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Title: Zoonomia, Vol. II - Or, the Laws of Organic Life
Author: Darwin, Erasmus, 1731-1802
Language: English
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listed at the end of the text.



ZOONOMIA;

OR,

THE LAWS

OF

ORGANIC LIFE.

VOL. II.

_By ERASMUS DARWIN, M.D. F.R.S._

AUTHOR OF THE BOTANIC GARDEN.



  Principiò coelum, ac terras, camposque liquentes,
  Lucentemque globum lunæ, titaniaque astra,
  Spiritus intùs alit, totamque infusa per artus
  Mens agitat molem, et magno se corpore miscet.--VIRG. Æn. vi.

  Earth, on whose lap a thousand nations tread,
  And Ocean, brooding his prolific bed,
  Night's changeful orb, blue pole, and silvery zones,
  Where other worlds encircle other suns,
  One Mind inhabits, one diffusive Soul
  Wields the large limbs, and mingles with the whole.



London:
Printed for. J. Johnson, in St. Paul's Church-Yard.
1796.

Entered at Stationers' Hall.



ZOONOMIA;

OR,

THE LAWS OF ORGANIC LIFE.

PART II.

CONTAINING

A CATALOGUE OF DISEASES

DISTRIBUTED INTO

NATURAL CLASSES ACCORDING TO THEIR PROXIMATE CAUSES,

WITH THEIR

SUBSEQUENT ORDERS, GENERA, AND SPECIES,

AND WITH

THEIR METHODS OF CURE.

       *       *       *       *       *

    Hæc, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa ut
    sint et fixa, quæ dixero; sed ut Homunculus unus e multis probabiliora
    conjecturâ sequens.--CIC. TUSC. DISP. l. 1. 9.

       *       *       *       *       *

PREFACE.

All diseases originate in the exuberance, deficiency, or retrograde action,
of the faculties of the sensorium, as their proximate cause; and consist in
the disordered motions of the fibres of the body, as the proximate effect
of the exertions of those disordered faculties.

The sensorium possesses four distinct powers, or faculties, which are
occasionally exerted, and produce all the motions of the fibrous parts of
the body; these are the faculties of producing fibrous motions in
consequence of irritation which is excited by external bodies; in
consequence of sensation which is excited by pleasure or pain; in
consequence of volition which is excited by desire or aversion; and in
consequence of association which is excited by other fibrous motions. We
are hence supplied with four natural classes of diseases derived from their
proximate causes; which we shall term those of irritation, those of
sensation, those of volition, and those of association.

In the subsequent classification of diseases I have not adhered to the
methods of any of those, who have preceded me; the principal of whom are
the great names of Sauvages and Cullen; but have nevertheless availed
myself, as much as I could, of their definitions and distinctions.

The essential characteristic of a disease consists in its proximate cause,
as is well observed by Doctor Cullen, in his Nosologia Methodica, T. ii.
Prolegom. p. xxix. Similitudo quidem morborum in similitudine causæ eorum
proximæ, qualiscunque sit, reverâ consistit. I have taken the proximate
cause for the classic character. The characters of the orders are taken
from the excess, or deficiency, or retrograde action, or other properties
of the proximate cause. The genus is generally derived from the proximate
effect. And the species generally from the locality of the disease in the
system.

Many species in this system are termed genera in the systems of other
writers; and the species of those writers are in consequence here termed
varieties. Thus in Dr. Cullen's Nosologia the variola or small-pox is
termed a genus, and the distinct and confluent kinds are termed species.
But as the infection from the distinct kind frequently produces the
confluent kind, and that of the confluent kind frequently produces the
distinct; it would seem more analogous to botanical arrangement, which
these nosologists profess to imitate, to call the distinct and confluent
small-pox varieties than species. Because the species of plants in
botanical systems propagate others similar to themselves; which does not
uniformly occur in such vegetable productions as are termed varieties.

In some other genera of nosologists the species have no analogy to each
other, either in respect to their proximate cause, or to their proximate
effect, though they may he somewhat similar in less essential properties;
thus the thin and saline discharge from the nostrils on going into the cold
air of a frosty morning, which is owing to the deficient action of the
absorbent vessels of the nostrils, is one species; and the viscid mucus
discharged from the secerning vessels of the same membrane, when inflamed,
is another species of the same genus, Catarrhus. Which bear no analogy
either in respect to their immediate cause or to their immediate effect.

The uses of the method here offered to the public of classing diseases
according to their proximate causes are, first, more distinctly to
understand their nature by comparing their essential properties. Secondly,
to facilitate the knowledge of the methods of cure; since in natural
classification of diseases the species of each genus, and indeed the genera
of each order, a few perhaps excepted, require the same general medical
treatment. And lastly, to discover the nature and the name of any disease
previously unknown to the physician; which I am persuaded will be more
readily and more certainly done by this natural system, than by the
artificial classifications already published.

The common names of diseases are not well adapted to any kind of
classification, and least of all to this from their proximate causes. Some
of their names in common language are taken from the remote cause, as
worms, stone of the bladder; others from the remote effect, as diarrhoea,
salivation, hydrocephalus; others from some accidental symptom of the
disease, as tooth-ach, head-ach, heart-burn; in which the pain is only a
concomitant circumstance of the excess or deficiency of fibrous actions,
and not the cause of them. Others again are taken from the deformity
occasioned in consequence of the unnatural fibrous motions, which
constitute diseases, as tumours, eruptions, extenuations; all these
therefore improperly give names to diseases; and some difficulty is thus
occasioned to the reader in endeavouring to discover to what class such
disorders belong.

Another difficulty attending the names of diseases is, that one name
frequently includes more than one disease, either existing at the same time
or in succession. Thus the pain of the bowels from worms is caused by the
increased action of the membrane from the stimulus of those animals; but
the convulsions, which sometimes succeed these pains in children, are
caused by the consequent volition, and belong to another class.

To discover under what class any disease should be arranged, we must first
investigate the proximate cause; thus the pain of the tooth-ach is not the
cause of any diseased motions, but the effect; the tooth-ach therefore does
not belong to the class of Sensation. As the pain is caused by increased or
decreased action of the membranes of the tooth, and these actions are owing
to the increase or decrease of irritation, the disease is to be placed in
the class of irritation.

To discover the order it must be inquired, whether the pain be owing to
increased or defective motion of the pained membrane; which is known by the
concomitant heat or coldness of the part. In tooth-ach without inflammation
there is generally a coldness attends the cheek in its vicinity; as may be
perceived by the hand of the patient himself, compared with the opposite
cheek. Hence odontalgia is found to belong to the order of decreased
irritation. The genus and species must be found by inspecting the synopsis
of the second order of the class of Irritation. See Class I. 2. 4. 12.

This may be further elucidated by considering the natural operation of
parturition; the pain is occasioned by the increased action or distention
of the vessels of the uterus, in consequence of the stimulus of the fetus;
and is therefore caused by increased irritation; but the action of the
abdominal muscles in its exclusion are caused by the pain, and belong to
the class of increased sensation. See Class II. 1. 1. 12. Hence the
difficulty of determining, under what class of diseases parturition should
be arranged, consists in there being two kinds of diseased actions
comprehended under one word; which have each their different proximate
cause.

In Sect. XXXIX. 8. 4. and in Class II. 1. 1. 1. we have endeavoured to give
names to four links of animal causation, which conveniently apply to the
classification of diseases; thus in common nictitation, or winking with the
eyes without our attention to it, the increased irritation is the proximate
cause; the stimulus of the air on the dry cornea is the remote cause; the
closing of the eyelid is the proximate effect; and the diffusion of tears
over the eye-ball is the remote effect. In some cases two more links of
causation may be introduced; one of them may be termed the pre-remote
cause; as the warmth or motion of the atmosphere, which causes greater
exhalation from the cornea. And the other the post-remote effect; as the
renewed pellucidity of the cornea; and thus six links of causation may be
expressed in words.

But if amid these remote links of animal causation any of the four powers
or faculties of the sensorium be introduced, the reasoning is not just
according to the method here proposed; for these powers of the sensorium
are always the proximate causes of the contractions of animal fibres; and
therefore in true language cannot be termed their remote causes. From this
criterion it may always be determined, whether more diseases than one are
comprehended under one name; a circumstance which has much impeded the
investigation of the causes, and cures of diseases.

Thus the term fever, is generally given to a collection of morbid symptoms;
which are indeed so many distinct diseases, that sometimes appear together,
and sometimes separately; hence it has no determinate meaning, except it
signifies simply a quick pulse, which continues for some hours; in which
sense it is here used.

In naming diseases I have endeavoured to avoid the affectation of making
new compound Greek words, where others equally expressive could be
procured: as a short periphrasis is easier to be understood, and less
burthensome to the memory.

In the Methodus Medendi, which is marked by M.M. at the end of many of the
species of diseases, the words incitantia, sorbentia, torpentia, &c. refer
to the subsequent articles of the Materia Medica, explaining the operations
of medicines.

The remote causes of many diseases, their periods, and many circumstances
concerning them, are treated of in the preceding volume; the descriptions
of many of them, which I have omitted for the sake of brevity, may be seen
in the Nosologia Methodica of Sauvages, and in the Synopsis Nosologiæ of
Dr. Cullen, and in the authors to which they refer.

In this arduous undertaking the author solicits the candour of the critical
reader; as he cannot but foresee, that many errors will be discovered, many
additional species will require to be inserted; and others to be
transplanted, or erased. If he could expend another forty years in the
practice of medicine, he makes no doubt, but that he could bring this work
nearer perfection, and thence render it more worthy the attention of
philosophers.----As it is, he is induced to hope, that some advantages will
be derived from it to the science of medicine, and consequent utility to
the public, and leaves the completion of his plan to the industry of future
generations.

  DERBY, _Jan._ 1, 1796.

       *       *       *       *       *


ZOONOMIA.

PART II.

       *       *       *       *       *

CLASSES OF DISEASES.

       *       *       *       *       *

  I.  DISEASES OF IRRITATION.

  II. DISEASES OF SENSATION.

  III. DISEASES OF VOLITION.

  IV. DISEASES OF ASSOCIATION.

       *       *       *       *       *


_The Orders and Genera of the First Class of Diseases._

       *       *       *       *       *

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENERA.

  1. With increased actions of the sanguiferous system.
  2. With increased actions of the secerning system.
  3. With increased actions of the absorbent system.
  4. With increased actions of other cavities and membranes.
  5. With increased actions of the organs of sense.

ORDO II.

_Decreased Irritation._

GENERA.

  1. With decreased actions of the sanguiferous system.
  2. With decreased actions of the secerning system.
  3. With decreased actions of the absorbent system.
  4. With decreased actions of other cavities and membranes.
  5. With decreased actions of the organs of sense.

ORDO III.

_Retrograde Irritative Motions._

GENERA.

  1. Of the alimentary canal.
  2. Of the absorbent system.
  3. Of the sanguiferous system.

       *       *       *       *       *

_The Orders, Genera, and Species, of the First Class of Diseases._

       *       *       *       *       *

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENUS I.

_With Increased Actions of the Sanguiferous System._

SPECIES.

  1. _Febris irritativa._            Irritative fever.
  2. _Ebrietas._                     Drunkenness.
  3. _Hæmorrhagia arteriosa._        Arterial hæmorrhage.
  4. _Hæmoptoe arteriosa._           Spitting of arterial blood.
  5. _Hæmorrhagia narium._           Bleeding from the nose.

GENUS II.

_With Increased Actions of the Secerning System._

SPECIES.

   1. _Calor febrilis._              Febrile heat.
   2. _Rubor febrilis._              Febrile redness.
   3. _Sudor calidus._               Warm sweat.
      ---- _febrilis._               Sweat in fevers.
      ---- _a labore._               ---- from exercise.
      ---- _ab igne._                ---- from fire.
      ---- _a medicamentis._         ---- from medicines.
   4. _Urina uberior colorata._      Copious coloured urine.
   5. _Diarrhoea calida._            Warm diarrhoea.
      ---- _febrilis._               ---- from fever.
      ---- _crapulosa._              ---- from indigestion.
      ---- _infantum._               ---- of infants.
   6. _Salivatio calida._            ---- salivation.
   7. _Catarrhus calidus._           ---- catarrh.
   8. _Expectoratio calida._         ---- expectoration.
   9. _Exsudatio pone aures._        Discharge behind the ears.
  10. _Gonorrhoea calida._           Warm gonorrhoea.
  11. _Fluor albus calidus._         ---- fluor albus.
  12. _Hæmorrhois alba._             White piles.
  13. _Serum e visicatorio._         Discharge from a blister.
  14. _Perspiratio foetida._         Fetid perspiration.
  15. _Crines novi._                 New hairs.

GENUS III.

_With increased Actions of the Absorbent System._

SPECIES.

   1. _Lingua arida._                 Dry tongue.
   2. _Fauces aridæ._                 Dry throat.
   3. _Nares aridi._                  Dry nostrils.
   4. _Expectoratio solida._          Solid expectoration.
   5. _Constipatio alvi._             Costiveness.
   6. _Cutis arida._                  Dry skin.
   7. _Urina parcior colorata._       Diminished coloured urine.
   8. _Calculus felleus et icterus._  Gall-stone and jaundice.
   9. ---- _renis._                   Stone of the kidney.
  10. ---- _vesicæ._                  Stone of the bladder.
  11. ---- _arthriticus._             Gout-stone.
  12. _Rheumatismus chronicus._       Chronic rheumatism.
  13. _Cicatrix vulnerum._            Healing of ulcers.
  14. _Corneæ obfuscatio._            Scar on the cornea.

GENUS IV.

_With increased Actions of other Cavities and Membranes._

SPECIES.

   1. _Nictitatio irritativa._        Irritative nictitation.
   2. _Deglutitio irritativa._        Irritative deglutition.
   3. _Respiratio et tussis._         Respiration and cough.
   4. _Exclusio bilis._               Exclusion of the bile.
   5. _Dentitio._                     Toothing.
   6. _Priapismus._                   Priapism.
   7. _Distensio mamularum._          Distention of the nipples.
   8. _Descensus uteri._              Descent of the uterus.
   9. _Prolapsus ani._                Descent of the rectum.
  10. _Lumbricus._                    Round worm.
  11. _Tænia._                        Tape-worm.
  12. _Ascarides._                    Thread-worms.
  13. _Dracunculus._                  Guinea-worm.
  14. _Morpiones._                    Crab-lice.
  15. _Pediculi._                     Lice.

GENUS V.

_With increased Actions of the Organs of Sense._

SPECIES.

   1. _Visus acrior._              Acuter sight.
   2. _Auditus acrior._            ---- hearing.
   3. _Olfactus acrior._           ---- smell.
   4. _Gustus acrior._             ---- taste.
   5. _Tactus acrior._             ---- touch.
   6. _Sensus caloris acrior._     ---- sense of heat.
   7. ---- _extensionis acrior._   ---- sense of extension.
   8. _Titillatio._                Tickling.
   9. _Pruritus._                  Itching.
  10. _Dolor urens._               Smarting.
  11. _Consternatio._              Surprise.

ORDO II.

_Decreased Irritation._

GENUS I.

_With decreased Actions of the Sanguiferous System._

SPECIES.

   1. _Febris inirritativa._     Inirritative fever.
   2. _Paresis inirritativa._    ---- debility.
   3. _Somnus interruptus._      Interrupted sleep.
   4. _Syncope._                 Fainting.
   5. _Hæmorrhagia venosa._      Venous hæmorrhage.
   6. _Hæmorrhois cruenta._      Bleeding piles.
   7. _Hæmorrhagia renum._       ---- from the kidneys.
   8. ---- _hepatis._            ---- from the liver.
   9. _Hæmoptoe venosa._         Spitting of venous blood.
  10. _Palpitatio cordis._       Palpitation of the heart.
  11. _Menorrhagia._             Exuberant menstruation.
  12. _Dysmenorrhagia._          Deficient menstruation.
  13. _Lochia nimia._            Too great lochia.
  14. _Abortio spontanea._       Spontaneous abortion.
  15. _Scorbutus._               Scurvy.
  16. _Vibices._                 Extravasations of blood.
  17. _Petechiæ._                Purple spots.

GENUS II.

_With decreased Actions of the Secerning System._

SPECIES.

   1. _Frigus febrile._          Coldness in fevers.
      ---- _chronicum._          ---- permanent.
   2. _Pallor fugitivus._        Paleness fugitive.
      ---- _permanens._          ---- permanent.
   3. _Pus parcius._             Diminished pus.
   4. _Mucus parcior._           Diminished mucus.
   5. _Urina parcior pallida._   Pale diminished urine.
   6. _Torpor hepaticus._        Torpor of the liver.
   7. _Torpor pancreatis._       Torpor of the pancreas.
   8. _Torpor renis._            Torpor of the kidney.
   9. _Punctæ mucosæ vultus._    Mucous spots on the face.
  10. _Maculæ cutis fulvæ._      Tawny blots on the skin.
  11. _Canities._                Grey hairs.
  12. _Callus._                  Callus.
  13. _Cataracta._               Cataract.
  14. _Innutritio ossium._       Innutrition of the bones.
  15. _Rachitis._                Rickets.
  16. _Spina distortio._         Distortion of the spine.
  17. _Claudicatio coxaria._     Lameness of the hip.
  18. _Spina protuberans._       Protuberant spine.
  19. _Spina bifida._            Divided spine.
  20. _Defectus palati._         Defect of the palate.

GENUS III.

_With decreased Actions of the Absorbent System._

SPECIES.

   1. _Mucus faucium frigidus._           Cold mucus from the throat.
   2. _Sudor frigidus._                   ---- sweat.
   3. _Catarrhus frigidus._               ---- catarrh.
   4. _Expectoratio frigida._             ---- expectoration.
   5. _Urina uberior pallida._            Copious pale urine.
   6. _Diarrhoea frigida._                Cold diarrhoea.
   7. _Fluor albus frigidus._             ---- fluor albus.
   8. _Gonorrhoea frigida._               ---- gonorrhoea.
   9. _Hepatis tumor._                    Swelling of the liver.
  10. _Chlorosis._                        Green sickness.
  11. _Hydrocele._                        Dropsy of the vagina testis.
  12. _Hydrocephalus internus._           ---- of the brain.
  13. _Ascites._                          ---- of the belly.
  14. _Hydrothorax._                      ---- of the chest.
  15. _Hydrops ovarii._                   ---- of the ovary.
  16. _Anasarca pulmonum._                ---- of the lungs.
  17. _Obesitas._                         Corpulency.
  18. _Splenis tumor._                    Swelling of the spleen.
  19. _Genu tumor albus._                 White swelling of the knee.
  20. _Bronchocele._                      Swelled throat.
  21. _Scrophula._                        King's evil.
  22. _Schirrus._                         Schirrus.
  23. ---- _recti._                       ---- of the rectum.
  24. ---- _urethræ._                     ---- of the urethra.
  25. ---- _oesophagi._                   ---- of the throat.
  26. _Lacteorum inirritabilitas._        Inirritability of the lacteals.
  27. _Lymphaticorum inirritabilitas._    Inirritability of the lymphatics.

GENUS IV.

_With decreased Actions of other Cavities and Membranes._

SPECIES.

   1. _Sitis calida._                    Thirst warm.
      ---- _frigida._                    ---- cold.
   2. _Esuries._                         Hunger.
   3. _Nausea sicca._                    Dry Nausea.
   4. _Ægritudo ventriculi._             Sickness of stomach.
   5. _Cardialgia._                      Heart-burn.
   6. _Arthritis ventriculi._            Gout of the stomach.
   7. _Colica flatulenta._               Flatulent colic.
   8. _Colica saturnina._                Colic from lead.
   9. _Tympanitis._                      Tympany.
  10. _Hypochondriasis._                 Hypochondriacism.
  11. _Cephalæa frigida._                Cold head-ach.
  12. _Odontalgia._                      Tooth-ach.
  13. _Otalgia._                         Ear-ach.
  14. _Pleurodyne chronica._             Chronical pain of the side.
  15. _Sciatica frigida._                Cold sciatica.
  16. _Lumbago frigida._                 ---- lumbago.
  17. _Hysteralgia frigida._             ---- pain of the uterus.
  18. _Proctalgia frigida._              ---- pain of the rectum.
  19. _Vesicæ felleæ inirritibilitas_    Inirritability of the gall-bladder
      _et icterus._                      and jaundice.

GENUS V.

_With decreased Actions of the Organs of Sense._

SPECIES.

   1. _Stultitia inirritabilis._      Folly from inirritability.
   2. _Visus imminutus._              Impaired vision.
   3. _Muscæ volitantes._             Dark moving specks.
   4. _Strabismus._                   Squinting.
   5. _Amaurosis._                    Palsy of the optic nerve.
   6. _Auditus imminutus._            Impaired hearing.
   7. _Olfactus imminutus._           ---- smell.
   8. _Gustus imminutus._             ---- taste.
   9. _Tactus imminutus._             ---- touch.
  10. _Stupor._                       Stupor.

ORDO III.

_Retrograde Irritative Motions._

GENUS I.

_Of the Alimentary Canal._

SPECIES.

   1. _Ruminatio._              Chewing the cud.
   2. _Ructus._                 Eructation.
   3. _Apepsia._                Indigestion, water-qualm.
   4. _Vomitus._                Vomiting.
   5. _Cholera._                Cholera.
   6. _Ileus._                  Iliac passion.
   7. _Globus hystericus._      Hysteric strangulation.
   8. _Vomendi conamen inane._  Vain efforts to vomit.
   9. _Borborigmus._            Gurgling of the bowels.
  10. _Hysteria._               Hysteric disease.
  11. _Hydrophobia._            Dread of water.

GENUS II.

_Of the Absorbent System._

SPECIES.

   1. _Catarrhus lymphaticus._      Lymphatic catarrh.
   2. _Salivatio lymphatica._       Lymphatic salivation.
   3. _Nausea humida._              Moist nausea.
   4. _Diarrhoea lymphatica._       Lymphatic flux.
   5. _Diarrhoea chylifera._        Flux of chyle.
   6. _Diabætes._                   Diabetes.
   7. _Sudor lymphaticus._          Lymphatic sweat.
   8. _Sudor asthmaticus._          Asthmatic sweat.
   9. _Translatio puris._           Translation of matter.
  10. ---- _lactis._                ---- of milk.
  11. ---- _urinæ._                 ---- of urine.

GENUS III.

_Of the Sanguiferous System._

SPECIES.

  1. _Capillarium motus retrogressus._   Retrograde motion of the
                                         capillaries.
  2. _Palpitatio cordis._                Palpitation of the heart.
  3. _Anhelatio spasmodica._             Spasmodic panting.

       *       *       *       *       *

CLASS I.

DISEASES OF IRRITATION.

ORDO I.

_Increased Irritation._

GENUS I.

_With increased Actions of the Sanguiferous System._

The irritability of the whole, or of part, of our system is perpetually
changing; these vicissitudes of irritability and of inirritability are
believed to depend on the accumulation or exhaustion of the sensorial
power, as their proximate cause; and on the difference of the present
stimulus, and of that which we had previously been accustomed to, as their
remote cause. Thus a smaller degree of heat produces pain and inflammation
in our hands, after they have been for a time immersed in snow; which is
owing to the accumulation of sensorial power in the moving fibres of the
cutaneous vessels during their previous quiescence, when they were benumbed
with cold. And we feel ourselves cold in the usual temperature of the
atmosphere on coming out of a warm room; which is owing to the exhaustion
of sensorial power in the moving fibres of the vessels of the skin by their
previous increased activity, into which they were excited by unusual heat.

Hence the cold fits of fever are the occasion of the succeeding hot ones;
and the hot fits contribute to occasion in their turn the succeeding cold
ones. And though the increase of stimulus, as of heat, exercise, or
distention, will produce an increased action of the stimulated fibres; in
the same manner as it is produced by the increased irritability which was
occasioned by a previous defect of stimulus; yet as the excesses of
irritation from the stimulus of external things are more easily avoided
than the deficiencies of it; the diseases of this country, except those
which are the consequences of drunkenness, or of immoderate exercise, more
frequently begin with torpor than with orgasm; that is, with inactivity of
some parts, or of the whole of the system, and consequent coldness, than
with increased activity, and consequent heat.

If the hot fit be the consequence of the cold one, it may be asked if they
are proportionate to each other: it is probable that they are, where no
part is destroyed by the cold fit, as in mortification or death. But we
have no measure to distinguish this, except the time of their duration;
whereas the extent of the torpor over a greater or less part of the system,
which occasions the cold fit; or of the exertion which occasions the hot
one; as well as the degree of such torpor or exertion, are perhaps more
material than the time of their duration. Besides this some muscles are
less liable to accumulate sensorial power during their torpor, than others,
as the locomotive muscles compared with the capillary arteries; on all
which accounts a long cold fit may often be followed by a short hot one.

SPECIES.

1. _Febris irritativa._ Irritative fever. This is the synocha of some
writers, it is attended with strong pulse without inflammation; and in this
circumstance differs from the febris inirritativa of Class I. 2. 1. 1.
which is attended with weak pulse without inflammation. The increased
frequency of the pulsation of the heart and arteries constitutes fever;
during the cold fit these pulsations are always weak, as the energy of
action is then decreased throughout the whole system; and therefore the
general arterial strength cannot be determined by the touch, till the cold
part of the paroxysm ceases. This determination is sometimes attended with
difficulty; as strong and weak are only comparative degrees of the greater
or less resistance of the pulsation of the artery to the compression of the
finger. But the greater or less frequency of the pulsations affords a
collateral evidence in those cases, where the degree of strength is not
very distinguishable, which may assist our judgment concerning it. Since a
moderately strong pulse, when the patient is in a recumbent posture, and
not hurried in mind, seldom exceeds 120 strokes in a minute; whereas a weak
one often exceeds 130 in a recumbent posture, and 150 in an erect one, in
those fevers, which are termed nervous or putrid. See Sect. XII. 1. 4.

The increased frequency of the pulsation of the heart and arteries, as it
is occasioned either by excess or defect of stimulus, or of sensorial
power, exists both in the cold and hot fits of fever; but when the cold fit
ceases, and the pulse becomes strong and full as well as quick, in
consequence of the increased irritability of the heart and arteries, it
constitutes the irritative fever, or synocha. It is attended with
considerable heat during the paroxysm, and generally terminates in a
quarter of a lunation, without any disturbance of the faculties of the
mind. See Class IV. 1. 1. 8.

M. M. Venesection. Emetics. Cathartics. Cool the patient in the hot fit,
and warm him in the cold one. Rest. Torpentia.

2. _Ebrietas._ Drunkenness. By the stimulus of wine or opium the whole
arterial system, as well as every other part of the moving system, is
excited into increased action. All the secretions, and with them the
production of sensorial power itself in the brain, seem to be for a time
increased, with an additional quantity of heat, and of pleasureable
sensation. See Sect. XXI. on this subject. This explains, why at the
commencement of the warm paroxysm of some fevers the patient is in greater
spirits, or vivacity; because, as in drunkenness, the irritative motions
are all increased, and a greater production of sensation is the
consequence, which when in a certain degree, is pleasureable, as in the
diurnal fever of weak people. Sect. XXXVI. 3. 1.

3. _Hæmorrhagia arteriosa._ Arterial hæmorrhage. Bleeding with a quick,
strong, and full pulse. The hæmorrhages from the lungs, and from the nose,
are the most frequent of these; but it sometimes happens, that a small
artery but half divided, or the puncture of a leech, will continue to bleed
pertinaciously.

M. M. Venesection. Cathartic with calomel. Divide the wounded artery. Bind
sponge on the puncture. If coffee or charcoal internally? If air with less
oxygen?

4. _Hæmoptoe arteriosa._ Spitting of arterial blood. Blood spit up from the
lungs is florid, because it has just been exposed to the influence of the
air in its passage through the extremities of the pulmonary artery; it is
frothy, from the admixture of air with it in the bronchia. The patients
frequently vomit at the same time from the disagreeable titillation of
blood about the fauces; and are thence liable to believe, that the blood is
rejected from the stomach.

Sometimes an hæmoptoe for several successive days returns in gouty persons
without danger, and seems to supply the place of the gouty paroxysms. Is
not the liver always diseased previous to the hæmoptoe, as in several other
hæmorrhages? See Class I. 2. 1. 9.

M. M. Venesection, a purge, a blister, diluents, torpentia; and afterwards
sorbentia, as the bark, the acid of vitriol, and opium. An emetic is said
to stop a pulmonary hæmorrhage, which it may effect, as sickness decreases
the circulation, as is very evident in the great sickness sometimes
produced by too large a dose of digitalis purpurea.

Dr. Rush says, a table spoonful or two of common salt is successful in
hæmoptoe; this may be owing to its stimulating the absorbent systems, both
the lymphatic, and the venous. Should the patient respire air with less
oxygen? or be made sick by whirling round in a chair suspended by a rope?
One immersion in cold water, or a sudden sprinkling all over with cold
water, would probably stop a pulmonary hæmorrhage. See Sect. XXVII. 1.

5. _Hæmorrhagia narium._ _Epistaxis_. Bleeding at the nose in elderly
subjects most frequently attends those, whose livers are enlarged or
inflamed by the too frequent use of fermented liquors.

In boys it occurs perhaps simply from redundancy of blood; and in young
girls sometimes precedes the approach of the catamenia; and then it shews a
disposition contrary to chlorosis; which arises from a deficiency of red
blood.

M. M. It is stopped by plunging the head into cold water, with powdered
salt hastily dissolved in it; or sometimes by lint strewed over with wheat
flour put up the nostrils; or by a solution of steel in brandy applied to
the vessel by means of lint. The cure in other respects as in hæmoptoe;
when the bleeding recurs at certain periods, after venesection, and
evacuation by calomel, and a blister, the bark and steel must be given, as
in intermittent fevers. See Section XXVII. 1.

       *       *       *       *       *

ORDO I.

_Increased Irritation._

GENUS II.

_With increased Actions of the Secerning System._

These are always attended with increase of partial or of general heat; for
the secreted fluids are not simply separated from the blood, but are new
combinations; as they did not previously exist as such in the blood
vessels. But all new combinations give out heat chemically; hence the
origin of animal heat, which is always increased in proportion to the
secretion of the part affected, or to the general quantity of the
secretions. Nevertheless there is reason to believe, that as we have a
sense purposely to distinguish the presence of greater or less quantities
of heat, as mentioned in Sect. XIV. 6. so we may have certain minute glands
for the secretion of this fluid, as the brain is believed to secrete the
sensorial power, which would more easily account for the instantaneous
production of the blush of shame, and of anger. This subject deserves
further investigation.

SPECIES.

1. _Calor febrilis._ The heat in fevers arises from the increase of some
secretion, either of the natural fluids, as in irritative fevers; or of new
fluids, as in infectious fevers; or of new vessels, as in inflammatory
fevers. The pain of heat is a consequence of the increased extension or
contraction of the fibres exposed to so great a stimulus. See CLASS I. 1.
5. 6.

2. _Rubor febrilis._ Febrile redness. When the cold fit of fever
terminates, and the pulsations of the heart and arteries become strong as
well as quick from the increase of their irritability after their late
quiescence, the blood is impelled forwards into the fine extremities of the
arteries, and the anastomozing capillaries, quicker than the extremities of
the veins can absorb and return it to the heart. Hence the pulse at the
wrist becomes full, as well as quick and strong, and the skin glows with
arterial blood, and the veins become empty and less visible.

In elderly people the force of the heart and arteries becomes less, while
the absorbent power of the veins remains the same; whence the capillary
vessels part with the blood, as soon as it is received, and the skin in
consequence becomes paler; it is also probable, that in more advanced life
some of the finer branches of the arteries coalesce, and become impervious,
and thus add to the opacity of the skin.

3. _Sudor calidus._ Warm sweat may be divided into four varieties,
according to their remote causes. _First_, the perspirable matter is
secreted in as great quantity during the hot fit of fever, as towards the
end of it, when the sweat is seen upon the skin. But during the hot fit the
cutaneous absorbents act also with increased energy, and the exhalation is
likewise increased by the greater heat of the skin; and hence it does not
appear in drops on the surface, but is in part reabsorbed, and in part
dissipated in the atmosphere. But as the mouths of the cutaneous absorbents
are exposed to the cool air or bedclothes; whilst those of the capillary
glands, which secrete the perspirable matter, are exposed to the warmth of
the circulating blood; the former, as soon as the fever-fit begins to
decline, lose their increased action first; and hence the absorption of the
sweat is diminished, whilst the increased secretion of it continues for
some hours afterwards, which occasions it to stand in drops upon the skin.

As the skin becomes cooler, the evaporation of the perspirable matter
becomes less, as well as the absorption of it. And hence the dissipation of
aqueous fluid from the body, and the consequent thirst, are perhaps greater
during the hot fit, than during the subsequent sweat. For the sweats do not
occur, according to Dr. Alexander's experiments, till the skin is cooled
from 112 to 108 degrees of heat; that is, till the paroxysm begins to
decline. From this it appears, that the sweats are not critical to the hot
fit, any more than the hot fit can be called critical to the cold one; but
simply, that they are the natural consequence of the decline of the hot
fit, commencing with the decreased action of the absorbent system, and the
decreased evaporation from the skin. And from hence it may be concluded,
that a fever-fit is not in general an effort of nature to restore health,
as Sydenham considered it, but a necessary consequence of the previous
torpor; and that the causes of fevers would be less detrimental, if the
fever itself could be prevented from existing; as appears in the cool
treatment of the small-pox.

It must be noted that the profuse sweats on the skin are more frequent at
the decline of fever-fits than the copious urine, or loose stools, which
are mentioned below; as the cutaneous absorbents, being exposed to the cool
air, lose their increased action sooner than the urinary or intestinal
absorbents; which open into the warm cavities of the bladder and
intestines; but which are nevertheless often affected by their sympathy
with the cutaneous absorbents. Hence few fevers terminate without a
moisture of the skin; whence arose the fatal practice of forcing sweats by
the external warmth of air or bedclothes in fevers; for external warmth
increases the action of the cutaneous capillaries more than that of the
other secerning vessels; because the latter are habituated to 98 degrees of
heat, the internal warmth of the body; whereas the cutaneous capillaries
being nearer the surface are habitually kept cooler by the contact of the
external air. Sweats thus produced by heat in confined rooms are still more
detrimental; as the air becomes then not only deprived of a part of its
oxygene by frequent respiration, but is loaded with animal effluvia as well
as with moisture, till it can receive no more; and in consequence, while
the cutaneous secretion stands upon the skin in drops for want of
exhalation, the lungs are exposed to an insalubrious atmosphere.

I do not deny, that sweating may be so managed as to be serviceable in
preventing the return of the cold paroxysm of fevers; like the warm bath,
or any other permanent stimulus, as wine, or opium, or the bark. For this
purpose it should be continued till past the time of the expected cold fit,
supported by moderate doses of wine-whey, with spirit of hartshorn, and
moderate degrees of warmth. Its salutary effect, when thus managed, was
probably one cause of its having been so much attended to; and the fetid
smell, which when profuse is liable to accompany it, gave occasion to the
belief, that the supposed material cause of the disease was thus eliminated
from the circulation.

When too great external heat is applied, the system is weakened by excess
of action, and the torpor which causes the cold paroxysm recurs sooner and
more violently. For though some stimuli, as of opium and alcohol, at the
same time that they exhaust the sensorial power by promoting increase of
fibrous action, may also increase the production or secretion of it in the
brain, yet experience teaches us, that the exhaustion far out-balances the
increased production, as is evinced by the general debility, which succeeds
intoxication.

In respect to the fetor attending copious continued sweats, it is owing to
the animalized part of this fluid being kept in that degree of warmth,
which most favours putrefaction, and not suffered to exhale into the
atmosphere. Broth, or other animal mucus, kept in similar circumstances,
would in the same time acquire a putrid smell; yet has this error
frequently produced miliary eruptions, and increased every kind of
inflammatory or sensitive fever.

The ease, which the patient experiences during sweating, if it be not
produced by much external heat, is similar to that of the warm bath; which
by its stimulus applied to the cutaneous vessels, which are generally
cooler than the internal parts of the system, excites them into greater
action; and pleasureable sensation is the consequence of these increased
actions of the vessels of the skin. From considering all these
circumstances, it appears that it is not the evacuation by sweats, but the
continued stimulus, which causes and supports those sweats, which is
serviceable in preventing the returns of fever-fits. And that sweats too
long continued, or induced by too great stimulus of warmth, clothes, or
medicines, greatly injure the patient by increasing inflammation, or by
exhausting the sensorial power. See Class I. 1. 2. 14.

_Secondly_, The sweats produced by exercise or labour are of the warm kind;
as they originate from the increased action of the capillaries of the skin,
owing to their being more powerfully stimulated by the greater velocity of
the blood, and by a greater quantity of it passing through them in a given
time. For the blood during violent exercise is carried forwards by the
action of the muscles faster in the arteries, than it can be taken up by
the veins; as appears by the redness of the skin. And from the consequent
sweats, it is evinced, that the secretory vessels of the skin during
exercise pour out the perspirable matter faster, than the mouths of the
absorbent vessels can drink it up. Which mouths are not exposed to the
increased muscular action, or to the stimulus of the increased velocity and
quantity of the blood, but to the cool air.

_Thirdly_, the increased secretion of perspirable matter occasioned by the
stimulus of external heat belongs likewise to this place; as it is caused
by the increased motions of the capillary vessels; which thus separate from
the blood more perspirable matter, than the mouths of their correspondent
absorbent vessels can take up; though these also are stimulated by external
heat into more energetic action. If the air be stationary, as in a small
room, or bed with closed curtains, the sweat stands in drops on the skin
for want of a quicker exhalation proportioned to the quicker secretion.

A _fourth_ variety of warm perspiration is that occasioned by stimulating
drugs, of which opium and alcohol are the most powerful; and next to these
the spices, volatile alkali, and neutral salts, especially sea salt; that
much of the aqueous part of the blood is dissipated by the use of these
drugs, is evinced by the great thirst, which occurs a few hours after the
use of them. See Art. III. 2. 12. and Art. III. 2. 1.

We may from hence understand, that the increase of this secretion of
perspirable matter by artificial means, must be followed by debility and
emaciation. When this is done by taking much salt, or salted meat, the
sea-scurvy is produced; which consists in the inirritability of the
bibulous terminations of the veins arising from the capillaries; see Class
I. 2. 1. 14. The scrophula, or inirritability of the lymphatic glands,
seems also to be occasionally induced by an excess in eating salt added to
food of bad nourishment. See Class I. 2. 3. 21. If an excess of
perspiration is induced by warm or stimulant clothing, as by wearing
flannel in contact with the skin in the summer months, a perpetual
febricula is excited, both by the preventing the access of cool air to the
skin, and by perpetually goading it by the numerous and hard points of the
ends of the wool; which when applied to the tender skins of young children,
frequently produce the red gum, as it is called; and in grown people,
either an erysipelas, or a miliary eruption, attended with fever. See Class
II. 1. 3. 12.

Shirts made of cotton or calico stimulate the skin too much by the points
of the fibres, though less than flannel; whence cotton handkerchiefs make
the nose sore by frequent use. The fibres of cotton are, I suppose, ten
times shorter than those of flax, and the number of points in consequence
twenty times the number; and though the manufacturers singe their calicoes
on a red-hot iron cylinder, yet I have more than once seen an erysipelas
induced or increased by the stimulus of calico, as well as of flannel.

The increase of perspiration by heat either of clothes, or of fire,
contributes much to emaciate the body; as is well known to jockeys, who,
when they are a stone or two too heavy for riding, find the quickest way to
lessen their weight is by sweating themselves between blankets in a warm
room; but this likewise is a practice by no means to be recommended, as it
weakens the system by the excess of so general a stimulus, brings on a
premature old age, and shortens the span of life; as may be further deduced
from the quick maturity, and shortness of the lives, of the inhabitants of
Hindostan, and other tropical climates.

M. Buffon made a curious experiment to shew this circumstance. He took a
numerous brood of the butterflies of silkworms, some hundreds of which left
their eggs on the same day and hour; these he divided into two parcels; and
placing one parcel in the south window, and the other in the north window
of his house, he observed, that those in the colder situation lived many
days longer than those in the warmer one. From these observations it
appears, that the wearing of flannel clothing next the skin, which is now
so much in fashion, however useful it may be in the winter to those, who
have cold extremities, bad digestions, or habitual coughs, must greatly
debilitate them, if worn in the warm months, producing fevers, eruptions,
and premature old age. See Sect. XXXVII. 5. Class I. 1. 2. 14. Art. III. 2.
1.

4. _Urina uberior colorata._ Copious coloured urine. Towards the end of
fever-fits a large quantity of high coloured urine is voided, the kidneys
continuing to act strongly, after the increased action of the absorbents of
the bladder is somewhat diminished. If the absorbents continue also to act
strongly, the urine is higher coloured, and so loaded as to deposit, when
cool, an earthy sediment, erroneously thought to be the material cause of
the disease; but is simply owing to the secretion of the kidnies being
great from their increased action; and the thinner parts of it being
absorbed by the increased action of the lymphatics, which are spread very
thick on the neck of the bladder; for the urine, as well as perhaps all the
other secreted fluids, is produced from the kidnies in a very dilute state;
as appears in those, who from the stimulus of a stone, or other cause,
evacuate their urine too frequently; which is then pale from its not having
remained in the bladder long enough for the more aqueous part to have been
reabsorbed. The general use of this urinary absorption to the animal
oeconomy is evinced from the urinary bladders of fish, which would
otherwise be unnecessary. High coloured urine in large quantity shews only,
that the secreting vessels of the kidnies, and the absorbents of the
bladder, have acted with greater energy. When there is much earthy
sediment, it shews, that the absorbents have acted proportionally stronger,
and have consequently left the urine in a less dilute state. In this urine
the transparent sediment or cloud is mucous; the opake sediment is probably
coagulable lymph from the blood changed by an animal or chemical process.
The floating scum is oil. The angular concretions to the sides of the pot,
formed as the urine cools, is microcosmic salt. Does the adhesive blue
matter on the sides of the glass, or the blue circle on it at the edge of
the upper surface of the urine, consist of Prussian blue?

5. _Diarrhoea calida._ Warm diarrhoea. This species may be divided into
three varieties deduced from their remote causes, under the names of
diarrhoea febrilis, diarrhoea crapulosa, and diarrhoea infantum. The
febrile diarrhoea appears at the end of fever-fits, and is erroneously
called critical, like the copious urine, and the sweats; whereas it arises
from the increased action of those secerning organs, which pour their
fluids into the intestinal canal (as the liver, pancreas, and mucous
glands), continuing longer than the increased action of the intestinal
absorbents. In this diarrhoea there is no appearance of curdled chyle in
the stools, as occurs in cholera. I. 3. 1. 5.

The _diarrhoea crapulosa_, or diarrhoea from indigestion, occurs when too
great a quantity of food or liquid has been taken; which not being
compleatly digested, stimulates the intestines like any other extraneous
acrid material; and thus produces an increase of the secretions into them
of mucus, pancreatic juice, and bile. When the contents of the bowels are
still more stimulant, as when drastic purges, or very putrescent diet, have
been taken, a cholera is induced. See Sect. XXIX. 4.

The _diarrhoea infantum_, or diarrhoea of infants, is generally owing to
too great acidity in their bowels. Milk is found curdled in the stomachs of
all animals, old as well as young, and even of carnivorous ones, as of
hawks. (Spallanzani.) And it is the gastric juice of the calf, which is
employed to curdle milk in the process of making cheese. Milk is the
natural food for children, and must curdle in their stomachs previous to
digestion; and as this curdling of the milk destroys a part of the acid
juices of the stomach, there is no reason for discontinuing the use of it,
though it is occasionally ejected in a curdled state. A child of a week
old, which had been taken from the breast of its dying mother, and had by
some uncommon error been suffered to take no food but water-gruel, became
sick and griped in twenty-four hours, and was convulsed on the second day,
and died on the third! When all young quadrupeds, as well as children, have
this natural food of milk prepared for them, the analogy is so strong in
favour of its salubrity, that a person should have powerful testimony
indeed of its disagreeing, before he advises the discontinuance of the use
of it to young children in health, and much more so in sickness. The
farmers lose many of their calves, which are brought up by gruel, or gruel
and old milk; and among the poor children of Derby, who are thus fed,
hundreds are starved into the scrophula, and either perish, or live in a
state of wretched debility.

When young children are brought up without a breast, they should for the
first two months have no food but new milk; since the addition of any kind
of bread or flour is liable to ferment, and produce too much acidity; as
appears by the consequent diarrhoea with green dejections and gripes; the
colour is owing to a mixture of acid with the natural quantity of bile, and
the pain to its stimulus. And they should never be fed as they lie upon
their backs, as in that posture they are necessitated to swallow all that
is put into their mouths; but when they are fed, as they are sitting up, or
raised up, when they have had enough, they can permit the rest to run out
of their mouths. This circumstance is of great importance to the health of
those children, who are reared by the spoon, since if too much food is
given them, indigestion, and gripes, and diarrhoea, is the consequence; and
if too little, they become emaciated; and of this exact quantity their own
palates judge the best.

M. M. In this last case of the diarrhoea of children, the food should be
new milk, which by curdling destroys part of the acid, which coagulates it.
Chalk about four grains every six hours, with one drop of spirit of
hartshorn, and half a drop of laudanum. But a blister about the size of a
shilling is of the greatest service by restoring the power of digestion.
See Article III. 2. 1. in the subsequent Materia Medica.

6. _Salivatio calida._ Warm salivation. Increased secretion of saliva. This
may be effected either by stimulating the mouth of the gland by mercury
taken internally; or by stimulating the excretory duct of the gland by
pyrethrum, or tobacco; or simply by the movement of the muscles, which lie
over the gland, as in masticating any tasteless substance, as a lock of
wool, or mastic.

In about the middle of nervous fevers a great spitting of saliva sometimes
occurs, which has been thought critical; but as it continues sometimes two
or even three weeks without the relief of the patient, it may be concluded
to arise from some accidental circumstance, perhaps not unsimilar to the
hysteric ptyalisms mentioned in Class I. 3. 2. 2. See Sect. XXIV.

M. M. Cool air, diluents, warm bath, evacuations.

7. _Catharrhus calidus._ Warm catarrh. Consists in an increased secretion
of mucus from the nostrils without inflammation. This disease, which is
called a cold in the head, is frequently produced by cold air acting for
some time on the membranes, which line the nostrils, as it passes to the
lungs in respiration. Whence a torpor of the action of the mucous glands is
first introduced, as in I. 2. 3. 3. and an orgasm or increased action
succeeds in consequence. Afterwards this orgasm and torpor are liable to
alternate with each other for some time like the cold and hot fits of ague,
attended with deficient or exuberant secretion of mucus in the nostrils.

At other times it arises from reverse sympathy with some extensive parts of
the skin, which have been exposed too long to cold, as of the head, or
feet. In consequence of the torpor of these cutaneous capillaries those of
the mucous membrane of the nostrils act with greater energy by reverse
sympathy; and thence secrete more mucus from the blood. At the same time
the absorbents, acting also with greater energy by their reverse sympathy
with those of some distant part of the skin, absorb the thinner parts of
the mucus more hastily; whence the mucus is both thicker and in greater
quantity. Other curious circumstances attend this disease; the membrane
becomes at times so thickened by its increased action in secreting the
mucus, that the patient cannot breathe through his nostrils. In this
situation if he warms his whole skin suddenly by fire or bed-clothes, or by
drinking warm tea, the increased action of the membrane ceases by its
reverse sympathy with the skin; or by the retraction of the sensorial power
to other parts of the system; and the patient can breathe again through the
nostrils. The same sometimes occurs for a time on going into the cold air
by the deduction of heat from the mucous membrane, and its consequent
inactivity or torpor. Similar to this when the face and breast have been
very hot and red, previous to the eruption of the small-pox by inoculation,
and that even when exposed to cool air, I have observed the feet have been
cold; till on covering them with warm flannel, as the feet have become
warm, the face has cooled. See Sect. XXXV. 1. 3. Class II. 1. 3. 5. IV. 2.
2. 10. IV. 1. 1. 5.

M. M. Evacuations, abstinence, oil externally on the nose, warm diluent
fluids, warm shoes, warm night-cap.

8. _Expectoratio calida._ Warm expectoration consists of the increased
secretion of mucus from the membrane, which lines the bronchiæ, or
air-cells of the lungs, without inflammation. This increased mucus is
ejected by the action of coughing, and is called a cold, and resembles the
catarrh of the preceding article; with which it is frequently combined.

M. M. Inhale the steam of warm water, evacuations, warm bath, afterwards
opium, sorbentia.

9. _Exsudatio pone aures._ A discharge behind the ears. This chiefly
affects children, and is a morbid secretion; as appears from its fetor; for
if it was owing to defect of absorption, it would be saline, and not fetid;
if a morbid action has continued a considerable time, it should not be
stopped too suddenly; since in that case some other morbid action is liable
to succeed in its stead. Thus children are believed to have had cholics, or
even convulsions, consequent to the too sudden healing of these morbid
effusions behind their ears. The rationale of this is to be explained from
a medical fact, which I have frequently observed; and that is, that a
blister on the back greatly strengthens the power of digestion, and removes
the heart-burn in adults, and green stools in children. The stimulus of the
blister produces sensation in the vessels of the skin; with this additional
sensorial power these vessels act more strongly; and with these the vessels
of the internal membranes of the stomach and bowels act with greater energy
from their direct sympathy with them. Now the acrid discharge behind the
ears of children produces sensation on that part of the skin, and so far
acts as a small blister. When this is suddenly stopped, a debility of the
digestive power of the stomach succeeds from the want of this accustomed
stimulus, with flatulency, green stools, gripes, and sometimes consequent
convulsions. See Class II. 1. 5. 6. and II. 1. 4. 6.

M. M. If the matter be absorbed, and produces swelling of the lymphatics of
the neck, it should be cured as soon as possible by dusting the part with
white lead, cerussa, in very fine powder; and to prevent any ill
consequence an issue should be kept for about a month in the arm; or a
purgative medicine should be taken, every other day for three or four
times, which should consist of a grain of calomel, and three or four grains
of rhubarb, and as much chalk. If there be no appearance of absorption, it
is better only to keep the parts clean by washing them with warm water
morning and evening; or putting fuller's earth on them; especially till the
time of toothing is past. The tinea, or scald head, and a leprous eruption,
which often appears behind the ears, are different diseases.

10. _Gonorrhea calida._ Warm gleet. Increased discharge of mucus from the
urethra or prostrate gland without venereal desire, or venereal infection.
See Class I. 2. 3. 8.

M. M. Cantharides, balsams, rhubarb, blister in perinæum, cold bath,
injections of metallic salts, flannel shirt, change of the form of the
accustomed chair or saddle of the patient.

11. _Fluor albus calidus._ Warm fluor albus. Increased secretion of mucus
in the vagina or uterus without venereal desire or venereal infection. It
is distinguished from the fluor albus frigidus by the increased sense of
warmth in the part, and by the greater opacity or spissitude of the
material discharged; as the thinner parts are reabsorbed by the increased
action of the absorbents, along with the saline part, whence no smarting or
excoriation attends it.

M. M. Mucilage, as isinglass, hartshorn jelly, gum arabic. Ten grains of
rhubarb every night. Callico or flannel shift, opium, balsams. See Class I.
2. 3. 7.

12. _Hæmorrhois alba._ White piles. An increased discharge of mucus from
the rectum frequently mistaken for matter; is said to continue a few weeks,
and recur like the bleeding piles; and to obey lunar influence. See Class
I. 2. 1. 6.

M. M. Abstinence from vinous spirit. Balsam of copaiva. Spice swallowed in
large fragments, as ten or fifteen black pepper-corns cut in half, and
taken after dinner and supper. Ward's paste, consisting of black pepper and
the powdered root of Helenium Enula.

13. _Serum e vesicatorio._ Discharge from a blister. The excretory ducts of
glands terminate in membranes, and are endued with great irritability, and
many of them with sensibility; the latter perhaps in consequence of their
facility of being excitable into great action; instances of this are the
terminations of the gall-duct in the duodenum, and of the salivary and
lachrymal glands in the mouth and eye; which produce a greater secretion of
their adapted fluids, when the ends of their excretory ducts are
stimulated.

The external skin consists of the excretory ducts of the capillaries, with
the mouths of the absorbents; when these are stimulated by the application
of cantharides, or by a slice of the fresh root of bryonia alba bound on
it, the capillary glands pour an increased quantity of fluid upon the skin
by their increased action; and the absorbent vessels imbibe a greater
quantity of the more fluid and saline part of it; whence a thick mucous or
serous fluid is deposited between the skin and cuticle.

14. _Perspiratio foetida._ Fetid perspiration. The uses of the perspirable
matter are to keep the skin soft and pliant, for the purposes of its easier
flexibility during the activity of our limbs in locomotion, and for the
preservation of the accuracy of the sense of touch, which is diffused under
the whole surface of it to guard us against the injuries of external
bodies; in the same manner as the secretion of tears is designed to
preserve the cornea of the eye moist, and in consequence transparent; yet
has this cutaneous mucus been believed by many to be an excrement; and I
know not how many fanciful theories have been built on its supposed
obstruction. Such as the origin of catarrhs, coughs, inflammations,
erysypelas, and herpes.

To all these it may be sufficient to answer, that the antient Grecians
oiled themselves all over; that some nations have painted themselves all
over, as the Picts of this island; that the Hottentots smear themselves all
over with grease. And lastly, that many of our own heads at this day are
covered with the flour of wheat and the fat of hogs, according to the
tyranny of a filthy and wasteful fashion, and all this without
inconvenience. To this must be added the strict analogy between the use of
the perspirable matter and the mucous fluids, which are poured for similar
purposes upon all the internal membranes of the body; and besides its being
in its natural state inodorous; which is not so with the other excretions
of feces, or of urine.

In some constitutions the perspirable matter of the lungs acquires a
disagreeable odour; in others the axilla, and in others the feet, emit
disgustful effluvia; like the secretions of those glands, which have been
called odoriferæ; as those, which contain the castor in the beaver, and
those within the rectum of dogs, the mucus of which has been supposed to
guard them against the great costiveness, which they are liable to in hot
summers; and which has been thought to occasion canine madness, but which,
like their white excrement, is more probably owing to the deficient
secretion of bile. Whether these odoriferous particles attend the
perspirable matter in consequence of the increased action of the capillary
glands, and can properly be called excrementitous; that is, whether any
thing is eliminated, which could be hurtful if retained; or whether they
may only contain some of the essential oil of the animal; like the smell,
which adheres to one's hand on stroking the hides of some dogs; or like the
effluvia, which is left upon the ground, from the feet of men and other
creatures; and is perceptible by the nicer organs of the dogs, which hunt
them, may admit of doubt.

M. M. Wash the parts twice a day with soap and water; with lime water;
cover the feet with oiled silk socks, which must be washed night and
morning. Cover them with charcoal recently made red hot, and beaten into
fine powder and sifted, as soon as cold, and kept well corked in a bottle,
to be warned off and renewed twice a day. Internally rhubarb grains vi. or
viii. every night, so as to procure a stool or two extraordinary every day,
and thus by increasing one evacuation to decrease another. Cool dress,
diluting liquids?

15. _Crines novi._ New hairs. The black points on the faces of some people
consist of mucus, which is become viscid, and which adheres in the
excretory ducts of the glands of the skin; as described in Class I. 2. 2.
9. and which may be pressed out by the fingers, and resembles little worms.
Similar to this would seem the fabrication of silk, and of cobweb by the
silk worm and spider; which is a secreted matter pressed through holes,
which are the excretory ducts of glands. And it is probable, that the
production of hair on many parts of the body, and at different periods of
life, may be effected by a similar process; and more especially as every
hair may be considered as a slender flexible horn, and is an appendage of
the skin. See Sect. XXXIX. 3. 2. Now as there is a sensitive sympathy
between the glands, which secrete the semen, and the throat, as appears in
the mumps; see Hydrophobia, Class IV. 1. 2. 7. and Parotitis, Class IV. 1.
2. 19. The growth of the beard at puberty seems to be caused by the greater
action of the cutaneous glands about the chin and pubes in consequence of
their sympathy with those of the testes. But this does not occur to the
female sex at their time of puberty, because the sensitive sympathy in them
seems to exist between the submaxillary glands, and the pectoral ones;
which secrete the milk, and afford pleasure both by that secretion, and by
the erection of the mamulæ, or nipples; and by delivering the milk into the
mouth of the child; this sensitive sympathy of the pectoral and
submaxillary glands in women is also observable in the Parotitis, or mumps,
as above referred to.

When hairs grow on the face or arms so as to be disagreeable, they may be
thus readily removed without pain or any ill consequence. Warm the ends of
a pair of nippers or forceps, and stick on them a little rosin, or burgundy
pitch; by these means each single hair may be taken fast hold of; and if it
be then plucked off slowly, it gives pain; but if plucked off suddenly, it
gives no pain at all; because the vis inertiæ of the part of the skin, to
which it adheres, is not overcome; and it is not in consequence separated
from the cellular membrane under it. Some of the hairs may return, which
are thus plucked off, or others may be induced to grow near them; but in a
little time they may be thus safely destroyed; which is much to be
preferred to the methods said to be used in Turkey to eradicate hair; such
as a mixture of orpiment and quick lime; or of liver of sulphur in
solution; which injure the skin, if they are not very nicely managed; and
the hair is liable to grow again as after shaving; or to become white, if
the roots of it have been much inflamed by the causticity of the
application. See Class I. 2. 2. 11. on grey hairs.

       *       *       *       *       *

ORDO I.

_Increased Irritation._

GENUS III.

_With increased Actions of the Absorbent System._

These are not attended with so great increase of heat as in the former
genus, because the fluids probably undergo less chemical change in the
glands of the absorbent system; nor are the glands of the absorbent vessels
so numerous or so extensive as those of the secerning ones. Yet that some
heat is produced by the increased action of the absorbents appears from the
greater general warmth of the skin and extremities of feeble patients after
the exhibition of the peruvian bark, and other medicines of the article
Sorbentia.

SPECIES.

1. _Lingua arida._ Dry tongue occurs in those fevers, where the expired air
is warmer than natural; and happens to all those, who sleep with their
mouths open; the currents of air in respiration increasing the evaporation.
There is also a dryness in the mouth from the increased action of the
absorbent vessels, when a sloe or a crab-apple are masticated; and after
the perforation has been much increased by eating salt or spice, or after
other copious secretions; as after drunkenness, cathartics, or fever fits,
the mucus of the mouth becomes viscid, and in small quantity, from the
increased absorption, adhering to the tongue like a white slough. In the
diabætes, where the thirst is very great, this slough adheres more
pertinaciously, and becomes black or brown, being coloured after a few days
by our aliment or drink. The inspissated mucus on the tongue of those, who
sleep with their mouths open, is sometimes reddened as if mixed with blood,
and sometimes a little blood follows the expuition of it from the fauces
owing to its great adhesion. When this mucus adheres long to the papillæ of
the tongue, the saliva, which it contains in its interstices, like a
sponge, is liable to become putrid, and to acquire a bitter taste, like
other putrid animal substances; which is generally mistaken for an
indication of the presence of bile.

M. M. Warm subacid liquids. See Class I. 2. 5. 8.

2. _Fauces aridæ._ Dry throat. The expuition of a frothy mucus with great
and perpetual hawking occurs in hydrophobia, and is very distressing to the
patient; which may be owing to the increased irritability or sensibility of
the upper part of the oesophagus, which will not permit any fluid to rest
on it.

It affects some people after intoxication, when the lungs remain slightly
inflamed, and by the greater heat of the air in expiration the mucus
becomes too hastily evaporated, and is expectorated with difficulty in the
state of white froth.

I knew a person, who for twenty years always waked with his tongue and
throat quite dry; so that he was necessitated to take a spoonful of water,
as soon as he awoke; otherwise a little blood always followed the forcible
expuition of the indurated mucus from his fauces. See Class II. 1. 3. 17.

M. M. Steel-springs fixed to the night-cap so as to suspend the lower jaw
and keep it closed; or springs of elastic gum. Or a pot of water suspended
over the bed, with a piece of list, or woollen cloth, depending from it,
and held in the mouth; which will act like a syphon, and slowly supply
moisture, or barley water should be frequently syringed into the mouth of
the patient.

3. _Nares aridi._ Dry nostrils with the mucus hardening upon their internal
surface, so as to cover them with a kind of skin or scale, owing to the
increased action of the absorbents of this membrane; or to the too great
dryness of the air, which passes into the lungs; or too great heat of it in
its expiration.

When air is so dry as to lose its transparency; as when a tremulous motion
of it can be seen over corn fields in a hot summer's day; or when a dry
mist, or want of transparency of the air, is visible in very hot weather;
the sense of smell is at the same time imperfect from the dryness of the
membrane, beneath which it is spread.

4. _Expectoratio solida._ Solid expectoration. The mucus of the lungs
becomes hardened by the increased absorption, so that it adheres and forms
a kind of lining in the air-cells, and is sometimes spit up in the form of
branching vessels, which are called polypi of the lungs. See Transact. of
the College, London. There is a rattling or weezing of the breath, but it
is not at first attended with inflammation.

The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polyposa of
Michaelis, if they differ from the peripneumony of infants, seem to belong
to this genus. When the difficulty of respiration is great, venesection is
immediately necessary, and then an emetic, and a blister. And the child
should be kept nearly upright in bed as much as may be. See Tonsillitis,
Class II. 1. 3. 3.

M. M. Diluents, emetics, essence of antimony, foetid gums, onions, warm
bath for half an hour every day for a month. Inhaling the steam of water,
with or without volatile alcali. Soap.

5. _Constipatio alvi._ Costiveness from increased action of the intestinal
absorbents. The feces are hardened in lumps called scybala; which are
sometimes obliged to be extracted from the rectum with a kind of marrow
spoon. This is said to have happened from the patient having taken much
rust of iron. The mucus is also hardened so as to line the intestines, and
to come away in skins, rolled up as they pass along, so as to resemble
worms, for which they are frequently mistaken; and sometimes it is
evacuated in still larger pieces, so as to counterfeit the form of the
intestines, and has been mistaken for a portion of them. Balls of this
kind, nearly as heavy as marble, and considerably hard, from two inches to
five in diameter, are frequently found in the bowels of horses. Similar
balls found in goats have been called Bezoar.

M. M. Cathartics, Diluents, fruit, oil, soap, sulphur, warm bath.
Sprinkling with cold water, cool clothing. See Class I. 2. 4. 18.

6. _Cutis arida._ Dry skin. This dry skin is not attended with coldness as
in the beginning of fever-fits. Where this cutaneous absorption is great,
and the secreted material upon it viscid, as on the hairy scalp, the skin
becomes covered with hardened mucus; which adheres so as not to be easily
removed, as the scurf on the head; but is not attended with inflammation
like the Tinea, or Lepra. The moisture, which appears on the skin beneath
resinous or oily plasters, or which is seen to adhere to such plasters, is
owing to their preventing the exhalation of the perspirable matter, and not
to their increasing the production of it, as some have idly imagined.

M. M. Warm bathing, oil externally, oil-skin gloves, resinous plasters.
Wax.

7. _Urina parca colorata._ Diminished urine, which is high coloured, and
deposits an earthy sediment, when cold, is owing to the great action of the
urinary absorbents. See Class I. 1. 2. 4. In some dropsies the cutaneous
absorbents are paralytic, as well as those opening into the cellular
membrane; and hence, no moisture being acquired from the atmosphere, or
from the cellular membrane, great thirst is excited; and great absorption
from all parts, where the absorbents are still capable of action. Hence the
urine is in very small quantity, and of deep colour, with copious sediment;
and the kidneys are erroneously blamed for not doing their office;
stimulant diuretic medicines are given in vain; and very frequently the
unhappy patient is restrained from quenching his thirst, and dies a martyr
to false theory.

M. M. Diluent liquids, and warm bathing, are the natural cure of this
symptom; but it generally attends those dropsies, which are seldom curable;
as they are owing to a paralysis both of the cutaneous and cellular
lymphatics.

8. _Calculus felleus._ Gall-stone. From the too hasty absorption of the
thinner parts of the bile, the remainder is left too viscid, and
crystallizes into lumps; which, if too large to pass, obstruct the ductus
choledochus, producing pain at the pit of the stomach, and jaundice. When
the indurated bile is not harder than a boiled pea, it may pass through the
bile-duct with difficulty by changing its form; and thus gives those pains,
which have been called spasms of the stomach; and yet these viscid lumps of
bile may afterwards dissolve, and not be visible among the feces.

In two instances I have seen from thirty to fifty gall-stones voided after
taking an oil vomit as below. They were about the size of peas, and
distinguishable when dry by their being inflammable like bad wax, when put
into the flame of a candle. For other causes of jaundice, see Class I. 2.
4. 19.

M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water.
Unboiled acrid vegetables, as lettice, cabbage, mustard, and cresses. When
in violent pain, four ounces of oil of olives, or of almonds, should be
swallowed; and as much more in a quarter of an hour, whether it stays or
not. The patient should lie on the circumference of a large barrel, first
on one side, and then on the other. Electric shocks through the gall-duct.
Factitious Selter's water made by dissolving one dram of Sal Soda in a pint
of water; to half a pint of which made luke-warm add ten drops of marine
acid; to be drank as soon as mixed, twice a day for some months. Opium must
be used to quiet the pain, if the oil does not succeed, as two grains, and
another grain in half an hour if necessary. See Class IV. 2. 2. 4.

9. _Calculus renis._ Stone of the kidney. The pain in the loins and along
the course of the ureter from a stone is attended with retraction of the
testicle in men, and numbness on the inside of the thigh in women. It is
distinguished from the lumbago or sciatica, as these latter are seldom
attended with vomiting, and have pain on the outside of the thigh,
sometimes quite down to the ankle or heel. See Herpes and Nephritis.

Where the absorption of the thinner parts of the secretion takes place too
hastily in the kidnies, the hardened mucus, and consequent calculous
concretions, sometimes totally stop up the tubuli uriniferi; and no urine
is secreted. Of this many die, who have drank much vinous spirit, and some
of them recover by voiding a quantity of white mucus, like chalk and water;
and others by voiding a great quantity of sand, or small calculi. This
hardened mucus frequently becomes the nucleus of a stone in the bladder.
The salts of the urine, called microcosmic salt, are often mistaken for
gravel, but are distinguishable both by their angles of crystallization,
their adhesion to the sides or bottom of the pot, and by their not being
formed till the urine cools. Whereas the particles of gravel are generally
without angles, and always drop to the bottom of the vessel, immediately as
the water is voided.

Though the proximate cause of the formation of the calculous concretions of
the kidneys, and of chalk-stones in the gout, and of the insoluble
concretions of coagulable lymph, which are found on membranes, which have
been inflamed in peripneumony, or rheumatism, consists in the too great
action of the absorbent vessels of those parts; yet the remote cause in
these cases is probably owing to the inflammation of the membranes; which
at that time are believed to secrete a material more liable to coagulate or
concrete, than they would otherwise produce by increased action alone
without the production of new vessels, which constitutes inflammation. As
defined in Class II. 1. 2.

The fluids secreted from the mucous membranes of animals are of various
kinds and consistencies. Hair, silk, scales, horns, fingernails, are owing
to natural processes. Gall-stones, stones found in the intestines of
horses, scurf of the skin in leprosy, stones of the kidnies and bladder,
the callus from the inflamed periosteum, which unites broken bones, the
calcareous cement, which repairs the injured shells of snails, the
calcareous crust on the eggs of birds, the annually renewed shells of
crabs, are all instances of productions from mucous membranes, afterwards
indurated by absorption of their thinner parts.

All these concretions contain phosphoric acid, mucus, and calcareous earth
in different proportions; and are probably so far analogous in respect to
their component parts as well as their mode of formation. Some calcareous
earth has been discovered after putrefaction in the coagulable lymph of
animals. Fordyce's Elements of Practice. A little calcareous earth was
detected by Scheel or Bergman in the calculus of the bladder with much
phosphoric acid, and a great quantity of phosphoric acid is shewn to exist
in oyster-shells by their becoming luminous on exposing them a while to the
sun's light after calcination; as in the experiments of Wilson. Botanic
Garden, P. 1. Canto 1. l. 182, note. The exchange of which phosphoric acid
for carbonic acid, or fixed air, converts shells into limestone, producing
mountains of marble, or calcareous strata.

Now as the hard lumps of calcareous matter, termed crabs' eyes, which are
found in the stomachs of those animals previous to the annual renewal of
their shells, are redissolved, probably by their gastric acid, and again
deposited for that purpose; may it not be concluded, that the stone of the
bladder might be dissolved by the gastric juice of fish of prey, as of
crabs, or pike; or of voracious young birds, as young rooks or hawks, or
even of calves? Could not these experiments be tried by collecting the
gastric juice by putting bits of sponge down the throats of young crows,
and retracting them by a string in the manner of Spallanzani? or putting
pieces of calculus down the throat of a living crow, or pike, and observing
if they become digested? and lastly could not gastric juice, if it should
appear to be a solvent, be injected and born in the bladder without injury
by means of catheters of elastic resin, or caoutchouc?

M. M. Diluents. Cool dress. Frequent change of posture. Frequent horizontal
rest in the day. Bathe the loins every morning with a sponge and cold
water. Aerated alcaline water internally. Abstinence from all fermented or
spirituous liquors. Whatever increases perspiration injures these patients,
as it dissipates the aqueous particles, which ought to dilute the urine.
When the constitution begins to produce gravel, it may I believe be
certainly prevented by a total abstinence from fermented or spirituous
liquors; by drinking much aqueous fluids; as toast and water, tea, milk and
water, lemonade; and lastly by thin clothing, and sleeping on a hardish
bed, that the patient may not lie too long on one side. See Class IV. 2. 2.
2. There is reason to believe, that the daily use of opium contributes to
produce gravel in the kidnies by increasing absorption, when they are
inflamed; in the same manner as is done by fermented or spirituous liquor.
See Class I. 3. 2. 11.

When the kidnies are so obstructed with gravel, that no urine passes into
the bladder; which is known by the external appearance of the lower part of
the abdomen, which, when the bladder is full, seems as if contracted by a
cord between the navel and the bladder; and by the tension on the region of
the bladder distinguishable by the touch; or by the introduction of the
catheter; the following methods of cure are frequently successful.
Venesection to six or eight ounces, ten grains of calomel, and an infusion
of senna with salts and oil, every three hours, till stools are procured.
Then an emetic. After the patient has been thus evacuated, a blister on the
loins should be used; and from ten to twenty electric shocks should be
passed through the kidnies, as large as can be easily borne, once or twice
a day. Along with this method the warm bath should be used for an hour once
or twice a day. After repeated evacuations a clyster, consisting of two
drams of turpentine dissolved by yolk of egg, and sixty drops of tincture
of opium, should be used at night, and repeated, with cathartic medicines
interposed, every night, or alternate nights. Aerated solution of alcali
should be taken internally, and balsam of copaiva, three or four times a
day. Some of these patients recover after having made no water for nine or
ten days.

If a stone sticks in the ureter with incessant vomiting, ten grains of
calomel must be given in small pills as above; and some hours afterwards
infusion of senna and salts and oil, if it can be made to stay on the
stomach. And after the purge has operated four or five times, an opiate is
to be given, if the pain continues, consisting of two grains of opium. If
this does not succeed, ten or twenty electric shocks through the kidney
should be tried, and the purgative repeated, and afterwards the opiate. The
patient should be frequently put into the warm bath for an hour at a time.
Eighty or an hundred drops of laudanum given in a glyster, with two drams
of turpentine, is to be preferred to the two grains given by the stomach as
above, when the pain and vomiting are very urgent.

10. _Calculus vesicæ._ Stone of the bladder. The nucleus, or kernel, of
these concretions is always formed in the kidney, as above described; and
passing down the ureter into the bladder, is there perpetually increased by
the mucus and salts secreted from the arterial system, or by the mucus of
the bladder, disposed in concentric strata. The stones found in the bowels
of horses are also formed on a nucleus, and consist of concentric spheres;
as appears in sawing them through the middle. But as these are formed by
the indurated mucus of the intestines alone without the urinary salts, it
is probable a difference would be found on their analysis.

As the stones of the bladder are of various degrees of hardness, and
probably differ from each other in the proportions at least of their
component parts; when a patient, who labours under this afflicting disease,
voids any small bits of gravel; these should be kept in warm solutions of
caustic alcali, or of mild alcali well aerated; and if they dissolve in
these solutions, it would afford greater hopes, that that which remains in
the bladder, might be affected by these medicines taken by the stomach, or
injected into the bladder.

To prevent the increase of a stone in the bladder much diluent drink should
be taken; as half a pint of water warmed to about eighty degrees, three or
four times a day: which will not only prevent the growth of it, by
preventing any microcosmic salts from being precipitated from the urine,
and by keeping the mucus suspended in it; but will also diminish the stone
already formed, by softening, and washing away its surface. To this must be
added cool dress, and cool bed-clothes, as directed above in the calculus
renis.

When the stone is pushed against or into the neck of the bladder, great
pain is produced; this may sometimes be relieved by the introduction of a
bougie to push the stone back into the fundus of the bladder. Sometimes by
change of posture, or by an opiate either taken into the stomach, or by a
clyster.

A dram of sal soda, or of salt of tartar, dissolved in a pint of water, and
well saturated with carbonic acid (fixed air), by means of Dr. Nooth's
glass-apparatus, and drank every day, or twice a day, is the most
efficacious internal medicine yet discovered, which can be easily taken
without any general injury to the constitution. An aerated alcaline water
of this kind is sold under the name of factitious Seltzer water, by J.
Schweppe, at N^o 8, King's-street, Holborn, London; which I am told is
better prepared than can be easily done in the usual glass-vessels,
probably by employing a greater pressure in wooden ones.

Lythotomy is the last recourse. Will the gastric juice of animals dissolve
calculi? Will fermenting vegetable juices, as sweet-wort, or sugar and
water in the act of fermentation with yest, dissolve any kind of animal
concretions?

11. _Calculus arthriticus._ Gout-stones are formed on inflamed membranes,
like those of the kidnies above described, by the too hasty absorption of
the thinner and saline parts of the mucus. Similar concretions have been
produced in the lungs, and even in the pericardium; and it is probable,
that the ossification, as it is called, of the minute arteries, which is
said to attend old age, and to precede some mortifications of the
extremities, may be a process of this kind.

As gout-stones lie near the surface, it is probable, that ether, frequently
applied in their early state, might render them so liquid as to permit
their reabsorption; which the stimulus of the ether might at the same time
encourage.

12. _Rheumatismus chronicus._ Chronic rheumatism. After the acute
rheumatism some inspissated mucus, or material similar to chalk-stones of
the gout, which was secreted on the inflamed membrane, is probably left,
owing to the too hasty absorption of the thinner and saline part of it; and
by lying on the fascia, which covers some of the muscles, pains them, when
they move and rub against it, like any extraneous material.

The pain of the shoulder, which attends inflammations of the upper membrane
of the liver, and the pains of the arms, which attend asthma dolorificum,
or dropsy of the pericardium, are distinguished from the chronic
rheumatism, as in the latter the pain only occurs on moving the affected
muscles.

M. M. Warm bath, cold bath, bandage of emplastrum de minio put on tight, so
as to compress the part. Cover the part with flannel. With oiled silk. Rub
it with common oil frequently. With ether. A blister. A warmer climate.
Venesection. A grain of calomel and a grain of opium for ten successive
nights. The Peruvian bark.

13. _Cicatrix vulnerum._ The scar after wounds. In the healing of ulcers
the matter is first thickened by increasing the absorption in them; and
then lessened, till all the matter is absorbed, which is brought by the
arteries, instead of being deposed in the ulcer.

M. M. This is promoted by bandage, by the sorbentia externally, as powder
of bark, white lead; solution of sugar of lead. And by the sorbentia
internally after evacuations. See Sect. XXXIII. 3. 2.

In those ulcers, which are made by the contact of external fire, the
violent action of the fibres, which occasions the pain, is liable to
continue, after the external heat is withdrawn. This should be relieved by
external cold, as of snow, salt and water recently mixed, ether, or spirits
of wine suffered to evaporate on the part.

The cicatrix of an ulcer generally proceeds from the edges of it; but in
large ones frequently from the middle, or commences in several places at
the same time; which probably contributes to the unevenness of large scars.

14. _Corneæ obfuscatio._ Opacity of the cornea. There are few people, who
have passed the middle of life, who have not at some time suffered some
slight scratches or injuries of the cornea, which by not healing with a
perfectly smooth surface, occasion some refractions of light, which may be
conveniently seen in the following manner: fill a tea-saucer with cream and
tea, or with milk, and holding it to your lips, as if going to drink it,
the imperfections of the cornea will appear like lines or blotches on the
surface of the fluid, with a less white appearance than that surface. Those
blemishes of the eye are distinguished from the muscæ volitantes described
in Class I. 2. 5. 3. by their being invariably seen at any time, when you
look for them.

Ulcers may frequently be seen on the cornea after ophthalmy, like little
pits or indentations beneath the surface of it: in this case no external
application should be used, lest the scar should be left uneven; but the
cure should be confined to the internal use of thirty grains of bark twice
a day, and from five to ten drops of laudanum at night, with five grains of
rhubarb, if necessary.

After ulcers of the cornea, which have been large, the inequalities and
opacity of the cicatrix obscures the sight; in this case could not a small
piece of the cornea be cut out by a kind of trephine about the size of a
thick bristle, or a small crow-quill, and would it not heal with a
transparent scar? This experiment is worth trying, and might be done by a
piece of hollow steel wire with a sharp edge, through which might be
introduced a pointed steel screw; the screw to be introduced through the
opake cornea to hold it up, and press it against the cutting edge of the
hollow wire or cylinder; if the scar should heal without losing its
transparency, many blind people might be made to see tolerably well by this
slight and not painful operation. An experiment I wish strongly to
recommend to some ingenious surgeon or oculist.

       *       *       *       *       *

ORDO I.

_Increased Irritation._

GENUS IV.

_With increased Actions of other Cavities and Membranes._

SPECIES.

1. _Nictitatio irritativa._ Winking of the eyes is performed every minute
without our attention, for the purpose of cleaning and moistening the
eye-ball; as further spoken of in Class II. 1. 1. 8. When the cornea
becomes too dry, it becomes at the same time less transparent; which is
owing to the pores of it being then too large, so that the particles of
light are refracted by the edges of each pore, instead of passing through
it; in the same manner as light is refracted by passing near the edge of a
knife. When these pores are filled with water, the cornea becomes again
transparent. This want of transparency of the cornea is visible sometimes
in dying people, owing to their inirritability, and consequent neglect of
nictitation.

The increase of transparency by filling the pores with fluid is seen by
soaking white paper in oil; which from an opake body becomes very
transparent, and accounts for a curious atmospheric phenomenon; when there
exists a dry mist in a morning so as to render distant objects less
distinct, it is a sign of a dry day; when distant objects are seen very
distinct, it is a sign of rain. See Botan. Garden, Part I. add. note xxv.
The particles of air are probably larger than those of water, as water will
pass through leather and paper, which will confine air; hence when the
atmosphere is much deprived of moisture, the pores of the dry air are so
large, that the rays of light are refracted by their edges instead of
passing through them. But when as much moisture is added as can be
perfectly dissolved, the air becomes transparent; and opake again, when a
part of this moisture collects into small spherules previous to its
precipitation. This also accounts for the want of transparency of the air,
which is seen in tremulous motions over corn-fields on hot summer-days, or
over brick-kilns, after the flame is extinguished, while the furnace still
remains hot.

2. _Deglutitio irritativa._ The deglutition of our saliva is performed
frequently without our attention, and is then an irritative action in
consequence of the stimulus of it in the mouth. Or perhaps sometimes for
the purpose of diffusing a part of it over the dry membranes of the fauces
and pharinx; in the same manner as tears are diffused over the cornea of
the eye by the act of nictitation to clean or moisten it.

3. _Respiratio et Tussis irritativæ._ In the acts of respiration and of
coughing there is an increased motion of the air-cells of the lungs owing
to some stimulating cause, as described above in Class I. 1. 2. 8. and I.
1. 3. 4. and which are frequently performed without our attention or
consciousness, and are then irritative actions; and thus differ from those
described in Class II. 1. 1. 2. and 5. To these increased actions of the
air-cells are superadded those of the intercostal muscles and diaphragm by
irritative association. When any unnatural stimulus acts so violently on
the organs of respiration as to induce pain, the sensorial power of
sensation becomes added to that of irritation, and inflammation of the
membranes of them is a general consequence.

4. _Exclusio bilis._ The exclusion of the bile from the gall-bladder, and
its derivation into the duodenum, is an irritative action in consequence of
the stimulus of the aliment on the extremity of the biliary duct, which
terminates in the intestine. The increased secretion of tears is occasioned
in a similar manner by any stimulating material in the eyes; which affects
the excretory ducts of the lacrymal glands. A pain of the external membrane
of the eye sometimes attends any unusual stimulus of it, then the sensorial
power of sensation becomes added to that of irritation, and a superficial
inflammation is induced.

5. _Dentitio._ Toothing. The pain of toothing often begins much earlier
than is suspected; and is liable to produce convulsions; which are
sometimes relieved, when the gum swells, and becomes inflamed; at other
times a diarrhoea supervenes, which is generally esteemed a favourable
circumstance, and seems to prevent the convulsions by supplying another
means of relieving the pain of dentition by irritative exertion; and a
consequent temporary exhaustion of sensorial power. See Class I. 1. 2. 5.
Sect. XXXV. 2. 1.

The convulsions from toothing generally commence long before the appearance
of the teeth; but as the two middle incisors of the lower jaw generally
appear first, and then those of the upper, it is adviseable to lance the
gums over these longitudinally in respect to the jaw-bones, and quite down
to the periosteum, and through it.

As the convulsions attending the commencement of toothing are not only
dangerous to life in their greatest degree, but are liable to induce stupor
or insensibility by their continuance even in a less degree, the most
efficacious means should be used to cure them.

M. M. Lance the gum of the expected teeth quite through the periosteum
longitudinally. Venesection by the lancet or by two or three leeches. One
grain of calomel as a purge. Tincture of jalap, five or six drops in water
every three hours til it purges, to be repeated daily. After evacuations a
small blister on the back or behind the ears. And lastly, two or three
drops of laudanum according to the age of the child. Warm bath. See Class
III. 1. 1. 5. and 6.

6. _Priapismus chronicus._ I have seen two cases, where an erection of the
penis, as hard as horn, continued two or three weeks without any venereal
desires, but not without some pain; the easiest attitude of the patients
was lying upon their backs with their knees up. At length the corpus
cavernosum urethræ became soft, and in another day or two the whole
subsided. In one of them a bougie was introduced, hoping to remove some bit
of gravel from the caput gallinaginis, camphor, warm bathing, opium,
lime-water, cold aspersion, bleeding in the veins of the penis, were tried
in vain. One of them had been a free drinker, had much gutta rosacea on his
face, and died suddenly a few months after his recovery from this
complaint. Was it a paralysis of the terminations of the veins, which
absorb the blood from the tumid penis? or from the stimulus of indurated
semen in the seminal vessels? In the latter case some venereal desires
should have attended. Class III. 1. 2. 16.

The priapismus, which occurs to vigorous people in a morning before they
awake, has been called the signum salutis, or banner of health, and is
occasioned by the increase of our irritability or sensibility during sleep,
as explained in Sect. XVIII. 15.

7. _Distentio mamularum._ The distention of the nipples of lactescent women
is at first owing to the stimulus of the milk. See Sect. XIV. 8. and Sect.
XVI. 5. See Class II. 1. 7. 10.

8. _Descensus uteri._ This is a very frequent complaint after bad labours,
the fundus uteri becomes inverted and descends like the prolapsus ani.

M. M. All the usual pessaries are very inconvenient and ineffectual. A
piece of soft sponge about two inches diameter introduced into the vagina
gives great ease to these patients, and supports the uterus; it should have
a string put through it to retract it by.

There are also pessaries now made of elastic gum, which are said to be
easily worn, and to be convenient, from their having a perforation in their
centre.

9. _Prolapsus ani._ The lower part of the rectum becomes inverted, and
descends after every stool chiefly in children; and thus stimulates the
sphincter ani like any other extraneous body.

M. M. It should be dusted over with very fine powder of gum sandarach, and
then replaced. Astringent fomentations; as an infusion of oak-bark, or a
slight solution of alum. Horizontal rest frequently in the day.

10. _Lumbricus._ Round worm. The round worm is suspected in children when
the belly is tumid, and the countenance bloated and pale, with swelling of
the upper lip. The generation of these worms is promoted by the too dilute
state of the bile, as is evident in the fleuke-worm found in the biliary
ducts and substance of the liver in sheep; and in water-rats, in the livers
of which last animals they were lately detected in large numbers by Dr.
Capelle. Transactions of the college at Philadelphia, v. i.

Now as the dilute state of the bile depends on the deficiency of the
absorption of its thinner parts, it appears, that the tumid belly, and
bloated countenance, and swelled upper lip, are a concomitant circumstance
attending the general inactivity of the absorbent system; which is
therefore to be esteemed the remote cause of the generation of worms.

The simplicity of the structure of worms probably enables them to exist in
more various temperatures of heat; and their being endued with life
prevents them from being destroyed by digestion in the stomach, probably in
the same manner as the powers of life prevent the fermentation and
putrefaction of the stomach itself. Hence I conclude, that worms are
originally taken into our alimentary canal from without; as I believe
similar worms of all kinds are to be found out of the body.

M. M. The round worm is destroyed by a cathartic with four or six grains of
calomel; and afterwards by giving six or eight grains of filings of iron
twice a day for a fortnight. See Hepatis tumor, Class I. 2. 3. 9. As worms
are liable to come away in fevers, whether of the hectic or putrid kind,
could they be removed by purulent matter, or rotten egg, or putrid flesh,
since in those fevers from the enfeebled action of the intestines the fæces
become highly putrid?

11. _Tænia._ Tape-worm consists of a chain of animals extending from the
stomach to the anus. See Sect. XXXIX. 2. 3. It frequently exists in cats,
rats, and geese, and probably in many other animals.

The worms of this genus possess a wonderful power of retaining life. Two of
them, which were voided by a pointer dog in consequence of violent
purgatives, each of which were several feet in length, had boiling water
poured on them in a bason; which seemed not much to inconvenience them.
When the water was cool, they were taken out and put into gin or whiskey of
the strongest kind, in which their life and activity continued unimpaired;
and they were at length killed by adding to the spirit a quantity of
corrosive sublimate. Medic. Comment. for 1791, p. 370.

The tape-worm is cured by an amalgama of tin and quicksilver, such as is
used on the back of looking-glasses; an ounce should be taken every two
hours, till a pound is taken; and then a brisk cathartic of Glauber's salt
two ounces, and common salts one ounce, dissolved in two wine pints of
water, half a pint to be taken every hour till it purges. The worm extends
from the stomach to the anus, and the amalgama tears it from the intestine
by mechanical pressure, acting upon it the whole way. Electric shocks
through the duodenum greatly assists the operation. Large doses of tin in
powder. Iron filings in large doses. The powder of fern-root seems to be of
no use, as recommended by M. Noufflier.

12. _Ascarides._ Thread-worms. These worms are said to be more frequent in
some parts of this kingdom than in others, as near the fens of
Lincolnshire. Do they escape from the body and become flies, like the
bott-worm in horses? Do they crawl from one child to another in the same
bed? Are they acquired from flies or worms, which are seen in putrid
necessary houses, as these worms as well as the tapeworms, are probably
acquired from without? this may account for their re-appearance a few weeks
or months after they have been destroyed; or can this happen from the eggs
or parts of them remaining?

Ascarides appear to be of two kinds, the common small ones like a thread;
which has a very sharp head, as appears in the microscope; and which is so
tender, that the cold air soon renders it motionless; and a larger kind
above an inch long, and nearly as thick as a very small crow-quill, and
which is very hard in respect to its texture, and very tenacious of life.
One of these last was brought to me, and was immediately immersed in a
strong solution of sugar of lead, and lived in it a very long time without
apparent inconvenience.

M. M. Ascarides are said to be weakened by twenty grains of cinnabar and
five of rhubarb taken every night, but not to be cured by this process. As
these worms are found only in the rectum, variety of clysters have been
recommended. I was informed of a case, where solutions of mercurial
ointment were used as a clyster every night for a month without success.
Clysters of Harrowgate water are recomended, either of the natural, or of
the factitious, as described below, which might have a greater proportion
of liver of sulphur in it. As the cold air soon destroys them, after they
are voided, could clysters of iced water be used with advantage? or of
spirit of wine and water? or of ether and water? Might not a piece of
candle, about an inch long, or two such pieces, smeared with mercurial
ointment, and introduced into the anus at night, or twice a day, be
effectual by compressing their nidus, as well as by the poison of the
mercury.

The clysters should be large in quantity, that they may pass high in the
rectum, as two drams of tobacco boiled a minute in a pint of water. Or
perhaps what might be still more efficacious and less inconvenient, the
smoke of tobacco injected by a proper apparatus every night, or alternate
nights, for six or eight weeks. This was long since recommended, I think by
Mr. Turner of Liverpool; and the reason it has not succeeded, I believe to
have been owing to the imperfections of the joints of the common apparatus
for injecting the smoke of tobacco, so that it did not pass into the
intestine, though it was supposed to do so, as I once observed. The smoke
should be received from the apparatus into a large bladder; and it may then
be certainly injected like the common clyster with sufficient force;
otherwise oiled leathers should be nicely put round the joints of the
machine; and a wet cloth round the injecting pipe to prevent the return of
the smoke by the sides of it. Clysters of carbonated hydrogen gas, or of
other factitious airs, might be tried.

Harrowgate water taken into the stomach, so as to induce six or seven
stools every morning, for four or six weeks, is perhaps the most
efficacious method in common use. A factitious Harrowgate water may be made
probably of greater efficacy than the natural, by dissolving one ounce of
marine salt, (called bay salt) and half an ounce of magnesia Glauber's
salt, (called Epsom salt, or bitter purging salt) in twenty-eight ounces of
water. A quarter or half a pint of this is to be taken every hour, or two
hours in the morning, till it operates, with a tea-spoonful of a solution
of liver of sulphur, which is to be made by putting an ounce of hepar
sulphuris into half a pint of water. See Class IV. 1. 2. 9.

13. _Dracunculus._ A thin worm brought from the coast of Guinea. It is
found in the interstices of the muscles, and is many yards long; it makes a
small ulcer; which is cured by extracting an inch of the worm a day, and
wrapping the extracted part slowly round a bit of tobacco pipe till next
day, so as not to break it. I have twice seen long worms, like a thick
horse-hair, in water in July in this country, which appeared hard and
jointed.

14. _Morpiones._ Crab-lice. The excrement of this animal stains the linen,
and appears like diluted blood.

M. M. Spirit of wine. Mercurial ointment, shaving the part. Oil destroys
other insects, if they be quite covered with it, as the ticks on dogs, and
would probably therefore destroy these. Its manner of operation is by
stopping up or filling their spiracula, or breathing pores; a few drops of
oil poured on a wasp, so as to cover it, destroys it in a few seconds.

15. _Pediculi._ Lice. There is said to be a disease, in which these animals
are propagated in indestructible numbers, so as to destroy the patient.

M. M. Cleanliness, mercurial ointment, stavis acria in powder, or the
tincture of it in spirit of wine. Spirit of wine alone? Bath of oil?

       *       *       *       *       *

ORDO I.

_Increased Irritation._

GENUS V.

_With Increased Actions of the Organs of Sense._

SPECIES.

1. _Visus acrior._ Acuter sight. There have been instances of people, who
could see better in the gloom of the evening, than in the stronger light of
the day; like owls, and bats, and many quadrupeds, and flying insects. When
the eye is inflamed, great light becomes eminently painful, owing to the
increased irritative motions of the retina, and the consequent increased
sensation. Thus when the eye is dazzled with sudden light, the pain is not
owing to the motion of the iris; for it is the contraction of the iris,
which relieves the pain from sudden light; but to the too violent
contractions of the moving fibres, which constitute the extremities of the
optic nerve.

2. _Auditus acrior._ The irritative ideas of hearing are so increased in
energy as to excite our attention. This happens in some diseases of the
epileptic kind, and in some fevers. Hence the whispering of the currents of
air in a room, the respiration of the company, and noises before
unperceived, become troublesome; and sounds louder than usual, or
unexpected, produce starting, and convulsions.

M. M. Put oil of almonds into the ears. Stop the meatus auditorius with
cotton wool. Set the feet of the patient's bed on cushions, or suspend it
by cords from the ceiling.

3. _Olfactus acrior._ The irritative ideas of smell from the increased
action of the olfactive nerve excite our attention. Hence common odours are
disagreeable; and are perceived from variety of objects, which were before
thought inodorous. These are commonly believed to be hallucinations of the
sense.

M. M. Snuff starch up the nostrils.

4. _Gustus acrior._ The irritative ideas of taste, as of our own saliva,
and even of the atmospheric air, excite our attention; and common tastes
are disagreeably strong.

M. M. Water. Mucilage. Vegetable acids. Scrape the tongue clean. Rub it
with a sage-leaf and vinegar.

5. _Tactus acrior._ The irritative ideas of the nerves of touch excite our
attention: hence our own pressure on the parts, we rest upon, becomes
uneasy with universal soreness.

M. M. Soft feather-bed. Combed wool put under the patients, which rolls
under them, as they turn, and thus prevents their friction against the
sheets. Drawers of soft leather. Plasters of cerate with calamy.

6. _Sensus caloris acrior._ Acuter sense of heat occurs in some diseases,
and that even when the perceptible heat does not appear greater than
natural to the hand of another person. See Class I. 1. 2. See Sect. XIV. 8.
All the above increased actions of our organs of sense separately or
jointly accompany some fevers, and some epileptic diseases; the patients
complaining of the perception of the least light, noises in their ears, bad
smells in the room, and bad tastes in their mouths, with soreness,
numbness, and other uneasy feels, and with disagreeable sensations of
general or partial heat.

7. _Sensus extensionis acrior._ Acuter sense of extension. The sense of
extension was spoken of in Sect. XIV. 7. and XXXII. 4. The defect of
distention in the arterial system is accompanied with faintness; and its
excess with sensations of fulness, or weight, or pressure. This however
refers only to the vascular muscles, which are distended by their
appropriated fluids; but the longitudinal muscles are also affected by
different quantities of extension, and become violently painful by the
excess of it.

These pains of muscles and of membranes are generally divided into acute
and dull pains. The former are generally owing to increase of extension, as
in pricking the skin with a needle; and the latter generally to defect of
extension, as in cold head-aches; but if the edge of a knife, or point of a
pin, be gradually pressed against the fibres of muscles or membranes, there
would seem to be three states or stages of this extension of the fibres;
which have acquired names according to the degree or kind of sensation
produced by the extension of them; these are 1. titillation or tickling. 2.
itching, and the 3. smarting; as described below. See Sect. XIV. 9.

8. _Titillatio._ Tickling is a pleasureable pain of the sense of extension
above mentioned, and therefore excites laughter; as described in Sect.
XXXIV. 1. 4. The tickling of the nostrils, which precedes the efforts of
sneezing, is owing to the increased irritation occasioned by external
stimulus; and is attended with a pleasureable sensation in consequence of
the increased action of the part. When this action is exerted in a greater
degree, the sensation becomes painful, and the convulsion of sneezing
ensues; as the pain in tickling the soles of the feet of children is
relieved by laughter.

A lady after a bruise on her nose by a fall was affected with incessant
sneezing, and relieved by snuffing starch up her nostrils. Perpetual
sneezings in the measles, and in catarrhs from cold, are owing to the
stimulus of the saline part of the mucous effusion on the membrane of the
nostrils. See Class II. 1. 1. 3.

9. _Pruritus._ Itching seems to be a greater degree of titillation, and to
be owing to the stimulus of some acrid material, as the matter of the itch;
or of the herpes on the scrotum, and about the anus; or from those
universal eruptions, which attend some elderly people, who have drank much
vinous spirit. It occurs also, when inflammations are declining, as in the
healing of blisters, or in the cure of ophthalmia, as the action of the
vessels is yet so great as to produce sensation; which, like the
titillations that occasion laughter, is perpetually changing from pleasure
to pain.

When the natural efforts of scratching do not relieve the pain of itching,
it sometimes increases so as to induce convulsions and madness. As in the
furor uterinus, and satyriasis, and in the sphincter ani and scrotum. See
Class II. 1. 4. 14. IV. 2. 2. 6.

M. M. Warm bath. Fomentation. Alcohol externally. Poultice. Oiled silk.
Mercurial ointments on small surfaces at once. See Class II. 1. 4. 12.
Solutions of lead on small surfaces at once.

10. _Dolor urens._ Smarting follows the edge of a knife in making a wound,
and seems to be owing to the distention of a part of a fibre, till it
breaks. A smarting of the skin is liable to affect the scars left by herpes
or shingles; and the callous parts of the bottoms of the feet; and around
the bases of corns on the toes; and frequently extends after sciatica along
the outside of the thigh, and of the leg, and part of the foot. All these
may be owing to the stimulus of extension, by blood or serum being forced
into vessels nearly coalesced.

M. M. Emplastrum de minio put like a bandage on the part. Warm fomentation.
Oil and camphor rubbed on the part. Oil-silk covering. A blister on the
part. Ether, or alcohol, suffered to evaporate on the part.

11. _Consternatio._ Surprise. As our eyes acquaint us at the same time with
less than half of the objects, which surround us, we have learned to
confide much in the organ of hearing to warn us of approaching dangers.
Hence it happens, that if any sound strikes us, which we cannot immediately
account for, our fears are instantly alarmed. Thus in great debility of
body, the loud clapping of a door, or the fall of a fire-shovel, produces
alarm, and sometimes even convulsions; the same occurs from unexpected
sights, and in the dark from unexpected objects of touch.

In these cases the irritability is less than natural, though it is
erroneously supposed to be greater; and the mind is busied in exciting a
train of ideas inattentive to external objects; when this train of ideas is
dissevered by any unexpected stimulus, surprise is excited; as explained in
Sect. XVII. 3. 7. and XVIII. 17. then as the sensibility in these cases is
greater, fear becomes superadded to the surprise; and convulsions in
consequence of the pain of fear. See Sect. XIX. 2.

The proximate cause of surprise is the increased irritation induced by some
violent stimulus, which dissevers our usual trains of ideas; but in
diseases of inirritability the frequent starting or surprise from sounds
not uncommon, but rather louder than usual, as the clapping of a door,
shews, that the attention of the patient to a train of sensitive ideas was
previously stronger than natural, and indicates an incipient delirium;
which is therefore worth attending to in febrile diseases.

       *       *       *       *       *

ORDO II.

_Decreased Irritation._

GENUS I.

_With decreased Action of the Sanguiferous System._

The reader should be here apprized, that the words strength and debility,
when applied to animal motions, may properly express the quantity of
resistance such motions may overcome; but that, when they are applied to
mean the susceptibility or insusceptibility of animal fibres to motion,
they become metaphorical terms; as in Sect. XII. 2. 1. and would be better
expressed by the words activity and inactivity.

There are three sources of animal inactivity; first, the defect of the
natural quantity of stimulus on those fibres, which have been accustomed to
perpetual stimulus; as the arterial and secerning systems. When their
accustomed stimulus is for a while intermitted, as when snow is applied to
the skin of the hands, an accumulation of sensorial power is produced; and
then a degree of stimulus, as of heat, somewhat greater than that at
present applied, though much less than the natural quantity, excites the
vessels of the skin into violent action. We must observe, that a deficiency
of stimulus in those fibres, which are not subject to perpetual stimulus,
as the locomotive muscles, is not succeeded by accumulation of sensorial
power; these therefore are more liable to become permanently inactive after
a diminution of stimulus; as in strokes of the palsy, this may be called
inactivity from defect of stimulus.

2. A second source of animal inactivity exists, when the sensorial power in
any part of the system has been previously exhausted by violent stimuli; as
the eyes after long exposure to great light; or the stomach, to repeated
spirituous potation; this may be termed inactivity from exhaustion of
sensorial power. See Sect. XII. 2. 1.

3. But there is a third source of inactivity owing to the deficient
production of sensorial power in the brain; and hence stimuli stronger than
natural are required to produce the accustomed motions of the arterial
system; in this case there is no accumulation of sensorial power produced;
as in the inactivity owing to defect of stimulus; nor any previous
exhaustion of it, as in the inactivity owing to excess of stimulus.

This third kind of inactivity causes many of the diseases of this genus;
which are therefore in general to be remedied by such medicines as promote
a greater production of sensorial power in the brain; as the incitantia,
consisting of wine, beer, and opium, in small repeated quantities; and
secondly of such as simply stimulate the arterial and glandular system into
their natural actions; as small repeated blisters, spices, and essential
oils. And lastly the sorbentia, which contribute to supply the more
permanent strength of the system, by promoting the absorption of
nourishment from the stomach, and intestines; and of the superfluous fluid,
which attends the secretions.

SPECIES.

1. _Febris inirritativa._ Inirritative fever. This is the typhus mitior, or
nervous fever of some writers; it is attended with weak pulse without
inflammation, or symptoms of putridity, as they have been called. When the
production of sensorial power in the brain is less than usual, the pulse
becomes quick as well as weak; and the heart sometimes trembles like the
limbs of old age, or of enfeebled drunkards; and when this force of the
contractions of the heart and arteries is diminished, the blood is pushed
on with less energy, as well as in less quantity, and thence its stimulus
on their sides is diminished in a duplicate ratio. In compressions of the
brain, as in apoplexy, the pulse becomes slower and fuller; for in that
disease, as in natural sleep, the irritative motions of the heart and
arteries are not diminished, volition alone is suspended or destroyed.

If the absorption of the terminations of the veins is not equally impaired
with the force of the heart and arteries, the blood is taken up by the
veins the instant it arrives at their extremities; the capillary vessels
are left empty, and there is less resistance to the current of the blood
from the arteries; hence the pulse becomes empty, as well as weak and
quick; the veins of the skin are fuller than the arteries of it; and its
appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1.

When this pulse persists many hours, it constitutes the febris
inirritativa, or typhus, or nervous fever, of some writers; it is attended
with little heat, the urine is generally of a natural colour, though in
less quantity; with great prostration of strength, and much disturbance of
the faculties of the mind. Its immediate cause seems to be a deficient
secretion of the sensorial power from the inaction of the brain; hence
almost the whole of the sensorial power is expended in the performance of
the motions necessary to life, and little of it can be spared for the
voluntary actions of the locomotive muscles, or organs of sense, see Class
I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some
other part of the body; as of the spleen, when a tumour is felt on the left
side, as in some intermittents; or of the kidnies, when the urine continues
pale and in small quantity. Does the revivescence of these affected parts,
or their torpor, recurring at intervals, form the paroxysms of these
fevers? and their permanent revivescence establish the cure? See Class IV.
2. 1. 19.

M. M. Wine and opium in small quantities repeated every three hours
alternately; small repeated blisters; warm but fresh air; sorbentia;
nutrientia; transfusion of blood. Small electric shocks passed through the
brain in all directions. Oxygene air?

2. _Paresis inirritativa._ Inirritative debility. A defective action of the
irritative motions without increase of the frequency of the pulse. It
continues three or four weeks like a fever, and then either terminates in
health, or the patient sinks into one kind of apoplexy, and perishes. Many
symptoms, which attend inirritative fevers, accompany this disease, as cold
hands and feet at periodic times, scurf on the tongue, want of appetite,
muddy urine, with pains of the head, and sometimes vertigo, and vomiting.

This disease differs from the inirritative fever by the pulse not being
more frequent than in health. The want of appetite and of digestion is a
principal symptom, and probably is the cause of the universal debility,
which may be occasioned by the want of nourishment. The vertigo is a
symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine
is owing to increased absorption from the bladder in consequence of the
diminished cutaneous and cellular absorption, as in anasarca, explained in
Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of
that part of the system; the foul tongue is owing to an increased
absorption of the thinner part of the mucus in consequence of the general
deficiency of fluid, which should be absorbed by the skin and stomach. The
sickness is owing to decreased action of the stomach, which is probably the
primary disease, and is connected with the vertigo.

M. M. An emetic. Calomel, grains iv. once or twice. Then a blister.
Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small
quantities, repeated alternately every three hours. Small electric
percussions through the stomach.

3. _Somnus interruptus._ Interrupted sleep. In some fevers, where the
inirritability is very great, when the patient falls asleep, the pulse in a
few minutes becomes irregular, and the patient awakes in great disorder,
and fear of dying, refusing to sleep again from the terror of this uneasy
sensation. In this extreme debility there is reason to believe, that some
voluntary power during our waking hours is employed to aid the irritative
stimuli in carrying on the circulation of the blood through the lungs; in
the same manner as we use voluntary exertions, when we listen to weak
sounds, or wish to view an object by a small light; in sleep volition is
suspended, and the deficient irritation alone is not sufficient to carry on
the pulmonary circulation. This explanation seems the most probable one,
because in cases of apoplexy the irritative motions of the arterial system
do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13.

M. M. Opium in very small doses, as three drops of laudanum. A person
should watch the patient, and awaken him frequently; or he should measure
the time between slumber and slumber by a stop-watch, and awaken the
patient a little before he would otherwise awake; or he should keep his
finger on the pulse, and should forcibly awaken him, as soon as it becomes
irregular, before the disorder of the circulation becomes so great as to
disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2.

4. _Syncope._ Fainting consists in the decreased action of the arterial
system; which is sometimes occasioned by defect of the stimulus of
distention, as after venesection, or tapping for the dropsy. At other times
it arises from great emotions of the mind, as in sudden joy or grief. In
these cases the whole sensorial power is exerted on these interesting
ideas, and becomes exhausted. Thus during great surprise or fear the heart
stops for a time, and then proceeds with throbbing and agitation; and
sometimes the vital motions become so deranged, as never to recover their
natural successive action; as when children have been frightened into
convulsions. See Sect. XII. 7. 1.

Miss ----, a young lady of Stafford, in travelling in a chaise was so
affected by seeing the fall of a horse and postillion, in going down a
hill, though the carriage was not overturned, that she fainted away, and
then became convulsed, and never spoke afterwards; though she lived about
three days in successive convulsions and stupor.

5. _Hæmorrhagia venosa._ A bleeding from the capillaries arising from
defect of venous absorption, as in some of those fevers commonly termed
putrid. When the blood stagnates in the cellular membrane, it produces
petechiæ from this torpor or paralysis of the absorbent mouths of the
veins. It must be observed, that those people who have diseased livers, are
more liable to this kind of hæmorrhages, as well as to the hæmorrhagia
arteriosa; the former, because patients with diseased livers are more
subject to paralytic complaints in general, as to hemiplegia, and to
dropsy, which is a paralysis of the lymphatics; and the latter is probably
owing to the delay of the circulation in the vena porta by the torpor of
this hepatic vessel, when the liver is not much enlarged; and to its
pressure on the vena cava, when it is much enlarged.

M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel
dissolved in spirit of wine externally. Flour.

6. _Hæmorrhois cruenta._ In the bleeding piles the capillary vessels of the
rectum become distended and painful from the defect of the venous
absorption of the part, and at length burst; or the mucous glands are so
dilated as to give a passage to the blood; it is said to observe lunar
periods.

M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia.
External compression by applying lint, sponge, or cotton. Internal
compression by applying a bit of candle smeared with mercurial ointment.
Strangulate the tumid piles with a silk string. Cut them off. See Class I.
2. 3. 22.

Mrs. ---- had for twelve or fifteen years, at intervals of a year or less,
a bleeding from the rectum without pain; which however stopped
spontaneously after she became weakened, or by the use of injections of
brandy and water. Lately the bleeding continued above two months, in the
quantity of many ounces a day, till she became pale and feeble to an
alarming degree. Injections of solutions of lead, of bark and salt of
steel, and of turpentine, with some internal astringents, and opiates, were
used in vain. An injection of the smoke of tobacco, with ten grains of
opium mixed with the tobacco, was used, but without effect the two first
times on account of the imperfection of the machine; on the third time it
produced great sickness, and vertigo, and nearly a fainting fit; from which
time the blood entirely stopped. Was this owing to a fungous excrescence in
the rectum; or to a blood-vessel being burst from the difficulty of the
blood passing through the vena porta from some hepatic obstruction, and
which had continued to bleed so long? Was it stopped at last by the
fainting fit? or by the stimulus of the tobacco?

7. _Hæmorrhagia renum._ Hæmorrhage from the kidnies, when attended with no
pain, is owing to defect of venous absorption in the kidney. When attended
with pain on motion, it is owing to a bit of gravel in the ureter or pelvis
of the kidney; which is a much more frequent disease than the former. See
Sect. XXVII. 1.

M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate;
cold immersion up to the navel, the upper part of the body being kept
cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent
liquids. Cool dress. Cool bed-room.

Cows are much subject to bloody urine, called foul water by the farmers; in
this disease about sixty grains of opium with or without as much rust of
iron, given twice a day, in a ball mixed with flour and water, or dissolved
in warm water, or warm ale, is, I believe, an efficacious remedy, to which
however should be added about two quarts of barley or oats twice a day, and
a cover at night, if the weather be cold.

8. _Hæmorrhagia Hepatis._ Hæmorrhage from the liver. It sometimes happens
in those, who have the gutta rosea, or paralytic affections owing to
diseased livers induced by the potation of fermented liquors, that a great
discharge of black viscid blood occasionally comes away by stool, and
sometimes by vomiting: this the ancients called Melancholia, black bile. If
it was bile, a small quantity of it would become yellow or green on
dilution with warm water, which was not the case in one experiment which I
tried; it must remain some time in the intestines from its black colour,
when it passes downwards, and probably comes from the bile-ducts, and is
often a fatal symptom. When it is evacuated by vomiting it is less
dangerous, because it shews greater remaining irritability of the
intestinal canal, and is sometimes salutary to those who have diseased
livers.

M. M. An emetic. Rhubarb, steel, wine, bark.

9. _Hæmoptoe venosa._ Venous hæmoptoe frequently attends the beginning of
the hereditary consumptions of dark-eyed people; and in others, whose lungs
have too little irritability. These spittings of blood are generally in
very small quantity, as a tea-spoonful; and return at first periodically,
as about once a month; and are less dangerous in the female than in the
male sex; as in the former they are often relieved by the natural periods
of the menses. Many of these patients are attacked with this pulmonary
hæmorrhage in their first sleep; because in feeble people the power of
volition is necessary, besides that of irritation, to carry on respiration
perfectly; but, as volition is suspended during sleep, a part of the blood
is delayed in the vessels of the lungs, and in consequence effused, and the
patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II.
1. 6. 6. III. 2. 1. 10.

M. M. Wake the patient every two or three hours by an alarum clock. Give
half a grain of opium at going to bed, or twice a day. Onions, garlic,
slight chalybeates. Issues. Leeches applied once a fortnight or month to
the hemorrhoidal veins to produce a new habit. Emetics after each period of
hæmoptoe, to promote expectoration, and dislodge any effused blood, which
might by remaining in the lungs produce ulcers by its putridity. A hard
bed, to prevent too sound sleep. A periodical emetic or cathartic once a
fortnight.

10. _Palpitatio cordis._ The palpitation of the heart frequently attends
the hæmoptoe above mentioned; and consists in an ineffectual exertion of
the heart to push forwards its contents in due time, and with due force.
The remote cause is frequently some impediment to the general circulation;
as the torpor of the capillaries in cold paroxysms of fever, or great
adhesions of the lungs. At other times it arises from the debility of the
action of the heart owing to the deficient sensorial power of irritation or
of association, as at the approach of death.

In both these cases of weak exertion the heart feels large to the touch, as
it does not completely empty itself at each contraction; and on that
account contracts more frequently, as described in Sect. XXXII. 2. 2.
Another kind of palpitation may sometimes arise from the retrograde motions
of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.

11. _Menorrhagia._ Continued flow of the catamenia. The monthly effusion of
blood from the uterus or vagina is owing to a torpor of the veins of those
membranes in consequence of the defect of venereal stimulus; and in this
respect resembles the mucus discharged in the periodical venereal orgasm of
the female quadrupeds, which are secluded from the males. The menorrhagia,
or continued flow of this discharge, is owing to a continued defect of the
venous absorption of the membranes of the uterus or vagina. See Class IV.
2. 4. 7.

M. M. Venesection in small quantity. A cathartic. Then opium, a grain every
night. Steel. Bark. A blister. Topical aspersion with cold water, or cold
vinegar.

12. _Dysmenorrhagia._ A difficulty of menstruation attended with pain. In
this complaint the torpor of the uterine vessels, which precedes
menstruation, is by sympathy accompanied with a torpor of the lumbar
membranes, and consequent pain; and frequently with cold extremities, and
general debility. The small quantity and difficulty of the discharge is
owing to arterial inactivity, as in chlorosis. Whence it happens, that
chalybeate medicines are of efficacy both to stop or prevent too great
menstruation, and to promote or increase deficient menstruation; as the
former is owing to inirritability of the veins, and the latter of the
arteries of the uterus. See Article IV. 2. 6. in the Materia Medica.

M. M. Opium, steel, pediluvium. Warm bath.

13. _Lochia nimia._ Too great discharge after delivery. In that unnatural
practice of some hasty accoucheurs of introducing the hand into the uterus
immediately after the delivery of the child, and forcibly bringing away the
placenta, it frequently happens, that a part of it is left behind; and the
uterus, not having power to exclude so small a portion of it, is prevented
from complete contraction, and a great hæmorrhage ensues. In this
circumstance a bandage with a thick compress on the lower part of the
belly, by appressing the sides of the uterus on the remaining part of the
placenta, is likely to check the hæmorrhage, like the application of a
pledget of any soft substance on a bleeding vessel.

In other cases the lochia continues too long, or in too great quantity,
owing to the deficiency of venous absorption.

M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark.
Clothes dipped in cold vinegar and applied externally. Bandages on the
limbs to keep more blood in them for a time have been recommended.

14. _Abortio spontanea._ Some delicate ladies are perpetually liable to
spontaneous abortion, before the third, or after the seventh, month of
gestation. From some of these patients I have learnt, that they have
awakened with a slight degree of difficult respiration, so as to induce
them to rise hastily up in bed; and have hence suspected, that this was a
tendency to a kind of asthma, owing to a deficient absorption of blood in
the extremities of the pulmonary or bronchial veins; and have concluded
from thence, that there was generally a deficiency of venous absorption;
and that this was the occasion of their frequent abortion. Which is further
countenanced, where a great sanguinary discharge precedes or follows the
exclusion of the fetus.

M. M. Opium, bark, chalybeates in small quantity. Change to a warmer
climate. I have directed with success in four cases half a grain of opium
twice a day for a fortnight, and then a whole grain twice a day during the
whole gestation. One of these patients took besides twenty grains of
Peruvian bark for several weeks. By these means being exactly and regularly
persisted in, a new habit became established, and the usual miscarriages
were prevented.

Miscarriages more frequently happen from eruptive fevers, and from
rheumatic ones, than from other inflammatory diseases. I saw a most violent
pleurisy and hepatitis cured by repeated venesection about a week or ten
days before parturition; yet another lady whom I attended, miscarried at
the end of the chicken pox, with which her children were at the same time
affected. Miscarriages towards the termination of the small pox are very
frequent, yet there have been a few instances of children, who have been
born with the eruption on them. The blood in the small pox will not
inoculate that disease, if taken before the commencement of the secondary
fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is
not yet formed, but after it has been oxygenated through the cuticle in the
pustules, it becomes contagious; and if it be then absorbed, as in the
secondary fever, the blood of the mother may become contagious, and infect
the child. The same mode of reasoning is applicable to the chicken pox. See
Class IV. 3. 1. 7.

15. _Scorbutus._ Sea-scurvy is caused by salt diet, the perpetual stimulus
of which debilitates the venous and absorbent systems. Hence the blood is
imperfectly taken up by the veins from the capillaries, whence brown and
black spots appear upon the skin without fever. The limbs become livid and
edematous, and lastly ulcers are produced from deficient absorption. See
Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of
the lungs, see Sect. XXVII. 2.

M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar.
Wine. Steel. Bark. Sorbentia. Opium?

16. _Vibices._ Extravasations of blood become black from their being
secluded from the air. The extravasation of blood in bruises, or in some
fevers, or after death in some patients, especially in the parts which were
exposed to pressure, is owing to the fine terminations of the veins having
been mechanically compressed so as to prevent their absorbing the blood
from the capillaries, or to their inactivity from disease. The blood when
extravasated undergoes a chemical change before it is sufficiently fluid to
be taken up by the lymphatic absorbents, and in that process changes its
colour to green and then yellow.

17. _Petechiæ._ Purple spots. These attend fevers with great venous
inirritability, and are probably formed by the inability of a single
termination of a vein, whence the corresponding capillary becomes ruptured,
and effuses the blood into the cellular membrane round the inert
termination of the vein. This is generally esteemed a sign of the putrid
state of the blood, or that state contrary to the inflammatory one. As it
attends some inflammatory diseases which are attended with great
inirritability, as in the confluent small pox. But it also attends the
scurvy, where no fever exists, and it therefore simply announces the
inactivity of the terminations of some veins; and is thence indeed a bad
symptom in fevers, as a mark of approaching inactivity of the whole
sanguiferous system, or death. The blue colour of some children's arms or
faces in very cold weather is owing in like manner to the torpor of the
absorbent terminations of the veins, whence the blood is accumulated in
them, and sometimes bursts them.

       *       *       *       *       *

ORDO II.

_Decreased Irritation._

GENUS II.

_Decreased Action of the Secerning System._

These are always attended with decrease of partial, or of general heat; for
as the heat of animal bodies is the consequence of their various
secretions, and is perpetually passing away into the ambient air, or other
bodies in contact with them; when these secretions become diminished, or
cease, the heat of the part or of the whole is soon diminished, or ceases
along with them.

SPECIES.

1. _Frigus febrile._ Febrile coldness. There is reason to believe, that the
beginning of many fever-fits originates in the quiescence of some part of
the absorbent system, especially where they have been owing to external
cold; but that, where the coldness of the body is not owing to a diminution
of external heat, it arises from the inaction of some part of the secerning
system. Hence some parts of the body are hot whilst other parts are cold;
which I suppose gave occasion to error in Martyn's Experiments; where he
says, that the body is as hot in the cold paroxysms of fevers as at other
times.

After the sensorial power has been much diminished by great preceding
activity of the system, as by long continued external heat, or violent
exercise, a sudden exposure to much cold produces a torpor both greater in
degree and over a greater portion of the system, by subtracting their
accustomed stimulus from parts already much deprived of their irritability.
Dr. Franklin in a letter to M. Duberge, the French translator of his works,
mentions an instance of four young men, who bathed in a cold spring after a
day's harvest work; of whom two died on the spot, a third on the next
morning, and the other survived with difficulty. Hence it would appear,
that those, who have to travel in intensely cold weather, will sooner
perish, who have previously heated themselves much with drams, than those
who have only the stimulus of natural food; of which I have heard one well
attested instance. See Article VII. 2. 3. Class III. 2. 1. 17.

_Frigus chronicum._ Permanent coldness. Coldness of the extremities,
without fever, with dry pale skin, is a symptom of general debility, owing
to the decreased action of the arterial system, and of the capillary
vessels; whence the perspirable matter is secreted in less quantity, and in
consequence the skin is less warm. This coldness is observable at the
extremities of the limbs, ears, and nose, more than in any other parts: as
a larger surface is here exposed to the contact of the air, or clothes, and
thence the heat is more hastily carried away.

The pain, which accompanies the coldness of the skin, is owing to the
deficient exertion of the subcutaneous vessels, and probably to the
accumulation of sensorial power in the extremities of their nerves. See
Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1.

M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes.
Fire. Joy. Anger.

2. _Pallor fugitivus._ The fugitive paleness, which accompanies the
coldness of the extremities, is owing to a less quantity of blood passing
through the capillaries of the skin in a given time; where the absorbent
power of the veins is at the same time much diminished, a part of the blood
lingers at their junction with the capillary arteries, and a bluish tinge
is mixed with the paleness; as is seen in the loose skin under the
eye-lids, and is always a mark of temporary debility. See Class II. 1. 4.
4. Where the paleness of the skin is owing to the deficiency of red
globules in the blood, it is joined with a yellowish tinge; which is the
colour of the serum, with which the blood then abounds, as in chlorosis,
and in torpor or paralysis of the liver, and is often mistaken for a
superabundance of bile.

A permanent paleness of the skin is owing to the coalescence of the minute
arteries, as in old age. See Class I. 2. 2. 9. There is another source of
paleness from the increased absorption of the terminations of the veins, as
when vinegar is applied to the lips. See Sect. XXVII. 1. and another from
the retrograde motions of the capillaries and fine extremities of the
arteries. See Class II. 3. 1. 1.

M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.

3. _Pus parcius._ Diminished pus. Dryness of ulcers. In the cold fits of
fever all the secretions are diminished, whether natural or artificial, as
their quantity depends on the actions of the glands or capillaries, which
then share in the universal inaction of the system. Hence the dryness of
issues and blisters in great debility, and before the approach of death, is
owing to deficient secretion, and not to increased absorption.

M. M. Opium, wine in very small quantities, Peruvian bark.

4. _Mucus parcior._ Diminished mucus. Dryness of the mouth and nostrils.
This also occurs in the cold fits of intermittents. In these cases I have
also found the tongue cold to the touch of the finger, and the breath to
the back of one's hand, when opposed to it, which are very inauspicious
symptoms, and generally fatal. In fevers with inirritability it is
generally esteemed a good symptom, when the nostrils and tongue become
moist after having been previously dry; as it shews an increased action of
the mucous glands of those membranes, which were before torpid. And the
contrary to this is the facies Hippocratica, or countenance so well
described by Hippocrates, which is pale, cold, and shrunk; all which are
owing to the inactivity of the secerning vessels, the paleness from there
being less red blood passing through the capillaries, the coldness of the
skin from there being less secretion of perspirable matter, and the shrunk
appearance from there being less mucus secreted into the cells of the
cellular membrane. See Class IV. 2. 4. 11.

M. M. Blisters. Incitantia.

5. _Urina parcior pallida._ Paucity of pale urine, as in the cold fits of
intermittents; it appears in some nervous fevers throughout the whole
disease, and seems to proceed from a palsy of the kidnies; which probably
was the cause of the fever, as the fever sometimes ceases, when that
symptom is removed: hence the straw-coloured urine in this fever is so far
salutary, as it shews the unimpaired action of the kidnies.

M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides
internally.

6. _Torpor hepaticus._ Paucity of bile from a partial inaction of the
liver; hence the bombycinous colour of the skin, grey stools, urine not
yellow, indigestion, debility, followed by tympany, dropsy, and death.

This paralysis or inirritability of the liver often destroys those who have
been long habituated to much fermented liquor, and have suddenly omitted
the use of it. It also destroys plumbers, and house-painters, and in them
seems a substitute for the colica saturnina. See Sect. XXX.

M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment
rubbed on the region of the liver. Rhubarb, three or four grains, with
opium half a grain to a grain twice a day. Equitation, warm bath for half
an hour everyday.

7. _Torpor Pancreatis._ Torpor of the pancreas. I saw what I conjectured to
be a tumour of the pancreas with indigestion, and which terminated in the
death of the patient. He had been for many years a great consumer of
tobacco, insomuch that he chewed that noxious drug all the morning, and
smoaked it all the afternoon. As the secretion from the pancreas resembles
saliva in its general appearance, and probably in its office of assisting
digestion, by preventing the fermentation of the aliment; as would appear
by the experiments of Pringle and Macbride; there is reason to suspect,
that a sympathy may exist between the salivary and pancreatic glands; and
that the perpetual stimulus of the former by tobacco might in process of
time injure the latter. See Tobacco, Article III. 2. 2.

8. _Torpor renis._ Inirritability or paralysis of the kidnies is probably
frequently mistaken for gravel in them. Several, who have lived rather
intemperately in respect to fermented or spirituous liquors, become
suddenly seized about the age of sixty, or later, with a total stoppage of
urine; though they have previously had no symptoms of gravel. In these
cases there is no water in the bladder; as is known by the introduction of
the catheter, of which those made of elastic gum are said to be preferable
to metallic ones; or it may generally be known by the shape of the abdomen,
either by the eye or hand. Bougies and catheters of elastic gum are sold at
N^o 37, Red Lion-street, Holborn, London.

M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1.
3. 9. When no gravel has been previously observed, and the patient has been
a wine-drinker rather than an ale-drinker, the case is generally owing to
inirritability of the tubuli uriniferi, and is frequently fatal. See Class
I. 2. 4. 20.

9. _Punctæ mucosæ vultûs._ Mucous spots on the face. These are owing to the
inactivity of the excretory ducts of the mucous glands; the thinner part of
this secretion exhales, and the remainder becomes inspissated, and lodges
in the duct; the extremity of which becomes black by exposure to the air.

M. M. They may be pressed out by the finger-nails. Warm water. Ether
frequently applied. Blister on the part?

10. _Maculæ cutis fulvæ._ Morphew or freckles. Tawny blotches on the skin
of the face and arms of elderly people, and frequently on their legs after
slight erysipelas. The freckles on the face of younger people, who have red
hair, seem to be a similar production, and seem all to be caused by the
coalescence of the minute arteries or capillaries of the part. In a scar
after a wound the integument is only opake; but in these blotches, which
are called morphew and freckles, the small vessels seem to have become
inactive with some of the serum of the blood stagnating in them, from
whence their colour. See Class III. 1. 2. 12.

M. M. Warm bathing. A blister on the part?

11. _Canities._ Grey hair. In the injection of the vessels of animals for
the purposes of anatomical preparations, the colour of the injected fluid
will not pass into many very minute vessels; which nevertheless uncoloured
water, or spirits, or quicksilver will permeate. The same occurs in the
filtration of some coloured fluids through paper, or very fine sand, where
the colouring matter is not perfectly dissolved, but only diffused through
the liquid. This has led some to imagine, that the cause of the whiteness
of the hair in elderly people may arise from the diminution, or greater
tenuity, of the glandular vessels, which secrete the mucus, which hardens
into hair; and that the same difference of the tenuity of the secerning
vessels may possibly make the difference of colour of the silk from
different silk-worms, which is of all shades from yellow to white.

But as the secreted fluids are not the consequence of mechanical
filtration, but of animal selection; we must look out for another cause,
which must be found in the decreasing activity of the glands, as we advance
in life; and which affects many of our other secretions as well as that of
the mucus, which forms the hair. Hence grey hairs are produced on the faces
of horses by whatever injures the glands at their roots, as by corrosive
blisters; and frequently on the human subject by external injuries on the
head; and sometimes by fevers. And as the grey colour of hair consists in
its want of transparency, like water converted into snow; there is reason
to suppose, that a defect of secreted moisture simply may be the cause of
this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13.

M. M. Whatever prevents the inirritability and insensibility of the system,
that is, whatever prevents the approach of old age, will so far counteract
the production of grey hairs, which is a symptom of it. For this purpose in
people, who are not corpulent, and perhaps in those who are so, the warm
bath twice or thrice a week is particularly serviceable. See Sect. XXXIX.
5. 1. on the colours of animals, and Class I. 1. 2. 15.

12. _Callus._ The callous skin on the hands and feet of laborious people is
owing to the extreme vessels coalescing from the perpetual pressure they
are exposed to.

As we advance in life, the finer arteries lose their power of action, and
their sides grow together; hence the paleness of the skins of elderly
people, and the loss of that bloom, which is owing to the numerous fine
arteries, and the transparency of the skin, that encloses them.

M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a
pumice stone. Cover the part with oiled silk to prevent the evaporation of
the perspirable matter, and thus to keep it moist.

13. _Cataracta_ is an opacity of the crystalline lens of the eye. It is a
disease of light-coloured eyes, as the gutta serena is of dark ones. On
cutting off with scissars the cornea of a calf's eye, and holding it in the
palm of one's hand, so as to gain a proper light, the artery, which
supplies nutriment to the crystalline humour, is easily and beautifully
seen; as it rises from the centre of the optic nerve through the vitreous
humour to the crystalline. It is this point, where the artery enters the
eye through the cineritious part of the optic nerve, (which is in part near
the middle of the nerve,) which is without sensibility to light; as is
shewn by fixing three papers, each of them about half an inch in diameter,
against a wall about a foot distant from each other, about the height of
the eye; and then looking at the middle one, with one eye, and retreating
till you lose sight of one of the external papers. Now as the animal grows
older, the artery becomes less visible, and perhaps carries only a
transparent fluid, and at length in some subjects I suppose ceases to be
pervious; then it follows, that the crystalline lens, losing some fluid,
and gaining none, becomes dry, and in consequence opake; for the same
reason, that wet or oiled paper is more transparent than when it is dry, as
explained in Class I. 1. 4. 1. The want of moisture in the cornea of old
people, when the exhalation becomes greater than the supply, is the cause
of its want of transparency; and which like the crystalline gains rather a
milky opacity. The same analogy may be used to explain the whiteness of the
hair of old people, which loses its pellucidity along with its moisture.
See Class I. 2. 2. 11.

M. M. Small electric shocks through the eye. A quarter of a grain of
corrosive sublimate of mercury dissolved in brandy, or taken in a pill,
twice a day for six weeks. Couching by depression, or by extraction. The
former of these operations is much to be preferred to the latter, though
the latter is at this time so fashionable, that a surgeon is almost
compelled to use it, lest he should not be thought an expert operator. For
depressing the cataract is attended with no pain, no danger, no
confinement, and may be as readily repeated, if the crystalline should rise
again to the centre of the eye. The extraction of the cataract is attended
with considerable pain, with long confinement, generally with fever, always
with inflammation, and frequently with irreparable injury to the iris, and
consequent danger to the whole eye. Yet has this operation of extraction
been trumpeted into universal fashion for no other reason but because it is
difficult to perform, and therefore keeps the business in the hands of a
few empyrics, who receive larger rewards, regardless of the hazard, which
is encountered by the flattered patient.

A friend of mine returned yesterday from London after an absence of many
weeks; he had a cataract in a proper state for the operation, and in spite
of my earnest exhortation to the contrary, was prevailed upon to have it
extracted rather than depressed. He was confined to his bed three weeks
after the operation, and is now returned with the iris adhering on one side
so as to make an oblong aperture; and which is nearly, if not totally,
without contraction, and thus greatly impedes the little vision, which he
possesses. Whereas I saw some patients couched by depression many years ago
by a then celebrated empyric, Chevalier Taylor, who were not confined above
a day or two, that the eye might gradually be accustomed to light, and who
saw as well as by extraction, perhaps better, without either pain, or
inflammation, or any hazard of losing the eye.

As the inflammation of the iris is probably owing to forcing the
crystalline through the aperture of it in the operation of extracting it,
could it not be done more safely by making the opening behind the iris and
ciliary process into the vitreous humour? but the operation would still be
more painful, more dangerous, and not more useful than that by depressing
it.

14. _Innutritio ossium._ Innutrition of the bones. Not only the blood
effused in vibices and petechiæ, or from bruises, as well as the blood and
new vessels in inflamed parts, are reabsorbed by the increased action of
the lymphatics; but the harder materials, which constitute the fangs of the
first set of teeth, and the ends of exfoliating bones, and sometimes the
matter of chalk-stones in the gout, the coagulable lymph, which is
deposited on the lungs, or on the muscles after inflammation of those
parts, and which frequently produces difficulty of breathing, and the pains
of chronic rheumatism, and lastly the earthy part of the living bones are
dissolved and absorbed by the increased actions of this system of vessels.
See Sect. XXXIII. 3. 1.

The earthy part of bones in this disease of the innutrition of them seems
to suffer a solution, and reabsorption; while the secerning vessels do not
supply a sufficient quantity of calcareous earth and phosphoric acid, which
constitute the substance of bones. As calcareous earth abounds every where,
is the want of phosphoric acid the remote cause? One cause of this malady
is given in the Philosophic Transactions, where the patient had been
accustomed to drink large quantities of vinegar. Two cases are described by
Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous
earth, and afterwards of bone-ashes, and of decoction of madder, and also
of sublimate of mercury, were given without effect. All the bones became
soft, many of them broke, and the patient seemed to die from the want of
being able to distend her chest owing to the softness of the ribs.

M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined
hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or
such as is found in all limestone or marly countries. The calcareous earth
in these waters might possibly be carried to the bones, as madder is known
to colour them. Warm bath. Volatile or fixed alcali as a lotion on the
spine, or essential oils.

The innutrition of the bones is often first to be perceived by the
difficulty of breathing and palpitation of the heart on walking a little
faster than usual, which I suppose is owing to the softness of the ends of
the ribs adjoining to the sternum; on which account they do not perfectly
distend the chest, when they are raised by the pectoral and intercostal
muscles with greater force than usual. After this the spine becomes curved
both by the softness of its vertebræ, and for the purpose of making room
for the disturbed heart. See Species 16 of this genus.

As these patients are pale and weak, there would seem to be a deficiency of
oxygene in their blood, and in consequence a deficiency of phosphoric acid;
which is probably produced by oxygene in the act of respiration.

Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to
arise from the prevalence of vegetable or acetous acid, which is known to
soften bones out of the body. Mr. Dettaen seems to have espoused a similar
opinion, and both of them in consequence give alcalies and testacea. If
this theory was just, the soft bones of such patients should shew evident
marks of such acidity after death; which I believe has not been observed.
Nor is it analogous to other animal facts, that nutritious fluids secreted
by the finest vessels of the body should be so little animalized, as to
retain acetous or vegetable acidity.

The success attending the following case in so short a time as a fortnight
I ascribed principally to the use of the warm bath; in which the patient
continued for full half an hour every night, in the degree of heat, which
was most grateful to her sensation, which might be I suppose about 94. Miss
----, about ten years of age, and very tall and thin, has laboured under
palpitation of her heart, and difficult breathing on the least exercise,
with occasional violent dry cough, for a year or more, with dry lips,
little appetite either for food or drink, and dry skin, with cold
extremities. She has at times been occasionally worse, and been relieved in
some degree by the bark. She began to bend forwards, and to lift up her
shoulders. The former seemed owing to a beginning curvature of the spine,
the latter was probably caused to facilitate her difficult respiration.

M. M. She used the warm bath, as above related; which by its warmth might
increase the irritability of the smallest series of vessels, and by
supplying more moisture to the blood might probably tend to carry further
the materials, which form calcareous or bony particles, or to convey them
in more dilute solution. She took twice a day twenty grains of extract of
bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of
calcined hartshorn mixed into a powder with ten drops of laudanum; with
flesh food both to dinner and supper; and port wine and water instead of
the small beer, she had been accustomed to; she lay on a sofa frequently in
a day, and occasionally used a neck-swing.

15. _Rachitis._ Rickets. The head is large, protuberant chiefly on the
forepart. The smaller joints are swelled; the ribs depressed; the belly
tumid, with other parts emaciated. This disease from the innutrition or
softness of the bones arose about two centuries ago; seems to have been
half a century in an increasing or spreading state; continued about half a
century at its height, or greatest diffusion; and is now nearly vanished:
which gives reason to hope, that the small-pox, measles, and venereal
disease, which are all of modern production, and have already become
milder, may in process of time vanish from the earth, and perhaps be
succeeded by new ones! See the preceding species.

16. _Spinæ distortio._ Distortion of the spine is another disease
originating from the innutrition or softness of the bones. I once saw a
child about six years old with palpitation of heart, and quickness of
respiration, which began to have a curvature of the spine; I then doubted,
whether the palpitation and quick respiration were the cause or consequence
of the curvature of the spine; suspecting either that nature had bent the
spine outwards to give room to the enlarged heart; or that the malformation
of the chest had compressed and impeded the movements of the heart. But a
few weeks ago on attending a young lady about ten years old, whose spine
had lately began to be distorted, with very great difficulty and quickness
of respiration, and alarming palpitation of the heart, I convinced myself,
that the palpitation and difficult respiration were the effect of the
change of the cavity of the chest from the distortion of the spine; and
that the whole was therefore a disease of the innutrition or softness of
the bones.

For on directing her to lie down much in the day, and to take the bark, the
distortion became less, and the palpitation and quick respiration became
less at the same time. After this observation a neck-swing was directed,
and she took the bark, madder, and bone-ashes; and she continues to amend
both in her shape and health.

Delicate young ladies are very liable to become awry at many boarding
schools. This is occasioned principally by their being obliged too long to
preserve an erect attitude, by sitting on forms many hours together. To
prevent this the school-seats should have either backs, on which they may
occasionally rest themselves; or desks before them, on which they may
occasionally lean. This is a thing of greater consequence than may appear
to those, who have not attended to it.

When the least tendency to become awry is observed, they should be advised
to lie down on a bed or sofa for an hour in the middle of the day for many
months; which generally prevents the increase of this deformity by taking
off for a time the pressure on the spine of the back, and it at the same
time tends to make them grow taller. Young persons, when nicely measured,
are found to be half an inch higher in a morning than at night; as is well
known to those, who inlist very young men for soldiers. This is owing to
the cartilages between the bones of the back becoming compressed by the
weight of the head and shoulders on them during the day. It is the same
pressure which produces curvatures and distortions of the spine in growing
children, where the bones are softer than usual; and which may thus be
relieved by an horizontal posture for an hour in the middle of the day, or
by being frequently allowed to lean on a chair, or to play on the ground on
a carpet.

Young ladies should also be directed, where two sleep in a bed, to change
every night, or every week, their sides of the bed; which will prevent
their tendency to sleep always on the same side; which is not only liable
to produce crookedness, but also to occasion diseases by the internal parts
being so long kept in uniform contact as to grow together. For the same
reason they should not be allowed to sit always on the same side of the
fire or window, because they will then be inclined too frequently to bend
themselves to one side.

Another great cause of injury to the shape of young ladies is from the
pressure of stays, or other tight bandages, which at the same time cause
other diseases by changing the form or situation of the internal parts. If
a hard part of the stays, even a knot of the thread, with which they are
sewed together, is pressed hard upon one side more than the other, the
child bends from the side most painful, and thus occasions a curvature of
the spine. To counteract this effect such stays, as have fewest hard parts,
and especially such as can be daily or weekly turned, are preferable to
others.

[Illustration]

Where frequent lying down on a sofa in the day-time, and swinging
frequently for a short time by the hands or head, with loose dress, do not
relieve a beginning distortion of the back; recourse may be had to a chair
with stuffed moveable arms for the purpose of suspending the weight of the
body by cushions under the arm-pits, like resting on crutches, or like the
leading strings of infants. From the top of the back of the same chair a
curved steel bar may also project to suspend the body occasionally, or in
part by the head, like the swing above mentioned. The use of this chair is
more efficacious in straightening the spine, than simply lying down
horizontally; as it not only takes off the pressure of the head and
shoulders from the spine, but at the same time the inferior parts of the
body contribute to draw the spine straight by their weight; or lastly,
recourse may be had to a spinal machine first described in the Memoires of
the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and
since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road,
London, which suspends the head, and places the weight of it on the hips.
This machine is capable of improvement by joints in the bar at the back of
it, to permit the body to bend forwards without diminishing the extension
of the spine.

The objections of this machine of M. Vacher, which is made by Mr. Jones,
are first, that it is worn in the day-time, and has a very unsightly
appearance. Mr. Jones has endeavoured to remedy this, by taking away the
curved bar over the head, and substituting in its place a forked bar,
rising up behind each ear, with webs fastened to it, which pass under the
chin and occiput. But this is not an improvement, but a deterioration of M.
Vacher's machine, as it prevents the head from turning with facility to
either side. Another objection is, that its being worn, when the muscles of
the back are in action, it is rather calculated to prevent the curvature of
the spine from becoming greater, than to extend the spine, and diminish its
curvature.

[Illustration]

For this latter purpose I have made a steel bow, as described in the
annexed plate, which receives the head longitudinally from the forehead to
the occiput; having a fork furnished with a web to sustain the chin, and
another to sustain the occiput. The summit of the bow is fixed by a swivel
to the board going behind the head of the bed above the pillow. The bed is
to be inclined from the head to the feet about twelve or sixteen inches.
Hence the patient would be constantly sliding down during sleep, unless
supported by this bow, with webbed forks, covered also with fur, placed
beneath the chin, and beneath the occiput. There are also proper webs lined
with fur for the hands to take hold off occasionally, and also to go under
the arms. By these means I should hope great advantage from gradually
extending the spine during the inactivity of the muscles of the back; and
that it may be done without disturbing the sleep of the patient, and if
this should happen, the bow is made to open by a joint at the summit of it,
so as to be instantly disengaged from the neck by the hand of the wearer.
This bow I have not yet had opportunity to make use of, but it may be had
from Mr. Harrison, whitesmith, Bridge-gate, Derby.

It will be from hence easily perceived, that all other methods of confining
or directing the growth of young people should be used with great skill;
such as back-boards, or bandages, or stocks for the feet; and that their
application should not be continued too long at a time, lest worse
consequences should ensue, than the deformity they were designed to remove.
To this may be added, that the stiff erect attitude taught by some modern
dancing masters does not contribute to the grace of person, but rather
militates against it; as is well seen in one of the prints in Hogarth's
Analysis of Beauty; and is exemplifyed by the easy grace of some of the
ancient statues, as of the Venus de Medici, and the Antinous, and in the
works of some modern artists, as in a beautiful print of Hebe feeding an
Eagle, painted by Hamilton, and engraved by Eginton, and many of the
figures of Angelica Kauffman.

Where the bone of one of the vertebræ of the back has been swelled on both
sides of it, so as to become protuberant, issues near the swelled part have
been found of great service, as mentioned in Species 18 of this genus. This
has induced me to propose in curvatures of the spine, to put an issue on
the outside of the curve, where it could be certainly ascertained, as the
bones on the convex side of the curve must be enlarged; in one case I
thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general
constitution is of service; as the use of the cold bath in the summer
months. This however requires some restriction both in respect to the
degree of coldness of the bath, the time of continuing in it, and the
season of the year. Common springs, which are of forty-eight degrees of
heat, are too cold for tender constitutions, whether of children or adults,
and frequently do them great and irreparable injury. The coldness of river
water in the summer months, which is about sixty-eight degrees, or that of
Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are
much to be preferred. The time of continuing in the bath should be but a
minute or two, or not so long as to occasion a trembling of the limbs from
cold. In respect to the season of the year, delicate children should
certainly only bathe in the summer months; as the going frequently into the
cold air in winter will answer all the purposes of the cold bath.

17. _Claudicatio coxaria._ Lameness of the hip. A nodding of the thigh-bone
is said to be produced in feeble children by the softness of the neck or
upper part of that bone beneath the cartilage; which is naturally bent, and
in this disease bends more downwards, or nods, by the pressure of the body;
and thus renders one leg apparently shorter than the other. In other cases
the end of the bone is protruded out of its socket, by inflammation or
enlargement of the cartilages or ligaments of the joint, so that it rests
on some part of the edge of the acetabulum, which in time becomes filled
up. When the legs are straight, as in standing erect, there is no
verticillary motion in the knee-joint; all the motion then in turning out
the toes further than nature designed, must be obtained by straining in
some degree this head of the thigh-bone, or the acetabulum, or cavity, in
which it moves. This has induced me to believe, that this misfortune of the
nodding of the head by the bone, or partial dislocation of it, by which one
leg becomes shorter than the other, is sometimes occasioned by making very
young children stand in what are called stocks; that is with their heels
together, and their toes quite out. Whence the socket of the thigh-bone
becomes inflamed and painful, or the neck of the bone is bent downward and
outwards.

In this case there is no expectation of recovering the straightness of the
end of the bone; but these patients are liable to another misfortune, that
is, to acquire afterwards a distortion of the spine; for as one leg is
shorter than the other, they sink on that side, and in consequence bend the
upper part of their bodies, as their shoulders, the contrary way, to
balance themselves; and then again the neck is bent back again towards the
lame side, to preserve the head perpendicular; and thus the figure becomes
quite distorted like the letter S, owing originally to the deficiency of
the length of one limb. The only way to prevent this curvature of the spine
is for the child to wear a high-heeled shoe or patten on the lame foot, so
as to support that side on the same level with the other, and thus to
prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle
in walking; but nevertheless, when she stands or sits, she sinks down
towards her right side, and turns out that toe more than the other. Hence,
both as she sits and stands, she bends her body to the right; whence her
head would hang a little over her right shoulder; but to replace this
perpendicularly, she lifts up her left shoulder and contracts the muscles
on that side of the neck; which are therefore become thicker and stronger
by their continued action; but there is not yet any very perceptible
distortion of the spine.

As her right toe is turned outward rather more than natural, this shews the
disease to be in the hip-joint; because, when the limb is stretched out,
the toe cannot turn horizontally in the least without moving the end of the
thigh-bone; although when the knee is bent, the toe can be turned through
one third or half of a circle by the rotation of the tibia and fibula of
the leg round each other. Hence if children are set in stocks with their
heels touching each other as they sit, and are then made to rise up, till
they stand erect, the socket or head of the thigh-bone becomes injured,
especially in those children, whose bones are soft; and a shortness of that
limb succeeds either by the bending of the neck of the thigh-bone, or by
its getting out of the acetabulum; and a consequent rising of one shoulder,
and a curvature of the spine is produced from so distant a cause.

M. M. An elastic cushion made of curled hair should be placed under the
affected hip, whenever she sits; or should be fitted to the part by means
of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying
down in the day, should be occasionally used to prevent or remove any
curvature of the spine. The rest as in Species 13 and 15 of this genus.

18. _Spina protuberans._ Protuberant spine. One of the bones of the spine
swells, and rises above the rest. This is not an uncommon disease, and
belongs to the innutrition of the bones, as the bone must become soft
before it swells; which softness is owing to defect of the secretion of
phosphorated calcareous earth. The swelling of the bone compresses a part
of the brain, called the spinal marrow, within the cavity of the
back-bones; and in consequence the lower limbs become paralytic, attended
sometimes with difficulty of emptying the bladder and rectum.

M. M. Issues put on each side of the prominent bone are of great effect, I
suppose, by their stimulus; which excites into action more of the sensorial
powers of irritation and sensation, and thus gives greater activity to the
vascular system in their vicinity. The methods recommended in distortion of
the spine are also to be attended to.

19. _Spina bifida._ Divided spine, called also Hydrorachitis, as well as
the Hydrocephalus externus, are probably owing in part to a defect of
ossification of the spine and cranium; and that the collection of fluid
beneath them may originate from the general debility of the system; which
affects both the secerning, and absorbent vessels.

A curious circumstance, which is affirmed to attend the spina bifida, is,
that on compressing the tumor with the hand gently, the whole brain becomes
affected, and the patient falls asleep. I suppose the same must happen on
compressing the hydrocephalus externus? See Sect. XVIII. 20.

20. _Ossis palati defectus._ A defect of the bone of the palate, which
frequently accompanies a division of the upper lip, occurs before nativity;
and is owing to the deficient action of the secerning system, from whence
the extremities are not completed. From a similar cause I have seen the
point of the tongue deficient, and one joint of the two least fingers, and
of the two least toes, in the same infant; who was otherwise a fine girl.
See Sect. XXXIX. 4. 4.

The operation for the hare-lip is described by many surgical writers; but
there is a person in London, who makes very ingenious artificial palates;
which prevents that defect of speech, which attends this malformation. This
factitious palate consists of a thin plate of silver of the shape and form
of the roof of the mouth; from the front edge to the back edge of this
silver plate four or five holes are made in a straight line large enough
for a needle to pass through them; on the back of it is then sewed a piece
of sponge; which when expanded with moisture is nearly as large as the
silver plate. This sponge is slipped through the division of the bone of
the palate, so as to lie above it, while the silver plate covers the
aperture beneath, and is suspended by the expanding sponge. This is removed
every night and washed, and returned into its place in the morning; on this
account it is convenient to have five or six of them, for the sake of
cleanliness. I have been more particular in describing this invention, as I
do not know the name, or place of residence, of the maker.

       *       *       *       *       *

ORDO II.

_Decreased Irritation._

GENUS III.

_The Decreased Action of the Absorbent System._

Some decrease of heat attends these diseases, though in a less degree than
those of the last genus, because the absorbent system of glands do not
generate so much heat in their healthy state of action as the secerning
system of glands, as explained in Class I. 1. 3.

SPECIES.

1. _Mucus faucium frigidus._ Cold mucus from the throat. Much mucus, of
rather a saline taste, and less inspissated than usual, is evacuated from
the fauces by hawking, owing to the deficient absorption of the thinner
parts of it. This becomes a habit in some elderly people, who are
continually spitting it out of their mouths; and has probably been brought
on by taking snuff, or smoking tobacco; which by frequently stimulating the
fauces have at length rendered the absorbent vessels less excitable by the
natural stimulus of the saline part of the secretion, which ought to be
reabsorbed, as soon as secreted.

M. M. A few grains of powder of bark frequently put into the mouth, and
gradually diffused over the fauces. A gargle of barley water.

2. _Sudor frigidus._ The cold dampness of the hands of some people is
caused by the deficient absorption of perspirable matter; the clammy or
viscid feel of it is owing to the mucous part being left upon the skin. The
coldness is produced both by the decreased action of the absorbent system,
and by the evaporation of a greater quantity of the perspirable matter into
the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quantity of volatile
alcali in water.

3. _Catarrhus frigidus._ The thin discharge from the nostrils in cold
weather. The absorbent vessels become torpid by the diminution of external
heat, sooner than the secerning ones, which are longer kept warm by the
circulating blood, from which they select the fluid they secrete; whereas
the absorbent vessels of the nostrils drink up their fluids, namely the
thin and saline part of the mucus, after it has been cooled by the
atmosphere. Hence the absorbents ceasing to act, and the secerning vessels
continuing some time longer to pour out the mucus, a copious thin discharge
is produced, which trickles down the nostrils in cold weather. This
discharge is so acrid as to inflame the upper lip; which is owing to the
neutral salts, with which it abounds, not being reabsorbed; so the tears in
the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7.

4. _Expectoratio frigida._ Cold expectoration. Where the pulmonary
absorption is deficient, an habitual cough is produced, and a frequent
expectoration of thin saline mucus; as is often seen in old enfeebled
people. Though the stimulus of the saline fluid, which attends all
secretions, is not sufficient to excite the languid absorbent vessels to
imbibe it; yet this saline part, together with the increased quantity of
the whole of the secreted mucus, stimulates the branches of the bronchia,
so as to induce an almost incessant cough to discharge it from the lungs. A
single grain of opium, or any other stimulant drug, as a wine-posset with
spirit of hartshorn, will cure this cold cough, and the cold catarrh of the
preceding article, like a charm, by stimulating the torpid mouths of the
absorbents into action. Which has given rise to an indiscriminate and
frequently pernicious use of the warm regimen in coughs and catarrhs of the
warm or inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes the absorption of
the more fluid and saline parts, and in consequence thickens the mucus, and
abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali.

5. _Urina uberior pallida._ On being exposed naked to cold air, or
sprinkled with cold water, a quantity of pale urine is soon discharged; for
the absorbents of the bladder become torpid by their sympathy with those of
the skin; which are rendered quiescent by the diminution of external heat;
but the kidnies continue to secrete the urine, and as no part of it is
absorbed, it becomes copious and pale. This happens from a similar cause in
cold fits of agues; and in less degree to many debilitated constitutions,
whose extremities are generally cold and pale. The great quantity of limpid
water in hysteric cases, and in diabætes, belongs to Class I. 3. 1. 10. I.
3. 2. 6.

M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in
cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire.

6. _Diarrhoea frigida._ Liquid stools are produced by exposing the body
naked to cold air, or sprinkling it with cold water, for the same reason as
the last article.

But this disease is sometimes of a dangerous nature; the intestinal
absorption being so impaired, that the aliment is said to come away
undiminished in quantity, and almost unchanged by the powers of digestion,
and is then called lientery.

The mucus of the rectum sometimes comes away like pellucid hartshorn jelly,
and liquefies by heat like that, towards the end of inirritative fevers,
which is owing to the thinner part of the mucus not being absorbed, and
thus resembles the catarrh of some old people.

M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold
weather. Clysters with opium. Friction on the bowels morning and night.
Equitation twice a day.

7. _Fluor albus frigidus._ Cold fluor albus. In weak constitutions, where
this discharge is pellucid and thin, it must proceed from want of
absorption of the mucous membrane of the vagina, or uterus, and not from an
increased secretion. This I suspect to be the most frequent kind of fluor
albus; the former one described at Class I. 1. 2. 11. attends menstruation,
or is a discharge instead of it, and thus resembles the venereal orgasm of
female quadrupeds. The discharge in this latter kind being more saline, is
liable to excoriate the part, and thus produce smarting in making water; in
its great degree it is difficult to cure.

M. M. Increase the evacuation by stool and by perspiration, by taking
rhubarb every night, about six or ten grains with one grain of opium for
some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters,
chalybeates, friction over the whole skin with flannel morning and night.
Partial cold bath, by sprinkling the loins and thighs, or sponging them
with cold water. Mucilage, as isinglass boiled in milk; blanc mange,
hartshorn jelly, are recommended by some. Tincture of cantharides sometimes
seems of service given from ten to twenty drops or more, three or four
times a day. A large plaster of burgundy pitch and armenian bole, so as to
cover the loins and lower part of the belly, is said to have sometimes
succeeded by increasing absorption by its compression in the manner of a
bandage. A solution of metallic salts, as white vitriol, sixty grains to a
pint; or an infusion of oak-bark may be injected into the vagina. Cold
bath.

8. _Gonorrhoea frigida._ Cold gleet. Where the gleet is thin and pellucid,
it must arise from the want of absorption of the membranes of the urethra,
rather than from an increased secretion from them. This I suppose to be a
more common disease than that mentioned at Class I. 1. 2. 10.

M. M. Metallic injections, partial cold bath, internal method as in the
fluor albus above described. Balsam of copaiva. Tincture of cantharides.

9. _Hepatis tumor._ The liver becomes enlarged from defect of the
absorption of mucus from its cells, as in anasarca, especially in feeble
children; at the same time less bile is secreted from the torpid
circulation in the vena portæ. And as the absorbents, which resume the
thinner parts of the bile from the gall-bladder and hepatic ducts, are also
torpid or quiescent, the bile is more dilute, as well as in less quantity.
From the obstruction of the passage of the blood through the compressed
vena porta these patients have tumid bellies, and pale bloated
countenances; their paleness is probably owing to the deficiency of the
quantity of red globules in the blood in consequence of the inert state of
the bile.

These symptoms in children are generally attended with worms, the dilute
bile and the weak digestion not destroying them. In sleep I have seen
fleuke-worms in the gall-ducts themselves among the dilute bile; which
gall-ducts they eat through, and then produce ulcers, and the hectic fever,
called the rot. See Class I. 1. 4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron-filings are specific in this
disease in children, and the worms are destroyed by the returning acrimony
and quantity of the bile. A blister on the region of the liver. Sorbentia,
as worm-seed, santonicum. Columbo. Bark.

10. _Chlorosis._ When the defect of the due action of both the absorbent
and secerning vessels of the liver affects women, and is attended with
obstruction of the catamenia, it is called chlorosis; and is cured by the
exhibition of steel, which restores by its specific stimulus the absorbent
power of the liver; and the menstruation, which was obstructed in
consequence of debility, recurs.

Indigestion, owing to torpor of the stomach, and a consequent too great
acidity of its contents, attend this disease; whence a desire of eating
chalk, or marl. Sometimes a great quantity of pale urine is discharged in a
morning, which is owing to the inaction of the absorbents, which are
distributed on the neck of the bladder, during sleep. The swelling of the
ankles, which frequently attends chlorosis, is another effect of deficient
action of the absorbent system; and the pale countenance is occasioned by
the deficient quantity of red globules of blood, caused by the deficient
quantity or acrimony of the bile, and consequent weakness of the
circulation. The pulse is so quick in some cases of chlorosis, that, when
attended with an accidental cough, it may be mistaken for pulmonary
consumption. This quick pulse is owing to the debility of the heart from
the want of stimulus occasioned by the deficiency of the quantity, and
acrimony of the blood.

M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all
over the body and limbs night and morning. Rhubarb five grains, opium half
a grain, every night. Flesh diet, with small beer, or wine and water. The
disease continues some months, but at length subsides by the treatment
above described. A bath of about eighty degrees, as Buxton Bath, is of
service; a colder bath may do great injury.

11. _Hydrocele._ Dropsy of the vagina testis. Dropsies have been divided
into the incysted and the diffused, meaning those of the cellular membrane,
the cells of which communicate with each other like a sponge, and those of
any other cavity of the body. The collections of mucous fluids in the
various cells and cavities of the body arise from the torpor of the
absorbent vessels of those parts. It is probable, that in dropsies attended
with great thirst the cutaneous absorbents become paralytic first; and then
from the great thirst, which is thus occasioned by the want of atmospheric
moisture, the absorption of the fat ensues; as in fevers attended with
great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some
have believed, that the cellular and adipose membranes are different ones;
as no fat is ever deposited in the eye-lids or scrotum, both which places
are very liable to be distended with the mucilaginous fluid of the
anasarca, and with air in Emphysema. Sometimes a gradual absorption of the
accumulated fluid takes place, and the thinner parts being taken up, there
remains a more viscid fluid, or almost a solid in the part, as in some
swelled legs, which can not easily be indented by the pressure of the
finger, and are called scorbutic. Sometimes the paralysis of the absorbents
is completely removed, and the whole is again taken up into the
circulation.

The Hydrocele is known by a tumor of the scrotum, which is without pain,
gradually produced, with fluctuation, and a degree of pellucidity, when a
candle is held behind it; it is the most simple incysted dropsy, as it is
not in general complicated with other diseases, as ascites with schirrous
liver, and hydrocephalus internus, with general debility. The cure of this
disease is effected by different ways; it consists in discharging the water
by an external aperture; and by so far inflaming the cyst and testicle,
that they afterwards grow together, and thus prevent in future any
secretion or effusion of mucus; the disease is thus cured, not by the
revivescence of the absorbent power of the lymphatics, but by the
prevention of secretion by the adhesion of the vagina to the testis. This I
believe is performed with less pain, and is more certainly manageable by
tapping, or discharging the fluid by means of a trocar, and after the
evacuation of it to fill the cyst with a mixture of wine and water for a
few minutes till the necessary degree of stimulus is produced, and then to
withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by
Dr. Duncan, for 1793.

12. _Hydrocephalus internus_, or dropsy of the ventricles of the brain, is
fatal to many children, and some adults. When this disease is less in
quantity, it probably produces a fever, termed a nervous fever, and which
is sometimes called a worm fever, according to the opinion of Dr.
Gilchrist, in the Scots Medical essays. This fever is attended with great
inirritability, as appears from the dilated pupils of the eyes, in which it
corresponds with the dropsy of the brain. And the latter disease has its
paroxysms of quick pulse, and in that respect corresponds with other fevers
with inirritability.

The hydrocephalus internus is distinguished from apoplexy by its being
attended with fever, and from nervous fever by the paroxysms being very
irregular, with perfect intermissions many times in a day. In nervous fever
the pain of the head generally affects the middle of the forehead; in
hydrocephalus internus it is generally on one side of the head. One of the
earliest criterions is the patient being uneasy on raising his head from
the pillow, and wishing to lie down again immediately; which I suppose is
owing to the pressure of the water on the larger trunks of the
blood-vessels entering the cavity being more intolerable than on the
smaller ones; for if the larger trunks are compressed, it must
inconvenience the branches also; but if some of the small branches are
compressed only, the trunks are not so immediately incommoded.

Blisters on the head, and mercurial ointment externally, with calomel
internally, are principally recommended in this fatal disease. When the
patient cannot bear to be raised up in bed without great uneasiness, it is
a bad symptom. So I believe is deafness, which is commonly mistaken for
stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of
either eye, or the squinting is very apparent, or the pupils of both eyes
much dilated, it is generally fatal. As by stimulating one branch of
lymphatics into inverted motion, another branch is liable to absorb its
fluid more hastily; suppose strong errhines, as common tobacco snuff to
children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed
with ten or fifteen grains of sugar, was gradually blown up the nostrils?
See Class I. 3. 2. 1. I have tried common snuff upon two children in this
disease; one could not be made to sneeze, and the other was too near death
to receive advantage. When the mercurial preparations have produced
salivation, I believe they may have been of service, but I doubt their good
effect otherwise. In one child I tried the tincture of Digitalis; but it
was given with too timid a hand, and too late in the disease, to determine
its effects. See Sect. XXIX. 5. 9.

As all the above remedies generally fail of success, I think frequent,
almost hourly, shocks of electricity from very small charges might be
passed through the head in all directions with probability of good event.
And the use of the trephine, where the affected side can be distinguished.
See Strabismus, Class I. 2. 5. 4. When one eye is affected, does the
disease exist in the ventricule of that side?

13. _Ascites._ The dropsy of the cavity of the abdomen is known by a tense
swelling of the belly; which does not sound on being struck like the
tympany; and in which a fluctuation can be readily perceived by applying
one hand expanded on one side, and striking the tumour on the other.

Effusions of water into large cavities, as into that of the abdomen or
thorax, or into the ventricules of the brain or pericardium, are more
difficult to be reabsorbed, than the effusion of fluids into the cellular
membrane; because one part of this extensive sponge-like system of cells,
which connects all the solid parts of the body, may have its power of
absorption impaired, at the same time that some other part of it may still
retain that power, or perhaps possess it in an increased degree; and as all
these cells communicate with each other, the fluid, which abounds in one
part of it, can be transferred to another, and thus be reabsorbed into the
circulation.

In the ascites, cream of tartar has sometimes been attended with success; a
dram or two drams are given every hour in a morning till it operates, and
is to be repeated for several days; but the operation of tapping is
generally applied to at last. Dr. Sims, in the Memoirs of the Medical
Society of London, Vol. III. has lately proposed, what he believes to be a
more successful method of performing this operation, by making a puncture
with a lancet in the scar of the navel, and leaving it to discharge itself
gradually for several days, without introducing a canula, which he thinks
injurious both on account of the too sudden emission of the fluid, and the
danger of wounding or stimulating the viscera. This operation I have twice
known performed with less inconvenience, and I believe with more benefit to
the patient, than the common method.

After the patient has been tapped, some have tried injections into the
cavity of the abdomen, but hitherto I believe with ill event. Nor are
experiments of this kind very promising of success. First because the
patients are generally much debilitated, most frequently by spirituous
potation, and have generally a disease of the liver, or of other viscera.
And secondly, because the quantity of inflammation, necessary to prevent
future secretion of mucus into the cavity of the abdomen, by uniting the
peritoneum with the intestines or mesentery, as happens in the cure of the
hydrocele, would I suppose generally destroy the patient, either
immediately, or by the consequence of such adhesions.

This however is not the case in respect to the dropsy of the ovarium, or in
the hydrocele.

14. _Hydrops thoracis._ The dropsy of the chest commences with loss of
flesh, cold extremities, pale countenance, high coloured urine in small
quantity, and general debility, like many other dropsies. The patient next
complains of numbness in the arms, especially when elevated, with pain and
difficulty of swallowing, and an absolute impossibility of lying down for a
few minutes, or with sudden starting from sleep, with great difficulty of
breathing and palpitation of his heart.

The numbness of the arms is probably owing more frequently to the increased
action of the pectoral muscles in respiration, whence they are less at
liberty to perform other offices, than to the connexion of nerves mentioned
in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the
compression of the oesophagus by the lymph in the chest; and the
impossibility of breathing in an horizontal posture originates from this,
that if any parts of the lungs must be rendered useless, the inability of
the extremities of them must be less inconvenient to respiration; since if
the upper parts or larger trunks of the air-vessels should be rendered
useless by the compression of the accumulated lymph, the air could not gain
admittance to the other parts, and the animal must immediately perish.

If the pericardium is the principal seat of the disease, the pulse is quick
and irregular. If only the cavity of the thorax is hydropic, the pulse is
not quick nor irregular.

If one side is more affected than the other, the patient leans most that
way, and has more numbness in that arm.

The hydrops thoracis is distinguished from the anasarca pulmonum, as the
patient in the former cannot lie down half a minute; in the latter the
difficulty of breathing, which occasions him to rise up, comes on more
gradually; as the transition of the lymph in the cellular membranes from
one part to another of it is slower, than that of the effused lymph in the
cavity of the chest.

The hydrops thoracis is often complicated with fits of convulsive
breathing; and then it produces a disease for the time very similar to the
common periodic asthma, which is perhaps owing to a temporary anasarca of
the lungs; or to an impaired venous absorption in them. These exacerbations
of difficult breathing are attended with cold extremities, cold breath,
cold tongue, upright posture with the mouth open, and a desire of cold air,
and a quick, weak, intermittent pulse, and contracted hands.

These exacerbations recur sometimes every two or three hours, and are
relieved by opium, a grain every hour for two or three doses, with ether
about a dram in cold water; and seem to be a convulsion of the muscles of
respiration induced by the pain of the dyspnea. As in Class III. 1. 1. 9.

M. M. A grain of dried squill, and a quarter of a grain of blue vitriol
every hour for six or eight hours, unless it vomit or purge. A grain of
opium. Blisters. Calomel three grains every third day, with infusion of
senna. Bark. Chalybeates. Puncture in the side.

Can the fluctuation in the chest be heard by applying the ear to the side,
as Hippocrates asserts? Can it be felt by the hand or by the patient before
the disease is too great to admit of cure by the paracentesis? Does this
dropsy of the chest often come on after peripneumony? Is it ever cured by
making the patient sick by tincture of digitalis? Could it be cured, if on
one side only, by the operation of puncture between the ribs, and
afterwards by inflaming the cavity by the admission of air for a time, like
the cure of the hydrocele; the pleura afterwards adhering wholly to that
lobe of the lungs, so as to prevent any future effusion of mucus?

15. _Hydrops ovarii._ Dropsy of the ovary is another incysted dropsy, which
seldom admits of cure. It is distinguished from ascites by the tumour and
pain, especially at the beginning, occupying one side, and the fluctuation
being less distinctly perceptible. When it happens to young subjects it is
less liable to be mistaken for ascites. It affects women of all ages,
either married or virgins; and is produced by cold, fear, hunger, bad food,
and other debilitating causes. I saw an elegant young lady, who was shortly
to have been married to a sensible man, with great prospect of happiness;
who, on being overturned in a chaise in the night, and obliged to walk two
or three miles in wet, cold, and darkness, became much indisposed, and
gradually afflicted with a swelling and pain on one side of the abdomen;
which terminated in a dropsy of the ovary, and destroyed her in two or
three years. Another young woman I recollect seeing, who was about
seventeen, and being of the very inferior class of people, seemed to have
been much weakened by the hardship of a cold floor, and little or no bed,
with bad food; and who to these evils had to bear the unceasing obloquy of
her neighbours, and the persecution of parish officers.

The following is abstracted from a letter of my friend Mr. Power, surgeon,
at Bosworth in Leicestershire, on examining the body of an elderly lady who
died of this disease, March 29, 1793. "On opening the abdomen I found a
large cyst attached to the left ovarium by an elastic neck as thick as the
little finger, and so callous as not to admit of being separated by
scissars without considerable difficulty. The substance of the cyst had an
appearance much resembling the gravid uterus near the full period of
gestation, and was as thick. It had no attachment to the peritonæum, or any
of the viscera, except by the hard callous neck I have mentioned; so that
the blood must with difficulty have been circulated through it for some
time. Its texture was extremely tender, being easily perforated with the
finger, was of a livid red colour, and evidently in a sphacelated state. It
contained about two gallons of a fluid of the colour of port wine, without
any greater tenacity. It has fallen to my lot to have opened two other
patients, whose deaths were occasioned by incysted dropsy of the ovarium.
In one of these the ovarium was much enlarged with eight or ten cysts on
its surface, but there was no adhesion formed by any of the cysts to any
other part; nor had the ovarium formed any adhesion with the peritonæum,
though in a very diseased state. In the other the disease was more simple,
being only one cyst, without any attachment but to the ovarium.

    "As the ovarium is a part not necessary to life, and dropsies of this
    kind are so generally fatal in the end, I think I shall be induced,
    notwithstanding the hazard attending wounds, which penetrate the cavity
    of the abdomen, to propose the extirpation of the diseased part in the
    first case, which occurs to me, in which I can with precision say, that
    the ovarium is the seat of the disease, and the patient in other
    respects tolerably healthy; as the cavity of the abdomen is often
    opened in other cases without bad consequences."

An argument, which might further countenance the operation thus proposed by
Mr. Power, might be taken from the disease frequently affecting young
persons; from its being generally in these subjects local and primary; and
not like the ascites, produced or accompanied with other diseased viscera;
and lastly, as it is performed in adult quadrupeds, as old sows, with
safety, though by awkward operators.

16. _Anasarca pulmonum._ The dropsy of the cellular membrane of the lungs
is usually connected with that of the other parts of the system. As the
cells of the whole cellular membrane communicate with each other, the
mucaginous fluid, which remains in any part of it for want of due
absorption, sinks down to the most depending cells; hence the legs swell,
though the cause of the disease, the deficiency of absorption, may be in
other parts of the system. The lungs however are an exception to this,
since they are suspended in the cavity of the thorax, and have in
consequence a depending part of their own.

The anasarca of the lungs is known by the difficulty of respiration
accompanied with swelled legs, and with a very irregular pulse. This last
circumstance has generally been ascribed to a dropsy at the same time
existing in the pericardium, but is more probably owing to the difficult
passage of the blood through the lungs; because I found on dissection, in
one instance, that the most irregular pulse, which I ever attended to, was
owing to very extensive adhesions of the lungs; insomuch that one lobe
intirely adhered to the pleura; and secondly, because this kind of dropsy
of the lungs is so certainly removed for a time along with the anasarca of
the limbs by the use of digitalis.

This medicine, as well as emetic tartar, or squill, when given so as to
produce sickness, or nausea, or perhaps even without producing either in
any perceptible degree, by affecting the lymphatics of the stomach, so as
either to invert their motion, or to weaken them, increases by reverse
sympathy the action, and consequent absorbent power of these lymphatics,
which open into the cellular membrane. But as those medicines seldom
succeed in producing an absorption of those fluids, which stagnate in the
larger cavities of the body, as in the abdomen, or chest, and do generally
succeed in this difficulty of breathing with irregular pulse above
described, I conclude that it is not owing to an effusion of lymph into the
pericardium, but simply to an anasarca of the lungs.

M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar
(antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain
twice a day. Raisin wine and water, or other wine and water, is preferred
to the spirit and water, which these patients have generally been
accustomed to.

The usual cause of anasarca is from a diseased liver, and hence it most
frequently attends those, who have drank much fermented or spirituous
liquors; but I suspect that there is another cause of anasarca, which
originates from the brain; and which is more certainly fatal than that,
which originates from a diseased liver. These patients, where the anasarca
originates from, or commences in, the brain, have not other symptoms of
diseased liver; have less difficulty of breathing at the beginning; and
hold themselves more upright in their chair, and in walking. In this kind
of dropsy I suspect the digitalis has less or no effect; as it particularly
increases the absorption from the lungs.

17. _Obesitas._ Corpulency may be called an anasarca or dropsy of fat,
since it must be owing to an analogous cause; that is, to the deficient
absorption of fat compared to the quantity secreted into the cells which
contain it. See Class II. 1. 1. 4.

The method of getting free from too much fat without any injury to the
constitution, consists, first, in putting on a proper bandage on the belly,
so that it can be tightened or relaxed with ease, as a tightish under
waistcoat, with a double row of buttons. This is to compress the bowels and
increase their absorption, and it thus removes one principal cause of
corpulency, which is the looseness of the skin. Secondly, he should omit
one entire meal, as supper; by this long abstinence from food the absorbent
system will act on the mucus and fat with greater energy. Thirdly, he
should drink as little as he can with ease to his sensations; since, if the
absorbents of the stomach and bowels supply the blood with much, or perhaps
too much, aqueous fluid, the absorbents of the cellular membrane will act
with less energy. Fourthly, he should use much salt or salted meat, which
will increase the perspiration and make him thirsty; and if he bears this
thirst, the absorption of his fat will be greatly increased, as appears in
fevers and dropsies with thirst; this I believe to be more efficacious than
soap. Fifthly, he may use aerated alcaline water for his drink, which may
be supposed to render the fat more fluid,--or he may take soap in large
quantities, which will be decomposed in the stomach. Sixthly, short rest,
and constant exercise.

18. _Splenis tumor._ Swellings of the spleen, or in its vicinity, are
frequently perceived by the hand in intermittents, which are called
Ague-cakes, and seem owing to a deficiency of absorption in the affected
part.

Mr. Y----, a young man about twenty-five years of age, who lived
intemperately, was seized with an obstinate intermittent, which had become
a continued fever with strong pulse, attended with daily remission. A large
hard tumour on the left side, on the region of the spleen, but extending
much more downward, was so distinctly perceptible, that one seemed to get
one's fingers under the edge of it, much like the feel of the brawn or
shield on a boar's shoulder. He was repeatedly bled, and purged with
calomel, had an emetic, and a blister on the part, without diminishing the
tumour; after some time he took the Peruvian bark, and slight doses of
chalybeates, and thus became free from the fever, and went to Bath for
several weeks, but the tumour remained. This tumour I examined every four
or five years for above thirty years. His countenance was pale, and towards
the end of his life he suffered much from ulcers on his legs, and died
about sixty, of general debility; like many others, who live intemperately
in respect to the ingurgitation of fermented or spirituous liquors.

As this tumour commenced in the cold fit of an intermittent fever, and was
not attended with pain, and continued so long without endangering his life,
there is reason to believe it was simply occasioned by deficient
absorption, and not by more energetic action of the vessels which
constitute the spleen. See Class II. 1. 2. 13.

M. M. Venesection. Emetic, cathartic with calomel; then sorbentia,
chalybeates, Peruvian bark.

19. _Genu tumor albus._ White swelling of the knee, is owing to deficient
absorption of the lymphatics of the membranes including the joint, or
capsular ligaments, and sometimes perhaps of the gland which secretes the
synovia; and the ends of the bones are probably affected in consequence.

I saw an instance, where a caustic had been applied by an empiric on a
large white swelling of the knee, and was told, that a fluid had been
discharged from the joint, which became anchylosed, and healed without loss
of the limb.

M. M. Repeated blisters on the part early in the disease are said to cure
it by promoting absorption; saturnine solutions externally are recommended.
Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with
the hand.

20. _Bronchocele._ Swelled throat. An enlargement of the thyroid glands,
said to be frequent in mountainous countries, where river water is drank,
which has its source from dissolving snows. This idea is a very ancient
one, but perhaps not on that account to be the more depended upon, as
authors copy one another. Tumidum guttur quis miratur in alpibus, seems to
have been a proverb in the time of Juvenal. The inferior people of Derby
are much subject to this disease, but whether more so than other populous
towns, I can not determine; certain it is, that they chiefly drink the
water of the Derwent, which arises in a mountainous country, and is very
frequently blackened as it passes through the morasses near its source; and
is generally of a darker colour, and attended with a whiter foam, than the
Trent, into which it falls; the greater quantity and whiteness of its froth
I suppose may be owing to the viscidity communicated to it by the colouring
matter. The lower parts of the town of Derby might be easily supplied with
spring water from St. Alkmond's well; or the whole of it from the abundant
springs near Bowbridge: the water from which might be conveyed to the town
in hollow bricks, or clay-pipes, at no very great expence, and might be
received into frequent reservoirs with pumps to them; or laid into the
houses.

M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage
into lozenges, and permitted to dissolve slowly under the tongue twice a
day, is asserted to cure in a few months; perhaps other animal charcoal, as
candle-snuffs, might do the same.

I have directed in the early state of this disease a mixture of common salt
and water to be held in the mouth, particularly under the tongue, for a few
minutes, four or six times a day for many weeks, which has sometimes
succeeded, the salt and water is then spit out again, or in part swallowed.
Externally vinegar of squills has been applied, or a mercurial plaster, or
fomentations of acetated ammoniac; or ether. Some empirics have applied
caustics on the bronchocele, and sometimes, I have been told, with success;
which should certainly be used where there is danger of suffocation from
the bulk of it. One case I saw, and one I was well informed of, where the
bronchocele was cured by burnt sponge, and a hectic fever supervened with
colliquative sweats; but I do not know the final event of either of them.

De Haen affirms the cure of bronchocele to be effected by flowers of zinc,
calcined egg-shells, and scarlet cloth burnt together in a close crucible,
which was tried with success, as he assured me, by a late lamented
physician, my friend, Dr. Small of Birmingham; who to the cultivation of
modern sciences added the integrity of ancient manners; who in clearness of
head, and benevolence of heart, had few equals, perhaps no superiors.

21. _Scrophula._ King's evil is known by tumours of the lymphatic glands,
particularly of the neck. The upper lip, and division of the nostrils is
swelled, with a florid countenance, a smooth skin, and a tumid abdomen.
Cullen. The absorbed fluids in their course to the veins in the scrophula
are arrested in the lymphatic or conglobate glands; which swell, and after
a great length of time, inflame and suppurate. Materials of a peculiar
kind, as the variolous and venereal matter, when absorbed in a wound,
produce this torpor, and consequent inflammation of those lymphatic glands,
where they first arrive, as in the axilla and groin. There is reason to
suspect, that the tonsils frequently become inflamed, and suppurate from
the matter absorbed from carious teeth; and I saw a young lady, who had
both the axillary glands swelled, and which suppurated; which was believed
to have been caused by her wearing a pair of new green gloves for one day,
when she had perspired much, and was much exhausted and fatigued by
walking; the gloves were probably dyed in a solution of verditer.

These indolent tumours of the lymphatic glands, which constitute the
scrophula, originate from the inirritability of those glands; which
therefore sooner fall into torpor after having been stimulated too
violently by some poisonous material; as the muscles of enfeebled people
sooner become fatigued, and cease to act, when exerted, than those of
stronger ones. On the same account these scrophulous glands are much longer
in acquiring increase of motion, after having been stimulated into
inactivity, and either remain years in a state of indolence, or suppurate
with difficulty, and sometimes only partially.

The difference between scrophulous tumours, and those before described,
consists in this; that in those either glands of different kinds were
diseased, or the mouths only of the lymphatic glands were become torpid;
whereas in scrophula the conglobate glands themselves become tumid, and
generally suppurate after a great length of time, when they acquire new
sensibility. See Sect. XXXIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by passing
electric shocks through them every day for two or three weeks, as I have
witnessed. It is probable, that the alternate application of snow or iced
water to them, till they become painfully cold, and then of warm flannel or
warm water, frequently repeated, might restore their irritability by
accumulation of sensorial power; and thence either facilitate their
dispersion, or occasion them to suppurate. See Class II. 1. 4. 13.

This disease is very frequent amongst the children of the poor in large
towns, who are in general ill fed, ill lodged, and ill clothed; and who are
further weakened by eating much salt with their scanty meal of insipid
vegetable food, which is seldom of better quality than water gruel, with a
little coarse bread in it. See diarrhoea of infants, Class I. 1. 2. 5.
Scrophulous ulcers are difficult to heal, which is owing to the deficiency
of absorption on their pale and flabby surfaces, and to the general
inirritability of the system. See Class I. 1. 3. 13.

M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium,
from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture
of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing
in salt and water, one pound to three gallons, made warm. The application
of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in
fine powder one part, mixed together and applied on the ulcers in dry
powder, by means of lint and a bandage, to be renewed every day. Or very
fine powder of calamy alone, lapis calaminaris. If powder of manganese?

22. _Schirrus._ After the absorbent veins of a gland cease to perform their
office, if the secerning arteries of it continue to act some time longer,
the fluids are pushed forwards, and stagnate in the receptacles or
capillary vessels of the gland; and the thinner part of them only being
resumed by the absorbent system of the gland, a hard tumour gradually
succeeds; which continues like a lifeless mass, till from some accidental
violence it gains sensibility, and produces cancer, or suppurates. Of this
kind are the schirrous glands of the breasts, of the lungs, of the
mesentery, and the scrophulous tumours about the neck and the bronchocele.

Another seat of schirrus is in the membranous parts of the system, as of
the rectum intestinum, the urethra, the gula or throat; and of this kind is
the verucca or wart, and the clavus pedum, or corns on the toes. A wen
sometimes arises on the back of the neck, and sometimes between the
shoulders; and by distending the tendinous fascia produces great and
perpetual pain.

M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation.
Electric shocks through the tumour. An issue into the substance of the wen.
Opium. Ether externally.

23. _Schirrus recti intestini._ Schirrus of the rectum. A schirrus
frequently affects a canal, and by contracting its diameter becomes a
painful and deplorable disease. The canals thus obstructed are the rectum,
the urethra, the throat, the gall-ducts, and probably the excretory ducts
of the lymphatics, and of other glands.

The schirrus of the rectum is known by the patient having pain in the part,
and being only able to part with liquid feces, and by the introduction of
the finger; the swelled part of the intestine is sometimes protruded
downwards, and hangs like a valve, smooth and hard to the touch, with an
aperture in the centre of it. See a paper on this subject by J. Sherwin.
Memoirs of a London Medical Society, Vol. II. p. 9.

M. M. To take but little solid food. Aperient medicines. Introduce a candle
smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of
laudanum. Introduce a leathern canula, or gut, and then either a wooden
maundril, or blow it up with air, so as to distend the contracted part as
much as the patient can bear. Or spread mercurial plaster on thick soft
leather, and roll it up with the plaster outwards to any thickness and
length, which can be easily introduced and worn; or two or three such
pieces may be introduced after each other. The same may be used to compress
bleeding internal piles. See Class I. 2. 1. 6.

24. _Schirrus urethræ._ Schirrus of the urethra. The passage becomes
contracted by the thickened membrane, and the urine is forced through with
great difficulty, and is thence liable to distend the canal behind the
stricture; till at length an aperture is made, and the urine forces its way
into the cellular membrane, making large sinuses. This situation sometimes
continues many months, or even years, and so much matter is evacuated after
making water, or at the same time, by the action of the muscles in the
vicinity of the sinuses, that it has been mistaken for an increased
secretion from the bladder, and has been erroneously termed a catarrh of
the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs.

M. M. Distend the part gradually by catgut bougies, which by their
compression will at the same time diminish the thickness of the membrane,
or by bougies of elastic gum, or of horn boiled soft. The patient should
gain the habit of making water slowly, which is a matter of the utmost
consequence, as it prevents the distention, and consequent rupture, of that
part of the urethra, which is between the stricture and the neck of the
bladder.

When there occurs an external ulcer in the perinæum, and the urine is in
part discharged that way, the disease can not be mistaken. Otherwise from
the quantity of matter, it is generally supposed to come from the bladder,
or prostate gland; and the urine, which escapes from the ruptured urethra,
mines its way amongst the muscles and membranes, and the patient dies
tabid, owing to the want of an external orifice to discharge the matter.
See Class II. 1. 4. 11.

25. _Schirrus oesophagi._ A schirrus of the throat contracts the passage so
as to render the swallowing of solids impracticable, and of liquids
difficult. It affects patients of all ages, but is probably most frequently
produced by swallowing hard angular substances, when people have lost their
teeth; by which this membrane is over distended, or torn, or otherwise
injured.

M. M. Put milk into a bladder tied to a canula or catheter; introduce it
past the stricture, and press it into the stomach. Distend the stricture
gradually by a sponge-tent fastened to the end of whale-bone, or by a plug
of wax, or a spermaceti candle, about two inches long; which might be
introduced, and left there with a string only fixed to it to hang out of
the mouth, to keep it in its place, and to retract it by occasionally; for
which purpose the string must be put through a catheter or hollow probang,
when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and
then distend it by blowing wind into it. The swallowing a bullet with a
string put through it, to retract it on the exhibition of an emetic, has
also been proposed. Externally mercurial ointment has been much
recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth.
Transfusion of blood into a vein three or four ounces a day? See Class III.
1. 1. 15.

I directed a young woman about twenty-two years of age, to be fed with new
milk put into a bladder, which was tied to a catheter, and introduced
beyond the stricture in her throat; after a few days her spirits sunk, and
she refused to use it further, and died. Above thirty years ago I proposed
to an old gentleman, whose throat was entirely impervious, to supply him
with a few ounces of blood daily from an ass, or from the human animal, who
is still more patient and tractable, in the following manner. To fix a
silver pipe about an inch long to each extremity of a chicken's gut, the
part between the two silver ends to be measured by filling it with warm
water; to put one end into the vein of a person hired for that purpose, so
as to receive the blood returning from the extremity; and when the gut was
quite full, and the blood running through the other silver end, to
introduce that end into the vein of the patient upwards towards the heart,
so as to admit no air along with the blood. And lastly, to support the gut
and silver ends on a water plate, filled with water of ninety-eight degrees
of heat, and to measure how many ounces of blood was introduced by passing
the finger, so as to compress the gut, from the receiving pipe to the
delivering pipe; and thence to determine how many gut-fulls were given from
the healthy person to the patient. See Class IV. 2. 4. 11. Mr. ----
considered a day on this proposal, and then another day, and at length
answered, that "he now found himself near the house of death; and that if
he could return, he was now too old to have much enjoyment of life; and
therefore he wished rather to proceed to the end of that journey, which he
was now so near, and which he must at all events soon go, than return for
so short a time." He lived but a few days afterwards, and seemed quite
careless and easy about the matter.

26. _Lacteorum inirritabilitas._ Inirritability of the lacteals is
described in Sect. XXVIII. under the name of paralysis of the lacteals; but
as the word paralysis has generally been applied to the disobedience of the
muscles to the power of volition, the name is here changed to
inirritability of the lacteals, as more characteristic of the disease.

27. _Lymphaticorum inirritabilitas._ The inirritability of the cellular and
cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Class I. 2.
3. 16. The inirritability of the cutaneous lymphatics generally accompanies
anasarca, and is the cause of the great thirst in that malady. At the same
time the cellular lymphatics act with greater energy, owing to the greater
derivation of sensorial power to them in consequence of the less
expenditure of it by the cutaneous ones; and hence they absorb the fat, and
mucus, and also the thinner parts of the urine. Whence the great emaciation
of the body, the muddy sediment, and the small quantity of water in this
kind of dropsy.

       *       *       *       *       *

ORDO II.

_Decreased Irritation._

GENUS IV.

_With Decreased Actions of other Cavities and Membranes._

Many of the diseases of this genus are attended with pain, and with cold
extremities, both which cease on the exhibition of wine or opium; which
shews, that they originate from deficient action of the affected organ.
These pains are called nervous or spasmodic, are not attended with fever,
but are frequently succeeded by convulsions and madness; both which belong
to the class of volition. Some of them return at periods, and when these
can be ascertained, a much less quantity of opium will prevent them, than
is necessary to cure them, when they are begun; as the vessels are then
torpid and inirritable from the want of sensorial power, till by their
inaction it becomes again accumulated.

Our organs of sense properly so called are not liable to pain from the
absence of their appropriated stimuli, as from darkness or silence; but the
other senses, which may be more properly called appetites, as those by
which we perceive heat, hunger, thirst, lust, want of fresh air, are
affected with pain from the defect or absence of their accustomed stimuli,
as well as with pleasure by the possession of them; it is probable that
some of our glands, whose sense or appetite requires or receives something
from the circulating blood, as the pancreas, liver, testes, prostate gland,
may be affected with aching or pain, when they cannot acquire their
appropriated fluid.

Wherever this defect of stimulus occurs, a torpor or inaction of the organ
ensues, as in the capillaries of the skin, when exposed to cold; and in the
glands, which secrete the gastric juice, when we are hungry. This torpor
however, and concomitant pain, which is at first owing to defect of
stimulus, is afterwards induced by other associations or catenations, and
constitutes the beginning of ague fits.

It must be further observed, that in the diseases of pain without fever,
the pain is frequently not felt in the part where the cause of the disease
resides; but is induced by sympathy with a distant part, whose irritability
or sensibility is greater or less than its own. Thus a stone at the neck of
the bladder, if its stimulus is not very great, only induces the pain of
strangury at the glans penis. If its stimulus be greater, it then induces
pain at the neck of the bladder. The concretions of bile, which are
protruded into the neck of the gall-bladder, when the disease is not very
great, produce pain at the other extremity of the bile-duct, which enters
the duodenum immediately under the pit of the stomach; but, when the
disease is great from the largeness of the bile-stone, the pain is felt in
the region of the liver at the neck of the gall-bladder.

It appears from hence, that the pains enumerated in this genus are
consequences of the inactivity of the organ; and, as they do not occasion
other diseases, should be classed according to their proximate cause, which
is defective irritation; there are nevertheless other pains from defect of
stimulus, which produce convulsions, and belong to Class III. 1. 1.; and
others, which produce pains of some distant part by association, and belong
to Class IV. 2. 2.

SPECIES.

1. _Sitis._ Thirst. The senses of thirst and of hunger seem to have this
connection, that the former is situated at the upper end, and the latter at
the lower end of the same canal. One about the pharinx, where the
oesophagus opens into the mouth, and the other about the cardia ventriculi,
where it opens into the stomach. The extremities of other canals have been
shewn to possess correspondent sensibilities, or irritabilities, as the two
ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4.

The membrane of the upper end of the gullet becomes torpid, and
consequently painful, when there is a deficiency of aqueous fluid in the
general system; it then wants its proper stimulus. In the same manner a
want of the stimulus of more solid materials at the other end of the canal,
which terminates in the stomach, produces hunger; as mentioned in Sect.
XIV. 8. The proximate causes of both of them therefore consist in deficient
irritation, when they are considered as pains; because these pains are in
consequence of the inactivity of the organ, according to the fifth law of
animal causation. Sect. IV. 5. But when they are considered as desires,
namely of liquid or solid aliment, their proximate cause consists in the
pain of them, according to the sixth law of animal causation. So the
proximate cause of the pain of coldness is the inactivity of the organ, and
perhaps the consequent accumulation of sensorial power in it; but the pain
itself, or the consequent volition, is the proximate cause of the
shuddering and gnashing the teeth in cold fits of intermittent fevers. See
Class I. 2. 2. 1.

Thirst may be divided into two varieties alluding to the remote cause of
each, and may be termed sitis calida, or warm thirst, and sitis frigida, or
cold thirst. The remote cause of the former arises from the dissipation of
the aqueous parts of our fluids by the increased secretion of perspirable
matter, or other evacuations. And hence it occurs in hot fits of fever, and
after taking much wine, opium, spice, salt, or other drugs of the Art.
incitantia or secernentia. The thirst, which occurs about three hours after
eating a couple of red herrings, to a person unaccustomed to salted meat,
is of this kind; the increased action of the cutaneous vessels dissipates
so much of our fluids by insensible perspiration, as to require above two
quarts of water to restore the fluidity of the blood, and to wash the salt
out of the system. See Art. III. 2. 1.

M. M. Cold water. Vegetable acids. Warm bath.

The remote cause of sitis frigida, or cold thirst, is owing to the inaction
of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the
blood is deprived of the great supply of moisture, which it ought to
receive from the atmosphere, and from the cells of the cellular membrane,
and from other cysts; this cause of thirst exists in dropsies, and in the
cold fits of intermittents. The desire of fluids, like that of solids, is
liable to acquire periods, and may therefore readily become diseased by
indulgence in liquids grateful to the palate.

Of diseased thirst, the most common is either owing to defect of the action
of the numerous absorbent vessels on the neck of the bladder, in which the
patient makes much paleish water; or to the defective absorption of the
skin and lungs, in which the patient makes but little water, and that
high-coloured, and with sediment. In both the tongue and lips are liable to
become very dry. The former in its greatest degree attends diabætes, and
the latter anasarca.

M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water.
Lemonade. Cyder.

2. _Esuries._ Hunger has been fancifully ascribed to the sides of the
stomach rubbing against each other, and to the increased acidity of the
gastric juice corroding the coats of it. If either of these were the cause
of hunger, inflammation must occur, when they had continued some time; but,
on the contrary, coldness and not heat are attendant on hunger; which
evinces, that like thirst it is owing to the inactivity of the membrane,
which is the seat of it; while the abundant nerves about the cardia
ventriculi, and the pain of hunger being felt in that part, gives great
reason to conclude, that it is there situated.

The sense of hunger as well as of thirst is liable to acquire habits in
respect to the times of its returning painfulness, as well as in respect to
the quantity required to satiate its appetency, and hence may become
diseased by indulgence, as well as by want of its appropriate stimulus.
Those who have been accustomed to distend their stomach by large quantities
of animal and vegetable food, and much potation, find a want of distention,
when the stomach is empty, which occasions faintness, and is mistaken for
hunger, but which does not appear to be the same sensation. I was well
informed, that a woman near Lichfield, who eat much animal and vegetable
food for a wager, affirmed, that since distending her stomach so much, she
had never felt herself satisfied with food; and had in general taken twice
as much at a meal, as she had been accustomed to, before she eat so much
for a wager.

3. _Nausea sicca._ Dry nausea. Consists in a quiescence or torpor of the
mucous or salivary glands, and precedes their inverted motions, described
in nausea humida, Class I. 3. 2. 3. In the same manner as sickness of the
stomach is a quiescence of that organ preceding the action of vomiting, as
explained in Sect. XXXV. 1. 3. This is sometimes induced by disagreeable
drugs held in the mouth, at other times of disgustful ideas, and at other
times by the association of these actions with those of the stomach; and
thus according to its different proximate causes may belong to this, or to
the second, or to the fourth class of diseases.

M. M. Lemonade. Tasteful food. A blister. Warm bath.

4. _Ægritudo ventriculi._ Sickness of stomach is produced by the quiescence
or inactivity of that organ, as is explained in Sect. XXXV. 1. 3. It
consists in the state between the usual peristaltic motions of that organ,
in the digestion of our aliment, and the retrograde motions of it in
vomiting; for it is evident, that the direct motions of it from the cardia
to the pylorus must stop, before those in a contrary direction can
commence. This sickness, like the nausea above described, is sometimes
produced by disgustful ideas, as when nasty objects are seen, and nasty
stories related, as well as by the exhaustion of the sensorial power by the
stimulus of some emetic drugs, and by the defect of the production of it,
as in enfeebled drunkards.

Sickness may likewise consist in the retrograde motions of the lymphatics
of the stomach, which regurgitate into it the chyle or lymph, which they
have lately absorbed, as in Class I. 3. 2. 3. It is probable, that these
two kinds of sickness may be different sensations, though they have
acquired but one name; as one of them attends hunger, and the other
repletion; though either of them may possibly be induced by association
with nauseous ideas.

M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the
head in bed. See Sect. XXV. 16. Class IV. 1. 1. 2. and 3.

5. _Cardialgia._ Heartburn originates from the inactivity of the stomach,
whence the aliment, instead of being subdued by digestion, and converted
into chyle, runs into fermentation, producing acetous acid. Sometimes the
gastric juice itself becomes so acid as to give pain to the upper orifice
of the stomach; these acid contents of the stomach, on falling on a marble
hearth, have been seen to produce an effervescence on it. The pain of heat
at the upper end of the gullet, when any air is brought up from the
fermenting contents of the stomach, is to be ascribed to the sympathy
between these two extremities of the oesophagus rather than to the pungency
of the carbonic gas, or fixed air; as the sensation in swallowing that kind
of air in water is of a different kind. See Class I. 3. 1. 3. and IV. 2. 2.
5.

M. M. This disease arising from indigestion is often very pertinacious, and
afflicting; and attended with emaciation of the body from want of
sufficient chyle. As the saliva swallowed along with our food prevents its
fermentation, as appears by the experiments of Pringle and Macbride, some
find considerable relief by chewing parched wheat, or mastic, or a lock of
wool, frequently in a day, when the pain occurs, and by swallowing the
saliva thus effused; a temporary relief is often obtained from antiacids,
as aerated alcaline water, Seltzer's water, calcareous earths, alcaline
salts made into pills with soap, soap alone, tin, milk, bitters. More
permanent use may be had from such drugs as check fermentation, as acid of
vitriol; but still more permanent relief from such things as invigorate the
digestion, as a blister on the back; a due quantity of vinous spirit and
water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat
made so tight as slightly to compress the bowels and stomach. A flannel
shirt in winter, not in summer. A less quantity of potation of all kinds.
Ten black pepper-corns swallowed after dinner. Half a grain of opium twice
a day, or a grain. The food should consist of such things as do not easily
ferment, as flesh, shell-fish, sea-biscuit, toasted cheese. I have seen
toasted cheese brought up from the stomach 24 hours after it had been
swallowed, without apparently having undergone any chemical change. See
Class II. 1. 3. 17. and IV. 1. 2. 13.

6. _Arthritis Ventriculi._ Sickness of the stomach in gouty cases is
frequently a consequence of the torpor or inflammation of the liver, and
then it continues many days or weeks. But when the patient is seized with
great pain at the stomach with the sensation of coldness, which they have
called an ice-bolt, this is a primary affection of the stomach, and
destroys the patient in a few hours, owing to the torpor or inaction of
that viscus so important to life.

This primary gout of the stomach, as it is a torpor of that viscus, is
attended with sensation of coldness, and with real defect of heat, in that
part, and may thence be distinguished from the pain occasioned by the
passage of a gall-stone into the duodenum, as well as by the weak pulse,
and cold extremities; to which must be added, that it affects those only,
who have been long afflicted with the gout, and much debilitated by its
numerous attacks.

M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied
externally to the stomach by hot cloths or fomentation.

7. _Colica flatulenta._ The flatulent colic arises from the too great
distention of the bowel by air, and consequent pain. The cause of this
disease is the inactivity or want of sufficiently powerful contraction of
the coats of the bowel, to carry forwards the gas given up by the
fermenting aliment. It is without fever, and generally attended with cold
extremities.

It is distinguished, first, from the pain occasioned by the passage of a
gall-stone, as that is felt at the pit of the stomach, and this nearer the
navel. Secondly, it is distinguished from the colica saturnina, or colic
from lead, as that arising from the torpor of the liver, or of some other
viscus, is attended with greater coldness, and with an aching pain; whereas
the flatulent cholic being owing to distention of the muscles of the bowel,
the pain is more acute, and the coldness less. Thirdly, it is distinguished
from inflammation of the bowels, or ileus, as perpetual vomiting and fever
attend this. Fourthly, it is distinguished from cholera, because that is
accompanied with both vomiting and diarrhoea. And lastly, from the colica
epileptica, or hysteric colic, as that is liable to alternate with
convulsion, and sometimes with insanity; and returns by periods.

M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain.
Spice. Volatile alcali. Warm fomentation externally. Rhubarb.

8. _Colica saturnina._ Colic from lead. The pain is felt about the navel,
is rather of an aching than acute kind at first, which increases after
meals, and gradually becomes more permanent and more acute. It terminates
in paralysis, frequently of the muscles of the arm, so that the hand hangs
down, when the arm is extended horizontally. It is not attended with fever,
or increase of heat. The seat of the disease is not well ascertained, it
probably affects some part of the liver, as a pale bluish countenance and
deficiency of bile sometimes attends or succeeds it, with consequent
anasarca; but it seems to be caused immediately by a torpor of the
intestine, whether this be a primary or secondary affection, as appears
from the constipation of the bowels, which attends it; and is always
produced in consequence of the great stimulus of lead previously used
either internally for a length of time, or externally on a large surface.

A delicate young girl, daughter of a dairy farmer, who kept his milk in
leaden cisterns, used to wipe off the cream from the edges of the lead with
her finger; and frequently, as she was fond of cream, licked it from her
finger. She was seized with the saturnine colic, and semi-paralytic wrists,
and sunk from general debility.

A feeble woman about 40 years of age sprained her ancle, and bruised her
leg and thigh; and applied by ill advice a solution of lead over the whole
limb, as a fomentation and poultice for about a fortnight. She was then
seized with the colica saturnina, lost the use of her wrists, and gradually
sunk under a general debility.

M. M. First opium one or two grains, then a cathartic of senna, jalap, and
oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A
blister on the navel. Warm bath. The stimulus of the opium, by restoring to
the bowel its natural irritability in this case of painful torpor, assists
the action of the cathartic.

9. _Tympanitis._ Tympany consists in an elastic tumor of the abdomen, which
sounds on being struck. It is generally attended with costiveness and
emaciation. In one kind the air is said to exist in the bowels, in which
case the tumor is less equal, and becomes less tense and painful on the
evacuation of air. In the other kind the air exists in the cavity of the
abdomen, and sometimes is in a few days exchanged for water, and the
tympany becomes an ascites.

Air may be distinguished in the stomach of many people by the sound on
striking it with the fingers, and comparing the sound with that of a
similar percussion on other parts of the bowels; but towards the end of
fevers, and especially in the puerperal fever, a distention of the abdomen
by air is generally a fatal symptom, though the ease, and often
cheerfulness, of the patient vainly flatters the attendants.

M. M. In the former case a clyster-pipe unarmed may be introduced, and left
some time in the rectum, to take off the resistance of the sphincter, and
thus discharge the air, as it is produced from the fermenting or putrefying
aliment. For this purpose, in a disease somewhat similar in horses, a
perforation is made into the rectum on one side of the sphincter; through
which fistula the air, which is produced in such great excess from the
quantity of vegetable food which they take, when their digestions are
impaired, is perpetually evacuated. In both cases also, balsams, essential
oil, spice, bandage on the abdomen, and, to prevent the fermentation of the
aliment, acid of vitriol, saliva. See Class I. 2. 4. 5.

10. _Hypochondriasis._ The hypochondriac disease consists in indigestion
and consequent flatulency, with anxiety or want of pleasureable sensation.
When the action of the stomach and bowels is impaired, much gas becomes
generated by the fermenting or putrescent aliment, and to this indigestion
is catenated languor, coldness of the skin, and fear. For when the
extremities are cold for too long a time in some weak constitutions,
indigestion is produced by direct sympathy of the skin and the stomach,
with consequent heart-burn, and flatulency. The same occurs if the skin be
made cold by fear, as in riding over dangerous roads in winter, and hence
conversely fear is produced by indigestion or torpor of the stomach by
association.

This disease is confounded with the fear of death, which is an insanity,
and therefore of a totally different nature. It is also confounded with the
hysteric disease, which consists in the retrograde motions of the
alimentary canal, and of some parts of the absorbent system.

The hypochondriasis, like chlorosis, is sometimes attended with very quick
pulse; which the patient seems to bear so easily in these two maladies,
that if an accidental cough attends them, they may be mistaken for
pulmonary consumption; which is not owing primarily to the debility of the
heart, but to its direct sympathy with the actions of the stomach.

M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain
twice a day. Rhubarb six grains every night. Bark. Steel. Spice.
Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No
liquor stronger than small beer, or wine and water. Gentle exercise on
horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4.
5.

11. _Cephalæa._ Head-ach frequently attends the cold paroxysm of
intermittents; afflicts inebriates the day after intoxication; and many
people who remain too long in the cold bath. In all which cases there is a
general inaction of the whole system, and as these membranes about the head
have been more exposed to the variations of heat and cold of the
atmosphere, they are more liable to become affected so far as to produce
sensation, than other membranes; which are usually covered either with
clothes, or with muscles, as mentioned in Sect. XXXIII. 2. 10.

The promptitude of the membranes about the scalp to sympathize with those
of other parts of the system is so great, that this cephalæa without fever,
or quickness of pulse, is more frequently a secondary than a primary
disease, and then belongs to Class IV. 2. 2. 7. The hemicrania, or partial
head-ach, I believe to be almost always a disease from association; though
it is not impossible, but a person may take cold on one side of the head
only. As some people by sitting always on the same side of the fire in
winter are liable to render one side more tender than the other, and in
consequence more subject to pains, which have been erroneously termed
rheumatic. See Class IV. 2. 2. 7. & 8.

M. M. The method of cure consists in rendering the habit more robust, by
gentle constant exercise in the open air, flesh diet, small beer at meals
with one glass of wine, regular hours of rest and rising, and of meals. The
cloathing about the head should be warmer during sleep than in the day;
because at that time people are more liable to take cold; that is, the
membranous parts of it are more liable to become torpid. As explained in
Sect. XVIII. 15. In respect to medicine, two drams of valerian root in
powder three or four times a day are recommended by Fordyce. The bark.
Steel in moderate quantities. An emetic. A blister. Opium, half a grain
twice a day. Decayed teeth should be extracted, particularly such as either
ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm
bath of 94 or 98 degrees every day for half an hour during a month. See
Class IV. 2. 2. 7. and 8.

A solution of arsenic, about the sixteenth part of a grain, is reported to
have great effect in this disease. It should be taken thrice a day, if it
produces no griping or sickness, for two or three weeks. A medicine of this
kind is sold under the name of tasteless ague-drops; but a more certain
method of ascertaining the quantity is delivered in the subsequent materia
medica, Art. IV. 2. 6.

12. _Odontalgia._ Tooth-ach. The pain has been erroneously supposed, where
there is no inflammation, to be owing to some acrid matter from a carious
tooth stimulating the membrane of the alveolar process into violent action
and consequent pain; but the effect seems to have been mistaken for the
cause, and the decay of the tooth to have been occasioned by the torpor and
consequent pain of the diseased membrane.

First, because the pain precedes the decay of the tooth in regard to time,
and is liable to recur, frequently for years, without certainly being
succeeded at last by a carious tooth, as I have repeatedly observed.

Secondly, because any stimulant drug, as pyrethrum, or oil of cloves,
applied to the tooth, or ether applied externally to the cheek, so far from
increasing the pain, as they would do if the pained membrane, already acted
too strongly, that they frequently give immediate relief like a charm.

And thirdly, because the torpor, or deficient action of the membrane, which
includes the diseased tooth, occasions the motions of the membranes most
connected with it, as those of the cheek and temples, to act with less than
their natural energy; and hence a coldness of the cheek is perceived easily
by the hand of the patient, comparing it with the other cheek; and the pain
of hemicrania is often produced in the temple of the affected side.

This coldness of the cheek in common tooth-ach evinces, that the pain is
not then caused by inflammation; because in all inflammations so much heat
is produced in the secretions of new vessels and fluids, as to give heat to
the parts in vicinity. And hence, as soon as the gum swells and inflames
along with the cheek, heat is produced, and the pain ceases, owing to the
increased exertions of the torpid membrane, excited by the activity of the
sensorial power of sensation; which previously existed in its passive state
in the painful torpid membrane. See Odontitis, Class II. 1. 4. 7. and IV.
2. 2. 8.

M. M. If the painful tooth be found, venesection. Then a cathartic.
Afterwards two grains of opium. Camphor and opium, one grain of each held
in the mouth; or a drop or two of oil of cloves put on the painful tooth.
Ether. If the tooth has a small hole in it, it should be widened within by
an instrument, and then stopped with leaf-gold, or leaf-lead; but should be
extracted, if much decayed. It is probable that half a small drop of a
strong solution of arsenic, put carefully into the hollow of a decayed
aching tooth, would destroy the nerve without giving any additional pain;
but this experiment requires great caution, lest any of the solution should
touch the tongue or gums.

Much cold or much heat are equally injurious to the teeth, which are endued
with a fine sensation of this universal fluid. The best method of
preserving them is by the daily use of a brush, which is not very hard,
with warm water and fine charcoal dust. A lump of charcoal should be put a
second time into the fire till it is red hot, as soon as it becomes cool
the external ashes should be blown off, and it should be immediately
reduced to fine powder in a mortar, and kept close stopped in a phial. It
takes away the bad smell from decayed teeth, by washing the mouth with this
powder diffused in water immediately. The putrid smell of decaying stumps
of teeth may be destroyed for a time by washing the mouth with a weak
solution of alum in water. If the calcareous crust upon the teeth adheres
very firmly, a fine powder of pumice-stone may be used occasionally, or a
tooth instrument.

Acid of sea-salt, much diluted, may be used; but this very rarely, and with
the greatest caution, as in cleaning sea-shells. When the gums are spongy,
they should be frequently pricked with a lancet. Should black spots in
teeth be cut out? Does the enamel grow again when it has been perforated or
abraded?

13. _Otalgia._ Ear-ach sometimes continues many days without apparent
inflammation, and is then frequently removed by filling the ear with
laudanum, or with ether; or even with warm oil, or warm water. See Class
II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the
consequence of association with a diseased tooth; in that case the ether
should be applied to the cheek over the suspected tooth, or a grain of
opium and as much camphor mixed together and applied to the suspected
tooth. In this case the otalgia belongs to the fourth class of diseases.

14. _Pleurodyne chronica._ Chronical pain of the side. Pains of the
membranous parts, which are not attended with fever, have acquired the
general name of rheumatic; which should, nevertheless, be restricted to
those pains which exist only when the parts are in motion, and which have
been left after inflammation of them; as described in Class I. 1. 3. 12.
The pain of the side here mentioned affects many ladies, and may possibly
have been owing to the pressure of tight stays, which has weakened the
action of the vessels composing some membranous part, as, like the cold
head-ach, it is attended with present debility; in one patient, a boy about
ten years old, it was attended with daily convulsions, and was supposed to
have originated from worms. The disease is very frequent, and generally
withstands the use of blisters on the part; but in some cases I have known
it removed by electric shocks repeated every day for a fortnight through
the affected side.

Pains of the side may be sometimes occasioned by the adhesion of the lungs
to the pleura, after an inflammation of them; or to the adhesion of some
abdominal viscera to their cavity, or to each other; which also are more
liable to affect ladies from the unnatural and ungraceful pressure of tight
stays, or by sitting or lying too long in one posture. But in these cases
the pain should be more of the smarting, than of the dull kind.

M. M. Ether. A blister. A plaster of Burgundy pitch. An issue or seton on
the part. Electric shocks. Friction on the part with oil and camphor. Loose
dress. Frequent change of posture both in the day and night. Internally
opium, valerian, bark.

15. _Sciatica frigida._ Cold sciatica. The pain along the course of the
sciatic nerve, from the hip quite down to the top of the foot, when it is
not attended with fever, is improperly termed either rheumatism or gout; as
it occurs without inflammation, is attended with pain when the limb is at
rest; and as the pain attends the course of the nerve, and not the course
of the muscles, or of the fascia, which contains them. The theory of
Cotunnius, who believed it to be a dropsy of the sheath of the nerve, which
was compressed by the accumulated fluid, has not been confirmed by
dissection. The disease seems to consist of a torpor of this sheath of the
nerve, and the pain seems to be in consequence of this torpor. See Class
II. 1. 2. 18.

M. M. Venesection. A cathartic. And then one grain of calomel and one of
opium every night for ten successive nights. And a blister, at the same
time, a little above the knee-joint on the outside of the thigh, where the
sciatic nerve is not so deep seated. Warm bath. Cold bath. Cover the limb
with oiled silk, or with a plaster-bandage of emplastrum de minio.

16. _Lumbago frigida._ Cold lumbago. When no fever or inflammation attends
this pain of the loins, and the pain exists without motion, it belongs to
this genus of diseases, and resembles the pain of the loins in the cold fit
of ague. As these membranes are extensive, and more easily fall into
quiescence, either by sympathy, or when they are primarily affected, this
disease becomes very afflicting, and of great pertinacity. See Class II. 1.
2. 17.

M. M. Venesection. A cathartic. Issues on the loins. Adhesive plaster on
the loins. Blister on the os sacrum. Warm bath. Cold bath. Remove to a
warmer climate in the winter. Loose dress about the waist. Friction daily
with oil and camphor.

17. _Hysteralgia frigida._ Cold pain of the uterus preceding or
accompanying menstruation. It is attended with cold extremities, want of
appetite, and other marks of general debility.

M. M. A clyster of half a pint of gruel, and 30 drops of laudanum; or a
grain of opium and six grains of rhubarb every night. To sit over warm
water, or go into a warm bath.

18. _Proctalgia frigida._ Cold pain at the bottom of the rectum previous to
the tumor of the piles, which sometimes extends by sympathy to the loins;
it seems to be similar to the pain at the beginning of menstruation, and is
owing to the torpor or inirritability of the extremity of the alimentary
canal, or to the obstruction of the blood in its passage through the liver,
when that viscus is affected, and its consequent delay in the veins of the
rectum, occasioning tumors of them, and dull sensations of pain.

M. M. Calomel. A cathartic. Spice. Clyster, with 30 drops of laudanum.
Sitting over warm water. If chalybeates after evacuation? See Class I. 2.
3. 23. and I. 2. 1. 6.

19. _Vesicæ felleæ inirritabilitas._ The inirritability of the gall-bladder
probably occasions one kind of _icterus_, or jaundice; which is owing to
whatever obstructs the passage of bile into the duodenum. The jaundice of
aged people, and which attends some fevers, is believed to be most
frequently caused by an irritative palsy of the gall-bladder; on which
account the bile is not pressed from the cyst by its contraction, as in a
paralysis of the urinary bladder.

A thickening of the coats of the common bile-duct by inflammation or
increased action of their vessels so as to prevent the passage of the bile
into the intestine, in the same manner as the membrane, which lines the
nostrils, becomes thickened in catarrh so as to prevent the passage of air
through them, is probably another frequent cause of jaundice, especially of
children; and generally ceases in about a fortnight, like a common catarrh,
without the aid of medicine; which has given rise to the character, which
charms have obtained in some countries for curing the jaundice of young
people.

The spissitude of the bile is another cause of jaundice, as mentioned in
Class I. 1. 3. 8. This also in children is a disease of little danger, as
the gall-ducts are distensible, and will the easier admit of the exclusion
of gall-stones; but becomes a more serious disease in proportion to the age
of the patient, and his habits of life in respect to spirituous potation.

A fourth cause of jaundice is the compression of the bile-duct by the
enlargement of an inflamed or schirrous liver; this attends those who have
drank much spirituous liquor, and is generally succeeded by dropsy and
death.

M. M. Repeated emetics. Mild cathartics. Warm bath. Electricity. Bitters.
Then steel, which, when the pain and inflammation is removed by
evacuations, acts like a charm in removing the remainder of the
inflammation, and by promoting the absorption of the new vessels or fluids;
like the application of any acrid eye-water at the end of ophthalmia; and
thus the thickened coats of the bile-duct become reduced, or the
enlargement of the liver lessened, and a free passage is again opened for
the bile into the intestine. Ether with yolk of egg is recommended, as
having a tendency to dissolve inspissated bile. And a decoction of madder
is recommended for the same purpose; because the bile of animals, whose
food was mixed with madder, was found always in a dilute state. Aerated
alcaline water, or Seltzer's water. Raw cabbage, and other acrid
vegetables, as water-cresses, mustard. Horses are said to be subject to
inspissated bile, with yellow eyes, in the winter season, and to get well
as soon as they feed on the spring grass.

The largest bile-stone I have seen was from a lady, who had parted with it
some years before, and who had abstained above ten years from all kinds of
vegetable diet to prevent, as she supposed, a colic of her stomach, which
was probably a pain of the biliary duct; on resuming the use of some
vegetable diet, she recovered a better state of health, and formed no new
bilious concretions.

A strong aerated alcaline water is sold by J. Schweppe, No. 8,
King's-street, Holborn. See Class I. 1. 3. 10.

20. _Pelvis renalis inirritabilitas._ Inirritability of the pelvis of the
kidney. When the nucleus of a stone, whether it be inspissated mucus, or
other matter, is formed in the extremity of any of the tubuli uriniferi,
and being detached from thence falls into the pelvis of the kidney, it is
liable to lodge there from the want of due irritability of the membrane;
and in that situation increases by new appositions of indurated animal
matter, in the same manner as the stone of the bladder. This is the general
cause of hæmorrhage from the kidney; and of obtuse pain in it on exercise;
or of acute pain, when the stone advances into the ureter. See Class I. 1.
3. 9.

       *       *       *       *       *

ORDO II.

_Decreased Irritation._

GENUS V.

_Decreased Action of the Organs of Sense._

SPECIES.

1. _Stultitia inirritabilis._ Folly from inirritability. Dulness of
perception. When the motions of the fibrous extremities of the nerves of
sense are too weak to excite sensation with sufficient quickness and
vigour. The irritative ideas are nevertheless performed, though perhaps in
a feeble manner, as such people do not run against a post, or walk into a
well. There are three other kinds of folly; that from deficient sensation,
from deficient volition, and from deficient association, as will be
mentioned in their places. In delirium, reverie, and sleep, the power of
perception is abolished from other causes.

2. _Visus imminutus._ Diminished vision. In our approach to old age our
vision becomes imperfect, not only from the form of the cornea, which
becomes less convex, and from its decreased transparency mentioned in Class
I. 2. 3. 26.; but also from the decreased irritability of the optic nerve.
Thus, in the inirritative or nervous fever, the pupil of the eye becomes
dilated; which in this, as well as in the dropsy of the brain, is generally
a fatal symptom. A part of the cornea as well as a part of the albuginea in
these fevers is frequently seen during sleep; which is owing to the
inirritability of the retina to light, or to the general paresis of
muscular action, and in consequence to the less contraction of the
sphincter of the eye, if it may be so called, at that time.

There have been instances of some, who could not distinguish certain
colours; and yet whose eyes, in other respects, were not imperfect. Philos.
Transact. Which seems to have been owing to the want of irritability, or
the inaptitude to action, of some classes of fibres which compose the
retina. Other permanent defects depend on the diseased state of the
external organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11.

3. _Muscæ volitantes._ Dark spots appearing before the eyes, and changing
their apparent place with the motions of the eyes, are owing to a temporary
defect of irritability of those parts of the retina, which have been lately
exposed to more luminous objects than the other parts of it, as explained
in Sect. XL. 2. Hence dark spots are seen on the bed-clothes by patients,
when the optic nerve is become less irritable, as in fevers with great
debility; and the patients are perpetually trying to pick them off with
their fingers to discover what they are; for these parts of the retina of
weak people are sooner exhausted by the stimulus of bright colours, and are
longer in regaining their irritability.

Other kinds of ocular spectra, as the coloured ones, are also more liable
to remain in the eyes of people debilitated by fevers, and to produce
various hallucinations of sight. For after the contraction of a muscle, the
fibres of it continue in the last situation, till some antagonist muscles
are exerted to retract them; whence, when any one is much exhausted by
exercise, or by want of sleep, or in fevers, it is easier to let the fibres
of the retina remain in their last situation, after having been stimulated
into contraction, than to exert any antagonist fibres to replace them.

As the optic nerves at their entrance into the eyes are each of them as
thick as a crow-quill, it appears that a great quantity of sensorial power
is expended during the day in the perpetual activity of our sense of
vision, besides that used in the motions of the eye-balls and eyelids; as
much I suppose as is expended in the motions of our arms, which are
supplied with nerves of about the same diameters. From hence we may
conclude, that the light should be kept from patients in fevers with
debility, to prevent the unnecessary exhaustion of the sensorial power. And
that on the same account their rooms should be kept silent as well as dark;
that they should be at rest in an horizontal posture; and be cooled by a
blast of cool air, or by washing them with cold water, whenever their skins
are warmer than natural.

4. _Strabismus._ Squinting is generally owing to one eye being less perfect
than the other; on which account the patient endeavours to hide the worst
eye in the shadow of the nose, that his vision by the other may not be
confused. Calves, which have an hydatide with insects inclosed in it in the
frontal sinus on one side, turn towards the affected side; because the
vision on that side, by the pressure of the hydatide, becomes less perfect;
and the disease being recent, the animal turns round, expecting to get a
more distinct view of objects.

In the hydrocephalus internus, where both eyes are not become insensible,
the patient squints with only one eye, and views objects with the other, as
in common strabismus. In this case it may be known on which side the
disease exists, and that it does not exist on both sides of the brain; in
such circumstances, as the patients I believe never recover as they are now
treated, might it not be adviseable to perforate the cranium over the
ventricule of the affected side? which might at least give room and
stimulus to the affected part of the brain?

M. M. If the squinting has not been confirmed by long habit, and one eye be
not much worse than the other, a piece of gauze stretched on a circle of
whale-bone, to cover the best eye in such a manner as to reduce the
distinctness of vision of this eye to a similar degree of imperfection with
the other, should be worn some hours every day. Or the better eye should be
totally darkened by a tin cup covered with black silk for some hours daily,
by which means the better eye will be gradually weakened by the want of
use, and the worse eye will be gradually strengthened by using it. Covering
an inflamed eye in children for weeks together, is very liable to produce
squinting, for the same reason.

5. _Amaurosis._ Gutta serena. Is a blindness from the inirritability of the
optic nerve. It is generally esteemed a palsy of the nerve, but should
rather be deemed the death of it, as paralysis has generally been applied
to a deprivation only of voluntary power. This is a disease of dark eyes
only, as the cataract is a disease of light eyes only. At the commencement
of this disease, very minute electric shocks should be repeatedly passed
through the eyes; such as may be produced by putting one edge of a piece of
silver the size of a half-crown piece beneath the tongue, and one edge of a
piece of zinc of a similar size between the upper lip and the gum, and then
repeatedly bringing their exterior edges into contact, by which means very
small electric sparks become visible in the eyes. See additional note at
the end of the first volume, p. 567. and Sect. XIV. 5.

M. M. Minute electric shocks. A grain of opium, and a quarter of a grain of
corrosive sublimate of mercury, twice a day for four or six weeks. Blister
on the crown of the head.

6. _Auditus imminutus._ Diminished hearing. Deafness is a frequent symptom
in those inflammatory or sensitive fevers with debility, which are
generally called putrid; it attends the general stupor in those fevers, and
is rather esteemed a salutary sign, as during this stupor there is less
expenditure of sensorial power.

In fevers of debility without inflammation, called nervous fevers, I
suspect deafness to be a bad symptom, arising like the dilated pupil from a
partial paralysis of the nerve of sense. See Class IV. 2. 1. 15.

Nervous fevers are supposed by Dr. Gilchrist to originate from a congestion
of serum or water in some part of the brain, as many of the symptoms are so
similar to those of hydrocephalus internus, in which a fluid is accumulated
in the ventricules of the brain; on this idea the inactivity of the optic
or auditory nerves in these fevers may arise from the compression of the
effused fluid; while the torpor attending putrid fever may depend on the
meninges of the brain being thickened by inflammation, and thus compressing
it; now the new vessels, or the blood, which thickens inflamed parts, is
more frequently reabsorbed, than the effused fluid from a cavity; and hence
the stupor in one case is less dangerous than in the other.

In inflammatory or sensitive fevers with debility, deafness may sometimes
arise from a greater secretion and absorption of the ear-wax, which is very
similar to the bile, and is liable to fill the meatus auditorius, when it
is too viscid, as bile obstructs the gall-ducts.

M. M. In deafness without fever Dr. Darwin applied a cupping-glass on the
ear with good effect, as described in Phil. Trans. Vol. LXIV. p. 348. Oil,
ether, laudanum, dropped into the ears.

7. _Olfactus imminutus._ Inactivity of the sense of smell. From our habits
of trusting to the art of cookery, and not examining our food by the smell
as other animals do, our sense of smell is less perfect than theirs. See
Sect. XVI. 5. Class IV. 2. 1. 16.

M. M. Mild errhines.

8. _Gustus imminutus._ Want of taste is very common in fevers, owing
frequently to the dryness or scurf of the tongue, or external organ of that
sense, rather than to any injury of the nerves of taste. See Class. I. 1.
3. 1. IV. 2. 1. 16.

M. M. Warm subacid liquids taken frequently.

9. _Tactus imminutus._ Numbness is frequently complained of in fevers, and
in epilepsy, and the touch is sometimes impaired by the dryness of the
cuticle of the fingers. See Class IV. 2. 1. 16.

When the sense of touch is impaired by the compression of the nerve, as in
sitting long with one thigh crossed over the other, the limb appears
larger, when we touch it with our hands, which is to be ascribed to the
indistinctness of the sensation of touch, and may be explained in the same
manner as the apparent largeness of objects seen through a mist. In this
last case the minute parts of an object, as suppose of a distant boy, are
seen less distinctly, and therefore we instantly conceive them to be
further from the eye, and in consequence that the whole subtends a larger
angle, and thus we believe the boy to be a man. So when any one's fingers
are pressed on a benumbed limb, the sensation produced is less than it
should be, judging from visible circumstances; we therefore conceive, that
something intervened between the object and the sense, for it is felt as if
a blanket was put between them; and that not being visibly the case, we
judge that the limb is swelled.

The sense of touch is also liable to be deceived from the acquired habits
of one part of it acting in the vicinity of another part of it. Thus if the
middle finger be crossed over either of the fingers next to it, and a nut
be felt by the two ends of the fingers so crossed at the same time, the nut
appears as if it was two nuts. And lastly, the sense of touch is liable to
be deceived by preconceived ideas; which we believe to be excited by
external objects, even when we are awake. It has happened to me more than
once, and I suppose to most others, to have put my hands into an empty
bason standing in an obscure corner of a room to wash them, which I
believed to contain cold water, and have instantly perceived a sensation of
warmth, contrary to that which I expected to have felt.

In some paralytic affections, and in cold fits of ague, the sensation of
touch has been much impaired, and yet that of heat has remained, See Sect.
XIV. 6.

M. M. Friction alone, or with camphorated oil, warm bath. Ether. Volatile
alcali and water. Internally spice, salt. Incitantia. Secernentia.

10. _Stupor._ The stupor, which occurs in fevers with debility, is
generally esteemed a favourable symptom; which may arise from the less
expenditure of sensorial power already existing in the brain and nerves, as
mentioned in species 6 of this genus. But if we suppose, that there is a
continued production of sensorial power, or an accumulation of it in the
torpid parts of the system, which is not improbable, because such a
production of it continues during sleep, to which stupor is much allied,
there is still further reason for believing it to be a favourable symptom
in inirritable fevers; and that much injury is often done by blisters and
other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and
XXXIII. 1. 4.

Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many
other ingenious observations and deductions, relates a curious experiment
on salmon, and other fish, and which he repeated upon eels with similar
event.

    "If a fish, immediately upon being taken out of the water, is stunned
    by a violent blow on the head, or by having the head crushed, the
    irritability and sweetness of the muscles will be preserved much
    longer, than if it had been allowed to die with the organs of sense
    entire. This is so well known to fishermen, that they put it in
    practice, in order to make them longer susceptible of the operation
    called _crimping_. A salmon is one of the fish least tenacious of life,
    insomuch, that it will lose all signs of life in less than half an hour
    after it is taken out of the water, if suffered to die without any
    farther injury; but if, immediately after being caught, it receives a
    violent blow on the head, the muscles will shew visible irritability
    for more than twelve hours afterwards."

Dr. Blane afterwards well remarks, that "in those disorders in which the
exercise of the senses is in a great measure destroyed, or suspended, as in
the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that
the appetite and digestion are better than in health."

       *       *       *       *       *

ORDO III.

_Retrograde Irritative Motions._

GENUS I.

_Of the Alimentary Canal._

The retrograde motions of our system originate either from defect of
stimulus, or from defect of irritability. Thus sickness is often induced by
hunger, which is a want of stimulus; and from ipecacuanha, in which last
case it would seem, that the sickness was induced after the violence of the
stimulus was abated, and the consequent torpor had succeeded. Hence spice,
opium, or food relieves sickness.

The globus hystericus, salivation, diabætes, and other inversions of motion
attending hysteric paroxysms, seem to depend on the want of irritability of
those parts of the body, because they are attended with cold extremities,
and general debility, and are relieved by wine, opium, steel, and flesh
diet; that is, by any additional stimulus.

When the longitudinal muscles are fatigued by long action, or are
habitually weaker than natural, the antagonist muscles replace the limb by
stretching it in a contrary direction; and as these muscles have had their
actions associated in synchronous tribes, their actions cease together. But
as the hollow muscles propel the fluids, which they contain, by motions
associated in trains; when one ring is fatigued from its too great
debility, and brought into retrograde action; the next ring, and the next,
from its association in train falls into retrograde action. Which continue
so long as they are excited to act, like the tremors of the hands of infirm
people, so long as they endeavour to act. Now as these hollow muscles are
perpetually stimulated, these retrograde actions do not cease as the
tremors of the longitudinal muscles, which are generally excited only by
volition. Whence the retrograde motions of hollow muscles depend on two
circumstances, in which they differ from the longitudinal muscles, namely,
their motions being associated in trains, and their being subject to
perpetual stimulus. For further elucidation of the cause of this curious
source of diseases, see Sect. XXIX. 11. 5.

The fluids disgorged by the retrograde motions of the various vascular
muscles may be distinguished, 1. From those, which are produced by
secretion, by their not being attended by increase of heat, which always
accompanies increased secretion. 2. They may be distinguished from those
fluids, which are the consequence of deficient absorption, by their not
possessing the saline acrimony, which those fluids possess; which inflames
the skin or other membranes on which they fall; and which have a saline
taste to the tongue. 3. They may be distinguished from those fluids, which
are the consequence both of increased secretion and absorption, as these
are attended with increase of warmth, and are inspissated by the
abstraction of their aqueous parts. 4. Where chyle, or milk, are found in
the feces or urine, or when other fluids, as matter, are translated from
one part of the system to another, they have been the product of retrograde
action of lymphatic or other canals. As explained in Sect. XXIX. 8.

SPECIES.

1. _Ruminatio._ In the rumination of horned cattle the retrograde motions
of the oesophagus are visible to the eye, as they bring up the softened
grass from their first stomach. The vegetable aliment in the first stomach
of cattle, which have filled themselves too full of young clover, is liable
to run into fermentation, and distend the stomach, so as to preclude its
exit, and frequently to destroy the animal. To discharge this air the
farmers frequently make an opening into the stomach of the animal with
success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that
of twenty cows in this situation two had died, and that he directed a pint
of gin or whisky, mixed with an equal quantity of water, to be given to the
other eighteen; all of which eructed immense quantities of air, and
recovered.

There are histories of ruminating men, and who have taken pleasure in the
act of chewing their food a second time. Philos. Transact.

2. _Ructus._ Eructation. An inverted motion of the stomach excluding
through its upper valve an elastic vapour generated by the fermentation of
the aliment; which proceeds so hastily, that the digestive power does not
subdue it. This is sometimes acquired by habit, so that some people can
eruct when they please, and as long as they please; and there is gas enough
generated to supply them for this purpose; for by Dr. Hale's experiments,
an apple, and many other kinds of aliment, give up above six hundred times
their own bulk of an elastic gas in fermentation. When people voluntarily
eject the fixable air from their stomachs, the fermentation of the aliment
proceeds the faster; for stopping the vessels, which contain new wines,
retards their fermentation, and opening them again accelerates it; hence
where the digestion is impaired, and the stomach somewhat distended with
air, it is better to restrain than to encourage eructations, except the
quantity makes it necessary. When wine is confined in bottles the
fermentation still proceeds slowly even for years, till all the sugar is
converted into spirit; but in the process of digestion, the saccharine part
is absorbed in the form of chyle by the bibulous mouths of the numerous
lacteals, before it has time to run into the vinous fermentation.

3. _Apepsia._ Indigestion. Water-qualm. A few mouthfuls of the aliment are
rejected at a time for some hours after meals. When the aliment has had
time to ferment, and become acid, it produces cardialgia, or heart-burn.
This disease is perhaps generally left after a slight inflammation of the
stomach, called a surfeit, occasioned by drinking cold liquors, or eating
cold vegetables, when heated with exercise. This inflammation of the
stomach is frequently, I believe, at its commencement removed by a critical
eruption on the face, which differs in its appearance as well as in its
cause from the gutta rosea of drunkards, as the skin round the base of each
eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs
from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with
pain of the cardia ventriculi, and from its retrograde motions of a part of
the stomach about the upper orifice of it. In the same manner as hysteria
differs from hypochondriasis; the one consisting in the weakness and
indigestion of the same portions of the alimentary canal, and the other in
the inverted motions of some parts of it. This apepsia or water-qualm
continues many years, even to old age; Mr. G---- of Lichfield suffered
under this disease from his infancy; and, as he grew old, found relief only
from repeated doses of opium.

M. M. A blister, rhubarb, a grain of opium twice a day. Soap, iron-powder.
Tin-powder.

4. _Vomitus._ An inverted order of the motions of the stomach and
oesophagus with their absorbent vessels, by which their contents are
evacuated. In the act of vomiting less sensorial power is employed than in
the usual peristaltic motion of the stomach, as explained in Sect. XXXV. 1.
3. Whence after the operation of an emetic the digestion becomes stronger
by an accumulation of sensorial power during its decreased action. This
decreased action of the stomach may be either induced by want of stimulus,
as in the sickness which attends hunger; or it may be induced by temporary
want of irritability, as in cold fits of fever; or from habitual want of
irritability, as the vomiting of enfeebled drunkards. Or lastly, by having
been previously too violently stimulated by an emetic drug, as by
ipecacuanha.

M. M. A blister. An emetic. Opium. Warmth of a bed, covering the face for a
while with the bed-clothes. Crude mercury. A poultice with opium or
theriaca externally.

5. _Cholera._ When not only the stomach, as in the last article, but also
the duodenum, and ilium, as low as the valve of the colon, have their
motions inverted; and great quantities of bile are thus poured into the
stomach; while at the same time some branches of the lacteals become
retrograde, and disgorge their contents into the upper part of the
alimentary canal; and other branches of them disgorge their contents into
the lower parts of it beneath the valve of the colon; a vomiting and
purging commence together, which is called cholera, as it is supposed to
have its origin from increased secretion of bile; but I suppose more
frequently arises from putrid food, or poisonous drugs, as in the case
narrated in Sect. XXV. 13. where other circumstances of this disease are
explained. See Class II. 1. 2. 11.

The cramps of the legs, which are liable to attend cholera, are explained
in Class III. 1. 1. 14.

6. _Ileus._ Consists in the inverted motions of the whole intestinal canal,
from the mouth to the anus; and of the lacteals and absorbents which arise
from it. In this pitiable disease, through the valve of the colon, through
the pylorus, the cardia, and the pharinx, are ejected, first, the contents
of the stomach and intestines, with the excrement and even clysters
themselves; then the fluid from the lacteals, which is now poured into the
intestines by their retrograde motions, is thrown up by the mouth; and,
lastly, every fluid, which is absorbed by the other lymphatic branches,
from the cellular membrane, the skin, the bladder, and all other cavities
of the body; and which is then poured into the stomach or intestines by the
retrograde motions of the lacteals; all which supply that amazing quantity
of fluid, which is in this disease continually ejected by vomiting. See
Sect. XXV. 15. for a further explanation of this disease.

M. M. Copious venesection. Twenty grains of calomel in small pills, or one
grain of aloe every hour till stools are procured. Blisters. Warm bath.
Crude mercury. Clyster of ice-water. Smear the skin all over with grease,
as mentioned in Sect. XXV. 15.

As this malady is occasioned sometimes by an introsusception of a part of
the intestine into another part of it, especially in children, could
holding them up by their heels for a second or two of time be of service
after venesection? Or the exhibition of crude quicksilver two ounces every
half hour, till a pound is taken, be particularly serviceable in this
circumstance? Or could half a pound, or a pound, of crude mercury be
injected as a clyster, the patient being elevated by the knees and thighs
so as to have his head and shoulders much lower than his bottom, or even
for a short time held up by the heels? Could this also be of advantage in
strangulated hernia?

Where the disease is owing to strangulated hernia, the part should be
sprinkled with cold water, or iced water, or salt and water recently mixed,
or moistened with ether. In cases of strangulated hernia, could
acupuncture, or puncture with a capillary trocar, be used with safety and
advantage to give exit to air contained in the strangulated bowel? Or to
stimulate it into action? It is not uncommon for bashful men to conceal
their being afflicted with a small hernia, which is the cause of their
death; this circumstance should therefore always be enquired into. Is the
seat or cause of the ileus always below the valve of the colon, and that of
the cholera above it? See Class II. 1. 2. 11.

7. _Globus hystericus._ Hysteric suffocation is the perception of a globe
rolling round in the abdomen, and ascending to the stomach and throat, and
there inducing strangulation. It consists of an ineffectual inversion of
the motions of the oesophagus, and other parts of the alimentary canal;
nothing being rejected from the stomach.

M. M. Tincture of castor. Tinct. of opium of each 15 drops. See Hysteria,
Class I. 3. 1. 10.

8. _Vomendi conamen inane._ An ineffectual effort to vomit. It frequently
occurs, when the stomach is empty, and in some cases continues many hours;
but as the lymphatics of the stomach are not inverted at the same time,
there is no supply of materials to be ejected; it is sometimes a symptom of
hysteria, but more frequently attends irregular epilepsies or reveries;
which however may be distinguished by their violence of exertion, for the
exertions of hysteric motions are feeble, as they are caused by debility;
but those of epilepsies, as they are used to relieve pain, are of the most
violent kind; insomuch that those who have once seen these ineffectual
efforts to vomit in some epilepsies, can never again mistake them for
symptoms of hysteria. See a case in Sect. XIX. 2.

M. M. Blister. Opium. Crude mercury.

9. _Borborigmus._ A gurgling of the bowels proceeds from a partial
invertion of the peristaltic motions of them, by which the gas is brought
into a superior part of the bowel, and bubbles through the descending
fluid, like air rushing into a bottle as the water is poured out of it.
This is sometimes a distressing symptom of the debility of the bowels
joined with a partial inversion of their motions. I attended a young lady
about sixteen, who was in other respects feeble, whose bowels almost
incessantly made a gurgling noise so loud as to be heard at a considerable
distance, and to attract the notice of all who were near her. As this noise
never ceased a minute together for many hours in a day, it could not be
produced by the uniform descent of water, and ascent of air through it, but
there must have been alternately a retrograde movement of a part of the
bowel, which must again have pushed up the water above the air; or which
might raise a part of the bowel, in which the fluid was lodged, alternately
above and below another portion of it; which might readily happen in some
of the curvatures of the smaller intestines, the air in which might be
moved backward and forward like the air-bubble in a glass-level.

M. M. Essential oil. Ten corns of black pepper swallowed whole after
dinner, that its effect might be slower and more permanent; a small pipe
occasionally introduced into the rectum to facilitate the escape of the
air. Crude mercury. See Class I. 2. 4. 9.

10. _Hysteria._ The three last articles, together with the lymphatic
diabætes, are the most common symptoms of the hysteric disease; to which
sometimes is added the lymphatic salivation, and fits of syncope, or
convulsion, with palpitation of the heart (which probably consists of
retrograde motions of it), and a great fear of dying. Which last
circumstance distinguishes these convulsions from the epileptic ones with
greater certainty than any other single symptom. The pale copious urine,
cold skin, palpitation, and trembling, are the symptoms excited by great
fear. Hence in hysteric diseases, when these symptoms occur, the fear,
which has been usually associated with them, recurs at the same time, as in
hypochondriasis, Class I. 2. 4. 10. See Sect. XVI. 8. 1.

The convulsions which sometimes attend the hysteric disease, are exertions
to relieve pain, either of some torpid, or of some retrograde organ; and in
this respect they resemble epileptic convulsions, except that they are
seldom so violent as entirely to produce insensibility to external stimuli;
for these weaker pains cease before the total exhaustion of sensorial power
is produced, and the patient sinks into imperfect syncope; whereas the true
epilepsy generally terminates in temporary apoplexy, with perfect
insensibility to external objects. These convulsions are less to be dreaded
than the epileptic ones, as they do not originate from so permanent a
cause.

The great discharge of pale urine in this disease is owing to the inverted
motions of the lymphatics, which arise about the neck of the bladder, as
described in Sect. XXIX. 4. 5. And the lymphatic salivation arises from the
inverted motions of the salivary lymphatics.

Hysteria is distinguished from hypochondriasis, as in the latter there are
no retrograde motions of the alimentary canal, but simply a debility or
inirritability of it, with distention and flatulency. It is distinguished
from apepsia and cardialgia by there being nothing ejected from the stomach
by the retrograde motions of it, or of the oesophagus.

M. M. Opium. Camphor. Assafoetida. Castor, with sinapisms externally; to
which must be added a clyster of cold water, or iced water; which,
according to Mons. Pomme, relieves these hysteric symptoms instantaneously
like a charm; which it may effect by checking the inverted motions of the
intestinal canal by the torpor occasioned by cold; or one end of the
intestinal canal may become strengthened, and regain its peristaltic motion
by reverse sympathy, when the other end is rendered torpid by ice-water.
(Pomme des Affections Vaporeuses, p. 25.) These remove the present
symptoms; and bark, steel, exercise, coldish bath, prevent their returns.
See Art. VI. 2. 1.

11. _Hydrophobia._ Dread of water occasioned by the bite of a mad dog, is a
violent inversion of the motions of the oesophagus on the contact or even
approach of water or other fluids. The pharinx seems to have acquired the
sensibility of the larinx in this disease, and is as impatient to reject
any fluid, which gets into it. Is not the cardia ventriculi the seat of
this disease? As in cardialgia the pain is often felt in the pharinx, when
the acid material stimulates the other end of the canal, which terminates
in the stomach. As this fatal disease resembles tetanus, or locked jaw, in
its tendency to convulsion from a distant wound, and affects some other
parts by association, it is treated of in Class III. 1. 1. 15. and IV. 1.
2. 7.

       *       *       *       *       *

ORDO III.

_Retrograde Irritative Motions._

GENUS II.

_Of the Absorbent System._

SPECIES.

1. _Catarrhus lymphaticus._ Lymphatic catarrh. A periodical defluxion of a
thin fluid from the nostrils, for a few hours, occasioned by the retrograde
motions of their lymphatics; which may probably be supplied with fluid by
the increased absorption of some other lymphatic branches in their
vicinity. It is distinguished from that mucous discharge, which happens in
frosty weather from decreased absorption, because it is less salt to the
taste; and from an increased secretion of mucus, because it is neither so
viscid, nor is attended with heat of the part. This complaint is liable to
recur at diurnal periods, like an intermittent fever, for weeks and months
together, with great sneezing and very copious discharge for an hour or
two.

I have seen two of these cases, both of which occurred in delicate women,
and seemed an appendage to other hysteric symptoms; whence I concluded,
that the discharge was occasioned by the inverted motions of the lymphatics
of the nostrils, like the pale urine in hysteric cases; and that they might
receive this fluid from some other branches of lymphatic vessels opening
into the frontal or maxillary cavities in their vicinity.

Could such a discharge be produced by strong errhines, and excite an
absorption of the congestion of lymph in the dropsy of the brain?

2. _Salivatio lymphatica._ Lymphatic salivation. A copious expuition of a
pellucid insipid fluid, occasioned by the retrograde motions of the
lymphatics of the mouth. It is sometimes periodical, and often attends the
hysteric disease, and nervous fevers; but is not accompanied with a saline
taste, or with heat of the mouth, or nausea.

3. _Nausea humida._ Moist nausea consists in a discharge of fluid, owing to
the retrograde motions of the lymphatics about the fauces, without increase
of heat, or saline taste, together with some retrograde motions of the
fauces or pharinx; along with this nausea a sickness generally precedes the
act of vomiting; which may consist of a similar discharge of mucus or chyle
into the stomach by the retrograde motions of the lymphatics or lacteals,
which open into it. See Class I. 2. 4. 3. and I. 2. 4. 4.

M. M. Subacid liquids. Wine. Opium. A blister.

4. _Diarrhoea lymphatica._ Lymphatic diarrhoea. A quantity of mucus and
lymph are poured into the intestines by the inverted motions of the
intestinal lymphatics. The feces are less fetid and more liquid; and it
sometimes portends the commencement of a diabætes, or dropsy, or their
temporary relief. This lymphatic diarrhoea sometimes becomes chronical, in
which the atmospheric moisture, absorbed by the cutaneous and pulmonary
lymphatics, is poured into the intestines by the retrograde motions of the
lacteals. See Section XXIX. 4. 6. where some cases of this kind are
related.

5. _Diarrhoea chylifera, coeliaca._ Chyliferous diarrhoea. The chyle drank
up by the lacteals of the upper intestines is poured into the lower ones by
the retrograde motions of their lacteals, and appears in the dejections.
This circumstance occurs at the beginning of diarrhoea crapulosa, where the
patient has taken and digested more aliment than the system can
conveniently receive, and thus eliminates a part of it; as appears when
there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It
differs from the lymphatic diarrhoea, as the chyliferous diabætes differs
from the aqueous and mucaginous diabætes.

6. _Diabætes._ By the retrograde motions of the urinary lymphatics, an
immense quantity of fluid is poured into the bladder. It is either termed
chyliferous, or aqueous, or mucaginous, from the nature of the fluid
brought into the bladder; and is either a temporary disease, as in hysteric
women, in the beginning of intoxication, in worm cases, or in those exposed
to cold damp air, or to great fear, or anxiety, or in the commencement of
some dropsies; or it becomes chronical.

When the urinary lymphatics invert their motions, and pour their refluent
contents into the bladder, some other branch of the absorbent system acts
with greater energy to supply this fluid. If it is the intestinal branch,
the chyliferous diabætes is produced: if it is the cutaneous or pulmonary
branch, the aqueous diabætes is produced: and if the cellular or cystic
branches, the mucaginous diabætes. In the two last the urine is pellucid,
and contains no sugar.

In dropsies the fluid is sometimes absorbed, and poured into the bladder by
the retrograde motions of the urinary lymphatics, as during the exhibition
of digitalis. In the beginning of the dropsies of infirm gouty patients, I
have frequently observed, that they make a large quantity of water for one
night, which relieves them for several days. In these cases the patient
previously feels a fulness about the precordia, with difficult respiration,
and symptoms similar to those of hysteria. Perhaps a previous defect of
absorption takes place in some part of the body in those hysteric cases,
which are relieved by a copious discharge of pale urine. See Diabætes
explained at large, Section XXIX. 4.

A discharge of blood sometimes attends the diabætes, which was occasionally
a symptom of that disease in Mr. Brindley, the great navigable canal maker
in this country. Which may be accounted for by the communication of a
lymphatic branch with the gastric branch of the vena portarum, as
discovered by J. F. Meckel. See Section XXVII. 2.

M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium.
See Sect. XXIX. 4.

7. _Sudor lymphaticus._ Profuse sweats from the inverted motions of the
cutaneous lymphatics, as in some fainting fits, and at the approach of
death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These
sweats are glutinous to the touch, and without increased heat of the skin;
if the part is not covered, the skin becomes cold from the evaporation of
the fluid. These sweats without heat sometimes occur in the act of
vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty
hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R.
Davis, which he cured by frequent application of lime. Though it is
possible, that cold sweaty hands may also arise from the want of due
absorption of the perspirable matter effused on them, and that the coldness
may be owing to the greater evaporation in consequence.

The acid sweats described by Dr. Dobson, which he observed in a diabætic
patient, and ascribes to the chyle effused on the skin, must be ascribed to
the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6.

8. _Sudor asthmaticus._ The cold sweats in this disease only cover the
head, arms, and breast, and are frequently exceedingly profuse. These
sweats are owing to the inverted motions of the cutaneous lymphatics of the
upper part of the body, and at the same time the increased absorption of
the pulmonary absorbents: hence these sweats when profuse relieve the
present fit of asthma. There is no other way to account for sweats
appearing on the upper parts of the body only, but by the fluid having been
absorbed by the lymphatic branch of the lungs, and effused on the skin by
the retrograde movements of the cutaneous lymphatics; which join those of
the lungs before they enter into the venous circulation. For if they were
occasioned, as generally supposed, by the difficulty of the circulation of
the blood through the lungs, the whole skin must be equally affected, both
of the upper and lower parts of the body; for whatever could obstruct the
circulation in the upper part of the venous system, must equally obstruct
it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma
these sweats do not occur; hence they may be distinguished; and might be
called the hydropic asthma, and the epileptic asthma.

9. _Translatio puris._ Translation of matter from one part of the system to
another can only be explained from its being absorbed by one branch of the
lymphatic system, and deposited in a distant part by the retrograde motions
of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these
translations of matter are attended generally, I believe, with cold fits;
for less heat is produced during the retrograde action of this part of the
system, as no secretion in the lymphatic glands of the affected branches
can exist at the same time. Do any ineffectual retrograde motions occasion
the cold fits of agues? The time when the gout of the liver ceases, and the
gout in the foot commences, is attended with a cold fit, as I have observed
in two instances, which is difficult to explain, without supposing the new
vessels, or the matter produced on the inflamed liver, to be absorbed, and
either eliminated by some retrograde motion, or carried to the newly
inflamed part? See Class IV. 1. 2. 15.

10. _Translatio lactis._ Translation of milk to the bowels in puerperal
fevers can only be explained by the milk being absorbed by the pectoral
branch of lymphatics, and carried to the bowels by the retrograde motions
of the intestinal lymphatics or lacteals. See many instances of this in
Sect. XXIX. 7. 4.

11. _Translatio urinæ._ Translation of urine. There is a curious case
related in the Transaction of the College of Physicians at Philadelphia,
Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine
for many months; which could not be distinguished from that which was at
other times drawn off by the catheter. After having taken much opium, she
seems at length to have formed gravel, some of which was frequently brought
up by vomiting. Dr. Senter ascribes this to the retrograde motions of the
lymphatics of the stomach, and the increased ones of those of the bladder,
and refers to those of Sect. XXIX. of this work; which section was first
published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine.

The patient above described sometimes had a discharge of urine by the
navel, and at other times by the rectum, and sometimes by urinous sweats.

       *       *       *       *       *

ORDO III.

_Retrograde Irritative Motions._

GENUS III.

_Of the Sanguiferous System._

SPECIES.

1. _Capillarium motus retrogressus._ In microscopic experiments it is usual
to see globules of blood regurgitate from the capillary vessels again and
again, before they pass through them; and not only the mouths of the veins,
which arise from these capillaries, are frequently seen by microscopes to
regurgitate some particles of blood during the struggles of the animal; but
a retrograde motion of the blood in the veins of these animals, from the
very heart to the extremities of the limbs, is observable by intervals
during the distresses of the dying creature. Haller, Elem. Phys. T. i. p.
216. See Section XXIX. 3. 8.

2. _Palpitatio cordis._ May not the ineffectual and weak unequal motions of
the heart in hysteric cases be ascribed to the retrograde motions of it,
which continue for a short time, or terminate in syncope? See Class IV. 3.
1. 6.

3. _Anhelatio spasmodica._ In some asthmas may not the difficulty of
respiration arise from the inverted action of the finer branches of the
bronchia, or of the pulmonary artery or vein, like those of the capillaries
above described in No. 1. of this genus?

       *       *       *       *       *


_The Orders and Genera of the Second Class of Diseases._

       *       *       *       *       *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENERA.

  1. With increased action of the muscles.
  2. With the production of new vessels by internal membranes or glands
      with fever.
  3. With the production of new vessels by external membranes or glands
      with fever.
  4. With the production of new vessels by internal membranes or glands
      without fever.
  5. With the production of new vessels by external membranes or glands
      without fever.
  6. With fever consequent to the production of new vessels or fluids.
  7. With increased action of the organs of sense.

ORDO II.

_Decreased Sensation._

GENERA.

  1. With decreased actions of the general system.
  2. With decreased actions of particular organs.

ORDO III.

_Retrograde Sensitive Motions._

GENERA.

  1. Of the excretory ducts.

       *       *       *       *       *

_The Orders, Genera, and Species, of the Second Class Of Diseases._

       *       *       *       *       *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENUS I.

_With Increased Action of the Muscles._

SPECIES.

   1. _Deglutitio._                     Deglutition.
   2. _Respiratio._                     Respiration.
   3. _Sternutatio._                    Sneezing.
   4. _Anhelitus._                      Panting.
   5. _Tussis ebriorum._                Cough of inebriates.
   6. _Syngultus._                      Hiccough.
   7. _Asthma humorale._                Humoral asthma.
   8. _Nictitatio sensitiva._           Winking from pain.
   9. _Oscitatio et pandiculatio._      Yawning and stretching.
  10. _Tenesmus._                       Tenesmus.
  11. _Stranguria._                     Strangury.
  12. _Parturitio._                     Parturition.

GENUS II.

_With the Production of new Vessels by internal Membranes or Glands, with
Fever._

SPECIES.

   1. _Febris sensitiva irritata._  Sensitive irritated fever.
   2. _Ophthalmia interna._         Inflammation of the eye.
   3. _Phrenitis._                  ---- of the brain.
   4. _Peripneumonia._              ---- of the lungs.
      ---- _trachealis._            ---- the croup.
   5. _Pleuritis._                  ---- of the pleura.
   6. _Diaphragmitis._              ---- of the diaphragm.
   7. _Carditis._                   ---- of the heart.
   8. _Peritonitis._                ---- of the peritoneum.
   9. _Mesenteritis._               ---- of the mesentery.
  10. _Gastritis._                  ---- of the stomach.
  11. _Enteritis._                  ---- of the bowels.
  12. _Hepatitis._                  ---- of the liver.
  13. _Splenitis._                  ---- of the spleen.
  14. _Nephritis._                  ---- of the kidney.
  15. _Cystitis._                   ---- of the bladder.
  16. _Hysteritis._                 ---- of the womb.
  17. _Lumbago sensitiva._          ---- of the loins.
  18. _Ischias._                    ---- of the pelvis.
  19. _Paronychia interna._         ---- beneath the nails.

GENUS III.

_With the Production of new Vessels by external Membranes or Glands, with
Fever._

SPECIES.

   1. _Febris sensitiva inirritata._    Sensitive inirritated fever.
   2. _Erysipelas irritatum._           Erysipelas irritated.
      _----inirritatum._                ---- inirritated.
      ---- _sensitivum._                ---- sensitive.
   3. _Tonsillitis interna._            Angina internal.
      ---- _superficialis._             ---- superficial.
      ---- _inirritata._                ---- inirritated.
   4. _Parotitis suppurans._            Mumps suppurative.
      ---- _mutabilis._                 ---- mutable.
      ---- _felina._                    ---- of cats.
   5. _Catarrhus sensitivus._           Catarrh inflammatory.
   6. ---- _contagiosus._               ---- contagious.
      ---- _equinus et caninus._        ---- among horses and dogs.
   7. _Peripneumonia superficialis._    Superficial peripneumony.
   8. _Pertussis._                      Chin-cough.
   9. _Variola discreta._               Small-pox distinct.
      ---- _confluens._                 ---- confluent.
      ---- _inoculata._                 ---- inoculated.
  10. _Rubeola irritata._               Measles irritated.
      ---- _inirritata._                ---- inirritated.
  11. _Scarlatina mitis._               Scarlet fever mild.
      ---- _maligna._                   ---- malignant.
  12. _Miliaria sudatoria._             Miliary fever sudatory.
      ---- _irritata._                  ---- irritated.
      ---- _inirritata._                ---- inirritated.
  13. _Pestis._                         Plague.
      ---- _vaccina._                   ---- of horned cattle.
  14. _Pemphigus._                      Bladdery fever.
  15. _Varicella._                      Chicken-pox.
  16. _Urticaria._                      Nettle rash.
  17. _Aptha sensitiva._                Thrush sensitive.
      ---- _irritata._                  ---- irritated.
      ---- _inirritata._                ---- inirritated.
  18. _Dysenteria._                     Bloody flux.
  19. _Gastritis superficialis._        Superficial inflam. of the stomach.
  20. _Enteritis superficialis._        ---- of the bowels.

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands,
without Fever._

SPECIES.

   1. _Ophthalmia superficialis._     Ophthalmy superficial.
      ---- _lymphatica._              ---- lymphatic.
      ---- _equina._                  ---- of horses.
   2. _Pterigion._                    Eye-wing.
   3. _Tarsitis palpebrarum._         Red eyelids.
   4. _Hordeolum._                    Stye.
   5. _Paronychia superficialis._     Whitlow.
   6. _Gutta rosea hepatica._         Pimpled face hepatic.
      ---- _stomatica._               ---- stomatic.
      ---- _hereditaria._             ---- hereditary.
   7. _Odontitis._                    Inflamed tooth.
   8. _Otitis._                       ---- ear.
   9. _Fistula lacrymalis._           Fistula lacrymalis.
  10. _Fistula in ano._               Fistula in ano.
  11. _Fistula urethræ._              Fistula urethræ.
  12. _Hepatitis chronica._           Chronical hepatitis.
  13. _Scrophula suppurans._          Suppurating scrophula.
  14. _Scorbutus suppurans._          Suppurating scurvy.
  15. _Schirrus suppurans._           Suppurating schirrus.
  16. _Carcinoma._                    Cancer.
  17. _Arthrocele._                   Swelling of the joints.
  18. _Arthropuosis._                 Suppuration of the joints.
  19. _Caries ossium._                Caries of the bones.

GENUS V.

_With the Production of new Vessels by external Membranes or Glands,
without Fever._

SPECIES.

   1. _Gonorrhoea venerea._       Clap.
   2. _Syphilis._                 Venereal disease.
   3. _Lepra._                    Leprosy.
   4. _Elephantiasis._            Elephantiasis.
   5. _Framboesia._               Framboesia.
   6. _Psora._                    Itch.
   7. _Psora ebriorum._           Itch of drunkards.
   8. _Herpes._                   Herpes.
   9. _Zona ignea._               Shingles.
  10. _Annulus repens._           Ring-worm.
  11. _Tinea capitis._            Scald-head.
  12. _Crusta lactea._            Milk-crust.
  13. _Trichoma._                 Plica polonica.

GENUS VI.

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

SPECIES.

   1. _Febris sensitiva._               Sensitive fever.
   2. ---- _a pure clauso._             Fever from concealed matter.
   3. ---- _a vomica._                  ---- from vomica.
   4. ---- _ab empyemate._              ---- from empyema.
   5. ---- _mesenterica._               ---- mesenteric.
   6. ---- _a pure aerato._             ---- from aerated matter.
   7. ---- _a phthisi._                 ---- from consumption.
   8. ---- _scrophulosa._               ---- scrophulous.
   9. ---- _ischiadica._                ---- from ischias.
  10. ---- _arthropuodica._             ---- from joint-evil.
  11. ---- _a pure contagioso._         ---- from contagious matter.
  12. ---- _variolosa secundaria._      ---- secondary of small-pox.
  13. ---- _carcinomatosa._             ---- cancarous.
  14. ---- _venerea._                   ---- venereal.
  15. ---- _a sanie contagiosa._        ---- from contagious sanies.
  16. ---- _puerpera._                  ---- puerperal.
  17. ---- _a sphacelo._                ---- from sphacelus.

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

   1. _Delirium febrile._        Delirium of fevers.
   2. ---- _maniacale._          ---- maniacal.
   3. ---- _ebrietatis._         ---- of drunkenness.
   4. _Somnium._                 Dreams.
   5. _Hallucinatio visûs._      Deception of sight.
   6. ---- _auditus._            ---- of hearing.
   7. _Rubor a calore._          Blush from heat.
   8. ---- _jucunditatis._       ---- from joy.
   9. _Priapismus amatorius._    Amorous priapism.
  10. _Distentio mamularum._     Distention of the nipples.

ORDO II.

_Decreased Sensation._

GENUS I.

_With decreased Action of the general System._

SPECIES.

  1. _Stultitia insensibilis._    Folly from insensibility.
  2. _Tædium vitæ._               Irksomeness of life.
  3. _Paresis sensitiva._         Sensitive debility.

GENUS II.

_With decreased Actions of particular Organs._

SPECIES.

  1. _Anorexia._                  Want of appetite.
  2. _Adipsia._                   Want of thirst.
  3. _Impotentia._                Impotence.
  4. _Sterilitas._                Barrenness.
  5. _Insensibilitas artuum._     Insensibility of the limbs.
  6. _Dysuria insensitiva._       Insensibility of the bladder.
  7. _Accumulatio alvina._        Accumulation of feces.

ORDO III.

_Retrograde Sensitive Motions._

GENUS I.

_Of Excretory Ducts._

SPECIES.

     _Motus retrogressus_        Retrograde motion.
  1. ---- _ureterum._            ---- of the ureters.
  2. ---- _urethræ._             ---- of the urethra.
  3. ---- _ductus choledoci._    ---- of the bile-duct.

       *       *       *       *       *

CLASS II.

DISEASES OF SENSATION.

ORDO I.

_Increased Sensation._

GENUS I.

_With Increased Action of the Muscles._

The actions belonging to this genus are those which are immediately excited
by the sensations of pain or pleasure, but which are neither followed by
inflammation, nor by convulsion. The former of which belong to the
subsequent genera of this order, and the latter to the class of voluntary
motions.

The criterion between the actions, which are the immediate consequence of
painful sensation, and convulsive actions properly so called, consists in
the former having a tendency to dislodge the stimulating cause, which
induces the painful sensation; and the latter being exerted for the purpose
of expending the sensorial power, and thus dulling or destroying the
general sensation of the system. See Class III. 1.

There is a degree of heat produced in the affected part by these sensitive
actions without inflammation, but in much less quantity than when attended
by inflammation; as in the latter there is a production of new vessels. See
Sect. XXXIII. 2. 3.

Some of the species of this genus cannot properly be termed diseases in
their natural state, but become so by their defect or excess, and are here
inserted to facilitate the explanation of the others.

SPECIES.

1. _Deglutitio._ Swallowing our food is immediately caused by the
pleasureable sensation occasioned by its stimulus on the palate or fauces
and is acquired long before the nativity of the animal. Afterwards the pain
of hunger previously produces the various voluntary exertions to procure
the proper material, but the actions of masticating and of swallowing it
are effected by the sensorial power of sensation; which appears by their
not being always controulable by the will, as when children in vain attempt
to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food
stimulates the palate, which is an organ of sense, into so much action, as
to produce agreeable sensation; and the muscles subservient to deglutition
are brought into action by the sensation thus produced. The pleasureable
sensation is the proximate cause; the action of the fibres of the
extremities of the nerves of taste is the remote cause; the sensorial power
of irritation exciting these fibres of the nerves of taste into increased
action is the pre-remote cause; the action of the muscles of deglutition is
the proximate effect; the pushing the food into the stomach is the remote
effect; and the nutrition of the body is the post-remote effect.

Though the muscles subservient to deglutition have their actions previously
associated, so as to be excited into synchronous tribes or successive
trains, either by volition, as when we swallow a disagreeable drug; or by
sensation, as when we swallow agreeable food; or by irritation, as when we
inattentively swallow our saliva; yet do all those three kinds of
deglutition belong to the respective classes of volition, sensation, and
irritation; because the first links of these tribes or trains of muscular
action are excited by those sensorial powers, and the associated links,
which accompany or succeed them, are excited by the combined powers either
of volition, or of sensation, or of irritation, along with that of
association.

2. _Respiratio._ Respiration is immediately caused by the sensorial power
of sensation in consequence of the baneful want of vital air; and not from
the accumulation of blood in the lungs, as that might be carried on by
inhaling azote alone, without the oxygenous part of the atmosphere. The
action of respiration is thus similar to that of swallowing our food to
appease the pain of hunger; but the lungs being surrounded with air, their
proper pabulum, no intermediate voluntary exertions are required, as in
hunger, to obtain and prepare the wanted material.

Respiration is similar to slow combustion; the oxygenous part of the
atmosphere is received through the moist membranes, which line the
air-cells of the lungs, and uniting with the inflammable part of the blood
generates an acid, probably the phosphoric acid; a portion of carbonic acid
is likewise produced in this process; as appears by repeatedly breathing
over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto
I. l. 401. note.

3. _Sternutatio._ Sneezing consists of muscular actions produced by the
sensorial faculty of sensation; and is an effort to dislodge, by means of
air forcibly impelled through the nostrils, some material; which stimulates
the membrane, which lines them, into too great action, and might thence
injure the sense of smell which is diffused on it.

In this operation the too great action of the vessels of the membrane of
the nostrils is the remote cause; the sensation thence induced is the
proximate cause; and the muscular actions are the proximate effect.

This action of sneezing frequently precedes common respiration in new-born
children, but I believe not always; as like the latter it cannot have been
previously acquired in the uterus.

It is produced in some people by sudden light, as by looking up at the sky
in a morning, when they come out of a gloomy bed-chamber. It then becomes
an associate action, and belongs to Class IV. 1. 2. 2.

M. M. When it is exerted to excess it may be cured by snuffing starch up
the nostrils. See Class I. 1. 2. 13.

4. _Anhelitus._ Panting. The quick and laborious breathing of running
people, who are not accustomed to violent exercise, is occasioned by the
too great conflux of blood to the lungs. As the sanguiferous system, as
well as the absorbent system, is furnished in many parts of its course with
valves, which in general prevent the retrograde movement of their contained
fluids; and as all these vessels, in some part of their course, lie in
contact with the muscles, which are brought into action in running, it
follows that the blood must be accelerated by the intermitted swelling of
the bellies of the muscles moving over them.

The difficulty of breathing, with which, very fat people are immediately
affected on exercise, is owing to the pressure of the accumulated fat on
the veins, arteries, and lymphatics; and which, by distending the skin,
occasions it to act as a tight bandage on the whole surface of the body.
Hence when the muscles are excited into quicker action, the progress of the
blood in the veins, and of the lymph and chyle in the absorbent system, is
urged on with much greater force, as under an artificial bandage on a limb,
explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the
circulation is instantly quickened to a great degree, and the difficulty of
breathing is the consequence of a more rapid circulation through the lungs.
The increased secretion of the perspirable matter is another consequence of
this rapid circulation; fat people, when at rest, are believed to perspire
less than others, which may be gathered from their generally having more
liquid stools, more and paler urine, and to their frequently taking less
food than many thin people; and lastly, from the perspiration of fat people
being generally more inodorous than that of lean ones; but when corpulent
people are put in motion, the sweat stands in drops on their skins, and
they "lard the ground" as they run. The increase of heat of corpulent
people on exercise, is another consequence of their more rapid circulation,
and greater secretion. See Class I. 2. 3. 17.

Other causes of difficult or quick respiration will be treated of under
Asthma, Pertussis, Peripneumony, Tonsillitis.

5. _Tussis ebriorum._ Sensitive cough is an exertion of the muscles used in
expiration excited into more violent action by the sensorial power of
sensation, in consequence of something which too powerfully stimulates the
lungs. As the saline part of the secreted mucus, when the absorption of it
is impeded; or the too great viscidity of it, when the absorption is
increased; or the too great quantity of the mucus, when the secretion is
increased; or the inflammation of the membranes of the lungs; it is an
effort to dislodge any of these extraneous materials.

Of this kind is the cough which attends free-drinkers after a debauch; it
consists of many short efforts to cough, with a frequent expuition of half
a tea-spoonful of frothy mucus, and is attended with considerable thirst.
The thirst is occasioned by the previous dissipation of the aqueous parts
of the blood by sensible or insensible perspiration; which was produced by
the increased action of the cutaneous and pulmonary capillaries during the
stimulus of the wine. In consequence of this an increased absorption
commences to replace this moisture, and the skin and mouth become dry, and
the pulmonary mucus becomes inspissated; which stimulates the bronchia, and
is raised into froth by the successive currents of air in evacuating it.
This production of froth is called by some free-drinkers "spitting
sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid
expectoration in some people succeeds the slightest degree of intoxication,
of which it may be esteemed a criterion. See Class IV. 2. 1. 8.

As coughs are not always attended with pain, the muscular actions, which
produce them, are sometimes excited by the sensorial faculty of irritation,
as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also
sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic,
as Class IV. 2. 1. 7.

M. M. Venesection, when the cough is attended with inflammation. Mucilages.
Opium. Torpentia. Blister.

6. _Singultus._ Hiccough is an exertion of the muscles used in inspiration
excited into more violent action by the sensorial power of sensation, in
consequence of something which too powerfully stimulates the cardia
ventriculi, or upper orifice of the stomach. As when solid food is too
hastily taken without sufficient dilution. And is an effort to dislodge
that offensive material, and push it to some less sensible part of the
stomach, or into the middle of the contained aliment.

At the end of fatal fevers it may arise from the acrimony of the undigested
aliment, or from a part of the stomach being already dead, and by its
weight or coldness affecting the surviving part with disagreeable
sensation. The pain about the upper orifice of the stomach is the proximate
cause, the too great or too little action of the fibres of this part of the
stomach is the remote cause, the action of the muscles used in inspiration
is the proximate effect, and the repercussion of the offending material is
the remote effect.

Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the
kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of
epilepsy or reverie, as in Sect. XIX. 2.

M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar,
or on chalk. Opium. Blister. Emetic.

7. _Asthma humorale._ The humoral asthma probably consists in a temporary
anasarca of the lungs, which may be owing to a temporary defect of
lymphatic absorption. Its cause is nevertheless at present very obscure,
since a temporary deficiency of venous absorption, at the extremities of
the pulmonary or bronchial veins, might occasion a similar difficulty of
respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that
the lymph effused into the cavity of the chest might, by some additional
heat during sleep, acquire an aerial form, and thus compress the lungs; and
on this circumstance the relief, which these patients receive from cold
air, would be readily accounted for.

The paroxysms attack the patient in his first sleep, when the circulation
through the lungs in weak people wants the assistance of the voluntary
power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less
able to fulfil the whole of their duty. And part of the thin mucus, which
is secreted into the air-cells, remains there unabsorbed, and occasions the
difficult respiration, which awakes the patient. And the violent exertions
of the muscles of respiration, which succeed, are excited by the pain of
suffocation, for the purpose of pushing forwards the blood through the
compressed capillaries, and to promote the absorption of the effused lymph.

In this the humoral differs from the convulsive asthma, treated of in Class
III. 1. 1. 10. as in that there is probably no accumulated fluid to be
absorbed; and the violent respiration is only an exertion for the purpose
of relieving pain, either in the lungs or in some distant part, as in other
convulsions, or epilepsy; and in this respect the fits of humoral and
convulsive asthma essentially differ from each other, contrary to the
opinion expressed without sufficient consideration in Sect. XVIII. 15.

The patients in the paroxysms both of humoral and convulsive asthma find
relief from cold air, as they generally rise out of bed, and open the
window, and put out their heads; for the lungs are not sensible to cold,
and the sense of suffocation is somewhat relieved by there being more
oxygen contained in a given quantity of cold fresh air, than in the warm
confined air of a close bed-chamber.

I have seen humoral asthma terminate in confirmed anasarca, and destroy the
patient, who had been an excessive drinker of spirituous potation. And M.
Savage asserts, that this disease frequently terminates in diabetes; which
seems to shew, that it is a temporary dropsy relieved by a great flow of
urine. Add to this, that these paroxysms of the asthma are themselves
relieved by profuse sweats of the upper parts of the body, as explained in
Class I. 3. 2. 8. which would countenance the idea of their being
occasioned by congestions of lymph in the lungs.

The congestion of lymph in the lungs from the defective absorption of it is
probably the remote cause of humoral asthma; but the pain of suffocation is
the immediate cause of the violent exertions in the paroxysms. And whether
this congestion of lymph in the air-cells of the lungs increases during our
sleep, as above suggested, or not; the pain of suffocation will be more and
more distressing after some hours of sleep, as the sensibility to internal
stimuli increases during that time, as described in Sect. XVIII. 15. For
the same reason many epileptic fits, and paroxysms of the gout, occur
during sleep.

In two gouty cases, complicated with jaundice, and pain, and sickness, the
patients had each of them a shivering fit, like the commencement of an
ague, to the great alarm of their friends; both which commenced in the
night, I suppose during their sleep; and the consequence was a cessation of
the jaundice, and pain about the stomach, and sickness; and instead of that
the gout appeared in their extremities. In these cases I conjecture, that
there was a metastasis not only of the diseased action from the membranes
of the liver to those of the foot; but that some of the new vessels, or new
fluids, which were previously produced in the inflamed liver, were
translated to the feet during the cold fit, by the increased absorption of
the hepatic lymphatics, and by the retrograde motions of those of the
affected limbs.

This I think resembles in some respects a fit of humoral asthma, where
stronger motions of the absorbent vessels of the lungs are excited, and
retrograde ones of the correspondent cutaneous lymphatics; whence the
violent sweats of the upper parts of the body only are produced; and for a
time the patient becomes relieved by the metastasis and elimination of the
offending material by sensitive exertion. For a further account of this
intricate subject see Class III. 1. 1. 10.

M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed
with water, with 10 drops of laudanum, to be repeated three or four times.
Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a
grain of opium at night, and two or three of aloes. A flannel shirt in
winter, but not in summer. Issues. Digitalis?

In this species of asthma, there is great reason to believe, that the
respiration of an atmosphere, with an increased proportion of oxygen, will
prove of great advantage; some well-observed and well-attested cases of
which are published by Dr. Beddoes; as this purer air invigorates the
circulation, and the whole system in consequence, perhaps not only by its
stimulus, but by its supplying the material from which the sensorial power
is extracted or fabricated. In spasmodic asthma, on the contrary, Dr.
Ferriar has found undoubted benefit from an atmosphere mixed with hydrogen.
See Sect. XVIII. 15. and Class III. 1. 1. 10.

8. _Nictitatio sensitiva._ Winking of the eyes is performed every minute,
without our attention, for the purpose of diffusing the tears over them,
which are poured into the eye a little above the external corner of it, and
which are afterwards absorbed by the lacrymal points above and below the
internal corner of it. When this operation is performed without our
attention, it is caused by the faculty of irritation, and belongs to Class
I. 1. 4. 1. but when it is produced by a stronger stimulus of any
extraneous material in the eye, so as to cause pain, the violent and
frequent nictitation is caused by the faculty of sensation.

This disease is sometimes produced by the introversion of the edge of the
lower eyelid, which bends the points of the hairs of the eyelash upon the
ball of the eye, which perpetually stimulate it into painful sensation.
This introversion of the eyelid is generally owing to a tumor of the
cellular membrane below the edge of the eyelid, and though a very
troublesome complaint may often be cured by the following simple means. A
little common plaster spread on thin linen, about a quarter of an inch
long, must be rolled up so as to be about the size of a crow-quill, this
must be applied immediately below the eyelash on the outside of the eye;
and must be kept on by another plaster over it. This will then act as a
slight compression on the tumor under the eyelash, and will prevent the
hairs from touching the eye-ball. In a week or two the compression will
diminish the tumor it lies over, and cure this painful deformity.

9. _Oscitatio et pandiculatio._ Yawning and stretching of the limbs is
produced either by a long inactivity of the muscles now brought into
action, as sometimes happens after sleep, or after listening a long time to
a dull narrative; or it is produced by a too long continued action of the
antagonist muscles. In the former case there is an accumulation of
sensorial power during the quiescence of the muscles now brought into
action; which probably constitutes the pain or wearisomeness of a continued
attitude. In the latter case there is an exhaustion of sensorial power in
the muscles, which have lately been acting violently, and a consequent
accumulation in the muscles, which are antagonists to them, and which were
at rest.

These involuntary motions are often seen in paralytic limbs, which are at
the same time completely disobedient to the will; and are frequently
observable in very young children; and from thence we may conclude, that
these motions are learnt before nativity; as puppies are seen to open their
mouths before the membranes are broken. See Sect. XVI. 2.

Where these motions are observed in limbs otherwise paralytic, it is an
indication that electric shocks may be employed with advantage, as the
excitability of the limb by irritation is not extinct, though it be
disobedient both to volition and sensation.

10. _Tenesmus_ consists in violent and frequent ineffectual efforts to
discharge the contents of the rectum, owing to pain of the sphincter. The
pain is produced by indurated feces, or by some acrid material, as the
acidity of indigested aliment; and the efforts are attended with mucus from
the pained membrane. The feces must sometimes be taken away by the end of a
marrow-spoon, as cathartics and even clyster will pass without removing
them. It is sometimes caused by sympathy with the urethra, when there is a
stone at the neck of the bladder. See Class II. 2. 2. 7. and IV. 1. 2. 8.

M. M. Fomentation, an enema with mucilage and laudanum.

The common exclusion of the feces from the rectum is a process similar to
this, except that the muscles of the sphincter ani, and those of the
abdomen, which act along with them by the combined powers of sensation and
association, are in tenesmus excited by painful sensation, and in the
latter by a sensation, which may in some instances be almost called
pleasurable, as relieving us from a painful one in the exclusion of the
feces.

11. _Stranguria._ Strangury consists in painful efforts to discharge the
contents of the urinary bladder. It is generally owing to a stone in the
sphincter of the bladder; or to the inflammation of the neck of it
occasioned by cantharides. It is sometimes caused by sympathy with the
piles; and then is liable in women to occasion convulsions, from the
violence of the pain without inflammation. See Class IV. 2. 2. 2. and 3.

M. M. Fomentation clyster with oil and laudanum, push the stone back with a
bougie; if from cantharides give half a pint of warm water every ten
minutes. Mucilage of gum arabic and tragacanth.

The natural evacuation of the urine is a process similar to this, except
that the muscular fibres of the bladder, and the muscles of the abdomen,
which act in concert with them by the combined powers of sensation and of
association, are, in the former case of strangury, excited into action by
painful sensation; and in the latter by a sensation, which may almost be
termed pleasurable, as it relieves us from a previous uneasy one.

The ejectio feminis is another process in some respects similar to
strangury, as belonging to the same sensible canal of the urethra, and by
exciting into action the accelerator muscles; but in the strangury these
muscles are excited into action by painful sensation, and in the ejection
of the semen by pleasureable sensation.

12. _Parturitio._ Parturition is not a disease, it is a natural process,
but is more frequently unfortunate in high life than amongst the middle
class of females; which may be owing partly to fear, with which the priests
of LUCINA are liable to inspire the ladies of fashion to induce them to lie
in in town; and partly to the bad air of London, to which they purposely
resort.

There are however other causes, which render parturition more dangerous to
the ladies of high life; such as their greater general debility from
neglect of energetic exercise, their inexperience of the variations of cold
and heat, and their seclusion from fresh air. To which must be added, that
great source of the destruction of female grace and beauty, as well as of
female health, the tight stays, and other bandages, with which they are
generally tortured in their early years by the active folly of their
friends, which by displacing many of the viscera impedes their actions, and
by compressing them together produces adhesions of one part to another, and
affects even the form and aperture of the bones of the pelvis, through
which the nascent child must be protruded.

As parturition is a natural, not a morbid process, no medicine should be
given, where there is no appearance of disease. The absurd custom of giving
a powerful opiate without indication to all women, as soon as they are
delivered, is, I make no doubt, frequently attended with injurious, and
sometimes with fatal consequences. See Class II. 1. 2. 16.

Another thing very injurious to the child, is the tying and cutting the
navel-string too soon; which should always be left till the child has not
only repeatedly breathed, but till all pulsation in the cord ceases. As
otherwise the child is much weaker than it ought to be; a part of the blood
being left in the placenta, which ought to have been in the child; and at
the same time the placenta does not so naturally collapse, and withdraw
itself from the sides of the uterus, and is not therefore removed with so
much safety and certainty. The folly of giving rue or rhubarb to new-born
children, and the danger of feeding them with gruel instead of milk, is
spoken of in Class I. 1. 2. 5. and II. 1. 2. 16.

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS II.

_With the Production of new Vessels by internal Membranes or Glands, with
Fever._

In the first class of diseases two kinds of fevers were described, one from
excess, and the other from defect of irritation; and were in consequence
termed irritative, and inirritative fevers. In this second class of
diseases another kind of fever occurs, which is caused by excess of
sensation, and termed in consequence Sensitive Fever. But there is no fever
from defect of sensation, because the circulation is carried on in health
without our consciousness, that is, without any sensation attending it.

But as excess of sensation may exist with excess or defect of irritation,
two other kinds of fever arise from a combination of sensitive fever with
the irritative, and inirritative ones. Making five kinds in all.

1. Irritative fever, described in Class I. 1. 1. 1.

2. Inirritative fever. Class I. 2. 1. 1.

3. Sensitive fever. Class II. 1. 6. 1.

4. Sensitive irritated fever. Class II. 1. 2. 1.

5. Sensitive inirritated fever. Class II. 1. 3. 1.

As the sensitive irritated fever attends all the diseases enumerated under
the genus about to be described, it is placed at the head of it. And as the
sensitive inirritated fever accompanies the greatest number of the species
enumerated under the third genus of this order, it is placed at the head of
them. And as the sensitive fever attends the diseases of the sixth genus,
it is placed at the head of them. But as every febrile paroxysm consists of
disordered tribes or trains of associated motions, it may be doubted,
whether they ought not all to have been placed in the fourth class, amongst
the diseases of association. See Class IV. 2. 4. 11.

All the subsequent species of this genus are attended with sensitive
irritated fever; there are nevertheless some superficial inflammations,
which affect the same situations without much fever, as the scrophulous
ophthalmy and spurious peripneumony, which belong to other genera.

Inflammation is uniformly attended with the production or secretion of new
fibres constituting new vessels; this therefore may be esteemed its
essential character, or the criterion of its existence. The extension of
the old vessels seems rather a consequence than a cause of the germination,
or pullulation, of these new ones; for the old vessels may be enlarged, and
excited with unusual energy, without any production of new ones, as in the
blush of shame or of anger.

When these new vessels are formed, if they are not reabsorbed into the
circulation, they secrete a new fluid called purulent matter; which
generally opens itself a passage on the external skin, and produces an
ulcer, which either gradually heals, or spreads, and is the cause of hectic
fever; or they secrete contagious matter, which has the property of
exciting the same kind of inflammation, and of producing the same kind of
contagious matter, when inserted by inoculation into the skin of other
persons. These contagious matters form ulcers, which either heal
spontaneously, or by art; or continue to spread, and destroy the patient,
by other kinds of hectic fever.

In this genus there is an increase of the sensorial power of irritation as
well as of sensation; whence great arterial energy is produced, and the
pulse becomes strong and full, as well as quick; and the coats of the
arteries feel hard under the finger, being themselves thickened and
distended by inflammation. The blood drawn, especially at the second
bleeding, is covered with a tough size; which is probably the mucus from
the inflamed internal surface of the arteries, increased in quantity, and
more coagulable than in its natural state; the thinner part being more
perfectly absorbed by the increased action of the inflamed absorbents. See
Sect. XXXIII. 2. 2. This is rendered more probable, because the hard feel
of the pulse, and the abundance of coagulable lymph commence, exist, and
cease together.

Great heat is produced from the new chemical combinations arising in the
secretion of new fibres, and great pain from the distention of old ones, or
from their increased action. The increased quantity of sensation from a
topical inflammation or phlegmon is the immediate cause of the febris
sensitiva irritata, or inflammatory fever; as when it arises from the pain
of pleurisy, or paronychia; but generally an irritative fever precedes this
topical inflammation, which occurs during the hot fit of it; and then the
irritative fever is changed into a sensitive irritated fever, by the
additional cause of the sensorial power of sensation besides that of
irritation.

SPECIES.

1. _Febris sensitiva irritata._ Sensitive irritated fever, or inflammatory
fever. Phlegmasia. A strong full pulse, with inflammation of the coats of
the arteries, constitutes this disease. It originates from some topical
inflammation, which, if the fever is not subdued, terminates in
suppuration; and differs from irritative fever in respect to the painful
sensation which accompanies it. For as pleasurable sensation is the cause
of the growth of the new vessels, and distention of the old ones, in the
natural enlargement of the body during our infancy; so a painful sensation
is the cause of the unnatural production of new vessels, and enlargement of
old ones in inflammatory diseases.

When matter is thus formed in any internal viscus, or in the cellular
membrane, as in the lungs or liver; so long as this abscess remains without
admission of air, this inflammatory fever is liable to continue, receiving
only temporary relief by bleeding or emetics, or cathartics; till the
patient, after a month, or two, or three, expires. But, if air be admitted
to these internal abscesses, this kind of fever is changed into a hectic
fever in a single day. It also sometimes happens, that when the abscess
remains unopened to the air, if the matter has become putrid, that hectic
fever supervenes, with colliquative sweats, or diarrhoea; the matter in
both cases is sometimes absorbed, and the sides of the abscess grow
together again without an external aperture. See Class II. 1. 4. 1. and 2.
Another termination of inflammation is in gangrene, but this belongs to the
inflammation of the external skin; as the production of purulent matter
belongs to inflammation of the internal or mucous membranes. Thus when the
external skin is the seat of inflammation, as in erythema, or erysipelas,
and produces sensitive irritated fever, no collection of purulent matter
can be formed; but a material oozes out, and lies upon the surface, like
that in the confluent small-pox, and the cuticle at length peels off, or
gangrene supervenes. It must be noted, that these kinds of inflammation can
exist together; and some parts of the cellular membrane may suppurate at
the same time that the external skin is affected with erythema, or
erysipelas.

M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath?
See Sect. XII. 6.

The increased arterial action in this sensitive irritated fever is not
simply owing to the increased irritability of the arterial system, or to
the stimulus of the distention of the vessels, but also to the increased
acrimony or pungency of the blood; which has now so far changed its nature
as to become more fluid, more dense, and to be loaded with coagulable
lymph. Hence it becomes necessary not only to lessen the quantity of blood
by venesection and by cathartics, but also to dilute its acrimony, or
pungency, by the introduction of aqueous and mucilaginous fluids, such as
barley water, cream and water, sugar and water, weak broths; to which may
be added so much of some vegetable essential oil, as may render them
grateful to the stomach, and thus promote their absorption, as by infusing
parsley or cellery and turneps in the broth; or by balm, mint, or sage
teas.

The following species of this genus only distinguish the situation of the
part previously inflamed, and which is the remote cause of the sensitive
irritated, or inflammatory fever, which attends it.

2. _Ophthalmia interna._ Inflammation of the eye is attended with the
production of new vessels, which spread over the tunica adjunctiva, and
over the cornea; these new vessels are easily seen, as they lie on a white
ground, and give ocular demonstration of their production in inflammation.
When this inflammation of the cornea suppurates, it is liable to leave
little ulcers, which may be seen beneath the surface in the form of little
excavations; and as these heal, they are liable to be covered with an opake
scar. This scar, in some months or years, is liable to wear away, and
become transparent, without the assistance of any polishing powder, as of
very finely levigated glass, as some have recommended. But when the cornea
is affected through all its thickness, the return of its transparency
becomes hopeless. See Class I. 1. 3. 14.

In violent degrees of ophthalmy the internal parts, as the retina, optic
artery, iris, ciliary process, become inflamed, as well as the external
ones; hence the least light admitted to the eye occasions intolerable pain.
This curious circumstance cannot be owing to the action of light on the
inflamed vessels of the cornea; it therefore shews, that the extremity of
the optic nerve or retina is also rendered more exquisitely sensible to
light, by partaking of the inflammation; and I have been told, that red
colours are in these cases sometimes painfully perceived even in perfect
darkness. This shews that the retina is excited into motion by the stimulus
of light; and that, when it is inflamed, these motions give great pain,
like those of other inflamed parts, as the muscles, or membranes. And
secondly, that the ideas of colours consist in the motions of the retina;
which ideas occasion pain, when the extremity of the moving nerve is
inflamed.

M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the
eye with cold water by means of a rag. Cool airy room. Darkness. When the
inflammation begins to decline, white vitriol gr. vi. in an ounce of water
is more efficacious to moisten the eye than solutions of lead. Tincture of
opium diluted. New vessels from the inflamed tunica adnata frequently
spread like a fly's wing upon the transparent cornea, which is then called
Pterigium. To stop the growth of this, the principal vessels should be cut
through with a lancet. When the inflammation begins to decline, after due
evacuation any stimulating material put into the eye increases the
absorption, which soon removes the new red vessels; which has given rise to
a hundred famous eye-waters, and eye-doctors; if these stimulating
materials are used too soon, the inflammation is increased by them. See
Sect. XXXII. 2. 10.

There is another ophthalmia, which attends weak children, and is generally
esteemed a symptom of scrophula, as described in Class II. 1. 4. 1. and
another, which is of venereal origin, mentioned in Class II. 1. 5. 2. both
which may be termed ophthalmia superficialis.

3. _Phrenitis._ Inflammation of the brain is attended with intolerance of
light and sound; which shews, that the extremities of the nerves of those
senses are at the same time inflamed; it is also attended with great pain
of the head, with watchfulness, and furious delirium. The violent efforts,
these patients are said sometimes to exert, are owing to the increased
secretion of sensorial power in the brain; as all other inflamed glands
have a greater circulation of blood passing through them, and a greater
secretion in consequence of their peculiar fluids, as in the hepatitis much
more bile is generated.

M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water
for hours together. Or with warm water. Cool airy room. Afterwards cupping
on the occiput. Leeches to the temples. When the patient is weakened a
blister on the head, and after further exhaustion five or six drops of
tincture of opium.

4. _Peripneumonia._ Inflammation of the lungs. The pulse is not always
hard, sometimes soft; which is probably owing to a degree of sickness or
inaction of the stomach; with dull pain of the chest; respiration
constantly difficult, sometimes with erect posture; the face bloated and
purplish; cough generally with moist expectoration, often stained with
blood.

When the difficulty of respiration is very great, the patient is not able
to cough; in this situation, after copious bleeding, the cough is liable to
return, and is so far a favourable symptom, as it shews some abatement of
the inflammation.

A peripneumony frequently occurs in the chin-cough, and destroys the
patient, except immediate recourse be had to the lancet, or to four or five
leeches; when blood cannot be otherwise taken.

The peripneumony is very fatal to young children, especially as I believe
it is frequently mistaken for a spasmodic asthma, or for the croup, or
cynanche trachealis of Cullen. Both which, however, when they occur,
require immediate venesection by the lancet or by leeches, as well as the
peripneumony.

The croup is an inflammation of the upper part, and the peripneumony of the
lower part of the same organ, viz. the trachea or windpipe. See Class I. 1.
3. 4. But as the inflammation is seldom I suppose confined to the upper
part of the trachea only, but exists at the same time in other parts of the
lungs, and as no inflammation of the tonsils is generally perceptible, the
uncouth name of cynanche trachealis should be changed for _peripneumonia
trachialis_. The method of cure consists in immediate and repeated
bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in
subtepid water, and in breathing over the steam of warm water, with or
without a little vinegar in it. And lastly, by keeping the child raised
high in bed.

Inflammation of the lungs is also liable to occur in the measles, and must
be attacked by venesection at any time of the disease; otherwise either a
present death, or an incurable consumption, is the consequence.

The peripneumony is frequently combined with inflammation of the pleura,
and sometimes with that of the diaphragm; either of these may generally be
distinguished, not only by the pain which attends inflammation of these
membranes, but by inspecting the naked chest, and observing whether the
patient breathes more by elevating the ribs, or by depressing the
diaphragm.

A crisis happens in children about the sixth day with much pale urine,
which must be waited for after evacuations have been used, as far as can be
done with safety; in this situation the warm bath twice a day, and small
blisters repeatedly in succession, are of peculiar service.

After the termination of peripneumony a collection of coagulable lymph is
frequently left in the cavity of the chest unabsorbed; or a common anasarca
of the lungs occurs from the present inaction of the absorbent vessels,
which had previously been excited too violently. This difficulty of
breathing is cured or relieved by the exhibition of digitalis. See Art. IV.
2. 8.

M. M. The lancet is the anchor of hope in this disease; which must be
repeated four or five times, or as often as the fever and difficulty of
breathing increase, which is generally in the evening; antimonials,
diluents, repeated small blisters about the chest, mucilage, pediluvium,
warm bath. Is a decoction of seneka-root of use? Do not neutral salts
increase the tendency to cough by their stimulus, as they increase the heat
of urine in gonorrhoea? Children in every kind of difficult breathing, from
whatever cause, should be kept as upright in bed as may be, and continually
watched; since, if they slip down, they are liable to be immediately
suffocated. After the patient is greatly debilitated, so that no further
evacuation can be admitted, and the difficult breathing and cough continue,
I have given four or five drops of tincture of opium, that is, about a
quarter of a grain of solid opium, with great advantage, and I believe in
several cases I have saved the patient. A greater quantity of opium in this
state of debility cannot be used without hazarding the life of the person.
This small quantity of an opiate should be given about six in the evening,
or before the access of the evening paroxysm, and repeated three or four
nights, or longer.

There is a peripneumony with weak pulse, which may be termed _peripneumonia
inirritata_, as described in Sect. XXVII. 2. which belongs to this place.
See also Superficial Peripneumony, Class II. 1. 3. 7.

5. _Pleuritis._ Pleurisy. Inflammation of the pleura, with hard pulse, pain
chiefly of the side, pungent, particularly increased during inspiration;
lying on either side uneasy, the cough very painful, dry at the beginning,
afterwards moist, often bloody.

One cause of pleurisy is probably a previous adhesion of the lungs to a
part of the pleura, which envelops them. This in many cases has been
produced in infancy, by suffering children to lie too long on one side. Or
by placing them uniformly on one side of a fire, or window, to which they
will be liable always to bend themselves.

When matter is produced during peripneumony or pleurisy in one side of the
chest, so long as it is a concealed vomica, the fever continues, if the
disease be great, for many weeks, and even months; and requires occasional
venesection, till the patient sinks under the inflammatory or sensitive
irritated fever. But if air be admitted, by a part of the abscess opening
itself a way into the air-vessels of the lungs, a hectic fever, with
colliquitive sweats or diarrhoea, supervenes, and frequently destroys the
patient; or the abscess heals the lungs adhering to the pleura.

M. M. The lancet must be used copiously, and repeated as often as the pain
and difficult respiration increase. A blister on the pained part.
Antimonial preparations. Diluents. Cool air. Do neutral salts increase the
tendency to cough? Pediluvium or semicupium frequently repeated.

6. _Diaphragmitis._ Inflammation of the diaphragm. Pain round the lower
ribs as if girt with a cord. Difficult respiration performed only by
elevating the ribs and in an erect posture. The corners of the mouth
frequently retracted into a disagreeable smile, called risus Sardonicus.

Those animals, which are furnished with clavicles, or collar-bones, not
only use their foremost feet as hands, as men, monkies, cats, mice,
squirrels, &c. but elevate their ribs in respiration as well as depress the
diaphragm for the purpose of enlarging the cavity of the chest. Hence an
inflammation of the diaphragm is sudden death to those animals, as horses
and dogs, which can only breaths by depressing the diaphragm; and is I
suppose the cause of the sudden death of horses that are over-worked;
whereas, in the human animal, when the diaphragm is inflamed, so as to
render its motions impossible from the pain they occasion, respiration can
be carried on, though in a less perfect manner, by the intercostal muscles
in the elevation of the ribs. In pleurisy the ribs are kept motionless, and
the respiration is performed by the diaphragm, as may be readily seen on
inspecting the naked chest, and which is generally a bad symptom; in the
diaphragmitis the ribs are alternately elevated, and depressed, but the
lower part of the belly is not seen to move.

M. M. As in pleurisy and peripneumony. When the patient becomes delirious,
and smiles disagreeably by intervals, and is become so weak, that
evacuations by the lancet could be used no further, and I have almost
despaired of my patient, I have found in two or three instances, that about
five or six drops of tinct. thebaic, given an hour before the evening
exacerbation, has had the happiest effect, and cured the patient in this
case, as well as in common peripneumony; it must be repeated two or three
evenings, see Class II. 1. 2. 4. as the exacerbation of the fever and
difficult respiration and delirium generally increase towards night.

The stimulus of this small quantity of opium on a patient previously so
much debilitated, acts by increasing the exertion of the absorbent vessels,
in the same manner as a solution of opium, or any other stimulant, put on
an inflamed eye after the vessels are previously emptied by evacuations,
stimulates the absorbent system, so as to cause the remaining new vessels
to be immediately reabsorbed. Which same stimulants would have increased
the inflammation, if they had been applied before the evacuations. See
Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full
of blood, the absorbents cannot act so powerfully, as the progress of their
contents is opposed by the previous fulness of the blood-vessels; whence
stimulants in that case increase the action of the secerning system more
than of the absorbent one; but after copious evacuation this resistance to
the progress of the absorbed fluids is removed; and when stimulants are
then applied, they increase the action of the absorbent system more than
that of the secerning one. Hence opium given in the commencement of
inflammatory diseases destroys the patient; and cures them, if given in
very small doses at the end of inflammatory diseases.

7. _Carditis._ Inflammation of the heart is attended with unequal
intermitting pulse, palpitation, pain in the middle of the sternum, and
constant vomiting. It cannot certainly be distinguished from peripneumony,
and is perhaps always combined with it.

8. _Peritonitis._ Inflammation of the peritonæum is known by pain all over
the abdomen, which is increased on erecting the body. It has probably most
frequently a rheumatic origin. See Class II. 1. 2. 17.

9. _Mesenteritis._ Inflammation of the mesentery is attended with pains
like colic, and with curdled or chyle-like stools. It is a very frequent
and dangerous disease, as the production of matter more readily takes place
in it than in any other viscus. The consequence of which, after a hard
labour, is probably the puerperal fever, and in scrophulous habits a fatal
purulent fever, or hopeless consumption.

M. M. Venesection. Warm bath. Emollient clysters.

10. _Gastritis._ In inflammation of the stomach the pulse is generally
soft, probably occasioned by the sickness which attends it. The pain and
heat of the stomach is increased by whatever is swallowed, with immediate
rejection of it. Hiccough.

This disease may be occasioned by acrid or indigestible matters taken into
the stomach, which may chemically or mechanically injure its interior coat.
There is however a slighter species of inflammation of this viscus, and
perhaps of all others, which is unattended by much fever; and which is
sometimes induced by drinking cold water, or eating cold insipid food, as
raw turnips, when the person has been much heated and fatigued by exercise.
For when the sensorial power has been diminished by great exertion, and the
stomach has become less irritable by having been previously stimulated by
much heat, it sooner becomes quiescent by the application of cold. In
consequence of this slight inflammation of the stomach an eruption of the
face frequently ensues by the sensitive association of this viscus with the
skin, which is called a surfeit. See Class IV. 1. 2. 13. and II. 1. 4. 6.
and II. 1. 3. 19.

M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See
Class II. 1. 3. 17.

11. _Enteritis._ Inflammation of the bowels is often attended with soft
pulse, probably owing to the concomitant sickness; which prevents sometimes
the early use of the lancet, to the destruction of the patient. At other
times it is attended with strong and full pulse like other inflammations of
internal membranes. Can the seat of the disease being higher or lower in
the intestinal canal, that is, above or below the valve of the colon,
produce this difference of pulse by the greater sympathy of one part of the
bowels with the stomach than another? In enteritis with strong pulse the
pain is great about the navel, with vomiting, and the greatest difficulty
in procuring a stool. In the other, the pain and fever is less, without
vomiting, and with diarrhoea. Whence it appears, that the enteritis with
hard quick pulse differs from Ileus, described in Class I. 3. 1. 6. only in
the existence of fever in the former and not the latter, the other symptoms
generally corresponding; and, secondly, that the enteritis with softer
quick pulse, differs from the cholera described in Class I. 3. 1. 5. only
in the existence of fever in the former, and not the latter, the other
symptoms being in general similar. See Class II. 1. 3. 20.

Inflammation of the bowels sometimes is owing to extraneous indigestible
substances, as plum-stones, especially of the damasin, which has sharp
ends. Sometimes to an introsusception of one part of the intestine into
another, and very frequently to a strangulated hernia or rupture. In
respect to the first, I knew an instance where a damasin stone, after a
long period of time, found its way out of the body near the groin. I knew
another child, who vomited some damasin stones, which had lain for near
twenty hours, and given great pain about the navel, by the exhibition of an
emetic given in repeated doses for about an hour. The swallowing of
plum-stones in large quantities, and even of cherry-stones, is annually
fatal to many children. In respect to the introsusception and hernia, see
Ileus, Class I. 3. 1. 6.

M. M. Repeated venesection. Calomel from ten to twenty grains given in
small pills as in Ileus; these means used early in the disease generally
succeed. After these evacuations a blister contributes to stop the
vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will
frequently stay in the stomach. Glauber's salt dissolved in pepper-mint
water given by repeated spoonfuls.

When the patient is much reduced, opium in very small doses may be given,
as a quarter of a grain, as recommended in pleurisy. If the pain suddenly
ceases, and the patient continues to vomit up whatever is given him, it is
generally fatal; as it indicates, that a mortification of the bowel is
already formed. Some authors have advised to join cathartic medicines with
an opiate in inflammation of the bowels, as recommended in colica
saturnina. This may succeed in slighter cases, but is a dangerous practice
in general; since, if the obstruction be not removed by the evacuation, the
stimulus of the opium is liable to increase the action of the vessels, and
produce mortification of the bowel, as I think I have seen more than once.

12. _Hepatitis._ Inflammation of the liver is attended with strong quick
pulse; tension and pain of the right side; often pungent as in pleurisy,
oftner dull. A pain is said to affect the clavicle, and top of the right
shoulder; with difficulty in lying on the left side; difficult respiration;
dry cough; vomiting; hiccough.

There is another hepatitis mentioned by authors, in which the fever, and
other symptoms, are wanting, or are less violent; as described in Class II.
1. 4. 12. and which is probably sometimes relieved by eruptions of the
face; as in those who are habituated to the intemperate use of fermented
liquors.

M. M. Hepatic inflammation is very liable to terminate in suppuration, and
the patient is destroyed by the continuance of a fever with sizy blood, but
without night-sweats, or diarrhoea, as in other unopened abscesses. Whence
copious and repeated venesection is required early in the disease, with
repeated doses of calomel, and cathartics. Warm bath. Towards the end of
the disease small doses of opium before the evening paroxysms, and lastly
the Peruvian bark, and chalybeate wine, at first in small doses, as 20
drops twice a day, and afterwards, if necessary, in larger. See Art. IV. 2.
6.

Mrs. C. a lady in the last month of her pregnancy, was seized with violent
hepatitis, with symptoms both of peripneumony and of pleurisy, for it
seldom happens in violent inflammations, that one viscus alone is affected;
she wanted then about a fortnight of her delivery, and after frequent
venesection, with gentle cathartics, with fomentation or warm bath, she
recovered and was safely delivered, and both herself and child did well.
Rheumatic and eruptive fevers are more liable to induce abortion.

13. _Splenitis._ Inflammation of the spleen commences with tension, heat,
and tumour of the left side, and with pain, which is increased by pressure.
A case is described in Class I. 2. 3. 18. where a tumid spleen, attended
with fever, terminated in schirrus of that viscus.

14. _Nephritis._ Inflammation of the kidney seems to be of two kinds; each
of them attended with different symptoms, and different modes of
termination. One of them I suppose to be an inflammation of the external
membrane of the kidney, arising from general causes of inflammation, and
accompanied with pain in the loins without vomiting; and the other to
consist in an inflammation of the interior parts of the kidney, occasioned
by the stimulus of gravel in the pelvis of it, which is attended with
perpetual vomiting, with pain along the course of the ureter, and
retraction of the testis on that side, or numbness of the thigh.

The former of these kinds of nephritis is distinguished from lumbago by its
situation being more exactly on the region of the kidney, and by its not
being extended beyond that part; after three or four days I believe this
inflammation is liable to change place; and that a herpes or erysipelas,
called zona, or shingles, breaks out about the loins in its stead; at other
times it is cured by a cathartic with calomel, with or without previous
venesection.

The other kind of nephritis, or inflammation of the interior part of the
kidney, generally arises from the pain occasioned by the stimulus of a
stone entering the ureter from the pelvis of the kidney; and, which ceases
when the stone is protruded forwards into the bladder; or when it is
returned into the pelvis of the kidney by the retrograde action of the
ureter. The kidney is nevertheless inflamed more frequently, though in a
less degree, from other causes; especially from the intemperate
ingurgitation of ale, or other fermented or spirituous liquors. This less
degree of inflammation is the cause of gravel, as that before mentioned is
the effect of it. The mucus secreted to lubricate the internal surface of
the uriniferous tubes of the kidney becomes secreted in greater quantity,
when these vessels are inflamed; and, as the correspondent absorbent
vessels act more energetically at the same time, the absorption of its more
fluid parts is more powerfully effected; on both these accounts the mucus
becomes both changed in quality and more indurated. And in this manner
stones are produced on almost every mucous membrane of the body; as in the
lungs, bowels, and even in the pericordium, as some writers have affirmed.
See Class I. 1. 3. 9.

M. M. Venesection. Ten grains of calomel given in small pills, then
infusion of sena with oil. Warm bath. Then opium a grain and half. See
Class I. 1. 3. 9. for a further account of the method of cure.

15. _Cystitis._ Inflammation of the bladder is attended with tumor and pain
of the lower part of the belly; with difficult and painful micturition; and
tenesmus. It generally is produced by the existence of a large stone in the
bladder, when in a great degree; or is produced by common causes, when in a
slighter degree.

The stone in the bladder is generally formed in the kidney, and passing
down the ureter into the bladder becomes there gradually increased in size;
and this most frequently by the apposition of concentric spheres, as may be
seen by sawing some of the harder calculi through the middle, and polishing
one surface. These new concretions superinduced on the nucleus, which
descended from the kidney, as described in Class I. 1. 3. 9. and in the
preceding article of this genus, is not owing to the microcosmic salt,
which is often seen to adhere to the sides of chamber-pots, as this is
soluble in warm water, but to the mucus of the bladder, as it rolls along
the internal surface of it. Now when the bladder is slightly inflamed, this
mucus of its internal surface is secreted in greater quantity, and is more
indurated by the absorption of its more liquid part at the instant of
secretion, as explained in Class I. 1. 3. 9. and II. 1. 2. 14. and thus the
stimulus and pain of a stone in the bladder contributes to its enlargement
by inflaming the interior coat of it.

M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See Class I. 1.
3. 9.

16. _Hysteritis._ Inflammation of the womb is accompanied with heat,
tension, tumor, and pain of the lower belly. The os uteri painful to the
touch. Vomiting. This disease is generally produced by improper management
in the delivery of pregnant women. I knew an unfortunate case, where the
placenta was left till the next day; and then an unskilful accoucheur
introduced his hand, and forcibly tore it away; the consequence was a most
violent inflammatory fever, with hard throbbing pulse, great pain, very
sizy blood, and the death of the patient. Some accoucheurs have had a
practice of introducing their hand into the uterus immediately after the
birth of the child, to take away the placenta; which they said was to save
time. Many women I believe have been victims to this unnatural practice.

Others have received injury, where inflammation has been beginning, by the
universal practice of giving a large dose of opium immediately on delivery,
without any indication of its propriety; which, though a proper and useful
medicine, where the patient is too feeble, when given in a small dose, as
10 drops of tincture of opium, or half a grain of solid opium, must do a
proportionate injury, when it is given improperly; and as delivery is a
natural process, it is certainly more wise to give no medicines, except
there be some morbid symptom, which requires it; and which has only been
introduced into custom by the ill-employed activity of the Priests or
Priestesses of LUCINA; like the concomitant nonsense of cramming rue or
rheubarb into the mouth of the unfortunate young stranger, who is thus soon
made to experience the evils of life. See Class II. 1. 1. 12. and I. 1. 2.
5. Just so some over-wise beldames force young ducks and turkeys, as soon
as they are hatched, to swallow a peppercorn.

M. M. Venesection repeatedly; diluents; fomentation; the patient should be
frequently raised up in bed for a short time, to give opportunity of
discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera.

17. _Lumbago sensitiva._ Sensitive lumbago. When the extensive membranes,
or ligaments, which cover the muscles of the back are torpid, as in the
cold paroxysm of ague, they are attended with pain in consequence of the
inaction of the vessels, which compose them. When this inaction continues
without a consequent renewal or increase of activity, the disease becomes
chronical, and forms the lumbago frigida, or irritativa, described in Class
I. 2. 4. 16. But when this cold fit or torpor of these membranes, or
ligaments or muscles of the back, is succeeded by a hot fit, and consequent
inflammation, a violent inflammatory fever, with great pain, occurs,
preventing the erect posture of the body; and the affected part is liable
to suppurate, in which case a very dangerous ulcer is formed, and a part of
one of the vertebrae is generally found carious, and the patient sinks
after a long time under the hectic fever occasioned by the aerated or
oxygenated matter.

This disease bears no greater analogy to rheumatism than the inflammation
of the pleura, or any other membranous inflammation; and has therefore
unjustly been arranged under that name. It is distinguished from nephritis,
as it is seldom attended with vomiting, I suppose never, except the ureter
happens to be inflamed at the same time.

The pain sometimes extends on the outside of the thigh from the hip to the
ankle, heel, or toes, and is then called sciatica; and has been thought to
consist in an inflammation of the theca, or covering of the sciatic nerve,
as the pain sometimes so exactly attends the principal branches of that
nerve. See Class I. 2. 4. 15. 16.

M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm
bath; poultice on the back, consisting of camomile flowers, turpentine,
soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs
from the torpor of the muscles, which had previously been too much excited,
frequently occurs at the end of this disease; in this case electricity, and
issues on each side of the lumber vertebræ, are recommended. See Class I.
2. 4. 16.

18. _Ischias._ The ischias consists of inflammatory fever, with great pain
about the pelvis, the os coccigis, and the heads of the thigh-bones,
preventing the patient from walking or standing erect, with increase of
pain on going to stool. This malady, as well as the preceding, has been
ascribed to rheumatism; with which it seems to bear no greater analogy,
than the inflammations of any other membranes.

The patients are left feeble, and sometimes lame after this disease; which
is also sometimes accompanied with great flow of urine, owing to the
defective absorption of its aqueous parts; and with consequent thirst
occasioned by the want of so much fluid being returned into the
circulation; a lodgment of fæces in the rectum sometimes occurs after this
complaint from the lessened sensibility of it. See Class I. 2. 4. 15.

M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with
camomile flowers, turpentine, soap, and opium; afterwards the bark. See
Class I. 1. 3. 5.

When this inflammation terminates in suppuration the matter generally can
be felt to fluctuate in the groin, or near the top of the thigh. In this
circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire,
proposes to tap the abscess by means of a trocar, and thus as often as
necessary to discharge the matter without admitting the air. Might a weak
injection of wine and water, as in the hydrocele, be used with great
caution to inflame the walls of the abscess, and cause them to unite? See
Class II. 1. 6. 9.

19. _Paronychia interna._ Inflammation beneath the finger-nail. The pain
occasioned by the inflammatory action and tumor of parts bound down between
the nail on one side and the bone on the other, neither of which will
yield, is said to occasion so much pain as to produce immediate delirium,
and even death, except the parts are divided by a deep incision; which must
pass quite through the periosteum, as the inflammation is said generally to
exist beneath it. This disease is thus resembled by the process of toothing
in young children; where an extraneous body lodged beneath the periosteum
induces pain and fever, and sometimes delirium, and requires to be set at
liberty, by the lancet.

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS III.

_With the Production of new Vessels by external Membranes or Glands with
Fever._

The diseases of this genus are perhaps all productive of contagious matter;
or which becomes so by its exposure to the air, either through the cuticle,
or by immediate contact with it; such are the matters of the small-pox and
measles. The purulent matter formed on parts covered from the air by
thicker membranes or muscles, as in the preceding genus, does not induce
fever, and cannot therefore be called contagious; but it acquires this
property of producing fever in a few hours, after the abscess has been
opened, so as to admit the air to its surface, and may then be said to
consist of contagious miasmata. This kind of contagious matter only induces
fever, but does not produce other matter with properties similar to its
own; and in this respect it differs from the contagious miasmata of
small-pox or measles, but resembles those which have their origin in
crowded jails; for these produce fever only, which frequently destroys the
patient; but do not produce other matters similar to themselves; as appears
from none of those, who died of the jail-fever, caught at the famous black
assizes at Oxford, at the beginning of this century, having infected their
physicians or attendants.

If indeed the matter has continued so long as to become putrid, and thus to
have given out air from a part of it, it acquires the power of producing
fever; in the same manner as if the ulcer had been opened, and exposed to
the common air; instances of which are not unfrequent. And from these
circumstances it seems probable, that the matters secreted by the new
vessels formed in all kinds of phlegmons, or pustles, are not contagious,
till they have acquired something from the atmosphere, or from the gas
produced by putrefaction; which will account for some phenomena in the lues
venerea, cancer, and of other contagious secretions on the skin without
fever, to be mentioned hereafter. See Class II. 1. 4. 14.

The theory of contagion has been perplexed by comparing it with fermenting
liquors; but the contagious material is shewn in Section XXXIII. to be
produced like other secreted matters by certain animal motions of the
terminations of the vessels. Hence a new kind of gland is formed at the
terminations of the vessels in the eruptions of the small-pox; the animal
motions of which produce from the blood variolous matter; as other glands
produce bile or saliva. Now if some of this matter is introduced beneath
the cuticle of a healthy person, or enters the circulation, and excites the
extremities of the blood-vessels into those kinds of diseased motions, by
which it was itself produced, either by irritation or association, these
diseased motions of the extremities of the vessels will produce other
similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion
seems to be propagated two ways; one, by the stimulus of contagious matter
applied to the part, which by an unknown law of nature excites the
stimulated vessels to produce a similar matter; as in venereal ulcers,
which thus continue to spread; or as when variolous matter is inserted
beneath the cuticle; or when it is supposed to be absorbed, and diffused
over the body mixed with the blood, and applied in that manner to the
cutaneous glands. The other way, by which contagion seems to be diffused,
is by some distant parts sympathizing or imitating the motions of the part
first affected; as the stomach and skin in the eruptions of the inoculated
small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3.

In some of the diseases of this genus the pulse is strong, full, and hard,
constituting the sensitive irritated fever, as described in the preceding
genus; as in one kind of erysipelas, which requires repeated venesection.
In others the arterial action is sometimes moderate, so as to constitute
the sensitive fever, as in the inoculated small-pox; where the action of
the arteries is neither increased by the sensorial power of irritation, as
in the sensitive irritated fever; nor decreased by the defect of that
power, as in the sensitive inirritated fever. But in the greatest number of
the diseases of this genus the arterial action is greatly diminished in
respect to strength, and consequently the frequency of pulsation is
proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing
to the deficiency of the sensorial power of irritation joined with the
increase of that of sensation, and thus constitutes the sensitive
inirritated fever; as in Scarlatina with gangrenous tonsils.

From this great debility of the action of the arteries, there appears to be
less of the coagulable lymph or mucus secreted on their internal surfaces;
whence there is not only a defect of that buff or size upon the blood,
which is seen on the surface of that, which is drawn in the sensitive
irritated fever; but the blood, as it cools, when it has been drawn into a
bason, scarcely coagulates; and is said to be dissolved, and is by some
supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3.
where the truth of this idea is controverted. But in the fevers of both
this genus and the preceding one great heat is produced from the chemical
combinations in the secretions of new vessels and fluids, and pain or
uneasiness from the distention of the old ones; till towards the
termination of the disease sensation ceases, as well as irritation, with
the mortification of the affected parts, and the death of the patient.

Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the
diseases of external membranes, because they are exposed either to the
atmospheric air, which is breathed, and swallowed with our food and saliva;
or they are exposed to the inflammable air; or hydrogen, which is generated
in the intestines; both which contribute to produce or promote the
contagious quality of these fluids; as mentioned in Class II. 1. 5.

It is not speaking accurate language, if we say, that in the diseases of
this genus the fever is contagious; since it is the material produced by
the external membranes, which is contagious, after it has been exposed to
air; while the fever is the consequence of this contagious matter, and not
the cause of it. As appears from the inoculated small-pox, in which the
fever does not commence, till after suppuration has taken place in the
inoculated arm, and from the diseases of the fifth genus of this order,
where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18.

SPECIES.

1. _Febris sensitiva inirritata._ Sensitive inirritated fever. Typhus
gravior. Putrid malignant fever. Jail fever. The immediate cause of this
disease is the increase of the sensorial power of sensation, joined with
the decrease of the sensorial power of irritation; that is, it consists in
the febris sensitiva joined with the febris inirritativa of Class I. 2. 1.
1. as the febris sensitiva irritata of the preceding genus consists of the
febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In
both which the word irritata, and inirritata, are designed to express more
or less irritation than the natural quantity; and the same when applied to
some of the diseases of this genus.

This fever is frequently accompanied with topical inflammation, which is
liable, if the arterial strength is not supported, to end in sphacelus; and
as mortified parts, such as sloughs of the throat, if they adhere to living
parts, soon become putrid from the warmth and moisture of their situation;
these fevers have been termed putrid, and have been thought to owe their
cause to what is only their consequence. In hot climates this fever is
frequently induced by the exhalations of stagnating lakes or marshes, which
abound with animal substances; but which in colder countries produce fevers
with debility only, as the quartan ague, without inflammation.

The sensitive inirritated, or malignant, fever is also frequently produced
by the putrid exhalations and stagnant air in prisons; but perhaps most
frequently by contact or near approach of the persons, who have resided in
them. These causes of malignant fevers contributed to produce, and to
support for a while, the septic and antiseptic theory of them; see Sect.
XXXIII. 1. 3. The vibices or bruises, and petechiæ or purples, were
believed to be owing to the dissolved state of the blood by its incipient
putrefaction; but hydrostatical experiments have been made, which shew the
sizy blood of the patient in sensitive irritated or inflammatory fever,
with strong pulse, is more fluid, while it is warm, than this uncoagulable
blood taken in this sensitive inirritated, or malignant fever; from whence
it is inferred, that these petechiæ, and vibices, are owing to the
deficient power of absorption in the terminations of the veins, See Class
I. 2. 1. 5.

This sensitive inirritated fever, or typhus gravior, is distinguished from
the inirritative fever, or typhus mitior, in the early stages of it, by the
colour of the skin; which in the latter is paler, with less heat, owing to
the less violent action of the capillaries; in this it is higher coloured,
and hotter, from the greater energy of the capillary action in the
production of new vessels. In the more advanced state petechiæ, and the
production of contagious matter from inflamed membranes, as the aphthæ of
the mouth, or ulcers of the throat, distinguishes this fever from the
former. Delirium, and dilated pupils of the eyes, are more frequent in
nervous fevers; and stupor with deafness more frequent attendants on
malignant fevers. See Class I. 2. 5. 6.

There is another criterion discernible by the touch of an experienced
finger; and that is, the coat of the artery in inflammatory fevers, both
those attended with strength of pulsation, and these with weak pulsation,
feels harder, or more like a cord; for the coats of the arteries in these
fevers are themselves inflamed, and are consequently turgid with blood, and
thence are less easily compressed, though their pulsations are nevertheless
weak: when the artery is large or full with an inflamed coat, it is called
hard; and when small or empty with an inflamed coat, it is called sharp, by
many writers.

M. M. The indications of cure consist, 1. In procuring a regurgitation of
any offensive material, which may be lodged in the long mouths of the
lacteals or lymphatics, or in their tumid glands. 2. To excite the system
into necessary action by the repeated exhibition of nutrientia, sorbentia,
and incitantia; and to preserve the due evacuation of the bowels. 3. To
prevent any unnecessary expenditure of sensorial power. 4. To prevent the
formation of ulcers, or to promote the absorption in them, for the purpose
of healing them.

1. One ounce of wine of ipecacuanha, or about ten grains of the powder,
should be given as an emetic. After a few hours three or four grains of
calomel should be given in a little mucilage, or conserve. Where something
swallowed into the stomach is the cause of the fever, it is liable to be
arrested by the lymphatic glands, as the matter of the small-pox inoculated
in the arm is liable to be stopped by the axillary lymphatic gland; in this
situation it may continue a day or two, or longer, and may be regurgitated
during the operation of an emetic or cathartic into the stomach or bowel,
as evidently happens on the exhibition of calomel, as explained in Sect.
XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if
indicated by the hardness and fulness of the pulse, will very frequently
remove fevers, if exhibited on the first, second, or even third day.

2. Wine and opium, in small doses repeated frequently, but so that not the
least degree of intoxication follows, for in that case a greater degree of
debility is produced from the expenditure of sensorial power in unnecessary
motions. Many weak patients have been thus stimulated to death. See Sect.
XII. 7. 8. The Peruvian bark should be given also in repeated doses in such
quantity only as may strengthen digestion, not impede it. For these
purposes two ounces of wine, or of ale, or cyder, should be given every six
hours; and two ounces of decoction of bark, with two drachms of the
tincture of bark, and six drops of tincture of opium, should be given also
every six hours alternately; that is, each of them four times in
twenty-four hours. As much rhubarb as may induce a daily evacuation, should
be given to remove the colluvies of indigested materials from the bowels;
which might otherwise increase the distress of the patient by the air it
gives out in putrefaction, or by producing a diarrhoea by its acrimony; the
putridity of the evacuations are in consequence of the total inability of
the digestive powers; and their delay in the intestines, to the inactivity
of that canal in respect to its peristaltic motions.

The quantities of wine or beer and opium, and bark, above mentioned, may be
increased by degrees, if the patient seems refreshed by them; and if the
pulse becomes slower on their exhibition; but this with caution, as I have
seen irrecoverable mischief done by greater quantities both of opium, wine,
and bark, in this kind of fever; in which their use is to strengthen the
digestion of the weak patient, rather than to stop the paroxysms of fever;
but when they are administered in intermittents, much larger quantities are
necessary.

The stimulus of small blisters applied in succession, one every three or
four days, when the patient becomes weak, is of great service by
strengthening digestion, and by preventing the coldness of the extremities,
owing to the sympathy of the skin with the stomach, and of one part of the
skin with another.

In respect to nutriment, the patient should be supplied with wine and
water, with toasted bread, and sugar or spice in it; or with sago with
wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with
cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish,
or whatever is grateful to the palate of the sick person, in small quantity
repeated frequently; with small beer, cyder and water, or wine and water,
for drink, which may be acidulated with acid of vitriol in small
quantities.

3. All unnecessary motions are to be checked, or prevented. Hence
horizontal posture, obscure room, silence, cool air. All the parts of the
skin, which feel too hot to the hand, should be exposed to a current of
cool air, or bathed with cold water, whether there are eruptions on it or
not. Wash the patient twice a day with cold vinegar and water, or cold salt
and water, or cold water alone, by means of a sponge. If some parts are too
cold, as the extremities, while other parts are too hot, as the face or
breast, cover the cold parts with flannel, and cool the hot parts by a
current of cool air, or bathing them as above.

4. For the healing of ulcers, if in the mouth, solution of alum in water
about 40 grains to an ounce, or of blue vitriol in water, one grain or two
to an ounce may be used to touch them with three or four times a day. Of
these perhaps a solution of alum is to be preferred, as it instantly takes
away the stench from ulcers I suppose by combining with the volatile alcali
which attends it. For this purpose a solution of alum of an ounce to a pint
of water should be frequently injected by means of a syringe into the
mouth. If there are ulcers on the external skin, fine powder of bark seven
parts, and cerusia in fine powder one part, should be mixed, and applied
dry on the sore, and kept on by lint, and a bandage.

As sloughs in the mouth are frequently produced by the previous dryness of
the membranes, which line it, this dryness should be prevented by
frequently moistening them, which may be effected by injection with a
syringe, or by a moist sponge, or lastly in the following manner. Place a
glass of wine and water, or of milk and sugar, on a table by the bedside, a
little above the level of the mouth of the patient; then, having previously
moistened a long piece of narrow listing, or cloth, or flannel, with the
same liquor, leave one end of it in the glass, and introduce the other into
the mouth of the patient; which will thus be supplied with a constant
oozing of the fluid through the cloth, which acts as a capillary syphon.

The viscid phlegm, which adheres to the tongue, should be coagulated by
some austere acid, as by lemon-juice evaporated to half its quantity, or by
crab-juice; and then it may be scraped off by a knife, or rubbed off by
flannel, or a sage leaf dipped in vinegar, or in salt and water.

2. _Erysipelas_, St. Anthony's fire, may be divided into three kinds, which
differ in their method of cure, the irritated, the inirritated, and the
sensitive erysipelas.

_Erysipelas irritatum_ is attended with increase of irritation besides
increase of sensation; that is, with strong, hard, and full pulse, which
requires frequent venesection, like other inflammations with arterial
strength. It is distinguished from the phlegmonic inflammations of the last
genus by its situation on the external habit, and by the redness, heat, and
tumour not being distinctly circumscribed; so that the eye or finger cannot
exactly trace the extent of them.

When the external skin is the seat of inflammation, and produces sensitive
irritated fever, no collection of matter is formed, as when a phlegmon is
situated in the cellular membrane beneath the skin; but the cuticle rises
as beneath a blister-plaster, and becomes ruptured; and a yellow material
oozes out, and becomes inspissated, and lies upon its surface; as is seen
in this kind of erysipelas, and in the confluent small-pox; or if the new
vessels are reabsorbed the cuticle peels off in scales. This difference of
the termination of erysipelatous and phlegmonic inflammation seems to be
owing in part to the less distensibility of the cuticle than of the
cellular membrane, and in part to the ready exhalation of the thinner parts
of the secreted fluids through its pores.

This erysipelas is generally preceded by a fever for two or three days
before the eruption, which is liable to appear in some places, as it
declines in others; and seems frequently to arise from a previous scratch
or injury of the skin; and is attended sometimes with inflammation of the
cellular membrane beneath the skin; whence a real phlegmon and collection
of matter becomes joined to the erysipelas, and either occasions or
increases the irritated fever, which attends it.

There is a greater sympathy between the external skin and the meninges of
the brain, than between the cellular membrane and those meninges; whence
erysipelas is more liable to be preceded or attended, or succeeded, by
delirium than internal phlegmons. I except the mumps, or parotitis,
described below; which is properly an external gland, as its excretory duct
opens into the air. When pain of the head or delirium precedes the
cutaneous eruption of the face, there is some reason to believe, that the
primary disease is a torpor of the meninges of the brain; and that the
succeeding violent action is transferred to the skin of the face by
sensitive association; and that a similar sympathy occurs between some
internal membranes and the skin over them, when erysipelas appears on other
parts of the body. If this circumstance should be supported by further
evidence, this disease should be removed into Class IV. along with the
rheumatism and gout. See Class IV. 1. 2. 17.

This supposed retropulsion of erysipelas on the brain from the frequent
appearance of delirium, has prevented the free use of the lancet early in
this disease to the destruction of many; as it has prevented the subduing
of the general inflammation, and thus has in the end produced the
particular one on the brain. Mr. B----, a delicate gentleman about sixty,
had an erysipelas beginning near one ear, and extending by degrees over the
whole head, with hard, full, and strong pulse; blood was taken from him
four or five times in considerable quantity, with gentle cathartics, with
calomel, diluents, and cool air, and he recovered without any signs of
delirium, or inflammation of the meninges of the brain. Mr. W----, a strong
corpulent man of inferior life, had erysipelas over his whole head, with
strong hard pulse: he was not evacuated early in the disease through the
timidity of his apothecary, and died delirious. Mrs. F---- had erysipelas
on the face, without either strong or weak pulse; that is, with sensitive
fever alone, without superabundance or deficiency of irritation; and
recovered without any but natural evacuations. From these three cases of
erysipelas on the head it appears, that the evacuations by the lancet must
be used with courage, where the degree of inflammation requires it; but not
where this degree of inflammation is small, nor in the erysipelas attended
with inirritation, as described below.

M. M. Venesection repeated according to the degree of inflammation. An
emetic. Calomel three grains every other night. Cool air. Diluents, emetic
tartar in small doses, as a quarter of a grain every six hours. Tea, weak
broth, gruel, lemonade, neutral salts. See Sect. XII. 6.

Such external applications as carry away the heat of the skin may be of
service, as cold water, cold flour, snow, ether. Because these applications
impede the exertions of the secerning vessels, which are now in too great
action; but any applications of the stimulant kind, as solutions of lead,
iron, copper, or of alum, used early in the disease, must be injurious; as
they stimulate the secerning vessels, as well as the absorbent vessels,
into greater action; exactly as occurs when stimulant eye-waters are used
too soon in ophthalmy. See Class II. 1. 2. 2. But as the cuticle peels off
in this case after the inflammation ceases, it differs from ophthalmy; and
stimulant applications are not indicated at all, except where symptoms of
gangrene appear. For as a new cuticle is formed under the old one, as under
a blister, the serous fluid between them is a defence to the new cuticle,
and should dry into a scab by exhalation rather than be reabsorbed. Hence
we see how greasy or oily applications, and even how moist ones, are
injurious in erysipelas; because they prevent the exhalation of the serous
effusion between the old and new cuticle, and thus retard the formation of
the latter.

_Erysipelas inirritatum_ differs from the former in its being attended with
weak pulse, and other symptoms of sensitive inirritated fever. The feet and
legs are particularly liable to this erysipelas, which precedes or attends
the sphacelus or mortification of those parts. A great and long coldness
first affects the limb, and the erysipelas on the skin seems to occur in
consequence of the previous torpor of the interior membranes. As this
generally attends old age, it becomes more dangerous in proportion to the
age, and also to the habitual intemperance of the patient in respect to the
use of fermented or spirituous liquor.

When the former kind, or irritated erysipelas, continues long, the patient
becomes so weakened as to be liable to all the symptoms of this inirritated
erysipelas; especially where the meninges of the brain are primarily
affected. As in that case, after two or three efforts have been made to
remove the returning periods of torpor of the meninges to the external
skin, those meninges become inflamed themselves, and the patient sinks
under the disease; in a manner similar to that in old gouty patients, where
the torpor of the liver or stomach is relieved by association of the
inflammation of the membranes of the feet, and then of other joints, and
lastly the power of association ceasing to act, but the excess of sensation
continuing, the liver or stomach remains torpid, or become themselves
inflamed, and the patient is destroyed.

M. M. Where there exists a beginning gangrene of the extremities, the
Peruvian bark, and wine, and opium, are to be given in large quantities; so
as to strengthen the patient, but not to intoxicate, or to impede his
digestion of aliment, as mentioned in the first species of this genus.
Class II. 1. 2. 1. But where the brain is inflamed or oppressed, which is
known either by delirium, with quick pulse; or by stupor, and slow
respiration with slow pulse; other means must be applied. Such as, first, a
fomentation on the head with warm water, with or without aromatic herbs, or
salt in it, should be continued for an hour or two at a time, and
frequently repeated. A blister may also be applied on the head, and the
fomentation nevertheless occasionally repeated. Internally very gentle
stimulants, as camphor one grain or two in infusion of valerian. Wine and
water or small beer, weak broth. An enema. Six grains of rhubarb and one of
calomel. Afterwards five drops of tincture of opium, which may be repeated
every six hours, if it seems of service. Might the head be bathed for a
minute with cold water? or with ether? or vinegar?

_Erysipelas sensitivum_ is a third species, differing only in the kind of
fever which attends it, which is simply inflammatory, or sensitive, without
either excess of irritation, as in the first variety; or the defect of
irritation, as in the second variety: all these kinds of erysipelas are
liable to return by periods in some people, who have passed the middle of
life, as at periods of a lunation, or two lunations, or at the equinoxes.
When these periods of erysipelas happen to women, they seem to supply the
place of the receding catamenia; when to men, I have sometimes believed
them to be associated with a torpor of the liver; as they generally occur
in those who have drank vinous spirit excessively, though not
approbriously; and that hence they supply the place of periodical piles, or
gout, or gutta rosea.

M. M. As the fever requires no management, the disease takes its progress
safely, like a moderate paroxysm of the gout; but in this case, as in some
of the former, the erysipelas does not appear to be a primary disease, and
should perhaps be removed to the Class of Association.

3. _Tonsillitis._ Inflammation of the tonsils. The uncouth term Cynanche
has been used for diseases so dissimilar, that I have divided them into
Tonsillitis and Parotitis; and hope to be excused for adding a Greek
termination to a Latin word, as one of those languages may justly be
considered as a dialect of the other. By tonsillitis the inflammation of
the tonsils is principally to be understood; but as all inflammations
generally spread further than the part first affected; so, when the summit
of the windpipe is also much inflamed, it may be termed tonsillitis
trachealis, or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and when the
summit of the gullet is much inflamed along with the tonsil, it may be
called tonsillitis pharyngea, as described in Dr. Cullen's Nosologia, Genus
X. p. 92. The inflammation of the tonsils may be divided into three kinds,
which require different methods of cure.

_Tonsillitis interna._ Inflammation of the internal tonsil. When the
swelling is so considerable as to produce difficulty of breathing, the size
of the tonsil should be diminished by cutting it with a proper lancet,
which may either give exit to the matter it contains, or may make it less
by discharging a part of the blood. This kind of angina is frequently
attended with irritated fever besides the sensitive one, which accompanies
all inflammation, and sometimes requires venesection. An emetic should be
given early in the disease, as by its inducing the retrograde action of the
vessels about the fauces during the nausea it occasions, it may eliminate
the very cause of the inflammation; which may have been taken up by the
absorbents, and still continue in the mouths of the lymphatics or their
glands. The patient should then be induced to swallow some aperient liquid,
an infusion of senna, so as to induce three or four evacuations. Gargles of
all kinds are rather hurtful, as the action of using them is liable to give
pain to the inflamed parts; but the patients find great relief from
frequently holding warm water in their mouths, and putting it out again, or
by syringing warm water into the mouth, as this acts like a warm bath or
fomentation to the inflamed part. Lastly, some mild stimulant, as a weak
solution of salt and water, or of white vitriol and water, may be used to
wash the fauces with in the decline of the disease, to expedite the
absorption of the new vessels, if necessary, as recommended in ophthalmy.

_Tonsillitis superficialis._ Inflammation of the surface of the tonsils. As
the tonsils and parts in their vicinity are covered with a membrane, which,
though exposed to currents of air, is nevertheless constantly kept moist by
mucus and saliva, and is liable to diseases of its surface like other
mucous membranes, as well as to suppuration of the internal substance of
the gland; the inflammation of its surface is succeeded by small elevated
pustules with matter in them, which soon disappears, and the parts either
readily heal, or ulcers covered with sloughs are left on the surface.

This disease is generally attended with only sensitive fever, and therefore
is of no danger, and may be distinguished with great certainty from the
dangerous inflammation or gangrene of the tonsils at the height of the
small-pox, or scarlet fever, by its not being attended with other symptoms
of those diseases. One emetic and a gentle cathartic is generally
sufficient; and the frequent swallowing of weak broth, or gruel, both
without salt in them, relieves the patient, and absolves the cure. When
these tumours of the tonsils frequently return I have sometimes suspected
them to originate from the absorption of putrid matter from decaying teeth.
See Class I. 2. 3. 21. and II. 2. 2. 1.

_Tonsillitis inirritata._ Inflammation of the tonsils with sensitive
inirritated fever is a symptom only of contagious fever, whether attended
with scarlet eruption, or with confluent small-pox, or otherwise. The
matter of contagion is generally diffused, not dissolved in the air; and as
this is breathed over the mucaginous surface of the tonsils, the contagious
atoms are liable to be arrested by the tonsil; which therefore becomes the
nest of the future disease, like the inflamed circle round the inoculated
puncture of the arm in supposititious small-pox. This swelling is liable to
suffocate the patient in small-pox, and to become gangrenous in scarlet
fever, and some other contagious fevers, which have been received in this
manner. The existence of inflammation of the tonsil previous to the scarlet
eruption, as the arm inflames in the inoculated small-pox, and suppurates
before the variolous eruption, should be a criterion of the scarlet fever
being taken in this manner.

M. M. All the means which strengthen the patient, as in the sensitive
inirritated fever, Class II. 1. 2. 1. As it is liable to continue a whole
lunation or more, great attention should be used to nourish the patient
with acidulous and vinous panada, broth with vegetables boiled in it,
sugar, cream, beer; all which given frequently will contribute much to
moisten, clean, and heal the ulcuscles, or sloughs, of the throat; warm
water and wine, or acid of lemon, should be frequently applied to the
tonsils by means of a syringe, or by means of a capillary syphon, as
described in Class II. 1. 3. 1. A slight solution of blue vitriol, as two
grains to an ounce, or a solution of sugar of lead of about six grains to
an ounce, may be of service; especially the latter, applied to the edges of
the sloughs, drop by drop by means of a small glass tube, or small
crow-quill with the end cut off, or by a camel's-hair pencil or sponge; to
the end of either of which a drop will conveniently hang by capillary
attraction; as solutions of lead evidently impede the progress of
erysipelas on the exterior skin, when it is attended with feeble pulse. Yet
a solution of alum injected frequently by a syringe is perhaps to be
preferred, as it immediately removes the fetor of the breath, which must
much injure the patient by its being perpetually received into the lungs by
respiration.

4. _Parotitis._ Mumps, or branks, is a contagious inflammation of the
parotis and maxillary glands, and has generally been classed under the word
Cynanche or Angina, to which it bears no analogy. It divides itself into
two kinds, which differ in the degree of fever which attends them, and in
the method of cure.

_Parotitis suppurans._ The suppurating mumps is to be distinguished by the
acuteness of the pain, and the sensitive, irritated, or inflammatory fever,
which attends it.

M. M. Venesection. Cathartic with calomel three or four grains repeatedly.
Cool air, diluents. This antiphlogistic treatment is to be continued no
longer than is necessary to relieve the violence of the pain, as the
disease is attended with contagion, and must run through a certain time,
like other fevers with contagion.

_Parotitis mutabilis._ Mutable parotitis. A sensitive fever only, or a
sensitive irritated fever, generally attends this kind. And when the tumor
of the parotis and maxillary glands subsides, a new swelling occurs in some
distant part of the system; as happens to the hands and feet, at the
commencement of the secondary fever of the small-pox, when the tumor of the
face subsides. This new swelling in the parotitis mutabilis is liable to
affect the testes in men, and form a painful tumor, which should be
prevented from suppuration by very cautious means, if the violence of the
pain threaten such a termination; as by bathing the part with coldish water
for a time, venesection, a cathartic; or by a blister on the perinæum, or
scrotum, or a poultice.

When women are affected with this complaint, after the swelling of the
parotis and maxillary glands subsides, a tumor with pain is liable to
affect their breasts; which, however, I have never seen terminate in
suppuration.

On the retrocession of the tumor of the testes above described, and I
suppose of that of the breasts in women, a delirium of the calm kind is
very liable to occur; which in some cases has been the first symptom which
has alarmed the friends of the patient; and it has thence been difficult to
discover the cause of it without much inquiry; the previous symptoms having
been so slight as not to have occasioned any complaints. In this delirium,
if the pulse will bear it, venesection should be used, and three or four
grains of calomel, with fomentation of the head with warm water for an hour
together every three or four hours.

Though this disease generally terminates favourably, considering the
numbers attacked by it, when it is epidemic, yet it is dangerous at other
times in every part of its progress. Sometimes the parotis or maxillary
glands suppurate, producing ulcers which are difficult to cure, and
frequently destroy the patient, where there was a previous scrophulous
tendency. The testis in men is also liable to suppurate with great pain,
long confinement, and much danger; and lastly the affection of the brain is
fatal to many.

Mr. W. W. had a swelled throat, which after a few days subsided. He became
delirious or stupid, in which state he was dying when I saw him; and his
friends ascribed his death to a coup de soleil, which he was said to have
received some months before, when he was abroad.

Mr. A. B. had a swelling of the throat, which after a few days subsided.
When I saw him he had great stupor, with slow breathing, and partial
delirium. On fomenting his head with warm water for an hour these symptoms
of stupor were greatly lessened, and his oppressed breathing gradually
ceased, and he recovered in one day.

Mr. C. D. I found walking about the house in a calm delirium without
stupor; and not without much inquiry of his friends could get the previous
history of the disease; which had been attended with parotitis, and swelled
testis, previous to the delirium. A few ounces of blood were taken away, a
gentle cathartic was directed, and his head fomented with warm water for an
hour, with a small blister on the back, and he recovered in two or three
days.

Mr. D. D. came down from London in the coach alone, so that no previous
history could be obtained. He was walking about the house in a calm
delirium, but could give no sensible answers to any thing which was
proposed to him. His pulse was weak and quick. Cordials, a blister, the
bark, were in vain exhibited, and he died in two or three days.

Mr. F. F. came from London in the same manner in the coach. He was mildly
delirious with considerable stupor, and moderate pulse, and could give no
account of himself. He continued in a kind of cataleptic stupor, so that he
would remain for hours in any posture he was placed, either in his chair,
or in bed; and did not attempt to speak for about a fortnight; and then
gradually recovered. These two last cases are not related as being
certainly owing to parotitis, but as they might probably have that origin.

The parotitis suppurans, or mumps with irritated fever, is at times
epidemic among cats, and may be called _parotitis felina_; as I have reason
to believe from the swellings under the jaws, which frequently suppurate,
and are very fatal to those animals. In the village of Haywood, in
Staffordshire, I remember a whole breed of Persian cats, with long white
hair, was destroyed by this malady, along with almost all the common cats
of the neighbourhood; and as the parotitis or mumps had not long before
prevailed amongst human beings in that part of the country, I recollect
being inclined to believe, that the cats received the infection from
mankind; though in all other contagious diseases, except the rabies canina
can be so called, no different genera of animals naturally communicate
infection to each other; and I am informed, that vain efforts have been
made to communicate the small-pox and measles to some quadrupeds by
inoculation. A disease of the head and neck destroyed almost all the cats
in Westphalia. Savage, Nosol. Class X. Art. 30. 8.

5. _Catarrhus sensitivus_ consists of an inflammation of the membrane,
which lines the nostrils and fauces. It is attended with sensitive fever
alone, and is cured by the steam of warm water externally, and by diluents
internally, with moderate venesection and gentle cathartics. This may be
termed catarrhus sensitivus, to distinguish it from the catarrhus
contagiosus, and is in common language called a violent cold in the head;
it differs from the catarrhus calidus, or warm catarrh, of Class I. 1. 2.
7. in the production of new vessels, or inflammation of the membrane, and
the consequent more purulent appearance of the discharge.

Raucedo catarrhalis, or catarrhal hoarseness, is a frequent symptom of this
disease, and is occasioned by the pain or soreness which attends the
thickened and inflamed membranes of the larynx; which prevents the muscles
of vocallity from sufficiently contracting the aperture of it. It ceases
with the inflammation, or may be relieved by the steam of warm water alone,
or of water and vinegar, or of water and ether. See Paralytic Hoarseness,
Class III. 2. 1. 4.

6. _Catarrhus contagiosus._ This malady attacks so many at the same time,
and spreads gradually over so great an extent of country, that there can be
no doubt but that it is disseminated by the atmosphere. In the year 1782
the sun was for many weeks obscured by a dry fog, and appeared red as
through a common mist. The material, which thus rendered the air muddy,
probably caused the epidemic catarrh, which prevailed in that year, and
which began far in the north, and extended itself over all Europe. See
Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV, line 294,
note; and was supposed to have been thrown out of a volcano, which much
displaced the country of Iceland.

In many instances there was reason to believe, that this disease became
contagious, as well as epidemic; that is, that one person might receive it
from another, as well as by the general unsalutary influence of the
atmosphere. This is difficult to comprehend, but may be conceived by
considering the increase of contagious matter in the small-pox. In that
disease one particle of contagious matter stimulates the skin of the arm in
inoculation into morbid action so as to produce a thousand particles
similar to itself; the same thing occurs in catarrh, a few deleterious
atoms stimulate the mucous membrane of the nostrils into morbid actions,
which produce a thousand other particles similar to themselves. These
contagious particles diffused in the air must have consisted of animal
matter, otherwise how could an animal body by being stimulated by them
produce similar particles? Could they then have had a volcanic origin, or
must they not rather have been blown from putrid marshes full of animal
matter? But the greatest part of the solid earth has been made from animal
and vegetable recrements, which may be dispersed by volcanos.--Future
discoveries must answer these questions.

As the sensitive fever attending these epidemic catarrhs is seldom either
much irritated or inirritated, venesection is not always either clearly
indicated or forbid; but as those who have died of these catarrhs have
generally had inflamed livers, with consequent suppuration in them,
venesection is adviseable, wherever the cough and fever are greater than
common, so as to render the use of the lancet in the least dubious. And in
some cases a second bleeding was necessary, and a mild cathartic or two
with four grains of calomel; with mucilaginous subacid diluents; and warm
steam occasionally to alleviate the cough, finished the cure.

The catarrhus contagiosus is a frequent disease amongst horses and dogs; it
seems first to be disseminated amongst these animals by miasmata diffused
in the atmosphere, because so many of them receive it at the same time; and
afterwards to be communicable from one horse or dog to another by
contagion, as above described. These epidemic or contagious catarrhs more
frequently occur amongst dogs and horses than amongst men; which is
probably owing to the greater extension and sensibility of the mucous
membrane, which covers the organ of smell, and is diffused over their wide
nostrils, and their large maxillary and frontal cavities. And to this
circumstance may be ascribed the greater fatality of it to these animals.

In respect to horses, I suspect the fever at the beginning to be of the
sensitive, irritated, or inflammatory kind, because there is so great a
discharge of purulent mucus; and that therefore they will bear once
bleeding early in the disease; and also one mild purgative, consisting of
about half an ounce of aloe, and as much white hard soap, mixed together.
They should be turned out to grass both day and night for the benefit of
pure air, unless the weather be too cold (and in that case they should be
kept in an open airy stable, without being tied), that they may hang down
their heads to facilitate the discharge of the mucus from their nostrils.
Grass should be offered them, or other fresh vegetables, as carrots and
potatoes, with mashes of malt, or of oats, and with plenty of fresh warm or
cold water frequently in a day. When symptoms of debility appear, which may
be known by the coldness of the ears or other extremities, or when sloughs
can be seen on the membrane which lines the nostrils, a drink consisting of
a pint of ale with half an ounce of tincture of opium in it, given every
six hours, is likely to be of great utility.

In dogs I believe the catarrh is generally joined with symptoms of debility
early in the disease. These animals should be permitted to go about in the
open air, and should have constant access to fresh water. The use of being
as much as may be in the air is evident, because all the air which they
breathe passes twice over the putrid sloughs of the mortified parts of the
membrane which lines the nostrils, and the maxillary and frontal cavities;
that is, both during inspiration and expiration; and must therefore be
loaded with contagious particles. Fresh new milk, and fresh broth, should
be given them very frequently, and they should be suffered to go amongst
the grass, which they sometimes eat for the purpose of an emetic; and if
possible should have access to a running stream of water. As the contagious
mucus of the nostrils, both of these animals and of horses, generally drops
into the water they attempt to drink. Bits of raw flesh, if the dog will
eat them, are preferred to cooked meat; and from five to ten drops of
tincture of opium may be given with advantage, when symptoms of debility
are evident, according to the size of the dog, every six hours. If sloughs
can be seen in the nostrils, they should be moistened twice a day, both in
horses and dogs, with a solution of sugar of lead, or of alum, by means of
a sponge fixed on a bit of whale bone, or by a syringe. The lotion may be
made by dissolving half an ounce of sugar of lead in a pint of water.

Ancient philosophers seem to have believed, that the contagious miasmata in
their warm climates affected horses and dogs previous to mankind. If those
contagious particles were supposed to be diffused amongst the heavy
inflammable air, or carbonated hydrogen, of putrid marshes, as these
animals hold their heads down lower to the ground, they may be supposed to
have received them sooner than men. And though men and quadrupeds might
receive a disease from the same source of marsh-putrefaction, they might
not afterwards be able to infect each other, though they might infect other
animals of the same genus; as the new contagious matter generated in their
own bodies might not be precisely similar to that received; as happened in
the jail-fever at Oxford, where those who took the contagion and died, did
not infect others.

  On mules and dogs the infection first began,
  And, last, the vengeful arrows fix'd on man.
                          POPE'S Homer's Iliad, I.

7. _Peripneumonia superficialis._ The superficial or spurious peripneumony
consists in an inflammation of the membrane, which lines the bronchia, and
bears the same analogy to the true peripneumony, as the inflammations of
other membranes do to that of the parenchyma, or substantial parts of the
viscus, which they surround. It affects elderly people, and frequently
occasions their death; and exists at the end of the true peripneumony, or
along with it; when the lancet has not been used sufficiently to cure by
reabsorbing the inflamed parts, or what is termed by resolution.

M. M. Diluents, mucilage, antimonials, warmish air constantly changed,
venesection once, perhaps twice, if the pulse will bear it. Oily volatile
draughts. Balsams? Neutral salts increase the tendency to cough. Blisters
in succession about the chest. Warm bath. Mild purgatives. Very weak
chicken broth without salt in it. Boiled onions. One grain of calomel every
night for a week. From five drops to ten of tincture of opium at six every
night, when the patient becomes weak. Digitalis? See Class II. 1. 6. 7.

8. _Pertussis._ Tussis convulsiva. Chin-cough resembles peripneumonia
superficialis in its consisting in an inflammation of the membrane which
lines the air-vessels of the lungs; but differs in the circumstance of its
being contagious; and is on that account of very long duration; as the
whole of the lungs are probably not infected at the same time, but the
contagious inflammation continues gradually to creep on the membrane. It
may in this respect be compared to the ulcers in the pulmonary consumption;
but it differs in this, that in chin-cough some branches of the bronchia
heal, as others become inflamed.

This complaint is not usually classed amongst febrile disorders, but a
sensitive fever may generally be perceived to attend it during some part of
the day, especially in weak patients. And a peripneumony very frequently
supervenes, and destroys great numbers of children, except the lancet or
four or six leeches be immediately and repeatedly used. When the child has
permanent difficulty of breathing, which continues between the coughing
fits: unless blood be taken from it, it dies in two, three, or four days of
the inflammation of the lungs. During this permanent difficulty of
breathing the hooping-cough abates, or quite ceases, and returns again
after once or twice bleeding; which is then a good symptom, as the child
now possessing the power to cough shews the difficulty of breathing to be
abated. I dwell longer upon this, because many lose their lives from the
difficulty there is in bleeding young children; where the apothecary is old
or clumsy, or is not furnished with a very sharp and fine-pointed lancet.
In this distressing situation the application of four leeches to one of the
child's legs, the wounds made by which should continue to bleed an hour or
two, is a succedaneum; and saves the patient, if repeated once or twice
according to the difficulty of the respiration.

The chin-cough seems to resemble the gonorrhoea venerea in several
circumstances. They are both received by infection, are both diseases of
the mucous membrane, are both generally cured in four or six weeks without
medicine. If ulcers in the cellular membrane under the mucous membrane
occur, they are of a phagedenic kind, and destroy the patient in both
diseases, if no medicine be administered.

Hence the cure should be similar in both these diseases; first general
evacuations and diluents, then, after a week or two, I have believed the
following pills of great advantage. The dose for a child of about three
years old was one sixth part of a grain of calomel, one sixth part of a
grain of opium, and two grains of rhubarb, to be taken twice a day.

The opium promotes absorption from the mucous membrane, and hence
contributes to heal it. The mercury prevents ulcers from being formed under
the mucous membrane, or cures them, as in the lues venerea; and the rhubarb
is necessary to keep the bowels open.

M. M. Antimonial vomits frequently repeated. Mild cathartics. Cool air.
Tincture of cantharides, or repeated blisters; afterwards opiates in small
doses, and the bark. Warm bath frequently used. The steam of warm water
with a little vinegar in it may be inhaled twice a day. Could the breathing
of carbonic acid gas mixed with atmospheric air be of service? Copious
venesection, when a difficulty of breathing continues between the fits of
coughing; otherwise the cough and the expectoration cease, and the patient
is destroyed. Ulcers of the lungs sometimes supervene, and the phthisis
pulmonalis in a few weeks terminates in death. Where the cough continues
after some weeks without much of the hooping, and a sensitive fever daily
supervenes, so as to resemble hectic fever from ulcers of the lungs; change
of air for a week or fortnight acts as a charm, and restores the patient
beyond the hopes of the physician.

Young children should lie with their heads and shoulders raised; and should
be constantly watched day and night; that when the cough occurs, they may
be held up easily, so as to stand upon their feet bending a little
forwards; or nicely supported in that posture which they seem to put
themselves into. A bow of whalebone, about the size of the bow of a key, is
very useful to extract the phlegm out of the mouths of infants at the time
of their coughing; as an handkerchief, if applied at the time of their
quick inspirations after long holding their breath, is dangerous, and may
suffocate the patient in an instant, as I believe has sometimes happened.

9. _Variola discreta._ The small-pox is well divided by Sydenham into
distinct and confluent. The former consists of distinct pustules, which
appear on the fourth day of the fever, are circumscribed and turgid; the
fever ceasing when the eruption is complete. Head-ach, pain in the loins,
vomiting frequently, and convulsive fits sometimes, precede the eruption.

The distinct small-pox is attended with sensitive fever only, when very
mild, as in most inoculated patients; or with sensitive irritated fever,
when the disease is greater: the danger in this kind of small-pox is owing
either to the tumor and soreness of the throat about the height, or eighth
day of the eruption; or to the violence of the secondary fever. For, first,
as the natural disease is generally taken by particles of the dust of the
contagious matter dried and floating in the air, these are liable to be
arrested by the mucus about the throat and tonsils in their passage to the
lungs, or to the stomach, when they are previously mixed with saliva in the
mouth. Hence the throat inflames like the arm in inoculated patients; and
this increasing, as the disease advances, destroys the patient about the
height.

Secondly, all those upon the face and head come out about the same time,
namely, about one day before those on the hands, and two before those in
the trunk; and thence, when the head is very full, a danger arises from the
secondary fever, which is a purulent, not a variolous fever; for as the
matter from all these of the face and head is reabsorbed at the same time,
the patient is destroyed by the violence of this purulent fever; which in
the distinct small-pox can only be abated by venesection and cathartics;
but in the confluent small-pox requires cordials and opiates, as it is
attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10.

When the pustules on the face recede, the face swells; and when those of
the hands recede, the hands swell; and the same of the feet in succession.
These swellings seem to be owing to the absorption of variolous matter,
which by its stimulus excites the cutaneous vessels to secrete more lymph,
or serum, or mucus, exactly as happens by the stimulus of a blister. Now,
as a blister sometimes produces strangury many hours after it has risen; it
is plain, that a part of the cantharides is absorbed, and carried to the
neck of the bladder; whether it enters the circulation, or is carried
thither by retrograde movements of the urinary branch of lymphatics; and by
parity of reasoning the variolous matter is absorbed, and swells the face
and hands by its stimulus.

_Variola confluens._ The confluent small-pox consists of numerous pustules,
which appear on the third day of the fever, flow together, are irregularly
circumscribed, flaccid, and little elevated; the fever continuing after the
eruption is complete; convulsions do not precede this kind of small-pox,
and are so far to be esteemed a favourable symptom.

The confluent small-pox is attended with sensitive inirritated fever, or
inflammation with arterial debility; whence the danger of this disease is
owing to the general tendency to gangrene, with petechiæ, or purple spots,
and hæmorrhages; besides the two sources of danger from the tumor of the
throat about the height, or eleventh day of the eruption, and the purulent
fever after that time; which are generally much more to be dreaded in this
than in the distinct small-pox described above.

M. M. The method of treatment must vary with the degree and kind of fever.
Venesection may be used in the distinct small-pox early in the disease,
according to the strength or hardness of the pulse; and perhaps on the
first day of the confluent small-pox, and even of the plague, before the
sensorial power is exhausted by the violence of the arterial action? Cold
air, and even washing or bathing in cold water, is a powerful means in
perhaps all eruptive diseases attended with fever; as the quantity of
eruption depends on the quantity of the fever, and the activity of the
cutaneous vessels; which may be judged of by the heat produced on the skin;
and which latter is immediately abated by exposure to external cold.
Mercurial purges, as three grains of calomel repeated every day during the
eruptive fever, so as to induce three or four stools, contribute to abate
inflammation; and is believed by some to have a specific effect on the
variolous, as it is supposed to have on the venereal contagion.

It has been said, that opening the pock and taking out the matter has not
abated the secondary fever; but as I had conceived, that the pits, or marks
left after the small-pox, were owing to the acrimony of the matter beneath
the hard scabs, which not being able to exhale eroded the skin, and
produced ulcers, I directed the faces of two patients in the confluent
small-pox to be covered with cerate early in the disease, which was daily
renewed; and I was induced to think, that they had much less of the
secondary fever, and were so little marked, that one of them, who was a
young lady, almost entirely preserved her beauty. Perhaps mercurial
plasters, or cerates, made without turpentine in them, might have been more
efficacious, in preventing the marks, and especially if applied early in
the disease, even on the first day of the eruption, and renewed daily. For
it appears from the experiments of Van Woensel, that calomel or sublimate
corrosive, triturated with variolous matter, incapacitates it from giving
the disease by inoculation. Calomel or sublimate given as an alterative for
ten days before inoculation, and till the eruptive fever commences, is said
with certainty to render the disease mild by the same author. Exper. on
Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.

_Variola inoculata._ The world is much indebted to the great discoverer of
the good effects of inoculation, whose name is unknown; and our own country
to Lady Wortley Montague for its introduction into this part of Europe. By
inserting the variolous contagion into the arm, it is not received by the
tonsils, as generally happens, I suppose, in the natural small-pox; whence
there is no dangerous swelling of the throat, and as the pustules are
generally few and distinct, there is seldom any secondary fever; whence
those two sources of danger are precluded; hence when the throat in
inoculated small-pox is much inflamed and swelled, there is reason to
believe, that the disease had been previously taken by the tonsils in the
natural way.--Which also, I suppose, has generally happened, where the
confluent kind of small-pox has occurred on inoculation.

I have known two instances, and have heard of others, where the natural
small-pox began fourteen days after the contagion had been received; one of
these instances was of a countryman, who went to a market town many miles
from his home, where he saw a person in the small-pox, and on returning the
fever commenced that day fortnight: the other was of a child, whom the
ignorant mother carried to another child ill of the small-pox, on purpose
to communicate the disease to it; and the variolous fever began on the
fourteenth day from that time. So that in both these cases fever commenced
in half a lunation after the contagion was received. In the inoculated
small-pox the fever generally commences on the seventh day, or after a
quarter of a lunation; and on this circumstance probably depends the
greater mildness of the latter. The reason of which is difficult to
comprehend; but supposing the facts to be generally as above related, the
slower progress of the contagion indicates a greater inirritability of the
system, and in consequence a tendency to malignant rather than to
inflammatory fever. This difference of the time between the reception of
the infection and the fever in the natural and artificial small-pox may
nevertheless depend on its being inserted into a different series of
vessels; or to some unknown effect of lunar periods. It is a subject of
great curiosity, and deserves further investigation.

When the inoculated small-pox is given under all the most favourable
circumstances I believe less than one in a thousand miscarry, which may be
ascribed to some unavoidable accident, such as the patient having
previously received the infection, or being about to be ill of some other
disease. Those which have lately miscarried under inoculation, as far as
has come to my knowledge, have been chiefly children at the breast; for in
these the habit of living in the air has been confirmed by so short a time,
that it is much easier destroyed, than when these habits of life have been
established by more frequent repetition. See Sect. XVII. 3. Thus it appears
from the bills of mortality kept in the great cities of London, Paris, and
Vienna, that out of every thousand children above three hundred and fifty
die under two years old. (Kirkpatrick on Inoculation.) Whence a strong
reason against our hazarding inoculation before that age is passed,
especially in crowded towns; except where the vicinity of the natural
contagion renders it necessary, or the convenience of inoculating a whole
family at a time; as it then becomes better to venture the less favourable
circumstances of the age of the patient, or the chance of the pain from
toothing, than to risk the infection in the natural way.

The most favourable method consists in, first, for a week before
inoculation, restraining the patients from all kinds of fermented or
spirituous liquor, and from animal food; and by giving them from one grain
to three or four of calomel every other day for three times. But if the
patients be in any the least danger of taking the natural infection, the
inoculation had better be immediately performed, and this abstinence then
began; and two or three gentle purges with calomel should be given, one
immediately, and on alternate days. These cathartics should not induce more
than two or three stools. I have seen two instances of a confluent
small-pox in inoculation following a violent purging induced by too large a
dose of calomel.

Secondly, the matter used for inoculation should be in a small quantity,
and warm, and fluid. Hence it is best when it can be recently taken from a
patient in the disease; or otherwise it may be diluted with part of a drop
of warm water, since its fluidity is likely to occasion its immediate
absorption; and the wound should be made as small and superficial as
possible, as otherwise ulcers have been supposed sometimes to ensue with
subaxillary abscesses. Add to this, that the making two punctures either on
the same, or one on each arm, secures the success of the operation in
respect to communicating the infection.

Thirdly, at the time of the fever or eruption the application of cool air
to those parts of the skin, which are too warm, or appear red, or are
covered with what is termed a rash, should be used freely, as well as
during the whole disease. And at the same time, if the feet or hands are
colder than natural, these should be covered with flannel. See Class IV. 2.
2. 10.

10. _Rubeola irritata, morbilli._ The measles commence with sneezing, red
eyes, dry hoarse cough, and is attended with sensitive irritated fever. On
the fourth day, or a little later, small thick eruptions appear, scarcely
eminent above the skin, and, after three days, changing into very small
branny scales.

As the contagious material of the small-pox may be supposed to be diffused
in the air like a fine dry powder, and mixing with the saliva in the mouth
to infect the tonsils in its passage to the stomach; so the contagious
material of the measles may be supposed to be more completely dissolved in
the air, and thus to impart its poison to the membrane of the nostrils,
which covers the sense of smell; whence a catarrh with sneezing ushers in
the fever; the termination of the nasal duct of the lacrymal sac is subject
to the same stimulus and inflammation, and affects by sympathy the lacrymal
glands, occasioning a great flow of tears. See Sect. XVI. 8. And the
redness of the eye and eyelids is produced in consequence of the tears
being in so great quantity, that the saline part of them is not entirely
reabsorbed. See Sect. XXIV. 2. 8.

The contagion of the measles, if it be taken a sufficient time before
inoculation, so that the eruption may commence before the variolous fever
comes on, stops the progress of the small-pox in the inoculated wound, and
delays it till the measle-fever has finished its career. See Sect. XXXIII.
2. 9.

The measles are usually attended with inflammatory fever with strong pulse,
and bear the lancet in every stage of the disease. In the early periods of
it, venesection renders the fever and cough less; and, if any symptoms of
peripneumony occur, is repeatedly necessary; and at the decline of the
disease, if a cough be left after the eruption has ceased, and the
subsequent branny scales are falling off, venesection should be immediately
used; which prevents the danger of consumption. At this time also change of
air is of material consequence, and often removes the cough like a charm,
as mentioned in a similar situation at the end of the chin-cough.

_Rubeola inirritata._ Measles with inirritated fever, or with weak pulse,
has been spoken of by some writers. See London Med. Observ. Vol. IV. Art.
XI. It has also been said to have been attended with sore throat. Edinb.
Essays, Vol. V. Art. II. Could the scarlet fever have been mistaken for the
measles? or might one of them have succeeded the other, as in the measles
and small-pox mentioned in Sect. XXXIII. 2. 9.?

From what has been said, it is probable that inoculation might disarm the
measles as much as the small-pox, by preventing the catarrh, and frequent
pulmonary inflammation, which attends this disease; both of which are
probably the consequence of the immediate application of the contagious
miasmata to these membranes. Some attempts have been made, but a difficulty
seems to arise in giving the disease; the blood, I conjecture, would not
infect, nor the tears; perhaps the mucous discharge from the nostrils might
succeed; or a drop of warm water put on the eruptions, and scraped off
again with the edge of a lancet; or if the branny scales were collected,
and moistened with a little warm water? Further experiments on this subject
would be worthy the public attention.

11. _Scarlatina mitis._ The scarlet fever exists with all degrees of
virulence, from a flea-bite to the plague. The infectious material of this
disease, like that of the small-pox, I suppose to be diffused, not
dissolved, in the air; on which account I suspect, that it requires a much
nearer approach to the sick, for a well person to receive the infection,
than in the measles; the contagion of which I believe to be more volatile,
or diffusible in the atmosphere. But as the contagious miasmata of
small-pox and scarlet fever are supposed to be more fixed, they may remain
for a longer time in clothes or furniture; as a thread dipped in variolous
matter has given the disease by inoculation after having been exposed many
days to the air, and after having been kept many months in a phial. This
also accounts for the slow or sporadic progress of the scarlet fever, as it
infects others at but a very small distance from the sick; and does not
produce a quantity of pus-like matter, like the small-pox, which can adhere
to the clothes of the attendants, and when dried is liable to be shook off
in the form of powder, and thus propagate the infection.

This contagious powder of the small-pox, and of the scarlet fever, becomes
mixed with saliva in the mouth, and is thus carried to the tonsils, the
mucus of which arrests some particles of this deleterious material; while
other parts of it are carried into the stomach, and are probably decomposed
by the power of digestion; as seems to happen to the venom of the viper,
when taken into the stomach. Our perception of bad tastes in our mouths, at
the same time that we perceive disagreeable odours to our nostrils, when we
inhale very bad air, occasions us to spit out our saliva; and thus, in some
instances, to preserve ourselves from infection. This has been supposed to
originate from the sympathy between the organs of taste and smell; but any
one who goes into a sick room close shut up, or into a crowded
assembly-room, or tea-room, which is not sufficiently ventilated, may
easily mix the bad air with the saliva on his tongue so as to taste it; as
I have myself frequently attended to.

Hence it appears that these heavy infectious matters are more liable to mix
with the saliva, and inflame the tonsils, and that either before or at the
commencement of the fever; and this is what generally happens in the
scarlet fever, always I suppose in the malignant kind, and very frequently
in the mild kind. But as this infection may be taken by other means, as by
the skin, it also happens in the most mild kind, that there is no
inflammation of the tonsils at all; in the same manner as there is
generally no inflammation of the tonsils in the inoculated small-pox.

In the mild scarlatina on the fourth day of the fever the face swells a
little, at the same time a florid redness appears on various parts of the
skin, in large blotches, at length coalescing, and after three days
changing into branny scales.

M. M. Cool air. Fruit. Lemonade. Milk and water.

_Scarlatina maligna._ The malignant scarlet fever begins with inflamed
tonsils; which are succeeded by dark drab coloured sloughs three or five
lines in diameter, flat, or beneath the surrounding surface; and which
conceal beneath them spreading gangrenous ulcers. The swellings of the
tonsils are sensible to the eye and touch externally, and have an elastic
rather than an oedematous feel, like parts in the vicinity of gangrenes.
The pulse is very quick and weak, with delirium, and the patient generally
dies in a few days; or if he recovers, it is by slow degrees, and attended
with anasarca.

M. M. A vomit once. Wine. Beer. Cyder. Opium. Bark; in small repeated
doses. Small successive blisters, if the extremities are cooler than
natural. Cool air on the hot parts of the skin, the cool extremities being
at the same time covered. Iced lemonade. Broth. Custards. Milk. Jellies.
Bread pudding. Chicken. Touch the ulcers with a dry sponge to absorb the
contagious matter, and then with a sponge filled with vinegar, with or
without sugar of lead dissolved in it, about six grains to an ounce; or
with a very little blue vitriol dissolved in it, as a grain to an ounce;
but nothing so instantaneously corrects the putrid smell of ulcers as a
solution of alum; about half an ounce to a pint of water, which should be a
little warmish, and injected into the fauces gently by means of a syringe.
These should be repeated frequently in a day, if it can be done easily, and
without fatigue to the child. A little powder of bark taken frequently into
the mouth, as a grain or two, that it may mix with the saliva, and thus
frequently stimulate the dying tonsils. Could a warm bath made of decoction
of bark, or a cold fomentation with it, be of service? Could oxygene gas
mixed with common air stimulate the languid system? Small electric shocks
through the tonsils every hour? ether frequently applied externally to the
swelled tonsils?

As this disease is attended with the greatest degree of debility, and as
stimulant medicines, if given in quantity, so as to produce more than
natural warmth, contribute to expend the already too much exhausted
sensorial power; it appears, that there is nothing so necessary to be
nicely attended to, as to prevent any unnecessary motions of the system;
this is best accomplished by the application of cold to those parts of the
skin, which are in the least too hot. And secondly, that the exhibition of
the bark in such quantity, as not to oppress the stomach and injure
digestion, is next to be attended to, as not being liable to increase the
actions of the system beyond their natural quantity; and that opium and
wine should be given with the greatest caution, in very small repeated
quantity, and so managed as to prevent, if possible, the cold fits of
fever; which probably occur twice in 25 hours, obeying the lunations like
the tides, as mentioned in Sect. XXXII. 6. that is, I suppose, the cold
periods, and consequent exacerbations of fever, in this malignant
scarlatina, occur twice in a lunar day; which is about ten minutes less
than 25 hours; so that if the commencement of one cold fit be marked, the
commencement of the next may be expected, if not disturbed by the
exhibition of wine or opium, or the application of blisters, to occur in
about twelve hours and a half from the commencement of the former; or if
not prevented by large doses of the bark.

No one could do an act more beneficial to society, or glorious to himself,
than by teaching mankind how to inoculate this fatal disease; and thus to
deprive it of its malignity. Matter might be taken from the ulcers in the
throat, which would probably convey the contagion. Or warm water might be
put on the eruption, and scraped off again by the edge of a lancet. These
experiments could be attended with no danger, and should be tried for the
public benefit, and the honour of medical science.

12. _Miliaria._ Miliary fever. An eruption produced by the warmth, and more
particularly by the stimulus of the points of the wool in flannel or
blankets applied to the skin, has been frequently observed; which, by cool
dress, and bed-clothes without flannel, has soon ceased. See Class I. 1. 2.
3. This, which maybe called _miliaria sudatoria_, has been confounded with
other miliary fevers, and has made the existence of the latter doubted. Two
kinds of eruptions I have seen formerly attended with fever, but did not
sufficiently mark their progress, which I conceived to be miliary
eruptions, one with arterial strength, or with sensitive irritated fever,
and the other with arterial debility, or with sensitive inirritated fever.

In the former of these, or _miliaria irritata_, the eruptions were distinct
and larger than the small-pox, and the fever was not subdued without two or
three venesections, and repeated cathartics with calomel.

The latter, or _miliaria inirritata_, was attended with great arterial
debility; and during the course of the fever pellucid points appeared
within the skin, particularly on the soft parts of the fingers. And, in one
patient, whom I esteemed near her end, I well recollect to have observed
round pellucid globules, like what are often seen on vines in hot-houses,
no larger than the smallest pins' heads, adhere to her neck and bosom;
which were hard to the touch, but were easily rubbed off. These diseases,
if they are allied, do not differ more than the kinds of small-pox; but
require many further observations.

The eruption so often seen on children in the cradle, and called by the
nurses red-gum, and which is attended with some degree of fever, I suspect
to be produced by too great warmth, and the contact of flannel next their
tender skins, like the miliaria sudatoria; and like that requires cool air,
cool clothes, and linen next their skin.

13. _Pestis._ The plague, like other diseases of this class, seems to be
sometimes mild, and sometimes malignant; according to the testimony of
different writers. It is said to be attended with inflammation, with the
greatest arterial debility, and to be very contagious, attended at an
uncertain time of the fever with buboes and carbuncles. Some authors
affirm, that the contagion of the plague may be repeatedly received, so as
to produce the disease; but as this is contrary to the general analogy of
all contagious diseases, which are attended with fever, and which cure
themselves spontaneously; there is reason to suspect, that where it has
been supposed to have been repeatedly received, that some other fever with
arterial debility has been mistaken for it, as has probably universally
been the case, when the small-pox has been said to have been twice
experienced.

M. M. Venesection has been recommended by some writers on the first day,
where the inflammation was supposed to be attended with sufficient arterial
strength, which might perhaps sometimes happen, as the bubo seems to be a
suppuration; but the carbuncle, or anthrax, is a gangrene of the part, and
shews the greatest debility of circulation. Whence all the means before
enumerated in this genus of diseases to support the powers of life are to
be administered. Currents of cold air, cold water, ice, externally on the
hot parts of the skin.

The methods of preventing the spreading of this disease have been much
canvassed, and seem to consist in preventing all congregations of the
people, as in churches, or play-houses; and to remove the sick into tents
on some airy common by the side of a river, and supply them with fresh
food, both animal and vegetable, with beer and wine in proper quantities,
and to encourage those who can, daily to wash both their clothes and
themselves.

The _pestis vaccina_, or disease amongst the cows, which afflicted this
island about half a century ago, seems to have been a contagious fever with
great arterial debility; as in some of them in the latter stage of the
disease, an emphysema could often be felt in some parts, which evinced a
considerable progress of gangrene beneath the skin. In the sensitive
inirritated fevers of these animals, I suppose about sixty grains of opium,
with two ounces of extract of oak-bark, every six hours, would supply them
with an efficacious medicine; to which might be added thirty grains of
vitriol of iron, if any tendency to bloody urine should appear, to which
this animal is liable. The method of preventing the infection from
spreading, if it should ever again gain access to this island, would be
immediately to obtain an order from government to prevent any cattle from
being removed, which were found within five miles of the place supposed to
be infected, for a few days; till the certainty of the existence of the
pestilence could be ascertained, by a committee of medical people. As soon
as this was ascertained, all the cattle within five miles of the place
should be immediately slaughtered, and consumed within the circumscribed
district; and their hides put into lime-water before proper inspectors.

14. _Pemphigus_ is a contagious disease attended with bladdery eruptions
appearing on the second or third day, as large as filberts, which, remain
many days, and then effuse a thin ichor. It seems to be either of a mild
kind with sensitive fever only, of which I have seen two instances, or with
irritated, or with inirritated fever, as appears from the observations of
M. Salabert. See Medical Comment, by Dr. Duncan, Decad. II. Vol. VI.

15. _Varicella._ Chicken-pox is accompanied with sensitive fever, pustules
break out after a mild fever like the small-pox, seldom suppurate, and
generally terminate in scales without scars. I once saw a lady, who
miscarryed during this disease, though all her children had it as slightly
as usual. It sometimes leaves scars or marks on the skin. This disease has
been mistaken for the small-pox, and inoculated for it; and then the
small-pox has been supposed to happen twice to the same person. See Trans.
of the College London. It is probable that the pemphigus and urticaria, as
well as this disease, have formerly been diseases of more danger; which the
habit of innumerable generations may have rendered mild, and will in
process of time annihilate. In the same manner as the small-pox, venereal
disease, and rickets, seem to become milder or less in quantity every half
century. While at the same time it is not improbable, that other new
diseases may arise, and for a season thin mankind!

16. _Urticaria._ Nettle-rash begins with mild sensitive fever, which is
sometimes scarcely perceptible. Hence this eruption has been thought of two
sorts, one with and the other without fever. On the second day red spots,
like parts stung with nettles, are seen; which almost vanish during the
day, and recur in the evening with the fever, succeeded in a few days by
very minute scales. See Trans. of the College, London.

17. _Aphtha._ Thrush. It has been doubted, whether aphtha or thrush, which
consists of ulcers in the mouth, should be enumerated amongst febrile
diseases; and whether these ulcers are always symptomatic, or the
consequence rather than the cause of the fevers which attend them. The
tongue becomes rather swelled; its colour and that of the fauces purplish;
sloughs or ulcers appear first on the throat and edges of the tongue, and
at length over the whole mouth. These sloughs are whitish, sometimes
distinct, often coalescing, and remain an uncertain time. Cullen. I shall
concisely mention four cases of aphtha, but do not pretend to determine
whether they were all of them symptomatic or original diseases.

_Aphtha sensitiva._ A lady during pregnancy was frequently seized with
ulcers on her tongue and cheeks, or other parts of the mouth, without much
apparent fever; which continued two or three weeks, and returned almost
every month. The thrush in the mouths of young children seems to be a
similar disease. These ulcers resemble those produced in the sea-scurvy,
and have probably for their cause an increased action of the secerning
system from increased sensation, with a decreased action of the absorbent
system from decreased irritation. See Class I. 2. 1. 15.

M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently
into the mouth in very small quantity. See Class II. 1. 3. 1.

_Aphtha irritata._ Inflammatory aphtha. A case of this kind is related
under the title of suppurative rheumatism. Class IV. 1. 2. 16.

_Aphtha inirritata._ Sloughs or ulcers of the mouth, attended with
sensitive fever with great arterial debility. They seem to spread downwards
from the throat into the stomach, and probably through the whole intestinal
canal, beginning their course with cardialgia, and terminating it with
tenesmus; and might perhaps be called an erysipelas of this mucous
membrane.

M. M. Cool air. A small blister on the back. Bark. Wine. Opium in small
repeated quantities. Soap neutralizes the gastric acid without
effervescence, and thus relieves the pain of cardialgia, where the stomach
is affected. Milk also destroys a part of this acid. Infusion of sage
leaves two ounces, almond soap from five grains to ten, with sugar and
cream, is generally both agreeable and useful to these patients. See I. 2.
4. 5.

Where the stomach may be supposed to be excoriated by poisons containing
acid, as sublimate of mercury or arsenic; or if it be otherwise inflamed,
or very sensible to the stimulus of the gastric acid; or where it abounds
with acid of any kind, as in cardialgia; the exhibition of soap is perhaps
a preferable manner of giving alcali than any other, as it decomposes in
the stomach without effervescence; while the caustic alcali is too acrid to
be administered in such cases, and the mild alcali produces carbonic gas.
If a drop of acid of vitriol be put on cap paper, it will be long before it
destroys the paper; but if a drop of mild alcali be added, a sudden
effervescence arises, and the paper is instantly destroyed by the escape of
the fixed air; in the same manner as lumps of solid lime are broken into
powder by the escape of the steam produced from the water, which is poured
on them. This shews why a succession of acid and of alcaline caustics
sooner destroys a part, than either of them applied separately.

18. _Dysenteria._ Bloody-flux is attended with sensitive fever generally
with arterial debility; with frequent mucous or bloody stools; which
contain contagious matter produced by the membranes of the intestines; the
alimentary excrement being nevertheless retained; with griping pains and
tenesmus.

M. M. Emetics. Antimonials. Peruvian bark. Opium and calomel of each a
grain every night. Bolus armeniæ. Earth of alum. Chalk. Calcined hartshorn.
Mucilage. Bee's wax mixt with yolk of egg. Cerated glass of antimony. Warm
bath. Flannel clothing next to the skin. Large clysters with opium. With
ipecacuanha, with smoke of tobacco? Two dysenteric patients in the same
ward of the infirmary at Edinburgh quarrelled, and whipped each other with
horsewhips a long time, and were both much better after it, owing perhaps
to the exertion of so much of the sensorial power of volition; which, like
real insanity, added excitement to the whole system.

The prevention of this contagion must consist principally in ventilation
and cleanliness; hence the patients should be removed into cottages distant
from each other, or into tents; and their fæces buried as soon as may be;
or conveyed into a running stream; and themselves should be washed with
cold or warm water after every evacuation. For the contagious matter
consists in the mucous or purulent discharge from the membrane which lines
the intestines; and not from the febrile perspiration, or breath of the
patients. For the fever is only the consequence and not the cause of
contagion; as appears from Genus the Fifth of this Order, where contagion
exists without fever.

19. _Gastritis superficialis._ Superficial inflammation of the stomach. An
erysipelatous inflammation of the stomach is mentioned by Dr. Cullen from
his own observations; which is distinguished from the inflammatory
gastritis by less pain, and fever, and by an erysipelatous redness about
the fauces. Does this disease belong to aphtha?

20. _Enteritis superficialis._ Superficial inflammation of the bowels is
also mentioned by Dr. Cullen from his own observation under the name of
enteritis erythematica; and is said to be attended with less pain and
fever, without vomiting, and with diarrhoea. May not this disease be
referred to aphtha, or to dysentery?

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS IV.

_With the Production of new Vessels by internal Membranes or Glands,
without Fever._

Where inflammation is produced in a small part, which has not great natural
sensibility, the additional sensation does not produce an increased action
of the arterial system; that is, the associated motions which are employed
in the circulation of the blood, those for instance of the heart, arteries,
glands, capillaries, and their correspondent veins, are not thrown into
increased action by so small an addition of the sensorial power of
sensation. But when parts, which naturally possess more sensibility, become
inflamed, the quantity of the sensorial power of sensation becomes so much
increased, as to affect the associated motions belonging to the
circulation, occasioning them to proceed with greater frequency; that is, a
fever is induced. This is well exemplified in the internal and superficial
paronychia, one of which is attended with great pain and fever, and the
other with little pain and no fever. See Class II. 1. 2. 19. and II. 1. 4.
5.

From hence it appears, that the sensitive fever is an accidental
consequence of the topical phlegmon, or inflammation, and not a cause of
it; that it is often injurious, but never salutary; and should therefore
always be extinguished, as soon as may be, either by the lancet and
cathartics, and diluents, and cold air, when it is of the irritated kind;
or by the bark, opium, cool air, and nutrientia, when it is of the
inirritated kind.

SPECIES.

1. _Ophthalmia superficialis._ As the membranes, which cover the eye, are
excluded from the air about one third part of the twenty-four hours; and
are moistened by perpetual nictitation during the other sixteen; they may
be considered as internal membranes; and from the analogy of their
inflammation to that of other internal membranes, it is arranged under this
genus; whilst the tonsillitis is esteemed an inflammation of an external
membrane, because currents of air are perpetually passing both day and
night over the fauces.

The superficial ophthalmy has generally been esteemed a symptom of
scrophula, when it recurs frequently in young persons; but is probably only
a concomitant of that disease, as a symptom of general debility;
ramifications of new red vessels, and of enlarged old ones, are spread over
the white part of the eye; and it is attended with less heat, less pain,
and less intolerance of light than the ophthalmia interna, described in
Class II. 1. 2. 2. It occurs in those of feeble circulation, especially
children of a scrophulous tendency, and seems to arise from a previous
torpor of the vessels of the tunica albuginea from their being exposed to
cold air; and from this torpor being more liable to occur in habits, which
are naturally inirritable; and therefore more readily fall into quiescence
by a smaller deduction of the stimulus of heat, than would affect stronger
or more irritable habits; the consequence of this torpor is increased
action, which produces pain in the eye, and that induces inflammation by
the acquisition of the additional sensorial power of sensation.

_Ophthalmia lymphatica_ is a kind of anasarca of the tunica adnata; in this
the vessels over the sclerotica, or white part of the eye, rise
considerably above the cornea, which they surround, are less red than in
the ophthalmia superficialis, and appear to be swelled by an accumulation
of lymph rather than of blood; it is probably owing to the temporary
obstruction of a branch of the lymphatic system.

M. M. If the pain be great, venesection by leeches on the temple, or
cutting the temporal artery, and one purge with three or four grains of
calomel should be premised. Then the Peruvian bark twice a day. Opium from
a quarter to half a grain twice a day for some weeks. Bathe the eye
frequently with cold water alone, or with cold water, to a pint of which is
added half an ounce of salt. White vitriol six grains dissolved in one
ounce of water; a drop or two to be put between the eyelids twice a day.
Take very small electric sparks from the eyes every day for a fortnight.
Bathe the whole head with salt and water made warm every night for some
months. Send such children to a school near the sea for the convenience of
sea-bathing for many months annually; such schools are to be found in or
near Liverpool.

When a child is afflicted with an inflamed eye of this kind, he should
always sit with his back to the window or candle; but it is generally not
necessary to cover it, or if the uneasy sensation of light makes this
proper, the cover should stand off from the eye, so as not much to exclude
the cool air from it. As covering an eye unnecessarily is liable to make
that eye weaker than the other, from its not being sufficiently used, and
thence to produce a squinting for ever afterwards.

Nevertheless, when the pain is great, a poultice must be applied to keep
the eyes moist, or a piece of oiled silk bound lightly over them. Or thus,
boil an egg till it is hard, cut it longitudinally into two hemispheres,
take out the yolk, sew the backs of the two hollow hemispheres of the white
to a ribbon, and bind them over the eyes every night on going to bed;
which, if nicely fitted on, will keep the eyes moist without any
disagreeable pressure. See Class I. 1. 3. 14.

_Ophthalmia equina._ An inflammation of this kind is liable to affect the
eyes of horses; one cause of which is owing to a silly custom of cutting
the hair out of horses' ears; by which they are not only liable to take
cold at the ear, but grass seeds are liable to fall into their ears from
the high racks in stables; and in both cases the eye becomes inflamed by
sympathy. I once directed the temporal artery of a horse to be opened, who
had frequent returns of an inflamed eye; and I believed it was of essential
service to him; it is probable that the artery was afterwards contracted in
the wounded part, and that thence less blood was derived to the eye: the
hæmorrhage was stopped by two persons alternately keeping their fingers on
the orifice, and afterwards by a long bandage of broad tape.

2. _Pterigion._ Eye-wing. A spot of inflammation sometimes begins on the
inside of the lower eyelid, or on the tunica albuginea, and spreads an
intertexture of red vessels from it, as from a center, which extend on the
white part of the eye, and have the appearance of the wing of a fly, from
whence its name.

M. M. Cut the ramifications of vessels again and again with the point of a
lancet close to the center of inflammation.

3. _Tarsitis palpebrarum._ Inflammation of the edges of the eyelids. This
is a disease of the glands, which produce the hairs of the eye-lashes, and
is frequently the cause of their falling off. After this inflammation a
hard scar-like ridge is left on the edge of the eyelid, which scratches and
inflames the eyeball, and becomes a very troublesome disease.

The Turkish ladies are said to colour the edge of the eyelash with crude
antimony in very fine powder, which not only gives lustre to the eye, as a
diamond set on a black soil, but may prevent extraneous light from being
reflected from these edges into the eye, and thus serve the purpose of the
black feathers about the eyes of swans, described in Sect. XXXIX. 5. 1. and
may also prevent the edges of the eyelids from being inflamed by the
frequent stimulus of tears on them. Black lead in fine powder might be
better for all these purposes than antimony, and might be put on with a
camel's hair brush.

M. M. Mercurial ointment smeared at night on the edges of the eyelids.
Burnt alum sixty grains, hog's grease half an ounce, well rubbed into an
ointment to be smeared on them in the night. Cold water frequently in the
day. See Class II. 1. 1. 8.

4. _Hordeolum._ Stye. This inflammation begins either on or near the edges
of the eyelids, or in the loose skin of them, and is sometimes very slow
either in coming to suppuration or in dispersing. The skin beneath the
lower eyelid is the most frequent seat of this tumor, which sometimes never
suppurates at all, but becomes an incysted tumor: for as this skin is very
loose for the purpose of admitting great motion to the eyelid, the
absorbent power of the veins seems particularly weak in this part; whence
when any person is weakened by fatigue or otherwise, a darker shade of
colour is seen beneath the eyes; which is owing to a less energetic action
of the absorbent terminations of the veins, whence the currents of dark or
venous blood are delayed in them. This dark shade beneath the eyes, when it
is permanent, is a symptom of habitual debility, or inirritability of the
circulating system. See Class I. 2. 2. 2.

M. M. Smear the tumors with mercurial ointment, moisten them frequently
with ether. To promote their suppuration they may be wounded with a lancet,
or slit down the middle, or they may be cut out. A caustic leaves a large
scar.

5. _Paronychia superficialis._ Whitlow. An inflammation about the roots of
the nail beneath the skin, which suppurates without fever, and sometimes
destroys the nail; which is however gradually reproduced. This kind of
abscess, though not itself dangerous, has given opportunity for the
inoculation of venereal matter in the hands of accoucheurs, and of putrid
matter from the dissection of diseased bodies; and has thus been the cause
of disease and death. When putrid matter has been thus absorbed from a dead
body, a livid line from the finger to the swelled gland in the axilla is
said to be visible; which shews the inflammation of the absorbent vessel
along its whole course to the lymphatic gland; and death has generally been
the consequence.

M. M. In the common paronychia a poultice is generally sufficient. In the
absorption of putrid matter rub the whole hand and arm with mercurial
ointment three or four times a day, or perpetually. Could the swelled
axillary gland be exsected? In the absorption of venereal matter the usual
methods of cure in syphilis must be administered, as in Class II. 1. 5. 2.

6. _Gutta rosea._ The rosy drop on the face is of three kinds. First, the
_gutta rosea hepatica_, or the red pimples on the faces of drunkards, which
are probably a kind of crisis, or vicarious inflammation, which succeeds,
or prevents, a torpor of the membranes of the liver. This and the
succeeding species properly belong to Class IV. 1. 2. 14.

Secondly, the pimpled face in consequence of drinking cold water, or eating
cold turnips, or other insipid food, when much heated with exercise; which
probably arises from the sympathy between the skin of the face and the
stomach; and may be called the _gutta rosea stomatica_. Which is
distinguished from the former by the habits of the patient in respect to
drinking; by the colour of the eruptions being less deep; and by the
patient continuing generally to be troubled with some degree of apepsia.
See Class I. 3. 1. 3. I knew a lady, who had long been afflicted with pain
about the region of the stomach; and, on drinking half a pint of vinegar,
as a medicine, she had a breaking out commenced on her face; which
remained, and she became free from the pain about the stomach. Was this a
stomachic, or an hepatic disease?

Thirdly, there is a red face, which consists of smaller pimples than those
above mentioned; and which is less liable to suppurate; and which seems to
be hereditary, or at least has no apparent cause like those above
mentioned; which may be termed _gutta rosea hereditaria_, or puncta rosea.

Mrs. S. had a pimpled face, which I believe arose from potation of ale. She
applied alum in a poultice to it, and had soon a paralytic stroke, which
disabled her on one side, and terminated in her death.

Mrs. L. had a red pimpled face, which seemed to have been derived from her
mother, who had probably acquired it by vinous potation; she applied a
quack remedy to it, which I believe was a solution of lead, and was seized
with epileptic fits, which terminated in palsy, and destroyed her. This
shews the danger of using white paint on the face, which is called bismuth,
but is in reality white lead or cerussa.

Mr. Y---- had acquired the gutta rosea on his nose, and applied a saturnine
solution on it for a few nights, and was then seized with paralysis on one
side of his face; which however he gradually recovered, and has since
acquired the gutta rosea on other parts of his face.

These fatal effects were probably caused by the disagreeable sensation of
an inflamed liver, which used before to be relieved of the sympathetic
action and consequent inflammation of the skin of the face, which was now
prevented by the stronger stimulus of the application of calx of lead. The
manner in which disagreeable sensations induce epilepsy and palsy is
treated of in Class III. In some cases where habitual discharges, or
eruptions, or ulcers are stopped, a torpor of the system may follow, owing
to the want of the accustomed quantity of sensation or irritation. See
Class I. 1. 2. 9. and II. 1. 5. 6. In both these situations some other
stimulus should be used to supply the place of that which is taken away;
which may either be perpetual, as an issue; or periodical, as a cathartic
repeated once a fortnight or month.

Miss W. an elegant young lady of about twenty, applied a mercurial lotion
to her face, which was covered with very small red points; which seemed to
have been not acquired by any known or avoidable means; she was seized with
inflammation of her liver, and after repeated bleeding and cathartics
recovered, and in a few weeks the eruption appeared as before.

M. M. Five grains of calomel once a month, with a cathartic, five grains of
rhubarb and a quarter of a grain of emetic tartar every night for many
weeks. With this preparation mercurial plasters, made without turpentine,
and applied every night, and taken off every morning, will sometimes
succeed, and may be used with safety. But blistering the face all over the
eruption, beginning with a part, succeeds better than any other means, as I
have more than once experienced.--Something like this is mentioned in the
Letters of Lady Mary Wortley Montague, who blistered her face with balsam
of Mecca.

Mrs. F. had for many years had a disagreeably looking eruption on her chin,
after a cathartic with calomel, she was advised to blister her whole chin;
on the healing of the blister a few eruptions again appeared, which ceased
on the application of a second blister. She took rhubarb five grains, and
emetic tartar a quarter of a grain every night for many weeks.

Miss L. a young lady about eighteen, had tried variety of advice for
pimples over the greatest part of her face in vain. She took the above
medicines internally, and blistered her face by degrees all over and became
quite beautiful. A spot or two now and then appeared, and on this account
she frequently slept with parts of her face covered with mercurial plaster,
made without turpentine, which was held on by a pasteboard mask, and taken
off in the mornings; if any part of the plaster adhered, a little butter or
oil destroyed the adhesion.

7. _Odontitis._ Inflammatory tooth-ach is occasioned by inflammation of the
membranes of the tooth, or a caries of the bone itself. The gum sometimes
suppurates, otherwise a swelling of the cheek succeeds by association, and
thus the violence of the pain in the membranes of the tooth is relieved,
and frequently cured; and when this happens the disease properly belongs to
Class IV. as it so far resembles the translations of morbid actions in the
gout and rheumatism.

At other times the tooth dies without caries, especially in people about
sixty years of age, or before; and then it stimulates its involving
membrane, like any other extraneous substance. The membrane then becomes
inflamed and thickened, occasioning some pain, and the tooth rises upwards
above the rest, and is gradually pushed out whole and undecayed; on its
rising up a pus-like mucus is seen discharged from the gum, which surrounds
it; and the gum seems to have left the tooth, as the fangs or roots of it
are in part naked.

M. M. Where the tooth is sound it can only be saved by evacuations by
venesection, and a cathartic; and after its operation two grains of opium,
a blister may also be used behind the ear, and ether applied to the cheek
externally. In slighter cases two grains of opium with or without as much
camphor may be held in the mouth, and suffered to dissolve near the
affected tooth, and be gradually swallowed. See Class I. 2. 4. 12.
Odontalgia may be distinguished from otitis by the application of cold
water to the affected tooth; for as the pain of common tooth-ach is owing
to torpor, whatever decreases stimulus adds to the torpor and consequent
pain; whereas the pain of an inflamed tooth being ceased by the increased
action of the membranes of it is in some measure alleviated by the
application of cold.

8. _Otitis._ Inflammation and consequent suppuration of some membranes of
the internal ear frequently occur in children, who sleep in cold rooms, or
near a cold wall, without a night-cap. If the bones are affected, they come
out in a long process of time, and the child remains deaf of that ear. But
in this case there is generally a fever attends this inflammation; and it
then belongs to another genus.

M. M. A warmer night-cap. Warmish water should be gently syringed into the
ear to keep it clean twice a day; and if it does not heal in a week, a
little spirit of wine should be added; first about a fourth part, and it
should be gradually increased to half rectified spirit and half water: if
it continues long to discharge matter with a very putrid smell, the bones
are injured, and will in time find their exit, during which time the ear
should be kept clean by filling it with a weaker mixture of spirit of wine
and water; or a solution of alum in water; which may be poured into the
ear, as the head is inclined, and shook out again by turning the head, two
or three times morning and evening. See Class II. 1. 4. 10.

9. _Fistula lacrymalis._ The lacrymal sack, with its puncta lacrymalia and
nasal duct, are liable to be destroyed by suppuration without fever; the
tears then run over the eyelids, and inflame the edges of them, and the
cheeks, by their perpetual moisture, and saline acrimony.

M. M. By a nice surgical operation a new aperture is to be made from the
internal corner of the eye into the nostril, and a silver tube introduced,
which supplies the defect by admitting the tears to pass again into the
nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has
improved this operation.

10. _Fistula in ano._ A mucous discharge from the anus, called by some
white piles, or matter from a suppurated pile, has been mistaken for the
matter from a concealed fistula. A bit of cotton wool applied to the
fundament to receive the matter, and renewed twice a day for a week or two,
should always be used before examination with the probe. The probe of an
unskilful empyric sometimes does more harm in the loose cellular membrane
of these parts than the original ulcer, by making a fistula he did not
find. The cure of a fistula in ano of those, who have been much addicted to
drinking spirituous liquor, or who have a tendency to pulmonary
consumption, is frequently of dangerous consequence, and is succeeded by
ulcers of the lungs, and death.

M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a
day; the pepper-corns should be cut each into two or three pieces. The late
Dr. Monro of Edinburgh asserted in his lectures, that he had known a
fistula in ano cured by injecting first a mixture of rectified spirit of
wine and water; and by gradually increasing the strength of it, till the
patient could bear rectified spirit alone; by the daily use of which at
length the sides of the fistula became callous, and ceased to discharge,
though the cavity was left. A French surgeon has lately affirmed, that a
wire of lead put in at the external opening of the ulcer, and brought
through the rectum, and twisted together, will gradually wear itself
through the gut, and thus effect a cure without much pain. The ends of the
leaden wire must be twisted more and more as it becomes loose. Or, lastly,
it must be laid open by the knife.

11. _Fistula urethræ._ Where a stricture of the urethra exists, from
whatever cause, the patient, in forcing the stream of urine through the
structure, distends the urethra behind it; which after a time is liable to
burst, and to become perforated; and some of the urine is pushed into the
cellular membrane, occasioning fistulas, which sometimes have large
surfaces producing much matter, which is pressed out at the time of making
water, and has been mistaken for a catarrh of the bladder; these fistulas
sometimes acquire an external opening in the perinæum, and part of the
urine is discharged that way.

Can this matter be distinguished from mucus of the bladder by the criterion
delivered in Class II. 1. 6. 6?

M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The
latter may be had at No. 37, Red-lion street, Holborn, London. The former
are easily made, by moistening the catgut, and keeping it stretched till
dry, and then rounding one end with a pen-knife. The use of a warm bath
every day for near an hour, at the heat of 94 or 96 degrees, for two or
three months, I knew to be uncommonly successful in one case; the extensive
fistulas completely healing. The patient should introduce a bougie always
before he makes water, and endeavour to make it as slowly as possible. See
Class I. 2. 3. 24.

12. _Hepatitis chronica._ Chronical inflammation of the liver. A collection
of matter in the liver has frequently been found on dissection, which was
not suspected in the living subject. Though there may have been no certain
signs of such a collection of matter, owing to the insensibility of the
internal parts of this viscus; which has thus neither been attended with
pain, nor induced any fever; yet there may be in some cases reason to
suspect the existence of such an abscess; either from a sense of fulness in
the right hypochondre, or from transient pains sometimes felt there, or
from pain on pressure, or from lying on the left side, and sometimes from a
degree of sensitive fever attending it.

Dr. Saunders suspects the acute hepatitis to exist in the inflammation of
the hepatic artery, and the chronical one in that of the vena portarum.
Treatise on the Liver. Robinson. London.

13. _Scrophula suppurans._ Suppurating scrophula. The indolent tumors of
the lymphatic glands are liable, after a long time, to regain their
sensibility; and then, owing to their former torpor, an increased action of
the vessels, beyond what is natural, with inflammation, is the consequence
of their new life, and suppuration succeeds. This cure of scrophula
generally happens about puberty, when a new energy pervades the whole
system, and unfolds the glands and organs of reproduction.

M. M. See Class I. 2. 3. 21. Where scrophulous ulcers about the neck are
difficult to heal, Dr. Beddoes was informed, in Ireland, that an empyric
had had some success by inflaming them by an application of wood sorrel,
oxalis acetosella, the leaves of which are bruised in a mortar, and applied
on the ulcers for two or three days, and then some more lenient application
is used.

A poor boy, about twelve years old, had a large scrophulous ulcer on one
side of the chest beneath the clavicle, and another under his jaw; he was
directed, about three weeks ago, to procure a pound of dry oak-bark from
the tanners, and to reduce it to fine powder, and to add to it one ounce of
white lead in fine powder, and to cover the ulcers daily with it, keeping
it on by brown paper and a bandage. He came to me a few minutes ago, to
shew me that both the ulcers are quite healed. The constant application of
linen rags, moistened with a solution of an ounce of sugar of lead in a
pint of water, I think I have seen equally efficacious.

14. _Scorbutus suppurans._ In the sea-scurvy there exists an inactivity of
venous absorption, whence vibices and petechiæ, and sometimes ulcers. As
the column of blood pressing on the of origins of the veins of the lower
extremities, when the body is erect, opposes the ascent of the blood in
them, they are more frequently liable to become enlarged, and to produce
varixes, or vibices, or, lastly, ulcers about the legs, than on the upper
parts of the body. The exposure to cold is believed to be another cause of
ulcers on the extremities; as happens to many of the poor in winter at
Lisbon, who sleep in the open air, without stockings, on the steps of their
churches or palaces. See Class I. 2. 1. 15.

M. M. A bandage spread with plaster to cover the whole limb tight. Rags
dipped in a solution of sugar of lead. A warm flannel stocking or roller.
White lead and oak bark, both in fine powder. Horizontal rest.

15. _Scirrhus suppurans._ When a scirrhus affects any gland of no great
extent or sensibility, it is, after a long period of time, liable to
suppurate without inducing fever, like the indolent tumors of the
conglobate or lymphatic glands above mentioned; whence collections of
matter are often found after death both in men and other animals; as in the
liver of swine, which have been fed with the grounds of fermented mixtures
in the distilleries. Another termination of scirrhus is in cancer, as
described below. See Class I. 2. 3. 22.

16. _Carcinoma._ Cancer. When a schirrous tumor regains its sensibility by
nature, or by any accidental hurt, new vessels shoot amongst the yet
insensible parts of it, and a new secretion takes place of a very injurious
material. This cancerous matter is absorbed, and induces swelling of the
neighbouring lymphatic glands; which also become schirrous, and afterwards
cancerous.

This cancerous matter does not seem to acquire its malignant or contagious
quality, till the cancer becomes an open ulcer; and the matter secreted in
it is thus exposed to the air. Then it evidently becomes contagious,
because it not only produces hectic fever, like common matter in ulcers
open to the air; but it also, as it becomes absorbed, swells the lymphatic
glands in its vicinity; as those of the axilla, when the open cancer is on
the breast. See Class II. 1. 3.

Hence exsection before the cancer is open is generally a cure; but after
the matter has been exposed to the air, it is seldom of service; as the
neighbouring lymphatic glands are already infected. I have observed some of
these patients after the operation to have had diseased livers, which might
either have previously existed, or have been produced by the fear or
anxiety attending the operation.

Erosion with arsenic, after the cancer is become an open ulcer, has
generally no better effect than exsection, but has been successful before
ulceration. The best manner of using arsenic, is by mixing one grain with a
dram of lapis calaminaris, and strewing on the cancer some of the powder
every day, till the whole is destroyed.

Cancers on the face are said to arise from the periosteum, and that unless
this be destroyed by the knife, or by caustics, the cancer certainly
recurs. After the cancer becomes an open ulcer of some extent, a purulent
fever supervenes, as from other open ulcers, and gradually destroys the
patient. See Class II. 1. 6. 13.

Two very interesting cases have been lately published by Dr. Ewart, of
Bath, in which carbonic acid gas, or fixed air, was kept constantly in
contact with the open cancerous ulcers of the breast; which then healed
like other common ulcers. This is rather to be ascribed to the exclusion of
oxygen, than to any specific virtue in the carbonic acid. As in common
ulcers the matter does not induce hectic fever, till it has been exposed to
the air, and then probably united with oxygen.

The manner of applying the fixed air, is by including the cancer in one
half or hemisphere of a large bladder; the edges are made to adhere to the
skin by adhesive plaster, or perhaps a mixture of one part of honey with
about twenty parts of carpenter's glue might better suit some tender skins.
The bladder is then kept constantly filled with carbonic acid gas, by means
of a pipe in the neck of it; and the matter let out at a small aperture
beneath.

17. _Arthrocele._ Swelling of the joints seems to have its remote cause in
the softness of the bones, for they could not swell unless they were
previously softened, see Class I. 2. 2. 14. The epiphyses, or ends of the
bones, being naturally of a looser texture, are most liable to this
disease, and perhaps the cartilages and capsular ligaments may also become
inflamed and swelled along with the heads of the bones. This malady is
liable to distort the fingers and knees, and is usually called gout or
rheumatism; the former of which is liable to disable the fingers by
chalk-stones, and thence to have somewhat a similar appearance. But the
arthrocele, or swelling of the joints, affects people who have not been
intemperate in the use of fermented or spirituous liquors; or who have not
previously had a regular gout in their feet; and in both these
circumstances differs from the gout. Nor does it accord with the
inflammatory rheumatism, as it is not attended with fever, and because the
tumors of the joints never entirely subside. The pain or sensibility, which
the bones acquire, when they are inflamed, may be owing to the new vessels,
which shoot in them in their soft state, as well as to the distention of
the old ones.

M. M. Half a grain of opium twice a day, gradually increased to a grain,
but not further, for many months. Thirty grains of powder of bark twice a
day for many months. Ten grains of bone-ashes, or calcined hartshorn, twice
a day, with decoction of madder? Soda phosphorata?

18. _Arthropuosis._ Joint-evil. This differs from the former, as that never
suppurates; these ulcers of the joints are generally esteemed to arise from
scrophula; but as scrophula is a disease of the lymphatic or absorbent
system, and this consists in the suppuration of the membranes, or glands,
or cartilages about the joints, there does not seem a sufficient analogy to
authorize their arrangement under the same name.

The white swelling of the knee, when it suppurates, comes under this
species, with variety of other ulcers attended with carious bones.

19. _Caries ossium._ A caries of the bones may be termed a suppuration of
them; it differs from the above, as it generally is occasioned by some
external injury, as in decaying teeth; or by venereal virus, as in nodes on
the tibia; or by other matter derived to the bone in malignant fevers; and
is not confined to the ends of them.

The separation of the dead bone from the living is a work of some time. See
Sect. XXXIII. 3. 1.

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS V.

_With the Production of new Vessels by external Membranes or Glands,
without Fever._

The ulcers, or eruptions, which are formed on the external skin, or on the
mouth or throat, or on the air-cells of the lungs, or on the intestines,
all of which are more or less exposed to the contact of the atmospheric
air, which we breathe, and which in some proportion we swallow with our
food and saliva; or to the contact of the inflammable air, or hydrogen,
which is set at liberty by the putrefying aliment in the intestines, or by
putrefying matter in large abscesses; all of them produce contagious
matter; which, on being inoculated into the skin of another person, will
produce fever, or a similar disease.

In some cases even the matter formed beneath the skin becomes in some
degree contagious, at least so much so as to produce fever of the hectic or
malignant kind, as soon as it has pierced through the skin, and has thus
gained access to some kind of air; as the fresh puss of a common abscess;
or the putrid pus of an abscess, which has been long confined; or of
cancerous ulcers.

From this analogy there is reason to suspect, that the matter of all
contagious diseases, whether with or without fever, is not infectious till
it has acquired something from the air; which, by oxygenating the secreted
matter, may probably produce a new acid. And secondly, that in hectic fever
a part of the purulent matter is absorbed; or acts on the surface of the
ulcer; as variolous matter affects the inoculated part of the arm. And that
hectic fever is therefore caused by the matter of an open ulcer; and not by
the sensation in the ulcer independent of the aerated pus, which lies on
it. Which may account for the venereal matter from buboes not giving the
infection, according to the experiments of the late Mr. Hunter, and for
some other phenomena of contagion. See Variola discreta, Class II. 1. 3. 9.

SPECIES.

1. _Gonorrhoea venerea._ A pus-like contagious material discharged from the
urethra after impure cohabitation, with smarting or heat on making water;
which begins at the external extremity of the urethra, to which the
contagious matter is applied, and where it has access to the air.

M. M. In this state of the venereal disease once venesection, with mild
cathartics of senna and manna, with mucilage, as almond emulsion, and gum
arabic, taken for two or three weeks, absolve the cure. Is camphor of use
to relieve the ardor urinæ? Do balsams increase or lessen the heat of
urine? Neutral salts certainly increase the smarting in making water, by
increasing the acrimony of the urine.

Can the discharge from the urethra be soon stopped by saturnine injections,
or mercurial ones, or with solution of blue vitriol, at first very dilute,
and gradually made stronger? And at the same time lest the syphilis, or
general disease, should supervene, the patient might take a quarter of a
grain of corrosive sublimate of mercury twice a day, as directed below?

2. _Syphilis._ Venereal disease. The contagion shews itself in ulcers on
the part first inoculated, as chancres; ulcers on the tonsils succeed, with
eruption on the skin, especially about the roots of the hair; afterwards on
other parts of the skin, terminating in dry scabs; and lastly, with pain
and swelling of the bones.

The corona veneris, or crown of Venus, consists of the eruptions at the
roots of the hair appearing most round the forehead; which is occasioned by
this part being more exposed to the air; which we observed, at the
beginning of this genus, either produces or increases the virulence of
contagious matter. But it is difficult to conceive from this history, why
the throat should be first affected; as it cannot be supposed, that the
disease is so often taken by the saliva, like the small-pox, though this
may sometimes occur, perhaps very often. The connection between the
genitals in men and the throat, is treated of in Class IV. 1. 2. 7.
Hydrophobia.

M. M. A quarter of a grain of corrosive sublimate of mercury, taken thrice
a day for five or six weeks, made into a pill with breadcrumbs, or
dissolved in a spoonful of brandy and water, is a very efficacious and
almost certain cure. When it does not succeed, it is owing either to the
drug being bad, or to its having precipitated from the brandy, or from its
being spoiled in the pill by long keeping. Opium contributes much to
expedite the cure both of the simple gonorrhoea, and of venereal ulcers, by
increasing absorption both from the mucous membrane, and from the surface
of ulcers.

3. _Lepra._ Leprosy. Leprosy of the Greeks. The skin is rough with white
branny scales, which are full of chinks; often moist beneath, and itching.
The scales on the head or arms of some drinking people are a disease of
this kind. The perspirable matter designed for the purpose of lubricating
the external skin is secreted in this disease in a too viscid state, owing
to the inflammation of the subcutaneous vessels; and, as the absorbents act
too strongly at the same time, a viscid mucus is left adhering to the
surface of the skin.

In the leprosy of the Jews, described in the thirteenth and fourteenth
chapters of Leviticus, the depression of the sore beneath the surface of
the skin, and the hairs in it becoming white, seem to have been the
principal circumstances, which the priest was directed to attend to for the
purpose of ascertaining the disease.

M. M. Essence of antimony from 20 drops to 100 twice or thrice a day, with
half a pint of decoction of elm-bark; or tincture of cantharides from 20 to
60 drops four times a day; or sublimate of mercury, with much diluting
fluid. Acid of vitriol? Perhaps the cure chiefly depends on much dilution
with water, from two to four pints a day, in which elm-bark, or pine-buds,
or juniper-tops, may be boiled. Bath or Buxton water drank in large
quantities. Warm bath. Oil-skin bound on the part to confine the
perspirable matter. Ointment of tar and suet; or poultice for two or three
days, and then cerate with lapis calaminaris. Diet of raisins and bread.
Abstinence from wine, beer, and all spirits.

4. _Elephantiasis._ Leprosy of the Arabs. A contagious disease; the skin is
thickened, wrinkled, rough, unctuous, destitute of hair, without any
sensation of touch in the extremities of the limbs; the face deformed with
tubercles; the voice hoarse, and with a nasal tone. Cullen.

5. _Framboesia._ Yaws is said to be contagious and hereditary. It
principally affects the negroes in the West Indies. Edinb. Essays, Vol. VI.

6. _Psora._ Itch. A contagious prurient eruption. There are two kinds of
itch, that which appears between the fingers, and under the joints of the
knees and elbows; and that which seldom is seen in these places, but all
over the other parts of the body. The latter is seldom thought to be the
itch, as it does not easily infect even a bedfellow, and resists the usual
means of cure by brimstone.

If the itch be cured too hastily by rubbing mercurial or arsenical
preparations over the whole body, or on too great a part of it, many bad
symptoms are produced; as weakness of digestion, with pale bloated
countenance, and tendency to dropsy. I have twice seen St. Vitus's dance
occur from the use of a mercurial girdle; and once a swelled liver. I have
also seen a swelled spleen and swelled legs from the external use of
arsenic in the cure of the itch. And very numerous and large phlegmons
commonly succeed the too hasty cure of it by other means.

There does not appear a strict analogy between the hasty cure of the itch,
and the retrocession of the pustles in the secondary fever of the
small-pox; because in that the absorption of the matter is evinced by the
swelling of the face and hands, as the pustles recede, as explained in
Class II. 1. 3. 9. Variola discreta. And a fever is produced by this
absorption; neither of which happen, when the pustles of the itch are
destroyed by mercury or arsenic.

Nor can these inconveniences, which occur on the too hasty cure of the
itch, be explained by those which follow the cure of some kinds of gutta
rosea, Class II. 1. 4. 6. as in those the eruptions on the face were an
associated disease with inflammation of the liver or stomach, which they
were accustomed to relieve; whereas the itch is not known to have had any
previous catenation with other diseases.

In the itch there exists not only great irritation in the production of the
pustles, but great sensation is caused by their acrimony afterwards;
insomuch that the pain of itching, without the interrupted smarting
occasioned by scratching, would be intolerable. This great excitement of
the two sensorial powers of irritation and sensation is so great, when the
pustles are diffused over the whole surface of the body, that a torpor
succeeds the sudden ceasing of it; which affects those parts of the system,
which were most catenated with the new motions of the skin, as the stomach,
whence indigestion and flatulency; or which are generally most liable to
fall into torpor, as the numerous glands, which form the liver. Whence the
diseases consequent to the hasty cure of the itch are diseases of debility,
as tumid viscera, oedematous swellings, and St. Vitus's dance, which is a
debility of association. In the same manner indigestion, with green
evacuations, are said to follow an injudicious application of cerussa to
stop too hastily the exsudation behind the ears of children, Class I. 1. 2.
9. And dropsies are liable to succeed the cure of old ulcers of the legs,
which have long stimulated the system.

M. M. The size of a large pea, of an ointment consisting of one part of
white precipitate of mercury to six parts of hogs' lard well triturated
together, to be rubbed on a part of the body every night, and washed off
with soap and water next morning, till every part is cleared; with lac
sulphuris twenty grains to be taken every morning inwardly. Warm saline
bath, with white vitriol in it. Flowers of sulphur mixed with thick gruel,
with hogs fat. With either of which the body may be smeared all over.

7. _Psora ebriorum._ Elderly people, who have been much addicted to
spirituous drinks, as beer, wine, or alcohol, are liable to an eruption all
over their bodies; which is attended with very afflicting itching, and
which they probably propagate from one part of their bodies to another with
their own nails by scratching themselves. I saw fatal effects in one such
patient, by a too extensive use of a solution of lead; the eruption
disappeared, he became dropsical, and died; I suppose from the too suddenly
ceasing of the great stimulus caused by the eruptions over the whole skin,
as in the preceding article.

M. M. The patient should gradually accustom himself to half his usual
quantity of vinous potation. The warm bath, with one pound of salt to every
three gallons. Mercurial ointments on small parts of the skin at a time. A
grain of opium at night instead of the usual potation of wine or beer.

8. _Herpes._ Herpes consists of gregarious spreading excoriations, which
are succeeded by branny scales or scabs. In this disease there appears to
be a deficient absorption of the subcutaneous mucus, as well as
inflammation and increased secretion of it. For the fluid not only
excoriates the parts in its vicinity by its acrimony, but is very saline to
the taste, as some of these patients have assured me; I believe this kind
of eruption, as well as the tinea, and perhaps all other cutaneous
eruption, is liable to be inoculated in other parts of the body by the
finger-nails of the patients in scratching themselves.

It is liable to affect the hands, and to return at distant periods; and is
probably a secondary disease, as well as the zona ignea, or shingles,
described below.

M. M. Poultice the eruption with bread and milk, or raw carrots grated, for
two or three whole days, to dilute or receive the discharged fluid, and
abate the inflammation; then cover the parts with fresh cerate mixed with
lapis calaminaris. On the parts not excoriated mercurial ointment, made of
one part of white calx of mercury and six of hogs' fat. Internally, after
venesection, gentle repeated cathartics. Lastly, the bark. Acid of vitriol.
Bolus Armeniæ, or testacia. Antimonials. Decoction of interior bark of elm.

9. _Zona ignea._ Shingles. This eruption has been thought a species of
herpes by some writers, and by others a species of erysipelas. Yellow or
livid vesicles appear, producing a corrosive ichor, which is sometimes
attended with a degree of fever. It is said to infest sometimes the thorax
and ribs, but its most general situation is on the small of the back, over
one kidney, extending forward over the course of one of the ureters.

There is reason to suspect, that this also is a secondary or sympathetic
disease, as well as the preceding one; but future observations are
required, before it can be removed to the fourth class, or diseases of
association. In three patients I have been induced to believe, that the
eruption on the loins was a translation of inflammation from the external
membrane of the kidney to the skin. They had, for a day or two before the
appearance of the eruption, complained of a dull pain on the region of one
kidney, but without vomiting; by which it was distinguished from nephritis
interna, or gravel; and without pain down the outside of the thigh, by
which it was distinguished from sciatica. In other situations the shingles
may sympathize with other internal membranes, as in a case published by Dr.
Russel (De Tabe Glandulari), where the retrocession of the shingles was
succeeded by a serious dyspnæa.

M. M. Venesection, if the pulse is strong. Calomel three or four grains,
very mild repeated cathartics. Poultice for a few days, then cerate of
lapis calaminaris, as in herpes. A grain of emetic tartar dissolved in a
pint of water, and taken so as to empty the stomach and intestines, is said
much to hasten the cure; compresses soaked in a saturnine solution are
recommended externally on the eruption; and cerate where there are
ulcerations. Desanet's Surgical Journal, Vol. II. p. 378. If this be a
vicarious disease, it should continue half a lunation; lest, on its
ceasing, the bad habits of motion of the primary disease should not have
been so perfectly dissevered, but that they may recur.

10. _Annulus repens._ Ring-worm. A prurient eruption formed in a circle,
affecting children, and would seem to be the work of insects, according to
the theory of Linnæus, who ascribes the itch and dysentery to microscopic
animalcula. These animalcula are probably the effect, and not the cause, of
these eruptions; as they are to be seen in all putrescent animal fluids.
The annular propagation of the ring-worm, and its continuing to enlarge its
periphery, is well accounted for by the acrimony of the ichor or saline
fluid eroding the skin in its vicinity.

M. M. Cover the eruption daily with ink. With white mercurial ointment, as
described above in herpes. With solution of white vitriol ten grains to an
ounce. These metallic calces stimulate the absorbents into stronger action,
whence the fluid has its saline part reabsorbed, and that before it has
access to the air, which probably adds to its acrimony by oxygenating it,
and thus, producing a new acid.

11. _Tinea._ Scald head. This contagious eruption affects the roots of the
hair, and is generally most virulent around the edges of the hair on the
back part of the head; as the corona veneris appears most on the edges of
the hair on the forepart of the head; for in these parts the eruption about
the roots of the hair is most exposed to the external air, by which its
acrimony or noxious quality is increased.

The absorption of the matter thus oxygenated swells the lymphatics of the
neck by its stimulus, occasioning many little hard lumps beneath the seat
of the eruption; when this happens, the sooner it is cured the better, lest
the larger lymphatics of the neck should become affected.

M. M. The art of curing these eruptions consists, first, in abating the
inflammation, and consequent secretion of a noxious material. Secondly, to
prevent its access to the air, which so much increases its acrimony. And
thirdly, to promote the absorption of it, before it has been exposed to the
air; for these purposes venesection once, and gentle cathartics, which
promote absorption by emptying the blood-vessels. Next poultices and
fomentations, with warm water, abate inflammation by diluting the saline
acrimony of the secreted fluid, and abating the painful sensation.
Afterwards cerate joined with some metallic calx, as of zinc or lead, or
solution of lead, mercury, or copper, or iron, which may stimulate the
absorbent system into stronger action.

Cover the shaved head with tar and suet, and a bladder; this, by keeping
the air from the secreted fluid, much contributes to its mildness, and the
stimulus of the tar increases its absorption. See the three preceding
species of this genus.

12. _Crusta lactea._ Milk-crust is a milder disease than tinea, affecting
the face as well as the hairy scalp of very young children. It is not
infectious, nor liable to swell the lymphatics in its vicinity like the
tinea.

M. M. Cover the eruption with cerate made with lapis calaminaris, to be
renewed every day. Mix one grain of emetic tartar with forty grains of
chalk, and divide into eight papers, one to be taken twice a day, or with
magnesia alba, if stools are wanted. The child should be kept cool and much
in the air.

13. _Trichoma._ Plica polonica. A contagious disease, in which the hair is
said to become alive and bleed, forming inextricable knots or plaits of
great length, like the fabled head of Medusa, with intolerable pain, so as
to confine the sufferer on his bed for years.

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS VI.

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

SPECIES.

1. _Febris sensitiva._ Sensitive fever, when unmixed with either irritative
or inirritative fever, may be distinguished from either of them by the less
comparative diminution of muscular strength; or in other words, from its
being attended with less diminution of the sensorial power of irritation.
An example of unmixed sensitive fever may generally be taken from the
pulmonary consumption; in this disease patients are seen to walk about with
ease, and to do all the common offices of life for weeks, and even months,
with a pulse of 120 strokes in a minute; while in other fevers, whether
irritated or inirritated, with a pulse of this frequency, the patient
generally lies upon the bed, and exerts no muscular efforts without
difficulty.

The cause of this curious phenomenon is thus to be understood; in the
sensitive fever a new sensorial power, viz. that of sensation, is
superadded to that of irritation; which in other fevers alone carries on
the increased circulation. Whence the power of irritation is not much more
exhausted than in health; and those muscular motions, which are produced in
consequence of it, as those which are exerted in keeping the body upright
in walking, riding, and in the performance of many customary actions, are
little impaired. For an account of the irritated sensitive fever, see Class
II. 1. 2. 1.; for the inirritated sensitive fever, Class II. 1. 3. 1. IV.
2. 4. 11.

2. _Febris a pure clauso._ Fever from inclosed matter is generally of the
irritated sensitive kind, and continues for many weeks, and even months,
after the abscess is formed; but is distinguished from the fever from
aerated matter in open ulcers, because there are seldom any night-sweats,
or colliquative diarrhoea in this, as in the latter. The pulse is also
harder, and requires occasional venesection, and cathartics, to abate the
inflammatory fever; which is liable to increase again every three or four
days, till at length, unless the matter has an exit, it destroys the
patient. In this fever the matter, not having been exposed to the air, has
not acquired oxygenation; in which a new acid, or some other noxious
property, is produced; which acts like contagion on the constitution
inducing fever-fits, called hectic fever, which terminate with sweats or
diarrhoea; whereas the matter in the closed abscess is either not absorbed,
or does not so affect the circulation as to produce diurnal or hectic
fever-fits; but the stimulus of the abscess excites so much sensation as to
induce perpetual pyrexia, or inflammatory fever, without such marked
remissions. Nevertheless there sometimes is no fever produced, when the
matter is lodged in a part of little sensibility, as in the liver; yet a
white pus-like sediment in those cases exists I believe generally in the
urine, with occasional wandering pains about the region of the liver or
chest.

3. _Vomica._ An abscess in the lungs is sometimes produced after
peripneumony, the cough and shortness of breath continue in less degree,
with difficulty in lying on the well side, and with sensitive irritated
fever, as explained in the preceding article.

The occasional increase of fever, with hard pulse and sizy blood, in these
patients, is probably owing to the inflammation of the walls of the vomica;
as it is attended with difficulty of breathing, and requires venesection.
Mr. B----, a child about seven years old, lived about five weeks in this
situation, with a pulse from 150 to 170 in a minute, without sweats, or
diarrhoea, or sediment in his water, except mucus occasionally; and took
sufficient nourishment during the whole time. The blood taken was always
covered with a strong cupped size, and on his death three or four pints of
matter were found in one side of the chest; which had probably, but lately,
been effused from a vomica. This child was frequently induced to swing,
both in a reciprocating and in a rotatory swing, without any apparent
absorption of matter; in both these swings he expressed pleasure, and did
not appear to be vertiginous.

M. M. Repeated emetics. Digitalis? Perseverance in rotatory swinging. See
Class II. 1. 6. 7.

Mr. I. had laboured some months under a vomica after a peripneumony, he was
at length taken with a catarrh, which was in some degree endemic in March
1795, which occasioned him to sneeze much, during which a copious
hæmorrhage from the lungs occurred, and he spit up at the same time half a
pint of very fetid matter, and recovered. Hence errhines may be
occasionally used with advantage.

4. _Empyema._ When the matter from an abscess in the lungs finds its way
into the cavity of the chest, it is called an empyema. A servant man, after
a violent peripneumony, was seized with symptoms of empyema, and it was
determined, after some time, to perform the operation; this was explained
to him, and the usual means were employed by his friends to encourage him,
"by advising him not to be afraid." By which good advice he conceived so
much fear, that he ran away early next morning, and returned in about a
week quite well. Did the great fear promote the absorption of the matter,
like the sickness occasioned by digitalis? Fear renders the external skin
pale; by this continued decrease of the action of the absorbents of the
skin might not those of the lungs be excited into greater activity? and
thus produce increased pulmonary absorption by reverse sympathy, as it
produces pale urine, and even stools, by direct sympathy?

M.M. Digitalis?

5. _Febris Mesenterica._ Fever from matter formed in the mesentery is
probably more frequent than is suspected. It commences with pain in the
bowels, with irritated sensitive fever; and continues many weeks, and even
months, requiring occasional venesection, and mild cathartics; till at
length the continuance of the pyrexia, or inflammatory fever, destroys the
patient. This is an affection of the lymphatic glands, and properly belongs
to scrophula; but as the matter is not exposed to the air, no hectic fever,
properly so called, is induced.

6. _Febris a pure aerato._ Fever from aerated matter. A great collection of
matter often continues a long time, and is sometimes totally absorbed, even
from venereal buboes, without producing any disorder in the arterial
system. At length, if it becomes putrid by its delay, and one part of the
matter thus becomes aerated by the air given out by the other part; or if
the ulcer has been opened, so that any part of it has been exposed to the
air for but one day, a hectic fever is produced. Whence the utility arises
of opening large abscesses by setons, as in that case little or no hectic
fever is induced; because the matter is squeezed out by the side of the
spongy threads of cotton, and little or no air is admitted; or by tapping
the abscess with a trocar, as mentioned in ischias, Class II. 1. 2. 18.

In this fever the pulse is about 120 in a minute, and its access is
generally in an evening, and sometimes about noon also, with sweats or
purging towards morning, or urine with pus-like sediment; and the patients
bear this fever better than any other with so quick a pulse; and lastly,
when all the matter from a concealed ulcer is absorbed, or when an open
ulcer is healed, the hectic fever ceases. Here the absorbed matter is
supposed to produce the fever, and the diarrhoea, sweats, or copious muddy
urine, to be simply the consequence of increased secretion, and not to
consist of the purulent matter, which was supposed to be absorbed from the
ulcer. See Sudor calidus, Class I. 1. 2. 3.

The action of the air on ulcers, as we have already shewn, increases the
acrimony of the purulent matter, and even converts it into a weaker kind of
contagious matter; that is, to a material inducing fever. This was ascribed
to the union of the azotic part of the atmosphere with the effused pus in
Sect. XXVIII. 2. but by contemplating more numerous facts and analogies, I
am now induced to believe, that it is by the union of oxygen with it;
first, because oxygen so greedily unites with other animal substances, as
the blood, that it will pass through a moist bladder to combine with it,
according to the experiment of Dr. Priestley. Secondly, because the poisons
of venomous creatures are supposed to be acids of different kinds, and are
probably formed by the contact of air after their secretion. And lastly,
because the contagious matter from other ulcers, as in itch, or small-pox,
are formed on external membranes, and are probably combinations of animal
matter and oxygen, producing other new acids; but further experiments must
determine this question.

It was thought a subject of consequence by the Æsculapian Society at
Edinburgh, to find a criterion which should distinguish pus from mucus, for
the purpose of more certainly discovering the presence of ulcers in
pulmonary diseases, or in the urinary passages. For this purpose that
society offered their first gold medal, which was conferred on the late Mr.
Charles Darwin, in the year 1778, for his experiments on this subject. From
which he deduces the following conclusions:

    "1. Pus and mucus are both soluble in the vitriolic acid, though in
    very different proportions, pus being much the less soluble.

    2. The addition of water to either of these compounds decomposes it;
    the mucus thus separated, either swims on the mixture, or forms large
    flocci in it; whereas the pus falls to the bottom, and forms on
    agitation a uniform turbid mixture.

    3. Pus is diffusible through a diluted vitriolic acid, though mucus is
    not; the same occurs with water, or a solution of sea salt.

    4. Nitrous acid dissolves both pus and mucus; water added to the
    solution of pus produces a precipitate; and the fluid above becomes
    clear and green; while water and the solution of mucus form a dirty
    coloured fluid.

    5. Alkaline lixivium dissolves (though sometimes with difficulty)
    mucus, and generally pus.

    6. Water precipitates pus from such a solution, but does not mucus.

    7. Where alkaline lixivium does not dissolve pus, it still
    distinguishes it from mucus; as it then prevents its diffusion through
    water.

    8. Coagulable lymph is neither soluble in diluted nor concentrated
    vitriolic acid.

    9. Water produces no change on a solution of serum in alkaline
    lixivium, until after long standing, and then only a very slight
    sediment appears.

    10. Corrosive sublimate coagulates mucus, but does not pus.

    From the above experiments it appears, that strong vitriolic acid and
    water, diluted vitriolic acid, and caustic alkaline lixivium and water
    will serve to distinguish pus from mucus; that the vitriolic acid can
    separate it from coagulable lymph, and alkaline lixivium from serum.

    And hence, when a person has any expectorated material, the composition
    of which he wishes to ascertain, let him dissolve it in vitriolic acid,
    and in caustic alkaline lixivium; and then add pure water to both
    solutions: and if there is a fair precipitation in each, he may be
    assured that some pus is present. If in neither a precipitation occurs,
    it is a certain test, that the material is entirely mucus. If the
    material cannot be made to dissolve in alkaline lixivium by time and
    trituration, we have also reason to believe that it is pus."
    Experiments on Pus and Mucus. Cadell. London.

7. _Phthisis pulmonalis._ In pulmonary consumption the fever is generally
supposed to be the consequence of the stimulus of absorbed matter
circulating in the blood-vessels, and not simply of its stimulus on their
extremities in the surface of the ulcers; as mentioned in Class II. 1. 5.
and Class II. 1. 3. 9. The ulcers are probably sometimes occasioned by the
putrid acrimony of effused blood remaining in the air-cells of the lungs
after an hæmoptoe. See Class I. 2. 1. 9. The remote cause of consumption is
ingeniously ascribed by Dr. Beddoes to the hyper-oxygenation of the blood,
as mentioned Section XXVIII. 2.

As the patients liable to consumption are of the inirritable temperament,
as appears by the large pupils of their eyes; there is reason to believe,
that the hæmoptoe is immediately occasioned by the deficient absorption of
the blood at the extremities of the bronchial vein; and that one difficulty
of healing the ulcers is occasioned by the deficient absorption of the
fluids effused into them. See Sect. XXX. 1. and 2.

The difficulty of healing pulmonary ulcers may be owing, as its remote
cause, to the incessant motion of all the parts of the lungs; whence no
scab, or indurated mucus, can be formed so as to adhere on them. Whence
these naked ulcers are perpetually exposed to the action of the air on
their surfaces, converting their mild purulent matter into a contagious
ichor; which not only prevents them from healing, but by its action on
their circumferences, like the matter of itch or tinea, contributes to
spread them wider. See the preceding article, and Sect. XXXIII. 2. 7. where
the pulmonary phthisis is supposed to be infectious.

This acidifying principle is found in all the metallic calces, as in lapis
calaminaris, which is a calciform ore of zinc; and in cerussa, which is a
calx of lead; two materials which are powerful in healing excoriations, and
ulcers, in a short time by their external application. How then does it
happen, that the oxygen in the atmosphere should prevent pulmonary ulcers
from healing, and even induce them to spread wider; and yet in its
combination with metals, it should facilitate their healing? The healing of
ulcers consists in promoting the absorption of the fluids effused into
them, as treated of in Section XXXIII. 3. 2. Oxygen in combination with
metals, when applied in certain quantity, produces this effect by its
stimulus; and the metallic oxydes not being decomposed by their contact
with animal matter, no new acid, or contagious material, is produced. So
that the combined oxygen, when applied to an ulcer, simply I suppose
promotes absorption in it, like the application of other materials of the
articles sorbentia or incitantia, if applied externally; as opium, bark,
alum. But in the pulmonary ulcers, which cannot protect themselves from the
air by forming a scab, the uncombined oxygen of the atmosphere unites with
the purulent matter, converting it into a contagious ichor; which by
infection, not by erosion, enlarges the ulcers, as in the itch or tinea;
which might hence, according to Dr. Beddoes's ingenious theory of
consumption, be induced to heal, if exposed to an atmosphere deprived of a
part of its oxygen. This I hope future experiments will confirm, and that
the pneumatic medicine will alleviate the evils of mankind in many other,
as well as in this most fatal malady.

M. M. First, the respiration of air lowered by an additional quantity of
azote, or mixed with some proportion of hydrogen, or of carbonic acid air,
may be tried; as described in a late publication of Dr. Beddoes on the
medicinal use of factitious airs. Johnson, London. Or lastly, by breathing
a mixture of one tenth part of hydro-carbonate mixed with common air,
according to the discovery of Mr. Watt, which has a double advantage in
these cases, of diluting the oxygen of the atmospheric air, and inducing
sickness, which increases pulmonary absorption, as mentioned below. An
atmosphere diluted with fixed air (carbonic acid) might be readily procured
by setting tubs of new wort, or fermenting beer, in the parlour and
lodging-room of the patient. For it is not acids floating in the air, but
the oxygen or acidifying principle, which injures or enlarges pulmonary
ulcers by combining with the purulent matter.

Another easy method of adding carbonic acid gas to the air of a room, would
be by means of an apparatus invented by Mr. Watt, and sold by Bolton and
Watt at Birmingham, as described in Dr. Beddoes' Treatise on Pneumatic
Medicine. Johnson, London. It consists of an iron pot, with an arm
projecting, and a method of letting water drop by slow degrees on chalk,
which is to be put into the iron pot, and exposed to a moderate degree of
heat over a common fire. By occasionally adding more and more chalk,
carbonic acid gas might be carried through a tin pipe from the arm of the
iron pot to any part of the room near the patient, or from an adjoining
room. In the same manner a diffusion of solution of flowers of zinc might
be produced and breathed by the patient, and would be likely much to
contribute to the healing of pulmonary ulcers; as observed by Mr. Watt. See
the treatise above mentioned.

Breathing over the vapour of caustic volatile alkali might easily be
managed for many hours in a day; which might neutralize the acid poison
formed on pulmonary ulcers by the contact of oxygen, and thus prevent its
deleterious quality, as other acids become less caustic, when they are
formed into neutral salts with alkalis. The volatile salt should be put
into a tin canister, with two pipes like horns from the top of it, one to
suck the air from, and the other to admit it.

[Illustration]

Secondly, the external ulcers in scrophulous habits are pale and flabby,
and naturally disinclined to heal, the deposition of fluids in them being
greater than the absorption; these ulcers have their appearance immediately
changed by the external application of metallic calxes, and the medicines
of the article Sorbentia, such as cerussa and the bark in fine powder, see
Class I. 2. 3. 21. and are generally healed in a short time by these means.
Induced by these observations, I wished to try the external application of
such powders to ulcers in the lungs, and constructed a box with a
circulating brush in it, as described in the annexed plate; into this box
two ounces of fine powder of Peruvian bark were put, and two drams of
cerussa in fine powder; on whirling the central brush, part of this was
raised into a cloud of powder, and the patient, applying his mouth to one
of the tin pipes rising out of the box, inhaled this powder twice a day
into his lungs. I observed it did not produce any cough or uneasiness. This
patient was in the last stage of consumption, and was soon tired of the
experiment, nor have I had such patients as I wished for the repetition of
it. Perhaps a fine powder of manganese, or of the flowers of zinc, or of
lapis calaminaris, might be thus applied to ulcers of the lungs with
greater advantage? Perhaps air impregnated with flowers of zinc in their
most comminuted state, might be a better way of applying this powder to the
lungs, as discovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine.
Johnson.

Thirdly, as the healing of an ulcer consists in producing a tendency to
absorption on its surface greater than the deposition on it; see Sect.
XXXIII. 3. 2. other modes of increasing pulmonary absorption, which are
perhaps more manageable than the preceding ones, may be had recourse to;
such as by producing frequent nausea or sickness. See Sect. XXIX. 5. 1. and
Art. IV. 2. The great and sudden absorption of fluid from the lungs in the
anasarca pulmonum by the sickness induced by the exhibition of digitalis,
astonishes those who have not before attended to it, by emptying the
swelled limbs, and removing the difficulty of breathing in a few hours.

The most manageable method of using digitalis is by making a saturated
tincture of it, by infusing two ounces of the powder of the leaves in a
mixture of four ounces of rectified spirit of wine, and four ounces of
water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are
to be taken twice in the morning part of the day, and to be so managed as
not to induce violent sickness. If sickness nevertheless comes on, the
patient must for a day or two omit the medicine; and then begin it again in
reduced doses.

Mr. ----, a young man about twenty, with dark eyes, and large pupils, who
had every symptom of pulmonary ulcers, I believed to have been cured by
digitalis, and published the case in the Transactions of the College, Vol.
III. But about two years afterwards I heard that he relapsed and died. Mr.
L----, a corpulent man, who had for some weeks laboured under a cough with
great expectoration, with quick pulse, and difficulty of breathing, soon
recovered by the use of digitalis taken twice a day; and though this case
might probably be a peripneumonia notha, or catarrh, it is here related as
shewing the power of pulmonary absorption excited by the use of this drug.

Another method of inducing sickness, and pulmonary absorption in
consequence, is by sailing on the sea; by which many consumptive patients
have been said to have received their cure; which has been erroneously
ascribed to sea-air, instead of sea-sickness; whence many have been sent to
breathe the sea-air on the coasts, who might have done better in higher
situations, where the air probably contains less oxygen gas, which is the
heaviest part of it. See a Letter from Dr. T. C. below.

A third method of inducing sickness, and consequent pulmonary absorption,
is by the vertigo occasioned by swinging; which has lately been introduced
into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed
that by swinging the hectic pulse became slower, which is explained in
Class IV. 2. 1. 10. The usual way of reciprocating swinging, like the
oscillations of a pendulum, produces a degree of vertigo in those, who are
unused to it; but to give it greater effect, the patient should be placed
in a chair suspended from the ceiling by two parallel cords in contact with
each other, the chair should then be forcibly revolved 20 or 40 times one
way, and suffered to return spontaneously; which induces a degree of
sickness in most adult people, and is well worthy an exact and pertinacious
trial, for an hour or two, three or four times a day for a month.

The common means of promoting absorption in ulcers, and of thickening the
matter in consequence, by taking the bark and opium internally, or by
metallic salts, as of mercury, steel, zinc, and copper, in small
quantities, have been repeatedly used in pulmonary consumption; and may
have relieved some of the symptoms. As mercury cures venereal ulcers, and
as pulmonary ulcers resemble them in their not having a disposition to
heal, and in their tendency to enlarge themselves, there were hopes, from
analogy, that it might have succeeded. Would a solution of gold in aqua
regia be worth trying? When vinegar is applied to the lips, it renders them
instantly pale, by promoting the venous absorption; if the whole skin was
moistened with warmish vinegar, would this promote venous absorption in the
lungs by their sympathy with the skin? The very abstemious diet on milk and
vegetables alone is frequently injurious. Flesh-meat once a day, with small
wine and water, or small beer, is preferable. Half a grain of opium twice a
day, or a grain, I believe to be of great use at the commencement of the
disease, as appears from the subsequent case.

Miss ----, a delicate young lady, of a consumptive family, when she was
about eighteen, had frequent cough, with quick pulse, a pain of her side,
and the general appearances of a beginning consumption. She took about five
drops of laudanum twice a day in a saline draught, which was increased
gradually to ten. In a few weeks she recovered, was afterwards married,
bore three or four children, and then became consumptive and died.

The following case of hereditary consumption is related by a physician of
great ability and very extensive practice; and, as it is his own case,
abounds with much nice observation and useful knowledge; and, as it has
been attended with a favourable event, may give consolation to many, who
are in a similar situation; and shews that Sydenham's recommendation of
riding as a cure for consumption is not so totally ineffectual, as is now
commonly believed.

    "J. C. aged 27, with black hair, and a ruddy complexion, was subject to
    cough from the age of puberty, and occasionally to spitting of blood.
    His maternal grandfather died of consumption under thirty years of age,
    and his mother fell a victim to this disease, with which she had long
    been threatened, in her 43d year, and immediately after she ceased to
    have children. In the severe winter of 1783-4, he was much afflicted
    with cough; and being exposed to intense cold, in the month of February
    he was seized with peripneumony. The disease was violent and dangerous,
    and after repeated bleedings as well as blisterings, which he supported
    with difficulty, in about six weeks he was able to leave his bed. At
    this time the cough was severe, and the expectoration difficult. A
    fixed pain remained on the left side, where an issue was inserted;
    regular hectic came on every day about an hour after noon, and every
    night heat and restlessness took place, succeeded towards morning by
    general perspiration.

    The patient, having formerly been subject to ague, was struck with the
    resemblance of the febrile paroxysm, with what he had experienced under
    that disease, and was willing to flatter himself it might be of the
    same nature. He therefore took bark in the interval of fever, but with
    an increase of his cough, and this requiring venesection, the blood was
    found highly inflammatory. The vast quantity of blood which he had lost
    from time to time, produced a disposition to fainting, when he resumed
    the upright posture, and he was therefore obliged to remain almost
    constantly in a recumbent position. Attempting to ride out in a
    carriage, he was surprised to find that he could sit upright for a
    considerable time, while in motion, without inconvenience, though, on
    stopping the carriage, the disposition to fainting returned.

    At this time, having prolonged his ride beyond the usual length, he one
    day got into an uneven road at the usual period of the recurrence of
    the hectic paroxysms, and that day he missed it altogether. This
    circumstance led him to ride out daily in a carriage at the time the
    febrile accession might be expected, and sometimes by this means it was
    prevented, sometimes deferred, and almost always mitigated.

    This experience determined him to undertake a journey of some length,
    and Bristol being, as is usual in such cases, recommended, he set out
    on the 19th of April, and arrived there on the 2d of May. During the
    greater part of this journey (of 175 miles) his cough was severe, and
    being obliged to be bled three different times on the road, he was no
    longer able to sit upright, but at very short intervals, and was
    obliged to lie at length in the diagonal of a coach. The hectic
    paroxysms were not interrupted during the journey, but they were
    irregular and indistinct, and the salutary effects of exercise, or
    rather of gestation, were impressed on the patient's mind.

    At Bristol he stayed a month, but reaped no benefit. The weather was
    dry and the roads dusty; the water insipid and inert. He attempted to
    ride on horseback on the downs, but was not able to bear the fatigue
    for a distance of more than a hundred yards. The necessity of frequent
    bleedings kept down his strength, and his hectic paroxysms continued,
    though less severe. At this time, suspecting that his cough was
    irritated by the west-winds bearing the vapour from the sea, he
    resolved to try the effects of an inland situation, and set off for
    Matlock in Derbyshire.

    During the journey he did not find the improvement he expected, but the
    nightly perspirations began to diminish; and the extraordinary fatigue
    he experienced proceeded evidently from his travelling in a
    post-chaise, where he could not indulge in a recumbent position. The
    weather at Bristol had been hot, and the earth arid and dusty. At
    Matlock, during the month of June 1784, there was almost a perpetual
    drizzle, the soil was wet, and the air moist and cold. Here, however,
    the patient's cough began to abate, and at intervals he found an
    opportunity of riding more or less on horseback. From two or three
    hundred yards at a time, he got to ride a mile without stopping; and at
    length he was able to sit on horseback during a ride from Mason's Bath
    to the village of Matlock along the Derwent, and round on the opposite
    banks, by the works of Mr. Arkwright, back to the house whence he
    started, a distance of five miles. On dismounting, however, he was
    seized with diliquium, and soon after the strength he had recovered was
    lost by an attack of the hæmorrhoids of the most painful kind, and
    requiring much loss of blood from the parts affected.

    On reflection, it appeared that the only benefit received by the
    patient was during motion, and continued motion could better be
    obtained in the course of a journey than during his residence at any
    particular place. This, and other circumstances of a private but
    painful nature, determined him to set out from Matlock on a journey to
    Scotland. The weather was now much improved, and during the journey he
    recruited his strength. Though as yet he could not sit upright at rest
    for half an hour together without a disposition to giddiness, dimness
    of sight, and deliquium, he was able to sit upright under the motion of
    a post-chaise during a journey of from 40 to 70 miles daily, and his
    appetite began to improve. Still his cough continued, and his hectic
    flushings, though the chills were much abated and very irregular.

    The salutary effects of motion being now more striking than ever, he
    purchased a horse admirably adapted to a valetudinarian in
    Dumfriesshire, and being now able to sit on horseback for an hour
    together, he rode out several times a day. He fixed his residence for a
    few weeks at Moffat, a village at the foot of the mountains whence the
    Tweed, the Clyde, and the Annan, descend in different directions; a
    situation inland, dry, and healthy, and elevated about three hundred
    feet above the surface of the sea. Here his strength recovered daily,
    and he began to eat animal food, which for several months before he had
    not tasted. Persevering in exercise on horseback, he gradually
    increased the length of his rides, according to his strength, from four
    to twenty miles a day; and returning on horseback to Lancashire by the
    lakes of Cumberland, he arrived at Liverpool on the first of September,
    having rode the last day of his journey forty miles.

    The two inferences of most importance to be drawn from this narrative,
    are, first, the extraordinary benefit derived from gestation in a
    carriage, and still more the mixture of gestation and exercise on
    horseback, in arresting or mitigating the hectic paroxysm; and
    secondly, that in the florid consumption, as Dr. Beddoes terms it, an
    elevated and inland air is in certain circumstances peculiarly
    salutary; while an atmosphere loaded with the spray of the sea is
    irritating and noxious. The benefit derived in this case from exercise
    on horseback, may lead us to doubt whether Sydenham's praise of this
    remedy be as much exaggerated as it has of late been supposed. Since
    the publication of Dr. C. Smyth on the effects of swinging in lowering
    the pulse in the hectic paroxysm, the subject of this narrative has
    repeated his experiments in a great variety of cases, and has confirmed
    them. He has also repeatedly seen the hectic paroxysm prevented, or cut
    short, by external ablution of the naked body with tepid water.

    So much was his power of digestion impaired or vitiated by the immense
    evacuations, and the long continued debility he underwent, that after
    the cough was removed, and indeed for several years after the period
    mentioned, he never could eat animal food without heat and flushing,
    with frequent pulse and extreme drowsiness. If this drowsiness was
    encouraged, the fever ran high, and he awoke from disturbed sleep,
    wearied and depressed. If it was resolutely resisted by gentle
    exercise, it went off in about an hour, as well as the increased
    frequency of the pulse. This agitation was however such as to
    incapacitate him during the afternoon for study of any kind. The same
    effects did not follow a meal of milk and vegetables, but under this
    diet his strength did not recruit; whereas after the use of animal food
    it recovered rapidly, notwithstanding the inconvenience already
    mentioned. For this inconvenience he at last found a remedy in the use
    of coffee immediately after dinner, recommended to him by his friend
    Dr. Percival. At first this remedy operated like a charm, but by
    frequent use, and indeed by abuse, it no longer possesses its original
    efficacy.

    Dr. Falconer, in his Dissertation on the Influence of the Passions and
    Affections of the Mind on Health and Disease, supposes that the
    cheerfulness which attends hectic fever, the ever-springing hope, which
    brightens the gloom of the consumptive patient, increases the diseased
    actions, and hastens his doom. And hence he is led to enquire, whether
    the influence of fear might not be substituted in such cases to that of
    hope with advantage to the patient? This question I shall not presume
    to answer, but it leads me to say something of the state of the mind in
    the case just related.

    The patient, being a physician, was not ignorant of his danger, which,
    some melancholy circumstances served to impress on his mind. It has
    already been mentioned, that his mother and grandfather died of this
    disease. It may be added, that in the year preceding that on which he
    himself was attacked, a sister of his was carried off by consumption in
    her 17th year; that in the same winter in which he fell ill, two other
    sisters were seized with the same fatal disorder, to which one of them
    fell a victim during his residence at Bristol, and that the hope of
    bidding a last adieu to the other was the immediate cause of his
    journey to Scotland, a hope which, alas! was indulged in vain. The day
    on which he reached the end of his journey, her remains were committed
    to the dust! It may be conjectured from these circumstances, that
    whatever benefit may be derived from the apprehension of death, must in
    this case have been obtained. The expectation of this issue was indeed
    for some time so fixed that it ceased to produce much agitation; in
    conformity to that general law of our nature, by which almost all men
    submit with composure to a fate that is foreseen, and that appears
    inevitable. As however the progress of disease and debility seemed to
    be arrested, the hope and the love of life revived, and produced, from
    time to time, the observations and the exertions already mentioned.

    Wine and beer were rigorously abstained from during six months of the
    above history; and all the blood which was taken was even to the last
    buffy." Feb. 3, 1795.

8. _Febris scrophulosa._ The hectic fever occasioned by ulcers of the
lymphatic glands, when exposed to the air, does not differ from that
attending pulmonary consumption, being accompanied with night-sweats and
occasional diarrhoea.

M. M. The bark. Opium internally. Externally cerussa and bark in fine
powder. Bandage. Sea-bathing. See Class I. 2. 3. 21. and II. 1. 4. 13.

9. _Febris ischiadica._ A hectic fever from an open ulcer between the
muscles of the pelvis, which differs not from the preceding. If the matter
in this situation lodges till part of it, I suppose, becomes putrid, and
aerates the other part; or till it becomes absorbed from some other
circumstance; a similar hectic fever is produced, with night-sweats, or
diarrhoea.

Mrs. ----, after a lying in, had pain on one side of her loins, which
extended to the internal part of the thigh on the same side. No fluctuation
of matter could be felt; she became hectic with copious night-sweats, and
occasional diarrhoea, for four or five weeks; and recovered by, I suppose,
the total absorption of the matter, and the reunion of the walls of the
abscess. See Class II. 1. 2. 18.

10. _Febris Arthropuodica._ Fever from the matter of diseased joints. Does
the matter from suppurating bones, which generally has a very putrid smell,
produce hectic fever, or typhus? See Class II. 1. 4. 16.

11. _Febris a pure contagioso._ Fever from contagious pus. When the
contagious matters have been produced on the external habit, and in process
of time become absorbed, a fever is produced in consequence of this
reabsorption; which differs with the previous irritability or
inirritability, as well as with the sensibility of the patient.

12. _Febris variolosa secundaria._ Secondary fever of small-pox. In the
distinct small-pox the fever is of the sensitive irritated or inflammatory
kind; in the confluent small-pox it is of the sensitive inirritated kind,
or typhus gravior. In both of them the swelling of the face, when the
matter there begins to be absorbed, and of the hands, when the matter there
begins to be absorbed, shew, that it stimulates the capillary vessels or
glands, occasioning an increased secretion greater than the absorbents can
take up, like the action of the cantharides in a blister; now as the
application of a blister on the skin frequently occasions the strangury,
which shews, that some part of the cantharides is absorbed; there is reason
to conclude, that a part of the matter of small-pox is absorbed, and thus
produces the secondary fever. See Class II. 1. 3. 9. And not simply by its
stimulus on the surface of the ulcers beneath the scabs. The exsudation of
a yellow fluid from beneath the confluent eruptions on the face before the
height is spoken of in Class II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from
that of open ulcers, as it is only aerated through the elevated cuticle;
and secondly, because there is not a constant supply of fresh matter, when
that already in the pustules is exhausted, either by absorption, or by
evaporation, or by its induration into a scab. Might not the covering the
face assiduously and exactly with plasters, as with cerate of calamy, or
with minium plaster, by precluding the air from the pustules, prevent their
contracting a contagious, or acescent, or fever-producing power? and the
secondary fever be thus prevented entirely. If the matter in those pustules
on the face in the confluent small-pox were thus prevented from
oxygenation, it is highly probable, both from this theory, and from the
facts before mentioned, that the matter would not erode the skin beneath
them, and by these means no marks or scars would succeed.

13. _Febris carcinomatosa._ Fever from the matter of cancer. In a late
publication the pain is said to be relieved, and the fever cured, and the
cancer eradicated, by the application of carbonic acid gas, or fixed air.
See Class II. 1. 4. 16.

14. _Febris venerea._ From the absorption of the matter from venereal
ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. _Febris a sanie putrida._ Fever from putrid sanies. When parts of the
body are destroyed by external violence, as a bruise, or by mortification,
a putrefaction soon succeeds; as they are kept in that degree of warmth and
moisture by their adhesion to the living parts of the body, which most
forwards that process. Thus the sloughs of mortified parts of the tonsils
give fetor to the breath in some fevers; the matter from putrefying teeth,
or other suppurating bones, is particularly offensive; and even the scurf,
which adheres to the tongue, frequently acquires a bitter taste from its
incipient putridity. This material differs from those before mentioned, as
its deleterious property depends on a chemical rather than an animal
process.

16. _Febris puerpera._ Puerperal fever. It appears from some late
dissections, which have been published, of those women who have died of the
puerperal fever, that matter has been formed in the omentum, and found in
the cavity of the abdomen, with some blood or sanies. These parts are
supposed to have been injured by the exertions accompanying labour; and as
matter in this viscus may have been produced without much pain, this
disease is not attended with arterial strength and hard full pulse like the
inflammation of the uterus; and as the fever is of the inirritative or
typhus kind, there is reason to believe, that the previous exhaustion of
the patient during labour may contribute to its production; as well as the
absorption of a material not purulent but putrid; which is formed by the
delay of extravasated or dead matter produced by the bruises of the
omentum, or other viscera, in the efforts of parturition, rather than by
purulent matter, the consequence of suppuration. The pulse is generally
about 120 when in bed and in the morning; and is increased to 134, or more,
when the patient sits up, or in the evening paroxysm. The pulse of all very
weak patients increases in frequency when they sit up; because the
expenditure of sensorial power necessary to preserve an erect posture
deducts so much from their general strength; and hence the pulse becomes
weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very
large and repeated quantities of the bark, by preventing sufficient food
from being taken, as bread, and wine, and water, I have thought has much
injured the patient; for the bark is not here given as in intermittent
fevers to prevent the paroxysm, but simply to strengthen the patient by
increasing the power of digestion. About two ounces of decoction of bark,
with four drops of laudanum, and a dram of sweet spirit of vitriol, once in
six hours, and a glass of wine between those times, with panada, or other
food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air,
so as to sound on striking them with the fingers, the case is always
dangerous, generally hopeless; which is more so in proportion to the
quickness of the pulse. Where the bowels are distended two drops of oil of
cinnamon should be given in the panada three or four times a day.

17. _Febris a sphacelo._ Fever from mortification. This fever from
absorption of putrid matter is of the inirritative or typhus kind. See the
preceding article.

M. M. Opium and the bark are frequently given in too great quantity, so as
to induce consequent debility, and to oppress the power of digestion.

       *       *       *       *       *

ORDO I.

_Increased Sensation._

GENUS VII.

_With increased Action of the Organs of Sense._

SPECIES.

1. _Delirium febrile._ Paraphrosyne. The ideas in delirium consist of those
excited by the sensation of pleasure or pain, which precedes them, and the
trains of other ideas associated with these, and not of those excited by
external irritations or by voluntary exertion. Hence the patients do not
know the room which they inhabit, or the people who surround them; nor have
they any voluntary exertion, where the delirium is complete; so that their
efforts in walking about a room or rising from their bed are unsteady, and
produced by their catenations with the immediate affections of pleasure or
pain. See Section XXXIII. 1. 4.

By the above circumstances it is distinguished from madness, in which the
patients well know the persons of their acquaintance, and the place where
they are; and perform all the voluntary actions with steadiness and
determination. See Sect. XXXIV. 2. 2.

Delirium is sometimes less complete, and then a new face and louder voice
stimulate the patient to attend to them for a few moments; and then they
relapse again into perfect delirium. At other times a delirium affects but
one sense, and the person thinks he sees things which do not exist; and is
at the same time sensible to the questions which are asked him, and to the
taste of the food which is offered to him.

This partial delirium is termed an hallucination of the disordered organ;
and may probably arise from the origin of one nerve of sense being more
liable to inflammation than the others; that is, an exuberance of the
sensorial power of sensation may affect it; which is therefore thrown into
action by slighter sensitive catenations, without being obedient to
external stimulus, or to the power of volition.

The perpetual flow of ideas in delirium is owing to the same circumstance,
as of those in our dreams; namely, to the defect or paralysis of the
voluntary power; as in hemiplagia, when one side of the body is paralytic,
and thus expends less of the sensorial power, the limbs on the other side
are in constant motion from the exuberance of it. Whence less sensorial
power is exhausted in delirium, than at other times, as well as in sleep;
and hence in fevers with great debility, it is perhaps, as well as the
stupor, rather a favourable circumstance; and when removed by numerous
blisters, the death of the patient often follows the recovery of his
understanding. See Class I. 2. 5. 6. and I. 2. 5. 10.

Delirium in diseases from inirritability is sometimes preceded by a
propensity to surprise. See Class I. 1. 5. 11.

M. M. Fomentations of the shaved head for an hour repeatedly. A blister on
the head. Rising from bed. Wine and opium, and sometimes venesection in
small quantity by cupping, if the strength of the arterial system will
allow it.

2. _Delirium maniacale._ Maniacal delirium. There is another kind of
delirium, described in Sect. XXXIII. 1. 4. which has the increase of
pleasureable or painful sensation for its cause, without any diminution of
the other sensorial powers; but as this excites the patient to the exertion
of voluntary actions, for the purpose of obtaining the object of his
pleasureable ideas, or avoiding the object of his painful ones, such as
perpetual prayer, when it is of the religious kind, it belongs to the
insanities described in Class III. 1. 2. 1, and is more properly termed
hallucinatio maniacalis.

3. _Dilirium ebrietatis._ The drunken delirium is in nothing different from
the delirium attending fevers except in its cause, as from alcohol, or
other poisons. When it is attended with an apoplectic stupor, the pulse is
generally low; and venesection I believe sometimes destroys those, who
would otherwise have recovered in a few hours.

M. M. Diluting liquids. An emetic.

4. _Somnium._ Dreams constitute the most complete kind of delirium. As in
these no external irritations are attended to, and the power of volition is
entirely suspended; so that the sensations of pleasure and pain, with their
associations, alone excite the endless trains of our sleeping ideas; as
explained in Sect. XVIII. on Sleep.

5. _Hallucinatio visûs._ Deception of sight. These visual hallucinations
are perpetual in our dreams; and sometimes precede general delirium in
fevers; and sometimes belong to reverie, and to insanity. See Class III. 1.
2. 1. and 2. and must be treated accordingly.

Other kinds of visual hallucinations occur by moon-light; when objects are
not seen so distinctly as to produce the usual ideas associated with them,
but appear to us exactly as they are seen. Thus the trunk of a tree appears
a flat surface, instead of a cylinder as by day, and we are deceived and
alarmed by seeing things as they really are seen. See Berkley on Vision.

6. _Hallucinatio auditûs._ Auricular deception frequently occurs in dreams,
and sometimes precedes general delirium in fevers; and sometimes belongs to
vertigo, and to reverie, and to insanity. See Sect. XX. 7. and Class III.
1. 2. 1. and 2.

7. _Rubor a calore._ The blush from heat is occasioned by the increased
action of the cutaneous vessels in consequence of the increased sensation
of heat. See Class I. 1. 2. 1. and 3.

8. _Rubor jucunditatis._ The blush of joy is owing to the increased action
of the capillary arteries, along with that of every moving vessel in the
body, from the increase of pleasurable sensation.

9. _Priapismus amatorius._ Amatorial priapism. The blood is poured into the
cells of the corpora cavernosa much faster than it can be reabsorbed by the
vena penis, owing in this case to the pleasurable sensation of love
increasing the arterial action. See Class I. 1. 4. 6.

10. _Distentio mamularum._ The teats of female animals, when they give
suck, become rigid and erected, in the same manner as in the last article,
from the pleasurable sensation of the love of the mother to her offspring.
Whence the teat may properly be called an organ of sense. The nipples of
men do the same when rubbed with the hand. See Class I. 1. 4. 7.

       *       *       *       *       *

ORDO II.

_Decreased Sensation._

GENUS I.

_Of the General System._

SPECIES.

1. _Stultitia insensibilis._ Folly from insensibility. The pleasure or pain
generated in the system is not sufficient to promote the usual activity
either of the sensual or muscular fibres.

2. _Tædium vitæ._ Ennui. Irksomeness of life. The pain of laziness has been
thought by some philosophers to be that principle of action, which has
excited all our industry, and distinguished mankind from the brutes of the
field. It is certain that, where the ennui exists, it is relieved by the
exertions of our minds or bodies, as all other painful sensations are
relieved; but it depends much upon our early habits, whether we become
patient of laziness, or inclined to activity, during the remainder of our
lives, as other animals do not appear to be affected with this malady;
which is perhaps left owing to deficiency of pleasurable sensation, than to
the superabundancy of voluntary power, which occasions pain in the muscles
by its accumulation; as appears from the perpetual motions of a squirrel
confined in a cage.

3. _Paresis sensitiva._ Weakness of the whole system from insensibility.

       *       *       *       *       *

ORDO II.

_Decreased Sensation._

GENUS II.

_Of Particular Organs._

SPECIES.

1. _Anorexia._ Want of appetite. Some elderly people, and those debilitated
by fermented liquors, are liable to lose their appetite for animal food;
which is probably in part owing to the deficiency of gastric acid, as well
as to the general decay of the system: elderly people will go on years
without animal food; but inebriates soon sink, when their digestion becomes
so far impaired. Want of appetite is sometimes produced by the putrid
matter from many decaying teeth being perpetually mixed with the saliva,
and thence affecting the organ of taste, and greatly injuring the
digestion.

M. M. Fine charcoal powder diffused in warm water held in the mouth
frequently in a day, as in Class I. 2. 4. 12. or solution of alum in water.
Extract the decayed teeth. An emetic. A blister. Chalybeates. Vitriolic
acid. Bile of an ox inspissated, and made into pills; 20 grains to be taken
before dinner and supper. Opium half a grain twice a day.

All the strength we possess is ultimately derived from the food, which we
are able to digest; whence a total debility of the system frequently
follows the want of appetite, and of the power of digestion. Some young
ladies I have observed to fall into this general debility, so as but just
to be able to walk about; which I have sometimes ascribed to their
voluntary fasting, when they believed themselves too plump; and who have
thus lost both their health and beauty by too great abstinence, which could
never be restored.

I have seen other cases of what may be termed anorexia epileptica, in which
a total loss of appetite, and of the power of digestion, suddenly occurred
along with epileptic fits. Miss B. a girl about eighteen, apparently very
healthy, and rather plump, was seized with fits, which were at first called
hysterical; they occurred at the end of menstruation, and returned very
frequently with total loss of appetite. She was relieved by venesection,
blisters, and opiates; her strength diminished, and after some returns of
the fits, she took to her bed, and has survived 15 or 20 years; she has in
general eaten half a potato a day, and seldom speaks, but retains her
senses, and had many years occasional returns of convulsion. I have seen
two similar cases, where the anorexia, or want of appetite, was in less
degree; and but just so much food could be digested, as supplied them with
sufficient strength to keep from the bed or sofa for half the day. As well
as I can recollect, all these patients were attended with weak pulse, and
cold pale skin; and received benefit by opium, from a quarter of a grain to
a grain four times a day. See Class III. 1. 1. 7. and III. 1. 2. 1. and
III. 1. 2. 20.

2. _Adipsia._ Want of thirst. Several of the inferior people, as farmers
wives, have a habit of not drinking with their dinner at all, or only take
a spoonful or two of ale after it. I have frequently observed these to
labour under bad digestion, and debility in consequence; which I have
ascribed to the too great stimulus of solid food undiluted, destroying in
process of time the irritability of the stomach.

3. _Impotentia_ (agenesia). Impotency much seldomer happens to the male sex
than sterility to the female sex. Sometimes a temporary impotence occurs
from bashfulness, or the interference of some voluntary exertion in the
production of an effect, which should be performed alone by pleasurable
sensation.

One, who was soon to be married to a lady of superior condition to his own,
expressed fear of not succeeding on the wedding night; he was advised to
take a grain of opium before he went to bed, and to accustom himself to
sleep with a woman previously, but not to enjoy her, to take off his
bashfulness; which succeeded to his wish.

M. M. Chalybeates. Opium. Bark. Tincture of cantharides.

4. _Sterilitas._ Barrenness. One of the ancient medical writers asserts,
that the female sex become pregnant with most certainty at or near the time
of menstruation. This is not improbable, since these monthly periods seem
to referable the monthly venereal orgasm of some female quadrupeds, which
become pregnant at those times only; and hence the computation of pregnancy
is not often erroneous, though taken from the last menstruation. See
Section XXXVI. 2. 3.

M. M. Opium a grain every night. Chalybeates in very small doses. Bark.
Sea-bathing.

5. _Insensibilitas artuum._ As in some paralytic limbs. A great
insensibility sometimes accompanies the torpor of the skin in cold fits of
agues. Some parts have retained the sense of heat, but not the sense of
touch. See Sect. XVI. 6.

M. M. Friction with flannel. A blister. Warmth.

6. _Dysuria insensitiva._ Insensibility of the bladder. A difficulty or
total inability to make water attends some fevers with great debility,
owing to the insensibility or inirritability of the bladder. This is a
dangerous but not always a fatal symptom.

M. M. Draw off the water with a catheter. Assist the patient in the
exclusion of it by compressing the lower parts of the abdomen with the
hands. Wine two ounces, Peruvian bark one dram in decoction, every three
hours alternately. Balsam of copaiva. Oil of almonds, with as much camphor
as can be dissolved in it, applied as a liniment rubbed on the region of
the bladder and perinæum, and repeated every four hours, was used in this
disease with success by Mr. Latham. Med. Comment. 1791, p. 213.

7. _Accumulatio alvina._ An accumulation of feces in the rectum, occasioned
by the torpor, or insensibility, of that bowel. But as liquids pass by
these accumulations, it differs from the constipatio alvi, which is owing
to too great absorption of the alimentary canal.

Old milk, and especially when boiled, is liable to induce this kind of
costiveness in some grown persons; which is probably owing to their not
possessing sufficient gastric acid to curdle and digest it; for as both
these processes require gastric acid, it follows, that a greater quantity
of it is necessary, than in the digestion of other aliments, which do not
previously require being curdled. This ill digested milk not sufficiently
stimulating the rectum, remains till it becomes a too solid mass. On this
account milk seldom agrees with those, who are subject to piles, by
inducing costiveness and large stools.

M. M. Extract the hardened scybala by means of a marrow-spoon; or by a
piece of wire, or of whale-bone bent into a bow, and introduced. Injections
of oil. Castor oil, or oil of almonds, taken by the mouth. A large clyster
of smoak of tobacco. Six grains of rhubarb taken every night for many
months. Aloes. An endeavour to establish a habit of evacuation at a certain
hour daily. See Class I. 1. 3. 5.

       *       *       *       *       *

ORDO III.

_Retrograde Sensitive Motions._

GENUS I.

_Of Excretory Ducts._

The retrograde action of the oesophagus in ruminating animals, when they
bring up the food from their first stomach for the purpose of a second
mastication of it, may probably be caused by agreeable sensation; similar
to that which induces them to swallow it both before and after this second
mastication; and then this retrograde action, properly belongs to this
place, and is erroneously put at the head of the order of irritative
retrograde motions. Class I. 3. 1. 1.

SPECIES.

1. _Ureterum motus retrogressus._ When a stone has advanced into the ureter
from the pelvis of the kidney, it is sometimes liable to be returned by the
retrograde motion of that canal, and the patient obtains fallacious ease,
till the stone is again pushed into the ureter.

2. _Urethræ motus retrogressus._ There have been instances of bougies being
carried up the urethra into the bladder most probably by an inverted motion
of this canal; for which some have undergone an operation similar to that
for the extraction of a stone. A case is related in some medical
publication, in which a catgut bougie was carried into the bladder, and
after remaining many weeks, was voided piece-meal in a semi-dissolved
state. Another case is related of a French officer, who used a leaden
bougie; which at length found its way into the bladder, and was, by
injecting crude mercury, amalgamated and voided.

In the same manner the infection from a simple gonorrhoea is probably
carried further along the course of the urethra; and small stones
frequently descend some way into the urethra, and are again carried up into
the bladder by the inverted action of this canal.

3. _Ductus choledochi motus retrogressus._ The concretions of bile, called
gall-stones, frequently enter the bile-duct, and give violent pain for some
hours; and return again into the gall-bladder, by the retrograde action of
this duct. May not oil be carried up this duct, when a gall-stone gives
great pain, by its retrograde spasmodic action? See Class I. 1. 3. 8.

M. M. Opium a grain and half.

       *       *       *       *       *


_The Orders and Genera of the Third Class of Diseases._

       *       *       *       *       *

CLASS III.

DISEASES OF VOLITION.

ORDO I.

_Increased Volition._

GENERA.

  1. With increased actions of the muscles.
  2. With increased actions of the organs of sense.

ORDO II.

_Decreased Volition._

GENERA.

  1. With decreased actions of the muscles.
  2. With decreased actions of the organs of sense.

       *       *       *       *       *

_The Orders, Genera, and Species, of the Third Class of Diseases._

       *       *       *       *       *

CLASS III.

DISEASES OF VOLITION.

ORDO I.

_Increased Volition._

GENUS I.

_With Increased Actions of the Muscles._

SPECIES.

   1. _Jactitatio._              Restlessness.
   2. _Tremor febrilis._         Febrile trembling.
   3. _Clamor._                  Screaming.
   4. _Risus._                   Laughter.
   5. _Convulsio._               Convulsion.
      ---- _debilis._            ---- weak.
   6. ---- _dolorifica._         ---- painful.
   7. _Epilepsia._               Epilepsy.
   8. ---- _dolorifica._         ---- painful.
   9. _Somnambulismus._          Sleep-walking.
  10. _Asthma convulsivum._      Asthma convulsive.
  11. ---- _dolorificum._        ---- painful.
  12. _Stridor dentium._         Gnashing of the teeth.
  13. _Tetanus trismus._         Cramp of the jaw.
  14. ---- _dolorificus._        ---- painful.
  15. _Hydrophobia._             Dread of water.

GENUS II.

_With increased Actions of the Organs of Sense._

SPECIES.

   1. _Mania mutabilis._             Mutable madness.
   2. _Studium inane._               Reverie.
   3. _Vigilia._                     Watchfulness.
   4. _Erotomania._                  Sentimental love.
   5. _Amor sui._                    Vanity.
   6. _Nostalgia._                   Desire of home.
   7. _Spes religiosa._              Superstitious hope.
   8. _Superbia stemmatis._          Pride of family.
   9. _Ambitio._                     Ambition.
  10. _Mæror._                       Grief.
  11. _Tædium vitæ._                 Irksomeness of life.
  12. _Desiderium pulchritudinis._   Loss of beauty.
  13. _Paupertatis timor._           Fear of poverty.
  14. _Lethi timor._                 ---- of death.
  15. _Orci timor._                  ---- of hell.
  16. _Satyriasis._                  Lust.
  17. _Ira._                         Anger.
  18. _Rabies._                      Rage.
  19. _Citta._                       Depraved appetite.
  20. _Cacositia._                   Aversion to food.
  21. _Syphilis imaginaria._         Imaginary pox.
  22. _Psora imaginaria._            ---- itch.
  23. _Tabes imaginaria._            ---- tabes.
  24. _Sympathia aliena._            Pity.
  25. _Educatio heroica._            Heroic education.

ORDO II.

_Decreased Volition._

GENUS I.

_With decreased Actions of the Muscles._

SPECIES.

   1. _Lassitudo._                     Fatigue.
   2. _Vacillatio senilis._            See-saw of old age.
   3. _Tremor senilis._                Tremor of old age.
   4. _Brachiorum paralysis._          Palsy of the arms.
   5. _Raucedo paralytica._            Paralytic hoarseness.
   6. _Vesicæ urinariæ paralysis._     Palsy of the bladder.
   7. _Recti paralysis._               Palsy of the rectum.
   8. _Paresis voluntaria._            Voluntary debility.
   9. _Catalepsis._                    Catalepsy.
  10. _Hemiplegia._                    Palsy of one side.
  11. _Paraplegia._                    Palsy of the lower limbs.
  12. _Somnus._                        Sleep.
  13. _Incubus._                       Night-mare.
  14. _Lethargus._                     Lethargy.
  15. _Syncope epileptica._            Epileptic fainting.
  16. _Apoplexia._                     Apoplexy.
  17. _Mors a frigore._                Death from cold.

GENUS II.

_With decreased Actions of the Organs of Sense._

SPECIES.

  1. _Recollectionis jactura._      Loss of recollection.
  2. _Stultitia voluntaria._        Voluntary folly.
  3. _Credulitas._                  Credulity.

       *       *       *       *       *

CLASS III.

DISEASES OF VOLITION.

ORDO I.

_Increased Volition._

GENUS I.

_Increased Actions of the Muscles._

We now step forward to consider the diseases of volition, that superior
faculty of the sensorium, which gives us the power of reason, and by its
facility of action distinguishes mankind from brute animals; which has
effected all that is great in the world, and superimposed the works of art
on the situations of nature.

Pain is introduced into the system either by excess or defect of the action
of the part. (Sect. IV. 5.) Both which circumstances seem to originate from
the accumulation of sensorial power in the affected organ. Thus when the
skin is exposed to great cold, the activity of the cutaneous vessels is
diminished, and in consequence an accumulation of sensorial power obtains
in them, because they are usually excited into incessant motion by the
stimulus of heat, as explained in Sect. XII. 5. 2. Contrarywise, when the
vessels of the skin are exposed to great heat, an excess of sensorial power
is also produced in them, which is derived thither by the increase of
stimulus above what is natural.

This accounts for the relief which is received in all kinds of pain by any
violent exertions of our muscles or organs of sense; which may thus be in
part ascribed to the exhaustion of the sensorial power by such exertions.
But this relief is in many cases so instantaneous, that it seems
nevertheless probable, that it is also in part owing to the different
manner of progression of the two sensorial powers of sensation and
volition; one of them commencing at some extremity of the sensorium, and
being propagated towards the central parts of it; and the other commencing
in the central parts of the sensorium, and being propagated towards the
extremities of it; as mentioned in Sect. XI. 2. 1.

These violent voluntary exertions of our muscles or ideas to relieve the
sensation of pain constitute convulsions and madness; and are distinguished
from the muscular actions owing to increased sensation, as in sneezing, or
coughing, or parturition, or ejectio feminis, because they do not
contribute to dislodge the cause, but only to prevent the sensation of it.
In two cases of parturition, both of young women with their first child, I
have seen general convulsions occur from excess of voluntary exertion, as
above described, instead of the actions of particular muscles, which ought
to have been excited by sensation for the exclusion of the fetus. They both
became insensible, and died after some hours; from one of them the fetus
was extracted in vain. I have heard also of general convulsions being
excited instead of the actions of the musculi acceleratores in the ejectio
feminis, which terminated fatally. See Class III. 1. 1. 7.

These violent exertions are most frequently excited in consequence of those
pains, which originate from defect of the action of the part. See Sect.
XXXIV. 1. and 2. The pains from excess and defect of the action of the part
are distinguishable from each other by the former being attended with
increase of heat in the pained part, or of the whole body; while the latter
not only exist without increase of heat in the pained part, but are
generally attended with coldness of the extremities of the body.

As soon as these violent actions of our muscular or sensual fibres for the
purpose of relieving pain cease to be exerted, the pain recurs; whence the
reciprocal contraction and relaxation of the muscles in convulsion, and the
intervals of madness. Otherwise these violent exertions continue, till so
great a part of the sensorial power is exhausted, that no more of it is
excitable by the faculty of volition; and a temporary apoplexy succeeds,
with snoring as in profound sleep; which so generally terminates epileptic
fits.

When these voluntary exertions become so connected with certain
disagreeable sensations, or with irritations, that the effort of the will
cannot restrain them, they can no longer in common language be termed
voluntary; but nevertheless belong to this class, as they are produced by
excess of volition, and may still not improperly be called depraved
voluntary actions. See Sect. XXXIV. 1. where many motions in common
language termed involuntary are shewn to depend on excess of volition.

When these exertions from excess of volition, which in common language are
termed involuntary motions, either of mind or body, are perpetually exerted
in weak constitutions, the pulse becomes quick; which is occasioned by the
too great expenditure of the sensorial power in these unceasing modes of
activity. In the same manner as in very weak people in fevers, the pulse
sometimes increases in frequency to 140 strokes in a minute, when the
patients stand up or endeavour to walk; and subsides to 110, when they lie
down again in their beds. Whence it appears, that when a very quick pulse
accompanies convulsion or insanity, it simply indicates the weakness of the
patient; that is, that the expenditure of sensorial power is too great for
the supply of it. But if the strength of the patient is not previously
exhausted, the exertions of the muscles are attended with temporary
increase of circulation, the reciprocal swellings and elongations of their
bellies push forwards the arterial blood, and promote the absorption of the
venous blood; whence a temporary increase of secretion and of heat, and a
stronger pulse.

SPECIES.

1. _Jactitatio._ Restlessness. There is one kind of restlessness attending
fevers, which consists in a frequent change of posture to relieve the
uneasiness of the pressure of one part of the body upon another, when the
sensibility of the system, or of some parts of it, is increased by
inflammation, as in the lumbago; which may sometimes be distinguished in
its early stage by the incessant desire of the patient to turn himself in
bed. But there is another restlessness, which approaches towards writhing
or contortions of the body, which is a voluntary effort to relieve pain;
and may be esteemed a slighter kind of convulsion, not totally
unrestrainable by opposite or counteracting volitions.

M. M. A blister. Opium. Warm bath.

2. _Tremor febrilis._ Reciprocal convulsions of the subcutaneous muscles,
originating from the pain of the sense of heat, owing to defect of its
usual stimulus, and consequent accumulation of sensorial power in it. The
actual deficiency of heat may exist in one part of the body, and the pain
of cold be felt most vividly in some other part associated with it by
sensitive sympathy. So a chillness down the back is first attended to in
ague-fits, though the disease perhaps commences with the torpor and
consequent coldness of some internal viscus. But in whatever part of the
system the defect of heat exists, or the sensation of it, the convulsions
of the subcutaneous muscles exerted to relieve it are very general; and, if
the pain is still greater, a chattering of the teeth is added, the more
suddenly to exhaust the sensorial power, and because the teeth are very
sensible to cold.

These convulsive motions are nevertheless restrainable by violent voluntary
counteraction; and as their intervals are owing to the pain of cold being
for a time relieved by their exertion, they may be compared to laughter,
except that there is no interval of pleasure preceding each moment of pain
in this as in the latter.

M. M. See I. 2. 2. 1.

3. _Clamor._ Screaming from pain. The talkative animals, as dogs, and
swine, and children, scream most, when they are in pain, and even from
fear; as they have used this kind of exertion from their birth most
frequently and most forcibly; and can therefore sooner exhaust the
accumulation of sensorial power in the affected muscular or sensual organs
by this mode of exertion; as described in Sect. XXXIV. 1. 3. This facility
of relieving pain by screaming is the source of laughter, as explained
below.

4. _Risus._ The pleasurable sensations, which occasion laughter, are
perpetually passing into the bounds of pain; for pleasure and pain are
often produced by different degrees of the same stimulus; as warmth, light,
aromatic or volatile odours, become painful by their excess; and the
tickling on the soles of the feet in children is a painful sensation at the
very time it produces laughter. When the pleasurable ideas, which excite us
to laugh, pass into pain, we use some exertion, as a scream, to relieve the
pain, but soon stop it again, as we are unwilling to lose the pleasure; and
thus we repeatedly begin to scream, and stop again alternately. So that in
laughing there are three stages, first of pleasure, then pain, then an
exertion to relieve that pain. See Sect. XXXIV. 1. 3.

Every one has been in a situation, where some ludicrous circumstance has
excited him to laugh; and at the same time a sense of decorum has forbid
the exertion of these interrupted screams; and then the pain has become so
violent, as to occasion him to use some other great action, as biting his
tongue, and pinching himself, in lieu of the reiterated screams which
constitute laughter.

5. _Convulsio._ Convulsion. When the pains from defect or excess of motion
are more distressing than those already described, and are not relievable
by such partial exertions, as in screaming, or laughter, more general
convulsions occur; which vary perhaps according to the situation of the
pained part, or to some previous associations formed by the early habits of
life. When these convulsive motions bend the body forwards, they are termed
emprosthotonoi; when they bend it backward, they are termed opisthotonoi.
They frequently succeed each other, but the opisthotonoi are generally more
violent; as the muscles, which erect the body, and keep it erect, are
naturally in more constant and more forcible action than their antagonists.

The causes of convulsion are very numerous, as from toothing in children,
from worms or acidity in their bowels, from eruption of the distinct
small-pox, and lastly, from breathing too long the air of an unventilated
bed-room. Sir G. Baker, in the Transactions of the College, described this
disease, and detected its cause; where many children in an orphan-house
were crowded together in one chamber without a chimney, and were almost all
of them affected with convulsion; in the hospital at Dublin, many died of
convulsions before the real cause was understood. See Dr. Beddoes's Guide
to Self-preservation. In a large family, which I attended, where many
female servants slept in one room, which they had contrived to render
inaccessible to every blast of air; I saw four who were thus seized with
convulsions, and who were believed to have been affected by sympathy from
the first who fell ill. They were removed into more airy apartments, but
were some weeks before they all regained their perfect health.

Convulsion is distinguished from epilepsy, as the patient does not intirely
lose all perception during the paroxysm. Which only shews, that a less
exhaustion of sensorial power renders tolerable the pains which cause
convulsion, than those which cause epilepsy. The hysteric convulsions are
distinguished from those, owing to other causes, by the presence of the
expectation of death, which precedes and succeeds them, and generally by a
flow of pale urine; these convulsions do not constantly attend the hysteric
disease, but are occasionally superinduced by the disagreeable sensation
arising from the torpor or inversion of a part of the alimentary canal.
Whence the convulsion of laughter is frequently sufficient to restrain
these hysteric pains, which accounts for the fits of laughter frequently
attendant on this disease.

M. M. To remove the peculiar pain which excites the convulsions.
Venesection. An emetic. A cathartic with calomel. Warm-bath. Opium in large
quantities, beginning with smaller ones. Mercurial frictions. Electricity.
Cold-bath in the paroxysm; or cold aspersion. See Memoirs of Med. Society,
Lon. V. 3. p. 147. a paper by Dr. Currie.

_Convulsio debilis._ The convulsions of dying animals, as of those which
are bleeding to death in the slaughter-house, are an effort to relieve
painful sensation, either of the wound which occasions their death, or of
faintness from want of due distention of the blood-vessels. Similar to this
in a less degree is the subsultus tendinum, or starting of the tendons, in
fevers with debility; these actions of the muscles are too weak to move the
limb, but the belly of the acting muscles is seen to swell, and the tendon
to be stretched. These weak convulsions, as they are occasioned by the
disagreeable sensation of faintness from inanition, are symptoms of great
general debility, and thence frequently precede the general convulsions of
the act of dying. See a case of convulsion of a muscle of the arm, and of
the fore-arm, without moving the bones to which they were attached, Sect.
XVII. 1. 8. See twitchings of the face, Class IV. 1. 3. 2.

6. _Convulsio dolorifica._ Raphania. Painful convulsion. In this disease
the muscles of the arms and legs are exerted to relieve the pains left
after the rheumatism in young and delicate people; it recurs once or twice
a-day, and has been mistaken for the chorea, or St. Vitus's dance; but
differs from it, as the undue motions in that disease only occur, when the
patient endeavours to exert the natural ones; are not attended with pain;
and cease, when he lies down without trying to move: the chorea, or dance
of St. Vitus, is often introduced by the itch, this by the rheumatism.

It has also been improperly called nervous rheumatism; but is distinguished
from rheumatism, as the pains recur by periods once or twice a day; whereas
in the chronic rheumatism they only occur on moving the affected muscles.
And by the warmth of a bed the pains of the chronic rheumatism are
increased, as the muscles or membranes then become more sensible to the
stimulus of the extraneous mucaginous material deposited under them.
Whereas the pains of the raphania, or painful convulsion, commence with
coldness of the part, or of the extremities. See Rheumatismus chronicus,
Class I. 1. 3. 12.

The pains which accompany the contractions of the muscles in this disease,
seem to arise from the too great violence of those contractions, as happens
in the cramp of the calf of the leg; from which they differ in those being
fixed, and these being reiterated contractions. Thus these convulsions are
generally of the lower limbs, and recur at periodical times from some
uneasy sensation from defect of action, like other periodic diseases; and
the convulsions of the limbs relieve the original uneasy painful sensation,
and then produce a greater pain from their own too vehement contractions.
There is however another way of accounting for these pains, when they
succeed the acute rheumatism; and that is by the coagulable lymph, which
may be left still unabsorbed on the membranes; and which may be in too
small quantity to affect them with pain in common muscular exertions, but
may produce great pain, when the bellies of the muscles swell to a larger
bulk in violent action.

M. M. Venesection. Calomel. Opium. Bark. One grain of calomel and one of
opium for ten successive nights. A bandage spread with emplastrum de minio
put tight on the affected part.

7. _Epilepsia_ is originally induced, like other convulsions, by a
voluntary exertion to relieve some pain. This pain is most frequently about
the pit of the stomach, or termination of the bile-duct; and in some cases
the torpor of the stomach, which probably occasioned the epileptic fits,
remains afterwards, and produces a chronical anorexia; of which a case is
related in Class II. 2. 2. 1. There are instances of its beginning in the
heel, of which a case is published by Dr. Short, in the Med. Essays, Edinb.
I once saw a child about ten years old, who frequently fell down in
convulsions, as she was running about in play; on examination a wart was
found on one ancle, which was ragged and inflamed; which was directed to be
cut off, and the fits never recurred.

When epilepsy first commences, the patients are liable to utter one scream
before they fall down; afterwards the convulsions so immediately follow the
pain, which occasions them, that the patient does not recollect or seem
sensible of the preceding pain. Thus in laughter, when it is not excessive,
a person is not conscious of the pain, which so often recurs, and causes
the successive screams or exertions of laughter, which give a temporary
relief to it.

Epileptic fits frequently recur in sleep from the increase of sensibility
at that time, explained in Sect. XVIII. 14. In two such cases, both of
young women, one grain of opium given at night, and continued many months,
had success; in one of them the opium was omitted twice at different times,
and the fit recurred on both the nights. In the more violent case,
described in Sect. XVIII. 15, opium had no effect.

Epileptic fits generally commence with setting the teeth, by which means
the tongue is frequently wounded; and with rolling the eyeballs in every
kind of direction; for the muscles which suspend the jaw, as well as those
which move the eyes, are in perpetual motion during our waking hours; and
yet continue subservient to volition; hence their more facile and forcible
actions for the purpose of relieving pain by the exhaustion of sensorial
power. See Section XXXIV. 1. 4.

Epileptic convulsions are not attended with the fear of death, as in the
hysteric disease, and the urine is of a straw colour. However it must be
noted, that the disagreeable sensations in hysteric diseases sometimes are
the cause of true epileptic convulsions, of syncope, and of madness.

The pain, which occasions some fits of epilepsy, is felt for a time in a
distant part of the system, as in a toe or heel; and is said by the patient
gradually to ascend to the head, before the general convulsions commence.
This ascending sensation has been called aura epileptica, and is said to
have been prevented from affecting the head by a tight bandage round the
limb. In this malady the pain, probably of some torpid membrane, or
diseased tendon, is at first only so great as to induce slight spasms of
the muscular fibres in its vicinity; which slight spasms cease on the
numbness introduced by a tight bandage; when no bandage is applied, the
pain gradually increases, till generally convulsions are exerted to relieve
it. The course of a lymphatic, as when poisonous matter is absorbed; or of
a nerve, as in the sciatica, may, by the sympathy existing between their
extremities and origins, give an idea of the ascent of an aura or vapour.

In difficult parturition it sometimes happens, that general convulsions are
excited to relieve the pain of labour, instead of the exertions of those
muscles of the abdomen and diaphragm, which ought to forward the exclusion
of the child. See Class III. 1. 1. That is, instead of the particular
muscular actions, which ought to be excited by sensation to remove the
offending cause, general convulsions are produced by the power of volition,
which still the pain, as in common epilepsy, without removing the cause;
and, as the parturition is not thus promoted, the convulsions continue,
till the sensorial power is totally exhausted, that is, till death. In
patients afflicted with epilepsy from other causes, I have seen the most
violent convulsions recur frequently during pregnancy without miscarriage,
as they did not tend to forward the exclusion of the fetus.

M. M. Venesection. A large dose of opium. Delivery.

The later in life epileptic fits are first experienced, the more dangerous
they may be esteemed in general; as in these cases the cause has generally
been acquired by the habits of the patient, or by the decay of some part,
and is thus probably in an increasing state. Whereas in children the
changes in the system, as they advance to puberty, sometimes removes the
cause. So in toothing, fits of convulsion with stupor frequently occur, and
cease when the tooth advances; but this is not to be expected in advanced
life. Sir ----, about sixty years of age, had only three teeth left in his
upper jaw, a canine tooth, and one on each side of it. He was seized with
epileptic fits, with pain commencing in these teeth. He was urged to have
them extracted, which he delayed too long, till the fits were become
habitual, and then had them extracted in vain, and in a few months sunk
under the disease.

Mr. F----, who had lived intemperately, and had been occasionally affected
with the gout, was suddenly seized with epileptic fits; the convulsions
were succeeded by apoplectic snoring; from which he was, in about 20
minutes, disturbed by fresh convulsions, and had continued in this
situation above four-and-twenty hours. About eight ounces of blood were
then taken from him; and after having observed, that the apoplectic's
torpor continued about 20 minutes, I directed him to be forcibly raised up
in bed, after he had thus lain about fifteen minutes, to gain an interval
between the termination of the sleep, and the renovation of convulsion. In
this interval he was induced to swallow forty drops of laudanum. Twenty
more were given him in the same manner in about half an hour, both which
evidently shortened the convulsion fits, and the consequent stupor; he then
took thirty more drops, which for the present removed the fits. He became
rather insane the next day, and after about three more days lost the
insanity, and recovered his usual state of health.

The case mentioned in Sect. XXVII. 2. where the patient was left after
epileptic fits with a suffusion of blood beneath the tunica adjunctiva of
the eye, was in almost every respect similar to the preceding, and
submitted to the same treatment. Both of them suffered frequent relapses,
which were relieved by the same means, and at length perished, I believe,
by the epileptic fits.

In those patients, who have not been subject to epilepsy before they have
arrived to about forty years of age, and who have been intemperate in
respect to spirituous potation, I have been induced to believe, that the
fits were occasioned by the pain of a diseased liver; and this became more
probable in one of the above subjects, who had used means to repel
eruptions on the face; and thus by some stimulant application had prevented
an inflammation taking place on the skin of the face instead of on some
part of the liver. Secondly, as in these cases insanity had repeatedly
occurred, which could not be traced from an hereditary source; there is
reason to believe, that this as well as the epileptic convulsions were
caused by spirituous potation; and that this therefore is the original
source both of epilepsy and of insanity in those families, which are
afflicted with them. This idea however brings some consolation with it; as
it may be inferred, that in a few sober generations these diseases may be
eradicated, which otherwise destroy the family.

M. M. Venesection. Opium. Bark. Steel. Arsenic. Opium one grain twice a day
for years together. See the preceding article.

8. _Epilepsia dolorifica._ Painful epilepsy. In the common epilepsy the
convulsions are immediately induced, as soon as the disagreeable sensation,
which causes them, commences; but in this the pain continues long with cold
extremities, gradually increasing for two or three hours, till at length
convulsions or madness come on; which terminate the daily paroxysm, and
cease themselves in a little time afterwards.

This disease sometimes originates from a pain about the lower edge of the
liver, sometimes in the temple, and sometimes in the pudendum; it recurs
daily for five or six weeks, and then ceases for several months. The pain
is owing to defect of action, that is, to the accumulation of sensorial
power in the part, which probably sympathizes with some other part, as
explained in Sect. XXXV. 2. XII. 5. 3. and Class II. 1. 1. 11. and IV. 2.
2. 3.

It is the most painful malady that human nature is liable to!--See Sect.
XXXIV. 1. 4.

Mrs. C---- was seized every day about the same hour with violent pain on
the right side of her bowels about the situation of the lower edge of the
liver, without fever, which increased for an hour or two, till it became
totally intolerable. After violent screaming she fell into convulsions,
which terminated sometimes in fainting, with or without stertor, as in
common epilepsy; at other times a tempory insanity supervened; which
continued about half an hour, and the fit ceased. These paroxysms had
returned daily for two or three weeks, and were at length removed by large
doses of opium, like the fits of reverie or somnambulation. About half an
hour before the expected return of the fit three or four grains of opium
were exhibited, and then tincture of opium was given in warm brandy and
water about 20 or 30 drops every half hour, till the eyes became somewhat
inflamed, and the nose began to itch, and by the sharp movements of the
patient, or quick speech, an evident intoxication appeared; and then it
generally happened that the pain ceased. But the effects of this large dose
of opium was succeeded by perpetual sickness and efforts to vomit, with
great general debility all the succeeding day.

The rationale of this temporary cure from the exhibition of opium and
vinous spirit depends on the great expenditure of sensorial power in the
increased actions of all the irritative motions, by the stimulus of such
large quantities of opium and vinous spirit; together with the production
of much sensation, and many movements of the organs of sense or ideas in
consequence of that sensation; and lastly, even the motions of the arterial
system become accelerated by this degree of intoxication, all which soon
exhausted so much sensorial power as to relieve the pain; which would
otherwise have caused convulsions or insanity, which are other means of
expending sensorial power. The general debility on the succeeding day, and
the particular debility of the stomach, attended in consequence with
sickness and frequent efforts to vomit, were occasioned by the system
having previously been so strongly stimulated, and those parts in
particular on which the opium and wine more immediately acted. This
sickness continued so many hours as to break the catenation of motions,
which had daily reproduced the paroxysm; and thus it generally happened,
that the whole disease ceased for some weeks or months from one great
intoxication, a circumstance not easily to be explained on any other
theory.

The excess or defect of motion in any part of the system occasions the
production of pain in that part, as in Sect. XII. 1. 6. This defect or
excess of fibrous action is generally induced by excess or defect of the
stimulus of objects external to the moving organ. But there is another
source of excessive fibrous action, and consequent pain, which is from
excess of volition, which is liable to affect those muscles, that have weak
antagonists; as those which support the under jaw, and close the mouth in
biting, and those of the calf of the leg; which are thus liable to fixed or
painful contractions, as in trismus, or locked jaw, and in the cramp of the
calf of the leg; and perhaps in some colics, as in that of Japan: these
pains, from contraction arising from excess of volition in the part from
the want of the counteraction of antagonist muscles, may give occasional
cause to epileptic fits, and may be relieved in the same way, either by
exciting irritative and sensitive motions by the stimulus of opium and
wine; or by convulsions or insanity, as described above, which are only
different methods of exhausting the general quantity of sensorial power.

Considering the great resemblance between this kind of painful epilepsy and
the colic of Japan, as described by Kemfer; and that that disease was said
to be cured by acupuncture, or the prick of a needle; I directed some very
thin steel needles to be made about three inches long, and of such a
temper, that they would bend double rather than break; and wrapped wax
thread over about half an inch of the blunt end for a handle. One of these
needles, when the pain occurred, was pushed about an inch into the painful
part, and the pain instantly ceased; but I was not certain, whether the
fear of the patient, or the stimulus of the puncture, occasioned the
cessation of pain; and as the paroxysm had continued some weeks, and was
then declining, the experiment was not tried again. The disease is said to
be very frequent in Japan, and its seat to be in the bowels, and that the
acupuncture eliminates the air, which is supposed to distend the bowel. But
though the aperture thus made is too small to admit of the eduction of air;
yet as the stimulus of so small a puncture may either excite a torpid part
into action, or cause a spasmodic one to cease to act; and lastly, as no
injury could be likely to ensue from so small a perforation, I should be
inclined at some future time to give this a fairer trial in similar
circumstances.

Another thing worth trial at the commencement of this deplorable disease
would be electricity, by passing strong shocks through the painful part;
which, whether the pain was owing to the inaction of that part, or of some
other membrane associated with it, might stimulate them into exertion; or
into inactivity, if owing to fixed painful contraction.

And lastly, the cold bath, or aspersions with cold water on the affected
part, according to the method of Dr. Currie in the Memoirs of a Med. Soc.
London, V. iii. p. 147, might produce great effect at the commencement of
the pain. Nevertheless opium duly administered, so as to precede the
expected paroxysm, and in such doses, given by degrees, as to induce
intoxication, is principally to be depended upon in this deplorable malady.
To which should be added, that if venesection can be previously performed,
even to but few ounces, the effect of the opium is much more certain; and
still more so, if there be time to premise a brisk cathartic, or even an
emetic. The effect of increased stimulus is so much greater after previous
defect of stimulus; and this is still of greater advantage where the cause
of the disease happens to consist in a material, which can be absorbed. See
Art. IV. 2. 8.

M. M. Venesection. An emetic. A cathartic. Warm bath. Opium a grain every
half hour. Wine. Spirit of wine. If the patient becomes intoxicated by the
above means, the fit ceases, and violent vomitings and debility succeed on
the subsequent day, and prevent a return. Blisters or sinapisms on the
small of the leg, taken off when they give much pain, are of use in
slighter convulsions. Acupuncture. Electricity. Aspersion with cold water
on the painful part.

9. _Somnambulismus._ Sleep-walking is a part of reverie, or studium inane,
described in Sect. XIX. In this malady the patients have only the general
appearance of being asleep in respect to their inattention to the stimulus
of external objects, but, like the epilepsies above described, it consists
in voluntary exertions to relieve pain. The muscles are subservient to the
will, as appears by the patient's walking about, and sometimes doing the
common offices of life. The ideas of the mind also are obedient to the
will, because their discourse is consistent, though they answer imaginary
questions. The irritative ideas of external objects continue in this
malady, because the patients do not run against the furniture of the room;
and when they apply their volition to their organs of sense, they become
sensible of the objects they attend to, but not otherwise, as general
sensation is destroyed by the violence of their voluntary exertions. At the
same time the sensations of pleasure in consequence of ideas excited by
volition are vividly experienced, and other ideas seem to be excited by
these pleasurable sensations, as appears in the case of Master A. Sect.
XXXIV. 3. 1. where a history of a hunting scene was voluntarily recalled,
with all the pleasurable ideas which attended it. In melancholy madness the
patient is employed in voluntarily exciting one idea, with those which are
connected with it by voluntary associations only, but not so violently as
to exclude the stimuli of external objects. In reverie variety of ideas are
occasionally excited by volition, and those which are connected with them
either by sensitive or voluntary associations, and that so violently as to
exclude the stimuli of external objects. These two situations of our
sensual motions, or ideas, resemble convulsion and epilepsy; as in the
former the stimulus of external objects is still perceived, but not in the
latter. Whence this disease, so far from being connected with sleep, though
it has by universal mistake acquired its name from it, arises from excess
of volition, and not from a suspension of it; and though, like other kinds
of epilepsy, it often attacks the patients in their sleep, yet those two,
whom I saw, were more frequently seized with it while awake, the
sleep-walking being a part of the reverie. See Sect. XIX. and XXXIV. 3. and
Class II. 1. 7. 4. and III. 1. 2. 18.

M. M. Opium in large doses before the expected paroxysm.

10. _Asthma convulsivum._ The fits of convulsive asthma return at periods,
and are attended with cold extremities, and so far resemble the access of
an intermittent fever; but, as the lungs are not sensible to the pain of
cold, a shivering does not succeed, but instead of it violent efforts of
respiration; which have no tendency, as in the humoral asthma, to dislodge
any offending material, but only to relieve the pain by exertion, like the
shuddering in the beginning of ague-fits, as explained Class III. 1. 1. 2.

The insensibility of the lungs to cold is observable on going into frosty
air from a warm room; the hands and face become painfully cold, but no such
sensation is excited in the lungs; which is another argument in favour of
the existence of a peculiar set of nerves for the purpose of perceiving the
universal fluid matter of heat, in which all things are immersed. See Sect.
XIV. 6. Yet are the lungs nevertheless very sensible to the deficiency of
oxygen in the atmosphere, as all people experience, when they go into a
room crowded with company and candles, and complain, that it is so close,
they can scarcely breathe; and the same in some hot days in summer.

There are two diseases, which bear the name of asthma. The first is the
torpor or inability of the minute vessels of the lungs, consisting of the
terminations of the pulmonary and bronchial arteries and veins, and their
attendant lymphatics; in this circumstance it resembles the difficulty of
breathing, which attends cold bathing. If this continues long, a congestion
of fluid in the air-cells succeeds, as the absorbent actions cease
completely before the secerning ones; as explained in Class I. 1. 2. 3. And
the coldness, which attends the inaction of these vessels, prevents the
usual quantity of exhalation. Some fits cease before this congestion takes
place, and in them no violent sweating nor any expuition of phlegm occurs.
This is the humoral asthma, described at Class II. 1. 1. 7.

The second kind of asthma consists in the convulsive actions in consequence
of the disagreeable sensations thus induced; which in some fits of asthma
are very great, as appears in the violent efforts to raise the ribs, and to
depress the diaphragm, by lifting the shoulders. These, so long as they
contribute to remove the cause of the disease, are not properly
convulsions, but exertions immediately caused by sensation; but in this
kind of asthma they are only efforts to relieve pain, and are frequently
preceded by other epileptic convulsions.

These two kinds of asthmas have so many resembling features, and are so
frequently intermixed, that it often requires great attention to
distinguish them; but as one of them is allied to anasarca, and the other
to epilepsy, we shall acquire a clearer idea of them by comparing them with
those disorders. A criterion of the humoral or hydropic asthma is, that it
is relieved by copious sweats about the head and breast, which are to be
ascribed to the sensitive exertions of the pulmonary vessels to relieve the
pain occasioned by the anasarcous congestion in the air-cells; and which is
effected by the increased absorption of the mucus, and its elimination by
the retrograde action of those lymphatics of the skin, whose branches
communicate with the pulmonary ones; and which partial sweats do not easily
admit of any other explanation. See Class I. 3. 2. 8. Another criterion of
it is, that it is generally attended with swelled legs, or other symptoms
of anasarca. A criterion of the convulsive asthma may be had from the
absence of these cold clammy sweats of the upper part of the body only, and
from the patient having occasionally been subject to convulsions of the
limbs, as in the common epilepsy.

It may thus frequently happen, that in the humoral asthma some exertions of
the lungs may occur, which may not contribute to discharge the anasarcous
lymph, but may be efforts simply to relieve pain; besides those efforts,
which produce the increased absorption and elimination of it; and thus we
have a bodily disease resembling in this circumstance the reverie, in which
both sensitive and voluntary motions are at the same time, or in
succession, excited for the purpose of relieving pain.

It may likewise sometimes happen, that the disagreeable sensation,
occasioned by the congestion of lymph in the air-cells in the humoral or
hydropic asthma, may induce voluntary convulsions of the respiratory organs
only to relieve the pain, without any sensitive actions of the pulmonary
absorbents to absorb and eliminate the congestion of serous fluid; and thus
the same cause may occasionally induce either the humoral or convulsive
asthma.

The humoral asthma has but one remote cause, which is the torpor of the
pulmonary vessels, like that which occurs on going into the cold bath; or
the want of absorption of the pulmonary lymphatics to take up the lymph
effused into the air-cell. Whereas the convulsive asthma, like other
convulsions, or epilepsies, may be occasioned by pain in almost any remote
part of the system. But in some of the adult patients in this disease, as
in many epilepsies, I have suspected the remote cause to be a pain of the
liver, or of the biliary ducts.

The asthmas, which have been induced in consequence of the recess of
eruptions, especially of the leprous kind, countenance this opinion. One
lady I knew, who for many years laboured under an asthma, which ceased on
her being afflicted with pain, swelling, and distortion of some of her
large joints, which were esteemed gouty, but perhaps erroneously. And a
young man, whom I saw yesterday, was seized with asthma on the
retrocession, or ceasing of eruptions on his face.

The convulsive asthma, as well as the hydropic, are more liable to return
in hot weather; which may be occasioned by the less quantity of oxygen
existing in a given quantity of warm air, than of cold, which can be taken
into the lungs at one inspiration. They are both most liable to occur after
the first sleep, which is therefore a general criterion of asthma. The
cause of this is explained in Sect. XVIII. 15. and applies to both of them,
as our sensibility to internal uneasy sensation increases during sleep.

When children are gaining teeth, long before they appear, the pain of the
gums often induces convulsions. This pain is relieved in some by sobbing
and screaming; but in others a laborious respiration is exerted to relieve
the pain; and this constitutes the true asthma convulsivum. In other
children again general convulsions, or epileptic paroxysms, are induced for
this purpose; which, like other epilepsies, become established by habit,
and recur before the irritation has time to produce the painful sensation,
which originally caused them.

The asthma convulsivum is also sometimes induced by worms, or by acidity in
the stomachs of children, and by other painful sensations in adults; in
whom it is generally called nervous asthma, and is often joined with other
epileptic symptoms.

This asthma is distinguished from the peripneumony, and from the croup, by
the presence of fever in the two latter. It is distinguished from the
humoral asthma, as in that the patients are more liable to run to the cold
air for relief, are more subject to cold extremities, and experience the
returns of it more frequently after their first sleep. It is distinguished
from the hydrops thoracis, as that has no intervals, and the patient sits
constantly upright, and the breath is colder; and, where the pericardium is
affected, the pulse is quick and unequal. See Hydrops Thoracis, I. 2. 3.
14.

M. M. Venesection once. A cathartic with calomel once. Opium. Assafoetida.
Warm bath. If the cause can be detected, as in toothing or worms, it should
be removed. As this species of asthma is so liable to recur during sleep,
like epileptic fits, as mentioned in Section XVIII. 15. there was reason to
believe, that the respiration of an atmosphere mixed with hydrogen, or any
other innocuous air, which might dilute the oxygen, would be useful in
preventing the paroxysms by decreasing the sensibility of the system. This,
I am informed by Dr. Beddoes, has been used with decided success by Dr.
Ferriar. See Class II. 1. 1. 7.

11. _Asthma dolorificum._ Angina pectoris. The painful asthma was first
described by Dr. Heberden in the Transactions of the College; its principal
symptoms consist in a pain about the middle of the sternum, or rather
lower, on every increase of pulmonary or muscular exertion, as in walking
faster than usual, or going quick up a hill, or even up stairs; with great
difficulty of breathing, so as to occasion the patient instantly to stop. A
pain in the arms about the insertion of the tendon of the pectoral muscle
generally attends, and a desire of resting by hanging on a door or branch
of a tree by the arms is sometimes observed. Which is explained in Class I.
2. 3. 14. and in Sect. XXIX. 5. 2.

These patients generally die suddenly; and on examining the thorax no
certain cause, or seat, of the disease has been detected; some have
supposed the valves of the arteries, or of the heart, were imperfect; and
others that the accumulation of fat about this viscus or the lungs
obstructed their due action; but other observations do not accord with
these suppositions.

Mr. W----, an elderly gentleman, was seized with asthma during the hot part
of last summer; he always waked from his first sleep with difficult
respiration, and pain in the middle of his sternum, and after about an hour
was enabled to sleep again. As this had returned for about a fortnight, it
appeared to me to be an asthma complicated with the disease, which Dr.
Heberden has called angina pectoris. It was treated by venesection, a
cathartic, and then by a grain of opium given at going to bed, with ether
and tincture of opium when the pain or asthma required, and lastly with the
bark, but was several days before it was perfectly subdued.

This led me to conceive, that in this painful asthma the diaphragm, as well
as the other muscles of respiration, was thrown into convulsive action, and
that the fibres of this muscle not having proper antagonists, a painful
fixed spasm of it, like that of the muscles in the calf of the leg in the
cramp, might be the cause of death in the angina pectoris, which I have
thence arranged under the name of painful asthma, and leave for further
investigation.

From the history of the case of the late much lamented John Hunter, and
from the appearances after death, the case seems to have been of this kind,
complicated with vertigo and consequent affection of the stomach. The
remote cause seems to have arisen from ossifications of the coronary
arteries; and the immediate cause of his death from fixed spasm of the
heart. Other histories and dissections are still required to put this
matter out of doubt; as it is possible, that either a fixed spasm of the
diaphragm, or of the heart, which are both furnished with but weak
antagonists, may occasion sudden death; and these may constitute two
distinct diseases.

Four patients I have now in my recollection, all of whom I believed to
labour under the angina pectoris in a great degree; which have all
recovered, and have continued well three or four years by the use, as I
believe, of issues on the inside of each thigh; which were at first large
enough to contain two pease each, and afterwards but one. They took besides
some slight antimonial medicine for a while, and were reduced to half the
quantity or strength of their usual potation of fermented liquor.

The use of femoral issues in angina pectoris was first recommended by Dr.
Macbride, physician at Dublin, Med. Observ. & Enquir. Vol. VI. And I was
further induced to make trial of them, not only because the means which I
had before used were inadequate, but from the ill effect I once observed
upon the lungs, which succeeded the cure of a small sore beneath the knee;
and argued conversely, that issues in the lower limbs might assist a
difficult respiration.

Mrs. L----, about fifty, had a small sore place about the size of half a
pea on the inside of the leg a little below the knee. It had discharged a
pellucid fluid, which she called a ley-water, daily for fourteen years,
with a great deal of pain; on which account she applied to a surgeon, who,
by means of bandage and a saturnine application, soon healed the sore,
unheedful of the consequences. In less than two months after this I saw her
with great difficulty of breathing, which with universal anasarca soon
destroyed her.

The theory of the double effect of issues, as above related, one in
relieving by their presence the asthma dolorificum, and the other in
producing by its cure an anasarca of the lungs, is not easy to explain.
Some similar effects from cutaneous eruptions and from blisters are
mentioned in Class I. 1. 2. 9. In these cases it seems probable, that the
pain occasioned by issues, and perhaps the absorption of a small quantity
of aerated purulent matter, stimulate the whole system into greater energy
of action, and thus prevent the torpor which is the beginning of so many
diseases. In confirmation of this effect of pain on the system, I remember
the case of a lady of an ingenious and active mind, who, for many of the
latter years of her life, was perpetually subject to great pains of her
head from decaying teeth. When all her teeth were gone, she became quite
low spirited, and melancholy in the popular sense of that word, and after a
year or two became universally dropsical and died.

M. M. Issues in the thighs. Five grains of rhubarb, and one sixth of a
grain of emetic tartar every night for some months, with or without half a
grain of opium. No stronger liquor than small beer, or wine diluted with
twice its quantity of water. Since I wrote the above I have seen two cases
of hydrops thoracis, attended with pain in the left arm, so as to be
mistaken for asthma dolorificum, in which femoral issues, though applied
early in the disease, had no effect.

12. _Stridor dentium._ The clattering of the teeth on going into cold
water, or in the beginning of ague-fits, is an exertion along with the
tremblings of the skin to relieve the pain of cold. The teeth and skin
being more sensible to cold than the more internal parts, and more exposed
to it, is the reason that the muscles, which serve them, are thrown into
exertion from the pain of cold rather than those of respiration, as in
screaming from more acute pain. Thus the poet,

  Put but your toes into cold water,
  Your correspondent teeth will clatter.
                          PRIOR.

In more acute pains the jaws are gnashed together with great vehemence,
insomuch that sometimes the teeth are said to have been broken by the
force. See Sect. XXXIV. 1. 3. In these cases something should be offered to
the patient to bite, as a towel, otherwise they are liable to tear their
own arms, or to bite their attendants, as I have witnessed in the painful
epilepsy.

13. _Tetanus trismus._ Cramp. The tetanus consists of a fixed spasm of
almost all the muscles of the body; but the trismus, or locked jaw, is the
most frequent disease of this kind. It is generally believed to arise from
sympathy with an injured tendon. In one case where it occurred in
consequence of a broken ankle from a fall from a horse, it was preceded by
evident hydrophobia. Amputation was advised, but not submitted to; two
wounds were laid into one with scissors, but the patient died about the
seventh day from the accident. In this case the wounded tendon, like the
wounds from the bite of a mad dog, did not produce the hydrophobia, and
then the locked jaw, till several days after the accident.

I twice witnessed the locked jaw from a pain beneath the sternum, about the
part where it is complained of in painful asthma, or angina pectoris, in
the same lady at some years distance of time. The last time it had
continued two days, and she wrote her mind, or expressed herself by signs.
On observing a broken tooth, which made a small aperture into her mouth, I
rolled up five grains of opium like a worm about an inch long, and
introducing it over the broken tooth, pushed it onward by means of a small
crow-quill; as it dissolved I observed she swallowed her saliva, and in
less than half an hour, she opened her mouth and conversed as usual.

Men are taught to be ashamed of screaming from pain in their early years;
hence they are prone to exert the muscles of the jaws instead, which they
have learnt to exert frequently and violently from their infancy; whence
the locked jaw. This and the following spasm have no alternate relaxations,
like the preceding ones; which is perhaps owing, first, to the weakness of
their antagonist muscles, those which elevate the jaw being very strong for
the purpose of biting and masticating hard substances, and for supporting
the under jaw, with very weak antagonist muscles; and secondly, to their
not giving sufficient relief even for a moment to the pain, or its
preceding irritation, which excited them.

M. M. Opium in very large quantities. Mercurial ointment used extensively.
Electricity. Cold bath. Dilate the wound, and fill it with lint moistened
with spirit of turpentine; which inflames the wound, and cures or prevents
the convulsions. See a case, Transact. of American Society, Vol. II. p.
227.

Wine in large quantities in one case was more successful than opium; it
probably inflames more, which in this disease is desirable. Between two or
three ounces of bark, and from a quart to three pints of wine a day,
succeeded better than opium. Ib.

14. _Tetanus dolorificus._ Painful cramp. This kind of spasm most
frequently attacks the calf of the leg, or muscles of the toes; it often
precedes paroxysms of gout, and appears towards the end of violent
diarrhoea, and from indigestion, or from acid diet. In these cases it seems
to sympathize with the bowels, but is also frequently produced by the pain
of external cold, and to the too great previous extension of the muscles,
whence some people get the cramp in the extensor muscles of the toes after
walking down hill, and of those of the calf of the leg after walking up a
steep eminence. For the reason why these cramps commence in sleep, see
Sect. XVIII. 15.

The muscle in this disease contracts itself to relieve some smaller pain,
either from irritation or association, and then falls into great pain
itself, from the too great action of its own fibres. Hence any muscle, by
being too vehemently exerted, falls into cramp, as in swimming too forcibly
in water, which is painfully cold; and a secondary pain is then induced by
the too violent contraction of the muscle; though the pain, which was the
cause of the contraction, ceases. Which accounts for the continuance of the
contraction, and distinguishes this disease from other convulsions, which
are relaxed and exerted alternately. Hence whatever may be the cause of the
primary pain, which occasions the cramp of the calf of the leg, the
secondary one is relievable by standing up, and thus by the weight of the
body on the toes forcibly extending the contracted muscles. For the cause,
which induces these muscles of the calf of the leg to fall into more
violent contraction than other spasmodic muscles, proceeds from the
weakness of their antagonist muscles; as they are generally extended again
after action by the weight of the body on the balls of the toes. See the
preceding article.

M. M. Rub the legs with camphor dissolved in oil, and let the patient wear
stockings in bed. If a foot-board be put at the bed's feet, and the bed be
so inclined, that he will rest a little with his toes against the
foot-board, that pressure is said to prevent the undue contractions of the
musculi gastrocnemii, which constitute the calf of the leg. In gouty
patients, or where the bowels are affected with acidity, half a grain of
opium, and six grains of rhubarb, and six of chalk, every night. Flesh-meat
to supper. A little very weak warm spirit and water may be taken for
present relief, when these cramps are very troublesome to weak or gouty
patients.

15. _Hydrophobia._ Dread of water generally attending canine madness. I was
witness to a case, where this disease preceded the locked jaw from a wound
in the ankle, occasioned by a fall from a horse; as mentioned in the
preceding article. It came on about the sixth day after the accident; when
the patient attempted to swallow fluids, he became convulsed all over from
the pain of this attempt, and spurted them out of his mouth with violence.
It is also said to happen in some hysterical cases. Hence it seems rather
the immediate consequence of a pained tendon, than of a contagious poison.
And is so far analogous to tetanus, according with the opinions of Doctor
Rusch and Doctor Percival.

In other respects, as it is produced by the saliva of an enraged animal
instilled into a wound, it would seem analogous to the poison of venomous
animals. And from the manner of its access so long after the bite, and of
its termination in a short time, it would seem to resemble the progress of
contagious fevers. See Sect. XXII. 3. 3.

If the patient was bitten in a part, which could be totally cut away, as a
finger, even after the hydrophobia appears, it is probable it might cure
it; as I suspect the cause still remains in the wounded tendon, and not in
a diffused infection tainting the blood. Hence there are generally uneasy
sensations, as cold or numbness, in the old cicatrix, before the
hydrophobia commences. See a case in Medical Communications, Vol. II. p.
190.

If the diseased tendon could be inflamed without cutting it out, as by
cupping, or caustic, or blister after cupping, and this in the old wound
long since healed, after the hydrophobia commences, might prevent the
spasms about the throat. As inflaming the teeth by the use of mercury is of
use in some kinds of hemicrania. Put spirit of turpentine on the wound,
wash it well. See Class I. 3. 1. 11. IV. 1. 2. 7.

M. M. Wine, musk, oil, internally. Opium, mercurial ointment, used
extensively. Mercurial fumigation. Turpeth mineral. To salivate the patient
as soon as possible. Exsection or a caustic on the scar, even after the
appearance of hydrophobia. Put a tight bandage on the limb above the scar
of the old wound to benumb the pained tendon, however long the wound may
have been healed. Could a hollow catheter of elastic gum, caoutchouc, be
introduced into the oesophagus by the mouth or nostril, and liquid
nourishment be thus conveyed into the stomach? See Desault's Journal, Case
I. where, in an ulcer of the mouth, such a catheter was introduced by the
nostril, and kept in the oesophagus for a month, by which means the patient
was nourished and preserved.

It is recommended by Dr. Bardsley to give oil internally by a similar
method contrived by Mr. John Hunter. He covered a probang with the skin of
a small eel, or the gut of a lamb or cat. It was tied up at one end above
and below the sponge, and a slit made above the upper ligature; to the
other end of the eel-skin or gut was fixed a bladder and pipe. The probang
thus covered was introduced into the stomach, and the liquid food or
medicine was put into the bladder and squeezed down through the eel-skin.
Mem. of Society at Manchester. See Class I. 2. 3. 25.

Dr. Bardsley has endeavoured to prove, that dogs never experience the
hydrophobia, or canine madness, without having been previously bitten or
infected; and secondly, that the disease in this species of animal always
shews itself in five or six weeks; and concludes from hence, that this
dreadful malady might be annihilated by making all the dogs in Great
Britain perform a kind of quarantine, by shutting them up for a certain
number of weeks. Though the disease from the bite of the mad dog is perhaps
more analogous to those from the wounds inflicted by venomous animals than
to those from other contagious matter, yet these observations are well
worthy further attention; which the author promises.

       *       *       *       *       *

ORDO I.

_Increased Volition._

GENUS II.

_With increased Actions of the Organs of Sense._

In every species of madness there is a peculiar idea either of desire or
aversion, which is perpetually excited in the mind with all its
connections. In some constitutions this is connected with pleasurable ideas
without the exertion of much muscular action, in others it produces violent
muscular action to gain or avoid the object of it, in others it is attended
with despair and inaction. Mania is the general word for the two former of
these, and melancholia for the latter; but the species of them are as
numerous as the desires and aversions of mankind.

In the present age the pleasurable insanities are most frequently induced
by superstitious hopes of heaven, by sentimental love, and by personal
vanity. The furious insanities by pride, anger, revenge, suspicion. And the
melancholy ones by fear of poverty, fear of death, and fear of hell; with
innumerable others.

  Quicquid agunt homines, votum, timor, ira, voluptas,
  Gaudia, discursus, nostri est farrago libelli.
                                JUVEN. I. 85.

This idea, however, which induces madness or melancholy, is generally
untrue; that is, the object is a mistaken fact. As when a patient is
persuaded he has the itch, or venereal disease, of which he has no symptom,
and becomes mad from the pain this idea occasions. So that the object of
madness is generally a delirious idea, and thence cannot be conquered by
reason; because it continues to be excited by painful sensation, which is a
stronger stimulus than volition. Most frequently pain of body is the cause
of convulsion, which is often however exchanged for madness; and a painful
delirious idea is most frequently the cause of madness originally, but
sometimes of convulsion. Thus I have seen a young lady become convulsed
from a fright, and die in a few days; and a temporary madness frequently
terminates the paroxysms of the epilepsia dolorifica, and an insanity of
greater permanence is frequently induced by the pains or bruises of
parturition.

Where the patient is debilitated a quick pulse sometimes attends insane
people, which is nevertheless generally only a symptom of the debility,
owing to the too great expenditure of sensorial power; or of the paucity of
its production, as in inirritative, or in sensitive inirritated fever. See
III. 1. 1.

But nevertheless where the quick pulse is permanent, it shews the presence
of fever; and as the madness then generally arises from the disagreeable
sensations attending the fever, it is so far a good symptom; because when
the fever is cured, or ceases spontaneously, the insanity most frequently
vanishes at the same time.

The stimulus of so much volition supports insane people under variety of
hardships, and contributes to the cure of diseases from debility, as
sometimes occurs towards the end of fevers. See Sect. XXXIV. 2. 5. And, on
the same account, they bear large doses of medicines to procure any
operation on them; as emetics, and cathartics, which, before they produce
their effect in inverting the motions of the stomach in vomiting, or of the
absorbents of the bowels in purging, must first weaken the natural actions
of those organs, as shewn in Sect. XXXV. 1. 3.

From these considerations it appears, that the indications of cure must
consist in removing the cause of the pain, whether it arises from a
delirious idea, or from a real fact, or from bodily disease; or secondly,
if this cannot be done, by relieving the pain in consequence of such idea
or disease. The first is sometimes effected by presenting frequently in a
day contrary ideas to shew the fallacy, or the too great estimation, of the
painful ideas. 2dly. By change of place, and thus presenting the stimulus
of new objects, as a long journey. 3dly. By producing forgetfulness of the
idea or object, which causes their pain; by removing all things which recal
it to their minds; and avoiding all conversation on similar subjects. For I
suppose no disease of the mind is so perfectly cured by other means as by
forgetfulness.

Secondly, the pain in consequence of the ideas or bodily diseases above
described is to be removed, first, by evacuations, as venesection, emetics,
and cathartics; and then by large doses of opium, or by the vertigo
occasioned by a circulating swing, or by a sea-voyage, which, as they
affect the organs of sense as well as evacuate the stomach, may contribute
to answer both indications of cure.

Where maniacs are outrageous, there can be no doubt but coercion is
necessary; which may be done by means of a straight waistcoat; which
disarms them without hurting them; and by tying a handkerchief round their
ankles to prevent their escape. In others there can be no doubt, but that
confinement retards rather than promotes their cure; which is forwarded by
change of ideas in consequence of change of place and of objects, as by
travelling or sailing.

The circumstances which render confinement necessary, are first, if the
lunatic is liable to injure others, which must be judged of by the outrage
he has already committed. 2dly. If he is likely to injure himself; this
also must be judged of by the despondency of his mind, if such exists.
3dly. If he cannot take care of his affairs. Where none of these
circumstances exist, there should be no confinement. For though the
mistaken idea continues to exist, yet if no actions are produced in
consequence of it, the patient cannot be called insane, he can only be
termed delirious. If every one, who possesses mistaken ideas, or who puts
false estimates on things, was liable to confinement, I know not who of my
readers might not tremble at the sight of a madhouse!

The most convenient distribution of insanities will be into general, as
mania mutabilis, studium inane, and vigilia; and into partial insanities.
These last again may be subdivided into desires and aversions, many of
which are succeeded by pleasurable or painful ideas, by fury or dejection,
according to the degree or violence of their exertions. Hence the analogy
between the insanities of the mind, and the convulsions of the muscles
described in the preceding genus, is curiously exact. The convulsions
without stupor, are either just sufficient to obliterate the pain, which
occasions them; or are succeeded by greater pain, as in the convulsio
dolorifica. So the exertions in the mania mutabilis are either just
sufficient to allay the pain which occasions them, and the patient dwells
comparatively in a quiet state; or those exertions excite painful ideas,
which are succeeded by furious discourses, or outrageous actions. The
studium inane, or reverie, resembles epilepsy, in which there is no
sensibility to the stimuli of external objects. Vigilia, or watchfulness,
may be compared to the general writhing of the body; which is just a
sufficient exertion to relieve the pain which occasions it. Erotomania may
be compared to trismus, or other muscular fixed spasm, without much
subsequent pain; and mæror to cramp of the muscles of the leg, or other
fixed spasm with subsequent pain. All these coincidences contribute to
shew, as explained in Sect. III. 5, that our ideas are motions of the
immediate organs of sense obeying the same laws as our muscular motions.

The violence of action accompanying insanity depends much on the education
of the person; those who have been proudly educated with unrestrained
passions, are liable to greater fury; and those, whose education has been
humble, to greater despondency. Where the delirious idea, above described,
produces pleasurable sensations, as in personal vanity or religious
enthusiasm; it is almost a pity to snatch them from their fool's paradise,
and reduce them again to the common lot of humanity; lest they should
complain of their cure, like the patient described in Horace,

  --------Pol! me occidistis, amici,
  Non servastis, ait, cui sic extorta voluptas,
  Et demptus per vim mentis gratissimus error!

The disposition to insanity, as well as to convulsion, is believed to be
hereditary; and in consequence to be induced in those families from
slighter causes than in others. Convulsions have been shewn to have been
most frequently induced by pains owing to defect of stimulus, as the
shuddering from cold, and not from pains from excess of stimulus, which are
generally succeeded by inflammation. But insanities are on the contrary
generally induced by pains from excess of stimulus, as from the too violent
actions of our ideas, as in common anger, which is an insanity of short
duration; for insanities generally, though not always, arise from pains of
the organs of sense; but convulsions generally, though not always, from
pains of the membranes or glands. And it has been previously explained,
that though the membrane and glands, as the stomach and skin, receive great
pain from want of stimulus; yet that the organs of sense, as the eye and
ear, receive no pain from defect of stimulus.

Hence it follows, that the constitutions most liable to convulsion, are
those which most readily become torpid in some part of the system, that is,
which possess less irritability; and that those most liable to insanity,
are such as have excess of sensibility; and lastly, that these two
circumstances generally exist in the same constitution; as explained in
Sect. XXXI. 2. on Temperaments. These observations explain why epilepsy and
insanity frequently succeed or reciprocate with each other, and why
inirritable habits, as scrophulous ones, are liable to insanity, of which I
have known some instances.

In many cases however there is no appearance of the disposition to epilepsy
or insanity of the parent being transmitted to the progeny. First, where
the insanity has arisen from some violent disappointment, and not from
intemperance in the use of spirituous liquors. Secondly, where the parent
has acquired the insanity or epilepsy by habits of intoxication after the
procreation of his children. Which habits I suppose to be the general cause
of the disposition to insanity in this country. See Class III. 1. 1. 7.

As the disposition to gout, dropsy, epilepsy, and insanity, appears to be
produced by the intemperate use of spirituous potation, and is in all of
them hereditary; it seems probable, that this disposition gradually
increases from generation to generation, in those families which continue
for many generations to be intemperate in this respect; till at length
these diseases are produced; that is, the irritability of the system
gradually is decreased by this powerful stimulus, and the sensibility at
the same time increased, as explained in Sect. XXXI. 1. and 2. This
disposition is communicated to the progeny, and becomes still increased, if
the same stimulus be continued, and so on by a third and fourth generation;
which accounts for the appearance of epilepsy in the children of some
families, where it was never known before to have existed, and could not be
ascribed to their own intemperance. A parity of reasoning shews, that a few
sober generations may gradually in the same manner restore a due degree of
irritability to the family, and decrease the excess of sensibility.

From hence it would appear probable, that scrophula and dropsy are diseases
from inirritability; but that in epilepsy and insanity an excess of
sensibility is added, and the two faulty temperaments are thus conjoined.

SPECIES.

1. _Mania mutabilis._ Mutable madness. Where the patients are liable to
mistake ideas of sensation for those from irritation, that is, imaginations
for realities, if cured of one source of insanity, they are liable in a few
months to find another source in some new mistaken or imaginary idea, and
to act from this new idea. The idea belongs to delirium, when it is an
imaginary or mistaken one; but it is the voluntary actions exerted in
consequence of this mistaken idea, which constitute insanity.

In this disease the patient is liable carefully to conceal the object of
his desire or aversion. But a constant inordinate suspicion of all people,
and a carelessness of cleanliness, and of decency, are generally
concomitants of madness. Their designs cannot be counteracted, till you can
investigate the delirious idea or object of their insanity; but as they are
generally timid, they are therefore less to be dreaded.

Z. Z. called a young girl, one of his maid-servants, into the parlour, and,
with cocked pistols in his hands, ordered her to strip herself naked; he
then inspected her with some attention, and dismissed her untouched. Then
he stripped two of his male servants in the same manner, to the great
terror of the neighbourhood. After he was secured, with much difficulty he
was persuaded to tell me, that he had got the itch, and had examined some
of his servants to find out from whom he had received it; though at the
same time there was not a spot to be seen on his hands, or other parts. The
outrages in consequence of this false idea were in some measure to be
ascribed to the pride occasioned by unrestrained education, affluent
wealth, and dignified family.

Madness is sometimes produced by bodily pain, particularly I believe of a
diseased liver, like convulsion and epilepsy; at other times it is caused
by very painful ideas occasioned by external circumstances, as of grief or
disappointment; but the most frequent cause of insanity arises from the
pain of some imaginary or mistaken idea; which may be termed hallucinatio
maniacalis. This hallucination of one of the senses is often produced in an
instant, and generally becomes gradually weakened in process of time, by
the perpetual stimulus of external objects, or by the successions of other
catenations of ideas, or by the operations of medicines; and when the
maniacal hallucination ceases, or is forgotten, the violent exertions
cease, which were in consequence of it, and the disease is cured.

Mr. ----, a clergyman, about forty years of age, who was rather a weak man,
happened to be drinking wine in jocular company, and by accident swallowed
a part of the seal of a letter, which he had just then received; one of his
companions seeing him alarmed, cried out in humour, "It will seal your
bowels up." He became melancholy from that instant, and in a day or two
refused to swallow any kind of nourishment. On being pressed to give a
reason for this refusal, he answered, he knew nothing would pass through
him. A cathartic was given, which produced a great many evacuations, but he
still persisted, that nothing passed through him; and though he was
frightened into taking a little broth once or twice by threats, yet he soon
ceased intirely to swallow any thing, and died in consequence of this
insane idea.

Miss ----, a sensible and ingenious lady, about thirty, said she had seen
an angel; who told her, that she need not eat, though all others were under
the necessity of supporting their earthly existence by food. After
fruitless persuasions to take food, she starved herself to death.--It was
proposed to send an angel of an higher order to tell her, that now she must
begin to eat and drink again; but it was not put into execution.

Mrs. ----, a lady between forty and fifty years of age, imagined that she
heard a voice say to her one day, as she was at her toilet, "Repent, or you
will be damned." From that moment she became melancholy, and this
hallucination affected her in greater or less degree for about two years;
she then recovered perfectly, and is now a cheerful old woman.

Mrs. ----, a farmer's wife, going up stairs to dress, found the curtains of
her bed drawn, and on undrawing them, she believed that she saw the corpse
of her sister, who was then ill at the distance of twenty miles, and became
from that time insane; and as her sister died about the time, she could not
be produced to counteract the insane hallucination, but she perfectly
recovered in a few months.

Mrs. ----, a most elegant, beautiful, and accomplished lady, about
twenty-two years of age, had been married about two months to an elegant,
polished, and affluent young man, and it was well known to be a love-match
on both sides. She suddenly became melancholy, and yet not to so great a
degree, but that she could command herself to do the honours of her table
with grace and apparent ease. After many days intreaty, she at length told
me, that she thought her marrying her husband had made him unhappy; and
that this idea she could not efface from her mind day or night. I withstood
her being confined, as some had advised, and proposed a sea-voyage to her,
with expectation that the sickness, as well as change of objects, might
remove the insane hallucination, by introducing other energetic ideas; this
was not complied with, but she travelled about England with her friends and
her husband for many months, and at length perfectly recovered, and is now
I am informed in health and spirits.

These cases are related to shew the utility of endeavouring to investigate
the maniacal idea, or hallucination; as it may not only acquaint us with
the probable designs of the patient, from whence may be deduced the
necessity of confinement; but also may some time lead to the most effectual
plan of cure.

I received good information of the truth of the following case, which was
published a few years ago in the newspapers. A young farmer in
Warwickshire, finding his hedges broke, and the sticks carried away during
a frosty season, determined to watch for the thief. He lay many cold hours
under a hay-stack, and at length an old woman, like a witch in a play,
approached, and began to pull up the hedge; he waited till she had tied up
her bottle of sticks, and was carrying them off, that he might convict her
of the theft, and then springing from his concealment, he seized his prey
with violent threats. After some altercation, in which her load was left
upon the ground, she kneeled upon her bottle of sticks, and raising her
arms to heaven beneath the bright moon then at the full, spoke to the
farmer already shivering with cold, "Heaven grant, that thou never mayest
know again the blessing to be warm." He complained of cold all the next
day, and wore an upper coat, and in a few days another, and in a fortnight
took to his bed, always saying nothing made him warm, he covered himself
with very many blankets, and had a sieve over his face, as he lay; and from
this one insane idea he kept his bed above twenty years for fear of the
cold air, till at length he died.

M. M. As mania arises from pain either of our muscles or organs of sense,
the arts of relieving pain must constitute the method of cure. See Sect.
XXXIV. 3. 4. Venesection. Vomits of from five grains to ten of emetic
tartar, repeated every third morning for three or four times; with solution
of gum-ammoniac, and soluble tartar, so as to purge gently every day.
Afterwards warm bath for two or three hours a day. Opium in large doses.
Bark. Steel.

Dr. Binns gave two scruples (40 grains) of solid opium at a dose, and
twenty grains four hours afterwards; which restored the patient. Dr.
Brandreth gave 400 drops of laudanum to a maniac in the greatest possible
furor, and in a few hours he became calm and rational. Med. Comment for
1791, p. 384.

_Prognostic._

The temporary quick pulse attending some maniacal cases is simply a symptom
of debility, and is the consequence of too great exertions; but a permanent
quick pulse shews the presence of fever, and is frequently a salutary sign;
because, if the life of the patient be safe, when the fever ceases, the
insanity generally vanishes along with it, as mentioned above. In this case
the kind of fever must direct the method of curing the insanity; which must
consist of moderate evacuations and diluents, if the pulse be strong; or by
nutrientia, bark, and small doses of opium, if the pulse be weak.

Where the cause is of a temporary nature, as in puerperal insanity, there
is reason to hope, that the disease will cease, when the bruises, or other
painful sensations attending this state, are removed. In these cases the
child should be brought frequently to the mother, and applied to her
breast, if she will suffer it, and this whether she at first attends to it
or not; as by a few trials it frequently excites the storgè, or maternal
affection, and removes the insanity, as I have witnessed.

When the madness is occasioned by pain of the teeth, which I believe is no
uncommon case, these must be extracted; and the cure follows the extinction
of the pain. There is however some difficulty in detecting the delinquent
tooth in this case, as in hemicrania, unless by its apparent decay, or by
some previous information of its pain having been complained of; because
the pain of the tooth ceases, as soon as the exertions of insanity
commence.

When a person becomes insane, who has a family of small children to solicit
his attention, the prognostic is very unfavourable; as it shews the
maniacal hallucination to be more powerful than those ideas which generally
interest us the most.

2. _Studium inane._ Reverie consists of violent voluntary exertions of
ideas to relieve pain, with all the trains or tribes connected with them by
sensations or associations. It frequently alternates with epileptic
convulsions; with which it corresponds, in respect to the insensibility of
the mind to the stimuli of external objects, in the same manner as madness
corresponds with common convulsion, in the patient's possessing at the same
time a sensibility of the stimuli of external objects.

Some have been reported to have been involved in reverie so perfectly, as
not to have been disturbed by the discharge of a cannon; and others to have
been insensible to torture, as the martyrs for religious opinions; but
these seem more properly to belong to particular insanities than to
reverie, like nostalgia and erotomania.

Reverie is distinguished from madness as described above; and from
delirium, because the trains of ideas are kept consistent by the power of
volition, as the person reasons and deliberates in it. Somnambulismus is a
part of reverie, the latter consisting in the exertions of the locomotive
muscles, and the former of the exertions of the organs of sense; see Class
III. 1. 1. 9. and Sect. XIX. both which are mixed, or alternate with each
other, for the purpose of relieving pain.

When the patients in reverie exert their volition on their organs of sense,
they can occasionally perceive the stimuli of external objects, as
explained in Sect. XIX. And in this case it resembles sometimes an
hallucination of the senses, as there is a mixture of fact and imagination
in their discourse; but may be thus distinguished: hallucinations of the
lenses are allied to delirium, and are attended generally with quick pulse,
and other symptoms of great debility; but reverie is without fever, and
generally alternates with convulsions; and so much intuitive analogy (see
Sect. XVII. 3. 7.) is retained in its paroxysms, as to preserve a
consistency in the trains of ideas.

Miss G----, whose case is related in Sect. III. 5. 8. said, as I once sat
by her, "My head is fallen off, see it is rolled to that corner of the
room, and the little black dog is nibbling the nose off." On my walking to
the place which she looked at, and returning, and assuring her that her
nose was unhurt, she became pacified, though I was doubtful whether she
attended to me. See Class III. 1. 1. 9. and Class III. 1. 2. 2.

M. M. Large doses of opium given before the expected paroxysm, as in
epilepsia dolorifica, Class III. 1. 1. 8.

The hallucinatio studiosa, or false ideas in reverie, differ from maniacal
hallucinations above described, as no insane exertions succeed, and in the
patients whom I have seen they have always been totally forgotten, when the
paroxysm was over.

Master ----, a school-boy about twelve years old, after he came out of a
convulsion fit and sat up in bed, said to me, "Don't you see my father
standing at the feet of the bed, he is come a long way on foot to see me."
I answered, no: "What colour is his coat!" He replied, "A drab colour."
"And what buttons?" "Metal ones," he answered, and added, "how sadly his
legs are swelled." In a few minutes he said, with apparent surprise, "He is
gone," and returned to his perfect mind. Other cases are related in Sect.
XIX. and XXXIV. 3. and in Class III. 1. 2. 2. with further observations on
this kind of hallucination; which however is not the cause of reverie, but
constitutes a part of it, the cause being generally some uneasy sensation
of the body.

3. _Vigilia._ Watchfulness consists in the unceasing exertion of volition;
which is generally caused by some degree of pain either of mind or of body,
or from defect of the usual quantity of pleasurable sensation; hence if
those, who are accustomed to wine at night, take tea instead, they cannot
sleep. The same happens from want of solid food for supper, to those who
are accustomed to use it; as in these cases there is pain or defect of
pleasure in the stomach.

Sometimes the anxiety about sleeping, that is the desire to sleep, prevents
sleep; which consists in an abolition of desire or will. This may so far be
compared to the impediment of speech described in Sect. XVII. 1. 10. as the
interference of the will prevents the effect desired.

Another source of watchfulness may be from the too great secretion of
sensorial power in the brain, as in phrenzy, and as sometimes happens from
the exhibition of opium, and of wine; if the exhaustion of sensorial power
by the general actions of the system occasioned by the stimulus of these
drugs can be supposed to be less than the increased secretion of it.

M. M. 1. Solid food to supper. Wine. Opium. Warm bath. 2. The patient
should be told that his want of sleep is of no consequence to his health.
3. Venesection by cupping. Abstinence from wine. 4. A blister by
stimulating the skin, and rhubarb by stimulating the bowels, will sometimes
induce sleep. Exercise. An uniform sound, as of a pausing drop of water, or
the murmur of bees. Other means are described in Sect. XVIII. 20.

4. _Erotomania._ Sentimental love. Described in its excess by
romance-writers and poets. As the object of love is beauty, and as our
perception of beauty consists in a recognition by the sense of vision of
those objects, which have before inspired our love, by the pleasure they
have afforded to many of our senses (Sect. XVI. 6); and as brute animals
have less accuracy of their sense of vision than mankind (ib.); we see the
reason why this kind of love is not frequently observable in the brute
creation, except perhaps in some married birds, or in the affection of the
mother to her offspring. Men, who have not had leisure to cultivate their
taste for visible objects, and who have not read the works of poets and
romance-writers, are less liable to sentimental love; and as ladies are
educated rather with an idea of being chosen, than of choosing; there are
many men, and more women, who have not much of this insanity; and are
therefore more easily induced to marry for convenience or interest, or from
the flattery of one sex to the other.

In its fortunate gratification sentimental love is supposed to supply the
purest source of human felicity; and from the suddenness with which many of
those patients, described in Species I. of this genus, were seized with the
maniacal hallucination, there is reason to believe, that the most violent
sentimental love may be acquired in a moment of time, as represented by
Shakespeare in the beginning of his Romeo and Juliet.

Some have endeavoured to make a distinction between beauty and grace, and
have made them as it were rivals for the possession of the human heart; but
grace may be defined beauty in action; for a sleeping beauty cannot be
called graceful in whatever attitude she may recline; the muscles must be
in action to produce a graceful attitude, and the limbs to produce a
graceful motion. But though the object of love is beauty, yet the idea is
nevertheless much enhanced by the imagination of the lover; which appears
from this curious circumstance, that the lady of his passion seldom appears
so beautiful to the lover after a few months separation, as his ideas had
painted her in his absence; and there is, on that account, always a little
disappointment felt for a minute at their next interview from this
hallucination of his ideas.

This passion of love produces reverie in its first state, which exertion
alleviates the pain of it, and by the assistance of hope converts it into
pleasure. Then the lover seeks solitude, lest this agreeable reverie should
be interrupted by external stimuli, as described by Virgil.

  Tantum inter densas, umbrosa cacumina, fagos
  Assiduè veniebat, ibi hæc incondita solus
  Montibus et sylvis studio jactabat inani.

When the pain of love is so great, as not to be relieved by the exertions
of reverie, as above described; as when it is misplaced on an object, of
which the lover cannot possess himself; it may still be counteracted or
conquered by the stoic philosophy, which strips all things of their
ornaments, and inculcates "nil admirari." Of which lessons may be found in
the meditations of Marcus Antoninus. The maniacal idea is said in some
lovers to have been weakened by the action of other very energetic ideas;
such as have been occasioned by the death of his favourite child, or by the
burning of his house, or by his being shipwrecked. In those cases the
violence of the new idea for a while expends so much sensorial power as to
prevent the exertion of the maniacal one; and new catenations succeed. On
this theory the lover's leap, so celebrated by poets, might effect a cure,
if the patient escaped with life.

The third stage of this disease I suppose is irremediable; when a lover has
previously been much encouraged, and at length meets with neglect or
disdain; the maniacal idea is so painful as not to be for a moment
relievable by the exertions of reverie, but is instantly followed by
furious or melancholy insanity; and suicide, or revenge, have frequently
been the consequence. As was lately exemplified in Mr. Hackman, who shot
Miss Ray in the lobby of the playhouse. So the poet describes the passion
of Dido,

  ----------Moriamur inultæ?--
  At moriamur, ait,--sic, sic, juvat ire sub umbras!

The story of Medæa seems to have been contrived by Ovid, who was a good
judge of the subject, to represent the savage madness occasioned by
ill-requited love. Thus the poet,

  Earth has no rage like love to hatred turn'd,
  Nor hell a fury like a woman scorn'd.
                          DRYDEN.

5. _Amor sui._ Vanity consists of an agreeable reverie, and is well
ridiculed in the story of Narcissus, who so long contemplated his own
beautiful image in the water, that he died from neglect of taking
sustenance. I once saw a handsome young man, who had been so much flattered
by his parents, that his vanity rose so near to insanity, that one might
discern by his perpetual attention to himself, and the difficulty with
which he arranged his conversation, that the idea of himself intruded
itself at every comma or pause of his discourse. In this degree vanity must
afford great pleasure to the possessor; and when it exists within moderate
bounds, may contribute much to the happiness of social life.

My friend Mr. ---- once complained to me, that he was much troubled with
bashfulness in company, and believed that it arose from his want of
personal vanity; on this account he determined on a journey to Paris, when
Paris was the center of politeness; he there learnt to dress, to dance, and
to move his hands gracefully in conversation; and returned a most
consummate coxcomb. But after a very few years he relapsed into rusticity
of dress and manners.

M. M. The cure of vanity may be attempted by excess of flattery, which will
at length appear ridiculous, or by its familiarity will cease to be
desired. I remember to have heard a story of a nobleman in the court of
France, when France had a court, who was so disagreeably vain in
conversation, that the king was pleased to direct his cure, which was thus
performed. Two gentlemen were directed always to attend him, one was to
stand behind his chair, and the other at a respectful distance before him;
whenever his lordship began to speak, one of them always pronounced, "Lord
Gallimaufre is going to say the best thing in the world." And, as soon as
his lordship had done speaking, the other attendant pronounced, "Lord
Gallimaufre has spoken the best thing in the world." Till in a few weeks
this noble lord was so disgusted with praise that he ceased to be vain; and
his majesty dismissed his keepers.

6. _Nostalgia._ Maladie de Pais. Calenture. An unconquerable desire of
returning to one's native country, frequent in long voyages, in which the
patients become so insane as to throw themselves into the sea, mistaking it
for green fields or meadows. The Swiss are said to be particularly liable
to this disease, and when taken into foreign service frequently to desert
from this cause, and especially after hearing or singing a particular tune,
which was used in their village dances, in their native country, on which
account the playing or singing this tune was forbid by the punishment of
death. Zwingerus.

  Dear is that shed, to which his soul conforms,
  And dear that hill, which lifts him to the storms.
                                GOLDSMITH.

7. _Spes religiosa._ Superstitious hope. This maniacal hallucination in its
milder state produces, like sentimental love, an agreeable reverie; but
when joined with works of supererogation, it has occasioned many
enormities. In India devotees consign themselves by vows to most painful
and unceasing tortures, such as holding up their hands, till they cannot
retract them; hanging up by hooks put into the thick skin over their
shoulders, sitting upon sharp points, and other self torments. While in our
part of the globe fasting and mortification, as flagellation, has been
believed to please a merciful deity! The serenity, with which many have
suffered cruel martyrdoms, is to be ascribed to this powerful reverie.

Mr. ----, a clergyman, formerly of this neighbourhood, began to bruise and
wound himself for the sake of religious mortification, and passed much time
in prayer, and continued whole nights alone in the church. As he had a wife
and family of small children, I believed the case to be incurable; as
otherwise the affection and employment in his family connections would have
opposed the beginning of this insanity. He was taken to a madhouse without
effect, and after he returned home, continued to beat and bruise himself,
and by this kind of mortification, and by sometimes long fasting, he at
length became emaciated and died. I once told him in conversation, that
"God was a merciful being, and could not delight in cruelty, but that I
supposed he worshipped the devil." He was struck with this idea, and
promised me not to beat himself for three days, and I believe kept his word
for one day. If this idea had been frequently forced on his mind, it might
probably have been of service.

When these works of supererogation have been of a public nature, what
cruelties, murders, massacres, has not this insanity introduced into the
world!--A commander, who had been very active in leading and encouraging
the bloody deeds of St. Bartholomew's day at Paris, on confessing his sins
to a worthy ecclesiastic on his death-bed, was asked, "Have you nothing to
say about St. Bartholomew?" "On that day," he replied, "God Almighty was
obliged to me!"--The fear of hell is another insanity, which will be spoken
of below.

8. _Superbia stemmatis._ Pride of family has frequently formed a maniacal
hallucination, which in its mild state has consisted in agreeable reverie,
but when it has been so painful as to demand homage from others, it has
frequently induced insane exertions. This insanity seems to have existed in
the flourishing state of Rome, as now all over Germany, and is attacked by
Juvenal with great severity, a small part of which I shall here give as a
method of cure. Sat. 8.

  Say, what avails the pedigree, that brings
  Thy boasted line from heroes or from kings;
  Though many a mighty lord, in parchment roll'd,
  Name after name, thy coxcomb hands unfold;
  Though wreathed patriots crowd thy marble halls,
  Or steel-clad warriors frown along the walls;
  While on broad canvas in the gilded frame
  All virtues flourish, and all glories flame?--
  Say,--if ere noon with idiot laugh you lie
  Wallowing in wine, or cog the dubious die,
  Or act unshamed, by each indignant bust,
  The midnight orgies of promiscuous lust!--
    Go, lead mankind to Virtue's holy shrine,
  With morals mend them, and with arts refine,
  Or lift, with golden characters unfurl'd,
  The flag of peace, and still a warring world!--
  --So shall with pious hands immortal Fame
  Wreathe all her laurels round thy honour'd name,
  High o'er thy tomb with chissel bold engrave,
  "THE TRULY NOBLE ARE THE GOOD AND BRAVE."

9. _Ambitio._ Inordinate desire of fame. A carelessness about the opinions
of others is said by Xenophon to be the source of impudence; certainly a
proper regard for what others think of us frequently incites us to virtuous
actions, and deters us from vicious ones; and increases our happiness by
enlarging our sphere of sympathy, and by flattering our vanity.

  Abstract what others feel, what others think,
  All pleasures sicken, and all glories sink.
                          POPE.

When this reverie of ambition excites to conquer nations, or to enslave
them, it has been the source of innumerable wars, and the occasion of a
great devastation of mankind. Cæsar is reported to have boasted, that he
had destroyed three millions of his enemies, and one million of his
friends.

The works of Homer are supposed to have done great injury to mankind by
inspiring the love of military glory. Alexander was said to sleep with them
always on his pillow. How like a mad butcher amid a flock of sheep appears
the hero of the Iliad, in the following fine lines of Mr. Pope, which
conclude the twentieth book.

    His fiery coursers, as the chariot rolls,
  Tread down whole ranks, and crush out heroes' souls;
  Dash'd from their hoofs, as o'er the dead they fly,
  Black bloody drops the smoaking chariot dye;--
  The spiky wheels through heaps of carnage tore,
  And thick the groaning axles dropp'd with gore;
  High o'er the scene of death ACHILLES stood,
  All grim with dust, all horrible with blood;
  Yet still insatiate, still with rage on flame,
  Such is the lust of never-dying fame!

The cure must be taken from moral writers. Woolaston says, Cæsar conquered
Pompey; that is, a man whose name consisted of the letters C. æ. s. a. r.
conquered a long time ago a man, whose name consisted of the letters P. o.
m. p. e. y. and that this is all that remains of either of them. Juvenal
also attacks this mode of insanity, Sat. X. 166.

  --I, demens, et sævas curre per alpes,
  Ut pueris placeas, et declamatio fias!

Which is thus translated by Dr. Johnson,

  And left a name, at which the world grew pale,
  To point a moral, or adorn a tale!

10. _Mæror._ Grief. A perpetual voluntary contemplation of all the
circumstances of some great loss, as of a favourite child. In general the
painful ideas gradually decrease in energy, and at length the recollection
becomes more tender and less painful. The letter of Sulpicius to Cicero on
the loss of his daughter is ingenious. The example of David on the loss of
his child is heroic.

A widow lady was left in narrow circumstances with a boy and a girl, two
beautiful and lively children, the one six and the other seven years of
age; as her circumstances allowed her to keep but one maid-servant, these
two children were the sole attention, employment, and consolation of her
life; she fed them, dressed them, slept with them, and taught them herself;
they were both snatched from her by the gangrenous sore throat in one week:
so that she lost at once all that employed her, as well as all that was
dear to her. For the first three or four days after their death, when any
friend visited her, she sat upright, with her eyes wide open, without
shedding tears, and affected to speak of indifferent things. Afterwards she
began to weep much, and for some weeks talked to her friends of nothing
else but her dear children. But did not for many years, even to her dying
hour, get quite over a gloom, which was left upon her countenance.

In violent grief, when tears flow, it is esteemed a good symptom; because
then the actions caused by sensitive association take the place of those
caused by volition; that is, they prevent the voluntary exertions of ideas,
or muscular actions, which constitute insanity.

The sobbing and sighing attendant upon grief are not convulsive movements,
they are occasioned by the sensorial power being so expended on the painful
ideas, and their connections, that the person neglects to breathe for a
time, and then a violent sigh or sob is necessary to carry on the blood,
which oppresses the pulmonary vessels, which is then performed by deep or
quick inspirations, and laborious expirations. Sometimes nevertheless the
breath is probably for a while voluntarily held, as an effort to relieve
pain. The paleness and ill health occasioned by long grief is spoken of in
Class IV. 2. 1. 9.

The melioration of grief by time, and its being at length even attended
with pleasure, depends on our retaining a distinct idea of the lost object,
and forgetting for a time the idea of the loss of it. This pleasure of
grief is beautifully described by Akenside. Pleasures of Imagination, Book
II. l. 680.

    ----------Ask the faithful youth,
  Why the cold urn of her, whom long he loved,
  So often fills his arms; so often draws
  His lonely footsteps at the silent hour
  To pay the mournful tribute of his tears?
  Oh! he will tell thee, that the wealth of worlds
  Should ne'er seduce his bosom to forego
  That sacred hour; when, stealing from the noise
  Of care and envy, sweet remembrance soothes
  With Virtue's kindest looks his aching breast,
  And turns his tears to rapture.

M. M. Consolation is best supplied by the Christian doctrine of a happy
immortality. In the pagan religion the power of dying was the great
consolation in irremediable distress. Seneca says, "no one need be unhappy
unless by his own fault." And the author of Telemachus begins his work by
saying, that Calypso could not console herself for the loss of Ulysses, and
found herself unhappy in being immortal. In the first hours of grief the
methods of consolation used by uncle Toby, in Tristram Shandy, is probably
the best; "he sat down in an arm chair by the bed of his distressed friend,
and said nothing."

11. _Tædium vitæ._ The inanity of sublunary things has afforded a theme to
philosophers, moralists, and divines, from the earliest records of
antiquity; "Vanity of vanities!" says the preacher, "all is vanity!" Nor is
there any one, I suppose, who has passed the meridian of life, who has not
at some moments felt the nihility of all things.

Weariness of life in its moderate degree has been esteemed a motive to
action by some philosophers. See Sect. XXXIV. 2. 3. But in those men, who
have run through the usual amusements of life early in respect to their
age; and who have not industry or ability to cultivate those sciences,
which afford a perpetual fund of novelty, and of consequent entertainment,
are liable to become tired of life, as they suppose there is nothing new to
be found in it, that can afford them pleasure; like Alexander, who is said
to have shed tears, because he had not another world to conquer.

Mr. ----, a gentleman about fifty, of polished manners, who in a few months
afterwards destroyed himself, said to me one day, "a ride out in the
morning, and a warm parlour and a pack of cards in the afternoon, is all
that life affords." He was persuaded to have an issue on the top of his
head, as he complained of a dull head-ach, which being unskilfully managed,
destroyed the pericranium to the size of an inch in diameter; during the
time this took in healing, he was indignant about it, and endured life, but
soon afterwards shot himself.

Mr. ----, a gentleman of Gray's Inn, some years ago was prevailed upon by
his friends to dismiss a mistress, by whom he had a child, but who was so
great a termagant and scold, that she was believed to use him very ill, and
even to beat him. He became melancholy in two days from the want of his
usual stimulus to action, and cut his throat on the third so completely,
that he died immediately.

Mr. Anson, the brother to the late Lord Anson, related to me the following
anecdote of the death of Lord Sc----. His Lordship sent to see Mr. Anson on
the Monday preceding his death, and said, "You are the only friend I value
in the world, I determined therefore to acquaint you, that I am tired of
the insipidity of life, and intend to-morrow to leave it." Mr. Anson said,
after much conversation, that he was obliged to leave town till Friday, and
added, "As you profess a friendship for me, do me this last favour, I
entreat you, live till I return." Lord Sc---- believed this to be a pious
artifice to gain time, but nevertheless agreed, if he should return by four
o'clock on that day. Mr. Anson did not return till five, and found, by the
countenances of the domestics, that the deed was done. He went into his
chamber and found the corpse of his friend leaning over the arm of a great
chair, with the pistol on the ground by him, the ball of which had been
discharged into the roof of his mouth, and passed into his brain.

Mr. ---- and Mr. ----, two young men, heirs to considerable fortunes, shot
themselves at the age of four or five and twenty, without their friends
being able to conjecture any cause for those rash actions. One of them I
had long known to express himself with dissatisfaction of the world; at
eighteen years of age he complained, that he could not entertain himself;
he tried to study the law at Cambridge, and afterwards went abroad for a
year or two by my advice; but returned dissatisfied with all things. As he
had had an eruption for some years on a part of his face, which he probably
endeavoured to remove by external applications; I was induced to ascribe
his perpetual ennui to the pain or disagreeable sensation of a diseased
liver. The other young gentleman shot himself in his bed-room, and I was
informed that there was found written on a scrap of paper on his table, "I
am impotent, and therefore not fit to live." From whence there was reason
to conclude, that this was the hallucinatio maniacalis, the delirious idea,
which caused him to destroy himself. The case therefore belongs to mania
mutabilis, and not to tædium vitæ.

M. M. Some restraint in exhausting the usual pleasures of the world early
in life. The agreeable cares of a matrimonial life. The cultivation of
science, as of chemistry, natural philosophy, natural history, which
supplies an inexhaustible source of pleasurable novelty, and relieves ennui
by the exertions it occasions.

In many of these cases, whence irksomeness of life has been the ostensible
cause of suicide, there has probably existed a maniacal hallucination, a
painful idea, which the patient has concealed even to his dying hour;
except where the mania has evidently arisen from hereditary or acquired
disease of the membranous or glandular parts of the system.

12. _Pulchritudinis desiderium._ The loss of beauty, either by disease, as
by the small-pox, or by age, as life advances, is sometimes painfully felt
by ladies, who have been much flattered on account of it. There is a
curious case of this kind related in Le Sage's Bachelor of Salamanca, which
is too nicely described to be totally imaginary.

In this situation some ladies apply to what are termed cosmetics under
various names, which crowd the newspapers. Of these the white has destroyed
the health of thousands; a calx, or magistery, of bismuth is supposed to be
sold in the shops for this purpose; but it is either, I am informed, in
part or entirely white lead or cerussa. The pernicious effects of the
external use of those saturnine applications are spoken of in gutta rosea,
Class II. 1. 4. 6. The real calx of bismuth would probably have the same
ill effect. As the red paint is prepared from cochineal, which is an animal
body, less if any injury arises from its use, as it only lies on the skin
like other filth.

The tan of the skin occasioned by the sun may be removed by lemon juice
evaporated by the fire to half its original quantity, or by diluted marine
acid; which cleans the cuticle, by eroding its surface, but requires much
caution in the application; the marine acid must be diluted with water, and
when put upon the hand or face, after a second of time, as soon as the tan
disappears, the part must be washed with a wet towel and much warm water.
Freckles lie too deep for this operation, nor are they in general
removeable by a blister, as I once experienced. See Class I. 2. 2. 9.

It is probable, that those materials which stain silk, or ivory, might be
used to stain the cuticle, or hair, permanently; as they are all animal
substances. But I do not know, that any trials of this kind have been made
on the skin. I endeavoured in vain to whiten the back of my hand by marine
acid oxygenated by manganese, which so instantly whitens cotton.

The cure therefore must be sought from moral writers, and the cultivation
of the graces of the mind, which are frequently a more valuable possession
than celebrated beauty.

13. _Paupertatis timor._ The fear of poverty is one kind of avarice; it is
liable to affect people who have left off a profitable and active business;
as they are thus deprived of their usual exertions, and are liable to
observe the daily expenditure of money, without calculating the source from
whence it flows. It is also liable to occur with a sudden and unexpected
increase of fortune. Mr. ----, a surgeon, about fifty years of age, who was
always rather of a parsimonious disposition, had a large house, with a
fortune of forty thousand pounds, left him by a distant relation; and in a
few weeks became insane from the fear of poverty, lamenting that he should
die in a jail or workhouse. He had left off a laborious country business,
and the daily perception of profit in his books; he also now saw greater
expences going forwards in his new house, than he had been accustomed to
observe, and did not so distinctly see the source of supply; which seems to
have occasioned the maniacal hallucination.--This idea of approaching
poverty is a very frequent and very painful disease, so as to have induced
many to become suicides, who were in good circumstances; more perhaps than
any other maniacal hallucination, except the fear of hell.

The covetousness of age is more liable to affect single men, than those who
have families; though an accumulation of wealth would seem to be more
desirable to the latter. But an old man in the former situation, has no
personal connections to induce him to open his purse; and having lost the
friends of his youth, and not easily acquiring new ones, feels himself
alone in the world; feels himself unprotected, as his strength declines,
and is thus led to depend for assistance on money, and on that account
wishes to accumulate it. Whereas the father of a family has not only those
connections, which demand the frequent expenditure of money, but feels a
consolation in the friendship of his children, when age may render their
good offices necessary to him.

M. M. I have been well informed of a medical person in good circumstances
in London, who always carries an account of his affairs, as debtor and
creditor, in his pocket-book; and looks over it frequently in a day, when
this disease returns upon him; and thus, by counteracting the maniacal
hallucination, wisely prevents the increase of his insanity. Another
medical person, in London, is said to have cured himself of this disease by
studying mathematics with great attention; which exertions of the mind
relieved the pain of the maniacal hallucination.

Many moral writers have stigmatised this insanity; the covetous, they say,
commit crimes and mortify themselves without hopes of reward; and thus
become miserable both in this world and the next. Thus Juvenal:

  Cum furor haud dubius, cum sit manifesta phrenitis,
  Ut locuples moriaris, egenti vivere fato!

The covetous man thought he gave good advice to the spendthrift, when he
said, "Live like me," who well answered him,

  ----------"Like you, Sir John?
  "That I can do, when all I have is gone!"
                          POPE.

14. _Lethi timor._ The fear of death perpetually employs the thoughts of
these patients; hence they are devising new medicines, and applying to
physicians and quacks without number. It is confounded with
hypochondriasis, Class I. 2. 4. 10. in popular conversation, but is in
reality an insanity.

A young gentleman, whom I advised to go abroad as a cure for this disease,
assured me, that during the three years he was in Italy and France he never
passed a quarter of an hour without fearing he should die. But has now for
above twenty years experienced the contrary.

The sufferers under this malady are generally at once discoverable by their
telling you, amidst an unconnected description of their complaints, that
they are nevertheless not afraid of dying. They are also easily led to
complain of pains in almost any part of the body, and are thus soon
discovered.

M. M. As the maniacal hallucination has generally arisen in early infancy
from some dreadful account of the struggles and pain of dying, I have
sometimes observed, that these patients have received great consolation
from the instances I have related to them of people dying without pain.
Some of these, which I think curious, I shall concisely relate, as a part
of the method of cure.

Mr. ----, an elderly gentleman, had sent for me one whole day before I
could attend him; on my arrival he said he was glad to see me, but that he
was now quite well, except that he was weak, but had had a pain in his
bowels the day before. He then lay in bed with his legs cold up to the
knees, his hands and arms cold, and his pulse scarcely discernible, and
died in about six hours. Mr. ----, another gentleman about sixty, lay in
the act of dying, with difficult respiration like groaning, but in a kind
of stupor or coma vigil, and every ten or twelve minutes, while I sat by
him, he waked, looked up, and said, "who is it groans so, I am sure there
is somebody dying in the room," and then sunk again into a kind of sleep.
From these two cases there appeared to be no pain in the act of dying,
which may afford consolation to all, but particularly to those who are
afflicted with the fear of death.

15. _Orci timor._ The fear of hell. Many theatric preachers among the
Methodists successfully inspire this terror, and live comfortably upon the
folly of their hearers. In this kind of madness the poor patients
frequently commit suicide; although they believe they run headlong into the
hell, which they dread! Such is the power of oratory, and such the debility
of the human understanding!

Those, who suffer under this insanity, are generally the most innocent and
harmless people; who are then liable to accuse themselves of the greatest
imaginary crimes, and have so much intellectual cowardice, that they dare
not reason about those things, which they are directed by their priests to
believe, however contradictory to human apprehension, or derogatory to the
great Creator of all things. The maniacal hallucination at length becomes
so painful, that the poor insane flies from life to become free from it.

M. M. Where the intellectual cowardice is great, the voice of reason is
ineffectual; but that of ridicule may save many from those mad-making
doctors; though it is too weak to cure those, who are already hallucinated.
Foot's Farces are recommended for this purpose.

16. _Satyriasis._ An ungovernable desire of venereal indulgence. The remote
cause is probably the stimulus of the semen; whence the phallus becomes
distended with blood by the arterial propulsion of it being more strongly
excited than the correspondent venous absorption. At the same time a new
sense is produced in the other termination of the urethra; which, like
itching, requires some exterior friction to facilitate the removal of the
cause of the maniacal actions, which may probably be increased in those
cases by some associated hallucinations of ideas. It differs from
priapismus chronicus in the desire of its appropriated object, which is not
experienced in the latter, Class I. 1. 4. 6. and from the priapismus
amatorius, Class II. 1. 7. 9. in the maniacal actions in consequence of
desire. The furor uterius, or nymphomania, is a similar disease.

M. M. Venesection. Cathartics. Torpentia. Marriage.

17. _Ira._ Anger is caused by the pain of offended pride. We are not angry
at breaking a bone, but become quite insane from the smallest stroke of a
whip from an inferior. Ira furor brevis. Anger is not only itself a
temporary madness, but is a frequent attendant on other insanities, and as,
whenever it appears, it distinguishes insanity from delirium, it is
generally a good sign in fevers with debility.

An injury voluntarily inflicted on us by others excites our exertions of
self-defence or of revenge against the perpetrator of it; but anger does
not succeed in any great degree unless our pride is offended; this idea is
the maniacal hallucination, the pain of which sometimes produces such
violent and general exertions of our muscles and ideas, as to disappoint
the revenge we meditate, and vainly to exhaust our sensorial power. Hence
angry people, if not further excited by disagreeable language, are liable
in an hour or two to become humble, and sorry for their violence, and
willing to make greater concessions than required.

M. M. Be silent, when you feel yourself angry. Never use loud oaths,
violent upbraidings, or strong expressions of countenance, or
gesticulations of the arms, or clenched fists; as these by their former
associations with anger will contribute to increase it. I have been told of
a sergeant or corporal, who began moderately to cane his soldiers, when
they were awkward in their exercise, but being addicted to swearing and
coarse language, he used soon to enrage himself by his own expressions of
anger, till toward the end he was liable to beat the delinquents
unmercifully.

18. _Rabies._ Rage. A desire of biting others, most frequently attendant on
canine madness. Animals in great pain, as in the colica saturnina, are said
to bite the ground they lie upon, and even their own flesh. I have seen
patients bite the attendants, and even their own arms, in the epilepsia
dolorifica. It seems to be an exertion to relieve pain, as explained in
Sect. XXXIV. 1. 3. The dread of water in hydrophobia is occasioned by the
repeated painful attempts to swallow it, and is therefore not an essential
or original part of the disease called canine madness. See Class III. 1. 1.
15.

There is a mania reported to exist in some parts of the east, in which a
man is said to run a muck; and these furious maniacs are believed to have
induced their calamity by unlucky gaming, and afterwards by taking large
quantities of opium; whence the pain of despair is joined with the energy
of drunkenness; they are then said to sally forth into the most populous
streets, and to wound and slay all they meet, till they receive their own
death, which they desire to procure without the greater guilt, as they
suppose, of suicide.

M. M. When there appears a tendency to bite in the painful epilepsy, the
end of a rolled-up towel, or a wedge of soft wood, should be put into the
mouth of the patient. As a bullet is said sometimes to be given to a
soldier, who is to be severely flogged, that he may by biting it better
bear his punishment.

19. _Citta._ A desire to swallow indigestible substances. I once saw a
young lady, about ten years of age, who filled her stomach with the earth
out of a flower-pot, and vomited it up with small stones, bits of wood, and
wings of infects amongst it. She had the bombycinous complexion, and looked
like a chlorotic patient, though so young; this generally proceeds from an
acid in the stomach.

M. M. A vomit. Magnesia alba. Armenian bole. Rhubarb. Bark. Steel. A
blister. See Class I. 2. 4. 5.

20. _Cacositia._ Aversion to food. This may arise, without disease of the
stomach, from connecting nauseous ideas to our usual food, as by calling a
ham a hog's a----. This madness is much inculcated by the stoic philosophy.
See Antoninus' Meditations. See two cases of patients who refused to take
nourishment, Class III. 1. 2. 1.

Aversions to peculiar kinds of food are thus formed early in life by
association of some maniacal hallucination with them. I remember a child,
who on tasting the gristle of sturgeon, asked what gristle was? And being
told it was like the division of a man's nose, received an ideal
hallucination; and for twenty years afterwards could not be persuaded to
taste sturgeon.

The great fear or aversion, which some people experience at the sight of
spiders, toads, crickets, and the like, have generally had a similar
origin.

M. M. Associate agreeable ideas with those which disgust; as call a spider
ingenious, a frog clean and innocent; and repress all expressions of
disgust by the countenance, as such expressions contribute to preserve, or
even to increase, the energy of the ideas associated with them; as
mentioned above in Species 17. Ira.

21. _Syphilis imaginaria._ The fear that they are infested with the
venereal disease, when they have only deserved it, is a very common
insanity amongst modest young men; and is not to be cured without applying
artfully to the mind; a little mercury must be given, and hopes of a cure
added weekly and gradually by interview or correspondence for six or eight
weeks. Many of these patients have been repeatedly salivated without curing
the mind!

22. _Psora imaginaria._ I have twice seen an imaginary itch, and twice an
imaginary diabætes, where there was not the least vestige of either of
those diseases, and once an imaginary deafness, where the patient heard
perfectly well. In all these cases the hallucinated idea is so powerfully
excited, that it is not to be changed suddenly by occular sensation, or
reason. Yet great perseverance in the frequently presenting contrary ideas
will sometimes slowly remove this hallucination, or in great length of time
oblivion, or forgetfulness, performs a cure, by other means in vain
attempted.

23. _Tabes imaginaria._ This imaginary disease, or hallucination, is caused
by the supposed too great frequency of parting with the semen, and had long
imposed upon the physician as well as the patient, till Mr. John Hunter
first endeavoured to shew, that in general the morbid effects of this
pollution was in the imagination; and that those were only liable to those
effects in general, who had been terrified by the villainous books, which
pretend to prevent or to cure it, but which were purposely written to vend
some quack medicine. Most of those unhappy patients, whom I have seen, had
evidently great impression of fear and self-condemnation on their minds,
and might be led to make contradictory complaints in almost any part of the
body, and if their confessions could be depended on, had not used this
pollution to any great excess.

M. M. 1. Assure them if the loss of the semen happens but twice a week, it
will not injure them. 2. Marry them. The last is a certain cure; whether
the disease be real or imaginary. Cold partial bath, and astringent
medicines frequently taken, only recal the mind to the disease, or to the
delinquency; and thence increase the imaginary effects and the real cause,
if such exists. Mr. ---- destroyed himself to get free from the pain of
fear of the supposed ill consequences of self-pollution, without any other
apparent disease; whose parents I had in vain advised to marry him, if
possible.

24. _Sympathia aliena._ Pity. Our sympathy with the pleasures and pains of
others distinguishes men from other animals; and is probably the foundation
of what is termed our moral sense and the source of all our virtues. See
Sect. XXII. 3. 3. When our sympathy with those miseries of mankind, which
we cannot alleviate, rises to excess, the mind becomes its own tormentor;
and we add to the aggregate sum of human misery, which we ought to labour
to diminish; as in the following eloquent lamentation from Akenside's
Pleasures of Imagination, Book II. 1. 200.

  ----------------Dark,
  As midnight storms, the scene of human things
  Appear'd before me; deserts, burning sands,
  Where the parch'd adder dies; the frozen south;
  And desolation blasting all the west
  With rapine and with murder. Tyrant power
  Here sits enthroned in blood; the baleful charms
  Of superstition there infect the skies,
  And turn the sun to horror. Gracious Heaven!
  What is the life of man? Or cannot these,
  Not these portents thy awful will suffice?
  That, propagated thus beyond their scope,
  They rise to act their cruelties anew
  In my afflicted bosom, thus decreed
  The universal sensitive of pain,
  The wretched heir of evils not its own!

A poet of antiquity, whose name I do not recollect, is said to have written
a book describing the miseries of the world, and to have destroyed himself
at the conclusion of his task. This sympathy, with all sensitive beings,
has been carried so far by some individuals, and even by whole tribes, as
the Gentoos, as not only to restrain them from killing animals for their
support, but even to induce them to permit insects to prey upon their
bodies. Such is however the condition of mortality, that the first law of
nature is, "Eat or be eaten." We cannot long exist without the destruction
of other animal or vegetable beings, either in their mature or their
embryon state. Unless the fruits, which surround the seeds of some
vegetables, or the honey stolen from them by the bee, may be said to be an
exception to this assertion. See Botanic Garden, P. I. Cant. I. l. 278.
Note. Hence, from the necessity of our nature, we may be supposed to have a
right to kill those creatures, which we want to eat, or which want to eat
us. But to destroy even insects wantonly shews an unreflecting mind or a
depraved heart.

Nevertheless mankind may be well divided into the selfish and the social;
that is, into those whose pleasures arise from gratifying their appetites,
and those whose pleasures arise from their sympathizing with others. And
according to the prevalence of these opposing propensities we value or
dislike the possessor of them.

In conducting the education of young people, it is a nice matter to inspire
them with so much benevolent sympathy, or compassion, as may render them
good and amiable; and yet not so much as to make them unhappy at the sight
of incurable distress. We should endeavour to make them alive to sympathize
with all remediable evils, and at the same time to arm them with fortitude
to bear the sight of such irremediable evils, as the accidents of life must
frequently present before their eyes. About this I have treated more at
large in a plan for the conduct of a boarding school for ladies, which I
intend to publish in the course of the next year.

25. _Educatio heroica._ From the kinds and degrees of insanities already
enumerated, the reader will probably recollect many more from his own
observation; he will perceive that all extraordinary exertions of voluntary
action in consequence of some false idea or hallucination, which strongly
affects us, may philosophically, though not popularly, be termed an
insanity; he will then be liable to divide these voluntary exertions into
disagreeable, pernicious, detestable, or into meritorious, delectable, and
even amiable, insanities. And will lastly be induced to conceive, that a
good education consists in the art of producing such happy hallucinations
of ideas, as may be followed by such voluntary exertions, as may be termed
meritorious or amiable insanities.

The old man of the mountain in Syria, who governed a small nation of people
called Assassines, is recorded thus to have educated those of his army who
were designed to assassinate the princes with whom he was at war. A young
man of natural activity was chosen for the purpose, and thrown into a deep
sleep by opium mixed with his food; he was then carried into a garden made
to represent the paradise of Mahomet, with flowers of great beauty and
fragrance, fruits of delicious flavor, and beautiful houries beckoning him
into the shades. After a while, on being a second time stupified with
opium, the young enthusiast was reconveyed to his apartment; and on the
next day was assured by a priest, that he was designed for some great
exploit, and that by obeying the commands of their prince, immortal
happiness awaited him.

Hence it is easy to collect how the first impressions made on us by
accidental circumstances in our infancy continue through life to bias our
affections, or mislead our judgments. One of my acquaintance can trace the
origin of his own energies of action from some such remote sources; which
justifies the observation of M. Rousseau, that the seeds of future virtues
or vices are oftener sown by the mother, than the tutor.

       *       *       *       *       *

ORDO II.

_Decreased Volition._

GENUS I.

_With decreased Actions of the Muscles._

Our muscles become fatigued by long contraction, and cease for a time to be
excitable by the will; owing to exhaustion of the sensorial power, which
resides in them. After a short interval of relaxation the muscle regains
its power of voluntary contraction; which is probably occasioned by a new
supply of the spirit of animation. In weaker people these contractions
cease sooner, and therefore recur more frequently, and are attended with
shorter intervals of relaxation, as exemplified in the quickness of the
pulse in fevers with debility, and in the tremors of the hands of aged or
feeble people.

After a common degree of exhaustion of the sensorial power in a muscle, it
becomes again gradually restored by the rest of the muscle; and even
accumulated in those muscles, which are most frequently used; as in those
which constitute the capillaries of the skin after having been rendered
torpid by cold. But in those muscles, which are generally obedient to
volition, as those of locomotion, though their usual quantity of sensorial
power is restored by their quiescence, or in sleep (for sleep affects these
parts of the system only), yet but little accumulation of it succeeds. And
this want of accumulation of the sensorial power in these muscles, which
are chiefly subservient to volition, explains to us one cause of their
greater tendency to paralytic affection.

It must be observed, that those parts of the system, which have been for a
time quiescent from want of stimulus, as the vessels of the skin, when
exposed to cold, acquire an accumulation of sensorial power during their
inactivity; but this does not happen at all, or in much less quantity, from
their quiescence after great expenditure of sensorial power by a previous
excessive stimulus, as after intoxication. In this case the muscles or
organs of sense gradually acquire their natural quantity of sensorial
power, as after sleep; but not an accumulation or superabundance of it. And
by frequent repetitions of exhaustion by great stimulus, these vessels
cease to acquire their whole natural quantity of sensorial power; as in the
schirrous stomach, and schirrous liver, occasioned by the great and
frequent stimulus of vinous spirit; which may properly be termed irritative
paralysis of those parts of the system.

In the same manner in common palsies the inaction of the paralytic muscle
seems not to be owing to defect of the stimulus of the will, but to
exhaustion of sensorial power. Whence it frequently follows great exertion,
as in Sect. XXXIV. 1. 7. Thus some parts of the system may cease to obey
the will, as in common paralysis; others may cease to be obedient to
sensation, as in the impotency of age; others to irritation, as in
schirrous viscera; and others to association, as in impediment of speech;
yet though all these may become inexcitable, or dead, in respect to that
kind of stimulus, which has previously exhausted them, whether of volition,
or sensation, or irritation, or association, they may still in many cases
be excited by the others.

SPECIES.

1. _Lassitudo._ Fatigue or weariness after much voluntary exertion. From
the too great expenditure of sensorial power the muscles are with
difficulty brought again into voluntary contraction; and seem to require a
greater quantity or energy of volition for this purpose. At the same time
they still remain obedient to the stimulus of agreeable sensation, as
appears in tired dancers finding a renovation of their aptitude to motion
on the acquisition of an agreeable partner; or from a tired child riding on
a gold-headed cane, as in Sect. XXXIV. 2. 6. These muscles are likewise
still obedient to the sensorial power of association, because the motions,
when thus excited, are performed in their designed directions, and are not
broken into variety of gesticulation, as in St. Vitus's dance.

A lassitude likewise frequently occurs with yawning at the beginning of
ague-fits; where the production of sensorial power in the brain is less
than its expenditure. For in this case the torpor may either originate in
the brain, or the torpor of some distant parts of the system may by
sympathy affect the brain, though in a less proportionate degree than the
parts primarily affected.

2. _Vacillatio senilis._ Some elderly people acquire a see-saw motion of
their bodies from one side to the other, as they sit, like the oscillation
of a pendulum. By these motions the muscles, which preserve the
perpendicularity of the body, are alternately quiescent, and exerted; and
are thus less liable to fatigue or exhaustion. This therefore resembles the
tremors of old people above mentioned, and not those spasmodic movements of
the face or limbs, which are called tricks, described in Class IV. 1. 3. 2.
which originate from excess of sensorial power, or from efforts to relieve
disagreeable sensation, and are afterwards continued by habit.

3. _Tremor senilis._ Tremor of old age consists of a perpetual trembling of
the hands, or of the head, or of other muscles, when they are exerted; and
is erroneously called paralytic; and seems owing to the small quantity of
animal power residing in the muscular fibres. These tremors only exist when
the affected muscles are excited into action, as in lifting a glass to the
mouth, or in writing, or in keeping the body upright; and cease again, when
no voluntary exertion is attempted, as in lying down. Hence these tremors
evidently originate from the too quick exhaustion of the lessened quantity
of the spirit of animation. So many people tremble from fear or anger, when
too great a part of the sensorial power is exerted on the organs of sense,
so as to deprive the muscles, which support the body erect, of their due
quantity.

4. _Brachiorum paralysis._ A numbness of the arms is a frequent symptom in
hydrops thoracis, as explained in Class I. 2. 3. 14. and in Sect. XXIX. 5.
2.; it also accompanies the asthma dolorificum, Class III. 1. 1. 11. and is
owing probably to the same cause in both. In the colica saturnina a
paralysis affects the wrists, as appears on the patient extending his arm
horizontally with the palm downwards, and is often attended with a tumor on
the carpal or metacarpal bones. See Class IV. 1. 2. 10.

Mr. M----, a miner and well-sinker, about three years ago, lost the power
of contracting both his thumbs; the balls or muscles of the thumbs are much
emaciated, and remain paralytic. He ascribes his disease to immersing his
hands too long in cold water in the execution of his business. He says his
hands had frequently been much benumbed before, so that he could not
without difficulty clench them; but that they recovered their motion, as
soon as they began to glow, after he had dried and covered them.

In this case there existed two injurious circumstances of different kinds;
one the violent and continued action of the muscles, which destroys by
exhausting the sensorial power; and the other, the application of cold,
which destroys by defect of stimulus. The cold seems to have contributed to
the paralysis by its long application, as well as the continued exertion;
but as during the torpor occasioned by the exposure to cold, if the degree
of it be not so great as to extinguish life, the sensorial power becomes
accumulated; there is reason to believe, that the exposing a paralytic limb
to the cold for a certain time, as by covering it with snow or iced water
for a few minutes, and then covering it with warm flannel, and this
frequently repeated, might, by accumulation of sensorial power, contribute
to restore it to a state of voluntary excitability. As this accumulation of
sensorial power, and consequent glow, seems, in the present case, several
times to have contributed to restore the numbness or inability of those
muscles, which at length became paralytic. See Class I. 2. 3. 21.

M. M. Ether externally. Friction. Saline warm bath. Electricity.

5. _Raucedo paralytica._ Paralytic hoarseness consists in the almost total
loss of voice, which sometimes continues for months, or even years, and is
occasioned by inability or paralysis of the recurrent nerves, which serve
the muscles of vocality, by opening or closing the larynx. The voice
generally returns suddenly, even so as to alarm the patient. A young lady,
who had many months been affected with almost a total loss of voice, and
had in vain tried variety of advice, recovered her voice in an instant, on
some alarm as she was dancing at an assembly. Was this owing to a greater
exertion of volition than usual? like the dumb young man, the son of
Croesus, who is related to have cried out, when he saw his father's life
endangered by the sword of his enemy, and to have continued to speak ever
afterwards. Two young ladies in this complaint seemed to be cured by
electric shocks passed through the larynx every day for a fortnight. See
Raucedo catarrhalis, Class II. 1. 3. 5.

M. M. An emetic. Electric shocks. Mustard-seed, a large spoonful swallowed
whole, or a little bruised, every morning. Valerian. Burnt sponge. Blisters
on each side of the larynx. Sea-bathing. A gargle of decoction of seneca.
Friction. Frequent endeavours to shout and sing.

6. _Vesicæ urinariæ paralysis._ Paralysis of the bladder is frequently a
symptom in inirritative fever; in this case the patient makes no water for
a day or two; and the tumor of the bladder distended with urine may be seen
by the shape of the abdomen, as if girt by a cord below the navel, or
distinguished by the hand. Many patients in this situation make no
complaint, and suffer great injury by the inattention of their attendants;
the water must be drawn off once or twice a day by means of a catheter, and
the region of the bladder gently pressed by the hand, whilst the patient be
kept in a sitting or erect posture.

M. M. Bark. Wine. Opium, a quarter of a grain every six hours. Balsam of
copaiva or of Peru. Tincture of cantharides 20 drops twice a day, or
repeated small blisters.

7. _Recti paralysis._ Palsy of the rectum. The rectum intestinum, like the
urinary bladder in the preceding article, possesses voluntary power of
motion; though these volitions are at times uncontrollable by the will,
when the acrimony of the contained feces, or their bulk, stimulate it to a
greater degree. Hence it happens, that this part is liable to lose its
voluntary power by paralysis, but is still liable to be stimulated into
action by the contained feces. This frequently occurs in fevers, and is a
bad sign as a symptom of general debility; and it is the sensibility of the
muscular fibres of this and of the urinary bladder remaining, after the
voluntarity has ceased, which occasions these two reservoirs so soon to
regain, as the fever ceases, their obedience to volition; because the
paralysis is thus shewn to be less complete in those cases than in common
hemiplegia; as in the latter the sense of touch, though perhaps not the
sense of pain, is generally destroyed in the paralytic limb.

M. M. A sponge introduced within the sphincter ani to prevent the constant
discharge, which should have a string put through it, by which it may be
retracted.

8. _Paresis voluntaria._ Indolence; or inaptitude to voluntary action. This
debility of the exertion of voluntary efforts prevents the accomplishment
of all great events in life. It often originates from a mistaken education,
in which pleasure or flattery is made the immediate motive of action, and
not future advantage; or what is termed duty. This observation is of great
value to those, who attend to the education of their own children. I have
seen one or two young married ladies of fortune, who perpetually became
uneasy, and believed themselves ill, a week after their arrival in the
country, and continued so uniformly during their stay; yet on their return
to London or Bath immediately lost all their complaints, and this
repeatedly; which I was led to ascribe to their being in their infancy
surrounded with menial attendants, who had flattered them into the
exertions they then used. And that in their riper years, they became torpid
for want of this stimulus, and could not amuse themselves by any voluntary
employment; but required ever after, either to be amused by other people,
or to be flattered into activity. This I suppose, in the other sex, to have
supplied one source of ennui and suicide.

9. _Catalepsis_ is sometimes used for fixed spasmodic contractions or
tetanus, as described in Sect. XXXIV. 1. 5. and in Class III. 1. 1. 13. but
is properly simply an inaptitude to muscular motion, the limbs remaining in
any attitude in which they are placed. One patient, whom I saw in this
situation, had taken much mercury, and appeared universally torpid. He sat
in a chair in any posture he was put, and held a glass to his mouth for
many minutes without attempting to drink, or withdrawing his hand. He never
spoke, and it was at first necessary to compel him to drink broth; he
recovered in a few weeks without relapse.

10. _Hemiplegia._ Palsy of one side consists in the total disobedience of
the affected muscles to the power of volition. As the voluntary motions are
not perpetually exerted, there is little sensorial power accumulated during
their quiescence, whence they are less liable to recover from torpor, and
are thus more frequently left paralytic, or disobedient to the power of
volition, though they are sometimes still alive to painful sensation, as to
the prick of a pin, and to heat; also to irritation, as in stretching and
yawning; or to electric shocks. Where the paralysis is complete the patient
seems gradually to learn to use his limbs over again by repeated efforts,
as in infancy; and, as time is required for this purpose, it becomes
difficult to know, whether the cure is owing to the effect of medicines, or
to the repeated efforts of the voluntary power.

The dispute, whether the nerves decussate or cross each other before they
leave the cavities of the skull or spine, seems to be decided in the
affirmative by comparative anatomy; as the optic nerves of some fish have
been shewn evidently to cross each other; as seen by Haller, Elem. Physiol.
t. v. p. 349. Hence the application of blisters, or of ether, or of warm
fomentations, should be on the side of the head opposite to that of the
affected muscles. This subject should nevertheless be nicely determined,
before any one should trepan for the hydrocephalus internus, when the
disease is shewn to exist only on one side of the brain, by a squinting
affecting but one eye; as proposed in Class I. 2. 5. 4. Dr. Sommering has
shewn, that a true decussation of the optic nerves in the human subject
actually exists, Elem. of Physiology by Blumenbach, translated by C.
Caldwell, Philadelphia. This further appears probable from the oblique
direction and insertion of each optic nerve, into the side of the eye next
to the nose, in a direct line from the opposite side of the brain.

The vomiting, which generally attends the attack of hemiplegia, is
mentioned in Sect. XX. 8. and is similar to that attending vertigo in
sea-sickness, and at the commencement of some fevers. Black stools
sometimes attend the commencement of hemiplegia, which is probably an
effusion of blood from the biliary duct, where the liver is previously
affected; or some blood may be derived to the intestines by its escaping
from the vena cava into the receptacle of chyle during the distress of the
paralytic attack; and may be conveyed from thence into the intestines by
the retrograde motions of the lacteals; as probably sometimes happens in
diabætes. See Sect. XXVII. 2. Palsy of one side of the face is mentioned in
Class II. 1. 4. 6. Paralysis of the lacteals, of the liver, and of the
veins, which are described in Sect. XXVIII. XXX. and XXVII. do not belong
to this class, as they are not diseases of voluntary motions.

M. M. The electric sparks and shocks, if used early in the disease, are
frequently of service. A purge of aloes, or calomel. A vomit. Blister.
Saline draughts. Then the bark. Mercurial ointment or sublimate, where the
liver is evidently diseased; or where the gutta rosea has previously
existed. Sudden alarm. Frequent voluntary efforts. Externally ether.
Volatile alcali. Fomentation on the head. Friction. When children, who have
suffered an hemiplegia, begin to use the affected arm, the other hand
should be tied up for half an hour three or four times a day; which obliges
them at their play to use more frequent voluntary efforts with the diseased
limb, and thus sooner to restore the dissevered associations of motion.

Dr. J. Alderson has lately much recommended the leaves of rhus toxicodendon
(sumach), from one gr. to iv. of the dried powder to be taken three or four
times a day. Essay on Rhus Toxic. Johnson, London, 1793. But it is
difficult to know what medicine is of service, as the movements of the
muscles must be learned, as in infancy, by frequent efforts.

11. _Paraplegia._ A palsy of the lower half of the body divided
horizontally. Animals may be conceived to have double bodies, one half in
general resembling so exactly the other, and being supplied with separate
sets of nerves; this gives rise to hemiplegia, or palsy of one half of the
body divided vertically; but the paraplegia, or palsy of the lower parts of
the system, depends on an injury of the spinal marrow, or that part of the
brain which is contained in the vertebræ of the back; by which all the
nerves situated below the injured part are deprived of their nutriment, or
precluded from doing their proper offices; and the muscles, to which they
are derived, are in consequence disobedient to the power of volition.

This sometimes occurs from an external injury, as a fall from an eminence;
of which I saw a deplorable instance, where the bladder and rectum, as well
as the lower limbs, were deprived of so much of their powers of motion, as
depended on volition or sensation; but I suppose not of that part of it,
which depends on irritation. In the same manner as the voluntary muscles in
hemiplegia are sometimes brought into action by irritation, as in
stretching or pendiculation, described in Sect. VII. 1. 3.

But the most frequent cause of paraplegia is from a protuberance of one of
the spinal vertebræ; which is owing to the innutrition or softness of
bones, described in Class I. 2. 2. 17. The cure of this deplorable disease
is frequently effected by the stimulus of an issue placed on each side of
the prominent spine, as first published by Mr. Pott. The other means
recommended in softness of bones should also be attended to; both in
respect to the internal medicines, and to the mechanical methods of
supporting, or extending the spine; which last, however, in this case
requires particular caution.

12. _Somnus._ In sleep all voluntary power is suspended, see Sect. XVIII.
An unusual quantity of sleep is often produced by weakness. In this case
small doses of opium, wine, and bark, may be given with advantage. For the
periods of sleep, see Class IV. 2. 4. 1.

The subsequent ingenious observations on the frequency of the pulse, which
sometimes occurs in sleep, are copied from a letter of Dr. Currie of
Liverpool to the author.

    "Though rest in general perhaps renders the healthy pulse slower, yet
    under certain circumstances the contrary is the truth. A full meal
    without wine or other strong liquor does not increase the frequency of
    my pulse, while I sit upright, and have my attention engaged. But if I
    take a recumbent posture after eating, my pulse becomes more frequent,
    especially if my mind be vacant, and I become drowsy; and, if I
    slumber, this increased frequency is more considerable with heat and
    flushing.

    "This I apprehend to be a general truth. The observation may be
    frequently made upon children; and the restless and feverish nights
    experienced by many people after a full supper are, I believe, owing to
    this cause. The supper occasions no inconvenience, whilst the person is
    upright and awake; but, when he lies down and begins to sleep,
    especially if he does not perspire, the symptoms above mentioned occur.
    Which may be thus explained in part from your principles. When the
    power of volition is abolished, the other sensorial actions are
    increased. In ordinary sleep this does not occasion increased frequency
    of the pulse; but where sleep takes place during the process of
    digestion, the digestion itself goes on with increased rapidity. Heat
    is excited in the system faster than it is expended; and operating on
    the sensitive actions, it carries them beyond the limitation of
    pleasure, producing, as is common in such cases, increased frequency of
    pulse.

    "It is to be observed, that in speaking of the heat generated under
    these circumstances, I do not allude to any chemical evolution of heat
    from the food in the process of digestion. I doubt if this takes place
    to any considerable degree, for I do not observe that the parts
    incumbent on the stomach are increased in heat during the most hurried
    digestion. It is on some parts of the surface, but more particularly on
    the extremities of the body, that the increased heat excited by
    digestion appears, and the heat thus produced arises, as it should
    seem, from the sympathy between the stomach and the vessels of the
    skin. The parts most affected are the palms of the hands and the soles
    of the feet. Even there the thermometer seldom rises above 97 or 98
    degrees, a temperature not higher than that of the trunk of the body;
    but three or four degrees higher than the common temperature of these
    parts, and therefore producing an uneasy sensation of heat, a sensation
    increased by the great sensibility of the parts affected.

    "That the increased heat excited by digestion in sleep is the cause of
    the accompanying fever, seems to be confirmed by observing, that if an
    increased expenditure of heat accompanies the increased generation of
    it (as when perspiration on the extremities or surface attends this
    kind of sleep) the frequent pulse and flushed countenance do not occur,
    as I know by experiment. If, during the feverish sleep already
    mentioned, I am awakened, and my attention engaged powerfully, my pulse
    becomes almost immediately slower, and the fever gradually subsides."

From these observations of Dr. Currie it appears, that, while in common
sleep the actions of the heart, arteries, and capillaries, are strengthened
by the accumulation of sensorial power during the suspension of voluntary
action, and the pulse in consequence becomes fuller and slower; in the
feverish sleep above described the actions of the heart, arteries, and
capillaries, are quickened as well as strengthened by their consent with
the increased actions of the stomach, as well as by the stimulus of the new
chyle introduced into the circulation. For the stomach, and all other parts
of the system, being more sensible and more irritable during sleep, Sect.
XVIII. 15. and probably more ready to act from association, are now exerted
with greater velocity as well as strength, constituting a temporary fever
of the sensitive irritated kind, resembling the fever excited by wine in
the beginning of intoxication; or in some people by a full meal in their
waking hours. Sect. XXXV. 1.

On waking, this increased sensibility and irritability of the system ceases
by the renewed exertions of volition; in the same manner as more violent
exertions of volition destroy greater pains; and the pulse in consequence
subsides along with the increase of heat; if more violent efforts of
volition are exerted, the system becomes still less affected by sensation
or irritation. Hence the fever and vertigo of intoxication are lessened by
intense thinking, Sect. XXI. 8; and insane people are known to bear the
pain of cold and hunger better than others, Sect. XXXIV. 2. 5; and lastly,
if greater voluntary efforts exist, as in violent anger or violent
exercise, the whole system is thrown into more energetic action, and a
voluntary fever is induced, as appears by the red skin, quickened pulse,
and increase of heat; whence dropsies and fevers with debility are not
unfrequently removed by insanity.

Hence the exertion of the voluntary power in its natural degree diminishes
the increased sensibility, and irritability, and probably the increased
associability, which occurs during sleep; and thus reduces the frequency of
the pulse in the feverish sleep after a full meal. In its more powerful
state of exertion, it diminishes or destroys sensations and irritations,
which are stronger than natural, as in intoxication, or which precede
convulsions, or insanity. In its still more powerful degree, the
superabundance of this sensorial power actuates and invigorates the whole
moving system, giving strength and frequency to the pulse, and an universal
glow both of colour and of heat, as in violent anger, or outrageous
insanities.

If, in the feverish sleep above described, the skin becomes cooled by the
evaporation of much perspirable matter, or by the application of cooler
air, or thinner clothes, the actions of the cutaneous capillaries are
lessened by defect of the stimulus of heat, which counteracts the increase
of sensibility during sleep, and the pulsations of the heart and arteries
become slower from the lessened stimulus of the particles of blood thus
cooled in the cutaneous and pulmonary vessels. Hence the admission of cold
air, or ablution with subtepid or with cold water, in fevers with hot skin,
whether they be attended with arterial strength, or arterial debility,
renders the pulse slower; in the former case by diminishing the stimulus of
the blood, and in the latter by lessening the expenditure of sensorial
power. See Suppl. I. 8. and 15.

13. _Incubus._ The night-mare is an imperfect sleep, where the desire of
locomotion is vehement, but the muscles do not obey the will; it is
attended with great uneasiness, a sense of suffocation, and frequently with
fear. It is caused by violent fatigue, or drunkenness, or indigestible
food, or lying on the back, or perhaps from many other kinds of uneasiness
in our sleep, which may originate either from the body or mind.

Now as the action of respiration is partly voluntary, this complaint may be
owing to the irritability of the system being too small to carry on the
circulation of the blood through the lungs during sleep, when the voluntary
power is suspended. Whence the blood may accumulate in them, and a painful
oppression supervene; as in some hæmorrhages of the lungs, which occur
during sleep; and in patients much debilitated by fevers. See Somnus
interruptus, Class I. 2. 1. 3. and I. 2. 1. 9.

Great fatigue with a full supper and much wine, I have been well informed
by one patient, always produced this disease in himself to a great degree.
Now the general irritability of the system is much decreased by fatigue, as
it exhausts the sensorial power; and secondly, too much wine and
stimulating food will again diminish the irritability of some parts of the
system, by employing a part of the sensorial power, which is already too
small, in digesting a great quantity of aliment; and in increasing the
motions of the organs of sense in consequence of some degree of
intoxication, whence difficulty of breathing may occur from the
inirritability of the lungs, as in Class I. 2. 1. 3.

M. M. To sleep on a hard bed with the head raised. Moderate supper. The
bark. By sleeping on a harder bed the patient will turn himself more
frequently, and not be liable to sleep too profoundly, or lie too long in
one posture. To be awakened frequently by an alarm clock.

14. _Lethargus._ The lethargy is a slighter apoplexy. It is supposed to
originate from universal pressure on the brain, and is said to be produced
by compressing the spinal marrow, where there is a deficiency of the bone
in the spina bifida. See Sect. XVIII. 20. Whereas in the hydrocephalus
there is only a partial pressure of the brain; and probably in nervous
fevers with stupor the pressure on the brain may affect only the nerves of
the senses, which lie within the skull, and not those nerves of the medulla
oblongata, which principally contribute to move the heart and arteries;
whence in the lethargic or apoplectic stupor the pulse is slow as in sleep,
whereas in nervous fever the pulse is very quick and feeble, and generally
so in hydrocephalus.

In cases of obstructed kidneys, whether owing to the tubuli uriniferi being
totally obstructed by calculous matter, or by their paralysis, a kind of
drowsiness or lethargy comes on about the eighth or ninth day, and the
patient gradually sinks. See Class I. 1. 3. 9.

15. _Syncope epileptica_, is a temporary apoplexy, the pulse continuing in
its natural state, and the voluntary power suspended. This terminates the
paroxysms of epilepsy.

When the animal power is much exhausted by the preceding convulsions, so
that the motions from sensation as well as those from volition are
suspended; in a quarter or half an hour the sensorial power becomes
restored, and if no pain, or irritation producing pain, recurs, the fit of
epilepsy ceases; if the pain recurs, or the irritation, which used to
produce it, a new fit of convulsion takes place, and is succeeded again by
a syncope. See Epilepsy, Class III. 1. 1. 7.

16. _Apoplexia._ Apoplexy may be termed an universal palsy, or a permanent
sleep. In which, where the pulse is weak, copious bleeding must be
injurious; as is well observed by Dr. Heberden, Trans. of the College.

Mr. ----, about 70 years of age, had an apoplectic seizure. His pulse was
strong and full. One of the temporal arteries was opened, and about ten
ounces of blood suddenly taken from it. He seemed to receive no benefit
from this operation; but gradually sunk, and lived but a day or two.

If apoplexy arises from the pressure of blood extravasated on the brain,
one moderate venesection may be of service to prevent the further effusion
of blood; but copious venesection must be injurious by weakening the
patient; since the effused blood must have time, as in common vibices or
bruises, to undergo a chemico-animal process, so to change its nature as to
fit it for absorption; which may take two or three weeks, which time a
patient weakened by repeated venesection or arteriotomy may not survive.

Mrs. ----, about 40 years old, had an apoplectic seizure after great
exertion from fear; she had lain about 24 hours without speech, or having
swallowed any liquid. She was then forcibly raised in bed, and a spoonful
of solution of aloes in wine put into her mouth, and the end of the spoon
withdrawn, that she might more easily swallow the liquid.--This was done
every hour, with broth, and wine and water intervening, till evacuations
were procured; which with other means had good effect, and she recovered,
except that a considerable degree of hemiplegia remained, and some
imperfection of her speech.

Many people, who have taken so much vinous spirit as to acquire the
temporary apoplexy of intoxication, and are not improperly said to be
dead-drunk, have died after copious venesection, I suppose in consequence
of it. I once saw at a public meeting two gentlemen in the drunken
apoplexy; they were totally insensible with low pulse, on this account they
were directed not to lose blood, but to be laid on a bed with their heads
high, and to be turned every half hour; as soon as they could swallow, warm
tea was given them, which evacuated their stomachs, and they gradually
recovered, as people do from less degrees of intoxication.

M. M. Cupping on the occiput. Venesection once in moderate quantity. Warm
fomentations long continued and frequently repeated on the shaved head.
Solution of aloes. Clysters with solution of aloe and oil of amber. A
blister on the spine. An emetic. Afterwards the bark, and small doses of
chalybeates. Small electric shocks through the head. Errhines. If small
doses of opium?

17. _Mors a frigore._ Death from cold. The unfortunate travellers, who
almost every winter perish in the snow, are much exhausted by their efforts
to proceed on their journey, as well as benumbed by cold. And as much
greater exercise can be borne without fatigue in cold weather than in warm;
because the excessive motions of the cutaneous vessels are thus prevented,
and the consequent waste of sensorial power; it may be inferred, that the
fatigued traveller becomes paralytic from violent exertion as well as by
the application of cold.

Great degrees of cold affect the motions of those vessels most, which have
been generally excited into action by irritation; for when the feet are
much benumbed by cold, and painful, and at the same time almost insensible
to the touch of external objects, the voluntary muscles retain their
motions, and we continue to walk on; the same happens to the fingers of
children in throwing snow-balls, the voluntary motions of the muscles
continue, though those of the cutaneous vessels are benumbed into
inactivity.

Mr. Thompson, an elderly gentleman of Shrewsbury, was seized with
hemiplegia in the cold bath; which I suppose might be owing to some great
energy of exertion, as much as to the coldness of the water. As in the
instance given of Mr. Nairn, who, by the exertion to save his relation,
perished himself. See Sect. XXXIV. 1. 7.

Whence I conclude, that though heat is a fluid necessary to muscular
motion, both perhaps by its stimulus, and by its keeping the minute
component parts of the ultimate fibrils of the muscles or organs of sense
at a proper distance from each other; yet that paralysis, properly so
called, is the consequence of exhaustion of sensorial power by exertion.
And that the accumulations of it during the torpor of the cutaneous vessels
by exposure to cold, or of some internal viscus in the cold fits of agues,
are frequently instrumental in recovering the use of paralytic limbs, or of
the motions of other paralytic parts of the system. See Spec. 4. of this
genus.

Animal bodies resist the power of cold probably by their exertions in
consequence of the pain of cold, see Botan. Gard. V. 1. additional note
xii. But if these increased exertions be too violent, so as to exhaust the
sensorial power in producing unnecessary motions, the animal will probably
sooner perish. Thus a moderate quantity of wine or spirit repeated at
proper intervals of time might be of service to those, who are long exposed
to excessive cold, both by increasing the action of the capillary vessels,
and thus producing heat, and perhaps by increasing in some degree the
secretion of sensorial power in the brain. But the contrary must happen
when taken immoderately, and not at due intervals. A well attested history
was once related to me of two men, who set out on foot to travel in the
snow, one of whom drank two or three glasses of brandy before they began
their journey, the other contented himself with his usual diet and
potation; the former of whom perished in spite of any assistance his
companion could afford him; and the other performed his journey with
safety. In this case the sensorial power was exhausted by the unnecessary
motions of incipient intoxication by the stimulus of the brandy, as well as
by the exertions of walking; which so weakened the dram-drinker, that the
cold sooner destroyed him; that is, he had not power to produce sufficient
muscular or arterial action, and in consequence sufficient heat, to supply
the great expenditure of it. Hence the capillaries of the skin first cease
to act, and become pale and empty; next those which are immediately
associated with them, as the extremities of the pulmonary artery, as
happens on going into the cold bath. By the continued inaction of these
parts of the vascular system the blood becomes accumulated in the internal
arteries, and the brain is supposed to be affected by its compression;
because these patients are said to sleep, or to become apoplectic, before
they die. I overtook a fishman asleep on his panniers on a very cold frosty
night, but on waking him he did not appear to be in any degree of stupor.
See Class I. 2. 2. 1.

When travellers are benighted in deep snow, they might frequently be saved
by covering themselves in it, except a small aperture for air; in which
situation the lives of hares, sheep, and other animals, are so often
preserved. The snow, both in respect to its component parts, and to the air
contained in its pores, is a bad conductor of heat, and will therefore well
keep out the external cold; and as the water, when part of it dissolves, is
attracted into the pores of the remainder of it, the situation of an animal
beneath it is perfectly dry; and, if he is in contact with the earth, he is
in a degree of heat between 48, the medium heat of the earth, and 32, the
freezing point; that is, in 40 degrees of heat, in which a man thus covered
will be as warm as in bed. See Botan. Garden, V. II. notes on Anemone,
Barometz, and Muschus. If these facts were more generally understood, it
might annually save the lives of many.

After any part of the vascular system of the body has been long exposed to
cold, the sensorial power is so much accumulated in it, that on coming into
a warm room the pain of hotach is produced, and inflammation, and
consequent mortification, owing to the great exertion of those vessels,
when again exposed to a moderate degree of warmth. See Sect. XII. 5. Whence
the propriety of applying but very low degrees of heat to limbs benumbed
with cold at first, as of snow in its state of dissolving, which is at 32
degrees of heat, or of very cold water. A French writer has observed, that
if frozen apples be thawed gradually by covering them with thawing snow, or
immersing them in very cold water, that they do not lose their taste; if
this fact was well ascertained, it might teach us how to preserve other
ripe fruits in ice-houses for winter consumption.

       *       *       *       *       *

ORDO II.

_Decreased Volition._

GENUS II.

_With decreased Actions of the Organs of Sense._

SPECIES.

1. _Recollectionis jactura._ Loss of recollection. This is the defect of
memory in old people, who forget the actions of yesterday, being incapable
of voluntary recollection, and yet remember those of their youth, which by
frequent repetition are introduced by association or suggestion. This is
properly the paralysis of the mind; the organs of sense do not obey the
voluntary power; that is, our ideas cannot be recollected, or acted over
again by the will.

After an apoplectic attack the patients, on beginning to recover, find
themselves most at a loss in recollecting proper names of persons or
places; as those words have not been so frequently associated with the
ideas they stand for, as the common words of a language. Mr. ----, a man of
strong mind, of a short necked family, many of whom had suffered by
apoplexy, after an apoplectic fit on his recovering the use of speech,
after repeated trials to remember the name of a person or place, applauded
himself, when he succeeded, with such a childish smile on the partial
return of his sagacity, as very much affected me.--Not long, alas! to
return; for another attack in a few weeks destroyed the whole.

I saw a child after the small-pox, which was left in this situation; it was
lively, active, and even vigorous; but shewed that kind of surprise, which
novelty excites, at every object it viewed; and that as often as it viewed
it. I never heard the termination of the case.

2. _Stultitia voluntaria._ Voluntary folly. The absence of voluntary power
and consequent incapacity to compare the ideas of present and future good.
Brute animals may be said to be in this situation, as they are in general
excited into action only by their present painful or pleasurable
sensations. Hence though they are liable to surprise, when their passing
trains of ideas are dissevered by violent stimuli; yet are they not
affected with wonder or astonishment at the novelty of objects; as they
possess but in a very inferior degree, that voluntary power of comparing
the present ideas with those previously acquired, which distinguishes
mankind; and is termed analogical reasoning, when deliberatively exerted;
and intuitive analogy, when used without our attention to it, and which
always preserves our hourly trains of ideas consistent with truth and
nature. See Sect. XVII. 3. 7.

3. _Credulitas._ Credulity. Life is short, opportunities of knowledge rare;
our senses are fallacious, our reasonings uncertain, mankind therefore
struggles with perpetual error from the cradle to the coffin. He is
necessitated to correct experiment by analogy, and analogy by experiment;
and not always to rest satisfied in the belief of facts even with this
two-fold testimony, till future opportunities, or the observations of
others, concur in their support.

Ignorance and credulity have ever been companions, and have misled and
enslaved mankind; philosophy has in all ages endeavoured to oppose their
progress, and to loosen the shackles they had imposed; philosophers have on
this account been called unbelievers: unbelievers of what? of the fictions
of fancy, of witchcraft, hobgobblins, apparitions, vampires, fairies; of
the influence of stars on human actions, miracles wrought by the bones of
saints, the flights of ominous birds, the predictions from the bowels of
dying animals, expounders of dreams, fortune-tellers, conjurors, modern
prophets, necromancy, cheiromancy, animal magnetism, with endless variety
of folly? These they have disbelieved and despised, but have ever bowed
their hoary heads to Truth and Nature.

Mankind may be divided in respect to the facility of their belief or
conviction into two classes; those, who are ready to assent to single facts
from the evidence of their senses, or from the serious assertions of
others; and those, who require analogy to corroborate or authenticate them.

Our first knowledge is acquired by our senses; but these are liable to
deceive us, and we learn to detect these deceptions by comparing the ideas
presented to us by one sense with those presented by another. Thus when we
first view a cylinder, it appears to the eye as a flat surface with
different shades on it, till we correct this idea by the sense of touch,
and find its surface to be circular; that is, having some parts gradually
receding further from the eye than others. So when a child, or a cat, or a
bird, first sees its own image in a looking-glass, it believes that another
animal exists before it, and detects this fallacy by going behind the glass
to examine, if another tangible animal really exists there.

Another exuberant source of error consists in the false notions, which we
receive in our early years from the design or ignorance of our instructors,
which affect all our future reasoning by their perpetual intrusions; as
those habits of muscular actions of the face or limbs, which are called
tricks, when contracted in infancy continue to the end of our lives.

A third great source of error is the vivacity of our ideas of imagination,
which perpetually intrude themselves by various associations, and compose
the farrago of our dreams; in which, by the suspension of volition, we are
precluded from comparing the ideas of one sense with those of another, or
the incongruity of their successions with the usual course of nature, and
thus to detect their fallacy. Which we do in our waking hours by a
perpetual voluntary exertion, a process of the mind above mentioned, which
we have termed intuitive analogy. Sect. XVII. 3. 7.

This analogy presupposes an acquired knowledge of things, hence children
and ignorant people are the most credulous, as not possessing much
knowledge of the usual course of nature; and secondly, those are most
credulous, whose faculty of comparing ideas, or the voluntary exertion of
it, is slow or imperfect. Thus if the power of the magnetic needle of
turning towards the north, or the shock given by touching both sides of an
electrized coated jar, was related for the first time to a philosopher, and
to an ignorant person; the former would be less ready to believe them, than
the latter; as he would find nothing similar in nature to compare them to,
he would again and again repeat the experiment, before he would give it his
entire credence; till by these repetitions it would cease to be a single
fact, and would therefore gain the evidence of analogy. But the latter, as
having less knowledge of nature, and less facility of voluntary exertion,
would more readily believe the assertions of others, or a single fact, as
presented to his own observation. Of this kind are the bulk of mankind;
they continue throughout their lives in a state of childhood, and have thus
been the dupes of priests and politicians in all countries and in all ages
of the world.

In regard to religious matters, there is an intellectual cowardice
instilled into the minds of the people from their infancy; which prevents
their inquiry: credulity is made an indispensable virtue; to inquire or
exert their reason in religious matters is denounced as sinful; and in the
catholic church is punished with more severe penances than moral crimes.
But in respect to our belief of the supposed medical facts, which are
published by variety of authors; many of whom are ignorant, and therefore
credulous; the golden rule of David Hume may be applied with great
advantage. "When two miraculous assertions oppose each other, believe the
less miraculous." Thus if a person is said to have received the small-pox a
second time, and to have gone through all the stages of it, one may thus
reason: twenty thousand people have been exposed to the variolous contagion
a second time without receiving the variolous fever, to every one who has
been said to have thus received it; it appears therefore less miraculous,
that the assertor of this supposed fact has been deceived, or wishes to
deceive, than that it has so happened contrary to the long experienced
order of nature.

M. M. The method of cure is to increase our knowledge of the laws of
nature, and our habit of comparing whatever ideas are presented to us with
those known laws, and thus to counteract the fallacies of our senses, to
emancipate ourselves from the false impressions which we have imbibed in
our infancy, and to set the faculty of reason above that of imagination.

       *       *       *       *       *


_The Orders and Genera of the Fourth Class of Diseases._

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENERA.

  1. Catenated with irritative motions.
  2. Catenated with sensitive motions.
  3. Catenated with voluntary motions.
  4. Catenated with external influences.

ORDO II.

_Decreased Associate Motions._

GENERA.

  1. Catenated with irritative motions.
  2. Catenated with sensitive motions.
  3. Catenated with voluntary motions.
  4. Catenated with external influences.

ORDO III.

_Retrograde Associate Motions._

GENERA.

  1. Catenated with irritative motions.
  2. Catenated with sensitive motions.
  3. Catenated with voluntary motions.
  4. Catenated with external influences.

       *       *       *       *       *

_The Orders, Genera, and Species, of the Fourth Class of Diseases._

       *       *       *       *       *

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

  1. _Rubor vultûs pransorum._           Flushing of the face after dinner.
  2. _Sudor stragulis immersorum._       Sweat from covering the face
                                         in bed.
  3. _Cessatio ægritudinis cute_         Cure of sickness by stimulating
     _excitata._                         the skin.
  4. _Digestio aucta frigore cutaneo._   Digestion increased by coldness of
                                         the skin.
  5. _Catarrhus a frigore cutaneo._      Catarrh from cold skin.
  6. _Absorptio cellularis aucta_        Cellular absorption increased by
     _vomitu._                           vomiting.
  7. _Syngultus nephriticus._            Nephritic hiccough.
  8. _Febris irritativa._                Irritative fever.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

   1. _Lacrymarum fluxus_              Sympathetic tears.
      _sympatheticus._
   2. _Sternutatio a lumine._          Sneezing from light.
   3. _Dolor dentium a Stridore._      Tooth-edge from grating sounds.
   4. _Risus sardonicus._              Sardonic smile.
   5. _Salivæ fluxus cibo viso._       Flux of saliva at sight of food.
   6. _Tensio mamularum viso puerulo._ Tension of the nipples of lactescent
                                       women at sight of the child.
   7. _Tensio penis in hydrophobia._   Tension of the penis in hydrophobia.
   8. _Tenesmus calculosus._           Tenesmus from stone.
   9. _Polypus narium ex ascaride._    Polypus of the nose from ascarides.
  10. _Crampus surarum in diarrhoea._  Cramp from diarrhoea.
  11. _Zona ignea nephritica._         Nephritic shingles.
  12. _Eruptio variolarum._            Eruption of small-pox.
  13. _Gutta rosea stomatica._         Stomatic rosy drop.
  14. ---- _hepatica._                 Hepatic rosy drop.
  15. _Podagra._                       Gout.
  16. _Rheumatismus._                  Rheumatism.
  17. _Erysipelas._                    Erysipelas.
  18. _Testium tumor in gonorrhoea._   Swelled testis in gonorrhoea.
  19. ---- _in parotitide._            ---- in mumps.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

  1. _Deglutitio invita._               Involuntary deglutition.
  2. _Nictitatio invita._               ---- nictitation.
  3. _Risus invitus._                   ---- laughter.
  4. _Lusus digitorum invitus._         ---- actions with the fingers.
  5. _Unguium morsiuncula invita._      ---- biting the nails.
  6. _Vigilia invita._                  ---- watchfulness.

GENUS IV.

_Catenated with External Influences._

SPECIES.

  1. _Vita ovi._                         Life of an egg.
  2. _Vita hiemi-dormientium._           Life of winter-sleepers.
  3. _Pullulatio arborum._               Budding of trees.
  4. _Orgasmatis venerei periodus._      Periods of venereal desire.
  5. _Brachii concussio electrica._      Electric shock through the arm.
  6. _Oxygenatio sanguinis._             Oxygenation of the blood.
  7. _Humectatio corporis._              Humectation of the body.

ORDO II.

_Decreased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

   1. _Cutis frigida pransorum._          Chillness after dinner.
   2. _Pallor urinæ pransorum._           Pale urine after dinner.
   3. ---- _a frigore cutaneo._           ---- from cold skin.
   4. _Pallor ex ægritudine._             Paleness from sickness.
   5. _Dyspnoea a balneo frigido._        Shortness of breath from cold
                                          bathing.
   6. _Dyspepsia a pedibus frigidis._     Indigestion from cold feet.
   7. _Tussis a pedibus frigidis._        Cough from cold feet.
   8. ---- _hepatica._                    Liver-cough.
   9. ---- _arthritica._                  Gout-cough.
  10. _Vertigo rotatoria._                Vertigo rotatory.
  11. ---- _visualis._                    ---- visual.
  12. ---- _ebriosa._                     ---- inebriate.
  13. ---- _febriculosa._                 ---- feverish.
  14. ---- _cerebrosa._                   ---- from the brain.
  15. _Murmur aurium vertiginosum._       Noise in the ears.
  16. _Tactus, gustus, olfactus_          Vertiginous touch, taste, smell.
      _vertiginosi._
  17. _Pulsus mollis a vomitione._        Soft pulse in vomiting.
  18. ---- _intermittens a ventriculo._   Intermittent pulse from the
                                          stomach.
  19. _Febris inirritativa._              Inirritative fever.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

  1.  _Torpor genæ a dolore dentis._  Coldness of the cheek from tooth-ach.
  2.  _Stranguria a dolore vesicæ._   Strangury from pain of the bladder.
  3.  ---- _convulsiva._              Convulsive strangury.
  4.  _Dolor termini ductûs_          Pain of the end of the bile-duct.
      _choledochi._
  5.  _Dolor pharyngis ab acido_      Pain of the throat from gastric acid.
      _gastrico._
  6.  _Pruritus narium a vermibus._   Itching of the nose from worms.
  7.  _Cephalæa._                     Head-ach.
  8.  _Hemicrania et otalgia._        Partial head-ach, and ear-ach.
  9.  _Dolor humeri in hepatitide._   Pain of shoulder in hepatitis.
  10. _Torpor pedum variolâ_          Cold feet in eruption of small-pox.
      _erumpente._
  11. _Testium dolor nephriticus._    Nephritic pain of testis.
  12. _Dolor digiti minimi_           Pain of little finger from sympathy.
      _sympatheticus._
  13. _Dolor brachii in hydrope_      Pain of the arm in dropsy of the
      _pectoris._                     chest.
  14. _Diarrhoea a dentitione._       Diarrhoea from toothing.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

   1. _Titubatio linguæ._         Impediment of speech.
   2. _Chorea sancti viti._       St. Vitus' dance.
   3. _Risus._                    Laughter.
   4. _Tremor ex irâ._            Trembling from anger.
   5. _Rubor ex irâ._             Redness from anger.
   6. ---- _criminati._           Blush of guilt.
   7. _Tarditas paralytica._      Slowness from palsy.
   8. ---- _senilis._             ---- of age.

GENUS IV.

_Catenated with External Influences._

SPECIES.

   1. _Somni periodus._                     Periods of sleep.
   2. _Studii inanis periodus._             ---- of reverie.
   3. _Hemicraniæ periodus._                ---- of head-ach.
   4. _Epilepsiæ dolorificæ periodus._      ---- of painful epilepsy.
   5. _Convulsionis dolorificæ periodus._   ---- of painful convulsion.
   6. _Tussis periodicæ periodus._          ---- of periodic cough.
   7. _Catameniæ periodus._                 ---- of catamenia.
   8. _Hæmorrhoidis periodus._              ---- of the piles.
   9. _Podagræ periodus._                   ---- of the gout.
  10. _Erysipelatis periodus._              ---- of erysipelas.
  11. _Febrium periodus._                   ---- of fevers.

ORDO III.

_Retrograde Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

SPECIES.

  1. _Diabætes irritata._               Diabetes from irritation.
  2. _Sudor frigidus in asthmate._      Cold sweat in asthma.
  3. _Diabætes a timore._               Diabetes from fear.
  4. _Diarrhoea a timore._              Diarrhoea from fear.
  5. _Pallor et tremor a timore._       Paleness and trembling from fear.
  6. _Palpitatio cordis a timore._      Palpitation of the heart from fear.
  7. _Abortio a timore._                Abortion from fear.
  8. _Hysteria a timore._               Hysterics from fear.

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

  1. _Nausea idealis._                  Nausea from ideas.
  2. ---- _a conceptu._                 Nausea from conception.
  3. _Vomitio vertiginosa._             Vomiting from vertigo.
  4. ---- _a calculo in uretere._       ---- from stone in the ureter.
  5. ---- _ab insultu paralytico._      ---- from stroke of palsy.
  6. ---- _a titilatione faucium._      ---- from tickling the throat.
  7. ---- _cute sympathetica._          ---- from sympathy with the skin.

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

  1. _Ruminatio._                 Rumination.
  2. _Vomitio voluntaria._        Voluntary vomiting.
  3. _Eructatio voluntaria._      ---- eructation.

GENUS IV.

_Catenated with External Influences._

SPECIES.

  1. _Catarrhus periodicus._      Periodical catarrh.
  2. _Tussis periodica._          Periodic cough.
  3. _Histeria a frigore._        Hysterics from cold.
  4. _Nausea pluvialis._          Sickness against rain.

       *       *       *       *       *

CLASS IV.

DISEASES OF ASSOCIATION.

ORDO I.

_Increased Associate Motions._

GENUS I.

_Catenated with Irritative Motion._

The importance of the subsequent class not only consists in its elucidating
all the sympathetic diseases, but in its opening _a road to the knowledge
of fever_. The difficulty and novelty of the subject must plead in excuse
for the present imperfect state of it. The reader is entreated previously
to attend to the following circumstances for the greater facility of
investigating their intricate connections; which I shall enumerate under
the following heads.

  A. Associate motions distinguished from catenations.
  B. Associate motions of three kinds.
  C. Associations affected by external influences.
  D. Associations affected by other sensorial motions.
  E. Associations catenated with sensation.
  F. Direct and reverse sympathy.
  G. Associations affected four ways.
  H. Origin of associations.
  I. Of the action of vomiting.
  K. Tertian associations.

A. _Associate Motions distinguished from Catenations._

Associate motions properly mean only those, which are caused by the
sensorial power of association. Whence it appears, that those fibrous
motions, which constitute the introductory link of an associate train of
motions, are excluded from this definition, as not being themselves caused
by the sensorial power of association, but by irritation, or sensation, or
volition. I shall give for example the flushing of the face after dinner;
the capillary vessels of the face increase their actions in consequence of
their catenation, not their association, with those of the stomach; which
latter are caused to act with greater energy by the irritation excited by
the stimulus of food. These capillaries of the face are associated with
each other reciprocally, as being all of them excited by the sensorial
power of association; but they are only catenated with those of the
stomach, which are not in this case associate motions but irritative ones.
The common use of the word association for almost every kind of connection
has rendered this subject difficult; from which inaccuracy I fear some
parts of this work are not exempt.

B. _Associate Motions of three Kinds._

Those trains or tribes of associate motions, whose introductory link
consists of an irritative motion, are termed irritative associations; as
when the muscles of the eyelids close the eye in common nictitation. Those,
whose introductory link consists of a sensitive motion, are termed
sensitive associations; as when the pectoral and intercostal muscles act in
sneezing. And lastly, those, whose introductory link consists of a
voluntary motion, are termed voluntary associations; as when the muscles of
the lower limbs act in concert with those of the arm in fencing.

C. _Associations affected by external Influences._

Circles of associate motions, as well as trains and tribes of them, are
liable to be affected by external influences, which consist of etherial
fluids, and which, by penetrating the system, act upon it perhaps rather as
a causa sine quâ non of its movements, than directly as a stimulus; except
when they are accumulated in unusual quantity. We have a sense adapted to
the perception of the excess or defect of one of these fluids; I mean that
of elementary heat; in which all things are immersed. See Class IV. 1. 4.
7. But there are others of them, which as we have no power to evade their
influence, so we have no sense to perceive it; these are the solar, and
lunar, and terrestrial gravitation, in which also all things are immersed;
the electric aura, which pervades us, and is perpetually varying, See Class
IV. 1. 4. 5; the magnetic fluid, Class IV. 1. 4. 5; and lastly, the great
life-preserver oxygen gas, and the aqueous vapour of the atmosphere, see
Class IV. 1. 4. 6. and 7. and 2.

Of these external influences those of heat, and of gravity, have diurnal
periods of increase and decrease; besides their greater periods of monthly
or annual variation. The manner in which they act by periodical increments
on the system, till some effect is produced, is spoken of in Sect. XXXII.
3. and 6.

D. _Associations affected by other Sensorial Motions._

Circles and trains of associate motions are also liable to be affected by
their catenations with other sensorial powers, as of irritation, or
sensation, or volition; which other sensorial powers either thus simply
form some of the links of the catenation, or add to the energy of the
associated motions. Thus when vomiting is caused by the stimulus of a stone
in the ureter, the sensation of pain seems to be a link of the catenation
rather than an efficient cause of the vomiting. But when the capillary
vessels of the skin increase their action from the influence of external
heat, they are excited both by the stimulus of unusual heat, as well as by
the stimulus of the blood, and by their accustomed association with the
actions of the heart and arteries. And lastly, in the blush of anger the
sensorial power of volition is added to that of association, and
irritation, to excite the capillaries of the face with increased action.
See Class IV. 2. 3. 5.

E. _Associations catenated with Sensation._

Pain frequently accompanies associate trains or circles of motion without
its being a cause, or a link, of them, but simply an attendant symptom;
though it frequently gives name to the disease, as head-ach. Thus in the
cramp of the calves of the legs in diarrhoea, the increased sensorial power
of association is the proximate cause; the preceding increased action of
the bowels is the remote cause; and the proximate effect is the violent
contractions of the musculi gastrocnemii; but the pain of these muscles is
only an attendant symptom, or a remote effect. See Sect. XVIII. 15. Other
sensitive associations are mentioned in Class IV. 1. 2. and IV. 1. 2. 15.

Thus, if the flushing of the face above mentioned after dinner be called a
disease, the immediate or proximate cause is the increased power of
association, the remote cause is the increased irritative motions of the
stomach in consequence of the stimulus of food and wine. The disease or
proximate effect consists in the increased actions of the cutaneous vessels
of the face; and the sensation of heat, the existence of heat, and the red
colour, are attendants or symptoms, or remote effects, of the increased
actions of these cutaneous vessels.

F. _Direct and reverse Sympathy._

The increased actions of the primary part of the trains of associated
motions are sometimes succeeded by increased actions of the secondary part
of the train; and sometimes by decreased actions of it. So likewise the
decreased actions of the primary part of a train of associate motions are
sometimes succeeded by decreased actions of the secondary part, and
sometimes by increased actions of it. The former of these situations is
called direct sympathy, and the latter reverse sympathy. In general I
believe, where the primary part of the train of associated motions is
exerted more than natural, it produces direct sympathy in strong people,
and reverse sympathy in weak ones, as a full meal makes some people hot,
and others chill. And where the primary part of the train is exerted less
than natural, it produces direct sympathy in weak people, and reverse
sympathy in strong ones, as on being exposed for a certain length of time
on horseback in a cold day gives indigestion and consequent heart-burn to
weak people, and strengthens the digestion, and induces consequent hunger
in strong ones. See Sect. XXXV. 1.

This may perhaps be more easily understood, by considering strength and
weakness, when applied to animal bodies, as consisting in the quantity of
sensorial power residing in the contracting fibres, and the quantity of
stimulus applied, as shewn in Sect. XII. 2. 1. Now when defective stimulus,
within certain limits, is partially applied to parts subject to perpetual
motion, the expenditure of sensorial power is for a while lessened, but not
its general production in the brain, nor its derivation into the
weakly-stimulated part. Hence in strong people, or such whose fibres abound
with sensorial power, if the first tribe of an associate train of motions
be deprived in part of its accustomed stimulus, its action becomes
diminished; and the sensorial power becomes accumulated, and by its
superabundance, or overflowing as it were, increases the action of the
second tribe of the associate actions by reverse sympathy. As exposing the
warm skin for a moderate time to cold air increases the action of the
stomach, and thus strengthens the power of digestion.

On the reverse, when additional stimulus within certain limits is partially
applied to parts, which are deficient in respect to the natural quantity of
sensorial power, the expenditure of sensorial power is increased, but in a
less degree than the increased production of it in the brain, or its
increased derivation into the strongly-stimulated organ. Hence in weak
people, or such whose fibres are deficient of sensorial power, if the first
tribe of an associate train of motions be subjected for a while to greater
stimulus than usual, a greater production of sensorial power, or a greater
derivation of it into the stimulated parts occurs; which by its excess, or
overflowing as it were, increases the actions of the second tribe of the
associate motions by direct sympathy. Thus when vomiting occurs with cold
extremities, a blister on the back in a few hours occasions universal
warmth of the skin, and stops the vomiting. And when a diarrhoea occurs
with pale skin and cold extremities, the pricking of the points of a
flannel shirt, worn next the skin, occasions universal warmth of it, and
checks or cures the diarrhoea.

In some associate trains of action nevertheless reverse sympathies more
frequently occur than direct ones, and in others direct ones more
frequently than reverse ones. Thus in continued fever with debility there
appears to be a reverse sympathy between the capillary vessels of the
stomach and those of the skin; because there exists a total aversion to
solid food, and constant heat on the surface of the body. Yet these two
systems of vessels are at other times actuated by direct sympathy, as when
paleness attends sickness, or cold feet induces indigestion. This subject
requires to be further investigated, as it probably depends not only on the
present or previous plus or minus of the sensorial power of association,
but also on the introduction of other kinds of sensorial power, as in Class
IV. 1. 1. D; or the increased production of it in the brain, or the greater
mobility of one part of a train of actions than another.

Thus when much food or wine is taken into the stomach, if there be no
superfluity of sensorial power in the system, that is, none to be spared
from the continual actions of it, a paleness and chillness succeeds for a
time; because now the expenditure of it by the increased actions of the
stomach is greater than the present production of it. In a little time
however the stimulus of the food and wine increases the production of
sensorial power in the brain, and this produces a superfluity of it in the
system; in consequence of which the skin now becomes warm and florid, which
was at first cold and pale; and thus the reverse sympathy is shortly
converted into a direct one; which is probably owing to the introduction of
a second sensorial power, that of pleasurable sensation.

On the contrary, when an emetic drug produces sickness, the skin is at
first pale for a time by direct sympathy with the capillaries of the
stomach; but in a few minutes, by the accumulation of sensorial power in
the stomach during its less active state in sickness, the capillaries of
the skin, which are associated with those of the stomach, act with greater
energy by reverse sympathy, and a florid colour returns. Where the quantity
of action is diminished in the first part of a train of motions, whether by
previous diminution of sensorial power, or present diminution of stimulus,
the second part of the train becomes torpid by direct sympathy. And when
the quantity of action of the first part becomes increased by the
accumulation of sensorial power during its previous torpor, or by increase
of stimulus, the actions of the second part of it likewise become increased
by direct sympathy.

In moderate hunger the skin is pale, as before dinner, and in moderate
sickness, as no great accumulation of sensorial power has commenced; but in
violent hunger, and in greater torpor of the stomach, as from contagious
matter, the accumulation of sensorial power becomes so great as to affect
the arterial and capillary system, and fever is produced in both cases.

In contagious fevers with arterial debilities commencing with torpor of the
stomach, why is the action of the heart weakened, and that of the
capillaries increased? Is it because the mobility of the heart is less than
that of the stomach, and the mobility of the capillaries greater? Or is it
because the association between the muscular fibres of the stomach and
those of the heart have been uniformly associated by direct sympathy; and
the capillaries of the stomach and those of the skin have been more
frequently associated by reverse sympathy?

Where the actions of the stomach have been previously exhausted by long
stimulus, as on the day after intoxication, little or no accumulation of
sensorial power occurs, during the torpor of the organ, beyond what is
required to replace the deficiency of it, and hence fever seldom follows
intoxication. And a repetition of the stimulus sometimes becomes necessary
even to induce its natural action, as in dram-drinkers.

Where there has been no previous exhaustion of sensorial power, and the
primary link of associate motions is violently actuated by the sensorial
power of sensation, the secondary link is also violently actuated by direct
sympathy, as in inflammatory fevers. Where however the sensorial power of
the system is less than natural, the secondary link of associated motions
becomes torpid by reverse sympathy, as in the inoculated small-pox during
the eruption on the face the feet are frequently cold.

G. _Associations affected four Ways._

Hence associated trains or circles of motions may be affected four
different ways. 1. By the greater or less energy of action of the first
link with which they are catenated, and from which they take their names;
as irritative, sensitive, or voluntary associations. 2. By being excited by
two or more sensorial powers at the same time, as by irritation and
association, as in the instance of the application of the stimulus of
increased external heat to the cutaneous capillaries. 3. By catenation with
other sensorial powers, as with pain or pleasure, which are in this case
not the proximate cause of motion, but which, by becoming a link of
catenation, excites the sensorial power of association into action; as the
pain at the neck of the gall-bladder occasioned by a gall-stone is
transferred to the other end of that canal, and becomes a link of
catenation between the action of the two extremities of it. 4. The
influence of ethereal fluids, as of heat and gravitation. To which last
perhaps might be added moisture and oxygen gas as constituting necessary
parts of the system, rather than stimuli to excite it into action.

H. _The Origin of Associations._

Some trains or circles of associate motions must have been formed before
our nativity, as those of the heart, arteries, and capillaries; others have
been associated, as occasion required them, as the muscles of the diaphragm
and abdomen in vomiting; and others by perpetual habit, as those of the
stomach with the heart and arteries directly, as in weak pulse during
sickness; with the capillaries directly, as in the flushed skin after
dinner; and lastly, with the cellular absorbents reversely, as in the
increased absorption in anasarca during sickness; and with the irritative
motions of the organs of sense reversely, as in vertigo, or sea-sickness.
Some of these associations shall be here shortly described to facilitate
the investigation of others.

First, other congeries of glands occupy but a particular part of the
system, or constitute a particular organ, as the liver, or kidneys; but
those glands, which secrete the mucus, and perspirable matter, which are
called capillaries, are of very great extent; they receive the blood from
the arteries, separate from it the mucus, which lines every cell, and
covers every cavity of body; and the perspirable matter, which softens and
lubricates the whole surface of the skin, and the more extensive surface of
the air-vessels, which compose the lungs. These are supplied with blood by
the perpetual action of the heart and arteries, and have therefore their
motions associated with the former, and with each other, by sympathy, which
is sometimes direct, and sometimes reverse.

One branch of this association, the capillaries of the skin, are very
irritable by the increased quantities of cold and heat, another branch,
that of the lungs, has not the perception of cold and heat, but is liable
by direct sympathy to act in concert with the former, as in going into the
cold bath. And it is probable the capillaries of the internal membranes are
likewise directly affected by their sympathy with those of the skin, as
appears from the defect of secretion in ulcers during the cold fits of
agues.

The motions of this extensive system of capillaries, thus associated by
direct sympathy, are also associated with those of the heart and arteries,
sometimes by reverse and sometimes by direct sympathy; and thus constitute
simple fever. The cold paroxysm of which consists in their torpor, and the
hot one in their orgasm, or increased activity.

I. _Of the Action of Vomiting._

The manner, in which the stomach and the diaphragm and abdominal muscles
acquire their associate action in vomiting, requires some attention. It is
not probable, that this action of vomiting occurs before nativity; as the
uniform application of the nutritive liquor amnii to the mouth of the
foetus, and the uniform expenditure of its nourishment, would not seem to
give occasion to too great temporary repletion of the stomach; and would
preclude the deglutition of any improper material. After nativity the
stomach of the child may be occasionally too much distended with milk; as
previous hunger may induce it to overgorge itself; and by repeated efforts
the act of vomiting is learned, as a means of getting free from a
disagreeable sensation. Thus when any disgustful material, as a bitter
drug, is taken into the mouth; certain retrograde motions of the tongue and
lips are produced, for the purpose of putting the disagreeable material out
of the mouth again.

When the stomach is disagreeably stimulated by the distention or acrimony
of the aliment, a similar effort to regurgitate it must occur; and by
repeated trials the action of the diaphragm and abdominal muscles by
squeezing the stomach assists its retrograde exertion to disgorge its
contents. In the same manner when a piece of gravel is pushed into the
urethra, or a piece of indurated bile into the neck of the gall-bladder,
after they have been in vain pressed forward by the usual motions of those
ducts, they return into the bladders of gall and urine by the retrograde
motions of them.

That this is one mode, in which vomiting is induced, appears from the
instantaneous rejection from the stomach occasioned by some nauseous drug,
or from some nauseous idea; and lastly, from the voluntary power, which
some people have been said to have acquired, of emptying their stomachs,
much in the same manner as ruminating animals bring up the grass from their
first stomach.

There are nevertheless many modes by which these inverted motions of the
stomach and oesophagus are induced, and which it is of consequence to
distinguish from each other. The first is the mode above described, where
an effort is made to dislodge something, which stimulates the stomach into
disagreeable sensation; and which is returned by repeated exertions; as
when a nauseous drug is taken into the mouth, or a bit of sand falls into
the eye, or a drop of water into the wind-pipe. In this the peristaltic
motions of the stomach are first stopped, and then reverted by painful
sensation; and the abdominal muscles and diaphragm by repeated efforts
become associated with them. Now as less sensorial power is expended on the
retrograde actions of the stomach, and of the lymphatics, which open their
mouths on its surface, than by their natural motions, an accumulation of
sensorial power in the fibres of the stomach follows the exhibition of an
emetic, and on that account an emetic will sometimes stop a spontaneous
vomiting which was owing to sensorial deficiency. See Sect. XXXV. 1. 3. and
Art. V. 2. 1.

As bitters and metallic salts, exhibited in small doses, stimulate the
stomach into greater action, as appears by their increasing the power of
digestion, and yet become emetic, when given in larger doses; one might
suspect, that they became emetic by inducing debility, and consequent
retrograde actions of the stomach, by their previously exhausting the
sensorial power by their great stimulus; which might be effected in a
moment without producing pain, and in consequence without our perceiving
it. But on the contrary, there does not in general appear on the exhibition
of emetics to be any previous exhaustion of sensorial power; because there
is evidently an accumulation of it during the sickness, as appears from the
digestion being stronger afterwards; and from the increased action of the
cellular and cutaneous absorbents during its operation. See Art. V. 2. 1.

Another mode, by which vomiting is induced, is owing to debility or
deficiency of sensorial power, from the previous exhaustion of it; as on
the day after intoxication, or which occurs in people enfeebled with the
gout, and in dropsy, and in some fevers with debility. In these, when the
vomiting ceases, there is no appearance of accumulation of sensorial power,
as the digestion still remains weak and imperfect.

Another mode by which sickness or vomiting is induced, is by defect of
stimulus, as in great hunger; and in those, who have been habituated to
spice and spirit with their meals, who are liable to be sick after taking
food without these additional stimuli. Other means of inducing sickness by
vertigo, or by nauseous ideas, will be mentioned below.

We shall only add, that the motions of the muscular fibres of the stomach
are associated with those of the heart and arteries by direct sympathy, as
appears by the weakness of the pulse during the exhibition of an emetic;
and that the absorbents of the stomach are associated with the cellular and
cutaneous absorbents by reverse sympathy, as is shewn by the great
absorption of the mucus of the cells in anasarca during sickness; at the
same time that the absorbents of the stomach invert their actions, and pour
the mucus and water thus absorbed into that viscus.

In cold paroxysms of fever the stomach partakes of the general torpor, and
vomiting is induced by its debility, either by its association with the
torpid capillaries, or other torpid parts, or by its own torpor commencing
first, and causing the cold fit. The disordered motions of the stomach
frequently seem to be the cause or primary seat of fever, as where
contagious miasmata are swallowed with the saliva, and where fever is
produced by sea-sickness, which I once saw. Nevertheless a disorder of the
stomach does not always induce fever, as in that case it should constantly
attend indigestion, and vertigo, and sea-sickness; but is itself frequently
induced by association with the disordered movements of other parts of the
system, as when it arises from gravel in the ureter, or from a percussion
on the head.

The connexion of the motions of the stomach with irritative ideas, or
motions of the organs of sense, in vertigo, is shewn in Sect. XX. and thus
it appears, that many circles of association are either directly or
reversely associated, or catenated, with this viscus; which will much
contribute to unfold some of the symptoms of fever.

K. _Tertian Associations._

The third link of associate trains of motion is sometimes actuated by
reverse sympathy, with the second link, and that by reverse sympathy with
the first link; so that the first and third link may act by direct
sympathy, and the intermediate one by reverse sympathy. Of this instances
are given in the syngultus nephriticus, Class IV. 1. 1. 7. and IV. 2. 1. At
other times the tertian or quartan links of associate motions are actuated
by direct sympathy; and that sometimes forwards and sometimes backwards in
respect to the usual order of those trains of associate motions, as in
Class IV. 1. 2. 1.

SPECIES.

1. _Rubor vultûs prandorum._ Flushing of the face after dinner is explained
in Sect. XXXV. 1. In the beginning of intoxication the whole skin becomes
florid from the association of the actions of the cutaneous arteries with
those of the stomach, because vinous spirit excites the fibres of the
stomach into more violent action than the stimulus of common food; and the
cutaneous capillaries of the face, from their more frequent exposure to the
vicissitudes of cold and heat, possess more mobility or irritability than
those of other parts of the skin, as further explained in Sect. XXXIII. 2.
10. Vinegar is liable to produce this flushing of the face, which probably
is owing to the quantity of vinous spirit it contains, as I believe the
unfermented vegetable acids do not produce this effect. In every kind of
blush the arterial blood is propelled into the capillaries faster than the
venous absorption can carry it forwards into the veins, in this respect
resembling the tensio phalli.

Can the beginning vinous or acetous fermentation of the aliment in weak
stomachs contribute to this effect? or is it to be ascribed to the greater
power of association between the arteries of the face and the fibres of the
stomach in some people than in others?

M. M. Eat and drink less at a time, and more frequently. Put 20 drops of
weak acid of vitriol into water to be drank at meals. Let the dress over
the stomach and bowels be loose. Use no fermented liquors, or vinegar, or
spice.

2. _Sudor stragulis immersorum._ Sweat from being covered in bed. In the
commencement of an epidemic fever, in which the perpetual efforts to vomit
was a distressing symptom, Dr. Sydenham discovered, that if the patient's
head was for a short time covered over with the bed clothes, warmth was
produced, and a sweat broke out upon the skin, and the tendency to vomit
ceased. In this curious fact two trains of associated motions are excited
into increased action. First, the vessels of the lungs are known to have
their motion associated with those of the skin by the difficulty of
breathing on going into the cold bath, as described in Sect. XXXII. 3. 2.
Hence, when the vessels of the lungs become excited into stronger action,
by the bad air under the bed clothes, warmed and adulterated by frequent
breathing, those of the external skin soon become excited by their
association into more energetic action, and generate more heat along with a
greater secretion of perspirable matter. Secondly, the sympathy between the
stomach and skin is evident in variety of circumstances; thus the cold air
of frosty days applied to the skin for a short time increases the action of
the stomach by reverse sympathy, but decreases it if continued too long by
direct sympathy; so in the circumstance above mentioned the action of the
stomach is increased by direct sympathy with that of the skin; and the
tendency to vomit, which was owing to its diminished action, ceases.

3. _Cessatio ægritudinis cute excitatâ._ The cure of sickness by
stimulating the skin. This is explained in the preceding article; and
further noticed in IV. 2. 2. 4. and in IV. 1. 1. f.

Similar to these is the effect of a blister on the back in relieving
sickness, indigestion, and heart-burn; and, on the contrary, by these
symptoms being frequently induced by coldness of the extremities. The
blister stimulates the cutaneous vessels into greater action; whence warmth
and pain are produced at the same time, and the fibres of the stomach are
excited into greater action by their association with those of the skin. It
does not appear, that the concomitant pain of the blister causes the
increased energy of the stomach, because the motions of it are not greater
than natural; though it is sometimes difficult to determine, whether the
primary part of some associated trains be connected with irritative or
sensitive motions.

In the same manner a flannel shirt, to one who has not been in the habit of
wearing one, stimulates the skin by its points, and thus stops vomiting in
some cases; and is particularly efficacious in checking some chronical
diarrhoeas, which are not attended with fever; for the absorbents of the
skin are thus stimulated into greater action, with which those of the
intestines consent by direct sympathy.

This effect cannot be ascribed to the warmth alone of the flannel shirt, as
being a covering of loose texture, and confining air in its pores, like a
sponge, which air is known to be a bad conductor of heat, since in that
case its use should be equally efficacious, if it were worn over a linen
shirt; and an increased warmth of the room of the patient would be equally
serviceable.

4. _Digestio aucta frigore cutaneo._ Digestion increased by coldness of the
skin. Every one has experienced the increase of his appetite after walking
in the cool air in frosty days; for there is at this time not only a saving
of sensorial power by the less exertion of the cutaneous vessels; but, as
these consent with those of the stomach and bowels, this saving of
sensorial power is transferred by reverse sympathy from the cutaneous
capillaries and absorbents to those of the stomach and intestines.

Hence weak people should use the cold air of winter as a cold bath; that
is, they should stay in it but a short time at once, but should immerse
themselves in it many times a day.

5. _Catarrhus a frigore cutaneo._ Catarrh from cold skin. This has been
already explained in Class I. 1. 2. 7. and is further described in Sect.
XXXV. 1. 3. In this disease the vessels of the membrane, which lines the
nostrils, are excited into greater action; when those of the skin, with
which they are associated, are excited into less action by the deficiency
of external heat, by reverse sympathy; and though the pain of cold attends
the torpor of the primary link of this association, yet the increased
motions of the membrane of the nostrils are associated with those of the
cutaneous vessels, and not with the pain of them, because no inflammation
follows.

6. _Absorptio cellularis aucta vomitu._ In the act of vomiting the
irritative motions of the stomach are inverted, and of the absorbents,
which open their mouths into it; while the cutaneous, cellular, and
pulmonary absorbents are induced, by reverse sympathy with them, to act
with greater energy. This is seen in cases of anasarca, when long sickness
and vomiting are caused by squills, or antimonial salts, or most of all by
the decoction of digitalis purpurea, foxglove; and Mr. J. Hunter mentions a
case, in which a large bubo, which was just ready to break, was absorbed in
a few days by sickness at sea. Treatise on the Blood, p. 501, which is thus
accounted for; less sensorial power is expended during sickness by the
decreased action of the fibres of the stomach, and of its absorbents; as
shewn in Sect. XXXV. 1. 3. whence an accumulation of it is produced, and
there is in consequence a greater quantity of sensorial power for the
exertion of those motions, which are associated with the absorbents of the
stomach by reverse sympathy.

The reverse sympathy between the lacteal and lymphatic branches of the
absorbent system have been produced by the one branch being less excited to
act, when the other supplies sufficient fluid or nutriment to the
sanguiferous vessels. Thus when the stomach is full, and the supply of
chyle and mucus and water is in sufficient quantity; the pulmonary,
cellular, and cutaneous lymphatics are not excited into action; whence the
urine is pale, and the skin moist, from the defect of absorption on those
surfaces.

7. _Syngultus nephriticus._ When a stone irritates the ureter, and that
even without its being attended with pain or fever, sometimes a chronical
hiccough occurs, and continues for days and weeks, instead of sickness or
vomiting; which are the common symptoms. In this case the motions of the
stomach are decreased by their sympathy with those of the ureter, which are
increased by the stimulus of the stone in it; and the increased motions of
the diaphragm seem to exist in consequence of their association with the
stomach by a second reverse sympathy. This hiccough may nevertheless admit
of another explanation, and be supposed to be a convulsive exertion of the
diaphragm to relieve the disagreeable sensation of the stomach in
consequence of its disordered irritative associations; and in that case it
would belong to Class III. 1. 1. See Class IV. 2. 1. for another example of
tertiary association.

M. M. Venesection. Emetic. Calomel. Cathartic, opium, oil of cinnamon from
two to ten drops. Aerated alcaline water. Peruvian bark.

8. _Febris irritativa._ Irritative fever, described in Class I. 1. 1. 1.
The diseases above explained in this genus are chiefly concerning the
sympathies of the absorbent system, or the alimentary canal, which are not
so much associated with the arterial system, as to throw it into disorder,
when they are slightly deranged; but when any great congeries of
conglomerate glands, which may be considered as the extremities of the
arterial system, are affected with torpor, the whole arterial system and
the heart sympathize with the torpid glands, and act with less energy;
which constitutes the cold fit of fever; which is therefore at first a
decreased action of the associate organ; but as this decrease of action is
only a temporary effect, and an increase of exertion both of the torpid
glands, and of the whole arterial system, soon follows; the hot fit of
irritative fever, or fever with strong pulse, properly belongs to this
class and genus of diseases.

       *       *       *       *       *

ORDO I.

_Increased Associate Motions._

GENUS II.

_Catenated with Sensitive Motions._

The primary links of the associated actions of this genus are either
produced or attended by painful or pleasurable sensation. The secondary
links of the first ten species are attended with increased motions without
inflammation, those of the remainder are attended with inflammation. All
inflammations, which do not arise in the part which was previously torpid,
belong to this genus; as the gout, rheumatism, erysipelas. It is probable
many other inflammations may, by future observation, require to be
transplanted into this class.

The circles of sensitive associate motions consist chiefly of the excretory
ducts of the capillaries and of the mouths of the absorbent vessels, which
constitute the membranes; and which have been induced into action at the
same time; or they consist of the terminations of canals; or of parts which
are endued with greater sensibility than those which form the first link of
the association. An instance of the first of those is the sympathy between
the membranes of the alveolar processes of the jaws, and the membranes
above or beneath the muscles about the temples in hemicrania. An instance
of the second is in the sympathy between the excretory duct of the lacrymal
gland, and the nasal duct of the lacrymal sack. And an instance of the
third is the sympathy between the membranes of the liver, and the skin of
the face in the gutta rosea of inebriates.

SPECIES.

1. _Lacrymarum fluxus sympatheticus._ A flow of tears from grief or joy.
When the termination of the duct of the lacrymal sac in the nostrils
becomes affected either by painful or pleasurable sensations, in
consequence of external stimulus, or by its association with agreeable or
disagreeable ideas, the motions of the lacrymal gland are at the same time
exerted with greater energy, and a profusion of tears succeeds by sensitive
association, as explained in Sect. XVI. 8. 2.

In this case there exists a chain of associated actions, the secretion of
the lacrymal gland is increased by whatever stimulates the surface of the
eye, at the same time the increased abundance of tears stimulates the
puncta lacrymalia into greater action; and the fluid thus absorbed
stimulates the lacrymal sac, and its nasal duct in the nose into greater
action. In a contrary direction of this chain of association the present
increase of action is induced. First, the nasal duct of the lacrymal sac is
excited into increased action by some pleasurable or painful idea, as
described in Sect. XVI. 8. 2.   2d. The puncta lacrymalia or other
extremity of the lacrymal sac sympathizes with it (as the two ends of all
other canals sympathize with each other).   3d. With these increased
motions of the puncta lacrymalia those of the excretory duct of the
lacrymal gland are associated from their having so perpetually acted
together. And, lastly, with the increased actions of the excretory duct of
this gland are associated those of the other end of it by their frequently
acting together; in the same manner as the extremities of other canals are
associated; and thus a greater flow of tears is poured into the eye.

When a flow of tears is produced in grief, it is believed to relieve the
violence of it, which is worthy a further inquiry. Painful sensations, when
great, excite the faculty of volition; and the person continues voluntarily
to call up or perform those ideas, which occasion the painful sensation;
that is, the afflicted person becomes so far insane or melancholy; but
tears are produced by the sensorial faculty of association, and shew that
the pain is so far relieved as not to excite the excessive power of
volition, or insanity, and are therefore a sign of the abatement of the
painful state of grief, rather than a cause of that abatement. See Class
III. 1. 2. 10.

2. _Sternutatio a lumine._ Some persons sneeze from looking up at the light
sky in a morning after coming out of a dark bedroom. The olfactory nerves
are brought into too great action by their sympathy with the optic nerves,
or by their respective sympathies with some intervening parts, as probably
with the two extremities of the lacrymal sac; that is, with the puncta
lacrymalia and the nasal duct. See Class II. 1. 1. 3.

3. _Dolor dentium Stridore._ Tooth-edge from grating sounds, and from the
touch of certain substances, and even from imagination alone, is described
and explained in Sect. XVI. 10. The increased actions of the alveolar
vessels or membranes are associated with the ideas, or sensual motions of
the auditory nerves in the first case; and of those of the sense of touch,
in the second case; and by imagination, or ideas exerted of painful
sensation alone, in the last.

4. _Risus sardonicus._ A disagreeable smile attends inflammations of the
diaphragm arising from the associations of the reiterated exertions of that
muscle with those of the lips and cheeks in laughing. See Diaphragmitis,
Class II. 1. 2. 6.

5. _Salivæ fluxus cibo viso._ The flow of saliva into the mouths of hungry
animals at the sight or smell of food is seen in dogs standing round a
dinner-table. The increased actions of the salivary glands have been
usually produced by the stimulus of agreeable food on their excretory ducts
during the mastication of it; and with this increased action of their
excretory ducts the other terminations of those glands in the capillary
arteries have been excited into increased action by the mutual association
of the ends of canals; and at the same time the pleasurable ideas, or
sensual motions, of the sense of smell and of sight have accompanied this
increased secretion of saliva. Hence this chain of motions becomes
associated with those visual or olfactory ideas, or with the pleasure,
which produces or attends them.

6. _Tensio mamularum viso puerulo._ The nipples of lactescent women are
liable to become turgid at the sight of their young offspring. The nipple
has generally been rendered turgid by the titillation of the lips or gums
of the child in giving suck; the visible idea of the child has thus
frequently accompanied this pleasurable sensation of parting with the milk,
and turgescence of the tubes, which constitute the nipple. Hence the visual
idea of the child, and the pleasure which attends it, become associated
with those increased arterial actions, which swell the cells of the mamula,
and extend its tubes; which is very similar to the tensio phalli visâ
muliere nudâ etiam in insomnio.

7. _Tensio penis in hydrophobia._ An erection of the penis occurs in the
hydrophobia, and is a troublesome symptom, as observed by Coelius
Aurelianus, Fothergill, and Vaughn, and would seem to be produced by an
unexplained sympathy between the sensations about the fauces and the penis.
In men the hair grows about both these parts, the voice changes, and the
neck thickens at puberty. In the mumps, when the swellings about the throat
subsides, the testicles are liable to swell. Venereal infection received by
the penis is very liable to affect the throat with ulcers. Violent coughs,
with soreness or rawness about the fauces are often attended with erection
of the penis; which is also said to happen to male animals, that are
hanged; which last circumstance has generally been ascribed to the
obstruction of the circulation of the blood, but is more probably
occasioned by the stimulus of the cord in compressing the throat; since if
it was owing to impeded circulation it ought equally to occur in drowning
animals.

In men the throat becomes so thickened at the time of puberty, that a
measure of this is used to ascertain the payment of a poll-tax on males in
some of the islands of the Mediterranean, which commences at puberty; a
string is wrapped twice round the thinnest part of the neck, the ends of it
are then put into each corner of the mouth; and if, when thus held in the
teeth, it passes readily over the head, the subject is taxable.

It is difficult to point out by what circumstance the sensitive motions of
the penis and of the throat and nose become associated; I can only observe,
that these parts are subjected to greater pleasurable sensations than any
other parts of the body; one being designed to preserve ourselves by the
pleasure attending the smell and deglutition of food, and the other to
ensure the propagation of our species; and may thus gain an association of
their sensitive motion by their being eminently sensible to pleasure. See
Class I. 3. 1. 11. and III. 1. 1. 15. and Sect. XVI. 5.

In the female sex this association between the face, throat, nose, and
pubis does not exist; whence no hair grows on their chins at the time of
puberty, nor does their voices change, or their necks thicken. This happens
probably from there being in them a more exquisite sensitive sympathy
between the pubis and the breasts. Hence their breasts swell at the time of
puberty, and secrete milk at the time of parturition. And in the parotitis,
or mumps, the breasts of women swell, when the tumor of the parotitis
subsides. See Class I. 1. 2. 15. Whence it would appear, that their breasts
possess an intermediate sympathy between the pubis and the throat; as they
are the seat of a passion, which men do not possess, that of suckling
children.

8. _Tenesmus calculosus._ The sphincter of the rectum becomes painful or
inflamed from the association of its sensitive motions with those of the
sphincter of the bladder, when the latter is stimulated into violent pain
or inflammation by a stone.

9. _Polypus narium ex ascaridibus?_ The stimulation of ascarides in the
rectum produces by sensitive sympathy an itching of the nose, as explained
in IV. 2. 2. 6; and in three children I have seen a polypus in the nose,
who were all affected with ascarides; to the perpetual stimulation of
which, and the consequent sensitive association, I was led to ascribe the
inflammation and thickening of the membrane of the nostrils.

10. _Crampus surarum in cholera._ A cramp of the muscles of the legs occurs
in violent diarrhoea, or cholera, and from the use of too much acid diet in
gouty habits. This seems to sympathize with uneasy sensation in the bowels.
See Class III. 1. 1. 14. This association is not easily accounted for, but
is analogous in some degree to the paralysis of the muscles of the arms in
colica saturnina. It would seem, that the muscles of the legs in walking
get a sympathy with the lower parts of the intestines, and those of the
arms in variety of employment obtain a sympathy with the higher parts of
them. See Cholera and Ileus.

11. _Zona ignea nephritica._ Nephritic shingles. The external skin about
the loins and sides of the belly I suppose to have greater mobility in
respect to sensitive association, than the external membrane of the kidney;
and that their motions are by some unknown means thus associated. When the
torpor or beginning inflammation of this membrane ceases, the external skin
becomes inflamed, in its stead, and a kind of herpes, called the shingles,
covers the loins and sides of the belly. See Class II. 1. 5. 9.

12. _Eruptio variolarum._ After the inflammation of the inoculated arm has
spread for a quarter of a lunation, it affects the stomach by reverse
sympathy; that is, the actions of the stomach are associated with those of
the skin; and as much sensorial power is now exerted on the inflamed skin,
the other part of this sensitive association is deprived of its natural
share, and becomes torpid, or inverts its motions. After this torpor of the
stomach has continued a time, and much sensorial power is thus accumulated;
other parts of the skin, which are also associated with it, as that of the
face first, are thrown into partial inflammation; that is, the eruptions of
the small-pox appear on the face.

For that the variolous matter affects the stomach previous to its eruption
on the skin appears from the sickness at the commencement of the fever; and
because, when the morbid motions affect the skin, those of the stomach
cease; as in the gout and erysipelas, mentioned below. The consent between
the stomach and the skin appears in variety of other diseases; and as they
both consist of surfaces, which absorb and secrete a quantity of moisture,
their motions must frequently be produced together or in succession; which
is the foundation of all the sympathies of animal motions, whether of the
irritative, sensitive, or voluntary kinds.

Now as the skin, which covers the face, is exposed to greater variations of
heat and cold than any other part of the body; it probably possesses more
mobility to sensitive associations, not only than the stomach, but than any
other part of the skin; and is thence affected at the eruption of the
small-pox with violent action and consequent inflammation, by the
association of its motions with those of the stomach, a day before the
other parts of the skin; and becomes fuller of pustules, than any other
part of the body. See Class II. 1. 3. 9.

It might be supposed, that the successive swelling of the hands, when the
face subsides, at the height of the small-pox, and of the feet, when the
hands subside, were governed by some unknown associations of those parts of
the system; but these successions of tumor and subsidence more evidently
depend on the times of the eruption of the pustules on those parts, as they
appear a day sooner on the face than on the hands, and a day sooner on the
hands than on the feet, owing to the greater comparative mobility of those
parts of the skin.

13. _Gutta rosea stomatica._ Stomatic red face. On drinking cold water, or
cold milk, when heated with exercise, or on eating cold vegetables, as raw
turnips, many people in harvest-time have been afflicted with what has been
called a surfeit. The stomach becomes painful, with indigestion and
flatulency, and after a few days an eruption of the face appears, and
continues with some relief, but not with entire relief; as both the pimpled
face and indigestion are liable to continue even to old age.

M. M. Venesection. A cathartic with calomel. Then half a grain of opium
twice a day for many weeks. If saturated solution of arsenic three or five
drops twice or thrice a day for a week?

14. _Gutta rosea hepatica._ The rosy drop of the face of some drinking
people is produced like the gout described below, in consequence of an
inflamed liver. In these constitutions the skin of the face being exposed
to greater variation of heat and cold than the membranes of the liver,
possesses more mobility than those hepatic membranes; and hence by whatever
means these membranes are induced to sympathize, when this sensitive
association occurs, the cutaneous vessels of the face run into greater
degrees of those motions, which constitute inflammation, than previously
existed in the membranes of the liver; and then those motions of the liver
cease. See Class II. 1. 4. 6.

An inflammation of the liver so frequently attends the great potation of
vinous spirit, there is reason to suspect, that this viscus itself becomes
inflamed by sensitive association with the stomach; or that, when one
termination of the bile-duct, which enters the duodenum is stimulated
violently, the other end may become inflamed by sensitive association.

15. _Podagra._ The gout, except when it affects the liver or stomach, seems
always to be a secondary disease, and, like the rheumatism and erysipelas
mentioned below, begins with the torpor of some distant part of the system.

The most frequent primary seat of the gout I suppose to be the liver, which
is probably affected with torpor not only previous to the annual paroxysms
of the gout, but to every change of its situation from one limb to another.
The reasons, which induce me to suspect the liver to be first affected, are
not only because the jaundice sometimes attends the commencement of gout,
as described in Sect. XXIV. 2. 8. but a pain also over the pit of the
stomach, which I suppose to be of the termination of the bile-duct in the
duodenum, and which is erroneously supposed to be the gout of the stomach,
with indigestion and flatulency, generally attends the commencement of the
inflammation of each limb. See Arthritis ventriculi, Class I. 2. 4. 6. In
the two cases, which I saw, of the gout in the limbs being preceded by
jaundice, there was a cold shivering fit attended the inflammation of the
foot, and a pain at the pit of the stomach; which ceased along with the
jaundice, as soon as the foot became inflamed. This led me to suspect, that
there was a torpor of the liver, and perhaps of the foot also, but
nevertheless the liver might also in this case be previously inflamed, as
observed in Sect. XXIV. 2. 8.

Now as the membranes of the joints of the feet suffer greater variations of
heat and cold than the membranes of the liver, and are more habituated to
extension and contraction than other parts of the skin in their vicinity; I
suppose them to be more mobile, that is, more liable to run into extremes
of exertion or quiescence; and are thence more susceptible of inflammation,
than such parts as are less exposed to great variations of heat and cold,
or of extension and contraction.

When a stone presses into the sphincter of the bladder, the glans penis is
affected with greater pain by sympathy, owing to its greater sensibility,
than the sphincter of the bladder; and when this pain commences, that of
the sphincter ceases, when the stone is not too large, or pushed too far
into the urethra. Thus when the membrane, which covers the ball of the
great toe, sympathizes with some membranous part of a torpid or inflamed
liver; this membrane of the toe falls into that kind of action, whether of
torpor or inflammation, with greater energy, than those actions excited in
the diseased liver; and when this new torpor or inflammation commences,
that with which it sympathises ceases; which I believe to be a general law
of associated inflammations.

The paroxysms of the gout would seem to be catenated with solar influence,
both in respect to their larger annual periods, and to their diurnal
periods--See Sect. XXXVI. 3. 6.--as the former occur about the same season
of the year, and the latter commence about an hour before sun-rise;
nevertheless the annual periods may depend on the succession of great
vicissitudes of cold and heat, and the diurnal ones on our increased
sensibility to internal sensations during sleep, as in the fits of asthma,
and of some epilepsies. See Sect. XVIII. 15.

In respect to the pre-remote cause or disposition to the gout, there can be
no doubt of its individually arising from the potation of fermented or
spirituous liquors in this country; whether opium produces the same effect
in the countries, where it is in daily use, I have never been well
informed. See Sect. XXI. 10, where this subject is treated of; to which I
have to add, that I have seen some, and heard of others, who have moderated
their paroxysms of gout, by diminishing the quantity of fermented liquors,
which they had been accustomed to; and others who, by a total abstinence
from fermented liquors, have entirely freed themselves from this
excruciating malady; which otherwise grows with our years, and curtails or
renders miserable the latter half, or third, of the lives of those, who are
subject to it. The remote cause is whatever induces temporary torpor or
weakness of the system; and the proximate cause is the inirritability, or
defective irritation, of some part of the system; whence torpor and
consequent inflammation. The great Sydenham saw the beneficial effects of
the abstinence from fermented liquors in preventing the gout, and adds, "if
an empiric could give small-beer only to gouty patients as a nostrum, and
persuade them not to drink any other spirituous fluids, that he might
rescue thousands from this disease, and acquire a fortune for his
ingenuity." Yet it is to be lamented, that this accurate observer of
diseases had not resolution to practise his own prescription, and thus to
have set an example to the world of the truth of his doctrine; but, on the
contrary, recommends Madeira, the strongest wine in common use, to be taken
in the fits of the gout, to the detriment of thousands; and is said himself
to have perished a martyr to the disease, which he knew how to subdue!

As example has more forcible effect: than simple assertion, I shall now
concisely relate my own case, and that of one of my most respected friends.
E. D. was about forty years of age, when he was first seized with a fit of
the gout. The ball of his right great toe was very painful, and much
swelled and inflamed, which continued five or six days in spite of
venesection, a brisk cathartic with ten grains of calomel, and the
application of cold air and cold water to his foot. He then ceased to drink
ale or wine alone; confining himself to small beer, or wine diluted with
about thrice its quantity of water. In about a year he suffered two other
fits of the gout, in less violent degree. He then totally abstained from
all fermented liquors, not even tasting small-beer, or a drop of any kind
of wine; but eat plentifully of flesh-meat, and all kinds of vegetables,
and fruit, using for his drink at meals chiefly water alone, or lemonade,
or cream and water; with tea and coffee between them as usual.

By this abstinence from fermented liquors he kept quite free from the gout
for fifteen or sixteen years; and then began to take small-beer mixed with
water occasionally, or wine and water, or perry and water, or cyder and
water; by which indulgence after a few months he had again a paroxysm of
gout, which continued about three days in the ball of his toe; which
occasioned him to return to his habit of drinking water, and has now for
above twenty years kept in perpetual health, except accidental colds from
the changes of the seasons. Before he abstained from fermented or
spirituous liquors, he was frequently subject to the piles, and to the
gravel, neither of which he has since experienced.

In the following case the gout was established by longer habit and greater
violence, and therefore required more cautious treatment. The Rev. R. W.
was seized with the gout about the age of thirty-two, which increased so
rapidly that at the age of forty-one he was confined to his room seven
months in that year; he had some degree of lameness during the intervals,
with chalky swellings of his heels and elbows. As the disease had continued
so long and so violently, and the powers of his digestion were somewhat
weakened, he was advised not entirely to leave off all fermented liquors;
and as small-beer is of such various strength, he was advised to drink
exactly two wine glasses, about four ounces, of wine mixed with three or
four times its quantity of water, with or without lemon and sugar, for his
daily potation at dinner, and no other fermented liquor of any kind; and
was advised to eat flesh-meat with any kind of boiled vegetables, and
fruit, with or without spice. He has now scrupulously continued this
regimen for above five years, and has had an annual moderate gouty paroxysm
of a few weeks, instead of the confinement of so many months, with great
health and good spirits during the intervals.

The following is a more particular account of the history of this case;
being part of a letter which Mr. Wilmot wrote on that subject at my
entreaty.

    "I entered into the army with an excellent constitution at the age of
    fifteen. The corps I served in was distinguished by its regularity,
    that is, the regular allowance of the mess was only one pint of wine
    per man each day; unless we had company to dine with us; then, as was
    the general custom of the time, the bottle circulated without limit.
    This mode of living, though by no means considered as excess for men,
    was certainly too great for a youth of my age. This style of living I
    continued, when with the regiment, till the latter end of the year
    1769, when I had the misfortune to sleep in a damp bed at Sheffield on
    a journey to York, but arrived there before I felt the ill effects of
    it. I was then seized with a violent inflammatory rheumatism with great
    inflammation of my eyes, and was attended by Dr. Dealtry; so violent
    was the disorder, that I was bled for it eight times in less than a
    fortnight; and was three months, before I could consider my health
    perfectly re-established. Dr. Dealtry told me, that I should be subject
    to similar attacks for many years; and that he had no doubt, from the
    tendency he found in my habit to inflammation, that, when I was farther
    advanced in life, I should change that complaint for the gout. He
    predicted truly; for the three succeeding winters I had the same
    complaint, but not so violently; the fourth winter I escaped, and
    imputed my escape to the continuance of cold bathing during the whole
    of that winter; after that I never escaped it, till I had a regular and
    severe fit of the gout: after the first attack of rheumatic fever I was
    more abstemious in my manner of living, though when in company I never
    subjected myself to any great restraint. In the year 1774 I had quitted
    the army, and being in a more retired situation, was seldom led into
    any excess; in 1776 and 1777 I was in the habit of drinking a good deal
    of wine very frequently, though not constantly. After that period till
    the year 1781, I drank a larger quantity of wine regularly, but very
    seldom to any degree of intoxication. I lived much at that time in the
    society of some gentlemen, who usually drank nearly a bottle of wine
    daily after dinner. I must here however observe, that at no part of my
    life was I accustomed to drink wine in an evening, and very seldom
    drank any thing more than a single half-pint glass of some sort of
    spirits diluted with much water. Till the year 1781 I had always been
    accustomed to use very violent and continued exercise on horseback; in
    the winter months I pursued all field diversions, and in the summer
    months I rode frequent and long journeys; and with this exercise was
    liable to perspire to great excess; besides which I was subject to very
    profuse night-sweats, and had frequently boils break out all over me,
    especially in the spring and autumn; for which I took no medicine,
    except a little flour of sulphur with cream of tartar in honey.

    "You will observe I bring every thing down to the date of 1781. In the
    month of October in that year, when I was just entered into the
    thirty-second year of my age, I had the first attack of gout; that fit
    was very severe, and of many weeks continuance. I now determined upon a
    more abstemious method of living, in respect to wine; and indeed the
    society, in which I had before been accustomed to live, being
    considerably changed, I had less frequent temptations to excess. From
    this time I enjoyed the most perfect good state of health till August
    1784, when I had my second attack of gout. I never perfectly recovered
    from this attack through the succeeding winter, and in March 1785 was
    advised to try the Bath waters, and drank them under the direction of
    one of the faculty of that place. I was there soon seized with a fever,
    and a slight attack of gout in one knee. I should observe, that when I
    set out from home, I was in a weak and low state, and unequal to much
    fatigue; as appeared by my having a fainting fit one day on the road,
    after having travelled only about fifty miles; in the course of the
    summer I had two or three more slight attacks of gout of less
    consequence, till the month of October; when I was afflicted with it
    all over me in such a manner, as to be without the possibility of the
    least degree of removal for some days; and was about two months without
    being able to get into the air. This was the severest attack I had then
    experienced; though I have since had several equally severe. In the
    course of this summer I had a fall with my horse; and soon after it,
    having discovered an enlargement on one elbow, I concluded I had hurt
    it at that time; but in the course of this last attack having a similar
    enlargement on the other elbow, I found my mistake, and that they were
    collections of gouty matter; these increased to the size of pullet's
    eggs, and continue in that state. I had soon after similar enlargements
    on my heels; the right heel being severely bruised, I was under the
    necessity of having it lanced, and a large quantity of chalky matter
    was discharged from it; and have since that time frequently had chalky
    matter taken from it, and sometimes small bits of apparently perfect
    chalk. My right hand soon was afflicted in the same way, and I have
    scarcely a joint on those fingers now in a natural state. My left hand
    has escaped tolerably well. After this last attack (viz. October 1785),
    I had two or three slight attacks before the month of June 1787, when I
    had a very severe intermittent fever; from that time I continued very
    well till the latter end of the year, when I began to feel the gout
    about me very much, but was not confined by it. I was in this state
    advised to try what is called the American Recipe (gum guaiacum and
    nitre dissolved in spirits); it had apparently been of essential
    service to a friend of mine, who from the inability to walk a mile for
    some years, was believed to be restored by the use of this medicine to
    a good state of health, so as to walk ten miles a day. In addition to
    this medicine I drank, as my common beverage with my meals, spruce
    beer. I had so high an opinion of this medicine in the gout, and of
    spruce beer as an antiscorbutic, that I contemplated with much
    satisfaction, and with very little doubt, the perfect restoration of my
    health and strength; but I was miserably deceived; for in September
    1788 I was seized with the gout in a degree that none but arthritics,
    and indeed but few of those, can easily conceive. From this time till
    August 1789 I scarcely ever passed a comfortable day; seven months of
    this time I had been confined, my health seemed much impaired, my
    strength was diminished, and my appetite almost gone. In this state my
    friends pressed me to consult you. I was unwilling for some time to do
    it, as I had lost all hope of relief; however, when I had determined to
    apply to you, I likewise determined to give up every prejudice of my
    own respecting my case, and to adhere most strictly to your advice. On
    the 20th of August 1789 I consulted you, on the 25th I entered upon the
    regimen, which you prescribed, and which was as follows.

    "Drink no malt liquor on any account. Let your beverage at dinner
    consist of two glasses of wine diluted with three half-pints of water.
    On no account drink any more wine or spirituous liquors in the course
    of the day; but, if you want more liquid, take cream and water, or milk
    and water, or lemonade, with tea, coffee, chocolate. Use the warm bath
    twice a week for half an hour before going to bed, at the degree of
    heat which is most grateful to your sensations. Eat meat constantly at
    dinner, and with it any kind of tender vegetables you please. Keep the
    body open by two evacuations daily, if possible without medicine, if
    not take the size of a nutmeg of lenitive electuary occasionally, or
    five grains of rhubarb every night. Use no violent exercise, which may
    subject yourself to sudden changes from heat to cold; but as much
    moderate exercise as may be, without being much fatigued or starved
    with cold. Take some supper every night; a small quantity of animal
    food is preferred; but if your palate refuses this, take vegetable
    food, as fruit pie, or milk; something should be eaten, as it might be
    injurious to you to fast too long." To the whole of this I adhered most
    scrupulously, and soon found my appetite improve, and with it my
    strength and spirits. I had in December a fevere attack, and two or
    three slight ones in the course of twelve months; but the improvement
    in the general state of my health induced me to persevere. On the 18th
    of August 1790 I had another severe attack, but it went off easier than
    before, and I soon recovered sufficiently to go to Buxton, which you
    advised me to, and from which I reaped great benefit; nevertheless on
    the 29th of December I had a slight attack in comparison of some that I
    had before experienced, and from that time I was free from gout, and
    enjoyed my health perfectly well till the fourth week in October 1791;
    from that till the third week in October 1792; from that till the third
    week in October 1793; and from that till June 1794. From what happened
    for the last three years I dreaded the month of October; but I escaped
    then, and have enjoyed my health most perfectly ever since till within
    the last week, that I have had a slight attack in one knee, which is
    nearly gone, without any symptom to lead me to suppose that it will go
    further.

    "I adhered to your advice most scrupulously for the first year; and in
    regard to the not drinking malt liquor, and taking only the two glasses
    of wine with water, I have never deviated but two days; and then the
    first day I only drank one glass of ale and one glass of Champaigne; on
    the second only one glass of Champaigne. With regard to the warm bath,
    I only use it now when I have gouty symptoms upon me, and in such
    situations I find it of infinite service; and in other respects I
    continue to live according to your direction.

    "Many persons have laughed at the idea of my perseverance in a system,
    which has not been able to _cure_ the gout after five years trial; but
    such persons are either ignorant of what I before suffered, or totally
    unacquainted with the nature of the disorder. Under the blessing of
    Providence, by an adherence to your advice, I am reaping all the
    benefit you flattered me I might expect from it, viz. my attacks less
    frequent, my sufferings less acute, and an improvement in the general
    state of my health.

    "I have been particular in this account of myself at your request, and
    am, Sir, &c.

      MORLEY, near DERBY,
      February 10th, 1795.
      ROBERT WILMOT."

There are situations nevertheless in which a paroxysm of gout has been
believed to be desirable, as relieving the patient from other disagreeable
diseases, or debilities, or sensations. Thus when the liver is torpid, a
perpetual uneasiness and depression of spirits occur; which a fit of gout
is supposed to cure by a metastasis of the disease. Others have acquired
epileptic fits, probably from the disagreeable sensation of a chronically
inflamed liver; which they suppose the pain and inflammation of gout would
relieve. When gouty patients become much debilitated by the progress of the
disease, they are liable to dropsy of the chest, which they suppose a fit
of the gout would relieve. But in all these cases the attempt to procure a
paroxysm of gout by wine, or aromatics, or volatiles, or blisters, or
mineral waters, seldom succeeds; and the patients are obliged to apply to
other methods of relief adapted to their particular cases. In the two
former situations small repeated doses of calomel, or mercurial unction on
the region of the liver may succeed, by giving new activity to the vessels
of the liver, either to secrete or to absorb their adapted fluids, and thus
to remove the cause of the gout, rather than to promote a fit of it. In the
last case the tincture of digitalis, and afterwards the class of sorbentia,
must be applied to.

M. M. In young strong patients the gout should be cured by venesection and
cathartics and diluents, with poultices externally. But it has a natural
crisis by producing calcareous matter on the inflamed membrane, and
therefore in old enfeebled people it is safest to wait for this crisis,
attending to the natural evacuations and the degree of fever; and in young
ones, where it is not attended with much fever, it is customary and popular
not to bleed, but only to keep the body open with aloes, to use gentle
sudorifics, as neutral salts, and to give the bark at the decline of the
fit; which is particularly useful where the patient is much debilitated.
See Arthritis ventriculi, Class I. 2. 4. 6. and Sect. XXV. 17.

When there is not much fever, and the patient is debilitated with age, or
the continuance of the disease, a moderate opiate, as twenty drops of
tincture of opium, or one grain of solid opium, may be taken every night
with advantage. Externally a paste made with double the quantity of yeast
is a good poultice; and booterkins made with oiled silk, as they confine
the perspirable matter, keep the part moist and supple, and thence relieve
the pain like poultices.

The only safe way of moderating the disease is by an uniform and equal
diminution, or a total abstinence from fermented liquors, with the cautions
directed in Sect. XII. 7. 8. The continued use of strong bitters, as of
Portland's powder, or bark, has been frequently injurious, as spoken of in
the Materia Medica, Art. IV. 2. 11.

One of my acquaintance, who was much afflicted with the gout, abstained for
about half a year from beer and wine; and not having resolution to persist,
returned to his former habits of potation in less quantity; and observed
that he was then for one winter stronger and freer from the gout than
usual. This however did not long continue, as the disease afterwards
returned with its usual or increased violence. This I think is a
circumstance not unlikely to occur, as opium has a greater effect after its
use has been a while intermitted; and the debility or torpor, which is the
cause of gout, is thus for a few months prevented by the greater
irritability of the system, acquired during the lessened use of fermented
liquor.

For the same reason an ounce of spirituous tincture of guaiacum, or of
bark, is said to have for some time prevented returns of the gout; which
has afterwards, like all other great stimuli when long continued, been
succeeded by greater debility, and destroyed the patient. This seems to
have been exemplified in the case of the ingenious Dr. Bown, see Preface to
his Elementa Medicinæ; he found temporary relief from the stimulus of wine,
regardless of its future effects.

16. _Rheumatismus._ Acute rheumatism. There is reason to suspect, that
rheumatic inflammations, like the gouty ones, are not a primary disease;
but that they are the consequence of a translation of morbid action from
one part of the system to another. This idea is countenanced by the
frequent change of place of rheumatic-like gouty inflammations, and from
their attacking two similar parts at the same time, as both ankles and both
wrists, and these attacks being in succession to each other. Whereas it is
not probable that both feet or both hands should at the same time be
equally exposed to any external cause of the disease, as to cold or
moisture; and less so that these should occur in succession. Lastly, from
the inflammatory diathesis in this disease being more difficult to subdue,
and more dangerous in event, than other common inflammations, especially to
pregnant women, and in weak constitutions.

From this idea of the rheumatism being not a primary disease, like the
gout, but a transferred morbid action owing to the previous torpor of some
other part of the system, we perceive why it attacks weak people with
greater pertinacity than strong ones; resisting or recurring again and
again after frequent evacuations, in a manner very different from primary
inflammations; because the cause is not removed, which is at a distance
from the seat of the inflammation.

This also accounts for rheumatic inflammations so very rarely terminating
in suppuration, because like the gout the original cause is not in the
inflamed part, and therefore does not continue to act after the
inflammation commences. Instead of suppuration in this disease, as well as
in the gout, a quantity of mucus or coagulable lymph is formed on the
inflamed membrane; which in the gout changes into chalkstones, and in the
rheumatism is either reabsorbed, or lies on the membrane, producing pains
on motion long after the termination of the inflammation, which pains are
called chronic rheumatism. The membranes, which have thus been once or
repeatedly inflamed, become less mobile, or less liable to be affected by
sympathy, as appears by the gout affecting new parts, when the joints of
the foot have been frequently inflamed by it; hence as the cause of the
inflammation does not exist in the inflamed part, and as this part becomes
less liable to future attacks, it seldom suppurates.

Secondly, when rheumatism affects the muscles of the chest, it produces
symptoms similar to pleurisy, but are distinguished from that by the
patient having previously suffered rheumatic affections in other parts, and
by the pertinacity or continuance of the inflammatory state of the patient,
this should be termed pleurodyne rheumatica.

Thirdly, when rheumatic inflammation affects the bowels, it produces a
disease very different from enteritis, or common inflammation of the
bowels, and should be termed enteralgia rheumatica. The pain is less than
in enteritis, and the disease of longer continuance, with harder pulse, and
the blood equally sizy. It is attended with frequent dejections, with much
mucus, and previous griping pains, but without vomiting; and differs
perhaps from dysentery from its not being attended with bloody stools, and
not being infectious.

Fourthly, there is another kind of rheumatism attended with debility, which
suppurates, and should be termed rheumatismus suppurans. It is generally
believed to be the gout, till suppuration takes place on the swelled joint;
and, as the patient sinks, there are sloughs formed over the whole mouth;
and he seems to be destroyed by inflammation or gangrene of the mucous
membranes. I have twice seen this disease in patients about sixty. Some
other diseases are erroneously called rheumatic, as hemicrania, and
odontalgia. See Sect. XXVI. 3.

M.M. In the three former kinds venesection repeatedly. Cathartics.
Antimonials. Diluents. Neutral salts. Oil. Warm bath. Afterwards the bark.
Opium with or without ipecacuanha; but not till the patient is considerably
weakened. Sweats forced early in the disease do injury. Opium given early
in the disease prolongs it. In the last kind, gentle stimulants, as wine
and water, mucilage, sorbentia.

The following is a case of suppurative rheumatism. Mr. F----, about sixty,
was supposed to have the gout in his hand, which however suppurated, and it
was then called the suppurative rheumatism. He had lived rather
intemperately in respect to wine, and was now afflicted with a tendency to
inflammation of the mucous membranes. As he lay on the bed half resupine,
propped up with pillows, and also slept in that posture, his lower jaw
dropped by its own weight, when the voluntary power of the muscles was
suspended. The mucus of his mouth and throat became quite dry, and at
length was succeeded with sloughs; this was a most distressing circumstance
to him, and was in vain endeavoured to be relieved by supporting his jaw by
slender steel springs fixed to his night-cap, and by springs of elastic
gum. The sloughs spread and seemed to accelerate his death. See Class I. 1.
3. 2.

17. _Erysipelas._ The erysipelas differs from the zona ignea, and other
species of herpes, in its being attended with fever, which is sometimes of
the sensitive irritated or inflammatory kind, with strong and full pulse;
and at other times with weak pulse and great inirritability, as when it
precedes or attends mortifications. See Class II. 1. 3. 2.

Like the zona ignea above described, it seems to be a secondary disease,
having for its primary part the torpor or inflammation of some internal or
distant membrane, as appears from its so frequently attending wounds;
sometimes spreading from issues over the whole limb, or back, by sympathy
with a tendon or membrane, which is stimulated by the pease in them. In its
more violent degree I suppose that it sympathizes with some extensive
internal membranes, as of the liver, stomach, or brain. Another reason,
which countenances this idea, is, that the inflammation gradually changes
its situation, one part healing as another inflames; as happens in respect
to more distant parts in gout and rheumatism; and which seems to shew, that
the cause of the disease is not in the same place with the inflammation.
And thirdly, because the erysipelas of the face and head is liable to
affect the membranes of the brain; which were probably in these cases the
original or primary seat of the disease; and lastly, because the fits of
erysipelas, like those of the gout, are liable to return at certain annual
or monthly periods, as further treated of in Class II. 1. 3. 2.

Many cases of erysipelas from wounds or bruises are related in Default's
Surgical Journal, Vol. II. in which poultices are said to do great injury,
as well as oily or fatty applications. Saturnine solutions were sometimes
used with advantage. A grain of emetic tartar given to clear the stomach
and bowels, is said to be of great service.

18. _Testium tumor in gonorrhoea._ Mr. Hunter in his Treatise on the
Venereal Disease observes, that the tumor of the testes in gonorrhoea
arises from their sympathy with the inflammation of the urethra; and that
they are not similar to the actions arising from the application of
venereal matter, whether by absorption or otherwise; as they seldom or
never suppurate; and when suppuration happens, the matter produced is not
venereal. Treatise on Venereal Disease, p. 53.

19. _Testium tumor in parotidite._ The sympathy between some parts about
the throat and the genitals has been treated of in Class IV. 1. 2. 7. The
swelling of the testes, when that of the parotis subsides, seems to arise
from the association of successive action; as the tension of the penis in
hydrophobia appears to arise from the previous synchronous associations of
the sensitive motions of these parts; but the manner of the production of
both these associations is yet very obscure. In women a swelling of the
breasts often succeeds the decline of the mumps by another wonderful
sympathy. See Class IV. 1. 2. 7. and I. 1. 2. 15. In many persons a
delirium succeeds the swelling of the parotis, or the subsequent ones of
the testes or breasts; which is sometimes fatal, and seems to arise from a
sympathy of successive action, and not of synchronous action, of the
membranes of the brain with those of the parotide glands. Sometimes a
stupor comes on instead of this delirium, which is relieved by fomenting
the shaved head for an hour or two. See Class II. 1. 3. 4.

       *       *       *       *       *

ORDO I.

_Increased Associate Motions._

GENUS III.

_Catenated with Voluntary Motions_

SPECIES.

1. _Deglutitio invita._ When any one is told not to swallow his saliva, and
that especially if his throat be a little sore, he finds a necessity of
immediately swallowing it; and this the more certainly, the more he
voluntarily endeavours not to do so.

In this case the voluntary power exerted by our attention to the pharinx
renders it more sensible to irritation, and therefore occasions it to be
more frequently induced to swallow the saliva. Here the irritation induces
a volition to swallow it, which is more powerful than the desire not to
swallow it. See XXIV. 1. 7. So in reverie, when the voluntary power was
exerted on any of the senses, as of sight or taste, the objects of those
senses became perceived; but not otherwise. Sect. XIX. 6. This is a
troublesome symptom in some sore throats.

M. M. Mucilage, as sugar and gum arabic. Warm water held in the mouth
frequently, as a fomentation to the inflamed throat.

2. _Nictitatio invita._ Involuntary winking with the eye-lids, and
twitchings of the face, are originally induced by an endeavour to relieve
some disagreeable sensations about inflamed eyes, as the dazzling of light;
and afterwards these motions become catenated with other motions or
sensations, so as not to be governed by the will. Here the irritation first
produces a volition to wink, which by habit becomes stronger than the
anti-volition not to wink.

This subject is rendered difficult from the common acceptation of the word,
volition, including previous deliberation, as well as the voluntary
exertion, which succeeds it. In the volitions here spoken of there is no
time for deliberation or choice of objects, but the voluntary act
immediately succeeds the sensation which excites it.

M. M. Cover the affected parts with a sticking plaster or a blister. Pass a
fine needle and thread through a part of the skin over the muscle, which
moves, and attach the other end of the thread by a sticking plaster to a
distant part. An issue behind the ear. To practise daily by a looking-glass
to stop the motions with the hand. See the cure of a case of the leaping of
a muscle of the arm, Sect. XVII. 1. 8. See Convulsio debilis, Class III. 1.
1. 5.

3. _Risus invitus._ Involuntary laughter. When the pleasure arising from
new combinations of words and ideas, as in puns; or of other circumstances,
which are so trivial, as to induce no voluntary exertion to compare or
consider their present importance or their future consequence; the pleasure
is liable to rise into pain; that is, the ideas or sensual motions become
exerted too violently for want of some antithetistic ideas; in the same
manner as those muscles, which have weak antagonists, as those of the calf
of the leg, are liable to fall into cramp or painful contraction. In this
situation a scream is begun to relieve this pain of ideas too violently
exerted, which is stopped again soon, as explained in Sect. XXXIV. 1. 4.
and Class III. 1. 1. 4. and IV. 2. 3. 3.

The pain, into which this pleasure rises, which would excite the scream of
laughter, has been felt forcibly by every one; when they have been under
such circumstances, as have induced them to restrain it by a
counter-volition; till at length the increased associate motions produce so
much pain as to overcome the counter-volition, and the patient bursts out
into indecent laughter, contrary to his will in the common acceptation of
that word.

4. _Lusus digitorum invitus._ An awkward playing with the fingers in
speaking in public. These habits are began through bashfulness, and seem
rather at first designed to engage the attention in part, and thus prevent
the disagreeable ideas of mauvaise hont; as timorous boys whistle, when
they are obliged to walk in the dark; and as it is sometimes necessary to
employ raw soldiers in perpetual manoeuvres, as they advance to the first
charge.

5. _Unguium morsiuncula invita._ Biting the nails is a depraved habit
arising from similar causes as those of the last article.

M. M. Dip the fingers in solution of aloes.

6. _Vigilia invita._ Watchfulness, where the person wishes, and endeavours
to fall asleep, properly belongs to this place, as the wish or volition to
sleep prevents the desired effect; because sleep consists in an abolition
of volition. See Class III. 1. 2. 3.

       *       *       *       *       *

ORDO I.

_Increased Associate Motions._

GENUS IV.

_Catenated with External Influences._

SPECIES.

1. _Vita ovi._ Life of an egg. The eggs of fowls were shewn by Mr. J.
Hunter to resist the freezing process in their living state more
powerfully, than when they were killed by having the yolk and white shook
together. Philos. Trans. It may be asked, does the heat during the
incubation of eggs act as a stimulus exciting the living principle into
activity? Or does it act simply as a causa sine quâ non, as an influence,
which penetrating the mass, removes the particles of it to a greater
distance from each other, so as to allow their movement over each other, in
the same manner as heat is conceived to produce the fluidity of water; not
by stimulus, but by its penetrating influence? Or may elementary heat in
its uncombined state be supposed to act only as an influence necessary to
life in its natural quantity; whence torpor and death follows the eduction
of it from the body; but in its increased state above what is natural, or
usual, that it acts as a stimulus; which we have a sense to perceive; and
which excites many parts of the system into unnatural action? See Class IV.
1. 1. C.

2. _Vita hiemi-dormientium._ The torpor of insects, and birds, and
quadrupeds, during the cold season, has been called sleep; but I suppose it
must differ very much from that state of animal life, since not only all
voluntary power is suspended, but sensation and vascular motion has ceased,
and can only be restored by the influence of heat. There have been related
instances of snails, which have recovered life and motion on being put into
water after having experienced many years of torpidity, or apparent death,
in the cabinets of the curious. Here the water as well as the heat are
required not only as a stimulus, but as a causa sine quâ non of fluidity
and motion, and consequent life.

3. _Pullulatio arborum._ The annual revivescence of the buds of trees seems
not only to be owing to the influence of the returning warmth of the
spring, but also to be catenated with solar gravitation; because seeds and
roots and buds, which are analogous to the eggs of animals, put forth their
shoots by a less quantity of heat in spring, than they had undergone in the
latter part of autumn, which may however be ascribed to their previous
torpid state, and consequent accumulation of sensorial power, or
irritability; as explained in Botanic Garden, Part II. Cant. I. l. 322.
note. Other circumstances, which countenance the idea, that vegetation is
affected by solar gravitation, as well as by heat, may be observed in the
ripening of the seeds of plants both in those countries where the summers
are short, and in those where they are long. And by some flowers closing
their bells at noon, or soon after; and hence seem to sleep rather at solar
diurnal periods, than from the influence of cold, or the deficiency of
light.

4. _Orgasmatis venerei periodus._ The venereal orgasm of birds and
quadrupeds commences or returns about the vernal or autumnal equinoxes, and
thence seems in respect to their great periods to be governed by solar
influence. But if this orgasm be disappointed of its object, it is said to
recur at about monthly periods, as observed in mares and bitches in this
respect resembling the female catamenia. See Sect. XXXVI. 2. 3. and Sect.
XVI. 13.

5. _Brachii concussio electrica._ The movement of the arm, even of a
paralytic patient, when an electric shock is passed through it, is owing to
the stimulus of the excess of electricity. When a piece of zinc and silver,
each about the size of a crown-piece, are placed one under the upper lip,
and the other on the tongue, so as the outer edges may be brought into
contact, there is an appearance of light in the eyes, as often as the outer
edges of these metals are brought into contact or separated; which is
another instance of the stimulus of the passage of electric shocks through
the fibres of the organs of sense, as well as through the muscular fibres.
See Sect. XII. 1. 1. and first addit. note to Vol. I. of this work. But in
its natural state electricity seems only to act as an influence on animal
and vegetable bodies; of the salutary or injurious effects of which we have
yet no precise knowledge.

Yet if regular journals were kept of the variations of atmospheric
electricity, it is probable some discoveries of its influence on our system
might in time be discovered. For this purpose a machine on the principle of
Mr. Bennet's electric doubler might be applied to the pendulum of a clock,
so as to manifest, and even to record the daily or hourly variations of
aerial electricity. Which has already been executed, and applied to the
pendulum of a Dutch wooden clock, by Mr. Bennet, curate of Wirksworth in
Derbyshire.

Besides the variations of the degree or kind of atmospheric electricity,
some animals, and some men, seem to possess a greater power of accumulating
this fluid in themselves than others. Of which a famous history of a
Russian prince was lately published; who, during the clear and severe
frosts of that country, could not move himself in bed without luminous
corruscations. Such may have been the case of those people, who have been
related to have taken fire spontaneously, and to have been reduced to
ashes. The electric concussion from the gymnotus electricus, and torpedo,
are other instances of the power of the animal system to accumulate
electricity, as in these it is used as a weapon of defence, or for the
purpose of taking their prey.

Some have believed that the accumulation or passage of the magnetic fluid
might affect the animal system, and have asserted that the application of a
large magnet to an aching tooth has quickly effected a cure. If this
experiment is again tried in odontalgia, or hemicrania, the painful
membrane of the tooth or head should be included between the south and
north poles of a horse-shoe magnet, or between the contrary poles of two
different magnets, that the magnetism may be accumulated on the torpid
part.

6. _Oxygenatio sanguinis._ The variation of the quantity of oxygen gas
existing in the atmosphere must affect all breathing animals; in its excess
this too must be esteemed a stimulus; but in its natural quantity would
seem to act as an influence, or cause, without which, animal life cannot
exist even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic
infirmary, for the purpose of putting this and various other airs to the
test of experiment, will meet with public encouragement, and render
consumption, asthma, cancer, and many diseases conquerable, which at
present prey with unremitted devastation on all orders and ages of mankind.

7. _Humectatio corporis._ Water, and probably the vapour of water dissolved
or diffused in the atmosphere, unites by mechanical attraction with the
unorganized cuticle, and softens and enlarges it; as may be seen in the
loose and wrinkled skin of the hands of washerwomen; the same probably
occurs to the mucous membrane of the lungs in moist weather; and by
thickening it increases the difficulty of respiration of some people, who
are said to be asthmatical. So far water may be said to act as an influx or
influence, but when it is taken up by the mouths of the absorbent system,
it must excite those mouths into action, and then acts as a stimulus.

There appears from hence to be four methods by which animal bodies are
penetrated by external things. 1. By their stimulus, which induces the
absorbent vessels to imbibe them. 2. By mechanical attraction, as when
water softens the cuticle. 3. By chemical attraction, as when oxygen passes
through the membranes of the air-vessels of the lungs, and combines with
the blood. And lastly, by influx without mechanical attraction, chemical
combination, or animal absorption, as the universal fluids of heat,
gravitation, electricity, magnetism, and perhaps of other ethereal fluids
yet unknown.

       *       *       *       *       *

ORDO II.

_Decreased Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

As irritative muscular motions are attended with pain, when they are
exerted too weakly, as well as when they are exerted too strongly; so
irritative ideas become attended with sensation, when they are exerted too
weakly, as well as when they are exerted too strongly. Which accounts for
these ideas being attended with sensation in the various kinds of vertigo
described below.

There is great difficulty in tracing the immediate cause of the deficiences
of action of some links of the associations of irritative motions; first,
because the trains and tribes of motions, which compose these links, are so
widely extended as to embrace almost the whole animal system; and secondly,
because when the first link of an associated train of actions is exerted
with too great energy, the second link by reverse sympathy may be affected
with torpor. And then this second link may transmit, as it were, this
torpor to a third link, and at the same time regain its own energy of
action; and it is possible this third link may in like manner transmit its
torpor to a fourth, and thus regain its own natural quantity of motion.

I shall endeavour to explain this by an example taken from sensitive
associated motions, as the origin of their disturbed actions is more easily
detected. This morning I saw an elderly person, who had gradually lost all
the teeth in his upper jaw, and all of the under except three of the
molares; the last of these was now loose, and occasionally painful; the
fangs of which were almost naked, the gums being much wasted both within
and without the jaw. He is a man of attentive observation, and assured me,
that he had again and again noticed, that, when a pain commenced in the
membranes of the alveolar process of the upper jaw opposite to the loose
tooth in the under one (which had frequently occurred for several days
past), the pain of the loose tooth ceased. And that, when the pain
afterwards extended to the ear and temple on that side, the pain in the
membranes of the upper jaw ceased. In this case the membranes of the
alveolar process of the upper jaw became torpid, and consequently painful,
by their reverse sympathy with the too violent actions of the inflamed
membranes of the loose tooth; and then by a secondary sympathy the
membranes about the ear and temple became torpid, and painful; and those of
the alveolar process of the upper jaw regained their natural quantity of
action, and ceased to be painful. A great many more nice and attentive
observations are wanted to elucidate these curious circumstances of
association, which will be found to be of the greatest importance in the
cure of many diseases, and lead us to the knowledge of fever.

SPECIES.

1. _Cutis frigida pransorum._ Chillness after dinner frequently attends
weak people, or those who have been exhausted by exercise; it arises from
the great expenditure of the sensorial power on the organs of digestion,
which are stimulated into violent action by the aliment; and the vessels of
the skin, which are associated with them, become in some measure torpid by
reverse sympathy; and a consequent chillness succeeds with less absorption
of atmospheric moisture. See the subsequent article.

2. _Pallor urinæ pransorum._ The paleness of urine after a full meal is an
instance of reverse association; where the secondary part of a train of
associate motions acts with less energy in consequence of the greater
exertions of the primary part. After dinner the absorbent vessels of the
stomach and intestines are stimulated into greater action, and drink up the
newly taken aliment; while those, which are spread in great number on the
neck of the bladder, absorb less of the aqueous part of the urine than
usual, which is therefore discharged in a more dilute state; and has been
termed crude by some medical writers, but it only indicates, that so great
a proportion of the sensorial power is expended on digestion and absorption
of the aliment, that other parts of the system act for a time with less
energy. See Class IV. I. 1. 6.

3. _Pallor urinæ a frigore cutaneo._ There is a temporary discharge of pale
water, and a diarrhoea, induced by exposing the skin to the cold air; as is
experienced by boys, who strip themselves before bathing. In this case the
mouths of the cutaneous lymphatics become torpid by the subduction of their
accustomed degree of heat, and those of the bladder and intestines become
torpid by direct sympathy; whence less of the thinner part of the urinary
secretion, and of the mucus of the intestines, is reabsorbed. See Sect.
XXIX. 4. 6. This effect of suddenly cooling the skin by the aspersion of
cold water has been used with success in costiveness, and has produced
evacuations, when other means have failed. When young infants are afflicted
with griping joined with costiveness, I have sometimes directed them to be
taken out of a warm bed, and carried about for a few minutes in a cool
room, with almost instant relief.

4. _Pallor ex ægritudine._ When sickness of stomach first occurs, a
paleness of the skin attends it; which is owing to the association or
catenation between the capillaries of the stomach and the cutaneous ones;
which at first act by direct sympathy. But in a short time there commences
an accumulation of the sensorial power of association in the cutaneous
capillaries during their state of inactivity, and then the skin begins to
glow, and sweats break out, from the increased action of the cutaneous
glands or capillaries, which is now in reverse sympathy with those of the
stomach. So in continued fevers, when the stomach is totally torpid, which
is known by the total aversion to solid food, the cutaneous capillaries are
by reverse sympathy in a perpetual state of increased activity, as appears
from the heat of the skin.

5. _Dyspnoea a balneo frigido._ The difficulty of breathing on going up to
the middle in cold water is owing to the irritative association or
catenation of the action of the extreme vessels of the lungs with those of
the skin. So that when the latter are rendered torpid or inactive by the
application of sudden cold, the former become inactive at the same time,
and retard the circulation of the blood through the lungs, for this
difficulty of breathing cannot be owing to the pressure of the water
impeding the circulation downwards, as it happens equally by a cold
shower-bath, and is soon conquered by habitual immersions. The capillaries
of the skin are rendered torpid by the subduction of the stimulus of heat,
and by the consequent diminution of the sensorial power of irritation. The
capillaries of the lungs are rendered torpid by the diminution of the
sensorial power of association, which is now excited in less quantity by
the lessened actions of the capillaries of the skin, with which they are
catenated. So that at this time both the cutaneous and pulmonary
capillaries are principally actuated, as far as they have any action, by
the stimulus of the blood. But in a short time the sensorial powers of
irritation, and of association, become accumulated, and very energetic
action of both these membranes succeed. Which thus resemble the cold and
hot fit of an intermittent fever.

6. _Dyspepsia a pedibus frigidis._ When the feet are long cold, as in
riding in cold and wet weather, some people are very liable to indigestion
and consequent heart-burn. The irritative motions of the stomach become
torpid, and do their office of digestion imperfectly, in consequence of
their association with the torpid motions of the vessels of the
extremities. Fear, as it produces paleness and torpidity of the skin,
frequently occasions temporary indigestion in consequence of this
association of the vessels of the skin with those of the stomach; as riding
in very bad roads will give flatulency and indigestion to timorous people.

A short exposure to cold air increases digestion, which is then owing to
the reverse sympathy between the capillary vessels of the skin, and of the
stomach. Hence when the body is exposed to cold air, within certain limits
of time and quantity of cold, a reverse sympathy of the stomach and the
skin first occurs, and afterwards a direct sympathy. In the former case the
expenditure of sensorial power by the skin being lessened, but not its
production in the brain; the second link of the association, viz. the
stomach, acquires a greater share of it. In the latter case, by the
continuation of the deficient stimulus of heat, the torpor becomes extended
to the brain itself, or to the trunks of the nerves; and universal
inactivity follows.

7. _Tussis a pedibus frigidis._ On standing with the feet in thawing snow,
many people are liable to incessant coughing. From the torpidity of the
absorbent vessels of the lungs, in consequence of their irritative
associations with those of the skin, they cease to absorb the saline part
of the secreted mucus; and a cough is thus induced by the irritation of
this saline secretion; which is similar to that from the nostrils in frosty
weather, but differs in respect to its immediate cause; the former being
from association with a distant part, and the latter from defect of the
stimulus of heat on the nostrils themselves. See Catarrhus frigidus, Class
I. 2. 3. 3.

8. _Tussis hepatica._ The cough of inebriates, which attends the
enlargement of the liver, or a chronical inflammation of its upper
membrane, is supposed to be produced by the inconvenience the diaphragm
suffers from the compression or heat of the liver. It differs however
essentially from that attending hepatitis, from its not being accompanied
with fever. And is perhaps rather owing to irritative association, or
reverse sympathy, between the lungs and the liver. As occurs in sheep,
which are liable to a perpetual dry cough, when the fleuk-worm is preying
on the substance of their livers. See Class II. 1. 1. 5.

M. M. From half a grain to a grain of opium twice a day. A drachm of
mercurial ointment rubbed on the region of the liver every night for eight
or ten times.

9. _Tussis arthritica._ Gout-cough. I have seen a cough, which twice
recurred at a few years distance in the same person, during his fits of the
gout, with such pertinacity and violence as to resist venesection, opiates,
bark, blisters, mucilages, and all the usual methods employed in coughs. It
was for a time supposed to be the hooping-cough, from the violence of the
action of coughing; it continued two or three weeks, the patient never
being able to sleep more than a few minutes at once during the whole time,
and being propped up in bed with pillows night and day.

As no fever attended this violent cough, and but little expectoration, and
that of a thin and frothy kind, I suspected the membrane of the lungs to be
rather torpid than inflamed, and that the saline part of the mucus not
being absorbed stimulated them into perpetual exertion. And lastly, that
though the lungs are not sensible to cold and heat, and probably therefore
less mobile; yet, as they are nevertheless liable to consent with the
torpor of cold feet, as described in Species 6 of this Genus, I suspected
this torpor of the lungs to succeed the gout in the feet, or to act a
vicarious part for them.

10. _Vertigo rotatoria._ In the vertigo from circumgyration the irritative
motions of vision are increased; which is evinced from the pleasure that
children receive on being rocked in a cradle, or by swinging on a rope. For
whenever sensation arises from the production of irritative motion with
less energy than natural, it is of the disagreeable kind, as from cold or
hunger; but when it arises from their production with greater energy than
natural, if it be confined within certain limits, it is of the pleasurable
kind, as by warmth or wine. With these increased irritative motions of
vision, I suppose those of the stomach are performed with greater energy by
direct sympathy; but when the rotatory motions, which produce this
agreeable vertigo, are continued too long, or are too violent, sickness of
the stomach follows; which is owing to the decreased action of that organ
from its reverse sympathy with the increased actions of the organ of
vision. For the expenditure of sensorial power by the organ of vision is
always very great, as appears by the size of the optic nerves; and is now
so much increased as to deprive the next link of association of its due
share. As mentioned in Article 6 of this Genus.

In the same manner the undulations of water, or the motions of a ship, at
first give pleasure by increasing the irritative motions belonging to the
sense of vision; but produce sickness at length by expending on one part of
the associated train of irritative actions too much of that sensorial
power, which usually served the whole of it; whence some other parts of the
train acquire too little of it, and perform their actions in consequence
too feebly, and thence become attended with disagreeable sensation.

It must also be observed, that when the irritative motions are stimulated
into unusual action, as in inebriation, they become succeeded by sensation,
either of the pleasurable or painful kind; and thus a new link is
introduced between the irritative motions thus excited, and those which
used to succeed them; whence the association is either dissevered or much
weakened, and thus the vomiting in sea-sickness occurs from the defect of
the power of association, rather than from the general deficiency of
sensorial power.

When a blind man turns round, or when one, who is not blind, revolves in
the dark, a vertigo is produced belonging to the sense of touch. A blind
man balances himself by the sense of touch, which being a less perfect
means of determining small quantities of deviation from the perpendicular,
occasions him to walk more carefully upright than those, who balance
themselves by vision. When he revolves, the irritative associations of the
muscular motions, which were used to preserve his perpendicularity, become
disordered by their new modes of successive exertion; and he begins to
fall. For his feet now touch the floor in manners or directions different
from those they have been accustomed to; and in consequence he judges less
perfectly of the situation of the parts of the floor in respect to that of
his own body, and thus loses his perpendicular attitude. This may be
illustrated by the curious experiment of crossing one finger over the next
to it, and feeling of a nut or bullet with the ends of them. When, if the
eyes be closed, the nut or bullet appears to be two, from the deception of
the sense of touch.

In this vertigo from gyration, both of the sense of sight, and of the sense
of touch, the primary link of the associated irritative motions is
increased in energy, and the secondary ones are increased at first by
direct sympathy; but after a time they become decreased by reverse sympathy
with the primary link, owing to the exhaustion of sensorial power in
general, or to the power of association in particular; because in the last
case, either pleasurable or painful sensation has been introduced between
the links of a train of irritative motions, and has dissevered, or much
enfeebled them.

Dr. Smyth, in his Essay on Swinging in Pulmonary Consumption, has observed,
that swinging makes the pulse slower. Dr. Ewart of Bath confirmed this
observation both on himself and on Col. Cathcart, who was then hectic, and
that even on shipboard, where some degree of vertigo might be supposed
previously to exist. Dr. Currie of Liverpool not only confirmed this
observation frequently on himself, when he was also phthisical, but found
that equitation had a similar effect on him, uniformly retarding his pulse.
This curious circumstance cannot arise from the general effect of exercise,
or fatigue, as in those cases the pulse becomes weaker and quicker; it must
therefore be ascribed to a degree of vertigo, which attends all those modes
of motion, which we are not perpetually accustomed to.

Dr. Currie has further observed, that "in cases of great debility the
voluntary muscular exertion requisite in a swing produces weariness, that
is, increases debility; and that in such instances he had frequently
noticed, that the diminution of the frequency of the pulse did not take
place, but the contrary." These circumstances may thus be accounted for.

The links of association, which are effected in the vertigo occasioned by
unusual motion, are the irritative motions of the sense of vision, those of
the stomach, and those of the heart and arteries. When the irritative ideas
of vision are exerted with greater energy at the beginning of vertigo, a
degree of sensation is excited, which is of the pleasurable kind, as above
mentioned; whence the associated trains of irritative motions of the
stomach, and heart, and arteries, act at first with greater energy, both by
direct sympathy; and by the additional sensorial power of sensation. Whence
the pulse of a consumptive patient becomes stronger and consequently
slower.

But if this vertigo becomes much greater in degree or duration, the first
link of this train of associated irritative motions expends too much of the
sensorial power, which was usually employed on the whole train; and the
motions of the stomach become in consequence exerted with less energy. This
appears, because in this degree of vertigo sickness supervenes, as in
sea-sickness, which has been shewn to be owing to less energetic action of
the stomach. And the motions of the heart and arteries then become weaker,
and in consequence more frequent, by their direct sympathy with the
lessened actions of the stomach. See Supplement, I. 12. and Class II. 1. 6.
7. The general weakness from fatigue is owing to a similar cause, that is,
to the too great expenditure of sensorial power in the increased actions of
one part of the system, and the consequent deficiency of it in other parts,
or in the whole.

The abatement of the heat of the skin in hectic fever by swinging, is not
only owing to the increased ventilation of cool air, but to the reverse
sympathy of the motions of the cutaneous capillaries with those of the
heart and arteries; which occurs in all fevers with arterial debility, and
a hot or dry skin. Hence during moderate swinging the action of the heart
and arteries becomes stronger and slower, and the action of the
capillaries, which was before too great, as appeared by the heat of the
skin, now is lessened by their reverse sympathy with that of the heart and
arteries. See Supplement, I. 8.

11. _Vertigo visualis._ Visual vertigo. The vertigo rotatoria described
above, was induced by the rotation or undulation of external objects, and
was attended with increased action of the primary link of the associated
motions belonging to vision, and with consequent pleasure. The vertigo
visualis is owing to less perfect vision, and is not accompanied with
pleasurable sensation. This frequently occurs in strokes of the palsy, and
is then succeeded by vomiting; it sometimes precedes epileptic fits, and
often attends those, whose sight begins to be impaired by age.

In this vertigo the irritative ideas of the apparent motions of objects are
less distinct, and on that account are not succeeded by their usual
irritative associations of motion; but excite our attention. Whence the
objects appear to librate or circulate according to the motions of our
heads, which is called dizziness; and we lose the means of balancing
ourselves, or preserving our perpendicularity, by vision. So that in this
vertigo the motions of the associated organs are decreased by direct
sympathy with their primary link of irritation; as in the preceding case of
sea-sickness they are decreased by reverse sympathy.

When vertigo affects people about fifty years of age, their sight has
generally been suddenly impaired; and from their less accurate vision they
do not soon enough perceive the apparent motions of objects; like a person
in a room, the walls of which are stained with the uniform figures of
lozenges, explained in Sect. XX. 1. This is generally ascribed to
indigestion; but it ceases spontaneously, as the patient acquires the habit
of balancing himself by less distinct objects.

A gentleman about 50 was seized with an uncommon degree of vertigo, so as
to fall on the ground, and not to be able to turn his head, as he sat up
either in his chair or in his bed, and this continued eight or ten weeks.
As he had many decayed teeth in his mouth, and the vertigo was preceded and
sometimes accompanied by pains on one side of his head, the disease of a
tooth was suspected to be the cause. And as his timidity was too great to
admit the extraction of those which were decayed; after the trial of
cupping repeatedly, fomentations on his head, repeated blisters, with
valerian, Peruvian bark, musk, opium, and variety of other medicines;
mercurials were used, both externally and internally, with design to
inflame the membranes of the teeth, and by that means to prevent the torpor
of the action of the membranes about the temple, and parietal bone; which
are catenated with the membranes of the teeth by irritative association,
but not by sensitive association. The event was, that as soon as the gums
became sore with a slight ptyalism, the pains about the head and vertigo
gradually diminished, and during the soreness of his gums entirely ceased;
but I believe recurred afterwards, though in less degree.

The idea of inflaming the membranes of the teeth to produce increased
sensation in them, and thus to prevent their irritative connection with
those of the cranium, was taken from the treatment of trismus, or locked
jaw, by endeavouring to inflame the injured tendon; which is said to
prevent or to remove the spasm of the muscles of the jaw. See Class III. 1.
1. 13. and 15.

M. M. Emetics. Blisters. Issues about the head. Extraction of decayed
teeth. Slight salivation. Sorbentia. Incitantia.

12. _Vertigo ebriosa._ Vertigo from intoxication is owing to the
association of the irritative ideas of vision with the irritative motions
of the stomach. Whence when these latter become much increased by the
immoderate stimulus of wine, the irritative motions of the retina are
produced with less energy by reverse sympathy, and become at the same time
succeeded by sensation in consequence of their decreased action. See Sect.
XXI. 3. and XXXV. 1. 2. So conversely when the irritative motions of vision
are increased by turning round, or by our unaccustomed agitation at sea,
those of the stomach become inverted by reverse sympathy, and are attended
in consequence with disagreeable sensation. Which decreased action of the
stomach is in consequence of the increased expenditure of the sensorial
power on the irritative ideas of vision, as explained in Vertigo rotatoria.

Whence though a certain quantity of vinous spirit stimulates the whole
system into increased action, and perhaps even increases the secretion of
sensorial power in the brain; yet as soon as any degree of vertigo is
produced, it is a proof, that by the too great expenditure of sensorial
power by the stomach, and its nearest associated motions, the more distant
ones, as those of vision, become imperfectly exerted. From hence may be
deduced the necessity of exhibiting wine in fevers with weak pulse in only
appropriated quantity; because if the least intoxication be induced, some
part of the system must act more feebly from the unnecessary expenditure of
sensorial power.

13. _Vertigo febriculosa._ Vertigo in fevers either proceeds from the
general deficiency of sensorial power belonging to the irritative
associations, or to a greater expenditure of it on some links of the trains
and tribes of associated irritative motions. There is however a slighter
vertigo attending all people, who have been long confined in bed, on their
first rising; owing to their having been so long unused to the apparent
motions of objects in their erect posture, or as they pass by them, that
they have lost in part the habit of balancing themselves by them.

14. _Vertigo cerebrosa._ Vertigo from injuries of the brain, either from
external violence, or which attend paralytic attacks, are owing to the
general deficiency of sensorial power. In these distressful situations the
vital motions, or those immediately necessary to life, claim their share of
sensorial power in the first place, otherwise the patient must die; and
those motions, which are less necessary, feel a deficiency of it, as these
of the organs of sense and muscles; which constitute vertigo; and lastly
the voluntary motions, which are still less immediately necessary to life,
are frequently partially destroyed, as in palsy; or totally, as in
apoplexy.

15. _Murmur aurium vertiginosum._ The vertiginous murmur in the ears, or
noise in the head, is compared to the undulations of the sound of bells, or
to the humming of bees. It frequently attends people about 60 years of age;
and like the visual vertigo described above is owing to our hearing less
perfectly from the gradual inirritability of the organ on the approach of
age; and the disagreeable sensation of noise attending it is owing to the
less energetic action of these irritative motions; which not being
sufficiently distinct to excite their usual associations become succeeded
by our attention, like the indistinct view of the apparent motions of
objects mentioned in vertigo visualis. This may be better understood from
considering the use, which blind men make of these irritative sounds, which
they have taught themselves to attend to, but which escape the notice of
others. The late blind Justice Fielding walked for the first time into my
room, when he once visited me, and after speaking a few words said, "this
room is about 22 feet long, 18 wide, and 12 high;" all which he guessed by
the ear with great accuracy. Now if these irritative sounds from the
partial loss of hearing do not correspond with the size or usual echoes of
the places, where we are; their catenation with other irritative ideas, as
those of vision, becomes dissevered or disturbed; and we attend to them in
consequence, which I think unravels this intricate circumstance of noises
being always heard in the head, when the sense of hearing begins to be
impaired, from whatever cause it occurs.

This ringing in the ears also attends the vertigo from intoxication; for
the irritative ideas of sound are then more weakly excited in consequence
of the deficiency of the sensorial power of association. As is known by
this also being attended with disagreeable sensation, and by its
accompanying other diseases of debility, as strokes on the head, fainting
fits, and paralytic seizures. For in this vertigo from intoxication so much
sensorial power in general is expended on the increased actions of the
stomach, and its nearest connections, as the capillaries of the skin; that
there is a deficiency for the purposes of the other irritative associations
of motions usually connected with it. This auditory vertigo attends both
the rotatory and the visual vertigo above mentioned; in the former it is
introduced by reverse sympathy, that is, by the diminution of sensorial
power; too great a quantity of it being expended on the increased
irritative motions of vision; in the latter it is produced either by the
same causes which produce the visual vertigo, or by direct sympathy with
it. See Sect. XX. 7.

M. M. Stimulate the internal ear by ether, or with essential oil diluted
with expressed oil, or with a solution of opium in wine, or in water. Or
with salt and water.

16. _Tactus, gustus, olfactius vertiginosi._ Vertiginous touch, taste, and
smell. In the vertigo of intoxication, when the patient lies down in bed,
it sometimes happens even in the dark, that the bed seems to librate under
him, and he is afraid of falling out of it. The same occurs to people, who
are sea-sick, even when they lie down in the dark. In these the irritative
motions of the nerves of touch, or irritative tangible ideas, are performed
with less energy, in one case by reverse sympathy with the stomach, in the
other by reverse sympathy with the nerves of vision, and in consequence
become attended with sensation, and produce the fear of falling by other
associations.

A vertigo of the sense of touch may be produced, if any one turns round for
a time with his eyes shut, and suddenly stops without opening them; for he
will for a time seem to be still going forwards; which is difficult to
explain. See the notes at the end of the first and second volume belonging
to Sect. XX. 6.

In the beginning of some fevers, along with incessant vomiting, the
patients complain of disagreeable tastes in their mouth, and disagreeable
odours; which are to be ascribed to the general debility of the great
trains and tribes of associated irritative motions, and to be explained
from their direct sympathy with the decreased action of a sick stomach; or
from the less secretion of sensorial power in the brain. These organs of
sense are constantly stimulated into action by the saliva or by the air;
hence, like the sense of hunger, when they are torpid from want of
stimulus, or from want of sensorial power, pain or disagreeable sensation
ensues, as of hunger, or faintness, or sickness in one case; and the ideas
of bad tastes or odours in the other. This accords with the laws of
causation, Sect. IV. 5.

17. _Pulsus mollis in vomitione._ The softness of the pulse in the act of
vomiting is caused by direct association between the heart and the stomach;
as explained in Sect. XXV. 17. A great slowness of the pulsation of the
heart sometimes attends sickness, and even with intermissions of it, as in
the exhibition of too great a dose of digitalis.

18. _Pulsus intermittens a ventriculo._ When the pulse first begins to
intermit, it is common for the patient to bring up a little air from his
stomach; which if he accomplishes before the intermission occurs, always
prevents it; whence that this debility of the heart is owing to the direct
association of its motions with those of the stomach is well evinced. See
Sect. XXV. 17.

I this morning saw Mr. ----, who has long had at times an unequal pulse,
with indigestion and flatulency, and occasional asthma; he was seized two
days ago with diarrhoea, and this morning with sickness, and his pulse was
every way unequal. After an emetic his pulse still continued very
intermittent and unequal. He then took some breakfast of toast and butter,
and tea, and to my great surprise his pulse became immediately perfectly
regular, about 100 in a minute, and not weak, by this stimulus on his
stomach.

A person, who for many years had had a frequent intermission of his pulse,
and occasional palpitation of his heart, was relieved from them both for a
time by taking about four drops of a saturated solution of arsenic three or
four times a day for three or four days. As this intermission of the pulse
is occasioned by the direct association of the motions of the heart with
those of the stomach, the indication of cure must be to strengthen the
action of the stomach by the bark. Spice. Moderate quantities of wine. A
blister. Half a grain of opium twice a day. Solution of arsenic?

19. _Febris inirritativa._ Inirritative fever described in Class I. 2. 1.
1. belongs to this place, as it consists of disordered trains and tribes of
associated irritative motions, with lessened actions of the associated
organs. In this fever the pulsations of the heart and arteries are weakened
or lessened, not only in the cold paroxysm, as in the irritative fever, but
also in the hot paroxysm. The capillary arteries or glands have their
actions nevertheless increased after the first cold fit, as appears by the
greater production of heat, and the glow of arterial blood, in the
cutaneous vessels; and lastly, the action of the stomach is much impaired
or destroyed, as appears by the total want of appetite to solid food.
Whence it would seem, that the torpid motions of the stomach, whatever may
occasion them, are a very frequent cause of continued fever with weak
pulse; and that these torpid motions of the stomach do not sufficiently
excite the sensorial power of association, which contributes in health to
actuate the heart and arteries along with the irritation produced by the
stimulus of the blood; and hence the actions of these organs are weaker.
And lastly, that the accumulation of the sensorial power of association,
which ought to be expended on the motions of the heart and arteries,
becomes now exerted on the cutaneous and pulmonary capillaries. See
Supplement I. 8. and Sect. XXXV. 1. 1. and XXXIII. 2. 10.

I have dwelt longer on the vertiginous diseases in this genus, both because
of their great intricacy, and because they seem to open a road to the
knowledge of fever, which consists of associated trains and tribes of
irritative or sensitive motions, which are sometimes mixed with the
vertiginous ones, and sometimes separate from them.

       *       *       *       *       *

ORDO II.

_Decreased Associate Motions._

GENUS II.

_Catenated with Sensitive Motions._

In this genus the sensorial power of association is exerted with less
energy, and thence the actions produced by it are less than natural; and
pain is produced in consequence, according to the fifth law of animal
causation, Sect. IV. This pain is generally attended with coldness of the
affected part, and is seldom succeeded by inflammation of it. This
decreased action of the secondary link of the associated motions, belonging
to this genus, is owing to the previous exhaustion of sensorial power
either in the increased actions of the primary link of the associated
motions, or by the pain which attends them; both which are frequently the
consequence of the stimulus of something external to the affected fibres.

As pain is produced either by excess or defect of the natural exertions of
the fibres, it is not, considered separately, a criterion of the presence
of either. In the associations belonging to this genus the sensation of
pain or pleasure produces or attends the primary link of the associated
motions, and very often gives name to the disease.

When great pain exists without causing any fibrous motions, I conjecture
that it contributes to exhaust or expend the general quantity of sensorial
power; because people are fatigued by enduring pain, till at length they
sleep. Which is contrary to what I had perhaps erroneously supposed in
Sect. XXXV. 2. 3. If it causes fibrous motions, it then takes the name of
sensation, according to the definition of sensation in Sect. II. 2. 9.; and
increased fibrous action or inflammation is the consequence. This
circumstance of the general exhaustion of sensorial power by the existence
of pain will assist in explaining many of the diseases of this genus.

Many of the canals of the body, as the urethra, the bile-duct, the throat,
have the motions of their two extremities associated by having been
accustomed to feel pleasurable or painful sensations at the same time or in
succession. This is termed sensitive association, though those painful or
pleasurable sensations do not cause the motions, but only attend them; and
are thus perhaps, strictly speaking, only catenated with them.

SPECIES.

1. _Torpor genæ a dolore dentis._ In tooth-ach there is generally a
coldness of the cheek, which is sensible to the hand, and is attended in
some degree with the pain of cold. The cheek and tooth have frequently been
engaged in pleasurable action at the same time during the masticating of
our food; whence they have acquired sensitive associations. The torpor of
the cheek may have for its cause the too great expenditure of sensorial
power by the painful sensation of the membranes of the diseased tooth;
whence the membranes of the cheek associated with those of the alveolar
process are deprived of their natural share of it, and become torpid; thus
they produce less secretions, and less heat, and the pain of cold is the
consequence. This torpor of the vessels of the cheek cannot be produced by
the activity of the sensorial power of sensation; for then they would act
more violently than natural, or become inflamed. And though the pain by
exhausting so much sensorial power may be a remote cause, it is the defeat
of the power of association, which is the immediate cause of the torpor of
the cheek.

After some hours this pain occasioned by the torpor of the vessels of the
cheek either gradually ceases along with the pain of the diseased tooth;
or, by the accumulation of sensorial power during their state of torpor,
the capillaries of the cheek act with greater violence, and produce more
secretions, and heat, and consequent tumour, and inflammation. In this
state the pain of the diseased tooth ceases; as the sensorial power of
sensation is now expended on the inflamed vessels of the cheek. It is
probable that most other internal membranous inflammations begin in a
similar manner; whence there may seem to be a double kind of sensitive
association; first, with decreased action of the associated organ, and then
with increased action of it; but the latter is in this case simply the
consequence of the former; that is, the tumor or inflammation of the cheek
is in consequence of its previous quiescence or torpor.

2. _Stranguria a dolore vesicæ._ The strangury, which has its origin from
pain at the neck of the bladder, consists of a pain in the external
extremity of the urethra or of the glans penis of men, and probably in the
external termination of the urethra or of the clitoris of women; and is
owing to the sympathy of these with some distant parts, generally with the
other end of the urethra; an endeavour and difficulty of making water
attends this pain.

Its remote cause is from the internal or external use of cantharides, which
stimulate the neck of the bladder; or from a stone, which whenever it is
pushed into the neck of the bladder, gives this pain of strangury, but not
at other times; and hence it is felt most severely in this case after
having made water.

The sensations or sensitive motions of the glans penis, and of the
sphincter of the bladder, have been accustomed to exist together during the
discharge of the urine; and hence the two ends of the urethra sympathize by
association. When there is a stone at the neck of the bladder, which is not
so large or rough as to inflame the part, the sphincter of the bladder
becomes stimulated into pain; but as the glans penis is for the purposes of
copulation more sensitive than the sphincter of the bladder, as soon as it
becomes affected with pain by the association above mentioned, the
sensation at the neck of the bladder ceases; and then the pain of the glans
penis would seem to be associated with the irritative motions only of the
sphincter of the bladder, and not with the sensitive ones of it. But a
circumstance similar to this occurs in epileptic fits, which at first are
induced by disagreeable sensation, and afterwards seem to occur without
previous pain, from the suddenness in which they follow and relieve the
pain, which occasioned them. From this analogy I imagine the pain of the
glans penis is associated with the pain of the sphincter of the bladder;
but that _as soon as the greater pain in a more sensible part is produced;
the lesser one, which occasioned it, ceases_; and that this is one of the
laws of sensitive association. See Sect. XXXV. 2. 1.

A young man had by an accident swallowed a large spoonful or more of
tincture of cantharides; as soon as he began to feel the pain of strangury,
he was advised to drink large quantities of warmish water; to which, as
soon as it could be got, some gum arabic was added. In an hour or two he
drank by intervals of a few minutes about two gallons of water, and
discharged his urine every four or five minutes. A little blood was voided
towards the end, but he suffered no ill consequence.

M. M. Warm water internally. Clysters of warm water. Fomentation. Opium.
Solution of fixed alkali supersaturated with carbonic acid. A bougie may be
used to push back a stone into the bladder. See Class I. 1. 3. 10.

3. _Stranguria convulsiva._ The convulsive strangury, like that before
described, is probably occasioned by the torpor or defective action of the
painful part in consequence of the too great expenditure of sensorial power
on the primary link of the associated motions, as no heat or inflammation
attends this violent pain. This kind of strangury recurs by stated periods,
and sometimes arises to so great a degree, that convulsion or temporary
madness terminates each period of it. It affects women oftener than men, is
attended with cold extremities without fever, and is distinguished from the
stone of the bladder by the regularity of its periods, and by the pain
being not increased after making water.

On introducing the catheter sometimes part of the urine will come away and
not the whole, which is difficult to explain; but may arise from the
weakness of the muscular fibres of the bladder; which are not liable
suddenly to contract themselves so far as to exclude the whole of the
urine. In some old people, who have experienced a long retention of urine,
the bladder never regains the power of completely emptying itself; and many
who are beginning to be weak from age can make water a second time, a few
minutes after they supposed they had emptied the bladder.

I have believed this pain to originate from sympathy with some distant
part, as from ascarides in the rectum, or from piles in women; or from
caruncles in the urethra about the caput gallinaginis in men; and that the
pain has been in the glans or clitoris by reverse sympathy of these more
sensible parts with those above mentioned.

M. M. Venesection. Opium in large quantities. Warm bath. Balsams. Bark.
Tincture of cantharides. Bougie, and the treatment for hæmorrhoids. Leeches
applied to the sphincter ani. Aerated alcaline water. Soap and sal soda.
Opium in clysters given an hour before the expected return. Smoke of
tobacco in clysters. Arsenic?

4. _Dolor termini intestinalis ductûs choledochi._ Pain at the intestinal
end of the gall-duct. When a gall-stone is protruded from the gall-bladder
a little way into the end of the gall-duct, the pain is felt at the other
end of the gall-duct, which terminates in the duodenum. For the actions of
the two terminations of this canal are associated together from the same
streams of bile passing through them in succession, exactly as the two
terminations of the urethra have their actions associated, as described in
Species 2 and 3 of this genus. But as the intestinal termination of the
bile-duct is made more sensible for the purpose of bringing down more bile,
when it is stimulated by new supplies of food from the stomach, it falls
into violent pain from association; and then the pain on the region of the
gall-bladder ceases, exactly as above explained in the account of the pain
of the glans penis from a stone in the sphincter of the bladder.

The common bile-duct opens into the intestine exactly at what is called the
pit of the stomach; and hence it has sometimes happened, that this pain
from association with the sensation of a gall-stone at the other end of the
bile-duct has been mistaken for a pain of the stomach.

For the method of cure see Class I. 1. 3. 8. to which should be added the
use of strong electric shocks passed through the bile-duct from the pit of
the stomach to the back, and from one side to the other. A case of the good
effect of electricity in the jaundice is related in Sect. XXX. 2. And
another case, where it promoted the passage of a painful gall-stone, is
described by Dr. Hall, experienced on himself. Trans. of the College at
Philadelphia, Vol. I. p. 192.

Half a pint of warm water two or three times a day is much recommended to
dilute the inspissated bile.

5. _Dolor pharyngis ab acido gastrico._ The two ends of the throat
sympathize by sensitive association in the same manner as the other canals
above mentioned, namely, the urethra and the bile-duct; hence when too
great acidity of undigested aliment, or the carbonic acid air, which
escapes in fermentation, stimulates the cardia ventriculi, or lower end of
the gula, into pain; the pharinx, or upper end of it, is affected with
greater pain, or a disagreeable sensation of heat.

6. _Pruritus narium a vermibus._ The itching of the nose from worms in the
intestines is another curious instance of the sensitive associations of the
motions of membranes; especially of those which constitute the canals of
the body. Previous to the deglutition of agreeable food, as milk in our
earliest infancy, an agreeable odour affects the membrane, which lines the
nostrils; and hence an association seems to take place between the
agreeable sensations produced by food in the stomach and bowels, and the
agreeable sensations of the nostrils. The existence of ascarides in the
rectum I believe produces this itching of the nostrils more than the worms
in other parts of the intestines; as we have already seen, that the
terminations of canals sympathize more than their other parts, as in the
urethra and gall-ducts. See Class I. 1. 5. 9. IV. 1. 2. 9.

7. _Cephalæa._ Head-ach. In cold fits of the ague, the head-ach arises from
consent with some torpid viscus, like the pain of the loins. After
drunkenness the head-ach is very common, owing to direct sympathy of the
membranes of the head with those of the stomach; which is become torpid
after the too violent stimulus of the preceding intoxication; and is hence
removeable by spirit of wine, or opium, exhibited in smaller quantities. In
some constitutions these head-achs are induced, when the feet are exposed
to much external cold; in this case the feet should be covered with oiled
silk, which prevents the evaporation of the perspirable matter, and thence
diminishes one cause of external cold.

M. M. Valerian in powder two drams three or four times a day is
recommended. The bark. Chalybeates. A grain of opium twice a day for a long
time. From five to ten drops of the saturated solution of arsenic two or
three times a day. See Class I. 2. 4. 11. A lady once assured me, that when
her head-ach was coming on, she drank three pints (pounds) of hot water, as
hastily as she could; which prevented the progress of the disease. A
solution of arsenic is recommended by Dr. Fowler of York. Very strong
errhines are said sometimes to cure head-achs taken at the times the pain
recurs, till a few drops of blood issue from the nostrils. As one grain of
turpeth mineral (vitriolic calx of mercury) mixed with ten grains of fine
sugar. Euphorbium or cayan pepper mixed with sugar, and used with caution
as an errhine. See the M. M. of the next Species.

8. _Hemicrania._ Pain on one side of the head. This disease is attended
with cold skin, and hence whatever may be the remote cause, the immediate
one seems to be want of stimulus, either of heat or distention, or of some
other unknown stimulus in the painful part; or in those, with which it is
associated. The membranes in their natural state are only irritable by
distention; in their diseased state, they are sensible like muscular
fibres. Hence a diseased tooth may render the neighbouring membranes
sensible, and is frequently the cause of this disease.

Sometimes the stomach is torpid along with the pained membrane of the head;
and then sickness and inappetency attends either as a cause or consequence.
The natural cure of hemicrania is the accumulation of sensorial power
during the rest or sickness of the patient. Mrs. ---- is frequently liable
to hemicrania with sickness, which is probably owing to a diseased tooth;
the paroxysm occurs irregularly, but always after some previous fatigue, or
other cause of debility. She lies in bed, sick, and without taking any
solid food, and very little of fluids, and those of the aqueous kind, and,
after about 48 or 50 hours, rises free from complaint. Similar to this is
the recovery from cold paroxysms of fever, from the torpor occasioned by
fear, and from syncope; which are all owing to the accumulation of
sensorial power during the inactivity of the system. Hence it appears,
that, though when the sensorial power of volition is much exhausted by
fatigue, it can be restored by eight or ten hours of sleep; yet, when the
sensorial power of irritation is exhausted by fatigue, that it requires two
whole solar or lunar days of rest, before it can be restored.

The late Dr. Monro asserted in his lectures, that he cured the hemicrania,
or megrim, by a strong vomit, and a brisk purge immediately after it. This
method succeeds best if opium and the bark are given in due quantity after
the operation of the cathartic; and with still more certainty, if bleeding
in small quantity is premised, where the pulse will admit of it. See Sect.
XXXV. 2. 1.

The pain generally affects one eye, and spreads a little way on that side
of the nose, and may sometimes be relieved by pressing or cutting the
nerve, where it passes into the bone of the orbit above the eye. When it
affects a small defined part on the parietal bone on one side, it is
generally termed Clavus hystericus, and is always I believe owing to a
diseased dens molaris. The tendons of the muscles, which serve the office
of mastication, have been extended into pain at the same time, that the
membranous coverings of the roots of the teeth have been compressed into
pain, during the biting or mastication of hard bodies. Hence when the
membranes, which cover the roots of the teeth, become affected with pain by
a beginning decay, or perhaps by the torpor or coldness of the dying part
of the tooth, the tendons and membranous fascia of the muscles about the
same side of the head become affected with violent pain by their sensitive
associations: and as soon as this associated pain takes place, the pain of
the tooth entirely ceases, as explained in the second species of this
genus.

A remarkable circumstance attends this kind of hemicrania, viz. that it
recurs by periods like those of intermittent fevers, as explained in the
Section on Catenation of Motions; these periods sometimes correspond with
alternate lunar or solar days like tertian agues, and that even when a
decaying tooth is evidently the cause; which has been evinced by the cure
of the disease by extracting the tooth. At other times they observe the
monthly lunations, and seem to be induced by the debility, which attends
menstruation.

The dens sapientiæ, or last tooth of the upper jaw, frequently decays
first, and gives hemicrania over the eye on the same side. The first or
second grinder in the under-jaw is liable to give violent pain about the
middle of the parietal bone, or side of the head, on the same side, which
is generally called the Clavus hystericus, of which an instructive case is
related in Sect. XXXV. 2. 1.

M. M. Detect and extract the diseased tooth. Cut the affected nerve, or
stimulate the diseased membrane by acu-puncture. Venesection to six ounces
by the lancet or by leeches. A strong emetic and a subsequent cathartic;
and then an opiate and the bark. Pass small electric shocks through the
pained membrane, and through the teeth on the same side. Apply vitriolic
ether externally, and a grain of opium with camphor internally, to the
cheek on the affected side, where a diseased tooth may be suspected. Foment
the head with warm vinegar. Drink two large spoonfuls of vinegar. Stimulate
the gums of the suspected teeth by oil of cloves, by opium. See Class I. 1.
4. 4. Snuff volatile spirit of vinegar up the nostrils. Lastly, in
permanent head-achs, as in permanent vertigo, I have seen good effect by
the use of mercurial ointment rubbed on the shaved head or about the
throat, till a mild salivation commences, which by inflaming the membranes
of the teeth may prevent their irritative sympathy with those of the
cranium. Thus by inflaming the tendon, which is the cause of locked jaw,
and probably by inflaming the wound, which is the cause of hydrophobia,
those diseases may be cured, by disuniting the irritative sympathy between
those parts, which may not possess any sensitive sympathy. This idea is
well worth our attention.

_Otalgia._ Ear-ach is another disease occasioned by the sympathy of the
membranes of the ear with those which invest or surround a decaying tooth,
as I have had frequent reason to believe; and is frequently relieved by
filling the ear with tincture of opium. See Class I. 2. 4.

9. _Dolor humeri in hepatitide._ In the efforts of excluding the fæces and
urine the muscles of the shoulders are exerted to compress the air in the
lungs, that the diaphragm may be pressed down. Hence the distention of the
tendons or fibres of these muscles is associated with the distention of the
tendons or fibres of the diaphragm; and when the latter are pained by the
enlargement or heat of the inflamed liver, the former sympathize with them.
Sometimes but one shoulder is affected, sometimes both; it is probable that
many other pains, which are termed rheumatic, have a similar origin, viz.
from sensitive associations.

As no inflammation is produced in consequence of this pain of the shoulder,
it seems to be owing to inaction of the membranous part from defect of the
sensorial power of association, of which the primary link is the inflamed
membrane of the liver; which now expends so much of the sensorial power in
general by its increased action, that the membranes about the shoulder,
which are links of association with it, become deprived of their usual
share, and consequently fall into torpor.

10. _Torpor pedum in eruptione variolarum._ At the commencement of the
eruption of the small-pox, when the face and breast of children are very
hot, their extremities are frequently cold. This I ascribe to sensitive
association between the different parts of the skin; whence when a part
acts too violently, the other part is liable to act too weakly; and the
skin of the face being affected first in the eruption of the small-pox, the
skin of the feet becomes cold in consequence by reverse sympathy.

M. M. Cover the feet with flannel, and expose the face and bosom to cool
air, which in a very short time both warms the feet and cools the face; and
hence what is erroneously called a rash, but which is probably a too hasty
eruption of the small-pox, disappears; and afterwards fewer and more
distinct eruptions of the small-pox supervene.

11. _Testium dolor nephriticus._ The pain and retraction of the testicle on
the same side, when there is a stone in the ureter, is to be ascribed to
sensitive association; whether the connecting cause be a branch of the same
nerve, or from membranes, which have been frequently affected at the same
time.

12. _Dolor digiti minimi sympatheticus._ When any one accidentally strikes
his elbow against any hard body, a tingling pain runs down to the little
finger end. This is owing to sensitive association of motions by means of
the same branch of a nerve, as in hemicrania from a decaying tooth the pain
is owing to the sensitive association of tendons or membranes.

13. _Dolor brachii in hydrope pectoris._ The pain in the left arm which
attends some dropsies of the chest, is explained in Sect. XXIX. 5. 2. 10.
which resembles the pain of the little finger from a percussion of the
nerve at the elbow in the preceding article. A numbness of this kind is
produced over the whole leg, when the crural nerve is much compressed by
sitting for a time with one leg crossed over the other.

Mr. ----, about sixty, had for two years been affected with difficulty of
respiration on any exertion, with pain about the sternum, and of his left
arm; which last was more considerable than is usual in dropsy of the chest;
some months ago the pain of his arm, after walking a mile or two, became
excessive, with coldness and numbness; and on the next day the back of the
hand, and a part of the arm swelled, and became inflamed, which relieved
the pain; and was taken for the gout, and continued several days. He after
some months became dropsical both in respect to his chest and limbs, and
was six or seven times perfectly relieved by one dram of saturated tincture
of digitalis, taken two or three times a day for a few days in a glass of
peppermint water. He afterwards breathed oxygen gas undiluted, in the
quantity of six or eight gallons a day for three or four weeks without any
effect, and sunk at length from general debility.

In this instructive case I imagine the pressure or stimulus of one part of
the nerve within the chest caused the other part, which serves the arm, to
become torpid, and consequently cold by sympathy; and that the inflammation
was the consequence of the previous torpor and coldness of the arm, in the
same manner as the swelling and inflammation of the cheek in tooth-ach, in
the first species of this genus; and that many rheumatic inflammations are
thus produced by sympathy with some distant part.

14. _Diarrhoea a dentitione._ The diarrhoea, which frequently attends
dentition, is the consequence of indigestion; the aliment acquires chemical
changes, and by its acidity acts as a cathartic; and changes the yellow
bile into green, which is evacuated along with indigested parts of the
coagulum of milk. The indigestion is owing to the torpor of the stomach and
intestines caused by their association with the membranes of the gums,
which are now stimulated into great exertion with pain; both which
contribute to expend the general quantity of sensorial power, which belongs
to this membranous association; and thus the stomach and intestines act
with less than their natural energy. This is generally esteemed a
favourable symptom in difficult dentition, as the pain of the alveolar
membranes exhausts the sensorial power without producing convulsions for
its relief. See Class I. 1. 4. 5. And the diarrhoea ceases, as the tooth
advances.

       *       *       *       *       *

ORDO II.

_Decreased Associate Motions._

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

1. _Titubatio linguæ._ Impediment of speech is owing to the associations of
the motions of the organs of speech being interrupted or dissevered by
ill-employed sensation or sensitive motions, as by awe, bashfulness,
ambition of shining, or fear of not succeeding, and the person uses
voluntary efforts in vain to regain the broken associations, as explained
in Sect. XVII. 1. 10. and XVII. 2. 10.

The broken association is generally between the first consonant and the
succeeding vowel; as in endeavouring to pronounce the word parable, the p
is voluntarily repeated again and again, but the remainder of the word does
not follow, because the association between it and the next vowel is
dissevered.

M. M. The art of curing this defect is to cause the stammerer to repeat the
word, which he finds difficult to speak, eight or ten times without the
initial letter, in a strong voice, or with an aspirate before it, as
arable, or harable; and at length to speak it very softly with the initial
letter p, parable. This should be practised for weeks or months upon every
word, which the stammerer hesitates in pronouncing. To this should be added
much commerce with mankind, in order to acquire a carelessness about the
opinions of others.

2. _Chorea St. Viti._ In the St. Vitus's dance the patient can at any time
lie still in bed, which shews the motions not to be convulsive; and he can
at different times voluntarily exert every muscle of his body; which
evinces, that they are not paralytic. In this disease the principal muscle
in any designed motion obeys the will; but those muscles, whose motions
were associated with the principal one, do not act; as their association is
dissevered, and thus the arm or leg is drawn outward, or inward, or
backward, instead of upward or forward, with various gesticulations exactly
resembling the impediment of speech.

This disease is frequently left after the itch has been too hastily cured.
See Convulsio dolorifica, Class III. 1. 1. 6. A girl about eighteen, after
wearing a mercurial girdle to cure the itch, acquired the Chorea St. Viti
in so universal a manner, that her speech became affected as well as her
limbs; and there was evidently a disunion of the common trains of ideas; as
the itch was still among the younger children of the family, she was
advised to take her sister as a bedfellow, and thus received the itch
again; and the dance of St. Vitus gradually ceased. See Class II. 1. 5. 6.

M. M. Give the patient the itch again. Calomel a grain every night, or
sublimate a quarter of a grain twice a day for a fortnight. Steel. Bark.
Warm-bath. Cold-bath. Opium. Venesection once at the beginning of the
disease. Electricity. Perpetual slow and repeated efforts to move each limb
in the designed direction, as in the titubatio linguæ above described.

3. _Risus._ Laughter is a perpetual interruption of voluntary exertion by
the interposition of pleasurable sensation; which not being checked by any
important consequences rises into pain, and requires to be relieved or
moderated by the frequent repetition of voluntary exertion. See Sect.
XXXIV. 1. 4. and Class III. 1. 1. 4. and IV. 1. 3. 3.

4. _Tremor ex irâ._ The trembling of the limbs from anger. The interruption
of the voluntary associations of motions by anger, originates from too
great a part of the sensorial power being exerted on the organs of sense;
whence the muscles, which ought to support the body upright, are deprived
of their due quantity, and tremble from debility. See Class III. 2. 1. 1.

5. _Rubor ex irâ._ Redness from anger. Anger is an excess of aversion, that
is of voluntarity not yet employed. It is excited by the pain of offended
pride; when it is employed it becomes outrage, cruelty, insanity. The
cutaneous capillaries, especially those of the face, are more mobile, that
is, more easily excited into increased action, or more easily become
torpid, from less variation of sensorial power, than any other parts of the
system, which is owing to their being perpetually subject to the
vicissitudes of heat and cold, and of extension and corrugation. Hence,
when an excess of voluntarity exists without being immediately expended in
the actions of the large muscles, the capillary arteries and glands acquire
more energetic action, and a flushed skin is produced, with increased
secretion of perspirable matter, and consequent heat, owing to the pause or
interruption of voluntary action; and thus the actions of these cutaneous
vessels become associated between the irascent ideas and irascent muscular
actions, which are thus for a time interrupted.

6. _Rubor criminati._ The blushing of accused people, whether guilty or
not, appears to be owing to circumstances similar to that of anger; for in
these situations there is always a sudden voluntarity, or wish, of clearing
their characters arises in the mind of the accused person; which, before an
opportunity is given for it to be expended on the large muscles, influences
the capillary arteries and glands, as in the preceding article. Whence the
increased actions of the capillaries, and the consequent redness and heat,
become exerted between the voluntary ideas of self-defence, and the
muscular actions necessary for that purpose; which last are thus for a time
interrupted or delayed.

Even in the blush of modesty or bashfulness there is a self-condemnation
for some supposed defect or indecorum, and a sudden voluntarity, or wish,
of self-defence; which not being expended in actions of the larger muscles
excites the capillaries into action; which in these subjects are more
mobile than in others.

The blush of young girls on coming into an assembly room, where they expect
their dress, and steps, and manner to be examined, as in dancing a minuet,
may have another origin; and may be considered as a hot fit of returning
confidence, after a previous cold fit of fear.

7. _Tarditas paralytica._ By a stroke of the palsy or apoplexy it
frequently happens, that those ideas, which were associated in trains,
whose first link was a voluntary idea, have their connection dissevered;
and the patient is under the necessity by repeated efforts slowly to renew
their associations. In this situation those words, which have the fewest
other words associated with them, as the proper names of persons or places,
are the most difficult to recollect. And in those efforts of recollection
the word opposite to the word required is often produced, as hot for cold,
winter for summer, which is owing to our associating our ideas of things by
their opposites as well as by their similitudes, and in some instances
perhaps more frequently, or more forcibly. Other paralytic patients are
liable to give wrong names to external objects, as using the word pigs for
sheep, or cows for horses; in this case the association between the idea of
the animal and the name of it is dissevered; but the idea of the class or
genus of the thing remains; and he takes a name from the first of the
species, which presents itself, and sometimes can correct himself, till he
finds the true one.

8. _Tarditas senilis._ Slowness of age. The difficulty of associating ideas
increases with our age; as may be observed from old people forgetting the
business of the last hour, unless they impress it strongly, or by frequent
repetition, though they can well recollect the transactions of their youth.
I saw an elderly man, who could reason with great clearness and precision
and in accurate language on subjects, which he had been accustomed to think
upon; and yet did not know, that he had rang the bell by his fire-side in
one minute afterwards; nor could then recollect the object he had wanted,
when his servant came.

Similar to this is the difficulty which old people experience in learning
new bodily movements, that is, in associating new muscular actions, as in
learning a new trade or manufactury. The trains of movements, which obey
volition, are the last which we acquire; and the first, which are
disassociated.

       *       *       *       *       *

ORDO II.

_Decreased Associate Motions._

GENUS IV.

_Catenated with External Influences._

As the diseases, which obey solar or lunar periods, commence with torpor or
inactivity, such as the cold paroxysms of fevers, the torpor and consequent
pain of hemicrania, and the pains which precede the fits of epilepsy and
convulsion, it would seem, that these diseases are more generally owing to
the diminution than to the excess of solar or lunar gravitation; as the
diseases, which originate from the influence of the matter of heat, are
much more generally in this country produced by the defect than by the
excess of that fluid.

The periodic returns of so many diseases coincide with the diurnal,
monthly, and annual rounds of time; that any one, who would deny the
influence of the sun and moon on the periods of quotidian, tertian, and
quartan fevers, must deny their effect on the tides, and on the seasons. It
has generally been believed, that solar and lunar effect was exerted on the
blood; which was thus rendered more or less stimulant to the system, as
described in Sect. XXXII. 6. But as the fluid matter of gravitation
permeates and covers all things, like the fluid matter of heat; I am
induced to believe, that gravitation acts in its medium state rather as a
causa sine quâ non of animal motion, like heat; which may disorder the
system chemically or mechanically, when it is diminished; but may
nevertheless stimulate it, when increased, into animal exertion.

Without heat and motion, which some philosophers still believe to be the
same thing, as they so perpetually appear together, the particles of matter
would attract and move towards each other, and the whole universe freeze or
coalesce into one solid mass. These therefore counteract the gravitation of
bodies to one center; and not only prevent the planets from falling into
the sun, but become either the efficient causes of vegetable and animal
life, or the causes without which life cannot exist; as by their means the
component particles of matter are enabled to slide over each other with all
the various degrees of fluidity and repulsion.

As the attraction of the moon countervails or diminishes the terrene
gravitation of bodies on the surface of the earth; a tide rises on that
side of the earth, which is turned towards the moon; and follows it, as the
earth revolves. Another tide is raised at the same time on the opposite
side of the revolving earth; which is owing to the greater centrifugal
motion of that side of the earth, which counteracts the gravitation of
bodies near its surface. For the earth and moon may be considered as two
cannon balls of different sizes held together by a chain, and revolving
once a month round a common center of gravity between them, near the
earth's surface; at the same time that they perform their annual orbits
round the sun. Whence the centrifugal force of that side of the earth,
which is farthest from this center of motion, round which the earth and
moon monthly revolve, is considerably greater, than the centrifugal force
of that side of the earth, which is nearest it; to which should be added,
that this centrifugal force not only contributes to diminish the terrene
gravitation of bodies on the earth's surface on that side furthest from
this center of motion, but also to increase it on that side, which is
nearest it.

Another circumstance, which tends to raise the tide on the part of the
earth's surface, which is most distant from the moon, is, that the
attraction of the moon is less on that part of the ocean, than it is on the
other parts of the earth. Thus the moon may be supposed to attract the
water on the side of the earth nearest it with a power equal to three; and
to attract the central parts of the earth with a power equal to two; and
the water on the part of the earth most distant from the moon with a power
only equal to one. Hence on the side of the earth most distant from the
moon, the moon's attraction is less, and the centrifugal force round their
common center of motion is greater; both which contribute to raise the
tides on that side of the earth. On the side of the earth nearest the moon,
the moon's attraction is so much greater as to raise the tides; though the
centrifugal force of the surface of the earth round their common center of
motion in some degree opposes this effect.

On these accounts, when the moon is in the zenith or nadir, the gravitation
of bodies on the earth's surface will be greatest at the two opposite
quadratures; that is, the greatest gravitation of bodies on the earth's
surface towards her center during the lunar day is about six hours and an
half after the southing, or after the northing of the moon.

Circumstances similar to these, but in a less degree, must occur in respect
to the solar influence on terrestrial bodies; that is, there must be a
diminution of the gravity of bodies, near the earth's surface at noon, when
the sun is over them; and also at midnight from the greater centrifugal
force of that side of the earth, which is most distant from the center,
round which the earth moves in her annual orbit, than on the side nearest
that center. Whence it likewise follows, that the gravitation of bodies
towards the earth is greatest about six hours after noon, and after
midnight.

Now when the sun and moon have their united gravitation on the same side of
the earth, as at the new moon; or when the solar attraction coincides with
the greater centrifugal motion of that side of the earth, which is furthest
distant from the moon, as at the full moon; and when this happens about
noon or midnight, the gravitation of terrene bodies towards the earth will
be greater about six hours after noon, and after midnight, than at any
other part of the lunar period; because the attraction of both these
luminaries is then exerted on those sides of the earth over which they
hang, which at other times of the month are more or less exerted on other
parts of it.

Lastly, as heat and motion counteract the gravitation of the particles of
bodies to each other, and hence become either the efficient causes of
vegetable and animal life, or the causes without which life cannot exist,
it seems to follow, that when our gravitation towards the earth's center is
greatest, the powers of life should be the least; and hence that those
diseases, which begin with torpor, should occur about six hours after the
solar or lunar noon, or about six hours after the solar or lunar midnight;
and this most frequently about six hours after or before the new or full
moon; and especially when these happen at noon or at midnight; or lastly,
according to the combination of these powers in diminishing or increasing
the earth's attraction to bodies on its surface.

The returns or exacerbations of many fevers, both irritative and
inflammatory, about six in the evening, and of the periodic cough described
in Sect. XXXVI. 3. 9. countenance this theory. Tables might be made out to
shew the combined powers of the sun and moon in diminishing the gravitation
of bodies on the earth's surface, at every part of their diurnal, monthly,
and annual periods; and which might facilitate the elucidation of this
subject. But I am well aware of the difficulty of its application to
diseases, and hope these conjectures may induce others to publish more
numerous observations, and more conclusive reasonings.

SPECIES.

1. _Somni periodus._ The periods of sleeping and of waking are shortened or
prolonged by so many other circumstances in animal life, besides the minute
difference between diurnal and nocturnal solar gravitation, that it can
scarcely be ascribed to this influence. At the same time it is curious to
observe, that vegetables in respect to their times of sleeping more
regularly observe the hour of the day, than the presence or absence of
light, or of heat, as may be seen by consulting the calendar of Flora.
Botanic Garden, Part II. Canto 2. l. 165. note.

Some diseases, which at first sight might be supposed to be influenced by
solar periods, seem to be induced by the increasing sensibility of the
system to pain during our sleeping hours; as explained in Sect. XVIII. 15.
Of these are the fits of asthma, of some epilepsies, and of some hæmoptoes;
all which disturb the patient after some hours sleep, and are therefore to
be ascribed to the increase of our dormant sensibility. There may likewise
be some doubt, whether the commencement of the pain of gout in the foot, as
it generally makes its attack after sleep, should be ascribed to the
increased sensibility in sleep, or to solar influence?

M. M. When asthmatic or epileptic fits or hæmoptoe occur after a certain
number of hours of sleep, the patient should be forcibly awakened before
the expected time by an alarm clock, and drink a cup of chocolate or
lemonade.--Or a grain of opium should be given at going to bed.--In one
case to prevent the too great increase of sensibility by shortening the
time of sleep; and in the other by increasing the irritative motions, and
expending by that means a part of the sensorial power.

2. _Studii inanis periodus._ Class III. 1. 2. 2. The cataleptic spasm which
preceded the reverie and somnambulation in the patient, whose case is
related in Sect. XIX. 2. occurred at exactly the same hour, which was about
eleven in the morning for many weeks; till those periods were disturbed by
large doses of opium; and must therefore be referred to some effect of
solar gravitation. In the case of Master A. Sect. XXXIV. 3. as the reverie
began early in the morning during sleep, there may be a doubt, whether this
commenced with torpor of some organ catenated with solar gravitation; or
was caused by the existence of a previous torpid part, which only became so
painful as to excite the exertions of reverie by the perpetual increase of
sensibility during the continuance of sleep, as in some fits of epilepsy,
asthma, and hæmoptoe mentioned in the preceding article.

3. _Hemicraniæ periodus._ Periods of hemicrania. Class IV. 2. 2. 8. The
torpor and consequent pain of some membranes on one side of the head, as
over one eye, is frequently occasioned by a decaying tooth, and is liable
to return every day, or on alternate days at solar or lunar periods. In
this case large quantities of the bark will frequently cure the disease,
and especially if preceded by venesection and a brisk cathartic; but if the
offending tooth can be detected, the most certain cure is its extraction.
These partial head-achs are also liable to return at the greater lunar
periods, as about once a month. Five drops from a two-ounce phial of a
saturated solution of arsenic twice a day for a week or two have been said
to prevent the returns of this disease. See a Treatise on Arsenic by Dr.
Fowler, of York. Strong errhines have also been recommended.

4. _Epilepsiæ dolorificæ periodus._ Class III. 1. 1. 8. The pain which
induces after about an hour the violent convulsions or insanity, which
constitute the painful epilepsy, generally observe solar diurnal periods
for four or five weeks, and are probably governed by solar and lunar times
in respect to their greater periods; for I have observed that the daily
paroxysms, unless disturbed by large doses of opium, recur at very nearly
the same hour, and after a few weeks the patients have recovered to relapse
again at the interval of a few months. But more observations are wanted
upon this subject, which might be of great advantage in preventing the
attacks of this disease; as much less opium given an hour before its
expected daily return will prevent the paroxysm, than is necessary to cure
it, after it has commenced.

5. _Convulsionis dolorificæ periodus._ Class III. 1. 1. 6. The pains, which
produce these convulsions, are generally left after rheumatism, and come on
when the patients are become warm in bed, or have been for a short time
asleep, and are therefore perhaps rather to be ascribed to the increasing
sensibility of the system during sleep, than to solar diurnal periods, as
in Species first and second of this Genus.

6. _Tussis periodicæ periodus._ Periodic cough, Class IV. 2. 1. 9. returns
at exact solar periods; that described in Sect. XXXVI. 3. 9. recurred about
seven in the afternoon for several weeks, till its periods were disturbed
by opium, and then it recurred at eleven at night for about a week, and was
then totally destroyed by opium given in very large quantities, after
having been previously for a few days omitted.

7. _Catameniæ periodus._ Periods of menstruation. The correspondence of the
periods of the catamenia with those of the moon was treated of in Sect.
XXXII. 6. and can admit of no more doubt, than that the returns of the
tides are governed by lunar influence. But the manner in which this is
produced, is less evident; it has commonly been ascribed to some effect of
the lunar gravitation on the circulating blood, as mentioned in Sect.
XXXII. 6. But it is more analogous to other animal phenomena to suppose
that the lunar gravitation immediately affects the solids by its influx or
stimulus. Which we believe of the fluid element of heat, in which we are
equally immersed; and of the electric fluid, which also surrounds and
pervades us. See Sect. XXXVI. 2. 3.

If the torpor of the uterine veins, which induces the monthly periods of
the catamenia, be governed by the increase of terrene gravitation; that is,
by the deficiency of the counter-influence of solar and lunar gravitation;
why does not it occur most frequently when the terrene gravitation is the
greatest, as about six hours after the new moon, and next to that at about
six hours after the full moon? This question has its difficulty; first, if
the terrene gravitation be greatest about six hours after the new moon, it
must become less and less about the same time every lunar day, till the end
of the first quarter, when it will be the least; it must then increase
daily till the full. After the full the terrene gravitation must again
decrease till the end of the third quarter, when it will again be the
least, and must increase again till the new moon; that is, the solar and
lunar counter-gravitation is greatest, when those luminaries are vertical,
at the new moon, and full moon, and least about six hours afterwards. If it
was known, whether more menstruations occur about six hours after the moon
is in the zenith or nadir; and in the second and fourth quarters of the
moon, than in the first and third; some light would be thrown on this
subject; which must in that respect wait for future observations.

Secondly, if the lunar influence produces a very small degree of
quiescence, suppose of the uterine veins, at first; and if that recurs at
certain periods, as of lunar days, or about 25 hours, even with less power
to produce quiescence than at first; yet the quiescence will daily increase
by the acquired habit acting at the same time, as explained in Sect. XII.
3. 3. till at length so great a degree of quiescence will be induced as to
cause the inaction of the veins of the uterus, and consequent venous
hæmorrhage. See Sect. XXXII. 6. Class I. 2. 1. 11. IV. 1. 4. 4. See the
introduction to this Genus.

8. _Hæmorrhoidis periodus._ The periods of the piles depend on the torpor
of the veins of the rectum, and are believed to recur nearly at monthly
intervals. See Sect. XXVII. 2. and Class I. 2. 1. 6.

9. _Podagræ periodus._ The periods of gout in some patients recur at annual
intervals, as in the case related above in Class IV. 1. 2. 15. in which the
gouty paroxysm returned for three successive years on nearly the same day
of the month. The commencement of the pain of each paroxysm is generally a
few hours after midnight, and may thence either be induced by diurnal solar
periods, or by the increasing sensibility during sleep, as mentioned in the
first species of this genus.

10. _Erysipelatis periodus._ Some kinds of erysipelas which probably
originate from the association of the cutaneous vessels with a diseased
liver, occur at monthly periods, like the hæmorrhois or piles; and others
at annual periods like the gout; as a torpor of some part I suppose always
precedes the erysipelatous inflammation, the periods should accord with the
increasing influence of terrene gravitation, as described in the
introduction to this Genus, and in Species the seventh of it. Other periods
of diseases referable to solar and lunar influence are mentioned in Sect
XXXVI. and many others will probably be discovered by future observation.

11. _Febrium periodus._ Periods of fevers. The commencement of the cold
fits of intermittent fevers, and the daily exacerbations of other fevers,
so regularly recur at diurnal solar or lunar periods, that it is impossible
to deny their connection with gravitation; as explained in Sect. XXXVI. 3.
Not only these exacerbations of fever, and their remissions, obey the
diurnal solar and lunar periods; but the preparatory circumstances, which
introduce fevers, or which determine their crisises, appear to be governed
by the parts of monthly lunar periods, and of solar annual ones. Thus the
variolous fever in the natural small-pox commences on the 14th day, and in
the inoculated small-pox on the seventh day. The fever and eruption in the
distinct kind take up another quarter of a lunation, and the maturation
another quarter.

The fever, which is termed canine madness, or hydrophobia, is believed to
commence near the new or full moon; and, if the cause is not then great
enough to bring on the disease, it seems to acquire some strength, or to
lie dormant, till another, or perhaps more powerful lunation calls it into
action. In the spring, about three or four years ago, a mad dog very much
worried one swine confined in a sty, and bit another in the same sty in a
less degree; the former became mad, refused his meat, was much convulsed,
and died in about four days; this disease commenced about a month after the
bite. The other swine began to be ill about a month after the first, and
died in the same manner.

       *       *       *       *       *

ORDO III.

_Retrograde Associate Motions._

GENUS I.

_Catenated with Irritative Motions._

Those retrograde associate motions, the first links of which are catenated
with irritative motions, belong to this genus. All the retrograde motions
are consequent to debility, or inactivity, of the organ; and therefore
properly belong to the genera of decreased actions both in this and the
former classes.

SPECIES.

1. _Diabætes irritata._ When the absorbents of the intestines are
stimulated too strongly by spirit of wine, as in the beginning of
drunkenness, the urinary absorbents invert their motions. The same happens
from worms in the intestines. In other kinds of diabetes may not the remote
cause be the too strong action of the cutaneous absorbents, or of the
pulmonary ones? May not in such cases oil externally or internally be of
service? or warm bathing for an hour at a time? In hysteric inversions of
motion is some other part too much stimulated? or pained from the want of
stimulus?

2. _Sudor frigidus in asthmate._ The cause of the paroxysms of humoral
asthma is not well understood; I suppose it to be owing to a torpidity or
inaction of the absorbents belonging to the pulmonary vessels, as happens
probably to other viscera at the commencement of intermittent fevers, and
to a consequent accumulation of fluids in them; which at length producing
great irritation or uneasy sensation causes the violent efforts to produce
the absorption of it. The motions of the cutaneous absorbent vessels by
their association with those of the pulmonary ones become retrograde, and
effuse upon the skin a fluid, which is said to be viscid, and which adheres
in drops.

A few days ago I saw a young man of delicate constitution in what was
called a fit of the asthma; he had about two months before had a
peripneumony, and had been ever since subject to difficult respiration on
exertion, with occasional palpitation of his heart. He was now seized about
eight at night after some exertion of mind in his business with cold
extremities, and difficulty of breathing. He gradually became worse, and in
about half an hour, the palpitation of his heart and difficult respiration
were very alarming; his whole skin was cold and pale, yet he did not
shudder as in cold paroxysm of fever; his tongue from the point to the
middle became as cold as his other extremities, with cold breath. He seemed
to be in the act of dying, except that his pulse continued equal in time,
though very quick. He lost three ounces of blood, and took ten drops of
laudanum with musk and salt of hartshorn, and recovered in an hour or two
without any cold sweat.

There being no cold sweat seems to indicate, that there was no accumulation
of serous fluid in the lungs; and that their inactivity, and the coldness
of the breath, was owing to the sympathy of the air-cells with some distant
part. There was no shuddering produced, because the lungs are not sensible
to heat and cold; as any one may observe by going from a warm room into a
frosty air, and the contrary. So the steam of hot tea, which scalds the
mouth, does not affect the lungs with the sensation of heat. I was induced
to believe, that the whole cold fit might be owing to suppuration in some
part of the chest; as the general difficulty of breathing seemed to be
increased after a few days with pulse of 120, and other signs of empyema.
Does the cold sweat, and the occurrence of the fits of asthma after sleep,
distinguish the humoral asthma from the cold paroxysm of intermittents, or
which attends suppuration, or which precedes inflammation?--I heard a few
weeks afterwards, that he spit up much matter at the time he died.

3. _Diabætes a timore._ The motions of the absorbent vessels of the neck of
the bladder become inverted by their consent with those of the skin; which
are become torpid by their reverse sympathy with the painful ideas of fear,
as in Sect. XVI. 8. 1. whence there is a great discharge of pale urine, as
in hysteric diseases.

The same happens from anxiety, where the painful suspense is continued,
even when the degree of fear is small; as in young men about to be examined
for a degree at the universities the frequency of making water is very
observable. When this anxiety is attended with a sleepless night, the
quantity of pale urine is amazingly great in some people, and the
micturition very frequent.

M. M. Opium. Joy. Consolations of friendship.

4. _Diarrhoea a timore._ The absorbent vessels of the intestines invert
their motions by direct consent with the skin; hence many liquid stools as
well as much pale urine are liable to accompany continued fear, along with
coldness of the skin. The immediate cause of this is the decreased
sensorial power of association, which intervenes between the actions of the
absorbents of the cold skin, and those of the intestinal absorbents; the
motions of the latter become on that account weakened and at length
retrograde. The remote cause is the torpor of the vessels of the skin
catenated with the pain of fear, as explained in Sect. XVI. 8. 1.

The capillaries of the skin consent more generally by direct sympathy with
those of the lower intestines, and of the bladder; but by reverse sympathy
more generally with those of the stomach and upper intestines. As appears
in fevers, where the hot skin accompanies indigestion of the stomach; and
in diarrhoeas attended with cold extremities.

The remote cause is the torpor of the skin owing to its reverse sympathy
with the painful sensual motions, or ideas, of fear; which are now actuated
with great energy, so as to deprive the second link of associated motions
of their due share of sensorial power. It is also probable, that the pain
of fear itself may contribute to exhaust the sensorial power, even when it
produces no muscular action. See Class IV. 2. 2.

5. _Pallor et tremor a timore._ A retrograde action of the capillaries of
the skin producing paleness, and a torpor of the muscular fibres of the
limbs occasioning trembling, are caused by their reverse associations with
the ideas or imaginations of fear; which are now actuated with violent
energy, and accompanied with great pain. The cause of these associations
are explained in Sect XVI. 8. 1.

These torpid actions of the capillaries and muscles of the limbs are not
caused immediately by the painful sensation of fear; as in that case they
would have been increased and not decreased actions, as occurs in anger;
where the painful volition increases the actions of the capillaries,
exciting a blush and heat of the skin. Whence we may gain some knowledge of
what is meant by depressing and exciting passions; the former confiding of
ideas attended with pain, which pain occasions no muscular actions, like
the pain of cold head-ach; the latter being attended with volitions, and
consequent muscular exertions.

That is, the pain of fear, and the pain of anger, are produced by the
exertion of certain ideas, or motions of certain nerves of sense; in the
former case, the painful sensation of fear produces no muscular actions,
yet it exhausts or employs so much sensorial power, that the whole system
acts more feebly, or becomes retrograde; but some parts of it more so than
others, according to their early associations described in Sect. XVI. 8. 1.
hence the tremor of the limbs, palpitation of heart, and even syncope. In
anger the painful volition produces violent muscular actions; but if
previous to these any deliberation occurs, a flushed countenance sometimes,
and a red skin, are produced by this superabundance of volition exerted on
the arterial system; but at other times the skin becomes pale, and the legs
tremble, from the exhaustion or expenditure of the sensorial power by the
painful volitions of anger on the organs of sense, as by the painful
sensations of fear above mentioned.

Where the passion of fear exists in a great degree, it exhausts or expends
so much sensorial power, either simply by the pain which attends it, or by
the violent and perpetual excitement of the terrific imaginations or ideas,
that not only a cold and pale skin, but a retrograde motion of the
cutaneous absorbents occurs, and a cold sweat appears upon the whole
surface of the body, which probably sometimes increases pulmonary
absorption; as in Class II. 1. 6. 4. and as in the cold sweats, which
attend the paroxysms of humoral asthma. Hence anxiety, which is a continued
pain of fear, so universally debilitates the constitution as to occasion a
lingering death; which happens much more frequently than is usually
supposed; and these victims of continued anxiety are said to die of a
broken heart. Other kinds of paleness are described in Class I. 2. 2. 2.

M. M. Opium. Wine. Food. Joy.

6. _Palpitatio cordis a timore._ The palpitation of the heart from fear is
owing to the weak action of it, and perhaps sometimes to the retrograde
exertion of the ventricules and auricles; because it seems to be affected
by its association with the capillaries, the actions of which, with those
of the arteries and veins, constitute one great circle of associate
motions. Now when the capillaries of the skin become torpid, coldness and
paleness succeed; and with these are associated the capillaries of the
lungs, whence difficult respiration; and with these the weak and retrograde
actions of the heart. At the same time the absorbents of the skin, and of
the bladder, and of the intestines, sometimes become retrograde, and
regurgitate their contents; as appears by the pale urine in large
quantities, which attends hysteric complaints along with this palpitation
of the heart; and from the cold sweats, and diarrhoea; all which, as well
as the hysteric complaints, are liable to be induced or attended by fear.

When fear has still more violently affected the system, there have been
instances where syncope, and sudden death, or a total stoppage of the
circulation, have succeeded: in these last cases, the pain of fear has
employed or exhausted the whole of the sensorial power, so that not only
those muscular fibres generally exerted by volition cease to act, whence
the patient falls down; and those, which constitute the organs of sense,
whence syncope; but lastly those, which perform the vital motions, become
deprived of sensorial power, and death ensues. See Class. I. 2. 1. 4. and
I. 2. 1. 10. Similar to this in some epileptic fits the patient first
suddenly falls down, without even endeavouring to save himself by his hands
before the convulsive motions come on. In this case the great exertion of
some small part in consequence of great irritation or sensation exhausts
the whole sensorial power, which was lodged in the extremities of the
locomotive nerves, for a short time, as in syncope; and as soon as these
muscles are again supplied, convulsions supervene to relieve the painful
sensation. See Class III. 1. 1. 7.

7. _Abortio a timore._ Women miscarry much more frequently from a fright,
than from bodily injury. A torpor or retrograde motion of the capillary
arteries of the internal uterus is probably the immediate cause of these
miscarriages, owing to the association of the actions of those vessels with
the capillaries of the skin, which are rendered torpid or retrograde by
fear. By this contraction of the uterine arteries, the fine vessels of the
placenta, which are inserted into them, are detruded, or otherwise so
affected, that the placenta separates at this time from the uterus, and the
fetus dies from want of oxygenation. A strong young woman, in the fifth or
sixth month of her pregnancy, who has since borne many children, went into
her cellar to draw beer; one of the servant boys was hid behind a barrel,
and started out to surprise her, believing her to be the maid-servant; she
began to flood immediately, and miscarried in a few hours. See Sect. XXXIX.
6. 5. and Class I. 2. 1. 14.

8. _Hysteria a timore._ Some delicate ladies are liable to fall into
hysteric fits from sudden fright. The peristaltic motions of the bowels and
stomach, and those of the oesophagus, make a part of the great circle of
irritative motions with those of the skin, and many other membranes. Hence
when the cutaneous vessels become torpid from their reverse sympathy with
the painful ideas of fear; these of the bowels, and stomach, and
oesophagus, become first torpid by direct sympathy with those of the skin,
and then feebly and ineffectually invert the order of their motions, which
constitutes a paroxysm of the hysteric disease. See Class I. 3. 1. 10.
These hysteric paroxysms are sometimes followed by convulsions, which
belong to Class III. as they are exertions to relieve pain; and sometimes
by death. See Species 9 of this Genus, and Class I. 2. 1. 4.

Indigestion from fear is to be ascribed in the same manner to the torpor of
the stomach, owing to its association with the skin. As in Class IV. 1. 2.
5. IV. 2. 1.

       *       *       *       *       *

ORDO III.

_Retrograde Associate Motions._

GENUS II.

_Catenated with Sensitive Motions._

SPECIES.

1. _Nausea idealis._ Nausea from disgustful ideas, as from nauseous
stories, or disgustful sights, or smells, or tastes, as well as vomiting
from the same causes, consists in the retrograde actions of the lymphatics
of the throat, and of the oesophagus, and stomach; which are associated
with the disgustful ideas, or sensual motions of sight, or hearing, or
smell, or taste; for as these are decreased motions of the lymphatics, or
of the oesophagus, or stomach, they cannot immediately be excited by the
sensorial power of painful sensation, as in that case they ought to be
increased motions. So much sensorial power is employed for a time on the
disgustful idea, or expended in the production of inactive pain, which
attends it, that the other parts of the associated chain of action, of
which this disgustful idea is now become a link, is deprived of their
accustomed share; and therefore first stop, and then invert their motions.
Owing to deficiency of sensorial power, as explained more at large in Sect.
XXXV. 1. 3.

2. _Nausea a conceptu._ The nausea, which pregnant women are so subject to
during the first part of gestation, is owing to the reverse sympathy
between the uterus and stomach, so that the increased action of the former,
excited by the stimulus of the growing embryon, which I believe is
sometimes attended with sensation, produces decreased actions of the latter
with the disagreeable sensation of sickness with indigestion and consequent
acidity. When the fetus acquires so much muscular power as to move its
limbs, or to turn itself, which is called quickening, this sickness of
pregnancy generally ceases.

M. M. Calcined magnesia. Rhubarb. Half a grain of opium twice a day.
Recumbent posture on a sofa.

3. _Vomitio vertiginosa._ Sea-sickness, the irritative motions of vision,
by which we balance ourselves, and preserve our perpendicularity, are
disturbed by the indistinctness of their objects; which is either owing to
the similarity of them, or to their distance, or to their apparent or
unusual motions. Hence these irritative motions of vision are exerted with
greater energy, and are in consequence attended with sensation; which, at
first is agreeable, as when children swing on a rope; afterwards the
irritative motions of the stomach, and of the absorbent vessels, which open
their mouths into it, become inverted by their associations with them by
reverse sympathy.

For the action of vomiting, as well as the disagreeable sensation of
sickness, are shewn to be occasioned by defect of the sensorial power;
which in this case is owing to the greater expenditure of it by the sense
of vision. On the same account the vomiting, which attends the passage of a
stone through the ureter, or from an inflammation of the bowels, or in the
commencement of some fevers, is caused by the increased expenditure of the
sensorial power by the too great action of some links of the associations
of irritative motions; and there being in consequence a deficiency of the
quantity required for other links of this great catenation.

It must be observed, that the expenditure of sensorial power by the retinas
of the eyes is very great; which may be estimated by the perpetual use of
those organs during our waking hours, and during most of our sleeping ones;
and by the large diameters of the two optic nerves, which are nearly the
size of a quill, or equal to some of the principal nerves, which serve the
limbs.

4. _Vomitio a calculo in uretere._ The action of vomiting in consequence of
the increased or decreased actions of the ureter, when a stone lodges in
it. The natural actions of the stomach, which consist of motions subject to
intermitted irritations from the fluids, which pass through it, are
associated with those of the ureter; and become torpid, and consequently
retrograde, by intervals, when the actions of the ureter becomes torpid
owing to previous great stimulus from the stone it contains; as appears
from the vomiting existing when the pain is least. When the motions of the
ureter are thus lessened, the sensorial power of association, which ought
to actuate the stomach along with the sensorial power of irritation, ceases
to be excited into action; and in consequence the actions of the stomach
become less energetic, and in consequence retrograde.

For as vomiting is a decreased action of the stomach, as explained in Sect.
XXXV. 1. 3. it cannot be supposed to be produced by the pain of gravel in
the ureter alone, as it should then be an increased action, not a decreased
one.

The perpetual vomiting in ileus is caused in like manner by the defective
excitement of the sensorial power of association by the bowel, which is
torpid during the intervals of pain; and the stomach sympathizes with it.
See Enteritis, Class II. 1. 2. 11. Does this symptom of vomiting indicate,
whether the disease be above or below the valve of the colon? Does not the
softer pulse in some kinds of enteritis depend on the sympathy of the heart
and arteries with the sickness of the stomach? See Ileus and Cholera.

Hence this sickness, as well as the sickness in some fevers, cannot be
esteemed an effort of nature to dislodge any offensive material; but like
the sea-sickness described above, and in Sect. XX. 4. is the consequence of
the associations of irritative or sensitive motions. See Class I. 1. 3. 9.

5. _Vomitio ab insultu paralytico._ Paralytic affections generally commence
with vomiting, the same frequently happens from a violent blow with a stick
on the head; this curious connection of the brain and stomach has not been
explained; as it resembles the sickness in consequence of vertigo at sea,
it would seem to arise from a similar cause, viz. from disturbed irritative
or sensitive associations.

6. _Vomitio a titillatione faucium._ If the throat be slightly tickled with
a feather, a nausea is produced, that is, an inverted action of the mouths
of the lymphatics of the fauces, and by direct sympathy an inverted action
of the stomach ensues. As these parts have frequently been stimulated at
the same time into pleasurable action by the deglutition of our daily
aliment, their actions become strongly associated. And as all the food, we
swallow, is either moist originally, or mixed with our moist saliva in the
mouth; a feather, which is originally dry, and which in some measure repels
the moist saliva, is disagreeable to the touch of the fauces; at the same
time this nausea and vomiting cannot be caused by the disagreeable
sensation simply, as then they ought to have been increased exertions, and
not decreased ones, as shewn in Section XXXV. 1. 3. But the mouths of the
lymphatics of the fauces are stimulated by the dry feather into too great
action for a time, and become retrograde afterwards by the debility
consequent to too great previous stimulus.

7. _Vomitio cute sympathetica._ Vomiting is successfully stopped by the
application of a blister on the back in some fevers, where the extremities
are cold, and the skin pale. It was stopped by Sydenham by producing a
sweat on the skin by covering the head with the bed-clothes. See Class IV.
1. 1. 3. and Suppl. I. 11. 6.

       *       *       *       *       *

ORDO III.

_Retrograde Associate Motions._

GENUS III.

_Catenated with Voluntary Motions._

SPECIES.

1. _Ruminatio._ In the rumination of horned cattle the food is brought up
from the first stomach by the retrograde motions of the stomach and
oesophagus, which are catenated with the voluntary motions of the abdominal
muscles.

2. _Vomitio voluntaria._ Voluntary vomiting. Some human subjects have been
said to have obtained this power of voluntary action over the retrograde
motions of the stomach and oesophagus, and thus to have been able to empty
their stomach at pleasure. See Sect. XXV. 6. This voluntary act of emptying
the stomach is possessed by some birds, as the pigeon; who has an organ for
secreting milk in its stomach, as Mr. Hunter observed; and softens the food
for its young by previously swallowing it; and afterwards putting its bill
into theirs returns it into their mouths. See Sect. XXXIX. 4. 8. The
pelicans use a stomach, or throat bag, for the purpose of bringing the
fish, which they catch in the sea to shore, and then eject them, and eat
them at their leisure. See Sect. XVI. 11. And I am well informed of a
bitch, who having puppies in a stable at a distance from the house,
swallowed the flesh-meat, which was given her, in large pieces, and
carrying it immediately to her whelps, brought it up out of her stomach,
and laid it down before them.

3. _Eructatio voluntaria._ Voluntary eructation. Some, who have weak
digestions, and thence have frequently been induced to eruct the quantity
of air discharged from the fermenting aliment in their stomachs, have
gradually obtained a power of voluntary eructation, and have been able thus
to bring up hogsheads of air from their stomachs, whenever they pleased.
This great quantity of air is to be ascribed to the increase of the
fermentation of the aliment by drawing off the gas as soon as it is
produced. See Sect. XXIII. 4.

       *       *       *       *       *

ORDO III.

_Retrograde Associate Motions._

GENUS. IV.

_Catenated with External Influences._

SPECIES.

1. _Catarrhus periodicus._ Periodical catarrh is not a very uncommon
disease; there is a great discharge of a thin saline mucous material from
the membranes of the nostrils, and probably from the maxillary and frontal
sinuses, which recur once a day at exact solar periods; unless it be
disturbed by the exhibition of opium; and resembles the periodic cough
mentioned below. See Class I. 3. 2. 1. It is probably owing to the
retrograde action of the lymphatics of the membranes affected, and produced
immediately by solar influence.

2. _Tussis periodica._ Periodic cough, called nervous cough, and tussis
serina. It seems to arise from a periodic retrograde action of the
lymphatics of the membrane, which lines the air-cells of the lungs. And the
action of coughing, which is violently for an hour or longer, is probably
excited by the stimulus of the thin fluid thus produced, as well as by the
disagreeable sensation attending membranous inactivity; and resembles
periodic catarrh not only in its situation on a mucous membrane, but in the
discharge of a thin fluid. As it is partly restrainable, it does not come
under the name of convulsion; and as it is not attended with difficult
respiration, it cannot be called asthma; it is cured by very large doses of
opium, see a case and cure in Sect. XXXVI. 3. 9. see Class IV. 2. 4. 6. and
seems immediately to be induced by solar influence.

3. _Histeria a frigore._ Hysteric paroxysms are occasioned by whatever
suddenly debilitates the system, as fear, or cold, and perhaps sometimes by
external moisture of the air, as all delicate people have their days of
greater or less debility, see Class IV. 3. 1. 8.

4. _Nausea pluvialis._ Sickness at the commencement of a rainy season is
very common among dogs, who assist themselves by eating the agrostris
canina, or dog's grass, and thus empty their stomachs. The same occurs with
less frequency to cats, who make use of the same expedient. See Sect. XVI.
11. I have known one person, who from his early years has always been sick
at the beginning of wet weather, and still continues so. Is this owing to a
sympathy of the mucous membrane of the stomach with the mechanical
relaxation of the external cuticle by a moister atmosphere, as is seen in
the corrugated cuticle of the hands of washing-women? or does it sympathize
with the mucous membrane of the lungs, which must be affected along with
the mucus on its surface by the respiration of a moister atmosphere?

       *       *       *       *       *


SUPPLEMENT TO CLASS IV.

_Sympathetic Theory of Fever._

As fever consists in the increase or diminution of direct or reverse
associated motions, whatever may have been the remote cause of them, it
properly belongs to the fourth class of diseases; and is introduced at the
end of the class, that its great difficulties might receive elucidation
from the preceding parts of it. These I shall endeavour to enumerate under
the following heads, trusting that the candid reader will discover in these
rudiments of the theory of fever a nascent embryon, an infant Hercules,
which Time may rear to maturity, and render serviceable to mankind.

     I. Simple fever of two kinds.
    II. Compound fever.
   III. Termination of the cold fit.
    IV. Return of the cold fit.
     V. Sensation excited in fever.
    VI. Circles of associated motions.
   VII. Alternations of cold and hot fits.
  VIII. Orgasm of the capillaries.
    IX. Torpor of the lungs.
     X. Torpor of the brain.
    XI. Torpor of the heart and arteries.
   XII. Torpor of the stomach and intestines.
  XIII. Case of continued fever explained.
   XIV. Termination of continued fever.
    XV. Inflammation excited in fever.
   XVI. Recapitulation.

I. _Simple fever._

1. When a small part of the cutaneous capillaries with their mucous or
perspirative glands are for a short time exposed to a colder medium, as
when the hands are immersed in iced water for a minute, these capillary
vessels and their glands become torpid or quiescent, owing to the eduction
of the stimulus of heat. The skin then becomes pale, because no blood
passes through the external capillaries; and appears shrunk, because their
sides are collapsed from inactivity, not contracted by spasm; the roots of
the hair are left prominent from the seceding or subsiding of the skin
around them; and the pain of coldness is produced.

In this situation, if the usual degree of warmth be applied, these vessels
regain their activity; and having now become more irritable from an
accumulation of the sensorial power of irritation during their quiescence,
a greater exertion of them follows, with an increased glow of the skin, and
another kind of pain, which is called the hot-ach; but no fever, properly
so called, is yet produced; as this effect is not universal, nor permanent,
nor recurrent.

2. If a greater part of the cutaneous capillaries with their mucous and
perspirative glands be exposed for a longer time to cold, the torpor or
quiescence becomes extended by direct sympathy to the heart and arteries;
which is known by the weakness, and consequent frequency of the pulse in
cold fits of fever.

This requires to be further explained. The movements of the heart and
arteries, and the whole of the circulatory vessels, are in general excited
into action by the two sensorial powers of irritation, and of association.
The former is excited by stimulus, the latter by the previous actions of a
part of the vital circle of motions. In the above situation the capillaries
act weakly from defect of irritation, which is caused by deficient stimulus
of heat; but the heart and arteries act weakly from defect of association,
which is owing to the weak action of the capillaries; which does not now
excite the sensorial power of association into action with sufficient
energy.

After a time, either by the application of warmth, or by the increase of
their irritability owing to the accumulation of the sensorial power of
irritation during their previous quiescence, the capillary vessels and
glands act with greater energy than natural; whence the red colour and heat
of the skin. The heart and arteries acquire a greater strength of
pulsation, and continue the frequency of it, owing to the accumulation of
the sensorial power of association during their previous torpor, and their
consequent greater associability; which is now also more strongly excited
by the increased actions of the capillaries. And thus a fit of simple fever
is produced, which is termed Febris irritativa; and consists of a torpor of
the cutaneous capillaries with their mucous and perspirative glands,
accompanied with a torpor of the heart and arteries; and afterwards of an
increased action of all these vessels, by what is termed direct sympathy.

This fever, with strong pulse without inflammation, or febris irritativa,
described in Class I. 1. 1. 1. is frequently seen in vernal intermittents,
as the orgasm of the heart and arteries is then occasioned by their
previous state of torpor; but more rarely I believe exists in the type of
continued fever, except there be an evident remission, or approximation to
a cold fit; at which time a new accumulation of the sensorial power of
association is produced; which afterwards actuates the heart and arteries
with unnatural vigour; or unless there be some stimulus perpetually acting
on the system so as to induce an increased secretion of sensorial power in
the brain, as occurs in slight degrees of intoxication. Since without one
or other of these circumstances in continued fevers without inflammation,
that is, without the additional sensorial power of sensation being
introduced, it seems difficult to account for the production of so great a
quantity of sensorial power, as must be necessary to give perpetual
increase of action to the whole sanguiferous system.

3. On the contrary, while the cutaneous capillaries with their mucous and
perspirative glands acquire an increased irritability, as above, by the
accumulation of that sensorial power during their previous quiescence, and
thus constitute the hot fit of fever; if the heart and arteries do not
acquire any increase of associability, but continue in their state of
torpor, another kind of simple fever is produced; which is generally of the
continued kind, and is termed Febris inirritativa; which consists of a
previous torpor of the capillaries of the skin, and of the heart and
arteries by direct sympathy with them; and afterwards of an orgasm or
increased action of the capillaries of the skin, with a decreased action,
or continued torpor, of the heart and arteries by reverse sympathy with
them. This orgasm of the cutaneous capillaries, which appears by the blush
and heat of the skin, is at first owing to the accumulation of the
sensorial power of irritation during their previous torpid state, as in the
febris irritata above described; but which is afterwards supported or
continued by the reverse sympathy of these capillaries with the torpid
state of the heart and arteries, as will be further explained in article 8
of this Supplement.

4. The renovated activity of the capillaries commences as soon or sooner
than that of the heart and arteries after the cold fit of irritative fever;
and is not owing to their being forced open by the blood being impelled
into them mechanically, by the renovated action of the heart and arteries;
for these capillaries of the skin have greater mobility than the heart and
arteries, as appears in the sudden blush of shame; which may be owing to
their being more liable to perpetual varieties of activity from their
exposure to the vicissitudes of atmospheric heat. And because in
inirritative fevers, or those with arterial debility, the capillaries
acquire increased strength, as is evinced by the heat of the skin, while
the pulsations of the heart and arteries remain feeble.

5. It was said above, that the cutaneous capillaries, when they were
rendered torpid by exposure to cold, either recovered their activity by the
reapplication of external warmth; or by their increased irritability, which
is caused by the accumulation of that sensorial power during their
quiescence. An example of the former of these may be seen on emerging from
a very cold bath; which produces a fit of simple fever; the cold fit, and
consequent hot fit, of which may be prolonged by continuing in the bath;
which has indeed proved fatal to some weak and delicate people, and to
others after having been much exhausted by heat and exercise. See Sect.
XXXII. 3. 2. An example of the latter may be taken from going into a bath
of about eighty degrees of heat, as into the bath at Buxton, where the
bather first feels a chill, and after a minute becomes warm, though he
remains in the same medium, owing to the increase of irritability from the
accumulation of that sensorial power during the short time, which the
chilness continued.

6. Hence simple fevers are of two kinds; first, the febris irritativa, or
fever with strong pulse; which consists of a previous torpor of the heart,
arteries, and capillaries, and a succeeding orgasm of those vessels.
Secondly, the febris inirritativa, or fever with weak pulse, which consists
of a previous torpor of the heart, arteries, and capillaries; and of a
succeeding orgasm of the capillaries, the torpor of the heart and arteries
continuing. But as the frequency of the pulse occurs both in the state of
torpor, and in that of orgasm, of the heart and arteries; this constitutes
a criterion to distinguish fever from other diseases, which are owing to
the torpor of some parts of the system, as paresis, and hemicrania.

7. The reader will please to observe, that where the cutaneous or pulmonary
capillaries are mentioned, their mucous and perspirative glands are to be
understood as included; but that the absorbents belonging to those systems
of vessels, and the commencement of the veins, are not always included; as
these are liable to torpor separately, as in anasarca, and petechiæ; or to
orgasm, or increased action, as in the exhibition of strong emetics, or in
the application of vinegar to the lips; yet he will also please to observe,
that an increased or decreased action of these absorbents and veins
generally occurs along with that of the capillaries, as appears by the dry
skin in hot fits of fever; and from there being generally at the same time
no accumulation of venous blood in the cutaneous vessels, which would
appear by its purple colour.

II. _Compound fever._

1. When other parts of the system sympathize with this torpor and orgasm of
the cutaneous capillaries, and of the heart and arteries; the fever-fit
becomes more complicated and dangerous; and this in proportion to the
number and consequence of such affected parts. Thus if the lungs become
affected, as in going into very cold water, a shortness of breath occurs;
which is owing to the collapse or inactivity (not to the active
contraction, or spasm), of the pulmonary capillaries; which, as the lungs
are not sensible to cold, are not subject to painful sensation, and
consequent shuddering, like the skin. In this case after a time the
pulmonary capillaries, like the cutaneous ones, act with increased energy;
the breathing, which was before quick, and the air thrown out at each
respiration in less quantity, and cool to the back of the hand opposed to
it, now becomes larger in quantity, and warmer than natural; which however
is not accompanied with the sensation of heat in the membrane, which lines
the air-vessels of the lungs, as in the skin.

2. One consequence of this increased heat of the breath is the increased
evaporation of the mucus on the tongue and nostrils. A viscid material is
secreted by these membranes to preserve them moist and supple, for the
purposes of the senses of taste and of smell, which are extended beneath
their surfaces; this viscid mucus, when the aqueous part of it is
evaporated by the increased heat of the respired air, or is absorbed by the
too great action of the mucous absorbents, adheres closely on those
membranes, and is not without difficulty to be separated from them. This
dryness of the tongue and nostrils is a circumstance therefore worthy to be
attended to; as it shews the increased action of the pulmonary capillaries,
and the consequent increased heat of the expired air; and may thus
indicate, when colder air should be admitted to the patient. See Class I.
1. 3. 1. The middle part of the tongue becomes dry sooner, and recovers its
moisture later, than the edges of it; because the currents of respired air
pass most over the middle part of it. This however is not the case, when
the dryness of the tongue is owing only to the increased mucous absorption.
When however a frequent cough attends pulmonary inflammation, the edges of
the tongue are liable to be as much furred as the middle of it; as during
the action of coughing the middle of the tongue is depressed, so as to form
half a cylinder, to give a greater aperture for the emission of air from
the larynx; and the edges of it become thus as much exposed to the currents
of air, as the middle parts of it.

3. When the internal capillaries or glands sympathize with the cutaneous
capillaries; or when any of them are previously affected with torpor, and
the external or cutaneous capillaries are affected secondarily; other
symptoms are produced, which render the paroxysms of fever still more
complicate. Thus if the spleen or pancreas are primarily or secondarily
affected, so as to be rendered torpid or quiescent, they are liable to
become enlarged, and to remain so even after the extinction of the
fever-fit. These in some intermittent fevers are perceptible to the hand,
and are called ague-cakes; their tumour seems to be owing to the permanent
torpor of the absorbent system, the secerning vessels continuing to act
some time afterwards. If the secretory vessels of the liver are affected
first with torpor, and afterwards with orgasm, a greater secretion of bile
is produced, which sometimes causes a diarrhoea. If a torpor of the
kidneys, and of the absorbents of the bladder occurs, either primarily, or
by sympathy with the cutaneous capillaries, the urine is in small quantity
and pale, as explained in Class I. 2. 2. 5.; and if these secretory vessels
of the kidneys, and the absorbents of the bladder act more strongly than
natural afterwards by their increased irritability or associability, the
urine becomes in larger quantity, and deeper coloured, or deposits its
earthy parts, as in Class I. 1. 2. 4. which has been esteemed a favourable
circumstance. But if the urine be in small quantity, and no sediment
appears in it, after the hot fit is over; it shews, that the secerning
vessels of the kidneys and the absorbent vessels of the bladder have not
regained the whole of their activity, and thence indicates a greater
tendency to a return of the cold fit.

4. When the stomach is affected with torpor either primarily; or
secondarily by its sympathy with the cutaneous capillaries; or with some
internal viscus; sickness occurs, with a total want of appetite to any
thing solid; vomiting then supervenes, which may often be relieved by a
blister on the skin, if the skin be cool and pale; but not if it be hot and
flushed. The intestines cease to perform their office of absorption from a
similar torpor; and a diarrhoea supervenes owing to the acrimony of their
putrid, or of their acid contents. The loose undigested or fetid stools
indicate the inability of the intestines to perform their proper office; as
the mucus and gastric acid, which are vomited up, does that of the stomach;
this torpor of the stomach is liable to continue after the cold paroxysm
ceases, and to convert intermittent fevers into continued ones by its
direct sympathy with the heart and arteries. See article 10 of this
Supplement.

5. If the meninges of the brain sympathize with other torpid parts, or are
primarily affected, delirium, stupor, and perhaps hydrocephalus internus
occur, see Class II. 1. 7. 1. and I. 2. 5. 10; and sometimes the pulse
becomes slow, producing paresis instead of fever. But if the membranes,
which cover the muscles about the head, or of the pericranium, become
torpid by their sympathy with other torpid parts, or are primarily
affected, a head-ach supervenes; which however generally ceases with the
cold paroxysm of fever. For as when the sensorial power of volition is
exhausted by labour, a few hours, or half a solar day, passed in sleep
recruits the system by accumulation of this sensorial power; so when the
sensorial power of irritation is exhausted, one or two solar or lunar days
of rest or quiescence of the affected part will generally restore its
action by accumulation of irritability, and consequent increase of
association, as in hemicrania, Class IV. 2. 2. 8. But when the heart and
arteries become torpid, either primarily, or by their sympathy with the
stomach, this accumulation of the sensorial power of irritation can take
place but slowly; _as to rest is death_! This explains the cause of the
duration of fevers with weak pulse, which continue a quarter, or half, or
three quarters, or a whole lunation, or still longer, before sufficient
accumulation of irritability can be produced to restore their natural
strength of action.

6. If the absorbent vessels, which are spread around the neck of the
bladder, become torpid by their direct sympathy with the absorbents of the
skin in cold fits of fever; the urine, which is poured into the bladder in
but small quantity from the torpid kidneys, has nevertheless none of its
aqueous saline part reabsorbed; and this saline part stimulates the bladder
to empty itself frequently, though the urine is in small quantity. Which is
not therefore owing to any supposed spasm of the bladder, for the action of
it in excluding the urine is weak, and as much controlable by the will as
in ordinary micturition.

7. If the beginnings or absorbent mouths of the venous system remain
torpid, petechiæ or vibices are produced in fevers, similar to those which
are seen in scurvy without fever. If the skin was frequently moistened for
an hour, and at the same time exposed to the common air, or to oxygen gas,
it might contribute to turn the black colour of these points of
extravasated blood into scarlet, and thus by increasing its stimulus
facilitate its reabsorption? For oxygen gas penetrates moist animal
membranes though not dry ones, as in the lungs during respiration.

8. When the sensorial power of sensation is introduced into the arterial
system, other kinds of compound fevers are produced, which will be spoken
of in their place.

III. _Termination of the cold Fit._

1. If all the parts, which were affected with torpor, regain their
irritability, and associability, the cold paroxysm of fever ceases; but as
some of the parts affected were previously accustomed to incessant action,
as the heart and arteries, and others only to intermitted action, as the
stomach and intestines; and as those, which are subjected during health to
perpetual action, accumulate sensorial power faster, when their motions are
impeded, than those which are subjected to intermitted action; it happens,
that some of the parts, which were affected with torpor during the cold
fit, recover their irritability or associability sooner than others, and
more perfectly, or acquire a greater quantity of them than natural; as
appears by the partial heat and flushings previous to the general hot fit.

Hence if all the parts, which were previously torpid, regain their due
degree of irritability, or of associability, the disease is removed, and
health restored. If some or all of them acquire more than their natural
degree of these sensorial powers; increased actions, and consequent
increased secretions, and greater heat occur, and constitute the hot fit of
fever. If after this hot fit of fever all the parts, which had acquired too
great irritability, or associability, regain their natural degree of it;
the disease is removed, and health restored. But if some of these parts do
not regain their natural degree of these sensorial powers, the actions of
those parts remain imperfect, and are more or less injurious to the system,
according to the importance of their functions.

2. Thus if a torpor of the heart and arteries remains; the quick pulse
without strength, which began in the cold fit, persists; and a continued
fever is produced. If the torpor of the stomach and intestines remains,
which are known by sickness and undigested stools, the fever is liable to
be of considerable length and danger; the same if the kidnies and absorbent
system retain some degree of torpor, as is shewn by the pale urine in not
unusual quantity. If part of the absorbent system remains torpid, as the
absorbent vessels of the spleen, a tumour of that viscus occurs, which may
be felt by the hand; the same sometimes happens to the liver; and these
from their tendency to more complete torpor are afterwards liable to give
occasion to a return of the cold fit. If the cellular absorbents do not
completely recover their activity, a pale and bloated countenance with
swelled legs mark their want of action.

3. As the termination of the cold fit is owing to the accumulation of the
sensorial power of irritation and of association during the previous
quiescence of the system; and as those parts, which are in perpetual action
during health, are more subject to this accumulation during their torpor,
or quiescence; one should have imagined, that the heart and arteries would
acquire this accumulation of sensorial power sooner or in greater degree
than other parts. This indeed so happens, where the pulse is previously
strong, as in febris irritativa; or where another sensorial power, as that
of sensation, is exerted on the arterial system, as in inflammations. The
heart and arteries in these cases soon recover from their torpor, and are
exerted with great violence.

Many other parts of the system subject to perpetual motion in health may
rest for a time without much inconvenience to the whole; as when the
fingers of some people become cold and pale; and during this complete rest
great accumulation of irritability may be produced, But where the heart and
arteries are previously feeble, they cannot much diminish their actions,
and certainly cannot rest entirely, for that would be death; and therefore
in this case their accumulation of the sensorial power of irritation or of
association is slowly produced, and a long fever supervenes in consequence;
or sudden death, as frequently happens, terminates the cold fit.

Whence it appears, that in fevers with weak pulse, if the action of the
heart, arteries, and capillaries could be diminished, or stopped for a
short time without occasioning the death of the patient, as happens in cold
bathing, or to persons apparently drowned, that a great accumulation of the
sensorial powers of irritation or of association might soon be produced,
and the pulse become stronger, and consequently slower, and the fever
cease. Hence cold ablution may be of service in fevers with weak pulse, by
preventing the expenditure and producing accumulation of the sensorial
power of irritation or association. Stupor may be useful on the same
account. Could a centrifugal swing be serviceable for this purpose, either
by placing the head or the feet in the outward part of the circle, as
described in Art. 15. 7. of this Supplement?

IV. _Return of the cold Fit._

1. If the increased action of the cutaneous and pulmonary capillaries, and
of the heart and arteries, in febris irritativa continues long and with
violence, a proportional expenditure or exhaustion of sensorial power
occurs; which by its tendency to induce torpor of some part, or of the
whole, brings on a return of the cold fit.

2. Another cause which contributes to induce torpor of the whole system by
the sympathy of its parts with each other, is the remaining torpor of some
viscus; which after the last cold paroxysm had not recovered itself, as of
the spleen, liver, kidnies, or of the stomach and intestines, or absorbent
vessels, as above mentioned.

3. Other causes are the deficiency of the natural stimuli, as hunger,
thirst, and want of fresh air. Other causes are great fatigue, want of
rest, fear, grief, or anxiety of mind. And lastly, the influence of
external ethereal fluids, as the defect of external heat, and of solar or
lunar gravitation. Of the latter the return of the paroxysms of continued
fevers about six o'clock in the evening, when the solar gravitation is the
least, affords an example of the influence of it; and the usual periods of
intermittents, whether quotidian, tertian, or quartan, which so regularly
obey solar or lunar days, afford instances of the influence of those
luminaries on these kinds of fevers.

4. If the tendency to torpor of some viscus is considerable, this will be
increased at the time, when the terrene gravitation is greatest, as
explained in the introduction to Class IV. 2. 4. and may either produce a
cold paroxysm of quotidian fever; or it may not yet be sufficient in
quantity for that purpose, but may nevertheless become greater, and
continue so till the next period of the greatest terrene gravitation, and
may then either produce a paroxysm of tertian fever; or may still become
greater, and continue so till the next period of greatest terrene
gravitation, and then produce a paroxysm of quartan ague. And lastly, the
periodical times of these paroxysms may exceed, or fall short of, the time
of greatest diurnal terrene gravitation according to the time of day, or
period of the moon, in which the first fit began; that is, whether the
diurnal terrene gravitation was then in an increasing or decreasing state.

V. _Sensation excited in Fever._

1. A curious observation is related by Dr. Fordyce in his Tract on Simple
fever, page 168. He asserts, that those people, who have been confined some
time in a very warm atmosphere, as of 120 or 130 degrees of heat, do not
feel cold, nor are subject to paleness of their skins, on coming into a
temperature of 30 or 40 degrees; which would produce great paleness and
painful sensation of coldness in those, who had been some time confined in
an atmosphere of only 86 or 90 degrees. Analogous to this, an observing
friend of mine assured me, that once having sat up to a very late hour with
three or four very ingenious and humorous companions, and drank a
considerable quantity of wine; both contrary to his usual habits of life;
and being obliged to rise early, and to ride a long journey on the next
day; he expected to have found himself weak and soon fatigued; but on the
contrary he performed his journey with unusual ease and alacrity; and
frequently laughed, as he rode, at the wit of the preceding evening. In
both these cases a degree of pain or pleasure actuated the system; and thus
a sensorial power, that of sensation, was superadded to that of irritation,
or volition. See Sect. XXXIV. 2. 6.

2. Similar to this, when the energetic exertions of some parts of the
system in the hot fit of fever arise to a certain excess, a degree of
sensation is produced; as of heat, which particularly increases the actions
of the cutaneous vessels, which are more liable to be excited by this
stimulus. When this additional sensorial power of sensation exists to a
greater degree, the pulse, which was before full, now becomes hard, owing
to the inflammation of the vasa vasorum, or coats of the arteries. In these
cases, whether there is any topical inflammation or not, the fever ceases
to intermit; but nevertheless there are daily remissions and exacerbations
of it; which recur for the most part about six in the evening, when the
solar gravitation is the least, as mentioned in Sect. XXXVI. 3. 7.

3. Thus the introduction of another sensorial power, that of sensation,
converts an intermittent fever into a continued one. If it be attended with
strong pulse, it is termed febris sensitiva irritata, or pyrexia, or
inflammation; if with a weak pulse, it is termed febris sensitiva
inirritata, or typhus gravior, or malignant fever. The seat of the
inflammation is in the glandular or capillary system, as it consists in the
secretion of new fluids, or new fibres, which form new vessels, as they
harden, like the silk of the silk-worm. See Art. 15. of this Supplement.

VI. _Circles of irritative Associate Motions._

1. There are some associate motions, which are perpetually proceeding in
our waking hours, and are catenated by their first link, or in some
subsequent parts of the chain, with the stimuli or the influence of
external things; which we shall here enumerate, as they contribute to the
knowledge of fever. Of these are the irritative ideas, or sensual motions
of the organs of sense, and the muscular motions associated with them;
which, when the chain is disturbed or interrupted, excite the sensorial
power of sensation, and proceed in confusion. Thus if the irritative ideas
of sight are disturbed, the paralactic motions of objects, which in general
are unperceived, become sensible to us; and the locomotive muscles
associated with them, which ought to preserve the body erect, stagger from
this decrease or interruption of the sensorial power of association; and
vertigo is produced.

When the irritative sensual motions, or ideas, belonging to one sense are
increased or diminished, the irritative sensual motions, or ideas, of the
other senses are liable to become disturbed by their general catenations;
whence occur noises in the ears, bad tastes in the mouth, bad odours, and
numbness or tingling of the limbs, as a greater or less number of senses
are affected. These constitute concomitant circles of disturbed irritative
ideas; or make a part of the great circle of irritative ideas, or motions
of the organs of sense; and when thus disturbed occasion many kinds of
hallucination of our other senses, or attend on the vertigo of vision.

2. Another great circle of irritative associated motions consists of those
of the alimentary canal; which are catenated with stimuli or with
influences external to the system, but continue to be exerted in our
sleeping as well as in our waking hours. When these associations of motion
are disturbed by the too great or too small stimulus of the food taken into
the stomach, or by the too great excess or deprivation of heat, or by
indigestible substances, or by torpor or orgasm occasioned by their
association with other parts, various diseases are induced under the names
of apepsia, hypochondriasis, hysteria, diarrhoea, cholera, ileus,
nephritis, fever.

3. A third circle of irritative associate motions consists of those of the
absorbent system; which may be divided into two, the lacteals, and the
lymphatics. When the stomach and intestines are recently filled with food
and fluid, the lacteal system is stimulated into great action; at the same
time the cellular, cutaneous, and pulmonary lymphatics act with less
energy; because less fluid is then wanted from those branches, and because
more sensorial power is expended by the lacteal branch. On this account
these two systems of absorbents are liable to act by reverse sympathy;
hence pale urine is made after a full dinner, as less of the aqueous part
of it is imbibed by the urinary lymphatics; and hence the water in anasarca
of the lungs and limbs is speedily absorbed, when the actions of the
lacteals of the stomach or intestines are weakened or inverted by the
exhibition of those drugs, which produce nausea, or by violent vomiting, or
violent cathartics.

Hence in diabetes the lacteal system acts strongly, at the same time that
the urinary lymphatics invert their motions, and transmit the chyle into
the bladder; and in diarrhoea from crapula, or too great a quantity of food
and fluid taken at a time, the lacteals act strongly, and absorb chyle or
fluids from the stomach and upper intestines; while the lymphatics of the
lower intestines revert their motions, and transmit this over-repletion
into the lower intestines, and thus produce diarrhoea; which accounts for
the speedy operation of some cathartic drugs, when much fluid is taken
along with them.

4. Other circles of irritative associate motions of great importance are
those of the secerning system; of these are the motions of the larger
congeries of glands, which form the liver, spleen, pancreas, gastric
glands, kidneys, salivary glands, and many others; some of which act by
direct and others by reverse sympathy with each other. Thus when the
gastric glands act most powerfully, as when the stomach is filled with
food, the kidneys act with less energy; as is shewn by the small secretion
of urine for the first hour or two after dinner; which reverse sympathy is
occasioned by the greater expenditure of sensorial power on the gastric
glands, and to the newly absorbed fluids not yet being sufficiently
animalized, or otherwise prepared, to stimulate the secretory vessels of
the kidneys.

But those very extensive glands, which secrete the perspirable matter of
the skin and lungs, with the mucus, which lubricates all the internal cells
and cavities of the body, claim our particular attention. These glands, as
well as all the others, proceed from the capillary vessels, which unite the
arteries with the veins, and are not properly a part of them; the mucous
and perspirative glands, which arise from the cutaneous and pulmonary
capillaries, are associated by direct sympathy; as appears from immersion
in the cold bath, which is therefore attended with a temporary difficult
respiration; while those from the capillaries of the stomach and heart and
arteries are more generally associated by reverse sympathy with those of
the cutaneous capillaries; as appears in fevers with weak pulse and
indigestion, and at the same time with a hot and dry skin.

The disturbed actions of this circle of the associate motions of the
secerning system, when the sensorial power of sensation is added to that of
irritation, frequently produces inflammation, which consists in the
secretion of new fluids or new vessels. Nevertheless, if these disturbed
actions be of the torpid kind, the pain, which attends them, is seldom
productive of inflammation, as in hemicrania; but is liable to excite
voluntary actions, and thus to expend much sensorial power, as in the
shuddering in cold fits of fever, or in convulsions; or lastly the pain
itself, which attends torpid actions, is liable to expend or exhaust much
sensorial power without producing any increased actions; whence the low
pulse, and cold extremities, which usually attend hemicrania; and hence
when inert, or inactive sensation attends one link of associated action,
the succeeding link is generally rendered torpid, as a coldness of the
cheek attends tooth-ach.

5. A fifth important circle of irritative motions is that of the
sanguiferous system, in which the capillary vessels are to be included,
which unite the arterial and venous systems, both pulmonary and aortal. The
disturbed action of this system of the heart and arteries, and capillaries,
constitute simple fever; to which may be added, that the secerning and
absorbent vessels appending to the capillaries, and the bibulous mouths of
the veins, are in some measure at the same time generally affected.

6. Now, though the links of each of these circles of irritative motions are
more strictly associated together, yet are they in greater or less degree
associated or catenated with each other by direct or reverse sympathy. Thus
the sickness, or inverted irritative motions of the stomach, are associated
or catenated with the disturbed irritative ideas, or sensual motions, in
vertigo; as in sea-sickness. This sickness of the stomach is also
associated or catenated with the torpor of the heart and arteries by direct
sympathy, and with the capillaries and absorbents by reverse sympathy; and
are thus all of them liable occasionally to be disturbed, when one of them
is diseased; and constitute the great variety of the kinds or symptoms of
fevers.

VII. _Alternation of the cold and hot Fits._

1. When any cause occurs, which diminishes to a certain degree the supply
of sensorial power in respect to the whole system; as suppose a temporary
inexertion of the brain; what happens? First, those motions are exerted
with less energy, which are not immediately necessary to life, as the
locomotive muscles; and those ideas, which are generally excited by
volition; at the same time this deficiency of voluntary motion is different
from that which occurs in sleep; as in that the movements of the arterial
system are increased in energy though not in frequency. Next, the motions
of the alimentary canal become performed with less energy, or cease
altogether; and a total want of appetite to solid food occurs, or sickness,
or a diarrhoea occasioned by the indigested aliment. Then the absorbent
vessels cease to act with their due energy; whence thirst, and pale urine,
though in small quantities. Fourthly, the secerning vessels become affected
by the general diminution of sensorial power; whence all the secreted
fluids are produced in less quantity. And lastly, the sanguiferous canals
feel the general torpor; the pulsations of the heart and arteries become
feeble, and consequently quick; and the capillaries of the skin become
inactive, acquire less blood from the arteries, and are consequently paler
and shrunk.

In this last circumstance of the torpor of the sanguiferous system consists
inirritative fever; as all the others are rather accidental or concomitant
symptoms, and not essential ones; as fewer or more of them may be present,
or may exist with a greater or less degree of inactivity.

2. Now as the capillaries of the skin are exposed to greater varieties of
heat and cold, than the heart and arteries, they are supposed to be more
mobile, that is, more susceptible of torpor or exertion, or to
inflammation, by external stimuli or influences, than the other parts of
the sanguiferous system; and as the skin is more sensible to the presence
of heat, than the internal parts of the body, the commencement of the cold
paroxysms of fever generally either first exists in, or is first perceived
by, the coldness and paleness of the skin; and the commencement of the hot
fits by the heat and redness of it.

3. The accumulation of sensorial power occurs in these organs soonest, and
in greatest quantity, during their quiescence, which were most perpetually
in action during health; hence those parts of the system soonest recover
from torpor in intermittent fever, and soonest fall into the contrary
extreme of increased activity; as the sanguiferous system of the heart and
arteries and capillaries. But of these the capillaries seem first to
acquire a renovation of their action, as the heat of the skin becomes first
renewed, as well as increased beyond its natural quantity, and this in some
parts sooner than in others; which quantity of heat is however not to be
estimated simply by the rise of the mercury in the thermometer, but also by
the quantity carried away into the atmosphere, or diffused amongst other
bodies in a given time; as more heat passes through water, which boils
vehemently, than when it boils gently, though the rise of the thermometer
in both cases continues the same. This fact may be known by boiling an egg
in water, the white of which coagulates in much less time, if the water
boils vehemently, than if it boils moderately, though the sensible heat of
the water is the same in both cases.

Another cause, which induces the cutaneous capillaries to renew their
actions sooner than the heart and arteries after immersion in the cold
bath, is, that their torpor was occasioned by defect of irritation; whereas
that of the heart and arteries was occasioned by defect of association;
which defect of association was owing to the decreased actions of the
capillaries, and is now again excited by their renewed action; which
excitement must therefore be subsequent to that increased action of the
capillaries; and in consequence the increased action of the heart and
arteries at the commencement of the hot fit of some fevers is subsequent to
the increased action of the cutaneous capillaries. There is, however, in
this case an accumulation of the sensorial power of association in the
heart and arteries, which must contribute to increase their orgasm in the
hot fit, as well as the increased excitement of it by the increased action
of the capillaries.

4. Now this increased action of the system, during the hot fit, by
exhausting the sensorial powers of irritation and association, contributes
to induce a renewal of the cold paroxysm; as the accumulation of those
sensorial powers in the cold fit produces the increased actions of the hot
fit; which two states of the system reciprocally induce each other by a
kind of libration, or a plus and minus, of the sensorial powers of
irritation and association.

If the exhaustion of sensorial power during the hot fit of fever only
reduces the quantity of irritability and associability to its natural
standard, the fever is cured, not being liable to return. If the quantity
of these sensorial powers be reduced only so much, as not to produce a
second cold fit during the present quantity of external stimuli or
influences; yet it may be so far reduced, that a very small subtraction of
stimulus, or of influence, may again induce a cold fit; such as the
coldness of the night-air, or the diminution of solar or lunar gravitation,
as in intermittent fevers.

5. Another cause of the renovation of the cold fits of fever is from some
parts of the system not having completely recovered from the former cold
paroxysm; as happens to the spleen, liver, or other internal viscus; which
sometimes remains tumid, and either occasions a return of the cold fit by
direct sympathy with other parts of the body, or by its own want of action
causes a diminution of the general quantity of heat, and thus facilitates
the renovation of the torpor of the whole system, and gives cause to
intermittent fevers catenated with lunar or solar influence.

VIII. _Orgasm of the Capillaries._

As the remaining torpor of some less essential part of the system, as of
the spleen, when the hot fit ceases, produces after one, two, or three days
a return of cold fit by direct sympathy with the cutaneous capillaries,
when joined with some other cause of torpor, as the defect of solar or
lunar influences, or the exposure to cold or hunger, and thus gives origin
to intermittent fever; so the remaining torpor of some more essential parts
of the system, as of the stomach and intestines, is probably the cause of
the immediate recurrence of the cold paroxysm, at the time the hot one
ceases, by their direct sympathy with the cutaneous capillaries, without
the assistance of any other cause of torpor; and thus produces remittent
fever. And lastly the remaining torpor of some still more essential parts
of the system, as the heart and arteries, after the hot fit ought to cease,
is liable by reverse sympathy with the cutaneous capillaries to continue
their orgasm, and thus to render a fever continual, which would otherwise
remit or intermit.

Many difficulties here occur, which we shall endeavour to throw some light
upon, and leave to future investigation; observing only that difficulties
were to be expected, otherwise fevers would long since have been
understood, as they have employed the unremitted attention of the
physicians of all ages of the world.

1. Why do the same parts of successive trains of action sometimes affect
each other by direct, and sometimes by reverse sympathy?--1st, When any
irritative motion ceases, or becomes torpid, which was before in perpetual
action; it is either deprived of its usual stimulus, and thence the
sensorial power of irritation is not excited; or it has been previously too
much stimulated, and the sensorial power has been thus exhausted.

In the former case an accumulation of sensorial power soon occurs, which is
excitable by a renewal of the stimulus; as when the fingers, which have
been immersed some time in snow, are again exposed to the usual warmth of a
room. Or, secondly, the sensorial power of irritation becomes so much
accumulated, that the motions, which were torpid, are now performed by less
stimulus than natural; as appears by the warmth, which soon occurs after
the first chill in going into frosty air, or into the bath at Buxton, which
is about eighty degrees of heat. Or, lastly, this accumulation of the
sensorial power of irritation so far abounds, that it increases the action
of the next link of the associated train or tribe of motions; thus on
exposing the skin to cold air, as in walking out in a frosty morning, the
actions of the stomach are increased, and digestion strengthened.

But where the torpor of some irritative motion is owing to the previous
exhaustion of the sensorial power of irritation by too great stimulus, the
restoration of it occurs either not at all, or much more slowly than in the
former instances; thus after intoxication the stomach is very slow in
recovering its due quantity of the sensorial power of irritation, and never
shews any accumulation of it.

2. When an associate motion, as described in the introduction to Class IV.
1. 1. acts with less energy, the sensorial power of association is either
not sufficiently excited by the preceding fibrous motions; or it has been
expended or exhausted by the too violent actions of the preceding fibrous
motions. In the former case there occurs an accumulation of the sensorial
power of association; exactly as, where the usual stimulus is withdrawn,
there occurs an accumulation of the sensorial power of irritation. Thus
when the actions of the capillaries of the skin are diminished by immersion
in cold water, the capillaries of the lungs are rendered torpid by the want
of the excitement of the sensorial power of association, owing to the
lessened actions of the previous fibrous motions, namely, of those of the
skin. Nevertheless as soon as the capillaries of the skin regain their
increased activity by the accumulation of the sensorial power of
irritation, these capillaries of the lungs act with greater energy also
owing to their accumulated sensorial power of association. These are
instances of direct sympathy, and constitute the cold and hot paroxysms of
intermittent fever; or the first paroxysm of a continued one.

3. When the first link of a train of associated motions, which is subject
to perpetual action, becomes a considerable time torpid for want of being
excited by the previous exertions of the irritative motions, with which it
is catenated; the sensorial power of association becomes accumulated in so
great a degree as to affect the second link of the train of associated
motions, and to excite it into stronger action. Thus when the stomach is
rendered torpid by contagious matter swallowed into it mixed with the
saliva, the heart and arteries act more feebly; because the sensorial power
of association, which used to be excited by the fibrous motions of the
stomach, is not now excited; and in consequence the motions of the heart
and arteries act only by the sensorial power of irritation, which is
excited by the stimulus of the blood.

But during this torpor of the stomach, and less action of the heart and
arteries, so great an accumulation of the sensorial powers of irritation
and of association occurs, that it adds to the action of the next link of
this vital circle of actions, that is, to that of the cutaneous
capillaries. Whence in this situation the torpor of the stomach occasions a
diminished action of the heart and arteries by direct sympathy, and may be
said to occasion an increased one of the cutaneous capillaries by reverse
sympathy; which constitute continued fever with weak pulse.

Nor is this increased action of the capillaries in consequence of the
decreased action of the heart and arteries, as in fevers with weak pulse, a
single fact in the animal economy; though it exists in this case in the
greatest degree or duration, because the heart and arteries are perpetually
in greater action than any other part of the system. But a similar
circumstance occurs, when the stomach is rendered inactive by defective
excitement of the sensorial power of association, as in sea-sickness, or in
nephritis. In these cases the sensorial power of association becomes much
accumulated in the stomach, and seems by its superabundance to excite the
absorbent system, which is so nearly connected with it, into great increase
of action; as is known by the great quantity frequently in these situations
rejected by vomit, which could not otherways be supplied. It is probable
the increase of digestion by walking in frosty air, with many other animal
facts, may by future observations be found to be dependent on this
principle, as well as the increased action of the capillaries in continued
fevers with weak pulse.

Whereas in continued fever with strong pulse, which may perhaps occur
sometimes on the first day even of the plague, the stomach with the heart
and arteries and the capillaries act by direct sympathy; that is, the
stomach is excited into stronger action by increased irritation owing to
the stimulus of contagious matter; these stronger irritative motions of the
stomach excite a greater quantity of the sensorial power of association,
which then actuates the heart and arteries with greater energy, as these
are catenated with the stomach; and in the same manner the increased
actions of the heart and arteries excite a greater quantity of the
sensorial power of association, which actuates the cutaneous capillaries
with increase of energy. See Class IV. 1. 1.

4. I shall dwell a little longer on this intricate subject. The
commencement of fever-fits is known by the inactivity of the cutaneous
capillaries, which inactivity is observable by the paleness and coldness of
the skin, and also by the pain of coldness, which attends it. There is
nevertheless in most cases, except those which are owing to exposure to
external cold, a torpor of the capillaries of some internal viscus
preceding this inactivity of the cutaneous capillaries; which is known, by
the tumour or hardness of the viscus, or by an aching pain of it. The
capillaries of the lungs are at the same time rendered inactive or torpid,
as appears by the difficulty of breathing, and coldness of the breath in
cold fits of fever, and in going into the cold bath; but the lungs are not
affected with the pain either of coldness or of torpor.

One cause of this synchronous or successive inactivity of the cutaneous
capillaries, in consequence of the previous torpor of some internal viscus,
may be owing to the deficiency of heat; which must occur, when any part
becomes inactive; because the secretions of that part cease or are
lessened, and the quantity of heat of it in consequence. But the principal
cause of it I suppose to be owing to the defect of the sensorial power of
association; which power of association is excited by some previous or
concomitant motions of the parts of every great circle of actions. This
appears on going into the cold bath, because the shortness of breath
instantly occurs, sooner than one can conceive the diminution of the heat
of the skin could affect the lungs by the want of its stimulus; but not
sooner than the defect of the sensorial power of association could affect
them; because this must cease to be excited into action on the instant that
the cutaneous capillaries cease to act; whence in the first moment of
contact of the cold water the cutaneous capillaries cease to act from
defect of irritation; which is caused by defect of the stimulus of heat;
and in the second moment the capillaries of the lungs cease to act from the
defect of association; which is caused by the defect of the motions of the
cutaneous capillaries. Thus the universal torpor in the cold paroxysm of
fever is an example of direct sympathy, though occasioned in part by defect
of irritation, and in part by defect of association.

5. Thus in walking out in a frosty morning the skin is cooled by the
contact of the cold air, whence the actions of its capillaries are
diminished for want of their usual stimulus of heat to excite a sufficient
quantity of the sensorial power of irritation. Hence there is at first a
saving of sensorial power of irritation for the purpose of actuating the
other parts of the system with greater energy. Secondly the sensorial power
of association, which used to be excited by the motions of the cutaneous
capillaries, is now not so powerfully excited; and in consequence the
parts, which constitute the next links of the circles of associated
motions, are for a time actuated with less energy, and a temporary general
chillness succeeds; which is so far similar to the cold fit of intermittent
fever.

In this situation there is a curious circumstance occurs, which merits
peculiar attention: after a short time, though the external skin continues
cool by its exposure to the cold air, and the actions of its capillaries
are consequently diminished, yet the capillaries of the stomach act with
greater energy; as is known by increased digestion and consequent hunger.
This is to be ascribed to the accumulation of the sensorial power of
irritation, which now excites by its superabundance, or overflowing, as it
were, the stomach into increased action; though it is at the same time
excited less powerfully than usual by the sensorial power of association.
Thus the accumulation of the sensorial power of irritation in the vessels
of the skin increases in this case the action of the stomach, in the same
manner as an accumulation of the sensorial power of association in the
heart and arteries in fevers with weak pulse increases the action of the
capillaries.

If nevertheless the coldness of the skin be too long continued, or exists
in too great a degree, so as in some measure to impair the life of the
part, no further accumulation of the sensorial power of irritation occurs;
and in consequence the actions of the stomach become less than natural by
the defect of the sensorial power of association; which has ceased to be
excited by the want of action of the cutaneous capillaries. Whence
continued coldness of the feet is accompanied with indigestion and
heartburn. See Class IV. 2. 1. 6.

6. Similar to this when the actions of the stomach are rendered torpid by
the previous stimulus of a violent emetic, and its motions become
retrograde in consequence, a great quantity of sensorial power is exerted
on the lymphatics of the lungs, and other parts of the body; which excites
them into greater direct action, as is evinced by the exhibition of
digitalis in anasarca. In this situation I suppose the emetic drug
stimulates the muscular fibres of the stomach into too great action; and
that in consequence a great torpor soon succeeds; and that this inaction of
the muscular parts of the stomach is not followed by much accumulation of
the sensorial power of irritation; because that sensorial power is in great
measure exhausted by the previous excessive stimulus. But the lymphatics of
the stomach have their actions lessened by defect of the sensorial power of
association, which is not now excited into action, owing to the lessened
motions of the muscular parts of it, with which the lymphatics are
associated. The sensorial power of association becomes therefore
accumulated in these lymphatics of the stomach, because it is not excited
into action; exactly as the power of irritation becomes accumulated in the
hand, when immersed in snow; and this accumulated sensorial power of
association excites the lymphatic of the lungs and of other parts, which
are most nearly associated with those of the stomach, into more energetic
actions. Thus the muscular fibres of the stomach act with the lymphatics of
that organ in direct sympathy; and the lymphatics of the stomach act in
reverse sympathy with those of the lungs and of other parts of the body;
the former of which is caused by defect of the excitement of the sensorial
power of association, and the latter by the accumulation of it.

Besides the efficient cause, as above explained, the final cause, or
convenience, of these organic actions are worthy our attention. In this
case of an acrid drug swallowed into the stomach the reverted actions of
the muscular fibres of the stomach tend to eject its enemy; the reverted
actions of its lymphatics pour a great quantity of fluids into the stomach
for the purpose of diluting or washing off the noxious drug; and the
increased actions of the other lymphatics supply these retrograde ones of
the stomach with an inconceivable supply of fluids, as is seen in Ileus and
Cholera.

7. The inquisitive reader will excuse my continuing this subject, though
perhaps with some repetitions, as it envelopes the very essence of fever.
When the first link of a train of actions is excited by excessive stimulus,
or excessive irritability, and thus acts with unusual energy by the
increased quantity of irritation, these increased motions excite a greater
quantity of the sensorial power of association, which causes increased
motions in the second link, which is catenated with the first; and then the
excessive action of this second link excites also a greater quantity of the
sensorial power of association, which increases the motions of the third
link of this chain of association, and thus the increase of the stimulus on
the irritative motions, to which the chain of association is catenated,
increases the action of the whole chain or circle of associated motions.

After a time the irritative motions become torpid by expenditure of the
sensorial power of irritation, and then the power of association also
becomes less exerted, both because it has been in part exhausted by too
great action, and is now less excited by the lessened action of the
irritative motions, wh