ZOONOMIA; OR THE LAWS OF ORGANIC LIFE. IN THREE PARTS. By ERASMUS DARWIN, M. D. F.R.S. AUTHOR OF THE BOTANIC GARDEN, PHYTOLOGIA, Principio coelum, ac terras, campofque liquentes, Lucentemque globum lunae, titaniaque aftra, Spiritus intus alit, totamque infufa per artus Mens agitat malem, et magno fe corpore mifcet. Virg. Ain. vi. Earth, on whofe lap a thoufand nations tread, And Ocean, brooding his prolific bed, Night's changeful orb, blue pole, and filvery zones, Where other worlds encircle other funs, One mind inhabits, one difiufive Soul Wields the large limbs, and mingles with the whole. COMPLETE IN TWO VOLUMES. Volume IL THIRD AMERICAN EDITION. BOSTON: PUBLISHED BY THOMAS & ANDREWS, No. 45, Newbury-Street.--1809. J. 7. BUCKINGHAM, PRINTER, WINTER.-STREET. ZOONOMIA; OR, THE LAWS OF ORGANIC LIFE. PART II. CONTAINING A CATALOGUE OF DISEASES, DISTRIBUTED INTO NATURAL CLASSES, ACCORDING TO THEIR PROXIMATE CAUSES, WITH THEIR SUBSEQUENT ORDERS, GENERA, AND SPECIES, AND WITH THEIR METHODS OF CURE. Hase, ut potero, explicabo ; nec tamen, quafi Pythius Apollo, certa ut fint et fixa, quze dixero; fed ut Homunculus unus e multis probabiliora conjedtura fe- quens. Cic. Tusc. Disp. I. 1. 9. PREFACE. ALL difeafes originate in the exuberance, deficiency, ©r retrograde adion, of the faculties of the fenforium, as their proximate caufe ; and confift in the difordered motions of the fibres of the body, as the proximate ef- fed of the exertions of thofe difordered faculties. The fenforium poffeffes four diftind powers, or facul- ties, which are occafionally exerted, and produce all the motions of the fibrous parts of the body; thefe are the faculties of producing fibrous motions in confequence of irritation, which is excited by external bodies ; in con- fequence of fenfation, which is excited by pleafure or pain ; in confequence of volition, which is excited by de- fire or averfion ; and in confequence of affociation, which is excited by other fibrous motions. We are hence fupplied with four natural claffes of difeafes de- rived from their proximate caufes ; which we fhall term thofe of irritation, thofe of fenfation, thofe of volition, and thofe of affociation. In VI PREFACE. In the fubfequent claflification of difeafes I have not adhered to the methods of any of thofe who have pre- ceded me ; the principal of whom are the great names of Sauvages and Cullen ; but have neverthelefs availed myfelf, as much as I could, of their definitions and dif- tindions. The eflential charaderiftic of a difeafe confifts in its proximate caufe, as is well obferved by Dodor Cullen, in his Nofologia Methodica, T. ii. Prolegom. p. xxix. Similitudo quidem morborum in fimilitudine caufae eorum proximo, qualifcunque fit, revera confiftit. I have taken the proximate caufe for the claflic character. The characters' of the orders are taken from the excefs, or deficiency, or retrograde adion, or other properties, of the proximate caufe. The genus is generally derived from the proximate effed. And the fpecies generally from the locality of the difeafe in the fyftem. Many fpecies in this fyftem are termed genera in the fyftems of other writers ; and the fpecies of thofe wri- ters, are, in confequence, here termed varieties. Thus, in Dr. Cullen's Nofologia, the variola or fmall-pox is termed a genus, and the diftind and confluent kinds are termed fpecies. But as the infedion from the diftind kind frequently produces the confluent kind, and that of the confluent kind frequently produces the diftind ; it would feem more analogous to botanical arrangement, which thefe nofologifts profefs to imitate, to call the dif- tind and confluent fmall-pox varieties than fpecies. Becaufe the fpecies of plants in botanical fyftems prop- agate others fimilar to themfelves ; which does not uni- formly occur in fuch vegetable produdions as are term- ed varieties. In PREFACE. VII In fome other genera of nofologifts the fpecies have no analogy to each other, either in refpeft to their prox- imate caufe, or to their proximate effect, though they may be fomewhat fimilar in lefs eflential properties.; thus the thin and faline difcharge from the noftrils on going into the cold air of a frofty morning, which is owing to the deficient adion of the abforbent veffels of the nof- trils, is one fpecies ; and the vifcid mucus difcharged from the fecerning veffels of the fame membrane, when inflamed, is another fpecies of the fame genus, Catarrhus. Which bear no analogy either in refpect to their imme- diate caufe, or to their immediate effect. The ufes of the method here offered to the public, of clafling difeafes according to their proximate caufes, are, firft, more diftindly to understand their nature by com- paring their eflential properties. Secondly, to facilitate the knowledge of the methods of cure ; fince in natural claflification of difeafes the fpecies of each genus, and in- deed the genera of each order, a few perhaps excepted, require the fame general medical treatment. And laftly, to difcover the nature and the name of any difeafe previ- oufly unknown to the phyfician ; which I am perfuaded will be more readily and more certainly done by this natural fyltem, than by the artificial claflifications alrea- dy published. The common names of difeafes are not well adapted to any kind of claflification, and leaft of all to this, from their proximate caufes. Some of their names in com- mon language are taken from the remote caufe, as worms, ftone of the bladder ; others from the remote effect, as diarrhoea, falivation, hydrocephalus ; others from fome accidental fymptom of the difeafe, as tooth- ach. VIII PREFACE. ach, head-ach, heart-burn ; in which the pain is only a concomitant circumftance of the excefs or deficiency of fibrous actions, and not the caufe of them. Others again are taken from the deformity occafioned in confe- quence of the unnatural fibrous motions, which confti- tute difeafes, as tumours, eruptions, extenuations ; all thefe therefore improperly give names to difeafes ; and fonre difficulty is thus occafioned to the reader in en- deavouring to difcover to what clafs fuch diforders belong. Another difficulty attending the names of difeafes is, that one name frequently includes more than one difeafe, either exifting at the fame time or in fucceffion. Thus the pain of the bowels from worms is caufed by the in- creafed action of the membrane from the ftimulus of thofe animals ; but the convulfions, which fometimes fuc- ceed thefe pains in children, are caufed by the confequent volition, and belong to another clafs. To difcover under what clafs any difeafe fhould be ar- ranged, we muft firft inveftigate the proximate caufe ; thus the pain of the tooth-ach is not the caufe of any difeafed motions, but the effect ; the tooth-ach there- fore does not belong to the clafs of Senfation. As the pain is caufed by increafed or decreafed action of the membranes of the tooth, and thefe actions are owing to the increafe or decreafe of irritation, the difeafe is to be placed in the clafs of Irritation. To difcover the order it muft be inquired, whether the pain be owing to increafed or defective motion of the pained membrane ; which is known by the concom- itant heat or coldnefs of the part. In tooth-ach without inflammation PREFACE. IX inflammation there is generally a coldnefs attends the cheek in its vicinity ; as may be perceived by the hand of the patient himfelf compared with the oppofite check. Hence odontalgia is found to belong to the order of de- creafed irritation. The genus and fpecies muft be found by infpe&ing the fynopfis of the fecond order of the clafs of Irritation. See Clafs I. 2. 4. 12. This may be further elucidated by confidering the natural operation of parturition ; the pain is occafioned by the increafed action or diftention of the veffels of the uterus, in confequence of the ftimulus of the fetus ; and is therefore caufed by increafed irritation ; but the ac- tions of the abdominal mufcles in its exclufion are cauf- ed by the pain, and belong to the clafs of increafed fen- fation. See Clafs II. 1. 1. 12. Hence the difficulty of determining, under what clafs of difeafes parturition fhould be arranged, confifts in there being two kinds of difeafed actions comprehended under one word ; which have each their different proximate caufe. In Sed. XXXIX. 8. 4. and in Clafs II. 1. I. 1. we have endeavoured to give names to four links of animal caufation, which conveniently apply to the claffification of difeafes ; thus in common niditation, or winking with the eyes without our attention to it, the increafed irrita- tion is the proximate caufe ; the ftimulus of the air on the dry cornea is the remote caufe; the doling of the eyelid is the proximate effect; and the diffufion of tears over the eyeball is the remote effect. In fome cafes two more links of caufation may be introduced ; one of them may be termed the preremote caufe ; as the warmth . or motion of the atmofphere, which caufes greater exhalation from the cornea. And the other the poft-re; Vol. II. b mqto PREFACE. X mote effect ; as the renewed pellucidity of the cornea ; and thus fix links of caufation may be expreffed in words. But if amid thefe remote links of animal caufation any of the four powers or faculties of the fenforium be intro- duced, the reafoning is not juft according to the method here propofed ; for thefe powers of the fenforium are always the proximate caufes of the contractions of an- imal fibres ; and therefore in true language cannot be termed their remote caufes. From this criterion it may always be determined, whether more difeafes than one are comprehended under one name ; a circumftance which has much impeded the inveftigation of the caufes, and cures of difeafes. Thus the term fever, is generally given to a colledion of morbid fymptoms ; which are indeed fo many diftind difeafes, that fometimes appear together, and fometimes feparately; hence it has no determinate meaning, except it fignifies fimply a quick pulfe, which continues for fome hours ; in which fenfe it is here ufed. In naming difeafes I have endeavoured to avoid the aftedation of making new compound Greek words, where others equally expreflive could be procured : as a fhort periphrafis is eafier to be underftood, and lefs burdenfome to the memory. In the Methodus Medendi, which is marked by M. M. at the end of many of the fpecies of difeafes, the words incitantia, forbentia, torpentia, &c. refer to the articles of the Materia Medica, explaining the operations of medicines. The PREFACE. XI The remote caufes of many difeafes, their periods, and many circumftances concerning them, are treated of in the preceding volume ; the defcriptions of many of them, which I have omitted for the fake of brevity, may be feen in the Nofologia Methodica of Sauvages, and in the Synopfis Nofologia of Dr. Cullen, and in the authors to which they refer. In this arduous undertaking the author folicits the candour of the critical reader ; as he cannot but forefee, that many errors will be difcovered, many additional fpe- cies will require to be inferted ; and others to be tranf- planted or erafed. If he could expend another forty years in the pradice of medicine, he makes no doubt, but that he could bring this work nearer perfection, and thence render it more worthy the attention of philofo- phers. As it is, he is induced to hope, that fome ad- vantages will be derived from it to the fcience of medi- cine, and confequent utility to the public, and leaves the completion of his plan to the induftry of future genera- tions. Derby, Jan. i, 1796. ZOONOMIA. PART II. CLASSES OF DISEASES. I. DISEASES OF IRRITATION. IL DISEASES OF SENSATION. III. DISEASES OF VOLITION. IV. DISEASES OF ASSOCIATION. The Orders and Genera of the Firf Clafs of Difeafes'. CLASS I. DISEASES OE IRRITATION. ORDO I. Increafed Irritation. GENERA. I. With increafed aflions of the fanguiferous fyftem. 2. With increafed actions of the fecerning fyftem. 3. With increafed actions of the abforbent fyftem. 4. With increafed actions of other cavities and membranes. 5. With increafed actions of the organs of fenfe. ORDO II. Decreafed Irritation. GENERA. r. With decreafed actions of the fanguiferous fyftem. 2. With decreafed actions of the fecerning fyftem. 3. With decreafed actions of the abforbent fyftem. Vol. II. B 4. With DISEASES 2 4. With decreafed anions of other cavities and membranes. 5. With decreafed actions of the organs of fenfe. ORDO III. Retrograde Irritative Motions. GENERA. 1. Of the alimentary canal. 2. Of the abforbent fyftem. 3. Of the fanguiferous fyftem. ClassI. 1. 1. The Orders, Genera, and Species, of the Firjl Clafs of Dif- eafes. CLASS I. DISEASES OF IRRITATION. ORDO I. Increafed Irritation. GENUS I. With increafed Actions of the Sanguiferous Syfem. SPECIES. I. Febris irritativa 2. Ebrietas 3. Hamorrhagia arteriofa 4. Hamoptoe arteriofa 5. Hamorrhagia narium Irritative fever Drunkennefs Arterial Hemorrhage Spitting of arterial blood. Bleeding from the nofe GENUS II. With increafed allions of the Secerning Syttem. I. Calorfebrilis 2. Ruborfebrilis 3. Sudsr Calidus Sudor febrilis a labore ab igne a medicamentis 4. Urina uberior colorata SPECIES. Febrile heat Febrile rednefs Warm fweat Sweat in fevers from exercife from fire from medicines Copious coloured urine 5. Diarrhoea Class I. 1. 3. OF IRRITATION. 3 3. Diarrhoea calida. febrilis crapulofa - infantum 6. Salivatio calida 7. Catarrhus calidus 8. Expedioratio calida 9. Exfudatio pone aures I®. Gonorrhoea calida 11. Fluor albus calidus 12. Hamorrhois alba 13. Serum e vifcatorio 14. Perfpiratio joetida 15. Crines novi. Warm diarrhoea Diarrhoea from fever ■ -- from indigeltion of infants Warm falivation catarrh expectoration Difcharge behind the ears Warm gonorrhoea fluor albus White piles Difcharge from a blitter Fetid perfpiration New hairs GENUS III. With increafed Actions of the Abforbent Syfem. SPECIES. 1. Lingua arida 2. Fauces arida 3. Nares aridi 4. Expedioratio folida 5. Conjlipatio alvi 6. Cutis arida "j. Urina parcior color at a 8. Calculus felleus et idler us g, - renis t o, veftca 11, - arthriticus 12. Rheumatifmus chronicus 13. Cicatrix vulnerum 14. Cornea obfufcatio Dry tongue Dry throat Dry noflrils Solid expectoration Coftivenefs Dry (kin Diminifhed coloured urine Gall-ftone and jaundice Stone of the kidney Stone of the bladder Gout-ftone Chronic rheumatifm Healing of ulcers Scar on the cornea GENUS IV. With increafed Actions of other Cavities and Membranes* SPECIES. I. Nidlitatio irritativa 2, Deglutitio irritativa 3. Refpiratio et tuffs 4. Exclufto bilis 5. Dentitio 6- Priapifmus 7. Difendio mammularum Irritative nictitation Irritative deglutition Refpiration and cough Exclufion of the bile Toothing Priapifm Diftention of the nipples 8. Defcenfus, DISEASES ClassI. 1. 5; 4 8- Defcenfus uteri f). Prolapfus ani IO. Lumbricus II. Ttenia 12 Afcarides 13. Dracunculus 14. Morpiones 15. Pediculi Defcent of the uterus Defcentof the re&um Round worm Tape- worm Thread-worms Guinea worm Crab-lice Lice GENUS V. With increafed Allions of the Organs of Senfei SPECIES. I. Vifcus acrior 2. Auditus acrior 3. Oh alius acrior 4 Guji us acrior 5. TaRus acrior 6. Senfus caloris acrior "]• extenfionis acrior 8. Titillatio 9. Pruritus io Dolor urens II. GonHernatio Acuter fight hearing fmell tafte touch fenfeofheat fenfe of extenfion Tickling Itching Smarii ig Surpnie ORDO IL Decreafed Irritation. GENUS I. With decreafed Actions of the Sanguiferous Syjlenu 1. Febris inirritativa 2. Parefis inirritativa 3. Sctnnus inter ruptus 4. Syncope 5. Hamorrhagia venofa 6. Hamorrhois cruenta 7. Hamorrhagia renum 8. hepatis 9. Heemopt oe venofa 10. PA pit at io cordis II. Menorrbagia 12. Dyjmenorrhagia 13. Lochia nimia 14. Abort™fpontanea SPECIES. Inirritative fever debility Interrupted fleep Fainting Venous haemorrhage Bleeding piles from the kidneys Bleeding from the liver Spitting of venous blood Palpitation of the heart Exuberant menftruation Deficient menftruation Too great lochia Spontaneous abortion 15. Scorbiitus Class I. 2. 2. OF IRRITATION. 5 13. Scorbutus 16. Vibices 17. Petechia 18 Aneurifma 19. Varix Scurvy Extravafations of blood Purple fpots Aneurifm Swelling of veins GENUS II. With decreafed Actions of the Secerning Syfem. I. Frigus febrile chronicum 2. Pallor fugitivus. permanent 3 Pus parcius. 4. Mucus parcior Urina parcior pallida 6. Torpor hepaticus 7 Torpor pancreatis 8. Torpor renis 9. Pun eta mucofe vidius io. Macula cutis fulva 11. Canities 12. Callus 13. Cataracla 14. Innutritio ofjium 15. Rachitis 16. Spina difortio 17. Claudicatio coxaria 18. Spina protuberans 19 Spina bifida 20. Def ePt us palati SPECIES. Coldnefs in fevers --- permanent Palenefs fugitive permanent Diminilhed pus Diminilhed mucus Pale diminilhed urine Torpor of the liver Torpor of the pancreas Torpor of the kidney Mucous fpots on the face Tawny blots on the ikin Grey hairs Callus Cataraft Innutrition of the bones Rickets Diliortion of the fpine Lamenefs of the hip Protuberant fpine Divided fpine Defeat of the palate GENUS III. With decreafed Actions of the Abforbent Syfem. SPECIES. I. Mucus faucium frigidus 2. Sudorfrigidus 3. Catarrhus frigidus 4. Expecloratio frigida 5. Urina uberior pallida 6- Diarrhoea frigida •j. Fluor albus frigidus 8. Gonorrhoea frigida Cold mucus from the throa't fweat catarrh expe&oration Copious pale urine Cold diarrhoea Fluor albus -- gonorrhoea 9. Hepatis Class I. 2. 4. 6 DISEASES 9. Hepatic tumor io. Chlorofts 11. Hydrocele 12. Hydrocephalus internus 13. A/cites 14, Hydrothorax 15. Hydrops ovarii 16. Ana/area pulmonum 17. O befit as 18. Splenis tumor 19 Genu tumor albus 20. Bronchocele 21. Scrofula 22. Scirrhus 23. --- recti 24. urethra 25. oefophagi •26. Lacleorum inirritabilitas 27. Lymphaticorum inirritabili- tas Swelling of the liver Green ficknefs Dropfy of the vagina teftis of the brain ■ ■ -- of the belly of the cheft • ' of the ovary of the lungs Corpulency Swelling of the fpleen White fwelling of the knee Swelled throat King's evil Scirrhus of the rectum of the urethra - of the throat Inirritability of the la&eals Inirritability of the lymphatics GENUS IV. With decreafed Adlions of other Cavities and Membranes. SPECIES. I. Sitis calida frigida 2. Efuries 3. Naufea ftcca 4. LEgritudo ventriculi 5. Cardialgia 6. Arthritis ventriculi •}. Colic a flatulent a 8. Colica faturnina Tympanitis io. Hypochondriafls 11. Cephalaa idiopathica. 12. Hemicrania idiopathica 13. Odontalgia Otalgia 14. Pleurodyne chronicha 1$. Sciatica frigida 16. Lumbago frigida 17. Hyfleralgia frigida 18. Proctalgia frigida Thirft warm cold Hunger Dry naufea Sicknefs of ftomach Heart-burn Gout of the ftomach Flatulent colic Colic from lead Tympany Hypochondriacifm Idiopathic head-ach Idiopathic hemicrania Tooth-ach Ear-ach Chronical pain of the fide Cold fciatica lumbago pain of the uterus pain of the return 19. Vejiet Class I. 3. i. OF IRRITATION. 7 19. Vefic# feller inirritabilitas et iEterus Inirritability of the gallbladder and jaundice GENUS V. With decreafed Actions of the Organs of Senfe. SPECIES. l. Stultitia inirritabilis 2. Rif us imminutus 3. Mufca volitantes 4 Strabifmus 5. Amaurofis 6. Auditus imminutus 7. OlfaElus imminutus 8. Gu/lus imminutus g. TaEius imminutus 10. Stupor Folly from irritability Impaired vifion Dark moving fpecks Squinting Palfy of the optic nerve Impaired hearing fmell tafte touch Stupor ORDO III. Retrograde Irritative Motions. GENUS I. Of the Alimentary Canal. SPECIES. I. Ruminatio 2. RuEtus 3. Apepfta 4. Vomitus 5. Cholera 6. Ileus 7. Globus hyjlericus 8 Vomendi conamen inane 9. Borborigmus 10. Hyferia 11. Hydrophobia Chewing the cud EruCtation Indigeftion, water-qualm Vomiting Cholera Iliac paflion Hyfteric ftrangulation Vain efforts to vomit Gurgling of the bowels Hyfteric difeafe Dread of water GENUS II. Of the Abforbent Sy Hem. I. Catarrhus lymphaticus 2. Salivatio lymphatica 3 Naufea humida 4. Diarrhoea lymphatica Diarrhoea chylifera ^SPECIES. Lymphatic catarrh Lymphatic falivation Moift naufea Lymphatic flux Flux of chyle 6. Diabetes 8 DISEASES, &c. ClassI. 3.3. 6. Diabetes 7. Sudor lymphaticus 8. Sudor a/lhmaticus 9 Tranfatio puris IQ. -- lafiis II. urina Diabetes Lymphatic fweat Afthmatic fweat Tranflation of matter - of milk of urine GENUS III. Of the Sanguiferous Syfem. I. Capillarium motus retrogref- f^, 2. Palpitatio cordis 3. Anhelatiofpafmodica SPECIES. Retrograde motion of the ca- pillaries Palpitation of the heart Spafmodic panting CLASS Class I. 1.1. DISEASES, &c. 9 CLASS I. DISEASES OF IRRITATION. ORDO I. Increafed Irritation. GENUS I. With increafed Anions of the Sanguiferous Sy fem. THE irritability of the whole, or of part, of our fyftem is per- petually changing ; thefe viciflitudes of irritability and of inir- ritability are believed to dep^pd on the accumulation or exhauf- tion of the fenforial power, as their proximate caufe ; and on the difference of the prefent ftimulus, and of that which we had previoufly been accuftomed to, as their remote caufe. Thus a fmaller degree of heat produces pain and inflammation in our hands, after they have been for a time immerfed in fnow ; which is owing to the.accumulation of fenforial power in the moving fibres of the cutaneous vefiels during their previous qui- efcence, when they were benumbed with cold. And we feel ourfelves cold in the ufual temperature of the atmofphere on coming out of a warm room ; which is owing to the exhauftion of fenforial power in the moving fibres of the vefiels of the ficin by their previous increafed activity, into which they were exci- ted by unufual heat. Hence the cold fits of fever are the occafion of the fucceeding hot ones ; and the hot fits contribute to occafion in their turn the fucceeding cold ones. And though the increafe of ftimulus, as of heat, exercife, or diftention, will produce an increafed ac- tion of ftimulated fibres; in the fame manner as it is pro- duced by the increafed irritability which is occafioned by a previous defect of ftimulus; yet as the excefles of irritation from the ftimulus of external things are more eafily avoided than the deficiencies of it -, the difeafes of this country, except thofe which are the confequences of drunkennefs, or of immediate exercife, more frequently begin with torpor than with orgafm ; that is, with inactivity of fbme parts, or of the whole of the fyftem, and confequent coldnefs, than with increafed activity, and confe- quent heat. , . - . , If the hot fit be the confequence of the cold one, it may be alked if they are proportionate to each other ? it is probable that Vol. II. C they 10 DISEASES ClassI. i. i. i. they are, where no part is deftroyed by the cold fit, as in morti- fication or death. But we have no meafure to diftinguifli this, except the time of their duration ; whereas the extent of the torpor over a greater or lefs part of the fyftem, which occafions the cold fit; or of the exertion which occafions the hot one ; as well as the degree of fuch torpor or exertion, are perhaps more material than the time of their duration. Befides this, fome mufcles are lefs liable to accumulate fenforial power during their torpor, than others, as the locomotive mufcles compared with the capillary arteries ; on all which accounts a long cold fit may often be followed by a Ihort hot one. As the torpor, with which a fit of fever commences, is fome- times owing to defect of ftimuius, as in going into the cold- bath ; and fometimes to a previous exhauftion of the fenforial power by the action of fome violent ftimuius, as after coming out of a hot room into cold air $ a J.nger time mult elapfe, be- fore there can be a fufficienc accumulation of fenforial power to produce a hot fit in one cafe than in the other. Becaufe in the latter cafe the quantity of fenforial power previoufly expended muft be fupplied, before an accumulation can begin. The cold paroxyfm commences, when the torpor of a part be- comes fo great, and its motions in confequence fo flow or feeble, as not to excite the fenforial power of aflbciation; which in health contributes to move the reft of the fyftem, which is cate- nated with it. And the hot fit commences by the accumulation of the fenforial power of irritation of the part firft affefted, either fo as to counteract: its deficient ftimuius, or its previous wafte of fenforial power ; and it becomes general by the accumulation of the fenforial power of aflbciation ; which is excited by the reno- vated actions of the part firft affeded ; or becomes fo great as to overbalance the deficient excitement of it. On all thefe accounts the hot fit cannot be fuppofed to bear any proportion to the cold one in length of time, though the latter may be the confequence of the former. See Suppl. I. 16. 8. SPECIES. I. Febris Iffitativa. Irritative fever. This is the fynocha of fome writers, it is attended with ftrong pulfe without inflamma- tion ; and in this circumftance differs from the febris inirritativa of Clafs I; 2. i. i. which is attended with weak pulfe without inflammation. The increafed frequency of the pulfation of the heart and arteries conftitutes fever; during the cold fit thefe pulfations are always weak, as the energy of adion is then de- creafed throughout the whole fyftem ; and therefore the gener- al OF IRRITATION. Glass I. 1. 1.2. 11 al arterial ftrength cannot be determined by the touch, till the cold part of the paroxyfm ceafes. This determination is fome- times attended with difficulty ; as ftrong and weak are only com- parative degrees of the greater or lefs refiftance of the pulfation of the artery to the compreffion of the linger. But the greater or lefs frequency of the pulfations affords a collateral evidence in ihofe cafes, where the degree of ftrength is not very diftin- guiffiable, which may affift our judgment concerning it. Since a moderately ftrong pulfe, when the patient is in a recumbent pofture, and not hurried in mind, feldom exceeds i 20 ftrokes in a minute ; whereas a weak one often exceeds 130 in a recum- bent pofture, and 150 in an ereCt one, in tbofe fevers, which are termed nervous or putrid. See Sect. XII. r 4. The increafed frequency of the pulfation of the heart and ar- teries, as it is occafioned either by exceft or defeCt of ftimulus, or of fenforial power, exifts both in the cold and hot fits of fever ; but when the cold fit ceafes, and the pulfe becomes ftrong and full as well as quick, in confequence of the increafed irritability of the heart and arteries, it conftitutes the irritative fever, or fy- nocha. It is attended with confiderable heat duiing the parox- yfm, and generally terminates in a quarter of a lunation, without any difturbance of the faculties of the mind. SeeClafs IV. 1.1.8. M. M. VenefeCtion. Emetics. Cathartics. Cool the patient in the hot fit, and warm him in the cold one Reft. Torpentia. 2. Ebrietas. Drunkennefs. By the ftimulus of wine or opi- um the whole arterial fyftem, as well as every other part of the moving fyftem, is excited into increafed action. All thefe fecre- tions, and with them the production of fenforial power itfelf in the brain, feem for a time increafed, with an additional quantity of heat, and of pleafurable fenfation. See SeCt XXL on this fubjeCt. This explains, why at the commencement of the warm paroxyfm of fome fevers the patient is in greater fpir- its, or vivacity ; becaufe, as in drunkennefs, the irritative motions are all increafed, and a greater production of fen fation is the con- fequence, which, when in a certain degree, is pleafurable, as in the diurnal fever of weak people. SeCt XXXVI. 3. 1. 3 Hamorrhagia arteriofa Arterial haemorrhage. Bleeding, with a quick, ftrong, and full pulfe. The haemorrhages from the lungs, and from the nofe, are the molt frequent of thefe ; but it fometimes happens, that a fmall artery but half divided, or the punCture of a leech will continue to bleed pertinacioufly. M M. VeneleCtion. Cathartic with calomel. Divide the wounded artery. Bind fponge on the punCture. If coffee or charcoal, internally ? If air, with lefs oxygene ? 4. Hamoptoe arteriofa. Spitting of arterial blood. Blood fpit up Class I. i. i: 5. 12 DISEASES up from the lungs is florid, becaufe it has juft been expofed to the influence of the air in its paflage through the extremities of the pulmonary artery ; it is frothy, from the admixture of air with it in the bronchia. The patients frequently vomit at the fame time from the difagreeable titillation of blood about the fauces; and are thence liable to believe, that the blood is ejected from the ftomach. Sometimes an haemoptoe for feveral fucceflive days returns in gouty perfons without danger, and feems to fupply the place of the gouty paroxyfms. Is not the liver always difeafed previous to the haemoptoe, as in feveral other haemorrhages ? See Clafs 1. 2. 1. 9. M M. Venefetrion, a purge, a blifter, diluents, torpentia ; and afterwards forbentia, as the bark, the acid of vitriol, and o- pium. An emetic is faid to flop a pulmonary haemorrhage, which it may effect, as ficknefs decreafes the circulation, as is very evident in the great ficknefs fometimes produced by too large a dofe of digitalis purpurea. Dr. Rufh fays, a table fpoonful or two of common fait is fuc- cefsful in haemoptoe ; this may be owing to its ftimulating the abforbent fyftems, both the lymphatic, and the venous. Should the patient refpire air with lefs oxygen? or be made fick by whirling round in a chair fufpended by a rope ? One immer- fion in cold water, or a fudden fprinkling all over with cold water, would probably ftop a pulmonary haemorrhage. See Sea. XXVII. I. 5. Hamorrhagia narium. EpiJiaxis. Bleeding at the nofe in elderly fubjefts moft frequently attends thofe, whofe livers are enlarged/)r inflamed by the too frequent ufe of fermented liquors. In boys it occurs perhaps Amply from redundancy of blood ; and in young girls fometimes precedes the approach of the cata- menia ; and then it fliews a difpofition contrary to chlorofis ; which arifes from a deficiency of red blood. M. M. It is flopped by plunging the head into cold water, with powdered fait haftily diflblved in it; or fometimes by lint ftrewed over with wheat flower put up the noftrils; or by a fo- lution of fteel in brandy applied to the veflel by means of lint. The cure in other refpe&s as in haemoptoe ; when the bleeding recurs at certain periods, after veneftftion, and evacuation by calomel, and a blifter, the bark and fteel muft be given, as in in- termittent fevers. See Sedh XXVII. 1. The tin&ure of digitalis given in proper quantities, as 30 drops from a two-ounce phial every fix hours for two or three or four dofes, is probably an efficacious medicine. See Dr. Ferri- ar's Treatife on Digitalis. He flopped active haemorrhages by the exhibition of digitalis. ORDO Class I. 1. 2. 1. OF IRRITATION. 13 ORDO I. Increafed Irritation. GENUS II. With increafed Actions of the Secerning Sfem. These are always attended with increafe of partial or of gen- eral heat; for the fecreted fluids are not Amply feparated from the blood, but are new combinations ; as they did not previouily exift as fuch in the blood veflels. But all new combinations give, out heat chemically ; hence the origin of animal heat, which is always increafed in proportion to the fecretion of the part affected, or to the general quantity of the fecretions. Neverthe- lefs there is reafon to believe, that as we have a fenfe purpofely to diftinguifh the prefence of greater or lefs quantities of heat, as mentioned in SeCt. XIV. 6. fo we may have certain minute glands for the fecretion of this fluid, as the brain is believed to fecrete the fenforial power, which would more eafily account for the inftantaneous production of the blulh of fhame, and of an- ger. This fubjeCl deferves further invelligation. SPECIES. I. Calor febrilis. The heat in fevers arifes from the increafe of fome fecretion, either of the natural fluids, as in irrita- tive fevers ; or of new fluids, as in infectious fevers ; or of new veflels, as in inflammatory fevers. The pain of heat is a confe- quence of the increafed extenfion or contraCtion of the fibres expofed to fo great a ftimulus. See ClafsI. i. 5. 6. 2. Rubor febrilis. Febrile rednefs. When the cold fit of fe- ver terminates, and the pulfations of the heart and arteries be- come ftrong as well as quick from the increafe of their irritabili- ty after their late quiefcence, the blood is impelled forwards in- to the fine extremities of the arteries, and the anaftamofing ca- pillaries, quicker than the extremities of the veins can abforb and return it to the heart. Hence the pulfe at the wrift becomes full, as well as quick and ftrong, and the fkin glows with arte- rial blood, and the veins become empty and lefs vifible. In elderly people the force of the heart and arteries becomes lefs, while the abforbent power of the veins remains the fame ; whence the capillary veflels part with the blood, as foon as it is received, and the fkin in confequence becomes paler ; it is alfo probable, DISEASES Class I. 1.2. 3. 14 probable, that in more advanced life fome of the finer branches of the arteries coalefce, and become impervious, and thus add to the opacity of the fkin. 3. Sudor calidus. Warm fweat may be divided into four va- rieties, according to its remote caufes. Firft, the perfpirable matter is fecreted in as great quantity during the hot fit of fever, as towards the end of it, when the fweat is feen upon the fkin. But during the hot fit the cutaneous abforbents aft alfo with in- creafed energy, and the exhalation is like wife increafed by the greater heat of the fkin ; and hence it does not appear in drops on the furface, but is in partre-abforbed, and in part diffipated in the atmofphere. But as the mouths of the cutaneous abforb- ents are expofed to the cool air or bedclothes ; whilft thofe of the capillary glands, which fecrete the perfpirable matter are ex- pofed to the warmth of the circulating blood; the former, as foon as the fever-fit begins to decline, lofe their increafed action firft, and hence the ablorption of the fweat is diminifhed, whilft the increafed fecretion of it continues for fome hours afterwards, which occafions it to ftand in drops upon the fkin. As the fkin becomes cooler, the evaporation of the perfpira- ble matter becomes lefs, as well as the abforption of it And hence the diflipation of aqueous fluid from the body, and the confequent thirft, are perhaps greater during the hot fit, than during the fubfequent fweat. For the fweats do not occur, ac- cording to Dr. Alexander's experiments, till the fkin is cooled from 112 to 108 degrees of heat; that is, till the paroxyfm be- gins to decline. From this it appears, that the fweats are not critical to the hot fir, any m^re than the hot fit can be called critical to the cold one ; but fimply, that they are the natural confequence of the decline of the hot fit, commencing with the decreafed action of the abforbent fyftem, and the decreafed evap- oration from the fkin. And from hence it may be concluded, that a fever-fit is not in general an effort of nature to reftore health, as Sydenham confidered it, but a neceflary confequence of the previous torpor ; and that the caufes of fevers would be lefs detrimental, if the fever itfelf could be prevented from ex- ifting ; as appears in the cool treatment of the fmall-pox. It muftbe noted that the profufe fweats on the fkin are more frequent at the decline of fever-fits than the copious urine, or loofe ftools, which are mentioned below ; as the cutaneous ab- forbents, being expofed to the cool air, lofe their increafed ac- tion fooner than the urinary or inteftinal abforbents j which open into the warm cavities of the bladder and inteftines ; but which are neverthelefs often aflfe&ed by their fympathy with the cutaneous abforbents. Hence few fevers terminate without a moifture Glass. I. 1. 2. 3. OF IRRITATION. 15 moifture of the (kin ; whence arofe the fatal practice of forcing fweats by the external warmth of air or bed-ciothes in fevers ; for external warmth increafes the action of the cutane- ous capillaries more than that of the other fecerning veflels ; be- caufe the latter are habituated to p8 degrees of heat, the inter- nal warmth of the body ; whereas the cutaneous capillaries be- ing nearer the furface are habitually kept cooler by the contact of the external air. Sweats thus produced by heat in confined rooms are ftill more detrimental; as the air becomes then not only deprived of a part of its oxygene by frequent refpiration, but is loaded with animal effluvia as well as with moifture, till it can receive no more j and in confequence, while the cutane- ous fecretion ftands upon the fkin in drops for want of exhala- tion, the lungs are expofed to an infalubrious atmofphere. I do not deny, that fweating may be fo managed as to be ferviceable in preventing the return of the cold paroxyfm of fe- vers ; like the warm bath, or any other permanent ftimulus, as wine, or opium, or the bark. For this purpofe it (hould be con- tinued till paft the time of the expected cold fit, fupported by moderate dofes of wine-whey, with fpirit of hartlhorn, and mod- erate degrees of warmth. Its falutary effed, when thus man- aged, was probably one caufe of its having been fo much attend- ed to ; and the fetid fmell, which when profufe is liable to ac- company it, gave occafion to the belief, that the fuppofed mate- rialcaufe of the difeafe was thus eliminated from the circulation. When too great external heat is applied, the fyftem is weak- ened by excefs of action, and the torpor which caufes the cold paroxyfm recurs fooner and more violently. For though fome ftimuli, as of opium and alcohol, at the fame time that they ex- hauft the fenforial power by promoting increafe of fibrous ac- tion, may alfo increafe the production or fecretion of it in the brain, yet experience teaches us that the exhauftion far out-bal- ances the increafed production, as is evinced by the general de- bility, which fucceeds intoxication. In refpeCt to the fetor attending copious continued fweats, it is owing to the animalized part of this fluid being kept in that degree of warmth, which moft favours putrefaction, and not fuf- fered to exhale into the atmofphere. Broth, or other animal mucus, kept in fimilar circumftances, would in the fame time acquire a putrid fmell ; yet has this error frequently produced miliary eruptions, and increafed every kind of inflammatory or fenfitive fever. The eafe, which the patient experiences during fweating, if it be not produced by much external heat, is fimilar to that of the warm bath ; which by its ftimulus applied to the cutaneous veflels, DISEASES Class I. i. 2. 3. 16 veflels, which are generally cooler than the internal parts of the fyftem, excites them into greater aflion ; and pleafurable fenfa- tion is the confequence of thefe increafed a&ions of the veflels of the (kin. From confidering all thefe circumftances, it ap- pears that it is not the evacuation by fweats, but the continued ftimulus, which caufes and fupports thofe fweats which is fer- viceable in preventing the returns of fever-fits And that fweats too long continued, or induced by too great ftimulus of warmth, clothes, or medicines, greatly injure the patient by increafing in- flammation, or by exhaufting the fenforial power. See ClafsI. 1. 2. 14. Secondly, The fweats produced by exercife or labour are of the warm kind ; as they originate from the increafed action of the capillaries of the fkin, owing to their being more powerfully ftimulated by the greater velocity of the blood, and by a greater quantity of it palling through them in a given time. For the blood during violent exercife is carried forwards by the a<flion of the mufcles falter in the arteries, than it can be taken up by the veins ; as appears by the rednefs of the fkin. And from the confequent fweats, it is evinced, that the fecretory veflels of the Ikin during exercife pour out the perfpirable matter fafter, than the mouths of the abforbent veflels can drink it up. Wihch mouths are not expofed to the increafed mufcular adlion, or to the ftimulus of the increafed velocity and quantity of the blood, but to the cool air. Thirdly, the increafed fecretion of perfpirable matter occafion- ed by the ftimulus of external heat belongs likewife tothis place; as it is caufed by the increafed motions of the capillary veflels ; which thus feparate from the blood more perfpirable matter, than the mouths of their correfpondent abforbent veflels can take up ; though thefe alfo are ftimulated by external heat into more energetic action. If the air be ftationary, as in a fmall room, or bed with clofed curtains, the fweat ftands in drops on the fkin for want of a quicker exhalation proportioned to the quicker fe- cretion. A fourth variety of warm perfpiration is that occafioned by ftimulating drugs, of which opium and alcohol are the moft powerful; and next to thefe the fpices, volatile alkali, and neu- tral faits, efpecialiy fea-falt; that much of the aqueous part of the blood is diflipated by the ufe of thefe drugs, is evinced by the great thirft, which occurs a few hours after the ufe of them. See Art. III. 2 1. We may from hence underftand, that the increafe of this fecretion of perfpirable matter by artificial means, muft be fol- lowed by debility and emaciation. When this is done by taking much Class I. 1. 2. 3. OF IRRITATION. 17 much fait, or falted meat, the fea-fcurvy is produced ; which confifts in the inirritability of the bibulous terminations of the veins arifing from the capillaries ; fee Clafs I. 2. I. 14. The fcrofula, or inirritability of the lymphatic glands, feems alfo to he occafionally induced by an excefs in eating fait added to food of bad nourilhment. See Clafs I. 2. 3. 21. If an excefs of per- fpiration is induced by warm or ftimulant clothing, as by wear- ing flannel in contact with the (kin in the fummer months, a per- petual febricula is excited, both by the preventing the accefs of cool air to the Ikin, and by perpetually goading it by the nume- rous and hard points of the ends of the wool; which when ap- plied to the tender fkins of young children, frequently produce the red gum, as it is called ; and in grown people, either an eryGpelas, or a miliary eruption, attended with fever. See Clafs II. 1. 3. 12. Shirts made of cotton or calico ftimulate the ikin too much by the points of the fibres, though lefs than flannel ; whence cotton handkerchiefs make the ndfe fore by frequent ufe. The fibres of cotton are, I fuppofe, ten rimes fhorter than thofe of flax, and the number of points in confequence twenty times the number ; and though the manufacturers finge their calicoes on a red-hot iron cylinder, yet I have more than once feen an ery- fipelas induced or increafed by the ftimulus of calico, as well as of flannel ; and have during the laft fummer prevailed on two, who were confined to their beds bv fevers, and three, who were in a ftate of great debility, to difencumber themfelves of the flannel fhirts, which they had worn for fome time ; all of them became immediately and confiderable relieved ; and found no inconvenience afterwards by difcontinuing an unneceflary ftim- ulus, which had nothing to recommend it to thofe patients but the frivolous fafhion of the day. The inconvenience, which weak conftitutions experience from wearing flannel fhirts, arifes from this circumftance ; that the ex- tremities of their limbs are more liable to become cold, than th,e furface of the cheft and abdomen, and that hence they fhould in preference wear warmer ftockings, (hoes, and focks, or gloves. By ftimulating the warmer parts of the ikin into too ftrong and ufelefs exertion, as by the hard points of a flannel fhirt at all fea- fons, and by its confining the warmth of the fkin too much in the fummer months, a part of the fenforial power becomes un- neceflarily expended ; and in weak conftitutions, where there is none to fpare, fome other parts of the fyftem muft aft with lefs energy ; and thus I believe the extremities of feeble people be- come colder by the ufe of a flannel fhirt ; in ftronger people, and perhaps in warmer climates, this increafed coldnefs of the ex- Vol. II. D tremities DISEASES 18 Class I. 1.2. 3,. tremities may not be perceptible ; as ftronger perfons can better bear feme increafed exertion, and the confequent unneceflary lofs of fome fenforial power ; and in warmer climates the ex- tremities may not be to liable to become cold. Analogous to this I remember to have feen an inoculated child about fix years old, whofe bofom and face, at the beginning of the eruptive fever, were of a fiery red colour, and exceedingly hot to the touch; and whofe feet were at the fame time pale, and cold to the touch. When on expofing the bofom and face to colder air with the feet only (lightly covered, the colour of the former in a few minutes became nearly natural, with little excefs of tangi- ble heat,and at the fame time the feet became as warm as natural. Whence I conclude, that all unneceflary increafe of ftimuli,as of warm clothing, wine, and opium, is more injurious to fee- ble conftitutions than to robufl ones ; and that fuchftimuli alone are falutary to weak perfons, as increafe thofe actions of the fyf- tem, which are immediately neceflary to life and health, as the clafs of medicines termed forbentia, as peruvian bark, and other bitters, and very fmall quantities of fteel,as thefe feem to increafe the activity of the abforbent fyftem, both of the lymphatic and venous ones, and thus fupply more nutrition, with all its falutary confequences. And that the ufe of thefe forbentia, as well as the occafional ufe of warmer clothing, wine, and opium, (hould be difcontinued, as foon as the fyftem can acquire the natural habit of acting with fufficient energy without them. See Article II. 2. 2. 1. of the Materia Medica. The increafe of perfpiration by heat either of clothes, or of fire, contributes much to emaciate the body ; as is well known to jock- eys, who, when they are a (tone or two too heavy for riding, find the quickeft way to leflen their weight is by fweating thena- felves between blankets in a warm room ; but this likewife is a practice by no means to be recommended, as it weakens the fyf- tem by the excefs of fo general a ftimulus, brings on a premature old age, and (hortens the fpan of life ; as may be further deduced from the quick maturity, and (hortnefs of the lives, of the inhab- itants of Hindoftan, and other tropical climates. When the heat of the body in weak patients in fevers is in- creafed by the ftimulus of the points of flannel, a greater confe- quent debility fucceeds, than when it is produced by the warmth of fire ; as in the former the heat is in part owing to the inceaf- ed activity of the (kin, and confequent expenditure of fenforial power ; whereas in the latter cafe it is in part owing to the in- flux of the fluid matter of heat. So the warmth produced by equitation,or by rubbing the body and limbs with a fmooth bruth or hand, as is done after bathing in Class. I. 1. 2. 4. OF IRRITATION. 19 in fome parts of the Eaft, does not expend nearly fo much fen- ferial power, as when the warmth is produced by the locomo- tion of the whole weight of the body by mufcular action, as in walking, or running, or fwimming. Whence the warmth of a fire is to be preferred to flannel fliirts for weak people, and the agitation of a horfe to exercife on foot. And I fuppofe thofe, who are unfortunately loft in fnow, who are on foot, are liable to peri Hi fooner by being exhaufted by their mufcular exertions; and might frequently preferve themfelvesby lying on the ground and covering themfelves with fnow, before they were too much exhaufted by fatigue. See Botan. Garden, Vol. IL the note on Barometz. M. Buffon made a curious experiment to (hew this circum- ftance. He took a numerous brood of the butterflies of filk- worms, fome hundreds of which left their eggs on the fame day and hour; thefe he divided into two parcels; and placing one par- cel in the fouth window,and the other in the north window of his houfe, he obferved, that thofe in the colder fituaticm lived many days longer than thofe in the warmer one. From thefe obferva- tions it appears, that the wearing of flannel clothing next the Ikin, which is now fo rituch in falhion, however ufeful it may be in the winter to thofe, who have cold extremities, bad di- geftions, or habitual coughs, muft greatly debilitate them, if worn in the warm months, producing fevers, eruptions, and pre- mature old age. See Se6t. XXXVII.5.Clafs Lf-2.14.Art IIL2.1. 4. Urina uberior color at a. Copious coloured urine. To- wards the end of fever-fits a large quantity of high coloured urine is voided, the kidneys continuing to act ftrongly, after the increafed action of the abforbents of the bladder is fomewhat diminifhed. If the abforbents continue alfo to act ftrongly, the urine is higher coloured, and fo loaded as to depofite, when cool, an earthy fediment, erroneoufly thought to be the material caufe of the difeafe; bnt is fimply owing to the fecretion of the kidneys being great from their increafed action ; and the thinner parts of it being abforbed by the increafed action of the lymphatics, which are fpread very thick on the neck of the bladder ; for the urine, as well as perhaps all the other fecreted fluids,is produced from the kidneys in a very dilute ftate ; as appears in thofe, who from the ftimulus of a ftone, or other caufe, 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 re-abforbed. The general ufe of this urinary ab- forption to the animal economy is evinced from the urinary blad- ders of fid), which would otherwife be unneceflary. High col- oured urine in large quantity (hews only, that the fecreting vef- Class I. 1.2. 5. 20 DISEASES fols of the kidneys, and the abforbents of the bladder, have aded with greater energy. When there is much earthy fediment, it (hews, that the abforbents have acted proportionally ftronger, and have consequently left the urine in a lefs dilute ftate. In this urine the tranfparent fediment or cloud is mucous ; the opaque fediment is probably coagulable lymph from the blood changed by an animal or chemical procefs. The floating fcum is oil. The angular concretions to the fides of the pot, formed as the urine cools, is microcofmic fait. Does the adhefive blue matter on the fides of the glafs, or the blue circle on it at the edge of the upper furface of the urine, confift of Prulfian blue ? 5. Diarrhea calida. Warm diarrhoea. This fpecies may be divided into three varieties, deduced from their remote caufes. Under the names of diarrhoea febrilis, diarrhoea crapulofa, and diarrhoea infantum. The febrile diarrhoea appears at the end of fever-fits, and is erroneoufly called critical, like the copious urine, and the fweats; whereas it arifes from the increafed ac- tion of thofe fecerning organs, which pour their fluids into the inteftinal canal (as the liver, pancreas, and mucous glands,) continuing longer than the increafed action of the inteftinal ab- forbents. In this diarrhoea there is no appearence of curdled chyle in the ftools, as occurs in cholera. I. 3. 1. 5. The diarrhoea crapulofa, or diarrhoea from indigeftion, occurs when too great a quantity of food or liquid has been taken ; which not being completely digefted, ftimulates the inteftines like any other extraneous acrid material ; and thus produces an increafe of the fecretions into them of mucus, pancreatic juice, and bile. When the contents of the bowels are ftill more ftim- ulant, as when draftic purges, or very putrefcent diet, have been taken, a cholera is induced. See Sedl. XXIX. 4. The diarrhoea infantum, or diarrhoea of infants, is generally owing to too great acidity in their bowels. Milk is found curdled in the ftomachs of all animals, old as well as young, and even of carnivorous ones, as of hawks. (Spallanzani.) And it is the gaftric juice of the calf, which is employed to curdle milk in the procefs of making cheefe. Milk is the natural food for children, and muft curdle in their ftomachs previous to di- geftion ; and as this curdling of the milk deftroys a part of the acid juices of the ftomach, there is no reafon for difcontinuing the ufe of it, though it is occafionally ejected in a curdled ftate. A child of a week old, which had been taken from the breaft of its dying mother, and had by fome uncommon error been fuf- fered to take no food but water-gruel, became fick and griped in twenty-four hours, and was convulfed on the fecond day, and died on the third 1 When all young quadrupeds, as well as children, Class I. 1. 2. 6. OF IRRITATION. 21 children, have this natural food of milk prepared for them, the analogy is fo ftrong in favour of its falubrity, that a perfon fliould have powerful teftimony indeed of its difagreeing before he advifes the difcontinuance of the ufe of it to young children in health, and much more fo in ficknefs. The farmers lofe many of their calves, which are brought up by gruel, or gruel and old milk ; and among the poor children of Derby, who are thus fed, hundreds are ftarved into the fcrofula, and either perifh or live in a Rate of wretched debility. When young children are brought up without a breaft, they fhould for the firft two months have no food but new milk ; fmce the addition of any kind of bread or flour is liable to fer- ment, and produce too much acidity ; as appears by the confe- quent diarrhoea with green dejections and gripes ; the colour is owing to a mixture of acid with the natural quantity of bile, and the pain to its ftimulus. And they fhould never be fed as they lie upon their backs, as in that pofture they are neceflitated to fwallow all that is put into their mouths ; but when they are fed, as they are fitting up, or raifed up, when they have had enough, they can permit the reft to run out of their mouths. This cir- cumftance is of great importance to the health of thofe children, who are reared by the fp'oon, fince if too much food is given them, indigeftion, and gripes, and diarrhoea, are the confe- quence ; and if too little, they become emaciated -, and of this exaCt quantity their own palates judge the beft. M- M. In this latt cafe of the diarrhoea of children, the food fhould be new milk, which by curdling deftroys part of the acid, which coagulates it. Chalk about four grains every fix hours> with one drop of fpirit of hartfhorn, and half a drop of lauda- num. But a blifter about the fize of a (hilling is of the greateft fervice by reftoring the power of digeftion. See Article III. 2. 1. in the Materia Medica. 6. Salivatio calida. Warm falivation. Increafed fecretion of faliva. This maybe eftecled cither by ftimulating the mouth of the gland by mercury taken internally ; or by ftimulating the excretory duCt of the gland by pyrethrum, or tobacco ; or lim- ply by the movement of the mufcles, which lie over the gland, as in mafticating any taftelefs fubftance, as a lock of wool, or maftic. In about the middle of nervous fevers a great fpittingof fali- va fometimes occurs, which has been thought critical ; but as it continues fometimes two or even three weeks without the relief of the patient, it may be concluded to arife from fome acciden- tal circumftance, perhaps not unfimilar to thehyfteric ptyalifms mentioned in Clafs I. 3. 2. 2. See Soft. XXIV. M. M. Cool 22 DISEASES Class I. 1.2. 7. M. M. Cool air, diluents, warm bath, evacuations. 7. Catarrhus calidus. Warm catarrh. Con lifts in an in- creafed fecretion of mucus from the noftrils without inflamma- tion. This difeafe, which is called a cold in the head, is fre- quently produced by cold air acting for fome time on the mem- branes, which line the noftrils, as it pafles to the lungs in refpi- ration. Whence a torpor of the action of the mucous glands is firft introduced, as in Clafs I- 2. 3 3. and an orgafm or in- creafed action fucceedsin confequence. Afterwards this orgafm and torpor are liable to alternate with each other for fome time like the cold and hot fits of ague, attended with deficient or ex- uberant fecretion of mucus in the noftrils. At other times it arifes from reverfe fympathy with fome ex- tenfive parts of the fkin, which have been expofed too long to cold, as of the head, or feet. In confequence of the torpor of thefe cutaneous capillaries thofeof the mucous membranes of the noftrils act with greater energy by reverfe fympathy ; and thence fecrete more mucus from the blood. At the fame time the ab- forbents, acting alfo with greater energy by their reverfe fym- pathy with thofe of fome diftant part of the Ikin, abforb the thinner parts of the mucus more haftily ; whence the mucus is both thicker and in greater quantity. Other curious circumftan- ces attend this difeafe ; the membrane becomes at times fo thick- ened by its increafed action in fecreting the mucus, that the pa- tient cannot breathe through his noftrils. In this fituation if he warms his whole fkin fuddenly by fire or bed-clothes, or by drinking warm tea, the increafed action of the membrane ceafes by its reverfe fympathy with the fkin ; or by the retra&ion of the fenforial power to other parts of the fyftem ; and the patient can breathe again through the noftrils. The fame fometimes oc- curs for a time on going into the cold air by the deduction of heat from the mucous membrane, and its confequent inactivity or torpor. Similar to this when the face and breaft have been very hot and red, previous to the eruption of the fmall-pox by inoculation, and that even when expofed to cool air, I have ob- ferved the feet have been cold \ till on covering them with warm flannel, as the feet have become warm, the face has cooled. See XXXV. I. 3. Clafs IL 1. 3. 5. IV. 2. 2. 10. IV. n 1. 5. M. M. Evacuations, abftinence, oil externally on the nofe, warm diluent fluids, warm fhoes, warm night-cap. 8. Expeclovatio calida. Warm expectoration confifts of the increafed fecretion of mucus from the membrane, which lines the bronchiae, or air-cells of the lungs, without inflammation. This increafed mucus is ejected by the aftion of coughing, and is OF IRRITATION. Class I. 1. 2. 9. 23 is called a cold, and refembles the catarrh of the preceding arti- cle ; with which it is frequently combined. M. M. Inhaling the fleam of warm water, evacuations, warm bath, afterwards opium, forbentia. g. Exfudatio pone aures. A difcharge behind the ears. This chiefly afFecSts children, and is a morbid fecretion ; as appears from its fetor ; for if it was owing to defect of abforption, it would be faline, and not fetid ; if a morbid action has continued a confiderable time, it (hould not be flopped too fuddenly ; fince in that cafe fome other morbid aflion is liable to fucceed in its Head. Thus children are believed to have had colics, or even convulfions, confequent to the too fudden healing of thefe mor- bid efFufions behind their ears. The rationale of this is to be ex- plained from a medical fad, which I have frequently obferved ; and that is, that a blitter on the back greatly ftrengthens the power of digeftion, and removes the heart-burn in adults, and green ftools in children. The ftimulus of the blitter produces fenfation in the veflels of the fkin ; with this additional fenfori- al power thefe veflels a£t more ftrongly; and with thefe the vef- fels of the internal membranes of the ftomach and bowels adt with greater energy from their direfl fympathy with them. Now the acrid difcharge behind the ears of children produces fenfation on that part of the fkin, and fo far atts as a fmall blif- ter. When this is fuddenly flopped, a debility of the digettive power of the ftomach fucceeds from the want of this accuftom- ed ftimulus, with flatulency, green ftools, gripes,'and fometimes confequent convulfions. See Clafs II. i. $ 6. and II. 1. 4. 6. M. M. If the matter be abforbed, and produce fwelling of the lymphatics of the neck, it fhould be cured as foon as poflible by dufting the part with white lead, cerufla, in very fine powder ; and to prevent any ill confequence an iflue fhould be kept for about a month in the arm ; or a purgative medicine fhould be taken every other day for three or four times, which fhould con- fift of a grain of calomel, and three or four grains of rhubarb, and as much chalk. If there be no appearance of abforption, it is better only to keep the parts clean br wafhing them with warm water morning and evening ; or putting fuller's earth on them ; efpecially till the time of toothing is paft The tinea, or fcald head, and a leprous eruption, which often appears behind the ears, are different difeafes. 10. Gonorrhea calida. Warm gleet. Increafed ditcharge of mucus from the urethra or proftrate gland without venereal de- fire, or venereal infection. See Clafs I. 2. 3. 8. M. M. Cantharides, balfams. rhubarb, blifter on. perinseum, cold DISEASES Class I. i. 2. 11. 24 cold bath, injedlions of metallic faits, flannel fhirt, change of the form of the accuflomed chair or faddle of the patient it. Fluor albus calides. Warm fluor albus. Increafed fecre- tion of mucus in the vagina or uterus without venereal defire or venereal infection.. It is diftinguilhed from the fluor albus frig- idus by the increafed fenfe of warmth in the part, and bv the greater opacity or fpiflitude of the material difcharged ; as the thinner parts are re-abforbed by the increafed adlion of the ab- forbents, along with the faline part, whence no fmarting or ex- coriation attends it. MM. Mucilage, as ifinglafs, hartfhorn jelly, gum arable. Ten grains of rhubarb every night. Calico oe flannel fliift,opi- um, balfams. See Clafs I. 2. 3. 7. 12. Hamorrhois alba. White piles. An increafed difcharge of mucus from the redlum frequently miftaken for matter ; is faid to continue a few weeks, and recur like the bleeding piles ; and to obey lunar influence. See Clafs I. 2. r. 6. M. M. Abftinence from vinous fpirit. Balfam of copaiva. Spice fwallowed in large fragments, as ten or fifteen black pep- per-corns cut in half, and taken after dinner and fupper. Ward's pafte, confining of black pepper and the powdered root of He- lenium Enula: 13. Serum e vejicatorio.. Difcharge from a blifler. The ex- cretory dudls of glands terminate in membranes, and are endu- ed with great irritability, and many of them with fenfibility ; the latter perhaps in confequence of their facility of being excitable into great adlion ; infiances of this are the terminations of the gall-dudl in the duodenum, and of the. falivary and lachrymal glands in the mouth a nd eye ; which produce a greater fecre- tion of their adapted fluids, when the ends of their excretory dudls are flimulated. The external fkin confifts of the excretory dudls of the capil- laries, with the mouths of the abforbents ; when thefe are flim- ulated by the application of cantharides, or by a flice of the frtfh root of bryonj^ alba bound on it, the capillary glands pour an increafed quantity of fluid upon the fkin by their increafed ac- tion ; and the abibrbent veflels imbibe a greater quantity of the more fluid and faline part of it; whence a thick mucous or fe- rous fluid is depofited between the fkin and cuticle. 14 Perfpiratio foetida. Fetid perfpiration The ufes of the perfpirable matter are to keep the fkin fott and pliant, for the purpofes of its eafier flexibility during the adlity of ohr limbs in locomotion, and for the prefervation of the accuracy of the fenfe of touch, which is diffufed under the whole furface of it to guard us againfl the injuries of exernal bodies ; in the fame manner Class I. 1. 2. 14. OF IRRITATION. 25 manner as the fecretion of tears is defigned to preferve the cor- nea of the eye moift, and in confequence tranfparent ; yet has this cutaneous mucous been believed by many to be an excre- ment ; and I know not how many fanciful theories have been built on its fuppofed obftruftion. Such as the origin of catarrhs, coughs, inflammations, eryfipelas, and herpes. To all thefe it may be fufficient to anfwer, that the ancient Grecians oiled themfelves all over ; that fome nations have painted themfelves all over, as the Picts of this ifland ; that the Hottentots fmear themfelves all over with greafe. And laftly, 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 wafteful fafhion, and all this without inconvenience. To this muit be added the ftrift analogy between the ufe of the perfpirable matter and the mucous fluids, which are poured for fimilar purpofes upon all the internal membranes of the body; and befides its being in its natural ftate inodorous ; which is not fo with the other excretions of feces, or of urine. The quantity of perfpirable matter being greater than that of the excrementitious matters voided by ftool and urine, has been ufed as anargument in favour of its being an excrement; the force of which I do not fee: but can readily underftand, that there mult of neceffity be a great exhalation of a fluid which is diffu- fed over the whole external furface of the warm fkin, and per- haps warmer lungs, for the purpole of keeping them moift and pliant, and which is perpetually renewed as it evaporates ; but, if it be conceived to be an excrement, there feems to have been no neceffity for its quantity being fo great. The evaporation of this great quantity of fluid fecrered on the furface of the Ikin and lungs, mult carry off much heat from the body ; and as both, this fecretion and confequent evaporation will be in proportion to the activity of the cutaneous veflels, and the heat occasioned by their increafed fecretion, it would feem, that this evaporation of perfpirable matter is the caufe which preferves the animal body at the uniform degree of heat of 98 ; in the fame manner as the evaporation of boiling water preferves it at 212 degrees of Fahrenheit's fcale. The peculiar ufe of the perfpirable matter in preferving the membranes moift, which line the air-pipes of the lungs, appears from the curious difcovery of Dr.Prieftley, that the oxygen of the atmofphere will pat's through moift animal membranes, but not through dry ones, fo that if the membranes of the trachea were to become dry, the animal mult as immediately penffi as if he was to breath azotic gas alone. See Sect. XX VIII 2. of the preceding volume. Vol. II. E In 26 DISEASES Class I. i. 2. 14. In fome conflitutions the perfpirable matter of the lungs ac- quires a difagreeable odour ; in others the axilla, and in others the feet, emit difgullful effluvia ; like the fecretions of thofe glands which have been called odoriferse ; as thofe, which con- tain the caftor in the beaver, and thofe within the return of dogs, the mucus of which has been fuppofed to guard them againft the great coftivenefs, which they are liable to in hot fummers ; and which has been thought to occafion canine mad- nefs, but which, like their white excrement, is more probably owing to the deficient fecretion of bile. Whether thefe odorif- erous particles attend the perfpirable matter in confequence of the increafed action of the capillary glands, and properly be called excrementitious ; that is, whether any thing is elimina- ted, which could be hurtful if retained ; or whether they may- only contain fome of the effential oil of the animal; like the fmell, which adheres to one's hand on ftroking the hides of fome dogs ; or like the effluvia, which is left upon the ground, from the feet of irten and other creatures , and is perceptible by the nicer organs of the dogs, which hunt them, may admit of doubt. Add to this, that fome parts of the fkin are liable to more profufe perfpiration than other parts without poffeffmg any fetid fcent, as the fkin of the face, on any more violent exercife. This feems to have been obferved very early in the hiftory of man- kind, as it was faid, that our firfl parents fhould earn their bread by the fweat of their brow. Why this circum (lance does not attend other animals is a curious inquiry. Mankind foon learn- ed to cover their bodies, except their faces, with clothes; when the face, by being more frequently expofed to greater variations of heat and cold, acquired greater irritability, or fenfibility, or affociability, and thus has become more excitable into greater ac- tion by the ftimulus of exercife, or by that of food, or by the va- riolus infedlion, than other parts of the fkin, as fpoken of in Clafs IV. 1. 2. 12 ; which alfo appears by its fympathy with difeafes of the liver or ftomach by fenfitive affociations, as in the gutta rofea. From all thefe analagous fadts the profufe fweat, which exudes from the face on exercife, does not appear to be an excrementitious fluid, but fimply the confequence of more violent adlion of the cutaneous or perfpirative glands. M. M. Wafh the part twice a day with foap and water ; with lime water; cover the feet with oiled filk focks, which muft be waffled night and morning. Cover them with charcoal recently made red hot, and beaten into fine powder and lifted, as foon as cold, and kept well corked in a bottle, to be waffled off Class!, i. 2.15. OF IRRITATION. 27 off and renewed twice a day. Internally rhubarb grains vi. or viii. every night, fo as to procure a (tool or two extraordinary every day, and thus by increasing one evacuation to decreafe an- other. Cool drefs, diluting liquids ? 15. Crines novi. New hairs. The black points on the fa- ces of fome people confift of mucus, which is become vifcid, and which adheres in the excretory duds of the glands of the (kin ; as defcribed in Clafs I. 2. 2. 9. and which may be preffed out by the fingers, and refembles little worms. Similar to this would feem the fabrication of filk and of cobweb, by the filk- Worm and fpider ; which is a fecreted matter preffed through holes, which are the excretory duCis of glands. And it is prob- able, that the production of hair on many parts of the body, and at different periods of life, may be effected by a Smilar procefs; and more efpecially as every hair may be confidered as a (lender flexible horn, and is an appendage of the fkin. See Sect. XXXIX. 3. 2. Now as there is a fenfitive Sympathy between the glands, which fecrete the Semen, and the throat, as appears in the mumps; fee Hydrophobia, Ciafs IV. 1.2. 7. and Paroti- tis, Clafs IV. 1. 2. 19. the growth of the beard at puberty feems to be caufed by the greater aCtion of the cutaneous glands about the chin and pubes in confequence of their Sympathy with thofe of the teftes. But this does not occur to the female Sex at their time of puberty, becaufe the fenfitive Sympathy in them feems to exift between the Submaxillary glands, and the pe€loral ones ; which fecrete the milk, and afford pleafure both by that Secre- tion, and by the ereCtion of the mammulae, or nipples ; and by delivering the milk into the mouth of the child ; this fen- fitive Sympathy of the peCtoral and fubmaxillary glands in women is alfo obfervable in the Parotitis, or mumps, as above referred to. When hairs grow on the face or arms fo as to be difagreea- ble, they may be thus readily removed without pain or any ill confequence. Warm the ends of a pair of nippers or forceps, and ftick on them a little refin, or burgundy pitch ; by thefe means each Single hair may be taken fall hold of ; and if it be then plucked off (lowly, it gives pain ; but if plucked off fuddenly, it gives no pain at all ; becaufe the vis inertias of the part of the (kin, to which it adheres, is not overcome ; and it is not in confequence feparated from the cellular mem- brane under it. Some of the hairs may return, which are thus plucked off, or others may be induced to grow near them ; but in a little time they may be thus fafely deftroyed ; which is much to be preferred to the methods Said to be ufed in Turkey to 28 DISEASES Class I. 1. 2. 15. to eradicate hair; fuch as a mixture of orpiment and quick lime ; or of liver of fulphur in folution ; which injure the fkin, if they are not very nicely managed ; and the hair is liable to grow again as after (having; or to become white, if the roots of it have been much inflamed by the caufticity of the applica- tion. See Clafs I. 2.2. 11. on grey hairs. ORDO Class L i. 3. 1. OF IRRITATION 29 ORDO I. Increafed Irritation, GENUS III. With increafed Anions of the Abforbent Syfem. These are not attended with fo great increafe of heat as in the former genus, becaufe the fluids probably undergo lefs chemical change in the glands of the abforbent fyftem ; nor are the glands of the abforbent veflels fo numerous or fo extenfive as thofe of the fecerning ones. Yet that fome heat is produced by the iru creafed action of the abforbents appears from the greater gener- al warmth of the Ikin and extremities of feeble patients after the exhibition of the peruvian bark, and other medicines of the arti- cle Sorbentia. SPECIES. i. Lingua arida. Dry tongue occurs in thofe fevers, where the expired air is warmer than natural; and happens to all thofe, who fleep with their mouths open ; the currents of air in refpi- ration increafing the evaporation. There is alfo a drynefs in the mouth from the increafed aflion of the abforbent veflels, when a floe or a crab-apple is mafticated ; and after the perfpi- ration has been much increafed by eating fait or fpice, or after other copious fecretions; as after drunkennefs, cathartics or fever fits, the mucus of the mouth becomes vifeid, and in fmall quantity, from the increafed abforption, adhering to the tongue like a white flough. In the diabetes, where the thirft is very great, this flough adheres more pertinacioufly, and becomes black or brown, being coloured after a few days by our aliment or drink. The infpiflated mucus on the tongue of thofe, who fleep with their mouths open, is fometimes reddened as if mixed with blood, and fometimes a little blood follows the expuition of it from the fauces owing to its great adhefion. When this mucus adheres long to the papillae of the tongue, the faliva, which it contains in its interftices, like a fponge, is liable to become pu- trid, and to acquire a bitter tafte, like other putrid animal fub- ftances ; which is generally miftaken for an indication of the prefence of bile. M. M Warm fubacid liquids. See Clafs I. 2. 5. 8. 2. Fauces arida. Dry throat. The expuition of a frothv mucus 30 DISEASES Class I. 1. 3. 3. mucus with great and perpetual hawking occurs in hydrophobia and is very diftreffing to the patient; which may be owing to the increafed irritability or fenfibility of the upper part of the cefophagus, which will not permit any fluid to reft on it. It affects fome people after intoxication, when the lungs re- main (lightly inflamed, and by the greater heat of the air in ex- piration the mucus becomes too haftily evaporated, and is expec- torated with difficulty in the ftate of white froth. I knew a perfon, who for twenty years always waked with his tongue and throat quite dry ; fo that he was neceffitated to take a fpoonful of water, as foon as he awoke ; otherwife a little blood always followed the forcible expuition of the indurated mucus from his fauces. See Clafs II. i. 3. 17. M.M. Steel-fprings fixed to the night-cap fo as to fufpend the lower jaw and keep it clofed ; or fprings of elaftic gum. Or a pot of water fufpended over the bed, with a piece of lift, or woolen cloth, depending from it, and held in the mouth; which will aft like a fyphon, and (lowly fupply moifture, or barley wa- ter (hould be frequently fyringed in the mouth of the patient. 3. Nares aridi. Dry noftrils with the mucus hardening up- on their internal furface, fo as to cover them with a kind of {kin or fcale, owing to the increafed action of the abforbents of this membrane ; or to the too great drynefs of the air, which paffes into the lungs ; or to too great heat of it in its expiration. When air is fo dry as to lofe its tranfparency; as when a trem- ulous motion of it can be feen over corn-fields in a hot fummer's day ; or when a dry mift, or want of tranfparency of the air, is vifible in very hot weather ; the fenfe of fmell is at the fame time imperfect from the drynefs of the membrane, beneath which it is fpread. 4. ExpeHoratio folida. Solid expefforation. The mucus of the lungs becomes hardened by the increafed abforption, fo that it adheres and forms a kind of lining in the air cells, and is fometimes fpit up in the form of branching veffels, which are called polypi of the lungs. See Tranfadt. of the College, Lon- don. There is a rattling or wheezing of the breath, but it is not at firft attended with inflammation. The Cynanche trachealis, or Croup, of Dr. Cullen, or Angina polypofa of Michaelis, if they differ from the peripneumony of infants, feem to belong to this genus. When the difficulty of ref- piration is great, venefetlion is immediately neceflary, and then an emetic and a blifter. And the child (hould be kept nearly upright in bed as much as may be, See Tonfillitis, Clafs II. 1. 3. and II. 1.24 M- M. Diluents, emetics, effence of antimony, foetid gums, onions, ClassI. 1. 3. 5. OF IRRITATION. 31 onions, warm bath for half an hour every day for a month. In- haling the fteam of water, with or without volatile alkali. Soap. 5. Conjlipatio alvi. Coftivenefs from increafed action of the inteftinal abforbents. The feces are hardened in lumps called fcybala; which are fometimes obliged to be extracted from the rectum with a kind of marrow fpoon. This is faid to have hap- pened from the patient having taken much ruft of iron. The mucus is alfo hardened fo as to line the inteftines, and to come away in Ikins, rolled up as they pafs along, fo as to refemble worms, for which they are frequently miftaken; and fometimes it is evacuated in Hill larger pieces, fo as to counterfeit the form of the inteftines, and has been miftaken for a portion of them. Balls of this kind, nearly as heavy as marble, and confidera Jy hard, from two inches to five in diameter, are frequently found in the bowels of horfes. Similar balls found in goats have been called Bezoar. M. M. Cathartics. Diluents, fruit, oil, foap, fulphur, warm bath. Sprinkling with cold water, cool clothing. See Clafs I. 2. 4. 18. 6. Cutis arida. Dry fkin. This dry Ikin is not attended with coldnefs as in the beginning of fever-fits. Where this cutaneous abforption is great, and the fecreted material upon it vifcid, as on the hairy fcalp, the Ikin becomes covered with hardened mu- cus 5 which adheres fo as not to be eafily removed, as the fcurf on the head ; but is not attended with inflammation like the Tinea, or Lepra. The moifture, which appears on the Ikin be- neath refinous or oily plafters, or which is feen to adhere to fuch plafters, is owing to their preventing the exhalation of the per- fpirable matter, and not to their increafing the production of it, as fome have idly imagined. M M. Warm bathing, oil externally, oil-lkin gloves, refin- ous plafters. Wax. 7. Urina parca colorata. Diminifhed urine, which is high col- oured, and depofites an earthy fediment, when cold, is owing to the great action of the urinary abforbents. See Clafs I. 1. 2. 4. In fome dropfies the cutaneous abforbents are paralytic, as well as thofe opening into the cellular membrane; and hence no moifture being acquired from the atmofphere, or from the cellular membrane, great thirft is excited ; and great abforption from all parts, where the abforbents are (till capable of action. Hence the urine is in very fmali quantity, and of deep colour, with copious fediment; and the kidneys are erroneously blamed for not doing their office ; ftimulant diuretic medicines are giv- en in vain ; and very frequently the unhappy patient is reftrain- ed from quenching his thirft, and dies a martyr to falfe theory. M. M. Diluent DISEASES 32 Class I. 1. 3; 8. M. M. Diluent liquids, and warm bathing, are the natural cure of this fymptom ; but it generally attends thofe dropfies, which are feldom curable ; as they are owing to a paralyfis both of the cutaneous and cellular lymphatics. 8. Calculus jelleus. Gall-ftone From the too hafty abforp- tion of the thinner parts of the bile, the remainder is left too vifcid, and cryflallizes into lumps; which, if too large to pafs, obftruCl the duClus choledochus, producing pain at the pit of the ftomach, and jaundice. When the indurated bile is not harder than a boiled pea, it may pafs through the bile dud with difficulty by changing its form ; and thus gives thofe pains, which have been called fpafms of the ftomach ; and yet thefe vifcid lumps of bile may afterwards diflblve, and not be vifible among the feces. In two inftances I have feen from thirty to fifty gall-ftones voided after taking an oil vomit as below. They were about the fize of peas, and diftinguiffiable when dry by their being in- flammable like bad wax, when put into the flame of a candle. For other caufes of jaundice, fee Clafs I. 2. 4. 19. M. M. Diluents, daily warm bathing. Ether mixed with yolk of egg and water. Unboiled acrid vegetables, as lettuce, cabbage, muftard, and crefles. When in violent pain, four ounces of oil of olives, or of almonds, ffiould be fwallowed; and as much more in a quarter of an hour, whether it flays or not. The patient fhould lie on the circumference of a large barrel, firft on one fide, and then on the other. Eleftric fhocks throu ;h the gall-duCl. Factitious Seltzer water made by diflblving one dram of fal foda in a pint of water ; to half a pint of which made luke-warm add ten drops of marine acid ; to be drunk as foon as mixed, twice a day for fome months Opium mult be ufed to quiet the pain, if the oil does not fucceed, as two grains, and another grain in half an hour if neceflary. See Clafs IV. 2. 2.4. 9. Calculus rents. Stone of the kidney. The pain in the loins and along the courfe of the ureter from a ftone is attended with retraClion of the tefticle in men, and numbnefs on the infide of the thigh in women. It is diftinguiffied from the lumbago or fciatica, as thefe latter are feldom attended with vomiting, and have pain on the outfide of the thigh, fometimes quite down to the ancle or heel. See Herpes and Nephritis. Where the abforption of the thinner parts of the fecretion takes place too haftily in the kidneys, the hardened mucus, and confequent calculus concretions, fometimes totally flop up the tubuli uriniferi, and no urine is fecreted. Of this many die, who have drunk much vinous fpirit, and fome of them recover by voiding a quantity of white mucus, like chalk and water; and others ClassI. 1. 3.9. OF IRRITATION. 33 others by voiding a great quantity of fand or fmall calculi. This hardened mucus frequently becomes the nucleus of a (tone in the bladder. The faits of the urine, called microcofmic fait are of- ten miftaken for gravel, but are diftinguifhable both by their an- gles of cryftallization, their adhefion to the fides or bottom of the pot, and by their not being formed till the urine cools- Where- as the particles of gravel are generally without angles, and always drop to the bottom of the veflel, immediately as the water is voided. Though the proximate caufe of the formation of the calculous concretions of the kidneys, and of chalk (tones in the gout, and of the infoluble concretions of coagulable lymph, which are found on membranes, which have been inflamed in peripneumony, or rheumatifm, confifts in the too great action of the abforbent veflels of thofe parts ; yet the remote caufes of thefe cafes is probably owing to the inflammation of the membranes ; which at that time are believed to fecrete a material more liable to co- agulate or concrete, than they would otherwife produce by in- creafed a&ion alone without the production of new veflels, which conftitutes inflammation. As defined in Clafs II. I. 2. The fluids fecreted from the mucus membranes of animals are of various kinds and confiftencies. Hair, filk, fcales, horns, finger-nails, are owing to natural procefles. Gall-ftones, (tones found in the inteftines of horfes, fcurf of the fkin in leprofy, ftonesof the kidneys and bladder, the callus from the inflamed periofteum, which unites broken bones, the calcareous cement, which repairs the injured (hells of fnails, the calcareous cruft on the eggs of birds, the annually renewed (hells of crabs, are all in- ftances of productions from mucous membranes, afterwards in- durated by abforption of their thinner parts. All thefe concretions contain phofphoric acid, mucus, and calcareous earth in different proportions ; and are probably fo far analagous in refpeCt to their component parts as well as their mode of formation. Some calcareous earth has been difcovered after putrefa&ion in the coagulable lymph of animals. Fordyce's Elements of PraCtice. A little calcareous earth was detected by Scheele or Bergman in the calculus of the bladder with much phofphoric acid, and a great quantity of phofphoric acid is fhewn toexift in oyftcr-(hells by their becoming luminous on expoflng them a while to the fun's light after calcination ; as in the ex- periments of Wilfon. Botanic Garden, P. i. Canto i. 1, 182, note. The exchange of which phofphoric acid for carbonic acid or fixed air, converts (hells into lime-ftone, producing mountains of marble, or calcareous ftrata. Now as the hard lumps of calcareous matter, termed crabs' Vol. II. F eyes. DISEASES 34 ClassI. 1. 3. 9. eyes, which are found in the ftomachs of thofe animals previous to the annual renewal of their fhells, are rediflblved, probably by their gaftric acid, and again depofited for that purpofe ; may it not be concluded, that the Rone of the bladder might be dif- folved by the gaftric juice of fifh of prey, as of crabs or pike ; or of voracious young birds, as young rooks or hawks, or even of calves ? Could not thefe experiments be tried by collecting the gaftric juice by putting bits of fponge down the throats of young crows, and retracting them by a firing in the manner of Spal- lanzani ? or putting pieces of calculus down the throat of a liv- ing crow, or pike, and obferving if they become digefted ? and laftly, could not gaftric juice, if it fhould appear to be a folvent, be injeCled and borne in the bladder without injury by means of catheters of claflic refin, or caoutchouc ? M. M. Diluents. Cool drefs. Frequent change of pofture. Frequent horizontal reft in the day. Bathe the loins every morn- ing with a fponge and cold water. Aerated alkaline water in- ternally. Abflinence from all fermented or fpiritous liquors. Whatever increafes perfpiration injures thefe patients, as it dif- fipates the aqueous particles, which ought to dilute the urine. When the conflitution begins to produce gravel, it may I believe be certainly prevented by a total abflinence from fermented or fpirituous liquors ; by drinking much aqueous fluids ; as toaft and water, tea, milk and water, lemonade ; and laftly by thin clothing, and fleeping on a hardifh bed, that the patient may not lie too long on one fide. See Clafs IV. 2. 2. 2. There is reafon to believe, that the daily ufe of opium contributes to produce gravel in the kidneys by increafing abforption, when they are inflamed ; in the fame manner as is done by fermented or fpir- itucas liquor. See Clafs I. 3. 2. 11. When the kidneys are fo obflruCled with gravel, that no urine pafles into the bladder; which is known by the external appear- ance of the lower part of the abdomen, which, when the bladder is full, feems as if contracted by a cord between the navel and the bladder ; and by the tenfion on the region of the bladder diftinguifhable by the touch ; or by the introduction of the ca- theter ; the following methods of cure are frequently fuccefsful. VenefeClion to fix or eight ounces, ten grains of calomel, and .an infufion of fcnna with faits and oil, every three hours, till flools are procured. Then an emetic. After the patient has been thus evacuated, a blifter on the loins fhould be ufed ; and from ten to twenty eledric fhocks fhould be pafled through the kidneys, as large as can be eafily borne, once or twice a day. Along with this method the warm bath fhould be ufed for an hour once or twice a day. After repeated evacuations, a clyfler, confiding Class I. i. 3. 10. OF IRRITATION. 35 confiding of two drams of turpentine diffolved by yolk of egg, and fixty drops of tinflure of opium, fhould be ufed at night, and repeated, with cathartic medicines interpofed, every night, or alternate nights. Aerated folution of alkali fhould be taken internally, and balfam of copaiva, three or four times a day Some of thefe patients recover after having made no water for nine or ten days. If a ftone flicks in the ureter with inceffant vomiting ten grains of calomel muft be given in fmall pills as above ; and fome hours afterwards infufion of fenpa and faits and oil, if it can be made to flay on the ftomach. And after the purge has operated four or five times, an opiate is to be given, if the pain continues, con- fiding of two grains of opium. If this does not fucceed, ten or twenty electric fhocks through the kidney fhould be tried, and the purgative repeated, and afterwards the opiate. The patient fhould be frequently pur into the warm bath for art hour at a time Eighty or a hundred drops of laudanum given in a clyf- ter, with two drams of turpentine, are to be preferred to the two grains given by the ftomach as above, when the pain and vomiting are very urgent. io Calculus Veftca. Stone of the bladder. The nucleus, or kernel, of thefe concretions is always formed in the kidney, as above defcribed ; and palling down the ureter into the bladder is there perpetually increafcd by the mucus and faits fecreted from the arterial fyflem, or by the mucus of the bladder, difpo- fed in concentric flrata. The (Iones found in the bowels of horfes are alfo formed on a nucleus, and confift of concentric fpheres ; as appears in fawing them through the middle. But as thefe are formed by the indurated mucus of the inteflines alone without the urinary faits, it is probable a difference would be found on their analyfis. As the flones of the bladder are of various degrees of hardnefs, and probably differ from each other in the proportions at lead of their component parts ; when a patient, who labours under this afflicting difeafe, voids any fmall bits of gravel; thefe fhould be kept in warm folutions of cauflic alkali, or of mild alkali well aerated ; and if they diffolve in thefe folutions, it would afford greater hopes, that that which remains in the bladder might be affected by thefe medicines taken by the ftomach, or injected into the bladder. To prevent the increafe of a ftone in the bladder much diluent drink fhould betaken j 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 microcofmic faits from being precipitated from the urine, and by keeping the mu- cus 36 DISEASES Class I. 1. 3. iq. cus fiifpended in it; but will alfo diminifh the ftone already formed, by foftening, and waffiing away its furface. To this muft be added cool drefs, and cool bed-clothes, as directed above in the calculus renis. When the ftone is pulhed againft or into the neck of the blad- der, great pain is produced ; this may fometimes be relieved by the introduction of a bougie to pu(h the ftone back into the fun- dus of the bladder. Sometimes by change of pofture, or by an opiate either taken into the ftomach, or by a clyfter. A dram of fal foda, or of fait of tartar, diflblved in a pint of water, and well faturated with carbonic acid (fixed air) by means of Dr. Nooth's glafs apparatus, and drunk every day, or twice a day, is the moft efficacious internal medicine yet difcovered, which can be eafily taken without any general injury to the con- ftitution, An aerated alkaline water of this kind is fold under the name of factitious Seltzer water, by J. Schweppe, at No. 8, King's-ftreet, Holborn, London ; which I am told is better pre- pared than can be eafily done in the ufual glafs veflels, probably by employing a greater preffure in wooden ones. A curious account is given in a letter to Sir John Sinclair from Colonel Martin ; who aflerts, that, after ufing bougies and in- jections into the- bladder, the paflage of the urethra became lefs fenfible to pain, and he was enabled to introduce fmall files (I fuppofe with their backs fmooth) ; and that by thefe he gradu- ally filed away the ftone, as it lay in the neck of the bladder. When the ftone did not properly prefent itfelf, he introduced warm water by injeCtion into the bladder, and thus, by again en- deavouring to difcharge it, brought forward the ftone to the neck of it. He ufed the file three times in twenty- four hours from April till OClober. Medical Journal, No. II. p. 121. If this procefs fhould be again attempted, perhaps the file might be intro- duced through a flexible canula, with a metallic hood at the in- ternal end of the canula to cover the back of the file, fo as to prevent the friCtion of it againft the urethra, or neck of the blad- der. If the urethra, by frequent trials, Ihould become fo infen- fible as to admit eafily the frequent introduClion of a metallic canula, might not two fine fteel wires properly tempered be join- ed at one end by a hinge, and thus introduced through the canula into the bladder ; and when protruded beyond the extremity of the canula, they might open by their elafticity fo as to receive the ftone, and confine it againft the end of the canula, by re- trafting them ? The proper direction of the wire-fprings, fo as to open when they are pufhed through the canula, muft be pre- vioufly given them. If this could be managed, a fmall file or borer might at the fame time be introduced through the canula, the Class. I. 1. 3. 11. OF IRRITATION. 37 the handles o£ which might confift of joints to permit them to bend in all directions, and thus the ft one might be broken to pieces by a few trials ; or if it was foft or fragile ftone, the re- traction of the wire-bow might divide it at every trial, till it be- came almoft reduced to powder. A little mechanical ingenuity might be neceflary in the conftruCtion and ufe of this machine- ry ; but I believe it not to be impracticable, fmee I read the above account of Colonel Martin, though I had often before thought of it with defpair of its fuccefsful application. Lithotomy is the laft refource. Will the gaftric juice of ani- mals diffolve calculi? Will fermenting vegetable juices, as fweet-wort, or fugar and water in the aCt of fermentation with yeaft, diflblve any kind of animal concretions ? it. Calculus arthriticus. Gout-ftones are formed on infla- med membranes, like thofe of the kidneys above defcribed, by the too hafty abforption of the thinner and faline parts of the mucus. Similar concretions have been produced in the lungs, and even in the pericardium ; and it is probable, that the oflification, as it is called, of the minute arteries, which is faid to attend old age, and to precede fome mortifications of the extremities, may be a procefs of this kind. As gout-ftones lie near the furface, it is probable, that ether, frequently applied in their early ftate, might render them fo li- quid as to permit their re-abforption ; which the ftimulus of the ether might at the fame time encourage. 12. Rheumatifmus chronicus. Chronic rheumatifm. After the acute rheumatifm fome infpiflated mucus, or material fimilar to chalk-ftones of the gout, which was fecreted on the inflamed membrane, is probably left, owing to the too hafty abforption of the thinner and faline part of it; and by laying on the fafeia, which covers fome of the mufcles, pains them, when they move and rub againft it, like any extraneous material. The pain of the fhoulder, which attends inflammations of the upper membrane of the liver, and the pains of the arms, which attend afthma dolorificum, or dropfy of the pericardium, are dif- tinguilhed from the chronic rheumatifm, as in the latter the pain only occurs on moving the affedted mufcles. M. M. Warm bath, cold bath, bandage of the emplaftrum de minio put on tight, fo as to comprefs the part. Cover the parr with flannel. With oiled filk. Rub it with common oil fre- quently. With ether. A blifter. A warmer climate. Ven- efeftion. A grain of calomel and a grain of opium for ten fuc- ceflive nights. The Peruvian bark. 13. Cicatrix vulnevum- The fear after wounds. In the healing of ulcers the matter is firft thickened by increafing the abforption 38 DISEASES Class I. 1. 3.14. abforption in them; and then leffened, till all the matter is ab- forbed, which is brought by the arteries, inftead of being depo- fited in the ulcer. M M This is promoted by bandage, by the forbentia exter- nally, as powder of bark, white lead ; folution of fugar of lead. And by the forbentia internally after evacuations. See Sect. XXXIII 3. 2. In thofe ulcers, which are made by the con tail of external fire, the violent action of the fibres, which occafions the pain, is liable to continue, after the external heat is withdrawn. This fhould be relieved by external cold, as of fnow, fait and water recently mixed, ether, or fpirits of wine, fuffered 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 com- mences in feveral places at the fame time ; which probably con- tributes to the unevennefs of large fears. 14. Comex obfufeatio. Opacity of the cornea. There are few people, who have palled the middle of life, who have not at fome time fuffered fome flight fcratches or injuries of the cotnea, which by not healing with a perfect fmooth furface, occafion fome refractions of light, whicn may be conveniently feen in the following maner: fill a tea-faucer with cream and tea, or with milk, and holding it to your lips, as if going to drink it, the im- perfections of the cornea will appear like lines or blotches on the furface of the fluid, with a lefs white appearance than that fur- face. Thofe blemilhes of the eye are diftinguifhed from the mufeae volitantes defcribed in Oafs I. 2. 5. 3 by their being in- variably feen at any time when you look for them. Ulcers may frequently be feen on the cornea after ophthalmy, like little pits or indentations beneath the furface of it; in this cafe no external application fhould be ufed, left the fear fhould be left uneven ; but the cure fhould be confined to the internal ufe of thirty grains of bark twice a day, and from five to te n drops of laudanum at night, with five grains of rhubarb, if neceffary. After ulcers of the cornea, which have been large, the ine- qualities and opacity of the cicatrix obfeure the fight: in this cafe, could not a fmall piece of the cornea be cut out by a kind of trephine about the fize of a thick briftle, or a fmall crow-quill, and would it not heal with a tranfparent fear ? This experiment is worth trying, and might be done by a piece of hollow Heel wire with a (harp edge, through which might be introduced a pointed fteel fcrew ; the fcrew to be introduced through the opaque cornea to hold it up, and prefs it againft the cutting edge of Class I. i- 3. M* OF IRRITATION. of the hollow wire or cylinder ; if the fear Ihould heal without lofing its tranfparency, many blind people might be made to fee tolerably well by this flight and not painful operation. An ex- periment I with ftrongly to recommend to fome ingenious fur- geon or oculift. Or it may be attempted by prefling one end of a fmall canula on the centre of the cornea, and palling down it a bit of luna cornea, fixed in the end of a fmaller canula, and thus introdu- ced : the eye may be held fteady by palling a thread by means of a fmall curved needle through a part of the tunica adjunfli- va, which may be held by an afliftant, or by prefling on it the end of the canula as above, which might have a flat circular rim round its extremity for that purpofe. 39 ORDO 40 DISEASES Class I. i. 4. i. ORDO I. Increnfed Irritation. GENUS IV. With increafed Afiions of either Cavities atrd Membranes. SPECIES. i. Niclitatio irritativa. Winking of the eyes is peformed every minute without our attention, for the purpofe of cleaning and moiftening the eye-ball; as further fpoken of in Clafs IL i, I. 8. When the cornea becomes too dry, it becomes at the fame time lefs tranfparent; which is owing to the pores of it being then too large, fo that the particles of light are refraded by the edges of each pore, inftead of palling through it ; in the fame manner as light is refracted by palling near the edge of a knife. When thefe pores are filled with water, the cornea becomes again tranfparent. This want of tranfparency of the cornea is vifible fometimes in dying people, owing to their inirritability, and confequent negledt of niditation. The increafe of tranfparency by filling the pores with fluid is feen by foaking white paper in oil; which from an opaque body becomes very tranfparent, and accounts for a curious atmofpher- ic phenomenon ; when there exifts a dry mill in a morning fo as to render diftant objects lefs diftind, it is a fign of a dry day ; when diflant objeds are feen very diftind, it is a fign of rain. See Botan. Garden, Part I. add. note xxv. The particles of air are probably larger than thofe of water, as water will pafs through leather and paper, which will confine air, hence when the atmofphere is much deprived of moifture, the pores of the dry air are fo large, that the rays of light are refraded by their edges inftead of palling through them. But when as much moif- ture is added as can be perfedly diflblved, the air becomes tranf- parent ; and opaque again, when a part of thisemoifture colleds into fmall fpherules previous to its precipitation. This alfo ac- counts for the want of tranfparency of the air, which is feen in tremulous motions over corn-fields on hot fummer-days, or over brick-kilns, after the flame is extinguilhed, while the furnace remains hot. 2. Deglutitio irritativa. The deglutition of our faliva is per- formed frequently without our attention, and is then an irritative adion m confequence of the ftimulus of it in the mouth. Or perhaps Class I. 1.4. 3. OF IRRITATION. 41 perhaps fometimes for the purpofe of diffufing a part of it over the dry membranes of rhe fauces and pharynx; in the fame manner as tears are diffufed over the cornea of the eye by the a€t of nidlitation to clean or moiften it. 3: Re/piratio et Tuflis irritative. In the a£ts of refpiration and of coughing there is an increafed motion of the air-cells of the lungs owing to fome ftimulating caufe, as defcribed above in Clafs I. I. 2. 8. and I. 1.3.4 and which are frequently per- formed without our attention or confcioufnefs, and are then ir- ritative actions ; and thus differ from thofe defcribed in Clafs II. 1. 1. 2. and 5. To thefe increafed actions of the air-cells are fuperadded thofe of the intercoftal mufcles and diaphragm by irritative affociation. When any unnatural ftimulus adls fo vi- olently on the organs of refpiration as to induce pain ; the fenfo- rial power of fenfation becomes added to that of irritation, and inflammation of the membranes of.them is a general confequence. 4. Exclufto bills. The exclufion of the bile from the gall-blad- der, and its derivation into the duodenum, is an irritative adlion in confequence of the ftimulus of the aliment on the extremity of the biliary dutt, which terminates in the inteftine. The in- creafed fecretion of tears is occafioned in a fimilar manner by any ftimulating material in the eyes; which affetSls the excretory duffs of the lachrymal glands. A pain of the external membrane of the eye fometimes attends any unufual ftimulus of it, then the fenforial power of fenfation becomes added to that of irrita- tion, and a fuperficial inflammation is induced. 5. Dentitio. Toothing. The pain of toothing often begins much earlier than is fufpe&ed ; and is liable to produce convul- fions ; which are fometimes relieved, when the gum fwells, and becomes inflamed ; at other times a diarrhoea fupervenes, which, is generally efteemed a favourable circumftance, and feems to prevent the convulfions by fupplying another means of relieving the pain of dentition by irritative exertion ; and a confequent temporary exhauftion of fenforial power. See Clafs I. 1.2. 5. Sett. XXXV 2. 1. The convulfions from toothing generally commence long be- fore the appearance of the teeth; but as the two middle incif- ors of the lower jaw generally appear firft, and then thofe of the upper, it is advifeable to lance the gums over thefe longitudi- nally inrefpeft to the jaw-bones, and quite down to the periof- teum, and through it. AstheconvulGonsattendingthe commencement of toothing are not only dangerous to life in their greateil degree, but are liable to induce ftupor or infenfibility by their continuance even in a lefs degree, the moft efficacious means fhould be ufed to cure them Vol. II. G M. M. Lance 42 DISEASES Class I. i. 4. 6O M. M. Lance the gutn of the expected teeth quite through the periofteum longitudinally. VenefeCiion by the lancet or by two or three leeches. One grain of calomel as a purge. Tinc- ture of jalap, five or fix drops in water every three hours till it purges, to be repeated daily. After evacuations a fmall blifter on the back or behind the ears. And laftly two or three drops of laudanum according to the age of the child. Warm bath. See Clafs TIL 1. 1. 5. and 6. 6. Priapifinus chronicus. I have feen two cafes, where an ere&ion of the penis, as hard as horn, continued two or three weeks without any venereal defires, but not without feme pain ; the eafielt attitude of the patients was lying upon their backs with their knees up. At length the corpus cavernofum urethrae became foft, and in another day or two the whole fubfided. In one of them a bougie was introduced, hoping to remove fome bit of gravel from the caput gallinaginis, camphor, warm bathing, opium, lime-water, cold afperfion, bleeding in the veins of the penis, were tried in vain. One of them had been a free drinker, had much gutta rofacea on his face, and died fuddenly a few months after his recovery from this complaint. Was it a paral- yfis of the terminations of the veins, which abforb the blood from the tumid penis ? or from the ftimulus of indurated femen in the feminal veffels ? In the latter cafe fome venereal defirea fhould have attended. Clafs III. 1. 2. 16. The priapifmus, which occurs to vigorous people in a morn- ing before they awake, has been called the fignum falutis, or banner of health, and is occafioned by the increafe of our irri- tability or fenfibility during ileep, as explained in Sedl.XVIII. 15. 7. Dijlentio mammularum. The diftention of the nipples of la&efcent women is firft owing to the ftimulus of the milk. See Seii. XIV. 8. andSeft. XVI, 5. See Clafs II. 1. 7. 10. 8. Defcenfus uteri. This is a very frequent complaint after bad labours, the fundus uteri becomes inverted and defcends like the prolapfus ani. M. M. All the ufual peflaries are very inconvenient and in- effectual. A piece of foft fponge about two inches diameter in- troduced into the vagina gives great eafe to thefe patients, and fupports the uterus ; it Ihould have a firing put through it to retract it by. There are alfo peflaries now made of elaftic gum, which are faid to be eafily worn, and to be convenient from their having a perforation in their centre. 9. Prolapfus ani. The lower part of the reftum becomes in- verted, and defcends after every ftool chiefly in children ; and .thus ftimulates the fphindter ani like any other extraneous body. M. M. Tt Class I. 1.4. iq. OF IRRITATION. 43 M M. It fhould be dufted over with very fine powder of gum fandarach, and then replaced. Aftringent fomentations ; as an infufion of oakbark or a flight folution of alum. Hori- zontal reft frequently in the day. io. Lutnbricus. Round worm. The round worm is fuf- peded in children when the belly is tumid, and the countenance bloated and pale, with fwelling of the upper lip. The genera- tion of thefe worms is promoted by the too dilute Rate of the bile, as is evident in the fluke-worm found in the biliary duds and fubftance of the liver in fheep ; and in water-rats, in the livers of which laft animals they were lately deteded in large numbers by Dr. Capelle. Tranfadions of the college at Phila- delphia, v. i. Now as the dilute ftate of the bile depends on the deficiency of the abforption of its thinner parts, it appears, that the tumid belly and bloated countenance, and fwelled upper lip, are con- comitant circumftances attending the general inadivity of the abforbent fyftem ; which is therefore to be efteemed the remote caufe of the generation of worms. The fimplicity of the ftrudure of worms probably enables them to exift in more various temperatures of heat ; and their being endued with life prevents them from being deftroyed by digeftion in the ftomach, probably in the fame manner as the powers of life prevent the fermentation and putrefadion of the ftomach itfelf. Hence I conclude that worms arc originally taken into our alimentary canal from without; as I believe fim^ ilar worms of all kinds are to be found out of the body. M. M. The round worm is deftroyed by a cathartic with four or fix grains of calomel ; and afterwards by giving fix or eight grains of filings of iron twice a day for a fortnight. See Hepatis tumor, Clafs I. 2. 3. 9. As worms are liable to come away in fevers, whether of the hedic or putrid kind, could they be removed by purulent matter, or rotten egg, or putrrd flefh fince in thofe fevers from the enfeebled adion of the inteftines the faeces become highly putrid. The {harp fpiculae or hairs, which are found on the pods of cowhage, ftruolobium filiqua hirfuta, have been recommended in worm-cafes, and faid to deftroy them by mechanical pundure • the late Mr. Power of Polefworth, allured me, he had had great fuccefs with this medicine and gave about fix or eight grains in a bolus three or four times on one day, with a brifk cathartic on the next day. Some have recommended chopped hair or brittles for this purpofe. There are numerous {harp fpiculje in the fruit of the wild rofe, which might be worth trying in this difeafe 44 DISEASES Class I. 1.4. 11. difeafe, and the hairs on full grown hairy caterpillars, if the ani- mal be laid on the hand, efpecially between the fingers, are liable to flick in the fkin, and to produce flight inflammation and itch- ing, and might alfo be worth trying in worm-cafes. But it is aflerted in M Vaillant's Travels in Africa, that when thefe in- fe£ls feed on poifonous plants, they become themfelves fo ven- omous, that the natives colledl a juice from them, with which when putrid they fmear their war-weapons to poifon them. it. Tania. 1 ape-worm confifts of a chain of animals ex- tending from the flomach to the anus. See Sed. XXXIX. 2 3. It frequently exifls in cats, rats, and geefe, and probably in many other animals. The worms of this genus poflefs a wonderful power of re- taining life. I wo of them, which were voided by a pointer dog in confequence of violent purgatives, each of which were feveral feet in length, had boiling water poured on them in a bafin ; which feemed not much to inconvenience them. When the water was cool, they were taken out and put into gin or whifkey of the ftrongeft kind,z in which their life and a&ivity continued unimpaired ; and they were at length killed by'adding to the fpirit a quantity of corrofive fublimate. Medic. Comment, for 1791, p. 370. The tape-worm is cured by an amalgama of tin and quickfilver, fuch as is ufed on the back of looking-glaffes ; an ounce fhould be taken every two hours, till a pound is taken ; and then a brifk cathartic of Glauber's fait two ounces, and common fait one ounce, diflblved in two wine pints of water, half a pint to be taken every hour till it purges. The worm extends from the flomach to the anus, and the amalgama tears it from the inteftine by me- chanical preflure, ailing upon it the whole way. Ele&ric fhocks through the duodenum greatly affift the operation. Large dofes of tin in powder. Tron filings in large dofes. The powder of fernroot feems to be of no ufe, as recommended by M. Nouffli- er. This worm, as well as the lumbricus or round-worm, is fometimes brought up by vomiting; when either of thefe worms is in the flomach it gives a tickling fenfation about the fauces, which parts fympathize with the cardia ventriculi. See Annals of Medicine, 1797. Give an emetic of tartarized antimony, or of vitriol of zinc. 12. ^fcarides. Thread worms. Thefe worms are faid to be more frequent in fome parts of this kingdom than in others, as near the fens of Lincolnfhire. Do they efcape from the body and be- come flies, like the bott-worm in horfes ? Do they crawl from one child to another in the fame bed ? Are they acquired from flies or worms, which are feen in putrid neceflary houfes, as thefe OF IRRITATION. Class. I. i. 4. 12. 45 thefe worms as well as the tape-worms, are probably acquired from without ? this may account for their re-appearance a few weeks or months after they have been deftroyed ; or can thin happen from the eggs or parts of them remaining ? Afcarides appear to be of two kinds, the common fmall one like a thread ; which has a very (harp head, as appears in the mi- crcfcope ; and which is fo tender, that the cold air foon renders it motionlefs; and a larger kind above an inch long, and nearly as thick as a very fmall crow-quill, and which is very hard in re- fpett to its texture, and very tenacious of life. One of thefe laft was brought to me, and was immediately immerfed in a ftrong folution of fugar of lead, and lived in it a very long time without apparent inconvenience. M. M. Afcarides are faid to be weakened by twenty grains of cinnabar and five of rhubarb taken every night, but not to be cured by this procefs. As thefe worms are found only in the reCtum, variety of clyfters have been recommended. A clyfter confining of one eighth or one fourth of an ounce of fuccotrine aloes in powder boiled in a pint of milk or of gruel, till it is dif- folved, and injected once a week for many weeks, I believe has fometimes effected a cure. I was informed of a cafe, where fo- lutions of mercurial ointment were ufed as a clylter every night for a month without fuccefs. Clyfters of Harrowgate water arc recommended, either of the natural, or of the factitious, as de- fcribed below, which might have a greater proportion of liver of fulphur in it. As the cold air foon deftroys them, after they are voided, could clyfttrsof iced water be ufed with advantage ? or of fpirit of wine and water ? or of ether and water ? Might not a piece of candle, about an inch long, or two fuch pieces, fmeared with mercurial ointment, and introduced into the anus at night, or twice a day, be effectual by comprefling their nidus, as well as by the poifon of the mercury ? The clyfters fhould be large in quantity, that they may pafs high in the reCtum, as two drams of tobacco boiled a minute in a pint of water. Or perhaps what might be ftill more effica- cious and lefs inconvenient, the fmoke of tobacco injeded by a proper apparatus every night, or alternate nights, for fix or eight weeks. This was long fince recommended, I think, by Mr. Turner of Liverpo )1 ; and the reafon it has not fucceeded, I believe to have been owing to the imperfections of the joints of the common apparatus for injeCting the fmoke of tobacco, fo that it did not pafs into the inteftine, though it was fuppofed to do fo, as 1 once obferved. The fmoke fhould be received from the apparatus into a larger bladder; and it may then be certainly injeCted like the common clyfter with fufficient force; otherwife oiled ClassI. i. 4.13'. 46 DISEASES oiled leathers fhould be nicely put round the joints of the ma- chine ; and a wet cloth round the injeCling pipe to prevent the return of the fmoke by the (ides of it. Clyfters of carbonated hydrogen gas, or of other factitious airs, might be tried ; or of the hairs of filiqua hirfuta. Harrowgate water taken into the (lomach, fo as to induce fix or feven (tools every morning, for four or fix weeks, is perhaps the molt efficacious method in common ufe. A fa&itious Har- rowgate water may be made probably of greater efficacy than the natural, by diflblving one ounce of marine fait, (called bay fait) and half an ounce of magnefia Glauber's fait, (called Epfom fait, or bitter purging fait) 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-fpoonful of a folution of liver of fulphur, which is to be made by putting an ounce of hepar fulphuris into half a pint of water See Clafs IV. i. 2. 9. 13. Dracunculus. A thin worm brought from the coaft of Guinea. It is found in the interftices of the mufcles, and is many yards long ; it makes a fmall ulcer; which is cured by extracting an inch of the worm a day, and wrapping the extract- ed part (lowly round a bit of tobacco-pipe till next day, fo as not to break it. I have twice feen long worms, like a thick horfe hair, in water in July in this country, which appeared hard and jointed. 14. Morpiones. Crab-lice. The excrement of this animal ftains the linen, and appears like diluted blood. M. M Spirit of wine. Mercurial ointment, (having the part. Oil deftroys other infedts, if they be quite covered with it, as the ticks on dogs, and would probably therefore deftroy thefe. Its manner of operation is by (lopping up or filling their fpiracula, or breathing pores; a few drops of oil poured on a wafp, fo as to cover it, deftroy it in a few feconds. 15 Pe die uli Lice. There is faid to be a difeafe, in which thefe animals are propagated in indeftrudible numbers, fo as to deftroy the patient. M M. Cleanlinefs, mercurial ointment, ftavis acria in powder, or the tinCture of it in fpirit of wine. Spirit of wine alone ? Bath of oil ? ORDO Class I. 1, 5. i* OF IRRITATION. 47 ORDO I. Increafed Irritation.. GENUS V. With increafed Allions of the Organs of Senje. SPECIES. i. Vifcus acrior. Acuter fight. There have been inftances of people, who could fee better in the gloom of the evening, than in the ftronger light of the day ; like owls, and bats, and many quadrupeds, and flying infects. When the eye is inflamed, great light becomes eminently painful, owing to the increafed irrita- tive motions of the retina, and the confequent increafed fenfa- tion. Thus when the eye is dazzled with fudden 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 fudden light; but to the too violent contraftions of the moving fibres, which conftitute the extremities of the optic nerve. 2. Auditus acrior. The irritative ideas of hearing are fo in- creafed in energy as to excite our attention. This happens in fome difeafes of the epileptic kind, and in fome fevers. Hence the whifpering of the currents of air in a room, the refpiration of the company, and noifes before unperceived, become trouble- fome ; and founds louder than ufual, or unexpected, produce flatting and convulfions. 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 cufhions, or fufpend it by cords from the ceiling. 3. Olfafius acrior. The irritative ideas of fmell from the in- creafed aCtion of the olfaCtive nerve excite our attention. Hence common odours are difagreeable ; and are perceived from vari- ety of objeCts, which were before thought inodorous. Thefe are commonly believed to be hallucinations of the fenfe. M. M. Snuff ftarch up the noftrils. 4. Gufus acrior. The irritative ideas of talle, as of our own faliva, and c .'en of the atmofpheric air, excite our attention ; and common taftes are difagreeably ftrong. M. M. Water. Mucilage. Vegetable acids. Scrape the tongue clean. Rub it with a fage-leaf and vinegar. 5. Tafias acrior. The irritative ideas of the nerves of touch excite 48 DISEASES ClassI. i. 5. 6. excite our attention : hence our own preflure on the parts, we reft upon, becomes uneafy with univerfal forenefs. M. M. Soft feather-bed. Combed wool put under the pa- tients, which rolls under them, as they turn, and thus prevents their friction againft the (beets. Drawers of foft leather. Plan- ters of cerate with calamy. 6. Senfus coloris acrior. Acuter fenfe of heat occurs in feme difeafes, and that even when the perceptible heat does not appear greater than natural to the hand of another perfon. See Clafs I. 1.2. See Sedt. XIV. 8. All the above increafed actions of our organs of fenfe feparately or jointly accompany fome fevers, and fome epileptic difeafes ; the patients complaining of the per- ception of the lead: light, noifes in their ears, bad fmells in the room, and bad taftes in their mouths, with forenefs, numbnefs, and other uneafy feels, and with difagreeable fenfations of gen- eral or partial heat. 7. Senfus extenjionis acrior. Acuter fenfe of extenfion. The fenfe of extenfion was fpoken of in Sedt. XIV 7. and XXXII. 4. The defeat of diftention in the arterial fyftem is accompani- ed with faintnefs ; and its excefs with fenfations of fulnefs, or weight, or prefliire. This however refers only to the vafcular mufcles, which are diftended by their appropriated fluids ; but the longitudinal mufcles are alfo affected by different quantities o-f extenfion, and become violently painful by the excefs of it. Thefe pains of mufcles and of membranes are generally divided into acute and dull pains. The former are generally owing to increafe of extenfion, as in pricking the fkin with a needle ; and the latter generally to defedt of extenfion, as in cold head-aches ; but if the edge of a knife, or point of a pin, be gradually prefled againft the fibres of mufcles or membranes, there would feem to be three ftates or ftages of this extenfion of the fibres ; which have acquired names according to the degree or kind of fenfation produced by the extenfion of them ; thefe are 1. titillation or tickling ; 2. itching ; and the 3. fmarting, as defcribed below. See Se&. XIV 9. 2. Titillatio. Tickling is a pleafurable pain of the fenfe of extenfion above mentioned, and therefore excites laughter ; as defcribed in Sedl. XXXIV. 1. 4. The tickling of rhe noftrils, which precedes the efforts of fneezing, is owing to the increafed irritation occafioned by external ftimulus ; and is attended with a pleafurable fenfation in confequence of the increafed action of the part. When this action is exerted in a greater degree, the fenfation becomes painful, and the convulfion of fneezing en- fues ; as the pain in tickling the foies of the feet of children is relieved by laughter. A Class I. 1. 5. 9. OF IRRITATION. 49 A lady after a bruife on her nofe by a fall was affe&ed with jnceffant freezings and relieved by fnuffing ftarch up her noftrils. Perpetual fneezings in the mealies, and in catarrhs from cold, are owing to the ftimulus of the faline part of the mucous effm fion on the membrane of the noftrils. See Clafs II. i. 1.2. 9. Pruritus. Itching feems to be a greater degree of titilla- tion, and to be owing to the ftimulus of fome acrid material, as the matter of the itch ; or of the herpes on the fcrotum, and about the anus ; or from thofe univerfal eruptions, which attend fome elderly people, who have drunk much vinous fpirit. It occurs alfo, when inflammations are declining, as in the healing of blifters, or in the cure of ophthalftiia, as the aftion of the vef- fels is yet fo great as to produce fenfation ; which, like the titil- lations that occafion laughter, is perpetually changing from pleaf- ure to pain. When the natural efforts of fcralching do not relieve the pain of itching, it fometimes increafes fo as to induce convulfions and madnefs. As in the furor uterinus, and fatyriafis, and in the fphin&er ani and fcrotum. See Clafs II. 1. 4. 14. IV. 2. 2. 6. M. M. Warm bath. Fomentation. Alcohol externally. Poultice. Oiled filk. Mercurial ointments on fmall furfaces at once. See Clafs II. 1.4. 12. Solutions of lead on fmall furfaces at once. 10. Dolor urens. Smarting follows the edge of a knife in ma- king a wound, and feems to be owing to the diftention of a part of a fibre, till it breaks. A fmarting of the fkin is liable to af- fe<£t the fears left by herpes or ihingles ; and the callous parts of the bottoms of the feet ; and around the bafes of corns on the toes ; and frequently extends after fciatica along the outfide of the thigh, and of the leg, and part of the foot. All thefe may be owing to the ftimulus of extenfion, by blood or ferum being forced into veffels nearly coalefced. M. M. Emplaftrum de minio put like a bandage on the part. Warm fomentation. Oil and camphor rubbed on the part. Oil- filk covering. A blifter on the part. Ether, or alcohol, fuffer- ed to evaporate on the part. 11. Conjlernatio. Surprife. As our eyes acquaint us at the fame time with lefs than half of the objects, which furround usj we have learned to confide much in the organ of hearing to warn us of approaching dangers. Hence it happens, that if any found ftrikes us, which we cannot immediately account for, our fears are inftantly alarmed. Thus in great debility of body, the loud clapping of a door, or the fall of a fire-fhovel, produces alarm, and fometimes even convulfions; the fame occurs from unex- pected fights, and in the dark from unexpected objects of touch. Vol. II. H r In DISEASES ClassI. 1.5. n. In thefe cafes the irritability is lefs than natural, though it is erroneously fuppofed to be greater ; and the mind is bufied in exciting a train of ideas inattentive to external objects ; when the train of ideas is diflevered by any unexpected ftimulus, fur- prife is excited; as explained in SeCt. XVII. 3. 7. and XVIII. 17. then as the fenfibility in thefe cafes is greater, fear becomes fuperadded to the furprife ; and convulfions in confequence of the pain of fear. See SeCU XIX. 2. The proximate caufe of furprife is the increafed irritation in- duced by fome violent ftimulus, which diflevers our ufual trains of ideas ; but in difeafes of inirritability the frequent ftarting or furprife from founds not uncommon, but rather louder than ufual, as the clapping of a door, (hews, that the attention of the patient to a train of fenfitive ideas was previoufly ftronger than natural, and indicates an incipient delirium ; which is therefore worth attending to in febrile difeafes.. 50 ordo Class I. 2. 1. OF IRRITATION 51 ORDO II. Decreafed Irritation. GENUS I. With decreafed Adi ion of the Sanguiferous Syfetn. The reader (hould be here apprized, that the words ftrength and debility, when applied to animal motions, may properly ex- prefs the quantity of refiftance fuch motions may overcome ; but that, when they are applied to mean the fufceptibility or infuf- ceptibility of animal fibres to motion, they become metaphorical terms ; as in Sett. XII. 2. 1. and would be better exprefled by the words activity and inactivity. There are three fources of animal inactivity ; firft, the defeCt of the natural quantity of ftimulus on thofe fibres, which have been accuftomed to perpetual ftimulus ; as the arterial and fe- cerning fyftems. When their accuftomed ftimulus is for a while intermitted, as when fnow is applied to the fkin of the hands, an accumulation of fenforial power is produced; and then a degree of ftimulus, as of heat, fomewhat greater than that at prefent applied, though much lefs than the natural quantity, ex* cites the veflels of the fkin into violent aCtion We mull ob- ferve, that a deficiency of ftimulus in thole fibres, which are not fubjeCt to perpetual ftimulus, as the locomotive mufclest is not fucceeded by accumulation of fenforial power; thefe therefore are more liable to become permanently inactive after a diminution of ftimulus ; as in ftrokes of the palfy, this may be called inactivity from defeCt of ftimulus. 2. A fecond fourceof animal inactivity exifts, when the fen- forial power in any part of the fyftem has been previoufly ex- haufted by violent ftimuli; as the eyes after long expofure to great light; or the ftomach, to repeated fpirituous potation ; this may be termed inactivity from exhauftion of fenforial pow~ er. See SeCt. XII. 2. 1. 3. But there is a third fource of inactivity owing to the defi- cient production of feniorial power in the brain ; and hence ftimuli ftronger than natural are required to produce the accuf- tomed motions of the arterial fyftem ; in this cafe there is no accumulation of fenforial power produced ; as in the inactivity owing to defeCt of ftimulus ; nor any previous exhauftion of it, as in the inactivity owing to excefsof ftimulus, This third kind of inactivity caufes many of the difeafes of this genus ; which are therefore in general to be remedied by Turk 52 DISEASES Class I: 2. i. 5. fuch medicines as promote a greater production of fenforial pow- er in the brain ; as the incirantia, confifting of wine, beer and opium, in fmall repeated quantities ; and fecondly of fuch as limply ftimulate the arterial and glandular fyltem into their nat- ural adions ; as fmall repeated blifters, fpices and eflential oils. And laltly the forbentia, which contribute to fupply the more permanent ftrength of the fyftem, by promoting the abforption of nourifhipent from the ftomach and inteftines and of the fu- perfluous fluid, which attends the fecretions. SPECIES. i. Febris inurritativa. Inirritative fever. This is the typhus mitior, or nervous fever of fome writers ; it is attended with weak pulfe without inflammation, or fymptoms of putridity, as they have been called. When the production of fenforial pow- er in the brain is lefs than ufual, the pulfe becomes quick as well as weak ; and the heart fometimes trembles like the limbs of old age, or of enfeebled drunkards ; and when this force of the contraCtions of the heart and arteries is diminifhed, the blood is pufhed on with lefs energy, as well as in lefs quantity,and thence its ftimulus on their fides is diminifhed in a duplicate ratio. In compreflions of the brain, as in apoplexy, the pulfe becomes flower and fuller ; for in that difeafe, as in natural fleep, the ir- ritative motions of the heart and arteries are not diminifhed, volition alone is fufpended or deftroyed. If the abforption of the terminations of the veins is not equal- ly impaired with the force of the heart and arteriqs, the blood is taken up by the veins the inftant it arrives at their extremities ; the capillary veflels are left empty, and there is lefs refiftance to the current of the blood from the arteries ; hence the pulfe be- comes empty, as well as weak and quick ; the veins of the fkin are fuller than the arteries of it; and its appearance becomes pale, bluifh, and fhrunk. See Clafs II. i. 3 1. When this pulfe perfifts many hours, it conftitutes the febris inirritativa, or typhus, or nervous fever, of fome writers $ it is attended with little heat, the urine is generally of a natural col- our, though in lefs quantity ; with great proftration of ftrength, and much difturbance of the faculties of the mind. Its imme- diate caufe feems to be a deficient fecretion of the fenforial pow- er from the inaCtion of the brain ; hence almoft the whole of the fenforial power is expended in the performance of the mo- tions neceflary to life, and little of it can be fpared for the volun- tary atlions of the locomotive mufcles, or organs of fenfe, fee Clafs I. 2. 5. 3. Its more remote caufe may be from a paraly- fis Class. I. 2. 1. 2. OF IRRITATION. 53 fis or death of feme other part of the body ; as of the fpleen, when a tumour is felt on the left fide, as in feme intermittents; or of the kidneys, when the urine continues pale and in fmall quantity. Does the revivefcence of thefe affeCted parts, or their torpor, recurring at intervals, form the paroxyfms of thefe fe- vers ? anrd their permanent revivefcence eftablilh the cure ? See Ciafs IV. 2. i. 19. The jnirritative fever differs from the puerperal and from the hectic fever, by the permanent inactivity of the ftomach, which in this difeafe admits of no folid nutriment. See Ciafs II. 1. 6., 16. and Suppl. I. 12. M. M. Wine and opium in fmall quantities repeated every three hours alternately ; fmall repeated blifters ; warm but frefh air ; forbentia ; nutrientia; transfufion of blood. Small electric (hocks paffed through the brain in all direCtions. Oxygene air ? 2. Parejis inirritativa. Inirritative debility. A defective ac- tion of the irritative motions without increafe of the frequency of the pulfe. It continues three or four weeks like a fever, and then either terminates in health, or the patient finks into one kind of apoplexy, and perifhes. Many fymptoms, which attend inirritative fevers, accompany this difeafe, as cold hands and feet at periodic times, fcurf on the tongue, want of appetite, muddy urine, with pains of the head, and fometimes vertigo, and vomiting. This difeafe differs from the inirritative fever by the pulfe not being more frequent than in health. The want of appetite and of digeftion is a principal fymptom, and probably is the caufeof the univerfal debility, which may beoccafioned by the want of nourifhment. The vertigo is a fymptom of inirritabil- ity, as fbewn in Ciafs IV. 1.2. 6. the muddy urine is owing to increafed abforption from the bladder in confequence of the di- minifhed cutaneous and cellular abforption, as in anafarca, ex- plained in SeCt. XXIX. 5. 1. and is therefore a confequence of the inirritability of that part of the fyftem ; the foul tongue is owing to an increafed abforption of the thinner part of the mu- cus in confequence of the general deficiency of fluid, which ihould be abforbed by the (kin and ftomach. The ficknefs is owing to decreafed aCtion of the ftomach, which is probably the primary difeafe, and is connected with the vertigo. M. M. An emetic. Calomel, grains iv. once or twice.. Then a blifter. Peruvian bark. Valerian. Columbo. Steel. Opi- um and wine in fmall quantities, repeated alternately every three hours. Small eleCtric percuffions through the ftomach. 3. Somnur interrupt™. Interrupted fleep. In fome fevers, where the inirritability is very great,when the patient falls afleep, the DISEASES Class I. 2. 1. 4. 54 the pulfe in a few minutes becomes irregular, and the patient a- wakes in great diforder, and fear of dying, refufing to Heep again from the terror of this uneafy fenfation. In this extreme debil- ity there is reafon to believe, that fome voluntary power during our waking hours is employed to aid the irritative ftimuli in carrying on the circulation of the blood through the lungs ; in the fame manner as we ufe voluntary exertions, when we liften to weak founds, cr wifh to view an object by a fmall light ; in fleep volition is fufpended, and the deficient irritation alone is not {efficient to carry on the pulmonary circulation. This ex- planation feems the moft probable one, becaufe in cafes of apo- plexy the irritative motions of the arterial fyftem do not feem to be impaired, nor in common fleep. See Incubus III. 2. 1 13. M. M Opium in very fmall dofes, as three drops of lauda- num. A perfon ffiould watch the patient, and awaken him fre- quently ; or he ffiould meafure the time between flumber and {lumber by a ftop-watch, and awaken the patient a little before he would otherwife awake ; or he fhould keep his finger on the pulfe, and ffiould forcibly awaken him, as foon as it becomes ir- regular, before the diforder of the circulation becomes fo great as to difturb him. See Clafs I. 2. 1. 9 and Seft. XXVII. 2. 4. Synccfe. Fainting confifts in the decreafed action of the arterial fyltem ; which is fometimes occafioned by defedt of the flimulus of diftention, as after venefe&ion, or tapping for the dropfy. At other times it arifes from great emotions of the mind, as in fudden joy or grief. In thefe cafes the whole fenfo- rial power is exerted on thefe interefting ideas, and becomes ex- hauiled. Thus during great furprife or fear the heart flops for a time, and then proceeds wuth throbbing and agitation ; and femetimes the vital motions become fo deranged, as never to re- cover their natural fucceffive action ; as when children have been frightened into ccnvulfions. See Se€t. XII 7 1. Mifs , a young lady of Stafford, in travelling in a chaife was fo aflc&ed by feemg the fall of a horfe and poliillion, in go- ing down a hill, though the carriage was not overturned, that ffie fainted away, and then became convulfed, and never fpoke afterwards •, though ffie lived about three days in fucceffive con- vulfions and ftupor. 5. Hamorrbagia venofa. A bleeding from the capillaries ari- fing from defeft of venous abforption, as in fome of thofe fevers commonly termed putrid When the blood ftagnates in the cel- lular membrane, it produces peteebiae from this torpor or paraly- fis of the abforbent mouths of the veins. It muft beobferved, that thofe people who have difeafed livers, are more liable to this kind of haemorrhages, as well as to the haemorrhagia arteriofa ; the Class I. 2. i. 6. OF IRRITATION. 55 the former, becaufe patients with difeafed livers are more fubjedt to paralytic complaints in general, as to hemiplegia, and to drop- fy, which is a paralyfis of the lymphatics ; and the latter is probably owing to the delay of the circulation in the vena por- ta by the torpor of this hepatic veflel, when the liver is not much enlarged ; and to its preflure on the vena cava, when it is much enlarged. I have feen two elderly men, and one middle aged woman, all of whom had drunk too much fermented or fpirituous liquors, and had been for fome months gradually linking, were feized with a ceafelefs haemorrhage from their mouths, and from every part of the Ikin, where they happened to fcratch themfelves, which continued fome days till they died. See Sedf. XXVII. 2. M. M. Vitriolic acid, opium, Heel, bark. Sponge bound on the part. Steel diflblved in fpirit of wine externally. Flour. 6. Hamorrhois ^cruenta. In the bleeding piles the capillary veflels of the reCtum become diftended and painful from the de- fect of the venous abforption of the part, and at length burft ; or the mucous glands are fo dilated as to give a paflage to the blood ; it is faid to obferve lunar periods. M. M. Venefedtion, poultices, cathartics, fpice, cold bath, and forbentia. External compreflion by applying lint, fponge, or cotton. Internal compreflion by applying a bit of candle fmeared with mercurial ointment. Strangulate the tumid piles with a filk ftring. Cut them off. See Se£l. XXVII. 2. Mrs. had for twelve or fifteen years, at intervals of a year or lefs, a bleeding from the rectum without pain ; which however Hopped fpontaneoufly after the became weakened, or by the ufe of injeClions of brandy and water. Lately the bleed- ing continued above two months, in the quantity of many ounces a day, till fhe became pale and feeble to an alarming degree. Injections of folutions of lead, of bark and fait of Reel, and of turpentine,with fome internal aflringents, and opiates,were ufed in vain. An injection of the fmoke of tobacco, with ten grains of opium mixed with the tobacco, was ufed, but without effect the two firRtimeson account of the imperfection of the machine; on the third time it produced greafficknefs, and vertigo,and nearly a fainting fit; from which time the blood entirely Hopped. Was this owing to a fungous excrefcence in the reCtum ; or to a blood-veflel being burfl from the difficulty of the blood paffing through the vena porta from fome hepatic obRrufiion, and which had continued to bleed fo long ? Was it Hopped at laff by the fainting fit ? or by the Rimulus of the tobacco ? 7. Hamorrhagia renum. Haemorrhage from the kidneys, when attended with no pain,is owing to defeCl of venous abforption in the 56 DISEASES Class I. 2. 1. 8. the kidney. When attended with paid on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney ; which is a much more frequent difeafe than the former. See SeQ.. XXVII. i. MM. i. Venefeclion in fmall quantity, calomel, bark, fteel, an opiate ; cold immerfion up to the navel, the upper part of the body being kept clothed. Neville-Holt water. 2. AJcali- zed water aerated. Much diluent liquids. Cool drefs. Cool bed-room. Cows are much fubjeft to bloody urine, called foul water by the farmers ; in this difeafe about fixty grains of opium with or without as much ruft of iron, given twice a day, in a ball mixed with flour and water, or diffolved in warm water, or warm ale* are, I believe, an efficacious remedy, to which however fhould be added about two quarts of barley or oats twice a day, and a cov- er at night, if the weather be cold. 8. Hamorrbagia bepatis. Haemorrhage from the liver. It fometimes happens in thofe, who have the gutta rofea, or para- lytic affections owing to difeafed livers induced by the potation of fermented liquors, that a great difcharge of black vifcid blood occafionally comes away by ftool, and fometimes by vomiting : this the ancients called melancholia, black bile. If it was bile, a fmall quantity of it would become yellow or green on dilution with warm water, which was not the cafe in one experiment which I tried ; it muff remain fome time in the inteftines from its black colour, when it paffes downwards, and probably comes from the bile-duds, and is often a fatal fymptom. When it is evacuated by vomiting it is lefs dangerous,becaufe it fliews great- er remaining irritability of the inteftinal canal, and is fometimes falutary to thofe who have difeafed livers. Two elderly men, who had loft their appetite for animal food, which is always a dangerous fymptom, when it occurs to thofe who have drank too much fermented liquor, obferved, that they parted with black ftools. One of them alfo had the mucus of his noftrils occafionally ftained with blood. The black ftools appeared evidently to confift of the coagulum of blood, fome- times without other feces. After a few weeks, they both funk under this difcharge, (which I fuppofed to proceed from the liv- er, as it never appeared florid in any part of it. See Section XXVII. 2. M. M. An emetic. Rhubarb, fteel, wine, bark, opium. 9. Hemoptoe venofa. Venous hsemoptoe frequently attends the beginning of the hereditary confumptions of dark-eyed peo- ple ; and in others, whofe lungs have too little irritability. Thefe fpittings of blood are generally in very fmall quantity, as a tea- fpoouful ; Class I. 2. 1. 10. OF IRRITATION. 57 fpoonful; and return at firft periodically, as about once a month ; and are lefs dangerous in the female than in the male fex ; as in the former they are often relieved by the natural pe- riods of the menfes. Many of thefe patients are attacked with this pulmonary haemorrhage in their firft ileep ; becaufe in fee- ble people the power of volition is neceflary, befides that of irri- tation, to carry on refpiration perfectly ; but, as volition is fuf- pended during deep, a part of the blood is delayed in the vef- fels of the lungs, and in confequence effufed, and the patient awakes from the difagreeaole fenfation See Clafs I. 2. I. 3. II 1.6. 6. III. 21 10. and Sett. XXVII. 2. M. M. Wake the patient every two or three hours by an alarum clock. Give half a grain of opium at going to bed, or twice a day. Onions, garlic, flight chalybeates. Iffues. Leeches applied once a fortnight or month to the herporrhoidal veins to produce a new habit. Emetics after each period of hremoptoe, to promote expectoration, and dillodge any effufed blood, which might by remaining in the lungs produce ulcers by its putridity. A hard bed, to prevent too found fleep. A periodical emetic or cathartic once a fortnight. 10. Palpitatio cordis. The palpitation of the heart frequently attends the hsemoptoe above mentioned ; and confifts in an in- effectual exertion of the heart to pufh forwards its contents in due time, and with due force. The remote caufe is frequently fome impediment to the general circulation ; as the torpor of the capillaries in cold paroxyfms of fever, or great adhefions of the lungs. At other times it arifes from the debilityof the aClion of the heart owing to the deficient fenforial power of irritation or of affociation, as at the approach of death. In both thefe cafes of weak exertion the heart feels large to the touch, as it does not completely empty itfelf at each contrari ion; and pn that account contracts more frequently, as defcribed in SeCt. XXXII. 2. 2 .Another kind of palpi ation may fometimes arife from the retrograde motions of the heart, as in fear. See Clafs I. 3. 1. 2. and IV. 3. 1.6. 11. Menorrhagia. Continued flow of the catamenia The monthly effufion of blood from rhe uterus or vagina is owing to a torpor of the veins of thofe membranes in confequence of the defeft of venereal fttmulus ; and in this refpefi refembles the mucus difcharged in the periodical venereal orgafm of the female quadrupeds, which are fecluded from the males The menor- rhagia, or continued flow of this difcharge, is owing to a con- tinued defeCt of the venous abforption of the membranes of the uterus or vagina. See Clafs IV. 2. 4- 7. M. M. VcnefeCtion in fmall quantitv. A cathartic. Then Vol. II. T 58 DISEASES Class I. 2. 1. 12. opium, a grain every night. Steel. Bark. A blifter. Topi- cal afperfion with cold water, or cold vinegar. One caufe of exceflive menftruation, which fometimes recurs monthly, and continues for a fortnight at each period, and is fucceeded by fluor albus during the intervals, I have fufpe&ed to arife, like the bleeding piles, from enlargement of the liver, which is liable to occur about the age of fortv to thofe who have drank much ftrong fmall beer, or wine ; or to thofe who have unfor- tunately been long accuftomed to the ufe of tight ftays, or other bandages round their bowels. In thefe fituations 6 or 8 grains of rhubarb fhould be taken every night for months, or even years. Calomel,4 or 6 grains fhould be taken as a cathartic once a month. A flannel drefs on the legs, thighs, and lower body may be ufe- ful in the cold feafon, but injurious in the warmer months. Weak acid of vitriol ten drops, two or three times a day ; fteel in very fmall quantity ; and a very loofe drefs round the body ; are recommended. 12. Dyfmenorrhagia. A difficulty of menftruation attended with pain. In this complaint the torpor of the uterine veflels, which precedes menftruation, is by fympathy accompanied with a torpor of the lumbar membranes, and confequent pain ; and frequently with cold extremities, and general debility. The. fmall quantity and difficulty of the difeharge is owing to arterial inactivity, as in chlorofis. Whence it happens, that chalybeate medicines are of efficacy both to flop or prevent too great men- ftruation, and to promote or increafe deficient menftruation ; as the former is owing to inirritability of the veins, and the lat- ter of the arteries of the uterus. Sec Article IV. 2. 6. in the Materia Medica. M. M. Opium, fteel, pediluvium. Warm bath. 13. Lochia nimia. Too great difeharge after delivery. In that unnatural practice of fome hafty accoucheurs of introducing the hand into the uterus immediately after the delivery of the child, and forcibly bringing away the placenta, it frequently happens, that a part of it is left behind ; and the uterus, not having pow- er to exclude fo fmall a portion of it, is prevented from com- plete contraction, and a great haemorrhage enfues. In this cir- cumftance a bandage with a thick comprefs on the lower part of the belly, by appreffing the fides of the uterus on the remaining part of the placenta, is likely to check the haemorrhage, like the application of a pledget of any foft fubftance on a bleeding veflel. In other cafes the lochia continues too long, or in too great quantity, owing to the deficiency of venous abforption. M. M. An enema. An opiate. A blifter. Slight chai ybe- ates. Peruvian bark. Cloths dipped in cold vinegar and applied externally- Glass 1.2. 1. 14. OF IRRITATION. 59 externally. Bandages on the limbs to keep more blood in them for a time have been recommended. 14. dbortio Spontanea. Some delicate ladies are perpetually liable to fpontaneous abortion, before the third, or after the fev- enth, month of geftation. From fome of thefe patients I have learnt, that they have awakened with a flight degree of difficult refpiration, fo as to induce them to rife haftily up in bed ; and have hence fufpe&ed, that this was a tendency to a kind of afth- ma, owing to a deficient abforption of blood in the extremities of the pulmonary or bronchial veins ; and have concluded from thence, that there was generally a deficiency of venous abforp- tion ; and that, this was the occafion of their frequent abortion. Which is further countenanced, where a great fanguinary dif- charge precedes or follows the exclufion of the fetus. Mifcarriages are fometimes induced by what is termed a re- troverfion of the uterus, in which the fundus uteri is retroverted and prefled down between the reftum and the vagina. 1 his can only occur in the firft or fecond month of geftation, and is generally preceded by a difficulty of making water, and a confe- quent tumour of the bladder; a violent pain about the perimeu.m or reflum is thus caufed, and a mifearriage is liable to follow. Draw off the urine with a catheter ; injefl an enema with fixty drops of tindlure of opium, if it can be done. If it recurs fre- quently after the mifearriage, a wax candle, or a peflary, made by rolling fome emplaftrum de minio fpread on iinen, may be introduced into the reflum, and worn as a comprefs to pre- vent the return for a few days, till the parts recover their ftrength. See London Medical Obfervations, Vol. IV. p. 388. and Dr. Hunter's Tables of the Gravid Uterus. M. M. Opium, bark, chalybeates in fmall quantity. Change to a warmer climate. I have directed with fuccefs in four cafes half a grain of opium twice a day for a fortnight, and then a whole grain twice a day during the whole geftation. One of thefe patients took befides twenty grains of Peruvian bark for feveral weeks. By thefe means being exactly and regularly per- fifted in, a new habit became eftabliflied, and the ufual mifcar- riages were prevented. Mifcarriages more frequently happen from eruptive fevers,and from rheumatic ones, than from other inflammatory difeafes. I faw a moft violent pleurify and hepatitis cured by repeated vene- fe&ion about a week or ten daysbefore parturition; yet another lady whom I attended, mifearried at the end of the chicken pox, with which her children were at the fame time affedfed.Mifcarri- ages towards the termination of the fmall-pox are very frequent, vet there have been a few inftances of children, who have been born DISEASES 60 Class I. 2; 1.15. born with the eruption on them. The blood in the fmall pox will not inoculate that difeafe, if taken before the commencement of the fecondary fever ; as (hewn in SeCl. XXXIII. 2. 10. becaufe the contagious matter is not yet formed, but after it has been Oxygenated through the cuticle in the puftules, it becomes con- tagious ; and if it be then abforbed, as in the fecondary fever, the blood of the mother may become contagious, and infe t the child. The fame mode of reafoning is applicable to the chicken pox. SeeClafs IV. 3. 1. 7. 15. Scorbutus. Sea-fcurvy is caufed by fait diet, the perpet- ual (timulus of which debilitates the venous and abforbent fyf- tems ; and may alfo be promoted by the fea-air, which is known to be fo injurious to molt vegetables, which grow near the coafts, and has been perhaps incautioufly recommended to consumptive patients. See Clafs II. 1.6. 7. Hence the blood is imperfect- ly taken up by the veins from the capillaries, whence brown and black fpots appear upon the fkin without fever. The limbs become livid and edematous, and laftly ulcers are produced from deficient abforption. See SeCt. XXXIII 3. 2. and Clafs II. 1, 4. 13. For an account of the fcurvy of the lungs, fee SeCt. XXVII. 2. M. M. Freda animal and vegetable food. Infufion of malt. New beer. Sugar. Wine. Steel. Bark. Sorbentia Opium ? 16. Vibices. Extravafations of blood become black from their being fecluded from the air. The extravafation of blood in bruifes, or in fome fevers, or after death in fome patients, ef- pecially in the parts which were expofed to prelfure, is owing to the fine terminations of rhe veins having been mechanically comprefled fo as to prevent their abforbing the blood from the capillaries, or to their inactivity from difeafe. The blood when extravafated undergoes a chemical change before it is fufficient- ly fluid to be taken up by the lymphatic abforbents, and in that procefs changes its colour to green and then yellow. 17. Petechia. Purple fpots. Thefe attend fevers with great venous inirritability, and are probably formed by the inability of a Angle termination of a vein, whence the correfponding capillary becomes ruptured, and effufes the blood into the cellu- lar membrane round the inert termination of the vein. This is generally efteemed a fign of the putrid ftate of the blood, or that Rate contrary to the inflammatory one. As it attends fome in- flammatory difeafes which are attended with great inirritability, as in the confluent fmall pox. But it alfo attends the fcurvy, where no fever exifts, and it therefore Amply announces the in- activity of the terminations of fome veins ; and is thence indeed a bad fymptom in fevers, as a mark of approaching inactivity of the Class I. 2. 1. 18. OF IRRITATION. 61 the whole fanguiferous fyftem, or death. The blue colour of fome children's arms or faces in very cold weather is owing in like manner to the torpor of the abforbent terminations of the veins whence the blood is accumulated in them, and fometimes burfts them. See Hjemorrhagia venofa, and Suppl. 1.27. In fome cafes of fever attended with petechite, Dr Hall, of Colchefter, directed the body to be wafhed with cold vinegar and water twice a day, with great advantage. The petechi^e be- came daily lefs numerous and lefs livid, the pulfe flower and ftronger, with lefs delirium, and more fleep. He has treated twenty cafes in this manner, and not loft one. Medical Re- view, Vol. III. p. 8. In thefe cafes not only the application of external cold feems to have been of fervice, by preventing the unneceflary expendi- ture of animal power 5 but as the ftimulus of vinegar renders the lips pale, when applied externally, and in confequence ftim- ulates the terminations of the veins into greater acftion ; it feems alfo to have contributed to remove the Petechia;. 18 Aneurifma. Aneurifm is probably owing to the want of due irritability of a part of the coat of an artery. As livng mufcles are known to refill: diruption more than dead ones, ac- cording to the experiments (I think) of Dr. Langrilh, it follows that when a part of the coat of an artery ceafes to contrail by the ftimulus of the blood, that it will foon become diftended by the force of it, till it widens into a fack, and at laft becomes ruptured. M. M Venefe&ion repeatedly in fmall quantities. Reft. Diluent, mild nutriment. Daily evacuation by a pill confifting of rhubarb eight grains, and foap four grains. It is poflible alfo, that an aneurifm may be produced by the refiftance to the circulation, and the force of the heart being greater than the fides of the arteries can counterbalance. Mr. Gimbernat is faid to have cured fome cafes of aneurifm in the popliteal artery by comprefling it by means of an adapted machine, confifting of a fteel ring above and below the knee, which are joined by a plate, beneath which is placed a proper culhinn, which can be prefled on the diftended part of the arte- ry more or lefs by means of a fcrew. The other method of cure is by a double ligature above the aneurifm, as firft pra£lifed by Mr. J. Hunter. 19. Varix. The varix of veins occurs frequently in the legs of women, polfibly fometimes from tight garters, and has for its proximate caufe the inirritability of the coat of the vein ; whence it becomes diftended, till it burfts, by the power with which the blood 62 DISEASES Class I. 2. 1. 19. blood is thrown into it by the abforbent mouths, which take it up from the capillary arteries. M. M. Tie the vena faphena below the joint of the knee,and the blood will then circulate by the internal veins ; and that flopped in the veins beneath the ligature will be abforbed. The piles may be termed varixes, and may be deftroyed by excifipn or ligature. See Haemorrhoid. ORDO Class I. 2. 2. 1. OF IRRITATION. 63 ORDO IL Decreafed Irritation-. GENUS IL Decreafed Action of the Secerning Syjletn. These are always attended with decreafe of partial, or of gen- eral heat; for as the heat of animal bodies is the confequence of their various fecretions, and is perpetually palling away into the ambient air, or other bodies in contact with them ; when thefe fecretions become diminilhed, or ceafe, the heat of the part or of the whole is foon diminilhed, or ceafes along with them. SPECIES. i. Frigus febrile. Febrile coldnefs. There is reafon to be- lieve, that the beginning of many fever-fits originates in the qui- efcence of fome part of the abforbent fyftem, efpecially where they have been owing to external cold ; but that, where the coldnefs of the body is not owing to a diminution of external heat, it arifes from the inaction of fome part of the fecerning fyftem. Hence fome parts of the body are hot whilft other parts are cold ; which I fuppofe gave occalion to error in Mar- tyn's Experiments ; where he fays, that the body is as hot in the cold paroxyfms of fevers as at other times. After the fenforial power has been much diminilhed by great, preceding activity of the fyftem, as by long continued external heat, or violent exercife, a fudden expofure to much cold produ- ces a torpor both greater in degree and over a greater portion of the fyftem, by fubtracSfing their accuftomed ftimulus from parts alreadymuch deprived of their irritability. Dr. Franklin in a letter to M. Duberge, the French tranflator of his works, men- tions an inftance of four young men, who bathed in a cold, fpring after a day's harveft work ; of whom two died on the fpot, a third on the next morning, and the other furvived with difficulty. Hence it would appear, that thofe, who have to trav- el in intenfely cold weather, will fooner perilh, who have pre- vioully heated themfelves much with drams, than thofe who have only the ftimulus of natural food ; of which I have heard one well attefted inftance. See Article VIL 2. 3. Clafs III. 2. 1. 17 Frigus chronicum. Permanent coldnefs. Coldnefs of the ex- tremities. 64 DISEASES Class I. 2. 2. 2. tremities, without fever, with dry pale (kin, is a fymptom of general debility, owing to the decreafed action of the arterial fyftem, and of the capillary vellels ; whence the perfpirable matter is fecreted in lefs quantity, and inconfequence the Ikin is lefs warm This col Inefs is obfervable at the extremities of the limbs, ears, and nofe, more than in any other parts : as a larger furface is here expofed to the contaff of the air, or clothes, and thence the heat is more haftily carried away. The pain, which accompanies the coldnefs of the (kin, is owing to the deficient exertion of the fubcutaneous veflels, and probably to the accumulation of fenforial power in the extremi- ties of their nerves. See Sett. XII. 5. 3. XIV. 6. XXXII. 3. and Clafs I. 2. 4. 1. M. M. A blifter. Incitantia, nutrientia, forbentia. Exer- cife. Clothes. Fire. Joy. Anger. 2. Pallor fugitivus. The fugitive palenefs, which accompa- nies the coldnefs of the extremities, is owing to a lefs quantity of blood palling through the capillaries of the Ikin in a given time ; where the abforbent power of the veins is at the fame time much diminilhed, a part of the blood lingers at their junc- tion with the capillary arteries, and a bluifh tinge is mixed with the palenefs ; as is feen in the loofe Ikin under the eye lids, and is always a mark of temporary debility See Clafs II 1.4 4. Where the palenefs of the Ikin is owing to the deficiency of red globules in the blood, it is joined with a yellowilh tinge ; which is the colour of the ferum, with which the blood then abounds, as in chlorofis, and in torpor or paralyfis of the liver, and is of- ten miftaken for a fuperabundance of bile A permanent palenefs of the Ikin is owing to the coalefcence of the minute arteries, as in old age. See Clafs I. 2. 2 9. There isanother fource of palenefs from the increafed abforprion of the termination of the veins, as when vinegar is applied to the lips. See Seit. XXVII. I. and another from rhe retrograde motions of the capillaries and fine extremities of the arteries. See Clafs II. 3. 1. 1 M M. A blifter, nutrientia, incitantia, exercife, oxygene gas. 3. Put parcius Diminilhed pus. Drynefs of ulcers In the cold fits of fever all the fecretions are diminilhed, whether natural or artificial, as their quantity depends on the actions of the glands or capillaries, which then Ihare in the univerfal inac- tion of the fyftem. Hence rhe drynefs of iflues and blifters in great debility, and before the aproach of death, is owing to de- ficient fecretion, and not to increafed abforption M. M. Opium, wine in very fmall quantities, Peruvian bark- 4. Mucus parcior. Diminilhed mucus. Drynefs of the mouth Class I. 2. 2. 5. OF IRRITATION. 65 mouth and noftrils. This alfo occurs in the cold fits of intermit- tents. In thefe cafes I have alfo found the tongue cold to the touch of the finger, and the breath to the back of one's hand, when oppofed to it, which are very inaufpicious fymptoms, and generally fatal In fevers with inirritability it is generally ef- teemed a gooi^fymptom, when the noftrils and tongue become moift after having been previoufly dry ; as it (hews an increafed action of the mucous glands of thofe membranes, which were be- fore torpid. And the contrary to this is the facies Hippocratica, or countenance fo well defcribed by Hippocrates, which is pale, cold, and (hrunk ; all which are owing to the inactivity of the fecerning veflels, the palenefs from there being lefs red blood palling through the capillaries, the boldnefs of the Ikin from there being lefs fecretion of perfpirable matter, and the fhrunk appearance from there being lefs mucus fecreted into the cells of the cellular membrane. See Clafs IV. 2. 4. 11. M. M. Blifters. Incitantia. 5. Urina parcior pallida. Paucity of pale urine, as in the cold fits of intermittents ; it appears in fome nervous fevers through- out the whole difeafe, and feems to proceed from a palfy of the kidneys; which probably was the caufe of the fever, as the fever fometimes ceafes, when that fymptom is removed : hence the ftraw-coloured urine in this fever is fo far falutary, as it fhews the unimpaired aftion of the kidneys. M. M. Balfams, eflential oil, afparagus, rhubarb, a blifter. Cantharides internally. 6 Torpor hepaticus. Paucity of bile from a partial inaClion of the liver ; hence the bombycinous colour of the fkin, grey, ftools, urine not yellow, indigeftion, debility, followed by tym- pany, dropfy, and death This paralyfis or inirritability of the liver often deftroys thofe who have been long habituated to much fermented liquor, and have fuddenly omitted the ufe of it. It alfo deftroys plumbers and houfe-painters, and in them feems a fubftitute for the colica faturnina. See SeCl. XXX. M M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment rubbed on the region of the liver. Rhubarb, three or tour grains, with opium half a grain to a grain twice a day. Equitation, warm bath for half an hour every day. 7. Torpor pancreatis. Torpor of the pancreas I faw what I conjectured to be a tumour of the pancreas with indigeftion ; and which terminated in the death of the patient. He had been for many years a great confumer of tobacco, infomuch that he chewed that noxious drug all the morning, and fmoked it all the aftern oon. As the fecretion from the pancreas refembles faliva Vol. II. K in 66 DISEASES Class I. 2. 2. 8. in its general appearance, and probably in its office of affifting di- geftion,by preventing the fermentation of the aliment; as would appear by the experiments of Pringle and Macbride ; there is reafon to fufpeCt, that a fympathy may exift between the fali- vary and pancreatic glands ; and that the perpetual ftimulus of the former by tobacco might in procefs of time injure the lat- ter. See Tobacco, Article III. 2. 2. 8. Torpor renis. Inirritability or paralyfis of the kidneys is probably frequently miftaken for gravel in them. Several, who have lived rather intemperately in refpeCt to fermented or fpir- ituous liquors, become fuddenly feized about the age of fixty, or later, with a total ftoppage of urine ; through they have previ- oufly had no fymptoms of gravel. In thefe cafes there is no water in the bladder ; as is known by the introduction of the catheter, of which thofe made of elaftic gum are faid to be pref- erable to metallic ones ; or it may generally be known by the ffiape of the abdomen, either by the eye or hand. Bougies and catheters of elaftic gum are fold at No. 37, Red Lion-ftreet,, Holborn, London. M. M. EleClric (hocks, warm bath. Emetics; See calcu- lus renis, Clafs I. 1. 3. 9. When no gravel has been previoufly obferved, and the patient has been a wine-drinker rather than an ale-drinker, the cafe is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Clafs I. 2. 4. 20. 9. PunEiamucofe vultus. Mucous fpots on the face. Thefe are owing to the inactivity of the excretory duCts of the mucous glands ; the thinner part of this fecretion exhales, and the re- mainder becomes infpiflated, and lodges in the duCt; the ex- tremity of which becomes black by expofure to the air. M. M. They may be preffied out by the finger-nails. Warm water. Ether frequently applied. Blifter on the part ? 10. Macula cutis fulva. Morphew or freCtles. Tawny blotches on the (kin of the face and arms of elderly people, and frequently on their legs after (light eryfipelas. The freckles on the face of younger people, who have red hair, feem to be a fim- ilar production, and feem all to be caufed by the coalefcence of the minute arteries or capillaries of the part. In a fear after a wound the integument is only opaque ; but in thefe blotches, which are called morphew and freckles, the fmall veflels feem to have become inaClive with fome of theferum of the blood ftag- nating in them, from whence their colour. See Clafs III. 1.2. 12. M. M. Warm bathing. A blifter on the part ? 11. Canities. Grey hair. In the injeClion of the veflels of animals for the purpofes of anatomical preparations, the colour of the injeded fluid will not pafs into many very minute veflels ; which OF IRRITATION. 67 Class I. 2. 2. 11. which neverthelefs uncoloured water, or fpirits, or quickfilver, will permeate. The fame occurs in the filtration of fome col- oured fluids through paper, or very fine fand, where the colour- ing matter is not perfeflly difiblved, but only diffufed through the liquid. This has led fome to imagine, that the caufe of the whitenefs of the hair in elderly people may arife from the dimi- nution, or greater tenuity, of the glandular veflels, which fecrete the mucus, which hardens into hair ; and that the fame differ- ence of the tenuity of the fecerning veflels may poflibly make the difference of colour of the filk from different filk-worms, which is of all (hades from yellow to white. But as the fecreted fluids are not the confequence of mechan- ical filtration, but of animal feleftion ; we mud look out for another caufe, which mud be found in the decreafing activity of the glands, as we advance in life ; and which affedls many of our other fecretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horfes by whatever injuries the glands at their roots, as bycorrofive blif- ters ; and frequently on the human fubje€t by external injuries on the head ; and fometimes by fevers. And as the grey col- our of hair confifts in its want of tranfparency, like water con- verted into fnow ; there is reafon to fuppofe, that a defeat of fe- creted moidure fimply may be the caufe of this kind of opacity, as explained in Catara&a, Clafs I. 2. 2. 13. M. M. Whatever prevents the inirritability and infenfibility of the fydem, that is, whatever prevents the approach of old age, will fo far counteract the production of grey hairs, which is a fymptom of it. For this purpofe in people, who are not corpu- lent, and perhaps in thofe who are fo, the warm bath twice or thrice a week is particularly ferviceable. See SeCt. XXXIX. 5. 1. on the colours of animals, and Clafs I. 1.2. 15. As mechanical injury from a percuflion, or a wound, or a cauftic, is liable to occafion the hair of the part to become grey ; fo I fufpeCt the compreflion of parts againft each other of fome animals in the womb is liable to render the hair of thofe parts of a lighter colour ; as feems often to occur in black cats and dogs. A fmall terrier bitch now dands by me, which is black on all thofe parts, which were external, when (he was wrapped up in the uterus, teres atque rotunda ; and thofe parts white, which were mod condantly prefled together ; and thofe parts tawny, which were generally but lefs condantly prefled togeth- er. Thus the hair of the back from the forehead to the end of the tail is black, as well as that of the fides, and external parts of the legs, both before and behind. As in the uterus the chin of the whelp is bent down, and lies in 68 DISEASES Class I. 2. 2. 11. in contact with the fore part of the neck and breafl ; the tail is applied clofe againft the divifion of the thighs behind ; the infde of the hinder thighs are prefled clofe to the fides of the belly, all thefe parts have white hairs. The fore-legs in the uterus lie on each fide of the face ; fo that the feet cover part of the temples, and comprefs the prom- inent part of the upper eye-brows, but are fo placed as to defend the eye-balls from preflure ; it is curious to obferve, that the hair of the fides of the face, and of the prominent upper eye- brows, are tawny, and of the infide of the feet and legs, which covered them ; for as this pofture admitted of more change in the latter weeks of geftation, the colour of thefe parts is not fo far removed from black, as of thofe parts, where the contact or compreflion was more uniform. I have lately alfo infpedied a male cat; who is quite black all over, except thofe parts which appear to have been folded togeth- er in the uterus; all which are perfectly white. In both thefe animals the parts comprefled together are fo diftind^ly defined by their colour, that the difference of the curvature and fituation of them in the uterus may be nicely difeerned : the hinder feet of the cat lay in the arm-pits of the fore-legs, and are white ; her fore-legs crofled over the hinder thighs, and left on them a white mark ; but the fore-feet, at leaft the hind part of them, lay under the tail ; whence the fore-feet are tipped with white. Where the foetus is lefs tender, I fuppofe, this compreflion in the uterus does not affect it ; as dogs and cats are perpetually feen, which are totally black. Where this uterine compreflion of parts has not been fo great as to render the hair white in other animals, it frequently hap- pens, that the extremities of the body are white, as the feet, and nofe, and tips of the ears of dogs and cats and horfes,where the circulation is naturally weaker ; whence it would feem, that the capillary glands, which form the hair, are impeded in the firft inftance by compreflion, and in the laft by the debility of the circulation in them. See Clafs I. 1. 2. 15. This day, Auguft 8th, 1794,1 have feen a negro, who was born (as he reports) of black parents, both father and mother, at Kingfton in Jamaica, who has many large white blotches on the Ikin of his limbs and body ; which 1 thought felt not fo foft to the finger, as the black parts. He has a white divergent blaze from the fummit of his nofe to the vertex of his head ; the up- per part of which, where it extends on the hairy fcalp, has thick curled hair, like the other part of his head, but quite white. By thefe marks I fuppofed him to be the fame black, who is defcri- bed, when only two years old, in the Tranfa&ion,s of the Ameri- can Class I. 2. 2. 12. OF IRRITATION. 69 can Philosophical Society, Vol. II. page 292, where a female one is likewife defcribed with nearly Similar marks. The joining of the frontal bones, and the bregma, having been later than that of the other futures of the cranium, probably gave caufe to the whitenefs of the hair on thefe parts by delaying or impeding its growth. 12. Callus. The callous Ikin on the hands and feet of laborious people is owing to the extreme veflels coalefcing from the per- petual prefliire they are expofed to. As we advance in life, the finer arteries lofe their power of action, and their Sides grow together; hence the paleiiefs of the fkins of elderly people, and the lofs of that bloom, which is ow- ing to the numerous fine arteries, and the transparency of the fkin, that enclofes them. M. M. Warm bath. Paring the thick fkin with a knife. Smoothing it with a pumice (tone. Cover the part with oiled Silk to prevent the evaporation of the perlpirable matter, and thus to keep it moift. 13. Cat ar a cl a is an opacity of the cryftalline lens of the eye. It is a difeafe of light-coloured eyes, as the gutta Serena is of dark ones. On cutting off with fciflars the cornea of a calf's eye, and holding it in the palm of one's hand,fo as to gain a prop- er light, the artery, which Supplies nutriment to the cryftalline humour, is eafily and beautifully Seen ; as it rifes from the cen- tre of the optic nerve through the vitreous humour to the cryf- talline. It is this point, where the artery enters the eye through the cineritious part of the optic nerve, (which is in part near the middle of the nerve,) which is without fenfiblility to light ; as is fhewn by fixing three papers, each of them about half an inch in diameter, againft a wall about a foot diftant from each other, about the height of the eye ; and then looking at the middle one, with one eye,and retreating till you lofe fight of one of the exter- nal papers. Now as the animal grows older, the* arter y becomes lefs vifible,and perhaps carries only atranfparent fluid,and at length in fome Subjects I fuppofe ceafes to be pervious; then it follows, that the cryftalline lens,lofing fome fluid,and gaining none, be- comes dry, and in confequence opaque; for the famereafon, that wet or oiled paper is more tranfparent than when it is dry,as explained in Clafs I. 1.4.1. The want of moifture in the cornea of old people, when the exhalation becomes greater than the Supply, is the caufe of its want of tranfparency ; and which like the cryf- talline gains rather a milkyopacity.Thefame analogy may be ufed to explain the whitenefs of the hair of old people, which lofes its pellucidity along with its moifture. See Clafs I. 22. 11. M. M. Small electric fhocks throgh the eye. A quarter of a 70 DISEASES Class I. 2. 2. 13. a grain of corrofive fublimate of mercury diflblved in brandy, or taken in a pill,twice a day for fix weeks. Couching by depref- fion, or by extraction. The former of thefe operations is much to be preferred to the latter, though the latter is at this time fo fafhionable, that a furgeon is almoft compelled to ufe it, left he fhould not be thought an expert operator. For depreffing the cataract is attended with no pain, no danger, no confinement, and may be as readily repeated, if the cryftalline Ihould rife again to the centre of the eye. The extraCtion of the cataraCt is at- tended with confiderable pain, with long confinement, generally with fever, always with inflammation, and frequently with irre- parable injury to the iris, and confequent danger to the whole eye. Yet has this operation of extraCtion been trumpeted into univerfal fafhion for no other reafon but becaufe it is difficult to perform, and therefore keeps the bufinefs in the hands of a few empirics, who receive larger rewards, regardlefs of the hazard, which is encountered by the flattered patient. A friend of mine returned yefterday from London after an abfence of many weeks ; he had a cataraCt in a proper ftate for the operation, and in fpite of my earneft exhortation to the con- trary,was prevailed upon to have it extracted rather than depreff- ed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one fide fo as to make an oblong aperture ; and which is nearly, if not totally, without contraCtion, and thus greatly impedes the little vifion, which he poflefles. Whereas I faw fome patients couched by depreffion many years ago by a then celebrated empiric, Cheva- lier Taylor, who were not confined above a day or two, that the eye might gradually be accuftomed to light, and who faw as well as by extraCtion, perhaps better, without either pain, or inflammation, or any hazard of lofing the eye. As the inflammation of the iris is probably owing to forcing the cryftalline through the aperture of it in the operation of ex- tracting it, could it not be done more fafely by making the open- ing behind the iris and ciliary procefs into the vitreous humour ? but the operation would ftill be more painful, more dangerous, and not more ufeful than that by depreffing it. If extraCiion of the cryftalline be ufed,Dr.Reimarus of Ham- burgh advifes to drop into the eye previous to the operation, fome extraCi: of belladonna diflblved in water,which he has found to produce a temporary paralyfis of the retina, and thence a to- tal inaClion of the iris, fo that it remains perfectly expanded, and is thence lefs liable to be injured by the operation, and the eye perhaps lefs liable to inflammation. Might not this be of advantage in fome ophthalmies ? 14. Innut ritio ClassI. 2. 2. 14. OF IRRITATION. 71 14. Innutritio ojjium. Innutrition of the bones. Not only the blood effufed in vibices and petechiae, or from bruifes, as well as the blood and new veflels in inflamed parts, are reabforbedby the increafed adion of the lymphatics ; but the harder materials, which conftitute the fangs of the firft fet of teeth, and the ends of exfoliating bones, and fometimes the matter of chalk-(tones in the gout, the coagulable lymph, which is depofited on the lungs, or on the mufcles after inflammation of thofe parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatifm, and laftly the earthy part of the living bones are diflblved and abforbed by the increafed adions of this fyftem of Veflels. See Sed. XXXIII. 3. 1. The earthy part of bones in this difeafe of the nutrition of them feems to fuller a folution, and reabforption ; while the fecerning veflels do not fupply a fuflicient quantity of calcareous earth and phofphoric acid, which conftitute the fubftance ofbones. As calcareous earth abounds every where, is the want of phof- phoric acid the remote caufe ? One caufe of this malady is given in the Philofophic Tran fadions, where the patient had been accuftomed to drink large quantities of vinegar. Two cafes are defcribed by Mr. Gouch. In one cafe, which I faw, a con- fiderable quantity of calcareous earth, and afterwards of bone- alhes, and of decodion of madder, and alfo of fublimate of mercury, were given without effed. All the bones became foft, many of them broke, and the patient feemed to die from the want of being able to diftend her cheft owing to the foftnefs of the ribs. M. M. Salt of urine, called fal microcofmicum, phofphorated foda. Calcined hartihorn. Bone-a(hes. Hard or petrifying water, as that of Matlock, or fuch as is found in all limeftone or marly countries. The calcareous earth in thefe waters might poflibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alkali as a lotion on the fpine, or eflential oils. The innutrition of the bones is often firft to be perceived bv the difficulty of breathing and palpitation of the heart on walking a little fafter than, ufual, which I fuppofe is owing to the foft- nefs of the ends of the ribs adjoining to the fternum; on which account they do not perfedly diftend the cheft, when they are raifed by the pedoral and intercoftal mufcles with greater force than ufual. After this the fpine becomes curved both by the foftnefs of its vertebrae, and for the purpofe of making room for the difturbed heart. See Species 16 of this Genus. As thefe patients are pale and weak, there would feem to be deficiency of oxygene in their blood, and in confequence a defi- ciency 72 DISEASES Class I. 2. 2. 14. ciency of phofphoric acid ; which is probably produced by ox- ygene in the aft of refpiration. Mr. Bonhome, in the Chemical Annals, Auguft, 1793, fup- pofes the rickets to arife from the prevalence of vegetable or acetous acid, which is known to foften bones out of the body. Mr. Dettaen feems to have efpoufed a fimilar opinion, and both of them in confequence give alkalies and teftacea. If this the- ory was juft, the foft bones of fuch patients (hould fhew evident marks of fuch acidity after death ; which I believe has not been obferved. Nor is it analagous to other animal fafts, that nu- tritious fluids fecreted by the fineft veflels of the body fhould be fo little animalized, as to retain acetous or vegetable acidity. The fuccefs attending the following cafe in fo (hort a time as a fortnight I afcribed principally to the ufe of the warm bath ; in which the patient continued for full half an hour every night, in the degree of heat, which was moft grateful to her fenfation, which might be I fuppofe about 94. Mifs , about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the leaft exercife, with oc- cafional violent dry cough, for a year or more, with dry lips, little appetite either for food or drink, and dry Ikin, with cold extremities. She has at times been occafionaliy worfe, and been relieved in fome degree by the bark. She began to bend for- wards, and to lift up her (boulders. The former feemed owing to a beginning curvature of the fpine, the latter was probably caufed to facilitate her difficult refpiration. M. M. She ufed the warm bath, as above related ; which by its warmth might increafe the irritability of the fmalleft feries of veflels, and by fupplying more moifture to the blood might probably tend to carry further the materials, which form calca- reous or bony particles, or to convey them in more dilute folu- tion. She took twice a day twenty grains of extraft of bark, twenty grains of foda phofphorata, and ten grains of chalk and ten of calcined hart (horn, mixed into a powder with ten drops of laudanum ; with flefli food both to dinner and fupper ; and port wine and water inftead of the fmall beer (he had been ac- cuftomed to ; (he lay on a fofa frequently in a day, and occafion- ally ufed a neck-fwing. There is no (ituation, where the foftnefs of the bones and eonfequent deformity of them is fo frequently attended with calamitous confequences, as when it affefts the bones of the pelvis, fo as to contract the form of it; whence many unfortu- nate women have loft their infants, or perifhed themfelves. In this miferable fltuation of the pregnant uterus, fome have deftroy- cd the child, others have undergone the Cefarean operation, and OF IRRITATION. Glass I. 2. 2.15. 73 and have thence generally peri (bed themfelves, But Dr. Den- man has ingenioufly introduced a new practice, which has faved, in fuch cafes, both the mother and child ; which is by promo- ting a premature delivery between the feventh andeighth months, before the child has acquired its full growth, which has been at- tended with fuccefs. See Denman's Midwifery, and Medical Journal, Vol. III. No. 1i. In one inftance nature feems to have had a fimilar expedient, and perhaps to overcome a fimilar difficulty, in the premature birth of the progeny of the kanguroo ; whofe young are exclu- ded from the uterus in a very early ftate of their growth, and re- ceived into an exterior bag; which is furnifhed with teats, to which they long adhere by their mouths, till they are ready for a fecond birth. 15. Rachitis. Rickets. The head is large, protuberant chief- ly on the forepart. The fmaller joints are fwelled ; the ribs de- prefled ; the belly tumid, with other parts emaciated. This dif- eafe from rhe innutrition or foftnefs of the bones arofe about two centuries ago ; feems to have been half a century in an increaf- ing or fpreading ftate ; continued about half a century at its height, or greateft diffufion ; and is now nearly vaniflred : which gives reafon to hope, that the fmall-pox, meafles, and venereal difeafe, which are all of modern production, and have already become milder, may in procefs of time vanifli from the earth, and perhaps be fucceeded by new ones ! See the preceding Species. 16. Spina dijlortio. Diftortion of the fpine is another difeafe originating from the innutrition or foftnefs of the bones. I once faw a child about fix years old with palpitation of heart, and quicknefsof refpiration, which began to have a curvature of the fpine ; I then doubted, whether the palpitation and quick refpi- ration were the caufe or confequence of the curvature of the fpine ; fufpeCting either that nature had bent the fpine outwards to give room to the enlarged heart; or that the malformation of the cheft had comprefled and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whofe fpine had lately begun to be diftorted, with very great difficulty and quicknefs of refpiration, and alarming palpitation of the heart, I convinced myfelf, that the palpitation and difficult refpiration were the effeCt of the change of the cav- ity of the cheft from the diftortion of the fpine ; and that the whole was therefore a difeafe of the innutrition or foftnefs of the bones. For on direCling her to lie down much in the day, and to take the bark, the diftortion became lefs, and the palpitation and Vol. II. L quick DISEASES Class I. 2. 2. 16. 74 quick refpiration became lefs at the fame time. After this ob~ fervation a neck-fwing was directed, and fhe took the bark, madder, and bone-afhes ; and fhe continues to amend both in her fhape and health. Delicate young ladies are very liable to become awry at many boarding-fchools. This is occafioned principally by their being obliged too long to preferve an erect attitude, by fitting on forms many hours together. To prevent this, the fchool-feats fhould have either backs, on which they may occafionally reft them- felves ; ordelks before them, on which they may occafionally lean. This is a thing of greater confequence than may appear to thofe, who have not attended to it. When the leaft tendency to become a wry is obferved, they {hould be advifed to lie down on a bed or fofa for an hour in the middle of the day for many months ; which generally prevents the in- creafe of this deformity by taking off for a time the prefiure on the fpine of the back, and it at the fame time tends to make them grow taller. Young perfons, when nicely meafured, are found to be half an inch higher in a morning than at night ; as is well known to thofe who enlift very young men for foldiers. This is owing to the cartilages between the bones of the back becom- ing compreffed by the weight of the head and fhoulders on them during the day. It is the fame preffure which produces curva- tures and diftortions of the fpine in growing children, where the bones are fofter than ufual; and which may thus be relieved by an horizontal pofture for an hour in the middle of the day, or by being frequently allowed to lean on a chair, or to play on the ground on a carpet. Young ladies ihould alfo be diredled, where two Heep in a bed, to change every night, or every week, their fides of the bed ; which will prevent their tendency to fleep always on the fame fide ; which is not only liable to produce crookednefs, but alfo to occafion difeafes by the internal parts being fo long kept in uniform contact as to grow together. For the fame reafon they ihould not be allowed to fit always on the fame fide of the fire or window, becaufe they will then be inclined too frequently to bend themfelves to one fide. Another great caufe of injury to the fhape of young ladies is from the preffure of ftays, or other tight bandages, which at the fame time caufe other difeafes by changing the form or fituation of the internal parts. If a hard part of the ftays, even a knot of the thread, with which they are fewed together, is preffed hard upon one fide more than the other, the child bends from the fide moft painful, and thus occafions a curvature of the fpine. To counteract this effed, inch ftays as have feweft hard parts, and Class I. 2. 2. 16. OF IRRITATION. 75 and efpecially fuch as can be daily or weekly turned, are pref- erable to others. Where frequent lying down on a fofa in the day-time, and fwinging frequently fora fhorttime by the hands or head, with loofe drefs, do not relieve a beginning diftortion of the back ; re- courfe may be had to a chair with fluffed moveable arms for the purpofe of fufpending the weight of the body by cufhions under the arm-pits, like refting on crutches, or like the leading-firings of infants. From the top of the back of the fame chair a curv- ed fleel bar may alfo project to fufpend the body occafionaily or in part by the head, like the fwing above mentioned. The ufe of this chair is more efficacious in flraightening the fpine, than fimply lying down horizontally ; as it not only takes off the preffure of the head and fhoulders from the fpine, but at the fame time the inferior parts of the body contribute to draw the fpine ftraight by their weight; or laflly, recourfe may be had to a fpinal machine firft defcribed in the Memoires of the acad- emy of furgery in Paris, Vol. III. p. 600, by M. Le Vacher, and fmee made by Mr. Jones, at No. 6, North-flreet, Tottenham court-road, London, which fufpends the head, and places the weight of it on the hips. This machine is capable of improve- ment by joints in the bar at the back of it, to permit the body to bend forwards without diminifhing the extenfion of the fpine. fhe objections of this machine of M. Vacher, which is made by Mr. Jones, are firfl, that it is worn in the day-time, and has a very un lightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and fubflituting in its place a forked bar, rifing up behind each ear, with webs fattened to it, which pafs under the chin and occiput. But this is notan improvement,but a deterioration ofM. Vacher's machine, as it prevents the head from turning with facility to either fide. Another objection is, that its being worn, when the mufcles of the back are in afHon, it is rather calculated to prevent the curvature of the fpine from becoming greater, than to extend the fpine, and diminifh its curvature. For this latter purpofe I have made a fleel bow, which re- ceives the head longitudinally from the forehead to the occiput; having a fork furnifhed with a web to fuflain the chin, and an- other to fuflain the occiput. The fummit of the bow is fixed by a fwivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or fixteen inches. Hence the patient would be conftantly Hiding down during Heep, unlefs fupported by this bow, with webbed forks, covered alfo with fur, placed beneath the chin, and beneath the occiput. There are alfo proper webs lined DISEASES 76 Class I. 2. 2. 16. lined with fur for the hands to take hold of occafionally, and al- fo to go under the arms. By thefe means I fhould hope great advantage from gradually extending the fpine during the inac- tivity of the mufcles of the back ; and that it may be done with- out difturbing the fleep of the patient, and if this fhould hap- pen, the bow is made to open by a joint at the fummit of it, foas to be inftantly dhengaged from the neck by the hand of the wearer. This bow I have now ufed with advantage on one pa- tient, and it may be had from Mr. Harrifon, whitefmith,Bridge- gate, Derby. It is alfo poflible that a flight comprefs on the prominent part of a curved fpine might be applied with advantage both in fleep and in waking hours, if it could be nicely held on the part by a weak and very flexible fpring, with a proper counter-preflure on fome diftant part; but this would require more art than could be managed, except by thofe who have very accurate mechanical ideas, and muft differ with every kind of curvature. Thus if the prominent part of the curve of the fpine be on one fide, a fluffed cufhion fixed to the centre of a long thin fteel fpring fhould be applied on the prominence ; one end of this long fpring fhould be bent by a ftrap joined to a waiftcoat on the op- pofite fhoulder, and the other end of it by a ftrap joined to draw- ers on the oppofite hip ; the degree of preflure to be adjufted by the tightnefs of thefe ftraps. If the prominent part of a curved fpine be exactly behind, the ends of the long fpring fhould extend from the loweft bone of the neck to the os cocci- gis, and fhould have its two ends attached to the top of a waift- coat, and to the waiftband of a pair of drawers. It will be from hence eafily perceived, that all other methods of confining or direfling the growth of young people fhould be ufed with great fkill; fuch as back-boards, or bandages, or flocks for the feet; and that their application fhould not be continued too long at a time, left worfe confequences fhould enfue, than the deformity they were defigned to remove. To this may be added, that the ftiff ereft attitude taught by fome modern danc- ing mafters does not contribute to the grace of perfon, but rather militates againft it ; as is well feen in one of the prints in Hogarth's Analyfis of Beauty ; and is exemplified by the eafy grace of fome of the ancient ftatutes, as of the Venus de Medicis, and the Antinous, and in the works of fome modern artifts, as in a beautiful print of Hebe feeding an Eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman. Where the bone of one of the vertebra of the back has been fwelled on both fides of it, fo as to become protuberant, iflues near Class. I. 2.2. 17. OF IRRITATION. 77 near the fwelled part have been found of great fervice, as men- tioned in Species 18 of this Genus. This has induced me to propofe in curvatures of the fpine, to put an iflue on the outfide of the curve, where it could be certainly afeertained, as the bones on the convex fide of the curve mult be enlarged ; in one cafe I thought this of fervice, and recommended the further trial of it. In the tendency to curvature of the fpine, whatever ftrength- ens the general confliturion is of fervice ; as the ufe of the cold bath in the fummer months This however requires fome re- ftriftion both in refpecl to the degree of coldnefs of the bath, the time of continuing in it, and the feafon of the year. Com- mon fprings, which are of forty-eight degrees of heat, are too eold for tender conftitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldnefs of river-water in the fummer months, which is about fixty-eight degrees, or that of Matlock, which is about fixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath fhould be but a minute or two, or not fo long as to occafion a trembling of the limbs from cold. In refpedl to the feafon of the year, delicate children fhould certainly only bathe in the fummer months ; as the going fre- quently into the cold air in winter will anfwer all the purpofes of the cold bath. 17. Claudicatio coxaria. Lamenefs of the hip. A nodding of the thigh-bone is faid to be produced in feeble children by the foftnefs of the neck or upper part of that bone beneath the car- tilage ; which is naturally bent, and in this difeafe bends more downwards, or nods, by the preflure of the body ; and thus renders one leg apparently fhorter than the other. In other cafes the end of the bone is protruded out of its focket, by in- flammation or enlargement of the cartilages or ligaments of the joint, fo that it refts on fome part of the edge of rhe acetabu- lum, which in time becomes filled up. When the legs* are flraight, as in (landing eretl, there is no verticillary motion in the knee-joint; all the motion then in turning out the toes fur- ther than nature defigned, muft be obtained by {training in fome degree this head of the thigh-bone, or the acetabulum, or cavi- ty, in which it moves. This has induced me to believe that this misfortune of the nodding of the head of the bone, or partial diflocation of it, by which one leg becomes fhorter than the other, is fometimes occafioned by making very young children ftand in what are called flocks; that is with their heels together, and their toes quite out. Whence the focket of the thigh-bone be- comes inflamed and painful, or the neck of the bone is bent downward and outwards. In 78 DISEASES Class I. 2. 2. 18. In this cafe there is no expectation of recovering the (Iraight- nefs of the end of the bone; but thefe patients are liable to another misfortune, that is, to acquire afterwards a diftor- tion of the fpine ; for as one leg is (hotter than the other, they fink on that fide, and in conlequence bend the upper part of their bodies, as their (houlders, the contrary way, to balance themfelves ; and then again the neck is bent back again towards the lame fide, to preferve the head perpendicular ; and thus the figure becomes quite dillorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the fpine is for the child to wear a high-heeled fhoe or patten on the lame foot, fo as to fupport that fide on the fame level with the other, and thus to prevent a greater deformity. I have this day feen a young lady about twelve, who does not limp or waddle in walking ; but neverthelefs, when (he (lands or fits, die finks down towards her right fide, and turns out that toe more than the other. Hence, both as (he fits and (lands, (he bends her body to the right; whence her head would hang a little over her right (houlder; but to replace this perpendicu- larly, (he lifts up her left (boulder and contracis the mufcles on that fide of the neck; which are therefore become thicker and flronger by their continued adion ; but there is not yet any very perceptible diftortion of the fpine. As her right toe is turned outward rather more than natural, this (hews the difeafe to be in the hip-joint; becaufe, when the limb is (Iretched our, the toe cannot turn horizontally in the leaft without moving the end of the thigh-bone ; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other Hence if children are fet in flocks with their heels touching each other as they fit, and are then made to rife up, till they ftand erect, the focket or head of the thigh-bone becomes injured, efpecially in thofe children, whofe bones are foft ; and a fhortnefs of that limb fucceeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum ; and a confequent rifing of one (houlder, and a curvature of the fpine are produced from fo dillant a caufe. M. M. An elaftic cufliion made of curled hair, fhould be pla- ced under the affected hip, whenever (he fits ; or (hould be fit- ted to the part by means of drawers, fo that (he could not avoid fitting on it. A neck-fwing and lying down in the day, (hould be occafionally ufed to prevent or remove any curvature of the fpine. The refl as in Species 13 and 15 of this genus. 18. Spina protuberant. Protuberant fpine. One of the bones of OF IRRITATION. Class!.2. 2. 19. 79 of the fpine fwells, and rifes above the reft. This is not an un- common difeafe, and belongs to the innutrition of the bones, as the bone muft become foft before it fweils ; which foftnefs is owing to defea of the fecretion of phofphorated calcareous earth. The fwelling of the bone comprefles a part of the brain, called the fpinal marrow, within the cavity of the back-bones ; and in x confequence the lower limbs become paralytic, attended fome- times with difficulty of emptying the bladder and rectum. M. M. Iflues put on each fide of the prominent bone are of great effect, I fuppofe, by their ftimulus ; which excites into action more of the fenforial powers of irritation and fenfation, and thus gives greater activity to the vafcular fyftem in their vicinity. The methods recommended in diftortion of the fpine are alfo to be attended to. 19. Spina bifida. Divided fpine, called alfo Hydrorachitis, as well as the Hydrocephalus externus, is probably owing in part to a defeat- of offification of the fpine and cranium.; and the col- leaion of fluid beneath them may originate from the general de- bility of the fyftem ; which affedts both the fecerning, and ab- forbent veflels. A curious circumftance, which is affirmed to attend the fpina bifida, is, that on compreffing the tumour with the hand gently, the whole brain becomes afledted, and the patient falls afleep. I fuppofe the fame muft happen on compreffing the hydrocephalus externus ? See Sea. XVIII. 20. 20. Ojfis palatidefeElus. A defea of the bone of the palate, which frequently accompanies a divifion of the upper lip, oc- curs before nativity ; and is owing to the deficient action of the fecerning fyftem, from whence the extremities are not comple- ted. From a fimilar caufe I have feen the point of the tongue deficient, and one joint of the two leaft fingers, and of the two leaft toes, in the fame infant; who was otherwife a fine girl. See Seft. XXXIX. 4. 4. The operation for the hare-lip is defcribed by many furgical writers ; but there is aperfon inTondon, who makes very ingeni- ous artificial palates ; which prevent that defea of fpeech, which attends this malformation. This faaitious palate confifts of a thin plate of filver of the ffiape and form of the roof of the mouth; from the front edge to the back edge of this filver plate four or five holes are made in a ftraight line large enough for a needle to pafs through them ; on the back of it is thenfewed apiece of fponge ; which when expanded with moifture is nearly as large as the filver plate. This fponge is flipped through the divifion of the bone of the palate, fo as to lie above it, while the filver plate DISEASES 80 Class I. 2. 2. 20. plate covers the aperture beneath, and is fufpended by the ex- panding fponge. This is removed every night and walhed, and returned into its place in the morning ; on this account it is con- venient to have five or fix of them, for the fake of cleanlinefs. I have been more particular in defcribing this invention, as J do not know the name, or place of refidence, of the maker. ORDO Class I. 2. 3.1. OF IRRITATION- 81 ORDO IL Decreased Irritation. GENUS III. With decreafed Ahiion of the Abforbent Syfem. Some decreafe of heat attends thefe difeafes, though in a lefs degree than thofe of the laft genus, becaufe the abforbent fyftem of glands do not generate fo much heat in their healthy ftate of action as the fecerning fyftem of glands, as explained in Clafs I. i. 3- SPECIES. i. Mucus faucium frigidus. Cold mucus from the throat. Much mucus, of rather a faline tafte, and lefs infpiflated than ufual, is evacuated from the fauces by hawking, owing to the deficient abforption of the thinner parts of it. This becomes a habit in fome elderly people, who are continually fpitting it out of their mouths ; and has probably been brought on by taking fnuff, or fmoking tobacco ; which by frequent ftimulating the fauces have at length rendered the abforbent veflels lefs excita- ble by the natural ftitnulus of the faline part of the fecretion, which ought to be reabforbed, as foon as fecreted. M M. A few grains of powder of bark frequently put into the mouth, and gradually diffufed over the fauces. A gargle of barley water. 2. Sudor frigidus. The cold dampnefs of the hands of fome people is caufed by the deficient abforption of perfpirable matter; the clammy or vifcid feel of it is owing to the mucous part being left upon the fkin. The coldnefs is produced both by the de- creafed aflion of the abforbent fyftem, and by the evaporation of a greater quantity of the perfpirable matter into the air, which, ought to have been abforbed. M. M. Wafh the hands in lime water, or with a fmall quan- tity of volatile alkali in water. 3. Catarrhus frigidus. The thin difcharge from the noftrils in cold weather. The abforbent veflels become torpid by the diminution of external heat, fooner than the fecerning ones:, which are longer kept warm by the circulating blood, from which they fclecl the fluid they fecrcte ; whereas the abforbent Vol. II. M veflels DISEASES 82 Class I. 2. 3. 4. veflels of the noftrils drink up their fluids, namely the thin and faline parts of the mucus, after it has been cooled by the atmof- phere. Hence the abforbents ceafing to aft, and the fecerning veflels continuing fome time longer to pour out the mucus, a copious thin difcharge is produced, which trickles down the noftrils in cold weather. This difcharge is fo acrid as to inflame the upper lip; which is owing to the neutral faits, with which it abounds, not being reabforbed; fothe tears in the fiftula lach- rymalis inflame the cheek. See Clafs I. i. 2. 7. 4. ExpeEtoratio frigida. Cold expeftoratioa. Where the pulmonary abforption is deficient, an habitual cough is produced, and a freqnent expeftoration of thin faline mucus; as is often feen in old enfeebled people. Though the ftimulus of the faline fluid, which attends all fecretions, is not fuflicient to excite the languid abforbent veflels to imbibe it ; yet this faline part, to- gether with the increafed quantity of the whole of the fecreted mucus, ftimulates the branches of the bronchia, fo as to induce an almoft inceffant cough to difcharge it from the lungs. A Angle grain of opium, or any other ftimulant drug, as a wine poflet with fpirit ofhartlhorn, will cure this cold cough, and the cold catarrh of the preceding article, like a charm, by ftimula- ting the torpid mouths of the abforbents into aftion. Which has given rife to an indifcriminate and frequently pernicious ufe of the warm regimen in coughs and catarrhs of the warm or inflammatory kind, to the greet injury of many. M. M. Half a grain of opium night and morning promotes the abforption of the more fluid and faline parts, and in confe- quence thickens the mucus, and abates its acrimony. Warm diluent drink, wine-whey, with volatile alkali. 5. Urina uberior pallida, On being expofed naked to 'cold air, or fprinkled with cold water, a quantity of pale urine is foon difcharged ; for the abforbents of the bladder become torpid by their fympathy with thofe of the fkin ; which are rendered qui- efcent by the diminution of external heat; but the kidneys con- tinue to fecrete the urine, and as no part of it is abforbed, it be- comes copious and pale. This happens from a fimilar caufe in cold fits of agues ; and in lefs degree to many debilitated confti- tutions, whofe extremities are generally cold and pale. The great quantity of limpid water in hyfteric cafes, and in diabetes, belongs to Clafs I. 3. 1. 10. 1.3. 2. 6. M. M. Tinfture of cantharides, opium, alum, forbentia. Flannel fhirt in cold weather. Animal food. Beer. Wine. Friftion, Exercife. Fire. 6. Diarrhoea frigida. Liquid ftools are produced by expofing the Class I. 2. 3. 7. OF IRRITATION. 83 the body naked to cold air, or fprinkling it with cold water, for the fame reafon as the laft article. But this difeafe is fometimes of a dangerous nature ; the in- teftinal abforption being fo impaired, that the aliment is faid to come away undtminifhed in quantity, and almoft unchanged by the powers of digeftion, and is then called lientery. The mucus of the reftum fometimes comes away like pellu- cid hartfliorn 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 abforbed, and thus refembles the catarrh •of fome old people. M. M. Opium, campechy wood, armenian bole. Blifter. Flannel fhirt in cold weather. Clyfters with opium. Fridlion on the bowels morning and night. Equitation twice a day. 7. Fluor albus frigidus. Cold fluor albus. In weak conftitu- tions, where this difoharge is pellucid and thin, it muft proceed from want of abfor-ption of the mucous membrane of the vagina, or uterus, and not from an increafed fecretion. This I fufpefl to be the moft frequent kind of fluor albus ; the former one de- fcribed at Clafs I. 1. 2. n. attends menftruation, or is a dif- charge inftead of it, and thus refembles the venereal orgafm of female quadrupeds. The difcharge in the cold kind being more faline, is liable to excoriate the part, and thus produce fmarting in making water ; in its great degree it is difficult to cure. M. M. Increafe the evacuation by ftool and by perfpiration, by taking rhubarb every night, about fix or ten grains with one grain of opium for fome months. Flannel fhirt in winter. Balfam copaiva. Gum kino, bitters, chalybeates, friction over the whole fkin with flannel morning and night. Partial cold bath, by fprinkling the loins and thighs, or fponging them with cold water Mucilage, as ifinglafs boiled in milk; blanc mange hartfliorn jelly, are recommended by fome. Tinfture of can- tharides fometimes feems of fervice given from ten to twenty drops or more, three or four times a day. A large plafler of burgundy pitch and armenian bole, fo as to cover the loins and lower part of the belly, is faid to have fometimes fucceeded by increafing abforption by its compreffion in the manner of a ban- dage- A folution of metallic faits, as white vitriol, fixty grains to a pint; or an infufion of oak-bark may be injected into the vagina. Cold bath. 8. Gonorrhoea frigida. Cold gleet. Where the gleet is thin and pellucid, it muft arife from the want of abforption of the membranes of the urethra, rather than from an increafed fecre- tion from them. This I fuppofe to be a more common difeafe than that mentioned at Clafs I. 1. 2. 10. M. M. Metallic 84 DISEASES Class I. 2. 3. 9. M. M. Metallic injections, partial cold bath, internal method as in the fluor albus above defcribed. Balfam of copaiva. Tinc- ture of cantharides. Introduce a few inches into the urethra a bougie fmeared with balfam of copaiva. See Home on urethra, p 105. 9. Hepatis tumor. The liver becomes enlarged from defeCt of the abforption of mucus from its cells, as in anafarca, efpeci- ally jn feeble children ; at the fame time lefs bile is fecreted from the torpid circulation in the vena portae. And as the ab- forbents, which refume the thinner parts of the bile from the gall-bladder and hepatic duCts, are alfo torpid or quiefcent, the bile is more dilute, as well as lefs in quantity. From the ob- ftruClion of the paflageof the blood through the comprefled ve- na porta thefe patients have tumid bellies, and pale bloated coun- tenances ; their palenefs is probably owing to the deficiency of the quantity of red globules in the blood in confequence of the inert ftate of the bile. Thefe fymptomsin children are generally attended with worms, the dilute bile and the weak digeftion not deftroying them. In fheep I have f^en fluke-worms in the gall-ducts themfelves among the dilute bile ; which gall-duCts they eat through, and then produce ulcers, and the heCtic fever called the rot. See Clafs I. 1.4 10 and Article IV. 2.6. M. M. After a calomel purge, crude iron filings are fpecific in this difeafe in children, and the worms are deftroyed by the returning acrimony and quantity of the bile. A blifter on the region of the liver. Sorbentia, as worm-feed, fantonicum. Co- lumbo. Bark. The nitrous acid has been ftrongly recommended by Mr. Scot in tumours of the liver, which frequently occur in the eaft, where this gentleman refides ; he gives two drachms of ftrong nitrous acid mixed with two pounds of water, to be drunk daily at in- tervals. See Syphilis, Oafs II. 1. 5. 2. 10. ChloroJis. When the defeat of the due adiion of both the abforbent and fecerning veflels of the liver affects women, and is attended with obftru&ion of the catamenia, it is called chlorofis ; and is cured by the exhibition of fteel, which reftores by its fpe- cific ftimulus the abforbent power of the liver ; and the men- ftruation, which was obftrufted in confequence of debility, recurs. Indigeflion, owing to torpor of the ftomach, and a confequent too great acidity of its contents, attend this difeafe ; whence a defire of eating chalk, or marl. Sometimes a great quantity of pale urine is difeharged in a morning, which is owing to the in- aCHon of the abforbents. which are diftributed on the neck of the Class 1.2. 3. ii OF IRRITATION. 85 the bladder, during fleep. The fwelling of the ankles, which frequently attends chlorofis, is another effect of deficient action of the abforbent fyftem; and the pale countenance is occafioned by the deficient quantity of red globules of blood, caufed by the deficient quantity or acrimony of the bile, and confequent weak- nefs of the circulation. The pulfe is fo quick in fome cafes of chlorofis, that, when attended with an accidental cough, it may be miftaken for pulmonary confumption. This quick pulfe is owing to the debility of the heart from the want of ftimulus oc- eafioned by the deficiency of the quantity, and acrimony of the blood. M M. Ste^. Bitters. Conftant moderate exercife. Fric- tion with flannel all over the body and limbs night and morn, ing. Rhubarb five grains, opium half a grain, every night. Flefh diet, with fmall beer, or wine and water. The difeafe continues fome m'onths, but at length fubfides by the treatment above defcribed. A bath of about eighty degrees, as Buxton Bath, is of fervice ; a colder bath may do great injury ii. Hydrocele. Dropfy of the vagina teftis. Dropfies have been divided into the encyfted and the difFufed, meaning thofe of the cellular membrane, the cells of which communicate with each other like a fponge, and thofe of any other cavity of the body. The collections of mucous fluids in the various cells and cavities of the body arife from the torpor of the abforbent vefFels of thofe parts. It is probable, that in dropfies attended with great thirft the cutaneous abforbents become paralytic firft; and then from the great thirft, which is thus occafioned by the want of atrnof- pheric moifture, the abforption of the fat enfues ; as in fevers attended with great thirft, the fat is quickly taken up. See Obe- fitas I. 2. 3. 16. Some have believed, that the cellular and adi- pofe membranes are different ones; as no fat is ever depofited in the eyelids or fcrotum, both which places are very liable to be diftended with the mucilaginous fluid of the anafarca, and with air in Emphyfema. Sometimes a gradual abforption of the ac- cumulated fluid takes place, and the thinner parts being taken up, there remains a more vifcid fluid, or almoft a folid in the part, as in fome fwelled legs, which cannot eafily be indented by the preffure of the finger, and are called fcorbutic. Sometimes the paralyfis of the abforbents is completely removed, and the whole is again taken up into the circulation. The Hydrocele is known by a tumour of the fcrotum, which is without pain, gradually produced, with fluctuation, and a de- gree of pellucidity, when a candle is held behind it; it is the molt fimple incyfted dropfy, as it is not in general complicated with other difeafcs, as afcites with fcirrhous fever, and hydro- cephalus 86 DISEASES Class I. 2. 3. 12. cephalus in'ternus, with great debility. The cure of this dif- eafe is effected by different ways ; it confifts in difcharging the water by an external aperture ; and by fo far inflaming the cyft and tefticle, that they afterwards grow together, and thus pre- vent in future any fecretion or effufion of mucus ; the difeafe is thus cured, not by the revivefcence of the abforbent power of the lymphatics, but by the prevention of fecretion by the adhefion of the vagina to the teftis. This I believe is performed with lefs pain, and is more certainly managable by rapping, or difcharg- ing the fluid by means of a trocar, and after the evacuation of it to fill the cyft with a mixture of wine and water for a few min- utes till the neceflary degree of ftimulus is produced, and then to withdraw it ; as recommended by Mr. Earle. See alfo Med- ical Commentaries by Dr. Duncan for 1793. 12. Hydrocephalus internus, or dropfy of the ventricles of the brain, is fatal to many children and to fome adults. When this difeafe is lefs in quantity, it probably produces a fever, termed a nervous fever, and which is fometimes called a worm fever, ac- cording to the opinion of Dr. Gilchrift, in the Scots Medical Eflays. This fever is attended with great inirritability, as appears from the dilated pupils of the eyes, in which it correfponds with the dropfy of the brain. And the latter difeafe has its parox- yfms of quick impulfe, and in that refpefi correfponds with oth- er fevers with inirritability. The hydrocephalus internus is diftinguilhed from apoplexy by its being attended with fever, and from nervous fever by the paroxyfms being very irregular, with perfect; intermiffions 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 fide of the head. One of the earlieft crite- rions is the patient being uneafy on railing his head from the pil- low, and wilhing to lie down again immediately ; which I fup- pofe is owing to the preflure of the water on the larger trunks of the blood-veflels entering the cavity being more intolerable than on the fmaller ones ; for if the larger trunks are comprefl"- ed, it mult inconvenience the branches alfo ; but if fome of the fmall branches are comprefled only, the trunks are not fo imme- diately incommoded. Blifters on the head, and mercurial ointment externally, with calomel internally, are principally recommended in this fatal dif- eafe. When the patient cannot bear to be raifed up in bed with- out great uneafinefs, it is a bad fymptom. So I believe is deaf- nefs, which is commonly miftaken for Itupor. See Clafs I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the fquinting is very apparent, or the pupils of both eyes much dila- ted, ClassI. 2. 3. 12. OF IRRITATION, 87 ted, it is generally fatal. As by ftimulating one branch of lymphatics into inverted motion, another branch is liable to ab- forb its fluid more haftily ; fuppofe llrong errhines, as common tobacco fnufF to children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed with ten or fifteen grains of fu- gar, were gradually blown up the noftrils ? See Clafs I. 3. 2. r. I have tried common fnufF upon two children in this difeafe ; one could not be made to fneeze, and the other was toonear death to receive advantage. When the mercurial preparations have produced falivation, I believe they may have been of fervice, but I doubt their good effect otherwife. In one child I tried the tincture of digitalis ; but it was given with too timid a hand, and too late in the difeafe, to determine its effects. See Sett. XXIX. 5. 9. As all the above remedies generally fail of fuccefs, I think frequent, almoft hourly, fhocks of electricity from very fmall charges might be paffed through the head in all directions with probability of good event; as by Volta's rods of zinc and filver defcribed in Clafs I. 2. 5. 5. A folution of hydrargyrus muria- tus, corrofive fublimate of mercury in rectified fpirit of wine, three grains to an ounce, is faid to produce inftantaneous and violent falivation; as defcribed in Clafs II. 1. 5. 1. on Gonor- rhoea. Could a fmall quantity of this violent ftimulus be ufed according to the age of the child with probable good ef- fe£t ? Could the trephine be ufed with fafety or advantage where the affected fide can be diftinguifhed ? See Stratifmus, Clafs I. 2. 5. 4. When one eye is affedled, does the difeafe ex- ift in the ventricle of that fide ? The following extract from a letter of Dr. Beddoes on hydro- cephalus internus, is well worthy to be attended to. " Mailer L , aged 9 years, became fuddenly ill in the night about a week before I faw him. On the day before the attack, he had taken opening medicines, and had bathed after- wards. He had complained of violently acute pain in his head, Ihrieked frequently, ground his teeth hard, could not bear to have his head railed from the pillow, and was torpid or deaf. His tongue was white, pulfe 110 in the evening and full. As yet the pupil of the eye was irritable, and he had no 11 rabif- mus. He had been bled with leeches about the head, and biifter- ed. I directed mercurial inundlion, and calomel from 3 to 6 grains to be taken at firft every fix, and afterwards every three hours. This plan produced no fenfible effect, and the patient died on the 18ih day after the feizure. He had convulfion-fits two days preceding his death, and the well-known fymptoms of hydro- cephalus internus all made their appearance. From what I had feen 88 DISEASES Class I. 2. 3. 13. feen and read of this difeafe, I believed it to belong to inflamma- tions, and at an earlier period I (hould be tempted to bleed as largely as for pneumonia. The fluid found after death in the ven- tricles of the brain I impute to debility of the abforbents indu- ced by inflammation. My reafons are briefly thefe : i. The acutnefs of the pain. 2. The (late of the pulfe. In the above cafe for the firft 9 or 10 days it did not exceed no, and was full and (Irong. 3. To find out whether any febrile alternations took place, Mader L/s feet were frequently felt, and they were found at times cold, and at other times of a dry heat. I have many times feen this difeafe, but the patients were too young, or too far advanced, to inform me, whether they had chillnefs fuc- ceeded by heat at its onfet. 4 The diforders to. which the young are more peculiarly liable afford a prefumption, that hy- drocephalus internus is an inflammatory difeafe ; and this is confirmed by the regularity of the period, within which it fin- ilhes its courfe. And laftly, does not happen mare frequently than is fufpeCted from external injury ? " I have juft now been well informed, that Dr Rufh has lately cured five out of fix patients by copious bleedings. I relate here the reafons for an opinion without pretending to a difcovery. Something like this doClrine may be found in cer- tain modern publications, but it is delivered in that vague and diffufe flyle, which I truft your example will banifh from medi- cal literature." To this idea of Dr. Beddoes may be added, that the hydrocele generally fucceeds an injury, and confequent inflammation of the bag, which contains it. And that other dropfies, which principally attend inebriates, are confequent to too great adlion of the mucous membranes by the ftimulus of beer, wine, and fpirits. And laltly, that as thefe cafes of hydrocephalus end fo fatally, a new mode of treating them is much to be defired, and deferves to be feriouily attended to. This idea of inflammation preceding hydrocephalus was men- tioned by Dr. Quin, and afterwards in a pamphlet of Dr. Pat- erfon of Dublin. 13. Jfcites. The dropfy of the cavity of the abdomen is known by a tenfe fwelling of the belly ; which does not found on being (truck like the tympany ; and in which a fluctuation can be readily perceived by applying one hand expanded on one fide, and ftriking the tumour on the other. Effufions of water into large cavities, as into that of the abdo- men or thorax, or into the ventricles of the brain or pericardi- um, are more difficult to be reabforbed, than the effufion of fluids into the cellular membrane ; becaufe one part of this ex- tenfive Class I. 2.3. 14. OF IRRITATION. 89 tenfive fponge-like fyftem of cells, which connects all the folid parts of the body, may have its power of abforption impaired, at the fame time that fome other part of it may ftill retain that power, or perhaps poflefs it in an increafed degree ; and as all thefe cells communicate with each oiher, the fluid,which abounds in one part of it, can be transferred to another, and thus be re- abforbed into the circulation. In the afcites, cream of tartar has fometimes been attended with fuccefs ; a dram or two drams are given every hour in a morning till it operates, and this is to be repeated for feveral days ; but the operation of rapping is generally applied to at laft. Dr. Sims, in the Memoirs of the Medical Society of London, Vol III. has lately propofed, what he believes to be a more fuc- cefsful method of performing this operation, by making a punc- ture with a lancet in the fear of the navel, and leaving it to dif- charge itfelf gradually for feveral days, without introducing a canula, which he thinks injurious, both on acccount of the too fudden emiflion of the fluid,and the danger of wounding or ftim- ulating the vifeera. This operation I have twice known per- formed with lefs inconvenience, and I believe with more benefit to the patient, than the common method. After the patient has been tapped, fome have tried inje&ions into the cavity of the abdomen, but hitherto I believe with ill event. Nor are experiments of this kind very promifing of fuc- cefs. Firft, becaufe the patients are generally much debilitated, molt frequently by fpirituous potation,and have generally a dif- eafe of the liver, or of other vifeera. And fecondly, becaufe the quantity of inflammation,neceflaryto preventfuture fecretion of mucus into the cavity of the abdomen, by uniting the perito- neum with the inteltines or mefentery, as happens in the cure of the hydrocele, would I fuppofe generally deftroy the patient, either immediately, or by the confequence of fuch adhefions. This however is not the cafe in refpedt to the dropfy of the ovarium, or in the hydrocele. 14. Hydrops thoracis. The dropfy of the cheft commences with lofs of flelh, cold extremities, pale countenance, high' col- oured urine in fmall quantity, and general debility, like many other dropfies. The patient next complains of numbnefs in the arms, efpecially when elevated, with pain and difficulty of fwal- lowing, and an abfolute impoflibility of lying down for a few minutes, or with fudden darting from fleep, with great difficulty of breathing and palpitation of his heart. It is often confound- ed with anafarca pulmonum, which fee. The numbnefs of the arms is probably owing more frequent- ly to the increafed action of the peroral mufcles in refpiration, Vol. IT. N whence DISEASES Class I. 2. 3. 14. 90 whence they are lefs at liberty to perform other offices, than to the connexion of nerves mentioned in SeCt. XXIX. 5.2. The difficulty of fwallowing is owing to the compreffion of the cefophagus by the lymph in the cheft ; and the impoffibility of breathing in a horizontal pofture originates from this, that if any parts of the lungs mud be rendered ufelefs, the inability of the extremities of them mull be lefs inconvenient to refpiration ; fince if the upper parts or larger trunks of the air-veflels ffiould be rendered ufelefs by the compreffion of the accumulated lymph, the air could not gain admittance to the other parts, and the ani- mal mud immediately periffi. If the pericardium is the principal feat of the difeafe, the pulfe is quick and irregular. If only the cavity of the thorax is hydropic, the pulfe is not quick nor irregular. If one fide is more affected than the other, the patient leans mod that way, and has more numbnefs in that arm. The hydrops thoracis is didinguilhed from the anafarca pul- monum, as the patient in the former cannot lie down half a min- ute ; in the latter the difficulty of breathing, which occafions him to rife up, comes on more gradually ; as the tranfition of the lymph in the cellular membrane from one part to another of it is flower, than that of the effufed lymph in the cavity of the cheft. The hydrops thoracis is often complicated with fits of con- vulfive breathing; and then it produces a difeafe for the time very fimilar to the common periodic afthma, which is perhaps owing to a temporary anafarca of the lungs ; or to an impaired venous abforption in them. Thefe exacerbations of difficult breathing are attended with cold extremities, cold breath, cold tongue, upright pofture with the mouth open, and a defire of cold air, and a quick, weak, intermittent pulfe, and contracted hands. Thefe exacerbationsrecur fometimesevery two or three hours, and are relieved by opium, a grain every hour for two or three dofes, with ether about a dram in cold water ; and feem to be a convulfion of the mufclesof refpiration induced by the pain of the dyfpnoea. As in Clafs III. 1. 1. 9. M. M. A grain of dried fquill, and a quarter of a grain of blue vitriol every hour for fix or eight hours, unlefs it vomit or purge. A grain of opium. Blifters. Calomel three grains every third day, with infufion of fenna. Bark. Chalybeates. Puncture in the fide. Can the fluctuation in the cheft be heard by applying the ear to the fide, as Hippocrates aflerts ? Can it be felt by the hand or by the patient before the difeafe is too great to admit of cure by the OF IRRITATION. Class. I. 2. 3. 15. 91 the paracentefis ? Does this dropfy of the cheft often come on af- ter peripneumony ? Is it ever cured by making the patient fick by tindure of digitalis ? Could it be cured, if on one fide only, by the operation of punfture between the ribs, and afterwards by inflaming the cavity by the admiffion of air for a time, like the cure of the hydrocele ; the pleura afterwards adhering whol- ly to that lobe of the lungs, fo as to prevent any future eflufion of mucus ? I fufpeCt the anafarca of the lungs, as well as the hydrops thoracis, to be moil frequently a difeafe of thofe membranes on- ly, and not to depend on the general paralyfis of the abforbent fyftem ; and that they are then not accom^ained with fwelled legs, till the patient becomes univerfally weak ; and that they have for their caufe a rheumatic or gouty peripneumony or pleu- rify ; that is, that the lungs or pleura have been inflamed from their fympathy with fome other vifcus, and have depofited much coagulable lymph on the furface of their inflamed membranes, which could not readily become abforbed, and has thus caufed the dropfy of the cavity of the cheft, like the coagulable lymph or chalky matter left after the gout and rheumatifm in other parts ; or that the cellular membrane of the lungs becomes fill- ed with a fluid from the prefent inaCtion of their abforbent vef- fels, which had previoufly been excited too violently ; and that the anafarca of the lungs is thus produced like the anafarca which, frequently.in weak conftitutions, exifts after the gout in the feet and knees, and after rheumatic inflammations of the joints. See Peripneumonia, Clafs II. r. 2. 4. whence it appears, why the hydrops thoracis and anafarca pulmonum fo generally occur in gouty conftitutions. 15. Hydrops ovarii. Dropfy of the ovary is another encyfted dropfy, which feldom admits of cure. It is diftinguifhed from afcites by the tumour and pain, efpecially at the beginning, oc- cupying one fide, and the fluctuation being lefs diftindly per- ceptible. When it happens to young fubjeCts it is lefs liable to be miftaken for afcites. It affeCis women of all ages, either married or virgins ; and is produced by cold, fear, hunger, bad food, and other debilitating caufes. I faw an elegant young la- dy,who was fhortly to have been married to a fenfible man,with great profpeCt of happinefs ; who, on being overturned in a chaife in the night, and obliged to walk two or three miles in wet, cold, and darknefs, became much indifpofed, and gradually affliCled with a fwelling and pain on one fide of the abdomen ; which terminated in a dropfy of the ovary, and deftroyed her in two or three years. Another young woman I recoiled feeing, who was about feventeen, and being of the very inferior clafs of 92 DISEASES Class I. 2; 3.16. of people, feemed to have been much weakened by the hardlhip of a cold floor, and little or no bed, with bad food ; and who to thefe evils had to bear the unceafing obloquy of her neighbours, and the perfecution of pariffi officers. The following is abftratfled from a letter of my friend Mr. Power, furgeon, at Bofworth in Leicefterfhire, on examining the body of an elderly lady who died of this difeafe, March 29, 1793- " On opening the abdomen I found a large cyft attach- ed to the left ovarium by an elaftic neck as thick as the little fin- ger, and fo callous as not to admit of being feparated by fciflars without confiderable difficulty. The fubftance of the cyft had an appearance much refembling the gravid uterus near the full period of geftation, and wa? as thick. It had no attachment to the peritoneum, or any of the vifcera, except by the hard callous neck I have mentioned ; fo that the blood mull with difficulty have been circulated through it for fome time. Its texture was extremely tender, being eafily perforated with the finger, was of a livid red colour, and evidently in a fphacelated ftate. It con- tained about two gallons of a fluid of the colour of port wine, without any greater tenacity It has fallen to my lot to have opened two other patients, whole deaths were occafioned by en- Cyfted dropfy of the ovarium. In one of thefe the ovarium was much enlarged with eight or teneyfts on its furface, but there was no adhefion formed by any of the cyfts to any other part ; nor had the ovarium formed any adhefion with the peritoneum, though in a very difeafed ftate. In the other the difeafe was more Ample, being only one cyft, without any attachment but to the ovarium. "As the ovarium is a part not neceflary to life, and dropfies of this kind are fo generally fatal in the end, I think I fhall be induced, notwithftanding the hazard attending wounds, which penetrate the cavity of the abdomen, to propofe the extirpation of the difeafed part in the firft cafe, which occurs to me, in which I can with precifion fay, that the ovarium is the feat of the difeafe, and the patient in other refpe&s tolerably healthy ; as the cavity of the abdomen is often opened in other cafes without bad confequences " An argument, which might further countenance the opera- tion thus propofed by Mr. Power, might be taken from the dif- eafe frequently affecting young perfons; from its being gener- ally in thefe fubjedts local and primary ; and not like the afeites, produced or accompanied with other difeafed vifcera ; and laft- ly, as it is performed in adult quadrupeds, as old flows, with fafety, though by awkward operators. 16. Anafarca puhnonum. The dropfy of the cellular mem- brane Class I. 2. 3. 16. OF IRRITATION. 93 brane of the lungs is ufually connected with that of the other- parts of the fyftem. As the cells of the whole cellular mem- brane communicate with each other, the mucilaginous fluid, which remains in any part of it for want of due abforption,finks down to the moft depending cells ; hence the legs fwell, though the caufe of the difeafe, the deficiency of abforption, may be in other parts of the fyftem. The lungs however are an exception to this, fince they are fufpended in the cavity of the thorax, and have in confequence a depending part of their own. The anafarca of the lungs is known by the difficulty of ref- piration accompanied with fwclled legs, and with a very irregu- lar pulfe. This laft circumftance has generally been afcribed to a dropfy at the fame time exifting in the pericardium, but is more probably owing to the difficult paflage of the blood through the lungs ; becaufe I found on difle&ion, in one inftance, that the moft irregular pulfe, which I ever attended to, was owing to very extenfive adhefion of the lungs j infomuch that one lobe in- tirely adhered to the pleura ; and fecondly, becaufe this kind of dropfy of the lungs is fo certainly removed for a time along with the anafarca of the limbs by the ufe of digitalis. This medicine, as well as emetic tartar, or fquill, when given fo as to produce ficknefs, or naufea, or perhaps even without producing either in any perceptible degree,by affecting the lym- phatics of the ftomach, fo as either to invert their motion, or to weaken them, increafesby reverfe fympathy the adion, and con- fequent abforbent power of thefe lymphatics, which open into the cellular membrane. But as thefe medicines feldom fucceed in producing an abforption of thofe fluids, which ftagnate in the larger cavities of the body, as in the abdomen, or cheft, and do generally fucceed in this difficulty of breathing with irregu- lar pulfe above defcribed, I conclude that it is not owing to an effufion of lymph into the pericardium, but fimply to an anafar- ca of the lungs. M. M. Digitalis. See Art. V. 2. i. 2. and IV. 2 3. 7. Tobacco. Squill. Emetic tartar (antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain twice a day. Raifin wine and water, or other wine and water, is pre- ferred to the fpirit and water, which thefe patients have general- ly been accuftomed to. I have feen two cafes, which were efteemed to be hydrotho- rax, but which I believed to be anafarca pulmonum, though they were attended with irregular pulfe ; for I do not underftand, why an irregularity of pulfe fhould be occafioned by water in the pericardium any more than by water in the lungs, or by any 94 DISEASES Class I. 2. 3. 17. any other obftru&ion to the circulation. See Clafs IV. 2. 1. 18. Pulfus intermittens, and Palpitatio cordis. In both thefe cafes the patients could not deep above one min- ute at a time ; which I afcribed to the debility of the action of the heart compared with the refiftance to the circulation, and that fome voluntary exertion became neceflary to carry on the circulation, which does not exift in deep. See Clafs I. 2. 1. 3. Somnus interruptus. Thefe two cafes of patients about fixty years of age are here mentioned from a curious circumftance, that both the patients became in fome degree infane after being relieved by the tinc- ture of digitalis taken to the quantity of thirty drops three or four times a day for two or three days ; and remained in a flight de- gree of infanity for fome months, and then as this increafe of voluntary exertion ceafed, they again became afflicted with the anafarca pulmonum, and fwelling of the legs, and this repeat- edly for two or three years. 1 have before feen a common an- afarca repeatedly cured by infanity for a year or two, and two fevers I have feen attended with great debility cured by the ac- cefs of infanity, which was called delirium by the attendants ; and I lately witnedcd the prefent cure of what was believed to be confumption by the accefs of infanity. All which were probably effected by the increafed energy of fome parts of the fyftem owing to the addition of volition to the fenforial powers of irritation or adbciation. The ufual caufe of anafarca is from a difeafed liver, and hence it moft frequently attends thefe, who have drunk much ferment- ed or fpirituous liquors ; but I fufpecT that there is another caufe of anafarca, which originates from the brain ; and which is more certainly fatal than that, which originates from a difeaf- ed liver. Thefe patients, where the anafarca originates from, or commences in, the brain, have not other fymptoms of difeafed liver ; have lefs difficulty of breathing at the beginning ; and hold themfelves more upright in their chair,and in walking. In this kind of dropfy I fufped: the digitalis has lefs or no die ft ; as it particularly increafes the abforption from the lungs. 17. Obejitas. Corpulency may be called anafarca or dropfy of fat, fmee it muft be owing to an analogous caufe ; that is, to the deficient abforption of fat compared to the quantity fccreted into the cells which contain it. See Clafs II. 1. 1.4. The method of getting free from too much fat without any injury to the conftitution, confitts, firft, in putting on a proper bandage on the belly, fo that it can be tightened or relaxed with eafe, as a tightiffi under waiftcoat, with a double row of buttons. This is to comprefs the bowels and increafe their abforption ; and Class. I. 2. 3. 18. OF IRRITATION. 95 and it thus removes one principal caufe of corpulency, which is the loofenefs of the Ikin. Secondly, he fliould omit one entire meal, as fupper ; by this long abftinence from food the abforb- ent fyftem will a<St on the mucus and fat with greater energy. Thirdly, he fliould drink as little as he can with eafe to his fen- fations ; fmce, if the abforbents of the ftomach and bowels fup- ply the blood with much, or perhaps too much, aqueous fluid, the abforbents of the cellular membrane will adt with lefs ener- gy. Fourthly, he fliould ufe much fait or falted meat, which will increafe the perfpiration and make him thirfty j and if he bears this thirft, the abforption of his fat will be greatly increaf- ed, as appears in fevers and dropfies with thirft ; this I believe to be more efficacious than foap. Fifthly, he may ufe aerated alkaline water for his drink, which may be fuppofed to render the fat more fluid,-or he may take foap in large quantities, which will be decompofed in the ftomach. Sixthly, fhort reft, and conftant exercife. Vinegar has been faid to reduce corpulency, but as it con- tains much vinous fpirit, it may injure the general health with- out previoufly inducing leannefs. Perhaps cryftals of tartar might fucceed better ufed daily in water at meals. The moft efficacious method of reducing the quantity of the fat I fufpedt may be by the ufe of the tin&ure of digitalis in fmall quantity, as twenty or thirty drops twice a day, as dirett- ed in Article IV. 2. 3. 7. As the effect of this medicine, when given in greater quantity, as in forty drops twice or thrice a day in hydrothorax or general anafarca,evidently confifts in weaken- ing the natural actions of the ftomach, perhaps by previoufly ftimulating that vifcus too violently; in confequence the heart and arteries acl lefs powerfully from their fympathy with the ftomach ; and the capillary veflels, and abforbents, a£t more powerfully in confequence of the lefs expenditure of fcnforia'1 power by the inert action of the heart and arteries ; and will confequently abforb the accumulated fat from the cellular mem- brane, as explained in Supplement I. 12. 10. 18. Splenis tumor. Swellings of the fpleen, or in its vicinity, are frequently perceived by the hand in intermittents, which are called Ague-cakes, and feem owing to a deficiency of abforption in the affected part. Mr. Y , a young man about twenty-five years of age* who lived intemperately, was feized with an obftinate intermit- tent, which had become a continued fever withftrong pulfe, at- tended with daily remiffion. A large hard tumour on the left fide, on the region of the fpleen, but extending much more downward, was fo diftinftly perceptible, that one feemed to get one's 96 DISEASES Class I. 2. 3.19. one's fingers under the edge of it, much like the feel of the brawn or fhield on a boar's (boulder. He was repeatedly bled, and purged with calomel, had an emetic, and a blifter on the part, without diminifiiing the tumour ; after fome time he took the P ruvian bark, and flight dofes of chalybeates, and thus became free from the fever, and went to Bath for feveral weeks, but the tumour remained. This tumour I examined every four or five years for above thirty years. His countenance was pale, and to- wards the end of his life he fuffered much from ulcers on his legs, and died about fixty, of general debility ; like many others who live intemperately in relpe6l to the ingurgitation of fer- mented or fpirituous liquors. As this tumour commenced in the cold fit of an intermittent fever, and was not attended with pain, and continued fo long without endangering his life, there is reafon to believe it was (imply occafioned by deficient abforption, and not by more en- ergetic action of the veflels which conftitute the fpleen. See Clafs II. i. 2 13. M. M. Venefeftion. Emetic, cathartic with calomel ; then forbentia, chalybeates, Peruvian bark. 19. Genu tumor albus. White fwelling of the knee, is owing to deficient abforption of the lymphatics of the membranes in- cluding the joint, or capfular ligaments, and fometimes perhaps of the gland which fecretes the fy novia ; and the ends of the bones are probably affedled in confequence. I faw an inftance, where a cauftic had been applied by an empyric on a large white fwelling of the knee, and was told, that a fluid had been difcharged from the joint, which became an- chylofed, and healed without lofs of the limb M. M. Repeated blifters on the part early in the difeafe are faid to cure it by promoting abforption ; faturnine folutions ex- ternally are recommended. Bark, animal charcoal, as burnt fponge, opium in fmall dofes. Fri&ion with the hand. Four or fix leeches applied on or beneath the knee alternately with the blifters, and a cupping glafs put over the wounds made by the leeches are much recommended. 20. Bronchocele. Swelled throat. An enlargement of the thyroid glands, faid to be frequent in mountainous countries, where river water is drunk, which has its fource from diflblving fnows. This idea is a very ancient one, but perhaps not on that account to be the more depended upon, as authors copy one another. Tumidum guttur quis miratur in Alpibus, feems to have been a proverb in the time of Juvenal. rJ he inferior people of Derby are much fubjeft to this difeafe, but whether more fo than other populous towns, I cannot determine j certain it- Class 1.2. 3. 21. OF IRRITATION. 97 it is, that they chiefly drink the water of the Derwent, which arifes in a mountainous country, and is very frequently blacken- ed as it pafles through the morafles near its fource ; and is gen- erally of a darker colour, and attended with a whiter foam, than the Trent, into which it falls ; the greater quantity and white- nefs of its froth I fuppofe may be owing to the vifcidity com- municated to it by the colouring matter. The lower parts of the to wn of Derby might be eafily funplied with fpring water from St. Alkmond's well; or the whole of it from the abun- dant fprings near Bowbridge ; the water from which might be conveyed to town in hollow bricks, or clay-pipes, at no very great expence, and might be received into frequent refervoirs with pumps to them ; or laid into the houfes. M. M. Twenty grains of burnt fponge with ten of nitre made with mucilage into lozenges, and permitted to diflolve flowly un- der the tongue twice a day, is aflerted to cure in a few months ; perhaps other animal charcoal, as candle-fnuffs, might do the fame. I have directed in the early ftate of this difeafe a mixture of common fait and water to be held in the mouth, particularly under the tongue, for a few minutes, four or fix times a day for many weeks, which has fometimes fucceeded; the fait and water is then fpit out again, or in part fwallowed. Externally vinegar of fquills has been applied, or a mercurial plafter,or fomentations of acetated ammoniac ; or other. Some empyrics have applied cauftics on the bronchocele, and fometimes, I have been told, with fuccefs ; which fhould certainly be ufed where there is danger of fuffbcation from the bulk of it. One cafe I faw, and one I was well informed of, where the bronchocelewas cured by burnt fponge, and a hetShic fever fupervened with colliquative fweats; but 1 do not know the final event of either of them. De Haen affirms the cure of bronchocele to be eftefted by flowers of zinc, calcined egg-(hel!s, and fcarlet-cloth burnt to- gether in a clofe crucible, which was tried with fuccefs, as he allured me, by a late lamented phyfician, my friend. Dr. Small of Birmingham ; who to the cultivation of modern fciences add- ed the integrity of ancient manners ; who in clearnefs of head, and benevolence of heart, had few equals, perhaps no fuperiors. 21. Scrofula. King's evil is known by tumours of the lym- phatic glands, particularly of the neck. The upper lip, and di- vifion of the noftrils are fwelled, with a florid countenance, a fmooth ikin,and a tumid abdomen. Cullen. The abforbed fl - ids in their courfe to the veins in the fcrofula are arrefted in the lymphatic or conglobate glands; which fwell, and after a great length of time, inflame and fuppurate. Materials of a peculiar Vol. II, O kind. 98 DISEASES ClassI. 2. 3. 21. kind, as the variolous and venereal matter, when abforbed in a wound, produce this torpor, and confequent inflammation of thofe lymphatic glands, where they firft arrive, as in the axilla and groin. There is reafon to fufped:, that the tonfils frequent- ly become inflamed, and fuppurate from the matter abforbed from carious teeth ; and I faw a young lady, who had both the axillary glands fwelled, and which fuppurated ; which was be- lieved to have been caufed by her wearing a pair of new green gloves for one day, when (he had perfpired much, and was much exhausted and fatigued by walking; the gloves were probably died in a folution of verditer. Thefe indolent tumours of the lymphatic glands, which con- ftitute the fcrofula, originate from the inirritability of thofe glands; which therefore fooner fall into torpor after having been ftimulated too violently by fome poifonous material ; as the mufcles of enfeebled people fooner become fatigued, and ceafe to aft, when exerted, than thofe of ftronger ones. On the fame account thefe fcrofulus glands are much longer in acquir- ing increafe of motion, after having been Simulated into in- activity, and either remain years in a Hate of indolence, or fup- purate with difficulty, and fometimes only partially. The difference between fcrofulus tumours, and thofe before defcribed, confilis in this ; that in thofe, either glands of differ- ent kinds were difeafed, or the mouths only of the lymphatic glands were become torpid; whereas in fcrofula the conglobate glands themfelves become tumid, and generally fuppurate after a great length of time, when they acquire new fenfibility. See Sed. XXXIX 4. 5. Thefe indolent tumours may be brought to fuppurate fome- times by palfing dearie (hocks through them every day for two or three weeks, as I have witneffed. it is probable, that the al- ternate application of fnow or iced water to them, till they be- come painfully cold, and then of warm flannel or warm water, frequently repeated, might reltore their irritability by accumula- tion of fenforial power; and thence either facilitate their difper- fion, or occafion them to fuppurate. See Clafs II. 1.4. 13. This difeafe is very frequent amongft the children of the poor in large towns, who are in general ill fed, ill lodged, and ill cloth- ed ; and who are further weakened by eating much fait with their fcanty meal of infipid vegetable food, which is feldom of better quality than water gruel, with a little coarfe bread in it. See diarrhoea of infants, Clafs I. 1. 2. 5. Scrofulous ulcers are difficult to heal, which is owing to the deficiency of abforption on their pale and flabby furfaces, and to the general inirritabili- ty of the fyllem. See Clafs I. i. 3. 13. M. M. Plentiful OF IRRITATION. Class I. 2. 3. 22. 99 M. M Plentiful diet of fleffi meat and vegetables with (mall 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 fea-bathing, or bathing in fait and water, one pound to three gallons, made warm. The application of Peru- vian bark in fine powder, feven parts, and white lead (ceruffa), in fine powder one part, mixed together and applied on the ul- cer in dry powder, by means of lint and a bandage, to be renew- ed every day. Or very fine powder of calamy alone, lapis ca- laminaris. If powder of manganefe ? See Clafs II. 1.4. 13. 22 Scirrbus. After the abforbent veins of a gland ceafe to perform their office, if the fecerning arteries of it continue to aft fome time longer, the fluids are puflied forwards, and flag- nate in the receptacles or capillary veflels of the gland ; and the thinner part of them only being refumed by the abforbent fyftem of the gland, a hard tumour gradually fucceeds ; which contin- ues like a lifelefs mafs, till from fome accidental violence it gains fenfibility, and produces a cancer, or fuppurates. Of this kind are the fcirrhus glands of the breafts, of the lungs, of the mefen- tery, and the fcrofulous tumours about the neck and the bron- chocele. Another feat of fcirrhus is in the membranous parts of the fyftem, as of the recftum inteftinum, the urethra, the gula or throat; and of this kind is the veruca or wart, and the clavus pe- dum, or corns on the toes. A wen fometimes arifes on the back of the neck, and fometimes between the (boulders ; and by dif- tending the tendinous fafcia produces great and perpetual pain. M. M. Mercurial ointment. Cover the part with oiled filk. Extirpation Electric (hocks through the tumour. An iflue into the fubftance of the wen. Opium. Ether externally. 23. Scirrbus reHi intejlini. Scirrhus of the redlum. A fcirrhus frequently affects a canal, and by contracting its diam- eter becomes a painful and deplorable difeafe. The canals thus obftru<Sted are the reCtum, the urethra, the throat, the gall-du£ts, and probably the excretory duCls of the lymphatics, and of oth- er glands The fcirrhus of the reftum 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 fwelled part of the teftine is fometimes protruded downwards, and hangs like a valve, fmooth and hard to the touch, with an aperture in the centre of it. See a paper on this fubject by J. Sherwin. Me- moirs of a London Medical .Society, Vol. II. p. 9. M. M. To take but little folid food. Aperient medicines. Introduce 100 DISEASES Class I. 2. 3. 24. Introduce a candle fmeared with mercurial ointment. Sponge- tent. Clyfters with forty drops of laudanum. Introduce a leathern canula, or gut, and then either a wooden maundrill, cr blow it up with air, fo as to diftend the contradied part as much, as the patient can bear. Or fpread mercurial plafter on thick foft leather, and roll it up with the platter outwards to any thick- nefs and length, which can be eafily introduced and worn ; or two or three fuch pieces may be introduced after each other. The fame may be ufed to comprefs bleeding internal piles. See Clafs I. 2. 1. 6. Rub mercurial ointment on the fphindter ani every night for a fortnight. May not this difeafe be cured by lunar cauftic applied on the end of a peflary or bougie, in the fame manner as ufed by J. Hunter, and fince by Mr. E. Home, in ttridtures of the urethra ; when, on introducing the finger, a kind of membranous valve can be diftinguilhed rather than an extenfive feirrhus or indura- tion. See the next article. 24. Scirrhus urethra. Scirrhus of the urethra. The paflage becomes contradied by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to dif- tend the canal behind the ftridlure ; till at length an aperture is made, and the urine forces its way into the cellular membrane, making large finufes. This fituation fometimes continues many months, or even years, and fo much matter is evacuated after making water, or at the fame time, by the adtion of the mufcles in the vicinity of the finufes, that it has been miftaken for an in- creafed fecretion from the bladder, and has been erroneoufly termed a catarrh of the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs. M. M. Dittend the part gradually by catgut bougies, which by their compreffion will at the fame timediminiih the thicknefs of the membrane, or by bougies of elaftic gum, or of horn boil- ed foft. The patient ffiould gain the habit of making water flowly, which is a matter of the utmoft confequence, as it pre- vents the dittention and confequent rupture, of that part of the urethra, which is between the llridture and the neck of the blad- der. When there occurs an external ulcer in the perinaeum, and the urine is in part difeharged that way, the difeafe cannot be miftaken. Otherwife, from the quantity of matter, it is gener- ally fuppofed to come from the bladder, or proftrate gland ; and the urine, which efcapes from the ruptured urethra, mines its way amongft the mufcles and membranes, and the patient dies tabid, owing to the want of an external orifice to difeharge the matter. See Clafs II. 1.4. 11. Mr. Home OF IRRITATION. Class I. 2. 3. 25. 101 Mr. Home has publifhed a very ingenious and ufeful work, entitled, a Diflertation on Strictures of the Urethra, in which he has recorded many cafes fuccefsfully treated by lunar cauf- tic, inferred in the end of a bougie, and applied to the contract- ed part of the urethra, fo as to deftroy the ftriCture. From the form of the cavity of the urethra, taken by injeCling wax into it, there appears naturally to exift a kind of valve im- mediately behind the bulb of the urethra, which when the penis is ereCt, (huts up the orifice, and prevents the regurgitation of the femen into the bladder during the aCtion of the accelerator mufcles in the aCt of its expulfion ; and this natural conflriCtion or valve appears generally to be the firft feat of ftriCture. Above the bulb, about two or three inches from the orifice of the glans, the cavity of the urethra appears alfo leflened; and in fome cafes the orifice of the very extremity appears lefs than other parts of the canal; thefe parts are therefore more contract- ed during the emiffio feminis, and add to its velocity at its exit; and are thence more liable to fchirrofity or ftriCture. And by fame obfervations, Mr. Home has fhewn, that a fympathy exifts between the ftriCtures of thefe parts ; and that the more for- ward ftriCtures are frequently produced in confequence of that behind the bulb ; and finds it neceflary to deftroy them all, by frequent application of the cauftic. By the ufe of which, (which was firft propofed by Wifeman, firft applied by John Hunter, and fo greatly improved by Mr.. Home) the lives of great numbers are rendered happy, w'ho oth- erwife gradually perifh by a moft painful and hopelefs malady. 25. Scirrhus oejophagi. A feirrhus of the throat contraCis the paflage fo as to render the fwallowing of folids impracticable, and of liquids difficult. It affeCts patients of all ages, but is probably moft frequently produced by fwallowing hard angular fubftances? when people have loft their teeth ; by which this membrane is over-diftended, or torn, or otherwife injured. M. M. Put milk into a bladder tied to a canula or catheter ; introduce it paft the ftriCture, and prefs it into the ftomach. Diftend the ftriCture gradually by a fponge-tent faftened to the end of whalebone, or by a plug of wax or a fpermaceti candle, about two inches long ; which might be introduced, and left there with a firing only fixed to it to hang out of the mouth, to keep it in its place, and to retraCt it by occafionally ; for which purpofe the firing muft be put through a catheter or hollow pro- bang, when it is to be retraCled. Or lafily, introduce a gut fixed to a pipe ; and then diftend it by blowing wind into it. The fwallowing a bullet with a firing put through it, to retraci it on the exhibition of an emetic has alfo been propofed. Ex- ternally, 102 DISEASES Class I. 2. 3. 2$. ternally, mercurial ointment has been much recommended. Poultice. Oiled filk. Clyfters of broth. Warm bath of broth. Transfufion of blood into a vein three or four ounces a day ? See Clafs III i. I. 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 ttriclure in her throat; af- ter a few days, her fpirits funk, and (he refufed to ufe it further, and died. Above thirty years ago, I propofed to an old gentle- man, whofe throat was entirely impervious, to fupply him with a few ounces of blood daily from an afs, or from the human an- imal, who is Rill more patient and tractable, in the following manner : To fix a filver pipe about an inch long to each extrem- ity of a chicken's gut, the part between the two filver end. to be meafured by filling it with warm water ; to put one end into the vein of a perfon hired for that purpofe, fo as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other filver end, to in- troduce that end into the vein of the patient upwards towards the heart, fo as to admit no air along with the blood. And laftly, to fupport the gut and filver ends on a water-plate, fill- ed with water of ninety-eight degrees of heat, and to meafure how many ounces of blood was introduced by palling the finger, fo as to comprefs the gut, from the receiving pipe to the deliv- ering-pipe ; and thence to determine how many gut-fulls were given from the healthy perfon to the patient. Mr con- fidered a day on this propofal, and then another day, and at length anfwered, that " he now found himfelf near the houfe of death ; and that, if he could return, he was now too old to have much enjoyment of life ; and therefore he wifhed rather to pro- ceed to the end of that journey, which he was now fo near, and which he mult at all events foon go, than return for fo (hort a time." He lived but a few days afterwards, and feemed quite carelefs and eafy about the matter. See Suppi. I. 14 4. A difficulty of fwallowing food, and a rejection foon after, of the whole or a part of it, may be often owing probably to a fort of valve made by a part of the membrane which lines the oefiph- agus; and may thus refemble ftriflures of the urethra ; which laft are fo frequently cured by the nice application of lunar cauf- tic, as defcribed by Mr. Everard Home, in his treatife on Stric- tures of the Urethra. Suppofe a thick bougie, made of linen fpread with adhefive platter, and rolled up, was armed at the end with a bit of lunar cauftic, with which the ftridture of the oefophagus could be touched repeatedly, till an unarmed bougie could be paiTed readily into the ftomach. Could fuch a valve be burftt OF IRRITATION. Class I. 2. 3. 26. 103 burft, or inverted, by pouring a pound or two of crude mercu- ry into the cefophagus ? 26. Lafleorum inirritabilitas. Inirritability of the la&eals is defcribed in Seel. XXVIII. under the name of paralyfis of the ladleals ; but as the word paralyfis has generally been applied to the difohedience of the mufcles to the power of volition, the name is here changed to inirritability of the lacleals, as more charaiteriftic of the difeafe. 27. Lymphaticorum inirritabilitas. The inirritability of the cellular and cutaneous lymphatics is defcribed in Seft. XXIX. 5. 1. and in Clafs I. 2. 3. 16. The inirritability of the cutaneous lymphatics generally accompanies anafarca, and is the caufe of the great thirft in that malady At the fame time, the cellular lymphatics act with greater energy, owing to the greater de- rivation of fenforial power to them, in confequence of the lefs expenditure of it by the cutaneous ones ; and hence they abforb the fat, and mucus, and alfo the thinner parts of the urine. Whence the great emaciation of the body, the muddy fediment, and the fmall quantity of water in this kind of dropfy. ORDO DISEASES Class I. 2. 4. 104 ORDO IL Decreafed Irritation. GENUS IV. With decreafed Allions of other Cavities and Membranes. Many of the difeafes of this genus are attended with pain, and with cold extremities, both which ceafe on the exhibition of wine or opium ; which Ihews that they originate from de- ficient adlion of the affedted organ. Thefe pains are called ner- vous or fpafmodic, are not attended with fever, but are fre- quently fucceeded by convulfions and madnefs; both which be- long to the clafs of volition. Some of them return at periods, and when thefe can be afcertained, a much lefs quantity of opi- um will prevent them, than is neceflary to cure them, when they are begun ; as the vefiels are then torpid and inirritable from the want of fenforial power, till by their inaction it becomes again accumulated. Our organs of fenfe, properly fo called, are not liable to pain from the abfence of their appropriated ftimuli, as from darknefs or fdence ; but the other fenfes, which may be more properly called appetites, as thofe by which we perceive heat, hunger, thirft, luft, want of freih air, are affedred with pain from the de- fedt or abfence of their accuftomed ftimuli, as well as with pleaf- ure by the pofleflion of them ; it is probable that fome of ©ur glands, the fenfe or appetite of which requires or receives tome- thing from the circulating blood, as the pancreas, liver, teftes, proftrate gland, may be affedled with aching or pain, when they cannot acquire their appropriate fluid. Wherever this defect of ftimulus occurs, a torpor or inadtion of the organ enfues, as in the capillaries of the Ikin, when expo- fed to cold ; and in the glands, which fecrete the gaftric juice, when we are hungry. This torpor however, and concomitant pain, which are at firft owing to defedt of ftimulus, are after- wards induced by other aflbeiationsor catenations, and conftitute the beginning of ague-fits. It muft be further obferved, that in the difeafes of pain with* out fever, the pain is frequently not felt in the part where the caufe of the difeafe refides ; but is induced by fympathy with a diftant part, the irritability or fenfibility of which is greater or lefs than its own. Thus a ftone at the neck of the bladder, if its ftimulus is not very great, only induces the pain of ftrangury at the QlassL 2. 4. 1. OF IRRITATION. 105 the glans penis. If its ftimulus be greater, it then induces pain at the neck of the bladder. The concretions of bile, which are protruded into the neck of the gall-badder, when the difeafe is not very great, produce pain at the other extremity of the bile- duel, which enters the duodenum immediately under the pit of the ftomach; but, when the difeafe is great from the largenefs of the bile-(lone, 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 tins ge- nus are confequences of the inactivity of the organ ; and, as they do not occafion other difeafes, fliould be clafled according to their proximate caufe, which is, defective irritation ; there are neverthelefs other pains from defect of ftimulus, which produce convulfions, and belong to Clafs III. I. I. j and others, which produce pains of fome diftant part by aflbeiation, and belong to Clafs IV. 2. 2. SPECIES. i. Sitis. Thirft. The fenfes of thirft and of hunger feem to have this connexion, that the former is fituated at the upper end, and the latter at the lower end of the fame canal. One about the pharinx, where the cefophagus opens into the mouth, and the other about the cardia ventriculi, where it opens into the ftomach. The extremities of other canals have been (hewn to poflefs correfpondent fenfibilities, or irritabilities, as the two ends of the urethra, and of the common gall-dud. See IV. 2. 2. 2. and 4. The membrane of the upper end of the gullet becomes torpid, and confequently painful, when there is a deficiency of aqueous fluid in the general fyHem ; it then wants its proper ftimulus. In the fame manner a want of the ftimulus of more folid mate- rials at the other end of the canal, which terminates in the ftom- ach, produces hunger ; as mentioned in SeCl. XIV. 8. The proximate caufes of both of them therefore confift in deficient irritation, when they are confidered as pains ; becaufe thefe pains are in confequence of the inactivity of the organ, according to the fifth law of animal caufation. Sefl. IV 5. But when they are confidered as defires, namely, of liquid or folid aliment, their proximate caufe confifts in the pain of them, according to the fixth law of animal caufation. So the proximate caufe of the pain of coldnefs is the inactivity of the organ, and perhaps the confequent accumulation of fenforial power in it ; but the gain itfelf or the confequent volition, is the proximate caufe of the Vol. II. P fhuddering DISEASES Class I. 2. 4. 2. 106 fhuddering and gnafliing the teeth in cold fits of intermittent fe- vers. See Clafs I. 2. 2. 1. Thirft may be divided into two varieties, alluding to the re- mote caufe of each, and may be termed fitis calida, or warm thirft, and fitis frigida, or cold thirft. The remote caufe of the former arifes from the diflipation of the aqueous parts of our fluids by the increafed fecretion of perfpirable matter, or other evacuations. And hence it occurs in hot fits of fever, and after taking much wine, opium, fpice, fait, or other drugs of the Art. incitantia or fecernentia. The thirft, which occurs about three hours after eating a couple of red herrings, to a perfon unaccuf- tomed to falted meat, is of this kind ; the increafed aClion of the cutaneous veflels diflipates fo much of our fluids by infenfible perfpiration, as to require above two quarts of water to reftore- the fluidity of the blood, and to walh the fait out of the fyftem. See Art. III. 2. 1. M. M. Cold water. Vegetable acids. Warm bath. The remote caufe of fitis frigida, or cold thirft, is owing to the inaction of the cutaneous, pulmonary, urinary, and cellular abforbents J whence the blood is deprived of the great fupply of moifture which it ought to receive from the atmofphere, and from the cells of the cellular membrane, and from other cyfts ; this caufe of thirft exifts in dropfies, and in the cold fits of inter- mittents. The defire of fluids, like that of folids, is liable to ac- quire periods, and may therefore readily become difeafed by in- dulgence in liquids grateful to the palate. Of difeafed thirft, the molt common is either owing to defeat of the aClion of the numerous abforbent veflels on the neck of the bladder, in which the patient makes much palifh water ; or to the defective abforption of the fkin and lungs, in which the patient makes but little water, and that high-coloured, and with fediment. In both the tongue and lips are liable to become very dry. The former in its greateft degree attends diabetes, and the latter anafarca. M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water. Lemonade. Cider. 2. Efuries. Hunger has been fancifully afcribed to the fides of the ftomach rubbing againft each other, and to the increafed acidity of the gaftric juice corroding the coats of it. If either of thefe werethe caufeof hunger, inflammation muft occur,when they had continued fome time ; but, on the contrary, coldnefs uot heat is attendant on hunger; which evinces, that like thirft it is owing to the inactivity of the membrane, which is the feat of it; while the abundant nerves about the cardia ventriculi, and Glass I. 2.4. 3. OF IRRITATION. 107 and the pain of hunger being felt in that part, gives great rea- fon to conclude, that it is there fituated. The fenfe of hunger as well as of thirft, is liable to acquire habits in refpeft to the times of its returning painfulnefs, as well as in refpeft to the quantity required to fatiate its appetency, and hence may beconqe difeafed by indulgence, as well as by want of its appropriate ftimulus. Thofe who have been accui- tomed to di (lend their ftomach by large quantities of animal and vegetable food, and much potation, find a want of diftention, when the ftomach is empty, which occafions faintnefs, and is miftaken for hunger, but which does not appear to be the fame fenfation. I wras well informed, that a woman near Litchfield, who eat much animal and vegetable food for a wager, affirmed, that fince diftending her ftomach fo much, (he had never felt herfelf fatisfied with food ; and had in general taken twice as much at a meal, as fhe had been accuftomed to, before fhe eat fo much for a wager. 3. Naufea ficca. Dry naufea. Confifts in a quiefcence or torpor of the mucous or falivary glands, and precedes their in- verted motions, defcribed in naufea humida, Clafs I. 3. 2. 3. In the fame manner as ficknefs of the ftomach is a quiefcence of that organ preceding the action of vomiting, as explained in Seft. XXXV. 1. 3. This is fometimes induced by difagreeable drugs held in the mouth, at other times by difguftful ideas, and at other times by the aflbciation of thefe aCtions with thofe of the ftomach ; and thus according ^o its different proximate caufes may belong to this, or to the fecond, or to the fourth clafs of difeafes. M. M: Lemonade. Taftefulfood. A blifter. Warm bath. 4. ^gritudo 'ventriculi. Sicknefs of ftomach is produced by the quiefcence or inactivity of that organ, as is explained in SeCt. XXXV. 1.3. It confifts in the ftate between the ufual periftaltic motions of that organ, in the digeftion of our aliment and the retrograde motions of it in vomiting ; for it is evident, that the direct motions of it from the cardia to the pylorus muft ftop, beforeihofe in a contrary direction can commence. This ficknefs, like the naufea above defcribed, is fometimes produced by difguftful ideas, as when nafty objeCts are feen, and nafty ftories related, as well as by the exhauftion of the fenforial pow- er by the ftimulus of fome emetic drugs, and by the defeCt of the production of it, as in enfeebled drunkards. Sicknefs may likewife confift in the retrograde motions of the lymphatics of the ftomach, which regurgitate into it the chyle or lymph, which they have lately abforbed, as in Clafs I. 3. 2. 3. It is probable, that thefe two kinds of ficknefs may be different fen- fations 108 DISEASES Class I. 2. 4. 5. fations, though they have acquired but one name j as one of them attends hunger, and the other repletion ; though either of them may poffiblybe induced by affociation with naufeous ideas. MM. A blifter on the back. An emetic. Opium. Crude mercury. Covering the head in bed. See Sed. XXV. 16. Clafs IV. 1. 1. 2 and 3. 5 Cardialgta. Heartburn originates from the ina&ivity of the ftomach, whence the aliment, inftead of being lubdued by digeftion, and converted into chyle, runs into fermentation, pro- ducing acetous acid. Sometimes the galtric juice itfelf becomes fo acid as to give pain to the upper orifice of the ftomach ; thefe acid contents of the ftomach, on falling on a marble hearth, have been feen to produce an eflervefcence on it. The pain of heat at the upper end of the gullet, when any air is brought up from the fermenting contents of the ftomach, is to be afcribed to the fympathy between thefe two extremities of the cefophagus rather than to the pungency of the carbonic gas, or fixed air ; as the fenfation in fwallowing that kind of air in water is of a different kind. See Clafs I. 3. 1. 3. and IV. 2. 2. 5. M M This difeafe arifing from indigeftion is often very per- tinacious, and afflicting ; and attended with emaciation of the body from want of fuflicient chyle. As the ialiva Iwallowed along with our food prevents its fermentation, as appears by the experiments of Pringle and Macbride, iome find confiderable re- lief by chewing parched wheat, or maftic, or a lock of wool, fre- quently in a day, when the pain occurs, and by fwallowing the faliva thus effufed ; a temporary relief is often obtained from an- tiacids, or aerated alkaline water, Seltzer water, calcareous earths, alkaline faits made into pills with foap, foap alone, tin, milk, bitters. More permanent ufe may be had from fuch drugs as check fermentation, as acid of vitriol; but ftill more permanent relief from fuch things as invigorate the digeftion, as a blifter on the back; a due quantity of vinous fpirit and water taken regularly. Steel. Temperance. A fleep after dinner. A waift- coat made fo tight as flightly to comprefs the bowels and ftom- ach. A flannel fhirt in winter, not in fummer. A lefs quan- tity of potation of all kinds. Ten black pepper-corns fwallow- ed after dinner. Half a grain of opium twice a day, ora grain. The food fhould confift of fuch things as do not eafily ferment, as flefli, fhell-fifh, fea-bifcuit, toafted cheefe. I have feen toaft- ed cheefe brought up from the ftomach 24 hours after it had been fwallowed, without apparently having undergone any chemical change. SeeClafsII. 1. 3. 17. and IV. 1. 2. 13. It is probable that violent cardialgia is moft frequently owing to increafe of the quantity or acidity of the galtric juice, rather than Class 1.2.4. 6. OF IRRITATION. 109 than to the acetous acid produced by fermenting aliment; be- caufe in violent apepfy, as in low fevers, and total want of di- geftion, no fuch violently ftrong or painful acidity occurs. See I 3. 1. 3. See Anorexia II. 2. 2. 1. And fecondly, becaufe in all thefe cafes, which have come under my eye, the diieafe was not increafed by vegetable food, or even by acid fruits, when taken in their ufual quantity ; and I have uniformly obferved, that the food which fuited the palate, and that water alone, or fmall wine and water, agreed with thele patients better than ftronger mixtures of fpirit and water, efpecially when they were more agreeable to the palate. 6. Arthritis Ventriculi. Sicknefs of the ftomach in gouty cafes is frequently a confequence of the torpor or inflammation of the liver, and then it continues many days or weeks. But when the patient is feized with great pain at the ftomach with the fenfation of coldnefs, which they have called an ice-bolt, this is a primary affection of the ftomach, and deftroys the patient in a few hours, owing to the torpor or inaction of that vilcus fo important to life. This primary gout of the ftomach, as it is a torpor of that vifcus, is attended with fenfation of coldnefs, and with real de- fed of heat in that part, and may thence be diftinguifhed from the pain occafioned by the paflageof a gall-ftone into the duo- denum, as well as by the weak pulfe, and cold extremities ; to which muft be added, that it affeCts thofe only, who have been long afflicted with the gout, and much debilitated by its numer- ous attacks. M M. Opium. Vinous fpirit. Volatile alkali. Spice. Warmth applied externally to the ftomach by hot cloths or fo- mentation. 7. Colica flatulenta. The flatulent colic arifes from the too great diftention of the bowels by air, and confequent pain. The caufe of this difeafe is the inactivity or want of fufficiently pow- erful contraCiion of the coats of the bowel, to carry forwards the gas given up by the fermenting aliment. It is without fe- ver, and generally attended with cold extremities. It is diftinguifhed, firft, from the pain occafioned by the paf- fage of a gall-ftone, as that is felt at the pit of the ftomach, and this nearer the navel. Secondly, it is diftinguifhed from the colica faturnina, or colic from lead, as that arifing from the tor- por of the liver, or of fome other vifcus, is attended with greater coldnefs, and with an aching pain ; whereas the flatulent colic being owing to diftention of the mufcles of the bowel, the pain is more acute, and the coldnefs lefs. Thirdly, it is diftinguifh- ed from inflammation of the bowels, or ileus, as perpetual vom- iting 110 DISEASES Class I. 2.4.8. iting and fever attend this. Fourthly, it is diftinguilhed from cholera, becaufe that is accompained with both vomiting and di- arrhoea. And laftly, from the colica epileptica, or hyfteric col- ic, as that is liable to alternate with convulfion, and fometimes with infanity ; and returns by periods. M. M. Spirit of wine and warm water, one fpoonful of each. Opium one grain- Spice. Volatile alkali. Warm fomenta- tion externally. Rhubarb. 8. Colica faturnina. Colic from lead. The pain is felt about the navel, is rather of an aching than acute kind at firft, which increafes after meals, and gradually becomes more permanent and more acute. It terminates in paralyfis, frequently of the mufcles of the arm, fo that the hand hangs down, when the arm is extended horizontally. It is not attended with fever, or increafe of heat. The feat of the difeafe is not well afcertain- ed; it probably affects fome part of the liver, as a pale bluiflr countenance and deficiency of bile fometimes attend or fucceed it, with confequent anafarca ; but it feems to be caufed imme- diately by a torpor of the inteftine, whether this be a primary or fecondary affe&ion, as appears from the conftipation of the bowels, which attends it ; and is always produced in confe- quence of the great ftimulus of lead previoufly ufed either inter- nally for a length of time, or externally on a large furface. A delicate young girl, daughter of a dairy farmer, who kept his milk in leaden cifterns ufed to wipe off the cream from the edges of the lead with her finger ; and frequently, as fhe was fond of cream, licked it from her finger. She was feized with the faturnine colic, and femi-paralytic wrifts, and funk from general debility. A feeble woman about forty years of age, fprained her ancle, and bruifed her leg and thigh ; and applied by ill advice a folu- tion of lead over the whole limb, as a fomentation and poultice for about a fornight. She was then feized with the colica fa- turnina, loft the ufe of her wrifts, and gradually funk under a general debility. There are various means by which lead finds its way into the fyftem ; in the cider counties of this country this difeafe has been frequently almoft epidemic from the ufe of fome lead about their mills, or by the pernicious ufe of it to correct the acidity ©f weak.cider- This difeafe has been fo frequent in fome of the wine countries, that in France the puniihment of death is di- rected for thofe, who ufe lead to deftroy the acidity of wine. There is a bad cuftom in almoft all families and public houfes of wafhing out their bottles by putting a handful of (hot corns into them, and by flraking them about forcibly, by which the lead Class I. 2. 4. 8. OF IRRITATION. 111 lead may in part adhere to the fides of the bottle, and becomes diffolved in the acid of the wine or cider. Milk kept in lead is highly pernicious, as in the inftance above related. Nor fhould coppers for brewing be edged at the top of them with lead, which is frequently done ; nor fhould flefh-meat be falted in leaden citterns. Another way by which lead is liable to be taken into the ttomach is by broth, which is boiled in copper vettels tinned within. Now the lining of thefe veflels confifts, I am well informed, of nearly half lead mixed with the tin ; which is very foluble in hot greafe. From this caufe thofe, who live much on foups long boiled, as the French, are perpetually fub- jeCl to complaints of the ftomach and intettines. When a fauce-pan has been new tinned, if the finger be rubbed hard on it, it becomes black ; which is owing to the lead, which is mix- ed with the tin. Hence the broth for all fick people fhould be boiled but a fhort time, and be immediately put into a china- bafon. In an ingenious pamphlet lately publifhed by Mr. Clutterbuck, feveral cafes are given of the fuccefsful ufe of mercury in the conftipation, colic, and paralyfis of the wrifts, produced by lead. In fome of thefe patients a drachm of ftrong mercurial ointment was rubbed morning and night on the wrifts, till the mouth be- came fore. In others calomel one grain was given daily with ol. ricini ; and in others a quarter of a grain of hydragyrum muria- tum, fublimate of mercury, was given three times a day with great apparent advantage. The author ingenioufly afks, if fmall dofes of fome preparation of lead might not be given inter- nally to counteract the ill effeCts fometimes believed to refult from the too long ufe of mercury. On the Poifon of Lead, Boofey, Lond. See Clafs III. 2. 1. 4. The effeCt of metals in deftroying or preventing the acidity of wine or cider, may be nicely obferved in attending to the colour of fyrup of violets ; which, if it ferments, is changed by the acid thus produced from blue to red : but if it be kept in a tin veffel, this does not occur ; as the acid is attracted by the metal producing an oxyde. Other metals are faid by M. Guy- ton, to have the fame effeCt in preferving the colour of fyrup of violets. M. M. Firft opium one or two grains, then a cathartic of fenna, jalap, and oil, as foon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A blitter on the navel. Warm bath. The ftimulus of the opium, by reftoring to the bowel its natural irritability in this cafe of painful torpor, aflifts the aCHon of the cathartic. A clytter of the fmoke of tobacco pufhed high up 112 DISEASES Class I. 2. 4. 9. up and continued, or repeated frequently for an hour or two, or longer, is faid to remove the pain, and totally to cure the difeafe. 9. Tympanitis. Tympany confifts in an elaftic tumor of the abdomen, which founds on being (truck. It is generally attend- ed with coftivenefs and emaciation. In one kind the air is faid to exift in the bowels, in which cafe the tumor is lefs equal, and becomes lefs tenfe and painful on the evacuation of air. In the other kind the air exifts in the cavity of the abdomen, and fometimes is in a few days exchanged for water, and the tympa- ny becomes an afcites. Air may be diftinguiflied in the (lomach of many people by the found on ftriking it with the fingers, and comparing the found with that of a fimilar percuflion on other parts of the bowels: but towards the end of fevers and efpecially in the puerperal fever, a diftention of the abdomen by air is generally a fatal fymptom, though the eafe, and often cheerfulnefs of the patient, vainly flatters the attendants. M. M. In the former cafe a clyfter-pipe unarmed may be in- troduced, and left fome time in the redlum, to take off the re- fiftance of the fphintler, and thus difcharge the air, as it is pro- duced from the fermenting or putrefying aliment. For this purpofe, in a difeafe fomewhat fimilar in horfes, a perforation is made into the rectum on one fide of the fphindter ; through which fiftula the air, which is produced in fuch great excels from the quantity of vegetable food which they take, when their digeftions are impaired, is perpetually evacuated. In both cafes alfo, balfams, effential oil, fpice, bandage on the abdomen, and, to prevent the fermentation of the aliment, acid of vitriol, faliva. See Clafs I. 2. 4. 5. 1 o. Hypochondriacs. The hypochondriac difeafe confifts in indigeftion and confequent flatulency, with anxiety or want of pleafurable fenfation. When the adiion of the ftomach and bowels is impaired, much gas becomes generated by the ferment- ing or putrefcent aliment, and to this indigeftion is catenated languor, coldnefs of the (kin, and fear. For when the extremi- ties are cold for too long a time in fome weak conftitutions,indi- geftion is produced by diredt fympathy of the (kin and the ftom- ach, with confequent heartburn, and flatulency. The fame oc- curs, if the (kin be made cold by fear, as in riding over dan- gerous roads in winter, and hence converfely fear is produced by indigeftion or torpor of the ftomach by aflbciation. This difeafe is confounded with the fear of death, which is an infanity, and therefore of a totally different nature. It is al- fo confounded with the hyfteric difeafe, which confifts in the retrograde Class I. 2. 4. 11. OF IRRITATION. 113 retrograde motions of the alimentary canal, and of fome parts of the abforbent fyftem. The hypochondriafis, like chlorofis, is fometimes attended with very quick pulfe; which the patient feems to bear fo eafily in thefe two maladies, that if any accidental cough attends them, they may be miftaken for pulmonary confumption ; which is not owing primarily to the debility of the heart, but to its direft fympathy with the aftions of the ftomach. M. M. Blitter. A plafter of Burgundy pitch on the abdo- men. Opium a grain twice a day. Rhubarb fix grains every night. Bark. Steel. Spice. Bath-water. Siefta, or Heep after dinner. Uniform hours of meals. No liquor ftronger than fmall beer, or wine and water. Gentle exercife on horfe- back in the open air uniformly perfifted in. See Cardialgia, I. 2. 4- 5- n. Cepbalaa idiopathica. Head-achs which are attended with inflammation, are termed phrenitis, defcribed in Clafs II. I. 2. 3. Thofe, which are not attended with inflammation, may be divided into fuch as affeft the whole head, to which the word cephalaea is applied, and into fuch as affetl one fide of the head only at a time, which is termed hemicrania. The former of thefe may be divided into cephalsea idiopathica, and cephalaea fympathetica; and the latter into hemicrania idiopathica, and hemicrania fympathetica. Befides thefe there exifts a cephalaea fomniofa, a cephalsea fyphilitica, and a cephalse hydropica. The idiopathic head-ach frequently attends the cold paroxyfni of intermittents; afflifts inebriates the day after intoxication ; and many people who remain too long in the cold bath. In all which cafes there is a general inaction of the whole fyftem, and as thefe membranes about the head have been more expofed to the variations of heat and cold of the atmofphere, they are more liable to become affefled fo far as to produce fenfation, than oth- er membranes; which are ufually covered either with clothes, ©rwith mufcles, as mentioned in Seii. XXXIII. 2. 10. The promptitude of the membranes about the fcalp to fym- pathize with thofe of other parts of the fyftem is fo great, that this cephalaea without fever, or quicknefs of pulfe, is more fre- quently a fecondary than a primary difeafe, and then belongs to Clafs IV. 2.27. The hemicrania, or partial head-ach, I be- lieve to be almoft always a dileafe from aflbciation ; though it is not impoflible, but a perfon may take cold on one fide of the head only. As fome people by fitting always on the fame fide of the fire in winter are liable to render one fide more tender than the other, and in confequence more fubjeit to pains, which have been erroneouflv termed rheumatic. Vol. IL Q M. M. / ' DISEASES Class I. 2. 4. 11. 114 M. M. The method of cure confifts in rendering the habit more robuft, by gentle conftant exercife in the open air, flefh diet, fmall beer at meals with one glafs of wine, regular hours of reft and riling, and of meals. The clothing about the head fhould be warmer during fleep than in the day •, becaufe at that time people are more liable to take cold ; that is the membra- nous parts of it are more liable to become torpid ; as explained in Sett. XVIII. 15. In refpedt to medicine, two drams of va- lerian root in powder three or four times a day are recommend- ed by Fordyce. The bark. Steel in moderate quantities. An emetic- A blifter. Opium, half a grain twice a day. Decay- ed teeth Ihould be extracted, particularly fuch as either ache or are ufelefs. Cold bath between 60 and 70 degrees of heat. Warm bath of 94 or 98 degrees every day for half an hour dur- ing a month. See Clafs IV. 2. 2. 7. and 8. and IV. 2. 4. 3. A folution of arfenic, about the fixteenth part of a grain, is re- ported to have great effect in this difeafe. It Ihould be taken thrice a day, if it produces -no griping or.ficknefs, for two or three weeks. A medicine of this kind is fold under the name of taftelefs ague-drops ; but a more certain method of afcer- taining the quantity is delivered in the preceding Materia Med- ica, Art. IV. 2. 6. 8. Five grains of the powdered leaves of Atropa Belladonna are recommended in fome foreign publica- tion to be repeated once in two days, and are faid to be fuccefs- ful in the dolor faciei, or hemicrania idiopathica. Cephalaa fomniofa. Head-achfrom fleep. This difeafe has not been defcribed, I believe, by any writer, though it affedls fome invalids for years. After fome hours of fleep the patients are afflicted with diftrefling dreams, and awake with pain of the head, which continues for fome time after they awake ; and fo circumftanced furnilhes the diagnoftic fymptom of this fpecies of cephalaea. The paroxyfms or repetitions of many difeafes are liable to commence in fleep, fome from the increafe of fenfibility during fleep, as explained in Seft. XVIII 5. and 15. of the firft part of this work, as thofe of fome epilepfies, of fome afthmas, and of the gout. Other difeafes are liable to return during fleep from the debility of the pulmonary circulation, or of pulmonary ab- forption, as in fomnus interruptus, Clafs I. 2. 1. 3. and in in- cubus, or night-mare, Clafs III. 2. 1. 13. and in hsemoptoe venofa, Clafs I. 2. 1.9. and probably in the humoral afthma, Clafs II. 1..1. 8. The cephalsea fomniofa I fufpeft to bear the fame analogy to the hydrocephalus internus, as I believe the afthma humorale to bear to the anafarca pulmonum ; and to confift in this circum- ftance, Class I. 2. 4. 12. OF IRRITATION. 115 fiance, that during fleep in the cephalaea fomniofa a temporary congeftion of fluid may occur in feme part of the brain, as a permanent one occurs in the hydrocephalus internus; in the fame manner as I believe in the afthma humorale, a temporary congeftion of fluid occurs in fome part within the cheft, and a permanent one in the anafarca of the lungs. M. M. The patient fhould fleep with his head raifed high on many pillows, and wear drawers to prevent his flipping down in the bed. 2. He fhould fleep on a hardifh bed, or mattrefs, to prevent his fleeping too profoundly, or too long together. 3. Or he may be wakened, after having flept a certain number of hours by an alarum clock. 4. Any carious teeth fhould be ex- trafied, as the matter from putrid bones, fwallowed with- the faliva, weakens the fyftem by its effect on the ftomach. 5. Twenty drops of faturated tincture of digitalis may be taken twice or thrice a day for three or four weeks. 6. Half a grain of opium and fix grains of rhubarb fhould be taken every night for many weeks or months. 7. Oxygen gas may be refpired daily for a time, till its effeil can be known. 12. Hetnicrania idiopathica. This difeafe is defcribed by Sau- vage, under the name of trifmus dolorificus, or tic douloureux, in Clafs IV. ord. 1. gen. 2. fpec. 14. of his elaborate work. But the word trifmus is an improper name, as no fixed fpafm like the locked jaw exifts in this malady, nor any ftridor dentium, or con- vulfion of the mufcles of the face, or trick, attends thefe patients in the few cafes which I have witnefled, though this may pofll- bly occur occafionally as the confequence of difagreeablc fenfa- tion, or to relieve it. I fuppofe the word tic douloureux is a vulgar French expreflion, like megrim in Englifh. The caufe of this affli&ing difeafe is yet unknown. As it does not appear to fympathize with a difeafed tooth, like the he- micrania fympathetica, defcribed in Clafs IV. 2. 2. 8. I fuf- pe6l the caufe to confift in a difeafed (late of the nerve itfelf, or of its covering or theca, and to refemble the fciata frigida, mentioned below ; or to refemble fome of thofe pains, which are fucceeded or relieved by epileptic convulfions, defcribed in Clafs III. 1. 1. 8. and that it thus differs from the hemicrania fym- pathetica ; as in this the caufe of the difeafe, and the feat of the pain, exift in the fame place. One cafe, which occurred to me loi^g ago, of this difeafe, was of an elderly gentleman, Mr. W. of Litchfield, who had long loft all his teeth ; the pain began chiefly about the cheek-bone, and extended fometimes to the ala of the nofe, and to other parts of the face on the fame fide; on examining the gums of the up- per jaw, there was no fufpicion of any flump of a decayed tooth remaining 116 DISEASES Class I. 2. 4.12. remaining in the alveolar precedes ; nor was there any reafon to fufpeCl any difeafe of the maxillary finus. Whence this did not appear to be any kind of fympathetic hemicrania. He was af- flicted with it for many years till his death. The cafe of Mr. B a gentleman between 20 and 30 years of age, whom I was lately concerned for, in this difeafe, is well worthy a minute defcription; I (hall therefore copy a letter, which I wrote on his cafe to Mr. Cruikfhank, and an antwer I receiv- ed fome time after from his partner, Mr Leigh Thomas, who I hope will publilh the fuccefsful method of cure, with adapted prints. To Mr. Cruibjbank. Sir, Derby> Dec. 1798. Mr. Bofworth, whofe cafe I wilh to remind you of, confulted you fome time ago in London, and I believe that you then told him, that his head-ach was owing to a difeafe of the third branch of the fifth pair of nerves. He came under my care at Derby a few weeks ago, and complained of much pain about the left cheek-bone; I fufpeded the antrum maxillare might be difeafed, and as the fecond of the dentes molares had then been lately ex- tracted, 1 defired a perforation might be made into the antrum, which was done by Mr. Hadley, of this town, and kept open for two three days without advantage. Afterwards, by fric- tion about the head and neck with mercurial unguent, he was copioufly falivated for a few days, and had another tooth extract- ed by his own defire, and had laftly an incifion made by Mr. Hadley, fo as to divide the artery near the centre of the ear next the cheek, hoping to divide a branch of the affeCted nerve, but without fuccefs ; and internally, opiates in a large quantity were given, when the pain was exceedingly violent, the bark alfo was uied for a time in large quantity without effeCt. On attending, as much as I could, to his fenfations when in pain, he feems to exprefs the commencement of the periods of pain to exilt about the part of the left cheek before the middle of the ear ; and then draws his finger from thence to the fore part of the lower jaw fometimes, and to the ala of the nofe on that fide ; and at other times he draws his finger from the fame part of the cheek before the ear upwards to the orbit of the eye, and from thence downwards, a little way on the nofe ; and alfo he complains of pain under his tongue on the fame fide. The pain returns many times in an hour on fome days, and continues many minutes, during which he feems to ftretch and exert his arms, and appears to have a tendency to epileptic aCtions j and his Class I. 2. 4. 12. OF IRRITATION. 117 his life is thus miferable to himfelf, and uncomfortable for his friends to witnefs. I write this to yop to beg that you will acquaint Mr. Bof- worth, whether you think you could divide by incifion the dif- eafed nerve ; as he is willing to undergo fuch an operation, if you think it practicable, as 1 believe it to be the only means, which promifes to cure him ; and have therefore advifed him again to apply to you ; and if you think this can b.e done with effeCt, he defigns to wait on you in London. I am, fir, &c. E. Darwin. The following anfwer of Mr. Leigh Thomas {hews the difeafe to have exifted in every branch of the affeCted nerve. Sir, Leicejler-fquarey May\ l "J 99. About the middle of December laft, you did Mr. Cruikfhank the favour to write him an account of Mr. Bofworth, a young gentleman, fome time under your care at Derby, with a painful affeCtion of the nerves of his face. The patient foon after came to town in a much worfe ftate, than you defcribed him to be at that time ; as the pain was extremely acute and almoft unremit- ting, opiates, which he had been in the habit of taking occafion- ally, afforded him now little or no relief, though taken to the quantity of fix tea-fpoonfuls of laudanum at a time. After pay- ing every attention to the cafe, your fuggeftion of the neceflity of dividing the difeafed nerve appeared obvious. As the pain felt was more acute in the left ala of the nofe, and the upper lip of the fame fide, we were induced to divide the fecond branch of the fifth pair of nerves, as it pafles out at the in- fraorbital foramen. He was inftantly relieved in the nofe and lip; but towards night the pain from the eye to the crown of the head became more acute than ever. Two days after, we were obliged to cut through the firft branch paffing out at the fupra-orbital foramen ; this afforded him the like relief with the firft. On the fame day the pain attacked, with great violence, the lower lip on the left fide, and the chin; this circumftance induced the neceflity of dividing the third branch paffing out at the foramen mentale. During the whole period, from the firft divifion of the nerves, he had frequent attacks of pain on the fide of the tongue ; thefe however difappeared on divifion of the laft nerve. Mr. Cruikfhank performed the above operations, but being particularly engaged at this time with leftures and other bufi- nefs, he now gave up the cafe to my management. The patient was evidently bettered by each operation ; (till the pain was very fevere, 118 DISEASES ClassI. 2.4. 12. fevere, paffmg from the ear under the zygoma toward the nofe and mouth, and upwards round the orbit. This route proved pretty clearly, that the portio dura of the auditory nerve was al- fo affected ; at leall the uppermoft branch of the pes anferinus. Before I proceded to divide this, I was willing to try the effect of arfenic internally, and he took it in fufficient quantity to excite naufea and vertigo, but without perceiving any good effect. I could now trull only to the knife to alleviate his mifery, as the pain round the orbit was become moft violent; and therefore intercepted the nerve by an incifion acrofs the fide of the nofe, and alfo made fome fmaller incifions about the ala nafi. To di- vide the great branch lying below the zygomatic procefs, I found it neceffary to pafs the fcalpel through the maffeter mufcle, till it came in contad with the jaw-bone, and then to cut upwards ; this relieved him as ufual. Then the lower branch was affect- ed, and alfo divided : then the middle branch running under the parotid gland. In cutting this, the gland was confequently di- vided into two equal parts, and healed tolerably well after a co- pious difcharge of faliva for feveral days. I hoped and expected, that this laft operation would have ter- minated his fufferings and my difficulties ; but the pain (till af- fected the lower lip and fide of the nofe, and upon coughing, or fwallowing, his mifery was dreadful. This pain could only arife from branches from the fecond of the fifth pair paffing into the check, and lying between the pterygoideus internus mufcle, and the upper part of the lower jaw. The fituation of this nerve rendered the operation hazardous, but after fome attempts it was accomplished, and this day he fet out for Leicefterfhire per- fedly reftored. I am, fir, &c. Leigh Thomas. Since I wrote the above, I have feen an equally deplorable and jnftruClwe cafe, of hemicrania idiopathica, of an elderly perfon, defcribed by Dr. Haighton, under the name of tic douloureux, with an equally fuccefsful cure, by dividing the difeafed nerves. Medical Records and Refearches. Cox, London. Two cafes of tic douloureux are related by a Dr. Watfon, in the Recueil periodique de Medicine, Paris, 1798, tom. IV. which are faid to have fiibmitted to mercurial fri&ions and warm bathing Thefe pains were probably venereal fymptoms, as the author fufpe&s ; but would perfuade us again to try the ufe of mercury, though it failed in the cafe above related, and efpecially as it fometimes fucceeds in the hemicrania fympathetica, as men- tioned in Clafs IV. 2. 2. 8. Five grains of the powdered leaf of .belladonna Class 1.2. 4. 13. OF IRRITATION. 119 belladonna are faid to have been fuccefsful. See Cephalsea idio- pathica. 13. Odontalgia. Tooth-ach. The pain has been erroneoufiy fuppofed, where there is no inflammation, to be owing to fome acrid matter from a carious tooth Simulating the membrane of the alveolar procefs into violent aflion and confequent pain ; but the effect feems to have been miftaken for the caufe, and the decay of the tooth to have been occafioned by the torpor and confequent pain of the difeafed membrane. Firft, becaufe the pain precedes the decay of the tooth in re- gard to time, and is liable to recur, frequently for years, without certainly being fucceeded at laft by a carious tooth, as I have repeatedly obferved. Secondly, becaufe any ftimulant drug, as pyrethrum, or oil of cloves, applied to the tooth, or ether applied, externally to the cheek, is lb far from increafing the pain, as it would do if the pained membrane already afted too ftrongly, that it frequently gives immediate relief like a charm. And thirdly, becaufe the torpor, or deficient a&ion of the membrane, which includes the difeafed tooth, occafions the mo- tions of the membranes moft connefted with it, as thofe of the cheek and temples, to act with lefs than their natural energy ; and hence a coldnefs of the cheek is perceived eafilyby the hand of the patient, comparing it with the other cheek ; and the pain of hemicrania is often produced in the temple of the affefted fide. This coldnefs of the cheek in common tooth-ach evinces, that the pain is not then caufed by inflammation ; becaufe in all in- flammations fo much heat is produced in the fecretions of new veflels and fluids, as to give heat to the parts in the vicinity,. And hence, as foon as the gum fwells and inflames along with the cheek, heat is produced, and the pain ceafes, owing to the increafed exertions of the torpid membrane, excited by the ac- tivity of the fenforial power of fenfation ; which previoufly ex- ifted in its paflive Liate in the painful torpid membrane. See Odontitis, Clafs II. 1. 4. 7. and IV. 2. 2. 8. M. M. If the painful tooth be found, venefeGion. 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 paiuful tooth. Ether. If the tooth has a fmall hole in it, this ihould be widened within by an inftru- ment, and then flopped with leaf-gold, or leaf-lead ; but the tooth Ihould be extracted, if much decayed. It is probable that half a fmall drop of a flrong folution of arfenic, put carefully into the hollow of a decayed acting tooth, would deftroy the nerve with- out giving any additional pain ; but this experiment requires , great 120 DISEASES ClassI. 2.4. 13. great caution left any of the folution fliould touch the tongue or gums. Much cold and much heat are equally injurious to the teeth, which are endued with a fine fenfation of this univerfal fluid. The beft method of preferving them is by the daily ufe of a brufli, which is not very hard, with warm water and fine charcoal dull. A lump of charcoal fliould be put a fecond time into the fire till it is red hot, as foon as it becomes cool the external afhes fliould be blown off, and it fliould be immediately reduced to fine pow- der in a mortar, and kept clofe ftopped in a phial. It takes away the bad fmell from decayed teeth, by wafliing the mouth with this powder diffufed in water, immediately. The putrid fmell of decaying ftumps of teeth may be deftroyed for a time by wafli- ing the mouth with a weak folution of alum in water. If the calcareous cruft upon the teeth adheres very firmly, a fine pow- der of pumice-ftone may be ufed occafionally, or a tooth-inftru* ment. Acid of fea-falt, much diluted, may be ufed; but this very rarely, and with the greateft caution, as in cleanfing fea-fhells. When the gums are fpongy, they fliould be frequently pricked with a lancet. Should black fpots in teeth be cut out ? Does the enamel grow again when it has been perforated or abraded ? Otalgia. Ear-ach fometimes continues many days without ap- parent inflammation, and is then frequently removed by filling the ear with laudanum, or with ether ; or even with warm oil, or warm water. See Clafs II. i. 4. 8. This pain of the ear, like hemicrania, is frequently the confequence of aflbeiation with a difeafed tooth ; in that cafe the ether fliould be applied to the cheek over the fufpe&ed tooth ; or a grain of opium and as much camphor mixed together, and applied to the fufpecled tooth. In this cafe the otalgia belongs to the fourth clafs of difeafes. 14. Pleurodyne chronica. Chronical pain of the fide. Pains of the membranous parts, which are not attended with fever, have acquired the general name of rheumatic ; which fliould, neverthelefs, be reftricted to thofe pains which exift only when the parts are in motion, and which have been left after inflam- mation of them; as defcribed in Clafs I. 1. 3. 12. The pain of the fide here mentioned affects many ladies, and may poflibly have been owing to the preflure of tight ftays, which has weak- ened the a&ion of the veflels compofing fome membranous part, as, like the cold head-ach, it is attended with prefent debility ; in one patient, a boy about ten years old, it was attended with daily convulfions, and was fuppofed to have originated from worms. The difeafe is very frequent, and generally withftands the ufe of blifters on the part; but in fome cafes I have known it Class I. 2. 4. 14. OF IRRITATION. 121 it removed by eleCtric (hocks repeated every day for a fortnight through the affeCted fide. Pains of the fide may be fometimes occafioned by the adhe- fion of the lungs to the pleura, after an inflammation of them ; or to the adhefion of fome abdominal vifcera to their cavity, or to each other ; which alfo are more liable to affeCt ladies from the unnatural and ungraceful preflure of tight (lays, or by fitting or Iving too long in one pofture. But in thefe cafes the pain ihould be more of the fmarting, than of the dull kind. M. M. Ether. A blifter. A plafter of Burgundy pitch An iflue or feton on the part. EleCtric (hocks- Friction on the part with oil and camphor. Loofedrefs. Frequent change of pollute both in the day and night. Internally, opium, vale- rian, bark. 15. Sciatica frigida. Cold fciatica. The pain along the courfe of the fciatic nerve, from the hip quite down to the top of the foot, when it is not attended with fever, is improperly termed either rheumatifm or gout; as it occurs without inflam- mation, is attended with pain when the limb is at reft ; and as the pain attends the courfe of the nerve, and not the courfe of the mufcles, or of the fafcia which contains them. The theory of Cotunnius, who believed it to be a dropfy of the (heath of the nerve, which was comprefled by the accumulated fluid, has not been confirmed by difleCtion. The difeafe feems to confift of a torpor of this (heath of the nerve, and the pain feems to be in confequence of this torpor. See Clafs II. 1.2. 17. M. M. VenefeCtion. A cathartic. And then one graiii of calomel and one of opium every night for ten fucceffive nights. And a blifter, at the fame time, a little above the knee-joint ou the outfide of the thigh, where the fciatic nerve is not fo deep feated. Warm bath. Cold bath. Cover the limb with oilgd (ilk, or with a plafter-bandage of emplaftrum de minio. 16. Lumbago frigida. Cold lumbago. When no fever of inflammation attends this pain of the loins, and the pain exifts without motion, it belongs to this genus of difeafes, and refem- bles the pain of the loins in the cold fit of ague. As thefe mem- branes are exten'five, and more eafily fall into quiefcence, either by fympathy, or when they are primarily affedted, this difeafe becomes very afflicting, and of great pertinacity. See Clafs II. 1. 2. 17. M. M. Venefedion. A cathartic. Iflues on the loins. Adhefive plafter on the loins. Blifter on the osfacrum. Warm bath. Cold bath. Remove to a warmer climate in the winter. Loofe drefs about the waift. Friction daily with oil and cam- phor. Vol. II. R 17* Hvferalgia 122 DISEASES Class I. 2. 4. 17. 17. Hyfteralgtafrigida. Cold pain rtf the uterus preceding or accompanying menftruation. It is attended with cold extremi- ties, want of appetite, and other marks of general debility. M M. A clyfter of half a pint of gruel, and 30 drops of laudanum ; or a grain of opium and fix grains of rhubarb every night. To fit over warm water, or go into a warm bath. 18. Proflalgia frigida. Cold pain at the bottom of the rec- tum previous to the tumor of the piles, which fometimes extends by fympathy to the loins ; it feems to be fimilar to the pain at the beginning of menftruation, and is owing to the torpor or inirritability of the extremity of the alimentary canal, or to the obftruCtion of the blood in its paflage through the liver, when that vifcus is affeCted, and its confequent delay in the veins of the reftum, occafioning tumours of them, and dull fenfations of pain. M. M. Calomel. A cathartic. Spice. Clyfter, with 30 drops of laudanum. Sitting over warm water. If chalybeates after evacuation ? See Clafs I. 2. 3. 23. and I. 2. 1. 6. 19. Vifica fellex inirritabilitas. The inirritability of the gall- bladder probably occafions one kind of icterus y or jaundice ; which is owing to whatever obftruCts the paflage of bile into the duodenum. The jaundice of aged people, and which attends fome fevers, is believed to be moft frequently caufed by an irri- tative palfy of the gall-bladder ; on which accout the bile is not prefled from the cyftby its contraction, as in a paralyfis of the urinary bladder. A thickening of the coats of the common bile-duCt by inflam- mation or increafed aClion of their veflels fo as- to prevent the paflage of the bile into the inteftine, in the fame manner as the membrane, which lines the noftrils, becomes thickened in ca- tarrh fo as to prevent the paflage of air through them, is proba- bly another frequent caufe of jaundice, efpecially of children ; and generally ceafes in about a fortnight, like a common catarrh, without the aid of medicine ; which has given rife to the char- acter, which charms have obtained in fome countries for curing the jaundice of young people. The fpiflitude of the bile is another caufe of jaundice, as men- tioned in Clafs I. 1.3. 8 This alfo in children is a difeafe of little danger, as the gall-duds are diftenfible, and will the eafier admit of the exclufion of gall-ftones ; but becomes a more feri- ous difeafe in proportion to the age of the patient, and his hab- its of life in refpetf to fpirituous potation. A fourth caufe of jaundice is the compreflionof the bile-duCI by the enlargement of an inflamed or fcirrhous liver; this attends thofe Class. I. 2. 4. 20. OF IRRITATION. 123 thofe who have drunk much fpirituous liquor, and is generally fucceeded by dropfy and death. M M. Repeated emetics. Mild cathartics. Warm bath. Eledhricity Bitters. Then Reel, which, when the pain and inflammation are removed by evacuations, afts like a charm in removing the remainder of the inflammation, and by promoting the abforption of the new veflels or fluids ; like the application of any acrid eye-wrater at the end of ophthalmia ; and thus the thickened coats of the bile-du€l become reduced, or the enlarge- ment of the liver leflened, and a free paflage is again opened for the bile into the intefline. Ether with yolk of egg is recom- mended, as having a tendency to diflblve infpiflated bile. And a decoction of madder is recommended for the famepurpofe ; becaufe the bile of animals, whole food was mixed with madder was found always in a dilute ftate. Aerated alkaline w-ater, or Seltzer water. Raw cabbage, and other acrid vegetables, as water-crefles, muftard. Horfes are faid to be fubjeft to infpif- fated bile, with yellow eyes, in the winter feafon, and to get well as foon as they feed on the fpring grafs. The largeft bile-ftone I have feen was from a lady, who had parted with it fome years before, and who had abftained above ten years from all kinds of vegetable diet to prevent, as (he fuppofed, a colic of her ftomach, which was probably a pain of the biliary duft; on refuming the ufe of fome vegetable diet, (he recovered a better ftate of health, and formed no new bilious concretions. A ftrong aerated alkaline water is'fold by J. Schweppe, No. 8, King-ftreet, Holbnrn. See Clafs I. 1.3. 10. 20. Pelws renalis inirritabilitas. Inirritability of the pelvis of the kidney. When the nucleus of a ftone, whether it be in- fpiflated 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 rhe kidney, it is liable to lodge there from the want of due irritability of the membrane ; and in that fituation, increafes by new appofitions of indurated animal matter, in the fame manner as the Hone of the bladder. This is the genend caufe of haemorrhage from the kidney ; and of obtufe pain in it on exercife ; or of acute pain, when the ftone advances into the ureter. See Clafs I. 1. 3. 9. QRDf> ' DISEASES Class I. 2; 5.1 124 ORDO II. Decreafed Irritation. GENUS V. Decreafed Action of the Organs of Senfe. SPECIES. 1. Ztidtitiainirritabilitas. Folly from inirritability. Dulnefs of perception. When the motions of the fibrous extremities of the nerves of fenfe are too weak, to excite fenfation with fuf- ficient quicknefs and vigour. The irritative ideas are neverthe- lefs performed, though perhaps in a feeble manner, as fuch peo- ple no not run againft a poft, or walk into a well. There are three other kinds of folly ; that from deficient fenfation, from deficient volition, and from deficient aflbciation, as will be men- tioned in their places. In delirium, reverie, and fleep, the pow- er of perception is abolifhed from other caufes. 2. Vifcus imminutus. Diminifhed vifion. In our approach to old age our vifion becomes imperfect, not only from the form of the cornea, which becomes lefs convex, and from its decreafed tranfparency mentioned in Clafs I. 1.3. 14 ; but alfo from the decreafed irritability of the optic nerve. Thus, in the inirritative or nervous fever, the pupil of the eye becomes dilated ; which in this, as well as in the dropfy of the brain, is generally a fatal fymptom. A part of the cornea as well as a part of the albugi- nea in thefe feversis frequently feen during fleep ; which isow- ing to the inirritability of the retina to light, or to the general parefis of mufcular action, and in confequence to the lefs con- traction of . the fphinder of the eye, if it may be fo called, at that time. In fome eyes .there is an inaptitude to adapt themfelves to xthe perception of objefts at different diftances, which I fuppofe may be owing to the inirritability of thofe mufcular fibres, which conftitute the ciliary procefs, fo well defcribed and explained by Dr. Porterfield, and in the Scots Medical Eflays, and fo elegant- ly feen in a differed eye. It was formerly believed, and has in- deed lately been again pretended, that the focus of the cryftal- line humour was adapted to objefls at different diftances by a change of the fhape of the whole eye by the aft ion of the exter- nal mufcles, which are inferted into the tunica albuginea, and give motion to it in every direction-, but in anfwer to this may be obferved, Class I. 2. 5. 3. OF IRRITATION. 125 obferved, that if the common aClions of the mufcles affected the focus of the eye, every motion of the eye-bail, when we attend to objects at any diftance, muft difturb our vifion. At the fame time though it is poflible, that a violent aClion of all the mufcles together, fo as to counter-balance each other, and keep the eye motionlefs as when we look painfully at a very diftant objedf, may in fome degree affeCt the form of it ; yet that the contrac- tion of the ciliary procefs perpetually adapts the focus of the cryf- talline lens to the diftance of the retina is not to be difputed. There have been inftances of fome, who could not diftinguifn certain colours ; and yet whofe eyes, in other refpeCts, were not imperfect. Philof. TranfaCi. Which feems to have been owing to the want of irritability, or the inaptitude to action, of fome claffes of fibres which compofe the retina. Other perma- nent defeats depend on the difeafed ftate of the external organ. Clafs I. i. 3. 14.1. 2. 2. 13-IV. 2. 1. 11. 3. Mufcavolitantes. Dark fpots appearing before the eyes, and changing their apparent place with the motions of the eyes, are owing to a temporary defeat of irritability of thofe parts of the retina, which have been lately expofed to more luminous ob- jeCls than the other parts of it, as explained in Se<T. XL. 2. Hence dark fpots are feen on the bed-clothes by patients, when the optic nerve is become lefs irritable, as in fevers with great debility ; and the patients are perpetually trying to pick them off with their fingers to difeover what they are ; for thefe parts of the retina of weak people are fooner exhaufted by the ftimulus of bright colours, and are longer in regaining their irritability. Other kinds of ocular fpeCira, as the coloured ones, are alfo more liable to remain in the eyes of people debilitated by fevers, and to produce various hallucination of fight. For after the contraction of a mufcle, the fibres of it continue in the laft fitu- ation, till fome antagonift mufcles are exerted to retrad them ; whence, when any one is much exhaufted by exercife, or by want of fleep, or in fevers, it is eafier to let the fibres of the retina re- main in their laft fituation, after having been ftimulated into contraction, than to exert any antagonift 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 fenforial power is expended during the day in the perpetual ac- tivity of our fenfe of vifion, befides that ufed in the motions of the eye-balls and eye-lids ; as much I fuppofe as is expended in the motions of our arms, which are fupplied with nerves of about the fame diameters. From hence we may conclude, that the light fhould be kept from, patients in fevers with debility, to prevent the unneceffary exhauftion of the fenforial power. And 126 DISEASES Class I. 2. 5. 4. And that on the fame account their rooms fhould be kept filent as well as dark ; that they fhould be at reft in a horizontal pof- ture ; and be cooled by a blait of cool air, or by wafhing them with cold water, whenever their fkins are warmer than natural. 4. Strabifmus. Squinting is generally owing to one eye be- ing lefs perfect than the other ; on which account the patient endeavours to hide the word eye in the fhadow of the nofe, that his vifion by the other may not be confuted. Calves which have an hydatide with infeCts inclofed in it in the frontal finus on one fide, turn towards the affected fide ; becaufe the vifion on that fide, by the preflure of the hydatide, becomes lefs per- fect ; and the difeafe being recent, the animal turns round, ex- pecting to get a more diftinCt view of objects. In the hydrocephalus internus, where both eyes are not be- come infenfible, the patient fquints with only one eye, and views objeCts with the other, as in common flrabifmus. In this cafe it may be known on which fide the difeafe exifts, and that it does not exift on both fides of the brain ; in fuch circumftances, as the patients I believe never recover as they are now treated, might it not be advifeable to perforate the cranium over the ven- tricule of the affeCled fide ? which might at leaft give room and ftimulus to the affeCled part of the brain ? M. M. If the fquinting has not been confirmed by long habit, and one eye be not much worfe than the other, a piece of gauze ftretched on a circle of whale-bone, to cover the beft eye in fuch a-manner as to reduce the diftinCtnefs of vifion of this eye to a fimilar degree of imperfection with the other, fhould be worn fome hours every day. Or the better eye fhould be total- ly darkened by a tin cup covered with black filkfor fome hours daily, by which means the better eye will be gradually weak- ened by the want of ufe, and the worfe eye will be gradually ftrengthened by ufing it. Covering an inflamed eye in chil- dren for weeks together, is very liable to produce fquinting, for the fame reafon. Amaurys. Gutta ferena. Is a blindnefs from the inirritabil- ity of theopticnerve. It is generally efteemed apalfy of the nerve, but fhould rather be deemed the death of it,as paralyfis hasgener- ally been applied to a depiivation only of voluntary power. This is a difeafe of dark eyes only, as the cataraCt is a dileafe of light eyes only. At the commencement of this difeafe, very minute eleCtric fhocks fhould berepeatedly paffed through the eyes; fuch as may be produced by putting one edge of a piece of filver the fize of a half crown piece beneath the tongue, and one edge of a piece of zinc of a fimilar fize between the upper bp and the gum* and ClassI. 2. 5. 6. OF IRRITATION. 127 and then repeatedly bringing their exterior edges into contact, by which means very fmall ele&ric fparks become vifible in the eyes. Mrs. T had for fome weeks complained of imperfeft fight. For the laft fortnight fhe could not in lefs than a minute fpell out a Angle word in a large print. Her eyes black, and the pupils large. Very flight eleCtric (hocks, not fparks, were patted through the forepart of her forehead twice a day, and the zinc and filver pencils as mentioned below were ufed many times a day. She took valerian and columbo internally, and regained her fight very perfectly in about three weeks. I ufed in the above cafe a more convenient and efficacious method of galvanifm by employing two rods, one of them of zinc about the fize of a writing pencil, and the other a filver pencil- cafe about the fame fize ; and by putting the end of the zinc rod in contact with the external corner of one eye, and the end of the filver pencil-cafe in contaft with the external corner of the other eye, and then repeatedly making the other ends touch each other ; fparks will be vifible in the eyes both at the time of contact and at the time of feparation of the two rods. This ex- periment was published by Volta fince the former one by Gal- vani. See Sed. XIV. 5. of Vol. I. A foreign phyfician, profeffior Arneman, has lately recom- mended the production of vertigo in gutta ferena, as he fays, to accumulate more blood in the head. If this fhould be really found of advantage the patient might lie on a large mill-ftone, which might be fullered to turn ilowly, but a very great velocity of the whirling ftone might occafion fleep, apoplexy, and death. See Supl. I. 15. 7. M. M. Minute eleftric Ihocks. A grain of opium, and a quarter of a grain of corrofive fublimate of mercury, twice a dav for four or fix weeks. Blitter on the crown of the head. Er- rhines, fo as to induce violent fneezing twice a day for a week. 6. Auditus imminutus. Diminiflied hearing. Deafnefs is a frequent fymptom in thofe inflammatory or fenfitive fevers with debility, which are generally called putrid ; it attends the general ftupor in thofe fevers, and is rather etteemed a falutary fign, as during this ftupor there is lefs expenditure of fenfonal power. In fevers of debility without inflammation, called nervous fe- vers, I fufpeCt deafnefs to be a bad fymptom, arifing, like the di- lated pupil, from a partial paralyfis of the nerve of fenfe. See Clafs IV. 2. 1. 15. Nervous fevers are fuppofed by Dr.Gilchrift to originate from a congeflion of feruin or water in fome part of the brain, as many of the fymptom? are fo fimilar to thofe of hydrocephalus inter-. nus3 128 DISEASES Class I. 2. 5. 6. nus, in which a fluid is accumulated in the ventricles of the brain ; on this idea the inactivity of the optic or auditory nerves in thefe fevers may arife from the compreflion of the efFufed fluid, while the torpor attending putrid fever may depend on the me- ninges of the brain being thickened by inflammation, and thus comprefling it ; now the new veflcls, or the blood, which thick- ens inflamed parts, is more frequently re-abforbed, than the ef- fufed fluid from a cavity ; and hence the Itupor in one cafe is Jefs dangerous than in the other. In inflammatory or fenfitive fevers with debility, deafnefs may fometimes arife from a greater fecretion and abforption of the ear-wax, which is very fimilar to the bile, and is liable to fill the meatus auditorius, when it is too vifcid, as bile obftruds the gall-du <5ls. M. M. In deafnefs without fever, Dr. Darwin applied a cup- ping-glafs on the ear with good efFeCt, as defcribed in Phil. Cranf. Vol. LXIV. p. 348. Oil, ether, laudanum, dropped into the ears. Errhines. EleClricity. If ether when dropped into the ears be not very pure, it is lia- ble to give pain ; it has otherwife the property both of diflblving the ear-wax, and of (Emulating torpid parts into their accuftom- ed activity, as is known from its relieving pains from inactivity of the pained part, as tooth-ach and head-ach- If unreCtified ether be diftilled from the oxyde of manganefe, the oxygen dif- engaged from the manganefe is aflerted to convert the fulphurous into fulphuric acid, which is then not difpofed to rife in diftilla- tion. Journal de Phyfique, April, 1798. And that this is the great fecret of procuring pure ether, and it will then give no pain on being dropped into the ear. See Art. II. 2. 3. Deafnefs is believed fometimes to arife from obftrudion of the Euftachian tubes, which communicate from the fauces to the in- .ternal ear behind the tympanum ; if this obftruClion be flight,as by infpiflated mucus, it has been propofed to injeCt the Eufta- chian tubes ; and it is faid, that if the deaf perfon frequently has recourfe to the fimple aCtion of (hutting his mouth and of doling his noftrils by pinching them together with his finger and thumb, and then forcibly endeavours to prefs the breath through his nofe, that air will pafs into the internal ear through the Eu- ftachian tubes, condenfing that air which exifts behind the tym- panum ; which the patient will himfelf be fenfible of, by a fen- fation of found in his ears. And that this has relieved many. Where an eruption occurs in the ear, followed by a dry fcale or fcab at the bottom of the meatus auditorius, a folution of corrofive fublimate of mercury ,;hydrargyrus muriatus, about one grain to an ounce of water, dropped into the ear, frequently has been Class I. 2. 5. 7. OF IRRITATION. 129 been ufed with advantage by Dr. Darwin of Shrewfbury; See Clafs IV 2. i. 15. 7. Ofafius imminutus. Inactivity of the fenfe of fmell. From our habits of trufting to the art of cookery, and not exam- ining our food by the fmell as other animals do, our fenfe of fmell is lefs perfect than theirs, SeeSeCt. XVI. 5. Clafs IV. 2. 1. 16. M. M. Mild errhines. 8. Guflus imminutus. Want of tafte is very common in fevers^ owing frequently to the drynefs or fcurf of the tongue, or exter- nal organ of that fenfe, rather than to any injury of the nerves of tafte. See Clafs I. 1.3.1. IV. 2. 1. 16. M. M. Warm fubacid liquids taken frequently. 9. Taolus imminutus. Numbnefs is frequently complained of in fevers, and in epilepfy, and the touch is fometimes impaired by the drynefs of the cuticle of the fingers. See Clafs IV. 2.1.16. When the fenfe of touch is impaired by the compreflion of the nerve, as in fitting long with one thigh crofled over the other, the limb appears larger, when we touch it with our hands, which is to be afcribed to the indiftinCtnefs of the fenfation of touch, and may be explained in the fame manner as the appar- ent largenefs of objects feen through a mift. In this laft cafe the minute parts of an object, as fuppofe of a diftant boy, are feen lefs diftinctly, and therefore we inftantly conceive them to be further from the eye, and in confequence that the whole fub- tends a larger angle, and thus we believe the boy to be a man. So when any one's fingers are prefled on a benumbed limb, the fenfation produced is lefs than it fhould be, judging from vifible circumftances ; we therefore conceive, that fomething interve- ned between the object and the fenfe, for it is felt as if a blank- et was put between them ; and that not being vifibly the cafe, we judge that the limb is fwelled. The fenfe of touch is alfo liable to be deceived from the ac- quired habits of one part of it aCTng in the vicinity of another part of it. Thus if the middle finger be crofled over either of the fingers next to it, and a nut be felt by the two ends of the fingers fo crofled at the fame time, the nut appears as if it was two nuts. And laftly, the fenfe of touch is liable to be deceived by preconceived ideas ; which we believe to be excited by exter- nal objects, even when we are awake. It has happened to me more than once, and I fuppofe to moft others, to have put my hands into an empty baton, (landing in an obfcure corner of a room, to wafh them, which I believed to contain cold water, and have inftantly perceived a fenfation of warmth, contrary to that which I expelled to have felt. Vol. II. S In 130 DISEASES Class I. 2. 5. 10. In fome paralytic affeClions, and in cold fits of ague, the fen- fation 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 alkali and water. Internally, fpice, fait. In- citantia. Secernentia. io. Stupor. The ftupor, which occurs in fevers with debili- ty, is generally efteemed a favourable fymptom ; which may arife from the lefs expenditure of fenforial power already exifting in the brain and nerves, as mentioned in fpecies 6 of this genus. But if we fuppofe, that there is a continued production of fen- forial power, or an accumulation of it in the torpid parts of the fyftem, which is not improbable, becaufe fuch a production of it continues during fleep, to which ftupor is much allied, there is ftill further reafon for believing it to be a favourable fymptom in irritable fevers; and that much injury is often done by blifters and other powerful ftimuli to remove the ftupor. See $ed. XII. 7. 8. and XXXIII. 1. 4. Dr. Blane, in his Croonian LeCture on mufcular motion, for 1788, among many other ingenious obfervations and deductions, relates a curious experiment on falmon, and other fifti, and which he repeated upon eels with fimilar event. " If a fifti, immediately upon being taken out of the water, is ftunned by a violent blow on the head, or by having the head cruftied, the irritability and fweetnefs of the mufcles will be pre- ferved much longer, than if it had been allowed to die with the organs of fenfe entire. This is fo well known to fifliermen, that they put it in pradice, in order to make them longer fufcep- tible of the operation called crimping. A falmon is one of the fifti leaft tenacious of life, infomuch, that it will lofe all figns of life in lefs than half an hour after it is taken out of the water, if fuffered to die without any farther injury ; but if, immediately after being caught, it receives a violent blow on the head', the mufcles will (hew vifible irritability for more than twelve hours afterwards." Dr. Blane afterwards well remarks, that, " in thofe diforders in which the exercife of the fenfes is in a great meafure deftroy- ed or fufpended, as in the hydrocephalus, and apopledic palfy, it happens, not uncommonly, that the appetite and digeftion are better than in health." ORDO Class I. 3. i» OF IRRITATION. 131 ORDO III. Retrograde Irritative 'Motion; GENUS I. Of the Alimentary Oanal. The retrograde motions of our fyftem originate either from defeat of ftimulus, or from defeft of irritability. Thus ficknefs is often induced by hunger, which is a want of ftimulus ; and from ipecacuanha, in which laft cafe it would feem, that the ficknefs was induced after the violence of the ftimulus was aba- ted, and the confequent torpor had fucceeded. Hence, fpice, opium, or food, relieves ficknefs. The globus hyftericus, falivation, diabetes, and other inver- fions of motion attending hyfteric paroxyfms, feem to depend on the want of irritability of thofe parts of the body, becaufe they are attended with cold extremities, and general debility, and are relieved by wine, opium, fteel, and flefh diet; that is, by any additional ftimulus. When the longitudinal mufcles are fatigued by long a&ion, or are habitually weaker than natural, the antagonift mufcles re- place the limb by ftretching it in a contrary direction ; and as thefe mufcles have had their actions aflbciated in fynchronous tribes, their ailions ceafe together. But as the hollow mufcles propel the fluids, which they contain, by motions aflbciated in trains ; when one ring is fatigued from its too great debility, and brought into retrograde aftion ; the next ring, and the next, from its aflbciation in train falls into retrograde afHon. Which continue lb long as they are excited to a€t, like the tremors of the hands of infirm people, fo long as they endeavour to a<£k. Now as thefe hollow mufcles are perpetually ftimulated, thefe retrograde actions do not ceafe as the tremors of the longitudi- nal mufcles, which are generally excited only by volition. Whence the retrograde motions of hollow mufcles depend on two circumftances, in which they differ from the longitudinal mufcles, namely, their motions being aflbciated in trains, and their being fubjefl to perpetual ftimulus. For further elucida- tion of the caufe of this curious fource of difeafes, fee Seft. XXIX. n. 5. The fluids difgorged by the retrograde motions of the various vafcular mufcles may be diftinguifhed, i. From thofe, which are produced by fecretion, by their not being attended by increafe of 132 DISEASES Class I. 3. 1. 1. of heat, which always accompanies increafed fecretion. 2. They may be diftinguiflied from thofe fluids, which are the confe- quence of deficient abforption, by their not poflefling the faline acrimony, which thofe fluids poflefs ; which inflames the fkin or other membranes on which they fall; and which have a faline tafte to the tongue. 3. They may be diftinguiflied from thofe fluids, which are the confequence both of increafed fecretion and abforption, as thefe are attended with increafe of warmth, and are infpiflated by the abftraftion of their aqueous parts. 4. Where chyle, or milk, is found in the feces or urine, or when other fluids, as matter, are tranflated from one part of the fyftem to another, they have been the product of retrograde action of lymphatic or other canals. As explained in Seft. XXIX. 8. SPECIES. I. Ruminatio. In the rumination of horned cattle the retro- grade motions of the oefophagus are vifible to the eye, as they bring up the foftened grafs from their firft ftomach. The veg- etable aliment in the firft ftomach of cattle, which have filled themfelves too full of young clover, is liable to run into ferment- ation, and diftend the ftomach, fo as to preclude its exit, and frequently to deftroy the animal. To difcharge this air the farmers frequently make an opening into the ftomach of the animal with fuccefs. I was informed, I believe by the late Dr. Whytt of Edinburgh, that of twenty cows in this fituation two had died, and that he directed a pint of gin or whifkey, mixed with an equal quantity of water, to be given to the other eigh- teen ; all of which eru&ed immenfe quantities of air, and recov- ered. There are hiftories of ruminating men, and who have taken pleafure in the aft of chewing their food a fecond time. Phi- lof. Tranfaft. 2. Ruel us. Eruftation. An inverted motion of the ftomach excluding through its upper valve an elaftic vapour, generated by the fermentation of the aliment; which proceeds fo haftily, that the digeftive power does not fubdue it. This is fometimes acquired by habit, fp that fome people can cruft when they pleafe, and as long as they pleafe ; and there is gas enough generated to fupply them for this purpofe ; for by Dr. Hale's experiments, an apple, and many other kinds of aliment, give up above fix hundred times their own bulk of an elaftic gas in fermentation. When people voluntarily ejeft the fixable air from their ftotn- achs, the fermentation of the aliment proceeds the fafter ; for flopping the veflels, which contain new wines, retards their fer- mentation, OF IRRITATION. Class I. 3.1. 3. 133 mentation, and opening them again accelerates it ; hence where the digeftion is impaired, and the ftomach fomewhat diftended with air, it is better to reftrain than'.to encourage eru&ations, except the quantity makes it neceffary. When wine is confined in bottles, the fermentation ftill proceeds flowly even for years, till all the fugar is converted into fpirit ; but in the procefs of digeftion, the faccharine part is abforbed in the form of chyle by the bibulous mouths of the numerous la&eals, before it has time to run into the vinous fermentation. 3. Apepjia. Indigeftion. Water-qualm. A few mouthfuls of the aliment are rejected at a time for fome hours after meals. When the aliment has had time to ferment, and become acid, it produces cardialgia, or heart-burn. This difeafe is perhaps gen- erally left after a flight inflammation of the ftomach, called a fur- feit, occafioned by drinking cold liquors, or eating cold vegeta- bles, when heated with exercife. This inflammation of the ftomach 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 caufe from the gutta rofea of drunkards, as the ficin round the bafe of each eruption is lefs inflamed. See Clafs II. 1. 4. 6. This difeafe differs from Cardialgia, Clafs 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 ftom- ach about the upper orifice of it. In the fame manner as hyfte* ria differs from hypochondriafis ; the one confifting in the weak- nefs and indigeftion of the fame portions of the alimentary canal, and the other in the inverted motions of fome parts of it. This apepfia or water-qualm continues many years, even to old age ; Mr. G of Litchfield fuffered under this difeafe from his in- fancy ; and, as he grew old, found relief only from repeated dofes of opium. M. M. A blifter, rhubarb, a grain of opium twice a day. Soap, iron-powder. Tin-powder. 4. Vonntus. An-inverted order of the motions of the ftom- ach and oefophagus with their abforbent veflels, by which their contents are evacuated. In the a<ft of vomiting lefs fenforial power is employed than in the ufual periftaltic motion of the ftomach, as explained in Seft. XXXV. 1.3. Whence after the operation of an emetic the digeftion becomes ftronger by an accumulation of fenforial power during its decreafed aflion. This decreafed action of the ftomach may be either induced by ■want of ftimulus, as in the ficknefs 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 134 DISEASES ClassI. 3.1. 5, of enfeebled drunkards. Or laftly, by having been previoufly too violently ftimulated by an emetic drug, as by ipecacuanha. M. M. A Blifter. An emetic. Opium. Warmth of a bed, Covering the face for a while with the bed-clothes. Crude mer- cury. A poultice with opium or theriaca externally. 5. Cholera. When not only the ftomach, as in the laft arti- cle, but alfo the duodenum, and ileum, as low as the valve of the colon, have their motions inverted; and great quantities of bile are thus poured into the ftomach; while at the fame time fome branches of the ladleals become retrograde, and difgorge their contents into the upper part of the alimentary canal; and other branches of them difgorge their contents into the lower parts of it beneath the valve of the colon ; a vomiting and purging com- mence together, which is called cholera, as it is fuppofed to have its origin from increafed fecretion of bile ; but I fuppofe more frequently arifes from putrid food, or poifonous drugs, as in the cafe narrated in Se&. XXV. 13. where other circumftances of this difeafe are explained. See Clafs II. 1. 2. 11. The cramps of the legs, which are liable to attend cholera, are explained in Clafs III. 1. 1. 15. 6. Ileus. Confifts in the inverted motions of the whole intefti- nal canal, from the mouth to the anus ; and of the ladleals and abforbents which arife from it. In this pitiable difeafe, through the valve of the colon, through the pylorus, the cardia, and the pharynx, are ejected, firft, the contents of the ftomach and in- teftines, with the excrement and even clyfters themfelves ; then the fluid from the ladleals, which is now poured into the intef- tines by their retrograde motions, is thrown up by the mouth ; and, laftly, every fluid, which is abforbed by the other lymphatic branches,' from the cellular membrane, the fkin, the bladder, and all other cavities of the body ; and which is then poured into the ftomach or inteftines by the retrograde motions of the ladte- als; all which fupply that amazing quantity of fluid, which is in this difeafe continually ejected by vomiting. See Sedt. XXV. 15. for a further explanation of this difeafe. M. M. Copious venefection. Twenty grains of calomel in fmall pills, or one grain of aloe every hour till ftools are procur- ed. Blifters. Warm bath. Crude mercury. Clyfter of ice- water. Smear the Ikin all over with greafe, as mentioned in Sedt.XXV. 15. As this malady is occafioned fometimes by an introfufception of a part of the inteftine into another part of it, efpecially in children, could holding them up by their heels for a fecond or two of time be of fervice after venefection ? Or the exhibition of crude quickfilver two ounces every half hour, till a pound is taken, Class i. 3. 1. 7. OF IRRITATION. 135 taken, be particularly ferviceable in this circumftance ? Or could half a pound, or a pound, of crude mercury be injected as a clyfter, the patient being elevated by the knees and thighs fo as to have his head and fhoulders much lower than his bottom, or even for a (hurt time held up by the heels ? Could this alfo be of advantage in ftrangulated hernia ? Where there exifts an introfufception of the inteftine, or in obftinate coftivenefs, perhaps a forcing pump, fuch as gardeners employ to water their trees, might be ufed with advantage, by driving water forcibly up the return, as is mentioned by Mr. Adair ; and was ufed by Dettaen in experiments on dogs, who found the valve of the colon did not prevent warm water being pulhed along the whole courfe of the alimentary canal by a forcing fyringe. This is well worthy trial, as well as the quick- filver introduced by the anus in inflammations of the inteltines, where no paflage downwards can be procured. Where an introfufception of the inteftine exifts, as is believed frequently to occur in thofe inflammations of the bowels of children, which are not owing to feme indigeftible material, as to plum (tones or cherry (tones, it is probable that a quantity of air alone, or of the fmoke of tobacco, might be injected fo forci- bly as to dilate, and in confequence to pafs the valve of the co- lon ; and might pu(h into its place the ftrangulated duplicature of the inteftine. Air might be thus injected from a large brown bladder by means of a clyfter-pipe covered with fofc leather moiftened with oil or mucilage, or by means of bellows, or the common apparatus for injecting the fmoke of tobacco, or by a fyringe ufed for condenfing air in philofophical experiments. I have feen fchool-boys blow air through a grafs-ftem into the bow- els of frogs, fo as to prevent their diving, without injuring them. Where the difeate is owing to ftrangulated hernia, the part fhould be fprinkled with cold water, or iced water, or fait and water recently mixed, or moiftened with ether In cafes of ftrangulated hernia, could a cupunclure, or punflure with a ca- pillary trocar, be ufed with fafety and advantage to give exit to air contained in the ftrangulated bowel ? Or to ftimulate it in- to action ? It is not uncommon for bafliful men to conceal their being afflicted with a fmall hernia, which is the caufe of their death ; this circumftance fhould therefore always be in- quired into. Is the feat or caufe of the ileus always below the valve of the colon, and that of the cholera above it ? See Clafs II. I. 2. I I. 7. Globus hyjlericus. Hyfteric fuffocation is the perception of a globe rolling round in the abdomen, and afcending to the ftomach and throat, and there inducing ftrangulation. It con- fifts 136 DISEASES Class I. 3.1.8. lifts of an ineffectual inverfion of the motions of the cefophagus* and other parts of the alimentary canal $ nothing being rejected from the ftomach. M. M. TinCiure of caftor, tinCt. of opium, of each i c drops. See Hyfteria, Clafs I. 3. 1.9. 8. Vomendi conatnen inane. An ineffectual effort to vomit. It frequently occurs, when the ftomach is empty, and in fome cafes continues many hours ; but as the lymphatics of the ftom- ach are not inverted at the fame time, there is no fupply of mate- rials to be ejeCted ; it is fometimes a fymptom of hyfteria, but more frequently attends irregular epilepfies or reveries ; which however may be diftinguilhed by their violence of exertion, for the exertions of hyfteric motions are feeble, as they are caufed by debility; but thofe of epilepfies, as they are ufed to relieve pain, are of the moft violent kind ; infomuch that thofe who have once feen thefe ineffectual efforts to vomit in fome epilep- fies, can never again miftake them for fymptoms of hyfteria. See a cafe in SeCt. XIX. 2. M. M. Blifter. Opium. Crude mercury. 9. Borborigmus. A gurgling of the bowels proceeds from a partial invertion of the periftaltic motions of them, by which the gas is brought into a fuperior part of the bowel, and bubbles through the defcending fluid, like air rufhing into a bottle as the water is poured out of it. This is fometimes a diftrefling fymp- tom of the debility of the bowels joined with a partial inverfion of their motions. I attended a young lady about fixteen, who was in other refpeCts feeble, whofe bowels almoft inceffantly made a gurgling noife fo loud as to be heard at a confiderable diftance, and to attract the notice of all who were near her. As this noife never ceafed a minute together for many hours in a day, it could not be produced by the uniform defeent of water, and afeent of air through it, but there muft have been alternately a retrograde movement of a part of the bowel, which muft again have pufhed up the water above the air ; or which might raife a part of the bowel, in which the fluid was lodged, alternately above and below another portion of it; which might readily hap- pen in fome of the curvatures of the fmaller inteftines, the air- in which might be moved backward and forward like the air- bubble in a glafs-level. M. M. Effential oil. Ten corns of black pepper fwallowed whole after dinner, that its effect might be flower and more per- manent ; a fmall pipe occafionally introduced into the reCtum to facilitate the efcape of the air. Crude mercury. See Clafs I. 2. 4. 8. 1 e. Hyfteria, The three laft articles, together with the lym- phatic <^LASS I. 3. I. 19. OF IRRITATION. 137 phatic diabetes, are the moft common fymptoms of the hyfteric difeafe; to which fometimes is added the lymphatic falivation, and fits of fyncope, or convulfion, with palpitation of the heart (which probably confifts of retrograde motions of it),and a great fear of dying. Which laft circumftance diftinguilhes thefe con- vulfions from the epileptic ones with greater certainty than any other fingle fymptom. The pale copious urine, cold Ikin, palpi- tation, and trembling, are the fymptoms excited by great fear. Hence in hyfteric difeafes,when thefe fymptoms occur, the fear, which has been ufually affbciated with them, recurs at the fame time, as in hypochondriafis, Clafs I. 2. 4. 10. See Seel. XVI. 8. i. The convulfions which fometimes attend the hyfteric difeafe, are exertions to relieve pain, either of fome torpid, or of fome retrograde organ ; and in this refpedt they refemble epileptic convulfions, except that they are feldom fo violent as entirely to produce infenfibility to external ftimuli; for thefe weaker pains ceafe before the total exhauftion of fenforial power is produced and the patient finks into imperfect fyncope ; whereas the true epilepfy generally terminates in temporary apoplexy, with per- fect infenfibility to external objects. Thefe convulfions are lefs to be dreaded than the epileptic ones, as they do not originate from fo permanent a caufe. The great difcharge of pale urine in this difeafe is owing to the inverted motions of the lymphatics, which arife about the neck of the bladder, as defcribed in Seii. XXIX. 4. 5. And the lymphatic falivation arifes from the inverted motions of the falivary lymphatics. Hyfteria is diftinguiflied from hypochondriafis, as in the latter there are no retrograde motions of the alimentary canal,but fim- ply a debilityor inirritability of it, with difteution and flatulency. It is diftinguilhed from apepfia and cardialgia by there being nothing ejected from the ftomach by the retrograde motions of it, or of the oefophagus. M. M. Opium. Camphor. Afafcetida. Caftor, with fm- apifms externally ; to which muft be added a clyfter of cold wa- ter, or iced water ; which, according to Monf. Pomme, relieves thefe hyfteric fymptoms inftantaneoufly like a charm ; which it may effect by checking the inverted motions of the inteftinal ca- nal by the torpor occasioned by cold; or one end of the intefti- nal canal may become ftrengthened, and regain its periftaltic motion by reverfe Sympathy, when the other end is rendered torpid by ice-water. (Pommes des Affediions Vaporeufes,p.25.) Thefe remove the prefent fymptoms.; and bark, fteel, exercife, coldifh bath, prevent their returns. See Art. VI. 2. 1. Vol. II. T if, Hydrophobia. 138 DISEASES Class I. 3. 1. 11. 11. Hydrophobia. Dread of water occafioned by the bite of a mad-dog, is a violent inverfion of the motions of the oefopha- gus on the contact or even approach of water or other fluids. The pharynx feems to have acquired the fenfibility of the larynx in this difeafe, and is as impatient to reject any fluid which get? into it. Is not the cardia ventriculi the feat of this difeafe ? As in cardialgia the pain is often felt in the pharynx, when the acid material ftimulates the other end of the canal, which terminates in the ftomach. As this fatal difeafe refembles tetanus, or lock- ed jaw, in its tendency to convulfion from a diftant wound, and affects fome other parts by aflbciation, it is treated of in Clafs III. i. i. 15. and IV. 2. 1. 7. M. M. I fhould recommend the trial of one grain and a half of corrofive fublimate of mercury, hydrargyrus muriatus, dif- fplved in half an ounce of reftified fpirit of wine, to be given undiluted, if poffible, as defcribed in Clafs II. 1. 5. 1. and to be repeated according to its operation. ORDO Class I. 3. 2. 1. OF irritation. 139 ORDO in. Retrograde Irritative Motions. GENUS II. Of the Abforbent Syfetn. SPECIES. I. Catarrhus Lymphaticus. Lymphatic catarrh. A periodic- al defluxion of a thin fluid from the noftrils, for a few hours, occafioned by the retrograde motions of their lymphatics; which may probably be fupplied with fluid by the increafed abforption of fome other lymphatic branches in their vicinity. It is dif- tinguifhed from that mucous difcharge, which happens iu frofty weather from decreafed abforption, becaufe it is lefs fait to the tafte ; and from an increafed fecretion of mucus, becaufe it is neither fo vifcid, nor is attended with heat of the part. This complaint is liable to recur at diurnal periods, like an intermit- tent fever, for weeks and months together, with great fneezing and very copious difcharge for an hour or two. I have feen two of thefe cafes, both of which occured in deli- cate women, and feemed an appendage to other hyfteric fymp- toms ; whence I concluded, that the difcharge was occafioned by the inverted motions of the lymphatics of the noftrils, like the pale urine in hyfteric cafes ; and that they might receive this fluid from fome other branches of lymphatic veflels opening into the frontal or maxillary cavities in their vicinity. Could fuch a difcharge be produced by ftrong errhines, and excite an abforption of the congeftion of lymph in the dropfy of the brain ? 2. Salivatio lymphatica. Lymphatic falivation. A copious expuition of a pellucid infipid fluid, occafioned by the retrograde motions of the lymphatics of the mouth. It is fometimes peri- odical,and often attends the hyfteric difeafe, and nervous fevers ; but is not accompained with a faline tafte, or with heat of the mouth, or naufea. 3. Naufea humida. Moift naufea confifts in a difcharge of fluid, owing to the retrograde motions of the lymphatics about the fauces, without increafe of heat, or faline tafte, together with fome retrograde motions of the fauces or pharynx along with this naufea, a ficknefs generally precedes the aft of vomit- ing ; which may confift of a fimilar difcharge of mucus or chyle into DISEASES Class I. 3. 2.4 140 into the ftomach by the retrograde motions of the lymphatics or Jatleals, which open into it. See Clafs I. 2. 4. 3. and I. 2.4.4. M. M. Subacid liquids. Wine. Opium. A blifter. 4. Diarrhoea lymphatics. Lymphatic diarrhoea. A quantity of mucus and lymph are poured into the inteftines by the in- verted motions of the inteftinal lymphatics. The feces are lefs fetid and more liquid; and it fometimes portends the commence- ment of a diabetes, ordropfy, or their temporary relief. This lymphatic diarrhoea fometimes becomes chronical, in which the atmofpheric moifture, abforbed by the cutaneous and pulmona- ry lymphatics, is poured into the inteftines by the retrograde motions of the latleals. See Section XXIX. 4. 6. where fomc cafes of this kind are related. 5. Diarrhoea chylifera, cxiiaca. Chyliferous diarrhoea. The chyle drunk up by the la&eals of the upper inteftines is poured into the lower ones by the retrograde motions of their lacleals, and appears in the dejections. This circumftance occurs at the beginning of diarrhoea crapulofa, where the patient has taken and digefted more aliment than the fyftem can conveniently re- ceive, and thus eliminates a part of it; as appears when there is curdled chyle in fome of the dejections. SeeSeCt. XXIX. 4. 7. It differs from the lymphatic diarrhoea, as the chyliferous diabe- tes differs from the aqueous and mucaginous diabetes. 6. Diabetes. By the retrograde motions of the urinary lym- phatics, an immenfe 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 difeafe, as in hyfteric Women, in the beginning of in- toxication, in worm cafes, or in thofe expofed to cold damp air, or to great fear, or anxiety, or in the commencement of fome dropfies; or it becomes chronical. When the urinary lymphatics invert their motions, and pour their refluent contents into the bladder, fome other branch of the abforbent fyftem ads with greater energy to fupply this flu- id. If it is the inteftinal branch, the chyliferous diabetes is pro- duced : if it is the cutaneous or pulmonary branch, the aqueous diabetes is produced : and if the cellular or cyftic branches, the mucaginous diabetes. In the two laft the urine is pellucid, and contains no fugar. In dropfies the fluid is fometimes abforbed, and poured into the bladder by theretrograde motions of the urinary lymphatics, as during the exhibition of digitalis. In the beginning of the dropfies of infirm gouty patients, I have frequently obferved, that they make a large quantity of water for one night, which relieves them for fcveral days. In thefe cafes the patient previ- oufly Class I. 3. 2. 4. OF IRRITATION. 141 oufly feels a fulnefs about the prsecordia, with difficult refpira- tion, and fymptoms fimilar to thofe of hyfteria. Perhaps a pre- vious defeat of abforption takes place in fome part of the body in thofe hyfteric cafes, which are relieved by a copious difcharge of pale urine. See Diabetes explained at large, Section XX1X. 4. A difcharge of blood fometimes attends the diabetes, which was occafionally a fymptom of that difeafe 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 gaftric branch of the vena portarum, as difcovered by J. F. Meckel. See Section XXVII. 2. M. M. Alum. Earth of alum. Cantharides. Calomel. Bark. Steel. Refin. Opium. See SeQ. XXIX. 4. Since the publication of the firft edition of this work, I have feen two patients affected with diabetes, who were both of them between fixty and feventy years old,and had formerly lived rath- er freely, though very temperately latterly for many years. The water they made had not been accurately meafured or evapora- ted ; but one of them obferved that his terrier bitch lapped his urine in large quantities,and preferred it much to common wa- ter; whence he concluded,it mull contain fome nutritious matter. They both complained of thirft, and had drunk two or three times as much as ufual, during the time they had been affected with the diabetes ; which was about four months in one, and about three in the other. Asi efteemed thefe cafes to be ow- ing to the patients fwallowing more fluid than could be fo hafti- ly taken into the circulation, and that therefore a part of it was conveyed to the bladder by the retrograde adlion of the lymphat- ics, as in the beginning of intoxication ; I prevailed on them to drink no more than their ufual quantity, or lefs ; and both thefe mild cafes of diabetes ceafed immediately by this Ample treat- ment of them. A fimilar event feems to have exifted in the two cafes of dia- betes firft publilhed by Dr. Rollo ; on thofe days the patients drank but little,the quantity of urine was not more than natural. Both from thefe cafes, and from others related by Dr. Rollo, it appears, that when the patient lived on animal food, lefs faccha- vine matter was detected in the urine, and alfo that the quanti- ty of the urine abated ; the former of thefe circumftances is read- ily accounted for, as vegetable materials are probably more co- pioufly convertible into fugar, either chemically or by the power of digeftion, than animal materials ; and the latter feems proba- bly owing to the patients drinking lefs in quantity, when they were reftrained from beer and milk, and were allowed only- broth in their Read. In . 142 DISEASES ClassI. 3. 2. 7. In the cafe from Liverpool, publifhed by Dr. Rollo, the pa- tient did not weigh heavier after fitting ten minutes in a bath of 11 o degrees of heat; which (hews that no part of the diabe- tic urine was owing to increafed cutaneous abforption, and that this difeafe was not the aqueous but the chyliferous diabetes ; and I fuppofe the patient's weighing heavier or not after ufing a warm bath may depend on the quantity of fluid previoufly taken by the mouth ; as the fkin may thence be either in an ab- forbent or exhalent ftate, and owing to a greater or lefs degree of heat, which may render the quantity of perfpiration in the bath greater than the quantity absorbed. SeeSeft. XXIX. 4. 5. 7. Sudor lymphaticus. Profufe fweats from the inverted mo- tions of the cutaneous lymphatics, as in fome fainting fits, and at the approach of death ; and as perhaps in the fudor anglica- nus. SeeSeft. XXIX. 5. Thefe fweats are glutinous to the touch, and without increafed heat of the fkin ; if the part is not covered, the fkin becomes cold from the evaporation of the fluid. Thefe fweats without heat fometimes occur in the a6t of vomit- ing, as in Se6l. XXV. 9. and are probably the caufe of the cold fweaty hands of fome people. As mentioned in Se<ft. XXIX. 4. 9. in the cafe of R. Davis, w'hich he cured by frequent ap- plication of lime. Though it is poflible, that cold fweaty hands may alfo arife from the want of due abforption of the perfpirable matter effufed on them, and that the coldnefs may be owing to the greater evaporation in confequence. The acid fweats defcribed by Dr. Dobfon, which he obferved in a diabetic patient, and afcribes to the chyle effufed on the fkin, muff be afcribed to the retrograde action of the cutaneous lymphatics. See Se6f. XXIX. 6. 8. Sudor ^Jihmaticus. The cold fweats in this difeafe only cover the head, arms, and bread, and are frequently exceeding- ly profufe. Thefe fweats are owing to the inverted motions of the cutaneous lymphatics of the upper part of the body, and at the fame time the increafed abforption of the pulmonary abfor- bents: hence thefe fweats when profufe relieve the prefent fit of afthma. There is no other way to account for fweats appear- ing on the upper parts of the body only, but by the fluid having been abforbed by the lymphatic branch of the lungs, and effufed on the fkin by the retrograde movements of the cutaneous lym- phatics ; which join thofe of the lungs before they enter into the venous circulation. For if they were occafioned, as gener- ally fuppofed, by the difficulty of the circulation of the blood through the lungs, the whole fkin muff: be equally affected, both of the upper and lower parts of the body ; for whatever could abftruct the circulation in the upper part of the venous fyftem, muft Class I. 3. 2. 9. OF IRRITATION. 143 muft equally obftruft; it in the lower part of it. See Seft. XXIX. 6. In the convulfive afthma thefe fweats do not occur; hence they may be diftinguifhed ; and might be called the hydropic afthma, and the epileptic afthma. 9. Tranjlatio puris. Tranflation of matter from one part of the fyftem to another can only be explained from its being ab- sorbed by one branch of the lymphatic fyftem, and depofited in a diftant part by the retrograde motions of another branch ; as mentioned Seft. XXIX. 7. 1. It is curious, that thefe tranfla- tions of matter are attended generally, I believe, with cold fits ; for lefs heat is produced during the retrograde aftion of this part of the fyftem,as no fecretion in the lymphatic glands of the affefted branches can exift at the fame time. Do any ineffec- tual retrograde motions occafion the cold fits of agues ? The time when the gout of the liver ceafes, and the gout in the foot commences,is attended with a cold fit, as I have obferved in two inftances, which is difficult to explain, without fuppofing the new veffels, or the matter produced on the inflamed liver, to be abforbed, and either eliminated by fome retrograde motion, or carried to the newly inflamed part ? See Clafs IV. 1.2. 15. 1 o. Tranjlatio la^is. Tranflation of milk to the bowels in puerperal fevers can only be explained by the milk being abforb- ed by the pectoral branch of lymphatics, and carried to the bowels by the retrograde motions of the inteftinal lymphatics or lafteals. See many inftances of this in Seft. XXIX. 7. 4. ii. Tranjlatio urince. Tranflation of urine. There is a curi- ous cafe related in the Tranfaftions of the College of Phyficians at Philadelphia, Vol. I. p. 96..of a girl, who labouring under an ifchuria vomited her urine for many months ; which could not be diftinguifhed from that which was at other times drawn off by the catheter. After'having taken much opium, fhe feems at length to have formed gravel, fome of which was frequently brought up by vomiting. Dr. Senter afcribes this to the retro- grade motions of the lymphatics of the ftomach,and the increas- ed ones of thofe of the bladder, and refers to thofe of Seft. XXIX.of this work ; which Seftion was firft publiffied in 1780 ; and of Macquer's Dictionary of Chemiftry, Art. Urine. The patient above defcribed Sometimes had a difcharge of urine by the navel, and at other times by the reftum, and Some- times by urinous Sweats. ORDO 144 DISEASES Class I. 3. 3. 1* ORDO in. Retrograde Irritative Motions. GENUS HI. Of the Sanguiferous Syfem. SPECIES. i. Capillarium motus retrogrefus. In microfcopic experi- ments it is ufual to fee globules of blood regurgitate from the capillary veflels again and again, before they pafs through them ; and not only the mouths of the veins, which arife from thefe ca- pillaries, are frequently feen by microfcopes to regurgitate fome particles of blood during the ftruggles of the animal; but a re- trograde motion of the blood in the veins of thefe animals, from the very heart to the extremities of the limbs, is obfervable by intervals during the diftrefles of the dying creature. Haller, Elem. Phyf. T. i. p. 216; See Seclion XXIX. 3. 8. 2. Palpitatio cordis. May not the ineffectual and weak une- qual motions of the heart in hyfteric cafes be afcribed to the re- trograde motions of it, which continue for a Ihort time, or ter- minate in fyncope ? See Clafs IV. 3. 1.6. 3. Anhelatio fpafmodica. In fome afthmas may not the difficul- ty of refpiration arife from the inverted action of the finer branches of the bronchia, or of the pulmonary artery or vein, like thofe of the capillaries above defcribed in No. 1- of this ge- nus ? th, Class II. 1. 1. DISEASES, ^c. 145 The Orders and Genera of the Second Clafs of Difeafes. CLASS IL DISEASES OF SENSATION. ORDO I. Increafed Senfation. GENERA. i. With increafed action of the mufcles. 2. With the production of new veflels by internal membranes or glands with fever. 3. With the production of new veffels by external membranes or glands with fever. 4. With the production of new veflels by internal membranes or glands without fever. 5. With the production of new veflels by external membranes or glands without fever. 6. With fever confequent to the production of new veflels or fluids. 7. With increafed aCtions of the organs of fenfe. ORDO II. Decreafed Senfation. GENERA. 1. With decreafed aCtions of the general fyftem. 2. With decreafed aCtions of particular organs. ORDO III. Retrograde Senfitive Motions. GENERA. 1. Of the arterial fyftem. 2. Of the abforbent fyftem. 3. Of the excretory duCts. Vol. II. U The 146 DISEASES Class II. 1. 1. The Orders, Genera, and Species, of the Second Clafs of Difeafes. CLASS II. DISEASES OF SENSATION. ORDO I. Increafed Senfation. GENUS I. With increafed Action of the mufcles. SPECIES. I. Deglutitio 2. Rfpiratio 3. Sternutatio 4. Anhelitus 5. Tufts ebriorum 6. Singultus q. Crapula ventriculi 8. Afhma hum or ale 9. NiClitatio feifttiva 1 o. Ofcitaiio et pandiculatio ii. Tenefmus 12. Stranguria 13. Parturitio Deglutition Refpiration Sneezing Panting Cough of inebriates Hiccough Indigeftion Humoral afthma Winking from pain Y awning and ftretching Tenefmus Strangury Parturition GENUS II. With the 'Production of new Vefels by internal Membranes of Glands, with Fever. SPECIES. I. Febris fenjitiva irritata 1- Ophthalmia internia 3. Phrenitis 4. Peripneumonia - trachealis 5. Pleuritic 6 Diaphragmitis 7. Carditis 8. Peritonitis 9. MefenteritiS Senfitive irritated fever Inflammation of the eye ■ of the brain of the lungs The croup Inflammation of the pleura of the diaphragm of the heart --- of the peritone- um ---- of the mefentery io. Gaftritis Class II. 1. 3. OF SENSATION. 147 Inflammation of the ftomach of the bowels of the liver of the fpleen of the kidney of the bladder of the womb of the loins of the pelvis beneath the nails 10. G aft r it is 11. Enteritis 12. Hepatitis 13. Splenitis 14. Nephritis 13. C flit is 16. Hyfleritis 17. Lumbagofenfitiva 18. Ifchias 19. Paronchyia interna GENUS III. With the Production of new Vefftls by external Membranes oV Glands, with Fever. SPECIES. I. Febris [enfitiva inirritata 2. Erifipelas irritatum inirritatum jenjitivum 3. Tonfillitis interna fuperficialis inirritata 4. Parotitisfuppurans mutabilis felina cp Catarrhus fenfitivus 6. contagiofus equinus et cani- nus 7. Peripneumonia fuperficialis 8. Pert 1 fits g. Variola difcreta confiuens inoculata 10. Rubeola irritata inirritata 11. Scarlatina mitis maligna 12. Miliaria fudatoria irritata inirritata 13. Pefiis vaccina 14. Pemphigus Sensitive inirritated fever Eryfipelas, irritated inirritated fenfitive Angina, internal fuperficial inirritated Mumps, fuppurative mutable of cats Catarrh, inflammatory contagious - among horfes and dogs Superficial peripneumony Chin-cough Small-pox, diftinft confluent • inoculated Meafles, irritated inirritated Scarlet fever, mild malignant Miliary fever, fudatory irritated ■ inirritated Plague of horned cattle Bladdery fever 15. Varicelli 148 DISEASES Class II. 1. 4. 15. Varicella 16. Urticaria 17. Aphtha fenfitiva --- irritata inirritata 18. Dyfenteria 19. Gaftritis fuperficialis 2o. Enteritis fuperficialis Chicken-pox Nettle-raih Thrufh, fenfitive irritated inirritated Bloody flux Superficial inflam, of the ftom- ach of the bowels GENUS IV. With the Production of new Veffels by internal Membranes or Glands, •without Fever, SPECIES. I. Ophthalmia fuperficialis -- lymphatica -' equina 2. Pt erigion 3. Parfitts palpebrarum 4. Hordeolum 5. Paronichia fuperficialis 6. Gutta Rofea hepatica fiomatica ■ hereditaria 7. Odontitis 8. Otitis 9. Fiftula lacrymalis I o. F'ftula in ano 11. Hepatitis chronica 12. Scrofula fuppurans 13. Scorbutusfuppurans 14. Scirrhus fuppurans 15. Carcinoma 16. Arthrocele 17- Arthropuofis 18. Caries Ofium Ophthalmy, fuperficial ■ ■ lymphatic of horfes Eye-wing Red eyelids Stye "Whitlow Pimpled face, hepatic ftomatic hereditary Inflamed tooth ear Fiftula lacrymalis Fiftula in ano Chronical hepatitis Suppurating fcrofula Suppurating fcurvy Suppurating fcirrhus Cancer Swelling of the joints Suppuration of the joints Caries of the bones GENUS V. With the Production of new Veffels by external Membranes or Glands, viitFout Feuer. I. Gonorrhoea venerea I* Syphilis SPECIES. Clap Venereal difeafe 3. Lepra Class.II. 1. 6. OF SENSATION. 149 3* 4. Elephantiafts 5. Frambuefta 6. Pfora q. Pfora ebribrum 8. Herpes g Zona ignea io. Annulus repens 11. Fine a capitis 12. Crufalactea 13. Trichoma Leprofy JLiephantiafis Frambcefia Itch Itch of drunkards Herpes Shingles Ring-worm Scald-head Milk-cruft Plica polonica GENUS VI. With Fever confequent to the Production of new Veffels or Fluids. SPECIES. 1. Febris ferftwa 2. a pure claufo 3. - a vomica 4. ab empyemate 5. mefenterica 6. a pure aerota q. a phthifi 8. fcrofulofa 9. i[chia die a 1 o. arthropuodica II. a pure contagiofo 12. variolofafecundaria 13. carcinomatofo 14. venerea 15. a fanie contagiofa 16. puerpera 17. „-■ a fphacelo Senfitive Fever. Fever from concealed matter from vomica from empyema mefenteric from aerated matter from confumption fcrofulous from ifchias from joint-evil from contagious matter fecondary of fmall-pox • Cancerous venereal from contagious fanies puerperal from fphacelus GENUS VII. With increafed A^ion of the Organs of Senfe. SPECIES. r. Delirium febrile 2. maniac ale 3. ebrietatis 4. Somnium 5. Hallucinatio vifus 6. audit^s 7. R ubor a calore Delirium of fevers maniacal of drunkennefs Dreams Deception of fight of hearing Blulh from heat 8. Rubor 150 DISEASES Class II. 2. 1. 8 Rubor jucunditalis 9. Priapifmus amatorius 10. Difentio mamularum Blufh from joy Amorous priapifm Diftention of the nipples ORDO II. Decreafed ^enfation. GENUS I. With decreafed Action of the general Syflem. SPECIES. 1. Stultitia infenftbilis. 2. Tadium vita 3. Par efts fenfttiva Folly from infenfibility Irkfomenefs of life Senfitive debility GENUS II. With decreafed Actions of particular Organs. SPECIES. I. Anorexia 2. Adipfta 3. Impotentia 4. Sterilitas 5. Infenfbilitas artuum 6. Difuria inferfitiva Accumulate alvina Want of appetite W ant of thirft Impotence Barrennefs Infenfibility of the limbs Infen Ability of the bladder Accumulation of feces ORDO III. Retrograde Senftive motions. GENUS I. Of Excretory Duels. SPECIES. Motus retrogrefus 1. ureterum 2. urethra 3. -- duMs coledoci Retrograde motion --- of the ureters of the urethra ■ of the bile-duft CLASS Class II. 1.1. OF SENSATION. 151 CLASS IL DISEASES OF SENSATION. ORDO I. Increafed Senfation. GENUS I. With increafed Asians of the Mufcles. THE aCtions belonging to this genus are thofe which are im- mediately excited by the fenfations of pain or pleafure, but which are neither followed by inflammation nor by convulfion. The former of which belong to the fubfequent genera of this order, and the latter to the clafs of voluntary motions. The criterion between the actions, which are the immediate confequence of painful fenfation, and convulfive aCtions prop- erly fo called, confifts in the former having a tendency to dif- lodge the [Emulating caufe, which induces the painful fenfation; and the latter being exerted for the purpofe of expending the fenforial power, and thus dulling or deftroying the general fen- fation of the fyftem. See Clafs III. i. There is a degree of heat produced in the affeCted part by thefe fenfitive actions without inflammation, but in much lefs quantity than when attended by inflammation ; as in the latter there is production of new veflels. See SeCt. XXXIII. 2. 3. Some of the fpecies of this genus cannot properly be termed difeafes in their natural ftate, but become fo by their defeat or excefs, and are here inferted to facilitate the explanation of the others. SPECIES. 1. Ueglutitio. Swallowing our food is immediately caufed by the pleafurable fenfation occafioned by its ftimulus on the palate or fauces, and is acquired long before the nativity of the animal. Afterwards the pain of hunger previoufly produces the various voluntary exertions to procure the proper material, but the aCtions of mafticating. and fwallowing it are effected by the fenforial power of fenfation ; which appears by their not being always controlable by the will, as when children in vain attempt to fwallow naufeous drugs. See Clafs IV. 1. 3. 1. The DISEASES 152 Class IE 1. 2. The mafticated food ftimulates the palate, which is an organ of fenfe, into fo much action, as to produce agreeable fenfarion ; and the mufcles fubfervient to deglutition are brought into ac- tion by the fenfation thus produced. The pleafurable fenfa- tion is the proximate caufe ; the action of the fibres of the ex- tremities of the nerves of tafte is the remote caufe ; the fenfo- rial power of irritation exciting thefe fibres of the nerves of tafte into increafed action is the pre-remote caufe ; the a£iion of the mufcles of deglutition is the proximate effect ; the pufhing the food into the ftomach is the remote effect ; and the nutrition of the body is the poft-remote effect. Though the mufcles fubfervient to deglutition have their ac- tions previoufly aflbciated, fo as to be excited into fynchronous tribes or fuccefTive trains, either by volition, as when we fwal- low a difagreeable drug ; or by fenfation, as when we fwallow agreeable food ; or by irritations, as when we inattentively fwal- low our fahva ; yet do all thofe three kinds of deglutition belong to the refpe&ive claffes of volition, fenfation, and irritation ; becaufe the firft links of thefe tribes or trains of mufcular action are excited by thofe fenforial powers, and the aflbciated links, which accompany or fucceed them, are excited by the combined powers either of volition, or of fenfation, or of irritation, along with that of aflbciation. 2. Refpiratio. Refpiration is immediately caufed by the fen- forial power of fenfation in confequence 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 atmofphere. The aftion of refpiration is thus fimilar to that of fwallowing our food to appeafe the pain of hunger ; but the lungs being furrounded with air, their prop- er pabulum, no interimmediate voluntary exertions are required, as in hunger, to obtain and prepare the wanted material. Refpiration is fimilar to flow combuftion; the oxygenous part of the atmofphere is received through the moift membranes, which line the air-cells of the lungs, and uniting with the in- flammable part of the blood generates an acid, probably the phofphoric acid ; a portion of carbonic acid is like wife produ- ced in this procefs; as appears by repeatedly breathing over lime water, which then becomes turbid. See Botanic Garden, P. I. C. 1.1. 401. note. 3. Sternutatio. Sneezing confifts of mufcular actions produ- ced by the fenforial faculty of fenfation ; and is an effort to dif- lodge, by means of air forcibly impelled through the noftrils, fome material; which ftimulates the membrane, which lines them. Class II. 1. 1.4. OF SENSATION. 153 them, into too great acftion, and might thence injure the fenfe of fmell which is diffufed on it. In this operation the too great a&ion of the veflels of the membrane of the noftrils is the remote caufe; the fen fation thence induced is the proximate caufe ; and the mufcular ac- tions are the proximate effect. This a<Slion of fneezing frequently precedes common refpira- tion in new-born children, but I believe not always ; as like the latter it cannot have been previoufly acquired in the uterus. It is produced in fome people by hidden light, as by looking up at the Iky in a morning, when they come out of a gloomy bed-chamber. It then becomes an aflbciate adlion, and belongs to Clafs IV. i. 2. 2. M. M. When it is exerted to excefs it may be cured by fnuffing ftarch up the noftrils. See Clafs I. i. 2. 13. 4. Anhelitus. Panting. The quick and labourious breathing of running people, who are not accuftomed to violent exercife, is occafioned by the too great conflux of blood to the lungs. As the fanguiferous fyftem, as well as the abforbent fyftem, is fur- nifhed in many parts of its courfe with valves, which in general prevent the retrograde movement of their contained fluids ; and as all thefe veflels, in fome part of their courfe, He in contact with the mufcles, which are brought into action in running, it follows that the blood muft be accelerated by the intermitted fwelling of the bellies of the mufcles moving over them. The difficulty of breathing, with which very fat people are immediately affected on exercife, is owing to the preflure of the accumulated fat on the veins, arteries, and lymphatics ; and which, by diftending the fkin, occafions it to aft as a tight ban- dage on the whole furface of the body. Hence when the muf- cles are excited into quicker action, the progrefs of the blood in the veins, and of the lymph and chyle in the abforbent fyftem, is urged on with much greater force, as under an artificial ban- dage on a limb, explained in Art. IV. 2. 10. and in Seft. XXXIII. 3.2. Hence the circulation is inftantly quickened to a great degree, and the difficulty of breathing is the confequence of a more rapid circulation through the lungs. The increafed fecretion of the perfpirable matter is another confequence of this rapid circulation ; fat people, when at reft, are believed to per- fpire lefs than others,which may be gathered from their generally having more liquid ftools, more and paler urine, and to their frequently taking lefs food than many thin people ; and laftly, from the perfpiration of fat people being generally more inodo- rous than that of lean ones ; but when corpulent people are put in motion, the fweat ftands in drops on their fkins, and they Vol. II. W «lard 154 DISEASES Class II. 1. 1. 5. lard the ground" as they run. The increafe of heat of corpulent people on excercife, is another confequence of their more rapid circulation, and greater fecretion. See Clafs I. 2. 3. 17. Other caufes of difficult or quick refpiration will be treated of under Afthma, Pertuffis, Peripneumonia, Tonfillitis. 5. Tujfis ebriorum. Senfitive cough is an exertion of the mufcles ufed in expiration excited into more violent aflion by the fenforial power of fenfation, in confequence of fomething which too powerfully ftimulates the lungs. As the faline part of the fecreted mucus, when the abforption of it is impeded ; or the too great vifcidity of it, when the abforption is increafed ; or the too great quantity of the mucus, when the fecretion is increafed ; or the inflammation of the membranes of the lungs ; it is on effort to diflodge any of thefe extraneous materials. Of this kind is the cough which attends free-drinkers after a debauch; it confifts of many ffiort efforts to cough, with a fre- quent expuition of half a tea-fpoonful of frothy mucus, and is attended with confiderable thirft. The thirft is occafioned by the previous diffipation of the aqueous parts of the blood by fen- fible or infenfible perfpiration ; which was produced by the in- creafed action of the cutaneous and pulmonary capillaries during the ftimulus of the wine. In confequence of this an increafed abforption commences to replace this moifture, and the fkin and mouth become dry, and the pulmonary mucus becomes infpiffa- ted ; which ftimulates the bronchia, and is raifed into froth by the fucceffive currents of air in evacuating it. This production of froth is called by fome free-drinkers " fpitting fixpences" af- ter a debauch. This fub/equent thirft, dry mouth, and vifcid expectoration in fome people fucceeds the flighteft degree of in- toxication, of which it may be efteemed a criterion. See Clafs IV. 2. 1. 8. As coughs are not always attended with pain, the mufcular actions, which produce them, are fometimes excited by the fen- forial faculty of irritation, as in Clafs I. 1. 2. 8. I. 1.3.4. I. 1.4 3. I. 2. 3.4. Coughs are alfo fometimes convulfive, as in Clafs III. 1. 1. 10. and fometimes fympathetic, as in Clafs IV. 2. 1. 7. M. M. Venefeftion, when the cough is attended with in- flammation. Mucilages. Opium. Torpentia. Blifter. 6. Singultus. Hiccough is an exertion of the mufcles ufed in infpiration excited into more violent action by the fenforial power of fenfation, in confequence of fomething which too pow- erfully ftimulates the cardia ventriculi, or upper orifice of the ftomach. As when folid food is too haftily taken without fuf- ficient dilution. And is an effort to diflodge that offenfive ma- terial. Class IL 1. 1. 7. OF SENSATION. 155 rial, and pufh it to fome lefs fenGble part of the ftomach, or in- to the middie of the contained aliment. At the end of fatal fevers it may arife from the acrimony of the undigefted aliment, or from a part of the ftomach being al- ready dead, and by its weight or coldnefs affecting the furviving part with difagreeable fenfation. The pain about the upper orifice of the ftomach is the proximate caufe, the too great or too little action of the fibres of this part of the ftomach is the remote caufe, the action of the mufcles ufed in infpiration is the proximate effect, and the repercuffion of the offending ma- terial is the remote effect. Hiccough is fometimes fympathetic, occafioned by the pain of gravel in the kidney or ureter, as in Clafs IV. i . 1.7. and is fometimes a fymptom of epilepfy or reverie,as in Se<ft.XIX.2. M. M. Oil of cinnamon from one drop gradually increafed to ten, on fugar, or on chalk. Opium, Blifter. Emetic. 7. Crapula ventriculi. Indigeftible fubftances in the ftomach. rjThis frequently occurs in children, who are reftrained by their ill-aClive friends from fruit or other fweet things; and thus the rational mind is taught to fuperintend the fatiety of the fenfation of the fenfe of hunger, or of the pleafure of the palate, which is contrary to nature, and a much more erroneous^guide. Hence children are liable to fwallow more plums and cherries than their ftomachs can digeft ; and if thefe run hafti 1 y into ferment- ation, much air, or gas, is generated ; and produces an incon- venient diftention of the ftomach, as well as a difagreenble fenfa- tion, which generally terminates in ejecting the offending mat- ter by vomiting. In cows which have eaten too much young clover, the faccha- rine and mucilaginous matter, which it contains, runs into fo violent fermentation as by diftention to deftroy the animal. Whence it has been cuftomary with fome to perforate the firft ftomach, and thus let out the air. Dr. White, of Edinburgh, afferted, that he witnefled about twenty beafts in this fituation, two were dead before the medicine could be adminiftered, but to the other eighteen he directed half a pint of fpirits, called gin or whifky, mixed with as much water, to be given ; and they all parted with much air by eructation, and recovered. An in- genious gentleman has lately put a flexible pipe down the oefoph- agus into the diftended ftomach of thefe animals with certain fuccefs, as related in fome late publication. A flexible tube for this purpofe might be made of wire wrapped round a flick about half an inch in diameter, and afterwards covered with leather. A boy about 8 years old fwallowed a halfpenny, which was believed to pafs through him at fchool, fome weeks afterwards, ' bu-r 156 DISEASES Class II. 1.1.8. but he has not recovered his health. I was informed, that an idiot had fwallowed a half-crown piece, and directed crude quickfilver to be given him in repeated quantities, but never heard the event of the cafe. A lady in my prefence was eating a cuftard out of a tea cup, and put 3 or 4 pins into her mouth, which were fuppofed to have been carelefsly left in the cup, and fwallowed one of them : now, though needles have found their way out of the body, and other fharp indigeftible materials, yet pins being terminated with heads are faid often to have occafioned dangerous and pain- ful difeafes, and fometimes death. What then fhould be done ? It occurred to me, that as the head of the pin would have fo much greater fridion than the point, that if it was carried for- wards by a ftream of mucilaginous fluid, the head muft go firft ; and I therefore immediately directed an emetic, and the pin was brought up without any pain, or any ftains of blood in the ejeft- ed fluid. 8. Ajlhma humorale. The humoral afthma probably confifts in a temporary anafarca of the lungs, which may be owing to a temporary defetSl of lymphatic abforption. Its caufe is never- thelefs at prefent very obfeure, fince a temporary deficiency of venous abforption, at the extremities of the pulmonary or bron- chial veins, might occafion a fimilar difficulty of refpiration. See Aborto, Clafs I. 2. i. 14. Or it might be fuppofed, that the lymph effufed into the cavity of the cheft might, by fome addi- tional heat during fleep, acquire an aerial form, and thus com- prefs the lungs ; and on this circumftance the relief, which thefe patients receive from cold air, would be readily accounted for. The paroxyfms attack the patient in his firft fleep, when the circulation through the lungs in weak people wants the affiftance of the voluntary power. Clafs I. 2. 1. 3. And hence the ab- forbents of the lungs are lefs able to fulfil the whole of their duty. And part of the thin mucus, which is fecreted into the air-cells, remains there unabforbed, and occafions the difficult refpiration, which awakes the patient. And the violent exer- tions of the mufcles of refpiration,which fucceed, are excited by the pain of fuffbeation, for the purpofeof pufhing forwards the blood through the compreffed capillaries, and to promote the ab- forption of the effufed lymph. In this the humoral differs from the convulfive afthma, treat- ed of in Clafs III. 1. 1. 10. as in that there is probably no ac- cumulated fluid to be abforbed ; and the violent refpiration is only an exertion for the purpofe of relieving pain, either in the lungs or in fome diftant part, as in other convulfions, or epilep- fv; and in this refpeft the fits of humoral and convulfive afthma , , ' effentiailv OF SENSATION. Class II. i. 1.8. 157 effentially differ from each other, contrary to the opinion ex- preffed without fufficient confederation in Se€L XVIII. 15. The patients in the paroxyfms both of humoral and convulfive afthma find relief from cold air, as they generally rife out of bed, and open the window, and put out their heads ; for the lungs are not fenfible to cold,and the fenfe of fuffocation is fome- what relieved by there being more oxygen contained in a given quantity of cold frefh air, than in the warm confined air of a clofe bed-chamber. I have feen humoral afthma terminate in confirmed anafarca and deftroy the patient, who had been an exceflive drinker of fpirituous potation. And M. Savage afferts, that this difeafe frequently terminates in diabetes ; which feems to fhew,that it is a temporary dropfy relieved by a great flow of urine. Add to this, that thefe paroxyfms of the afthma are themfelves relieved by profufe fweats of the upper parts of the body, as explained in Clafs I. 3.2. 8. which would countenance the idea of their being occafioned by congeftions of lymph in the lungs. The congeftion of lymph in the lungs from the defective ab~ forption of it is probably the remote caufe of humoral afthma ; but the pain of fuffocation is the immediate caufe of the violent exertions in the paroxyfms. And whether this congeftion of lymph in the air-cells of the lungs increafes during our fleep, as above fuggefted, or not ; the pain of fuffocation will be more and more diftreffing after fome hours of fleep, as the fenfibility to internal ftimuli increafes during that time, as defcribed in Secft. XVIII. 15. For the fame reafon many epileptic fits, and paroxyfms of the gout, occur during fleep. In two gouty cafes, complicated with jaundice, and pain, and ficknefs, the patients had each of them a fhivering fit, like the commencement of an ague, to the great alarm of their friends ; both which commenced in the night, I fuppofe during their fleep ; and the confequence was a ceffation of the jaundice, and pain about the ftomach, and ficknefs ; and inftead of that the gout appeared in their extremities. In thefe cafes I conjecture, that there was a metaftafis not only of the difeafed aflion from the membranes of the liver to thofe of the foot ; but that fome of the new veffels, or new fluids, which were previoufly produ- ced in the inflamed liver, were tranflated to the feet during the cold fit, by the increafed abforption of the hepatic lymphatics, and by the retrograde motions of thofe of the affeCted limbs. This I think refembles in fome refpeCts a fit of humoral afth- ma, where ftronger motions of the abforbent veffels of the lungs are excited, and retrograde ones of the correfpondent cutaneous lymphatics; whence the violent fweats of the upper parts of the body 158 DISEASES Class II. 1.1.9. body only are produced ; and for a time the patient becomes re- lieved by the metaftafis and elimination of the offending material by fenfitive exertion. For a further account of this intricate fubjeft fee Clafs III. i. i. io. M. M. To relieve the paroxyfm a tea-fpoonful of ether may be given mixed with water, with io drops of laudanum, to be repeated three or four times. Venefeftion. An emetic. A blifter. Afterwards the Peruvian bark ; with a grain of opium at night, and two or three of aloes. A flannel ihirt in winter but not in fummer. Iffues. Digitalis ? In this fpecies of afthma, there is great reafon to believe, that the refpiration of an atmofphere, with an increafed proportion of oxygen, will prove of great advantage ; fome well obferved and well attelled cafes of which are publilhed by Dr. Beddoes; as this purer air invigorates the circulation, and the whole fyftem in confequence, perhaps not only by its ftimulus, but by its fup- plying the material from which the fenforial power is extracted or fabricated. In fpafmodic afthma, on the contrary, Dr. Fer- riar has found undoubted benefit from an atmofphere mixed with hydrogen. See Seft. XVIII. 15. and Clafs III. 1. 1. 10. 9. Niflitaiiofenjitvua. Winking of the eyes is performed eve- ry minute, without our attention, for the purpofe of diffufing the tears over them, which are poured into the eye a little above the external corner of it, and which are afterwards abforbed by the lachrymal points above and below the internal corner of iu When this operation is performed without our attention, it is caufed by the faculty of irritation, and belongs to Clafs I. 1.4. 1. but when it is produced by a ftronger ftimulus of any extra- neous material in the eye, fo as to caufe pain, the violent and fre- quent nictitation is caufed by the faculty of fenfation. This difeafe is fometimes produced by the introverfion of the edge of the lower eyelid, which bends the points of the hairs of the eyelafh upon the ball of the eye, which perpetually ftimulate it into painful fenfation. This introverfion of the eyelid is gen- erally owing to a tumour of the cellular membrane below the edge of the eyelid, and though a very troublefome complaint may often be cured by the following fimple means. A little common plafter fpread on thin linen, about a quarter of an inch long, muft be rolled up lo as to be about the fize of a crow-quill ; this muft be applied immediately below the eyelafh on the out- fide of the eye, and muft be kept on by another plafter over it. This will then aft as a flight compreflion on the tumor under the eyelafh, and will prevent the hairs from touching the eye- ball. Ina week or two the compreflion will dimini th the tu- mor it lies over, and cure this painful deformity. 10. Ofcitcrti9 Class II. 1. 1. 10. OF SENSATION. 159 io. Ofcitatio etpandiculatio. Yawning and ftretching of the limbs is produced either by a long inactivity of the mufcles now brought into action, as fometimes happens after fleep, or after liftening a long time to a dull narrative ; or it is produced by a too long continued action of the antagonift mufcles. In the former cafe there is an accumulation of fenforial power during the quiefcence of the mufcles now brought into action ; which probably conftitutes the pain or wearifomenefs of a continued attitude. In the latter cafe there is an exhauftion of fenforial power in the mufcles, which have lately been a£ling violently, and a confequent accumulation in the mufcles, which are antag- onifts to them, and which were at reft. Theft involuntary motions are often ften in paralytic limbs, which are at the fame time completely difobedient to the will; and are frequently obfervable in very young children ; and from thence we'may conclude, that theft motions are learnt be- fore nativity ; as puppies are ften to open their mouths before the membranes are broken. See SeCk. XVI. 2. Where theft motions are obftrved in limbs otherwife paralyt- ic, it is an indication that eleftric fhocks may be employed with advantage, as the excitability of the limb by irritation is not ex- tinct, though it be difobedient both to volition and ftnfation. 11. 'Tenefmus confifts in violent and frequent ineffectual ef- forts to difcharge the contents of the reCtum, owing to pain of the fphinCter. The pain is produced by indurated feces, or by fome acrid material, as the acidity of indigefted aliment; and the efforts are attended with mucus from the pained membrane. The feces muft fometimes be taken away by the end of a mar- row-fpoon, as cathartics and even clyfters will pafs without re- moving them. It is fometimes caufed by fympathy with the urethra, when there is a ftone at the neck of the bladder. Sec Clafs IL 2. 2. 7. and IV. 1. 2. 8. M. M. Fomentation, an enema with mucilage and laudanum. The common exclufion of the feces from the reftum is a pro- cefs fimilar to this, except that the mufcles of the fphinder ani, and thofe of the abdomen, which acl along with them by the combined powers of ftnfation and affbciation, are in tenefmus excited by painful ftnfation, and in the latter by a ftnfation, which may in fome inftances be almoft called pleafurable, as re- lieving us from a painful one in the exclufion of the feces. 12 Stranguria. Strangury confifts in painful efforts to dif- charge the contents of the urinary bladder. It is generally ow- ing to a ftone in the Iphin&er of the bladder ; or to the inflam- mation of the neck of it occafioned by cantharides. It is fome- times caufed by fympathy with the piles •> and then is liable in women 160 DISEASES Class II. 1. 1. 13. women to occafion convulfions, from the violence of the pain without inflammation. See Clafs IV. 2. 2. 2. and 3. M. M. Fomentation clyIler with oil and laudanum, pu(h the Hone 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 procefs fimilar to this, except that the mufcular fibres of the bladder, and the mufcles of the abdomen, which aft in concert with them by the combi- ned powers of fenfation and of aflbciation, are, in the former cafe of ftrangury, excited into action by painful fenfation ; and in the latter by a fenfation, which may almoft be termed pleaf- urable, as it relieves us from a previous uneafy one. The ejeftio feminis is another procefs in fome refpefts fimilar to ftrangury, as belonging to the fame fenfible canal of the ure- thra, and by exciting into aftion the acceleratory mufcles ; but in the ftrangury thefe mufcles are excited into aftion by painful fenfation, and in the ejeftion of the femen by pleafurable fenfa- tion. 13. Parturiiio. Parturition is not a difeafe, it is a natural pro- cefs,but is more frequently unfortunate in high life than amongft the middle clafs of females ; which may be owing partly to fear, with which the priefts of Lucina are liable to infpire the ladies of fafhion to induce them to lie-in in town ; and partly to the bad air of London, to which they purpofely refort. There are however other caufes^ which render parturition more dangerous to the ladies of high life ; fuch as their greater general debility from negleft of energetic exercife, their inexpe- rience of the variations of cold and heat, and their fecluuon from frefh air. To which muft be added, that great fource of the deftruftion of female grace and beauty, as well as of female health, the tight ftays and other bandages, with which they are generally tortured in their early years by the aftive folly of their friends, which by difplacing many of the vifeera impedes their aftions, and by comprefling them together produces adhefions of one part to another, and affefts even the form and aperture of the bones of the pelvis, through which the nafent child muft be protruded. As parturition is a natural, not a morbid procefs, no medicine fhould be given, where there is no appearance of difeafe. The abfurd cuftom of giving a powerful opiate without indication to all women, as foon as they are delivered, is, I make no doubt, frequently attended with injurious, and fometimes with fatal confequences. See Clafs II. 1.2. 16. Another thing very injurious to the child, is the tying and cutting Class II. 1. 1.13. OF SENSATION. 161 cutting the navel-ftring too foon ; which (hould always be left till the child has not only repeatedly breathed, but till all pulfa- tion in the cord ceafes. As otherwife the child is much weaker than it ought to be ; a part of the blood being left in the pla- centa, which ought to have been in the child ; and at the fame time the placenta does not fo naturally collapfe, and withdraw it- felf from the Tides of the uterus,and is not therefore removed with fo much fafety and certainty. The folly of giving rue or rhu- barb to new-born children, and the danger of feeding them with gruel inftead of milk, is fpoken of inClafs I. x. 2- 5. and II. 1. 2. 16. Many ladies become difeafed by an unnatural refufal of giving fuck to their child, which ought to relieve their breafts of the load of milk, and give confolation to their minds by the ftorge or love to their infant. Many ladies indeed experience a diffi- culty in nurfing their children from their not having nipples to their breads ; which have been often inflamed and deftroyed in their early years, even in their infancy, as I have feen, by the hard edge of ftiff ftays rubbing againft them, and fometimes, I believe, by the fmall-pox. M. Herholdt,ofCopenhagen,has announced a difcovery, which he thinks highly interefting to humanity ; which is, that the apparent death of new-born infants arifes from the trachea, or wind-pipe, being filled with water ; and that they may be gen- erally faved by giving them fuch an inclined pofition, that the water may run out. Of thirteen children, which were fuppofed to be dead or ftill-born, he fays, that twelve recovered by thefe Ample means. As the trachea may not have acquired due fen- fibility before delivery, in fome feeble or premature births, this eircumftance may poffibly arife, though it feldom occurs even in drowned people. Medical Review, July, 1799. Vol. II. X ORDO 162 DISEASES Class II. 1. 2. ORDO I. Increajed Zenfation. GENUS IL With the Production of neiv Vejfels by internal Membranes or Glands, with Fever. In the firft clafs of difeafes two kinds of fevers were defcri- bed, one from excefs, and the other from defeat of irritation ; and were in confequence termed irritative, and inirritative fevers. In this fecond clafs of difeafes another kind of fever occurs, which is caufed by excefs of fenfation, and termed in confe- quence Senfitive Fever. But there is no fever from defect of fenfation, becaufe the circulation is carried on in health without our confcioufnefs, that is, without any fenfation attending it. But as excefs of fenfation may exift with excefs or defect of irritation, two other kinds of fever arife from a combination of fenfitive fever with the irritative, and inirritative ones. Making five kinds in all. I. Irritative fever, defcribed in Clafs I. i. i. i. 2. Inirritative fever. Clafs I. 2. I. I. 3. Senfitive fever. Clafs II. 1. 6.1. 4. Senfitive irritated fever. Clafs II. 1. 2. 1. 5. Senfitive inirritated fever. Clafs II. I. 3. 1. As the fenfitive irritated fever attends all the difeafes enumer- ated under the genus about to be defcribed, it is placed at the head of it. And as the fenfitive inirritated fever accompanies the greateft number of the fpecies enumerated under the third genus of this order, it is placed at the head of them. And as the fenfitive fever attends the difeafes of the fixth genus, it is placed at the head of them. But as every febrile paroxyfm con- lifts of difordered tribes or trains of affociated motions, it may be doubted, whether they ought not all to have been placed in the fourth clafs, amongft the difeafes of aflbciation. See Clafs IV. 2. 4. 11. All the fubfequent fpecies of this genus are attended with fen- fitive irritated fever ; there are neverthelefs fome luperficial in- flammations, which affect the famefituations without much fever, as the fcrofulous ophthalmy and fpurious peripneumony, which belong to other genera. Inflammation is uniformly attended with the production or fecretion of new fibres conftituting new veffels; this therefore may Class. II. 1. 2. r. OF SENSATION. 163 may be efteemed its eflential charader, or the criterion of its exiftence. The extenfion of the old veflels feems rather a con- fequencethan a caufe of the germination, or pullulation, of thefe new ones ; for the old veflels may be enlarged, and excited with unufual energy, without any production of new ones, as in the blufh of (hame or of anger. When thefe new veflels are formed, if they are not reabforbed into the circulation, they fecrete a new fluid called purulent matter ; which generally opens itfelf a paflage on the externat fkin, and produces an ulcer, which either gradually heals, or fpreads, and is the caufe of hettic fever ; or they fecrete conta- gious matter, which has the property of exciting the fame kind of inflammation, and of producing the fame kind of contagious matter, when inferted by inoculation into the fkin of other per- fons. Thefe contagious matters form ulcers, which either heal fpontaneoufly, or by art; or continue to fpread, and deftroy the patient, by other kinds of heftic fever. In this genus there is an increafe of the fenforial power of ir- ritation as well as of fenfation ; whence great arterial energy is produced, and the pulfe becomes ftrong and full, as well as quick ; and the coats of the arteries feel hard under the finger, being themfelves thickened and diftended by inflammation. The blood drawn, especially at the fecond bleeding, is covered with a tough fize ; which is probably the mucus from the inflamed internal furface of the arteries, increased in quantity, and more coagulable than in its natural ftate ; the thinner part being more perfectly abforbed by the increafed action of the inflamed abforb- ents. See Seed. XXXIII. 2 2. This is rendered more prob- able, becaufe the hard feel of the pulfe, and the abundance of coagulable lymph commence, exift, and ceafe together. Great heat is produced from the new chemical combinations arifing in the fecretion of new fibres, and great pain from the diflention of old ones, or from their increafed adlion. The in- creafed quantity of fenfation from a topical inflammation or phlegmon is the immediate caufe of the febris fenfitiva irritata, or inflammatory fever ; as when it arifes from the pain of pleu- rify, 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 fenfitive irritated fever, by the additional caufe of the fenforial power of fenfation befides that of imitation. SPECIES. Febris fenfitiva irritata. Senfitive irritated fever, or in- flammatory 164 DISEASES Class II. 1. 2. r. flammatory fever. Phlegmafla. A ftrong full pulfe, with in- flammation of the coats of the arteries, conftitutes this difeafe. It originates from feme topical inflammation, which, if the fever is not fubdued, terminates in fuppuration ; and differs from ir- ritative fever in refped to the painful fenfation which accompa- nies it. For as pleafurable fenfation is the caufe of the growth of the new veflels and inflammation of the old ones,in the natural enlargement of them during our infancy ; fo a painful fenfa- tion is the caufe of the unnatural production of new veflels, and enlargement of old ones in inflammatory difeafes. When matter is thus formed in any internal vifeus, or in the cellular membrane, as in the lungs or liver ; fo long as this abfeefs remains without admiflion 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 the airbe admitted to thefe internal ab- feefles, this kind of fever is changed into a heClic fever in a An- gle day. It alfo fometimes happens, that when the abfeefs re- mains unopened to the air, if the matter has become putrid, hec- tic fever fupervenes, with colliquative tweats, or diarrhoea; the matter in both cafes is fometimes abforbed, and the fldes of the abfeefs grow together again without an external aperture. See Clafs II. i. 4. i. and 2. Another termination of inflammation is in gangrene, but this belongs to the inflammation of the ex- ternal fkin ; as the production of purulent matter belongs to in- flammation of the internal or mucous membranes. Thus when the external fkin is the feat of inflammation, as in erythema, or eryApelas, and produces fenfltive irritated fever, no collection of purulent matter can be formed ; but a material oozes out, and lies upon the furface, like that in the confluent fmall-pox, and the cuticle at length peels off, or gangrene fupervenes. It muft be noted, that thefe kinds of inflammation can exift together ; and fome parts of the cellular membrane may fuppurate at the fame time that the external fkin is affeCled with erythema, or eryfipelas. M. M. VenefeCtion. Cathartics. Diluents. Cool air. Torpentia. Cold bath ? See SeCt. XII. 6. The increafed arterial action in this fenfltive irritated fever is not Amply owing to the increafed irritability of the arterial fyf- tem, or to the ftimulus of the diftention of the veflels, but alfo to the increafed acrimony or pungency of the blood ; which has now fo far changed its nature as to become more fluid, more denfe, and to be loaded with coagulable lymph Hence it becomes neceflary not only to leflen the quantity of blood by venefeCiion and by cathartics, but alfo to dilute its acrimo- ny, Class II. 1. 2. 2. OF SENSATION. 165 ny, or pungency, by the introduction of aqueous and mucilagin- ous fluids, fuch as barley water, cream and water, fugar and water, weak broths ; to which may be added fo much of tome vegetable eflential oil, as may render them grateful to the ftom- ach, and thus promote their abforption ; as by infufing parfley or cellery and turnips in the broth ; or by balm, mint, or fage teas. The following fpecies of this genus only diftinguifh the fitua- tion of the part previoufly inflamed, and which is the remote caufe of the fenfitive irritated, or inflammatory fever, which at- tends it. 2. Ophthalmia interna. Inflammation of the eye is attended with the production of new veflels, which fpread over the tunica adjunCtiva, and over the cornea; thefe new veflels are eaftly feen, as they lie on a white ground, and give ocular demonftra- tion of their production in inflammation. .When this inflamma- tion of the cornea fuppurates, it is liable to leave little ulcers, which may be feen beneath the furface in the form of little ex- cavations ; and as thefe heal, they are liable to be covered with an opaque fear. This fear, in fome months or years, is liable to wear away, and become tranfparent, without the affiftance of any polifhing powder, as of very finely levigated glafs, as fome have recommended. But when the cornea is affeCted through all its thicknefs, the return of its tranfparency becomes hopelefs. See ClafsI. 1.3. 14. In violent degrees of ophthalmy the internal parts, as the reti- na, optic artery, iris, ciliary procefs, become inflamed, as well as the external ones ; hence the leaft light admitted to the eye occafions intolerable pain. This curious circumftance cannot be owing to the aClion of light on the inflamed veflels of the cornea ; it therefore (hews, that the extremity of the optic nerve or retina is alfo rendered more exquifitely fenfible to light, by partaking of the inflammation ; and I have been told, that red colours are in thefe cafes fometimes painfully perceived even in perfeCt darknefs. This (hews that the retina is excited into motion by the ftimulus of light; and that, when it is inflamed, thefe motions give great pain, like thofe of other inflamed parts, as the mufcles or membranes. And fecondly, that the ideas of colours confift in the motions of the retina ; which ideas occafion pain, when the extremity of the moving nerve is in- flamed. M. M. VenefeClion. Cathartics. Diluents. Torpentia. Frequently moiften the eye with cold water by means of a rag. Cool airy room. Darknefs. When the inflammation begins to decline, white vitriol gr. vi, in an ounce of water is more effica- cious 166 DISEASES Class II. 1. 2. 3. clous to moiften the eye than folutions of lead. Tintlure of o- pium diluted. ExtraCi of belladonna. New veflels from the inflamed tunica adnata frequently fpread like a fly's wing upon the tranfparent cornea, which is then called Pterigium. To flop the growth of this, the principal veflels fhould be cut through with a lancet. When the inflammation begins to decline, after due evacuation any ftimulating material put into the eyeincreaf- es the abforption, which foon removes the new red veflels; which has given rife to a hundred famous eye-waters, and eye- doctors •, if thefe ftimulating materials are ufed too foon, the inflammation is increafed by them. See bed. XXXII. 2. io. Clafs I. 2- 2. 13. 1 here is another ophthalmia, which attends weak children, and is generally efteemed a fymptom of fcrofula, as defcribed in Clafs II. 1. 5. 3. and another, which is of the venereal origin, mentioned in Clafs II. 1. 3. 2. both which may be termed ophthalmia fuperficialis. 3. Phrenitis. Inflammation of the brain is attended with in- tolerance of light and found ; which fhews, that the extremities of the nerves of thofe fenfes are at the fame time inflamed ; it is alfo attended with great pain of the head, with watchfulnefs, and furious delirium. The violent efforts, thefe patients are faid fometimes to exert, are owing to the increafed fecretion of fenfo- rial power in the brain ; as all other inflamed glands have a greater circulation of blood paffing through them, and a greater fecretion in confequence of their peculiar fluids, as in the hepa- titis much more bile is generated. M. M. VenefeClion. 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 blifter on the head, and after further exhauftion five or fix drops of tinfture of opium. 4. Peripneumonia. Inflammation of the lungs. The pulfe is not always hard, fometimes foft; which is probably owing to a degree of ficknefs or inaCtion of the ftomach; with dull pain of the chefl; refpiration conftantly difficult, fometimes with ereCl pollure; the face bloated and purpliffi ; cough generally with moift expectoration, often flained with blood. When the difficulty of refpiration is very great, the patient is not able to cough ; in this fituation, after copious bleeding, the cough is liable to return, and is fo far a favourable fymptom, as it fhews fome abatement of the inflammation. A peripncumony frequently occurs in the chin-cough, and de (troys the patient, except immediate recourfe be had to the Class II. 1. 2. 4. OF SENS YFION. 167 the lancet, or to four or five leeches ; when blood cannot be otherwise taken. The peripneumony is very fatal to young children, efpecially as I believe it is frequently miftaken for afpafmodic afthma, or for the croup, or cynanche trachealis of Cullen. Both which, however, when they occur, require immediate venefeCtion by the lancet or by leeches, as well as the peripneumony ; as men- tioned below. Inflammation of the lungs is alfo liable to occur in the mealies, and in the hooping-cough, and muft be attacked by venefeCtion at any time of the difeafe ; otherwife either a prefent death, or an incurable confumption, is the confequence. The peripneumony is frequently combined with inflammation of the pleura, and fometimes with that of the diaphragm ; either of thefe may generally be diftinguifhed, not only by the pain which attends inflammation of thefe membranes, but by infpe6t- ing the naked chert, and obferving whether the patient breathes more by elevating the ribs, or by deprelhng the diaphragm. A crifis happens in children about the fixth day with much pale urine, which murt be waited for after evacuations have been ufed, as far as can be done with fafety ', in this fituation the warm bath twice a day, and fmall blifters repeatedly in fuccef- fion, are of peculiar fervice. After the termination of peripneumony a collection of coag- ulable lymphis frequently left in the cavity of the cheft unabforb- ed ; or a common anafarcaof the lungs occurs from the prefent inaction of the abforbent veflels, which had previoufly been ex- cited too violently. This difficulty of breathing is cured or re- lieved by the exhibition of digitalis. See Art. IV. 2. 7. M M. The lancet is the anchor of hope in this difeafe ; which murt be repeated four or five times, or as often as the fe- ver and difficulty of breathing increafe, which is generally in the evening ; antimonials, diluents, repeated fmall biirters about the cheft, mucilage, pediluvium, warm bath. Is a decoCtion of feneca-root of ufe ? Do not neutral faits increafe the tenden- cy to cough by their ftimulus,as they increafe the heat of urine in gonorrhoea ? Children in every kind of difficult breathing, from whatever caufe, fhould be kept as upright in bed as may be, and continually watched ; fince, if they flip down, they are liable to be immediately fuffocated : to prevent which a pillow fhould be put beneath the undermoft (heet half way down in the bed, fo as to receive the pofteriors of the child, and thus coun- teract its Aiding down lower ; or dray/ers on the thighs might be ocafionally ufed for this purpofe, as mentioned in Clafs III. 2. 1. 10. And children fhould have no cap firing tied mid'r their 168 DISEASES Class II. i. 2.4. their chins, in any cough or difficulty of refpiration, fince if they flip down in their bed the friction of the night-cap on the pil- low is liable to draw the tape or ribbon under the chin too tight, and fuffocate them. After the patient is greatly debilitated, fo 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 folid opium, with great advantage, and I believe in feveral cafes I have faved the patient. A greater quantity of opium in this ftate of debility cannot be ufed without hazarding the life of the perfon. This fmall quantity of an opiate fhouid be given about fix in the evening, or before the accefs of the evening paroxyfm, and repeated three or four nights, or longer. There is a peripneumony with weak pulfe, which may be termed peripneumonia inirritata^ as defcribed in Se6t. XXVII. 2. which belongs to this place. See alfo Superficial Peripneumo- ny, Clafs II. 1. 3. 7. Peripneutnonia arthritica. Gouty peripneumony. I believe, that there exifts a peripneumony, and a pleurify which owe their inflammation to the fympathy of thofe membranes with fome other parts of the fyftem, and may then be properly termed rheumatic or gouty peripneumony, or pleurify. And that the coagulable lymph left upon the inflamed membranes has gener- ally been owing to thefe fympathetic inflammations, and that hy- drops thoracis, and anafarca pulmonum are generally caufed by gouty affections of the lungs, or rheumatic affections of the pleu- ra, and not by the more common idiopathic inflammations of thofe membranes. See Clafs I. 2. 3. 14. and Clafs IV. 1. 2. j 6. and Clafs IV. 1. 2. 9. Peripneumonia trachealis. Croup. The croup is an inflam- mation of the upper part, and,the peripneumonia of the lower part of the fame organ, viz. the trachea or wind-pipe. See Clafs I. 1. 3- 4. But as the inflammation is feldom, I believe, confined to the upper part of the trachea only, but exifts at the lame time in other parts of the lungs; and as no inflammation of the tonfils is generally perceptible, the uncouth name of cynan- che. trachealis Ihould be changed for peripneumony trachealis. Dr; Wichmann, of Hanover, believes, that the acute afthma of Millar, or hives,has been confounded with the angina polypofa, or croup, which has occafioned the great difference in the treat- ment recommended by authors; as the difeafe has been efteem- ed inflammatory by fome, and fpafmodic by others. The convulfive afthma, which I have witneffed in one child, was readily diftinguifhed from the croup ; as there was Amply a great exertion in breathing, but without the harlh found which attends Class II. 1. 2. 4. OF SENSATION. 169 attends the infpiration in the latter, and there was no attendant fever ; and the difeafe was cured by one venefedion, and a moderate dofe of opium after the venefebtion. See afthma convulfivum Clafs III. i. i. io. A convulfive difficulty of refpiration may thus be eafily dif- tinguiffied from the croup ; as in the former the patient draws in the breath eafily, and then voluntarily clofes the larynx, and voluntarily ufes great exertion in forcing out the breath, with defign to relieve fome pain by this violent exertion, as in parox- yfms of epilepfy. On the contrary, in the croup the breath is eafily expired, but the infpirations are attended with the utmoft difficulty. This difficulty of infpiration may be feen by viewing the region of the ftomach ; as when the child raifes the fternum for the purpofe of drawing in its breath, the preffure of the atmof- phere on the pit of the ftomach preffies the diaphragm upwards, and makes a fudden and great hollow in the fcrobiculus cordis. This difficulty of infpiration, and not of expiration, is alfo known by the harfh found, which only attends the infpiration. This difficulty of infpiration may in part be owing to this cir- cumftance. In differing thofe children who have died of the croup, I believe the upper part of the adherent coagulable lymph, or indurated mucus, formed within the trachea, is found to be- come loofe, and to feparate from the upper part of the trachea before the lower part of that adhefive membranous cruft begins to feparate, and hence the loofe upper part at the time of infpira- tibn is bent downwards into the trachea, and thus becomes dou- ble, and obftrubts the paflage ; but this duplicature of it does not happen in expiration. See Tranfacf. of a Society, Vol. II. Account of Croup, by Henry Ramfey, cafe the 8th. Might not this be prevented from being fatal, by an aperture into the wind- pipe beneath the larynx ? I have very lately feen a moft diftindt cafe of this peripneu- monia trachealis, or croup. The child, about ten months old, had great difficulty in drawing in its breath, with much noife ; but had much lefs difficulty in its expiration, with little or gener- ally no found. On obferving its naked cheft, the fternum, or breaft-bone, was feen to be raifed with great force ; and then the diaphragm, and the bowels under it, rofe haftily up into the low- er part of the cavity of the cheft ; and the air ruffied with diffi- culty, and with great found, through the contracted larynx into the upper part of the cheft ; both thefe effects were evidently owing to the prefiure of the atmofphere, to fupply the vacuity, which mull otherwife fucceed the forcibly raifing of the fternum. Why the difficulty of infpiring was fo much greater than Vol. II. Y of 170 DISEASES Glass II. 1. 2. 4. of expiring) requires to be further explained. During infpira- tion, the preflure of the atmofphere, when the cavity of the cheft is enlarged by raifing the fiernum, and depreffing the dia- phragm, adls upon the external part of the larynx, as well as on the aperture of it, and thus contradis it, and affifts the diftafe; whereas in expiration there is no increafe of atmofpheric pref- fure on the outfide of the larynx, or trachea, to prevent the ex- clufion of the air. In the fame manner, if a flexible pipe of foft leather was extended upwards a few inches through the bottom of a bucket of water, but very little of the water could be dif- charged by it; as the preflure on its Iides would foon comprefs the pipe, and thus flop up its mouth. After repeated venfeftion, and a cathartic of calomel, a blif- ter was applied on each fide of the larynx, and the difficulty of breathing became greatly relieved ; and though the child had in- tervals of eafier refpiration, and without noife, yet it died on the fucceeding day. Where the difficulty of breathing is very urgent in the croup, bronchotomy, is recommended by Mr. Field. Memoirs of a Medical Society, in London, 1773, Vol IV. After repeated venfeClion, and cathartics, perhaps a drop or two drops of tincture of opium, about fix in the evening, might be of ufe to prevent the return of the evening paroxyfm, and this efpecially if the difficulty of refpiration has an interval or remif- fion, as mentioned below. A ftrong deco&ion of feneca root is recommended by Dr. Archer, of America. He boils half an ounce of the root, from eight ounces of water to four, and gives a tea-fpoonful every hour or half hour, fo as to produce vomiting or purging, and then gives it in fmaller quantities. He alfo rubs mercurial ointment about the throat, and ufes calomel internally, fo as to affeCl the glands of the throat as quickly as poffible, when the dileafe is more advanced, and the difficulty of breathing with harfh and thrill infpiration is more urgent. Medical and Phyfic- al Journal, No. I. p. 83- As a decoCtion of feneca root partic- ularly (Emulates fome parts of the throat, occafioning a difagree- able fenfation in it, it may in fome cafes contribute to loofen or difcharge the adhefive coagulable lymph, which has been fecre- ted on the inflamed membrane of the wind-pipe, and occafions the difficulty of infpiration by contracting its aperture ; and may therefore be worth trial after repeated venefection, and cathartics, and blifters on each fide of the throat. Dr. Wichmann of Hanover, above mentioned, aflerts, that in the croup the difeafe continues regularly to increafe, from the commencement of it, without intervals of relief from the great difficulty Class II. 1. 2. 5. OF SENSATION. 171 difficulty of breathing ; and gives this as a criterion to diftin- guifh the angina polypofa from the afthma acutum. Annals of Medicine, Vol. I. But in the cafes of true croup, peripneumo- nia trachealis, I have feen with furprife the difficulty of refpira- tion to ceafe for a time, and return again with unabated violence. Thefe remiffions of the difficult refpiration are alfp mentioned by Dr. Ferrair, who then terms it a fpurious croup, but which I fufpeft to be owing Gmply to the following circumftances. In a common catarrh, when the mucous membrane of the noftrils is much inflamed, it becomes fo thickened as totally to prevent refpiration through them ; yet on fuddenly warming the Ikin, by drinking tea or by a fire, and fometimes by only cooling the membrane of the noftrils by going into the cold air, the fwel- ling of this membrane will fuddenly fubfide, fo as to permit the air to pafs through quite eafily for a time, as explained in ca- tarrhus calidus. Clafs I. I. 2. 7. The fame circumftance may occur to the inflammation of the membrane, which lines the up- per part of the trachea, or it may happen from the doubling of the loofened upper part of the adhefive mucus. M. M. Frequent bleeding by the lancet or leeches. A few grains of calomel. Seneca. Blifters about the throat. An opiate in fmall quantity at night after previous evacuations. Mercurial ointment. Warm bath. Breathing over the fteam of warm water, with or without volatile alkali, or ether, or vine- gar. Particular attention fhouldbe ufed to keep the child raifed high in bed. Might the fkin be kept-agreeably warm, and at the fame time might quite cold air be breathed through a tube coming from without, through a broken window, or hole in a door ? Or might the child be carried out into the cold air very warmly clad ? If a folution of fublimate could be fafely ufed, as in gonorrhea, Clafs II. 1. 5. 1 ? After evacuation by copious venefeflion, might not the fre- quent application of ether externally to the throat be ferviceable ? And where there occur intervals of eafy refpiration, might not breathing over the duft of powdered Peruvian bark prevent a re- turn of the thickening of the membrane, as defcribed in Clafs II. 5. Pletiritis. Pleurify. Inflammation of the pleura, with hard pulfe, pain chiefly of the fide, pungent, particularly increaf- ed during infpiration : lying on either fide uneafy, the cough very painful,dry at the beginning, afterwards moift, often bloody. One caufe of pleurify is probably a previous adhefion of the lungs to a part of the pleura, which envelopes them. . This in many cafes has been produced in infancy, by fuffering children to lie too long on one fide. Or bv placing them uniformly on one fide DISEASES Class II. 1. 2. 6. 172 fide of a fire Or window, to which they will be liable always to bend themfelves. When matter is produced during peripneumony or pleurify in one fide of the cheft, fo long as it is a concealed vomica, the fever continues, if the difeafe be great, for many weeks, and even months ; and requires occafional venefe&ion, till the patient finks under the inflammatory or fenfitive irritated fever. But if air be admitted, by a part of the abfcefs opening itfelf a way in- to the air veflels of the lungs, a heflic fever, with colliquative fweats or diarrhoea, fupervenes, and frequently deftroys the pa- tient ; or the abfcefs heals, the lungs adhering to the pleura. See pleurodyne rheumatica. Clafs IV. 1.2. 16. M. M. The lancet muft be ufed copioufly, and repeated as often as the pain and difficult refpiration increafe. A blifter on the pained part. Antimonial preparations. Diluents. Cool air. Do neutral faits increafe the tendency to cough ? Pedi- luvium or femicupium frequently repeated. 6. Diaphragmitis. Inflammation of the diaphragm. Pain round the lower ribs as if girt with a cord. Difficult refpira- tion performed only by elevating the ribs and in an eredt pof- ture. The corners of the mouth frequently retraced into a dif- agreeable fmile, called rifus Sardonicus. Thofe animals, which are furniffied with clavicles, or collar- bones, not only ufe their foremoft feet as hands, as men, mon- keys, cats, mice, fquirrels, &c. but elevate their ribs in refpira- tion as well as deprefs the diaphragm for the purpofe of enlarg- ing the cavity of the cheft. Hence an inflammation of the dia- phragm is fudden death to thofe animals, as horfes and dogs, which can only breathe by depreffing the diaphragm ; and is I fuppofe the caufe of the fudden death of horfes that are over- worked ; whereas, in the human animal, when the diaphragm is inflamed, fo as to render its motions impoffible from the pain they occafion, refpiration can be carried on, though in a lefs per- fect manner, by the intercoftal mufcles in the elevation of the ribs. In pleurify the ribs are kept motionlefs, and the refpira- tion is performed by the diaphragm, as may be readily feen on infpetfting the naked cheft, and which is generally a bad fymp- tom; in the diaphragmitis the ribs are alternately elevated, and deprefled, but the lower part of the belly is not feen to move. M.M. As in pleurify and peripneumony. When the pa- tient becomes delirious, and fmiles difagreeably by intervals, and is'become fo weak, that evacuations by the lancet could be ufed no further, and I have almoft defpaired of my patient, I have found in two or three inftances, that about five or fix drops of tin ci. thebaic, given an hour before the evening exacerbation, have Class II. 1. 2.7. OF SENSATION. 173 have had the happieft effect, and cured the patient in this cafe, as well as in common peripneumony ; it muft be repeated two or three evenings, fee Clafs II. i. 2.4. as the exacerbation of the fever, and difficult refpiration, and delirium, generally in- creafe towards night. The ftimulus of this fmall quantity of opium on a patient previoufly fo much debilitated, aCts by increasing the exertion of the abforbent veflels, in the fame manner as a folution of opium, or any other ftimulant, put on an inflamed eye after the veflels are previoufly emptied by evacuations, ftimulates the abforbent fyftem, fo as to caufe the remaining new veflels to be immediate- ly reabforbed. Which fame ftimulants would have increafed the inflammation, if they had been applied before the evacua- tions. See Clafs II. 1. 2. 2. SeCt. XXXIII. 3. 1. When the fanguiferous fyftem is full of blood, the abforbents cannot aCt fo powerfully, as the progrefs of their contents is oppofed by the previous fulnefs of the blood-veflels; whence ftimulants in that cafe increafe the adlion of the fecerning fyftem more than of the abforbent one; but after copious evacuation this refiftance to the progrefs of the abforbed fluids is removed ; and when ftim- ulants are then applied, they increafe the action of the abforb- ent fyftem more than that of the fecerning one. Hence opium given in the commencement of inflammatory difeafes de- ftroys the patient; and cures them, if given in very fmall dofes at the end of inflammatory difeafes. 7. Carditis. Inflammation of the heart is attended with un- equal intermitting pulfe, palpitation, pain in the middle of the fternum, and conftant vomiting. It cannot certainly be diftin- guiffied from peripneumony, and is perhaps always combined with it. । 8. Peritonitis. Inflammation of the peritonaeum is known by pain all over the abdomen, which is increafed on erecting the body. It has probably molt frequently a rheumatic origin. See Clafs II. 1.2. 17. 9. Mefenteritis. Inflammation of the mefentery is attended with pains like colic, and with curdled or chyle-like (tools. It is a very frequent and dangerous difeafe, as the production of matter more readily takes place in it than in any other vifeus. The confequence of which, after a hard labour, is probably the puerperal fever, and in fcrofulous habits a fatal purulent fever, or hopelefs confumption. M. M. Venefedtion. Warm bath. Emollient clyfters. 10. Gajlritis. In inflammation of the ftomach the pulfe is generally foft, probably occafioned by the ficknefs which attends it. DISEASES ClassII. i. 2. li. 174 it. The pain and heat of the ftomach are increafed by what- ever is fwallowed, with immediate rejection of it. Hiccough. This difeaie may be occafioned by acrid or indigeftible mat- ters taken into the ftomach, which may chemically or mechanical- ly injure its interior coat. There is however a {lighter fpecies of inflammation of this vifcus, and perhaps of all others, which is unattended by much fever ; and which is fometimes induced by drinking cold water, or eating cold infipid food, as raw turnips, when the perfon has been much heated and fatigued by exercife. For when the fenforial power has been diminifhed by great ex- ertion, and the ftomach has become lefs irritable by having been previoufly ftimulated by much heat, it fooner becomes quiefcent by the application of cold. In confequence of this flight inflam- mation of the ftomach an eruption of the face frequently enfues by the fenfitive aflbciation of this vifcus with the fkin, which is called a forfeit. See ClafsIV. i. 2. 13. and II. 1. 4. 6. and II. 1. 3. 19. M. M. Venefeclion. Warm bath. Blifter. Anodyne clyf- tcrs. Almond foap. See Clafs II. 1. 3. 17. 11. Enteritis. Inflammation of the bowels is often attended with foft pulfe, probably owing to the concomitant ficknefs ; which prevents fometimes the early ufe of the lancet, to the de- ftru&ion of the patient. At other times it is attended with ftrong and full pulfe like other inflammations of internal mem- branes. Can the feat of the difeafe being higher or lower in theinteftinal canal, that is, above or below the valve of the co- lon, produce this difference of pulfe by the greater fympathy of one part of the bowels with the ftomach than another ? In en- teritis with ftrong pulfe the pain is great above the navel, with vomiting, and the greateft difficulty in procuring ftool. In the other, the pain and fever are lefs, without vomiting, and with diarrhoea. Whence it appears that the enteritis with hard quick pulfe differs from ileus, defcribed in Clafs I. 3. 1. 6. only in the exiftence of fever in the former and not in the latter, the other fymptoms generally correfponding ; and, fecondly, that the enteritis with fofter quick puife, differs from the cholera de- fcribed in Clafs I. 3. 1.5 only in the exiftence of fever in the former, and not in the latter, the other fymptoms being in gen- eral fimilar. See Oafs II. 1.3.20. Inflammation of the bowels fometimes is owing to extraneous indigeftible fubftances, as plum-ftones, efpecially of the dama- fin, which has {harp ends. Sometimes to an introfufeeption of one part of the inteftine into another, and very frequently to a ftrangulated hernia or rupture. In refpect to the firft, I knew an inftance where a damafin ftone, after a long period of time, found Class II. 1.2.52. OF SENSATION. 175 found its way out of the body near the groin. I knew another child, who vomited fome damafin ftones, which had lain for near twenty hours, and given great pain about the navel, by the exhi- bition of an emetic given in repeated dofes for about an hour. The fwallowing of plum ftones in large quantities, and even of cherry-ftones, is annually fatal to many children. In refpedt to the introfufception and hernia, fee Ileus, Clafs I. 3. 1. 6. M. M. Repeated venefeftion. Calomel from ten to twen- ty grains given in fmall pills as in ileus; thefe means ufed early in the difeafe generally fucceed. After thefe evacuations a blif- ter contributes to ftop the vomiting. Warm bath. Crude mercu- ry. Aloes one grain-pill every hour will frequently ftay in the ftomach. Glauber's fait diflblved in pepper-mint water given by repeated fpoonfuls. When the patient is much reduced, opium in every fmall do- fes may be given,as a quarter of a grain,as recommended in pleu- rify. If thepainfuddenly ceafes,and the patient continues to vom- it up whatever is given him,it is generally fatal; as it indicates, that a mortification of the bowel is already formed. Some au- thors have advifed to join cathartic medicines with an opiate in inflammation of the bowels, as recommended in colica faturnina. This may fucceed in (lighter cafes, but is a dangerous practice in general; fince, if the obftrudlion be not removed by the e- vacuation, the ftimulus of the opium is liable to increafe the action of the veflels, and produce mortification of the bowel, as I think I have feen more than once. Mercury injected by the anus, or water by a forcing-pump. See Ileus I. 3. 1. 6. 12. Hepatitis. Inflammation of the liver is attended with ftrong quick pulfe ; tenfion and pain of the right fide; often pungent as in pleurify, oftener dull. A pain is faid to a fie it the clavicle, and top of the right (boulder ; with difficulty in ly- ing on the left fide ; difficult refpiration ; dry cough ; vomit- ing hiccough. There is another hepatitis mentioned by authors, in which the fever, and other fymptoms, are wanting, or are lei's violent; as defcribed in Clafs II. 1.4. it. and which is probably fome- times relieved by eruptions of the face •, as in thofe who are ha- bituated to the intemperate ufe of fermented liquors. M. M. Hepatic inflammation is very liable to terminate in fuppuration, and the patient is deftroyed by the continuance of a fever with fizy blood, but without night fweats, or diarrhoea, as in other unopened abfcefles. Whence copious and repeated venefedtion is required early in the difeafe, with repeated dofes of calomel, and cathartics. Warm bath. Towards the end of the difeafe fmall dofes of opium before the evening paroxyfms, and DISEASES 176 Class II. 1. 2. 13. and laftly the Peruvian bark, and chalybeate wine, at firft in fmall dofes, as 20 drops twice a day, and afterwards, if ne- ceiflary, in larger. See Art. IV. 2. 6. Towards the end of hepatitis, after repeated venefedHon and catharfis, an eruption fometimes appears round the lips, which is generally a falutary fymptorh: and the decoftion of Peruvian bark given at this time, in the quantity of about two ounces ev- ery fix hours, removes the remaining inflammatory tendency, and cures in a day or two. Mrs. C. a lady in the laft month of her pregnancy, was feiz- ed with violent hepatitis, with fymptoms both of peripneumony and of pleurify, for it teldom happens in violent inflammations, that one vifcus alone is affedled ; fhe wanted then about a fort- night of her delivery, and after frequent venefedtion, with gen- tle cathartics, with fomentation or warm bath, (he recovered and was fafely delivered,and both herfelf and child did well. Rheu- matic and eruptive fevers are more liable to induce abortion. 13. Splenitis. Inflammation of the fpleen commences with tenfion, heat, and tumour of the left fide, and with pain, which is increafed by preflure. A cafe is defcribed in Clafs I. 2. 3. 18. where a tumid fpleen, attended with fever, terminated in fcir- rhus of that vifcus. 14. Nephritis. Inflammation of the kidney teems to be of two kinds; each of them attended with different fymptoms, and different modes of termination. One of them I fuppofe to be an inflammation of the external membrane of the kidney, ari- fing from general cautes of inflammation, and accompanied with pain in the loins without vomiting; and the other to confift in an inflammation of the interior parts of the kidney, occafioned by the ftimulus of gravel in the pelvis of it, which is attended with perpetual vomiting, with pain along the courfe of the ureter, and retrailion of the teftis on that fide, or numbnefs of the thigh. The former of thete kinds of nephritis is diftinguifhed from lumbago by its fituation 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 eryfipelas, called zona, or fhingles, breaks out about the loins in its (lead : at other times it is cured by a cathartic with calomel, with or without previous venefec- tion. The other kind of nephritis, or inflammation of the interior part of the kidney, generally arites from the pain occafioned by the ftimulus of a ftone entering the ureter from the pelvis of the kidney ; and which ceafes when the ftone is protruded forwards into the bladder ; or when it is returned into the pelvis of the kidney Class II. 1. 2. 15. OF SENSATION. 177 kidney by the retrograde adiion of the ureter. The kidney 13 neverthelefs inflamed more frequently, though in a lefs degree, from other caufes; efpecially from the intemperate ingurgitation of ale, or other fermented or fpirituous liquors. This lefs de- gree of inflammation is the caufe of gravel, as that before men- tioned is the effeft of it. The mucus fecreted to lubricate the internal furface of the uriniferous tubes of the kidney becomes fecreted in greater quantity, when thefe veflels are inflamed ; and, as the correfpondent abforbent veflels ad}: more energetically at the fame time, the abforption of its more fluid parts is more powerfully affedled ; on both thefe accounts the mucus becomes both changed in quality and more indurated. And in this man- ner ftones are produced on almoft every mucous membrane of the body ; as in the lungs, bowels, and even the pericardium, as fome writershave affirmed. See Clafs I. 1. 3. 9. M. M. Venefedtion. Ten grains of calomel given in fmall pills, then infufion of fena with oil. Warm bath. Then opi- um a grain and half. See Clafs I. 1. 3. 9. for a further ac- count of the method of cure. 15. Cyftitis. Inflammation of the bladder is attended with .tumor and pain of the lower part of the belly ; with difficult and painful midlurition ; and tenefmus. It generally is produ- ced by the exiftence of a large ftone in the bladder, when in a great degree ; or is produced by common caufes, when in a ilighter degree. The ftone in the bladder is generally formed in the kidney, and palling down the ureter into the bladder becomes there grad- ually increafed in fize ; and this moft frequently by the appofi- tion of concentric fpheres, as may be feen by fawing fome of the harder calculi through the middle,and polifhing one furface. Thefe new concretions fuperinduced on the nucleus, which de- fcended from the kidney, as defcribed in Clafs I 13 9. and in the preceding article of this genus, is not owing to the micro- cofmic fait, which is often feen to adhere to the Tides of cham- ber-pots, as this is foluble in warm water, but to the mucus of the bladder, as it rolls along the internal furface of it. Now when the bladder is flightly inflamed, this mucus of its internal furface is fecreted in greater quantity, and is more indurated by the abforption of its more liquid part at the in ft ant of fecre- tion, as explained in Clafs I. 1. 3. 9. and II. 1. 2. 14. and thus the ftimulus and pain of a ftone in the bladder contribute to its enlargement by inflaming the interior coat of it. M. M. Venefedlion. Warm bath. Diluents. Anodyne clyfters. See Clafs I. f. 3 9. 16. Hyfieritus. Inflammation of the womb is accompanied Vol. II. Z with 178 DISEASES Class II. 2. 1. 17. with heat, tenfion, tumour, and pain of the lower belly. The os uteri painful to the touch. Vomiting. This difeafe is gen- erally produced by improper management in the delivery of pregnant women. I knew an unfortunate cafe, where the pla- centa was left till the next day; and then an unlkilful accouch- eur introduced his hand, and forcibly tore it away ; the confe- quence was a moft violent inflammatory fever, with hard throb- bing pulfe, great pain, very fizy blood, and the death of the pa- tient. 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 faid was to fave time. Many women I believe have been victims to this unnat- ural practice. Others have received injury, where inflammation has been beginning, by the univerfal practice of giving a large dofe of o- pium immediately on delivery, without any indication of its propriety ; which, though a proper and ufeful medicine, where the patient is too feeble, when given in a fmall dofe, as io drops of tinfture of opium, or half a grain of folid opium, mud do a proportionate injury, when it is given improperly ; and as delivery is a natural procefs, it is certainly more wife to give no medicines, except there be fome morbid fymptom, which re- quires it ; and which has only been introduced into cuftom by the ill-employed activity of the priefts or prieftefles of Lucina ; like the concomitant nonfenfe of cramming rue or rhubarb into the mouth of the unfortunate young ftranger, who is thus foon made to experience the evils of life. See Clafs II. i. i. 12. and I. 1. 2. 5. Juft fo fome over-wife beldames force young ducks and turkeys, as foon as they are hatched, to fwallow a pepper corn. M. M. Venefeftion repeatedly ; diluents ; fomentation ; the patient flrould be frequently raifed up in bed for a fhort time, to give opportunity of difcharge to the putrid lochia ; mucilag- inous clyfters. See Febris Puerpera. 17. Lumbago fenjitiva. Senfitive lumbago. When the exten- five membranes, or ligaments, which cover the mufcles of the back are torpid, as in the cold paroxyfm of ague,they are attend- ed with pain in confequence of the inaction of the veflels, which compofe them. When this inaction continues without a confe- quent renewal or increafe of activity, the difeafe becomes chron- ical, and forms the lumbago frigida, or irritativa defcribed in Clafs I 2. 4. 16. But when this cold fit or torpor of thefe membranes, or ligaments or mufcles of the back, is fucceeded by a hot fit, and consequent inflammation, a violent inflammatory fever, with great pain, occurs, preventing the ereft pofture of the Class II. 1. 2. 18. OF SENSATION. 179 the bodv, and the afleCled part is liable to fuppurate, in which cafe a very dangerous ulcer is formed, and a part of one of the vertebrae is generally found carious, and the patient finks after a long time under the hectic fever occafioned by the aerated or oxygenated matter. This difeafe bears no greater analogy to rheumatifm than the inflammation of the pleura, or any other membranous inflam- mation ; and has therefore unjulily been arranged under that name. It is diltinguifhed from nephritis, as it is feldom attend- ed with vomiting, I fuppofe never, except the ureter happens to be inflamed at the fame time. The pain fometimes extends on the outfide of the thigh from the hip to the ankle, heel, or toes, and is then called fci- atica ; and has been thought to confift in an inflammation of the theca, or covering of the fciatic nerve, as the pain fometimes fo exactly attends the principal branches of that nerve. See Clafs I. 2. 4. 15. 16. M. M. VenefeCtion repeatedly ; calomel; gentle cathartics ; diluents ; warm bath ; poultice on the back, confiding of camo- mile flowers, turpentine, foap, and opium ; a burgundy-pitch plafter. A debility of the inferior limbs from the torpor of the mufcles, which had previoufly been too much excited, frequent- ly occurs at the end of this difeafe ; in this cafe electricity, and ifl'ues on each fide of the lumbar vertebrae, are recommended. See Clafs I. 2. 4. 16. 18. Ifchias. The ifchias confi(Is of inflammatory fever, with great pain about the pelvis, the oscoccygis, and the heads of the thigh bones, preventing the patient from walking or (landing ereCt, with increafe of pain on going to ftool. This malady, as well as the preceding, has been afcribed to rheumatifm ; with which it feems to bear no greater analogy, than the inflamma- tions of any other membranes. The patients are left feeble, and fometimes lame after this difeafe ; which is alfo fometimes accompained with great flow of urine, owing to the defective abforption of its aqueous parts ; and with confequent thirft occafioned by the want of fo much fluid being returned into the circulation ; a lodgment of faeces in the rectum fometimes occurs after this complaint from the leflened fenfibility of it. See Clafs I. 2. 4. 15. M. M. VeneleClion ; gentle cathartics ; diluents; fomenta- tion ; poultice with camomile flowers, turpentine, foap, and opium ; afterwards the bark. See Clafs I. 1.3. 5. When this inflammation terminates in fuppuration the matter generally can be felt to fluCluate in the groin, or near the top of the thigh. In this circumftance, my friend Mr. Bent, furgeon, near 180 DISEASES Class II. 1. 2. 19, near Newcaftle in Staffordfhire, propofes to tap the abfcefs by means of a trocar, and thus as often as neceflary to difcharge the matter without admitting the air. Might a weak injeftion of wine and water, as in the hydrocele, be ufed with great caution to inflame the walls of the abfcefs, and caufe them to unite ? See Clafs II. I. 6. 9. 191 Paronychia interna. Inflammation beneath the finger-nail. The pain occafioned by the inflammatory action and tumor of parts bound down between' the nail on one fide and the bone on the other, neither of which will yield,is faid to occafion fo much pain as to produce immediate delirium, and even death, except the parts are divided by a deep incifion ; which muft pafs quite through the periofteum, as the inflammation is faid generally to exift beneath it. This difeafe is thus refembled by the procefs of toothing of young children ; where an extraneous body lodg- ed beneath the periofteum induces pain and fever, and fome- times delirium, and requires to be fet at liberty by the lancet. ORDO. Class II. 1.3. OF SENSATION. 181 ORDO I. Increafed Senfation. GENUS III. With the Produttion of new Vejfels by external Membranes or Glands, with Fever. The difeafes of this genus are perhaps all productive of con- tagious matter ; or which becomes fo by its expofure to the air, either through the cuticle, or by immediate contact with it ; fuch are the matters of the fmall-pox and meafles. The puru- lent matter formed on parts covered from the air by thicker membranes or mufcles, as in the preceding genus, does not in- duce fever ; and cannot therefore be called contagious ; but it acquires this property of producing fever in a few hours, after the abfcefs has been opened, fo as to admit the air to its furface, and may then be faid to confift of contagious miafmata. This kind of contagious matter only induces fever, but does not pro-, duce other matter with properties fimilar to its own ; and in this refped it differs from the contagious miafmata of fmall-pox or meafles,but refembles thofe which have their origin in crowd- ed jails ; for thefe produce fever only, which frequently de- ftroys the patient; but do not produce other matters fimilar to themfelves; as appears from none of thofe who died of the jail- fever, caught at the famous black affixes at Oxford, at the be- ginning of this century, having infeCted their phyficians or at- tendants. If indeed the matter has. continued fo long as to become pu- trid, and thus to have given out air from a part of it, it acquires the power of producing fever ; in the fame manner as if the ul- cer had been opened, and expofed to the common air ; infian- ces of which are not unfrequent. And from thefe circumftan- ces it feems probable, that the matters fecreted by the new veffels formed in all kinds of phlegmons, or puftules, are not conta- gious, till they have acquired fomething from the atmofphere, or from the gas produced by putrefaction ; which will account for fome phenomena in the lues venerea, cancer, and of other contagious fecretions on the fkin without fever, to be mention- ed hereafter. See Clafs II. 1.4. 14. The theory of contagion has been perplexed by comparing it with fermenting liquors ; but the contagious material is (hewn in SeCtion XXXIII. to be produced like other feereted matters by 182 DISEASES Class II. 1. 3* by certain animal motions of the terminations of the veflels. Hence a new kind of gland is formed at the terminations of the veflels in the eruptions of the fmall-pox ; the animal motions of which produce from the blood variolous matter ; as other glands produce bile or faliva. Now if fome of this matter is introdu- ced beneath the cuticle of a healthy perfon,or enters the circula- tion, and excites the extremities of the blood-yeffds into thofe kinds of difeafed motions, by which it was itfelf produced, either by irritation or aflbciation, thefe difeafed motions of the extremi- ties of the veflels will produce other fimilar contagious matter. See Sect. XXXIII 2. 5. and 9. Hence contagion feems to be propagated two ways ; one, by the Rimulus of contagious mat- ter applied to the part, which by an unknown law of nature ex- cites the ftimulated veflels to produce a fimilar matter ; as in venereal ulcers, which thus continue to fpread ; or as when va- riolous matter is inferted beneath the cuticle ; or when it is fuppofed to be abforbed, and difl'ufed over the body mixed with the blood, and applied in that manner to the cutaneous glands. The other way, by which contagion feems to be diffufed, is by fome diftant parts fympathizing or imitating the motions of the part firft affecSted ; as the ftomach and fkin in the eruptions of the inoculated fmall-pox, or in the bite of a mad dog ; as treat- ed of in Se€f. XXII. 3. 3. In fome of the difeafes of this genus, the pulfe is ftrong, full, and hard, conftituting the fenfitive irritated fever, as defcribed in the preceding genus ; as in one kind of eryfipelas, which re- quires repeated venefedtioh. In others the arterial action is fometimes moderate, fo as to conftitute the fenfitive fever, as in the inoculated fmall-pox ; where the action of the arteries is neither increafed by the fenforial power of irritation, as in the fenfitive irritated fever ; nor decreafed by the defeat of that pow- er, as in the fenfitive inirritated fever. But in the greateft num- ber of the difeafes of this genus the arterial action is greatly di- minifhed in refpe€t to ftrength, and confequently the frequen- cy of pulfation is proportionally increafed, as explained in Seft. XXXII. 2. 1. Which is owing to the deficiency of the fenfo- rial power of irritation joined with the increafe of that of fenfa- tion, and thus conflitutes the fenfitive inirritated fever ; as in fcarlatina with gangrenous tonfils. From this great debility of the action of the arteries, there appears to be lefs of the coagulable lymph or mucus fecreted on their internal furfaces ; whence there is not only a defeat of that buff or fize upon the blood, which is feen on the furface of that which is drawn in the fenfitive irritated fever ; but the blood, as it cools, when it has been drawn into a bafin, fcarcely coagulates; Class. IL 1.3. OF SENSATION. 183 coagulates ; and is laid to be didolved, and is by fome fuppofed to be in a ftate of actual putrefaction. See SeCt. XXXIII. i. 3. where the truth of this idea is controverted. But in the fe- vers of both this genus and the preceding one, great heat is pro- duced from the chemical combinations in the fecretions of new veflels and fluids, and pain or uneafinefs from the diflention of the old ones ; till towards the termination of the difeafe fenfa- tion ceafes, as well as irritation, with the mortification of the affected parts, and the death of the patient. Dyfenteria, as well as tonfillitis and aphtha, are enumerated amongft the difeafes of external membranes, becaufe they are expofed either to the atmofpheric air which is breathed and fwallowed with our food and faliva ; or they are expofed to the inflammable air, or hydrogen, which is generated in the intef- tines ; both which contribute to produce or promote the conta- gious quality of thefe fluids ; as mentioned in Clafs II. 1. 6. It is not fpeaking accurate language, if we fay, that, in the difeafes of this genus the fever is contagious ; fince it is the ma- terial produced by the external membranes which is contagious, after it has been expofed to air ; while the fever is the confe- quence of this contagious matter, and not the caufe of it. As appears from the inoculated fmall-pox, in which the fever does not commence, till after fuppuration has taken place in the in- oculated arm, and from the difeafes of the fifth genus of this order, where contagion exifts without fever. See Clafs II. 1. 5. and II. 1. 3. 18. The exiftence of contagious miafmata in the atmofphere was believed even in the time of Homer, and was allegorized under the title of the arrows of Apollo. See catarrhus contagiofus, II. 1. 3. 6. Of thefe it is probable, that fome contagious mat- ters are only diffufed in the atmofphere, as that of the fmall- pox, as it feems only to infeft thofe who are very near the va- riolous patient; and feems to be fwallowed with the faliva, and thence to afFedt the tonfils. Other contagions may be diflblved in the atmofphere, as that of the meafles, and of epidemic ca- tarrhs,which therefore firft afFeft the membranes of the noftrils in men, and of the maxillary finufes alfo in dogs and horfes. Contagious materials have been alfo believed from remote antiquity to lodge in the walls of rooms where the fick have been confined ; as in the wards of hofpitals, jails, (hips, as well as in the bedding or clothes of the infected. The methods of purifying infected houfes feem alfo to have been ftudied in the remote times ; the Levitical law directs the walls of the houfe of a leprous perfon to be fcraped ; and in modern times white- wafliings 184 DISEASES Class II. i. j; walkings with lime and painting with oil have been direfled, I believe with great fuccefs. Mr. Cruikthank has lately recommended two or three parts of fulphur with one of nitre to be mixed together, and fet in a room clofe (hut up, and ignited by dropping a lighted coal up- on it; as the nitre will fupply Sufficient oxygen to inflame the fulphur in a clofe apartment, and thus to fill the whole with the Sulphurous vapour ; fo as to pafs into every minute aperture of the walls or furniture. Another means of fweetening the air of hofpitals, where ma- ny ulcerous patients are crowded together, has been alfo recom- mended, and might perhaps be ufed with falutary effect to re- ftore the air of play-houfes, churches, clofe parlours, courts of law, and other places, where many people refort without due ventilation, which cbnfifts in well mixing four ounces of com- mon fait with two ounces of pulverized manganefe in a bafm ; to thefe are then to be added about two ounces of water, and af- terwards three ounces of concentrated fulphuric acid, in finall portions at a time ; and when managed in this way the gas is faid not to be in the leaft offenfive itfelf, and at the fame time dellroys difagreeable fmells, and perhaps alfo infectious miaf- mata. Medical Review, No. 32. The white vapours, not the red ones, of nitrous acid have been employed with wonderful fuccefs, by Dr C. Smyth, in the hof- pital fhips, without removing the patients ; fome fand is made hot in crucibles, many of which are brought into the rooms to be fumigated; in this hot fand is then fet a tea-cup containing about half an ounce of concentrated vitriolic acid, to which, af- ter it had acquired a proper heat, an equal quantity of nitre in powder is gradually added, and the mixture Jtirred with a glafs fpatula, till the vapour arifes from it in confiderable quantity. The crucible or pipkin is then carried about the wards by the nurfes or convalefcents, who walk about with them, like incenfe- pcts, in their hands, and by thus fumigating the fhip morning and night, with the care of walking the beds and clothes, and expofmg them to the air, the contagion appeared to be quickly flopped, and the patients already affected foon recovered. If any metallic veflel be ufed, the white nitrous vapour be- comes red, and what was falutary before becomes now noxious, as is obferved by Mr. Keir, in his letter on this fubjeCt, who adds, that though much vital air is extricated from the mixture, he rather afctibes its good effect to the known property of all mineral acids in flopping the procefles of fomentation and pu- trefaction ; as the contagious miafmata are prefumed to confift of Class II. 1. 3. i. OF SENSATION. 185 of animal matter in feme vicious kind of fermentation. Medi- cal Review, Vol. III. p. 17. SPECIES. I. Febris fenjitiva inirritata. Sensitive inirritated fever. Ty- phus gravior. Putrid malignant fever. Jail fever. The imme- diate caufe of this difeafe is the increafe of the fenforial power of fenfation, joined with the decreafe of the fenforial power of ir- ritation ; that is, it confifts in the febris fenfitiva joined with the febris inirritativa of Clafs I. 2. 1. 1. as the febris fenfitiva irri- tata of the preceding genus confifts of the febris fenfitiva joined with the febris irritativa of Clafs I. 1. 1. 1. In both which the words irritata and inirritata, are defigned to exprefs more or lefs irritation than the natural quantity ; and the fame when applied to fome of the difeafes of this genus. This fever is frequently accompanied with topical inflamma- tion, which is liable, if the arterial ftrength is not fupported, to end in fphacelus; and as mortified parts, fuch as floughs of the throat, if they adhere to living parts, foon become putrid from the warmth and moifture of their fituation ; thefe fevers have been termed putrid, and have been thought to owe their caufe to what is only their confequence. In hot climates this fever is frequently induced by the exhalations of ftagnating lakes or marfhes, which abound with animal fubftances ; but which in colder countries produce fevers with debility only, as the quar- tan ague, without inflammation. The fenfitive inirritated, or malignant fever, is alfo frequently produced by the putrid exhalations and ftagnant air in prifons ; but perhaps molt frequently by contadl or near approach of the perlons who have refided in them. Thefe caufes of malignant fevers contributed to produce, and to fupport for a while, the feptic and antifeptic theory of them ; fee Seft. XXXIII. r. 3. The vibices or bruifes, and petechia or purples, were believed to be owing to the diflblved Hate of the blood by its incipient putrefaction ; but hydroftatical experiments have been made, * which Ihew the fizy blood of the patient in fenfitive irritated or inflammatory fever, with ftrong pulfe, is more fluid, while it is warm, than this uncoagulable blood taken in this fenfitive inir- ritated, or malignant fever; from whence it is inferred, that thefe petechia, and vibices, are owing to the deficient power of abforp- tion in the terminations of the veins. See Clafs I. 2. i. 5. This fenfitive inirritated fever, or typhus gravior, is diftin- guiflied from the inirritative fever, or typhus mitior, in the ear- ly ftages of it, by the colour of the fkin •, which in the latter is Vol. II. A a paler 186 DISEASES ClassII. 1. 3. 1. paler, with lefs heat, owing to the lefs violent aftion of the ca- pillaries ; in this it is high coloured, and hotter, from the great- er energy of the capillary adion in the production of new vef- fels. ' In the more advanced ftate petechiae, and the production of contagious matter from inflamed membranes, as the aphthae of the mouth, or ulcers of the throat, diftinguifh this fever from the former. Delirium, and dilated pupils of the eyes, are more frequent in nervous fevers ; and flupor with deafnefs a more frequent attendant on malignant fevers. See Clafs1.2.5. 6. There is another criterion difcernible by the touch of an ex- perienced finger ; and that is, the coat of the artery in inflamma- tory fevers, both thofe attended with ftrength of pulfation, and thefe with quick pulfation, feels harder, or more like a cord ; for the coats of the arteries in thefe fevers are themfclves infla- med and are confequently turgid with blood, and thence are lefs eafily comprefled, though their pulfations are neverthelefs weak : when the artery is large or full with an inflamed coat, it is hard ; and when fmall or empty with an inflamed coat, it is called (harp, by many writers. M. M. The indications of cure confift, 1. In procuring a regurgitation of any offenfive material, which may be lodged in the long mouths of the ladeals or lymphatics, or in their tumid glands. 2. To excite the fyftem into neceflary adion by the repeated exhibition of nutrientia, forbentia, and incitantia ; and to preferve the due evacuation of the bowels. 3. To prevent any unneceflary expenditure of fenforial power. 4. To prevent the formation of ulcers, or to promote the abforption in them, for the purpofe of healing them. 1. One ounce of wine of ipecacuanha, or about ten grains of the powder, Ihould be given as an emetic. After a few hours three or four grains of calomel Ihould be given in a little mu- cilage, or conferve. Where fomething fwallowed into the ftom- ach is the caufe of the fever, it is liable to be arrefted by the lym- phatic glands, as the matter of the fmall-pox inoculated in the arm is liable to be flopped by the axillary lymphatic gland ; in this fituation it may continue a day or two, or longer, and may be regurgitated during the operation of an emetic or cathartic into the ftomach or bowel, as evidently happens on the exhibition of calomel, as explained in Sed. XXIX. 7. 2. For this reafon an emetic and cathartic, with venefedion, if indicated by the hardnefs and fulnefs of the pulfe, will very frequently remove fevers, if exhibited on the firft, fecond, or even third day. 2. Wine and opium, in fmall dofes repeated frequently, but fo that not the leaft degree of intoxication follows, for in that cafe a greater degree of debility is produced from the expendi- ture Class II. 1. 3. r. OF SENSATION. 187 ture of fenforial power in unneceflary motions. Many weak patients have been thus ftimulated to death. See Se<Sl. XII. 7. 8. The Peruvian bark Ihould be given alfo in repeated dofes in fuch quantity only as may ftrengthen digeftion, not impede it. For thefe purpofes two ounces of wine, or of ale, or cyder, Ihould be given every fix hours ; and two ounces of decoftion of bark, with two drachms of the tinflure of bark, and fix drops of tindlure of opium, Ihould be given alfo every fix hours alter- nately ; that is, each of them four times in twenty-four hours. As much rhubarb as may induce a daily evacuation, Ihould be given to remove the colluvies of indigefted materials from the bowels ; which might otherwife increafe the diftrefs of the pa- tient by the air it gives out in putrefaction, or by producing a diarrhoea by its acrimony ; the putridity of the evacuations is owing to the total inability of the digeftive powers ; and their delay in the intellines, to the inactivity of that canal in refpect to its periftaltic motions. The quantities of wine or beer and opium, and bark, above- mentioned, may be increafed by degrees, if the patient feems refrelhed by them; and if the pulfe becomes flower on their exhibition ; but this with caution, as I have feen irrecover- able mifchief done by greater quantities both of opium, wine, and bark, in this kind of fever ; in which their ufe is to ftrength- en the digeftion of the weak patient, rather than to Hop the par- oxyfms of fever ; but when they are adminiftered in intermit- tents, much larger quantities are neceflary. The ftimulusof fmall blifters applied in fuccelfion, one every three or four days, when the patient becomes weak, is of great fervice by ftrengthening digeftion, and by preventing the cold- nefs of the extremities, owing to the fympathy of the Ikin with the ftomach, and of one part of the Ikin with another. In refpe€t to nutriment, the patient Ihould be fupplied with wine and water, with toafted bread, and fugar or fpice in it ; or with fago with wine ; frefh broth with turnips, cellery, parfley, fruit; new milk. Tea with cream and fugar ; bread-pudding, with lemon-juice and fugar ; chicken, filh, or whatever is grate- ful to the palate of the fick perfon, in fmall quantity repeated fre- quently ; with fmall beer, cyder and water, or wine and water, for drink, which may be acidulated with acid of vitriol in fmall quantities. 3. All unneceflary motions are to be checked, or prevented. Hence horizontal pofture, obfcure room, filence, cool air. All the parrs of the Ikin, which feel too hot to the hand, Ihould be expofed to a current of cool air, or bathed with cold water, whether there are eruptions on it or not. Walh the patient twice 188 DISEASES Class II. 1.3. ?. twice a day with cold vinegar and water, or cold fait and water, or cold water alone by means of a fponge. If fome parts are too cold, as the extremities, while other parts are too hot, as the face or breaft, 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, folution 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 ufed to touch them with three or four times a day. Of thefe perhaps a folu- tion of alum is to be preferred, as it inftantly takes away the ftench from ulcers I fuppofe by combining with the volatile al- kali which attends it. For this purpofe a folution of alum of an ounce to a pint of water fliould be frequently injected by means of a fyringe into the mouth. If there are ulcers on the exter- nal (kin, fine powder of bark feven parts, and cerufla in fine powder one part, fhould be mixed and applied dry on the fore, and kept on by a lint and a bandage. As Houghs in the mouth are frequently produced by the pre- vious drynefs of the membranes which line it, this drynefs fliould be prevented by frequently moiftening them, which may be ef- fected by injeCtion with a fyringe, or by a moift fponge, or laft- ly in the following manner. Place a glafs of wine and water, or of milk and fugar, on a table by the bedfide, a little above the level of the mouth of the patient; then, having previoufly moif- tened a long piece of narrow lilting, or cloth, or flannel, with the fame liquor, leave one end of it in the glafs, and introduce the other into the mouth of the patient; which will thus be fup- plied with a conftant oozing of the fluid through the cloth, which aCts as a capillary fyphon. The vilcid phlegm, which adheres to the tongue, fhould be coagulated by fome auftere acid, as by lemon-juice evaporated to half its quantity, or by crab-juice ; and then it may be fcra- ped off by a knife, or rubbed off by flannel, or a fage-leaf dip- ped in vinegar, or in fait and water. 2. Eryfipelas. St. Anthony's fire may be divided into three kinds, which differ in their method of cure, the irritated, the in- irritated, and the fenfidve eryfipelas. Eryfipelas irritatum is attended with increafe of irritation be- fides increafe of fenfation ; that is, with ftrong, hard and full pulfe, which requires frequent venefeClion, like other inflam- mations with arterial ftrength. It is diftinguiflied from the phlegmonic inflammations of the laft genus by its fituation on the external habit, and by the rednefs, heat, and tumour, not be- ing diftinClly circumfcribed ; fo that the eye or finger cannot exaClly trace the extent of them. When Class II. 1. 3. 2. OF SENSATION. 189 When the external ficin is the feat of inflammation, and pro- duces fenfitive irritated fever, no collection of matter is formed, as when a'phlegmon is fituated in the cellular membrane beneath the ficin ; but the cuticle rifes as beneath a blifter-plafter, and becomes ruptured ; and a yellow material oozes out, and be- comes infpiflated, and lies upon its furface ; as is feen in this kind of eryfipelas, and in the confluent fmall-pox ; or if the new veflels are reabforbed the cuticle peels off in fcales. This differ- ence of the termination of eryfipelatous and phlegmonic inflam- mation feems to be owing in part to the lefs diftenfibility of the cuticle than of the cellular membrane, and in part to the ready exhalation of the thinner parts of the fecreted fluids through its pores. This eryfipelas is generally preceded by a fever for two or three days before the eruption, which is liable to appear in fome places, as it declines in others ; and feems frequently to arife from a previous fcratch or injury of the ficin ; and is attended fometimes with inflammation of the cellular membrane beneath the ficin ; whence a real phlegmon and collection of matter be- come joined to the eryfipelas, and either occafion or increafe the irritated fever, which attends it. There is a greater fympathy between the external ficin and the meninges of the brain, than between the cellular membrane and thofe meninges ; whence eryfipelas is more liable to be pre- ceded, or attended, or fucceeded, by delirium than internal phlegmons. I except the mumps, or parotitis, defcribed below ; which is properly an external gland, as its excretory duCl opens into the air. When pain of the head or delirium precedes the cutaneous eruption of the face, there is fome reafon to believe, that the primary difeafe is a torpor of the meninges of the brain ; and that the fucceeding violent aflion is transferred to the ficin of the face by fenfitive aflbciation ; and that a fimilar fympathy occurs between fome internal membranes and the ficin over them, when eryfipelas appears on other parts of the body. If this cir- cumftance fhould be fupported by further evidence, this difeafe fliould be removed into Clafs IV. along with the rheumatifm and gout. See Clafs IV. i. 2. 17. This fuppofed retropulfion of eryfipelas on the brain from the frequent appearance of delirium, has prevented the free ufe of the lancet early in this difeafe to the deftruCtion of many ; as it has prevented the fubduing of the general inflammation, and thus has in the end produced the particular one on the brain. Mr. B , a delicate gentleman about fixty, had an ery- fipelas beginning near one ear, and extending by degrees over the whole head, with hard; full, and ftrong pulfe ; blood was ta- ken 190 DISEASES Class II. r. 3. 2. ken from him four or five times in confiderable quantity, with gentle cathartics, with calomel, diluents, and cool air, and he recovered without any figns of delirium, or inflammation of the meninges of the brain. Mr. W- , a ftrong corpulent man of inferior life, had eryfipelas over his whole head, with ftrong hard pulfe ; he was not evacuated early in the difeafe through the timidity of his apothecary, and died delirious. Mrs. F had eryfipelas on the face, without either ftrong or weak pulfe ; that is, with fenfitive fever alone, without fuperabun- dance or deficiency of irritation ; and recovered without any but natural evacuations. From thefe three cafes of eryfipelas on the head, it appears that tire evacuations by the lancet muft be ufed with courage, where the degree of inflammation requires it ; but not where this degree of inflammation is fmall, nor in the eryfipelas attended with inirritation, as defcribed below. M. M. Venefection repeated according to the degree of in- flammation. An emetic. Calomel, three grains every other night. Cool air. Diluents, emetic tartar in fmall dofes, as a quarter of a grain every fix hours. Tea, weak broth, gruel, lem- onade, neutral faits. See Sedl. XII. 6. Such external applications as carry away the heat of the fkin may be of fervice, as cold water, cold flour, fnow, ether. Be- caufe thefe applications impede the exertions of the fecerning veflels, which are now in too great action ; but any applica- tions of the ftimulant kind, as folutions of lead, iron, copper, or of alum, ufed early in the difeafe, muft be injurious ; as they ftimulate the fecerning veflels, as well as the abforbent veflels, into greater action ; exactly as occurs when ftimulant eye wa- ters are ufed too foon in ophthalmy. See Clafs II. i. 2. 2. But as the cuticle peels elfin this cafe after the inflammation ceaf- es, it differs from ophthalmy; and ftimulant applications are not indicated at all, except where fymptoms of gangrene appear. For as a new cuticle is formed under the old one, as under a blif- ter, the ferous fluid between them is a defence to the new cuti- cle, and {hould dry into a fcab by exhalation rather than be re- abforbed. Hence we fee how greafy or oily applications, and even how moift ones, are injurious in eryfipelas ; becaufe they prevent the exhalation of the ferous effufion between the old and new cuticle, and thus retard the formation of the latter. Eryfipelas inirritatum differs from the former in its being at- tended with weak pulfe, and other fymptoms of fenfitive inir- ritated fever. The feet and legs are particularly liable to this eryfipelas, which precedes or attends the fphacelus or mortifica- tion of thofe parts. A great and long coldnefs firft affects the limb, and the eryfipelas on the fkin feems to occur in confe- quence Class II. i* 3. 2. OF SENSATION. 191 quence of the previous torpor of the interior membranes. As this generally attends old age, it becomes more dangerous in proportion to the age, and alfo to the habitual intemperance of the patient in refpetl to the ufe of fermented or fpirituous liquor. When the former kind, or irritated eryfipelas, continues long, the patient becomes fo weakened as to be liable to all the fymp- toms of this inirritated eryfipelas ; efpesially where the menin- ges of the brain are primarily affected. As in that cafe, after two or three efforts have been made to remove the returning periods of torpor of the meninges to the external ikin, thofe meninges become inflamed themfelves, and the patient (inks un- der the difeafe ; in a manner fimilar to that in old gouty patients, where the torpor of the liver or ftomach is relieved by aflbcia- tion of the inflammation of the membranes of the feet, and then of other joints, and laftly the power of aflbciation ceafing to act, but the excefs of fenfation continuing, the liver or ftomach re- mains torpid, or becomes itfelf inflamed, and the patient is de- ftroyed. M. M. Where there exifts a beginning gangrene of the ex- tremities, the Peruvian bark, and wine, and opium, are to be given in large quantities ; fo as to ftrengthen the patient, but not to intoxicate, or to impede his digeftion of aliment, as men- tioned in the firftfpecies of this genus. ClafsII. I. 2. 1. But where the brain is inflamed or opprefled, which is known either by delirium, with quick pulfe ; or by ftupor and flow refpira- tion with flow pulfe; other means muft be applied. Such as, firft, a fomentation on the head with warm water, with or with- out aromatic herbs, or fait in it, fhould be continued for an hour or two at a time, and frequently repeated. A blifter may alib be applied on the head, and the fomentation nevertheless occa- fionally repeated. Internally very gentle ftimulants, as camphor one grain or two in infufion of valerian. Wine and water, or fmall beer, weak broth. An enema. Six grains of rhubarb and one of calomel. Afterwards five drops of tinefture of opium, which may be repeated every fix hours, if it feems of fervice. Might the head be bathed for a minute with cold water ? or with ether ? or vinegar ? Eryfipelas fenftivum is a third fpecies, differing only in the kind of fever which attends it, which is fimply inflammatory, or fen- fitive, without either excefs of irritation, as in the firft variety ; or the defeat of irritation, as in the fecond variety ; all thefe kinds of eryfipelas are liable to return by periods in fome people, who have palled the middle of life, as at periods of a lunation, or two lunations, or at the equinoxes. When thefe periods of eryfipelas happen to women, they feem to fupply the place of the DISEASES Class II. 1.3. 3 192 the receding catamenia; when to men, I have fometimes be- lieved them to be aflbciated with a torpor of the liver; as they generally occur in thofe who have drunk vinous fpirit exceffive- ly, though not opprobrioully ; and that hence they fupply the place of periodical piles, or gout, or gutta rofea. M. M. As the fever requires no management, the difeafe takes its progrefs fafely, like a modern paroxyfm of the gout ; but in this cafe, as in fome of the former ; the eryfipelas does not appear to be a primary difeafe, and Ihould perhaps be re- moved to the Clafs of AfTociation. 3. Torftlhtis. Inflammation of the tonfils. The uncouth term Cynanche has been ufed for difeafes fo diffimilar, that I have di- vided them into Tonfillitis and Parotitis; and hope to be excufed for adding a Greek termination to a Latin word, as one of thofe languages may juftly be confidered as a dialed: of the other. By tonfillitis the inflammation of the tonfils is principally to be underftood ; but as all inflammations generally fpread further than the part firft affected ; fo, when rhe fummit of the wind- pipe is alfo much inflamed, it may be termed tonfillitis trachea- lis, or croup. See Clafs I 1.3.4. and II. 1. 2. 4. ; and when the fummit of the gullet is much inflamed along with the tonfil, it may be called tonfillitis pharyngea, as defcribed in Dr. Cullen's Nofologia, Genus X. p. 92. The inflammation of the tonfils may be divided into three kinds, which require different methods of cure. Tonfillitis interna. Inflammation of the internal tonfil. When the fwelling is fo confiderable as to produce difficulty of breath- ing, the fize of the tonfil ffiould be diminiffied by cutting it with a proper lancet, which may either give exit to the matter it con- tains, or may make it lefs by difcharging a part of the blood. This kind of angina is frequently attended with irritated fever befides the fenfitive one, which accompanies all inflammation, and fometimes requires venefedion. An emetic ffiould be giv- en early in the difeafe, as by its inducing the retrograde action of the veflels about the fauces during the naufea it occafions, it may eliminate the very caufe of the inflammation ; which may have been taken up by the abforbents, and ft ill continue in the mouths of the lymphatics or their glands. The patient ffiould then be induced to fwallow fome aperient liquid, as an infufion of fenna, fo as to induce three or four evacuations. Gargles of all kinds are rather hurtful, as the aftion of ufing them is lia- ble 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 fyringing warm water into the mouth, as this ads like a warm bath, or fomentation to the inflamed part. ClassII. 1.3.3. OF SENSATION. 193 part. Laftly, fome mild ftimulant, as a weak folution of fait and water, or of white vitriol and water, may be ufed to walh the fauces with in the decline of the difeafe, to expedite the ab- forption of the new veflels, if neceflary, as recommended in ophthalmy. Tonjillitis Juperficialis. Inflammation of the furface of the tonfils. As the tonfils and parts in their vicinity are covered with a membrane, which though expofed to currents of air, is neverthelefs conftantly kept moift by mucus and faliva, and is liable to difeafes of its furface like other mucous membranes, as well as to fuppuration of the internal fubftance of the gland j the inflammation of its furface is fucceeded by fmall elevated puftules with matter in them, which foon difappears, and the parts either readily heal, or ulcers covered with floughs are left on the furface. This difeafe is generally attended with only fenfitive fever, and therefore is of no danger, and may be diftinguifhed with great certainty from the dangerous inflammation or gangrene of the ton fils at the height of the fmall-pox, or fcarlet fever, by its not being attended with other fymptoms of thofe difeafes. One emetic and a gentle cathartic is generally fufficient ; and the frequent fwallowing of weak broth, or gruel, both without fait in them, relieves the patient, and abfolves the cure. When thefe tumours of the tonfils frequently return I have fometimes fufpe&ed them to originate from the abforption of putrid matter from decaying teeth. See Oafs I. 2. 3. 21. and II. 2. 2. 1. Tonjillitis inirritata. Inflammation of the tonfils with fenfi- tive inirritated fever is a fymptom only of contagious fever, whether attended with fcarlet eruption, Or with confluent fmall- pox, or otherwife. The matter of contagion is generally difFu- fed,not diffblved in the air ; and as this is breathed over the mu- caginous furface of the tonfils, the contagious atoms are liable to be arrefted by the tonfil ; which therefore becomes the neft of the future difeafe, like the inflamed circle round the inocu- lated punfture of the arm in fuppofitious fmall-pox. The fwell- ing is liable to fuffocate the patient in fmall-pox, and to become gangrenous in fcarlet fever, and fome other contagious fevers, which have been received in this manner. The exiftence of in- flammation of the tonfil previous to the fcarlet eruption, as the arm inflames in the inoculated fmall-pox, and fuppurates before the variolous eruption, fhould be a criterion of the fcarlet fever being taken in this manner. M. M. All the means which ftrengthen the patient, as in the fenfitive inirritated fever, Clafs II. 1. 2. 1. As it is liable to continue a whole lunation or more, great attention fhould be Vol. II. B b ufed 194 DISEASES Class II. 1. 3. 4. ufed to nourifli the patient with acidulous and vinous panada, broth with vegetables boiled in it, fugar, cream, beer ; all which given frequently will contribute much to moiften,clean,and heal the ulcufcles, or Houghs, of the throat ; warm water and wine, or acid of lemon, fhould be frequently applied to the tonfils by means of a fyringe, or by means of a capillary fyphon, as de- fcribed in Clafs II. I. 2. I. A flight folution of blue vitriol, as two grains to an ounce, or a folution of fugar of lead of about fix grains to an ounce, may be of fervice ; efpecially the latter, a fmall glafs tube, or fipall crow-quill with the end cut off, or by a camel's-hair pencil or fponge ; to the end of either of which a drop will conveniently hang by capillary attraction ; as folutions of lead evidently impede the progrefs of eryfipelas on the exterior ikin, when it is attended with feeble pulfe. Yet a folution of alum injected frequently by a fyringe is perhaps to be preferred, as it immediately removes the fetor of the breath, which mull much injure the patient by its being perpetually re- ceived into the lungs by refpiration. 4. Parotitis. Mumps, or branks, is a contagious inflamma- tion of the parotis and maxillary glands, and has generally been clafled under the word Cynanche or Angina, to which it bears no analogy. It divides itfelf into two kinds, which differ in the degreeof fever which attends them, and in the method of cure. Parotitisfuppurans. The fuppurating mumps is to be diftin- guifhed by the acutenefs of the pain, and the fenfitive, irritated, or inflammatory fever, which attends it. M. M. VenefeClion. Cathartic with calomel three or four grains repeatedly. Cool air, diluents. This antiphlogiftic treat- ment is to be continued no longer than is neceflary to relieve the violence of the pain, as the difeafe is attended with conta- gion, and muft run through a certain time, like other fevers with contagion. Parotitis mutabilis. Mutable parotitis. A fenfitive fever on- ly, or a fenfitive irritated fever, generally attends this kind. And when the tumour of the parotis and maxillary glands fubfides, a new fwelling occurs in fome diftant part of the fyftem ; as happens to the hands and feet, at the commencement of the fec- ondary fever of the fmall-pox, when the tumor of the face fub- fides. This new fwelling in the parotitis mutabilis is liable to affeCt the teftes in men,and form a painful tumor, which fhould be prevented from fuppuration by very cautious means, if the violence of the pain threaten fuch a termination ; as by bathing the part with coldifh water for a time, venefecStion, a cathartic ; or by a blifter on the perinocum, or fcrotum, or a poultice. When Class II. i. 3/4. OF SENSATION. 195 When women are affected with this complaint, after the fwelling of the parotis and maxillary glands fubfides, tumor with pain is liable to affect their breafts ; which, however, I have never feen terminate in fuppuration. On the retroceffion of the tumor of the teftes above defcribed, and I fuppofe of that of the breafts in women, a delirium of the calm kind is very liable to occur ; which in fome cafes has been the firft fymptom which has alarmed the friends of the patient; and it has thence been difficult to difcover the caufe of it with- out much inquiry ; the previous fymptoms having been fo flight as not to have occafioned any complaints. In this delirium, if the pulfe will bear it, venefedtion fhould be ufed, 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 difeafe generally terminates favourably confider- ing the numbers attacked by it, when it is epidemic, yet it is dangerous at other times in every part of its progrefs. Some- times the parotis or maxillary glands fuppurate, producing ul- cers which are difficult to cure, and frequently deftroy the pa- tient, where there was a previous fcrofulous tendency. The teftis in men is alfo liable to fuppurate with great pain, long con- finement, and much danger ; and laftly, the affection of the brain is fatal to many. Mr. W. W. had a fwelled throat, which after a few days fubfided. He became delirious or ftupid, in which ftate he was dying when I faw him ; and his friends afcribed his death to a coup de foleil, which he was faid to have received fome months before, when he was abroad. Mr. A. B. had a fwelling of the throat, which after a few days fubfided. When I faw him he had great ftupor, with flow breathing, and partial delirium. On fomenting his head with warm water for an hour thefe fymptoms of ftupor were gently leflened, and his opprefled breathing gradually ceafed, and he recovered in one day. Mr. C. D. I found walking about the houfe in a calm delir- ium without ftupor ; and not without much inquiry of his friends could get the previous hiftory of the difeafe •, which had been attended with parotitis, and fwelled teftis, previous to the deliri- um. A few ounces of blood were taken away, a gentle cathar- tic was directed, and his head fomented with warm water for an hour, with a fmall blifter on the back, and he recovered in two or three days. Mr. D. D. came down from London in the coach alone, fo that no previous hiftory could be obtained. He was walkinga- about the houfe in a calm delirium, but could give no fenfible anfwers 196 DISEASES Class II. i. 3. 5. anfwers to any thing which was propofed to him. His pulfe was weak and quick. Cordials, a blifter, the bark, were in vain exhibited, and he died in two or three days. Mr. F. F. came from London in the fame manner in the coach. He w'as mildly delirious with confiderable ftupor, and moderate pulfe, and could give no account of himfelf. He con- tinued in a kind of cataleptic ftupor, fo that he would remain for hours in any pofture he was placed, either in his chair, or in bed ; and did not attempt to fpeak for about a fortnight, and then gradually recovered. Thefe two laft cafes are not related as being certainly owing to parotitis, but as they might probably have that origin. The parotitis fuppurans, or mumps with irritated fever, is at times epidemic among cats, and may be called parotitis felina; as I have reafon to believe from the fwellings under the jaws, which frequently fuppurate, and are very fatal to thofe animals. In the village of Haywood, in Staffordfhire, I remember a whole breed of Perfian cats, with long white hair, was deftroy- ed by this malady, along with almoft all the common cats of the neighbourhood •, and as the parotitis or mumps had not long be- fore prevailed amongft human beings in that part of the coun- try, I recollect being inclined to believe, that the cats received the infection from mankind ; though in all other contagious dif- eafes, except the rabies canina can be fo called, no different gen- era of animals naturally communicate infection to each other ; and I am informed, that vain efforts have been made to commu- nicate the fmall-pox and meafles to fome quadrupeds by inocu- lation. A difeafe of the head and neck deltroyed almoft all the cats in Weftphalia. Savage, Nofol. Clafs X. Art. 30. 8. Since the above was firft publifhed, the cow pox, variolic vac- cinae, has been fuccefsfully inoculated on the human fubjedt, and produced a difeafe in fome refpe&s fimilar to the fmall-pox. See Variolae. 5. Catarrhus fenjitivus confifts of an inflammation of the membrane, which lines the noftrils and fauces. It is attended with fenfitive fever alone, and is cured by the fteam of warm water externally, and by diluents internally, with moderate ven- efe&ion and gentle cathartics. This may be termed catarrhus fenfitivus, to diftinguifh it from the catarrhus contagiofus, and is in common language called a violent cold in the head ; it dif- fers from the catarrhus calidus,or warm catarrh, of Clafs I. 1. 2. 7. in the produ&ion of new veifels, or inflammation of the membrane, and the confequent more purulent appearance of the difeharge. Raucedo catavrhalis,or catarrhal hoarfenefs,isa frequent fymp- fom Class II. 1. 3.6. OF SENSATION. 197 tom of this difeafe, and is occafioned by the pain or forenefs which attends the thickened and inflamed membranes of the larynx ; which prevents the mufcles of vocality from fufficient- ly contracting the aperture of it. It ceafes with the inflamma- tion, or may be relieved by the fleam of warm water alone, or of water and vinegar, or of water and ether. See Paralytic Hoarfenefs, Clafs III. 2. 1.4. 6. Catarrbus contagio/us. This malady attacks fo many at the fame time, and fpreads gradually over fo great an extent of coun- try, that there can be no doubt but that it is difleminated by the atmofphere. In the year 1782 the fun was for many weeks ob- feured by a dry fog,and appeared red as through a common mill. The material,which thus rendered the air muddy,probably cauf- ed the epidemic catarrh, which prevailed in that year, and which began far in the north, and extended itfelf over all Europe. See Botanic Garden, Vol. II. note on Chunda, and Vol. I. Canto IV. line 294, note ; and was fuppofed to have been thrown out of a volcano, which much difplaced the country of Iceland. In many inftances there was reafon to believe that this difeafe became contagious, as well as epidemic ; that is, that one perfon might receive it from another, as well as by the general unfalu- tary influence of the atmofphere. This is difficult to compre- hend, but may be conceived by confidering the increafe of conta- gious matter in the fmall-pox. In that difeafe one particle of contagious matter ftimulates the fkin of the arm in inoculation into morbid action fo as to produce a thoufand particles fimilar to itfelf ; the fame thing occurs in catarrh, a few deleterious atoms llimulate the mucous membrane of the noftrils into mor- bid actions, which produce a thoufand other particles fimilar to themfelves. Thefe contagious particles diffufed in the air muR have confifted of animal matter, otherwife how could an animal body by being ftimulated by them produce fimilar particles ? Could they then have had a volcanic origin,or mull they not rath- er have been blown from putrid marlhes full of animal matter ? But the greateft part of the folid earth has been made from ani- mal and vegetable recrements, which may be difperfed by volca- noes.-Future difeoveries muft anfwer thefe quellions. As the fenfitive fever attending thefe epidemic catarrhs is fel- dom either much irritated or inirritated, venefe£lion is not al- ways either clearly indicated or forbidden ; but as thofe who have died of thefe catarrhs have generally had inflamed livers, with confequent fuppuration in them, venefedtion is advifable, wherever the cough and fever are greater than common, fo as to render the ufe of the lancet in the leafl dubious. And in fome cafes a fecond bleeding was neceflary,and a mild cathartic or two with 198 DISEASES ClassII. i. 3.6. with four grains of calomel ; with mucilaginous fubacid dilu- ents ; and warm fteam occafionally to alleviate the cough, fin- ifhed the cure. The catarrhus contagiofus is a frequent difeafe amongft horf- es and dogs ; it feems firft to be difleminated amongft thefe ani- mals by miafmata diffufed in the atmofphere, becaufe fo many of them receive it at the fame time ; and afterwards to be commu- nicable from one horfe or dog to another by contagion, as above defcribed. Thefe epidemic or contagious catarrhs more fre- quently occur amongft dogs and horfes than amongft men ; which is probably owing to the greater extenfion and fenfibility of the mucous membrane, which covers the organ of fmell, and is diffufed over their wide noftrils, and their large maxillaryand frontal cavities. And to this circumftance may be afcribed the greater fatality of it to thefe animals. In refpeft to horfes, I fufpeft the fever at the beginning to be of the fenfitive, irritated, or inflammatory kind, becaufe there is fo great a difcharge of purulent mucus ; and that therefore they will bear once bleeding early in the difeafe ; and alfo one mild purgative, confifting of about half an ounce of aloe, and as much white hard foap, mixed together. They fliould be turned out to grafs both day and night for the benefit of pure air, unlefs the weather be too cold (and in that cafe they fliould be kept in an open airy ftable, without being tied,) that they may hang down their heads to facilitate the difcharge of the mucus from their noftrils. Grafs fliould be offered them, or other frefh vegeta- bles, as carrots and potatoes, with maflies of malt,or of oats,and with plenty of frefh warm or cold water frequently in a day. When fymptoms of debility appear, which may be known by the coldnefs of the ears or other extremities,or when floughs can be feen on the membrane, which lines the noftrils, a drink confifting of a pint of ale with half an ounce of tincture of opi- um in it, given every fix hours, is likely to be of great utility. In dogs I believe the catarrh is generally joined with fymp- toms of debility early in the difeafe. Thefe animals fliould be permitted to go about in the open air, and fliould have conftant accefs to frefh water. The ufe of being as much as may be in the air is evident, becaufe all the air, which they breathe, gaff- es twice over the putrid floughs of the mortified parts of the membrane, which lines the noftrils, and the maxillary and fron- tal cavities ; that is both during infpiration and expiration ; and muft therefore be loaded with contagious particles. Frefh new milk, and frefh broth, fliould be given them very frequently and they fliould be fuffered to go amongft the grafs, which they fometimes eat for the purpofe of an emetic; and if poflible fhould have Class II. 1. 3. 7. OF SENSATION. 199 have accefs to a running ftream of water. As the contagious mucus of the noftrils, both of thefe animals and of horfes,gener- ally drops into the water, they attempt to drink. Bits of raw flefh, 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 fymptoms of debility are evident, according to the fize of the dog every fix hours. If Houghs can be feen in the noftrils, they {hould be moiftened twice a day, both in horf- es and dogs, with a folution of fugar of lead, or of alum, by means of a fponge fixed on a bit of whale-bone, or by a fyringe. The lotion may be made by diffolving half an ounce of fugar of lead, or of alum, in a pint of water. Ancient philofophers feem to have believed, that the conta- gious miafmata in their warm climates affefled horfes and dogs previous to mankind. If thofe contagious particles were fup- pofed to be diffufed amongft the heavy inflammable air, or car- bonated hydrogen, of putrid marfhes, as thefe animals hold their heads down lower to the ground, they may be fuppofed to have received them fooner than men. And though men and quadru- peds might receive a difeafe from the fame fource of marlh-pu- trefa&ion, they might not afterwards be able to infeft each oth- er, though they might infect other animals of the fame genus ; as the new contagious matter generatedintheir own bodies might not be precifely fimilar to that received ; as happened in the jail-fever at Oxford, where thofe who took the contagion and died, did not infect others. On mules and dogs the infection firfl: began, And, laft, the vengeful arrows fix'd on man. Pope's Homer's Iliad, f. 7. Peripneumonia fuperficialis. The fuperficial or fpurious peripneumony confifts in an inflammation of the membrane, which lines the bronchia, and bears the fame analogy to the true peripneumony, as the inflammation of other membranes do to that of the parenchyma, or fubftantial parts of the vifcus, which they furround. It affects elderly people, and frequently occa- fions their death ; and exifts at the end of the true peripneu- mony, or along with it ; when the lancet has not been ufed fuf- ficiently to cure by reabforbing the inflamed parts, or what is termed by refolution. M. M. Diluents,mucilage, antimonials, warmilh air conftant- ly changed, venefeftion once, perhaps twice, if the pulfe will bear it. Oily volatile draughts. Balfams ? Neutral faits in- creafe the tendency to cough. Blifters in fuccefllon about the cheft. Warm bath. Mild purgatives. Very weak chicken broth 200 DISEASES Class II. i. 3. 8^ broth without fait in it. Boiled onions. One grain of cal- omel every night for a week. From five drops to ten of tinfture of opium at fix every night, when the patient becomes weak. Digitalis? See Clafs II. i. 6. 7. 8. Pertuflis. Tuffis convulfiva. Chin-cough refembles pe- ripneumonia fuperficialis in its confifting in an inflammation of the membrane which lines the air-vefl'els of the lungs ; but dif- fers in the circumftance 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 fame time, but the contagious in- flammation continues gradually to creep on the membrane. It may in thisrefpeft be compared to the ulcers in the pulmonary confumption ; but it differs in this, that in chin-cough fome branches of the bronchia heal, as others become inflamed. This complaint is not ufually claffed amongft febrile diforders, but a fenfitive fever may generally be perceived to attend it du- ring fome part of the day, efpecially in weak patients. And a peripneumony very frequently fupervenes, and deftroys great numbers of children, except the lancet or four or fix leeches be immediately and repeatedly ufed. When the child has perma- nent difficulty of breathing, which continues between the cough- ing fits, unlefs blood be taken from it, it dies in two, three, or four days of the inflammation of the lungs. During this perma- nent difficulty of breathing, the hooping cough abates, or quite ceafes, and returns again after once or twice bleeding ; which is then a good fymptom, as the child now pofleffing the power to cough ffiews the difficulty of breathing to be abated. I dwell longer upon this, becaufe many lofe their lives from the difficulty there is in bleeding young children ; where the apoth- ecary is old or clumfy, or is not furnifhed with a very (harp and fine pointed lancet. In this diftreffing fituation the application of four leeches to one of the child's legs, the wounds made by which ffiould continue to bleed an hour or two, is a fuccedane- um ; and faves the patient, if repeated once or twice, according to the difficulty of the refpiration. The chin-cough feems to refemble the gonorrhoea venerea in feveral circumftances. They are both received by infection, are both difeafes of the mucous membrane, are both generally cured in four or fix weeks without medicine. If ulcers in the cellular membrane under the mucous membrane occur, they are of a phagedenic kind, and deftroy the patient in both difeafes, if no medicine be adminiftered. Hence the cure ffiould be fimilar in both thefe difeafes; firft general evacuation and diluents,|then, after a week or two,I have believed the following pills of great advantage. The dofe for OF SENSATION. Class II. 1. 3 9. 201 for a child of about three years old wasone-fixth part of a grain of calomel, one-fixth part of a grain of opium, and two grains of rhubarb, to be taken twice a day. The opium promotes abforption from the mucous membrane, and thence contributes to heal it. The mercury prevents ul- cers from being formed under the mucous membrane, or cures them, as in the lues venerea ; and the rhubarb is neceflary to keep the bowels open. M. M. Antimonial vomits frequently repeated. Mild ca- thartics. Cool air. Tincture of cantharides, or repeated blif- ters ; afterwards opiates in fmall doles, and the bark. Warm bath frequently ufed. The fteam of warm water with a little vinegar in it may be inhaled twice a day. Thirty drops of fatu- rated tincture of digitalis puerpurea, purple foxglove, were giv- en twice a day to a lady, feventy years of age, in this difeafe, with great and almoft immediate advantage. I have fince giv- en from five to ten drops twice a day to two children, with alfo great apparent advantage. See Art. IV. 2. 3. 7. Arfenic has lately been recommended in the hooping cough. See Art. IV. 2. 6. 9. And externally a folution of 20 grains of emetic tartar, antimonium tartarifatum, in two ounces of water, to which is to be added one ounce of tincture of cantharides, is re- commended, by Dr. Struve of America, to be rubbed very fre- quently on the region of the ftomach. Could the breathing of carbonic acid gas mixed with atmofpheric air be of fervice ? Copious venefeti ion, when a difficulty of breathing continues be- tween the fits of coughing ; otherwise the cough and the expec- toration ceafe, and the patient is deftroyed. Ulcers of the lungs fometimes fupervene, and the phthifis pulmonalis in a few weeks terminates in death. Where the cough continues after fome weeks without much of the hooping, and a fenfitive fever daily fupervenes, fo as to refemble hedtic fever from ulcers of the lungs ; change of air for a week or fortnight afts as a charm, and reftores the patient beyond the hopes of the phyfician. Young children Ihould lie with their heads and fhoulders raif- ed; and Ihould be conftantly watched day and night; that when the cough occurs, they may be held up eafily, fo as to ftand upon their feet bending a little forwards; or nicely fupported in thatpof- ture which they feem to put themfelves into. A bow of whalebone about the fize of the bow of a key, is very ufeful to extradl the phlegm out of the mouths of infants at the time of their coughing; as a handkerchief, if applied at the time of their quick infpirations after long holding their breath is dangerous, and may fuffocate the patient in an inftant, as I believe has fometimes happened. 9. Variola difereta. The fmall-pox is well divided by Syden- Voi.. II. C c ham 202 DISEASES ClassII. i. 3. 9. ham into diftintft and confluent. The former confifts of diftinft puftules, which appear on the fourth day of the fever, are cir- cumfcribed and turgid ; the fever ceafing when the eruption is complete. Head-ach, pain in the loins, vomiting frequently, and convulfive fits fometimes, precede the eruption The diftinfl Imall-pox is attended with fenfitive fever only, when very mild, as in moft inoculated patients ; or with fenfi- tive irritated fever, when the difeafe is greater : the danger in this kind of fmall-pox is owing either to the tumor and forenefs of the throat about the height, or eighth day of the eruption j or to the violence of the fecondary fever. For, fir ft, as the nat- ural difeafe is generally taken by particles of the dull of the con- tagious matter dried and floating in the air, thefe are liable to be arrefted by the mucus about the throat and tonfils in their paflage to the lungs, or to the ftomach, when they are previoufly mixed with faliva in the mouth. Hence the throat inflames like the arm in inoculated patients; and this increafing, as the difeafe advances, deftroys the patient about the height. Secondly, all thofe upon the face and head come out about the fame time, namely, about one day before thofe on the hands, and two before thofe in the trunk ; and thence, when the head is very full, a danger arifes from the fecondary fever, which is a purulent not a variolous fever; for as the matter from all thefe of the face and head is reabforbed at the fame time, the patient is deftroyed by the violence of this purulent fever ; which in the diftinct fmall-pox can only be abated by venefeiftion and cathar- tics ; but in the confluent fmall-pox requires cordials and opi- ates, as it is attended with arterial debility. See Setft. XXXV. I. and XXXIII. 2. io. When the puftules on the face recede, the face fwells ; and when thofe of the hands recede, the hands fwell; and the fame of the feet in fucceflion. Thefe fwellings feem to be owing to the abforptionof variolous matter, which by its ftimulus excites the cutaneous veflels to fecrete more lymph, or ferum, or mucus, exactly as happens by the ftimulus of a blifter. Now, as a blif- ter fometimes produces ftrangury many hours after it has rifen, it is plain, that a part of the cantharides is abforbed, and carri- ed 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 reafoning the variolous matter is abforbed, and fwells the face and hands by its ftimulus. Variola confluent. The confluent fmall-pox confifts of numer- ous puftules, which appear on the third day of the fever, flow together, are irregularly circumfcribed, flaccid, and little eleva- ted, the fever continuing after the eruption is complete ; con- vulfions Class II. 1.3.9- OF SENS ATION. 203 vulfions do not precede this kind of fmall-pox, and are fo far to be efteemed a favourable fymprom. The confluent fmall-pox is attended with fenfitive inirritated fever, or inflammation with arterial debility ; whence the dan- ger of this difeafe is owing to the general tendency to gangrene, with petechite, or purple fpots, and haemorrhages ; betides the two fources of danger from the tumour 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 diftin<£t fmall-pox defcribed above. M. M. The method of treatment muft vary with the degree and kind of fever. Venefedtion may be ufed in the diftinfb fmall-pox early in the difeafe, according to the ftrength or hard- nefs of the pulfe ; and perhaps on the firft day of the confluent fmall-pox, and even of the plague, before the fenforial power is exhaufted by the violence of the arterial action ? Cold air, and even walking or bathing in cold water, is a powerful means in perhaps all eruptive difeafes attended with fever ; as the quan- tity of eruption depends on the quantity of the fever, and the activity of the cutaneous veffels ; which may be judged of by the heat produced on the fkin ; and which latter is immediately abated by expofure to external cold. Mercurial purges, as three grains of calomel repeated every day during the eruptive fever, fo as to induce three or four (tools, contribute to abate inflam- mation ; and is believed by fome to have a fpecific effect on the variolous, as it is fuppofed to have on the venereal contagion. It has been faid, that opening the pock and taking out the matter has not abated the fecondary fever; but as I had conceiv- ed, that the pits or marks, left after the fmall-pox, were owing to the acrimony of the matter beneath the hard fcabs, which not being able to exhale eroded the (kin, and produced ulcers, I directed the faces of two patients in the confluent fmall-pox to be covered with cerate early in the difeafe, which was daily renewed ; and I was induced to think, that they had much lefs of the fecondary fever, and were fo little marked, that one of them, who was a young lady, almoft entirely preferved her beauty. Perhaps mercurial plafters, or cerates, made without turpentine in them, might have been more efficacious in pre- venting the marks, and efpecially if applied early in the difeafe, even on the firft day of the eruption, and renewed daily. For it appears from the experiments of Van Woenfel, that calomel or corrofive fublimate, triturated with variolous matter, incapaci-. tates it from giving the difeafe by inoculation. Calomel or fublimate given as an alterative for ten days before inoculation, and till the eruptive fever commences, is faid with certainty to render 204 DISEASES Class II. i. 3. 9. render the difeafe mild by the fame author. Exper. on Mercu- ry by Van Woenfel, tranflated by Dr. Fowle, Salifbury. C. Deflarts, in the fitting of the French national inftitute is faid to have adduced a number of faits to prove, that the natural fmall-pox is rendered much milder by the ufe of mercurial rem- edies ; which I fuppofe is probably true, as mercurials increafe the abforption in many other ulcers, and confequently diminifh the acrimony of the matter, and forward their healing. Variola inoculata. The world is much indebted to the great difcoverer of the good effects of inoculation, whofe name is un- known ; and our own country to lady Wortley Montague for its introduction into this part of Europe. By inferting the vario- lous contagion into the arm, it is not received by the tonfils, as generally happens, I fuppofe, in the natural fmall-pox ; whence there is no dangerous fwelling of the throat, and as the puftules are generally few and diftintt, there is feldom any fecondary fever ; whence thofe two fources of danger are precluded; hence when the throat in inoculated fmall-pox is much infla- med and fwelied, there is reafon to believe, that the difeafe had been previoufly taken by the tonfils in the natural way : which alfo, I fuppofe, has generally happened, where the confluent kind of fmall-pox has occurred on inoculation. I have known two inftances, and have heard of others, where the natural fmall-pox began fourteen days after the contagion had been received ; one of thefe inftances was of a countryman, who went to a market-town many miles from his home, where he faw a perfon in the fmall-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 fmall-pox, on purpofe to communicate the difeafe to it; and the variolous fever began on the fourteenth day from that time. So that in both thefe cafes fever commenced in half a lunation after the contagion was received. In the inoculated fmall-pox the fever generally commences on the feventh day ; or after a quarter of a lunation; and on this circumftance probably depends the greater mildnefs of the latter. The reafon of which is difficult to comprehend ; but fuppofing the fafts to be generally as above related, the flower progrefs of the contagion indicates a greater inirritability of the fyftem, and in confequence 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 fmall-pox may neverthelefs depend on its being inferted into a different feries of veflels; or to fome un- known effect of lunar periods. It is a fubje£t of great curiofity, and deferves further inveftigation. When OF SENSATION. Class II. 1. 3. 9. 205 When the inoculated fmall-pox is given under all the moft fa- vourable circumftances, I believe lefs than one in a thoufand mifcarry, which may be afcribed to tome unavoidable accident, fuch as the patient having previouily received the infeftion, or being about to be ill of fomeother difeafe. Thofe which have late- ly mifcarried under inoculation, as far as has come to my knowl- edge, have been chiefly children at the breaft ; for in thefe the habit of living in the air has been confirmed by fo fhort a time, that it is much eafier deftroyed, than when thefe habits of life have been eftablifhed by more frequent repetition. See Sett. XVII. 3. Thus it appears from the bills of mortality kept in the great cities of London, Paris, and Vienna, that out of every thoufand children above three hundred and fifty die under two years old. (Kirkpatrick on Inoculation.) Whence a ftrong reafon againft our hazarding inoculation before that age is pafl- ed, efpecially in crowded towns ; except where the vicinity of the natural contagion renders it neceflary, or the convenience of inoculating a whole family at a time ; as it then becomes better to venture the lefs favourable circumftance of thet age of the pa- tient, or the chance of the pain from toothing, than to rilk the infection in the natural way. The moft favourable method confifts in, firft, for a week be- fore inoculation, reftraining the patients from all kinds of fer- mented or fpirituous liquor, and from animal food ; and by giv- ing them from one grain to three or four of calomel every oth- er day for three times. But if the patients be in any the leaft danger of taking the natural infection, the inoculation had bet- ter be immediately performed, and this abftinence then begun ; and two or three gentle purges with calomel fhould be given, one immediately, and on alternate days. Thefe cathartics fhould not induce more than two or three ftools. I have feeri two inftances of a confluent fmall-pox in inoculation following a violent purging induced by too large a dofe of calomel. Secondly, the matter ufed for inoculation fhould be in a fmall quantity, and warm, and fluid. Hence it is beft when it can be recently taken from a patient in the difeafe ; or otherwife it may be diluted with a part of a drop of warm water, fince its flu- idity is likely to occafion its immediate abforption ; and the wound fhould be made as fmall and fuperficial as poffible, as otherwife ulcers have been fuppofed fometimes to enfue with fubaxillary abfcefles. Add to this, that the making two punc- tures either on the fame or one on each arm, fecures the fuccefs of the operation in refpe£t to communicating the infection. Thirdly, at the time of the fever or eruption, the application of cool air to thofe parts of the fkin which are too warm, or ap- pear 206 DISEASES Class II. 1. 3.9. pear red, or are covered with what is termed a ralh, (hould be ufed freely, as well as during the whole difeafe. And at the fame time, if the feet or hands are colder than natural, thefe fhould be covered with flannel. See Clafs II. 2. 2. 10. Where the matter ufed is not procured quite frefh, the man- ner of preferving it fhould be nicely attended to : as I have been informed that a furgeon procured fome matter in a fluid hate, about a tea-fpoonful, which had been kept fome time in a quill, and afterwards in a fmall phial, which he carried fixteen hours in his breeches-pocket; with this he inoculated many children, moft of whom had not the fmall-pox in confequence, but were affedled with typhus, one of whom died. Whence it appears, that the variolous matter had undergone by <putrefaCHon a de- compofition, and that another kind of contagious material had been produced ; which agrees with the ingenious obfervations of Dr Jenner, in his treatifes on the variolae vaccinse, or cow- pox ; and of Mr. Kite, related in the Memoirs of the Medical Society of London, Vol. IV. May not the confluent fmall-pox proceed from the contagious matter having undergone a partial putrefaction, fo as to contain both the variolous and the typhus contagion ? and that, whether the difeafe be taken naturally or by inoculation ? and that hence the confluent kind confifts of the fmall pox, with the fever com- monly termed putrid ? and that, laftly, as Dr. Jenner obferves, where the fmall-pox has been faid to recede, or not to rife, the difeafe has been Amply a malignant or typhus fever, febris fenfa- tiva inirritata, miftaken for the fmall-pox ? Variola vaccina. Cow-pox. Cows are liable to an eruption on their paps or udders, in fome counties as in Gloucefterfbire; which has occafionally communicated to the hands or arms of thofe who milked them, producing an ulcer, and fome degree of fever : and it had been long obferved by the people of thofe counties, that thofe who had undergone this difeafe, which was called the cow-pox, were not liable to the fmall-pox. Dr. Jenner, an eminent phyfician in Gioucefterfhire, fortu- nately attended to this difeafe, found it to be much milder than the fmall-pox, and that the fail was true, that it fecured thofe who had been infeCted with it from afterwards being liable to the variolous infeCtion. He alfo obferved, that the vaccine-pox is not infectious, but by careful inoculation ; and that on this account, it might be inoculated in a family, without endanger- ing others A circumftance of great confequence to the public, as the inoculation of the fmall-pox is known frequently to prop- agate that difeafe ; and alfo to private families, when there hap- pens to be a pregnant woman in them, who has not had the fmall-pox : Class II. 1. 3. 9. OF SENSATION. 207 fmall-pox : to all whom in that fituation it is dangerous, as it generally produces mifcarriage, and frequently death. Dr. Cappe, in an ingenious paper in the Tork Herald, obferves, that the vaccine difeafe is never communicated but by contad, and then only when the matter lies on the broken Ikin ; and that many women during pregnancy have pafled through this dif- eafe, and none have fuftered from it; and that inilead of being peculiarly dangerous to young infants, as the fmall-pox is, it feems to be peculiarly mild to them. From all thefe circumftances it may be hoped, that the inoc- ulation of the cow-pox may become fo general, and performed fo early in life, as totally to eradicate the fmall-pox ; by which latter difeafe above two thoufand perfons are (hewn by Dr. Cappe, by the bills of mortality, to be annually deftroyed in a part of London only. As the cow-pox is fo much lefs infectious than the fmall-pox, it requires much more care in the inoculation to give the difeafe with certainty ; whence it has fometimes happened, that a flight inflammation from the punCture of the lancet has been miftaken by the unfkilful for the vaccine difeafe : and I have heard of four fuch patients in this country^ who have afterwards taken the fmall-pox. But as Dr. Woodville inoculated a thoufand people with the fmall-pox, who had previoufly received the cow-pox, without one of them taking the infection, there can be no doubt bur that the four patients above mentioned had not previoufly undergone the vaccine difeafe; and ought not therefore to dif- credit this fortunate and wonderful difcovery. In the counties where the cows are fubjeci to this difeafe, the milking is performed principally by men-fervants ; and it is there believed, as Dr. Jenner mentions, that the difeafe was pre- vioufly given to the paps of the cows by the hands of the men who milked them, and who had previoufly acquired the infec- tious matter from the heels of horfes, which difcharged an acrid fanies, when they had a difeafe called the greafe. This may be worth further inveitigation ; as the prefervation of people from the fmall-pox, by their having undergone the cow-pox, is fo won- derful a phenomenon, fo contrary to our previous knowledge of any analogy between the infectious difeafes of men and quadru- peds, that other fads equally furprifing may exift. May not the fmall-pox have been originally acquired from the cow-pox ? which latter, having been a much older difeafe, may by procefs of time have become milder than the former: as the fmall-pox is believed alfoto have become much milder than formerly-, ow- ing probably to the in apacity of receiving it, which exifts in thofe who have undergone that difeafe, having in procefs of time become DISEASES Class II. 1. 3. 10. 208 become hereditary. Which incapacity of receiving a fecond time the fmall-pox may be explained from the general law of anima- tion, that liimuli greater than natural lofe their effect by habit, or from their being too violently or too frequently applied. As the cow-pox is faid to be fo favourable to infants, great benefit might accrue to mankind by their early inoculation, which might in time exterminate the fmall-pox. This might be perhaps effedled by ellablilhing a difpenfary in towns, and even villages, and allowing a premium of a few (hillings to eve- ry one of the poor who (hould be thus inoculated, as well as their daily fuftenance for eight or ten days, that their arms might be infpedted by a furgeon, to afcertain that they underwent the genuine difeafe. io. Rubeola irrltata^morbilli. The mealies commence with freezing, red eyes, dry hoarfe cough, and are attended with fen- fitive irritated fever. On the fourth day, or a little later, fmall thick eruptions appear, fcarcely eminent above the Ikin, and, af- ter three days, changing into very fmall branny fcales. As the contagious material of the fmall-pox may be fuppofed to be diffufed in the air like a fine dry powder, and mixing with -the faliva in the mouth to infedt the tonfils in its paffage to the itomach ; fo the contagious material of the mealies may be fuppo- fed to be more completely diflblved in the air, and thus to impart its poifon to the membrane of the noftrils, which covers the fenfe of fmell; whence a catarrh with fneezing ulhers in the fever ; the termination of the nafal dudt of the lachrymal fac is fubjedl to the fame ftimulus and inflammation, and affedls by fympathy the lachrymal glands, occafioning a great flow of tears. See Sedt. XVI. 8. And the rednefs of the eye and eyelids is pro- duced in confequence of the tears being in fo great quantity, that the faline part of them is not entirely reabforbed. See Sedt. XXIV. 2. 8. The contagion of the mealies, if it be taken a fufficient time before inoculation, fo that the eruption may commence before the variolous fever comes on, flops the progrefs of the fmall-pox in the inoculated wound, and delays it till the meafle-fever has finilhed its career. See Sedi. XXXIII. 2. 9. The mealies are ufually attended with inflammatory fever with ftrong pulfe, and bear the lancet in every ftage of the dif- eafe. In the early periods of it, venfedtion renders the fever and cough lefs ; and, if any fymptoms of peripneumony occur, is repeatedly neceffary ; and at the decline of the difeafe, if a cough be left after the eruption has ceafed, and the fubfequent branny fcales are falling off, venfedtion (hould be immediately ufed j which prevents the danger of confumption. At this time alfo Class II. 1. 3. 11. OF SENSATION. 209 alfo change of air is of material confequence, and oven removes the cough like a charm, as mentioned in a fimilar fituation at the end of the chin cough. Rubeola inirritata. Meafles with inirritated fever, or with weak pulfe, has been fpoken of by fome writers. See London Med. Obferv. Vol. IV. Art. XI. It has alfo been faid to have been attended with fore throat. Edinb. Eflays, Vol. V. Art. II. Could the fcarlet fever have been miftaken for the meafles ? or might one of them have fucceeded the other, as in the meafles and fmall-pox mentioned in SeCf. XXXIII. 2. p. ? From what has been faid, it is probable that inoculation might difarm the meafles as much as the fmall-pox, by preventing the catarrh, and frequent pulmonary inflammation, which attends this difeafe ; both of which are probably the confequence of the immediate application of the contagious miafmata to thefe membranes. Some attempts have been made, but a difficulty feems to arife in giving the difeafe ; the blood, I conjecture, would not infeCt, nor the tears ; perhaps the mucous difcharge from the noftrils might fucceed ; or a drop of warm water put on the eruptions, and fcraped off again with the edge of a lan- cet ; or if the branny fcales were collected, and moiftened with a little warm water ? Further experiments on this fubjeCt would be worthy the public attention. i r. Scarlatina mitis. The fcarlet fever exifts with all degrees of virulence, from a flea-bite to the plague. The infectious material of this difeafe, like that of the fmall-pox, I fuppofe to be diffufed, not diffolved, in the air ; on which account I fuf- peCt that it requires a much nearer approach to the fick for a well perfon to receive the infection, than in the meafles ; the contagion of which I believe to be more volatile, or diffufible, in the atmofphere. But as the contagious miafmata of fmall- pox and fcarlet fever are fuppofed to be more fixed, they may remain for a longer time in clothes or furniture ; as a thread dip - ped in variolous matter has given the difeafe by inoculation after- having been expofed many days to the air, and after having been kept many months in a phial. This alfo accounts for the flow or fporadic progrefs of the fcarlet fever, as it infeCls others at but a very fmall diftance from the fick ; and does not produce a quantity of pus-like matter, like the fmail-pox, which can ad- here to the clothes of the attendants, and when dried is liable to be fhaken off in the form of powder, and thus propagate the infeClion. This contagious powder of rhe fmall-pox, and of the fcarlet fever, becomes mixed with faliva in the mouth, and is thus car- ried to the tonfils, the mucus of which arrefts fome particles of Vol. IL D n this DISEASES Class II. 1.3. 1 1. 210 this deleterious materia^ ; while other parts of it are carried into the ftomach, and are probably decompofed by the power of di- geftion ; as feems to happen to the venom of the viper, when taken into the ftomach. Our perception of bad taftes in our mouths, at the fame time that we perceive difagreeable odours to our noftrils, when we inhale very bad air, occafions us to fpit out our faliva ; and thus in fome inftances, to preferve ourfelves from infection. This has been fuppofed to originate from the fympathy between the organs of tafte and fmell ; but any one who goes into a fick-room clofe fliut up, or into a crowded aflembly-room, or tea-room, which is not fufficiently ventilated, may eafily mix the bad air with the faliva on his tongue fo as to tafte it; as I have myfelf frequently attended to. Hence it appears that thefe heavy infectious matters are more liable to mix with the faliva, and inflame the tonfils, and that either before or at the commencement of the fever ; and this is what generally happens in the fcarlet fever, always I fuppofe in the malignant kind, and very frequently in the mild kind. But as this infeCtion may be taken by other means, as by the Ikin, it alfo happens in the moft mild kind, that there is no inflamma- tion of the tonfils at all ; in the fame manner as there is gener- ally no inflammation of the tonfils in the inoculated fmall-pox. In the mild fcarlatina on the fourth day of the fever the face fwells a little, at the fame time a florid rednefs appears on vari- ous parts of the fkin in large blotches, at length coalefcing, and after three days changing into branny fcales. M. M. Cool air. Fruit. Lemonade. Milk and water. Scarlatina maligna. The malignant fcarlet fever begins with inflamed tonfils ; which are fucceeded by dark drab-coloured Houghs from three to five lines in diameter, flat, or beneath the furrounding furface; and which conceal beneath them fpreading gangrenous ulcers. The fwellings of the tonfils are fenfible to the eye and touch externally, and have an elaftic rather than an cedematous feel, like parts in the vicinity of gangrenes. The pulfe is very quick and weak, with delirium, and the patient generally dies in a few days; or if he recovers, it is by flow de- grees, and attended with anafarca. M. M. A vomit once. Wine. Beer. Cider. Opium. Bark, in fmall repeated dofes. Small fucceflive blifters, if the extremities are cooler than natural. Cool air on the hot parts of the Ikin, the cool extremities being at the fame time covered. Iced lemonade. Broth. Cuftards. Milk. Jellies Bread pudding. Chicken Touch the ulcers with a dry fponge to •abforb the contagious matter, and then with a fponge filled with vinegar, with or without fugar of lead diflblved in it, about fix grains Class II. 1.3. 12. OF SENSATION. 211 grains to an ounce ; or with a very little blue vitriol diflblved in it, as a grain to an ounce ; but nothing fo inftantaneoufly cor- rects the putrid fmell of ulcers as a folution of alum, about half an ounce to a pint of water, which (hould be a little warmifli, and injected into the fauces gently by means of a fyringe. Thefe (hould be repeated frequently in a day, if it can be done eafily, and without fatigue to the child. A little powder of bark taken frequently into the mouth, as a grain or two, that it may mix with the faliva, and thus frequently ftimulate the dying ton- fils. Could a warm bath made of decoction of bark, or a cold alluviation with it, be of fervice ? Could oxygene gas mix- ed with common air ftimulate the languid fyftem ? Small elec- tric (hocks through the tonfils every hour ? ether frequently applied externally to the fwelled tonfils ? As this difeafe is attended with the greateft degree of debility, and as ftimulant medicines,if given in quantity,fo as to produce more than natural warmth, contribute to expend the already too much exhaufted fenforial power ; it appears, that there is noth- ing fo neceflary to be nicely attended to as to prevent any un- neceflary motions of the fyftem ; this is beft accomplifhed by the application of cold to thofe parts of the (kin, which are in the leaft too hot. Dr. Mofman, of Bradford, direfled a boy of eight years of age, who was very hot, and covered with the fear- let eruption, to be taken naked out of bed, and moiftened his (kin all over with cold vinegar, by means of a fponge, with great and good event. It is probable that cold vinegar might dimin- i(h the inflammation and confequent heat of the (kin more ef- feflually than cold water, as its application to the lips renders them pale, probably by ftimulating the abforbent extremities of the veins into greater action. Annals of Medicine, Vol. IV. 1799. Secondly, that the exhibition of the bark in fuch quan- tity as not to opprefs the ftomach and injure digeftion, is next to be attended to, as not being liable to increafe the aftions of the fyftem beyond their natural quantity ; and that opium and wine' (hould be given with the greateft caution, in very fmall repeated quantity, and fo managed as to prevent, if poflible, the cold fits of fever ; which probably occur twice in 25 hours,obeying the luna- tions like the tides, as mentioned in Se<ft. XXXII. 6. that is, 1 fuppofe, the cold periods, and confequent exacerbations of fe- ver, in this malignant fcarlatina, occur twice in a lunar day ; which is about ten minutes lefs than 25 hours ; fo that if the commencement of one cold fit be marked, the commencement of the next may be expelled (if not difturbedby the exhibition of wine, or opium, or the application of blifters) to occur in about twelve DISEASES Class II. 1. 3. 12. 212 twelve hours and a half from the commencement of the former ; or if not prevented by large dofes of the bark. No one could do an a£t more beneficial to fociety, or glorious to himfelf, than by teaching mankind how to inoculate this fa- tal difeafe ; and thus to deprive it of its malignity. Matter might be taken from the ulcers in the throat, which would prob- ably convey the contagion ; or warm water might be put on the eruption, and fcraped off again by the edge of a lancet. Thefe experiments could be attended with no danger, and fhould be tried for the public benefit, and the honour of medical fcience. Dr. Harwood, profeflbr of anatomy, at Cambridge, favoured me with the following curious cafe of this infection : Mr. N had a violent delirium in the fcarlet fever, with the Ikin cracked in many places, exuding an ichorous matter ; he was attended by a poor man who had recently cut his hand with a glafs bottle, and in the ftruggle of,confining him to bed his wounded hand was frequently applied to the patient's body. This happened on the Friday night ; his hand was inflamed and the arm fwell- ed the next day ; on the Monday following he was feized with the fame fever, and died on the Wednefday morning after. This would feem to (hew, as far as a fingle cafe can be relied on, that the fcarlet fever may be communicated, like the fmall-pox, by inoculation, and probably with fimilar fuccefs, if the matter be diluted with warm water, ufed in fmall quantity, and by fuper- ficial incifions only, through the cuticle. 12. Miliaria. Miliary fever. An eruption produced by the warmth, and more particularly by the ftimulus, of the points of the wool in flannel or blankets applied to the ikin, has been frequently obferved ; which,by cool drefs, and bed-clothes with- out flannel, has foon ceafed. See Clafs I. i. 2. 3. This, which may be called miliaria fuditoriat has been confounded with other miliary fevers, and has made the exiftence of the latter doubted. Two kinds of eruptions I have feen formerly attended with fe- ver, but did not fufliciently mark their progrefs, which I con- ceived to be miliary eruptions, one with arterial ftrength, or with fenfitive irritated fever, and the other with arterial debility, or with fenfitive inirritated fever. In the former of thefe, or miliaria irritata* the eruptions were diftind and larger than the fmall-pox, and the fever was not fub- dued without two or three venefeflions, and repeated cathartics with calomel. The latter, or miliaria inirritata, was attended with great ar- terial debility ; and during the courfe of the fever pellucid points appeared within the Ikin, particularly on the foft parts of the fingers. And, in one patient, whom I efteemed near her end, T OF SENSATION. Class II. i. 3. 13. 213 I well recollect to have obferved round pellucid globules, like what are often feen on vines in hot-houfes, no larger than the fmalleft pins' heads, adhere to her neck and bofom; which were hard to the touch, but were eafily rubbed oft'. Thefe difeafes, if they are allied,do not differ more than the kinds of fmall-pox ; but require many further obfervations. The eruption fo often feen on children in the cradle, and call- ed by the nurfes red-gum, and which is attended with fome de- gree of fever, I fufpect to be produced by too great warmth,and the contact of flannel next their tender (kins, like the miliaria fudatoria ; and like that requires cool air, cool clothes, and lin« en next their fkin. 13. Pejlis. The plague, like other difeafes of this clafs, feems to be fometimes mild, and fometimes malignant; according to the teftimony of different writers. It is faid to be attended with inflammation, with the greateft arterial debility, and to be very contagious, attended at an uncertain time of the fever with buboes and carbuncles, borne authors affirm, that the conta- gion of the plague may be repeatedly received, fo as to produce the difeafe ; but as this is contrary to the general analogy of all contagious difeafes, which are attended with fever, and which cure themfelves fpontaneoufly •, there is reafon to fufpedt, that where it has been fuppofed to have been repeatedly received, fome other fever with arterial debility has been miftaken for it, as has probably univerfally been the cafe, when the fmall-pox has been faid to have been twice experienced. M. M. Venefeclion has been recommended by fome writers on the firft day, where the inflammation was fuppofed to be at- tended with fufficient arterial ttrength, which might perhaps fometimes happen, as the bubo feems to be a fuppuration; but the carbuncle, or anthrax, is a grangrene of the part, and (hews the greateft debility of circulation. Whence all the means be- fore enumerated in this genus of difeafes to fupport the powers of life are to be adminiftered. Currents of cold air, cold water, ice, externally on the hot parts of the Ikin. The methods of preventing the fpreading of this difeafe have been much canvaffed, and feem to confift in preventing all con- gregations of the people, as in churches, or play-houfes ; and to remove the fick into tents, on fome airy common, by the (ide of a river, and fupply them with freffi food, both animal and veg- etable ; with beer and wine, in proper quantities ; and to en- courage thofe who can, daily to waffi both their clothes and themfelves. The/(/for vaccina^ or difeafe amongft the cows, which affiift- ed this ifland about half a century ago, feems to have been a contagious 214 DISEASES Class II. 1. 3. 14. contagious fever,with great arterial debility ; as in fome of them, in the latter Hage of the difeafe, an emphyfema could often be felt in fome parts, which evinced a confiderable progrefs of gan- grene beneath the (kin. In the fenfitive inirritated fevers of thefe animals, I fuppofe about fixty grains of opium, with two ounces of extraft of oak-bark, every fix hours, would fupply them with an efficacious medicine ; to which might be added thirty grains of vitriol of iron, if any tendency to blood urine fhould appear, to which this animal is liable. The method of preventing the infection from fpreading, if it fhould ever again gain accefs to this ifland, would be immediately to obtain an or- der from government to prevent any cattle from being removed, which were found within five miles of the place fuppofed to be infedted, for a few days ; till the certainty of the exigence of the peftilence-could be afeertained, by a committee of medical people. As foon as this was afeertained, all the cattle within five miles of the place fhould be immediately flaughtered, and confumed within the circumfcribed diflridl; and their hides put into lime-water before proper infpe&ors. 14. Pemphigus is a contagious difeafe, attended with blad- dery eruptions, appearing on the fecond or third day, asArge as filberts, which remain many days, and then effufe a thin ichor. It feems to be either of a mild kind, with fenfitive fever only, of which I have feen two inftances ; or with irritated, or with in- irritated fever ; as appears from the obfervations of M. Salbert- See Medical Comment. By Dr. Duncan, Decad. II. Vol. VI. 1 5/ Varicella. Chicken-pox is accompanied with fenfitive fever, puftules break out after a mild fever, like the fmall-pox, feldom fuppurate,and generally terminate in fcales without fears. I once faw a lady who mifearried during this difeafe, though all her children had it as flightly as ufual. It fometimes leaves fears or marks on the Ikin. This difeafe has been miftaken for the fmall-pox, and inoculated for it ; and then the fmall-pox has been fuppofed to happen twice to the fame perfon. See Tranf. of the College, London. It is probable that the pemphigus and urticaria, as well as this difeafe, have formerly been difeafesof more danger ; which the habit of innumerable generations may have rendered mild, and will in procefs of time annihilate. In the fame manner as the fmall-pox, venereal difeafe, and rickets, feem to become milder or lefs in quantity every half century. While, at the fame time, it is not improbable, that other new difeafes may arife, and, for a feafon, thin mankind 1 16. Urticaria. Nettle-rafh begins with mild fenfitive fever, which is fometimes fcarcely perceptible. Hence this eruption has been thought of two forts, one with and the other without fever. OF SENSATION. Class II. 1. 3. 17. 215 fever. On the fecond day red fpots, like parts flung with net- tles, are feen ; which almoft vanifh during the day, and recur in the evening with the fever, fucceeded in a few days by very mi- nute fcales. See Tranf. of the College, London. 17. Aphtha. Thrufh. It has been doubted, whether aphtha or thrufli, which confifts of ulcers in the mouth, fliould be enu- merated amongft febrile difeafes ; and whether thefe ulcers are always fymptomatic, or the confequence rather than the caufe of the fevers which attend them. The tongue becomes rather fwelled ; its colour and that of the fauces purplifh ; Roughs or ulcers appear firft on the throat and edges of the tongue, and at length over the whole mouth. Thefe Roughs are whitifh, fometimes diftinft, often coalefcing, and remain an uncertain time. Cullen. I fhall concifely mention four cafes of aphtha, but do not pretend to determine whether they were all of them fymptomatic or original difeafes. Aphtha fenjitiva, A lady during pregnancy was frequently feized with ulcers on her tongue and cheeks, or other parts of the mouth, without much apparent fever ; which continued two or three weeks, and returned almoft every month. The thrufli in the mouths of young children feems to be a fimilar difeafe. Thefe ulcers refemble thofeproduced in the fea-fcurvy,and have probably for their caufe an increafed action of the fecerning fyftem from increafed fenfation, with a decreafed action of the abforbent fyftem from decreafed irritation. See ClafsI. 2. 1. 14. M. M. Solutions of alum, of blue vitriol. Powder of bark taken frequently into the mouth in very fmall quantity. See Clafs II. 1. 3. 1. Aphtha irritata. Inflammatory aphtha. A cafe of this kind is related under the title of fuppurative rheumatifm. Clafs IV. 2. 1. 16. Aphtha inirritata. Sloughs or ulcers of the mouth, attended with fenfitive fever with great arterial debility. They feem to fpread downwards from the throat into the ftomach, and proba- bly through the whole inteftinal canal, beginning their courfe with cardialgia, and terminating it with tenefmus ; and might perhaps be called an eryfipelas of this mucous membrane. M. M. Cool air. A fmall blifter on the back. Bark. Wine. Opium in fmall repeated quantities. Soap neutralizes the gaf- tric acid without effervefcence, and thus, relieves the pain of car- dialgia, where the ftomach is affected. Milk alfo deftroys a part of this acid. Infuflon of fage-leaves two ounces, almond-foap from five grains to ten, with fugar and cream, is generally both agreeable and ufeful to thefe patients. See I. 2. 4. 5. Where the ftomach inav be fuppofed to be excoriated by poi- fons 216 DISEASES Class II. i. 3.18' fons containing acid, as fublimate of mercury or arfenic ; or if it be otherwife inflamed, or very fenfible to the ftimulus of the gaftric acid ; or where it abounds with acid of any kind, as in cardialgia ; the exhibition of foap is perhaps a preferable man- ner of giving alkali than any other, as it decompofes in the ftom- ach without eflervefcence $ while the cauftic alkali is too acrid to be adminiftcred in fuch cafes, and the mild alkali produces car- bonic gas. If a drop of acid of vitriol be put on cap-paper, it will be long before it deftroys the paper ; but if a drop of mild alkali be added, a fudden eflervefcence arifes, and the paper is inftantly deftroyed by the efcape of the fixed air ; in the fame manner as lumps of folid lime are broken into powder by the ef- cape of the fteam produced from the water, which is poured on them. This fhews why a fucceffion of acid and of alkaline cauf- tics fooner deftroys a part,than either of them applied feparately. 18. Dyfenteria. Bloody-flux is attended with fenfitive fever, generally with arterial debility ; with frequent mucousor bloody ftools, which contain contagious matter produced by the mem- branes of the inteftines ; the alimentary excrement being never- thelefs, retained ; with griping pains, and tenefmus. Linneus obferved microfcopic animals in the ftools of dyfen- teric patients, and concluded from thence that they were the caufe of the difeafe ; in the fame manner the animalcula, feen by microfcopes, in the puftules of the itch, have been fuppofed to be the caufe of thofe eruptions. See Article IV. 2. I. 3. Thefe animalcula are neverthelefs feen inalmoft all animal fluids which have for a time ftagnated ; as in the femen, and in all liquid evacuations from the inteftines, as aflerted by Buffon ; who efteems them to be organized beings, though not perfect animals, in his ingenious treatife on generation. Hiftorie Nat- urel. M. M. Emetics. Antimonials. Peruvian bark. Opium and calomel, of each a grain every night. Bolus armenite. Earth of alum. Chalk. Calcined hartfhorn. Mucilage. Bees wax mixed with yolk of egg. Cerated glafs of antimony. Warm bath. Flannel clothing next to the fkin. Large clyfters with opium. With ipecacuanha, with fmoke of tobacco ? Two dyfenteric patients in the fame ward, of the infirmary at Edinburgh,quarrelled, and whipped each otherlwith horfewhips a long time, and were both much better after it, owing perhaps to the exertion of fo much of the fenforial power of volition ; which, like real infanity, added excitement to the whole fyftem. The prevention of this contagion mult confift principally in ventilation and cleaniinefs ; hence the patients fhould be re- moved into cottages diftant from each other, or into tents •, and their Class II. 1. 3. 19. OF SENSATION. 217 their faeces buried as foon as may be ; or conveyed into a running ftream ; and themfelves fhould be wafhed with cold or warm water after every evacuation. For the contagious matter confifts in the mucous or purulent difcharge from the membrane which lines the inteftines ; and not from the febrile perfpiration, or breath of the patients. For the fever is only the confequence and not the caufe of contagion ; as appears from Genus the Fifth of this Order, where contagion exifts without fever. 19. Gajlritis fuperficialis. Superficial inflammation of the ftomach. An eryfipelatous inflammation of the ftomach is men- tioned by Dr. Cullen from his own obfervations ; which is dif- tinguifhed from the inflammatory gaftritis by lefspain and fever, and by an eryfipelatous rednefs about the fauces. Does this difeafe belong to aphtha ? 20. Enteritis fuperficiaYis. Superficial inflammation of the bowels is alfo mentioned by Dr. Cullen, from his own obferva- tion, under the name of enteritis erythe.matica; and is faid to be attended with lefs pain and fever, without vomiting, and with diarrhoea. May not this difeafe be referred to aphtha, or to dyfentery ? Vol. II. E e ORDO DISEASES Class II. r. 4. 1. 218 ORDO I. / Increafed Senfation. GENUS IV. With the Production of new Veffels by internal Membranes or Glands, without Fever. Where inflammation is produced in a fmall part, which has no great natural fenfibility, the additional fenfation does not produce an increafed action of the arterial fyftem ; that is, the aflbciated motions which are employed in the circulation of the blood (thofe for inftance of the heart, arteries, glands, capillaries, and their correfpondent veins), are not thrown into increafed ac- tion by fo fmall an addition of the fenforial power of fenfation. But when parts which naturally poflefs more fenfibility become inflamed,the quantity of the fenforial power of fenfation becomes fo much increafed, as to affebt the aflbciated motions belonging to the circulation, occafioning them to proceed with greater fre- quency ; that is, a fever is induced. This is well exemplified in the internal and fuperficial paronychia ; one of which is at- tended with great pain and fever, and the other with little pain and no fever. SeeClafs II. i. 2. 19- and II. 1. 4. 5. From hence it appears, that the fenfitive fever is an accident- al confequence of the topical phlegmon, or inflammation and not a caufe of it ; that it is often injurious, but never falutary ; and fhould therefore always be extinguifhed, as foon 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 fuperficialis. As the membranes, which cover the eye, are excluded from the air about one third part of the twenty-four hours, and are moiftened by perpetual nictitation during the other fixteen, they may be confidered as internal membranes ; and, from the analogy of their inflammation to that of other internal membranes, it is arranged under this ge- nus ; whilft the tonfillitis is efteemed an inflammation of an ex- ternal membrane, becaufe currents of air are perpetually palling both day and night over the fauces. The fuperficial ophthalmy has generally been efteemed a fymptom Class II. 1. 4.1. OF SENSATION. 219 fymptom of fcrofula, when it recurs frequently in young per- fons ; but is probably only a concomitant of that difeafe, as a fymptom of general debility ; ramifications of new red veflels, and of enlarged old ones, are fpread over the white part of the eye ; and it is attended with lefs heat, lefs pain, and lefs intoler- ance of light than the ophthalmia interna, defcribed in Oafs II. I. 2. 2. It occurs in thofe of feeble circulation, efpecially chil- dren of a fcrofulous tendency, and feems to arife from a previ- ous torpor of the veflels of the tunica albuginea from their being expofed to cold air; and from this torpor being more liable to occur in habits, which are naturally inirritable ; and therefore more readily fall into quiefcence by a fmaller deduction of the ftimulus of heat, than would affect ftronger or more irritable habits ; the confequence of this torpor is increafed action, which produces pain in the eye, and that induces inflammation by the acquifition of the additional fenforial power of fenfation. Ophthalmia lymphatica is a kind of anafarca of the tunica adna- ta ; in this the veflels over the fclerotica, or white part of the eye, rife confiderably above the cornea, which they furround, are lefs red than in the ophthalmia fuperficialis, and appear to be fwelled by an accumulation of lymph rather than of blood ; it is probably owing to the temporary obftrudlion of a branch of the lymphatic fyfiem. M. M If the pain be great, venefeftion by leeches on the temple, or cutting the temporal artery, and one purge with three or four grains of calomel (hould be premifed. Then the Peru- vian bark twice a day. Opium from a quarter to half a grain twice a day for fome weeks. Bathe the eye frequently with cold water alone, or with cold water to a pint of which is added half an ounce of fait. White vitriol, fix grains diflolved in one ounce of water ; a drop or two to be put between the eyelids twice a day. Take very fmall electric (parks from the eyes eve- ry day for a fortnight. Bathe the whole head with fait and wa- ter made warm, every night for fome months. Send fuch chil- dren to a fchool near the fea, for the convenience of fea-bathing, for many months, annually ; fuch fchools are to be found in or near Liverpool. When a child is afHi<£ted with an inflamed eye of this kind, he (hould always fit with his back to the window or candle 5 but it is generally not neceffary to cover it, or if the uneafy fen- fation of light makes this proper, the cover (hould (land ofl'from the eye, fo as not much to exclude the cool air from it. As covering an eye unneceffarily is liable to make that eye weaker than the other, from its not being fufliciently ufed, and thence to produce a fquinting forever afterwards. Neverthelefs, 220 DISEASES Class II. 1.4. 2. Neverthelefs, when the pain is great, a poultice muft be ap- plied to keep the eyes moift, or a piece of oiled (ilk bound light- ly over them. Or thus, boil an egg till it is hard, cut it longi- tudinally into two hemifpheres, take out the yolk, few the backs of the two-hollow hemifpheres 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 moift without any difagreea- ble preflure. See Clafs I. i. 3. 14. Ophthalmia equina. An inflammation of this kind is liable to affeft the eyes of horfes; one caufe of which is owing to a filly cuftom of cutting the hair out of horfes' ears ; by which they are not only liable to take cold at the ear, but grafs-feeds are li- able to fall into their ears from the high racks in ftables ; and in both cafes the eye becomes inflamed by fympathy. I once directed the temporal artery of a horfe to be opened, who had frequent returns of an inflamed eye ; and I believed it was of eflential fervice to him •, it is probable that the artery was after- wards contracted in the wounded part, and that thence Jefs blood was derived to the eye: the haemorrhage was flopped by two perfons alternately keeping their fingers on the orifice, and after- wards by a long bandage of broad tape. 2. Pierigion. Eye-wing. A fpot of inflammation fometimes begins on the infide of the lower eyelid, or on the tunica albu- ginea, and fpreads an intertexture of red veflels from it, as from a centre, 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 veflels again and again, with the point of a lancet, clofe to the centre of inflammation. Touch them repeatedly with lunar cauftic. See Home on the urethra. Page 101. Mr. Hadley of Derby procured an ingenious inftrument to be made to cut the veflels, which had fpread their numerous branches over an opaque cornea, after a violent inflammation ; by which they were repeatedly divided, with little pain to the patient, as there was no neceflity to hold them by a forceps. The inftrument was in the form of a corn-fickle, or the early crefcent of the new moon, about an inch in length, the inner edge of the curve Was fharp, and the point fine ; the back was rounded and fmooth, and the other end fixed in an ivory han- dle. The point of this was fuddenly introduced under the branches of the new veflels, which were thus cut upwards, and there was no occafion to hold the eye, or the trunks of the veflels. 3. Tarjitis palpebrarum. Inflammation of the edges of the eyelids. This is a difeafe of the glands, which produce the hairs of the eyelalhes, and is frequently the caufe of their falling off. After Class II. 1. 4/4. OF SENSATION. 221 After this inflammation a hard fcar-like ridge is left on the edge of the eyelid, which fcratches and inflames the eyeball, and be- comes a very troublefome difeafe. The Turkilh ladies are faid to colour the edge of the eyelalh with crude antimony in very fine powder, which not only gives 1 nitre to the eye, as a diamond fet on a black foil, but may pre- vent extraneous light from being reflected from thefe edges into the eye, and thus ferve the purpoie of the black feathers about the eyes of fwans, defcribed in Sect. XXXIX. 5. 1. and may alfo prevent the edges of the eyelids from being inflamed by the frequent Itimulus of tears on them. Black lead in fine powder might be better for all thefe purpofes than antimony, and might be put on with a camel's hair brufh. M M. Mercurial ointment fmeared at night on the edges of the eyelids. Burnt alum fixty grains, hog's greafe half an ounce, well rubbed into an ointment to be fmeared on them in the night. Cold water frequently in the day. See Clafs IL 1. 1. 8. 4. Hordeolum. Stye. This inflammation begins either on or near the edges of the eyelids, or in the loofe Ikin of them, and is fometimes very flow either in coming to fuppuration or in difperfing. The Ikin beneath the lower eyelid is the molt frequent feat of this tumor, which fometimes never fuppurates at all, but becomes an encyfted tumor : for as this Ikin is very loofe for the purpofe of admitting great motion to the eyelid, the abforbent power of the veins feems particularly weak in this part; whence when any perfon is weakened by fatigue or other- wife, a darker Ihade of colour is feen beneath the eyes ; which is owing to a lefs energetic action of the abforbent terminations of the veins, whence the currents of dark or venous blood are delayed in them. This dark Ihade beneath the eyes, when it is permanent, is a fymptom of habitual debility, or inirritability of the circulating fyftem. See Clafs I. 2. 2. 2. M. M. Smear the tumors with mercurial ointment, moiften them frequently with ether. To promote their fuppuration they may be wounded with a lancet, or flit down the middle, or they may be cut out. . A cauftic leaves a large fear. 5. Paronychia fuperfaialis. Whitlow. An inflammation a- bout the roots of the nail beneath the Ikin, which fuppurates without fever, and fometimes deftroys the nail; which is, how- ever, gradually reproduced. This kind of abfeefs, though not itfelf dangerous, has given opportunity for the inoculation of venereal matter in the hands of accoucheurs, and of putrid mat- ter from the difledtion of difeafed bodies ; and has thus been the caufe of difeafe and death. When putrid matter has been thus 222 DISEASES Class II. 1. 4. 6. thus abforbed from a dead body, a livid line from the finger to the fwelled gland in the axilla is faid to be vifible; which (hews the inflammation of the abforbe.nt veflel along its whole courfe to the lymphatic gland ; and death has generally been the confequence. M. M. In the common paronychia a poultice is generally fufficient. In the abforption of putrid matter rub the whole hand and arm with mercurial ointment three or four times a day, or perpetually. Could the fwelled axillary gland be exfedt- ed ? In the abforption of venereal matter the ufual methods of cure in fyphilis muft be adminiltered, as in Clafs II. i. 5. 1. 6. Gutta rofea. The rofy drop on the face is of three kinds. Firft the gutta rofea hepatica, or the red pimples on the faces of drunkards, which are probably a kind of crifis, or vicarious in- flammation, which fucceeds or prevents, a torpor of the mem- branes of the liver. This and the fucceeding fpecies properly belong to Clafs IV. 1. 2. 14. Secondly, the pimpled face, in confequence of drinking cold water, creating cold turnips, or other infipid food, when much heated with exercife ; which probably arifes from the fympathy between the (kin of the face and the ftomach ; and may be call- ed the gutta rofea fomatica. Which is diftinguifhed from the former by the habits of the parient in refpect to drinking ; by the colour of the eruptions being lefs deep ; and by the patient continuing generally to be troubled with fome degree of apepfia. See Clafs I. 3. 1. 3. I knew a lady who had long been afflict- ed with pain about the region of the ftomach ; and, on drinking half a pint of vinegar, as a medicine, Ihe had a breaking out commenced on her face; which remained, and (he became free from pain about the ftomach. Was this a ftomachic, or an hepatic difeafe ? Thirdly, there is a red face, which confifts of fmaller pimples than thofe above mentioned ; and which is lefs liable to fuppu- rate ; and which feems to be hereditary, or at leaft has no appar- ent caufe like thofe above mentioned ; which may be termed. gutta rofea hereditaria, or punCla rofea. Mrs. S. had a pimpled face, which I believe arofe from pota- tion of ale. She applied alum in a poultice to it, and had foon a paralytic ftroke, which difabled her on one fide, and termina- ted in her death. Mrs. L. had a red pimpled face, which feemed to have been derived from her mother, who had probably acquired it by vi- nous potation ; (he applied a quack remedy to it, which I believe was a folution of lead, and was feized with epileptic fits, which terminated in palfy, and deftroyed her. This (hews the danger of ufing white paint on the face, which is called bifmuth, but is irt Class II. 1. 4. 6. OF SENSATION. 223 in reality white lead or cerufla; and if it be bifmuth, it may be equally deleterious. Mr. Y had acquired the gutta rofea on his nofe, and ap- plied a faturnine folution on it for a few nights, and was then feized with paralyfis on one fide of his face ; which however he gradually recovered, and has fince acquired the gutta rofea on other parts of his face. Thefe fatal effects were probably cauTed by the difagreeable fenfation of an inflamed liver, which ufed before to be relieved by the fympathetic action and confequent inflammation of the (kin of the face, which was now prevented by the ftronger ftim- ulus of the application of calx of lead. The manner in which difagreeable fenfations induce epilepfy and palfy is treated of in Clafs III. In fome cafes where habitual difcharges, or eruptions, or ulcers, are flopped, a torpor of the fyftem may follow, owing to the want of the accuftomed quantity of fenfation or irritation. See Clafs I. i. 2.9. and II. 1. 5.6. In both thefe fituations fome other ftimulus fhould be ufed to fupply the place of that which is taken away; which may either be perpetual, as an iflue ; or periodical, as a cathartic repeated once a fortnight or month. Mifs W. an elegant young lady, of about twenty, applied a mercurial lotion to her face, which was covered with very fmall red points (which feemed to have been not acquired by any known or avoidable means); (he was feized 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 cathar- tic, five grains of rhubarb and a quarter of a grain of emetic tar- tar every night for many weeks. With this preparation mer- curial plafters, made without turpentine, and applied every night, and taken off every morning, will fometimes fucceed, and may be ufed with fafety. But bliftering the face all over the eruption, beginning with a part, fucceeds better than any other means, as I have more than once experienced.-Something like this is mentioned in the Letters of Lady Mary Wortley Mon- tague, who bliftered her face with balfam of Mecca Mrs. F. had for many years had a difagreeable looking erup- tion on her chin. After a cathartic with calomel, fhe was ad- vifed to blifter her whole chin; on the healing of the blifter a few eruptions again appeared, which ceafed on the application of a fecond blifter. She took rhubarb five grains, and emetic tartar a quarter of a grain every night for many weeks. Mifs L. a young lady, about eighteen, had tried variety of ad- vice, for pimples over the greateft part of her face, in vain She took 224 DISEASES Class II. 1. 4.7. took the above medicines internally, and bliftered her face by de- grees all over, and became quite beautiful. A fpot or two now and then appeared, and on this account {he frequently ilept with parts of her face covered with mercurial plafter, made without turpentine, which was held on by a pafteboard mafk, and taken oft'in the mornings ; if any part of the plafter adhered, a little butter or oil deftroyed the adhefion. If there be turpentine, or any other native balfam, mixed with the mercurial plafter, it is very liable much to inflame the face (I fuppofe like the balfam of Mecca); but if a fmall quantity of flour of brimftone be added, I believe it will readily mix. As a mercurial ointment is faid to be quickly made by adding only fix grains of flour of fulphur to fix drachms of mercury, and two ounces of hog's greafe. 7. Odontitis. Inflammatory tooth-ach is occafioned by in- flammation of the membranes of the tooth, or a caries of the bone itfelf. The gum fometimes fuppurates, otherwife a fwell- ingof the cheek fucceeds by afibciation, and thus the violence of the pain in the membranes of the tooth is relieved, and fre- quently cured ; and when this happens the difeafe properly be- longs to Clafs IV. as it fo far refembles the tranflations of mor- bid actions in the gout and rheumatifm. At other times the tooth dies without caries, efpecially in peo- ple about 60 years of age, or before; and then it ftimulates its involving membrane, like any other extraneous fubftance. The membrane then becomes inflamed and thickened, occafioning fome pain, and the tooth rifes upwards above the reft, and is gradually pufhed out whole and undecayed ; on its rifing up a pus- like mucus is feen difcharged from the gum which furrounds it; and the gum feems to have left the tooth, as the fangs or roots of it are in part naked. M. M. Where the tooth is found it can only be faved by evacuations, by venefedlion, and a cathartic ; and after its op- eration two grains of opium. A blifter may alfo be ufed behind the ear, and ether applied to the cheek externally. In {lighter cafes two grains of opium with or without as much camphor may be held in the mouth, and fuffered to diflblve near the af- feched tooth, and be gradually fwallowed. See Clafs I. 2. 4. 12. Odontalgia may be diftinguifhed from otitis by the appli- cation of cold water to the affected tooth ; for as the pain of common tooth-ach is owing to torpor, whatever decreafes ftimu- lus adds to the torpor and confequent pain ; whereas the pain of an inflamed tooth, being caufed by th'e increafed action of the membranes of it, is in fome meafure alleviated by the applica- tion of cold 8. Otitis. Inflammation and confequent fuppuration of fome membranes Class II. 1. 4. 9. OF SFNSATION. 225 membranes of the internal ear frequently occur in children, who fleep in cold rooms, or near a cold wall, without a night-cap. If the bones are affected,they come out in a long procefs of time, and the child remains deaf of that ear. But in this cafe there is generally a fever attends this inflammation ; and it then belongs to another genus. M. M. A warmer night-cap. Warmilh water fhould be gently fyringed into the ear, to keep it clean, twice a day ; and if it does not heal in a week, a little fpirit of wine fhould be added ; firft about a fourth part, and it fhould be gradually in- creafed to half redlified fpirit and half water : if it continues long to difcharge matter with a very putrid fimell, the bones are injured, and will in time find their exit ; during which time the ear fhould be kept clean, by filling it with a weaker mixture of fpirit of wine and water, or a folution of alum in water ; which may be poured into the ear, as the head is inclined, and fhook out again by turning the head, two or three times morn- ing and evening. See Oafs II. 1.4. 10. p. Fijlula lacrymalis. The lacrymal fack, with its pundta lac- rymalia and nafal du6t,are liable to be deftroyed by fuppuration without fever; the tears then run over the eyelids, and inflame the edges of them and the cheeks, by their perpetual moifture and faline acrimony. M. M. By a nice furgical operation, a new aperture is to be made from the internal corner of the eye into the noftril, and a filver tube introduced, which fupplies the defedt by admitting the tears to pafs again into the noftril. See Melanges de Chir- urgie, par M. Ponteau ; who thinks he has improved this oper- ation. 10. Fiftula in ano. A mucous difcharge from the anus, call- ed by tome white piles, or matter from a fuppurated pile, has been miftaken for the matter from a concealed fiftula. A bit of cotton-wool applied to the fundament to receive the matter,and renewed twice a day for a week or two, fhould always be ufed before examination with the probe. The probe of an unfkilful empyric fometimes does more harm in the loofe cellular mem- brane of thefe parts than the original ulcer, by making a fiftula he did not find. The cure of a fiftula in ano, of thofe who have been much addidted to drinking fpirituous liquor, or who have a tendency to pulmonary confumption, is frequently of danger- ous confequence, and is fucceeded by ulcers of the lungs, and death. M M. Ward's pafte, or 20 black pepper-corns taken after each meal twice a day ; the pepper-corns fhould be cut each in- to two or three pieces. The late Dr. Munro, of Edinburgh, Vol. II. F f aflerted 226 DISEASES Class II. 1.4. 11. aflerted, in his lectures, that he had known a fiftula in ano cured by in jedding firft a mixture of rectified fpirit of wine and water ; and, by gradually increafing the ftrength of it, till the patient could bear rectified fpirit alone ; by the daily ufe of which, at length, the fides of the fiftula became callous, and ceafed to dif- charge, though the cavity was left. A French furgeon has lately affirmed, that a wire of lead put in at the external open- ing of the ulcer, and brought through the reClum, and twifted together, will gradually wear itfelf though the gut, and thus ef- fect a cure without much pain. The ends of the leaden wire muft be twifted more and more as it becomes loofe. Or, laftly, it muft be laid open by the knife. 11. Fiftula urethra. Where a ftri&ure of the urethra exifts, from whatever caufe, the patient, in forcing the ftream of urine through the ftriClure, diftends the urethra behind it; which, after a time, is liable to burft, and to become perforated ; and fome of the urine is puflied into the cellular membrane, occa- fioning fiftulas, which fometimes have large furfaces producing much matter, which is prefled out at the time of making water, and has been miftaken for a catarrh of the bladder ; thefe fiftu- las fometimes acquire an external opening in the perinseum, and part of the urine is difeharged that way. Can this matter be diftinguilhed from mucus of the bladder by the criterion delivered in Clafs II. i. 6. 6. ? M. M. The perpetual ufe of bougies, either of catgut or of caoutchouc. The latter may be had at No. 37, Red-lion-ftreet, Holborn, London. The former are eafily made, by moiftening the catgut, and keeping it ftretched till dry, and then rounding one end with a pen-knife. The ufe 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 fuccefsful in one cafe ; the extenfive fiftulas completely healing. The patient fhould introduce a bougie always before he makes water, and endeavour to make it as flowly as poflible. See Clafs I. 2. 3. 24. 12. Hepatitis chronica. Chronical inflammation of the liver. A collection of matter in the liver has frequently been found on difl'eCtion, which was not fufpeCted in the living fubjeCt. Though there may have been no certain figns of fuch a collection of matter, owing to the infenfibility of the internal parts of this vifeus ; which has thus neither been attended with pain, nor in- duced any fever ; yet there may be in fome cafes reafon to fuf- pett the exiftence of fuch an abfeefs ; either from a fenfe of ful- nefs in the right hypochondre, or from tranfient pains fometimes felt there, or from pain on prefliire, or from lying on the left fide, and fometimes from a degree of fenfitive fever attending it. Dr. Saunders Class II. 1.4. .13. OF SENSATION. 227 Dr. Saunders fufpefls the acute hepatitis to exift in the in- flammation of the hepatic artery, and the chronical one in that of the vena portarum. Treatife on the Liver. Robinfons. London. 13. Scrofula fuppurans. Suppurating fcrofula. The indolent tumors of the lymphatic glands are liable, after a long time, to regain their fenfibility ; and then, owing to their former torpor, an increafed action of the veflels, beyond what is natural, with inflammation, is the confequence of their new life, and fuppura- tion fucceeds. This cure of fcrofula generally happens about puberty, when a new energy pervades the whole fyltem, and un- folds the glands and organs of reproduction. M. M. See Clafs I. 2. 3. 21. Where fcrofulous ulcers about the neck are difficult to heal, Dr. Beddoeswas informed, in Ire- land, that an empyric had had feme fuccefs by inflaming them by an application of wood forrel,oxalis aceto fella,the leaves of which are bruifed in a mortar, and applied on the ulcers for two or three days, and then fome more lenient application is uled. A poor boy, about twelve years old, had a large fcrofulous ul- cer on one tide of the cheft beneath the clavicle, and another under his jaw ; he was directed, about three weeks ago, to pro- cure 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 fhew me that both the ulcers are quite healed. The con- llant application of linen rags, moiftened with a folution of an ounce of fugar of lead in a pint of water, I think I have feen equally efficacious. Small dofes internally of a folution of arfenic have been faid to contribute to cure thefe ulcers. I fhould recommend from one drop to five of a faturated decoflion of arfenic, as direfled in Mat. Med. Art. IV. 2. 6. 8. for children, twice or thrice a day, according to their age, and from five to ten to grown per- lons, diminifhing the quantity if it affefls the bowels. Tinc- ture of Digitalis is recommended in Clafs I. 2. 3. 21. 14. Scorbutus fuppurans. In the fea-feurvy there exifts an inaflivity of venous abforption, whence vibices and petechia?, and fometimes ulcers. As the column of blood preffingon the origins of the veins of the lower extremities, when the body is erefl, oppofes the afeent of the blood in them, they are more frequently liable to become enlarged, and to produce varixes, or vibices, or, laftly, ulcers about the legs, than on the upper parts of the body. The expofure to cold is believed to be another caufe of ulcers on the extremities ; as happens to many of the poor 228 DISEASES Class II. 1.4. 15. poor in winter, at Lifbon, who deep in the open air, without flockings, on the fteps of their churches or palaces. See Clafs I. 2. I- 15. M. M. A bandage fpread with plafter to cover the whole limb tight. Rags dipped in a folution of fugar of lead. A warm flannel flocking or roller. White lead and oak-bark, both in fine powder. Horizontal reft. An ingenious treatife on the ufe of bandage, in the cure of ulcers, has lately been pub- lifhed by Mr. Baynton, of Briftol; and another, on the fame fub- je£l, by Mr. Whately, of London, who fucceeds without ufing plafter on the bandage. 15. Scirrbus fuppurans. When a fcirrhus affedls any gland of no great extent or fenfibility, it is, after a long period of time, liable to fuppurate without inducing fever, like the indolent tu- mors 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 livers of fwine, which have been fed with the grounds of fermented mixtures in the diftil- leries. Another termination of fcirrhus is in cancer, as defcri- bed below. See Clafs I. 2. 3. 22. 16. Carcinoma. Cancer. When a fcirrhous tumor regains its fenfibility by nature, or by any accidental hurt, new veflels fhoot amongft the yet infenfible parts of it, and a new fecretion takes place of a very injurious material. This cancerous mat- ter is abforbed, and induces fwelling of the neighbouring lymph- atic glands ; which alfo become fcirrhous, and afterwards cancerous. This cancerous matter does not feem to acquire its malignant or contagious quality, till the cancer becomes an open ulcer ; and the matter fecreted in it is thus expofed to the air. Then it evidently becomes contagious, becaufe it not only produces heftic fever, like common matter in ulcers open to the air, but it alfo, as it becomes abforbed, fwells the lymphatic glands in its vicinity ; as thofe of the axilla, when the open cancer is on the breaft. See Clafs II. 1.3. Hence exfe£lion before the cancer is open is generally a cure ; but after the matter has been expofed to the air, it is feldom of fervice ; as the neighbouring lymphatic glands are already in- fefted. I have obferved fome of thefe patients after the opera- tion to have had difeafed livers, which might either have previ- oufly exifted, or have been produced by the fear or anxiety at- tending the operation. Erofion with arfenic, after the cancer is become an open ul- cer, has generally no better effedl than exfedtion, but has been fuccefsful before ulceration. The beft manner of ufing arfenic, is Class II. 1. 4. 19. OF SENSATION. 229 is by mixing one grain with a drachm of lapis calaminaris, and brewing on the cancer fome of the powder every day, till the whole is deftroyed. Cancers on the face are faid to arife from the periofteum, and that, unlefs this be deftroyed by the knife, or by cauftics, the cancer certainly recurs. After the cancer becomes an open ulcer of fome extent, a purulent fever fupervenes, as from other open ulcers, and gradually deftroys the patient. See Clafs II. i. 6. 13. Two very interefting cafes have been lately publifhed by Dr. Ewart, of Bath, in which carbonic acid gas, or fixed air, was kept conftantly in contact with the open cancerous ulcers of the breaft ; which then healed like other common ulcers. This is rather to be afcribed to the exclufion of oxygen, than to any fpecific virtue in the carbonic acid. As in common ulcers the matter does not induce hedlic fever, till it has been expoled to the air, and then probably united with oxygen. The manner of applying the fixed air, is by including the can- cer in one half, or hemifphere, of a large bladder; the edges are made to adhere to Ikin by the adhefive plafter, or perhaps a mixture of one part of honey with about twenty parts of car- penter's glue might better fuitfome tender Ikins The bladder is then kept conftantly filled with carbonic acid gas, by means of a pipe in the neck of it; and the matter let out at a fmall a- perture beneath. M. M. Where extirpation is not advifable, as in moft open cancers of the breaft, keep the ulcer carefully from the air,either by applying carbonic acid gas, as above ; or by covering it with charcoal in powder,and a double oiled filk. The charcoal-pow- der Ihould be renewed once in two or three days, and at thofe times it Ihould be puttied off by frelh charcoal-powder on lint, fo as not for a moment to expofe it to the air. The charcoal Ihould be frelh taken from the fire, and powdered very fine as foon as cool, and kept in a bottle to be as little expofed to the air as poflible. The tumor Ihould be fufpended by a falh or foft cufhion, fo as to keep it as eafy as poflible night and day, and Ihould be kept neither too warm nor too cold, as both extremes are injurious. Internally, fix grains of rhubarb every night,for many months, and to drink nothing ftronger than common weak fmall beer, confifting of three ftrike of malt to the hogfhead,or wine diluted with thrice its quantity of water. If cauftics cannot be applied fo as to deftroy the whole, even before ulceration, I fufpeft that they aggravate the evil, and fooner deftroy the patient; as, I was well informed, occurred to DISEASES Class IL 1.4. 17. 230 to a quack who was for a time much reforted to, in this part of the country. Another method of unng charcoal-powder is by mixing it with boiled oil, to the confiftence of common paint; and to foak a piece of flannel with this, and cover the ulcer ; and daily to (hove or thruft this off by applying the edge of another piece of flannel, foaked with the oil and charcoal, to the edge of that up- on the ulcer, fo as to change them without the poflibility of let- ting any air come into contact with the cancerous fore. 17. Artbrocele. Swelling of the joints feems to have its remote caufe in the foftnefs of the bones, for they could not fwell unlefs they were previoufly foftened, fee Clafs I. 2. 2. 12. The epiphy- fes, or ends of the bones, being naturally of a loofer texture, are moft liable to this difeafe, and perhaps the cartilages and capfu- lar ligaments may alfo become inflamed and fwclled along with the heads of the bones. This malady is liable to diftort the fin- gers and knees, and is ufually called gout or rheumatifm ; the former of which is liable to difable the fingers by chalk-itones, and thence to have fomewhat a fimilar appearance. But rhe arthrocele, or fwelling of the joints, affects people who have not been intemperate in the ufe of fermented or fpirituous liquors ; or who have not previoufly had a regular gout in their feet; and in both thefe circumftances differs from the gout. Nor does it accord with the inflammatory rheumatifm, as it is not attend- ded with fever, and becaufe the tumors of the joints never en- tirely fubfide. The pain or fenfibility, with the bones acquire when they are inflamed, may be owing to the new vefl'els, which fhoot in them in tfyeir foft (late, as well as to the deten- tion of the old ones. M. M. Half a grain of opium twice a day, gradually increafed 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-afhes, or calcined hartfhorn, twice a day, with decodtion of madder ? Soda phofphorata ? 1%. Arthropuojis. Joint-evil. This differs from the former, as that never fuppurates ; thefe ulcers of the joints are gener- ally efteemed to arife from fcrofula ; but as fcrofula is a difeafe of the lymphatic or abforbent fyftem, and this conflfts in the fuppuration of the membranes, or glands, or cartilages about the joints, there does not feem a fufficient analogy to authorize their arrangement under the fame name. The white fwelling of the knee, when it fuppurates, comes un- der this fpecies, with variety of other ulcers, attended with cari- ous bones. 19. Caries oflium, or Necrojis offium. A caries of the bones may Class II. 1. 4. 19. OF SENSATION. 231 may be termed a fuppuration of them ; it differs from the above as it generally is occafioned by fome external injury, as in decay- ing teeth ; or by venereal virus, as in nodes on the tibia ; or by other matter derived to the bone in malignant fevers ; and is not confined to the ends of them. The feparation of the dead bone from the living is a work of fome time. See Sect. XXXIII. r. A new and able work on the neci ofis of bones is publifhed by I. Ruffel, Edinburgh ; London, Robinfons. And another by I P. Wiedmann, de Ne- crofi Offium at Francfort 5 Boofey, London ; which is alfo a valuable work. M. M. When this difeafe is not formed in fyphilis, or by metaftafis in fever, but is (imply an inflammation of the periof- teum, or of the folid bone, or of its medullary cells, the method of cure (hould confift in evacuations by bleeding and cathartics, and by leeches applied to the painful or tumid parts ; and after- wards by taking inwardly foda phofphorata and a decoftion of rubia tinfforum, madder-root; as the former is believed to give folidity to bones, and the latter, as it colours the bones of young or growing animals, is known to be carried thither during their fofter or more fenfitive ftate, and may be therefore worth a trial. See Innutritio offium, Clafs I. 2. 2. 14. ORDO DISEASES Class II. i. 5. 1. 232 ORDO I. Increafed Senfation. GENUS V. With the Production of new Veffels by external Membranes 01 Glands, without Fever. The ulcers, or eruptions, which are formed on the external fkin, or on the mouth or throat, or on the air-cells of the lungs or on the inteftines, all of which are more or lefs expofed to the contact of the atmofpheric air, which we breathe, and which in fome proportion we fwallow with our food and faliva ; or to the contact of the inflammable air, or hydrogen, which is fet at liberty by the putrefying aliment in the inteftines, or by putre- fying matter in large abfcefles; all of them produce contagious matter ; which, on being inoculated into the fkin of another perfon, will produce fever, or a fimilar difeafe. In fome cafes even the matter formed beneath the fkin be- comes in fome degree contagious, at leaft fo much fo as to pro- duce fever of the he&ic or malignant kind,as foon as it has pierc- ed through the fkin, and has thus gained accefs to fome kind of air ; as the frefh pus of a common abfcefs ; or the putrid pus of an abfcefs which had been long confined ; or of cancerous ulcers. From this analogy there is reafon to fufpeCt that the matter of all contagious difeafes, whether with or without fever, is not in- fectious till it has acquired fomething from the air : which, by oxygenating the fecreted matter, may probably produce a new acid. And, fecondly, that in heClic fever a part of the purulent matter is abforbed *, or adts on the furface of the ulcer ; as va- riolous matter afFeCls the inoculated part of the arm. And that heCtic fever is therefore caufed by the matter of an open ulcer ; and not by the fenfation of the ulcer'independent of the aerated pus, which lies on it. Which may account for the venereal mat- ter from buboes not giving rhe infe&ion, according to the exper- iments of the late Mr. Hunter, and for fome other phenomena of contagion. See Variola difcreta, Clafs II. 1. 3. 9. SPECIES. 1. Gonorrhoea venerea. A pus-like contagious material dif- charged from the urethra after impure cohabitation, with fmart- ing Class II. 1. 5. 1. OF SENSATION. 233 ing or heat on making water ; which begins at the external ex- tremity of the urethra, to which the contagious matter is appli- ed, and where it has accefs to the air ; which probably height- ens its acrimony. M. M. In this ftate of the venereal difeafe, one venfe£lion, with mild cathartics of fenna and manna, with mucilage, as al- mond emulfion, and gum arabic, taken for two or three weeks, abfolve the cure. Is camphor of ufe to relieve the ardor urinae ? Do balfams increafe or leflen the heat of urine ? Neutral faits certainly increafe the fmarting in making water, by increafing the acrimony of the urine. Can the difcharge from the urethra be foon flopped by faturnine inje&ions, or mercurial ones, or with folution of blue vitriol, at firft very dilute, and gradually made ftronger ? And at the fame time, left the fyphilis, or general difeafe, fhould fupervene, the patient might take a quarter of a grain of corrofive fublimate of mercury twice a day, as diretied below ? There is a curious paper by Mr. Addington, of Weft Bromage, in the Contributions of Medical Knowledge, publifhed by Dr. Bed does, on the cure of gonorrhoea virulenta, by large dofes of corrofive fublimate of mercury, hydrargyrus muriatus. Three grains of corrofive fublimateof mercury are diflblved in one ounce of redlified fpirit of wine. Half of this mixture is taken undi- luted at going to bed ; it produces a copious falivation for an hour and a half, or longer, during which the patient fpits a quart. Some Glauber's faits are to be taken on the fecond day after this operation, and on the evening of that day he is to re- peat the draught, and the faits on the day but one following. And Mr. Addington witnefled that three or four fuch dofes fre- quently cured a venereal gonorrhoea in fo (hort a time, without any difagreeable confequence, and was informed that hundreds had been cured by it. The probable mode of aftion of this medicine is owing to the confent of parts between the throat and the urethra, of which many inftances are given in Clafs IV. i. 2. 7. on Hydrophobia. Mr. Wright, an elderly furgeon in Derby, thirty years ago, af- fured me that he had frequently given half a drachm of corrofive fublimate as an emetic, without any inconvenience to the patient; and that it was the famous emetic of a celebrated empyric, and had been faid to do wonders. Might not this dofe of one grain and a half, diflblved in half an ounce of rectified fpirit, be given repeatedly, with profpeft of advantage, in Hydrophobia ? And perhaps, in an adapted ftrength and quantity, in Hydrocephalus ? If in Croup, Perip- neumonia trachealis ? Vol. II. Gg 2. Syphilir. 234 DISEASES Class II. 1. 5. 2. 2. Syphilis. Venereal difeafe. The contagion Ihews itfelf in ulcers on the part fir ft inoculated as chancres ; ulcers on the tonfils fucceed, with eruption on the fkin, efpecially about the roots of the hair ; afterwards on other parts of the fkin, termin- ating in dry fcabs; and laftly, with pain and fwelling of the bones. The corona veneris, or crown of Venus, confifts of the erup- tions at the roots of the hair appearing moft round the forehead ; which is occafioned by this part being more expofed to the air ; which we obferved at the beginning of this genus, either produ- ces or increafes the virulence of contagious matter. But it is difficult to conceive, from this hiftory, why the throat fhould be firlt affecled ; as it cannot be fuppofed, that the difeafe is fo often taken by the faliva, like the fmall-pox, though this may fometimes occur ; perhaps very often. The connection be- tween the genitals in men and the throat, is treated of in Clafs IV. I. 2. 7. Hydrophobia. M. M. A quarter of a grain of corrofive fublimate of mer- cury, taken thrice a day for five or fix weeks, made into a pill with bread crumbs, or diffolved in a fpoonful of brandy and water, is a very efficacious and almoft certain cure. When it does not fucceed, it is owing either to the drug being bad, or to its having precipitated from the brandy, or from its being fpoiled in the pill by long keeping. Opium contributes much to expedite the cure, both of the Pimple gonorrhoea and of ve- nereal ulcers, by increafing abforption both from the mucous membrane and from the furface of ulcers A quarter of a grain, or half a grain, may be given with every dofe of the fublimate. Nitrous acid has been lately ftrongly recommended, by Mr. Scott, in venereal cafes ; from an idea that the oxygen, which it confifts of in part, is loofely combined, and may be feparable in the animal fyftem ; and that it may be the oxygen, only, which exifts loofely in mercurial calces or oxydes, that atfts fo fuccefs- fully, when mercurials are exhibited. Some fuccefsful exhibi- tions of this acid in venereal cafes are publiffied ; the dofe is one drachm and a half, or two drachms, of the ftrong nitric acid mixed in two pounds of water, to be drunk daily at repeated in- tervals. Mr. Scott has fince ufed the nitrous acid much diluted with water externally as a warm bath, either partially or gener- ally, with great fuccefs, at Bombay, in venereal cafes. See Ar- ticle II. 2. 4. and IV. 2. 7. 1. in the Materia Medica. It has been now ufed in this country with fuccefs by fome, and without fuccefs by others, and may perhaps affift the ufe of mercurials as well as opium in the cure of venereal ulcers ; but fhould not yet befolely depended upon. 2. Lepra. Class II. 1. 5. 3. OF SENSATION. 235 3. Lepra. Leprofy. Leprofy of the Greeks. The (kin is rough with white branny fcales, which are full of chinks ; often moilt beneath, and itching. The fcales on the head or arms of fome drinking people are a difeafe of this kind. The perfpirable matter defighed for the purpofe of lubricating the external Ikin is fecreted in this difeafe in a too vifcid ftate, owing to the inflam- mation of the fubcutaneous veflels; and, as the abforbents ail too ftrongly at the fame time, a vifcid mucus is left adhering to the furface of the Ikin. In the leprofy of rhe Jews, defcribed in the thirteenth and four- teenth chapters of Leviticus, the depreflion of the fore beneath the furface of the Ikin, and the hairs in it becoming white, feem to have been the principal circumftances, which the pried: was diretfed to attend to for the purpofe of afcertaining the dif- eafe. M. M. Eflence of antimony, from 20 drops to 100, twice or thrice a day, with half a pint of decotlion of elm-bark ; or of malt-tea; or tintlure of cantharides, from 20 to 60 drops, four times a day ; or fublimate 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 drunk in large quantities. Warm bath. Oil-lkin bound on the part to confine the perfpirable matter. Ointment of tar and fuet; or poultice for two or three days, and then cerate with lapis calaminaris. Diet of raifins and bread. Abftinence from wine, beer, and all fpirits, is indifpenfably nec- eflary to the cure. 4. Elephantiafts. Leprofy of the Arabs. A contagious dif- eafe ; the Ikin is thickened, wrinkled, rough, untluous, delti- tute of hair, without any fenfation of touch in the extremities of the limbs; the face deformed with tubercles ; the voice hoarfe, and with a nafal tone. Cullen. 5 Framboejia. Yaws is faid to be contagious and hereditary. It principally affedls the negroes in the Well-Indies. Edinb. Eflays, Vol. VI. 6. Pfora. 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 feldom is feen in thefe places, but all over the other parts of the body. The latter is feldom thought to be the itch, as it does not eafily infefl even a bed-fellow, and refills the ufual means of cure by brimllone. If the itch be cured too haftily, by rubbing mercurial or ar- fenical preparations over the whole body, or on too great a part of 236 DISEASES Class II. 1. 5. 6. of it, many bad fymptomsare produced ; as weaknefs of digef- t on, with pale bloated countenance, and tendency to drcpfy. I have twice feen St. Vitus's dance occur, from the ufe of a mer- curial girdle *, and once a fwelled liver. 1 have alfo feen a fwell- ed fpleen and fwelled legs from the external ufe of arfenic in the cure of the itch. And very numerous and large phlegmons commonly fucceed the too hafty cure of it by other means. There does not appear a ftridi analogy between the hafty cure of the itch, and the retroceflion of the puftules in the fecondary fever of the fmall-pox ; becaufe in that the abforption of the matter is evinced by the fwelling of the face and hands, as the puftules recede, as explained in Clafs II. 1.3. 9. Variola difcreta. And a fever is produced by this abforption; neither of which happen, when the puftules of the itch are deftroyed by mercury or arfenic. Nor can thefe inconveniences, which occur on the too hafty cure of the itch, be explained by thofe which follow the cure of fome kinds of gutta rofea, Clafs II. 1.4. 6. as in thofe the erup- tions on the face were an affociated difeafe with inflammation of the liver or ftomach, which they were accuftomed to relieve ; whereas the itch is not known to have had any previous catena- tion with other difeafes. In the itch there exifts not only great irritation in the produc- tion of the puftules, but great fenfation is caufed by their acri- mony afterwards; infomuch that the pain of itching without the interrupted fmarting occafioned by fcratching, would be intol- erable. This great excitement of the two fenforial powers of irritation and fenfation isfo great, when the puftules are diffufed over the whole furface of the body, that a torpor fucceeds the fudden ceafing of it; which aft'edls thofe parts of the fyftem which were moft catenated with the new motions of the Ikin, as the ftomach, whence indigeftion and flatulency ; or which are generally moft liable to fall into torpor, as the numerous glands, which form the liver. Whence the difeafes confequent to the hafty cure of the itch are difeafes of debility, as tumid vif- cera, oedematous fwellings, and St. Vitus's dance, which is a debility of aflbciation. In the fame manner indigeftion, with green evacuations, are faid to follow an injudicious application bf cerufla to ftop too haftily the exfudation behind the ears of children, Clafs I. 1. 2 9. And dropfies are liable to fucceed the cure of cold ulcers of the legs, which have long ftimulated the fyftem. M. M. The fize of a large pea, of an ointment confifting of one part of white precipitate of mercury, to fix parts of hog's lard well triturated together, to be rubbed on a part of the body every Class II. t. 5. 7. OF SENSATION. 237 every night, and waffled off with foap and water next toothing, till every part is cleared ; with lac fulphuris twenty grains to be taken every morning inwardly. Warm faline bath, With white vitriol in it. Flowers of fulphur mixed with thick gtuel, or with hog's fat. With either of which the body may be fmeared all over. Mr. Grille fays, that thofe who get manganefe from its mines are not fubjeft to the itch; and that he found an ointment, coto- pofed of fix parts of finely levigated manganefe and of fixteeh parts of lard, a more efficacious remedy for the itch than thofe in common ufe. Parmentier. 7. Pfora ebriorum. Elderly people, who have been much ad- difted to fpirituous drinks, as be-er, wine, or alcohol, are liable to an eruption all over their bodies j which is attended with very afflicting itching, and which they probably propagate from one part of their bodies to another with their own Pails by fcratching themfelves. I faW fatal effects in one fuch patient, by a too extenfive ufe of a folution of lead; the eruption difap- peared, he became dropfical and died; I fuppofe from the too fuddenly ceafing of the great ftimulus caufed by the eruptions over the whole Ikin, as in the preceding article. M. M. The patient fhould gradually acculiotn himfelf to half his ufual quantity of vinous potation. The warm bath, with one pound of fait to every three gallons. Mercurial ointments on fmall parts of the Ikin at a time. A grain of opium at night inftead of the ufual potation of wine or beer. 8. Herpes. Herpes confifts of gregarious fpreading excoria- tions, which are fucceeded by branny fcales or fcabs. In this difeafe there appears to be a deficient abforption of the fubcuta- neous mucus, as well as inflammation and increafed fecretion of it. For the fluid not only excoriates the parts in its vicinity by its acrimony, but is very faline to the tafte, as fome of thefe pa- tients have affured me ; I believe this kind of eruptions, as well as the tinea, and perhaps all other cutaneous eruption, is liable ro be inoculated in other parts of the body by the finger nails of the patients in fcratching themfelves. It is liable to affect the hands, and to return at diftant periods ; and is probably a fecondary difeafe, as well as the zona ignea, or (hingles, defcribed 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 difcharged fluid, and abate the inflammation ; then covet the parts with frefli cerate mixed with lapis calaminaris. On the parts not excoriated mercurial ointment, made of one part of white calx of mercury and fix of hogls fat. Internally, after vene- fedion. 238 DISEASES Class II. 1.5-9. feftion, gentle repeated cathartics. Laftly, the bark. Acid of vitriol. Bolus Armenia?, or teftacea. Antimonials. Pecoc- tion of interior bark of elm. 9. Zona ignea. Shingles. This eruption has been thought a fpecies of herpes by feme writers, and by others a fpecies of eryfipelas. Yellow or livid veficles appear, producing a corrofive ichor, which is fometimes attended with a degree of fever. It is faid to infeft fometimes the thorax and ribs, but its moft gen- eral fituation is on the fmall of the back, over one kidney, ex- tending forward over the courfe of one of the ureters. There is reafon to fufpeft, that this alfo is a fecondary or fym- pathetic difeafe, as well as the preceding one ; but future obfervations are required, before it can be removed to the fourth clafs, or difeafes of aflbciation- In three patients, 1 have been induced to believe, that the eruption on the loins was a tranfla- tion of inflammation from the external membrane of the kidney to the fkin. 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 diftinguilhed from nephritis interna, or gravel; and without pain down the ourfideof the thigh, by which it was diftinguilhed from fciatica. In other fituations the (hingles may fympathize with other inter- nal membranes, as in a cafe publilhed by Dr. Ruflel (De Tabe Glandulari), where the retroceflion of the fhingles was fucceed- ed by a ferious dyfpncea. M. M Venefe&ion, if the pulfe is ftrong. 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 diflolved in a pint of water, and taken fo as to emp- ty the itomach and inteltines, is faid much to haften the cure ; comprefles foaked in a faturnine folurion are recommended ex- ternally on the eruption ; and cerate where there are ulcerations. Defanet's Surgical Journal, Vol. II. p. 378. If this be a vicari- ous difeafe, it (hould continue half a lunation ; left, on its ceaf- ing, the bad habits of motion of the primary difeafe fhould not have been fo perfectly diflevered, but that they may recur. 10. Annulus repens. Ring-worm. A prurient eruption formed in a circle, affecting children, and would feem to be the work of infers, according to the theory of Linnaeus, who afcribes the itch and dyfentery to micofcropic animalcula. Thefe ani- malcula are probably the effefl, and not the caufe, of thefe erup- tions ; as they are to be feen in all putrefcent animal fluids. The annular propagation of the ring-worm, and its continuing to en- large its periphery, is well accounted for by the acrimony of the ichor or faline fluid eroding the Ikin in its vicinity. M. M. Cover Class II. 1. 5. 11. OF SENSATION. 239 M. M Cover the eruption daily with ink. With white mer- curial ointment, as defcribed above in herpes. With folution of white vitriol ten grains to an ounce. Thefe metallic calces ftim- ulate the abforbents into ftronger action, whence the fluid has its faline part reabforbed, and that before it has accefs to the air, which probably adds to its acrimony by oxygenating it and thus producing a new acid. ri. Tinea. Scald head. This contagious eruption affects the roots of the hair, and is generally moft virulent round the edges of the hair on the back part of the head ; as the corona veneris appears moft on the edges of the hair on the fore part of the head : for in thefe parts the eruption about the roots of the hair is moft expofed to the external air, by which its acrimony or noxious quality is increafed. Theabforption of the matter thus oxygenated fwells the lymph- atics of the neck by its ftimulus, occafioning many little hard lumps beneath the feat of the eruption ; when this happens, the fooner it is cured the better, left the larger lymphatics of the neck Ihould become afle&ed. M. M. The aft of curing thefe eruptions confifts, firft, in abating the inflammation, and confequent fecretion of a noxious material. Secondly, in preventing its accefs to the air, which fo much increafes its acrimony. And thirdly, in promoting the ab- forption of it, before it has beeti expofed to the air. For thefe purpofes venefeftion once, and gentle cathartics, which promote abforption by emptying the blood-veffels. Next poultices and fomentations, with warm water, abate inflammation by diluting the faline acrimony of the fecreted fluid, and abating the painful fenfation. Afterwards cerate joined with fome metallic calx, as of zinc or lead, or folution of lead, mercury, or copper, or iron, which may ftimulate the abforbent fyftem into ftronger adion. Cover the fhaved head with tar and fuet, and a bladder ; this, by keeping the air from the fecreted fluid, much contributes to its mildnefs, and the ftimulus of the tar increafes its abforption. See the three preceding fpecies of this genus. Mr. Morifon of Dublin cures the tinea capitis by what he terms an adhefive pafte, which is made by boiling half a pound of fine flour in two pounds of common ale, and then adding four ounces of yellow refin in fine powder, and ftirring them well together, until they are perfectly incorporated. After removing the hair, and poulticing the head for a day or two, to take off the hard fcabs, this pafte is fpread on flips of linen, which are applied over the whole affected part, and removed and frefh ones appli- ed every morning ; after one or two days, I fufpeil, that re- moving the plafters feldomer might be more advantageous. 12. Gru ft a 240 DISEASES Class II. 1.5.12. 12. Crufta laclea. Milk-cruft i$ a milder difeafe than tinea, affecting the face as well as the hairy fcalp of very young chil- dren. It is not infectious, nor liable to fwell the lymphatics in its vicinity like the tine^. M. M. Cover the eruption with cerate made with lapis cala- minaris, to be renewed every day. Mix one grain of emetic tar- tar with forty grains of chalk, and divide into eight papers, one to be taken twice a day, or with magnefia alba,.if ftools are want- ed- The child fhpuld be kept cool and much in the air. Trichoma. Plica polonica. A contagious difeafe, in which the hair is faid to become alive and bleed, forming ineX' tricable knots or plaits of great length, like the fabled head of Medufa, with intolerable pain, f<? as to confine the fufferer on his bed for years. ORDO Class II. 1.6. 1. OF SENSATION. 241 ORDO I. Increafed Senfation. GENUS VI. With Fever confequent to the Production of new Veffls or Fluids. SPECIES. I. Febrisfenftiva. Senfitive fever, when unmixed with either irritative or inirritative fever, may be diftinguiflied from either of them by the lefs comparative diminution of mufcular ftrength; or in other words, from its being attended with lefs diminution of the fenforial power of irritation. An example of unmixed fenfitive fever may generally be taken from the pulmonary con- fumption ; in this difeafe patients are feen to walk about with eafe, and to do all the common offices of life for weeks, and even months, with a pulfe of 120 ftrokes in a minute ; while in other fevers, whether irritated or inirritated, with a pulfe of this frequency, the patient generally lies upon the bed and ex- erts no mufcular efforts without difficulty. The caufe of this curious phenomenon is thus to be under- ftood ; in the fenfitive fever a new fenforial power, viz. that of fenfation,is fuperaddedto that of irritation; which in other fevers alone carries on the increafed circulation. Whence the power of irritation is not much more exhaufted than in health ; and thofe mufcular motions, which are produced in confequence of it, as thole which are exerted in keeping the body upright in walking, riding, and in the performance of many cuftomary ac- tions, are little impaired. For an account of the irritated fenfi- tive fever, fee Clafs II. 1.2. 1. ; for the inirritated fenfitive fe- ver, Clafs II. 1. 3. 1. IV. 2. 4. 11. 2. Febris a pure claufo. Fever from inclofed matter is gener- ally of the irritated fenfitive kind,and continues for many weeks, and even months, after the abfcefs is formed ; but is diftinguiffi- ed from the fever from aerated matter in open ulcers, becaufe there are feldom any night-fweats, or colliquative diarrhoea in this, as in the matter. The pulfe is alfo harder, and requires oc- cafional venefe&ion, and cathartics, to abate the inflammatory fever ; which is liable to increafe again every three or four days, till at length, unlefs the matter has an exit, it deftroys the patient. In this fever the matter, not having been expofed to the air, has not acquired oxygenation ; in which a new acid, or fome other Vol. II. H h noxious 242 DISEASES Class II. 1.6. 3. noxious property, is produced ; which like contagion on the conftitution inducing fever-fits,called hecftic fever,which termin- ate with fweats or diarrhoea ; whereas the matter in the clofed abfcefs is either not abforbed, or does not fo affect the circula- tion as to produce diurnal orheftic fever-fits ; but the ftimulus of the abfcefs excites fo much fenfation as to induce perpetual pyrexia, or inflammatory fever, without fuch marked remiffions. Neverthelefs there fometimes is no fever produced, when the matter is lodged in a part of little fenfibility, as in the liver ; yet a white pus-like fediment in thofe cafes exifts I believe general- ly in the urine, with occafional wandering pains about the region of the liver or cheft. 3. Vomica. An abfcefs in the lungs is fometimes produced after peripneumony, the cough and fhortnefs of breath continue in lefs degree, with difficulty in lying on the well fide, and with fenfitive irritated fever, as explained in the preceding article. The occafional increafe of fever, with hard pulfe and fizy blood, in thefe patients, is probably owing to the inflammation of the walls of the vomica ; as it is attended with difficulty of breathing, and requires venefedtion. Mr. B , a child about feven years old, lived about feven weeks in this fituation, with a pulfe from 150 to 170 in a minute, without fweats, or diarrhoea, or fediment in his water, except mucus occafionally ; and took fufficient nouriffiment during the whole time. The blood ta- ken was always covered with a ftrong cupped fize, and on his death three or four pints of matter were found in one fide of the cheft \ which had probably, but lately, been effufed from a vom- ica. This child was frequently induced to fwing, both in a re- ciprocating and in a rotatory fwing, without any apparent ab- forption of matter ; in both thefe fwings he exprefled pleafure, and did not appear to be vertiginous. M. M. Repeated emetics. Digitalis ? Perfeverance in ro- tatory fwinging. See Clafs II. 1. 6. 7. Mr. I. had laboured fome months under a vomica after a pe-. ripneumony, he was at length taken with a catarrh, which was in fome degree endemic in March 1795, which occafioned him to fneeze much, during which a copious haemorrhage from the lungs occurred and he fpit up at the fame time half a pint of very fetid matter, and recovered. Hence errhines may be oc- cafionally ufed with advantage. 4. Empyema. When the matter from an abfcefs in the lungs finds its way into the cavity of the cheft, it is called an empye- ma. A fcrvant man, after a violent peripneumony, was feized with fymptoms of empyema, and it was determined, after fome time, to perform the operation ; this was explained to him, and the Class II. 1.6. 5. OF SENSATION. 243 the ufual means were employed by his friends to encourage him, " by advifing him not to be afraid." By which good advice he conceived fo much fear, that he ran away early next morning, and returned in about a week quite well. Did the great fear promote the abforption of the matter, like the ficknefs occafion- ed by digitalis ? Fear renders the external fkin pale ; by this continued decreafe of the action of the abforbents of the Ikin might not thofe of the lungs be excited into greater activity ? and thus produce increafed pulmonary abforption by reverfe fympa- thy, as it producespale urine,andeven (tools,by direct fympathy? M. M. Digitalis ? 5. Febris Mefenterica. Fever from matter formed in the mef- entery is probably more frequent than is fufpected. It commen- ces with pain in the bowels, with irritated fenfitive fever ; and continues many weeks, and even months, requiring occafional venefedtion, and mild cathartics; till at length the continuance of the pyrexia, or inflammatory fever, deftroys the patient. This is an affection of the lymphatic glands, and properly belongs to fcrofula ; but as the matter is not expofed to the air, no hectic fever, properly fo called, is induced. 6. Febris a pure aerato. Fever from aerated matter. A great collection of matter often continues a long time, and is fome- times totally abforbed, even from venereal buboes, without pro- ducing any diforder in the arterial fyftem. At length, it be- comes putrid by its delay, and one part of the matter thus be- comes aerated by the air given out by the other part; or if the ulcer has been opened, fo that any part of it has been expofed to the air for but one day, a hedlic fever is produced. Whence the utility arifes of opening large abfceffes by fetons, as in that cafe little or no hedlic fever is induced ; becaufe the matter is fqueezed out by the fide of the fpongy threads of cotton, and little or no air is admitted ; or by tapping the abfcefs with a trocar, as mentioned in ifchias, Clais II. 1.2. 18. In this fever the pulfe is about 120 in a minute, and its accefs is generally in an evening, and fometimes about noon alfo, with fweats or purging towards morning, or urine with pus- like fediment : and the patients bear this fever better than any other with fo quick a pulfe ; and laftly, when all the matter from a concealed ulcer is abforbed, or when an open ulcer is heal- ed, the hedlic fever ceafes. Here the abforbed matter is fuppo- fed to produce the fever, and the diarrhoea, fweats, or copious muddy urine,to be (imply the confequence of increafed fecretion, and not to confid of the purulent matter, which was fuppofed to be abforbed from the ulcer See Sudor calidus, Clafs I. 1. 2. 3. The adlion of the air on ulcers, as we have already (hewn,in- creafes 244 DISEASES Class II. 1.6.6. creafes the acrimony of the purulent matter, and even converts it into a weaker kind of contagious matter ; that is, to a mate- rial inducing fever. This was afcribed to the union of the azotic part of the atmofphere with the effufed pus in Se<T. 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; firft,becaufe oxygen fo greedily unites with other animal fubftan- ces, as the blood, that it will pafs through a moift bladder to com- bine with it, according to the experiment of Dr. Prieftley. Se- condly, becaufe the poifons of venomous creatures are fuppofed to be acids of different kinds, and are probably formed by the contact of air after their fecretion. And laftly, becaufe the con- tagious matter from other ulcers, as in itch, or fmall-pox, is form- ed on external membranes, and are probably combinations of animal matter and oxygen, producing other new acids. Since having written the above, Dr. Mitchill, of New-York has fpoken much of the feptic quality of azote, or nitrogen ; and thinks that it is the union of this part of the atmofphere with the matter of ulcers, which produces or increafes its contagious or fever-exciting property ; which I had myfelf at firft believed, as mentioned in Part I. Sedh XXVIII. 2. In fupport of this opinion, it may be faid, that proper ventilation with purer air is believed certainly to diminilh or deftroy infection ; as fpoken of in Clafs II. I. 3. where it is propofed to difengage oxygen from manganefe, for the purpofe of purifying crowded apartments. But further experiments mull determine this curious inquiry ; which might be attended with important confequences, if azote, and not oxygen, could be fhewn to prevent the healing of pul- monary ulcers ; as oxygen might be refpired alone, or mixed with hydrogen or with carbonic acid gas, inftead of with azote. It was thought a fubject of confequence by the jEfculapian Society at Edinburgh, to find a criterion which fhould diftin- guilh pus from mucus, for the purpofe of more certainly dif- covering the prefence of ulcers in pulmonary difeafes, or in the urinary paffages. For this purpofe that fociety offered their firft gold medal, which was conferred on the late Mr* Charles Darwin, in the year 1778, for his experiments on this fubjeft. From which he deduces the following conclufions : « 1. Pus and mucus are both foluble in the vitriolic acid, through in very different proportions, pus being much the lefs foluble. " 2. The addition of water to either of thefe compounds de- compofes it; the mucus thus feparated, either fwims on the mix- ture, or forms large flocci in it; whereas the pus falls to the bottom, and forms on agitation a uniform turbid mixture. " 3. Pus* Class II. 1.6. 7. OF SENSATION. 245 ft 3. Pus is diffufible through a diluted vitriolic acid, though mucus is not; the fame occurs with water, or a folution of fea fait. « 4. Nitrous acid diflblves both pus and mucus ; water added to the folution of pus produces a precipitate; and the fluid a- bove becomes clear and green ; while water and the folution of mucus form a dirty coloured fluid. 5. Alkaline lixivium diflblves (though fometimes with diffi- culty) mucus, and generally pus. " 6. Water precipitates pus from fuch a folution, but does not mucus. "7. Where alkaline lixivium does not diflblve pus, it (till dif- tinguifhes it from mucus; as it then prevents its diffufion through water. " 8. Coagulable lymph is neither foluble in diluted nor con- centrated vitriolic acid. " 9. Water produces no change on a folution of ferum in al- kaline lixivium, until after long (landing, and then only a very flight fediment appears. " to. Corrofive fublimate coagulates mucus, but not pus. " From the above experiments it appears, that (Irong vitri- olic acid and water, diluted vitriolic acid, and cauftic alkaline lixivium and water, will ferve to diftinguifh pus from mucus ; that the vitriolic acid can feparate it from coagulable lymph,and alkaline lixivium from ferum. « And hence, when a perfon has any expe&orated material, the compofition of which he wiffies to afcertain, let him diflblve it in vitriolic acid, and in cauftic alkaline lixivium ; and then add pure water to both folutions and if there is a fair precipi- tation in each, he may be aflured that fome pus is prefent. If in neither a precipitation occurs, it is a certain teft, that the material is entirely mucus. If the material cannot be made to diflblve in alkaline lixivium by time and trituration, we have alfo reafon to believe that it is pus." Experiments on Pus and Mucus. Cadell. London. Dr. Cappe, of York, in his inagural treatife de Hedlica, and Dr. Ryan, of Dublin, in his Eflay on Confumption, have repeat- ed thefe experiments of Mr. Darwin with nearly fimilar refults. 7. Phthifis pulmonalis. In pulmonary confumption the fever is generally fuppofed to be the confequence of the ftimulus of abforbed matter circulating in the blood-veflels, and not Amply of its ftimulus on their extremities in the furface of the ulcers ; as mentioned in Clafs II. 1. 5. and ClafsII. 1. 3. 9. The ul- cers are probably fometimes occafioned by the putrid acrimony of eflbfed blood remaining in the air-cells of the lungs after an , hoemoptoe. 246 DISEASES Class II. i. 6. 7. htemoptoe. See Clafs I. 2. 1.9. The remote caufe of con- fumption is ingenioufly afcribed by Dr. Beddoes to the hyper- oxygenation of the blood, as mentioned Section XXVIII. 2. As the patients liable to confumption are of the inirritable temperament, as appears by the large pupils of their eyes ; there is reafonto believe, that the hsemoptoe is immediately occafio- ed by the deficient abforption of the blood at the extremities of the bronchial vein ; and that one difficulty of healing the ulcers is occafioned by the deficient abforption of the fluids effufed in- to them. SeeSert. XXX. 1. and 2. The difficulty of healing pulmonary ulcers may be owing, as its remote caufe, to the inceffant motion of all the parts of the lungs ; whence no fcab, or indurated mucus, can be formed fo as to adhere on them. Whence thefe naked ulcers are perpet- ually expofed to the action of the air on their furfaces, conver- ting 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 fpread them wider. See the preceding article, and Seft. XXXIII. 2.7. where the pulmonary phthifis is fuppofed 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 minium, which is a calx of lead ; two materials which are powerful in healing excoriations and ulcers, in a fhort time, by their external application. How then does it happen, that the oxygen in the atmofphere Ihould prevent pul- monary ulcers from healing, and even induce them to fpread wider ; and yet in its combination with metals, it fhould facili- tate their healing ? The healing of ulcers confifts in promoting the abforption of the fluids effufed into them, as treated of in Seftion XXXIII. 3. 2. Oxygen in combination with metals, when applied in certain quantity, produces this effeCt by its ftimulus; and the metallic oxydes not being decompofed by their contact with animal matter, no new acid, or contagious material, is produced. So that the combined oxygen, when ap- plied to an ulcer, fimply I fuppofe promotes abforption in it, like the application of other materials of the articles forbentia or incitantia, if applied externally ; as opium, bark, alum. But in the pulmonary ulcers, which cannot proteCt themfelves from the air by forming a fcab, the uncombined oxygen of the atmof- phere unites with the purulent matter, converting it into a con- tagious ichor ; which by infection, not by erofion, enlarges the ulcers, as in the itch or tinea ; which might hence, accor- ding to Dr. Beddoes's ingenious theory of confumption, be in- duced to heal, if expofed to an atmofphere deprived of a part' of its Class II. 1. 6. 7. OF SENSATION. 247 its oxygen. This I hope future experiments will confirm, and that the pneumatic medicine will alleviate the evils of mankind in many others, as well as in this moft fatal malady. M. M. Firft, the refpiration of air lowered by an additional quantity of azote, or mixed with fome proportion of hydrogen, or of carbonic acid air, may be tried ; as described in a late pub- lication of Dr. Beddoes on the medicinal ufe of factitious airs. Johnfon, London. Or laftly, by breathing a mixture of one- tenth part of hydrocarbonate mixed with common air, according to the difcovery of Mr. Watt, which has a double advantage in thefe cafes, of diluting the oxygen of the atmofpheric air, and inducing ficknefs, which increafes pulmonary abforption, as mentioned below. An atmofphere diluted with fixed air car- bonic acid) might be readily procured by fetting 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 oxy- gen or acidifying principle, which injures or enlarges pulmona- ry ulcers by combining with the purulent matter. Another eafy method of adding carbonic acid gas to the air of a room, would be by means of an apparatus invented by Mr. Watt, and fold by Bolton and Watt, at Birmingham, as defcri- bed in Dr. Beddoes' Treatife on Pneumatic Medicine. John- fon, London. It confifts of an iron pot, with an arm projecting, and a method of letting water drop by flow degrees on chalk, which is to be put into the iron pot, and expofed 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 fame manner a diffufion of folution of flowers of zinc might be pro- duced and breathed by the patient, and would be likely much to contribute to the healing of pulmonary ulcers ; as obferved by Mr. Watt. See the treatife above mentioned. Breathing over the vapour of cauftic volatilealkali might eafily be managed for many hours in a day; which might neutralize the acid poifon formed on pulmonary ulcers by the contaCi of oxygen, and thus prevent its deleterious quality, as other acids become lefs cauftic, when they are formed into neutral faits with alkalies. The volatile fait fhould be put into a tin canifter, with two pipes like horns from the top of it, one to fuck the air from, and the other to admit it. Secondly, the external ulcers in fcrofulous habits are pale and flabby, and naturally difmclined to heal, the depofition of fluids in them being greater than the abforption ; thefe ulcers have their appearance immediately changed by the external application of 248 DISEASES Class II. 1.6. 7. of metallic calxes, and the medicines of the article Sorbentia, fuch as ceruflaand the barkin fine powder, fee Clafs I. 2. 3 21. and are generally healed in a fhort time by thefe means. Indu- ced by thefe obfervations, I wifhed to try the external application of fuch powders to ulcers in the lungs, and conftru&ed a box with a circulating brufh in it. Into this box two ounces of fine powder of Peruvian bark were put, and two drachms of cerufla in fine powder ; on whirling the central brufh, part of this was raifed into a cloud of powder and the patient, applying his mouth to one of the tin pipes rifingout of the box, inhaled this powder twice a day into his lungs. I obferved it did not produce any cough or uneafinefs. This patient was in the laft ftage of con- fumption, and was foon tired of the experiment, nor have I had fuch patients as I wifhed for the repetition of it. Perhaps a fine powder of manganefe, 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 moft comminuted Hate, might be a better way of applying this powder to the lungs, as difeovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine. Johnfon. Thirdly, as the healing of an ulcer confifts in producing a tendency to abforption on the furface greater than the depofition on it; feeSe€l. XXXIII. 3. 2. ; other modes of increafing pul- monary abforption, which are perhaps more manageable than the preceding ones, may be had recourfe to ; fuch as by pro- ducing frequent naufea or ficknefs. See Se£t. XXIX. 5. i.and Art. IV. 2. The great and fudden abforption of fluid from the lungs in the anafarca pulmonum by the ficknefs induced by the exhibition of digitalis, aftonifhes thofe who have not before at- tended to it, by emptying the fwelled limbs, and removing the difficulty of breathing in a few hours. The moft manageable method of ufing digitalis is by making a faturated tinefture of it, by infufing two ounces of the powder of the leaves in a mixture of four ounces of rectified fpirit 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 fo managed as not to induce violent ficknefs. If ficknefs neverthelefs comes on, the patient muft for a day or two omit the medicine ; and then begin it again in reduced dofes. Mr. , a young man about twenty, with dark eyes and large pupils, who had every fymptom of pulmonary ulcers, I believed to have been cured by digitalis, and publifhed the cafe in the Tranfaclions of the College, Vol. III. But I heard, that about two years afterwards he relapfed and died. Mr. L , Class II. 1. 6. 7. OF SENSATION. 249 L , a corpulent man, who had for tome weeks laboured under a cough with great expectoration, with quick pulfe, and difficulty of breathing, foon recovered by the ufe of digitalis taken twice a day ; and though this cafe might probably be a peripneumonia notha, or catarrh, it is here related as (hewing the power of pulmonary abforption excited by the ufe of this drug. Since the publication of the above, fome fuccefsful cafes of the treatment of confumption by the lindure of digitalis are re- lated in Medical and Phyfical Contributions, edited by Dr. Bed- does, Longman, London. Two of the fuccefsful cafes are from Dr. Drake, who obferves, " that by gradually increafing the dofe of the faturated tinCture of digitalis from 20 drops to 100 twice a day, all the fymptoms of fever, cough, pain, and dyfpnoea, daily grew better, and at length totally ceafed, and that on the quanti- ty and quality of the expectorated matter the digitalis foon exert- ed a very remarkable effeCt, either promoting its abforption, or diminiffiing its fecretion, or perhaps both, in a rapid manner; while at the fame time it deprived it of its fetor.'' Many cafes with great relief, or with profperous event, are related by Dr. Fowler, and by Dr Beddoes. One I have alfo lately feen my- felf, whom I believed to be confumptive, and who is of a con- fumptive family, and after having ufed the faturated tinCture about fix weeks, or two months, in various dofes, is now believed by herfelf and friends to be perfectly restored to health, but there has not been time enough yet elapfed to determine, whether fhe may not relapfe, now fhe difcontinues the medicine. Neverthelefs as the digitalis has been given in many cafes without fuccefs, there is reafon to believe, that it ffiould be taken early in the difeafe, before too great ulcerations are produced, and too great debility exifts. As thefe patients are fubjeCt to flatter themfelves more than moft others, and are liable, on that account, not to apply foon enough for proper affiftance, they ihould be warned that a cough attended with a pulfe that beats 120 times a minute, is al wavs a difeafe of danger. Another method of inducing ficknefs, and pulmonary abforp- tion in confequence, is by failing on the fea ; by which many confumptive patients have been laid to have received their cure ; which has been erroneoufly afcribed to fea-air, inftead of fea- ficknefs ; whence many have been Cent to breathe the fea-air on the coalts, who might have done better in higher fituations, where the air probably contains lefs oxygen gas, which is the heavieft part of it. See a letter from Dr. J. C. below. A third method of inducing ficknefs, and confequent pulmo- nary abforption, is by the vertigo occafioned by fwinging 5 which Vol. IL I 1 has 250 DISEASES Class II. 1. 6. 7. has lately been introduced into practice by Dr Smith, (Eflay on Pulmonary Confumption), who obferved that by Twinging the he&ic pulfe became flower, which is explained in Clafs IV 2. i. io. The ufual way of reciprocating Twinging, like the of- cillations of a pendulum, produces a degree of vertigo in thofe, who are unufed to it; but to give it greater effect, the patient fhould be placed in a chair fufpended from the ceiling by two parallel cords in contact with each other, the chair fhould then be forcibly revolved 20 or 40 times one way, and fuffered to re- turn fpontaneoufly ; which induces a degree of ficknefs in molt adult people, and is well worthy an exaft and pertinacious trial, for an hour or two, three or four times a day for a month. The common means of promoting abforption in ulcers, and of thickening the matter in confequence, by taking the bark and opium internally, or by metallic faits, as of mercury, fteel, zinc, and copper, in fmall quantities, have been repeatedly ufed in pulmonary confumption ; and may have relieved Tome of the fymptoms. As mercury cures venereal ulcers, and as pul- monary ulcers refemble them in their not having a difpofition to heal, and in their tendency to enlarge themfelves, there were hopes, from analogy, that it might have fucceeded. Would a folution of gold in aqua regia be worth trying ? When vinegar is applied to the lips, it renders them inftantly pale, by promo- ting the venous abforption ; if the whole fkin was moiftened with warmifli vinegar, would this promote venous abforption in the lungs by their fympathy with the fkin ? The very abftemious di- et on milk and vegetables alone is frequently injurious. Flefh meatonce a day, with fmall wine and water, or fmall beer, is pref- erable. Half a grain of opium twice a day, or a grain, I believe to be of great ufe at the commencement of the difeafe, as ap- pears from the fubfequent cafe. Mifs , a delicate young lady, of a confumptive family, when fhe was about eighteen, had frequent cough, with quick pulfe, a pain of her fide, and the general appearances of a begin- ning confumption. She took about five drops of laudanum twice a day in a faline draught, which was increafed gradually to ten. In a few weeks fhe recovered, was afterwards married, bore three or four children, and then became confumptive and died. The following cafe of hereditary confumption is related by a phyfician of great ability and very extenfive practice ; and, as it is his own cafe, abounds with much nice obfervation and ufe- ful knowledge; and, as it has been attended with a favourable event, may give confolation to many, who are in a fimilar fitua- tion ; and (hews that Sydenham's recommendation of riding as a Class H. 1. 6. 7. OF SENSATION. 251 a cure for confumption is not fo totally ineffedual, as is now commonly believed. J. C. aged 27, with black hair, and a ruddy complexion, was fubjed to cough from the age of puberty, and occafionallv to fpitting of blood- His maternal grandfather died of confump- tion under thirty years of age, and his mother fell a vidim to this difeafe, with which (he had long been threatened, in her 43d year, and immediately after Ihe ceafed to have children. In the fevere winter of 1783-4, he was much afflided with cough ; and being expofed to intenfe cold, in the month of February he was feized with peripneumony. The difeafe was violent and dangerous, and after repeated bleedings as well as blifterings, which he fupported with difficulty, in about fix weeks he was able to leave his bed. At this time the cough was fevere, and the expedoration difficult. A fixed pain remained on the left fide, where an iffue was inferted ; regular hedic came on every day about an hour after noon, and every night heat and reftleff. nefs took place, fucceeded towards morning by general perfpi- ration. The patient, having formerly been fubjed to ague, was flruck with the refemblance of the febrile paroxyfm, with what he had experienced under that difeafe, and was willing to flatter himfelf it might be of the fame nature. He therefore took bark in the in- terval of fever, but with an increafe of his cough, and this requir- ing venefedion, the blood was found highly inflammatory. The vaft quantity of blood which he had Jolt from time to time, pro- duced a difpofition to fainting, when he refumed the upright pofture, and he was therefore obliged to remain almoft conflant- ly in a recumbent pofition. Attempting to ride out in a carriage, he was furprifed to find that he could fit upright for a confider- abletime, while in motion, without inconvenience, though, on flopping the carriage, the difpofition to fainting returned. At this time, having prolonged his ride beyond the ufual length, he one day got into an uneven road at the ufual period of the recurrence of the hedic paroxyfms, and that day he mill- ed it altogether. This circumflance led him to ride out daily in a carriage at the time the febrile acceffion might be expeded, and fometimes by this means it was prevented, fometimes de- ferred, and almoft always mitigated. This experience determined him to undertake a journey of fome length, and Briftol being, as is ufual in fuch cafes, recom- mended, he fet 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 fevere, and be'ing obliged to be bled, three different times on the road, he was no longer able to fit up- right, DISEASES Class II. 1.6. 7. 252 right, but at very fhort intervals, and was obliged to lie at length in the diagonal of a coach. The heflic paroxyfms were not in- terrupted during the journey, but they were irregular and indif- tin€l, and the falutary effects of exercife, or rather geftation, were impreffed on the patient's mind. At Briftol he flayed a month, but reaped no benefit. The weather was dry and the roads dufty ; the water infipid and in- ert. He attempted to ride on horfeback on the downs, but was not able to bear the fatigue for a diftance of more than a hundred yards. The neceflity of frequent bleedings kept down his ftrength, and his hedlic paroxyfms continued, though lefs fe- vere. At this time, fufpedling that his cough was irritated by the weft winds bearing the vapour from the fea, he refolved to try the effects of an inland fituation, and fet off for Matlock in Derby (hire. During the journey he did not find the improvement he ex- pected, but the nightly perfpirations began to diminifh ; and the extraordinary fatigue he experienced proceeded evidently from his travelling in a poft-chaife, where he could not indulge in a recumbent pofition. The weather at Briftol had been hot, and the earth arid and dufty. At Matlock, during the month of June 1784, there was almoft a perpetual drizzle, the foil was wet, and the air moift and cold. Here, however, the patient's cough began to abate, and at intervals he found an opportunity of riding more or lefs on horfeback. From two to three hundred yards at a time, he got to ride a mile without flopping ; and at length he was able to fit on horfeback during a ride from Mafon's Bath to the village of Matlock along the Derwent, and round on the oppofite banks, by the works of Mr. Arkwright, back to the houfe where he ftarted, a diftance of five miles. On dif- mounting, however, he was feized with diliquium, and foon after the ftrength he had recovered was loft by an attack of the haem- orrhoids of the moft painful kind, and requiring much lofs 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 bet- ter be obtained in the courfe of a journey than during his refi- dence at any particular place. This, and other circumftances of a private but painful nature, determined him to fet out from Matlock on a journey to Scotland. The weather was now much improved, and during the journey he recruited his ftrength. Though as yet he could not fit upright at reft for half an hour together without a difpofition to giddinefs, dimnefs of fight, and diliquium, he was able to fit upright under the motion of a poft- chaife during a journey of from 40 to 70 miles daily, and his appetite Class II. 1. 6. 7. OF SENSATION. 253 appetite began to improve. Still his cough continued, and his hedtic flufhings, though the chills were much abated and very irregular. The falutary effects of motion being now more ftriking than ever, he purchafed a horfe admirably adapted to a valetudinarian in Dumfriesfhire, and being now able to fit on horfeback for an hour together, he rode out feveral times a day. He fixed his refidence for a few weeks at Moffat, a village at the foot of the mountains whence the Tweed, the Clyde, and the Annan, de- fcend m different directions ; a fituation inland, dry and healthy, and elevated about three hundred feet above the furface of the fea. Here his ftrength recovered daily, and he began to eat an- imal food, which for feveral months before he had not tailed. Perfevering in exercife on horfeback, he gradually increafed the length of his rides, according to his ftrength, from four to twenty miles a day ; and returning on horfeback to Lancafhire, by the lakes of Cumberland, he arrived at Liverpool on the firft of Sep- tember, having rode the laft day of his journey forty miles. The two inferences of moft importance to be drawn from this narrative, are, firft, the extraordinary benefit derived from gefta- tion in a carriage, and ftill more the mixture of geftation and exercife on horfeback, in arrefting or mitigating the hectic par- oxyfm ; and fecondly, that in the florid confumption, as Dr. Beddoes terms it, an elevated and inland air is in certain circum- ftances peculiarly falutary; while an atmofphere loaded with the fpray of the fea is irritating and noxious. The vicinity of the fea appears very injurious to almoft all vegetables, and Ihould on that account be fufpeCled in refpeCi to its general falubrity, though it may neverthelefs be medicinal in fome difeafes, if re- forted to for a time in the fummer months, but muft be ineligible as a permanent refidence. See Clafs I. 2. i. 15. The benefit derived in this cafe from exercife on horfeback, may lead us to doubt whether Sydenham's praife of this remedy be as much exaggerated as it has of late been fuppofed. Since the publication of Dr. C. Smith on the effects of fwinging in low- ering the pulfe in the heflic paroxyfm, the fubjedl of this nar- rative has repeated his experiments in a great variety of cafes, and has confirmed them. He has alfo repeatedly feen the he£tic paroxyfm prevented, or cut fhort, by external ablution of the naked body with tepid water. So much was his power of digeftion impaired or vitiated by the immenfe evacuations, and the long continued debility he un- derwent, that after the cough was removed, and indeed for fev- eral years after the period mentioned, he never could eat animal food without heat and flufhing, with frequent pulfe and extreme drowfinels. DISEASES Class II. r. 6. 7. 254 drowfinefs. If this drowfinefs was encouraged, the fever ran high, and he awoke from dilturbed fleep, wearied and deprefled. If it was reiolutely refilled by gentle exercife, it went off-in about an hour, as well as the increafed frequency of the pulfe. This agitation was however fuch as to incapacitate him during the afternoon for lludy of any kind. The fame effeCts did not fol- low a meal of milk and vegetables, but under this diet his ftrength did not recruit; whereas after the ufe of animal food it recov- ered rapidly, notwithftanding the inconvenience already men- tioned. For this inconvenience he at lafi found a remedy in the ufe of coffee immediately after dinner, recommended to him by his friend Dr. Percival. At firft this remedy operated iike a charm, but by frequent ufe, and indeed by abufe, it no longer pofleffes its original efficacy. Dr. Falconer, in his Diflertation on the Influence of the Paf- fions and Affections of the Mind on Health and Difeafe, fuppo- fes that the cheerfuinefs which attends heCtic fever, the ever- fpringing hope, which brightens the gloom of the confumptive patient, increafes the difeafed aftions, and haftens his doom. And hence he is led to inquire, whether the influence of fear might not be lubftituted in iuch cafes to that of hope with ad- vantage to the patient ? This queftion I {hall not prefume to anfwer, but it leads me to fay fomething of the Hate of the mind in rhe cafe juft related. The patient, being a phyfician, was not ignorant of his dan- ger, which fome melancholy circumitances ferved to imprefs on his mind. It has already been mentioned, that his mother and grandfather died of this difeafe. It may be added, that in the year preceding that on which he himfelf was attacked, a filter of his was carried off by confumption in her 17th year ; that in the fame winter in which he fell ill, two other filters were feized with the fame fatal diforder, to which one of them fell a viCtim during his refidence at Briftol, and that the hope of bidding a lalt adieu to the other was the immediate caufe 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 dull ! It may be conjectured from thefe circumitances, that whatever benefit may be derived from the apprehenfion of death, muft in this cafe have been obtained. The expectation of this iflue was indeed for fome time fo fixed that it ceafed to produce much agitation j in con- formitv to that general law of our nature, by which almoft all men fubmit with compofure to a fate that is forefeen, and that appears inevitable. As however the progrefs of difeafe and de- , bility feemed to be arrelted, the hope and the love of life reviv- ed, Class II. 1. 6. 8. OF SENSATION. 255 ed, and produced, from time to time, the obfervations and the exertions already mentioned. Wine and beer were rigoroufly abftained from during fix months of the above hillory ; and all the blood, which was ta- ken, was even to the laft buffy. Feb. 3, 1795. It has lately been afferted, that the people of Holland are lefs liable to confumption of the lungs, than thofe of many other parts of Europe, which has been afcribed to their warmer cloth- ing. I am aware of the difficulty of making fuch eftimates with any great degree of certainty, but if fuch be the fail, it may in- deed be afcribed with fome degree of probability to their ufing very warm clothing, but not very warm rooms during the winter feafon. Whence the lungs are not fo much expofed to the great and fudden tranfition from very warm rooms into frofty air, as in this country. And though the lungs have not a fen- fation of cold or of chilnefslike the exernal fkin, in paffing from very warm air into great cold, often much below the freezing point, yet they are liable to inflammation, like other parts of the fyftem. But to this may be objected, that the hereditary pul- monary confumption attacks the patient fo infallibly a few years after puberty, that it does not appear to depend much on exter- nal circumftances. 8. Febrisfcrofulofa. The heClic fever occafioned by ulcers of the lymphatic glands, when expofed to the air, does not differ from that attending pulmonary confumption, being accompanied with night-fweats and occafional diarrhoea. M. M. The bark. Opium internally. Externally ceruffa and bark in fine powder. Bandage. Sea-bathing. See Clafs I. 2. 3. 21. and II. 1.4. 12. 9. Febris Ifchiadica. A hedic fever from an open ulcer be- tween the mufcles of the pelvis, which differs not from the pre- ceding. If the matter in this fituation lodges till part of it, I lup- pofe, becomes putrid, and aerates the other part; or till it be- comes abforbed from fome other circumftance ; a fimilar heClic fever is produced, with night-fweats or diarrhoea. Mrs. , after a lying in, had pain on one fide of her loins, which extended to the internal part of the thigh on the fame fide. No fluctuation of matter could be felt ; ffie became hec- tic with copious night fweats, and occafional diarrhoea, for four or five weeks ; and recovered by, I fuppofe, the total abforption of the matter, and the reunion of the walls of the abfcefs. See Clafs II 1. 2. 18. 10. Febris ^rtbropuodica. Fever from the matter of difeafed joints. Does the matter from fuppurating bones, which gener- ally 256 DISEASES Class II. 1. 6. 11. ally has a very putrid frnell, produce heCtic fever or typhus ? See Clafs II. 1.4. 16. 11. Febris a pure contagiofo. Fever from a contagious pus. When the contagious matters have been produced on the exter- nal habit, and in procefs of time become abforbed, a fever is produced in confequence of this reabforption ; which differs with the previous irritability or inirritability, as well as with the fenfibility of the patient. 12. Febris 'uariolofa fecundaria. Secondary fever of fmall-pok. In the diftinCl fmall-pox the fever is of the fenfitive irritated or inflammatory kind ; in the confluent fmall-pox it is of the fenfi- tive inirritated kind, or typhus gravior. In both of them the fwelling of the face, when the matter there begins to be ab- forbed, and of the hands, when the matter there begins to be ab- forbed, (hew, that it ftimulates the capillary veffels or glands, occafioning an increafed fecretion greater than the abforbents can take up, like the aCtion of the cantharides in a blifter; now as the application of a blifter on the fkin frequently occafions the ftranguary, which (hews, that fome part of the cantharides is abforbed ; there is reafon to conclude, that a part of the matter of fmall-pox is abforbed, and thus produces the fecondary fever. See Clafs II. 1. 3. 9. And not fimply by its ftimulus on the furface of the ulcers beneath the fcabs The exfudation of a yellow fluid from beneath the confluent eruptions on the face before the height is fpoken of in Clafs II. 1.3.2. The material thus abforbed in the fecondary fever of fmall- pox differs from that of open ulcers, as it is only aerated through the elevated cuticle ; and fecondly, becaufe there is not a con- ftant fupply of frefh matter, when that already in the puftules is exhaufted, either by abforption, or by evaporation, or by its induration into a fcab. Might not the covering the face af- fiduloufly and exactly with plafters, as with cerate of calamy, or with minium plafter, by precluding the air from the puftules, prevent their contracting a contagious, or acefcent, or fever pro- ducing power? and the fecondary fever be thus prevented entirely. If the matter in thofe puftules on the face in the confluent fmall- pox were thus prevented from oxygenation, it is highly proba- ble, both from this theory, and from the faCts before mentioned, that the matter would not erode the fkin beneath them, and by thefe means no marks or fears would fucceed. 13. Febris carcinomato/a. Fever from the matter of cancer. In a late publication the pain is laid to be relieved, and the fe- ver cured, and the cancer eradicated, by the application of car- bonic acid gas, or fixed air. See Clafs II. 1.4. 16. 14. Febris Class II. 1. 6. 14. OF SENSATION. 257 14. Febris venerea. From the abforption of the matter from venereal ulcers and fuppurating bones. See Syphilis, II. 1.5.2. M. M. Any mercurial calx. Sarfaparilla ? Mezerpon ? 15. Febris a Janie putrida. Fever from putrid fanies. When parts of the body are deftroyed by external violence, as a bruife, or by mortification, a putrefa&ion foon fucceeds ; as they are kept in that degree of warmth and moifture, by their adhefion to the living parts of the body, which moft forwards that proc- efs. Thus the Houghs of mortified parts of the tonfils give fe- tor to the breath in fome fevers ; the matter from putrefying teeth, or other fuppurating bones, is particularly offenfive ; and even the fcurf, which adheres to the tongue, frequently acquires a bitter tafte from its incipient putridity. This material differs from thofe before mentioned, as its deleterious property depends on a chemical rather than an animal procefs. 16. Febris puerpera. Puerperal fever. It appears from fome late difleftions, which have been publifhed, of thofe 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 fome blood or fanies. Thefe parts are fuppofed to have been injured by the exertions accompanying labour ; and as matter in this vifcus may have been produced without much pain, this difeafe is not attended with arterial ftrength and hard full pulfe, like the inflammation of the uterus ; and as the fever is of the inirritative or typhus kind, there is reafon to believe, that the previous exhauftion of the patient during labour may contribute to its production ; as well as the abforption of a material not purulent but putrid ; which is formed by the delay of extrava- fated or dead matter produced by the bruifes of the omentum, or other vifcera, in the efforts of parturition, rather than by pu- rulent matter, the confequence of fuppuration. The pulfe is generally about 120 when in bed, and in the morning ; and is increafed to 134, or more, when the patient fits up, or in the evening paroxyfm. The pulfe of all very weak patients increaf- es in frequency when they fit up ; becaufe the expenditure of fenforial power neceflary to preferve an erect pofture deduces fo much from their general ftrength ; and hence the pulfe becomes weaker and in confequence quicker. SeeSeft. XII. 1. 4. Whence I fufpect that the puerperal fever is diftinguifhed from the hectic fever, by the former being produced and fup- ported by the abforption of a putrid fanies, arifing from dead parts of the omentum or mefentery ; and the latter being pro- duced and fupported by the abforption of purulent matter, which is the confequence of inflammation, after it has been ox- ygenated by expofure to the air ; and that lienee they differ in Vol. II. K k the 258 DISEASES Class II. 1.6. 16. the greater debility, and confequent quicker pulfe, and more rapid progrefs of the former than the latter ; but agree, in the few patients which I have attended, in the circumftance of the patients bearing the quantity of thefe fevers better than the typhus, as is feen in their frequent rifing from their beds for hours, and even attending to their occupations with a pulfe of mote than 120 in a minute ; and alfo in another important cir- cumltance, which is, that they take folid food, as bread, and eggs, and oyfters, and even chicken, in great quantities ; which in the inirritative fever, or typhus, is refufed during the whole courfe of the difeafe. And hence it feems probable, that the caufe or commencement of the inirritative fever, or typhus, may have been from the torpor or paralyfis of the ftomach, owing to the fwallowing of contagious matter along with our faliva ; and the actions of the heart fuffer in confequence from fympathy. And that hence thefe three kinds of fever may'be diftinguifhed from each other ; the typhus, by the total lofs of appetite for folid food ; the he€lic fever, by the pulfe being feldom above 120, and with attendant inflammation ; and the puerperal fever, by a quicker and weaker pulfe ; but both the latter exifting without the inability to take fome folid nourifhment. In this fever time mull be allowed for the abforption of the matter. Very large and repeated quantities of the bark, by preventing fufficient food from being taken, as bread, and wine, and water, I have thought, have much injured the patient ; for the bark is not here given, as in intermittent fevers, to prevent the paroxyfm, but limply to ftrengthen the patient by increafing the power of digeftion. About two ounces of decocftion of bark, with four drops of laudanum, and a drachm of fweet fpir- it of vitriol, once in fix hours, and a glafs of wine between thofe times, with panada, or other food, 1 have thought of molt ad- vantage, with a fmall blifter occafionally. Where not only the ftomach but alfo the bowels are much diftended with air, fo as to found on ftriking them with the fin- gers, the cafe is always dangerous, generally hopelefs 5 which is more fo in proportion to the quicknefs of the pulfe. Where the bowels are diftended two drops of oil of cinnamon fhould be given in the panada three or four times a day, with ten grains of alum. In one cafe of puerperal fever, which lafted above forty days, and was attended for the laft fortnight with perpetual fubfultus of the tendons, and even twitching of the hands with unceafing delirium, and inability to fleep, mufk given in the dofe of ten grains every fix hours, with five drops of tindlure of opium, feemed to be of fervice ; and when the abdomen became tumid . with Class II. 1. 6. 16. OF SENSATION. 259 with air, about the 36th day from the commencement of the fever, alum given in dofes of about feven grains every three hours, feemed of uncommon fervice, as the tumour of the abdo- men much fubfides in one day, and the patient immediately^be- came able to fleep two or three hours at a time ; but the event of the difeafe was fatal. In this fituation I fuppofe the fever to have been kept up by the abforption of a putrid material in the abdomen, on the outfide of the inteftines ; and as alum inftantaneoufly deftroys the volatile alkali which occafions a part of the fmeil, and per- haps the whole of the gas of putrid matter ; which alkali pre- cipitates the argillaceous earth from the vitrioliic acid ; I fup- pofe this effeCt would be produced by alum, though it might not be produced by vitriolic acid, as the latter would unite with the contents of the ftomach ; but the alum would not unite with any thing, till it became expofed to exhalations of putrid matter. See Clafs II. 1.3.1. Might not a pundure by a lan- cet into the tumid abdomen, through the fear of the navel, be of ufe, when it is much diftended with air ? The want of deep was owing to debility, and ceafed when that became leflened. As fome motions of the hands were the confequence of her delirious ideas, thefe became tremulous, like the hands of very old men, or drunkards, from debility whenev- er they were exerted. A very interefting account of the puerperal fever, which was epidemic at Aberdeen, has been lately publilhed by Dr. Alexan- der Gordon. (Robinfons, London.) In feveral diffeClions of thofe who died of this difeafe, purulent matter was found in the cavity of the abdomen ; which he afcribes to an eryfipelatous inflammation of the peritonaeum, as its principal feat, and of its productions, as the omentum, mefentery, and peritonaeal coat of the inteftines. He believes, that it was infectious, and that the contagion was always carried by the accoucheur, or the nurfe, from one lying-in woman to another. The difeafe began with violent unremitting pain of the abdo- men on the day of delivery, or the next day, with fhuddering, and very quick pulfe, often 140 in a minute. In this fituation if he faw the patient within 12 or 24 hours of her feizure, he took away from 16 to 24 ounces of blood, which was always fizy. He then immediately gave a cathartic, confifting of three grains of calomel, and forty grains of powder of jalap. After this had operated, he gave an opiate at night ; and continued the purging and the opiate for feveral days. He aflerts, that almoft all thofe, whom he was permitted to treat 260 DISEASES Class II. 1. 6. 16. treat in this manner early in the difeafe, recovered, to the num- ber of 50 ; and that almoft all the reft died. But that when two or three days were elapfed, the patient became too weak for this method ; and the matter was already formed, which de- ftroyed them. Except that he faw two patients who recovered, after difcharging a large quantity of matter at the navel. And a few who were relieved, by the appearance of external eryfip- elas on the extremities. This difeafe, confifting of an eryfipelatous inflammation, may occafion the great debility fooner to occur than in inflammation of the uterus ; which latter is neither eryfipelatous, I fuppofe, nor contagious. And the fuccefs of Dr. Gordon's practice feems to correfpond with that of Dr. Rufli, in the contagious fever or plague at Philadelphia ; which appeared to be much af- fifted by early evacuations. One cafe I faw, fome time ago, where violent unceafing pain of the whole abdomen occurred, a few hours after delivery, with quick pulfe ; which ceafed after the patient had twice loft about eight ounces of blood, and had taken a moderate cathartic with calomel. This cafe induces me to think, that it might be fafer, and equally efficacious, to take lefs blood at firft than Dr. Gordon mentions, and to repeat the operation in a few hours, if the continuance of the fymptoms ffiould require it. And the fame in refpeft to the cathartic, which might perhaps be given in lefs quantity, and repeated every two or three hours. Nor ffiould I wiffi to give an opiate after the firft venefeftion and cathartic ; as I fufpeft that this might be injurious, except thofe evacuations had emptied the veflels fo much, that the ftim- ulus of the opiate fhould aft only by increafing the abforption of the new Veflels or fluids produced on the furface of the infla- med membranes. In other inflammations of the bowels, and in acute rheumatifm, I have feen the difeafe much prolonged, and I believe fometimes rendered fatal, by the too early adminif- tration of opiates, either along with cathartics, or at their inter- vals ; while a fmall dofe of opium given after fufficient evacua- tions produces abforption only by its ftimulus, and much con- tributes to the cure of the patient. We may have vifible tefti- mony of this effeft of opium, when a folution of it is put into an inflamed eye ; if it be thus ufed previous to fuflicient evac- uation, it increafes the inflammation ; if it be ufed after fuffi- cient evacuation, it increafes abforption only, and clears the eye in a very fmall time. I cannot omit obferving,from confidering thefe circumftances, how unwife is the common praftice of giving an opiate to every woman Class II. 1. 6. 17. OF SENSATION. 261 woman immediately after her delivery, which muft often have been of dangerous confequence. 17. Febris a fphacelo. Fever from mortification. This fever from abforption 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, fo as to induce confequent debility,and to opprefs the power of digeftion. ORDO. 262 DISEASES Class II. 1.7. 1. ORDO I. Increased Senfation. GENUS VII. With decreased Actions of Organs of Zenfe. SPECIES. I. Delirium febrile. Paraphrofyne. The ideas in delirium confift of thofe excited by the fenfation of pleafure or pain, which precedes them, and the trains of other ideas affociated with thefe and not of thofe excited by external irritations or by voluntary exertion. Hence the patients do not know the room which they inhabit, or the people who furround them ; nor have they any voluntary exertion, where the delirium is complete ; fo that their efforts in walking about a room or rifing from their bed are unfteady,and produced by their catenations with the im- mediate affedions of pleafure or pain. See Section XXXIII. 1.4. By the above circumftances it is diltinguifhed from madnefs, in which the patients well know the perfons of their acquaint- ance, and the place where they are ; and perform all the volun- tary actions with fteadinefs and determination. See Seft. XXXIV.,2. 2. Delirium is fometimes lefs complete, and then a new face and louder voice Simulate the patient to attend to them for a few moments ; and then they relapfe again into perfect delirium. At other times a delirium affects but one fenfe, and the perfon thinks he fees things which do not exift ; and is at the fame time fenfible to the queftions which are alked him, and to the tafte of the food which is offered to him. This partial delirium is termed a hallucination of the difor- dered organ ; and may probably arife from the origin of one nerve of fenfe being more liable to inflammation than the oth- ers ; that is, an exuberance of the fenforial power of fenfation may affect it ; which is therefore thrown into action by {light- er fenfitive catenations, without being obedient to external ftim- ulus, or to the power of volition. The perpetual flow of ideas in delirium is owing to the fame circumftance, as of thofe in our dreams; namely, to the defeat or paralyfis of the voluntary power ; as in hemiplegia, when one fide of the body is paralytic, and thus expends lefs of the fenforial power, the limbs on the other fide are in conflant motion from the Class II. 1. 7. 2. OF SENSATION. 263 the exuberance of it. Whence lefs fenforial power is exhaufted in delirium, than at other times, as well as in fleep ; and hence in fevers with great debility, it is perhaps, as well as the ftupor, rather a favourable circumftance ; and when removed by numer- ous blitters, the death of the patient often follows the recovery of his underftanding. See Clafs I. 2. 5. 6. and I. 2. 5. io- Delirium in difeafes from inirritability is fometimes preceded by a propenfity to furprife. See Clafs I. 1.5. 12. M. M. Fomentations of the fhaved head for an hour repeat- edly. A blifter on the head. Rifmg from bed. Wine and opium, and fometimes venefeCtion in fmall quantity by cupping, if the ftrength of the arterial fyttem will allow it. 2. Delirium maniacale. Maniacal delirium. There is anoth- er kind of delirium, defcribed in SeCt. XXXIII. 1. 4. which has the increafe of pleafurable or painful fenfation for its caufe, without any diminution of the other fenforial powers ; but as this excites the patient to the exertion of voluntary actions, for the purpofe of obtaining the object of his pleafurable ideas, or avoiding the object of his painful ones, fuch as perpetual prayer, when it is of the religious kind ; it belongs to the infanities de- fcribed in Clafs III. 1. 2. 1. and is more properly termed hal- lucinatio maniacalis. 3. Delirium ebrietatis. The drunken delirium is in nothing different from the delirium attending fevers except in its caufe, as from alcohol, or other poifons. When it is attended with an apoplectic ftupor, the pulfe is generally low ; and venefeCtion I believe fometimes deftroys thofe, who would otherwife have recovered in a few hours. M. M. Diluting liquids. An emetic. 4. Somnium. Dreams conftitute the moft complete kind of delirium. As in thefe no external irritations are attended to, and the power of volition is entirely fufpended ; fo that the fenfations of pleafure and pain, with their affociations, alone ex- cite the endlefs trains of our fleeping ideas; as explained in Se<St. XVIII. on deep. 5. Hallucinatio vifus. Deception of fight. Thefe vifual hal- lucinations are perpetual in our dreams; and fometimes pre- cede general delirium in fevers ; and fometimes belong to rev- erie, and to infanity. See Clafs III. 1. 2. 1. and 2. and muft be treated accordingly. Other kinds of vifual hallucinations occur by moon-light; when objects are not feen fo diftinftly as to produce the ufual ideas afibciated with them, but appear to us exaCtly as they are feen. Thus the trunk of a tree appears a flat furface, inftead of a 264 DISEASES Class II. 1. 7. 6. a cylinder as by day, and we are deceived and alarmed by fee- ing things as they really are feen. See Berkley on Vifion. 6. Hallucinatio auditus. Auricular deception frequently oc- curs in dreams, and fometimes precedes general delirium in fe- vers ; and fometimes belongs to vertigo, and to reverie, and to infanity. See Se£t. XX. 7. and Clafs III. 1 2 1. and. 2. 7. Rubor a calore. The blufh from heat is occafioned by the increafed aflion of the cutaneous veflels in confequence of the increafed fenfation of heat. See Clafs I. 1. 2. 1. and 3. 8. Rubor jucunditatis. The blufh of joy isowing to the in- creafed a&ion of the capillary arteries, along with that of every moving veflel in the body, from the increafe of pleafurable fen- fation. 9. Priapifmut amatorius. Amatorial priapifm. The blood is poured into the cells of the corpora cavernofa much fatter than it can be reabforbed by the vena penis, owing in this cafe to the pleafurable fenfation of love increafing the arterial action. See Clafs I. 1.4. 6. 10. Diftentio mamularum. The teats of female animals, when they give fuck, become rigid and erected, in the fame manner as in the laft article, from the pleafurable fenfation of the love of the mother to her offspring. Whence the teat may properly be called an organ of fenfe. The nipples of men do the fame when rubbed with the hand. See Clafs I. 1. 4. 7. ORDO Class II. i. i. OF SENSATION. 265 ORDO I. Uecreafecl Senfation. GENUS I. Of the General Syfem. SPECIES. 1. Stultitia infenftbilis. Folly from infenfibility. The pleal- ure or pain generated in the fyftem is not fuflicient to promote the ufuai activity either of the fenforial or mufcular fibres. 2. Tadium vita. Ennui. Irkfomenefs of life. The pain of lazinefs has been thought by fome philofophers to be that prin- ciple of action, which has excited all our induftry, and diitin- guifhed mankind front the brutes of the field. It is certain that, where the ennui exifts, it is relieved by the exertions of our minds or bodies, as all other painful fenfations are relieved ; but it depends much upon our early habits, whether we become patient of lazinefs, or inclined to activity, during the remainder of our lives, as other animals do not appear to be affected withth's malady ; which is perhaps lefs owing to deficiency of the pleaf- urable fenfation, than to the fuperabundancy of voluntary pow- er which occafions pain in the mufcles by its accumulation ; as appears from the perpetual motions of a fquirrel confined in a cage. 3. Parefs fenfitiva. Weaknefs of the whole fyftem from in- fcnfibilitv. Vol. II. L l ORDO 266 DISEASES Class II. 2. 2.1. ORDO IL Decreafed Sen fation. GENUS IL Of particular Organs. SPECIES. i. Anorexia. Want of appetite. Some elderly people, and thofe debilitated by fermented liquors, are liable to lofe their appetite for animal food ; which is probably in part owing to the deficiency of gaftric acid, as well as to the general decay of the fyftem : elderly people will go on years without animal food ; but inebriates foon fink, when their digeftion becomes fo far im- paired. Want of appetite is fometimes produced by the putrid matter from many decaying teeth being perpetually mixed with the faliva, and thence affecting the organs of tafte, and greatly injuring the digeftion. M. M. Fine charcoal powder diffufed in warm water, held in the mouth frequently in a day, as in Clafs I. 1.4. 4. or folution of alum in water. Extract the decayed teeth. An emetic. A blifler. Chalybeates. Vitriolic acid. Bile of an ox infpiflated, and made into pills; 20 grains to be taken before dinner and fupper. Opium half a grain twice a day. All the ilrength we poflefs is ultimately derived from the food, which we are able to digeft ; whence a total debility of the fyftem frequently follows the want of appetite, and of the power of digeftion. Some young ladies I have obferved to fall into this general debility, fo as but juft to be able to walk about; which I have fometimes afcribed to their voluntary failing, when they believed themfelves too plump ; and who have thus loft both their health and beauty by too great abftinence, which could never be reftored. , Two young ladies applied to me, who had experienced many months of great debility, and of almoft total want of appetite, from another caufe, which was from bathing on a warm day in a cold fountain of water, which was covered from the fun and fupplied by a powerful fpring ; but gradually afterwards recov- ered their health by the ufe of fix grains of rhubarb with one grain of opium every night for fome weeks, and a bitter draught twice a day with a flight chalybeate. See Clafs III. 2. I. 17. I have feen other cafes c-f what may be termed anorexia epi- leptica, Class II. 2. 2. 2. OF SENSATION. 267 leptica, in which a total tofs of appetite, and of the power of di- geftion, fuddenly occurred along with epileptic fits. Mifs B. a girl about eighteen, apparently very healthy, and rather plump, was feized with fits, which were at firft called hyfterical; they occurred at the end of menftruation, and returned very fre- quently with total lofs of appetite. She was relieved by vene- fedtion, blifters, and opiates; her ftrength diminilhed, and af- ter fome returns of the fits, (he took to her bed, and has furvi- ved 15 or 20 years; (he has in general eaten half a potato a day, and feldom fpeaks but retains her fenfes, and had many years occafional returns of convulfion. I have feen two fimilar cafes, where the anorexia, or want of appetite, was in lefs degree; and but juft fo much food could be digefted, as fupplied them with fufficient ftrength to keep from the bed or fofa for half a day. As well as I can recoiled!, all thefe patients were attend- ed with weak pulfe, and cold pale Ikin ; and received benefit by opium, from a quarter of a grain to a grain four times a day. See Clafs III. 1. 1. 7. and III 1. 2. 20. and Suppl. I. 14. 3. 2. Adipjia. Want of thirft. Several of the inferior people, as farmer's wives, have a habit of not drinking with their dinner at all, or only take a fpoonful or two of ale after it. I have frequently obferved thefe to labour under bad digeftion, and de- bility in confequence ; which I have afcribed to the too great ftimulus of folid food undiluted, deftroying in procefs of time the irritability of the ftomach. 3. Impotentia (agenefia.) Impotency much feldomer happens to the male fex than fterility to the female fex. Sometimes a temporary impotence occurs from bafhfulnefs, or the interfer- ence of fome voluntary exertion in the production of an effect, which fhould be performed alone by pleafurable fen fation. One, who was foon to be married to a lady of fuperior condi- tion to his own, expreffed fear of not fucceeding on the wed- ding night; he was advifed to take a grain of opium before he went to bed, and to accuftom himfelf to fleep with a woman previoufly, but not to enjoy her, to take off his bafhfulnefs ; which fucceeded to his wifh. Mr. John Hunter in his work on the venereal difeafe, has given an ingenious fectionon this fubject of mental impotence in which he relates a luccefsful mode of treatment. He prevailed on a perfon in this fituation to promife on his honor to pafs fix nights in bed with a young woman without attempting tohave connection with her, whatever might be his power or inclination. He after- wards affured Mr. Hunter, that this refolution had produced luch a total alteration in the ftate of his mind, that the power of connection foon recurred, for inftead of going to bed with the fear 268 DISEASES Class II. 2.3.4. fear of inability, he went with fears, that he fhould be poffeff- ed with too much defire, and too much power, fo as to become uneafy to him, which really happened, as he would have been happy to have fhortened the time ; and when he had once broken the fpell, his mind and powers went on together *; and his mind never returned to its former Rate. A gentleman about 50 years of age, who had lived too freely, as he informed me, both in refpeft to wine and women, com- plained, that his defire for the fex remained, and that he occa- fionally parted with femen, but with defeat of a perfect tenfio pen s, and that he had tried 20 drops of laudanum, and 20 drops of tincture of cantharides on going to bed without effeCt ; and. that as the debility or inirritabilty of the fyftem in this cafe rather than any mental affeCtion feemed to be a part of the caufe, he was advifed to ftimulate the fphinCter ani by the in- troduction of a piece of the root of ginger, as is done by the horfe-dealers to fale-horfes. And, however ridiculous the oper- ation may appear, he allured me, that it fucceeded ; which 'I fuppofe might be owing to the fympathy between the fphinder ani and the penis ; which is fo often the caufe of painful fenfa- tion in the former, when a Hone at the neck of the bladder af- feCts the latter ; and converfely when painful piles affeCt the rectum, a itranguary is fometimes produced by fympathy. For refloring the venereal power M. Le Roy thinks phofpho- rus taken in a dofe of a quarter of a grain rubbed with oil dr yolk of egg, or honey ; or even the acid of phofphorus, to pof- fefsgreat efficacy. Med Review, Vol. V p. 204- The water in which phofphorus has been kept fome time, probably pof- fefles fome of this acid, and is alfo recommended by M. Le Roy. I ought here to add, that I have been lately informed, that a gentleman directed four grains of phofphorus to be made into pills with conferve, with defign of increafing his venereal power. He was feized with intolerable fenfe of heat at his ftomach, pulfe feeble, but not quickened, livid countenance, forenefs of his bowels to the touch, and inceffant vomitings,.by which he at laft brought up fome blood. His illnefs lafted five or fix days. He did not acknowledge any caufe of his fudden illnefs, but faid he was certain emetics would cure him, and took tw'o by his own requeft. After his death, the apothecary men- tioned his having direCled the pills as above, which were made three days before he was taken ill; and he was believed to have taken about half of them. M. M. Chalybeates. Opium. Bark. TinClure of can- tharides. 4. St erilitas. Barrennefs. One of the ancient medical wri- ters Class II. 2. 2.5. OF SENSATION. 269 ters aflerts, that the female fex become pregnant with moft cer- tainty at or near the time of menftruation. This is not im- probable, fince thefe monthly periods feem to refemble the monthly venereal orgafm of fome female quadrupeds, which be- come pregnant at thofe times only ; and hence the computation of pregnancy is not often erroneous, though taken from the laft menftruation. See Sefl. XXXVI. 2. 3. M. M. Opium a grain every night. Chalybeates in very fmall dofes. Bark. Sea-bathing. 5. Infenjililitas artuum. As in fome paralytic limbs. A great infenfibility fometimes accompanies the torpor of the (kin in cold fits of agues. Some parts have retained the fenfe of heat, but not the fenfe of touch. See Seif. XVI. 6. M. M. Friction with flannel. A blifter. Warmth. 6. Difuria infenjitiva. Infenfibility of the bladder. A diffi- culty or total inability to make water attends fome fevers with great debility, owing to the infenfibility or inirritability of the bladder. This is a dangerous but not always a fatal fymptom. See Clafs III. 2. 1.6. M. M. Draw off the water with a catheter. Affift the pa- tient to the exclufion of it by comprefling the lower parts of the abdomen with the hands. Wine two ounces, Peruvian bark one dram in decoflion, every three hours alternately. Balfam of copaiva. Oil of almonds, with as much camphor as can be diffolved in it, applied as a liniment rubbed on the region of the bladder and perinxum, and repeated every four hours, was ufed in this difeafe with fuccefs by Mr. Latham. Med. Comment. i79bP-2I3- 7. Accumulatio alvina. An accumulation of feces in the return, occafioned by the torpor, or infenfibility, of that bowel. Bur as liquids pafs by thefe accumulations, it differs from the conftipatio alvi, which is owing to too great abforption of the alimentary canal. Old milk, and efpecially when boiled, is liable to induce this kind of coftivenefs in fome grown perfons ; which is probably owing to their not poffeffing fufficient gaftric acid to curdle and digeft it; for as both thefe proceffes require gaftric acid, it fol- lows, that a greater quantity of it is neceffary, than in the digef- tion of other aliments, which do not previoufly require being curdled. This ill digefted milk not fufficiently ftimulating the reftum, remains till it becomes a too folid mafs. On this ac- count milk feldom agrees with thofe, who are fubjefl to piles, by inducing coftivenefs and large ftools. M. M. Extract the hardened fcybala by means of a marrow- fpoon ; or by a piece of wire, or of whale-bone bent into a bow, and 270 PISEASES Class II. 2. 2. 7. and introduced. Inje&ions of oil. Caftor oil, or oil of al- monds, taken by the mouth. A large clyfter of fmoke of to- bacco Six grains of rhubarb taken every night for many months. Aloes. An endeavour to eftablilh a habit of evacua- tion at a certain hour daily. See Clafs I. i. 3. 5. ORDO Class II. 3. 1. 1. OF SENSATION. 271 ORDO III. Retrograde Senjitive Motions. GENUS I. Of Excretory Dufis. The retrograde action of the oefophagus in ruminating ani- mals, when they bring up the food from their firft ftomach for the purpofe of a fecond maftication of it, may probably be caufed by agreeable fenfation ; fimilar to that which induces them to fwal- low it both before and after this fecond maftication ; and then this retrograde aClion properly belongs to this place, and is er- roneoufly put at the head of the order of irritative retrograde motions. Clafs I. 3. 1. 1. SPECIES. I. Ureterum motus retrogrefjius. When a ftone has advanced into the ureter from the pelvis of the kidney, it is fometimes lia- ble to be returned by the retrograde motion of that canal, and the patient obtains fallacious eafe, till the ftone is again puffied into the ureter. 2. Urethra motus retrogrefjius. There have been inftances of bougies being carried up the urethra into the bladder moft prob- ably by an inverted motion of this canal; for which fome have undergone an operation fimilar to that for the extraction of a ftone. A cafe is related, in fome medical publication, in which a catgut bougie was carried into the bladder, and, after remain- ing many weeks, was voided peace-meal in a femi-diflblved ftate. Another cafe is related of a French officer, who ufed a leaden bougie ; which at length found its way into the bladder, and was, by injecting crude mercury, amalgamated and voided. In the fame manner the infection, from a fimple gonorrhoea, is probably carried further along the courfe of the urethra ; and fmall (tones frequently defcend fome way into the urethra,and are again carried into the bladder by the inverted adtion of this canal. 3. Ductus choledochi motus retrogrejfius. The concretions of bile, called gall-ftones, frequently enter the bile-dudt, and give violent pain for fome hours ; and return again into the gall-blad- der, by the retrograde aCtion of this du£t. May not oil be car- ried up this duct, when a gall-ftone gives great pain, by its re- trograde fpafmodic aCtion ? See Clafs I. 1.3.8. M. M. Onium a grain and half. The 272 DISEASES Class'III. 1. 1; The Orders and Genera of the Third Clafs of Difcafes. CLASS III. DISEASES OP VOLITION. ORDO I. Increafed Volition. GENERA. r. With increafed actions of the mufcles. 2. With increafed actions of the organs of fenfe. ORDO II. Decreafed Volition. GENERA. 1. With decreafed actions of the mnfcles. 1. With decreafed actions of the organs of fenfe. The Orders, Genera, and Species, of the Third Clafs of Difeafes. CLASS III. DISEASES OF VOLITION. ORDO I. Increafed Volition. GENUS I. With increafed Actions of the Mufcles. SPECIES. I. faciitatio 2. Tremor febrilis Reftleflhefs Febrile trembling 3. Clamor. Class III. i. 2. OF SENSATION. 273 3. Clamor 4. Rifus c. Convullio --debilis dolorifica T Epilepfia g dolor ifea 9. Somnambulifmus 10. A/lhma convulfivum ,!. dolorificum 12. Stridor dentium 13. Tetanus trifmus 14. dolorificus. 15. Hydrophobia Screaming Laughter Convulfion weak painful Epilepfy -- painful Sleep-walking Afthma convulfive painful Gnalhing of the teeth Cramp of the jaw painful Dread of water GENUS II. With increafed Action of the Organs of Senfe. SPECIES. I. Mania mutabilis 2. Stadium inane 3. Vigilia 4. Erotomania 5. Amor fui 6 Nojlalgia I- Spes religioja 8. Superbia femmatis 9. Ambitio 10. Moeror 11, Tedium vita 12. Eefiderium pulchritudinis 13. Paupertatis timer 14. Lethi timor 15. Or ci timor 16. Satyriafs 17. Ira 18 Rabies 19. Citta 20 Cacofitia 2i. Syphilis imaginaria 22. Pfora imaginaria 23. Tabes imaginaria 24. Sympathia aliena 25. Educatio hercica Mutable madnefs Reverie W atchfulnefs Sentimental love Vanity Defire of home Superftitious hope Pride of family Ambition Grief Irkfomenefs of life Lofs of beauty Fear of poverty of death of Hell Luft Anger Rage Depraved appetite Averfion to food Imaginary pox itch tabes Pity Heroic education Vol. IL Mm . ORDO r DISEASES Class III. 2. 1. 274 ORDO II. Decreafed Volition. GENUS I. With decreafed Action of the mufcles. SPECIES. I. Laflitudo 2. Viccillatio fenilis 3. ^Tremor fenilis 4. Brachiorum paralyfis 5. Rance do paralytica 6. Veficce urinaria paralyfis 7. ReBi paralyfis 8. Par efts voluntaria 9. Catalepfis 1 o. Hemiplegia 11. Paraplegia I 2. Somnus 13. Incubus 14. Lethargus 15. Syncope epileptica 16. Apoplexia 17. Mors a frigore Fatigue See-faw of old age Tremor of old age Palfy of the arms. Paralytic hoarfenefs Palfy of the bladder Palfy of the reCtum Voluntary debility Catalepfy Palfy of one fide Palfy of the lower limbs Sleep Night-mare Lethargy Epileptic fainting Apoplexy Death from cold GENUS IL With decreafed Anions of the Organs of Senfe. SPECIES. 1. Recolleclionis jaclura 2. Stultitia voluntaria 3. Gredulitas Lofs of recollection Voluntary folly Credulity CLASS Class III. 1. 1. OF VOLITION. 275 CLASS in. DISEASES OF VOLITION. ORDO I. Increafed Volition. GENUS I. With increafed AHions of the Mufcles. WE now ftep forward to confider the difeafes of volition, that fuperior faculty of the fenforium, which gives us the pow- er of reafon, and by its facility of action diftinguifhes mankind from brute animals; which has effected all that is great in the world, and fuperimpofed the works of art on the fituations of nature. Pain is introduced into the fyftem either by excefs or defeat of the action of the part. (Sedt. IV. 5.) Both which circum- ftances feem to originate from the accumulation of fenforial power in the affected organ. Thus when the (kin is expofed to great cold, the activity of the cutaneous veflels is diminiflied, and in confequence an accumulation of fenforial power obtains in them, becaufe they are ufually excited into inceflant motion by the ftimulus of heat as explained in Seft. XII. 5. 2. Contra- rywife, when the veflels of the fkin are expofed to great heat, an excefs of fenforial power is alfo produced in them, which is derived thither by the increafe of ftimulus above what is natural. This accounts for the relief which is received in all kinds of pain by any violent exertions of our mufcles or organs of fenfe; which may thus be in part afcribed to the exhauftion of the fen- forial power by fuch exertions. But this relief is in many cafes fo inftantaneous, that it feems neverthelefs probable, that it is alfo in part owing to the different manner of progreflion of the two fenforial powers of fenfation and volition ; one of them com- mencing at fome extremity of the fenforium, and being propa- gated towards the central parts of it; and the other commenc- ing in the fenforial parts of the fenforium, and being propagated towards the extremities of it; as mentioned in Sect. XL 2. 1. Thefe violent voluntary exertions of our mufcles or ideas to relieve the fenfation of pain conftitute convulfions and madnefs : and are diftinguiftied from the mufcular actions owing to in- creafed fenfation, as in fneezing, or coughing, or parturition, or eietftio 276 DISEASES Cl/iss III. 1. 1. eje&io feminis, becaufe they do not contribute to diflodge the caufe, but only to prevent the fenfation of it. In two cafes of parturition, both of young women with their firft child, I have ieen general convulfions occur from excefs of voluntary exer- tion, as above defcribed, inftead of the actions of particular muf- cles, which ought to have been excited by fenfation for the ex- clufion of the fetus. They both became infenfible, and died af- ter fome hours; from one of them the fetus was extracted in vain. 1 have heard alfo of general convulfions being excited inftead of the actions of the mufculi acceleratores in the ejeftio feminis, which terminated fatally. See Clafs III. I. i. 7. Thefe violent exertions are moft frequently excited in con- fequence of thofe pains, which originate from defeat of the action of the part. See Se<ft. XXXIV. 1. and 2. The pains from excefs and defeat of the action of the part are diftin- guifhable from each other by the former being attended with increafe of heat in the pained part, or of the whole body ; while the latter not only exift without increafe of heat in the pained part, but are generally attended with coldnefs of the ex- tremities of the body. As foon as thefe violent aflions of our mufcular or fenfual fibres for the purpofe of relieving pain ceafe to be exerted, the pain recurs ; whence the reciprocal contraction and relaxation of the mufcles in convulfion, and the intervals of madnefs- Otherwife thefe violent exertions continue, till fo great a part of the fenforial power is exhaufted, that no more of it is excitable by the faculty of volition; and a temporary apoplexy fucceeds, with fnoring as in profound fleep ; which fo generally termin- ates epileptic fits. When thefe voluntary exertions become fo connected with certain difagreeable fenfations, or with irritations, that the ef- fort of the will cannot reftrain them, they can no longer in com- mon language be termed voluntary ; but neverthelefs belong to this clafs, as they are produced by excefs of volition, and may ftill not improperly be called depraved voluntary actions. See Sett. XXXIV. 1. where many motions in common language termed involuntary are (hewn to depend on excefs of volitipn. When thefe exertions from excefs of volition, which in com- mon language are termed involuntary motions, either of mind or body, are perpetually exerted in weak conftitutions, the pulfe becomes quick; which is occafioned by the too great expendi- ture of the fenforial power in thefe unceafing modes of activity. In the fame manner as in very weak people in fevers, the pulfe fometimes increafes in frequency to 140 ftrokes in a minute, when the patients ftand up or endeavour to walk ; and fubfides to CfcASS III. 1. I. OF VOLITION. 277 to iio, when they lie down again in their beds. Whence it appears, that when a very quick pulfe accompanies convulfion or infanity, it {imply indicates the weaknefs of the patient ; that is, that the expenditure of fenforial power is too great for the fupply of it. But. if the ftrength of the patient is not previoufly exhaufted, the exertions of the mufcles are attended with tem- porary increafe of circulation, the reciprocal fwellings and elon- gations of their bellies pufh forwards the arterial blood, and promote the abforption of the venous blood ; whence a tempo- rary increafe of fecretion and of heat, and a ftronger pulfe. A correfpondent aquaints me, that he finds difficulty in un- derftanding how the convulfions of the limbs in epilepfy can be induced by voluntary exertions. This I fufpecl firft to have arifen from the double meaning of the words " involuntary mo- tions which are fometimes ufed for thofe motion?, which are performed without the interference of volition, as the pulfarions of the heart and arteries; and at other times for thofe actions, which occur, where two counter volitions opppfe each other, and the ftronger prevails ; as in endeavouring to fupprefs laugh- ter, and to ftop the fhudderings when expofed to cold. Thus when the poet writes, video meliora, proboque, Deteriora fequor. The ftronger volition actuates the fyftem, but not without the countera&ion of unavailing fmaller ones ; which conftitute de- liberation. A fecond difficulty may have arifen from the confined ufe of the words " to will," which in common difcourfe generally mean to choofe after deliberation ; and hence our will or voli- tion is fuppofed to be always in our own power. But the will or voluntary power, ads always from motive, as explained in Seft. XXXIV. i. and in Clafs IV. i. 3. 2. and III. 2. 1. 12. which motive can frequently be examined previous to aft ion, and balanced againft oppofite motives, which is called delibera- tion ; at other times the motive is fo powerful as immediately to excite the fenforial power of volition into action, without a previous balancing of oppofite motives, or counter volitions. The former of thefe volitions is exercifed in the common pur- pofes of life, and the latter in the exertions of epilepfy and in- fanity. It is difficult to think without words, which however all thofe muft do, who difcover new truths by reafoning ; and ft ill more difficult, when the words in common ufe deceive us by their twofold DISEASES Class III. 1. 1. 1. 278 twofold meanings, or by the inaccuracy of the ideas, which they fuggeft. SPECIES. I. JaHitatio. Reftleflhefs. There is one kind of reftleflhefs attending fevers, which confifts in a frequent change of pofture to relieve the uneafmefs of the preflure of one part of the body upon another, when the fenfibility of the fyftem, or of fome parts of it, is increafed by inflammation, as in the lumbago ; which may fometimes be diftinguiflied in its early ftage by the inceflant defire of the patient to turn himfelf in bed. But there is another reftleflhefs, which approaches towards writhing or contortions of the body, which is a voluntary effort to relieve pain ; and may be efteemed a (lighter kind of convulfion, not totally unreftrainable by oppofite or counteracting volitions. Thus when a fquirrel is confined in a cage, he feels uneafi- nefs from the accumulation of fenforial power, in his mufcles, which were before in continual violent exertion in his habits of life ; and in this fituation finds relief by perpetually jump- ing about his cage to expend a part of this accumulated fenfo- rial power. For the fame reafon tbofe children, who are conftrained to fit in fome fchools for hours together, are liable to acquire habits of moving fome mufcles of their faces, or hands, or feet, which are called tricks, to exhauft a part of the accumulated fenforial pow- er. Hence reftleflhefs is occafioned by increafe of ftimulus, or by accumulation of fenforial power. M. M. A blifter. Opium. Warm bath. Bandage on the moving mufcles. See Convulfio debilis, Clafs III. i. 1.5. exercife. 2. Tremor febrilis. Reciprocal convulfions of the fubcu- taneous mufcles, originating from the pain of the fenfe of heat, owing to defeCl: of its ufual ftimulus, and confequent accumulation of fenforial power in it. The actual defi- ciency of heat may exift in one part of the body, and the pain of cold be felt moft vividly in fome other part aflbciated with it by fenfitive fympathy. So a chilnefs down the back is firft attended to in ague fits, though the difeafe perhaps com- mences with the torpor and confequent coldnefs of fome inter- nal vifcus. But in whatever part of the fyftem the defeat of heat exifts, or the fenfation of it, the convulfions of the fubcu- taneous mufcles exerted to relieve it are very general; and, if the pain is ftill greater, a chattering of the teeth is added, the more Class III. 1.1.3. OF VOLITION. 279 more fuddenly to exhauft the fenforial power, and becaufe the teeth are very fenfible to cold. Thefe convulfive motions are neverthelefs reftrainable by vi- olent voluntary counteranion ; 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 in- terval of pleafure preceding each moment of pain in this as iii the latter. u ^7 M. M. See I. 2. 2. 2. 3. Clamor. Screaming from pain. The talkative animals, as dogs, and fwine, and children, fcream moft, when they are in pain, and even from fear ; as they have ufed this kind of exer- tion from their birth moft frequently and moft forcibly; and can therefore fooner exahuft the accumulation of fenforial pow- er in the affected mufcular or fenfual organs by this mode of exertion; as defcribed in Se6t. XXXIV. 1. 3. This facility of relieving pain by fcreaming is the fource of laughter, as explain- ed below. 4. Rif us. The pleafurable fenfations, which occafion laugh- ter, are perpetually paffmg into the bounds of pain ; for pleaf- ure and pain are often produced by different degrees of the fame ftimulus ; as warmth, light, aromatic or volatile odours, become painful by their excefs; and the tickling on the foies of the feet in children is a painful fenfation at the very time it produces laughter. When the pleafurable ideas, which excite us to laugh, pafs into pain, we ufe fome exertion, as a fcream, to relieve the pain, but foon ftop it again, as we are unwilling to lofe the pleafure ; and thus we repeatedly begin to fcream, and ftop again alternately. So that in laughing there are three ftages, firft of pleafure, then pain, then an exertion to relieve that pain. See Sefl. XXXIV. 1. 3. Every one has been in a fituation, where fome ludicrous cir- cumftance has excited him to laugh ; and at the fame time a fenfe of decorum has forbid the exertion of thefe interrupted fcreams ; and then the pain has become fo violent, as to occa- fion him to ufe lome other great aftion, as biting his tongue, and pinching himfelf, in lieu of the reiterated fcreams which conftitute laughter. 5. Convuljio. Convulfion. When the pains from defeat or excefs of motion are more diftreffmg than thofe already defcrib- ed, and are not relievable by fuch partial exertions, as in fcream- ing, or laughter, more general convulfions occur; which vary perhaps according to the fituation of the pained part, or to fome previous affociations formed by the early habits of life. When thofe convulfive motions bend, the body forwards, they are term- ed DISEASES Class HI. f. 1.5. 280 ed emprofthotonoi; when they bend it backward, they are term- ed opifthotonoi. They frequently fucceed each other, but the epifthotonoi are generally more violent; as the mufcles, which cred the body, and keep it ered, are naturally in more conllaht and more forcible action than their antagonifts. The caufes of convulfion are very numerous, as from tooth- ing in children, from worms or acidity in their bowels, from eruption of the diftind fmall pox, and laftly, from breathing too long the air of an unventilated bed-room. Sir G Baker, in the Tranfadions of the College, defcribed this difeafe, and deteded its caufe ; where many children in an orphan-houfe were crowded together in one chamber without a chimney, and were almoft all of them affected with convulfion ; in the hof- pital at Dublin, many died of convuilions before the real caufe Was underftood. See Dr. Beddoes' Guide to Self-prefervation. In a large family which I attended, where many female fervants flept in one room, which they had contrived to render inaccefli- ble to every blaft of air ; I faw four who were thus feized with eonvullions, and who were believed to have been affeded by fympathy from the firft who fell ill. They were removed into more airy apartments, but were fome weeks before they all re- gained their perfect health. Convulfion is diftinguilhed from epilepfy, as the patient does not entirely lofe all perception during the paroxyfm. Which only fliews, that a lefs exhauftion of fenforial power renders tol- erable the pains which caufe donvulfion, than thofe which caufe epilepfy. The hyfteric eonvullions are dillinguilhed from thofe, owing to other caufes, by the prefence of the expectation of death, which precedes and fucceeds them, and generally by a flow of pale urine ; thefe eonvullions do not conftantly attend the hyfteric difeafe, but are occafionally fuperinduced by the dlfagreeable fenfation arifing from the torpor or inverfion of a part of the alimentary canal. Whence the convulfion of laugh- ter is frequently fufficient to reftrain thefe hyfteric pains, which accounts for the fits of laughter frequently attendant on this difeafe. M. M. To remove the peculiar pain which excites the con- vulfions. Venefedion. An emetic. A cathartic with calo- mel. Warm-bath. Opium in large quantities, beginning with fmaller ones. Mercurial fridions. Eledricity. Cold-bath in the paroxyfm ; or cold afperfion. See Memoirs of Med. Soci- ety, Lon. Vol. III. p. 147 a paper by Dr- Currie. 5. Cotivuljio debilis. The convulfions of dying animals, as of thofe which are bleeding to death in the flaughter-houfe, are an effort to relieve painful fenfation, either of the wound which occafion? Class III. 1. i. 6. OF VOLITION. 0 281 occasions their death, or of faintnefs from want of due diften- tion of the blood veffels. Similar to this in a lefs degree is the fubfultus tendinum, or darting of the tendons, in fevers with de- bility ; thefe actions of the mufcles are too weak to move the limb, but the belly of the aCiing mufcles is feen to fwell, and the tendon to be ftretched. Thefe weak convulfions, as they are occafloned by the difagree'able fenfation of faintnefs from inanition, are fymptoms of great general debility, and thence frequently precede the general convulfions of the a£t of dying. See a cafe of convulfion of a mufcle of the arm, and of the fore- arm, without moving the bones to which they were attached, SeCt. XVII. i. 8. See twitchings of the face, Clafs IV. i. 3. 2. 6. Convul/io dolorifica. Raphania Painful convulfion. In this difeafe the mufcles of the arms and legs are exerted to re- lieve the pains left after the rheumatifm in young and delicate people ; it recurs once or twice a day, and has been miftaken for the chorea, or St. Vitus's dance ; but differs from it, as the un- due motions in that difeafe only occur, when the patient endeav- ours to exert the natural ones ; are not attended with pain ; and ccafe, when he lies down without trying to move : the chorea, or dance of St. Vitus, is often introduced by the itch, this by the rheumatifm. It has alfo been improperly called nervous rheumatifm ; but is diftinguifhed from rheumatifm, as the pains recur by peri- ods once or twice a day ; whereas in the chronic rheumatifm they only occur on moving the affeCied mufcles. And by the warmth of a bed the pains of the chronic rheumatifm are in- creafed, as the mufcles or membranes then become more fenfi- ble to the ftimulus of the extraneous mucaginous material de- polited under them. Whereas the pains of the raphania, or painful convulfion, commence with coldnefs of the part, or of the extremities. See Rheumatifmus chronicus. Clafs I. 1. 3. 12. The pains which accompany the contraCiions of the mufcles in this difeafe, feem to arife from the too great violence of thofe contraCtions, as happens in the cramp of the calf of the leg ; from which they differ in thofe being fixed, and thefe being re- iterated contractions. Thus thefe convulfions are generally of the lower limbs, and recur at periodical times from fome unea- fy fenfation from defeCt of aCtion, like other periodic difeafes ; and the convulfions of the limbs relieve the original uneafy pain- ful fenfation, and then produce a greater pain rrom their own too vehement contraCtions. There is however another wav of accounting for thefe pains, tvhen they fuccecd the acute rheu- matifm : and that is by the coagulable lymph, which may ba Vol. II. N n ' left 282 DISEASES Class III. 1. 1.7. (till unabforbed on the membranes ; and which may be in too fmall quantity to affedt them with pain in common mufcular exertions, but may produce great pain, when the bellies of the mufcles fwell to a larger bulk in violent adlion. M. M. Venefedtion. Calomel. Opium. Bark. One grain of calomel and one of opium for ten fucceffive nights. A ban- dage fpread with emplaftrum de minio put tight on the affedted part. 7. Epilepfia is originally induced, like other convulfions, by a voluntary exertion to relieve fome pain. This pain is molt fre- quently about the pit of the ftomach, or termination of the bile- duff ; and in fome cafes the torpor of the ftomach, which prob- ably occafioned the epileptic fits, remains afterwards, and pro- duces a chronical anorexia ; of which a cafe is related in Clafs II. 2. 2. 1. There are inftances of its beginning in the heel, of which a cafe is publifhed by Dr. Short, in the Med. Eflays. Edin. I once faw a child about ten years old, who frequently fell down in convulfions, as fhe 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 epilepfy firft commences, the patients are liable to ut- ter one fcream before they fall down ; afterwards the convul- fions fo immediately follow the pain, which occafions them, that the patient does not recoiled! or feem fenfible of the pre- ceding pain. Thus in laughter, when' it is not exceflive, a per- fon is not confcious of the pain, which fo often recurs, and cauf- es the fucceffive fcreams or exertions of laughter, which give a temporary relief to it. Epileptic fits frequently recur in fleep from the increafe of fenfibility at that time, explained in Sedt. XVIII. 14. In two fuch cafes, both of young women, one grain of opium given at night, and continued many months, had fuccefs ; in one of them the opium was omitted twice at different times, and the fit re- curred on both the nights. In the more violent cafe, defcribed in Sedt. XVIII. 15, opium had no effedt. Epileptic fits generally commence with fetting the teeth, by which means the tongue is frequently wounded ; and with roll- ing the eye-balls in every kind of diredtion ; for the mufcles which fufpend the jaw, as well as thofe which move the eyes, are in perpetual motion during our waking hours ; and yet con- tinue fubfervient to volition ; hence their more-facile and forci- ble actions for the purpofe of relieving pain by the exhauftion of fenforial power. See Sedtion XXXIV. 1. 4. Epileptic convulfions are not attended with the fear of death, as Class III. 1.1.7. OF VOLITION. 283 as in the hyfteric difeafe, and the urine is of a ftraw colour. However it muft be noted, that the difagreeable fenfations in hyfteric difeafes fometimes are the caufe of true epileptic con- vulfions, of fyncope, and of madnefs. 'Ehe pain, which occafions fome fits of epilepfy, is felt for a time in a diftant part of the fyftem, as in a toe or heel ; and is faid by the patient gradually to afcend to the head, before the general convulfions commence. This afcending fenfation has been called aura epileptica, and is faid to have been prevented from affecting the head by a tight bandage round the limb. In this malady the pain, probably of fome torpid membrane, or dif- eafed tendon, is at firft only fo great as to induce flight fpafms of the mufcular fibres in its vicinity ; which flight fpafms ceafe on the numbnefs introduced by a tight bandage ; when no band- age is applied, the pain gradually increafes, till general convul- fions are exerted to relieve it. The courfe of a lymphatic, as when poifonous matter is abforbed; or of a nerve, as in the fciatica, may, by the fympathy exifting between their extrem- ities and organs, give an idea of the afcent of an aura or va- pour. In difficult parturition it fometimes happens, that general con- vulfions are excited to relieve the pain of labour, inftead of the exertions ofthofe mufcles of the abdomen and diaphragm,which ought to forward the exclufion of the child. See Clafs III. i. i. That is, inftead of the particular mufcular actions, which ought to be excited by fenfation to remove the offending caufe, gene- ral convulfions are produced by the power of volition, which ftill the pain, as in common epilepfy, without removing the caufe ; and,as the parturition is not thus promoted, the convulfions con- tinue, till the fenforial power is totally exhaufted, that is, till death. In patients afflicted with epilepfy from other caufes, I have feen the molt violent convulfions recur frequently dur- ing pregnancy without mifcarriage ; as they did not tend to forward the exclufion of the fetus. Pains of this kind have been called falfe pains by fome writers on midwifery, and are directed to be relieved by an opiate, and then they fay the true pains will commence. M. Daventer di- rects the accoucheur to attend to the os tincae, to diftinguifh them from each other, which dilates with every true pain, but contracts with every falfe one, that isy the voluntary ahions of other mufcles to relieve pain are attended with thofe of the os uteri, as mentioned in Genus I. of this Clafs and Order prece- ding the defcription of the Species. M.M. Venefedlion. A large dofe of opium. Delivery. The later in life epileptic fits are firft experienced, the more dangerous 284 DISEASES Class III. 1. 1. 7. dangerous they may be efteemed in general; as in thefe cafes the caufr has generally been acquired by the habits of the pa- tient, or by the decay of fome part, and is thus probably in an increafing ftate. Whereas in children the change in the fyf- tem, as they advance to puberty, fometimes removes the caufe. So in toothing, fits of convulfion with ftupor frequently occur, and ceafe when the tooth advances ; but this is not to be ex- peCled in advanced life. Sir , about fixty years of age, had only three teeth left in his upper jaw, a canine tooth, and one on each fide of it. He was feized with epileptic fits, with pain commencing in thefe teeth. He was urged to have them extradied, which he delayed too long, till the fits were become habitual, and then had them extradied in vain, and in a few months funk under the difeafe. Mr. H. M. was feized with pain in the addudfor mufcle of the right thumb, and had epileptic convulfions in confequence ; thefe gradually increafed in itrength and frequency ; a bandage on the arm, drawn very tight as loon as the pain of the ball of the thumb commenced, prevented the epileptic fits, I fuppofe by lefl'ening the pain by the numbnefs occafioned by comprefling the nerve. I advifed the nerves of this mufcle to be cut, which was done or attempted, and was fuppofed for a time to have cured the difeafe, as I was informed. Afterwards it recurred and deftroyed the patient, who might have probably been faved by the lofs of a hand, which I fhould have advifed, but was not again confulted. I have to add, that the tic douloureux, or hemicrania idio- pathica, I believe to be a difeafe of this kind, owing to a torpor of the extremity of fome branch of a nerve, and fhould recom- mend, when the nerve cannot be bifefled, to pafs through it for many hours or even days, a current of galvanic electricity from Volta's pillar of zinc, and filver, and cloth moiflened with fait and water. Mr. F , who had lived intemperately, and had been oc- cafionally affedled with the gout, was fuddenly feized with epi- leptic fits ; the convulfions were fucceeded by apople&ic fnor- ing ; from which he was, in about 20 minutes, difturbed by frefh convulfions, and had continued in this fituation above four- and-twenty hours. About eight ounces of blocfd were then taken from him . and after having obferved, that the apoplectic tor- por continued about 20 minutes,! directed him to be forcibly raif- ed up in bed, after he had thus lain about fifteen minutes,togain an interval between the termination of the deep, and the reno- vation of convulfion. In this interval he was induced to fwal- low forty drops of laudanum. Twenty more were given him in Class III. 1. 1.7. OF VOLITION. 285 in the fame manner in about half an hour, both which evidently Ihortcned the convulfion fits, and the confequent ftupor ; he then took thirty more drops, which for the prtfent removed the fits. He became rather infane the next day, and after about three more days loft the infanity, and recovered his ufual ftate of health. The cafe mentioned in Se<ft. XXVII. 2. where the patient was left after epileptic fits with a luffufion of blood beneath the tunica adjundiva of the eye, was in almoft every refped fimilar to the preceding, and lubmitted to the fame treatment. Both of them fuffered frequent relapfes, which were relieved by the fame means, and at length perilhed.I believe,by the epileptic fits. In thofe patients, who have not been fubjeQ to epiiepiy be- fore they have arrived to about forty years of age, and who have been intemperate in refpecl to fpirituous potation, I have been induced to believe, that the fits were occaiioned by the pain of a difeafed liver ; and this became more probable in one of the above fubjeds, who had ufed means to repel eruptions on the face ; and thus by fome ftimulant application had pre- vented an inflammation taking place on the Ikin of the face in- ftead of on fome part of the liver. Secondly, as in thefe cafes in- fanity had repeatedly occurred, which could not be traced from an hereditary fource ; there is reafon to believe, that this as well as the epileptic convulfions were caufed by fpirituous potation ; and that this therefore is the original fource both of epilepfy and of infanity in thofe families, which are afflicted with them. This idea however brings fome confolation with it; as it may be inferred, that in a few fober generations thefe difeafes may be eradicated, which otherwife deftroy the family M. M. Venefeflion. Opium. Bark. Steel. Arfenic. Opium one grain twice a day for years together. See the preceding article, and the fucceeding one. Anorexia epileptica, as mentioned in Clafs II. 2. 2. f. is a dread- ful difeafe, originating, 1 believe, from a paralyfis of the ftom- ach, and generally occafioned by the application of great exter- nal cold to the Ikin. A young lady, whom I faw yefterday, who had long experienced a weak ftate of health, went to church on an uncommonly cold Sunday, when the thermometer was faid to ftand below 20 during the whole day. She became immedi- ately indifpofed, and was feized in a day or two with tremors and convulfions in her fleep ; and which returned every two or three days. Her extremities are now always uncommonly cold and her appetite to food totally defective. She took three drops of a faturated folution of arfenic and a bitter draught twice a day fora fortnight,and gradually recovered her former ftate of health Another 286 DISEASES Class III. 1.1.8. Another young lady, whom I lately faw, began to ftart fome- what like a violent hiccough many times in an hour, after ufing a very cold Ihower-bath repeatedly. This had continued daily at uncertain times for many months, and received temporary advantage from one drop of oil of cinnamon, three or four times a day, on powdered fugar ; this cafe belongs to convulfion rather than epilepfy, but was attended, like the former, with great defeat of appetite. In both thefe cafes I fufpedt, that the great torpor of the ftomach was caufed by too violent or too long continued coldnefs applied to the ikin ; whence the fenfo- rial power of alfociation, which ought to have been excited by the action of the cutaneous veffels,and to have then contributed to the action of the ftomach, did not exift ; and that the ftom- ach in confcquence became torpid. See Suppl. I. 14. 3. and Art. IV. 2. 6 8. and ClafsIII. 2. 1. 17. Dr. Wilfon, of Spalding, has lately much recommended the argentum nitratum in epilepfy ; he gives two grains and a half three times a day, mixed with bread crumbs into pills, as he af- ferts, with the happieft fuccefs. Annals of Medicine, 1797. 8. Epiiepfia dolorifica. Painful epilepfy. In the common epilepty the convulfions are immediately induced, as foon as the difagreeable fenfation, which caufes them, commences ; but in this the pain continues long with cold extremities, gradually in- creafing for two or three hours, till at length convulfions or mad- nefs come on ; which terminate the daily paroxyfm, and ceafe themfelves in a little time afterwards. This difeafe fometimes originates from a pain about the lower edge of the liver, fometimes in the temple, and fometimes in the pudendum ; it recurs daily for five or fix weeks, and then ceafes for feveral months. The pain is owing to defedt of action,that is, to the accumulation of fenforial power in the part, which probably fympathizes with fame other part, as explained in 8,e(T XXXV.2XII.5. 3. and Clafs II. j. 1 it. and IV. 2. 2 3. It is the moft painful malady that human nature is liable to ' - See Sedl. XXXIV. 1. 4, Mrs. C was feized every day about the fame hour with violent pain on the right fide of her bowels about the fituation of the lower edge of the liver, without fever, which increafed for an hour or two, till it became totally intolerable. After violent fcreaming fhe fell into convulfions, which terminated fometimes in fainting, with or without ftertor, as in common epilepfy ; at other times a temporary infanity fupervened ; which continued about half an hour, and the fit ceafed. Thefe paroxyfms had returned daily for two or three weeks, and were at length removed by large dofes of opium, like the fits of rev- erie Class III. 1. 1.8. OF VOLITION. 287 erie or fomnambulation. About half an hour before the ex- peCled return of the fit three or four grains of opium were ex- hibited, and then tinCture of opium was given in warm brandy and water about twenty or thirty drops every half hour, till the eyes became fomewhat inflamed, and the nofe began to itch, and by the (harp movements of the patient, or quick fpeech, an evident intoxication appeared ; and then it generally happened that the pain ceafed. But the effeCts of this large dofe of opium was fucceeded by perpetual ficknefs and efforts to vomit, with great general debility ail the fucceeding day. The rationale of this temporary cure from the exhibition of opium and vinous fpirit depends on the great expenditure of fenforial power in the incr^afed aCtions of all the irritative mo- tions, by the ftimulus of fuch large quantities of opium and vi- nous fpirit ; together with the production of much fenfation, and many movements of the organs of fenfe or ideas in confe- quence of that fenfation ; and laftly, even the motions of the arterial fyftem become accelerated by this degree of intoxica- tion, all which foon exhaufted fomuch fenforial power as to re- lieve the pain ; which would otherwife have caufed convulfions or infanity, which are other means of expending fenforial pow- er. The general debility on the fucceeding day, and the partic- ular debility of the ftomach, attended in confequence with fick- nefs and frequent efforts to vomit, were occafioned by the fyf- tem having previoufly been fo ftrongly ftimulated, and thofe parts in particular on which the opium and w'ine more imme- diately aCted. This ficknefs continued fo many hours as to break the catenation of motions, which had daily reproduced the paroxyfm ; and thus it generally happened, that the whole difeafe ceafed for fome weeks or months from one great intoxi- cation, a circumftance not eafily to be explained on any other theory. The excefs or defeCt of motion in any part of the fyftem oc- cafions the production of pain in that part, as in SeCt. XII. i. 6. This defeCt or excefs of fibrous aCtion is generally induced by excefs or defeCt of the ftimulus ofobjeCls external to the mov- ing organ. But there is another fource of exceflive fibrous ac- tion, and confequent pain, which is from excefs of volition, which is liable to afleCt thofe mufcles, that have weak antago- nifts; as thofe which fupport the under jaw, and clofe the mouth in biting, and thofe of the calf of the leg ; which are thus liable to fixed or painful contraCtions, as in trifmus, or locked jaw,and in the cramp of the calf of the leg; and perhaps in fome colics, as in that of Japan : thefe pains, from contraCtion arifing from excefs of volition in the part from the want of the counteraction of 288 DISEASES Class HE 1. 1.8. o£ antagonift mufcles, may give occafional caufe to epileptic fits, and may be relieved in the fame way, either by exciting irrita- tive and fenfitive motions by the ftimulus of opium and wine ; or by convulfionsor infanity, as defcribed above, which are only different methods of exhaufting the general quantity of fenfori- al power. Confitlering the great refemblance between this kind of pain- ful epilepfy and the colic of Japan, as defcribed by Kaempfer ; and that that difeafe was faid to be cured by acupuncture, or the prick of a needle ; I dire led fome very thin fteel needles to be made about three inches long, and of fuch 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 thefe needles, when the pain occurred, was puflied about an inch into the painful part, and the pain inftantly ceafed ; but I was not certain, whether the fear of the patient, or the ftimulus of the punhture, occafioned the ceflation of pain ; and as the paroxyfm had continued fome weeks, and was then declining, the experiment was not tried again. The difeafe is faid to be very frequent in Japan, and its feat to be in the bowels, and that the acupunCture eliminates the air, which is fuppofed to diftend the bowel. But though the aperture thus made is too fmall to admit of the eduftion of air ; yet as the ftimulus of fo fmall a punfture may either excite a torpid part into action, or caufe a fpafmodic one to ceafe to aft ; and laftly, as no injury could be likely to eufue from fo fmall a perforation, I Ihould be inclined at fome future time to give this a fairer trial in fimilar circumftances. Another thing worth trial at the commencement of this de- plorable difeafe would be eleftricity, by palling ftrong (hocks through the painful part; which, whether the pain was owing to the inaction of that part, or of fome other membrane aflbei- ated with it, might ftimulate them into exertion; or into inac- tivity, if owing to fixed painful contraction. And laftly, the cold bath, or afperfions with cold water on the affefted parr, according to the method of Dr. Currie in the Me- moirs of a Med. Soc. London, Vol. III. p 147, might produce great efteft at the commencement of the pain, bleverthdefs opium duly adminiftered, fo as to precede the expefted parox- yfm, and in fuch dofes, given by degrees, as to induce intoxica- tion, is principally to be depended upon in this deplorable mala- dy. To which (hould be added, that if venefeftion can be previ- oullv performed, even to but few ounces,the effeC| of the opium is much more certain ; and ftiil more fo, if there be time to pre- mife a brilk cathartic, or even an emetic. The effeft; of increaf- ed Class III. 1. 1.9. OF VOLITION. 289 ed ftimulusis fo much greater after a previous defeat of ftimulus; and this is Rill of greater advantage, where the caufe of the dif- eafe happens to confift in a material, which can be abforbed. See Art. IV. 2. 8. M. M. VenefeCtion. 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 ceafes, and violent vomitings and debility fucceed on the fubfe- quent day, and prevent a return. Blifters or finapifms on the fmall of the leg, taken off when they give much pain, are of ufe in {lighter convulfions. Acupuncture. Electricity. Afper- fion with cold water on the painful part. A bag of fnow or ice applied on the pained part. 9. Somnambuli/mus. Sleep-walking is a part of reverie, or ftudium inane, defcribed in Seft. XIX. In this malady the pa- tients have only the general appearance of being afleep in re- fpeCt to their inattention to the ftimulus of external objects, but, like the epilepfies above defcribed, it confifts in voluntary exer- tions to relieve pain. The mufcles are fubfervient to the will, as appears by the patient's walking about, and fometimes doing the common offices of life. The ideas of the mind alfo are obe- dient to the will, becaufe the patient's difcourfe is confiftent, though he anfwers imaginary queftions. The irritative ideas of external objeCts continue in this malady, becaufe rhe patients do not run again ft the furniture of the room ; and when they ap- ply their volition to their organs of fenfe, they become fenfible of the objedls they attend to, but not otherwise, as general fen- fation is deftroyed by the violence of their voluntary exertions. At the fame time the fenfations of pleafure in confequence of ideas excited by volition are vividly experienced, and other ideas feem to be excited by thcfe pleafurable fenfations, as appears in the cafe of Mailer A. Seel. XXXIV. 3. 1. where a hiftory of a hunting fcene was voluntarily recalled, with all the pleafurable ideas which attended it. In melancholy madnefs the patient is employed in voluntarily exciting one idea, with thofe which are connected with it by voluntary aflbciationsonly, but not fo vio- lently as to exclude the ftimuli of external obje&s. In reverie variety of ideas are occafionally excited by volition, and thofe which are connected with them either by fenfitive or voluntary afl'ociations, and that fo violently as to exclude the ftimuli of ex- ternal objeCts. Thefe two fituations of our fenfual motions, or ideas, refemble convulfion and epilepfy ; as in the former rhe ftimulus of external objeCts is ftill perceived, but not in the lat- ter. Whence this dileafe, fo far from being connected with deep, though it has by univerfal miftake acquired its name from Vol. IL O o it, DISEASES Class 111. 1.1. 10. 290 it, arifes from excefs of volition,and not from a fufpenfion of it; and though, like other kinds of epilepfy, it often attacks the pa- tients in their deep, yet thofe two, whom I faw, were more fre- quently feized with it while awake, the deep-walking being a part of the reverie. See Sedt. XIX. and XXXIV. 3. and Clafs II. 1. 7. 4. and III. 1. 2. 18. M. M. Opium in large dofes before the expelled paroxyfm. 10. AJlhma convulftvum. The fits ofconvulfive afthma return at periods, and are attended with cold extremities, and fo far refemble the accefs of an intermittent fever ; but, as the lungs are not fenfible to the pain of cold, a fhivering does not fuc- ceed, but inftead of it violent efforts of refpiration ; which have no tendency, as in the humoral afthma, to didodge any offend- ing material, but only to relieve the pain by exertion, like the ihuddering in the beginning of ague-fits, as explained Clafs III. 1. 1. 2. The infenfibility of the lungs to cold is obfervable on going into frofty air from a warm room ; the hands and face become painfully cold, but no fuch fenfation is excited in the lungs ; which is another argumentin favourof the exiftence of a peculiar fet of the nerves for the purpofe of perceiving the univerfal duid matter of heat, in which all things are immerfed. See Se£t. XIV. 6. Yet are the lungs neverthelefs very fenfible to the de- ficiency of oxygen in the atmofphere, as all people experience, when they go into a room crowded with company and candles, and complain, that it is fo clofe, they can fcarcely breathe ; and the fame in fome hot days in fummer. There are two difeafes, which bear the name of afthma. The firft is the torpor or inability of the minute vefl'els of the lungs, confiding of the terminations of the pulmonary and bronchial arteries and veins, and their attendant lymphatics ; in this cir- cumftance it refembles the difficulty of breathing, which attends cold bathing. If this continues long, a congeftion of duid in the air-cells fucceeds, as the abforbent actions ceafe completely before the fecerning ones ; as explained in Clafs I. 1. 2.3. And the coldnefs, which attends the inadlion of thefe veffels, prevents the ufual quantity of exhalation. Some fits ceafe be- fore this congeftion takes place, and in them no violent fweat- ing nor any expuition of phlegm occurs. This is the humoral afthma, defcribedin Clafs II. 1. 1 7. The fecond kind of afthma confifts in the convulfive actions in confequence of the difagreeable fenfations thus induced ; which in fome fits of afthma are very great, as appears in the violent efforts to raife the ribs, and to deprefs the diaphragm, by lifting the Ihoulders. Thefe, fo long as they contribute to remove Class III. i.'r. 10. OF VOLITION. 291 remove the caufe of the difeafe, are not properly convulfions, but exertions immediately caufed by fenfation ; but in this kind of afthma they are only efforts to relieve pain, and are frequent- ly preceded by other epileptic convulfions. Thefe two kinds of afthma have fo many refembling features, and are fo frequently intermixed, that it often requires great at- tention to diftinguifh them ; but as one of them is allied to ana- farca, and the other to epilepfy, we- (hall acquire a clearer idea of them by comparing them with thofe diforders. A criterion of the humoral or hydropic afthma is, that it is relieved by copi- ous fweats about the head and breaft, which are to be afcribed to the fenfitive exertions of the pulmonary veffels to relieve the pain occafioned by the anafarcous congeftion in the air-cells ; and which is effected by the increafed abforption of the mucus, and its elimination by the retrograde adlion of thofe lymphatits of the fkin, the branches of which communicate with the pul- monary ones ; and which partial fweats do not eafily admit of any other explanation. .See Clafs I. 3. 2 8. Another criterion of it is, that it is generally attended with fwelled legs, or other fymptoms of anafarca. A criterion of the convulfive afthma may be had from the abfence of thefe cold clammy fweats of the upper part of the body only, and from the patient having occa- fionally been fubjedl to convulfions of the limbs, as in the com- mon epilepfy. It may thus frequently happen, that in the humoral afthma fome exertions of the lungs may occur, which may not contrib- ute to difcharge tire anafarcous lymph, but may be efforts (imply to relieve pain ; frefides thofe efforts, which produce the increa- ed abforption and elimination of it ; and thus we have a bodily difeafe refembling in this circumftance the reverie, in which both fenfitive and voluntary motions are at the fame time, or in fucceflion, excited for the purpofe of relieving pain. It may likewife fometimes happen, that the difagreeable fen- fation, occafioned by the congeftion of lymph in the air cells in the humoral or hydropic afthma, may induce voluntary convul- fions of the refpiratory organs only to relieve the pain, without any fenfitive actions of the pulmonary abforbents to abforb and eliminate the congeftion of ferous fluid ; and thus the fame caufe may occafionally induce either the humoral or convulfive afthma. The humoral afthma has but one remote caufe, which is the torpor of the pulmonary veffels, like that which occurs on going into the cold bath ; or the want of abforption of the pulmonary lymphatics to take up the lymph effufed into the air-cells. Whereas the convulfive afthma, like other convulfions, or epi- lepfies, DISEASES Class III. i.'i. 16, 292 lepfies, may be occafioned by pain in almoft any remote part of the fyftem. But in fome of the adult patients in this difeafe, as in many epilepfies, I have fufpefted the remote caufe to be a pain of the liver, or of the biliary ducts. The afthmas, which have been induced in confequence of the recefs of eruptions, efpecially of the leprous kind, countenance this opinion. One lady I knew, who for many years laboured under an afthma, which ceafed on her being afflicted with pain, fwelling, and diftortion of fome of her large joints, which were efteemed gouty, but perhaps erroneoufly. And a young man, whom I faw yefterday, was feized with afthma on the retrocef- fion, or ceafing of eruptions on his face. The convulfive afthma, as well as the hydropic, is more lia- ble to return in hot weather ; which may be occafioned by the lefs quantity of oxygen exifting in a given quantity of warm air, than of cold, which can be taken into the lungs at one infpira- tion. They are both moft liable to occur after the firft fleep, which is therefore a general criterion of afthma. The caufe of this is explained in Se£b XVIII. 15. and applies to both of them, as our fenfibility to internal uneafy fenfation increafes during fleep. When children are gaining teeth, long before they appear, the pain of the gums often induces convulfions. This pain is relieved in fome by fobbing and fcreaming ; but in others a la- borious refpiration is exerted to relieve the pain ; and this con- ftitutes the true afthma convulfivum. In other children again general convulfions, or epileptic paroxyfms, are induced for this purpofe ; which, like other epilepfies, become eftablifhed by habit, and recur before the irritation has time to produce the painful fenfation, which originally caufed them. The afthma convulfivum is alfo fometimes induced by worms, or by acidity in the ftomachs of children, and by other painful fenfations in adults ; in whom it is generally called nervous afthma, and is often joined with other epileptic fymptoms. This afthma is diftinguifhed from the peripneumony, and from the croup, by the prefence of fever in the two latter. It is diftinguilhed from the humoral afthma, as in that the patients are more liable to run to the cold air for relief, are more fubjeft to cold extremities, and experience the returns of it more fre- quently after their firft fleep. It is diftinguilhed from the hy- drops thoracis, as that has no intervals, and the patient fits con- ftantly upright, and the breath is colder ; and, where the peri- cardium is affefted, the pulfe is quick and unequal. See Hy- drops Thoracis, I. 2. 3.14. M. M. Venefetfiononce. A cathartic with calomel once. Opium. Class III. 1.1.11. OF VOLITION. 293 Opium. Afafoetida. Warm bath. If the caufe can be detect- ed, as in toothing or worms, it fhould be removed. As this fpecies of afthma is fo liable to recur during deep, like epileptic fits, as mentioned in SeCtion XVIII. 15. there wasreafon to be- lieve, that the refpiration of an atmofphere mixed with hydro- gen, or any other innocuous air, which might dilute the oxygen, would be ufeful in preventing the paroxyfms by decreafing the fenfibility of the fyftem. This, I am informed by Dr. Beddoes, has been ufed with decided fuccefs by Dr. Ferriar. See Clafs II. 1. 1. 7. 11. Aftbma dolorificum. Angina pedoris. The painful afthma was firft defcribed by Dr. Heberden in the TranfaCtions of the College ; its principal fymptoms confift in a pain about the middle of the fternum, or rather lower, on every increafe of pulmonary'or mufcular exertion, as in walking fafter than ufual, or going quick up a hill, or even up ftairs ; with great difficul- ty of breathing, fo as to occafion the patient inftantly to ftop. A pain in the arms about the infertion of the tendon of the pec- toral mufcle generally attends, and a defire of refting by hang- ing on a door or branch of a tree by the arms is fometimes ob- ferved. Which is explained in Clafs I. 2. 3. 14. and in Sect. XXIX. 5.2. Thefe patients generally die fuddenly ; and on examining the thorax no certain caufe, or feat, of the difeafe has been detect- ed ; fome have fuppofed the valves of the arteries, or of the heart, were imperfeCt ; and others that the accumulation of fat about this vifcus or the lungs obftruCted their due aCtion ; but other obfervations do not accord with thefe fuppofitions. Mr. W , an elderly gentleman, was feized with afthma during the hot part of laft fummer ; he always waked from his firft deep with difficult refpiration, and pain in the middle of his fternum, and after about an hour was enabled to deep again. As this had returned for about a fortnight, it appeared to me to be an afthma complicated with the difeafe, which Dr.Herberden has called angina peCtoris. It was treated by venefeCtion, a ca- thartic, and then by a grain of opium given at going to bed,with ether and tinCture of opium when the pain or afthma recurred, and laftly with the bark, but was feveral days before it was per- fectly fubdued. This led me to conceive, that in this painful afthma the dia- phragm, as well as the other mufcles of refpiration, was thrown into convulfive aCtion, and that the fibres of this mufcle not hav- ing proper antagonifts, a painful fixed fpafm of it, like that of the mufcles in the calf of the leg in the cramp, might be the caufe of death in the angina pedoris, which I have thence ar- ranged DISEASES 294 Class III. r. r. 11. ranged under the name of painful afthma, and leave for further inveftigation. From the hiftory of the cafe of the late much lamented John Hunter, and from the appearances after death, the cafe feems to have been of this kind, complicated with vertigo and confequent affection of the ftomach. The remote caufe feems to have arifen from edifications of the coronary arteries ; and the immediate caufe of his death from fixed fpafm of the heart. Other hifto- ries and difleftions are ftill required to put this matter out of doubt; as it is poflible, that either a fixed fpafm of the dia- phragm, or of the heart, which are both furnifhed with but weak antagonifts, may occafion hidden death ; and thefe may conftitute two diftinft difeafes. 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 ufe, as I believe, of iflues on the infide of each thigh ; which were at firft large enough to contain two peas each, and afterwards but one. They took befides tome flight antimonial medicine for a while, and were reduced to half the quantity or ftrength of their ufual potation of fermented liquor. The ufe of femoral iflues in angina pectoris was firft recom- mended by Dr. Macbride, phyfician at Dublin, Med. Obferv. and Enquir. Vol. VI And I was further induced to make trial of them, not only becaufe the means which 1 had before ufed were inadequate, but from the ill effect I once obferved upon the lungs, which fucceeded the cure of afmall fore beneath the knee ; and argued converfely, that iflues in the lower limbs might affift adifficub refpiration. Mrs. L , about fifty, had a fmall fore place, about the fize of half a pea on the infide of the leg a little below the knee. It had difcharged a pellucid fluid, which fhe called a ley-water, daily for fourteen years, with a great deal of pain ; on which account fhe applied to a furgeon, who, by means of bandage and a faturnine application, foon healed the fore, unheedful of the confequences. In lefs than two months after this I faw her with great difficulty of breathing, which with univerfal anafarca foon deftroyed her. The theory of the double effedl of iflues, as above related, one in relieving by their prefence the afthma dolorificum, and the other in producing by its cure an anafarca of the lungs, is not eafy to explain. Some fimilar effects from cutaneous erup- tions and from blifters are mentioned in Clafs I i. 2. 9. In thefe cafes it feems probable, that the pain occafioned by iflues, and perhaps the abforption of a fmall quantity of aerated puru- lent OF VOLITION. Class III. 1. 1. 12. 295 lent matter, ftimulate the whole fyftem into greater energy of action, and thus prevent the torpor which is the beginning of fo many difeafes. In confirmation of this effedt of pain on the fyftem, I remember the cafe of a lady of an ingenious and ac- tive mind, who, for many of the latter years of her life, was perpetually fubjedt to great pains of her head from decaying teeth. When all her teeth were gone, (he became quite low fpirited, and melancholy in the popular fenfe of that word, and after a year or two became univerfally dropfical and died. M. M. Iffues in the thighs. Five grains of rhubarb, and one fixth of a grain of emetic tartar every night for fome months, with or without half a grain of opium. No ftronger liquor than fmall beer or wine diluted with twice its quantity of water. Since I wrote the above I have feen two cafes of hydrops tho- racis attended with pain in the left arm, fo as to be miftaken for afthma dolorificum, in which femoral iffues, though applied early in the difeafe, 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 Ikin to relieve the pain of cold. The teeth and fkin being more fenfible to cold than the more internal parts, and more expofed to it, is the reafon that the mufcles which ferve them, are thrown into exertion from the pain of cold rather than thofe of refpiration, as in fcreaming from more acute pain. Thus the poet, Put but your toes into cold water, Your correfpondent teeth will clatter. Prior. In more acute pains the jaws are gnafhed together with great vehemence, infomuch that fometimes the teeth are faid to have been broken by the force. See Sect. XXXIV. i. 3. In thefe cafes fomething fhould be offered to the patient to bite, as a towel, otherwife they are liable to tear their own arms, or to bite their attendants, as I have witneffed in the painful epi- lepfy 13. Tetanus trifmus. Cramp. The tetanus confifts of a fix- ed fpafm of almoft all the mufcles of the body ; but the trifmus, or locked jaw, is the moft frequent difeafe of this kind. It is generally believed to arife from fympathy with an injured ten- don. In one cafe where it occurred in confequence of a broken ancle from a fall from a horfe, it was preceded by evident hy- drophobia. Amputation was advifed but not fubmitted to ; two wounds were laid into one with feiffors, but the patient di- ed about the feventh day from the accident. In this cafe the wounded 296 DISEASES Class III. 1. 1. 14. wounded tendon, like the wounds from the bite of a mad dog, did not produce the hoydrophobia, and then the locked jaw, till feveral days after the accident. I twice witnefl'ed the locked jaw from a pain beneath the fternum, about the part where it is complained of in painful afthma, or angina pectoris, in. the fame lady at fome years dif- tance of time. The laft time had continued two days, and the wrote her mind or exprefled herfelf by figns. On obferv- ing a broken tooth, which made a fmall aperture into her mouth, I roiled up five grains of opium like a worm about an inch long, and introducing it over the broken tooth, pufhed it onward by means of a fmall crow-quill ; as it diflblved I obferved (he fwal- lowed her faliva, and in lefs than half an hour Ihe opened her mouth and converfed as ufual. Men are taught to be afhamed of fcreaming from pain in their early years ; hence they are prone to exert the mufcles of the jaws inftead, which they have learnt to exert frequently and violently from their infancy ; whence the locked jaw. This and the following fpafm have no alternative relaxations, like the preceding ones ; which is perhaps owing, firft, to the weaknefs of their antagonift mufcles, thofe which elevate the jaw being very ftrong for the purpofe of biting and mafticating hard fub- ftances, and for fupporting the under jaw, with very weak an- tagonift mufcles ; and fecondly, to their not giving fuflicient re- lief even for a moment to the pain, or its preceding irritation, which excited them. M. M. Opium in very large quantities. Mercurial oint- ment ufed extenfively. Electricity Cold bath. Dilate the wound, and fill it with lint moiftened with fpirit of turpen- tine ; which inflames the wound, and cures or prevents the con- vulfions. See a cafe, Tranfaft. of American Society, Vol. II. P- 227* Wine in large quantities in one cafe was more fuccefsful than opium ; it probably inflames more, which in this difeafe is defirable. Between two or three ounces of bark, and from a quart or three pints of wine a day, fucceeded better than opi- um. Ib. 14. Tetanus dolorijicus. Painful cramp. This kind of fpafm moft frequently attacks the calf of the leg, or mufcles of the toes j it often precedes paroxyfms of gout, and appears towards the end of violent diarrhoea, and from indigeftion, or from acid diet. In thefe cafes it feems to fympathize with the bowels, but is alfo frequently produced by the pain of external cold, and by the too great previous extenfion of the mufcles, whence fome people get the cramp in the extenfor mufcles of the toes after walking Class III. 1.1.15. OF VOLITION. 297 walking down hill, and of thofe of the calf of the leg after walk- ing up a fteep eminence. For the reafon why thefe cramps commence in deep, fee SeCt. XVIII. 15. The mufcle in this difeafe contracts itfelf to relieve fome fmaller pain, either from irritation or aflbciation, and then falls into great pain itfelf. from the too great a dion of its own fibres. Hence any mufcle, by being too vehemently exerted, falls into cramp, as in fwimming too forcibly in water, which is painfully cold ; and a fecondary pain is then induced by the too violent contraCiion of the mufcle ; thou th the pain, which was the caufe of the contraction, ceafes W tich accounts for the con- tinuance of the contraCiion, and dillinguifhes this difeafe from other convulfions, which are relaxed and exerted alternately. Hence whatever may be the caufe of the primary pain, which occafions the cramp of the calf of the leg, the fecondary one is relievable by (landing up, and thus by the weight of the body on the toes forcibly extending the contracted mufcles. For the caufe which induces thefe mufcles of the calf of the leg to fail into more violent contraCiion than other fpafmodic mufcles, proceeds from the weaknefs of their antagonift mufcles ; as they are generally extended again after aCtion by the weight of the body on the balls of the toes. See rhe preceding article. M. M. Rub the legs with camphor diflblvedin oil, and let the patient wear flockings in bed. If a foot-board be put at the bed's feet, and the bed be fo inclined, that he will reft a little with his toes againft the foot-board that preffure is faid to prevent the undue contraCtions of the mufculi gaftrocnemii, which conftitute the calf of the leg. In gouty patients, or where the bowels are affeCled with acidity, half a grain of opi- um, and fix grains of rhubarb, and fix of chalk, every night. Flefh-meat for fupper. A little very weak warm fpirit and water may be taken for prefent relief, when thefe cramps are very troublefome to weak or gouty patients. 15. Hydrophobia. Dread of water generally attending ea- nine madnefs. I was witnefs to a cafe, where this difeafe pre- ceded the locked jaw from a wound in the ancle, occafioned by a fall from a horfe ; as mentioned in the preceding article. It came on about the fixth day after the accident ; when the pa- tient attempted to fwallow fluids, he became convulfed <ill over from the pain of the attempt, and fpurted them out of his mouth with violence. It is alfo faid to happen in fome hyfterical cafes. Hence it feems rather the immediate confequence of a pained tendon, than of a contagious poifon. And is fo far anal- ogous to tetanus, according with the opinions of Dr. Rufh and Dr Percival. Vnr It P n Tn 298 DISEASES Class III. 1. l. 15. In other refpedls, as it is produced by the faliva of an enrag- ed animal inftilled into a wound, it would feem analogous to the poifon of venomous animals. And from the manner of its ac- cefsfolong after the bite, and of its termination in a fhort time, it would feem to refemble the progrefs of contagious fevers. See 8e<St. 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 prob- able it might cure it ; as I fufpect the caufe flill remains in the wounded tendon, and not in a diffufed infection tainting the blood. Hence there are generally uneafy fenfations, as cold or numbnefs, in the old cicatrix, before the hydrophobia commenc- es. See a cafe in Medical Communications, Vol. II. p. 190. If the difeafed tendon could be inflamed without cutting it out, as by cupping, or cauftic, or blifter after cupping, and this in the old wound long fince healed, after the hydrophobia com- mences, it might prevent the fpafms about the throat. As in- flaming the teeth by the ufeof mercury is of ufe in fome kinds of hemicrania. Put fpirit of turpentine on the wound, wafh it well. See Clafs I. 3. 1. 11. IV. 1. 2. 7. M. M. Wine, malk, oil, internally. Opium, mercurial oint- ment, ufed extenfively. Mercurial fumigation. Turpeth min- eral. To falivate the patient as foon as polhble. Exfecftion or a cauftic on the fear, even after the appearance of hydrophobia. Put a tight bandage on the limb above the fear of the old wound to benumb the pained tendon, however long the wound may have been healed. Could a hollow catheter of elaftic gum, ca- outchouc, be introduced into the cefophagus by the mouth or noftril, and liquid nourifhment be thus conveyed into the ftom- ach ? See Default's Journal, Cafe I. where in an ulcer of the mouth, fuch a catheter was introduced by the noftril, and kept in the cefophagus for a month, by which means the patient was nourilhed and preferved. It is recommended by Dr. Bardfley to give oil internally by a fimilar method contrived by Mr. John Hunter. He covered a probang with the fkin of a fmall eel, or the gut of a lamb or cat. It was tried up at one end above and below the fponge, and a flit made above the upper ligature ; to the other end of the eel fkin or gut was fixed a bladder and pipe. The probang thus cover- ed was introduced into the ftomach, and the liquid food or med- icine was put into the bladder and fqueezed down through the eel-fkin. Mem. of Society at Manchefter. See Clafs I. 2. 3- 25. Dr. Bardfley has endeavoured to prove, that dogs never ex- perience the hydrophobia, or canine madnefs, without having been previoufly bitten or infedled ; and fecondly, that the dif- eafe Class III. 1. 1.15. OF VOLITION. 299 eafe in this fpecies of animal always (hews itfelf in five or fix 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 (hutting them up for a certain number of weeks. Though the difeafe from the bite of the mad dog is perhaps more analogous to thofe from the wounds inflict- ed by venomous animals than to thofe from other contagious matter, yet thefe obfervations are well worthy further atten- tion ; which the author promifes. In Dr. Hamilton's elaborate treatife on hydrophobia, Long- man, London, it is propofed to try the effect of arfenic in this difeafe, which is faid to be the principal ingredient of theTan- jore pill, which is faid to cure thofe who are difeafed by the bite of ferpents, and to cure the hydrophobia. A folution of fublimate of mercury in rectified fpirits is alfo worthy a trial, as mentioned in ClafsI. 3. 1. 11. ORDO 300 DISEASES Class III. i. 2. ORDO I. Increafed Volition. GENUS II. IVit h increafed Actions of the Organs of Senje. In every fpecies of madnefs there is a peculiar idea either of defire or averfion, which is perpetually excited in the mind with all its connections. In fome conftitutions this is connected with pleafurable ideas without the exertion of m^ch mufcular aCtion, in others it produces violent mufcular aCtion to gain or avoid the objeCt of it, in others it is attended with defpair and inac- tion. Mania is the general word for the two former of thefe, and melancholia for the latter ; but the fpecies of them are as numerous as the defires and averfions of mankind. In the prefent age the pleafurable infanities are moft fre- quently induced by fuperftitious hopes of Heaven, by fentimen- tal love, and by perfonal vanity. The furious infanities by pride, anger, revenge, fufpicion. And the melancholy ones by fear of proverty, fear of death, and fear of hell ; with innumer- able others. Quicquid argunt homines, votum, timor, ira, voluptas, Gaudia, dilcurfas, noftri eft farrago libelli. Juvew. I. 85. This idea, however, which induces madnefs or melancholy, is generally untrue ; that is, the objeCt is a miftaken fad. As when a patient is perfuaded he has the itch, or venereal difeafe, of which he has no fymptom, and becomes mad from the pain this idea occafions. So that the objeCt of madnefs is generally a delirious idea, and thence cannot be conquered by reafon ; be- caufe it continues to be excited by painful fenfation, which is a flronger ftimulus than volition. Moft frequently pain of body is the caufe of convulfion, which is often however exchanged for madnefs ; and a painful delirious idea is moft frequently the caufe of madnefs originally, but fometimes of convulfion. Thus I have feen a young lady become convulfed from a fright, and die in a few days ; and a temporary madnefs frequently terminates the paroxyfms of the epilepfia dolorifica, and an in- fanity of greater permanence is frequently induced by the pains or bruifes of parturition. Where the patient is debilitated a quick pulfe fometimes at- tends Class III. 1. 2. OF VOLITION. 301 tends infane people, which is neverthelefs generally only a fymp- tom of the debility owing to the too great expenditure of fenfo- rial power ; or of the paucity of its production, as in irritative, or infenfitive inirritated fever. See Clafs III. i. i. But neverthelefs where the quick pulfe is permanent, it fhews the prefence of fever; and as the madnefs then generally arifes from the difagreeable fenfations attending the fever, it is fo far a good fymptom ; becaufe when the fever is cured, or ceafes fpontaneoufly, the infanity moft frequently vanifhes at the fame time. The ftimulus of fo much volition fupports infane people un- der variety of hardfhips, and contributes to the cure of difeafes from debility, as fometimes occurs towards the end of fevers. See SeCt. XXXIV. 2. 5. And, on the fame account, they bear large dofes of medicines to procure any operation on them ; as emetics, and cathartics, which, before they produce their effect in inverting the motions of the ftomach in vomiting, or of the abforbentsof the bowels in purging, muft firft weaken the nat- ural aCtions of thofe organs, as fhewn in SeCl XXXV. 1. 13. From thefe confiderations it appears, that the indications of cure muft confift in removing the caufe of the pain, whether it arifes from a delirious idea, or from a real faCt, or from bodily difeafe ; or fecondly, if this cannot be done, by relieving the pain in confequence of fuch idea or difeafe. The firft is fome- times effeCted by prefenting frequently in a day contrary ideas to fhew the fallacy, or the too great eftimation, of the painful ideas- 2dly. By change of place, and thus prefenting the fiim- ulus of new objects, as a long journey 3dly. By producing forgetfulnefs of the idea or objeCt, which caufes their pain ; by removing all things which recal it to their minds ; and avoiding all converfation on fimilar fubjeCts. For I fuppole no difeafe of the mind is fo perfectly cured by other means as by forget- fulnefs. Secondly, the pain in confequence of the ideas or bodily dif- eafes above defcribed is to be removed, firft, by evacuations, as venefeCiion, emetics, and cathartics ; and then by large dofes of opium, or by the vertigo occafioned by a circulating fwing,or by a fea-voyage, which, as they affect the organs of fenfe as well as evacuate the ftomach, may contribute to anfwer both indica- tions of cure. Where maniacs are outrageous, there can be no doubt but co- ercion is neceffary ; which may be done by means of a ftrait waiftcoat; which difarms them without hurting them ; and by tying a handkerchief round their ankles to prevent their efcape. In others there can be no doubt, but that confinement retards rather DISEASES Class III. 1. 2, 302 rather than promotes their cure ; which is forwarded by change of ideas in confequence of change of place and objects, as bv travelling or failing. The circumftances which render confinement neceflary, arc firft, if the lunatic is liable to injure others, which mu ft be judg- ed of by the outrage he has already committed. 2dly. If he is likely to injure himfelf; this alfo mutt be judged of by the def- pondency of his mind, if fuchexifts. gdiy If he cannot take care of his affairs. Where none of thefe circumftances exift, there fhould be no confinement. For though the miftaken idea continuesto exift, yet if no actions areproduced in confequence of it, the patient cannot be called infane. He can only be term- ed delirious. If every one, who poffeffes miftaken ideas, or who puts falfe eftimates on things, was liable to confinement, I know not who of my readers might not tremble at the fight of a mad- houfe I The moft convenient diftribution of infinities will be into general, as mania mutabilis, ftudium inane, and vigilia ; and into partial infanities. Thefe laft again may be fubdivided into defires and averfions, many of which are fucceeded by pleafura- ble or painful ideas, by fury or dejection, according to the de- gree or violence of their exertions. Hence the analogy between the infanities of the mind, and the convulfions of the mufcles defcribed in the preceding genus, is curiouf.y exadl. The con- vulfions without ftupor, are either juft fufficient to obliterate the pain, which occafions them ; or are fucceeded by greater pain, as in the convulfio dolorifica. So the exertions of the mania mutabilis are either juft fufficient to allay the pain which occa- fions them, and the patient , dwells comparatively in a quiet ftate ; or thofe exertions excite painful ideas, which are fucceed- ed by furious difcourfes, or outrageous actions; The ftudium inane, or reverie, refembles epilepfy, in which there is no fenfi- bility to the ftimuli of external objects. Vigilia, or watchful- nefs, may-be compared to the general writhing of the body ; which is juft a fufficient exertion to relieve the pain which occa- fions it. Erotomania may be compared to trifmus, or other muf- cular fixed fpafm, without much fubfequent pain ; and moeror to cramp of the mufcles of the leg, or other fixed fpafm with fubfequent pain. All thefe coincidences contribute to (hew, as explained in Seft. III. 5, that our ideas are motions of the im- mediate organs of fenfe obeying the fame laws as our mufcular motions. The violence of aftion accompanying infanity depends much on the education of the perfon ; thofe who have been proudly educated with unreftrained paffions, are liable to greater fury ; and Class III. 1. 2. OF VOLITION. 303 and thofe, whofe education has been humble, to greater defpon- dency. Where the delirious idea, above defcribed, produces pleafurable fenfations, as in perfonal vanity or religious enthufi- afm; it is almoft a pity to fnatch them from their fool's para- dife, and reduce them again to the common lot of humanity ; left they fhould complain of their cure, like the patient defcrib- ed in Horace, -- Pol ! me occidiftis, amici, Non fervaftis, ait, cui fie extorta voluptas, Et demptus per vim mentis gratiffimus error ! As infanities arife from excefs of action of the fenforial pow- er of volition, this excefs of action may be owing either to the increafe of motive or ftimulus, or to an increafed quantity or accumulation of that fenforial power. And hence, though the greateft number of infanities originate from increafed motive to voluntary action, as to avoid pain or to acquire pieafure ; yet there appear to be fome, which have for their caufe an accumu- lation of the fenforial power of volition. Thus thofe, who have been accuftomed to perpetual exer- tions of volition in carrying on fome extenfive employment or profeffion during the firft half of their lives, are liable to be- come melancholy, and even to deftroy themfelves, if they fud- denly leave off their very active and anxious exertions, and re- tire to a fituation without employment, of which many inftances have occurred. This feems to originate from the pain occafion- ed by the accumulation of the fenforial power of volition, which now ceafes to be expended for want of motive. The tsedium vit?e defcribed in No X. of this genus of difeafes affedls indo- lent people, who poflefs accumulated fenforial power, but want motive to excite it into fuch actions of the mufcles or ideas, as might in part expend it. The accumulation of fenforial power from the defedl of ac- cuftomed actions feems to give rife to fome inordinate mufcular motions, as the inceflant jumping of a fquirrel confined in a cage, and fome of the motionsof children confined too long in fchools, which are called tricks. See Clafs III. I. i. I. and IV. i. 3. 2. And I am inclined to think,that thefe infanities,which are term- ed melancholy, where no previous misfortune has occurred,as in grief or difappointed love, but where the patient fits perpetually brooding over fome painful idea, which was not previoufly ex- cited by any external event, as in the tiedium vitse, are in gener- al occafioned by accumulations of fenforial power ; and the vio- lent infanities to increafe of motive ; that is, to thofe pains or want of pieafure, which excite averfion or defire. There 304 DISEASES Class III. r. 2. There is finally reafon to believe, that not only fenforial power in general is capable of accumulation in thofe parts which have been accullomed to almoft perpetual adlion ; but alfo that each kind or fpecies of fenforial power, as that of irritation, fenfation, volition, and aflbciation, is feparately capable of accu- mulation in the parts which have almolt perpetually been actu- ated by it ; which I hope fometime to confider more at large, as I fufpeCt it may fupply a key to many of the phenomena not only of infanities and convulfions, but to thofe of fever. The difpofition to infinity, as well as to convulfion, is believ- ed to be hereditary ; and in confequence to be induced in thofe families from fighter caufes than in others. Convulfions have been fhewn to have been moft frequently induced by pains ow- ing to defeCt of llimulus, as the thuddering from cold, and not from pains from excefs of llimulus, which are generally fucceed- ed by inflammation. But infanities are on the contrary gener- ally induced by pains from excefs of llimulus, as from the too violent actions of our ideas, as in common anger, which is an infinity of Ihort duration ; for infanities generally, though not always, arife from pains of the organs.of fenfe ; but convulfions generally, though not always, from pains of the membranes or glands. And it has been previoully explained, that though the membranes and glands, as the ftomach and fkin, receive great pain from want of llimulus; yet that the organs of fenfe, as the eye and ear, receive no pain from defeCt of llimulus. Hence it follows, that the conflitutions moil liable to convul- fipn, are thofe which moll readily become torpid in fome part of the fyflem, that is which poll! fs lefs irritability ; and that thofe moll liable to infanity, are Inch as have excefs of fenfibil- ity ; and laltly, that thefe two circumftances generally exilt in the fame conliitution : as explained in Setl XXXI 2. on Tem- peraments Thefe obfervations explain why epilepfy and in- fanity frequently ficceecf or reciprocate with each other, and why inirritable habits, as fcrofulous ones, are liable to infanity, of which I have known fome inllances. In many cafes however there is no appearance of the difpofi- tion to epilepfy or infanity of rhe parent being tranfmitted to the progeny. Firfl, where the infanity has arifen from fome violent difappointment, and not from intemperance in the ufe of fpirituous liquors. Secondly, where the parent has acquired the infanity or epilepfy by habits of intoxication after the pro- creation of his children. Which habits I fuppofe to be the gen- eral caufe of the difpofition to infanity in this country. See Clafs III i. i. 7 As the difpofition to gout, dropfy, epilepfy, and infanity, ap- pears Class III. 1.2.1. OF VOLITION. 305 pears to be produced by the intemperate uie of fpirituous po- tation, and is in all of them hereditary ; it feems probable, that this difpofition gradually increafes from generation to generation in thofe families which continue for many generations to be in- temperate in this refpeCt; till at length thefe difeafes are produc- ed ; that is, the irritability of the fyftem gradually is decreafed by this powerful ftimulus, and the fenlibility at the fame time increafed, as explained in Set. XXXI. I. and 2. This difpofi- tion is communicated to the progeny, and becomes (till increaf- ed, if the fame ftimulus be continued, and fo on by a third and fourth generation ; which accounts for the appearance of epilep- fy in the children of fome families, where it was never known before to have exifted, and could not be afcribed to their own intemperance. A parity of reafoning fhews, that a few fober generations may gradually in the fame manner reftore a due de- gree of irritability to the family, and decreafe the excefs of fenfi- bility. From hence it would appear probable, that fcrofula and drop- fy are difeafes from inirritability ; but that in epilepfy and infan- ity an excefs of fenfibility is added, and the two faulty temper- aments are thus conjoined. SPECIES. I. Mania mutabilis. Mutable madnefs. Where the patients are liable to miftake ideas of fenfation for thofe from irritation, that is,imaginations for realities, if cured of one fource ofinfan- ity, they are liable in a few months to find another fource in. fome new miftaken or imaginary idea, and to a<St from this new idea. The idea belongs to delirium, when it is an imaginary or miftaken one ; but it is the voluntary actions exerted in confe- quence of this miftaken idea, which conftitute infanitv. In this difeafe the patient is liable carefully to conceal the object of his defire or averfion But a conftant inordinate fuf- picion of all people, and a careleflhefs of cleanlinefs, and of de- cency, are generally concomitants of madnefs. Their defigns cannot be counteracted, till you can inveftigate the delirious idea or objeCt of their infanity ; but as they are generally timid, they are therefore lefs to be dreaded. Z. Z. called a young girl, one of his maid-fervants, into the parlour, and, with cocked piftols in his hands, ordered her to ftrip herfelf naked ; he then infpeCted her with fome attention, and difmifled her untouched. Then he (tripped two of his male fervants in the fame manner, to the great terror of the neighbourhood. After he was fecured, with much difficulty he Vol. II. was 306 DISEASES Class III. 1. 2. 1. was perfuaded to tell me, that he had got the itch, and had ex- amined fome of his fervants to find out from whom he had re- ceived it; though at the fame time there was not a fpot to be feen on his hands, or other parts. The outrages in confequence of this falfe idea were in fome meafure to be afcribed to the pride occafioned by unreftrained education, affluent wealth,and dignified family. Madnefs is fometimes produced by bodily pain, particularly I believe of a difeafed liver, like convulfion and epilepfy ; at other times it is caufed by very painful ideas occafioned by ex- ternal circumftances, as of grief, or difappointment; but the molt frequent caufe of infanity arifes from the pain of fome imaginary or miftaken idea ; which may be termed hallucinatio maniacalis. This hallucination of one of the fenfes is often produced in an inftant, and generally becomes gradually weak- ened in procefs of time, by the perpetual ftimulus of external objects, or by the fucceflions or other catenations of ideas, or by the operations of medicines ; and when the maniacal hallucina- tion ceafes, or is forgotten, the violent exertions ceafe, which were in confequence of it, and the difeafe 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 fwallowed part of the feal of a letter, which he had juft then received ; one of his companions feeing him alarmed, cried cut in humour," It will feal your bowels up." He became melancholy from that inftant, and in a day or two refufed to fwaliow any kind of nourilhment. On being prefled to give a reafon for this refufal,he anfwered he knew nothing would pafs through him. A cathartic was given, which produced a great many evacuations, but he fttll perfifted, that nothing pair- ed through him ; and though he was frightened into taking a little broth once or twice by threats, yet he foon ceafed intirely to fwaliow any thing,and died in confequenceof this infane idea. Mifs , a fenfible and ingenious lady, about thirty, faid flie had feen an angel; who told her, that fhe need not eat, though all others were under the necefflty of fupporting their earthly exiftence by food. After fruitlefs perfuafions to take food, Ihe ftarved herfelf to death -It was propofed to fend an angel of a higher order to tell her, that now fihe muft 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 (he heard a voice fay to her one day, as Ihe was at her toilet, " Repent, or you will be damned." From that moment Ihe became melancholy, and this hallucination affefled her Class III. 1. 2. 1. OF VOLITION. 307 her in greater or lefs degree for about two years ; fhe then re- covered perfectly, and is now a cheerful old woman. Mrs. , a farmer's wife, going up ftairs to drefs, found the curtains of her bed drawn, and on undrawing them, fhe be- lieved that fhe faw the corpfe of her fitter, who was then ill at the diftance of twenty miles, and became from that time infane ; and as her filter died about that time, fhe could not be produc- ed to counteract the infane hallucination, but fhe perfectly re- covered in a few months. Mrs. - , a molt elegant, beautiful, and accomplifhed la- dy, about twenty-two years of age, had been married about two months to an elegant, polifhed, and affluent young man, and it •was well known to be a love-match on both fides. She fudden- ly became melancholy, and yet not to fo great a degree, but that fhe could command herfelf to do the honours of her table with grace and apparent eafe. After many days intreaty, fhe at length told me, that fhe thought her marrying her hufband had made him unhappy ; and that this idea fhe could not efface from her mind day or night. I withflood her being confined, as fome had advifed, and propofed a fea-voyage to her, with ex- pectation that the ficknefs as well as change of objects, might remove the infane hallucination by introducing other energetic ideas ; this was not complied with, but fhe travelled about Eng- land with her friends and her hufband for many months, and at length perfectly recovered, and is now I am informed in health and fpirits. Theie cafes are related to fhew the utility of endeavouring to inveltigate the maniacal idea, or hallucination j as it may not only acquaint us with the probable defigns of the patient, from whence may be deduced the neceffity of confinement ; but alfo may fome time lead to the moft effectual plan of cure. 1 received good information of the truth of the following cafe, which was publilhed a few years ago in the newfpapers. A young farmer in Warwickshire, finding his hedges broke, and the iticks carried away during a frofty feafon, determined to watch for the thief. He lay many cold hours under a hay- flack, and at length an old woman, like a witch in a play, ap- proached, and began to pull up the hedge ; he waited till fhe had tied up her bottle of iticks, and was carrying them off, that he might convict her of the theft, and then fpringing from his con- cealment, he feized his prey with violent threats. After fome altercation, in which her load was left upon the ground, fhe kneeled upon her bottle of flicks,and raifing her arms to Heaven beneath the bright moon then at the full, fpoke to the farmer al- ready fhiveringwith cold," Heaven grant,that thou never mayefl know 308 DISEASES Class III. 1. 2. 1. know again the bleffing 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 faying noth- ing made him warm, he covered himfelf with very many blank- ets, and had a fieve over his face, as he lay; and from this one infane idea he kept his bed above twenty years for fear of the cold air, till at length he died. M. M. As mania arifes from pain either of our mufcles or organs of fenfe, the arts of relieving pain muft conftitute the method of cure. See Se£l. XXXIV. 3 4. VenefeClion. Vomits of from five grains to ten of emetic tartar, repeated ev- ery third morning for three or four times ; with folution of gum ammoniac, and foluble tartar, fo as to purge gently every day. Afterwards warm bath for two or three hours a day Opium in large dofes. Bark. Steel. Dr. Binns gave two fcruples (40 grains) of folid opium at a dole, and twenty grains four hours afterwards ; which reftored the patient. Dr. Brandreth gave 400 drops of laudanum to a maniac in the greateft poflible furor, and in a few hours he be- came calm and rational. Med. Comment, for 1791, p. 384. Prognojiic. The temporary quick pulfe attending fome maniacal cafes is limply a fymptom of debility, and is the confequence of too great exertions ; but a permanent quick pulfe Ihews the pref- ence of fever, and is frequently a falutary fign ; becaufe, if the life of the patient be fafe, when the fever ceafes, the infanity generally vanilhes along with it, as mentioned above. In this cafe the kind of fever muft direct the method of curing the in- fanity ; which muft confift of moderate evacuations and dilu- ents, if the pulfe be ftrong ; or of nutrientia, bark, and fmall dofes of opium, if the pulfe be weak. Where the caufe is of a temporary nature, as in puerperal infanity, there is reafon to hope, that the difeafe will ceafe, when the bruifes, or other painful fenfations attending this ftate, are removed. In thefe cafes the child fhould be brought fre- quently to the mother, and applied to her breaft, if (he will fuf- fer it, and this whether Ilie at firft attends to it or not ; as by a few trials it frequently excites the ftorge, or maternal affection, and removes the infanity, as I have witneffed. When the madnefs is occafioned by pain of the teeth, which I believe is no uncommon cafe, thefe muft be extracted ; and the cure follows the extinction of the pain. There is however fome difficulty in detecting the delinquent tooth in this cafe, as in OF VOLITION. Class III. i . 2. 2. 309 in hemicrania, unlefs by its apparent decay, or by fome previ- ous information of its pain having been complained of; be- caufe the pain of the tooth ceafes, as foon as the exertions of in- fanity commence. In this cafe falivation might be tried. When a perfon becomes infane, who has a family of fmall children to folicit his attention, the prognoftic is very unfavour- able ; as it (hews the maniacal hallucination to be more pow- erful than thofe ideas which generally intereft us the mpft. When an infane young man (hews nolafcivious idea, when an opportunity of gratifying the paffion of love is prefented to him, as in the cafe above mentioned of Z. Z. or when an in- fane young lady fhews no fymptom of attachment, when ad- dreffed honourably by a proper lover, the prognoftic is unfa- vourable, as it thews the maniacal hallucination to affect the mind itronger than the natural paflion of love, which in civilized fociety is ftrengthened by rellraint. Paralytic affections are faid by Mr. Hallam, to be frequently lucceeded by infanity, and that in thefe cafes the inactivity of fome paralytic mufcles about the face or limbs with defective memory continue along with the infanity ; and he adds that thefe patients are ieldom relieved. Obfervations on Infanity by J. Hallam, 8vo. Rivington. It was before obferved, that when fome limbs become paralytic, as in the common hemiplegia, that the other limbs are liable to be for fome time in almolt per- petual aCtion, owing to the fuperfluity of volition, which was previoufly expended by the aCtion of thofe mufcles, which are now rendered difobedient to the fenforial power of volition, though they may continue to be excitable by irritation or fenfa- tion, as in the aCt of pandiculation, or by eleClric fhocks. Now if this fuperfluity of voluntary aCtivity be exerted on the organs of fenfe, delirious hallucinations and infane aClions are the con- fequence ; and as the power of life is already injured in a part of the fyitem, they are lefs liable to recover, and die like other paralytic patients. And thus the infanities in contequence of paralytic affections, as well as thofe in confequence of pain- ful fenfations or ideas, contenance the theory, that they arife from the exceflive aCtivity of the fenforial power of voli- tion. 2- Stadium inane. Reverie confifts of violent voluntary exer- tions of ideas to relieve pain, with all the trains or tribes con- nected with them by fenfations or affociations. It frequently alternates with epileptic convulfions; with which it correlponds, in refpedl-to the infenfibility of the mind to the ftimuli of ex- ternal objcCts, in the fame manner as madnefs correlponds with common DISEASES 310 Class III. i. 2. 2. common convulfion, in the patient's poffeffing at the fame time a ienfibility of the llimuli of external objefts. Some have been reported to have been involved in reverie fo periedtly, as not to have been diiturbed by the difcharge of a cannon; and others to have been infenfible to torture, as the martyrs for religious opinions ; but thefe feem more properly to belong to particular infanities than to reverie, like noftalgia and erotomania. Reverie is diftinguilhed from madnefs as defcribed above ; and from delirium, becaule the trains of ideas are kept confid- ent by the power of volition, as the perfon reafons and delib- erates in it. Somnambulifmus is a part of reverie, fomnambu- lilm confiding in the exertions of the locomotive mufcles, and reverie in the exertions of the organs of fenfe ; See Clafs I. I. i. 9 and Sect. XIX. both which are mixed, or alternate with each other fur the purpofeof relieving pain. When the patients in reverie exert their volition on their or- gans of fenfe, they can occafionally perceive the ftimuli of ex- erual objects, as explained in Seft. XIX. And in this cafe it reiembies fometimes an hallucination of the fenfes, as there is a mixture of fatt and imagination in their difcourfe; but may be thus diitinguilhed : hallucinations of the fenfes are allied to de- lirium, and are attended generally with quick pulfe, and other fymptoms of great debility ; but reverie is without fever, and generally alternates with convulfions ; and fo much intuitive analogy (fee Sedl. XVII 3 7.) is retained in itsparoxyfms, as to preferve a confiftency in the trains of ideas. Mifs G , whole cafe is related in SeCl. III. 5. 8. faid as I once fat by her, " My head is fallen off, fee it is rolled to that corner of the room, and the little black dog is nibbling the nofe off." On my walking to the place which Ihe looked at, and returning, and affuring her that her nofe was unhurt, fhe be- came pacified, though I was doubtful whether fhe attended to me. See Clafs III. 1. 1. 9. and Clafs III. 1. 2. 2. M. M. Large doles of opium given before the expected par- oxyfm, as in epilepfia dolorifica, Clafs III. 1. 1.8. fhe hallucinatio ftudiofa, or falfe ideas in reverie, differ from maniacal hallucinations above defcribed, as no infane ex- ertions fucceed, and in the patients whom I have feen they have always been totally forgotten, when the paroxyfm was over. Mafter , a fchool-boy about twelve years old, after he came out of a convulfion fit and fat up in bed, faid to me, " Dont you fee my father (landing at the feet of the bed, he is come a long way on foot to fee me." I anfwered, no : " What colour Class III. 1. 1. 3. OF VOLITION. 311 colour is his coat ?" He replied, " A drab colour." « And what buttons ?" " Metal ones," he anfwered, and added, " how fadly his legs are fwelled." In a few minutes he faid, with ap- parent furprife, " He is gone," and returned to his perfect mind. Other cafes are related in Se£t. XIX. and XXXIV. 3. and in Clafs III. 1. 2. 2. with further obfervations on this kind of hallucination ; which however is not the caufe of reverie, but conilitutes a part of it, the caufe being generally fome uneafy fenfation of the body. 3. Vigilia. Watchfulnefs confifts in the unceafing exertion of volition ; which is generally caufed by fome degree of pain either of mind or of body, or from defeat of the ufual quantity of pleafurable fenfation ; hence if thofe, who are accuitomed to wine at night, take tea inftead, they cannot deep. The fame happens from want of folid food for fupper, to thofe who are accuftomed to ufe it; as in thefe cafes there is pain or defect of pleafure in the ftomach. Sometimes the anxiety about deeping, that is the defire to Heep, prevents deep ; which confifts in an abolition of defire or will. This may fo far be compared to the impediment of fpeech defcribed in Sefl. XVII. 1. 10. as the interference of the will prevents the effect defired. Another fource of watchfulnefs may be from the too great fecretion of fenforial power in the brain, as in frenzy, and as fometimes happens from the exhibition of opium, and of wine ; if the exhauftion of fenforial power by the general actions of the fyftem occafioned by the llimulus of thefe drugs can be fuppo- fed to be lefs than the increafed fecretion of it. M. M. 1. Solid food to fupper. Wine. Opium. Warm bath. 2. The patient (hould be told that his want of deep is of no confequence to his health. 3. Venefe&ion by cupping. Ab- ftinence from wine. 4. A blifter by ftimulating the Ikin, and rhubarb by ftimulating the bowels, will fometimes induce deep. Exercife. An uniform found, as of a paufing drop of water, or the murmur of bees. Other means are defcribed in Sedl. XVIII. 20. 4. Erotomania. Sentimental love. Defcribed in its excefs by romance writers and poets. As the object of love is beauty, and as our perception of beauty confifts in a recognition by the fenfe of vifion of thofe objects, which have before infpired our love, by the pleafure they Jiave afforded to many of our fenfes (Sedt. XVI. 6.); and as brute animals have lefs accuracy of their fenfe of vifion than mankind (ib.); we fee the reafon why this kind of love is not frequently obfervable in the brute crea- tion, except perhaps in fome married birds, or in the affection of the 312 DISEASES Class III. i. 2. 3. the mother to her offspring. Men who have not had leifure to cultivate their tafte for vifible objects, and who have not read the works of poets and romance-writers, are lefs liable to fentimen- tal love ; and as ladies are educated rather with an idea of being chofen, than of choofing ; there are many men and more wo- men, who have not much of this infanity ; and are therefore more eafily induced to marry for convenience or intereft, or from the flattery of one fex to the other. In its fortunate gratification fentimental love is fuppofed to fupply the pureft fource of human felicity ; and from the fud- dennefs with which many of thofe patients, defcribed in fpecies I. of this genus, were feized with the maniacal hallucination, there is reafon to believe, that the molt violent fentimental love may be acquired in a moment of time, as reprefented by Shake- fpeare in the beginning of his Romeo and Juliet, as originally written Some have endeavoured to make a diflindion between beau- ty and grace, and have made them as it were rivals for the pof- feffion of the human heart; but grace may be defined beauty in action ; for a fleeping beauty cannot be called graceful in what- ever attitude fhe may recline ; the mufcles muft be in action to produce a graceful attitude, and the limbs to produce a grace- ful motion. But though the object of love is beauty, yet the idea is neverthelefs much enhanced by the imagination of the lover j which appears from this curious circumftance, that the lady of his paflion feldom appears fo beautiful to the lover after a few months reparation, as his ideas had painted her in his abfence ; and there is on that account, always a little difappoint- ment felt for a minute at their next interview from this halluci- nation of his ideas. This paflion of love produces reverie in its firfl ftate, which exertion alleviates the pain of it, and by the afliftance of hope converts it into pleafure. Then the lover feeks folitude, left this agreeable reverie fhould be interrupted by external ftimuli, as defcribed by Virgil. Tantum inter denfas, umbrofa cacumina, fagos Afliduc veniebat, ibi haec incondita folus *Montibus et fylvis ftudio jadtabat inani. When the pain of love is fo great as not to be relieved by the exeitions of reverie, as above defcribed ; as when it is mifplaced on an object, of which the lover cannot poflefs himfelf ; it may Hill be counteracted or conquered by the ftoic philofophy,which [trips all things of their ornaments, and inculcates " nit admira- ri." Of which leflbns may be found in the meditations of Mar- cus Class III. 1.2. 4. OF VOLITION. 313 cus Antoninus. The maniacal idea is faid in fome lovers to have been weakened by the action of other very energetic ideas; fuch as have been occafioned by the death of his favourite child, or by the burning of his houfe, or by his being (hip wrecked. In thofe cafes the violence of the new idea for a while expends fo much fenforial power as to prevent the exertion of the mania- cal one; and new catenations fucceed. On this theory the lov- er's leap, fo celebrated by poets, might effect a cure, if the pa- tient efcaped with life. The third ftage of this difeafe I fuppofe is irremediable; when a lover has previoufly been much encouraged, and at length meets with neglect or difdain ; the maniacal idea is fo painful as not to be for a moment relievable by the exertions of reverie, but is inftantly followed by furious or melancholy mfanity ; and fuicide, or revenge, have frequently been the confequence. As was lately exemplified in Mr. Hackman, who (hot Mifs Ray in the lobby of the playhoufe. So the poet defcribes the paflion of Dido, Moriamur inultae ?- At moriamur, ait,-fic, fic, juvat ire fub umbras •! The ftory of Medsea feems to have been contrived by Ovid, who was a good judge of the fubjed, to reprefent the favage madnefs occafioned by ill-requited love. Thus the poet, Earth has no rage like love to hatred turn'd, Nor Hell a fury like a woman fcorn'd Dryden. Hence it appears that though fentimental love does not fo frequently arife fpontaneoufly in female bofoms, yet that it is liable to become as violent, when it has been excited by the courtlhip of the other fex, and though, when it is rejeded, after courtfhip has produced it, it is not al ways fucceeded by fuch vi- olent effects as thofe above mentioned ; which may be afcribe.d to the greater modefty and referve of their education; yet the difappointed paflion is liable to prey upon their minds even to the hazard of their lives, of which I have witneffed two inftan- ces, in both which the effects approached to that occafioned by great grief. See Moeror, Clafs TII. i. 2. io. One of thefe ladies, about 30 years of age, was deferted by an Iriffi gentleman, who was foon to have married her ; fhe was feized fuddeniy with a ftupor, which by thofe, who were not acquainted with the caufe, was miftaken for a kind of apoplexy ; fhe gradually recovered fo as to apply to her ufual habits of life, V ol. II. R R and 314 DISEASES Class III. 1. 2. $. and in four or five years regained her cheerfulnefs, and married another man. The other was affefled with long ftupor, lofs of digeftion, and total inability of mind and body, which contin- ued a year or two, and from which (he alfo gradually re- covered. 5. Amor fui. Vanity confifts of an agreeable reverie, and is well ridiculed in the ftory of Narciflus, who fo long contemplat- ed his own beautiful image in the water, that he died from neg- lect of taking fuftenance. I once faw a handfome young man, who had been fo much flattered by his parents, that his vanity rofe fo near to infanity, that one might difcern by his perpetual attention to himfelf, and the difficulty with which he arranged his converfation, that the idea of himfelf intruded itfelf at every comma or paufe of his difcourfe. In this degree vanity mult afford great pleafure to the pofleflor ; and when it exifts with- in moderate bounds, may contribute much to the happinefs of focial life. My friend Mr. once complained to me, that he was much troubled with baffifulnefs in company, and believed that it arofe from his want of perfonal vanity ; on this account he de- termined on a journey to Paris, when Paris was the centre of politenefs ; he there learnt to drefs, to dance, and to move his hands gracefully in converfation ; and returned a moft confum- mate coxcomb But after a very few years he relapfed into ruf- ticity of drefs and manners. M. M. The cure of vanity may be attempted by excefs of flattery, which will at length appear ridiculous, or by its famil- iarity will ceafe to be defired. I remember to have heard a ftory of a nobleman in the court of France, when France hada court, who was fo difagreeably vain in converfation, that the king was pleafed to diretft his cure, which was thus performed. Two gentlemen were directed always to attend him, one was to ftand behind his chair, and the other at arefpedlful diftance before him; whenever his lordlhip began to fpeak, one of them always, pronounced " Lord Gallimaufre is going to fay the belt thing in the world." And, as foon as his Lordfhip had done fpeaking, the other attendant pronounced, " Lord Gallimaufre has fpoken the beft thing in the world." Till in a few weeks this noble lord was fo difgufted with praife that he ceafed to be vain ; and his majefty difmifled his keepers. 6. Nojlalgia. Maladie de Pais. Calenture. An unconquer- able defire of returning to one's native country, frequent in long voyages, in which the patients become fo infane as to throw themfelvesinto the fea, miftaking it for green fields or meadows. The Swifs are faid to be particularly liable to this difeafe, and when Class III. 1.2. 7. OF VOLITION. 315 when taken into foreign fervice frequently to dcfert from this caufe, and efpecially after hearing or tinging a particular tune, which was ufed in their village dances, in their native country, on which account the playing or finging this tune was forbid by the punithment of death. Zwingerus. Dear is that fhedto which his foul conforms, And dear that hill, which lifts him to the ftorms. Goldsmith. 7. Sepes religiofa. Superftitious hope. This maniacal hallu- cination in its milder ftate produces, like fentimental love, an agreeable reverie ; but when joined with works of fupereroga- tion, it has occafioned many enormities. In India devotees con- fign themfelves by vows to mod painful and unceafing tortures, fiich as holding up their hands, till they cannot retract them ; hanging up by hooks put into the thick Ikin over their Ihoulders, fitting upon (harp points, and other felf torments While in our part of the globe farting and mortification, as flagellation, has been believed to pleafe a merciful Deity ! The ferenity, with which many have fuffered cruel martyrdoms, is to be afcribed to this powerful reverie. Mr a clergyman, formerly of this neighbourhood, be- gan to bruife and wound himfelf for the fake of religious morti- fication, and pafled much time in prayer, and continued whole nights alone in the church. As he had a wife and family of fmall children, I believed the cafe to be incurable; as otherwife the affeXion and employment in his family connexions would have oppofed the beginning of this infanity. He was taken to •a madhoufe without effeX, and after he returned home, continu- ed to beat and bruife himfelf, and by this kind of mortification, and by fometimes long falling, he at length became emaciated and died. I once told him in converfation, that, " God was a merciful being, and could not delight in cruelty, but that I fup- pofed he worlhipped the devil." He was (truck with this idea, and promifed me not to beat himfelf for three days, and I believe kept his word for one day. If this idea had been fre- quently forced on his mind, it might probably have been of fervice. When thefe works of fupererogation have been of a public nature, what cruelties, murders, maflacres, has not this infanity introduced into the word !-A commander, who had been very aXive in leading and encouraging the bloody deeds of St. Bar- tholomew's day at Paris, on confeffing his fins to a worthy ec- clefiaftic on his death-bed, was alked, " Have you nothing to fay about St. Bartholomew ?" " On that day," he replied, " God Almighty 316 DISEASES Class III. 1. 2. 8. Almighty was obliged to me '''-The fear of Hell is another infamty, which will be fpoken of below. 8. Superbia Jlemmatis. Pride of family has frequently form-r ed a maniacal hallucination, which in its mild Hate has confifted in agreeable reverie, but when it has been fo painful as to de- mand homage from others, it has frequently induced infane ex- ertions. This infanity feems to have exifted in the flourifhing ftate of Rome, as now all over Germany, and is attacked by Ju- venal with great feverity, a fmall part of which I (hall here give as a method of cure. Sat. 8. Say, what avails the pedigree, that brings Thy boafted 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 fteel-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 adl unfhamed, by each indignant buft. The midnight orgies of promifcuous lull - Go, lead mankind to Virtue's holy flirine, With morals mend them, and with arts refine, Or lift, with golden characters unfurl'd, The flag of peace, and fave a warring world !- -So fhall with pious hands immortal Fame Wreath all her laurels round thy honour'd name, High o'er thy tomb with chiflel bold engrave, " The truly noble are the good and brave." y. Ambitio. Inordinate defire of fame. A careleflhefs about the opinions of others is faid by Xenophon to be the fource 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 increafes our happinefs by enlarging our fphere of fympathy, and by flattering our vanity. AbftraCt what others feel, what others think. All pictures ficken, and all glories fink. Pope. When this reverie of ambition excites to conquer nations, or to enflave them, it has been the fource of innumerable wars,and the occafion of a great devaluation of mankind. Csefar is re- ported to have boafted, that he had deftroyed three millions of his enemies, and one million of his friends. The works of Homer are fuppofed to have done great injury to mankind by infpiring the love of military glory. Alexander was faid to fleep with them always on his pillow. How like a mad butcher Class III. 1. 2.10. OF VOLITION. 317 butcher amid a flock of (heep appears the hero of the Iliad, in the following fine lines of Mr. Pope, which conclude the twen- tieth book. His fiery couriers, as the chariot rolls, Tread down whole ranks and crufh out heroes' fouls ; Dafli'd from their hoofs, as o'er the dead they fly, Black bloody drops the fmoking chariot die ;- The fpiky wheels through heaps of carnage tore, And thick the groaning axles dropp'd with gore ; High o'er the fceneof death Achilles flood, All grim with dufl, all horrible with blood ; Yet flill infatiate, flill with rage on flame, Such is the lull of never dying fame ! The cure muft be taken from moral writers. Woolafion fays, Cxfar conquered Pompey ; that is, a man whofe name confuted of the letters C, x, f, a, r, conquered a long time ago a man, whofe name confifted of the letters P, o, m, p, e, y, and that this is all that remains of either of them. Juvenal alfo at- tacks this mode of infanity, Sat. X. 166. I, demens, et fasvas curre per Alpes, Ut pueris placeas, et declamatio fias ! Which is thus tranflated by Dr.. Johnfon, And left a name, at which the world grew pale, To point a moral, or adorn a tale ! io. Mosror. Grief. A perpetral voluntary contemplation of all the circumftances of fome: great lofs, as of a favourite child. In general the painful ide as gradually decreafe in ener- gy, and at length the recollection becomes more tender and lefs painful. The letter of Sulpicir is to Cicero on the lofs of his daughter is ingenious. The exau iple of David on the lofs of his child is heroic. A widow lady was left in naj row circumftances with a boy and a girl, two beautiful and lively children, the one fix, and the other feven years of age 5 as her circumftances allowed her to keep but one maid-fervant, th efe two children were the foie attention, employment, and coi ifohtion of her life ; fhe fed them, dreffed them, flept with th em, and taught them herfelf ; they were both fnatched from hej • by the gangrenous fore throat in one week : fo that fhe loft at once all that employed her, as well as all- that was dear to he r. For the fir ft three or four days after their death, when any friend vifited her, (he fat up- right, with her eyes wide open, • without fhedding teats, and af- fected to fpeak of indifferent thij ngs. Afterwards fhe began to weep much, and for fome week, s talked to her friends of noth- ing 318 DISEASES Class III. 1.2.11. ingelfebut 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 efteemed a good fymp- tom ; becaufe then the actions caufed by fenfitive aflbciation take the place of thofe caufed by volition ; that is, they prevent the voluntary exertions of ideas, or mufcular actions, which conftitute infanity. The fobbing and fighing attendant upon grief are not convul- five movements, they are occafioned by the fenforial power be- ing fo expended on the painful ideas, and their connections, that the perfon negleCts to breathe for a time, and then a vio- lent figh or fob is neceflary to carry on the blood, which oppreffes the pulmonary veflels, which is then performed by deep or quick infpirations, and laborious expirations. Sometimes neverthelefs the breath is probably for a while voluntarily held, as an effort to relieve pain. The palenefs and ill health occafioned by long grief are fpoken of in Clafs IV. 2. 1.9. The melioration of grief by time, and its being at length even attended with plealure, depends on our retaining a diftincl idea of the loft objett, and forgetting for a time the idea of the lofs of it. This pleafure of grief is beautifully defcribed by Aken- fide, Pleafures of Imagination, Book II. 1. 680. --- Afk the faithful youth, Why the cold urn of her, whom long he loved, So often fit's his arms; fo often draws His lonely footfteps at the filent hour To pay the mournful tribute of his tears ? Oh ! he will tell thee, that the wealth of worlds Should ne'er feduce his bofom to forego That facred hour ; when, ftealing from the nOife Of care and envy, fweet remembrance foothes With Virtue's kindeft looks his aching breaft, And turns his tears to rapture. M. M. Confolation is beft fupplied by the Chriftian doflrinc of a happy immortality. In the Pagan religion the power of dying was the great confolation in irremediable diftrefs. Seneca fays, " no one need be unhappy unlefs by his own fault." And the author of Telemachus begins his work by faying, that Ca- lypfo could not confole herfelf for the lofs of Ulyffes, and found herfelf unhappy in being immortal. In the firlt hours of grief the method of confolation ufed by uncle Toby, in Triftram Shandy, is probably the beft; « he fat down in an arm chair by the bed of his diftrefled friend, and faid nothing." 11. Tadiumvita. Ennui. Irkfomenefs of life. The inani- ty of fublunary things has afforded a theme to philofophers, moralifts, Class III. i. a. u. OF VOLITION. 319 moralifts, and divines, from the earlieft records of antiquity ; « Vanity of vanities I" fays the preacher, " all is vanity !" Sol- omon. « Man is the dream of a fhadow !*' ^6^0?. Pindar. O ! quantam eft in rebus inane 1 Juvenal. Nor is there any one, I fuppofe, who has pafled the meridian of life, who has not at fome moments felt the nihility of all things. Wearinefsof Kfe or ennui in its moderate degree has been ef- teemed a motive to action by fome phiiofophers. See Seft. XXXIV. 2. 3. But in thofe men, who have run through the ufual amufements of life early in refpeft of their age ; and who have not induftry or ability to cultivate thofe fciences, which af- ford a perpetual fund of novelty, and of confequent entertain- ment, are liable to become tired of life, as they fuppofe there is nothing new to be found in it, that can afford them pleafure ; like Alexander, who is faid to have fhed tears becaufe he had not another world to conquer. Mr. , a gentleman, about fifty,of polidied manners, who in a few months afterwards deftroyed himfelf, faid to me one day, « A ride out in the morning, and a warm parlour and a pack of cards in the afternoon, are all that life affords." He was perfuaded to have an iffue on the top of his head, as he com- plained of a dull head-ach, which being unfkilfully managed, deftroyed the pericranium to the fize of an inch in diameter ; during the time this took in healing, he was indignant about it, and endured life, but foon afterwards fhot himfelf. Mr. , a gentleman of Gray's Inn, fome years ago was pre- vailed upon by his friends to difmifs a miftrefs, by whom he had a child, but who was fo great a termagant and fcold, that fhe was believed to ufe him very ill, and even to beat him. He be- came melancholy in two days from the want of his ufual ftimu- lus to adlion, and cut his throat on the third fo completely, that he died immediately. Mr. Anfon, the brother to the late lord Anfon, related to me the following anecdote of the death of lord Sc . His lord- Ihip fent to fee Mr. Anfon on the Monday preceding his death, and faid, " You are the only friend I value in the world, I determined therefore to acquaint you, that I am tired of the infipidity of life, and intend to morrow to leave it." Mr. Anfon faid, after much converfation, that he was obliged to leave town till Friday, and added, " As you profefs a friendship for me, do me this laft favour, I entreat you, live till I return." Lord Sc. believed this to be a pious artifice to gain time, but nev- erthelefs agreed, if he fhould return by four o'clock on that day. Mr Anion did not return till five, and perceived by the coun- tenances of the domeftics, that the deed was done. He went < « • into 320 DISEASES Class III. 1. 2. 11, into his chamber and found the corpfe of his friend leaning over the arm of a great chair, with the piftol on the ground by him, the ball of which had been difcharged into the roof of bis mouth and palled into his brain. Mr. and Mr. , two young men,heirs tv confiderable fortunes, (hot themfelves at the age of four or fi.ve and twenty, without their friends being able to conjecture ar,y caufe for thofe rafh actions. One of them I had long known to exprefs himfelf with diflatisfadion of the world ; at eighteen years of age he complained, that he could not entertain, himfelf ; he tried to ftudy the law at Cambridge, and afterwards went abroad for a year or two by my advice ; but returned diflatisfied with all things. As he had an eruption for fome years on a part of his face, which he probably endeavoured to remove by external ap- plications ; I was induced to afcribe his perpetual ennui to the pain or difagreeable fenfation of a difeaied liver. The other young gentleman Ihot himfelf in his bed-room, and I was in- formed that there was found written on a fcrap of paper on his table, " I am impotent, and therefore not fit to live." From whence there was reafon to conclude, that this was the halluci- natio maniacalis, the delirious idea, which caufed him to deftroy himfelf. The cafe therefore belongs to mania mutabilis, and not to tsedium vitae. Thofe, who have been employed during the firft half of their lives in fome very adive bufinefs, and fuddenly leave it, are li- able to this kind of infanity, and even to fuicide ; of which I have known two inftances, one of them a Birmingham manu- facturer, and the other a great and fuccefsful commander. This may be afcribed to the accumulation of the fenforial power of volition, and the want of motive to exert or expend it, and which thence becomes painful. See pain of cold from the want of ftimulus. III. 2. I 17. This may afford confolation to thofe, whofe fituation in life obliges them to ufe perpetual induftry in their occupation : they may fay, that as they have been long in the habit of exerting much voluntary aCtion, they muft continue to employ them- felves ; otherwife that they (hall fink into low fpirits, as it is call- ed, and become unhappy. And as the continuance of adivity is now neceflary to their happmefs, they had better employ themfelves on fuch objeCts, as are ufeful to themfelves or their connexions, than to confume their time, and miiapply their la- bour, in card-playing, wine-drinking, or fox hunting, which are other methods of relieving ennui or the irkfomenefs of life by exertion, and confequent expenditure of voluntary power. Lefs degrees of this malady are eyroneoufly termed hypochon- driacifm, Class III. 1. 2. 11. OF VOLITION. 321 driacifm, fee Clafs I, 2. 4. 10 by the people, and are general- ly afcribed to the want of voluntary power, or of induftry ; but I believe it is generally owing to want of motive or ftimulus ; and that the pain attending this ftate of our ideas or mufcles is occafioned by accumulation of voluntary power, as above men- tioned. The cure of this difeafe, is popularly known to confift in any kind of voluntary exertion of the mind, or of the body ; one of our poets has perfonified hypochondriacifm, and well ad- vifestheufeofexercife,or exertion to oppofe the monfter,and fays, " Throw but a flone the giant dies." To this (hould be added, that thofe, who have been educated in indolence, do not find or feel ennui, or the pain of exifience, when they are inactive •, like our domeftic animals* as dogs and cats, who fleep by the fire without inclination to hang or drown themfelves ; as thefe beings, not having been long accuftomed to expend much voluntary power, are not liable to much accu- mulation of it, and unealinefs in confequence ; which is not fo however with the more adtive fquirrel before mentioned. But on the contrary, thofe, whofe education has induced them to ufe much voluntary exertion, and have afterwards had no active employment, as happens to fome unmarried ladies, are more liable, as I have repeatedly witnefled, to this malady ; an idea, which {hould be attended to in female education. Another fource of ennui or tredium vitae is alfo derived from wrong education, and is immediately owing to the want of ftim- ulus rather than to the great accumulation of voluntary power ; and is liable to attend fome ladies in high life, whofe exertions during their early years were excited by the flattery of numer- ous menial fervants. And afterwards, when this flattery ceafes by their living with their equals, they want their accuftomed motive to activity, and in confequence become indolent and un- happy, as further defcribed in ClafsIII. 2. I. 8. under the name of Parcfis voluntaria. M M. The prevention of this malady muft confift in the due care of education. Thofe who are not defigned for very active life, particularly young ladies, fhould not be forced in their early years to ufe too violent or too conftant voluntary ex- ertions They fhould not be flattered into all their exertions, but fhould be taught to a 61 from duty to themlelves and others, or for their future advantage as well as for their prefent amufe- ment. Some reftraint in exhaufting the ufual pleafures of the world in early life fhould be laid on young men of fortune ; and after- wards the pleafures and folicitudes of a matrimonial life are Vol. II. S s ftrongly 322 DISEASES Class III. 1. 2. i2» ftrongly to be recommended ; and finally the cultivation of fci- ence, as of chemiftry, natural philofophy, natural hiftory, which fupplies an inexhauftible fource of pleafurable novelty, and re- lieves ennui by the exertions it occafions. In many of thefe cafes, when irkfomenefs of life has been the oftenfible caufe of fuicide, there has probably exided a maniacal hallucination, a painful idea, which the patient has concealed even to his dying hour ; except where the mania has evidently arifen from hereditary or acquired difeafe of the membranous or glandular parts of the fyftem. 12. Pulchritudinis dtjiderimn. The lofs of beauty, either by difeafe, as by the fmall-pox, or by age, as life advances, is fome- times painfully felt by ladies, who have been much flattered on account of it. There is a curious cafe of this kind related in le Sage's Bachelor of Salamanca, which is too nicely defcribed to be totally imaginary. In this fituation fome ladies apply to what are termed cofmet- ics under various names, which crowd the newfpapers. Of thefe the white has deftroyed the health of thoufands ; a calx, or magiftery, of bifmuth is fuppofed to be fold in the (hops for this purpofe ; but it is either, I am informed, in part or entirely white lead or cerufl'a; The pernicious effects of the external ufe of thofe faturnine applications are fpoken of in gutta rofea, Clafs II. 1.4. 6. The real calx of bifmuth would probably have the fame ill effect. As the red paint is prepared from cochineal, which is an animal body, lefs if any injury arifes from its ufe, as it only lies on the Ikin like other filth. The tan of the ikin occafioned by the fun 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 furface, but requires much caution in the application ; the marine acid muft be diluted with water, and then put upon the hand or face, after a fecond of time, as foon as the tan difap- pears, the part muft be waihed with a wet towel and much warm water. Freckles lie too deep for this operation, nor arc they in general removable by a blifter, as I once experienced. See Clafs I. 2. 2. 9. It is probable, that thofe materials which ftain filk, or ivory, might be ufed to ftain the cuticle, or hair, permanently; as they are all animal fubftances. But I do not know, that any trials of this kind have been made on the Ikin. I endeavoured in vain to vzhiten the back of my hand by marine acid oxygenated by manganefe, which fo inftantly whitens cotton. The cure therefore muft be fought from moral writers, and Class III. i. 2. 13. OF VOLITION. 323 the cultivation of the graces of the mind, which are frequently a more valuable pbffeffion than^ celebrated beauty. 13. Paupertatls Umor. The fear of poverty is one kind of avarice; it is liable to affeX people who have left off a profita- ble and active bufinefs ; as they are thus deprived of their ufual exertions, and are liable to obferve the daily expenditure of mon- ey, without calculating the fource from whence it flows. It is alfo liable to occur with a fudden and unexpected increafe of fortune. Mr. , a furgeon, about fifty years of age, who was always rather of a parfimonious difpofition, had a large houfe, with a fortune of forty thoufand pounds, left him by a diftant relation ; and in a few weeks became infane from the fear of poverty, lamenting that he Ihould die in a jail or a work- houfe. He had left off a laborious country bufinefs, and the daily perception of profit in his book ; he alfo now faw greater expenfes going forwards in his new houfe, than he had been accuftomed to obferve, and did not fo diftinXly fee the fource of fupply ; which feems to have occafioned the maniacal hallu- cination.--This idea of approaching poverty is a very frequent and very painful difeafe, fo as to have induced many to become fuicides, who were in good circumftances ; more perhaps than any other maniacal hallucination, except the fear of Hell The covetoufnefs of age is more liable to afteX fingle men, thanthofe who have families ; thoughanaccumulation of wealth would feem to be more defirable to the latter. But an old man in the former fituation, has no perfonal connexions to induce him to open his purfe ; and having loft the friends of his youth, and not eafily acquiring new ones, feels himfelf alone in the world : feels himfelf unprotected, as his ftrength declines, and is thus led to depend for affiftance on money, and on that ac- count withes to accumulate it. Whereas the father of a family has not only thofe connexions, which demand the frequent ex- penditure of money, but feels a confolation in the friendftiip of his children, when age may render their good offices neceffary to him. M. M. I have been well informed of a medical perfon in good circumftances 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 difeafe returns upon him ; and thus, by counteraXing the maniacal hallucination, wifely prevents the increafe of his infanity. Another medical perfon, in London, is faid to have cured himfelf of this difeafe by ftudying mathematics with great attention ; which exertion of the mind relieved the pain of the maniacal hallucination. Many moral writers have ftigmatifed this infanity ; the covet- ous, DISEASES Class III. 1. 2. 14. 324 ous, they fay, commit crimes and mortify themfelves without hopes of reward ; and thus become miferable both in this world and the next. Thus Juvenal; Cum furor hand dubius, cum fit manifefta phrenitis, Ut locuples moriaris, egenti vivere fato ! The covetous man thought he gave good advice to the fpendthrift, when he faid, " Live like me," who well anfwered him. " Like you, Sir John ? " That I can do, when all I have is gone !" Pope. 14. Letbi timer. The fear of death perpetually employs the thoughts of thefe patients : hence they are deviling new medi- cines, and applying to phyficians and quacks without number. It is confounded with hypochondriafis Oafs I. 2. 3. 9. in pop- ular converfation, but is in reality an infanity. A young gentleman, whom I advifed to go abroad as a cure for this difeafe, affured me, that during the three years he was in Italy and France he never pafled a quarter of an hour with- out fearing he ffiould die. But he has now for above twenty years experienced the contrary. The fufFerers under this malady are generally at once difcov- erable by their telling you, amidlt an unconnected defcription of their complaints, that they are neverthelefs not afraid of dy- ing. They are alfo eafdy led to complain of pains in aimoft any part of the body, and are thus foon difeovered. M. M. As the maniacal hallucination has generally arifen in early infancy from fome dreadful account of the ftruggles and pain of dying, I have fometimes obferved, that thefe patients- have received great confolation from the inftances I have re- lated to them of people dying without pain. Some of thefe, which I think curious, I (hall concifely relate, as a part of the method of cure. Mr. , an elderly gentleman, had fent for me one whole day before I could attend him ; on my arrival he faid he was glad to fee 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 pulfe fcarcely difcernible, and died in about fix hours Mr. , another gentleman about fixty, lay in the aCt of dying, with difficult refpiration like groaning, but in a kind of (tupor or coma vigil, and every ten or twelve minutes, while I fat by him, he waked, looked up, and faid, " who is it groans Class III. 1. 2. 15. OF VOLITION. 325 groans fo, I am fare there is fomebody dying in the room," and then funk again into a kind of deep. From thefe two cafes there appeared to be no pain in the aft of dying, which may afford confolation to all, but particularly to thofe who are afflict- ed with the fear of death. 15. Orel timor. The fear of Hell. Many theatric preachers among the Methodifls fuccefsfully infpire this terror, and live comfortably upon the folly of their hearers. In this kind of madnefs the poor patients frequently commit fuicide ; although they believe they run headlong into the Hell, which they dread 1 Such is the power of oratory, and fuch the debility of the hu- man underftanding ! Thofe, who luffer under this infanity, are generally the moft innocent and harmlefs people ; who are then liable to accufe themfelves of the greateft imaginary crimes, and have fo much intellectual cowardice, that they dare not reafon about thofe things, which they are directed by their prieft to believe, how- ever contradictory to human apprehenfion, or derogatory to the great Creator of all things. The maniacal hallucination at length becomes fo painful, that the poor infane flies from life to become free from it. M. M. Where the intellectual cowardice is great, the voicex of reafon is ineffectual; but that of ridicule may fave many from thofe mad-making doctors ; though it is too weak to cure thofe who are already hallucinated. Foote's Farces are recom- mended for this purpofe. 16. Satyriajis. An ungovernable defire of venereal indul- gence. The remote caufe is probably the ftimulus of the fe- men ; whence the phallus becomes diftended with blood by the arterial propulfion of it being more llrongly excited than the correfpondent venous abforption At the fame time a new fenfe is produced in the other termination of the urethra ; which, like itching, requires fome exterior friCtion to facilitate the removal of the caufe of the maniacal actions, which may probably be in- creafed in thofe cafes by fome affociated hallucination of ideas. It differs from priapifmus chronicus in the defire of its appro- priated objeCt, which is not experienced in the latter, Clafs I. I. 4. 6. and from the priapifmus amatorius, Clafs II. 1. 7. 9. in the maniacal aCtions in confequence of defire. The furor ute- rinus, or nymphomania, is a fimilar difeafe. M. M. VenefeCtion Cathartics. Torpentia. Marriage. 17 Lra. Anger is caufed by offended pride. Weare not angry at breaking a bone, but become quite inlanc from the fmalleil ftroke of a whip from an inferior. Ira furor brevis. An- ger is not only itfelf a temporary madnefs, but is a frequent at- * tendant 326 DISEASES Class HI. 1. 2.18. tendant on other infanities, and as, whenever it apppears, it dif- tinguilhes infanity from delirium, it is generally a good fign in fevers with debility. An injury voluntarily inflicted on us by others excites our ex- ertions of felf-defence or of revenge againft the perpetrator of it; but anger does not fucceed in any great degree unlefs our pride is offended ; this idea is the maniacal hallucination, the pain of which fometimes produces fuch violent and general ex- ertions of our mufcles and ideas, as to difappoint the revenge we meditate, and vainly to exhaull our fenforial power. Hence angry people, if not further excited by difagreeable language, are liable in an hour or two'to become humble, and forryfor their violence, and willing to make greater conceflions than required. M. M. Be filent when you feel yourfelf angry. Never ufe loud oaths, violent upbraidings, or ftrong expreflions of counte- nance, or gelliculations of the arms, or clenched fills ; as thefe by their former affbciations with anger will contribute to in- creafe it. I have been told of a fergeant or corporal, who be- gan moderately to cane his foldiers, when they were awkward in their exercife, but being addicted to fwearing and coarfe lan- guage, he ufedfoon to enrage himfelf by his own expreflions of an^er, till toward the end he was liable to be at the delin- quents unmercifully. 18. Rabies. Rage. A defire of biting others, moil frequent- ly attendant on canine madnefs. Animals in great pain, as in the colica faturnina, are faid to bite the ground they lie upon, and even their own flelh; I have feen patients bite the attend- ants, and even their own arms, in the epilepfia dolorifica. It feems to be an exertion to relieve pain, as explained in Seft. XXXIV. 1.3. The dread of water in hydrophobia is occafion- ed by the repeated painful attempts to fwallow it, and is there- fore not an effential or original part of the difeafe called canine madnefs. See Clafs III. 1. 1. 15. There is a mania reported to exift in fome parts of the eaft, in which a man is faid to run a muck ; and thefe furious mani- acs are believed to have induced their calamity by unlucky gam- ing, and afterwards by taking large quantities of opium; whence the pain of defpair is joined with the energy of drunkennefs ; they are then faid to fally forth into the molt populous ftreets, and to wound and flay all they meet, till they receive their own death, which they defire to procure without the greater guilt, as they fuppofe, of fuicide. M. M. When there appears a tendency to bite in the pain_ ful epilepfy, the end of a rolled up towel, or a wedge of foft wood, fhould be put into the mouth of the patient. As a bul- Class III. 1. 2. 19. OF VOLITION. 327 let is faid fometimes to be given to a foldier, who is to be fe- verely flogged, that he may by biting it better bear his punifh- ment. 19. fytta. A defire to fwallow indigeftible fubftances. I once faw a young lady, about ten years of age, who filled her ftomach with the earth out of a flow'er-pot, and vomited it up with fmall flones, bits of wood, and wings of infers amongft it. She h^td the bombycinous complexion, and looked like a chloro- tic patient, though fo young ; this generally proceeds from an acid in the ftomach. M. M. A vomit. Magnefia alba. Armenian bole. Rhu- barb. Bark. Steel. A blifter. See Clafs I. 2. 4 5. 20. Cacofttia. Avcrfion to food. This may arife, without difeafe of the ftomach, from connecting naufeous ideas to our ufual food, as by calling a ham a hog's a . This madnefs is much inculcated by the ftoic philofophy. See Antoninus' Meditations. See two cafes of patients who refufcd to take nourilhment, Clafs III. I. 2. 1. Averfions to peculiar kinds of food are thus formed early in life by afl'ociation of fome maniacal hallucination with them, I remember a child, who on tafting the griftle of fturgeon, afked whatgriftle was? And being told it was like the divifion of a man's nofe, received an ideal hallucination ; and for twenty years afterwards could not be perfuaded to tafte fturgeon. The great fear or averfion, which fome people experience at the fight of fpiders, toads, crickets, and the like, have generally- had a fimilar origin. M. M. Aflbciate agreeable ideas with thofe which difguft ; as call a fpider ingenious,a frog clean and innocent; and reprefs all expreflions of difguft by the countenance, as fuch e.xpreflions contribute to preferve, or even to increafe the energy of the ideas aflbciated with them ; as mentioned above in Species 17. Ira. 21. Syphilis imaginaria. The fear that they are infeCled with the venereal difeafe, when they have only deferred it, is a very common infanity amongft modeft young men ; and is not to be cured without applying artfully to the mind ; a little mercury mud be given, and hopesofa cure added weekly and gradually by interview or correfpondence for fix or eight weeks. Many of thefc patients have been repeatedly falivated without curing the mind 1 22. Pfora imagiaaria. I have twice feen an imaginary itch, and twice an imaginary diabetes, where there was not the leaft veflige of either of thofe difeafes, and once an imaginary deaf- nefs, v here the patient heard perfectly well. In all thefecales the hallucinated idea is fo powerfully excited, that it is not to be changed 328 DISEASES Class III. 1. 2. 23. changed fuddenly by ocular fenfation, or reafon. Yet great perfeverance in the frequently prefenting contrary ideas will fometimes llowly remove this hallucination, or in great length of time oblivion, or forgetfulnefs, performs a cure, by other means in vain attempted. 23. Tabes imaginaria. This imaginary difeafe, or hallucina- tion, is caufed by the fuppofed too great frequency of parting with the femen, and had long impofed upon the phyfician as well as the patient, till Mr. John Hunter firft endeavoured to Ihew, that in general the morbid effects of this pollution were in the imagination ; and that thofe were only liable to thofe ef- fects in general, who had been terrified by the villanous books, which pretend to prevent or to cure it, but which were purpofely written to vend fome quack medicine. Molt of thofe unhappy patients, whom I have feen, had evidently great impreflion of fear and felf-condemnation on their minds, and might be led to make contradictory complaints in almolt any part of the body, and if their confeflions could be depended on, had not ufed this pollution to any great excefs. M. M. 1. Allure them if the lofs of the femen happens but twice a week, it will not injure them. 2 Marry them. The laft is a certain cure ; whether the difeafe be real or imaginary. Cold partial bath, and aftringent medicines frequently taken,on- ly recal the mind to the difeafe, or to the delinquency ; and thence increafe the imaginary effects and the real caufe, if fuch exifts. Mr deltroyed himfelf to get free from the pain of fear of the fuppofed ill confequences of felf-pollution, without any other apparent difeafe ; whofe parents I had in vain advifed to marry him, if poffible 24 Sympatbia aliena. Pity. Our fympathy with the pleaf- ures and pains of others diftinguilhes men from other animals ; and is probably the foundation of what is termed our moral fenfe ; and the fource of all our virtues. See Sett. XXII. 3. 3. When our fympathy with thoie miferies of mankind, which we cannot alleviate, rifes to excefs, the mind becomes its own tor- mentor ; and we add to the aggregate fum of human mifery, which we ought to labour to diminilh ; as in the following elo- quent lamentation from Akenfide's Pleafures of Imagination, Book II. 1. 200. - Dark, midnight Itorms, the fcene of human things Appear'd before me ; deferts, burning fands, Where the parch'd adder dies ; the frozen fouth s And defolation blafting all the weft With rapine and with murder. Tyrant power Here fits enthroned in blood; the baleful charms Of Class III. 1. 2. 25. OF VOLITION. 329 Of fuperftition there infedt the ikies, And turn the fun to horror. Gracious Heaven ! What is the life of man ? Or cannot thefe, Not thefe portents thy awful will fuffiee ? That, propagated thus beyond their fcope, They rife to ail their cruelties anew In my afflicted bofom, thus decreed The univerfal fenlitive of pain, The wretched heir of evils not its own ! A poet of antiquity, whole name I do not recollect, is faid to have written a book defcribing the miferies of the world, and to have deilroyed himfelfatthe conclufion of his talk. This fym- pathy, with all fenlitive beings, has been carried fo far by fome individuals, and even by whole tribes, as the Gentoos, as not only to reftrain them from killing animals for their fupport, but even to induce them to permit infects to prey upon their bodies. Such is however the condition of mortality, that the firft law of nature is, " Eat or be eaten." We cannot long exift without the deftrudion of other animal or vegetable beings, either in their mature or their embryon ftate. Unlefs the fruits, which furround the feeds of fome vegetables, or the honey ftolen from them by the bee, may be faid to be an exception to this afler- tion. See Botanic Garden, P. I. Cant. I 1. 278. Note. Hence, from the neceflity of our nature, we may be fuppofed to have a right to kill thofe creatures, which we want to eat, or which want to eat us. But to deftroy even infeds wantonly fhews an unreflecting mind or a depraved heart. Neverthelefs mankind may be well divided into the felfilh and the focial ; that is, into thofe whofe pleafures arife from grati- fying their appetites, and thofe whofe pleafures arife from their fympathifing with others. And according to the prevalence of thefe oppofing propenlities we value or diflike the pofleflor of them. In conducing the education of young people, it is a nice matter to infpire them with fo much benevolent fympathy, or compaflion, as may render them good and amiable ; and yet not fo much as to make them unhappy at the fight of incurable dif- trefs. We fliould endeavour to make them alive to fympathize with all remediable evils, and at the fame time to arm them with fortitude to bear the fight of fuch irremediable evils, as the acci- dents of life muft frequently prefent before their eyes. About this I have treated more at large in a plan for the conduCt of a boarding-fchool for ladies, which I intend to publilh in the courfe of the next year. 25. Educatio heroic a. From the kinds and degrees of infan - ities already enumerated, the reader will probably recoiled: ma- Vol. II. T t ny 330 DISEASES Class III. i. 2. 25. ny more from his own obfervation ; he will perceive that all extraordinary exertions of voluntary action in confequence of fome falfe idea or hallucination, which ftrongly affeds us, may philofophically, though not properly, be termed an infanity ; he will then be liable to divide thefe voluntary exertions into difagreeable, pernicious, deteftable, or into meritorious, delega- ble, and even amiable, infanities. And will laftly be induced to conceive, that a good education confifls in the art of produc- ing fuch happy hallucinations of ideas, as may be followed by fuch voluntary exertions, as may be termed meritorious or ami- able infanities. The old man of the mountain in Syria, who governed a fmall nation of people called Aflaflines, is recorded thus to have edu- cated thofe of his army who were defigned to aflaflinate the princes with whom he was at war. A young man of natural activity was chofen for the purpofe, and thrown into a deep fleep by opium mixed with his food ; he was then carried into a garden made to reprefent the paradife of Mahomet, with flow- ers of great beauty and fragrance, fruits of delicious flavour,and beautiful Houries beckoning him into the (hades. After a while, on being a fecond time ftupified with opium, the young enthufiaft was reconveyed to his apartment; and on the next day was aflured by a prieft,'that he was defigned for fome great ex- ploit, and that by obeying the commands of their prince, im- 'mortal happinefs awaited him. Hence it is eafy to colleft how the firfl; impreffions made on us by accidental circumllances in our infancy continue through life to bias our affeftions, or miflead our judgments. One of my acquaintance can trace the origin of his own energies of ac- tion from fome fuch remote fources, which juftifies the obferva- tion of M Roufleau, that the feeds of future virtues or vices are oftener fown by the mother than the tutor. ORDO Class HI. 2. 1. OF VOLITION. 331 ORDO II. Increafed Volition. GENUS I. With decreafed action of the mufcles. Our mufcles become fatigued by long contraction, and ceafe for a time to be excitable by the will ; owing to exhaultion of the fenforial power, which refides in them. After a fliort inter- val of relaxation the mufcle regains its power of voluntary con- traction ; which is probably occafioned by a new fupply of the fpirit of animation. In weaker people thefe contraCtions ceafe fooner, and therefore recur more frequently, and are attended with fhorter intervals of relaxation, as exemplified in the quick- nefs of the pulfe in fevers with debility, and in the tremors of the hands of aged or feeble people. After a common degree of exhaultion of the fenforial power in a mufcle, it becomes again gradually reftored by the reft of the mufcle, and even accumulated in thofe mufcles, which are moll frequently ufed ; as in thofe which conftitute the capilla- ries of the Ikin after having been rendered torpid by cold. But in thofe mufcles, which are generally obedient to volition, as thofe of locomotion, though their ufual quantity of fenforial power is reftored by their quiefcence, or in Heep (for Heep af- feCts thefe parts of the fyftem only), yet but little accumulation of it fucceeds. And this want of accumulation of the fenforial power in thefe mufcles, which are chiefly lubfervient to voli- tion, explains to us one caufe of their greater tendency to para- lytic affeCtion. It muft be obferved, that thofe parts of the fyftem, which have been for a time quiefcent from want of ftimulus, as the veflels of the fkin, when expofed to cold, acquire an accumula- tion of fenforial power during their inactivity ; but this does not happen at all, or in much lefs quantity, from their quief- cence after great expenditure of fenforial power by a previous exceffive ftimulus, as after intoxication. In this cafe the muf- cles or organs of fenfe gradually acquire their natural quantity of fenforial power, as after fleep ; but not an accumulation or fuperabundance of it. And by frequent repetitions of exhauf- tion by great ftimulus, thefe veflels ceafe to acquire their whole natural quantity of fenforial power ; as in the fcirrhous ftom- ach, and fcirrhous liver, occafioned by the great and frequent ftimulus 332 DISEASES Class III. 2. 1. 1. ftimulus of vinous fpirit ; which may properly be termed irri- tative paralyfis of thofe parts of the fyftem. In the fame manner in common palfies the inaClion of the paralytic mufcle feems not to be owing to defeCt of the ftimu-s lus of the will, but to exhauftion of fenforial power. Whence it frequently follows great exertion, as in Sett, XXXIV. i. 7. Thus fome parts of the fyftem may ceafe to obey the will, as in common paralyfis ; others may ceafe to be obedient to fenfation, as in the impotency of age ; others to irritation, as in fcirrhous vifcera ; and others to aiTociation, as in impediment of fpeech ; yet though all thefe may become inexcitable, or dead, in rcfpeCt to that kind of ftimulus, which has previoufly exhaufted them, whether of volition, or fenfation, or irritation, or aflbciation, they may ftill in many cafes be excited by the others. SPECIES. 1. Laflitudo. Fatigue or wearinefs after much voluntary ex- ertion. From the too great expenditure of fenforial power the mufcles are with difficulty brought again into voluntary con- traction ; and feem to require a greater quantity or energy of vo- lition for this purpofe. At the fame time they ftill remain obe- dient to the ftimulus of agreeable fenfation, as appears in tired dancers finding a renovation of their aptitude to motion on the acquifition of an agreeable partner; or from a tired child riding on a gold-headed cane, as in SeCt. XXXIV. 2. 6. Thefe muf- cles are likewife ftill obedient to the fenforial power of aflbcia- tion, becaufe the motions when thus excited, are performed in their defigned direCtions, and are not broken into variety of gef- ticulation, as in St. Vitus's dance. A laffitude likewife frequently occurs with yawning at the beginning of ague-fits ; where the production of fenforial pow- er in the brain is lefs than its expenditure. For in this cafe the torpor may either originate in the brain, or the torpor of fome diftant parts of the fyftem may by fympathy affeCt the brain, though in a lefs proportionate degree than the parts primarily affeCted. 2. Vacillatio fenilis. Some elderly people acquire a fee-faw motion of their bodies from one fide to the other, as they fit, like the ofcillation of a pendulum. By thefe motions the muf- cles, which preferve the perpendicularity of the body, are alter- nately quiefcent, and exerted ; and are thus lefs liable to fatigue or exhauftion. This therefore refembles the tremors of old people above mentioned, and not thofe fpafmodic movementsol the face or limbs, which are called tricks, defcribed inCIafs IV. 3- Class III. 2. 1.3. OF VOLITION. 333 3« 2. 2. which originate from excefs of fenforial power, or from efforts to relieve difagreeable fenfation, and are afterwards con- tinued by habit. 3. Tremor fenilis. Tremor of old age confifts of a perpetual trembling of the hands, or of the head, or of other mufcles, when they are exerted ; and is erroheoufly called paralytic ; and feems owing to the fmall quantity of animal power refiding in the mufcular fibres. Thefe tremors only exift when the a fie cl - ed mufcles are excited into action, as in lifting a glafs to the mouth, or in writing, or in keeping the body upright; and ceafe again, when no voluntary exertion is attempted, as in lying down. Hence thefe tremors evidently originate from the too quick exhauftion of the leflened quantity of the fpirit of anima- tion. So many people tremble from fear or anger, when too great a part of the fenforial power is exerted on the organs of fenfe, fo as to deprive the mufcles, which fupport the body creel, of their due quantity. 4. Brachiorum paralyfts. A numbnefs of the arms is a fre- quent fymptom in hydrops thoracis, as explained in Oafs I. 2. 3. 14. and in Sect XXIX. 5. 2.; it alfo accompanies the afthma dolorificum, Oafs III. I. I. 11. and is owing probably to the fame caufe in both. In the colica faturnina a paralyhs affects the wrifts, as appears on the patient extending his arm horizon- tally with the palm downwards, and is often attended with a tu- mor on the carpal or metacarpal bones. See Oafs IV. 2. 2. 10. and I. 2. 4 8. Mr. M , a miner and well-finker, about three yearsago, loft the power of contracting both his thumbs ; the balls or muf- blesof the thumbs are much emaciated, and remain paralytic. He afcribes his difeafe to immerfing his hands too long in cold water in the execution of his bufinefs. He fays his hands had frequently been much benumbed before, fo that he could not without difficulty clench them ; but that they recovered their motion, as foon as they began to glow, after he had dried and covered them. In this cafe there exifted two injurious circumftances of dif- ferent kinds ; one the violent and continued action of the muf- cles, which deftroys by exhaufting the fenforial power ; and the other, the application of cold, which deftroys by defeat of ftim- ulus. The cold feems to have contributed to the paralyhs by its long application, as well as the continued exertion ; but as during the torpor occafioned by the expofure to cold, if the de- gree of it be not fo great as to extinguilh life, the fenforial pow- er becomes accumulated ; there is reafon to believe, that the ex- pofing a paralytic limb to the cold for a certain time, as by cov- ering DISEASES Class III. 2. 1.5. 334 ering it with fnow or iced water for a few minutes, and then covering it with warm flannel, and this frequently repeated, might, by accumulation of fenforial power, contribute to reilore it to a ftate of voluntary excitability. As this accumulation of fenforial power, and confequent glow, feem, in the prefent cafe, feveral times to have contributed to reftore the numbnefs or ina- bility of thofe mufcles, which at length became paralytic. See Clafs I. 2. 3. 21. M. M. Ether externally. Fri&ion. Saline warm bath. Electricity. Mercurial ointment. See Clafs I. 2. 4. 8. 5. Raucedo paralytica. Paralytic hoarfenefs confifts in the al- moft total lofs of voice, which fometimes continues for months, or even years, and is occafioned by inability or paralyfis of the recurrent nerves which ferve the mufcles of vocality, by open- ing or clofing the larynx. The voice generally returns fuddenly, even io as to alarm the patient. A young lady, who had many months been affe&ed with almoit a total lofs of voice, and had in vain tried variety of advice, recovered her voice in an initant, on fome alarm as (he was dancing at an aflembly. Was this owing to a greater exertion of volition than ufual ? like the dumb young man, the fon of Croefus, who is related to have cried out, when he faw his father's life endangered by the fword of his enemy, and to have continued to fpeak ever afterwards. Two young ladies in this complaint feemed to be cured by elec- tric fhocks pafled through the larynx every day for a fortnight. See Raucedo catarrhalis, Clafs II. 1. 3. 5. M. M. An emetic. Electric [hocks. Muftard-feed, a large fpoonful [wallowed whole, or a little bruifed, every morning. Valerian. Burnt fponge. Blifters on each fide of the larynx. Sea-bathing. A gargle of decodtion of feneca. Friction. Fre- quent endeavours to fhout and fing. 6. Viftca urinaria paralyfis. Paralyfis of the bladder is fre- quently a fymptom in irritative fever ; in this cafe the patient makes no water for a day or two ; and the tumor of the blad- der diftended with urine may be feen by the Ihape of the abdo- men, as if girt by a chord below the navel, or diftinguifhed by the hand. Many patients in this fituation make no complaint, and fufler great injury by the inattention of their attendants ; the water muft be drawn ofF once or twice a day by means of a catheter, and the region of the bladder gently prefled by the hand, whilft the patient is kept in a fitting or eredt pofture. See Clafs II. 2. 2. 6. M. M. Bark. Wine. Opium, a quarter of a.grain every fix hours. Balfam of copaiva or of Peru. Tindlure of can- tharides 20 drops twice a day, or repeated fmall blitters. An Glass III. 2. 1.7. OF VOLITION. 335 An inability to empty the bladder frequently occurs to elder- ly men, and is often fatal. This fometimes arifes from their having too long been reftrained from making water from acci- dental confinement in public fociety, or otherwife ; whence the bladder has become fo far diftended as to become paralytic ; and not only this, but the neck of the bladder has become contracted fo as to refill the introduction of the catheter. In this deplora- ble cale it has frequently happened, that the forcible efforts to introduce the catheter have perforated the urethra ; and the in- ftrument has been fuppofed to pafs into the bladder, when it has only paffed into the cellular membrane along the fide of it; of which I believe I have feen two or three inftances ; and after- wards the part has become fo much inflamed as to render the introduction of the catheter into the bladder impracticable. In this fituation the patients are in imminent danger, and fome have advifed a trocar to be introduced into the bladder from the reClum ; which I believe is generally followed by an incurable ulcer. One patient, whom I faw in this fituation, be- gan to make a fpoonful of water after fix or feven days, and gradually in a few days emptied his bladder to about half its fize, and recovered ; but I believe he never afterwards was able completely to evacuate it. In this fituation I lately advifed about two pounds of crude quickfilver to be poured down a glafs tube, which was part of a barometer tube, drawn lefs at one end, and about two feet long, into the urethra, as the patient lay on his back ; which I had previoufly performed upon a horfe ; this eafily paffed, as was fuppofed, into the bladder ; on (landing ereCl it did not return, but on kneeling down, and lying horizontally on his hands, the mercury readily returned ; and on this account it was believed to have paffed into the bladder,as it fo eafily returned, when the neck of the bladder was lower than the fundus of it. But nev- erthelefs as no urine followed the mercury, though the bladder was violently diftended, I was led to believe, that the urethra had been perforated by the previous efforts to introduce a cathe- ter and bougie ; and that the mercury had paffed on the outfide of the bladder into the cellular membrane. As the urethra is fo liable to be perforated by the forcible ef- forts to introduce the catheter, when the bladder is violently dif- tended in this deplorable difeafe, I fhould ftrongly recommend the injedion of a pound or two of crude mercury into the ure- thra to open by its weight the neck of the bladder previous to any violent or very frequent effays with a catheter whether of metal or of elaftic refin. 7. Recti paralyfa. Palfy of the redlum. The redlum intef- tinum. 336 DISEASES Class III. 2. 1.8. tinum, like the urinary bladder in the preceding article, poflefles voluntary power of motion ; though thefe volitions are at times uncontrolable by the will, when the acrimony of the contained, feces, or their bulk, ftimulates it to a greater degree. Hence it happens, that this part is liable to lofe its voluntary power by paralyfis, but is ftill liable to be ftimulated into action by the contained feces. This frequently occurs in fevers, and is a bad fign as a fymptom of general debility ; and it is the fenfibility of the mufcular fibres of this and the urinary bladder remaining, after the voluntarily has ceafed, which occafions thefe two ref- ervoirs fo foon to regain, as the fever ceafes, their obedience to volition ; becaufe the paralyfis is thus fhewn to be lefs complete in thofe cafes than in common hemiplegia; as in the latter the fenfe of touch, though perhaps not the fenfe of pain, is gener- ally deftroyed in the paralytic limb. M. M. A fponge introduced within the fphinfter ani to prevent the conftant difcharge, which fhould have a firing put through it, by which it may be retraced. 8. Parejis voluntaria. Indolence ; or inaptitude to voluntary action. This debility of the exertion of voluntary efforts pre- vents the accomplifhment of all great events in life. It often originates from a miftaken education, in which pleafure or flat- tery is made the immediate motive of adiion, and not future ad- vantage ; or what is termed duty. This obfervation is of great value to thofe, who attend to the education of their own chil- dren. I have feen one or two young married ladies of fortune, who perpetually became uneafy, and believed themfelves ill, a week after their arrival in the country, and continued fo uniform- ly during their ftay ; yet on their return to London or Bath im- mediately loft all their complaints, and this repeatedly .; which I was led to afcribe to their being in their infancy furrounded with menial attendants, who had flattered them into the exertions they then ufed. And that in their riper years, they became tor- pid for want of this ftimulus, and could not amufe themfelves by any voluntary employment; but required ever after, either to be amufed by other people, or to be flattered into activity. This I fuppofe, in the other fex, to have fupplied one fource of ennui and fuicide. See Clafs III. 1.2. 11. 9. Catalepjis is fometimesufed forfixed fpafmodic contradlions or tetanus, as defcribed in Sedt. XXXIV. 1. 5. and in Clafs III. 1. I.. 13. but is properly fimply an inaptitude to mufcular motion, the limbs remaining in any attitude in which they are placed. One patient whom I faw in this fituation, had taken much mercury, and appeared univerfally torpid. He fat in a chair in any pofture he was put, and held a glafs to his mouth for Class III. 2. 1. 10. OF VOLITION. 337 for many minutes without attempting to drink, or withdrawing his hand. He never fpoke, and it was at firft neceffary to compel him to drink broth ; he recovered in a few week with- out relapfe. io. Hemiplegia. Palfy of one fide confifts in the total difo- bedience of the affedted mufcles to the power of volition. As the voluntary motions are not perpetually exerted, there is little fenforial power accumulated during their quiefcence, whence they are lefs liable to recover from torpor, and are thus more frequently left paralytic, or disobedient to the power of volition, though they are fometimes ftill alive to painful fenfation, as to the prick of a pin, and to heat ; alfo to irritation, as in ftretch- ing and yawning ; or to electric (hocks. Where the paralyfis is complete the patient feems gradually to learn to ufe his limbs over again by repeated efforts, as in infancy : and, as time is re- quired for this purpofe, 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 difpute, whether the nerves decuffate or crofs each other before they leave the cavities of the fkull or fpine, feems to be decided in the affirmative by comparative anatomy ; as the op- tic nerves of fome fiffi have been (hewn evidently to crofs each other; as feen by Haller, Elem. Phyfiol. t. v. p. 349. Hence the application of blifters or of ether, or of warm fomentations, fhould be on the fide of the head oppofite to that of rhe affected mufcles. This fubjecSt fhould neverthelefs be nicely determin- ed, before any one fhould trepan for the hydrocephalus inrer- nus, when the difeafe is fhewn to exift only on one fide of the brain, by a fquinting affecting but one eye ; as propofed in Clafs I. 2. 5. 4. Dr. Sommering has fhewn, that a true decuf- fation of the optic nerves in the human fubjed actually exifts, Elem. of Phyfiology by Blumenbach, tranflated by C. Caldwell, Philadelphia. This further appears probable from the oblique direction and infertion of each optic nerve, into the fide of the eye next to the nofe, in a direct line from the oppofite fide of the brain. The vomiting, which generally attends the attack of hemiple- gia, is mentioned in Se£t. XX. 8. and is fimilar to that attend- ing vertigo in fea-ficknefs, and at the commencement of fome fevers. Black flools fometimes attend the commencement of hemiplegia, which is probably an eftiifion of blood from the biliary du<St,wffiere the liver is previoufly affected ; orfomeblood may be derived to the inteftines by its efcaping from the vena cava into the receptacle of chyle during the diftrefs of rhe para- lytic attack ; and may be conveyed from thence into the intef- Vol. II. U u tines 338 DISEASES Class III. 2. 1. 10. tines by the retrograde motions of the lafleals ; as probably fometimes happens in diabetes. See Seet. XXVII. 2. Palfy of one fide of the face is mentioned in Clafs II. 1 4. 6. Paralyfis of the la&eals, of the liver, and of the veins, which are defcrib- ed in Sect. XXVIII. XXX. and XXVII. do not belong to this clafs, as they are not difeafes of voluntary motions. M. M. The electric fparks and fhocks, if ufed early in the difeafe, are frequently of fervice. A purge of aloes, or calo- mel. A vomit. Blitter. Saline draughts. Then the bark. Mercurial ointment or fublimate, where the liver is evidently difeafed ; or where the gutta rofea has previoufly exifted. Sud- den alarm. Frequent voluntary efforrs. Externally ether. Volatile alkali. Fomentation on the head. Friction. When children, who have fuffered a hemiplegia, begin to ufe the af- fected arm, the other hand fhould be tied up for half an hour three or four times a day ; which obliges them at their play to ufe more frequent voluntary efforts with the difeafed limb, and thus fooner to reftore the diffevered aflbciations of motion. In hemiplegia, as well as toward the end of fome fevers with great debility, the parts about the loins are liable to mortify by the preffure of a continued recumbency upon them, and in part by the friction of thofe parts againft the fheet, as the patient Aides down again after being frequently raifed higher in his bed, to prevent which a pillow fhould be put beneath the under- flreethalf way down the bed, as in Clafs II. 1. 2. 4. A folu- tion of fugar of lead, or white lead in fine powder, or a cerate of lapis calaminaris contributes to heal or to prevent thefe ex- coriations. But the moft efficacious preventive confifts in the patient's wearing a pair of linen drawers ; by which means, when he Aides down in his bed, the friction will be between the fheet and his drawers, not between the fheet and his fkm; and this greater fri&ion will in general prevent his Aiding down in bed, when his head and Aioulders are raifed on more pillows, which will on this account alfo contribute much to his comfort; this is alfo worthy the attention of thofe dropfical patients, who are neceffitated to lie with the head raifed high in bed. When thefe patients have any difficulty of fwallowing, they flrould be raifed up when any Auid is put into the mouth, left it fliould fuffocate them. See Apoplexia, No. 16. Nor fhould young children be fed as they lie on their backs, as they are then obliged to fwallow as much as the nurfe pleafes ; like one of the puniftiments formerly ufed in the inquifition, where the delinquent was made to fwallow many quarts of water, as he was chained down on his back, and was fuftbcated by it. In paralyfis of the writts from lead, Mr. Clutterbuck has late- ly Class III. 2.1. 11. OF VOLITION. 339 ly publiflied tome fuccefsful cafes of the ufe of mercurial oint- ment. See Colica Saturnina, I 2. 4 8. See Clafs III. 2. 14. Dr. J. Alderfon has lately much recommended the leaves of thus toxicodendron (fumach,) from i. gr. to iv of the dried powder to be taken three or four times a day. Eflay on Rhus Toxic. Johnfon, London, 1793- But it is difficult to know what medicine is of fervice, as the movements of the mulcles muff: again be learned, as in infancy, by frequent efforts. 11. Paraplegia. A palfy of the lower half of the body di- vided horizontally. Animals may be conceived to have double bodies, one half in general refembling fo exactly the other, and being fupplied with feparate fets of nerves ; this gives rife to hemiplegia, or palfy of one half of the body divided vertically ; but the paraplegia, or palfy of the lower parts of the fyftem, depends on an injury of the fpinal marrow, or that part of the brain which is contained in the vertebras of the back ; by which all the nerves fituated below the injured part are deprived of their nutriment, or precluded from doing their proper offices ; and the mufcles, to which they are derived, are in confequence flifobedient to the power of volition. This fometimes occurs from an external injury, as a fall from ah eminence; of which I faw a deplorable inltance, where the bladder and rectum, as well as the lower limbs, were deprived of fo much of their powers of motion, as depended on volition or fenfation ; but I fuppofe not of that part of it, which depends on irritation. In the fame manner as the voluntary mufcles in hemiplegia are fometimes brought into action by irritation, as in ftretching or pandiculation, defcribed in Se£l. VII. 1. 3. But the moft frequent caufe of paraplegia is from a protuber- ance of one of the fpinal vertebrae ; which is owing to the in- nutrition or foftnefs of bones, defcribed in Clafs I. 2. 2. 17. The cure of this deplorable difeafe is frequently affected by the ftimulus of an iflue placed on each fide of the prominent {pine, as firft publiflied by Mr. Pott. The other means recommend- ed in foftnefs of bones (hould alfo be attended to ; both in re- £pe<St to the internal medicines, and to the mechanical methods of fupporting, or extending the fpine ; which laft, however, in this cafe requires particular caution. 12. Somnus. In deep all voluntary power is fufpended, fee Sect. XVIII. An unufual quantity of fleep is often produc- ed by weaknefs. In this cafe fmall dofes of opium, wine, and bark, may be given with advantage. For the periods of fleep, fee Clafs IV. 2 4. 1. The fubfequent ingenious obfervations on the frequency of the DISEASES 340 Class III. 2. i» 12. the pulfe, which fometimes occurs in deep, are copied from a letter of Dr. Currie of Liverpool to the author. " Though reft in general perhaps renders the healthy pulfe flower, yet under certain circumftancesthe contrary is the truth. A full meal without wine or other ftrong liquor does not in- creafe the frequency of my pulfe, while I fit upright, and have my attention engaged. But if I take a recumbent pofture af- ter eating, my pulfe becomes more frequent, efpecially if my mind be vacant, and I become drowfy ; and, if I dumber, this increafed frequency is more confiderable with heat and dudiing. " This I apprehend to be a general truth. The obfervation may be frequently made upon children ; and the reftlefs and fe- veriih nights experienced by many people after a full fupper are, I believe, owing to this caufe. The fupper occafions no incon- venience, whilft the perfon is upright and awake ; but, when he lies down and begins to deep, efpecially if he does not per- fpire, the fymptoms above mentioned occur. Which may be thus explained in part from your principles. When the power oi volition is aboliftied, the other fenforial actions are increafed. In ordinary deep this doesnot occafion increafed frequency of the pulfe ; but where deep takes place during the procefs of di- geftion, the digeftion itfelf goes on with increafed rapidity. Heat is excited in the fyftem fafter than it is expended ; and operating on the fenfitive actions, it carries them beyond the limitation of pleafure, producing, as is common in fuch cafes, increafed frequency of pulfe " It is to be obferved, that in fpeaking of the heat generated under thefe circumftances, I do not allude to any chemical evo- lution of heat from the food in the procefs of digeftion. I doubt if this takes place to any confiderable degree, for I do not ob- ferve that the parts incumbent on the ftomach are increafed in heat during the moft hurried digeftion. It is on fome parts of the furface, but more particularly on the extremities of the body, that the increafed heat excited by digeftion appears, and the heat thus produced arifes, as it fhould feem, from the fympa- thy between the ftomach and the veifels of the Ikin. The parts moft aft'edled are the palms of the hands, and the foies of the feet. Even there the thermometer feldom rifes 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 tem- perature of thefe parts, and therefore producing an uneafy fen- fation of heat, a fenfation increafed by the great fenfibility of the parts affected. " That the increafed heat excited by digeftion in deep is the 1 caufe Class III. i. 1. 12. OF VOLITION. 341 caufe of the accompanying fever, feems to he confirmed by ob- ferving, that if an increased expenditure of heat accompanies the increafed generation of it (as when perfpiration on the ex- tremities or furface attends this kind of fleep) the frequent pulfe and flufhed countenance do not occur, as I know by experi- ment. If, during the feverifh fleep already mentioned, I am awakened, and my attention engaged powerfully, my pulfe becomes almofl immediately flower, and the fever gradually fub- fides" From thefe obfervations of Dr. Currie it appears, that, while in common fleep the actions of the heart,arteries,and capillaries, are ftrengthened by the accumulation of fenforial power during the fufpenfion of voluntary acSlion, and the pulfe in confequence becomes fuller and flower ; in the feverifh fleep above defcrib- ed the actions of the heart arteries, and capillaries, are quicken- ed as well as ftrengthened by their confent with the increafed actions of the flomach, as well as by the ftimulus of the new chyle introduced into the circulation. For the flomach, and all other parts of the fyflem, being more fenfible and more irritable during fleep, Sett. XVIII. 15. and probably more ready to a6t from aflbeiation, are now exerted with greater velocity,as well as ftrength, conftituting a temporary fever of the fenfitive irri- tated kind, refembling the fever excited by wine in the begin- ning of intoxication j or in fome people by a full meal in their waking hours. Sedb. XXXV. 1. On waking, this increafed fenfibility and irritability of the fyflem ceafes by the renewed exertions of volition ; in the fame manner as more violent exertions of volition deltroy greater pains ; and the pulfe in confequence fubfides along with the in- creafe of heat; if more violent efforts of volition are exerted, the fyflem becomes flill lefs affe£ted by fenfation or irritation. Hence the fever and vertigo of intoxication are lefiened by in- tenfe thinking, SetSl. XXI. 8 ; and infane people are known to bear the pain of cold and hunger better than others, Sedb. XXXIV. 2. 5.; and laflly, if greater voluntary efforts exift, as in violent anger or violent exercife, the whole fyflem is thrown into more energetic a6lion, and a voluntary fever is induced, as appears by the red fkin, quickened pulfe, and increafe of heat ; whence dropfies and fevers with debility are not unfrequently removed by infanity. Hence the exertion of the voluntary power in its natural de- gree diminifhes the increafed fenfibility, and irritability, and probably the increafed aflbciability, which occur during fleep ; and thus reduces the frequency of the pulfe in the feverifh fleep after a full meal. In its more powerful flate of exertion, it di- miniflies 342 DISEASES Class III. 2. 1.13. minifhes or deftroys fenfations and irritations, which are ftronger than natural, as in intoxication, or which precede convulfions, or infanity In its ftdl more powerful degree, the fuperabun- dance of this fenforial power actuates and invigorates the whole moving fyftem, giving ftrength and frequency to the pulie, and an univerfal glow both of colour and of heat, as in violent an- ger, or outrageous infanities. If, in the feveriih fleep above defcribed, the (kin becomes cool- ed by the evaporation of much perfpirable matter, or by the ap- plication of cooler air, or thinner clothes, the actions of the cu- taneous capillaries are leflened by defebt of the itimulus of heat, which counteracts the increafe of fenfibility during fleep, and the pulfations of the heart and arteries become flower from the leflened ftimulus of the particles of blood thus cooled in the cu- taneous and pulmonary veflels. Hence the admiflion of cold air, or ablution with fubtepid or with cold water, in fevers with hot fkin, whether they be attended with arterial ftrength, or ar- terial debility, renders the pulfe flower ; in the former cafe by diminifhing the ftimulus of the blood, and in the latter by lef- fening the expenditure of fenforial power. See Suppl I. 8. and 15. 13. Incubus. The night-mare is an imperfect fleep, where the defire of locomotion is vehement, but the mufcles do not obey the will; it is attended with great uneafinels, a fenfe of fuffbcatiun, and frequently with fear. It is caufed by violent fatigue, or drunkennefs, or indigeftible food, or lying on the back, or perhaps from many other kinds of uneafinefs in our fleep, which may originate either from the body or mind. Now as the aClion of refpiration is partly voluntary, this com- plaint may be owing to the irritability of the fyftem being too fmall to carry on the circulation of the blood through the lungs during fleep, when the voluntary power is fu<pended. Whence the blood may accumuiate in them, and a painful oppreflion fu- pervene ; as in fome haemorrhages of the lungs, which occur during fleep ; and in patients much debilitated by fevers. See Somnus interruptus, Clafs I. 2. 1. 3. and I. 2. I. 9. Great fatigue with a full fupper and much wine, I have been well informed by one patient, always produced this difeafe in himfelf to a great degree. Now' the general irritability of the fyftem is much decreafed by fatigue, as it exhaufts the fenforial power ; and fecondly, too much wine and ftimulating food will again diminifli the irritability of fome parts of the fyftem, by employing a part of the fenforial power, which is already too fmall, indigeftmg a great quantity of aliment ; and in increafing the motions of the organs of fenfe in confequence of fome de- gree Class III. 2. 1. 14. OF VOLITION. 343 gree of intoxication, whence difficulty of breathing may occur from the inirritability of the lungs, as in Clafs I 2. 1. 3. This explains an apparent paradox, why people who are fee- ble, digeit their dinners beft, if they lie down and fleep, as molt animals do, when their ftomachs are full. Yet many weak peo- ple ileep very unealily after a large fupper. If the debility of the patient be not very great, and the dinner he has taken, be moderate, the fufpenfion of voluntary action during fleep pre- vents the expenditure of fo much fenforial power, which may be employed on the actions of the ftomach, and thus facilitate the digeftive procefs. If the patient be further exhaufted as in the evening, or his debility greater, and fleep enfues after a co- pious or Ihmuiating fupper, fo much fenforial power will be exerted on the actions of the ftomach for digeftion, that the circulation of the blood through the lungs will be impeded from the diminithed irritability to external ftimuli, and the abfence of volition, as in the incubus, and fomnus interruptus. M. M. To fleep on a hard bed with the head raifed. Mod- erate fupper. The bark. By fleeping on a harder bed the pa- tient will turn himfelf more frequently, and not be liable to fleep too profoundly, or lie too long in one pofture. To be awakened frequently by an alarm clock. 14. Letbargus. The lethargy is a (lighter apoplexy. It is fuppofed to originate from univerfal preflure on the brain, and is faid to be produced by compreffing the fpinal marrow, where there is a deficiency of the bone in the fpina bifida. See Sect. XVIII 20. Whereas in the hydrocephalus there is only a par- tial preflure of the brain : and probably in nervous fevers with ftupor the preflure on the brain may affect only the nerves of the fenfes, which lie within the ikull, and not thofe nerves of the medulla oblongata, which principally contribute to move the heart and arteries ; whence in the lethargic or apople&ic ftu- por the pulfe is flow as in fleep, whereas in nervous fever the pulfe is very quick and feeble, and generally fo in hydrocephalus. In cafes of obftruifted kidneys, whether owing to the tubuli uriniferi being totally obftrufted by calculous matter, or by their paralyfis, a kind of drowfinefsor lethargy comes on about the eighth or ninth day, and the patient gradually finks. See Clafs I. 1. 3. 9. 15. Syncope epileptica, is a temporary apoplexy, the pulfe con- tinuing in its natural ftate, and the voluntary power fufpended. This terminates the paroxyfms of epilepfy. When the animal power is much exhaufted by the preced- ing convulfions, fo that the motions from fenfation as well as thofe from volition are fufpended 5 in a quarter or half an hour the 344 DISEASES Class III. 2. 1. 16. the fenforial power becomes reftored, and if no pain, or irrita- tion producing pain, recurs, the fit of epilepfy ceafes ; if the pain recurs, or the irritation, which ufed to produce it, a new fit of convuifion takes place, and is fucceeded again by a fyn- cope. See Epilepfy, Clafs III. i. 1.7. 16 Apoplexia- Apoplexy may be termed an univerfal palfy, or a permanent fleep. In which, where the pulfe is weak, co- pious bleeding mult be injurious; as is well obferved by Dr. Heberden, Tranf. of the College. Mr. -, about 70 years of age, had an apople&ic feizure. His pulfe was ftrong and full. One of the temporal arteries was opened, and about ten ounces of blood fuddenly taken from it. He feemed to receive no benefit from this operation ; but gradually funk, and lived but a day or two. If apoplexy arifes from the preflure of blood extravafated on the brain, one moderate venefeCtion may be of fervice to pre- vent the further effufion of blood ; but copious venefeclion mult be injurious by weakening the patient ; fince the effufed blood mull have time, as in common vibices or bruifes, to undergo a chemico-animal procefs, fo to change its nature as to fit it for abforption ; which may take two or three weeks, which time a patient weakened by repeated venefeiftion or arteriotomy may not furvive. Mrs. , about 40 years old, had an apoplectic feizure af- ter great exertion from fear ; fhe had lain about 24 hours with- out fpeech, or having fwallowed any liquid. She was then forci- bly raifed in bed, and a fpoonful of folution of aloes in wine put into her mouth, and the end of the fpoon withdrawn, that fhe might more eafily fwallow the liquid.-This was done every hour, with broth, and wine and water intervening, till evacua- tions were procured ; which with other means had good effect, and fhe recovered, except that a confiderable degree of hemi- plegia remained, and fome imperfection of her fpeech. Many people, who have taken fo much vinous fpirit as to ac- quire the temporary apoplexy of intoxication, and are not im- properly faid to be dead-drunk, have died after copious venefec- tion, I fuppofe in confequence of it. I once faw at a public meeting two gentlemen in the drunken apoplexy ; they were to- tally infenfible with low pulfe, on this account they were directed not to lofe blood, but to be laid oil a bed with their heads high, and to be turned every half hour ; as foon as they could fwallow, warm tea was given them, which evacuated their ftomach, and they gradually recovered, as people do from lefs degrees of in- toxication. M. M. Cupping on the occiput. VenefeClion once in mod- erate Class III. 2. 1.17., OF VOLITION, 345 erate quantity. Warm fomentations long continued and fre- quently repeated on the (haved head. Solution of aloes. Clyf- ters with folution of aloes and oil of amber. A blifter on the fpine. An emetic. Afterwards the bark, and fmall dofes of chalybeates. Small electric (hocks through the head. Errhines. If fmall dofes of opium ? mercurial ointment rubbed on the head or neck ? Where there is a difficulty of fwallowing in apoplectic or par- alytic patients, or in thofe near death in fevers, or other difeaf* es, no fluid (hould be put into their months as they lie upon their backs, left it fhould choke them ; but they (hould be raifed and fupported upright in their beds, and ftimulated by ftrong light, and fpoken to in a louder voice, defiring them to fwallow, as the fluid is put into the mouth, and the fpoon (hould be im- mediately withdrawn, that they may clofe their mouths. Hence if they cannot fwallow, it will flow out of their mouths, and not endanger fuffocating them. See Hemiplegia, Spec, io, of this genus. 17. Mors a frigore. Death from cold The unfortunate travellers, who almoft every winter peri(h in the fnow, are much exhaufted by their efforts to proceed on their journey, as well as benumbed by cold. And as much greater exercife can be borne without fatigue in cold weather than in warm ; becaufe the exceffive motions of the cutaneous veffels are thus prevented, and the confequent wafte of fenforial 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 thofe veffels moft, which have been generally excited into aCtion by irritation ; for when the feet are much benumbed by cold, and painful, and at the fame time almoft infenfible to the touch of external objetts, the voluntary mufcles retain their motions, and we continue to walk on ; the fame happens to the fingers of children in throw- ing fnow-balls, the voluntary motions of the mufcles continue, though thofe of the cutaneous veffels are benumbed into inac- tivity. Mr. Thompfon, an elderly gentleman of Shrewfbury, was feized with hemiplegia in the cold bath ; which I fuppofe might be owing to fome great energy of exertion, as much as to the coldnefs of the water. As in the inftance given of Mr. Nairn, who, by the exertion to fave his relation, periflied himfelf. See Sert. XXXIV. 1. 7. Whence I conclude, that, though heat is a fluid neceffary to mufcular motion, both perhaps by its ftimulus, and by its keep- ing the minute component parts of the ultimate fibrils of the Vol. II. * W w mufcles 346 DISEASES Class III. 2.1. 17. mufcles or organs of fenfe at a proper diftance from each other ; yet pafalyfis, properly fo called, is the confeq uence of exhauf- tion of fenforial power by exertion. And that the accumula- tions of it during the torpor of the cutaneous veflels by expofure to cold, or of fome internal vifcus in the cold fits of agues, arc frequently inftrumental in recovering the ufeof paralytic limbs, or of the motions of other paralytic parts of the fyftem. See Spec. 4. of this genus. Animal bodies refift the power of cold probably by their ex- ertions in confequence of the pain of cold, fee Botan. Gard. V. i. additional note xii But if thefe increafed exertions be too violent, fo as to exhauft the fenforial power in producing un- necefl'ary motions, the animal will probablyfooner perifh. Thus a moderate quantity of wine or fpirit repeated at proper inter- vals of time might be of fervice to thofe, who are long expofed to exceflive cold, both by increafing the adion of the capillary veflels, and thus producing heat, and perhaps by increafing in fome degree the fecretion of fenforial power in the brain. But the contrary muft happeh when taken immoderately, and not at due intervals. A well-attefted hiftory was once related to me of two men, who fet out on foot to travel in the fnow, one of whom drank two or three glaffes of brandy before they began their journey, the other contented himfelf with his ufual diet and potation ; the former of whom perifhed in fpite of any af- fiftance his companion could afford him ; and the other perform- ed his journey with fafety. In this cafe the fenforial power was exhaufted by the unneceffary motions of incipient intoxication by the ftimulus of the brandy, as well as by the exertions of walking ; which fo weakened the dram-drinker, that the cold fooner deftroyed him ; that is, he had not power to produce fuf- ficient mufcular or arterial action, and in confequence fufficient heat, to fupply the great expenditure of it. Hence the capilla- ries of the fkin firft ceafed to adl, and became pale and empty ; next thofe which are immediately aflbciated with them, as the extremities of the pulmonary artery, as happens on going into tjie cold bath. By the continued inadion of thefe parts of the vafcular fyftem the blood becomes accumulated in the internal arteries, and the brain is fuppofed to be affeded by its compref- fion ; becaufe thefe patients are faid to fleep, or to become apo- ple<SHc, before they die. I overtook a fifherman afleep on his panniers on a very cold frofty night, but on waking him he did not appear to be in any degree of ftupor. See Clafs I. 2.2. 1. When travellers are benighted in deep fnow, they might fre- quently be faved by covering themfelves in it, except a fmall aperture for air ; in which fituation the lives of hares, fheep, and Class III. 2. 1. 17. OF VOLITION. 347 and other animals, are fo often preferved. The fnow, both in reipetf 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 dif- folves, is attracted into the pores of the remainder of it, the fit- uation 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. IL notes on Ane- mone, Barometz, and Mufcus. If thefe fafts were more gen- erally underitood, it might annually fave the lives of many. After any part of the vafcular fyftem of the body has been long expoled to the cold, the fenforial power is fo much accu- mulated in it, that on coming into a warm room the pain of hot- ach is produced, and inflammation, and confequent mortifica- tion, owing to the great exertion of thofe veflels, when again ex- poled to a moderate degree of warmth. See Sedt. XII. 5. Whence the propriety of applying but very low degrees of heat to limbs benumbed with cold at firft, as of fnow in its ftate of difi'olving, which is at 32 degrees of hCat, or of very cold water. A French writer has obferved, that if frozen apples be thawed gradually by covering them with thawing fnow, or immerfing them in very cold water, they do not lofe their tafte ; if this fact was well afcertained, it might teach us how to prefervc other ripe fruits in ice-houfes for winter confumption. See Sup. I. M- 3- The pain of cold is probably owing to the accumulation of the fenforial power of irritation. As the Ikins of thofe, who have been conftantly ftimulated into great action by external heat, mull foon poflefs an accumulation of that fenforial power, when the ftimulus of heat is withdrawn. See taedium vitae from ac- cumulation of the fenforial power of volition, III. f. 2. 11. 0RDO 348 DISEASES Class III. 2. 2. 1. ORDO II. Decreafed Volition. GENUS II. With decreafed Anions of the Organs of Senfe. SPECIES. i. Recollehlionis jaHura. Lofs of recolleClion. This is the defeat of memory in old people, who forget the actions of yef- terday, being incapable of voluntary recollection, and yet re- member thofe of their youth, which by frequent repetition are introduced by aflbciation orfuggeftion. This is properly the paralyfis of the mind ; the organs of fenfe do not obey the vol- untary power ; that is, our ideas cannot be recollected, or aCled over again by the will. After an apopleftic attack the patients, on beginning to re- cover, find themfelves moft at a lofs in recolleCtingproper names of perfons or places ; as thofe words have not been fo frequent- ly aflbciated with the ideas they Hand for, as the common words of a language. Mr. a man of ftrong mind, of a Ihort- necked family, many of whom had buffered by apoplexy, after an apopleCtic fit, on his recovering the ufe of fpeech, after re- peated trials to remember the name of a perfon or place,applaud- ed himfelf, when he fucceeded, with fuch a childifh fmile on the partial return of his fagacity, as very much affeCted me.-Not long, alas ! to return ; for another attack in a few weeks de- ftroyed the whole. SeeClafs IV. 2. 3. 8. I faw a child after the fmall-pox, which was left in this fitu- ation ; it was lively, aCtive, and even vigorous ; but (hewed that kind of furprife, which novelty excites, at every objeCl it view- ed ; and that as often as it viewed it. I never heard the ter- mination of the cafe. 2. Stultitia voluntaries. Voluntary folly. The abfence of voluntary power and confequent incapacity to compare the ideas of prefent and future good. Brute animals may be faid to be in this fituation, as they are in general excited into aCliononly by their prefent painful or pleafurable fenfations. Hence though they are liable to furprife, when their palling trains of ideas are diffevered by violent ftimuli: yet are they not affeCled with wonder or aftonilhment at the novelty of objects, as they pof- fefs but in a very inferior degree, that voluntary power of com- paring Class III. 2. 2. 3. OF VOLITION. 349 paring the prefent ideas with thofe previoufly acquired, which diftinguifhes mankind ; and is termed analogical reafoning, when deliberatively exerted ; and intuitive analogy, when ufed without our attention to it, and which always preferves our hourly trains of ideas confiftent with truth and nature. See Sed. XVII. 3. 7. 3. Ratiocinatio verbofa. Verbal reafoning. This arifes from the feeble or inaccurate exertions of the faculty of volition in the aa of recalling the ideas of things, and thus miftaking the ideas of words for them. One great imperfeaion of language con- fifts in the ufe of what Mr. Horne Tooke calls general terms, as mentioned in Sea. XV. 1.5. and Sea. XVI. 17. of this work, and which Mr. Locke fuppofed to exprefs abftraaed or general ideas, fuch as the word cattle or army, which in common con- verfation includes any part of property of thofe complex things, and is thus liable to miflead inaccurate thinkers. Thus it was faid laft night, " That horfe ftrikes fire as he paffes along the pavement." And it was added jocularly, " that his feet muft be as hard as iron," which miftake might arife from the general term, horfe, including in common converfation both every part of the animal and his accoutrements. A fecond fource of falfe reafoning may arife from the fame word having two lignifications totally different from each oth- er; which may miflead thofe who reafon from ideas of words initead of ideas of things. Thefe are generally efleemed witti- cifms, and are called puns or quibbles ; as the jocular fyllogifm on the word fpirit. " Brandy is a fpirit; the Devil is a fpirit ; therefore brandy is the devil." A third fource of falfe reafoning is derived from the two-fold meaning of fome fentences, or phrafes in all languages; this is alfo ufed defignedly in jocular compofiiions, and conttitutes the wit of fome comedies. An old miller riding on his fack of flour was accofted by two young Cantabs, who rode on each fide of him, with " Gentlemen of your profeflion have fometimes a doubtful character-pray, miller, do you think yourfelf more knave or fool r" the witty miller anfwered, looking firtt at one of them and then at the other, " I think myfelf at prefent be- tween both." This double entendre of a fentence was ufed by the priefts of the ancient oracles to deceive the inquirer into fu- ture events. As that of Aio te, JEacide, Romanos vincere potTe. I fay, that you, TEacides, the Romans fliall conquer. There is a fourth mode of verbofe ratiocination, which con- fifts in the conclufion of the fyllogifm containing an imaginary, but DISEASES Class III.. 2.1.4. 350 but not even a verbal analogy to the preceding propofitions. Thus a rultic devotee faid to his prieft, " I have often wonder- ed, why God Almighty called the firft man Adam ?" " Don't you know/' replied the teacher,« that A is the firft letter of the alphabet ?" " Aye, fo it is," anfwered the contented inquirer. Another kind of falfe reafoning is called by logicians a logic- al vice ; and another kind arifes from the firft propofition being untrue in refpect to its exiftence : but as all thefe, and perhaps many other fources of falfe reafonings, may be refolved into the miftaken ufe of ideas of words, or general terms, inftead of ideas of the things, or parts of things, which they ought to fugged ; they belong properly to this article of ratiocinatio verbofa : while the rare faculty of reafoning without words by comparing ideas of things, as in the invention of new'machines, and other new difcoveries, diftinguifhes the phiiofopher from the fophift. M. M. Children Ihould be permitted to ufe their hands early in their infancy, and Ihould be fupplied with pencils, pens, and various tools ; by which they will acquire accurate ideas of ex- ternal things by the organ of touch, at the fame time that they acquire words ; and will thence be lefs liable to be ferioufly de- ceived by general terms, or by the double meanings of words, or of fentences, or laftly by falfe propofitions or inconclufive de- ductions ; and will thus be enabled to compare the analogies of things, and to think without words ; the faculty, which confti- tutes genius, and which fo few poflefs ! 4. Credulitas. Credulity. Life is ihort, opportunities of knowledge rare ; our fenfes are fallacious, our reafonings un- certain ; man therefore ftruggles with perpetual error from the cradle to the coffin. He is neceffitated to correct experiment by analogy, and analogy by experiment ; and not always to reft fatisfied in the belief of faCts even with this two-fold teftimony, till future opportunities, or the obfervations of others, concur in their fdpport. Ignorance and credulity have ever been companions, and have milled and enllaved mankind ; philofophy has in all ages en- deavoured to oppofe their progrefs, and to loofen the ffiackles they had impofed; philofophers have on this account been called unbelievers : unbelievers of what ? of the fictions of fancy, of witchcraft, hobgoblins, ' apparitions, vampires, faries ; of the influence of ftars on human aftions, miracles wrought by the bones of faints, the flights of ominous birds, the prediCtions from the bowels of dying animals, expounders of dreams, for- tune-tellers, conjurors, modern prophets, necromancy, cheiro- mancy, animal magnetifm, metallic traCtors, with endlefs varie- ty Class III. 2.2.4. OF VOLITION. 351 Uy of folly ? Thefe they have difbelieved and defpifed, but have ever bowed their hoary heads to Truth and Nature. Mankind may be divided in refpeCt to the facility of their be- lief or conviction into two claffes ; thofe, who are ready to af- fent to (ingle fa Cis from the evidence of their fenfes, or from the ferious affertions of others ; and thofe, who require analogy to corroborate or authenticate them. Our firft knowledge is acquired by our fenfes ; but thefe are liable to deceive us, and we learn to deteCt thefe deceptions by comparing the ideas prefented to us by one fenfe with thofe pre- fented by another. Thus when we firft view a cylinder, it ap- pears to the eye as a flat furnace with different (hades on it,till we correCt this idea by the fenfe of touch, and find its furface to be circular; that is, having fome parts gradually receding further from the eye than others. So when a child, or a cat, or a bird, firft fees its own image in a looking-glafs, it believes that anoth- er animals exifts before it, and deteCls this fallacy by going be- hind the glafs to examine, if another tangible animal really exifts there. Another exuberant fource of error confifts in the falfe notions which we receive in ourearly years from the defign or ignorance of our inftruCiors, which affeCl all our future reafoning by their perpetual intrufions ; as thofe habits of mufcular aCtions of the face or limbs, which are called tricks, when contracted in in- fancy continue to the end of our lives. A third great fource of errour is the vivacity of our ideas of imagination, which perpetually intrude themfelves by various affociations, and compofe the farrago of our dreams ; in which, by the fufpenfion of volition, we are precluded from comparing the ideas of one fenfe with thofe of another, or the incongruity of their fucceflions with the ufual courfe of nature, and thus to deted their fallacy. Which we do in our waking hours by a perpetual voluntary exertion, a procefs of the mind above men- tioned, which we have termed intuitive analogy. SeCt. XVII. 3' 7- This analogy prefuppofes an acquired knowledge of things, hence children and ignorant people are the moft credulous,as not ^offeffing much knowledge of the ufual courfe of nature ; and fecondly, thofe are moft credulous, whofe faculty of comparing ideas, or the voluntary exertion of it, is flow or imperfeCl. Thus if the power of the magnetic needle of turning towards the north, or the (hock given by touching both fides of an eleCtrized coat- ed jar, was related for the firft time to a philofopher, and to an ignorant perfon; the former would be lefs ready to believe them, than the latter ; as he would find nothing fimilar in nature to compare DISEASES Class III. 2. 2. 4. 352 compare them to, he would again and again repeat the experi- ment, before he would give it his entire credence ; till by thefe repetitions it would ceafe to be a fingle fadt, and would there- fore gain the evidence of analogy. But the latter, as having lefs knowledge of nature, and lefs facility of voluntary exertion, would more readily believe the aflertions of others, or a fingle fadl, as prefented to his own obfervation. Of this kind are the bulk of mankind ; they continue throughout their lives in a ftate of childhood, and have thus been the dupes of priefts and poli- ticians in all countries and in all ages of the world. In regard to religious matters, there is an intellectual coward- ice inftilled into the minds of the people from their infancy ; which prevents their inquiry: credulity is made an indifpenfable virtue ; to inquire or exert their reafon in religious matters is denounced as finful; and in the catholic church is punilhed with more fevere penances than moral crimes. But in refpedl to our belief of the fuppofed medical facSts, which are publilhed by variety of authors ; many of whom are ignorant, and there- fore credulous ; the golden rule of David Hume may be applied with great advantage. " When two miraculous aflertions op- pofe each other, believe the lefs miraculous." Thus if a perfon is faid to have received the fmall-pox a fecond time, and to have gone through all the ftages of it, one may thus reafon : twenty thoufand people have been expofed to the variolous con- tagion a fecond time without receiving the variolous fever, to every one who has been faid to have thus received it; it ap- pears therefore lefs miraculous, that the aflertor of this fuppofed fact has been deceived, or wifhes to deceive, than that it has fo happened contrary to the long experienced order of nature. M. M. The method of cure is to increafe our knowledge of the laws of nature, and our habit of comparing whatever ideas are prefented to us with thofe known laws, and thus to coun- teraft the fallacies of our fenfes, to emancipate ourfelves from the falfe impreflions, which we have imbibed in our infancy,, and to fet the faculty of reafon above that of imagination. The Class IV. OF ASSOCIATION. 353 The Orders and Genera of the Fourth Olafs of Difeafes. CLASS IV. DISEASES OF ASSOCIATION. ORDO I. Increafed Ajfociate Motions. GENERA. i. Catenated with irritative motions. 2. Catenated with fenfitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences. ORDO II. Decreafed Ajfociate Motions. GENERA. 1. Catenated with irritative motions. 2- Catenated with fenfitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences. ORDO III. Retrograde Ajfociate Motions. GENERA. 1. Catenated with irritative motions. 2. Catenated with fenfitive motions. 3. Catenated with voluntary motions. 4. Catenated with external influences. Vol.II. X x The 354 DISEASES Class IV. 1. 1. The Orders, Genera, and Species, of the Fourth Clafs of Difeafes. CLASS IV. DISEASES OF ASSOCIATION. ORDO I. Increafed Afociate Motions. GENUS I. Catenated 'with Irritative Motions. SPECIES. 1. Rubor vultus pranforum. 2. Sudor f ragulus immerfarum. 3. Cefatio agritudinis cute ex* citato. 3. Digejlio audio frigore cuta- nea. 5. Catarrhus a frigore cutaneo. 6. Abforptio cellularis audio voniitu. Singultus nephriticus. 8. Febris irritativa. Fluthing of the face after din- ner. Sweat from covering the face in bed. Cure of ficknefs by {Emulating the fkin. Digeftion increafed by cold- nefs of the fkin. Catarrh from cold fkin. Cellular abforption increafed by vomiting. Nephritic hiccough. Irritative fever. GENUS IL Catenated with Senftive Motions. i. Lacrymarutn fluxus fympa- theticus. 2. Sternutatio a lumine. 3. Dolor dentium a Jlridore. 4. RifusJardonicus. Salivafluxus cibo vifo. 6. Fenfw mammularum vifo puerulo. 7. TenJiQ penis in hydrophobia. SPECIES. Sympathetic tears. Sneezing from light. Tooth-edge from grating founds. Sardonic fmile. Flux of faliva at fight of food. Tenfion of the nipples of lac- tefeent women at fight of the child Tenfion of the penis in hydro- phobia. 8. Tene/mus. Class IV. 1.3. OF ASSOCIATION. 355 8. Tenefmus calculofus. 9. Polypus narium ex afcaride. 10. Crampus fur arum in diar- rhoea. 11. Zona ignea nephritica.^ 12 Eruptio variolarum. 13. Gutta rofeaflomatica. 14. hepatica. 15. Podagra. 16- Rheumatifmus. 17 Eryfipelas. 18. Teflium tumor in gonorrhoea. - in parotitide. Tenefmus from ftone. Polypus of the nofe from af- carides. Cramp from diarrhoea. Nephritic fliingles. Eruption of fmall-pox. Stomaticrofy drop. Hepatic rofy drop. Gout. Rheumatifm. Eryfipelas. Swelled teftis in gonorrhoea. in mumps. GENUS III. Catenated with Voluntary Motions. SPECIES. I. Deglutitio invita. 2. Niblitatio invita. 3. Rif us invitus. 4. Lufus digitorum invitus. 5. Unguium morfluncula invita. 6. Vigilia invita. Involuntary deglutition. nictitation. . laughter. aCtions with the fingers. biting the nails. watchfulnefs. GENUS IV. Catenated with external Influences. I. Vita ovi. 2. Vita biemi-dormientium. 3. Pullulatio arborum. 4. Orgafmatis venerei periodus. 5. Brachii concuflio eleClrica. 6. Oxygenatio fanguinis. q. HumeStatio corporis. SPECIES. Life of an egg. Life of winter-fleepers. Budding of trees. Periods of venereal defire. EleCtric fhockthroughthe arm. Oxygenation of the blood. HumeClation of the body. ORDO II. Decreafed Affociate Motions. GENUS I. Catenated with Irritative Motions. SPECIESA I. Cutis frigida pranjorum. Chilnefs after dinner. 2. Pallor 356 DISEASES Class IV. 2. 1. 2- Pallor urina pranforum. 3. afrigorecutaneb. 4. Pallor ex agritudine. 5. Dyfpnoea a balneo frigido. 6. Dyfpepjia a pedibus frigidis. 7. Tujjis a pedibus frigidis. 8. hepaiica. 9. arthritica. I o Vertigo rotatoria. 11. ■■ ■ ■- vifualis. 12. - - ebriofa. 13. - 11 \-febriculofa. 14. v cerebrofa. 15. Murmur aurium vertigin- ofum. 16. 'TaEtus^guf us^olfactus ver- tiginof. 17 Pulfus mollis a vomitione. 18. intermittens a ven- triculo. 19. Febris inirritativa. Pale urine after dinner. from cold fkin. Palenefsfrom ficknefs. Shortnefs of breath from cold bathing. Indigeftion from cold feet. Cough from cold feet. Liver-cough. Gout-cough. Vertigo rotatorio. vifual. - inebriate. - feverifh. from the brain. Noife in the ears. Vertiginous touch,tafte, fmell. Soft pulfe in vomiting. Intermittent pulfe from the ftomach. Inirritative fever. GENUS II. Catenated 'with Senftive Motions. I. Torpor gen# a dolore dentis. 2. Stranguria a dolore veficx. 3. ■ --convulftva. 4. Dolor termini ductus chole- dochi. 5. Dolor pharyngis abacido gaf- trico 6 Pruritus nariumavermibus. 7. Cephataa. 8. Hemicrania et otalgia. g. Dolor humeri in hepatidide. 10. Torporpedumvariold erum- ' pente. 11. Tejlium dolor nephriticus. 12. Dolor digiti minimifympa- theticus. SPECIES. Coldnefs of the cheek from tooth-ach. Strangury from pain of the bladder. Convulfive ftrangury. Pain of the end of the bile- duff. Pain of the throat from gaftric acid. Itchingof thenofefrom worms. Head-ach. Partial head-ach, and ear-ach. Pain of fhoulder in hepatitis. Cold feet in eruptibn of fmall- pox. Nephritic pain of teftis. Pain of little finger from fym~ pathy. 13. Dqlor Class IV. 2. 3. OF ASSOCIATION. 357 13- Dolor brachii in hydrope peBoris. 14* Diarrhoea a dent it tone. Pain of the arm ih dtdpfy ©f the cheft. Diarrhoea from toothing. GENUS III. Catenated with Voluntary Motions. I. Titubatio lingua. 2. Choreafandii Viti. 3. Rifus 4. Tremors ex ird. 5. Rubor ex ird. 6. enminati. 7. Tarditas paralytica. 8. - fenilis. SPECIES. Impediment of /peech. St. Vitus's Dance. Laughter. Trembling from ang^r. Rednefs from anger. Blufh of guilt. Slownefs from palfy. --- of age. GENUS IV. Catenated with external Influences. SPECIES. I. Sunni periodus. 2 Studii inanis periodus. 3. Hemicrania periodus. 4. Epilepfla dolor iflea periodus. Convulflonis dolor flea peri- odus. 6. Tiflis periodica periodus. 7. Catamenia periodus. 8. Hamorrhoidis periodus. 9. Podagra periodus. I o. Eryflpilatis periodus. 11. Febrium periodus. Periods of deep. of reverie. - of head-ach. of painful epilepfy. of painful convulfion. - of periodic cough. of catanienia. ■ of the piles. -- of the gout. of erylipelas. • of fevers. ORDO III. Retrograde Aflociate Motions. GENUS I. Catenated with Irritative Motions. I. Diabetes irritata. 2. Sudor frigidus in cflhmate. 3. Diabetes a timore. 4. Diarrhoea a timore. SPECIES. Diabetes from irritation. Cold fweat in afthma. Diabetes from fear. Diarrhoea from fear. 5. Pallor 358 DISEASES Class IV. 3. 2. 5. Pallor el tremor a timore. 6. Palpitatio cordis a timore. 7 Abort io a timore. 8. Hyjieriaa timore. Palenefs and trembling from fear. Palpitation of the heart from fear. Abortion from fear. Hyfterics from fear. GENUS II. Catenated with Serfitive Motions. SPECIES. I. Naufea idealis. 2. a conceptu. 3 Eomitio vertiginofa. 4. a calculo in uretere. 3. ab infultu paralyt- ica. 6. a titillatione fau- cium y. ■ • -- cute fympathetica. Naufeafrom ideas. Naufeafrom conception. Vomitmg from vertigo. from Rone in the u- reter. from Rroke of palfy. from tickling the throat. -s. from fympathy with the fkin. GENUS III. Catenated with Vduntary Motions. SPECIES. 1. Ruminatio. 2. Vumitio voluntaria. 3. Eruftatio 'voluntaria. Rumination. Voluntary vomiting. --- eructation. GENUS IV. Catenated with External Influences. I. Catarrhus periodicus. 2. Eufis periodica. 3. Hyjleria a frigore. 4. Naufea pluvialis. SPECIES. Periodical catarrh. Periodic cough. Hyfterics from cold. Sicknefs againft rain. CLASS Class IV, i. i. OF ASSOCIATION. 359 CLASS IV. DISEASES OF ASSOCIATION. ORDO I. Increased Affociate Motions. GENUS I. Catenated 'with Irritative Motions. The importance of the fubfequent clafs not only confifts in its elucidating all the fympathetic difeafes, but in its opening a road to the knowledge of fever. The difficulty and novelty of the fubjeX muft plead in excufe for the prefent imperfeX Rate of it. The reader is entreated previoufly to attend to the follow- ing circumftances for the greater facility of inveftigating their intricate connexions ; which I fhall enumerate under the fol- lowing heads. A Aflbciate motions diftinguifhed from catenations. B. Aflbciate motions of three kinds. C- Aflbciations affeXed by external influences. L). Aflbciations affeXed by other fenforial motions. E Aflbciations catenated with fenfation. F. DireX and reverfe fympathy. G. Aflbciations affeXed four ways. H. Origin of aflbciations. I. Of the aXion of vomiting. K. Terrain aflbciations. A. AJfociate Motions diflinguifedfrom Catenations.} Aflbciate motions properly mean only thofe, which are caufed by the fenforial power of aflbciation. Whence it appears, that thofe fibrous motions, which conftitute the introduXory link of an aflbciate train of motions, are excluded from this definition, -as not being themfelves caufed by the fenforial power of aflbcia- tion,but by irritation, or fenfation,or volition, I (hall give forex- ample the flufhing of the face after dinner; the capillary veffels of the face increafe their adions in confequence of their catenation, not their aflbciations,with thofe of the ftomach ; which latter are caufed to aX with greater energy by the irritation excited by the ftimulus of food. Thefe capillaries of the face are affocia- ted 360 DISEASES Class IV. 1. ted with each other reciprocally, as being all of them excited by the fenforial power of affociation; but they are only catenated with thofe of the ftomach, which are not in this cafe aflbciate motions but irritative ones. The common ufe of the word af- fociation for almoft every kind of connection has rendered this fubjeCt difficult; from which inaccuracy I fear fome parts of this work are not exempt. B. Affociate Motions of three Kinds. Thofe trains or tribes of aflbciate motions, the introductory link of which confifts of an irritative motion, are termed irrita- tive aflbciations; as when the mufcles of the eyelids clofe the eye in common nictitation. Thofe, whofe introductory link confifts of a fenfitive motion,are termed fenfitive,affbciations ; as when the peCtoral and intercoftal mufcles aCt in fneezing. And laftly,thofe whofe introductory link confifts of a voluntary motion, are termed voluntary aflbciations ; as when the mufcles of the lowerlimbsaCt in concert with thofe of the arm in fencing. C. Affociations affected by external Influences. Circles of aflbciate motions, as well as trains and tribes of them, are liable to be affected by external influences, which con- fift of ethereal fluids, and which, by penetrating the fyftem, aCt upon it perhaps rather as a caufa fine qua non of its movements, than direCtly as a ftimulus; except when they are accumulated in unufual quantity. We have a fenfe adapted to the perception of the excels or defeCt of one of thefe fluids ; I mean that of elementary heat; in which all things are immerled. See Clafs IV. 1.4. 1. But there are others of them, which as we have no power to evade their influence, fo we have no fenfe to per- ceive it; thefe are the folar, and lunar,and terreft rial gravitation, in which alfo all things are immerfed ; the eleCtric aura, which pervades us, and is perpetually varying. See Clafs IV. 1 4. 5 ; the magnetic fluid, Clafs IV. 1.46; and laftly, the great life-preferver oxygen gas, and the aqueous vapour of the atmof- phere, fee Clafs IV. 1. 4. 6. and 7 and 2. Of thefe external influences thofe of heat, and of gravity, have diurnal periods of increafe and decreafe ; befides their greater periods of monthly or annual variation. The manner in which they aCt by periodical increments on the fyftem, till fome effect is produced, is fpoken of in Se6t. XXXII. 3. and 6. D. Affociations Class IV. 1.1. OF ASSOCIATION. 361 D. Ajfociations affected by other Senforial Motions. Circles and trains of aflbciate motions are alfo liable to be af- feCted by their catenations with other fenforial powers, as of ir- ritation,or fenfation,or volition ; which other fenforial powers ei- ther thus Amply form fome of the links of the catenation, or add to the energy of the aflbciated motions. Thus when vomiting is caufed by the ftimulus of a (tone in the ureter, the fenfation of pain feems to be a link of the catenation rather than an efficient caufe of the vomiting. But when the capillary veflels of the ikin increafe their aCtion from the influence of external heat, they are excited both by the ftimulus of unufual heat, as well as by the ftimulus of the blood, and by their accuftomed aflbci- ation with the actions of the heart and arteries. And laftly, in the blufh of anger the fenforial power of volition is added to that of aflbciation, and irritation, to excite the capillaries of the face with increafed action. See Clafs IV. 2. 3. 5. E. Ajfociations catenated with fenfat ion. Pain frequently accompanies aflbciate trains or circles of mo- tion without its being a caufe, or a link, of them, but fimply an attendant fymptom ; though it frequently gives name to the difeafe, as head-ach. Thus in the cramp of the calves of the legs in diarrhoea, the increafed fenforial power of aflbciation is the proximate caufe ; the preceding increafed adtion of the bow- els is the remote caufe ; and the proximate effedt is the violent contractions of the mufculi gaftrocnemii ; but the pain of thefe mufcles is only an attendant fymptom, or a remote efledt. See Sedt XVIII. 15. Other fenfitive aflbciations are mention- ed in Clafs IV. 1. 2. and IV. 1.2. 15. Thus, if the flufliing of the face above mentioned after dinner be called a difeafe, the immediate or proximate caufe is the in- creafed power of aflbciation, the remote caufe is the increaf- ed irritative motions of the ftomach in confequence of the ftim- ulus of food and wine. The difeafe or proximate efledt confifts in the increafed actions of the cutaneous veflels of the face; and the fenfation of heat, the exiftence of heat, and the red colour, are attendants or fymptoms, or remote efledt s, of the increafed actions of thefe cutaneous veflels. F. DireEi and reverfe Sympathy. The increafed actions of the primary part of thei nsea} of af- ibciated motions are fometimes fucceeded by increafed adtions Vol. II. Y y of 362 DISEASES ClassIV. 1.1. of the fecondary part of the train ; and fometimes by decreafed aftions of it. So likewife the decreafed actions of the primary part of a train of aflbeiate motions are fometimes fucceeded by decreafed aftions of the fecondary part, and fometimes by increafed aftions of it. The former of thefe fituations is called direft fympathy, and the latter reverfe fympathy. In general I believe, where the primary part of the train of aflbciafed motions is exerted more than natural, it produces direft fympathy in ftrong people, and reverfe fympathy in weak ones, as a full meal makes fome people hot, and others chill. And where the pri- mary part of the train is exerted lefs than natural, it produces direft fympathy in weak people, and reverfe fvmpathy in ftrong ones, as on being expofed for a certain length of time on horfe- back in a cold day gives indigeftion and confequent heart-burn to weak people, and ftrengthens the digedion, and induces con- fequent hunger in ftrong ones. See Seft XXXV. i This may perhaps be more eafily underftood, by confidering ftrength and weaknefs, when applied to animal bodies, as con- fifting in the quantity of fenforial power refiding in the con- trafting fibres, and the quantity of ftimulus applied, as fliewn in Seft. XII. 2. I. Now when defective ftimulus, within certain limits, is partially applied to parts fubjeft to perpetual motion, the expenditure of fenforial power is for a while leflened, but not its general produftion in the brain, nor its derivation into the weakly ftimulated part. Hence in ftrong people, or fuch whofe fibres abound with fenforial power, if the firft tribe of an affociate train of motions be deprived in part of its accuftomed ftimulus, its aftion becomes diminifhed ; and the fenforial pow- er becomes accumulated, and by its fuperabundance, or over- flowing as it were, increafes the aftion of the fecond tribe of the aflbeiate aftions by reverfe fympathy. As expofing the warm fkin for a moderate time to cold air increafes the aftion of the ftomach, and thus ftrengthens the power of digeftion. On the reverfe, when additional ftimulus within certain lim- its is partially applied to parrs, which are deficient in refpeft to the natural quantity of fenforial power, the expenditure of fen- forial power is increafed, but in a lefs degree than the increafed produftion of it in the brain, or its increafed derivation into the ftrongly-ftimulated organ. Hence in weak people, or fuch whofe fibres are deficient of fenforial power, if the firft tribe of an aflbeiate train of motions be fubjefted for a while to greater ftimulus than ufual, a greater produftion of fenforial power, or a greater derivation of it into the ftimulated parts occurs ; which by itsexcefs, or overflowing as it were, increafes the aftions of the fecond tribe of the aflbeiate motions by direft fympathy. Thus Class IV. i. i. OF ASSOCIATION. 363 Thus when vomiting occurs with cold extremities, a blitter on the back in' a few hours occafions univerfal warmth of the fkin, and (tops the vomiting. And when a diarrhoea occurs with pale fk.n and cold extremities, the pricking of the points of a flannel fhn t, worn next the fkin, occafions univerfal warmth of it, and checks or cures the diarrhoea. In tome aflociate trains of aCtion neverthelefs reverfe fympa- thies more trequently occur than direCt ones, and in others di- rect ones more frequently than reverfe ones. Thus in continu- ed fever with debility there appears to be a reverfe fympathy be- tween the capillary veflels of the ftomach and thpfe of the ikin ; became there exiils a total averfion to folid food, and conitant heat on the furiace of the body. Yet thefe two fyilems of vef- feis are at other times actuated by direct fympathy, as when palenels attends ficknefs, or cold feet induce indigeftion. This iubjeCt requires to be further inveitigated, as it probably depends not only on the prefent or previous plus or minus of the fenfo- riai power of aflociation, but alfo on the introduction of other kinds of lenfonai power, as in Clafs IV. i. i. D ; or the in- crealed production of it in the brain, or the greater mobility of one part of a train of adions than another. Thus when much food or wine is taken into the ftomach, if there be no iuperfluity of fenforial power in the fyflem, that is, none to be fpared from the continual adions of it, a palenefs and chihnefs fucceed for a time ; becaufe now the expenditure of it by the increafed aCtions of the ftomach is greater than the prefent production of it. In a little time however the ftimulus of the food and wine increafes the production of fenforial pow- er in the brain, and this produces a fuperfluity of it in the fyf- tem 5 in confequence of which the Ikin now becomes warm and florid, which was at firit cold and pale; and thus the reverfe fympathy is fhortly converted into a direCt one ; which is prob- ably owing to the introduction of a fecond fenforial power, that of pleafurable fenfation. On the contrary, when an emetic drug produces ficknefs, the fkin is at firit pale for a time by direCt fympathy with the capil- laries of the ftomach ; but in a few minutes, by the accumula- tion of fenforial power in the ftomach during its lefs aClive ftate in ficknefs, the capillaries of the fkin, which are aflbeiated with thofe of the ftomach, act with greater energy by reverfe fympa- thy, and a florid colour returns. Where the quantity of aCtion is diminifhed in the firit part of a train of motions, whether by previous diminution of fenforial power, or prefent diminution of itimulus, the fecond part of the train becomes torpid by di- reCt fympathy. And when the quantity of aCtion of the firit part 364 DISEASES Class IV. 1. n part becomes increafed by the accumulation of fenforial power during its previous torpor, or by increafe of ftimulus, the actions of the fecond part of it likewife become increafed by direct fym- pathy. In moderate hunger the Ikin is pale, as before dinner, and in moderate ficknefs, as no great accumulation of fenforial power has commenced ; but in violent hunger, and in greater torpor of the ftomach, as from contagious matter, the accumulation of fenforial power becomes fo great as to affect the arterial and capillary fyftem, and fever is produced in both cafes. In contagious fevers with arterial debility commencing with torpor of the ftomach, why is the action of the heart weakened, and that of the capillaries increafed ? Is it becaufe the mobility of the heart is lefs than that of the ftomach, and the mobility of the capillaries greater ? Or is it becaufe the affociation between the mufcular fibres of the ftomach and thofe of the heart have been uniformly affociated by direct fympathy ; and the capilla- ries of the ftomach and thofe of the fkin have been more fre- quently affociated by reverfe fympathy ? Where the actions of the ftomach have been previoufly ex- haufted by long ftimulus, as on the day after intoxication, little or no accumulation of fenforial power occurs, during the tor- por of the organ, beyond what is required to replace the defi- ciency of it, and hence fever feldom follows intoxication. And a repetition of the ftimulus fometimes becomes neceffary even to induce its natural action, as in dram-drinkers. Where there has been no previous exhauftion of fenforial power, and the primary link of afl'ociate motions is violently actuated by the fenforial power of fenfation, the fecondary link is alfo violently actuated by dired fympathy; as in inflammato- ry fevers. Where however the fenforial power of the fyftem is lefs than natural, the fecondary link of affociated motions be- comes torpid by reverfe fympathy, as in the inoculated fmall-pox during the eruption on the face the feet are frequently cold. G. Affectations affected four Ways. Hence affociated trains or circles of motions may be afle&ed four different ways. r. By the greater or lefs energy of action of the firft link with which they are catenated, and from which they take their names ; as irritative, fenfitive, or voluntary affo- ciations. 2. By being excited by two or more fenforial powers at the fame time, as by irritation and affociation, as in the in- ftance of the application of the ftimulus of increafed external heat to the cutaneous capillaries. 3« By catenation with other fenforial Class IV. 1. 1. OF ASSOCIATION. 365 fenforial powers, as with pain or pleafure, which are in this cafe not the proximate caufe of motion, but which, by becoming a link of catenation, excite the fenforial power of aflbciation into action ; as the pain at the neck of the gall-bladder occafioned by a gall-ftone is transferred to the other end of that canal, and becomes a link of catenation between the action of the two ex- tremities of it. 4. The influence of ethereal fluids, as of heat and gravitation. To which laft perhaps might be added moif- ture and oxygen gas as conftituting neceflary parts of the fyf- tem, rather than ftimuli to excite it into aftion. H. The Origin of ^fociations. Some trains or circles of aflbciate motions muft have been formed before our nativity, as thofe of the heart, arteries, and capillaries ; others have been aflbciated, as occafion required them, as the mufcles of the diaphragm and abdomen in vomit- ing ; and others by perpetual habit, as thofe of the ftomach with the heart and arteries directly, as in weak pulfe during ficknefs ; with the capillaries direftly, as in the flufhed Ikin after dinner ; and laftly, with the cellular abforbents reverfely, as in the in- creafed abforption in anafarca during ficknefs; and with the ir- ritative motions of the organs of fenfe reverfely, as in vertigo, or fea-ficknefs. Some of thefe aflbciations (hall be here fhortly defcribed to facilitate the inveftigation of others. Firft, other congeries of glands occupy but a particular part of the fyftem, or conftitute a particular organ, as the liver, or kidneys ; but thofe glands, which fecrete the mucus, and per- fpirable matter, which are called capillaries, are of very great extent; they receive the blood from the arteries, feparate from it the mucus, which lines every cell, and covers every cavity ot the body ; and the perfpirable matter, which foftens and lubri- cates the whole furface of the Ikin, and the more extenfive fur- face of the air-veflels, which compofe the lungs. Thefe are fupplied with blood by the perpetual aftion of the heart and ar- teries, and have therefore their motions aflbciated with the form- er, and with each other, by fympathy, which is fometimes di- reft, and fometimes reverfe. One branch of this aflbciation, the capillaries of the fkin, is very irritable by the increafed quantities of cold and heat; anoth- er branch, that of the lungs, has not the perception of cold and heat, but is liable by direct fympathy to aft in concert with the former, as in going into the cold bath. And it is probable the capillaries of the internal membranes are likewife direftly aflefted 366 DISEASES Class IV. i. i. affefted by their fympathy with thofe of the fkin, as appears from the defeat of fecretion in ulcers during the cold fits of agues. The motions of this extenfive fyftem of capillaries, thus affo- ciated oy diredl fympathy, are alfo afibciated with thofe of the heart and arteries, fometimes by reverfe and fometimes by di- reCt fympathy ; and thus conftitute fimple fever. The cold paroxyfm of which confifts in their torpor, and the hot one in their orgafm, or increafed activity. I. Of the Action of Vomiting. The manner, in which the ftomach and the diaphragm and abdominal mufcles acquire their aflbeiate a&ion in vomiting, requires fome attention. It is not probable, that this adlion 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 nourilhment, would not feem to give occafion to too great temporary repletion of the ftomach ; and would preclude the deglutition of any improper material. After nativity the ftomach of the child may be occafionally too much diltended with milk ; as previous hunger may induce it to over- gorge itfelf; and by repeated efforts the act of vomiting is learn- ed, as a means of getting free from a difagreeable fenfation. Thus when any difguftful material, as a bitter drug, is taken into the mouth ; certain retrograde motions of the tongue and lips are produced, for the purpofe of putting the difagreeable material out of the mouth again. W hen the ftomach is difagreeably ftimulated by the diftention or acrimony of the aliment, a hmilar effort to regurgitate it mult occur ; and by repeated trials the abtion of the diaphragm and aboominal mufcles by iqueezing the ftomach affifts its retro- grade exertion to dilgorge its contents. In the fame manner when a piece of gravei is pulhed into the urethra, or a piece of induiated bile into the neck of the gali-bladder, after they have been in vain prefi'ed forward by the ufual motions of thofe duCts, they return into the bladders of gall and urine by the re- trograde motions of them. 1 hat this is one mode, iri which vomiting is induced, appears from the initantaneous rejection from the ftomach occafioned by fome naufeous drug, or from fome naufeous idea; and laft- ly, from the voluntary power,which fome people have been faid to have acquired, of emptying their ftomachs, much in the fame manner as ruminating animals bring up the grafs from their firft ftomach. There are neverthelefs many modes by which thefe inverted motions Class IV. 1. 1. OF ASSOCIATION. 367 motions of the ftomach and cefophagus are induced, and which it is of confequence to diftinguifh from each other. The firft is the mode above defcribed; where an effort is made to diflodge fomething, which ftimulates the ftomach into difagreeable fen- fation ; and which is returned by repeated exertions : as when a naufeous drug is taken into the mouth, or a bit of fand falls into the eye, or a drop of water into the wind-pipe. In this the peiiftaltic motions of the ftomach are firft flopped, and then re- verted by painful fenfation ; and the abdominal mufcles and di- aphragm by repeated efforts become affociated with them. Now as lefs fenforial power is expended on the retrograde actions of the ftomach, and of. the lymphatics, which open their mouths on its furface, than by their natural motions, an accumulation of fenforial power in the fibres of the ftomach follows the ex- hibition of an emetic, and on that account an emetic'will fome- times flop a fpontaneous vomiting which was owing to fenfori- al deficiency. See Seii. XXXV. i. 3. and Art. V. 2. 1. As bitters and metallic faits, exhibited in fmall dofes, ftimu- late the ftomach into greater action, as appears by their increaf- ing the power of digeftion, and yet become emetic, when given in larger dofes ; one might fufpeR, that they became emetic by inducing debility, and confequent retrograde actions of the ftomach, by their previoufly exhaufting the fenforial power by their great ftimulus ; which might be effected in a moment without producing pain, and in confequence without our per- ceiving it. But on the contrary, there does not in general ap- pear on the exhibition of emetics to be any previous exhauftion of fenforial power ; becaufe there is evidently an accumulation of it during the ficknefs, as appears from the digeftion being ftronger afterwards ; and from the decreafed a<Bion of the cel- lular and cutaneous abforbents during its operation. See Art- V.2. I. Another mode by which vomiting is induced, is owing to de- bility or deficiency of fenforial power, from the previous ex- hauftion of it; as on the day after intoxication, or which occurs in people enfeebled with the gout, and in dropfy, and in fome fevers with debility. In thefe, when the vomiting ceafes. there is no appearance of accumulation of fenforial power, as the di- geftion Rill remains weak and imperfeR. Another mode by which ficknefs of vomiting is induced, is by deleft of ftimulus, as in ■ great hunger ; and in thole, who have been habituated to fpice and fpirit with their meals, who are liable to be fick after taking food without thefe additional ftimuli. Other means of inducing ficknefs by vertigo, or by naufeous ideas, will be mentioned below. 368 DISEASES Class IV. 1. 1. We (hall only add, that the motions of the mufcular fibres of the ftomach are aflbciated with thofe of the heart and arteries by direft fympathy, as appears by the weaknefs of the pulfe during the exhibition of an emetic ; and that the abforbents of the ftomach are aflbciated with the cellular and cutaneous abfor- bents by reverfe fympathy, as is (hewn by the great abforption of the mucus of the cells in anafarca during ficknefs ; at the fame time that the abforbentsof the ftomach invert their aftions, and pour the mucus and water thus abforbed into that vifcus. In cold paroxyfms of fever the ftomach partakes of the gen- eral torpor, and vomiting is induced by its debility, either by its aflbciation with the torpid capillaries, or other torpid parts,or by its own torpor commencing firft, and caufing the cold fit. The difordered motions of the ftomach frequently feem to be the caufe or primary feat of fever, as where contagious miafma are fwallowed with the faliva, and where fever is produced by fea- ficknefs, which I once faw. Neverthelefs a diforder of the ftom- ach does not always induce fever, as in that cafe it fliould con- ftantly attend indigeftion,and vertigo, and fea-ficknefs ; but is it- felf frequently induced by aflbciation with the difordered move- ments of other parts of the fyftem, as when it arifes from grav- el in the ureter, or from a percuflion on the head. The conneftion of the motions of the ftomach with irritative ideas, or motions of the organs of fenfe, in vertigo, is (hewn in Seft XX. and thus it appears, that many circles of aflbciation are either direftly or reverfely aflbciated, or catenated, with this vifcus, which will much contribute to unfold fome of the fymp- tomps of fever. K. Tertian pjjbciations. The third link of aflbciate trains of motion is fometimes aftu- ated by reverfe fympathy, with the fecond link, and that by re- verfe fympathy with the firft link; fo that the firft and third link may aft by direft fympathy, and the intermediate one by re- verfe fympathy. Of this, inftances are given in the fingultus nephriticus, Clafs IV. i. i. 7. and IV. 2. 1. At other times the tertian or quartan links of aflbciate motions are aftuated by direft fympathy ; and that fometimes forwards and fometimes backwards in refpeft to the ufual order of thofe trains of aflbci- ate motions, as in Clafs IV. 1.2. 1. SPECIES. 1. Rubor vultus pranforum. Flufhingof the face after dinner is OF ASSOCIATION. Class IV. 1. 1.2. 369 is explained in Seft. XXXV. i. In the beginning of intoxica- tion the whole (kin becomes florid from the affociation of the ac- tions of the cutaneous arteries with thofe of the ftomach, be- caufe vinous fpirit excites the fibres of the ftomach into more violent action than the ftimulus of common food ; and the cu- taneous capillaries of the face, from the more frequent expo- fure to the viciflitudes of cold and heat, poffefs more mobility or irritability than thofe of other parts of the ikin, as further ex- plained in Seft. XXXIII. 2. io. Vinegar is liable to produce this flulhing of the face, which is probably owing to the quan- tity of vinous fpirit it contains, as I believe the unfermented ve- getable acids do not produce this effect. In every kind of blulh. the arterial blood is propelled into the capillaries fafter than the venous abforption can carry it forwards into the veins, in this refpedt refembling the ten ho phalli. Can the beginning vinous or acetous fermentation of the ali- ment in weak ftomachs contribute to this effect ? or is it to be afcribed to the greater power of aflociation between the arteries of the face and the fibres of the ftomach in fome people than in others ? M. M. Eat and drink lefs at a time, and more frequently. Put 20 drops of weak acid of vitriol into wafer to be drunk at meals. Let the drefs over the ftomach and bowels be loofe. Ufe no fermented liquors, or vinegar, or fpice. 2. Sudor JI ragulis immerjorutn. Sweat from being covered in bed. In the commencement of an epidemic fever, in which the perpetual efforts to vomit was a diftrefling fvmptom, Dr. Syd- enham difcovered, that if the patient's head was for a fhort time covered over with the bed-clothes, warmth was produced, and a fweat broke out upon the Ikin, and the tendency to vomit ceaf- ed. In this curious fad two trains of afftciated motions are excited into increafed action. Firft, rhe veffels of the lungs are known to have their motion affociated with thofe of the Ikin by the difficulty of breathing on going into the cold bath, defcrib- ed in Sect. XXXII. 3. 2. Hence, when the veffels of the lungs become excited into ftronger action, by the bad air under the be I-clothes, warmed and adulterated by frequent breathing, thofe of the external Ikin foon become excited by their affocia- tion into more energetic action, and generate more heat along with a greater fecretion of perfpirable matter. Secondly, the fympathy between the ftomach and Ikin is evident in variety of circumftances; thus the cold air-of frofty days applied to the Ik n for a Ihort time increases the action of the ftomach bv re- verie fy '.pathy, bur decreases it if continued too long by direct fympathy : fo in the circumftance above mentioned, the action Vol. II. Z z of DISEASES 370 Class IV. j. 1.3. of the ftomach is increafed by direct fympathy with that of the fkin ; and the tendency to vomit, which was owing to its di- minifhed action, ceafes. 3. Cejjatio eegritudinis cute excitatd. The cure of ficknefs by Simulating the fkin. This is explained in the preceding arti- cle ; and further noticed in IV. 2- 2. 4. and in IV. 1. 1. F. Similar to thefe is the effect of a blifter on the back in reliev- ing ficknefs, indigeftion, and heart-burn ; and, on the contrary, by thefe fymptoms being frequently induced by coldness of the extremities. The blifter Simulates the cutaneous veffels into greater action ; whence warmth and pain are produced at the fame time, and the fibres of the ftomach are excited into greater action by their affociation with thofe of the fkin. It does not appear, that the concommitant pain of the blifter caufes the in- creafed energy of the ftomach, becaufe the motions of it are not greater than natural; though it is fometimes difficult to deter- mine, whether the primary part of fome affociated trains be connected with irritative or fenfitive motions. In the fame manner a flannel fhirt, to one who has not been in the habit of wearing one, ftimulates the fkin by its points, and thus flops vomiting in fome cafes ; and is particularly effi- cacious in checking fome chronical diarrhoeas, which are not at- tended with fever ; for the abforbents of the fkin are thus ftim- ulated into greater aclion, with which thofe of the inteftines confent by direct fympathy. This effect cannot be afcribed to the warmth alone of the flannel fhirt, as being a covering of loofe texture, and confining air in its pores, like a fponge, which air is known to be a bad conductor of heat, fince in that cafe its ufe fhould be equally efficacious, if it were worn over a linen fhirt; and an increafed warmth of the room of the patient would be equally ferviceable. 4. Digejlio audta frigore cutanea. Digeftion increafed by cold- nefs of the fkin. Every one has experienced the increafe of his appetite after walking in the cool air in frofty days ; for there is at this time not only a faving of fenforial power by the lefs exertion of the cutaneous veffels ; but, as thefe confent with thofe of the ftomach and bowels, this faving of fenforial power is transferred by reverfe fympathy from the cutaneous capilla- ries and abforbents to thofe of the ftomach and inteftines. Hence weak people fhould ufe the cold air of winter as a cold bath; that is, they fhould flay in it but a fhort time at once, but fhould immerfe themfelves in it many times a day. 5. Catarrhus a jrigore cutaneo. Catarrh from cold fkin. This has been already explained in Clafs I. 1.2. 7. and is further defcribed in Seft. XXXV. 1.3. In this difeafe the veffels of the Class VI. 1. 1. 6. OF ASSOCIATION. 371 the membrane, which lines the noftrils, are excited into greater action ; when thofe of the (kin, with which they are aflbciated, are excited into lefs adion by the deficiency of external heat, by reverfe fympathy; and though the pain of cold attends the torpor of the primary link of this aflbeiation, yet the increafed motions of the membrane of the noftrils are aflbciated with thofe of the cutaneous veflels, and not with the pain of them, becaufe no inflammation follows. 6. Abforptio cellularis auEia vomitu. In the aft of vomiting the irritative motions of the ftomach are inverted, and of the abforbents, which open their mouths into it; while the cutane- ous, cellular, and pulmonary abforbents are induced, by reverfe fympathy with them, to ad with greater energy. This is feen in cafes of anafarca, when long ficknefs and vomiting are cauf- ed by fquills, or antimonial faits, or moft of all by the decodion of digitalis purpurea, foxglove ; and Mr. J. Hunter mentions a cafe, in which a large bubo, which was juft ready to break, was abforbed in a few days by ficknefs at fea. Treatife on the Blood, p. 501, which is thus accounted for; lefs fenforial pow- er is expended during ficknefs by the decreafed adion of the fibres of the ftomach, and of its abforbents ; as (hewn in Sed. XXXV. 1 3. whence an accumulation of it is produced, and there is in confequence a greater quantity of fenforial power for the exertion of thofe motions, which are aflbciated with the abforbents of the ftomach by reverfe fympathy. The reverfe fympathy between the ladeal and lymphatic branches of the abforbent fyftem have been produced by the one branch being lefs excited to ad, when the other fupplies fufli- cient fluid or nutriment to the fanguiferous veflels. Thus when the ftomach is full, and the fupply of chyle, and mucus, and water is in fuflicient quantity ; the pulmonary, cellular, and cu- taneous lymphatics are not excited into adion ; whence the urine is pale, and the Ikin moift, from the defed of abforption on thefe fur faces. 7. Singultus nephriticus. When a ftone irritates the ureter, and that even without its being attended with pain or fever, fometimes a chronical hiccough occurs, and continues for days and weeks, inftead of ficknefs or vomiting ; which are the com- mon fymptoms. In this cafe the motions of the ftomach are decreafed by their fympathy with thofe of the ureter, which are increafed by the ftimulus of the ftone in it ; and the increafed motions of the diaphragm feem to exift in confequence of their aflbeiation with the ftomach by a fecond reverfe fympathy. This hiccough may neverthelefs admit of another explanation, and be fuppofed to be a convulfive exertion of the diaphragm to re- lieve DISEASES Class IV. t. 1.8. 372 lieve the difagreeable fenfation of the ftomach in confequence of its difordered irritative afibciations ; and in that cafe it would belong to Clafs III. i. I. See Clafs IV. 2. 1. for another exam- ple of tertiary aifociation. M. M. Venefedion. Emetic. Calomel. Cathartic, opium, oil of cinnamon, from two to ten drops. Aerated alkaline wa- ter. Peruvian bark. 8. Febris Irritativa. Irritative fever, defcribed in Clafs I 1. I. 1. The difeafes above explained in this genus are chiefly concerning the fympathies of the abforbent fyftem, or the ali- mentary canal, which are not fo much aflbciated with the arte- rial fyftem as to throw it into diforder, when they are Rightly deranged ; but when any great congeries of conglomerate glands, which may be confidered as the extremities of the arterial fyf- tem, are affedted with torpor, the whole arterial fyftem and the heart fympathize with the torpid glands, and adi with lefs ener- gy ; which conftitutes the cold fit of fever ; which is therefore at firft a decreafed ablion of the aflbciate organ ; but as this de- creafc of action is only a temporary effect, and an increafe of exertion both of the torpid glands, and of the whole arterial fyftem, foon follows ; the hot fit of irritative fever, or fever with ftrong pulfe, properly belongs to this clafs and genus of difeafes. ORDO Class IV. i. 2. OF ASSOCIATION. 373 ORDO I. Increafed Affociate Motions. GENUS IL Catenated 'with Senfitvve Motions. The primary links of the aflociated actions of this genus are either produced or attended by painful or pleafurable fenfation. The fecondary links of the firlt ten fpecies are attended with increafed motions without inflammation, thofe of the remainder are attended with inflammation. All inflammations, which do not arife in the part which was previoufly torpid, belong to this genus ; as the gout, rheumatifm, eryfipelas. It is probable many other inflammations may, by future obfervation, require to be transplanted into this clafs. The circles of fenfitive aflbciate motions confift chiefly of the excretory duffs of the capillaries and of the mouths of the ab- forbent veflels, which conftitute the membranes ; and which have been induced into afiion at the fame time ; or they confift of the terminations of canals ; or of parts which are endued with greater fenfibility than thofe which form the firlt link of the aflbciation. An inltance of the firlt of thofe is the fympa- thy between the membranes of the alveolar procefles of the jaws, and the membranes above or beneath the mufcles about the temples in hemicrania. An inltance of the fecond is in the fympathy between the excretory dudt of the lachrymal gland,and the nafal dudt of the lachrymal fac. And,an inltance of the third is the fympathy between the membranes of the liver, and the Ikin of the face in the gutta rofea of inebriates. SPECIES. I. Lachrymarum fluxus fympatbeticus. A flow of tears from grief or joy. When the termination of the dudt of the lachry- mal fac in the noltrils becomes affedted either by painful or pleafurable fenfations, in confequence of external Itimulus, or by its aflbciation with agreeable or difagreeable ideas, the mo- tions of the lachrymal gland are at the fame time exerted with greater energy, and a profufion of tears fucceeds by fenfitive af~ lociation as explained in Sedt. XVL 8. 2. In this cafe there exifts a chain of aflociated adtions, the fe- cretioii of the lachrymal gland is increafed by whatever ftimu- lates DISEASES Class IV. 1. 2. 2. 374 lates the furface of the eye, at the fame time the increafed abun- dance of tears ftimulatesthe pundta lachrymalia into greater ac- tion ; and the fluid thus abforbed ftimulates the lachrymal fac, and its ufual du£t in the nofe into greater action. In a contra- ry direction of this chain of aflbciation the prefent increafe of action is induced. Firft, the nafal duCt of the lachrymal fac is excited into increafed action by fome pleafurable or painful idea, as defcribed in SeCt. XVI. 8. 2. 2d. The punCta lacrymalia or o:her extremity of the lachrymal fac fympathizes with it (as the two ends of all other canals fympathize with each other.) 3d With thefe increafed motions of the punCta lacrymalia thofe of the excretory duCt of the lachrymal gland are aflbciated from their having fo perpetually aCted together. And, latlly, with the increafed actions of the excretory duCt of this gland are af- fociated tho e of the other end of it by their frequently acting together ; in the fame manner as the extremities of other ca- nals are aflbciated, and thus a greater flow of tears is poured in- to 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 fenfations, when great, excite the faculty of volition ; and the perfon continues voluntarily to call up or perform thofe ideas, which occafion the painful fenfation ; that is, the afflict- ed perfon becomes fo far infane or melancholy ; but tears are produced by the fenforial faculty of aflbciation, and fhew that the pain is fo far relieved as not to excite the exceflive power of volition, or infanity, and are therefore a fign of the abatement of the painful ftate of grief, rather than a caufe of that abatement. See Clafs III. 1. 2. 10. 2. Sternutatio a lumine. Some perfons fneeze from looking up at the light Iky in a morning after coming our of a dark bed room. The olfadory nerves are brought into too great ac- tion by their fympathy with the optic nerves, or by their refpec- tive fympa^hies with fome intervening parts, as probably with the two extremities of the lachrymal fac ; that is, with the punc- ta lacrymalia and the nafal duCt. See Clafs II. 1. 1. 3. 3. Dolor dentium aftridore. Tooth-edge from grating founds, and from the touch of certain fubitances, and even from im- agination alone, is defcribed and explained in SeCt. XVI. 10. The increafed actions of the alveolar veflels or membranes are aflbciated with the ideas, or fenfual motions of the auditory nerves in the fir It cafe ; and of thofe of the fenfe of touch, in the fecond cafe ; and by imagination, or ideas exerted of painful fenfation alone, in the laft. 4. Rifusfardomcw. A difagreeable fmile attends inflammations of Class IV. 1. 2. 5. OF ASSOCIATION. 375 of the diaphragm arifing from the aflbciations of the reiterated exertions of that mufcle with thofe of the lips and cheeks in laughing. See Diaphragmitis, Clafs II. i. 2. 6. 5. Salivafiuxus cibo vifo. The flow of faliva into the mouths of hungry animals at the fight or fmell of food is feen in dogs (landing round a dinner-table. The increafed actions of the falivary glands have been ufually produced by the ftimulus of agreeable food on their excretory ducfts during the maflication of it; and with this increafed action of their excretory ducts the other terminations of thofe glands in the capillary arteries have been excited into increafed adtion by the mutual aflbciation of the ends of canals ; and at the fame time the pleafurable ideas, or fenfual motions, of the fenfe of fmell and of fight have accom- panied this increafed fecretion of faliva. Hence this chain of motions becomes aflbciated with thofe vifual or olfactory ideas, or with the pleafure, which produces or attends them. 6. Tenfo mammularum vifopuerulo. The nipples of latlefcent women are liable to become turgid at the fight of their young offspring. The nipple has generally been rendered turgid by the titillation of the lips or gums of the child in giving fuck ; the vifible idea of the child has thus frequently accompanied this pleafurable fenfation of parting with the milk, and turgef- cence of the tubes, which conftitute the nipple. Hence the vifual idea of the child, and the pleafure which attends it, be- come aflbciated with thofe increafed arterial adlions, which iwell the cells of the mammula, and extend its tubes; which is very fimilar to the tenfio phalli vifa muliere nuda etiam in in- fomnio. 7. Tenfiopenis in hydrophobia. An ereflion of the penis oc- curs in the hydrophobia, and is a troublefome fymptom, as ob- ferved by Coelius Aurelianus, Fothergil, and Vaughan, and would feem to be produced by an unexplained fymparhy between the fenfations about the fauces and the penis. In men the hair grows about both thefe parts, the voice changes, and the neck thickens at puberty. In the mumps, when the fwellings about the throat fubfide, the tefticles are liable to fwell. Venereal in- fefiion received by the penis is very liable to a fib 61 the throat with ulcers. Violent coughs, with forenefs or rawnefs about the fauces are often attended with erection of the penis ; which is alfo faid to happen to male animals, that are hanged ; which laft circumftance has generally been afcribed to the obftruclion of the circulation of the blood, but is more probably occafioned by the ftimulus of the cord in comprefling the throat; fince if it was owing to impeded circulation it ought equally to occur in drowning animals. Tn 376 DISEASES Class IV. 1. 2. 8- In men the throat becomes fo thickened at the time of puber- ty, that a meafure of this is ufed to afcertain the payment of a poll-tax on males in fome of the iflands of the Mediterranean, which commences at puberty ; a bring is wrapped twice round the thinned 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 pafles readily over the head, the fubjeft is taxable. It is difficult to point out by what circumdance the fenfitive motions of the penis and of the throat and nofe become affoci- ated ; lean only obferve, that thefe parts are fubjedted to great- er pleafurable fenfations than any other parts of the body; one being defigned to preferve ourfelves by the pleafure attending the fmell and deglutition of food, and the other to enfure the propagation of our fpecies : and may thus gain an aflbeiation of their fenfitive motions by their being eminently fenfible to pleaf- ure. See Ciafs I. 3. r. 11. and III. 1. 1. 15. and Sect. XVI. 5. See Gonorrhoea venerea, IL 1. 5. 1. In the female fex this aflbeiation between the face, throat, nofe, and pubis, does not exid : whence no hair grows on their chins at the time of' puberty, nor do their voices change, or their necks thicken. This happens probably from there being in them a more exquifite fenfitive fympathy between the pubis and the breads. Hence their breads fwell at the time of puberty, and fecrete milk at the time of parturition. And in the parotitis, or mumps, the breads of women fwell, when the tumor of the pa- rotitis fubfides. See Ciafs I. 1. 2. 15. Whence it would ap- pear, that their breads poflefs an intermediate fympathy between the pubis and the throat ; as they are the feat of a paffion, which men do not poflefs, that of fucking children. 8- Tenefmus calculofus. The fphin<Ter of the rectum becomes painful or inflamed from the aflbeiation of its fenfitive motions with thofe of the fphindter of the bladder, when the latter is ftimulated into violent pain or inflammation by a (tone. 9. Polypus narium ex afcaridibus ? The dimulation of afcari- des in the reftum produces, by fenfitive fympathy, an itching of the nofe, as explained in IV. 2 2.6; and in three children I have feen a polypus in the nofe. who were all affebted with afcarides; to the perpetual dimulation of which, and the confequent fenfitive aflbeiation, I was led to afcribe the inflammation and thickening of the membrane of the nodrils. 10. Crampus J'urarum in cholera. A cramp of the mufcles of the legs occurs in violent diarrhoea, or cholera, and from the ufe of too much acid diet in gouty habits. This feems to Sym- pathize with uneafy fenfation in the bowels. See Ciafs Ill 1. 1. 14. This aflbeiation is not eafily accounted for, but is anal- ogous Class IV. i. 2. 11. OF ASSOCIATION. 377 ogous in fome degree to the paralyfis of the mufclesof the arms in colica faturnina. It would feem, that the mufcles of the legs in walking get a fympathy with the lower parts of the inteitines, and thofe of the arm in variety of employment obtain a fympa- thy with the higher parts of them. See Cholera and Ileus. it. Eona. ignea nephrit'ca. Nephritic thingies. The exter- nal (kin about the loins and tides of the belly I fuppofe to have greater mobility in refpedl to fenfitive aflbciation, than the ex- ternal membrane of the kidney ; and that their motions are by fome unknown means thus aflbciated. When the torpor or be- ginning inflammation of this membrane ceafes, the external Ikin becomes inflamed in its Read, and a kind of herpes, called the fhingles, covers the loins and tides of the belly. See Clafs II. 12. Eruptio variolarinn. After the inflammation of the in- oculated arm has fpread for a quarter of a lunation, it aftedts the ftomach by reverfe fympathy ; that is, the actions of the ftom- ach are aflbciated with thofe of the fkin ; and as much fenfori- al power is now exerted on the inflamed fkin, the other part of this fenfitive affbciation is deprived of its natural fhare, and be- comes torpid, or inverts its motions. After this torpor of the llomach has continued a time, and much fenforial power is thus accumulated ; other parts of the fkin, which are alfo aflbciated with it, as that of the face firft, are thrown into partial in- flammation ; that is, the eruptions of the fmall-pox appear on the face. For that the variolous matter affedts the ftomach previous to its eruption on the fkin, appears from the ficknefs at the com- mencement of the fever ; and becaufe,when the morbid motions affedt the fkin, thofe of the ftomach ceafe ; as in the gout and eryfipelas, mentioned below. The confent between the ftom- ach and the fkin appears in variety of other difeafes ; and as they both confift of furfaces, which abforb and fecrete a quanti- ty of moifture, their motions muft frequently be produced to- gether, or in fucceflion ; which is the foundation of all the fym- pathies of animal motions, whether of the irritative, fenfitive, or voluntary kinds. Now as the fkin, which covers the face, is expofed to greater variations of heat and cold than any other part of the body ; it probably poflefles more mobility to fenfitive aflbciations, not on- ly than the ftomach, but than any other part of the fkin ; and is thence affected at the eruption of the fmall pox with violent action and confequent inflammation,by the aflbciation of its mo- uons with thofe of the ftomach, a day before the other parts of Vol. II. A a a the 378 DISEASES Class IV. 1.2. 13. the (kin ; and becomes fuller of puftules,than any other part of the body. SeeClafsII. i. 3.9. It might be fuppofed, that the fucceflive fwelling of the hands, when the face fubfides, ar the height of the fmall-pox, and of the feet, when the hands fubfide, where governed by fome un- known aflbciations of thofe parts of the fyftem ; but thefe fuc- ceflions of tumor and fubfidence more evidently depend on the times of the eruption of the puftules on thofe parts,as they ap- pear a day fooner on the face than on the hands, and a day fooner on the hands than on the feet, owing to the greater comparative mobility of thofe parts of the (kin. 13. Gutta rofeajlomatica. Stomatic red face. On drinking cold water, or cold milk, when heated with exercife, or on eat- ing cold vegetables, as raw turnips, many people in harveft-time have been affli6ked with what has been called a furfeit. The ftomach becomes painful, with indigeftion and flatulency, and after a few days an eruption of the face appears, and continues with fome relief, but not with entire relief ; as both the pimpled face and indigeftion are liable to continue even to old age. M. M. Venefettion. A cathartic with calomel. Then half a grain of opium twice a day for many weeks. If faturated fo- lution of arfenic three or five drops twice or thrice a day for a week ? 14. Gutta rofea bepatica. The rofy drop of the face of fome drinking people is produced like die gout defcribed below, in confequence of an inflamed liver." In thefe conftiturions the fkin of the face being expofed to greater variation of heat and cold than the membranes of the liver, poflefles more mobility than thofe hepatic membranes; and hence by whatever means thefe membranes are induced to fympathize, when this fenlitive aflbciation occurs, the cutaneous veflels of the face run into greater degrees of thofe motions, which conftitute inflammation, than previoufly exifted in the membranes of the liver ; and then thofe motions of the liver ceafe. See Clafs II. 1. 4. 6 As inflammation of the liver fo frequently attends the great potation of vinous fpirit, there is reafon to fufpe<St, that this vif- cus itfelf becomes inflamed by fenfitive aflbciation with the ftomach ; or that, when one termination of the bile-duft, which enters the duodenum, is ftimulated violently, the other end may become inflamed by fenfitive aflbciation. 15. Podagra. The gout, except when it affects the liver or ftomach, feems always to be a fecondary difeafe, and, like the rheumatifm and eryfipelas mentioned below, begins with the torpor of fome diftant part of the fyftem. The rnoft frequent primary feat of the gout I fuppofe to be the Class IV. 1. 2.15. OF ASSOCIATION. 379 the liver, which is probably affeded with torpor not only previ- ous to the annual paroxyfms of the gout, but to every change of its fituation from one limb to another. The reafons, which induce me to fufped the liver to be firft affeded, are not only becaufe the jaundice fometimes attends the commencement of gout, as defcribed in Seel. XXIV. 2. 8 but a pain alfo over the pit of the ftomach, which I luppofe to be of the termination of the bile-dud: in the duodenum, and which is eroneoufly fup- pofed to be the gout of the ftomach, with indigeftion and flatu- lency, generally attends the commencement of the inflamma- tion of each limb. See Arthritis ventriculi, Clafs I. 2. 4. 6. In the two cafes, which I faw, of the gout in the limbs being preceded by jaundice, there was a cold Ihivering fit attended the inflammation of the foot, and a pain at the pit of the ftom- ach ; which ceafed along with the jaundice, as foon as the foot became inflamed. This led me to fufped, that there was a torpor of the liver, and perhaps of the foot alfo, but neverthe- lefs the liver might alfo in this cafe be previoufly inflamed, as obfervedin Sed. XXIV. 2. 8. Now as the membranes of the joints of the feet fuffer greater variations of heat and cold than the membranes of the liver, and are more habituated to extenfion and contradion than other parts of the ikin in their vicinity ; I fuppofe them to be more mobile, that is, more liable to run into extremes of exertion or quiefcence ; and are thence more fufceptible of inflammation, than fuch parts as are lefs expofed to great variations of heat and cold, or of extenfion and contradion. When a ftone preffes into the fphinder of the bladder, the glans penis is affeded with greater pain by fympathy, owing to its greater fenfibility, than the fphinder of the bladder ; and when this pain commences, that of the fphinder ceafes, when the ftone is not too large, or pufhed too far into the urethra. Thus when the membrane, which covers the ball of the great toe, fympathizes with fome membranous part of a torpid or in- flamed liver ; this membrane of the toe falls into that kind of adion, whether of torpor or inflammation, with greater energy, than thofe adions excited in the difeafed liver ; and when this new torpor or inflammation commences, that with which it fympathizes ceafes •, which I believe to be a general law of af- fociated inflammations. The paroxyfms of the gout would feem to be catenated with folar influence, both in refped to their larger annual periods, and to their diurnal periods-See Sed. XXXVI. 3 6.-as the former occur about the fame feafon of the year, and the latter ommence about an hour before fun-rife ; neverthelefs the an- nual 380 DISEASES Class IV. r. 2. 15. nual periods may depend on the fucceflion of great viciflitudes of cold and heat, and the diurnal ones on our increafed fenfibili- ty to internal fenfations during deep, as in the fits of afthma, and of fome epilepfies. See Seii:. XVIII. re. In refpett to the pre-remote caufe or difpofition to the gout, there can be no doubt of its individually arifing from the pota- tion of fermented or fpirituous liquors in this country ; wheth- er opium produces the fame effeft in the countries, where it is in daily ufe, I have never been well informed. See Seif. XXI. io. where this fubjeit is treated of; to which I have to add, that I have feen fome, and heard of others, who have moderat- ed their paroxyfms of gout, by diminilhing the quantity of fer- mented liquors, which they had been accuftomed to ; and oth- ers who, by a total abftinence from fermented liquors, have en- tirely freed themfelves from this excruciating malady ; which otherwife grows with our years, and curtails or renders mifera- ble the latter half, or third, of the lives of thofe, who are fub- jed: to it. The remote caufe is whatever induces temporary torpor or weaknefs of the fyftem ; and the proximate caufe is the inirritability, or defective irritation, of fome part of the fyf- tem ; whence torpor and confequent inflammation. The great Sydenham faw the beneficial effe&s of the abftinence from fer- mented liquors in preventing the gout, and adds, " if an empiric « could give fmali-beer only to gouty patients as a noftrum,and " perfuade them not to drink any other fpirituous fluids, he <t might refcue thoufands from this difeafe, and acquire a for- « tune for his ingenuity." Yet it is to be lamented, that this accurate obferver of difeafes had not refolution to pra^fife his own prefcription, and thus to have fet an example to the world of the truth of his do&rine ; but, on the contrary, recommend- ed Madeira, the ftrongeft wine in common ufe, to be taken in the fits of the gout, to the detriment of thoufands; and is faid himfelf to have perilhed a martyr to the difeafe, which he knew how to fubdue ! As example has more forcible effect than fimple aflertion, 1 {hall now concifely relate my own cafe, and that of one of my moft refpe&ed friends. E. D. was about forty years of age, when he was firft feized with a fit of the gout. The ball of his right great toe was very painful, and much fwelled and inflam- ed, which continued five or fix days in fpite of venfe€lion, a a brifk cathartic with ten grains of calomel, and the application of cool air and cold water to his foot. He then ceafed to drink ale or wine alone ; confining himfelf to fmall-beer, or wine di- luted with about thrice its quantity of water. In about a year he fuflered two other fits of the gout, in lefs violent degree. He then OF ASSOCIATION. Class IV. 1.2. 15. 381 then totally abftained from all fermented liquors, not even tatt- ing fmall-beer, or a drop of any kind of wine ; but ate plenti- fully of flefh-meat, and all kinds of vegetables, and fruit, ufing for his drink at meals chiefly water alone, or lemonade, or cream water ; with tea and coffee between them as ufual. By this abftinence from fermented liquors he kept quite free from the gout for fifteen or fixteen years ; and then began to take fmall-beer mixed with water occafionaily, or wine and water, or perry and water, or cyder and water ; by which in- dulgence after a few months he had again a paroxyfm of gout, which continued about three days in the ball of his toe ; which occafioned him to return to his habit of drinking water, and he has now for above twenty years kept in perpetual health, ex- cept accidental colds from the changes of the feafons. Before he abitained from fermented or fpirituous liquors, he was fre- quently fubjeft to the piles, and to the gravel, neither of which he has fince experienced. In the following cafe the gout was eflablifhed by longer habit and greater violence, and therefore required more cautious treat- ment. The Rev. R. W. was feized with the gout about the age of thirty-two, which increafed fo rapidly that at the age of for- ty-one he was confined to his room feven months in that year ; he had fome degree of lamenefs during the intervals, with chalky fwellings of his heels and elbows. /Is the difeafe had continued fo long and fo violently, and the powers of his digef- tion where fomewhat weakened, he was advifed not entirely to leave off all fermented liquors ; and as fmall-beer is of fuch va- rious ftrength, he was advifed to drink exadfly two wine-glafl'es, about four ounces, of wine mixed with three or four times its quantity of water, with or without lemon and fugar, for his dai- ly potation at dinner, and no other fermented liquor of any kind ; and was advifed to eat flefh-meat with any kind of boil- ed vegetables, and fruit, with or without fpice. He has now fcrupuloufly continued this regimen for above five years, and has had an annual moderate gouty paroxyfm of a few weeks, infteadof the confinement of fo many months, with great health and good fpirits during the intervals. The following is a more particular account of the hittory of this cafe ; being part of a letter which Mr. Wilmot wrote on that fubjefl at my entreaty. I entered into the army with an excellent conftitution at the age of fifteen. The corps I ferved in was dittinguifhed by its regularity, that is, the regular allowance of the mefs was on- ly one pint of wine per man each day ; unleis we had company to difie with us ; then, as was the general cuttom of the time, the 382 DISEASES Class IV. 1. 2. 15. the bottle circulated without limit. This mode of living, though by no means confidered as excefs for men, was certainly too g eat for a youth of my age. This ftyle of living I contin- ued, when with the regiment, till the latter end of the year 1769, when I had the misfortune to fleep 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 feized with a violent inflamma- tory rheumatifm with great inflammation of my eyes, and was attended by Dr Dealtry ; fo violent was the diforder, that I was bled for it eight time in lefs than a fortnight ; and was three months, before I could confider my health perfectly reeftablifh- ed. Dr Dealtry told me, that I fhould be fubjeCt to fimilar at- tacks for many years; and that he had no doubt, from the ten- dency he found in my habit to inflammation, thatj when I was farther advanced in life, I fhould change that complaint for the gout. He predicted truly; for the three fucceeding winters I had the fame complaint, but not fo violently; the fourth winter I efcaped, and imputed my efeape to the continuancte of cold bathing during the whole of that winter ; after that I never eleaped it, till I had a regular and fevere fit of the gout: after the firft attack ot rheumatic fever I was more abltemious in my manner of living, though when in company I never fubjected myieif to any great reftraint. In the year 1 774 I had quitted the army, and being in a more retired fituation, was feldom led into any exc; fs , in 1776 and 1777 I was in the habit of drink- ing a good deal of wine very frequently, though not conftantly. After that period ti l the year 1781, 1 drank a larger quantity of wine regularly, but very feldom to any degree of intoxication. I lived much at that time in the fociety of fome gentlemen, who uiualiy drank nearly a bottle of wine daily after dinner. I mult here however obierve, that at no part of my life was I accuftom- ed to drink wine in an evening, and very feldom drank any thing more than a Tingle half-pint glafs of fome fort of fpirits diluted with much water. Till the year 1781 I had always been accuftomed to ule very violent and continued exerciie on horfe-back ; in the winter months I purfued all field diverfions, and in the fummer months I rode frequent and long journeys ; and with this exercife was liable to perfpire to great excefs; be- fides which I was fubjeft to very profule night-fweats, and had frequently boils break out all over me, efpecially in the fpring and autumn ; for which I took no medicine, except a little of the flowers of fulphur with cream of tartar in honey. " You will obierve I bring every thing down to the date of 1781. In the month of October in that year, when I was juft entered into the thirty-fecond year of my age, I had the firft at- tack Class IV. 1. 2.15. OF ASSOCIATION. 383 tack of gout; that fit was very fevere, and of many weeks con- tinuance. I now determined upon a more abftemious method of living, in refpedl to wine ; and indeed rhe fociery, in which I had before been accuftomed to live, being considerably chang- ed, I had lefs frequent temptations to excefs. From this time I enjoyed the molt perfect good Rate of health till Auguft 1784, when I had my fecond attack of gout. I never perfectly recov- ered from this attack through the fucceeding winter, and in March 1785, was advifed to try the Bath waters, and drank them under the direction of one of the faculty of that place. I was there foon feized with a fever, and a flight attack of gout in one knee. I Ihould obferve, that when I fet out from home, I was in a weak and low ftate, 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 courfe of the fummer I had two or three more flight attacks of gout of lefs confequence, till the month of O&ober ; when I was afflicted with it all over me in fuch a manner, as to be without the pof- fibility of the leaft degree of removal for fome days ; and was about two months without being able to get into the air. This was the fevered attack I had then experienced ; though I have fince had feveral equally fevere. In the courfe of this fummer I had a fall with my horfe ; and foon after it, having difcovered an enlargement on one elbow, I concluded I had hurt it at that time 5 but in the courfe of this laft attack having a fimilar en- largement on the other elbow, I found my miltake, and that they were collections of gouty matter; thefe increafed to the fize of pullet's eggs, and continue in that ftate. I had foon af- ter fimilar enlargements on my heels ; the right heel being fe- verely bruited, I was under the neceffity of having it lanced,and a large quantity of chalky matter was difcharged from it ; and have fince that time frequently had chalky- matter taken from it, and fometimes fmall bits of apparently perfect chalk. My right hand was foon afflicted in the fame way,and I have fcarce- ly a joint on thofe fingers now in a natural ftate. My left hand has efcaped tolerably well. After this laft attack (viz. October 1785) I had two or three flight attacks before the month of June 1787, when I had a very fevere 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 confin- ed by it. I was in this ftate advifed to try what is called the American Recipe (gum guaiacum and nitre diflblved in fpirirs) ; it had apparently been of eflential fervice to a friend of mine, who from the inability to walk a mile for fome years, was be- lieved to be reftored by the ufe of this medicine to a good ftate of 384 DISEASES Class IV. 1. 2. 15 of health, fo as to walk ten miles a day. In addition to this medicine I drank, as my common beverage with my meals, fpruce beer. I had fo high an opinion of this medicine in the gout, and of fpruce beer as an antifcorbutic, that I contemplated with much farisfaftion, and with very little doubt, the perfect reftoration of my health and ftrength ; but I was miferably de- ceived ; for in September 1788 I was feized with the gout in a degree that none but arthritics, and indeed but few of thefe, can eafily conceive. From this time till Auguft 1789 I fcarcely ever palled a comfortable day ; feven months of this time I had been confined, my health feemed much impaired, my ftrength was diminithed, and my appetite alrnoft gone. In this ftate my friends preiTed me to confult you. I was unwilling for fome time to do it, as I had loft all hope of relief; however, when I had determined to apply to you, I likewife determined to give up every prejudice of my own refpefting my cafe, and to ad- here moft ftriclly to your advice. On the 20th of Auguft 1780 I confulted you, on the 25th I entered upon the regimen,which you prefcribed, and which was as follows. " Drink no malt liquor on any account. Let your beverage at « dinner confift of two glades of wine diluted with three half- « pints of water. On no account drink any more wine or fpir- ituous liquors in the courfe of the day ; but, if you want more « liquid, take cream and water, or milk and water, or lemonade with tea, coffee, chocolate. Ufe the warm bath twice a week « for half an hour before going to bed, at the degree of heat « which is moft grateful to your fenfations. Eat meat conftant- « ly at dinner, and with any kind of tender vegetables you pleafe. « Keep the body open by two evacuations daily, if poflible « without medicine, if not take the fize of a nutmeg of lenitive « electuary occafionally, or five grains of rhubarbs every night. c< Ufe no violent exercife, which may fubjetft yourfelf to fudden " changes from heat to cold ; but as much moderate exercife as « may be, without being much fatigued or ftarved with cold. « Take fome fupper every night ; a fmall quantity of animal food is preferred ; but if your palate refufes this, take veg- « etable food, as fruit-pie, or milk; fomething fhould be eaten, « as it might be injurious to you to faft too long." To the whole of this I adhered moft fcrupuloufly, and foon found my appetite improve, and with it my ftrength and fpirits. I had in Decem- ber a fevere attack, and two or three flight ones in the courfe of twelve months; but the improvement in the general ftate of my health induced me to perfevere. On the 1 Sth of Auguft 1790 I had another fevere attack, but it went off- eafier than before, and I foon recovered fufliciently to go to Buxton, which you ad- vifed Class IV. 1. 2.15. OF ASSOCIATION. 385 vifed me to, and from which I reaped great benefit ; ne ver the- lefs on the 29th of December I had a flight attack in compan- ion of fome 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 Octo- ber 1793 j and from that till June 1794. From what happen- ed for the laft three years I dreaded the month of October ; but I efcaped then, and have enjoyed my health moft perfectly ever fince till within the laft week, that I have had a flight at- tack in one knee, which is nearly gone, without any Symptom to lead me to luppoie it will go further. « I adhered to your advice moft fcrupuloufly for the firft year; and in regard to the not drinking malt liquor, and taking only the two glafles of wine with water, I have never deviated but two days; and then the firft day I only drank one glafs of ale and one glafs of champaigne; on the Second day only one glafs of champaigne. With regard to the warm bath, I only ufe it now when I have gouty Symptoms upon me, and in fuch fituations I find it of infinite fervice ; and in other refpects I coritinue to live according to your direction. « Many perlons have laughed at the idea of my perfeyerance in a fyftem, which has not been able to cure the gout after five vears' trial; but fuch perfons are either ignorant of what I be- fore fuffered, or totally unacquainted with the nature of the dis- order. Under the blefling of Providence, by ah adherence to your advice, I am reaping all the benfit you flattered the I might expert from it, viz my attacks lefs frequent, my fuffer- ings lefs acute, and an improvement in the general ftate of my health. « I have been particular in this account of myfelf at your re- queft, and am, Sir, &c. Morley near Derby, Feb. 10th, 1795. Robert Wilmot.'' There are fituations neverthelefs in which a paroxyfm of gout has been believed to be defirable, as relieving the patient from other difagreeable difeafes, or debilities or fenfations. Thus when the liver is torpid, a perpetual uneafinefs and depreffion of Spirits occur; which a fit of gout is fuppofed to cure by a metaftafis of the difeafe. Others have acquired epileptic nt^ probably from the difagreeable fenfation of a chronically inflam- ed liver ; which they fuppofe the pain and inflammation of gout would relieve. When gouty patients become much debilitated by the progrefs of the difeafe, they are liable to dropfy of the Vol. II. Bb b cheft, DISEASES Class IV. 1. 2. 15. 386 cheft, which they fuppofe a fit of the gout would relieve. But in all thefe cafes the attempt to procure a paroxyfm of gout by wine or aromatics, or volatiles, or blifters, or mineral waters, feldom fucceeds ; and the patients are obliged to apply to oth- er methods of relief adapted to other particular cafes. In the two former fituations final 1 repeated dofes of calomel, or mer- curial unction on the region of the liver, may fucceed, by giv- ing new activity to the veflels of the liver, either to fecrete or to abforb their adapted fluids, and thus to remove the caufe of the gout, rather than to promote a fit of it. In the laft cafe the tin&ure of digitalis, and afterwards the clafs of forbentia, muft be applied to. M. M. In young ftrong patients the gout fhould be cured by venefeciion and cathartics and diluents, with poultices ex- ternally. But it has a natural crifis by producing calcareous mattpr on the inflamed membrane, and therefore in old enfee- bled people it is fafeft to wait for this crifis, attending to the natural evacuations and the degree of fever ; and in young ones, where it is not attended with much fever, it is cuftomary and popular not to bleed, but only to keep the body open, with aloes, to ufe gentle fudorifics, as neutral faits, and to give the bark at the dec|ine of the fit; which is particularly ufeful where the patient is much debilitated. See Arthritis ventriculi, Clafs I.- 2. 4., 6, and Se<St. XXV. 17. Mr. Kelly, furgeon in the navy, in an ingenious treatife, printed at Edinb. 1797, termed Obfervations on Compreflion by the Tourniquet, advifes in both inflammatory and chronic rheumatifm to comprefs the artery of the affecfled limb by the tourniquet, for 15 or 20 minutes, relaxing or tightening the bandage, as the patient feems to bear it. And in inflammatory rheumatifm, he advifes to take blood from a vein below the bandage, which he fays relieves the pain and deftroys the in- flammation. Could not this experiment be ufed fafely in the gout of young or ftrong patients ? and perhaps with fpeedy fuccefs ? When there is not much fever, and the patient is debilitated with age, or the continuance of the difeafe, a moderate opiate, as twenty drops of tinifture of opium, or one grain of folid opi- um, may be taken every night with advantage. Externally a pafte made with double the quantity of yeft is a good poultice ; and booterkins made with oiled filk, as they confine the perfpir- able matter, keep the part moift and fupple, and thence relieve the pain like poultices. The only fafe way of moderating the difeafe is by an uniform and, equal diminution, or a total abftinence from fermented liquors. Class IV. 1. 2. 16. OF ASSOCIATION. 387 liquors, with the cautions directed in Se6t. XII. 7. 8. The continued ufe of ftrong bitters, as of Portland's powder, or bark, has been frequently injurious, as fpoken of in the Materia Med- ica, Art. IV. 2. 11. One of my acquaintance, who was much afflicted with the gout, abftained for about half a year from beer and wine; and not having refolution to perfift, returned to his former habits of potation in lefs quantity ; and obferved that he was then for one winter ftronger and freer from the gout than ufual. This how- ever did not long continue, as the difeafe afterwards returned with its ufual or increaled violence. This I think is a circumftance not unlikely to occur, as opium has a greater effect after its ufe has been a while intermitted ; and the debility or torpor, which is the caufe of gout, is thus for a few months prevented by the greater irritability of the fyftem, acquired during the leflened ufe of fermented liquor. For the fame reafon an ounce of fpirituous tincture of guaia- cum, or of bark, is faid to have for fome time prevented returns of the gout; which has afterwards, like all other great ftimuli when long continued, been fucceeded by greater debility, and deftroyed the patient. This feems to have been exemplified in the cafe of the ingenious Dr. Brown, fee Preface to his Ele- menta Medicinte; he found temporary relief from the ftimulus of wine, regardlefs of its future effects. Laftly, as the gouty inflammation, like the rheumatic fwellings of the wrifts and ankles, is not a primary difeafe ; and is like them not liable to fuppurate ; there is reafon to believe that opi- ates may be given with lefs danger than in other inflammations, and with a profpeft of advantage ; fince by preventing the pe- riods of torpor of the liver, or other part, primarily affe&ed, the diurnal additional attack, or its producing inflammation of another limb, may fometimes be prevented. A perfon a few days ago affured me, that when the gout came into his foot, his practice was to take thirty drops of tincture of opium ; and in half an hour thirty drops more ; and even a third dofe if the pain did not fubfide; and that the fit foon ceafed. I fhould think this a dangerous experiment. A Mr. Warner wrote a book recommending opium in the gout, but died loon after its publication. 16. Rheumatifmus. Acute rheumatifm. There is reafon to fufpect, that rheumatic inflammations, like the gouty ones, are not a primary difeafe ; but that they are the confequence of a tranflation of morbid action from one part of the fyftem to another. This idea is countenanced by the frequent change of place of rheumatic-like gouty inflammations, and from their at- tacking DISEASES 388 Class IV. 1.2. 16. tacking two flmilar parts at the fame time, as both ankles and both wrifts, and thefe attacks being in fucceffion to each other. Whereas it is not probable that both feet or both hands fhould at the fame time be equally expofed to any external caufe of the difeafe, as to cold or moifture ; and lefs fo that thefe Ihould oc- cur in fucceffion. Laftly, from the inflammatory diathefis in this difeafe being more difficult to fubdue, and more dangerous in event, than other common inflammations, efpecially to preg- nant women, and in weak conftitutions. From this idea of the rheumatifm being not a primary dif- eafe, like the gout, but a transferred morbid action owing to the previous torpor of fome other part of the fyftem, we perceive why it attacks weak people with greater pertinacity than ftrong ones ; refilling or recurring again and again after frequent evac- uations, in a manner very different from primary inflammations; becaufe the caufe is not removed, which is at a diftance from the feat of inflammation. This alfo accounts for rheumatic inflammations fo very rarely terminating in fuppuration, becaufe like the gout, the original caufe is not in the inflamed part, and therefore does not con- tinue to ad: after the inflammation commences. Inftead of fup- puration in this difeafe, as well as in the gout, a quantity of mucus of coagulable lymph is formed on the inflamed mem- brane ; which in the gout changes into chalk-ftones, and in the rheumatifm is either reabforbed, or lies on the membrane, pro- ducing pains on motion long after the termination of the inflam- mation, which pains are called chronic rheumatifm. The mem- branes, whichhave thus been once or repeatedly inflamed, become lefs mobile, or lefs liable to be affected by fympathy, as appears by the gout affecting new parts, when the joints of the foot have been frequently inflamed by it; hence as the caufe of the inflammation does not exift in the inflamed part, and as this part becomes lefs liable to future attacks, it feldom fuppurates. Pleurcdyne rheutnatica. When rheumatifm affeCts the mufcles of the cheft, it produces fymptoms fimilar to pleu- rify, but diftinguifhed from it by the patient having previoufly fuffered rheumatic affections in other parts, and by the perti- nacity or continuance of the inflammtory Rate of the patient. This fhould be termed pleurodyne rheumatica. Enteralgia rheumatica. When rheumatic inflammation af- feCts the bowels, it produces a difeafe very different from en- teritis, or common inflammation of the bowels, and fhould be termed interalgia rheumatica. The pain is lefs than in enteri- tis, and the difeafe of longer continuance, with harder pulfe, and the blood equally fizy. It is attended with frequent dejections, with Class IV. 1. 2. 16. OF ASSOCIATION. 389 with much mucus, and previous griping pains, but without vomiting; and differs perhaps from dyfentery from its not be- ing attended with bloody ftools, and not being infectious. Rheumatic inflammations, which I believe to arife from the fympathy of the inflamed part with the torpor of fome diftant part, may I think be certainly diftinguifhed from thofe inflam- mations of the fame part, which have not arifen from fympathy with the torpor of fome diftant part, but where the caufe of the inflammation began in the part where the inflammation exifts, by this circumftance ; that in rheumatic inflammation the hard or fharp pulfe continues at about 118 in a minute after the pain abates or ceafes. Whereas in the latter the inflammatory fever ceafes along with the pain. In two cafes of pain of the fide, and difficult refpiration, which I efteemed rheumatic, as the hard pulfe of 118 wdth fized blood continued after repeated venefeftion, gentle cathartics, and mild antimonials, I found ten drops of faturated tindure of digitalis given every fix hours appear to produce gieat good ef- fect, and to abate and remove the inflammatory diathefis in three or four days. Hence when a fever has continued more than one lunar pe- riod, attended with a hard or fharp pulfe of it8 or 120 in a minute, and is not attended with cough or fymptoms of abforb- ed matter, it may be efteemed of rheumatic origin, though no local pain or inflammation at prefent exifts ; and this with great- er certainty, if pain had previoufly exifted : for no fevers, ex- cept the hectic fevers from abforbed matter, and this attended with inflammatory diathefis, and which may be called rheumat- ic, ever properly extend, I believe, beyond one lunation ; though fymptoms of debility may continue a while longer. This ob~ fervation is worth attending to in practice, as it diftguifhes the kind of fever, in which when the bark is erroneoufly given, it does no fervice, and in which I believe faturated tindlure of digitalis given as above to be the moft efficacious medicine. Rheumatifmus fuppurans. There is another kind of rheuma- tifm attended with debility, which fuppurates and fhould be termed rheumatifmus fuppurans. It is generally believed to be the gout, till fuppuration takes place on the fwelled joint ; and, as the patient finks, there are floughs formed over the whole mouth ; and he feems to be deftroyed by inflammation or gan- grene of the mucous membranes. I have twice feen this dif- eafe in patients about fixty. Some other difeafes are erroneouf- ly called rheumatic, as hemicrania, and odontalgia. See Se<ft. XXVI. 3. M. M. In the three former kinds venefeClion repeatedly. Ca- thartics. 390 DISEASES Class IV. r. 2. 16. thirties. Antimonials. Diluents. Neutral faits. Oil. Wann bath. Afterwards the bark. Opium with or without ipecacu- anha ; but not till the patient is confiderably weakened. Sweats forced early in the difeafe do injury. Opium given early in the difeafe prolongs it. In the laft kind, gentle ftimulants, as wine and water, mucilage, forbentia. In acute rheumatifm, when the fwelling of the joints firft af- fefted fubfides, a return of torpor in the part primarily difeafed commences previous to an inflammation of the joints fecondari- ly affe&ed. Hence when the tumour of the joints firft affected fubfides, half a grain of opium, every night, and Peruvian bark, or other bitter medicine, may be given to prevent this return of torpor with great advantage ; if the patient has previoufly been properly evacuated, and is not now too much inflamed. Dr. Fordyce aflerts, that when it was the practice to bleed largely in acute rheumatifm, a metaftafis frequently took place to the interior parts of the body, and deftroyed the patient. And adds, that during the laft fifteen years of his practice this has rarely happened, as he has entirely left off bleeding in the acute rheumatifm. Third diflertation on fever by G. Fordyce, M. D. London, Johnfon. On this fubject it may be remarked, that as rheumatifm like gout is a fecondary difeafe, the inflammation of one part being fymptomatic, the feat of torpor exifting in fome other part, it may not be fo conftantly neceflary to bleed fo copioufly in thofe fecondary inflammatory difeafes, as in thofe primary ones, where the inflamed part was previoufly the feat of torpor, as in pleurify, peripneumony, and interitis ; but in rheumatifm, as well as in eryfipelas, I am convinced, that where the inflammation of the fyftem is great, repeated venefeftion is not only ufeful; but that thofe, who perifh by either of thofe difeafes, perifli for the want of venefe6tion early, where the at- tack is violent. And laftly, that even in the gout of young and ftrong fubjefts, as I know by experience on myfelf, a moderate venefeftion fhortens the fit, and leflens I believe the hazard of metaftafis. The following is a cafe of fuppurative rheumatifm. Mr. F- , about fixty, was fuppofed to have the gout in his hand, which however fuppurated, and it was then called the fuppura- tive rheumatifm. He had lived rather intemperately in refpect to wine, and was now afflicted with a tendency to inflammation of the mucous membranes. As he lay on the bed half refupine, propped up with pillows, and alfo flept in that pofture, his lower jaw dropped by its own weight, when the voluntary power of the mufcles was fufpended. The mucus of his mouth and throat became quite dry, and at length was fucceeded by floughs ; this Class IV. 1.2.17. OF ASSOCIATION. 391 this was a moft diftrefling circumftance to him, and was in vain endeavoured to be relieved by fupporting his jaw by {lender fteel fprings fixed to his night-cap, and by fprings of elaftic gum. The floughs fpread and feemed to accelerate his death. See Clafs I. i. 3/2. In acute rheumatifm Mr. Kellie aflerts that he has had great fuccefs by putting a tourniquet on the affected limb, fo as. to comprefs the artery, and then by taking blood from a vein below the bandage, as mentioned above in Podagra. Clafs IV. 1. 2. 15. 17. Eryfipelas. The eryfipelas differs from the zona ignea, and other fpecies of herpes, in its being attended with fever, which is fometimes of the fenfitive irritated or inflammatory kind, with ftrong and full pulfe ; and at other times with weak pulfe and great inirritabilty, as when it precedes or attends mortifications. See Clafs II. 1.3.2. Like the zona ignea above defcribed, it feems to be a fecond- ary difeafe, having for its primary part the torpor or inflam- mation of fome internal or diftant membrane, as appears from its fo frequently attending wounds ; fometimes fpreading from iiiues over the whole limb, or back, by fympathy with a tendon or membrane, which is ftimulated by the peafe in them. In its more violent degree I fuppofe that it fympathizes with fome extenfive internal membranes, as of the liver, ftomach, or brain. Another reafon which countenances this idea, is, that the in- flammation gradually changes its fituation, one part healing as another inflames ; as happens in refpeft to more diftant parts in gout and rheumatifm ; and which feems to ihew, that the caufe of the difeafe is not in the fame place with the inflammation. And thirdly, becaufe the eryfipelas of the face and head is liable to affect the membranes of the brain ; which were probably in thefe cafes the original and primary feat of the difeafe ; and laftly, becaufe the fits of eryfipelas, like thofe of the gout, are liable to return at certain annual or monthly periods, as further treat- ed of in Clafs II. 1. 3. 2. Many cafes of eryfipelas from wounds or bruifes are related in Default's Surgical Journal, Vol. II. in which poultices are faid to do great injury, as well as oily or fatty applications. Sat- urnine folutions were fometimes ufed with advantage. A grain of emetic' tartar given to clear the ftomach and bowels, is laid to be of great fervice. 18. Tefium tumor in gonorrhaa. Mr. Hunter in his Treatife on the Venereal Difeafe obferves, that the tumor of the teftes in gonorrhoea arifes from their fympathy with the inflammation of the urethra ; and that they are not fimilar to the actions arifing from the application of venereal matter, whether by abforption nr DISEASES Class IV. 1. 2- 19. 392 or otherwife ; as they feldom or never fuppurate ; and when fuppuration happens-, the matter produced is not venereal. Trea- tife on Venereal Difeafe, p. 53. 19. Tejlium tumor in parotidite. The fympathy between fome parts about the throat and the genitals has been treated of in Clafs IV. 1. 2. 7. The fwelling of the teftes, when that of the parotis fubfides, feems to arife from the affociation of fuc- ceflive action ; as the tenfion of the peins in hydrophobia appears to arife from the previous fynchronous aflbciations of the feafi- tive motions of thefe parts ; but the manner of the production of both thefe aflbciations is yet very obfcure. In women a fwelling of the breafts often fucceeds the decline of the mumps by another wonderful fympathy. See Clafs IV. 1. 2. 7. and I. 1. 2. 15. In many perfons a delirium fucceeds the fwelling of the parotis, or the fubfequent ones of the teftes or breafts ; which is fometimes fatal, and feems to arife from a fympathy of fncceflive aCtion, and not of fynchronous aCtion, of' the mem- branes of the brain with thofe of the parotid glands. Sometimes a ftupor comes on inftead of this delirium, which is relieved by fomenting the fhaved head for an hour or two. See Clafs IL 1. 3. 4. ORDO Cuss IV. 1.3.1. OF ASSOCIATION. 393 ORDO I. Increafed ^jjbciate Motions. GENUS in. Catenated with Voluntary Motions. SPECIES. i. Deglutitio invita. When any one is told not to fwal- low his faliva, and that efpecially if his throat be a little fore, he finds a neceffity of immediately fwallowing it ; and this the more certainly, the more he voluntarily endeavours not to do fo. In this cafe the voluntary power exerted by our attention to the pharynx renders it more fenfible to irritation, and therefore occafions it to be more frequently induced to fwallow the fali* Va. Here the irritation induces a volition to fwallow it, which is more powerful than the defire not to fwallow it. See XXIV. 1.7. So in reverie, when the voluntary power was exerted on any of the fenfes, as of fight or tafte, the objects of thofe fenfes became perceived; but not otherwife. See Se<St XIX. 6. This is a troublefome fymptom in fome fore throats. M. M. Mucilage, as fugar and gum arabic. Warm water held in the mouth frequently, 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 en- deavour to relieve fome difagreeable fenfations about inflamed eyes, as the dazzling of light; and afterwards thefe motions be- come catenated with other motions or fenfations, fo as not to be governed bv the will. Here the irritation firft produces a vo- lition to wink, which by habit becomes ftronger than the anti- volition not to wink. This fubje^t is rendered difficult from the common accepta- tion of the word volition, including previous deliberation, as well as the voluntary exertion, which fucceeds it. In the voli- tions here fpoken of there is no time for deliberation or choice of objects, but the voluntary aft immediately fucceeds the fenfa- tion which excites it. M M. Cover the affected parts with a flicking plafter or a blifter. Pafs a fine needle and thread through a part of the Ikin over the mufcle, which moves, and attach the other end of Vol. II. C c c the 394 DISEASES Class IV. 1. 3.3. the thread by a flicking plafter to a diftant part. An ifiue be- hind the ear. To practice daily by a looking-glafs to flop the motions with the hand. See the cure of a cafe of the leaping of a mufcle of the arm, Sett. XVII. i. 8. See Convulfio debi- lis, Clafs III. I. i. 5. Frequent electric fparks, or very flight fhocks. 3. Rifus invitus. Involuntary laughter. When the pleafure arifing from new combinations of words and ideas, as in puns ; or of other circumftances, which are fb trivial, as to induce no voluntary exertion to compare or confider their prefent impor- tance or their future confequence ; the pleafure is liable to rife into pain j that is, the ideas or fenfual motions become exerted too violently for want of fome antithefiftic ideas ; in the fame manner as thofe mufcles, which have weak antagonifts, as thofe of the calf of the leg, are liable to fall into cramp or painful contrac- tion. In this fituation a fcream is begun to relieve this pain of ideas too violently exerted, which is flopped again foon, as ex- plained in Seft. XXXIV. 1. 4. and Ciafs III. 1. 1.4. and IV.. 2-3-3- The pain into which this pleafure rifes, which would excite the fcream of laughter, has been felt forcibly by every one; when they have been under fuch circumftances, as have induc- ed them to reftrain it by a counter-volition ; till at length the increafed aflbciate motions produce fo much pain as to over- come the counter-volition, and the patient burfts out into inde- cent laughter, contrary to his will in the common acceptation of that word. 4. Lujus digitorum invitus. An awkward playing with the fingers in fpeaking in public. Thefe habits are begun through bafhfulnefs, and feem rather at firft defigned to engage the at- tention in part, and thus prevent the difagreeable ideas of mau- vaife honte ; as timorous boys whiffle, when they are obliged to walk in the dark; and as it is fometimes necefiary to employ raw foldiers in perpetual manoeuvres, as they advance to the firft charge. 5. Unguium morfiuncula invita. Biting the nails is a deprav- ed habit arifing from fimilar caufes as thofe of the laft article. M. M Dip the fingers in folution of aloes. 6. Vigilia invita. Watchfulnefs, where the perfon wifhes and endeavours to fall afleep, properly belongs to this place, as the with or volition to fleep prevents the defired effect; becaufe fleep confifts in an abolition of volition. See Clafs III. 1.2. 3. ORDO Class IV. 1. 4.1, OF ASSOCIATION. 395 ORDO I. Increafed AJfociate Motions. GENUS IV. Catenated with External Influences. SPECIES. i. Vita ovi. Life of an egg. The eggs of fowls were (hewn by Mr. J. Hunter to refift the freezing procefs in their living Rate more powerfully than when they were killed by having the yolk and white fliook together. Philof. Tranf. It may beafk- ed, does the heat during the incubation of eggs aft as a ftimulus exciting the living principle into aftivity ? Or does it aft lim- ply as a caufa fine qua non, as an influence, which penetrating the mafs, removes the particles of it co a greater diftance from each other, fo as to allow their movement over each other, in the fame manner as heat is conceived to produce the fluidity of wa- ter ; not by ftimulus, but by its penetrating influence ? Or may elementary heat in its uncombined ftate be fuppofed to aft only as an influence neceflary to life in its natural quantity ; whence torpor and death follow the eduftion of it from the body ; but in its increafed ftate above what is natural, or ufual, that it afts as a ftimulus; which we have a fenfe to perceive ; and which excites many parts of the fyftem into unnatural aftion ? See Clafs IV. i. i.C. 2. Vita hiemi-dormientium. The torpor of infefts, and birds, and quadrupeds, during the cold feafon, has been called fleep ; but I fuppofe it muft differ very much from that ftate of animal life, fince not only all voluntary power is fufpended, but fenfa- tion and vafcular motion have ceafed, and can only be reftored by the influence of heat. There have been related inftances of ihails, which have recovered life and motion on being put into water after having experienced many years of torpidity, or ap- parent death, in the cabinets of the curious. Here the water as well as the heat are required not only as a ftimulus, but as a caufa fine qua non of fluidity and motion, and confequent life. 3. Pullulatio arborum. The annual revivefcence of the buds of trees feems not only to be owing to the influence of the re- turning warmth of the fpring, but alfo to be catenated with fo- lar.gravitation ; becaufe feeds and roots and buds, which are analagous to the eggs of animals, put forth their ihoots by a lefs quantity 396 DISEASES Class IV. 1.4. 4. quantity of heat in fpring, than they had undergone in the lat- ter part of autumn, which may however be aicribed to their previous torpid ftate, and confequent accumulation of fenforial power, or irritability ; as explained in Botanic Garden, Part II. Canto I. 1. 322. note. Other circumftances, which counte- nance the idea, that vegetation is affe&ed by folar gravitation, as well as by heat, may be obferved in the ripening of the feeds of plants both in thofe countries where the iummers are fhort, and in thole where they are long. And by fome flowers clof- ing their bells at noon, or foon after ; and hence feem to fleep rather at folar diurnal periods, than from the influence of cold, or the deficiency of light. 4. Orgdfmatis venerei periodus. The venereal orgafm of birds and quadrupeds commences or returns about the vernal or au- tumnal equinoxes, and thence feems in refpeft to their great periods to be governed by folar influence. But if this orgafm be disappointed of its object, it is laid to recur at about month- ly periods, as obferved in mares and bitches, in this refpeft re- fembling the female catamenia. See Seii. XXXVI. 2. 3. and Sea. XVI. 13. 5. Brachii concitjjio eledlrica. The movement of the arm, even of a paralytic patient, when an electric fhock is pafled through it, is owing to the ftimulus of the excels of eleftricity. When a piece of zinc and another of filver, each about the fize of a crown-piece, are placed one under the upper lip, and the other on the tongue, io 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 thefe metals are brought into contaft or fep- arated ; which is another inftance of the ftimulus of the paflage of eleftric fliocks through the fibres of the organs of lenle, as well as through the mufcular fibres. See Seft. XII. 1. 1. But in its natural ftate eleftricity feems only to aft as an influence on animal and vegetable bodies ; of the falutary or injurious ef- fefts of which we have yet no precife knowledge. Yet if regular journals were kept of the variations of atmof- pheric eleftricity, it is probable fome difcoveries of its influence on our fyftem might in time be difcovered. For this purpofe a machine on the principle of Mr. Bennet's eleftric doubler might be applied to the pendulum of a clock, fo as to manifeft and even to record the daily or hourly variations of aerial eleftricity. Which has already been executed, and applied to the pendu- lum of a Dutch wooden clock, by Mr. Bennet, curate of Wirki- worth in Derbyfhire. Befides the variations of the degree or kind of atmofpheric eleftricity, fome animals, and fome men, feem to poflefs a great- er Class IV. 1.4.6. OF ASSOCIATION. 397 er power of accumulating this fluid in themfelves than others. Of which a famous hiftory of a Ruffian prince was lately pub- lifhed; who, during the clear and fevere frofts of that country, could not move himfelf in bed without luminous corrufcations. Such may have been the cafe of thofe people, who have been related to have taken fire fpontaneoufly, and to have been reduced to afhes. The eleCtric concuffion from the gymnotus eledricus, and torpedo, are other inftances of the power of the animal fyf- tem to accumulate electricity, as in thefe it *is ufed as a weapon of defence, for the purpofe of taking their prey. Some have believed that the accumulation or paffage of the magnetic fluid might affeCt the animal fyftem, and have aflerted 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 fhould be included between the fbuth and north poles of a horfe-fhoe magnet, or between the contrary poles of two different magnets, that the magnetifrn may be accumulated on the torpid part. 6. Oxygenatio Janguinis. The variation of the quantity of oxygen gas exifting in the atmofphere muft affect all breathing animals; in its excefs this too muft be efteemed a ftimulus ; but in its natural quantity would feem to aCt as an influence, or caufe, without which animal fife cannot exift even a minute. It is hoped that Dr. Beddoes's plan for a pneumatic infirmary, for the purpofe of putting this and various other airs to the teft of experiment, will meet with public encouragement, and ren- der confumption, afthma, cancer, and many dileafes conquera- ble, which at prelent prey with unremitted devaluation on all orders and ages of mankind. 7. Humectatio corporis. Water, and probably the vapour of water diffolved or diffufed in the atmofphere, unites by mechan- ical attraction with the unorganized cuticle, and foftens and en- larges it; as may be feen in the loofe and wrinkled fkin of the hands of wafherwomen ; the fame probably occurs to the mu- cous membrane of the lungs in moift weather; and by thick- ening it increafes the difficulty of refpiration of fbme peopie, who are faid to be afthmatical. So far water may be faid to act as an influx or influence, but when it is taken up by the mouths of the abforbent fyftem, it muft excite thofe mouths into aCtion, and then aCts as a ftimulus. There appears from hence to be four methods by which ani- mal bodies are penetrated by external things, i. By their ftim- ulus, which induces the abforbent veffels to imbibe them. 2. By mechanical attraction, as when water foftens the cuticle. 3. By chemical 398 DISEASES Class IV. i. 4. 7. chemical attraction, as when oxygen pafles through the mem- branes of the air-veflels of the lungs, and combines with the blood. And laftly, by influx without mechanical attraftion, chemical combination, or animal abforption, as the univerfal fluids of heat, gravitation, eleftricity, magnetifm, and perhaps of other etherial fluids vet unknown. ORDO Class IV. 2.1. OF ASSOCIATION, 399 ORDO II. Decreafed AJJbciate Motions. GENUS I. Catenated with Irritative Motions. As irritative mufcular motions are attended with pain, when they are exerted too weakly, as well as when they are exerted too ftrongly ; fo irritative ideas become attended with fenfation when they are exerted too weakly, as well as when they are ex- erted too ftrongly. Which accounts for thefe ideas being at- tended with fenfation in the various kinds of vertigo defcribed below. There is great difficulty in tracing the immediate caufe of the deficiencies of atftion of fome links of the afibciations of irrita- tive motions ; firft, becaufe the trains and tribes of motions, which compofe thefe links, are fo widely extended as to embrace almoft the whole animal fyftem ; and fecondly, becaufe when the firft link of an afibciated train of actions is exerted with too great energy, the fecond link by reverfe fyinpathy may be affefted with torpor. And then this fecond link may tranfmit, as it were, this torpor to a third link, and at the fame time regain its own energy of action ; and it is poffible this third link may in like manner tranfmit its torpor to a fourth, and thus regain its own natural quantity of motion. I fhall endeavour to explain this by an example taken from fenfitive afibciated motions, as the origin of their difturbed ac- tions is more eafily detected. This morning I faw an elderly perfon, who had gradually loft all the teeth in his upper jaw, and of all of the under except three of the molares ; the laft of thefe was now loofe, and occafionally painful ; the fangs of which were almoft naked, the gums being much wafted both within and without the jaw. He is a man of attentive obfer- vation, and aflured me, that he had again and again noticed, that, when a pain commenced in the membranes of the alveolar procefs of the upper jaw oppofite to the loofe tooth in the under one (which had frequently occurred for feveral days paft) the pain of the loofe tooth ceafed. And that, when the pain after- wards extended to the ear and temple on that fide, the pain in the membranes of the upper jaw ceafed. In this cafe the mem- branes of the alveolar procefs of the upper jaw became torpid, and confequently painful, by their reverfe fympathy -with the too DISEASES. Class IV. 2.1. i. 400 too violent actions of the inflamed membranes of the loofe tooth ; and then by a fecondary fympathy the membranes about the ear and temple became torpid, and painful; and thofe of the alveolar procefs of the upper jaw regained their natural quanti- ty of action, and ceafed to be painful. A great many more nice and attentive obiervations are wanted to elucidate thefe curious circumftances of aflbciation, which will be found to be of the greateft importance in the cure of many difeafes, and lead us to the knowledge of fever. SPECIES. i. Cutis frigida pranjorum. Chillnefs after dinner frequently attends weak people, or thole who have been exhaufted by exer- cife ; it ariies from the great expenditure of the fenforial power on the organs of digeftion, which are ftimulated into violent action by the aliment; and the veflels of the ikin, which are af- fociated with them, become in fome meafure torpid by reverie fympathy ; and a confequent chillnefs fucceeds with lefs abforp- tion of atmofpheric moifture. See the lubfequent article. 2. Pallor urinx pranforum. The palenefs of urine after a full meal is an inftance of reverfe aflbciation ; where the fecond- ary part of a train of afibciate motions acts with lefs energy in confequence of the greater exertions of the primary part. Af- ter dinner the abforbent veflels of the ftomach and inteftines are flimulated into greater action, and drink up the newly taken al- iment ; while thofe, which are fpread in great number on the neck of the bladder, ablorb lefs of the aqueous part of the urine than ufual, which is therefore difcharged in a more dilute ftate ; and has been termed crude by fome medical writers, but it only indicates, that fo great a proportion of the fenforial power is ex- pended on digeftion and abforption of the a.iment, that other parts of the fyftem act for a time with lefs energy. See Clafs IV. i. i. 6. Pallor urina a frigore cutaneo. There is a temporary dif- charge of pale water, and a diarrhoea, induced by expofing the ikin to the cold air; as is experienced by boys, who ftrip them- felves before bathing. In this cafe the mouths of the cutaneous lymphatics become torpid by the lubduction of their accuftom- ed degree of heat, and thofe of the bladder and inteftines be- come torpid by direft fympathy ; whence lefs of the thinner part of the urinary fecretion, and of the mucus of the inteftines, is reabforbed. See Sect. XXIX 4. 6. This effect cf fuddenly cooling the fkin by the afperfion of cold water has been ufed with fuccefs in coftivenefs, and has produced evacuations, when other Class IV. 2. 1. 4. OF ASSOCIATION. 401 other means have failed. When young infants are afflicted with griping joined with coftivenefs, I have fometimes directed them to be taken out of a warm bed, and carried about for a few minutes in a cool room, with almoft inftant relief. 4. Pallor ex agritudine. When ficknefs of ftomach firft oc- curs, a palenefs of the ficin attends it ; which is owing to the affociation or catenation between the capillaries of the ftomach and the cutaneous ones ; which at firft a6t by direct fympathy. But in a fhort time there commences an accumulation of the fenforial power of affociation in the cutaneous capillaries during their ftate of inactivity, and then the fkin begins to glow, and fweats break out, from the increafed actions of the cutaneous glands or capillaries, which are now in reverfe fympathy with thofe of the ftomach. So in continued fevers, when the itom- ach is totally torpid, which is known by the total averfion to folid food, the cutaneous capillaries are by reverfe fympathy in a perpetual ftate of increafed activity, as appears from the heat of the fkin. 5. Dyfpnaa a balnea frigido. The difficulty of breathing on going up to the middle in cold water, is owing to the irritative affociation or catenation of the action of the extreme veffels of the lungs with thofe of the fkin. So that when the latter are rendered torpid or inactive by the application of fudden cold, the former become inactive at the fame time, and retard the circulation of the blood through the lungs, for this difficulty of breathing cannot be owing to the preffure of the water imped- ing the circulation downwards, as it happens equally by a cold fhower-bath, and is foon conquered by habitual imme'fions. The capillaries of the fkin are rendered torpid by the fubduc- tion of rhe flitnulus of heat, and by the confequent diminutions of the fenforial power of irritation. The capillaries of the lungs are rendered torpid by the diminution of the fenforial power of affociation, which is now excited in lefs quantity by the leffen- ed actions of the capillaries of the fkin, with which they are catenated. So that at this time both the cutaneous and pulmo- nary capillaries are principally actuated, as far as they have any action by the ftimulus of the blood. But in a fhort time the fenforial power of irritation, and of affociation, become accu- mulated, and very energetic action of both thefe membranes fucceeds. Which thus refemble the cold and hot fit of an in- termittent fever. 6. Dyfpepfia a pedibus frigidis. When the feet are long cold, as in riding in cold and wet weather, fome people are very liable to indigeftion and confequent heart burn. The irritative motions of the ftomach become torpid, and do their office of di- Vol. II. Dod geftion 402 DISEASES ClassIV. 2. 1.7. geftion imperfedly, in confequence of their aflbciation with the torpid motions of the veflels of the extremities. Fear, as it pro- duces palenefs and torpidity of the (kin, frequently occafions tem- porary indigeftion in confequence of this aflbciation of the vef- fels of the (kin with thofe of the ftomach ; as riding in very bad roads will give flatulency and indigeftion to timorous people A fhort expofure to cold air increafes digeftion, which is then owing to the reverfe fympathy between the capillary veflels of the fkin, and the ftomach Hence when the body is expofed to cold air, within certain limits of time and quantity, a reverfe fympathy of the ftomach and the fkin firft occurs, and after- wards a direct fympathy. In the former cafe the expendi- ture of fenforial power by the fkin being leffened, but not its production in the brain ; the fecond link of the aflbciation, viz. the ftomach, acquires a greater fhare of it. In the latter cafe, by the continuation of the deficient ftimulus of heat, the torpor becomes extended to the brain itfelf, or to the trunks of the nerves ; and univerfal inactivity follows. 7. Tujjis a pedibus frigidis. On (landing with the feet in thawing fnow, many people are liable to inceffant coughing. From the torpidity of the abforbent veflels of the lungs, in con- fequence of their irritative aflbciations with thofe of the fkin, they ceafe to abforb the faline part of the fecreted mucus; and a cough is thus induced by the irritation of this faline fecretion ; which is fimilar to that from the noftrils in frofty weather, but differs in refpeCi to its immediate caufe ; the former being from aflbciation with a diftant part, and the latter from defeCt of the ftimulus of heat on the noftrils themfelves. See Catarrhus fri- gidus, Clafs I. 2. 3. 3. 8. Tuftis hepatica. The cough of inebriates, which attends the enlargement of the liver, or a chronical inflammation of its upper membrane, is fuppofed to be produced by the inconveni- ence the diaphragm fuffers from the compreffion or heat of the liver. It differs however eflentially from that attending hepati- tis, from its not being accompanied with fever. And is per- haps rather owing to irritative aflbciation, or reverfe fympathy, between the lungs and the liver. As occurs in fheep, which are liable to a perpetual dry cough, when the fluke-worm is prey- ing on the fubftance of their livers. See Clafs II. 1. 1. 5. M. M. From half a grain to a grain of opium twice a day. A drachm of mercurial ointment rubbed on the region of the liver every night for eight or ten times. 9. Tuffis arthritica. Gout-cough. I have feen a cough, which twice recurred at a few years diftance in the fame per- fon, during his fits of the gout, with fuch pertinacity and vio- lence Class IV. 2. 1.1©. OF ASSOCIATION. 403 lence as to refill venefedion, opiates, bark, blifters, mucilages, and all the ufual methods employed in. coughs. It was for a time fuppofed to be the hooping cough, from the violence of the -aClion of coughing; it continued two or three weeks, the pa- tient never being able to fleep more than a few minutes at once during the whole time, and being propped up in bed with pil- lows night and day. As no fever attended this violent cough, and but little expec- toration, and that of a thin and frothy kind, I fufpefted the membrane of the lungs to be rather torpid than inflamed, and that the faline parts of the mucus not being abforbed llimulated them into perpetual exertion. And laftly, that though the lungs are not fenfible to cold and heat, and probably therefore lefs mobile, yet, as they are neverthelefs liable to confent with the torpor of cold feet, as defcribed in fpecies 6 of this Genus, I fufpeCled this torpor of the lungs to fucceed the gout in the feet, or to aCl a vicarious part for them. io. Vertigo rotatoria. In the vertigo from circumgyration, the irritative motions of vifion are increafed ; which is evinced from the pleafure that children receive on being rocked in a cradle, or by Iwinging on a rope. For whenever fenfation arif- es from the production of irritative motions with lefs energy than natural, it is of the difagreeable kind, as from cold or hun- ger ; but when it arifes from their production with greater en- ergy than natural, if it be confined within certain limits, it is of the pleafurable kind, as by warmth or wine. With thefe in- creafed irritative motions of vifion, I fuppofe thofe of the ftom- ach are performed with greater energy by direCt fympathy ; but when the rotatory motions, which produce this agreeable verti- go, are continued too long, or are too violent, ficknefs of the ftomach follows ; which is owing to the decreafed aCtion of that organ from its reverfe fympathy with the increafed actions of the organ of vifion. For the expenditure of fenforial power by the organ of vifion is always very great, as appears by the fize of the optic nerves ; and is now fo much increafed as to deprive the next link of aflbciation of its due (hare. As mentioned in Species 6 of this Genus. In the fame manner the undulations of water, or the motions of a Ihip, at firft give pleafure by increafing the irritative mo- tions belonging to the fenfe of vifion ; but produce ficknefs at length by expending on one part of the aflbciated train of irri- tative actions too much of that fenforial power, which ufually ferved the whole of it; whence feme other parts of the train ac- quire too little of it, and perform their adions in confequence too feebly, and thence become attended with difagreeable fenfation. It DISEASES 404 ClassIV. 2.. 1. la. It muft alfo be obferved, that when the irritative motions are {Emulated into unufual adHon, as in inebriation, they become fucceeded by fenfation, either of the pleafurable or painful kind ; and thus a new link is introduced between the irritative mo- tions thus excited, and thofe which ufed to fucceed them ; whence the aflbciation is either diflevered or much weakened, and thus the vomiting in fea-ficknefs occurs from the defeft of the power of aflbciation, rather than from the general deficien- cy of fenforial power. When a blind man turns round, or when one, who is not blind, revolves in^he dark, a vertigo is produced belonging to the fenfe of touch. A blind man balances himfelf by the fenfc of touch, which being a lefs perfect means of determining fmall quantities of deviation from the perpendicular, occafions him to walk more carefully upright than thofe, who balance themfelves by vifion. When he revolves, the irritative aflbciations of the mufcular motions, which were ufed to preferve his perpendicu- larity, become difordered by their new modes of fuccefllve ex- ertion ; and he begins to fall. For his feet now touch the floor in manners or directions different from thofe they have been ac- cuftomed to ; and in confequence he judges lefs perfectly of the fituation of the parts of the floor in refpect to that of his own body, and thus lofes his perpendicular attitude. This may be illuftrated by the curious experiment of eroding one finger over the next to it, and feeling a nut or bullet with the ends of them. When, if the eyes be clofed, the nut or bullet appears to be two, from the deception of the fenfe of touch. In this vertigo from gyration, both of the fenfe of fight, and of the fenfe of touch, the primary link of the aflbeiated irritative motions is increafed in energy, and the fecondary ones are in- creafed at firft by direct fympathy ; but after a time they become decreafed by reverfe fympathy with the primary link, owing to the exhauftion of fenforial power in general, or to the power of aflbciation in particular ; becaufe in the laft cafe, either pleafur- able or painful fenfation has been introduced between the links of a train of irritative motions, and has diflevered, or much en- feebled them. Dr. Smyth, in his Eflay on Swinging in Pulmonary Confump- tion, has obferved, that fwinging makes the pulfe flower. Dr. Ewart of Bath confirmed this obfervation both on himfelf and on Col. Cathcart, who was then hectic, and that even on fliip- board, where feme degree of vertigo might be fuppofed previ- oufly to exift. Dr. Currie of Liverpool not only confirmed this obfervation frequently on himfelf, when he was alfo phtifical, but found that equitation had a fimilar effect on him, uniform - ly Class IV. 2.1. 1®. OF ASSOCIATION. 405 ly retarding his pulfe. This curious eircumftance cannot arife from the general effeft of exercife, or fatigue, as in thofe cafes the pulfe becomes weaker and quicker ; it muft therefore be af- cribed to a degree of vertigo, which attends all thofe modes of motion, which we are not perpetually accuftomed to. Dr. Currie has further obferved, that " in cafes of great de- bility the voluntary mufcular exertion requifite in a fwing pro- duces wearinefs, that is, increafes debility ; and that in fuch in- ftances he had frequently noticed, that the diminution of the fre- quency of the pulfe did not take place, but the contrary." Thefe circumftances may thus be accounted for. The links of aflbciation, which are effefted in the vertigo oc* cafioned by unufual motion, are the irritative motions of the fenfe of vifion, thofe of the ftomach, and thofe of the heart and arteries. When the irritative ideas of vifion are exerted with greater energy at the beginning of vertigo, a degree of fenfat on is excired, which is of the pleafurable kind, as above mentioned j whence tl}e aflbciated trains of irritative motions of the ftomach, and heart, and arteries, aft at firft with greater energy, both by direft fympathy, and by the additional fenforial power of fenfa- tion. Whence the pulfe of a confumptive patient becomes ftronger and confequently flower. Bur if this vertigo becomes much greater in degree or dura- tion, the firft link of this train of aflbciated irritative motions expends too much of the fenforial power, which was ufually em- ployed on the whole train ; and the motions of the ftomach be- come in confequence exerted with lefs energy. This appears, becaufe in this degree of vertigo ficknefs fupervenes, as in fea- ficknefs, which has been {hewn to be owing to lefs energetic ac- tion of the ftomach. And the motions of the heart and arteries then become weaker, and in confequence more frequent, by their direft fympathy with the leflened aftions of the ftomach. See Supplement, I. 12. and Clafs II. I. 6. 7. The general weak- nefs from fatigue is owing to a fimilar caufe, that is, to the too great expenditure of fenforial power in the increafed aftions of one part of the fyftem, and the confequent deficiency of it iu other parts, or in the whole. The abatement of the heat of the Ikin in heftic fever by fwinging, is not only owing to the increafed ventilation of cool air, bur to the reverfe fympathy of the motions of the cutaneous capillaries with thofe of the heart and arteries ; .which occurs in all fevers with arterial debility, and a hot or dry Ikin. Hence during moderate fwinging the aftion of the heart and arteries becomes ftronger and flower, and the aftion of the capillaries, which was before too great, ae appeared by the heat of the fkin, is 406 DISEASES ClassIV. 2.T. 11. is now leflened by their reverfe fympathy with that of the heart and arteries. See Supplement, I 8. ii. Vertigo vi/uaUs Vifual vertigo. The vertigo rotaroria described above, was induced by the rotation or undulation of external objefts, and was attended with increafed action of the primary link of the aflbeiated motions belonging to vifion, and with confequent pleafure. The vertigo vifualis is owing to lefs perfect vifion, and is not accompanied with pleafurable fenfa- tion. This frequently occurs in ftrokes of the palfy, and is then fucceeded by vomiting; it fometimes precedes epileptic fits, and often attends thofe, whofe fight begins to be impaired by age- In this vertigo the irritative ideas of the apparent motions of objects are lefs diftinft, and on that account are not fucceeded by their ufual irritative aflbeiations of motion ; but excite our attention. Whence the objects appear to librate or circulate according to the motions of our heads, which is called dizzinefs ; and we lofe the means of balancing ourfelves, or preferving our perpendicularity, by vifion. So that in this vertigo the motions of the aflbeiated organs are decreafed by direft fympathy with their primary link of irritation ; as in the preceding cafe of fea- ficknefs they are decreafed by reverfe fympathy. When vertigo affefts people about fifty years of age, their fight has generally been fuddenly impaired ; and from their lefs accurate vifion they do not foon enough perceive the apparent motions of objefts ; like a perfon in a room, the walls of which are ftained with the uniform figures of lozenges, explained in Seft XX i- This is generally afcribed to indigeftion ; but it ceafes fpontaneoufly, as the patient acquires the habit of balanc- ing himfelf by lefs diftinft objefts. A gentleman about 50 was feized with an uncommon degree of vertigo, io as to fall on the ground, and not be able to turn his head, as he fat up either in his chair or in his bed, and this continued eight or ten weeks. As he had many decayed teeth in his mouth, and the vertigo was preceded and fometimes ac- companied by pains on one fide of his head, the difeafe of a tooth was fufpefted to be the caufe. And as his timidity was too great to admit the extraction of thofe which were de- cayed ; after the trial of cupping repeatedly, fomentations on his head, repeated blifters, with valerian, Peruvian bark, mufk, opium, and variety of other medicines ; mercurials were ufed, both externally and internally, with defign to inflame the mem- branes of the teeth, and by that means to prevent the torpor of the aftion of the membranes about the temple, and parietal bonej which are catenated with the membranes of the teeth by irrita- tive Class IV. 2.1.12. OF ASSOCIATION. tive aflbciation, but not by fenfitive aflbciation. The event was, that as foon as the gums became fore with a flight ptyalifm, the pains about the head and vertigo gradually diminilhed, and dur- ing the forenefs of his gums entirely ceafed ; but I believe recur- red afterwards, though in lefs degree. The idea of inflaming the membranes of the teeth to pro- duce increafed fenfation in them, and thus to prevent their irritative connexion with thofe of the cranium, was taken from the treatment of trifmus, or locked jaw, by endeavouring to in- flame the injured tendon; which is faid to prevent or remove the fpafm of the mufcles of the jaw. See Clafs III. i. i. 13. and 15. M. M. Emetics. Blifters. Iflues about the head. Extrac- tion of decayed teeth. Slight falivation. Sorbentia. Incitantia. Galvanifm. A lady was fuddenly feized with violent vertigo, fo as to pre- vent her walking fafely acrofs the room ; this was attended with confiderable diminution of fight ; and after various evacu- ations, and other medicines, had been tried without cure, Mr. Volta's galvanic pillar was ufed, confifting of about 30 plates of fdver, the diameter of about one inch and a half, and as many zinc plates, with interfperfed circles of cloth moiftened with brine. A wire connected with each end of this pillar was approached repeatedly to her temples, which were previoufly moiftened with brine, and 100 galvanic fhocks were daily palled through the optic nerves, which foon appeared to be of great advantage, and ihe foon recovered, both from the vertigo and dimnefs of fight. 12. Vertigo ebrio/a. Vertigo from intoxication is owing to the aflbciation of the irritative ideas of vifion with the irritative motions of the ftomach. Whence when thefe latter become much increafed by the immoderate ftimulus of wine, the irrita- tive motions of the retina are produced with lefs energy by re- verfe fympathy, and become at the fame time fucceeded bv fen- fation in confequence of their decreafcd action. See Seel. XXL 3. and XXXV. 1.2. So converfely when the irritative mo- tions of vifion are increafed by turning round, or by our unac- cuftomed agitation at fea, thofe of the ftomach become inverted by reverfe fympathy, and are attended in confequence with difa- greeable fenfation. Which decreafed atlion of the ftomach is in confequence of the increafed expenditure of the fenforial power on the irritative ideas of vifion, as explained in Vertigo rotatoria. Whence though a certain quantity of vinous fpirit ftimulates the whole fyftem into increafed action, and perhaps even in- creafes the fecretion of fenforial power in the brain ; yet as foon as 407 408 DISEASES Class IV 2. 1.13. as any degree of vertigo is produced, it is a proof, that by the too great expenditure of fenforial power by the ftomach, and its neareft affociated motions, the more diftant ones, as thofe of vif- ion, become imperfectly exerted. From hence may be deduc- ed the neceflity of exhibiting wine in fevers with weak pulfe in only appropriated quantity ; becaufe if the leaft intoxication be induced, fome parr of the fyftem muft aft more feebly from the unneceflary expenditure of fenforial power. 13. Vertigo jebriculofa. Vertigo in fevers either proceeds from the general deficiency of fenforial power belonging to the irritative aifociations, or to a greater expenditure of it on fome links of the trains and tribes of afibciated irritative motions. There is however a (lighter vertigo attending all people, who have been long confined in bed, on their firft rifing ; owing to their having been fo long unufed to the apparent motions of ob- jefts in their ereft pofture, or as they pafs by them, that they have loft in part the habit of balancing themfelves by them. 14. Vertigo cerebrofa. Vertigo from injuries of the brain, ei- ther from external violence or which attend paralytick attacks, are owing to the general deficiency of fenforial power. In thefe diftrefsful fituations the vital motions, or thofe immediate- ly neceflary to life, claim their (bare of fenforial power in the firft place, otherwife the patient muft die ; and thofe motions, which are lefs neceflary, feel a deficiency of it, as thefe of the organs of fenfe and mufcles; which conftitute vertigo ; and laft- ly the voluntary motions, which are ftill lefs immediately necef- fary to life, are frequently partially deftroyed, as in palfy ; or totally, as in apoplexy. 15. Murmur aurium vertiginofum. The vertiginous murmur in the ears, or noife in the head, is compared to the undulations of the found of bells, or to the humming of bees. It frequent- ly attends people about 60 years of age ; and like the vifual ver- tigo defcribed above is owing to our hearing lefs perfeftly from the gradual inirritability of the organ on the approach of age ; and the difagreeable fenfation of noife attending it is owing to the lefs energetic aftion of thefe irritative motions ; which not being fufficiently diftinft to excite their ufual aflbeiations become fucceeded by our attention, like the indiftinft view of the appa- rent motions of objefts mentioned in vertigo vifualis. This may be better underftood from confidering the ufe, which blind men make of thefe irritative founds, which they have taught themfelves to attend to, but which efcape the notice of others. The late blind Juftice Fielding walked for the firft time into my room, when he once vifited me, and after fpeak- ine a few words laid, " This room is about 22 feet long, ,18 wide, Class IV. 2. 1. 16.' OF ASSOCIATION. 409 wide, and 12 high all which he guefled by the ear with great accuracy. Now if thefe irritative founds from the partial lofs of hearing do not correfpond with the fize of ufual echoes of the places, where we are ; their catenation with other irritative ideas, as thofe of vifion, becomes diflevered or difturbed ; and we attend to them in confequence, which I think unravels this in- tricate circumflance of noifes being always heard in the head, when the fenfe of hearing begins to be impaired, from whatever caufe it occurs. This ringing in the ears alfo attends the vertigo from intoxi- cation ; for the irritative ideas of found are then more weakly excited in confequence of the deficiency of the fenforial power of affbciation. As is known by this alfo being attended with difagreeable fenfation, and by its accompanying other difeafes of debility, as ftrokes on the head, fainting fits, and paralytic feiz- ures. For in this vertigo from intoxication fo much fenforial power in general is expended on the increafed actions of the ftomach,and its neareft connections,as the capillaries of the fkin ; that there is a deficiency for the purpofes of the other irritative aflbciations of motions ufually connected with it. This auditory vertigo attends both the rotatory and the vifual vertigo above- mentioned ; in the former it is introduced by reverfc fympathy, that is, by the diminution of fenforial power ; too great a quantity of it being expended on the increafed irritative motions of vifion ; in the latter it is produced either by the fame caufes which produced the vifual vertigo, or by direCt fympathy with it. See SeCi. XX. 7. M. M. Stimulate the internal ear by ether, or with eflential oil diluted with expreffed oil, of with a folution of opium in wine, or in water. Or with fait and water. Apply a cupping glafs over the ear. See I. 2. 5.6. Galvanic fhocks through the temples. See IV. 2. 1. 11. 16. <TaHusy gujluiy olfaEliiSy vertiginoft. Vertiginous touch, tafte, and fmell. In the vertigo of intoxication, when the patient lies down in bed, it fometimes happens even in the dark, that the bed feems to librate under him, and he is afraid of falling out of it. The fame occurs to people, who are fea-fick, even when they lie down in the dark. In thefe the irritative motions of the nerves of touch, or irritative tangible ideas, are performed with let's energy, in one cafe by reverfc fympathy with the (lom- ach, in the other by reverfe fympathy with the nerves of vifion, and in confequence become attended with fenfation, and pro- duce the fear of falling by other aflbciations. A vertigo of the fenfe of touch may be produced, if any one turns round for a time with his eyes (hut, and fuddenly flops Vol. II. E e e without DISEASES Class IV. 2. 1. 17, 410 without opening them ; for he will for a time feem to be Rill going forwards ; which is difficult to explain. See Sect. XX. 6. In the beginning of fome fevers, along with inceflant vomit- ing, the patients complain of difagreeable taftes in their mouth, and difagreeable odours ; which are to be afcribed to the gen- eral debility of the great trains, and tribes of affociated and irrita- tive motions, and to be explained from their direft fympathy with the decreafed aftion of a fick ftomach; or from the lefs fecretion of fenforial power in the brain. Thefe organs of fenfe are conftantly ftimulated into action by the faliva or by the air ; hence, like the fenfe of hunger, when they are torpid from want of ftimulus, or from want of fenforial power, pain, or difagreea- ble fenfation enfues, as of hunger, or faintnefs, or ficknefs in one cafe ; and the ideas of bad taftes or odours in the other. This accords with the laws of caufation, Seft. IV. 5. 17. Pulfiis mollis in vomitione. The foftnefs of the pulfe in the aft of vomiting is caufed by direct aflbciation between the heart and the ftomach \ as explained in Seft.^XXV. 17. A great flownefs of the pulfation of the heart fometimes attends ficknefs, and even with intermiffions of it, as in the exhibition of too great a dole of digitalis. 18. Puljus iniermittens a ventriculo. When the pulfe firft be- gins to intermit, it is common for the patient to bring up a lit- tle air from his ftomach ; which if he accompliffies before the intermiffion occurs, always prevents it; whence that this debil- ity of the heart is owing to the direft aflbciation of its motions with thofe of the ftomach is well evinced. See Seft. XXV. 17. I this morning faw Mr. , who has long had at times an unequal pulfe, with indigeftion and flatulency, and occafional afthma ; he was feized two days ago with, diarrhoea, and this morning with ficknefs, and his pulfe was every way unequal. After an emetic his pulfe fthl continued very intermittent and unequal. He then took fome breakfaft of toaft and butter, and tea, and to my great furprife his pulfe became immediately per- fectly regular, about 100 in a minute, and not weak, by this ftimulus on his ftomach. A perfon, who for many years had had a frequent intermif- fion of his pulfe, and occafional palpitation of his heart, was re- lieved from them both for a time by taking about four drops of a faturated folution of arfenic three or four times a day for three or four days. As this intermiffion of the pulfe is occafioned by the direft aflbciation of the motions of the heart with thofe of the ftomach, the indication of cure muft be to ft"engthen the ac- tion of the ftomach by the bark. Spice. Moderate quantifies of Class VI. 2. 1. 19. OF ASSOCIATION. 411 of wine. A blifter. Half a grain of opium twice a day. So- lution of arfenic ? 19. Febris inirritativa. Inirritative fever defcribed in Clafs I. 2. I. 1. belongs to this place, as it confifts of difordered trains and tribes of affociated irritative motions, with leflened adfions of the aflbciated organs. In this fever the pulfations of the heart and arteries are weakened or leflened, not only in the cold paroxyfm, as in the irritative fever, but alfo in the hot paroxyfm The capillary arteries or glands have their ac- tions neverthelefs increafed after the firft cold fit, as appears by the greater production of heat, and the glow of arterial blood in the cutaneous veflels; and laftly, the action of the ftomach is much impaired or deftroyed, as appears by the total want of ap- petite to folid food. Whence it would feem, that the torpid motions of the ftomach, whatever may occafion them, are a very frequent caufe of continued fever with weak pulfe; and that thefe torpid motions of the ftomach do not fufficiently ex- cite the fenforial power of aflbciation, which contributes in health to actuate the heart and arteries along with the irritation produced by the ftimulus of the blood ; and hence the aftions of thefe organs are weaker. And laftly, that the accumulation the fenforial power of aflbciation, 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 Sea. XXXV. 1. 1. and XXXIII. 2. 10. I have dwelt longer on the vertiginous difeafes in this genus, both becaufe of their great intricacy, and becaufe they feem to open a road to the knowledge of fever, which confifts of afloci- ated trains and tribes of irritative or fenfitive motions, which are fomeumes mixed with the vertiginous ones, and fometimes Separate from them. ORDO DISEASES Class IV. 2- 2. 412 ORDO II. Deereafed Ajfodate Motions. GENUS II. Catenated 'with Senjitive Motions. In this genus the fenforial power of affociation is exerted with lefs energy, and thence the'aClions produced by it are lefs than natural ; and pain is produced in confequence, according to the fifth law of animal caufation, SeCt. IV. This pain is generally attended with coldnefs of the afle&ed part, and is feldom fuc- ceeded by inflammation of it. This deereafed action of the fecondary link of the aflbeiated motions, belonging to this ge- nus, is owing to the previous exhaultion of fenforial power either in the increafed actions of the primary link of the aflbeiated mo- tions, or by the pain which attends them ; both which are fre- quently the confequence of the ftimulus of fomething external to the affected fibres. As pain is produced either by excefs or defect of the natural exertions of the fibres, it is not, confidered feparately, a criteri- on of the prefence of either. In the aflbeiations belonging to this genus the fenfation of pain or pleafure produces or attends the primary link of the aflbeiated motions, and very often gives name to the difeafe. When great painexifts without caufing any fibrous motions, I conjecture that it contributes to exhauft or expend the gen- eral quantity of fenforial power ; becaufe people are fatigued by enduring pain, till at length they fleep. Which is contrary to what I had perhaps erroneoufly fuppofed in Sect. XXXV. 2. 3. If it caufes fibrous motions, it then takes the name of fenfation, according to the definition of fenfation in SeCt. IL 2. 9 j and increafed fibrous action or inflammation is the confe- quence. This circumftance of the general exhauftion of fenfo- rial power by the exiftence of pain will aflift in explaining ma- ny of the difeafes 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 aflbeiated by having been accuftomed to feel pleafurable or painful fenfa- tions at the fame time or in fucceflion. This is termed fenfi- tive aflbeiation, though thofe painful or pleafurable fenfations do not caufe the motions, but only attend them ; and are thus perhaps, ftri&ly fpeaking, only catenated with them. SPECIES. Class IV. 2. 2. 1. OF ASSOCIATION. 413 SPECIES. i. Torpor gents a dolore dentis. In tooth-ach there is general- ly a coldnefs of the cheek, which is fenfible to the hand, and is attended in fome degree with the pain of cold. The cheek and tooth have frequently been engaged in pleafurable adtion at the fame time during the mafticating of our food ; whence they have acquired fenfitive aflbciations. The torpor of the cheek may have for its caufe the too great expenditure of fenforial power by the painful fenfation of the membranes of the difeaf- ed tooth ; whence the membranes of the cheek aflbciated with thofe of the alveolar procefs are deprived of their natural Ihare of it, and become torpid ; thus they produce lefs fecretions, and ]efs heat, and the pain of cold is the confequence. This torpor of the veflels of the cheek cannot be produced by the adfivity of the fenforial power of fenfation ; for then they would aft more violently than natural, or become inflamed. And though the pain by exhaufting fo much fenforial power may be a re- mote caufe, it is the defeat of the power of aflbciation, which is the immediate caufe of the torpor of the cheek. After fome hours this pain occafioned by the torpor of the veflels of the cheek either gradually ceafes along with the pain of the difeafed tooth ; or, by the accumulation of fenforial pow- er during their ftate of torpor, the capillaries of the cheek a 61 with greater violence, and produce more fecretions, and heat, and confequent tumor, and inflammation. In this ftate the pain of the difeafed tooth ceafes; as the fenforial power of fen- fation is now expended on the inflamed veflels of the cheek. It is probable that moft other internal membranous inflammations begin in a fin.ilar manner; w'hence there may feem to be a double kind of fenfitive aflbciation ; fir ft, with decreafed a 61 ion of the aflbciated organ, and then with increafed action of it ; but the latter is in this cafe Amply the confequence of the former ; that is, the tumor or inflammation of the cheek is in confequence of its previous quiefcence or torpor. 2. Stranguria a dolore vefca. The ftrangury, which has its origin from pain at the neck of the bladder, confifts of a pain in the external extremity of the urethra or of the glans penis of men. and probably in the external termination of the urethra or of the clitoris of women ; and is owing to the fympathy of thvfe with fome diftant parts, generally with the other end of the urethra ; an endeavour and difficulty of making water at- tends this pain. Its remote caufe is from the internal or external ufe of can- tharides, which ftimulate the neck of the bladder \ or from a ftone, DISEASES Class IV. 2. 2. 3. 414 ftone, which whenever it is pufhed into the neck of the bladder, gives this pain of ftrangury, but not at other times ; and hence it is felt moft feverely in this cafe after having made water The fenfations or fenfitive motions of the glans penis, and of the fphinfter of the bladder, have been accuftomed to exift together during the difcharge of the urine ; and hence the two ends of the urethra fympathize by aflbciation. When there is a ftone at the neck of the bladder, which is not fo large or rough as to inflame the part, the fphincter of the bladder be- comes ftimulated into pain ; but as the glans penis is for the purpofes of copulation more fenfitive than the fphimfter of the bladder, as foon as it becomes affebled with pain by the aflbcia- tion above mentioned, the fenfation at the neck of the bladder ceafes ; and then the pain of the glans penis would feem to be aflbciated with the irritative motions only of the fphintfter of the bladder, and not with the fenfitive ones of it. But a circum- ftance fimilar to this occurs in epileptic fits, which at firft are induced by difagreeable fenfation, and afterwards feem to occur without previous pain, from the fuddennefs with which they follow and relieve the pain, which occafioned them. From this analogy I imagine the pain of the glans penis is aflbciated with the pain of the fphinbier of the bladder ; but that as foon as the greater pain in a morefenftble part is produced ; the lefs pain, which occafioned it, ceafes; and that this is one of the laws of fenfitive af- fociation. See Se£h XXXV. 2. 1. A young man had by an accident fwallowed a large fpoonful or more of tincture of cantharides ; as foon as he began to feel the pain of ftrangury, he was advifed to drink large quantities of warmifti water : to which, as foon as it could be gotten, fome gum arabic was added. In an hour or two he drank by inter- vals of a few minutes about two gallons of water,and difcharg- ed his urine every four or five minutes. A little blood was voided towards the end, but he fuffered no ill confequence. M. M. Warm water internally. Clyfters of warm water. Fomentation Opium. Solution of fixed alkali fuperfaturated with carbonic acid. A bougie may be ufed to pufh back a ftone into the bladder. See Clafs I. 1.3. 10. 3. Stranguria convulfrva. The convulfive ftrangury, like that before defcribed, is probably occafioned by the torpor or defec- tive action of the painful part in confequence of the too great expenditure of fenforial power on the primary linkof the aflbciat- ed motions, as no heat or inflammation attends this violent pain. This kind of ftrangury recurs by ftated periods, and fometimes arifes to fo great a degree, that convulfion or temporary mad- nefs terminates each period of it. It affefts women oftener than Class IV. 2. 2.4. OF ASSOCIATION. 415 than men, is attended with cold, extremities without fever, and is diftinguifhed from the ftone of the bladder by the regularity of its periods, and by the pain being not increafed after making water. On introducing the catheter fometimes part of the urine will come away and not the whole, which is difficult to explain ; but may arife from the weaknefs of the mufcular fibres of the bladder ; which are not liable fuddenly to contradl themfelves fo far as to exclude the whole of the urine. In fome old peo- ple, who have experienced a long retention of urine, the blad- der never regains the power of completely emptying itfelf; and many who are beginning to be weak from age can make water a fecond time, a few minutes after they fuppoied they had emp- tied the bladder. I have believed this pain to originate from fympathy with fome diftant part, as from afcarides 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 reverfe fympathy of thefe more fcnfible parts with thofe above mentioned. M. M. Venefebtion. Opium in large quantities. Warm bath. Balfams. Bark. Tincture of canthrides. Bougie, and the treatment for haemorrhoids. Leeches applied to the fphinc- ter ani. Aerated alkaline water. Soap and fal foda. Opium in clyfters given an hour before the expelled return. Smoke of tobacco in clyfters. Arfenic. 4. Dolor termini intejlinalis duEtus choledocD. Pain at the in- teftinal end of the gall-duct. When a gall-ftone is protruded from the gall-bladder a little way into the end of the gall-dudb, the pain is felt at the other end of the gall-dudt, which termin- ates in the duodenum. For the actions of the two terminations of this canal are ailbciated together from the fame ftreams of bile paffing through them in fucceffion, exactly as the two terminations of the urethra have their actions ailbciated, as defcribed in Species 2 and 3 of this genus. But as the in- teftinal termination of the bile-du£t is made more fenfible for the purpofe of bringing down more bile, when it is ftimulated by new fupplies of food from the ftomach, it falls into violent pain from afibciation ; and then the pain on the region of the gall-bladder ceafes, exaflly as above explained in the account of the pain of the glans penis from a ftone in the fphimfter of the bladder. The common bile-du£l opens into the inteftine exactly at what is called the pit of the ftomach ; and hence it has fome- times happened, that this pain from aflbeiation with the fenfa- tion 416 DISEASES Class IV. 2. 2. 5. tion of a gall-ftone at the other end of the bile-duct has been miftaken for a pain of the ftomach. For the method of cure fee Clafs I. i. 3. 8. to which fhould be added the ufe of ftrong electric (hocks pafled through the bile- dudi from the pit of the ftomach to the back, and from one fide to the other. A cafe of the good effect of electricity in the jaundice is related in SeCt. XXX. 2. And another cafe, where it promoted the paflage of a painful gall-ftone, is defcrib- ed by Dr. Hall, experienced on himfelf. Tranf. of the Col- lege at Philadelphia, Vol. I. p. 192. Half a pint of warm water two or three times a day is much recommended to dilute the infpiffated bile. 5. Dolor pharyngis ab acido gajlrico. The two ends of the throat fympathize by fenfitive aflbciation in the fame manner as the other canals above mentioned, namely, the urethra and the bile-duel; ; hence when too great acidity of undigefted ali- ment, or the carbonic acid air, which efcapes in fermentation, ftimulates the cardia ventriculi, or lower end of the gula, into pain, the pharynx, or upper end of it, is affeCted with greater pain, or a difagreeable fenfation of heat. 6. Pruritus narium a vermibus. The itching of the nofe from worms in the .inteftines is another curious inftance of the fen- fitive aflbeiations of the motions of membranes ; efpecially of thofe which conftitute the canals of the body. Previous to the deglutition of agreeable food, as milk in our earlieft infancy, an agreeable odour affeCts the membrane, which lines the noftrils ; and hence an aflbciation feems to take place between the agreea- ble fenfations produced by food in the ftomach and bowels, and the agreeable fenfations of the noftrils. The exiftence of afcar- ides in the reeftum I believe produces this itching of the noftrils more than the worms in other parts of the inteftines ; as we have already feen, that the terminations of canals fympathize more than their other parts, as in the urethra and gall-dudls. See Clafs I. 1. 5. 9. IV. 1. 2. 9. 7. Cephaloea fympathetica. Sympathetic head-ach. In cold fits of the ague, the head-ach arifes from confent with fome torpid vifeus, like the pain of the loins. After drunkennefs the head- ach is very common, owing to dired: fympathy of the mem- branes of the head with thofe of the ftomach ; which is become torpid after the too violent ftimulus of the preceding intoxica- tion ; and is hence removable by fpirit of wine, or opium, ex- hibited in fmaller quantities. In fome conftitutions thefe head- achs are induced, when the feet are expofed to much external cold ; in this cafe the feet fiiould be covered with oiled filk, which Class IV. 2. 2. 8. OF ASSOCIATION. 417 which prevents the evaporation of the perfpirable matter, and thence diminithes one caufe of external cold. M M. Valerian in powder two drams three or four times a day is recommended. The bark. Chalybeates. A grain of opium twice a day for a long time. From five to ten drops of the faturated folution of arfenic two or three times a day. See Clafs I. 2. 4. 11. A lady once afflired me, that when her head- ach was coming on,(he drank three pints (pounds) of hot water, as haftily as (he could ; which prevented the progrefs of the dif- eafe. A folution of arfenic is recommended by Dr. Fowler of York. Very ftrong errhines are faid fometimes to cure head- achs taken at the times the pain recurs, till a few drops of blood iflue from the noftrils. As one grain of turpeth mineral (vitriol- ic calx of mercury) mixed with ten grains of fine fugar. Eu- phorbium or cayenne pepper mixed with fugar, and ufed with caution as an errhine. See theM. M. of the next Species. 8. Hemicrania fympathetica. Sympathetic pain on one (ide of the head. This difeafe is attended with cold (kin, and hence whatever may be the remote caufe, the immediate one feems to be want of ftimulus, either of heat or diftention, or of fome other unknown ftimulus in the painful part ; or in thofe, with which it is aflbciated. The membranes in their natural ftate are only irritable by diftention ; in their difeafed ftate, they are fenfible like mufcular fibres. Hence a difeafed tooth may ren- der the neigbouring membranes fenfible, and is frequently the caufe of this difeafe. Sometimes the ftomach is torpid along with the pained mem- brane of the head ; and then ficknefs and inappetency attend either as caufe or confequences. The natural cure of hemi- crania is the accumulation of fenforial power during the reft or ficknefs of the patient. Mrs - is frequently liable to hem- icrania with ficknefs, which is probably owing to a difeafed tooth ; the paroxyfin occurs irregularly, but always after fome previous fatigue, or other caufe of debility. She lies in bed, fick, and without taking any folid food, and very little of fluids, and thofe of the aqueous kind, and, after about 48 or 50 hours, rifes free from complaint. Similar to this is the recovery from cold paroxyfms of fever, from the torpor occafioned by fear, and from fyncope; which are all owing to the accumulation of fenforial power during the inactivity of the fyftem. Hence it ap- pears, that, though when the fenforial power of volition is much exhaufted by fatigue, it can be reftored by eight or ten hours of Heep : yet, when the fenforial power of irritation is exhaufted by fatigue, that it requires two whole folar or lunar days of reft, before it can be reftored. Vol. II. F f f The 418 DISEASES Class IV. 2. 2. 8. The late Dr. Monro aflerted in his lectures, that he cured the hemicrania, or megrim, by a ftrong vomit, and a brilk purge immediately after it. This method fucceeds beft if opium and the bark are given in due quantity after the operation of the cathartic ; and with ftill more certainty, if bleeding in fmall quantity is premifed, where the pulfe will admit of it. See Sed. XXXV. 2. i. Mr. Kellie aflerts, that fome kinds of head-achs, efpecially thofe which arife from defea of ftimulation, may be cured by comprefling the two fubclavian arteries, as they pafs over the firft rib j which he thinks would produce a preflure on the brain fimilar to that, which may be produced by the centrifugal force, if a perfon was to lie acrofs a mill ftone as it revolves. See Suppl. I. 15. 7. Would fuch a circulating bed remove any kind ofhead-ach ? The pain generally affects one eye, and fpreads a little way on that fide of the nofe, and may fometimes be relieved by prefix- ing or cutting the nerve, where it pafles into the bone of the orbit above the eye. When it affects a fmall defined part on the parietal bone on one fide, it is generally termed Clavus hyf- tericus, and is always I believe owing to a difeafed dens mola- ris. The tendons of the mufcles, which ferve the office of maftication, have been extended into pain at the fame time that the membranous coverings of the roots of the teeth have been compreffed into pain, during the biting or maftication 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 coldnefs of the dying part of the tooth, the tendons and membranous fafcia of the mufcles about the fame fide of the head become affefted with violent pain by their fenfitive aflbciations : and as foon as this .aflbciated pain takes place, the pain of the tooth entirely ceafes, as explained in the fecond fpecies of this genus. A remarkable circumftance attends this kind of hemicrania, viz. that it recurs by periods like thofe of intermittent fevers, as explained in the Section on Catenation of Motions ; thefe peri- ods fometimes correfpond with alternate lunar or folar days like tertian agues, and that even when a decaying tooth is evi- dently the caufe ; which has been evinced by the cure of the difeafe by extracting the tooth. At other times they obferve the monthly lunations, and feem to be induced by the debility, which attends menftruation. The dens fapientite, or laft tooth of the upper jaw, fre- quently decays firft, and gives hemicrania over the eye on the fame fide. The firft or fecond grinder in the under-jaw is lia- ble Class IV. 2. 2. 8. OF ASSOCIATION. 419 ble to give violent pain about the middle of the parietal bone, or fide of the head, on the fame fide, which is generally called the Clavus hydericus, of which an inftrudlive cafe is related in Sea. XXXV. 2. i. Since the above was firft publifhed I have feen two cafes, which vere very fimilar, and feem much to confirm the above theory of fympathetic hemicrania being perhaps always owing to the fympathy of the membranes about the cranium with thofe about difeafed teeth. Lord M. and Mr. B. of Edinburgh, both of them about the middle of life were affliaed with vio- lent hemicrania for about two years ; in the beginning of which time they both aflured me, that their teeth were perfectly found, but on infpeaing their mouths, I found all the molares were now fo decayed as to have loft their crowns. After having fuf- fered pain for fixreen or eighteen months almoft inceflantly in different parts of their heads, they had each of them a hemiple- gia, from which they gradually recovered, as much as paralytic affeaions generally do recover. All the ftumps of their teeth, which were ufelefs, were direaed to be extraaed ; as the fwal- lowing fo much putrid matter from decaying bones feemed to injure their digeftion. They were defired not drink wine or ale without its being diluted with twice or thrice its quantity of water, to prevent any accefs of torpor from too grep.t previous ftimulus, and to take fix grains of rhubarb with three of foap made into pills, every night, with fome bitter and very flight chalybeate medicines. If the teeth which became torpid in fuc- ceflion, could have been difcovered, and extraaed, before they decayed, and could have been replaced, might not this continu- ance of pain, and confequent paralyfis, have been prevented ? or might not a moderate falivation have effeaed this purpofe ? M. M Detea and extraa the difeafed tooth. Cut the af- feaed nerve, or ftimulate the difeafed membrane by acupunc- ture. Venefeaion to fix ounces by the lancet or by leeches. A ftrong emetic and a fubfequent cathartic ? and then an opiate and the bark Pafs fmail dearie fhocks through the pained membrane, and through the teeth on the fame fide. Apply vit- riolic ether externally, and a grain of opium with camphor in- ternally, to the cheek on the affeaed fide, where a difeafed tooth may be fufpeaed. Foment the head with warm vinegar. Drink two large fpoonfuls of vinegar. Stimulate the gums of the fufpecled teeth by oil of cloves, by opium. See Clafs I. i. 4. 4. Snuff volatile fpirit of vinegar up the noftrils. Laftly, in permanent head-achs, as in permanent vertigo, I have feen good effea in two cafes by the ufe of mercurial ointment rubbed on the fhaved head or about the throat, till a mild falivation com- mences, 420 DISEASES Class IV. 2. 2. 9, mences, which by inflaming the membranes of the teeth may prevent their irritative fympathy with thofe of the cranium. Thus by inflaming the tendon, which is the caufe of locked jaw, and probably by inflaming the wound, which is the caufe of hy- drophobia, thofe difeafes may be cured, by difuniting the irrita- tive fympathy between thofe parrs, which may not poffefs any fenfitive fympathy. This idea is well worth our attention. Otalgia. Ear-ach is another difeafe occafioned by the fympa- thy of the membranes of the ear with thofe which inveft or fur- round a decaying tooth, as I have had frequent reafon to be- lieve \ and is frequently relieved by filling the ear with tincture of opium. See Clafs I. 2. 4. 9 Dolor humeri in hepatidide. In the efforts of excluding the faeces and urine the mufcles of the fhoulders are exerted to com- prefs the air in the lungs, that the diaphragm may fee prefled down. Hence the diftention of the tendons or fibres of thefe mufcles is aflbciated with rhe diftention of the tendons or fibres of the diaphragm ; and when the latter are pained by the en- largement or heat of the inflamed liver, the former fympathize with them, Sometimes but one fhoulder is affetSled, fometimes both ; it is probable that many other pains, which are termed rheumatic, have a fimilar origin, viz, from fenfitive aflbcia- tions. As no inflammation is produced in confequence of this pain of the fhoulder, it feems to be owing to inaction of the mem- branous part from defedt of the fenforial power of aflbciation, of which the primary link is the inflamed membrane of the liv- er j which now expends fo much of the fenforial power in gen- eral by its increafed adtion, that the membranes about the fhoul- der, which are Jinks of aflbciation with it, become deprived 01 their ufual fhare, and confequently fall into torpor. io. Torpor pedum in eruptione variolarum. At the commence- ment of the eruption of the fmall-pox, when the face and breaft of children are very hot, their extremities are frequently cold. This I afcribc to fenfitive aflbciation between the different parts of the fkin ; whence when a part adts too violently, the other part is liable to act too weakly ; and the fkin of the face being affedled firft in the eruption of the fmall-pox, the fkin of the feet becomes cold in confequence by the reverfe fympathy. M. M. Cover the feet, with flannel, and expofe the face and bofom to cool air, which in a very fhort time both warms the feet and cools the face ; and hence what is erroneoufly called a rafh, but which is probably a too hafty eruption of the fmal! pox, difappears ; and afterwards fewer and more diftindt erup- tions of the fmall-pox fupervene. 7 I. Tedium Class IV. 2. 2. ji. OF ASSOCIATION. 421 ii. Dejaum dolor nephriticus. The pain and retraction of the tefticle on the fame fide, when there is a (tone in the ureter, is to be afcribec. to ienfitive aflbciation ; whether the connecting caufe be a branch of the fame nerve, or from membranes,which have been frequently affeCted at the fame time. 12. Dolor digiti minimi fympatheticus. When any one acci- dentally ftrikes his elbow againft any hard body, a tingling pain runs down to the little finger end. This is owing to fenfitive aflbciation of motions by means of the fame branch of a nerve, as in hemicrania from a decaying tooth the pain is owing to the fenfitive aflbciation of tendons or membranes. 13. Dolor brnchii in hydrope peHoris. The pain in the left arm which attends fome dropfies of the cheft, is explained ip SeCE XXIX. 5. 2. 10. which refembles the pain of the little finger from a percuflion of the nerve at the elbow in the preceding ar- ticle. A numbnefs of this kind is produced over the whole leg, when the crural nerve is much comprefled by fitting for a time with one leg crofled over the other. Mr, ,about fixty, had for two years been affeCted with difficulty of refpiration on any exertion, with pain about the fter- num, and of his left arm ; which laft was more confiderable than is ufual in dropfy of the cheft ; fome months ago the pain of his arm, after walking a mile or two, became exceffive, with coldnefs and numbnefs ; and on the next day the back of the hand, and a part of the arm fwelled and became inflamed, which, relieved the pain ; and was taken for the gout, and continued feveral days. He after fome months became dropfical both in refpeCl to this cheft and limbs, and was fix or feven times per- fectly * relieved by one dram of faturated tinCture of digitalis, taken two or three times a day for a few days in a ghfs of pep- permint water. He afterwards breathed oxygen gas undiluted, in the quantity of fix or eight gallons a day for three or four weeks without any effeCl, and funk at length from general de- bility. In this inftrudive cafe I imagine the preflure or ftimulus of one part of the nerve within the cheft caufed the other part, which ferves the arm, to become torpid, and confequently cold by fympathy ; and that the inflammation was the confequence of the previous torpor and coldnefs of the arm, in the fame manner as the fuelling and inflammation of the cheek in tooth- ach, in the firft fpecies of this genus ; and that many rheumatic inflammations arc thus produced by fympathy with fome diE tant part. 14. Diarrhea a dentitione. The diarrhoea, which frequently attends dentition, is the confequence of indigeftion; the aliment acquires 422 DISEASES Class IV. 2. 2. 14. acquires chemical changes, and by its acidity afts as a cathar- tic ; and changes the yellow bile into green, which is evac- uated along with indigefted parts of the coagulum of milk. The indigeftiOn is owing to the torpor of the ftomach and intef- tines caufed by their aflbciarion with the membranes of the gums, which are now ftimulated into great exertion with pain ; both which contribute to expend the general quantity of fen- forial power, which belongs to this membranous aflbciation; and thus the ftomach and inteftines ad: with lefs than their natural energy. This is generally efteemed a favourable fymp- tom in difficult dentition, as the pain of the alveolar membranes exhaufts the fenforial power without producing convulfions for its relief. See Clafs I. 1.4. 5. And the diarrhoea ceafes, as the tooth advances. ORDO Class IV, 2. 3.1. OF ASSOCIATION. 423 ORDO II. Decreased AJ^ociate Motions. GENUS II. Catenated 'with Vduntary Motions. SPECIES. i. Titubatio lingua. Impediment of fpeech is owing to the aflbciations of the motions of the organs of fpeech being inter- rupted or diflevered by ill-employed fenfation or fenfitive mo- tions, as by awe, baffifulnefs, ambition of (hining, or fear of not fucceeding, and the perfon ufes voluntary efforts in vain to re- gain the broken affociations, as explained inSect. XVII. i. io. and XVII. 2. to. The broken affociation is generally between the firft confo- nant and the fucceeding 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, becaufe the af- fociation between it and the next vowel is diflevered. M. M. The art of curing this defeat is to caufe the ftam- merer to repeat the word, which he finds difficult to fpeak, eight or ten times without the initial letter, in a ftrong voice, or with an afpirate before it, as arable, or harable ; and at length to fpeak it very foftly with the initial letter p, parable. This Ihould be pra&ifed for weeks or months upon every word, which the ftammerer hefitates in pronouncing. To this ffiould be added much commerce with mankind, in order to acquire a carleflhefs about the opinions of others. 2. Chorea St. Viti. In the St. Vitius's dance the patient can at any time lie ftill in bed, which fhews the motions not to be convulfive ; and he can at different times voluntarily exert every mufcle of his body ; which evinces, that they are not paralytic. In this difeafe the principal mufcle in any defigned motion obeys the will; but thofe mufcles, whofe motions were affociated with the principal one, do not act; as their affociation is diflevered, and thus the arm or leg is drawn outward, or inward, or back- ward, inftead of upward or forward, with various gefticulations exactly refembling the impediment of fpeech. This difeafe is frequently left after the itch hasbeen toohaftily cured. See convulfio dolorifica, Clafs III. r. I. 6. A girl about eighteen, after wearing a mercurial girdle to cure the itch, acquired 424 DISEASES Class IV. 2. 3. 3. acquired the chorea St. Viti in fo univerfal a manner, that her fpeech became affected as well as her limbs ; and there was evi- dently a difunion of the common trains of ideas ; as the itch ■was (till among the younger children of the family, fhe was ad- vifed to take her fitter as a bedfellow, and thus received the itch again ; and the dance of St. Vitus gradually ceafed. See Clafs II. i. 5. 6. M. M. Give the patient the itch again. Calomel a grain every night, or fublimate a quarter of a grain twice a day for a fortnight. Steel. Bark. Warm bath. Cold bath. Opium. Venefeftion once at the beginning of the difeafe. Eleftricity. Perpetual flow and repeated efforts to move each limb in the defigned direftion, as in the titubatio linguae above defcribed. 3. Rifut. Laughter is a perpetual interruption of voluntary exertion by the interpofition of pleafurable fenfation ; which not being checked by any important confequences rifes into pain, and requires to be relieved or moderated by the frequent repe- tition of voluntary exertion. See Seft. XXXIV. 1. 4. and Clafs III. 1. r. 4. and IV. 1. 3. 3. 4. Tremor ex ira. The trembling of the limbs from anger. The interruption of the voluntary aflbciations of motions by an- ger, originates from too great a part of the fenforial power being exertedon theorgans of fenfe; whence the mufcles, which ought to fupport the body upright, are deprived of their due quantity, and trembling from debility. See Clafs III. 2. 1. 1. 3. Rubor ex ira. Rednefs from anger. Anger is an excefs of averfion, that is of voluntarity not yet employed. It is excit- ed by the pain of offended pride ; when it is employed it be- comes outrage, cruelty, infanity. The cutaneous capillaries, efpecially thofe of the face, are more mobile, that is, more eafi- ]y excited into increafed aftion, or more eafily become torpid, from lefs variation of fenforial power, than any other parts of the fyftem, which is owing to their being perpetually fubjeft to the viciflitudes of heat and cold, and of extenfion and corruga- tion. Hence, when an excefs of voluntarity exifts without be- ing immediately expended in the aftions of the large mufcles, the capillary arteries and glands acquire more energetic aftion, and a flufhed fkin is produced, with increafed fecretion of per- fpirable matter, and confequent heat, owing to thepaufe or in- terruption of voluntary aftion ; and thus the aftions of thefe cutaneous veffels become aflbciated between the irafcent ideas and irafcent mufcular aftions, which are thus for a time inter- rupted. 6. Rubor criminati. The blufhing of accufed people, wheth- er guilty or not, appears to be owing to circumftances fimilar to that Class IV. 2. 3. 7. OF ASSOCIATION. that of anger ; for in thefe fituations there is always a hidden voluntarity, or wiffi, of clearing their characters arifes in the mind of the accufed perfon ; which, before an opportunity is given for it to be expended on the large mufcles, influences the capillary arteries and glands, as in the preceding article. Whence the increafed actions of the capillaries, and the confequent red- nefs and heat, become exerted between the voluntary ideas of felf-defence, and the mufcular actions neceffary for that purpofe; which laft are thus for a time interrupted or delayed. Even in the blufh of modefty or bafhfulnefs there is a felf- condemnation for fome fuppofed defeat or indecorum, and a fudden voluntarity, or with, of fclf-defence ; which not being expended in actions of the larger mufcles excites the capillaries into action ; which in thefe fubjects are more mobile than in others. The blufh of young girls on coming into an aflembly room, where they expert their drefs, and fteps, and manner, to be ex- amined, as in dancing a minuet, may have another origin ; and may be confidered as a hot fit of returning confidence after a previous cold fit of fear. 7. Tarditas paralytica. By a ftroke of the palfy or apoplexy it frequently happens that thofe ideas which were aflbciated in trains,whofe firft link was a voluntary idea,have their connection difl'evered ; and the patient is under the necefhty, by repeated efforts, flowly to renew their affociations. In this fituation thofe words, which have the feweft other words affociated with them, as the proper names of perfons or places, are the moll difficult to recollect. And in thofe efforts of recollection the word op- pofite to the word required is often produced, as hot for cold, w'nter for fummer, which is owing to our afibciating our ideas of things by their oppontes as well as by their fimilitudes, and in fome inftances perhaps more frequently, or more forcibly. Other paralytic patients are liable to give wrong names to exter- nal objects, as ufing the word pigs for ffieep, or cows for horfes; in this cafe the affociation between the idea of the animal and the name of it is diffevered ; but the idea of the clafs or genus of the thing remains ; and he takes a name from the firft fpecies which prefents itfelf, and fometimes can correCt himfelf, till he finds the true one. 8 Tarditas fenilis. Slownefs of age. The difficulty of aflb- eiating ideas increafes with our age ; as may be obferved from old people forgetting the bufinefs of the laft hour, unlefs they imprefs it ftrongly, or by frequent repetition, though they can well recoiled the tranfaCiions of their youth. I faw an elderly man, who could reafon with greater clearnefs and precifion, and Vol. IT. G g g in 425 426 DISEASES Class IV. 2. 3. 8. in accurate language on fubjeds, which he had been accuftomed to think upon ; and yet did not know that he had rung the bell by his fire-Gde in one minute afterwards ; nor could then recoi- led the object he had wanted, when his fervant came. Similar to this is the difficulty which old people experience in learning new bodily movements, that is, in affociating new muf- cular adions, as in learning a new trade or manufacture. The trains of movements, which obey volition, are the laft which we acquire ; and the firft, which are diflbciated. The fymbolsmoftin ufe, with which we haveaflbciated ideas, are thofe of vifible and of audible language. It is curious to ob- ferve in the inftrudion of young people, that fome remember written language the beft, and others vocal language. The fame thing fometimes occurs in aged people, that is, that fome lofe the ideas aflbciated with founds fooneft, and others thofe aflb- ciated with letters. See recolledionis jadura, Clafs III. 2. 2. I. and Tarditas paralytica above. The following curious account of this defed of aflbciation of ideas with audible but not with vifible fymbols was fent me by Dr. Darwin of Shrewfbury. « The cafe of an old man lately occurred to me, who was fu- perannuated ; his hearing and vifion were perfed, but he could only call up a train of ideas from the -latter. When he was told it was nine o'clock, and time for him to eat his breakfaft,he re- peated the words diftindly but without underftanding them. His fervant put a watch into his hand. " Why, William, have not I my breakfaft, for it is juft nine o'clock ?" he would fay with expreffion, that (hewed he felt what he faid. " On almoft every occafion his fervants converfed with him by vifible objeds, although his hearing was perfed ; and when this kind of communication was ufed, he did not appear impair- ed in his intelleds. This (late came on from a ftroke of the palfy ; and till he and his attendants ufed this kind of language he was quite childiffi." ORDO Class IV. 2. 3. OF ASSOCIATION. 427 ORDO II. Decreased Aflociate Motions. GENUS IV. Catenated with External Influences. As the difeafes, which obey folar or lunar periods, commence with torpor or inactivity, fuch as the cold paroxyfms of fevers the torpor and confequent pain of hemicrania, and the pains which precede the fits of epilepfy and convulfion, it would feem, that thefe difeafes are more generally owing to the diminution than to the excefs of folar or lunar gravitation ; as the difeafes which originate from the influence of the matter of heat, are much more generally in this country produced by the defeCt than by the excefs of that fluid. The periodic returns of fo many difeafes coincide with the diurnal, monthly, and annual rounds of time ; that any one, who would deny the influence of the fun and moon on the periods of quotidian, tertian, and quartan fevers, muft deny their effeCt on the tides, and on the feafons. It has generally been believed, that folar and lunar effeCt was exerted on the blood ; which was thus rendered more or lefs ftimulant to the fyfiem, as de- fcribed in SeCt. XXXII. 6. But as the fluid matter of gravita- tion permeates and covers all things, like the fluid matter of heat; I am induced to believe, that gravitation ads in its medi- um flate rather as a caufa fine qua non of animal motion like heat; which may diforder the fyftem chemically or mechanical- ly, when it is diminiffied ; but may neverthelefs ftimulate it, when increafed, into animal exertion. Without heat and motion, which fome philofophers ftill be- lieve to be the fame thing, as they fo perpetually appear togeth- er, the particles of matter would attract and move towards each other, and the whole univerfe freeze or coalefce into one folid mafs. Thefe therefore counteract the gravitation of bodies to one centre; and not only prevent the planets from falling into the fun, but become either the efficient caufes of vegetable and animal life, or the caufes without which life cannot exift ; as by their means the component particles of matter are enabled to Aide over each other with all the various degrees of fluidity and repulfion. As the attraction of the moon countervails or diminiffies the terrene gravitation of bodies on the furface of the earth ; a tide rifes 428 DISEASES Class IV. 2. 4. rifes on that fide of the earth, which is turned towards the inoon ; and follows it, as the earth revolves. Another tide is raifed at the fame time on the oppofite fide of the revolving earth,which is owing to the greater centrif ugal motion of that fide of the earth, which counteracts the gravitation of bodies near its furface. For the earth and moon may be confidered as two can- non balls of different fizes held together by a chain, and revolv- ing once a month round a common centre of gravity between them, near the earth's furface ; at the fame time that they per- form their annual orbits round the fun. Whence the centrifu- gal force of that fide of the earth, which is fartheft from this centre of motion, round which the earth and moon monthly re- volve, is confiderably greater, than the centrifugal force of that fide of the earth which is neareft it ; to which fhould be added, that this centrifugal force not only contributes to diminifh the terrene gravitation of bodies on the earth's furface on that fide furtheft from the centre of motion, but alfo to increafe it on that fide, which is neareft it. Another circumftance,which tends to raife the tide on the part of the earth's furface, which is moft diftant from the moon, is, that the attraction of the moon is lefs on that part of the ocean, than it is on the other parts of the earth. Thus the moon may be fuppofed to attract the water on the fide of the earth neareft 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 moft diftant from the moon with a power only equal to one. Hence on the fide of the earth moft diftant from the moon, the moon's attraction is lefs, and the centrifugal force round their common centre of motion is greater ; both which contribute to raife the tides on that fide of the earth. On the fide of the earth neareft the moon, the moon's attraction is fo much greater as to raife the tides ; though the centrifugal force of the furface of the earth round their common centre of mo- tion in fome degree oppofes this effect. On thefe accounts, when the moon is in the zenith or nadir, the gravitation of bodies on the earth's furface will be greateft at the two oppofite quadratures; that is, the greateft gravitation of bodies on the earth's furface towards her centre during the lunar day is about fix hours and a half after the fouthing, or af- ter the northing of the moon. Circumftances fimilar to thefe, but in a lefs degree, muft oc- cur in refpeft to the folar influence on terreftrial bodies ; that is, there muft be a diminution of the gravity of bodies near the earth's furface at noon, when the fun is over them ; and al- fo at midnight from the greater centrifugal force of that fide of the Class IV. 2. 4. 1. OF ASSOCIATION. 429 the earth, which is moft diftant from the centre, round which the earth moves in her annual orbit, than on the fide neareft that centre. Whence it likewife follows, that the gravitation of bodies towards the earth is greateft about fix hours after noon, and after midnight. Now when the fun and moon have their united gravitation on the fame fide of the earth, as at the new moon ; or when the folar attraction coincides with the greater centrifugal motion of that fide of the earth, which is furtheft diftant from the moon, as at the full moon ; and when this happens about noon or mid- night, the gravitation of terrene bodies towards the earth will be greater about fix hours after noon, and after midnight, than at any other part of the lunar period ; becaufe the attraction of both thefe luminaries is then exerted on thofe fides of the earth over which they hang, which, at other times of the month are more or lefs exerted on other parts of it. Laftly, as heat and motion counteract the gravitation of the particles of bodies to each other, and hence become either the efficient caufes of vegetable and animal life, or the caufes with- out which life cannot exift, it feems to follow, that when our gravitation towards the earth's centre is greateft, the powers of life ffiould be the leaft ; and hence that thofe difeafes, which begin with torpor, ffiould occur about fix hours after the folar or lunar noon, or about fix hours after the folar or lunar midnight; and this moft frequently about fix hours after or before the new- er full moon ; and efpecially when thefe happen at noon or at mid-night; or laftly, according to the combination of thefe powers in diminiffiing or increafing the earth's attraction to bodies on its furface. The returns or exacerbations of many fevers, both irritative and inflammatory, about fix in the evening, and of the periodic cough defcribed in SeCt. XXXVI. 3. 9. countenance this theo- ry. Tables might be made out to ffiew the combined powers of the fun and moon in diminiffiing the gravitation of bodies on the earth's furface, at every part of their diurnal, monthly, and annual periods ; and which might facilitate the elucidation of this fubjeCt. But I am well aware of the difficulty of its appli- cation to difeafes, and hope thefe conjectures may induce oth- ers to publiffi more numerous obfervations, and more conclu- five reafonings. SPECIES. i. Somni periodus. The periods of fleeping and of waking are fhortened or prolonged by fo many other circumftances in animal life, befides the minute difference between diurnal and noClurnal 430 DISEASES Class IV. 2. 4. 2. no&urnal folar gravitation, that it can fcarcely be afcribed to this influence. At the fame time it is curious to obferve, that veget- ables in refpect to their times of fleeping more regularly obferve the hour of the day, than the prefence or abfence of light, or of heat, as may be feen by confulting the calendar of Flora. Bo- tanic Garden, Part II. Canto 2. 1. 165. note. Some difeafes, which at fir ft fight might be fuppofed to be in- fluenced by folar periods, feem to be induced by the increafing fenfibility of the fyftem to pain during our fleeping hours ; as explained in Sebl. XVIII. 15. Of thefe are the fits of afthma, of fome epilepfies, and of fome hiemoptoes ; all which difturb the patient after fome hours fleep, and are therefore to be af- cribed to the increafe of our dormant fenfibility. There may like wife be fome doubt, whether the commencement of the pain of gout in the foot, as it generally makes its attack after fleep, fhould be afcribed to the increafed fenfibility in fleep, or to fo- lar influence ? M. M. When afthmatic or epileptic fits or haemoptoe occur after a certain number of hours of fleep, the patient fhould be forcibly awakened before the expected time by an alarm clock, and drmk a cup of chocolate or lemonade.-Or a grain of opi- um fhould be given at going to bed-In one cafe to prevent the too great increafe of fenfibility by fhortening the time of fleep ; and in the other by increafing the irritative motions, and expending by that means a part of the fenforial power. 2. iStudii inanis periodus. Clafs III. 1. 2. 2. The cataleptic fpafrn which preceded the reverie and fomnambulation in the patient, whofe cafe is related in Sett. XIX. 2. occurred at ex- adly the fame hour, which was about eleven in the morning for many weeks ; till thofe periods were difturbed by large dofes of opium ; and muft therefore be referred to fome efled; of folar gravitation. In the cafe ofMafter A. Sect. XXXIV. 3. as the reverie began early in the morning during fleep, there may be a doubt, whether this commenced with torpor of fome organ catenated with folar gravitation ; or was caufed by the exift- ence of a previous torpid part, which only became fo painful as to excite the exertions of reverie by the perpetual increafe of fenfibility during the continuance of fleep, as in fome fits of epi- lepfy, afthma, and haemoptoe mentioned in the preceding article. 3. Hemicrania periodus. Periods of Hemicrania. Clafs IV. 2. 2. 8. The torpor and confequent pain of fome membranes on one fide of the head, as over one eye, are frequently occa- fioned by a decaying tooth, and are liable, to return every day, or on alternate days at folar or lunar periods. In this cafe large quantities of the bark will frequently cure the difeafe, and ef- peciallv Class IV. 2. 4.4. OF ASSOCIATION; 431 pecially if preceded by venefe&ion and a brifk cathartic ; but if the offending tooth can be detected, the mod certain cure is its extraction. Thefe partial head-achs are alfo liable to return at the greater lunar periods, as about once a month. Five drops from a two-ounce phial of a faturated folution of arfenic twice a day for a week or two have been faid to prevent the returns of this difeafe. See a Treatife on Arfenic by Dr. Fowler, of York. Strong errhines have alfo been recommended. 4. Epilepjia dolorijica periodus. Clafs III. 1. 1.8. The pain which induces after about an hour the violent convulfions or in- fanity, which conftitute the painful epilepfy, generally obferve folar diurnal periods for four or five weeks, and are probably governed by folar and lunar times in refpeCt to their greater pe- riods ; for 1 have obferved that the daily paroxyfms, unlefs dif- turbed by large dofes of opium, recur at very nearly the fame hour, and after a few weeks the patients have recovered to re- lapfe again at the interval of a few months. But more obfer- vations are wanted upon this fubjeCt, which might be of great advantage in preventing the attacks of this difeafe ; as much lefs opium given an hour before its expeded daily return will pre- vent the paroxyfm, than is neceifary to cure it, after it has com- menced. 5. Convuljionis dolorifica periodus. Clafs III. I. 1.6. The pains, which produce thefe convulfions, are generally left after rheumatifm, and come on when the patients are become warm in bed, or have been for a ihort time afleep, and are therefore perhaps rather to be afcribed to the increafing fenfibility of the fyllem during deep, than to folar diurnal periods, as in Species firft and fecond of this Genus. 6. TuJJis periodica periodus. Periodic cough, Clafs IV. 2. 1. 9. returns at exaCt folar periods ; that defcribed in SeCt.XXXVI. 3. 9. recurred about feven in the afternoon for feveral weeks, till its periods were difturbed by opium, and then it recurred at eleven at night for about a week, and was then totally deflroy- ed by opium given in very large quantities, after having been previoufly for a few days omitted. 7. Catameniaperiodus. Periods of menftruation. The cor- refpondence of the periods of the catamenia with thofe of the moon was treated of in SeCl. 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 lefs evident; it has commonly been afcribed to fome effeCt of the lunar gravitation on the circulating blood, as mentioned in SeCI. XXXII. 6. But it is more analogous to other animal phenomena to fuppofe that the lunar gravitation immediately affeCIs 432 DISEASES Class IV. 2. 4. 8. adepts the folids by its influxor ftimulus. Which we believe, of the fluid element of heat, in which we are equally immerfed ; and of the elettric fluid, which alfo furrounds and pervades us. See Sed. XXXVI. 2. 3. If the torpor of the uterine veins, which induces the monthly periods of the catamenia, be governed by the increafe of terrene gravitation ; that is, by the deficiency of the counter-influence of folar and lunar gravitation ; why does not it occur molt fre-. quently when the terrene gravitation is the greateft, as about fix hours after the new moon,and next to that at about fix hours after the full moon ? This queltion has its difficulty ; firft, if the ter- renegravitation be greatelt about fix hours after the new moon, it mull become lefs and lefs about the fame time every lunar day, till the end of the firlt quarter, when it will be the leaft ; it mull then increafe daily till the full. After the full the terrene grav- itation mult again decreafe till the end of the third quarter, when it will again be the leaft, and muft increafe again till the new moon ; that is, the folar and lunar counter-gravitation is greateft, when thofe luminaries are vertical, at the new moon, and full moon, and leaft about fix hours afterwards. If it was known, whether more menftruations occur about fix hours after the moon is in the zenith or nadir ; and in the fecond and fourth quarters of the moon, than in the firft and third ; fome light would be thrown on this fubjedt ; which muft in that refpe€t wait for future obfervations. Secondly, if the lunar influence produces a very fmall degree of quiefcence, fuppofe of the uterine veins, at firft ; and if that recurs at certain periods, as of lunar days, or about 25 hours, even with lefs power to produce quiefcence than at firft ; yet the quiefcence will daily increafe by the acquired habit acting at the fame time, as explained in Se€t. XII. 3. 3. till at length fo great a degree of quiefcence will be induced as to caufe the inadtion of the veins of the uterus, and confequent venous haem- orrhage. See Se€t. XXXII. 6. Clafs I. 2. 1. 11. IV. 1, 4. 4, See the introduction to this Genus. 8. Hamorrhoidis periodus. The periods of the piles depend on the torpor of the veins of tire reCtum, and are believed to re- cur nearly at monthly intervals. See Sect. XXVII. 2. and Oafs I. 2- 1.6. 9. Podagra periodus. The periods of gout in fome patients recur at annual intervals, as in the cafe related above in Clafs IV. 1. 2. 15. in which the gouty paroxyfm returned for three fucceffive years on nearly the fame day of the month. The commencement of the pain of each paroxyfm is generally a few hours after midnight, and may thence either be induced by di- urnal Class IV. 2. 4. 10. OF ASSOCIATION. urnal folar periods, or by the increafing fenfibility during fleep, as mentioned in the fir ft fpecies of this genus. io. Eryfipelatis periodic. Some kinds of eryfipelas, which probably originate from the aflbciation of the cutaneous veflels with a difeafed liver, occur at monthly periods, like the hsemor- rhois or piles ; and others at annual periods, like the gout; as a torpor of fome part I fuppofe always precedes the eryfipelatous inflammation, the periods fhould accord with the increafing in- fluence of terrene gravitation, as defcribed in the introduction to this Genus, and in fpecies the feventh of it. Other periods of difeafes, referrable to|folar and lunar influence, are mentioned in SeClion XXXVI. and many others will probably be difcovered. by future obfervation. ii. Febrium periodus. Periods of fevers. The commence- ment of the cold fits of intermittent fevers, and the daily exac- erbations of other fevers, fo regularly recur at diurnal, folar, or lunar periods ; that it is impoflible to deny their connection with gravitation ; as explained in Sect. XXXVI. 3. Not only thefe exacerbations of fever, and their remiflions, and the diurnal fo- lar and lunar periods ; but the preparatory circumftances, which introduce fevers, or which determine their crifes, appear to be governed by the parts of monthly lunar periods, and of folar annual ones. Thus the variolous fever in the natural fmall- pox commences on the 14th day, and in the innoculated fmall- pox on the feventh day. The fever and eruption in the diftinCt kind take up another quarter of a lunation, and the maturation another quarter. The rever, which is termed canine madnefs or hydrophobia, is believed to commence near the new or full moon ; and, if the caufe is not then great enough to bring on the difeafe, it feems to acquire fome flrength, or to lie dormant, till another, or per- haps more powerful lunation calls it into aClion. In the fpring, about three or four years ago, a mad dog very much worried one fwine, confined in a fly, and bit another in the fame fty in a lefs degree ; the former became mad, refufed his meat, was much convulfed, and died in about four days ; this difeafe commenced about a month after the bite. The other fwine began to be ill about a month after the firft, and died in the fame manner. 433 Vol. IT. Hnh ORDO 434 DISEASES Class IV. 3. r. 1. ORDO III. Retrograde Ajjociate Motions. GENUS I. Catenated "with Irritative Motions. Those retrograde aflbciate motions, the firft 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 de- creafed actions, both in this and the former clafles. SPECIES. i. Diabetes irritata. When the abforbents of the inteftines are ftimulated too ftrongly by fpirit of wine, as in the beginning of drunkennefs, the urinary abforbents invert their motions. The fame happens from worms in the inteftines. In other kinds of diabetes may not the remote caufe be the too ftrong aClion of the cutaneous abforbents, or of the pulmonary ones ? May not in fuch cafes oil externally or internally be of fervice ? or warm bathing for an hour at a time ? In hyfteric inverfions of motion, is fome other part too much ftimulated ? or pained from the want of ftimulus ? 2. Sudor frigidus in ajlhmate.. The caufe of the paroxyfms of humoral afthma is not well underftood ; I fuppofe it to be ow- ing to a torpidity or inaCtion of the abforbents belonging to the pulmonary veffels, as happens probably to other vifcera at the commencement of intermittent fevers, and to a confequent ac- cumulation of fluids in them ; which at length, producing great, irritation or uneafy fenfation, caufes the violent efforts to pro- duce the abforption of it. The motions of the cutaneous ab- forbent veffels by their aflbciation with thofe of the pulmonary ones become retrograde, and effiife upon the fkin a fluid, which is faid to be vifcid, and which adheres in drops. A few days ago I faw a young man of delicate conftitution, in ■what was called a fit of the afthma •, he had about two months before had a peripneumony, and had been ever fince fubjeft to difficult refpiration on exertion, with occafional palpitation of his heart. He was now feized about eight at night after fome exertion of mind in his bufinefs with cold extremities, and diffi- culty of breathing. He gradually became worfe, and in about half Class IV. 3.1.3. OF ASSOCIATION. 435 half an hour, the palpitation of his heart and difficult refpiration were very alarming ; his whole ikin was cold and pale, yet he did not Ihudder as in cold paroxyfm of fever ; his tongue from the point to the middle became as cold as his other extremities, with cold breath. He feemed to be in the atf of dying, except that his pulfe continued equal in time, though very quick. He loft three ounces of blood, and took ten drops of laudanum, with mufk and fait of hartftiorn, and recovered in an hour or two without any cold fweat. There being no cold fweat feems to indicate that there was no accumulation of ferous fluid in the lungs ; and that their inactivity, and the coldnefs of the breath, was owing to the fympathy of the air-cells with fome diftant part. There was no ffiuddering produced, becaufe the lungs are not fenfible to heat and cold ; as any one may obferve by going from a warm room into a frofty air, and the contrary. So the fleam of hot tea, which fcalds the mouth, does not affeCt the lungs with the fenfation of heat. I was induced to believe that the whole cold fit might be owing to fuppuration in fome part of the cheft ; as the general difficulty of breathing feemed to be increafed after a few days with pulfe of 120, and other figns of empyema. Do the cold fweat, and the occurrence of the fits of afthma after fleep, diftinguiffi the humoral afthma from the cold paroxyfm of intermittents, or that which attends fuppuration, or which pre- cedes inflammation ?-I heard a few weeks afterwards, that he fpit up much matter at the time he died. 3. Diabetes a timore. The motions of the abforbent veflels of the neck of the bladder become inverted by their confent with thofe of the ikin ; which are become torpid by their reverfe fympathy with the painful ideas of fear, as in Section XVI. 8. 1. whence there is a great difcharge of pale urine, as in hyfteric difeafes. The fame happens from anxiety, where the painful fufpenfe is continued, even when the degree of fear is fmall; as in young men about to be examined for a degree at the univerfities, the frequency of making water is very obfervable. When this anxi- ety is attended with a fleeplefs night, the quantity of pale urine is amazingly great in fome people, and the micturition very fre- quent. M. M. Opium. Joy. Confolations of friendffiip. 4. Diarrhoea a timore. The abforbent veflels of the inteftines invert their motion, by direct confent with the Ikin ; hence many liquid ftools as well as much pale urine are liable to ac- company continued fear, along with coldnefs of the Ikin. The immediate caufe of this is the decreafed fenforial power of aflb- ciation, DISEASES 436 ClassIV. 3.1. ciation, which intervenes between the actions of the abforbents of the cold fkin, and thofe of the inteftinal abforbents ; the mo- tions of the latter become on that account weakened and at length retrograde. The remote caufe is the torpor of the vef- fels of the ikin catenated with the pain of fear, as explained in Sea. XVI. 8. I. The capillaries of the (kin confent more generally by dired fympathy with thofe of the lower inteftines, and of the bladder ; but by reverfe fympathy more generally with thofe of the ftom* ach and upper inteftines. As appears in fevers, where the hot Ikin accompanies indigeftion of the ftomach ; and in diarrhoeas attended with cold extremities. rhe remote caufe is the torpor of the Ikin owing to its reverfe fympathy with the painful fenfual motions, or ideas, of fear ; which are now actuated with great energy, fo as to deprive the fecond link of aflbciated motions of their due (hare of fenforial power. It is alfo probable that rhe pain of fear itfelf may con- tribute to exhauft the fenforial power, even when it produces no mufcular action. See ClafsIV. 2. 2. 5. Pallor et tremor a timore. A retrograde action of the ca- pillaries of the Ikin producing palenefs, and a torpor of the muf- cular fibres of the limbs occafioning trembling, are caufed by their reverfe aflbciations with the ideas or imaginations of fear ; which are now actuated with violent energy, and accompanied with great pain. The caufe of thefe aflbciations is explained in Sed. XVI 8. 1. Thefe torpid actions of the capillaries, and mufcles of the limbs are not caufed immediately by the painful fenfation of fear ; as in that cafe they would have been increafed and not decreafed a&ions, as occurs in anger ; where the painful voli- tions increafes the actions of the capillaries, exciting a blufh and heat of the ikin. Whence we may gain fome knowledge of what is meant by deprefling and exciting paflions ; the former confifting of ideas attended with pain, which pain occafions no mufcular aiSHons, like the pain of cold head-ach ; the latter be- ing attended with volitions, and confequent mufcular 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 fenfe ; in the former cafe the painful fenfation of fear produces no mufcular a&ions, yet it exhaufts or employs fo much fenforial power, that the whole fyftem ads more feebly, or becomes retrograde ; but fome parts of it more fo than others, according to their early aflbciations defcribed in Sed. XVI. 8. 1. hence the tremor of the limbs, palpitation of heart, and even fyncope. In anger the painful volition produces violent mufcular adions ; but Class IV. 3.1. 6. OF ASSOCIATION. 437 but if previous to thefe any deliberation occurs, a fluffied coun- tenance fometimes, and a red (kin, are produced by this fupera- bundance of volition exerted on the arterial fyftem ; but at oth- er times the Ikin becomes pale, and the legs tremble, from the exhauftion or expenditure of the fenforial power by the painful volitions of anger on the organs of fenfe, as by the painful fen- fations of fear above mentioned. Where the paflion of fear exifts in a great degree, it exhaufts or expends fo much fenforial power, either fimply 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 fkin, but a retrograde motion of the cutaneous abforbents oc- curs, and a cold fweat appears upon the whole furface of the body, which probably fometimes increafes pulmonary abforp- tion ; as in Clafs II. i. 6. 4. and as in the cold fweats, which attend the paroxyfms of humoral afthma. Hence anxiety, which is a continued pain of fear, fo univerfally debilitates the conftitution as to occafion a lingering death ; which happens much more frequently than is ufually fuppofed ; and thefe vic- tims of continued anxiety are faid to die of a broken heart. Other kinds of palenefs are defcribed in Clafs 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 adHon of it, and perhaps fome- times to the retrograde exertion of the ventricles and auricles; becaufe it feems to be affected by its aflbciation with the capil- laries, the adtions of which, with thofe of the arteries and veins, conftitute one great circle of aflbciate motions. Now when the capillaries of the fkin become torpid, coldnefs and palenefs fucceed ; and with thefe are aflbciated the capillaries of the lungs, whence difficult refpiration ; and with thefe the weak and retrograde adiions of the heart. At the fame time the ab- forbents of the fkin, and of the bladder, and of the inteftines, fometimes become retrograde and regurgitate their contents ; as appears by the pale urine, in large quantities, which attends hyfteric complaints along with this palpitation of the heart ; and from the cold fweats and diarrhoea ; all which, as well as the hyfteric complaints, are liable to be induced or attended by fear. When fear has ftill more violently affedted the fyftem, there have been inftances where fyncope, and fudden death, or a total ftoppage of the cirulation have fucceeded ; in thefe laft cafes, the pain of fear has employed or exhaufted the whole of the fenforial power, fo that not only thofe mulcular fibres generally exerted by volition ceafe to adt, whence the patient falls down ; and 438 DISEASES Class IV. 3. 1. 7. and thofe which conftitute the organs of fenfe, whence fynco- pe ; but laftly thofe, which perform the vital motions, become deprived of fenforial power, and death enfues. See Clafs I. 2. 1. 4. and I 2. 1. 10. Similar to this in fome epileptic fits, the patient firit fuddenly falls down, without even endeavouring to fave himfelf by his hands, before the convulfive motions come on. In this cafe the great exertion of fome fmall part in confe- tjuence of great irritation or fenfation exhaufts the whole fen- forial power, which was lodged in the extremities of the lo- comotive nerves, for a fhort time, as in fyncope ; and as foon as thefe mufcles are again fupplied, convulfions fupervene to relieve the painful fenfation. See Clafs III. 1. 1. 7. 7. Abortio atimore. Women mifcarry much more frequent- ly from a fright, than from bodily injury. A torpor or retro- grade motion of the capillary arteries of the internal uterus is probably the immediate caufe of thefe mifcarriages, owing to the affociation of the actions of thofe vefl'els with the capillaries of the (kin, which are rendered torpid or retrograde by fear. By this contraction of the uterine arteries, the fine vefl'els of the placenta, which are inferred into them, are detruded, or oth- erwife fo affected, that the placenta feparates at this time from the uterus, and the fetus dies from want of oxygenation. A ftrong young woman, in the fifth or fixth month of her preg- nancy) who has fince borne many children, went into her cellar to draw beer ; one of her fervant boys was hid behind a bar- rel, and ftarted out to furprife her, believing her to be the maid-fervant ; fhe began to flood immediately, and mifcarried in a few hours. See Se<T XXXIX. 6. 5. and Clafs I. 2. 1. 14. 8. Hyjleria a timore. Some delicate ladies are liable to fall into hyfteric fits from fudden fright. The periftaltic motions of the bowels and ftomach, and thofe of the cefophagus, make a part of the great circle of irritative motions with thofe of the fkin, and many other membranes. Hence when the cutaneous vefl'els become torpid from their reverfe fympathy with the painful ideas of fear ; thofe of the bowels, and flomach, and cefophagus, become firft torpid by direct fympathy with thofe of the Ikin, and then feebly and incffeftually invert the order of their motions, which conftitutes a paroxyfm of the hyfteric dif- eafe. See Clafs I. 3. 1. 10. Thefe hyfteric paroxyfms are fometimes followed by convulfions, which belong to Clafs III. as they are exertions to relieve pain ; and fometimes by death. See Species 9. of this Genus, and Clafs I. 2. 1. 4. Indigeftion from fear is to be afcribed in the fame manner to the torpor of the ftomach, owing to its aflbciation with the fkin. As in Clafs IV. 1. 2. 5. IV. 2. 1. ORDO Class IV. 3. 2. 1. OF ASSOCIATION, 439 ORDO III. Retrograde AJfociate Motions. GENUS II. Catenated •with Zenfitive Motions. SPECIES. I. Naufea idealis. Naufea from difguftful ideas, as from naufeous ftories, or diguftful fights, or fmells, or taftes, as well as vomiting from the fame caufes, confifts in the retrograde ac- tions of the lymphatics of the throat, and of the cefophagus, and ftomach ; which are affociated with the difguftful ideas, or fen- fual motions of fight, or hearing, or fmell, or tafte ; for as thele are decreafed motions of the lymphatics, or of the cefophagus, or ftomach, they cannot immediately be excited by the fenforial power of painful fenfation, as in that cafe they ought to be in- creafed motions. So much fenforial power is employed for a time on the difguftful idea, or expended in the production of inadive pain, which attends it, that the other parts of the aflb- ciated chain of aClion, of which this difguftful idea is now be- come a link, are deprived of their accuftomed {bare ; and there- fore firft (top and then invert their motions. Owing to defi- ciency of fenforial power, as explained more at large in SeCt. XXXV. 1.3. 2. Naufea a conceptu. The naufea, which pregnant women are fo fubjeCl to during the firft part of geftation, is owing to the reverfe fympathy between the uterus and ftomach, fo that the increafed aCtion of the former, excited by the ftimulus of the growing embryon, which I believe is fometimes attended with fenfation, produces decreafed aCtions of the latter with the difagreeable fenfation of ficknefs with indigeftion and confe- quent acidity. When the fetus acquires fo much mufcular power as to move its limbs, or to turn itfelf, which is called quickening, this ficknefs of pregnancy generally ceafes. M. M. Calcined magnelia. Rheubarb. Half a grain of o- pium twice a day. Recumbent pofture on a fofa. 3. Vomitio vertiginofa. Sea-ficknefs, the irritative motions of vifion, by which we balance ourfelves, and preferve our perpen- dicularity, are difturbed by the indiftimftnefs of their objeds ; which is either owing to the fimilarity of them, or to their dif- tance, 440 DISEASES Class IV. 3. 2. 4. tance, or to their apparent or unufual motions. Hence thefe irritative motions of vifion are exerted with greater energy, and are in confequence attended with fenfation ; which at firft is agreeable, as when children fwing on a rope ; afterwards the irritative motions of the ftomach, and of the abforbent veflels, which open their mouths into it, become inverted by their af- fociations with them by reverfe fympathy. For the adion of vomiting, as well as the difagreeable fen- fiition of ficknefs are (hown to be occafioned by defed of the fenforial power ; which in this cafe is owing to the greater ex- penditure of it by the fenfe of vifion. On the fame account the vomiting, which attends the paflage of a ftone through the ure- ter, or an inflammation of the bowels, or the commencement of fome fevers, is caufed by the increafed expenditure of the fen- ibrial power by the too great adion of fome links of the aflbci- ations of irritative motions ; and there being in confequence a deficiency of the quantity required for other links of this great catenation. It muft be obferved, that the expenditure of fenforial power by the retinas of the eyes is very great; which may be eftimated by the perpetual ufe of thofe organs during our waking hours, and during moft of our fleeping ones; and by the large diam- eters of the two optic nerves, which are nearly the fize of a quill, or equal to fome of the principal nerves, which ferve the limbs. 4. Vomitio a calculo in uretere. The adion of vomiting in con- fequence of the increafed or decreafed adions of the ureter, when a ftone lodges in it. The natural adions of the ftomach, which confift of motions fubjed to intermitted irritations from the fluids, which pafs through it, are aflbciated with thofe of the ureter, and become torpid, and confequently retrograde, by in- tervals, when the adions of the ureter become torpid owing to previous great ftimulus from the ftone it contains ; as appears from the vomiting exifting when the pain is leaft. When the motions of the ureter are thus leflened, the. fenforial power of aflbciation, which ought to aduate the ftomach along with the fenforial power of irritation, ceafes to be excited into adion , and in confequence the adions of the ftomach become lefs en- ergetic, and in confequence retrograde. For as vomiting is a decreafed adion of the ftomach, as ex- plained in Sedion XXXV. 1. 3. it cannot be fuppofed to be produced by the pain of gravel in the ureter alone, as it fhould then be an increafed adion, not a decreafed one. The perpetual vomiting in ileus is caufed in like manner by the defedive excitement of the fenforial power of aflbciation by the Class IV. 3.2. 5. OF ASSOCIATION. the bowel, which is torpid during the intervals of pain ; and the ftomach fympathizes with it. See Enteritis, Clafs IL i. 2. n. Does this fymptom of vomiting indicate, whether the difeafe be above or below the valve of the colon ? Does not the fofter pulfe in fome kinds of enteritis depend on the fympathy of the heart and arteries with the ficknefs of the ftomach ? See Ileus and Cholera. Hence this ficknefs, as well as the ficknefs in fome fevers, cannot be efteemed an effort of nature to diflodge any offenfive material; but like the fea-ficknefs defcribed above, and in SeCt. XX. 4. is the confequence of the affociations of irritative or fen- fitive motions. See Clafs I. 1.3.9. 5. Vomitia ab infultu paralytica. Paralytic affeCtions generally commence with vomiting ; the fame frequently happens from a violent blow with a ftick on the head ; this curious connection of the brain and ftomach has not been explained ; as it refem- bles the ficknefs in confequence of vertigo at fea, it would feem to arife from a fimilar caufe, viz. from difturbed irritative or fenfitive affociations. 6. Vomitia a titillatione faucium. If the throat be flightly tick- led with a feather, a naufea is produced, that is, an inverted ac- tion of the mouths of the lymphatics of the fauces, and by di- reCt fympathy an inverted aClion of the ftomach enfues. As thefe parts have frequently been ftimulated at the fame time in- to pleafurable aCtion by the deglutition of our daily aliment, their aCtions become ftrongly affociated. And as all the food we fwallow, is either moift originally or mixed with our moift faliva in the mouth ; a feather, which is originally dry, and which in fome meafure repels the moift faliva, is difagreeable to the touch of the fauces; at the fame time this naufea and vom- iting cannot be caufed by difagreeable fenfation fimply, as then they ought to have been iricreafed exertions, and not decreafed ones, as fhewn in SeCtion XXXV. 1. 3. But the mouths of the lymphatics of the fauces are ftimulated by the dry feather into too great aCtion for a time, and become retrograde afterwards by the debility confequent to too great previous ftimulus. 7. Vomitio cute fympathetica. Vomiting is fuccefsfully flopped by the application of a blifter on the back in fome fevers, where the extremities are cold and the fkin pale. It was flopped by Sydenham by producing a fweat on the ikin by covering the head with the bedclothes. See Clafs IV. 1. 1. 3. and Suppl. I. 11. 6. Vol. IT- IJ i ORDO 441 442 DISEASES Class IV. 3.3.1, ORDO III, Retrograde .Ajjcciate Motions. GENUS III. Catenated with Voluntary Motions. SPECIES. 1 Ruminatio. In the rumination of horned cattle the food is brought up from the firft ftomach by the retrograde motions of the ftomach and oefophagus, which are catenated with the vol- untary motions of the abdominal mufcles. 2. Vomitio voluntaries. Voluntary vomiting. Some human fuhjeds have been faid to have obtained this power of volunta- ry action over the retrograde motions of the ftomach and oefoph- agus, and thus to have been able to empty their ftomach at pleafure. See Seft. XXV. 6. This voluntary aft of empty- ing the ftomach is poflefled by fome birds, as the pigeon ; who has an organ for fecreting milk in its ftomach, as Mr. Hunter obferved ; and foftens the food for its young by previoufly fwal- lowing it ; and afterwards putting its bill into theirs returns it into their mouths. See Seft. XXXIX. 4. 8. The pelicans ufe a ftomach, or throat-bag, for the purpofe of bringing the fifh, which they catch in the fea to fhore, and then eject them, and eat them at their leifure. See Seft. XVI. 11. And I am well informed of a bitch, who having puppies in a ftable at a diftance from the houfe, fwallowed the flefh-meat, which was given her, in large pieces, and carrying it immediately to her whelps, brought it up out of her ftomach, and laid it down before them. 3. Eruffatio voluntaria. Voluntary eruftation. Some, who have weak digeftions, and thence have frequently been induced to eruft the quantity of air difcharged from the fermenting ali- ment in their ftomachs, have gradually obtained a power of vol- untary eruftation, and have been able thus to bring up ^hogf- heads of air from their ftomachs whenever they pleafed. This great quantity of air is to be afcribed to the ihcreafe of the fer- mentation of the aliment by drawing off the gas as foon as it is produced. See Seft. XXIII. 4. ORDO Class IV. 3. 4. t OF ASSOCIATION. 443 ORDO III. Retrograde Ajflociate Motions. GENUS IV. Catenated with External Influences. SPECIES. I. Catarrhus peirodicus. Periodical catarrh is not a very un- common difeafe : there is a great difcharge of a thin faline mu- cous material from the membranes of the noftrils, and probably from the maxillary and frontal finufes, which recur once a day at exaCt folar periods; unlefs it be difturbed by exhibition of opium: and refembles the periodic cough mentioned below. See Clafs I. 3. 2. 1. It is probably owing to the retrograde ac- tion of the lymphatics of the membranes affected, and produced immediately by folar influence. 2. Tujfls periodica. Periodic cough, called nervous cough, and tuflis ferina. It feems to arife 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 vio- lent for an hour or longer, is probably excited by the ftimulus of the thin fluid thus produced, as well as by the difagreeable fenfation attending membranous inactivity; and refembles pe- riodic catarrh not only in its fituation on a mucous membrane, but in the difcharge of a thin fluid. As it is partly reftrainable, it does not come under the name of convulfion ; and as it is not attended with difficult refpiration, it cannot be called afthma ; it is cured by very large dofes of opium; fee a cafe and cure in Sect. XXXVI. 3. 9. Clafs IV. 2. 4. 6. and feems immediately to be induced by folar influence. 3. Hyfleria a frigore. Hyfteric paroxyfms are occafloned by whatever fuddenly debilitates the fyftem, as fear, or cold, and perhaps fometimes by external moifture of the air, as all delicate people have their days of greater or lefs debility, fee Clafs IV. 3.1.8. 4. Naufea pleuvialis. Sicknefs at the commencement of a rainy feafon is very common among dogs, who aflift themfelves by eating the agroftis canina, or dog's grafs, and thus empty their ftomachs. The fame occurs with lefs frequency to cats, who make ufe of the fune expedient. See SeCt. XVI. 11. I have known one perfon, who from his early years has always been 444 DISEASES, &c. Class IV. 3.4. -4 been fick at the beginning of wet weather, and ftill continues fo. Is this owing to a fympathy of the mucous membrane of the ftom- ach with the mechanical relaxation of the external cuticle by a moifter atmofphere, as is feen in the corrugated cuticle of the hands of wafher-women ? or does it fympathize with the mu- cous membrane of the lungs, which muft be affected along with the mucus on its furface by the refpiration of a moifter atmof- phere. SUPPLEMENT. SUPPLEMENT TO CLASS IV. Sympathetic Theory of Fever. As fever confifts in the increafe or diminution of direft ar reverfe affociated motions, whatever may have been the remote caufe of them, it properly belongs to the fourth dafs of difeaf- es; and is introduced at the end of the clafs, that its great dif- ficulties might receive elucidation from the preceding parts of it. Thefe I ihall endeavour to enumerate under the following heads, trufting that the candid reader will difcover in thefe ru- diments of the theory of fever a nafcent embryon, an infant Hercules, which time may rear to maturity, and render fervice- able to mankind. I. Simple fever of two kinds. IL Compound fever. III. Termination of the cold fit. IV. Return of the cold fit. V. Senfation excited in fever. VI. Circles of affociated motions. VII. Alternations of cold and hot fits. VIII. Orgafm of the capillaries. IX. Torpor of the lungs. X. Torpor of the brain. XI. Torpor of the heart and arteries. XII. Torpor of the ftomach and inteftin€s XIII. Cafe of continued fever explained. XIV. Termination of continued fever. XV. Inflammation excited in fever. XVI. Recapitulation. I. Simple Fever. i. When a fmall part of the cutaneous capillaries with their raucous or perfpirative glands are for a fhort time expofed to a -older medium, as when the hands are immerfed in iced water fnr 446 THEORY OF FEVER. Sup. I. i. 2. for a minute, thefe capillary veffels and their glands become tor- pid or quiefcent, owing to the eduftion of the ftimulus of heat. The ikin then becomes pale, becaufe no blood paffes through the external capillaries ; and appears flirunk, becaufe their fides are collapfed from inadfivity, not contracted by fpafm ; the roots of the hair are left prominent from the feceding or fubfiding of the ikin around them ; and the pain of coldnefs is produced. In this fituation, if the ufual degree of warmth be applied, thefe veffels regain their activity ; and having now become more irritable from an accumulation of the fenforial power of irritation during their quiefcence, a greater exertion of them fol- lows, with an increafed glow of the ikin, and another kind of pain, which is called the hot-ach ; but no fever, properly fo called, is yet produced ; as this effeCt is not univerfal, nor permanent, nor recurrent. 2. If a greater part of the cutaneous capillaries with their mucous and perfpirative glands be expofed for a longer time to cold, the torpor or quiefcence becomes extended by direct fym- pathy to the heart and arteries ; which is known by the weak- nefs, and confequent frequency of the pulfe in cold fits of fever. This requires to be further explained. The movements of the heart and arteries, and the whole of the circulatory veffels, are in general excited into action by the two fenforial powers o f irritation, and of affociation. The former is - excited by ftimu- lus, the latter by the previous actions of a part of the vital circle of motions. In the above fituation the capillaries act weakly from defeat of irritation, which is caufed by deficient ftimulus of heat; but the heart and arteries aft weakly from defeat of aflociation, which is owing to the weak action of the capilla- ries ; which does not now excite the fenforial power of affocia- tion into action with fufiicient energy. After a time, either by the application of warmth, or by the increafe of their irritability owing to the accumulation of the fenforial power of irritation, during their previous quiefcence, the capillary veffels and glands aft with greater energy than natural ; whence the red colour and heat of the ikin. The heart and ar- teries acquire a greater ftrength of pulfation, and continue the frequency of it, owing to the accumulation of the fenforial pow- er of affociation during their previous torpor, and their confe- quent greater affociability ; which is now alfo more ftrongly ex- cited by the increafed actions of the capillaries. And thus a fit of fimple fever is produced, which is termed Febris irritati- va 5 and confifts of a torpor of the cutaneous capillaries with their mucous and perfpirable glands, accompanied with a tor- por Sup. I. 1. 3. THEORY OF FEVER. 447 por of the heart and arteries; and afterwards of an increafed action of all thefe veflels, by what is termed direCt fympathy. This fever, with ftrong pulfe, without inflammation, or febris irritativa, defcribed in Clafs I. i. i. i. is frequently feea in ver- nal intermittents, as the orgafm of the heart and arteries is then occafioned by their previous Rate of torpor ; but more rarely I believe exifls in the type of continued fever, except there be an evident remiffion, or approximation to a cold fit; at which time a new accumulation of the fenforial power of aflbciation is pro- duced ; which afterwards actuates the heart and arteries with unnatural vigour ; or unlefs there be fome ftimulus perpetually acting on the fyftem, fo as to induce an increafed fecretion of fenforial power in the brain, as occurs in flight degrees of intoxi- cation. Since without one or other of thefe circumftances in continued fevers without inflammation, that is, without the ad- ditional fenforial power of fenfation being introduced, it feems difficult to account for the production of fo great a quantity of fenforial power, as muff be neceffary to give perpetual increafe of aCtion to the whole fanguiferous fyftem. 3. On the contrary, while the cutaneous capillaries with their mucous and perfpirative glands acquire an increafed irritability, as above, by the accumulation of that fenforial power during their previous quiefcence, and thus conftitute the hot fit of fe- ver ; if the heart and arteries do not acquire any increafe of af- fbciability, but continue in their ftate of torpor, another kind of fimple fever is produced ; which is generally of the continued kind, and is termed febris inirritativa; which confifts of a pre- vious torpor of the capillaries of the ficin, and of the heart and arteries by direCt fympathy with them; and afterwards of an orgafm or increafed action of the capillaries of the ficin,' with a decreafed aCtion, or continued torpor, of the heart and arteries by reverfe fympathy with them. This orgafm of the cutaneous capillaries, which appears by th® blufh and heat of the ficin, is at firft owing to the accumulation of the fenforial power of irri- tation during their previous torpid ftate, as in the febris irritata above defcribed ; but which is afterwards fupported or continu- ed by the reverfe fympathy of thefe capillaries with the torpid ftate of the heart and arteries, as will be further explained in ar- ticle 8. of this Supplement. 4. The renovated activity of the capillaries commences as foon or fooner than that of the heart and arteries after the cold fit of irritative fever; and is not owing to their being forced open by the blood being impelled into them mechanically, by the renovated aCtion of the heart and arteries; for thefe capil- laries of the ficin have greater mobility than the heart and arte- ries, 448 THEORY OF FEVER. Sup. I. r.5. ries, as appears in the fudden blufli of Ihame ; which may be owing to their being more liable to perpetual varieties of activi- ty from their exposure to the viciffitudes of atmofpheric heat. And becaufe in inirritative fevers, or thofe with arterial debility, the capillaries acquire increafed ftrength, as it is evinced by the heat of the fkin, while the pulfations of the heart and arteries remain feeble. 5. It was faid above, that the cutaneous capillaries, when they were rendered torpid by expofure to cold, either recover- ed their activity by the reapplication of external warmth ; or by their increafed irritability, which is caufed by the accumu- lation of that fenforial power during their quiefcence. An example of the former of thefe may be feen on emerging from a very cold bath ; which produces a fit of fimple fever ; the cold fit, and confequent hot fit, of which may be prolonged by con- tinuing in the bath ; which has indeed proved fatal to fome weak and delicate people, and to others after having been much ex- haufted by heat and exercife. See Seih XXXII. 3. 2. An example of the latter may be taken from going into a bath of about eighty degrees of heat, as into the bath at Buxton, where the bather firft feels a chill, and after a minute becomes warm, though he remains in the fame medium, owing to the increafe of irritability from the accumulation of that fenforial power during the fhort time which the chilnefs continued. 6. Hence fimple fevers are of two kinds ; firft, the febris ir- ritativa, or fever with ftrong pulfe, which confifts of a previous torpor of the heart, arteries, and capillaries, and a fucceeding orgafm of thofe veflels. Secondly, the febris inirritativa, or fe- ver with weak pulfe, which confifts of a previous torpor of the heart, arteries, and capillaries; and of a fucceeding orgafm of the capillaries, the torpor of the heart and arteries continuing. But as the frequency of the pulfe occurs both in the ftate of tor- por, and in that of orgafm, of the heart and arteries ; this con- ftitutes a criterion to diftinguifh fever from other difeafes, which are owing to the torpor of fbme parts of the fyftem, as pareiis, and hemicrania. 7. The reader will pleafe to obferve, that where the cutane- ous or pulmonary capillaries are mentioned, their mucous and perfpirative glands are to be underftood as included; but that the abforbents belonging to thofe fyftems of veflels, and the commencement of the veins, are not always included ; as thefe are liable to torpor feparately, as in anafarca, and petechias ; or to orgafm, or increafed action, as in the exhibition of ftrong emetics, or in the application of vinegar to the lips ; yet he will alfo pleafe to obferve, that an increafed or decreafed action of thefe Sup. I. 2. 1. THEORY OF FEVER. 449 thefe abforbents and veins generally occurs along with that of the capillaries, as appears by the dry (kin in hot fits of fever; and from there being generally at the fame time no accumula- tion of venous blood m the cutaneous veflels, which would ap- pear by its purple colour. II. Compound Fever. i. When other parts of the fyftem fympathize with this tor- por and orgafm of the cutaneous capillaries, and of the heart and arteries ; the fever-fit becomes more complicated and dan- gerous ; and this in proportion to the number and confequence of fuch affected parts. Thus if the lungs become affe&ed, as in going into very cold water, a fhortnefs of breath occurs; which is owing to the collapfe or inactivity (not to the active contraction or fpafm), of the pulmonary capillaries; which, as the lungs are not fenfible to cold, are not fubjedt to painful fenfat ion, and confequent ihuddering, like the Ikin. In this cafe after a time the pulmonary capillaries, like the cutaneous ones, adt with increafed energy ; the breathing, which was before quick, and the air thrown out at each refpiration in lefs quan- tity, and cool to the back of the hand oppofed to it, now becomes larger in quantity, and warmer than natural; which however is not accompanied with the fenfation of heat in the membrane, which lines the air-velfels of the lungs, as in the fkin. 2. One confequence of this increafed heat of the breath is the increafed evaporation of the mucus on the tongue and nof- rtils. A vifcid material is fecreted by thefe membranes to pre- ferve them moift and fupple, for the purpofes of the fenfes of tafte and of fmell, which are extended beneath their furfaces ; the vifcid mucus, when the aqueous part of it is evaporated by the increafed heat of the refpired air, or is abforbed by the too great adtion of the mucous abforbents, adheres clofely on thofe membranes, and is not without difficulty to be feparated from them. This drynefs of the tongue and noftrils is a circumftance therefore worthy to be attended to; as it {hews the increafed action of the pulmonary capillaries, and the confequent increaf- ed heat of the expired air ; and may thus indicate, when colder air fhould be admitted to the patient. See Clafs I. 1.3. 1. The middle part of the tongue becomes dry fooner, and recov- ers its moifture later, than the edges of it; becaufe the currents of refpired air pafs moft over the middle part of it. This how- ever is not-the cafe, when the drynefs of the tongue is owing only to the increafed mucous abforption. When however a frequent cough attends pulmonary inflammation, the edges of Vol. II. K k k the THEORY OF FEVER. 450 Sup. I. 2. 3. the tongue are liable to be as much furred as the middle of it; as during the aflion of coughing the middle of the tongue is de- preffed, fo as to form half a cylinder, to give a greater aper- ture for the emiffion of air from the larynx , and the edges of it become thus as much expofed to the currents of air as the middle parts of it. 3. When the internal capillaries or glands fympathize with the cutaneous capillaries ; or when any of them are previoufly affefled with torpor, and the external or cutaneous capillaries are affected fecondarily ; other fymptoms are produced, which render the paroxyfms of fever ftill more complicate. Thus if fpleen or pancreas are primarily or fecondarily affefled, fo as to be rendered torpid or quiefcent, they are liable to become en- larged, and to remain fo even after the extinflion of the fever- lit. Thefe in fome intermittent fevers are perceptible to the hand, and are called ague-cakes; their tumour feems to be ow- ing to the permanent torpor of the abforbent fyftem, the fecern- ing veffels continuing to aft fome time afterwards. If the fe- cretory veffels of the liver are affefled fir ft with torpor, and af- terwards with orgafm, a greater fecretion of bile is produced, which fometimes caufes a diarrhoea. If a torpor of the kidneys, and of the abforbents of the bladder occurs, either primarily, or bv fvmpathy with the cutaneous capillaries, the urine is in linall quantity and pale, as explained in Oafs I. 2. 2. 5. ; and if thefe fecretory veffels of the kidneys, and the abforbents of the blad- der aft more ftrongly than natural afterwards by their increafed irritability or affociability, the urine becomes in larger quantity, and deeper coloured, or depofftes its earthy parts, as inClafs I. 1. 2. 4. which has been efteemed a favourable circumftance. But if the urine be in fmall quantity, and no fediment appears in it, after the hot fit is over ; it fhews that the fecerning veffels of the kidneys and the ablbrbent veffels of the bladder have not regained the whole of their affivity, and thence indicates a greater tendency to a return of the cold fit. 4. When the ftomach is affefted with torpor either primari- ly ; or fecondarily by its fympathy with the cutaneous capilla- ries ", or with fome internal vifeus ; ficknels occurs, with a total want of appetite to any thing folid ; vomiting then fupervenes, which may often be relieved by a blifter on the fkin, if the fkin be cool and pale ; but not if it be hot and llulhed. The intef- tines ceafe to perform their office of abforption from a fimilar torpor ; and a diarrhoea fupervenes owing to the acrimony of their putrid, or of their acid contents. The loofe undigefted or fetid ftools indicate the inability of the inteftines to perform their proper office ; as the mucus and gaftric acid, which are vomited Sup. I. 2. 5. THEORY OF FEVER. 451 vomited up, does that of the ftomach ; this torpor of the ftom- ach is liable to continue after the cold paroxyfm ceafes, and to convert intermittent fevers into continued ones by its direft fympathy with the heart and arteries. See article io. of this Supplement. 5. If the meninges of the brain fympathize with other torpid parts, or are primarily affefted, delirium, ftupor, and perhaps hydrocephalus internus, occur, fee Clafs II. 1. 7. 1. and I. 2. 5. 10 ; and fometimes the pulfe becomes flow, producing parefis inftead of fever. But if the membranes, which cover the muf- cles about the head, or of the pericranium, become torpid by their fympathy with other torpid parts, or are primarily affeft- ed, a head-ach fupervenes; which however generally ceafes with the cold paroxyfm of fever. For as when the fenforial power of volition is exhaufted by labour, a few hours, or half a fblar day, paHed in deep recruits the fyftem by accumulation of this fenforial power ; fo when the fenforial power of irritation is exhaufted, one or two folar or lunar days of reft or quiefcence of the aftefted part will generally reftore its aftion by accumu- lation of irritability, and confequent increafe of aflbciation, as in hcmicrania, Clafs IV 2.2 8. But when the heart and arteries become torpid, either primarily, or by their fympathy with the ftomach, this accumulation of the fenforial power of irritation can take place but flowly ; as to reft is death ! This explains the caufe of the duration of fevers with weak pulfe, which con- tinue a quarter, or half, or three quarters, or a whole lunation, or ftill longer, before fufficient accumulation of irritability can be produced to reftore their natural ftrength of aftion. 6. If the abforbent vefiels, which are fpread around the neck of the bladder, become torpid by their direft fympathy with the abforbents of the ikin in cold fits of fever ; the urine, which is poured into the bladder in but fmall quantity from the torpid kidneys, has neverthelefs none of its aqueous faline part reab- Ibrbed ; and this faline part ftimulates the bladder to empty it- felf frequently, though the urine is in fmall quantity. Which is not therefore owing to any fuppofed fpai m of the bladder, for the aftion of it in excluding the urine is weak, and as much controllable by the will as in ordinary mifturition. 7. If the beginnings or abforbent mouths of the venous fyf- tem remain torpid, petechise or vibices are produced in fevers, fimilar to thole which are feen in fcurvy without fever. If the fkin was frequently moiftened for an hour, and at the fame time expoied to the common air, or oxygen gas, it might con- tribute to turn the black colour of thefe points of extravafated blood into fcarlet, and thus by increafing its ftimulus facilitate its 452 THEORY OF FEVER. Sup. 1.2. 8. its reabforption ? For oxygen gas penetrates moift animal mem- branes though not dry ones, as in the lungs during relpiration. See Clafs I. 2. 1. 17. 8. When the fenforial power of fenfation is introduced into the arterial fyftem, other kinds of compound fevers are produc- ed, which will be fpoken of in their place. III. Termination of the cold Fit. 1. If all the parts, which were affedted with torpor, regain their irritability, and afibciability, the cold paroxyfm of fever ceafes ; but as fome of the parts affected were previoufly accuf- tomedto inceffant ablion, as the heart and arteries, and others only to intermitted action, as the ftomach and inteftines ; and as thofe, which are fubjebted during health to perpetual action, accumulate fenforial power fafter, when their motions are im- peded, than thofe which are fubje<fted to intermitted action; it happens, that fome of the parts, which were affected with tor- por during the cold fit, recover their irritability or afibciability fooner than others, and more perfectly, or acquire a greater quantity of them than natural; as appears by the partial heat and flufhings previous to the general hot fit. Hence if all the parts, which were previoufly torpid, regain their due degree of irritability, or of afibciability, the difeafe is removed, and health reftored If fome or all of them acquire more than their natural degree of thefe fenforial powers ; in- creafed actions, and confequent increafed fecretions, and greater heat occur, and conftitute the hot fit of fever. If after this hot fit of fever all the parts, which had acquired too great irritabili- ty, or afibciability, regain their natural degree of it ; the dif- eafe is removed, and health reftored. But if fome of thefe parts do not regain their natural degree of thefe fenforial powers, the actions of thofe parts remain imperfecft, and are more or lefs injurious to the fyftem, according to the importance of their functions. 2. Thus if a torpor of the heart and arteries remains ; the quick pulfe without ftrength, which began in the cold fit, per- fifts ; and a continued fever is produced. If the torpor of the ftomach and inteftines remains, which is known by ficknefs and undigefted ftools, the fever is liable to be of confiderable length and danger ; the fame if the kidneys and abforbent fyftem re- tain fome degree of torpor, as is fhewn by the pale urine in not unufual quantity. If part of the abforbent fyftem remains tor- pid, as the abforbent veflels of the fpleen, a tumour of ,that vif- cus occurs, which may be felt by the hand ; the fame fome- times Sup. I. 3. 3. THEORY OF FEVER. 453 times happens to the liver ; and thefe from their tendency to more complete torpor are afterwards liable to give occasion to a return of the cold fit. If the cellular abforbents do not com- pletely recover their activity, a pale and bloated countenance with Swelled legs marks their want of adlion. 3. As the termination of the cold fit is owing to the accumu- lation of the fenforial power of irritation and of aSTociation du- ring the previous quiefcence of the fyftem ; and as thofe parts, which are in perpetual action during health, are more fubject to this accumulation during their torpor, or quiefcence ; one fhould have imagined, that the heart and arteries would acquire this accumulation of fenforial power fooner or in greater degree than other parts. This indeed fo happens, where the pulfe is previously Strong, as in febris irritativa ; or where another fen- forial power, as that of fenfation, is exerted on the arterial fyf- tem, as in inflammations. The heart and arteries in thefe cafes foon recover from their torpor, and are exerted with great vi- olence. Many other parts of the fyftem fubjeft to perpetual motion in health may reft for a time without much inconvenience to the whole ; as when the fingers of fome people become cold and pale ; and during this complete reft great accumulation of irritability may be produced. But where the heart and ar- teries are previously feeble, they cannot much diminish their actions, and certainly cannot reft entirely, for that would be death ; and therefore in this cafe their accumulation of the fen- forial power of irritation or of aSTociation is Slowly produced, and a long fever fupervenes in confequence ; or fudden death, as frequently happens, terminates the cold fit. Whence it appears, that in fevers with weak pulfe, if the ac- tion of the heart, arteries, and capillaries could be diminished, or flopped for a Short time without occasioning the death of the patient, as happens in cold bathing, or to perfons apparently drowned, that a great accumulation of the fenforial powers of irritation or of aSTociation might foon be produced, and the pulfe become Stronger, and confequently Slower, and the fever ceafe. Hence cold ablution may be of Service in fevers with weak pulfe, by preventing the expenditure and producing accumula- tion of the fenforial power of irritation or aSTociation. Stupor may be ufeful on the fame account. Could a centrifugal fwing be ferviceable for this purpofe, either by placing the head or the feet in the outward part of the circle, as defcribed in Art. 15. 7. of this Supplement ? Return THEORY OF FEVER. Sup. I. 4. 1. 454 IV. Return of the cold Fit. I. If the increafed action of the cutaneous and pulmonary capillaries, and of the heart and arteries, in febris irritativa, con- tinues long and with violence, a proportional expenditureor ex- hauftion of fenforial power occurs ; which by its tendency to in- duce torpor of fome part, or of the whole, brings on a return of the cold fit. 2 Another caufe which contributes to induce torpor of the whole fyftem by the fympathy of its parts with each other, is the remaining torpor of fome vifcus ; which after the laft cold paroxyfm had not recovered itfelf, as of the fpleen, liver, kid- neys, or of the ftomach and inteftines, or abforbent veffels, as above mentioned. 3. Other caufes are the deficiency of the natural ftimuli, as hunger, thirft, and want of frefh air. Other caufes are great fatigue, want of reft, fear, grief, or anxiety of mind. And laftly, the influence of external ethereal fluid, as the defeat of exter- nal heat, and of folar or lunar gravitation. Of the latter the return of the paroxyfms of continued fevers about fix o'clock in the evening, when the folar gravitation i< the leaft, affords an example of the influence of it ; and the ufual periods of inter- mittents, whether quotidian, tertian, or quartan, which fo regu- larlv obey folar or lunar days, afford inftances of the influence of thofe luminaries on thefe kinds of fevers. 4. If the tendency to torpor of fome vifcus is confiderable, this will be increafed at the time, when the terrene gravitation is greateft, as explained in the introduction to Clafs IV 2. 4. and may either produce a cold paroxyfm of quotidian fever; or it may not yet be fufficient in quantity for t hat purpofe, but may n everthelefs become greater,and continue fo till the next period of the greateft terrene gravitation, and may then either produce a paroxyfm of tertian fever ; or may ftill become greater, and continue fo till the next period of greateft terrene gravitation, and then produce a paroxylm of quartan ague. And laftly, the periodical times of thefe paroxyims may exceed, or fall ihort of, the time of greateft diurnal terrene gravitation according to the time of day, or period of the moon, in which the firft fit began ; that is, whether the diurnal terrene gravitation was then in an increafing or decreaiing ftate. V. Senfation excited in Fever. 1, A curious obfervation is related by Dr. Fordyce in his Tract Sup. I. 5. 2. THEORY OF FEVER. 455 Tract on Simple fever, page 168. He aflerts, that tliofe people who have been confined fome time in a very warm atmofphere, as of 120 or 130 degrees of heat, do not feel cold, nor are fub- jeCt to palenefs of their fkins, on coming into a temperature of 30 or 40 degrees ; which would produce great palenefs and painful fenfation of coldnefs in thofe, who had been fome time confined in an atmofphere of only 86 or 90 degrees. Analo- gous to this, an obferving friend of mine allured me, that once having fat up to a very late hour with three or four very inge- nious and humorous companions, and drunk a confiderable quantity of wine ; both contrary to his ufual habits of life ; and being obliged to rife early, and to ride a long journey on the next day ; he expected to have found himfelf weak and foon fatigued ; but on the contrary he performed his journey with unufual eafe and alacrity ; and frequently laughed, as he rode, at the wit of the preceding evening. In both thefe cafes a de- gree of pain or pleafure actuated the fyfiem ; and thus a fenfo- rial power, that of fenfation, was fuperadded to that of irrita- tion, or volition. See Sett. XXXIV. 2. 6. 2. Similar to this, when the energetic exertions of fome parts of the fyfiem in the hot fit of fever arife to a certain excefs, a degree of fenfation is produced ; as of heat which particularly increafes the actions of the cutaneous vefiels, which are more liable to be excited by this ftimulus. When this additional fen- forial power of feniation exifts to a greater degree, the pulfe, which was before full, now becomes hard, owing to the inflam- mation of the vafa vaforum, or coats of thearteries. In thefe cafes whether there is any topical inflammation or not, the fever ceaf- es to intermit; but neverthelefs there are daily remiflions and exacerbations of it ; which recur for the moft part about fix in the evening, when the folar gravitation is the leaft, as mention- ed in Se£ XXXVI. 3. 7. 3. Thus the introduction of another fenforial power, that of fenfation, converts an intermittent fever into a continued one. If it be attended with flrong pulfe, it is termed febris fenfitiva irritata, or pyrexia, or inflammation ; if with a weak pulfe, it is termed febris fenfitiva inirritata, or typhus gravior, or malig- nant fever. The feat of the inflammation is in the glandular or capillary fyftem, as it confifts in the fecretion of new fluids, or new fibres, which form hew vefiels, as they harden, like the filk of the filk-worm. See Art. 15. of this Supplement. VI. Circlet of Irritative Afociate Motions. 1. There are fome afibciate motions, which are perpetually proceeding 456 * THEORY OF FEVERS. Sup. I. 6.2. proceeding in our waking hours, and are catenated by their firft link, or in fome fubfequent parts of the chain, with the ftimuli or the influence of external things ; which we fhall here enu- merate, as they contribute to the knowledge of fever. Of thefe are the irritative ideas, or fenfual motions of the organs of fenfe, and the mufcular motions aflbciated with them ; which, when the chain is difturbed or interrupted, excite the fenforial power of fenfation, and proceed in confufion. Thus if the irritative ideas of fight are difturbed, the paralactic motions of objects, which in general are unperce^ved, become fenfible to us ; and the locomotive mufcles aflbciated with them, which ought to preferve the body erebt, ftagger from this decreafe or interrup- tion of the fenforial power of aflbciation ; and vertigo is pro- duced. When the irritative fenfual motions, or ideas, belonging to one fenfe are increafed or diminifhed, the irritative fenfual mo- tions, or ideas, of the other fenfes are liable to become difturbed by their general catenations; whence occur noifes in the ears, bad taftesin the mouth, bad odours, and numbnefs or tingling of the limbs, as a greater or lefs number of fenfes are affected. Thefe conftitute concomitant circles of difturbed irritative ideas; or make a part of the great circle of irritative ideas, or motions of the organs of fenfe ; and when thus difturbed occafion many kinds of hallucinations of our other fenfes, or attend on the vertigo of vifion. 2. Another great circle of irritative aflbciated motions con- fifts of thofe of the alimentary canal; which are catenated with ftimuli or with influences external to the fyftem, but continue to be exerted in our fleeping as well as in our waking hours. When thefe affociations of motion are difturbed by the too great or too fmall ftimulus of the food taken into the ftomach, or by the too great excefs or deprivation of heat, or by indigeftible fubftances, or by torpor or orgafm occafioned by their aflbcia- tion with other parts, various difeafes are induced under the names of apepfia, hypochondriafis, hyfteria, diarrhoea, cholera, ileus, nephritis, fever. 3. A third circle of irritative aflbeiate motions confifts of thofe of the abforbent fyftem ; which may be divided into two, the la&eals, and the lymphatics. When the ftomach and inteftines are recently filled with food and fluid, the lafteal fyftem is ftimulated into great adion ; at the fame time the cellular, cuta- neous, and pulmonary lymphatics a6lwith lefs energy ; becaufe lefs fluid is then wanted from thofe branches, and becaufe more fenforial power is expended by the lafteal branch. On this ac- count thefe two fyftems of abforbents are liable to aft by re-. verfe §up. I. 6. 4. THEORY OF FEVER. 457 verfe fympathy; hence pale urine is made after a full dinner, as lefs of the aqueous part of it is imbibed by the urinary lym- phatics ; and hence the water in anafarca of the lungs and limbs is fpeedily abforbed, when the actions of the lafteals of the ftomach or inteftines are weakened or inverted by the exhibition of thofe drugs, which produce naufea, or by violent vomiting, or violent cathartics. Hence in diabetes the lacteal fyftem afts ftrongly, at the fame that that the urinary lymphatics invert their motions, and tranf- mit the chyle into the bladder ; and in diarrhoea from crapula, or too great a quantity of food and fluid taken at a time, the lafteals aft ftrongly, and abforb chyle or fluids from the ftomach and upper inteftines; while the lymphatics of the low- er inteftines revert their motions, and tranfmit this over-reple- tion into the lower inteftines, and thus produce diarrhoea ; which accounts for the fpeedy operation of fome cathartic drugs, when much fluid is taken along with them. 4. Other circles of irritative afibciate motions of great impor- tance are thofe of the fecreting fyftem ; of thefe are the motions of the larger congeries of glands, which form the liver, fpleen, pancreas, gaftric glands, kidneys, falivary glands, and many oth- ers ; fome of which aft by direft and others by reverfe fympa- thy with each other. Thus when the gaftric glands aft molt powerfully, as when the ftomach is filled with food, the kidneys aft with lefs energy ; as is fhewn by the fmall fecretion of urine for the firft hour or two after dinner ; which reverfe fym- pathy is occafioned by the greater expenditure of fenforial pow- er on the gaftric glands, and to the newly abforbed fluids not yet being Sufficiently animalized, or otherwife prepared, to ftim- ulate the fecretory veflels of the kidneys. But thofe very extenfive glands, which fecrete the perfpira- ble matter of the fkin and lungs, with the mucus, which lubri- cates all the internal cells and cavities of the body, claim our particular attention. Thefe glands, as well as all the others, proceed from the capillary veflels which unite the arteries with the veins, and are not properly a part of them ; the mucous and perfpirative glands, which arife from the cutaneous and pulmo- nary capillaries, are afl'ociated by direft fympathy ; as appears from immerfion in the cold bath, which is therefore attended with a temporary difficult refpiration ; while thole from the ca- pillaries of the ftomach and heart and arteries are more gener- ally afl'ociated by reverfe fympathy with thofe of the cutaneous capillaries; as appears in fevers with weak pulfe and indigeftion, and at the fame time with hot and dry fkin. The difturbed aftionsof this circle of the afibciate motions of Vol. II. L l 1 THEORY OF FEVER. Sup. I. 6. 5, 458 the fecerning fyftem, when the fenforial power of fenfation is added to that of irritation, frequently produces inflammation, which confifts in the fecretion of new fluids or new veflels. Neverthelefs, if thefe difturbed actions be of the torpid kind, the pain, which attends them, is feldom productive of inflam- mation, as in hemicrania; but is liable to excite voluntary ac- tions, and thus to expend much fenforial power, as in the fhud- dering in cold fits of fever, or in convulfions ; or laitly the pain itfelf, which attends torpid actions, is liable to texpend or ex- hauft much fenforial power without producing any increafed aCtions ; whence the low pulfe, and cold extremities, which ufu- ally attend hemicrania ; and hence when inert, or inaCtive fen- fation attends one link of aflbciated aCtions, the fucceeding link is generally rendered torpid, as a coldnefs of the cheek attends tooth-ach. 5. A fifth important circle of irritative motions is that of the fanguiferous fyftem, in which the capillary veflels are to be in- cluded, which unite the arterial and venous fyftems, both pul- monary and aortal. The difturbed aCtion of this fyftem of the heart and arteries, and capillaries, conftitutes fimple fever ; to which may be added, that the fecerning and abforbent veflels appending to the capillaries, and the bibulous mouths of the veins, are in fome meafure at the fame time generally affeded. 6. Now, though the links of each of thefe circles of irritative motions are more ftridly aflbciated together, yet are they in greater or lefs degree aflbciated or catenated with each other by direCt or reverfe fympathy. Thus the ficknefs, or inverted irri- tative motions of the ftomach, are aflbciated or catenated with the difturbed irritative ideas, or fenfual motions, in vertigo ; as in fea-ficknefs. This ficknefs of the ftomach is alfo aflbciated or catenated with the torpor of the heart and arteries by direCt fympathy, and with the capillaries and abforbents by reverfe fympathy ; and are thus all of them liable occafionally to be dif- turbed, when one of them is difeafed ; and conftitute the great variety of the kinds or fymptoms of fevers. VII. Alternation of the cold and hot Fits. 1. When any caufe occurs, which diminifhes to a certain de- gree the fupply of fenforial power in refpeCl to the whole fyf- tem ; as fuppofe a temporary inexertion of the brain ; what happens ? Firft, thofe motions are exerted with lefs energy, which are not immediately neceflary to life, as the locomotive mufcles ; and thofe ideas, which are generally excited by voli- tion ; at the fame time this deficiency of voluntary motion is different Sup. I. 7. 2. THEORY OF FEVER. 459 different from that which occurs in deep ; as in that the move- ments of the arterial fyftem are increafed in energy though not in frequency. Next, the motions of the alimentary canal be- come performed with lefs energy, or ceafe altogether ; and a total want of appetite to folid food occurs, or ficknefs or a diar- rhoea occafioned by the indigefted aliment. Then the abforbent veffels ceafe to adit with their due energy; whence thirft, and pale urine, though in fmall quantities. Fourthly, the fecerning veffels become affedted by the general diminution of fenforia! power ; whence all the fecreted fluids are produced in lefs quantity. And laftly, the fanguiferous canals feel the general torpor; the pulfations of the heart and arteries become feeble, and confequently quick ; and the capillaries of the fkin become inactive, acquire lefs blood from the arteries, and are confe- quently paler and fhrunk. In this laft circumftance of the torpor of the fanguiferous fyftem confifts inirritative fever ; as all the others are rather ac- cidentaltor concomitant fymptoms, and not effential ones ; as fewer or more of them may be prefent, or may exift with a greater or lefs degree of inactivity. 2. Now as the capillaries of the fkin are expofed to greater varieties of heat and cold, than the heart and arteries, they are fuppofed to be more mobile, that is, more fufceptible of torpor or exertion, or to inflammation, by external ftimuli or influences, than the other parts of the fanguiferous fyftem ; and as the fkin is more fenfible to the prefence of heat, than the internal parts of the body, the commencement of the cold paroxyfms of fever generally either firft exifts in, or is firft perceived by, the cold- nefs and palenefs of the fkin ; and the commencement of the hot fits by the heat and rednefs of it. 3. The accumulation of fenforial power occurs in thefe or- gans fooneft, and in greateft quantity, during their quiefcence, which were moft perpetually in action during health ; hence thofe parts of the fyftem fooneft recover from torpor in inter- mittent fever, and fooneft fall into the contrary extreme of in- creafed activity ; as the fanguiferous fyftem of the heart and ar- teries and capillaries. But of thefe the capillaries feem firft to acquire a renovation of their action, as the heat of the fkin be- comes firft renewed, as well as increafed beyond its natural quantity, and this in fome parts fooner than in others ; which quantity of heat is however not to be eftimated limply by the rife of the mercury in the thermometer, but alfo by the quanti- ty carried away into the atmofphere, or diffufed amongft other bodies in a given time ; as more heat pafles through water, which boils vehemently, than when it boils gently, though the rife 460 THEORY OF FEVER. Sup. I. 7. 4. rife of the thermometer in both cafes continues the fame. This faff may be known by boiling an egg in water, the white of which coagulates in much lefs time, if the water boils vehement- ly, than if it boils moderately, though the fenfible heat of the water is the fame in both cafes. Another caufe, which induces the cutaneous capillaries to re- new their actions fooner than the heart and arteries after im- merfion in the cold bath, is, that their torpor was occafioned by defeft of irritation : whereas that of the heart and arteries was occafioned by defeat of affociation ; which defeat of aifociation was owing to the decreafed actions of the capillaries, and is now again excited by their renewed action ; which excitement muft therefore be fubfequent to that increafed action of the capilla- ries ; and in confequence the increafed adlion of the heart and arteries at the commencement of the hot fit of fome fevers is fubfequent to the increafed action of the cutaneous capillaries. There is, however, in this cafe an accumulation of the fenforial power of affociation in the heart and arteries, which muft con- tribute to increafe their orgafm in the hot fit, as well as the in- creafed excitement of it by the increafed action of the capillaries 4 Now this increafed action of the fyftem, during the hot fit, by exhaufting the fenforial powers of irritation and affocia- tion, contributes to induce a renewal of the cold paroxyfm ; as the accumulation of thofe fenforial powers in the cold fit pro- duces the increafed actions of the hot fit; which two ftates of the fyftem reciprocally induce each other by a kind of libration, or a plus and minus, of the fenforial powers of irritation and affociation. If the exhauftion of fenforial power during the hot fit of fe- ver only reduces the quantity of irritability and affociability to its natural ftandard, the fever is cured, not being liable to re- turn. If the quantity of thefe fenforial powers be reduced only fo much, as not to produce a fecond cold fit during the prefent quantity of external ftimuli or influences ; yet it may be fo far reduced, that a very fmall fubtracrion of ftimulus, or of influ- ence, may again induce a cold fit ; fuch as the coldnefs of the night-air ; or the diminution of folar or lunar gravitation, as in intermittent fevers. 5. Another caufe of the renovation of the cold fits of fever is from fome parts of the fyftem not having completely recov- ered from the former cold paroxyfm ; as happens to the fpleen, liver, or other internal vifeus; which fometimes remains tumid, and either occafions a return of the cold fit by direfl fympathy with other parts of the body, or by its own want of adtion cauf- es a diminution of the general quantity of heat, and thus facili- tates Sup. I. 8.i. THEORY OF FEVER. 461 tates the renovation of the torpor of the whole fyftem, and gives caufe to intermittent fevers catenated wi,th lunar or folar influ- ence. VIII. Orgafm of the Capillaries. As the remaining torpor of feme lefs eflential part of the fyf- tem, as of the fpleen, when the hot fit ceafes, produces after one, two, or three days a return of cold fit by direft fympathy* with the cutaneous capillaries, when joined with fome other caufe of torpor, as the defeft of folar or lunar influences, or the expofure to cold or hunger, and thus gives origin to intermit- tent fever ; fo the remaining torpor of fome more eflential parts of the fyftem, as of the ftomach and inteftines, is probably the caufe of the immediate recurrence of the cold paroxyfm, at the time the hot one ceafes, by their direft fympathy with the cu- taneous capillaries, without the afliftance of any other caufe of torpor ; and thus produces remittent fever. And laftly the re- maining torpor of fome ftill more eflential parts of the fyftem, as the heart and arteries, after the hot fit ought to ceafe, is lia- ble by reverfe fympathy with the cutaneous capillaries to con- tinue their orgafm, and thus to render a fever continual, which would otherwife remit or intermit. Many difficulties here occur, which we ffiall endeavour to throw fome light upon, and leave to future inveftigation ; ob- ferving only that difficulties were to be expefted, otherwife fe- vers would long fince have been underftood, as they have em- ployed the unremitted attention of the phyficians of all ages of the world. i. Why do the fame parts of fucceffive trains of aftion fome- times affeft each other by direft, and fometimes by reverfe fym- pathy ?- ill. When any irritative motion ceafes, or becomes torpid, which was before in perpetual aftion ; it is either de- prived of its ufual ftimulus, and thence the fenforial power of irritation is not excited; or it has been previoufly too much ftim- ulated, and the fenforial power has been thus exhaufted. In the former cafe an accumulation of fenforial power foon occurs, which is excitable by a renewal of the ftimulus ; as when the fingers, which have been immerfed fome time in fnow, are again expofed to the ufual warmth of a room. Or, fecondly, the fenforial power of irritation becomes fo much accumulated, that the motions, which were torpid, are now performed by lefs ftimulus than natural; as appears by the warmth, which foon occurs after the firft chill in going into frofty air, or into the bath at Buxton, which is about eighty degrees of heat. Or, laftly, THEORY OF FEVER. Sup. I. 8. 2. 462 laftly, this accumulation of the fenforial power of Irritation fo far abounds, that it increafes the action of the next link of the aflbeiated train or tribe of motions ; thus on expofing the Ikin to cold air, as in walking out in a frofty morning, the actions of the ftomach are increafed, and digeftion ftrengthened. But where the torpor of fome irritative motion is owing to the previous exhauftion of the fenforial power of irritation by too great ftimulus, the reiteration of it occurs either not at all, or much more ilowly than in the former inftances ; thus after intoxication the ftomach is very flow in recovering its due quan- tity of the fenforial power of irritation, and never ihews any ac- cumulation of it. 2. When an aflbeiate motion, as defcribed in the introduc- tion toClafs IV. i. i. adis with lefs energy, the fenforial pow- er of aflbeiation is either not fufficiently excited by the preced- ing fibrous motions ; or it has been expended or exhaufted by the too violent actions of the preceding fibrous motions. In the former cafe there occurs an accumulation of the fenforial power of aflbeiation; exactly, as, where the ufual ftimulus is with- drawn, there occurs an accumulation of the fenforial power of irritation. Thus when the actions of the capillaries of the fkin are diminifhed by immerfionin cold water, the capillaries of the lungs are rendered torpid by the want of the excitement of the fenforial power of aflbeiation,owing to the leflened actions of the previous fibrous motions, namely, of thofe of the fkin. Never- thelefs as foon as the capillaries of the fkin regain their increafed activity by the accumulation of the fenforial power of irrita- tion, thefe capillaries of the lungs a£t with greater energy alfo owing to their accumulated fenforial power of aflbeiation. Thefe are inftances of direbt fympathy, and conftitute the cold and hot paroxyfms of intermittent fever ; or the firft paroxyfm of a continued one. 3. When the firft link of a train of aflbeiated motions,which is fubject to perpetual action, becomes a confiderable time tor- pid for want of being excited by the previous exertions of the irritative motions, with which it is catenated ; the fenforial power of aflbeiation becomes accumulated in fo great a degree as to affect the fecond link of the train of aflbeiated motions, and to excite it into ftronger action. Thus when the ftomach is rendered torpid by contagious matter fwallowed into it mixed with the faliva, the heart and arteries a£t more feebly ; becaufe the fenforial power of aflbeiation, which ufed to be excited by the fibrous motions of the ftomach, is not now excited ; and in confequence the motions of the heart and arteries act only by the Sup. I. 8. 4. THEORY OF FEVER. 463 the fenforial power of irritation, which is excited by the ftimu- lus of the blood. But during this torpor of the ftomach, and lefs action of the heart and arteries, fo great an accumulation of the fenforial powers of irritation and of affociation 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 fituation the torpor of the ftomach occafions a diminifhed action of the heart and arteries by direft fympathy, and may be faid to occafion an increafed one of the cutaneous capillaries by reverfe fympathy ; which conftitute continued fever with weak pulfe. Nor is this increafed aftion of the capillaries in confequence of the decreafed aftion of the heart and arteries, as in fevers with weak pulfe, a Angle faft in the animal economy ; though it exifts in this cafe in the greateft degree of duration, becaufe the heart and arteries are perpetually in greater aftion than any other part of the fyftem. But a fimilar circumftance occurs, when the ftomach is rendered inaftive by defeftive excitement of the fenforial power of aflociation, as in fea-ficknefs, or in nephritis. In thefe cafes the fenforial power of aflociation be- comes much accumulated in the ftomach, and feems by its fu- perabundance to excite the abforbent fyftem, which is fo nearly connefted with it, into great increafe of aftion ; as is known by the great quantity frequently in thefe fituations ejefted by vom- it, which could not otherways be fupplied. It is probable the increafe of digeftion by walking in frofty air, with many other animal fafts, may by future obfervations be found to be depend- ent on this principle, as well as the increafed aftion of the ca- pillaries in continued fevers with weak pulfe. Whereas in continued fever with ftrong pulfe, which may perhaps occur fometimes on the firft day even of the plague, the ftomach with the heart and arteries and the capillaries aft by direft fympathy ; that is, the ftomach is excited into ftronger aftion by increafed irritation owing to the ftimulus of conta- gious matter ; thefe ftronger irritative motions of the ftomach excite a greater quantity of the fenforial power of aflociation, which then aftuates the heart and arteries with greater energy, as thefe are catenated with the ftomach ; and in the fame man- ner the increafed aftions of the heart and arteries excite a great- er quantity of the fenforial power of aflociation, which aftuates the cutaneous capillaries with increafe of energy. See Clafs IV. i. i. 4. I fhall dwell a little longer on this intricate fubjeft. The commencement of fever-fits is known by the inaftivity of the cutaneous capillaries, which inaftivity is obfervable by the pale- nefs 464 THEORY OF FEVER. Sup. I. 8. 5. nefs and coldnefs of the Ikin, and alfo by the pain of coldnefs, which attends it. There is neverthelefs in moll cafes, except thofe which are owing to expofure to external cold, a torpor of the capillaries of fome internal vifcus preceding this inactivity of the cutaneous capillaries ; which is known by the tumour or hardnefs of the vifcus, or by an aching pain of it. The capilla- ries of the lungs are at the fame time rendered inactive or tor- pid, as appears by the difficulty of breathing, and coldnefs of the breath in cold fits of fever, and in going into the cold bath ; but the lungs are not affeCted with the pain either of coldnefs or of torpor. One caufe of this fynchronous or fucceflive inactivity of the cutaneous capillaries, in confequence of the previous torpor of fome internal vifcus, may be owing to the deficiency of heat ; which muft occur, when any part becomes inactive ; becaufe the fecretions of that part ceafe or are leflened, and the quantity of heat of it in confequence. But the principal caufe of it I fuppofe to be owing to the defeCt of the fenforial power of af- fociation ; which power of aflbciation is excited by fome pre- vious or concomitant motions of the parts of every great circle of aCtions. This appears on going into the cold bath, becaufe the fliortnefs of breath inftantly occurs, fooner than one can con- ceive the diminution of the heat of the Ikin could affeCt the lungs by the want of its (timulus ; but not fooner than the defeCt of the fenforial power of aflbciation could affeCt them ; becaufe this muft ceafe to be excited into aCtion on the inftant that the cu- taneous capillaries ceafe to aCt ; whence in the firft moment of contaCt of the cold water the cutaneous capillaries ceafe to aCt from defeCt of irritation ; which is caufed by defeCt of the ftim- ulus of heat ; and in the fecond moment the capillaries of the lungs ceafe to aCt from the defeCt of aflbciation ; which is cauf- ed by the defeCt of the motions of the cutaneous capillaries. Thus the univerfal torpor in the cold paroxyfm of fever is an ex- ample of direCt fympathy, though occafioned in part by defeCt of irritation, and in part by defeCt of aflbciation. 5. Thus in walking out in a frofty morning the ikin is cool- ed by the contaCt of the cold air, whence the aCtions of its ca- pillaries are diminifhed for want of their ufual ftimulus of heat to excite a fufficient quantity of the fenforial power of irritation. Hence there is at firft a faving of the fenforial power of irrita- tion for the purpofe of actuating the other parts of the fyftem with greater energy. Secondly, the fenforial power of aflbcia- tion, which ufed to be excited by the motions of the cutaneous capillaries, is now notfo powerfully excited; and in confequence the parts, which conftitute the next links of the circles of aflb- ciated Sup. I. 8. 6. THEORY OF FEVER. 465 dated motions, are for a time actuated with lefs energy, and a temporary general chillnefs fucceeds; which is fo far fimilar to the cold fit of intermittent fever. In this fituation there is a curious circumftance occurs, which, merits peculiar attention : after a Ihort time, though the exter- nal fkin continues cool by its expofure to the cold air, and the actions of its capillaries are confequently diminiflied, yet the ca- pillaries of the ftomach ad with greater energy; as is known by increafed digeftion and confequent hunger. This is to be afcribed to the accumulation of the fenforial power of irritation, which now excites by its fuperabundance, or overflowing, as it were, the ftomach into increafed adion; though it is at the fame time excited lefs powerfully than ufual by the fenforial power of afibciation. Thus the accumulation of the fenforial power of irritation in the veflels of the fkin increafes in this cafe the ac- tion of the ftomach in the fame manner as an accumulation of the fenforial power of afibciation in the heart and arteries in fe- vers with weak pulfe increafes the adion of the capillaries. If neverthelefs the coldnefs of the fkin be too long continued, or exifts in too great a degree, fo as in fome meafure to impair the life of the part, no further accumulation of the fenforial power of irritation occurs; and in confequence the adions of the ftomach become lefs than natural by the defed of the fen- forial power of afibciation ; which has ceafed to be excited by the want of adion of the cutaneous capillaries. Whence con- tinued coldnefs of the feet is accompanied with indigeftion and heart-burn. See Clafs IV. 2. 1.6. 6. Similar to this when the adions of the ftomach are ren- dered torpid by the previous ftimulus of a violent emetic, and its motions become retrograde in confequence, a great quantity of fenforial power is exerted on the lymphatics of the lungs, and other parts of the body ; which excites them into greater dired adion, as is evinced by the exhibition of digitalis in ana- farca. In this fituation I fiippofe the emetic drug ftimulates mufcular fibres of the ftomach into too great adion; and that in confequence a great torpor foon fucceeds; and that this in- adion of the mufcular parts of the ftomach is not followed by much accumulation of the fenforial power of irritation ; be- caufe that fenforial power is in great meafure exhaufted by the previous exceflive ftimulus. But the lymphatics of the ftom- ach have their adions lefiened by defed of fenforial power of afibciation, which is not now excited into adion, owing to the lefiened motions of the mufcular parts of it, with which the lymphatics are aflbciated. The fenforial power of afibciation becomes therefore accumulated in thefe lymphatics of the ftom- Vol. IL M m m ach. 466 THEORY OF FEVER. Sup. 8. 7. ach, becaufe it is not excited into action ; exactly as the power of irritation becomes accumulated in the hand, when immerfed in fnow ; and this accumulated fenforial power of aflbciation excites the lymphatics of the lungs and of other parts, which are moft nearly aflbciated with thofe of the ftomach, into more en- ergetic actions. Thus the mufcular fibres of the ftomach ait with the lymphatics of that organ in direit fympathy ; and the lymphatics of the ftomach ait in reverfe fympathy with thofe of the lungs and of other parts of the body; the former of which is caufed by defeit of the excitement of the fenforial power of aflbciation, and the latter by the accumulation of it. Befides the efficient caufe, as above explained, the final caufe, or convenience of thefe organic ailions are worthy our atten- tion. In this cafe of an acrid drug fwallowed into the ftomach the reverted ailions of the mufcular fibres of the ftomach tend to ejeil its enemy ; the reverted ailions of its lymphatics pour a great quantity of fluids into the ftomach for the purpofe of di- luting or waffling oft' the noxious drug ; and the increafed ac- tions of the other lymphatics fupply thefe retrograde ones of the ftomach with an inconceivable fupply of fluids, as is feen in Ileus and Cholera. 7. The inquifitive reader will excufe my continuing this fubjeil, though perhaps with fome repetitions, as it envelopes the very eflence of fever. When the firft link of a train of ac- tions is excited by exceflive ftimulus,or exceflive irritability,and thus acts with unufual energy by the increafed quantity of irri- tation, thefe increafed motions excite a greater quantity of the fenforial power of aflbciation, which caufes increafed motions in the fecond link, which is catenated with the firft ; and then the exceflive action of this fecond link excites alfo a greater quantity of the fenforial power of aflbciation, which increafes the motions of the third link of this chain of aflbciation, and thus the increafe of the ftimulus on the irritative motions, to which the chain of aflbciation is catenated, increafes the action of the whole chain or circle of aflbciated motions. After a time the irritative motions become torpid by expendi- ture of the fenforial power of irritation, and then the power of aflbciation alfo becomes lefs exerted, both becaufe it has been in part exhaufted by too great a€lion, and is now lels excited by the leflened a6lion of the irritative motions, which ufed to ex- cite it. Thefe are both inftances of direct fympathy, and fre- quently conftitute the cold and hot fit of intermittents. But though the accumulation of the fenforial power of irri- tation during the quiefcence of fome motion owing to want of ftimulus generally induces torpor in the firft link of the train of aflbciated Sup. I. 8. 8. THEORY OF FEVER. 467 aflbciated motions catenated with it; as the capillaries of the lungs become torpid immediately on immerfion of the ikin into cold water; yet in fome fituations an orgafm or excefs of action is produced in the firft link of the aflbciated motions thus cate- nated with irritative ones; as in the increafed adtion of the ftomach, when the ikin is for a time expofed to cold air; which may in part be afcribed to the general increafe of adtion of the whole fyftem, owing to the diminiihed expenditure of fenforial power, but particularly of the parts, which have habitually adl- ed together ; as when one arm is paralytic the other is liable to more frequent or almoft continual motion ; and when one eye becomes blind the other frequently becomes itronger ; which is well known to farriers, who are faid fometimes to deftroy the fight of one eye to ftrengthen that of the other in difeafed horfes. Hence there is fometimes a diredt fympathy, and fometimes a reverfe one fucceeds the torpor occafioned by defedt of ftimu- lus, the latter of which is perhaps owing to a certain time be- ing required for the produdtion of an accumulation of the fen- forial power of irritation by the nervous branches of the tor- pid organ ; which accumulation is now in part or entirely de- rived to the next link of the aflbciation. Thus in going into a coldiih bath, as into a river in the fummer months, we at firft experience a difficulty of breathing from the torpid adtion of the pulmonary capillaries, owing to the deficient excitement of the fenforial power of aflbciation in confequence of the torpor of the cutaneous capillaries. But in a very ihort time, as in one min- ute, the fenforial power of irritation becomes accumulated by the inadtivity of the cutaneous capillaries ; and as its fuperabun- dance becomes now expended on the pulmonary capillaries, the difficult refpiration ceafes ; though the cutaneous capillaries con- tinue torpid by their contadt with the cold water, and confe- quently the fenforial power of affbciation, which ufed to con- tribute to adtuate the pulmonary capillaries, is lefs excited. 8. In like manner when there .xifts an accumulation of the fenforial power of aflbciation, owing to defedt of its excitement by fome previous irritative or aflbciate motions, it is generally accompanied for a certain time by a torpor not only of the link firft affedted, but of the fubfequent parts, or of the whole train of aflbciated motions, as in the cold fits of intermittent fevers. Yet after a time an increafed adtion of the next links of aflbci- ated motions fucceeds the torpor of the firft, as the abforbent veflels of the lungs adt more violently in confequence of the deficient adtion of thofe of the ftomach ; and the fkin at the commencement of ficknefs is pale and cold, but in a little time becomes fluflied and warm. Thus 468 THEORY OF FEVER. Sup. I. 8. 9. Thus we fee in affociate motions, which are rendered torpid by defeat of excitement, that fometimes a direft, and fometimes a reverfe fympathy fucceeds in the fubfequent links of the chain. But I believe where a torpor of irritative or of the affociate mo- tions is caufed by a previous too great expenditure or exhauf- tion of the fenforial powers of irritation or affociation, no in- creafe of aflion in the fubfequent link ever occurs, or not till after a very long time. Thus when the ftomach becomes torpid by previous violent exertion, and confequent exhauftion of the fenforial power of irritation, as after intoxication with wine or opium, or after the exhibition of fome violent emetic drug, the torpor is communi- cated to the heart and arteries, as in continued fevers with weak pulfe. But where the torpor of the ftomach is produced from defective affociation, as in fea-ficknefs; or in the ficknefs which occurs, when a ftone ftimulates the ureter ; no torpor is then communicated to the heart and arteries. For in the former cafe there is no accumulation of fenforial power in the ftomach, which was previoufly exhaufted by too great ftimulus ; but in the latter cafe the accumulation of fenforial power in the ftomach during its torpor is evinced by this circumftance ; that in fea-ficknefs the patients eat and drink voracioufly at inter- vals ; and the pulfe is generally not afte&ed by the ficknefs oc- cafioned by a ftone in the ureter. For the adiion of the ftom- ach is then leffened, and in confequence becomes retrograde, not owing to the exhauftion of the fenforial power of irritation, but to the want of excitement of the fenforial power of affocia- tion j which is caufed by the defective action of the ureter, which becomes occafionally torpid by the great ftimulus of the ftone it contains ; or which is caufed by the great exhauftion of fenfori- al power by the pain ; which affects the ureter without exciting inflammation, or increafed action of it. 9. Thus though the ftomach after the great ftimulus of in- toxication from excefs of wine or opium will continue many hours without accumulation of fenforial power, as appears from the patient's experiencing no appetite at the intervals of fick- nefs ; yet after long abftinence from food, at length not only the exhaufted quantity of fenforial power is renewed, but an ac- cumulation of it at length occurs, and hunger returns. In this fit- uation the ftomach is generally about a whole day before it regains its ufual powers of digeftion; but if it has been ftill more violently ftimulated, and its actions further impaired, a ftill more perma- nent torpor, along with a continued fever with weak pulfe is liable to occur j and a fourth part or half, or three-fourths, or a whole THEORY OF FEVER. 469 Sup. 1.8.10. whole lunar period pafles, before it recovers its due irritability and confequent action. In fimilar manner, after a perfon has been confined in a very warm room for fome hours, the cutaneous capillaries, with their fecretory and abforbent veflels, become exhaufted of their fenfo- rial power, of irritation by the too great violent exertions occa- fioned by the unufual ftimulus of heat; and in coming into a colder atmofphere an inactivity of the cutaneous veflels exifts at firft for fome time without accumulation of fenforial power ; as is fbewn by the continuance of the pain of cold and the pale- nefs; but after a time both the pain of cold and palenefs van- ifh, which now indicates an accumulation of the fenforial pow- er of irritation, as lefs degrees of heat ftimulate the fyftem into due aCtion. In the fame manner, after anyone has been fome time in the fummer funfhine, on coming into a dark cell he continues much longer before he can clearly diftinguifh objeCts, than if his eyes had only been previoufly expofed to the light of a cloudy day in winter-, becaufe the fenforial power of irritation, and confequent fenfation, had in the firft cafe been previoufly much expended or exhaufted ; and therefore required a much longer time be- fore it could be produced in the brain, or derived to the optic nerves, in fuch quantity as to reftore the deficiency, and to caufe an accumulation of it ; whereas in the latter cafe no deficiency had occurred. io. Thus the accumulation or deficiency of fenforial power in a torpid organ, which had previoufly been accuftomed to per- petual action, depends on the manner in which it becomes tor- pid ; that is, whether by great previous ftimulus, or great previ- ous excitement of the powrer of aflbciation ; or by defeat of its accuftomed ftimulus, or of its accuftomed excitement of the power of aflbciation. In the former cafe the fenforial power is in an exhaufted ftate, and therefore is not likely to become fo foon accumulated, as after drunkennefs, or expofure to great heat, ot- to great light -, in the latter a great accumulation of fenforial power occurs, as after expofure to cold, or hunger, or darknefs. Hence when the ftomach continues torpid by previous vio- lent ftimulus, as in the exhibition of digitalis, no accumulation of fenforial power of irritation fupervenes; and in confequence the motions of the heart and arteries, which are aflociated with thofe of the ftomach, become weak, and flow and intermittent, from the defeat of the excitement of the fenforial power of aflb- ciation. But what follows ? as the actions of the heart and ar- teries are leflened by the deficient action of the fenforial power of aflbciation, and not by previous increafed excitement of it; a THEORY OF FEVER. Sup. I. 8. it; 470 a great accumulation of the fenforial power of aflbciation oc- curs, which is exerted on the pulmonary and cutaneous abforb- ents by reverfe fympathy, and produces a great abforption of the fluid effufed into the cellular membrane in anafarca, with dry fkin ; conftituting one kind of atrophy. But if at the fame time the fecerning veflels of the ftomach are ftimulated into fo violent activity as to induce great confer quent torpor, as probably happens when contagious matter is {wallowed into the ftomach with our faliva, thofe of the heart and arteries aCt feebly from the deficient excitement of the pow- er of aflbciation ; and then the cutaneous and pulmonary fe- cerning veflels ait with greater force than natural, owing to the accumulation of the fenforial power of aflbciation ; and unnatur- al heat of the fkin, and of the breath fucceed ; but without frequency of pulle, conftituting the parefis irritativa of Clafs I. 2.1.2 And laftly, if a paucity of blood attends this parefis or fome other caufe inducing a frequency of pulfe, the febris inir- ritativa, or with weak pulfe, is produced. But on the contrary when the ftomach has previoufly been rendered torpid by defeCt of ftimulus, as by hunger, if food be too haftily fupplied, not only great exertion of the ftomach it- felf fucceeds, but fever with ftrong pulfe is induced in confe- quence j that is,the heart and arteries are excited into more en- ergetic aCtion by the excefs of the power of aflbciation, which catenates their motions with thofe of the ftomach. For the re- dundancy of fenforial power of irritation, which was accumu- lated during the inactivity of the ftomach, and is now called into action by ftimulus, actuates that organ with increafed en- ergy, and excites by thefe increafed motions the fenforial power of afibciauon ; .vhich has alfo been accumulated during the in- activity of the heart and arteries; and thus thefe organs alfo are now excited into greater adtion. So after the fkin has been expofed fome hours to greater heat than natural in the warm room, other parts as the membranes of the noftrils, or of the lungs, or of the ftomach, are liable to become torpid from direCt fympathy with it, when we come in- to air of a moderate temperature ; whence catarrhs, coughs, and fevers. But if this torpor be occafioned by defeCt of ftim- ulus, as after being expofed to frofty air, the accumulation of fenforial power is exerted, and a glow of the fkin follows, with increafed digeftion, full refpiration, and more vigorous circula- tion. 11. It may be afked, Why is there a great and conftant accu- mulation of the fenforial power of aflbciation, owing to the tor- por of the ftomach and heart and arteries, in continued fever with Sup. I. 8. 12. THEORY OF FEVER. 471 with weak pulfe ; which is exerted on the cutaneous and pul- monary capillaries, fo as to excite them into increafed aCtion for many weeks, and yet no fuch exuberance of fenforial pow- er produces fever in winter-fleeping animals, or in chlorofis, or apepfia, or hyfteria ? In winter-fleeping animals I fuppofe the whole nervous fyf- tem is torpid, or paralyfed, as in the fleep of frozen people j and that the ftomach is torpid in confequence of the inactivity or quiefcence of the brain ; and that all other parts of the body, and the cutaneous capillaries with the reft, labour under a fim- ilar torpor. In chlorofis, I imagine, the aCtions of the heart and arteries, as well as thofe of the cutaneous and pulmonary capillaries, fuf- fer along with thofe of the ftomach from the deficient ftimulus of the pale blood ; and that though the liver is probably the feat of the original torpor in this difeafe, with which all other parts fympathize from defeCl of the excitation of the fenforial power of aflbciation; yet as this torpor occurs in fo fmall a degree as not to excite a Ihuddering or cold fit,no obfervable confequences are in general occafioned by the confequent accumulation of fenfori- al power. Sometimes indeed in chlorofis there does occur a frequent pulfe and hot Ikin ; in which circumftances I fup- pofe the heart and arteries are become in fome degree torpid by direCt fympathy with the torpid liver ; and that hence not on- ly the pulfe becomes frequent, but the capillaries of the ficin aCt more violently by reverfe fympathy with the heart and arteries, owing to the accumulation of the fenforial power of aflbciation in them during their torpid ftate, as occurs in irritative fever. See Article 11. of this Supplement- In apepfia chronica the aCtions of the ftomach are not fo far impaired or deftroyed as totally to prevent the excitation of the fenforial power of aflbciation, which therefore contributes fome- thing towards the aCtions of the heart and arteries, though lefs than natural, as a weak pulfe always I believe attends this dif- eafe. There is a torpor of the ftomach, and of the upper part of the alimentary canal in hyfteria, as is evident from the retro- grade aCtions of the duodenum, ftomach, and oefophagus, which conftitute the globus hyftericus, or fenfation of a globe riling in- to the throat. But as thefe retrograde aCtions are lefs than thofe, which induce ficknefs or vomiting, and are not occafioned by previous exhauftion of the fenforial power of irritation, they do not fo totally prevent the excitement of the fenforial power of aflbciation, as to leflen the motion of the heart and arteries fo much as to induce fever; yet in this cafe, as in apepfia, and i». cholorofis, THEORY OF FEVER. Sup. I. 8. 12. 472 chlorofis, the pulfations of the heart and arteries are weaker than natural, and are fometimes attended with occafionally increafed aCtion of the capillaries ; as appears from the fluihings of the face, and hot ikin, which generally form an evening febricula in difeafes attended with weak digedion. 12. The increafed a&ion, or orgafm, of the cutaneous, pul- monary, and cellular capillaries, with their fecerning and abforb- ent veffels, in thofe fevers which are attended with deficiency of vital action, exhauds the patient both by the additional ex- penditure of fenforial power on thofe organs of fecretion, and by the too great abforption of the mucus and fat of the body ; whence great debility and great emaciation. Hence one great indication of cure of continued fever with arterial debility is to diminifli the too great adtion of the capillaries; which is to be done by frequent ablutions, or bathing the whole ikin in tepid or in cold water, as recommended by Dr Currie of Liverpool (Philof. Tranf. for 1792), for half an hour, twice a day, or at thofe times when the fkin feels dried and hotted. Much cool air ftiould alfo be admitted, when the breath of the patient feels hot to one's hand ; or when the tongue, efpecially its middle part is dry, and covered with a crud of indurated' mucus ; as thefe indicate the increafed adion of the pulmonary capillaries ; in the fame manner as the dry and hot ficin indicates the orgafm of the cutaneous capillaries ; and the emaciation of the body that of the cellular ones. For this purpofe of abating the action of the capillaries by frequent ablution or fomentation, water of any degree of heat beneath that of the body will be of fervice, and ought in accu- rate language to be called a cold bath ; but the degree of cold- nefs, where the patient is fenfible, fhould in fome meafure be governed by his fenfations; as it is probable, that the degree of coldnefs, which is mod grateful to him, will alfo be of the great- eft benefit to him. See Clafs III. 2. 1. 12. and Article 15. of this Supplement. Another great ufe of frequent ablutions, or fomentations, or baths, in fevers, where the fiomach is in fome degree torpid, is to fupply the fydem with aqueous fluid by means of the cutane- ous abforbents ; which is diflipated fader by the increafed ac - tion of the fecerning capillaries, than the domach can furniih, and occafions great third at the intervals of the ficknefs. IX. Torpor of the Lungs. 1. The lungs in many cafes of contagion may firft be affect- ed with torpor, and the ikin become cold by fympathy ; in the fame Sup. I. 9. 2. THEORY OF FEVER. 473 fame manner as a cold fkin on going into the cold bath induces difficulty of breathing. Or the ftomach may become affe&ed with torpor by its fympathy with the lungs, as in the experi- ments of Mr. Watt with hydrocarbonate gas ; a few refpira- tions of which induced ficknefs, and even fyncope. When the ftomach or fkin is thus aflefted fecondarily by aflbciation, an accumulation of fenforial power occurs much fooner, than when thefe parts become torpid in confequence of previous excefs of ftimulus ; and hence they fooner recover their accuftomed ac- tion, and the fever ceafes. The particles of contagious matter thus received by refpiration fomewhat refemble in their effects the acid gafes from burning fulphur, or from charcoal; which, if they do not inftantly deftroy, induce a fever, and the patient ilowly recovers. 2. I was fome years ago (looping down, to look which way the water oozed from a morafs, as a labourer opened it with a fpade, to detect the fource of the fpring, and inhaled a vapour, which occafioned an inllant fenfe of fuffocation. Immediately recoiling I believe I inhaled it but once ; yet a few hours after- wards in the cool of the evening, when I returned home rather fatigued and hungry, a fhivering and cold fit occurred, which was followed by a hot one ; and the whole difeafe began and terminated in about twelve hours without return. In this cafe the power of fear, or of imagination, was not concerned ; as I neither thought of the bad air of a morafs before I perceived it, nor expected a fever-fit till it occurred. In this cafe the torpor commenced in the lungs, and after a few hours, by the addition of fatigue, and cold, and hunger, was propagated by diredk fympathy, to the reft of the fyftem. An orgafm or increafed action of the whole fyftem was then induced by the accumulation of fenforial power of irritation in the lungs, and of aflbciation in the other organs ; and when thefe fubfided, the difeafe ceafed. It may be afked, could a tor- por of the capillaries of the air-veflels of the lungs be fo fud- denly produced by great ftimulation ?-It appears probable, that it might, becaufe great exertion of irritative motions may be in- ftanrly produced without our perceiving them ; that is, without their being attended by fenfation, both in the lungs and ftom- ach ; and the organs may become torpid by the great expendi- ture of the fenforial power of irritation in an inllant of time ; as paralyfis frequently inftantly follows too great an exertion of voluntary power. 3. When the capillaries of the fkin a<Sl too violently, as in fome continued fevers ; which is known by the heat of the breath, and by the drynefs of the tongue, efpecially of the mid- Vol. II. * Nit n die THEORY OF FEVER. Sup. I. io. 1. 474 die part of it; not only cooler air might be admitted more free- ly into a fick room to counteraft this orgafm of the pulmonary capillaries ; but perhaps the patient might breathe with advan- tage a mixture of carbonic acid gas, or of hydrogene gas, or of azote with atmofpheric air. And on the contrary, when there exifts an evident torpor of the pulmonary capillaries, which may be known by the correfpondent chillnefs of the fkih ; and by a tickling cough, which fometimes attends cold paroxyfms of fe- ver, and is then owing to the deficient abforption of the pulmo- nary mucus, the faline parts of which ftimulate the bronchiae, or air-veflels ; a mixture of one part of oxygen gas with i o or 20 parts of atmofpheric air, might probably be breathed with great advantage. X. Torpor of the Brain. As the inaffivity or torpor of the abforbent veflels of the brain is the caufe of hydrocephalus internus ; and as the deficiency of venous abforption in the brain, or torpor of the extremities of its veins, is believed frequently to be the caufe of apoplexies ; fo there is reafon to conclude that the torpor of the fecerning vef- fels of the brain, which are fuppofed to produce the fenforial power, may conftitute the immediate caufe of fome fevers with arterial debility. And alfo that the increafed affion of thefe fe- cerning veflels may fometimes conftitute the immediate caufe of fevers with arterial ftrength. It is neverthelefs probable, that the torpor or orgafm of the fanguiferous, abforbent, or fecerning veflels of the brain may frequently exift as a fecondary effect, owing to their aflbciation with other organs, as the ftomach or lungs ; and may thus be produced like the torpor of the heart and arteries in inirritative fevers, or like the orgafm of thofe organs in irritative fevers, or inflammatory ones. Where there exifts a torpor of the brain, might not very flight eleftric fhocks pafled frequently through it in all direc- tions be ufed with advantage ? Might not fomentations of 94 or 96 degrees of heat on the head for an hour at a time, and fre- quently repeated, ftimulate the brain into aftion ; as in the re- vival of winter-fleeping animals by warmth ?'Ether externally might be frequently applied, and a blifter on the fhaved head. Where the fecerning veflels of the brain aft with too great energy, as in fome inflammatory fevers, might it not be dimin- ilhed by laying the patient horizontally on a mill ftone, and whirling him till fleep fhould be produced, as the brain be comes Sup. I. 11. 1; THEORY OF FEVER. 475 comes compreffed by the centrifugal force ? See Article 15. of this Supplement. XI. Torpor of the Heart and Arteries. 1. It was fhown in Clafs IV. 1. 1. 6. in IV. 2. 1. 2. and in Suppl. I. 6. 3. that a reverfe fympathy generally exifts between the lafteal and lymphatic branches of the abforbent fyftem. Hence, when the motions of the abforbents of the ftomach are rendered torpid or retrograde in fevers with arterial debility, thofe of the ficin, lungs, and cellular membrane, aft with in- creafed energy But the a&ions of the mufcular fibres of the heart and arteries are at the fame time affociated with thofe of the mufcular fibres of the ftomach by direct fympathy. Both thefe actions occur during the operation of powerful emetics, as fquill or digitalis ; while the motions of the ftomach con- tinue torpid or retrograde, the cellular and cutaneous abforbents act with greater energy, and the pulfations of the heart and ar- teries become weaker, and fometimes flower. The increafed action of the ftomach after a meal, and of the heart and arteries at the fame time from the ftimulus of the new fupply of chyle, feems originally to have produced, and to have eftablifhed this direft fympathy between them. As the increafed action of the abforbents of the ftomach after a meal has been ufually attended with diminiflied aftion of the other branches of the abforbent fyftem, as mentioned in Clafs IV. 1. 1.6. and has thus eftablifhed a reverfe fympathy between them. 2. Befides the reverfe fympathy of the abforbent veflels of the mufcles of the ftomach, and of the heart and arteries, with thofe of the ficin, lungs, and cellular membrane ; there exifts a fimilar reverfe fympathy between the fecerning veflels or glands of the former of thefe organs with thofe of the latter ; that is the mu- cous glands of the heart and arteries aft generally by direct fym- pathy with thofe of the ftomach ; and the mucous glands of the cellular membrane of the lungs, and of the ficin, aft by re- verfe fympathy with them both. Hence when the ftomach is torpid, as in ficknefs, this torpor fometimes only affects the abforbent veflels of it ; and then the abforbents of the cellular mCmbrane and the ficin only aft with increafed energy by reverfe fympathy. If the torpor affefts the mufcular fibres of the ftomach, thofe of the heart and arteries aft by direft fympathy with it, and a weak pulfe is produced, as in the exhibition of digitalis, but without increafe of heat. But if the torpor alfo affefts the glands of the ftomach, the cu- taneous 476 THEORY OF FEVER. Sup. I. 11. 3. taneous and pulmonary glands aft with greater energy by their reverfe fympathy with thofe of the ftomach, and of the heart and arteries ; and great heat is produced along with increafed perfpiration both from the ficin and lungs. 3. There is fome difficulty in explaining, why the aftions of the extenfive fyftem of capiflary glands, which exift on every other membrane and cell in the body for the purpofe of fecreting mucus and perfpirable matter, (hould fo generally aft by reverfe fympathy with thofe of the ftomach and upper part of the in- teftines. It was fhewn in Clafs IV. 1. 1.6. that when the ftom- ach was filled with folid and fluid aliment, the abfcrbents of the cellular membrane, and of the bladder, and of the fkin, afted with lefs energy ; as the fluids, they were ufed to abforb and tranfmit into the circulation, were now lefs wanted ; and that hence by habit a reverfe fympathy obtained between thefe branches of the abforbents of the alimentary canal, and thofe of the other parts of the body. Now, as at this time lefs fluid was abforbed by the cutane- ous and cellular lymphatics, it would happen, that lefs would be fecreted by their correfpondent fecerning veflels, or capillary glands; and that hence by habit thefe fecerning veflels would acquire a reverfe fympathy of aftion with the fecerning veflels of the alimentary canaL Thus when the abforption of the tears by the punfta lacry- malia is much increafed by the ftimulus of fnuff; or of an af- fefting idea, on the nafal dufts, as explained in Seft. XVI. 8. 2. a great increafe of the fecretion of tears from the lacrymal glands is produced by the direft fympathy of the aftion of thefe glands with thofe of their correfpondent abforbents ; and that though in this cafe they are placed at fo great a diftance from each other. 4. A difficult queftion here occurs ; why does it happen, that in fevers with weak pulfe the contraftions of the heart and ar- teries become at the fame time more frequent; which alfo fome- times occurs in chlorofis, and in fome hyfteric and hypochon- driac difeafes, and in fome infanities ; yet at other times the weak pulfe becomes at the fame time flow, as in the exhibition of digitalis, and in parefis irritativa, defcribed in Clafs I. 2. I. 2. which may be termed a fever with flow pulfe ? this frequency of pulfe cannot depend on heat, becaufe it fometimes exifts without heat, as towards the end of fome fevers with debility. Now as apoplexies, which are fometimes afcribed to fulnefs of blood, are attended with flow pulfe ; and as in animals dy- ing in the flaughter-houfe from deficiency of blood the pulfe be- comes frequent in extreme j may not the frequency of pulfe in fevers Sup. I. 11. 1. THEORY OF FEVER. 477 fevers with arterial debility be in general owing to paucity of blood ? as explained in Sect. XXXII. 2. 3. and its flownefs in parefis irritativa be caufed by the debility being accompanied with due quantity of blood ? or may not the former circum- ftance fometimes depend on a concomitant affection of the brain approaching to fleep ? or to the unufual facility of the paflage of the blood through the pulmonary and aortal capillaries ? in which circumftance the heart may completely empty itfelf at each puliation, though its contractions may be weak. While the latter depends on the difficulty of the paflage of the blood through the pulmonary or aortal capillaries, as in the cold fits of intermittents, and in fome palpitations of the heart, and in fome kinds of haemoptoe ; in thefe cafes the increafed refiftance prevents the heart from emptying itfelf, and in confequence a new diaftole fooner occurs, and thus the number of pulfations becomes greater in a given time/ 5. In refpect to the fympathies of action, which produce or conftitute fever with debility, the fyftem may be divided into certain provinces, which are effentient or oppofite to each oth- er. Firft, the iacteals or abforbent vefl'els of the ftomach, and upper part of the inteftines ; fecondly, the lymphatics or all the other branches of the abforbent vefl'els, which arife from the fkin, mucous membranes, cellular membranes, and the various glands. Thefe two divifions a€t by reverfe fympathy with each other in the hot fits of fever with debility, though by dire<9; fympathy in the cold ones. The third divifion confifts of the fecerning veflels of the ftomach and upper inteftines ; and the fourth of the fecerning veflels of all the other parts of the body, as the capillary glands of the fkin, lungs, and cellular membrane, and the various other glands belonging to the fanguiferous fyf- tem. Many of thefe frequently, but the capillaries always, act by reverfe fympathy with thofe of the third divifion above men- tioned in the hot fits of fever -with debility, though by direct fympathy with them in the cold fits. Fifthly, the mufcular fi- bres of the ftomach, and upper inteftines ; and fixthly, the muf- cular fibres of the heart and arteries. The actions of thefe two laft divifions of moving fibres act by direct fympathy with each other, both in the cold and hot fits of fevers with debility. The efficient caufe of thofe apparent fympathies in fevers with weak pulfe may be thus underftood. In the cold paroxyfm of fever with weak pulfe, the firft part affected I believe to be the ftomach, and that it has become torpid by previous violent exertion, as by fwallowing contagious matter mixed with faliva, and not by defect of ftimulus; as from cold or hunger. The actions of this important organ, which fympathizes with almoft every THEORY OF FEVER. 478 Sup. I. 11. 6. every part of the body, being thus much diminilhed or nearly deftroyed, the fenforial power of aflbciation is not excited ; which in health contributes to move the heart and arteries, and all the reft of the fyftem ; whence an univerfal torpor occurs. When the hot fit approaches, the ftomach in fevers with ftrong pulfe regains its activity by the accumlation of the fen- forial power either of irritation, if it was the part firft affected, or of affociation if it was affefted in fympathy with fome other torpid part, as the fpleen or liver ; which accumulation is pro- duced during its torpor. At the fame time all the other parts of the fyftem acquire greater energy of action by the accumula- tion of the fenforial power of aflbciation, which was produced, during their inactivity in the cold fit. But in fevers with weak pulfe the ftomach, in which the fen- forial power of irritation had been previoufly exhaufted by vio- lent aClion, acquires no fuch quick accumulation of fenforial power, but remains in a ftate of torpor after the hot fit com- mences. The heart and arteries remain alfo in a ftate of tor- por, becaufe there continues to be no excitement of their power of aflbciation owing to the torpid motions of the ftomach ; but hence it happens, that there exifts at this time a great accumu- lation of the power of aflbciation in the lefs aCtive fibres of the heart and arteries ; which, as it is not excited and expended by them, increafes the aflbciability of the next link of the aflbciated chain of motions, which confifts of the capillaries or other glands ; and that in fo great a degree as to aCluate them with unnatural energy, and thus to produce a perpetual hot fit of fe- ver. Becaufe the aflbciability of the capillaries is fo much in- creafed by the accumulation of this power, owing to the leflen- ed activity of the heart and arteries, as to overbalance the lef- fened excitement of it by the weaker movements of the heart and arteries. 6- When the accumulation of the fenforial power of irrita- tion caufed by defeat of ftimulus is greater in the firft link of a train of actions, to which aflbciated motions are catenated, than the deficiency of the excitement of the fenforial power of aflbcia- tion in the next link, what happens ?-the fuperabundanee of the unemployed fenforial power of the firft link is derived to the fecond ; the aflbciability of which thus becomes fo greatly in- creafed, that it a&s more violently than natural, though the ex- citement of its power of aflbciation by the leflened attion of the firft link is lefs than natural. So that in this fituation the with- drawing of an accuftomed ftimulus in fome parts of the fyftem will decreafe the irritative motions of that part, and at the fame time Sup. I. 11. 6. THEORY OF FEVER. 479 time occafion an increafe of the aflbciate motion of another part, which is catenated with it. This circumftance neverthelefs can only occur in thofe parts of the fyftem, whofe natural actions are perpetual, and the ac- cumulation of fenforial power on that account very great, when their activity is much leflened by the deduction of their ufual ftimulus ; and are therefore only to be found in the fan- guiferous fyftem, or in the alimentary canal, or in the glands and capillaries. Of the firft of which the following is an inftance. • The refpiration of a reduced atmofphere, that is of air mixed with hydrogene or azote, quickens the pulfe, as obferved in the cafe of Mrs. Eaton by Dr. Reynolds and Dr. Thornton ; to which Dr. Beddoes adds in a note that " he never faw an in- ftance in which a lowered atmofphere did not at the moment quicken the pulfe, while it weakened the action of the heart and arteries." Confiderations on Factitious Airs, by Thomas Beddoes and James Watt, Part III. p. 67. Johnfon, London. By the afliftance of this new fatt, the curious circumftance of the quick production of warmth of the fkin on covering the head under the bed-clothes, which every one mult at fome time have experienced, receives a more fatisfaCtory explanation, than that which is given in Clafs IV. 1. 1.2. which was printed before this part of Dr. Beddoes's Confiderations was publifhed. For if the blood be deprived of its accuftomed quantity of ox, ygen, as in covering the head in bed, and thus breathing an air rendered impure by repeated refpiration, or by breathing a fac- titious air with lefs proportion of oxygen, which in common ref- piration pafles through the moift membranes of the lungs, and mixes with the blood, the pulfations of the heart and arteries become weaker, and confequently quicker, by the defeCt of the ftimulus of oxygen. And as thefe veflels are fubjeCt to perpet- ual motion, the accumulation of the fenforial power of irrita- tion becomes fo great by their leflened activity, that it excites the veflels next connected, the cutaneous capillaries for inftance, into more energetic aCtions, fo as to produce increafed heat of the Ikin, and greater perfpiration. How exaCtly this refembles a continued fever, with weak and quick pulfe !-in the latter the aCtion of the heart and arteries are leflened by defeCt of the excitement of the fenforial power of aflociation, owing to the torpor or leflened aCtions of the ftom- ach ; hence the accumulation of the fenforial power of aflbcia- tion in this cafe, as the accumulation of that of irritation in the former, becomes fo abundant as to excite into increafed aCtion the parts moft nearly connected, as the cutaneous capillaries. In refpeCt to the circumftance mentioned by Sydenham, that covering 480 THEORY OF FEVER. Sup. I. n. 7. covering the head in bed in a fhort time relieved the pertina- cious ficknefs of the patient, it muft be obferved that when the action of the heart and arteries becomes weakened by the want of the due ftimulus of the proper quantity of oxygen in the blood, an accumulation of the fenforial power of irritation oc- curs in the fibres of the heart and arteries, which then is ex- pended on thofe of the capillary glands, increafing their actions and confequent fecretions and heat. And then the ftomach is thrown into ftronger action, both by the greater excitement of its natural quantity of the fenforial power of aflbciation by the increafed aftions of the capillaries, and alfo by fome increafe of aflbciability, as it had been previoufly a long time in a ftate of torpor or lefs activity than natural, as evinced by its perpetual ficknefs. In a manner fomewhat fimilar to this, is the rednefs of the Ikin produced in angry people by the fuperabundance of the un- employed fenforial power of volition, as explained in Clafs IV. 2. 3 5. Rubor ex ira. From hence we learn how, when people in fevers with weak pulfe, or in dropfies, become infane, the abundance of the unemployed fenforial power of volition increafes the actions of the whole moving fyftem, and cures thofe difeafes. 7. As the orgafm of the capillaries in fevers with weak pulfe is immediately caufed by the torpid actions of the heart and ar- teries, as above explained, this fupplies us with another indica- tion of cure in fuch fevers, and that is to ftimulate thefe organs. This may probably be done by fome kind of medicines, which are known to pafs into the blood unchanged in fome of their properties. It is poffible that nitre, or its acid, may pafs into the blood and increafe the colour of it, and thus increafe its ftimu- lus, and the fame may be fuppofed of other faits, neutral or me- tallic ? As rubia timftoria, madder, colours the bones of young animals, it muft pafs into the blood with its colouring matter at leaft unchanged, and perhaps many other medicines may likewife affedt the blood, and thus aft by ftimulating the heart and arteries, as well as bv ftimulating the ftomach ; which cir- cumftance deferves further attention. x^nother way of immediately ftimulating the heart and arte- ries would be by transfufing new blood into them. Is it poflible that any other fluid befides blood, as chyle, or milk, or water, could, if managed with great art, be introduced fafely or advan- tageoufly into the vein of a living animal ? A third method of exciting the heart and arteries immediate- ly is by increafing the natural ftimulus of the blood, and is well worthy experiment in all fevers with weak pulfe ; and that con- fifts THEORY OF FEVER. Sup. I. 12. 1. 481 fids in fanplying the blood with a greater proportion of oxygen ; which may be done by refpiration, if the patient was to breathe either oxygen gas pure, or dilated with atmofpheric air, which might be given to many gallons frequently in a day, and by palling through the moift membranes of the lungs, according to the experiments of Dr. Prieftley, and uniting with the blood, might render it more ftimulant, and thus excite the heart and arteries into greater aftion ! May not fome eafier method of exhibiting oxygen gas by refpiration be difcovered, as by uling yery fmall quantities of hyper-oxygenated marine acid gas very much diluted with atmofpheric air ? XII. Torpor of the Stomach and upper Inteflines. i. The principal circumftance, which fupports the increafed attion of the capillaries in continued fever with weak pulfe, is their reverfe fympathy with thofe of the ftomach and upper in- teftines, or with thofe of the heart and arteries. The torpor of the ftomach and upper inteftines is apparent in continued fevers from the total want of appetite for folid food, befide the fick- nefs with which fevers generally commence, and the frequent diarrhoea with indigefted ftools, at the fame time the thirft of the patient is fometimes urgent at the intervals of the ficknefs. Why the ftomach can at this time take fluids by intervals, and not folids, is difficult to explain ; except it be fuppofed, as fome have affirmed, that the lafteal abforbents are a different branch from the lymphatic abforbents, and that in this cafe the former only are in a ft ate of permanent torpor. 2. The torpor of the heart and arteries is known by the weaknefs of the pulfe. When the actions of the abforbents of the ftomach are diminiffied by the exhibition of fmall dofes of digitalis, or become retrograde by larger ones, the heart and ar- teries aft more feebly by direft fympathy ; but the cellular, cu- taneous and pulmonary abforbents are excited into greater ac- tion. Whence in anafarca the fluids in the cellular membrane throughout the whole body are abforbed during the ficknefs, and frequently a great quantity of atmofpheric moifture at the fame time; as appears by the very great difeharge of urine, which fometimes happens in thefe cafes ; and in ileus the pro- digious evacuations by vomiting, which are often a hundred fold greater than the quantity fwallowed, evince the great aflion of all the other abforbents during the ficknefs of the ftomach. 3. But when the ftomach is rendered permanently fick by an emetic drug, as by digitalis, it is not probable, that much ac- cumulation of fenforial power is foon produced in this organ ; Vol. II. Q p o becaufe 482 THEORY OF FEVER. Sup. I. 12. 4. becaufe its ufual quantify of fenforial power is previoufly ex- haufted by the great ftimulus of the foxglove ; and hence it Teems probable, that the great accumulation of fenforial power, which now caufes the increafed action of the abforbents, is pro- duced in confequence of the inactivity of the heart and arteries ; which inactivity is induced by deficient excitement of the fen- forial power of aflbciation between thofe organs and the ftom- ach, and not by any previous exhauftion of their natural quan- tity of fenforial power ; whereas in ileus, where the torpor of the ftomach, and confequent ficknefs, is induced by reverfe fympathy with an inflamed inteftine, that is, by diflevered or defective aflbciation ; the accumulation of fenforial power, which in that difeafe fo violently aCluates the cellular, pulmo- nary, and cutaneous abforbents, is apparently produced by the torpor of the ftomach and laCteals, and the confequent accumu- lation of the fenforial power of aflbciation in them owing to their leflened aCtion in ficknefs. 4. This accounts for the dry (kin in fevers with weak pulfe, where the ftomach and the heart and arteries are in a torpid ftate, and for the fudden emaciation of the body ; becaufe the aflions of the cellular and cutaneous abforbents are increafed by reverfe fympathy with thofe of the ftomach, or with thofe of the heart and arteries; that is by the expenditure of that fenfo- rial power of aflbciation, which is accumulated in confequence of the torpor of the ftomach and heart and arteries, or of either of them ; this alfo explains the fudden abforption of the milk in puerperal fevers ; and contributes along with the heat of the refpired air to the drynefs of the mucous membrane of the tongue and noftrils. 5. Befides the reverfe fympathy, with which the abforbent veflels of the ftomach and upper inteftines aCt in refpeCt to all the other abforbent veflels, as in the exhibition of digitalis, and in ileus ; there is another reverfe fympathy exifts between the capillaries, or fecretory veflels of the ftomach, and thofe of the fkin. Which may neverthelefs be occafioned by the accumula- tion of fenforial power by the torpor of the heart and arteries, which is induced by direCt fympathy with the ftomach ; thus when the torpor of the ftomach remains in a fever-fit, which might otherwife have intermitted, the torpor of the heart and arteries remains alfo by direCt fympathy, and the increafed cu- taneous capillary aCtion, and confequent heat, are produced by reverie fympathy ; and the fever is thus rendered continual, owing primarily to the torpor of the ftomach. 6. The reverfe fympathy, with exifts between the capilla- ries of the ftomach and the cutaneous capillaries, appears by the chillnefs Sup. I. 12. 7. THEORY OF FEVER. 483 chillnefs of tome people after dinner ; and contrariwife by the digeftion being ftrengthened, when the Ikin is expofed to cold air for a ihort time ; as mentioned in Clafs IV. I. 1.4. and IV. 2. 1. 1. and from the heat and glow on the Ikin, which attends the action of vomiting; for though when licknefs firft com- mences, the ikin is pale and cold ; as it then partakes of the gen- eral torpor, which induces the licknefs ; yet after the vomiting has continued fome minutfes, fo that an acumulation of fenfo- rial power exifts in the capillaries of the ftomach, and of the Ikin, owing to their diminilhed action ; a glow of the Ikin fuc- ceeds, with fweat, as well as with increased abforption. 7. Neverthelefs in fome circumftances the ftomach and the heart and arteries feem to aft by direft fympathy with the cu- taneous capillaries, as in the fluihing of the face and glow of the ikin of fome people after dinner; and as in fevers with ftrong pulfe. In thefe cafes there appears to be an increafed produc- tion of fenforial power, either of fenfation, as in the blufh of ihame; or of volition, as in the blulh of anger ; or of irritation, as in the flulhed face after dinner above mentioned. This increafed aftion of the capillaries of the Ikin along with the increafed aftions of the ftomach and heart is perhaps to be ef- teemed a fynchronous increafe of aftion, rather thana fympathy between thofe organs. Thus the fluihing of the face after din- ner may be owing to the fecretion of fenforial power in the brain being increafed by the aflbciation of that organ with the ftom- ach, in a greater proportion than the increafed expenditure of it, or may be owing alfo to the ftimulus of new chyle received into the blood. 8. When the ftomach and the heart and arteries are render- ed torpid in fevers, not only the cutaneous, cellular, and pulmo- nary abforbents are excited to aft with greater energy ; but alfo their correlpondent capillaries and fecerning veflels, or glands, efpeciaily perhaps thofe of the Ikin, are induced into more ener- getic aftion. Whence greater heat, a greater fecretion of per- fpirable matter, and of mucus ; and a greater abforption of them both, and of aerial moifture. Thefe reverfe fympathies coin- cide with other animal fafts, as in eruption of fmall-pox on the face and neck the feet become cold, while the face and neck are much fluflied ; and in the hemiplegia, when one arm and leg be- come difobedient to volition, the patient is perpetually moving the other. Which are well accounted for by the accumulation of fenforial power in one part of an aflbciated feries of aftions, when lefs of it is expended by another part of it; and by a defi- ciency of fenforial power in the fecond link of aflbciation, when too much of it is expended by the firft, 0. This 484 THEORY OF FEVER. Sup. I. 12. 9. p. This doctrine of reverfe fympathy enables us to account for that difficult problem, why in continued fevers the increafed aftion of the cutaneous, cellular, and pulmonary capillaries pro- ceeds without interruption or return of cold fit ; though per- haps with fome exacerbations and remiffions; and that during a quarter, or half, or three quarters, or a whole lunation ; while at the fame time the pulfations of the heart and arteries are weaker than natural. To this ffiould be added the diredl fympathy, which exifts be- tween the periftaltic motions of the fibres of the ftomach, and the pulfations of the heart. And that the ftomach has become torpid by the too great ftimulus of fome poifonous or contagious matter ; and this very intricate idea of continued fever with fee- ble pulfe is reduced to curious fimplicity. The direfl fympathy of the ftomach and heart and arteries not only appears from the ftronger and flower pulfe of perfons exhaufled by fatigue, after they have drunk a glafs of wine, and eaten a few mouthfuls ; but appears alfo from the exhibition of large dofes of digitalis; when the patient labours under great and inceflant efforts to vomit, at the fame time that the actions of the abforbent fyftem are known to be much increafed by the hafty abforption of the ferous fluid in analarca, the pulfations of the heart become flow and intermittent to an alarming degree. See Clafs IV. 2. 1. 17. and 18. 10. It would affift us much in the knowledge and cure of fe- vers, if we could always determine, which part of the fyftem was primarily affected ; and whether the torpor of it was from previous excefs or defeat of ftimulus ; which the induftry of fu- ture obfervers muft difcover. Thus if the ftomach be affected primarily, and that by previous excefs of ftimulus, as wrhen cer- tain quantities of opium, or wine, or blue vitriol, or arfenic, are fwallowed, it is fome time in recovering the quantity of fenforial power previoufly exhaufted by excefs of ftimulus, before any accumulation of it can occur. But if it be alleged with torpor fecondarily, by fympathy with fome diftant part; as with the torpid capillaries of the fkin, that is by defective excitement of the fenforial power of afiociation ; or if it be affetied by defeat of ftimulus of food or of heat; it fooner acquires fo much ac- cumulation of fenforial power, as to be enabled to accommodate itfelf to its leffened ftimulus by increafe of its irritability. Thus in the hemicrania the torpor generally commences in a difeafed tooth, and the membranes about the temple, and alfo thofe of the ftomach become torpid by dire<ft fynchronous fym- pathy ; and painof the head, and ficknefs fupervene; but no fever or quickne ' e pulfe. In this cafe the torpor of the ftom - ach Sup. I. 12. io. THEORY OF FEVER. 485 ach is owing to defeat of the fenforial power of aflbciation, which is caufed by the too feeble actions of the membranes fur- rounding the difeafed tooth, and thus the train of fympathy ceaf- es here without affecting the motions of the heart and arteries ; but where contagious matter is fwallowed into the ftomach, the ftomach after a time becomes torpid from exhauftion of the fen- forial power of irritation, and the heart and arteries aft feebly from defeat of the excitement of the power of aflbciation. In the former cafe the torpor of the ftomach is conquered by accumulation of the power of aflbciation in one or two whole days ; in the latter it recovers by accumulation of the power of irritation in three or four weeks. In intermittent fevers the ftomach is generally I believe af- fefted fecondarily by fympathy with the torpid cutaneous ca- pillaries, or with fome internal torpid vifcus, and on this ac- count an accumulation of fenforial power arifes in a few hours fufhcient to reftore the natural irritability of this organ ; and hence the hot fit fucceeds, and the fever intermits. Or if this accumulation of fenforial power becomes exceftive and per- manent, the continued fever with ftrong pulfe is produced, or febris irritativa. In continued fevers the ftomach is frequently I fuppofe af- fected with torpor by previous excefs of ftimulus, and confe- quent exhauftion of fenforial power, as when contagious matter is fwallowed with the faliva, and it is then much flower in pro- ducing an accumulation of fenforial power fufficient to reftore its healthy irritability ; which is a frequent caufe of continued fe- ver with weak pulfe or febris inirritativa. Which confifts, after the cold fit is over, in a more frequent and more feeble aCtion of the' heart and arteries, owing to their diredl fympathy with the mufcular fibres of the torpid ftomach ; together with an in- creafed adlion of the capillaries, glands, and abforbents of the ikin, and cellular membrane, owing to their reverfe fympathy with the torpid capillaries, glands, and abforbents of the ftom- ach, or with thofe of the heart and arteries. Orin more accurate language, i. The febris inirritativa, or fever with weak pulfe, commences with torpor of the ftomach, occafioned by previous exhauftion of fenforial power of irrita- tion by the ftimulus of contagious matter fwallowed with the faliva. 2. The whole fyftem becomes torpid from defeat of the excitement of the fenforial power of aflbciation owing to the too feeble actions of the ftomach, this is the cold fit. 3. The whole fyftem, except the ftomach with the upper inteftines,and the heart and arteries, falls into increafed atftion, or orgafm, owing to accumulation of fenforial power of aflbciation during their 486 THEORY OF FEVER. S fp. I. 12. II. their previous torpor, this is the hot fit. 4. The ftomach and upper inteftines have not acquired their natural quantity of fen- forial power of irritation, which was previoufly exhaufted by vi- olent action in confequence of the ftimulus of contagious matter, and the heart and arteries remain torpid from defi- cient excitement of the fenforial power of aflbciation, owing to the too feeble actions of the ftomach. 5. The accumulation of fenforial power of aflbciation in confequence of the torpor of the heart and arteries occafions a perpetual orgafm, or increafcd adtion of the capillaries. 11. From hence it may be ded uCled firft, that when the tor- por of the ftomach firft occurs, either as a primary effect, or as a fecondary link of fome aflbciate train or circle of motions, a general torpor of the fyftem fometimes accompanies it, which conftitutes the cold fit of fever ; at other times no fuch general torpor occurs, as during the operation of a weak emetic, or dur- ing fea-ficknefs. Secondly. After a time it generally happens, that a torpor of the ftomach ceafes, and its actions are renewed with increafe of vigour by accumulation of fenforial power during its quief- cence ; as after the operation of a weak emetic, or at the inter- vals of fea-ficknefs, or after the parox yfm of an intermittent fever. Thirdly. The ftomach is fometimes much flower in recov- ering from a previous torpor, and is then the remote caufe of continued fever with weak pulfe ; which is owing to a torpor of the heart and arteries, produced in confequence of the defi- cient excitement of the power of aflbciation by the too weak actions of the ftomach ; and to an orgafm of the capillaries of the other parts of the fyftem, in confequence of the accumula- tion of fenforial power occafioned by the inactivity of the heart and arteries. Fourthly. The torpor of the ftomach is fometimes fo com- plete, that probably the origin of its nerves is likewife affedled, and then no accumulation of fenforial power occurs. In this cafe the patient dies for want of nourifliment: either in three or four weeks, of the inirritative fever ; or without quick pulfe, by what we have called parefis irritativa. Or he continues ma- ny years in a ftate of total debility. When this torpor fudden- ly commences, the patient generally fuffers epileptic fits or temporary infanity from the difagreeable fenfation of fo great a torpor of the ftomach ; which alfo happens fometimes at the eruption of the diftinCt fmall-pox; whence we have termed this difeafe anorexia epileptica. See Clafs II. 2. 2. 1. and III. 1. 1, 7. and Suppl. I. 14. 3. Fifthly. THEORY OF FEVER. Sup. I. i2. 11. 487 Fifthly. When this torpor of the ftomach is lefs in degree or extent, and yet without recovering its natural irritability by accumulation of fenforial power, as it does after the cold fit of intermittent fever, or after the operation of mild emetics, or during fyncope ; a permanent defeat of its activity, and of that of the upper inteftines, remains, which conftitutes apepfia, car- dialgia, hypochondriafis, and hyfteria. See Clafs I. 3. 1. 3. and I. 2. 4. 5. Sixthly. If the torpor of the ftomach be induced by dire£lr fympathy, as in confequence of a previous torpor of the liver, or fpleen, or fkin, an accumulation of fenforial power will fooner be produced in the ftomach ; becaufe there has been no previ- ous expenditure of it, the prefent torpor of* the ftomach arifing from defebt of aflbciation. Hence fome fevers perfectly inter- mit, the ftomach recovering its complete action after the torpor and confequent orgafm, which conftitute the paroxyfm of fever, are terminated. Seventhly. If the torpor of the ftomach be owing to defeat of irritation, as to the want of food, an accumulation of fenfo- rial power foon occurs with an increafe of digeftion, if food be timely applied; or with violent inflammation, if food be given in too great quantity after very long abftinence. Eighthly. If the torpor of the ftomach be induced by defect of pleafurable fenfation, as when ficknefs is caufed by the fug- geftion of naufeous ideas; an accumulation of fenforial power foon occurs, and the ficknefs ceafes with the return of hunger ; for in this cafe the inactivity of the ftomach is occafioned by the fubduCtion of agreeable fenfation, which aCts as a fubdudtion of ftimulus, and not by exhaufting the natural quantity of fen- forial power in the fibres or nerves of the ftomach. Ninthly. If the torpor of the ftomach be induced by a two- fold caufe, as in fea-ficknefs. See vertigo rotatoria. Clafs IV. 2. 1. 10. in which the firft link of aflbciation acts too ftrongly, and in confequence expends more than ufual of the fenforial power of irritation ; and fecondly in which fenfation is produc- ed between the links of aflbciation, and diflevers or enfeebles them ; the accumulation of fenforial power foon occurs in the ftomach ; as no previous expenditure of it in that organ has oc- curred. Whence in fea-ficknefs the perfons take food with ea- gernefs at times, when the vertigo ceafes for a few minutes. Tenthly. If the gaftric torpor be induced by previous vio- lent exertion, as after intoxication, or after contagious matter has been fwallowed, or fome poifons, as digitalis, or arfenic ; an accumulation of fenforial power very flowly fucceeds ; whence 488 THEORY OF FEVER. Sup. 1.12. 12. whence long ficknefs, or continued fever, becaufe the quantity of fenforial power already wafted muft firft be renewed, before an accumulation of it can be produced. 12. This leads us to a fecond indication of cure in continued fevers, which confifts in ftrengthening the actions of the ftom- ach ; as the firft indication confifted in decreafing the actions of the cutaneous capillaries and abforbents. The actions of the ftomach may fometimes be increafed by exhibiting a mild emet- ic ; as an accumulation of fenforial power in the fibres of the ftomach is produced during their retrograde actions Befides the evacuation of any noxious material from the ftomach, and duodenum, and from the abforbents, which open their mouths on their internal furfaces, by their retrograde motion. It is probable, that when mild emetics are given, as ipecacu- anha, or antimonium tartarizatum, or infufion of camomile, they are rejected by an inverted motion of the ftomach and oefophagus in confequence of difagreeable fenfation, as duft is excluded from the eye ; and thefe actions having by previous habit been found effectual, and that hence there is no exhauftion of the fenforial power of irritation. But where ftrong emetics are adminiftered, as digitalis, or contagious matter, the previous exhauftion of the fenforial power of irritation feems to be a caufe of the continued retrograde actions and ficknefs of the ftomach. An emetic of the former kind may therefore ftrength- en the power of the ftomach immediately after its operation by the accumulation of fenforial power of irritation during its ac- tion. See Clafs IV. i. i. Another method of decreafing the action of the ftomach for a time, and thence of increasing it afterwards, is by the accumu- lation of the fenforial power of irritation during its torpor ; is by giving ice, iced waiter, iced creams, or iced wine. This ac- counts for the pleafure, which many people in fevers with weak pulfe exprefs on drinking cold beverage of any kind. A fecond method of exciting the ftomach into action, and of decreafing that of the capillaries in confequence, is by the ftimu- lus of wine, opium, bark, metallic faits of antimony, fteel, cop- per, arfenic, given in fmall repeated quantities ; which fo long as they render the pulfe flower are certainly of fervice, and may- be given warm or cold, as moft agreeable to the patient. For it is poflible, that the capillaries of the ftomach may aft too vio- lently, and produce heat, at the fame time that the large mufcles of it may be in a torpid ftate; which curious cir«umftance future obfervations muft determine. Thirdly. Hot fomentation on the region of the ftomach might be of moft eflential fervice by its ftimulus, as heat pene- trates THEORY OF FEVER. Sup. I. 12. 12. 489 trates the fyftem not by the abforbent veflels, but by external influence; whence the ufe of hot fomentation to the head in tor- por of the brain ; and the ufe of hot bath in cafes of general de- bility, which has been much too frequently neglected from a pop- ular error occafioned by the unmeaning application of the word relaxation to animal power. If the fluid of heat could be di- refted to pafs through particular parts of the body with as lit- tle diffufion of its influence, as that of eleftricity in the {hocks from the coated jar, it might be employed with ftill greater ad- vantage. Fourthly. The ufe of repeated fmall eleftric (hocks through the region of the ftomach might be of fervice in fevers with weak pulfe, and well deferves a trial; twenty or thirty fmall (hocks twice a day for a week or two would be a promiflng ex- periment. Fifthly. A blifter on the back, or fides, or on the pit of the ftomach, repeated in fucceflion, by ftimulating the (kin frequent- ly flrengthens the aftion of the ftomach by exciting the fenfo- rial power of aflbciation ; this, efpecially in thofe fevers where the (kin of the extremities, as of the hands or nofe or ears, foon- er becomes cold, when expofed to the air, than ufual. Sixthly. The aftion of the ftomach may be increafed by pre- venting too great expenditure of fenforial power in the link of previous motion with which it is catenated, efpecially if the aftion of that link be greater than natural. Thus as the capillaries of the (kin aft too violently in fevers with weak pulfe, if thefe are expofed to cold air or cold water, the fenfori- al power, which previoufly occafioned their orgafm, becomes accumulated, and tends to increafe the aftion of the ftomach ; thus in thofe fevers with weak pulfe and hot (kin, if the ftomach be ftimulated by repeated fmall dofesofbark and wine or opi- um, and be further excited at the fame time by accumulation of fenforial power occafioned by rendering the capillaries torpid by cold air or water, this twofold application is frequently attended, with vifible good effeft By thus ftimulating the torpid ftomach into greater aftion, the motions of the heart and arteries will likewife be increafed by the greater excitement of the power of aflbciation. And the capillaries of the (kin will ceafe to aft fo violently, from their not poflefling fo great a fuperfluity of fenforial power as during the greater quiefcence of the ftomach and of the heart and arte- ries. Which is in fome circumftances fimilar to the curious phenomenon mentioned in Oafs IV. 2. 2. 10; where, by cov- ering the chill feet with flannel at the eruption of the fmall-pox, the points of the flannel ftimulate the (kin of the feet into greater Vol. II. P p p aftion. 490 THEORY OF FEVER. Sup. I. 13.. action, and the quantity of heat, which they poflefs, is alfo con- fined, or infulated, and further increafes by its ftimulus the ac- tivity of the cutaneous veflels of the feet ; and by that circum- itance abates the too great action of the capillaries of the face, and the confequent heat of it. XIII. Cafe of continued Fever. The following cafe of continued fever which I frequently faw during its progrefs, as it is lefs complicate than ufual, may il- lullrate this doctrine. Matter 8. L). an aflive boy about eight years of age, had been in the fnow for many days, and fat in the clafllcal fchool with wet feet ; he had alfo about a fortnight at- tended a writing fchool, where many children of the lower or- der were inftrufled. He was feized on February the Sth, 1795, with great languor, and pain in his forehead, with vomiting and perpetual ficknefs ; his pulfe weak, but not very frequent. He took an emetic, and on the next day had a blitter, which check- ed the ficknefs only for a few hours; his fkin became perpetu- ally hot, and dry ; and his tongue white and furred ; his pulfe when afleep about 104 in a minute, and when awake about 112. Fourth day of the difeafe. He has had another blifter, the pain of his head is gone, but the ficknefs continues by intervals; he refufes to take any folid food, and will drink nothing but milk, or milk and water, cold. He has two or three very liquid ftools every day, which are fometimes green, but generally of a dark- ifh yellow, with great flatulency both upwards and downwards at thofe times. An antimonial powder was once given, but in- ftantly rejected ; a fpoonful of decoflion of bark was alfo ex- hibited with the fame event. His legs are bathed, and his bands and face are moittened twice a day for half an hour in warmilh water, which is neverthelefs much colder than his fkin. Eighth day. His fkin continues hot and dry without any ob- fervable remifllons, with liquid ftools and much flatulency and ficknefs ; his water when obferved was of a ftraw colour. He has afked for cider, and drinks nearly a bottle a day mixed with cold water, and takes three drops of laudanum twice a day. Twelfth day. He continues much the fame, takes no milk, drinks only cider and water, fkin hot and dry, tongue hot and furred, with liquid ftools, and ficknefs always at the fame time ; fleeps much. Sixteenth day. Was apparently more torpid, and once rath- er Sup. I. 13. THEORY OF FEVER. 491 er delirious ; pulfe 112. Takes only capillaire and water; fleeps much. Twentieth day. Pulfe 100, (kin dry but lefs hot, liquid (tools not fo frequent, he is emaciated to a great degree, he has eaten half a tea-cup full of cuftard to day, drinks only capillaire and water, has thrice taken two large fpoonfuls ofdecoftion of bark with three drops of laudanum, refufes to have his legs bathed, and will now take nothing but three drops of laudanum twice a day. Twenty-fourth day. He has gradually taken more cuftard every day, and began to attend to fome new playthings, and takes wine fyllabub. Twenty-eighth day. He daily grows ftronger, eats eggs, and bread and butter, and fleeps immediately after his food,can creep on his hands and knees, but cannot ftand ereft. Thirty-fecond day. He cannot yet ftand alone fafely, but feems hourly to improve in ftrength of body, and aftivity of mind. In this cafe the remote caufe of his fever could not be well afcertained, as it might be from having his feet cold for many fucceflive days, or from contagion ; but the latter feems more probable, becaufe his younger brother became ill of a flmilar fe- ver about three weeks afterwards, and probably received the in- feftion from him. The difeafe commenced with great torpor of the ftomach, which was ihewn by his total averfion to folid fobd, and perpetual ficknefs; the watery ftools, which were fometimes green, or of a darkifh yellow, were owing to the ac- rimony, or acidity of the contents of the bowels ; which as well as the flatulency were occafioned by indigeftion. This torpor of the ftomach continued throughout the whole fever, and when it ceafed, the fever ceafed along with it. The contagious material of this fever I fuppofe to have been mixed with the faliva, and fwallowed into the ftomach ; that it excited the veflels, which conftitute the ftomach, into the greateft irritative motion like arfenic ; which might not be per- ceived, and yet might render that organ paralytic or inirritable in a moment of time ; as animals fometimes die by one Angle exertion, and confequent paralyfis, without a fecond ftruggle ; as by lightning, or being (hot through the back part of the brain ; of both which I have feen inftances. I had once an opportunity of infpefting two oxen, a few minutes after they were killed by lightning under a crab-tree on moift ground in long grafs ; and obferved, that they could not have ftruggled, as the grafs was not prefled or bent near them ; I have alfo feen two horfes ihot through the cerebellum, who never once drew in their legs after they 492 THEORY OF FEVER. Sup. I. 1 J. they firft ftretched them out, but died inftantancoufly ; in a fim- ilar manner the lungs feem to be rendered inftantly inanimate by the fumes of burning fulphur. The lungs may be fometimes primarily affeCled with conta- gious matter floating in the atmofphere as well as the ftomach, as mentioned in article 9. of this Supplement. But probably this may occur much lefs frequently, becaufe the oxygene of the atmofphere does not appear to be taken into the blood by ani- mal abforption, as the faliva in the ftomach, but pafles through the moift membranes into the blood, like the ethereal fluids of electricity or heat, or by chemical attraction,and in confequence the contagious matter may be left behind ; except it may fome- times be abforbed along with the mucus •, of which however in this cafe there appeared no fymptoms. The tonfils are other organs liable to receive contagious mat- ter, as in the fmall-pox, fcarlet-fever, and in other fenfitive in- irritated fevers ; but no fymptom of this appeared here, as the tonfils were at no time of the fever inflamed, though they were in this child previoufly uncommonly large. The pain of the forehead does not feem to have been of the internal parts of the head, becaufe the nerves, which ferve the ftomach, are not derived from the anterior part of the brain ; but it feems to have been owing to a torpor of the external mem- branes about the forehead from their direCt fympathy with thofe of the ftomach ; that is, from the deficient excitement of the fenforial power of aflbciation ; and feemed in fome meafure to be relieved by the emetics and blifters. The pulfations of the heart were weaker and in confequence quicker than natural, owing to their direCt fympathy with the torpid periftaltic motions of the ftomach; that is, to the deficient excitement of the fenforial power of aflbciation. The aCtion of the cutaneous capillaries and abforbents were ftronger than natural, as appeared by the perpetual heat and drynefs of the fkin j which was owing to their reverfe fympathy with the heart and arteries. This weaker and quicker aCtion of the heart and arteries, and the ftronger aCtion of the cutaneous capillaries and abforbents, continued throughout the difeafe, and may be faid to have conftituted the fever, of which the tor- por of the ftomach was the remote caufe. His tongue was not very much furred or very dry, nor his breath very hot; which fhewed, that there was no great increafe of the aCtion of the mucous abforbents, nor of the pulmonary capillaries, and yet fufficient to produce great emaciation. His urine was nearly natural both in quantity and colour ; which fire wed, Sup. I. 14. 1. THEORY OF FEVER. 493 (hewed, that there was no increafe of aClion either of the kid- neys, or of the urinary abforbents. The bathing his legs and hands and face for half an hour twice a day feemed to refrefh him, and fometimes made his pulfe flower, and thence I fuppofe ftronger. This feems to have been caufed by the water, though fubtepid, being much below the heat of his fkin, and confequently contributing to cool the capillaries, and by fatiating the abforbents to relieve the uneafy fenfation from the drynefs of the Ikin. He continued the ufe of three drops of tinCture of opium from about the eighth day to the twenty-fourth, and for the three preceding days too along with it two large fpoonfuls of an infufion of bark in equal parts of wine and water. The for- mer of thefe by its ftimulus feemed to decreafe his languor for a time, and the latter to ftrengthen his returning power of di- geftion. The daily exacerbations or remiflions were obfcure, and not well attended to ; but he appeared to be worfe on the four- teenth or fifteenth days, as his pulfe was then quickeft, and his inattention greateft; and he began to get better on the twen- tieth or twenty-firft days of his difeafe ; for the pulfe then be- came lefs frequent, and his fkin cooler, and he took rather more food : thefe circumftances feemed toobferve the quarter periods of lunation. XIV. 'Termination of continued Fever. i. When the ftomach is primarily afFeCted with torpor not by defeat of ftimulus, but in confequence of the previous ex- hauftion of its fenforial power ; and not fecondarily by its aflb- ciation with other torpid parts ; it feems to be the general caufe of the weak pulfations of the heart and arteries, and the confe- quent increased aCtion of the, capillaries, which conftitute con- tinued fever with weak pulfe. In this fituation if the patient recovers, it is owing to the renovation of life in the torpid ftom- ach, as happens to the whole fyftem in winter-fleeping animals. If he perifhes, it is owing to the exhauftion of the body for want of nourifhment occafioned by indigeftion ; which is haft- ened by the increafed actions of the capillaries and abforbents. 2. When the ftomach is primarily afteCted by defeCt of ftim- ulus, as by cold or hunger; or fecondarily by defeat of the pow- er of aflbciation, as in intermittent fevers ; or laftly in confe- quence of the introduction of the fenforial power of fenfation, as in inflammatory difeafes ; the aftions of the heart and arte- ries are not diminifhed, as when the ftomach is primarily af- fected 494 THEORY OF FEVER. Sup. I. 14. 3. felted with torpor by its previous exhauftion of fenforial pow- er, but become greatly increafed, producing irritative or inflam- matory fever. Where this fever is continued, though with fome remiflions and exacerbations, the exceffive action is at length fo much leffened by expenditure of fenforial power, as to gradually terminate in health ; or it becomes totally exhaufted, and death fucceeds the^eftruftion of the irritability and affocia- bility of the fyftem. 3. There is aifo another termination of the difeafes in con- fequence of great torpor of the ftomach, which are not always termed fevers ; one of thefe is attended with fo great and uni- verfal torpor, that the patient dies in the firft cold fit ; that is, within twelve hours or lefs of the firft feizure ; this is common- ly termed fudden death. But the quicknefs of the pulfe, and the coldnefs with fhuddering, and with fick ftomach,diftinguifh- ed a cafe, which I lately faw, from the fudden deaths occafion- ed by apoplexy, or ruptured blood-veffels. In hemicrania I believe the ftomach is always affe<Sled fec- ondarily, as no quicknefs of pulfe generally attends it, and as the ftomach recovers its activity in about two whole days. But in the following cafe, which I faw laft week, I fuppofe the ftomach fuddenly became paralytic, and caufed in about a week the death of the patient. Mifs , a fine young lady about nineteen, had bathed a few times, about a month before, in a cold fpring, and was always much indifpofed after it ; (he was feized with ficknefs, and cold fhuddering, with very quick pulfe, which was fucceeded by a violent hot fit ; during the next cold paroxyftn fhe had a convulfion fit ; and after that fymptoms of infanity, fo as to ftrike and bite the attendants, and to fpeak furious language ; the fame circumftances occur- red during a third fit, in which I believe a ftrait waiftcoat was put on, and fome blood taken from her ; during all this time her ftomach would receive no nutriment, except once or twice a little wine and water. On the feventh day of the difeafe, when I faw her, the extremities were cold, the pulfe not to be counted, and fhe was unable to fwallow, or to fpeak ; a clyfter was ufed with turpentine and mufk and opium, with warm fo- mentations, but fhe did not recover from that cold fit. In this cafe the convulfion fit and the infanity feem to have been violent efforts to relieve the difagreeable fenfation of the paralytic ftomach ; and the quick pulfe, and returning fits of torpor and of orgafm, evinced the difeafe to be attended with fever, though it might have been called anorexia maniacalis, or epileptica. 4. Might not many be faved in thefe fevers with weak pulfe for Sup. I. 15. 1. THEORY OF FEVER. 495 for a few weeks by the. introduction of blood into a vein, once in two or three days ; which might thus give further time for the recovery of the torpid ftomach ? Which feems to require fome weeks to acquire its former habits of action, like the muf- cles of paralytic patients, who have all their habits of voluntary aflbciations to form afrefh, as in infancy. If this experiment be again tried on the human fubjeCl, it fhould be fo contrived, that the blood in palling from the well perfon to the lick one Ihould not be expofed to the air ; it fiiould not be cooled or heated ; and it fhould be meafured ; all which may be done in the following manner. Procure two filver pipes, each about an inch long, in the form of funnels, wide at top, with a tail beneath, the former fomething wider than a fwan- quill, and the latter lefs than a fmall crow-quill. Fix one of thefe filver funnels by its wide end to one end of the gut of a chicken frefh killed about four or fix inches long, and the other to the other end of the gut ; then introduce the fmall end of one funnel into the vein of the arm of a well perfon downwards towards the hand ; and laying the gut with the other end on a water-plate heated to 98 degrees in a very warm room, let the blood run thought it. Then prefling the finger on the gut near the arm of the well perfon, Aide it along fo as to prefs out one gutful into a cup, in order to afcertain the quantity by weight. Then introduce the other end of the other funnel into a fimilar vein in the arm of the fick perfon upwards towards the {houl- der ; and by Aiding one finger, and then another reciprocally, along the chicken's gut, fo as to comprefs it, from the arm of the well perfon to the arm of the fick one, the blood may be meafured, and thus the exa€t quantity known which is given and received. See ClafsI. 2. 3. 25. XV. Inflammation excited in Fever. 1. When the actions of any part of the fyftem of capillaries are excited to a certain degree, fenfation is produced, along with a greater quantity of heat, as mentioned in the fifth article of this fupplement. When this increafed capillary action be- comes ftill more energetic, by the combined fenforial powers of fenfation with irritation, new fibres are fecreted, or new fluids, (which harden into fibres like the mucus fecreted by the filk- worm,or fpider, or pinna,) from which new veflels are con- ftruited ; it is then termed inflammation : if this exifts in the capillary veflels of the cellular membrane or Ikin only, with fee- ble pulfations of the heart and arteries, the febris fenfitiva inir- ritata, or malignant fever, occurs; if the coats of the arteries are 496 THEORY OF FEVER. Sup. 1.15. 2. are alfo inflamed, the febris fenfitiva irritata, or inflammatory fever, exifts. In all thefe fevers the part inflamed is called a phlegmon, and by its violent adions excites fo much pain, that is, fo much of the fenforial power of fenfation, as to produce more violent ac- tions, and inflammation, throughout the whole fyftem. Whence great heat from the excited capillaries of the fkin, large and quick pul fations of the heart, full and hard arteries, with great univerfal fecretions and abforptions. Thefe perpetually con- tinue, though with exacerbations and remiflions •, which feem to be governed by folar or lunar influence. 2. In this fituation there generally, I fuppofe, exifts an in- creafed adivity of the fecerning veffels of the brain, and confe- quently an increafed produdion of fenforial power ; in lefs vio- lent quantity of this difeafe however the increafe of the adion of the heart and arteries may be owing limply to the accumula- tion of fenforial power of aflbciation in the ftomach, when that organ is affeded by fympathy with fome inflamed part. In the fame maner as the capillaries are violently and permanently ac- tuated by the accumulation of the fenforial power of aflbciation in the heart and arteries, when the ftomach is affeded primari- ly by contagious matter, and the heart and arteries fecondarily. Thus I fufped, that in the diftind fmall-pox the ftomach is af- feded fecondarily by fympathy with the infeded tonlils of inoculated arm ; but that in the confluent fmall-pox the ftom- ach is affeded primarily, as well as the tonfils, by contagious matter mixed with the faliva, and fwallowed. 3. In inflammatory fevers with great arterial adion, as the ftomach is not always affeded with torpor, and as there is a di- red fympathy between the ftomach and heart, fome people have believed, that naufeating dofes of fome emetic drug, as of anti- monium tartarizatum, have been adminiftered with advantage, abating by dired fympathy the adions of the heart. This the- ory is not ill-founded, and the ufe of digitalis, given in fmall dofes, as from half a dram to a dram of the faturated tindure, two or three times a day, as well as other lefs violent emetic drugs, would be worth the attention ofhofpital phyficians. In three cafes of what I believed to be inflammatory rheu- inatifm, two of them attended with pain of the fide, and diffi- cult refpiration, and the other with fwelled joints, after repeated venefedions and moderate cathartics, and mild dofes of anti- monials, without fuccefs, the tindure of digitalis given in the fmall dofe of ten drops every fix hours, appeared to abate the quicknefs and hardnefs of the pulfe in two or three or four days, without inducing any degree of ficknefs. Sicknefs Sup. I. 15.4. THEORY OF FEVER. 497 Sicknefs might alfo be produced probably with advantage by whirling the patient in a chair fufpended from the ceiling by two parallel cords ; which after being revolved fifty or a hun- dred times in one diredlion, would return with great circular velocity, hnd produce vertigo, fimilar I fuppofe to fea-ficknefs. And laftly the ficknefs produced by refpiring an atmofphere mixed with one tenth of carbonated hydrogen, difcovered by Mr. Watt, and publifhed by Dr. Beddoes, would be well wor- thy exadt and repeated experiment. 4. Cool air, cool fomentations, or ablutions, are alfo ufeful in this inflammatory fever ; as by cooling the particles of blood in the cutaneous and pulmonary veflels, they muff return to the heart with lefs ftimulus, than when they are heated above the natural degree of ninety-eight. For this purpofe fnow and ice have been fcattered on the patients in Italy ; and cold bathing has been ufed at the eruption of the fmall-pox in China, and both, it is faid, with advantage. See Clafs III. 2. 1. 12. and Suppl. I. 8. 5. The lancet however with repeated mild cathartics is the great agent in deftroying this enormous excitement of the fyf- tem, fo long as the flrength of the patient will admit of evacua- tions. Bliflers over the painful part, where the phlegmon or topical inflammation is fituated, after great evacuation, is of ev- ident fervice, as in pleurify. Warm bathing for half an hour twice a day, when the patient becomes enfeebled, is of great benefit, as in peripneumony and rheumatifm. 6. When other means fail of fuccefs in abating the violent excitement of the fyftem in inflammatory difeafes, might not the fhaved head be covered with large bladders of cold water, in which ice or fait had been recently diflblved ; and changed as often as neceflary, till the brain is rendered in fome degree tor- pid by cold ?-Might not a greater degree of cold, as iced water, or fnow, be applied to the cutaneous capillaries ? 7. Another experiment I have frequently wifhed to try, which cannot be done in private practice, and which I there- fore recommend to fome hofpital phyfician ; and that is to en- deavour to ftill the violent actions of the heart and arteries, after due evacuations by venefedtion and cathartics, by gently com- prefling the brain. This might be done by fufpending a bed, fo as to whirl the patient round with his head moft diftant from the centre of motion, as if he lay acrofs a mill-ftone, as defcrib- ed in Sett. XVIII. 20. For this purpofe a perpendicular (haft armed with iron gudgeons might have one end pafs into the floor, and the other into a beam in the ceiling, with an horizon tai arm, to which a fmall bed might be readily fufpended. Vol. II. Qj<q By 498 THEORY OF FEVER. Sup. I. 16. r. By thus whirling the patient with increafing velocity fleep might be produced, and probably the violence of the actions of the heart and arteries might be diminifhed in inflammatory fe- vers ; and, as it is believed, that no accumulation of fenforial power would fucceed a torpor of the origin of the nerves, either thus procured by mechanical compreffion, or by the bladder- cap of cold water above defcribed, the lives of thoufands might probably be faved by thus extinguifhing the exacerbations of fe- brile paroxyfms, or preventing the returns of them. In fevers with weak pulfe fleep, or a degree of ftupor, thus produced, might prevent the too great expenditure of fenforial power, and thus contribute to preferve the patient. See Clafs I. 2. 5. 10. on ftupor. What might be the confequence of whirling a perfon with his head next the centre of motion, fo as to force the blood from the brain into the other parts of the body, might be difcovered by cautious experiment without danger, and might probably add to our ability of curing fever. Mr. Kelly, in his obfervations on compreffion, Edinb. 1797, afferts, that by compreffing the two fubclavian arteries, as they pafs over the firft rib, more blood will comprefs the brain, and produce a kind of apoplectic ftate fimilar to that, which may occur by the centrifugal force, if the patient was whirled round as before defcribed. And adds, that by this compreffion of the two fubclavian arteries a greater quantity of blood will be cir- culated through the head, whence the patient foon complains of drowfinefs and vertigo ; and that hence different fpecies of head-achs are foon removed, efpecially thofe which depend on defeat of ftimulation. XVI. Recapitulation. 1. The fenforial power caufes the contraCtion of the fibres, and is excited into aCtion by four different circumftances, by the ftimulus of external bodies, by pain or pleafure, by defire or averfion, or by the previous motions of other contracting fibres. In the firft fituation it is called the fenforial power of irritation, in the fecond the fenforial power of fenfation, in the third the fenforial power of volition, and in the fourth the fenforial power of affociation. Many parts of the body are excited into perpetual action, as the fanguiferous veflels, confifting of the heart, arteries, and veins ; others into nearly pepetual aCtion, as the conglomerate and capillary glands; and'others into actions ftill fomewhat lefs frequent, as the alimentary canal, and the laCteal and lymphatic abforbents with their conglobate glands : all thefe are principally THEORY OF FEVER. Sup. I. 16.2. 499 principally situated by the fenforial powers of irritation, and of aflbciation ; but in fome degree or at fome times by thofe of fenfation, and even of volition. There are three kinds of Rim- ulus, which may eafily be occasionally diminifhed, that of heat on the fkin, of food in the ftomach, and of the oxygenous part of the atmofphere, which mixes with the blood in refpiration, and Rimulates the heart and arteries. 2. When any parts, which are naturally excited into perpetu- al aftion by Rimulus, become torpid or lefs active from decreafe of that fiimulus ; there firR occurs a decreafe of the aftivity of the parts next catenated with them ; thus going into cold water, produces a torpor of the capillary veflels of the lungs, as is known by the difficult refpiration, which immediately occurs ; for the fenforial power of aflbciation, which naturally contrib- utes to actuate the lungs, is now lefs excited by the decreafed actions of the cutaneous veflels, with which they are catenated. This conflitutes the cold fit of fever. There next occurs an accumulation of the fenforial power of irritation in the parts, which were torpid from defeat of Rimu- lus, as the cutaneous veflels for inRance when expofed to cold air ; and a fimilar accumulation of the fenforial power of aflb- ciation occurs in the parts which were catenated with the for- mer, as the veflels of the lungs, in the example above mentioned. Whence if the fubduftion of Rimulus has not been too great, fo as to impair the health of the part, the activity of the irrita- tive motions returns, even though the Rimulus continues lefs than ufual; and thofe of the aflbeiate motions become confid- erably increafed, becaufe thefe latter are now excited by the pre- vious fibrous motions, which now aft as Rrong or Rronger than formerly, and have alfo acquired an accumulation of the fenfo- rial power of aflbciation. This accounts for the curious event of our becoming warm in a minute or two after remaining in water of about 80 degrees of heat, as in the bath at Buxton ; or in the cold air of a froRy morning of about 30 degrees of heat. But if the parts\hus poflefled of the accumulated fenforial powers of irritation and of aflbciation be expofed again to their natural quantity of Rimulus, a great excefs of aftivity fuper- venes ; becaufe the fibres, which pofiefs accumulated irritation, are now excited by their ufual quantity of Rimulus ; and thofe which pofiefs accumulated aflbciation, are now excited by double or treble the quantity of the preceding irritative fibrous mo- tions, with which they are catenated ; this conflitutes the hot fit of fever. Another important circumftance occurs, when the parts which are torpid from decreafed ftimulus, do not accumulate a quantity THEORY OF FEVER. 500 Sup. I. 16. 3. quantity of fenforial power fufficient for the purpofe of renew- ing their own natural quantiy of attion ; but are neverthelefs not fo torpid, as to have the life of the part impaired. In this fituation, the fuperabundance of the accumulated power of irri- tation contributes to actuate the aflbciate motions next catenated with them. Thus, when a perfon breathes air with lefs oxy- gene than natural, as by covering his head in bed, and thus re- fpiring the fame atmofphere repeatedly, the heart and arteries become lefs active by defeat of the ftimulus of oxygene ; and then the accumulation of fenforial power of irritation becomes inftantly very great, as thefe organs are fubject to perpetual and energetic action. This accumulation neverthelefs is not fo great as to renew their own activity under this defeat of ftimulus, but yet is in fufficient abundance to increafe the affociability of the next link of catenation, that is, to actuate the capillaries of the fkin with great and perpetual increafe of energy. This refem- bles continued fever, with weak pulfe ; in which the accumula- tion of the fenforial power caufed by the leflened motions of the heart and arteries, aftuates the capillaries with increafeof energy. 3. When the accumulation of the fenforial power of aflbci- ation, which is caufed, as above explained, by deficient excite- ment, owing to the leflened quantity of aftion of the irritative fibrous motions, with which the aflbciated train is catenated, is not in quantity fufficient to renew the natural actions of the firft link of an aflbciate train of motions ; it is neverthelefs fre- quently fo abundant as to actuate the next link of the aflbciated train with unnatural energy by increafing its aflbciability ; and that in a ft ill greater degree if that fecond link of the aflbciated train was previoufly in a torpid ftate, that is, had previoufly ac- quired fome accumulation of the fenforial power of aflbciation. This important circumftance of the animal economy is worthy our moft accurate attention. Thus if the heart and arteries are deprived of their due quantity of the ftimulus of oxygene in the blood, a weak and quick pulfe enfues, with an accumulation of the fenforial power of irritation ; next follows an increafe of the aftion of the capillaries by the fuperabundance of this accumu- lated power of irritation ; but there alfo exifts an accumulation of the power of aflbciation in thefe abling capillaries, which is not now excited by the deficient actions of the heart and arte- ries ; but which by its abundance contributes to a&uate the next link of aflbciation, which is the fick ftomaeh in the cafe related from Sydenham in Clafs IV. 1. 1. 2. and explained in this Supplement I. 4. And as this fick ftomaeh was in a pre- vious ftate of torpor, it might at the fame time poflefs an accu- mulation of fome fenforial power, which, if it was of aflbciation would Sup. I. 16. 4. THEORY OF FEVER. 501 would be thus more powerfully excited by the increafed a&ions of the capillaries ; which exifted in confequence of the weak adion of the heart and arteries. This alfo refembles in tome refpeds the continued fevers with weak pulfe, and with increaf- ed adfivity of the capillaries. 4. When a torpor of fome irritative motions occurs from a previous exhauftion of the fenforial power of irritation by the action of fome very great ftimulus, it is long before any accu- mulation of the fenforial power of irritation is produced ; as is experienced in the ficknefs and languor, which continues a whole day after a fit of drunkennefs. But neverthelefs there occurs an accumulation of the fenforial power of aflbciation in the firft link of the aifociate train of motions, which is catenated with thefe torpid irritative ones ; which accumulation is owing to de- ficient excitement of that fenforial power in the firft link of the aifociate train. This firft link therefore exifts alfo in a lefs ac- tive or torpid ftate, but the accumulation of the fenforial power of aifociation by its fuperabundance contributes to actuate the fecond link of the aifociate train with unnatural quantity of mo- tion ; and. that though its own natural quantity of the power of aifociation is not excited by the deficient aftion of preceding fibrous motions. When this happens to the ftomach, as after its irritative mo- tions have been much exerted from the unnatural ftimulus of wine, or opium, or of contagious matter mixed with the faliva, a torpor or inadivity of it fucceeds for a greater or lefs length of time ; as no accumulation of the fenforial power of irritation can occur till the natural quantity which has been previoufly ex- pended, is firft reftored. Then the heart and arteries, which are next in catenation, become lefs adive from the want of fufli- cient excitement of the fenforial power of aifociation, which previoufly contributed to actuate them. This fenforial power of aifociation therefore becomes accumulated, and by its super- abundance contributes to actuate the link next in aifociation, which has thus acquired fo great a degree of alfociability, as to overbalance the lefs quantity of the excitement of it by the tor- pid action of the previous or firft aifociate link. This happens to the capillaries, when the heart and arteries are a lie died as above by the torpor of the ftomach, when it is occafioned by previous great expenditure of its fenforial power, and thus con- ftitutes fever with weak pulfe, which is here termed inirritative fever, typhus mitior. 5. When a deficiency of ftimulus is too great or too long con- tinuedf fo as to impair the life of the part, no further accumu- lation of fenforial power occurs as when the Ikin is long ex- po fed THEORY OF FEVER. Sup. I. 16. 6. 502 pofed to cold and damp air. In that cafe, the link in catenation, that is, the firft of the affociate train, is rendered torpid by de- feat of excitement of its ufual quantity of the fenforial power of affociation, and from there being no accumulation of the fenfori- al power of irritation to increafe its aflbciability, and thus to con- tribute to actuate it by overbalancing the defeat of the excite- ment of its affociation. Thus on riding long and flowly on a cold and damp day, the exhalation of the vapour, which is impinged on the (kin, as the traveller proceeds, carries away his warmth fafter, than it is generated within the fyftem ; and thus the capillaries of the fkin have their actions fo much impaired after a time, that no accu- mulation of the fenforial power of irritation occurs ; and then the ffomach, the motions of which are catenated with thofe of the capillaries, ceafes to act from the deficient excitement of the power of affociation ; and indigeftion and flatulency fucceed, inftead of the increafed indigeftion and hunger, which occur, when the cutaneous capillaries are expofed to a Jefs degree of cold, and for a Ihorter time. In which latter fituation the accu- mulation of the fenforial power of irritation increafes by its fu- perabundance the aflbciability of the fibres of the ftomach, fo as to overbalance the defeat of the excitement of their affocia- tion. 6. The ftomach is affected fecondarily in fevers with ftrong pulfe, as in thofe with weak pulfe it is affedled primarily. To illuftrate this doctrine I (hall relate the following cafe of Mr. Y He was a young man rather intemperate in the ufe of wine or beer, and was feized with a cold fit,, and with a con- fequent hot one with ftrong pulfe ; ofi examining his hypochon- drium an oblong tumour was diftindly felt on the left fide of the ftomach, which extended fix or eight inches downward, and was believed to be a tumour of the fpleen, which thus occafioned by its torpor the cold fit and confequent hot fit of fever with ftrong pulfe. This fever continued, though with remiflions, for two or three weeks; and the patient repeatedly loft blood, ufed cathartics with calomel and fenna, and had frequent antimo- nial and faline medicines. And after he was much weakened by evacuations, the peruvian bark and fmall dofes of fteel re- moved the fever, but the tumour remained many years during the remainder of his life. In this cafe the tumour of the fpleen was occafioned by the torpor of the abforbent veffels ; while the fecerning veflels con- tinued fomewhat longer to pour their fluids into the cells of it. Then the inactivity of this vifcus affedted the whole fyftem with torpor by the deficient excitement of the fenforial power of affo- ciation, Sup. I. 16. 6. THEORY OF FEVER. 503 ciation, which contributes along with the irritation caufed by their fpecific ftimuli to actuate the whole fanguiferous, fecern- ing, and abforbent veflels ; and along with thefe the ftomach, which poflefles perhaps greater mobility, or promptitude to tor- por or to orgafm, than any other part. And after a time all thefe parts recover their actions by the acumulation of their fenfori- al power of affociation. But the fpleen not recovering its ac- tion from the accumulation of its power of irritation, as appear- ed from the continuance of the tumour, ft ill affects the ftomach by its defective irritative motions ceafing to excite the aflbcia- tion, which ought to contribute to actuate it. Hence the ftomach. continues torpid in refpeCt to its motions but accumulates its power of aflbciation ; which is not excited into a£lion by the defective motions of the fpleen ; this accu- mulation of the fenforial power of aflbciation now by its fuper- abundance actuates the next link of aflbciate motions, which confifts of the heart and arteries, into greater energy of action than natural, and thus caufes fever with ftrong pulfe ; which, as it was fuppofed to be moft frequently excited by increafe of irritation, is called irritative fever, or fynocha. Similar to this in the fmall pox, which is given by innocula- tion, the ftomach is affeCted fecondarily, when the fever com- mences, and hence in this fmall-pox the pulfations of the heart and arteries are frequently ftronger than natural, but never weaker, for the reafons above given. Whereas in that fmall-pox, which is caufed by the ftomach being primarily affeded, by the contagious matter being fwallowed with the faliva, whether the tonfils are at the fame time affeCted or not, the pulfations of the heart and arteries become weak, and the inirritative fever is produced, as explained above, along with the confluent fmall- pox. This unfolds the caufe of the mildnefs of the innoculated fmall-pox; becaufe in this difeafe the ftomach is affeCled fecond- arily, whereas in the natural fmall-pox it is frequently affect- ed primarily by fwallowing the contagious matter mixed with faliva. In the mealies I fuppofe the contagious matter to be diflblved in the air, and therefore not liable to be mixed with the faliva ; whereas the variolous matter is probably only diffufed in the air, and thence more readily mixed with the faliva in the mouth dur- ing refpiration. This difference appears more probable, as the fmall-pox I believe is always taken at a lefs diftance from the difeafed perfon than is neceflary to acquire the mealies. The contagion of the mealies affebts the membranes of the noftrils, and the fecretion of tears in confequence, but never I fufpeCt the ftomach primarily, but always fecondarily ; whence the pul- fation 504 THEORY OF FEVER. Sup, I. 16. 7. fation of the heart and arteries is always ftronger than natural, fo as to bear the lancet at any period of the difeafe. The great mildnefs fometimes, and fatality at other times, of the fcarlet fever may depend on the fame circumftance ; that is, on the ftomach being primarily or fecondarily affected by the contagious matter, obferving that the tonfils may be afFeded at the fame time with the ftomach. Should this prove to be the cafe, which future obfervations muft determine, what certain ad- vantage muft arife from the innoculation of this difeafe 1 When it is received by the fkin primarily I fuppofe no fore throat at- tends it, nor fever with weak pulfe ; when it is received by the ftomach primarily, the tonfils are affeded at the fame time, and the torpor of the ftomach produces inirritative fever, and the mortification of the tonfils fucceeds. We may hence conclude, that when the torpor of the ftom- ach is either owing to defect of ftimulus, which is not fo great as to impair the life of the part, as in moderate hunger, or in fwallowing iced water, or when its torpor is induced by its cat- enation or aflbciation with other torpid parts, as in the com- mencement of intermi! tent fevers and innoculatedfmall-pox, that the fubfequent action of the heart and arteries is generally in- creafed, producing irritative fever. Which is owing to the ac- cumulation of the fenforial power of irritation in one cafe, and of aflbciation in the other, contributing to actuate the next link of the catenated or aflbciated motions. But when the torpor of the ftomach is induced by previous exhauftion of its fenforial powers of irritation or of aflbciation by continued violent adion, as by the ftimulus of digitalis, or of contagious matter, or after intoxication from wine or opium, a weaker adion of the heart and arteries fucceeds, becaufe there is no accumulation of fen- forial power, and a deficient excitement of aflbciation. And finally, as this weak adion of the heart and arteries is not in- duced by exhauftion of fenforial power, but by defect of the ex- citement of aflbciation, the accumulation of this power of aflb- ciation increafes the action of the capillaries, and thus induces inirritative fever 7. When any part of the fyftem ads very violently in fevers, the fenforial power of fenfation is excited, which increafes the actions of the moving fyftem : whereas the pain, which arifes from decreafed irritative motions, as in hemicrania, feems to ex- hauft a quantify of fenforial power, without producing or in- creafing any fibrous adions. When the ftomach is primarily affeded, as in inirritative fevers from contagion, and in fuch a manner as to occafion pain the adion of the capillaries feems to be increafed by this addnional fenforial Sup. I. 16. 7. THEORY OF FEVER. 505 fenforial power of fenfation, whence extenfive inflammation or mortification ; but when the ftomach and confequently the heart and arteries continue their torpidity of action ; as in confluent fmall-pox, and fatal fcarlatina ; this conftitutes fenfitive inirri- tative fever, or typhus gravior. But when the ftomach is fecondarily affected, if the fenforial power of fen fat ion is excited, as in pleurify or peripneumony, the actions of the heart and arteries are violently increafed, and of all the moving fyftem along with them. Thus the peripneu- mony is generally induced by the patient refpiring very cold air, and this efpecially after being long confined to warm air, or af- ter being much fatigued and heated by exceflive labour or exer- cife. For we can cover the ficin with more clothes, when we feel ourfelves cold ; but the lungs not having the perception of cold, we do not think of covering them, nor have the power to cover them, if we defired it; and the torpor thus produced is greater, or of longer duration, in proportion to the previous ex- penditure of fenforial power by heat or exercife. This torpor of the lungs affefts the Ikin with fhuddering,and the ftomach is alfo fecondarily affected ; next follows the violent action of the lungs from the accumulation of the power of irri- tation, and an inflammation of them follows this violent action. While the ftomach recovers its activity by the increafe of the excitement of the fenforial power of affociation, and along with it the heart and arteries, and the whole moving fyftem. Hence this inflammation occurs during the hot fit of fever, and no cold fit fucceeds, becaufe the excels of the fenforial power of fenfa- tion prevents a fucceeding torpor. Thefe new motions of certain parts of the fyftem produce in- creafed fesretion's of nutritious or organic mucus, which forms new veffels ; thefe new veffels by their unufual motions produce new kinds of fluids ; which are termed contagious, becaufe they have the power, when introduced into a healthy body, of pro- ducing fimilar actions and effects, with or without fever, as in the fmall-pox and meafles, or in the itch and venereal difeafe. If any of thefe contagious matters affect the ftomach with tor- por either by their ftimulus immediately applied, or by its fym- pathy with the parts firft difeafed, a fever is produced with lick- nefs and want of appetite ; as in fmall-pox, and fcarlatina. If the ftomach is not affected by contagious matter, no fever fuc- eeeds, as in itch, tinea, fyphilis. All thefe contagious matters are conceived to be harmlefs, till they have been expofed to the air, either openly or through a moift membrane ; from which they are believed to acquire oxy- gene, and thence to become fome kinds of animal acids. As Vol. II. R r r the 506 THEORY OF FEVER. Sup. I. 16. 8. the preparations of mercury cure venereal ulcers ; as a quarter of a grain of fublimate diflblved in wine, and given thrice a day; this effedl feems to be produced either by its ftimulating the abforbents in the ulcer to abforb the venereal matter before it has acquired oxygene ; or by afterwards uniting with it chem- ically, and again depriving it of its acquired acidity. On either fuppofition it might probably be given with advantage in fmall- pox, and in all infectious difeafes, both previous to their com- mencement, and during their whole progrefs. 8. The cold fits of intermittent fevers are caufed by the tor- por of feme part owing to deficient irritation, and of the other parts of the fyftem from deficient aflbeiation. The hot fits are owing firft to the accumulation of irritation in the part prima- rily affedfed, if it recovers its action, which does not always hap- pen ; and fecondly to the accumulation of aflbeiation in the oth- er parts of the fyftem, which during health are fubjeCt to per- petual aClion ; and laftly alfo to the greater excitement of the power of aflbeiation, when the part primarily affeCted recovers its irritability, and ads with greater energy than natural. The deficient fecretions in the cold fit depend on the torpor of the glandular fyftem ; and the increafed fecretions in the hot fit on their more energetic aCtion. The thirft in the cold fit is owing to the deficient abforption from the ficin, cellular mem- brane, and bladder ; the thirft in the hot fit is owing to the too great diflipation of the aqueous part of the blood. The urine is pale and in fmall quantity in the cold fit from deficient fecre- tion of it, and from deficient abforption of its aqueous parts ; it is high coloured, and fometimes depofites afediment, in the hot fit,from the greater fecretion of it in the kidneys, and the great- er abforption of its aqueous and faline part in the bladder. The drynefs and feurf on the tongue and noftrils are owing to the increafed heat of the air expired from the lungs, and confequent greater evaporation of the aqueous part of the mucus. The fweats appear in confequence of the declenfion of the hot fit, owing to the abforbent veflels of the ficin lofing their increafed a&ion fooner than the fecerning ones; and to the evaporation leflening as the ficin becomes colder. The returns of the par- oxyfms are principally owing to the torpor of fome lefs eflential part of the fyftem remaining after the termination of the laft fit; and are alfo dependent on folar or lunar diurnal periods. The torpor of the part, which induces the cold paroxyfm, is owing to deficient irritation occafioned either by the fubdu&ion of the natural ftimuli of food, or water, or pure air, or by de- ficiency of external influences, as of heat, or of folar or lunar gravitation. Or fecondly, in confequence of the exhauftion of fenforial Sup. I. 16. 9. THEORY OF FEVER. 507 fenforial power by great previous exertions of fome parts of the fyftem, as of the limbs by great labour or exercife, or of the ftomach by great ftimulus, as by contagious matter fwallowed with the faliva, or by much wine or opium previoufly taken into it. Or laftly a torpor of a part may be occafioned by fome me- chanic injury, as by a compreflion of the nerves of the part, or of their origin in the brain ; as the fitting long with one leg eroded over the other occcafions numbnefs, and as a torpor of the ftomach with vomiting frequently precedes paralytic ftrokes of the limbs. As fleep is produced, either by defefl of ftimulus, or by pre- vious exhauftion of fenforial power ; fo the accumulation of the fenforial power of volition in thofe mufcles and organs of fenfe, which are generally obedient to it, awakens the fleeping perfon ; when it has increafed the quantity of voluntarity fo much as to overbalance the defeat of ftimulus in one cafe, and the exhauf- tion of fenforial power in the other ; which latter requires a much longer time of fleep than the former. So the cold par- oxyfm of fever is produced either by defect of ftimulus, or by previous exhauftion of the fenforial power of fome part of the fyftem ; and the accumulation of the fenforial power of irrita- tion in that part renews the action of it, when it has increafed its irritability fo much as to overbalance the defeat of ftimulus in one cafe, and the exhauftion of fenforial power in the other ; which latter requires a much longer torpor or cold fit than the former. But in the cold paroxyfms of fever, befides the torpor of one part of the fyftem from defeft of irritation, the remainder of it becomes torpid owing to defeat of excitement of the fenforial power of aflociation by the leflened action of the part firft affeiSt- ed. This torpor of the general fyftem remains, till the accumu- lation of the fenforial power of aflociation has increafed the af- fociability fo much as to overbalance the defeat of the ex- citement of aflociation ; then the torpor ceafes, and if the firll affected part has recovered its activity, the other parts are all thrown into excefs of aiftion by their increafed aflbeiability, and the hot fit of fever is produced. 9. In the continued fevers with ftrong pulfe the ftomach is affected fecondarily, and thus a£ls feebly from deficient excite- ment of the power of aflociation ; but the accumulation of the power of aflociation thus produced in an organ fubjecT to per- petual and energetic abtion, is fo great as to afled. the next link of the aflbeiate train, which confifts of the heart and arteries ; thefe therefore are exerted perpetually with increafe of aiftion. In continued fevers with weak pulfe the torpid ftomach is af- fedled THEORY OF FEVER. 508 Sup. I. 16'. 9. fefled primarily by previous exhauftion of its irritability by ftim- ulus, as of contagious matter fwallowed into it. The heart and arteries act feebly from deficient excitement of the power of aflbciation, owing to the torpor of the ftomach, with which they are catenated ; but the accumulation of the power of aflbciation, thus produced in organs fubjefl to perpetual and energetic mo- tion, is fo great, as to affect the next link of the aflbciate train ; which confifts of the capillaries of the fkin or other glands ; thefe therefore are exerted perpetually with great increafe of ablion. The continued fevers with ftrong pulfe terminate by the re- duction or exhauftion of the fenforial power by violent aCHon of the whole fyftem ; which is followed either by return of health with the natural quantity of irritability, and of aflbciabil- ity, or by a total deftrubtion of them both, and confequent death. In continued fevers with weak pulfe the ftomach remains torpid during the whole courfe of the fever ; and at length by the recovery of its irritability and fenfibility effects the cure of it. Which generally happens about the firft, fecond, or third quarter of the lunar period, counted from the commencement of the difeafe, or continues a whole lunation, and fometimes more ; which gave rife to what are termed critical days. See SeCl. XXXVI. 4. on this fubjeCl. If the ftomach does not re- cover from its torpor, the patient becomes emaciated, and dies exhaufted by the continuance of the increafed aCtion of the ca- pillaries and abforbents, and the want of nourifhment. The cure of continued fever with weak pulfe confifts firft in weakening the undue action of the capillaries of the ikin by ab- lution with cold water from 32 to 80 degrees of heat; or by ex- pofing them to cool air. Secondly by invigorating the actions of the ftomach, by decreafing them for a time, and thence ac- cumulating the power of irritation, as by an emetic, or by iced water, or iced wine. Or by increafe of ftimulus, as by bark, wine,opium, and food, infmail quantities frequently repeated. Or by renewing the action of the ftomach by flight electric ihocks. Or by fomenting it frequently with water heated to 96 or too degrees. Or laftly by exciting its power of aflbciation with other parts of the fyftem, as by a blifter; which fucceeds beft when the extremities are cool ; or by fwinging, as in verti- go rotatoria. If by the ftimulus of the Peruvian bark on the fibres of the ftomach, they regain their due action, the heart and arteries alfo regain their due action ; as their fenforial power of aflbciation is now excited, and expended as ufual. And as there is then no accumulation of fenforial power in the heart and arteries, the capillaries Sup. I. 16. io. THEORY OF FEVER. 509 capillaries ceafe to ad with too great energy, and the fever is cured. Thirdly. If the heart and arteries could be themfelves ftim- ulated into greater action, although the ftomach remained tor- pid, they might probably by expending a greater quantity of the fenforial power of irritation, prevent an accumulation of the fenforial power of affociation, (for thefe may poflibly be only different modes of adion of the fpir.it of animation,) and thus the too great adion of the capillaries might be prevented and the fever ceafe. This new mode of cure might poflibly be ac- complifhed, if the patient was to breathe a gallon or two of pure or diluted oxygene gas frequently in a day ; which by paffing through the moift membranes of the lungs and uniting with the blood might render it more ftimulant, and thus excite the heart o . and arteries into greater adion. Fourthly. Greater energy might probably be given to the whole fyftem, and particularly to thofe parts which ad too fee- bly in fevers, as the ftomach and the heart and arteries, if the adion of the fecerning veflels of the brain could be increafed in energy ; this is probably one effed of all thofe drugs, which when given in large quantity induce intoxication, as wine and opium. And when given with great caution in fmall quanti- ties uniformly repeated, as from three drops to five of the tinc- ture of opium, but not more, every fix hours, I believe they fup- ply an efficacious medicine in fevers with great arterial debility ; and the more fo, if the Peruvian bark be exhibited alternately every fix hours along with them. There are other means of ex- citing the veflels of the brain into adion ; as firft by decreafing the ftimulus of heat by temporary cold fomentation ; fecondly, increasing the ftimulus of heat by long continued warm fomen- tation ; thirdly, by eledricity,as very fmall fhocks pafled through it in all diredions; and laftly by blitters on the head. All thofe require to be ufed with great caution, and efpecially where there exifts an evident ftupor, as the removing of that is 1 believe fre- quently injurious. See ftupor, Clafs I. 2. 5. 10. The cure of fever with ftrong pulfe confifts in the repeated ufe of venefedion, gentle cathartics, diluents,; medicines pro- ducing ficknefs, as antimonials, digitalis ; or the refpiration of carbonated hydrogen; or by refpiration of atmofpheric air low- ered by a mixture of hydrogen, azote, or carbonic acid gas, or by comprtffing the brain by whirling in a decumbent pofture, as if lying acrofs a horizontal mill-ftone. See the former parts of this fupplement for the methods of cure both of fevers with ftrong and weak pulfe. 10. When any difficulty occurs in determining the weak pulfe 510 THEORY OF FEVER. Sup. I. 16. 10. pulfe from the ftrong one, it may generally be aflifted by count- ing its frequency. For when an adult patient lies horizontally in a cool room, and is not hurried or alarmed by the approach of his phyfician, nor ftimulated by wine or opium, the ftrong pulfe feldom exceeds 118 or 120 in a minute ; and the weak pulfe is generally not much below 130, and often much above that number ; except where a patient has naturally a pulfe flower than ufual in his healthy ftate. Secondly in fitting up in bed, or changing the horizontal to a perpendicular pofture, the quick- nefs of the weak pulfe is liable immediately to increafe 10 or 20 pulfations in a minute, which does not I believe occur in the ftrong pulfe, when the patient has relted himfelf after the exer- tion of riling. I fhall here infert a remark on the general ufe of ftimulating materials, whether medicinal or culinary, to counteract or pre- vent debility. When a ftimulating material is exhibited, as the Peruvian bark, or opium, or wine ; it fhould be continued but a certain time, as half a lunation, or a whole lunation. If the whole fyftem be ftimulated into increafed exertion, as by wine or opium, there appears to be a temporary increafed fecretion of fenforial power in the brain, fo long as this ftimulus affetts the fyftem. If a part only of the fyftem be ftimulated, as by the exhibition of fpices, eflential oils, or bitter medicines, or metal- lic ones, then the ftimulated organ has derived to it a greater quantity of fenforial power, or a greater fecretion of it is pro- duced in that part of the brain, where the ftimulated nerves arife. Which is probably owing to the fympathy of the ftimu- lated extremity of every nerve, or its organ of fenfe, with the other extremity of it in the brain, in the fame manner as when the excretory duct of a gland is ftimulated, a greater fecretion is produced in the body of it, as when the duCts of the lacrymal glands in the eyes, or of the falivary glands in the mouth are ftimulated by duft or acrid materials. Now if a ftimulating medicine be given at certain intervals of time, as the Peruvian bark or wine in fevers, the increafed ac- tion of a part or of the whole fyftem foon becomes a link of the aflbeiated circle of diurnal actions, and may be faid to be- come habitual. The quantity of the ftimulating medicine may then be dimin- ifhed, and yet the increafed activity of the fyftem will continue ; becaufe the increafed exertions are now produced partly by the fenforial power of aflbeiation, as they are become a part of the diurnal circle of actions. And finally the ftimulating medicine may be totally omitted, and yet the increafed activity of the fyf- tem continue for the lame reafon. On Sup. I. 17. THEORY OF FEVER. 511 On this circumftance depends the power of the bitter medi- cines, as the bark, and other ftimulating materials, as beer and wine, in preventing the returns of the cold paroxyfms of fevers, and in ftrengthening the fyftem, which increafe of irritability, that is of ftrength, continues after the ufe of the medicine is withdrawn. But on the contrary, if the ftimulating material be continued much longer than one lunation, the whole fyftem, or the ftimu- lated organ alone, is excited into too forcible action by the two fenforial powers of irritation, and of aflbciation ; and confe- quently in procefs of time lofes in fome degree both its irrita- bility and its aflbciability ; and inactivity or torpor fucceeds ; which conftitutes weaknefs, as is fecn in all thofe, who accuf- tom themfelves to dram-drinking Hence wine or opium, or Peruvian bark, may be continued twice or four times a day for half a lunation, or for a whole one with advantage in difeafes of debility, for the purpofe of gaining both diurnal and monthly aflbciations of activity. But fhould not be much longer continued j as a confcquent debility will then be liable to fucceed. XVII. Conclufion. Thus have I given an outline of what may be termed the fympathetic theory of fevers, to diftinguifh it from the mechan- ic. theory of Boerhaave, the fpafmodic theory of Hoffman and of Cullen, and the putrid theory of Pringle. What I have thus delivered, I beg to be confidered rather as obfervation and conjectures, than as things explained and demonftrated ; to be confidered as a foundation and a fcaffolding, which may enable future induftry to ereCt a folid and a beautiful edifice, eminent both for its fimplicity and utility, as well as for the permanency of its materials,-which may not moulder, like the ftruClures already ereCted, into the fand of which they were compofed ; but which may ftand unimpaired, like the Newtonian philofo- phv, a rock amid the wafte of ages ! end of the second part. LINES. LINES, TO BE PLACED AT THE END OF Z O O N O M I A. BF A FRIEND. •JAM^UE OPUS EXEGE The work is done !-nor Folly's aftive rage. Nor Envy's self, shall blot the golden page ; Time shall admire, his mellowing touch employ. And mend the immortal tablet, not destroy. ZOONOMIjE auctori S. P. D. AMICUS. CURRUS TRIUMPH ALTS MEDICINE Currus it Hygeise, Medicus movet arma triumphans, Undique vi&a fugit lurida turma mali.- Laura dum Phoebi viridis tua tempora cingit, Nec mortale sonans Fama coronat opus ; Post equitat trepidans. repetitque Senedlus in aurem, Voce canens stridula, " sis memor ipse mori 1" INDEX TO THE GLASSES OF PART SECOND. .Abortion, i. 2,1,14. from fear, iv. 3, 1, 7. not from epilepfy, iii. 1, 1, 7. not from hepatitis, ii. 1, 2, 12. Abforption of folids, i. 2, 2, 14. of matter, ii. 1, 6, 2, and 6. cellular, iv. 1. 1, 6. from the lungs, iv. 3, 1,5. Suppl. i. 8, 6. Abftinence of young ladies, ii. 2, 2, 1. Accumulation of feces, ii. 2, 2, 7. Acupuncture, iii. 1, 1, 8. Adiplia, ii. 2, 2, 2. TEgritudo ventriculi, i. 2, 4, 4. See Sicknefs. Agripnia. See Vigilia. Ague cakes, Suppl. i. 2, 3. Alum in ulcers of the mouth, ii. 1, 3, 1. ii. 1, 6, 16. Ambition, iii. 1, 2, 9. Amaurofis, i. 2, 5, 5. Anafarca of the lungs, i. 2, 3, 16. Aneurifma, i. 2, 1, 18. Anger, iii. 1, 2,17. tremor of, iv. 2, 3,4. blulh of, iv. 2, 3, 5. Angina. See Tonfillitis. pectoris. See Afthma pain- ful. Anhelitus, ii. 1, 1,4. Anhelatio fpafmodica, i. 3, 3, 3. Annulus repens, ii. 1, 5, 10. Anorexia, ii. 2, 2, 1. mauiacalis, Suppl. i. 14, 3. epileptica, ii, 2, 2, 1. iii. 1, 1, 7. Apepfia,i. 3, 1, 3. Suppl. i. 8, II. Aphtha, ii. 1,3, 1, 17. Apoplexy, iii. 2, 1, 16. Appetite defective, ii. 2, 2, 1. depraved iii. 1, 2, 19. from abftinence, ii. 2, 2, 1. Appetite deftroyed, iii. 1, 2, 20. from epilepfy, ii. 2, 2, 1, Arm, pain of, iv. 2, 2, 13. palfy of, iii. 2, 1, 4. Arfenic in tooth-ach, i. 2, 4, 12. in head-ach, i. 2, 4, 11. Arthrocele, ii. 1, 4, 17. Arthropuofis, ii. 1, 4, 18. Arthritis. See Gout. Afcarides, i. 1, 4, 12. iv. 1, 2, 9. iv. 2, 2, 6. Afcites, i. 2, 3, 13. Aflbciations affedled four ways, iv. I, 1. G. how produced, iv. 1, 1. H. diftinft from catenations, iv. 1. 1. A. three kinds of, iv. 1, 1. B. tertian, iv. 1, 1. K. of the fauces and pubis, iv. 1, 2, 7. fenfitive, a law of, iv. 2, 2, 2. fenfitive, iv. 2, 1. accumulates, Suppl. i. 8, 3. i. 11, 4. Afthma humoral, ii. 1, 1, 8. i. 3, 2, 8. of infants, i. 1,3, 4. convulfive, iii. 1, 1, 10. painful, iii. 1, 1, 11. Auditus acrior, i. 1, 5, 2. imminutus, i. 2, 5- 6. Azote, Suppl. i. 9, 3. i. 11,4., fceptic, ii. 1, 6, 6. B. Bandages, ill effect of ii. 1, 1, 12. promote abforption, i. 1,3, 13. in gout, iv. 1, 2, 15. in rheumatifm, iv. 1, 2, 16. in hemicrania, iv. 2, 2, 8. in epilepfia, iii. 1, 1,7. Vol, II. § s f Bath, 514 INDEX TO THE CLASSES.-Part II. Bath, cold, i. 2, 2, 1. Suppl. 1, 14, 3. warm, i. 1,2, 3. Beauty, iii. 1, 2, 4. lofs of, iii. 1, 2, 12. Bile-du6t, pain of, iv. 2, 2, 4. Bile cryflallized, i. 1,3, 8. Bitter tafle, i. 1, 3,1. not from bile, i. 1,3,1. Bleeding. See Haemorrhage. Bladder, diftention of, ii. 2, 2, 6. flone of, i. 1,3, 10. catarrh of, ii. 1, 4, 11. Blindnefs, i. 2, 5,"5. Blufh of anger, iv. 2, 3, 5. Suppl. i. 12, 7. of guilt, iv. 2, 3, 6. Suppl. i. 12, 7 Bones, innutrition of, i. 2, 2, 14. caries of, ii. 1,4, 19, Borborigmus, i. 3, 1, 9. Bougies, ii. 1, 4, 11. Bowels, gurgling of, i. 3, 1, 9. Brachiorum paralylis, iii. 2, 1, 4. Brain flimulated, Suppl. i. 16, 9. Bronchocele, i. 2, 3, 20. Broth, i. 2, 4, 8. Burns, i. 1, 3, 13. Butterflies, experiment on, i. I, 2, 3. Buxton bath feels warm, Suppl. i. 16. C. Cacofitia, iii. 1, 2, 20. Calculi produdtio, i. I, 3, 9. ii. 1, 2, 14. renis, i. 1,3, 9. iv. 2, 3, 3. vertical i, 1, 3, 10. iv. 2, 2, 2. Callico fliirts, i. 1,2, 3, Callus, i. 2, 2, 12. Canities. See Hair Grey. Calor febrilis, i 1, 2, 1. Calves fed on gruel, i. 1, 2,5. hydatides of, i. 2, 5, 4. Cancer ii. 1, 4, 16. ii. 1, 6, 13. Cantharides, large dofe of, iv. 2, 2, 2. Carbonic acid gas, Suppl. i. 9, 3. Cardialgia, i. 2, 4, 5. Carcinoma, ii. 1, 4, 16. ii. 1, 6, 13. Caries offium, ii. 1, 4, 19. Cataradt, i. 2, 2, 13. Catarrh, warm, i. 1, 2, 7. cold, i. 2, 3,3. lymphatic, i. 3, 2, 1. fenfitive, ii. 1, 3, 5. epidemic, ii. 1,3,6. of dogs and horfes, ii. 1, 3, 6. from cold fkin, iv. 1, 1,5. periodic, iv. 3, 4, 1. Catamenia, i. 2, 1,10. iv. 2, 4, 7. Catalepfis, iii. 2, 1,9. Cats, mumps of, ii. 1, 3, 4. Cephaltea, fympathetica, iv. 2, 2, 7. idiopathica, i. 2, 4, 11. fomniofa, i. 2, 4, 11. Cefarian operation, i 2, 2, 14. Charcoal tooth-powder, i 2, 4, 12. Cheek, torpor of, iv. 2, 2,1. Chicken pox, ii. 1,3, 15. Chin-cough, ii. 1, 3, 8. Child-bed fever, ii. 1, 6, 16. Children, new-born, ii. 1, 1, 12. gripes and purging of i. 1, 2, 5. Chlorofis, i. 2, 3, 10. Suppl. i. 8, 11. Chorea, St. Vita, iv. 2, 3, 2. Citta, iii. 1,2, 19. Clamor, iii. 1, 1,3. Clavicular animals, ii. 1, 2,6. Clavus hyflericus, iv 2, 2, 8. Claudicatio coxaria, i. 2, 2, 17. Cold in the head. See Catarrh. Cold air in fevers, iii. 2, 1, 12. iv. 2, 4, 41. effects of, iii. 2, 1, 17. how to be ufed, iv. 1, 1,4. death from, iii. 2, 1, 17. Colic, flatulent, i. 2, 4, 7. from lead, i. 2, 4, 8. hyfleric,i, 2,4, 7. iii. 1, 1,8. Compaffion, iii. 1, 2, 24. Confumption, ii. 1,6,7. Convullion, iii. 1, 1,5. weak, iii. 1, 1, 5. from bad air, iii. 1, 1,5. painful, iii, 1, 1, 6. iv. 2, 4, 5. Confternation, i. 2,5, 12. Conflipation, i. 1,3, 5. ii 2,1, 7. Contagious matter of two kinds, ii. 1, 3. is oxygenated, ii. 1, 5. produces fever, how, Suppl. i. 16, 7. deflroyed by ni- trous vapour, ii. 1, 8. deflroyed by ful- phurous va- pour ii. 1, 3. Cornea to perforate, i. 1, 3. 14. fears of feen on milk, i. 1,3, 14. Corpulency, i. 2, 3, 17. Coryza. See Catarrh. Coflivenefs, i. 1, 3, 5. ii. 2, 1, 7. Cough of drunkards, ii. 1, 1, 5. hooping, ii. 1, 3, 8. hepatic, iv. 2, 1, 8. gouty, tv. 2, 1, 9, Cough INDEX TO THE CLASSES.-Part IL 515 Cough periodic, iv. 2, 4, 6 iv. 3, 4, 2. from cold feet, iv. 2, 1,7. Cows, peltilence of, ii. 1,3, 13. bloody urine of, ii. 1, 3, 13. fwelled by clover, ii. 1, 7. Cow-pox, ii. 1, 3, 9. Crab-lice, i. 1,4, 14. Cramp, iii. 1, 1, 13. painful, iii. 1, 1, 14. in diarrhoea, iv. 1,2, 10. Crapula ventriculi, ii. 1, 1, 7. Credulity, iii. 2, 2, 4. Crinesnovi, i. 1, 2, 15 Croup, i. 1,3, 4. ii. 1, 2, 4. ii. 1, 3, 3. Crufta ladlea, ii. 1,5, 12. Cutis arida, i. 1, 3, 6. Cynanche. See Tonfdlitis. parotidaea. See Parotitis. D. Darknefs in fevers, i. 2, 5, 3. Deafnefs, two kinds of, i. 2, 5, 6. Debility, three kinds of, i. 2, 1. Debility and ftrength metaphors, i. 2, 1. Decuflation, of nerves, iii. 2, 1, 10. Deglutition, ii. 1, 1, 1. involuntary, iv. 1, 3, 1. Delirium, febril, ii. 1, 7, 1. of drunkennefs, ii 1, 7, 3. maniacal, ii. 1, 7, 2. in parotitis, iv. 2, 1,19. Dentition, i. 1,4, 5. Dentium dolor a ftridore, iv. 1, 2, 3. Defcent of the uterus, i. 1, 4, 8. Diabetes, i. 3, 2, 6. foul tongue in i. 1, 3,1. irritative, iv. 3, 1, 1. from fear, iv. 3, 1,3. Diarrhoea warm, i. 1,2, 5. of infants, i. 1,2, 5. lymphatic, i. 3, 2, 4. chyliferous, i. 3, 2, 5. cold, i. 2, 3, 6. rheumatic, iv. 2, 1, 16. from fear, iv. 1, 3, 4. from toothing, iv. 2, 2, 14. in fevers, Suppl. i. 2,4. cure of, iv. i. 1. F. Digeftion increafed by cold, iv. 1, 1,4. decreafed by cold, iv, 1, 2,55. Digitalis in rheumatifm, iv. 1,2. 16. Diluents, ufe of, ii. 1,2, 1. Diftention of the nipples, ii. 1, 7, 10. iv. 1, 2, 7. Diuretics ufelefs in dropfy, i. 1,3, 7. Dizzinefs. See Vertigo. Dogs, catarrh of, ii. 1, 3, 6. Dolor, digiti fympathet. iv. 2, 2, 12. duCtus choledochi, iv. 2, 2,4. Dolor humeri in hepatidite, iv. 2, 2, 9. pharyngis ab acido, iv. 2, 2, 5. teftium nephriticus, iv. 2, 2, 11. urens, i. 1, 5, 10. Dracunculus, i. 1, 4,13. Dreams, ii. 1, 7,4. Dropfy of the brain, i. 2, 5, 12. of the belly, i. 2, 3, 13. of the cheft, i. 2, 3, 14. of the ovary, i. 2, 3, 15. of the lungs, i. 2, 3, 16. of the fcrotum, i. 2, 3, 11. Dyfentery, ii 1,3, 18. Dyl'menorragia, i. 2, 1, 12. Dyfpepfia, i. 3, 1, 3. a frigore, iv. 2, 1, 6. Dyfpncea from cold bath, iv. 2, 1,5. rheumatica, iv. 2,1, 16. Dyfuria infenfitiva, ii. 2, 2, 6. paralytica, iii. 2, 1,6. E. Ears, discharge behind, i. 1,2, 9. noife in them, iv. 2, 1, 15. Ear-ach, iv. 2, 2, 8. Ebrietas, i. 1, 1, 2. Education, iii. 2, 1, 8. iii. 1, 2, 24. iii. 1, 2, 11. heroic, iii. 1, 2, 25. Egg boiled for inflamed eyes, ii. 1, 4, 1. boiled fooneft, Suppl. i. 7. life of, iv. 1,4, 1. Electric fhocks, iv, 1, 4, 5. in paralyfis, iii. 2, I, 10. in fcrofula, i. 2, 3, 21. in hoarfenefs, iii. 2, 1,5. Electrized zinc and filver, i. 2, 5, 5. iv. 2, 1, 11. Empyema, ii. 1, 6, 4. Ennui, iii. 1, 2,11. iii. 2, 1, 8. Enteralgia, rheumatica, iv. 1,2, 16. Enteritis, ii. 1,2, 11. fuperficialis, ii. 1,3, 10. Epilepfy, iii. 1, 1, 7. iv. 3,1, 6. painful, iii. 1, 1, 8. iv. 2, 4, 4. terminates with fleep, iii. T, 1. in parturition, iii. 1, 1, 7. with digeftion, ii. 2, 2, 1. Epiftaxis. See Haemorrhagia. Epoulofis. See Cicatrix. Erotomania, iii. 1, 2, 4. Erudtation, voluntary, iv. 3, 3, 3. Eruption of fmall-pox, iv. 2, 1, 12. iv. 2, 2, 10. Eryfipelas, iv. 1, 2, 17. ii. 1, S, 2. iv. 2, 4, 10. Eryfipelas 516 INDEX TO THE CLASSES.-Part II. Eryfipelas feldom fuppurates, why, ii. 1,3, 2. Efuries, i. 2, 4, 2. Ether, to purify, i. 2, 5, 6. Evil, i. 2, 3, 21. Expectoration, warm, i. 1, 2, 8. folid, i. 1,3, 4. cold, L 2, 3, 4. Exfudation behind the ears, i. 1, ?, 9. Eyes, blue under the, i. 2, 2, 2. ii. 1, 4, 4. Eye-wing, ii. 1, 4, 2. Eye-lids, red, ii. 1,4, 3. Eye-lid inverted, cure of, ii. 1, 1, 8. coloured with antimony, ii. 1, 4, 3. Excoriations, iii. 2,1,10. _ E- Face, pimpled, ii. 1,4, 6. red after meals, Suppl. i. 12, 7. flufhed after dinner, iv. 1, 1,1. Eat people why fliort breathed, ii. 1, 1, 4. how to reduce, i. 2, 3, 17. Fear, fyncope from, i. 2, 1, 4. abortion from, iv. 1, 3, 7. produces abforption, ii. 1, 6, 4, palenefs in, iv. 1, 3, 5. of death, iii. 1, 2, 14. of hell, iii. 1, 2, 15. of poverty, iii. 1, 2, 13. Feet cold produces heartburn, Suppl. i. 8, 5. fetid, i. 1, 2, 14. cold in fmall-pox, iv. 2, 2, 10. Fevers, five kinds, ii. 1, 2. Suppl. i. 1, 2. irritative, i. 1, 1, 1, iv. 1, 1, 8. inirritative, i. 2,1,1, iv. 2, 1, 19 Suppl. i. 1, 2, fenfitive, ii. 1, 5, 1. fienfitive irritated, ii. 1, 2, 1. fenfitive inirritated, ii. 1, 3, 1. intermit, why, Suppl, i. continue, why, Suppl. i. periods of, iv. 2, 4, 11. fimple, Suppl i. 1. compound, Suppl i. 2. termination of cold fit, Suppl. i. 3. return of cold fit, Suppl. i. 3. fenfation in, Suppl. i. 5. circles of motions in, Suppl. i. 6. cold and hot fits, Suppl. i. 7. continued, Suppl. i. 8. Fevers, torpor of lungs in Suppl. i 9, 1. not determinable in cold fit, i- hl, 1 frequency of pulfe in, i. 1, i, 1. ' not an effort to cure, i. 1, . 2, 3. from enclofed matter, ii. 1, 6, 2. from aerated matter, ii. 1, 6, 6. from contagious matter, ii, 1, 6, 11 from contagious fanies, ii. I, 6, 15. puerperal fecond, ii. 1, 6, 16. torpor of the ftomach in, Suppl, i. 12. cafe of, Suppl. i. 13. termination of, Suppl. i. 14. inflammation excited in, Suppl, i. 15. returns of. Suppl. i. 4. when cold air in. Suppl. i. 2, 2. fympathetic, theory of, Suppl. i. duration of explained, Suppl . i. 2, 5. Fingers, playing with, iv. 1, 3, 4. pain of, iv. 2, 2, 12. Fire, animal, iv. 1, 4, 5. Fifh, live longer with injured brain, i. 2, 5. 10. Fiflula in ano, ii. 1, 4, 10. lacrymalis, ii. 1, 4, 9. in urethra, ii. 1, 4, 11. Flannel fhirt in diarrhoea, iv. 1,1, 3, injurious in fummer, i. 1, 2, 3. Fluor albus warm, i. 1, 2, 11. cold, i. 2, 3, 7. Frigus febrile, i. 2, 2, 1. chronicum, i. 2, 2, 2. lethale, iii. 2, 1, 17. G. Galvanifm, i. 2, 5, 5. iv, 2, 1, 11. Gall-ftone, i. 1,3, 8. Gangrene, ii. 1, 6, 17. Gargles, ii. 1, 3, 3. Gaftritis, ii. 1, 2, 10. Gaftritis fuperficialis, ii. 1, 3,19. Genu tumor albus, i. 2, 3, 19. Gleet. See Gonorrhoea. Globus hyflericus, i. 3, 1, 7. Gonorrhoea warm, i. 1, 2, 10. . cold, i 2, 3, 8. venereal, ii. 1, 5, 1. Goyt, iv. 1, 2, 15. iv. 2, 4, 9. of the liver, ii. 1,1,7. Gout, INDEX TO THE CLASSES.-Part II. 517 Gout, cafes of, iv, 1, 2, 15. cough, iv. 2, 1, 9. of the ftomach, i. 2, 4, 6. haemorrhage in, i. 1, 1, 4. ©race defined, iii. 1,2, 4. Gravel diftinguifhed from faits, i. 1, 3, 9. Gravitation, iv. 2, 4. Green ficknefs. See Clorofis. Grief, iii 1,2, 10. Gripes of children, i. 1, 2, 5. iv. 2, 1, 3. Guftus acrior, i. 1,5, 4, imminutus, i. 2, 5, 8. Gum, red, i. 1, 2, 3. ii. 1, 3,12. Gutta rofea, ii. 1, 4, 6. iv. 1, 2, 13, and 14. ferena, i. 2, 5, 5. H. Haemorrhage arterial, i. 1,1, 3. of the lungs, i. 1, 1, 4. of the nofe, i, 1, 1, 5. venous, i, 2, 1, 5. of the rectum, i. 2, 1, 6. of the kidnies, i. 2, 1, 7. of the liver, i. 2,1, 8. Haemoptoe arterial, i. 1, 1,4. venous, i. 2, 1, 9. Haemorrhois cruenta, i. 2, 1, 6. iv. 2, 4, 8. alba, i. 1, 2, 12. Hair, grey, i. 2, 2, 11. new, i. 1,2, 15. white by uterine preflure, i. 2, 2, 11. Hallucination of fight, ii. 1,7, 5. of hearing, ii, 1, 7, 6. maniacal, iii. 1, 2, 1. Hallucinatio ftudiofa, iii. 1, 2, 2. Harrogate water, factitious, i. 1, 4, 12. Head-ache. See Hemicrania and Ce- phalzea. Hearing acuter, i. 1,5, 2. diminifhed, i. 2, 5, 6. Heart-burn. i. 2, 4, 5. Heart-ftimulated, Suppl. i, 11, 7, i. 16, 9. Heat, animal, i. 1, 2, 1. i. 1,2,3. fenfe of acuter, i. 1,5, 6. elemental, iv. 2, 4, hectic leflened by twinging, iv. 2, 1, 10. not perceived bv the lungs, iii. 1, I, 10. Heat not eftimated by thermometers, Suppl. i. 7. of the breath, Suppl, i. 2, 2. Hemicrania idiopathica, i. 2, 4, 12. fympathetica, iv. 2, 2, 8, iv. 2, 4, 3. Suppl. 1, 14, 3. relieved by mercury, iv. 2, 2, 8. Hemiplegia, iii. 2, 1, 10. Hepatis tumour, i. 2, 3, 9. Hepatitis, ii. 1, 2, 12. chronica, ii. 1,4, 12. Herpes, ii. 1,5, 8. nephritica, iv. 1, 2, 11. Hiccough, ii. 1, 1, 6. iv. 1, 1, 7. Hip-joint injured, i. 2, 2, 17. Hoarfenefs, ii. 1, 3, 5. iii. 2, 1, 4. Hordeolum, ii. 1, 4, 4. Hooping-cough, ii. 1,3, 8. Hories, broken wind of, i. 2, 4, 9. catarrh of, ii, 1, 3, 6. Humedtation of the body, iv. 1, 4, 7. Hunger, i. 2, 4, 2. Hunger, i. 2, 4, 2. Hydatides, in calves, i. 2, 5, 4. Hydrocele, i. 2, 3,11, Hydrocephalus inter, i. 2, 3, 12. i. 2, 5, 4. iii. 2, I, 10. from inflammation, i. 2, 3, 12. Hydrogene gas, Suppl, i. 9, 3, i. 11, 4. in fevers, Suppl. i. 11, 6. i. 16, 9. Hydrothorax, i. 2, 3, 14. cafe of iv. 2, 2, 13. Hydro-carbonate gas, Suppl. i. 9, J. Suppl. i. 15, 3. Hydrops ovarii, i. 2, 3, 15. Hydrophobia, i. 3, 1, 11. iii. 1, 1, 15. 'iv. 1, 2, 7. iv. 2, 4, 11. Hypochondriafis, i. 2, 4, 10. Hyfteralgia frigida, i. 2, 4,17. Hyfteria, i. 3, 1, 10. Suppl. i, 1, 8, 11. from fear, iv. 3, 1, 8. from cold, iv. 3, 3, 3. convulfions in, iii. 1,1* 5. laughter in, iii. 1, 1,5. Hyfteritis, ii. 1,2,16. I. Jadlitatio, iii. i, 1, 1. Jaundice, i. j, 3,8. i. 2, 4, 19. Idterus, i. 1, 3, 8. i. 2, 4, 19. Ileus, i, 3, 1, 6. ii. 1, 2, 11, Impotentia, ii. 2, 2, 3. Indigeftion, i. 3, 1, 3. Indigeftion, 518 INDEX TO THE CLASSES.-Part II. Indigeflion. See Anorexia and Apep- fia. from cold feet, iv. 2, 1,6. Suppl. i. 8, 5. Incubus, iii. 2, 1, 13. Infants green ftools of, i. 1,2, 5. new born, ii. 1, 1, 13. Inflammation of the eye, ii. 1, 2, 2. fuperficial, ii. 1, 4, 1. of the brain, ii, 1, 2, 3. of the lungs, iii. 1, 2, 4. fuperficial, ii. 1, 3, 7. of the pleura, ii. 1, 2, 5 of the diaphragm, ii. I, 2, 6. of the heart, ii. 1, 2, 7. of the peritoneum, ii. 1, 2, 8. of the mefentery, ii. 1, 2, 9. of the ftomach, ii. 1, 2, 10. fuper- ficial, ii. 1, 3, 19. of the bowels, ii. i, 2, 11. fuper- ficial, ii. I, 3, 20. of the liver, ii. i, 2, 12. chronical, ii. I, 4, 12. of the fpleen, ii. I, 2, 13, Suppl i. 16, 6. of the kidnies, ii. I, 2, 14. of the bladder, ii. I, 2, 15. of the womb, ii. t, 2, 16. of the tonfils, ii. I, 3, 3. of the parotis, ii. I, 3, 4. ^irritability of la&eals, i. 2, 3, 26. of lymphatics, i. 2, 3, 27. of the gall-bladder, i. 2, 4, i9. of the kidney, i. 2, 4, 20. of the fpleen, Suppl. i. 16, 6. viciflitudes of, i. I, I. Innutrition of bones, i. 2, 2, i4. Inoculation, ii. i, 3, 9. Infanity, quick pulfe in, iii. r, I. from parturitions iii. i, 2. from paralyfis, iii. i, 2. Infanity, with fever, iii. 1, 2. cure of, iii. 1, 2. confinement in, iii. 1, 2. cures other difeafes, i. 2, 3, 16. Infenfibility, ii. 2, 1, 1. Introfufception of the inteftine, i. 3, 1, 6. Ira, iii. 1, 2, 17. Ifchias, ii. 1, 2, 18. i. 2, 4, 15. Iflues, ufe of, i. 1,2, 9. iii. 1, 1, 11. Itch, ii. 1,5, 6. Itching, i. 1,5, 9. of the nofe, iv. 2, 2, 6. K. Kanguroo, i. 2, 2, 14. L. Labour, difficult, i. 2, 2, 14. Lachrymarum, fluxus, fym. iv. 1, 2, 1. Lamenefs of the hip, i, 2, 2, 17. Laffitude, iii. 2, 1,1. Laughter, iv. 2, 3, 3. iii. 1, 1, iv. 1, 3, 3. See Rifus. Lead, pernicious, i. 2, 4, 8. Leg, one fhorter, i. 2, 2, 17. Lepra, ii. 1, 5, 3. Lethargus, iii. 2, 1, 14. Lethi timor, iii. 1, 2, 14. Lice, i. 1,4, 15. Lientery, i. 2, 3, 6. Life of an egg, iv. 1, 4, 1, of winter-fleepers, iv. 1,4, 2. Light debilitates in fevers, i. 2, 5, 3. Lingua arida, i. 1, 3, 1. iv. 2, 4, 11. Liver, torpor of, i. 2, 2, 6. tumor of, i. 2,3, 9. inflamed, ii. 1,2, 12. Lochia nimia, i. 2. Locked jaw, iii. 1, 1, 13. Love, fentimental, iii. 1, 2, 4. Lues veneria, ii. 1, 5, 8. imaginaria, iii. 1, 2, 21. Lumbago, ii. 1,2, 17. iii. 1, 1,1. cold, i. 2, 4, 16. Lumbricus, i. 1, 4, 10. Lunar influence on the folids, i, 2, 1, 11 Lungs, adhefions of, ii 1,2, 5. not fenfible to heat, iii. 1, 1, 10. Lufus digitorum invitus, iv. 1,3,4. M. Maculae vultus, i. 2, 1, 9. M dnefs, mutable, iii. 1, 2, 1. Magnetic fluid, iv. J, 4, 5. Mammarum INDEX TO THE CLASSES-Part II. 519 Mammarum tumor iv. 2, 1, 19. Mammularum, tenfio, iv. 2, 1, 6. i. 1, 4, 7. Mania mutabilis, iii. 1, 2, 1. Matter, variolous, ii. 1, 3, 9. contagious, ii. 1, 3. ii. 1, 6, 11. enclofed, ii. 1,6, 11. oxygenated, ii. 1, 6, 6. fanious, ii. 1,6, 15. Mealies, ii. 1, 3, 10. Suppl. i. 16, 6. Membranes, what, iv. 1, 2. Menorrhagia i. 2, 1,11. Mercury crude, as a clyfter, i. 3, 1, 6. in colic from lead, i. 2, 4, 8. in all contagions, Suppl. i. 16, 7. in vertigo, iv. 1, 2, 11. Miliaria, ii. 1, 3, 12. Milk new, for children, i. 1,2, 5. old, induces coftivenefs, ii. 2, 2, 7. Milk-cruft, ii. 1, 5, 12. Mifcarriage. See Abortion. Maeror, iii. 1, 2, 10. Mobility, iv. 1, 2. of the ikin, Suppl. 1, 7. Mollities offium, i. 2, 2, 14. Moon, effect of, iv. 2, 4. Morbilli. See Rubeola. Mortification, ii. 1, 6, 17. iii. 2, 1, 10. Morpiones, i. 1, 4, 14. Mucus diminifhed, i. 2, 2, 4. of the throat cold, i. 2, 3, 1. of the bowels, i. 2, 3, 6. i. 1, 2, 12. of the lungs, i 1,3, 4. forms ftones, i. 1,3, 9. diftinguifhed from pus, ii. 1, 6, 6. Mumps, ii. 1, 3, 4. Murmur aurium. iv. 2, 1, 15. Mufcx volitantss, i. 2, 5, 3. N. Nails, biting of, iv. 1,3, 5. Nares arida, i. 1, 3, 3. Naufea, dry, i. 2, 4, 3, humid, i. 3, 2, 3. ideal, iv. 3, 2, 1. from conception, iv. 3, 2, 2. Navel-ftring of infants, ii. 1, 1, 12. cut too foon, ii. 1, 1, 12. Neck thickens at puberty, iv. 1, 2, Neck-fwing, i. 2, 2, 16. Necrofis offium, ii. I, 4, 19. Nephritis, ii. 1, 2, 14. i. I, 3, 9. iii. 2, 1, 14. Nerves decuffate, iii. 2, 1, 10. Nictitation irritative, i. 1,4, 1. fenfitive, ii. 1,1,9. involuntary, iv. 1, 3, 2. Night-mare, iii. 2, 1, 13. Nipples, tenfion of, i. 1, 4, 7. iv. 2, i, 6. want of, ii. 1, 1,13. Noftalgia, iii. 1, 2, 6. Noftrils, dry, i. 1, 3, 3. O. Obefitas, i. 2, 3, 17. Odontalgia, i. 2, 4, 13. Odontitis, ii, 1, 4, 7. CEfophagia fcirrhus, i. 2, 3, 25. Olfactus acrior, i. 1,5, 3. imminutus, i. 2, 5, 7. Oil deftroys infedts, i. 1,4, 14. eflential ot animals, i. 1,2, 14. why injurious in eryfipelas, ii. 1, 3, 2. Opthahny, internal, ii. 1, 2, 2. fuperficial, ii. 1, 4, 1. Opium in catarrh, i. 2, 3, 3. in diaphragmitis, ii. 1, 2, 6. Orci timor, iii. 1,2, 15. Ofcitatio, ii. 1, 1, 10. Offium innutritio, i. 2, 2, 14. Otalgia, i. 2, 4, 13. iv, 2, 2, 8 Otitis, ii, 1, 4, 8 Otopuofis, ii, 1, 4, 8 Ovary, dropfy of, i, 2, 3, 15 exfecStion of, i, 2, 3,15 Oxygen gas, Suppl, i, 9, 3 in fevers, Suppl. i, 11, 7, i, 16, 9 Oxygenation of blood, iv, 1, 4, 6 P. Pain exhaufts fenforial power, iv, 2, 2 greater prevents lets, iv, 2, 2, 2. nervous, i, 2, 4 of the little finger, fymptom, iv, 2, 2, 12 of arm in hvdrothorax, iv, 2, 2, 13 of the bile du iv, 2, 2, 4 of the fhpulder, iv, 2, 2, 9 of the pharinx, iv, 2, 2 5 of the teftis, iv, 2, 2, 11. fmarting, i, 1, 5, 10 of the fide, i, 2, 4, 14, iv, 1, 2, 16 of menftruation, i. 2, 1, 12. ufe of, iii. 1, I, 11. i. 1, 2, 9 of the uterus, i, 2, 4, 17 Paint, white, dangerous, ii, 1,4, 6 Palate, 520 INDEX TO THE CLASSES.-Part II. Palate, defect of i, 2, 2, 20 Palenefs, i, 2, 2, 2 from fear, iv, 3, 1, 5 from licknefs, iv, 2, 1, 4 of urine after dinner, iv, 2, 1, 2 from cold Ikin, iv, 2, 1, 1 Palpitation of heart, i, 3, 3, 2, i, 2, 1, 10 from fear, iv, 3, 1, 6 relieved by arfenic, iv, 2, 1, 18 Pancreas, torpor of, i, 2, 2, 7 Pandiculatio, ii, 1, 1, 10 Panting, ii, 1, 1, 4, i. 3, 3, 3 Paracentefis at the navel, i, 2, 3, 13. Paralylis, iii, 6, 1, 10 of the bladder, iii, 2,1, 6 of the redlum, iii, 2,1, 7 of the hands, iii, 2, 1, 4 cure of, iii, 2, 1, 4 Paraplegia, iii, 2, 1, 11. Parelis inirritativa, i, 2, 1, 2, Suppl, i, 8, 10 fenfitiva, i, 2, 1, 3 voluntaria, iii, 2, 1, 8 Paronychia, internal, ii, 1, 2, 19 fuperficial, ii, 1, 4, 5 Parotitis, ii, 1, 3, 4 Parturition, ii, 1, 1, 12, ii, 1, 2, 16 more fatal in high life, ii, 1, 1, 13 with convullion, iii, 1, I, iii, 1, 1, 7 difficult, i, 2, 2, 14 Paffions depreffing and exciting, iv, 3, 1, 5 Pupertatis timor, iii, 1, 2, 13 Pedicuius, i, 1,4,15 Pemphigus, ii, 1,3, 14. Penetration of animal bodies, iv, 1, 4, 7 Peripneumony, ii, 1,2, 4 tracheal, ii, 1,2,4 fuperficial, ii, 1, 3, 7 inirritative, ii, 1, 2, 4 Peritonitis, ii, 1, 2, 8 Perfpiration, not an excrement, i, 1,2, 14 greateft in the hot fit, i, 1, 2, 3 fetid, i, 1, 2, 14 Pertuffis, ii, 1, 3, 8 Peftis, ii, 1, 3, 13 Petechias, i, 2, 1, 17 cure of, Suppl, i, 2, 7 Pharynx, pain of, iv, 2, 2, 5 Phofphorus, ii, 2,2, 3 Phrenitis, ii, 1, 2, 3 Phthifis, pulmonary, ii, 1, 6, 7 Piles, bleeding, i, 7, 1, 6 white, i, 1, 2, 12 Pimples on the face, ii, 1, 4, 6 Pins fwallowed, ii, I, 1, 7 Placentia, ii, 1, 1, 12, ii, 1, 2, 16 Plague, ii, 1,3, 13 Plafters, why moift, i, 1, 3, 6 Pleurify, i, 1, 2, 5 Pleurodyne chronica, i, 2, 4, 14 rheumatica, iv, 1, 7, 16 Podagra, iv, 1,2, 15, iv, 7, 4, 9 Polypus of the lungs, i, 1, 3, 4 of the nol'e from worms, iv, 1, 2, 9 Pregnancy, ii, 1, 1, 12 Priapifmus, i, 1,4, 6, ii, 1, 7, 9 Prodtalgia, i, 2, 4, 12 Prolapfus ani, i, 1, 4, 9 Pruritus, i, 1, 5, 9 narium a vermibus, iv, 6, 2, 6 Pfora, ii, 1, 5, 6 imaginaria, iii, 1, 2, 22 Pterigion, ii, 1, 4, 2 Ptyalifmus, See Salivatio Pubis and throat fmpathize, iv, 2, I, 7 Puerperal fever, i, 2, 4, 9, ii, 1, 6, 16 infanity, iii, 1, 2, 1 Pulchritudinis defiderium, iii, 1, 2, 12 Pullulation of trees, iv, 1,4, 3 Pulfe full, why, i, 1, 1, 1 ftrong, how determined, i, 1, 1, 1, Suppl, i, 16, 10 foft in vomiting, iv, 2, 1, 17 intermittent, iv, 2, 1, 18 quick from paucity of blood, Suppl, ii, 11,4 quick fometimes in fleep, iii, 2, 1, 12 quick in weak people, iii, 1, 1, iii, 2, 1, Suppl, i, 11,4 flower by Twinging, iv, 2, 1, 10 quick in chlorofis, i, 2, 3, 10 Punctse mucofa vultus, iii, 2, 2, 9 Purging, See Diarrhoea Pus diminifhed, i, 2, 2, 3 diftinguilhed from mucus, ii, 1, 6, 6 R. Ratiocionatio verbofa, iii, 2, 2, 3 Rabies, iii, 1, 2, 18 Rachitis, i, 2, 2, 15 Raucedo, catarrhal, ii, 1,3, 5 paralytic, iii, 2, 1, 5 Reafoning, falfe, iii, 2, 2, 3 Recollection, lofs of, iii, 2, 2, 1 Redti paralylis, iii, 2,1, 7 fcirrhus, i, 2, 3, 23 Red-gum, ii, 1,3, 12, i, 1, 2,3. Rednefs INDEX TO THE CLASSES Part II. 521 Rednefs from heat, ii. 1, 7, 7. of joy, ii 1,7, 8. after dinner, iv. 1, 1, 1. of anger, iv. 2, 3, 5. of guilt, iv. 2, 3, 6. of modefty, iv. 2, 3, 6. Refpiration, ii. 1, 1, 2. quick in exercife, ii. 1, 1, 3. in foftnefs of bones, i. 2, 2, 14. Reflleflhefs, iii. 1, 1, 1. Retroverfio uteri, i. 2, 1, 14. Reverie, iii. 1. 2, 2. iv. 2, 4, 2. Rhaphania, iii. 1,1, 6. Rheumatifm, iv. 1,2, 16. ofthe joints,iv, 1,2,16. of the bowels, iv. 1, 2, 16. of the pleura, iv. 1. 2, 16. fuppurating, iv. 1, 2, 16. from fympathy, iv. 2, 2, 13. chronical, i. 1, 3, 12, iii. 1, 1, 6. venefe&ion, in, iv. 1, 2, 16. Rickets, i. 2, 2, 15. Ring-worm, ii. 1,5,10. Rifus, iii. 1, 1,4. iv. 2, 3, 3. fardonicus, iv. 1,2, 4. invitus, iv. 1, 3, 3. Rubeola, ii. 1, 3, 10. Rubor a calore, ii. 1, 7, 7. jucunditatis, ii. 1, 7, 8. pranforum, iv. 1,1,1. Rudlus, i. 3, 1, 2. Ruminatio, i. 3, 1, l.iv. 3,3,1. S. Sailing in phthifis, ii. 1, 6, 7. Salivation warm, i. 1,2, 6. lymphatic, i. 3, 2, 2 fympathetic, iv. 1, 2, 5. in low fevers, i. 1, 2, 6. Salt of urine, i. 1, 2, 4. i. 1, 3, 9. Satyriafis, iii. 1, 2,16. Scabies. See Pfora. Scald-head, ii. 1, 5, 11. Scarlatina, ii. 1,3, 11. Sciatica frigida, i. 2, 4, 15. Scirrhus, i. 2, 3, 22. fuppurans, ii. 1, 4, 14. of the recium, i. 2, 3, 23. of the urethra, i. 2, 3, 24. of the cefophagus, i. 2,3,25. Scorbutus, i. 2, 1, 15. fuppurans, ii. 1,4, 14. Scrofula, i. 2, 3, 21. Scrofula, fuppurating, ii. 1, 4, 13. produces infanity, iii. 1, '2. Scurf of the head, i. 1,3, 6. of the tongue, i. 1,3, 1. Scurvy, i. 2, 1, 15. fuppurating, ii. 1, 4, 14. Sea-air in phthifis, ii. 1, 6, 7. Sea-ficknefs, iv. 2, 1, 10. Supph i. 8, 3. Seat, defcent of, i. 1,4, 9. Seed, ejection of, ii. 1, 1,11. See-faw, of old people, iii. 2, 1, 2. Senfation inert, Suppl. i. 6, 4. Senfitive aHbciation, law of, iv. 2, 2, 2. Setons, ii. 1, 6. Shingles, ii. 1, 5, 9. Shoulder, pain of, iv. 2, 2, 9. Shrieking, iii. 1, 1, 3. Sicknefs, i, 2, 4, 4. i. 3, 2, 3. cured by a blifler, iv. 1,1, 3. by warm fkin, iv. 1, 2, 2. Suppl i. 11,4. by whirling, i. 1, 1,4. by fwinging, Suppl. i. 15,3. by hydrocarbonate gas. Suppl. i. 15, 3. See Naufea. Sight acuter, i. 1,5, 1. impaired, i. 2, 5, 2. Side chronical pain of, i. 2, 4, 14. Sighing and fobbing, iii. 1, 2, 10. Sitis, calida, i. 2, 4, 1. frigida, i. 2, 4, 1. defectus, ii. 2, 2, 2. Skin pale in old age, i. 2, 2, 2; from cold, i. 2, 2, 2. Skin dry, i. 1,3, 6. yellowifh, i. 2, 2, 2. bhtifh and fhrunk, i. 2,1, I. reddifh, ii. 1,3, 1. cold after meals, iv. 2, 1, 1. Sleep, iii. 2, 1, 12. interrrupted, i. 2, 1, 3. periods in, iv. 2, 4,1. with quick pulfe,pii. 2,1, 12. difturbed by digeftion, iii. 2, 1, 12. Sleep-walkers, iff. 1, 1, 9. Small-pox, ii. 1, 3, 9. why diflindl and conflu- ent, Sup. i, 15, 2. i. 16, 8. fecondary fever of, ii. I, 6, 12. eruption of, iv. 1, 2, 12. Smarting, i. 1, 5; 10. Smell acuter, i. 1, 5, 3. impaired, i. 2, 5, 7. Sneezing, ii. 1, 1,3. iv. 1, 2, 2. Snow in fcrofula, i. 2, 3, 21. Vol. II. T t t Show 522 INDEX TO THE CLASSES.-Part IL Snow in paralyfis, iii. 2, 1,4. Snuff in hydrocephalus, i. 2, 3, 12. Softnefs of bones, i. 2, 2, 14. Somnambulifm, iii. 1, 1, 9. Somnium, ii. 1, 7, 4. Somnus, iii. 2. i 12. iv. 2, 4,1, interruptus, i. 2,1,3. Spafm of diphragm, iii. 1, 1, 11. of the heart, iii. 1, 1,11. Spine diftorted, i. 2, 2, 16. protuberant, i. 2, 2, 18. bifid, i. 2, 2, 19. Spitting blood, i. 1, 1, 4. i, 2,1,9. Spleen fwelled, i, 2, 3, 18. Suppl. i. 16, 6. Splenitis, ii. 2, 2, 13. Spots on the face, i. 2, 2, 9. feen on bed clothes, i. 2, 5, 3. Squinting, i. 2, 5, 4. in hydrocephalus, i. 2, 5, 4. Stammering, iv. 2, 3, 1. Stays tight, injurious, ii. 1, 1, 12. Sterility, ii. 2, 2, 4. Sternutatio, ii. 1,1,3. iv. 1,2,2. a lumine, iv. 2, 1, 2. Stimulants, their twofold effedt, ii. 1, 2, 6. injure weak people, i. 1, o q except the forbem tia, i. 1,2, 3. Stocks for children dangerous, ii. 2, 2, 17. Stomach, torpor of, i. 2, 1,2. Suppl. i. 12. i. 8, 10. i. 16, 6. inflammation of, ii. 1, 2, 10. ii. 1,3, 19. its affociation, iv. 1, 1. caufe of fever, Suppl. i. 8, 8. Stones in the bladder See Calculi- in horfes, i, 1, 3, 5. i. 1, 3,10. Strabifmus, i 2, 5,4. Strangury, ii. 1, 1, 12. iv. 2, 2, 2. convulfive, iv. 2, 2, 3. Strength and debility metaphors, i. 2, 1. Stridor dentimn, iii. 1,1, 12. Studium inane, iii. 1,2, 2. iv, 2, 4, 2. Stultitia inirritabilis, i. 2, 5, 1. infenfibilis, ii. 2, 1, 1. voluntaria, iii. 2, 2, 2. Stupor, i. 2, 5, 10. Suppl. i. 15, Stye,ii. 1, 4, 4. Subfultus tendinum, iii. 1,1,5. Sudor. See Sweats. Suggeflion, flow, iv. 2, 3, 8. ijuperannuatioh, iv, 2,3,8 Surprife, i. 1, 5, 12. Sweats, warm, i. 1,2, 3. cold, i. 2, 3, 2. lymphatic, i. 3, 2,7. afthmatic, i. 3, 2, 8. iv. 8, 1,2. covered in bed, iv. 1, 1, 2, Suppl. i. 11,6. of the brows, i. 1, 2, 3. in fevers fits, why, i. 1, 2, 5. from exercife, i. 1,2, 3. from heat, i. 1,2, 3. from medicines, i. 1,2, 3. Sweaty hands cured, i, 3, 2, 7. Swinging, ii. 1, 6, 7. makes the pulfe flower, iv. 2, 1, 10. Swing centrifugal, Suppl. i. 15. and 3. Symbols of ideas, iv. 2, 3, 8. Sympathy direct and reverfe, iv. 1, 1. F. with others, iii. 1, 2, 24. of various parts, Suppl. i. 11, 5. reverfe of ladleals and lym- phatics, Suppl. i. 11, 5. of capillaries, Suppl. i. 11, 5. diredl of ftomach and heart Suppl. i. 11,5. how to deftroy, iv. 2, 2, 8. of throat and pubis, iv. 2,1, 7. Syncope, i. 2, 1,4. epileptic, iii. 2, 1,15. Syngultus, ii. 1, 1, 6. nephriticus, iv. 1, 1, T. Syphilis, ii. 1, 5, 2. Syphilis imaginaria, iii. I, 2, 21. Syphon capillary of cloth, ii. 1,8,1. T. Tadlus acrior, i. 5, 5. imminutus, i. 2, 5, 6. Taedium vitas, ii. 2, 1, 2. iii. 1, 2, 11, iii. 2, 1, 8. Tjenia, i 1,4, 11. Tape-worm, i. 4, 1,1. Tapping at the navel, i. 2, 3, 13. Tarditas fenilis, iv. 2, 3, 8. paralytica, iv. 2, 3, 7. Tarfitis, ii. 1, 4,3. Tafte. See Guflus. bitter, not from bile, i. 1, 3, I. Tears fympathetic, iv. 1,2, 1. iii. 1, 1, 10. 1'eeth, to preferve, i. 1. 4,5. fall out whole, ii. 1, 4, 7. Tenefmus, INDEX TO THE CLASSES-Part. II. Tenefmus, ii. 1, 1, 11. calculofus. iv. 1, 2, 8. Tellium dolor nephriticus, iv. 2, 2, 11. tumor in gonnorrhcea, iv. 1, 2, 18. tumor in parotide, iv. 1, 2, 19. Tetanus trifmus, iii. 1,1, 13. dolorificus, iii. 1, 1,14. Thirft. See Sitis and Adipfia. Thread-worm, i. 1,4, 12. Throat fwelled, i. 2, 3, 20. thickens at puberty, iv. 2,1,'7. grown up, i. 2, 3, 25. Thrufh, ii. 1,3, 17. Tic doloureux, i. 2, 4, 12. Tickling, i. 1,5, 8. Timor orci, iii. 1, 2, 15. lethi, iii. 1, 2, 14. paupertatis, iii. 1,2, 13. Tinea, ii. 1, 5,11. Tinnitus aurium. iv. 1, 1, 15. Titibatio, i, i, 5, 8. Titubatio, iingute, iv. 2, 3, 1. Tobacco, fmoke of in piles, i. 2, 1, 6, Tongue dry, i. 1, 3, 1. Suppl. i. 2. coloured mucus, i. 1, 3, 1. Tonfillitis,ii. 1, 3, 3. Tonfils fwelled from bad teeth, i. 2, 3, 21. ii. 1, 3, 3. Tooth-ach, i. 2, 4, 12. ii. 1, 4, 7. Tooth-edge, iv. 1, 2, 3. Toothing, i. 1,4, 5. Tooth-powder, i. 1,4, 5. Torpor of the liver, i. 1,2, 6. of the pancreas, i. 2, 2, 7. of the lungs, Suppl. 1, 9. of the ftomach, Suppl. i 10. of the heart, Suppl, i. 10. Touch. See Tadlus. deceived three ways, i. 2, 5, 9, iv. 2, 1, 10. Transfufion of blood, i. 2, 3, 25. Suppl. i. 14, 4. Tranflation of matter, i. 3, 2, 9. of milk, i. 3, 2, 10. of urine, i 3, 2, 11. Tranfparency of cornea, i. 1, 4, 1. of cryflalline, i. 2, 2, 13. of air before rain, i. 1, 4, 1. Tremor of old age, iii. 2, 1,3. of fever, iii. 1, 1, 2. of anger, iv. 3, 1,4. of fear, iv. 1, 2, 5. Tricks of the face, iii. 1, 1, 5. iv. I, 3, 2 Trifmus, iii. 1,1, 13. Trifmus, dolorificus, i. 2, 4, 12. Twitchings of the face, iv. 1, 3, 2. Tuffis ebriorum, ii. 1, 1,5. convulfiva, iii. 1, 3, 8. hepatica, iv. 2, 1, 2. arthritica, iv. 2, 1,9. periodica, iv. 3, 4, 2. a pedibu« frigidis, iv. 2,1, 7. Tympany, i. 2, 4, 9. Typhus, i. 2, 1, 1. ii. 1, 3,1, U. Ulcers, healing of, i. 1, 8, 13. of the cornea, i. 1, 3, 14. from burns, i. 1,3, 13. fcrofulous, ii. 1, 4, 13. of the throat, ii. 1, 3, 3. ii. 1, 3, 11. of the legs, ii. 1, 4, 14. Unguium morfiuncula, iv. 1, 3, 5. Urethra, fcirrhus of, i. 2,3, 24. fiftula of, ii. 1, 4, 11. Urine, copious, colored, i. 1,2, 4. copious, pale, i 2, 3,5. ' diminifhed, coloured, i. 1, 3, 7. diminifhed, pale, i. 2, 2, 5. its mucus, faits, Pruffian blue, i. 1, 2, 4. why lefs and coloured in drop- lies, i. 1,3, 7. tranflation of, i. 3, 2, 11. difficulty of, iii. 2, 1, 6. not fecreted, i. 2, 2, 8. pale after meals, iv. 2, 1, 2. pale from cold Ikin, iv. 2,1, 3. fediment in fevers, Suppl. i. 2, 3. pale in fevers, Suppl. i. 2, 3S and 5. Urticaria, ii. 1, 3, 16. Uteri defcenfus, i. 1,4, 8. retroverfio, i. 2, 1, 14, V. Varix, i. 2, 1, 19. Vacillatio fenilis, iii. 2, 1, 2. Varicella, ii. 1,3, 15. Variola, ii. 1, 3, 9. eruption of, iv. 2,1,12. Vaforum capil. retrogreffio, i. 3, 3, I, Venereal orgafm, iv. 1, 4,4. difeafe, ii. 1, 5, 2. imaginary, iii. 1,2, 21. Ventriculi tegritudo, i. 2, 4,4. veficatorio, fana- ta, iv. 1, 1, 3. Vermes, i. 1,4, 10. Vertigo rotatory, iv. 2, 1, 10. of fight, iv. 2,1, 11. Vertigo 523 524 INDEX TO THE CLASSES-Part II. Vertigo inebriate, iv 2, 1, 12. of fever, iv. 2, 1, 13. from the brain, iv. 2, 1, 14. of the ears, iv. 2, 1, 15. of the touch, tafte and fmell, iv. 2,1, 16. with vomiting, iv. 2, 3, 2. produces flow pulfe, iv. 2, 1, 10. of blind men, iv. 2,1, 10. ufe of mercurials in it, iv. 2, 1,11. Vibices, i. 2, 1,16. Suppl. i. 2, 7. Vigilia, iii. 1, 2, 3. iv. 1, 3, 6. Vinegar, in petechias, i. 2,4, 17. in fcarlet fever, i. 1,3, 11. Vifion acuter, i, 1, 5, 1. diminifhed, i. 2, 5, 2. expends much fenforial power, i. 2, 5, 3. Vita ovi, iv. 1, 4, 1. hiemi-dormientium, iv. 1, 4, 2. Vitus's dance, iv. 2, 3, 2. Volition, three degrees of, iii. 2,1, 12. leflens fever, iii. 2, 1, 12. Suppl i. 11, 6 produces fever, iii. 2, 1, 12. without deliberation, iii. 1, 1, iv. 1,3,2. Vomica, ii 1, 6, 3. Vomitus, i. 3, 1, 4, Vomendi, conamen inane, i. 3, 1, 8. Vomiting flopped, iv. 1, 1, 3. iv. 1, 1. F. voluntary, iv. 3, 3, 2. how acquired, iv. 1,1,2. F. vertiginous, iv. 3, 2, 3. from ftone in ureter, iv. 3, 2, 4. Vomiting from paralytic ftroke, iv. 3, 2, 5. from tickling the throat, iv. 3, 2,'6. fympathifes with the fkin, iv. 3, 2, 7. in haemaptoe, i 1,1,4. from defeat of affociation, iv. 2, 1, 10. Vulnerum cicatrix, i. 1, 3,13. W. Watchfulnefs, iii. 1, 2, 3. iv. 3, 2,5. Water-qualm, i. 3, 1, 3. Weaknefs, three kinds of, i. 2, 1. Whirling-chair, Suppl. i. 15, 3. Whirling-bed, Suppl. i. 15, 7. i. 2, 5, 5. White fwelling, of the knee, i. 2, 3, 19. Whitlow, fuperficial, ii. 1, 4, 5. internal, ii. 1, 2, 19. Wine in fevers, ii. 1, 3, 1. iv. 2, 1, 12. Winking, ii. 1, 1, 8. i. 1, 4, 1. iv. 3, 2, 2. Winter-fleeping animals, iv. 1, 4, 2, Womb, defcent of, i. 1,4, 8. retroverlion of, i. 2, 1, 14. inflammation of, ii. 1,8, 16. Worms, i. 1, 4,10. mucus counterfeits, i. 1,3, 4. in fheep, i. 1,4, 10. Wounds, healing of, i. 1, 3, 13. Y. Yawning, ii. 1, 1,9. Yaws, ii. 1, 5, 5. Z. Zona ignea, ii. 1, 5, 9. iv. 1, 2,11. ii. 1. 2, 14.