ii l ♦ I /'puy-ccU ZOONOMIA ; OR THE LAWS OF ORGANIC LIFE. IN THREE PARTS. By ERASMUS DARWIN, M. D. F.R.S. AUTHOR OF THE BOTANIC GARDEN, PH YT0L0GIA, &C. Principio ccelum, ac terras, campofque liquentes, Lucentemque glohum lun.-r, titaniaque aftra, Spiritus intus alit, totamque infufa per artus Mens agitat malem, et magno fe corpore mifcet. Virg. Ain. vi. Earth, on whofe lap a thoufand nations tread, And Ocean, brooding his prolific bed, Night’s changeful orb, blue pole, and filvery zones. Where other worlds encircle other funs, One mind inhabits, one diffufive Soul Wields the large limbs, and mingles with the whole. COMPLETE IN TWO VOLUMES, Volume II. THIRD AMERICAN EDITION. : 7 ;' BOSTON : PUBLISHED BY THOMAS & ANDREWS, No. 45, Newbury-Street. — 1809. ?. r. BUCKINGHAM) PRINTER, WINTER-STREET, 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, at potero, explicabo ; nec tamen, quafi Pythius Apollo, certa ut lint et fixa, qus dixero ; fed ut Homunculus unus e multis probabiliora conjedhira fe- quens. Cic. Tusc. Disp. I. 1. 9. Digitized by the Internet Archive in 2016 ' ? https://archive.org/details/zoonomiaorlawsof21darw_2 PREFACE. ALL difeafes originate in the exuberance, deficiency, or retrograde adion, of the faculties of the fenforium, as their proximate caufe ; and confift in the difordered motions of the fibres of the body, as the proximate ef- fect of the exertions of thofe difordered faculties. The fenforium poffefies four diftind powers, or facul- ties, which are occafionally exerted, and produce all the motions of the fibrous parts of the body ; thefe are the faculties of producing fibrous motions in confequence of irritation, which is excited by external bodies ; in con- fequence of fenfation, which is excited by pleafure or pain ; in confequence of volition, which is excited by de- fire or averfion ; and in confequence of aflociation, which is excited by other fibrous motions. We are hence fupplied with four natural claffes of difeafes de- rived from their proximate caufes ; which we fhall term thofe of irritation, thofe of fenfation, thofe of volition, and thofe of alfociation. In VI PREFACE. In the fubfequent clarification of difeafes I have not adhered to the methods of any of thofe who have pre- ceded me ; the principal of whom are the great names of Sauvages and Cullen ; but have neverthelefs availed myfelf, as much as I could, of their definitions and dif- tindions. The efiential charaderiftic of a difeafe confifts in its proximate caufe, as is well obferved by Dodor Cullen, in his Nofologia Methodica, T. ii. Prolegom. p. xxix. Similitudo quidem morborum in fimilitudine caufae eorum proximal, qualifcunque fit, revera confiftit. I have taken the proximate caufe for the claflic character. The charaders of the orders are taken from the excefs, or deficiency, or retrograde adion, or other properties, of the proximate caufe. The genus is generally derived from the proximate effed. And the fpecies generally from the locality of the difeafe in the fyftem. Many fpecies in this fyftem are termed genera in the fyftems of other writers ; and the fpecies of thofe wri- ters, are, in confequence, here termed varieties. Thus, in Dr. Cullen’s Nofologia, the variola or fmall-pox is termed a genus, and the diftind and confluent kinds are termed fpecies. But as the infedion from the diftind kind frequently produces the confluent kind, and that of the confluent kind frequently produces the diftind ; it would feem more analogous to botanical arrangement, which thefe nofologifts profefs to imitate, to call the dif- tind and confluent fmall-pox varieties than fpecies. Becaufe the fpecies of plants in botanical fyftems prop- agate others fimilar to themfelves ; which does not uni- formly occur in fuch vegetable produdions as are term- ed varieties. In PREFACE. Vil In fome other genera of nofologifls the fpecies have no analogy to each other, either in refpeft to their prox- imate caufe, or to their proximate effect, though they may be fomewhat fimilar in lefs eflential properties ; thus the thin and faline difcharge from the noftrils on going into the cold air of a frofty morning, which is owing to the deficient a&ion of the abforbent veflels of the nof- trils, is one fpecies ; and the vifcid mucus difcharged from the fecerning veflels of the fame membrane, when inflamed, is another fpecies of the fame genus, Catarrhus. Which bear no analogy either in refped to their imme- diate caufe, or to their immediate effect. The ufes of the method here offered to the public, of clafling difeafes according to their proximate caufes, are, firft, more diftindly to underftand their nature by com* paring their eflential properties. Secondly, to facilitate the knowledge of the methods of cure ; fince in natural claflification of difeafes the fpecies of each genus, and in- deed the genera of each order, a few perhaps excepted, require the fame general medical treatment. And laftly, to difcover the nature and the name of any difeafe previ- oufly unknown to the phyfician j which I am perfuaded will be more readily and more certainly done by this natural fyftem, than by the artificial claflifications alrea> dy publifhed. The common names of difeafes are not well adapted to any kind of claflification, and lead of all to this, from their proximate caufes. Some of their names in com- mon language are taken from the remote caufe, as worms, flone of the bladder ; others from the remote effe£l, as diarrhoea, falivation, hydrocephalus ; others from fome accidental fymptom of the difeafe, as tooth- ach, via PREFACE. ach, head-ach, heart-burn ; in which the pain is only a concomitant circumftance of the excefs or deficiency of fibrous a&ions, and not the caufe of them. Others again are taken from the deformity occafioned in confe- quence of the unnatural fibrous motions, which confti- tute difeafes, as tumours, eruptions, extenuations ; all thefe therefore improperly give names to difeafes ; and fome difficulty is thus occafioned to the reader in en- deavouring to difcover to what clafs fuch diforders belong. Another difficulty attending the names of difeafes is, that one name frequently includes more than one difeafe, either exifting at the fame time or in fucceifion. Thus the pain of the bowels from worms is caufed by the in- creafed a£lion of the membrane from the ftimulus of thofe animals ; but the convulfions, which fometimes fuc- ceed thefe pains in children, are caufed by the confequent volition, and belong to another clafs. To difcover under what clafs any difeafe fhould be ar- ranged, we muff firfl invefligate the proximate caufe ; thus the pain of the tooth-ach is not the caufe of any difeafed motions, but the effect ; the tooth-ach there- fore does not belong to the clafs of Senfation. As the pain is caufed by increafed or decreafed action of the membranes of the tooth, and thefe actions are owing to the increafe or decreafe of irritation, the difeafe is to be placed in the clafs of Irritation. To difcover the order it mull be inquired, whether the pain be owing to increafed or defective motion of the pained membrane ; which is known by the concom- itant heat or coldnefs of the part. In tooth-ach without inflammation PREFACE. inflammation there is generally a coldnefs attends the cheek in its vicinity ; as may be perceived by the hand of the patient himfelf compared with the oppofite check. Hence odontalgia is found to belong to the order of de- creafed irritation. The genus and fpecies mull be found by infpe&ing the fynopfis of the fecond order of the clafs of Irritation. See Clafs I. 2. 4. 12. This may be further elucidated by confidenng the natural operation of parturition ; the pain is occafioned by the increafed aCtion or diftention of the veffels of the uterus, in confequence of the ftimulus of the fetus ; and is therefore caufed by increafed irritation ; but the ac- tions of the abdominal mufcles in its excluhon are cauf- ed by the pain, and belong to the clafs of increafed fen- fation. See Clafs II. 1. 1. 12. Hence the difficulty of determining, under what clafs of difeafes parturition Ihould be arranged, confifls in there being two kinds of difeafed actions comprehended under one word ; which have each their different proximate caufe. In Se£t. XXXIX. 8. 4. and in Clafs II. 1. 1. 1. we have endeavoured to give names to four links of animal caufation, which conveniently apply to the claffification of difeafes ; thus in common nictitation, or winking with the eyes without our attention to it, the increafed irrita- tion is the proximate caufe ; the ftimulus of the air on the dry cornea is the remote caufe ; the doling of the eyelid is the proximate effeCt ; and the diffufton of tears over the eyeball is the remote effect. In fome cafes two more links of caufation may be introduced ; one of them may be termed the preremote caufe ; as the warmth or motion of the atmofphere, which caufes greater exhalation from the cornea. And the other the poft-re- Vol. II. b mote X PREFACE. mote effeft ; as the renewed pellucidity of the cornea j and thus fix links of caufation may be expreffed in words. But if amid thefe remote links of animal caufation any of the four powers or faculties of the fenforium be intro- duced, the reafoning is not juft according to the method here propofed ; for thefe powers of the fenforium are always the proximate caufes of the contractions of an- imal fibres ; and therefore in true language cannot be termed their remote caufes. From this criterion it may always be determined, whether more difeafes than one are comprehended under one name ; a circumftance which has much impeded the inveftigation of the caufes, and cures of difeafes. Thus the term fever, is generally given to a colledtion of morbid fymptoms ; which are indeed fo many diftinft difeafes, that fometimes appear together, and fometimes feparately \ hence it has no determinate meaning, except it fignifies fimply a quick pulfe, which continues for fome hours ; in which fenfe it is here ufed. In naming difeafes I have endeavoured to avoid the affeftation of making new compound Greek words, where others equally exprefiive could be procured : as a fhort periphrafis is eafier to be underftood, and lefs burdenfome to the memory. In the Methodus Medendi, which is marked by M. M. at the end of many of the fpecies of difeafes, the words incitantia, forbentia, torpentia, &c. refer to the articles of the Materia Medica, explaining the operations of medicines. The PREFACE. Xi The remote caufes of many difeafes, their periods, and many circumftances concerning them, are treated of in the preceding volume ; the defcriptions of many of them, which I have omitted for the fake of brevity, may be feen in the Nofologia Methodica of Sauvages, and in the Synopfis Nofologise of Dr. Cullen, and in the authors to which they refer. In this arduous undertaking the author folicits the candour of the critical reader ; as he cannot but forefee, that many errors will be difcovered, many additional fpe- cies will require to be inferted ; and others to be tranf- planted or erafed. 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 philofo- phers. As it is, he is induced to hope, that fome ad- vantages will be derived from it to the fcience of medi- cine, and confequent utility to the public, and leaves the completion of his plan to the induftry of future genera- tions. Derby, Jan. i, 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 Firjl Clafs of Dfeafes . CLASS I. DISEASES OF IRRITATION. ORDO I. Increafed Irritation. GENERA. 1. With increafed aftions of the fanguiferous fyftena. 2. With increafed actions of the fecerning fyitem. 3. With increafed adtions of the abforbent fyftem. 4 . With increafed adtions of other cavities and membranes. 5. With increafed actions of the organs of fenfe, ORDO II. Decreafed Irritation. GENER A. 1. With decreafed actions of the fanguiferous fyftem, 2. With decreafed actions of the fecerning fyftem 3. With decreafed actions of the abforbent fyftem. Vol. I!. B 4 . With 2 DISEASES Class I. i. 2. 4. With decreafed a&ions of other cavities and membranes. 5 . With decreafed aftions of the organs of fenfe. ORDO III. Retrograde Irritative Motions. GENERA. 1. Of the alimentary canal. 2. Of the abforbent fyftem. 3. Of the fanguiferous fyftem. The Orders , Genera , and Species , of the Firjl Clafs of Dif- eafes. CLASS I. DISEASES OF IRRITATION. ORDO I. Increafed Irritation. GENUS I. With increafed Allions of the Sanguiferous Syjlem. SPECIES. 1. Febris irritativa 2. Ebrietas 3. Hcemorrhagia arteriofa 4. Hamoptoe arteriofa 5. Hcemorrhagia narium Irritative fever Drunkennefs Arterial Haemorrhage Spitting of arterial blood. Bleeding from the nofe GENUS II. With increafed aBions of the Secerning Syflem. SPECIES. 1 . Color febrilis 2. Rubor febrilis 3. Sudor Calidus Sudor febrilis - — - a labore ab igne a medicamentis 4. Urina uberior colorata Febrile heat Febrile rednefs Warm fweat Sweat in fevers from exercife from fire from medicines Copious coloured urine 5. Diarrhoea Class I. i. 3. OF IRRITATION. 5. Diarrhoea calida. febrilis crapulofa — infant uqi 6 . Salivatio calida 7. Catarrhus calidus 8. ExpeEloratio calida 9. Exfudatio pone aures I © . Gonorrhoea calida 1 1 . Fluor albas calidus 1 2 . Hamorrhois alba 13. Serum e vificatorio 14. Perfpiratio Joetida 1 5 . Crines novi. Warm diarrhoea Diarrhoea from fever from indigeition of infants Warm falivation catarrh expectoration Difcharge behind the ears Warm gonorrhoea flu or albus White piles Difcharge from a blifter Fetid perfpiration New hairs GENUS III. With increafed AElions of the Abforbent Syjlem. SPECIES. X . Lingua arida 2 . Fauces arida 3. Nares aridi 4. ExpeEloratio folida 3 . Conjlipatio alvi 6 . Cutis arida 7. Urina parcior color at a 8. Calculus felleus et icierus 9. renis 10. vefica 1 1 . arthriticus 1 2. Rheumatfmus chronicus 1 3 . Cicatrix vulnerum 14. Cornea obfufcatio Dry tongue Dry throat Dry noftrils Solid expectoration Coftivenefs Dry Ikin Diminilhed coloured urine Gall-ftone and jaundice Stone of the kidney Stone of the bladder Gout-ftone Chronic rheumatifm Healing of ulcers Scar on the cornea GENUS IV. With increafed Aciions of other Cavities and Membranes. SPECIES. 1. NiSiitatio irritativa 2. Deglutitio irritativa 3. Refpiratio et tuffs 4. Exclufo bilis 5. Dentitio 6 . Priapifmus 7. Diflenfio mammularum Irritative nictitation Irritative deglutition Refpiration and cough Exclufion of the bile Toothing Priapifm Diftention of the nipples 8. Defcenfus , DISEASES 8. Defcenfus uteri 9. Prolapfus ani 10. Lumbricus 1 1 . Tania I 2 Afcarides 1 3 . Dractwculus 1 4. Morpiones 15. Pediculi Clas»I. i. 5. Defcent of the uterus Defcent of the re£tum Hound worm Tape- vi orm Thread- worms Guinea -worm Crab-lice Lice 1. 2. 3 - 4 - S' 6 . 7 - S. 9 - 10 11. GENUS V. With increafed Aflions of the Organs of Senfe. SPECIES. Acuter Vifctts acrior Auditus acrior Olfadtus acrior Gujlus acrior Taft us acrior Senfus colons acrior extenfionis acrior Titil/atio Id uritus Dolor ureas Lonllernatio Tickling Itching Smarting Surprtfe fight hearing fmell tafte touch fenfe of heat fenfe of extenfion ORDO II. Decreafed Irritation. GENUS I. With decreafed Adlions of the Sanguiferous Syjlem. 1. Febris inirritctiva 2. Parefis inirritativa 3. Scmnus interruptus ‘4. Syncope 5. Hamorrhagia venofa 6. Hamorrhois cruenta 7. Hamorrhagia renum 8. hepatis 9. Hamoptoe venofa 10. Palpitatio cordis 1 1 . Menorrhagia 1 2. Dyjmenorrhagia 13. Lochia nimia 1 4. Abortio fpontanea SPECIES Inirritative fever ■ debility Interrupted fleep Fainting Venous haemorrhage Bleeding piles - — from the kidneys Bleeding from the liver Spitting of venous blood Palpitation of the heart Exuberant menftruation Deficient menltruation Too great lochia Spontaneous abortion 1 5 . ScorbutiTs Class I. 2. 2. OF IRRITATION. 5 15. Scorbutus 16. Vibices 17. Petechia 18 Aneurifmd 1 9. Varix Scurvy Extravafations o£ blood Purple fpots Aneurifm Swelling of veins GENUS II. With decreafed Actions of the Secerning Syfetn. SPECIES. 1. Frigus febrile chronicuni 2. Pallor fugitivus. permanens 3 Pus parcius 4. Mucus parcior 5 . Urina parcior pallida 6 . Torpor hepaticus 7 Torpor pancreatis 8. Torpor renis 9. PunElce mucofa vultus 10. Macuhe cutis fulva 1 1 . Canities 12. Callus 13. CataraEla 1 4. Innvtritio ojftum 15. Rachitis 16. Spina dijlortio 1 7. Claudicatio coxaria 18 Spina protuberans 1 9 Spina bifida 20 . DefeElus palati Coldnefs in fevers permanent Palenefs fugitive permanent Diminifhed pus Diminifhed mucus Pale diminifhed urine Torpor of the liver Torpor of the pancreas Torpor of the kidney Mucous fpots on the face Tawny blots on the fkin Grey hairs Callus Catara£t Innutrition of the bones Rickets Diltortfon of the fpine Lamenefs of the hip Protuberant fpine Divided fpine Defe£t of the palate GENUS III. With decreafed AElions of the Abforbent Syfem. SPECIES. X . Mucus faucium frigidus 2. Sudor frigidus 3. Catarrhus frigidus 4 Expefloratio frigida 5. Urina uberior pallida 6 . Diarrhoea frigida 7. Fluor albus frigidus 8. Gonorrhoea frigida Cold mucus from the throat fweat catarrh expedloration Copious pale urine Cold diarrhoea Fluor albus gonorrhoea 9. Hepatis 6 DISEASES Class I. 2. 4. 9. Hepatis tumor 10. Chlorofs 1 1 . Hydrocele 12. Hydrocephalus internus 1 3 . Aj cites 14. Hydrothorax 15. Hydrops ovarii 16. Anafarca pulmonum 17. Obefitas 18. Splenic tumor 19 Genu tumor a lb us 20. Bronchocele 2 1 • Scrofula 22. Scirrhus 23. re Eli 24. urethra 25. cefophagi 26. LaEleorum inirritabilitas 27. Lymphaticorum inirritabili- tas Swelling of the liver Green ficknefs Dropfy of the vagina teftis of the brain of the belly of the cheft of the ovary of the lungs Corpulency Swelling of the fpleen W hite {welling of the knee Swelled throat King’s evil Scirrhus of the re urn of the urethra of the throat Inirritability of the ladleals Inirritability of the lymphatics GENUS IV. With decreafed A Elions of other Cavities and Membrane. SPECIES. 1 . Sitis calida — — frigida 2. Efuries 3. Naufea fee a 4. JEgritudo veniriculi 3. Cardialgia 6. Arthritis ventriculi 7. Colica fatulenta 8. Colica faturnina 9. Tympanitis 10. Hypochondriafis 1 1 . Cephalaa idiopathica. 12 . Hemicrania idiopathica 1 3 . Odontalgia Otalgia 1 4. Pleurodyne chronicha 15. Sciatica frigida 16. Lumbago frigida 17. Hyjleralgia frigida 18. ProElalgia frigida Thirft warm cold Hunger Dry naufea Sicknefs of ftomach Heart-burn Gout of the ftomach Flatulent colic Colic from lead Tympany Hypochondriacifm Idiopathic head-ach Idiopathic hemicrania Tooth-ach Ear-ach Chronical pain of the fide Cold fciatica lumbago pain of the uterus — pain of the re&um 19. VeftCct Class I. 3. i- OF IRRITATION. 19. 1. 2. 3 - 4 - 5 - 6 . 7 - 8 . 9 - 10. 1. 2. 3 - 4 - s- 6. 7 - 8 9. 10. 11. 1. 2. 3 . 4 - 5 - fell eg inirritabilitas Inirritability of the gallbladder J et idler us and jaundice GENUS V. With decreafed Actions of the Organs of Senfe. Stultitia hiirritabilis Vifcus imminutus Mufae volitantes Strabifmus Amaurofis Auditus imminutus OlfaBus imminutus Gujlus imminutus T aBus imminutus Stupor SPECIES. Folly from irritability Impaired vifion Dark moving fpecks Squinting Palfy of the optic nerve Impaired hearing fmell tafte touch Stupor ORDO III. Retrograde Irritative Motions. GENUS I. Of the Alimentary Canal. SPECIES. Ruminatio RuBus Apepfia Vomitus Cholera Ileus Globus hyjlericus Vomendi conamen inane Borborigmus Hyferia Hydrophobia Chewing the cud Eructation Indigeftion, water-qualm Vomiting Cholera Iliac paffion Hylleric ftrangulation Vain efforts to vomit Gurgling of the bowels Hyfteric difeafe Dread nf water GENUS II. Of the Abforbent Sydetn, Catarrhus lymphaticus Salivatio lymphatica Naufea humida Diarrhoea lymphatica Diarrhoea chylifera SPECIES. Lymphatic catarrh Lymphatic falivation Moift naufea Lymphatic flux Flux of chyle 6 . Diabetes 8 DISEASES, &c. Class I. 3. 3. 6 . Diabetes 7. Sudor lymphatic us 8. Sudor ajlhmaticus 9 Tranjlatio puris 1 o. laclis 1 1 , ■ ' urine Diabetes Lymphatic fweat Afthmatic fweat Tranflation of matter of milk of urine GENUS III. Of the Sanguiferous Syjlem. SPECIES. 1. Capillarium motus retrogref- f us . . 2. Palpitatio cordis 3. Anhelatio fpafmodica Retrograde motion of the ca- pillaries Palpitation of the heart Spafmodic panting CLASS Class I. 1. 1. DISEASES, &c. 9 CLASS I. DISEASES OF IRRITATION. ORDO I. liter enfed Irritation. GENUS I. With increafed AElions of the Sanguiferous Syfem. THE irritability of the whole, or of part, of our fyftem is per- petually changing ; thefe viciflitudes of irritability and of inir- ritability are believed to depend on the accumulation or exhauf- tion of the fenfonal power, as their proximate caufe ; and on the difference of the prefent ftimulus, and of that which we had previoufly been accuftomed to, as their remote caufe. Thus a fmaller degree of heat produces pain and inflammation in our hands, after they have been for a time immerfed in fnow ; which is owing to the accumulation of fenforial power in the moving fibres of the cutaneous vcflels during their previous qui- efcence, when they were benumbed with cold. And we feel ourfelves cold in the ufual temperature of the atmofphere on coming out of a warm room ; which is owing to the exhauftion of fenforial power in the moving fibres of the veffels of the (kin by their previous increafed activity, into which they were exci- ted by unufual heat. Hence the cold fits of fever are the occafion of the fucceeding hot ones ; and the hot fits contribute to occafion in their turn the fucceeding cold ones. And though the increafe of ftimulus, as of heat, exercife, or diftention, will produce an increafed ac- tion of ftimulated fibres ; in the fame manner as it is pro- duced by the increafed irritability which is occafioned by a previous defe£t of ftimulus ; yet as the exceffes of irritation from the ftimulus of external things are more eafily avoided than the deficiencies of it ; the difeafes of this country, except thofe which are the confequences of drunkennefs, or of immediate exercife, more frequently begin with torpor than with orgafm ; that is, with inactivity of fome parts, or of the whole of the fyftem, and confequent coldnefs, than with increafed activity, and confe- quent heat. If the hot fit be the confequence of the cold one, it may be afleed if they are proportionate to each other ? it is probable that Vol. II. C they lb DISEASES Class I. i. r. x. they are, where no part is deftroyed by the cold fit, as in morti- fication or death. But we have no meafure to diftinguilh this, except the time of their duration ; whereas the extent of the torpor over a greater or lefs part of the fyftem, which occafions the cold fit ; or of the exertion which occafions the hot one ; as well as the degree of fuch torpor or exertion, are perhaps more material than the time of their duration. Befides this, fome mufcles are lefs liable to accumulate fenforial power during their torpor, than others, as the locomotive mufcles compared with the capillary arteries ; on all which accounts a long cold fit may often be followed by a (hort hot one. As the torpor, with which a fit of fever commences, is fome- times owing to defect of ftimuius, as in going into the cold- bath ; and fometimes to a previous exhauftion of the fenforial power by the a&ion of fome violent (timulus, as after coming out of a hot room into cold air ; a longer time mull elapfe, be- fore there can be a fufficient accumulation of fenforial power to produce a hot fit in one cafe than in the other. Becaufe in the latter cafe the quantity of fenforial power previoufly expended mud be fupplied, before an accumulation can begin. The cold paroxyfm commences, when the torpor of a part be- comes fo great, and its motions in confequence fo flow or feeble, as not to excite the fenforial power of aflociation ; which in health contributes to move the reft of the fyftem, which is cate- nated with it. And the hot fit commences by the accumulation of the fenforial power of irritation of the part firft affected, either fo as to counteract its deficient ftimuius, or its previous wafte of fenforial power ; and it becomes general by the accumulation of the fenforial power of aflociation •, which is excited by the reno- vated aCtions of the part firft affeCted ; or becomes fo great as to overbalance the deficient excitement of it. On all thefe accounts the hot fit cannot be fuppofed to bear any proportion to the cold one in length of time, though the latter may be the confequence of the former. See Suppl. I. 1 6. 8 . SPECIES. I . Felris Irritativn. Irritative fever. This is the fynocha of fome writers, it is attended with ftrong pulfe without inflamma- tion ; and in this circumftance differs from the febris inirritariva of Clafs I. 2. i. i. which is attended with weak pulfe without inflammation. The increafed frequency of the pulfation of the heart and arteries conftitutes fever ; during the cold fit thefe pulfations are always weak, as the energy of aCtion is then de- creafed throughout the whole fyftem j and therefore the gener- al Class I. i. i. 2. OF IRRITATION. 11 al arterial ftrength cannot be determined by the touch, till the cold part of the paroxyfm ceafes. This determination is fome- times attended with difficulty ; as flrong and weak are only com- parative degrees of the greater or lefs refiftance of the pulfation of the artery to the compreffion of the finger. But the greater or lefs frequency of the pulfations affords a collateral evidence in rhofe cafes, where the degree of ftrength is not very diftin- guifhable, which may affift our judgment concerning it. Since a moderately ftrong pulfe, when the patient is in a recumbent pofture, and not hurried in mind, feldom exceeds 1 20 ftrokes in a minute ; whereas a weak one often exceeds 130 in a recum- bent pofture, and 150 in an ere£t one, in thofe fevers, which are termed nervous or putrid. See Sect. XII. 1. 4. The increafed frequency of the pulfation of the heart and ar- teries, as it is occafioned either by excefs or defe£t of ftimulus, or of fenforial power, exitts both in the cold and hot fits of fever ; but when the cold fit ceafes, and the pulfe becomes ftrong and full as well as quick, in confequence of the increafed irritability of the heart and arteries, it conftitutes the irritative fever, or fy- nocha. It is attended with confiderable heat during the parox- yfm, and generally terminates in a quarter of a lunation, without any difturbance of the faculties of the mind. SeeClafs IV. 1.1.8. M. M. Venefe&ion. Emetics. Cathartics. Cool the patient in the hot fit, and warm him in the cold one. Reft. Torpentia. 2. Ebrietas. Drunkennefs. By the ftimulus of wine or opi- um the whole arterial fyftem, as well as every other part of the moving fyftem, is excited into increafed a£tion. All thefe fecre- tions, and with them the pvoduftion of fenforial power itfelf in the brain, feern for a time increafed, with an additional quantity of heat, and of pleafurable fenfation. See Sedt- XXI. on this fubje£t. This explains, why at the commencement of the warm paroxyfm of fome fevers the patient is in greater fpir- its, or vivacity ; becaufe, as in drunkennefs, the irritative motions are all increafed, and a greater production of fenfation is the con- fequence, which, when in a certain degree, is pleafurable, as in the diurnal fever of weak people. SeCt XXXVI. 3. 1. 3 H&morrhagia arteriofa Arterial haemorrhage. Bleeding, with a quick, ftrong, and full pulfe. The haemorrhages from the lungs, and from the nofe, are the molt frequent of thel'e ; but it fometimes happens, that a fmall artery but half divided, or the punCture of a leech will continue to bleed pertinacioufly M. M. Venefection. Cathartic with calomel. Divide the wounded artery. Bind fponge on the puncture. If coffee or charcoal, internally ? If air, with lefs oxygene ? 4. HWmoptos avterhfa. Spitting of arterial blood. Blood fpit up DISEASES Class I. r. n 5. A 2 up from the lungs is florid, becaufe it has juft been expofed to the influence of the air in its paflage 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 fame time from the difagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is ejected from the ftomach. Sometimes an hemoptoe for feveral fucceffive days returns in gouty perfons without danger, and feems to fupply the place of the gouty paroxyfms Is not the liver always difeafed previous to the htemoptoe, as in feveral other haemorrhages ? See Clafs 1.2. I. 9. M M. Venefettion, a purge, a blifter, diluents, torpentia ; and afterwards forbentia, as the bark, the acid of vitriol, and 0- pium. An emetic is faid to ftop a pulmonary haemorrhage, which it may effedt, as ficknefs decreafes the circulation, as is very evident in the great ficknefs fometimes produced by too large a dofe of digitalis purpurea. Dr. Rufli fays, a table fpoonful or two of common fait is fuc- cefsful in hsemoptoe ; this may be owing to its ftimulating the abforbent fyftems, both the lymphatic, and the venous. Should the patient refpire air with lefs oxygen? or be made fick by whirling round in a chair fufpended by a rope ? One immer- fion in cold water, or a fudden fprinkling all over with cold water, would probably ftop a pulmonary haemorrhage. See Sea. XXVII I. 5. Hamorrhagia narium. Epi/Iaxis. Bleeding at the nofe in elderly fubjeas mod frequently attends thofe, whofe livers are enlarged or inflamed by the too frequent ufe of fermented liquors. In boys it occurs perhaps Amply from redundancy of blood ; and in young girls fometimes precedes the approach of the cata- menia ; and then it fhews a difpofition contrary to chlorofis ; which arifes from a deficiency of red blood. M. M. It is (topped by plunging the head into cold water, with powdered fait haftily dilfolved in it ; or fometimes by lint ftrewed over with w'heat flower put up the noftrils ; or by a fo- lution of fteel in brandy applied to the veflel by means of lint. The cure in other refpects as in hsemoptoe ; when the bleeding recurs at certain periods, after venefedtion, and evacuation by calomel, and a blifter, the bark and fteel muft be given, as in in- termittent fevers. See Sect. XXVII. 1. The tindture of digitalis given in proper quantities, as 30 drops from a two-ounce phial every fix hours for two or three or four doles, is probably an efficacious medicine. See Dr. Ferri- ar’s Treatife on Digitalis. He (topped active hemorrhages by the exhibition of digitalis. ORDO Class I. i. 2. r. OF IRRITATION. *3 ORDO I. Increafed Irritation. GENUS II. With increafed Actions of the Secerning Syjlem. These are always attended with increafe of partial or of gen- eral heat ; for the fecreted fluids are not Amply feparated from the blood, but are new combinations •, as they did not previoufly exift as fuch in the blood veflels. But all new combinations give out heat chemically ; hence the origin of animal heat, which is always increafed in proportion to the fecretion of the part afle£ted, or to the general quantity of the fecretions. Neverthe- lefs there is reafon to believe, that as we have a fenfe purpofely to diftinguifh the prefence of greater or lefs quantities of heat, as mentioned in Se£l. XIV. 6 . fo we may have certain minute glands for the fecretion of this fluid, as the brain is believed to fecrete the fenforial power, which would more eafily account for the inftantaneous production of the blufh of fhame, and of an- ger. This fubject deferves further inveftigation. SPECIES. 1. Calor febrilis. The heat in fevers arifes from the increafe of fome fecretion, either of the natural fluids, as in irrita- tive fevers ; or of new fluids, as in infectious fevers ; or of new veflels, as in inflammatory fevers. The pain of heat is a confe- quence of the increafed extenflon or contraction of the fibres expofed to fo great a ftimulus. See ClafsI. 1. 5. 6 . 2. Rubor febrilis. Febrile rednefs. When the cold fit of fe- ver terminates, and the pulfations of tire heart and arteries be- come ftrong as well as quick from the increafe of their irritabili- ty after their late quiefcence, the blood is impelled forwards in- to the fine extremities of the arteries, and the anaftamofing ca- pillaries, quicker than the extremities of the veins can abforb and return it to the heart Hence the pulfe at the wrilt becomes full, as well as quick and ftrong, and the fkin glows with arte- rial blood, and the veins become empty and lefs vifible. In elderly people the force of the heart and arteries becomes lefs, while the abforbent power of the veins remains the fame 5 whence the capillary veflels part with the blood, as foon as it is received, and the fkin in confequence becomes paler ; it is alfo probable, 14 DISEASES Class I. i. 2. 3. probable, that in more advanced life fome of the finer branches of the arteries coalefce, and become impervious, and thus add to the opacity of the (kin. 3. Sudor calidus. Warm fweat may be divided into four va- rieties, according to its remote caufes. Firft, the perfpirable matter is fecreted in as great quantity during the hot fit of fever, as towards the end of it, when the fweat is feen upon the Ikin. But during the hot fit the cutaneous abforbents aft alfo with in- creafed energy, and the exhalation is likewife increafed by the greater heat of the Ikin ; and hence it does not appear in drops on the furface, but is in part re-abforbed, and in part diflipated in the atmofphere. But as the mouths of the cutaneous abforb- ents are expofed to the cool air or bedclothes ; whilft thofe of the capillary glands, which fecrete the perfpirable matter are ex- pofed to the warmth of the circulating blood ; the former, as foon as the fever-fit begins to decline, lofe their increafed aflion firft, and hence the abforption of the fweat is diminifhed, whilft the increafed fecretion of it continues for fome hours afterwards, which occafions it to Hand in drops upon the fkin. As the fkin becomes cooler, the evaporation of the perfpira- ble matter becomes lefs, as well as the abforption of it And hence the diflipation of aqueous fluid from the body, and the confequent third, are perhaps greater during the hot fit, than during the fubfequent fweat. For the fweats do not occur, ac- cording to Dr. Alexander’s experiments, till the fkin is cooled from 112 to 108 degrees of heat ; that is, till the paroxyim be- gins to decline. From this it appears, that the fweats are not critical to the hot fit, any mere than the hot fit can be called critical to the cold one ; but fimply, that they are the natural confequence of the decline of the hot fit, commencing with the decreafed aftion of the abforbent fyftem, and the decreafed evap- oration from the fkin. And from hence it may be concluded, that a fever-fit is not in general an effort of nature to reftore health, as Sydenham confidered it, but a neceffary confequence of the previous torpor ; and that the caufes of fevers would be lefs detrimental, if the fever itfelf could be prevented from ex- ifting ; as appears in the cool treatment of the fmail-pox. It muftbe noted that the profufe fweats on the fkin are more frequent at the decline of fever-fits than the copious urine, or loofe ftools, which are mentioned below ; as the cutaneous ab- forbents, being expofed to the cool air, lofe their increafed ac- tion fooner than the urinary or inteftinal abforbents ■, which open into the warm cavities of the bladder and inteftines ; bu$ which are neverthelefs often affected by their fympathy with the cutaneous abforbents. Hence few fevers terminate without a moifture Class. I. i. 2. 3. OF IRRITATION. moifture of the Ikin ; whence arofe the fatal pra&ice of forcing fweats by the external warmth of air or bed-clothes in fevers ; for external warmth increafes the a&ion of the cutane- ous capillaries more than that of the other fecerning veffels ; be- caufe the latter are habituated to 98 degrees of heat, the inter- nal warmth of the body ; whereas the cutaneous capillaries be- ing nearer the furface are habitually kept cooler by the contact of the external air. Sweats thus produced by heat in confined rooms are ftill more detrimental ; as the air becomes then not only deprived of a part of its oxygene by frequent refpiration, but is loaded with animal effluvia as well as with moifture, till it can receive no more ; and in confequence, while the cutane- ous fecretion Hands upon the fkin in drops for want of exhala- tion, the lungs are expofed to an infalubrious atmofphere. I do not deny, that fweating may be fo managed as to be ferviceable in preventing the return of the cold paroxyfm of fe- vers ; like the warm bath, or any other permanent ftimulus, as wine, or opium, or the bark. For this purpofe it fhould be con- tinued till pad the time of the expended cold fit, fupported by moderate dofes of wine- whey, with fpirit of hartfhorn, and mod- erate degrees of warmth. Its falutary effect, when thus man- aged, was probably one caufe of its having been fo much attend- ed to ; and the fetid fmell, which when profufe is liable to ac- company it, gave occafion to the belief, that the fuppofed mate- rialcaufe of the difeafe was thus eliminated from the circulation. When too great external heat is applied, the fyftem is weak- ened by excefs of action, and the torpor which caufes the cold paroxyfm recurs fooner and more violently. For though fome ftimuli, as of opium and alcohol, at the fame time that they ex- hauft the fenforial power by promoting increafe of fibrous ac- tion, may alfo increafe the production or fecretion of it in the brain, yet experience teaches us that the exhauftion far out-bal- ances the increafed production, as is evinced by the general de- bility, which fucceeds intoxication. In refpeCt to the fetor attending copious continued fweats, it is owing to the animalized part of this fluid being kept in that degree of warmth, which moft favours putrefaction, and not fuf- fered to exhale into the atmofphere. Broth, or other animal mucus, kept in fimilar circumilances, would in the fame time acquire a putrid fmell 3 yet has this error frequently produced miliary eruptions, and increafed every kind of inflammatory or fenfitive fever. The eafc, which the patient experiences during fweating, if it be not produced by much external heat, is fimilar to that of the warm bath ; which by its ftimulus applied to the cutaneous veffels, DISEASES 16 Class I. i. 2. 3. veflels, which are generally cooler than the internal parts of the fvftem, excites them into greater adlion ; and pleafurable fenfa- tion is the confequence of thefe increafed aftions of the veflels of the Ikin. From confidering all thefe circumflances, it ap- pears that it is not the evacuation by fweats, but the continued ftimulus, which caufes and fupports thofe fweats which is fer- viceable in preventing the returns of fever-fits And that fweats too long continued, or induced by too great ftimulus of warmth, clothes, or medicines, greatly injure the patient by increafing in- flammation, or by exhaufting the fenforial power. See ClafsI. 1. 2. 14. Secondly , The fweats produced by exercife or labour are of the warm kind ; as they originate from the increafed a&ion of the capillaries of the lkin, owing to their being more powerfully ftimulated by the greater velocity of the blood, and by a greater quantity of it palling through them in a given time. For the blood during violent exercife is carried forwards by the action of the mufcles falter in the arteries, than it can be taken up by the veins ; as appears by the rednefs of the lkin. And from the confequent fweats, it is evinced, that the fecretory veflels of the lkin during exercife pour out the perfpirable matter falter, than the mouths of the abforbent veflels can drink it up. Wihch mouths are not expofed to the increafed mufcular aftion, or to the ftimulus of the increafed velocity and quantity of the blood, but to the cool air. Thirdly , the increafed fecretion of perfpirable matter occafion- ed by the ftimulus of external heat belongs likewife tothis place; as it is caufed by the increafed motions of the capillary veflels ; which thus feparate from the blood more perfpirable matter, than the mouths of their correfpondent abforbent veflels can take up ; though thefe alfo are ftimulated by external heat into more energetic a&ion. If the air be ftationary, as in a fmall room, orbed with clofed curtains, the fweat ftands in drops on the lkin for want of a quicker exhalation proportioned to the quicker fe- cretion. A fourth variety of warm perfpiration is that occafioned by ftimulating drugs, of which opium and alcohol are the moft powerful ; and next to thefe the fpices, volatile alkali, and neu- tral falts, efpecialiy fea-falt ; that much of the aqueous part of the blood is diflipated by the ufe of thefe drugs, is evinced by the great thirft, which occurs a few hours after the ufe of them. See Art. III. 2 1. We may from hence underftand, that the increafe of this fecretion of perfpirable matter by artificial means, muft be fol- lowed by debility and emaciation. When this is done by taking much Class I. i. 2. 3. OF IRRITATION. 17 much fait, or falted meat, the fea-fcurvy is produced ; which confifts in the inirritability of the bibulous terminations of the veins ariling from the capillaries ; fee Clafs I. 2. 1. 14. The fcrofula, or inirritability of the lymphatic glands, feems alfo to be occafionally induced by an excefs in eating fait added to food of bad nouriihment. See Clafs I 2 3 21. If an excefs of per- fpiration is induced by warm or ftimulant clothing, as by wear- ing flannel in contaft: with the (kin in the fummer months, a per- petual febricula is excited, both by the preventing the aecefs of cool air to the (kin, and by perpetually goading it by the nume- rous and hard points of the ends of the wool ; which when ap- plied to the tender Ikins of young children, frequently produce the red gum, as it is called ; and in grown people, either an eryfipelas, or a miliary eruption, attended with fever. See Clafs II. 1. 3. 12. Shirts made of cotton or calico ftimulate the (kin too much by the points of the fibres, though lefs than flannel ; whence cotton handkerchiefs make the nofe fore by frequent ufe. The fibres of cotton are, I fuppofe, ten times fhorter than thofe of flax, and the number of points in confequence twenty times' the number ; and though the manufacturers finge their calicoes on a red-hot iron cylinder, yet I have more than once feen an ery- fipelas induced or increafed by the Stimulus of calico, as well as of flannel ; and have during the laft fummer prevailed on two, who were confined to their beds by fevers, and three, who were in a ftate of great debility, to difencumber themfelves oi the flannel fhirts, which they had worn for fome time ; all of them became immediately and considerable relieved ; and found no inconvenience afterwards by discontinuing an unneceflary ftim- ulus, which had nothing to recommend it to thofe patients but the frivolous fafhion of the day. The inconvenience, which weak conftitutions experience from wearing flannel fhirts, arifes from this circumftance ; that theex- tremities of their limbs are more liable to become cold, than the furface of the cheft and abdomen, and that hence they Should in preference wear warmer (lockings, Shoes, and focks, or gloves. By Stimulating the warmer parts of the fkin into too ftrong and ufelefs exertion, as by the hard points of a flannel Shirt at all fea- fons, and by its confining the warmth of the Ikin too much in the fummer months, a part of the fenforial power becomes un- Heceflarily expended •, and in weak conftitutions, w’here there is none to fpare, fome other parts of the fyftem muft aft with lefs energy ; and thus I believe the extremities of feeble people be- come colder by the ufe of a flannel Shirt ; in Stronger people, and perhaps in warmer climates, this increafed coldnefs of the ex- Vol. II. D tremities DISEASES Glass I. i. 2. 3. trcmities may not be perceptible ; as ftronger perfons can better bear fome increafed exertion, and the confequent unneceflary lofs of fome fenforial power ; and in warmer climates the ex- tremities may not be fo liable to become cold. Analogous to this I remember to have feen an inoculated child about fix years old, whofe bofom and face, at the beginning of the eruptive fever, were of a fiery red colour, and exceedingly hot to the touch ; and whofe feet were at the fame time pale, and cold to the touch. When on expofing the bofom and face to colder air with the feet only flightly covered, the colour of the former in a few minutes became nearly natural, with little excefs of tangi- bleheat,and atthe fame time the feet became as warm as natural. Whence I conclude, that all unneceflary increafe of fl:imuli,as of warm clothing, wine, and opium, is more injurious to fee- ble conftitutions than to robuft ones •, and that fuch Itimuli alone are falutary to weak perfons, as increafe thofe addions of the fyf- tem, which are immediately neceflary to life and health, as >he clafs of medicines termed forbentia, as peruvian bark, and other bitters, and very fmall quantities of fteel,as thefe feem to increafe the addivity of the abforbent fyllem, both of the lymphatic and venous ones, and thus fupply more nutrition, with all its falutary confequences. And that the ufe of thefe forbentia, as well as the occafional ufe of warmer clothing, wine, and opium, fhould be difcontinued, as foon as the fyftem can acquire the natural habit of adding with fufficient energy without them. See Article II. 2. 2. I. of the Materia Medica. The increafe of perfpiration by heat either of clothes, or of fire, contributes much to emaciate the body ; as is well known to jock- eys, who, when they are a ftone or two too heavy for riding, find the quickest way to leflen their weight is by fweating them- felves between blankets in a warm room ; but this likewife is a praddice by no means to be recommended, as it weakens the fyf- tem by the excefs of fo general a ftimulus, brings on a premature old age, and fhortens the fpan of life ; as may be further deduced from the quick maturity, and Ihortnefs of the lives, of the inhab- itants of Hindoftan, and other tropical climates. When the heat of the body in weak patients in fevers is in- creafed by the ftimulus of the points of flannel, a greater confe- quent debility fucceeds, than when it is produced bv the warmth of fire as in the former the heat is in part owing to the inceaf- ed addivity of the fkin, and confequent expenditure of fenforial power ; whereas in the latter cafe it is in part owing to the in- flux of the fluid matter of heat. . So the warmth produced by equitation, or by rubbing the body and limbs with a fmooth brufh or hand, as is done after bathing in Class. I. i. 2. 4- OF IRRITATION. i$> in fome parts of the Eaft, does not expend nearly fo much fen- foriaJ power, as when the warmth is produced by the locomo- tion of the whole weight of the body by mufcular action, as in walking, or running, or fwimming. Whence the warmth of a fire is to be preferred to flannel (hirts for weak people, and the agitation of a horfe to exercife on foot. And I fuppofe thofe, who are unfortunately loft in fnow, who are on foot, are liable to perifh fooner by being exhaufted by their mufcular exertions; and might frequently preferve themfelvesby lying on the ground and covering themfelves with fnow, before they were too much exhaufted by fatigue. See Botan. Garden, Vol. II. the note on Barometz. M. Buffon made a curious experiment to fhew this circum- stance. He took a numerous brood of the butterflies of filk- worms, fome hundreds of which left their eggs on the fame day and hour; thefe he divided into two parcels; and placing one par- cel in the fouth window, and the other in the north window ofhis houfe, he obferved, that thofe in the colder fituation lived many days longer than thofe in the warmer one. From thefe obferva- tions it appears, that the wearing of flannel clothing next the fkin, which is now fo much in fafhion, however ufeful it may be in the winter to thofe, who have cold extremities, bad di- geftions, or habitual coughs, muft greatly debilitate them, if worn in the warm months, producing fevers, eruptions, and pre- mature old age. See Se£t. XXXVII. 5. Clafs 1 . 1.2. 14. Art III. 2. 1. 4. Uritia uberior color at a. Copious coloured urine. To- wards the end of fever-fits a large quantity of high coloured urine is voided, the kidneys continuing to a£t ftrongly, after the increafed atlion of the abforbents of the bladder is fomewhat diminiflied. If the abforbents continue alfo to act ftrongly, the urine is higher coloured, and fo loaded as to depofite, when cool, an earthy fediment, erroneoufly thought to be the material caufe of the diieafe; but is Amply owing to the fecretion of the kidneys being great from their increafed a£tion ; and the thinner parts of it being abforbed by the increafed a£lk»n of the lymphatics, which are fpread very thick on the neck of the bladder ; for the urine, as well as perhaps all the other fecreted fluids, is produced from the kidneys in a very dilute ftate ; as appears in thofe, who from the ftimulus of a (tone, or other caufe, evacuate their urine too frequently ; which is then pale from its not having remained in die bladder long enough for the more aqueous part to have been re-abforbed. The general ufe of this urinary ab- forption to the animal economy is evinced from the urinary blad- ders of fill), which would otherwife be unneceffary. High col- oured urine in large quantity fhews only, that the Secreting veft- Sets 20 DISEASES Class I. i. 2. 5. fels of the kidneys, and the abmrbents of the bladder, have acted with greater energy. When there is much earthy fediment, it fhews, that the abforbents have acted proportionally ftronger, and have confequently left the urine in a lefs dilute ftate. In this urine the tranfparent fediment or cloud is mucous ; the opaque fediment is probably coagulable lymph from the blood changed by an animal or chemical procefs. The floating fcum is oil. The angular concretions to the Cdes of the pot, formed as the urine cools, is microcofmic fait. Does the adhefiveblue matter on the fides of the glafs, or the blue circle on it at the edge of the upper furface of the urine, confift of Pruftian blue ? 5. Diorrhaa calida. Warm diarrhoea. This fpecies maybe divided into three varieties, deduced from their remote caufes, under the rihmes of diarrhoea febrilis, diarrhoea crapulofa, and diarrhoea infantum. The febrile diarrhoea appears at the end of fever fits, and is erroneoufly called critical, like the copious urine, and the fweats ; whereas it arifes from the increafed ac- tion of thofe fecerning organs, which pour their fluids into the inteftinal canal (as the liver, pancreas, and mucous glands,) continuing longer than the increafed aflion of the inteftinal ab- forbents. In this diarrhoea there is no appearence of curdled chyle in the ftools, as occurs in cholera. I 3. 1 5. The diarrhoea crapulofa , or diarrhoea from indigeftion, occurs when too great a quantity of food or liquid has been taken ; which not being completely digefted, ftimulates the inteftines like any other extraneous acrid material ; and thus produces an increafe of the fec^etions into them of mucus, pancreatic juice, and bile. When the contents of the bowels are ft ill more ltim- ulant, as when draftic purges, or very putrefcent diet, have been taken, a cholera is induced. See Se£t 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 ftomachs of all animals, old as well as young, and even of carnivorous ones, as of hawks. (Spallanzani.) And it is the gaftric juice of the calf, which is employed to curdle milk in the procefs of making cheefe. Milk is the natural food for children, and muft curdle in their ftomachs previous to di- geltion ; and as this curdling of the milk deftroys a part of the acid juices of the ftomach, there is no reafon for difcontinuing the ufe of it, though it is occafionally ejected in a curdled ftate. A child of a week old, which had been taken from the breaftof its dying mother, and had by fome uncommon error been fuf- fered to take no food but water-gruel, became fick and griped in twenty-four hours, and was convulsed on the fecond day, and died on the third ! When all young quadrupeds, as well as children, Glass I. i. 2. 6 . OF IRRITATION. 21 children, have this natural food of milk prepared for them, the analogy is fo ftrong in favour of its falubrity, that a perfon (hculd have powerful teftimony indeed of its difagreeing before he advifes the difcontinuance of the ufe of it to young children in health, and much more fo in ficknefs. The farmers lofe 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 ftarved into the fcrofula, and either perifh qr live in a ftate of wretched debility. When young children are brought up without a breaft, they fhould for the firft two months have no food but new milk ; fince the addition of any kind of bread or flour is liable to fer- ment, and produce too much acidity ; as appears by the confe- quent diarrhoea with green dejedions and gripes ; the colour is owing to a mixture of acid with the natural quantity of bile, and the pain to its ftimulus. And they fhould never be fed as they lie upon their backs, as in that pofture they are neceflitated to fwallow all that is put into their mouths •, but when they are fed, as they are fitting up, or raifed up, when they have had enough, they can permit the reft to run out of their mouths. This cir- cumftance is of great importance to the health of thofe children, who are reared by the fpoon, fince if too much food is given them, indigeftion, and gripes, and diarrhoea, are the confe- quence ; and if too little, they become emaciated ; and of this exad quantity their own palates judge the beft. M. M. In this laft cafe of the diarrhoea of children, the food fhould be new milk, which by curdling deftroys part of the acid, which coagulates it. Chalk about four grains every fix hours, with one drop of fpiritof hartfhorn, and half a drop of lauda- num. But a blifter about the fize of a (hilling is of the greateft fervice by reftoring the power of digeftion. See Article III. 2. 1. in the Materia Medica. 6. Salivatio calida. Warm falivation. Increafed fecretion of faliva. This may be effected either by ftimulating the mouth of the gland by mercury taken internally ; or by ftimulating the excretory dud of the gland by pyrethrum, or tobacco ; or (im- ply by the movement of the mufcles, which lie over the gland, as in mafticating any taftelefs fubftance, as a lock of wool, or maftic. In about the middle of nervous fevers a great fpittingof fali- va fometimes occurs, which has been thought critical ; but as it continues fometimes two or even three weeks without the relief of the patient, it may be concluded to arife from fome acciden- tal circumftance, perhaps not unfimilar to thehyfteric ptyalifms mentioned in Clafs I. 3. 2. 2. See Sed. XXIV. M. M. Cool 22 DISEASES Class I. r. 2. 7'. ■ M. M. Cool air, diluents, warm bath, evacuations. 7. Catarrhus calidus. Warm catarrh. Confifts in an in- created fecretion of mucus from the noftrils without inflamma- tion. This difeafe, which-is called a cold in the head, is fre- quently produced by cold air acting for fome time on the mem- branes, which line the noftrils, as it pafles to the lungs in refpi- ration. Whence a torpor of the aClion of the mucous glands is firft introduced, as in Clafs I. 2. 3. 3. and an orgafm or in- created action fucceedsin confequence. Afterwards this orgafm and torpor are liable to alternate with each other for fome time like the cold and hot fits of ague, attended with deficient or ex- uberant fecretion of mucus in the noftrils. At other times it arifes from reverfe fympathy with fome ex- tenfive parts of the fkin, which have been expofed too long to cold, as of the head, or feet. In confequence of the torpor of thefe cutaneouscapillaries thofeof the mucous membranes of the noftrils aft with greater energy by reverfe fympathy •, and thence feciete more mucus from the blood. At the fame time the ab- forbents, acting alfo with greater energy by their reverfe fym- pathy with thofe of fome diftant part of the fkin, abforb the thinner parts of the mucus more haftily ; whence the mucus is both thicker and in greater quantity. Other curious circumftan- ces attend this difeafe ; the membrane becomes at times fo thick- ened by its increafed action in fecreting the mucus, that the pa- tient cannot breathe through his noftrils. In this fituation if he warms his whole fkin fuddenly by fire or bed-clothes, or by drinking warm tea, the increafed aCiion of the membrane ceafes by its reverfe fympathy with the fkin ; or by the retraction of the fenforial power to ether parts of the fyftem ; and the patient can breathe again through the noftrils. The fame fometimes oc- curs for a time on going into the cold air by the deduChon of heat from the mucous membrane, and its confequent inactivity or torpor. Similar to this when the face and breafl have been very hot and red, previous to the eruption of the fmall-pox by inoculation, and that even when expofed to cool air, I have ob- ferved the feet have been cold ; till on covering them with warm flannel, as the feet have become warm, the face has cooled. See XXXV. 1. 3. Clafs II. I. 3. 5. IV. 2. 2. 10. IV. 1. 1. 5. M. M. Evacuations, abftinence, oil externally on the nofe, warm diluent fluids, warm fhoes, warm night-cap. 8. Expefloratio calida. Warm expe&oration confifts of the increafed fecretion of mucus from the membrane, which lines the bronchia;, or air-cells of the lungs, without inflammation. This increafed mucus is ejeCted by the a&ion of coughing, and is Class Li.a. 9. OF IRRITATION. is called a cold, and refembles the catarrh of the preceding arti- cle ; with which it is frequently combined. M. M. Inhaling the fteam of warm water, evacuations, warm bath, afterwards opium, forbentia. 9 . Exfudatio pone aures. A difcharge behind the ears. This chiefly affedls children, and is a morbid fecretion ; as appears from its fetor ; for if it was owing to defect of abforption, it would befaline, and aot fetid ; if a morbid adtion has continued a confiderable time, it Ihould not be flopped too fuddenly ; fince in that cafe fome other morbid adtion is liable to fucceed in its ftead. Thus children are believed to have had colics, or even convulfions, confequent to the too fudden healing of thefe mor- bid effufions behind their ears. The rationale of this is to be ex- plained from a medical fadt, which I have frequently obferved; and that is, that a blifter on the back greatly ftrengthens the power of digeftion, and removes the heart-burn in adults, and green {tools in children. The ftimulus of the blifter produces fenfation in the veflels of the fkin ; with this additional fenfori- al power thefe veflels adt more ftrongly ; and with thefe the vef- fels of the internal membranes of the ftomach and bowels adt with greater energy from their diredt fympathy with them. Now the acrid difcharge behind the ears of children produces fenfation on that part of the Ikin, and fo far adts as a fmall blit- ter. When this is fuddenly flopped, a debility of the digeftive power of the ftomach fucceeds from the want of this accuftom- ed ftimulus, with flatulency, green ftools, gripes, 'and fometimes confequent convulfions. See Clafs II. e. 5 6 . and II. 1. 4, 6. M. M. If the matter be abforbed, and produce fwelling of the lymphatics of the neck, it Ihould be cured as foon as poffible by dufting the part with white lead, cerufla, in very fine powder ; and to prevent any ill confequence an ifl'ue flrould be kept for about a month in the arm ; or a purgative medicine Ihould be taken every other day for three or four times, which ftiould con- fift of a grain of calomel, and three or four grains of rhubarb, and as much chalk. If there be no appearance of abforption, it is better only to keep the parts clean br waffling them with warm water morning and evening ; or putting fuller’s earth on them ; eipecially till the time of toothing is paft The tinea, or fcald head, and a leprous eruption, which often appears behind the ears, are different difeafes. 10. Gonorrhaa calida. Warm gleet. Increafsd ducharge of mucus from the urethra or proftrate gland without venereal de- fire, or venereal infedtion. See Clafs 1 . 2. 3. 8. M. M. Cantharides, balfams. rhubarb, blifter on perinteum, cold 24 DISEASES Class I. 1.2. 11. cold bath, injections of metallic falts, flannel fhirt, change of the form of the accudomed chair or faddle of the patient 11. Fluor albus calides Warm fluor albus. Increafed fecre- tion of mucus in the vagina or uterus without venereal defire pr venereal infection.. It is didinguifhed from the fluor albus frig- id us by the increafed fenfe of warmth in the part, and by the greater opacity or fpiflitude of the material difcharged •, as the thinner parts are re-abforbed by the increafed a£tion of the ab- forbents, along with the faline part, whence no fmarting or ex- coriation attends it. M. M. Mucilage, as ifinglafs, hartfliorn jelly, gum arabic. Ten grains of rhubarb every night. Calico oe flannel fhift, opi- um, balfams. See Clafs I. 2 3. 7. 12. Hamorrhois alba. White piles. An increafed difcharge of mucus from the redlum frequently midaken for matter ; is faid to continue a few weeks, and recur like the bleeding piles ; and to obey lunar influence. See Clafs I. 2. 1. 6. M. M. Abdinence from vinous fpirit. Balfam of copaiva. Spice fwallowed in large fragments, as ten or fifteen black pep- per-corns cut in half, and taken after dinner and fupper. Ward’s pafte, confiding of black pepper and the powdered root of He- lenium Enula. 13. Serum e veficatorio . Difcharge from a blifler. The ex- cretory duffs of glands terminate in membranes, and are endu- ed with great irritability, and many of them with fenfibility ; the latter perhaps in confequence of their facility of being excitable into great action ; indances of this are the terminations of the gall-duff in the duodenum, and of the falivary and lachrymal glands in the mouth and eye ; which produce a greater fecre- tion of their adapted fluids, when the ends of their excretory duffs are dimulated. The external Ikin confids of the excretory duffs of the capil- laries, with the mouths of the abforbents ; when thefe are dim- ulated by the application of cantharides, or oy a flice of the frelh root of bryonia alba bound on it, the capillary glands pour an increafed quantity of fluid upon the (kin by their increafed ac- tion ; and the abforbent vefiels imbibe a greater quantity of the more fluid and faline part of it $ whence a thick mucous or fe- rous fluid is depofited between the (kin and cuticle. 14. Perfpiratio foetida. Fetid perfpirarion. The ufes of the perfpirable matter are to keep the (kin fott and pliant, for the purpofes of its eafier flexibility during the affity of our limbs in locomotion, and for the prefervation of the accuracy of the fenfe of touch, which is diffufed under the whole furface of it to guard us againd the injuries of exernal bodies 5 in the fame manner Class 1 . 1. 2. 14. OF IRRITATION. 2S manner as the fecretion of tears is defigned to preferve the cor- nea of the eye moid, and in confequence tranfparent ; yet has this cutaneous mucous been believed by many to be an excre- ment ; and I know not how many fanciful theories have been built on its fuppofed obltruftion. Such as the origin of catarrhs, coughs, inflammations, eryfipelas, and herpes. To all thefe it may be fufficient to anfwer, that the ancient Grecians oiled themfelves all over ; that fome nations have painted themfelves all over, as the Pifts of this ifland ; that the Hottentots fmear themfelves all over with greafe. And ladly, 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 wadeful falhion, and all this without inconvenience. To this mull be added the drift analogy between the ufe of the perfpirable matter and the mucous fluids, which are poured for fimilar purpofes upon all the internal membranes of the body ; and befides its being in its natural date inodorous ; which is not fo with the other excretions of feces, or of urine. The quantity of perfpirable matter being greater than that of the excrementitious matters voided by dool and urine, has been ufed as anargumentin favour of its being an excrement; the force of which I do not fee : but can readily underdand, that there mud of neceflity be a great exhalation of a fluid which is diffu- fed over the whole external furface of the warm fkin, and per- haps warmer lungs, for the purpole of keeping them moid and pliant, and which is perpetually renewed as it evaporates ; but, if it be conceived to be an excrement, there feems to have been no neceflity for its quantity being fo great. The evaporation of this great quantity of fluid fecreted on the furface of the fkin and lungs, mud carry off much heat from the body ; and as both this fecretion and confequent evaporation will be in proportion to the aftivity of the cutaneous veffels, and the heat occafioned by their increafed fecretion, it would feem, that this evaporation of perfpirable matter is the caufe which preferves the animal body at the uniform degree of heat of 98 ; in the fame manner as the evaporation of boiling water preferves it at 212 degrees of Fahrenheit’s fcale. The peculiar ufe of the perfpirable matter in preferving the membranes moid, which line the air-pipes of the lungs, appears from the curious difcovery of Dr.Priedley, that the oxygen of the atmofphere will pals through moid animal membranes, but not through dry ones, fo that if the membranes of the trachea were to become dry, the animal mud as immediately periih as if he was to breath azotic gas alone. See Seft. XXVIII 2. of the preceding volume. Vol. II. E In 2,6 DISEASES Class I. x. 2. 14. In fome conititutions the perfpirable matter of the lungs ac- quires a disagreeable odour ; in others the axilla, and in others the feet, emit difguftful effluvia ; like the fecretions of thofe glands which have been called odorifene ; as thofe, which con- tain the caftor in the beaver, and thofe within the rectum of dogs, the mucus of which has been fuppofed to guard them againtl the great coftivenefs, which they are liable to in hot fummers ; and which has been thought to occafion canine mad- nefs, but which, like their white excrement, is more probably owing to the deficient fecretion of bile. Whether thefe odorif- erous particles attend the perfpirable matter in confequence of the increafed adion of the capillary glands, and pro erly be called excrementitious ; that is, whether any thing is elimina- ted, which could be hurtful if retained ; or whether they may only contain fome of the efiential oil of the animal j like the fmell, which adheres to one’s hand on broking the hid s of fome 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. Add to this, that fome parts of the {kin are liable to mor* profufe perfpiration than other parts without poflefling any fetid fcent, as the (kin of the face, on any more violent exercife. l his feems to have been obferved very early in the hiltory of man- kind, as it was faid, that our firft parents fhould earn their bread by the fweat of their brow. Why this circumltance does not attend other animals is a curious inquiry. Mankind foon learn- ed to cover their bodies, except their faces, with clothes ; when the face, by being more frequently expofed to greater variations of heat and cold, acquired greater irritability, or fenfibility, or aflociability, and thus has become more excitable into greater ac- tion by the ftimulus of exercife, or by that of food, or by the va- riolus infedion, than other parts of the fkin, as fpoken of in Clafs IV. 1. 2 . £2 ; which alfo appears by its fympathy with difeafes of the liver or ftomach bv fenfitive aflociations, as in the gutta rofea. From all thefe analagous fads the profufe fweat, which exudes from the face on exercife, does not appear to be an excrementitious fluid, but Amply the confequence of more violent action of the cutaneous or perfpirative glands. M. M. Waffl the part twice a day with foap and water ; with lime water ; cover the feet with oiled fllk focks, which muft be wafhed night and morning. Cover them with charcoal recently made red hot, and beaten into fine powder and lifted, as foon as cold, and kept well corked in a bottle, to be waffled Glass I. r. 2. 15. OF IRRITATION. 27 off and renewed twice a day. Internally rhubarb grains vi. or viii. every night, fo as to procure a (tool or two extraordinary every day, and thus by increafing one evacuation to decreafe an- other. Cool drefs, diluting liquids ? 15. Crines ncvi. New hairs. The black points on the fa- ces of fome people confift of mucus, which is become vifcid, and which adheres in the excretory duffs of the glands of the fkin as defcribed in Clafs I. 2. 2. 9. and which may be prefTed out by the fingers, and refembles little worms. Similar to this would feem the fabrication of filk and of cobweb, by the fiilc- worm and fpider ; which is a fecreted matter prefled through holes, which are the excretory duffs of glands. And it is prob- able, that the production of hair on many parts of the body, and at different periods of life, may be effefted by a fimilar procefs ; and more efpecially as every hair may be coriudered as a flenaer flexible horn, and is an appendage of the fkin. See Sect. XXXIX. 3. 2. Now as there is a fenfitive fympathy between the glands, which fecrete the femen, and the throat, as appears in the mumps; fee Hydrophobia, Clafs IV. 1.2. 7, and Paroti- tis, Clafs IV. 1. 2. 19. the growth of the beard at puberty feems to be caufed by the greater aftion of the cutaneous glands about the chin and pubes in confequence of their fympathy with thole of the teftes. But this does not occur to the female lex at their time of puberty, becaufe the fenfitive fympathy in them feems to exift between the fubmaxillary glands, and the pectoral ones which fecrete the milk, and afford pleafure both by that fecre- tion, and by the ereffion of the mammuke, or nipples ; and by delivering the milk into the mouth of the child ; this fen- fitive fympathy of the pectoral and fubmaxillarv glands in women is alfo obfervable in the Parotitis, or mumps, as above referred to. "When hairs grow on the face or arms fo as to be difagreea* ble, they may be thus readily removed without pain or any ill confequence. Warm the ends of a pair of nippers or forceps, and flick on them a little refin, or burgundy pitch •, by thefe means each fingle hair may be taken faff hold of ; and if it be then plucked off flowly, it gives pain ; but if plucked off fudaenly, it gives no pain at all ; becaufe the vis inertias of the part of the fkin, to which it adheres, is not overcome ; and it is not in confequence feparated from the cellular mem- brane 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 fafely deltroyed ; which is much to be preferred to the methods fard to be ufed in Turkey to 2 $ DISEASES Class I. i. 2. 15. to eradicate hair ; fuch as a mixture of orpiment and quick lime ; or of liver of fulphur in folution ; which injure the fkin, if they are not very nicely managed j and the hair is liable to grow again as after fhaving ; or to become white, if the roots of it have been much inflamed by the caufticity of the applica- tion. See Clafs I. 2.2. 1 1. on grey hairs. ORDO Class I. i. 3. t. OF IRRITATION 29 ORDO I. Increafed Irritation. GENUS III. With increafed Actions of the Abforbent Syfctn. These are not attended with fo great increafe of heat as in the former genus, becaufe the fluids probably undergo lefs chemical change in the glands of the abforbent fyftem ; nor are the glands of the abforbent veflels fo numerous or fo extenfive as thofe of the fecerning ones. Yet that fome heat is produced by the in- creafed a&ion of the abforbents appears from the greater gener- al warmth of the lkin and extremities of feeble patients after the exhibition of the peruvian bark, and other medicines of the arti- cle Sorbentia. SPECIES. 1. Lingua arida. Dry tongue occurs in thofe fevers, where the expired air is warmer than natural ; and happens to all thofe, who fleep with their mouths open ; the currents of air in refpi- ration increafing the evaporation. There is alfo a drynefs in the mouth from the increafed a£lion of the abforbent veflels, when a floe or a crab-apple is mafticated 5 and after the perfpi- ration has been much increafed by eating fait or fpice, or after other copious fecrctions; as after drunkennefs, cathartics or fever fits, the mucus of the mouth becomes vifcid, and in fmah quantity, from the increafed abforption, adhering to the tongue like a white flough. In the diabetes, where the third is very- great, this flough adheres more pertinacioufly, and becomes black or brown, being coloured after a few days by our aliment or drink. The infpiflated mucus on the tongue of thofe, who fleep with their mouths open, is fometimes reddened as if mixed with blood, and fometimes a little blood follows the expuition of it from the fauces owing to its great adhefion. When this mucus adheres long to the papillae of the tongue, the faliva, which it. contains in its interftices, like a fponge, is liable to become pu- trid, and to acquire a bitter tafte, like other putrid animal fub- ftances ; which is generally miftaken for an indication of the prefence of bile. M. M Warm fubacid liquids. See Clafs I. 2. 5. 8. 2. Fauces arida. Dry throat. The expuition of a frothy mucus 3 ® DISEASES Class I. r. 3. 3. mucus with great and perpetual hawking occurs in hydrophobia and is very diftreffing to the patient ; which may be owing to the increafed irritability or fenfibility of the upper part of the cefophagus, which will not permit any fluid to reft on it. It afFeffs fome people after intoxication, when the lungs re- main {lightly inflamed, and by the greater heat of the air in ex- piration the mucus becomes too haftily evaporated, and is expec- torated with difficulty in the ftate of white froth. I knew a perfon, who for twenty years always waked with his tongue and throat quite dry ; fo that he was neceffitated to take a fpoonful of water, as foon as he awoke •, otherwife a little blood always followed the forcible expuition of the indurated mucus from his fauces. See Clafs II. 1. 3. 17. M.M. Steel-fprings fixed to the night-cap fo as to fufpend the lower jaw and keep it clofed ; or fprings of elaftic gum. Or a pot of water fufpended over the bed, with a piece of lift, or woolen cloth, depending from it, and held in the mouth ; which will a£t like a fyphon, and flowly fupply moiftare, or barley wa- ter fhould be frequently fyringed in the mouth of the patient. 3. Narcs aridi. Dry noftrds with fife mucus hardening up- on their internal furface, fo as to cover them with a kind of {kin or fcale, owing to the increafed aCtion of the abforbents of this membrane ; or to the too great drynefs of the air, which pafles into the lungs ; or to too great heat of it in its expiration. When air is fo dry as to lofe its tranfparency ; as when a trem- ulous motion of it can be feen over corn-fields in a hot fummer’s day •, or when a dry mift, or want of tranfparency of the air, is vifible in very hot weather ; the fenfe of fmell is at the fame time imperfeCI from the drynefs of the membrane, beneath which it is fpread. 4. ExpeBoratio folida. Solid expectoration. The mucus of the lungs becomes hardened by the increafed abforption, fo that it adheres and forms a kind of lining in the air cells, and is fometimes fpit up in the form of branching vefiels, which are called polypi of the lungs. See TranfaCI. of the College, Lon- don. There is a rattling or wheezing of the breath, but it is not at firft attended with inflammation. The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polypofa of Michaelis, if they differ from the peripneumony of infants, feem to belong to this genus. When the difficulty of ref- piration is great, venefecdion is immediately neceflary, and then an emetic and a blifter. And the child fhould be kept nearly upright in bed as much as may be, See Tonfillitis, Clafs II. 1. >. 2- and II. 1.2 4 M- M. Diluents, emetics, eflenpe of antimony, foetid gums, Onions, of irritation. 3 * Class I. i. 3. 5. onions, warm bath for half an hour every day for a month. In- haling the (team of water, with or without volatile alkali. Soap. 5. Conjlibatio alvi. Coftivenefs from increaled adtion of the inteftinal abforbents. The feces are hardened in lumps called fcybala ; which are fometimes obliged to be extracted from the redtum with a kind of marrow fpoon. This is faid to have hap- pened from the patient having taken much ruft of iron. The mucus is alfo hardened fo as to line the inteftines, and to come away in fkins, rolled up as they pafs along, fo as to refemble worms, for which they are frequently miltaken ; and fometimes it is evacuated in ftili larger pieces, fo as to counterfeit the form of the inteftines, and has been miltaken for a portion of them. Balls of this kind, nearly as heavy as marble, and confidera oly hard, from two inches to five in diameter, are frequently found in the bowels of horfes. Similar balls found in goats have been called Bezoar. M. M. Cathartics. Diluents, fruit, oil, foap, fulphur, warm bath. Sprinkling with cold water, cool clothing. See Clgls I. 2. 4. 18. 6 . Cutis arida. Dry fkin. This dry fkin is not attended with coldnefs as in the beginning of fever-fits. Where this cutaneous abforption is great, and the fecreted material upon it vifcid, as on the hairy fcalp, the fkin becomes covered with hardened mu- cus ; which adheres fo as not to be eafily removed, as the fcurf on the head ; but is not attended with inflammation like the Tinea, or Lepra. The moifture, which appears on the fkin be- neath refinous or oily plafters, or which is feen to adhere to fuch plafters, is owing to their preventing the exhalation of the per- fpirable matter, and not to their increafing the production of it, as fome have idly imagined. M M. Warm bathing, oil externally, oil-finn gloves, refin- ous plafters. Wax. 7. Urina parca colorata. Diminifhed urine, which is high col- oured, and depofites an earthy fediment, when cold, is owing to the great adtion of the urinary abforbents. See Clafs I. 1. 2. 4. In fome dropfies the cutaneous abforbents are paralytic, as well as thofe opening into the cellular membrane ; and hence no moifture being acquired from the atmofphere, or from the cellular membrane, great third is excited ; and great abforption from all parts, where the abforbents are ftili capable of adtion. Hence the urine is in very final! quantity, and of deep colour, with copious fediment ; and the kidneys are erroneoufly blamed for not doing their office ; ftimulant diuretic medicines are giv- en in vain ; and very frequently the unhappy patient is reftrain- ed from quenching his third, and dies a martyr to falfe theory. M. M. Diluent 3 * DISEASED Class I. x. 3; 8. M. M. Diluent liquids, and warm bathing, are the natural cure of this fymptom ; but it generally attends thofe dropfies, which are feldom curable ; as they are owing to a paralyfis both of the cutaneous and cellular lymphatics. 8. Calculus felleus. Gall-ftone From the too haftv abforp- tion of the thinner parts of the bile, the remainder is left too vifcid, and cryllallizes into lumps ; which, if too large to pafs, obftrucl the du£tus choledochus, producing pain at the pit of the (tomach, and jaundice. When the indurated bile is not harder than a boiled pea, it may pafs through the bile duff with difficulty by changing its form ; and thus gives thofe pains, which have been called fpafms of the {tomach ; and yet thefe vifcid lumps of bile may afterwards diflolve, and not be vifible among the feces. In two inftances I have feen from thirty to fifty gall-ftones voided after taking an oil vomit as below. They were about the fize of peas, and diltinguiffiable when dry by their being in- flammable like bad wax, when put into the flame of a candle. For other caufes of jaundice, fee Clafs I. 2. 4 19. M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. Unboiled acrid vegetables, as lettuce, cabbage, muftard, and crefles When in violent pain, four ounces of oil of olives, or of almonds, ffiould be fwallowed; and as much more in a quarter of an hour, whether it flays or not. The patient fliould lie on the circumference of a large barrel, firft on one fide, and then on the other. Electric (hocks throu ;h the gall-duff. Faffitious Seltzer water made by diflolving one dram of fal foda in a pint of water *, to half a pint of which made luke-warm add ten drops of marine acid ; to be drunk as foon as mixed, twice a day for fome months. Opium mult be uied to quiet the pain, if the oil does not fucceed, as two grains, and another grain in half an hour if neceflary. See Clafs IV. 2. 2.4. 9. Calculus ren'is. Stone of the kidney. The pain in the loins and along the courfe of the ureter from a (lone is attended with retraffion of the tefticle in men, and numbnefs on the mfide of the thigh in women. It is diftinguifhed from the lumbago or fciatica, as thefe latter are feldom attended with vomiting, and have pain on the outfide of the thigh, fometimes quite down to the ancle or heel. See Herpes and Nephritis. Where the abforption of the thinner parts of the fecretion takes place too haltily in the kidneys, the hardened mucus, and confequent calculus concretions, fometimes totally flop up the tubuli uriniferi, and no urine is fecreted. Of this many die, who have drunk much vinous fpirit, and fome of them recover by voiding a quantitv of white mucus, like chalk and water ; and others Class 1 . 1. 3.9. OF IRRITATION. 83 others by voiding a great quantity of fand or fmall calculi. This hard ned mucus frequently becomes the nucleus of a (tone in the bladder. The falts of the urine, called microcofmic fait are of- ten miftaken for gravel, but are diftinguifhable both by their an- gles of cryftalhzation, their adhefion to the fides or bottom of the pot, and by their not being formed- till the urine cools Where- as the particles of gravel are generally without angles, and always drop to the bottom of the veffel, immediately as the water is voided. Though the proximate caufe of the formation of the calculous concretions of the kidneys, and of chalk ftones in the gout, and of the infoluble concretions of coagulable lymph, which are found on membranes, which have been inflamed in peripneumony, or rheumatifm, confifts in the too great a£tion of the abforbent velfels of thole parts ; yet the remote caufes of thefe cafes is probably owing to the inflammation of the membranes ; which at that time are believed to fecrete a material more liable to co- agulate or concrete, than they would otherwife produce by in- creaied a£tion alone without the production of new veffels, which conltitures inflammation. As defined in Clafs II. 1. 2. The fluids fecreted from the mucus membranes of animals are of various kinds and confiftencies. Hair, filk, fcales, horns, finger-nails, are owing to natural proceffes. Gall-ftones, ftones found in the inteftines of horfes, fcurf of the Ikin in leprofy, ftones of the kidneys and bladder, the callus from the inflamed periofteum, which unites broken bones, the calcareous cement, which repairs the injured fhells of fnails, the calcareous cruft on the eggs of birds, the annually renewed fhells of crabs, are all in- ftances of productions from mucous membranes, afterwards in- durated by abforption of their thinner parts. All thefe concretions contain phofphoric acid, mucus, and calcareous earth in different proportions ; and are probably fo far analagous in refpedt to their component parts as well as their mode of formation. Some calcareous earth has been difcovered after putrefadtion in the coagulable lymph of animals. Fordyce’s Elements of Practice. A little calcareous earth was detected by Scheele or Bergman in the calculus of the bladder with much phofphoric acid, and a great quantity of phofphoric acid is {hewn toexift in oyfter-fhells by their becoming luminous on expofing them a while to the fun’s light after calcination ; as in the ex- periments of Wilfon. Botanic Garden, P. 1. Canto x. 1 . 182, note. The exchange of which phofphoric acid for carbonic acid or fixed air, converts fhells into lime-ftone, producing mountains of marble, or calcareous ftrata. Now as the hard lumps of calcareous matter, termed crabs’ Vol. II. F eves. DISEASES 34 Class I. i. 3. 9. eyes, which are found in the ftomachs of thofe animals previous to the annual renewal of their {hells, are rediflolved, probably by their gaftric acid, and again depofited for that purpofe ; may it not be concluded, that the hone of the bladder might be dif- folved by the gaftric juice of fifh of prey, as of crabs or pike ; or of voracious young birds, as young rooks or hawks, or even of calves ? Could not thefe experiments be tried by collecting the gaftric juice by putting bits of fponge down the throats of young crows, and retracing them by a firing in the manner of Spal- lanzani ? or putting pieces of calculus down the throat of a liv- ing crow, or pike, and obferving if they become digefted ? and laltly, could not gaftric juice, if it {hould appear to be a folvent, be injected and borne in the bladder without injury by means of catheters of claftic refin, or caoutchouc ? M. M: Diluents. Cool drefs. Frequent change of pofture. Frequent horizontal reft in the day. Bathe the loins every morn- ing with a fponge and cold water. Aerated alkaline water in- ternally. Abftinence from all fermented or fpiritous liquors. Whatever increafes perforation injures thefe patients, as it dif- fipates the aqueous particles, which ought to dilute the urine. When the conftitution begins to produce gravel, it may I believe be certainly prevented by a total abftinence from fermented or fpirituous liquors ; by drinking much aqueous fluids ; as toaft and water, tea, milk and water, lemonade ; and laftly by thia clothing, and fleeping on a hardifh bed, that the patient may not lie too long on one fide. See Clafs IV. 2. 2. 2. There is reafon to believe, that the daily ufe of opium contributes to produce gravel in the kidneys by increafing abforption, when they are inflamed ; in the fame manner as is done by fermented or fpir- ituous liquor. See Clafs I. 3. 2. 11. When the kidneys are fo obftru&ed with gravel, that no urine pafics into the bladder; which is known by the external appear- ance of the lower part of the abdomen, which, when the bladder is full, feems as if contracted by a cord between the navel and the bladder ; and by the tenfion on the region of the bladder diftinguifhable by the touch ; or by the introduction of the ca- theter ; the following methods of cure are frequently fuccefsful. VenefeCtion to fix or eight ounces, ten grains of calomel, and an infufion of fenna with falts and oil, every three hours, till ftools are procured. Then an emetic. After the patient has been thus evacuated, a blifter on the loins fhould be ufed ; and from ten to twenty electric (hocks fhould be pafled through the kidneys, as large as can be eafily borne, once or twice a day. Along with this method the warm bath fhould be ufed for an hour once or twice a day. After repeated evacuations, a clyfter, confiding Class I. x. 3. 10. OF IRRITATION. 3.5 confiding of two drams of turpentine diflolved by yolk of egg, and fixty drops of tindfure of opium, fhould be uled at night, and repeated, with cathartic medicines interpofed, every night, or alternate nights. Aerated folution of alkali fhould be taken internally, and balfam of copaiva, three or four times a day. Some of thefe patients recover after having made no water for nine or ten days. If a done dicks in the ureter with inceffant vomiting ten grains of calomel mud be given in fmall pills as above ; and fome hours afterwards infufion of fenna and falts and oil, if it can be made to day on the domach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, con- fiding of two grains of opium. If this does not fucceed, ten or twenty eledtric {hocks through the kidney fhould be tried, and the purgative repeated, and afterwards the opiate. The patient fhould be frequently put into the warm bath for an hour at a time. Eighty or a hundred drops of laudanum given in a clyf- ter, with two drams of turpentine, are to be preferred to the two grains given by the domach as above, when the pain and vomiting are very urgent. 10. Calculus Veftcin this difeafe admits of no folid nutriment. See Clafs II. 1.6. 16. and Suppl. I. 12. M. M. Wine and opium in fmall quantities repeated every three hours alternately ; fmall repeated blifters ; warm but freftr air ; forbentia ; nutrientia ; transfufion of blood. Small eleCtric (hocks pa,ffed through the brain in all directions. Oxygene airf 2. Parejts inirritativa. Inirritative debility. A defective ac- tion of the irritative motions without increafe of the frequency of the pulfe. It continues three or four weeks like a fever, and then either terminates in health, or the patient finks into one kind of apoplexy, and perifhes. Many fymptoms, which attend inirritative fevers, accompany this difeafe, as cold hands and feet at periodic times, fcurf on the tongue, want of appetite, muddy urine, with pains of the head, and fometimes vertigo, and vomiting. This difeafe differs from the inirritative fever by the pulfe not being more frequent than in health. The want of appetite and of digeftion is a principal fymptom, and probably is the caufe of the univerfal debility, which may be occafioned by the want of nourifhment. The vertigo is a fymptom of inirritabil- ity, as (hewn in Clafs IV. 1.2. 6. the muddy urine is owing to increafed abforptiou from the bladder in confequence of the di- minifhed cutaneous and cellular abforption, as in anafarca, ex- plained inSeCt. XXIX. 5. 1. and is therefore a confequence of the inirritability of that part of the fyftem ; the foul tongue is owing to an increafed abforption of the thinner part of the mu- cus in confequence of the general deficiency of fluid, which (hould be abforbed by the fkin and (tomach. The fickr.efs is owing to decreafed aCtion of the ftomach, which is probably the primary difeafe, and is connected with the vertigo. M. M. An emetic. Calomel, grains iv. once or twice. Then a blifter. Peruvian bark. Valerian. Columbo. Steel. Opi- um and wine in fmali quantities, repeated alternately every three hours. Small eleCtric percuffions through the ftomach. 3. Somni/f interruptus. Interrupted fleep. In fome fevers, where the inirritability is very great, when the patient falls afleep, the S4 DISEASES Class I. 2. 1.4 the puUe in a few minutes becomes irregular, and the patient a- wakes in great diforder, and fear of dying, refufing to fleep again from the terror of this uneafy fenfation In this extreme debil- ity thfre is reafon to believe, that fomt voluntary power during our waking hours is employed to aid the irritative ftimuli in carrying on the circulation of the blood through the lungs ; in the fame manner as we ufe voluntary exertions, when we liflen to weak founds, or wilh to view an objedl by a fmall light ; in fleep volition is fufpended, and the deficient irritation alone is not fufficient to carry on the pulmonary circulation. This ex- planation feems the moft probable one, becaufe in cafes of apo- plexy the irritative motions of the arterial fyftem do r.ot feem to be impaired, nor in common fleep. See Incubus III. 2. 1 13. M. M Opium in very fmall dofes, as three drops of lauda- num. A perfon (hould w'atch the patient, and awaken him fre- quently ; or he fhould mealure the time between flumber and flumber by a flop-watch, and awaken the patient a little bcforehe would otherwife awake ; or he fliould keep his finger on the pulfe, and fhould forcibly awaken him, as foon as it becomes ir- regular, before the diforder of the circulation becomes fo great as to difturb him. See Clafs I. 2 1. 9 and Sefl. XXVII. 2. 4. Synccpe. Fainting confifts in the decreafed atflion of the arterial fyftem ; which is fometimes occafioned by defeat of the ftimulus of diftention, as after venefe£lion, or tapping for the dropfy. At other times it arifes from great emotions of the mind, as in fudden joy or grief. In thefe cafes the whole fenfo- rial power is exerted on thefe interefting ideas, and becomes ex- haufted. Thus during great furprife or fear the heart flops for a time, and then proceeds with throbbing and agitation ; and fometimes the vital motions become fo deranged, as never to re- cover their natural fucceflive action ; as when children have been frightened into ccnvulfions. See Se£l XII 7 1. Mifs ,a young lady of Stafford, in travelling in a chaile was io affedled by feeing the fail of a hoife and poftillion, in go- ing down a hill, though the carriage was not overturned, that fhe fainted away, and then became convulfed, and never fpoke afterwards ; though fl.e lived about three days in fucceflive con- vulfions and ftupor. 3. Hamorrhagia •venofn. A bleeding from the capillaries ari- fing from defedb of venous abforption, as in feme of thofe fevers commonly termed putrid When the blood ftagnates in the cel- lular membrane, it produces petechiae from this torpor or paraly- fis of the abforbent mouths of the veins. It mull beobferved, that thofe people who have difeafed livers, ate more liable to this kind of haemorrhages, as well as to the haemorrhagia arterio a ; 55 Class I. 2 . i. 6. OF IRRITATION. the former, becaufe patients with difeafed livers are more fubjeG to paralytic complaints in general, as to hemiplegia, and to drop- fy, which is a paralvfis of the lymphatics ; and the latter is probably owing to the delay of the circulation in the vena por- ta by the torpor of this hepatic veflel, when the liver is not much enlarged ; and to its preflure on the vena cava, when it is much enlarged. I have feen two elderly men, and one middle aged woman, all of whom had drunk too much fermented or fpirituous liquors, and had been for fome months gradually finking, were feized with a ceafelefs haemorrhage from their mouths, and from every part of the fkin, where they happened to fcratch themfelves, which continued fome days till they died. See Se£l. XXVII. 2. M. M. Vitriolic acid, opium, fteel, bark. Sponge bound on the part. Steel diffolved in fpitit of wine externally. Flour. 6. H/zmcrrhois \cruenta. In the bleeding piles the capillary veflels of the redtum become diftended and painful from the de- left of the venous abforption of the part, and at length burfl ; or the mucous glands are fo dilated as to give a paflage to the blood ; it isfaid to obferve lunar periods. M. M. Venefedlion, poultices, cathartics, fpice, cold bath, and forbentia. External compreflion by applying lint, fponge, or cotton. Internal compreflion by applying a bit of candle fmeared with mercurial ointment. Strangulate the tumid piles with a filk firing. Cut them off. See Se£l. XXVII. 2. Mrs. had for twelve or fifteen years, at intervals of a year or lefs, a bleeding from the retlum without pain ; which however flopped fpontaneoufly after fhe became weakened, or by the life of injedlions of brandy and water. Lately the bleed- ing continued above two months, in the quantity of many ounces a day, till fhe became pale and feeble to an alarming degree. Injedlions of folutions of lead, of bark and fait of fteel, and of turpentine, with fome internal aftringents, and opiates, were ufed in vain. An injedtion of the fmoke of tobacco, with ten grains of opium mixed with the tobacco, was ufed, but without effedl the two firft times on account of the imperfedlion of the machine; on the third time it produced great ficknefs, and vertigo, and nearly a fainting fit ; from which time the blood entirely flopped. Was this owing to a fungous excrefcence in the re£lum ; or to a blood- veflel being burfl from the difficulty of the blood paffing through the vena porta from fome hepatic obftrudlion, and which had continued to bleed fo long ? Was it flopped at laft by the fainting fit ? or by the ftimulus of the tobacco ? 7 Hamorrhagia retium. Haemorrhage from the kidneys, when attended with no pain, is owing to defedl of venous abforption in the 56 DISEASES Class I. 2. 1. 8 .^ the kidney. When attended with paid on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney ; which is a much more frequent difeafe than the former. See Se£t. XXVII. 1. M M. r. Venefeflion in fmall quantity, calomel, bark, fteel, an opiate ; cold immerfion up to the navel, the upper part of the body being kept clothed. Neville-Holt water. 2. Alcali- zed water aerated. Much diluent liquids. Cool drefs. Cool bed-room. Cows are much fubje£I to bloody urine, called foul water by the farmers ; in this difeafe about fixty grains of opium with or Without as much ruft of iron, given twice a day, in a ball mixed with flour and water, or diflolved in warm water, or warm ale, are, I believe, an efficacious remedy, to which however ffiould be added about two quarts of barley or oats twice a day, and a cov- er at night, if the weather be cold. 8- Hamorrhagla hepatis. Haemorrhage from the liver. It fometimes happens in thofe, who have the gutta rofea, or para- lytic afFedlions owing to difeafed livers induced by the potation of fermented liquors, that a great difcharge of black vifcid blood occafionally comes away by (tool, and fometimes by vomiting : this the ancients called melancholia, black bile. If it was bile, a fmall quantity of it would become yellow or green on dilution with warm water, which was not the cafe in one experiment which I tried ; it mud remain fome time in the inteftines from its black colour, when it pafles downwards, and probably comes from the bile-dudls, and is often a fatal fymptom. "When it is evacuated by vomiting it is lefs dangerous, becaufe it {hews great- er remaining irritability of the inteftinal canal* and is fometimes falutary to thofe who have difeafed livers. Two elderly men, who had loft their appetite for animal food, which is always a dangerous fymptom, when it occurs to thofe who have drank too much fermented liquor, obferved, that they parted with black ftools. One of them alfo had the mucus of his noftrils occafionally ftained with blood. The black ftools appeared evidently to confift of the coagulum of blood, fome- times without other feces. After a few weeks, they both funk under this difcharge, ([which I fuppofed to proceed from the liv- er, as it never appeared florid in any part of it. See Sedtion XXVII. 2. M. M. An emetic. Rhubarb, fteel, wine, bark, opium. 9. Hcvmoptoe vetiofa. Venous htemoptoe frequently attends the beginning of the hereditary confumptions of dark-eyed peo- ple •, and in others, whofe lungs have too little irritability. Thefe fpittings of blood are generally in very fmall quantity, as a tea- fpoonful } Glass I. 2. 1. 10. OF IRRITATION. 57 fpoonful ; and return at firft periodically, as about once a month ; and are lefs dangerous in the female than in the male fex ; as in the former they are often relieved by the natural pe- riods of the menfes Many of thefe patients are attacked with this pulmonary haemorrhage in their firft ileep ; becaufe in fee- ble people the power of volition is neceffary, befides that of irri- tation, to carry on refpiration perfectly ; but, as volition is fuf- pended during fleep, a part of the blood is delayed in the vef- fels of the lungs, and in confequence effufed, and the patient awakes from the difagreeable fenfation. See Clafs I 2. 1. 3. II 1 .6. 6. III. 2. 1. 10. and Sedt. XXVII. 2. 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, flight chalybeates Iffues. Leeches applied once a fortnight or month to the hemorrhoidal veins to produce a new habit. Emetics after each period of hsmoptoe, to promote expedforation, and diflodge any effufed blood, which might by remaining in the lungs produce ulcers by its putridity. A hard bed, to prevent too found fleep. A periodical emetic or cathartic once a fortnight. xo. Palpitatio cordis. The palpitation of the heart frequently attends the haemoptoe above mentioned ; and conlifts in an in- effectual exertion of the heart to pufh forwards its contents in due time, and with due force. The remote caufe is frequently fome impediment to the general circulation ; as the torpor of the capillaries in cold paroxyfms of fever, or great adhefions of the lungs. At other times it arifes from the debilityof the adlion of the heart owing to the deficient fenforial power of irritation or of affociation, as at the_ approach of death. In both thefe cafes of weak exertion the heart feels large to the touch, as it does not completely empty itfelf at each contraction; and on that account contradb more frequently, as defcribed in SedE XXXII. 2. 2. Another kind of palpitation may fometimes arife from the retrograde motions of the heart, as in fear. See Clafs I. 3. 1. 2. and IV. 3. 1.6. 11. Menorrhagia. Continued flow of the catamenia. The monthly effufion of blood from the uterus or vagina is owing to a torpor of the veins of thofe membranes in confequence of the defedt of venereal ftimulus ; and in this refpedl refembles the mucus difcharged in the periodical venereal orgafm of the female quadrupeds, which are fecluded from the males. The menor- rhagia, or continued flow of this difcharge, is owing to a con- tinued defedf of the venous abforption of the membranes of the uterus or vagina. See Clafs IV. 2. 4 7. M. M. Venefedtion in final 1 quantity. A cathartic. Then Vol. II. I DISEASES Class I. 2. 1. 12 5 # dpium, a grain every night. Steel. Bark. A blifter. Topi- cal afperfion with cold water, or cold vinegar. One caufe of exceflive menftruation, which fometimes recurs monthly, and continues for a fortnight at each period, and is fucceeded by fluor albus during the intervals, I have fufpeded to arife, like the bleeding piles, from enlargement of the liver, which is liable to occur about the age of forty to thofe who have drank much ftrong fmall beer, or wine ; or to thofe who have unfor- tunately been long accuftomed to the ufe of tight flays, or other bandages round their bowels. In thefe fituations 6 or 8 grains o£ rhubarb fhould be taken every night for months, or even years. Calomel, 4 or 6 grains fhould be taken as a cathartic once a month. A flannel drefs on the legs, thighs, and lower body may be ufe- ful in the cold feafon, but injurious in the warmer months. Weak acid of vitriol ten drops, two or three times a day *, fleel in very fmall quantity ; and a very loofe drefs round the body ; are recommended. 1 2. Dyfmenorrhagia. A difficulty of menftruation attended with pain. In this complaint the torpor of the uterine veflels, which precedes menftruation, is by fympathy accompanied with a torpor of the lumbar membranes, and confequent pain ; and frequently with cold extremities, and general debility. The fmall quantity and difficulty of the difcharge is owing to arterial inadivity, as in chlorofis. Whence it happens, that chalybeate medicines are of efficacy both to flop or prevent too great men- ftruation, and to promote or increafe deficient menftruation ; as the former is owing to inirritability of the veins, and the lat- ter of the arteries of the uterus. Sec Article IV. 2. 6. in the Materia Medica. M. M. Opium, fteel, pediluvium. Warm bath. 13. Lochia nimia. Too great difcharge after delivery. In that unnatural pradiceof fome hafty 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 pow- er to exclude fo fmall a portion of it, is prevented from com- plete contradion, and a great haemorrhage enfues. In this cir- cumftance a bandage with a thick comprefs on the lower part of the belly, by appreffing the Tides of the uterus on the remaining part of the placenta, is likely to check the haemorrhage, like the application of a pledget of any foft fubftance on a bleeding vefiel. In other cafes the lochia continues too long, or in too great quantity, owing to the deficiency of venous abforption. M. M. An enema. An opiate. A blifter. Slight chalybe- ites. Peruvian bark. Cloths dipped in cold vinegar and applied externally- OF IRRITATION. Glass 1.2. i. 14. 5.9 externally. Bandages on the limbs to keep more blood in them for a time have been recommended. 14. Abcrtio Spontanea. Some delicate ladies are perpetually liable to fpontaneous abortion, before the third, or after the fev- enth, month of geftation. From fome of thefe patients 1 have learnt, that they have awakened with a flight degree of difficult refpiration, fo as to induce them to rife haftily up in bed ; and have hence fufpedled, that this was a tendency to a kind of afth- ma, owing to a deficient abforption of blood in the extremities of the pulmonary or bronchial veins ; and have concluded from thence, that there was generally a deficiency of venous abforp- tion ; and that this was the occafion of their frequent abortion. Which is further countenanced, where a great fanguinary dif- charge precedes or follows the exclufion of the fetus. Mifcarriages are fometimes induced by what is termed a re- troverfion of the uterus, in which the fundus uteri is retroverted and prefled down between the redlum and the vagina. This can only occur in the firft or fecond month of geftation, and is generally preceded by a difficulty of making water, and a confe- quent tumour of the bladder; a violent pain about the perinceum or redtum is thus caufed, and a mifcarriage is liable to follow. Draw off the urine with a catheter ; injeft an enema with fixty drops of tindfure of opium, if it can be done. If it recurs fre- quently after the mifcarriage, a wax candle, or a peflary, made by rolling fome emplaftrum de minio fpread on linen, may be introduced into the re£lum, and worn as a comprefs to pre- vent the return for a few days, till the parrs recover their ftrength. See London Medical Obfervations, Vol. IV. p. 388. and Dr. Hunter’s Tables of the Gravid Uterus. M. M. Opium, bark, chalybeates in fmall quantity. Change to a warmer climate. I have directed with fuccefs in four cafes half a grain of opium twice a day for a fortnight, and then a whole grain twice a day during the whole geftation. One of thefe patients took befides twenty grains of Peruvian bark for feveral weeks. By thefe means being exaflly and regularly per- fifted in, a new habit became eftablifhed, and the ufual mifcar- riages were prevented. Mifcarriages more frequently happen from eruptive fevers, and from rheumatic ones, than from other inflammatory dileafes. I faw a nioft violent pleurify and hepatitis cured by repeated vene- feffion about a week or ten daysbefore parturition; yet another lady whom I attended, mifcarried at the end of the chicken pox, with which her children wereat the fame time affefted. Mifcarri- ages towards the termination of the fmall-pox are very frequent, yet there have been a few inftances of children, who have been born. 6 o DISEASES Class I. 2 . 1. 15. born with the eruption on them. The blood in the fmall pox will not inocula'e thar difeafe, if taken before the commencement of the fecondary fever ; as Ihewn in Se£t. XXXIII 2, 10 becaufe the contagious matter is not yet formed, but after it has been oxygenated through the cuticle in the puftules, it becomes con- tagious ; and if it be then abforbed, as in the fecondary fever, the blood of the mother may become contagious, and infe> the child. The fame mode of reafoning is applicable to the chicken pox. See Clafs IV. 3. 1. 7. 1 5. Scorbutus. Sea-fcurvy is caufed by fait diet, the perpet- ual ftimulus of which debilitates the venous and abforbent fyf- tems ; and may alfo be promoted by the fea-air, which is known to be fo injurious to molt vegetables, which grow near the coafts, and has been perhaps incautioufly recommended to conmmptive patients. See Clafs II. 1.6. 7. Hence the blood is imperfe£t- ly taken up by the veins from the capillaries, whence brown and black fpots appear upon the Ikin without fever. The limbs become livid and edematous, and laftlv ulcers are produced from deficient abforption. See Seel. XXXIII 3. 2. and Clafs II. 1. 4. 13. For an account of the feurvy of the lungs, fee Seel. XXVII. 2. M. M. Frefh animal and vegetable food. Infufion of malt. New beer. Sugar. Wine Steel. Bark. Sorbentia Opium ? 16. Vibices. Extravafations of blood become black from their being fecluded from the air. The extravafation of blood in bruifes, or in fome fevers, or after death in fome patients, es- pecially in the parts which were expofed to preflure, is owing to the fine terminations of the veins having been mechanically comprefled fo as to prevent their abforbing the blood from the capillaries, or to their inactivity from difeafe I he blood when extravafated undergoes a chemical change before it is fufficient- ly fluid to be taken up by the lymphatic abforbents, and in that procefs changes its colour to green and then yellow. 17. Petechia:. Purple fpots. Thefe attend fevers with great venous inirritability, and are probably formed by the inability of a Angle termination of a vein, whence the correfponding capillary becomes ruptured, and effufes the blood into the cellu- lar membrane round the inert termination of the vein. Phis is generally efteemed a fign of the putrid ftate of the blood, or that ftate contrary to the inflammatory one. As it attends fome in- flammatory difeafes which are attended with great inirritability, as in the confluent fmall pox. Butk alfo attends the feurvy, where no fever exifts, and it therefore Amply announces the in- activity of the terminations of fome veins -, and is thence indeed a bad fymptom in fevers, as a mark of approaching inactivity of Class I. 2. i. 18. OF IRRITATION. V* the whole fanguiferous fvftem, or death. The blue colour of fome children’s arms or faces in very cold weather is owing in like manner to the torpor of the abfcrbent terminations of the veins whence the blood is accumulated in them, and fometimes burfts them. See Haemorrhagia venofa, and Suppl. i. 2 7. In fome cafes of fever attended with petechiae, Dr. Hall, of Colchefter, directed the body to be wafhed with cold vinegar and water twice a day, with great advantage. The petechiae be- came daily lefs numerous and lefs livid, the pulfe flower and ftronger, with lefs delirium, and more fleep. He has treated twenty cafes in this manner, and not loft one. Medical Re- view, Vol. III. p. 8. In thefe cafes not only the application of external cold feems to have been of fervice, by preventing the unneceflary expendi- ture of animal power j but as the ftimulus of vinegar renders the lips pale, when applied externally, and in confequence ftim- ulates the terminations of the veins into greater aftion ; it feems alfo to have contributed to remove the Petechiae. 18. Aneurijma . Aneurifm is probably owing to the want of due irritability of a part of the coat of an artery. As livng mufcles are known to refift diruption more than dead ones, ac- cording to the experiments (I think) of Dr. Langrifn, it follows that when a part of the coat of an artery ceafes to contract by the ftimulus of the blood, that it will foon become diftended by the force of it, till it widens into a fack, and at laft becomes ruptured. M. M. Venefe&ion repeatedly in fmall quantities. Reft. Diluent, mild nutriment. Daily evacuation by a pill confifting of rhubarb eight grains, and foap four grains. It is poflible alfo, that an aneurifm may be produced by the refiftance to the circulation, and the force of the heart being greater than the Tides of the arteries can counterbalance. Mr. Gimbernat is faid to have cured fome cafes of aneurifm in the popliteal artery by comprefling it by means of an adapted machine, confifting of a fteel ring above and below the knee, which are joined by a plate, beneath which is placed a proper culhion, which can be prefled on the diftended part of the arte- ry more or lefs by means of a fcrew. The other method of cure is by a double ligature above the aneurifm, as firft pradlifed by Mr. J. Hunter. U). Farix. The varix of veins occurs frequently in (he legs of women, poflihly fometimes from tight garters, and has for its proximate caufe the inirritability of the coat of the vein ; whence it becomes diftended, till it burfts, by the power with which the blood DISEASES 62 ClaSs I. 2. 1. 19. blood is thrown into it by the abforbent mouths, which take it up from the capillary arteries. M. M. Tie the vena faphena below the joint of the knee, and the blood will then circulate by the internal veins ; and that flopped in the veins beneath the ligature will be abforbed. The piles may be termed vari xes, and may be deftroyed by excjfion or ligature. See Hsemorrhois. ORDO Class 1 . 2. 2. i> OF IRRITATION* ORDO II. Decreafed Irritation.- GENUS II. Decreafed Action of the Secerning Myfem. These are always attended with decreafe of partial, or of gen- eral heat ; for as the heat of animal bodies is the confequence of their various fecretions, and is perpetually palling away into the ambient air, or other bodies in contadf with them ; when thefe fecretions become diminilhed, or ceafe, the heat of the part or of the whole is foon diminilhed, or ceafes along with them. SPECIES. 1. Frigus febrile. Febrile coldnefs. There is reafon to be- lieve, that the beginning of many fever-fits originates in the qui- efcence of fome part of the abforbsnt fyltem, efpecially where they have been owing to external cold •, but that, where the coldnefs of the body is not owing to a diminution of external heat, it arifes from the inaftion of fome part of the fecerning fyftem. Hence fome parts of the body are hot whilft other parts are cold *, which I fuppofe gave occafion to error in Mar- tyn’s Experiments ; where he fays, that the body is as hot in the cold paroxyfms of fevers as at other times. After the fenforial power has been much diminilhed by great preceding aftivity of the fyftem, as by long continued external heat, or violent exercife, a fudden expofure to much cold produ- ces a torpor both greater in degree and over a greater portion of the fyftem, by fubtra&ing their accuftomed ftimulus from parts already much deprived of their irritability. Dr. Franklin in a letter to M. Duberge, the French tranllator of his works, men- tions an inftance of four young men, who bathed in a cold fpring after a day’s harveft work ; of whom two died on the fpot, a third on the next morning, and the other furvived with difficulty. Hence it would appear, that thofe, who have to trav- el in intenfely cold weather, will fooner perifh, who have pre- vioufly heated themfelves much with drams, than thofe who have only the ftimulus of natural food ; of which I have heard one well attefted inftance. See Article VII. 2- 3. Clafs III, 2. r. 17. Frigus chronic am. Permanent coldnefs. Coldnefs of the ex- tremities. 64 DISEASES Class I. 2. 2. 2. tremities, without fever, with drv pale lkin, is a fymptom of general debility, owing to the decreafed 1 "lion of the arterial fyftem, and of the capillary veffels ; whence the perfpirable matter is fecretedin lefs quantity, and inconfequence the lkin is lefs warm. This col inefs is obfe-vable at the extremities of the limbs, ears, and nofe, more than in any other parts : as a larger furface is here expofed to the contact of the air, or clothes, and thence the heat is more haltily carried away. The pain, which accompanies the coidnefs of the fkin, is owing to the deficient exertion of the fubcutaneous veflels, and probably to the accumulation of fenforial power in the extremi- ties of their nerves. See Sett. XII. 5.3. XIV. 6 . XXXII. ' . and Clafs I. 2. 4. 1. M. M. A blifter. Incitantia, nutrientia, forbentia. Exer- cife. Clothes. Fire. Joy. Anger. 2. Pallor fugitivus. The fugitive palenefs, which accompa- nies the coidnefs of the extremities, is owing to a lefs quantity of blood palling through the capillaries of the lkin in a given time ; where the abforbent power of the veins is at the fame time much diminilhed, a part of the blood lingers at their junc- tion with the capillary arteries, and a bluifh tinge is mixed with the palenefs ; as is feen in the loofe (kin under the eye-lids, and is always a mark of temporary debility. See Clafs II r. 4 4. Where the palenefs of the lkin is owing to the deficiency of red globules in the blood, it is joined with a yellowilh tinge ; which is the colour of the ferum, with which the blood then abounds, as in chlorofis, and in torpor or paralylis of the liver, and is of- ten miftaken for a fuperabundance of bile. A permanent palenefs of the lkin is owing to the coalefcence of the minute arteries, as in old age. See Clafs I. 2. 2. 9, There isanother fource of palenefs from the increafed abforpdoa of the termination of the veins, as when vinegar is applied to the lips. See Se£t. XXVII. r and another from the retrograde motions of the capillaries and fine extremities of the arteries. See Clafs II. 3. 1. 1. M M. A blifter, nutrientia, incitantia, exercife, oxygene gas. 3. Pur parcitu ■ Diminilhed pus. Drynels of ulcers. In the cold fits of fever all the fecretions are d miniihed, whether natural or artificial, as their quantity depends on the actions of the glands or capillaries, which then fhare in the univerfal inac- tion of the fyftem. Hence the drynefs of iffues and blifters in great debility, and before the aproach of death, is owing to de- ficient fecretion, and nor to increafed abforprion. M. M. Opium, wine in very fmall quantities. Peruvian bark. 4. Mucus parcior. Diminilhed mucus. Drynefs of the mouth Class I. 2. 2. 5. OF IRRITATION. < 5 $ mouth and noftrils. This alfo occurs in the cold fits of intermit- tents. In thefe cafes I have alfo found the tongue cold to the touch of the finger, and the breath to the back of one’s hand, when oppofed to it, which are very inaufpicious fymptoms, and generally fatal In fevers with inirritability it is generally ef- teemed a good fymptom, when the noftrils and tongue become moilt after having been previoufly dry ; as it (hews an increafed. aftion of the mucous glands of thofe membranes, which were be= fore torpid. And the contrary to this is the facies Hippocratica, or countenance fo well defcribed by Hippocrates, which is pale, cold, and Ihrunk ; all which are owing to the inactivity of the fecerning veflels, the palenefs from there being lefs red blood palling through the capillaries, the coldnefs of the (kin from there being lefs fecretion of perfpirable matter, and the ihrunk appearance from there being lefs mucus fecreted into the cells of the cellular membrane. See Clafs IV. 2. 4 11. M. M. Blitters. Incitamia. 5 Uriria parcior pallida. Paucity of pale urine, as in the cold fits of inter mittents ; it appears in fome nervous fevers through- out the whole difeafe, and feems to proceed from a palfy of the kidneys ; which probably was the caufe of the fever, as the fever fometimes ceafes, when that fymptom is removed : hence the ftraw-coloured urine in this fever is fo far falutary, as it ihews the unimpaired action of the kidneys. M. M. Balfams, eflential oil, afparagus, rhubarb, a blifter. Cantharides internally. 6 Torpor hepaticus. Paucity of bile from a partial ina&ion of the liver ; hence the bombycinous colour of the ikin, grey, ftools, urine not yellow, indigeftion, debility, followed by tym- pany, dropfy, and death This paralyfis or inirritability of the liver often deftroys thofe who have been long habituated to much fermented liquor, and have fuddenly omitted the ufe of it. It alfo deftroys plumbers and houfe- painters, and in them feems a fubftitute for the colica faturnina. See Sefl. XXX. M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment rubbed on the region of the liver. Rhubarb, three or tour grains, with opium half a grain to a grain twice a day. Equitation, warm bath for half an hour every day. 7. Torpor pancreatis. Torpor of the pancreas. I faw what I conjectured to be a. tumour of the pancreas with indigeftion ; and which terminated in the death of the patient. He had been for many years a great confumer of tobacco, infomuch that he chewed that noxious drug all the morning, and fmoked it all the afternoon. As the fecretion from the pancreas refembles laliya Vol. II. K in 66 DISEASES Class I. 2. 2. 8. in its general appearance, and probably in itsoffice of aflifting di- geftion,by preventing the fermentation of the aliment ; as would appear by the experiments of Pringle and Macbride ; there is reafon to fufpeCt, that a fympathy may exift between the fali- vary and pancreatic glands ; and that the perpetual ftimulus of the former by tobacco might in procefs of time injure the lat- ter. See Tobacco, Article III. 2. 2. 8. Torpor renit. Inirritability or paralyfis of the kidneys is probably frequently miftaken for gravel in them. Several, who have lived rather intemperately in refpeCt to fermented or fpir- ituous liquors, become fuddenly feized about the age of fixty, or later, with a total ftoppage of urine ; through they have previ- oufly had no fymptoms of gravel. In thefe cafes there is no water in the bladder ; as is known by the introduction of the catheter, of which thofe made of elaftic gum are faid to be pref- erable to metallic ones ; or it may generally be known by the fhape of the abdomen, either by the eye or hand. Bougies and catheters of elaftic gum are fold at No. 37, Red Lion-ftreet, Holborn, London. M. M. EleClric (hocks, warm bath. Emetics. See calcu- lus renis, Clafs I. 1.3.9. When no gravel has been previoufly obferved, and the patient has been a wine-drinker rather than an ale-drinker, the cafe is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Clafs I. 2. 4. 20. 9. PunEla mucofa vultus. Mucous fpots on the face. Thefe are owing to the inactivity of the excretory duCts of the mucous glands ; the thinner part of this fecretion exhales, and the re- mainder becomes infpiflated, and lodges in the duCt ; the ex- tremity of which becomes black by expofure to the air. M. M. They may be prefled out by the finger-nails. Warm water. Ether frequently applied. Blifter on the part ? xo. Macula cutis fulva. Morphew or freCtles. Tawny blotches on the (kin of the face and arms of elderly people, and frequently on their legs after flight eryfipelas. The freckles on the face of younger people, who have red hair, feem to be a fim- ilar production, and feem all to be caufed by the coalefcence of the minute arteries or capillaries of the part. In a fear after a wound the integument is only opaque ; but in thefe blotches, which are called morphew and freckles, the fmall veflels feem to have become inactive with fome of theferum of the blood ftag- nating in them, from whence their colour. See Clafs III. 1.2. 12. M. M. Warm bathing. A blifter on the part ? 11. Canities. Grey hair. In the injection of the veflels of animals for the purpofes of anatomical preparations, the colour of the injeCled fluid will not pafs into many very minute veflels ; which Class I. 2. 2. 11. OF IRRITATION. 67 which neverthelefs uncoloured water, or fpirits, or quickfilver, will permeate. The fame occurs in the filtration of fome col- oured fluids through paper, or very fine fand, where the colour- ing matter is not perfedtly difiolved, but only diffufed through the liquid. This has led fome to imagine, that the caufe of the whitenefs of the hair in elderly people may arife from the dimi- nution, or greater tenuity, of the glandular vefiels, which fecrete the mucus, which hardens into hair ; and that the fame differ- ence of the tenuity of the fecerning vefiels may pofiibly make the difference of colour of the filk from different filk-worms, which is of all fhades from yellow to white. But as the fecreted fluids are not the confequence of mechan- ical filtration, but of animal feledtion ; we muff look out for another caufe, which muff be found in the decreafing adtivity of the glands, as we advance in life ; and which affedts many of our other fecretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horfes by whatever injuries the glands at their roots, as bycorrofive blif- ters ; and frequently on the human fubjedl by external injuries on the head ; and fometimes by fevers. And as the grey col- our of hair confifts in its want of tranfparency, like water con- verted into fnow ; there is reafon to fuppofe, that a defedt of fe- creted moifture limply may be the caufe of this kind of opacity, as explained in Cataradta, Clafs I. 2. 2. 13. M. M. Whatever prevents the inirritability and infenfibility of the fyftem, that is, whatever prevents the approach of old age, will fo far counteradt the produdlion of grey hairs, which is a fymptom of it. For this purpofe in people, who are not corpu- lent, and perhaps in thofe who are fo, the warm bath twice or thrice a week is particularly ferviceable. See Sedt. XXXIX. 5. 1. on the colours of animals, and Clafs I. r. 2. 15. As mechanical injury from a percufiion, or a wound, or a cauftic, is liable to occafion the hair of the part to become grey j fo I fufpedt the compreflion of parts againft each other of fome animals in the womb is liable to render the hair of thofe parts of a lighter colour ; as feems often to occur in black cats and dogs. A fmall terrier bitch now ftands by me, which is black on all thofe parts, which were external, when (he was wrapped up in the uterus, teres atque rotunda ; and thofe parts white, which were moft conftantly preffed together ; and thofe parts tawny, which were generally but lefs conftantly preffed togeth- er. Thus the hair of the back from the forehead to the end of the tail is black, as well as that of the fides, and external parts pf the legs, both before and behind. As in the uterus the chin of the whelp is bent down, and lies in 08 DISEASES Class I. 2 . 2 . 1 1. in contact with the fore part of the neck and breafl ; the tail is applied clofe againft the divifion of the thighs behind ; the inf.de of the hinder thighs are prefled clofe to the fides of the belly, all thefe parts have white hairs. The fore-legs in the uterus lie on each fide of the face ; fo that the feet cover part of the temples, and comprefs the prom- inent part of the upper eye-brows, but are fo placed as to defend the eye-balls from preflure ; it is curious to obferve, that the hair of the fides of the face, and of the prominent upper eye- brows, are tawny, and of the infide of the feet and legs, which covered them ; for as this pofture admitted of more change in the latter weeks of geftation, the colour of thefe parts is not fo far removed from black, as of thofe parts, where the contaft or compreflion was more uniform. I have lately alfo infpecled a male cat; who is quite black all over, except thofe parts which appear to have been folded togeth- er in the uterus ; all which are perfectly white. In both thefe animals the parts compreffed together are fo diftinfHy defined by their colour, that the difference of the curvature and fituation of them in the uterus may be nicely difcerned : the hinder feet of the cat lay in the arm-pits of the fore-legs, and are white ; her fore-legs croffed over the hinder thighs, and left on them a white mark ; but the fore-feet, at lead the hind part of them, lay under the tail ; whence the fore-feet are tipped with white. Where the foetus is lefs tender, I fuppofe, this compreflion in the uterus does not affeft it ; as dogs and cats are perpetually feen, which are totally black. Where this uterine compreflion of parts has not been fo great as to render the hair white in other animals, it frequently hap- pens, that the extremities of the body are white, as the feet, and nofe, and tips of the ears of dogs and cats and horfes,w-here the circulation is naturally weaker ; whence it would feem, that the capillary glands, which form the hair, are impeded in the firft inftance by compreflion, and in the laft by the debility of the circulation in them. See Clafs I. 1. 2 . 15. This day, Auguft 8th, 1794 , 1 have feen a negro, who was born (as he reports) of black parents, both father and mother, at Kingfton in Jamaica, who has many large white blotches on the Ikin of his limbs and body ; which 1 thought felt not fo foft to the finger, as the black parts. He has a w'hite divergent blaze from the fummit of his nofe to the vertex of his head ; the up- per part of which, where it extends on the hairy fcalp, has thick curled hair, like the other part of his head, but quite white. By thefe marks I fuppofed him to be the fame black, w'ho is defcri- bfed, when only two years old, in the Tranfafbions of the Ameri- can Class I. 2. 2. 12. OF IRRITATION. 69 can Philofophical Society, Vol. II. page 292, where a female one is likewife defcribed with nearly fnnilar marks. The joining of the frontal bones, and the bregma, having been later than that of the other futures of the cranium, probably gave caufe to the whitenefs of the hair on thefe parts by delaying or impeding its growth. 1 2. Callus. The callous (kin on the hands and feet of laborious people is owing to the extreme veflels coalefcing from the per- petual preflure they are expofed to. As we advance in life, the finer arteries lofe their power of aftion, and their fides grow together ; hence the palenefs of the {kins of elderly people, and the lofs of that bloom, which is ow- ing to the numerous fine arteries, and the tranfparency of the fkin, that enclofes them. M. M. Warm bath. Paring the thick fkin with a knife. Smoothing it with a pumice Hone. Cover the part with oiled filk to prevent the evaporation of the perfpirable matter, and thus to keep it moift. 13. CataraEla is an opacity of tire cryftalline lens of the eye. It is a difeafe of light-coloured eyes, as the gutta ferena is of dark ones. On cutting off with fciflars the cornea of a calf’s eye, and holding it in the palm of one’s hand,fo as to gain a prop- er light, the artery, which fupplies nutriment to the cryftalline humour, is eafily and beautifully feen ; as it rifes from the cen- tre of the optic nerve through the vitreous humour to the cryf- talline. 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 fenfiblility to light ; as is (hewn by fixing three papers, each of them about half an inch in diameter, againft a wall about a footdiftant from each other, about the height of the eye ; and then looking at the middle one, with one eye, and retreating till you lofe fight of one of the exter- nal papers. Nowastheanimal grows older, the arterybeeomeslefs vifible,and perhaps carries only atranfparent fluid, and at length in fome fubjedls I fuppofe ceafes to be pervious ; then it follows, that the cryftalline lens,lofing fome fluid, and gaining none, be- comes dry, and in confequence opaque; for the famereafon, that wet or oiled paper is more tranfparent than when it is dry, as explained in Clafs I 1.4.1. The want of moifture in the cornea of old people, when the exhalationbecomesgreater than the fupply, is the caufe of its want of tranfparency ; and which like the cryf- talline gains rather a milkyopacity.Thefame analogymay be ufed to explain the whitenefs of the hair of old people, which lofes its pellucidity along with its moifture. See Clafs I. 2. 2. 1 1. M. M. Small ele&ric- {hocks throgh the eye. A quarter of a DISEASES Class I. 2. 2. 13. a grain of corrofive fublimate of mercury diflolved in brandy, or taken in a pill, twice a day for fix weeks. Couching by depref- fion, or by extraction. The former of the fe operations is much to be preferred to the latter, though the latter is at this time fo falbionable, that a furgeon is almoft compelled to ufe it, left he fhould not be thought an expert operator. For deprefling the cataraCt is attended with no pain, no danger, no confinement, and may be as readily repeated, if the cryftalline Ihould rife again to the centre of the eye. The extraction of the catarad is at- tended with confiderable pain, with long confinement, generally with fever, always with inflammation, and frequently with irre- parable injury to the iris, and confequent danger to the whole eye. Yet has this operation of extraction been trumpeted into univerfal falhion for no other reafon but becaufe it is difficult to perform, and therefore keeps the bufinefs in the hands of a few empirics, who receive larger rewards, regardlefs of the hazard, whieh is encountered by the flattered patient. A friend of mine returned yefterday from London after an abfence of many weeks ; he had a cataraCt in a proper ftate for the operation, and in fpite of my earneft exhortation to the con- trary, was prevailed upon to have it extracted rather than depreflT- ed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one fide fo as to make an oblong aperture ; and which is nearly, if not totally, without contraction, and thus greatly impedes the little vifion, which he poflefles. Whereas I faw fome patients couched by depreffion many years ago by a then celebrated empiric, Cheva- lier Taylor, who were not confined above a day or two, that the eye might gradually be accuftomed to light, and who faw as well as by extraction, perhaps better, without either pain, or inflammation, or any hazard of lofing the eye. As the inflammation of the iris is probably owing to forcing the cryftalline through the aperture of it in the operation of ex- tracting it, could it not be done more fafely by making the open- ing behind the iris and ciliary procefs into the vitreous humour ? but the operation would ftill be more painful, more dangerous, and not more ufeful than that by depreffing it. If extraction of the cryftalline be ufed,Dr.Reimarus of Ham- burgh advifes to drop into the eye previous to the operation, fome extraCt of belladonna diflolved in water, which he has found to produce a temporary paralyfis of the retina, and thence a to- tal inaCtion of the iris, fo that it remains perfectly expanded, and is thence lefs liable to be injured by the operation, and the eye perhaps lefs liable to inflammation. Might not this be of advantage in fome ophthalmies ? 14. Innufritiy Class I. 2. 2. 14. OF IRRITATION. 7 *. 14. Innutritio ojfium. Innutrition of the bones. Not only the blood efFufed in vibices and petechiae, or from bruifes, as well as the blood and new vellels in inflamed parts, are reabforbed by the increafed affion of the lymphatics ; but the harder materials, which conftitu'te the fangs of the firft fet of teeth, and the ends of exfoliating bones, and fometimes the matter of chalk-flones in the gout, the coagulable lymph, which is depofited on the lungs, or on the mufcles after inflammation of thofe parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatifm, and laftly the earthy part of the living bones are diflolved and abforbed by the increafed actions of this fyftem of vellels. See Se£h XXXIII. 3. x. The earthy part of bones in this difeafe of the nutrition of them feems to fuffer a folution, and reabforption ; while the fecerning veflels do not fupply a fufficient quantity of calcareous earth and phofphoric acid, which conftitute the fubftance ofbones. As calcareous earth abounds every where, is the want of phof- phoric acid the remote caufe ? One caufe of this malady is given in the Philofophic Tranfaflions, where the patient had been accuftomed to drink large quantities of vinegar. T wo cafes are defcribed by Mr. Gouch. In one cafe, which I faw, a con- fiderable quantity of calcareous earth, and afterwards of bone- affies, and of decoftion of madder, and alfo of fublimate of mercury, were given without effeft . All the bones became foft, many of them broke, and the patient feemed to die from the want of being able to diftend her cheft owing to the foftnefs of the ribs. M. M. Salt of urine, called fal microcofmicum, phofphorated foda. Calcined hartlhorn. Bone-alhes. Hard or petrifying water, as that of Matlock, or fuch as is found in all limeftone or marly countries. The calcareous earth in thefe waters might poffibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alkali as a lotion on the fpine, or effential oils. The innutrition of the bones is often firft to be perceived by the difficulty of breathing and palpitation of the heart on walking a little falter than ufual, which I fuppofc is owing to the foft- nefs of the ends of the ribs adjoining to the fternum ; on which account they do not perfectly diftend the cheft, when they are raifed by the pe£toral and intercoftal mufcles with greater force than ufual. After this the fpine becomes curved both by the foftnefs of its vertebrae, and for the purpofe of making room for the difturbed heart. See Species 16 of this Genus. As thefe patients are pale and weak, there would feem to be deficiency of oxygene in their blood, and in confequence a defi- ciency 72 .DISEASES Class I. 2. 2. ia. ciency of phofphoric acid ; which is probably produced by ox- ygene in the act of refpiration. Mr. Bonhome, in the Chemical Annals, Auguft, 1793 fup- pofes the rickets to arife from the prevalence of vegetable or acetous acid, which is known to foften bones out of the body. Mr. Dettaen feems to have efpoufed a Gmilar opinion, and both of them in confequence give alkalies and teftacea. If this the- ory was juft, the loft bones of fuch patients Ihould fhew evident marks of fuch acidity after death ; which I believe has not been obferved. Nor is ft analagous to other animal faffs, that nu- tritious fluids fecreted by the fineft vefiels of the body fnould be fo little animalized, as to retain acetous or vegetable acidity. The fuccefs attending the following cafe in fo fhort a time as a fortnight I afcribed principally to the ufe of the warm bath ; in which the patient continued for full half an hour every night, in the degree of heat, which was moft grateful to her fenfation, which might be I fuppofe about 94. Mifs , about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the leaft exercife, with oc- cafional violent dry cough, for a year or more, with dry lips, little appetite either for food or drink, and dry flcin, with cold extremities. She has at times been occaflonally worfe, and been relieved in fome degree by the bark. She began to bend for- wards, and to lift up her fhoulders. The former feemed owing to a beginning curvature of the fpine, the latter was probably caufed to facilitate her difficult refpiration. M M. She ufed the warm bath, as above related ; which bv its warmth might increafe the irritability of the fmalleft feries of vefiels, and by fupplying more moifture to the blood might probably tend to carry further the materials, which form calca- reous or bony particles, or to convey them in more dilute folu- tion. She took twice a day twenty grains of extradl of bark, twenty grains of foda phofphorata, and ten grains of chalk and ten of calcined hartffiorn, mixed into a powder with ten drops of laudanum ; with fleffi food both to dinner and fupper ; and port wine and water inftead of the fmall beer Ihe had been ac- cuftomed to ; Ihe lay on a fofa frequently in a day, and occafion- ally ufed a neck-fwing. There is no fituation, where the foftnefs of the bones and confequent deformity of them is fo frequently attended with calamitous confequences, as when it affedts the bones of the pelvis, fo as to contract the form of it ; whence many unfortu- nate women have loft their infants, or periffied themfelves. In this miferable fituation of the pregnant uterus, fome have dedroy- ed the child, others have undergone the Cefarean operation, and Glass 1 . 2. 2. 15. OF IRRITATION. 73 and have thence generally perifhed themfelves. But Dr. Den- man has ingenioufly introduced a new praflice, which has faved, in fuch cafes, both the mother and child ; which is by promo- ting a premature delivery between the feventh andeighth months, before the child has acquired its full growth, which has been at- tended with fuccefs. See Denman’s Midwifery, and Medical Journal, Vol. III. No. 1 1. In one inftance nature feems to have had a fimilar expedient, and perhaps to overcome a fimilar difficulty, in the premature birth of the progeny of the kanguroo ; whofe young are exclu- ded from the uterus in a very early ftate of their growth, and re- ceived into an exterior bag ; which is furnifhed with teats, to which they long adhere by their mouths, till they are ready for a fecond birth. 15. Rachitis. Rickets. The head is large, protuberant chief- ly on the forepart. The fmaller joints are fwelled ; the ribs de- prefled ; the belly tumid, with other parts emaciated. This dif- eafe from the innutrition or foftnefs of the bones arofe about two centuries ago ; feems to have been half a century in an increaf- ing or fpreading ftate ; continued about half a century at its height, or greateft diffufion ; and is now nearly vanifhed : which gives reafon to hope, that the fmall-pox, mealies, and venereal difeafe, which are all of modern production, and have already become milder, may in procefs of time vanifti from the earth, and perhaps be fucceeded by new ones ! See the preceding Species. 16. Spina diftortio. Diftortion of the fpine is another difeafe originating from the innutrition or foftnefs of the bones. I once faw a child about fix years old with palpitation of heart, and quicknefs of refpiration, which began to have a curvature of the fpine ; I then doubted, whether the palpitation and quick refpi- ration were the caufe or confequence of the curvature of the fpine ; fufpecting either that nature had bent the fpine outwards to give room to the enlarged heart ; or that the malformation of the cheft had comprefled and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whofe fpine had lately begun to be diftorted, with very great difficulty and quicknefs of refpiration, and alarming palpitation of the heart, I convinced myfelf, that the palpitation and difficult refpiration were the effeft of the change of the cav- ity of the cheft from the diftortion of the fpine ; and that the whole was therefore a difeafe of the innutrition or foftnefs of the bones- For on direfling her to lie down much in the day, and to. takejffie bark, the diftortion became lefs, and the palpitation and. k quick Vt>L. n. 74 DISEASES Class I. 2. 2. 16. quick refpiration became lefs at the fame time. After this ob- servation a neck-fwing was diredled, and {he took the bark, madder, and bone-aihes ; and (he continues to amend both in her Shape and health. Delicate young iadies are very liable to become awry at many boarding-fchools. This is occasioned principally by their being obliged too long to preferve an ere£l attitude, by fitting on forms many hours together. To prevent this, the fchool-feats Should have either backs, on which they may occafionally reft them- felves or delks before them, on which they may occasionally lean. This is a thing of greater confequence than may appear to thofe, who have not attended to it. Whentheleaft tendency to become awry is obferved, they Ihould be advifed to lie down on a bed or fofa for an hour in the middle of the day for many months ; which generally prevents the in- creafe of this deformity by taking off for a time the prdfure on the fpine of the back, and it at the fame time tends to make them grow taller. Young perfons, when nicely meafured, are found to be half an inch higher in a morning than at night ; as is well known to thofe who enlift very young men for foldiers. This is owing to the cartilages between the bones of the back becom- ing comprelfed by the weight of the head and (boulders on them during the day. It is the fame preflure which produces curva- tures and distortions of the fpine in growing children, where the bones are fofter than ufual ; and which may thus be relieved by an horizontal pofture 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 (hould alfo be dire£led, where two fleep in a bed, to change every night, or every week, their fides of the bed ; which will prevent their tendency to fleep always on the fame fide ; which is not only liable to produce crookednefs, but alfo to occafion difeafes by the internal parts being fo long kept in uniform contact as to grow together. For the fame reafon they Should not be allowed to fit always on the fame fide of the fire or window, becaufe they will then be inclined too frequently to bend themfelves to one fide. Another great caule of injury to the Shape of young ladies is from the preSTure of Slays, or other tight bandages, which at the fame time caufe other difeafes by changing the form or Situation of the internal parts. If a hard part of the Slays, even a knot of the thread, with which they are fewed together, is prefled hard upon one fide more than the other, the child bends from the fide molt painful, and thus occafions a curvature of the fpine. To counteract this effeCt, tuch Slays as have feweft hard parts, and Class I. 2. 2. 16. OF IRRITATION. 75 and efpecially fuch as can be daily or weekly turned,, are pref- erable to others. Where frequent lying down on a fofa in the day-time, and fwinging frequently fora fhorttime by the hands or head, with loofe drefs, do not relieve a beginning diftortion of the back ; re- courfe may be had to a chair with (luffed moveable arms for the purpofe of fufpendirig the weight of the body by cuftiions under the arm-pits, like refting on crutches, or like the lead i tig- firings of infants. From the top of the back of the fame chair a curv- ed fteel bar may alfo projeCt to fufpend the body occafionally or in part by the head, like the fwing above mentioned. The ufe of this chair is more efficacious in ftraightening the fpine, than fimply lying down horizontally ; as it not only takes off the prefiure of the head and fhoulders from the fpine, but at the fame time the inferior parts of the body contribute to draw the fpine ftraight by their weight ; or laftly, recourfe may be had to a fpinal machine firfl defcribed in the Memoires of the acad- emy of furgery in Paris, Vol. III. p. 600, by M. Le Vacher, and fince made by Mr. Jones, at No. 6, North-ftreef, Tottenham court-road, London, which fufpends the head, and places the weight of it on the hips. This machine is capable of improve- ment by joints in the bar at the back of it, to permit the body to bend forwards without diminifhing the extenfion of the fpine. The objections of this machine of M. Vacher, which is made by Mr. Jones, are firfl, that it is worn in the day-time, and has a very unfightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and fubftituting in its place a forked bar, rifing up behind each ear, with webs fattened to it, which pafs under the chin and occiput. But this is notan improvement, but a deterioration ofM. Vacher’s machine, as it prevents the head from turning with facility to either fide. Another objection is, that its being worn, when the mufcles of the back are in aCtion, it is rather calculated to prevent the curvature of the fpine from becoming greater, than to extend the fpine, and diminifh its curvature. For this latter purpofe I have made a fteel bow, which re- ceives the head longitudinally from the forehead to the occiput ; having a fork furnifhed with a web to fuftain the chin, and an- other to fuftain the occiput. The fummit of the bow is fixed by a fwivel 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 fixteen inches. Hence the patient would be conftantly Aiding down during Aeep, unlefs fupported by this bow, with webbed forks, covered alfo with fur, placed beneath the chin, and beneath the occiput. There are alfo proper webs lined DISEASES Class I. 2. 2. 16. 7 6 lined with fur for the hands to take hold of occafionally, and al- fo to go under the arms. By thefe means I fhould hope great advantage from gradually extending the fpine during the inac- tivity of the mufcles of the back ; and that it may be done with- out difturbing the fleep of the patient, and if this (hould hap- pen, the bow is made to open by a joint at the fummit of it, foas to be inftantly dilengaged from the neck by the hand of the wearer. This bow I have now ufed with advantage on one pa- tient, and it may be had from Mr. Harrifon, whitesmith, Bridge- gate, Derby. It is alfo poffible that a flight com prefs on the prominent part of a curved fpine might be applied with advantage both in fleep and in waking hours, if it could be nicely held on the part bv a weak and very flexible fpring, with a proper counter-preffure on fome diftant part ; but this would require more art than could be managed, except by thofe who have very accurate mechanical ideas, and mull differ with every kind of curvature Thus if the prominent part of the curve of the fpine be on one fide, a fluffed cufhion fixed to the centre of a long thin fteel fpring {hould be applied on the prominence ; one end of this long fpring fhould be bent by a (trap joined to a waiftcoat on theop- pofite fhoulder, and the other end of it by a (trap joined to draw- ers on the oppofite hip ; the degree of preffure to be adjufted by the tightnefs of thefe ftraps. If the prominent part of a curved fpine be exadlly behind, the ends of the long fpring {hould extend from the lowed bone of the neck to the os cocci- gis, and fhould have its two ends attached to the top of a waift- coat, and to the waiftband of a pair of drawers. It will be from hence eafily perceived, that all other methods of confining or direfling the growth of young people fhould be ufed with great {kill ; fuch as back-boards, or bandages, or flocks for the feet ; and that their application {hould not be continued too long at a time, left worfe confequences fhould enfue, than the deformity they were defigned to remove. To this may be added, that the ftiff erefl attitude taught by fome modern danc- ing mafters does not contribute to the grace of perfon, but rather militates againft it ; as is well feen in one of the prints in Hogarth’s Analyfis of Beauty ; and is exemplified by the eafy grace of fome of the ancient ftatutes, as of the Venus de Medicis, and the Antinous, and in the works of fome modern artifts, 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 ftyelled dn both Tides of it, fo as to become protuberant, iflue ; nej>r Class. I. 2. 2. 17. OF IRRITATION. 77 near the fwelled part have been found of great fervice, as men- tioned in Species 18 of this Genus. This has induced me to propofe in curvatures of the fpine, to put an iflue on the outfide of the curve, where it could be certainly afeertained, as the bones on the convex fide of the curve muft be enlarged ; in one cafe I thought this of fervice, and recommended the further trial of it. In the tendency to curvature of the fpine, whatever ftrength- ens the general conftitution is of fervice ; as the ufe of the cold bath in the fummer months This however requires fome re- ftriftion both in refpect to the degree of coldnefs of the bath, the time of continuing in it, and the feafon of the year. Com- mon fprings, which are of forty-eight degrees of heat, are too oold for tender conftitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldnefs of river-water in the fummer months, which is about fixty-eight degrees, or that of Matlock, which is about fixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath fhould be but a minute or two, or not fo long as to occafion a trembling of the limbs from cold. In refpe£t to the feafon of the year, delicate children fhould certainly only bathe in the fummer months ; as the going fre- quently into the cold air in winter will anfwer all the purpofes of the cold bath. 17. Claudicatio coxaria. Lamenefs of the hip. A nodding of the thigh- bone is faid to be produced in feeble children by the foftnefs of the neck or upper part of that bone beneath the car- tilage ; which is naturally bent, and in this difeafe bends more downwards, or nods, by the prefiure of the body ; and thus renders one leg apparently fhorter than the other. In other cafes the end of the bone is protruded out of its focket, by in- flammation or enlargement of the cartilages or ligaments of the joint, fo that it refts on fome part of the edge of the acetabu- lum, which in time becomes filled up. When the legs are ftraight, as in Handing eretf, there is no verticillary motion in the knee-joint ; all the motion then in turning out the toes fur- ther than nature defigned, muft be obtained by ftraining in fome degree this head of the thigh-bone, or the acetabulum, or cavi- ty, in which it moves. This has induced me to believe that this misfortune of the nodding of the head of the bone, or partial diflocation of it, by which one leg becomes fhorter than the other, is fometimes occafioned by making very young children ftand in what are called ftocks ; that is with their heels together, and their toes quite out. Whence the focket of the thigh-bone be- comes inflamed and painful, or the neck of the bone is bent downward and outwards. In ?* DISEASES Class I- 2. 2. 18. In this cafe there is no ejcpe£lation of recovering the (Iraight- nefs of the end of the bone 5 but thefe patients are liable to another misfortune, that is, to acquire afterwards a diftor- tion of the fpine ; for as one leg is (hotter than the other, they fmk on that fide, and in conlequence bend the upper part of their bodies, as their fhoulders, the contrary way, to balance themfelves ; and then again the neck is bent back again towards the iame fide, to preferve the head perpendicular ; and thus the figure becomes quite diftorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the fpine is for the child to wear a high- heeled fhoe or patten on the lame foot, fo as to fupport that fide on the fame level with the other, and thus to prevent a greater deformity. I have this day feen a young lady about twelve, who does not limp or waddle in walking ; but neverthelefs, when (he (lands or fits, (he finks down towards her right fide, and turns out that toe more than the other. Hence, both as (he fits and (lands, lhe bends her body to the right ; whence her head would hang a little over her right (houlder; but to replace this perpendicu- larly, (he lifts up her left (houlder and contrails the mufcles on that fide of the neck ; which are therefore become thicker and (Ironger by their continued action ; but there is not yet any very perceptible diftortion of the (pine. As her right toe is turned outward rather more than natural, this (hews the difeafe to be in the hip-joint ; becaufe, when the limb is (Iretched our, the toe cannot turn horizontally in the lead 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 fet in (locks with their heels touching each other as they fit, and are then made to rife up, till they (land eretfl, the f^cket or head of the thigh-bone becomes injured, efpecially in thofe children, whofe bones are foft ; and a (hortnefs of that limb fucceeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum ; and a confequent rifing of one (houlder, and a curvature of the fpine are produced from fo diilant a caufe. M. M. An elaflic cu(hion made of curled hair, (hould be pla- ced under the affefled hip, whenever (he fits ; or (hould be fit- ted to the part by means of drawers, fo that (lie could not avoid fitting on it. A neck-fwing and lying down in the day, (hould be occafionally ufed to prevent or remove any curvature of the fpine. The reil as in Species 13 and 15 of this genus. 18. Spina protuberant . Protuberant fpine. One of the bones of Class 1.2. 2. 19. OF IRRITATION. 79 of the fpine fwells, and rifes above the reft. This is not an un- common difeafe, and belongs to the innutrition of the bones, as the bone mull become foft before it fwells ; which foftnefs is owing to defedl of the fecretion of phofphorated calcareous earth. The fwelling of the bone comprefles a part of the brain, called the fpinal marrow, within the cavity of the back -bones ; and in eonfequence the lower limbs become paralytic, attended fome- times with difficulty of emptying the bladder and rectum. M. M. Iffues put on each fide of the prominent bone are of great effedt, I fuppofe, by their ftimulus *, which excites into adtion more of the fenforial powers of irritation and fenfation, and thus gives greater adtivity to the vafcular fyftem in their vicinity. The methods recommended in diftortion of the fpine are alfo to be attended to. 19. Spina bifida. Divided fpine, called alfo Hydrorachitis, as well as the Hydrocephalus externus, is probably owing in part to adefedt of offification of the fpine and cranium ; and the col- ledtion of fluid beneath them may originate from the general de- bility of the fyftem ; which affedls both the fecerning, and ab- forbent veflels. A curious circumftance, which is affirmed to attend the fpina bifida, is, that on compreffing the tumour with the hand gently, the whole brain becomes affedfed, and the patient falls afleep, I fuppofe the fame muft happen on compreffing the hydrocephalus externus ? See SedL XVIII. 20. 20. OJfis palati, defeBus. A defect of the bone of the palate, which frequently accompanies a divifion of the upper lip; oc- curs before nativity ; and is owing to the deficient adfion of the fecerning fyftem, from whence the extremities are not comple- ted. From a fimilar caufe I have teen the point of the tongue deficient, and one joint of the two leaft fingers, and of the two lead toes, in the fame infant ; who was otherwife a fine girl. See Sed. XXXIX. 4. 4. The operation for the hare-lip is defcribed by many furgical writers ; but there is a perfon in London, who makes very ingeni- ous artificial palates ; which prevent that defea of fpeech, which attends this malformation. This faaitious palate confifts of a thin plate of Giver Gf the ffiape and form of the roof of the mouth; from the front edge to the back edge of this filver plate four or five holes are made in a ftraight line large enough for a needle to pafs through them ; on^he back of it is then fewed a piece of fponge ; which when expanded" with moifture is nearly as large as the filver plate. This fponge is flipped through the divifion of the hone of the palate, fo as to lie above it, while the filver plate 8'o DISEASES Class I. 2. 2. 20. plate covers the aperture beneath, and is fufpended by the ex- panding fponge. This is removed every night and walhed, and returned into its place in the morning ; on this account it is con- venient to have five or fix of them, for the fake of cleanlinefs. I have been more particular in defcribing this invention, as I dc not know the name, or place of refidence, of the maker. ORDO Class I. 2. 3. 1. OF IRRITATION, 81 ORDO II. Decreafed Irritation. GENUS III. With decreafed AElion of the Abforbent Syjiem. Some decreafe of heat attends thefe difeafes, though in a lefs degree than thofe of the lad genus, becaufe the abforbent fydem of glands do not generate fo much heat in their healthy date of action as the fecerning fydem of glands, as explained in Clafs I. x-3* SPECIES. 1. Mucus faucium frigidus. Cold mucus from the throat. Much mucus, of rather a faline tade, and lefs infpiflated than ufual, is evacuated from the fauces by hawking, owing to the deficient abforption of the thinner parts of it. This becomes a habit in fome elderly people, who are continually fpitting it out of their mouths ; and has probably been brought on by taking fnulf, or fmoking tobacco ; which by frequent dimulating the fauces have at length rendered the abforbent veflels lefs excita- ble by the natural dimulus of the faline part of the fecretion, which ought to be reabforbed, as foon as fecreted. M. M. A few grains of powder of bark frequently put into the mouth, and gradually diffufed over the fauces. A gargle of barley water. 2. Sudor frigidus. The cold dampnefs of the hands of fomft people is caufed by the deficient abforption of perfpirable matter \ the clammy or vifcid feel of it is owing to the mucous part being left upon the Ikin. The coldnefs is produced both by the de- creafed action of the abforbent fydem, and by the evaporation of a greater quantity of the perfpirable matter into the air, which ought to have been abforbed. M. M. Walh the hands in lime water, or with a fmall quan- tity of volatile alkali in water. 3. Catarrhus frigidus. The thin difcharge from the nodrils in cold weather. The abforbent veflels become torpid by the diminution of external heat, fooner than the fecerning ones, which are longer kept warm by the circulating blood, from which they feledt the fluid they fecrete ; whereas the abforbent Vot. II. M veflels 82 DISEASES Class I. 2. 3. 4. veflels of the noftrils drink up their fluids, namely the thin and faline parts of the mucus, after it has been cooled by the atmof- phere. Hence the abforbents ceafing to a£t, and the fecerning veflels continuing fome time longer to pour out the mucus, a copious thin dsfcharge is produced, which trickles down the noftrils in cold weather. This difcharge is fo acrid as to inflame the upper lip ; which is owing to the neutral falts, with which it abounds, not being reabforbed •, fo-the tears in the filtula lach- rymalis inflame the cheek. See Clafs I. 1.2. 7. 4. Expecloratlo frigida. Cold expectoration. Where the pulmonary abforption is deficient, an habitual cough is produced, and a freqnent expectoration of thin faline mucus ; as is often feen in old enfeebled people. Though the ftimulus of the faline fluid, which attends all fecretions, is not fufficient to excite the languid abforbent veflels to imbibe it ; yet this faline part, to- gether with the increafed quantity of the whole of the fecreted mucus, ftimulates the branches of the bronchia, fo as to induce an almoft inceflant cough to difcharge it from the lungs. A Angle grain of opium, or any other ftimulant drug, as a wine poflet with fpirit of hartlhorn, will cure this cold cough, and the cold catarrh of the preceding article, like a charm, by (Emula- ting the torpid mouths of the abforbents into aftion. Which has given rife to an indifcriminate and frequently pernicious ufe 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 abforption of the more fluid and faline parts, and in confe- quence thickens the mucus, and abates its acrimony. Warm diluent drink, wine-whey, with volatile alkali. 5. Urimi uberior pallida. On being expofed naked to cold air, or fprinkled with cold water, a quantity of pale urine is foon difcharged ; for the abforbents of the bladder become torpid by their fympathy with thofe of the (kin ; which are rendered qui- efcent by the diminution of external heat ; but the kidneys con- tinue to fecrete the urine, and as no part of it is abforbed, it be- comes copious and pale. This happens from a fimilar caule in cold fits of agues j and in lefs degree to many debilitated confti- tutions, whofe extremities are generally cold and pale. The great quantity of limpid water in hyfteric cafes, and in diabetes, belongs to Clafs I. 3. 1. xo. 1. 3. 2. 6. M. M. Tindture of cantharides, opium, alum, forbentia. Flannel fhirt in cold weather. Animal food. Beer. Wine. Friftion, Exercife. Fire. 6 . Diarrhoea frigida. Liquid (tools are produced by expofing the Class I. 2. 3. 7. OF IRRITATION. 83 the body naked to cold air, or iprinkling it with cold water, for the fame reafon as the lad article. But this difeafe is fometimes of a dangerous nature ; the in- teftinal abforption being fo impaired, that the aliment is faid to come away undiminilhed in quantity, and almofl unchanged by the powers of digeftion, and is then called lientery. The mucus of the redtum fometimes comes away like pellu- cid hartffiorn jelly, and liquefies by heat like that, towards the end of inirritative fevers, which is owing to the thiqner part of the mucus not being abforbed, and thus refembles the catarrh of fome old people. M. M. Opium, campechy wood, armenian bole. Biifter. Flannel fhirt in cold weather. Clyfters with opium. Fridtion on the bowels morning and night. Equitation twice a day. 7. Fluor albus frigidus. Cold fluor albus. In weak conftitu- tions, where this difcharge is pellucid and thin, it mult proceed from want of abforption of the mucous membrane of the vagina, or uterus, and not from an increafed fecretion. This I fufpedt to be the molt frequent kind of fluor albus ; the former one de- feribed at Clafs I. 1. 2. 11. attends menftruation, or is a dif- charge inflead of it, and thus refembles the venereal orgafm of female quadrupeds. The difcharge in the cold kind being more faline, is liable to excoriate the part, and thus produce fmarting in making water ; in its great degree it is difficult to cure. M. M. Increafe the evacuation by ftool and by perforation, by taking rhubarb every night, about fix or ten grains with one grain of opium for fome months. Flannel fhirt in winter. Balfam copaiva. Gum kino, bitters, chalybeates, fridtion over .the whole fkin with flannel morning and night. Partial cold bath-, by fprinkling the loins and thighs, or (ponging them with cold water Mucilage, as ifinglafs boiled in milk ; blanc mange hartffiorn jelly, are recommended by fome. Tindture of can- tharides fometimes- feems of fervice given from ten to twenty drops or more, three or four times a day. A large plafter of burgundy pitch and armenian hole, fo as to cover the loins and lower part of the belly, is faid to have fometimes fucceeded by increasing abforption by its compreffion in the manner of a ban- dage. A folution of metallic fairs, as white vitriol, fixty grains to a pint ; or an infufion of oak-bark may be injetted into the vagina. Cold bath. 8. Gonorrhoea frigida. Cold gleet. Where the gleet is thin and pellucid, it mull; arife from the want of abforption of the membranes of the urethra, rather than from an increafed fecre- tion from them. This I fuppofe to be a more common difeafe than that mentioned at Clafs I. 1. 2. 10. M. M. Metallic - DISEASES 84 Class I. 2. 3. 9, M. M. Metallic injections, partial cold bath, internal method as in the fluor albus above defcribed. Balfam of copaiva. Tinc- ture of cantharides. Introduce a few inches into the urethra a bougie fmeared with balfam of copaiva. See Home on urethra, p. 105. 9. Hepatis tumor. The liver becomes enlarged from defe£t of the abforptionof mucus from its cells, as in anafarca, efpeci- ally in feeble children ; at the fame time lefs bile is fecreted from the torpid circulation in the vena portae. And as the ab- forbents, which refume the thinner parrs of the bile from the gall-bladder 2nd hepatic dutls, are alfo torpid or quiefeent, the bile is more dilute, as well as lefs in quantity. From the ob- ftruClion of the paflage of the blood through the comprefled ve- na porta thefe patients have tumid bellies, and pale bloated coun- tenances ; their palenefs is probably owing to the deficiency of the quantity of red globules in the blood in confequence of the inert ftate of the bile. Thefe fymptomsin children are generally attended with worms, the dilute bile and the weak digeftion not deftroving them. In flieep I have feen fluke- worms in the gall-du£ts themfelves among the dilute bile $ which gall-dudts they eat through, and then produce ulcers, and the heCtic fever called the rot. See Clafi. I. 1.4 10. and Article IV. 2. 6. M. M. After a calomel purge, crude iron filings are fpecific in this difeafe in children, and the worms are deftroyed by the returning acrimony and quantity of the bile. A blifter on the region of the liver. Sorbentia, as worm-feed, fantonicum. Co- lumbo. Bark. The nitrous acid has been ftrongly recommended by Mr. Sco: in tumours of the liver, which frequently occur in the eaft, where this gentleman refides ; he gives two drachms of ftrong nitrous acid mixed with two pounds of water, to be drunk daily at in- tervals. See Syphilis, Clafs II. 1. 5. 2. 10. Cblorofis. When the defedt of the due aCtion of both the abforbent and fecerning veflels of the liver affedts women, and is attended with obftrudtion of the catamenia, it is called chlorofis ; and is cured by the exhibition of fteel, which reftores by its fpe- cific ftimulus the abforbent power of the liver ; and the men- ftruation, which was obftrudted in confequence of debility, recurs. Indigeftion, owing to torpor of the ftomach, and a confequent too great acidity of its contents, attend this difeafe ; whence a defire of eating chalk, or marl. Sometimes a great quantity of pale urine is difeharged in a morning, which is owing to the in- action of the abforbents, which are diflributed on the neck o r OF IRRITATION. S S Class 1 . 2. 3. 11. the bladder, during fleep. The (Welling of the ankles, which frequently attends chlorofis, is another effect of deficient addion of the abforbent fyftem ; and the pale countenance is occafioned by the deficient quantity of red globules of blood, caufed by the deficient quantity or acrimony of the bile, and confequent weak- nefs of the circulation. The pulfe is fo quick in fome cafes of chlorofis, that, when attended with an accidental cough, it may be miftaken for pulmonary confumption. This quick pulfe is owing to the debility of the heart from the want of ftimulus oc- cafioned by the deficiency of the quantity, and acrimony of the blood. M M. Steel. Bitters. Cendant moderate exercife. Fric- tion with flannel all over the body and limbs night and morn- ing. Rhubarb five grains, opium half a grain, every night. Flefh diet, with fmall beer, or wine and water. The difeafe continues fome months, but at length fubfides by the treatment above defcribed. A bath of about eighty degrees, as Buxton Bath, is of fervice ; a colder bath may do great injury. 11. Hydrocele. Dropfy of the vagina teflis. Dropfies have been divided into the encyded and the diffufed, meaning thofe of the cellular membrane, the cells of which communicate with each other like a fponge, and thofe of any other cavity of the body. The colleflions of mucous fluids in the various cells and cavities of the body arife from the torpor of the abforbent veffels of thofe parts. It is probable, that in dropfies attended with great third the cutaneous abforbents become paralytic fird ; and then from the great third, which is thus occafioned by the want of atmof- pheric moiflure, the abforption of the fat enfues ; as in fevers attended with great third, the fat is quickly taken up. See Obe- fitas I. 2. 3. 16. Some have believed, that the cellular and adi- pofe membranes are different ones ; as no fat is ever depofited in the eyelids or fcrotum, both which places are very liable to be didended with the mucilaginous fluid of the anafarca, and with air in Emphyfema. Sometimes a gradual abforption of the ac- cumulated fluid takes place, and the thinner parts being taken up, there remains a more vifcid fluid, or almod a folid in the part, as in fome fwelled legs, which cannot eafily be indented by the preffure of the finger, and are called fcorbutic. Sometimes the paralyfis of the abforbents is completely removed, and the whole is again taken up into the circulation. The Hydrocele is known by a tumour of the fcrotum, which is without pain, gradually produced, with flu£luation, and a de- gree of pellucidity, when a candle is held behind it ; it is the mod Ample incyded dropfy, as it is not in general complicated with other difcafes, as afcites with fcirrhous fever, and hydro- cephalus DISEASES %6 Class I. 2. 3. 12, cephalus interims, with great debility. The cure of this dif- eafe is effected by different ways •, it confifts in difcharging the water by an external aperture ; and by fo far inflaming the cyft and tefticle, that they afterwards grow together, and thus pre- vent in future any fecretion or effufion of mucus ; the difeafe is thus cured, not by the revivefcence of the abforbent power of the lymphatics, but by the prevention of fecretion by the adheiion of the vagina to the teftis. This I believe is performed with lefs pain, and is more certainly managable by tapping, or difcharg- ing the fluid by means of a trocar, and after the evacuation of it to fill the cyft with a mixture of wine and water for a few min- utes till the neceflary degree of ftimulus is produced, and then to withdraw it ; as recommended by Mr. Earle. See alfo Med- ical Commentaries by Dr. Duncan for 1793. 1 2. Hydrocephalus inter ntts, or dropfy of the ventricles of the brain, is fatal to many children and to fome adults. When this difeafe is lefs in quantity, it probably produces a fever, termed a nervous fever, and which is fometimes called a worm fever, ac- cording to the opinion of Dr. Gilchrift, in the Scots Medical Efiays. This fever is attended with great inirritabilitv, as appears from the dilated pupils of the eyes, in which it correfponds with the dropfy of the brain. And the latter difeafe has its parox- yfms of quick impulfe, and in that iefpeft correfponds with oth- er fevers with inirritability. The hydrocephalus internus is diftinguifhed from apoplexy by its being attended with fever, and from nervous fever by the paroxyfms being very irregular, with perfe£t intermifiions many times in a day. In nervous fever the pain of the head generally affedfs the middle of the forehead -, in hydrocephalus internus it is generally on one fide of the head. One of the earlieft crite- rions is the patient being uneafy on raiding his head from the pil- low, and wifliing to lie down again immediately ; which I fup- pofe is owing to the prefliire of the water on the larger trunks of the blood-veflels entering the cavity being more intolerable than on the fmaller ones ; for if the larger trunks are comprefl- ed, it muft inconvenience the branches alfo ; but if fome of the fmall branches are comprefled only, the trunks are not fo imme- diately incommoded. Blifters on the head, and mercurial ointment externally, with calomel internally, are principally recommended in this fatal dif- eafe. When the patient cannot bear to be raifed up in bed with- out great uneafinefs, it is a bad fymptom. So I believe is deaf- nefs, which is commonly miftaken for ftupor. See Clals I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the fquinting is very apparent, or the pitpjls of both eyes much dila- Class I;a. 3 - OF IRRITATION, 87 ted, it is generally fatal. As by ftimulating one branch of lymphatics into inverted motion, another branch is liable to ab-. forb its fluid more haftily ; fuppofe ftrong errhines, as common tobacco fnuff" to children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed with ten or fifteen grains of fu- gar, were gradually blown up the noftrils ? See Clafs I. 3. 2. 1. I have tried common fnuff upon two children in this difeafe ; one could not be made to fneeze, and the other was too near death to receive advantage. When the mercurial preparations have produced falivation, I believe they may have been of fervice, but I doubt their good effect otherwife. In one child I tried the tincture of digitalis ; but it was given with too timid a hand, and too late in the difeafe, to determine its efFebls. See Sect. XXIX. 5. 9. As all the above remedies generally fail of fuccefs, I think frequent, almoft hourly, fhocks of elebtricity from very fmall charges might be palled through the head in all directions with probability of good event ; as by Volta’s rods of zinc and filver defcribedin Clafs I. 2. 5. 5. A folution of hydrargyrus muria- tus, corrofive fublimate of mercury in rebtified fpirit of wine, three grains to an ounce, is faid to produce inftantaneous and violent falivation; as defcribed in Clafs II. 1. 5. 1. on Gonor- rhoea. Could a fmall quantity of this violent ftimulus be ufed according to the age of the child with probable good ef- fect ? Could the trephine be ufed with fafety or advantage where the affebted fide can be diftinguifhed ? See Strabifmus, Clafs I. 2. 5. 4. When one eye is affebted, does the difeafe ex- ift in the ventricle of that fide ? The following extrabt from a letter of Dr. Beddoes on hydro- cephalus internus, is well worthy to be attended to. “ Matter L , aged 9 years, became fuddenly ill in the night about a week before I faw him. On the day before the attack, he had taken opening medicines, and had bathed after- wards. He had complained of violently acute pain in his head, fhrieked frequently, ground his teeth hard, could not bear t© have his head raifed from the pillow, and was torpid of deaf. His tongue was white, pulfe 1 10 in the evening and full. As yet the pupil of the eye was irritable, and he had no ftrabif- mus. He had been bled with leeches about the head, and bfifter- ed. I direbted mercurial inunbtion, and calomel from 3 to 6 grains to be taken at firft every fix, and afterwards every three hours. This plan produced no fenfible effebf, and the patient died on the 1 8th day after the feizure. He had convulfion-fits two days preceding his death, and the well-known fymptoms of hydro- cephalus internus all made their appearance. From what I had feen 88 DISEASES Class 1. 2. 3. 13 feen and read of this difeafe, I believed it to belong to inflamma- tions, and at an earlier period I fhould be tempted to bleed as largely as for pneumonia. The fluid found after death in the ven- tricles of the brain I impute to debility of the abforbents indu- ced by inflammation. My reafons are briefly thefe : 1. The acutnefs of the pain. 2. The ftate of the pulfe. In the above cafe for the firft 9 or 10 days it did not exceed 1 10, and was full and ftrong. 3. To find out whether any febrile alternations took place, Mailer 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 feen this difeafe, but the patients were too young, or too far advanced, to inform me, whether they had chillnefs fuc- ceeded by heat at its onfet. 4. The diforders to which the young are more peculiarly liable afford a prefumption, that hy- drocephalus internus is an inflammatory difeafe •, and this is confirmed by the regularity of the period, within which it fin- ilhes its courfe. And laftiy, does not happen more frequently than is fufpefled from external injury ? “ I have juft now been well informed, that Dr Rufli has lately cured five out of fix patients by copious bleedings. I relate here the reafons for an opinion without pretending to a difcovery. Something like this do&rine may be found in cer- tain modern publications, but it is delivered in that vague and diffufe ftyle, which I truft your example will banifti from medi- cal literature.” To this idea of Dr. Beddoes may be added, that the hydrocele generally fucceeds an injury, and confequent inflammation of the bag, which contains it. And that other dropfies, which principally attend inebriates, are confequent to too great a&ion of the mucous membranes by the ftimulus of beer, wine, and fpirits. And laftiy, that as thefe cafes of hydrocephalus end fo fatally, a new mode of treating them is much to be defired, and deferves to be ferioufly attended to. This idea of inflammation preceding hydrocephalus was men- tioned by Dr. Quin, and afterwards in a pamphlet of Dr. Pat- erfon of Dublin. 13. Jlfcites. The dropfy of the cavity of the abdomen is known by a tenfe fwelling of the belly ; which does not found on being ftruck like the tympany ; and in which a fluctuation can be readily perceived by applying one hand expanded on one fide, and ftriking the tumour on the other. Effufions of water into large cavities, as into that of the abdo- men or thorax, or into the ventricles of the brain or pericardi- um, are more difficult to be reabforbed, than the effufion of fluids into the cellular membrane : beeaufe one part of this es- tenfive OF IRRITATION. Glass I. 2- 3. 14* 8p tenfive fponge-like fyftem of cells, which conne&s all the folid parts of the body, may have its power of abforption impaired, at the fame time that fome other part of it may (till retain that power, or perhaps poffefs it in an increafed degree ; and as all thefe cells communicate with each other, the fluid, which abounds in one part of it, can be transferred to another, and thus be re- abforbed into the circulation. In the afcites, cream of tartar has fometimes been attended with fuccefs ; a dram or two drams are given every hour in a morning till it operates, and this is to be repeated for feveral days ; but the operation of tapping is generally applied to at laft. Dr. Sims, in the Memoirs of the Medical Society of London, Vol. III. has lately propofed, what he believes to be a more fuc- cefsful method of performing this operation, by making a punc- ture with a lancet in the fear of the navel, and leaving it to dif- charge itfelf gradually for feveral days, without introducing a canula, which he thinks injurious, both on acccount of the too fudden emiflion of the fluid, and the danger of wounding or ftim- ulating the vifeera. This operation I have twice known per- formed with lefs inconvenience, and I believe with more benefit to the patient, than the common method. After the patient has been tapped, fome have tried inje&ions into the cavity of the abdomen, but hitherto I believe with ill event. Nor are experiments of this kind very promifing of fuc- cefs. Firft, becaufe the patients are generally much debilitated, moft frequently by fpirituous potation, and have generally a dif- eafe of the liver, or of other vifeera. And fecondly, becaufe the quantity of inflammation, neceflary to prevent future fecretion of mucus into the cavity of the abdomen, by uniting the perito- neum with the inteflines or mefentery, as happens in the cure of the hydrocele, would I fuppofe generally deftroy the patient, either immediately, or by the confequence of fuch adhefions. This however is nor the cafe in refpetrt to the dropfy of the ovarium, or in the hydrocele. 1 4. Hydrops thoracis. The dropfy of the chert commences with lofs of flefh, cold extremities, pale countenance, high col- oured urine in fmall quantity, and general debility, like many other dropfies. The patient next complains of numbnefs in the arms, efpecially when elevated, with pain and difficulty of fwal- lowing, and an abfolute impoffibility of lying down for a few minutes, or with fudden ftarting from fleep, with great difficulty of breathing and palpitation of his heart. It is often confound- ed with anafarca pulmonum, which fee. The numbnefs of the arms is probably owing more frequent- ly to the increafed atrtion of the pedloral mufcles in refpiration, Vol. II. N whence po DISEASES Class I. 2. 3. 14. whence they are lefs at liberty to perform other offices, than to the connexion of nerves mentioned in Se£t. XXIX. 5.2. The difficulty of fwallowing is owing to the compreffion of the cefophagus by the lymph in the cheft ; and the impoffibility of breathing in a horizontal pofture originates from this, that if any parts of the lungs muft be rendered ufelefs, the inability of the extremities of them muft be lefs inconvenient to refpiration ; fince if the upper parts or larger trunks of the air-vefiels (hould be rendered ufelefsbythe compreffion of the accumulated lymph, the air could not gain admittance to the other parts, and the ani- mal muft immediately perilh. If the pericardium is the principal feat of the difeafe, the pulfe is quick and irregular. If only the cavity of the thorax is hydropic, the pulfe is not quick nor irregular. If one fide is more affeCted than the other, the patient leans raoft that way, and has more numbnefs in that arm. The hydrops thoracis is diftinguifhed from the anafarca pul- monum, as the patient in the former cannot lie down half a min- ute ; in the latter the difficulty of breathing, which occafions him to rife up, comes on more gradually ; as the tranfition of the lymph in the cellular membrane from one part to another of it is flower, than that of the efFufed lymph in the cavity of the cheft. The hydrops thoracis is often complicated with fits of con- vulfive breathing ; and then it produces a difeafe for the time very fimilar to the common periodic afthma, which is perhaps owing to a temporary anafarca of the lungs ; or to an impaired venous abforption in them. Thefe exacerbations of difficult breathing are attended with cold extremities, cold breath, cold tongue, upright pofture with the mouth open, and a defire of cold air, and a quick, weak, intermittent pulfe, and contracted hands. Thefe exacerbationsrecur fometimes every two or three hours, and are relieved by opium, a grain every hour for two or three dofes, with ether about a dram in cold water ; and feem to be a convulGon of the mufcles of refpiration induced by the pain of thedyfpncea. As in Clafs III. x. 1. 9. M. M. A grain of dried fquill, and a quarter of a grain of blue vitriol every hour for fix or eight hours, unlefs it vomit or purge. A grain of opium. Blifters. Calomel three grains every third day, with infufion of fenna. Bark. Chalybeates. Puncture in the fide. Can the fluctuation in the cheft be heard by applying the ear to the fide, as Hippocrates afierts ? Can it be felt by the hand or by the patient before the difeafe is too great to admit of cure by the Class. I. 2. 3. 15. OF IRRITATION. 9 * the paracentefis ? Does this dropfy of the cheft often come on af- ter peripneumony ? Is it ever cured by making the patient fick by tinCture of digitalis ? Could it be cured, if on one fide only, by the operation of punCture between the ribs, and afterwards by inflaming the cavity by the admiflion of air for a time, like the cure of the hydrocele ; the pleura afterwards adhering whol- ly to that lobe of the lungs, fo as to prevent any future effufion of mucus ? I fufpeCt the anafarca of -the lungs, as well as the hydrops thoracis, to be moft frequently a difeafe of thofe membranes on- ly, and not to depend on the general paralyfis of the abforbent fyftem ; and that they are then not accompanied with fwelled legs, till the patient becomes univerfally weak ; and that they have for their caufe a rheumatic or gouty peripneumony or pleu- rify ; that is, that the lungs or pleura have been inflamed from their fympathy with fome other vifcus, and have depofited much coagulable lymph on the furface of their inflamed membranes, which could not readily become abforbed, and has thus caufed the dropfy of the cavity of the cheft, like the coagulable lymph or chalky matter left after the gout and rheumatifm in other parts ; or that the cellular membrane of the lungs becomes fill- ed with a fluid from the prefent inaCtion of their abforbent vef- fels, which had previoufly been excited too violently ; and that the anafarca of the lungs is thus produced like the anafarca which, frequentlylin weak conftitutions, exifts after the gout in the feet and knees, and after rheumatic inflammations of the joints. See Peripneumonia, Clafs II. r. 2. 4. whence it appears, why the hydrops thoracis and anafarca pulmonum fo generally occur in gouty conftitutions. 15. Hydrops ovarii. Dropfy of the ovary is another encyfted dropfy, which feldom admits of cure. It is diftinguifhed frorir afcites by the tumour and pain, efpecially at the beginning, oc- cupying one fide, and the fluctuation being lefs diftinCtly per- ceptible. When it happens to young fubjeCts it is lefs liable to be miftaken for afcites. It affeCts women of all ages, either married or virgins ; and is produced by cold, fear, hunger, bad food, and other debilitating caufes. 1 faw an elegant young la- dy, who was fhortly to have been married to a fenfible man, with great profpeCt of happinefs who, on being overturned in a chaife in the night, and obliged to walk two or three miles in wet, cold", and darknefs, became much indifpofed, and gradually affliCted with a fwelling and pain on one fide of the abdomen ; which terminated in a dropfy of the ovary, and deftroyed her in two or three years. Another young woman I recolleCt feeing, who was about feventeen, and being of the very inferior clafs of 92 DISEASES Class I. 2. 3. 16. of people, feemed to have been much weakened by the hardffiip of a cold floor, and little or no bed, with bad food ; and who to thefe evils had to bear the unceafing obloquy of her neighbours, and the perfecution of parifh officers. The following is abftrafled from a letter of my friend Mr. Power, furgeon, at Bofworth in Leicefterfliire, on examining the body of an elderly lady who died of this difeafe, March 29, 1793. “ On opening the abdomen I found a large cyft attach- ed to the left ovarium by an elaftic neck as thick as the little fin- ger, and fo callous as not to admit of being feparated by fciflars without confiderable difficulty. The fubftance of the cyft had an appearance much refembling the gravid uterus near the full period of geftation, and was as thick. It had no attachment to the peritoneum, or any of the vifcera, except by the hard callous neck I have mentioned ; fo that the blood muft with difficulty have been circulated through it for fome time. Its texture was extremely tender, being eafily perforated with the finger, was of a livid red colour, and evidently in a fphacelated ftate. It con- tained 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, whole deaths were occafioned by en- cyfted dropfy of the ovarium. In one of thefe the ovarium was much enlarged with eight or ten cyfts on its furface, but there was no adhefion formed by any of the cyfts to any other part ; nor had the ovarium formed any adhefion with the peritoneum, though in a very difeafed ftate. In the other the difeafe was more fimple, being only one cyft, without any attachment but to the ovarium. « As the ovarium is a part not neceflary to life, and dropfies of this kind are fo generally fatal in the end, I think I {hall be induced, notwithftanding the hazard attending wounds, which penetrate the cavity of the abdomen, to propofe the extirpation of the difeafed part in the firft cafe, which occurs to me, in which I can with precifion fay, that the ovarium is the feat of the difeafe, and the patient in other refpe£is tolerably healthy ; as the cavity of the abdomen is often opened in other cafes without bad confequences.” An argument, which might further countenance the opera- tion thus propofed by Mr. Power, might be taken from the dif- eafe frequently affe£Hng young perfons ; from its being gener- ally in thefe fubjefts local and primary ; and not like the al'cites, produced or accompanied with other difeafed vifcera ; and laft- ly, as it is performed in adult quadrupeds, as old fows, with fafety, though by awkward operators. i 6. Anafarca pulmonum. The dropfy of the cellular mem- brane OF IRRITATION. 93 Class I. 2. 3. 16 . brane of the lungs is ufually connected with that of the other parts of the fyftem. As the cells of the whole cellular mem- brane communicate with each other, the mucilaginous fluid, which remains in any part of it for want of due abforption .links down to the moll depending cells ; hence the legs fwell, though the caufe of the difeafe, the deficiency of abforption, may be in other parts of the fyftem. The lungs however are an exception to this, fince they are fufpended in the cavity of the thorax, and have in confequence a depending part of their own. The anafarca of the lungs is known by the difficulty of ref- piration accompanied with fwelled legs, and with a very irregu- lar pulfe. This laft circumftance has generally been afcribed to a dropfy at the fame time exifting in the pericardium, but is more probably owing to the difficult paflage of the blood through the lungs ; becaufe I found on difie&ion, in one inftance, that the moft irregular pulfe, which I ever attended to, was owing to very extenfive adhefion of the lungs ; infomuch that one lobe in- tirely adhered to the pleura ; and fecondly, becaufe this kind of dropfy of the lungs is fo certainly removed for a time along with the anafarca of the limbs by the ufe of digitalis. This medicine, as well as emetic tartar, or fquill, when given fo as to produce ficknefs, or naufea, or perhaps even without producing either in any perceptible degree.by affedling the lym- phatics of the ftomach, fo as either to invert their motion, or to weaken them, increafes by reverfe fympathy the a&ion, and con- fequent abforbent power of thefe lymphatics, which open into the cellular membrane. But as thefe medicines feldom fucceed in producing an abforption of thofe fluids, which ftagnate in the larger cavities of the body, as in the abdomen, or cheft, and do generally fucceed in this difficulty of breathing with irregu- lar pulfe above defcribed, I conclude that it is not owing to an effufion of lymph into the pericardium, but Amply to an anafar- ca of the lungs. M. M. Digitalis. See Art. V. 2. 1. 2. and IV. 2 3. 7. Tobacco. Squill. Emetic tartar (antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain twice a day. Raifin wine and water, or other wine and water, is pre- ferred to the fpirit and water, which thefe patients have general- ly been accuftomed to. I have feen two cafes, which were efteemed to be hydrotho- rax, but which I believed to be anafarca pulmonum* though they were attended with irregular pulfe ; for I do not underftand, why an irregularity of pulfe ffiould be occafioned by water in the pericardium any more than by water in the lungs, or by any 94 DISEASES Class I- 2. 3. 17. any other obftruftion to the circulation. See Clafs IV. 2. 1. 18. Pulfus intermittens, and Palpitatio cordis. In both thefe cafes the patients could not fleep above one min- ute at a time ; which I afcribed to the debility of the aftion of the heart compared with the refiftance to the circulation, and that fome voluntary exertion became necefiary to carry on the circulation, which does notexift in fleep. See Clafs I. 2. 1. 3. Somnus interruptus. Thefe two cafes of patients about fixty years of age are here mentioned from a curious circumftance, that both the patients became in fome degree infane after being relieved by the tinc- ture of digitalis taken to the quantity of thirty drops three or four times a day for two or three days ; and remained in a flight de- gree of infanity for fome months, and then as this increafe of voluntary exertion ceafed, they again became afflicted with the anafarca pulmonum, and fwelling of the legs, and this repeat- edly for two or three years. I have before l'een a common an- afarca repeatedly cured by infanity for a year or two, and two fevers I have feen attended with great debility cured by the ac- cefs of infanity, which was called delirium by the attendants ; and I lately witnefled the prefent cure of what was believed to be confumption by the accefs of infanity. All which were probably effected by the increafed energy of fome parts of the fyftem owing to the addition of volition to the fenforial powers of irritation or alTociation. The ufual caufe of anafarca is from a difeafed liver, and hence it mod frequently attends thofe, who have drunk much ferment- ed or fpirituous liquors ; but I fufpedl that there is another caufe of anafarca, which originates from the brain ; and which is more certainly fatal than that, which originates from a difeaf- ed liver. Thefe patients, where the anafarca originates from, or commences in, the brain, have not other fymptoms of difeafed liver ; have lefs difficulty of breathing at the beginning ; and hold themfelves more upright in their chair, and in walking. In this kind of dropfy I fufpeft the digitalis has lefs or no efieft ; as it particularly increafes the abforption from the lungs. 17. Obefitas. Corpulency may be called anafarca or dropfy of fat, fince it mull be owing to an analogous caufe ; that is, to the deficient abforption of fat compared to the quantity fccreted into the cells which contain it. See Clafs II. 1. 1.4. The method of getting free from too much fat without any injury to the conftitution, confifts, firft, in putting on a proper bandage on the belly, fo that it can be tightened or relaxed with eafe, as a tightiffl under waiftcoat, with a double row of buttons. This is to comprefs the bowels and increafe their abforption ; 95 Class. I. 2. 3. 18. OF IRRITATION. and it thus removes one principal caufe of corpulency, which is the loofenefs of the Ikin. Secondly, he ffiould omit one entire meal, as fupper ; by this long abftinence from food the abforb- ent fyftem will a£t on the mucus and fat with greater energy. Thirdly, he Ihould drink as little as he can with eafe to his fen- fations ; fince, if the abforbents of the ftomach and bowels fup- ply the blood with much, or perhaps too much, aqueous fluid, the abforbents of the cellular membrane will a£l with lefs ener- gy. Fourthly, he fhould ufe much fait or falted meat, which will increafe the perfpiration and make him thirfty ; and if he bears this thirft, the abforption of his fat will be greatly increaf- ed, as appears in fevers and dropfies with thirft ; this I believe to be more efficacious than foap. Fifthly, he may ufe -aerated alkaline water for his drink, which may be fuppofed to render the fat more fluid,— or he may take foap in large quantities, which will be decompofed in the ftomach. Sixthly, fhort reft, and conftant exercife. Vinegar has been faid to reduce corpulency, but as it con- tains much vinous fpirit, it may injure the general health with- out previoufly inducing leannefs. Perhaps cryftals of tartar might fucceed better ufed daily in water at meals. The moft efficacious method of reducing the quantity of the fat I fufpeff may be by the ufe of the tin&ure of digitalis in fmall quantity, as twenty or thirty drops twice a day, as direct- ed in Article IV. 2. 3. 7. As the efleCt of this medicine, when given in greater quantity, as in forty drops twice or thrice a day in hydrothorax or general anafarca, evidently confifts in weaken- ing the natural actions of the ftomach, perhaps by previoufly ftimulating that vifcus too violently ; in confequence the heart and arteries a£t lefs powerfully from their fympathy with the ftomach ; and the capillary veflels, and abforbents, a£t more powerfully in confequence of the lefs expenditure of fenforial power by the inert aftion of the heart and arteries ; and will confequently abforb the accumulated fat from the cellular mem- brane, as explained in Supplement I. 12. Jo. 1 8. Splenis tumor. Swellings of the fpleen, or in its vicinity, are frequently perceived by the hand in intermittents, which are called Ague-cakes, and feem owing to a deficiency of abforption in the affeCled part. Mr. Y , a young man about twenty- five years of age, who lived intemperately, was feized with an obftinate intermit- tent, which had become a continued fever with ftrong pulfe, at- tended with daily remiffion. A large hard tumour on the left fide, on the region of the fpleen, but extending much more downward, was fo diftin&ly perceptible, that one feemed to get one’s 9 6 DISEASES Class I. 2. 3. 19. one’s fingers under the edge of it, much like the feel of the brawn or fhield on a boar’s fhoulder. He was repeatedly bled, and purged with calomel, had an emetic, and a blifter on the part, without diminiihing the tumour ; after fome time he took the Peruvian bark, and flight dofes of chalybeates, and thus became free from the fever, and went to Bath for feveral weeks, but the tumour remained. This tumour I examined every four or five years for above thirty years. His countenance was pale, and to- wards the end of his life he fuffered much from ulcers on his legs, and died about fixty, of general debility ; like many others who live intemperately in refpe£l to the ingurgitation of fer- mented or fpirituous liquors. As this tumour commenced in the cold fit of an intermittent fever, and was not attended with pain, and continued fo long without endangering his life, there is reafon to believe it was limply occafioned by deficient abforption, and not by more en- ergetic action of the veflels which conflitute the fpleen. See ClafsII. 1 2 13. M. M. Venefeftion. Emetic, cathartic with calomel ; then forbentia, chalybeates, Peruvian bark. 19. Genu tumor albus. White fwelling of the knee, is owing to deficient abforption of the lymphatics of the membranes in- cluding the joint, or capfular ligaments, and fometimes perhaps of the gland which fecretes the fvnovia ; and the ends of the bones are probably afle&ed in confequence. I faw an inftance, where a cauftic had been applied by an empyric on a large white fwelling of the knee, and was told, that a fluid had been difcharged from the joint, which became an- chylofed, and healed without lofs of the limb M. M. Repeated blifters on the part early in the difeafe are faid to cure it by promoting abforption ; faturnine folutions ex- ternally are recommended. Bark, animal charcoal, as burnt fponge, opium in fmall dofes. Fridlion with the hand. Four or fix leeches applied on or beneath the knee alternately with the bliflers, and a cupping glafs put over the wounds made by the leeches are much recommended. 20. Bronch'.cele. Swelled throat. An enlargement of the thyroid glands, faid to be frequent in mountainous countries, where river water is drunk, which has its fource from diflolving i'nows. 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, feems to have been a proverb in the time of Juvenal. I he inferior people of Derby are much lubje£f to this difeafe, but whether more fo than other populous towns, I cannot determine ; certain it OF IRRITATION. 97 . Class 1.2. 3. 21. it is, that they chiefly drink the water of the Derwent, which arifes in a mountainous country, and is very frequently blacken- ed as it pafles through the morafles near its fource ; and is gen- erally of a darker colour, and attended with a whiter foam, than the Trent, into which it falls ; the greater quantity and white- nefs of its froth I fuppofe may be owing to the vifeidity com- municated to it by the colouring matter. The lower parts of the town of Derby might be eafily fuppiied with fpring water from St. Alkmond’s well ; or the whole of it from the abun- dant fprings near Bowbridge ; the water from which might be conveyed to town in hollow bricks, or clay-pipes, at no very great expence, and might be received into frequent refervoirs with pumps to them ; or laid into the houfes. M. M. Twenty grains of burnt fponge with ten of nitre made with mucilage into lozenges, and permitted to diflolve flowly un- der the tongue twice a day, is aliened to cure in a few months *, perhaps other animal charcoal, as candle-fnufFs, might do the fame. I have directed in the early ftate of this difeafe a mixture of common fait and water to be held in the mouth, particularly under the tongue, for a few minutes, four or fix times a day for many weeks, which has fometimes fucceeded; the fait and water is then fpit out again, or in part fwallowed. Externally vinegar of fquills has been applied, or a mercurial plafter,or fomentations of acetated ammoniac ; or other. Some empyrics have applied caultics on the bronchocele, and fometimes, I have been told, with fuccefs ; which Ihould certainly be ufed where there is danger of fuffocation from the bulk of it. One cafe I faw, and one I was well informed of, where the bronchocelewas cured by burnt fponge, and a he£tic fever fupervened with colliquative fweats ; 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-ffiells, and fcarlet-cloth burnt to- gether in a clofe crucible, which was tried with fuccefs, as he allured me, by a late lamented phyfician, my friend, Dr. Small of Birmingham ; who to the cultivation of modern fciences add- ed the integrity of ancient manners ; who in clearnefs of head, and benevolence of heart, had few equals, perhaps no fuperiors. 2 1 . Scrofula. King’s evil is known by tumours of the lym- phatic glands, particularly of the neck. The upper lip, and di- vifion of the noltrils are fwelled, with a florid countenance, a fmooth Ikin, and a tumid abdomen. Cullen. The abforbed flu- ids in their courfe to the veins in the fcrofula are arretted in the lymphatic or conglobate glands ; which fwell, and after a great length of time, inflame and fuppurate. Materials of a peculiar Vol. II. O kind, diseases 98 Class 1. 2. 3 21. kind, as the variolous and venereal matter, when abforbed in a wound, produce this torpor, and confequent inflammation of thofe lymphatic glands, where they firlt arrive, as in the axilla and groin. There is reafon to fufpedt, that the tonfns frequent- ly become inflamed, and fuppurate from the matter abforbed from carious teeth ; and I faw a young lady, who had both the axillary glands fwelled, and which fuppurated ; which was be- lieved to have been caufed by her wearing a pair of new green gloves for one day, when (he had perfpired much, and was much exhausted and fatigued by walking ; the gloves were probably died in a folution of verditer. Thefe indolent tumours of the lymphatic glands, which con- ftitute the fcrofuh, originate from the inirritability of thofe glands ; which therefore fooner fall into torpor after having been {Emulated too violently by fome poifonous material ; as the mufcles of enfeebled people fooner become fatigued, and ceafe to act, when exerted, than thofe of ftronger ones. O.i the fame account thefe fcrofulus glands are much longer in acquir- ing increafe of motion, after having been (Emulated into in- a£Evity, and either remain years in a (late of indolence, or fup- purate with difficulty, and fometimes only partially. The difference between fcrofulus tumours, and thofe before defcribed, confilts in this ; that in thofe, either glands of ditFer- ent kinds were difeafed, or the mouths only of the lymphatic glands were become torpid ; whereas in fcrofula the conglobate glands themfelves become tumid, and generally fuppurate after a great length of time, when they acquire new fenfibility. See Seft. XXXIX 4. 5. Thefe indolent tumours may be brought to fuppurate fome- times by palling eledflric ffiocks through them every day for two or three weeks, as I have witnefled. It is probable, that the al- ternate application of fnow or iced water to them, till they be- come painfully cold, and then of warm flannel or warm water, frequently repeated, might reftore their irritability by accumula- tion of fenforial power ; and thence either facilitate their dil'per- fion, or occa (ion them to fuppurate. See Oafs II. t. 4 13. This difeafe is very frequent amongft the children of the poor in large towns, who are in general ill fed, ill lodged, and ili ciot ti- ed ; and who are further weakened by eating much fait with their fcanty meal of infipid vegetable food, which is feldom of better quality than water gruel, with a littie coarfs bread m it. See diarrhoea of infants, Clafs 1 . 1. 2. 5. Scrofulous ulcers tire difficult to heal, which is owing to the deficiency of abforption on their pale and flabby furfaces, and to the general inirritabili- ty of the fyltem. See Clafs I 1 . 3. 13. M. M. Plentiful Class I. 2. 3. 22. OF IRRITATION, 99 M. M Plentiful diet of flefh meat and vegetables with fmall beer. Opium, from a quarter of a grain to half a grain twice a day. Sorbentia. Tindbure of digitalis, thirty drops twice a day. Externally fea-bathing, or bathing in fait and water, one pound to three gallons, made warm. The application of Peru- vian bark in fine powder, feven parts, and white lead (cerufla), in fine powder one part, mixed together and applied on the ul- cer in dry powder, by means of lint and a bandage, to be renew- ed every day. Or very fine powder of calamy alone, lapis ca- laminaris. If powder of manganefe ? See Clafs II. 14. 13. 22. Scirrhus. After the abforbent veins of a gland ceafe to perform their office, if the fecerning arteries of it continue to adb fome time longer, the fluids are puffied forwards, and ftag- nate in the receptacles or capillary veflels of the gland ; and the thinner part of them only being refumed by the abforbent fyftem of the gland, a hard tumour gradually fucceeds ; which contin- ues like a lifelefs mafs, till from fome accidental violence it gains fenfibility, and produces a cancer, or fuppurates. Of this kind are the fcirrhus glands of the breads, of the lungs, of the mefen- terv, and the fcrofulous tumours about the neck and the bron- chocele. Another feat of fcirrhus is in the membranous parts of the fyftem, as of the redbum inteftinum, the urethra, the gula or throat ; and of this kind is the veruca or wart, and the clavus pe- dum, or corns on the toes. A wen fometimes arifes on the back of the neck, and fometimes between the fhoulders ; and by dif- tending the tendinous fafcia produces great and perpetual pain* M. M. Mercurial ointment. Cover the part with oiled filk. Extirpation Eledbric tbocks through the tumour. An ifiue into the fubftance of the wen. Opium. Ether externally. 23. Scirrhus reHi intejlini. Scirrhus of the redbum. A fdrrhus frequently affecbs a canal, and by contracbing its diam- eter becomes a painful and deplorable difeafe. The canals thus obftrudbed are the redbum, the urethra, the throat, the gall-dudbs, and probably the excretory dudbs of the lymphatics, and of oth- er glands The fcirrhus of the redbum is known by the patient having pain in the part, and being only able to part with liquid feces, and by the introdudbion of the finger ; the fwel ed part of the teftine is fometimes protruded downwards, and hangs like a valve, fmooth and hard to the touch, with an aperrure in the centre of it. See a paper on this fubjedb by J. Sherwin. Me- moirs of a London Medical ociety, Vol II. p. 9. M. M. To take but little folid food. Aperient medicines. Introduce IOO DISEASES Class I. 2. 3. 24. Introduce a candle fmeared with mercurial ointment. Sponge- tent. Clyfters with forty drops of laudanum. Introduce a leathern canula, or gut, and then either a wooden maundrill, or .blow it up with air, fo as to diftend the contracted part as much as the patient can bear. Or fpread mercurial platter on thick foft leather, and roll it up with the platter outwards to any thick- nefs and length, which can be eafily introduced and worn ; or two or three fuch pieces may be introduced after each other. The fame may be ufed to comprefs bleeding internal piles. See Clafs I. 2. 1. 6. Rub mercurial ointment on the fphin&er ani every night for a fortnight. May not this difeafe be cured by lunar cauftic applied on the end of a pefiary or bougie, in the fame manner as ufed by J. Hunter, and fince by Mr. E. Home, in ftri&ures of the urethra ; when, on introducing the finger, a kind of membranous valve can be diftinguifhed rather than an extenGve fcirrhus or indura- tion. See the next article. 24. Scirrhus urethra. Scirrhus of the urethra. The paffage becomes contracted by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to dif- tend the canal behind the ftriCture ; till at length an aperture is made, and the urine forces its way into the cellular membrane, making large finufes. This fituation fometimes continues many months, or even years, and fo much matter is evacuated after making water, or at the fame time, by the aClion of the mufcles in the vicinity of the finufes, that it has been miftaken for an in- creafed fecretion from the bladder, and has been erroneoufly termed a catarrh of the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs. M. M. Diftend the part gradually by catgut bougies, which by their compreffion will at the fame time diminifh the thicknefs of the membrane, or by bougies of elaftic gum, or of horn boil- ed foft. The patient fhould gain the habit of making water flowly, which is a matter of the utmoft confequence, as it pre- vents the dittention and confequent rupture, of that part of the urethra, which is between the ftriCture and the neck of the blad- der. When there occurs an external ulcer in the perinseum, and the urine is in part difcharged that way, the difeafe cannot be miftaken. Otherwife, from the quantity of matter, it is gener- ally fuppofed to come from the bladder, or proftrate gland ; and the urine, which efcapes from the ruptured urethra, mines its way amongft the mufcles and membranes, and the patient dies tabid, owing to the want of an external orifice to diicharge the matter. See Clafs II. 1.4. 1 1 Mr. Home Class I. 2. 3. 25. OF IRRITATION. 10 j Mr Home has publifhed a very ingenious and ufeful work, entitled, a Diflertation on Strictures of the Urethra, in which he has recorded many cafes fuccefsfully treated by lunar cauf- tic, inferred in the end of a bougie, and applied to the contract- ed part of the urethra, fo as to deftroy the ftriCture. From the form of the cavity of the urethra, taken by injecting wax into it, there appears naturally to exift a kind of valve im- mediately behind the bulb of the urethra, which when the penis is ereCt, (huts up the orifice, and prevents the regurgitation of the femen into the bladder during the aCtion of the accelerator mufcles in the aCt of its expulfion ; and this natural conftriCtion or valve appears generally to be the firlt feat of ftriCture. Above the bulb, about two or three inches from the orifice of the glans, the cavity of the urethra appears alfo leflened ; and in fome cafes the orifice of the very extremity appears lefs than other parts of the canal ; thefe parts are therefore more contract- ed during theemiflio feminis, and add to its velocity at its exit ; and are thence more liable to fchirrofity or ftriCture. And by fome obfervations, Mr. Home has (liewn, that a fympathy exifts between the ftriCtures of thefe parts ; and that the more for- ward ftriCtures are frequently produced in confequence of that behind the bulb ; and finds it neceflary to deftroy them all, by frequent application of the cauftic. By the ufe of which, (which was firft propofed by Wifeman, firft applied by John Hunter, and fo greatly improved by Mr. Home) the lives of great numbers are rendered happy, who oth- erwife gradually perifh by a molt painful and hopelefs malady. 25. Scirrhus usfophagi. A fcirrhus of the throat contracts the paflage fo as to render the fwallowing of folids impracticable, and of liquids difficult. It affeCts patients of all ages, but is probably molt frequently produced by fwallowing hard angular fubftances, when people have loft their teeth ; by which this membrane is over-diftended, or torn, or otherwife injured. M. M. Put milk into a bladder tied to a canula or catheter ; introduce it paft the ftriCture, and prefs it into the ftomach. Diftend the ftriCture gradually by a fponge-tent faftened to the end of whalebone, or by a plug of wax or a fpermaceti candle, about two inches long ; which might be introduced, and left there with a ftring only fixed to it to hang out of the mouth, to keep it in its place, and to retraCt it by occafionally ; for which purpofe the ftring mult be put through a catheter or hollow pro- bang, when it is to be retraCted. Or laftly, introduce a gut fixed to a pipe *, and then diftend it by blowing wind into it. The fwallowing a bullet with a ftring put through it, to retraCt it on the exhibition of an emetic has alfo been propofed. Ex- ternally, 102 DISEASES Class I. 2 . 3. 25 ternally, mercurial ointment has been much recommended. Poultice. Oiled filk. Cly Iters of broth. Warm bath of broth. Transfufion of blood into a vein three or four ounces a day ? See Clafs 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 oeyond the Itridture in her throat ; af- ter a few days, her fpirits funk, and Ihe refufed to ufe it further, and died. Above thirty years ago, I propofed to an old gentle- man, whofe throat was entirely impervious, to fupply him with a few ounces of blood daily from an afs, or from the human an- imal, who is dill more patient and tractable, in the following manner : To fix a fi'iver pipe about an inch long to each extrem- ity of a chicken’s gut, the part between the two filver ends to be meafured by filling it with warm water ; to put one end into the vein of a perfon hired for that purpofe, fo as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other filver end, to in- troduce that end into the vein of the patient upwards towards the heart, fo as to admit no air along with the blood. And Ialtly, to fupport the gut and filver ends on a water-plate, fill- ed with water of ninety-eight degrees of heat, and to meafure how many ounces of blood was introduced by palling the finger, fo as to comprcfs the gut, from the receiving pipe to the deliv- ering-pipe-, and thence to determine how many gut-fulls were given from the healthy perfon to the patient. Mr con- sidered a day on this propofal, and then another day, and at length anfwered, that “ he now found himfelf near the houfe of death ; and that, if he could return, he was now too old to have much enjoyment of life ; and therefore he wifhed rather to pro- ceed to the end of that journey, which he was now fo near, and which he mult at all events foon go, than return for fo Ihort a time.” He lived but a few days afterwards, and feemed quite carelefs and eafy about the matter. See Suppl. I. 14 4. A difficulty of fw allowing food, and a rejection foon after, of the whole or a part of it, may be often owing probably to a fort of valve made by a parr of the membrane which lines the oefoph- agus ; and may thus refemble ftridtures of the urethra ; which lalt are fo frequently cured by the nice application of lunar cauf- tic, as defcribed by Mr. Everard Home, in his treatife on Stric- tures of the Urethra. Suppofe a thick bougie, made of linen fpread with adhefive plafter, and rolled up, was armed at the end with a bit of lunar caultic, with which the Itridture of the oefophagus could be touched repeatedly, tiil an unarmed bougie could be palfed readily into the ftomach. Could fuch a valve be burft, Class I. 2. 3. 2 6 . OF IRRITATION. burft, or inverted, by pouring a pound or two of crude mercu- ry into the oefophagus ? 26. Lafteorum inirritabilitas. Inirritability of the lacteals is defcribed in Sect. XXVIII. under the name of paralyfis of the lafteals ; but as the word paralyfis has generally been applied to the difobedience of the mufcles to the power of volition, the name is here changed to inirritabiiity of the lacteals, as more charaCferiflic of the difeafe.. 27. Lymphaticorum inirritabilitas. The inirritabiiity of the cellular and cutaneous lymphatics is defcribed in Se£t. XXIX. 5. t. and in Clafs I. 2. 3. 16. The inirritabiiity of the cutaneous lymphatics generally accompanies anafarca, and is the caufe of the great third in that malady. At the fame time, the cellular lymphatics adt with greater energy, owing to the greater de- rivation of fenforial power to them, in confequence of the lets expenditure of it by the cutaneous ones *, and hence they abforb the fat, and mucus, and alfo the thinner parts of the urine. Whence the great emaciation of the body, the muddy fedjmenr, and the fmall quantity of water in this kind of dropfy. ORDO 104 DISEASES Class I. 2. 4. 0RD0 II. Dccreafcd Irritation. GENUS IV. With decreafed Allions of other Cavities and Membranes. Many of the difeafes of this genus are attended with pain, and with cold extremities, both which ceafe on the exhibition of wine or opium ; which fliews that they originate from de- ficient action of the affeded organ. Thefe pains are called ner- vous or fpafmodic, are not attended with fever, but are fre- quently fucceeded by convulfions and madnefs ; both which be- long to the clafs of volition. Some of them return at periods, and when thefe can be afeertained, a much lefs quantity of opi- um will prevent them, than is necefiary to cure them, when they are begun ; as the veftels are then torpid and inirritable from the want of fenforial power, till by their inadion it becomes again accumulated. Our organs of fenfe, properly fo called, are not liable to pain from the abfence of their appropriated ftimuli, as from darknefs or filence ; but the other fenfes, which may be more properly called appetites, as thofe by which we perceive heat, hunger, third, lull, want of frelh air, are affeded with pain from the de- fed: or abfence of their accuftomed ftimuli, as well as with pleaf- ure by the poffeflion of them ; it is probable that fome of our glands, the fenfe or appetite of which requires or receives fome- thir.g from the circulating blood, as the pancreas, liver, teftes, proftrate gland, may be affeded with aching or pain, when they cannot acquire their appropriate fluid. Wherever this defed of ftimulus occurs, a torpor or inadion. of the organ enfues, as in the capillaries of the flein, when expo- fed to cold ; and in the glands, which fecrete the gaftric juice, when we are hungry. This torpor however, and concomitant pain, which are at firft owing to defed of ftimulus, are after- wards induced by other aflociations or catenations, and conftitute the beginning of ague-fits. It muft be further obferved, that in the difeafes of pain with- out fever, the pain is frequently not felt in the part where the caufe of the difeafe refides *, but is induced by fympathy with a diftant part, the irritability or fenfibility of which is greater or lefs than its own. Thus a ftone at the neck of the bladder, if its ftimulus is not very great, only induces the pain of ftrangury at Class I. 2. 4. 1. OF IRRITATION. I0 5 theglans penis. If its dimulus 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-badder, when the difeafe is not very great, produce pain at the other extremity of the bile- dudf, which enters the duodenum immediately under the pit of the ftomach; but, when the difeafe is great from the largenefs of the bile-done, 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 ge- nus are confequences of the inactivity of the organ ; and, as they do not occafion other difeafes, Ihould be clafled according to their proximate caufe, which is, defective irritation ; there are neverthelefs other pains from defect of ftimulus, which produce convulfions, and belong to Clafs III, 1. 1. ; and others, which produce pains of fome diftant part by afiociation, and belong to Clafs IV. 2. 2. SPECIES. x. Sitif. Third. The fenfes of third and of hunger feem to have this connexion, that the former is fituated at the upper end, and the latter at the lower end of the fame canal. One* about the pharinx, where the cefophagus opens into the mouth, and the other about the cardia ventriculi, where it opens into the domach. The extremities of other canals have been fhewn to poflefs correfpondent fenfibilities, 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 confequently painful, when there is a deficiency of aqueous fluid in the general fyflem ; it then wants its proper dimulus. In the fame manner a want of the dimulus of more folid mate- rials at the other end of the canal, which terminates in the dom- ach, produces hunger ; as mentioned in Sect. XIV. 8 The proximate caufes of both of them therefore confifl in deficient irritation, when they are confidered as pains ; becaufe therfe pains are in confequence of the inactivity of the organ, according to the fifth law of animal caufation. Sect. IV. 5. But when they are confidered as defires, namely, of liquid or folid aliment, their proximate caufe confids in the pain of them, according to the fixth law of animal caufation. So the proximate caufe of the pain of coldnefs is the inactivity of the organ, and perhaps the confequent accumulation of fenforial power in it ; but the pain itfelf or the confequent volition, is the proximate caufe of the Vol. II. P ftxuddering DISEASES i ©6 Class I. 2. 4. 2. fhuddering and gnalhing the teeth in cold fits of intermittent fe- vers. See ClafsI. 2. 2. 1. Thirft may be divided into two varieties, alluding to the re- mote caufe of each, and may be termed fitis calida, or warm thirft, and fitis frigida, or cold thirft. The remote caufe of the former arifes from the diflipation of the aqueous parts of our fluids by the increafed fecretion of perfpirable matter, or other evacuations. And hence it occurs in hot fits of fever, and after taking much wine, opium, fpice, fait, or other drugs of the Art. incitantia or fecernentia. The thirft, which occurs about three hours after eating a couple of red herrings, to a perfon unaccuf- tomed to falted meat, is of this kind ; the increafed atlion of the cutaneous veflels diflipates fo much of our fluids by infenGble perfpiration, as to require above two quarts of water to reftore the fluidity of the blood, and to wafh the fait out of the fyftem. See Art. III. 2. 1. M. M. Cold water. Vegetable acids. Warm bath. The remote caufe of fitis frigida, or cold thirft, is owing to the inaction of the cutaneous, pulmonary, urinary, and cellular abforbents ; whence the blood is deprived of the great fupply of moifture which it ought to receive from the atmofphere, and from the cells of the cellular membrane, and from other cyfts ; this caufe of thirft exifts in dropfies, and in the cold fits of inter- mittents. The defire of fluids, like that of folids, is liable to ac- quire periods, and may therefore readily become difeafed by in- dulgence in liquids grateful to the palate. Of difeafed thirft, the moil common is either owing to defeft of the a&ion of the numerous abforbent veflels on the neck of the bladder, in which the patient makes much palifh water ; or to the defedlive abforption of the Ikin and lungs, in which the patient makes but little water, and that high-coloured, and with fediment. In both the tongue and lips are liable to become very dry. The former in its greateft degree attends diabetes, and the latter anafarca. M- M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water Lemonade. Cider. 2. Efuries. Hunger has been fancifully afcribed to the fides of the ftomach rubbing againft each other, and to the increafed acidity of the gaftric juice corroding the coats of it. If either of thefe were the caufe of hunger, inflammation muft occur, when they had continued fome time ; but, on the contrary, coldnefs not heat is attendant on hunger ; which evinces, that like thirft it is owing to the inactivity of the membrane, which is the feat of it ; while the abundant nerves about the cardia ventriculi, . . and OF IRRITATION. Glass I. 2. 4. 3. 107 and the pain of hunger being felt in that part, gives great rea- fon to conclude, that it is there lituated. The fenfe of hunger as well as of third, is liable to acquire habits in refpedl to the times of its returning painfulnefs, as well as in refpedl to the quantity required to fatiate its appetency, and hence may become difeafed by indulgence, as well as by want of its appropriate ftimulus. Thofe who have been accuf- tomed to di fiend their ftomach by large quantities of animal and vegetable food, and much potation, find a want of diftention, when the ftomach is empty, which occafions faintnefs, and is miftaken for hunger, but which does not appear to be the fame fenfation. I was well informed, that a woman near Litchfield, who eat much animal and vegetable food for a wager, affirmed, that fince diftending her ftomach fo much, {he had never felt herfelf fatisfied with food ; and had in general taken twice as much at a meal, as ffie had been accuftomed to, before fhe eat fo much for a wager. 3. Naufea ficca. Dry naufea. Confifts in a quiefcence or torpor of the mucous or falivary glands, and precedes their in- verted motions, defcribed in naufea humida, Clafs I. 3. 2. 3. In the fame manner as ficknefs of the ftomach is a quiefcence of that organ preceding the adlion of vomiting, as explained in Sedl. XXXV. 1. 3. This is fometimes induced by difagreeable drugs held in the mouth, at other times by difguftful ideas, and at other times by the aflociation of thefe adtions wfith thofe of the ftomach ; and thus according to its different proximate caufes may belong to this, or to the fecond, or to the fourth clafs of difeafes. M. M. Lemonade. Taftefulfood. A blifter. Warm bath. 4. JEgritudo ventriculi. Sicknefs of ftomach is produced by the quiefcence or inadlivity of that organ, as is explained in Sect. XXXV. 1. 3. It confifts in the ftate between the ufual periftaltic motions of that organ, in the digeftion of our aliment and the retrograde motions of it in vomiting ; for it is evident, that the diredt motions of it from the cardia to the pylorus mull flop, beforethofe in a contrary diredtion can commence. This ficknefs, like the naufea above defcribed, is fometimes produced by difguftful ideas, as when nafty objedts are feen, and nafty ftories related, as v'ell as by the exhauftion of the fenforial pow- er by the ftimulus of fome emetic drugs, and by the defedl of the produdlion of it, as in enfeebled drunkards. Sicknefs may 1 ike wife con fi ft in the retrograde motions of the lymphatics of the ftomach, which regurgitate into it the chyle or lymph, which they have lately abforbed, as in Clafs I. 3. 2. 3. It is probable, that thefe two kinds of ficknefs may be different fen fations io8 DISEASES Class I. 2. 4. 5. fations, though they have acquired but one name ; as one of them attends hunger, and the other repletion ; though either of them may poffibly be induced by affociation with naufeous ideas. M. M. A blifter on the back. An emetic. Opium. Crude mercury. Covering the head in bed. See Se£t. XXV. 16. Clafs IV. 1. 1.2. and 3. 5. Cardialgia. Heartburn originates from the inactivity of the ftomach, whence the aliment, inftead of being fubdued by digeftion, and converted into chyle, runs into fermentation, pro- ducing acetous acid. Sometimes the gaftric juice itfelf becomes fo acid as to give pain to the upper orifice of the ftomach ; thefe acid coments of the ftomach, on falling on a marbie hearth, have been feen to produce an effervefcence 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 ftomach, is to be afcribed to the fympathy between thefe two extremities of the cefophagus rather than to the pungency of the carbonic gas, or fixed air j as the fenfation in fwallowing that kind of air in water is of a different kind. See Clafs I. 3. 1.3. and IV. 2. 2. 5. M M This difeafe arifing from indigeftion is often very per- tinacious, and afflicting *, and attended with emaciation of the body from want of fufficient chyle. As the faliva lwallowed along with our food prevents its fermentation, as appears by the experiments of Pringle and Macbriae, fome find confiaerable re- lief by chewing parched wheat, or maltic, or a lock of wool, fre- quently in a day, when the pain occurs, and by fwallowing tire ialiva-thus effufed ; a temporary Telief is often obtained from an- tiacids, or aerated alkaline water, Seltzer water, calcareous earths, alkaline falts made into pills with foap, foap alone, tin, milk, bitters. More permanent ufe may be had from fuch drugs as check fermentation, as acid of vitriol ; but ftill more permanent relief from fuch things as invigorate the digeftion, as a blifter on the back ; a due quantity of vinous fpirit and water taken regularly. Steel. Temperance. A fleep after dinner. A waift- coat made fo tight as flightly to comprefs the bowels and ftom- ach. A flannel (hirt in winter, not in fummer. A lefs quan- tity of potation of all kinds. Ten black pepper-corns fwallow- ed after dinner. Half a grain of opium twice a day, ora gr.>in. The food fhould confift of fuch things as do not eafiiy ferment, as flefti, ftiell-fifh, fea-bifcuit, toafted cheefe. I have feen toaft- ed cheefe brought up from the ftomach 24 hours after it had been fwallowed, without apparently having undergone any chemical change. SeeClafsII. 1. 3. 17. and IV. 1. 2. 13. It is probable that violent cardialgia is molt frequently owing to increafe of the quantity or acidity of the galtric juice, rather than Class 1 . 2. 4. 6. OF IRRITATION.' ioy than to the acetous acid produced by fermenting aliment 5 be- caufe in violent apepfy, as in low fevers, and total want of di- geftion, no fuch violently ftrong or painful acidity occurs. See I. 3. 1. 3. See Anorexia II. 2. 2. 1. And fecondly, becaufe in all thefe cafes, which have come under my eye, the diieafe was not increafed by vegetable food, or even by acid fruits, when taken in their ufual quantity ; and I have uniformly obferved, that the food which fuited the palate, and that water alone, or fmall wine and water, agreed with thele patients better than ftronger mixtures of fpirit and water, efpecially when they were more agreeable to the palate. 6. Arthritis Veniriculi. Sicknefs of the ftomach in gouty cafes is frequently a confequence of the torpor or inflammation of the liver, and then it continues many days or weeks. But when the patient is feized with great pain at the ftomach with the fenfation of coldnefs, which they have called an ice-bolt, this is a primary affedtion of the ftomach, and deftroys the patient in a few hours, owing to the torpor or inadtion of that vilcus fo important to life. This primary gout of the ftomach, as it is a torpor of that vifcus, is attended with fenfation of coldnefs, and with real de- fect of heat in that part, and may thence be diftinguifhed from the pain occafioned by the paflage of a gall-ftone into the duo- denum, as well as by the weak pulfe, and cold extremities ; to which muft be added, that it affedts thofe only, who have been long afflidted with the gout, and much debilitated by its numer- ous attacks. M M. Opium. Vinous fpirit. Volatile alkali. Spice. Warmth applied externally to the ftomach by hot cloths or fo- mentation. 7. Colica Jlatulenta. The flatulent colic arifes from the too great diftention of the bowels by air, and confequent pain. The caufe of this difeafe is the inadlivity or want of fufiiciently pow- erful conrradlion of the coats of the bowel, to carry forwards the gas given up by the fermenting aliment. It is without fe- ver, and generally attended with cold extremities. It is diftinguifhed, firft, from the pain occafioned by the paf- fage of a gall-ftone, as that is felt at the pit of the ftomach, and this nearer the navel. Secondly, it is diftinguifhed from the colica faturnina, or colic from lead, as that arifing from the tor- por of the liver, or of fome other vifcus, is attended with greater coldnefs, and with an aching pain ; whereas the flatulent colic being owing to diftention of the mufcles of the bowel, the pain is more acute, and the coldnefs lefts. Thirdly, it is diftinguifh- ed from inflammation of the bowels, or ileus, as perpetual vom- iting t ID DISEASE'S Class I. 2. 4. 8, itingand fever attend this. Fourthly, it is diftinguifhed from cholera, becaufe that is accompanied with both vomiting and di- arrhoea. And laftly, from the colica epileptica, or hyfteric col- ic, as that is liable to alternate with convuifion, and fometimes with infanity ; and returns by periods. M. M. Spirit of wine and warm water, one fpoonful of each. Opium one grain. Spice. Volatile alkali. Warm fomenta- tion externally Rhubarb. 8. Colica J'aturnina. Colic from lead. The pain is felt about the navel, is rather of an aching than acute kind at firft, which increafes after meals, and gradually becomes more permanent and more acute. It terminates in paralyfis, frequently of the mufcles of the arm, fo that the hand hangs down, when the arm is extended horizontally. It is not attended with fever, or increafe of heat. The feat of the difeafe is not well afcertain- ed ; it probably affects fome part of the liver, as a pale bluifh countenance and deficiency of bile fometimes attend or fucceed it, with confequent anafarca •, but it feems to be caufed imme- diately by a torpor of the inteftine, whether this be a primary or fecondary affection, as appears from the conftipation of the bowels, which attends it ; and is always produced in confe- quence of the great ftimulus of lead previoufly ufed either inter- nally for a length of time, or externally on a large furface. A delicate young girl, daughter of a dairy farmer, who kept his milk in leaden cifterns ufed to wipe off the cream from the edges of the lead with her finger ; and frequently, as fhe was fond of cream, licked it from her finger. She was feized with the faturnine colic, and femi-paralytic wrifts, and funk from general debility. A feeble woman about forty years of age, fprained her ancle, and bruifed her leg and thigh ; and applied by ill advice a folu- tionof lead over the whole limb, as a fomentation and poultice for about a fornight. She was then feized with the colica fa- turnina, loft the ufe of her w r rifts, and gradually funk under a general debility. There are various means by which lead finds its way into the fyftem ; in the cider counties of this country this difeafe has been frequently almoft epidemic from the ufe of fome lead about their mills, or by the pernicious ufe of it to correct the acidity of weak cider. This difeafe has been fo frequent in fome of the wine countries, that in France the punifhment of death is di- rected for thofe, who ufe lead to deftroy the acidity of wine. There is a bad cuftom in almoft all families and public houfes of wafhing out their bottles by putting a handful of fhot corns into them, and by ftiaking them about forcibly, by which the lead Class I. 2. 4. 8. OF IRRITATION. j 1 1 lead may in part adhere to the fides of the bottle, and becomes diflolved in the acid of the wine or cider. Milk kept in lead is highly pernicious, as in the inftance above related. Nor fhould coppers for brewing be edged at the top of them with lead, which is frequently done ; nor fhould flefh-meat be faited in leaden cifterns. Another way by which lead is liable to be taken into the ftomach is by broth, which is boiled in copper veflels tinned within. Now the lining of thefe veflels confifts, I am well informed, of nearly half lead mixed with the tin ; which is very foluble in hot greafe. From this caule thofe, who live much on foups long boiled, as the French, are perpetually fub- je£l to complaints of the ftomach and inteltines. When a fauce-pan has been new tinned, if the finger be rubbed hard on it, it becomes black ; which is owing to the lead, which is mix- ed with the tin. Hence the broth for ajl fick people fhould be boiled but a fhort time, and be immediately put into a ehina- bafon. In an ingenious pamphlet lately publiflied by Mr. Clutterbuek, feveral cafes are given of the fuccefsful ufe of mercury in the conftipation, colic, and paralyfis of the wrifts, produced by lead. In fome of thefe patients a drachm of ftrong mercurial ointment was rubbed morning and night on the wrifts, till the mouth be- came fore. In others calomel one grain was given daily with ol. ricini ; and in others a quarter, of a grain of hydragyrum muria- tum, fublimate of mercury, was given three times a day with great apparent advantage. The author ingenioully afks, if fmall dofes of fome preparation of lead might not be given inter- nally to counteract the ill effects fometimes believed to refult from the too long ufe of mercury. On the Poifon of Lead, Boofey, Lond. See Clafs III. 2. 1.4. The effe£t of metals in deftroying or preventing the acidity of wine or cider, may be nicely obferved in attending to the colour of fyrup of violets ; which, if it ferments, is changed by the acid thus produced from blue to red : but if it be kept in a tin veflel, this does not occur ; as the acid is attra&ed by the metal producing an oxyde. Other metals are faid by M. Guy- ton, to have the fame effedl in preferving the colour of fyrup of violets. M. M. Firft opium one or two grains, then a cathartic of fenna, jalap, and oil, as foon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A blifter on the navel. Warm bath. The ftimulus of the opium, by reftoring to the bowel its natural irritability in this cafe of painful torpor, afiifts the aftion of the cathartic A clvfter pf the fmoke of tobacco pufhed high 1 12 DISEASES Class I. 2.'^. 9, up and continued, or repeated frequently for an hour or two, or longer, is faid to remove the pain, and totally to cure the difeafe. 9. Tympanitis. Tympany confifts in an elaftic tumor of the abdomen, which founds on being (truck. It is generally attend- ed with coftivenefs and emaciation. In one kind the air is faid to exift in the bowels, in which cafe the tumor is lefs equal, and becomes lefs tenfe and painful on the evacuation of air. In the other kind the air exifts in the cavity of the abdomen, and fometimes is in a few days exchanged for water, and the tympa- ny becomes an afcites. Air may be diltinguifhed in the ftomach of many people by the found on ftriking it with the fingers, and comparing the found with that of a fimilar percuflion on other parts of the bowels : but towards the end of fevers and elpecially in the puerperal fever, a dillention of the abdomen by air is generally a fatal fymptom, though the eafe, and often cheerfulnefs of the patient, vainly flatters the attendants. M. M. In the former cafe a clyfter-pipe unarmed may be in- troduced, and left fome time in the re£lum, to take off the rc- fiftance of the fphintfter, and thus difcharge the air, as it is pro- duced from the fermenting or putrefying aliment. For this purpofe, in a difeafe fomewhat fimilar in horfes, a perforation is made into the reclum on one fide of the fphin£ter ; through which fiftula the air, which is produced in fuch great excels from the quantity of vegetable food which they take, when their digeftions are impaired, is perpetually evacuated. In both cafes alfo, balfams, effential oil, fpice, bandage on the abdomen, and, to prevent the fermentation of the aliment, acid of vitriol, faliva. See Clafs I 2. 4. 5. 1 o. Hypochondriacs. The hypochondriac difeafe confifts in indigeftion and confequent flatulency, with anxiety or want of pleafurable fenfation. When the a£lion of the ftomach and bow'els is impaired, much gas becomes generated by the ferment- ing or putrefcent aliment, and to this indigeftion is catenated languor, coldnefs of the (kin, and fear. For when the extremi- ties are cold for too long a time in fome weak conftitutions,indi- geftion is produced by diredb fympathy of the (kin and the ftom- ach, with confequent heartburn, and flatulency. The fame oc- curs, if the (kin be made cold by fear, as in riding over dan- gerous roads in winter, and hence converfely fear is produced by indigeftion or torpor of the ftomach by affociation. This difeafe is confounded with the fear of death, which is an infanity, and therefore of a totally different nature. It is al- fo confounded with the hyfteric difeafe, which confifts in the retrograde Class I. 2. 4. 11. OF IRRITATION. 113 retrograde motions of the alimentary canal, and of fome parts of the abforbent fyftem. The hvpochondriafis, like chlorofis, is fometimes attended with very quick pulfe ; which the patient feems to bear fo eafdy in thefe two maladies, that if any accidental cough attends them, ^ they may be miftaken for pulmonary confumption ; which is not owing primarily to the debility of the heart, but to its dire£t fympathy with the actions of the ftomach. M. M, Blifter. A plafter of Burgundy pitch on the abdo- men. Opium a grain twice a day. Rhubarb fix grains every night. Bark. Steel. Spice. Bath-water. Siefta, or fleep after dinner. Uniform hours of meals. No liquor ftronger than fmall beer, or wine and water. Gentle exercife on horfe- back in the open air uniformly perfifted in. See Cardial gia, I. 2. 4. 5. 1 1 . Cephal&a idiopathica. Head-achs which are attended with inflammation, are termed phrenitis, defcribed in Clafs II. 1. 2. 3. Thofe, which are not attended with inflammation, may be divided into fuch as afFe£l the whole head, to which the word cephalaea is applied, and into fuch as affeft one fide of the head only at a time, which is termed hemicrania. The former of thefe may be divided into cephalaea idiopathica, and cephalaea fympathetica ; and the latter into hemicrania idiopathica, and hemicrania fympathetica. Befides thefe there exifts a cephalaea fomniofa, a cephalaea fyphilitica, and a cephalae hydropica. The idiopathic head-ach frequently attends the cold paroxyfm of intermittents ; affliffs inebriates the day after intoxication ; and many people who remain too long in the cold bath. In all which cafes there is a general ina&ion of the whole fyftem, and as thefe membranes about the head have been more expofed to the variations of heat and cold of the atmofphere, they are more liable to become affected fo far as to produce fenfation, than oth- er membranes ; which are ufually covered either with clothes, or with mufcles, as mentioned in Se£t. XXXIII. 2. 10. The promptitude of the membranes about the fcalp to fym- pathize with thofe of other parts of the fyftem is fo great, that this cephalaea without fever, or quicknefs of pulfe, is more fre- quently a fecondary than a primary difeafe, and then belongs to Clafs IV. 2. 2 7. The hemicrania, or partial head-ach, I be. lieve to be almoft always a difeafe from afiociation ; though it is not impoffible, but a perfon may take cold on one fide of the head only. As fome people by fitting always on the fame fide of the fire in winter are liable to render one fide more tender than the other, and in confequence more fubjeft to pains, which have been erroneously termed rheumatic. Vol. II. Q_ M. M. 114 DISEASES Class I. 2. 4. 1 1. M. M. The method of cure con lifts in rendering the habit more robuft, by gentle conftant exercife in the open air, flefh diet, fmall beer at meals with one glafs of wine, regular hours of reft and rifmg, and of meals. The clothing about the head fhould be warmer during fleep than in the day •, becaufe at that time people are more liable to take cold ; that is the membra- nous parts of it are more liable to become torpid ; as explained in Se£t. XVIII. 15. In refpefl to medicine, two drams of va- lerian root in powder three or four times a day are recommend- ed by Fordyce. The bark. Steel in moderate quantities. An .emetic. A blifter. Opium, half a grain twice a day. Decay- ed teeth fhould be extracted, particularly fuch as either ache or are ufelefs. Cold bath between 60 and 70 degrees of heat. Warm bath of 94 or 98 degrees every day for half an hour dur- ing a month. See Clafs IV. 2. 2. 7. and 8 and IV. 2. 4. 3. A folution of arfenic, about the Gxteenth part of a grain, is re- ported to have great effedl in this difeafe. It Ihould be taken thrice a day, if it produces no griping or Gcknel's, for two or three weeks. A medicine of this kind is fold under the name of taftelefs ague-drops ; but a more certain method of afcer- taining the quantity is delivered in the preceding Materia Med- ica, Art. IV. 2. 6. 8. Five grains of the powdered leaves of Atropa Belladonna are recommended in fome foreign publica- tion to be repeated once in two days, and are faid to be i'uccefs- ful in the dolor faciei, or hemicrania idiopathica. Cephalaa fomniofa. Head-ach from fleep. This difeafe has not been defcribed, I believe, by any writer, though it affe£ts fome invalids for years. After fome hours of fleep the patients are afflicted with diftrefling dreams, and awake with pain of the head, which continues for fome time after they awake ; and fo circumftanced furnifhes the diagnoftic fymptom of this fpecies of cephalaea. The paroxyfms or repetitions of many difeafes are liable to commence in fleep, fome from the increafe of fenfibility during fleep, as explained in Se£l. XVIII 5. and 15. of the firft part of this work, as thofe of fome epilepGes, of fome afthmas, and of the gout. Other difeafes are liable to return during fleep from the debility of the pulmonary circulation, or of pulmonary ab- forption, as in fomnus interruptus, Clafs I. 2. 1 . 3. and in in- cubus, or night-mare, Clafs III. 2. 1. 13. and in hsemoptoe venofa, Clafs I. 2. 1.9. and probably in the humoral afthma, Clafs II. 1. 1. 8. The cephaltea fomniofa I fufpeft to bear the fame analogy to the hydrocephalus internus, as I believe the afthma humorale to bear to the anafarca pulmonum *, and to conflft in this circum- ftance. Class I. 2. 4. 12. OF IRRITATION. i*S (lance, that during deep in the cephalsea fomniofa a temporary congeftion of fluid may occur in fome part of the brain, as a permanent one occurs in the hydrocephalus internus ; in the fame manner as I believe in the afthma humorale, a temporary congeftion of fluid occurs in fome part within the cheft, and a permanent one in the anafarca of the lungs. M. M. The patient (hould fleep with his head raifed high on many pillows, and wear drawers to prevent his flipping down in the bed. 2. He (hould fleep on a hardifh bed, or mattrefs, to prevent his deeping toa profoundly, or too long together. 3. Or he may be wakened, after having flept a certain number of hours by an alarum clock. 4. Any carious teeth (hould be ex- tracted, as the matter from putrid bones, fwallowed with the faliva, weakens the fyftem by its effeCl on the ftomach. 5, Twenty drops of faturated tinClure of digitalis may be taken twice or thrice a day for three or four weeks. 6 . Half a grain of opium and fix grains of rhubarb {hould be taken every night for many weeks or months. 7. Oxygen gas may be refpired daily for a time, till its effect can be known. 12. Hemicrania idiopathica. This difeafe is defcribed by Sau- vage, under the name of trifmus dolorificus, or tic douloureux, in Clafs IV. ord. 1. gen. 2. fpec. 14. of his elaborate work. But the word trifmus is an improper name, as no fixed fpafm like the locked jaw exifts in this malady, nor any ftridor denti'um, or con- vulfion of the mufcles of the face, or trick, attends thefe patients in the few cafes which I have witnefled, though this may poffi- bly occur occafionally as the confequence of difagreeable fenfa- tion, or to relieve it. I fuppofe the word tic douloureux is a vulgar French expreflion, like megrim in Englifh. The caufe of this afflicting difeafe is yet unknown. As it does not appear to fympathize with a difeafed tooth, like the he- micrania fympathetica, defcribed in Clafs IV. 2. 2. 8. I fuf- peCl the caufe to confift in a difeafed (late of the nerve itfelf, or of its covering or theca, and to refemble the fciata frigida, mentioned below ; or to refemble fome of thofe pains, which are fucceeded or relieved by epileptic convulfions, defcribed in Clafs III 1. 1. 8. and that it thus differs from the hemicrania fym- pathetica ; as in this the caufe of the difeafe, and the feat of the pain, exift in the fame place. One cafe, which occurred to me long ago, of this difeafe, was of an elderly gentleman, Mr. W. of Litchfield, who had long, loft all his teeth ; the pain began chiefly about the cheek-bone, and extended fometimes to the ala of the nofe, and to other parts of the face on the fame fide ; on examining the gums of the up- per jaw, there was no fufpicion of any flump of a decayed tooth remaining ii 6 DISEASES Class I. 2. 4. remaining in the alveolar procefles ; nor was there any reafon to fufpedt any difeafe of the maxillary finus. Whence this did not appear to be any kind of fympathetic hemicrania. He was af- flicted with it for many years till his death. The cafe of Mr B a gentleman between 20 and 30 years of age, whom I was lately concerned for, in this difeafe, is well worthy a minute defcription; I (hall therefore copy a letter, which I wrote on his cafe to Mr. Cruiklhank, and an anfwer I receiv- ed fome time after from his partner, Mr. Leigh Thomas, who I hope will publifh the fuccefsful method of cure, with adapted prints. To Mr. Cruikjhank. Sir, Derby, Dec. 1798. Mr. Bofworth, whofe cafe I with to remind you of, confulted you fome time ago in London, and I believe that you then told him, that his head-ach was owing to a difeafe of the third branch of the fifth pair of nerves. He came under my care at Derby a few weeks ago, and complained of much pain about the left cheek-bone ; I fufpetled the antrum maxillare might be difeafed, and as the fecond of the dentes molareshad then been lately ex- tradled, I defired a perforation might be made into the antrum, which was done by Mr. Hadley, of this town, and kept open for two three days without advantage. Afterwards, by fric- tion about the head and neck with mercurial unguent, he was copioufly falivated for a few days, and had another tooth extract- ed by his own deflre, and had laftly an incifion made by Mr. Hadley, fo as to divide the artery near the centre of the ear next the cheek, hoping to divide a branch of the affedted nerve, but without fuccefs ; and internally, opiates in a large quantity were given, when the pain was exceedingly violent, the bark alfo was ufed for a time in large quantity without effedi. On attending, as much as I could, to his fenfations when in pain, he feems to exprefs the commencement of the periods of pain to exift about the part of the left cheek before the middle of the ear ; and then draws his finger from thence to the fore part of the lower jaw fometimes, and to the ala of the nofe on that fide ; and at other times he draws his finger from the fame part of the cheek before the ear upwards to the orbit of the eye, and from thence downwards, a little way on the nofe ; and alfo he complains of pain under his tongue on the fame fide. The pain returns many times in an hour on fome days, and continues many minutes, during which he feems to ftretch and exert his arms, and appears to have a tendency to epileptic adtions ; and Class I. 2. 4. 12. OF IRRITATION. 1 17 his life is thus raiferable to himfelf, and uncomfortable for his friends to witnefs. I write this to you to beg that you will acquaint Mr. Bof- worth, whether you think you could divide by incifion the dif- eafed nerve ; as he is willing to undergo fuch an operation, if you think it practicable, as 1 believe it to be the only means, which promifes to cure him ; and have therefore advifed him again to apply to you ; and if you think this can be done with effedt, he defigns to wait on you in London. I am, fir, See. E. Darwin. The following anfwer of Mr. Leigh Thomas ffiews the difeafe to have exifted in every branch of the affefted nerve. Sir, Leicejier-fquare, May , 1799. About the middle of December laft, you did Mr. Cruiklhank the favour to write him an account of Mr. Bofworth, a young gentleman, fome time under your care at Derby, with a painful affeCtion of the nerves of his face. The patient foon after came to town in a much worfe ftate, than you deferibed him to be at that time ; as the pain was extremely acute and almoft unremit- ting, opiates, which he had been in the habit of taking occafion- ally, afforded him now little or no relief, though taken to the quantity of fix tea-fpoonfuls of laudanum at a time. After pay- ing every attention to the cafe, your fuggeftion of the neceffity of dividing the difeafed nerve appeared obvious. As the pain felt was more acute in the left ala of the nofe, and the upper lip of the fame fide, we were induced to divide the fecond branch of the fifth pair of nerves, as it paffes out at the in- fraorbital foramen. He was inftantly relieved in the nofe and lip ; but towards night the pain from the eye to the crown of the head became more acute than ever. Two days after, we were obliged to cut through the firft branch paffrng out at the fupra-orbital foramen ; this afforded him the like relief with the firft. On the fame day the pain attacked, with great violence, the lower lip on the left fide, and the chin ; this circumftance induced the neceffity of dividing the third branch palling out at the foramen mentale. During the whole period, from the firft divifion of the nerves, he had frequent attacks of pain on the fide of the tongue ; thefe however difappeared on divifion of the laft nerve. Mr. Cruiklhank performed the above operations, but being particularly engaged at this time with ledures and other bufi- nefs, he now gave up the cafe to my management. The patient was evidently bettered by each operation ; ftill the pain was very fevere. DISEASES 1 18 Class I. 2. 4. 12. fevere, palling- from the ear under the zygoma toward the nofe and mouth, and upwards round the orbit. This route proved pretty clearly, that the portio dura of the auditory nerve was al- fo affected ; at leal! the uppermoft branch of the pes anferinus. Before I proceded to divide this, I was willing to try the effe£f of arfenic internally, and he took it in fufficient quantity to excite naufea and vertigo, but without perceiving any good effect. I could now truft only to the knife to alleviate his mifery, as the pain round the orbit was become mod violent ; and therefore intercepted the nerve by an incifion acrofs the fide of the nofe, and alfo made fome fmaller incifions about the ala nafi. To di- vide the great branch lying below the zygomatic procefs, I found it neceffary to pafs the fcalpel through the maflcter mufcle, till it came in contaCl with the jaw-bone, and then to cut upwards ; this relieved him as ufual. Then the lower branch was affeCl- ed, and alfo divided : then the middle branch running under the parotid gland. In cutting this, the gland was confequently di- vided into two equal parts, and healed tolerably well after a co- pious difcharge of faliva for feveral days. I hoped and expected, that this laft operation would have ter- minated his fufferings and my difficulties ; but the pain ftill af- fe£ted the lower lip and fide of the nofe, and upon coughing, or fwallowing, his mifery was dreadful. This pain could only arife from branches from the fecond of the fifth pair paffing into the cheek, and lying between the pterygoideus internus mufcle, and the upper part of the lower jaw. The fituation of this nerve rendered the operation hazardous, but after fome attempts it was accompliflied, and this day he fet out for Leicefterlhire per- fectly reftored. I am, fir, & c. Leigh Thomas. Since I wrote the above, I have feen an equally deplorable and inftructh e cafe, of he nicrania idiopathica, of an elderly perfon, defcribed by Dr. Haighton, under the name of tic douloureux, with an equally fuccefsful cure, by dividing the difeafed nerves. Medical Records and Refearches. Cox, London. Two cafes of tic douloureux are related by a Dr. Watfon, in the Recueil periodtque de Medicine, Paris, 1 798, tom. IV. which are faid to have fubmitted to mercurial fri£tions and warm bathing Thefe pains were probably venereal fymptoms, as the author fufpeCts ; but would perfuade us again to try the ufe of mercury, though it failed in the cafe above related, and efpecially as it fometimes fucceeds in the hemicrania fympathetica, as men- tioned in Clafs IV. 2. 2. 8. Five grains of the powdered leaf of belladonna Class 1.2. 4. 13. OF IRRITATION. 119 belladonna are laid to have been fuccefsful. See Cephalsea idio- *pathica. 13. Odontalgia . Tooth-ach. The pain has been erroneouflv fnppofed, where there is no inflammation, to be owing to fome acrid matter from a carious tooth ftimulating the membrane of the alveolar procefs into violent action and confequent pain ; but the effect feems to have been miftaken for the caufe, and the decay of the tooth to have been occafioned by the torpor and confequent pain of the difeafed membrane. Firft, becaufe the pain precedes the decay of the tooth in re- gard to time, and is liable to recur, frequently for years, without certainly being fucceeded at laft by a carious tooth, as I have repeatedly obferved. Secondly, becaufe any ftimulant drug, as pyrethrum, or oil of cloves, applied to the tooth, or ether applied externally to the cheek, is fo far from increafing the pain, as it would do if the pained membrane already a£led too ftrongly, that it frequently gives immediate relief like a charm. And thirdly, becaufe the torpor, or deficient a£lion of the membrane, which includes the difeafed tooth, occafions the mo- tions of the membranes moil: connected with it, as thofe of the cheek and temples, to a£l with lefs than their natural energy ; and hence a coldnefs of the cheek is perceived eafilyby the hand of the patient, comparing it with the other cheek ; and the pain of hemicrania is often produced in the temple of the afFedled fide. This coldnefs of the cheek in common tooth-ach evinces, that the pain is not then caufed by inflammation ; becaufe in all in- flammations fo much heat is produced in the fecretions of new veffels and fluids, as to give heat to the parts in the vicinity. And hence, as foon as the gum fwells and inflames along with the cheek, heat is produced, and the pain ceafes, owing to the increafed exertions of the torpid membrane, excited by the ac- tivity of the fenforial power of fenfation ; which previously ex- ifted in its pafiive ftate in the painful torpid membrane. See Odontitis, Clafs II. 1. 4. 7. and IV 2. 2. 8. M. M. If the painful tooth be found, veneje£lion. Theta 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 paiuful tooth. Ether. If the tooth has a fmall hole in it, this fhould be widened within by an inftru- ment, and then flopped with leaf-gold, or leaf-lead ; but the tooth fhould be extracted, if much decayed. It is probable that half a fmall drop of a flrong folution of arfenic, put carefully into the hollow of a decayed adling tooth, would deflroy the nerve with- out giving any additional pain ; but this experiment requires great DISEASES 120 Class I. 2. 4. 13 great caution left any of the folution fhould touch the tongue or gums. Much cold and much heat are equally injurious to the teeth, which are endued with a fine fenfation of this univerfal fluid. The bed method of preferving them is by the daily ufe of a brufh, which is not very hard, with warm water and fine charcoal dull. A lump of charcoal {hould be put a fecond time into the fire till it is red hot, as foon as it becomes cool the external afhes {hould be blown off", and it {hould be immediately reduced to fine pow- der in a mortar, and kept clofe (topped in a phial. It takes away the bad fmell from decayed teeth, by wafhing the mouth with this powder diffiifed in water, immediately. The putrid fmell of decaying (tumps of teeth may be deftroyed for a time by wafh- ing the mouth with a weak folution of alum in water. If the calcareous cruft upon the teeth adheres very firmly, a fine pow- der of pumice-ftone may be ufed occafionally, or a tooth-inftru- ment. Acid of fea-falt, much diluted, may be ufed ; but this very rarely, and with the greateft caution, as in cleanfing fea-ftiells. When the gums are fpongy, they fhould be frequently pricked with a lancet. Should black fpots in teeth be cut out ? Does the enamel grow again when it has been perforated or abraded ? Otalgia. Ear-ach fometimes continues many days without ap- parent inflammation, and is then frequently removed by filling the ear with laudanum, or with ether ; or even with warm oil, or warm water. See Clafs II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the confequence of aflociation with a difeafed tooth ; in that cafe the ether (hould be applied to the cheek over the fufpe£ted tooth ; or a grain of opium and as much camphor mixed together, and applied to the fufpecled tooth. In this cafe the otalgia belongs to the fourth clafs of difeafes. 14. Pleurodyne chronica. Chronical pain of the Gde. Pains of the membranous parts, which are not attended with fever, have acquired the general name of rheumatic •, which fhould, neverthelefs, be reftricled to thofe pains which exift only when the parts are in motion, and which have been left after inflam- mation of them ; as defcribed in Clafs I. 1. 3. 12. The pain of the fide here mentioned affedts many ladies, and may poflibly have been owing to the preflure of tight ftays, which has weak- ened the attion of the veflels compofing fome membranous part, as, like the cold head-ach, it is attended with prefent debility in one patient, a boy about ten years old, it was attended with daily convulfions, and was fuppofed to have originated from worms. The difeafe is very frequent, and generally withftands the ufe of blifters on the part ; but in fome cafes I have known* it " Class I. 2. 4. 14. OF IRRITATION. 1 2 1 it removed by eleftric (hocks repeated every day for a fortnight through the affedted fide. Pains of the fide may be fometimes occauoned by the adhe- fion of the lungs to the pleura, after an inflammation of them ; or to the adhefion of fome abdominal vifcera to their cavity, or to each other ; which alfo are more liable to affeCt ladies from 4 the unnatural and ungraceful preflure of tight flays, or by fitting or lving too long in one pofture. But in thefe cafes the pain fhould be more of the fmarting, than of the dull kind. M. M. Ether. A blifter. A plafter of Burgundy pitch An iflue or feton on the part. EleCtric (hocks- FriCtion on the part with oil and camphor. Loofe drefs. Frequent change of pofture both in the day and night. Internally, opium, vale- rian, bark. 15. Sciatica frigida . Cold fciatica. The pain along the courfe of the fciatic nerve, from the hip quite down to the top of the foot, when it is not attended with fever, is improperly termed either rheumatifm or gout ; as it occurs without inflam- mation, is attended with pain when the limb is at reft ; and as the pain attends the courfe of the nerve, and not the courfe of the mufcles, cr of the fafcia which contains them. The theory of Cotunnius, who believed it to be a dropfy of the flieath of the nerve, which was comprefled by the accumulated fluid, has not been confirmed by diife&ion. The difeafe feems to con/ift of a torpor of this (heath of the nerve, and the pain feems to be in confequence of this torpor. See Clafs II. 1. 2. 17. M. M. VenefeCtion. A cathartic. And then one grain of calomel and one of opium every night for ten fuccelfive nights. And a blifter, at the fame time, a little above the knee-joint on the outfide of the thigh, where the fciatic nerve is not fo deep feated'. Warm bath. Cold bath. Cover the limb with oiled (ilk, or with a plafter-bandage of emplaftrum de minio. x6. Lumbago frigida. Cold lumbago. When no fever or inflammation attends this pain of the loins, and the pain exifts without motion, it belongs to this genus of difeafes, and refem- bles the pain of the loins in the cold fit of ague. As thefe mem- branes are extenfive, and more eafily fall into quiefcence, either by fympathy, or when they are primarily affe&ed, this difeafe becomes very afflicting, and of great pertinacity. See Clafs II. 1. 2. 17. M. M. VenefeCtion. A cathartic. Iflues on the loins. Adhefive plafter on the loins. Blifter on the os facrum. Warm bath. Cold bath. Remove to a warmer climate in the winter. Loofe drefs about the waift. Friction daily with oil and cam- phor. VoL. II. R 17. Hyjleralgia 122 Diseases Class I. 2. 4. 17. 17. Hyjleralgia frigida. Cold pain of the uterus preceding or accompanying menflruation. It is attended with cold extremi- ties, want of appetite, and other marks of general debility. M M. A clyfter of half a pint of gruel, and 30 drops of laudanum ; or a grain of opium and fix grains of rhubarb everv night. To fit over warm water, or go into a warm bath. 18. Profialgia frigida. Cold pain at the bottom of the rec- tum previous to the tumor of the piles, which fometimes extends by fympathy to the loins ; it feems to be fimilar to the pain at the beginning of menflruation, and is owing to the torpor or inirritability of the extremity of the alimentary canal, or to the obflruftion of the blood in its paflage through the liver, when that vifcus is affefted, and its confequent delay in the veins of the reftum, occafioning tumours of them, and dull fenfations of pain. M. M. Calomel. A cathartic. Spice. Clyfter, with 30 drops of laudanum. Sitting over warm water. If chalybeates after evacuation ? See Clafs I. 2. 3. 23. and I. 2. 1. 6. 1 9. Vificx fellex inirritabilitas. The inirritability of the gall- bladder probably occafions one kind of ifterus, or jaundice ; which is owing to whatever obflrufts the paflage of bile into the duodenum. The jaundice of aged people, and which attends fome fevers, is believed to be moft frequently caufed by an irri- tative palfy of the gall-bladder ; on which accout the bile is mot prefled from the cyft by its contraction, as in a paralyfis of the urinary bladder. A thickening of the coats of the common bile-duft by inflam- mation or increafed aftion of their veflels fo as to prevent the paflage of the bile into the inteftine, in the fame manner as the membrane, which lines the noftrils, becomes thickened in ca- tarrh fo as to prevent the paflage of air through them, is proba- bly another frequent caufe of jaundice, efpecially of children ; and generally ceafes in about a fortnight, like a common catarrh, without the aid of medicine ; which has given rife to the char- after, which charms have obtained in fome countries for curing the jaundice of young people. The fpiflitude of the bile is another caufe of jaundice, as men- tioned in Clafs I. 1.3. 8. This alfo in children is a difeafe of little danger, as the gall-duftsare diftenfible, and will the eafier admit of the exclufion of gall-ftones ; but becomes a more feri- ous difeafe in proportion to the age of the patient, and his hab- its of life in refpeft to fpirituous potation. A fourth caufe of jaundice is the compreflion of the bile-duct by the enlargement of an inflamed or fcirrhous liver ; this at j nds thofe Class. I. 4. 20. OF IRRITATION. J23 thofe who have drunk much fpirituous liquor, and is generally fucceeded by droply and death. M M. Repeated emetics. Mild cathartics. Warm bath. Electricity Bitters. 1 hen fieel, which, when the pain and inflammation are removed bv evacuations, a£ts like a charm in removing the remainder of the inflammation, and by promoting the abforption of the new veflels or fluids ; like the application of any acrid eye-water at the end of ophthalmia ; and thus the thickened coats of the bile- duel become reduced, or the enlarge- ment of the liver lefiened, and a free paffage is again opened for the bile into the intefline. Ether W'ith yolk of egg is recom- mended, as having a tendency to diflolve inipiflated bile. And. a decodlion of madder is recommended for the lame purpofe ; becaufe the bile of animals, whofe food was mixed with madder was found always in a dilute Hate. Aerated alkaline water, or Seltzer water. Raw cabbage, and other acrid vegetables, as water- crefTes, muftard. Horfes are faid to be iuhjedt to infpif- fated bile, with yellow eyes, in the winter feafon, and to get well as foon as they feed on the fpring grafs. The largeft bile-ftone I have feen w^as from a lady, who had parted with it fome years before, and who had abltained above ten years from all kinds of vegetable diet to prevent, as (he fuppofed, a colic of her ftomach, which was probably a pain of the biliary duCt ; on refuming the ufe of fome vegetable diet, (he recovered a better ftate of health, and formed no new bilious concretions. A ftrong aerated alkaline water is fold byj. Schweppe, No. 8, King-llreet, Holborn. See Clafs I. 1.3. i o. 20. Pelvis renalis itiirritabihtas. Inirritability of the pelvis of the kidney When the nucleus of a (tone, whether it be in- fpiffated mucus, or other matter, is formed in the extremity of any of the tubuli unniferi, and being detached from thence falls into the pelvis of he kidney, it is liable to lodge there from the want of due irri. ability of the membrane ; and in that fituation increafes by new appofitions of indurated animal matter, in the fame manner as the hone of the bladder. This is the general caufe of haemorrhage from the kidney ; and of obtufe pain in it on exercife •, or of acute pain, when the (tone advances into the ureter. See Clafs I. x. 3. 9. ORDD 124 DISEASES Class I. 2; 5. t ORDO II. Decreafed Irritation. GENUS V. Decreafed Action of the Organs of Senfe. SPECIES. 1. Stul titia inirritabilitas. Folly from inirritability. Dulnefs of perception. "When the motions of the fibrous extremities of the nerves of fenfe are too weak, to excite fenfation with fuf- ficient quicknefs and vigour. The irritative ideas are neverthe- lefs performed, though perhaps in a feeble manner, as fuch peo- ple no not run again ft a poll, or walk into a well. There are three other kinds of folly ; that from deficient fenfation, from deficient volition, and from deficient aflociation, as will be men- tioned in their places. In delirium, reverie, and fleep, the pow- er of perception is abolifhed from other caufes. 2. Vifcus imminutus. Diminilhed vifion. In our approach to old age our vifion becomes imperfedt, not only from the form of the cornea, which becomes lefs convex, and from its decreafed tranfparency mentioned in Clafs I. 1.3. 14 ; but alfo from the decreafed 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 dropfy of the brain, is generally a fatal fymptom. A part of the cornea as well as a part of the albugi- nea in thefe fevers is frequently feen during fleep ; which isow- ing to the inirritability of the retina to light, or to the general parefis of mufcular adtion, and in confequence to the lefs con- tradlion of the fphindler of the eye, if it may be fo called, at that time. In fome eyes there is an inaptitude to adapt themfelves to the perception of objects at different diftances, w hich I fuppofe may be owing to the in irritability of thofe mufcular fibres, which conftitute the ciliary procefs, fo well deferibed and explained by Dr. Porterfield, and in the Scots Medical Effays, and fo elegant- ly feen in a differed eye. It was formerly believed^and has in- deed lately been again pretended, that the focus of the cryftal- line humour was adapted to objefls at different diftances by a change of the fhape of the whole eye by the adlion of the exter- nal mufcles, which are inferted into the tunica albuginea, and give motion to it in every direction; but in anfwer to this may be obferved, 12 S Class I. 2. 3. OF IRRITATION. obferved, that if the common adfions of the mufcles aftefted the focus of the eye, every motion of the eye-ball, when we attend to objects at any diftance, muft difturb our vifion. At the fame time though it is poflible, that a violent action of all the mufcles together, fo as to counter-balance each other, and keep the eve motionlefs as when we look painfully at a very diftant object, may in fome degree affedt the form of it ; yet that the contrac- tion of the ciliary procefs perpetually adapts the focus of the cryl- talline lens to the diftance of the retina is not to be difputed. There have been inftances of fome, who could not diftinguiflr certain colours ; and yet whofe eyes, in other refpe vomit- ing hiccough. There is another hepatitis mentioned by authors, in which the fever, and other fymptoms, are wanting, or are lefs violent ; as defcribed in Clafs II. 1.4. u.and which is probably fome- times relieved by eruptions of the face ; as in thofe who are ha- bituated to the intemperate ufe of fermented liquors. M. M. Hepatic inflammation is very liable to terminate in fuppuration, and the patient is deftroyed by the continuance of a fever with fizy blood, but without night fweats, or diarrhoea, as in other unopened abfcefles. Whence copious and repeated venefeftion is required early in the difeafe, with repeated dofes of calomel, and cathartics. Warm bath. Towards the end of the difeafe fmall dofes of opium before the evening paroxyfms, and DISEASES j 76 Class II. 1. 2. 13. and laflly the Peruvian bark, and chalybeate wine, at firft in fmall doles, as 20 drops twice a day, and afterwards, if ne- ceflary, in larger. See Art. IV. 2. 6 . Towards the end of hepatitis, after repeated venefe£tion and catharfis, an eruption fometimes appears round the lips, which is generally a falutary fymptom : and the decoQion of Peruvian bark given at this time, in the quantity of about two ounces ev- ery fix hours, removes the remaining inflammatory tendency, and cures in a day or two. Mrs. C. a lady in the lad month of her pregnancy, was feiz- ed with violent hepatitis, with fymptoms both of peripneumony and of pleurify, for it feldom happens in violent inflammations, that one vifeus alone is afFedted ; fire wanted then about a fort- night of her delivery, and after frequent venefe> ried to the tonfils, the mucu 3 of which arrefts fome particles of Vol. II. D n this DISEASES 210 ClassII. 1.3. 11. this deleterious material ; while other parts of it are carried into the ftomach, and are probably decompofed by the power of di- geftion ; as feems to happen to the venom of the viper, when taken into the ftomach. Our perception of bad taftes in our mouths, at the fame time that we perceive difagreeable odours to our noftrils, when we inhale very bad air, occafions us to fpit out our faliva •, and thus in fome inftances, to preferve ourfelves from infection. This has been fuppofed to originate from the fympathy between the organs of tafte and fmell ; but any one who goes into a fick-room clofe (hut up, or into a crowded affembly-room, or tea-room, which is not fufficiently ventilated, may eafily mix the bad air with the faliva on his tongue fo as to tafte it ; as I have myfelf frequently attended to. Hence it appears that thefe heavy infectious matters are more liable to mix with the faliva, and inflame the tonfils, and that either before or. at the commencement of the fever ; and this is what generally happens in the fcarlet fever, always I fuppofe in the malignant kind, and very frequently in the mild kind. But as this infeCtion may be taken by other means, as by the fkin, it alfo happens in the moft mild kind, that there is no inflamma- tion of the tonfils at all ; in the fame manner as there is gener- ally no inflammation of the tonfils in the inoculated fmall-pox. In the mild fcarlatina on the fourth day of the fever the face fwells a little, at the fame time a florid rednefs appears on vari- ous parts of the fkin in large blotches, at length coalefcing, and after three days changing into branny fcales. M. M. Cooi air. Fruit. Lemonade. Milk and water. Scarlatina maligna. The malignant fcarlet fever begins with, inflamed tonfils ; which are fucceeded by dark drab-coloured Houghs from three to five lines in diameter, flat, or beneath the furrounding furface ; and which conceal beneath them fpreading gangrenous ulcers. The fwellings of the tonfils are fenfible to the eye and touch externally, and have an elaftic rather than an cedematous feel, like parts in the vicinity of gangrenes. The pulfe is very quick and weak, with delirium, and the patient generally dies in a few days ; or if he recovers, it is by flow de- grees, and attended with anafarca. MM. A vomit once. Wine. Beer. Cider. Opium. Bark, in fmall repeated dofes. Small fuccefiive blifters, if the extremities are cooler than natural. Cool air on the hot parts of the fkin, the cool extremities being at the fame time covered. Iced lemonade. Broth. Cuftards. Milk. Jellies Bread pudding. Chicken. Touch the ulcers with a dry fponge to abforb the contagious matter, and then with a fponge filled with vinegar, with or without fugar of lead dhTolved in it, about Gx OF SENSATION. 21 1 Class II. i. 3. 12. grains to an ounce ; or- with a very little blue vitriol diflolved in it, as a grain to an ounce ; but nothing fo inftantaneoufly cor- rects the putrid fmell of ulcers as a folution of alum, about half an ounce to a pint of water, which fhould be a little warmilb, and injected into the fauces gently by means of a fyringe. Thefe fhould be repeated frequently in a day, if it can be done eafily, 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 faliva, and thus frequently ftimulate the dying ton- fils. Could a warm bath made of decoftion of bark, or a cold alluviation with it, be of fervice ? Could oxygene gas mix- ed with common air ftimulate the languid fyftem ? Small elec- tric (hocks through the tonfils every hour ? ether frequently applied externally to the fwelled tonfils ? As this difeafe is attended with the greateft degree of debility, and as ftimulant medicines,if given in quantity, fo as to produce more than natural warmth, contribute to expend the already too much exhaufted fenforial power ; it appears, that there is noth- ing fo neceflary to be nicely attended to as to prevent any un- neceflary motions of the fyftem ; this is bed accomplifhed by the application of cold to thofe parts of the (kin, which are in the leaft too hot. Dr. Mofman, of Bradford, directed a boy of eight years of age, who was very hot, and covered with the fear- let eruption, to be taken naked out of bed, and moiftened his (kin all over with cold vinegar, by means of a fponge, with great and good event. It is probable that cold vinegar might dimin- i(h the inflammation and confequent heat of the (kin more ef- fectually than cold water, as its application to the lips renders them pale, probably by ftimulating the abforbent extremities of the veins into greater aftion. Annals of Medicine, Vol. IV. 1799. Secondly, that the exhibition of the bark in fuch quan- tity as not to opprefs the ftomach and injure digeftion, is next to be attended to, as not being liable to increafe the aCtions of the fyftem beyond their natural quantity ; and that opium and wine fhould be given with the greateft caution, in very fmall repeated quantity, and fo managed as to prevent, if poflible, the cold fits of fever •, which probably occur twice in 25 hours, obeying the luna- tions like the tides, as mentioned in Se£t. XXXII. 6. that is, 1 fuppofe, the cold periods, and confequent exacerbations of fe- ver, in this malignant fcarlatina, occur twice in a lunar day ; which is about ten minutes lefs than 25 hours ; fo that if the commencement of one cold fit be marked, the commencement of the next may be expeCIed (if not difturbedby the exhibition of wine, or opium, or the application of blifters) to occur in about 212 DISEASES Class II. i. 3,. 12. twelve hours and a half from the commencement of the former ; <> or if not prevented by large dofes of the bark. No one could do an a£t more beneficial to fociety, or glorious to himfelf, than by teaching mankind how to inoculate this fa- tal difeafe ; and thus to deprive it of its malignity. Matter might be taken from the ulcers in the throat, which would prob- ably convey the contagion ; or warm water might be put on the eruption, and fcraped off again by the edge of a lancet. Thefe experiments could be attended with no danger, and fhould be tried for the public benefit, and the honour of medical fcience. Dr. Harwood, profeffor of anatomy, at Cambridge, favoured me with the following curious cafe of this infe&ion : Mr. N had a violent delirium in the fcarlet fever, with the {kin cracked in many places, exuding an ichorous matter ; he was attended by a poor man who had recently cut his hand with a glafs bottle, and in the ftruggle of confining him to bed his wounded hand was frequently applied to the patient’s body. This happened on the Friday night ■, his hand was inflamed and the arm dwell- ed the next day ; on the Monday following he was feized with the fame fever, and died on the Wednefday morning after. This would feem to fhew, as far as a fingle cafe can be relied on, that the fcarlet fever may be communicated, like the fmall-pox, by inoculation, and probably with fimilar fuccefs, if the matter be diluted with warm water, ufed in fmall quantity, and by fupcr- ficial incifions only, through the cuticle. 12. Miliaria. Miliary fever. An eruption produced by the warmth, and more particularly by the ftimulus, of the points of the wool in flannel or blankets applied to the {kin, has been frequently obferved j which, by cool drefs, and bed-clothes with- out flannel, has foon ceafed. See Clafs I. r. 2. 3. This, which may be called miliaria fuditoria, has been confounded with other miliary fevers, and has made the exiftence of the latter doubted. Two kinds of eruptions I have feen formerly attended with fe- ver, but did not fufficiently mark their progrefs, which I con- ceived to be miliary eruptions, one with arterial ftrength, or with fenfitive irritated fever, and the other with arterial debility, or with fenfitive inirritated fever. In the former of thefe, or miliaria irritaia , the eruptions were diftindl and larger than the fmall-pox, and the fever was not fub- dued without two or three venefeftions, and repeated cathartics with calomel. The latter, or miliaria inirritata , was attended with great ar- terial debility ; and during the courfe of the fever pellucid points appeared within the flcin, particularly on the foft parts of the fingers. And, in one patient, whom I efteemed near her end, Class II. i. 3. 13. OF SENSATION. 213 I well recoiled! to have obferved round pellucid globules, like what are often feen on vines in hot-houfes, no larger than the fmallefl pins’ heads, adhere to her neck and bofom ; which were hard to the touch, but were eafily rubbed off. Thefe difeafes, if they are allied, do not differ more than the kinds of fmall-pox ; but require many further obfervations. The eruption fo often feen on children in the cradle, and call- ed by the nurfes red-gum, and which is attended with fome de- gree of fever, I fufpedt to be produced by too great warmth, and the contadl of flannel next their tender fkins, like the miliaria fudatoria ; and like that requires cool air, cool clothes, and lin= en next their fkin. 13. Pejlis. The plague, like other difeafes of this clafs, feems to be fometimes mild, and fometimes malignant ; according to the teftimony of different writers. It is faid to be attended with inflammation, with the greatelt arterial debility, and to be very contagious, attended at an uncertain time of the fever with buboes and carbuncles. Some authors affirm, that the conta- gion of the plague may be repeatedly received, fo as to produce the difeafe ; but as this is contrary to the general analogy of all contagious difeafes, which are attended with fever, and which cure themfelves fpontaneoufly ; there is reafon to fufpe£t, that where it has been fuppofed to have been repeatedly received, fome other fever with arterial debility has been miftaken for it, as has probably univerfally been the cafe, when the fmall-pox has been faid to have been twice experienced. M. M. Venefe&idn has been recommended by fome writers on the firft day, where the inflammation was fuppofed to be at- tended with fufficient arterial ftrength, which might perhaps fometimes happen, as the bubo feems to be a fuppuration ; but the carbuncle, or anthrax, is a grangrene of the part, and {hews the greatelt debility of circulation. Whence all the means be- fore enumerated in this genus of difeafes to fupport the powers of life are to be adminiltered. Currents of cold air, cold water, ice, externally on the hot parts of the lkin. The methods of preventing the fpreading of this difeafe have been much canvaffed, and feem to confilt in preventing all con- gregations of the people, as in churches, or play-houfes ; and to remove the fick into tents, on fome airy common, by the fide of a river, and fupply them with frefh food, both animal and veg- etable ; with beer and wine, in proper quantities ; and to en- courage thofe who can, daily to wafh both their clothes and themfelves. The pejlis vaccina , or difeafe amongfl the cows, which afflidt- ed this ifland about half a century ago, feems to have been a contagious 214 DISEASES Class II. i. 3. 14. contagious fever, with great arterial debility ; as in fome of them, in the latter ftage of the difeafe, an emphyfema could often be felt in fome parts, which evinced a confiderable progrefs of gan- grene beneath the (kin. In the fenfitive inirritated fevers of thele animals, I fuppofe about fixty grains of opium, with two ounces of extract of oak-bark, every fix hours, would fupply them with an efficacious medicine ; to which might be added thirty grains of vitriol of iron, if any tendency to blood urine fhould appear, to which this animal is liable. The method of preventing the infection from fpreading, if it fhould ever again gain accel's to this illand, would be immediately to obtain an or- der from government to prevent any cattle from being removed, which were found within five miles of the place fuppofed to be inferred, for a few days ; till the certainty of the exiftence of the peftilence could be afcertained, by a committee of medical people. As foon as this was afcertained, all the cattle within five miles of the place fhould be immediately flaughtered, and confumed within the circumlcribed diltrict ; and their hides put into lime-water before proper infpedors. 14. Pemphigus is a contagious difeafe, attended with blad- dery eruptions, appearing on the fecond or third day, as large as filberts, which remain many days, and then efFufe a thin ichor. It feems to be either of a mild kind, with fenfitive fever only, of which I have feen two inftances ; or with irritated, or with in- irritated fever ; as appears from the obfervations of M. Salbert- See Medical Comment. By Dr. Duncan, Decad. II. Vol. VI. 15 . Varicella. Chicken-pox is accompanied with fenfitive fever, puftules break out after a mild fever, like the fmall-pox, feldorn luppurate, and generally terminate in feales without fears. I once faw a lady who mifearried during this difeafe, though all her children had it as flightly as ufual. It fometimes leaves fears or marks on the fkin, This difeafe has been miftaken for the fmall-pox, and inoculated for it ; and then the fmall-pox has been fuppofed to happen twice to the fame perfon. SeeTranf. of the College, London. It is probable that the pemphigus and urticaria, as well as this difeafe, have formerly been difeafesof more danger ; which the habit of innumerable generations may have rendered mild, and will in procefs of time annihilate. In the fame manner as the fmall-pox, venereal difeafe, and rickets, feem to become milder or lefs in quantity every half century. While, at the fame time, it is not improbable, that other new difeafes may arife, and, for a feafon, thin mankind ! 16. Urticaria. Nettle-rafh begins with mild fenfitive fever, which is fometimes fcarcely perceptible. Hence this eruption has been thought of two forts, one with and the other without fever. Class II. i. 3. 17. OF SENSATION. 215 fever. On the fecond day red fpots, like parts (lung with net- tles, are feen ; which almoft vanifh during the day, and recur in the evening with the fever, fucceeded in a few days by very mi- nute fcales. See Tranf. of the College, London. 17. aphtha. Thru(h. It has been doubted, whether aphtha or thrufh, which confifts of ulcers in the mouth, fhould be enu- merated amongft febrile difeafes ; and whether thefe ulcers are always fymptomatic, or the confequence rather than the caufe of the fevers which attend them. The tongue becomes rather (welled ; its colour and that of the fauces purplifh ; (loughs or ulcers appear firft on the throat and edges of the tongue, and at length over the whole mouth. Thele (loughs are whitifh, fometimes diftindl, often coalefcing, and remain an uncertain time. Cullen. I fhall concifely mention four cafes of aphtha, but do not pretend to determine whether they were all of them fymptomatic or original difeafes. Aphtha fenfitivci. A lady during pregnancy was frequently feized 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 almoft every month. The thrufti in the mouths of young children feems to be a fimilar difeafe. Thefe ulcers refemble thofeproduced in the fea-fcurvy,and have probably for their caufe an increafed adtion of the fecerning fyftem from increafed fenfation, with a decreafed adlion of the abforbent fyftem from decreafed irritation. See Clafs I. 2. 1. 14. M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently into the mouth in very fmall quantity. See Clafs II. 1. 3. 1. Aphtha irritata. Inflammatory aphtha. A cafe of this kind is related under the title of fuppurative rheumatifm. Clafs IV. 2. 1. 1 6. Aphtha itiirritata. Sloughs or ulcers of the mouth, attended with fenfitive fever with great arterial debility. They feem to fpread downwards from the throat into the ftomach, and proba- bly through the whole inteftinal canal, beginning their courl'e with cardialgia, and terminating it with tenefmus ; and might perhaps be called an eryfipelas of this mucous membrane. M. M. Cool air. A fmall blifter on the back. Bark. Wine. Opium in fmall repeated quantities. Soap neutralizes the gaf- tric acid without effervefcence, and thus relieves the pain of car- dialgia, where the ftomach is afFedled. Milk alfo deftroys a part of this acid. Infufion of fage-leaves two ounces, almond-foap from five grains to ten, with fugar and cream, is generally both agreeable and ufeful to thefe patients. See I. 2. 4. 5. Where the ftomach may be fuppofed to be excoriated by poi- fons 210 DISEASES Class II. i. 3. i8* Tons containing acid, as fublimate of mercury orarfenic; or if it be otherwife inflamed, or very fenfible to the ftimulus of the gaftric acid ; or where it abounds with acid of any kind, as in cardialgia ; the exhibition of foap is perhaps a preferable man- ner of giving alkali than any other, as it decompofes in the ftom- ach without effervefcence ; while the cauftic alkali is too acrid to be adminiftered in fuch cafes, and the mild alkali produces car- bonic gas. If a drop of acid of vitriol be put on cap-paper, it will be long before it deftroys the paper ; but if a drop of mild alkali be added, a fudden effervefcence arifes, and the paper is inftantly deftroyed by the efcape of the fixed air ; in the fume manner as lumps of folid lime are broken into powder by the ef- cape of the fleam produced from the water, which is poured on them. This fhews why a fucceffion of acid and of alkaline cauf- tics fooner deftroys a part, than either of them applied feparatel v. 18. Dyfenteria. Bloody-flux is attended with fenfitive fever, generally with arterial debility •, with frequent mucousor bloody ltools, which contain contagious matter produced by the mem- branes of the inteftines ; the alimentary excrement being never- thelefs, retained ; with griping pains, and tenefmus. Linneus obferved microfcopic animals in the ftools of dyfen- teric patients, and concluded from thence that thev were the caufe of the difeafe ; in the fame manner the animalcula, feen by microfcopes, in the puftules of the itch, have been fuppofed to be the caufe of thofe eruptions. See Article IV. 2. 1. 3. Thefe animalcula are neverthelefs feen inalmoft all animal fluids which have for a time ftagnated ; as in the femen, and in all liquid evacuations from the inteftines, as afferted by Buffon ; who efteems them to be organized beings, though not perfe or Necrofis ojfium. A C2ries of the bones may Class II. i. 4. 19. OF SENSATION. 231 may be termed a fuppuration of them ; it differs from the above as it generally is occafioned by fome external injury, as in decay- ing teeth j 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 feparation of the dead bone from the living is a work of fome time. See Sedt. XXXIII. 1. A new and able work on the necrofis of bones is publilhed by I. Ruffel, Edinburgh ; London, Robinfons. And another by I P. Wiedmann, de Ne- crofi Odium at Francfort ; Boofey, London ; which is alfo a valuable work. M. M. When this difeafe is not formed in fyphilis, or by metaftafis in fever, but is limply an inflammation of the perioi- teurn, or of the folid bone, or of its medullary cells, the method of cure Qiould confift in evacuations by bleeding and cathartics, and by leeches applied to the painful or tumid parts ; and after- wards by taking inwardly foda phofphorata and a decodtion of rubia tindforum, madder-root ; as the former is believed to give folidity to bones, and the latter, as it colours the bones of young or growing animals, is known to be carried thither during their fofter or more fenfitive ftate, and may be therefore worth a trial. See Innutritio olfium, Clafs I. 2. 2. 14. ORDG 232 DISEASES Class II. x. 5. i. ORDO I. In ere nfed Senfation. GENUS V. With the Production of new Veffels by external Membranes or Glands , without Fever. The ulcers, or eruptions, which are formed on the external fkin, or on the mouth or throat, or on the air-cells of the lungs or on the inteflines, all of which are more or lefs expofed to the contact of the atmofpheric air, which we breathe, and which in fome proportion we fwallow with our food and faliva ; or to the contatt of the inflammable air, or hydrogen, which is fet at liberty by the putrefying aliment in the inteftines, or bv putre- fying matter in large abfeefles *, all of them produce contagious matter ; which, on being inoculated into the fkin of another perfon, will produce fever, or a fimilar difeafe. In fome cafes even the matter formed beneath the (kin be- comes in fome degree contagious, at leaft fo much fo as to pro- duce fever of the hedtic or malignant kind, as foon as it has pierc- ed through the fkin, and has thus gained accefs to fome kind of air ; as the frefh pus of a common abfeefs ; or the putrid pus of an abfeefs which has been long confined ; or of cancerous ulcers. From this analogy there is reafon to fufpect that the matter of all contagious difeafes, whether with or without fever, is not in- fectious till it has acquired fomething from the air : which, by oxygenating the fecreted matter, may probably produce a new acid- And, fecondly, that in hectic fever a part of the purulent matter is abforbed ; or a ted with each other reciprocally, as being all of them excited by the fenforial power of aflbciation; but they are only catenated with thofe of the ftomach, which are not in this cafe aflociate motions but irritative ones. The common ufe of the word af- fociation for almoft every kind of connexion has rendered this fubjeCt difficult ; from which inaccuracy I fear fome parts of this work are not exempt. B. AJfoaate Motions of three Kinds. Thofe trains or tribes of aflociate motions, the introductory link of which confifts of an irritative motion, are termed irrita- tive aflociations ; as when the mufcles of the eyelids clofe the eye in common nictitation. Thofe, whofe introductory link confifts of a fenfitive motion, are termed fenfitive aflociations ; as when the peCtoral and intercoftal mufcles aCt in fneezing. And laftly, thofe whofe introductory link confifts of a voluntary motion, are termed voluntary aflociations ; as when the mufcles of the lowerlimbsaCt in concert with thofe of the arm in fencing C. Affociations affeBed by external Influences. Circles of aflociate motions, as well as trains and tribes ol them, are liable to be affected by external influences, which con- fift of ethereal fluids, and which, by penetrating the fyftem, aCt upon it perhaps rather as a caufa fine qua non of its movements, than direCtly as a ftimulus ; except when they are accumulated in unufual quantity. We have a fenfe adapted to the perception of the excels or defeCt of one of thefe fluids ; I mean that of elementary heat •, in which all things are immerfed. See Clafs IV. i. 4. r. But there are others of them, which as we have no power to evade their influence, fo we have no fenfe to per- ceive it ; thefe are the folar, and lunar, and terreftrial gravitation, in which alfo all things are immerfed ; the eleCtric aura, which pervades us, and is perpetually varying. See Clafs IV. 1. 4. 5 ; the magnetic fluid, Clafs IV. 1.4. 6 : and laftly, the great life-preferver oxygen gas, and the aqueous vapour of the atmof- phere, fee Clafs IV. 1.4 .6- and 7. and 2. Of thefe external influences thofe of hear, and of gravity, have diurnal periods of increafe and decreafe ; befides their greater periods of monthly or annual variation. The manner in which they aCl by periodical increments on the fyftem, till fome effeCt is produced, is fpoken of in SeCt. XXXII. 3. and 6. D. Affectations Class IV. i. i. OF ASSOCIATION. 361 D. Affociations ajfehled by other Senforial Motions. Circles and trains of afiociate motions are alfo liable to be af- fected by their catenations with other fenforial powers, as of ir- ritation, or fenfation,or volition ; which other fenforial powers ei- ther thus (imply form fome of the links of the catenation, or add to the energy of the affociated motions. Thus when vomiting is caufed by the ftimulus of a done in the ureter, the fenfation of pain feems to be a link of the catenation rather than an efficient caufe of the vomiting. But when the capillary vefiels of the fkin increafe their adtion from the influence of external heat, they are excited both by the ftimulus of unufual heat, as well as by the ftimulus of the blood, and by their accuftorned affoci- ation with the actions of the heart and arteries. And laftly, in the blufh of anger the fenforial power of volition is added to that of aflociation, and irritation, to excite the capillaries of the' face with increafed action. See ClafsIV. 2. 3. 5. E. AJfociations catenated with fenfation. Pain frequently accompanies afiociate trains or circles of mo- tion without its being a caufe, or a link, of them, but (imply an attendant fymptom ; though it frequently gives name to the difeafe, as head-ach. Thus in the cramp of the calves of the legs in diarrhoea, the increafed fenforial power of aflociation is the proximate caufe ; the preceding increafed action of the bow- els is the remote caufe ; and the proximate effedt is the violent contractions of the mufculi gaftrocnemii ; but the pain of thefe mufcles is only an attendant fymptom, or a remote effect. See Sect XVIII. 15. Other fenfitive aflociations are mention- ed in Clafs IV. 1. 2. and IV. i. 2. 15. Thus, if the flulhing of the face above mentioned after dinner be called a difeafe, the immediate or proximate caufe is the in- creafed power of aflociation, the remote caufe is the increaf- ed irritative motions of the ftomach in confequence of the ftim- ulus of food and wine. The difeafe or proximate effect confifts in the increafed actions of the cutaneous vefiels of the face ; and the fenfation of heat, the exiftence of heat, and the red colour, are attendants or fymptoms, or remote effects, of the increafed adlions of thefe cutaneous veffels. F. Direhl and red) erf Sympathy. __ The increafed actions of the primary part of the trains of af- fociated motions are fometimes fucceeded by increafed at ions Vol. II. Y y ' of DISEASES Class IV'. i.i. 361 of the fecondary part of the train ; and fometimes by decreafed aCtions of it. So likewife the decreafed aCtions of, the primary part of a train of aflociate morions are fometimes fucceeded by decreafed aCtions of the fecondary part, and fometimes by increafed aCtions of it The former of thefe fituations is called direCt fympathy, and the latter reverfe fympathy. In general I believe, where the primary part of the train of aflociated motions is exerted more than natural, it produces direct fympathy in ftrong people, and reverfe fympathy in weak ones, as a full meal makes fome people hot, and others chill. And where the pri- mary part of the train is exerted lefs than natural, it produces direCt fympathy in weak people, and reverfe fympathy in ftrong ones, as on being expofed for a certain length of time on horfe- back in a cold day gives indigeftion and confequent heart-burn to weak people, and ftrengthens the digeftion, and induces con- fequent hunger in ftrong ones. See SeCt. XXXV. r. This may perhaps be more eafily underftood, by confidering ftrength and weaknefs, when applied to animal bodies, as con- fiding in the quantity of fenforial power refiding in the con- tracting fibres, and the quantity of ftimulus applied, as fhewn in SeCt. XII. 2. i. Now when defective ftimulus, within certain limits, is partially applied to parts fubjeCt to perpetual motion, the expenditure of fenforial power is for a while leflened, but not its general production in the brain, nor its derivation into the weakly ftimulated part. Hence in ftrong people, or fuch whofe fibres abound with fenforial power, if the firft tribe of an aflociate train of motions be deprived in part of its accuftomed ftimulus, its aCtion becomes diminifhed ; and the fenforial pow- er becomes accumulated, and by its fuperabundance, or over- flowing as it were, increafes the aCtion of the fecond tribe of the aflociate aCtions by reverfe fympathy. As expofing the warm fkin for a moderate time to cold air increafes the aCtion of the ftomacb, and thus ftrengthens the power of digeftion. On the reverfe, when additional ftimulm within certain lim- its is partially applied to parts, which are deficient in refpeCt to the natural quantity of fenforial power, the expenditure of fen- forial power is increafed, but in a lefs degree than the increafed production of it in the brain, or its increafed derivation into the ftronglv-ftimulated organ. Hence in weak people, or fuch whofe fibres are deficient of fenforial power, if the firft tribe of an aflociate train of motions be fubjeCted for a while to greater ftimulus than ufual, a greater production of fenforial power, cr a greater derivation of it into the ftimulated parts occurs •, which by itsexcefs, or overflowing as it were, increafes the aCtions of the fecond tribe of the aflociate motions by direCt fympathy. Thus Class IV. i. i. OF ASSOCIATION. 363 Thus when vomiting occurs with cold extremities, a blifter on the back in a few hours occafions univerfal warmth of the fkin, and hops the vomiting. And when a diarrhoea occurs with pale flan and cold extremities, the pricking of the points of a flannel Hurt, worn next the ikin, occafions univerfal warmth of it, and checks or cures the diarrhoea. I11 fome aflociate trains of aCtion neverthelefs reverfe fympa- thies more frequently occur than direCt ones, and in others di- rect ones more frequently than reverfe ones. Thus in continu- ed fever with debility there appears to be a reverfe fympathy be- tween the capillary veflels of the ltomach and thofe of the fkin ; becaule there exifts a total averfion to folidfood, and conitant heat on the iuriace of the body. Yet thefe two fyitems of vef- feis are at other times actuated by direCt fympathy, as when paicnefs attends ficknefs, or cold feet induce indigeftion. This lubjeCt requires to be further inveftigated, as it probably depends not only on the prefent or previous plus or minus of the fenfo- riai power of afiociation, but alfo on the introduction of other kinds of lenional power, as in Clafs IV. 1. i.D; or the in- creafed production of it in the brain, or the greater mobility of one part of a train of adtions than another. Ihus when much food or wine is taken into the ftomach, if there be no luperfluity of fenforial power in the fyftem, that is, none to be fpared from the continual actions of it, a paienefs and chilinefs lucceed for a time ; becaufe now the expenditure of it by the increaled actions of the ftomach is greater than the prefent production of it. In a little time however the ltimulus of the food and wine increafes the production of fenforial pow- er in the brain, and this produces a luperfluity of it in the fyf- tem ; in coniequence of which the {kin now becomes warm and florid, yvhich was at firft cold and pale ; and thus the reverfe fympathy is fhortly converted into a direCt one ; which is prob- ably owing to the introduction of a lecond fenforial power, that of pleamraule fenlation. On the contrary, when an emetic drug produces ficknefs, the fkin is at brlt pale for a time by direct iympathy with the capil- laries of the ltomach ; but in a few minutes, by the accumula- tion of feniorial power in the ltomach during its lefs aCtive ftate in fickneis, the capillaries of the flan, which are afl'ociated with thole of the ltomach, act with greater energy by reverfe fympa- thy, and a florid colour returns. Where the quantity of aCtion is dimimihed in the firft part of a train of motions, whether by previous diminution of fenforial power, or prefent diminution of ltimulus, the fecond part of the train becomes torpid by di- rect fympathy. And when the quantity of aCtion of the firft part 37 motions of the ftomach and oefophagus are induced, and which it is of confequence to diftinguilh from each other. The firft is the mode above defcribed, where an effort is made to diflodge fomething, which ftimulates the ftomach into difagreeable fen- fation ; and which is returned by repeated exertions : as when a naufeous drug is taken into the mouth, or a bit of fand falls into the eye, or a drop of water into the wind-pipe. In this the periftaltic motions of the ftomach are firft flopped, and then re- verted by painful fenfation ; and the abdominal muffles and di- aphragm by repeated efforts become affociated with them. Now as lefs fenforial power is expended on the retrograde aftions of the ftomach, and of the lymphatics, which open their mouths on its furface, than by their natural motions, an accumulation of fenforial power in the fibres of the ftomach follows the ex- hibition of an emetic, and on that account an emeticiwiil fome- times flop a fpontaneous vomiting which was owing to fenfori- al deficiency. See Seft. XXXV. 1.3. and Art. V. 2. 1. As bitters and metallic falts, exhibited in fmall dofes, ftimu- late the ftomach into greater aftion, as appears by their increaf- ing the power of digeftion, and yet become emetic, when given in larger dofes •, one might fufpeft, that they became emetic by inducing debility, and confequent retrograde actions of the ftomach, by their previoufly exhaufting the fenforial power by their great ftimulus ; which might be effected in a moment without producing pain, and in confequence without our per- ceiving it. But on the contrary, there does not in general ap- pear on the exhibition of emetics to be any previous exhauftion of fenforial power ; becaufe there is evidently an accumulation of it during the ficknefs, as appears from the digeftion being ftronger afterwards ; and from the decreafed action of the cel- lular and cutaneous abforbents during its operation. See Art- V. 2. x. Another mode by which vomiting is induced, is owing to de- bility or deficiency of fenforial power, from the previous ex- hauttion of it ; as on the day after intoxication, or which occurs in people enfeebled with the gout, and in dropfy, and in fome fevers with debility. In thefe, when the vomiting ceal'es, there is no appearance of accumulation of fenforial power, as the di- geftion ftill remains weak and imperfect. Another mode by which ficknefs of vomiting is induced, is by deleft of ftimulus, as in great hunger ; and in thofe, who have been habituated to fpice and fpirit with their meals, who are liable to be lick after taking food without thefe additional ftimoli Other means of inducing ficknefs by vertigo, or by naufeous ideas, will be mentioned below. We DISEASES Class IV. i. i- 368 "We (hall only add, that the motions of the mufcular fibres of the ftomach are afl'ociated with thofe of the heart and arteries by direfl fympathy, as appears by the weaknefs of the pulfe during the exhibition of an emetic ; and that the abforbents of the ftomach are aftociated with the cellular and cutaneous abfor- bents by reverfe fympathy, as is (hewn by the great abforprbr of the mucus of the cells in anafarca during ficknefs ; at the fame time that the abforbentsof the ftomach invert their actions, and pour the mucus and water thus abforbed into that vifcus. In cold paroxyfms of fever the ftomach partakes of the gen- eral torpor, and vomiting is induced by its debility, either by its affociation with the torpid capillaries, or other torpid parts, or by its own torpor commencing firft, and caufing the cold fit. The difordered motions of the ftomach frequently feem to be the caufe or primary feat of fever, as where contagious miafma are fwallowed with the faliva, and where fever is produced by fea- ficknefs, which I once faw. Neverthelefs a diforder of the ftom- ach does not always induce fever, as in that cafe it fhouldcon- ftantly attend indigeftion,and vertigo, and fea-Gcknefs ; but is it- felf frequently induced by aflociation with the difordered move- ments of other parts of the fyftem, as when it arifes from grav- el in the ureter, or from a percuflion on the head. The connexion of the motions of the ftomach with irritative ideas, or motions of the organs of fenfe, in vertigo, is (hewn in Se£I XX. and thus it appears, that many circles of aflociation are either directly or reverfely afl'ociated, or catenated, with this vifcus, which will much contribute to unfold fome of the fymn- tomps of fever. K. Tertian ajfociations. The third link of aflociate trains of motion is fometimes actu- ated by reverfe fympathy, with the fecond link, and that by re- verfe fympathy with the firft link ; fo that the firft and third link may aft by direft fympathy, and the intermediate one by re- verfe fympathy. Of this, inftances are given in the fingultu? nephriticus, Clafs IV. 1. 1. 7. and IV. 2. 1. At other times the tertian or quartan links of aflociate motions are actuated by direft fympathy *, and that fometimes forwards and fometimes backwards in refpeft to the ufual order of thofe trains of afl'oci- ate motions, as in Clafs IV. 1.2. 1. SPECiES. j. Rubor vult&s pratifor urn. Flufhingof the face after dinner is Class IV. i. 1.2. OF ASSOCIATION. 3<>9 is explained in Seift. XXXV. 1. In the beginning of intoxica- tion the whole fkin becomes florid from the aflociation of the ac- tions of the cutaneous arteries with thofe of the ftomach, be- caufe vinous fpirit excites the fibres of the ftomach into more violent aftion than the ftimulus of common food ; and the cu- taneous capillaries of the face, from the more frequent expo- fure to the viciflitudes of cold and heat, poffefs more mobility or irritability than thofe of other parts of the (kin, as further ex- plained in Sett. XXXIII. 2. 10. Vinegar is liable to produce this flufhing of the face, which is probably owing to the quan- tity of vinous fpirit it contains, as I believe the unfermented ve- getable acids do not produce this effect. In every kind of blufh the arterial blood is propelled into the capillaries falter than the venous abforption can carry it forwards into the veins, in this refpedl refembling the tenfio phalli. Can the beginning vinous or acetous fermentation of the ali- ment in weak ftomachs contribute to this effect ? or is it to be afcribed to the greater power of alfociation between the arteries of the face and the fibres of the ftomach in fome people than in others ? M. M. Eat and drink lefs at a time, and more frequently. Put 20 drops of weak acid of vitriol into water to be drunk at meals. Let the drefs over the ftomach and bowels be loofe. Ufe no fermented liquors, or vinegar, or fpice. 2. Sudor Jiragulis immerforum. Sweat from being covered in bed. In the commencement of an epidemic fever, in which the perpetual efforts to vomit was a diftreffing fymptom, Dr. Syd- enham difcovered, that if the patient’s head was for a fhort time covered over with the bed-clothes, warmth was produced, and a fweat broke out upon the fkin, and the tendency to vomit ceaf- ed. In this curious fa<£t two trains of affociated motions are excited into increafed adlion. Firft, the veffels of the lungs are known to have their motion affociated with thofe of the fkin by the difficulty of breathing on going into the cold bath, defcrib- ed in Se achii concujjio eletirica. The movement of the arm, even of a paralytic patient, when an eleftric {hock is palled through it, is owing to the Aimulus of the excels of electricity. When a piece of zinc and another of fllver, each about the flze of a crown-piece, are placed one under the upper lip, and the other on the tongue, lo 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 theie metals are brought into contaft or fep- zrated ; which is another inftance of the ftimulus of the paflage of eleftric fhocks through the fibres of the organs of fenfe, as well as through the mufcular fibres. See Seft. XII. 1. 1. Bu. in its natural ftate eleftricity feems only to aft as an influence on animal and vegetable bodies ; of the falutary or injurious ef- fefts of which we have yet no precife knowledge. Yet if regular journals were kept of the variations of atmof- pheric eleftricity, it is probable forne difcoveries of its influence on our fyftem might in time be difcovered. For this purpofe a machine on the principle of Mr. Bennet’s eleftric doubler might be applied to the pendulum of a clock, fo as to manifeft and even to record the daily or hourly variations of aerial eleftricity. Which lias already been executed, and applied to the pendu- lum of a Dutch wooden clock, by Mr. Bennet, curate of Wirki- wortli in Derbyfhire. Befides the variations of the degree or kind of atmolpheric eleftricity, fome animals, and fome men, feem to poflefs a grea: cr Class IV. 1.4.6. OF ASSOCIATION. 397 er power of accumulating this fluid in themfelves than others. Of which a famous liiftory of a Ruffian prince was lately pub- liffied ; who, during the clear and fevere frofts of that country, could not move himfelf in bed without luminous corrulcations. Such may have been the cafe of thofe people, who have been related to have taken fire fpontaneoufly, and to have been reduced to allies. The eleCtric concuffion from the gymnotus ele&xicus, and torpedo, are other inftances of the power of the animal fyf- tem to accumulate electricity, as in thefe it is ufed as a weapon of defence, for the purpofe of taking their prey. Some have believed that the accumulation or paffage of the magnetic fluid might affect the animal fyftem, and have afferted 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 fliould be included between the fouth and north poles of a horfe-fhoe magnet, or between the contrary poles of two different magnets, that the magnetifin may be accumulated on the torpid part. 6. Oxygenatio fanguinis. The variation of the quantity of oxygen gas exifting in the atmofphere muft affeCt all breathing animals ; in its excefs this too muft be efteemed a ftimulus ; but in its natural quantity would feem to act as an influence, or caufe, without which animal life cannot exift even a minute. It is hoped that Dr. Beddoes’s plan for a pneumatic infirmary, for the purpofe of putting this and various other airs to the teft of experiment, will meet with public encouragement,- and ren- der confumption, afthma, cancer, and many difeafes conquera- ble, which at prefent prey with unremitted devaftation on all orders and ages of mankind. 7. HumeBatio corporis. Water, and probably the vapour of water diffolved or diffufed in the atmofphere, unites by mechan- ical attraction with the unorganized cuticle, and foftens and en- larges it ; as may be feen in the loofe and wrinkled flcin of the hands of walherwomen ; the fame probably occurs to the mu- cous membrane of the lungs in moift weather ; and by thick- ening it increafes the difficulty of refpiration of fome people, who are faid to be afthmatical. So far water may be faid to a£t as an influx or influence, but when it is taken up by the mouths of the abforbent fyftem, it muft excite thofe mouths into aftion, and then afts as a ftimulus. There appears from hence tc be four methods by which ani- mal bodies are penetrated by external things. 1. By their ftirn- ulus, which induces the abforbent veffels to imbibe them. 2. By mechanical attraction, as when water foftens the cuticle. 3. By chemical DISEASES Class IV. r. 4. 7. 39 8 chemical attraction, as when oxygen pafles through the mem- branes of the air-velTels of the lungs, and combines with the blood. And laftly, by influx without mechanical attraction, chemical combination, or animal abforption, as the univerfal fluids of heat, gravitation, electricity, magnetifm, and perhaps of other etherial fluids yet unknown. ORDO Class IV. 2 . i. OF ASSOCIATION. ?99 ORDO II. Decreafed AJJociate Motions. GENUS I. Catenated with Irritative Motions. As irritative mufcular motions are attended with pain, when they are exerted too weakly, as well as when they are exerted too ftrongly ; fo irritative ideas become attended with fenfation when they are exerted too weakly, as well as when they are ex- erted too ftrongly. Which accounts for thefe ideas being at- tended with fenfation in the various kinds of vertigo delcribed below. There is great difficulty in tracing the immediate caufe of the deficiencies of action of fome links of the aflbciations of irrita- tive motions ; firft, becaufe the trains and tribes of motions, which compofe thefe links, are fo widely extended as to embrace almoft the whole animal fyftem ; and fecondly, becaufe when the firft link of an affociated train of actions is exerted with too great energy, the fecond link by reverfe fvmpathy may be affected with torpor. And then this fecond link may tranfmit, as it were, this torpor to a third link, and at the fame time regain its own energy of action ; and it is poffible this third link may in like manner tranfmit its torpor to a fourth, and thus regain its own natural quantity of motion. I fliall endeavour to explain this by an example taken from fenlitive affociated motions, as the origin of their difturbed ac- tions is more eafily detected. This morning I faw an elderly perfon, who had gradually loft all the teeth in his upper jaw, and of all of the under except three of the molares ; the laft of thefe was now loofe, and occafionally painful ; the fangs of which were almoft naked, the gums being much wafted both within and without the jaw. He is a man of attentive obfer- vation, and affured me, that he had again and again noticed, that, when a pain commenced in the membranes of the alveolar procefs of the upper jaw oppofite to the loofe tooth in the under one (which had frequently occurred for feveral days paft) the pain of the loofe tooth ceaied. And that, when the pain after- wards extended to the ear and temple on that fide, the pain in the membranes of the upper jaw ceafed. In this cafe the mem- branes of the alveolar procefs of the upper jaw became torpid, and confequentiy painful, by their reverfe fympathv with the too 4oo DISEASES. Class IV. 2. r. 1, too violent actions of the inflamed membranes of the loofe tooth and then by a fecondary l’ympathy the membranes about the ear and temple became torpid, and painful ; and thofe of the alveolar procefs of the upper jaw regained their natural quanti- ty of action, and ceafed to be painful. A great many more nice and attentive obfervations are wanted to elucidate thefe curious circumftances of aflociation, which will be found to be of the greateft importance in the cure of many difeafes, and lead us to the knowledge of fever. SPECIES. 1 . Cutis frigida pranforum ■ Chilinefs after dinner frequently attends weak people, or thofe who have been exhaufted by exer- cife ; it arifes from the great expenditure of the fenforial power on the organs of digeftion, which are ftimulated into violent action by the aliment ; and the veflels of the flrin, which are af- fociated with them, become in fome meafure torpid by reverie fympathv ; and a confequent chilinefs. fucceeds with lefs abforp- tion of atmofpheric moifture. See the i'ubfequent article. 2. Pallor uritia pranforum. The palenefs of urine after a full meal is an inftance of reverie aflociation ; where the fecond- ary part of a train of aflociate motions afts with lefs energy in confequence of the greater exertions of the primary part. Af- ter dinner the abforbent veflels of the ftomach and inteftines arc ftimulated into greater action, and drink up the newly taken al- iment ; while thofe, which are fpread in great number on the neck of the bladder, abforb lefs of the aqueous part of the urin:- than ufual, which is therefore difeharged in a more dilute ftate ; and has been termed crude by fome medical writers, but it only indicates, that fo great a proportion of the fenforial power is ex- pended on digeftion and abforption of the aliment, that other parts of the fyftem adt for a time with lefs energy. See Clafs IV. 1 . i. 6. 3. Pallor urinx a frigore cutaneo. There is a temporary dif- cliarge of pale water, and a diarrhoea, induced by expofing the fkin to the cold air ; as is experienced by boys, who ftrip them- felves before bathing. In this cafe the mouths of the cutaneous lymphatics become torpid by the fubduftion of their accuftom- ed degree of heat, and thofe of the bladder and inteftines be- come torpid by direft fympathy ; whence lefs of the thinner part of the urinary fecretion, and of the mucus of the inteftines, is reabforbed. See Seft. XXIX 4. 6 . This effect cf fuddenly cooling the fkin by the alperfion of cold water has been ufed >vith fuccefs in coftivenefs, and has produced evacuations, when other Class IV. 2. 1. 4. OF ASSOCIATION. 401 other means have failed. When young infants are afflifted with griping joined with coftivenefs, I have fometimes directed them to be taken out of a warm bed, and carried about for a few minutes in a cool room, with almoft inftant relief. 4. Pallor ex eegritudine. When ficknefs of ftomach firft oc- curs, a palenefs of the (kin attends it ; which is owing to the affociation or catenation between the capillaries of the ftomach and the cutaneous ones ; which at firfl aft by direct fympathy. But in a fhort time there commences an accumulation of the fenforial power of affociation in the cutaneous capillaries during their (late of inaftivity, and then the fkin begins to glow, and fweats break out, from the increafed aftions of the cutaneous glands or capillaries, which are now in reverfe fympathy with thofe of the ftomach. So in continued fevers, when the ftom- ach is totally torpid, which is known by the total averfion to folid food, the cutaneous capillaries are by reverfe fympathy in a perpetual ftate of increafed aftivity, as appears from the heat of the fkin. 5. Dyfptuea a balneo frigido. The difficulty of breathing on going up to the middle in cold water, is owing to the irritative affociation or catenation of the aftion of the extreme veffels of the lungs with thofe of the fkin. So that when the latter are rendered torpid or inaftive by the application of fudden cold, the former become inaftive at the fame time, and retard the circulation of the blood through the lungs, for this difficulty of breathing cannot be owing to the preffure of the water imped* ing the circulation downwards, as it happens equally by a cold fhower-bath, and is foon conquered by habitual immerfions. The capillaries of the fkin are rendered torpid by the fubduc- tion of the ftimulus of heat, and by the confequent diminutions of the fenforial power of irritation. The capillaries of the lungs are rendered torpid by the diminution of the fenforial power of affociation, which is now excited in lefs quantity by die leffen- ed aftions of the capillaries of the fkin, with which they are catenated. So that at this time both the cutaneous and pulmo- nary capillaries are principally actuated, as far as they have any aftion, by the ftimulus of the blood. But in a fhort time the fenforial power of irritation, and of affociation, become accu- mulated, and very energetic aftion of both thefe membranes fucceeds. Which thus refemble the cold and hot fit of an in- termittent fever. 6 Dyfpepfia a pedibus frigidis. When the feet are long cold, as in riding in cold and wet weather, fome people are very liable to indigeftion and confequent heart-burn. The irritative motions of the ftomach become torpid, and do their office ft di Vol. II. D d d geftion 402 DISEASES Class IV. 2. 1.7 ,< geftion imperfedlv, in confequence of their afiociation with the torpid motions of the veflels of the extremities. Fear, as it pro- duces palenefs and torpidity of the {kin, frequently occafions tem- porary indigeftion in confequence of this aiTociation of the vef- fels of the {kin with thofe of the ftomach ; as riding in very bad roads will give flatulency and indigeftion to timorous people A fhort expofure to cold air increales digeftion, which is then owing to the reverfe fympathy between the capillary veflels of the {kin, and the ftomach. Hence when the body is expofed to cold air, within certain limits of time and quantity, a reverfe fympathy of the ftomach and the {kin firft occurs, and after- wards a dired fympathy. In the former cafe the expendi- ture of fenforial power by the flcin being leflened, but not its production in the brain ; the fecond link of the afiociation, viz. the ftomach, acquires a greater fhare of it. In the latter cafe, by the continuation of the deficient ftimulus of heat, the torpor becomes extended to the brain itfelf, or to the trunks of the nerves ; and univerfal inactivity follows- 7. TuJJis a pedibus frigidis. On {landing with the feet in thawing fnow, many people are liable to inceflant coughing. From the torpidity of the abforbent veflels of the lungs, in con- fequence of their irritative aflociations with thofe of the flcin, they ceafe to abforb the faline part of the fecreted mucus ; and a cough is thus induced by the irritation of this faline fecretion ; which is fimilar to that from the noftrils in frofty weather, but differs in refped to its immediate caufe ; the former being from afiociation with a diftant part, and the latter from defed of the ftimulus of heat on the noftrils themfelves. See Catarrhus fri- gidus, Clafs I. 2. 3. 3. 8. TuJJts hepatica. The cough of inebriates, which attends the enlargement of the liver, or a chronical inflammation of its upper membrane, is fuppofed to be produced by the inconveni- ence the diaphragm fuffers from the compreflion or heat of the liver. It differs however eflentially from that attending hepati- tis, from its not being accompanied with fever. And is per- haps rather owing to irritative afiociation, or reverfe fympathy, between the lungs and the liver. As occurs in {heep, which are liable to a perpetual dry cough, when the fluke- worm is prey- ing on the fubftance of their livers. See Clafs 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. T ujfts arthritica. Gout-cough. I have feen a cough, which twice recurred at a few years diftance in the fame per- son, during his fits of the gout, with fuch pertinacity and vie lence •Class IV. 2. 1. le. OF ASSOCIATION. 403 lence as to refift venefe&ion, opiates, bark, blifters, mucilages, and all the ufual methods employed in coughs. It was for a time fuppofed to be the hooping cough, from the violence of the addion of coughing ; it continued two or three weeks, the pa- tient never being able to fleep more than a few minutes at once during the whole time, and being propped up in bed with pil- lows night and day. As no fever attended this violent cough, and but little expec- toration, and that of a thin and frothy kind, I fufpedded the membrane of the lungs to be rather torpid than inflamed, and that the faline parts of the mucus not being abforbed ftimulated them into perpetual exertion. And laftly, that though the lungs are not fenfible to cold and heat, and probably (therefore lefs mobile, yet, as they are neverthelefs liable to confent with the torpor of cold feet, as deferibed in fpecies 6 of this Genus, I fufpedted this torpor of the lungs to fucceed the gout in the feet, or to aft a vicarious part for them. 10. Vertigo rotatoria. In the vertigo from circumgyration the irritative motions of vifion are increafed ; which is evinced from the pleafure that children receive on being rocked in a cradle, or by {winging on a rope. For whenever fenfaticn arif- es from the produdtion of irritative motions with lefs energy than natural, it is of the difagreeable kind, as from cold or hun- ger •, but when it arifes from their production with greater en- ergy than natural, if it be confined within certain limits, it is of the pleafurable kind, as by warmth or wine. With thefe in- creafed irritative motions of vifion, I fuppofe thofe of the (torn- ach are performed with greater energy by direct fympalhyq but when the rotatory motions, which produce this agreeable verti- go, are continued too long, or are too violent, ficknefs of the flomach follows ; which is owing /to the decreafed addion of that organ from its reverfe fympathy with the increafed actions ol the organ of vifion. For the expenditure of fenforial power by the organ of vifion is always very great, as appears by the fizc of the optic nerves ; and is now fo much increafed as to deprive the next link of affociation of its due {hare. As mentioned in Species 6 of this Genus. In the fame manner the undulations of water, or the motions of a (hip, at firft give pleafure by increafing the irritative mo- tions belonging to the fenfe of vifion ; but produce ficknefs at length by expending on one part of the affociated train of irri- tative attions too much of that fenforial power, which ufually ferved the whole of it ; whence fome other parts of the train ac- quire too little of it, and perform their addions in confequence too reebly, and thence become attended with difagreeable fenfation. It 4«4 DISEASES Class IV. 2. 1. 10. It muft alfo be obferved, that when the irritative motions are ftimulated into unufual aCtion, as in inebriation, they become fucceeded by fenfation, either of the pleafurable or painful kind ; and thus a new link is introduced between the irritative mo- tions thus excited, and thofe which ufed to fucceed them ; whence the afiociation is either diflevered or much weakened, and thus the vomiting in fea-ficknefs occurs from the defeft of the power of afiociation, rather than from the general deficien- cy of fenforial 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 fenfe of touch. A blind man balances himfelf by the fenfe of touch, which being a lefs perfedt means of determining fmall quantities of deviation from the perpendicular, occafions him to walk more carefully upright than thofe, who balance themfelves by vilion. When he revolves, the irritative aflbciations of the mufcular motions, which were ufed to preferve his perpendicu- larity, become difordered by their new modes of fucceflive ex- ertion ; and he begins to fall. For his feet now touch the floor in manners or directions different from thofe they have been ac- cuftomed to ; and in confequence he judges lefs perfectly of the. fituation of the parts of the floor in refpect to that of his own body, and thus lofes his perpendicular attitude. This may be illuftrated by the curious experiment of eroding one finger over the next to it, and feeling a nut or bullet with the ends of them. When, if the eyes be clofed, the nut or bullet appears to be two, from the deception of the fenfe of touch In this vertigo from gyration, both of the fenfe of fight, and of the fenfe of touch, the primary link of the affociated irritative motions is increafed in energy, and the fecondary ones are in- creafed at firfl: by diredl fympathy ; but after a time they become decreafed by reverfe fympathy with the primary link, owing to the exhauftion of fenforial power in general, or to the power oi afiociation in particular ; becaufe in the laft cafe, either pleafur- able or painful fenfation has been introduced between the links of a train of irritative motions, and has diflevered, or much en- feebled them. Dr. Smyth, in his Efiay on Swinging in Pulmonary Confump- tion,has obferved, that fwinging makes the pulfe flower. Dr. Ewart of Bath confirmed this obferration both on himfelf and on Col. Cathcart, who was then heClic, and that even on fhip- board, where fome degree of vertigo might be fuppofed previ- oufly to exift. Dr. Currie of Liverpool not only confirmed this obfervation frequently on himfelf, when he was alfo phtifical, but found that equitation bad's fimilar effect on him, uniform. iy Class IV. 2. 1. 10. OF ASSOCIATION. 405 ly retarding his pulfe. This curious circumftance cannot arife from the general effect of exercife, or fatigue, as in thofe cafes the pulfe becomes weaker and quicker ; it muft therefore be af- cribed to a degree of vertigo, which attends all thofe modes of motion, which we are not perpetually acculiomed to. Dr. Currie has further obferved, that “ in cafes of great de- bility the voluntary mufcular exertion requifite in a fwing pro- duces wearinefs, that is, increafes debility and that in fuch in- ftances he had frequently noticed, that the diminution of the fre- quency of the pulfe did not take place, but the contrary.” Tliefe circumftances may thus be accounted for. The links of aflociation, which are effected in the vertigo oc- cafioned by unufual motion, are the irritative motions of the fenfe of vifion, thofe of the ftomach, and thofe of the heart and arteries. When the irritative ideas of vifion are exerted with greater energy at the beginning of vertigo, a degree of fenfation is excited, which is of the pleafurable kind, as above mentioned ; whence the aflociated trains of irritative motions of the ftomach, and heart, and arteries, a£t at firft with greater energy, both by diredl fympathy, and by the additional fenforial power of fenfa- tion. Whence the pulfe of a confumptive patient becomes ftronger and consequently flower. But if this vertigo becomes much greater in degree or dura- tion, the firft link of this train of aflociated irritative motions expends too much of the fenforial power, which was ufually em- ployed on the whole train ; and the motions of the ftomach be- come in confequence exerted with lefs energy. This appears, becaufe in this degree of vertigo ficknefs fupervenes, as in fea- ficknefs, which has been (hewn to be owing to lefs energetic ac- tion of the ftomach. And the motions of the heart and arteries then become weaker, and in confequence more frequent, by their dire£l fympathy with the lefiened actions of the ftomach. bee Supplement, I. 12. and Clafs II. 1. 6. 7. The general weak- ness from fatigue is owing to a fimilar caufe, that is, to the too great expenditure of fenforial power in the increafed aftions of one part of the fyftem, and the confequent deficiency of it in other parts, or in the whole. The abatement of the heat of the {kin in he£lic fever by fwinging, is not only owing to the increafed ventilation of coo! air, but to the reverfe fympathy of the motions of the cutaneous capillaries with thofe of the heart and arteries ; which occurs in ail fevers with arterial debility, and a hot or dry {kin. Hence during moderate fwinging the adftion of the heart and arteries becomes ftronger and flower, and the a£tion of the capillaries, •which was before tod great, as appeared by the heat of the {kin, is 406 DISEASES ClassIV. 2.’i. i r. is now leflened by their reverie fympathy with that of the heart and arteries.- See Supplement, I 8. ii. Vertigo vifualis . Vifual vertigo. The vertigo rotaroria defcribed above, was induced by the rotation or undulation of external objects, and was attended with increafed action of the primary link of the affociated motions belonging to vifion, and with confequent pleafure. The vertigo vifualis is owing to lefs perfect vifion, and is not accompanied with pleafurable fenfa- tion. This frequently occurs in ftrokes of the palfy, and is then fucceeded by vomiting ; it fometimes precedes epileptic fits, and often attends thofe, w'hofe fight begins to be impaired by age. In this vertigo the irritative ideas of the apparent motions of objefts are lefs diftintt, and on that account are not fucceeded by their ufual irritative alfociations of motion ; but excite our attention. Whence the objedls appear to librate or circulate according to the motions of our heads, which is called dizzinefs •„ and we lofe the means of balancing ourfelves, or preferring our perpendicularity, by vifion. So that in this vertigo the motions of the affociated organs are decreafed by diredl fympathy with their primary link of irritation j as in the preceding cafe of fea- ficknefs they are decreafed by reverfe fympathy. When vertigo affects people about fifty years of age, their fight has generally been fuddenly impaired ; and from their lefs accurate vifion they do not foon enough perceive the apparent motions or objects ; like a perfon in a room, the walls of which are ftained with the uniform figures of lozenges, explained in Seel XX i. This is generally aferibed to indigeftion ; but it ceafes ipontaneoufly, as the patient acquires the habit of balanc- ing himfelf by lefs diftindl objects. A gentleman about 50 vvasfeized with an uncommon degree of vertigo, fo as to fall on the ground, and not be able to turn his head, as he fat 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 fometimes ac- companied by pains on one fide of his head, the difeafe of a tooth was fufpedled to be the caufe. And as his timidity was too great to admit the extraction of thofe which were de- cayed ; after the trial of cupping repeatedly, fomentations on his head, repeated blifters, with valerian, Peruvian bark, mufk, opium, and variety of other medicines •, mercurials were ufed, both externally and internally, with defign to inflame the mem- branes of the teeth, and by that means to prevent the torpor of the a£tion of the membranesabout the temple, and parietal bone ; which are catenated with the membranes of the teeth by irriu Class IV. 2. 1. 12; OF ASSOCIATION. 407- tive alTociation, but not by fenfitive aflociation. The event was, that as foon as the gums became fore with a flight ptyalifm, the pains about the head and vertigo gradually diminilhed, and dur- ing the forenefs of his gums entirely ceafed ; but I believe recur- red afterwards, though in lefs degree. The idea of inflaming the membranes of the teeth to pro- duce increafed fenfation in them, and thus to prevent their irritative connexion with thofe of the cranium, was taken from the treatment of trifmus, or locked jaw, by endeavouring to in- flame the injured tendon; which is faid to prevent or remove the fpafm of the mufcles of the jaw. See Clafs III. 1. 1. 13. and 15. M. M. Emetics. Blifters. Ifiues about the head. Extrac- tion of decayed teeth. Slight falivation. Sorbentia. Incitantia. Galvanifm. A lady was fuddenly feized with violent vertigo, fo as to pre- vent her walking fafely acrofs the room ; this was attended with confiderable diminution of fight ; and after various evacu- ations, and other medicines, had been tried without cure, Mr. Volta’s galvanic pillar was ufed, confiding of about 30 plates of filver, the diameter of about one inch and a half, and as many zinc plates,with interfperfed circles of cloth moiftened with brine. A wire conne£Ied with each end of this pillar was approached repeatedly to her temples, which were previoufly moiflened with brine, and 100 galvanic (hocks were daily pafled through the optic nerves, which foon appeared to be of great advantage, and fhe foon recovered, both from the vertigo and dimnefs of fight. 12. Vertigo ebrio/a. Vertigo from intoxication is owing to the aflociation of the irritative ideas of vifion with the irritative motions of the ftomach. Whence when thefe latter become much increafed by the immoderate ftimulus of wine, the irrita- tive motions of the retina are produced with lefs energy by.re- verfe fympathy, and become at the fame time fucceeded by fen- fation in confequence of their decreafed attion. See Se£I. XXL 3. and XXXV. 1.2. So converfely when the irritative mo- tions of vifion are increafed by turning round, or by our unac- euftomed agitation at fea, thofe of the ftomach become inverted by reverfe fympathy, and are attended in confequence with difa- greeable fenfation. Which decreafed a£tion of. the ftomach is in confequence of the increafed expenditure of the fenforial power on the irritative ideas of vifion, as explained in Vertigo rotatoria. Whence though a certain quantity of vinous fpirit flimulates the whole fyftem into increafed affion, and perhaps even in- creafes the fecretion of fenforial power in the brain ; yet as foon as DISEASES 408 Class IV. 2. r. 13. as any degree of vertigo is produced, it is a proof, that by the too great expenditure of fenforial power by the ftomach, and its neareft aflociated motions, the more diftant ones, as thofe of vif- ion, become imperfeftly exerted. From hence may be deduc- ed the neceflity of exhibiting wine in fevers with weak pulfe in only appropriated quantity ; becaufe if the leaft intoxication be induced, fome part of the fyftem muft act more feebly from the unneceflary expenditure of fenforial power. 13. Vertigo febrictilofa. Vertigo in fevers either proceeds from the general deficiency of fenforial power belonging to the irritative aflociations, or to a greater expenditure of it on fome links of the trains and tribes of aflociated irritative motions. There is however a {lighter vertigo attending all people, who have been long confined in bed, on their firft rifing ; owing to their having been fo long unufed to the apparent motions of ob- jects in their erect pofture, or as they pals by them, that they have loft in part the habit of balancing themfelves by them. 14. Vertigo cerebrofa. Vertigo from injuries of the brain, ei- ther from external violence or which attend paralvtick attacks, are owing to the general deficiency of fenforial power. In thefe diftrefsful fituations the vital motions, or thofe immediate- ly neceflary to life, claim their fhare of fenforial power in the firft place, otherwife the patient muft die ; and thofe motions, which are lefs neceflary, feel a deficiency of it, as thefe of the organs of fenfe and mufcles ; which conftitute vertigo ; and lalt- ly the voluntary motions, which are ftill lefs immediately necef- fary to life, are frequently partially deftroyed, as in palfy ; or totally, as in apoplexy. 15 Murmur aurium vertigiaofum. The vertiginous murmur in the ears, or noife in the head, is compared to the undulations of the found of bells, or to the humming of bees. It frequent- ly attends people about 60 years of age ; and like the vifual ver- tigo defcribed above is owing to our hearing lefs perfectly from the gradual inirritability of the organ on the approach of age ; and the difagreeable fenl'ation of noife attending it is owing to the lefs energetic action of thefe irritative motions ; which not being fufhciently diftintft to excite their ufual aflociations become fucceeded by our attention, like the indiftincl view of the apoa- rent motions of objetfts mentioned in vertigo vifualis. This may be better underftood from confidev ng the ufe. which blind men make of thefe irrita ive founds, which they have taught themfelves to attend to, but which efcape the notice O; others. The late blind Juftice Fielding walked for the firft time into my room, when he once vifited me, and after fpeak- ing a few words faid, “This room is about 22 feet long, j S wide, Class IV. 2. r. 1 6. OF ASSOCIATION. AOi) wide, and 12 high ;”ali which he guefled by the ear with great accuracy. Now if thefe irritative founds from the partial lofs of hearing do not correfpond with the fize of ufual echoes of the places, where we are •, their catenation with other irritative ideas, as thofe of vilion, becomes diflevered or difturbed ; and we attend to them in confequence, which I think unravels this in- tricate circumftance of noifes being always heard in the head, when the fenfe of hearing begins to be impaired, from whatever eaufe it occurs. This ringing in the ears alfo attends the vertigo from intoxi- cation ; for the irritative ideas of found are then more weakly excited in confequence of the deficiency of the fenforial power of affociation. As is known by this alfo being attended with difagreeable fenfation, and by its accompanying other difeafes of debility, as ftrokes on the head, fainting fits, and paralytic feiz- ures. For in this vertigo from intoxication fo much fenforial power in general is expended on the increafed aXions of the domach,and its neared connexions, as the capillaries of the fkin ; that there is a deficiency for the purpofes of the other irritative aflociations of motions ufually conneXed with it. This auditory vertigo attends both the rotatory and the vifual vertigo above- mentioned ; in the former it is introduced by reverfe fympathy, that is, by the diminution of fenforial power ; too great a .quantity of it being expended on the increafed irritative motions of vifion ; in the latter it is produced either by the fame caufes which produced the vifual vertigo, or by direX fympathy with it. See SeX. XX. 7. M. M. Stimulate the internal ear by ether, or with eflential oil diluted with exprefled oil, or with a folution of opium in wine,' or in water. Or with fait and water. Apply a cupping glafs over the ear. See I. 2. 5.6. Galvanic (hocks through the temples. See IV. 2. 1. 11. t 6 . Taclus, gujlus , olfaSIus, vertiginoji. Vertiginous touch, tade, and fmell. In the vertigo of intoxication, when the patient lies down in bed, it fometimes happens even in the dark, that the bed feems to librate under him, and he is afraid of falling out of it. The fame occurs to people, who are fea-fick, even when they lie down in the dark. In thefe the irritative motions of the nerves of touch, or irritative tangible ideas, are performed with lefs energy, in one cafe by reverie fympathy with the ftom- ach, in the other by reverfe fympathy with the nerves of vifion, and in confequence become attended with fenfation, and pro- duce the fear of falling by other afiociations. A vertigo of the fenfe of touch may be produced, if any one turns round for a time with his eyes (hut, and fuddenly dops Vol. II. E e e without 4io DISEASES Class IV. 2. 1. jy. without opening them ; for he will for a time feem to be Oil] going forwards •, which is difficult to explain. See Sect. XX. 6 . In the beginning of fome fevers, along with inceflant vomit- ing, the patients complain of difagreeable taftes in their mouth, and difagreeable odours ; which are to be afcribed to the gen- eral debility of the great trains, and tribes of affociated and irrita- tive motions, and to be explained from their dirett fvmpathy with the decreafed attion of a fick ftomach ; or from the lefs fecretion of fenforial power in the brain. Thefe organs of fenfe are conftantly ftimulated into attion by thefaliva or by the air ; hence, like the fenfe of hunger, when they are torpid from want of ftimulus, or from want of fenforial power, pain, or difagreea- ble fenfation enfues, as of hunger, or faintnefs, or ficknefs in one cafe ; and the ideas of bad taftes or odours in the other. This accords with the laws of caufation, Sett. IV. 5. 17. Pul/us mollis tn vomit tone. The foftnefs of the pulfe in the att of vomiting is caufed by dirett afl'ociation between the heart and the ftomach ; as explained in Sett., XXV. 1 7. A great flownefs of the pulfntion of the heart fometimes attends ficknefs, and even with intermiffions of it, as in the exhibition of too great a dofe of digitalis. 1 8. Puljus intermittent a ventricalo. When the pulfe firft be- gins to intermit, it is common for the patient to bring up a lit- tle air from his ftomach ; which if he accompliflies before the intermiffion occurs, always prevents it ; whence that this debil- ity of the heart is owing to the dirett afl’ociation of its motions with thofe of the ftomach is well evinced. See Sett. XXV. 17. I this morning faw Mr. , who has long had at times an unequal pulfe, with indigeftion and flatulency, and occafional afthma ; he was feized two days ago with diarrhoea, and this morning with ficknefs, and his pulfe was every way unequal. After an emetic his pulfe ftill continued very intermittent and unequal. He then took fome breakfaft of toaft and butter, and tea, and to my great furprife his pulfe became immediately per- fettly regular, about 100 in a minute, and not weak, by this ftimulus on his ftomach. A perfon, who for many years had had a frequent intermif- fion of his pulfe, and occafional palpitation of his heart, was re- lieved from them both for a time by taking about four drops of a faturated folution of arfenic three or four times a day for three or four days. As this intermiffion of the pulfe is occafioned by the dirett afl'ociation of the motions of the heart with thofe of the ftomach, the indication of cure muft be to ftrengthen the ac- tion of the ftomach by the bark. Spice. Moderate quantities Glass VI. 2 . 1. 19. OF ASSOCIATION. 411 of wine. A blifter. Half a grain of opium twice a day. So- lution of arfenic ? 19. Febris inirritativa. Inirritative fever defcribed in Clafs I. 2. I. 1. belongs to this place, as it confifts of difordered trains and tribes of aflbciated irritative motions, with leflened adions of the affociated organs. In this fever the pulfations of the heart and arteries are weakened or leflened, not only in the cold paroxyfm, as in the irritative fever, but alfo in the hot paroxyfm The capillary arteries or glands have their ac- tions neverthelefs increafed after the firft cold fit, as appears by the greater production of heat, and the glow of arterial blood in the cutaneous vefiels ; and laftly, the adion of the ftomach is much impaired or deftroyed, as appears by the total want of ap- petite to folid food. Whence it would feem, that the torpid motions of the ftomach, whatever may occafion them, are a very frequent caufe of continued fever with weak pulfe ; and that thefe torpid motions of the ftomach do not fuffieiently ex- cite the fenforial power of afiociation, which contributes in health to aduate the heart and arteries along with the irritation produced by the ltimulus of the blood ; and hence the adions of thefe organs are weaker. And laftly, that the accumulation the fenforial power of afiociation, 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 Sed. XXXV. 1. x. and XXXIII. 2. 10. I have dwelt longer on the vertiginous difeafes in this genus, both becaul'e of their great intricacy, and becaufe they feem to open a road to the knowledge of fever, which confifts of aflbci- ated trains and tribes of irritative or fenfitive motions, which are fometimes mixed with the vertiginous ones, and fometimes feparate from them. ORDO DISEASES Class IV. 2. 2. 412 ORDO II. Decreafed AJfociate Motions. GENUS II. Catenated "with Senfitive Motions. In tins genus the fenforial power of affociation is exerted with iefs energy, and thence the.attions produced by it are lefs than natural ; and pain is produced in confequence, according to the fifth law of animal caufation, Sett. IV. This pain is generally attended with coldnefs of the affetted part, and is feldom fuc- ceeded by inflammation of it. This decreafed attion of the fecondary link of the affociated motions, belonging to this ge- nus, is owing to the previous exhauftion of fenforial power either in the increafed actions of the primary link of the affociated mo- tions, or by the pain which attends them ; both which are fre- quently the confequence of the ftimulus of fomething external to the affetted fibres. As pain is produced either by excefs or defett of the natural exertions of the fibres, it is not, confidered feparately, a criteri- on of the prefence of either. In the affociations belonging to this genus the fenfation of pain or pleafure produces or attends the primary link of the affociated motions, and very often gives name to the difeafe. When great pain exifts without caufing any fibrous motions, I conjetture that it contributes to exhauft or expend the gen- eral quantity of fenforial power ; becaufe people are fatigued by enduring pain, till at length they fleep. Which is contrary to what I had perhaps erroneoufly fuppofed in Sett. XXXV. a. 3. If it caufes fibrous motions, it then takes the name of fenfation, according to the definition of fenfation in Sett. II. 2. 9 ; and increafed fibrous attion or inflammation is the confe- quence. This circumftance of the general exhaultion of fenfo- rial power by the exiftence of pain will affift in explaining ma- ny of the difeafes of this genus. Many of the canals of the body, as the urethra, the bile-dutt, the throat, have the motions of their two extremities affociated by having been accuftomed to feel pleafurable or painful fenfa- tions at the fame time or in fucceffion. This is termed fenfi- tive affociation, though thofe painful or pleafurable fenfations do not caufe the motions, but only attend them ; and are thus perhaps, ftrittly fpeaking, only catenated with them. SPECIES, Class IV. 2. 2. 1. OF ASSOCIATION. 453 SPECIES. I. Torpor getue a dolor e dentis. In tooth-ach there is general- ly a coldnefs of the cheek, which is fenfible to the hand, and is attended in fome degree with the pain of cold. The cheek and tooth have frequently been engaged in pleafurable a&ion at the fame time during the mafticating of our food ; whence they have acquired fenfitive aflociations. The torpor of the cheek may have for its caufe the too great expenditure of fenforial power by the painful fenfation of the membranes of the difeaf- ed tooth ; whence the membranes of the cheek afTociated with thofe of the alveolar procefs are deprived of their natural fhare of it, and become torpid ; thus they produce lei's fecretions, and lefs heat, and the pain of cold is the confequence. This torpor of the veflels of the cheek cannot be produced by the adivity of the fenforial power of fenfation ; for then they would a£t more violently than natural, or become inflamed. And though the pain by exhaufting fo much fenforial power may be a re- mote caufe, it is the defe£t of the power of afiociation, which is the immediate caufe of the torpor of the cheek. After fome hours this pain occafioned by the torpor of the veflels of the cheek either gradually ceafes along with the pain of the difeafed tooth j or, by the accumulation of fenforial pow- er during their ftate of torpor, the capillaries of the cheek a£I with greater violence, and produce more fecretions, and heat, and confequent tumor, and inflammation. In this Hate the pain of the difeafed tooth ceafes ; as the fenforial power of fen- fation is now expended on the inflamed veflels of the cheek. It is probable that molt other internal membranous inflammations begin in a fimilar manner 5 whence there may feem to be a double kind of fenfitive afiociation ; firft, with decreafed adlion of the afi'oeiated organ, and then with increafed action of it j but the latter is in this cafe Amply the confequence of the former ; that is, the tumor or inflammation of the cheek is in confequence of its previousquiefcer.ee or torpor. 2. Stranguria a dolor e vejica. The ftrangury, which has its origin from pain at the neck of the bladder, confifts 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 fympathy of thefe with fome diftant parts, generally with the ether end of the urethra ; an endeavour and difficulty of making water at- tends this pain. Its remote caufe is from the internal or externa! ufe of can- tharides, which ftimulate the neck of the bladder ; or from a Hone, 4*4 DISEASES Class IV. 2. 2. 3. {tone, which whenever it is pufhed into the neck of the bladder, gives this pain of ftrangury, but not at other times ; and hence it is felt moft feverely in this cafe after having made water. The fenfations or fenfitive motions of the glans penis, and of the fphmdter of the bladder, have been accuftomed to exift together during the difcharge of the urine ; and hence the two ends of the urethra l'ympathize by aflociation. When there is a {tone at the neck of the bladder, which is not fo large or rough as to inflame the part, the fphincfer of the bladder be- comes ftimulated into pain ; but as the glans penis is for the purpofes of copulation more fenfitive than the fphindler of the bladder, as foon as it becomes affedted with pain by the aflocia- tion above mentioned, the lenfation at the neck of the bladder ceafes ; and then the pain of the glans penis would feem to be aflociated with the irritative motions only of the fphincter of the bladder, and not with the fenfitive ones of it. But a circum- ftanceTimilar to this occurs in epileptic fits, which at firft are induced by diiagreeable fenfation, and afterwards feem to occur without previous pain, from the fuddennefs with which they follow and relieve the pain, which occafioned them. From this analogy I imagine the pain of the glans penis is aflociated with the pain of the fphindler of the bladder ; but that as foon as the greater pain in a more fenfible part is produced the lefs pain, which occaftoned it, ceafes ; and that this is one of the laws of fenfitive af- fociation. See Sedt. XXXV. 2. 1. A young man had by an accident fwallowed a large fpoonful or more of tindlure of cantharides ; as foon as he began to feel the pain of ftrangury, he was advifed to drink large quantities of warmilh water : to which, as foon as it could be gotten, feme gum arabic was added. In an hour or two he drank by inter- vals of a few minutes about two gallons of water, and difeharg- ed his urine every four or five minutes. A little blood was voided towards the end, but he fuffered 110 ill confequence- M. M. Warm water internally. Clyfters of warm water. Fomentation Opium. Solution of fixed alkali fuperfaturated with carbonic acid. A bougie may be ufed to pu(h back a ftone into the bladder. See Clafs I. 1.3. 10. 3. Stranguria ccnvulfiva. The convulfive ftrangury, like that before deferibed, is probably occafioned by the torpor or defec- tive action of the painful part in confequence of the too great expenditure of fenforial power on the primary linkof the afiociat- ed motions, as no heat or inflammation attends this violent pain. This kind of ftrangury recurs by ftated periods, and fometimes arifes to fo great a degree, that convulfion or temporary mad- nefs terminates each period of it. It affecls women oftener than Class IV. 2. 2. 4. OF ASSOCIATION. 4K than men, is attended with cold extremities without fever, and is diftinguiffied from the ftone of the bladder by the regularity of its periods, and by the pain being not increafed after making water. On introducing the catheter fometimes part of the urine will come away and not the whole, which is difficult to explain ; but may arife from the weaknefs of the mufcular fibres of the bladder ; which are not liable fuddenly to contrad themfelves fo far as to exclude the whole of the urine. In fome old peo- ple, who have experienced a long retention of urine, the blad- der never regains the power of completely emptying itfelf ; and many who are beginning to be weak from age can make water a fecond time, a few minutes after they fuppofed they had emp- tied the bladder. I have believed this pain to originate from fympathy with fome diftant part, as from afcarides in the redum, 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 reverfe fympathy of thefe more fenfible parts with thofe above mentioned. M. M. Venefedion. Opium in large quantities. Warm bath. Balfams. Bark. Tindure of canthrides. Bougie, and the treatment for haemorrhoids. Leeches applied to the fphinc- ter ani. Aerated alkaline water. Soap and fal foda. Opium in clyfters given an hour before the expeded return. Smoke of tobacco in clyfters. Arfenic. 4. Dolor termini intejlinnlis duBus choledoch:. Pain at the in- ternal end of the gall-dud. When a gall-ftone is protruded from the gall-bladder a little way into the end of the gall-dud, ' the pain is felt at the other end of the gall-dud, which termin- ates in the duodenum. For the ad ions of the two terminations of this canal are affcciated together from the fame ftreams of bile paffing through them in fucceffion, exadly as the two terminations of the urethra have their adions affociated, as defcribed in Species 2 and 3 of this genus. But as the in- teftinal termination of the bile-dud; is made more fenfible for the purpofe of bringing down more bile, when it is ftimulated by new fupplies of food from the ftomach, it falls into violent pain from affociation ; and then the pain on the region of the gall-bladder ceafes, exadly as above explained in the account of the pain of the glans penis from a ftone in the fphinder of the bladder. The common bile-dud opens into the inteftine exadly at what is called the pit of the ftomach ; and hence it has fome» times happened, that this pain from affociation with the fenfa- tion DISEASES 416 Class IV. z. z. 5. tion of a gall-done at the other end of the bile-dutt has been miftaken for a pain of the ftomach. For the method of cure fee Chfs I. 1. 3. 8. to which fhould be added the ufe of ftrong eledtric {hocks palled through the bile- du£i from the pit of the ftomach to the back, and from one fide to the other. A cafe of the good effedl of electricity in the jaundice is related in Se£t. XXX z. And another cafe, where it promoted the pafiage of a painful gall-ftone, is defcrib- ed by Dr. Hall, experienced on himfelf. Tranf. of the Col- lege at Philadelphia, Vol. I. p. 192. Half a pint of warm water two or three times a day is much recommended to dilute the infpiffated bile. 5. Dolor pharyngis ah acido gajlrico The two ends of the throat fympachize by fenfitive aflociation in the fame manner as the other canals above mentioned, namely, the urethra and the bile-duff ; hence when too great acidity of undigefted ali- ment, or the carbonic acid air, which elcapes in fermentation, ftimulates the cardia ventriculi, or lower end of the gula, into pain, the pharynx, or upper end of it, is affefbed with greater pam, or a difagreeable fenfation of heat. 6 . Pruritus r.arium a vermibus. The itching of the nofe from worms in the ioteftines is another curious inftance of the fen- fitive aflociations of the motions of membranes ; efpecially of thofe which conftitute the canals of the body. Previous to the deglutition of agreeable food, as milk in our earlieft infancy, an agreeable odour afre£ts the membrane, which lines the noftrils ; and hence an aflociation feems to take place between the agreea- ble fenfations produced by food in the ftomach and bowels, and the agreeable fenfations of the noftrils. The exiftence of afcar- ides in the reflum I believe produces this itching of the noftrils more than the worms in other parts of the inteftines ; as we have already feen, that the terminations of canals fympathize more than their other parts, as in the urethra and gall-du£fs. See Clafs I. 1. 5. 9. IV. 1. 2. 9. 7. Cephaloca fympathetica. Sympathetic head-ach. In cold fit; of the ague, the head-ach arifes from confent with fome torpid vifcus, like the pain of the loins. After drunkennefs the head- ach is very common, 6wing to diredl fympathy of the mem- branes of the head with thofe of the ftomach ; which is become torpid after the too violent ftimulus of the preceding intoxica- tion ; and is hence removable by fpirit of wine, or opium, ex- hibited in fmaller quantities. In fome conftitutions thefe head- achs are induced, when the feet are expofed to much external cold ; in this cafe the feet fhould be covered with oiled filk, which Class IV. 2. 2. 8. OF ASSOCIATION. 417 which prevents the evaporation of the perfpirable matter, and thence diminifhes one caufe 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 faturated folution of arfenic two or three times a day. See Clafs I. 2. 4. 1 1. A lady once allured me, that when her head- ach was coming on,fhe drank three pints (pounds) of hot water, as haftily as (he could ; which prevented the progrefs of the dif- eafe. A folution of arfenic is recommended by Dr. Fowler of York. Very ftrong errhines are faid fometimes to cure head- achs taken at the times the pain recurs, till a few drops of blood iflue from the noftrils. As one grain of turpeth mineral (vitriol- ic calx of mercury) mixed with ten grains of fine fugar. Eu- phorbium or cayenne pepper mixed with fugar, and ufed with caution as an errhine. See the M. M. of the next Species. 8. Hemicrania fympathetica. Sympathetic pain on one fide of the head. This difeafe is attended with cold Ikin, and hence whatever may be the remote caufe, the immediate one feems to be want of ftimulus, either of heat or diftention, or of fome other unknown ftimulus in the painful part ; or in thofe, with which it is aflociated. The membranes in their natural ftate are only irritable by diftention ; in their difeafed ftate, they are fenfible like mufcular fibres. Hence a difeafed tooth may ren- der the neigbouring membranes fenfible, and is frequently the caufe of this difeafe. Sometimes the ftomach is torpid along with the pained mem- brane of the head ; and then ficknefs and inappetency attend either as caufe or confequences The natural cure of hemi- crania is the accumulation of fenforial power during the reft or ficknefs of the patient. Mrs ———is frequently liable to hem- icrania with ficknefs, which is probably owing to a difeafed tooth ; the paroxyfm occurs irregularly, but always after fome previous fatigue, or other caufe of debility. She lies in bed, lick, and without taking any folid food, and very little of fluids, and thofe of the aqueous kind, and, after about 48 or 50 hours, rifes free from complaint. Similar to this is the recovery from cold paroxyfms of fever, from the torpor occafioned by fear, and from fyncope ; which are all owing to the accumulation of fenforial power during the inactivity of the fyftem. Hence it ap- pears, that, though when the fenforial power of volition is much exhaufted by fatigue, it can be reftored by eight or ten hours of fleep ; yet, when the fenforial power of irritation is exhaufted by fatigue, that it requires two whole folar or lunar days of reft, before it can be reftored. Vol. IF F f f The 4 1 B DISEASES Class IV. 2. 2. 8 . The late Dr. Monro afferted in his lectures, that he cured the hemicrania, or megrim, by a ftrong vomit, and a brilk purge immediately after it. This method fucceeds bell if opium and the bark are given in due quantity after the operation of the cathartic ; and with ftill more certainty if bleeding in fmall quantity is premifed, where the pulfe will admit of it. See Sea. XXXV. 2. 1. Mr. Kellie afferts, that fome kinds of head-achs, efpecially thofe which arife from defea of (timulation, may be cured by comprefling the two fubclavicvn arteries, as they pafs over the firll rib j which he thinks w ould produce a preflure on the brain fimilar to that, which maybe produced by the centrifugal force, if a perfon was to lie acrofs a mill (tone as it revolves. See Suppl. I. 15. 7. Would fuch a circulating bed remove any kind ofhead-ach ? The pain generally affects one eye, and fpreads a little u'ay on that fide of the nofe, and may fometimes be relieved by prefix- ing or cutting the nerve, where it paffes into the bone of the orbit above the eye. When it affefts a fmall defined part on the parietal bone on one fide, it is generally termed Clavus hvf- tericus, and is always I believe ov/ing to a difeafed dens mola- ris. The tendons of the mufcles, w'hich ferve the office of maftication, have been extended into pain at the fame rime that the membranous coverings of the roots of the teeth have been coinpreffed into pain, during the biting or mafticarion 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 coldnefsof the dying part of the tooth, the tendons and membranous falcia of the mufcles about the fame fide of the head become affefted with violent painbytheiv fenfitive affociations : and as foon as this affociated pain takes place, the pain of the tooth entirely ceafes, as explained in the fecond lpecies of this genus. A remarkable circumftance attends this kind of hemicrania, viz. that it recurs by periods like thofe of intermittent fevers, as explained in the Section on Catenation of Motions ; thefe peri- ods fometimes correfpond wdrh alternate lunar or folar days like tertian agues, and that even when a decayin. tooth is evi- dently the caufe ; which has been evinced by the cure of the difeafe by extracting the tooth. At ocher times they obferve the monthly lunations, and feern to be induced by the debility, which attends menftruation. The dens fapientise, or laft tooth of the upper jaw, fre- quently decays firft, and gives hemicrania over the eye on the fame fide. The firft: or fecond grinder in the under-jaw is lia- ble Class IV 2. 2. 8 . OF ASSOCIATION. 419 ble to give violent pain about the middle of the parietal bone, or fide of the head, on the fame fide, which is generally called the Clavus hyftericus, of which an inftru&ive cafe is related in Setl. XXXV. 2- 1. Since the above was firft publifhed I have feen two cafes ; which vere very fimilar, and feem much to confirm the above theory of fympathetic hemicrania being perhaps always owing to the fympathy of the membranes about the cranium with thofe about difeafed teeth. Lord M. and Mr. B. of Edinburgh, both of them about the middle of life were afflided with vio- lent hemicrania for about two years ; in the beginning of which time they both allured me, that their teeth were perfeaiy found, but on infpeaing their mouths, I found all the molares were now fo decayed as to have loft their crowns. After having fuf- fered pain for fixteen or eighteen months almoft inceffantly in different parts of their heads, they had each of them a hemiple- gia, from which they gradually recovered, as much as paralytic affeaions generally do recover. All the ftumps of their teeth, which were ufelefs, were dire&ed to be extradited ; as the fwal- lowing lo much putrid matter from decaying bones feemed to injure their digeftion. They were defired not drink wine or ale without its being diluted with twice or thrice its quantity of water, to prevent any accefs of torpor from too great previous ftimulus, and to take fix grains of rhubarb with three of foap made into pills, every night, with fome bitter and very flight chalybeate medicines. If the teeth which became torpid in fuc- ceflion, could have been difcovered, and extraded, before they decayed, and could have been replaced, might not this continu- ance of pain, and confequent paralyfis, have been prevented ? or might not a moderate falivation have effe&ed this purpofe ? M. M Deted and extract the difeafed tooth. Cut the af- fected nerve, or ftimulate the difeafed membrane by acupunc- ture. Venefedion to fix ounces by the lancet or by leeches. A ltrong emetic and a fubfequent cathartic ? and then an opiate and the bark Pafs fmail electric fhocks through the pained membrane, and through the teeth on the fame fide. Apply vit- riolic ether externally, and a grain of opium with camphor in- ternally, to the cheek on the affeded fide, where a difeafed tooth may be fufpeded. Foment the head with warm vinegar. Drink two large fpoonfuls of vinegar. Stimulate the gums of the fufpeded teeth by oil of cloves, by opium. See Clafs I. 1. 4. 4. Snuff volatile fpirit of vinegar up the noftrils. Laftly, in permanent head-achs, as in permanent vertigo, I have feen good effect in two cafes by the ufe of mercurial ointment rubbed on the lhaved head or about the throat, till a mild falivation com- mences, 420 DISEASES ' Class IV. 2. 2.9. mences, which by inflaming the membranes of the teeth may prevent their irritative fympathy with thofe of the cranium. Thus by inflaming the tendon, which-is the caufe of locked jaw, and probably by inflaming the wound, which is the caufe of hy- drophobia, thofe difeafes may be cured, by difuniting the irrita- tive fympathy between thofe parts, which may not poffefs any fen fi rive fympathy. This idea is well worth our attention. Otalgia . Ear-ach is another difeafe occafioned by the fympa- thy of the membranes of the ear with thofe which invelt or fur- round a decaying tooth, as I have had frequent reafon to be- lieve ; and is frequently relieved by filling the ear with tincture of opium. See Clafs I. 2. 4. 9. Dolor humeri in hepatidide. In the efforts of excluding the faeces and urine the mufclesof the fhoulders are exerted to com- prefs the air in the lungs, that the diaphragm may be prefled down. Hence the diftention of the tendons or fibres of thefe mufcles is afl'ociated with the diftention of the tendons or fibres of the diaphragm ; and when the latter are pained by the en- largement or hear of the inflamed liver, the former fympaihize with them. Sometimes but one fhoulder is affefted, fometimes both ; it is probable that many other pains, which are termed rheumatic, have a fimilar origin, viz. from fenfltive aflocia- tions. As no inflammation is produced in confequence of this paii. of the fhoulder, it feems to be owing to inaftion of the mem- branous part from defeft of the fenforial pov/er of affociation, of which the primary link is the inflamed membrane of the liv- er ; which now expends fo much of the ienforial power in gen- eral by its increafed aftion, that the membranes about the fhoul- der, which are links of affociation with it, become deprived of their ufual fhare, and confequently fall into torpor. 1 o. Torpor pedum in cruptione variolarum. At the commence- ment of the eruption of the fmall-pox, when the face and breafc of children are very hot, their extremities are frequently cold. This I afcribe to fenfltive alfociation between the different parts of the fkin ; whence when a part afts too violently, the other part is liable to aft too weakly ; and the fkin of the face being affefted firft in the eruption of the fmall-pox, the fkin of the feet becomes cold in confequence by the reverfe fympathy. M. M. Cover the feet with flannel, and expofe the face and bofom to cool air, which in a very ihort time both warms the feet and cools the face ; and hence what is erroneoufly called a rafh, but which is probably a too hafty eruption of the fmal! pox, difappears ; and afterwards fewer and morediftinft erup- tions of the fmall-pox fupervene. : T . Teflium Class IV. 2. 2. 11. OF ASSOCIATION. 421 11. TeJHum dolor nephriticus. The pain and retraction of the tefticle on the fame fide, when there is a ftone in the ureter, is to be afcribed to fenfitive affociation •, whether the connecting caufe be a branch of the fame nerve, or from membranes, which have been frequently affected at the fame time. 12. Dolor digiti minimi fympatheticus. When any one acci- dentally {trikes his elbow againft any hard body, a tingling pain runs down to the little finger end. This is owing to fenfitive alfociation of motions by means of the fame branch of a nerve, as in hemicrania from a decaying tooth the pain is owing to the fenfitive affociation of tendons or membranes. 13. Dolor brachii in hydrope peBoris. The pain in the left arm which attends fome dropfies of the cheff, is explained in Sect. XXIX. 5. 2. 10. which refembles the pain of the little finger from a percuffion of the nerve at the elbow in the preceding ar- ticle. A numbnefs of this kind is produced over the whole leg, when the crural nerve is much comprefied by fitting for a time with one leg eroded over the other. Mr. , about fixty, had for two years been affefted with difficulty of refpiration on any exertion, with pain about the fter- num, and of his left arm ; which lalt was more confiderable than is ufual in dropfy of the chelt ; fome months ago the pain of his arm, after walking a mile or two, became exceffive, with coldnefs and numbnefs ; and on the next day the back of the hand, and a part of the arm dwelled and became inflamed, which relieved the pain $ and was taken for the gout, and continued feveral days. He after fome months became dropfical both in reipeCt to his cheff and limbs, and was fix or feven times per- fectly relieved by one dram of faturated tinCture of digitalis, taken two or three times a day for a few days in a glafs of pep- nermint water. He afterwards breathed oxygen gas undiluted, in the quantity of fix or eight gallons a day for three or four weeks without any effeCt, and funk at length from general de- bility. In this inftruftive cafe I imagine the preffure or ftimulus of one part of the nerve within the cheff caufed the other part, which ferves the arm, to become torpid, and confequently cold by fympathy ; and that the inflammation was the confequence of the previous torpor and coldnefs of the arm, in the fame manner as the fwelling and inflammation of the cheek in tooth- ach, in the firft fpecies of this genus ; and that many rheumatic inflammations are thus produced by fympathy with fome dif- tant part. 14. Diarrhoea a dentitions. The diarrhoea, which frequently attends dentition, is the confequence of indigeftion ; the aliment acquires 422 DISEASES Class IV. 2. 2. 14, acquires chemical changes, and by its acidity a£ts as a cathar- tic ; and changes the yellow bile into green, which is evac- uated along with indigefted parts of the coagulum of milk. The indigeftion is owing to the torpor of the ftomach and intef- tines caufed by their aflociation with the membranes of the gums, which are now (limulated into great exertion with pam ; both which contribute to expend the general quantity of fen- forial power, which belongs to this membranous aflociation ; and thus the ftomach and inteftines a 8 * 4. Naufea pleuvialis. Sicknefs at the commencement of a rainy leafon is very common among dogs, who affift themfelves by eating the agroftis canina, or dog’s grafs, and thus empty their itomachs. ' The fame occurs with lefs frequency to cats, who make ufe of the fame expedient. See Se£t. XVI. 11. I have known one perfon, who from his early years has always been 444 DISEASES, &c. Class IV. 3. 4. -4 been fick at the beginning of wet weather, and ftill continues fo. Is this owing to a fympathy of the mucous membrane of the ftom- ach with the mechanical relaxation of the external cuticle by a moifter atmofphere, as is feen in the corrugated cuticle of the hands of wafher-women ? or does it fympathize with the mu- cous membrane of the lungs, which muft be affected along with the mucus on its furface by the refpiration of a moifter atmof- phere. SUPPLEMENT. supplement TO CLASS IV. Sympathetic Theory of Fever. As fever confifts in the increafe or diminution of direct or reverfe alTociated motions, whatever may have been the remote caufe of them, it properly belongs to the fourth clafs of difeaf- es ; and is introduced at the end of the clafs, that its great dif- ficulties might receive elucidation from the preceding parts of it. Thefe I fhall endeavour to enumerate under the following heads, trufting that the candid reader will difcover in thefe ru- diments of the theory of fever a nafcent embryon, an infant Hercules, which time may rear to maturity, and rentier fervice- able to mankind. I. Simple fever of two kinds. II. Compound fever. III. Termination of the cold fit. IV. Return of the cold fit. V. Senfation excited in fever. VI. Circles of affociated motions. a VII. Alternations of cold and hot fits. VIII. Orgafm of the capillaries. IX. Torpor of the lungs. X. Torpor of the brain. XI. Torpor of the heart and arteries. XII. Torpor of the ftomach and inteftines. XIII. Cafe of continued fever explained. XIV. Termination of continued fever. XV. Inflammation excited in fever. XVI. Recapitulation. I. Simple Fever. i. "When a fmall part of the cutaneous capillaries with their mucous or perfpirative glands are for a fhort time expofed to a colder medium, as when the hands are immerfed in iced water for 446 THEORY OF FEVER. Sup. I. 1.2. for a minute, th'efe capillary velTels and their glands become tor- pid or quiefcent, owing to the eduddion of the ftimulus of heat. The Ikin then becomes pale, becaufe no blood paffes through the external capillaries ; and appears fhrunk, becaufe their fides are eollapfed from inaddivity, not contracted by fpafm ; the roots of the hair are left prominent from the feceding or fubfiding of the fkin around them ; and the pain of coldnefs is produced. In this fituation, if the ufual degree of warmth be applied, thefe velTels regain their activity •, and having now became more irritable from an accumulation of the fenforial power of irritation during their quiefcence, a greater exertion of them fol- lows, with an increafed glo w of the fkin, and another kind of pain, which is called the laot-ach ; but no fever, properly fo called, is yet produced •, as this effect is not univerfal, nor permanent, nor recurrent. 2- If a greater part of the cutaneous capillaries with their mucous and perfpirative glands be expofed for a longer time to cold, the torpor or quiefcence becomes extended by direct lym- pathv to the heart and arteries ; which is known by the weak- nefs, and confequent frequency of the pulfe in cold fits of fever. This requires to be further explained. The movements of the heart and arteries, and the whole of the circulatory velTels, are in general excited into action by the two fenforial powers of irritation, and of affociation. The former is excited by ftimu- lus, the latter by the previous addions of a part of the vital circle of motions. In the above fituation the capillaries add weakly from defedd of irritation, which is caufed by deficient ftimulus of heat ; but the heart and arteries add weakly from defedd of aflociation, which is owing to the weak addion of the capilla- ries j which does not now excite the fenforial power of affocia- tion into addion with fufficient energy. After a time, either by the application of warmth, or by the increafe of their irritability owing to the accumulation of the fenforial power of irritation, during their previous quiefcence, the capillary velTels and glands add with greater energy than natural ; whence the red colour and heat of the fkin. The heart and ar- teries acquire a greater ftrength of pulfation, and continue the frequency of it, owing to the accumulation of the fenforial pow- er of aflociation during their previous torpor, and their confe- quent greater aflociability ; which is now alfo more ftronglv ex- cited by the increafed addions of the capillaries. And thus a fit of fimple fever is produced, which is termed Febris irritati- va ; and conlifts of a torpor of the cutaneous capillaries with their mucous and perfpirable glands, accompanied with a tor- por Sup. I. i. 3. THEORY OF FEVER. 447 por of the heart and arteries ; and afterwards of an increafed action of all thefe veffels, by what is termed diredt fympathy. This fever, with ftrong pulfe, without inflammation, or febris irritativa, defcribed in Clafs I. 1. 1. 1. is frequently feen in ver- nal intermittents, as the orgafm of the heart and arteries is then occafioned by their previous ftate of torpor ; but more rarely I believe exifts in the type of continued fever, except there be an evident remiffion, or approximation to a cold fit ; at which time a new accumulation of the fenforial power of affociation is pro- duced ; which afterwards actuates the heart and arteries with unnatural vigour ; or unlefs there be forne ftimulus perpetually adting on the fyftem, fo as to induce an increafed fecretion of fenforial power in the brain, as occurs in flight degrees of intoxi- cation. Since without one or other of thefe circumftances in continued fevers without inflammation, that is, without the ad- ditional fenforial power of fenfation being introduced, it feems difficult to account for the produdtion of fo great a quantity of fenforial power, as mull be necefiary to give perpetual increafe of adtion to the whole fanguiferous fyftem. 3. On the contrary, while the cutaneous capillaries with their mucous and perfpirative glands acquire an increafed irritability, as above, by the accumulation of that fenforial power during their previous quiefcence, and thus conftitute the hot fit of fe- ver ; if the heart and arteries do not acquire any increafe of aft- fociability, but continue in their ftate of torpor, another kind of Ample fever is produced •, which is generally of the continued kind, and is termed febris inirritativa ; which confifts of a pre- vious torpor of the capillaries of the fkin, and of the heart and arteries by diredl fympathy with them ; and afterwards of an orgafm or increafed adtion of the capillaries of the fkin, with a decreafed adtion, or continued torpor, of the heart and arteries by reverfe fympathy with them. This orgafm of the cutaneous capillaries, which appears by th» blufh and heat of the fkin, is at firft owing to the accumulation of the fenforial power of irri- tation during their previous torpid ftate, as in the febris irritata above defcribed ; but which is afterwards fupported or continu- ed by the reverfe fympathy of thefe capillaries with the torpid ftate of the heart and arteries, as will be further explained in ar- ticle 8. of this Supplement. 4. The renovated adfivity of the capillaries commences as foon or fooner 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 adtion of the heart and arteries ; for thefe capil- laries of the fkin have greater mobility than the heart and arte- ries, THEORY OF FEVER. 44 S SlTP. I. 1.5. ries, as appears in the fudden blufh of fhame ; which may be owing to their being more liable to perpetual varieties of activi- ty from their expofure to the vicilfitudes of atmofpheric heat. And becaufe in inirritative fevers, or thofe with arterial debility, the capillaries acquire increafed ftrength, as it is evinced by the heat of the fkin, while the pulfations of the heart and arteries remain feeble. 5. It was faid above, that the cutaneous capillaries, when they were rendered torpid by expofure to cold, either recover- ed their activity by the reapplication of external warmth ; or by their increafed irritability, which is caufed by the accumu- lation of that fenforial power during their quiefcence. An example of the former of thefe may be feen on emerging from a very cold bath ; which produces a fit of fimple fever ; the cold fit, and confequent hot fit, of which may be prolonged by con- tinuing in the bath ; which has indeed proved fatal to lome weak and delicate people, and to others after having been much ex- haufted by heat and exercife. See Se£t. 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 firft feels a chill, and after a minute becomes warm, though he remains in the fame medium, owing to the increafe of irritability from the accumulation of that fenforial power during the fhort time which the chilnefs continued. <5. Hence fimple fevers are of two kinds ; firft, the febris ir- ritativa, or fever with ftrong pulfe, which ccnfifts of a previous torpor of the heart, arteries, and capillaries, and a fucceeding orgafm of thofe veflels. Secondly, the febris inirritativa, or fe- ver with weak pulfe, which confifts of a previous torpor of the heart, arteries, and capillaries ; and of a fucceeding orgafm of the capillaries, the torpor of the heart and arteries continuing. But as the frequency of the pulfe occurs both in the ftate of tor- por, and in that of orgafm, of the heart and arteries -, this con- ftitutes a criterion to diftinguifh fever from other difeafes, which are owing to the torpor of fome parts of the fyftem, as parefis, and hemicrania. 7. The reader will pleafe to obferve, that where the cutane- ous or pulmonary capillaries are mentioned, their mucous and perfpirative glands are to be underftood as included ; but that the abforbents belonging to thofe fyftems of veflels, and the commencement of the veins, are not always included ; as thefe are liable to torpor feparately, as in anafarca, and petechiae ; or to orgafm, or increafed action, as in the exhibition of ftrong emetics, or in the application of vinegar to the lips ; yet he will alfo pleafe to obferve, that an increafed or decreafed action o‘ thele Sup. I. 2 . i. THEORY OF FEVER. 4 A9 thefe abforbents and veins generally occurs along with that of the capillaries, as appears by the dry ficin in hot fits of fever ; and from there being generally at the fame time no accumula- tion of venous blood in the cutaneous vefiels, which would ap- pear by its purple colour. II. Compound Fever. 1. When other parts of the fyftem fympathize with this tor- por and orgafm of the cutaneous capillaries, and of the heart and arteries ; the fever -fit becomes more complicated and dan- gerous ; and this in proportion to the number and confequence of fuch affected parts. Thus if the lungs become affefted, as in going into very cold water, a fhortnefs of breath occurs ; which is owing to the collapfe or inactivity (not to the aftive contraction or fpafm), of the pulmonary capillaries ; which, as the lungs are not fenfible to cold, are not fubjeft to painful fenfation, and confequent fhiiddering, like the Ikin. In this cafe after a time the pulmonary capillaries, like the cutaneous ones, aft with increafed energy ; the breathing, which was before quick, and the air thrown out at each refpiration in lefs quan- tity, and cool to the back of the hand oppofed to it, now becomes larger in quantity, and warmer than natural ; which however is not accompanied with the fenfation of heat in the membrane, which lines the air-veflels of the lungs, as in the fkin. 2. One confequence of this increafed heat of the breath is the increafed evaporation of the mucus on the tongue and nof- rtils. A vifcid material is fecreted by thefe membranes to pre- serve them moift and fupple, for the purpofes of the fenfes of tafte and of frnell, which are extended beneath their furfaces ; the vifcid mucus, when the aqueous part of it is evaporated by the increafed heat of the refpired air, or is abforbed by the too great action of the mucous abforbents, adheres clofely on thofe membranes, and is not without difficulty to be feparated from them- This drynefs of the tongue and noftrils is a circumftance therefore worthy to be attended to ; as it fhews the increafed aftion of the pulmonary capillaries, and the confequent increaf- ed heat of the expired air ; and may thus indicate, when colder air fhould be admitted to the patient. See Clafs I. i. 3. i. The middle part of the tongue becomes dry fooner, and recov- ers its moifture later, than the edges of it; becaufe the currents of refpired air pafs mod over the middle part of it. This how- ever is not the cafe, when the drynefs of the tongue is owing only to the increafed mucous abforption. When however a frequent cough attends pulmonary inflammation, the edges of Vol. II. K k k the 450 THEORY OF FEVER. Sup. I. 2. 3. the tongue ar6 liable to be as much furred as the middle of it ; as during the action of coughing the middle of the tongue is de- prefled, fo as to form half a cylinder, to give a greater aper- ture for the emillion of air from the larynx , and the edges of it become thus as much expofed to the currents of air as the middle parts of it. 3. When the internal capillaries or glands fympathize with the cutaneous capillaries ; or when any of them are previoufly affefted with torpor, and the external or cutaneous capillaries are affetted fecondarilv ; other fymptoms are produced, which render the paroxyfms of fever ftill more complicate. Thus it fpleen or pancreas are primarily or fecondarily affe&ed, fo as to be rendered torpid or quiefcent, they are liable to become en- larged, and to remain fo even after the extinction of the fever- fit Thefe in fome intermittent fevers are perceptible to the hand, and are called ague-cakes; their tumour feems to be ow- ing to the permanent torpor of the abforbent fyftem, the fecern- ing veflels continuing to a£t fome time afterwards. If the fe- cretory veflels of the liver are affeCted firft-with torpor, and af- terwards with orgafm, a greater fecretion of bile is produced, which fometimes caufes a diarrhoea. If a torpor of the kidneys, and of the abforbents of the bladder occurs, either primarily, or bv fvmpathy with the cutaneous capillaries, the urine is in fmall quantity and pale, as explained in Clafs I. 2. 2. 5. ; and if thefe decretory veflels of the kidneys, and the abforbents of the blad- der a£t more ftrongly than natural afterwards by their increafed irritability or aflociability, the urine becomes in larger quantity, and deeper coloured, or depofites its earthy parts, as inClafs I. 1 . 2. 4. which has been efteemcd a favourable circumftance. But if the urine be in fmall quantity, and no fediment appears in it, after the hot fit is. over ; it thews that the fecerning veflels of the kidneys and the abforbent veflels 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 ftomach is afteCted with torpor either primari- ly ; or fecondarily by its fympathy with the cutaneous capilla- ries ; or with fome internal vil'cus ; ficknels occurs, with a total want of appetite to any thing folid ; vomiting then l'upervenes, ■which may often be relieved by a blifter on the fkin, if the lkin be cool and pale ; but not if it be hot and fluthed. The intef- tines ceafe to perform their office of abforption from a fimilar torpor ; and a diarrhoea fupervenes owing to the acrimony of their putrid, or of their acid contents. The loofe undigefted or fetid flools indicate the inability of the inteftines to perform their proper office ; as the mucus and gaftric acid, which are vomited Sup. I. 2. 5. THEORY OF FEVER. 451 vomited up, does that of the ftomach ; this torpor of the ftom- ach is liable to continue after the cold paroxyfm ceafes, and to convert intermittent fevers into continued ones by its direCfc fympathy with the heart and arteries. See article 10. of this Supplement, 5. If the meninges of the brain fympathize with other torpid parts, or are primarily affeCted, delirium, ftupor, . and perhaps hydrocephalus internus, occur, fee Clafs II. 1. 7. 1. and I. 2. 5. 10 ; and fometimes the pulfe becomes flow, producing parefis inftead of fever. But if the membranes, which cover the muf- cles about the head, or of the pericranium, become torpid by their fympathy with other torpid parts, or are primarily affect- ed, a head-ach fupervenes ; which however generally ceafes with the cold paroxyfm of fever For as when the fenforial power of volition is exhaufted by labour, a few hours, or half a folar day, paffed in deep recruits the fyftem by accumulation of this fenforial power fo when the fenforial power of irritation is exhaufted, one or two folar or lunar days of reft or quiefcence of the afteCted part will generally reftore its aCtion by accumu- lation of irritability, and confequent increafe of affociation, as in hemicrania, Clafs IV. 2. 2 8. But when the heart and arteries become torpid, either primarily, or by their fympathy with the ftomach, this accumulation of the fenforial power of irritation can take place but {lowly ; as to reji is death ! This explain' the caufe of the duration of fevers with weak pulfe, which con- tinue a quarter, or half, or three quarters, or a whole lunation, or ftill longer, before fufficient accumulation of irritability can be produced to reftore their natural ftrength of action. 6 If the abforbent veffels, which are fpread around the beck of the bladder, become torpid by their direCt fympathy with the abforbents of the {kin in cold fits of fever ; the urine, which is poured into the bladder in but fmall quantity from the torpid kidneys, has neverthelefs none of its aqueous faline part reab- forbed ; and this faline part flimulates the bladder to empty it- felf frequently, though the urine is in fmall quantity. Which is not therefore owing to any fuppofed fpaiin of the bladder, for the action of it in excluding the urine is weak, and as much controllable by the will as in ordinary micturition. 7. If the beginnings or abforbent mouths of the venous fyf- tem remain torpid, petechise or vibices are produced in fevers, fimilar to thole which are feen in fcurvy without fever. If the {kin was frequently moiftened for an hour, and at the fame time expofed to the common air, or oxygen gas, it might con- tribute to turn the black colour of thefe points of extravafated blood into fcarlet, and thus by increafing its ftimulus facilitate 452 THEORY OF FEVER. Sup. 1.2. 8. its reabforption ? For oxygen gas penetrates moift animal mem- branes though not dry ones, as in the lungs during relpiration. See Clafs I. 2. i. 17. 8. When the fenforial power of fenfation is introduced into the arterial fyftem, other kinds of compound fevers are produc- ed, which will be fpoken of in their place. III. Termination of the cold Fit. 1. If all the parts, which were affefted with torpor, regain their irritability, and affociability, the cold paroxyfm of fever ceafes ; but as fome of the parts affeited were previoufly accuf- tomed to inceffant action, as the heart and arteries, and others only to intermitted a£tion, as the ftomach and inteftines ; and as thofe, which are fubjected during health to perpetual adtion, accumulate fenforial power fafter, when their motions are im- peded, than thofe which are fubje&ed to intermitted action ; it happens, that fome of the parts, which were affected with tor- por during the cold fit, recover their irritability or affociability fooner than others, and more perfectly, or acquire a greater quantity of them than natural ; as appears by the partial heat and flulhings previous to the general hot fit. Hence if all the parts, which were previoufly torpid, regain their due degree of irritability, or of afl'ociability, the dileafe is removed, and health reftored. If fome or all of them acquire more than their natural degree of thefe fenforial powers ; in- creafed actions, and confequent increafed fecretions, and greater heat occur, and conltitute the hot fit of fever. If after this hot fit of fever all the parts, which had acquired too great irritabili- ty, or affociability, regain their natural degree of it ; the dif- eafe is removed, and health reftored. But if fome of thefe parts do not regain their natural degree of thefe fenforial powers, the actions of thofe parts remain imperfeft, and are more or lefs injurious to the fyftem, according to the importance of their functions. 2. Thus if a torpor of the heart and arteries remains ; the quick pulfe without ftrength, which began in the cold fit, per- fifts ; and a continued fever is produced. If the torpor of the ftomach and inteftines remains, which is known by ficknefs and undigefted ftools, the fever is liable to be of confiderable length and danger ; the fame if the kidneys and abforbent fyftem re- tain fome degree of torpor, as is ftiewn by the pale urine in not unufual quantity. If part of the abforbent fyftem remains tor- pid, as the abforbent veffels of the fpleen, a tumour of that vif- cus occurs, which may be felt by the hand *, the fame fome- times Sup. I. 3. 3. THEORY OF FEVER. 453 times happens to the liver ; and thefe from their tendency to more complete torpor are afterwards liable to give occalion to a return of the cold fit. If the cellular abforbents do not com- pletely recover their aflivity, a pale and bloated countenance with fwelled legs marks their want of adtion. 3. As the termination of the cold fit is owing to the accumu- lation of the fenforial power of irritation and of alTociation du- ring the previous quiefcence of the fyftem ; and as thofe parts, which are in perpetpal aflion during health, are more fubject to this accumulation during their torpor, or quiefcence ; one fhould have imagined, that the heart and arteries would acquire this accumulation of fenforial power fooner or in greater degree than other parts. This indeed fo happens, where the pulfe is previoufly ftrong, as in febris irritativa ; or where another fen- l'orial power, as that of fenfation, is exerted on the arterial fyf- tem, as in inflammations. The heart and arteries in thefe cafes foon recover from their torpor, and are exerted with great vi- olence. Many other parts of the fyftem fubjeft to perpetual motion in health may reft for a time without much inconvenience to the whole ; as when the fingers of fome people become cold and pale ; and during this complete reft great accumulation of irritability may be produced. But where the heart and ar- teries are previoufly feeble, they cannot much diminifh their adlions, and certainly cannot reft entirely, for that would be death j and therefore in this cafe their accumulation of the fen- forial power of irritation or of alTociation is flowly produced, and a long fever fupervenes in confequence ; or fudden death, as frequently happens, terminates the cold fit. Whence it appears, that in fevers with weak pulfe, if the ac- tion of the heart, arteries, and capillaries could be diminilhed, or flopped for a fhort time without occafioning the death of the patient, as happens in cold bathing, or to perfons apparently drowned, that a great accumulation of the fenforial powers of irritation or of alTociation might foon be produced, and the pulfe become ftronger, and confequently flower, and the fever ceafe. Hence cold ablution may be of fervice in fevers with weak pulfe, by preventing the expenditure and producing accumula- tion of the fenforial power of irritation or alTociation. Stupor may be ufeful on the fame account. Could a centrifugal fwing be ferviceable for this purpofe, either by placing the head or the feet in the outward part of the circle, as defcribed in Art. 15. 7. of this Supplement ? IV, Return 454 THEORY OF FEVER. Sup. I. 4. i. IV. Return of the cold Fit. 1. If the increafed a£lion of the cutaneous and pulmonary capillaries, and of the heart and arteries, in febris irritativa, con- tinues long and with violence, a proportional expenditureor ex- hauftion of fenforial power occurs ; which by its tendency to in- duce torpor of fome part, or of the whole, brings on a return of the cold fit. 2 Another caufe which contributes to induce torpor of the whole fyftem by the fympathy of its parts with each other, is the remaining torpor of fome vifcus •, which after the laft cold paroxyfm had not recovered itfelf, as of the fpleen, liver, kid- neys, or of the ftomach and inteftines, or abforbent veffels, as above mentioned. 3. Other caufes are the deficiency of the natural ftimuli, as hunger, thirft, and want of frefh air. Other caufes are great fatigue, want of reft, fear, grief, or anxiety of mind. And laftly, the influence of external ethereal fluid, as the defefl of exter- nal heat, and of folar or lunar gravitation. Of the latter the return of the paroxyfms of continued fevers about fix o’clock in the evening, when the folar gravitation i- the leaft, affords an example of the influence of it ; and the ufual periods of inter- mittents, whether quotidian, tertian, or quartan, which l'o regu- larly obey folar or lunar days, afford inftances of the influence of thofe luminaries on thefe kinds of fevers. 4. If the tendency to torpor of fome vifcus is confiderabie, this will be increafed at the time, when the terrene gravitation is greateft, as explained in the introdudlion to Clafs IV 2. 4. and may either produce a cold paroxyfm of quotidian fever ; or itmay not yet be fufficient in quantity for that purpofe, but may n everthelefs become greater, and continue fo till the next pe riod of the greateft terrene gravitation, and may then either produce a paroxyfm of tertian fever j or may ftill become greater, and continue fo till the next period of greateft terrene gravitation, and then produce a paroxyfm of quartan ague. And laftly, the periodical times of thefe paroxyfms may exceed, or fall ihort of, the time of greateft diurnal terrene gravitation according to the time of day, or period of the moon, in which the firft fit began ; that is, whether the diurnal terrene gravitation was then in an increafing or decrealing ftate. V. Senfation excited in Fever. 1. A curious obfervation is related by Dr. Fordyce in his Tra added to that of irritation, frequently produces inflammation, which confifts in the fecretion of new fluids or new veflels. NeVferthelefs, if thefe diflurbed adlions be of the torpid kind, the pain, which attends them, is feldom productive of inflam- mation, as in hemicrania ; but is liable to excite voluntary ac- tions, and thus to expend much fenforial power, as in the fliud- dering in cold fits of fever, or in convulfions ; or laltly the pain itfelf, which attends torpid actions, is liable to fexpend or ex- hauft much fenforial power without producing any increafed actions •, whence the low pulfe, and cold extremities, which ufu- ally attend hemicrania •, and hence when inert, or inactive fer.- fation attends one link of aflbciated adtions, the fucceeding link is generally rendered torpid, as a coldnefs of the cheek attends tooth-ach. 5. A fifth important circle of irritative motions is that of the fanguiferous fyftem, in which the capillary veflels are to be in- cluded, which unite the arterial and venous fyftems, both pul- monary and aortal. The diflurbed adtion of this fyftem of the heart and arteries, and capillaries, conftitutes Ample fever ; to which may be added, that the fecerning and abforbent veflels appending to the capillaries, and the bibulous mouths of the veins, are in fome meafure at the fame time generally afredted. 6. Now, though the links of each of thefe circles of irritative motions are more ftridfly aflbciated together, yet are they in greater or lefs degree aflbciated or catenated with each other by direct or reverie fympathy. Thus the ficknefs, or inverted irri- tative motions of the ftomach, are aflbciated or catenated with the diflurbed irritative ideas, or fenfual motions, in vertigo ; as in lea-ficknefs. This ficknefs of the ftomach is alfo aflbciated or catenated with the torpor of the heart and arteries by direct fympathy, and with the capillaries and abforbents by reverfe fympathy •, and are thus all of them liable occafionally to be dis- turbed, when one of them is difeafed ; and conftitute the great variety of the kinds or fymptoms of fevers. VII. Alternation of the cold and hot Fits. 1. When any caufe occurs, which diminiflies to a certain de- gree the fupply of fenforial power in refpecf to the whole fyf- tem ; as fuppofe a temporary inexertion of the brain ; what happens ? Firft, thofe motions are exerted with lefs energy, which are not immediately neceflary to life, as the locomotive mufcles ; and thofe ideas, which are generally excited by voli- tion •, at the fame time this deficiency of voluntary motion is different Sup. I. 7. 2. THEORY OF FEVER. 459 different from that which occurs in deep ; as in that the move- ments of the arterial fyftem are increafed in energy though not in frequency. Next, the motions of the alimentary eanal be- come performed with lefs energy, or ceafe altogether ; and a total want of appetite to folid food occurs, or ficknefs or a diar- rhoea occafioned by the indigefted aliment. Then the abforbent veffels ceafe to a£t with their due energy ; whence third:, and pale urine, though in fmall quantities. Fourthly, the fecerning vedels become affe&ed by the general diminution of fenforial power ; whence all the fecreted duids are produced in lefs quantity. And laftly, the fanguiferous canals feel the general torpor; the pulfations of the heart and arteries become feeble, and confequently quick ; and the capillaries of the fkin become inactive, acquire lefs blood from the arteries, and are confe- quently paler and fhrunk. In this laft circumftance of the torpor of the fanguiferous fyftem confifts inirritative fever ; as all the others are rather ac- cidental-or concomitant fymptoms, and not edential ones ; as fewer or more of them may be prefent, or may exift with a greater or lefs degree of inadiivity. 2. Now as the capillaries of the fkin are expofed to greater varieties of heat and cold, than the heart and arteries, they are fuppofed to be more mobile, that is, more fufceptible of torpor or exertion, or to indammation, by external ftimuli or induences, than the other parts of the fanguiferous fyftem ; and as the fkin is more fenfible to the prefence of heat, than the internal parts of the body, the commencement of the cold paroxyfms of fever generally either firft exifts in, or is firft perceived by, the cold- nefs and palenefs of the fkin ; and the commencement of the hot fits by the heat and rednefs of it. 3. The accumulation of fenforial power occurs in thefe or- gans fooneft, and in greateft quantity, during their quiefcence, which were moft perpetually in action during health ; hence thofe parts of the fyftem fooneft recover from torpor in inter- mittent fever, and fooneft fall into the contrary extreme of in- creafed adlivity ; as the fanguiferous fyftem of the heart and ar- teries and capillaries. But of thefe the capillaries feem firft to acquire a renovation of their adtion, as the heat of the fkin be- comes firft renewed, as well as increafed beyond its natural quantity, and this in fome parts fooner than in others -, which quantity of heat is however not to be eftimated fimply by the rife of the mercury in the thermometer, but alfo by the quanti- ty carried away into the atmofphere, or diffufed amongft other bodies in a given time ; as more heat pafies through water, which boils vehemently, than when it boils gently, though the rife 46® THEORY OF FEVER. Sup. I. 7. 4. rife of the thermometer in both cafes continues the fame. This faft may be known by boiling an egg in water, the white of which coagulates in much lefs time, if the water boils vehement- ly, than if it boils moderately, though the fenfible heat of the water is the fame in both cafes. Another caufe, which induces the cutaneous capillaries to re- new their a£tions fooner than the heart and arteries after im- merfion in the cold bath, is, that their torpor was occafioned by defed! of irritation : whereas that of the heart and arteries was occafioned by defedf of aflociation ; which defetft of aflociation was owing to the decreafed actions of the capillaries, and is now again excited by their renewed adlion ; which excitement muft therefore be fubfequent to that increafed adlion of the capilla- ries ; and in confequence the increafed action of the heart and arteries at the commencement of the hot fit of fome fevers is fubfequent to the increafed adlion of the cutaneous capillaries. There is, however, in this cafe an accumulation of the fenforial power of affociation in the heart and arteries, which muft con- tribute to increafe their orgafm in the hot fit, as well as the in- creafed excitement of it by the increafed adlion of the capillaries 4. Now this increafed atlion of the fyftem, during the hot fit, by exhaufting the fenforial powers of irritation and aflocia- tion, contributes to induce a renewal of the cold paroxyfm ; as the accumulation of thofe fenforial powers in the cold fit pro- duces the increafed adfions of the hot fit ; which two ftates of the fyftem reciprocally induce each other by a kind oflibration, or a plus and minus, of the fenforial powers of irritation and aflociation. If the exhauftion of fenforial power during the hot fit of fe- ver only reduces the quantity of irritability and aflociability to its natural ftandard, the fever is cured, not being liable to re- turn. If the quantity of thefe fenforial powers be reduced only fo much, as not to produce a fecond cold fit during the prefent quantity of external ftimuli or influences ; yet it may be fo far reduced, that a very fmall fubtradfion of ftimulus, or of influ- ence, may again induce a cold fit ; fuch as the coldnefs of the night-air ; or the diminution of folar or lunar gravitation, as in intermittent fevers. 5. Another caufe of the renovation of the cold fits of fever is from fome parts of the fyftem not having completely recov- ered from the former cold paroxyfm ; as happens to the ipieen liver, or other internal vifeus; which fometimes remains tumia, and either occafions a return of the cold fit by diredt fympathy with other parts of the body, or by its own want of action cauf- es a diminution of the general quantity of heat, and thus facili- tates Sup. I. 8. i. THEORY OF FEVER. 461 tates the renovation of the torpor of the whole fyftem, and gives caufe to intermittent fevers catenated with lunar or folar influ- ence. VIII. Orgafm of the Capillaries. As the remaining torpor of fome lefs eflentiai part of the fyf- tem, as of the fpleen, when the hot fit ceafes, produces after one, two, or three days a return of cold fit by direct fympathy with the cutaneous capillaries, when joined with fome other caufe of torpor, as the defedt of folar or lunar influences, or the expofure to cold or hunger, and thus gives origin to intermit- tent fever ; fo the remaining torpor of fome more eflentiai parts of the fyftem, as of the ftomach and inteftines, is probably the caufe of the immediate recurrence of the cold paroxyfm, at the time the hot one ceafes, by their diredt fympathy with the cu- taneous capillaries, without the afliftance of any other caufe of torpor ; and thus produces remittent fever. And laftly the re- maining torpor of fome ftill more eflentiai parts of the fyftem, as the heart and arteries, after the hot fit ought to ceafe, is lia- ble by reverfe fympathy with the cutaneous capillaries to con- tinue their orgafm, and thus to render a fever continual, which would otherwife remit or intermit. Many difficulties here occur, which we fhall endeavour to throw fome light upon, and leave to future inveftigation ; ob- ferving only that difficulties were to be expedted, otherwife fe- vers would long fince have been underftood, as they have em- ployed the unremitted attention of the phyficians of all ages of the world. 1. Why do the fame parts of fucceffive trains of adfion fome- times afredl: each other by diredf , and fometimes by reverfe fym- pathy ? — ift. When any irritative motion ceafes, or becomes torpid, which was before in perpetual adtion ; it is either de- prived of its ufual ftimulus, and thence the fenforial power of irritation is not excited; or it has been previoufly too much ftim- ulated, and the fenforial power has been thus exhaufted. In the former cafe an accumulation of fenforial power foon occurs, which is excitable by a renewal of the ftimulus ; as when the fingers, which have been immerfed fome time in fnow, are again expofed to the ufual warmth of a room. Or, fecondly, the fenforial power of irritation becomes fo much accumulated, that the motions, which were torpid, are now performed by lefs ftimulus than natural ; as appears by the warmth, which foon occurs after the firfc chill in going into frofty air, or into the bath at Buxton, which is about eighty degrees of heat. Or, laftlv, 462 THEORY OF FEVER. Sup. I. 8. 2 . laftly, this accumulation of the fenforial power of irritation fo far abounds, that it increafes the adlion of the next link of the aflbciated train or tribe of motions ; thus on expofing the (kin to cold air, as in walking out in a frofty morning, the adlions of the ftomach are increafed, and digeftion ftrengthened. But where the torpor of fome irritative motion is owing to tire previous exhau Elion of the fenforial power of irritation by tea great ftimulus, the reftoration of it occurs either not at all, or much more flowly than in the former inftances ; thus after intoxication the ftomach is very flow in recovering its due quan- tity of the fenforial power of irritation, and never fltews any ac- cumulation of it. 2. When an aflfociate motion, as described in the introduc- tion toCiafs IV. 1. 1. adls with lefs energy, the fenforial pow- er of aflociation is either not fulliciently excited by the preced- ing fibrous motions ; or it has been expended or exhaufted by the too violent adlions of the preceding fibrous motions. In the former cafe there occurs an accumulation of the fenforial power of affociation ; exactly, as, where the ufual ftimulus is with- drawn, there occurs an accumulation of the fenforial power of irritanon. Thus when the adlions of the capillaries of the ftcin are dirninifhed by immerfion in cold water, the capillaries of the lungs are rendered torpid by the want of the excitement of the fenforial pow r er of afi'ociation, ’owing to the leiTened adlions of the previous fibrous motions, namely, of thofe of the nun. Never- thelefs as foon as the capillaries of the fkin regain their increafed adlivity by the accumulation of the fenforial power of irrita- tion, thefe capillaries of the lungs acl with greater energy alfo owing to their accumulated fenforial power of aflociation. Thefe are inftances of diredl fympathy, and conftitute the cold and hot paroxyfms of intermittent fever ; or the firfl paroxyfm of a continued one. 3, When the firfl link of a train of aflbciated motions, which is fubjedl to perpetual adlion, becomes a confiderable time tor- pid for want of being excited by the previous exertions of the irritative motions, with which it is catenated j the fenforial power of aflociation becomes accumulated in fo great a degree as to affedl the fecond link of the train of aflbciated motions, and to excite it into ftronger adlion. Thus when the ftomach is rendered torpid by contagious matter fwallowed into it mixed with the faliva, the heart and arteries adl more feebly •, becaufe the fenforial power of aflociation, which ufed to be excited by the fibrous motions of the ftomach, is not now excited ; and in eonfeouence the motions of the heart and arteries acl only b; the Sup. I. 8. 4. THEORY OF FEVER. '463 the fenforial power of irritation, which is excited by the Pdmu- lus of the blood. But during this torpor of the ftomach, and lefs adlion of the heart and arteries, fo great an accumulation of the fenforiai powers of irritation and of aflociation occurs, that it adds to the adtion of the next link of this vital circle of adlions, that is, to that of the cutaneous capillaries. Whence in this fituation the torpor of the ftomach occafions a diminifhed action of the heart and arteries by diredf fympathy, and may be faid to occafion an increafed one of the cutaneous capillaries by reverfe fympathy ; which conftitute continued fever with weak pulfe. Nor is this increafed adtion of the capillaries in confequencc of the decreafed adtion of the heart and arteries, as in fevers with weak pulfe, a Angle fadt in the animal economy ; though it exifts in this cafe in the greateft degree of duration, becaufe the heart and arteries are perpetually in greater adtion than any other part of the fyftem. But a fimilar circumftance occurs, when the ftomach is rendered inadtive by defedtive excitement of the fenforial power of aflociation, as in fea-ficknefs, or in nephritis. In thefe cafes the fenforial power of aflociation be- comes much accumulated in the ftomach, and feems by its fu- perabundance to excite the abforbent fyftem, which is fo nearly connedted with it, into great increafe of adtion ; as is known by the great quantity frequently in thefe fituations ejected by vom- it, which could not otherways be fupplied. It is probable the increafe of digeftion by walking in frofty air, with many other animal fadts, may by future obfervations be found to be depend- ent on this principle, as well as the increafed adtion of the ca- pillaries in continued fevers with weak pulfe. Whereas in continued fever with ftrong pulfe, which may perhaps occur fometimes on the firft day even of the plague, the ftomach with the heart and arteries and the capillaries adt by diredt fympathy ; that is, the ftomach is excited into ftronger adtion by increafed irritation owing to the ftimulus of conta- gious matter *, thefe ftronger irritative motions of the ftomach excite a greater quantity of the fenforial power of aflociation, which then adtuates the heart and arteries with greater energy, as thefe are catenated with the ftomach ; and in the fame man- ner the increafed actions of the heart and arteries excite a great- er quantity of the fenforial power of aflociation, which acluates the cutaneous capillaries with increafe of energy. See Clafs IV. 1. 1. 4. I (hall dwell a little longer on this intricate fubjedt. The commencement of fever-fits is known by the inactivity of the cutaneous capillaries, which inadtivity is obfervable by the pale- nefs 464 THEORY OF FEVER. Sup. I. 8. 5. nefs and coldnefs of the fkin, and alfo by the pain of coldnefs, which attends it. There is neverthelefs in mod cafes, except thofe which are owing to expofnre to external cold, a torpor of the capillaries of fome internal vifcus preceding this inactivity of the cutaneous capillaries ; which is known by the tumour or hardnefs of the vifcus, or by an aching pain of it. The capilla- ries of the lungs are at the fame time rendered inactive or tor- pid, as appears by the difficulty of breathing, and coldnefs 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 coldnefs or of torpor. One caufe of this fynchronous or fucceffive inactivity of the cutaneous capillaries, in confequence of the previous torpor of fome internal vifcus, may be owing to the deficiency of heat ; which mult occur, when any parr becomes inaftive ; becaufe the fecretions of that part ceafe or are leffened, and the quantity of heat of it in confequence. But the principal caufe of it I fuppofe to be owing to the defect of the fenforial power of af- iociation ; which power of affiociation is excited by fome pre- vious or concomitant motions of the parts of every great circle of actions. This appears on going into the cold bath, becaufe the fhortnefs of breath inftantly occurs, fooner than one can con- ceive the diminution of the heat of the fkin could affedfthe lungs by the want of its (timulus ; but norfooner than the defedt of the fenforial power of affiociation could affect them ; becaufe this muft ceafe to be excited into adtion on the inltant that the cu- taneous capillaries ceafe to adt -, whence in the firft moment of contadt of the cold water the cutaneous capillaries ceafe to act from defedt of irritation ; which is caufed by defedt of the ftim- ulus of heat ; and in the fecond moment the capillaries of the lungs ceafe to adt from the defedt of affiociation ; which is cauf- ed by the defedt of the motions of the cutaneous capillaries. Thus the univerfal torpor in the cold paroxyfm of fever is an ex- ample of diredt fympathy, though occafioned in part by defedt of irritation, and in part by defedt of affiociation. 5. Thus in walking out in a frofty morning the fkin is cool- ed by the contadt of the cold air, whence the adtions of its ca- pillaries are diminiffied for want of their ufual ftimulus of hea: to excite a fufficient quantity of the fenforial power of irritation. Hence there is at firlt a faving of the fenforial power of irrita- rion for the purpofe of adtuating the other parts of the fylterr with greater energy. Secondly, the fenforial power of affocia- tion, which ufed to be excited by the motions of the cutaneous capillaries, is now not fo powerfully excited ; and in confequence the parts, which conftitute the next links of the circles of affio* dated Sup. I. 8. 6. THEORY OF FEVER. 4^5 dated motions, are for a time actuated with lefs energy, and a temporary general chillnefs fucceeds ; which is fo far fimilar to the cold fit of intermittent fever. In this fituation there is a carious circumftance occurs, which merits peculiar attention : after a fhort time, though the exter- nal Ikin continues cool by its expofure to the cold air, and the adions of its capillaries are confequently diminiflied, yet the ca- pillaries of the ftomach ad with greater energy j as is known by increafed digeftion and confequent hunger. This is to be afcribed to the accumulation of the fenforial power of irritation, which now excites by its fuperabundance, or overflowing, as it were, the ftomach into increafed adion ; though it is at the fame time excited lefs powerfully than ufual by the fenforial power of aflociation. Thus the accumulation of the fenforial power of irritation in the veflels of the fkin increafes in this cafe the ac- tion of the ftomach in the fame manner as an accumulation of the fenforial power of aflociation in the heart and arteries in fe- vers with weak pulfe increafes the adion of the capillaries. If neverthelefs the coldnefs of the Ikin be too long continued, or exifts in too great a degree, fo as in fome meafure to impair the life of the part, no further accumulation of the fenforial power of irritation occurs ■, and in confequence the adions of the ftomach become lefs than natural by the defed of the fen- forial power of aflociation ; which has ceafed to be excited by the want of adion of the cutaneous capillaries. Whence con- tinued coldnefs of the feet is accompanied with indigeftion and heart-burn. See Clafs IV. 2. 1.6. 6 . Similar to this when the adions of the ftomach are ren- dered torpid by the previous ftimulus of a violent emetic, and its motions become retrograde in confequence, a great quantity of fenforial power is exerted on the lymphatics of the lungs, and other parts of the body ; which excites them into greater dired adion, as is evinced by the exhibition of digitalis in ana- farca. In this fituation I fuppofe the emetic drug ftimulates mufcular fibres of the ftomach into too great adion ; and that in confequence a great torpor foon fucceeds ; and that this in- adion of the mufcular parts of the ftomach is not followed by much accumulation of the fenforial power of irritation ; be- caufe that fenforial power is in great meafure exhaufted by the previous exceflive ftimulus. But the lymphatics of the ftom- ach have their adions leflened by defed of fenforial power of aflociation, which is not now excited into adion, owing to the leflened motions of the mufcular parts of it, with which the lymphatics are afiociated. The fenforial power of aflociation becomes therefore accumulated in thefe lymphatics of the ftorn- Vol. II. M m m ach. 460 THEORY OF FEVER. Sup. 8. 7, ach, becaufe it is. not excited into action ; exactly as the power of irritation becomes accumulated in the hand, when immerfed in fnow ; and this accumulated fenforial power of affociation excites the lymphatics of the lungs and of other parts, which are molt nearly affociated with thofe of the ftomach, into more en- ergetic actions. Thus the mufcular fibres of the ftomach act with the lymphatics of that organ in diredt fympathy •, and the lymphatics of the ftomach adl in reverfe fympathy with thofe of the lungs and of other parts of the body ; the former of which is caufed by defedt of the excitement of the fenforial power of affociation, and the latter by the accumulation of it. Befides the efficient caufe, as above explained, the final caufe, or convenience of thefe organic adfions are worthy our atten- tion. In this cafe of an acrid drug fwallowed into the ftomach the reverted actions of the mufcular fibres of the ftomach tend, to ejedt its enemy ; the reverted adtions of its lymphatics pour a great quantity of fluids into the ftomach for the purpofe of di- luting or waffling off the noxious drug •, and the increafed ac- tions of the other lymphatics fupply thefe retrograde ones of the ftomach with an inconceivable fupply of fluids, as is feen in Ileus and Cholera. 7. The inquifitive reader will excufe my continuing this fubjedt, though perhaps with fome repetitions, as it envelopes the very eifence of fever. When the firft link of a train of ac- tions is excited by exceffive ftimulus,or exceffive irritability, and thus adfs with unufual energy by the increafed quantity of irri- tation, thefe increafed motions excite a greater quantity of the fenforial power of affociation, which caufes increafed motions in the fecond link, which is catenated with the firft ; and then the exceffive adtion of this fecond link excites alfo a greater quantity of the fenforial power of affociation, which increafes the motions of the third link of this chain of affociation, and thus the increafe of the ftimulus on the irritative motions, to which the chain of affociation is catenated, increafes the action of the whole chain or circle of affociated motions. After a time the irritative motions become torpid by expendi- ture of the fenforial power of irritation, and then the power of affociation alfo becomes lefs exerted, both becauie it has been in part exhaufted by too great adlion, and is now lefs excited by the leifened adlion of the irritative motions, which ufed to ex- cite it. Thefe are both inftances of diredf fympathy, and fre- quently conftitute the cold and hot fit of intermittents. But though the accumulation of the fenforial power of irri- tation during the quiefcence of fome motion owing to want of ftimulus generally induces torpor in the firft link of the train of affociated Sup. I. 8. 8. THEORY OF FEVER. 4*>7 affociated motions catenated with it ; as the capillaries of the lungs become torpid immediately on immerfion of the ikin into cold water ; yet in fome lituaticns an orgafm or excefs of adfion is produced in the firft link of the affociated motions thus cate- nated with irritative ones ; as in the increafed adtion of the ftomach, when the lkin is for a time expofed to cold air ; which may in part be afcribed to the general increafe of adtion of the whole fyftem, owing to the diminilhed expenditure of fenforial power, but particularly of the parts, which have habitually adt- ed together ; as when one arm is paralytic the other is liable to more frequent or almoft continual motion ; and when one eye becomes blind the other frequently becomes ffronger ; which is well known to farriers, who are faid fometimes to deftroy the light of one eye to ftrengthen that of the other in difeafed horfes. Hence there is fometimes a diredt fympathy, and fometimes a reverfe one fucceeds the torpor occalioned by defedf of ftimu- lus, the latter of which is perhaps owing to a certain time be- ing required for the produdtion of an accumulation of the fen- forial power of irritation by the nervous branches of the tor- pid organ ; which accumulation is now in part or entirely de- rived to the next link of the affociation. Thus in going into a coldifh bath, as into a river in the fummer months, we at firft experience a difficulty of breathing from the torpid action of the pulmonary capillaries, owing to the deficient excitement of the fenforial power of affociation in confequence of the torpor of the cutaneous capillaries. But in a very Ihort time, as in one min- ute, the fenforial power of irritation becomes accumulated by the inadlivity of the cutaneous capillaries ; and as its fuperabun? dance becomes now expended on the pulmonary capillaries, the difficult refpiration ceafes ; though the cutaneous capillaries con- tinue torpid by their contact with the cold water, and confe- quently the fenforial power of affociation, which ufed to con- tribute to adtuate the pulmonary capillaries, is lefs excited. 8. In like manner when there exifts an accumulation of the fenforial power of affociation, owing to defedt of its excitement by fome previous irritative or affociate motions, it is generally accompanied for a certain time by a torpor not only of the link firft affedted, but of the fubfequent parts, or of the whole train of affociated motions, as in the cold fits of intermittent fevers. Yet after a time an increafed adtion of the next links of affoci- ated motions fucceeds the torpor of the firft, as the abforbent veffels of the lungs adt more violently in confequence of the deficient adtion of thofe of the ftomach ; and the fkin at the commencement of ficknefs is pale and cold, but in a little time becomes flufiied and warm. Thus 468 THEORY OF FEVER. Sup. I. 8. 9. Thus we fee in affociate motions, which are rendered torpid by defeat of excitement, that fometimes a direct, and fometirr.es a reverfe fympathy fucceeds in the fubfequent links of the chain. But I believe where a torpor of irritative or of the affociate mo- tions is caufed by a previous too great expenditure or exhauf- tion of the fenforial powers of irritation or aflociation, no in- creafe of adtion in the fubfequent link ever occurs, or not till after a very long time. Thus when the ftomach becomes torpid by previous violent exertion, and confequent exhauftion of the fenforial power of irritation, as after intoxication with wine or opium, or after the exhibition of fome violent emetic drug, the torpor is communi- cated to the heart and arteries, as in continued fevers with weak pulfe. But where the torpor of the ftomach is produced from defective aflociation, as in fea-ficknefs ; or in the licknefs which occurs, when a ftone ftimulates the ureter ; no torpor is then communicated to the heart and arteries. For in the former cafe there is no accumulation of fenforial power in the ftomach, which was previoufly exhaufted by too great ftimulus ; but in the latter cafe the accumulation of fenforial power in the ftomach during its torpor is evinced by this circumftance ■, that in fea-ficknefs the patients eat and drink voracioufly at inter- vals ; and the pulfe is generally not affected by the licknefs oc- cafioned by a ftone in the ureter. For the adtion of the ftom- ach is then leffened, and in confequence becomes retrograde, not owing to the exhauftion of the fenforial power of irritation, but to the want of excitement of the fenforial power of alfocia- tion; which is caufed bvthe defective adtion of the ureter, which becomes occasionally torpid by the great ftimulus of the ftone it contains ; or which is cauied by the great exhauftion of fenfori- al power by the pain •, which affects the ureter without exciting inflammation, or increafed adtion of it. 9. Thus though the ftomach after the great ftimulus of in- toxication from excels of wine or opium will continue many hours without accumulation of fenforial power, as appears from the patient's experiencing no appetite at the intervals of fick- nels ; yet after long abftinence Irom food, at length not only the exhaufted quantity of fenforial power is renewed, but an ac- cumulation of it at length occurs, and hunger returns. In this Sit- uation the ftomach is generally about a whole day before it regains its ufual powers of digeftion ; but if it has been ftill more violently Stimulated, and its adtions further impaired, a ftill more perma- nent torpor, along with a continued fever with weak pulle is liable to occur ; and a fourth part or half, or three-fourths, or a whole Sup. 1. 8. xo. THEORY OF FEVER. 46 9 whole lunar period pafles, before it recovers its due irritability and confequent adlion. In limilar manner, after a perfon has been confined in a very warm room for fome hours, the cutaneous capillaries, with their fecretory and abforbent veflels, become exhaufted of their fenfo- rial power of irritation by the too great violent exertions occa- fioned by the unufual ftimulus of heat ; and in coming into a colder atmofphere an ina&ivity of the cutaneous veflels exifts at firfl: for fome time without accumulation of fenforial power as is (hewn by the continuance of the pain of cold and the pale- nefs ; but after a time both the pain of cold and palenefs van- ilh, which now indicates an accumulation of the fenforial pow- er of irritation, as lefs degrees of heat ftimulate the fyftem into due action. In the fame manner, after any one has been fome time in the fummer funfhine. on coming into a dark cell he continues much longer before he can clearly diftinguifli objects, than if his eyes had onLy been previoufly expofed to the light of a cloudy day in winter becaufe the fenforial power of irritation, and confequent fenfation, had in the firfl: cafe been previoufly much expended or exhaufted ; and therefore required a much longer time be- fore it could be produced in the brain, or derived to the optic nerves, in l'uch quantity as to reftore the deficiency, and to caufe an accumulation of it ; whereas in the latter cafe no deficiency had occurred xo. Thus the accumulation or deficiency of fenforial power in a torpid organ, which had previoufly been accuftomed to per- petual action, depends on the manner in which it becomes tor- pid ; that is, whether by great previous ftimulus, or great previ- ous excitement of the power of aflociation ; or by defeift of its accuftomed ftimulus, or of its accuftomed excitement of the power of alfociation. In the former cafe the fenforial power is in an exhaufted Itate, and therefore is not likely to become fo foon accumulated, as after drunkennefs, or expofure to great heat, or to great light-, in the latter a great accumulation of fenforial power occurs, as after expofure to cold, or hunger, or darknefs. Hence when the ftomach continues torpid by previous vio- lent ftimulus, as in the exhibition of digitalis, no accumulation of fenforial power of irritation fupervenes •, and in confequence the motions of the heart and arteries, which are aflociated with thole of the ftomach, become weak, and flow and intermittent, from the defeat of the excitement of the fenforial power of aflo- ciation. But what follows ? as the actions of the heart and ar- teries are leflened by the deficienqacfion of the fenforial power ef aflociation, and not by previous increafed excitement of it ; a 47 ° THEORY OF FEVER. Sup. I. 8. ii. a great accumulation of the fenforial power of aflociation oc- curs, which is exerted on the pulmonary and cutaneous abforb- ents by reverfe fympathy, and produces a great abforption of the fluid effufed into the cellular membrane in anafarca, with dry fkin j conftituting one kind of atrophy. But if at the fame time the fecerning veflels of the ftomach are ftimulated into fo violent adlivity as to induce great confe- quent torpor, as probably happens when contagious matter is fwallovved into the ftomach with our faliva, thofe of the heart and arteries adt feebly from the deficient excitement of the pow- er of aflociation ; and then the cutaneous and pulmonary fe- cerning veflels act with greater force than natural, owing to the accumulation of the fenforial power of aflociation ; and unnatur- al heat of the fkin, and of the breath fucceed •, but without frequency of pulfe, conftituting the parefis irritativa of Clafs'I. 2 . i. 2. And taftly, if a paucity of blood attends this parefis or fome other caufe inducing a frequency of pulfe, the febris mir- ritativa, or with weak pulfe, is produced. But on the contrary when the ftomach has previoufly been rendered torpid by defedt of ftimulus, as by hunger, if food be too haftily fupplied, not only great exertion of the ftomach it- felf fucceeds, but fever with ftrong pulfe is induced in confe- quence ; that is, the heart and arteries are excited into more en- ergetic addon by the excefs of the power of aflociation, which catenates their motions with thofe of the ftomach. For the re- dundancy of fenforial power of irritation, which was accumu- lated during the inadlivity of the ftomach, and is now called into addon by ftimulus, adtuates that organ with increafed en- ergy, and excites by thefe increafed motions the fenforial power of aflociation ; which has alfo been accumulated during the in- adtiviry of the heart and arteries ; and thus thefe organs alfo are now excited into greater action. So after tue fkin has been expofed fome hours to greater heat than natural in the warm room, other parts as the membranes of the noftrils, or of the lungs, or of the ftomach, are liable to become torpid from diredt fympathy with it, when we come in- to air of a moderate temperature ; whence catarrhs, coughs, and fevers, But if this torpor be occafiorad by defedt of ftim- ulus, as after being expofed to frofty air, the accumulation of fenforial power is exerted, and a glow of the fkin follows, with increafed digeftion, full refpiration, and more vigorous circula- tion. 1 1 . It may be afked, Why is there a great and conftant accu- mulation of the fenforial power of aflociation, owing to the tor- por of the ftomach and heart and arteries, in continued fever with Sup. I. 8 . 12. THEORY OF FEVER. 47 * with weak pulfe ; which is exerted on the cutaneous and pul- monary capillaries, fo as to excite them into increafed action for many weeks, and yet no fuch exuberance of fenforial pow- er produces fever in winter-deeping animals, or in chlorofis, or apepfia, or hyfteria ? In winter-fleeping animals I fuppofe,lhe whole nervous fyf- tem is torpid, or paralyfed, as in the deep of frozen people ; and that the ftomach is torpid in confequence of the inaddvitv or quiefcence of the brain ; and that all other parts of the body, and the cutaneous capillaries with the reft, labour under a fim- ilar torpor. In chlorofis, I imagine, the addons of the heart and arteries, as well as thofe of the cutaneous and pulmonary capillaries, dif- fer along with thofe of the ftomach from the deficient ftimulus of the pale blood ; and that though the liver is probably the feat of the original torpor in this difeafe, with which all other parts fympathize from defedt of the excitation of the fenforial power of aflociation; yet as this torpor occurs in fo fmall a degree as not to excite a ftiuddering or cold fit, no obfervable confequences are in general occafioned by the confequent accumulation of fenfori- al power. Sometimes indeed in chlorods there does occur a frequent pulfe and hot fkin ; in which circumftances I fup- pofe the heart and arteries are become in fome degree torpid by diredt fympathy with the torpid liver ; and that hence not on- ly the pulfe becomes frequent, but the capillaries of the Ikin act more violently by reverfe fympathy with the heart and arteries, owing to the accumulation of the fenforial power of aflociation- in them during their torpid ftate, as occurs in irritative fever. See Article 1 1. of this Supplement. In apepfia chronica the addons of the ftomach are not fo far % impaired or deftroyed as totally to prevent the excitation of the fenforial power of aflociation, which therefore contributes fome- thing towards the addons of the heart and arteries, though lefs than natural, as a weak pulfe always I believe attends this dif- eafe. There is a torpor of the ftomach, and of the upper part of the alimentary canal in hyfteria, as is evident from the retro- grade addons of the duodenum, ftomach, and aefophagus, which conftitute the globus hyftericus, or fenfation of a globe riling in- to the throat. But as thefe retrograde addons are lefs than thofe, which induce ficknefs or vomiting, and are not occafioned by previous exhauftion of the fenforial power of irritation, they do not fo totally prevent the excitement of the fenforial power of aflociation, as to leflen the motion of the heart and arteries fo much as to induce fever ; vet in this cafe, as in apepfia, and in cholorofis. 472 THEORY OF FEVER. Sup. I. 8 . 12. chlorofis, the pulfationsof the heart and arteries are weaker than natural, and are fometimes attended with occafionally increafed adlion of the capillaries ; as appears from the flulhings of the face, and hot lkin, which generally form an evening febricula in difeafes attended with weak digeftion. 12. The increafed adlion, or orgafm, of the cutaneous, pul- monary, and cellular capillaries, with their fecerning and abforb- ent veflels, in thofe fevers which are attended with deficiency of vital adlion, exhaufts the patient both by the additional ex- penditure of fenforial power on thofe organs of fecretion, and by the too great abforption 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 diminifh the too great adtion of the capillaries ; which is to be done by frequent ablutions, or bathing the whole ikin in tepid or in cold water, as recommended by Dr Currie of Liverpool (Philof. Tranf. for 1792), for half an hour twice a day, or at thofe times when the fkin feels dried and hotteft. Much cool air fhould alfo be admitted, when the breath of the patient feels hot to one’s hand ; or when the tongue, efpecially its middle part is dry, and covered with a cruft of indurated mucus ; as thefe indicate the increafed adlion of the pulmonary capillaries ; in the fame manner as the dry and hot fkin indicates the orgafm of the cutaneous capillaries ; and the emaciation of the body that of the cellular ones. For this purpofe of abating the adlion of the capillaries by frequent ablution or fomentation, water of any degree of heat beneath that of the body will be of fervice, and ought in accu- rate language to be called a cold bath •, but the degree of cold- nefs, where the patient is fenfible, fhould in fome meafure be governed by his fenfations ; as it is probable, that the degree of coldnefs, which is moft grateful to him, will alfo be of the great- eft benefit to him. See Clafs III. 2. 1. 12. and Article 15. of this Supplement. Another great ufe of frequent ablutions, or fomentations, or baths, in fevers, where the ftomach is in fome degree torpid, is to fupply the fyftem with aqueous fluid by means of the cutane- ous abforbents ; which is diffipated fafter by the increafed ac - tion of the fecerning capillaries, than the ftomach can furnifh and occafions great thirft at the intervals of the ficknefs. IX. Torpor of the Lungs. 1. The lungs in many cafes of contagion may firft be affedt ed with torpor, and the fkin become cold by fympathy ; in the fame THEORY OF FEVER. 473 Sup. I. y. 2. fame manner as a cold Hein on going into the cold bath induces difficulty of breathing. Or the ftomach may become a(Fe£ted with torpor by its fympathy with the lungs, as in the experi- ments of Mr. Watt with hydrocarbonate gas ; a few refpira- tions of which induced licknefs, and even fyncope. When the ftomach or fkin is thus affe£ted fecondariiy by afibciation, an accumulation of fenforial power occurs much fooner, than when thefe parts become torpid in confequence of previous excefs of ftimulus ; and hence they fooner recover their accuftomed ac- tion, and the fever ceafes. The particles of contagious matter thus received by refpiration fomewhat referable in their effedts the acid gafes from burning fulphur, or from charcoal ; which, if they do not inftantly deftroy, induce a fever, and the patient (lowly recovers. 2. I was fome years ago (looping down, to look which way the water oozed from a morafs, as a labourer opened it with a fpade, to detedl the fource of the fpring, and inhaled a vapour, which occafioned an inftant fenfe of fuffocation. Immediately recoiling I believe I inhaled it but once ; yet a few hours after- wards in the cool of the evening, when I returned home rather fatigued and hungry, a {hivering and cold (it occurred, which was followed by a hot one ; and the whole difeafe began and terminated in about twelve hours without return. In this cafe the power of fear, or of imagination, was not concerned ; as I neither thought of the bad air of a morafs before I perceived it, nor expended a fever-fit till it occurred. In this cafe the torpor commenced in the lungs, and after a few hours, by the addition of fatigue, and cold, and hunger, was propagated by diredt fympathy, to the reft of the fyftem. An orgafm or increafed aclion of the whole fyftem was then induced by the accumulation of fenforial power of irritation in the lungs, and of afibciation in the other organs and when thele fubfided, the difeafe ceafed. It may be a(ked, could a tor- por of the capillaries of the air-veflels of the lungs be fo fud- denly produced by great ftimulation ? — It appears probable, that it might, becaufe great exertion of irritative motions may be in- ftantly produced without our perceiving them ; that is, without their being attended by fenfation, both in the lungs and ftom- ach ; and the organs may become torpid by the great expendi- ture of the fenforial power of irritation in an inftant of time j as paralyfis frequently inftantly follows too great an exertion of voluntary power. 3. When the capillaries of the (kin a£l too violently, as in fome continued fevers ; which is known by the heat of the breath, and by the drynefs of the tongue, efpecially of the mid- Vol. II. FT n n die 474 THEORY OF FEVER. Sup. I. io. i. dle part of it ; not only cooler air might be admitted more free- ly into a fick room to counteract this orgafm of the pulmonary capillaries ; but perhaps the patient might breathe with advan- tage a mixture of carbonic acid gas, or of hydrogene gas, or of azote with atmofpheric air. And on the contrary, when there exifts an evident torpor of the pulmonary capillaries, which may be known by the correfpondent chillnefs of the fkin ; and by a tickling cough, which fometimes attends cold paroxyfms of fe- ver, and is then owing to the deficient abforption of the pulmo- nary mucus, the faline parts of which ftimulate the bronchias, or air-veflels ; a mixture of one part of oxygen gas with i o or 20 parts of atmofpheric air, might probably be breathed with great advantage. X. Torpor of the Brain. As the inactivity or torpor of the abforbent veflels of the brain is the caufe of hydrocephalus internus ; and as the deficiency of venous abforption in the brain, or torpor of the extremities of its veins, is believed frequently to be the caufe of apoplexies ; fo there is reafon to conclude that the torpor of the fecerning vef- fels of the brain, which a»e fuppofed to produce the fenforial power, may conftitute the immediate caufe of fome fevers with arterial debility. And alfo that the increafed aCtion of thefe fe- cerning veffels may fometimes conftitute the immediate caufe of fevers with arterial ftrength. It is neverthelefs probable, that the torpor or orgafm of the fanguiferous, abforbent, or fecerning veflels of the brain may frequently exift as a fecojtdary effeCf, owing to their afiociation with other organs, as the ftomach or lungs ; and may thus be produced like the torpor of the heart and arteries in inirritative fevers, or like the orgafm of thofe organs in irritative fevers, or inflammatory ones. Where there exifts a torpor of the brain, might not very flight eleCfric fliocks pafled frequently through it in all direc- tions be ufed with advantage ? Might not fomentations of 94 or 96 degrees of heat on the head for an hour at a time, and fre- quently repeated, ftimulate the brain into aCtion $ as in the re- vival of winter-fleeping animals by warmth ? Ether externally might be frequently applied, and a blifter on the fhaved head. Where the fecerning veflels of the brain aCfc with too great energy, as in fome inflammatory fevers, might it not be dimin- ifhed by laying the patient horizontally on a mill ftone, and whirling him till fleep fhould be produced, as the brain be comes Sup. I. n. i. THEORY OF FEVER. 47 5 comes compreffed by the centrifugal force ? See Article 15. of this Supplement. XI. Torpor of the Heart and Arteries. 1. It was fhown in Clafs IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6. 3. that a reverfe fympathy generally exifts between the lafteal and lymphatic branches of the abforbent fyftem. Hence, when the motions of the abforbents of the ftomach are rendered torpid or retrograde in fevers with arterial debility, thofe of the fkin, lungs, and cellular membrane, aft with in- creafed energy. But the aftions of the mufcular fibres of the heart and arteries are at the fame time aflociated with thofe of the mufcular fibres of the ftomach by direft fympathy. Both thefe aftions occur during the operation of powerful emetics, as fquill or digitalis ; while the motions of the ftomach con- tinue torpid or retrograde, the cellular and cutaneous abforbents aft with greater energy, and the pulfations of the heart and ar- teries become weaker, and fometimes flower. The increafed aftion of the ftomach after a meal, and of the heart and arteries at the fame time from the ftimulus of the new fupply of chyle, feems originally to have produced, and to have eftablifhed this direft fympathy between them. As the increafed aftion of the abforbents of the ftomach after a meal has been ufually attended with diminifhed aftion of the other branches of the abforbent fyftem, as mentioned in Clafs IV. 1 . 1. 6. and has thus eftablifhed a reverfe fympathy between them. 2. Befides the reverfe fympathy of the abforbent veflels of the mufcles of the ftomach, and of the heart and arteries, with thofe of the fkin, lungs, and cellular membrane ; there exifts a fimilar reverfe fympathy between the fecerning veflels or glands of the former of thefe organs with thofe of the latter ; that is the mu- cous glands of the heart and arteries aft generally by direft fym- pathy with thofe of the ftomach ; and the mucous glands of the cellular membrane of the lungs, and of the Ikin, aft by re- verfe fympathy with them both. Hence when the ftomach is torpid, as in ficknefs, this torpor fometimes only affects the abforbent veflels of it ; and then the abforbents of the cellular membrane and the fkin only aft with increafed energy by reverfe fympathy. If the torpor affefts the mufcular fibres of the ftomach, thofe of the heart and arteries aft by direft fympathy with it, and a weak pulfe is produced, as in the exhibition of digitalis, but without increafe of heat. But if the torpor alfo affefts the glands of the ftomach, the cu- taneous 476 THEORY OF FEVER. Sup. I. i j. 3. taneous and pulmonary glands a£l with greater energy by their reverfe fympathy with thofe of the ftomach, and of the heart and arteries ; and great heat is produced along with increafed perfpiration both from the fkin and lungs. 3. There is fome difficulty in explaining, why the actions of the extenfive fyftem of capillary glands, which exift on every other membrane and cell in the body for the purpofe of fecreting mucus and perfpirable matter, ffiould fo generally a£t by reverfe fympathy with thofe of the ftomach and upper part of the in- teftines. It was fhewn in Clafs IV. 1. 1.6. that when the ftom- ach was filled with folid and fluid aliment, the abfcrbents of the cellular membrane, and of the bladder, and of the fkin, a£ted with lefs energy ; as the fluids, they were ufed to abforb and tranfmit into the circulation, were now lefs wanted ; and that hence by habit a reverfe fympathy obtained between thefe branches of the abforbents of the alimentary canal, and thofe of the other parts of the body. Now, as at this time lefs fluid was abforbed by the cutane- ous and cellular lym’phatics, it would happen, that lefs would be fecreted by their correfpondent fecerning veflels, or capillary glands ; and that hence by habit thefe fecerning veflels would acquire a reverfe fympathy of adlion with the fecerning veflels of the alimentary canal. Thus when the abforption of the tears by the punfta lacry- malia is much increafed by the ftimulus of fnuff; or of an af- fe&ing idea, on the nafal du£ts, as explained in Seel. XVI. 8. 2. a great increafe of the fecretion of tears from the lacryma! glands is produced by the direft fympathy of the aftion of thefe glands with thofe of their correfpondent abforbents ; and that though in this cafe they are placed at fo great a diftance from each other. 4. A difficult queftion here occurs ; why does it happen, that in fevers with weak pulfe the contractions of the heart and ar- teries become at the fame time more frequent ; which alfo lome- times occurs in chlorofis, and in fome hyfteric and hypochon- driac difeafes, and in fome infanities ; yet at other times the weak pulfe becomes at the fame time flow, as in the exhibition of digitalis, and in parefis irritativa, deferibed in Clafs I. 2. 1. 2. which may be termed a fever with flow pulfe ? this frequency of pulfe cannot depend on heat, becaufe it fometimes exifts without heat, as towards the end of fome fevers with debility. Now as apoplexies, which are fometimes aferibed to fulnefs of blood, are attended with flow pulfe ; and as in animals dy- ing in the flaughter-houfe from deficiency of blood the pulfe be- comes frequent in extreme * may not the frequency of pulfe in fevers Sup. I. ii. i. THEORY OF FEVER. 477 fevers with arterial debility be in general owing to paucity of blood ? as explained in Sett. XXXII. 2. 3. and its flownefs in parefis irritativa be caufed by the debility being accompanied with due quantity of blood ? or may not the former circum- ftance fometimes depend on a concomitant affection of the brain approaching to ileep ? or to the unufual facility of the paffage of the blood through the pulmonary and aortal capillaries ? in which circumftance the heart may completely empty itfelf at each pulfation, though its contradtions may be weak. While the latter depends on the difficulty of the paffage of the blood through the pulmonary or aortal capillaries, as in the cold fits of intermittents, and in fome palpitations of the heart, and in fome kinds of hsemoptoe ; in thefe cafes the increafed refiftance prevents the heart from emptying itfelf, and in confequence a new diaftole fooner occurs, and thus the number of pulfations becomes greater in a given time. 5. In refpedt to the fympathies of adtion, which produce or conftitute fever with debility, the fyftem may be divided into * certain provinces, which are eflentient or oppofite to each oth- er. Firft, the lacteals or abforbent vefiels of the ftomach, and upper part of the inteftines ; fecondly, the lymphatics or all the other branches of the abforbent vefiels, which arife from the lkin, mucous membranes, cellular membranes, and the various glands. Thefe two divifions adt by reverfe fympathy with each other in the hot fits of fever with debility, though by diredt fympathy in the cold ones. The third divifion confifts of the fecerning vefiels of the ftomach and upper inteftines ; and the fourth of the fecerning vefiels of all the other parts of the body, as the capillary glands of the fkin, lungs, and cellular membrane, and the various other glands belonging to the fanguiferous fyf- tem. Many of thefe frequently, but the capillaries always, adt by reverfe fympathy with thofe of the third divifion above men- tioned in the hot fits of fever with debility, though by diredl fympathy with them in the cold fits. Fifthly, the mufcular fi» bres of the ftomach, and upper inteftines ; and fixthly, tire muf- cular fibres of the heart and arteries. The adtions of thefe two laft divifions of moving fibres adt by diredt fympathy with each other, both in the cold and hot fits of fevers with debility. The efficient caufe of thofe apparent fympathies in fevers with weak pulfe may be thus underftood. In the cold paroxyfin of fever with weak pulfe, the firft part affedted I believe to be the ftomach, and that it has become torpid by previous violent exertion, as by fwallowing contagious matter mixed with faliva, and not by defedl of ftimulus j as from cold or hunger. The adtions of this important organ, which fympathizes with almoft every 47 s THEORY OF FEVER. Sup. I. i x. 6 . every part of the body, being thus much diminilhed or nearly deftroyed, the fenforial power of aflociation is not excited j which in health contributes to move the heart and arteries, and all the reft of the fyftem ; whence an univerfal torpor occurs. When the hot fit approaches, the ftomach in fevers with ftrong pulfe regains its activity by the accumlation of the fen- forial power either of irritation, if it was the part firft affedfed, or of aflociation if it was affedt ed in fympathy with fome other torpid part, as the fpleen or liver ; which accumulation is pro- duced during its torpor. At the fame time all the other parts of the fyftem acquire greater energy of action by the accumula- tion of the fenforial power of aflociation, which was produced, during their inactivity in the cold fit. But in fevers with weak pulfe the ftomach, in which the fen- forial power of irritation had been previoufly exhaufted by vio- lent adtion, acquires no fuch quick accumulation of fenforial power, but remains in a ftate of torpor after the hot fit com- mences. The .heart and arteries remain alfo in a ftate of tor- por, becaufe there continues to be no excitement of their power of aflociation owing to the torpid motions of the ftomach ; but hence it happens, that there exifts at this time a great accumu- lation of the power of aflociation in the lefs adlive fibres of the heart and arteries ; which, as it is not excited and expended by them, increafes the afiociability of the next link of the aflociated chain of motions, which confifts of the capillaries or other glands ; and that in fo great a degree as to adluate them with unnatural energy, and thus to produce a perpetual hot fit of fe- ver. Becaufe the afiociability of the capillaries is fo much in- creafed by the accumulation of this power, owing to the leflen- ed activity of the heart and arteries, as to overbalance the lef- fened excitement of it by the weaker movements of the heart and arteries. 6. When the accumulation of the fenforial power of irrita- tion caufed by defedt of ftimulus is greater in the firft link of a train of adtions, to which aflociated motions are catenated, than the deficiency of the excitement of the fenforial power of afiocia- tion in the next link, what happens ? — the fuperabundanee of the unemployed fenforial power of the firft link is derived to the fecond ; the afiociability of which thus becomes fo greatly in- creafed, that it adfs more violently than natural, though the ex- citement of its power of aflociation by the leflened adtion of the firft link is lefs than natural. So that in this fituation the with- drawing of an accuftomed ftimulus in fome parts of the fyftem will decreafe the irritative motions of that part, and at the fame time Sup, I. ii . 6 . THEORY OF FEVER. 479 time occafion an increafe of the aflociate motion of another part, which is catenated with it. This circumftance neverthelefs can only occur in thofe parts of the fyftem, whofe natural aCtions are perpetual, and the ac- cumulation of fenforial power on that account very great, when their aCtivity is much leflened by the deduction of their ufual ftimulus ; and are therefore only to be found in the fan- guiferous fyftem, or in the alimentary canal, or in the glands and capillaries. Of the firft of which the following is an inftance. The refpiration of a reduced atmofphere, that is of air mixed with hydrogene or azote, quickens the pulfe, as obferved in the cafe of Mrs. Eaton by Dr. Reynolds and Dr. Thornton ; to which Dr. Beddoes adds in a note that “ he never faw an in- ftance in which a lowered atmofphere did not at the moment quicken the pulfe, while it weakened the action of the heart and arteries.” Conliderations on Factitious Airs, by Thomas Beddoes and James Watt, Part III. p. 6 7. Johnfon, London. By the affiftance of this new faCt, the curious circumftance of the quick production of warmth of the Ikin on covering the head under the bed-clothes, which every one mult at fome time have experienced, receives a more fatisfaCtory explanation, than that which is given in Clafs IV. 1. 1. 2. which was printed before this part of Dr. Beddoes’s Conliderations was publilhed. For if the blood be deprived of its accuftomed quantity of ox- ygen, as in covering the head in bed, and thus breathing an air rendered impure by repeated refpiration, or by breathing a fac- titious air with lefs proportion of oxygen, which in common ref- piration pafies through the moift membranes of the lungs, and mixes with the blood, the pulfaticns of the heart and arteries become weaker, and confequently quicker, by the defeCt of the ftimulus of oxygen. And as thefe veflels are fubjeCt to perpet- ual motion, the accumulation of the fenforial power of irrita- tion becomes fo great by their leflened aCtivity, that it excites the veflels next connected, the cutaneous capillaries for inftance, into more energetic aCtions, fo as to produce increafed heat of the fkin, and greater perfpiration. * How exaCtly this refembles a continued fever, with weak and quick pulfe ! — in the latter the aCtion of the heart and arteries are leflened by defeCt of the excitement of the fenforial power of aflociation, owing to the torpor or leflened aCtions of the ftom- ach ; hence the accumulation of the fenforial power of aflocia- tion in this cafe, as the accumulation of that of irritation in the former, becomes fo abundant as to excite into increafed action the parts mod nearly connected, as the cutaneous capillaries. In refpect to the circumftance mentioned by Sydenham, tha^ 48o THEORY OF FEVER. Sup. I. n. 7. covering the head in bed in a fhort time relieved the pertina- cious ficknefs of the patient, it muft be obferved that when the action of the heart and arteries becomes weakened by the want of the due ftimulus of the proper quantity of oxygen in the blood, an accumulation of the fenforial power of irritation oc- curs in the fibres of the heart and arteries, which then is ex- pended on thofe of the capillary glands, increafing their actions and confequent fecretions and heat. And then the ftomach is thrown into (tronger aftion, both by the greater excitement of its natural quantity of the fenforial power of aflociation by the increafed adtions of the capillaries, and alfo by fome increale of ^Sociability, as it had been previoufly a long time in a (late of torpor or lefs activity than natural, as evinced by its perpetual ficknefs. In a manner fomewhat fimilar to this, is the rednefs of the ficin produced in angry people by the fuperabundance of the un- employed fenforial pow-er of volition, as explained in Clals IV. 2. 3 5. Rubor ex ira. From hence we learn how, when people in fevers with weak pulfe, or in dropfies, become in fane, the abundance of the unemployed fenforial power of volition increafes the adtions of the whole moving fyftem, and cures thofe difeafes. 7. As the orgafm of the capillaries in fevers with weak pulfe is immediately cauied by rhe torpid actions of the heart and ar- teries, as above explained, thh fupplies us with another indica- tion of cure in fuch fevers, and that is to ftimulate thefe organs. This may probably be done by fome kind of medicines, which are known to pafs into the blood unchanged in fome of their properties. It is poffible that nitre, or its acid, may pafs into the blood and increafe the colour of it, and thus increafe its ftimu- lus, and the fame may be fuppofed of other falts, neutral or me- tallic ? As rubia tincloria, madder, colours the bones of young animals, it muft pafs into the blood with its colouring matter at lead unchanged, and perhaps many other medicines may likewife affedf the blood, and thus a£l by ftimulaiing the heart and arteries, as well as b\ ftimulating the ftomach ; which cir- cumftance deferves further attention. Another way of immediately ftimulating the heart and arte- ries would be by transfufing new blood into them. Is it poffible that any other fluid befides blood, as chyle, or milk, or water, could, if managed with great art, be introduced fafely or advan- tageoufly into the vein of a