with their primary link of irritation; as in the preceding case of +sea-sickness they are decreased by reverse sympathy. + +When vertigo affects people about fifty years of age, their sight has +generally been suddenly impaired; and from their less accurate vision they +do not soon enough perceive the apparent motions of objects; like a person +in a room, the walls of which are stained with the uniform figures of +lozenges, explained in Sect. XX. 1. This is generally ascribed to +indigestion; but it ceases spontaneously, as the patient acquires the habit +of balancing himself by less distinct objects. + +A gentleman about 50 was seized with an uncommon degree of vertigo, so as +to fall on the ground, and not to be able to turn his head, as he sat up +either in his chair or in his bed, and this continued eight or ten weeks. +As he had many decayed teeth in his mouth, and the vertigo was preceded and +sometimes accompanied by pains on one side of his head, the disease of a +tooth was suspected to be the cause. And as his timidity was too great to +admit the extraction of those which were decayed; after the trial of +cupping repeatedly, fomentations on his head, repeated blisters, with +valerian, Peruvian bark, musk, opium, and variety of other medicines; +mercurials were used, both externally and internally, with design to +inflame the membranes of the teeth, and by that means to prevent the torpor +of the action of the membranes about the temple, and parietal bone; which +are catenated with the membranes of the teeth by irritative association, +but not by sensitive association. The event was, that as soon as the gums +became sore with a slight ptyalism, the pains about the head and vertigo +gradually diminished, and during the soreness of his gums entirely ceased; +but I believe recurred afterwards, though in less degree. + +The idea of inflaming the membranes of the teeth to produce increased +sensation in them, and thus to prevent their irritative connection with +those of the cranium, was taken from the treatment of trismus, or locked +jaw, by endeavouring to inflame the injured tendon; which is said to +prevent or to remove the spasm of the muscles of the jaw. See Class III. 1. +1. 13. and 15. + +M. M. Emetics. Blisters. Issues about the head. Extraction of decayed +teeth. Slight salivation. Sorbentia. Incitantia. + +12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the +association of the irritative ideas of vision with the irritative motions +of the stomach. Whence when these latter become much increased by the +immoderate stimulus of wine, the irritative motions of the retina are +produced with less energy by reverse sympathy, and become at the same time +succeeded by sensation in consequence of their decreased action. See Sect. +XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision +are increased by turning round, or by our unaccustomed agitation at sea, +those of the stomach become inverted by reverse sympathy, and are attended +in consequence with disagreeable sensation. Which decreased action of the +stomach is in consequence of the increased expenditure of the sensorial +power on the irritative ideas of vision, as explained in Vertigo rotatoria. + +Whence though a certain quantity of vinous spirit stimulates the whole +system into increased action, and perhaps even increases the secretion of +sensorial power in the brain; yet as soon as any degree of vertigo is +produced, it is a proof, that by the too great expenditure of sensorial +power by the stomach, and its nearest associated motions, the more distant +ones, as those of vision, become imperfectly exerted. From hence may be +deduced the necessity of exhibiting wine in fevers with weak pulse in only +appropriated quantity; because if the least intoxication be induced, some +part of the system must act more feebly from the unnecessary expenditure of +sensorial power. + +13. _Vertigo febriculosa._ Vertigo in fevers either proceeds from the +general deficiency of sensorial power belonging to the irritative +associations, or to a greater expenditure of it on some links of the trains +and tribes of associated irritative motions. There is however a slighter +vertigo attending all people, who have been long confined in bed, on their +first rising; owing to their having been so long unused to the apparent +motions of objects in their erect posture, or as they pass by them, that +they have lost in part the habit of balancing themselves by them. + +14. _Vertigo cerebrosa._ Vertigo from injuries of the brain, either from +external violence, or which attend paralytic attacks, are owing to the +general deficiency of sensorial power. In these distressful situations the +vital motions, or those immediately necessary to life, claim their share of +sensorial power in the first place, otherwise the patient must die; and +those motions, which are less necessary, feel a deficiency of it, as these +of the organs of sense and muscles; which constitute vertigo; and lastly +the voluntary motions, which are still less immediately necessary to life, +are frequently partially destroyed, as in palsy; or totally, as in +apoplexy. + +15. _Murmur aurium vertiginosum._ The vertiginous murmur in the ears, or +noise in the head, is compared to the undulations of the sound of bells, or +to the humming of bees. It frequently attends people about 60 years of age; +and like the visual vertigo described above is owing to our hearing less +perfectly from the gradual inirritability of the organ on the approach of +age; and the disagreeable sensation of noise attending it is owing to the +less energetic action of these irritative motions; which not being +sufficiently distinct to excite their usual associations become succeeded +by our attention, like the indistinct view of the apparent motions of +objects mentioned in vertigo visualis. This may be better understood from +considering the use, which blind men make of these irritative sounds, which +they have taught themselves to attend to, but which escape the notice of +others. The late blind Justice Fielding walked for the first time into my +room, when he once visited me, and after speaking a few words said, "this +room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by +the ear with great accuracy. Now if these irritative sounds from the +partial loss of hearing do not correspond with the size or usual echoes of +the places, where we are; their catenation with other irritative ideas, as +those of vision, becomes dissevered or disturbed; and we attend to them in +consequence, which I think unravels this intricate circumstance of noises +being always heard in the head, when the sense of hearing begins to be +impaired, from whatever cause it occurs. + +This ringing in the ears also attends the vertigo from intoxication; for +the irritative ideas of sound are then more weakly excited in consequence +of the deficiency of the sensorial power of association. As is known by +this also being attended with disagreeable sensation, and by its +accompanying other diseases of debility, as strokes on the head, fainting +fits, and paralytic seizures. For in this vertigo from intoxication so much +sensorial power in general is expended on the increased actions of the +stomach, and its nearest connections, as the capillaries of the skin; that +there is a deficiency for the purposes of the other irritative associations +of motions usually connected with it. This auditory vertigo attends both +the rotatory and the visual vertigo above mentioned; in the former it is +introduced by reverse sympathy, that is, by the diminution of sensorial +power; too great a quantity of it being expended on the increased +irritative motions of vision; in the latter it is produced either by the +same causes which produce the visual vertigo, or by direct sympathy with +it. See Sect. XX. 7. + +M. M. Stimulate the internal ear by ether, or with essential oil diluted +with expressed oil, or with a solution of opium in wine, or in water. Or +with salt and water. + +16. _Tactus, gustus, olfactius vertiginosi._ Vertiginous touch, taste, and +smell. In the vertigo of intoxication, when the patient lies down in bed, +it sometimes happens even in the dark, that the bed seems to librate under +him, and he is afraid of falling out of it. The same occurs to people, who +are sea-sick, even when they lie down in the dark. In these the irritative +motions of the nerves of touch, or irritative tangible ideas, are performed +with less energy, in one case by reverse sympathy with the stomach, in the +other by reverse sympathy with the nerves of vision, and in consequence +become attended with sensation, and produce the fear of falling by other +associations. + +A vertigo of the sense of touch may be produced, if any one turns round for +a time with his eyes shut, and suddenly stops without opening them; for he +will for a time seem to be still going forwards; which is difficult to +explain. See the notes at the end of the first and second volume belonging +to Sect. XX. 6. + +In the beginning of some fevers, along with incessant vomiting, the +patients complain of disagreeable tastes in their mouth, and disagreeable +odours; which are to be ascribed to the general debility of the great +trains and tribes of associated irritative motions, and to be explained +from their direct sympathy with the decreased action of a sick stomach; or +from the less secretion of sensorial power in the brain. These organs of +sense are constantly stimulated into action by the saliva or by the air; +hence, like the sense of hunger, when they are torpid from want of +stimulus, or from want of sensorial power, pain or disagreeable sensation +ensues, as of hunger, or faintness, or sickness in one case; and the ideas +of bad tastes or odours in the other. This accords with the laws of +causation, Sect. IV. 5. + +17. _Pulsus mollis in vomitione._ The softness of the pulse in the act of +vomiting is caused by direct association between the heart and the stomach; +as explained in Sect. XXV. 17. A great slowness of the pulsation of the +heart sometimes attends sickness, and even with intermissions of it, as in +the exhibition of too great a dose of digitalis. + +18. _Pulsus intermittens a ventriculo._ When the pulse first begins to +intermit, it is common for the patient to bring up a little air from his +stomach; which if he accomplishes before the intermission occurs, always +prevents it; whence that this debility of the heart is owing to the direct +association of its motions with those of the stomach is well evinced. See +Sect. XXV. 17. + +I this morning saw Mr. ----, who has long had at times an unequal pulse, +with indigestion and flatulency, and occasional asthma; he was seized two +days ago with diarrhoea, and this morning with sickness, and his pulse was +every way unequal. After an emetic his pulse still continued very +intermittent and unequal. He then took some breakfast of toast and butter, +and tea, and to my great surprise his pulse became immediately perfectly +regular, about 100 in a minute, and not weak, by this stimulus on his +stomach. + +A person, who for many years had had a frequent intermission of his pulse, +and occasional palpitation of his heart, was relieved from them both for a +time by taking about four drops of a saturated solution of arsenic three or +four times a day for three or four days. As this intermission of the pulse +is occasioned by the direct association of the motions of the heart with +those of the stomach, the indication of cure must be to strengthen the +action of the stomach by the bark. Spice. Moderate quantities of wine. A +blister. Half a grain of opium twice a day. Solution of arsenic? + +19. _Febris inirritativa._ Inirritative fever described in Class I. 2. 1. +1. belongs to this place, as it consists of disordered trains and tribes of +associated irritative motions, with lessened actions of the associated +organs. In this fever the pulsations of the heart and arteries are weakened +or lessened, not only in the cold paroxysm, as in the irritative fever, but +also in the hot paroxysm. The capillary arteries or glands have their +actions nevertheless increased after the first cold fit, as appears by the +greater production of heat, and the glow of arterial blood, in the +cutaneous vessels; and lastly, the action of the stomach is much impaired +or destroyed, as appears by the total want of appetite to solid food. +Whence it would seem, that the torpid motions of the stomach, whatever may +occasion them, are a very frequent cause of continued fever with weak +pulse; and that these torpid motions of the stomach do not sufficiently +excite the sensorial power of association, which contributes in health to +actuate the heart and arteries along with the irritation produced by the +stimulus of the blood; and hence the actions of these organs are weaker. +And lastly, that the accumulation of the sensorial power of association, +which ought to be expended on the motions of the heart and arteries, +becomes now exerted on the cutaneous and pulmonary capillaries. See +Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10. + +I have dwelt longer on the vertiginous diseases in this genus, both because +of their great intricacy, and because they seem to open a road to the +knowledge of fever, which consists of associated trains and tribes of +irritative or sensitive motions, which are sometimes mixed with the +vertiginous ones, and sometimes separate from them. + + * * * * * + +ORDO II. + +_Decreased Associate Motions._ + +GENUS II. + +_Catenated with Sensitive Motions._ + +In this genus the sensorial power of association is exerted with less +energy, and thence the actions produced by it are less than natural; and +pain is produced in consequence, according to the fifth law of animal +causation, Sect. IV. This pain is generally attended with coldness of the +affected part, and is seldom succeeded by inflammation of it. This +decreased action of the secondary link of the associated motions, belonging +to this genus, is owing to the previous exhaustion of sensorial power +either in the increased actions of the primary link of the associated +motions, or by the pain which attends them; both which are frequently the +consequence of the stimulus of something external to the affected fibres. + +As pain is produced either by excess or defect of the natural exertions of +the fibres, it is not, considered separately, a criterion of the presence +of either. In the associations belonging to this genus the sensation of +pain or pleasure produces or attends the primary link of the associated +motions, and very often gives name to the disease. + +When great pain exists without causing any fibrous motions, I conjecture +that it contributes to exhaust or expend the general quantity of sensorial +power; because people are fatigued by enduring pain, till at length they +sleep. Which is contrary to what I had perhaps erroneously supposed in +Sect. XXXV. 2. 3. If it causes fibrous motions, it then takes the name of +sensation, according to the definition of sensation in Sect. II. 2. 9.; and +increased fibrous action or inflammation is the consequence. This +circumstance of the general exhaustion of sensorial power by the existence +of pain will assist in explaining many of the diseases of this genus. + +Many of the canals of the body, as the urethra, the bile-duct, the throat, +have the motions of their two extremities associated by having been +accustomed to feel pleasurable or painful sensations at the same time or in +succession. This is termed sensitive association, though those painful or +pleasurable sensations do not cause the motions, but only attend them; and +are thus perhaps, strictly speaking, only catenated with them. + +SPECIES. + +1. _Torpor genae a dolore dentis._ In tooth-ach there is generally a +coldness of the cheek, which is sensible to the hand, and is attended in +some degree with the pain of cold. The cheek and tooth have frequently been +engaged in pleasurable action at the same time during the masticating of +our food; whence they have acquired sensitive associations. The torpor of +the cheek may have for its cause the too great expenditure of sensorial +power by the painful sensation of the membranes of the diseased tooth; +whence the membranes of the cheek associated with those of the alveolar +process are deprived of their natural share of it, and become torpid; thus +they produce less secretions, and less heat, and the pain of cold is the +consequence. This torpor of the vessels of the cheek cannot be produced by +the activity of the sensorial power of sensation; for then they would act +more violently than natural, or become inflamed. And though the pain by +exhausting so much sensorial power may be a remote cause, it is the defeat +of the power of association, which is the immediate cause of the torpor of +the cheek. + +After some hours this pain occasioned by the torpor of the vessels of the +cheek either gradually ceases along with the pain of the diseased tooth; +or, by the accumulation of sensorial power during their state of torpor, +the capillaries of the cheek act with greater violence, and produce more +secretions, and heat, and consequent tumour, and inflammation. In this +state the pain of the diseased tooth ceases; as the sensorial power of +sensation is now expended on the inflamed vessels of the cheek. It is +probable that most other internal membranous inflammations begin in a +similar manner; whence there may seem to be a double kind of sensitive +association; first, with decreased action of the associated organ, and then +with increased action of it; but the latter is in this case simply the +consequence of the former; that is, the tumor or inflammation of the cheek +is in consequence of its previous quiescence or torpor. + +2. _Stranguria a dolore vesicae._ The strangury, which has its origin from +pain at the neck of the bladder, consists of a pain in the external +extremity of the urethra or of the glans penis of men, and probably in the +external termination of the urethra or of the clitoris of women; and is +owing to the sympathy of these with some distant parts, generally with the +other end of the urethra; an endeavour and difficulty of making water +attends this pain. + +Its remote cause is from the internal or external use of cantharides, which +stimulate the neck of the bladder; or from a stone, which whenever it is +pushed into the neck of the bladder, gives this pain of strangury, but not +at other times; and hence it is felt most severely in this case after +having made water. + +The sensations or sensitive motions of the glans penis, and of the +sphincter of the bladder, have been accustomed to exist together during the +discharge of the urine; and hence the two ends of the urethra sympathize by +association. When there is a stone at the neck of the bladder, which is not +so large or rough as to inflame the part, the sphincter of the bladder +becomes stimulated into pain; but as the glans penis is for the purposes of +copulation more sensitive than the sphincter of the bladder, as soon as it +becomes affected with pain by the association above mentioned, the +sensation at the neck of the bladder ceases; and then the pain of the glans +penis would seem to be associated with the irritative motions only of the +sphincter of the bladder, and not with the sensitive ones of it. But a +circumstance similar to this occurs in epileptic fits, which at first are +induced by disagreeable sensation, and afterwards seem to occur without +previous pain, from the suddenness in which they follow and relieve the +pain, which occasioned them. From this analogy I imagine the pain of the +glans penis is associated with the pain of the sphincter of the bladder; +but that _as soon as the greater pain in a more sensible part is produced; +the lesser one, which occasioned it, ceases_; and that this is one of the +laws of sensitive association. See Sect. XXXV. 2. 1. + +A young man had by an accident swallowed a large spoonful or more of +tincture of cantharides; as soon as he began to feel the pain of strangury, +he was advised to drink large quantities of warmish water; to which, as +soon as it could be got, some gum arabic was added. In an hour or two he +drank by intervals of a few minutes about two gallons of water, and +discharged his urine every four or five minutes. A little blood was voided +towards the end, but he suffered no ill consequence. + +M. M. Warm water internally. Clysters of warm water. Fomentation. Opium. +Solution of fixed alkali supersaturated with carbonic acid. A bougie may be +used to push back a stone into the bladder. See Class I. 1. 3. 10. + +3. _Stranguria convulsiva._ The convulsive strangury, like that before +described, is probably occasioned by the torpor or defective action of the +painful part in consequence of the too great expenditure of sensorial power +on the primary link of the associated motions, as no heat or inflammation +attends this violent pain. This kind of strangury recurs by stated periods, +and sometimes arises to so great a degree, that convulsion or temporary +madness terminates each period of it. It affects women oftener than men, is +attended with cold extremities without fever, and is distinguished from the +stone of the bladder by the regularity of its periods, and by the pain +being not increased after making water. + +On introducing the catheter sometimes part of the urine will come away and +not the whole, which is difficult to explain; but may arise from the +weakness of the muscular fibres of the bladder; which are not liable +suddenly to contract themselves so far as to exclude the whole of the +urine. In some old people, who have experienced a long retention of urine, +the bladder never regains the power of completely emptying itself; and many +who are beginning to be weak from age can make water a second time, a few +minutes after they supposed they had emptied the bladder. + +I have believed this pain to originate from sympathy with some distant +part, as from ascarides in the rectum, or from piles in women; or from +caruncles in the urethra about the caput gallinaginis in men; and that the +pain has been in the glans or clitoris by reverse sympathy of these more +sensible parts with those above mentioned. + +M. M. Venesection. Opium in large quantities. Warm bath. Balsams. Bark. +Tincture of cantharides. Bougie, and the treatment for haemorrhoids. +Leeches applied to the sphincter ani. Aerated alcaline water. Soap and sal +soda. Opium in clysters given an hour before the expected return. Smoke of +tobacco in clysters. Arsenic? + +4. _Dolor termini intestinalis ductus choledochi._ Pain at the intestinal +end of the gall-duct. When a gall-stone is protruded from the gall-bladder +a little way into the end of the gall-duct, the pain is felt at the other +end of the gall-duct, which terminates in the duodenum. For the actions of +the two terminations of this canal are associated together from the same +streams of bile passing through them in succession, exactly as the two +terminations of the urethra have their actions associated, as described in +Species 2 and 3 of this genus. But as the intestinal termination of the +bile-duct is made more sensible for the purpose of bringing down more bile, +when it is stimulated by new supplies of food from the stomach, it falls +into violent pain from association; and then the pain on the region of the +gall-bladder ceases, exactly as above explained in the account of the pain +of the glans penis from a stone in the sphincter of the bladder. + +The common bile-duct opens into the intestine exactly at what is called the +pit of the stomach; and hence it has sometimes happened, that this pain +from association with the sensation of a gall-stone at the other end of the +bile-duct has been mistaken for a pain of the stomach. + +For the method of cure see Class I. 1. 3. 8. to which should be added the +use of strong electric shocks passed through the bile-duct from the pit of +the stomach to the back, and from one side to the other. A case of the good +effect of electricity in the jaundice is related in Sect. XXX. 2. And +another case, where it promoted the passage of a painful gall-stone, is +described by Dr. Hall, experienced on himself. Trans. of the College at +Philadelphia, Vol. I. p. 192. + +Half a pint of warm water two or three times a day is much recommended to +dilute the inspissated bile. + +5. _Dolor pharyngis ab acido gastrico._ The two ends of the throat +sympathize by sensitive association in the same manner as the other canals +above mentioned, namely, the urethra and the bile-duct; hence when too +great acidity of undigested aliment, or the carbonic acid air, which +escapes in fermentation, stimulates the cardia ventriculi, or lower end of +the gula, into pain; the pharinx, or upper end of it, is affected with +greater pain, or a disagreeable sensation of heat. + +6. _Pruritus narium a vermibus._ The itching of the nose from worms in the +intestines is another curious instance of the sensitive associations of the +motions of membranes; especially of those which constitute the canals of +the body. Previous to the deglutition of agreeable food, as milk in our +earliest infancy, an agreeable odour affects the membrane, which lines the +nostrils; and hence an association seems to take place between the +agreeable sensations produced by food in the stomach and bowels, and the +agreeable sensations of the nostrils. The existence of ascarides in the +rectum I believe produces this itching of the nostrils more than the worms +in other parts of the intestines; as we have already seen, that the +terminations of canals sympathize more than their other parts, as in the +urethra and gall-ducts. See Class I. 1. 5. 9. IV. 1. 2. 9. + +7. _Cephalaea._ Head-ach. In cold fits of the ague, the head-ach arises +from consent with some torpid viscus, like the pain of the loins. After +drunkenness the head-ach is very common, owing to direct sympathy of the +membranes of the head with those of the stomach; which is become torpid +after the too violent stimulus of the preceding intoxication; and is hence +removeable by spirit of wine, or opium, exhibited in smaller quantities. In +some constitutions these head-achs are induced, when the feet are exposed +to much external cold; in this case the feet should be covered with oiled +silk, which prevents the evaporation of the perspirable matter, and thence +diminishes one cause of external cold. + +M. M. Valerian in powder two drams three or four times a day is +recommended. The bark. Chalybeates. A grain of opium twice a day for a long +time. From five to ten drops of the saturated solution of arsenic two or +three times a day. See Class I. 2. 4. 11. A lady once assured me, that when +her head-ach was coming on, she drank three pints (pounds) of hot water, as +hastily as she could; which prevented the progress of the disease. A +solution of arsenic is recommended by Dr. Fowler of York. Very strong +errhines are said sometimes to cure head-achs taken at the times the pain +recurs, till a few drops of blood issue from the nostrils. As one grain of +turpeth mineral (vitriolic calx of mercury) mixed with ten grains of fine +sugar. Euphorbium or cayan pepper mixed with sugar, and used with caution +as an errhine. See the M. M. of the next Species. + +8. _Hemicrania._ Pain on one side of the head. This disease is attended +with cold skin, and hence whatever may be the remote cause, the immediate +one seems to be want of stimulus, either of heat or distention, or of some +other unknown stimulus in the painful part; or in those, with which it is +associated. The membranes in their natural state are only irritable by +distention; in their diseased state, they are sensible like muscular +fibres. Hence a diseased tooth may render the neighbouring membranes +sensible, and is frequently the cause of this disease. + +Sometimes the stomach is torpid along with the pained membrane of the head; +and then sickness and inappetency attends either as a cause or consequence. +The natural cure of hemicrania is the accumulation of sensorial power +during the rest or sickness of the patient. Mrs. ---- is frequently liable +to hemicrania with sickness, which is probably owing to a diseased tooth; +the paroxysm occurs irregularly, but always after some previous fatigue, or +other cause of debility. She lies in bed, sick, and without taking any +solid food, and very little of fluids, and those of the aqueous kind, and, +after about 48 or 50 hours, rises free from complaint. Similar to this is +the recovery from cold paroxysms of fever, from the torpor occasioned by +fear, and from syncope; which are all owing to the accumulation of +sensorial power during the inactivity of the system. Hence it appears, +that, though when the sensorial power of volition is much exhausted by +fatigue, it can be restored by eight or ten hours of sleep; yet, when the +sensorial power of irritation is exhausted by fatigue, that it requires two +whole solar or lunar days of rest, before it can be restored. + +The late Dr. Monro asserted in his lectures, that he cured the hemicrania, +or megrim, by a strong vomit, and a brisk purge immediately after it. This +method succeeds best if opium and the bark are given in due quantity after +the operation of the cathartic; and with still more certainty, if bleeding +in small quantity is premised, where the pulse will admit of it. See Sect. +XXXV. 2. 1. + +The pain generally affects one eye, and spreads a little way on that side +of the nose, and may sometimes be relieved by pressing or cutting the +nerve, where it passes into the bone of the orbit above the eye. When it +affects a small defined part on the parietal bone on one side, it is +generally termed Clavus hystericus, and is always I believe owing to a +diseased dens molaris. The tendons of the muscles, which serve the office +of mastication, have been extended into pain at the same time, that the +membranous coverings of the roots of the teeth have been compressed into +pain, during the biting or mastication of hard bodies. Hence when the +membranes, which cover the roots of the teeth, become affected with pain by +a beginning decay, or perhaps by the torpor or coldness of the dying part +of the tooth, the tendons and membranous fascia of the muscles about the +same side of the head become affected with violent pain by their sensitive +associations: and as soon as this associated pain takes place, the pain of +the tooth entirely ceases, as explained in the second species of this +genus. + +A remarkable circumstance attends this kind of hemicrania, viz. that it +recurs by periods like those of intermittent fevers, as explained in the +Section on Catenation of Motions; these periods sometimes correspond with +alternate lunar or solar days like tertian agues, and that even when a +decaying tooth is evidently the cause; which has been evinced by the cure +of the disease by extracting the tooth. At other times they observe the +monthly lunations, and seem to be induced by the debility, which attends +menstruation. + +The dens sapientiae, or last tooth of the upper jaw, frequently decays +first, and gives hemicrania over the eye on the same side. The first or +second grinder in the under-jaw is liable to give violent pain about the +middle of the parietal bone, or side of the head, on the same side, which +is generally called the Clavus hystericus, of which an instructive case is +related in Sect. XXXV. 2. 1. + +M. M. Detect and extract the diseased tooth. Cut the affected nerve, or +stimulate the diseased membrane by acu-puncture. Venesection to six ounces +by the lancet or by leeches. A strong emetic and a subsequent cathartic; +and then an opiate and the bark. Pass small electric shocks through the +pained membrane, and through the teeth on the same side. Apply vitriolic +ether externally, and a grain of opium with camphor internally, to the +cheek on the affected side, where a diseased tooth may be suspected. Foment +the head with warm vinegar. Drink two large spoonfuls of vinegar. Stimulate +the gums of the suspected teeth by oil of cloves, by opium. See Class I. 1. +4. 4. Snuff volatile spirit of vinegar up the nostrils. Lastly, in +permanent head-achs, as in permanent vertigo, I have seen good effect by +the use of mercurial ointment rubbed on the shaved head or about the +throat, till a mild salivation commences, which by inflaming the membranes +of the teeth may prevent their irritative sympathy with those of the +cranium. Thus by inflaming the tendon, which is the cause of locked jaw, +and probably by inflaming the wound, which is the cause of hydrophobia, +those diseases may be cured, by disuniting the irritative sympathy between +those parts, which may not possess any sensitive sympathy. This idea is +well worth our attention. + +_Otalgia._ Ear-ach is another disease occasioned by the sympathy of the +membranes of the ear with those which invest or surround a decaying tooth, +as I have had frequent reason to believe; and is frequently relieved by +filling the ear with tincture of opium. See Class I. 2. 4. + +9. _Dolor humeri in hepatitide._ In the efforts of excluding the faeces and +urine the muscles of the shoulders are exerted to compress the air in the +lungs, that the diaphragm may be pressed down. Hence the distention of the +tendons or fibres of these muscles is associated with the distention of the +tendons or fibres of the diaphragm; and when the latter are pained by the +enlargement or heat of the inflamed liver, the former sympathize with them. +Sometimes but one shoulder is affected, sometimes both; it is probable that +many other pains, which are termed rheumatic, have a similar origin, viz. +from sensitive associations. + +As no inflammation is produced in consequence of this pain of the shoulder, +it seems to be owing to inaction of the membranous part from defect of the +sensorial power of association, of which the primary link is the inflamed +membrane of the liver; which now expends so much of the sensorial power in +general by its increased action, that the membranes about the shoulder, +which are links of association with it, become deprived of their usual +share, and consequently fall into torpor. + +10. _Torpor pedum in eruptione variolarum._ At the commencement of the +eruption of the small-pox, when the face and breast of children are very +hot, their extremities are frequently cold. This I ascribe to sensitive +association between the different parts of the skin; whence when a part +acts too violently, the other part is liable to act too weakly; and the +skin of the face being affected first in the eruption of the small-pox, the +skin of the feet becomes cold in consequence by reverse sympathy. + +M. M. Cover the feet with flannel, and expose the face and bosom to cool +air, which in a very short time both warms the feet and cools the face; and +hence what is erroneously called a rash, but which is probably a too hasty +eruption of the small-pox, disappears; and afterwards fewer and more +distinct eruptions of the small-pox supervene. + +11. _Testium dolor nephriticus._ The pain and retraction of the testicle on +the same side, when there is a stone in the ureter, is to be ascribed to +sensitive association; whether the connecting cause be a branch of the same +nerve, or from membranes, which have been frequently affected at the same +time. + +12. _Dolor digiti minimi sympatheticus._ When any one accidentally strikes +his elbow against any hard body, a tingling pain runs down to the little +finger end. This is owing to sensitive association of motions by means of +the same branch of a nerve, as in hemicrania from a decaying tooth the pain +is owing to the sensitive association of tendons or membranes. + +13. _Dolor brachii in hydrope pectoris._ The pain in the left arm which +attends some dropsies of the chest, is explained in Sect. XXIX. 5. 2. 10. +which resembles the pain of the little finger from a percussion of the +nerve at the elbow in the preceding article. A numbness of this kind is +produced over the whole leg, when the crural nerve is much compressed by +sitting for a time with one leg crossed over the other. + +Mr. ----, about sixty, had for two years been affected with difficulty of +respiration on any exertion, with pain about the sternum, and of his left +arm; which last was more considerable than is usual in dropsy of the chest; +some months ago the pain of his arm, after walking a mile or two, became +excessive, with coldness and numbness; and on the next day the back of the +hand, and a part of the arm swelled, and became inflamed, which relieved +the pain; and was taken for the gout, and continued several days. He after +some months became dropsical both in respect to his chest and limbs, and +was six or seven times perfectly relieved by one dram of saturated tincture +of digitalis, taken two or three times a day for a few days in a glass of +peppermint water. He afterwards breathed oxygen gas undiluted, in the +quantity of six or eight gallons a day for three or four weeks without any +effect, and sunk at length from general debility. + +In this instructive case I imagine the pressure or stimulus of one part of +the nerve within the chest caused the other part, which serves the arm, to +become torpid, and consequently cold by sympathy; and that the inflammation +was the consequence of the previous torpor and coldness of the arm, in the +same manner as the swelling and inflammation of the cheek in tooth-ach, in +the first species of this genus; and that many rheumatic inflammations are +thus produced by sympathy with some distant part. + +14. _Diarrhoea a dentitione._ The diarrhoea, which frequently attends +dentition, is the consequence of indigestion; the aliment acquires chemical +changes, and by its acidity acts as a cathartic; and changes the yellow +bile into green, which is evacuated along with indigested parts of the +coagulum of milk. The indigestion is owing to the torpor of the stomach and +intestines caused by their association with the membranes of the gums, +which are now stimulated into great exertion with pain; both which +contribute to expend the general quantity of sensorial power, which belongs +to this membranous association; and thus the stomach and intestines act +with less than their natural energy. This is generally esteemed a +favourable symptom in difficult dentition, as the pain of the alveolar +membranes exhausts the sensorial power without producing convulsions for +its relief. See Class I. 1. 4. 5. And the diarrhoea ceases, as the tooth +advances. + + * * * * * + +ORDO II. + +_Decreased Associate Motions._ + +GENUS III. + +_Catenated with Voluntary Motions._ + +SPECIES. + +1. _Titubatio linguae._ Impediment of speech is owing to the associations +of the motions of the organs of speech being interrupted or dissevered by +ill-employed sensation or sensitive motions, as by awe, bashfulness, +ambition of shining, or fear of not succeeding, and the person uses +voluntary efforts in vain to regain the broken associations, as explained +in Sect. XVII. 1. 10. and XVII. 2. 10. + +The broken association is generally between the first consonant and the +succeeding vowel; as in endeavouring to pronounce the word parable, the p +is voluntarily repeated again and again, but the remainder of the word does +not follow, because the association between it and the next vowel is +dissevered. + +M. M. The art of curing this defect is to cause the stammerer to repeat the +word, which he finds difficult to speak, eight or ten times without the +initial letter, in a strong voice, or with an aspirate before it, as +arable, or harable; and at length to speak it very softly with the initial +letter p, parable. This should be practised for weeks or months upon every +word, which the stammerer hesitates in pronouncing. To this should be added +much commerce with mankind, in order to acquire a carelessness about the +opinions of others. + +2. _Chorea St. Viti._ In the St. Vitus's dance the patient can at any time +lie still in bed, which shews the motions not to be convulsive; and he can +at different times voluntarily exert every muscle of his body; which +evinces, that they are not paralytic. In this disease the principal muscle +in any designed motion obeys the will; but those muscles, whose motions +were associated with the principal one, do not act; as their association is +dissevered, and thus the arm or leg is drawn outward, or inward, or +backward, instead of upward or forward, with various gesticulations exactly +resembling the impediment of speech. + +This disease is frequently left after the itch has been too hastily cured. +See Convulsio dolorifica, Class III. 1. 1. 6. A girl about eighteen, after +wearing a mercurial girdle to cure the itch, acquired the Chorea St. Viti +in so universal a manner, that her speech became affected as well as her +limbs; and there was evidently a disunion of the common trains of ideas; as +the itch was still among the younger children of the family, she was +advised to take her sister as a bedfellow, and thus received the itch +again; and the dance of St. Vitus gradually ceased. See Class II. 1. 5. 6. + +M. M. Give the patient the itch again. Calomel a grain every night, or +sublimate a quarter of a grain twice a day for a fortnight. Steel. Bark. +Warm-bath. Cold-bath. Opium. Venesection once at the beginning of the +disease. Electricity. Perpetual slow and repeated efforts to move each limb +in the designed direction, as in the titubatio linguae above described. + +3. _Risus._ Laughter is a perpetual interruption of voluntary exertion by +the interposition of pleasurable sensation; which not being checked by any +important consequences rises into pain, and requires to be relieved or +moderated by the frequent repetition of voluntary exertion. See Sect. +XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 1. 3. 3. + +4. _Tremor ex ira._ The trembling of the limbs from anger. The interruption +of the voluntary associations of motions by anger, originates from too +great a part of the sensorial power being exerted on the organs of sense; +whence the muscles, which ought to support the body upright, are deprived +of their due quantity, and tremble from debility. See Class III. 2. 1. 1. + +5. _Rubor ex ira._ Redness from anger. Anger is an excess of aversion, that +is of voluntarity not yet employed. It is excited by the pain of offended +pride; when it is employed it becomes outrage, cruelty, insanity. The +cutaneous capillaries, especially those of the face, are more mobile, that +is, more easily excited into increased action, or more easily become +torpid, from less variation of sensorial power, than any other parts of the +system, which is owing to their being perpetually subject to the +vicissitudes of heat and cold, and of extension and corrugation. Hence, +when an excess of voluntarity exists without being immediately expended in +the actions of the large muscles, the capillary arteries and glands acquire +more energetic action, and a flushed skin is produced, with increased +secretion of perspirable matter, and consequent heat, owing to the pause or +interruption of voluntary action; and thus the actions of these cutaneous +vessels become associated between the irascent ideas and irascent muscular +actions, which are thus for a time interrupted. + +6. _Rubor criminati._ The blushing of accused people, whether guilty or +not, appears to be owing to circumstances similar to that of anger; for in +these situations there is always a sudden voluntarity, or wish, of clearing +their characters arises in the mind of the accused person; which, before an +opportunity is given for it to be expended on the large muscles, influences +the capillary arteries and glands, as in the preceding article. Whence the +increased actions of the capillaries, and the consequent redness and heat, +become exerted between the voluntary ideas of self-defence, and the +muscular actions necessary for that purpose; which last are thus for a time +interrupted or delayed. + +Even in the blush of modesty or bashfulness there is a self-condemnation +for some supposed defect or indecorum, and a sudden voluntarity, or wish, +of self-defence; which not being expended in actions of the larger muscles +excites the capillaries into action; which in these subjects are more +mobile than in others. + +The blush of young girls on coming into an assembly room, where they expect +their dress, and steps, and manner to be examined, as in dancing a minuet, +may have another origin; and may be considered as a hot fit of returning +confidence, after a previous cold fit of fear. + +7. _Tarditas paralytica._ By a stroke of the palsy or apoplexy it +frequently happens, that those ideas, which were associated in trains, +whose first link was a voluntary idea, have their connection dissevered; +and the patient is under the necessity by repeated efforts slowly to renew +their associations. In this situation those words, which have the fewest +other words associated with them, as the proper names of persons or places, +are the most difficult to recollect. And in those efforts of recollection +the word opposite to the word required is often produced, as hot for cold, +winter for summer, which is owing to our associating our ideas of things by +their opposites as well as by their similitudes, and in some instances +perhaps more frequently, or more forcibly. Other paralytic patients are +liable to give wrong names to external objects, as using the word pigs for +sheep, or cows for horses; in this case the association between the idea of +the animal and the name of it is dissevered; but the idea of the class or +genus of the thing remains; and he takes a name from the first of the +species, which presents itself, and sometimes can correct himself, till he +finds the true one. + +8. _Tarditas senilis._ Slowness of age. The difficulty of associating ideas +increases with our age; as may be observed from old people forgetting the +business of the last hour, unless they impress it strongly, or by frequent +repetition, though they can well recollect the transactions of their youth. +I saw an elderly man, who could reason with great clearness and precision +and in accurate language on subjects, which he had been accustomed to think +upon; and yet did not know, that he had rang the bell by his fire-side in +one minute afterwards; nor could then recollect the object he had wanted, +when his servant came. + +Similar to this is the difficulty which old people experience in learning +new bodily movements, that is, in associating new muscular actions, as in +learning a new trade or manufactury. The trains of movements, which obey +volition, are the last which we acquire; and the first, which are +disassociated. + + * * * * * + +ORDO II. + +_Decreased Associate Motions._ + +GENUS IV. + +_Catenated with External Influences._ + +As the diseases, which obey solar or lunar periods, commence with torpor or +inactivity, such as the cold paroxysms of fevers, the torpor and consequent +pain of hemicrania, and the pains which precede the fits of epilepsy and +convulsion, it would seem, that these diseases are more generally owing to +the diminution than to the excess of solar or lunar gravitation; as the +diseases, which originate from the influence of the matter of heat, are +much more generally in this country produced by the defect than by the +excess of that fluid. + +The periodic returns of so many diseases coincide with the diurnal, +monthly, and annual rounds of time; that any one, who would deny the +influence of the sun and moon on the periods of quotidian, tertian, and +quartan fevers, must deny their effect on the tides, and on the seasons. It +has generally been believed, that solar and lunar effect was exerted on the +blood; which was thus rendered more or less stimulant to the system, as +described in Sect. XXXII. 6. But as the fluid matter of gravitation +permeates and covers all things, like the fluid matter of heat; I am +induced to believe, that gravitation acts in its medium state rather as a +causa sine qua non of animal motion, like heat; which may disorder the +system chemically or mechanically, when it is diminished; but may +nevertheless stimulate it, when increased, into animal exertion. + +Without heat and motion, which some philosophers still believe to be the +same thing, as they so perpetually appear together, the particles of matter +would attract and move towards each other, and the whole universe freeze or +coalesce into one solid mass. These therefore counteract the gravitation of +bodies to one center; and not only prevent the planets from falling into +the sun, but become either the efficient causes of vegetable and animal +life, or the causes without which life cannot exist; as by their means the +component particles of matter are enabled to slide over each other with all +the various degrees of fluidity and repulsion. + +As the attraction of the moon countervails or diminishes the terrene +gravitation of bodies on the surface of the earth; a tide rises on that +side of the earth, which is turned towards the moon; and follows it, as the +earth revolves. Another tide is raised at the same time on the opposite +side of the revolving earth; which is owing to the greater centrifugal +motion of that side of the earth, which counteracts the gravitation of +bodies near its surface. For the earth and moon may be considered as two +cannon balls of different sizes held together by a chain, and revolving +once a month round a common center of gravity between them, near the +earth's surface; at the same time that they perform their annual orbits +round the sun. Whence the centrifugal force of that side of the earth, +which is farthest from this center of motion, round which the earth and +moon monthly revolve, is considerably greater, than the centrifugal force +of that side of the earth, which is nearest it; to which should be added, +that this centrifugal force not only contributes to diminish the terrene +gravitation of bodies on the earth's surface on that side furthest from +this center of motion, but also to increase it on that side, which is +nearest it. + +Another circumstance, which tends to raise the tide on the part of the +earth's surface, which is most distant from the moon, is, that the +attraction of the moon is less on that part of the ocean, than it is on the +other parts of the earth. Thus the moon may be supposed to attract the +water on the side of the earth nearest it with a power equal to three; and +to attract the central parts of the earth with a power equal to two; and +the water on the part of the earth most distant from the moon with a power +only equal to one. Hence on the side of the earth most distant from the +moon, the moon's attraction is less, and the centrifugal force round their +common center of motion is greater; both which contribute to raise the +tides on that side of the earth. On the side of the earth nearest the moon, +the moon's attraction is so much greater as to raise the tides; though the +centrifugal force of the surface of the earth round their common center of +motion in some degree opposes this effect. + +On these accounts, when the moon is in the zenith or nadir, the gravitation +of bodies on the earth's surface will be greatest at the two opposite +quadratures; that is, the greatest gravitation of bodies on the earth's +surface towards her center during the lunar day is about six hours and an +half after the southing, or after the northing of the moon. + +Circumstances similar to these, but in a less degree, must occur in respect +to the solar influence on terrestrial bodies; that is, there must be a +diminution of the gravity of bodies, near the earth's surface at noon, when +the sun is over them; and also at midnight from the greater centrifugal +force of that side of the earth, which is most distant from the center, +round which the earth moves in her annual orbit, than on the side nearest +that center. Whence it likewise follows, that the gravitation of bodies +towards the earth is greatest about six hours after noon, and after +midnight. + +Now when the sun and moon have their united gravitation on the same side of +the earth, as at the new moon; or when the solar attraction coincides with +the greater centrifugal motion of that side of the earth, which is furthest +distant from the moon, as at the full moon; and when this happens about +noon or midnight, the gravitation of terrene bodies towards the earth will +be greater about six hours after noon, and after midnight, than at any +other part of the lunar period; because the attraction of both these +luminaries is then exerted on those sides of the earth over which they +hang, which at other times of the month are more or less exerted on other +parts of it. + +Lastly, as heat and motion counteract the gravitation of the particles of +bodies to each other, and hence become either the efficient causes of +vegetable and animal life, or the causes without which life cannot exist, +it seems to follow, that when our gravitation towards the earth's center is +greatest, the powers of life should be the least; and hence that those +diseases, which begin with torpor, should occur about six hours after the +solar or lunar noon, or about six hours after the solar or lunar midnight; +and this most frequently about six hours after or before the new or full +moon; and especially when these happen at noon or at midnight; or lastly, +according to the combination of these powers in diminishing or increasing +the earth's attraction to bodies on its surface. + +The returns or exacerbations of many fevers, both irritative and +inflammatory, about six in the evening, and of the periodic cough described +in Sect. XXXVI. 3. 9. countenance this theory. Tables might be made out to +shew the combined powers of the sun and moon in diminishing the gravitation +of bodies on the earth's surface, at every part of their diurnal, monthly, +and annual periods; and which might facilitate the elucidation of this +subject. But I am well aware of the difficulty of its application to +diseases, and hope these conjectures may induce others to publish more +numerous observations, and more conclusive reasonings. + +SPECIES. + +1. _Somni periodus._ The periods of sleeping and of waking are shortened or +prolonged by so many other circumstances in animal life, besides the minute +difference between diurnal and nocturnal solar gravitation, that it can +scarcely be ascribed to this influence. At the same time it is curious to +observe, that vegetables in respect to their times of sleeping more +regularly observe the hour of the day, than the presence or absence of +light, or of heat, as may be seen by consulting the calendar of Flora. +Botanic Garden, Part II. Canto 2. l. 165. note. + +Some diseases, which at first sight might be supposed to be influenced by +solar periods, seem to be induced by the increasing sensibility of the +system to pain during our sleeping hours; as explained in Sect. XVIII. 15. +Of these are the fits of asthma, of some epilepsies, and of some +haemoptoes; all which disturb the patient after some hours sleep, and are +therefore to be ascribed to the increase of our dormant sensibility. There +may likewise be some doubt, whether the commencement of the pain of gout in +the foot, as it generally makes its attack after sleep, should be ascribed +to the increased sensibility in sleep, or to solar influence? + +M. M. When asthmatic or epileptic fits or haemoptoe occur after a certain +number of hours of sleep, the patient should be forcibly awakened before +the expected time by an alarm clock, and drink a cup of chocolate or +lemonade.--Or a grain of opium should be given at going to bed.--In one +case to prevent the too great increase of sensibility by shortening the +time of sleep; and in the other by increasing the irritative motions, and +expending by that means a part of the sensorial power. + +2. _Studii inanis periodus._ Class III. 1. 2. 2. The cataleptic spasm which +preceded the reverie and somnambulation in the patient, whose case is +related in Sect. XIX. 2. occurred at exactly the same hour, which was about +eleven in the morning for many weeks; till those periods were disturbed by +large doses of opium; and must therefore be referred to some effect of +solar gravitation. In the case of Master A. Sect. XXXIV. 3. as the reverie +began early in the morning during sleep, there may be a doubt, whether this +commenced with torpor of some organ catenated with solar gravitation; or +was caused by the existence of a previous torpid part, which only became so +painful as to excite the exertions of reverie by the perpetual increase of +sensibility during the continuance of sleep, as in some fits of epilepsy, +asthma, and haemoptoe mentioned in the preceding article. + +3. _Hemicraniae periodus._ Periods of hemicrania. Class IV. 2. 2. 8. The +torpor and consequent pain of some membranes on one side of the head, as +over one eye, is frequently occasioned by a decaying tooth, and is liable +to return every day, or on alternate days at solar or lunar periods. In +this case large quantities of the bark will frequently cure the disease, +and especially if preceded by venesection and a brisk cathartic; but if the +offending tooth can be detected, the most certain cure is its extraction. +These partial head-achs are also liable to return at the greater lunar +periods, as about once a month. Five drops from a two-ounce phial of a +saturated solution of arsenic twice a day for a week or two have been said +to prevent the returns of this disease. See a Treatise on Arsenic by Dr. +Fowler, of York. Strong errhines have also been recommended. + +4. _Epilepsiae dolorificae periodus._ Class III. 1. 1. 8. The pain which +induces after about an hour the violent convulsions or insanity, which +constitute the painful epilepsy, generally observe solar diurnal periods +for four or five weeks, and are probably governed by solar and lunar times +in respect to their greater periods; for I have observed that the daily +paroxysms, unless disturbed by large doses of opium, recur at very nearly +the same hour, and after a few weeks the patients have recovered to relapse +again at the interval of a few months. But more observations are wanted +upon this subject, which might be of great advantage in preventing the +attacks of this disease; as much less opium given an hour before its +expected daily return will prevent the paroxysm, than is necessary to cure +it, after it has commenced. + +5. _Convulsionis dolorificae periodus._ Class III. 1. 1. 6. The pains, +which produce these convulsions, are generally left after rheumatism, and +come on when the patients are become warm in bed, or have been for a short +time asleep, and are therefore perhaps rather to be ascribed to the +increasing sensibility of the system during sleep, than to solar diurnal +periods, as in Species first and second of this Genus. + +6. _Tussis periodicae periodus._ Periodic cough, Class IV. 2. 1. 9. returns +at exact solar periods; that described in Sect. XXXVI. 3. 9. recurred about +seven in the afternoon for several weeks, till its periods were disturbed +by opium, and then it recurred at eleven at night for about a week, and was +then totally destroyed by opium given in very large quantities, after +having been previously for a few days omitted. + +7. _Catameniae periodus._ Periods of menstruation. The correspondence of +the periods of the catamenia with those of the moon was treated of in Sect. +XXXII. 6. and can admit of no more doubt, than that the returns of the +tides are governed by lunar influence. But the manner in which this is +produced, is less evident; it has commonly been ascribed to some effect of +the lunar gravitation on the circulating blood, as mentioned in Sect. +XXXII. 6. But it is more analogous to other animal phenomena to suppose +that the lunar gravitation immediately affects the solids by its influx or +stimulus. Which we believe of the fluid element of heat, in which we are +equally immersed; and of the electric fluid, which also surrounds and +pervades us. See Sect. XXXVI. 2. 3. + +If the torpor of the uterine veins, which induces the monthly periods of +the catamenia, be governed by the increase of terrene gravitation; that is, +by the deficiency of the counter-influence of solar and lunar gravitation; +why does not it occur most frequently when the terrene gravitation is the +greatest, as about six hours after the new moon, and next to that at about +six hours after the full moon? This question has its difficulty; first, if +the terrene gravitation be greatest about six hours after the new moon, it +must become less and less about the same time every lunar day, till the end +of the first quarter, when it will be the least; it must then increase +daily till the full. After the full the terrene gravitation must again +decrease till the end of the third quarter, when it will again be the +least, and must increase again till the new moon; that is, the solar and +lunar counter-gravitation is greatest, when those luminaries are vertical, +at the new moon, and full moon, and least about six hours afterwards. If it +was known, whether more menstruations occur about six hours after the moon +is in the zenith or nadir; and in the second and fourth quarters of the +moon, than in the first and third; some light would be thrown on this +subject; which must in that respect wait for future observations. + +Secondly, if the lunar influence produces a very small degree of +quiescence, suppose of the uterine veins, at first; and if that recurs at +certain periods, as of lunar days, or about 25 hours, even with less power +to produce quiescence than at first; yet the quiescence will daily increase +by the acquired habit acting at the same time, as explained in Sect. XII. +3. 3. till at length so great a degree of quiescence will be induced as to +cause the inaction of the veins of the uterus, and consequent venous +haemorrhage. See Sect. XXXII. 6. Class I. 2. 1. 11. IV. 1. 4. 4. See the +introduction to this Genus. + +8. _Haemorrhoidis periodus._ The periods of the piles depend on the torpor +of the veins of the rectum, and are believed to recur nearly at monthly +intervals. See Sect. XXVII. 2. and Class I. 2. 1. 6. + +9. _Podagrae periodus._ The periods of gout in some patients recur at +annual intervals, as in the case related above in Class IV. 1. 2. 15. in +which the gouty paroxysm returned for three successive years on nearly the +same day of the month. The commencement of the pain of each paroxysm is +generally a few hours after midnight, and may thence either be induced by +diurnal solar periods, or by the increasing sensibility during sleep, as +mentioned in the first species of this genus. + +10. _Erysipelatis periodus._ Some kinds of erysipelas which probably +originate from the association of the cutaneous vessels with a diseased +liver, occur at monthly periods, like the haemorrhois or piles; and others +at annual periods like the gout; as a torpor of some part I suppose always +precedes the erysipelatous inflammation, the periods should accord with the +increasing influence of terrene gravitation, as described in the +introduction to this Genus, and in Species the seventh of it. Other periods +of diseases referable to solar and lunar influence are mentioned in Sect +XXXVI. and many others will probably be discovered by future observation. + +11. _Febrium periodus._ Periods of fevers. The commencement of the cold +fits of intermittent fevers, and the daily exacerbations of other fevers, +so regularly recur at diurnal solar or lunar periods, that it is impossible +to deny their connection with gravitation; as explained in Sect. XXXVI. 3. +Not only these exacerbations of fever, and their remissions, obey the +diurnal solar and lunar periods; but the preparatory circumstances, which +introduce fevers, or which determine their crisises, appear to be governed +by the parts of monthly lunar periods, and of solar annual ones. Thus the +variolous fever in the natural small-pox commences on the 14th day, and in +the inoculated small-pox on the seventh day. The fever and eruption in the +distinct kind take up another quarter of a lunation, and the maturation +another quarter. + +The fever, which is termed canine madness, or hydrophobia, is believed to +commence near the new or full moon; and, if the cause is not then great +enough to bring on the disease, it seems to acquire some strength, or to +lie dormant, till another, or perhaps more powerful lunation calls it into +action. In the spring, about three or four years ago, a mad dog very much +worried one swine confined in a sty, and bit another in the same sty in a +less degree; the former became mad, refused his meat, was much convulsed, +and died in about four days; this disease commenced about a month after the +bite. The other swine began to be ill about a month after the first, and +died in the same manner. + + * * * * * + +ORDO III. + +_Retrograde Associate Motions._ + +GENUS I. + +_Catenated with Irritative Motions._ + +Those retrograde associate motions, the first links of which are catenated +with irritative motions, belong to this genus. All the retrograde motions +are consequent to debility, or inactivity, of the organ; and therefore +properly belong to the genera of decreased actions both in this and the +former classes. + +SPECIES. + +1. _Diabaetes irritata._ When the absorbents of the intestines are +stimulated too strongly by spirit of wine, as in the beginning of +drunkenness, the urinary absorbents invert their motions. The same happens +from worms in the intestines. In other kinds of diabetes may not the remote +cause be the too strong action of the cutaneous absorbents, or of the +pulmonary ones? May not in such cases oil externally or internally be of +service? or warm bathing for an hour at a time? In hysteric inversions of +motion is some other part too much stimulated? or pained from the want of +stimulus? + +2. _Sudor frigidus in asthmate._ The cause of the paroxysms of humoral +asthma is not well understood; I suppose it to be owing to a torpidity or +inaction of the absorbents belonging to the pulmonary vessels, as happens +probably to other viscera at the commencement of intermittent fevers, and +to a consequent accumulation of fluids in them; which at length producing +great irritation or uneasy sensation causes the violent efforts to produce +the absorption of it. The motions of the cutaneous absorbent vessels by +their association with those of the pulmonary ones become retrograde, and +effuse upon the skin a fluid, which is said to be viscid, and which adheres +in drops. + +A few days ago I saw a young man of delicate constitution in what was +called a fit of the asthma; he had about two months before had a +peripneumony, and had been ever since subject to difficult respiration on +exertion, with occasional palpitation of his heart. He was now seized about +eight at night after some exertion of mind in his business with cold +extremities, and difficulty of breathing. He gradually became worse, and in +about half an hour, the palpitation of his heart and difficult respiration +were very alarming; his whole skin was cold and pale, yet he did not +shudder as in cold paroxysm of fever; his tongue from the point to the +middle became as cold as his other extremities, with cold breath. He seemed +to be in the act of dying, except that his pulse continued equal in time, +though very quick. He lost three ounces of blood, and took ten drops of +laudanum with musk and salt of hartshorn, and recovered in an hour or two +without any cold sweat. + +There being no cold sweat seems to indicate, that there was no accumulation +of serous fluid in the lungs; and that their inactivity, and the coldness +of the breath, was owing to the sympathy of the air-cells with some distant +part. There was no shuddering produced, because the lungs are not sensible +to heat and cold; as any one may observe by going from a warm room into a +frosty air, and the contrary. So the steam of hot tea, which scalds the +mouth, does not affect the lungs with the sensation of heat. I was induced +to believe, that the whole cold fit might be owing to suppuration in some +part of the chest; as the general difficulty of breathing seemed to be +increased after a few days with pulse of 120, and other signs of empyema. +Does the cold sweat, and the occurrence of the fits of asthma after sleep, +distinguish the humoral asthma from the cold paroxysm of intermittents, or +which attends suppuration, or which precedes inflammation?--I heard a few +weeks afterwards, that he spit up much matter at the time he died. + +3. _Diabaetes a timore._ The motions of the absorbent vessels of the neck +of the bladder become inverted by their consent with those of the skin; +which are become torpid by their reverse sympathy with the painful ideas of +fear, as in Sect. XVI. 8. 1. whence there is a great discharge of pale +urine, as in hysteric diseases. + +The same happens from anxiety, where the painful suspense is continued, +even when the degree of fear is small; as in young men about to be examined +for a degree at the universities the frequency of making water is very +observable. When this anxiety is attended with a sleepless night, the +quantity of pale urine is amazingly great in some people, and the +micturition very frequent. + +M. M. Opium. Joy. Consolations of friendship. + +4. _Diarrhoea a timore._ The absorbent vessels of the intestines invert +their motions by direct consent with the skin; hence many liquid stools as +well as much pale urine are liable to accompany continued fear, along with +coldness of the skin. The immediate cause of this is the decreased +sensorial power of association, which intervenes between the actions of the +absorbents of the cold skin, and those of the intestinal absorbents; the +motions of the latter become on that account weakened and at length +retrograde. The remote cause is the torpor of the vessels of the skin +catenated with the pain of fear, as explained in Sect. XVI. 8. 1. + +The capillaries of the skin consent more generally by direct sympathy with +those of the lower intestines, and of the bladder; but by reverse sympathy +more generally with those of the stomach and upper intestines. As appears +in fevers, where the hot skin accompanies indigestion of the stomach; and +in diarrhoeas attended with cold extremities. + +The remote cause is the torpor of the skin owing to its reverse sympathy +with the painful sensual motions, or ideas, of fear; which are now actuated +with great energy, so as to deprive the second link of associated motions +of their due share of sensorial power. It is also probable, that the pain +of fear itself may contribute to exhaust the sensorial power, even when it +produces no muscular action. See Class IV. 2. 2. + +5. _Pallor et tremor a timore._ A retrograde action of the capillaries of +the skin producing paleness, and a torpor of the muscular fibres of the +limbs occasioning trembling, are caused by their reverse associations with +the ideas or imaginations of fear; which are now actuated with violent +energy, and accompanied with great pain. The cause of these associations +are explained in Sect XVI. 8. 1. + +These torpid actions of the capillaries and muscles of the limbs are not +caused immediately by the painful sensation of fear; as in that case they +would have been increased and not decreased actions, as occurs in anger; +where the painful volition increases the actions of the capillaries, +exciting a blush and heat of the skin. Whence we may gain some knowledge of +what is meant by depressing and exciting passions; the former confiding of +ideas attended with pain, which pain occasions no muscular actions, like +the pain of cold head-ach; the latter being attended with volitions, and +consequent muscular exertions. + +That is, the pain of fear, and the pain of anger, are produced by the +exertion of certain ideas, or motions of certain nerves of sense; in the +former case, the painful sensation of fear produces no muscular actions, +yet it exhausts or employs so much sensorial power, that the whole system +acts more feebly, or becomes retrograde; but some parts of it more so than +others, according to their early associations described in Sect. XVI. 8. 1. +hence the tremor of the limbs, palpitation of heart, and even syncope. In +anger the painful volition produces violent muscular actions; but if +previous to these any deliberation occurs, a flushed countenance sometimes, +and a red skin, are produced by this superabundance of volition exerted on +the arterial system; but at other times the skin becomes pale, and the legs +tremble, from the exhaustion or expenditure of the sensorial power by the +painful volitions of anger on the organs of sense, as by the painful +sensations of fear above mentioned. + +Where the passion of fear exists in a great degree, it exhausts or expends +so much sensorial power, either simply by the pain which attends it, or by +the violent and perpetual excitement of the terrific imaginations or ideas, +that not only a cold and pale skin, but a retrograde motion of the +cutaneous absorbents occurs, and a cold sweat appears upon the whole +surface of the body, which probably sometimes increases pulmonary +absorption; as in Class II. 1. 6. 4. and as in the cold sweats, which +attend the paroxysms of humoral asthma. Hence anxiety, which is a continued +pain of fear, so universally debilitates the constitution as to occasion a +lingering death; which happens much more frequently than is usually +supposed; and these victims of continued anxiety are said to die of a +broken heart. Other kinds of paleness are described in Class I. 2. 2. 2. + +M. M. Opium. Wine. Food. Joy. + +6. _Palpitatio cordis a timore._ The palpitation of the heart from fear is +owing to the weak action of it, and perhaps sometimes to the retrograde +exertion of the ventricules and auricles; because it seems to be affected +by its association with the capillaries, the actions of which, with those +of the arteries and veins, constitute one great circle of associate +motions. Now when the capillaries of the skin become torpid, coldness and +paleness succeed; and with these are associated the capillaries of the +lungs, whence difficult respiration; and with these the weak and retrograde +actions of the heart. At the same time the absorbents of the skin, and of +the bladder, and of the intestines, sometimes become retrograde, and +regurgitate their contents; as appears by the pale urine in large +quantities, which attends hysteric complaints along with this palpitation +of the heart; and from the cold sweats, and diarrhoea; all which, as well +as the hysteric complaints, are liable to be induced or attended by fear. + +When fear has still more violently affected the system, there have been +instances where syncope, and sudden death, or a total stoppage of the +circulation, have succeeded: in these last cases, the pain of fear has +employed or exhausted the whole of the sensorial power, so that not only +those muscular fibres generally exerted by volition cease to act, whence +the patient falls down; and those, which constitute the organs of sense, +whence syncope; but lastly those, which perform the vital motions, become +deprived of sensorial power, and death ensues. See Class. I. 2. 1. 4. and +I. 2. 1. 10. Similar to this in some epileptic fits the patient first +suddenly falls down, without even endeavouring to save himself by his hands +before the convulsive motions come on. In this case the great exertion of +some small part in consequence of great irritation or sensation exhausts +the whole sensorial power, which was lodged in the extremities of the +locomotive nerves, for a short time, as in syncope; and as soon as these +muscles are again supplied, convulsions supervene to relieve the painful +sensation. See Class III. 1. 1. 7. + +7. _Abortio a timore._ Women miscarry much more frequently from a fright, +than from bodily injury. A torpor or retrograde motion of the capillary +arteries of the internal uterus is probably the immediate cause of these +miscarriages, owing to the association of the actions of those vessels with +the capillaries of the skin, which are rendered torpid or retrograde by +fear. By this contraction of the uterine arteries, the fine vessels of the +placenta, which are inserted into them, are detruded, or otherwise so +affected, that the placenta separates at this time from the uterus, and the +fetus dies from want of oxygenation. A strong young woman, in the fifth or +sixth month of her pregnancy, who has since borne many children, went into +her cellar to draw beer; one of the servant boys was hid behind a barrel, +and started out to surprise her, believing her to be the maid-servant; she +began to flood immediately, and miscarried in a few hours. See Sect. XXXIX. +6. 5. and Class I. 2. 1. 14. + +8. _Hysteria a timore._ Some delicate ladies are liable to fall into +hysteric fits from sudden fright. The peristaltic motions of the bowels and +stomach, and those of the oesophagus, make a part of the great circle of +irritative motions with those of the skin, and many other membranes. Hence +when the cutaneous vessels become torpid from their reverse sympathy with +the painful ideas of fear; these of the bowels, and stomach, and +oesophagus, become first torpid by direct sympathy with those of the skin, +and then feebly and ineffectually invert the order of their motions, which +constitutes a paroxysm of the hysteric disease. See Class I. 3. 1. 10. +These hysteric paroxysms are sometimes followed by convulsions, which +belong to Class III. as they are exertions to relieve pain; and sometimes +by death. See Species 9 of this Genus, and Class I. 2. 1. 4. + +Indigestion from fear is to be ascribed in the same manner to the torpor of +the stomach, owing to its association with the skin. As in Class IV. 1. 2. +5. IV. 2. 1. + + * * * * * + +ORDO III. + +_Retrograde Associate Motions._ + +GENUS II. + +_Catenated with Sensitive Motions._ + +SPECIES. + +1. _Nausea idealis._ Nausea from disgustful ideas, as from nauseous +stories, or disgustful sights, or smells, or tastes, as well as vomiting +from the same causes, consists in the retrograde actions of the lymphatics +of the throat, and of the oesophagus, and stomach; which are associated +with the disgustful ideas, or sensual motions of sight, or hearing, or +smell, or taste; for as these are decreased motions of the lymphatics, or +of the oesophagus, or stomach, they cannot immediately be excited by the +sensorial power of painful sensation, as in that case they ought to be +increased motions. So much sensorial power is employed for a time on the +disgustful idea, or expended in the production of inactive pain, which +attends it, that the other parts of the associated chain of action, of +which this disgustful idea is now become a link, is deprived of their +accustomed share; and therefore first stop, and then invert their motions. +Owing to deficiency of sensorial power, as explained more at large in Sect. +XXXV. 1. 3. + +2. _Nausea a conceptu._ The nausea, which pregnant women are so subject to +during the first part of gestation, is owing to the reverse sympathy +between the uterus and stomach, so that the increased action of the former, +excited by the stimulus of the growing embryon, which I believe is +sometimes attended with sensation, produces decreased actions of the latter +with the disagreeable sensation of sickness with indigestion and consequent +acidity. When the fetus acquires so much muscular power as to move its +limbs, or to turn itself, which is called quickening, this sickness of +pregnancy generally ceases. + +M. M. Calcined magnesia. Rhubarb. Half a grain of opium twice a day. +Recumbent posture on a sofa. + +3. _Vomitio vertiginosa._ Sea-sickness, the irritative motions of vision, +by which we balance ourselves, and preserve our perpendicularity, are +disturbed by the indistinctness of their objects; which is either owing to +the similarity of them, or to their distance, or to their apparent or +unusual motions. Hence these irritative motions of vision are exerted with +greater energy, and are in consequence attended with sensation; which, at +first is agreeable, as when children swing on a rope; afterwards the +irritative motions of the stomach, and of the absorbent vessels, which open +their mouths into it, become inverted by their associations with them by +reverse sympathy. + +For the action of vomiting, as well as the disagreeable sensation of +sickness, are shewn to be occasioned by defect of the sensorial power; +which in this case is owing to the greater expenditure of it by the sense +of vision. On the same account the vomiting, which attends the passage of a +stone through the ureter, or from an inflammation of the bowels, or in the +commencement of some fevers, is caused by the increased expenditure of the +sensorial power by the too great action of some links of the associations +of irritative motions; and there being in consequence a deficiency of the +quantity required for other links of this great catenation. + +It must be observed, that the expenditure of sensorial power by the retinas +of the eyes is very great; which may be estimated by the perpetual use of +those organs during our waking hours, and during most of our sleeping ones; +and by the large diameters of the two optic nerves, which are nearly the +size of a quill, or equal to some of the principal nerves, which serve the +limbs. + +4. _Vomitio a calculo in uretere._ The action of vomiting in consequence of +the increased or decreased actions of the ureter, when a stone lodges in +it. The natural actions of the stomach, which consist of motions subject to +intermitted irritations from the fluids, which pass through it, are +associated with those of the ureter; and become torpid, and consequently +retrograde, by intervals, when the actions of the ureter becomes torpid +owing to previous great stimulus from the stone it contains; as appears +from the vomiting existing when the pain is least. When the motions of the +ureter are thus lessened, the sensorial power of association, which ought +to actuate the stomach along with the sensorial power of irritation, ceases +to be excited into action; and in consequence the actions of the stomach +become less energetic, and in consequence retrograde. + +For as vomiting is a decreased action of the stomach, as explained in Sect. +XXXV. 1. 3. it cannot be supposed to be produced by the pain of gravel in +the ureter alone, as it should then be an increased action, not a decreased +one. + +The perpetual vomiting in ileus is caused in like manner by the defective +excitement of the sensorial power of association by the bowel, which is +torpid during the intervals of pain; and the stomach sympathizes with it. +See Enteritis, Class II. 1. 2. 11. Does this symptom of vomiting indicate, +whether the disease be above or below the valve of the colon? Does not the +softer pulse in some kinds of enteritis depend on the sympathy of the heart +and arteries with the sickness of the stomach? See Ileus and Cholera. + +Hence this sickness, as well as the sickness in some fevers, cannot be +esteemed an effort of nature to dislodge any offensive material; but like +the sea-sickness described above, and in Sect. XX. 4. is the consequence of +the associations of irritative or sensitive motions. See Class I. 1. 3. 9. + +5. _Vomitio ab insultu paralytico._ Paralytic affections generally commence +with vomiting, the same frequently happens from a violent blow with a stick +on the head; this curious connection of the brain and stomach has not been +explained; as it resembles the sickness in consequence of vertigo at sea, +it would seem to arise from a similar cause, viz. from disturbed irritative +or sensitive associations. + +6. _Vomitio a titillatione faucium._ If the throat be slightly tickled with +a feather, a nausea is produced, that is, an inverted action of the mouths +of the lymphatics of the fauces, and by direct sympathy an inverted action +of the stomach ensues. As these parts have frequently been stimulated at +the same time into pleasurable action by the deglutition of our daily +aliment, their actions become strongly associated. And as all the food, we +swallow, is either moist originally, or mixed with our moist saliva in the +mouth; a feather, which is originally dry, and which in some measure repels +the moist saliva, is disagreeable to the touch of the fauces; at the same +time this nausea and vomiting cannot be caused by the disagreeable +sensation simply, as then they ought to have been increased exertions, and +not decreased ones, as shewn in Section XXXV. 1. 3. But the mouths of the +lymphatics of the fauces are stimulated by the dry feather into too great +action for a time, and become retrograde afterwards by the debility +consequent to too great previous stimulus. + +7. _Vomitio cute sympathetica._ Vomiting is successfully stopped by the +application of a blister on the back in some fevers, where the extremities +are cold, and the skin pale. It was stopped by Sydenham by producing a +sweat on the skin by covering the head with the bed-clothes. See Class IV. +1. 1. 3. and Suppl. I. 11. 6. + + * * * * * + +ORDO III. + +_Retrograde Associate Motions._ + +GENUS III. + +_Catenated with Voluntary Motions._ + +SPECIES. + +1. _Ruminatio._ In the rumination of horned cattle the food is brought up +from the first stomach by the retrograde motions of the stomach and +oesophagus, which are catenated with the voluntary motions of the abdominal +muscles. + +2. _Vomitio voluntaria._ Voluntary vomiting. Some human subjects have been +said to have obtained this power of voluntary action over the retrograde +motions of the stomach and oesophagus, and thus to have been able to empty +their stomach at pleasure. See Sect. XXV. 6. This voluntary act of emptying +the stomach is possessed by some birds, as the pigeon; who has an organ for +secreting milk in its stomach, as Mr. Hunter observed; and softens the food +for its young by previously swallowing it; and afterwards putting its bill +into theirs returns it into their mouths. See Sect. XXXIX. 4. 8. The +pelicans use a stomach, or throat bag, for the purpose of bringing the +fish, which they catch in the sea to shore, and then eject them, and eat +them at their leisure. See Sect. XVI. 11. And I am well informed of a +bitch, who having puppies in a stable at a distance from the house, +swallowed the flesh-meat, which was given her, in large pieces, and +carrying it immediately to her whelps, brought it up out of her stomach, +and laid it down before them. + +3. _Eructatio voluntaria._ Voluntary eructation. Some, who have weak +digestions, and thence have frequently been induced to eruct the quantity +of air discharged from the fermenting aliment in their stomachs, have +gradually obtained a power of voluntary eructation, and have been able thus +to bring up hogsheads of air from their stomachs, whenever they pleased. +This great quantity of air is to be ascribed to the increase of the +fermentation of the aliment by drawing off the gas as soon as it is +produced. See Sect. XXIII. 4. + + * * * * * + +ORDO III. + +_Retrograde Associate Motions._ + +GENUS. IV. + +_Catenated with External Influences._ + +SPECIES. + +1. _Catarrhus periodicus._ Periodical catarrh is not a very uncommon +disease; there is a great discharge of a thin saline mucous material from +the membranes of the nostrils, and probably from the maxillary and frontal +sinuses, which recur once a day at exact solar periods; unless it be +disturbed by the exhibition of opium; and resembles the periodic cough +mentioned below. See Class I. 3. 2. 1. It is probably owing to the +retrograde action of the lymphatics of the membranes affected, and produced +immediately by solar influence. + +2. _Tussis periodica._ Periodic cough, called nervous cough, and tussis +serina. It seems to arise from a periodic retrograde action of the +lymphatics of the membrane, which lines the air-cells of the lungs. And the +action of coughing, which is violently for an hour or longer, is probably +excited by the stimulus of the thin fluid thus produced, as well as by the +disagreeable sensation attending membranous inactivity; and resembles +periodic catarrh not only in its situation on a mucous membrane, but in the +discharge of a thin fluid. As it is partly restrainable, it does not come +under the name of convulsion; and as it is not attended with difficult +respiration, it cannot be called asthma; it is cured by very large doses of +opium, see a case and cure in Sect. XXXVI. 3. 9. see Class IV. 2. 4. 6. and +seems immediately to be induced by solar influence. + +3. _Histeria a frigore._ Hysteric paroxysms are occasioned by whatever +suddenly debilitates the system, as fear, or cold, and perhaps sometimes by +external moisture of the air, as all delicate people have their days of +greater or less debility, see Class IV. 3. 1. 8. + +4. _Nausea pluvialis._ Sickness at the commencement of a rainy season is +very common among dogs, who assist themselves by eating the agrostris +canina, or dog's grass, and thus empty their stomachs. The same occurs with +less frequency to cats, who make use of the same expedient. See Sect. XVI. +11. I have known one person, who from his early years has always been sick +at the beginning of wet weather, and still continues so. Is this owing to a +sympathy of the mucous membrane of the stomach with the mechanical +relaxation of the external cuticle by a moister atmosphere, as is seen in +the corrugated cuticle of the hands of washing-women? or does it sympathize +with the mucous membrane of the lungs, which must be affected along with +the mucus on its surface by the respiration of a moister atmosphere? + + * * * * * + + +SUPPLEMENT TO CLASS IV. + +_Sympathetic Theory of Fever._ + +As fever consists in the increase or diminution of direct or reverse +associated motions, whatever may have been the remote cause of them, it +properly belongs to the fourth class of diseases; and is introduced at the +end of the class, that its great difficulties might receive elucidation +from the preceding parts of it. These I shall endeavour to enumerate under +the following heads, trusting that the candid reader will discover in these +rudiments of the theory of fever a nascent embryon, an infant Hercules, +which Time may rear to maturity, and render serviceable to mankind. + + I. Simple fever of two kinds. + II. Compound fever. + III. Termination of the cold fit. + IV. Return of the cold fit. + V. Sensation excited in fever. + VI. Circles of associated motions. + VII. Alternations of cold and hot fits. + VIII. Orgasm of the capillaries. + IX. Torpor of the lungs. + X. Torpor of the brain. + XI. Torpor of the heart and arteries. + XII. Torpor of the stomach and intestines. + XIII. Case of continued fever explained. + XIV. Termination of continued fever. + XV. Inflammation excited in fever. + XVI. Recapitulation. + +I. _Simple fever._ + +1. When a small part of the cutaneous capillaries with their mucous or +perspirative glands are for a short time exposed to a colder medium, as +when the hands are immersed in iced water for a minute, these capillary +vessels and their glands become torpid or quiescent, owing to the eduction +of the stimulus of heat. The skin then becomes pale, because no blood +passes through the external capillaries; and appears shrunk, because their +sides are collapsed from inactivity, not contracted by spasm; the roots of +the hair are left prominent from the seceding or subsiding of the skin +around them; and the pain of coldness is produced. + +In this situation, if the usual degree of warmth be applied, these vessels +regain their activity; and having now become more irritable from an +accumulation of the sensorial power of irritation during their quiescence, +a greater exertion of them follows, with an increased glow of the skin, and +another kind of pain, which is called the hot-ach; but no fever, properly +so called, is yet produced; as this effect is not universal, nor permanent, +nor recurrent. + +2. If a greater part of the cutaneous capillaries with their mucous and +perspirative glands be exposed for a longer time to cold, the torpor or +quiescence becomes extended by direct sympathy to the heart and arteries; +which is known by the weakness, and consequent frequency of the pulse in +cold fits of fever. + +This requires to be further explained. The movements of the heart and +arteries, and the whole of the circulatory vessels, are in general excited +into action by the two sensorial powers of irritation, and of association. +The former is excited by stimulus, the latter by the previous actions of a +part of the vital circle of motions. In the above situation the capillaries +act weakly from defect of irritation, which is caused by deficient stimulus +of heat; but the heart and arteries act weakly from defect of association, +which is owing to the weak action of the capillaries; which does not now +excite the sensorial power of association into action with sufficient +energy. + +After a time, either by the application of warmth, or by the increase of +their irritability owing to the accumulation of the sensorial power of +irritation during their previous quiescence, the capillary vessels and +glands act with greater energy than natural; whence the red colour and heat +of the skin. The heart and arteries acquire a greater strength of +pulsation, and continue the frequency of it, owing to the accumulation of +the sensorial power of association during their previous torpor, and their +consequent greater associability; which is now also more strongly excited +by the increased actions of the capillaries. And thus a fit of simple fever +is produced, which is termed Febris irritativa; and consists of a torpor of +the cutaneous capillaries with their mucous and perspirative glands, +accompanied with a torpor of the heart and arteries; and afterwards of an +increased action of all these vessels, by what is termed direct sympathy. + +This fever, with strong pulse without inflammation, or febris irritativa, +described in Class I. 1. 1. 1. is frequently seen in vernal intermittents, +as the orgasm of the heart and arteries is then occasioned by their +previous state of torpor; but more rarely I believe exists in the type of +continued fever, except there be an evident remission, or approximation to +a cold fit; at which time a new accumulation of the sensorial power of +association is produced; which afterwards actuates the heart and arteries +with unnatural vigour; or unless there be some stimulus perpetually acting +on the system so as to induce an increased secretion of sensorial power in +the brain, as occurs in slight degrees of intoxication. Since without one +or other of these circumstances in continued fevers without inflammation, +that is, without the additional sensorial power of sensation being +introduced, it seems difficult to account for the production of so great a +quantity of sensorial power, as must be necessary to give perpetual +increase of action to the whole sanguiferous system. + +3. On the contrary, while the cutaneous capillaries with their mucous and +perspirative glands acquire an increased irritability, as above, by the +accumulation of that sensorial power during their previous quiescence, and +thus constitute the hot fit of fever; if the heart and arteries do not +acquire any increase of associability, but continue in their state of +torpor, another kind of simple fever is produced; which is generally of the +continued kind, and is termed Febris inirritativa; which consists of a +previous torpor of the capillaries of the skin, and of the heart and +arteries by direct sympathy with them; and afterwards of an orgasm or +increased action of the capillaries of the skin, with a decreased action, +or continued torpor, of the heart and arteries by reverse sympathy with +them. This orgasm of the cutaneous capillaries, which appears by the blush +and heat of the skin, is at first owing to the accumulation of the +sensorial power of irritation during their previous torpid state, as in the +febris irritata above described; but which is afterwards supported or +continued by the reverse sympathy of these capillaries with the torpid +state of the heart and arteries, as will be further explained in article 8 +of this Supplement. + +4. The renovated activity of the capillaries commences as soon or sooner +than that of the heart and arteries after the cold fit of irritative fever; +and is not owing to their being forced open by the blood being impelled +into them mechanically, by the renovated action of the heart and arteries; +for these capillaries of the skin have greater mobility than the heart and +arteries, as appears in the sudden blush of shame; which may be owing to +their being more liable to perpetual varieties of activity from their +exposure to the vicissitudes of atmospheric heat. And because in +inirritative fevers, or those with arterial debility, the capillaries +acquire increased strength, as is evinced by the heat of the skin, while +the pulsations of the heart and arteries remain feeble. + +5. It was said above, that the cutaneous capillaries, when they were +rendered torpid by exposure to cold, either recovered their activity by the +reapplication of external warmth; or by their increased irritability, which +is caused by the accumulation of that sensorial power during their +quiescence. An example of the former of these may be seen on emerging from +a very cold bath; which produces a fit of simple fever; the cold fit, and +consequent hot fit, of which may be prolonged by continuing in the bath; +which has indeed proved fatal to some weak and delicate people, and to +others after having been much exhausted by heat and exercise. See Sect. +XXXII. 3. 2. An example of the latter may be taken from going into a bath +of about eighty degrees of heat, as into the bath at Buxton, where the +bather first feels a chill, and after a minute becomes warm, though he +remains in the same medium, owing to the increase of irritability from the +accumulation of that sensorial power during the short time, which the +chilness continued. + +6. Hence simple fevers are of two kinds; first, the febris irritativa, or +fever with strong pulse; which consists of a previous torpor of the heart, +arteries, and capillaries, and a succeeding orgasm of those vessels. +Secondly, the febris inirritativa, or fever with weak pulse, which consists +of a previous torpor of the heart, arteries, and capillaries; and of a +succeeding orgasm of the capillaries, the torpor of the heart and arteries +continuing. But as the frequency of the pulse occurs both in the state of +torpor, and in that of orgasm, of the heart and arteries; this constitutes +a criterion to distinguish fever from other diseases, which are owing to +the torpor of some parts of the system, as paresis, and hemicrania. + +7. The reader will please to observe, that where the cutaneous or pulmonary +capillaries are mentioned, their mucous and perspirative glands are to be +understood as included; but that the absorbents belonging to those systems +of vessels, and the commencement of the veins, are not always included; as +these are liable to torpor separately, as in anasarca, and petechiae; or to +orgasm, or increased action, as in the exhibition of strong emetics, or in +the application of vinegar to the lips; yet he will also please to observe, +that an increased or decreased action of these absorbents and veins +generally occurs along with that of the capillaries, as appears by the dry +skin in hot fits of fever; and from there being generally at the same time +no accumulation of venous blood in the cutaneous vessels, which would +appear by its purple colour. + +II. _Compound fever._ + +1. When other parts of the system sympathize with this torpor and orgasm of +the cutaneous capillaries, and of the heart and arteries; the fever-fit +becomes more complicated and dangerous; and this in proportion to the +number and consequence of such affected parts. Thus if the lungs become +affected, as in going into very cold water, a shortness of breath occurs; +which is owing to the collapse or inactivity (not to the active +contraction, or spasm), of the pulmonary capillaries; which, as the lungs +are not sensible to cold, are not subject to painful sensation, and +consequent shuddering, like the skin. In this case after a time the +pulmonary capillaries, like the cutaneous ones, act with increased energy; +the breathing, which was before quick, and the air thrown out at each +respiration in less quantity, and cool to the back of the hand opposed to +it, now becomes larger in quantity, and warmer than natural; which however +is not accompanied with the sensation of heat in the membrane, which lines +the air-vessels of the lungs, as in the skin. + +2. One consequence of this increased heat of the breath is the increased +evaporation of the mucus on the tongue and nostrils. A viscid material is +secreted by these membranes to preserve them moist and supple, for the +purposes of the senses of taste and of smell, which are extended beneath +their surfaces; this viscid mucus, when the aqueous part of it is +evaporated by the increased heat of the respired air, or is absorbed by the +too great action of the mucous absorbents, adheres closely on those +membranes, and is not without difficulty to be separated from them. This +dryness of the tongue and nostrils is a circumstance therefore worthy to be +attended to; as it shews the increased action of the pulmonary capillaries, +and the consequent increased heat of the expired air; and may thus +indicate, when colder air should be admitted to the patient. See Class I. +1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its +moisture later, than the edges of it; because the currents of respired air +pass most over the middle part of it. This however is not the case, when +the dryness of the tongue is owing only to the increased mucous absorption. +When however a frequent cough attends pulmonary inflammation, the edges of +the tongue are liable to be as much furred as the middle of it; as during +the action of coughing the middle of the tongue is depressed, so as to form +half a cylinder, to give a greater aperture for the emission of air from +the larynx; and the edges of it become thus as much exposed to the currents +of air, as the middle parts of it. + +3. When the internal capillaries or glands sympathize with the cutaneous +capillaries; or when any of them are previously affected with torpor, and +the external or cutaneous capillaries are affected secondarily; other +symptoms are produced, which render the paroxysms of fever still more +complicate. Thus if the spleen or pancreas are primarily or secondarily +affected, so as to be rendered torpid or quiescent, they are liable to +become enlarged, and to remain so even after the extinction of the +fever-fit. These in some intermittent fevers are perceptible to the hand, +and are called ague-cakes; their tumour seems to be owing to the permanent +torpor of the absorbent system, the secerning vessels continuing to act +some time afterwards. If the secretory vessels of the liver are affected +first with torpor, and afterwards with orgasm, a greater secretion of bile +is produced, which sometimes causes a diarrhoea. If a torpor of the +kidneys, and of the absorbents of the bladder occurs, either primarily, or +by sympathy with the cutaneous capillaries, the urine is in small quantity +and pale, as explained in Class I. 2. 2. 5.; and if these secretory vessels +of the kidneys, and the absorbents of the bladder act more strongly than +natural afterwards by their increased irritability or associability, the +urine becomes in larger quantity, and deeper coloured, or deposits its +earthy parts, as in Class I. 1. 2. 4. which has been esteemed a favourable +circumstance. But if the urine be in small quantity, and no sediment +appears in it, after the hot fit is over; it shews, that the secerning +vessels of the kidneys and the absorbent vessels of the bladder have not +regained the whole of their activity, and thence indicates a greater +tendency to a return of the cold fit. + +4. When the stomach is affected with torpor either primarily; or +secondarily by its sympathy with the cutaneous capillaries; or with some +internal viscus; sickness occurs, with a total want of appetite to any +thing solid; vomiting then supervenes, which may often be relieved by a +blister on the skin, if the skin be cool and pale; but not if it be hot and +flushed. The intestines cease to perform their office of absorption from a +similar torpor; and a diarrhoea supervenes owing to the acrimony of their +putrid, or of their acid contents. The loose undigested or fetid stools +indicate the inability of the intestines to perform their proper office; as +the mucus and gastric acid, which are vomited up, does that of the stomach; +this torpor of the stomach is liable to continue after the cold paroxysm +ceases, and to convert intermittent fevers into continued ones by its +direct sympathy with the heart and arteries. See article 10 of this +Supplement. + +5. If the meninges of the brain sympathize with other torpid parts, or are +primarily affected, delirium, stupor, and perhaps hydrocephalus internus +occur, see Class II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse +becomes slow, producing paresis instead of fever. But if the membranes, +which cover the muscles about the head, or of the pericranium, become +torpid by their sympathy with other torpid parts, or are primarily +affected, a head-ach supervenes; which however generally ceases with the +cold paroxysm of fever. For as when the sensorial power of volition is +exhausted by labour, a few hours, or half a solar day, passed in sleep +recruits the system by accumulation of this sensorial power; so when the +sensorial power of irritation is exhausted, one or two solar or lunar days +of rest or quiescence of the affected part will generally restore its +action by accumulation of irritability, and consequent increase of +association, as in hemicrania, Class IV. 2. 2. 8. But when the heart and +arteries become torpid, either primarily, or by their sympathy with the +stomach, this accumulation of the sensorial power of irritation can take +place but slowly; _as to rest is death_! This explains the cause of the +duration of fevers with weak pulse, which continue a quarter, or half, or +three quarters, or a whole lunation, or still longer, before sufficient +accumulation of irritability can be produced to restore their natural +strength of action. + +6. If the absorbent vessels, which are spread around the neck of the +bladder, become torpid by their direct sympathy with the absorbents of the +skin in cold fits of fever; the urine, which is poured into the bladder in +but small quantity from the torpid kidneys, has nevertheless none of its +aqueous saline part reabsorbed; and this saline part stimulates the bladder +to empty itself frequently, though the urine is in small quantity. Which is +not therefore owing to any supposed spasm of the bladder, for the action of +it in excluding the urine is weak, and as much controlable by the will as +in ordinary micturition. + +7. If the beginnings or absorbent mouths of the venous system remain +torpid, petechiae or vibices are produced in fevers, similar to those which +are seen in scurvy without fever. If the skin was frequently moistened for +an hour, and at the same time exposed to the common air, or to oxygen gas, +it might contribute to turn the black colour of these points of +extravasated blood into scarlet, and thus by increasing its stimulus +facilitate its reabsorption? For oxygen gas penetrates moist animal +membranes though not dry ones, as in the lungs during respiration. + +8. When the sensorial power of sensation is introduced into the arterial +system, other kinds of compound fevers are produced, which will be spoken +of in their place. + +III. _Termination of the cold Fit._ + +1. If all the parts, which were affected with torpor, regain their +irritability, and associability, the cold paroxysm of fever ceases; but as +some of the parts affected were previously accustomed to incessant action, +as the heart and arteries, and others only to intermitted action, as the +stomach and intestines; and as those, which are subjected during health to +perpetual action, accumulate sensorial power faster, when their motions are +impeded, than those which are subjected to intermitted action; it happens, +that some of the parts, which were affected with torpor during the cold +fit, recover their irritability or associability sooner than others, and +more perfectly, or acquire a greater quantity of them than natural; as +appears by the partial heat and flushings previous to the general hot fit. + +Hence if all the parts, which were previously torpid, regain their due +degree of irritability, or of associability, the disease is removed, and +health restored. If some or all of them acquire more than their natural +degree of these sensorial powers; increased actions, and consequent +increased secretions, and greater heat occur, and constitute the hot fit of +fever. If after this hot fit of fever all the parts, which had acquired too +great irritability, or associability, regain their natural degree of it; +the disease is removed, and health restored. But if some of these parts do +not regain their natural degree of these sensorial powers, the actions of +those parts remain imperfect, and are more or less injurious to the system, +according to the importance of their functions. + +2. Thus if a torpor of the heart and arteries remains; the quick pulse +without strength, which began in the cold fit, persists; and a continued +fever is produced. If the torpor of the stomach and intestines remains, +which are known by sickness and undigested stools, the fever is liable to +be of considerable length and danger; the same if the kidnies and absorbent +system retain some degree of torpor, as is shewn by the pale urine in not +unusual quantity. If part of the absorbent system remains torpid, as the +absorbent vessels of the spleen, a tumour of that viscus occurs, which may +be felt by the hand; the same sometimes happens to the liver; and these +from their tendency to more complete torpor are afterwards liable to give +occasion to a return of the cold fit. If the cellular absorbents do not +completely recover their activity, a pale and bloated countenance with +swelled legs mark their want of action. + +3. As the termination of the cold fit is owing to the accumulation of the +sensorial power of irritation and of association during the previous +quiescence of the system; and as those parts, which are in perpetual action +during health, are more subject to this accumulation during their torpor, +or quiescence; one should have imagined, that the heart and arteries would +acquire this accumulation of sensorial power sooner or in greater degree +than other parts. This indeed so happens, where the pulse is previously +strong, as in febris irritativa; or where another sensorial power, as that +of sensation, is exerted on the arterial system, as in inflammations. The +heart and arteries in these cases soon recover from their torpor, and are +exerted with great violence. + +Many other parts of the system subject to perpetual motion in health may +rest for a time without much inconvenience to the whole; as when the +fingers of some people become cold and pale; and during this complete rest +great accumulation of irritability may be produced, But where the heart and +arteries are previously feeble, they cannot much diminish their actions, +and certainly cannot rest entirely, for that would be death; and therefore +in this case their accumulation of the sensorial power of irritation or of +association is slowly produced, and a long fever supervenes in consequence; +or sudden death, as frequently happens, terminates the cold fit. + +Whence it appears, that in fevers with weak pulse, if the action of the +heart, arteries, and capillaries could be diminished, or stopped for a +short time without occasioning the death of the patient, as happens in cold +bathing, or to persons apparently drowned, that a great accumulation of the +sensorial powers of irritation or of association might soon be produced, +and the pulse become stronger, and consequently slower, and the fever +cease. Hence cold ablution may be of service in fevers with weak pulse, by +preventing the expenditure and producing accumulation of the sensorial +power of irritation or association. Stupor may be useful on the same +account. Could a centrifugal swing be serviceable for this purpose, either +by placing the head or the feet in the outward part of the circle, as +described in Art. 15. 7. of this Supplement? + +IV. _Return of the cold Fit._ + +1. If the increased action of the cutaneous and pulmonary capillaries, and +of the heart and arteries, in febris irritativa continues long and with +violence, a proportional expenditure or exhaustion of sensorial power +occurs; which by its tendency to induce torpor of some part, or of the +whole, brings on a return of the cold fit. + +2. Another cause which contributes to induce torpor of the whole system by +the sympathy of its parts with each other, is the remaining torpor of some +viscus; which after the last cold paroxysm had not recovered itself, as of +the spleen, liver, kidnies, or of the stomach and intestines, or absorbent +vessels, as above mentioned. + +3. Other causes are the deficiency of the natural stimuli, as hunger, +thirst, and want of fresh air. Other causes are great fatigue, want of +rest, fear, grief, or anxiety of mind. And lastly, the influence of +external ethereal fluids, as the defect of external heat, and of solar or +lunar gravitation. Of the latter the return of the paroxysms of continued +fevers about six o'clock in the evening, when the solar gravitation is the +least, affords an example of the influence of it; and the usual periods of +intermittents, whether quotidian, tertian, or quartan, which so regularly +obey solar or lunar days, afford instances of the influence of those +luminaries on these kinds of fevers. + +4. If the tendency to torpor of some viscus is considerable, this will be +increased at the time, when the terrene gravitation is greatest, as +explained in the introduction to Class IV. 2. 4. and may either produce a +cold paroxysm of quotidian fever; or it may not yet be sufficient in +quantity for that purpose, but may nevertheless become greater, and +continue so till the next period of the greatest terrene gravitation, and +may then either produce a paroxysm of tertian fever; or may still become +greater, and continue so till the next period of greatest terrene +gravitation, and then produce a paroxysm of quartan ague. And lastly, the +periodical times of these paroxysms may exceed, or fall short of, the time +of greatest diurnal terrene gravitation according to the time of day, or +period of the moon, in which the first fit began; that is, whether the +diurnal terrene gravitation was then in an increasing or decreasing state. + +V. _Sensation excited in Fever._ + +1. A curious observation is related by Dr. Fordyce in his Tract on Simple +fever, page 168. He asserts, that those people, who have been confined some +time in a very warm atmosphere, as of 120 or 130 degrees of heat, do not +feel cold, nor are subject to paleness of their skins, on coming into a +temperature of 30 or 40 degrees; which would produce great paleness and +painful sensation of coldness in those, who had been some time confined in +an atmosphere of only 86 or 90 degrees. Analogous to this, an observing +friend of mine assured me, that once having sat up to a very late hour with +three or four very ingenious and humorous companions, and drank a +considerable quantity of wine; both contrary to his usual habits of life; +and being obliged to rise early, and to ride a long journey on the next +day; he expected to have found himself weak and soon fatigued; but on the +contrary he performed his journey with unusual ease and alacrity; and +frequently laughed, as he rode, at the wit of the preceding evening. In +both these cases a degree of pain or pleasure actuated the system; and thus +a sensorial power, that of sensation, was superadded to that of irritation, +or volition. See Sect. XXXIV. 2. 6. + +2. Similar to this, when the energetic exertions of some parts of the +system in the hot fit of fever arise to a certain excess, a degree of +sensation is produced; as of heat, which particularly increases the actions +of the cutaneous vessels, which are more liable to be excited by this +stimulus. When this additional sensorial power of sensation exists to a +greater degree, the pulse, which was before full, now becomes hard, owing +to the inflammation of the vasa vasorum, or coats of the arteries. In these +cases, whether there is any topical inflammation or not, the fever ceases +to intermit; but nevertheless there are daily remissions and exacerbations +of it; which recur for the most part about six in the evening, when the +solar gravitation is the least, as mentioned in Sect. XXXVI. 3. 7. + +3. Thus the introduction of another sensorial power, that of sensation, +converts an intermittent fever into a continued one. If it be attended with +strong pulse, it is termed febris sensitiva irritata, or pyrexia, or +inflammation; if with a weak pulse, it is termed febris sensitiva +inirritata, or typhus gravior, or malignant fever. The seat of the +inflammation is in the glandular or capillary system, as it consists in the +secretion of new fluids, or new fibres, which form new vessels, as they +harden, like the silk of the silk-worm. See Art. 15. of this Supplement. + +VI. _Circles of irritative Associate Motions._ + +1. There are some associate motions, which are perpetually proceeding in +our waking hours, and are catenated by their first link, or in some +subsequent parts of the chain, with the stimuli or the influence of +external things; which we shall here enumerate, as they contribute to the +knowledge of fever. Of these are the irritative ideas, or sensual motions +of the organs of sense, and the muscular motions associated with them; +which, when the chain is disturbed or interrupted, excite the sensorial +power of sensation, and proceed in confusion. Thus if the irritative ideas +of sight are disturbed, the paralactic motions of objects, which in general +are unperceived, become sensible to us; and the locomotive muscles +associated with them, which ought to preserve the body erect, stagger from +this decrease or interruption of the sensorial power of association; and +vertigo is produced. + +When the irritative sensual motions, or ideas, belonging to one sense are +increased or diminished, the irritative sensual motions, or ideas, of the +other senses are liable to become disturbed by their general catenations; +whence occur noises in the ears, bad tastes in the mouth, bad odours, and +numbness or tingling of the limbs, as a greater or less number of senses +are affected. These constitute concomitant circles of disturbed irritative +ideas; or make a part of the great circle of irritative ideas, or motions +of the organs of sense; and when thus disturbed occasion many kinds of +hallucination of our other senses, or attend on the vertigo of vision. + +2. Another great circle of irritative associated motions consists of those +of the alimentary canal; which are catenated with stimuli or with +influences external to the system, but continue to be exerted in our +sleeping as well as in our waking hours. When these associations of motion +are disturbed by the too great or too small stimulus of the food taken into +the stomach, or by the too great excess or deprivation of heat, or by +indigestible substances, or by torpor or orgasm occasioned by their +association with other parts, various diseases are induced under the names +of apepsia, hypochondriasis, hysteria, diarrhoea, cholera, ileus, +nephritis, fever. + +3. A third circle of irritative associate motions consists of those of the +absorbent system; which may be divided into two, the lacteals, and the +lymphatics. When the stomach and intestines are recently filled with food +and fluid, the lacteal system is stimulated into great action; at the same +time the cellular, cutaneous, and pulmonary lymphatics act with less +energy; because less fluid is then wanted from those branches, and because +more sensorial power is expended by the lacteal branch. On this account +these two systems of absorbents are liable to act by reverse sympathy; +hence pale urine is made after a full dinner, as less of the aqueous part +of it is imbibed by the urinary lymphatics; and hence the water in anasarca +of the lungs and limbs is speedily absorbed, when the actions of the +lacteals of the stomach or intestines are weakened or inverted by the +exhibition of those drugs, which produce nausea, or by violent vomiting, or +violent cathartics. + +Hence in diabetes the lacteal system acts strongly, at the same time that +the urinary lymphatics invert their motions, and transmit the chyle into +the bladder; and in diarrhoea from crapula, or too great a quantity of food +and fluid taken at a time, the lacteals act strongly, and absorb chyle or +fluids from the stomach and upper intestines; while the lymphatics of the +lower intestines revert their motions, and transmit this over-repletion +into the lower intestines, and thus produce diarrhoea; which accounts for +the speedy operation of some cathartic drugs, when much fluid is taken +along with them. + +4. Other circles of irritative associate motions of great importance are +those of the secerning system; of these are the motions of the larger +congeries of glands, which form the liver, spleen, pancreas, gastric +glands, kidneys, salivary glands, and many others; some of which act by +direct and others by reverse sympathy with each other. Thus when the +gastric glands act most powerfully, as when the stomach is filled with +food, the kidneys act with less energy; as is shewn by the small secretion +of urine for the first hour or two after dinner; which reverse sympathy is +occasioned by the greater expenditure of sensorial power on the gastric +glands, and to the newly absorbed fluids not yet being sufficiently +animalized, or otherwise prepared, to stimulate the secretory vessels of +the kidneys. + +But those very extensive glands, which secrete the perspirable matter of +the skin and lungs, with the mucus, which lubricates all the internal cells +and cavities of the body, claim our particular attention. These glands, as +well as all the others, proceed from the capillary vessels, which unite the +arteries with the veins, and are not properly a part of them; the mucous +and perspirative glands, which arise from the cutaneous and pulmonary +capillaries, are associated by direct sympathy; as appears from immersion +in the cold bath, which is therefore attended with a temporary difficult +respiration; while those from the capillaries of the stomach and heart and +arteries are more generally associated by reverse sympathy with those of +the cutaneous capillaries; as appears in fevers with weak pulse and +indigestion, and at the same time with a hot and dry skin. + +The disturbed actions of this circle of the associate motions of the +secerning system, when the sensorial power of sensation is added to that of +irritation, frequently produces inflammation, which consists in the +secretion of new fluids or new vessels. Nevertheless, if these disturbed +actions be of the torpid kind, the pain, which attends them, is seldom +productive of inflammation, as in hemicrania; but is liable to excite +voluntary actions, and thus to expend much sensorial power, as in the +shuddering in cold fits of fever, or in convulsions; or lastly the pain +itself, which attends torpid actions, is liable to expend or exhaust much +sensorial power without producing any increased actions; whence the low +pulse, and cold extremities, which usually attend hemicrania; and hence +when inert, or inactive sensation attends one link of associated action, +the succeeding link is generally rendered torpid, as a coldness of the +cheek attends tooth-ach. + +5. A fifth important circle of irritative motions is that of the +sanguiferous system, in which the capillary vessels are to be included, +which unite the arterial and venous systems, both pulmonary and aortal. The +disturbed action of this system of the heart and arteries, and capillaries, +constitute simple fever; to which may be added, that the secerning and +absorbent vessels appending to the capillaries, and the bibulous mouths of +the veins, are in some measure at the same time generally affected. + +6. Now, though the links of each of these circles of irritative motions are +more strictly associated together, yet are they in greater or less degree +associated or catenated with each other by direct or reverse sympathy. Thus +the sickness, or inverted irritative motions of the stomach, are associated +or catenated with the disturbed irritative ideas, or sensual motions, in +vertigo; as in sea-sickness. This sickness of the stomach is also +associated or catenated with the torpor of the heart and arteries by direct +sympathy, and with the capillaries and absorbents by reverse sympathy; and +are thus all of them liable occasionally to be disturbed, when one of them +is diseased; and constitute the great variety of the kinds or symptoms of +fevers. + +VII. _Alternation of the cold and hot Fits._ + +1. When any cause occurs, which diminishes to a certain degree the supply +of sensorial power in respect to the whole system; as suppose a temporary +inexertion of the brain; what happens? First, those motions are exerted +with less energy, which are not immediately necessary to life, as the +locomotive muscles; and those ideas, which are generally excited by +volition; at the same time this deficiency of voluntary motion is different +from that which occurs in sleep; as in that the movements of the arterial +system are increased in energy though not in frequency. Next, the motions +of the alimentary canal become performed with less energy, or cease +altogether; and a total want of appetite to solid food occurs, or sickness, +or a diarrhoea occasioned by the indigested aliment. Then the absorbent +vessels cease to act with their due energy; whence thirst, and pale urine, +though in small quantities. Fourthly, the secerning vessels become affected +by the general diminution of sensorial power; whence all the secreted +fluids are produced in less quantity. And lastly, the sanguiferous canals +feel the general torpor; the pulsations of the heart and arteries become +feeble, and consequently quick; and the capillaries of the skin become +inactive, acquire less blood from the arteries, and are consequently paler +and shrunk. + +In this last circumstance of the torpor of the sanguiferous system consists +inirritative fever; as all the others are rather accidental or concomitant +symptoms, and not essential ones; as fewer or more of them may be present, +or may exist with a greater or less degree of inactivity. + +2. Now as the capillaries of the skin are exposed to greater varieties of +heat and cold, than the heart and arteries, they are supposed to be more +mobile, that is, more susceptible of torpor or exertion, or to +inflammation, by external stimuli or influences, than the other parts of +the sanguiferous system; and as the skin is more sensible to the presence +of heat, than the internal parts of the body, the commencement of the cold +paroxysms of fever generally either first exists in, or is first perceived +by, the coldness and paleness of the skin; and the commencement of the hot +fits by the heat and redness of it. + +3. The accumulation of sensorial power occurs in these organs soonest, and +in greatest quantity, during their quiescence, which were most perpetually +in action during health; hence those parts of the system soonest recover +from torpor in intermittent fever, and soonest fall into the contrary +extreme of increased activity; as the sanguiferous system of the heart and +arteries and capillaries. But of these the capillaries seem first to +acquire a renovation of their action, as the heat of the skin becomes first +renewed, as well as increased beyond its natural quantity, and this in some +parts sooner than in others; which quantity of heat is however not to be +estimated simply by the rise of the mercury in the thermometer, but also by +the quantity carried away into the atmosphere, or diffused amongst other +bodies in a given time; as more heat passes through water, which boils +vehemently, than when it boils gently, though the rise of the thermometer +in both cases continues the same. This fact may be known by boiling an egg +in water, the white of which coagulates in much less time, if the water +boils vehemently, than if it boils moderately, though the sensible heat of +the water is the same in both cases. + +Another cause, which induces the cutaneous capillaries to renew their +actions sooner than the heart and arteries after immersion in the cold +bath, is, that their torpor was occasioned by defect of irritation; whereas +that of the heart and arteries was occasioned by defect of association; +which defect of association was owing to the decreased actions of the +capillaries, and is now again excited by their renewed action; which +excitement must therefore be subsequent to that increased action of the +capillaries; and in consequence the increased action of the heart and +arteries at the commencement of the hot fit of some fevers is subsequent to +the increased action of the cutaneous capillaries. There is, however, in +this case an accumulation of the sensorial power of association in the +heart and arteries, which must contribute to increase their orgasm in the +hot fit, as well as the increased excitement of it by the increased action +of the capillaries. + +4. Now this increased action of the system, during the hot fit, by +exhausting the sensorial powers of irritation and association, contributes +to induce a renewal of the cold paroxysm; as the accumulation of those +sensorial powers in the cold fit produces the increased actions of the hot +fit; which two states of the system reciprocally induce each other by a +kind of libration, or a plus and minus, of the sensorial powers of +irritation and association. + +If the exhaustion of sensorial power during the hot fit of fever only +reduces the quantity of irritability and associability to its natural +standard, the fever is cured, not being liable to return. If the quantity +of these sensorial powers be reduced only so much, as not to produce a +second cold fit during the present quantity of external stimuli or +influences; yet it may be so far reduced, that a very small subtraction of +stimulus, or of influence, may again induce a cold fit; such as the +coldness of the night-air, or the diminution of solar or lunar gravitation, +as in intermittent fevers. + +5. Another cause of the renovation of the cold fits of fever is from some +parts of the system not having completely recovered from the former cold +paroxysm; as happens to the spleen, liver, or other internal viscus; which +sometimes remains tumid, and either occasions a return of the cold fit by +direct sympathy with other parts of the body, or by its own want of action +causes a diminution of the general quantity of heat, and thus facilitates +the renovation of the torpor of the whole system, and gives cause to +intermittent fevers catenated with lunar or solar influence. + +VIII. _Orgasm of the Capillaries._ + +As the remaining torpor of some less essential part of the system, as of +the spleen, when the hot fit ceases, produces after one, two, or three days +a return of cold fit by direct sympathy with the cutaneous capillaries, +when joined with some other cause of torpor, as the defect of solar or +lunar influences, or the exposure to cold or hunger, and thus gives origin +to intermittent fever; so the remaining torpor of some more essential parts +of the system, as of the stomach and intestines, is probably the cause of +the immediate recurrence of the cold paroxysm, at the time the hot one +ceases, by their direct sympathy with the cutaneous capillaries, without +the assistance of any other cause of torpor; and thus produces remittent +fever. And lastly the remaining torpor of some still more essential parts +of the system, as the heart and arteries, after the hot fit ought to cease, +is liable by reverse sympathy with the cutaneous capillaries to continue +their orgasm, and thus to render a fever continual, which would otherwise +remit or intermit. + +Many difficulties here occur, which we shall endeavour to throw some light +upon, and leave to future investigation; observing only that difficulties +were to be expected, otherwise fevers would long since have been +understood, as they have employed the unremitted attention of the +physicians of all ages of the world. + +1. Why do the same parts of successive trains of action sometimes affect +each other by direct, and sometimes by reverse sympathy?--1st, When any +irritative motion ceases, or becomes torpid, which was before in perpetual +action; it is either deprived of its usual stimulus, and thence the +sensorial power of irritation is not excited; or it has been previously too +much stimulated, and the sensorial power has been thus exhausted. + +In the former case an accumulation of sensorial power soon occurs, which is +excitable by a renewal of the stimulus; as when the fingers, which have +been immersed some time in snow, are again exposed to the usual warmth of a +room. Or, secondly, the sensorial power of irritation becomes so much +accumulated, that the motions, which were torpid, are now performed by less +stimulus than natural; as appears by the warmth, which soon occurs after +the first chill in going into frosty air, or into the bath at Buxton, which +is about eighty degrees of heat. Or, lastly, this accumulation of the +sensorial power of irritation so far abounds, that it increases the action +of the next link of the associated train or tribe of motions; thus on +exposing the skin to cold air, as in walking out in a frosty morning, the +actions of the stomach are increased, and digestion strengthened. + +But where the torpor of some irritative motion is owing to the previous +exhaustion of the sensorial power of irritation by too great stimulus, the +restoration of it occurs either not at all, or much more slowly than in the +former instances; thus after intoxication the stomach is very slow in +recovering its due quantity of the sensorial power of irritation, and never +shews any accumulation of it. + +2. When an associate motion, as described in the introduction to Class IV. +1. 1. acts with less energy, the sensorial power of association is either +not sufficiently excited by the preceding fibrous motions; or it has been +expended or exhausted by the too violent actions of the preceding fibrous +motions. In the former case there occurs an accumulation of the sensorial +power of association; exactly as, where the usual stimulus is withdrawn, +there occurs an accumulation of the sensorial power of irritation. Thus +when the actions of the capillaries of the skin are diminished by immersion +in cold water, the capillaries of the lungs are rendered torpid by the want +of the excitement of the sensorial power of association, owing to the +lessened actions of the previous fibrous motions, namely, of those of the +skin. Nevertheless as soon as the capillaries of the skin regain their +increased activity by the accumulation of the sensorial power of +irritation, these capillaries of the lungs act with greater energy also +owing to their accumulated sensorial power of association. These are +instances of direct sympathy, and constitute the cold and hot paroxysms of +intermittent fever; or the first paroxysm of a continued one. + +3. When the first link of a train of associated motions, which is subject +to perpetual action, becomes a considerable time torpid for want of being +excited by the previous exertions of the irritative motions, with which it +is catenated; the sensorial power of association becomes accumulated in so +great a degree as to affect the second link of the train of associated +motions, and to excite it into stronger action. Thus when the stomach is +rendered torpid by contagious matter swallowed into it mixed with the +saliva, the heart and arteries act more feebly; because the sensorial power +of association, which used to be excited by the fibrous motions of the +stomach, is not now excited; and in consequence the motions of the heart +and arteries act only by the sensorial power of irritation, which is +excited by the stimulus of the blood. + +But during this torpor of the stomach, and less action of the heart and +arteries, so great an accumulation of the sensorial powers of irritation +and of association occurs, that it adds to the action of the next link of +this vital circle of actions, that is, to that of the cutaneous +capillaries. Whence in this situation the torpor of the stomach occasions a +diminished action of the heart and arteries by direct sympathy, and may be +said to occasion an increased one of the cutaneous capillaries by reverse +sympathy; which constitute continued fever with weak pulse. + +Nor is this increased action of the capillaries in consequence of the +decreased action of the heart and arteries, as in fevers with weak pulse, a +single fact in the animal economy; though it exists in this case in the +greatest degree or duration, because the heart and arteries are perpetually +in greater action than any other part of the system. But a similar +circumstance occurs, when the stomach is rendered inactive by defective +excitement of the sensorial power of association, as in sea-sickness, or in +nephritis. In these cases the sensorial power of association becomes much +accumulated in the stomach, and seems by its superabundance to excite the +absorbent system, which is so nearly connected with it, into great increase +of action; as is known by the great quantity frequently in these situations +rejected by vomit, which could not otherways be supplied. It is probable +the increase of digestion by walking in frosty air, with many other animal +facts, may by future observations be found to be dependent on this +principle, as well as the increased action of the capillaries in continued +fevers with weak pulse. + +Whereas in continued fever with strong pulse, which may perhaps occur +sometimes on the first day even of the plague, the stomach with the heart +and arteries and the capillaries act by direct sympathy; that is, the +stomach is excited into stronger action by increased irritation owing to +the stimulus of contagious matter; these stronger irritative motions of the +stomach excite a greater quantity of the sensorial power of association, +which then actuates the heart and arteries with greater energy, as these +are catenated with the stomach; and in the same manner the increased +actions of the heart and arteries excite a greater quantity of the +sensorial power of association, which actuates the cutaneous capillaries +with increase of energy. See Class IV. 1. 1. + +4. I shall dwell a little longer on this intricate subject. The +commencement of fever-fits is known by the inactivity of the cutaneous +capillaries, which inactivity is observable by the paleness and coldness of +the skin, and also by the pain of coldness, which attends it. There is +nevertheless in most cases, except those which are owing to exposure to +external cold, a torpor of the capillaries of some internal viscus +preceding this inactivity of the cutaneous capillaries; which is known, by +the tumour or hardness of the viscus, or by an aching pain of it. The +capillaries of the lungs are at the same time rendered inactive or torpid, +as appears by the difficulty of breathing, and coldness of the breath in +cold fits of fever, and in going into the cold bath; but the lungs are not +affected with the pain either of coldness or of torpor. + +One cause of this synchronous or successive inactivity of the cutaneous +capillaries, in consequence of the previous torpor of some internal viscus, +may be owing to the deficiency of heat; which must occur, when any part +becomes inactive; because the secretions of that part cease or are +lessened, and the quantity of heat of it in consequence. But the principal +cause of it I suppose to be owing to the defect of the sensorial power of +association; which power of association is excited by some previous or +concomitant motions of the parts of every great circle of actions. This +appears on going into the cold bath, because the shortness of breath +instantly occurs, sooner than one can conceive the diminution of the heat +of the skin could affect the lungs by the want of its stimulus; but not +sooner than the defect of the sensorial power of association could affect +them; because this must cease to be excited into action on the instant that +the cutaneous capillaries cease to act; whence in the first moment of +contact of the cold water the cutaneous capillaries cease to act from +defect of irritation; which is caused by defect of the stimulus of heat; +and in the second moment the capillaries of the lungs cease to act from the +defect of association; which is caused by the defect of the motions of the +cutaneous capillaries. Thus the universal torpor in the cold paroxysm of +fever is an example of direct sympathy, though occasioned in part by defect +of irritation, and in part by defect of association. + +5. Thus in walking out in a frosty morning the skin is cooled by the +contact of the cold air, whence the actions of its capillaries are +diminished for want of their usual stimulus of heat to excite a sufficient +quantity of the sensorial power of irritation. Hence there is at first a +saving of sensorial power of irritation for the purpose of actuating the +other parts of the system with greater energy. Secondly the sensorial power +of association, which used to be excited by the motions of the cutaneous +capillaries, is now not so powerfully excited; and in consequence the +parts, which constitute the next links of the circles of associated +motions, are for a time actuated with less energy, and a temporary general +chillness succeeds; which is so far similar to the cold fit of intermittent +fever. + +In this situation there is a curious circumstance occurs, which merits +peculiar attention: after a short time, though the external skin continues +cool by its exposure to the cold air, and the actions of its capillaries +are consequently diminished, yet the capillaries of the stomach act with +greater energy; as is known by increased digestion and consequent hunger. +This is to be ascribed to the accumulation of the sensorial power of +irritation, which now excites by its superabundance, or overflowing, as it +were, the stomach into increased action; though it is at the same time +excited less powerfully than usual by the sensorial power of association. +Thus the accumulation of the sensorial power of irritation in the vessels +of the skin increases in this case the action of the stomach, in the same +manner as an accumulation of the sensorial power of association in the +heart and arteries in fevers with weak pulse increases the action of the +capillaries. + +If nevertheless the coldness of the skin be too long continued, or exists +in too great a degree, so as in some measure to impair the life of the +part, no further accumulation of the sensorial power of irritation occurs; +and in consequence the actions of the stomach become less than natural by +the defect of the sensorial power of association; which has ceased to be +excited by the want of action of the cutaneous capillaries. Whence +continued coldness of the feet is accompanied with indigestion and +heartburn. See Class IV. 2. 1. 6. + +6. Similar to this when the actions of the stomach are rendered torpid by +the previous stimulus of a violent emetic, and its motions become +retrograde in consequence, a great quantity of sensorial power is exerted +on the lymphatics of the lungs, and other parts of the body; which excites +them into greater direct action, as is evinced by the exhibition of +digitalis in anasarca. In this situation I suppose the emetic drug +stimulates the muscular fibres of the stomach into too great action; and +that in consequence a great torpor soon succeeds; and that this inaction of +the muscular parts of the stomach is not followed by much accumulation of +the sensorial power of irritation; because that sensorial power is in great +measure exhausted by the previous excessive stimulus. But the lymphatics of +the stomach have their actions lessened by defect of the sensorial power of +association, which is not now excited into action, owing to the lessened +motions of the muscular parts of it, with which the lymphatics are +associated. The sensorial power of association becomes therefore +accumulated in these lymphatics of the stomach, because it is not excited +into action; exactly as the power of irritation becomes accumulated in the +hand, when immersed in snow; and this accumulated sensorial power of +association excites the lymphatic of the lungs and of other parts, which +are most nearly associated with those of the stomach, into more energetic +actions. Thus the muscular fibres of the stomach act with the lymphatics of +that organ in direct sympathy; and the lymphatics of the stomach act in +reverse sympathy with those of the lungs and of other parts of the body; +the former of which is caused by defect of the excitement of the sensorial +power of association, and the latter by the accumulation of it. + +Besides the efficient cause, as above explained, the final cause, or +convenience, of these organic actions are worthy our attention. In this +case of an acrid drug swallowed into the stomach the reverted actions of +the muscular fibres of the stomach tend to eject its enemy; the reverted +actions of its lymphatics pour a great quantity of fluids into the stomach +for the purpose of diluting or washing off the noxious drug; and the +increased actions of the other lymphatics supply these retrograde ones of +the stomach with an inconceivable supply of fluids, as is seen in Ileus and +Cholera. + +7. The inquisitive reader will excuse my continuing this subject, though +perhaps with some repetitions, as it envelopes the very essence of fever. +When the first link of a train of actions is excited by excessive stimulus, +or excessive irritability, and thus acts with unusual energy by the +increased quantity of irritation, these increased motions excite a greater +quantity of the sensorial power of association, which causes increased +motions in the second link, which is catenated with the first; and then the +excessive action of this second link excites also a greater quantity of the +sensorial power of association, which increases the motions of the third +link of this chain of association, and thus the increase of the stimulus on +the irritative motions, to which the chain of association is catenated, +increases the action of the whole chain or circle of associated motions. + +After a time the irritative motions become torpid by expenditure of the +sensorial power of irritation, and then the power of association also +becomes less exerted, both because it has been in part exhausted by too +great action, and is now less excited by the lessened action of the +irritative motions, which used to excite it. These are both instances of +direct sympathy, and frequently constitute the cold and hot fit of +intermittents. + +But though the accumulation of the sensorial power of irritation during the +quiescence of some motion owing to want of stimulus generally induces +torpor in the first link of the train of associated motions catenated with +it; as the capillaries of the lungs become torpid immediately on immersion +of the skin into cold water; yet in some situations an orgasm or excess of +action is produced in the first link of the associated motions thus +catenated with irritative ones; as in the increased action of the stomach, +when the skin is for a time exposed to cold air; which may in part be +ascribed to the general increase of action of the whole system, owing to +the diminished expenditure of sensorial power, but particularly of the +parts, which have habitually acted together; as when one arm is paralytic +the other is liable to more frequent or almost continual motion; and when +one eye becomes blind the other frequently becomes stronger; which is well +known to farriers, who are said sometimes to destroy the sight of one eye +to strengthen that of the other in diseased horses. + +Hence there is sometimes a direct sympathy, and sometimes a reverse one +succeeds the torpor occasioned by defect of stimulus, the latter of which +is perhaps owing to a certain time being required for the production of an +accumulation of the sensorial power of irritation by the nervous branches +of the torpid organ; which accumulation is now in part or entirely derived +to the next link of the association. Thus in going into a coldish bath, as +into a river in the summer months, we at first experience a difficulty of +breathing from the torpid action of the pulmonary capillaries, owing to the +deficient excitement of the sensorial power of association in consequence +of the torpor of the cutaneous capillaries. But in a very short time, as in +one minute, the sensorial power of irritation becomes accumulated by the +inactivity of the cutaneous capillaries; and as its superabundance becomes +now expended on the pulmonary capillaries, the difficult respiration +ceases; though the cutaneous capillaries continue torpid by their contact +with the cold water, and consequently the sensorial power of association, +which used to contribute to actuate the pulmonary capillaries, is less +excited. + +8. In like manner when there exists an accumulation of the sensorial power +of association, owing to defect of its excitement by some previous +irritative or associate motions, it is generally accompanied for a certain +time by a torpor not only of the link first affected, but of the subsequent +parts, or of the whole train of associated motions, as in the cold fits of +intermittent fevers. Yet after a time an increased action of the next links +of associated motions succeeds the torpor of the first, as the absorbent +vessels of the lungs act more violently in consequence of the deficient +action of those of the stomach; and the skin at the commencement of +sickness is pale and cold, but in a little time becomes flushed and warm. + +Thus we see in associate motions, which are rendered torpid by defect of +excitement, that sometimes a direct, and sometimes a reverse sympathy +succeeds in the subsequent links of the chain. But I believe where a torpor +of irritative or of the associate motions is caused by a previous too great +expenditure or exhaustion of the sensorial powers of irritation or +association, no increase of action in the subsequent link ever occurs, or +not till after a very long time. + +Thus when the stomach becomes torpid by previous violent exertion, and +consequent exhaustion of the sensorial power of irritation, as after +intoxication with wine or opium, or after the exhibition of some violent +emetic drug, the torpor is communicated to the heart and arteries, as in +continued fevers with weak pulse. But where the torpor of the stomach is +produced from defective association, as in sea-sickness; or in the sickness +which occurs, when a stone stimulates the ureter; no torpor is then +communicated to the heart and arteries. For in the former case there is no +accumulation of sensorial power in the stomach, which was previously +exhausted by too great stimulus; but in the latter case the accumulation of +sensorial power in the stomach during its torpor is evinced by this +circumstance; that in sea-sickness the patients eat and drink voraciously +at intervals; and the pulse is generally not affected by the sickness +occasioned by a stone in the ureter. For the action of the stomach is then +lessened, and in consequence becomes retrograde, not owing to the +exhaustion of the sensorial power of irritation, but to the want of +excitement of the sensorial power of association; which is caused by the +defective action of the ureter, which becomes occasionally torpid by the +great stimulus of the stone it contains; or which is caused by the great +exhaustion of sensorial power by the pain; which affects the ureter without +exciting inflammation, or increased action of it. + +9. Thus though the stomach after the great stimulus of intoxication from +excess of wine or opium will continue many hours without accumulation of +sensorial power, as appears from the patient's experiencing no appetite at +the intervals of sickness; yet after long abstinence from food, at length +not only the exhausted quantity of sensorial power is renewed, but an +accumulation of it at length occurs, and hunger returns. In this situation +the stomach is generally about a whole day before it regains its usual +powers of digestion; but if it has been still more violently stimulated, +and its actions further impaired, a still more permanent torpor along with +a continued fever with weak pulse is liable to occur; and a fourth part, or +a half, or three fourths, or a whole lunar period passes, before it +recovers its due irritability and consequent action. + +In similar manner, after a person has been confined in a very warm room for +some hours, the cutaneous capillaries, with their secretory and absorbent +vessels, become exhausted of their sensorial power of irritation by the too +great violent exertions occasioned by the unusual stimulus of heat; and in +coming into a colder atmosphere an inactivity of the cutaneous vessels +exists at first for some time without accumulation of sensorial power; as +is shewn by the continuance of the pain of cold and the paleness; but after +a time both the pain of cold and paleness vanish, which now indicates an +accumulation of the sensorial power of irritation, as less degrees of heat +stimulate the system into due action. + +In the same manner, after any one has been some time in the summer +sunshine, on coming into a dark cell he continues much longer before he can +clearly distinguish objects, than if his eyes had only been previously +exposed to the light of a cloudy day in winter; because the sensorial power +of irritation, and consequent sensation, had in the first case been +previously much expended or exhausted; and therefore required a much longer +time before it could be produced in the brain, or derived to the optic +nerves, in such quantity as to restore the deficiency, and to cause an +accumulation of it; whereas in the latter case no deficiency had occurred. + +10. Thus the accumulation or deficiency of sensorial power in a torpid +organ, which had previously been accustomed to perpetual action, depends on +the manner in which it becomes torpid; that is, whether by great previous +stimulus, or great previous excitement of the power of association; or by +defect of its accustomed stimulus, or of its accustomed excitement of the +power of association. In the former case the sensorial power is in an +exhausted state, and therefore is not likely to become so soon accumulated, +as after drunkenness, or exposure to great heat, or to great light; in the +latter a great accumulation of sensorial power occurs, as after exposure to +cold, or hunger, or darkness. + +Hence when the stomach continues torpid by previous violent stimulus, as in +the exhibition of digitalis, no accumulation of sensorial power of +irritation supervenes; and in consequence the motions of the heart and +arteries, which are associated with those of the stomach, become weak, and +slow, and intermittent, from the defect of the excitement of the sensorial +power of association. But what follows? as the actions of the heart and +arteries are lessened by the deficient action of the sensorial power of +association, and not by previous increased excitement of it; a great +accumulation of the sensorial power of association occurs, which is exerted +on the pulmonary and cutaneous absorbents by reverse sympathy, and produces +a great absorption of the fluid effused into the cellular membrane in +anasarca, with dry skin; constituting one kind of atrophy. + +But if at the same time the secerning vessels of the stomach are stimulated +into so violent activity as to induce great consequent torpor, as probably +happens when contagious matter is swallowed into the stomach with our +saliva, those of the heart and arteries act feebly from the deficient +excitement of the power of association; and then the cutaneous and +pulmonary secerning vessels act with greater force than natural, owing to +the accumulation of the sensorial power of association; and unnatural heat +of the skin, and of the breath succeed; but without frequency of pulse, +constituting the paresis irritativa of Class I. 2. 1. 2. And lastly, if a +paucity of blood attends this paresis, or some other cause inducing a +frequency of pulse, the febris inirritativa, or fever with weak pulse, is +produced. + +But on the contrary when the stomach has previously been rendered torpid by +defect of stimulus, as by hunger, if food be too hastily supplied, not only +great exertion of the stomach itself succeeds, but fever with strong pulse +is induced in consequence; that is, the heart and arteries are excited into +more energetic action by the excess of the power of association, which +catenates their motions with those of the stomach. For the redundancy of +sensorial power of irritation, which was accumulated during the inactivity +of the stomach, and is now called into action by stimulus, actuates that +organ with increased energy, and excites by these increased motions the +sensorial power of association; which has also been accumulated during the +inactivity of the heart and arteries; and thus these organs also are now +excited into greater action. + +So after the skin has been exposed some hours to greater heat than natural +in the warm room, other parts, as the membranes of the nostrils, or of the +lungs, or of the stomach, are liable to become torpid from direct sympathy +with it, when we come into air of a moderate temperature; whence catarrhs, +coughs, and fevers. But if this torpor be occasioned by defect of stimulus, +as after being exposed to frosty air, the accumulation of sensorial power +is exerted, and a glow of the skin follows, with increased digestion, full +respiration, and more vigorous circulation. + +11. It may be asked, Why is there a great and constant accumulation of the +sensorial power of association, owing to the torpor of the stomach and +heart and arteries, in continued fever with weak pulse; which is exerted on +the cutaneous and pulmonary capillaries, so as to excite them into +increased action for many weeks, and yet no such exuberance of sensorial +power produces fever in winter-sleeping animals, or in chlorosis, or +apepsia, or hysteria? + +In winter-sleeping animals I suppose the whole nervous system is torpid, or +paralysed, as in the sleep of frozen people; and that the stomach is torpid +in consequence of the inactivity or quiescence of the brain; and that all +other parts of the body, and the cutaneous capillaries with the rest, +labour under a similar torpor. + +In chlorosis, I imagine, the actions of the heart and arteries, as well as +those of the cutaneous and pulmonary capillaries, suffer along with those +of the stomach from the deficient stimulus of the pale blood; and that +though the liver is probably the seat of the original torpor in this +disease, with which all other parts sympathize from defect of the +excitation of the sensorial power of association; yet as this torpor occurs +in so small a degree as not to excite a shuddering or cold fit, no +observable consequences are in general occasioned by the consequent +accumulation of sensorial power. Sometimes indeed in chlorosis there does +occur a frequent pulse and hot skin; in which circumstances I suppose the +heart and arteries are become in some degree torpid by direct sympathy with +the torpid liver; and that hence not only the pulse becomes frequent, but +the capillaries of the skin act more violently by reverse sympathy with the +heart and arteries, owing to the accumulation of the sensorial power of +association in them during their torpid state, as occurs in irritative +fever. See Article 11 of this Supplement. + +In apepsia chronica the actions of the stomach are not so far impaired or +destroyed as totally to prevent the excitation of the sensorial power of +association, which therefore contributes something towards the actions of +the heart and arteries, though less than natural, as a weak pulse always I +believe attends this disease. + +There is a torpor of the stomach, and of the upper part of the alimentary +canal in hysteria, as is evident from the retrograde actions of the +duodenum, stomach, and oesophagus, which constitute the globus hystericus, +or sensation of a globe rising into the throat. But as these retrograde +actions are less than those, which induce sickness or vomiting, and are not +occasioned by previous exhaustion of the sensorial power of irritation, +they do not so totally prevent the excitement of the sensorial power of +association, as to lessen the motion of the heart and arteries so much as +to induce fever; yet in this case, as in apepsia, and in chlorosis, the +pulsations of the heart and arteries are weaker than natural, and are +sometimes attended with occasionally increased action of the capillaries; +as appears from the flushings of the face, and hot skin, which generally +form an evening febricula in diseases attended with weak digestion. + +12. The increased action, or orgasm, of the cutaneous, pulmonary, and +cellular capillaries, with their secerning and absorbent vessels, in those +fevers which are attended with deficiency of vital action, exhausts the +patient both by the additional expenditure of sensorial power on those +organs of secretion, and by the too great absorption of the mucus and fat +of the body; whence great debility and great emaciation. Hence one great +indication of cure of continued fever with arterial debility is to diminish +the too great action of the capillaries; which is to be done by frequent +ablutions, or bathing the whole skin in tepid or in cold water, as +recommended by Dr. Currie of Liverpool (Philos. Trans. for 1792), for half +an hour, twice a day, or at those times when the skin feels dryest and +hottest. Much cool air should also be admitted, when the breath of the +patient feels hot to one's hand; or when the tongue, especially its middle +part, is dry, and covered with a crust of indurated mucus; as these +indicate the increased action of the pulmonary capillaries; in the same +manner as the dry and hot skin indicates the orgasm of the cutaneous +capillaries; and the emaciation of the body that of the cellular ones. + +For this purpose of abating the action of the capillaries by frequent +ablution or fomentation, water of any degree of heat beneath that of the +body will be of service, and ought in accurate language to be called a cold +bath; but the degree of coldness, where the patient is sensible, should in +some measure be governed by his sensations; as it is probable, that the +degree of coldness, which is most grateful to him, will also be of the +greatest benefit to him. See Class III. 2. 1. 12. and Article 15 of this +Supplement. + +Another great use of frequent ablutions, or fomentations, or baths, in +fevers, where the stomach is in some degree torpid, is to supply the system +with aqueous fluid by means of the cutaneous absorbents; which is +dissipated faster by the increased action of the secerning capillaries, +than the stomach can furnish, and occasions great thirst at the intervals +of the sickness. + +IX. _Torpor of the Lungs._ + +1. The lungs in many cases of contagion may first be affected with torpor, +and the skin become cold by sympathy; in the same manner as a cold skin on +going into the cold bath induces difficulty of breathing. Or the stomach +may become affected with torpor by its sympathy with the lungs, as in the +experiments of Mr. Watt with hydro-carbonate gas; a few respirations of +which induced sickness, and even syncope. When the stomach or skin is thus +affected secondarily by association, an accumulation of sensorial power +occurs much sooner, than when these parts become torpid in consequence of +previous excess of stimulus; and hence they sooner recover their accustomed +action, and the fever ceases. The particles of contagious matter thus +received by respiration somewhat resemble in their effects the acid gases +from burning sulphur, or from charcoal; which, if they do not instantly +destroy, induce a fever, and the patient slowly recovers. + +2. I was some years ago stooping down to look, which way the water oozed +from a morass, as a labourer opened it with a spade, to detect the source +of the spring, and inhaled a vapour, which occasioned an instant sense of +suffocation. Immediately recoiling I believe I inhaled it but once; yet a +few hours afterwards in the cool of the evening, when I returned home +rather fatigued and hungry, a shivering and cold fit occurred, which was +followed by a hot one; and the whole disease began and terminated in about +twelve hours without return. In this case the power of fear, or of +imagination, was not concerned; as I neither thought of the bad air of a +morass before I perceived it; nor expected a fever-fit, till it occurred. + +In this case the torpor commenced in the lungs, and after a few hours, by +the addition of fatigue, and cold, and hunger, was propagated by direct +sympathy to the rest of the system. An orgasm or increased action of the +whole system was then induced by the accumulation of sensorial power of +irritation in the lungs, and of association in the other organs; and when +these subsided, the disease ceased. It may be asked, could a torpor of the +capillaries of the air-vessels of the lungs be so suddenly produced by +great stimulation?--It appears probable, that it might, because great +exertion of irritative motions may be instantly produced without our +perceiving them; that is, without their being attended by sensation, both +in the lungs and stomach; and the organs may become torpid by the great +expenditure of the sensorial power of irritation in an instant of time; as +paralysis frequently instantly follows too great an exertion of voluntary +power. + +3. When the capillaries of the lungs act too violently, as in some +continued fevers; which is known by the heat of the breath, and by the +dryness of the tongue, especially of the middle part of it; not only cooler +air might be admitted more freely into a sick room to counteract this +orgasm of the pulmonary capillaries; but perhaps the patient might breathe +with advantage a mixture of carbonic acid gas, or of hydrogene gas, or of +azote with atmospheric air. And on the contrary, when there exists an +evident torpor of the pulmonary capillaries, which may be known by the +correspondent chilness of the skin; and by a tickling cough, which +sometimes attends cold paroxysms of fever, and is then owing to the +deficient absorption of the pulmonary mucus, the saline parts of which +stimulate the bronchiae, or air-vessels; a mixture of one part of oxygen +gas with 10 or 20 parts of atmospheric air might probably be breathed with +great advantage. + +X. _Torpor of the Brain._ + +As the inactivity or torpor of the absorbent vessels of the brain is the +cause of hydrocephalus internus; and as the deficiency of venous absorption +in the brain, or torpor of the extremities of its veins, is believed +frequently to be the cause of apoplexies; so there is reason to conclude, +that the torpor of the secerning vessels of the brain, which are supposed +to produce the sensorial power, may constitute the immediate cause of some +fevers with arterial debility. And also that the increased action of these +secerning vessels may sometimes constitute the immediate cause of fevers +with arterial strength. + +It is nevertheless probable, that the torpor or orgasm of the sanguiferous, +absorbent, or secerning vessels of the brain may frequently exist as a +secondary effect, owing to their association with other organs, as the +stomach or lungs; and may thus be produced like the torpor of the heart and +arteries in inirritative fevers, or like the orgasm of those organs in +irritative fevers, or inflammatory ones. + +Where there exists a torpor of the brain, might not very slight electric +shocks passed frequently through it in all directions be used with +advantage? Might not fomentations of 94 or 96 degrees of heat on the head +for an hour at a time, and frequently repeated, stimulate the brain into +action; as in the revival of winter-sleeping animals by warmth? Ether +externally might be frequently applied, and a blister on the shaved head. + +Where the secerning vessels of the brain act with too great energy, as in +some inflammatory fevers, might it not be diminished by laying the patient +horizontally on a mill-stone, and whirling him, till sleep should be +produced, as the brain becomes compressed by the centrifugal force? See +Article 15 of this Supplement. + +XI. _Torpor of the Heart and Arteries._ + +1. It was shewn in Class IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6. +3. that a reverse sympathy generally exists between the lacteal and +lymphatic branches of the absorbent system. Hence, when the motions of the +absorbents of the stomach are rendered torpid or retrograde in fevers with +arterial debility, those of the skin, lungs, and cellular membrane, act +with increased energy. But the actions of the muscular fibres of the heart +and arteries are at the same time associated with those of the muscular +fibres of the stomach by direct sympathy. Both these actions occur during +the operation of powerful emetics, as squill, or digitalis; while the +motions of the stomach continue torpid or retrograde, the cellular and +cutaneous absorbents act with greater energy, and the pulsations of the +heart and arteries become weaker, and sometimes slower. + +2. The increased action of the stomach after a meal, and of the heart and +arteries at the same time from the stimulus of the new supply of chyle, +seems originally to have produced, and to have established, this direct +sympathy between them. As the increased action of the absorbents of the +stomach after a meal has been usually attended with diminished action of +the other branches of the absorbent system, as mentioned in Class IV. 1. 1. +6. and has thus established a reverse sympathy between them. + +2. Besides the reverse sympathy of the absorbent vessels and the muscles of +the stomach, and of the heart and arteries, with those of the skin, lungs, +and cellular membrane; there exists a similar reverse sympathy between the +secerning vessels or glands of the former of these organs with those of the +latter; that is the mucous glands of the heart and arteries act generally +by direct sympathy with those of the stomach; and the mucous glands of the +cellular membrane of the lungs, and of the skin, act by reverse sympathy +with them both. + +Hence when the stomach is torpid, as in sickness, this torpor sometimes +only affects the absorbent vessels of it; and then the absorbents of the +cellular membrane and the skin only act with increased energy by reverse +sympathy. If the torpor affects the muscular fibres of the stomach, those +of the heart and arteries act by direct sympathy with it, and a weak pulse +is produced, as in the exhibition of digitalis, but without increase of +heat. But if the torpor also affects the glands of the stomach, the +cutaneous and pulmonary glands act with greater energy by their reverse +sympathy with those of the stomach, and of the heart and arteries; and +great heat is produced along with increased perspiration both from the skin +and lungs. + +3. There is some difficulty in explaining, why the actions of the extensive +system of capillary glands, which exist on every other membrane and cell in +the body for the purpose of secreting mucus and perspirable matter, should +so generally act by reverse sympathy with those of the stomach and upper +part of the intestines. It was shewn in Class IV. 1. 1. 6. that when the +stomach was filled with solid and fluid aliment, the absorbents of the +cellular membrane, and of the bladder, and of the skin acted with less +energy; as the fluids they were used to absorb and transmit into the +circulation, were now less wanted; and that hence by habit a reverse +sympathy obtained between these branches of the absorbents of the +alimentary canal, and those of the other parts of the body. + +Now, as at this time less fluid was absorbed by the cutaneous and cellular +lymphatics, it would happen, that less would be secreted by their +correspondent secerning vessels, or capillary glands; and that hence by +habit, these secerning vessels would acquire a reverse sympathy of action +with the secerning vessels of the alimentary canal. + +Thus when the absorption of the tears by the puncta lacrymalia is much +increased by the stimulus of snuff; or of an affecting idea, on the nasal +dusts, as explained in Sect. XVI. 8. 2. a great increase of the secretion +of tears from the lacrymal glands is produced by the direct sympathy of the +action of these glands with those of their correspondent absorbents; and +that though in this case they are placed at so great a distance from each +other. + +4. A difficult question here occurs; why does it happen, that in fevers +with weak pulse the contractions of the heart and arteries become at the +same time more frequent; which also sometimes occurs in chlorosis, and in +some hysteric and hypochondriac diseases, and in some insanities; yet at +other times the weak pulse becomes at the same time slow, as in the +exhibition of digitalis, and in paresis irritativa, described in Class I. +2. 1. 2. which may be termed a fever with slow pulse? this frequency of +pulse can not depend on heat, because it sometimes exists without heat, as +towards the end of some fevers with debility. + +Now as apoplexies, which are sometimes ascribed to fulness of blood, are +attended with slow pulse; and as in animals dying in the slaughter house +from deficiency of blood the pulse becomes frequent in extreme; may not the +frequency of pulse in fevers with arterial debility be in general owing to +paucity of blood? as explained in Sect. XXXII. 2. 3. and its slowness in +paresis irritativa be caused by the debility being accompanied with due +quantity of blood? or may not the former circumstance sometimes depend on a +concomitant affection of the brain approaching to sleep? or to the unusual +facility of the passage of the blood through the pulmonary and aortal +capillaries? in which circumstance the heart may completely empty itself at +each pulsation, though its contractions may be weak. While the latter +depends on the difficulty of the passage of the blood through the pulmonary +or aortal capillaries, as in the cold fits of intermittents, and in some +palpitations of the heart, and in some kinds of haemoptoe? in these cases +the increased resistance prevents the heart from emptying itself, and in +consequence a new diastole sooner occurs, and thus the number of pulsations +becomes greater in a given time. + +5. In respect to the sympathies of action, which produce or constitute +fever with debility, the system may be divided into certain provinces, +which are assentient or opposite to each other. First, the lacteals or +absorbent vessels of the stomach, and upper part of the intestines; +secondly, the lymphatics or all the other branches of the absorbent +vessels, which arise from the skin, mucous membranes, cellular membranes, +and the various glands. These two divisions act by reverse sympathy with +each other in the hot fits of fever with debility, though by direct +sympathy in the cold ones. The third division consists of the secerning +vessels of the stomach and upper intestines; and the fourth of the +secerning vessels of all the other parts of the body, as the capillary +glands of the skin, lungs, and cellular membrane, and the various other +glands belonging to the sanguiferous system. Many of these frequently, but +the capillaries always, act by reverse sympathy with those of the third +division above mentioned in the hot fits of fever with debility, though by +direct sympathy with them in the cold fits. Fifthly, the muscular fibres of +the stomach, and upper intestines; and sixthly, the muscular fibres of the +heart and arteries. The actions of these two last divisions of moving +fibres act by direct sympathy with each other, both in the cold and hot +fits of fevers with debility. + +The efficient cause of those apparent sympathies in fevers with weak pulse +may be thus understood. In the cold paroxysm of fever with weak pulse the +part first affected I believe to be the stomach, and that it has become +torpid by previous violent exertion, as by swallowing contagious matter +mixed with saliva, and not by defect of stimulus, as from cold or hunger. +The actions of this important organ, which sympathizes with almost every +part of the body, being thus much diminished or nearly destroyed, the +sensorial power of association is not excited; which in health contributes +to move the heart and arteries, and all the rest of the system; whence an +universal torpor occurs. + +When the hot fit approaches, the stomach in fevers with strong pulse +regains its activity by the accumulation of the sensorial power of either +irritation, if it was the part first affected, or of association if it was +affected in sympathy with some other torpid part, as the spleen or liver; +which accumulation is produced during its torpor. At the same time all the +other parts of the system acquire greater energy of action by the +accumulation of the sensorial power of association, which was produced, +during their inactivity in the cold fit. + +But in fevers with weak pulse the stomach, whose sensorial power of +irritation had been previously exhausted by violent action, acquires no +such quick accumulation of sensorial power, but remains in a state of +torpor after the hot fit commences. The heart and arteries remain also in a +state of torpor, because there continues to be no excitement of their power +of association owing to the torpid motions of the stomach; but hence it +happens, that there exists at this time a great accumulation of the power +of association in the less active fibres of the heart and arteries; which, +as it is not excited and expended by them, increases the associability of +the next link of the associated chain of motions, which consists of the +capillaries or other glands; and that in so great a degree as to actuate +them with unnatural energy, and thus to produce a perpetual hot fit of +fever. Because the associability of the capillaries is so much increased by +the accumulation of this power, owing to the lessened activity of the heart +and arteries, as to over-balance the lessened excitement of it by the +weaker movements of the heart and arteries. + +6. When the accumulation of the sensorial power of irritation caused by +defect of stimulus is greater in the first link of a train of actions, to +which associated motions are catenated, than the deficiency of the +excitement of the sensorial power of association in the next link, what +happens?--the superabundance of the unemployed sensorial power of the first +link is derived to the second; the associability of which thus becomes so +greatly increased, that it acts more violently than natural, though the +excitement of its power of association by the lessened action of the first +link is less than natural. So that in this situation the withdrawing of an +accustomed stimulus in some parts of the system will decrease the +irritative motions of that part, and at the same time occasion an increase +of the associate motion of another part, which is catenated with it. + +This circumstance nevertheless can only occur in those parts of the system, +whose natural actions are perpetual, and the accumulation of sensorial +power on that account very great, when their activity is much lessened by +the deduction of their usual stimulus; and are therefore only to be found +in the sanguiferous system, or in the alimentary canal, or in the glands +and capillaries. Of the first of which the following is an instance. + +The respiration of a reduced atmosphere, that is of air mixed with +hydrogene or azote, quickens the pulse, as observed in the case of Mrs. +Eaton by Dr. Reynolds and Dr. Thornton; to which Dr. Beddoes adds in a +note, that "he never saw an instance in which a lowered atmosphere did not +at the moment quicken the pulse, while it weakened the action of the heart +and arteries." Considerations on Factitious Airs, by Thomas Beddoes and +James Watt, Part III. p. 67. Johnson, London. By the assistance of this new +fact the curious circumstance of the quick production of warmth of the skin +on covering the head under the bed-clothes, which every one must at some +time have experienced, receives a more satisfactory explanation, than that +which is given in Class IV. 1. 1. 2. which was printed before this part of +Dr. Beddoes's Considerations was published. + +For if the blood be deprived of its accustomed quantity of oxygen, as in +covering the head in bed, and thus breathing an air rendered impure by +repeated respiration, or by breathing a factitious air with less proportion +of oxygen, which in common respiration passes through the moist membranes +of the lungs, and mixes with the blood, the pulsations of the heart and +arteries become weaker, and consequently quicker, by the defect of the +stimulus of oxygen. And as these vessels are subject to perpetual motion, +the accumulation of the sensorial power of irritation becomes so great by +their lessened activity, that it excites the vessels next connected, the +cutaneous capillaries for instance, into more energetic actions, so as to +produce increased heat of the skin, and greater perspiration. + +How exactly this resembles a continued fever with weak and quick pulse!--in +the latter the action of the heart and arteries are lessened by defect of +the excitement of the sensorial power of association, owing to the torpor +or lessened actions of the stomach; hence the accumulation of the sensorial +power of association in this case, as the accumulation of that of +irritation in the former, becomes so abundant as to excite into increased +action the parts most nearly connected, as the cutaneous capillaries. + +In respect to the circumstance mentioned by Sydenham, that covering the +head in bed in a short time relieved the pertinacious sickness of the +patient, it must be observed, that when the action of the heart and +arteries become weakened by the want of the due stimulus of the proper +quantity of oxygen in the blood, that an accumulation of the sensorial +power of irritation occurs in the fibres of the heart and arteries, which +then is expended on those of the capillary glands, increasing their actions +and consequent secretions and heat. And then the stomach is thrown into +stronger action, both by the greater excitement of its natural quantity of +the sensorial power of association by the increased actions of the +capillaries, and also by some increase of associability, as it had been +previously a long time in a state of torpor, or less activity than natural, +as evinced by its perpetual sickness. + +In a manner somewhat similar to this, is the redness of the skin produced +in angry people by the superabundance of the unemployed sensorial power of +volition, as explained in Class IV. 2. 3. 5. Rubor ex ira. From hence we +learn how, when people in fevers with weak pulse, or in dropsies, become +insane, the abundance of the unemployed sensorial power of volition +increases the actions of the whole moving system, and cures those diseases. + +7. As the orgasm of the capillaries in fevers with weak pulse is +immediately caused by the torpid actions of the heart and arteries, as +above explained, this supplies us with another indication of cure in such +fevers, and that is to stimulate these organs. This may probably be done by +some kind of medicines, which are known to pass into the blood unchanged in +some of their properties. It is possible that nitre, or its acid, may pass +into the blood and increase the colour of it, and thus increase its +stimulus, and the same may be supposed of other salts, neutral or metallic? +As rubia tinctoria, madder, colours the bones of young animals, it must +pass into the blood with its colouring matter at least unchanged, and +perhaps many other medicines may likewise affect the blood, and thus act by +stimulating the heart and arteries, as well as by stimulating the stomach; +which circumstance deserves further attention. + +Another way of immediately stimulating the heart and arteries would be by +transfusing new blood into them. Is it possible that any other fluid +besides blood, as chyle, or milk, or water, could, if managed with great +art, be introduced safely or advantageously into the vein of a living +animal? + +A third method of exciting the heart and arteries immediately is by +increasing the natural stimulus of the blood, and is well worthy experiment +in all fevers with weak pulse; and that consists in supplying the blood +with a greater proportion of oxygen; which may be done by respiration, if +the patient was to breathe either oxygen gas pure, or diluted with +atmospheric air, which might be given to many gallons frequently in a day, +and by passing through the moist membranes of the lungs, according to the +experiments of Dr. Priestley, and uniting with the blood, might render it +more stimulant, and thus excite the heart and arteries into greater action! +May not some easier method of exhibiting oxygen gas by respiration be +discovered, as by using very small quantities of hyper-oxygenated marine +acid gas very much diluted with atmospheric air? + +XII. _Torpor of the Stomach and upper Intestines._ + +1. The principal circumstance, which supports the increased action of the +capillaries in continued fever with weak pulse, is their reverse sympathy +with those of the stomach and upper intestines, or with those of the heart +and arteries. The torpor of the stomach and upper intestines is apparent in +continued fevers from the total want of appetite for solid food, besides +the sickness with which fevers generally commence, and the frequent +diarrhoea with indigested stools, at the same time the thirst of the +patient is sometimes urgent at the intervals of the sickness. Why the +stomach can at this time take fluids by intervals, and not solids, is +difficult to explain; except it be supposed, as some have affirmed, that +the lacteal absorbents are a different branch from the lymphatic +absorbents, and that in this case the former only are in a state of +permanent torpor. + +2. The torpor of the heart and arteries is known by the weakness of the +pulse. When the actions of the absorbents of the stomach are diminished by +the exhibition of small doses of digitalis, or become retrograde by larger +ones, the heart and arteries act more feebly by direct sympathy; but the +cellular, cutaneous, and pulmonary absorbents are excited into greater +action. Whence in anasarca the fluids in the cellular membrane throughout +the whole body are absorbed during the sickness, and frequently a great +quantity of atmospheric moisture at the same time; as appears by the very +great discharge of urine, which sometimes happens in these cases; and in +ileus the prodigious evacuations by vomiting, which are often a hundred +fold greater than the quantity swallowed, evince the great action of all +the other absorbents during the sickness of the stomach. + +3. But when the stomach is rendered permanently sick by an emetic drug, as +by digitalis, it is not probable, that much accumulation of sensorial power +is soon produced in this organ; because its usual quantity of sensorial +power is previously exhausted by the great stimulus of the foxglove; and +hence it seems probable, that the great accumulation of sensorial power, +which now causes the increased action of the absorbents, is produced in +consequence of the inactivity of the heart and arteries; which inactivity +is induced by deficient excitement of the sensorial power of association +between those organs and the stomach, and not by any previous exhaustion of +their natural quantity of sensorial power; whereas in ileus, where the +torpor of the stomach, and consequent sickness, is induced by reverse +sympathy with an inflamed intestine, that is, by dissevered or defective +association; the accumulation of sensorial power, which in that disease so +violently actuates the cellular, pulmonary, and cutaneous absorbents, is +apparently produced by the torpor of the stomach and lacteals, and the +consequent accumulation of the sensorial power of association in them owing +to their lessened action in sickness. + +4. This accounts for the dry skin in fevers with weak pulse, where the +stomach and the heart and arteries are in a torpid state, and for the +sudden emaciation of the body; because the actions of the cellular and +cutaneous absorbents are increased by reverse sympathy with those of the +stomach, or with those of the heart and arteries; that is by the +expenditure of that sensorial power of association, which is accumulated in +consequence of the torpor of the stomach and heart and arteries, or of +either of them; this also explains the sudden absorption of the milk in +puerperal fevers; and contributes along with the heat of the respired air +to the dryness of the mucous membrane of the tongue and nostrils. + +5. Besides the reverse sympathy, with which the absorbent vessels of the +stomach and upper intestines act in respect to all the other absorbent +vessels, as in the exhibition of digitalis, and in ileus; there is another +reverse sympathy exists between the capillaries, or secretory vessels of +the stomach, and those of the skin. Which may nevertheless be occasioned by +the accumulation of sensorial power by the torpor of the heart and +arteries, which is induced by direct sympathy with the stomach; thus when +the torpor of the stomach remains in a fever-fit which might otherwise have +intermitted, the torpor of the heart and arteries remains also by direct +sympathy, and the increased cutaneous capillary action, and consequent +heat, are produced by reverse sympathy; and the fever is thus rendered +continual, owing primarily to the torpor of the stomach. + +6. The reverse sympathy, which exists between the capillaries of the +stomach and the cutaneous capillaries, appears by the chillness of some +people after dinner; and contrary-wise by the digestion being strengthened, +when the skin is exposed to cold air for a short time; as mentioned in +Class IV. 1. 1. 4. and IV. 2. 1. 1. and from the heat and glow on the skin, +which attends the action of vomiting; for though when sickness first +commences, the skin is pale and cold; as it then partakes of the general +torpor, which induces the sickness; yet after the vomiting has continued +some minutes, so that an accumulation of sensorial power exists in the +capillaries of the stomach, and of the skin, owing to their diminished +action; a glow of the skin succeeds, with sweat, as well as with increased +absorption. + +7. Nevertheless in some circumstances the stomach and the heart and +arteries seem to act by direct sympathy with the cutaneous capillaries, as +in the flushing of the face and glow of the skin of some people after +dinner; and as in fevers with strong pulse. In these cases there appears to +be an increased production of sensorial power, either of sensation, as in +the blush of shame; or of volition, as in the blush of anger; or of +irritation, as in the flushed face after dinner above mentioned. + +This increased action of the capillaries of the skin along with the +increased actions of the stomach and heart is perhaps to be esteemed a +synchronous increase of action, rather than a sympathy between those +organs. Thus the flushing of the face after dinner may be owing to the +secretion of sensorial power in the brain being increased by the +association of that organ with the stomach, in a greater proportion than +the increased expenditure of it, or may be owing also to the stimulus of +new chyle received into the blood. + +8. When the stomach and the heart and arteries are rendered torpid in +fevers, not only the cutaneous, cellular, and pulmonary absorbents are +excited to act with greater energy; but also their correspondent +capillaries and secerning vessels or glands, especially perhaps those of +the skin, are induced into more energetic action. Whence greater heat, a +greater secretion of perspirable matter, and of mucus; and a greater +absorption of them both, and of aerial moisture. These reverse sympathies +coincide with other animal facts, as in eruption of small pox on the face +and neck the feet become cold, while the face and neck are much flushed; +and in the hemiplagia, when one arm and leg become disobedient to volition, +the patient is perpetually moving the other. Which are well accounted for +by the accumulation of sensorial power in one part of an associated series +of actions, when less of it is expended by another part of it; and by a +deficiency of sensorial power in the second link of association, when too +much of it is expended by the first. + +9. This doctrine of reverse sympathy enables us to account for that +difficult problem, why in continued fevers the increased action of the +cutaneous, cellular, and pulmonary capillaries proceeds without +interruption or return of cold fit; though perhaps with some exacerbations +and remissions; and that during a quarter, or half, or three quarters, or a +whole lunation; while at the same time the pulsations of the heart and +arteries are weaker than natural. + +To this should be added the direct sympathy, which exists between the +peristaltic motions of the fibres of the stomach, and the pulsations of the +heart. And that the stomach has become torpid by the too great stimulus of +some poisonous or contagious matter; and this very intricate idea of +continued fever with feeble pulse is reduced to curious simplicity. + +The direct sympathy of the stomach and heart and arteries not only appears +from the stronger and slower pulse of persons exhausted by fatigue, after +they have drank a glass of wine, and eaten a few mouthfuls; but appears +also from the exhibition of large doses of digitalis; when the patient +labours under great and incessant efforts to vomit, at the same time that +the actions of the absorbent system are known to be much increased by the +hasty absorption of the serous fluid in anasarca, the pulsations of the +heart become slow and intermittent to an alarming degree. See Class IV. 2. +1. 17. and 18. + +10. It would assist us much in the knowledge and cure of fevers, if we +could always determine, which part of the system was primarily affected; +and whether the torpor of it was from previous excess or defect of +stimulus; which the industry of future observers must discover. Thus if the +stomach be affected primarily, and that by previous excess of stimulus, as +when certain quantities of opium, or wine, or blue vitriol, or arsenic, are +swallowed, it is some time in recovering the quantity of sensorial power +previously exhausted by excess of stimulus, before any accumulation of it +can occur. But if it be affected with torpor secondarily, by sympathy with +some distant part; as with the torpid capillaries of the skin, that is by +defective excitement of the sensorial power of association; or if it be +affected by defect of stimulus of food or of heat; it sooner acquires so +much accumulation of sensorial power, as to be enabled to accommodate +itself to its lessened stimulus by increase of its irritability. + +Thus in the hemicrania the torpor generally commences in a diseased tooth, +and the membranes about the temple, and also those of the stomach become +torpid by direct synchronous sympathy; and pain of the head, and sickness +supervene; but no fever or quickness of pulse. In this case the torpor of +the stomach is owing to defect of the sensorial power of association, which +is caused by the too feeble actions of the membranes surrounding the +diseased tooth, and thus the train of sympathy ceases here without +affecting the motions of the heart and arteries; but where contagious +matter is swallowed into the stomach, the stomach after a time becomes +torpid from exhaustion of the sensorial power of irritation, and the heart +and arteries act feebly from defect of the excitement of the power of +association. In the former case the torpor of the stomach is conquered by +accumulation of the power of association in one or two whole days; in the +latter it recovers by accumulation of the power of irritation in three or +four weeks. + +In intermittent fevers the stomach is generally I believe affected +secondarily by sympathy with the torpid cutaneous capillaries, or with some +internal torpid viscus, and on this account an accumulation of sensorial +power arises in a few hours sufficient to restore the natural irritability +of this organ; and hence the hot fit succeeds, and the fever intermits. Or +if this accumulation of sensorial power becomes excessive and permanent, +the continued fever with strong pulse is produced, or febris irritativa. + +In continued fevers the stomach is frequently I suppose affected with +torpor by previous excess of stimulus, and consequent exhaustion of +sensorial power, as when contagious matter is swallowed with the saliva, +and it is then much slower in producing an accumulation of sensorial power +sufficient to restore its healthy irritability; which is a frequent cause +of continued fever with weak pulse or febris inirritativa. Which consists, +after the cold fit is over, in a more frequent and more feeble action of +the heart and arteries, owing to their direct sympathy with the muscular +fibres of the torpid stomach; together with an increased action of the +capillaries, glands, and absorbents of the skin, and cellular membrane, +owing to their reverse sympathy with the torpid capillaries, glands, and +absorbents of the stomach, or with those of the heart and arteries. + +Or in more accurate language. 1. The febris inirritativa, or fever with +weak pulse, commences with torpor of the stomach, occasioned by previous +exhaustion of sensorial power of irritation by the stimulus of contagious +matter swallowed with the saliva. 2. The whole system becomes torpid from +defect of the excitement or the sensorial power of association owing to the +too feeble actions of the stomach, this is the cold fit. 3. The whole +system, except the stomach with the upper intestines, and the heart and +arteries, falls into increased action, or orgasm, owing to accumulation of +sensorial power of association during their previous torpor, this is the +hot fit. 4. The stomach and upper intestines have not acquired their +natural quantity of sensorial power of irritation, which was previously +exhausted by violent action in consequence of the stimulus of contagious +matter, and the heart and arteries remain torpid from deficient excitement +of the sensorial power of association owing to the too feeble actions of +the stomach. 5. The accumulation of sensorial power of association in +consequence of the torpor of the heart and arteries occasions a perpetual +orgasm, or increased action of the capillaries. + +11. From hence it may be deducted first, that when the torpor of the +stomach first occurs, either as a primary effect, or as a secondary link of +some associate train or circle of motions, a general torpor of the system +sometimes accompanies it, which constitutes the cold fit of fever; at other +times no such general torpor occurs, as during the operation of a weak +emetic, or during sea-sickness. + +Secondly. After a time it generally happens, that a torpor of the stomach +ceases, and its actions are renewed with increase of vigour by accumulation +of sensorial power during its quiescence; as after the operation of a weak +emetic, or at the intervals of sea-sickness, or after the paroxysm of an +intermittent fever. + +Thirdly. The stomach is sometimes much slower in recovering from a previous +torpor, and is then the remote cause of continued fever with weak pulse; +which is owing to a torpor of the heart and arteries, produced in +consequence of the deficient excitement of the power of association by the +too weak actions of the stomach; and to an orgasm of the capillaries of the +other parts of the system, in consequence of the accumulation of sensorial +power occasioned by the inactivity of the heart and arteries. + +Fourthly. The torpor of the stomach is sometimes so complete, that probably +the origin of its nerves is likewise affected, and then no accumulation of +sensorial power occurs. In this case the patient dies for want of +nourishment; either in three or four weeks, of the inirritative fever; or +without quick pulse, by what we have called paresis irritativa. Or he +continues many years in a state of total debility. When this torpor +suddenly commences, the patient generally suffers epileptic fits or +temporary insanity from the disagreeable sensation of so great a torpor of +the stomach; which also happens sometimes at the eruption of the distinct +small pox; whence we have termed this disease anorexia epileptica. See +Class II. 2. 2. 1. and III. 1. 1. 7. and Suppl. I. 14. 3. + +Fifthly. When this torpor of the stomach is less in degree or extent, and +yet without recovering its natural irritability by accumulation of +sensorial power, as it does after the cold fit of intermittent fever, or +after the operation of mild emetics, or during syncope; a permanent defect +of its activity, and of that of the upper intestines, remains, which +constitutes apepsia, cardialgia, hypochondriasis, and hysteria. See Class +I. 3. 1. 3. and I. 2. 4. 5. + +Sixthly. If the torpor of the stomach be induced by direct sympathy, as in +consequence of a previous torpor of the liver, or spleen, or skin, an +accumulation of sensorial power will sooner be produced in the stomach; +because there has been no previous expenditure of it, the present torpor of +the stomach arising from defect of association. Hence some fevers perfectly +intermit, the stomach recovering its complete action after the torpor and +consequent orgasm, which constitute the paroxysm of fever, are terminated. + +Seventhly. If the torpor of the stomach be owing to defect of irritation, +as to the want of food, an accumulation of sensorial power soon occurs with +an increase of digestion, if food be timely applied; or with violent +inflammation, if food be given in too great quantity after very long +abstinence. + +Eighthly. If the torpor of the stomach be induced by defect of pleasurable +sensation, as when sickness is caused by the suggestion of nauseous ideas; +an accumulation of sensorial power soon occurs, and the sickness ceases +with the return of hunger; for in this case the inactivity of the stomach +is occasioned by the subduction of agreeable sensation, which acts as a +subduction of stimulus, and not by exhausting the natural quantity of +sensorial power in the fibres or nerves of the stomach. + +Ninthly. If the torpor of the stomach be induced by a twofold cause, as in +sea-sickness. See Vertigo rotatoria. Class IV. 2. 1. 10. in which the first +link of association acts too strongly, and in consequence expends more than +usual of the sensorial power of irritation; and secondly in which sensation +is produced between the links of association, and dissevers or enfeebles +them; the accumulation of sensorial power soon occurs in the stomach; as no +previous expenditure of it in that organ has occurred. Whence in +sea-sickness the persons take food with eagerness at times, when the +vertigo eases for a few minutes. + +Tenthly. If the gastric torpor be induced by previous violent exertion, as +after intoxication, or after contagious matter has been swallowed, or some +poisons, as digitalis, or arsenic; an accumulation of sensorial power very +slowly succeeds; whence long sickness, or continued fever, because the +quantity of sensorial power already wasted must first be renewed, before an +accumulation of it can be produced. + +12. This leads us to a second indication of cure in continued fevers, which +consists in strengthening the actions of the stomach; as the first +indication consisted in decreasing the actions of the cutaneous capillaries +and absorbents. The actions of the stomach may sometimes be increased by +exhibiting a mild emetic; as an accumulation of sensorial power in the +fibres of the stomach is produced during their retrograde actions. Besides +the evacuation of any noxious material from the stomach and duodenum, and +from the absorbents, which open their mouths on their internal surfaces, by +their retrograde motion. + +It is probable, that when mild emetics are given, as ipecacuanha, or +antimonium tartarizatum, or infusion of chamomile, they are rejected by an +inverted motion of the stomach and oesophagus in consequence of +disagreeable sensation, as dust is excluded from the eye; and these actions +having by previous habit been found effectual, and that hence there is no +exhaustion of the sensorial power of irritation. But where strong emetics +are administered, as digitalis, or contagious matter, the previous +exhaustion of the sensorial power of irritation seems to be a cause of the +continued retrograde actions and sickness of the stomach. An emetic of the +former kind may therefore strengthen the power of the stomach immediately +after its operation by the accumulation of sensorial power of irritation +during its action. See Class IV. 1. 1. + +Another method of decreasing the action of the stomach for a time, and +thence of increasing it afterwards, is by the accumulation of the sensorial +power of irritation during its torpor; is by giving ice, iced water, iced +creams, or iced wine. This accounts for the pleasure, which many people in +fevers with weak pulse express on drinking cold beverage of any kind. + +A second method of exciting the stomach into action, and of decreasing that +of the capillaries in consequence, is by the stimulus of wine, opium, bark, +metallic salts of antimony, steel, copper, arsenic, given in small repeated +quantities; which so long as they render the pulse slower are certainly of +service, and may be given warm or cold, as most agreeable to the patient. +For it is possible, that the capillaries of the stomach may act too +violently, and produce heat, at the same time that the large muscles of it +may be in a torpid state; which curious circumstance future observations +must determine. + +Thirdly. Hot fomentation on the region of the stomach might be of most +essential service by its stimulus, as heat penetrates the system not by the +absorbent vessels, but by external influence; whence the use of hot +fomentation to the head in torpor of the brain; and the use of hot bath in +cases of general debility, which has been much too frequently neglected +from a popular error occasioned by the unmeaning application of the word +relaxation to animal power. If the fluid of heat could be directed to pass +through particular parts of the body with as little diffusion of its +influence, as that of electricity in the shocks from the coated jar, it +might be employed with still greater advantage. + +Fourthly. The use of repeated small electric shocks through the region of +the stomach might be of service in fevers with weak pulse, and well +deserves a trial; twenty or thirty small shocks twice a day for a week or +two would be a promising experiment. + +Fifthly. A blister on the back, or sides, or on the pit of the stomach, +repeated in succession, by stimulating the skin frequently strengthens the +action of the stomach by exciting the sensorial power of association; this +especially in those fevers where the skin of the extremities, as of the +hands or nose or ears, sooner becomes cold, when exposed to the air, than +usual. + +Sixthly. The action of the stomach may be increased by preventing too great +expenditure of sensorial power in the link of previous motion with which it +is catenated, especially if the action of that link be greater than +natural. Thus as the capillaries of the skin act too violently in fevers +with weak pulse, if these are exposed to cold air or cold water, the +sensorial power, which previously occasioned their orgasm, becomes +accumulated, and tends to increase the action of the stomach; thus in those +fevers with weak pulse and hot skin, if the stomach be stimulated by +repeated small doses of bark and wine or opium, and be further excited at +the same time by accumulation of sensorial power occasioned by rendering +the capillaries torpid by cold air or water, this twofold application is +frequently attended with visible good effect. + +By thus stimulating the torpid stomach into greater action, the motions of +the heart and arteries will likewise be increased by the greater excitement +of the power of association. And the capillaries of the skin will cease to +act so violently, from their not possessing so great a superfluity of +sensorial power as during the greater quiescence of the stomach and of the +heart and arteries. Which is in some circumstances similar to the curious +phenomenon mentioned in Class IV. 2. 2. 10; where, by covering the chill +feet with flannel at the eruption of the small-pox, the points of the +flannel stimulate the skin of the feet into greater action, and the +quantity of heat, which they possess, is also confined, or insulated, and +further increases by its stimulus the activity of the cutaneous vessels of +the feet; and by that circumstance abates the too great action of the +capillaries of the face, and the consequent heat of it. + +XIII. _Case of continued fever._ + +The following case of continued fever which I frequently saw during its +progress, as it is less complicate than usual, may illustrate this +doctrine. Master S. D. an active boy about eight years of age, had been +much in the snow for many days, and sat in the classical school with wet +feet; he had also about a fortnight attended a writing school, where many +children of the lower order were instructed. He was seized on February the +8th, 1795, with great languor, and pain in his forehead, with vomiting and +perpetual sickness; his pulse weak, but not very frequent. He took an +emetic, and on the next day, had a blister, which checked the sickness only +for a few hours; his skin became perpetually hot, and dry; and his tongue +white and furred; his pulse when asleep about 104 in a minute, and when +awake about 112. + +Fourth day of the disease. He has had another blister, the pain of his head +is gone, but the sickness continues by intervals; he refuses to take any +solid food, and will drink nothing but milk, or milk and water, cold. He +has two or three very liquid stools every day, which are somtimes green, +but generally of a darkish yellow, with great flatulency both upwards and +downwards at those times. An antimonial powder was once given, but +instantly rejected; a spoonful of decoction of bark was also exhibited with +the same event. His legs are bathed, and his hands and face are moistened +twice a day for half an hour in warmish water, which is nevertheless much +colder than his skin. + +Eighth day. His skin continues hot and dry without any observable +remissions, with liquid stools and much flatulency and sickness; his water +when observed was of a straw colour. He has asked for cyder, and drinks +nearly a bottle a day mixed with cold water, and takes three drops of +laudanum twice a day. + +Twelfth day. He continues much the same, takes no milk, drinks only cyder +and water, skin hot and dry, tongue hot and furred, with liquid stools, and +sickness always at the same time; sleeps much. + +Sixteenth day. Was apparently more torpid, and once rather delirious; pulse +112. Takes only capillaire and water; sleeps much. + +Twentieth day. Pulse 100, skin dry but less hot, liquid stools not so +frequent, he is emaciated to a great degree, he has eaten half a tea-cup +full of custard to day, drinks only capillaire and water, has thrice taken +two large spoonfuls of decoction of bark with three drops of laudanum, +refuses to have his legs bathed, and will now take nothing but three drops +of laudanum twice a day. + +Twenty-fourth day. He has gradually taken more custard every day, and began +to attend to some new play things, and takes wine syllabub. + +Twenty-eighth day. He daily grows stronger, eats eggs, and and butter, and +sleeps immediately after his food, can creep on his hands and knees, but +cannot stand erect. + +Thirty-second day. He cannot yet stand alone safely, but seems hourly to +improve in strength of body, and activity of mind. + +In this case the remote cause of his fever could not be well ascertained, +as it might be from having his feet cold for many successive days, or from +contagion; but the latter seems more probable, because his younger brother +became ill of a similar fever about three weeks afterwards, and probably +received the infection from him. The disease commenced with great torpor of +the stomach, which was shewn by his total aversion to solid food, and +perpetual sickness; the watery stools, which were sometimes green, or of a +darkish yellow, were owing to the acrimony, or acidity, of the contents of +the bowels; which as well as the flatulency were occasioned by indigestion. +This torpor of the stomach continued throughout the whole fever, and when +it ceased, the fever ceased along with it. + +The contagious material of this fever I suppose to have been mixed with the +saliva, and swallowed into the stomach; that it excited the vessels, which +constitute the stomach, into the greatest irritative motion like arsenic; +_which might not be perceived, and yet might render that organ paralytic or +inirritable in a moment of time_; as animals sometimes die by one single +exertion, and consequent paralysis, without a second struggle; as by +lightning, or being shot through the back part of the brain; of both which +I have seen instances. I had once an opportunity of inspecting two oxen, a +few minutes after they were killed by lightning under a crab-tree on moist +ground in long grass; and observed, that they could not have struggled, as +the grass was not pressed or bent near them; I have also seen two horses +shot through the cerebellum, who never once drew in their legs after they +first stretched them out, but died instantaneously; in a similar manner the +lungs seem to be rendered instantly inanimate by the fumes of burning +sulphur. + +The lungs may be sometimes primarily affected with contagious matter +floating in the atmosphere as well as the stomach, as mentioned in article +9. of this Supplement. But probably this may occur much less frequently, +because the oxygene of the atmosphere does not appear to be taken into the +blood by animal absorption, as the saliva in the stomach, but passes +through the moist membranes into the blood, like the ethereal fluids of +electricity or heat, or by chemical attraction, and in consequence the +contagious matter may be left behind; except it may sometimes be absorbed +along with the mucus; of which however in this case there appeared no +symptoms. + +The tonsils are other organs liable to receive contagious matter, as in the +small-pox, scarlet-fever, and in other sensitive inirritated fevers; but no +symptom of this appeared here, as the tonsils were at no time of the fever +inflamed, though they were in this child previously uncommonly large. + +The pain of the forehead does not seem to have been of the internal parts +of the head, because the nerves, which serve the stomach, are not derived +from the anterior part of the brain; but it seems to have been owing to a +torpor of the external membranes about the forehead from their direct +sympathy with those of the stomach; that is, from the deficient excitement +of the sensorial power of association; and seemed in some measure to be +relieved by the emetics and blisters. + +The pulsations of the heart were weaker and in consequence quicker than +natural, owing to their direct sympathy with the torpid peristaltic motions +of the stomach; that is to the deficient excitement of the sensorial power +of association. + +The action of the cutaneous capillaries and absorbents were stronger than +natural, as appeared by the perpetual heat and dryness of the skin; which +was owing to their reverse sympathy with the heart and arteries. This +weaker and quicker action of the heart and arteries, and the stronger +action of the cutaneous capillaries and absorbents, continued throughout +the disease, and may be said to have constituted the fever, of which the +torpor of the stomach was the remote cause. + +His tongue was not very much furred or very dry, nor his breath very hot; +which shewed, that there was no great increase of the action of the mucous +absorbents, nor of the pulmonary capillaries, and yet sufficient to produce +great emaciation. His urine was nearly natural both in quantity and colour; +which shewed, that there was no increase of action either of the kidnies, +or of the urinary absorbents. + +The bathing his legs and hands and face for half an hour twice a day seemed +to refresh him, and sometimes made his pulse slower, and thence I suppose +stronger. This seems to have been caused by the water, though subtepid, +being much below the heat of his skin, and consequently contributing to +cool the capillaries, and by satiating the absorbents to relieve the uneasy +sensation from the dryness of the skin. + +He continued the use of three drops of tincture of opium from about the +eighth day to the twenty-fourth, and for the three preceding days took +along with if two large spoonfuls of an infusion of bark in equal parts of +wine and water. The former of these by its stimulus seemed to decrease his +languor for a time, and the latter to strengthen his returning power of +digestion. + +The daily exacerbations or remissions were obscure, and not well attended +to; but he appeared to be worse on the fourteenth or fifteenth days, as his +pulse was then quickest, and his inattention greatest; and he began to get +better on the twentieth or twenty-first days of his disease; for the pulse +then became less frequent, and his skin cooler, and he took rather more +food: these circumstances seemed to observe the quarter periods of +lunation. + +XIV. _Termination of continued fever._ + +1. When the stomach is primarily affected with torpor not by defect of +stimulus, but in consequence of the previous exhaustion of its sensorial +power; and not secondarily by its association with other torpid parts; it +seems to be the general cause of the weak pulsations of the heart and +arteries, and the consequent increased action of the capillaries, which +constitute continued fever with weak pulse. In this situation if the +patient recovers, it is owing to the renovation of life in the torpid +stomach, as happens to the whole system in winter-sleeping animals. If he +perishes, it is owing to the exhaustion of the body for want of nourishment +occasioned by indigestion; which is hastened by the increased actions of +the capillaries and absorbents. + +2. When the stomach is primarily affected by defect of stimulus, as by cold +or hunger; or secondarily by defect of the power of association, as in +intermittent fevers; or lastly in consequence of the introduction of the +sensorial power of sensation, as in inflammatory diseases; the actions of +the heart and arteries are not diminished, as when the stomach is primarily +affected with torpor by its previous exhaustion of sensorial power, but +become greatly increased, producing irritative or inflammatory fever. Where +this fever is continued, though with some remissions and exacerbations, the +excessive action is at length so much lessened by expenditure of sensorial +power, as to gradually terminate in health; or it becomes totally +exhausted, and death succeeds the destruction of the irritability and +associability of the system. + +3. There is also another termination of the diseases in consequence of +great torpor of the stomach, which are not always termed fevers; one of +these is attended with so great and universal torpor, that the patient dies +in the first cold fit; that is, within twelve hours or less of the first +seizure; this is commonly termed sudden death. But the quickness of the +pulse, and the coldness with shuddering, and with sick stomach, +distinguished a case, which I lately saw, from the sudden deaths occasioned +by apoplexy, or ruptured blood-vessels. + +In hemicrania I believe the stomach is always affected secondarily, as no +quickness of pulse generally attends it, and as the stomach recovers its +activity in about two whole days. But in the following case, which I saw +last week, I suppose the stomach suddenly became paralytic, and caused in +about a week the death of the patient. Miss ----, a fine young lady about +nineteen, had bathed a few times, about a month before, in a cold spring, +and was always much indisposed after it; she was seized with sickness, and +cold shuddering, with very quick pulse, which was succeeded by a violent +hot fit; during the next cold paroxysm she had a convulsion fit; and after +that symptoms of insanity, so as to strike and bite the attendants, and to +speak furious language; the same circumstances occurred during a third fit, +in which I believe a strait waistcoat was put on, and some blood taken from +her; during all this time her stomach would receive no nutriment, except +once or twice a little wine and water. On the seventh day of the disease, +when I saw her, the extremities were cold, the pulse not to be counted and +she was unable to swallow, or to speak; a clyster was used with turpentine +and musk and opium, with warm fomentations, but she did not recover from +that cold fit. + +In this case the convulsion fit and the insanity seem to have been violent +efforts to relieve the disagreeable sensation of the paralytic stomach; and +the quick pulse, and returning fits of torpor and of orgasm, evinced the +disease to be attended with fever, though it might have been called +anorexia maniacalis, or epileptica. + +4. Might not many be saved in these fevers with weak pulse for a few weeks +by the introduction of blood into a vein, once in two or three days; which +might thus give further time for the recovery of the torpid stomach? Which +seems to require some weeks to acquire its former habits of action, like +the muscles of paralytic patients, who have all their habits of voluntary +associations to form afresh, as in infancy. + +If this experiment be again tried on the human subject, it should be so +contrived, that the blood in passing from the well person to the sick one +should not be exposed to the air; it should not be cooled or heated; and it +should be measured; all which may be done in the following manner. Procure +two silver pipes, each about an inch long, in the form of funnels, wide at +top, with a tail beneath, the former something wider than a swan-quill, and +the latter less than a small crow-quill. Fix one of these silver funnels by +its wide end to one end of the gut of a chicken fresh killed about four or +six inches long, and the other to the other end of the gut; then introduce +the small end of one funnel into the vein of the arm of a well person +downwards towards the hand; and laying the gut with the other end on a +water-plate heated to 98 degrees in a very warm room; let the blood run +through it. Then pressing the finger on the gut near the arm of the well +person, slide it along so as to press out one gutful into a cup, in order +to ascertain the quantity by weight. Then introduce the other end of the +other funnel into a similar vein in the arm of the sick person upwards +towards the shoulder; and by sliding one finger, and then another +reciprocally, along the chicken's gut, so as to compress it, from the arm +of the well person to the arm of the sick one, the blood may be measured, +and thus the exact quantity known which is given and received. See Class I. +2. 3. 25. + +XV. _Inflammation excited in fever._ + +1. When the actions of any part of the system of capillaries are excited to +a certain degree, sensation is produced, along with a greater quantity of +heat, as mentioned in the fifth article of this supplement. When this +increased capillary action becomes still more energetic, by the combined +sensorial powers of sensation with irritation, new fibres are secreted, or +new fluids, (which harden into fibres like the mucus secreted by the +silk-worm, or spider, or pinna,) from which new vessels are constructed; it +is then termed inflammation: if this exists in the capillary vessels of the +cellular membrane or skin only, with feeble pulsations of the heart and +arteries, the febris sensitiva inirritata, or malignant fever, occurs; if +the coats of the arteries are also inflamed, the febris sensitiva irritata, +or inflammatory fever, exists. + +In all these fevers the part inflamed is called a phlegmon, and by its +violent actions excites so much pain, that is, so much of the sensorial +power of sensation, as to produce more violent actions, and inflammation, +throughout the whole system. Whence great heat from the excited capillaries +of the skin, large and quick pulsations of the heart, full and hard +arteries, with great universal secretions and absorptions. These +perpetually continue, though with exacerbations and remissions; which seem +to be governed by solar or lunar influence. + +2. In this situation there generally, I suppose, exists an increased +activity of the secerning vessels of the brain, and consequently an +increased production of sensorial power; in less violent quantity of this +disease however the increase of the action of the heart and arteries may be +owing simply to the accumulation of sensorial power of association in the +stomach, when that organ is affected by sympathy with some inflamed part. +In the same manner as the capillaries are violently and permanently +actuated by the accumulation of the sensorial power of association in the +heart and arteries, when the stomach is affected primarily by contagious +matter, and the heart and arteries secondarily. Thus I suspect, that in the +distinct small-pox the stomach is affected secondarily by sympathy with the +infected tonsils or inoculated arm; but that in the confluent small-pox the +stomach is affected primarily, as well as the tonsils, by contagious matter +mixed with the saliva, and swallowed. + +3. In inflammatory fevers with great arterial action, as the stomach is not +always affected with torpor, and as there is a direct sympathy between the +stomach and heart, some people have believed, that nauseating doses of some +emetic drug, as of antimonium tartarizatum, have been administered with +advantage, abating by direct sympathy the actions of the heart. This theory +is not ill founded, and the use of digitalis, given in small doses, as from +half a dram to a dram of the saturated tincture, two or three times a day, +as well as other less violent emetic drugs, would be worth the attention of +hospital physicians. + +Sickness might also be produced probably with advantage by whirling the +patient in a chair suspended from the cieling by two parallel cords; which +after being revolved fifty or one hundred times in one direction, would +return with great circular velocity, and produce vertigo, similar I suppose +to sea-sickness. And lastly the sickness produced by respiring an +atmosphere mixed with one tenth of carbonated hydrogen, discovered by Mr. +Watt, and published by Dr. Beddoes, would be well worthy exact and repeated +experiment. + +4. Cool air, cool fomentations, or ablutions, are also useful in this +inflammatory fever; as by cooling the particles of blood in the cutaneous +and pulmonary vessels, they must return to the heart with less stimulus, +than when they are heated above the natural degree of ninety-eight. For +this purpose snow and ice have been scattered on the patients in Italy; and +cold bathing has been used at the eruption of the small pox in China, and +both, it is said, with advantage. See Class III. 2. 1. 12. and Suppl. I. 8. + +5. The lancet however with repeated mild cathartics is the great agent in +destroying this enormous excitement of the system, so long as the strength +of the patient will admit of evacuations. Blisters over the painful part, +where the phlegmon or topical inflammation is situated, after great +evacuation, is of evident service, as in pleurisy. Warm bathing for half an +hour twice a day, when the patient becomes enfeebled, is of great benefit, +as in peripneumony and rheumatism. + +6. When other means fail of success in abating the violent excitement of +the system in inflammatory diseases, might not the shaved head be covered +with large bladders of cold water, in which ice or salt had been recently +dissolved; and changed as often as necessary, till the brain is rendered in +some degree torpid by cold?--Might not a greater degree of cold, as iced +water, or snow, be applied to the cutaneous capillaries? + +7. Another experiment I have frequently wished to try, which cannot be done +in private practice, and which I therefore recommend to some hospital +physician; and that is, to endeavour to still the violent actions of the +heart and arteries, after due evacuations by venesection and cathartics, by +gently compressing the brain. This might be done by suspending a bed, so as +to whirl the patient round with his head most distant from the center of +motion, as if he lay across a millstone, as described in Sect. XVIII. 20. +For this purpose a perpendicular shaft armed with iron gudgeons might have +one end pass into the floor, and the other into a beam in the cieling, with +an horizontal arm, to which a small bed might be readily suspended. + +By thus whirling the patient with increasing velocity sleep might be +produced, and probably the violence of the actions of the heart and +arteries might be diminished in inflammatory fevers; and, as it is +believed, that no accumulation of sensorial power would succeed a torpor of +the origin of the nerves, either thus procured by mechanical compression, +or by the bladder-cap of cold water above described, the lives of thousands +might probably be saved by thus extinguishing the exacerbations of febrile +paroxysms, or preventing the returns of them. + +In fevers with weak pulse sleep, or a degree of stupor, thus produced, +might prevent the too great expenditure of sensorial power, and thus +contribute to preserve the patient. See Class I. 2. 5. 10. on stupor. What +might be the consequence of whirling a person with his head next the center +of motion, so as to force the blood from the brain into the other parts of +the body, might be discovered by cautious experiment without danger, and +might probably add to our ability of curing fever. + +XVI. _Recapitulation._ + +1. The sensorial power causes the contraction of the fibres, and is excited +into action by four different circumstances, by the stimulus of external +bodies, by pain or pleasure, by desire or aversion, or by the previous +motions of other contracting fibres. In the first situation it is called +the sensorial power of irritation, in the second the sensorial power of +sensation, in the third the sensorial power of volition, and in the fourth +the sensorial power of association. + +Many parts of the body are excited into perpetual action, as the +sanguiferous vessels consisting of the heart, arteries, and veins; others +into nearly perpetual action, as the conglomerate and capillary glands; and +others into actions still somewhat less frequent, as the alimentary canal, +and the lacteal and lymphatic absorbents with their conglobate glands: all +these are principally actuated by the sensorial powers of irritation, and +of association; but in some degree or at some times by those of sensation, +and even of volition. There are three kinds of stimulus, which may easily +be occasionally diminished, that of heat on the skin, of food in the +stomach, and of the oxygenous part of the atmosphere, which mixes with the +blood in respiration, and stimulates the heart and arteries. + +2. When any parts, which are naturally excited into perpetual action by +stimulus, become torpid or less active from decrease of that stimulus; +there first occurs a decrease of the activity of the parts next catenated +with them; thus going into cold water produces a torpor of the capillary +vessels of the lungs, as is known by the difficult respiration, which +immediately occurs; for the sensorial power of association, which naturally +contributes to actuate the lungs, is now less excited by the decreased +actions of the cutaneous vessels, with which they are catenated. This +constitutes the cold fit of fever. + +There next occurs an accumulation of the sensorial power of irritation in +the parts, which were torpid from defect of stimulus, as the cutaneous +vessels for instance when exposed to cold air; and a similar accumulation +of the sensorial power of association occurs in the parts which were +catenated with the former, as the vessels of the lungs in the example above +mentioned. Whence, if the subduction of stimulus has not been too great, so +as to impair the health of the part, the activity of the irritative motions +returns, even though the stimulus continues less than usual; and those of +the associate motions become considerably increased, because these latter +are now excited by the previous fibrous motions, which now act as strong or +stronger than formerly, and have also acquired an accumulation of the +sensorial power of association. This accounts for the curious event of our +becoming warm in a minute or two after remaining in water of about 80 +degrees of heat, as in the bath at Buxton; or in the cold air of a frosty +morning of about 30 degrees of heat. + +But if the parts thus possessed of the accumulated sensorial powers of +irritation and of association be exposed again to their natural quantity of +stimulus, a great excess of activity supervenes; because the fibres, which +possess accumulated irritation, are now excited by their usual quantity of +stimulus; and those which possess accumulated association, are now excited +by double or treble the quantity of the preceding irritative fibrous +motions, with which they are catenated; this constitutes the hot fit of +fever. + +Another important circumstance occurs, when the parts, which are torpid +from decreased stimulus, do not accumulate a quantity of sensorial power +sufficient for the purpose of renewing their own natural quantity of +action; but are nevertheless not so torpid, as to have the life of the part +impaired. In this situation the superabundance of the accumulated power of +irritation contributes to actuate the associate motions next catenated with +them. Thus, when a person breathes air with less oxygene than natural, as +by covering his head in bed, and thus respiring the same atmosphere +repeatedly, the heart and arteries become less active by defect of the +stimulus of oxygene; and then the accumulation of sensorial power of +irritation becomes instantly very great, as these organs are subject to +perpetual and energetic action. This accumulation nevertheless is not so +great as to renew their own activity under this defect of stimulus, but yet +is in sufficient abundance to increase the associability of the next link +of catenation, that is, to actuate the capillaries of the skin with great +and perpetual increase of energy. This resembles continued fever with weak +pulse; in which the accumulation of the sensorial power caused by the +lessened motions of the heart and arteries, actuates the capillaries with +increase of energy. + +3. When the accumulation of the sensorial power of association, which is +caused as above explained by deficient excitement owing to the lessened +quantity of action of the irritative fibrous motions, with which the +associate train is catenated, is not in quantity sufficient to renew the +natural actions of the first link of an associate train of motions; it is +nevertheless frequently so abundant as to actuate the next link of the +associated train with unnatural energy by increasing its associability; and +that in a still greater degree if that second link of the associated train +was previously in a torpid state, that is, had previously acquired some +accumulation of the sensorial power of association. This important +circumstance of the animal economy is worthy our most accurate attention. +Thus if the heart and arteries are deprived of their due quantity of the +stimulus of oxygene in the blood, a weak and quick pulse ensues, with an +accumulation of the sensorial power of irritation; next follows an increase +of the action of the capillaries by the superabundance of this accumulated +power of irritation; but there also exists an accumulation of the power of +association in these acting capillaries, which is not now excited by the +deficient actions of the heart and arteries; but which by its abundance +contributes to actuate the next link of association, which is the sick +stomach in the case related from Sydenham in Class IV. 1. 1. 2. and +explained in this Supplement I. 4. And as this sick stomach was in a +previous state of torpor, it might at the same time possess an accumulation +of some sensorial power, which, if it was of association, would be thus +more powerfully excited by the increased actions of the capillaries; which +existed in consequence of the weak action of the heart and arteries. This +also resembles in some respects the continued fevers with weak pulse, and +with increased activity of the capillaries. + +4. When a torpor of some irritative motions occurs from a previous +exhaustion of the sensorial power of irritation by the action of some very +great stimulus, it is long before any accumulation of the sensorial power +of irritation is produced; as is experienced in the sickness and languor, +which continues a whole day after a fit of drunkenness. But nevertheless +there occurs an accumulation of the sensorial power of association in the +first link of the associate train of motions, which is catenated with these +torpid irritative ones; which accumulation is owing to deficient excitement +of that sensorial power in the first link of the associate train. This +first link therefore exists also in a less active or torpid state, but the +accumulation of the sensorial power of association by its superabundance +contributes to actuate the second link of the associate train with +unnatural quantity of motion; and that though its own natural quantity of +the power of association is not excited by the deficient action of +preceding fibrous motions. + +When this happens to the stomach, as after its irritative motions have been +much exerted from the unnatural stimulus of wine, or opium, or of +contagious matter mixed with the saliva, a torpor or inactivity of it +succeeds for a greater or less length of time; as no accumulation of the +sensorial power of irritation can occur, till the natural quantity, which +has been previously expended, is first restored. Then the heart and +arteries which are next in catenation, become less active from the want of +sufficient excitement of the sensorial power of association, which +previously contributed to actuate them. This sensorial power of association +therefore becomes accumulated, and by its superabundance contributes to +actuate the link next in association, which has thus acquired so great a +degree of associability, as to overbalance the less quantity of the +excitement of it by the torpid action of the previous or first associate +link. This happens to the capillaries, when the heart and arteries are +affected as above by the torpor of the stomach, when it is occasioned by +previous great expenditure of its sensorial power, and thus constitutes +fever with weak pulse, which is here termed inirritative fever, typhus +mitior. + +5. When a deficiency of stimulus is too great or too long continued, so as +to impair the life of the part, no further accumulation of sensorial power +occurs; as when the skin is long exposed to cold and damp air. In that case +the link in catenation, that is, the first of the associate train, is +rendered torpid by defect of excitement of its usual quantity of the +sensorial power of association, and from there being no accumulation of the +sensorial power of irritation to increase its associability, and thus to +contribute to actuate it by overbalancing the defect of the excitement of +its association. + +Thus on riding long and slowly on a cold and damp day, the exhalation of +the vapour, which is impinged on the skin, as the traveller proceeds, +carries away his warmth faster, than it is generated within the system; and +thus the capillaries of the skin have their actions so much impaired after +a time, that no accumulation of the sensorial power of irritation occurs; +and then the stomach, whose motions are catenated with those of the +capillaries, ceases to act from the deficient excitement of the power of +association; and indigestion and flatulency succeed, instead of the +increased digestion and hunger, which occur, when the cutaneous capillaries +are exposed to a less degree of cold, and for a shorter time. In which +latter situation the accumulation of the sensorial power of irritation +increases by its superabundance the associability of the fibres of the +stomach, so as to overbalance the defect of the excitement of their +association. + +6. The stomach is affected secondarily in fevers with strong pulse, as in +those with weak pulse it is affected primarily. To illustrate this doctrine +I shall relate the following case of Mr. Y----. He was a young man rather +intemperate in the use of wine or beer, and was seized with a cold fit, and +with a consequent hot one with strong pulse; on examining his hypochondrium +an oblong tumour was distinctly felt on the left side of the stomach, which +extended six or eight inches downward, and was believed to be a tumour of +the spleen, which thus occasioned by its torpor the cold fit and consequent +hot fit of fever with strong pulse. This fever continued, though with +remissions, for two or three weeks; and the patient repeatedly lost blood, +used cathartics with calomel and sena, and had frequent antimonial and +saline medicines. And after he was much weakened by evacuations, the +peruvian bark and small doses of steel removed the fever, but the tumour +remained many years during the remainder of his life. + +In this case the tumour of the spleen was occasioned by the torpor of the +absorbent vessels; while the secerning vessels continued somewhat longer to +pour their fluids into the cells of it. Then the inactivity of this viscus +affected the whole system with torpor by the deficient excitement of the +sensorial power of association, which contributes along with the irritation +caused by their specific stimuli to actuate the whole sanguiferous, +secerning, and absorbent vessels; and along with these the stomach, which +possesses perhaps greater mobility, or promptitude to torpor or to orgasm, +than any other part. And after a time all these parts recover their actions +by the accumulation of their sensorial power of association. But the spleen +not recovering its action from the accumulation of its power of irritation, +as appeared from the continuance of the tumor, still affects the stomach by +its defective irritative motions ceasing to excite the association, which +ought to contribute to actuate it. + +Hence the stomach continues torpid in respect to its motions, but +accumulates its power of association; which is not excited into action by +the defective motions of the spleen; this accumulation of the sensorial +power of association now by its superabundance actuates the next link of +associate motions, which consists of the heart and arteries, into greater +energy of action than natural, and thus causes fever with strong pulse; +which, as it was supposed to be most frequently excited by increase of +irritation, is called irritative fever or synocha. + +Similar to this in the small pox, which is given by inoculation, the +stomach is affected secondarily, when the fever commences; and hence in +this small-pox the pulsations of the heart and arteries are frequently +stronger than natural, but never weaker, for the reasons above given. +Whereas in that small-pox, which is caused by the stomach being primarily +affected, by the contagious matter being swallowed with the saliva, whether +the tonsils are at the same time affected or not, the pulsations of the +heart and arteries become weak, and the inirritative fever is produced, as +explained above, along with the confluent small-pox. This unfolds the cause +of the mildness of the inoculated small-pox; because in this disease the +stomach is affected secondarily, whereas in the natural small-pox it is +frequently affected primarily by swallowing the contagious matter mixed +with saliva. + +In the measles I suppose the contagious matter to be dissolved in the air, +and therefore not liable to be mixed with the saliva; whereas the variolous +matter is probably only diffused in the air, and thence more readily mixed +with the saliva in the mouth during respiration. This difference appears +more probable, as the small-pox I believe is always taken at a less +distance from the diseased person than is necessary to acquire the measles. +The contagion of the measles affects the membranes of the nostrils, and the +secretion of tears in consequence, but never I suspect the stomach +primarily, but always secondarily; whence the pulsation of the heart and +arteries is always stronger than natural, so as to bear the lancet at any +period of the disease. + +The great mildness sometimes, and fatality at other times, of the scarlet +fever may depend on the same circumstance; that is, on the stomach being +primarily or secondarily affected by the contagious matter, observing that +the tonsils may be affected at the same time with the stomach. Should this +prove to be the case, which future observations must determine, what +certain advantage must arise from the inoculation of this disease! When it +is received by the skin primarily I suppose no sore throat attends it, nor +fever with weak pulse; when it is received by the stomach primarily, the +tonsils are affected at the same time, and the torpor of the stomach +produces inirritative fever, and the mortification of the tonsils succeeds. + +We may hence conclude, that when the torpor of the stomach is either owing +to defect of stimulus, which is not so great as to impair the life of the +part, as in moderate hunger, or in swallowing iced water, or when its +torpor is induced by its catenation or association with other torpid parts, +as in the commencement of intermittent fevers, and inoculated small-pox, +that the subsequent action of the heart and arteries is generally +increased, producing irritative fever. Which is owing to the accumulation, +of the sensorial power of irritation in one case, and of association in the +other, contributing to actuate the next link of the catenated or associated +motions. But when the torpor of the stomach is induced by previous +exhaustion of its sensorial powers of irritation or of association by +continued violent action, as by the stimulus of digitalis, or of contagious +matter, or after intoxication from wine or opium, a weaker action of the +heart and arteries succeeds, because there is no accumulation of sensorial +power, and a deficient excitement of association. And finally, as this weak +action of the heart and arteries is not induced by exhaustion of sensorial +power, but by defect of the excitement of association, the accumulation of +this power of association increases the action of the capillaries, and thus +induces inirritative fever. + +7. When any part of the system acts very violently in fevers, the sensorial +power of sensation is excited, which increases the actions of the moving +system; whereas the pain, which arises from decreased irritative motions, +as in hemicrania, seems to exhaust a quantity of sensorial power, without +producing or increasing any fibrous actions. + +When the stomach is primarily affected, as in inirritative fevers from +contagion, and in such a manner as to occasion pain, the action of the +capillaries seems to be increased by this additional sensorial power of +sensation, whence extensive inflammation or mortification; but when the +stomach and consequently the heart and arteries continue their torpidity of +action; as in confluent small-pox, and fatal scarlatina; this constitutes +sensitive inirritative fever, or typhus gravior. + +But when the stomach is secondarily affected, if the sensorial power of +sensation is excited, as in pleurisy or peripneumony, the actions of the +heart and arteries are violently increased, and of all the moving system +along with them. Thus the peripneumony is generally induced by the patient +respiring very cold air, and this especially after being long confined to +warm air, or after being much fatigued and heated by excessive labour or +exercise. For we can cover the skin with more clothes, when we feel +ourselves cold; but the lungs not having the perception of cold, we do not +think of covering them, nor have the power to cover them, if we desired it; +and the torpor, thus produced is greater, or of longer duration, in +proportion to the previous expenditure of sensorial power by heat or +exercise. + +This torpor of the lungs affects the skin with shuddering, and the stomach +is also secondarily affected; next follows the violent action of the lungs +from the accumulation of the power of irritation, and an inflammation of +them follows this violent action. While the stomach recovers its activity +by the increase of the excitement of the sensorial power of association, +and along with it the heart and arteries, and the whole moving system. +Hence this inflammation occurs during the hot fit of fever, and no cold fit +succeeds, because the excess of the sensorial power of sensation prevents a +succeeding torpor. + +These new motions of certain parts of the system produce increased +secretions of nutritious or organic mucus, which forms new vessels; these +new vessels by their unusual motions produce new kinds of fluids; which are +termed contagious, because they have the power, when introduced into a +healthy body, of producing similar actions and effects, with or without +fever, as in the small-pox and measles, or in the itch and venereal +disease. + +If any of these contagious matters affect the stomach with torpor either by +their stimulus immediately applied, or by its sympathy with the parts first +diseased, a fever is produced with sickness and want of appetite; as in +small-pox, and scarlatina. If the stomach is not affected by contagious +matter, no fever succeeds, as in itch, tinea, syphilis. + +All these contagious matters are conceived to be harmless, till they have +been exposed to the air, either openly or through a moist membrane; from +which they are believed to acquire oxygene, and thence to become some kinds +of animal acids. As the preparations of mercury cure venereal ulcers; as a +quarter of a grain of sublimate dissolved in wine, and given thrice a day; +this effect, seems to be produced either by its stimulating the absorbents +in the ulcer to absorb the venereal matter before it has acquired oxygene; +or by afterwards uniting with it chemically, and again depriving it of its +acquired acidity. On either supposition it might probably be given with +advantage in small-pox, and in all infectious diseases, both previous to +their commencement, and during their whole progress. + +8. The cold fits of intermittent fevers are caused by the torpor of some +part owing to deficient irritation, and of the other parts of the system +from deficient association. The hot fits are owing first to the +accumulation of irritation in the part primarily affected, if it recovers +its action, which does not always happen; and secondly to the accumulation +of association in the other parts of the system, which during health are +subject to perpetual action; and lastly also to the greater excitement of +the power of association, when the part primarily affected recovers its +irritability, and acts with greater energy than natural. + +The deficient secretions in the cold fit depend on the torpor of the +glandular system; and the increased secretions in the hot fit on their more +energetic action. The thirst in the cold fit is owing to the deficient +absorption from the skin, cellular membrane, and bladder; the thirst in the +hot fit is owing to the too great dissipation of the aqueous part of the +blood. The urine is pale and in small quantity in the cold fit from +deficient secretion of it, and from deficient absorption of its aqueous +parts; it is high coloured, and sometimes deposits a sediment, in the hot +fit from the greater secretion of it in the kidneys, and the greater +absorption of its aqueous and saline part in the bladder. The dryness and +scurf on the tongue and nostrils is owing to the increased heat of the air +expired from the lungs, and consequent greater evaporation of the aqueous +part of the mucus. The sweats appear in consequence of the declension of +the hot fit, owing to the absorbent vessels of the skin losing their +increased action sooner than the secerning ones; and to the evaporation +lessening as the skin becomes cooler. The returns of the paroxysms are +principally owing to the torpor of some less essential part of the system +remaining after the termination of the last fit; and are also dependent on +solar or lunar diurnal periods. + +The torpor of the part, which induces the cold paroxysm, is owing to +deficient irritation occasioned either by the subduction of the natural +stimuli of food, or water, or pure air, or by deficiency of external +influences, as of heat, or of solar or lunar gravitation. Or secondly, in +consequence of the exhaustion of sensorial power by great previous +exertions of some parts of the system, as of the limbs by great labour or +exercise, or of the stomach by great stimulus, as by contagious matter +swallowed with the saliva, or by much wine or opium previously taken into +it. Or lastly a torpor of a part may be occasioned by some mechanic injury, +as by a compression of the nerves of the part, or of their origin in the +brain; as the sitting long with one leg crossed over the other occasions +numbness, and as a torpor of the stomach, with vomiting frequently precedes +paralytic strokes of the limbs. + +As sleep is produced, either by defect of stimulus, or by previous +exhaustion of sensorial power; so the accumulation of the sensorial power +of volition in those muscles and organs of sense, which are generally +obedient to it, awakens the sleeping person; when it has increased the +quantity of voluntarity so much as to overbalance the defect of stimulus in +one case, and the exhaustion of sensorial power in the other; which latter +requires a much longer time of sleep than the former. So the cold paroxysm +of fever is produced either by defect of stimulus, or by previous +exhaustion of the sensorial power of some part of the system; and the +accumulation of the sensorial power of irritation in that part renews the +action of it, when it has increased its irritability so much as to +overbalance the defect of stimulus in one case and the exhaustion of +sensorial power in the other; which latter requires a much longer torpor or +cold fit than the former. + +But in the cold paroxysm of fever besides the torpor of one part of the +system from defect of irritation, the remainder of it becomes torpid owing +to defect of excitement of the sensorial power of association by the +lessened action of the part first affected. This torpor of the general +system remains, till the accumulation of the sensorial power of association +has increased the associability so much as to overbalance the defect of the +excitement of association; then the torpor ceases, and if the first +affected part has recovered its activity the other parts are all thrown +into excess of action by their increased associability, and the hot fit of +fever is produced. + +9. In the continued fevers with strong pulse the stomach is affected +secondarily, and thus acts feebly from deficient excitement of the power of +association; but the accumulation of the power of association thus produced +in an organ subject to perpetual and energetic action, is so great as to +affect the next link of the associate train, which consists of the heart +and arteries; these therefore are exerted perpetually with increase of +action. + +In continued fevers with weak pulse the torpid stomach is affected +primarily by previous exhaustion of its irritability by stimulus, as of +contagious matter swallowed into it. The heart and arteries act feebly from +deficient excitement of the power of association, owing to the torpor of +the stomach, with which they are catenated; but the accumulation of the +power of association, thus produced in organs subject to perpetual and +energetic motion, is so great, as to affect the next link of the associate +train; which consists of the capillaries of the skin or other glands; these +therefore are exerted perpetually with great increase of action. + +The continued fevers with strong pulse terminate by the reduction or +exhaustion of the sensorial power by violent action of the whole system; +which is followed either by return of health with the natural quantity of +irritability, and of associability, or by a total destruction of them both, +and consequent death. + +In continued fevers with weak pulse the stomach remains torpid during the +whole course of the fever; and at length by the recovery of its +irritability and sensibility effects the cure of it. Which generally +happens about the first, second, or third quarter of the lunar period, +counted from the commencement of the disease, or continues a whole +lunation, and sometimes more; which gave rise to what are termed critical +days. See Sect. XXXVI. 4. on this subject. If the stomach does not recover +from its torpor, the patient becomes emaciated, and dies exhausted by the +continuance of the increased action of the capillaries and absorbents, and +the want of nourishment. + +The cure of continued fever with weak pulse consists first in weakening the +undue action of the capillaries of the skin by ablution with cold water +from 32 to 80 degrees of heat; or by exposing them to cool air. Secondly by +invigorating the actions of the stomach, by decreasing them for a time, and +thence accumulating the power of irritation, as by an emetic, or by iced +water, or iced wine. Or by increase of stimulus, as by bark, wine, opium, +and food, in small quantities frequently repeated. Or by renewing the +action of the stomach by slight electric shocks. Or by fomenting it +frequently with water heated to 96 or 100 degrees. Or lastly by exciting +its power of association with other parts of the system, as by a blister; +which succeeds best when the extremities are cool; or by swinging, as in +vertigo rotatoria. + +If by the stimulus of the Peruvian bark on the fibres of the stomach, they +regain their due action, the heart and arteries also regain their due +action; as their sensorial power of association is now excited, and +expended as usual. And as there is then no accumulation of sensorial power +in the heart and arteries, the capillaries cease to act with too great +energy, and the fever is cured. + +Thirdly. If the heart and arteries could be themselves stimulated into +greater action, although the stomach remained torpid, they might probably +by expending a greater quantity of the sensorial power of irritation, +prevent an accumulation of the sensorial power of association, (for these +may possibly be only different modes of action of the spirit of animation,) +and thus the too great action of the capillaries might be prevented and the +fever cease. This new mode of cure might possibly be accomplished, if the +patient was to breathe a gallon or two of pure or diluted oxygene gas +frequently in a day; which by passing through the moist membranes of the +lungs and uniting with the blood might render it more stimulant, and thus +excite the heart and arteries into greater action. + +Fourthly. Greater energy might probably be given to the whole system, and +particularly to those parts which act too feebly in fevers, as the stomach +and the heart and arteries, if the action of the secerning vessels of the +brain could be increased in energy; this is probably one effect of all +those drugs, which when given in large quantity induce intoxication, as +wine and opium. And when given with great caution in small quantities +uniformly repeated, as from three drops to five of the tincture of opium, +but not more, every six hours, I believe they supply an efficacious +medicine in fevers with great arterial debility; and the more so, if the +Peruvian bark be exhibited alternately every six hours along with them. +There are other means of exciting the vessels of the brain into action; as +first by decreasing the stimulus of heat by temporary cold fomentation; +secondly, increasing the stimulus of heat by long continued warm +fomentation; thirdly, by electricity, as very small shocks passed through +it in all directions; and lastly by blisters on the head. All those require +to be used with great caution, and especially where there exists an evident +stupor, as the removing of that is I believe frequently injurious. See +stupor, Class I. 2. 5. 10. + +The cure of fever with strong pulse consists in the repeated use of +venesection, gentle cathartics, diluents; medicines producing sickness, as +antimonials, digitalis; or the respiration of carbonated hydrogen; or by +respiration of atmospheric air lowered by a mixture of hydrogen, azote, or +carbonic acid gas, or by compressing the brain by whirling in a decumbent +posture, as if lying across an horizontal mill-stone. See the former parts +of this supplement for the methods of cure both of fevers with strong and +weak pulse. + +10. When any difficulty occurs in determining the weak pulse from the +strong one, it may generally be assisted by counting its frequency. For +when an adult patient lies horizontally in a cool room, and is not hurried +or alarmed by the approach of his physician, nor stimulated by wine or +opium, the strong pulse seldom exceeds 118 or 120 in a minute; and the weak +pulse is generally not much below 130, and often much above that number. +Secondly in sitting up in bed, or changing the horizontal to a +perpendicular posture, the quickness of the weak pulse is liable +immediately to increase 10 or 20 pulsations in a minute, which does not I +believe occur in the strong pulse, when the patient has rested himself +after the exertion of rising. + +XVII. _Conclusion._ + +Thus have I given an outline of what may be termed the sympathetic theory +of fevers, to distinguish it from the mechanic theory of Boerhaave, the +spasmodic theory of Hoffman and of Cullen, and the putrid theory of +Pringle. What I have thus delivered, I beg to be considered rather as +observations and conjectures, than as things explained and demonstrated; to +be considered as a foundation and a scaffolding, which may enable future +industry to erect a solid and a beautiful edifice, eminent both for its +simplicity and utility, as well as for the permanency of its +materials,--which may not moulder, like the structures already erected, +into the sand of which they were composed; but which may stand unimpaired, +like the Newtonian philosophy, a rock amid the waste of ages! + + * * * * * + + +ADDITIONS. + + * * * * * + +ADDITION I. + + At the end of the article Canities, in Class I. 2. 2. 11. please to add + the following: + +As mechanical injury from a percussion, or a wound, or a caustic, is liable +to occasion the hair of the part to become grey; so I suspect the +compression of parts against each other of some animals in the womb is +liable to render the hair of those parts of a lighter colour; as seems +often to occur in black cats and dogs. A small terrier bitch now stands by +me, which is black on all those parts, which were external, when she was +wrapped up in the uterus, teres atque rotunda; and those parts white, which +were most constantly pressed together; and those parts tawny, which were +generally but less constantly pressed together. Thus the hair of the back +from the forehead to the end of the tail is black, as well as that of the +sides, and external parts of the legs, both before and behind. + +As in the uterus the chin of the whelp is bent down, and lies in contact +with the fore part of the neck and breast; the tail is applied close +against the division of the thighs behind; the inside of the hinder thighs +are pressed close to the sides of the belly, all these parts have white +hairs. + +The fore-legs in the uterus lie on each side of the face; so that the feet +cover part of the temples, and compress the prominent part of the upper +eye-brows, but are so placed as to defend the eye-balls from pressure; it +is curious to observe, that the hair of the sides of the face, and of the +prominent upper eye-brows, are tawny, and of the inside of the feet and +legs, which covered them; for as this posture admitted of more change in +the latter weeks of gestation, the colour of these parts is not so far +removed from black, as of those parts, where the contact or compression was +more uniform. + +Where this uterine compression of parts has not been so great as to render +the hair white in other animals, it frequently happens, that the +extremities of the body are white, as the feet, and noses, and tips of the +ears of dogs and cats and horses, where the circulation is naturally +weaker; whence it would seem, that the capillary glands, which form the +hair, are impeded in the first instance by compression, and in the last by +the debility of the circulation in them. See Class I. 1. 2. 15. + +This day, August 8th, 1794, I have seen a negro, who was born (as he +reports) of black parents, both father and mother, at Kingston in Jamaica, +who has many large white blotches on the skin of his limbs and body; which +I thought felt not so soft to the finger, as the black parts. He has a +white divergent blaze from the summit of his nose to the vertex of his +head; the upper part of which, where it extends on the hairy scalp, has +thick curled hair, like the other part of his head, but quite white. By +these marks I supposed him to be the same black, who is described, when +only two years old, in the Transactions of the American Philosophical +Society, Vol. II. page 292, where a female one is likewise described with +nearly similar marks. + +The joining of the frontal bones, and the bregma, having been later than +that of the other sutures of the cranium, probably gave cause to the +whiteness of the hair on these parts by delaying or impeding its growth. + +ADDITION II. + +The following extract from a letter of Dr. Beddoes on hydrocephalus +internus, I esteem a valuable addition to the article on that subject at +Class I. 2. 3. 12. + + "Master L----, aged 9 years, became suddenly ill in the night about a + week before I saw him. On the day before the attack, he had taken + opening medicines, and had bathed afterwards. He had complained of + violently acute pain in his head, shrieked frequently, ground his teeth + hard, could not bear to have his head raised from the pillow, and was + torpid or deaf. His tongue was white, pulse 110 in the evening and + full. As yet the pupil of the eye was irritable, and he had no + strabismus. He had been bled with leeches about the head, and + blistered. I directed mercurial inunction, and calomel from 3 to 6 + grains to be taken at first every six, and afterwards every three + hours. This plan produced no sensible effect, and the patient died on + the 18th day after the seizure. He had convulsion fits two days + preceding his death, and the well-known symptoms of hydrocephalus + internus all made their appearance. From what I had seen and read of + this disease, I believed it to belong to inflammations, and at an + earlier period I should be tempted to bleed as largely as for + pneumonia. The fluid found after death in the ventricules of the brain + I impute to debility of the absorbents induced by inflammation. My + reasons are briefly these; 1. The acuteness of the pain. 2. The state + of the pulse. In the above case for the first 9 or 10 days it did not + exceed 110, and was full and strong. + + 3. To find out whether any febrile alternations took place, Master L.'s + feet were frequently felt, and they were found at times cold, and at + other times of a dry heat. I have many times seen this disease, but the + patients were too young, or too far advanced, to inform me, whether + they had chillness succeeded by heat at its onset. 4. The disorders to + which the young are more peculiarly liable afford a presumption, that + hydrocephalus internus is an inflammatory disease; and this is + confirmed by the regularity of the period, within which it finishes its + course. And lastly, does it not happen more frequently than is + suspected from external injury? + + I have just now been well informed, that Dr. Rush has lately cured five + out of six patients by copious bleedings. I relate here the reasons for + an opinion without pretending to a discovery. Something like this + doctrine may be found in certain modern publications, but it is + delivered in that vague and diffuse style, which I trust your example + will banish from medical literature." + + Clifton, near Bristol, + _July 28, 1795_. + +To this idea of Dr. Beddoes may be added, that the hydrocele generally +succeeds an injury, and consequent inflammation of the bag, which contains +it. And that other dropsies, which principally attend inebriates, are +consequent to too great action of the mucous membranes by the stimulus of +beer, wine, and spirits. And lastly, that as these cases of hydrocephalus +end so fatally, a new mode of treating them is much to be desired, and +deserves to be seriously attended to. + +ADDITION III. ON VERTIGO. + +_To be placed after the additional Note at the end of Vol. I. on this +Subject._ + +Having reperused the ingenious Essay of Dr. Wells on Single Vision, and his +additional observations in the Gentleman's Magazine on the apparent +retrogression of objects in vertigo, I am induced to believe, that this +apparent retrogression of objects is not always owing to the same cause. + +When a person revolves with his eyes closed, till he becomes vertiginous, +and then stands still without opening them, he seems for a while to go +forward in the same direction. This hallucination of his ideas cannot be +owing to ocular spectra, because, as Dr. Wells observes, no such can have +been formed; but it must arise from a similar continuance or repetition of +ideas belonging to the sense of touch, instead of to the sense of vision; +and should therefore be called a tangible, not a visual, vertigo. In common +language this belief of continuing to revolve for some time, after he +stands still, when a person has turned round for a minute in the dark, +would be called a deception of imagination. + +Now at this time if he opens his eyes upon a gilt book, placed with other +books on a shelf about the height of his eye, the gilt book seems to recede +in the contrary direction; though his eyes are at this time kept quite +still, as well as the gilt book. For if his eyes were not kept still, other +books would fall on them in succession; which, when I repeatedly made the +experiment, did not occur; and which thus evinces, that no motion of the +eyes is the cause of the apparent retrocession of the gilt book. Why then +does it happen?--Certainly from an hallucination of ideas, or in common +language the deception of imagination. + +The vertiginous person still imagines, that he continues to revolve +forwards, after he has opened his eyes; and in consequence that the +objects, which his eyes happen to fall upon, are revolving backward; as +they would appear to do, if he was actually turning round with his eyes +open. For he has been accustomed to observe the motions of bodies, whether +apparent or real, so much more frequently by the eye than by the touch; +that the present belief of his gyration, occasioned by the hallucinations +of the sense of touch, is attended with ideas of such imagined motions of +visible objects, as have always accompanied his former gyrations, and have +thus been associated with the muscular actions and perceptions of touch, +which occurred at the same time. + +When the remains of colours are seen in the eye, they are termed ocular +spectra; when remaining sounds are heard in the ear, they may be called +auricular murmurs; but when the remaining motions, or ideas, of the sense +of touch continue, as in this vertigo of a blindfolded person, they have +acquired no name, but may be termed evanescent titillations, or tangible +hallucinations. + +Whence I conclude, that vertigo may have for its cause either the ocular +spectra of the sense of vision, when a person revolves with his eyes open; +or the auricular murmurs of the sense of hearing, if he is revolved near a +cascade; or the evanescent titillations of the sense of touch, if he +revolves blindfold. All these I should wish to call vanishing ideas, or +sensual motions, of those organs of sense; which, ideas, or sensual +motions, have lately been associated in a circle, and therefore for a time +continue to be excited. And what are the ideas of colours, when they are +excited by imagination or memory, but the repetition of finer ocular +spectra? What the idea of sounds, but the repetition of finer auricular +murmurs? And what the ideas of tangible objects, but the repetition of +finer evanescent titillations? + +The tangible, and the auricular, and the visual vertigo, are all perceived +by many people for a day or two after long travelling in a boat or coach; +the motions of the vessel, or vehicle, or of the surrounding objects, and +the noise of the wheels and oars, occur at intervals of reverie, or at the +commencement of sleep. See Sect. XX. 5. These ideas, or sensual motions, of +sight, of hearing, and of touch, are succeeded by the same effects as the +ocular spectra, the auricular murmurs, and the evanescent titillations +above mentioned; that is, by a kind of vertigo, and cannot in that respect +be distinguished from them. Which is a further confirmation of the truth of +the doctrine delivered in Sect. III. of this work, that the colours +remaining in the eyes, which are termed ocular spectra, are ideas, or +sensual motions, belonging to the sense of vision, which for too long a +time continue their activity. + +ADDITION IV. OF VOLUNTARY MOTIONS. + +A correspondent acquaints me, that he finds difficulty in understanding how +the convulsions of the limbs in epilepsy can be induced by voluntary +exertions. This I suspect first to have arisen from the double meaning of +the words "involuntary motions;" which are sometimes used for those +motions, which are performed without the interference of volition, as the +pulsations of the heart and arteries; and at other times for those actions, +which occur, where two counter volitions oppose each other, and the +stronger prevails; as in endeavouring to suppress laughter, and to stop the +shudderings, when exposed to cold. Thus when the poet writes, + + ------video meliora, proboque, + Deteriora sequor.---- + +The stronger volition actuates the system, but not without the +counteraction of unavailing smaller ones; which constitute deliberation. + +A second difficulty may have arisen from the confined use of the words "to +will," which in common discourse generally mean to choose after +deliberation; and hence our will or volition is supposed to be always in +our own power. But the will or voluntary power, acts always from motive, as +explained in Sect. XXXIV. 1. and in Class IV. 1. 3. 2. and III. 2. 1. 12. +which motive can frequently be examined previous to action, and balanced +against opposite motives, which is called deliberation; at other times the +motive is so powerful as immediately to excite the sensorial power of +volition into action, without a previous balancing of opposite motives, or +counter volitions. The former of these volitions is exercised in the common +purposes of life, and the latter in the exertions of epilepsy and insanity. + +It is difficult _to think without words_, which however all those must do, +who discover new truths by reasoning; and still more difficult, when the +words in common use deceive us by their twofold meanings, or by the +inaccuracy of the ideas, which they suggest. + +ADDITION V. OF FIGURE. + +I feel myself much obliged by the accurate attention given to the first +volume of Zoonomia, and by the ingenious criticisms bestowed on it, by the +learned writers of that article both in the Analytical and English Reviews. +Some circumstances, in which their sentiments do not accord with those +expressed in the work, I intend to reconsider, and to explain further at +some future time. One thing, in which both these gentlemen seem to dissent +from me, I shall now mention, it is concerning the manner, in which we +acquire the idea of figure; a circumstance of great importance in the +knowledge of our intellect, as it shews the cause of the accuracy of our +ideas of motion, time, space, number, and of the mathematical sciences, +which are concerned in the mensurations or proportions of figure. + +This I imagine may have in part arisen from the prepossession, which has +almost universally prevailed, that ideas are immaterial beings, and +therefore possess no properties in common with solid matter. Which I +suppose to be a fanciful hypothesis, like the stories of ghosts and +apparitions, which have so long amused, and still amuse, the credulous +without any foundation in nature. + +The existence of our own bodies, and of their solidity, and of their +figure, and of their motions, is taken for granted in my account of ideas; +because the ideas themselves are believed to consist of motions or +configurations of solid fibres; and the question now proposed is, how we +become acquainted with the figures of bodies external to our organs of +sense? Which I can only repeat from what is mentioned in Sect. XIV. 2. 2. +that if part of an organ of sense be stimulated into action, as of the +sense of touch, that part so stimulated into action must possess figure, +which must be similar to the figure of the body, which stimulates it. + +Another previous prepossession of the mind, which may have rendered the +manner of our acquiring the knowledge of figure less intelligible, may have +arisen from the common opinion of the perceiving faculty residing in the +head; whereas our daily experience shews, that our perception (which +consists of an idea, and of the pleasure or pain it occasions) exists +principally in the organ of sense, which is stimulated into action; as +every one, who burns his finger in the candle, must be bold to deny. + +When an ivory triangle is pressed on the palm of the hand, the figure of +the surface of the part of the organ of touch thus compressed is a +triangle, resembling in figure the figure of the external body, which +compresses it. The action of the stimulated fibres, which constitute the +idea of hardness and of figure, remains in this part of the sensorium, +which forms the sense of touch; but the sensorial motion, which constitutes +pleasure or pain, and which is excited in consequence of these fibrous +motions of the organ of sense, is propagated to the central parts of the +sensorium, or to the whole of it; though this generally occurs in less +degree of energy, than it exists in the stimulated organ of sense; as in +the instance above mentioned of burning a finger in the candle. + +Some, who have espoused the doctrine of the immateriality of ideas, have +seriously doubted the existence of a material world, with which only our +senses acquaint us; and yet have assented to the existence of spirit, with +which our senses cannot acquaint us; and have finally allowed, that all our +knowledge is derived through the medium of our senses! They forget, that if +the spirit of animation had no properties in common with matter, it could +neither affect nor be affected by the material body. But the knowledge of +our own material existence being granted, which I suspect few rational +persons will seriously deny, the existence of a material external world +follows in course; as our perceptions, when we are awake and not insane, +are distinguished from those excited by sensation, as in our dreams, and +from those excited by volition or by association as in insanity and +reverie, by the power we have of comparing the present perceptions of one +sense with those of another, as explained in Sect. XIV. 2. 5. And also by +comparing the tribes of ideas, which the symbols of pictures, or of +languages, suggest to us, by intuitive analogy with our previous +experience, that is, with the common course of nature. See Class III. 2. 2. +3. on Credulity. + +ADDITION VI. + +_Please to add the following in page 14, after line 20._ + +_Cold and hot Fit._ + +As the torpor, with which a fit of fever commences, is sometimes owing to +defect of stimulus, as in going into the cold-bath; and sometimes to a +previous exhaustion of the sensorial power by the action of some violent +stimulus, as after coming out of a hot room into cold air; a longer time +must elapse, before there can be a sufficient accumulation of sensorial +power to produce a hot fit in one case than in the other. Because in the +latter case the quantity of sensorial power previously expended must be +supplied, before an accumulation can begin. + +The cold paroxysm commences, when the torpor of a part becomes so great, +and its motions in consequence so slow or feeble, as not to excite the +sensorial power of association; which in health contributes to move the +rest of the system, which is catenated with it. And the hot fit commences +by the accumulation of the sensorial power of irritation of the part first +affected, either so as to counteract its deficient stimulus, or its +previous waste of sensorial power; and it becomes general by the +accumulation of the sensorial power of association; which is excited by the +renovated actions of the part first affected; or becomes so great as to +overbalance the deficient excitement of it. On all these accounts the hot +fit cannot be supposed to bear any proportion to the cold one in length of +time, though the latter may be the consequence of the former. See Suppl. I. +16. 8. + +ADDITION VII. ON WARMTH. + +_To be added at the end of the Species Sudor Calidus, in Class I. 1. 2. 3._ + +When the heat of the body in weak patients in fevers is increased by the +stimulus of the points of flannel, a greater consequent debility succeeds, +than when it is produced by the warmth of fire; as in the former the heat +is in part owing to the increased activity of the skin, and consequent +expenditure of sensorial power; whereas in the latter case it is in part +owing to the influx of the fluid matter of heat. + +So the warmth produced by equitation, or by rubbing the body and limbs with +a smooth brush or hand, as is done after bathing in some parts of the East, +does not expend nearly so much sensorial power, as when the warmth is +produced by the locomotion of the whole weight of the body by muscular +action, as in walking, or running, or swimming. Whence the warmth of a fire +is to be preferred to flannel shirts for weak people, and the agitation of +a horse to exercise on foot. And I suppose those, who are unfortunately +lost in snow, who are on foot, are liable to perish sooner by being +exhausted by their muscular exertions; and might frequently preserve +themselves by lying on the ground, and covering themselves with snow, +before they were too much exhausted by fatigue. See Botan. Garden, Vol. II. +the note on Barometz. + +ADDITION VIII. PUERPERAL FEVER. + +_To be added to Class II. 1. 6. 16._ + +A very interesting account of the puerperal fever, which was epidemic at +Aberdeen, has been lately published by Dr. Alexander Gordon. (Robinson, +London.) In several dissections of those, who died of this disease, +purulent matter was found in the cavity of the abdomen; which he ascribes +to an erysipelatous inflammation of the peritonaeum, as its principal seat, +and of its productions, as the omentum, mesentery, and peritonaeal coat of +the intestines. + +He believes, that it was infectious, and that the contagion was always +carried by the accoucheur or the nurse from one lying-in woman to another. + +The disease began with violent unremitting pain of the abdomen on the day +of delivery, or the next day, with shuddering, and very quick pulse, often +140 in a minute. In this situation, if he saw the patient within 12 or 24 +hours of her seizure, he took away from 16 to 24 ounces of blood, which was +always sizy. He then immediately gave a cathartic consisting of three +grains of calomel, and 40 grains of powder of jalap. After this had +operated, he gave an opiate at night; and continued the purging and the +opiate for several days. + +He asserts, that almost all those, whom he was permitted to treat in this +manner early in the disease, recovered to the number of 50; and that almost +all the rest died. But that when two or three days were elapsed, the +patient became too weak for this method; and the matter was already formed, +which destroyed them. Except that he saw two patients, who recovered after +discharging a large quantity of matter at the navel. And a few, who were +relieved by the appearance of external erysipelas on the extremities. + +This disease, consisting of an erysipelatous inflammation, may occasion the +great debility sooner to occur than in inflammation of the uterus; which +latter is neither erysipelatous, I suppose, nor contagious. And the success +of Dr. Gordon's practice seems to correspond with that of Dr. Rush in the +contagious fever or plague at Philadelphia; which appeared to be much +assisted by early evacuations. One case I saw some time ago, where violent +unceasing pain of the whole abdomen occurred a few hours after delivery, +with quick pulse; which ceased after the patient had twice lost about eight +ounces of blood, and had taken a moderate cathartic with calomel. + +This case induces me to think, that it might be safer and equally +efficacious, to take less blood at first, than Dr. Gordon mentions, and to +repeat the operation in a few hours, if the continuance of the symptoms +should require it. And the same in respect to the cathartic, which might +perhaps be given in less quantity, and repeated every two or three hours. + +Nor should I wish to give an opiate after the first venesection and +cathartic; as I suspect that this might be injurious, except those +evacuations had emptied the vessels so much, that the stimulus of the +opiate should act only by increasing the absorption of the new vessels or +fluids produced on the surfaces of the inflamed membranes. In other +inflammations of the bowels, and in acute rheumatism, I have seen the +disease much prolonged, and I believe sometimes rendered fatal, by the too +early administration of opiates, either along with cathartics, or at their +intervals; while a small dose of opium given after sufficient evacuations +produces absorption only by its stimulus, and much contributes to the cure +of the patient. We may have visible testimony of this effect of opium, when +a solution of it is put into an inflamed eye; if it be thus used previous +to sufficient evacuation, it increases the inflammation; if it be used +after sufficient evacuation, it increases absorption only, and clears the +eye in a very small time. + +I cannot omit observing, from considering these circumstances, how unwise +is the common practice of giving an opiate to every woman immediately after +her delivery, which must often have been of dangerous consequence. + +END OF THE SECOND PART. + + * * * * * + +ZOONOMIAE AUCTORI + +_S.P.D._ + +AMICUS. + + * * * * * + +_CURRUS TRIUMPHALIS MEDICINAE._ + + * * * * * + + Currus it Hygeiae, Medicus movet arma triumphans, + Undique victa fugit lurida turma mali.---- + Laurea dum Phoebi viridis tua tempora cingit, + Nec mortale sonans Fama coronat opus; + Post equitat trepidans, repetitque Senectus in aurem, + Voce canens stridula, "sis memor ipse mori!" + + * * * * * + + +INDEX OF THE CLASSES. + + A. + + Abortion, i. 2. 1. 14. + ---- from fear, iv. 3. 1. 7. + ---- not from epilepsy, iii. 1. 1. 7. + ---- not from hepatitis, ii. 1. 2. 12. + Absorption of solids, i. 2. 2. 14. + ---- of matter, ii. 1. 6. 2. and 6. + ---- cellular, iv. 1. 1. 6. + ---- from the lungs, iv. 3. 1. 5. Suppl. i. 8. 6. + Abstinence of young ladies, ii. 2. 2. 1. + Accumulation of feces, ii. 2. 2. 7. + Acupuncture, iii. 1. 1. 8. + Adipsia, ii. 2. 2. 2. + Aegritudo ventriculi, i. 2. 4. 4. + ---- See Sickness. + Agrypnia. See Vigilia. + Ague-cakes, Suppl. i. 2. 3. + Alum in ulcers of the mouth, ii. 1. 3. 1. + Ambition, iii. 1. 2. 9. + Amaurosis, i. 2. 5. 5. + Anasarca of the lungs, i. 2. 3. 16. + Anger, iii. 1. 2. 17. + Anger, tremor of, iv. 2. 3. 4. + ---- blush of, iv. 2. 3. 5. + Angina. See Tonsillitis. + ---- pectoris. See Asthma painful. + Anhelitus, ii. 1. 1. 4. + Anhelatio spasmodica, i. 3. 3. 3. + Annulus repens, ii. 1. 5. 10. + Anorexia, ii. 2. 2. 1. + ---- maniacalis, Suppl. i. 14. 3. + ---- epileptica, ii. 2. 2. 1. iii. 1. 1. 7. + Apepsia, i. 3. 1. 3. Suppl. i. 8. 11. + Aphtha, ii. 1. 3. 17. + Apoplexy, iii. 2. 1. 16. + Appetite defective, ii. 2. 2. 1. + ---- depraved, iii. 1. 2. 19. + ---- from abstinence, ii. 2. 2. 1. + ---- destroyed, iii. 1. 2. 20. + ---- from epilepsy, ii. 2. 2. 1. + Arm, pain of, iv. 2. 2. 13. + ---- palsy of, iii. 2. 1. 4. + Arsenic in tooth-ach, i. 2. 4. 12. + ---- in head-ach, i. 2. 4. 11. + Arthrocele, ii. 1. 4. 17. + Arthropuosis, ii. 1. 4. 18. + Arthritis. See Gout. + Ascarides, i. 1. 4. 12. iv. 1. 2. 9. + Ascites, i. 2. 3. 13. + Associations affected four ways, iv. 1. 1. G. + ---- how produced, iv. 1. 1. H. + ---- distinct from catenations, iv. 1. 1. A. + ---- three kinds of, iv. 1. 1. B. + ---- tertian, iv. 1. 1. K. + ---- of the fauces and pubis, iv. 1. 2. 7. + ---- sensitive, a law of, iv. 2. 2. 2. + ---- sensitive iv. 2. 1. + ---- accumulates, Suppl. i. 8. 3. i. 11. 4. + Asthma humoral, ii. 1. 1. 7. i. 3. 2. 8. + ---- of infants, i. 1. 3. 4. + ---- convulsive, iii. 1. 1. 10. + ---- painful, iii. 1. 1. 11. + Auditus acrior, i. 1. 5. 2. + ---- imminutus, i. 2. 5. 6. + Azote, Suppl. i. 9. 3. i. 11. 6. + + B. + + Bandages, ill effect of, ii. 1. 1. 12. + ---- promote absorption, i. 1. 3. 13. + Bath, cold, i. 2. 2. 1. + ---- warm, Addit. vii. + Beauty, iii. 1. 2. 4. + ---- loss of, iii. 1. 2. 12. + Bile-duct, pain of, iv. 2. 2. 4. + Bile crystalized, i. 1. 3. 8. + Bitter taste, i. 1. 3. 1. + ---- not from bile, i. 1. 3. 1. + Bleeding. See Haemorrhage. + Bladder, distention of, ii. 2. 2. 6. + ---- stone of, i. 1. 3. 10. + ---- catarrh of, ii. 1. 4. 11. + Blindness, i. 2. 5. 5. + Blush of anger, iv. 2. 3. 5. Suppl. i. 12. 7. + ---- of guilt, iv. 2. 3. 6. Suppl. i. 12. 7. + Bones, innutrition of, i. 2. 2. 14. + ---- caries of, ii. 1. 4. 19. + Borborigmus, i. 3. 1. 9. + Bougies, ii. 1. 4. 11. + Brachiorum paralysis, iii. 2. 1. 4. + Brain stimulated, Suppl. i. 16. 9. + Bronchocele, i. 2. 3. 20. + Burns, i. 1. 3. 13. + Butterflies, experiment on, i. 1. 2. 3. + + C. + + Cacositia, iii. 1. 2. 20. + Calculi productio, i. 1. 3. 9. ii. 1. 2. 14. + ---- renis, i. 1. 3. 9. iv. 2. 3. 3. + ---- vesicae, i. 1. 3. 10. iv. 2. 2. 2. + Callico shirts, i. 1. 2. 3. + Callus, i. 2. 2. 12. + Canities. See Hair grey. + Calor febrilis, i. 1. 2. 1. + Calves fed on gruel, i. 1. 2. 5. + ---- hydatides of, i. 2. 5. 4. + Cancer, ii. 1. 4. 16. ii. 1. 6. 13. + Cantharides, large dose of, iv. 2. 2. 2. + Carbonic acid gas, Suppl. i. 9. 3. + Cardialgia, i. 2. 4. 5. + Carcinoma, ii. 1. 4. 16. ii. 1. 6. 13. + Caries ossium, ii. 1. 4. 19. + Cataract, i. 2. 2. 13. + Catarrh, warm, i. 1. 2. 7. + ---- cold, i. 2. 3. 3. + ---- lymphatic, i. 3. 2. 1. + ---- sensitive, ii. 1. 3. 5. + ---- epidemic, ii. 1. 3. 6. + ---- of dogs and horses, ii. 1. 3. 6. + ---- from cold skin, iv. 1. 1. 5. + ---- periodic, iv. 3. 4. 1. + Catamenia, i. 2. 1. 11. iv. 2. 4. 7. + Catalepsis, iii. 2. 1. 9. + Cats, mumps of, ii. 1. 3. 4. + Cephalaea frigida, i. 2. 4. 11. iv. 2. 2. 7. + Charcoal tooth-powder, i. 2. 4. 12. + Cheek, torpor of, iv. 2. 2. 1. + Chicken pox, ii. 1. 3. 15. + Chin-cough, ii. 1. 3. 8. + Child-bed fever, ii. 1. 6. 16. + Children, new born, ii. 1. 1. 12. + ---- gripes and purging of, i. 1. 2. 5. + Chlorosis, i. 2. 3. 10. Suppl. i. 8. 11. + Chorea St. Viti, iv. 2. 3. 2. + Citta, iii. 1. 2. 19. + Clamor, iii. 1. 1. 3. + Clavicular animals, ii. 1. 2. 6. + Clavus hystericus, iv. 2. 2. 8. + Claudicatio coxaria, i. 2. 2. 17. + Cold in the head. See Catarrh. + Colic, flatulent, i. 2. 4. 7. + ---- from lead, i. 2. 4. 8. + ---- hysteric, i. 2. 4. 7. iii. 1. 1. 8. + Cold air in fevers, iii. 2. 1. 12. iv. 2. 4. 11. + ---- effects of, iii. 2. 1. 17. + ---- how to be used, iv. 1. 1. 4. + Compassion, iii. 1. 2. 24. + Consumption, ii. 1. 6. 7. + Convulsion, iii. 1. 1. 5. + ---- weak, iii. 1. 1. 5. + ---- from bad air, iii. 1. 1. 5. + ---- painful, iii. 1. 1. 6. iv. 2. 4. 5. + Consternation, i. 1. 5. 11. + Constipation, i. 1. 3. 5. ii. 2. 2. 7. + Contagious matter of two kinds, ii. 1. 3. + ---- is oxygenated, ii. 1. 5. + ---- produces fever, how, Suppl. i. 16. 7. + Cornea to perforate, i. 1. 3. 14. + ---- scars of seen on milk, i. 1. 3. 14. + Corpulency, i. 2. 3. 17. + Coryza. See Catarrh. + Costiveness, i. 1. 3. 5. ii. 2. 2. 7. + Cough of drunkards, ii. 1. 1. 5. + ---- hooping, ii. 1. 3. 8. + ---- hepatic, iv. 2. 1. 8. + ---- gouty, iv. 2. 1. 9. + ---- periodic, iv. 2. 4. 6. iv. 3. 4. 2. + ---- from cold feet, iv. 2. 1. 7. + Cows, pestilence of, ii. 1. 3. 13. + ---- bloody urine of, ii. 1. 3. 13. + Cramp, iii. 1. 1. 13. + ---- painful, iii. 1. 1. 14. + ---- in diarrhoea, iv. 1. 2. 10. + Crab-lice, i. 1. 4. 14. + Credulity, iii. 2. 2. 3. + Crines novi, i. 1. 2. 15. + Croup, i. 1. 3. 4. ii. 1. 2. 4. ii. 1. 3. 3. + Crusta lactea, ii. 1. 5. 12. + Cutis arida, i. 1. 3. 6. + Cynanche. See Tonsillitis. + ---- parotidaea. See Parotitis. + + D. + + Darkness in fevers, i. 2. 5. 3. + Deafness, two kinds of, i. 2. 5. 6. + Debility, three kinds of, i. 2. 1. + ---- and strength metaphors, i. 2. 1. + Decussation of nerves, iii. 2. 1. 10. + Deglutition, ii. 1. 1. 1. + ---- involuntary, iv. 1. 3. 1. + Dentition, i. 1. 4. 5. + Dentium dolor a stridore, iv. 1. 2. 3. + Descent of the uterus, i. 1. 4. 8. + Diabetes, i. 3. 2. 6. + ---- foul tongue in, i. 1. 3. 1. + ---- irritative, iv. 3. 1. 1. + ---- from fear, iv. 3. 1. 3. + Diarrhoea warm, i. 1. 2. 5. + ---- of infants, i. 1. 2. 5. + ---- lymphatic, i. 3. 2. 4. + ---- chyliferous, i. 3. 2. 5. + ---- cold, i. 2. 3. 6. + ---- rheumatic, iv. 1. 2. 16. + ---- from fear, iv. 3. 1. 4. + ---- from toothing, iv. 2. 2. 14. + ---- in fevers, Suppl. i. 2. 4. + ---- cure of, iv. 1. 1. f. + Digestion increased by cold, iv. 1. 1. 4. + ---- decreased by cold, iv. 2. 1. 6. + Dilirium febrile, ii. 1. 7. 1. + ---- of drunkenness, ii. 1. 7. 3. + ---- maniacal, ii. 1. 7. 2. + ---- in parotitis, iv. 1. 2. 19. + Diluents, use of, ii. 1. 2. 1. + Distention of the nipples, ii. 1. 7. 10. iv. 1. 2. 7. + Diuretics useless in dropsy, i. 1. 3. 7. + Dizziness. See Vertigo. + Dogs, catarrh of, ii. 1. 3. 6. + Dolor digiti sympathet, iv. 2. 2. 12. + ---- ductus choledochi, iv. 2. 2. 4. + ---- humeri in hepatitide, iv. 2. 2. 9. + ---- pharyngis ab acido, iv. 2. 2. 5. + ---- testium nephriticus, iv. 2. 2. 11. + ---- urens, i. 1. 5. 10. + Dracunculus, i. 1. 4. 13. + Dreams, ii. 1. 7. 4. + Dropsy of the brain, i. 2. 3. 12. + ---- of the belly, i. 2. 3. 13. + ---- of the chest, i. 2. 3. 14. + ---- of the ovary, i. 2. 3. 15. + ---- of the lungs, i. 2. 3. 16. + ---- of the scrotum, i. 2. 3. 11. + Dysentery, ii. 1. 3. 18. + Dysmenorrhagia, i. 2. 1. 12. + Dyspnoea from cold bath, iv. 2. 1. 5. + ---- rheumatica, iv. 1. 2. 16. + Dyspepsia, i. 3. 1. 3. + ---- a frigore, iv. 2. 1. 6. + Dysuria insensitiva, ii. 2. 2. 6. + + E. + + Ears, discharge behind, i. 1. 2. 9. + ---- noise in them, iv. 2. 1. 15. + Ear-ach, iv. 2. 2. 8. + Ebrietas, i. 1. 1. 2. + Education, iii. 2. 1. 8. iii. 1. 2. 24. + ---- heroic, iii. 1. 2. 25. + Egg boiled for inflamed eyes, ii. 1. 4. 1. + ---- boiled soonest, Suppl. i. 7. + ---- life of, iv. 1. 4. 1. + Electric shocks, iv. 1. 4. 5. + Electrized zinc and silver, i. 2. 5. 5. + ---- in paralysis, ii. 1. 1. 9. + ---- in scrophula, i. 2. 3. 21. + ---- in hoarseness, iii. 2. 1. 5. + Empyema, ii. 1. 6. 4. + Enteralgia rheumatica, iv. 1. 2. 16. + Enteritis, ii. 1. 2. 11. + ---- superficialis, ii. 1. 3. 20. + Epilepsy, iii. 1. 1. 7. iv. 3. 1. 6. + ---- painful, iii. 1. 1. 8. iv. 2. 4. 4. + ---- terminates with sleep, iii. 1. 1. + ---- in parturition, iii. 1. 1. 7. + ---- with indigestion, ii. 2. 2. 1. + Epistaxis. See Haemorraghia. + Epoulosis. See Cicatrix. + Erotomania, iii. 1. 2. 4. + Eructation, voluntary, iv. 3. 3. 3. + Eruption of small-pox, iv. 1. 2. 12. iv. 2. 2. 10. + Erysipelas, iv. 1. 2. 17. ii. 1. 3. 2. iv. 2. 4. 10. + ---- seldom suppurates, why, ii. 1. 3. 2. + Esuries, i. 2. 4. 2. + Evil, i. 2. 3. 21. + Expectoration, warm, i. 1. 2. 8. + ---- solid, i. 1. 3. 4. + ---- cold, i. 2. 3. 4. + Exsudation behind the ears, i. 1. 2. 9. + Eyes, blue under the, i. 2. 2. 2. ii. 1. 4. 4. + Eyelid inverted, cure of, ii. 1. 1. 8. + ---- coloured with antimony, ii. 1. 4. 3. + + F. + + Face, pimpled, ii. 1. 4. 6. + ---- red after meals, Suppl. i. 12. 7. + ---- flushed after dinner, iv. 1. 1. 1. + Fat people why short breathed, ii. 1. 1. 4. + Fear, syncope from, i. 2. 1. 4. + ---- abortion from, iv. 3. 1. 7. + ---- produces absorption, ii. 1. 6. 4. + ---- paleness in, iv. 3. 1. 5. + ---- of death, iii. 1. 2. 14. + ---- of hell, iii. 1. 2. 15. + ---- of poverty, iii. 1. 2. 13. + Feet cold produces heartburn. Suppl. i. 8. 5. + ---- fetid, i. 1. 2. 14. + ---- cold in small-pox, iv. 2. 2. 10. + Fevers, five kinds, ii. 1. 2. Suppl. i. 1. 2. + ---- irritative, i. 1. 1. 1. iv. 1. 1. 8. + ---- inirritative, i. 2. 1. 1. iv. 2. 1. 19. Suppl. i. 1. 2. + ---- sensitive, ii. 1. 6. 1. + ---- sensitive irritated, ii. 1. 2. 1. + ---- sensitive inirritated, ii. 1. 3. 1. + ---- intermit, why, Suppl. i. + ---- continue, why, Suppl. i. + ---- periods of, iv. 2. 4. 11. + ---- simple, Suppl. i. 1. + ---- compound, Suppl. i. 2. + ---- termination of cold fit, Suppl. i. 3. + ---- return of cold fit, Suppl. i. 4. + ---- sensation in, Suppl. i. 5. + ---- circles of motions in, Suppl. i. 6. + ---- cold and hot fits, Suppl. i. 7. + ---- continued, Suppl. i. 8. + ---- torpor of lungs in, Suppl. i. 9. 1. + ---- not determinable in cold fit, i. 1. 1. 1. + ---- frequency of pulse in, i. 1. 1. 1. + ---- not an effort to cure, i. 1. 2. 3. + ---- puerperal, ii. 1. 6. 16. i. 2. 4. 9. + ---- from inclosed matter, ii. 1. 6. 2. + ---- from aerated matter, ii. 1. 6. 6. + ---- from contagious matter, ii. 1. 6. 11. + ---- from contagious sanies, ii. 1. 6. 15. + ---- torpor of the stomach, Suppl. i. 12. + ---- case of, Suppl. i. 13. + ---- termination of, Suppl. i. 14. + ---- inflammation excited, Suppl. i. 15. + ---- returns of, Suppl. i. 4. + ---- when cold air in, Suppl. i. 2. 2. + ---- sympathetic, theory of, Suppl. i. + ---- duration of explained, Suppl. i. 2. 5. + Fingers, playing with, iv. 1. 3. 4. + ---- pain of, iv. 2. 2. 12. + Fish live longer with injured brain, i. 2. 5. 10. + Fistula in ano, ii. 1. 4. 10. + ---- lacrymalis, ii. 1. 4. 9. + ---- urethra, ii. 1. 4. 11. + Flannel shirt in diarrhoea, iv. 1. 1. 3. + ---- injurious in summer, i. 1. 2. 3. + Fluor albus warm, i. 1. 2. 11. + ---- cold, i. 2. 3. 7. + Frigus febrile, i. 2. 2. 1. + ---- chronicum, i. 2. 2. 1. + + G. + + Gall-stone, i. 1. 3. 8. + Gangreen, ii. 1. 6. 17. + Gargles, ii. 1. 3. 3. + Gastritis, ii. 1. 2. 10. + ---- superficialis, ii. 1. 3. 19. + Genu tumor albus, i. 2. 3. 19. + Gleet. See Gonorrhoea. + Globus hystericus, i. 3. 1. 7. + Gonorrhoea warm, i. 1. 2. 10. + ---- cold, i. 2. 3. 8. + Gout, iv. 1. 2. 15. iv. 2. 4. 9. + ---- of the liver, ii. 1. 1. 7. + ---- cases of, iv. 1. 2. 15. + ---- cough, iv. 2. 1. 9. + ---- of the stomach, i. 2. 4. 6. + ---- haemorrhage in, i. 1. 1. 4. + Grace defined, iii. 1. 2. 4. + Gravel distinguished from salts, i. 1. 3. 10. + Gravitation, iv. 2. 4. + Green-sickness. See Chlorosis. + Grief, iii. 1. 2. 10. + Gripes of children, i. 1. 2. 5. iv. 2. 1. 3. + Gustus acrior, i. 1. 5. 4. + ---- imminutus, i. 2. 5. 8. + Gutta rosea, ii. 1. 4. 6. iv. 1. 2. 13. and 14. + ---- serena, i. 2. 5. 5. + + H. + + Haemorrhage arterial, i. 1. 1. 3. + ---- of the lungs, i. 1. 1. 4. + ---- of the nose, i. 1. 1. 5. + ---- venous, i. 2. 1. 5. + ---- of the rectum, i. 2. 1. 6. + ---- of the kidnies, i. 2. 1. 7. + ---- of the liver, i. 2. 1. 8. + Haemoptoe arterial, i. 1. 1. 4. + ---- venous, i. 2. 1. 9. + Haemorrhois cruenta, i. 2. 1. 6. iv. 2. 4. 8. + ---- alba, i. 1. 2. 12. + Hair, grey, i. 2. 2. 11. + ---- new, i. 1. 2. 15. + ---- white by uterine pressure, Addit. i. + Hallucination of sight, ii. 1. 7. 5. + ---- of hearing, ii. 1. 7. 6. + ---- maniacal, iii. 1. 2. 1. + ---- studiosa, iii. 1. 2. 2. + Harrogate water fact, i. 1. 4. 12. + Head-ach. See Hemicrania and Cephalaea. + Hearing acuter, i. 1. 5. 2. + ---- diminished, i. 2. 5. 6. + Heart-burn, i. 2. 4. 5. + Heart stimulated, Suppl. i. 11. 7. i. 16. 9. + Heat, animal, i. 1. 2. 1. i. 1. 2. 3. + ---- sense of acuter, i. 1. 5. 6. + ---- elemental, iv. 2. 4. + ---- hectic lessened by swinging, iv. 2. 1. 10. + ---- not perceived by the lungs, iii. 1. 1. 10. + ---- not estimated by thermometers, Suppl. i. 7. + ---- of the breath, Suppl. i. 2. 2. + Hemicrania, iv. 2. 2. 8. iv. 2. 4. 3. + ---- relieved by mercury, iv. 2. 2. 8. + Hemiplegia, iii. 2. 1. 10. + Hepatis tumor, i. 2. 3. 9. + Hepatitis, ii. 1. 2. 12. + ---- chronica, ii. 1. 4. 12. + Herpes, ii. 1. 5. 8. + ---- nephritica, iv. 1. 2. 11. + Hiccough, ii. 1. 1. 6. iv. 1. 1. 7. + Hip-joint injured, i. 2. 2. 17. + Hoarseness, ii. 1. 3. 5. iii. 2. 1. 5. + Horses, broken wind of, i. 2. 4. 9. + Humectation of the body, iv. 1. 4. 7. + Hunger, i. 2. 4. 2. + Hydatides in calves, i. 2. 5. 4. + Hydrocele, i. 2. 3. 11. + Hydrocephalus inter, i. 2. 3. 12. i. 2. 5. 4. iii. 2. 1. 10. + ---- from inflammation, Addit. ii. + Hydrogene gas. Suppl. i. 9. 3. i. 11. 6. + ---- in fevers, Suppl. i. 11. 6. i. 16. 9. + Hydrothorax, i. 2. 3. 14. case of, iv. 2. 2. 13. + Hydro-carbonate gas, Suppl. i. 9. 1. Suppl. i. 15. 3. + Hydrops ovarii, i. 2. 3. 15. + Hydrophobia, i. 3. 1. 11. iii. 1. 1. 15. iv. 1. 2. 7. + Hypochondriasis, i. 2. 4. 10. + Hysteralgia frigida, i. 2. 4. 17. + Hysteria, i. 3. 1. 10. Suppl. i. 8. 11. + ---- from fear, iv. 3. 1. 8. + ---- from cold, iv. 3. 4. 3. + ---- convulsions in, iii. 1. 1. 5. + ---- laughter in, iii. 1. 1. 5. + Hysteritis, ii. 1. 2. 16. + + I. + + Jactitatio, iii. 1. 1. 1. + Jaundice, i. 1. 3. 8. i. 2. 4. 19. + Icterus, i. 1. 3. 8. i. 2. 4. 19. + Ileus, i. 3. 1. 6. ii. 1. 2. 11. + Impotentia, ii. 2. 2. 3. + Indigestion, i. 3. 1. 3. + ---- See Anorexia and Apepsia. + ---- from cold feet, iv. 2. 1. 6. Sup. i. 8. 5. + Incubus, iii. 2. 1. 13. + Infants, green stools of, i. 1. 2. 5. + ---- new born, ii. 1. 1. 12. + Inflammation of the eye, ii. 1. 2. 2. + ---- superficial, ii. 1. 4. 1. + ---- of the brain, ii. 1. 2. 3. + ---- of the lungs, ii. 1. 2. 4. + ---- superficial, ii. 1. 3. 7. + ---- of the pleura, ii. 1. 2. 5. + ---- of the diaphragm, ii. 1. 2. 6. + ---- of the heart, ii. 1. 2. 7. + ---- of the peritoneum, ii. 1. 2. 8. + ---- of the mesentery, ii. 1. 2. 9. + ---- of the stomach, ii. 1. 2. 10. + ---- superficial, ii. 1. 3. 19. + ---- of the bowels, ii. 1. 2. 11. + ---- superficial, ii. 1. 3. 20. + ---- of the liver, ii. 1. 2. 12. + ---- chronical, ii. 1. 4. 12. + ---- of the spleen, ii. 1. 2. 13. Sup. i. 16. 6. + ---- of the kidnies, ii. 1. 2. 14. + ---- of the bladder, ii. 1. 2. 15. + ---- of the womb, ii. 1. 2. 16. + ---- of the tonsils, ii. 1. 3. 3. + ---- of the parotis, ii. 1. 3. 4. + Inirritability of lacteals, i. 2. 3. 26. + ---- of lymphatics, i. 2. 3. 27. + ---- of the gall-bladder, i. 2. 4. 19. + ---- of the kidney, i. 2. 4. 20. + ---- of the spleen, Suppl. i. 16. 6. + ---- vicissitudes of, i. 1. 1. + Inoculation, ii. 1. 3. 9. + Innutrition of bones, i. 2. 2. 14. + Insanity, quick pulse in, iii. 1. 1. + ---- from parturition, iii. 1. 2. + ---- with fever, iii. 1. 2. + ---- cure of, iii. 1. 2. + ---- confinement in, iii. 1. 2. + Insensibility, ii. 2. 1. 1. + Ira, iii. 1. 2. 17. + Ischias, ii. 1. 2. 18. i. 2. 4. 15. + Issues, use of, i. 1. 2. 9. iii. 1. 1. 11. + Itch, ii. 1. 5. 6. + Itching, i. 1. 5. 9. + ---- of the nose, iv. 2. 2. 6. + + L. + + Lacrymarum fluxus sym. iv. 1. 2. 1. + Lameness of the hip, i. 2. 2. 17. + Lassitude, iii. 2. 1. 1. + Laughter, iv. 2. 3. 3. iii. 1. 1. 4. iv. 1. 3. 3. + ---- See Risus. + Leg, one shorter, i. 2. 2. 17. + Lepra, ii. 1. 5. 3. + Lethargus, iii. 2. 1. 14. + Lethi timor, iii. 1. 2. 14. + Lice, i. 1. 4. 15. + Lientery, i. 2. 3. 6. + Light debilitates in fevers, i. 2. 5. 3. + Lingua arida, i. 1. 3. 1. iv. 2. 4. 11. + Liver, torpor of, i. 2. 2. 6. + ---- tumor of, i. 2. 3. 9. + ---- inflamed, ii. 1. 2. 12. + Lochia nimia, i. 2. 1. 13. + Locked jaw, iii. 1. 1. 13. + Love, sentimental, iii. 1. 2. 4. + Lues venerea, ii. 1. 5. 2. + ---- imaginaria, iii. 1. 2. 21. + Lumbago, ii. 1. 2. 17. iii. 1. 1. 1. + ---- cold, i. 2. 4. 16. + Lumbricus, i. 1. 4. 10. + Lunar influence on the solids, i. 2. 1. 11. + Lungs, adhesions of, ii. 1. 2. 5. + ---- not sensible to heat, iii. 1. 1. 10. + Lusus digitorum invitus, iv. 1. 3. 4. + + M. + + Maculae vultus, i. 2. 2. 10. + Madness, mutable, iii. 1. 2. 1. + Mammarum tumor, iv. 1. 2. 19. + Mammularum tensio, iv. 1. 2. 6. i. 1. 4. 7. + Mania mutabilis, iii. 1. 2. 1. + Matter variolous, ii. 1. 3. 9. + ---- contagious, ii. 1. 3. ii. 1. 6. 11. + ---- inclosed, ii. 1. 6. 2. + ---- oxygenated, ii. 1. 6. 6. + ---- sanious, ii. 1. 6. 15. + Measles, ii. 1. 3. 10. + Membranes, what, iv. 1. 2. + Menorrhagia, i. 2. 1. 11. + Mercury crude, as a clyster, i. 3. 1. 6. + ---- in all contagions, Suppl. i. 16. 7. + ---- in vertigo, iv. 2. 1. 11. + Miliaria, ii. 1. 3. 12. + Milk new, for children, i. 1. 2. 5. + ---- old, induces costiveness, ii. 2. 2. 7. + Milk-crust, ii. 1. 5. 12. + Miscarriage. See Abortion. + Maeror, iii. 1. 2. 10. + Mobility, iv. 1. 2. + ---- of the skin, Suppl. i. 7. + Mollities ossium, i. 2. 2. 14. + Moon, effect of, iv. 2. 4. + Morbilli. See Rubeola. + Mortification, ii. 1. 6. 17. + Morpiones, i. 1. 4. 14. + Mucus diminished, i. 2. 2. 4. + ---- of the throat cold, i. 2. 3. 1. + ---- of the bowels, i. 2. 3. 6. i. 1. 2. 12. + ---- of the lungs, i. 1. 3. 4. + ---- forms stones, i. 1. 3. 9. + ---- distinguished from pus, ii. 1. 6. 6. + Mumps, ii. 1. 3. 4. + Murmur aurium, iv. 2. 1. 15. + Muscae volitantes, i. 2. 5. 3. + + N. + + Nails, biting of, iv. 1. 3. 5. + Nares aridi, i. 1. 3. 3. + Nausea, dry, i. 2. 4. 3. + ---- humid, i. 3. 2. 3. + ---- ideal, iv. 3. 2. 1. + ---- from conception, iv. 3. 2. 2. + Navel-string of infants, ii. 1. 1. 12. + ---- cut too soon, ii. 1. 1. 12. + Neck thickens at puberty, iv. 1. 2. 7. + Neck-swing, i. 2. 2. 16. + Nephritis, ii. 1. 2. 14. i. 1. 3. 9. iii. 2. 1. 14. + Nerves decussate, iii. 2. 1. 10. + Nictitation irritative, i. 1. 4. 1. + ---- sensitive, ii. 1. 1. 8. + ---- involuntary, iv. 1. 3. 2. + Night-mare, iii. 2. 1. 13. + Nipples, tension of, i. 1. 4. 7. iv. 1. 2. 6. + Nostalgia, iii. 1. 2. 6. + Nostrils, dry, i. 1. 3. 3. + + O. + + Obesitas, i. 2. 3. 17. + Odontitis, ii. 1. 4. 7. + Odontalgia, i. 2. 4. 12. + Oesophagi schirrus, i. 2. 3. 25. + Olfactus acrior, i. 1. 5. 3. + ---- imminutus, i. 2. 5. 7. + Oil destroys insects, i. 1. 4. 14. + ---- essential of animals, i. 1. 2. 14. + ---- why injurious in erysipelas, ii. 1. 3. 2. + Opium in catarrh, i. 2. 3. 3. + ---- in diaphragmitis, ii. 1. 2. 6. + Ophthalmy, internal, ii. 1. 2. 2. + ---- superficial, ii. 1. 4. 1. + Orci timor, iii. 1. 2. 15. + Oscitatio, ii. 1. 1. 9. + Ossium innutritio, i. 2. 2. 14. + Otitis, ii. 1. 4. 8. + Otalgia, i. 2. 4. 13. iv. 2. 2. 8. + Otopuosis, ii. 1. 4. 8. + Ovary, dropsy of, i. 2. 3. 15. + ---- exsection of, i. 2. 3. 15. + Oxygenation of blood, iv. 1. 4. 6. + Oxygen gas, Suppl. i. 9. 3. + ---- in fevers, Suppl. i. 11. 7. i. 16. 9. + + P. + + Pain exhausts sensorial power, iv. 2. 2. + ---- greater prevents less, iv. 2. 2. 2. + ---- nervous, i. 2. 4. + ---- of the little finger, symptom, iv. 2. 2. 12. + ---- of arm in hydrothorax, iv. 2. 2. 13. + ---- of the bile-duct, iv. 2. 2. 4. + ---- of the shoulder, iv. 2. 2. 9. + ---- of the pharynx, iv. 2. 2. 5. + ---- of the testis, iv. 2. 2. 11. + ---- smarting, i. 1. 5. 10. + ---- of the side, i. 2. 4. 14. iv. 1. 2. 16. + ---- of menstruation, i. 2. 1. 12. + ---- use of, iii. 1. 1. 11. i. 1. 2. 9. + ---- of the uterus, i. 2. 4. 17. + Paint, white, dangerous, ii. 1. 4. 6. + Palate, defect of, i. 2. 2. 20. + Paleness, i. 2. 2. 2. + ---- from fear, iv. 3. 1. 5. + ---- from sickness, iv. 2. 1. 4. + ---- of urine after dinner, iv. 2. 1. 2. + ---- from cold skin, iv. 2. 1. 1. + Palpitation of heart, i. 3. 3. 2. i. 2. 1. 10. + ---- from fear, iv. 3. 1. 6. + ---- relieved by arsenic, iv. 2. 1. 18. + Pancreas, torpor of, i. 2. 2. 7. + Pandiculatio, ii. 1. 1. 9. + Panting, ii. 1. 1. 4. i. 3. 3. 3. + Paracentesis at the navel, i. 2. 3. 13. + Paralysis, iii. 2. 1. 10. + ---- of the bladder, iii. 2. 1. 6. + ---- of the rectum, iii. 2. 1. 7. + ---- of the hands, iii. 2. 1. 4. + ---- cure of, iii. 2. 1. 4. + Paraplegia, iii. 2. 1. 11. + Paresis inirritativa, i. 2. 1. 2. Suppl. i. 8. 10. + ---- sensitiva, ii. 2. 1. 3. + ---- voluntaria, iii. 2. 1. 8. + Paronychia internal, ii. 1. 2. 19. + ---- superficial, ii. 1. 4. 5. + Parturition, ii. 1. 1. 12. ii. 1. 2. 16. + ---- more fatal in high life, ii. 1. 1. 12. + ---- with convulsion, iii. 1. 1. iii. 1. 1. 7. + Parotitis, ii. 1. 3. 4. + Passions depressing and exciting, iv. 3. 1. 5. + Paupertatis timor, iii. 1. 2. 13. + Pediculus, i. 1. 4. 15. + Pemphigus, ii. 1. 3. 14. + Penetration of animal bodies, iv. 1. 4. 7. + Peripneumony, ii. 1. 2. 4. + ---- tracheal, ii. 1. 2. 4. + ---- superficial, ii. 1. 3. 7. + ---- inirritated, ii. 1. 2. 4. + Peritonitis, ii. 1. 2. 8. + Perspiration not an excrement, i. 1. 2. 14. + ---- greatest in the hot fit, i. 1. 2. 3. + ---- fetid, i. 1. 2. 14. + Pertussis, ii. 1. 3. 8. + Pestis, ii. 1. 3. 13. + Petechiae, i. 2. 1. 17. + ---- cure of, Suppl. i. 2. 7. + Pharynx, pain of, iv. 2. 2. 5. + Phthisis, pulmonary, ii. 1. 6. 7. + Pimples on the face, ii. 1. 4. 6. + Piles, bleeding, i. 2. 1. 6. + ---- white, i. 1. 2. 12. + Placenta, ii. 1. 1. 12. ii. 1. 2. 16. + Plague, ii. 1. 3. 13. + Plasters, why moist, i. 1. 3. 6. + Pleurisy, ii. 1. 2. 5. + Pleurodyne chronica, i. 2. 4. 14. + ---- rheumatica, iv. 1. 2. 16. + Podagra, iv. 1. 2. 15. iv. 2. 4. 9. + Polypus of the lungs, i. 1. 3. 4. + ---- of the nose from worms, iv. 1. 2. 9. + Pregnancy, ii. 1. 1. 12. + Priapismus, i. 1. 4. 6. ii. 1. 7. 9. + Proctalgia, i. 2. 4. 18. + Prolapsus ani, i. 1. 4. 9. + Pruritus, i. 1. 5. 9. + ---- narium a vermibus, iv. 2. 2. 6. + Psora, ii. 1. 5. 6. + ---- imaginaria, iii. 1. 2. 22. + Ptyalismus. See Salivatio. + Pubis and throat sympathize, iv. 1. 2. 7. + Puerperal fever, i. 2. 4. 9. ii. 1. 6. 16. Add. 8. + ---- insanity, iii. 1. 2. 1. + Pulchritudinis desiderium, iii. 1. 2. 12. + Pullulation of trees, iv. 1. 4. 3. + Pulse full, why, i. 1. 1. 1. + ---- strong, how determined, i. 1. 1. 1. Suppl. i. 16. 10. + ---- soft in vomiting, iv. 2. 1. 17. + ---- intermittent, iv. 2. 1. 18. + ---- quick from paucity of blood, Suppl. i. 11. 4. + ---- quick sometimes in sleep, iii. 2. 1. 12. + ---- quick in weak people, iii. 2. 1. Sup. i. 11. 4. + ---- slower by swinging, iv. 2. 1. 10. + ---- quick in chlorosis, i. 2. 3. 10. + Punctae mucosae vultus, i. 2. 2. 9. + Purging. See Diarrhoea. + Pus diminished, i. 2. 2. 3. + ---- distinguished from mucus, ii. 1. 6. 6. + + R. + + Rabies, iii. 1. 2. 18. + Rachitis, i. 2. 2. 15. + Raucedo catarrhal, ii. 1. 3. 5. + ---- paralytic, iii. 2. 1. 5. + Recollection, loss of, iii. 2. 2. 1. + Recti paralysis, iii. 2. 1. 7. + ---- schirrus, i. 2. 3. 23. + Red-gum, ii. 1. 3. 12. i. 1. 2. 3. + Redness from heat, ii. 1. 7. 7. + ---- of joy, ii. 1. 7. 8. + ---- after dinner, iv. 1. 1. 1. + ---- of anger, iv. 2. 3. 5. + ---- of guilt, iv. 2. 3. 6. + ---- of modesty, iv. 2. 3. 6. + Respiration, ii. 1. 1. 2. + ---- quick in exercise, ii. 1. 1. 4. + ---- in softness of bones, i. 2. 2. 14. + Restlessness, iii. 1. 1. 1. + Reverie, iii. 1. 2. 2. iv. 2. 4. 2. + Rhaphania, iii. 1. 1. 6. + Rheumatism, iv. 1. 2. 16. + ---- of the joints, iv. 1. 2. 16. + ---- of the bowels, iv. 1. 2. 16. + ---- of the pleura, iv. 1. 2. 16. + ---- suppurating, iv. 1. 2. 16. + ---- from sympathy, iv. 2. 2. 13. + ---- chronical, i. 1. 3. 12. iii. 1. 1. 6. + Rickets, i. 2. 2. 15. + Ring-worm, ii. 1. 5. 10. + Risus, iii. 1. 1. 4. iv. 2. 3. 3. + ---- sardonicus, iv. 1. 2. 4. + ---- invitus, iv. 1. 3. 3. + Rubeola, ii. 1. 3. 10. + Rubor a calore, ii. 1. 7. 7. + ---- jucunditatis, ii. 1. 7. 8. + ---- pransorum, iv. 1. 1. 1. + Ructus, i. 3. 1. 2. + Ruminatio, i. 3. 1. 1. iv. 3. 3. 1. + + S. + + Sailing in phthisis, ii. 1. 6. 7. + Salivation warm, i. 1. 2. 6. + ---- lymphatic, i. 3. 2. 2. + ---- sympathetic, iv. 1. 2. 5. + ---- in low fevers, i. 1. 2. 6. + Salt of urine, i. 1. 2. 4. i. 1. 3. 9. + Satyriasis, iii. 1. 2. 16. + Scabies. See Psora. + Scarlatina, ii. 1. 3. 11. + Scarlet fever, ii. 1. 3. 11. + Scald-head, ii. 1. 5. 11. + Sciatica frigida, i. 2. 4. 15. + Schirrus, i. 2. 3. 22. + ---- suppurans, ii. 1. 4. 15. + ---- of the rectum, i. 2. 3. 23. + ---- of the urethra, i. 2. 3. 24. + ---- of the oesophagus, i. 2. 3. 25. + Scorbutus, i. 2. 1. 15. + ---- suppurans, ii. 1. 4. 14. + Scrophula, i. 2. 3. 21. + ---- suppurating, ii. 1. 4. 14. + ---- produces insanity, iii. 1. 2. + Scurvy, i. 2. 1. 15. + ---- suppurating, ii. 1. 4. 14. + Scurf of the head, i. 1. 3. 6. + ---- of the tongue, i. 1. 3. 1. + Sea air in phthisis, ii. 1. 6. 7. + Seat, descent of, i. 1. 4. 9. + Seed, ejection of, ii. 1. 1. 11. + Sea-sickness, iv. 2. 1. 10. Suppl. i. 8. 3. + See-saw of old people, iii. 2. 1. 2. + Sensitive association, law of, iv. 2. 2. 2. + Sensation inert, Suppl. i. 6. 4. + Setons, ii. 1. 6. 6. + Shingles, ii. 1. 5. 9. + Shoulder, pain of, iv. 2. 2. 9. + Shrieking, iii. 1. 1. 3. + Sickness, i. 2. 4. 4. i. 3. 2. 3. + ---- cured by a blister, iv. 1. 1. 3. + ---- by warm skin, iv. 1. 1. 2. Suppl. i. 11. 4. + ---- by whirling, i. 1. 1. 4. + ---- by swinging, Suppl. i. 15. 3. + ---- by hydrocarbonate gas, Suppl. i. 15. 3. + ---- See Nausea. + Sight acuter, i. 1. 5. 1. + ---- impaired, i. 2. 5. 2. + Side, chronical pain of, i. 2. 4. 14. + Sighing and sobbing, iii. 1. 2. 10. + Sitis calida, i. 2. 4. 1. + ---- frigida, i. 2. 4. 1. + ---- defectus, ii. 2. 2. 2. + Skin pale in old age, i. 2. 2. 2. + ---- from cold, i. 2. 2. 2. + ---- dry, i. 1. 3. 6. + ---- yellowish, i. 2. 2. 2. + ---- bluish and shrunk, i. 2. 1. 1. + ---- reddish, ii. 1. 3. 1. + ---- cold after meals, iv. 2. 1. 1. + Sleep, iii. 2. 1. 12. + ---- interrupted, i. 2. 1. 3. + ---- periods in, iv. 2. 4. 1. + ---- with quick pulse, iii. 2. 1. 12. + ---- disturbed by digestion, iii. 2. 1. 12. + Sleep-walkers, iii. 1. 1. 9. + Small-pox, ii. 1. 3. 9. + ---- why distinct and confluent, Sup. i. 15. 2. + ---- secondary fever of, ii. 1. 6. 12. + ---- eruption of, iv. 1. 2. 12. + Smarting, i. 1. 5. 10. + Smell acuter, i. 1. 5. 3. + ---- impaired, i. 2. 5. 7. + Sneezing, ii. 1. 1. 3. iv. 1. 2. 2. + Snow in scrophula, i. 2. 3. 21. + ---- in paralysis, iii. 2. 1. 4. + Snuff in hydrocephalus, i. 2. 3. 12. + Somnambulism, iii. 1. 1. 9. + Somnium, ii. 1. 7. 4. + Somnus, iii. 2. 1. 12. iv. 2. 4. 1. + ---- interruptus, i. 2. 1. 3. + Softness of bones, i. 2. 2. 14. + Spasm of diaphragm, iii. 1. 1. 11. + ---- of the heart, iii. 1. 1. 11. + Spine distorted, i. 2. 2. 16. + ---- protuberant, i. 2. 2. 18. + ---- bifid, i. 2. 2. 19. + Spitting blood, i. 1. 1. 4. i. 2. 1. 9. + Spleen swelled, i. 2. 3. 18. Suppl. i. 16. 6. + Splenitis, ii. 1. 2. 13. + Spots on the face, i. 2. 2. 9. + Spots seen on bed-clothes, i. 2. 5. 3. + Squinting, i. 2. 5. 4. + ---- in hydrocephalus, i. 2. 5. 4. + Stammering, iv. 2. 3. 1. + Stays tight, injurious, ii. 1. 1. 12. + Sterility, ii. 2. 2. 4. + Sternutatio, ii. 1. 1. 3. iv. 1. 2. 2. + ---- a lumine, iv. 1. 2. 2. + Stimulants, their twofold effect, ii. 1. 2. 6. + Stocks for children dangerous, i. 2. 2. 17. + Stomach, torpor of, Suppl. i. 10. i. 16. 6. + ---- inflammation of, ii. 1. 2. 10. ii. 1. 3. 19. + ---- its association, iv. 1. 1. + ---- cause of fever, Suppl. i. 8. 8. + Stones in the bladder, See Calculi. + ---- in horses, i. 1. 3. 5. i. 1. 3. 10. + Strabismus, i. 2. 5. 4. + Strangury, ii. 1. 1. 11. iv. 2. 2. 2. + ---- convulsive, iv. 2. 2. 3. + Strength and debility metaphors, i. 2. 1. + Stridor dentium, iii. 1. 1. 12. + Studium inane, iii. 1. 2. 2. iv. 2. 4. 2. + Stultitia inirritabilis, i. 2. 5. 1. + ---- insensibilis, ii. 2. 1. 1. + ---- voluntaria, iii. 2. 2. 2. + Stupor, i. 2. 5. 10. Suppl. i. 15. + Subsultus tendinum, iii. 1. 1. 5. + Sudor. See Sweats. + Suggestion, slow, + Surprise, i. 1. 5. 11. + Sweats, warm, i. 1. 2. 3. + ---- cold, i. 2. 3. 2. + ---- lymphatic, i. 3. 2. 7. + ---- asthmatic, i. 3. 2. 8. iv. 3. 1. 2. + ---- covered in bed, iv. 1. 1. 2. Suppl. i. 11. 6 + ---- in fever fits, why, i. 1. 2. 5. + ---- from exercise, i. 1. 2. 3. + ---- from heat, i. 1. 2. 3. + ---- from medicines, i. 1. 2. 3. + Sweaty hands cured, i. 3. 2. 7. + Swinging, ii. 1. 6. 7. + ---- makes the pulse slower, iv. 2. 1. 10. + Swing centrifugal, Suppl. i. 15 and 3. + Sympathy direct and reverse, iv. 1. 1. f. + ---- with others, iii. 1. 2. 24. + ---- of various parts, Suppl. i. 11. 5. + ---- reverse of lacteals and lymphatics, Suppl. i. 11. 5 + ---- of capillaries, Suppl. i. 11. 5. + ---- direct of stomach and heart, Sup. i. 11. 5. + ---- of throat and pubis, iv. 1. 2. 7. + Syncope, i. 2. 1. 4. + ---- epileptic, iii. 2. 1. 15. + Syngultus, ii. 1. 1. 6. + ---- nephriticus, iv. 1. 1. 7. + Syphilis, ii. 1. 5. 2. + ---- imaginaria, iii. 1. 2. 21. + Syphon capillary of cloth, ii. 1. 3. 1. + + T. + + Tactus acrior, i. 1. 5. 5. + ---- imminutus, i. 2. 5. 6. + Tape-worm, i. 1. 4. 11. + Tapping at the navel, i. 2. 3. 13. + Taste. See Gustus. + ---- bitter, not from bile, i. 1. 3. 1. + Taedium vitae, ii. 2. 1. 2. + Taenia, i. 1. 4. 11. + Tears sympathetic, iv. 1. 2. 1. iii. 1. 2. 10. + Teeth, to preserve, i. 1. 4. 5. + ---- fall out whole, ii. 1. 4. 7. + Tenesmus, ii. 1. 1. 10. + ---- calculosus, iv. 1. 2. 8. + Testium dolor nephriticus, iv. 2. 2. 11. + ---- tumor in gonorrhoea, iv. 1. 2. 18. + ---- tumor in parotitide, iv. 1. 2. 19. + Tetanus trismus, iii. 1. 1. 13. + ---- doloroficus, iii. 1. 1. 14. + Thirst. See Sitis and Adipsia. + Thread-worm, i. 1. 4. 12. + Throat swelled, i. 2. 3. 20. + ---- thickens at puberty, iv. 2. 1. 7. + ---- grown up, i. 2. 3. 25. + Thrush, ii. 1. 3. 17. + Tickling, i. 1. 5. 8. + Timor orci, iii. 1. 2. 15. + ---- lethi, iii. 1. 2. 14. + ---- paupertatis, iii. 1. 2. 13. + Tinea, ii. 1. 5. 11. + Tinnitus aurium, iv. 2. 1. 15. + Titillatio, i. 1. 5. 8. + Titubatio linguae, iv. 2. 3. 1. + Tobacco, smoke of in piles, i. 2. 1. 6. + Tongue dry, i. 1. 3. 1. Suppl. i. 2. + ---- coloured mucus, i. 1. 3. 1. + Tonsillitis, ii. 1. 3. 3. + Tonsils swelled from bad teeth, i. 2. 3. 21. ii. 1. 3. 3. + Torpor of the liver, i. 2. 2. 6. + ---- of the pancreas, i. 2. 2. 7. + ---- of the lungs, Suppl. 1. 9. + ---- of the stomach, Suppl. i. 10. + ---- of the heart, Suppl. i. 10. + Tooth-ach, i. 2. 4. 12. ii. 1. 4. 7. + Tooth-edge, iv. 1. 2. 3. + Toothing, i. 1. 4. 5. + Tooth-powder, i. 1. 4. 5. + Touch. See Tactus. + ---- deceived three ways, i. 2. 5. 9. iv. 2. 1. 10. + Transfusion of blood, i. 2. 3. 25. Suppl. i. 14. 4. + Translation of matter, i. 3. 2. 9. + ---- of milk, i. 3. 2. 10. + ---- of urine, i. 3. 2. 11. + Transparency of cornea, i. 1. 4. 1. + ---- of crystalline, i. 2. 2. 13. + ---- of air before rain, i. 1. 4. 1. + Tremor of old age, iii. 2. 1. 3. + ---- of fever, iii. 1. 1. 2. + ---- of anger, iv. 2. 3. 4. + ---- of fear, iv. 3. 1. 5. + Tussis ebriorum, ii. 1. 1. 5. + ---- convulsiva, ii. 1. 3. 8. + ---- hepatica, iv. 2. 1. 8. + ---- arthritica, iv. 2. 1. 9. + ---- periodica, iv. 3. 4. 2. + ---- a pedibus frigidis, iv. 2. 1. 7. + Tympany, i. 2. 4. 9. + + U. + + Ulcers, healing of, i. 1. 3. 13. + ---- of the cornea, i. 1. 3. 14. + ---- from burns, i. 1. 3. 13. + ---- scrophulous, ii. 1. 4. 13. + ---- of the throat, ii. 1. 3. 3. ii. 1. 3. 11. + ---- of the legs, ii. 1. 4. 14. + Unguium morsiuncula, iv. 1. 3. 5. + Urethra, scirrhus of, i. 2. 3. 24. + ---- fistula of, ii. 1. 4. 11. + Urine copious, coloured, i. 1. 2. 4. + ---- copious, pale, i. 2. 3. 5. + ---- diminished, coloured, i. 1. 3. 7. + ---- diminished, pale, i. 2. 2. 5. + ---- its mucus, salts, Prussian blue, i. 1. 2. 4. + ---- why less and coloured in dropsies, i. 1. 3. 7. + ---- translation of, i. 3. 2. 11. + ---- difficulty of, iii. 2. 1. 6. + ---- not secreted, i. 2. 2. 8. + ---- pale after meals, iv. 2. 1. 2. + ---- pale from cold skin, iv. 2. 1. 3. + ---- sediment in fevers, Suppl. i. 2. 3. + ---- pale in fevers, Suppl. i. 2. 3. and 5. + Urticaria, ii. 1. 3. 16. + Uteri descensus, i. 1. 4. 8. + + V. + + Vacillatio senilis, iii. 2. 1. 2. + Varicella, ii. 1. 3. 15. + Variola, ii. 1. 3. 9. + ---- eruption of, iv. 1. 2. 12. + Vasorum capil retrogressio, i. 3. 3. 1. + Venereal orgasm, iv. 1. 4. 4. + ---- disease, ii. 1. 5. 2. + ---- imaginary, iii. 1. 2. 21. + Ventriculi aegritudo, i. 2. 4. 4. + ---- vesicatorio sanata, iv. 1. 1. 3. + Vermes, i. 1. 4. 10. + Vertigo rotatory, iv. 2. 1. 10. + ---- of sight, iv. 2. 1. 11. + ---- inebriate, iv. 2. 1. 12. + ---- of fever, iv. 2. 1. 13. + ---- from the brain, iv. 2. 1. 14. + ---- of the ears, iv. 2. 1. 15. + ---- of the touch, Addit. iii. + ---- of the touch, taste and smell, iv. 2. 1. 16. + ---- with vomiting, iv. 3. 2. 3. + ---- produces slow pulse, iv. 2. 1. 10. + ---- of blind men, iv. 2. 1. 10. + ---- use of mercurials in it, iv. 2. 1. 11. + ---- from ideas, Addit. iii. + Vibices, i. 2. 1. 16. Suppl. i. 2. 7. + Vigilia, iii. 1. 2. 3. iv. 1. 3. 6. + Vision acuter, i. 1. 5. 1. + ---- diminished, i. 2. 5. 2. + ---- expends much sensorial power, i. 2. 5. 3. + Vita ovi, iv. 1. 4. 1. + ---- hiemi-dormientium, iv. 1. 4. 2. + Vitus's dance, iv. 2. 3. 2. + Volition, three degrees of, iii. 2. 1. 12. + ---- lessens fever, iii. 2. 1. 12. Suppl. i. 11. 6. + ---- produces fever, iii. 2. 1. 12. + ---- without deliberation, iv. 1. 3. 2. Addit. iv. + Vomica, ii. 1. 6. 3. + Vomitus, i. 3. 1. 4. + Vomendi conamen inane, i. 3. 1. 8. + Vomiting stopped, iv. 1. 1. 3. iv. 1. 1. f. + ---- voluntary, iv. 3. 3. 2. + ---- how acquired, iv. 1. 1. 2. + ---- vertiginous, iv. 3. 2. 3. + ---- from stone in ureter, iv. 3. 2. 4. + ---- from paralytic stroke, iv. 3. 2. 5. + ---- from tickling the throat, iv. 3. 2. 6. + ---- sympathizes with the skin, iv. 3. 2. 7. + ---- in haemoptoe, i. 1. 1. 4. + ---- from defect of association, iv. 2. 1. 10. + Vulnerum cicatrix, i. 1. 3. 13. + + W. + + Watchfulness, iii. 1. 2. 3. iv. 1. 3. 6. + Water-qualm, i. 3. 1. 3. + Weakness, three kinds of, i. 2. 1. + Whirling-chair, Suppl. i. 15. 3. + Whirling-bed, Suppl. i. 15. 7. + White swelling of the knee, i. 2. 3. 19. + Winking, ii. 1. 1. 8. i. 1. 4. 1. iv. 1. 3. 2. + Wine in fevers, ii. 1. 3. 1. iv. 2. 1. 12. + Winter-sleeping animals, iv. 1. 4. 2. + Witlow, superficial, ii. 1. 4. 5. + ---- internal, ii. 1. 2. 19. + Womb, descent of, i. 1. 4. 8. + ---- inflammation of, ii. 1. 2. 16. + Worms, i. 1. 4. 10. + ---- mucus counterfeits, i. 1. 3. 4. + ---- in sheep, i. 2. 3. 9. + Wounds, healing of, i. 1. 3. 13. + + Y. + + Yawning, ii. 1. 1. 9. + Yaws, ii. 1. 5. 5. + + Z. + + Zona ignea, ii. 1. 5. 9. iv. 1. 2. 11. ii. 1. 2. 14. + + * * * * * + + +ZOONOMIA; + +OR, + +THE LAWS OF ORGANIC LIFE. + +PART III. + +CONTAINING + +THE ARTICLES OF THE MATERIA MEDICA, + +WITH AN ACCOUNT OF THE + +OPERATION OF MEDICINES. + + * * * * * + + IN VIVUM CORPUS + AGUNT MEDICAMENTA. + + * * * * * + +PREFACE. + +THE MATERIA MEDICA includes all those substances, which may contribute to +the restoration of health. These may be conveniently distributed under +seven articles according to the diversity of their operations. + +1. NUTRIENTIA, or those things which preserve in their natural state the +due exertions of all the irritative motions. + +2. INCITANTIA, or those things which increase the exertions of all the +irritative motions. + +3. SECERNENTIA, or those things which increase the irritative motions, +which constitute secretion. + +4. SORBENTIA, or those things which increase the irritative motions, which +constitute absorption. + +5. INVERTENTIA, or those things which invert the natural order of the +successive irritative motions. + +6. REVERTENTIA, or those things which restore the natural order of the +inverted irritative motions. + +7. TORPENTIA, those things which diminish the exertions of all the +irritative motions. + +It is necessary to apprize the reader, that in the following account of the +virtues of Medicines their usual doses are always supposed to be exhibited; +and the patient to be exposed to the degree of exterior heat, which he has +been accustomed to, (where the contrary is not mentioned), as any variation +of either of these circumstances varies their effects. + + * * * * * + + +ARTICLES + +OF THE + +MATERIA MEDICA. + + * * * * * + +ART. I. + +NUTRIENTIA. + +I. 1. Those things, which preserve in their natural state the due exertions +of all the irritative motions, are termed nutrientia; they produce the +growth, and restore the waste, of the system. These consist of a variety of +mild vegetable and animal substances, water, and air. + +2. Where stronger stimuli have been long used, they become necessary for +this purpose, as mustard, spice, salt, beer, wine, vinegar, alcohol, opium. +Which however, as they are unnatural stimuli, and difficult to manage in +respect to quantity, are liable to shorten the span of human life, sooner +rendering the system incapable of being stimulated into action by the +nutrientia. See Sect XXXVII. 4. On the same account life is shorter in +warmer climates than in more temperate ones. + +II. OBSERVATIONS ON THE NUTRIENTIA. + +I. 1. The flesh of animals contains more nourishment, and stimulates our +absorbent and secerning vessels more powerfully, than the vegetable +productions, which we use as food; for the carnivorous animals can fast +longer without injury than the graminivorous; and we feel ourselves warmer +and stronger after a meal of flesh than of grain. Hence in diseases +attended with cold extremities and general debility this kind of diet is +preferred; as in rickets, dropsy, scrophula, and in hysteric and +hypochondriac cases, and to prevent the returns of agues. Might not flesh +in small quantities bruised to a pulp be more advantageously used in fevers +attended with debility than vegetable diet? + +That flesh, which is of the darkest colour, generally contains more +nourishment, and stimulates our vessels more powerfully, than the white +kinds. The flesh of the carnivorous and piscivorous animals is so +stimulating, that it seldom enters into the food of European nations, +except the swine, the Soland goose (Pelicanus Bassanus), and formerly the +swan. Of these the swine and the swan are fed previously upon vegetable +aliment; and the Soland goose is taken in very small quantity, only as a +whet to the appetite. Next to these are the birds, that feed upon insects, +which are perhaps the most stimulating and the most nutritive of our usual +food. + +It is said that a greater quantity of volatile alkali can be obtained from +this kind of flesh, to which has been ascribed its stimulating quality. But +it is more probable, that fresh flesh contains only the elements of +volatile alkali. + +2. Next to the dark coloured flesh of animals, the various tribes of +shell-fish seem to claim their place, and the wholesome kinds of mushrooms, +which must be esteemed animal food, both for their alkalescent tendency, +their stimulating quality, and the quantity of nourishment, which they +afford; as oysters, lobsters, crabfish, shrimps; mushrooms; to which +perhaps might be added some of the fish without scales; as the eel, +barbolt, tench, smelt, turbot, turtle. + +The flesh of many kinds of fish, when it is supposed to have undergone a +beginning putrefaction, becomes luminous in the dark. This seems to shew a +tendency in the phosphorus to escape, and combine with the oxygen of the +atmosphere; and would hence shew, that this kind of flesh is not so +perfectly animalized as those before mentioned. This light, as it is +frequently seen on rotten wood, and sometimes on veal, which has been kept +too long, as I have been told, is commonly supposed to have its cause from +putrefaction; but is nevertheless most probably of phosphoric origin, like +that seen in the dark on oyster-shells, which have previously been ignited, +and afterwards exposed to the sunshine, and on the Bolognian stone. See +Botan. Gard. Vol. I. Cant. I. line 1 and 2, the note. + +3. The flesh of young animals, as of lamb, veal, and sucking pigs, supplies +us with a still less stimulating food. The broth of these is said to become +sour, and continues so a considerable time before it changes into +putridity; so much does their flesh partake of the chemical properties of +the milk, with which these animals are nourished. + +4. The white meats, as of turkey, partridge, pheasant, fowl, with their +eggs, seem to be the next in mildness; and hence are generally first +allowed to convalescents from inflammatory diseases. + +5. Next to those should be ranked the white river-fish, which have scales, +as pike, perch, gudgeon. + +II. 1. Milk unites the animal with the vegetable source of our nourishment, +partaking of the properties of both. As it contains sugar, and will +therefore ferment and produce a kind of wine or spirit, which is a common +liquor in Siberia; or will run into an acid by simple agitation, as in the +churning of cream; and lastly, as it contains coagulable lymph, which will +undergo the process of putrefaction like other animal substances, as in old +cheese. + +2. Milk may be separated by rest or by agitation into cream, butter, +butter-milk, whey, curd. The cream is easier of digestion to adults, +because it contains less of the coagulum or cheesy part, and is also more +nutritive. Butter consisting of oil between an animal and vegetable kind +contains still more nutriment, and in its recent state is not difficult of +digestion if taken in moderate quantity. See Art. I. 2. 3. 2. Butter-milk +if it be not bitter is an agreeable and nutritive fluid, if it be bitter it +has some putrid parts of the cream in it, which had been kept too long; but +is perhaps not less wholesome for being sour to a certain degree: as the +inferior people in Scotland choose sour milk in preference to skimmed milk +before it is become sour. Whey is the least nutritive and easiest of +digestion. And in the spring of the year, when the cows feed on young +grass, it contains so much of vegetable properties, as to become a salutary +potation, when drank to about a pint every morning to those, who during the +winter have taken too little vegetable nourishment, and who are thence +liable to bilious concretions. + +3. Cheese is of various kinds, according to the greater or less quantity of +cream, which it contains, and according to its age. Those cheeses, which +are easiest broken to pieces in the mouth, are generally easiest of +digestion, and contain most nutriment. Some kinds of cheese, though slow of +digestion, are also slow in changing by chemical processes in the stomach, +and therefore will frequently agree well with those, who have a weak +digestion; as I have seen toasted cheese vomited up a whole day after it +was eaten without having undergone any apparent change, or given any +uneasiness to the patient. It is probable a portion of sugar, or of animal +fat, or of the gravy of boiled or roasted meat, mixed with cheese at the +time of making it, might add to its pleasant and nutritious quality. + +4. The reason, why autumnal milk is so much thicker or coagulable than +vernal milk, is not easy to understand, but as new milk is in many respects +similar to chyle, it may be considered as food already in part digested by +the animal it is taken from, and thence supplies a nutriment of easy +digestion. But as it requires to be curdled by the gastric acid, before it +can enter the lacteals, as is seen in the stomachs of calves, it seems more +suitable to children, whose stomachs abound more with acidity, than to +adults; but nevertheless supplies good nourishment to many of the latter, +and particularly to those, who use vegetable food, and whose stomachs have +not been much accustomed to the unnatural stimulus of spice, salt, and +spirit. See Class I. 1. 2. 5. + +III. 1. The seeds, roots, leaves, and fruits of plants, constitute the +greatest part of the food of mankind; the respective quantities of +nourishment, which these contain, may perhaps be estimated from the +quantity of starch, or of sugar, they can be made to produce: in +farinaceous seeds, the mucilage seems gradually to be converted into +starch, while they remain in our granaries; and the starch by the +germination of the young plant, as in making malt from barley, or by animal +digestion, is converted into sugar. Hence old wheat and beans contain more +starch than new; and in our stomachs other vegetable and animal materials +are converted into sugar; which constitutes in all creatures a part of +their chyle. + +Hence it is probable, that sugar is the most nutritive part of vegetables; +and that they are more nutritive, as they are convertible in greater +quantity into sugar by the power of digestion; as appears from sugar being +found in the chyle of all animals, and from its existing in great quantity +in the urine of patients in the diabaetes, of which a curious case is +related in Sect. XXIX. 4. where a man labouring under this malady eat and +drank an enormous quantity, and sometimes voided sixteen pints of water in +a day, with an ounce of sugar in each pint. + +2. Oil, when mixed with mucilage or coagulable lymph, as in cream or new +milk, is easy of digestion, and constitutes probably the most nutritive +part of animal diet; as oil is another part of the chyle of all animals. As +these two materials, sugar and butter, contain much nutriment under a small +volume, and readily undergo some chemical change so as to become acid or +rancid; they are liable to disturb weak stomachs, when taken in large +quantity, more than aliment, which contains less nourishment, and is at the +same time less liable to chemical changes; because the chyle is produced +quicker than the torpid lacteals can absorb it, and thence undergoes a +further chemical process. Sugar and butter therefore are not so easily +digested, when taken in large quantity, as those things, which contain less +nutriment; hence, where the stomach is weak, they must be used in less +quantity. But the custom of some people in restraining children entirely +from them, is depriving them of a very wholesome, agreeable, and +substantial part of their diet. Honey, manna, sap-juice, are different +kinds of less pure sugar. + +3. All the esculent vegetables contain a bland oil, or mucilage, or starch, +or sugar, or acid; and, as their stimulus is moderate, are properly given +alone as food in inflammatory diseases; and mixed with milk constitute the +food of thousands. Other vegetables possess various degrees and various +kinds of stimulus; and to these we are beholden for the greater part of our +Materia Medica, which produce nausea, sickness, vomiting, catharsis, +intoxication, inflammation, and even death, if unskilfully administered. + +The acrid or intoxicating, and other kinds of vegetable juices, such as +produce sickness, or evacuate the bowels, or such even as are only +disagreeable to the palate, appear to be a part of the defence of those +vegetables, which possess them, from the assaults of larger animals or of +insects. As mentioned in the Botanic Garden, Part II. Cant. I. line 161, +note. This appears in a forcible manner from the perusal of some travels, +which have been published of those unfortunate people, who have suffered +shipwreck on uncultivated countries, and have with difficulty found food to +subsist, in otherwise not inhospitable climates. + +4. As these acrid and intoxicating juices generally reside in the mucilage, +and not in the starch of many roots, and seeds, according to the +observation of M. Parmentier, the wholesome or nutritive parts of some +vegetables may be thus separated from the medicinal parts of them. Thus if +the root of white briony be rasped into cold water, by means of a +bread-grater made of a tinned iron plate, and agitated in it, the acrid +juice of the root along with the mucilage will be dissolved, or swim, in +the water; while a starch perfectly wholesome and nutritious will subside, +and may be used as food in times of scarcity. + +M. Parmentier further observes, that potatoes contain too much mucilage in +proportion to their starch, which prevents them from being converted into +good bread. But that if the starch be collected from ten pounds of raw +potatoes by grating them into cold water, and agitating them, as above +mentioned; and if the starch thus procured be mixed with other ten pounds +of boiled potatoes, and properly subjected to fermentation like wheat +flour, that it will make as good bread as the finest wheat. + +Good bread may also be made by mixing wheat-flour with boiled potatoes. +Eighteen pounds of wheat flour are said to make twenty-two pounds and a +half of bread. Eighteen pounds of wheat-flour mixed with nine pounds of +boiled potatoes, are said to make twenty-nine pounds and a half of bread. +This difference of weight must arise from the difference of the previous +dryness of the two materials. The potatoes might probably make better +flour, if they were boiled in steam, in a close vessel, made some degrees +hotter than common boiling water. + +Other vegetable matters may be deprived of their too great acrimony by +boiling in water, as the great variety of the cabbage, the young tops of +white briony, water-cresses, asparagus, with innumerable roots, and some +fruits. Other plants have their acrid juices or bitter particles diminished +by covering them from the light by what is termed blanching them, as the +stems and leaves of cellery, endive, sea-kale. The former method either +extracts or decomposes the acrid particles, and the latter prevents them +from being formed. See Botanic Garden, Vol. I. additional note XXXIV. on +the Etiolation of vegetables. + +5. The art of cookery, by exposing vegetable and animal substances to heat, +has contributed to increase the quantity of the food of mankind by other +means besides that of destroying their acrimony. One of these is by +converting the acerb juices of some fruits into sugar, as in the baking of +unripe pears, and the bruising of unripe apples; in both which situations +the life of the vegetable is destroyed, and the conversion of the harsh +juice into a sweet one must be performed by a chemical process; and not by +a vegetable one only, as the germination of barley in making malt has +generally been supposed. + +Some circumstances, which seem to injure the life of several fruits, seem +to forward the saccharine process of their juices. Thus if some kinds of +pears are gathered a week before they would ripen on the tree, and are laid +on a heap and covered, their juice becomes sweet many days sooner. The +taking off a circular piece of the bark from a branch of a pear-tree causes +the fruit of that branch to ripen sooner by a fortnight, as I have more +than once observed. The wounds made in apples by insects occasion those +apples to ripen sooner; caprification, or the piercing of figs, in the +island of Malta, is said to ripen them sooner; and I am well informed, that +when bunches of grapes in this country have acquired their expected size, +that if the stalk of each bunch be cut half through, that they will sooner +ripen. + +The germinating barley in the malt-house I believe acquires little +sweetness, till the life of the seed is destroyed, and the saccharine +process then continued or advanced by the heat in drying it. Thus in animal +digestion, the sugar produced in the stomach is absorbed by the lacteals as +fast as it is made, otherwise it ferments, and produces flatulency; so in +the germination of barley in the malt-house, so long as the new plant +lives, the sugar, I suppose, is absorbed as fast as it is made; but that, +which we use in making beer, is the sugar produced by a chemical process +after the death of the young plant, or which is made more expeditiously, +than the plant can absorb it. + +It is probably this saccharine process, which obtains in new hay-stacks too +hastily, and which by immediately running into fermentation produces so +much heat as to set them on fire. The greatest part of the grain, or seeds, +or roots, used in the distilleries, as wheat, canary seed, potatoes, are +not I believe previously subjected to germination, but are in part by a +chemical process converted into sugar, and immediately subjected to vinous +fermentation; and it is probable a process may sometime be discovered of +producing sugar from starch or meal; and of separating it from them for +domestic purposes by alcohol, which dissolves sugar but not mucilage; or by +other means. + +Another method of increasing the nutriment of mankind by cookery, is by +dissolving cartilages and bones, and tendons, and probably some vegetables, +in steam or water at a much higher degree of heat than that of boiling. +This is to be done in a close vessel, which is called Papin's digester; in +which, it is said, that water may be made red-hot, and will then dissolve +all animal substances; and might thus add to our quantity of food in times +of scarcity. This vessel should be made of iron, and should have an oval +opening at top, with an oval lid of iron larger than the aperture; this lid +should be slipped in endways, when the vessel is filled, and then turned, +and raised by a screw above it into contact with the under edges of the +aperture. There should also be a small tube or hole covered with a weighted +valve to prevent the danger of bursting the digester. + +Where the powers of digestion are weakened, broths made by boiling animal +and vegetable substances in water afford a nutriment; though I suppose not +so great as the flesh and vegetables would afford, if taken in their solid +form, and mixed with saliva in the act of mastication. The aliment thus +prepared should be boiled but a short time, nor should be suffered to +continue in our common kitchen-utensils afterwards, as they are lined with +a mixture of half lead and half tin, and are therefore unwholesome, though +the copper is completely covered. And those soups, which have any acid or +wine boiled in them, unless they be made in silver, or in china, or in +those pot-vessels, which are not glazed by the addition of lead, are truly +poisonous; as the acid, as lemon-juice or vinegar, when made hot, erodes or +dissolves the lead and tin lining of the copper-vessels, and the leaden +glaze of the porcelain ones. Hence, where silver cannot be had, iron +vessels are preferable to tinned copper ones; or those made of tinned +iron-plates in the common tin-shops, which are said to be covered with pure +or block tin. + +6. Another circumstance, which facilitates the nourishment of mankind, is +the mechanic art of grinding farinaceous seeds into powder between +mill-stones; which may be called the artificial teeth of society. It is +probable, that some soft kinds of wood, especially when they have undergone +a kind of fermentation, and become of looser texture, might be thus used as +food in times of famine. + +Nor is it improbable, that hay, which has been kept in stacks, so as to +undergo the saccharine process, may be so managed by grinding and by +fermentation with yeast like bread, as to serve in part for the sustenance +of mankind in times of great scarcity. Dr. Priestley gave to a cow for some +time a strong infusion of hay in large quantity for her drink, and found +that she produced during this treatment above double the quantity of milk. +Hence if bread cannot be made from ground hay, there is great reason to +suspect, that a nutritive beverage may be thus prepared either in its +saccharine state, or fermented into a kind of beer. + +In times of great scarcity there are other vegetables, which though not in +common use, would most probably afford wholesome nourishment, either by +boiling them, or drying and grinding them, or by both those processes in +succession. Of these are perhaps the tops and the bark of all those +vegetables, which are armed with thorns or prickles, as gooseberry trees, +holly, gorse, and perhaps hawthorn. The inner bark of the elm tree makes a +kind of gruel. And the roots of fern, and probably of very many other +roots, as of grass and of clover taken up in winter, might yield +nourishment either by boiling or baking, and separating the fibres from the +pulp by beating them; or by getting only the starch from those, which +possess an acrid mucilage, as the white briony. + +7. However the arts of cookery and of grinding may increase or facilitate +the nourishment of mankind, the great source of it is from agriculture. In +the savage state, where men live solely by hunting, I was informed by Dr. +Franklin, that there was seldom more than one family existed in a circle of +five miles diameter; which in a state of pasturage would support some +hundred people, and in a state of agriculture many thousands. The art of +feeding mankind on so small a grain as wheat, which seems to have been +discovered in Egypt by the immortal name of Ceres, shewed greater ingenuity +than feeding them with the large roots of potatoes, which seem to have been +a discovery of ill-fated Mexico. + +This greater production of food by agriculture than by pasturage, shews +that a nation nourished by animal food will be less numerous than if +nourished by vegetable; and the former will therefore be liable, if they +are engaged in war, to be conquered by the latter, as Abel was slain by +Cain. This is perhaps the only valid argument against inclosing open arable +fields. The great production of human nourishment by agriculture and +pasturage evinces the advantage of society over the savage state; as the +number of mankind becomes increased a thousand fold by the arts of +agriculture and pasturage; and their happiness is probably under good +governments improved in as great a proportion, as they become liberated +from the hourly fear of beasts of prey, from the daily fear of famine, and +of the occasional incursions of their cannibal neighbours. + +But pasturage cannot exist without property both in the soil, and the herds +which it nurtures; and for the invention of arts, and production of tools +necessary to agriculture, some must think, and others labour; and as the +efforts of some will be crowned with greater success than that of others, +an inequality of the ranks of society must succeed; but this inequality of +mankind in the present state of the world is too great for the purposes of +producing the greatest quantity of human nourishment, and the greatest sum +of human happiness; there should be no slavery at one end of the chain of +society, and no despotism at the other.--By the future improvements of +human reason such governments may possibly hereafter be established, as may +a hundred-fold increase the numbers of mankind, and a thousand-fold their +happiness. + +IV. 1. Water must be considered as a part of our nutriment, because so much +of it enters the composition of our solids as well as of our fluids; and +because vegetables are now believed to draw almost the whole of their +nourishment from this source. As in them the water is decomposed, as it is +perspired by them in the sunshine, the oxygen gas increases the quantity +and the purity of the atmosphere in their vicinity, and the hydrogen seems +to be retained, and to form the nutritive juices, and consequent secretions +of rosin, gum, wax, honey, oil, and other vegetable productions. See +Botanic Garden, Part I. Cant. IV. line 25, note. It has however other uses +in the system, besides that of a nourishing material, as it dilutes our +fluids, and lubricates our solids; and on all these accounts a daily supply +of it is required. + +2. River-water is in general purer than spring-water; as the neutral salts +washed down from the earth decompose each other, except perhaps the marine +salt; and the earths, with which spring-water frequently abounds, is +precipitated; yet it is not improbable, that the calcareous earth dissolved +in the water of many springs may contribute to our nourishment, as the +water from springs, which contain earth, is said to conduce to enrich those +lands, which are flooded with it, more than river water. + +3. Many arguments seem to shew, that calcareous earth contributes to the +nourishment of animals and vegetables. First because calcareous earth +constitutes a considerable part of them, and must therefore either be +received from without, or formed by them, or both, as milk, when taken as +food by a lactescent woman, is decomposed in the stomach by the process of +digestion, and again in part converted into milk by the pectoral glands. +Secondly, because from the analogy of all organic life, whatever has +composed a part of a vegetable or animal may again after its chemical +solution become a part of another vegetable or animal, such is the general +transmigration of matter. And thirdly, because the great use of lime in +agriculture on almost all kinds of soil and situation cannot be +satisfactorily explained from its chemical properties alone. Though these +may also in certain soils and situations have considerable effect. + +The chemical uses of lime in agriculture may be, 1. from its destroying in +a short time the cohesion of dead vegetable fibres, and thus reducing them +to earth, which otherwise is effected by a slow process either by the +consumption of insects or by a gradual putrefaction. Thus I am informed +that a mixture of lime with oak bark, after the tanner has extracted from +it whatever is soluble in water, will in two or three months reduce it to a +fine black earth, which, if only laid in heaps, would require as many years +to effect by its own spontaneous fermentation or putrefaction. This effect +of lime must be particularly advantageous to newly inclosed commons when +first broken up. + +Secondly, lime for many months continues to attract moisture from the air +or earth, which it deprives I suppose of carbonic acid, and then suffers it +to exhale again, as is seen on the plastered walls of new houses. On this +account it must be advantageous when mixed with dry or sandy soils, as it +attracts moisture from the air above or the earth beneath, and this +moisture is then absorbed by the lymphatics of the roots of vegetables. +Thirdly, by mixing lime with clays it is believed to make them less +cohesive, and thus to admit of their being more easily penetrated by +vegetable fibres. A mixture of lime with clays destroys their +superabundancy of acid, if such exists, and by uniting with it converts it +into gypsum or alabaster. And lastly, fresh lime destroys worms, snails, +and other insects, with which it happens to come in contact. + +Yet do not all these chemical properties seem to account for the great uses +of lime in almost all soils and situations, as it contributes so much to +the melioration of the crops, as well as to their increase in quantity. +Wheat from land well limed is believed by farmers, millers, and bakers, to +be, as they suppose, thinner skinned; that is, it turns out more and better +flour; which I suppose is owing to its containing more starch and less +mucilage. In respect to grass-ground I am informed, that if a spadeful of +lime be thrown on a tussock, which horses or cattle have refused to touch +for years, they will for many succeeding seasons eat it quite close to the +ground. + +One property of lime is not perhaps yet well understood, I mean its +producing so much heat, when it is mixed with water; which may be owing to +the elementary fluid of heat consolidated in the lime. It is the steam +occasioned by this heat, when water is sprinkled upon lime, if the water be +not in too great quantity or too cold, which breaks the lime into such fine +powder as almost to become fluid, which cannot be effected perhaps by any +other means, and which I suppose must give great preference to lime in +agriculture, and to the solutions of calcareous earth in water, over chalk +or powdered limestone, when spread upon the land. + +4. It was formerly believed that waters replete with calcareous earth, such +as incrust the inside of tea-kettles, or are laid to petrify moss, were +liable to produce or to increase the stone in the bladder. This mistaken +idea has lately been exploded by the improved chemistry, as no calcareous +earth, or a very minute quantity, was found in the calculi analysed by +Scheel and Bergman. The waters of Matlock and of Carlsbad, both which cover +the moss, which they pass through, with a calcareous crust, are so far from +increasing the stone of the bladder or kidnies, that those of Carlsbad are +celebrated for giving relief to those labouring under these diseases. +Philos. Trans. Those of Matlock are drank in great quantities without any +suspicion of injury; and I well know a person who for above ten years has +drank about two pints a day of cold water from a spring, which very much +incrusts the vessels, it is boiled in, with calcareous earth, and affords a +copious calcareous sediment with a solution of salt of tartar, and who +enjoys a state of uninterrupted health. + +V. 1. As animal bodies consist much both of oxygen and azote, which make up +the composition of atmospheric air, these should be counted amongst +nutritious substances. Besides that by the experiments of Dr. Priestley it +appears, that the oxygen gains admittance into the blood through the moist +membranes of the lungs; and seems to be of much more immediate consequence +to the preservation of our lives than the other kinds of nutriment above +specified. + +As the basis of fixed air, or carbonic acid gas, is carbone, which also +constitutes a great part both of vegetable and animal bodies; this air +should likewise be reckoned amongst nutritive substances. Add to this, that +when this carbonic acid air is swallowed, as it escapes from beer or cyder, +or when water is charged with it as detruded from limestone by vitriolic +acid, it affords an agreeable sensation both to the palate and stomach, and +is therefore probably nutritive. + +The immense quantity of carbone and of oxygen which constitute so great a +part of the limestone countries is almost beyond conception, and, as it has +been formed by animals, may again become a part of them, as well as the +calcareous matter with which they are united. Whence it may be conceived, +that the waters, which abound with limestone in solution, may supply +nutriment both to animals and to vegetables, as mentioned above. + +VI. 1. The manner, in which nutritious particles are substituted in the +place of those, which are mechanically abraded, or chemically decomposed, +or which vanish by animal absorption, must be owing to animal appetency, as +described in Sect. XXXVII. 3. and is probably similar to the process of +inflammation, which produces new vessels and new fluids; or to that which +constitutes the growth of the body to maturity. Thus the granulations of +new flesh to repair the injuries of wounds are visible to the eye; as well +as the callous matter, which cements broken bones; the calcareous matter, +which repairs injured snail-shells; and the threads, which are formed by +silk-worms and spiders; which are all secreted in a softer state, and +harden by exsiccation, or by the contact of the air, or by absorption of +their more fluid parts. + +Whether the materials, which thus supply the waste of the system, can be +given any other way than by the stomach, so as to preserve the body for a +length of time, is worth our inquiry; as cases sometimes occur, in which +food cannot be introduced into the stomach, as in obstructions of the +oesophagus, inflammations of the throat, or in hydrophobia; and other cases +are not unfrequent in which the power of digestion is nearly or totally +destroyed, as in anorexia epileptica, and in many fevers. + +In the former of these circumstances liquid nutriment may sometimes be got +into the stomach through a flexible catheter; as described in Class III. 1. +1. 15. In the latter many kinds of mild aliment, as milk or broth, have +frequently been injected as clysters, together with a small quantity of +opium, as ten drops of the tincture, three or four times a day; to which +also might be added very small quantities of vinous spirit. But these, as +far as I have observed, will not long sustain a person, who cannot take any +sustenance by the stomach. + +2. Another mode of applying nutritive fluids might be by extensive +fomentations, or by immerging the whole body in a bath of broth, or of warm +milk, which might at the same time be coagulated by rennet, or the acid of +the calf's stomach; broth or whey might thus probably be introduced, in +part at least, into the circulation, as a solution of nitre is said to have +been absorbed in a pediluvium, which was afterwards discovered by the +manner in which paper dipped frequently in the urine of the patient and +dried, burnt and sparkled like touch-paper. Great quantity of water is also +known to be absorbed by those, who have bathed in the warm bath after +exercise and abstinence from liquids. Cleopatra was said to travel with +4000 milch-asses in her train, and to bathe every morning in their milk, +which she probably might use as a cosmetic rather than a nutritive. + +3. The transfusion of blood from another animal into the vein of one, who +could take no sustenance by the throat, or digest none by the stomach, +might long continue to support him; and perhaps other nutriment, as milk or +mucilage, might be this way introduced into the system, but we have not yet +sufficient experiments on this subject. See Sect. XXXII. 4. and Class I. 2. +3. 25. and Sup. I. 14. 2. + +VII. Various kinds of condiments, or sauces, have been taken along with +vegetable or animal food, and have been thought by some to strengthen the +process of digestion and consequent process of nutrition. Of these wine, or +other fermented liquors, vinegar, salt, spices, and mustard, have been in +most common use, and I believe to the injury of thousands. As the stomach +by their violent stimulus at length loses its natural degree of +irritability, and indigestion is the consequence; which is attended with +flatulency and emaciation. Where any of these have been taken so long as to +induce a habit, they must either be continued, but not increased; or the +use of them should be gradually and cautiously diminished or discontinued, +as directed in Sect. XII. 7. 8. + +III. CATALOGUE OF THE NUTRIENTIA. + + I. 1. Venison, beef, mutton, hare, goose, duck, woodcock, snipe, + moor-game. + + 2. Oysters, lobsters, crabs, shrimps, mushrooms, eel, tench, barbolt, + smelt, turbot, sole, turtle. + + 3. Lamb, veal, sucking-pig. + + 4. Turkey, partridge, pheasant, fowl, eggs. + + 5. Pike, perch, gudgeon, trout, grayling. + + II. Milk, cream, butter, buttermilk, whey, cheese. + + III. Wheat, barley, oats, peas, potatoes, turnips, carrots, cabbage, + asparagus, artichoke, spinach, beet, apple, pear, plum, apricot, + nectarine, peach, strawberry, grape, orange, melon, cucumber, dried + figs, raisins, sugar, honey. With a great variety of other roots, + seeds, leaves, and fruits. + + IV. Water, river-water, spring-water, calcareous earth. + + V. Air, oxygene, azote, carbonic acid gas. + + VI. Nutritive baths and clysters, transfusion of blood. + + VII. Condiments. + + * * * * * + +ART. II. + +INCITANTIA. + +I. 1. Those things, which increase the exertions of all the irritative +motions, are termed incitantia. As alcohol, or the spirituous part of +fermented liquors, opium, and many drugs, which are still esteemed poisons, +their proper doses not being ascertained. To these should be added the +exhilarating passions of the mind, as joy, love: and externally the +application of heat, electricity, aether, essential oils, friction, and +exercise. + +2. These promote both the secretions and absorptions, increase the natural +heat, and remove those pains, which originate from the defect of irritative +motions, termed nervous pains; and prevent the convulsions consequent to +them. When given internally they induce costiveness, and deep coloured +urine; and by a greater dose intoxication, and its consequences. + +II. OBSERVATIONS ON THE INCITANTIA. + +I. 1. Opium and alcohol increase all the secretions and absorptions. The +increase of the secretion of sensorial power appears from the violent +exertions of drunken people; the secretion of sweat is more certainly +excited by opium or wine than by any other medicine; and the increase of +general heat, which these drugs produce, is an evidence of their effect in +promoting all the secretions; since an increase of secretion is always +attended with increase of heat in the part, as in hepatic and other +inflammations. + +2. But as they at the same time promote absorption; those fluids, which are +secreted into receptacles, as the urine, bile, intestinal and pulmonary +mucus, have again their thinner parts absorbed; and hence, though the +quantity of secreted fluid was increased, yet as the absorption was also +increased, the excretion from these receptacles is lessened; at the same +time that it is deeper coloured or of thicker consistence, as the urine, +alvine feces, and pulmonary mucus. Whereas the perspiration being secreted +on the surface of the body is visible in its increased quantity, before it +can be reabsorbed; whence arises that erroneous opinion, that opium +increases the cutaneous secretion, and lessens all the others. + +3. It must however be noted, that after evacuations opium seems to promote +the absorptions more than the secretions; if you except that of the +sensorial power in the brain, which probably suffers no absorption. Hence +its efficacy in restraining haemorrhages, after the vessels are emptied, by +promoting venous absorption. + +4. In ulcers the matter is thickened by the exhibition of opium from the +increased absorption of the thinner parts of it; but it is probable, that +the whole secretion, including the part which is absorbed, is increased; +and hence new fibres are secreted along with the matter, and the ulcer +fills with new granulations of flesh. But as no ulcer can heal, till it +ceases to discharge; that is, till the absorption becomes as great as the +excretion; those medicines, which promote absorption only, are more +advantageous for the healing an ulcer after it is filled with new flesh; as +the Peruvian bark internally; with bandages and solutions of lead +externally. + +5. There are many pains which originate from a want of due motion in the +part, as those occasioned by cold; and all those pains which are attended +with cold extremities, and are generally termed nervous. These are relieved +by whatever excites the part into its proper actions, and hence by opium +and alcohol; which are the most universal stimulants we are acquainted +with. In these cases the effect of opium is produced, as soon as the body +becomes generally warm; and a degree of intoxication or sleep follows the +cessation of the pain. + +These nervous pains (as they are called) frequently return at certain +periods of time, and are also frequently succeeded by convulsions; in these +cases if opium removes the pain, the convulsions do not come on. For this +purpose it is best to exhibit it gradually, as a grain every hour, or half +hour, till it intoxicates. Here it must be noted, that a much less quantity +will prevent the periods of these cold pains, than is necessary to relieve +them after their access. As a grain and half of opium given an hour before +the expected paroxysm will prevent the cold fit of an intermittent fever, +but will not soon remove it, when it is already formed. For in the former +case the usual or healthy associations or catenations of motion favour the +effect of the medicine; in the latter case these associations or +catenations are disordered, or interrupted, and new ones are formed, which +so far counteract the effect of the medicine. + +When opium has been required in large doses to ease or prevent convulsions, +some have advised the patient to omit the use of wine, as a greater +quantity of opium might then be exhibited; and as opium seems to increase +absorption more, and secretion less, than vinous spirit; it may in some +cases be useful to exchange one for the other; as in diseases attended with +too great evacuation, as diarrhoea, and dysentery, opium may be preferable; +on the contrary in tetanus, or locked-jaw, where inflammation of the system +might be of service, wine may be preferable to opium; see Class III. 1. 1. +13. I have generally observed, that a mixture of spirit of wine and warm +water, given alternately with the doses of opium, has soonest and most +certainly produced that degree of intoxication, which was necessary to +relieve the patient in the epilepsia dolorifica. + +6. There is likewise some relief given by opium to inflammatory pains, or +those from excess of motion in the affected part; but with this difference, +that this relief from the pains, and the sleep, which it occasions, does +not occur till some hours after the exhibition of the opium. This requires +to be explained; after the stimulus of opium or of alcohol ceases, as after +common drunkenness, a consequent torpor comes on; and the whole habit +becomes less irritable by the natural stimuli. Hence the head-achs, +sickness, and languor, on the next day after intoxication, with cold skin, +and general debility. Now in pains from excess of motion, called +inflammatory pains, when opium is given, the pain is not relieved, till the +debility comes on after the stimulus ceases to act; for then after the +greater stimulus of the opium has exhausted much of the sensorial power; +the less stimulus, which before caused the pain, does not now excite the +part into unnatural action. + +In these cases the stimulus of the opium first increases the pain; and it +sometimes happens, that so great a torpor follows, as to produce the death +or mortification of the affected part; whence the danger of giving opium in +inflammatory diseases, especially in inflammation of the bowels; but in +general the pain returns with its former violence, when the torpor above +mentioned ceases. Hence these pains attended with inflammation are best +relieved by copious venesection, other evacuations, and the class of +medicines called torpentia. + +7. These pains from excess of motion are attended with increased heat of +the whole, or of the affected part, and a strong quick pulse; the pains +from defect of motion are attended with cold extremities, and a weak pulse; +which is also generally more frequent than natural, but not always so. + +8. Opium and alcohol are the only two drugs, we are much acquainted with, +which intoxicate; and by this circumstance are easily distinguished from +the secernentia and sorbentia. Camphor, and cicuta, and nicotiana, are +thought to induce a kind of intoxication; and there are many other drugs of +this class, whose effects are less known, or their doses not ascertained; +as atropa belladonna, hyocyamus, stramonium, prunus laurocerasus, +menispermum, cynoglossum, some fungi, and the water distilled from black +cherry-stones; the last of which was once much in use for the convulsions +of children, and was said to have good effect; but is now improvidently +left out of our pharmacopias. I have known one leaf of the laurocerasus, +shred and made into tea, given every morning for a week with no ill +consequence to a weak hysteric lady, but rather perhaps with advantage. + +9. The pernicious effects of a continued use of much vinous spirit is daily +seen and lamented by physicians; not only early debility, like premature +age, but a dreadful catalogue of diseases is induced by this kind of +intemperance; as dropsy, gout, leprosy, epilepsy, insanity, as described in +Botanic Garden, Part II. Canto III. line 357. The stronger or less diluted +the spirit is taken, the sooner it seems to destroy, as in dram-drinkers; +but still sooner, when kernels of apricots, or bitter almonds, or +laurel-leaf, are infused in the spirit, which is termed ratafia; as then +two poisons are swallowed at the same time. And vinegar, as it contains +much vinous spirit, is probably a noxious part of our diet. And the +distilled vinegar, which is commonly sold in the shops, is truly poisonous, +as it is generally distilled by means of a pewter or leaden alembic-head or +worm-tube, and abounds with lead; which any one may detect by mixing with +it a solution of liver of sulphur. Opium, when taken as a luxury, not as a +medicine, is as pernicious as alcohol; as Baron de Tott relates in his +account of the opium-eaters in Turkey. + +10. It must be observed, that a frequent repetition of the use of this +class of medicines so habituates the body to their stimulus, that their +dose may gradually be increased to an astonishing quantity, such as +otherwise would instantly destroy life; as is frequently seen in those, who +accustom themselves to the daily use of alcohol and opium; and it would +seem, that these unfortunate people become diseased as soon as they omit +their usual potations; and that the consequent gout, dropsy, palsy, or +pimpled face, occur from the debility occasioned from the want of +accustomed stimulus, or to some change in the contractile fibres, which +requires the continuance or increase of it. Whence the cautions necessary +to be observed are mentioned in Sect. XII. 7. 8. + +11. It is probable, that some of the articles in the subsequent catalogue +do not induce intoxication, though they have been esteemed to do so; as +tobacco, hemlock, nux vomica, stavisagria; and on this account should +rather belong to other arrangements, as to the secernentia, or sorbentia, +or invertentia. + +II. 1. Externally the application of heat, as the warm bath, by its +stimulus on the skin excites the excretory ducts of the perspirative +glands, and the mouths of the lymphatics, which open on its surface, into +greater action; and in consequence many other irritative motions, which are +associated with them. To this increased action is added pleasurable +sensation, which adds further activity to the system; and thus many kinds +of pain receive relief from this additional atmosphere of heat. + +The use of a warm bath of about 96 or 98 degrees of heat, for half an hour +once a day for three or four months, I have known of great service to weak +people, and is perhaps the least noxious of all unnatural stimuli; which +however, like all other great excitement, may be carried to excess, as +complained of by the ancients. The unmeaning application of the words +relaxation and bracing to warm and cold baths has much prevented the use of +this grateful stimulus; and the misuse of the term warm-bath, when applied +to baths colder than the body, as to those of Buxton and Matlock, and to +artificial baths of less than 90 degrees of heat, which ought to be termed +cold ones, has contributed to mislead the unwary in their application. + +The stimulus of wine, or spice, or salt, increases the heat of the system +by increasing all or some of the secretions; and hence the strength is +diminished afterwards by the loss of fluids, as well as by the increased +action of the fibres. But the stimulus of the warm-bath supplies heat +rather than produces it; and rather fills the system by increased +absorption, than empties it by increased secretion; and may hence be +employed with advantage in almost all cases of debility with cold +extremities, perhaps even in anasarca, and at the approach of death in +fevers. In these cases a bath much beneath 98 degrees, as of 80 or 85, +might do injury, as being a cold-bath compared with the heat of the body, +though such a bath is generally called a warm one. + +The activity of the system thus produced by a bath of 98 degrees of heat, +or upwards, does not seem to render the patients liable to take cold, when +they come out of it; for the system is less inclined to become torpid than +before, as the warmth thus acquired by communication, rather than by +increased action, continues long without any consequent chillness. Which +accords with the observation of Dr. Fordyce, mentioned in Sup. I. 5. 1. who +says, that those who are confined some time in an atmosphere of 120 or 130 +degrees of heat, do not feel cold or look pale on coming into a temperature +of 30 or 40 degrees; which would produce great paleness and sensation of +coldness in those, who had been some time confined in an atmosphere of only +86 or 90 degrees of heat. Treatise on Simple Fever, p. 168. + +Hence heat, where it can be confined on a torpid part along with moisture, +as on a scrophulous tumour, will contribute to produce suppuration or +resolution. This is done by applying a warm poultice, which should be +frequently repeated; or a plaster of resin, wax, or fat; or by covering the +part with oiled silk; both which last prevent the perspirable matter from +escaping as well as the heat of the part, as these substances repel +moisture, and are bad conductors of heat. Another great use of the stimulus +of heat is by applying it to torpid ulcers, which are generally termed +scrophulous or scorbutic, and are much easier inclined to heal, when +covered with several folds of flannel. + +Mr. ---- had for many months been afflicted with an ulcer in perinaeo, +which communicated with the urethra, through which a part of his urine was +daily evacuated with considerable pain; and was reduced to a great degree +of debility. He used a hot-bath of 96 or 98 degrees of heat every day for +half an hour during about six months. By this agreeable stimulus repeated +thus at uniform times not only the ulcer healed, contrary to the +expectation of his friends, but he acquired greater health and strength, +than he had for some years previously experienced. + +Mrs. ---- was affected with transient pains, which were called nervous +spasms, and with great fear of diseases, which she did not labour under, +with cold extremities, and general debility. She used a hot-bath every +other day of 96 degrees of heat for about four months, and recovered a good +state of health, with greater strength and courage, than she had possessed +for many months before. + +Mr. Z. a gentleman about 65 years of age, who had lived rather +intemperately in respect to vinous potation, and had for many years had +annual visits of the gout, which now became irregular, and he appeared to +be losing his strength, and beginning to feel the effects of age. He used a +bath, as hot as was agreeable to his sensations, twice a week for about a +year and half, and greatly recovered his health and strength with less +frequent and less violent returns of regular gout, and is now near 80 years +of age. + +When Dr. Franklin, the American philosopher, was in England many years ago, +I recommended to him the use of a warm-bath twice a week to prevent the too +speedy access of old age, which he then thought that he felt the approach +of, and I have been informed, that he continued the use of it till near his +death, which was at an advanced age. + +All these patients were advised not to keep themselves warmer than their +usual habits, after they came out of the bath, whether they went into bed +or not; as the design was not to promote perspiration, which weakens all +constitutions, and seldom is of service to any. Thus a flannel shirt, +particularly if it be worn in warm weather, occasions weakness by +stimulating the skin by its points into too great action, and producing +heat in consequence; and occasions emaciation by increasing the discharge +of perspirable matter; and in both these respects differs from the effect +of warm bathing, which communicates heat to the system at the same time +that it stimulates it, and causes absorption more than exhalation. + +2. The effect of the passage of an electric shock through a paralytic limb +in causing it to contract, besides the late experiments of Galvani and +Volta on frogs, intitle it to be classed amongst universal stimulants. +Electric shocks frequently repeated daily for a week or two remove +chronical pains, as the pleurodyne chronica, Class I. 2. 4. 14. and other +chronic pains, which are termed rheumatic, probably by promoting the +absorption of some extravasated material. Scrophulous tumours are sometimes +absorbed, and sometimes brought to suppurate by passing electric shocks +through them daily for two or three weeks. + +[Illustration] + +Miss ----, a young lady about eight years of age, had a swelling about the +size of a pigeon's egg on her neck a little below her ear, which long +continued in an indolent state. Thirty or forty small electric shocks were +passed through it once or twice a day for two or three weeks, and it then +suppurated and healed without difficulty. For this operation the coated jar +of the electric machine had on its top an electrometer, which measured the +shocks by the approach of a brass knob, which communicated with the +external coating to another, which communicated with the internal one, and +their distance was adjusted by a screw. So that the shocks were so small as +not to alarm the child, and the accumulated electricity was frequently +discharged, as the wheel continued turning. The tumour was inclosed between +two other brass knobs, which were fixed on wires, which passed through +glass tubes, the tubes were cemented in two grooves on a board, so that at +one end they were nearer each other than at the other, and the knobs were +pushed out so far as exactly to include the tumour, as described in the +annexed plate, which is about half the size of the original apparatus. + +Inflammations of the eyes without fever are frequently cured by taking a +stream of very small electric sparks from them, or giving the electric +sparks to them, once or twice a day for a week or two; that is, the new +vessels, which constitute inflammation in these inirritable constitutions, +are absorbed by the activity of the absorbents induced by the stimulus of +the electric aura. For this operation the easiest method is to fix a +pointed wire to a stick of sealing wax, or to an insulating handle of +glass, one end of this wire communicates with the prime conductor, and the +point is approached near the inflamed eye in every direction. + +III. Externally the application of ether, and of essential oils, as of +cloves or cinnamon, seem to possess a general stimulating effect. As they +instantly relieve tooth-ach, and hiccough, when these pains are not in +violent degree; and camphor in large doses is said to produce intoxication; +this effect however I have not been witness to, and have reason to doubt. + +The manner in which ether and the essential oil operate on the system when +applied externally, is a curious question, as pain is so immediately +relieved by them, that they must seem to penetrate by the great fluidity or +expansive property of a part of them, as of their odoriferous exhalation or +vapour, and that they thus stimulate the torpid part, and not by their +being taken up by the absorbent vessels, and carried thither by the long +course of circulation; nor is it probable, that these pains are relieved by +the sympathy of the torpid membrane with the external skin, which is thus +stimulated into action; as it does not succeed, unless it is applied over +the pained part. Thus there appears to be three different modes by which +extraneous bodies may be introduced into the system, besides that of +absorption. 1st. By ethereal transition, as heat and electricity; 2d. by +chemical attraction, as oxygen; and 3d. by expansive vapour, as ether and +essential oils. + +IV. The perpetual necessity of the mixture of oxygen gas with the blood in +the lungs evinces, that it must act as a stimulus to the sanguiferous +system, as the motions of the heart and arteries presently cease, when +animals are immersed in airs which possess no oxygen. It may also +subsequently answer another important purpose, as it probably affords the +material for the production of the sensorial power; which is supposed to be +secreted in the brain or medullary part of the nerves; and that the +perpetual demand of this fluid in respiration is occasioned by the +sensorial power, which is supposed to be produced from it, being too subtle +to be long confined in any part of the system. + +Another proof of the stimulant quality of oxygen appears from the increased +acrimony, which the matter of a common abscess possesses, after it has been +exposed to the air of the atmosphere, but not before; and probably all +other contagious matters owe their fever-producing property to having been +converted into acids by their union with oxygen. + +As oxygen penetrates the fine moist membranes of the air-vessels of the +lungs, and unites with the blood by a chemical attraction, as is seen to +happen, when blood is drawn into a bason, the lower surface of the +crassamentum is of a very dark red so long as it is covered from the air by +the upper surface, but becomes florid in a short time on its being exposed +to the atmosphere; the manner of its introduction into the system is not +probably by animal absorption but by chemical attraction, in which +circumstance it differs from the fluids before mentioned both of heat and +electricity, and of ether and essential oils. + +As oxygen has the property of passing through moist animal membranes, as +first discovered by the great Dr. Priestley, it is probable it might be of +use in vibices, and petechiae in fevers, and in other bruises; if the skin +over those parts was kept moist by warm water, and covered with oxygen gas +by means of an inverted glass, or even by exposing the parts thus moistened +to the atmosphere, as the dark coloured extravasated blood might thus +become florid, and by its increase of stimulus facilitate its reabsorption. + +Two weak patients, to whom I gave oxygen gas in as pure a state as it can +easily be procured from Exeter manganese, and in the quantity of about four +gallons a day, seemed to feel refreshed, and stronger, and to look better +immediately after respiring it, and gained strength in a short time. Two +others, one of whom laboured under confirmed hydrothorax, and the other +under a permanent and uniform difficulty of respiration, were not +refreshed, or in any way served by the use of oxygen in the above quantity +of four gallons a day for a fortnight, which I ascribed to the +inirritability of the diseased lungs. For other cases the reader is +referred to the publications of Dr. Beddoes; Confederations on the Use of +Factitious Airs, sold by Johnson, London. + +Its effects would probably have been greater in respect to the quantity +breathed, if it had been given in a dilute state, mixed with 10 or 20 times +its quantity of atmospheric air, as otherwise much of it returns by +expiration without being deprived of its quality, as may be seen by the +person breathing on the flame of a candle, which it enlarges. See the +Treatise of Dr. Beddoes above mentioned. + +V. Those passions, which are attended with pleasurable sensation, excite +the system into increased action in consequence of that sensation, as joy, +and love, as is seen by the flush of the skin. Those passions, which are +attended with disagreeable sensation, produce torpor in general by the +expence of sensorial power occasioned by inactive pain; unless volition be +excited in consequence of the painful sensation; and in that case an +increased activity of the system occurs; thus paleness and coldness are the +consequence of fear, but warmth and redness are the consequence of anger. + +VI. Besides the exertions of the system occasioned by increased stimuli, +and consequent irritation, and by the passions of the mind above described, +the increased actions occasioned by exercise belong to this article. These +may be divided into the actions of the body in consequence of volition, +which is generally termed labour; or secondly, in consequence of agreeable +sensation, which is termed play or sport; thirdly, the exercise occasioned +by agitation, as in a carriage or on horseback; fourthly, that of friction, +as with a brush or hand, so much used in the baths of Turkey; and lastly, +the exercise of swinging. + +The first of these modes of exercise is frequently carried to great excess +even amongst our own labourers, and more so under the lash of slavery; so +that the body becomes emaciated and sinks under either the present +hardships, or by a premature old age. The second mode of exercise is seen +in the play of all young animals, as kittens, and puppies, and children; +and is so necessary to their health as well as to their pleasure, that +those children, which are too much confined from it, not only become +pale-faced and bloated, with tumid bellies, and consequent worms, but are +liable to get habits of unnatural actions, as twitching of their limbs, or +of some parts of their countenance; together with an ill-humoured or +discontented mind. + +Agitation in a carriage or on horseback, as it requires some little +voluntary exertion to preserve the body perpendicular, but much less +voluntary exertion than in walking, seems the best adapted to invalids; who +by these means obtain exercise principally by the strength of the horse, +and do not therefore too much exhaust their own sensorial power. The use of +friction with a brush or hand, for half an hour or longer morning and +evening, is still better adapted to those, who are reduced to extreme +debility; and none of their own sensorial power is thus expended, and +affords somewhat like the warm-bath activity without self-exertion, and is +used as a luxury after warm bathing in many parts of Asia. + +Another kind of exercise is that of swinging, which requires some exertion +to keep the body perpendicular, or pointing towards the center of the +swing, but is at the same time attended with a degree of vertigo; and is +described in Class II. 1. 6. 7. IV. 2. 1. 10. Sup. I. 3. and 15. + +The necessity of much exercise has perhaps been more insisted upon by +physicians, than nature seems to demand. Few animals exercise themselves so +as to induce visible sweat, unless urged to it by mankind, or by fear, or +hunger. And numbers of people in our market towns, of ladies particularly, +with small fortunes, live to old age in health, without any kind of +exercise of body, or much activity of mind. + +In summer weak people cannot continue too long in the air, if it can be +done without fatigue; and in winter they should go out several times in a +day for a few minutes, using the cold air like a cold-bath, to invigorate +and render them more hardy. + +III. CATALOGUE OF THE INCITANTIA. + +I. Papaver somniferum; poppy, opium. + + Alcohol, wine, beer, cyder. + + Prunus lauro-cerasus; laurel, distilled water from the leaves. + + Prunus cerasus; black cherry, distilled water from the kernels. + + Nicotiana tabacum; tobacco? the essential oil, decoction of the leaf. + + Atropa belladona; deadly nightshade, the berries. + + Datura stramoneum; thorn-apple, the fruit boiled in milk. + + Hyoscyamus reticulatus; henbane, the seeds and leaves. + + Cynoglossum; hounds tongue. + + Menispermum, cocculus; Indian berry. + + Amygdalus amarus; bitter almond. + + Cicuta; hemlock. Conium maculatum? + + Strychnos nux vomica? + + Delphinium stavisagria? + +II. Externally, heat, electricity. + +III. Ether, essential oils. + +IV. Oxygen gas. + +V. Passions of love, joy, anger. + +VI. Labour, play, agitation, friction. + + * * * * * + + +ART. III. + +SECERNENTIA. + +I. Those things which increase the irritative motions, which constitute +secretion, are termed secernentia; which are as various as the glands, +which they stimulate into action. + +1. Diaphoretics, as aromatic vegetables, essential oils, ether, volatile +alcali, neutral salts, antimonial preparations, external heat, exercise, +friction, cold water for a time with subsequent warmth, blisters, electric +fluid. + +2. Sialagogues, as mercury internally, and pyrethrum externally. + +3. Expectorants, as squill, onions, gum ammoniac, seneka root, mucilage: +some of these increase the pulmonary perspiration, and perhaps the +pulmonary mucus. + +4. Diuretics, as neutral salts, fixed alcali, balsams, resins, asparagus, +cantharides. + +5. Cathartics of the mild kind, as sena, jalap, neutral salts, manna. They +increase the secretions of bile, pancreatic juice, and intestinal mucus. + +6. The mucus of the bladder is increased by cantharides, and perhaps by oil +of turpentine. + +7. The mucus of the rectum by aloe internally, by clysters and +suppositories externally. + +8. The mucus of the cellular membrane is increased by blisters and +sinapisms. + +9. The mucus of the nostrils is increased by errhines of the milder kind, +as marum, common snuff. + +10. The secretion of tears is increased by volatile salts, the vapour of +onions, by grief, and joy. + +11. All those medicines increase the heat of the body, and remove those +pains, which originate from a defect of motion in the vessels, which +perform secretion; as pepper produces a glow on the skin, and balsam of +Peru is said to relieve the flatulent cholic. But these medicines differ +from the preceding class, as they neither induce costiveness nor deep +coloured urine in their usual dose, nor intoxication in any dose. + +12. Yet if any of these are used unnecessarily, it is obvious, like the +incitantia, that they must contribute to shorten our lives by sooner +rendering peculiar parts of the system disobedient to their natural +stimuli. Of those in daily use the great excess of common salt is probably +the most pernicious, as it enters all our cookery, and is probably one +cause of scrophula, and of sea-scurvy, when joined with other causes of +debility. See Botanic Garden, Part II. Canto IV. line 221. Spices taken to +excess by stimulating the stomach, and the vessels of the skin by +association, into unnecessary action, contribute to weaken these parts of +the system, but are probably less noxious than the general use of so much +salt. + +II. OBSERVATIONS ON THE SECERNENTIA. + +I. 1. Some of the medicines of this class produce absorption in some +degree, though their principal effect is exerted on the secerning part of +our system. We shall have occasion to observe a similar circumstance in the +next class of medicines termed Sorbentia; as of these some exert their +effects in a smaller degree on the secerning system. Nor will this surprise +any one, who has observed, that all natural objects are presented to us in +a state of combination; and that hence the materials, which produce these +different effects, are frequently found mingled in the same vegetable. Thus +the pure aromatics increase the action of the vessels, which secrete the +perspirable matter; and the pure astringents increase the action of the +vessels, which absorb the mucus from the lungs, and other cavities of the +body; hence it must happen, that nutmeg, which possesses both these +qualities, should have the double effect above mentioned. + +Other drugs have this double effect, and belong either to the class of +Secernentia or Sorbentia, according to the dose in which they are +exhibited. Thus a small dose of alum increases absorption, and induces +costiveness; and a large one increases the secretions into the intestinal +canal, and becomes cathartic. And this accounts for the constipation of the +belly left after the purgative quality of rhubarb ceases, for it increases +absorption in a smaller dose, and secretion in a greater. Hence when a part +of the larger dose is carried out of the habit by stools, the small +quantity which remains induces costiveness. Hence rhubarb exhibited in +small doses, as 2 or 3 grains twice a day, strengthens the system by +increasing the action of the absorbent vessels, and of the intestinal +canal. + +2. Diaphoretics. The perspiration is a secretion from the blood in its +passage through the capillary vessels, as other secretions are produced in +the termination of the arteries in the various glands. After this secretion +the blood loses its florid colour, which it regains in its passage through +the lungs; which evinces that something besides water is secreted on the +skins of animals. + +No statical experiments can ascertain the quantity of our perspiration; as +a continued absorption of the moisture of the atmosphere exists at the same +time both by the cutaneous and pulmonary lymphatics. + +3. Every gland is capable of being excited into greater exertions by an +appropriated stimulus applied either by its mixture with the blood +immediately to the secerning vessel, or applied externally to its excretory +duct. Thus mercury internally promotes an increased salivation, and +pyrethrum externally applied to the excretory ducts of the salival glands. +Aloes stimulate the rectum internally mixed with the circulating blood; and +sea-salt by injection externally. Now as the capillaries, which secrete the +perspirable matter, lie near the surface of the body, the application of +external heat acts immediately on their excretory ducts, and promotes +perspiration; internally those drugs which possess a fragrant essential +oil, or spiritus rector, produce this effect, as the aromatic vegetables, +of which the number is very great. + +4. It must be remembered, that a due quantity of some aqueous vehicle must +be given to support this evacuation; otherwise a burning heat without much +visible sweat must be the consequence. When the skin acquires a degree of +heat much above 108, as appears by Dr. Alexander's experiments, no visible +sweat is produced; which is owing to the great heat of the skin evaporating +it as hastily, as it is secreted; and, where the sweat is secreted in +abundance, its evaporation cannot carry off the exuberant heat, like the +vapour of boiling water; because a great part of it is wiped off, or +absorbed by the bed-clothes; or the air about the patient is not changed +sufficiently often, as it becomes saturated with the perspirable matter. +And hence it is probable, that the waste of perspirable matter is as great, +or greater, when the skin is hot and dry, as when it stands in drops on the +skin; as appears from the inextinguishable thirst. + +Hence Dr. Alexander found, that when the heat of the body was greater than +108, nothing produced sweats but repeated draughts of cold water; and of +warm fluids, when the heat was much below that degree. And that cold water +which procured sweats instantaneously when the heat was above 108, stopped +them as certainly when it was below that heat; and that flannels, wrung out +of warm water and wrapped round the legs and thighs, were then most +certainly productive of sweats. + +5. The diaphoretics are all said to succeed much better, if given early in +the morning, about an hour before sun-rise, than at any other time; which +is owing to the great excitability of every part of the system after the +sensorial power has been accumulated during sleep. In those, who have +hectic fever, or the febricula, or nocturnal fever of debility, the morning +sweats are owing to the decline of the fever-fit, as explained in Sect. +XXXII. 9. In some of these patients the sweat does not occur till they +awake; because then the system is still more excitable than during sleep, +because the assistance of the voluntary power in respiration facilitates +the general circulation. See Class I. 2. 1. 3. + +6. It must be observed, that the skin is very dry and hard to the touch, +where the absorbents, which open on its surface, do not act; as in some +dropsies, and other diseases attended with great thirst. This dryness, and +shrivelled appearance, and roughness, are owing to the mouths of the +absorbents being empty of their accustomed fluid, and is distinguishable +from the dryness of the skin above mentioned in the hot fits of fever, by +its not being attended with heat. + +As the heat of the skin in the usual temperature of the air always evinces +an increased perspiration, whether visible or not, the heat being produced +along with the increase of secretion; it follows, that a defect of +perspiration can only exist, when the skin is cold. + +7. Volatile alcali is a very powerful diaphoretic, and particularly if +exhibited in wine-whey; 20 drops of spirit of hartshorn every half hour in +half a pint of wine-whey, if the patient be kept in a moderately warm bed, +will in a few hours elicit most profuse sweats. + +Neutral salts promote invisible perspiration, when the skin is not warmed +much externally, as is evinced from the great thirst, which succeeds a meal +of salt provisions, as of red herrings. When these are sufficiently diluted +with water, and the skin kept warm, copious sweats without inflaming the +habit, are the consequence. Half an ounce of vinegar saturated with +volatile alcali, taken every hour or two hours, well answers this purpose; +and is preferable perhaps in general to all others, where sweating is +advantageous. Boerhaave mentions one cured of a fever by eating +red-herrings or anchovies, which, with repeated draughts of warm water or +tea, would I suppose produce copious perspiration. + +Antimonial preparations have also been of late much used with great +advantage as diaphoretics. For the history and use of these preparations I +shall refer the reader to the late writers on the Materia Medica, only +observing that the stomach becomes so soon habituated to its stimulus, that +the second dose may be considerably increased, if the first had no +operation. + +Where it is advisable to procure copious sweats, the emetics, as +ipecacuanha, joined with opiates, as in Dover's powder, produce this effect +with greater certainty than the above. + +8. We must not dismiss this subject without observing, that perspiration is +designed to keep the skin flexile, as the tears are intended to clean and +lubricate the eye; and that neither of these fluids can be considered as +excretions in their natural state, but as secretions. See Class I. 1. 2. 3. +And that therefore the principal use of diaphoretic medicines is to warm +the skin, and thence in consequence to produce the natural degree of +insensible perspiration in languid habits. + +9. When the skin of the extremities is cold, which is always a sign of +present debility, the digestion becomes frequently impaired by association, +and cardialgia or heartburn is induced from the vinous or acetous +fermentation of the aliment. In this disease diaphoretics, which have been +called cordials, by their action on the stomach restore its exertion, and +that of the cutaneous capillaries by their association with it, and the +skin becomes warm, and the digestion more vigorous. + +10. But a blister acts with more permanent and certain effect by +stimulating a part of the skin, and thence affecting the whole of it, and +of the stomach by association, and thence removes the most obstinate +heartburns and vomitings. From this the principal use of blisters is +understood, which is to invigorate the exertions of the arterial and +lymphatic vessels of the skin, producing an increase of insensible +perspiration, and of cutaneous absorption; and to increase the action of +the stomach, and the consequent power of digestion; and thence by sympathy +to excite all the other irritative motions: hence they relieve pains of the +cold kind, which originate from defect of motion; not from their +introducing a greater pain, as some have imagined, but by stimulating the +torpid vessels into their usual action; and thence increasing the action +and consequent warmth of the whole skin, and of all the parts which are +associated with it. + +II. 1. _Sialagogues._ The preparations of mercury consist of a solution or +corrosion of that metal by some acid; and, when the dose is known, it is +probable that they are all equally efficacious. As their principal use is +in the cure of the venereal disease, they will be mentioned in the +catalogue amongst the sorbentia. Where salivation is intended, it is much +forwarded by a warm room and warm clothes; and prevented by exposing the +patient to his usual habits of cool air and dress, as the mercury is then +more liable to go off by the bowels. + +2. Any acrid drug, as pyrethrum, held in the mouth acts as a sialagogue +externally by stimulating the excretory ducts of the salivary glands; and +the siliqua hirsuta applied externally to the parotid gland, and even hard +substances in the ear, are said to have the same effect. Mastich chewed in +the mouth emulges the salivary glands. + +3. The unwise custom of chewing and smoking tobacco for many hours in a day +not only injures the salivary glands, producing dryness in the mouth when +this drug is not used, but I suspect that it also produces schirrhus of the +pancreas. The use of tobacco in this immoderate degree injures the power of +digestion, by occasioning the patient to spit out that saliva, which he +ought to swallow; and hence produces that flatulency, which the vulgar +unfortunately take it to prevent. The mucus, which is brought from the +fauces by hawking, should be spit out, as well as that coughed up from the +lungs; but that which comes spontaneously into the mouth from the salivary +glands, should be swallowed mixed with our food or alone for the purposes +of digestion. See Class I. 2. 2. 7. + +III. 1. Expectorants are supposed to increase the secretion of mucus in the +branches of the windpipe, or to increase the perspiration of the lungs +secreted at the terminations of the bronchial artery. + +2. If any thing promotes expectoration toward the end of peripneumonies, +when the inflammation is reduced by bleeding and gentle cathartics, small +repeated blisters about the chest, with tepid aqueous and mucilaginous or +oily liquids, are more advantageous than the medicines generally enumerated +under this head; the blisters by stimulating into action the vessels of the +skin produce by association a greater activity of those of the mucous +membrane, which lines the branches of the windpipe, and air-cells of the +lungs; and thus after evacuation they promote the absorption of the mucus +and consequent healing of the inflamed membrane, while the diluting liquids +prevent this mucus from becoming too viscid for this purpose, or facilitate +its expuition. + +Blisters, one at a time, on the sides or back, or on the sternum, are also +useful towards the end of peripneumonies, by preventing the evening access +of cold fit, and thence preventing the hot fit by their stimulus on the +skin; in the same manner as five drops of laudanum by its stimulus on the +stomach. For the increased actions of the vessels of the skin or stomach +excite a greater quantity of the sensorial power of association, and thus +prevent the torpor of the other parts of the system; which, when patients +are debilitated, is so liable to return in the evening. + +3. Warm bathing is of great service towards the end of peripneumony to +promote expectoration, especially in those children who drink too little +aqueous fluids, as it gently increases the action of the pulmonary +capillaries by their content with the cutaneous ones, and supplies the +system with aqueous fluid, and thus dilutes the secreted mucus. + +Some have recommended oil externally around the chest, as well as +internally, to promote expectoration; and upon the nose, when its mucous +membrane is inflamed, as in common catarrh. + +IV. 1. Diuretics. If the skin be kept warm, most of these medicines promote +sweat instead of urine; and if their dose is enlarged, most of them become +cathartic. Hence the neutral salts are used in general for all these +purposes. Those indeed, which are composed of the vegetable acid, are most +generally used as sudorifics; those with the nitrous acid as diuretics; and +those with the vitriolic acid as cathartics: while those united with the +marine acid enter our common nutriment, as a more general stimulus. All +these increase the acrimony of the urine, hence it is retained a less time +in the bladder; and in consequence less of it is reabsorbed into the +system, and the apparent quantity is greater, as more is evacuated from the +bladder; but it is not certain from thence, that a greater quantity is +secreted by the kidnies. Hence nitre, and other neutral salts, are +erroneously given in the gonorrhoea; as they augment the pain of making +water by their stimulus on the excoriated or inflamed urethra. They are +also erroneously given in catarrhs or coughs, where the discharge is too +thin and saline, as they increase the frequency of coughing. + +2. Balsam of Copaiva is thought to promote urine more than the other native +balsams; and common resin is said to act as a powerful diuretic in horses. +These are also much recommended in gleets, and in fluor albus, perhaps more +than they deserve; they give a violet smell to the urine, and hence +probably increase the secretion of it. + +Calcined egg-shells are said to promote urine, perhaps from the phosphoric +acid they contain. + +3. Cold air and cold water will increase the quantity of urine by +decreasing the absorption from the bladder; and neutral and alcalious salts +and cantharides by stimulating the neck of the bladder to discharge the +urine as soon as secreted; and alcohol as gin and rum at the beginning of +intoxication, if the body be kept cool, occasion much urine by inverting +the urinary lymphatics, and thence pouring a fluid into the bladder, which +never passed the kidnies. But it is probable, that those medicines, which +give a scent to the urine as the balsams and resins, but particularly +asparagus and garlic, are the only drugs, which truly increase the +secretion of the kidnies. Alcohol however, used as above mentioned, and +perhaps great doses of tincture of cantharides, may be considered as +drastic diuretics, as they pour a fluid into the bladder by the retrograde +action of the lymphatics, which are in great abundance spread about the +neck of it. See Sect. XXIX. 3. + +V. Mild cathartics. The ancients believed that some purges evacuated the +bile, and hence were termed Cholagogues; others the lymph, and were termed +Hydragogues; and that in most each cathartic selected a peculiar humour, +which it discharged. The moderns have too hastily rejected this system; the +subject well deserves further observation. + +Calomel given in the dose from ten to twenty grains, so as to induce +purging without the assistance of other drugs, appears to me to +particularly increase the secretion of bile, and to evacuate it; aloe seems +to increase the secretion of the intestinal mucus; and it is probable that +the pancreas and spleen may be peculiarly stimulated into action by some +other of this tribe of medicines; whilst others of them may simply +stimulate the intestinal canal to evacuate its contents, as the bile of +animals. It must be remarked, that all these cathartic medicines are +supposed to be exhibited in their usual doses, otherwise they become +drastic purges, and are treated of in the Class of Invertentia. + +VI. The mucus of the bladder is seen in the urine, when cantharides have +been used, either internally or externally, in such doses as to induce the +strangury. Spirit of turpentine is said to have the same effect. I have +given above a dram of it twice a day floating on a glass of water in +chronic lumbago without this effect, and the patient gradually recovered. + +VII. Aloe given internally seems to act chiefly on the rectum and, spincter +ani, producing tenesmus and piles. Externally in clysters or suppositories, +common salt seems to act on that bowel with greater certainty. But where +the thread-worm or ascarides exist, 60 or 100 grains of aloes reduced to +powder and boiled in a pint of gruel, and used as a clyster twice a week +for three months, has frequently destroyed them. + +VIII. The external application of cantharides by stimulating the excretory +ducts of the capillary glands produces a great secretion of subcutaneous +mucus with pain and inflammation; which mucaginous fluid, not being able to +permeate the cuticle, raises it up; a similar secretion and elevation of +the cuticle is produced by actual fire; and by caustic materials, as by the +application of the juice of the root of white briony, or bruised +mustard-seed. Experiments are wanting to introduce some acrid application +into practice instead of cantharides, which might not induce the strangury. + +Mustard-seed alone is too acrid, and if it be suffered to lie on the skin +many minutes is liable to produce a slough and consequent ulcer, and should +therefore be mixed with flour when applied to cold extremities. Volatile +alkali properly diluted might stimulate the skin without inducing +strangury. + +IX. The mild errhines are such as moderately stimulate the membrane of the +nostrils, so as to increase the secretion of nasal mucus; as is seen in +those, who are habituated to take snuff. The stronger errhines are +mentioned in Art. V. 2. 3. + +X. The secretion of tears is increased either by applying acrid substances +to the eye; or acrid vapours, which stimulate the excretory duct of the +lacrymal gland; or by applying them to the nostrils, and stimulating the +excretory duct of the lacrymal sack, as treated of in the Section on +Instinct. + +Or the secretion of tears is increased by the association of the motions of +the excretory duct of the lacrymal sack with ideas of tender pleasure, or +of hopeless distress, as explained in Sect. XVI. 8. 2. and 3. + +XI. The secretion of sensorial power in the brain is probably increased by +opium or wine, because when taken in certain quantity an immediate increase +of strength and activity succeeds for a time, with consequent debility if +the quantity taken be so great as to intoxicate in the least degree. The +necessity of perpetual respiration shews, that the oxygen of the atmosphere +supplies the source of the spirit of animation; which is constantly +expended, and is probably too fine to be long contained in the nerves after +its production in the brain. Whence it is probable, that the respiration of +oxygen gas mixed with common air may increase the secretion of sensorial +power; as indeed would appear from its exhilarating effect on most +patients. + +III. CATALOGUE OF THE SECERNENTIA. + +I. Diaphoretics. + + 1. Amomum zinziber, ginger. Caryophyllus aromaticus, cloves. Piper + indicum, pepper. Capsicum. Cardamomum. Pimento, myrtus pimenta. Canella + alba. Serpentaria virginiana, aristolochia serpentaria, guaiacum. + Sassafras, laurus sassafras. Opium. Wine. + + 2. Essential oils of cinnamon, laurus cinnamomum. Nutmeg, myristica + moschata. Cloves, caryophyllus aromaticus. Mint, mentha. Camphor, + laurus camphora. Ether. + + 3. Volatile salts, as of ammoniac and of hartshorn. Sal cornu cervi. + + 4. Neutral salts, as those with vegetable acid; or with marine acid, as + common salt. Halex. Red-herring, anchovy. + + 5. Preparations of antimony, as emetic tartar, antimonium tartarizatum, + wine of antimony. James's powder. + + 6. External applications. Blisters. Warm bath. Warm air. Exercise. + Friction. + + 7. Cold water with subsequent warmth. + +II. Sialagogues. Preparations of mercury, hydrargyrus. Pyrethrum, anthemis +pyrethrum, tobacco, cloves, pepper, cowhage, stizolobium siliqua hirsuta. +Mastich, pistacia lentiscus. + +III. Expectorants: + + 1. Squill, scilla maritima, garlic, leek, onion, allium, asafoetida, + ferula asafoetida, gum ammoniac, benzoin, tar, pix liquida, balsam of + Tolu. + + 2. Root of seneka, polygala seneka, of elicampane, inula helenium. + + 3. Marsh-mallow, althaea, coltsfoot, tussilago farfara, gum arabic, + mimosa nilotica, gum tragacanth, astragalus tragacantha. Decoction of + barley, hordeum distichon. Expressed oils. Spermaceti, soap. Extract of + liquorice, glycyrrhiza glabra. Sugar. Honey. + + 4. Externally blisters. Oil. Warm bath. + +IV. Mild diuretics. + + 1. Nitre, kali acetatum, other neutral salts. + + 2. Fixed alkali, soap, calcined egg-shells. + + 3. Turpentine. Balsam of Copaiva. Resin. Olibanum. + + 4. Asparagus, garlic, wild daucus. Parsley, apium. Fennel faeniculum, + pareira brava, Cissampelos? + + 5. Externally cold air, cold water. + + 6. Alcohol. Tincture of cantharides. Opium. + +V. Mild cathartics. + + 1. Sweet subacid fruits. Prunes, prunus domestica. Cassia sistula. + Tamarinds, crystals of tartar, unrefined sugar. Manna. Honey. + + 2. Whey of milk, bile of animals. + + 3. Neutral salts, as Glauber's salt, vitriolated tartar, sea-water, + magnesia alba, soap. + + 4. Gum guaiacum. Balsam of Peru. Oleum ricini, castor-oil, oil of + almonds, oil of olives, sulphur. + + 5. Senna, cassia senna, jalap, aloe, rhubarb, rheum palmatum. + + 6. Calomel. Emetic tartar, antimonium tartarizatum. + +VI. Secretion of mucus of the bladder is increased by cantharides, by +spirit of turpentine? + +VII. Secretion of mucus of the rectum is increased by aloe internally, by +various clysters and suppositories externally. + +VIII. Secretion of subcutaneous mucus is increased by blisters of +cantharides, by application of a thin slice of the fresh root of white +briony, by sinapisms, by root of horse-radish, cochlearia armoracia. +Volatile alcali. + +IX. Mild errhines. Marjoram. Origanum. Marum, tobacco. + +X. Secretion of tears is increased by vapour of sliced onion, of volatile +alcali. By pity, or ideas of hopeless distress. + +XI. Secretion of sensorial power in the brain is probably increased by +opium, by wine, and perhaps by oxygen gas added to the common air in +respiration. + + * * * * * + +ART. IV. + +SORBENTIA. + +I. Those things which increase the irritative motions, which constitute +absorption, are termed sorbentia; and are as various as the absorbent +vessels, which they stimulate into action. + +1. Cutaneous absorption is increased by austere acids, as of vitriol; hence +they are believed to check colliquative sweats, and to check the eruption +of small-pox, and contribute to the cure of the itch, and tinea; hence they +thicken the saliva in the mouth, as lemon-juice, crab-juice, sloes. + +2. Absorption from the mucous membrane is increased by opium, and Peruvian +bark, internally; and by blue vitriol externally. Hence the expectoration +in coughs, and the mucous discharge from the urethra, are thickened and +lessened. + +3. Absorption from the cellular membrane is promoted by bitter vegetables, +and by emetics, and cathartics. Hence matter is thickened and lessened in +ulcers by opium and Peruvian bark; and serum is absorbed in anasarca by the +operation of emetics and cathartics. + +4. Venous absorption is increased by acrid vegetables; as water-cress, +cellery, horse-radish, mustard. Hence their use in sea-scurvy, the vibices +of which are owing to a defect of venous absorption; and by external +stimulants, as vinegar, and by electricity, and perhaps by oxygen. + +5. Intestinal absorption is increased by astringent vegetables, as rhubarb, +galls; and by earthy salts, as alum; and by argillaceous and calcareous +earth. + +6. Hepatic absorption is increased by metallic salts, hence calomel and sal +martis are so efficacious in jaundice, worms, chlorosis, dropsy. + +7. Venereal virus in ulcers is absorbed by the stimulus of mercury; hence +they heal by the use of this medicine. + +8. Venesection, hunger, thirst, and violent evacuations, increase all +absorptions; hence sweating produces costiveness. + +9. Externally bitter astringent vegetables, earthy and metallic salts, and +bandages, promote the absorption of the parts on which they are applied. + +10. All these in their usual doses do not increase the natural heat; but +they induce costiveness, and deep coloured urine with earthy sediment. + +In greater doses they invert the motions of the stomach and lacteals; and +hence vomit or purge, as carduus benedictus, rhubarb. They promote +perspiration, if the skin be kept warm; as camomile tea, and testaceous +powders, have been used as sudorifics. + +The preparations of antimony vomit, purge, or sweat, either according to +the quantity exhibited, or as a part of what is given is evacuated. Thus a +quarter of a grain of emetic tartar (if well prepared) will promote a +diaphoresis, if the skin be kept warm; half a grain will procure a stool or +two first, and sweating afterwards; and a grain will generally vomit, and +then purge, and lastly sweat the patient. In less quantity it is probable, +that this medicine acts like other metallic salts, as steel, zinc, or +copper in small doses; that is, that it strengthens the system by its +stimulus. As camomile or rhubarb in different doses vomit, or purge, or act +as stimulants so as to strengthen the system. + +II. OBSERVATIONS ON THE SORBENTIA. + +I. 1. As there is great difference in the apparent structure of the various +glands, and of the fluids which they select from the blood, these glands +must possess different kinds of irritability, and are therefore stimulated +into stronger or unnatural actions by different articles of the materia +medica, as shewn in the secernentia. Now as the absorbent vessels are +likewise glands, and drink up or select different fluids, as chyle, water, +mucus, with a part of every different secretion, as a part of the bile, a +part of the saliva, a part of the urine, &c. it appears, that these +absorbent vessels must likewise possess different kinds of irritability, +and in consequence must require different articles of the materia medica to +excite them into unusual action. This part of the subject has been so +little attended to, that the candid reader will find in this article a +great deal to excuse. + +It was observed, that some of the secernentia did in a less degree increase +absorption, from the combination of different properties in the same +vegetable body; for the same reason some of the class of sorbentia produce +secretion in a less degree, as those bitters which have also an aroma in +their composition; these are known from their increasing the heat of the +system above its usual degree. + +It must also be noted, that the actions of every part of the absorbent +system are so associated with each other, that the drugs which stimulate +one branch increase the action of the whole; and the torpor or quiescence +of one branch weakens the exertions of the whole; or when one branch is +excited into stronger action, some other branch has its actions weakened or +inverted. Yet though peculiar branches of the absorbent system are +stimulated into action by peculiar substances, there are other substances +which seem to stimulate the whole system, and that without immediately +increasing any of the secretions; as those bitters which possess no +aromatic scent, at the head of which stands the famed Peruvian bark, or +cinchona. + +2. Cutaneous absorption. I have heard of some experiments, in which the +body was kept cold, and was thought to absorb more moisture from the +atmosphere than at any other time. This however cannot be determined by +statical experiments; as the capillary vessels, which secrete the +perspirable matter, must at the same time have been benumbed by the cold; +and from their inaction there could not have been the usual waste of the +weight of the body; and as all other muscular exertions are best performed, +when the body possesses its usual degree of warmth, it is conclusive, that +the absorbent system should likewise do its office best, when it is not +benumbed by external cold. + +The austere acids, as of vitriol, lemon-juice, juice of crabs and sloes, +strengthen digestion, and prevent that propensity to sweat so usual to weak +convalescents, and diminish the colliquative sweats in hectic fevers; all +which are owing to their increasing the action of the external and internal +cutaneous absorption. Hence vitriolic acid is given in the small-pox to +prevent the too hasty or too copious eruption, which it effects, by +increasing the cutaneous absorption. Vinegar, from the quantity of alcohol +which it contains, exerts a contrary effect to that here described, and +belongs to the incitantia; as an ounce of it promotes sweat, and a flushing +of the skin; at the same time externally it acts as a venous absorbent, as +the lips become pale by moistening them with it. And it is said, when taken +internally in great and continued quantity, to induce paleness of the skin, +and softness of the bones. + +The sweet vegetable acids, as of several ripe fruits, are among the +torpentia; as they are less stimulating than the general food of this +climate, and are hence used in inflammatory diseases. + +Where the quantity of fluids in the system is much lessened, as in hectic +fever, which has been of some continuance, or in spurious peripneumony, a +grain of opium given at night will sometimes prevent the appearance of +sweats; which is owing to the stimulus of opium increasing the actions of +the cutaneous absorbents, more than those of the secerning vessels of the +skin. Whence the secretion of perspirable matter is not decreased, but its +appearance on the skin is prevented by its more facile absorption. + +3. There is one kind of itch, which seldom appears between the fingers, is +the least infectious, and most difficult to eradicate, and which has its +cure much facilitated by the internal use of acid of vitriol. This disease +consists of small ulcers in the skin, which are healed by whatever +increases the cutaneous absorption. The external application of sulphur, +mercury, and acrid vegetables, acts on the same principle; for the +animalcula, which are seen in these pustules, are the effect, not the +cause, of them; as all other stagnating animal fluids, as the semen itself, +abounds with similar microscopic animals. + +4. Young children have sometimes an eruption upon the head called Tinea, +which discharges an acrimonius ichor inflaming the parts, on which it +falls. This eruption I have seen submit to the internal use of vitriolic +acid, when only wheat-flour was applied externally. This kind of eruption +is likewise frequently cured by testaceous powders; two materials so widely +different in their chemical properties, but agreeing in their power of +promoting cutaneous absorption. + +II. Absorption from the mucous membrane is increased by applying to its +surface the austere acids, as of vitriol, lemon-juice, crab-juice, sloes. +When these are taken into the mouth, they immediately thicken, and at the +same time lessen the quantity of the saliva; which last circumstance cannot +be owing to their coagulating the saliva, but to their increasing the +absorption of the thinner parts of it. So alum applied to the tip of the +tongue does not stop in its action there, but independent of its diffusion +it induces cohesion and corrugation over the whole mouth. (Cullen's Mat. +Med. Art. Astringentia.) Which is owing to the association of the motions +of the parts or branches of the absorbent system with each other. + +Absorption from the mucous membrane is increased by opium taken internally +in small doses more than by any other medicine, as is seen in its +thickening the expectoration in coughs, and the discharge from the nostrils +in catarrh, and perhaps the discharge from the urethra in gonorrhoea. The +bark seems next in power for all these purposes. + +Externally slight solutions of blue vitriol, as two or three grains to an +ounce of water, applied to ulcers of the mouth, or to chancres on the glans +penis, more powerfully induces them to heal than any other material. + +Where the lungs or urethra are inflamed to a considerable degree, and the +absorption is so great, that the mucus is already too thick, and adheres to +the membrane from its viscidity, opiates and bitter vegetable and austere +acids are improper; and mucilaginous diluents should be used in their stead +with venesection and torpentia. + +III. 1. Absorption from the cellular membrane, and from all the other +cavities of the body, is too slowly performed in some constitutions; hence +the bloated pale complexion; and when this occurs in its greatest degree, +it becomes an universal dropsy. These habits are liable to intermittent +fevers, hysteric paroxysms, cold extremities, indigestion, and all the +symptoms of debility. + +The absorbent system is more subject to torpor or quiescence than the +secerning system, both from the coldness of the fluids which are applied to +it, as the moisture of the atmosphere, and from the coldness of the fluids +which we drink; and also from its being stimulated only by intervals, as +when we take our food; whereas the secerning system is perpetually excited +into action by the warm circulating blood; as explained in Sect. XXXII. + +2. The Peruvian bark, camomile flowers, and other bitter drugs, by +stimulating this cellular branch of the absorbent system prevents it from +becoming quiescent; hence the cold paroxysms of those agues, which arise +from the torpor of the cellular lymphatics, are prevented, and the hot fits +in consequence. The patient thence preserves his natural heat, regains his +healthy colour, and his accustomed strength. + +Where the cold paroxysm of an ague originates in the absorbents of the +liver, spleen, or other internal viscus, the addition of steel to vegetable +bitters, and especially after the use of one dose of calomel, much advances +the cure. + +And where it originates in any part of the secerning system, as is probably +the case in some kinds of agues, the addition of opium in the dose of a +grain and half, given about an hour before the access of the paroxysm, or +mixed with chalybeate and bitter medicines, ensures the cure. Or the same +may be effected by wine given instead of opium before the paroxysm, so as +nearly to intoxicate. + +These three kinds of agues are thus distinguished; the first is not +attended with any tumid or indurated viscus, which the people call an ague +cake, and which is evident to the touch. The second is accompanied with a +tumid viscus; and the last has generally, I believe, the quartan type, and +is attended with some degree of arterial debility. + +3. This class of absorbent medicines are said to decrease irritability. +After any part of our system has been torpid or quiescent, by whatever +cause that was produced, it becomes afterwards capable of being excited +into greater motion by small stimuli; hence the hot fit of fever succeeds +the cold one. As these medicines prevent torpor or quiescence of parts of +the system, as cold hands or feet, which perpetually happen to weak +constitutions, the subsequent increase of irritability of these parts is +likewise prevented. + +4. These absorbent medicines, including both the bitters, and metallic +salts, and opiates, are of great use in the dropsy by their promoting +universal absorption; but here evacuations are likewise to be produced, as +will be treated of in the Invertentia. + +5. The matter in ulcers is thickened, and thence rendered less corrosive, +the saline part of it being reabsorbed by the use of bitter medicines; +hence the bark is used with advantage in the cure of ulcers. + +6. Bitter medicines strengthen digestion by promoting the absorption of +chyle; hence the introduction of hop into the potation used at our meals, +which as a medicine may be taken advantageously, but, like other +unnecessary stimuli, must be injurious as an article of our daily diet. + +The hop may perhaps in some degree contribute to the production of gravel +in the kidnies, as our intemperate wine-drinkers are more subject to the +gout, and ale-drinkers to the gravel; in the formation of both which +diseases, there can be no doubt, but that the alcohol is the principal, if +not the only agent. + +7. Vomits greatly increase the absorption from the cellular membrane, as +squill, and foxglove. The squill should be given in the dose of a grain of +the dried root every hour, till it operates upwards and downwards. Four +ounces of the fresh leaves of the foxglove should be boiled from two pounds +of water to one, and half an ounce of the decoction taken every two hours +for four or more doses. This medicine by stimulating into inverted action +the absorbents of the stomach, increases the direct action of the cellular +lymphatics. + +Another more convenient way of ascertaining the dose of foxglove is by +making a saturated tincture of it in proof spirit; which has the twofold +advantage of being invariable in its original strength, and of keeping a +long time as a shop-medicine without losing any of its virtue. Put two +ounces of the leaves of purple foxglove, digitalis purpurea, nicely dried, +and coarsely powdered, into a mixture of four ounces of rectified spirit of +wine and four ounces of water; let the mixture stand by the fire-side +twenty-four hours frequently shaking the bottle, and thus making a +saturated tincture of digitalis; which must be poured from the sediment or +passed through filtering paper. + +As the size of a drop is greater or less according to the size of the rim +of the phial from which it is dropped, a part of this saturated tincture is +then directed to be put into a two-ounce phial, for the purpose of +ascertaining the size of the drop. Thirty drops of this tincture is +directed to be put into an ounce of mint-water for a draught to be taken +twice or thrice a day, till it reduces the anasarca of the limbs, or +removes the difficulty of breathing in hydrothorax, or till it induces +sickness. And if these do not occur in two or three days, the dose must be +gradually increased to forty or sixty drops, or further. + +From the great stimulus of this medicine the stomach is rendered torpid +with consequent sickness, which continues many hours and even days, owing +to the great exhaustion of its sensorial power of irritation; and the +action of the heart and arteries becomes feeble from the deficient +excitement of the sensorial power of association; and lastly, the +absorbents of the cellular membrane act more violently in consequence of +the accumulation of the sensorial power of association in the torpid heart +and arteries, as explained in Suppl. I. 12. + +A circumstance curiously similar to this occurs to some people on smoking +tobacco for a short time, who have not been accustomed to it. A degree of +sickness is presently induced, and the pulsations of the heart and arteries +become feeble for a short time, as in the approach to fainting, owing to +the direct sympathy between these and the stomach, that is from defect of +the excitement of the power of association. Then there succeeds a tingling, +and heat, and sometimes sweat, owing to the increased action of the +capillaries, or perspirative and mucous glands; which is occasioned by the +accumulation of the sensorial power of association by the weaker action of +the heart and arteries, which now increases the action of the capillaries. + +8. Another method of increasing absorption from the cellular membrane is by +warm air, or by warm steam. If the swelled legs of a dropsical patient are +inclosed in a box, the air of which is made warm by a lamp or two, copious +sweats are soon produced by the increased action of the capillary glands, +which are seen to stand on the skin, as it cannot readily exhale in so +small a quantity of air, which is only changed so fast as may be necessary +to permit the lamps to burn. At the same time the lymphatics of the +cellular membrane are stimulated by the heat into greater action, as +appears by the speedy reduction of the tumid legs. + +It would be well worth trying an experiment upon a person labouring under a +general anasarca by putting him into a room filled with air heated to 120 +or 130 degrees, which would probably excite a great general diaphoresis, +and a general cellular absorption both from the lungs and every other part. +And that air of so great heat may be borne for many minutes without great +inconvenience was shewn by the experiments made in heated rooms by Dr. +Fordyce and others. Philos. Trans. + +Another experiment of using warmth in anasarca, or in other diseases, might +be by immersing the patient in warm air, or in warm steam, received into an +oil-skin bag, or bathing-tub of tin, so managed, that the current of warm +air or steam should pass round and cover the whole of the body except the +head, which might not be exposed to it; and thus the absorbents of the +lungs might be induced to act more powerfully by sympathy with the skin, +and not by the stimulus of heat. See Uses of Warm Bath, Art. II. 2. 2. 1. + +IV. 1. Venous absorption. Cellary, water-cresses, cabbages, and many other +vegetables of the Class Tetradynamia, do not increase the heat of the body +(except those whose acrimony approaches to corrosion), and hence they seem +alone, or principally, to act on the venous system; the extremities of +which we have shewn are absorbents of the red blood, after it has passed +the capillaries and glands. + +2. In the sea-scurvy and petechial fever the veins do not perfectly perform +this office of absorption; and hence the vibices are occasioned by blood +stagnating at their extremities, or extravasated into the cellular +membrane. And this class of vegetables, stimulating the veins to perform +their natural absorption, without increasing the energy of the arterial +action, prevents future petechiae, and may assist the absorption of the +blood already stagnated, as soon as its chemical change renders it proper +for that operation. + +3. The fluids, which are extravasated, and received into the cells of the +cellular membrane, seem to continue there for many days, so as to undergo +some chemical change, and are then taken up again by the mouths of the +cellular absorbents. But the new vessels produced in inflamed parts, as +they communicate with the veins, are probably absorbed again by the veins +along with the blood which they contain in their cavities. Hence the blood, +which is extravasated in bruises or vibices, is gradually many days in +disappearing; but after due evacuations the inflamed vessels on the white +of the eye, if any stimulant lotion is applied, totally disappear in a few +hours. + +Amongst absorbents affecting the veins we should therefore add the external +application of stimulant materials; as of vinegar, which makes the lips +pale on touching them. Friction, and electricity. + +4. Haemorrhages are of two kinds, either arterial, which are attended with +inflammation; or venous, from a deficiency in the absorbent power of this +set of vessels. In the former case the torpentia are efficacious; in the +latter steel, opium, alum, and all the tribe of sorbentia, are used with +success. + +5. Sydenham recommends vegetables of the class Tetradynamia in rheumatic +pains left after the cure of intermittents. These pains are perhaps similar +to those of the sea-scurvy, and seem to arise from want of absorption in +the affected part, and hence are relieved by the same medicines. + +V. 1. Intestinal absorption. Some astringent vegetables, as rhubarb, may be +given in such doses as to prove cathartic; and, after a part of it is +evacuated from the body, the remaining part augments the absorption of the +intestines; and acts, as if a similar dose had been exhibited after the +operation of any other purgative. Hence 4 grains of rhubarb strengthen the +bowels, 30 grains first empty them. + +2. The earthy salts, as alum, increase the intestinal absorption, and hence +induce constipation in their usual dose; alum is said sometimes to cure +intermittents, perhaps when their seat is in the intestines, when other +remedies have failed. It is useful in the diabaetes by exciting the +absorbents of the bladder into their natural action; and combined with +resin is esteemed in the fluor albus, and in gleets. Lime-stone or chalk, +and probably gypsum, possess effects in some degree similar, and increase +the absorption of the intestines; and thus in certain doses restrain some +diarrhoeas, but in greater doses alum I suppose will act as a cathartic. +Five or ten grains produce constipation, 20 or 30 grains are either emetic +or cathartic. + +3. Earth of alum, tobacco-pipe clay, marl, Armenian bole, lime, crab's eyes +or claws, and calcined hartshorn, or bone ashes, restrain fluxes; either +mechanically by supplying something like mucilage, or oil, or rollers to +abate the friction of the aliment over inflamed membranes; or by increasing +their absorption. The two last consist of calcareous earth united to +phosphoric acid, and the Armenian bole and marl may contain iron. By the +consent between the intestines and the skin 20 grains of Armenian bole +given at going into bed to hectic patients will frequently check their +tendency to sweat as well as to purge, and the more certainly if joined +with one grain of opium. + +VI. 1. Absorption from the liver, stomach, and other viscera. When +inflammations of the liver are subdued to a certain degree by venesection, +with calomel and other gentle purges, so that the arterial energy becomes +weakened, four or eight grains of iron-filings, or of salt of steel, with +the Peruvian bark, have wonderful effect in curing the cough, and restoring +the liver to its usual size and sanity; which it seems to effect by +increasing the absorption of this viscus. The same I suppose happens in +respect to the tumours of other viscera, as of the spleen, or pancreas, +some of which are frequently enlarged in agues. + +2. Haemorrhages from the nose, rectum, kidnies, uterus, and other parts, +are frequently attendant on diseased livers; the blood being impeded in the +vena portarum from the decreased power of absorption, and in consequence of +the increased size of this viscus. These haemorrhages after venesection, +and a mercurial cathartic, are most certainly restrained by steel alone, or +joined with an opiate; which increase the absorption, and diminish the size +of the liver. + +Chalybeates may also restrain these haemorrhages by their promoting venous +absorption, though they exert their principal effect upon the liver. Hence +also opiates, and bitters, and vitriolic acid, are advantageously used +along with them. It must be added that some haemorrhages recur by periods +like the paroxysms of intermittent fevers, and are thence cured by the same +treatment. + +3. The jaundice is frequently caused by the insipidity of the bile, which +does not stimulate the gall-bladder and bile-ducts into their due action; +hence it stagnates in the gall-bladder, and produces a kind of +crystallization, which is too large to pass into the intestines, blocks up +the bile-duct, and occasions a long and painful disease. A paralysis of the +bile duct produces a similar jaundice, but without pain. + +4. Worms in sheep called flukes are owing to the dilute state of the bile; +hence they originate in the intestines, and thence migrate into the biliary +ducts, and corroding the liver produce ulcers, cough, and hectic fever, +called the rot. In human bodies it is probable the inert state of the bile +is one cause of the production of worms; which insipid state of the bile is +owing to deficient absorption of the thinner parts of it; hence the pale +and bloated complexion, and swelled upper lip, of wormy children, is owing +to the concomitant deficiency of absorption from the cellular membrane. +Salt of steel, or the rust of it, or filings of it, with bitters, increase +the acrimony of the bile by promoting the absorption of its aqueous part; +and hence destroy worms, as well as by their immediate action on the +intestines, or on the worms themselves. The cure is facilitated by +premising a purge with calomel. See Class I. 2. 3. 9. + +5. The chlorosis is another disease owing to the deficient action of the +absorbents of the liver, and perhaps in some degree also to that of the +secretory vessels, or glands, which compose that viscus. Of this the want +of the catameniae, which is generally supposed to be a cause, is only a +symptom or consequence. In this complaint the bile is deficient perhaps in +quantity, but certainly in acrimony, the thinner parts not being absorbed +from it. Now as the bile is probably of great consequence in the process of +making the blood; it is on this account that the blood is so destitute of +red globules; which is evinced by the great paleness of these patients. As +this serous blood must exert less stimulus on the heart, and arteries, the +pulse in consequence becomes quick as well as weak, as explained in Sect. +XII. 1. 4. + +The quickness of the pulse is frequently so great and permanent, that when +attended by an accidental cough, the disease may be mistaken for hectic +fever; but is cured by chalybeates, and bitters exhibited twice a day; with +half a grain of opium, and a grain of aloe every night; and the expected +catamenia appears in consequence of a restoration of the due quantity of +red blood. This and the two former articles approach to the disease termed +paralysis of the liver. Sect. XXX. 1. 4. + +6. It seems paradoxical, that the same treatment with chalybeates, bitters, +and opiates, which produces menstruation in chlorotic patients, should +repress the too great or permanent menstruation, which occurs in weak +constitutions at the time of life when it should cease. This complaint is +an haemorrhage owing to the debility of the absorbent power of the veins, +and belongs to the paragraph on venous absorption above described, and is +thence curable by chalybeates, alum, bitters, and particularly by the +exhibition of a grain of opium every night with five grains of rhubarb. + +7. Metallic salts supply us with very powerful remedies for promoting +absorption in dropsical cases; which frequently are caused by enlargement +of the liver. First, as they may be given in such quantities as to prove +strongly cathartic, of which more will be said in the article on +invertentia; and then, when their purgative quality ceases, like the effect +of rhubarb, their absorbent quality continues to act. The salts of mercury, +silver, copper, iron, zinc, antimony, have all been used in the dropsy; +either singly for the former purpose, or united with bitters for the +latter, and occasionally with moderate but repeated opiates. + +8. From a quarter of a grain to half a grain of blue vitriol given every +four or six hours, is said to be very efficacious in obstinate +intermittents; which also frequently arise from an enlarged viscus, as the +liver or spleen, and are thence owing to the deficient absorption of the +lymphatics of that viscus. A quarter of a grain of white arsenic, as I was +informed by a surgeon of the army, cures a quartan ague with great +certainty, if it be given an hour before the expected fit. This dose he +said was for a robust man, perhaps one eighth of a grain might be given and +repeated with greater safety and equal efficacy. + +Dr. Fowler has given many successful cases in his treatise on this subject. +He prepares it by boiling sixty-four grains of white arsenic in a Florence +flask along with as much pure vegetable fixed alcali in a pint of distilled +water, till it is dissolved, and then adding to it as much distilled water +as will make the whole exactly sixteen ounces. Hence there are four grains +of arsenic in every ounce of the solution. This should be put into a phial +of such a size of the edge of its aperture, that sixty drops may weigh one +dram, which will contain half a grain of arsenic. To children from two +years old to four he gives from two to five drops three or four times a +day. From five years old to seven, he directs seven or eight drops. From +eight years old to twelve, he directs from seven to ten drops. From +thirteen years old to eighteen he directs from ten to twelve drops. From +eighteen upwards, twelve drops. In so powerful a medicine it is always +prudent to begin with smaller doses, and gradually to increase them. + +A saturated solution of arsenic in water is preferable I think to the above +operose preparation of it; as no error can happen in weighing the +ingredients, and it more certainly therefore possesses an uniform strength. +Put much more white arsenic reduced to powder into a given quantity of +distilled water, than can be dissolved in it. Boil it for half an hour in a +Florence flask, or in a tin sauce-pan; let it stand to subside, and filter +it through paper. My friend Mr. Greene, a surgeon at Brewood in +Staffordshire, assured me, that he had cured in one season agues without +number with this saturated solution; that he found ten drops from a +two-ounce phial given thrice a day was a full dose for a grown person, but +that he generally began with five. + +9. The manner, in which arsenic acts in curing intermittent fevers, cannot +be by its general stimulus, because no intoxication or heat follows the use +of it; nor by its peculiar stimulus on any part of the secreting system, +since it is not in small doses succeeded by any increased evacuation, or +heat, and must therefore exert its power, like other articles of the +sorbentia, on the absorbent system. In what manner it destroys life so +suddenly is difficult to understand, as it does not intoxicate like many +vegetable poisons, nor produce fevers like contagious matter. When applied +externally it seems chemically to destroy the part like other caustics. +Does it chemically destroy the stomach, and life in consequence? or does it +destroy the action of the stomach by its great stimulus, and life in +consequence of the sympathy between the stomach and the heart? This last +appears to be the most probable mode of its operation. + +The success of arsenic in the cure of intermittent fevers I suspect to +depend on its stimulating the stomach into stronger action, and thus, by +the association of this viscus with the heart and arteries, preventing the +torpor of any part of the sanguiferous system. I was led to this conclusion +from the following considerations. + +First. The effects of arsenic given a long time internally in small doses, +or when used in larger quantities externally, seem to be similar to those +of other great stimuli, as of wine or alcohol. These are a bloated +countenance, swelled legs, hepatic tumours, and dropsy, and sometimes +eruptions on the skin. The former of these I have seen, where arsenic has +been used externally for curing the itch; and the latter appears on +evidence in the famous trial of Miss Blandy at Chelmsford, about forty +years ago. + +Secondly. I saw an ague cured by arsenic in a child, who had in vain +previously taken a very large quantity of bark with great regularity. And +another case of a young officer, who had lived intemperately, and laboured +under an intermittent fever, and had taken the bark repeatedly in +considerable quantities, with a grain of opium at night, and though the +paroxysms had been thrice thus for a time prevented, they recurred in about +a week. On taking five drops of a saturated solution of arsenic thrice a +day the paroxysms ceased, and returned no more, and at the same time his +appetite became much improved. + +Thirdly. A gentleman about 65 years of age had for about ten years been +subject to an intermittent pulse, and to frequent palpitations of his +heart. Lately the palpitations seemed to observe irregular periods, but the +intermission of every third or fourth pulsation was almost perpetual. On +giving him four drops of a saturated solution of arsenic from a two-ounce +phial about every four hours for one day, not only the palpitation did not +return, but the intermission ceased entirely, and did not return so long as +he took the medicine, which was three or four days. + +Now as when the stomach has its action much weakened by an over-dose of +digitalis, the pulse is liable to intermit, this evinces a direct sympathy +between these parts of the system, and as I have repeatedly observed, that +when the pulse begins to intermit in elderly people, that an eructation +from the stomach, voluntarily produced, will prevent the threatened stop of +the heart; I am induced to think, that the torpid state of the stomach, at +the instant of the production of air occasioned by its weak action, caused +the intermission of the pulse. And that arsenic in this case, as well as in +the cases of agues above mentioned, produced its effects by stimulating the +stomach into more powerful action; and that the equality of the motions of +the heart was thus restored by increasing the excitement of the sensorial +power of association. See Sect. XXV. 17. Class IV. 2. 1. 18. + +10. Where arsenic has been given as a poison, it may be discovered in the +contents of the stomach by the smell like garlic, when a few grains of it +are thrown on a red-hot iron. 2. If a few grains are placed between two +plates of copper, and subjected to a red heat, the copper becomes whitened. +3. Dissolve arsenic in water along with vegetable alcali, add to this a +solution of blue vitriol in water, and the mixture becomes of a fine green, +which gradually precipitates, as discovered by Bergman. 4. Where the +quantity is sufficient, some wheat may be steeped in a solution of it, +which given to sparrows or chickens will destroy them. + +VII. Absorption of the matter from venereal ulcers. No ulcer can heal, +unless the absorption from it is as great as the deposition in it. The +preparations or oxydes of mercury in the cure of the venereal disease seem +to act by their increasing the absorption of the matter in the ulcers it +occasions; and that whether they are taken into the stomach, or applied on +the skin, or on the surface of the ulcers. And this in the same manner as +sugar of lead, or other metallic oxydes, promote so rapidly the healing of +other ulcers by their external application; and probably when taken +internally, as rust of iron given to children affected with scrophulous +ulcers contributes to heal them, and solutions of lead were once famous in +phthisis. + +The matter deposited in large abscesses does not occasion hectic fever, +till it has become oxygenated by being exposed to the open air, or to the +air through a moist membrane; the same seems to happen to other kinds of +matter, which produce fever, or which occasion spreading ulcers, and are +thence termed contagious. See Class II. 1. 3. II. 1. 5. II. 1. 6. 6. This +may perhaps occur from these matters not being generally absorbed, till +they become oxygenated; and that it is the stimulus of the acid thus formed +by their union with oxygen, which occasions their absorption into the +circulation, and the fever, which they then produce. For though collections +of matter, and milk, and mucus, are sometimes suddenly absorbed during the +action of emetics or in sea-sickness, they are probably eliminated from the +body without entering the circulation; that is, they are taken up by the +increased action of one lymphatic branch, and evacuated by the inverted +action of some other lymphatic branch, and thus carried off by stool or +urine. + +But as the matter in large abscesses is in general not absorbed, till it +becomes by some means exposed to air, there is reason to conclude, that the +stimulus of this new combination of the matter with oxygen occasions its +absorption; and that hence the absorption of matter in ulcers of all kinds, +is still more powerfully effected by the external application or internal +use of metallic oxydes; which are also acids consisting of the metal united +with oxygen; and lastly, because venereal ulcers, and those of itch, and +tinea, will not heal without some stimulant application; that is, the +secretion of matter in them continues to be greater, than the absorption of +it; and the ulcers at the same time continue to enlarge, by the contagion +affecting the edges of them; that is, by the stimulus of the oxygenated +matter stimulating the capillary vessels in its vicinity into actions +similar to those of the ulcer, which produces it. + +This effect of the oxydes of mercury occurs, whether salivation attends its +use or not. Salivation is much forwarded by external warmth, when mercury +is given to promote this secretion; but as the cure of venereal complaints +depends on its absorbent quality, the act of salivation is not necessary or +useful. A quarter of a grain of good corrosive sublimate twice a day will +seldom fail of curing the most confirmed pox; and will as seldom salivate, +if the patient be kept cool. A quarter of a grain thrice a day I believe to +be infallible, if it be good sublimate. + +Mercury alone when swallowed does not act beyond the intestines, its active +preparations are the salts formed by its union with the various acids, as +mentioned in the catalogue. Its union with the vegetable acid, when +triturated with manna, is said to compose Keyser's Pill. Triturated with +gum arabic it is much recommended by Plenk; and triturated with sugar and a +little essential oil, as directed in a former Edinburgh Dispensatory, it +probably forms some of the syrups sold as nostrums. + +United with sulphur it seldom enters the circulation, as when cinnabar, or +Aethiop's mineral, are taken inwardly. But united with fat and rubbed on +the skin, it is readily absorbed. I know not whether it can be united to +charcoal, nor whether it has been given internally when united with animal +fat. + +VIII. 1. Absorptions in general are increased by inanition; hence the use +of evacuations in the cure of ulcers. Dr. Jurin absorbed in one night, +after a day's abstinence and exercise, eighteen ounces from the atmosphere +in his chamber; and every one must have observed, how soon his sheets +became dry, after having been moistened by sweat, if he throws off part of +the bed-clothes to cool himself; which is owing to the increased cutaneous +absorption after the evacuation by previous sweat. + +2. Now as opium is an universal stimulant, as explained in the article on +Incitantia, it must stimulate into increased action both the secretory +system, and the absorbent one; but after repeated evacuation by +venesection, and cathartics, the absorbent system is already inclined to +act more powerfully; as the blood-vessels being less distended, there is +less resistance to the progress of the absorbed fluids into them. Hence +after evacuations opium promotes absorption, if given in small doses, much +more than it promotes secretion; and is thus eminently of service at the +end of inflammations, as in pleurisy, or peripneumony, in the dose of four +or five drops of the tincture, given before the access of the evening +paroxysm; which I have seen succeed even when the risus sardonicus has +existed. Some convulsions may originate in the want of the absorption of +some acrid secretion, which occasions pain; hence these diseases are so +much more certainly relieved by opium after venesection or other +evacuations. + +IX. 1. Absorption is increased by the calces or solutions of mercury, lead, +zinc, copper, iron, externally applied; and by arsenic, and by sulphur, and +by the application of bitter vegetables in fine powder. Thus an ointment +consisting of mercury and hog's fat rubbed on the skin cures venereal +ulcers; and many kinds of herpetic eruptions are removed by an ointment +consisting of 60 grains of white precipitate of mercury and an ounce of +hog's fat. + +2. The tumours about the necks of young people are often produced by the +absorption of a saline or acrid material, which has been deposited from +eruptions behind the ears, owing to deficient absorption in the surface of +the ulcer, but which on running down on the skin below becomes absorbed, +and swells the lymphatic glands of the neck; as the variolous matter, when +inserted into the arm, swells the gland of the axilla. Sometimes the +perspirative matter produced behind the ears becomes putrid from the want +of daily washing them, and may also cause by its absorption the tumours of +the lymphatics of the neck. In the former case the application of a cerate +of lapis calaminaris, or of cerussa applied in dry powder, or of rags +dipped in a solution of sugar of lead, increases the absorption in the +ulcers, and prevents the effusion of the saline part of the secreted +material. The latter is to be prevented by cleanliness. + +After the eruptions or ulcers are healed a solution of corrosive sublimate +of one grain to an ounce of water applied for some weeks behind the ear, +and amongst the roots of the hair on one side of the head, where the mouths +of the lymphatics of the neck open themselves, frequently removes these +tumours. + +3. Linen rags moistened with a solution of half an ounce of sugar of lead +to a pint of water applied on the erysipelas on anasarcous legs, which have +a tendency to mortification, is more efficacious than other applications. +White vitriol six grains dissolved in one ounce of rose-water removes +inflammations of the eyes after evacuation more certainly than solutions of +lead. Blue vitriol two or three grains dissolved in an ounce of water cures +ulcers in the mouth, and other mucous membranes, and a solution of arsenic +externally applied cures the itch, but requires great caution in the use of +it. See Class II. 1. 5. 6. + +4. Bitter vegetables, as the Peruvian bark, quilted between two shirts, or +strewed in their beds, will cure the ague in children sometimes. Iron in +solution, and some bitter extract, as in the form of ink, will cure one +kind of herpes called the ringworm. And I have seen seven parts of bark in +fine powder mixed with one part of ceruss, or white lead, in fine powder, +applied dry to scrophulous ulcers, and renewed daily, with great advantage. + +5. To these should be added electric sparks and shocks, which promote the +absorption of the vessels in inflamed eyes of scrophulous children; and +disperse, or bring to suppuration, scrophulous tumours about the neck. For +this last purpose smart shocks should be passed through the tumours only, +by inclosing them between two brass knobs communicating with the external +and internal coating of a charged phial. See Art. II. 2. 2. 2. + +X. 1. Bandages increase absorption, if they are made to fit nicely on the +part; for which purpose it is necessary to spread some moderately adhesive +plaster on the bandage, and to cut it into tails, or into shreds two inches +wide; the ends are to be wrapped over each other; and it must be applied +when the part is least tumid, as in the morning before the patient rises, +if on the lower extremities. The emplastrum de minio made to cover the +whole of a swelled leg in this manner, whether the swelling is hard, which +is usually termed scorbutic; or more easily compressible, as in anasarca, +reduces the limb in two or three days to its natural size; for this purpose +I have sometimes used carpenter's glue, mixed with one twentieth part of +honey to prevent its becoming too hard, instead of a resinous plaster; but +the minium plaster of the shops is in general to be preferred. Nothing so +much facilitates the cure of ulcers in the legs, as covering the whole limb +from the toes to the knee with such a plaster-bandage; which increases the +power of absorption in the surface of the sore. + +2. The lymph is carried along the absorbent vessels, which are replete with +valves, by the intermitted pressure of the arteries in their neighbourhood. +Now if the external skin of the limb be lax, it rises, and gives way to the +pressure of the arteries at every pulsation; and thence the lymphatic +vessels are subject to the pressure of but half the arterial force. But +when the external skin is tightened by the surrounding bandage, and thence +is not elevated by the arterial diastole, the whole of this power is +exerted in compressing the lymphatic vessels, and carrying on the lymph +already absorbed; and thence the absorbent power is so amazingly increased +by bandage nicely applied. Pains are sometimes left in the fleshy parts of +the thighs or arms, after the inflammation is gone, in the acute +rheumatism, or after the patient is too weak for further evacuation; in +this case after internal absorbent medicines, as the bark, and opiates, +have been used in vain, I have successfully applied a plaster-bandage, as +above described, so as to compress the pained part. + +XI. 1. We shall conclude by observing, that the sorbentia strengthen the +whole habit by preventing the escape of the fluid part of the secretions +out of the body, before it has given up as much nourishment, as it is +capable; as the liquid part of the secretion of urine, sweat, saliva, and +of all other secretions, which are poured into receptacles. Hence they have +been said to brace the body, and been called tonics, which are mechanical +terms not applicable to the living bodies of animals; as explained in Sect. +XXXII. 3. 2. + +2. A continued use of bitter medicines for years together, as of Portland's +powder, or of the bark, is supposed to induce apoplexy, or other fatal +diseases. Two cases of this kind have fallen under my observation; the +patients were both rather intemperate in respect to the use of fermented +liquors, and one of them had been previously subject to the gout. As I +believe the gout generally originates from a torpor of the liver, which +instead of being succeeded by an inflammation of it, is succeeded by an +inflammation of some of the joints; or by a pimpled face, which is another +mode, by which the disease of the liver is terminated. I conceive, that the +daily use of bitter medicine had in these patients prevented the removal of +a gouty inflammation from the liver to the membranes of the joints of the +extremities, or to the skin of the face, by preventing the necessary torpor +of these parts previous to the inflammation of them; in the same manner as +cold fits of fever are prevented by the same medicines; and, as I believe, +the returns of the gout have sometimes for two or three years been +prevented by them. + +One of these patients died of the apoplexy in a few hours; and the other of +an inflammation of the liver, which I believe was called the gout, and in +consequence was not treated by venesection, and other evacuations. From +hence it appears, that the daily use of hop in our malt liquor must add to +the noxious quality of the spirit in it, when taken to excess, and +contribute to the production of apoplexy, or inflammation of the liver. + +III. CATALOGUE OF THE SORBENTIA. + +I. Sorbentia affecting the skin. + + 1. Acid of vitriol, of sea-salt, lemons, sloes, prunus spinosa, crabs, + pyrus, quince, pyrus cydonia, opium. + + 2. Externally calx of zinc, of lead, of mercury. + +II. Sorbentia affecting the mucous membranes. + + 1. Juice of sloes, crabs, Peruvian bark, cinchona, opium. + + 2. Externally blue vitriol. + +III. Sorbentia affecting the cellular membrane. + + 1. Peruvian bark, wormwoods, artemisia maritima, artemisia absynthium, + worm-seed, artemisia santonicum, chamomile, anthemis nobilis, tansey + tanacetum, bogbean, menyanthes trifoliata, centaury, gentiana + centaurium, gentian, gentiana lutea, artichoke-leaves, cynara scolymus, + hop, humulus lupulus. + + 2. Orange-peel, cinnamon, nutmeg, mace. + + 3. Vomits, squill, digitalis, tobacco. + + 4. Bath of warm air, of steam. + +IV. Sorbentia affecting the veins. + + 1. Water-cress, sisymbrium nasturtium aquaticum, mustard, sinapis, + scurvy-grass cochlearia hortensis, horse-radish cochlearia armoracia, + cuckoo-flower, cardamine, dog's-grass, dandelion, leontodon taraxacon, + cellery apium, cabbage brassica. + + 2. Chalybeates, bitters, and opium, after sufficient evacuation. + + 3. Externally vinegar, friction, electricity. + +V. Sorbentia affecting the intestines. + + 1. Rhubarb, rheum palmatum, oak-galls, gallae quercinae, tormentil, + tormentilla erecta, cinquefoil potentilla, red-roses, uva ursi, + simarouba. + + 2. Logwood, haematoxylum campechianum, succus acaciae, dragon's blood, + terra japonica, mimosa catechu. + + 3. Alum, earth of alum, Armenian bole, chalk, creta, crab's claws, + chelae cancrorum, white clay, cimolia, calcined hartshorn, cornu cervi + calcinatum, bone-ashes. + +VI. Sorbentia affecting the liver, stomach, and other viscera. Rust of +iron, filings of iron, salt of steel, sal martis, blue vitriol, white +vitriol, calomel, emetic tartar, sugar of lead, white arsenic. + +VII. Sorbentia affecting venereal ulcers. Mercury dissolved or corroded by +the following acids: + + 1. Dissolved in vitriolic acid, called turpeth mineral, or hydrargyrus + vitriolatus. + + 2. Dissolved in nitrous acid, called hydrargyrus nitratus ruber. + + 3. Dissolved in muriatic acid, mercurius corrosivus sublimatus, or + hydrargyrus muriatus. + + 4. Corroded by muriatic acid. Calomel. + + 5. Precipitated from muriatic acid, mercurius precipitatus albus, calx + hydrargyri alba. + + 6. Corroded by carbonic acid? The black powder on crude mercury. + + 7. Calcined, or united with oxygen. + + 8. United with animal fat, mercurial ointment. + + 9. United with sulphur. Cinnabar. + + 10. Partially united with sulphur. Aethiops mineral. + + 11. Divided by calcareous earth. Hydrargyrus cum creta. + + 12. Divided by vegetable mucilage, by sugar, by balsams. + +VIII. Sorbentia affecting the whole system. Evacuations by venesection and +catharsis, and then by the exhibition of opium. + +IX. Sorbentia externally applied. + + 1. Solutions of mercury, lead, zinc, copper, iron, arsenic; or metallic + calces applied in dry powder, as cerussa, lapis calaminaris. + + 2. Bitter vegetables in decoctions and in dry powders, applied + externally, as Peruvian bark, oak bark, leaves of wormwood, of tansey, + camomile flowers or leaves. + + 3. Electric sparks, or shocks. + +X. Bandage spread with emplastrum e minio, or with carpenter's glue mixed +with one twentieth part of honey. + +XI. Portland's powder its continued use pernicious, and of hops in beer. + + * * * * * + +ART. V. + +INVERTENTIA. + +I. Those things, which invert the natural order of the successive +irritative motions, are termed invertentia. + +1. Emetics invert the motions of the stomach, duodenum, and oesophagus. + +2. Violent cathartics invert the motions of the lacteals, and intestinal +lymphatics. + +3. Violent errhines invert the nasal lymphatics, and those of the frontal +and maxillary sinuses. And medicines producing nausea, invert the motions +of the lymphatics about the sauces. + +4. Medicines producing much pale urine, as a certain quantity of alcohol, +invert the motions of the urinary absorbents; if the dose of alcohol is +greater, it inverts the stomach, producing the drunken sickness. + +5. Medicines producing cold sweats, palpitation of the heart, globus +hystericus; as violent evacuations, some poisons, fear, anxiety, act by +inverting the natural order of the vascular motions. + +II. OBSERVATIONS ON THE INVERTENTIA. + +I. 1. The action of vomiting seems originally to have been occasioned by +disagreeable sensation from the distention or acrimony of the aliment; in +the same manner as when any disgustful material is taken into the mouth, as +a bitter drug, and is rejected by the retrograde motions of the tongue and +lips; as explained in Class IV. 1. 1. 2. and mentioned in Sect. XXXV. 1. 3. +Or the disagreeable sensation may thus excite the power of volition, which +may also contribute to the retrograde actions of the stomach and +oesophagus, as when cows bring up the contents of their first stomach to +re-masticate it. To either of these is to be attributed the action of mild +emetics, which soon cease to operate, and leave the stomach stronger, or +more irritable, after their operation; owing to the accumulation of the +sensorial power of irritation during its torpid or inverted action. Such +appears to be the operation of ipecacuanha, or of antimonium tartarizatum, +in small doses. + +2. But there is reason to believe, that the stronger emetics, as digitalis, +first stimulate the absorbent vessels of the stomach into greater action; +and that the inverted motions of these absorbents next occur, pouring the +lymph, lately taken up, or obtained from other lymphatic branches, into the +stomach: the quantity of which in some diseases, as in the cholera morbus, +is inconceivable. This inverted motion, first of the absorbents of the +stomach, and afterwards of the stomach itself, seems to originate from the +exhaustion or debility, which succeeds the unnatural degree of action, into +which they had been previously stimulated. An unusual defect of stimulus, +as of food without spice or wine in the stomachs of those, who have been +much accustomed to spice or wine, will induce sickness or vomiting; in this +case the defective energy of the stomach is owing to defect of accustomed +stimulus; while the action of vomiting from digitalis is owing to a +deficiency of sensorial power, which is previously exhausted by the excess +of its stimulus. See Sect. XXXV. 1. 3. and Class IV. 1. 1. 2. + +For first, no increase of heat arises from this action of vomiting; which +always occurs, when the secerning system is stimulated into action. +Secondly, the motions of the absorbent vessels are as liable to inversion +as the stomach itself; which last, with the oesophagus, may be considered +as the absorbent mouth and belly of that great gland, the intestinal canal. +Thirdly, the class of sorbentia, as bitters and metallic salts, given in +large doses, become invertentia, and vomit, or purge. And lastly, the +sickness and vomiting induced by large potations of wine, or opium, does +not occur till next day in some people, in none till some time after their +ingurgitation. And tincture of digitalis in the dose of 30 or 60 drops, +though applied in solution, is a considerable time before it produces its +effect; though vomiting is instantaneously induced by a nauseous idea, or a +nauseous taste in the mouth. At the same time there seem to be some +materials, which can immediately stimulate the stomach into such powerful +action, as to be immediately succeeded by paralysis of it, and consequent +continued fever, or immediate death; and this without exciting sensation, +that is, without our perceiving it. Of these are the contagious matter of +some fevers swallowed with the saliva, and probably a few grains of arsenic +taken in solution. See Suppl. I. 8. 8. Art. IV. 2. 6. 9. + +3. Some branches of the lymphatic system become inverted by their sympathy +with other branches, which are only stimulated into too violent absorption. +Thus when the stomach and duodenum are much stimulated by alcohol, by +nitre, or by worms, in some persons the urinary lymphatics have their +motion inverted, and pour that material into the bladder, which is absorbed +from the intestines. Hence the drunken diabetes is produced; and hence +chyle is seen in the urine in worm cases. + +When on the contrary some branches of the absorbent systems have their +motions inverted in consequence of the previous exhaustion of their +sensorial power by any violent stimulus, other branches of it have their +absorbent power greatly increased. Hence continued vomiting, or violent +cathartics, produce great absorption from the cellular membrane in cases of +dropsy; and the fluids thus absorbed are poured into the stomach and +intestines by the inverted motions of the lacteals and lymphatics. See +Sect. XXIX. 4. and 5. + +4. The quantity of the dose of an emetic is not of so great consequence as +of other medicines, as the greatest part of it is rejected with the first +effort. All emetics are said to act with greater certainty when given in a +morning, if an opiate had been given the night before. For the sensorial +power of irritation of the stomach had thus been in some measure previously +exhausted by the stimulus of the opium, which thus facilitates the action +of the emetic; and which, when the dose of opium has been large, is +frequently followed on the next day by spontaneous sickness and vomitings, +as after violent intoxication. + +Ipecacuanha is the most certain in its effect from five grains to thirty; +white vitriol is the most expeditious in its effect, from twenty grains to +thirty dissolved in warm water; but emetic tartar, antimonium tartarizatum, +from one grain to four to sane people, and from thence to twenty to insane +patients, will answer most of the useful purposes of emetics; but nothing +equals the digitalis purpurea for the purpose of absorbing water from the +cellular membrane in the anasarca pulmonum, or hydrops pectoris. See Art. +IV. 2. 3. 7. + +II. Violent cathartics. 1. Where violent cathartics are required, as in +dropsies, the squill in dried powder made into small pills of a grain, or a +grain and a half, one to be given every hour till they operate briskly, is +very efficacious; or half a grain of emetic tartar dissolved in an ounce of +peppermint-water, and given every hour, till it operates. Scammony, and +other strong purges, are liable to produce hypercatharsis, if they are not +nicely prepared, and accurately weighed, and are thence dangerous in common +practice. Gamboge is uncertain in its effects, it has otherwise the good +property of being tasteless; and on that account some preparation of it +might be useful for children, by which its dose could be ascertained, and +its effects rendered more uniform. + +2. In inflammations of the bowels with constipation calomel, given in the +dose from ten to twenty grains after due venesection, is most efficacious; +and if made into very small pills is not liable to be rejected by vomiting, +which generally attends those cases. When this fails, a grain of aloes +every hour will find its way, if the bowel is not destroyed; and sometimes, +I believe, if it be, when the mortification is not extensive. If the +vomiting continues after the pain ceases, and especially if the bowels +become tumid with air, which sounds on being struck with the finger, these +patients seldom recover. Opiates given along with the cathartics I believe +to be frequently injurious in inflammation of the bowels, though they may +thus be given with advantage in the saturnine colic; the pain and +constipation in which disease are owing to torpor or inactivity, and not to +too great action. + +III. Violent errhines and sialagogues. 1. Turpeth mineral in the quantity +of one grain mixed with ten grains of sugar answers every purpose to be +expected from errhines. Their operation is by inverting the motions of the +lymphatics of the membrane, which lines the nostrils, and the caverns of +the forehead and cheeks; and may thence possibly be of service in the +hydrocephalus internus. + +Some other violent errhines, as the powder of white hellebore, or Cayan +pepper, diluted with some less acrid powder, are said to cure some cold or +nervous head-achs; which may be effected by inflaming the nostrils, and +thus introducing the sensorial power of sensation, as well as increasing +that of irritation; and thus to produce violent action of the membranes of +the nostrils, and of the frontal and maxillary sinuses, which may by +association excite into action the torpid membranes, which occasion the +head-ach. + +2. A copious salivation without any increase of heat often attends hysteric +diseases, and fevers with debility, owing to an inversion of the lymphatics +of the mouth, see Class I. 1. 2. 6. The same occurs in the nausea, which +precedes vomiting; and is also excitable by disagreeable tastes, as by +squills, or by nauseous smells, or by nauseous ideas. These are very +similar to the occasional discharge of a thin fluid from the nostrils of +some people, which recurs at certain periods, and differs from defective +absorption. + +IV. Violent diuretics. 1. If nitre be given from a dram to half an ounce in +a morning at repeated draughts, the patient becomes sickish, and much pale +water is thrown into the bladder by the inverted action of the urinary +lymphatics. Hence the absorption in ulcers is increased and the cure +forwarded, as observed by Dr. Rowley. + +2. Cantharides taken inwardly so stimulate the neck of the bladder as to +increase the discharge of mucus, which appears in the urine; but I once saw +a large dose taken by mistake, not less than half an ounce or an ounce of +the tincture, by which I suppose the urinary lymphatics were thrown into +violent inverted motions, for the patient drank repeated draughts of +subtepid water to the quantity of a gallon or two in a few hours; and +during the greatest part of that time he was not I believe two entire +minutes together without making water. A little blood was seen in his water +the next day, and a soreness continued a day longer without any other +inconvenience. + +3. The decoction of foxglove should also be mentioned here, as great +effusions of urine frequently follow its exhibition. See Art. IV. 2. 3. 7. +And an infusion or tincture of tobacco as recommended by Dr. Fowler of +York. + +4. Alcohol, and opium, if taken so as to induce slight intoxication, and +the body be kept cool, and much diluting liquids taken along with them, +have similar effect in producing for a time a greater flow of urine, as +most intemperate drinkers must occasionally have observed. This +circumstance seems to have introduced the use of gin, and other vinous +spirits as a diuretic, unfortunately in the gravel, amongst ignorant +people; which disease is generally produced by fermented or spirituous +liquors, and always increased by them. + +5. Fear and anxiety are well known to produce a great frequency of making +water. A person, who believed he had made a bad purchase concerning an +estate, told me, that he made five or six pints of water during a sleepless +night, which succeeded his bargain; and it is usual, where young men are +waiting in an anti-room to be examined for college preferment, to see the +chamber-pot often wanted. + +V. Cold sweats about the head, neck, and arms, frequently attend those, +whose lungs are oppressed, as in some dropsies and asthma. A cold sweat is +also frequently the harbinger of death. These are from the inverted motions +of the cutaneous lymphatic branches of those parts. + +III. CATALOGUE OF INVERTENTIA. + +I. Emetics, ipecacuanha, emetic tartar, antimonium tartarisatum, squill, +scilla maritima, carduus benedictus, cnicus acarna, chamoemile, anthemis +nobilis, white vitriol, vitriolum zinci, foxglove, digitalis purpurea, +clysters of tobacco. + +II. Violent cathartics, emetic tartar, squill, buckthorn, rhamnus +catharticus, scammonium, convolvulus scammonia, gamboge, elaterium, +colocynth, cucumis colocynthis, veratrum. + +III. Violent errhines and sialagogues, Turpeth mineral, hydrargyrus +vitriolatus, asarum europaeum, euphorbium, capsicum, veratrum, nauseous +smells, nauseous ideas. + +IV. Violent diuretics, nitre, squill, seneka, cantharides, alcohol, +foxglove, tobacco, anxiety. + +V. Cold sudorifics, poisons, fear, approaching death. + + * * * * * + +ART. VI. + +REVERTENTIA. + +I. Those things, which restore the natural order of the inverted irritative +motions, are termed Revertentia. + +1. As musk, castor, asafoetida, valerian, essential oils. + +2. Externally the vapour of burnt feathers, of volatile salts, or oils, +blisters, sinapisms. + +These reclaim the inverted motions without increasing the heat of the body +above its natural state, if given in their proper doses, as in the globus +hystericus, and palpitation of the heart. + +The incitantia revert these morbid motions more certainly, as opium and +alcohol; and restore the natural heat more; but if they induce any degree +of intoxication, they are succeeded by debility, when their stimulus +ceases. + +II. OBSERVATIONS ON THE REVERTENTIA. + +I. The hysteric disease is attended with inverted motions feebly exerted of +the oesophagus, intestinal canal and lymphatics of the bladder. Hence the +borborigmi, or rumbling of the bowels, owing to their fluid contents +descending as the air beneath ascends. The globus hystericus consists in +the retrograde motion of the oesophagus, and the great flow of urine from +that of the lymphatics spread on the neck of the bladder; and a copious +salivation sometimes happens to these patients from the inversion of the +lymphatics of the mouth; and palpitation of the heart owing to weak or +incipient inversion of its motions; and syncope, when this occurs in its +greatest degree. + +These hysteric affections are not necessarily attended with pain; though it +sometimes happens, that pains, which originate from quiescence, afflict +these patients, as the hemicrania, which has erroneously been termed the +clavus hystericus; but which is owing solely to the inaction of the +membranes of that part, like the pains attending the cold fits of +intermittents, and which frequently returns like them at very regular +periods of time. + +Many of the above symptoms are relieved by musk, castor, the foetid gums, +valerian, oleum animale, oil of amber, which act in the usual dose without +heating the body. The pains, which sometimes attend these constitutions, +are relieved by the secernentia, as essential oils in common tooth-ach, and +balsam of Peru in the flatulent colic. But the incitantia, as opium, or +vinous spirit, reclaim these morbid inverted motions with more certainty, +than the foetids; and remove the pains, which attend these constitutions, +with more certainty than the secernentia; but if given in large doses, a +debility and return of the hysteric symptoms occurs, when the effect of the +opium or alcohol ceases. Opiates and foetids joined seem best to answer the +purpose of alleviating the present symptoms; and the sorbentia, by +stimulating the lymphatics and lacteals into continued action, prevent a +relapse of their inversion, as Peruvian bark, and rust of iron. See Class +I. 3. 1. 10. + +II. Vomiting consists in the inverted order of the motions of the stomach, +and oesophagus; and is also attended with the inverted motions of a part of +the duodenum, when bile is ejected; and of the lymphatics of the stomach +and fauces, when nausea attends, and when much lymph is evacuated. +Permanent vomiting is for a time relieved by the incitantia, as opium or +alcohol; but is liable to return, when their action ceases. A blister on +the back, or on the stomach, is more efficacious for restraining vomiting +by their stimulating into action the external skin, and by sympathy +affecting the membranes of the stomach. In some fevers attended with +incessant vomiting Sydenham advised the patient to put his head under the +bed-clothes, till a sweat appeared on the skin, as explained in Class IV. +1. 1. 2. + +In chronical vomiting I have observed crude mercury of good effect in the +dose of half an ounce twice a day. The vomitings, or vain efforts to vomit, +which sometimes attend hysteric or epileptic patients, are frequently +instantly relieved for a time by applying flour of mustard-seed and water +to the small of the leg; and removing it, as soon as the pain becomes +considerable. If sinapisms lie on too long, especially in paralytic cases, +they are liable to produce troublesome ulcers. A plaster or cataplasm, with +opium and camphor on the region of the stomach, will sometimes revert its +retrograde motions. + +III. Violent catharsis, as in diarrhoea or dysentery, is attended with +inverted motions of the lymphatics of the intestines, and is generally +owing to some stimulating material. This is counteracted by plenty of +mucilaginous liquids, as solutions of gum arabic, or small chicken broth, +to wash away or dilute the stimulating material, which causes the disease. +And then by the use of the intestinal sorbentia, Art. IV. 2. 5. as rhubarb, +decoction of logwood, calcined hartshorn, Armenian bole; and lastly, by the +incitantia, as opium. + +IV. The diabaetes consists in the inverted motions of the urinary +lymphatics, which is generally I suppose owing to the too great action of +some other branch of the absorbent system. The urinary branch should be +stimulated by cantharides, turpentine, resin (which when taken in larger +doses may possibly excite it into inverted action), by the sorbentia and +opium. The intestinal lymphatics should be rendered less active by +torpentia, as calcareous earth, earth of alum; and those of the skin by oil +externally applied over the whole body; and by the warm-bath, which should +be of 96 or 98 degrees of heat, and the patient should sit in it every day +for half an hour. + +V. Inverted motions of the intestinal canal with all the lymphatics, which +open into it, constitute the ileus, or iliac passion; in which disease it +sometimes happens, that clysters are returned by the mouth. After +venesection from ten grains to twenty of calomel made into very small +pills; if this is rejected, a grain of aloe every hour; a blister; crude +mercury; warm-bath; if a clyster of iced water? + +Many other inverted motions of different parts of the system are described +in Class I. 3. and which are to be treated in a manner similar to those +above described. It must be noted, that the medicines mentioned under +number one in the catalogue of revertentia are the true articles belonging +to this class of medicines. Those enumerated in the other four divisions +are chiefly such things as tend to remove the stimulating causes, which +have induced the inversion of the motions of the part, as acrimonious +contents, or inflammation, of the bowels in diarrhoea, diabetes, or in +ileus. But it is probable after these remote causes are destroyed, that the +fetid gums, musk, castor, and balsams, might be given with advantage in all +these cases. + +III. CATALOGUE OF REVERTENTIA. + +I. Inverted motions, which attend the hysteric disease, are reclaimed, 1. +By musk, castor. 2. By asafoetida, galbanum, sagapaenum, ammoniacum, +valerian. 3. Essential oils of cinnamon, nutmeg, cloves, infusion of +penny-royal, mentha, pulegium, peppermint, mentha piperita, ether, camphor. +4. Spirit of hartshorn, oleum animale, spunge burnt to charcoal, +black-snuffs of candles, which consist principally of animal charcoal, +wood-soot, oil of amber. 5. The incitantia, as opium, alcohol, vinegar. 6. +Externally the smoke of burnt feathers, oil of amber, volatile salt applied +to the nostrils, blisters, sinapisms. + +II. Inverted motions of the stomach are reclaimed by opium, alcohol, +blisters, crude mercury, sinapisms, camphor and opium externally, clysters +with asafoetida. + +III. Inverted motions of the intestinal lymphatics are reclaimed by +mucilaginous diluents, and by intestinal sorbentia, as rhubarb, logwood, +calcined hartshorn, Armenian bole; and lastly by incitantia, as opium. + +IV. Inverted motions of the urinary lymphatics are reclaimed by +cantharides, turpentine, rosin, the sorbentia, and opium, with calcareous +earth, and earth of alum, by oil externally, warm-bath. + +V. Inverted motions of the intestinal canal are reclaimed by calomel, aloe, +crude mercury, blisters, warm-bath, clysters with asafoetida, clysters of +iced water? or of spring water further cooled by salt dissolved in water +contained in an exterior vessel? Where there exists an introsusception of +the bowel in children, could the patient be held up for a time by the feet +with his head downwards, or be laid with his body on an inclined plane with +his head downwards, and crude mercury be injected as a clyster to the +quantity of two or three pounds? + + * * * * * + +ART. VII. + +TORPENTIA. + +I. Those things, which diminish the exertion of the irritative motions, are +termed torpentia. + +1. As mucus, mucilage, water, bland oils, and whatever possesses less +stimulus than our usual food. Diminution of heat, light, sound, oxygen, and +of all other stimuli; venesection, nausea, and anxiety. + +2. Those things which chemically destroy acrimony, as calcareous earth, +soap, tin, alcalies, in cardialgia; or which prevent chemical acrimony, as +acid of vitriol in cardialgia, which prevents the fermentation of the +aliment in the stomach, and its consequent acidity. Secondly, which destroy +worms, as calomel, iron filings or rust of iron, in the round worms; or +amalgama of quicksilver and tin, or tin in very large doses, in the +tape-worms. Will ether in clysters destroy ascarides? Thirdly, by +chemically destroying extraneous bodies, as caustic alcali, lime, mild +alcali in the stone. Fourthly, those things which lubricate the vessels, +along which extraneous bodies slide, as oil in the stone in the urethra, +and to expedite the expectoration of hardened mucus; or which lessen the +friction of the contents in the intestinal canal in dysentery or aphtha, as +calcined hartshorn, clay, Armenian bole, chalk, bone-ashes. Fifthly, such +things as soften or extend the cuticle over tumors, or phlegmons, as warm +water, poultices, fomentations, or by confining the perspirable matter on +the part by cabbage-leaves, oil, fat, bee's-wax, plasters, oiled silk, +externally applied. + +These decrease the natural heat and remove pains occasioned by excess of +irritative motions. + +II. OBSERVATIONS ON THE TORPENTIA. + +I. As the torpentia consist of such materials as are less stimulating than +our usual diet, it is evident, that where this class of medicines is used, +some regard must be had to the usual manner of living of the patient both +in respect to quantity and quality. Hence wounds in those, who have been +accustomed to the use of much wine, are very liable to mortify, unless the +usual potation of wine be allowed the patient. And in these habits I have +seen a delirium in a fever cured almost immediately by wine; which was +occasioned by the too mild regimen directed by the attendants. On the +contrary in great inflammation, the subduction of food, and of spirituous +drink, contributes much to the cure of the disease. As by these means both +the stimulus from distention of the vessels, as well as that from the +acrimony of the fluids, is decreased; but in both these respects the +previous habits of diet of the patients must be attended to. Thus if tea be +made stronger, than the patient has usually drank it, it belongs to the +article sorbentia; if weaker, it belongs to the torpentia. + +II. Water in a quantity greater than usual diminishes the action of the +system not only by diluting our fluids, and thence lessening their +stimulus, but by lubricating the solids; for not only the parts of our +solids have their sliding over each other facilitated by the interposition +of aqueous particles; but the particles of mucaginous or saccharine +solutions slide easier over each other by being mixed with a greater +portion of water, and thence stimulate the vessels less. + +At the same time it must be observed, that the particles of water +themselves, and of animal gluten dissolved in water, as the glue used by +carpenters, slide easier over each other by an additional quantity of the +fluid matter of heat. + +These two fluids of heat and of water may be esteemed the universal +solvents or lubricants in respect to animal bodies, and thus facilitate the +circulation, and the secretion of the various glands. At the same time it +is possible, that these two fluids may occasionally assume an aerial form, +as in the cavity of the chest, and by compressing the lungs may cause one +kind of asthma, which is relieved by breathing colder air. An increased +quantity of heat by adding stimulus to every part of the system belongs to +the article Incitantia. + +III. 1. The application of cold to the skin, which is only another +expression for the diminution of the degree of heat we are accustomed to, +benumbs the cutaneous absorbents into inaction; and by sympathy the urinary +and intestinal absorbents become also quiescent. The secerning vessels +continuing their action somewhat longer, from the warmth of the blood. +Hence the usual secretions are poured into the bladder and intestines, and +no absorption is retaken from them. Hence sprinkling the skin with cold +water increases the quantity of urine, which is pale; and of stool, which +is fluid; these have erroneously been ascribed to increased secretion, or +to obstructed perspiration. + +The thin discharge from the nostrils of some people in cold weather is +owing to the torpid state of the absorbent vessels of the membrana +sneideriana, which as above are benumbed sooner than those, which perform +the secretion of the mucus. + +The quick anhelation, and palpitation of the heart, of those, who are +immersed in cold water, depends on the quiescence of the external absorbent +vessels and capillaries. Hence the cutaneous circulation is diminished, and +by association an almost universal torpor of the system is induced; thence +the heart becomes incapable to push forwards its blood through all the +inactive capillaries and glands; and as the terminating vessels of the +pulmonary artery suffer a similar inaction by association, the blood is +with difficulty pushed through the lungs. + +Some have imagined, that a spasmodic constriction of the smaller vessels +took place, and have thus accounted for their resistance to the force of +the heart. But there seems no necessity to introduce this imaginary spasm; +since those, who are conversant in injecting bodies, find it necessary +first to put them into warm water to take away the stiffness of the cold +dead vessels; which become inflexible like the other muscles of dead +animals, and prevent the injected fluid from passing. + +All the same symptoms occur in the cold fits of intermittents; in these the +coldness and paleness of the skin with thirst evince the diminution of +cutaneous absorption; and the dryness of ulcers, and small secretion of +urine, evince the torpor of the secerning system; and the anhelation, and +coldness of the breath, shew the terminations of the pulmonary artery to be +likewise affected with torpor. + +After these vessels of the whole surface of the body both absorbent and +secretory have been for a time torpid by the application of cold water; and +all the internal secerning and absorbent ones have been made torpid from +their association with the external; as soon as their usual stimulus of +warmth is renewed, they are thrown into more than their usual energy of +action; as the hands become hot and painful on approaching the fire after +having been immersed some time in snow. Hence the face becomes of a red +colour in a cold day on turning from the wind, and the insensible +perspiration increased by repeatedly going into frosty air, but not +continuing in it too long at a time. + +2. When by the too great warmth of a room or of clothes, the secretion of +perspirable matter is much increased, the strength of the patient is much +exhausted by this unnecessary exertion of the capillary system, and thence +of the whole secerning and arterial system by association. The diminution +of external heat immediately induces a torpor or quiescence of these +unnecessary exertions, and the patient instantly feels himself +strengthened, and exhilarated; the animal power, which was thus wasted in +vain, being now applied to more useful purposes. Thus when the limbs on one +side are disabled by a stroke of the palsy, those of the other side are +perpetually in motion. And hence all people bear riding and other exercises +best in cold weather. + +Patients in fevers, where the skin is hot, are immediately strengthened by +cold air; which is therefore of great use in fevers attended with debility +and heat; but may perhaps be of temporary disservice, if too hastily +applied in some situations of fevers attended with internal topical +inflammation, as in peripneumony or pleurisy, where the arterial strength +is too great already, and the increased action of the external capillaries +being destroyed by the cold, the action of the internal inflamed part may +be suddenly increased, unless venesection and other evacuations are applied +at the same time. Yet in most cases the application of cold is nevertheless +salutary, as by decreasing the heat of the particles of blood in the +cutaneous vessels, the stimulus of them, and the distention of the vessels +becomes considerably lessened. In external inflammations, as the small-pox, +and perhaps the gout and rheumatism, the application of cold air must be of +great service by decreasing the action of the inflamed skin, though the +contrary is too frequently the practice in those diseases. It must be +observed, that for all these purposes the application of it should be +continued a long time, otherwise an increased exertion follows the +temporary torpor, before the disease is destroyed. + +3. After immersion in cold water or in cold air the whole system becomes +more exciteable by the natural degree of stimulus, as appears from the +subsequent glow on the skin of people otherwise pale; and even by a degree +of stimulus less than natural, as appears by their becoming warm in a short +time during their continuance in a bath, of about 80 degrees of heat, as in +Buxton bath. See Sect XII. 2. 1. XXXII. 3. 3. + +This increased exertion happens to the absorbent vessels more particularly, +as they are first and most affected by these temporary diminutions of heat; +and hence like the medicines, which promote absorption, the cold-bath +contributes to strengthen the constitution, that is to increase its +irritability; for the diseases attended with weakness, as nervous fevers +and hysteric diseases, are shewn in Section XXXII. 2. 1. to proceed from a +want of irritability, not from an excess of it. Hence the digestion is +greater in frosty weather, and the quantity of perspiration. For these +purposes the application of cold must not be continued too long. For in +riding a journey in cold weather, when the feet are long kept too cold, the +digestion is impaired, and cardialgia produced. + +4. If the diminution of external heat be too great, produced too hastily, +or continued too long, the torpor of the system either becomes so great, +that the animal ceases to live; or so great an energy of motion or orgasm +of the vessels succeeds, as to produce fever or inflammation. This most +frequently happens after the body has been temporarily heated by exercise, +warm rooms, anger, or intemperance. Hence colds are produced in the +external air by resting after exercise, or by drinking cold water. See +Class I. 2. 2. 1. + +Frequent cold immersions harden or invigorate the constitution, which they +effect by habituating the body to bear a diminution of heat on its surface +without being thrown into such extensive torpor or quiescence by the +consent of the vessels of the skin with the pulmonary and glandular system; +as those experience, who frequently use the cold-bath. At first they have +great anhelation and palpitation of heart at their ingress into cold water; +but by the habit of a few weeks they are able to bear this diminution of +heat with little or no inconvenience; for the power of volition has some +influence over the muscles subservient to respiration, and by its counter +efforts gradually prevents the quick breathing, and diminishes the +associations of the pulmonary vessels with the cutaneous ones. And thus +though the same quantity of heat is subducted from the skin, yet the torpor +of the pulmonary vessels and internal glands does not follow. Hence during +cold immersion less sensorial power is accumulated, and in consequence, +less exertion of it succeeds on emerging from the bath. Whence such people +are esteemed hardy, and bear the common variations of atmospheric +temperature without inconvenience. See Sect. XXXII. 3. 2. + +IV. Venesection has a just title to be classed amongst the torpentia in +cases of fever with arterial strength, known by the fulness and hardness of +the pulse. In these cases the heat becomes less by its use, and all +exuberant secretions, as of bile or sweat, are diminished, and room is made +in the blood-vessels for the absorption of mild fluids; and hence the +absorption also of new vessels, or extravasated fluids, the produce of +inflammation, is promoted. Hence venesection is properly classed amongst +the sorbentia, as like other evacuations it promotes general absorption, +restrains haemorrhages, and cures those pains, which originate from the too +great action of the secerning vessels, or from the torpor of the +absorbents. I have more than once been witness to the sudden removal of +nervous head-achs by venesection, though the patient was already exhausted, +pale, and feeble; and to its great use in convulsions and madness, whether +the patient was strong or weak; which diseases are the consequence of +nervous pains; and to its stopping long debilitating haemorrhages from the +uterus, when other means had been in vain essayed. In inflammatory pains, +and inflammatory haemorrhages, every one justly applies to it, as the +certain and only cure. + +V. When the circulation is carried on too violently, as in inflammatory +fevers, those medicines, which invert the motions of some parts of the +system, retard the motions of some other parts, which are associated with +them. Hence small doses of emetic tartar, and ipecacuanha, and large doses +of nitre, by producing nausea debilitate and lessen the energy of the +circulation, and are thence useful in inflammatory diseases. It must be +added, that if nitre be swallowed in powder, or soon after it is dissolved, +it contributes to lessen the circulation by the cold it generates, like +ice-water, or the external application of cold air. + +VI. The respiration of air mixed with a greater proportion of azote than is +found in the common atmosphere, or of air mixed with hydrogen, or with +carbonic acid gas, so that the quantity of oxygen might be less than usual, +would probably act in cases of inflammation with great advantage. In +consumptions this might be most conveniently and effectually applied, if a +phthisical patient could reside day and night in a porter or ale brewery, +where great quantities of those liquors were perpetually fermenting in vats +or open barrels; or in some great manufactory of wines from raisins or from +sugar. + +Externally the application of carbonic acid gas to cancers and other ulcers +instead of atmospheric air may prevent their enlargement, by preventing the +union of oxygen with matter, and thus producing a new contagious animal +acid. + +III. CATALOGUE OF TORPENTIA. + +1. Venesection. Arteriotomy. + +2. Cold water, cold air, respiration of air with less oxygen. + +3. Vegetable mucilages. + + a. Seeds.--Barley, oats, rice, young peas, flax, cucumber, melon, &c. + + b. Gums.--Arabic, Tragacanth, Senegal, of cherry-trees. + + c. Roots.--Turnip, potatoe, althea, orchis, snow-drop. + + d. Herbs.--Spinach, brocoli, mercury. + +4. Vegetable acids, lemon, orange, currants, gooseberries, apples, grape, +&c. &c. + +5. Animal mucus, hartshorn jelly, veal broth, chicken water, oil? fat? +cream? + +6. Mineral acids, of vitriol, nitre, sea-salt. + +7. Silence, darkness. + +8. Invertentia in small doses, nitre, emetic tartar, ipecacuanha given so +as to induce nausea. + +9. Antacids.--Soap, tin, alcalies, earths. + +10. Medicines preventative of fermentation, acid of vitriol. + +11. Anthelmintics.--Indian pink, tin, iron, cowhage, amalgama, smoak of +tobacco. + +12. Lithonthriptics, lixiv. saponarium, aqua calcis, fixable air. + +13. Externally, warm bath, and poultices, oil, fat, wax, plasters, oiled +silk, carbonic acid gas on cancers, and other ulcers. + + * * * * * + +ADDENDA. + +_Page 625, line 1, after 'number' please to add_, 'except when the patient +has naturally a pulse slower than usual in his healthy state.' + +_Page 197, after line 8, please to add_, 'Where the difficulty of breathing +is very urgent in the croup, bronchotomy is recommended by Mr. Field.' +Memoir of a Medical Society, London, 1773, Vol. IV. + + * * * * * + + +ADDITION. + + * * * * * + +INABILITY TO EMPTY THE BLADDER. + +To be introduced at the end of Class III. 2. 1. 6. on Paralysis Vesicae +Urinariae. + +An inability to empty the bladder frequently occurs to elderly men, and is +often fatal. This sometimes arises from their having too long been +restrained from making water from accidental confinement in public society, +or otherwise; whence the bladder has become so far distended as to become +paralytic; and not only this, but the neck of the bladder has become +contracted so as to resist the introduction of the catheter. In this +deplorable case it has frequently happened, that the forcible efforts to +introduce the catheter have perforated the urethra; and the instrument has +been supposed to pass into the bladder when it has only passed into the +cellular membrane along the side of it; of which I believe I have seen two +or three instances; and afterwards the part has become so much inflamed as +to render the introduction of the catheter into the bladder impracticable. + +In this situation the patients are in imminent danger, and some have +advised a trocar to be introduced into the bladder from the rectum; which I +believe is generally followed by an incurable ulcer. One patient, whom I +saw in this situation, began to make a spoonful of water after six or seven +days, and gradually in a few days emptied his bladder to about half its +size, and recovered; but I believe he never afterwards was able completely +to evacuate it. + +In this situation I lately advised about two pounds of crude quicksilver to +be poured down a glass tube, which was part of a barometer tube, drawn less +at one end, and about two feet long, into the urethra, as the patient lay +on his back; which I had previously performed upon a horse; this easily +passed, as was supposed, into the bladder; on standing erect it did not +return, but on kneeling down, and lying horizontally on his hands, the +mercury readily returned; and on this account it was believed to have +passed into the bladder, as it so easily returned, when the neck of the +bladder was lower than the fundus of it. But nevertheless as no urine +followed the mercury, though the bladder was violently distended, I was led +to believe, that the urethra had been perforated by the previous efforts to +introduce a catheter and bougee; and that the mercury had passed on the +outside of the bladder into the cellular membrane. + +As the urethra is so liable to be perforated by the forcible efforts to +introduce the catheter, when the bladder is violently distended in this +deplorable disease, I should strongly recommend the injection of a pound or +two of crude mercury into the urethra to open by its weight the neck of the +bladder previous to any violent or very frequent essays with a catheter +whether of metal or of elastic resin. + + * * * * * + + +LINES + +TO BE PLACED AT THE END OF + +ZOONOMIA. + +_BY A FRIEND._ + + * * * * * + +_JAMQUE OPUS EXEGI._ + + * * * * * + + The work is done!--nor Folly's active rage, + Nor Envy's self, shall blot the golden page; + Time shall admire, his mellowing touch employ, + And mend the immortal tablet, not destroy. + + * * * * * + + +INDEX + +OF THE + +ARTICLES. + + A. + + Absorption, iv. 2. 1. + ---- cutaneous, mucous, cellular, iv. 2. 2. + ---- of the veins, iv. 2. 4. + ---- of inflamed vessels, iv. 2. 4. 3. + ---- of intestines and liver, iv. 2. 5. + ---- of venereal ulcers, iv. 2. 7. + ---- not increased by cold, iv. 2. 1. + ---- increased by opium after evacuation, ii. 2. 1. + Acacia, iv. 3. 5. 2. + Acids austere, iv. 2. 1. 2. iv. 3. 1. + ---- vegetable, sweet, vii. 3. 4. iv. 2. 1. 2. + ---- mineral, vii. 3. 6. + Acrid plants, iv. 2. 4. + Agriculture, i. 2. 3. 7. + Agues, three kinds, iv. 2. 3. 2. iv. 2. 5. iv. 2. 6. 8. + Air nourishes, i. 2. 5. + ---- warm bath of, iv. 2. 3. 8. + Alcali vol. iii. 3. 8. + Alcohol, ii. 2. 1. v. 2. 4. + Almond, bitter, ii. 3. 1. + Althaea, iii. 3. 3. 3. + Allium, iii. 3. 3. + Aloe, iii. 2. 5. iii. 2. 7. iii. 3. 5. 5. vi. 2. 5. + Alum, iii. 2. 1. iv. 2. 2. iv. 2. 5. 2. iv. 2. 5. 3. + Amalgama in worms, vii. 1. 2. + Amomum zinziber, iii. 3. 1. + Amber, oil of, vi. 3. 1. 4. + Ammoniac gum, vi. 3. 1. iii. 3. 3. + ---- salt or spirit, iii. 3. 1. 3. + Anasarca, warm bath in, ii. 2. 2. + Anchovy, iii. 2. 1. iii. 3. 1. 4. + Animal food, i. 2. 1. 1. + Antimony prepared, iii. 3. 1. 5. iii. 2. 1. iv. 1. 10. + Anthemis nobilis, iv. 3. 3. + ---- pyrethum, iii. 3. 2. + Anxiety, v. 2. 4. + Apium, petroselinum, iii. 3. 4. 4. + Apoplexy, iv. 2. 11. + Aristolochia serpentaria, iii. 3. 1. + Armenian bole, vi. 2. 3. iv. 3. 5. 3. + Arsenic in ague, iv. 2. 6. 8. iv. 3. 6. + ---- saturated solution of, iv. 2. 6. 8. + ---- in itch, iv. 2. 9. + ---- how it acts, iv. 2. 6. 9. + ---- how to detect it, iv. 2. 6. 10. + Artemisia maritima, iv. 3. 3. + ---- absynthium, iv. 3. 3. + ---- santonicum, iv. 3. 3. + Artichoke-leaves, iv. 3. 3. + Asa foetida, iii. 3. vi. 3. 1. + Asarum Europeum v. 3. 3. + Ascarides, vii. 1. 2. iii. 2. 7. + Asparagus, iii. 3. 4. 4. + Astragalus tragacanth, iii. 3. 3. 3. + Atropa belladona, ii. 3. 1. + Azote, i. 2. 5. + + B. + + Balsams diuretic, iii. 2. 4. + Bandages promote absorption, iv. 2. 10. + Bark, Peruvian, iv. 2. 2. + ---- long used noxious, iv. 2. 11. + Barley, iii. 3. 3. 3. + Bath, warm, ii. 2. 2. 1. iii. 3. 1. 6. iii. 3. 3. 4. iii. 2. 3. 3. + ---- of warm air, iv. 2. 3. 8. + ---- of steam, iv. 2. 3. 8. + ---- cold, vii. 2. 3. + ---- nutritive, i. 2. 6. 1. + Benzoin, iii. 3. 3. + Bile of animals, iii. 3. 5. 2. + ---- dilute state of, iv. 2. 6. + Blisters, how they act, iii. 2. 1. 10. + ---- cure heart-burn, iii. 2. 1. 10. + ---- stop vomiting, vi. 2. 2. + ---- produce expectoration, iii. 2. 3. 2. + ---- increase perspiration, iii. 2. 1. 10. + Blood, transfusion of, i. 2. 6. 3. + Bog-bean, iv. 3. 3. + Bole armeniae, iv. 2. 5. 3. + Bone-ashes, iv. 2. 5. 3. + Bowels, inflammation of, v. 2. 2. 2. + Bryony, white, iii. 3. 8. + ---- as a blister, iii. 2. 8. + Butter, i. 2. 3. 2. + Butter-milk, i. 2. 2. 2. + + C. + + Cabbage-leaves, vii. 1. 2. + Calcareous earth, i. 2. 4. 3. + Calomel, iii. 2. 5. vi. 2. 5. + ---- in enteritis, v. 2. 2. 2. + Camphor, iii. 3. 1. + Canella alba, iii. 3. 1. + Cantharides, iii. 2. 6. iii. 2. 8. v. 2. 4. vi. 2. 4. + Capillary action increased by tobacco, iv. 2. 3. 7. + Capsicum, iii. 3. 1. + Carbonic acid gas, vii. 2. 6. + Cardamomum, iii. 3. 1. + Caryophyllus aromat. iii. 3. 1. + Cardamine, iv. 3. 4. + Cassia sistul, iii. 3. 5. 1. + ---- senna, iii. 3. 5. 5. + Castor, vi. 2. 1. vi. 3. 1. + Cathartics, mild, iii. 2. 5. + ---- violent, v. 2. 2. + Cerussa in ulcers, iv. 2. 9. iv. 2. 7. + Chalk, iv. 2. 5. 3. + Chalybeates, iv. 3. 4. 2. + Cheese, i. 2. 2. 3. + Cherries, black, ii. 2. 1. 8. + Chlorosis, iv. 2. 6. 5. + Cicuta, ii. 3. 1. + Cinchona, iv. 2. 2. + Cinnamon, iii. 3. 1. 2. + Clay, iv. 2. 5. 3. + Cloves, iii. 3. 1. iii. 3. 2. + Cnicus acarna, v. 3. 1. + Cocculus indicus, ii. 3. 1. + Cochlearia armoracia, iii. 3. 8. iv. 3. 4. + ---- hortensis, iv. 3. 4. + Cold, continued application of, vii. 2. 3. + ---- interrupted, vii. 2. 3. iii. 3. 1. 7. + ---- excessive, vii. 2. 3. + ---- first affects lymphatics, vii. 2. 3. + ---- produces rheum from the nose, vii. 2. 3. + ---- quick anhelation, vii. 2. 3. + ---- increases digestion, vii. 2. 3. + Cold-fit easier prevented than removed, ii. 2. 1. + Colic from lead, v. 2. 2. 2. + Condiments, i. 2. 7. + Convolvulus scammonium, v. 3. 2. + Convulsions, iv. 2. 8. + Cookery, i. 2. 3. 5. + Copaiva balsam, iii. 3. 4. 3. + Cowhage, iii. 3. 2. + Crab-juice, iv. 2. 2. + Cream, i. 2. 3. 2. i. 2. 2. 2. + Cucumis colocynthis, v. 3. 2. + Cynara scolymus, iv. 3. 3. + Cynoglossum, ii. 3. 1. + + D. + + Dandelion, iv. 3. 4. + Datura stramonium, ii. 3. 1. + Daucus sylvestris, iii. 3. 4. 4. + Delphinium stavisagria, ii. 3. 1. + Diabetes, iv. 2. 5. + ---- warm bath in, vi. 2. 4. + Diaphoretics, iii. 3. 1. iii. 2. 1. 2. + ---- best in a morning, iii. 2. 1. 5. + Diarrhoea, vi. 2. 3. + Digestion injured by cold, iii. 2. 1. + ---- increased by cold, vii. 2. 3. + Digitalis, iv. 2. 3. 7. v. 2. 1. 2. + ---- tincture of, iv. 2. 3. 7. + Dragon's blood, iv. 3. 5. 2. + Dropsy, iv. 2. 3. 4. iv. 2. 6. 7. + + E. + + Ears, eruption behind, iv. 2. 9. 2. + Earth of bones, iv. 2. 5. + ---- of alum, vi. 2. 4. + ---- calcareous, iv. 2. 5. 3. vi. 2. 4. i. 2. 4. 3. + Eggs, i. 2. 1. 4. + Egg-shells diuretic, iii. 2. 4. + Electricity, ii. 2. 2. 2. iv. 2. 9. + Emetics, how they act, v. 2. 1. + Errhines mild, iii. 2. 9. + ---- in hydrocephalus, v. 2. 3. 1. + ---- violent, v. 2. 3. + ---- in head-ach, v. 2. 3. 1. + Erysipelas, iv. 2. 9. + Essential oils, ii. 2. 3. + Ether, vitriolic, ii. 2. 3. iii. 3. 1. vi. 3. 1. 3. + ---- in ascarides, vii. 1. 2. + Etiolation, i. 2. 3. 4. + Euphorbium, v. 3. 3. + Exercise, iii. 3. 1. 6. ii. 2. 6. + Eyes inflamed, ii. 2. 2. 2. iv. 2. 4. 3. + + F. + + Famine, times of, i. 2. 3. 5. and 6. + Fear, v. 2. 4. + Feathers, smoke of, vi. 3. 1. 6. + Fennel, iii. 3. 4. 4. + Ferula asafoetida, iii. 3. 3. + Fish, i. 2. 1. 2. i. 2. 1. 5. + Flannel shirt, ii. 2. 2. 1. + Flesh of animals, i. 2. 1. + Fluke-worm, iv. 2. 6. + Foxglove, iv. 2. 3. 7. v. 2. 1. v. 2. 4. + ---- tincture of, iv. 2. 3. 7. + Friction, ii. 2. 6. iii. 3. 1. 6. + + G. + + Galanthus nivalis, vii. 3. 3. + Galbanum, vi. 3. 1. + Gall-stones, iv. 2. 6. + Galls of oak, iv. 3. 5. + Garlic, iii. 3. 3. + Gentiana centaurium, iv. 3. 3. + ---- lutea, iv. 3. 3. + Ginger, iii. 3. 1. iii. 3. 4. + Gonorrhoea, iv. 2. 2. iii. 2. 4. + Gout, iv. 2. 11. 2. + Guaiacum, iii. 3. 1. + Gum arabic, iii. 3. 3. 3. + ---- tragacanth, iii. 3. 3. 3. + Glycyrrhiza glabra, iii. 3. 3. 3. + Gravel, v. 2. 4. 4. + + H. + + Hartshorn, spirit and salt of, iii. 3. 3. iii. 3. 1. vi. 3. 1. 4. + ---- calcined, iv. 2. 5. vi. 2. 3. + Haemorrhages, iv. 2. 4. 4. iv. 2. 6. 2. + Haematoxylon campechianum, iv. 3. 5. 2. + Hay, infusion of, i. 2. 3. 6. + Head-ach, snuff in, v. 2. 3. 1. + Heat, ii. 2. 2. 1. See Bath. + ---- an universal solvent, vii. 2. 2. + Helenium, iii. 3. 3. 2. + Herpes, iv. 2. 1. iv. 2. 9. + Herrings, red, iii. 3. 1. 4. + Honey, iii. 3. 3. 3. iii. 3. 5. 1. + Hop in beer, why noxious, iv. 2. 3. 6. iv. 2. 11. 2. + Hordeum distichon, iii. 3. 3. 3. + Humulus lupulus, iv. 2. 3. iv. 2. 11. + Hydrargyrus vitriolatus, v. 2. 3. + Hysteric disease, vi. 2. 1. + ---- pains, vi. 2. 1. + ---- convulsions, vi. 2. 1. + + I. + + Jalapium, iii. 3. 5. 5. + Japan earth, iv. 3. 5. 2. + Jaundice, iv. 2. 6. 3. + Ileus, vi. 2. 5. + Incitantia, ii. + Intermittents. See Agues. + Inverted motions, vi. 2. 1. + ---- in hysteric disease, vi. 2. 1. + ---- of the stomach, vi. 2. 2. + ---- intestinal canal, vi. 2. 5. + ---- of lymphatics, vi. 2. 3. + Inula helenium, iii. 3. 3. 2. + Ipecacuanha, v. 2. 1. + Iron, rust of, iv. 3. 6. + Irritability prevented, iv. 2. 3. 3. + Itch, iv. 2. 1. 3. + + L. + + Laurus camphora, iii. 3. 1. + ---- cinnamomum, iii. 3. 1. + ---- sassafras, iii. 3. 1. + Lead, iv. 3. 6. + ---- colic from, v. 2. 2. 2. + ---- sugar of, iv. 2. 9. + Leeks, iii. 3. 3. 1. + Legs, ulcers of, iv. 2. 10. + Lemon-juice, iv. 2. 1. iv. 2. 2. + Leontodon taraxacum, iv. 3. 4. + Life shortened by great stimulus, i. 1. + Lime, i. 2. 4. 3. + Liquorice, iii. 3. 3. 3. + Liver inflamed, iv. 2. 6. + Logwood, iv. 3. 5. 2. + Lymphatics, inverted motions of, v. 2. 1. + + M. + + Magnesia alba, iii. 3. 5. 3. + Malt, i. 2. 3. 5. + Manna, iii. 3. 5. + Marsh-mallows, iii. 3. 3. 3. + Marjoram, iii. 3. 9. + Marum, iii. 3. 9. + Mastich, iii. 3. 2. iii. 3. 3. + Menianthes trifoliata, iv. 3. 3. + Menispermum cocculus, ii. 3. 1. + Menstruation promoted, iv. 2. 6. 6. + ---- repressed, iv. 2. 6. 6. + Mercury, iii. 3. 2. vi. 2. 2. + ---- preparations of, iv. 3. 7. iv. 2. 7. iv. 2. 9. + ---- injected as a clyster, vi. 3. 5. + Metallic salts, iv. 2. 6. + Milk, i. 2. 2. + Mimosa nilotica, iii. 3. 3. 3. + ---- catechu, iv. 3. 5. 2. + Mint, vi. 3. 1. 3. + Mortification, iv. 2. 9. + Mucilage, vegetable, vii. 3. 3. + Mucus, animal, vii. 3. 5. + Mushrooms, i. 2. 1. 2. + Musk, vi. 2. 1. vi. 3. 1. + Mustard, iv. 3. 4. See Sinapism. + + N. + + Nausea in fevers, vii. 2. 5. + Neutral salts diuretic, why, iii. 2. 4. + ---- increase some coughs, iii. 2. 4. + ---- increase heat of urine, iii. 2. 4. + Nicotiana tabacum, iii. 3. 9. ii. 3. 1. + Nitre, iii. 3. 4. v. 2. 4. + Nutmeg, iii. 2. 1. + Nutrientia, i. + + O. + + Oil of almonds, iii. 3. 5. 4. + ---- in cream, i. 2. 3. 2. + ---- of amber, vi. 2. 1. + ---- expressed externally, iii. 2. 3. + ---- essential, ii. 2. 3. iii. 3. 1. 2. + Oiled silk, vii. 3. 13. + Oleum, animale, vi. 2. 1. vi. 3. 4. + ---- ricini, iii. 3. 5. 4. + Onions, iii. 3. 3. + Opium, ii. 2. 1. 2. iv. 1. 2. + ---- in nervous pains, ii. 2. 1. 5. + ---- in inflammatory pains, ii. 2. 1. 6. + ---- increases all secretions and absorptions, ii. 2. 1. 1. + ---- absorption after evacuation, iv. 2. 8. 2. ii. 2. 1. 3. + ---- stops sweats, iv. 2. 1. 2. + ---- intoxicates, ii. 2. 1. 1. + Oranges, their peel, iv. 3. 3. + Orchis, vii. 3. 3. + Oxygen gas, ii. 2. 4. i. 2. 5. iii. 2. 11. iv. 1. 4. + ---- produces and heals ulcers, iv. 2. 7. + + P. + + Papin's digester, i. 2. 3. 5. + Papaver somniferum, ii. 3. 1. iv. 3. 2. See Opium. + Pains, periodic, cured by opium, ii. 2. 1. + Pareira brava, iii. 3. 4. 4. + Parsley, iii. 3. 4. + Passions, ii. 2. 5. + Pasturage, i. 2. 3. 7. + Pepper, iii. 3. 1. + Peripneumony, iv. 2. 8. 2. + Perspiration in a morning, iii. 2. 1. + ---- not an excrement, iii. 2. 1. + Peru, balsam of, iii. 3. 5. 4. + Petechiae, iv. 2. 4. 2. + Pimento, iii. 3. 1. + Piper indicum, iii. 3. 1. + Pistacia lentiscus, iii. 3. 2. + Pix liquida, iii. 3. 3. + Plaster-bandage, iv. 2. 10. + Pleurisy, iv. 2. 8. 2. + Polygala seneka, iii. 3. 3. 2. + Poppy. See Papaver. + Portland's powder noxious, why, iv. 2. 11. 2. + Potatoe-bread, i. 2. 3. 4. + Potentilla, iv. 3. 5. + Prunes, iii. 3. 5. 1. + Prunus domestica, iii. 3. 5. 1. + ---- spinosa, iv. 3. 1. + ---- lauro-cerasus, ii. 3. 1. + Pulegium, vi. 3. 1. 3. + Pulse, intermittent, relieved by arsenic, iv. 2. 6. + Pyrethrum, iii. 3. 2. + Pyrus malus, vii. + ---- cydonia, iv. 3. 1. + + Q. + + Quassia, iv. 2. 2. + Quince, iv. 3. 1. + Quinquefolium, iv. 3. 5. + + R. + + Ratafie, why destructive, ii. 2. 1. + Resin diuretic, iii. 2. 4. vi. 2. 4. + Rhamnus catharticus, v. 3. 2. + Rheumatism, iv. 2. 4. 5. iv. 2. 10. 2. + Rheum palmatum. See Rhubarb. + Rhubarb, iii. 2. 1. iv. 2. 5. 1. iii. 3. 5. 5. + ---- causes constipation, why, iii. 2. 1. 1. + Rice, vii. + Roses, iv. 3. 5. + Rot in sheep, iv. 2. 6. + + S. + + Sago, vii. 3. + Sagopaenum, vi. 3. 1. + Salivation not necessary, iv. 2. 7. + ---- hysteric, v. 2. 3. + Salt, common, unwholesome, iii. 1. 12. + ---- muriatic, iii. 3. 1. + ---- in clysters, iii. 2. 7. + Salts, why diuretic, iii. 2. 4. + ---- neutral, iii. 3. 5. 3. iii. 2. 4. + ---- improper in coughs and gonorrhoea, iii. 2. 4. + Salt fish and salt meat increase perspiration, iii. 2. 1. + Sassafras, iii. 3. 1. + Scammony, v. 2. 2. + Scarcity, times of, i. 2. 3. 5. and 6. + Scilla maritima, v. 2. 2. iv. 2. 3. iii. 3. 3. v. 2. 3. + Scorbutic legs, iv. 2. 10. + Scrophulous tumours, ii. 2. 4. iv. 2. 9. + Sea-water, iii. 3. 5. 3. + Secernentia, iii. + Secretion of the bladder, iii. 2. 6. + ---- of the rectum, iii. 2. 7. + ---- of the skin, iii. 2. 8. + Seneka, iii. 3. 3. 2. + Senna, iii. 3. 5. 5. + Serpentaria virginiana, iii. 3. 1. + Sialagogues, iii. 2. 2. v. 2. 3. + Simarouba, iv. 3. 5. + Sinapi, iv. 3. 4. + Sinapisms, vi. 2. 2. iii. 2. 8. vi. 2. 2. + Sisymbrium nasturtium, iv. 3. 4. + Sloes, iv. 2. 2. + Snuffs of candles, vi. 3. 1. 4. + Society, i. 2. 3. 7. + Soot, vi. 3. 1. 4. + Sorbentia, various kinds, iv. 2. 1. + Spasmodic doctrine exploded, vii. 2. 3. + Spermaceti, iii. 3. 3. 3. + Spice noxious, iii. 1. 12. + Spirit of wine noxious, ii. 2. 1. + Sponge, burnt, vi. 3. 1. 4. + Squill. See Scilla. + Starch, i. 2. 3. 1. + ---- from poisonous roots, i. 2. 3. 4. + Steam, bath of, iv. 2. 3. 8. + Steel, iv. 2. 6. + ---- forwards and represses menstruation, iv. 2. 6. + Stizolobium siliqua hirsuta, iii. 3. 2. vii. 3. 11. + Strychnos nux vomica, ii. 3. 1. + Sublimate of mercury, iv. 2. 7. iv. 2. 9. + Sugar nourishing, i. 2. 3. 1. and 5. iii. 3. 3. 3. + ---- formed after the death of the plant, i. 2. 3. 5. + ---- aperient, iii. 3. 5. 1. + Sulphur, iii. 3. 5. 4. + Sweats in a morning, iii. 2. 1. 5. + ---- on waking, iii. 2. 1. 5. + ---- cold, v. 2. 5. + ---- stopped by opium, iv. 2. 1. 2. + + T. + + Taenia, vermes. See Worms. + Tamarinds, iii. 3. 5. 1. + Tansey, tanacetum, iv. 3. 3. + Tar, iii. 3. 3. + Tartar, crystals of, iii. 3. 5. 1. Class i. 2. 3. 13. + ---- vitriolate, iii. 3. 5. 3. + ---- emetic, v. 2. 1. v. 2. 2. + Tea, vii. 2. 1. + Tears, iii. 2. 10. + Testaceous powders, iv. 2. 1. + Tetradynamia, plants of, iv. 2. 4. + Tincture of digitalis, iv. 2. + Tinea, herpes, iv. 2. 1. 4. + Tobacco, ii. 3. 1. iii. 3. 9. iv. 2. 3. 7. + ---- injures digestion, iii. 2. 2. 3. + Tolu balsam, iii. 3. 3. + Tormentilla erecta, iv. 3. 5. + Torpentia, vii. + Tragacanth gum, iii. 3. 3. 3. + Turpentine, vi. 2. 4. + ---- spirit of, iii. 2. 6. + Turpeth mineral, v. 2. 3. + Tussilago farfara, iii. 3. 3. 3. + + U. + + Ulcers, scrophulous, iv. 2. 9. + ---- of the mouth, iv. 2. 2. + ---- cured by absorption, ii. 2. 1. 4. iv. 2. 3. 5. + Uva ursi, iv. 3. 5. + + V. + + Valerian, vi. 3. 1. + Vegetable acids, iv. 2. 1. + ---- food, i. 2. 1. 2. + Venereal ulcers, iv. 2. 7. + Venesection, vii. 2. 4. iv. 2. 8. + ---- diminishes secretions, vii. 2. 4. + ---- increases absorptions, vii. 2. 4. + Veratrum, v. 3. 2. + Vibices, iv. 2. 4. 3. + Vinegar, iv. 2. 1. 2. iv. 2. 4. 3. ii. 2. 1. 9. + Vitriol blue in agues, iv. 2. 6. iv. 2. 2. + ---- in ulcers, iv. 2. 9. + ---- white, iv. 3. 6. v. 2. 1. + ---- acid of, iv. 2. 1. + ---- in sweats, iv. 1. 1. + ---- in small-pox, iv. 1. 1. + Volatile salt, vi. 3. 1. 6. + Vomiting, v. 2. 2. + Vomiting stopped by mercury, vi. 2. 2. + Vomits, iv. 2. 3. 7. + + W. + + Warm bath, ii. 2. 2. 1. + ---- in diabetes vi. 2. 4. + Water, i. 2. 4. + ---- dilutes and lubricates, vii. 2. 2. + ---- cold, produces sweats, iii. 2. 1. + ---- iced, in ileus, vi. 2. 5. + ---- cresses, iv. 3. 4. + Whey of milk, iii. 3. 5. 2. i. 2. 2. 2. + Wine, ii. 3. 1. + Worms, vii. 1. 2. iii. 2. 7. iv. 2. 6. 4. + ---- in sheep, iv. 2. 6. 4. + + Z. + + Zinc, vitriol of, v. 3. 1. + + + +THE END. + + + + * * * * * + + + +Corrections made to printed original. + +Species list for I. 2. 5.: "Tactus imminutus.": 'Tactu, imminutus' in +original (compare main text). + +I. 1. 4. 1. "Nictitatio irritativa": 'Nectitatio' in original (compare +contents list). + +I. 1. 5. 8. "Perpetual sneezings in the measles": 'sneeezings' in original. + +I. 2. 1. 11. "the periodical venereal orgasm of the female quadrupeds": +'quadupeds' in original. + +I. 2. 3. 1. "Mucus faucium frigidus": 'fancium' in original (compare +contents list). + +I. 3. 1. 1. "the retrograde motions of the oesophagus": 'retograde' in +original. + +Genus list for II. 3. Original reads + + 1. Of the arterial system. + 2. Of the absorbent system. + 3. Of the excretory ducts. + +- the first two genera do not appear in the species lists or the main text, +with "Of the excretory ducts." appearing there as 1. + +Species list for II. 1. 3.: "Peripneumonia superficialis": 'superficialie' +in original (compare main text). + +Species list for II. 1. 4.: "11. Fistula urethrae." Entry missing in +original and subsequent entries wrongly numbered. + +Species list for II. 1. 6.: "Febris a pure clauso.": 'clanso' in original +(compare main text). + +Species list for II. 1. 7.: "Rubor jucunditatis": 'jucunditalis' in +original (compare main text). + +II. 1. 3. 5. "Raucedo catarrhalis.": 'Rancedo' in original. + +II. 1. 4. 11. "The perpetual use of bougies, either of catgut or of +caoutchouc": 'coartchouc' in original. The same error occurs in III. 1. 1. +15. + +II. 1. 5. 6. "Psora": 'Psory' in original (compare contents list & index). + +Species list for III. 1. 2.: "Superstitious hope": 'Supestitious' in +original (compare main text). + +III. 1. 1. 9. "Assafoetida": 'Assafaetida' in original. + +III. 1. 2. 12. "Pulchritudinis desiderium.": 'Pulchitudinis' in original +(compare contents list). + +III. 1. 2. 12. "a medical person in good circumstances": +'cir-circumstances' over line break in original. + +III. 1. 2. 24. "See Botanic Garden, P. I. Cant. I. l. 278.": 'Botannic' in +original. + +Species list for IV. 2. 2. "Dolor humeri in hepatitide": 'hepatidide' in +original. So in text IV. 2. 2. 9.: in index 'hepatidite'. + +IV. 2. 1. 4. "the capillaries of the stomach and the cutaneous ones": +'cataneous' in original. + +SUPPLEMENT TO CLASS IV. + +XII. 11. Ninthly. "the sensorial power of irritation": 'iritation' in +original. + +ibid. "the vertigo eases for a few minutes.": 'cases' (for 'eases') in +original. + +XIII. "once rather delirious": 'delious' in original. + +XVI. 7. 8. "The urine is pale and in small quantity": 'quanity' in +original. + +INDEX TO CLASSES: + +"Fever puerperal": 'perpetual' in original. + +"Suggestion, slow," gives no section number & does not seem to exist. + +ARTICLES OF THE MATERIA MEDICA: + +II. 2. 1. 5. "epilepsia dolorifica": 'dolorofica' in original. + +II. 3. 1. "Strychnos nux vomica": 'nuc' in original. + +VI. 2. 4. "The diabaetes consists": 'diaboetes' in original. + +V. 3. 3. "hydrargyrus": 'hydragyrus' in original. + +VII. 2. Article "II." was numbered 'II. 2.', and "III. 1." was numbered +'III. 3. 1.'. + +Corrected cross references. + + In SECTION Printed reference Corrected to + I. 1. 2. 3. Art. III. 2. 12. (no correction) + I. 1. 5. 8. Class II. 1. 1. 2. II. 1. 1. 3. + I. 2. 1. 2. Class IV. 1. 2. 6. IV. 2. 1. 16. + I. 2. 2. 2. Class II. 3. 1. 1. (no correction) + (see Genus list for II. 3.) + I. 2. 3. 11. Class I. 2. 3. 16. I. 2. 3. 17. + I. 2. 4. 11 Class IV. 1. 2. 11. IV. 2. 2. 7. (first) + ibid. Class IV. 2. 1. 7. IV. 2. 2. 7. (second) + I. 2. 4. 15. Class II. 1. 2. 13. II. 1. 2. 18. + I. 2. 5. 1. Class I. 2. 3. 26. (no correction) + ibid. Class I. 2. 3. 25. (no correction) + I. 3. 1. 3. Class II. 1. 4. 7. II. 1. 4. 6. + I. 3. 1. 5. Class III. 1. 1. 15. III. 1. 1. 14. + I. 3. 1. 7. Class I. 3. 1. 9. I. 3. 1. 10. + I. 3. 1. 11. Class IV. 2. 1. 7. IV. 1. 2. 7. + II. 1. 2. 2. Class II. 1. 5. 3. II. 1. 4. 1. + II. 1. 2. 12. Class II. 1. 4. 11. II. 1. 4. 12. + II. 1. 3. 3. Class II. 2. 2. 1. (no correction) + ibid. Class II. 1. 2. 1. II. 1. 3. 1. + II. 1. 3. 17. Class I. 2. 1. 14. I. 2. 1. 15. + ibid. Class IV. 2. 1. 16. IV. 1. 2. 16. + II. 1. 4. 5. Class II. 1. 5. 1. II. 1. 5. 2. + II. 1. 4. 8. Class II. 1. 4. 10. (no correction) + II. 1. 4. 17. Class I. 2. 2. 12. I. 2. 2. 14. + II. 1. 6. 8. Class II. 1. 4. 12. II. 1. 4. 13. + II. 1. 7. 1. Class I. 1. 5. 12. I. 1. 5. 11. + II. 2. 2. 1. Class I. 1. 4. 4. I. 2. 4. 12. + III. 1. 1. 5. Class IV. 3. 2. 2. IV. 1. 3. 2. + III. 1. 2. Sect. XXXV. 1. 13. XXXV. 1. 3. + III. 1. 2. 2. Class I. 1. 1. 9. III. 1. 1. 9. + III. 1. 2. 10. Class IV. 2. 1. 9. (no correction) + III. 1. 2. 14. Class I. 2. 3. 9. I. 2. 4. 10. + III. 2. 1. 2. Class IV. 3. 2. 2. IV. 1. 3. 2. + III. 2. 1. 4. Class IV. 2. 2. 10. IV. 1. 2. 10. + IV. 1. 1. C. Class IV. 1. 4. 6 IV. 1. 4. 5. (2nd time.) + + In INDEX OF CLASSES: + Ascarides iv. 2. 1. 9. iv. 1. 2. 9. + Azote i. 11. 4. i. 11. 6. + Calculi renis iv. 2. 3. 3. (no correction) + Catamenia i. 2. 1. 10. i. 2. 1. 11. + Consternation i. 1. 5. 12. i. 1. 5. 11. + Constipation ii. 2. 1. 7. ii. 2. 2. 7. + Costiveness ii. 2. 1. 7. ii. 2. 2. 7. + Diarrhoea rheumatic iv. 2. 1. 16. iv. 1. 2. 16. + Digestion decreased ... iv. 1. 2. 5 iv. 2. 1. 6. + Dilirium in parotitis iv. 2. 1. 19 iv. 1. 2. 19. + Dyspnoea rheumatica iv. 2. 1. 16. iv. 1. 2. 16. + Eruption of small-pox iv. 2. 1. 12. iv. 1. 2. 12. + Fear, abortion from iv. 1. 3. 7. iv. 3. 1. 7. + ---- paleness in iv. 1. 3. 5. iv. 3. 1. 5. + Fever sensitive ii. 1. 5. 1. ii. 1. 6. 1. + ---- return of cold fit Suppl. i. 3. Suppl. i. 4. + Frigus chronicum i. 2. 2. 2. i. 2. 2. 1. + Gangreen ii. 1. 6. 17. (no correction) + Hoarseness iii. 2. 1. 4. iii. 2. 1. 5. + Hydatides in calves i. 2. 5. 2. i. 2. 5. 4. + Hydrogene gas i. 11. 4. i. 11. 6. + Hysteria from cold iv. 3. 3. 3. iv. 3. 4. 3. + Inflammation ... bowels ii. 1. 2. 3. ii. 1. 2. 11. + Lingua arida iv. 2. 4. 11. (no correction) + Lochia nimia i. 2. i. 2. 1. 13. + Lues venerea ii. 1. 5. 8. ii. 1. 5. 2. + Maculae vultus i. 2. 1. 9. i. 2. 2. 10. + Mammarum tumor iv. 2. 1. 19. iv. 1. 2. 19. + Mammularum tensio iv. 2. 1. 6. iv. 1. 2. 6. + Mercury in vertigo iv. 1. 2. 11. iv. 2. 1. 11. + Nipples, tension of iv. 2. 1. 6. iv. 1. 2. 6. + Paresis sensitiva i. 2. 1. 3. ii. 2. 1. 3. + Pubis and throat ... iv. 2. 1. 7. iv. 1. 2. 7. + Respiration quick ... ii. 1. 1. 3. ii. 1. 1. 4. + Setons ii. 1. 6. ii. 1. 6. 6. + Sickness cured by warm iv. 1. 2. 2. iv. 1. 1. 2. + Splenitis ii. 2. 2. 13. ii. 1. 2. 13. + Sternutatio a lumine iv. 2. 1. 2. iv. 1. 2. 2. + Stocks for children ii. 2. 2. 17. i. 2. 2. 17. + Surprise i. 1. 5. 12. i. 1. 5. 11. + Sympathy throat & pubis iv. 2. 1. 7. iv. 1. 2. 7. + Tears sympathetic iii. 1. 1. 10. iii. 1. 2. 10. + Tinnitus aurium iv. 1. 1. 15. iv. 2. 1. 15. + Torpor of the liver i. 1. 2. 6. i. 2. 2. 6. + Tremor of anger iv. 3. 1. 4 iv. 2. 3. 4. + ---- of fear iv. 1. 2. 5. iv. 3. 1. 5. + Tussis hepatica iv. 1. 2. 7. iv. 2. 1. 8. + ---- arthritica iv. 1. 2. 8. iv. 2. 1. 9. + ---- periodica iv. 1. 2. 9. iv. 3. 4. 2. + ---- a pedibus frigidis iv. 1. 2. 6. iv. 2. 1. 7. + Ulcers of the legs ii. 1. 4. 13. ii. 1. 4. 14. + Variola eruption of iv. 2. 1. 12. iv. 1. 2. 12. + Vertigo with vomiting iv. 2. 3. 2. iv. 3. 2. 3. + Watchfulness iv. 3. 2. 5. iv. 1. 3. 6. + Winking iv. 3. 2. 2. iv. 1. 3. 2. + Womb, inflammation of ii. 1. 8. 16. ii. 1. 2. 16. + + In ARTICLES OF THE MATERIA MEDICA: + II. 2. 1. 5. Class III. 1. 1. 12. III. 1. 1. 13. + IV. 2. 3. 8. Class IV. 2. 2. 1. Art. II. 2. 2. 1. + IV. 2. 6. 5. Sect. XXX. 4. XXX. 1. 4. + V. 2. 1. 4. Art. II. 3. 7. IV. 2. 3. 7. + VI. 2. 2. Class IV. 1. 1. 3. IV. 1. 1. 2. + + INDEX OF THE ARTICLES + Acacia iv. 2. 5. 2. iv. 3. 5. 2. + Alcali vol. iii. 3. 3. iii. 3. 8. + Althaea iii. 2. 3. 3. iii. 3. 3. 3. + Aloe iii. 2. 5. 5. iii. 3. 5. 5. + Alum iv. 2. 1. iv. 2. 2. + Amalgama in worms vii. 2. 2. vii. 1. 2. + Amber, oil of vi. 3. 4. vi. 3. 1. 4. + Ammoniac salt iii. 3. 3. iii. 3. 1. 3. + Anchovy iii. 2. 1. 4. iii. 3. 1. 4. + Antimony prepared iii. 2. 1. 5. iii. 3. 1. 5. + Apium, petroselinum iii. 2. 4. 4. iii. 3. 4. 4. + Armenian bole vi. 3. 5. 3. iv. 3. 5. 3. + Asa foetida ii. 3. iii. 3. + Ascarides iii. 2. 9. 7. iii. 2. 7. + Asparagus iii. 2. 4. 4. iii. 3. 4. 4. + Astragalus tragacanth iii. 2. 3. 3. iii. 3. 3. 3. + Barley iii. 2. 3. 3. iii. 3. 3. 3. + Bath, warm iii. 2. 1. 6. iii. 3. 1. 6. + ibid. iii. 2. 3. 4. iii. 3. 3. 4. + Bile of animals iii. 2. 5. 2. iii. 3. 5. 2. + Blood, transfusion of i. 2. 6. 2. i. 2. 6. 3. + Bryony as a blister iii. 2. 9. iii. 2. 8. + Cassia sistul iii. 2. 5. 1. iii. 3. 5. 1. + ---- senna iii. 2. 5. 5. iii. 3. 5. 5. + Chalybeates iv. 2. 4. 2. iv. 3. 4. 2. + Cinnamon iii. 3. 2. iii. 3. 1. 2. + Cold, interrupted iii. 2. 1. 7. iii. 3. 1. 7. + Copaiva balsam iii. 2. 4. 3. iii. 3. 4. 3. + Daucus sylvestris iii. 2. 4. 4. iii. 3. 4. 4. + Dragon's blood iv. 2. 5. 2. iv. 3. 5. 2. + Ether, vitriolic vi. 3. 3. vi. 3. 1. 3. + Exercise iii. 2. 1. 6. iii. 3. 1. 6. + Eyes inflamed iv. 2. 3. iv. 2. 4. 3. + Feathers, smoke of vi. 3. 6. vi. 3. 1. 6. + Fennel iii. 2. 4. 4. iii. 3. 4. 4. + Friction ii. 2. 5. ii. 2. 6. + ibid. iii. 2. 1. 6. iii. 3. 1. 6. + Ginger iii. 3. 4. (no correction) + Gum arabic iii. 2. 3. 3. iii. 3. 3. 3. + ---- tragacanth iii. 2. 3. 3. iii. 3. 3. 3. + Glycyrrhiza glabra iii. 2. 3. 3. iii. 3. 3. 3. + Haematoxylon camp... iv. 2. 5. 2. iv. 3. 5. 2. + Hartshorn, spirit ... iii. 3. 3. (no correction) + ibid. vi. 3. 4. vi. 3. 1. 4. + Helenium iii. 2. 3. 2. iii. 3. 3. 2. + Herrings, red iii. 2. 1. 4. iii. 3. 1. 4. + Honey iii. 2. 3. 3. iii. 3. 3. 3. + ibid. iii. 2. 5. 1. iii. 3. 5. 1. + Hordeum distichon iii. 2. 3. 3. iii. 3. 3. 3. + Jalapium iii. 2. 5. 5. iii. 3. 5. 5. + Japan earth iv. 2. 5. 2. iv. 3. 5. 2. + Inula helenium iii. 2. 3. 2. iii. 3. 3. 2. + Leeks iii. 2. 3. 1. iii. 3. 3. 1. + Liquorice iii. 2. 3. 3 iii. 3. 3. 3. + Logwood iii. 2. 5. 2. iv. 3. 5. 2. + Magnesia alba iii. 2. 5. 3. iii. 3. 5. 3. + Marsh-mallows iii. 2. 3. 3. iii. 3. 3. 3. + Mastich iii. 3. 3. (no correction) + Mimosa nilotica iii. 2. 3. 3. iii. 3. 3. 3. + ---- catechu iv. 2. 5. 2. iv. 3. 5. 2. + Mint vi. 3. 3. vi. 3. 1. 3. + Oil essential iii. 3. 2. iii. 3. 1. 2. + Oleum, ricini iii. 2. 5. 4. iii. 3. 5. 4. + Pareira brava iii. 2. 4. 4. iii. 3. 4. 4. + Peru, balsam of iii. 2. 5. 4. iii. 3. 5. 4. + Pix liquida iii. 3. 2. iii. 3. 3. + Prunes iii. 2. 5. 1. iii. 3. 5. 1. + Prunus domestica iii. 2. 5. 1. iii. 3. 5. 1. + Pulegium vi. 3. 3. vi. 3. 1. 3. + Rhubarb iii. 2. 5. 5. iii. 3. 5. 5. + Salts, neutral iii. 2. 5. 3. iii. 3. 5. 3. + Sea-water iii. 2. 5. 3. iii. 3. 5. 3. + Seneka iii. 2. 3. 2. iii. 3. 3. 2. + Senna iii. 2. 5. 5. iii. 3. 5. 5. + Snuffs of candles vi. 3. 4. vi. 3. 1. 4. + Soot vi. 3. 4. vi. 3. 1. 4. + Spermaceti iii. 2. 3. 3. iii. 3. 3. 3. + Sponge, burnt vi. 3. 4. vi. 3. 1. 4. + Sugar nourishing iii. 2. 4. 3. iii. 3. 3. 3. + ---- aperient iii. 2. 5. 1. iii. 3. 5. 1. + Sulphur iii. 2. 5. 4. iii. 3. 5. 4. + Sweats in a morning iii. 2. 1. 1. iii. 2. 1. 5. + ---- on waking iii. 2. 1. 1. iii. 2. 1. 5. + Tamarinds iii. 2. 5. 1. iii. 3. 5. 1. + Tartar, crystals of iii. 2. 5. 1. iii. 3. 5. 1. + ---- vitriolate iii. 2. 5. 3. iii. 3. 5. 3. + Testaceous powders iv. 2. 2. iv. 2. 1. + Tobacco iv. 2. 3. 8. iv. 2. 3. 7. + Tragacanth gum iii. 2. 3. 3. iii. 3. 3. 3. + Tussilago farfara iii. 2. 3. 3. iii. 3. 3. 3. + Valerian vi. 3. 3. vi. 3. 1. + Vinegar iv. 2. 1. 9. iv. 2. 1. 2. + Volatile salt vi. 3. 6. vi. 3. 1. 6. + Whey of milk iii. 2. 5. 2. iii. 3. 5. 2. + + + +***END OF THE PROJECT GUTENBERG EBOOK ZOONOMIA, VOL. 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