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THE
STUDY  OF MEDICINE.
9>SB7SII®lEi®aiI0AJ&  SVS1FSI
NOSOLOGY.
BY
JOHN MASON GOOD, M. D.  F. R. S.

   MEM. AM. PHIL. SOC. AND F. L. S. OF FHIIADEtPHIA.
IN FIVE VOLUMES
VOL. IV.
FOURTH AMERICAN EDITION.
             Piflatteijrttta:

H. C CAREY & I. LEA, E. PARKER, MAROT & WALTER, A\i»
              T. DES1LVER .*
                 AND
        COLLINS & HANNAY, NEW-YORK.
                1825. 
m
    j^ljiiaMlpljia,
Ptinteii by Wiliiak Browx. 
CLASS V. 
         CLASS V.





      GENETICA,




 DISEASES OF THE SEXUAL FUNCTION




ORDER I.




         CENOTICA.




           AFFECTING THE FLUIDS




       II.




         ORGASTICS




           AFFECTING THE ORGASM*




      III.




         CARPOTICA.




           AFFECTING THE IMPREGNATION 
CLASS V.
PHYSIOLOGICAL PROEM,
\Ve now enter upon the maladies of that important  function by
which animal life is extended beyond the individual that possesses
it, and propagated from generation to generation.  To  this division
of diseases the author has given the classic name of genetica, from
ytivopxt, " gignor," whence genesis (yittrts) " origo," " ortus."
   In almost every preceding system of nosology the diseases of this
function are scattered through every division of the classification,
and are rather to be found by accident, an index, or the aid of  the
memory, than by any clear methodical clue. Dr. Macbride's classi-
fication forms the only exception I am acquainted with ;  which,
however, is rather an attempt at what may be  accomplished, than
the accomplishment itself.  His division is into four orders ; gene-
ral, and local as proper to men, and general, and local  as proper to
women ; thus giving us in the ordinal name little or no  leading idea
of the nature of the diseases  which each subdivision is to include,
or any strict line of division between them ; for it must be obvious
that many diseases commencing locally very soon become general,
and  effect  the entire system, as  obstructed menstruation; while
others, as abortion, or morbid pregnancy, may be both  general and
local.
   Under the present system,  ther-fore, a different arrangement is
chosen, and one  which will perhaps be found not only mure strict
to the limits of the respective orders, but more explanatory of  the
leading features of the various genera or species that are included
under them.  These ordei> are three:  the first  embracing those
diseases that affect the sexual ttui Is  the second those that affect the
orgasm ;  and the third those that affect the i-noregnation.  To  the
first order i9 applied the term cenotica (*?v»t<«s  from  xtvarif-
" evacuatio," "exinanitio," to the second oho\stica («fy*o-Tjxos)
from «fy*£» " irrito," " incito," and especially libidinose; and to
the third carfotica (x.*^totik») from kxattcs,  " fructus."
   Before we enter upon these divisions, it will  perhaps  prove  ad-
vantageous to pursue the  plan we have hitherto followed upon 
6
PHYSIOLOGICAL PHOEM.
[CL. V.
commencing  the  preceding classes, and  take a  brief survey of
the general nature of the function before  Us, under the following
heads:
   I. THE MACHINERY BY WHICH IT OPERATES.
  II. THE PROCESS BY WHICH IT ACCOMPLISHES ITS ULTIMATE END.
  III. THE DIFFICULTIES ACCOMPANYING THIS PROCESS WHICH STILL
REMAIN  TO BE EXPLAINED.
  I. One of the chief characters by which animals and vegetables
are distinguished  from minerals, is to be found in the mode of their
formation or origin.   While minerals are  produced fortuitously or
by the casual juxta-position of the different particles that enter into
their make, animals and vegetables can only be produced by gene-
ration, by a system of organs contrived  for this express  purpose,
and  regulated by  laws peculiar to itself.
  Generation is effected in two ways : by the medium  of seeds or
eggs, and by  that of  offsets:  and it has been supposed that there
may be  a third way, to  which  we shall advert hereafter; that ot
the union of  seminal  molecules, furnished equally  by the male and
the  female, without the intervention of eggs; which constitutes the
leading principle  of what has been called  the theory of epi-genesis.
  Many plants are propagable by offsets, and all plants are suppos-
ed to be so by eggs or seeds.   As we descend in the scale of ani-
mal  life, we meet in the lowest class, consisting of  the worm tribes,
with examples of  both these modes of propagation  also.   For
while a production by ova is more commonly adhered to, the hydra
or polype is  well known to multiply by  bulbs or knob? thrown
forth from  different  parts of the body, and the hirudo vindis, or
green leech, by longitudinal sections, which correspond  with the
slips or suckers of plants.
   In these cases  we meet with no distinction of sex; the same in-
dividual being capable of continuing its own kind by a  power  of
spontaneous  generation.  In other animals of the worm  class we
trace examples of the organs of both sexes united in the  same in-
dividual, making a near approach to the class of monoicous  plants,
er  those which bear  male and female  flowers distinct from each
other but on  the  same  stock, as  the  cucumber: thus  constituting
proper  hermaphrodites, evincing  a complexity of  sexual structure
which is not to  be  found in any class of animals  above that  of
 worms.  Some of the intestinal worms  are of this description, as
 the fasciola  or fluke,  which  is at the  same  time oviparous, the
 ovaries being placed  laterally.
   The  helix  hortensis, or garden-snail, is hermaphrodite, but incapa-
 ble of breeding singly.   In order to accomplish this, it is necessary
 that one individual should copulate with another, the male organ of
 each uniting with the female, and the female with the male, when
 both become impregnated.  The manner in which this  armour is 
GL. V.]
PHYSIOLOGICAL PROEM.
7
conducted is singular and highly curious.   They make their  ap-
proach by discharging several small darts at each Hfther, which  are
of a sharp form, and of a horny substance.   The quiver is contain-
ed within a cavity on the right side of the neck, and the darts are
launched  with some degree of force, at about the distance  of two
inches, till the whole are exhausted; when the war  of love is over
and its consummation succeeds.  The increase is by eggs, which
are perfectly round, and about the size of small peas.
  There are some animals in which a single impregnation is capa-
ble ot producing several generations in succession: we have a fami-
liar example ot this in the common cock and hen ;  for a single co-
pulation is here sufficient to give fecundity to as many eggs as will
constitute a whole brood.   But the same curious fact is  still more
obvious in various  species of insects, and  especially in the aphis
(puceron  or  green plant  louse) through all its division, and  the
Daphnia Pulex of Miiller and Latreille  (the monoculus Pulex of
Xinneus.)  In both these a single impregnation will suffice for at
least six or seven generations; in  both which, likewise, we  have
another curious deviation from the common laws  of propagation,
which is that in the warmer summer months the young are produc-
ed viviparously, and in the cooler autumnal months oviparously.
It is also very extraordinary that,  in the aphis,  and  particularly in
the viviparous broods, the offspring are many of them winged and
many of them without wings or distinction of sex:  in this  respect
making an approach to the working-bees, and still  more  nearly to
the working-ants, known, till of late, by the name of neuters.
   For the generative process which takes place in  these two last
kinds we are almost entirely indebted to the nice and persevering
labours of the  elder and the young Huber; who have  decidedly
proved that what have hitherto been called neuters are females
with undeveloped female organs, and therefore non-breeders; but
whose organs,  at least in the case of bees,  are capable of develop-
ment by a more stimulating or richer honey, with which one of
them, selected from the rest, is actually treated for this purpose by
the general consent of  the hive on the accidental loss of a queen-
bee,  or common bearer of the whole, and  in order to supply her
place.  It is these alone that are armed with stings; for the males,
or drones, as we commonly call them, are without stings ;  they are
much larger than  the non-breeders or workers,  of a darker colour,
and make a great buz in flying.  They are always less numerous in
a hive than the workers, and only serve to insure the impregnation
 of the few young queens that may be produced in the course of the
season, and are regularly massacred by the stings of the workers in
the beginning of the autumn.  The impregnation of the queen-bee
is produced by a process too curious to be passed over. It was con-
jectured by Swamiuerdam that this was effected by an aura seminalis
thrown  forth from the body of the whole of the drones  or males
collectively. By other naturalists it has been said, but erroneously,
to take place from an intermixture of a male milt or sperm with 
f
PHYSIOLOGICAL PROEM.
£CL. V.
  the eggs or sp^wn of the queen-bee,  as in the case of fishes.   M.
  Huber, however,' has sufficiently proved that the queen-bee for this
  purpose forms an  actual coition,  and this never in the  hive, but
  during a tour into the air, which she takes for this purpose, a few-
  days only after her birth, and in the course of which she is sure to
  meet  with some one or other of her numerous  seraglio of males.
  As soon as copulation has been effected,  she returns to the  hive,
 which is usually in the space of about half an hour, and often bears
 home  with her the full proofs of a  connexion in the ipsa verenda of
 the drone ; who thus wounded and deprived of his virility by the
 violence of his embrace, dies almost immediately afterwards.  This
 single impregnation will serve to fecundate all the eggs the queen
 will lay for two years at least;  Huber believes for the whole of her
 life ; but he has had repeated proofs of the former.   She begins to
 lay her  eggs, for  the bee is unquestionably oviparous, forty-six
 hours  after impregnation, and will commonly lay about three thou-
 sand in  two months, or,  at the rate of fifty eggs daily.  For the-
 first eleven months she lays  none but the eggs of workers; after
 which she  commences a second laying which consists of drones'
 eggs alone.
   Of the mode of procreation among fishes, in consequence of their
 living in a different element from our own, we know but little.   A
 few of them, as the squalus, or shark genus, some of the skates, and
 other cartilaginous fishes, have manifest organs of generation, and
 unquestionably copulate.  The male shark, indeed, is furnished with
 a peculiar  sort of holders for the purpose of maintaining his grasp
 upon the female amidst the utmost violence of the waves, and his
 penis is cartilaginous or horny.  The female  produces her young
 by eggs, which, in  several species of this genus, are hatched  in
 her own body, so that the young, when cast forth, are viviparous.
   The blenny produces its young in the same manner; in most spe-
 cies by spawn or eggs hatched externally, but in one or two vivi-
 parously, three or  four hundred young being thus brought forth at
 a time.  The blenny, however, and by far the greater number  of
 fishes,  have no external organ of generation, and appear to  have
 no sexual conpexion.  The females, in a particular season of the
 year,  seem merely to throw  forth  their ova,  which we call  hard
 roe or spawn, in immense multitudes, in some shallow part of the
 water in which they reside, where it may be best exposed to the
 vivific action of the sun's rays;  when the male shortly afterwards
 passes  over the spawn or hard roe, and discharges upon it his sperm,
 which we call soft  roe or milt.  These substances are contained ia
 the respective sexes in two bags  that unite near the podex, and at
 spawning time are very much distended.  The spawn and milt thus
 discharged intermix; and,  influenced by the vital warmth of the
sun, commence a  new action, the result  of which  is a shoal of
young fishes of a definite  species.
  Yet though no actual connexion can be traced among the greater
 number of the class of fishes, something like pairing is often dis- 
CL. V.]
PHYSIOLOGICAL PROEM.
9
cernible among many of those that have no visible organs of copu-
lation :  for if we watch attentively the motions of such as are kept
in ponds, we shall find the sexes in great tumult, and apparently
struggling together among the grass or  rushes at the brink of the
water,  about spawning-time ; while the male and female salmon,
after having  ascended a fresh stream to  a sufficient height and shal-
lowness for the purpose, are well knov/n to unite  in digging a nest
or pit in the  sand,  of about  eighteen inches in depth, into which
the female casts her spawn,  and the male immediately  afterward
ejects his milt;  when the nest is covered over with fresh  sand by a
joint exertion of their tails.
  The salmon, the sturgeon, and  many other marine fishes, seek
out a fresh-water stream  for this  purpose: and  their navigations
are often  of very considerable length  before they  can satisfy them-
selves,  or obtain a proper gravelly bed.   The salmon tribe some-
times make  a voyage  of several hundred  miles, cutting  their way
against  the most rapid currents, leaping over floodgates, or up cata-
racts of an astonishing height: in their endeavour to surmount which
they often fail, and tumble back into the water ; and, in some places
are, in  consequence, caught in baskets placed in the current for this
purpose.
  The power of fecundity in fishes surpasses all calculation,  and
appears almost incredible. A single herring,  if suffered to multiply
unmolested,  and undiminished for twenty years, would show a pro-
geny greater in bulk  than the globe itself.  This species,  as also
the  pilchard, and some others of the genus clupea,  as a proof  of
their great  fertility,  migrate annually  from the Arctic regions  in
shoals of such vast extent, that for miles  they are seen  to darken
the surface of the water.
  The mode of procreating  among frogs doos not much  vary from
that of fishes.  Early  in the spring the male is found upon the back
of the female in close contact with her, but there is no discoverable
communication, although  this contact continues  for several days;
nor  can we trace in the male any external genital  organ.  After the
animals quit each other, the female seeks out some secure and ^hal-
low  water, in which, like the  race of fishes, she deposits her spawn,
which consists of small specks held together  in a  sort of chain  or
string by  a whitish glutinous liquor that envelops them ; and over
this  the male passes and deposits his sperm, which soon constitutes
a part of the glutinous matter itself.   The  result is a  fry  of minute
tadpoles,  whose evolution into the very  different form and organi-
zation of frogs, is one of the most striking curiosities of natural his-
tory. In the Surinam toad (rana Pipa),  this process is varied. The
female here deposits her eggs or spawn without any attention to or-
der; the male takes up the amorphous mass with his feet and smears it
over her back, driving many of the eggs hereby into a variety of cells
that open upon it; and afterwards ejecting over them  his  spermous
fluid.  These cells are so  many nests in which the eggs are hatched
  VOL. IV.                       B 
 10                PHYSIOLOGICAL PROEM.              [CL. V.

 into tadpoles, which are perfected and burst their imprisonment in
 about three months.
   But a volume would not suffice to point out all the singularities
 exhibited  by different animals in the economy of procreation.  It
 is worth while, however, to notice how variously some of the or-
 gans of generation are situated in many tribes. In the female libel-
 lula, or dragon-fly, the vagina is situated on the upper part of the
 belly near the breast.  In  the male spider, the generative organ is
 fixed on the extremity of an antenna.  In the female ascaris vermi-
 cutaris, or  maw-worm, the young are discharged  from  a minute
 punctiform aperture a little below the head, which appears, there-
fore, to constitute the ascarine  vagina.  In the snail we find  this
 organ placed near the neck, in the immediate vicinity of the spira-
 cle which serves for its lungs.  The taenia solium,  or tape-worm,
 throws forth its young from the joints.   So some plants bear flow-
 ers on the petioles or edges of the leaves instead of on the flower-
 stalk.
   In like manner, while the mammse in the human kind are placed
 on the chest,  and made a  graceful and attractive ornament, in all
 quadrupeds they are placed backward, and concealed by the thighs.
 In the mare, the teats, which are two, are inguinal;  in the horse,
 they are singularly placed  on the glands penis.
   The testes of most animals that possess this organ, and  procreate
 only once a year, are extremely small during the months in which
 they are not excited.  Those of the sparrow, in the winter-season,
 are scarcely larger than a pin's head,  but in the spring are of the
 size of a hazle-nut.   In man this organ, before birth, or rather dur-
 ing the early months of pregnancy, is an abdominal viscus : about
 the seventh month it descends gradually through the abdominal  ring
 into the scrotum,  which  it reaches in the eighth month.  And if
 this descent do not take place anterior to birth,  it is accomplished
 with difficulty, and  is rarely completed till the seventh or eighth
 year.  Sometimes,  indeed, only one testes descends under these
 circumstances, and  occasionally neither.
   There is a set of barbarians at the back of the  Cape  of Good
 Hope who appear to be very generally monorchid,  or possessed of
 only a single testis ; and Linneus, believing this to be a natural and
 tribual defect, has made them  a distinct variety of the human  spe-
 cies.  Mr. Barrow has noticed the same singularity : but it is doubt-
 ful whether, like the want of a beard among the American savages,
 this destitution is not owing to" a barbarous custom of extirpation in
 early life.   It is generally admitted that the productive power of
 man is greatly impaired, if not totally lost, by a retention of  both
 testes in the abdomen :  yet in the erinaceus  or  hedge-hog genus,
 and a few other quadrupeds, they never quit the cavity of the ab-
 domen.  In the cock, whose penis is dichotomous or two-pronged,
 they are situated on each side of the back-bone.
   It has been made a question among physiologists whether the se-
 minal fluid is secreted by the testes at the moment  of the demand, 
k L. V.]
PHYSIOLOGICAL PROEM.
11
or gradually and imperceptibly in the intervals of copulation, and
lodged in the vesiculfe seuiinales as a reservoir for the generative
power to draw upon.  The latter is  a common opinion.  It is, how-
ever, opposed, and with very powerful arguments, by Swammerdam
and Mr. John Hunter.  The  secretion found in the vesiculse seuii-
nales is different from that of the testes in the properties of colour
and smell; those of the former  being yellow and inodorous, those
of the latter whitish, and possessing the odour of the orchis-root, or
the down  of  chesnuts.  On the dissection of those who have natu-
rally or accidentally been destitute  of one testis, the vesicula of the
one side has been found filled with the same fluid, and as largely as
that of the  other; and consequently the fluid on the  vacant  side
must have been supplied by a secretory action of the  vesicula it-
self.  There  are  no  organs of generation that differ so much in
their form and comparative size in different animals as these vesi-
cular bags :  in  the  hedge-hog they are twice as large as in man,
and in many animals  they  are utterly wanting. They  are so in the
dog, which continues  for a very long time in a state ot copulation,
and in birds, whose copulation is momentary.  They are, moreover,
wanting in most animals whose food is chiefly derived from an ani-
mal  source,  though not in  all,  as the hedge-hog,  to which I have
just referred, is an example of the contrary.
   Mr. Hunter hence  concludes that the vesiculse seuiinales are not
seminal reservoirs but glands secreting  a  peculiar mucus, and that
the bulb  of the urethra is,  properly  speaking, the receptacle in
which the semen is accumulated previous to ejection.  Of the actual
use of these  vesicular bags, he  confesses himself to  be ignorant,
yet imagines that in some way or other they are subservient to the
purposes of generation, though not according to the common  con-
jecture.
   The ovaria are to  the  female what the testes are  to the male.
They were formerly,  indeed, called female testes, and furnish, on
the part of the female, what is necessary towards  the production of
a progeny.  They are, in fact, two spheroidal flattened bodies, in-
closed between the folds of the broad ligaments by which  the ute-
rus is suspended.  They have  no  immediate connection with  the
uterus ;  but  near them the extremity of a tube, which opens on
either side into that organ, hangs with loose fimbriee in the cavity
of the abdomen into which it opens  at the fimbrial end.  This tube
is called the Fallopian, from the name of its discoverer.*   At the
age of puberty, the ovaria acquire their full growth, and continue
to weigh about a drachm and a half each till menstruation ceases.
They contain a peculiar fluid resembling the  white of eggs, once
supposed to be secreted by the glandular structure of various small
bodies imbedded in them,  which have been  denominated corpora
lutea.  By some early writers this fluid was contemplated as a fe-
male semen,  forming  a counterpart to the semen  of males ; but it

                    * Fallop. Observ. Anat. 197. 
IS                PHYSIOLOGICAL PROEM.              [CL. V.

has since been held, and the tenet is well supported by anatomical
facts, to be a secretion of a different kind thrown forth in conse-
quence  of the  excitement sustained by the separation of one or
more of the minute  vesicles,  which seem  to issue from them a9
their nucleus or matrix, and which are themselves regarded by the
same school as  the real ovula of subsequent fetuses : to which sub-
ject, however, we shall advert presently.
   It is singular to contemplate the very powerful influence which
the secretion,  or even the preparation  for  secreting the seminal
fluid, but still more its ejection, produces over the entire system.
   On the perfection, and a certain and entonous degree of distention,
of the seminal vessels,apparently producing an absorption ot the fluid
when at rest, the spirits, the vigour, and the general health of man de-
pend. Hence antecedently to the full elaboration of the sexual system,
and the secretion of this fluid, the  male has scarcely any distinctive
character from  the female : the face  is fair and beardless, the voice
shrill, and the courage doubtful. And whenever, in subsequent life,
we find this entonous distention relaxed, we find at the same time
languor, debility, and a want of energy both in the corporeal  and
mental functions.  And where the supply is entirely suppressed or
cut off by accident, disease, or unnatural mutilation, the whole sys-
tem is  changed, the voice weakened,  the beard checked in its
growth, and the sternum expanded : so that the male again sinks
down into the female character. These changes occur chiefly where
the testicles are extirpated before manhood; but they take place
also, though in  a less degree, afterwards.
   In like manner, during the discharge  of the seminal fluid in  sex-
ual commerce,  the most vigorous  frames of the stoutest animals be-
come exhausted by the pleasurable shock : and  the feeble frames
of many of the insect tribes  are  incapable of  recovering from the
exhaustion, and perish  immediately afterwards ; the female alone
surviving to give maturity to the  eggs hereby fecundated.  The
same effect  occurs after the  same consummation in plants.  The
stoutest tree, if superfructified,  is  impaired for bearing fruit the
next year;  while the plants of the feeblest structure die as soon as
fructification has taken place.   Hence, by preventing fructification,
we are enabled to prolong their duration ; for by taking away the
styles  and  stigmas, the filaments and anthers,  and especially by
plucking off the entire corols of our  garden-flowers, we are able of
annuals to make biennials, and of biennials triennials.
   In many animals, during the season of their amours, the aroma of
the seminal fluid is so strong, and at the same time so extensive in
its influence as to taint the flesh ; and hence the flesh of goats at this
period is not eatable.  Most fishes are extremely emaciated in both
sexes at the same time, and from the same cause, and are equally un-
fit for the table.  Stags, in the rutting season, are so exhausted as to
be quite lean and feeble, and to retire into the recesses of the forest
in quest of repose and quiet.  They are  well known to be totally
inadequate to the chase j  and hence, for the purpose of maintaining 
CL. V.]
PHYSIOLOGICAL PROEM.
13
a succession of sporting, they are sometimes  castrated, in  which
state  they are called  heaviers.   If the castration be performed
while the  norns are shed,  these  never grow  again ; and,  if while
the horns  are in perfection, they  are never shed.
  The male and female rein-deer (cervus Tarandus) ordinarily cast
their horns every  year in November.  If the male  be castrated the
horns will not grow after he is nine years old ; and the female, in-
stead of dropping her horns as usual in November, retains them, if
gravid, till she fawns, which is about the middle of May.   In this
case the usual stimulus necessary for the operation of exfoliation  is
transferred to another part of the  system. And for the same reason,
we often find that a broken bone in a pregnant woman will  secrete
no callus, and, consequently, not unite till after child-birth.   In the
former case the roots of  the horns are  affected by sympathy with
the general sexual system,  of  which, indeed,  they may be  said to
form a part,  and by their  superior size are discriminative of the
male sex.   In the human race, the strong deep voice characteristic
of manhood  is rarely acquired,  if castration  be performed in in-
fancy.
  There is no animal, perhaps, but shows  some sympathic action
of the  system at large, or some  remote part of it  with the genital
organs, when they are in a state of peculiar excitement.   The tree-
frog (rana arborea) has, in the  breeding season, a peculiar orbicular
pouch  attached to its throat; the fore-thumb  of the common male
toad is at the same season affected  with warts : and the females of
some of the monkey tribes evince a regular  menstruation.
  II. The process by which the generative  power is able to accom-
plish its ultimate end, is to the present hour  involved in no small
degree of mystery ; and has given rise to three distinct and highly
ingenious  hypotheses that  have a strong claim upon our attention.
and which we shall proceed to notice in the order in  which they
have appeared.
  The first and most ancient of these consists in regarding the fetus
in the  womb as the joint production of matter afforded in coition by
both sexes, that of the male being secreted  by the  testes, and that
of the  female by  the uterus itself, or  some  collateral organ, as the
ovaria, which last, however, is a name of  comparatively  modern
origin,  and derived from a supposed office which was not contem-
plated among the ancients.  To  this hypotheses has been given the
name of epigenesis.
  The seed or matter afforded by the female was regarded by Hip-
pocrates,  Aristotle, and Galen, as the menstrual blood or secretion,
which  they supposed furnished the  substance  and  increment of the
fetus,  while the male semen furnished the living principle: Empe-
docles, Epicurus,  and various other physiologists contending, on the
contrary, that the father and mother respectively contributed a se-
minal  fluid that equally co-operated in the generation and growth of
the fetus, and stamped it a male or a female, and with features more
closely resembling the one or the other according as the orgasm of 
14
PHYSIOLOGICAL PROEM.
[CL. V.
either was  predominant at  the  time, or accompanied with a more
copious discharge.  In the words of Lucretius, who has elegantly
compressed the Epicurean doctrine :
         Et muliebre oritur patrio  de semine seclum ;
         Maternoque mares exsistunt corpore cretei.
         Semper enim partus duplici <le semine constat :
         Atque, utri simile est magis id, quodquomque creator,
         Ejus habet plus parte aequa, quod cernere possis,
         Sive virum suboles, sive est muliebris origo.*
  The distinction of sex, however, was accounted for in a different
manner by Hippocrates,  who supposed that  each  of the sexes pos-
sesses a strong and a weaker seminal fluid ; and very ungallantly as-
serted  that the male fetus was formed by an intermixture of the ro-
buster  fluids  of the two sexes,  and the female by that of the more
imbecile.   Lactantius, in quoting the opinion of Aristotle  upon this
subject, adds fancifully enough "that the right side  of the  uterus is
the proper  chamber of the male fetus,  and the left  of the  female :
a belief which is still prevalent  among the vulgar in many parts of
Great  Britain.   But he adds that if the male, or stronger, semen
should by mistake enter the left side of the uterus a male child may
still be conceived ;  yet, inasmuch as  it occupies the female depart-
ment, its voice, its face, and its general complexion will be effemi-
nate.   And, on the contrary, if the weaker or female seed should
flow into the  right side of the uterus, and a female  fetus be begot-
ten, the female  will exhibit many signs of  a masculine character,
and be inordinately vigorous and muscular, t
  The doctrine of epigenesis under  one modification or  another,
continued to  be the leading, if not the  only  hypothesis  of the day
till the beginning of the sixteenth century, when, in  consequence of
the more accurate examinations  and dissections of Sylvius, Vesalius,
Fallopius, and De Graaf, the organs which had  hitherto  been re-
garded as female testes, and so  denominated, were now declared to
be repositories of minute ova, and at length named ovaria  by Steno
in 16674   We now therefore enter upon the  second of the three
hypotheses above alluded to, which derives the fetus from rudi-
ments  furnished by the mother alone.  This hypotheses was origi-
nally advanced by Josephus de Aromatariis, as flowing from these
anatomical discoveries, but was  chiefly brought into notice by Swam-
merdam and  Harvey, who established the doctrine  of omne ab ovo.
Observing  a cluster of about fifteen vesicles in each of the female
ovaria, apparently filled with a minute drop of albuminous yellow
serum, and perceiving that they appeared to diminish in number in
some kind  of proportion to the  number of parturitions a woman had
undergone, it was conceived by these  physiologists that such vesi-
* De Rer. Nat. Lib. iv. 1220.
f De opificio Dei. Cap. xn.
i F.lem. Myologise Specimen, p. 117. 
CL. V.]
PHYSIOLOGICAL PROEM.
id
cles  are inert eggs or ovula, containing miniature embryons of the
form to be  afterwards evolved, one of  which,  by the  pleasurable
shock that darts over the whole body,  but in  an especial degree
through this  organ, during the act of copulation, is instantly thrown
into  a state of vital activity, detached from the common  cluster, and
in a  short time passes into the uterus through the canal of the Fal-
lopian tube  which spontaneously enlarges for the purpose ;  where
its miniature germ is gradually unfolded and augmented into a sen-
sible fetus, partaking of  the form and figure of the parent stock.
The elementary animalcule, it was farther asserted by Harvey, may
be occasionally impressed with a resemblance in its features to the
father from  the electric impulse given in the genial act to every
portion of the solids and fluids of the body, and of consequence to
the fluid contained  in the ovula  themselves : but, reasoning from
the length of the vagina  in cows and many other animals, and an
occasional dissection of the human  subject soon after coition,  he
contended that the male semen never did, or indeed, could enter the
uterus, and  of course could not add any thing to the embryon in its
evolution.
   Leewenhoek  and Hartsoeker, however,  upon a more  accurate
anatomy of the uterus immediately after copulation, discovered not
only that the projected male semen could enter its cavity, but actu-
ally did thus enter, and in some instances,  which fell within their
notice, had  clearly  ascended into the Fallopian  tubes.  And now a
new doctrine was started, and one altogether opposite to the  theory
of Harvey.   Upon the principle of the former, the  father had  no
immediate connexion with his own child ; he could not bestow upon
it a particle of  his own matter, and the  whole  production was the
operation of the mother.  But, in  consequence of this later discove-
ry, it was contended that the entire formation was the  work of the
father, and that the mother, in her turn, had nothing to do with  it:
that every particle of the propelled fluid was a true and proper  se-
minium, containing in itself, like the ovulum of the female upon the
hypothesis of Harvey, a miniature of all the organs and members of
the  future fetus, in due time to be gradually evolved and augment-
ed ; and that the uterus, and possibly the ovulum, into  which some
one of these male semima or seminia is almost sure of being protrud-
ed in the act of generation, offers nothing more than a nest, in which
the homunculusor rudimental fetus is deposited for warmth and nu-
triment. And as the former hypothesis appealed to the natural eco-
nomy of oviparous animals during the period of incubation, that of
worms and tadpoles was  appealed to by the latter : and a very con-
siderable  degree of life and motion was  supposed to be discovered
and proved by the aid of good magnifying glasses in the simple fluid
of the male  semen insomuch that no less than many millions of these
homunculi,  or unborn manikins, were pointed out as capering in a
diameter  not greater than that  of the smallest  grain of sand, each
resembling  the tadpole in shape.  Delappius, indeed, a celebrated
pupil of Leewenhoek, advanced  farther; for he  not  only saw these 
IQ                 PHYSIOLOGICAL PROEM.             [CL- V.

homuncular tadpoles, but pretended to  trace one of them bursting
through the tunic by which it was swaddled, and exhibiting  two
arms, two legs, a human head and heart.
   Such was the dream of the popular philosophy on the subject ot
generation indulged in at the  period we are now adverting to, and
which continued for upwards of a century.   It is truly astonishing
to reflect on the universality with which this opinion was accredited,
and how decisively every anatomist, and indeed every man who pre-
tended to the smallest poVtion of medical science, was convinced that
his children were  no more related, in point of generative power, to
his own wife  than they were to his neighbour's.  It was  in  vain
that Verheyen denied  the existence of  animalcules in the seminal
fluid, and undertook to demonstrate, that the motion supposed to be
traced there, was a mere  microscopic delusion : it  was in vain to
adduce the fact of an equal proportion of paternal and maternal fea-
tures in almost every family  in the world, the undeviating intermix-
ture of features in mules, and  other hybrid animals, and the casual
transfer of maternal impressions to the unborn progeny when  sud-
denly  frightened  in the earlier months of pregnancy.  The theory,
as it was triumphantly called, of generation ab animalculo maris,
was still confidently maintained ; and  the mother, it was contend-
ed, had nothing to do with the formation of her own offspring, but
to give it a warm nest and nourishment.
   At length arose the celebrated and indefatigable Buffon, who was
not inattentive to the facts before him, nor to the absurdities to
which some of them had led.  He readily accredited the microsco-
pic motion pointed  out by  Leewenhoek in the floating bodies of
male semen, and  which Spalanzani  has since persuaded himself he
has detected not only in this fluid but in various others of an animal
origin ;* but instead of admitting them to be animalcules, he regard-
ed them as primordial monads, molecules organiques, of a peculiar
activity existing through all nature, and  constituting the nutrient
elements  of living matter: and upon this principle he founded not
indeed a  new  hypothesis, but a new edition of that of epigenesis,
with so much accessary, and in his view of the subject, important
matter, as very nearly to entitle it  to the character of an  original
plan.   Like the speculations to which it succeeded, it soon acquir-
ed a very high degree of popularity.
   All organized beings, and  hence plants as well as animals, accord-
ing to the doctrine of M. de Buffon, contain a vast number of these
active  molecules in  every part of their  frames, but especially in
the generative organs of both sexes, and the seed-vessels of plants,
in which  they are more numerous than in any other parts.  These
organic primordia afford nutrition and growth to the animal and ve-
getable fabrics ; and, as soon as these fabrics are matured, and con-
sequently a smaller proportion of such molecules are requisite,  their
surplus is secreted and strained off for the formation  of vegetable

   * Opuscoli de Fisica, Animale, Yegitabile, &c. vol. ii. 8vo. Milan. 1776. 
CL. V.]
PHYSIOLOGICAL PROEM.
17
and animal seeds.  The existence of ovula, in the female ovaria,
impregnated and detached at the time of conception, is by this hy-
pothesis declared to be a chimsera, and their passage into the uterus
asserted to be contrary to all observation and fact.  The ovaria are
once more regarded as female testes receiving, like  those of the
male, the surplus of the organic molecules of the body, and secret-
ing  them, like the  latter, for the common purpose of generation.
The seminal liquor thus  secerned in the male and female frames
are, in the act of coition, projected simultaneously into the uterus,
and, becoming intimately blended there, produce, by a kind of fer-
mentation, the first filaments of the fetus, which grow and expand
like the filaments of plants.  To render such combination of semi-
nal fluids productive, however, it was contended that their quanti-
ties must be duly proportioned, their powers of action  definite, and
their solidity, tenacity, or rarefaction symphonious; and the fetus,
it was added, would be either male or female, as the seminal  fluid
of the man or woman abounded most with organic  molecules, and
would  resemble  either  the  father  or  the  mother, according to
the  overbalance  of the respective elements contributed  by  each
parent.
   It is obvious, from this brief view  of the subject, that Buffon  in
the planning of this hypothesis did nothing more than  avail himself
of the anatomical facts of Vesalius, De Graaf, and  Harvey and the
supposed discoveries of Leewenhoek, to revive in a new form the
doctrine of the Greek schools, and especially that of Epicurus.  The
subject, however, was offered to the  world in plausible arguments
and captivating eloquence, and  had soon the good fortune to meet
with powerful and enlightened supporters in Maupertuis, and Need-
ham, who added some improvements, but of no very great  impor-
tance, to several of M. de Buffon's tenets; while Haller and Bonet
strove hard to revive the hypothesis of a female generative power
or evolution alone, as first established by Harvey; or rather to erect
an edifice, somewhat similar to it, out of the crumbling ruins of the
primary building; in doing which they appealed to the pheenomena
of the vegetable creation with considerable research, and some de-
gree of  success.  But  this revived  hypothesis, notwithstanding,
has never been very generally followed; and is now almost, if not
altogether, relinquished even in Germany.
   In like manner, there are several physiologists, who  have endea-
voured to improve upon the hypothesis of Buffon, of whom it  may
be sufficient to mention Dr.  Darwin  and Professor Blumenbach.
The alterations, however, are little more than verbal, and  conse-
quently of no great  importance, and chiefly relate to the subordi-
nate doctrine of organic molecules.   For the  term  organic mole-
cules Darwin prefers that of vital germs, which he assorts into  two
kinds, or rather maintains are thus formed by nature,  as being se-
creted or  provided by male or female organs, whether animal or
vegitablej for in  the  philosophy  of this writer, the two  depart-
ments tread closely upon each other.   In this subdivision of germs,
   vol. iv.                     C 
18
PHYSIOLOGICAL PROEM.
LGL. V.
however, the term molecule is still  retained, but limited to the fe-
male character or department:  the vital germs or particles secret-
ed by the female organs of a bud or flower, or the female organs of
an animal being by Dr. Darwin  denominated molecules with forma-
tive  propensities; while those  secreted  from the  male  organs  of
either department  are called fibrils with formative appetencies.
To the fibrils he assigns a  higher degree of organization than  to
the molecules.  Both, however,  we are told, have  a propension  or
an appetency to form or create ; as  we are told  also  that " they
reciprocally  stimulate  and  embrace  each  other and instantly
coalesce;  and  may thus  popularly be compared to  the double
affinities of chemistry.''
  In the view of Professor Blumenbach, matter is divided into two
kinds, possessing properties  essentially different from each other,
these are organized and unorganized : unorganized matter is endu-
ed with a creative or formative power throughout every particle ;
and organized matter with a creative or formative effort, a  nisus
furmativus, or bildungslrieb,* as he calls it, a principle in  many
respects similar to that of gravitation, but endowing every separate
organ, as soon as it acquires  structure, with a vita propria.   From
the first, he trices the origin of the  world in  the simple and inor-
ganic state of the mineral kingdom ;  from the last the rise of vege-
tables and animals.
   It is only necessary to add farther a remark of Mr. John Hunter's,
that in plants of all kinds, the seed, properly so called, is produced
by the  female organization, while  the  male gives nothing more
than the principle of arrangement; and that the same operation and
principles  take place in many orders of animals.f
   In all these attempts to improve upon  the older speculations,
there is a great deal that cannot but be regarded  as philosophical
nugfe.  The physiological experiments  that  have  been made, and
the anatomical facts that have been discovered, since the  days of
Harvey, and particularly during the last half century, though they
leave the doctrine of generation still surrounded  with  many diffi-
 culties, have sufficiently established the following positions:
   First, that, in all ordinary cases, the male semen enters into the
 uterus  at the time  of  coition;  and that in those cases in which it
 does not or cannot  enter immediately, from the extreme length of
the vagina, as in  some quadrupeds, or from a greater or less degree
 of imperforation  of  the vaginal passage, it is conveyed there soon
afterwards inconsequence of its proximity of situation.
   Secondly, that the  uterus itself, worked up at this  time to the
 highest pitch of  excitement, secretes also  some portion of a  pecu-
 liar fluid, the female semen of the Epicurean  philosophers, with
 which the male semen  combines, and which is  probably the basis
 of the membranes soon afterwards prepared for the fetus.
* Uberden Bildungstrieb, 8vo. Gotting. 1791.
t Animal Economy, p. 55. 
CL. V.]
PHYSIOLOGICAL PROEM.
10
  Thirdly, that the Fallopian tubes  at this period become rigid ;
their fimbriae embrace the ovaria; and consequently form a direct
channel of communication between the ovaria and the uterus; that
what  were formerly supposed to be vesicles  are real ovula; and
that one of them detached by the momentary shock or excitement,
bursts  from  its nucleus  or  matrix, enters into  one of the open
mouths of the  fimbrse of  the  Fallopian tube, and, inconsequence,
into the tube itself, by which it is conveyed to the uterus; an effect,
however, which does not  seem to take place during the act of
coition, since the ovulum is  seldom  found, even in the Fallopian
tube, till some time afterwards :  and  that, as  soon as the ovulum
has thus escaped,the lips of the  wound hereby made  in the side of
the ovary are closed by an external cicatrix, and  indented with a
small cavity, which forms what is meant by a corpus  luteum.
  Fourthly, that the cervix of the uterus is, from this time, closed
in its canal toward the upper part, so as  to prevent a  close fetation
by the introduction of fresh male semen ; while the internal surface
of this organ becomes lined with a fine coagulable and plastic lymph,
being probably the  fluid  secreted  at the  moment of intercourse,
assumes a thin  membranous form, and has  been called tunica
caduca or decidua, and constitutes the uterine ovum or egg of the
fetus; which important  part of the process  seems  to take place
about a  week  after the time  of copulation.  In the rabbit  Mr.
Cruickshank has found it as early as  the fourth day.
  Fifthly, that, for the better protection and nutrition of the fetus,
the waifs of the  uterine ovum  are  multiplied ;  and that hence,
while  the tunica caduca itself  possesses a duplicate,  which  is
called  tunica reflexa, there are also two other  membranes by which
the decidua is lined, denominated chorion and amnion, both which
are filled with  peculiar fluids; the fluid of the chorion occupying
the space between itself  and the amnion which it surrounds;  and
the fluid of the amnion occupying the whole of the interior which
is distended with it like a bladder.
  Sixthly, that the medium of connexion between the fetus and the
mother is the umbilical chord and the  placenta  into which it  is
distributed ;  the former consisting of an  artery from each of the
fetal iiiacs, and a vein running  to the fetal liver, twisted spirally
and surrounded by a common integument; and the latter consisting
of two  parts, an uterine  or  spongy parenchyma, derived from the
decidua, and a fetal parenchyma consisting of a great multitude of
exquisitely beautiful  knotty  flocculi  that cover the  chorion,  and
constitute not only an organ of nutriment, but, as was first ingeni-
ously supposed by Sir Edward Hulse, of oxygenation.
   Seventhly, that about the third week, or as  -soon as the uterine
ovum is thus prepared for its reception,  we can trace the first ves-
tige of the embryon, oval in its shape and resembling a minute bean
or kidney, swimming  in the fluid of the  amnion, and  suspended by
the umbilical chord which  has  now shot forth from  the placenta.
From  this reniform  substance  the general figure pullulates, the
limbs are protruded and the face takes its rise. 
20
PHYSIOLOGICAL PROEM.
[CL.  V-
  III. The chief difficulties  that  have  been felt as accompanying
these positions, and the general doctrine that flows from them, are
the following:                                             ,
  First, as to the mode by which  the male semen is conveyed to
the ovulum in the Fallopian tube.
  Secondly, the occasional existence of corpora lutea in the oyana
of virgins, or of those who, from  misinformation,  have been inca-
pable of indulging in sexual commerce.
  Thirdly, the  occasional detection of a full-sized fetus in the
uterus  without any placenta, umbilical chord, or mark of  an  um-
bilicus.
  The  first of these difficulties was earliest started,  as we have
already observed, by Dr. Harvey, who  contended  that in the case
of cows, whose  vagina is very  long, as well as in  various other
cases, the semen cannot possibly  reach even the uterus; and  that
hence there is no reason to  suppose it ever reaches it.   It  was not
then known that impregnation  commences in the Fallopian tube,
and that it must also reach this canal as well; which, by  Harvey
would have been received as an objection still more triumphant.
  By what means  the ejected semen is conveyed into the uterus
we do  not, indeed, very clearly know  even to  the  present hour ;
but that it is so  conveyed and  even in animals  in which the male
organ can by no means come in contact with it, has been proved by
incontrovertible facts.  Mr. John Hunter killed a bitch in the act
of copulation, and  found that the semen was then existing in  the
cavity of the uterus, in his opinion carried there per saltum* Now
if it reach the uterus there  can be no difficulty in conceiving that
it may also reach the Fallopian tubes, which by  one end open into
the uterus ; sucked in, perhaps, as supposed by M. Blumenbach, by
the latter organ during the thrilling orgasm  of the moment. Lee-
wenhoek  and Hartsoeker,  seem,  indeed,   to- have  removed  the
difficulty  altogether, by having, in  some instances, detected  the
seminal fluid in the Fallopian tubes themselves.  And there seems
great reason to believe that it has, occasionally, entered the ovari-
um, and even produced impregnation in that organ  instead of in the
uterus, where an obstruction has been  offered to the descent of an
ovulum into the fimbrial openings of the tube, after its detachment:
for we cannot otherwise readily account for the formation of fetuses
in the ovarium ; facts, however, well known to occur, and  of which
Mr. Stanley has given a singular instance of late,*  and Dr. Gran-
ville a still more extraordinary example, the last fetus at its exami-
tion appearing perfect, and four months old.f
   The second difficulty is also capable of a plausible answer, but
 not quite so satisfactory as the preceding:
   There  can be no doubt that the ovarium is directly concerned in
 the great business of generation:  for it  is well known  that the
* Med. Trans. Vol. VI. Art. XVI.
f Phil. Trans. 1820, p. 101. 
CL. V.]            THYSIOLOGICAL PROEM.                2i

operation of spaying  or excising the ovaries corresponds in fe-
males to that of castration in males.   It takes off, not  only power
of production, but all desire.  And, in a recent volume of the Phi-
losophical Transactions, there is tlie case of a natural defect of this
kind in an adult woman, who, in like  manner, had never evinced
any inclination for sexual  union, and had never menstruated : and
who on dissection was found, with the deficiency of ovaria, to have
the uterus only of the size of an infant's, a very narrow pelvis, and
no hair on the pubes.*
   It seems, also, perfectly clear that  in  conception an ovum does
really descend from the ovarium into the uterus within a few days
after sexual intercourse has taken place : in  proof of which it will
be sufficient  to quote the following curious historical fact from Sir
Everard Home,t who appears to have traced  its path very accurate-
ly : "A servant maid, twenty-one years of age, died of  an epileptic
fit seven days after coition, there being circumstances to prove that
she chould not have seen  her lover after  the day here adverted to,
nor for many days before.  The sexual  organs were submitted to
dissection : the right ovarium had a small  torn orifice upon  the most
prominent part of its external surface, which  led to a  cavity filled
with  coagulated blood, and surrounded  by  a yellowish organized
structure: its inner surface  was covered with an exudation  of co-
agulable lymph. A minute spherical body, supposed to  be an ovum,
was concealed in the cavity of the womb among the long fibres of
coagulable lymph which covered its  inner  surface, and especially
towards the cervix.  This supposed  ovum  was submitted  to the
microscopical powers of M. Bauer, who has  made various drawings
of it, and who detected in it two projecting points  which  are con-
sidered as the future situations of the heart and brain."
   What exact period of time the ovum demands to work its way
down the tube into the uterus, has not been very accurately ascer-
tained.  That it does not  descend at once is admitted on all hands :
and there can be no doubt that in different kinds of animals a differ-
ent period is requisite.  Mr.   Cruickshank, whose experiments
were confined to rabbits, ascertained that in this species the ovum
demanded for its journey about forty-eight hour6.  In the  case just
alluded to, seven days had elapsed, and consequently a period per-
fectly sufficient seems to  have been given for the purpose, and
there  can be little  doubt that  the  minute body observed  in the
cavity  of the uterus was a genuine impregnated  ovum  that had
completed its travels.
   But whence comes it to  pass, if the copulative perculsion, felt
through every fibre, is the cause  of the detachment of ova or ovula
from the ovaria, that examples should  be  found of a  like detach-
ment, and consequently of  a formation of  corpora lutea in cases
where no copulation has ever taken place ?   Of the fact itself there
• Vol. for the year 1805. p. 226.
j Phil. Trans. 1817. p. 252. 
99                 PHYSIOLOGICAL TUOKM.             tCL- ^

is no question.  « Upon examining," savs Sir Everard Home, «the
ovaria of several women who had died virgins, and in whom the
hymen was too perfect to admit of the possibility of impregnation,
there were not only distinct corpora  lutea, but also small cavities
round the edgeof the ovarium, evidently left by ova that had passett
out at some former  period, so that this happens during the state oj
virginity"*  Professor Blumenbach has met with similar examples;
andthev have endeavoured to  account for it, first, by supposing
that the""females thus circumstanced must have been of a peculiarly
amorous  disposition, and at particular times morbidly excited by
a venereal orgasm originating in their own persons alone, without
any intercourse with the male sex.  And next, that a high-wrought
excitement of this kind may be  sufficient to produce such an eflect,
and to lead to the  first and most important step in the generative
process.   All this is highly ingenious, but we seem at present to
want facts to justify us in offering such an explanation.  " We can-
not doubt," says Sir Everard  Home, " that every time a female
quadruped is in heat, one or more ova pass from the ovarium te
the uterus, whether she receives the male or not.f"  And to the
same effect Professor Blumenbach, who first  launched this opinion
in 1718, before the Royal  Society! of Gbttengen.  «' The state of
the ovaria," says he, " of women who have died under strong sexual ,
passion has been found similar to that of rabbits during heat."   And
in confirmation of this he adds : " in the body of a young woman,
eighteen years of age, who had been brought up in a convent, and
had every  appearance of being  a virgin, Valisncri found five or six
vesicles  pushing forward in one ovarium, and the correspondent
Fallopian tube redder and longer than usual, as he had frequently
observed in animals during heat.  Bonet,  he adds,  gives the history
of a young lady who died furiously in love with a man of low  rank,
and whose ovaria  were turgid with vesicles of great size."  In
neither  of these cases, however, do we  meet with ovula actually
detached, and still  less with corpora lutea.  Add to which, that, not
only corpora lutea, but detached ovula, and even imperfect fetation,
have at  times been found in the ovaries of infants  of ten or twelve
 vears of a«-e, who can scarcely be suspected of any such erethism :
a very curious instance of which we shall have to quote from Dr.
 Baillie,  under the genus Proeotia.§
   I am  aware that the same explanation  had been adopted by M.
 Cuvier, indeed it is difficult to adopt any other, but direct facts in
 support of it are wanting in him as  well  as in the authorities just
 referred to.  There  is an indirect  fact appealed  to, however, by
 the last, which is  well worth  noticing for its curiosity, whatever


   * Phil. Trans. 1817. ut supra.
   t Ibid.
   * Specimen Physiologic comparata. Comment. Soc. Reg. Scienti* Gotten.
 gens. Vol. IX. 128.
    * Class. V. Old. II. Gen. II. Spec. II. of die present volume. 
CL. V.]          PHYSIOLOGICAL PROEM.                  g3

degree of bearing it may have  upon the  present question.   After
observing that a corpus luteum is not positive evidence of impreg-
nation, he adds, nor does the existence of a decidua in the uterus
constitute better evidence of the same, since it has sometimes hap-
pened that at each  period of painful menstruation the excitement
of the uterine vessels has produced a perfect decidua not to be dis-
tinguished  from that belonging; to an ovum.   The present author
has never met with a case of this kind, but of the  fact itself there
seems no doubt: Morgagni has given one striking instance of it in
his day,* and  Mr.  Stanley another in  our own.f   To explain the
origin of such a membrane under such circumstances is by no means
difficult, as  it follows upon  the  common principle by which other
membranous or membrane-like tunics are produced in other hollow
organs in a state of peculiar irritation, of which some  curious ex-
amples have already been offered under diarrhoea tubularis.I
The peculiar character of  the  membrane  must necessarily be go-
verned by the character of the organ in which it is formed.   Upon
the whole, it does not seem to afford much support to the argument
in whose favour it  is appealed to, and the subject requires  further
investigation.
   The third difficulty attendant upon the common doctrine of the
day, which supposes the fetus to hold its entire communication with,
and to derive its blood, nutriment, and oxygen from the mother by
means of the placenta and umbilical chord, is founded upon the oc-
casional instances  of fetuses of large and even full growth being
found in the womb, and even brought forth at the proper  period
without any placenta, or at least of any utility, without any umbili-
cal chord, or even the trace of an umbilicus.  Admitting the course
just glanced at to be the ordinary provision of nature, what is the
substitute she employs on these occasions ? the  means by which
the bereft fetus is supplied with air and nourishment ?
   The advocates of the doctrine of epigenesis, as new modelled by
the hands of Buffon and Darwin, triumphantly appeal to these curi-
ous  deviations from the established  order  of nature, as effecting a
direct overthrow of the doctrine of evolution by  an impregnated
ovum :  while the supporters of the latter  doctrine  have too gene-
rally cut the question short by a flat denial  of such monstrous aber-
rations.
   There is little of the true spirit of philosophy in either conduct.
Admitting the existence of such cases, they just as much  cripple
the one doctrine as the other, for, granting the explanation which
is usually offered by the former, the ordinary machinery of a pla-
ceuta and  an umbilical  chord, become immediately a work of su-
pererogation : a bulky and complicated piece of furniture to which
no important use can be assigned, and which the overloaded uterus
might be well rid of.
* De Sed. et Caus. Morb. Ep.
f Med. Trans. Vol. VI. Art. XVI.
t Vol. I. p. 162. 
21
PHYSIOLOGICAL PROEM.
[CL. V.
   But, on the  contrary, to deny the  existence of well established
 and accumulated facts merely because we cannot bend them to our
 own speculation,  is  still  weaker  and  more reprehensible.  The
 kangaroo, opossum, and  wombat,  all breed  their young  without
 either placenta or naval-string.   The embryons are inclosed in one
 or  more  membranes,  which are not attached to the coats of the
 uterus, and are supplied with nourishment, and apparently  with air
 from a gelatinous matter by which  they are surrounded.  Hoffman
 gives us the case of a fetus born in  full health and  vigour with  the
 funis sphacelated and divided into two parts.* Vander Wiel gives the
 history of a living child exhibited without any umbilicus, as a pub-
 lic  spectacle :f and in a foreign  collection of  literary  curiosities is
 the case of a hare which was found,  on  being opened, to  contain
 three leverets, two of them without  a placenta or umbilical vessels :
 and the other with both.}   Ploucquet has collected a list of several
 other instances in his  Initia:§ but, perhaps, the most  striking ex-
 ample  on  record is  one which occurred  to the present author  in
 December 1791, an account of which  he gave  to the public  in
 1795.11  The labour was natural, the child, scarcely less than of the
 ordinary size, was born alive, cried  feebly once or twice afterbirth,
 and died in about ten minutes.  The organization, as well external
 as internal, was  imperfect in many parts.  There was no  sexual
 character whatever, neither penis nor pudendum, nor  any interior
 organ of generation : there was no anus or rectum, no funis,  no
 umbilicus; the minutest investigation could not discover the  least
 trace of any. With the use of a little force, a small, shrivelled pla-
 centa, or rather the rudiment of a placenta followed soon after the
 birth of the child, without a funis or umbilical vessels of any kind,
or any  other  appendage  by which it appeared to have been at-
 tached to the child.  iNo hemorrhage or even  discoloration follow-
 ed its removal from the uterus.  In a quarter of an hour afterwards
 a second living child was protruded into the vagina and delivered
 with ease, being a perfect boy attached to its proper placenta by a
proper funis.  The author dissected the first of these shortly  after
its  birth in the presence  of two medical friends of distinguished
reputation, Dr. Drake of Hadleigh, and Mr. Anderson  of Sunbury,
 both of whom are still able  to vouch for the correctness of this
 statement.  On the present occasion, however, it is not necessary
 to follow up the amorphous  appearances any further,  as they are
 already before the public, except to state that the stomach which was
 natural, was half filled with a liquid resembling that of the amnios,
  * Op. de Pinguedine.
  | Observ. Cent. post.
  i Commerc. Literar. Norimberg.
  § Initia Bibliothecae, Medico-Pract. et Chirurg. Tom. iii. p. 554 4to  Tu-
bing, 1794.
  || Case of Preter-natural Fetation, with observations : read before the MedL.
cal Society of London, Oct. 20, 1794. 
CL. V.]
PHYSIOLOGICAL PROEM.
85
   This  subject has been brought forward, and will be found ably
 discussed in the earlier volumes of the Edinburgh Medical Essays,
 by Professor Monro, and Mr. Gibson.* The latter giving full credit
 to the few histories of the case theu before the world, endeavours
 very ingeniously to account for  the nutriment of the fetus by the
 liquor amnii, which he  conjectures  to  be the ordinary  source of
 supply and not the placenta.  The chief arguments are, that the
 embryon is at all times found at an earlier period in the uterus than
 the placenta itself; which does not appear to be perfected till two
 or three months after conception ;  and consequently that the em-
 bryon must thus far, at least, be  supported from some other source
 than  the placenta; and if thus far, why not through the whole term
 of parturition ?  That extra-uterine fetuses have no  placenta, and yet
 obtain the  means  of growth and evolution from  the  surrounding
 parts.  That the liquor amnii is analogous in its appearance to the
 albumen of a hen's  egg,  which  forms the proper nourishment of
 the young chick: that it is found in the stomach and mouths  of vi-
 viparous animals when first born : and that it diminishes  in its vo-
 lume in proportion to the growth  of the fetus.
   To these arguments it was replied by Professor Monro, that we
 have no satisfactory proof that the liquor amnii is a nutritive fluid
 at all, and that  in the case of amorphous fetuses produced without
 the vestige of a  mouth or of any other kind of passage leading  to
 the stomach, it cannot possibly be of any such use : that if the office of
 the placenta be not that  of affording  food to the  embryon, it  be-
 comes those who maintain the contrary  to determine what  other
 office can be allotted to it; and that till  this is satisfactorily done,
 it is  more consistent with reason to doubt the few and  unsatisfac-
 tory cases at that time brought forward, than  to perplex ourselves
 with  facts  directly  contradictory of each other.
   For the  full scope of the argument  the reader  must turn to the
 Edinburgh Medical Essays themselves, or for a close summary to
 the present author's observations appended  to his own case.  It
 must  be  admitted that the instances adverted to in  the course of the
 discussion are but few, and most of them stamped with something
 unsatisfactory.  Others, however, might  have been advanced  even
 at that time on  authorities that would have settled the matter of
 fact at once, how much soever they might have confounded all ex-
 planation.   But after the history just given, and  the reference to
 other  cases by which it may be confirmed, this is not necessary on
 the present occasion.
   It is singular  that the subject of aeration, which forms another
difficulty in discussing the question,  is  not dwelt upon on either
side, notwithstanding the ingenious conjecture of Sir Edward Hulse,
that the placenta might be an organ  of  respiration as well as of
nutrition, had  at this time been before the public for nearly half a
D'V«l L Art ,XIU- Vol. H. Art. IX, X, XI. See also Dr. Fleming's paper
Phd. Trans. Vol. XLIJC. 1775-6. p. 254.
  VOL. IV.                      ]) 
26
PHYSIOLOGICAL PROEM.
[CL.  V.
century: and  it shows us how slow the best founded theories not
unfrequently are in obtaining the meed of public assent to which
they are entitled from the first.
  These, however, are only a few of  the peculiar difficulties  that
still accompany the subject of generation, to whatever doctrine we
attach ourselves.  There are others  that  are  more general, but
equally inexplicable.  The whole range of extra-uterine fetuses is
of this character; often formed and nourished and developed with-
out either  placenta or an amnios, and  yet sometimes advancing,
even in the remote cavity of the ovarium, and perfect in every or-
gan, to the age of, a least, four months, of which we have already
offered an example.  A great part of the range of amorphous births
defy equally all mental  solution ; particularly the  production  of
monsters without heads  or  hearts, some of whom  have lived for
several days after  birth ;*  of others  consisting  of a head alone,
wholly destitute of a trunk, and yet possessing a full development,
a specimen of which was lately in the possession of Dr. Elfes,  ot
Neuss, on the Mine :f and of  others again, the  whole of whose  ab-
dominal and thoracic  viscera has been found transposed.!.
  Nor less inexplicable is the generative power of transmitting pe-
culiarities of talents, of form, or of defects  in a long line of heredi-
tary descent, and occasionally of suspending the peculiarity through
a link or two, or an individual or two, with an apparent capricious-
ness, and then of exhibiting them once more in  full vigour.  The
vast influence which this  recondite, but active power possesses, as
well over the  mind as the body,  cannot at all times, escape the
notice of the most inattentive. Not only are wit, beauty,  and genius
propagable in  this manner, but dulness, madness, and deformity of
very kind.
  Even where accident, or a cause we cannot discern, has produced
a preternatural conformation or singularity in a  particular organ, it
is astonishing to behold how readily it is often copied by the gene-
rative power, and  how tenaciously it adheres to the future lineage.
A preternatural defect in the hand or foot, has,  in many cases, been
so common to the succeeding members of a  family, as to  lay a foun-
dation in every age and country for the family  name, as in  that of
Yarro, Valgius, Flaccus and  Plautus of Rome.  Seleucus had  the
mark of an anchor on  his thigh, and  is said to have transmitted it to
his posterity: and supernumerary fingers and toes have descended
in a direct line for many generations in various  countries.   Hence
hornless sheep and hornless oxen produce an equally hornless off-
spring, and the  broad-tailed Asiatic sheep yields a progeny  with a
tail equally monstrous, often of not less than half a hundred pounds
weight.  And hence,  too, those enormous prominences in the hind-
er parts of one or two of the nations at the back  of the Cape of
* See for examples and ati'horities the author's volume of Nosologv.
t Hufeland, Journal der Practischen IP-ilkunde. Apr. 1816.
  Sampson, Phil. Tn.ns 1074. 
CL. V.]
PHYSIOLOGICAL I'ROEM.
27
Good Hope, of which examples have been furnished to us in our
own island.
   How, are we moreover to account for that fearful host of diseases,
gout, consumption, scrophula, leprosy and madness, which, originat-
ing, perhaps, in the first  sufferer accidentally, are propagated so
deeply and so extensively that it is difficult to meet with a family
whose blood is totally free from all hereditary taint P By what means
this predisposition may be best resisted it is not easy to determine.
But as there can be no question that intermarriages among the col-
lateral branches of the same family tend  more than any thing  else
to fix and multiply and  aggravate it, there is reason to believe  that
unions between total strangers, and, perhaps, inhabitants of different
countries, form the surest antidote.  For admitting that such stran-
gers to each other may  be tainted on  either side with  some morbid
predisposition peculiar  to their respective lineages, each must  lose
something  of its influence by the mixture of  a new soil; and we
are not without  analogies to render it probable that in their mutual
encounter the one may  even destroy the other by a specific power.
And, hence, nothing can be wiser, on physical as well as on moral
grounds, than the restraints which divine and human laws have con-
curred in laying on marriages between relations : and though there
is something quaint and extravagant, there is something sound at
the bottom in the following remark of the sententious Burton upon
this subject:  " And surely," says he,  " I think it has been ordered
by God's especial providence,  that,  in all ages, there should be,
once in six hundred years, a transmigration  of nations to amend
and purify their blood., as we  alter seed upon our land, and that
there should be, as it were, an  inundation of those  nothern Goths
and Vandals  and many such like  people, which came out of that
continent of Scandia and Sarmatia, as some suppose, and over-ran,
as a deluge, most part of Europe and Africa, to alter, for our good,
our complexions that were much defaced with hereditary infirmi-
ties, which by our lust and intemperance we had contracted."*
Boethius informs us of a different and still  severer mode of disci-
pline at onetime established in Scotland for the same purpose,  but
which, however  successful, would  make,  I am afraid, sad havoc in
our own day,  were it ever to be carried into execution.  " If  any
one," says he, " were visited with the falling  sickness, madness,
gout, leprosy, or any such dangerous  disease, which was likely to
be propagated  from father  to son, he was  instantly castrated ;  if it
were a woman she was debarred all intercourse with men ; and if she
were found pregnant with such complaint upon her,  she and  her
unborn child were buried alive."t
• Anatomy of Melancholy, Vol. I. Part I. Sect. II. p. 89. 8vo.
* De Veterum Scotorum Moribus, Lib. I. 
f 
                      CLASS V.


                   GENETICA.




                        ORDER I.


                    CENOTICA.


             jODigeageg  affecting tije i?(utt>s5*

MORBID DISCHARGES ; OR EXCESS, DEFICIENCY OR IRREGULARITY
                 OF SUCH AS ARE NATURAL.

This order, the name of which is derived from Galen, and has been
explained already, is designed to include a considerable number of
diseases which have hitherto been scattered  over every part of a
nosological classification, but which are related to each other aa
being morbid discharges dependent upon a morbid condition of one
or more of the sexual organs.   The genera are five, and they may
be thus expressed :

  I. PARAMENIA.           MISMENSTRUATION.
 II. LEUCORRHtEA.         WHITES.
III. BLENNORRHEA.        GONORRHEA.
 IV. SPERMORRHQ2A.         SEMINAL FLUX.
  V. GALACTIA.             MISLACTATION.
                      GENUS  I.

                  PARAMENIA.

                  Hfctemengttuattom

MORBID EVACUATION OR DEFICIENCY  OF THE CATAMENIAL FLUX.

Paramenia is a Greek term derived  from vupu " male" and (*t*
fi men sis,"  The genus is here limited to such  diseases as relate to 
30
L.KNET1CA.
[CL. V.—OR
 the menstrual flux, or the vessels from which it issues.   This Add
 is incorrectly regarded as blood, by Cullen, Leake, Richerand, and
 other physiologists :  for  in  truth, it has  hardly any common pro-
 perty with blood, except that of being a liquid  of a red colour.  It
 is  chiefly distinguished by  its not being  coagulable;  and hence,
 when coagula are found in it, as in laborious and profuse menstrua-
 tion, serum or blood intermixed with it, and extruded  either from
 atonic relaxation or  entonic  action of the menstrual vessels.  " It
 is," observes Mr. John Hunter, " neither similar to blood taken from
 a vein  of the same person, nor to that  which is  extravasated by
 accident  in any other part of the body ; but is a species of blood,
 changed,  separated, or thrown  off from  the common  mass by an
 action of the vessels of the uterus, similar to that of secretion ; by
 which action the blood loses the  principle of  coagulation, and, I
 suppose, life." Mr. Cruickshank supposes it to be thrown from the
 mouths of the exhaling arteries of the uterus, enlarged  periodically
 for this purpose; and his view of the subject seems to be confirmed
 Oy  a singular case of a prolapse, both of the  uterus any vagina, given
 by  Mr. Hill, of Dumfries, in the Edinburgh Medical Commentaries.
 In  this  case, the os tincse appeared like a nipple projecting below
 the retroverted vagina, which  assumed  the form of a bag.  The
 patient, at times, laboured under leucorrhcea: but it was observed
 that, when she menstruated, the discharge flowed entirely from the
 projecting nipple of the prolapse;  while the leucorrhcea proceeded
 from the surrounding bag  alone.*
  As this distinction has not been sufficiently attended  to either by
 nosologists or physiologists,  many of  the diseases occurring in the
 present arrangement under paramenia, have been placed  by other
 writers  under a genus named menorrhagia, which, properly speak-
 ing, should import hemorrhage (a morbid flow of blood alone) from
 the  menstrual vessels.  And we have here, therefore, not only a
 wrong  doctrine,  but the formation  of  an improper  genus; for
 menorrhagia or  uterine hemorrhage is, correctly speaking, only a
 species  of the genus  h^morrhagia, and  will  be so found in the
 present system, in  which it occurs in Class III. Order IV.  This
 remark  applies  directly  to  Sauvages;  and  quite as much so to
 Cullen,  who, in his  attempt to simplify, has carried the confusion
 even further than Sauvages.   Few diseases, perhaps, of the uterus,
 or urine  passage,  can be more distinct from  each other  than
 vicarious menstruation, lochial discharge, and sanious ichor; yet all
 these, with several others equally unallied, are arranged  by Sau-
 vages under the genus menorrhagia, though not one of them belongs
 to it.  While Cullen not only  copies nearly the whole of these
 maladies with the names Sauvages  has assigned them, but adds to
the  generic list leucorrhcea or whites, abortion, and the mucous
fluid, secreted in the beginning of labour from the glandulse  Na-
bothi at  the  orifice of the womb, and  hence vulgarly denominated
its show, or  appearance.
Vol. IV. p. 91. 
&E.I—SP. I.]         SEXUAL FUNCTION.
31
  Menstruation may be diseased  from obstruction, severe pain in
its secretion, excess of discharge, transfer to some other organ, or
cessation : thus oftering us  the five following species, accompanied
with distinct symptoms:

1. paramenia obstructions.   obstructed menstruation.
2.--------difficilis.        laborious menstruation.
SUPERFLUA.      EXCESSIVE MENSTRUATION.
4.-----------ERRORIS.         VICARIOUS MENSTRUATION.

5.------    ■ CESSATIONIS.      IRREGULAR CESSATION OF THE

                                 MENSES.
                        SPECIES I.

        PARAMENIA  OBSTRUCTIONS.

               £Db0tt'iutet> H&engtruation,

 oatamenial secretion obstructed in its course j sense of
              oppression; languor; dyspefsy.

 This species, by many writers called menostatio, appears under the
 two following varieties :—

 * Emansio.                     The secretion obstructed on its
  Retention of the menses.         accession or first appearance.
                                 The feet and ancles edematous
                                 at night; the eyes and face in
                                 the morning.
 S Suppressio.                   The secretion obstructed  in its
  Suppression of the menses.       regular periods of recurrence.
                                 Head-ache, dyspnoea, palpita-
                                 tion of the heart.

  In order to explain the first of these varieties, or retention
 of the menses, it is necessary to observe, that when the growth of
 the animal frame is completed, or nearly  so, the quantity of blood
 and sensorial power which have hitherto been employed in providing
 for such growth,  constitutes an excess, and must produce plethora
 by being diffused generally, or  congestion by being accumulated
 locally.   Professor Monro contended for  the former effect;  Dr.
 Cullen,  with apparently  more reason, for the latter.  And this last
 turn it seems to take for  the wisest of purposes; I mean in order
 to prepare for a future race by perfecting that system of organs
 which is immediately concerned  in the process of generation ;  and
 which, during the general growth of the body, has  remained dor-
mant and inert, to be developed  and perfected alone when every
 other part of the frame  has made a considerable advance towards 
32
GENETIC A
[CL. V.—OR. I
maturity, and  there is, so to speak, more leisure and materials for
so important a work.   We shall have occasion to touch upon this
subject more at large when  we come to treat of the genus chlo-
rosis : for the present it will  be  sufficient  to observe, that this
accumulation of nervous and sanguineous fluid seems.first to show
itself among men in the testes and among women in the  ovaria, and
that from the ovaria it spreads to all those organs that are connected
with them either by sympathy or unity of intention, chiefly to the
uterus and the mammee ; exciting  in the uterus a new action and
secretion, which secretion, in order to relieve the organ from the
congestion it  is hereby undergoing, is thrown off periodically, and
by lunar intervals  in the form of  a blood-like discharge, although
when minutely examined, the discharge, as already stated, is found
to consist not of genuine blood, but  of a fluid possessing peculiar
properties.  These properties we have already enlarged upon, and
have shown  in what they differ from those of proper blood : and it
is upon  this point  that the  physiology of Dr. Cullen is strikingly
erroneous, for not  only in his First  Lines, but  long afterwards in his
Materia Medica, he  regards the discharge as  pure blood, and, con-
sequently, the economy of menstruation as a periodical hemorrhage.
" I suppose,"  says he, " that in consequence  of the gradual evolu-
tion of  the system,  at a certain period of life, the vessels of the
uterus are dilated  and filled : and that by this congestion these ves-
sels are stimulated to a stronger action by which their extremities
are forced open and pour out blood.  According to this idea it will
appear  that,  I suppose, the  menstrual discharge to be upon the
footing of an active hemorrhagy, which, by the laws of economy, is
disposed to return after a certain interval."*
   From the sympathy prevailing between the  uterus and most other
organs  of the system, we  meet not unfrequently with some con-
comitant affection  in various remote parts ; as an appearance of spots
on the hands or forehead antecedently to the efflux ;t or, which is
more common, a peculiar sensation or emotion in the breasts.i.
   We cannot explain the reason why this fluid should be thrown off
once a  month or by lunar periods, rather  than after  intervals of
any other duration.  But the same remark might have  been made
if the periods had been of any other kind : and will equally apply
to the recurrence of intermittent fevers.  It  is enough that  we
trace in this action  the marks of design and  regularity : and after
the establishment of a habit by a few repetitions, there is no diffi-
culty in accounting for the intervals of equal  length.
   The time in which the secretion, and consequently the discharge,
 commences,  varies  from many circumstances, chiefly, however,
 from those of climate, and of peculiarity of constitution.  In warm
 climates menstruation  appears often as early as  at eight or nine

                  • Mat. Med. Vol. II. p. 587.4to.
                  | Salmuth, Cent. III.  Obs. 18.
                  * Act.Nat. Cur. Vol. III. App.  p. 168. 
GL\ I.—SP. I.]
SEXUAL FUNCTION.
33
 years of age—for here the general growth of the body advances
 more rapidly than in colder quarters, and the atmosphere is more
 stimulant.  In temperate climates  it is  usually postponed till the
 thirteenth or fourteenth year, and in the arctic regions till the nine-
 teenth or twentieth.
   In all climates, however, when the constitution has acquired the
 age  in which it  is prepared for the discharge, various causes, ob-
 serves Dr. Gulbrand, may accelerate its appearance. Among these
 we may mention any supernatural degree of heat or fever, or any
 other stimulus that quickens the circulation.   Mauriceau relates a
 case in which it was brought on suddenly by an attack of a tertian
 intermittent:  and  in like manner anger or any other violent emo-
 tion of the mind, has been  found to produce it as abruptly.   The
 depressing passions, as fear and severe grief, conduce to the same
 end  though in a  different way :  for here there is rather uterine con-
 gestion than increased impetus, in consequence of the spastic chill
 of the small  vessels on the surface, which lessens their diameter.
 Inordinate exercise, or a high temperature of the atmosphere, has
 in like manner  a tendency to hurry on the menstrual tide; and
 hence  its appearing so early in tropical regions.  Dr. Gulbrand,
 indeed, conceives that even an  increase in the elasticity or weight
 of the  atmosphere is sufficient to produce a like effect, and  refers
 to a curious fact in proof of this.  In an hospital, to which he was
 one  of the physicians, he tells us that a very considerable number
 of the female patients were suddenly seized withcatamenia; which
 was  the more remarkable because several  of these had, for a con-
 siderable  time, laboured under a suppression of that discharge, and
 had  been  taking emmenagogues to  no purpose; while others had
 only been free from their regular returns for a few days. On in-
 quiring into the cause, the only one which  could be  ascertained
 was  a  very great augmentation in  the weight or pressure of the
 atmosphere, the  mercury in the barometer having attained a height
 at which it had never been  observed at Copenhagen before: though
 he does not state the point  it had actually reached.*  It is possible
 that the other general causes may sometimes operate to a like extent;
and hence this disease is said, by Stoll and other writers, to  be oc-
 casionally epidemicf
  Still  much depends  on  the  idiosyncrasy: some girls are of a
 more rapid growth than others  of the same climate; and in some
 there is a peculiar sexual  precocity or prematurity of orgasm that
 hurries  on the discharge  before the general growth of the  body
 would lead us to expect it,  of which Pecklin gives au example in a
girl of seven years of age who,  in the intervals, laboured under a
leucorrhcea4  And hence chiefly we are able to account  for those
       • Ue Sanguifiuxu Uterine, 8vo. Hafn.
       f ltat. Med. P. III. p. 48.
         Samml. Med. Wahrnchm. IX. P. p. 401.
       t Lib. I. Obs. 24-.
VOL. iv.                     E 
34
(,EN1 "PICA
[CL. V — OK. I
very early and marvellous stories of pregnancy in girls of not more
than nine years old, which if not well authenticated, and from dif-
ferent and unconnected quarters, might jutify a very high degree
of scepticism.*
  The efflux continues from two to  eight or ten days; and the
quantity thrown forth  varies from four to ten ounces in different
individuals : the monthly return running on till the fortieth or tiftiet.i
year, and sometimes,  as  we shall have occasion to  observe  here-
after, to a much later period of life.
  It is not always, however, that a retention of the menses to a
much later date than sixteen, or even twenty years  of age consti-
tutes disease: for  sometimes it  never takes place at all, as where
the ovaries are absent  or perhaps imperfect; or where, instead  ot
precocity in the gentinal system, there is a constitutional tardiness
and  want of stimulus; under which circumstances it appeared tor
the first time, according to Holdefreund, in one instance at the age
of seventy.t  It is only,  therefore, when symptoms  take place in-
dicating a disordered state of some part or other of  the body, and
which experience teaches  us is apt to arise upon a retention of the
menstrual flux, that we can  regard such retention as a disease.
  These symptoms, as already stated in the definition of the disor-
der, consist chiefly in  a general  sense of oppression, languor, and
dyspepsy. The languor extends  over the whole system, and effects
the mind as well as the  body:  and hence, while the appetite  is
feeble and capricious, and shows a desire for the most unaccount-
able and innutrient substances, the mind is capricious and variable,
often pleased with  trifles, and incapable of fixing on any serious pur-
suit.  The  heat of the system is diffused irregularly, and is almost
always  below the  point  of  health : there is,  consequently,  great
general  inactivity, and  particularly in the small vessels and extreme
parts of  the body.   The pulse is quick but low, the breathing at-
tended with labour, the sleep disturbed, the face pale, the feet cold,
the nostrils dry, the intestines irregularly confined,  and the  urine
colourless.   There is also, sometimes,  an  irritable and distressing
cough ; and  the patient is thought to be on the verge of a decline,
or perhaps to be running rapidly through its stages.
  A decline, however, does  not follow, nor  is  the  disease found
fatal, although it should continue, as it has done not  unfrequently,
for many years : for if the proper discharge do not take place, the
constitution will often in  some  degree accommodate itself to the
morbid circumstances that press upon it, and many of  the symptoms
will  become slighter or  altogether disappear.   Most  commonly,
however, when the patient is supposed to be at the worst, probably
from the  increased  irritation of the system peculiarly directed  to
• Haller, (Gottl. Eman.) Blumenbach. Bibl. I. p. 558.
  Schmid, Art. Helvet. IV. p. 167.
  Eph. Nat. Cur. Dec. III. An. II. Obs. 172.
-j- Erzaklungen, N. 4. 
GE. I.—SP. I.]          SEXUAL FUNCTION.
3d
the defaulting organs, a little  mucous or serous discharge, with a
slight show of colour is the harbinger of a beneficial change, and is
soon succeeded by the proper discharge itself: though it often hap-
pens that the efflux is at first not very regular either as to time or
quantity : but this is an evil which generally wears away by degrees,
and is diminished by every recurrent tide.
  All the symptoms indicate that retained menstruation is a disease
of debility; and there can be little doubt that debility is its primary
cause—a want of energy in the secernent vessels of'thc uterus.that
prevents them  from fulfilling their office, till the increase of irrita-
bility from the increase of general weakness, at length produces a
sufficient degree  of stimulus, and thus  momentarily supplies  the
place of strength.  The system  at large  suffers evidently from
sympathy.                              •
  Yet menostation may take place from a suppression of the men-
ses after they  have become habitual,  as well  as from their retention
in early life, which constitutes the second variety of the disease.
  The causes  of this form are for the most  part those of the  pre-
ceding, and consist in a torpitude of the extreme or secernment ves-
sels of the uterus produced by anxiety of mind, cold, or suddenly
suppressed perspiration ; falls, especially when accompanied  with
terror, or a general inertness and flaccidity of the system, and more
particularly of the ovaria.  Hence the disease may exist equally in
a robust and plethoric habit and in the midst of want and misery.
In the last case, however, it is usually a result of weakness alone :
and on  this account it is sometimes found  as  a sequel upon  pro-
tracted fevers.
  As this modification of the disease occurs after a habit has been
established in  the constitution, its symptoms differ in some degree
from those we have just contemplated.   And as it occurs  also  both
in a state of entony and atony, the symptoms  must likewise differ
according to the state of the constitution  at the time.  If,  however,
the frame be at the time peculiarly weak and delicate, the si°-ns
will not essentially vary from  those  of the  first variety, only that
there will be a greater tendency to head-ache, and palpitation of
the heart.
  If the  habit be  plethoric, and more particularly, if the cause of
suppression take place just at the period  of menstruation, or during
its afflux, a feverish heat and aridity  of the skin usually  make their
appearance, the face is flushed  and the  eyes red, the head is  op-
pressed and often aches, with distressing pains down  the back, oc-
casionally relieved by hemorrhage from the  nose.
  As the principle  which should guide us in the mode of treating
both these varieties, will also extend to the  ensuing species, it will
be most convenient to defer the consideration of it till that species has
passed in review before us.  We shall then  be able to see how far
a common  process  may  apply, and  to contrast the few points in
which it will be necessary to institute a  difference. 
3f)                       GENETICA.             [UT.. V.—OK. I.



                       SPECIES  II.


           PARAMENIA  DIFFICILTS.


                ^Laborious 3]Ben$tt*uatiom

CATAMENIA ACCOMPANIED WITH GREAT LOCAL PAIN, AND ESPE-
    CIALLY IN THE LOINS ; PART OF THE FLUID COAGULABLE.

In the preceding species#the regular efflux is altogether prevented,
as we have already observed, by a torpitude of the secerning ves-
sels of the uterus, perhaps of the  ovaries also.  In the species  be-
fore us there is no actual suppression, but the quantity thrown forth
is for the most part too small, and attended with severe and forcing
pains about the hips and region of the loins, that clearly indicate  a
spasmodic constriction of the extreme vessels of the uterus. The
secretion is hence extruded  with great difficulty, and is sometimes
perhaps of a morbid  character: while from the force of the action
the mouths of some of the vessels give  way and a small portion of
genuine blood becomes intermixed with the menstrual discharge,
forming coagula in  the midst of  an  uncoagulating fluid, and thus
drawing a critical line of distinction between the two.
  The spastic action, thus commencing in  the minute vessels of
the uterus, not only spreads externally  to the lumbar muscles,  but
internally to the adjoining organs  of the rectum or bladder, in ma-
ny instances, indeed, to the kidneys; and hence an obstinate costive-
ness, and suppression of urine is added to the other symptoms,
and increase the periodical  misery, the frequent return of which
embitters the life of the patient, and effectually prohibits all hope
of a family;  for if impregnation should take place in  the interval
the expulsory force of the pains is sure  to detach the embryon from
its hold,  and to destroy  the endearing promise which it offers.
These pains generally recur at the regular period, but  often antici-
pate it  by a day or two, and rarely  cease till  a week afterwards.
The  disease,  moreover, is peculiarly obstinate, and  in some  in-
stances has defied the best exertions of medical science,  and  has
only yielded  to time, and the natural  cessation of the discharge.
   We have frequently had occasion  to  observe, and especially  un-
der croup, and tubular diarrhoea, that where hollow and mucous or-
gans labour under a certain  degree of irritation, a  portion  of gluten
is often thrown forth  with the morbid secretion that takes place on
 the surface, and the result is the formation  of a new membrane or
 membrane-like substance that lines  the cavity to a  greater or  less
 extent: the nature of this substance  being regulated by the nature
 of the organ in which it takes place.  This  remark applies particu-
 larly to the uterus under the influence of the irritation we are now 
GK. 1.—SP. II.]         SEXUAL FUNCTION.
37
speaking of; and, consequently, a membrane very much resembling
the decidua, or that naturally elaborated by the uterus on impregna-
tion,  has been occasionally formed and discharged in fragments,*
during the violence and forcing pain of laborious menstruation.
   Cold, mental emotion, local injury  from a fall, and, above all, a
peculiar irritability of the uterus itself, are the  common causes.
   The cure of all  the  forms of paramenia, we have thus far no-
ticed, is to be attempted first, by increasing the tone of the system
in general,  and next, by exciting the action of the uterine vessels,
where they  are morbidly torpid,  or relaxing them  where they are
in pain from spasmodic  constriction.   Both the  last,  however, are
subordinate to the  first; for if we can once get the system into  a
state  of good general health the balance of action will be restored,
and the  organs peculiarly affected will soon fall into the common
train  of healthful order.
   To give strength and activity to the circulation is  generally at-
tempted  by tonics: to give local action, by stimulants.  Both these
should be employed conjointly in the  two forms of the first species.
The astringent tonics, however, are supposed, and apparently with
good reason, to be  injurious, and in many instances to extend the
retardation, or diminish the  flow where there is any appearance.
 Myrrh has  long been a  favourite medicine, but its power does not
appear to be very considerable in mismenstruation,  though it un-
doubtedly acts as a stimulant in phthisis, and has at times, in highly
irritable habits,  produced haemoptysis.  The  metallic tonics are
those on which we can chiefly depend ; and of these the principal
that have been employed are iron and copper.   The  first requires
less care than the second,  and has hence been  more frequently re-
curred to as the  safer.   It has been given under a great variety of
forms, but that of the sulphate, or green vitriol, is one of the best,
and most readily obtained.  It is  often tried, in union with myrhh;
and,  where symptoms of dyspepsy exist, and especially acidity in
the stomach, the two have been united with the fixed alkali, a com-
bination which makes the celebrated draught so well known by
the name of its inventor, Dr.  Griffiths.
   Iron is, by some writers, supposed  to show an astringent, and by
 others, an aperient power.   In different constitutions it maybe said
 to operate  both ways.   " If for example," says Dr. Cullen, " a re-
 tention of  menses depends upon a weakness of the vessels of the
 uterus, chalybeate  medicines, by invigorating the force of the ves-
 sels may cure  the disease, and thereby appear  to be aperient: and
 on the contrary in a menorrhagia, when the disease depends  upon
 a laxity of  the extreme vessels of the uterus, iron exhibited, by re-
 storing the tone of these vessels may show an astringent operation."!
   The preparations of  copper labour under  two disadvantages :
 they arc essentially more astringent than many of the other metals,

          * Morg-agni, De Sed. et Caus. Morb. Ep. XLVIII. 12.
            Denman, Medical Facts and Observations, I. 12.
          f Mat. Med. Vol. II. p. 22, 4to. 
61
GENETICA.
[CL.  V.—Oil. L
and at the same time more uncertain  in their effect.   They are,
perhaps, more soluble in  the stomach than any other metallic pre-
parations, wherever there is a sufficient proportion of acid  for this
purpose : but as the quantity of acid in this organ is constantly va-
rying, their effect must vary also.   Dr. Fordyce  advises to  avoid
cupreous preparations when the  intention is to  strengthen ; but
when we attempt  to  lessen irritability he observes that they are
extremely useful;  and hence, their advantage in epilepsy and ple-
thoric  hysteria. It is, however, a just remark of Dr. Saunders,
that all solutions of metals  are sedative and ease pain, or, in other
words, take off irritability,  provided the solution be not too strong.
The  old tinctura  veneris  volatilis,  consisting of one drachm  of
filings of copper infused  in twelve drachms of  water  of ammonia,
is  one of the simplest,  and best preparations  of this  metal  ; and
forms a good substitute  for the cuprum ammoniacum,  or c. ammo-
niatum of the Edinburgh  and London Pharmacopoeias.  Boerhaave
directs us to begin with  three drops as a dose, and  gradually  to
increase it to twenty-four.
  The chalybeate mineral waters have  also been used with conside-
rable success, and the more so as with  these are usually conjoined
the advantages of travelling, change of air, and  a  new  stimulus
given to both the mind and body by novelty of scene, novelty  of
company,  amusing  and animating  conversation,  and  exercise  of
various kinds.  \Vith these may also be combined^in the intervals
of the  menstrual  season, and particularly before the discharge
has appeared,  the use of cold, and especially of  sea-bathing.  An
unnecessary apprehension of catching  cold by the employment of
this powerful tonic has been entertained by many practitioners: with
proper  care  I  have  never known  it  produce this  effect; and it
should  only  be relinquished where no reactive  glow succeeds to
the chill produced by immersion, and the system  is hereby proved
to be too debilitated for its use.
  The stimulants to be employed under the first species,  in con-
junction with  a tonic plan, are those that operate generally and
locally.  The general stimulants should consist of those that do not
exhaust the excitability  or nervous power of the  frame, but rather
by the moderation  of their  effect, and  the constancy of their appli-
cation,  support and  augment it.  Exercise, which we have already
recommended, will in this view also be of essential service; as will
likewise be uniform warmth; and hence, the warmth of a mild cli-
mate, and a generous diet  with a temperate use  of wine.   Hence
also  the benefit of friction and electricity applied directly to the
hypogastric and lumbar regions.*
   As the depressing passions produce the disease,  the elevating pas-
  * Albcrti, Diss, de Vi Electrica in Amenorrhoeam, seu Catamcniorum ob-
structionem.  Coett. 1764.
  Birch, Considerations of the Efficacy of Electricity in Female Obstructions
3-.c. Lond. 1799.                                                 ' 
tVE. I.—SP. II.]        SEXUAL FUNCTION.
39
sions have often been known to operate the best and speediest cure.
It has sometimes suddenly yielded to a fit of joy,*  and, in  one
instance, from the violence of the emotion, to a fit of terror.!  We
can hence  easily see how it may be induced  by  disappointed  love
and removed by a return of hope, and a prospect of approaching
happiness.|
  The stimulants  operating locally in this  disease are known bv
the name of emmenagogues.   In the old writers  the catalogue of
these is very numerous.   Those that  are most worthy of notice
consist of the warmer gums and balsams, as  guaiacum, assafcetida,
turpentine, and petroleum ; castor, and the  more irritating cathar-
tics, as aloes and black hellebore.   The last is, in most cases, too
stimulant upon the  whole  range of the intestinal  canal, though at
one  time  in high  favour as  an emmenagogue.   Aloes is a very
valuable  medicine.   Dr. Adair gave it in combination with can-
tharides; but in this form it will often be found to produce a trou-
blesome irritation on the rectum or bladder, rather than a salutary
stimulus to the vessels of the uterus.
  The juniperus Sabina, or common savine, is also a valuable me-
dicine, as being both stimulant and slightly aperient, and operating
not only locally but upon the  system at large.  It may be given in
powder, extract, or essential oil : of the powder, the dose varies
from  a  scruple to a drachm twice or three times a day: of the
extract from half a scruple to half a drachm ; and of the  essential
oil from two to four drops. Dr. Home thought highly of it, and
M. Herz has praised it in equal terms.§  The former declares that
by employing the scruple doses three times a day  he succeeded in
three out of five cases.   But  the most favourite  emmenagogue in
his hands,  was the root of the rubia tinctorum or madder.  Of nine-
teen cases, of  which he gives an account,  fourteen, he  tells us,,
were cured by it.  From half a drachm to a drachm was prescribed
twice or oftener daily.  Dr. Home asserts, that, in this quantity, it
produces scarcely any sensible operation, never quickens the pulse
nor lies heavy on the stomach; yet that  it generally restores the
discharge  before the  twelfth day from the time of its commence-
ment.||  The present author  has  never  tried  it;  he  has been
deterred by the very different, and even contradictory accounts of
its effects upon the constitution which have been given by  different
writers of high authority.  While Dr. Home found it thus beneficial
in cases of obstructed menstruation, Dr. Parr tells us that it pro-
duced a cure in excessive menstruation, but  in the former disea^
effected no change whatever.^!  From its tinging the  urine of a red
* Medicin. Wochenblatt, 1782. p. 416.
t Walther, Thes. Obs. 37.
*  Eph. Nat. Cur. Dec. I. Ann. IX. X. Obs. 58.
§ Briefe, II. p. 5.
B  Clinical Experiments, Histories,  &c. 8vo. 1780.
1 Med.  Die. Vol. II. in verb. p. 524. 
'10
GENET1CA.
i.CL. V.—OR. I.
 colour it has been supposed  to be a powerful  diuretic,  but even
 this quality it has been incapable of supporting:  and yet in the
 opinion  of  Dr. Cullen this seems to be its only pretention to tie
 character of an emmenagogue.*   Given freely to brute animals,
 Dr. Cullen tells us, that it always disorders them very considerably,
 and appears hurtful to the system.  Its direct virtues do not.there-
 fore seem to have been in any degree ascertained; but let them De
 what they may, it has deservedly fallen into disrepute as a remedy
 for any misaftection of the uterus.
   Theathamanta Meum, or spignel, which  once rivalled the repu-
 tation of madder, and has long sunk with it into desuetude, is better
 entitled  to notice, and ought not to be abandoned.  It seems to
 have a  peculiar  influence  in stimulating the  lower viscera, and
 especially the uterus and bladder; and is no indifferent sudorific.
 On this  last account  it was at  one time highly in favour also in
 intermittents, and was afterwards employed in hysteria, and humo-
 ral asthma.
   This part of the subject must not be quitted without glancing at a
 medicine that has lately acquired great popularity in North America,
 as an emmenagogue, and is said to have been employed with unques-
 tionable success.  This  is spurred rye, or rye vitiated  by  being
 infested with the clavus or ergot,  a  parasitic plant which we have
 already  had occasion to notice as producing a powerful effect on
 the whole system, and especially  on  the nervous part of it, and the
 abdominal viscera in general. "When taken in such a quantity as
 to be poisonous, it first excites a sense of  tingling or formication,
 and fiery heat in the extremities, where the action of the system is
 weakest; to this succeed cardialgia, and griping pains in the bowels;
 and then vertigo, an alternation of clonic  and entonic spasms in
.different parts of the body, and mania, or loss of intellect.  If the
 quantity be something smaller than this,  it excites that  pestilent
 fever, which the French denominate  mal  des  ardens, and  in the
 present  work is described under the name of pestis erythematica :f
 while in a quantity still smaller it seems to  spend  itself almost en-
 tirely'on the extremities as  being the weakest part of the body,
 and to produce that species of gangr.ena, which is here denomi-
 nated ustilaginea, or mildew mortification.^
   It is hence a very acrid irritant, and from its peculiar tendency
 to stimulate the hypogastric viscera, seems often,  in small quanti-
 ties, to prove a powerful emmenagogue.  For this purpose an ounce
 of spurred rye is boiled down in a quart of water to a pint: half  of
 which is usually taken in the course of the day, both in obstructed
 and difficult menstruation, and continued  for  three or four days.
 The symptoms said to be produced are head-ache, increased heat,
 and occasional pain in the hypogastrium, succeeded by a  free and

     • Mat. Med. Vol. II. p. 553 4to. edit. comp. with p. 38, of the same.
     + Vol. II. p. 427, 428.
     t Vdl. II. p. 608. 
GE. I—SP. II.]        SEXUAL FUNCTION.
41
 easy flow  of the menstrual fluid.  Advantage has been  taken of
 this effect on another occasion,  for the same  medicine has been
 prescribed in lingering  labours,  and we are told by Dr.  Bigelow,
 with the best success, as good forcing pains are hereby very gene-
 rally produced  speedily.*   In this case Dr. Bigelow, instead of a
 decoction  of spurred rye,  prefers giving the crude powder, to the
 amount of ten grains to a dose.
   We have hitherto regarded  the spur in  spurred rye, and other
 grain, as a clavus or species of ustilago.  It was formerly, however,
 conceived  to be a disease  of the grain itself.  M. Decandolle  has
 since described  it as a variety of champignon, under the  name of
 sclerotium, from its rendering the grain hard  and horny.   And M.
 Virey in a work reported upon by M. Desfontaines, to the Acade-
 my of Sciences of the French Institute in 1817, has still more lately
 endeavoured to revive the obsolete opinion,  by contending that it
 is a specific disease of the  plant under which the grain is rendered
 not  properly speaking hard and horny, as is actually the case
 when infested  with the sclerotium, but rather friable and easily
 detached.
   There is something highly plausible and  ingenious in  the plan
 that was at one  time tried  rather extensively,  of compressing  the
 crural arteries by a  tourniquet, and thus  gorging the organs  that
 lie above and are supplied from collateral branches. By compress-
 ing the jugular  veins we can easily gorge  the head and endanger
 extravasation and apoplexy. But it appears upon trial that the tide
 thus dammed up in  the  case before  us, is thrown back upon  too
 many organs to  produce  any very sensible  effect upon the uterus.
 Independently of which the uterus is not like the brain,  exactly in-
 closed in a bony box that prohibits a general and equable dilatation
 of its vessels.  In six  cases in which Dr. Homemade experiment
 of this remedy, he succeeded but  once ; and  others have been less
 successful still.t
  Impeded menstruation is sometimes, however, a disease strictly
local, and proceeds from  the obstruction of the passage by a poly-
pous or other tumour or an  imperforate hymen.  In all these cases
it is obvious that the  cure must depend  upon a removal of the local
cause.
  Emetics have often been recommended;  they rouse  the system
generally, but have not often been found useful in retention of the
menses :  though  when employed in cases of suppression, and espe-
cially at  the  regular periods of return, or so as to anticipate such
return by a few days, they frequently prove a valuable adjunct.  If
this period be passed by without any salutary  effect, and  particu-
larly, if,  at the same time, the system labour under symptoms of

 _______________________ft____________________________________-

         * New England Journ. of Med. and Surg. Vol. V. No.  II.
         f Hamilton, Edin. Com. Vol. II. Art. 31.
           Weiz ad Fabric. IV. 98.
  vol. iv.                    K 
42
GENE1ICA.
[CL. V.—OR. I.
oppression in the head  or chest, venesection to the extent of from
four to six ounces  of blood will be found a very useful  palliative,
and will have a tendency to keep  up that periodical habit ot deple-
tion  which will probably prove advantageous  against the ensuing
lunations.  Venesection will  also be found useful  and often  abso-
lutely necessary where  the suspension  has  suddenly taken  |.i..ce
during the flow of the catamenia, from cold, depressing pasm-ms,
fright, or, indeed, any other cause.
  In treating the second species of paramenia, or difficult menstrua-
tion, the stimulant part of the process we have thus  far recommend-
ed must be sedulously abstained from, but the rest may be followed
with advantage. Every thing, indeed, that has a tendency to pro-
duce local  excitement, and  in this respect  the conjugal embrace
itself, where the patient is married, must be systematically abstained
from.  The  diet must be plain and inirritant, and the bowels be
kept cautiously open with  neutral salts or other cooling aperients.
And, to allay the strong spasmodic action on which the severe pains
in the  lumbar  and hypogastric  regions depend,  it will be found
highly advantageous, a  short  time  before  the expected return of
menstruation, to employ relaxants, and especially local relaxants ;
and of these, one of the best and pleasantest is the hip-bath, which
operates directly upon the  diseased quarter, and has a tendency to
produce the  desired effect without weakening the system generally.
The ease and comfort of this  \aluable contrivance is acknowledged
by almost all who have had  recourse to it.  Martini and  various
other writers recommend  the cold bath in preference  to the hot,
and Tissot represents the latter as injurious.  But this  is to  speak
without due discrimination.  That the cold bath has been found of
use in some instances is unquestionable: but only where there has
been  such a degree of energy in  the  constitution  as to produce a
reaction co-respondent  to the antecedent rigour.  The direct effect
of the cold bath is to constringe, and consequently where a spastic
contraction  exists  already, as is mostly the case from local or con-
stitutional debility, to increase the evil.  But where the constitution
is naturally robust, and but little  inroad has hitherto been made up-
on its strength, the latent energy  of the system is capable of resist-
ing the sudden shudder: an  increased action  and  consequently an
increased and glowing heat ensue : the repelled  fluids are forced
forward ; the blood flows more briskly ; the mouths of the capillary
vessels give way in  every direction ;  the muscular fibres lose their
 rigidity, and the suppressed  secretions, of whatever kind, recom-
 mence.  And, hence it is,  that cold  bathing may sometimes be
 serviceable in  the disease before us, and warm bathing less useful;
 but these cases are rare, and warm  bathing is mostly to  be pre-
 ferred.                               0
   Even the hip-bath, however, though  it mitigates the  pain, occa-
 sionally does nothing more;  there is the same paucity of discharge,
 the same intermixture of coagula, and the same tendency to a re- 
GE. I.—SP. II.]           SEXUAL FUNCTION
43
 turn of the disease.   In such cases it has been common to abstract
 eight or ten ounces of blood from the loins by cupping, antecedently
 to the use of the bath ; and this, by diminishing the spastic con-
 striction, has, at times diminished in a still greater degree the dis-
 tressing pains.  But I do not think that the hip-bath is in general
 had  recourse to early enough to give it  all the  beneficial effect it
 may be made to possess.  Instead of waiting till the periodical
pains return, as is the common practice, I have found it more advan-
tageous to  anticipate  this period, and to relax the vessels  by em-
ploying it  for two or three nights before the pains are  expected.
And where in this and every other way it has failed, or the patient
from great delicacy of constitution has appeared too much exhausted
by its use,  I  have availed myself of the same  relaxant power in
another way,  and, with a like anticipation, have prescribed the use
of a  broad folded swathe of flannel wrung out in hot water, to be
applied round the loins and belly  at the time of going to rest, and
bound over with a linen swathe of equal width, as already recom-
mended in peritonitis, and hepatitis.  The whole should be suffered
to remain till the morning, by which  time the  warmth of the body
will  be usually found  to have evaporated all the moisture, though
 the skin will  still  be  dewy with perspiration from so powerful a
sudorific.  I have often found this plan succeed still better than the
hip-bath ; and have never known the patient catch cold, or complain
of any chilly sensation from the use of the epithem.
                       SPECIES III.

            PARAMENIA SUPERFLUA.

                £mpecfluou0 IBengtruatton,

CATAMENIA  excessive, and accompanied  with  hemorrmagf
                FROM THE MENSTRUAL VESSELS.

This species offers us a disease precisely the reverse of the last,
not less in the facility with which the mouths of the vessels give
way,  than in  the  quantity of the discharge.  It exhibits the two
following varieties :

 « Reduplicata.                 Excessive from a too frequent re-
   Reduplicate menstruation.       currence.
 £ Profusa.                     Excessive from too large a flow at
   Profuse  menstruation.           the proper periods.

  The second variety, or profuse menstruation, is often techni-
cally distinguished by the name of menorrhagia.  It is, in effect, the 
44
GENETKA
| CL. V.—OK. I.
menorrhagia rubra of Cullen, who makes it a distinct affection from
metrorrhagia or hemorrhagia uteri, by confining the latter term to a
signification of hemorrhage from  other vessels of the uterus than
those concerned in separating and  discharging the catamenial flux.
  We have already observed that we cannot lay down any general
rule to determine the exact quantity of fluid that ought to be thrown
forth at each lunation,  some individuals secreting more and others
less; and the measure varies from four to eight or ten ounces.  We
can only,  therefore, decide  that  the  quantity is  immoderate and
morbid when it exceeds what is usually discharged by the individual,
or when it is  associated with unquestionable symptoms of debility,
as paleness of the  face, feebleness of the pulse,  unwonted fatigue
on exercise; coldness  in the extremities, accompanied  with an
edematous swelling of the ancles towards the night,  pain in the
back in an erect posture; and various dyspeptic affections.
  Either of the varieties may be entonic  or atonic, or, in common
language,  active or passive: but in the first there is usually a
greater degree of local irritability than in the second,  so that the
secernents are excited, or the  extremities  of the minute' blood-
vessels open  upon very slight occasions.  As the disease may oc-
cur under these two different states of body, it may proceed, ^as Dr.
Gulbrand has observed, from an increased impetus in  the circula-
tion, a relaxed state of the solids, or an attenuate state of the fluids:*
to which he might have added uterine congestion.
  Increased  impetus usually indicates great robustness of consti-
tution, or an  entonic habit, and is not unfrequently connected with
uterine gestation;  and the accidental causes, are,  in many  cases,
cold, a violent shock or jar, or an accidental blow.  Under this
form the disease commonly yields  to venesection, cooling laxatives,
and quiet.
  Superfluous menstruation from atony, or in other words, a relaxed
state of the solids, and an attenuate state of  the fluids, frequently
arises from repeated miscarriages or labours, poverty of diet, and an
immoderate indulgence in sexual pleasure. It often proceeds, also,
and especially in the higher ranks, from a life of indolent ease, and
enervating luxury, producing what we have denominated atonic
plethora, lax vessels easily distended by  a current of blood super-
fluous in quantity but loose and unelaborate in crasis, and which is
reproduced, and perhaps still more abundantly but at the same time
still more  loosely, as soon as the excess is attempted to be removed
by bleeding.
  Here, therefore, venesection is almost sure to do mischief we
must restrain every luxurious  excess as far as it may  be in our
power, and we may have authority enough to insure  a compliance,
which is not  always the case ; we must employ,  at the same time,
the milder tonics  with astringents,  kino, catechu, or sulphate of
zinc, and  carefully guard against costiveness by cool unirritatino-
* De Sanguine Uterino, 3vo. Hayn. 1778. 
UE. I.—SP. IIL]       SEXUAL FUNCTION.
45
laxatives.  If the discharge be very considerable, astringent injec-
tions of cold  water, or which will commonly be found better,  of a
solution  of alum or zinc,  or cold water with a third part of new
port wine, should be  had  recourse to without fail;  or the vagina
may be closely plugged up  with a sponge, confined with  a proper
bandage.  Early hours are of especial importance, with a due inter-
mixture of moderate exercise, and the use of cold sea-bathing. The
Cheltenham waters, as those  also of many other chalybeate springs,
have often proved serviceable, partly from their own  medicinal
powers, and  partly from the greater purity of air and increase of
exercise  with which a temporary residence at a watering-place is
usually accompanied.
  It is a common observation, in moral as well as in physical phi-
losophy,  that extremes meet in their effects, or produce like results.
There  is, perhaps, no part of natural history in which this is more
frequently exemplified than  in  the  sphere  of medicine.  In the
cases of apoplexies and palsies, as well as various other  diseases,
we have  had  particular occasion to make this remark; and in the
genus immediately before us, as well as others closely connected
with it,  we  have another  striking instance of  its  truth.  " The
proportion of the diseases  peculiar to  the female sex in the hospi-
tal," says Sir Gilbert Blane, speaking from tables accurately kept
by  himself for this  purpose, "is the  same as in  private cases;
from which it would appear that the unfavourable influence of indo-
lent habits, excessive delicacy, and sensibility of mind and body in
the upper ranks, compensate for the bad effects of hard labour and
various privations in the lower orders."



                       SPECIES IV.

              PARAMENIA ERROR1JS.

                Clicanou^ i&engmiatiott*

   6ATAMENIA TRANSFERRED TO, AND  EXCRETED AT REMOTE
                           ORGANS.

We have already observed  upon the extensive sympathy which the
sexual  organs maintain with every other part of the system.  With
the exception of the stomach, which is the grand centre of the sym-
pathetic action, there is no organ,  or set of organs, possessed of any
thing like so wide an influence.  And hence,  where, from any
particular circumstance, as  sudden fright or cold, the mouths of the
menstrual vessels become spasmodically constricted at the period of
menstruation, and the fluid  is not thrown forth, almost every organ
seems  ready  to offer it  a  vicarious  outlet.   We have accounts,
therefore, of  its having been discharged, by substitution,  from the 
Irt
GENETICA.
[CL. V.—OR. I.
eves the nostrils, the sockets of the teeth, the ears,  the nipples,
the stomach, the rectum, the bladder, the navel, and the skin gene-
rally, as  noticed more fully in the volume of Nosology to which the
reader may turn at his leisure.                        u-u-*u
  In effect, there is scarcely an organ of the body from which it nas
not been discharged under different circumstances.*   In the Edin-
burgh Medical Essays is a very singular case of its being thrown
forth from an ulcer in the ancle of a young woman little more than
twenty years  of age, and which continued to flow  at  monthly
periods,  for two or three days at  a time, for about five years;
after  which  some part of the bone having separated in a carious
state, the ulcer assuming a more healthy appearance, and the body
becoming plumper and stronger, the vicarious outlet was no longer
needed, and the menstrual tide returned to its proper channel.!
  In all these cases there is a considerable degree of uterine torpi-
tude, and commonly of general debility : while the part forming the
temporary outlet is in a state of high irritability or rather diseased
action.   And hence the  remedial process should consist in allaying
the remote irritation, strengthening  the system generally, and gra-
dually stimulating the uterus to a state of  healthy  excitement by
the means already recommended.
                       SPECIES V.

           PARAMENIA CESSATIONS.

         Irregula* Cessation of t&e |®emses3,

CATAMENIAt  FLUX  IRREGULAR AT  THE  TERM OF ITS  NATURAL
  CESSATION ; OCCASIONALLY  ACCOMPANIED WITH SYMPTOMS OF
  DROPSY,  GLANDULAR TUMOURS, OR SPURIOUS  PREGNANCY.

The set of  organs that are most tardily completed and soonest ex-
hausted are those of the sexual system.  They arrive latest at per-
fection, and are the  first to become worn out and decrepit.  In this
early progress to superannuation the secretory vessels of the uterus
grow torpid,  and, by  degrees, the catamenial flux ceases.  This
cessation, however, has sometimes been  protracted to a very late
period, and, in a few rare instances, the menses have continued


       * Eph. Nat. Cur. passim. Act. Nat. Cur. Act. Med. Berol.
         Bertholin. Obs. passim. Cent, passim.
         Pechlin, Lib. I. passim.
         Bierling. Thes. Pract.
         Senneitus, Pract. et Pavalip. Lib. IV.
       f Art. by Mr. James Calder, Vol. III. Art. xxix. p.  >■*! 
GE. I.—Sl'.Y.]         SEXUAL FUNCTION.                   J~

nearly, or altogether, through the whole term of life :  we have ex-
amples of it, noticed in the volume of Nosology, at seventy, eighty,*
and even ninety years of age; but the usual term is between forty
and fifty, except where women marry late in life, in  which case,
from the postponement of the generative orgasm, they will, occa-
sionally, breed beyond their fiftieth year.   On approaching the na-
tural term of the cessation of the menses, the sexual organs do not
always appear to act in perfect harmony with each other, and per-
haps, at  times, not even  every part of the same organ with every
other part.   In proof  of the  first remark,  we seem, occasionally,
to meet with a lingering excitement in the ovaria,  after all  excite-
ment  has ceased  in  the  uterus : and we  have  hence a kind of
conceptive stimulation, a physcony of the abdomen, accompanied
with peculiar feelings, and peculiar cravings, which  mimic those
of pregnancy, and give the individual room to believe  she is really
pregnant, and the more so in consequence of the cessation of her
lunar discharge, while the uterus takes no part in  the process, or
merely that of sympathetic irritation, without any change in size
or  structure.
   On the contrary, we may chance to find the uterus itself chiefly,
 if not solely affected with irregular action at this  period : evincing,
sometimes a suppression of menstruation  for several months, some-
times a profuse  discharge at  the  proper period,  and  sometimes a
smaller  discharge returning every ten or twelve days, often suc-
ceeded by leucorrhcea. And not unfrequently the system associates
generally in the misaffection, and  suffers from oppression, head-
ache, nausea, or universal languor.
   All these are cases that require rather  to be carefully watched,
than vigorously practised upon ; and  the character  of an expectant
physician, as the French denominate it, is the whole that is  called
for.  The prime object should be to  quiet irregular local irritation
wherever necessary, by gentle laxatives, moderate opiates, or other
narcotics, and to prevent any incidental stimulus, mental emotion,
or  any other cause, from interfering with the natural inertness into
which the sexual system is progressively sinking.   Hence the diet
should be nutritive but plain; the exercise moderate;  and costive-
ness prevented by lenient, but not cold eccoproctics : aloes, though
most usually had recourse to, from its pungency, in earlier life, is
one of the worst medicines we  can employ at this period, as the
Epsom salts, warmed  with any pleasant aromatic, is, perhaps,  one
of  the best.
   If the constitution be vigorous and plethoric, and particularly it
the head feel oppressed and vertiginous, six or seven ounces of
blood may, at first, be taken from the arm; but it is a practice  wf
should avoid if possible, from the danger of  its  being necessarily
resorted to again, and at  length running into an  inconvenient  and
debilitating habit.
   The mainmee that constantly associate in the changes of the ute-
rus and constitute a direct part of the sexual  system, are  at  ti.'<« 
48
GENETICA.
[CL.V.—OK. I.
 time, also, not unfrcquently in a state of considerable irritation; and
<f a cancerous diathesis be lurking in the constitution, such irrita-
 tion is often found sufficient to excite it into action.   And  hence,
 the period  before us is that in which cancers of the  breast most
 frequently show themselves.
   From the natural paresis into which this important and active
 system is hereby thrown, a certain surplus of sensorial power seems
 to  be  let loose upon the system, which  operates in various ways.
 The ordinary and most favourable mode is that of expending itself
 upon the adipose membrane generally, in consequence of which  a
 larger portion of animal oil is poured forth, and the  body becomes
 plump and corpulent.   The most  unfavourable, next to the excit-
 nient of a cancerous diathesis into action, is that of irritating some
 neighbouring organ, as the spleen,  or liver, and thus working up  a
 distressing  parabysma or visceral  turgescence; or deranging the
 order  of the stomach, and laying a foundation for dyspepsy.
                       GENUS II.

                    LEUCORRHCEA.




MUCOUS DISCHARGE FROM THE VAGINA, COMMONLY WITHOU 1 IN-
       FECTION; DISAPPEARING  DURING MENSTRUATION.

The term leucorrhcea from \tv #«?, "white," and pea, "to flow," is
apparently of modern origin; as it is not to be found in either the
Greek or Roman writers;  and seems first to have been met with  in
Bonet and  Castellus.
  This is the menorrhagia alba of Dr. Cullen,  so denominated be-
cause he conceives the evacuation  to  flow from the same vessels  as
the catamenia; as also that it is often joined with menorrhagia,  or
succeeds to it.  Its source, however, is  yet a point of dispute.*
Stoll,t Pinseus, and various other  distinguished writers have ascrib-
ed it, like Cullen,  to the uterus.  But  as it occurs often in great
abundance in pregnant women, ru girls of seven, eight, and nine
vears of age,\ and even in infants,  it has been supposed by YVedel,§
and most writers of the present day, to flow from the internal sur-
• Rat. Med. P. VII. p. 155.
j De Notis Virginitatis.  Lib. I. Prob. 3.
i Heister, Wahrnemungen, B. II. N. 128.
  Hoechstatter, Obs. Med. Dec. IV. Cas. I. Scliol,
§ Di?s. De Fltiore albo.  Jen. 1743. 
GE. II—SP. I.]
SEXUAL FUNCTION.
49
face of the vagina, or at the utmost, from the  vagina jointly with
the cervix of the uterus.   Morgagni is, perhaps, mo9t correct, who
conceives, and appears, indeed, to have proved  by dissections, that,
in different cases, the morbid secretion issues from both organs; for
he has sometimes found the uterus exhibiting in its internal surface
whitish tubercles, tumid vessels, or some other diseased indication,
and sometimes the  vagina, during the  prevalence  of this malady.*
In the case  narrated  by  Mr. Hill of Dumfries, and noticed under
the preceding genus, it was evidently confined to the vagina alone.f
  From its  frequency in Sweden, Riedlin conjectures it to be en-
demic there :\ but this can hardly be allowed,  and there are more
obvious causes to which such frequency may be referred.
  When  first secreted it is bland and whitish, but differs in colour
and quality under different circumstances,  and hence affords the
three following species :

1.  LEUCORRHCEA  COMMUNIS.       COMMON  WHITES.
2.----------NABOTHI.           LAI10UR-SHOW.
5.----------SENESCENTIUM.     WHITES  OF ADVANCED LIFE.
                         SPECIES I.

            LEUCORRHCEA COMMUNIS.

                     Common OTIjtteg*

THE DISCHARGE OF A  YELLOWISH-WHITE  COLOUR,  VERGING TO
                            GREEN.

This species is the fluor albus of most writers.  It is found in girls
antecedently to  menstruation, or any simple local  irritation  in
the middle of life, and hence also, as  just  observed, during preg-
nancy. It is said in the Berlin Transactions to be occasionally con-
tagious :§  and I have met with various cases which seem to justify
this remark.
  It has occurred as the result of suppressed menstruation : as it is
said also to have done on a suppressed catarrh ;|| and chillness or sup-
pressed  perspiration of the  feet.lf  Local irritations  morever are
  * De Sed. et Caus. Morb. En. XLVII.  Art. 12, 14, 16, 17,18, 19, 27. Ep.
LXVII. Art. 14.
  f Edinb. Med. Comment. VI. p. 91.
  * Lin. Med. 1695. p. 164.
  § Act. Med. Berol. Dec. I. Vol. V. p. 85.
  || Act. Erud. Lips. 1709, p. 376.
   Raulin, Surles Flenrs blanches, p. 329.
  U Act. Nat. Cur. Vol. VIII. Obs. 38.
  VOL. IV.                     G 
50
GENETICA.
[CL. V.—OR. I.
frequent causes.  And hence one reason of its being an occasional
concomitant of pregnancy; as also of its  being produced by pes-
saries injudiciously employed,  by voluptuous excitements, and un-
cleanliness.  It is said at times to exist as a metastasis, and parti-
cularly to appear on a  sudden  failure of milk during the period of
lactation ; a failure which may be set down to the list of suppressed
discharges.*  Jensen gives  a singular  case  of leucorrhcea  that
alternated with a pituitous cough.f
  It is usually accompanied with  a sense of languor, and a weak-
ness or  pain in the back.  And if it become chronic, or of long
continuance, the countenance looks pale and unhealthy, the stomach
is troubled with symptoms of indigestion, the skin is dry and fe-
verish, and the feet is edematous.
  The discharge, in its  mildest form, is slimy, nearly colourless,
or of an opaline hue, and unaccompanied with local irritation.  It
afterwards becomes more opake and muculent, and is accompanied
with a sense of heat, and itching  or smarting; in this stage it is of
a yellowish-white.   But  as the disease advances in degree it ap-
pears greenish, thinner,  more  acrid,  and highly offensive, and is
apt to excoriate  the whole surface of the vagina : while  there is
often a considerable degree of pain in the uterus itself and even in
the  loins.
  Among novices there is some difficulty in distinguishing the dis-
charge of whites from that of blenorrhcea, which we shall describe
presently.   But though the appearance of the two fluids is often
similar,  they may easily be known by their accompanying signs.
In blenorrhcea there is a  local irritation from the first, and this irri-
tation extends through a  considerable part of the meatus urinarius,
so as to produce a considerable pain  in making water ; symptoms
which are not found in  leucorrhcea.   There is also from the first
in the former a  swelling of  the labia,  a  more  regular  though  a
smaller secretion, and of a more purulent appearance.
  When the disease is violent, or of long continuance, it leads to
great general as well as local debility, so as in some instances to
make sad inroads on the  strength of the constitution.  It has some-
times been followed by  a  prolapse of  the uterus or vagina;{ by
abortion or miscarriage,  where there is pregnancy; and by barren-
ness, where no pregnancy has occurred.  When it acts on the sys-
tem at  large, it has given rise to cutaneous eruptions  of various
kinds ;§  and is said to  have  introduced tabes  and hectic  fever,[)
 cirrhus, and cancer.^
  The cure is  often difficult: but it is of no small importance to be
* Astruc, DeMorb. Mulier. Lib. I. cap. 10.
t Prod. Act. Havn. p. 160.
+ Boehman, Diss, de Prolapsd et Inversione Uteri. Hal. 1745.
§ Klein, Interpres Clinicus. p. 112.
H Hippocr. Aph. Sect. v.
7 Raulin, Sur les Fleurs blanches. Tom, I. passim. 
 GE. II.—SP. I.]         SEXUAL FUNCTION,                  «.

 from the first, fully acquainted with the nature of its cause and cha-
 racter, for the  proper  means to be pursued  will  mainly depend
 upon this.  And hence it will often  be necessary to examine the
 organs themselves, or  to  entrust the examination to a nurse on
 whose judgment we can fully depend.
   [f the cause be uncleanliness, a lodgment of  some portion of a
 late menstrual flux, or  any other actuating material in the vagina,
 nothing more may be necessary than frequent injections  of warm
 water: or if the vagina itself be much irritated, injections of the
 diluted solution of the acetate of lead : which last will often indeed
 be  found  highly serviceable  where the discharge  proceeds  from
 debility and relaxation produced by a severe labour or miscarriage,
 forming no uncommon  causes : as they are  also no uncommon ef-
 fects.
  Other instringent injections have often been tried, as green tea, a
 solution of alum, or sulphate of zinc, a decoction  of pomegranate
 bark, or a solution of catechu.   All these are sure to b^ of service
 as tending to wash away the discharge, and keep the parts clean ;
 and in many cases they will also succeed as astringents i nor is it
 always easy to determine which is to be preferred, for in some cases
 one answers the purpose best, and in others another.
  Sir Kenelm  Digby recommended a local application of the fume
 of sulphur,* which may be communicated "in various ways; and so
 far as this  has a tendency to change the nature of the morbid ac-
 tion, by originating a new excitement, it is worthy of attention;
 but perhaps the diluted aqua-regia bath, of which we have spoken
 under spasmodic jaundice,! may prove more advantageous.
  The disease, however, is often highly  troublesome and obstinate,
 and hence it has been necessary to employ constitutional as well as
 local means.
  The general remedies that havU been had recourse to are almost
 innumerable.  Acids have been taken internally in as concentrated
 a state as  possible, but  rarely with much  success.  The sulphuric
 acid has been  chiefly depended upon : and, in the form of the eau
 de Rabel,  which is that of digesting one part to three of  spirit of
 wine, it was at one  period supposed to be almost a specific.  The
 compound, however, has not been able to maintain its reputation,
 and has long sunk into disuse.
  Emetics  have been found more useful, as operating by revulsion
 and  stimulating the system generally: and on this ground a sea-
 voyage  accompanied with  sea-sickness has often  effected a cure.
 Stimulating the bowels, and particularly in  the commencement of
 the  disease, and  where the general  strength has  not been much
encroached upon, has  for  the  same  reason  been frequently found
useful, as  transferring  the irritation  to a neighbouring organ,  and
under a more manageable form.  And one of the best stimulants for
* Medic. Experiment, p. 65.
f Medic. Experiment, Vol. 
52
CENETICA.
[CL. V—OK. I.
 this purpose is sulphate of magnesia.  Small doses of calomel have
 been given daily with the same view, but they have not succeeded
 in general.  Heister, howeyer, recommended  mercury in this dis-
 ease, even to the extent of salivation ;* yet this  is a very doubtful
 remedy, and even under the best issue purchases success at a very
 dear. rate.   A spontaneous  salivation has sometimes indeed effected
 a cure ;t but this is a very different affair, for here the blood is not
 broken down into a dilute state, nor the general strength interfered
 with.  Mr. John Hunter, with a view of changing the  nature of the
 morbid action in its own field, advised mercurial inunctions in the
 vagina itself.
  Other  stimulants  have been recommended that operate  more
 generally,  and have a peculiar tendency  to influence the secretion
 of mucous membranes, as the  terebinthinate preparations, particu-
 larly camphor, balsam ofcopaiva, and turpentine itself: and  there
 is reason to believe that the second of these has  often been useful.
 It has sometimes been employed  in combination with tincture  ot
 cantharidel:  but the  latter is, in most instances, too irritating,
 whether made use of alone, or with any other medicine.
  As the'acids have not succeeded, neither have other astringents
 to any great extent.  The argentina or  wild  tansy (Potentilla
 anserina, Linn.) was at one time in high favour; it was particularly
 recommended by M. Tournefoot,  and, upon  his recommendation,
 very generally adopted. Alum has been supported by a still greater
 number of advocates  for its  use;  and  kino has, perhaps, been
 employed quite as extensively.  Dr. Cullen asserts that he has tried
 all these alone without success, but that oy uniting kino and alum,
 as in the pulvis stypticus of the Edinburgh College,  he  obtained
 not only a  most powerful astringent, but  one  that had occasionally
 proved serviceable in the present disease.  The anserina has justly
 sunk into oblivion.
  Upon the whole, the  best general treatment we can recommend
 is a use of  the metallic tonics, and  especially zinc and  iron, in con-
junction with a generous but temperate diet, exercise that produces
 no fatigue,  pure  air, and change of  air,  cold bathing, regular and
 early hours, and especially a course of the mineral waters of Tun-
 bridge or Cheltenham.
* Wahrnemungen. Band. II.
f Eph. Nat. Cur. Dec. HI. Ann. IX. X. Obs. 140. 
GE. II.—SP. II.]        SEXUAL FUNCTION.                 03
                       SPECIES II.

            LEUCORRHCEA NABOTHI.

                      &afcottr*0|joto«

  THE DISCHARGE SLIMY,  AND MOSTLY TINGED WITH BLOOD;

In this species the fluid is secreted by the glandulee Nabothi situate
on the mouth of the uterus,  whence this specific name.  It is the
leucorrhcea Nabothi of Sauvages, and the hsemorrhagia Nabothi of
Cullen.  It is most usually found as the harbinger of labour:  and
indicates that the irritation  which stimulates the uterus to spasmo-
dic and expulsory contractions, when the full term of pregnancy
has been completed, or some accident has hurried forward the  pro-
cess, has now commenced, and that the pains of child-birth may be
expected soon.   It  is probably nothing more than the usual fluid
secreted by the glands from which it flows,  augmented in quantity
in consequence of temporary excitement, and mixed with a small
quantity of blood thrown forth at the same time, and from the same
cause, by the mouths of the exhalants, which gives it, soon after its
first appearance, a sanguineous hue.  It is  hardly entitled to the
name of a hemorrhage, as given by  Dr. Cullen, though blood from
the uterus often succeeds to it, apparently thrown forth by anasto-
mosis, in consequence of the violence of the pains.
  In its ordinary occurrence it is only worthy of notice, as a devia-
tion from the  common secretions  of  health, and is  rather to be
hailed than to become a subject of cure or removal.  But there is
a state of irritation to which these glands are sometimes subject that
produces the same discharge, and in considerable abundance, for
many weeks or  months before labour, and which, for the comfort of
the patient, requires a little medical advice and attention.
  The irritation may proceed from plethora and distention, or from
a weak or relaxed state of the constitution.  If from the former,
venesection and gentle laxatives will prove the best course we can
pursue: if from the latter, a reclined position, easy intestinal eva-
cuations, and such  sedatives as may sit  most pleasantly on the
stomach, and produce less disturbance to the head. 
;>i
GENETIC A.
LCL.  V—OR. i.
                       SPECIES  III.


       LEUCORRHCEA  SENESCENTIUM.


                M§itt$ of afc&awefc llife*

 THE DISCHARGE THIN,  ACRID,  FREQUENTLY EXCORIATING AND
                           FETID.

 This is usually, but not always connected with a morbid state of the
 uterus.   It commonly shows itself on the cessation of the menses :
 and is often chronic and obstinate.
  The more common diseases of the uterus with which the discharge
 is combined are an incipient cancer, or a polypous fungus.   But I
 have occasionally met with it unconnected with either, and appa-
 rently  dependent upon  a peculiar and chronic irritability of the
 uterus, or  rather perhaps of those glands  which secrete the fluid
 that is  poured  forth during the act of sexual intercourse.   A lady
 about forty years of age,  not long ago applied to me, who had for
more than a twelve month been labouring under a very distressing
case of this kind.   She had been married from an early period of
life, but had never been  pregnant.  Her general health  was good,
 her temper easy, her imagination peculiarly warm and vivid. She
 had no local pain, and had ceased to menstruate at the age of about
thirty-eight.  The discharge at the time I first saw her consisted of
 at least from a  quarter to half-a-pint daily ;—thick, slimy, brownish,
 and  highly offensive.   Every external and internal remedy that
 could be thought of appeared to be of only temporary avail, and
 sometimes of no avail whatever,  though she certainly derived relief
 from injections of the punica Granatum, with a fourth part port
 wine, which for some time checked the discharge, and diminished
 the fetor.  In the mean time, the general strength was preyed upon,
 the loins  became full of pain, the appetite failed,  and the sleep was
 disturbed.  Accidental circumstances compelled  her, even  in this
 debilitated state, to undertake a  voyage to India.  During  its pro-
 gress she suffered severely  from sea-sickness ;  but the   change
 hereby produced, or effected by the warmth of the climate,  proved
 peculiarly salutary : for she gradually lost the complaint, and reco-
 vered her usual health.
  Emetics, change of climate, and the tor.?c  plan already recom-
 mended under the  first species, seem, hence, to be the best course
 we can pursue in the species before us. 
GE- IH-1             SEXUAL FUNCTION.                    53
                       GENUS  III.


                    BLENORRHCEA.


                        CDonow&oea*

 MUCULENT DISCHARGE FROM THE URETHRA, OR VAGINA;  GENE-
   RALLY WITH LOCAL IRRITATION AND DYSURY J NOT DISAPPEAR-
   ING DURING MENSTRUATION.

 Blenorrhcea is a Greek compound of modern writers, derived
 from £a«v*, « mucus," and ,'**,« to flow." Sauvages, and after him
 Lullen, have employed gonorrhoea from yov.s, « semen," and  «'<«. as
 a common term for this and spermorrhcea constituting the ensuing
 genus, and consisting in  an evacuation of semen.  Cullen, indeed
 has extended the term still further in his First Lines,  and  hence
 morbid secretion of mucus, all kinds  of venereal contagion, and se-
 minal flux, are equally arranged as species of the  same generic dis-
 ease; and this too under  a  word which imports the  last  alone
 While, to add to the confusion, this very word, in its vulgar sense
 is restrained to venereal contagion, which, in its strict meaning, that
 ot seminal flux, it signifies just as  much as it does abortion 01 stone
 in the bladder.  It is  high time to make  a distinction,  and  to di-
 vide thejhst  ot  Sauvages into  two  genera.  Blenorrhcea  has,
 indeed, been already employed of late by various  writers to denote
 the first of these genera, and  there  is no necessity for chanein*
 the term.                                                 b  °
  The genus  under Muller,*  is  subdivided into numerous  spe-
cies : but the three following include  the whole that fairly belong
to it:                                                j       h

 1.  BLENORRHCEA SIMPLEX.      SIMPLE URETHRAL RUNNING.
 2.-----------LUODES.      CLAP.
CHRONICA.    GLEET.
* Miiller, Medic. Wochenblatt, 1784. N. 51, plures species. 
56
GENET1CA.
[CL. V.—OR. I.
                        SPECIES I.

             BLENORRHCEA  SIMPLEX.

               Simple mvttbval Running*

 SIMPLE INCREASED SECRETION FROM THE MUCOUS GLANDS OF THE
                          URETHRA.

 This definition is given in the words of Dr. Fordyce, and is suffi-
 ciently clear and  expressive.  In effect, the efflux proceeds from
 mere local irritation, unaccompanied  by contagion, or virulence  of
 any  kind, and is chiefly found in persons in whom the affected or-
 gan is in a state of debility; the occasional causes of irritation be-
 ing venereal  excess, too large an indulgence in spirituous liquors,
 cold, topical inflammation,  too  frequent purging, violent exercise
 on horseback, to which various authors add transferred rheumatic
 action ;* and occasionally, according to Mr. John Hunter, transfer-
 red irritation of the teeth.t
  The matter discharged is whitish and mild,  producing no exco-
 riation, pain in  micturition, or other disquiet.   It  is the mild go-
 norrhoea of many  writers, the gonorrhoea pura of Dr. Cullen ;  and
 usually yields without difficulty to  rest, emollient injections,  and
 very gentle and cooling purgatives.



                       SPECIES  II.

             BLENORRHCEA LUODES.

                           £la$L

 MUCULENT DISCHARGE FROM THE  URETHRA OR VAGINA,  INTER-
  MIXED WITH  SPECIFIC VIRUS.'  BURNING PAIN IN MICTURITION :
  PRODUCED BY IMPURE COITION : INFECTIOUS.

 This is a disorder of far greater mischief  and violence than the
preceding, and  in contradistinction to it has been very generally
 denominated the virulent or malignant gonorrhoea. It U the Gonor-
 rhoea impura of Cullen.
* De Plaigne, Journal de Med. Tom. LXXfV .
  Richter, Chir. Bibl. B. IV. p. 508.
  Ponteau, Oeuvres Posthumes. I.
| Natural History of the teetb. 
GE.ITI.—SP. II.]        SEXUAL FUNCTION.
57
  . The disease was for  many years supposed  to be a local effect of
that poison, which when communicated  to the  system, produces
syphilis.  It is in truth received in the same manner, and by the same
organs—its medium of  conveyance being that of cohabitation with
an infected person.   We are chiefly indebted to Mr. John Hunter
for having pointed out the distinction:  and there is now scarcely
an individual who has any doubt upon the subject, though there are
several who conjecture that it has been derived from the  syphilitic
venom changed and softened in its virulence by an introduction into
different constitutions.   These conjectures are harmless, but they
have little ground for support.   That it is a disease specifically dif-
ferent from syphilis, is clear from the following facts. Its appear-
ance did not commence till more than a hundred years after that of
syphilis; it will continue for months without any syphilitic symp-
toms, which are rarely, indeed, found connected with it; and where
such  symptoms have shown themselves, there has been full evi-
dence of a new and different infection or strong ground  for suspi-
cion : the matter of chancre, the pathognomic symptom of syphilis,
when introduced into the urethra has been found not to produce
clap, and the matter of clap inserted under the skin, has been prov-
ed not to produce syphilis;  the common course of mercury which
is the only specific cure for the latter, is a very inconvenient, and
dilatory  way of treating the former; while the local plan by which
the former is conquered with great speed  and ease, produces no
effect on the latter.
   Some  of these  facts  were known to physiologists and  reasoned
from even before the time of Mr. John Hunter; and hence Baglivi
contended that virulent gonorrhoea, as it was  then called, may be
produced by other acrimonies  than  the syphilitic,* while Zeller,
towards the close of the seventeenth century,  affirmed, that it may
originate  in either sex without  contact;+  and Stoll  in the middle
of the eighteenth, that  it proceeds from  various  causes  of which
syphilitic contagion is one.j
  It is not easy to account for the primary appearance of this or of
any other specific  poison : but  wc see daily that most, perhaps all,
mucous membranes, under a state of some  peculiar morbid action,
have a tendency to secrete a virulent and even contagious material
of some kind or other; the particles of which are in some instances
highly volatile,  and  capable of communicating their specific effect
to organs of a like  kind ; and of propagating their power by assimu-
lation, after having  been diffused to some distance through the
atmosphere, which does not at all times readily  dissolve them;
though, agreeably to  a general law we have formerly pointed out,
the more readily, the purer the constitution of the atmosphere.§ We
 * De Fibra Motice, &c.
 \ Diss, de Gonorrhoea viruleiKta in utroque sexii, Tubing. IT'JO.
 % Prsclect. p. 104.
 § \ol.H. Sect. 9. p. 76.
VOL.  IV.                      II 
5d
ULXLl'lCA.
[CL. V.—OR. I
have a manifest proof of this in the muculent discharge of dysentery,
in canine catarrh of the muculent affection in the nostrils of dogs,
which is  vulgarly called distemper,  and in the  glanders, possibly
also  in the farcy,  of horses.  And although that species of catarrh
which we name influenza,  is probably a  miasm rather dependent
on some intemperament of the atmosphere itself in its  origin, than
on the  temperament of the individual who suffers from it; yet this
also  becomes a contagion in its progress, and is communicable  in
consequence of such new property,  from  individual to individual,
after a removal into fresh and very remote atmospheres by travelling;*
whilst nothing can be more highly contagious than the discharge from
the mucous glands of the tunica conjunctiva in purulent ophthalmy,
although  possibly  the matter of this  contagion dissolves rapidly  in
the atmosphere, or it is not sufficiently volatile to float in it; whence
a direct contact is necessary for the production  of its effect.
  In like manner, leucorrhcea,  as we have already observed, has
sometimes seemed to be contagious ; for I have  occasionally found
a kind of blenorrhoea produced in men, accompanied with a  slight
pain in the urethra,  and  some  difficulty  in making  water, upon
cohabitation with  women who upon inspection, had no  marks  what-
ever of luodic blenorrhcea, or clap ; and, in some instances, indeed,
were wives and matrons of an unimpeachable character.
  The  disease before us, however, has symptoms peculiar to itself,
and undoubtedly depends upon a specific virus.  The chief of these
symptoms are described  in the definition.  They are  generally
preceded by a troublesome itching in the glans penis, and a general
sense of  soreness up the  whole  course of  the urethra: soon after
which the discharge appears, on  pressing the glands, in the form of
a whitish pus oozing from its orifice.  In  a day or two it  increases
in quantity, and becomes yellowish; and, as the inflammation aug-
ments, and the disorder grows more virulent, the yellow is convert-
ed into a greenish hue, and the matter loses its purulent appearance,
and is  thinner and more  irritant.  The  burning or scalding  pain
that  takes place on making water is usually seated about half an inch
within  the orifice of the urethra, at which part the passage feels
peculiarly straitened or contracted, whence the urine flows  in  a
small,  interrupted  stream : the lips of the urethra are thickened
and inflamed, and a general tension is felt up the course of the penis.
This last symptom is sometimes extremely violent, and accompanied
with involuntary erections; at which time, as the frsenum, in conse-
quence of the inflammation, has lost its freedom of motion, the penis
is incurvated with intolerable pain.  It is to this state  of the penis
in which it bears some resemblance to a hard, twisted cord, that the
French have given the name of  choudee.  Under these circum-
stances we often meet with a troublesome  phimosis, either of the
strangulating,  or  incarcerating kind; in  consequence of the in-
creased spread of the inflammation.   Sometimes it extends to one

      * Sc* Catarrh us epidemicus, of this work, Vol. II. p. 295, 296. 
GE. III.—SP. II]       SEXUAL FUNCTION.
59
 or both groins, in which case the glands swell and buboes are often
 formed ;  sometimes it reaches  to the bladder, the surface of which
 pours forth a cheesy or wheyey fluid instead of its proper lubricous
 secretion, which is communicated to the urine; and sometimes the
 testes participate in the inflammation, become swollen and painful,
 and excite a considerable degree of fever.
   In women, the  chief seat of affection is the vagina;  but  as this
 is a less sensible part than  the urethra, the pain is seldom so pun-
 gent, except when the  meatus  urinarius and the nymphse associate
 and  participate in the inflammation.
   The disease appeals at very different  intervals after infection,
 according to the irritability of the constitution.   The usual time is
 about the fourth or fifth day.   But it  has  shewn itself within the
 first twenty-four hours, and has sometimes continued dormant for a
 fortnight.  Domeier lays down the time  from the fourth  to the
 fourteenth day.*   Plenciz fixes it after the tenth.t  Sometimes by
 the violence of the irritation the secretion  is absorbed as fast as it
 is effused; so that only a very small discharge takes place,  while
 the  other symptoms are peculiarly  exasperated.  To this  state of
 the  disease some  practitioners have applied the very absurd  name
 of gonorrhea sicca.
   It was at one time imagined  that the puriform fluid which is usu-
 ally poured forth in considerable abundance, proceeds from an ulcer
 in the urethra; but it is now well known,  as we have already had
 occasion to observe frequently, that it is not necessary for an ulcer
 or an abscess to exist for the formation of pus,  and the  dissection
 of persons who have died  while labouring under, this disease, have
 sufficiently shown that the secretion is thrown forth from the internal
 membrane of the urethra, chiefly at the lacuiue,  without the least
 appearance of ulceration, or even, in most instances, of excoriation.
   The cure,  in the present day, is simple; for the venereal clap,
 like  the venereal pox, appears  to have  lost much of that virulence
 and  severity of character, by passing from one constitution to an-
 other, which is evinced on its first detection.  Rest, diluent drinks,
 and an antiphlogistic regimen  will often effect a cure alone.   But
 it may be expedited by cooling  laxatives, and topical applications.
  The remedies employed are of two kinds, and of very opposite
 characters; stimulant, and sedative. Both, also, are used generally
 and locally;  with  a view of taking off  the  irritation indirectly by
 exciting a new action ; or directly,  by rendering the parts affected
torpid to the existing action, and thus allowing it to die away  of its
 own accord.  Many of these medicines, indeed, as well the local as
 the general, were,  at one time, supposed to be natural antidotes, and
to cure by a specific power: an idea, however, which haslongbeen
banished from the minds of most practitioners.
  The general sedatives that have  hitherto been principally em-
* Fragmente liber die Erkenntnis venerisclier Kran^heiteu  Hanoy. 1790,
t Aeta, et Obscrvationes, Med. p. 139. 
60
GENETICA.
[CL.  V.—OR. I.
ployed are opium,  coniuni. nitre, oily emulsions,  and mucilages-
The first has often succeeded, but with considerable and very un-
necessary inconvenience to the constitution: the others are not much
to be depended upon.  They may have co-operated with a rigidly
reducent diet, but have seldom answered alone.
  Employed locally, some of them, and particularly opium, have
proved far more beneficial.  The best form of this last is that of an
injection rendered  somewhat viscid by oil or mucilage, both which
have a greater chance of acting as demulcents, and sheathing, or
inviscating the acrimonious  corpuscles in this case, than on the
irritable  surface of the lungs in catarrhs, and asthma, when given
by the mouth.
 "The stimulant process has, however, been  found to answer so
much more rapidly and more effectually, that it  has almost  super-
seded the use of sedatives in modern practice.
  Formerly  this process, alr,o, was employed generally, and it  was
supposed, and,in many  cases,sufficiently ascertained,that by strong-
ly irritating some other part, the morbid excitement of the urethra
would subside, and the organ have  time  to recover its natural ac-
tion.  And hence the intestines were daily stimulated by cathartics,
as neutral salts, mercury,  and colocynth,  which last was at one time
regarded as  a  specific ; or terebinthinates, as camphor, balsam  of
copaiba,  and  turpentine  itself.   And sometimes the bladder was
treated in the same manner,  with diuretics of all  kinds, and espe-
cially with cantharides.
  This plan is still continued in many parts of the East, and par-
ticularly in  Bengal and  Java ; where, as we are informed by  Mr.
Crawfurd, the  common remedy,  and one to which the disease,  in
those hot regions,  yields  very easily is that of cubebs, the piper
cubeba of Linneus.  This pepper, well  pounded,  is exhibited  in  a
little water, five or six times a day, in the  quantity of  a  dessert
spoonful, or about three drachms, as well in the ensuing as in the
present  species,  during which time  all heating aliments  are to  be
carefully abstained from.  The cure, we arc told, is entirely com-
pleted in two or three days, the ardor urinse first  ceasing, and the
discharge again becomes viscid. A slight  diarrhoea is sometimes
produced, with a flushing in the face, and  a sense of heat in the
palms of the hands, and the soles of the feet.  In a few instances,
Mr. Crawfurd tells us, inflamed testicles  have supervened, an affec-
tion which yields easily to the common treatment.*
   There is  no necessity,  however,  for subjecting the constitution
to so severe a discipline : for the stimulant process, and particular-
ly that of astringent stimulants, when  employed locally,"succeeds
 ordinarily in a few days without any trouble.  These consist chiefly
 of metallic salts in solution, as the muriate, and sub-muriate of mer-
 cury, the former in  the proportion  of three or four grains to eight
 ounces of water:—sulphate of zinc, sulphate of copper, ammoniacal
  * Account of the Piper Cubeba, &c. Edinb. Med. and Sure. Journ. No. LIII
p. <j*. 
GE. III.—Sl\ II.]        SEXUAL FUNCTION.                   Q \

copper, and sub-acetated solution of lead. The astringent property
of most of these, under due management, instead of being found
mischievous, gives a  check to the  morbid secretion, at the same
time that it acts as a direct tonic and rapidly restores the irritated
mouths of  the exhalants to their healthy and proper action; and
this, too, without the inconvenience of a secondary inflammation.
A slight solution of alum alone, indeed, in the proportion of one or
two grains  to an ounce of water, has,  for this purpose, been often
employed with  sufficient efficacy;  though the present author  has
reason to prefer the sulphate of zinc, which he has  usually combined
with the bole armenic in the proportion of one  scruple of the former
and two of the latter to half a pint  of water.   And he  can venture
to say that through a pretty extensive course of practice, for  up-
wards of thirty years, he has never known this composition to fail:
and has never perceived it produce any of the inconveniences of
stricture or swelled testicle  which were so much but so  ground-
lessly apprehended  when the  stimulating and astringent  practice
was first introduced.
  The addition of the bole may to some practitioners appear trifling,
but it adds to  the  power of the zinc,  probably by giving an in-
creased body to  the solution without diminishing its stimulant effect,
which would certainly follow by using oil or mucilage  in its stead.
The sulphate of copper is more irritating than that of zinc, and, in
a strong solution, is more likely to produce inflammation ; and it is
on this account chiefly that the author has confined himself to the
latter.  It  is in  effect, by an analogous practice, that several modi-
fications of purulent opthalmy, and particularly that of infancy, is
most  successfully subdued, as we observed when treating of this
disease.
  It is almost unnecessary to  add that  the utmost cleanliness by
frequent washing should be maintained from the first appearance
of the disease.
  Where  the complaint, however,  is improperly treated with  sti-
mulants, and particularly astringent stimulants, or where it has con-
tinued too  long before application for medical  assistance, the whole
range of the uretha, or some particular parts  of  it, are apt to  be-
come  so irritable as to excite spasmodic  contractions, which com-
monly pass under the name of strictures, without being so in reality ;
and, as we have already observed, this irritation in some cases, ex-
tends to the interior surface of the bladder, and  even thickens it.
We have often had  occasion to  remark that  in  fibrous structures
and canals  the most sensible pSrts are their extremities ; and this
remark is particularly applicable  to blenorrhcea, for the portions of
the urethra which suffer most from irritation are the interior mem-
brane of the glans and the prostate, particularly the latter, in con-
sequence  of its direct connection with the bladder as well as the
urethral canal.
  On  this  account,  when a patient once labours under spasmodic
constrictions from the disease before us, whatever other parts these 
fjo                        (.ENETICA.            [CL. V—OH. I.

mav exist  in, the  introduction of a bougie will be almost sure to
prove that there is also a constriction in the prostate.  Generally
speaking it will be found to originate  here, and to occur in other
parts of the canal from sympathy.  But the case  will often be re-
versed, and while the irritation originates in some  other part, or in
the bladder, it is by sympathy with these that the prostate itself is
affected.  Mr. Abernethy has pointed out this double source of spas-
modic constriction in. the prostate, in the clearest manner possible ;*
and the remarks he has offered upon the propriety of employing or
withholding the bougie as  an instrument of  cure cannot  be too
deeply imprinted on  every student's mind : the general principle of
which, is to persevere  in  its use wherever it appears to blunt the
sensibility; and to pass it as high up the urethra as can be accom-
plished with  this  effect, if  possible indeed  through  the prostate
into the bladder; but in every  instance to desist where a second or
third  trial  of the instrument gives  more pain than the first, or to
content ourselves with passing it as high as can be done without
any such symptoms  of increased  irritation,  and there  stopping
short: and  only making an occasional trial when we have reason to
hope that the  morbid sensibility has still further subsided.
                       SPECIES III.

            BLENORRHCEA  CHRONICA.




PLIMY  DISCHARGE FROM THE  MUCOUS GLANDS OF THE UR1CTHI1A,
  WITHOUT SPECIFIC VENOM  Oil INFECTION :  SLIGHTLY IRRITAT-
  ING : CHRONIC.

This species is a frequent sequel upon a  clap that has been ill-ma-
naged, or has lasted long, and produced an obstinate local debility.
lint it exists also independently of clap, and is occasioned by strains,
excess  of venery, and other causes of weakness.  The discharge is,
for the most part, a bland and slimy mucus not accompanied with
inflammation,  apparently proceeding from  a  morbid relaxation of
the mucous  glands of  the  urethra, and  at times, like other dis-
charges from debilitated organs, accompanied with and kept up bv
irritation and  especially irritation  produced  by a stricture in the
urethra properly so called,  or a  diseased state  of the prostrate
gland.
  In common causes, the disease yields to the  local tonics and as-
tringents recommended under the preceding species, but itissome-
'  s;ur^icai observations on Diseases of the Urethra, p. 194, 8vo. 1810. 
GE. Ill—SP. Ill]         SEXUAL FUNCTION.                63

times peculiarly  irritable, and bids defiance to all the ingenuity of
the medical art.   A. Castro gives an instance of its having conti-
nued for eighteen years.*
   The stimulants ordinarily employed have consisted of copaiba or
some terebinthinate or resinous  balsam  in the form of injection;
tincture of ipecacuanha, as recommended by Schwediauer; infusion
of cantharides, a favourite remedy with Bartholin; or a blister ap-
plied to the urethra, as advised  by Mr. John Hunter and  several
other writers.
  The bougie may here be used, for the most part more fearlessly
than in the preceding species.  Its own simple stimulus, if employ-
ed regularly once or twice a-day, has often proved sufficient: and
where this fails it may be rendered more active by being smeared
with turpentine, mercurial ointment, or camphorated linament; or
armed with nitrate of silver, where there are strictures that require
it.  Even in this species, however,  it is  a valuable remark of Mr.
John Hunter, that, before we have recourse to any powerful acuants,
we should well weigh the degree of irritability  of the patient's
constitution :  for we may otherwise run a risk of exciting a violent
local inflammation, or of extending the  irritation to the testes or
the bladder.  Should such an issue unfortunately occur, one of the
most salutary injections we can employ is a solution of the extract
of hyoscyamus in water.  Even in chordees, which resisted the in-
fluence of opium, Mr. Bell asserts that he has  found this medicine
advantageous in the quantity of from one to three  grains at a time,
and  repeated  three times a-day or oftener.   Or we may have  re-
course to a warm hemlock poultice, applied every  night, and made
sufficiently large to cover the whole of the perinseum, testes, and pe-
nis.  I have known this succeed in taking off" an habitual irritation,
and with it effectually suppressing the discharge, on the third appli-
cation, in two instances of more  than a twelvemonth's  standing  :
and this after  stimulants of all kinds, and narcotics of many kinds,
and particularly opium, had been tried in  succession.  The leaves
were here employed in a fresh state. Nisbet  gives an instance of
cure, procured by a fresh infection:  but this is not a remedy to be
recommended  either medically or morally.
  In women this disease is often mistaken for leucorrhcea; we have
pointed  out the distinctive character under the last species.   Yet
the mistake is not of essential consequence, as the same treatment
will often effect a cure in both.   As the  vagina, however,  is  less
irritable than the uretha, gleet in females is a less frequent and a
less troublesome complaint than in males.
* De Morb. Mul. p. 68, 
G4
UENETICA.
[CL. V.—OR. I.
                      GENUS IV.


                 SPERMORRHtEA.


                      Seminal f\w*

INVOLUNTARY  EMISSION OF  SEMINAL FLUID  WITHOUT  COPULA-
                           TION.

The generic name is derived from  r™c.,  « sero" ",,emino£
whence aspermus, « void of seed,"  gymnospermus,   having the
seed naked "-a term well known in botany; and hence also nume-
rous otherderivafives of the same  kind   Gonorrhoea which^s a
direct synonym, would have been retained as the name for thi= ge-
nus, buY from the confused  signification in which  »t has  been em-
ployed by Sauvages and Cullen ; and from its being usually, though
mosytTmproperly^applied in the present day to blenorrhcea luodes.
  The genus offers two varieties as follow :
1. SPERMORRH.KA ENTONICA.     ENTONIC SEMINAL FLUX.
2_____________ATONICA.        ATONIC SEMINAL FLUX.
                       SPECIES  I.

          SPERMORRHtEA ENTONICA.

                @ntomi Seminal jFlu*»

JWOI.UNTARY  EMISSION  OF PROPER SEMEN  WITH ERECTION?
     MOSTLY FROM AN INDULGENCE OF LIBIDINOUS  IDEAS.

The usual cause is assigned in the definition, and it very strikingly
noints out the influence which the mind bears upon the body, and
the necessity of subjecting the passions to the discipline ot a chaste
and virtuous deportment; since, as there  is no passion more debas-
ing than that of'gross lust, there is none more mischievous to the
general health of the body.  It  leads the besotted  slave  straight
forward to  every other sensuality, anil, by becoming at length an
established and chronic disease,  stupefies the mind,  debilitates the
body, and is apt to terminate in hectic fever and tabes.
   This affection sometimes originates in  the body itself: in a local
and urgent erethism, produced,  as Forestes conjectures,* by a su-
• Lib. XXVI. Obs. II. 
GE. IV.—SP. II.]       SEXUAL FUNCTION.
65
pcrabundant secretion of seminal fluid in a constitution of entonic
health and vigour.  And,  as in the former case, the  body is to be
chastised through the mind, in the present the mind is to be chastis-
ed through the body : particularly by purgatives and venesection, a
low diet and  severe exercise.  If, however,  the  patient be single,
as is commonly  the  case, the pleasantest as well as the most ef-
fectual remedy is to be sought for in marriage.
                        SPECIES II.

           SPERRMORRHGEA ATONIGA.

                   Atonic Seminal jrfit**

 INVOLUNTARY EMISSION OF A DILUTE AND  NEARLY PELLUCID SE-
   MINAL  FLUID; WITH LIUIIUNOUS PROPENSITY BUT WITHOUT
   ERECTION.

 Of this species Sauvages gives us two curious examples : one from
 Deidier, in which the patient was an exemplary monk,  who shrunk
 with horror at the idea of this involuntary self-pollution, as he re-
 garded  it: the other a case in his own practice, in which the pa-
 tient  a  most religious young female, was, as he affirms, driven al-
 most  to madness under the same erroneous contemplation  of the
 disease.   From  his having  included a female under this genus, it
 should seem  that Sauvages inclined to the theory of epigenesis, or
 that which supposes the male and female to contribute equally  a
 seminal fluid in the act  of  procreation.   It is probable that some
 local irritation is the  usual  cause.  Professor Deidier himself sus-
 pected this in the first of the  above cases ;  and referred it  rather
 to a calculus in the bladder, sympathetically affecting  the prostate
 gland, than to any idiopathetic disease of the vesiculse seminales, or
 the testes. The pious monk found himself most relieved by scourg-
 ing his legs :  a blister applied to the perinseum would probably have
 relieved him  still more effectually.  The fluid is a thin degenerate
 secretion, apparently from the vesiculae seminales,  rather than se-
 men itself.  It is sometimes found intermixed with blood ; and in
 this case we have the further irritation of a wound or ruptured ves-
 sel.  The most common cause of  this miserable disorder is a pre-
 vious life of unrestrained concupiscence :  and under this debility,
 hereby  produced, the morbid discharge is peculiarly apt to flow
upon the mere muscular excitement that takes place on evacuating
the rectum;  and hence follows hard upon a stool.*
         * Art. Med. Berol. Dec. I. Vol. IV. p. 70.
          Wichmann De Pollutione, Goett. 1712.
vol. ir.                     I 
66
GENETICA.
[CL.  V.—OIL I.
  A cure should be attempted by the daily use of a bidet of cold
sea-water,  or of early bathing in the sea, and the internal use ot
metallic tonics.  The bowels should be kept lax, but the warm and
irritating purgatives should be carefully abstained from.  Blistering
the perinseum, or making a seton in it has occasionally been tound
serviceable; as has also  a local use of electricity.
                       GENUS  V.


                       GALACTIA.


                      jlBtglactatiotL

           MORBID  " i.OW OR DEFICIENCY OF MILK.

This includes the greater part of those affections,  treated of by
Dioscorides, under the name of sparganosis, which, however, in his
arrangement embraced, as we observed under phlegmone mammae,*
many complaints that have little or no connection  with each other,
and particularly one of the species of bucnemia, or tumid-leg : so
that it has been necessary to break up the division and allot to its
different members their proper positions.
  Galactia  is a Greek term, from y<*A«, " lac,"  whence yxXa-
%tikos,  " lacteus."   It occurs in Linneus and Vogel for  the genus
now before us, which by Sauvages and Sagar is written galactirrhcea,
literally " milk-flux," in a morbid sense of the term.  The author
has preferred galactia as more comprehensive than galactirrhcea,
so as to  allow the idea of a depraved or defective, as well  as  of a
superabundant secretion of milk:  all which are equally entitled to
be comprized  under one common head, as excess,  deficiency, or
other irregularity of arterial action in  fever.   Hitherto, however,
from an opposite fault to that of Dioscorides, these affections have
been separated from each other by many  nosologists, and  carried
to different heads, sometimes to different orders, and occasionally to
different classes; whence the student has had to hunt for them
through  every section of the nosological  arrangement.   It has al-
ready been necessary to make the same remark respecting many of
the species of paramenia : and various other instances will occur
to us in the ensuing orders of the class  we are now explaining
  The flow of milk may become a source of disease as being out of
season,  defective in quantity, vitiated in quality, transferred to an
improper organ, and as discharged from the proper organ but in
• Vol. II. p. 187. 
GE. V.—SP. I.]        SEXUAL FUNCTION.
67
the male  sex.  These  differences  will furnish the present  genus
with five distinct species as follows :

1. galactia prematura.       premature milk-flow.
DEFICIENT MILK-FLOW.
2.----     DEFECTIVA.

3.--------DEPRAVATA.       DEPRAVED MILK-FLOW.

4.--------ERRATIOA.         ERRATIC MILK-FLOW.

2. '--------VIROBUM.          MILK-FLOW IN MALES.
                         SPECIES I.

             GALACTIA PREMATURE.

                  IBrematuve IBrtfe^totD,

             EFFLUX OF MILK DURING  PREGNANCY.

 The mammae, which maintain the closest sympathy with the ovaria,
 and uterus, and in most animals possessing them are placed in their
 direct vicinity,  and which in truth  are as much  entitled to the
 character of a sexual organ as any organ of the entire frame, par-
 ticipate in the developement of the generative function from the first
 stimulus of puberty.   It is then that the breasts  assume a globose
 plumpness, and the catamenial flux commences; when pregnancy
 takes place, and  the  uterus enlarges, the breasts exhibit, a corre-
 spondent increase of swell 3 and when, shortly after child-birth, the
 lochial discharge ceases, and the uterus takes rest, the lacteal dis-
 charge is secreted and poured forth in immediate succession. The
 sympathy continues, however, even after this rest has commenced,
 for one of the most effectual  means of increasing the flow of milk
 from the breasts is a slight excitement of the uterus as  soon as it
 has recovered its tone ; and hence the mother of an infant living
 with her husband, and herself in good health, makes a far better
 nurse and even  requires a less stimulant regimen than a stranger
 brought from her own family,  and secluded  from  her  husband's
 visits.  Of this, indeed, many of the rudest  and most barbarous na-
 tions, but who are not always inattentive to the  voice of nature,
 have the fullest conviction; insomuch that the Scythians, according
 to Herodotus, and the Hottentots  in our own day, irritate the va-
 gina to increase the flow of milk in their cows and mares.
  It sometimes happens, however, that this  stimulus of sympathy is
 carried to excess  even during pregnancy, and that the lactiferous
 ducts w  the mammse secrete  milk from the  ultimate branches of
the arteries sooner than it is wanted.  If the quantity thus separat-
ed be small it is of no moment; but if it be considerable, some de-
cree of debility is  usually produced with restlessness and pyrexy. 
68
GENETIC A.
[CL. V.—OR. I.
And hence Galen observes, that a premature flow of milk indicates
a weakly child;* and the collections of medical curiosities contain
various cases, in which it has appeared to be injurious.!   Sauvages
gives an instance in which a pint and a half was poured forth daily,
as early as the fifth month.  Where  the constitution is peculiarly
robust/even this  mav for some  time be borne with as little mis-
chief as menstruation" during  pregnancy; but in ordinary cases  the
system must  be weakened  by so  excessive and unprofitable a dis-
charge.   There is an instance noticed in the volume of Nosology,
in which  a pint  and a half was poured forth daily at the fifth
month.
  The morbid irritation, however, may generally be taken off by
venesection, and, if this should not succeed, by a few doses of ape-
rient medicines, which have the double advantage of lowering the
action in the affected  organ,  and  exciting a new and revulsive  ac-
tion in an organ that is usually more manageable.
  It has sometimes happened that a like precocity has occurred in
young virgins, 'and that these also have  secreted and  discharged
milk "from the proper  organ.  In many cases this has occurred as a
substitute for the  catamenial flux which has been retained or sup-
pressed at the time,! but more generally it has  proceeded from en-
tonic  plethora, or a morbid erethism  of the  sexual organs at  the
period of puberty ;§ and is to be removed by a reducent regimen,
bleeding and purgatives, as just pointed out.
  On the other  hand we have occasional instances of a supply of
milk, in  women considerably advanced in life, and who have long
ceased to bear children, and even to  menstruate.   Thus  a woman
of sixty-eight, is stated by Dr. Stack, in the Philosophical  Transac-
tions, to have given suck to two of her grand-children ;|| and  an-
other of eighty in  a  Swedish Journal,  is said to have performed
the same office. 1   In most of these  cases the antiquated  nurses
have consisted of  married  women,  who had  many years before
reared families of their own, and whose  lactiferous organs were
therefore more easily  re-excited to the renewed action, than if they
had never suckled, the  cause has been  some peculiar  irritation
originating in the radicles  of the lactiferous ducts, or excited by a
transfer of action from the uterus or ovaria in  consequence of a
cessation of the menses.
  * Fragm. ex Aplior. Itab. Alois, p. 34
  t Act. Nat. Cur. Vol. IV. Obs. 66.
  $ De la Corde, Ergo virgo, menstmis deficientibus, lac in mammis habere
potest.  Paris, 1580.
  § Hippocr. Aph. Sect. V. § 39.
   Vega, Corominent. in Hippocr. Aph. V. § 39.
  I Vol. XLI, year 1739. 141.                                •
  i  See also Phil. Trans. Vol. IX. year 1674. 
GE. V.—SP. 11.3        SEXUAL FUNCTION.
69
                        SPECIES  II.


              GALACTIA DEFECTIVA.


                    ^Deficient  MUM\q\x>.

            INABILITY TO SUCKLE UPON CHILD-BIRTH.

 This is the agalaxis or agalactatio of preceding  nosologists;  and
 may proceed from two causes, accompanied with symptoms pro-
 ducing the two following varieties :
 <*■ Atonica.                      From want of secretion.
   Atonic inability to suckle.
 * Organica.                     From  imperfect nipple or other
   Organic inability to  suckle.      organic defect.

   To every feeling and considerate mother, inability to suckle is a
 serious evil: and, generally speaking,  it is an evil of as great a mag-
 nitude to the mother herself as to the child ; for a free secretion of
 milk prevents many present and not a few eventual mischiefs. The
 health of women during suckling is, in most instances,  better than
 at  any period of their lives.  Their appetite  is excellent, their
 sleep sound and refreshing,  their spirits free, their temper cheerful.
 But to every conscientious mother there is, superadded to all this,
 a pleasurable feeling of a still higher and nobler kind : it is a sense
 of  consciously discharging  the maternal yduty :  it is the gratifica-
 tion of beholding the  lovely babe  to whom she has given birth
 saved from the cold  caresses of a hireling, to lie in the warm em-
 braces of her own bosom : to grow from the sweet fountain which
 she furnishes from her own veins, rich, ample, and untainted : to
 swell  with the tender thrill  that shoots through the heart at every
 little  draught which  is drawn away from  her;  to see  the cheeks
 dimple and the eyes brighten, and the limbs play, and the features
 open ;  and to trace,  in every fresh lineament, a softened image of
 herself or one  dearer to her  than herself.   This is the luxury that
 awaits the mother, whose unseduced ear still listens to the voice of
 Nature, and estimates the endearments of domestic life  at a higher
 value  than the intoxicating charm of fashionable amusements and
 midnight revels.   Though transported with the present, her com-
 forts d-> not end with the present: For she has yet to look forward
 to,a term of life in which, when those who have made a sacrifice
 ot maternal duty at the altar of pleasure, are wasting with decline,
 trembling with palsy, or tormented with the dread of cancer, she
 will still   enjoy the "blessing  of unbroken  health, and sink as on a
downy pillow into a tranquil old age.
  But though these remarks apply to the  greater  number of  those 
70
GENETICA.
[CL. V__OR. I.
 who in the career of fashion, abstain from the duty of a mother, it
 by no means applies to all. There are many excellent mothers who
 would  undergo the severest discipline of pain to accomplish this ob-
ject, but after all are not able.  There are some who from the want
 of a proper  nipple, or perhaps the want or  undevelopment of lac-
 tiferous ducts, are naturally disqualified for the office: as there are
 others  whose constitutional debility renders them incapable  of se-
 creting their milk in sufficient abundance, or with a sufficient ela-
 boration  for healthy food.  And in all  such cases it is expedient,
 wherever the means will allow, to seek carefully for the substitute
 of a foster mother.
  But  let not the natural office be abandoned too soon,  and parti-
cularly where  the child  is strong and hearty.  If the nipple be at
fault much maybe done to remedy it.  If it be buried in the breast.
it  may often be drawn out by exciting a vacuum with  the ordinary
glass tube invented for the purpose, if dexterously applied ; or,
which will often succeed better, by the suction of a woman who is
well  skilled in the art: or an artificial nipple may be employed if
these do not succeed.
  And if the breasts be hard and lumpy, and a considerable degree
of symptomatic fever supervene, the same kind of suction must be
had recourse to twice a day, while the breasts are kept in a constant
state of relaxation by gentle friction with warm-oil, large cataplasms
of bread and water, and  a suspensory bandage of flannel passed un-
der the arms and drawn as tight as may be borne without incon-
venience.
  Even where the milk is not very  promising, either in respect to
quantity or quality, let not the unhappy mother despair for the first
week or two.  As her own strength increases, the  strength of the
milk will often  be  found to increase  also:  the  milk vessels  will
yield with more facility, and the symptomatic pain in the back  will
subside.   Added to which the matrimonial excitement to  which I
have alluded in  the preceding species,  will in due time be called
 in to bear its beneficial part; and the woman who had a hopeless
 prospect before  her may in due  time reap the full harvest of her
 labours. 
GE. V.—SP. III.]        SEXUAL FUNCTION.                  ^i


                       SPECIES III.

             GALACTIA DEPRAVATA.

                  SDepratai) |Etlfe4Ioto>

            EFFLUX OF A DILUTE OR VITIATED MILK.

Here also we have two varietes :

  « Serosa.                  Weakened by too large a proportion
   Serous Milk-flow.             of serum.
  £ Contaminata.             Deteriorated  by  intermixture with
   Contaminated Milk-flow.      some foreign material.

  To the first  variety we have alluded under the preceding spe-
cies : for it sometimes happens that milk, when deficient in quanti-
ty, is also of a more dilute quality than it ought to be.  But more
frequently, as local irritation is a result or concomitant of debility,
there is in weakly habits a very large flow of a thin, slightly blue,
and almost pellucid milk, containing little sugar, and still less cream.
The properties of a sound woman's, milk  we  have  already given
under consumption, and to save an unnecessary repetition, the rea-
der  may turn to the passage at his leisure, and compare it with the
defective character before us.*
  Tonics, and a generous diet, afford in this case the best chance
of success, and are often employed with full effect.
  Under the  second variety the assimilation is imperfect, and the
milk has the taste or smell of beer, or wine, or some other fluid that
has  been  introduced into the stomach: proving that the digestive
power is weak, and requires correction and invigoration.  In other
cases we have examples of black, green, or yellow milk: probably
discoloured by an union with effused  blood.
  All violent exertions, whether of body or mind, and hence vio-
lent passion, as rage and  terror,  have a peculiar influence in
changing  the natural character of milk; and the  distressing pas-
sions frequently drive it away entirely.!  It is hence, of no  small
moment that a wet nurse be of an easy and even temper,  and not
disposed to mental disturbance.
* Marasmus Phthisis, Vol. II. p. 494.
f Starch, Archiv. fur Geburtsbelfer. B. III. 12. B. II. p. 3. 
73
GENET1CA.
| CL. V .—Ok. I
                       SPECIES IV.

               GALACTIA ERRATIC A

                   (Erratic IBtlfuflotan

MILK TRANSFERRED TO, AND DISCHARGED  OR ACCUMULATED AT
   SOME REMOTE ORGANS, OFTEN UNDER A DIFFERENT FORM.

Like the menstrual flux, there is scarcely  an organ to which the
flow  of milk has not been transferred under different circumstances,
or in different constitutions.  And  hence the author has adverted
in the  volume of Nosology  to examples of its translation to the
fauces, where it has been discharged in the form  of a ptyalism : to
the general surface of the mammee, where it has been evacuated in
the form of sweat: to the navel, where it has assumed an ichorous
appearance : to the kidneys, which have thrown it off in an  increas-
ed flow of urine: to the eyes, whence it has been discharged as a
milky epiphora :  to the veins, which it has overloaded, so as to de-
mand the use of the lancet:  and to  the vagina, where it has excited
a copious leucorrhcea.   It is also said to be frequently translated to
the thighs,  so as to produce the disease we have already described
under the name of bucnemia sparganosis, but which is clearly
unconnected with the state of the milk or of the breasts.
  The causes are chiefly a sudden exposure of the  breasts  to cold ;
cold-water  drunk improvidently when  in a state  of perspiration,
spirituous potation, and sudden emotion of mind.
  The irregular action is  best subdued by gentle laxatives, dia-
phoretics, and perfect quiet in a warm bed.  Where ardent spirits
have been the cause,  the aperients  should be more  stimulant, and
bleeding will often be necessary.
  The blood itself, however, during the time of suckling  is often
loaded with milk from resorption, and evinces a milky appearance,
as are likewise several of the fluids  secreted from the blood : and
hence, also, one cause of many of the above peculiarities. 
BE. V.«-SP. V.]
SEXUAL FUNCTION.
ya
SPECIES  V.
                GALACTIA VIRORUM.


                  JIBUfcsfloto in  J&aleg*


 MILK SECRETED IN MALES AND DISCHARGED FROM THE PROPER
                          EMUNCTORY.

 A milky serum, and sometimes genuine milk has been  found  to
 distil from the nipples of new-born infants, of both sexes, and some-
 times from boys of a later age.   But various authors, as Scholk, P.
 Borelli, and  Lauremberg have  given cases,  of genuine milk, dis-
 charged in like manner by adult males ; occasionally continuing for
 a long time:  and, in some instances, enabling them to perform the
 office of nurses.  In the Commentaries of the  St. Petersburg Aca-
 demy,* a flow of milk from the breasts of males, is said to be very
 common in Russia; and  Bluuu>nbach has noticed the same peculia-
 rity in the males of various other mdmmals.t  Among men, indeed,
 the  discharge appears  occasionally to have occurred  even  in ad-
 vanced life;  for Paullini gives the case of a  man, who was able  to
 suckle at the age of sixty.f
   Why man  should, in every instance, possess the same organiza-
 tion as woman for secreting and conveying milk, is among the many
 mysteries of physiology that yet remain to be solved.  But as there
 is little or no sympathy between  the mammae in man and any of the
 proper organs of generation, as in woman, we are at no loss to ac-
 count for their general sterility auu  want of action.  Occasionally,
 however, the  lacteal glands in  man, or the minute tubes which
 emerge from them are  more than ordinarily irritable, and throw-
 forth some portion of their proper fluid.   And  if this irritation be
 encouraged and supported, there is no reason why such persons may
 not become wet-nurses as well as females.  And hence Dr. Parr
 inquires, with some degree of quaintness, whether this organization
 is allotted to both sexes,  in order that " in cases of necessity men
 should be able to supply the office of the  woman ?" Under these
eircuinstances,  the discharge,  though unquestionably a deviation
from the ordinary law of nature, can scarcely be regarded as a dis-
ease.
       *  Tom. III. p. 278.
       f  Hanorcrsich Magazin, 1787.
       *  Cent. II. Obs. 93.
         Shacker, Diss, de lacte Virorum et Virginum.
vol. iv.                    K 
  CLASS V.

GENETICA.
                       ORDER II.

                     ORGASTIC A.

            2Di0eaae0 affecting tlje jSDrgasm*

  ORGANIC OR CONSTITUTIONAL  INFIRMITY,  DISORDERING THE
          POWER, OR THE DESIRE, OF  PROCREATING.

The ordinal term orgastic a, is derived from opyau  "appeto im-
patienter; proprie de animantibus dicitur, quae  turgent libidine."
Scapul.   Orgasmus is, hence, used by most writers for salacity in
general; though by Linneus it is employed in a very different sense,
being restrained to subsidtus arteriarum.
  The following are the genera which appertain  to this order:

      I.  CHLOROSIS.          GREEN-SICKNESS.
      II.  PRCEOTIA.           genital precocity.
     ill.  LAGNESIS.           LUST.
     IV.  AGENESIA.           MALE STERILITY.
      V.  APHORIA.           FEMALE STERILITY. BARRENNESS
     VI.  iEDOPTOSIS.         GENITAL PROLAPSE.
                      GENUS  I.

                     CHLOROSIS.

                    d&reem&tcfewgjcft

PALE, CHLORID COMPLEXION; LANGUOR J  LISTLESSWESS ;  DEPRAV-
  ED  APPETITE AND DIGESTION: THE SEXUAL  SECRETIONS DE-
  PRAVED OR INERT, ESPECIALLY AT THEIR COMMENCEMENT.

Chlorosis  is  a derivative from xXex or %*•■» "herba  virens •''
whence,among the Greeks, £A«»e*o>«e and #A«g ieca-l 5 "viror,'' "pal- 
GE. I.]
SEXUAL FUNCTION.
75
 lor;'' evidently applied to the disease, like  our own term green-
 sickness, from the pale, lurid, and greenish cast of the skin.
   The causes of this disorder are  numerous :  one of the most fre-
 quent is menostration, retrained or suppressed catamenia; another
 is excessive menstruation ; a third, inability of obtaining the object
 of desire, in popular terms love-sickness : a fourth is dyspepsy, or
 any other source of general debility about the age of puberty, by
 which  the  natural development of the sexual  system  and the
 energy of its secretions is  at  this time interfered with.  Dr. Parr
 makes it a question whether love-sickness or an ungratifled longing
 for an object of desire is ever a  cause; but  the examples  are too
 numerous to give  countenance to any doubts upon the  subject;*
 and  pining, eager,  ungratifled  desire for any object whatever, in a
 particular state of constitution, whether for an individual or for a
 particular circle of society, forborne or for country, is  well known
 in many cases to break down tiie general health, and to lay a foun-
 dation for chlorosis, as well as many  other complaints even of a
 severer kind.  We have already noticed it as producing suppressed
 menstruation;  as we have also the opposite state of disappointment
 overcome, renewed hope, and a prospect of connubial happiness,
 as one of the best and  speediest means  of cure.
   Perhaps retained menses, and dyspepsy at the period of puberty,
 are the most common causes ; and hence chlorosis  makes so near an
 approach to both these complaints, that some nosologists have merg-
 ed it altogether in the  first, and others in the second.   Dr. Cullen
 so far as relates to  his opinion, is an example of  the former.  Dr.
 Young, so far as relates to  his arrangement,  ot the  latter.   It is
 necessary to attend to this limitation :  for while Dr. Cullen, in the
 later editions of his Synopsis, asserts  "nullam chlorosis  speciem
 veram,  prseter  illam quse retentionem  menstruorum comitatur, ag-
 noscere vellem"—he still continues chlorosis in all the editions of
 this  work as a distinct genus  from amenorrhcea, or  paramenia
 obstructionis, of which upon this view of the  subject it should be
 only a species of variety.   In the same manner, Dr. Young, while
 he makes chlorosis a mere  species  of  dyspepsia  in his classifica-
 tion, observes, as though dissatisfied with its arrangement, " I  have
 followed a prevalent opinion,  but there are  various  reasons for
 thinking it is quite  as naturally connected with amenorrhcea."
  Chlorosis is often, indeed, not only connected with amenorrhcea,
 but a consequence of it.  Yet few writers have felt themselves able
 to adopt Dr. CuIIen's views upon the subject, and to  believe it in
 every instance a modification of this disease. Sauvages asserts that
there are daily cases of chlorosis occurring among children from
 their cradles; and he has hence, among his chloroses  verje, set
down one  species  under  the  name of  chlorosis infantum.  This,
however, is  to  generalize the  term too widely,  and  to make it
* Panarol. J. trolog. Pentech. III. Obs. 14.
  Ephem. Nat. Cur. Dec. II. Ann. IX. Obs. 114. 
7*
GENET1CA.
[CL. V—OR. II.
include all cases marked by indigestion, and a chlorid countenance.
Yet  I  cannot but concur with those authors  who  contend that
chlorosis is by no means uncommon  among females  who have no
interruption of the menstrual flux; though a derangement of some
kind or other in quantity, quality, or constituent principles appears
to be always connected with it;"and  is for the most part the cause
Or leading symptom.   There is even ground for carrying the term,
with other authors, still further, and applying it to green-sick boys
as well as green-sick girls, for reasons which will be offered in their
proper place.
  For  the  present, it is sufficient to  characterize chlorosis as  a
dysthesis or cachexy,  produced by a diseased condition of the sexual
functions operating upon the system at large, and  hence most com-
mon to the age of puberty, in which this function is first called forth
by the  complete elaboration of organs that have hitherto been inert
and  undeveloped.  "A certain state  of the genitals," says  Dr.
Cullen, " and the remark will apply to both sexes equally, is  ne-
cessary to give tone  and tension to the whole  system ; and there-
fore, that if the stimulus arising from the genitals be wanting,  the
whole  system may fall into a torpid and  flaccid state, and from
thence chlorosis may  arise."
  The  genus chlorosis offers the two following species :

     1. CHLOROSIS ENTONICA.    ENTONIC  GREEN-SICKNESS.
     2.     ii.     ATONICA.     ATONIC GREEN-SICKNESS.
                       SPECIES I.

             CHLOROSIS  ENTONICA.

                Cntamc 4Dmn=&tcfem0&

HAniT plethoric; pain in the head, back, or loins; fre-
  quent PALPITATIONS AT THE HEART; FLUSHES IN THE FACE*
  PULSE  FULL,  TENSE, AND FREQUENT.

Chlorosis has been commonly confined to  the second or atonic
species.  But the symptoms and mode of treatment of the disease
as it appears in a vigorous,  florid, and  full-bosomed country-girl
overflowing with health and  hilarity ; and in  a delicate, pale-faced,
emaciated town-girl, debilitated  by an indulgence in a course of
luxurious indolence from her infancy, seem to justify and even
demand a distinction.
  In both cases tbere is a want of energy of mind, great irregularity
in the mental functions, and often a high degree of irritability in the
nervous system, clearly proving a very extensive disturbance of the 
GE. I__SP. I.]          SEXUAL FUNCTION.                  rff

general balance.  But they differ in the symptoms enumerated in
the definitions, than which no two sets can well be more at variance.
They differ also in the remote-and proximate causes, and conse-
quently  in the mode  of treatment.
   In the species before us, characterized by a  rich and oppilated
habit, with a full and tense pulse, and pressive pains in the head or
loins, the ordinary causes are catching cold in the feet at the period
of the catamenial discharge, by which the constitutional plethora is
considerably aggravated, and the plethoric excess itself even where
no cold  has  been received.  The pains so  common  and  often so
severe in the back and loins, and from sympathy, not unfrequently
in  other parts, evince local irritability with entastic  spasm in the
organs  which form  the seat of the disease.   There is here a  mor-
bid accumulation of  living power: the fabric is satiated or over-
loaded ; and  for the very reason that in  dyspermia entonica or
super-erection, as we shall have occasion to observe presently,  there
is  no seminal emission,  or as in double-flowering parts there  is no
efficient development of the sexual distinctions, in the present case
there is no efficient secretion of the genital fluids.  And as we have
 shown in the Physiological Proem to the present order, that the ma-
turity of the system in females as well as in males, depends upon a
development of the sexual organization in all its powers, and a  cer-
tain degree of resorption of its secreted materials, the general frame,
how rich soever and even oppressed with juices of other kinds,  must
remain incomplete and unripened, and sicken at the time of matu-
ity for  want of this  appropriate stimulus.  And if such an effect
 may occur  where there is  no concomitant source of exitement, we
 can easily conceive how much more readily it may take place upon
 catching cold in the  feet,  or on a sudden and violent mental  emo-
 tion, or any other cause that may  accidentally add to the pressive
 irritation of  the organs immediately affected,  and increase  their
 tendency to spasmodic action.
    Yet there can be no doubt that the species  before us, though the
 offspring of a redundancy of living power, if neglected, or obstinate,
 and of long continuance,  may, and often does, by debilitating the
 constitution, terminate in  the atonic species we shall presently
 enter upon.
    Before such a change, however,  takes place, and particularly in
 the commencement of the disease, we  are loudly called upon for
 general depletion.   Copious,  and not unfrequently repeated vene-
 sections will be found necessary:  cooling, rather than heating  and
 irritant purgatives  should be interposed ; and where pain about the
 lumbar  region, or any other  local irritation, is very troublesome,
 the hip-bath, or a general warm-bath should be used steadily.  And
 when, by this plan, the sanguiferous entony is subdued, a plain diet,
 regular exercise, and sober hours, will easily accomplish the rest. 
7S                       GENETICA,           [CL. V.—OR. to


                       SPECIES II.

               CHLOROSIS  ATONICA.

                 Atonic d3mni&itkim$.

 HABIT DEBILITATED ; GREAT INACTIVITY AND  LOVE OF  INDUL-
   GENCE;  DYSPNOEA ON MOVING; LOWER LIMBS  COLD AND EDEM-
   ATOUS, ESPECIALLY AT NIGHT ; PULSE QUICK AND FEEBLE.

In conjunction with the above specific  symptoms, there is, in this
division of the disease, the same want of energy of mind, and fickle-
ness of temper,  and corporeal irritability which we have  already
noticed  in  the preceding,  and this too  in a much greater degree;
abundantly proving a very extensive  disturbance  of the  general
balance.
  For examples of this species we are to look not into the quiet and
sober retreats of rural life, marked by simple meals, healthful acti-
vity, and early hours ; but to the gay and glittering routine of town-
indulgences,  and midnight parties, and hot  unventilated  atmos-
pheres; the havoc of all  which is  to be seen in  the pale, but  bloated
countenance, the withering form, emaciated muscles, and  depart-
ing symmetry of those  who are  the victims of a life of pleasure;
and  who, in consequence of their turning night into day,  are ex-
hausted, and drowsy, and spiritless, and perhaps confined to their
beds all the morning; thus carrying on the inversion of  nature,
and turning in like manner, the day into night.
  Under a  life of this kind, it is  impossible for a growing girl to
acquire a healthy maturity : and  most  happy is it for her that the
caprice of fashion, which calls upon her to make this heavy sacri-
fice of her person for one half of the year, drives her, in most cases,
into the freshening shades and soberer manners of the country for
the other half.
  There  are other girls,  however, who without  these peculiar
sources of exhaustion,  have so much constitutional debility  and re-
laxation, as to be incapable of bearing the double load of  growth
and sexual development without manifesting a considerable degree
of sickliness in all their functions.
  In both these cases,  the disease is probably produced by a che-
mical imperfection or want of elaboration in the blood itself, so as
not to keep pace with the expansion and irritability of the sexual
organs; and consequently so as not to afford them a pabulum suffi-
ciently rich and ripe for secretion.
  Here, therefore, bleeding and  purgatives would only add to the
evil; and it behoves us even from the first to employ a strengthen-
ing and tonic plan, and to extend  it through all the departments of
diet, exercise, and medicine :  the whole of which, however,  mav be 
GE. I—SP. II.]        SEXUAL FUNCTION.
79
collected from what has already been observed on the genus para-
menia.
  The same kind of debility which prevents  the  full development
of the  sexual  organization  and a  secretion of the sexual juices  in
growing girls, prevails, not unfrequently, in growing boys, and espe-
cially when about the age of puberty the growth is rapid, and out-
runs the general  strength of the system.  And it is to this state I
alluded when observing a page or two back, that the term chlorosis
has occasionally  been applied to males as well as to females at this
Unsettled period  of life.   In the volume of Nosology I have remark-
ed that it is frequently so applied in the East, and especially among
Persian writers, who accordingly express one  subdivision oi the
disease by the  name of bimariy kodek or morbus puerorum.  Bonet
has followed the oriental extension of the term, and has given in-
stances of its occurring not only in pubescent but even adult males :
and, in like manner, Sir Gilbert Blane in his table of diseases, under
the article  chlorosis, observes that one of his  patients affected with
this complaint " was a male of seventeen, who had  all the charac-
ters of this malady  except that which is  peculiar to the female sex.
He was treated  like  the others, and recovered  under the use of
carbonated iron  and aloes."*  It  is on this account that the defini-
tion of chlorosis will be found, in the  present work, to vary in  some
degree from all that have preceded it, so as to render its characters
capable of  embracing  the male as weil  as the female form  of the
disease, which unquestionably ought to be included under it: and is
to be attacked by the same remedial  plan.
                       GENUS  II.

                       PRCEOTIA.

                     d&emtal precocity*

PREMATURE DEVELOPMENT OF SEXUAL ORGANIZATION OR POWER.

The generic term  prosotia or promotes is copied  from Theo-
phrastus, and deprived from -r^at " prsemature."  It is, however,
peculiarly applied to premature semination.
  The genus, as embracing both sexes,  comprises the two follow-
ing species:

1. PR030TIA MASCULINA.          MALE FRECOCITY.
2.    •---FEMININA.           FEMALE PRECOCITY.
* Medico-Chir. Trans. Vol. IV. p. 140. 
80
ttENETICA.            [CL. V.—OR. D.
                         SPECIES  I.

              PROEOTIA MASCULINA.


                       |E ale  precocitp*

 PREMATURE DEVELOPMENT OF SEXUAL ORGANIZATION IN MALES.

 Both the mind and body advance in their ordinary career, by slow
 and almost imperceptible steps to maturity ; faculty after faculty,
 and function after function  puts forth, acquires  strength, and be-
 comes perfected.  But  it occasionally happens that  this  ordinary
 course is departed from, and that the whole system as well mental
 as corporeal, or, which is still more frequent, that particular powers
 or organs, push forward with incredible rapidity.  The admirable
 Crichton, as he is commonly called, and others pre-eminently gifted
 in the same extensive way, afford instances of the first of  these re-
 marks : and those who, in early and even in infant life, have shown
 a peculiar aptitude for an acquisition of languages, or of music, or
 numerical arithmetic, give examples of the last kind.
  It is not hence much to be wondered at that a like extraordinary
 precocity should sometimes  exhibit  itself in  the development of
 sexual organization and  power: and that from a peculiar degree of
 local irritation or erethism, the pubes should be found covered  with
 hair, the testes be formed and  capable of secreting a seminal fluid,
 and the penis be  susceptible  of a  concupiscent  turgescence and
 erection.
  It is not necessary to dwell upon instances of exemplification,
 which may be traced in  great numbers  in the writings of physiolo-
 gists  who have  been  curious  upon the subject.   Those  who are
 desirous of doing so, may turn to the Journal des Scavans for 1688,
 and the Philosophical Transactions for  1745. In the former Bioset,
 gives  an instance of this disgusting anticipation  in a boy  of three
years  old ;  in the latter, the subject in  the case recorded was  two
years  and eleven months.  A  similar example at a similar age is
 well  known to have occurred, only a few years since, in a  boy  who
was exhibited by his friends for money to medical practitioners in
this metropolis: and  maybe found, together with various others,
minutely described  in the first volume of the Medico-Chirurgical
 Transactions.
  With respect to  moral, or even medical treatment, nothing can
be worse than  this very common practice  of a  public  exposure
 whenever  the case  occurs among the poor, who  are so  strongly
tempted to make a profit of it.  The orgasm  is fed by a repetition
of examinations, and the polluting tide that exhausts  and  debases
the body, is at length accompanied, even though it should not be so
 at first, with a polluting pleasure, that in a still greater degree ex- 
\iE. II—SP.L]
SEXUAL FUNCTION.
81
haunts and debases the mind.  An occasional application of leeches
to the  seat of affection, cooling aperients, a cool, loose, and unirri-
tating  lower dress,  with the daily use  of a bidet of cold water, or
iced water, will form the best plan that can be  pursued  on such
occasions: and, by producing a healthful repression, may enable
the unhappy infant to grow up with gradual vigour to the possession
of a hearty manhood, instead of sinking, as has been sometimes the
case, into a premature and tabid old age at the early period of pu-
berty.
                        SPECIES II.

               PRCEOTIA FEM1NINA.

                     female ^recocitpt

 PREMATURE DEVELOPMENT OF SEXUAL ORGANIZATION IN FEMALES.

 Under the species of obstructed menstruation, we have observed
 that this secretion, which commonly affords a  proof that the sex-
 ual organization is developed, and its function completed, takes
 place at very different periods of life under different circumstances,
 chiefly those of climate and peculiarity of constitution : and that
 though  its ordinary epoch is that  of thirteen  or fourteen, it has
 sometimes, under the influence of a tropical sun, or a warm and
 forward temperament, shown itself as early as eight or nine years of
 age.*
  There is hence no difficulty in conceiving that, under the influ-
 ence of the same  kind of local erethism we have noticed in the
 preceding species, the sexual organization in females may acquire
 a similar precocity to  that in males.  And so complete has been the
 development occasionally, that we have numerous and well authen-
ticated instances of pregnancy itself occurring at the early age of
nine, on which we shall have to remark  more fully in the introduc-
tory observations to the  third Order of the present Class, when
 treating of morbid impregnation.
  This foremarch of nature  should be timely checked, for it will
 otherwise assuredly lead to a very great debility of the system in
general, and is usually found to stint the stature, and induce a pre-
mature old age.  And the means of repression  may be the same as
those already proposed for male precocity.
  The  premature development of  organization before us does not
always  seem to be  connected with any cupidinous orgasm, or at
least it has occurred under circumstances that render it extremely
VOL. IV.
• Walther, Thes. Obs. 40.
           L 
82
GENETIC A.
[CL. V__OR. It
difficult to entertain  any such idea.   One of the most singular in-
stances of this kind is a case of extra-uterine fetation communicated
by Dr. Baillie to the  Royal  Society, and published in  their Trans-
actions for 1789.  It  consisted of a suetty substance, hair, and  the
rudiments of four teeth,  found in the ovarium of a child of not more
than twelve  or thirteen years of age, with an infantine uterus, and
perfect hymen.*
  In this case there can  be little doubt that an ovulum by some pe-
culiar irritation had  been excited to the rudimental  process of an
imperfect conception, and that it had, in consequence, been separat-
ed  from its  niche, and  a corpus luteum  taken its place.   In  the
Physiological Proem to  the present Class, we have  observed that
such  changes are occasionally met  with in  mature virgins whose
organs  have afforded ample proof of  freedom from  sexual com-
merce, the ordinary  mode of accounting for which, is by supposing
that although they have  never  cohabited with the male sex, they
have at times felt a  very high  degree of orgasm or inordinate  de-
sire, and that such feeling  has been a sufficient excitement to pro-
duce such an effect. The author has already expressed himself
not  satisfied with this   explanation; and the case before  us  can
hardly be resolved into  any such causation.
                     GENUS III.


                      LAGNESIS.

                          IUi0t*

INORDINATE DESIRE OF SEXUAL COMMERCE, WITH ORGANIC TUR-
                   GESCENCE AND ERECTION.

Lagnesis is a derivative from ywyvvs, " libidinosus;" " prseceps in
venerem;" and, as a genus, is intended to include the satyriasis
and nymphomania of Sauvages, and later authors ; which, chiefly, if
not  entirely,  differ  from  each other only as appertaining to the
'pale or female sex, and in their symptoms do not, like the preced-
ing genus, offer ground  for two distinct species.  The proper spe-
cies belonging to this genus are the following :

1. LAGNESIS SALACITAS.                SALACITY.
2* ——— FUROR.                   LASCIVIOUS MADNESS.
♦ Phil. Trans. Vol. LXXIX. p. 71. 
GE. III.-SP. I.]
SEXUAL FUNCTION.
83
                        SPECIES I.

              LAGNESIS  SALACITAS.


                          &alatttp<

THE APPETENCY  CAPABLE  OF  RESTRAINT :  THE  EXCITEMENT
          CHIEFLY OONFINED TO THE SEXUAL SYSTEM.

In a state of health and civilized society there are two reasons why
mankind are easily capable of  restraining  within due bounds the
animal desire that exists in their frame  from the period of puberty
till the infirmity of age : the one is of a physical and the other of
a  moral  kind.  The natural orgasm of men differs from that of
brutes in being permanent instead of being periodical, or dependent
upon the return of particular seasons; and on this very account is
less violent, more uniform, and  kept with comparative facility
within proper limits.  This is a cause  derived  from the physical
constitution of man.  But the power of habit and the early incul-
cation of a principle of abstinence and chastity in civilized  life, from
a  moral  cause of temperance  that  operates with a still  stronger
influence than the preceding, and lays down a barrier, which, though
too often stealthily broken into, yet in the main, makes good its
post and serves as a general check upon society.
   As man rises in education and moral  feeling, he proportionally
rises in the power of self-restraint; and  consequently, as he be-
comes deprived of this wholesome law of discipline, he sinks into
self-indulgence*and the brutality of savage life.   And were  it not
that the  very permanency of the  desire, as we have already ob-
served, torpefies  and  wears out it goad, the  savage, destitute of
moral discipline,  would be at all times as ferocious in his libidinous
career as brutes are  in the season of returning heat; when, stung
with the  periodical  ardour, and worked  up almost to  fury, the
whole frame of the animal  is actuated with an unbridled  force, his
motions are quick and rapid, his eyes glisten,  and his nerves seem
to circulate fire.  Food is neglected ; fences are broken down ; he
darts wild through fields and forests, plunges into the deepest rivers,
or scales the loftiest rocks  and mountains,  to meet the object that
is ordained by nature to quell the pungent impulse by which he is
urged forward :*

           Nonne vides ut tota tremor pertentet equorum
           Corpora, si tantum notas odor attulit auras ?
           Ac neque eos jam frxna virum, neque verbera sxva,
See Crichton on Mental Derangement, II. p. 301, 
84
<>ENETICA.                i^L. V.—Oil. 11.
Non scopuli, rubesque cavx, atque objecta rctardant
Flumina, correptos unda torquentia raontes.*
  The power of restraint, however, does not operate alike on all
persons even in the same state of society, and under a common
discipline.   Period of life, constitution, and habit, produce a con-
siderable difference in this  respect, and lay a foundation for the
four following varieties of morbid salacity :

         * Pubertatis.         Salacity of youth.
         £ Senilis.            --------of age.
         y Entonica.--------of full habit.
         3 Assueta.           --------of a debauched life.

   The first variety proceeds not so much  from organic tumes-
cence, as from local irritability : for it is chiefly found in relaxed and
delicate frames, weakened by overgrowth, or a life of indolence and
indulgence. The action is new, and where, from whatever cause the
irritability is  more than  ordinary, a degree of excitement is pro-
duced which shows itself constitutionally or topically.  If in  the
former way, hysteria or chorea, or some other nervous affection, is
a very frequent effect: if in the latter, a high-wrought and distress-
ing degree of appetency.   It is under this state  that females  are
said to be capable of separating  ovula from their ovaries, and to
 form corpora lutea without copulative perculsion, in the same man-
 ner as the ovaries of quadrupeds that are only capable of breeding
 in a certain season of the year, exhibit during their heat, manifest
 proofs of excitement and especially of florid redness, when examin-
 ed by dissection.  I do not think the assertion concerning women
 is altogether established ; but in the  case of young men when en-
 tering upon, or emerging from pubescence, and of t]je relaxed and
 delicate frame just noticed, nothing is more common than involun-
 tary erection and seminal  emission  during sleep, often connected
 with a train of amorous ideas excited by the local stimulus, as we
 have already observed under paroniria salax.I
    It is possible that this affection may occasionally be a result  of
 entony or plethoric vigour  as well as of atony or delicacy of health;
 but the last is by far the most common cause.
    In the first case we have nothing mbre to do than to reduce the
 excess  of  living power by  copious  venesections and purgatives,
 active labour, or other exercise and a low diet.   In the second,  it
 will be  expedient in a very considerable degree to reverse the
 plan.  We may, indeed, palliate the topical irritation by the use  of
 leeches and  cooling laxatives; but  in conjunction with this, we
  should employ the  unirritant tonics as the salts of bismuth, zinc,
  and silver, or the sedative tonics, as the mineral acids, most of the
  bitters, and the cold bath.  By taking off the debility we take off the
♦ Vir. Ceorp. Lib. III. 250.
t Vol. III. p. 120. 
GE. III.—SP. 1.3
SEXUAL FUNCTION.
85
irritation, and, by taking off the irritation, we overpower the dia
ease.
  The salacity of age is a very afflictive malady, and often wears
away the hoary form to the last stage of a tabid decline by the fre-
quency of the orgastic paroxysms,  and the drain of seminal emis-
sions without enjoyment.  It is usually a result of some accidental
cause of irritation in  the ovaria, the uterus, the testes, or the pro-
strate gland ; and has sometimes followed upon a stone in the kid-
neys or bladder; and is hence best relieved by removing or palliating
the local irritation by  a warm hip-bath, anodyne injections, or cata-
plasms of hemlock, or the other  umbellate or  lurid plants in com-
mon use. Where these do not succeed, our only resource is opium,
and the warmer tonics.
  In the first volume of the Transactions of the Medical Society of
London, Mr. Norris  has given a very curious  and striking case of
this variety, produced by a blow received a few months before near
the prostate gland, followed by a small, but nearly indolent tumour
on the part affected. The patient was a married man of sixty-seven,
and during the violence of  the erethism occasioned  by this local
irritation, which had  now continued for  two months, was reduced
to a state of the most wretched and squalid emaciation.   He could
not restrain the libidinous propensity, though he confined himself to
his wife,  with whom he  copulated from fifteen  to twenty times
nightly, receiving,  nevertheless,  pain rather  than  pleasure from
the indulgence.   The wife, a matronly  woman of great modesty,
was hereby rendered extremely ill from local inflammation.  By
supporting the system with tonics, and bringing the tumour to sup-
puration, the man completely recovered.
  Entonic salacity, or that of a robust and sa nguine temperament,
is not always so easily remedied as might at first be supposed. Co-
pious'venesections, purgatives, and a reducent diet, and this suc-
ceeded by a  regular use of neutral salts, and especially of nitre,
will often, indeed, be found highly beneficial.   But the erethism,
occasionally becomes  chronic, and defies the effects of all medicines
whatever:  and,  where  there is  an excess of irritability in the
constitution,  and  the  patient, from  a principle of  chastity, has
sedulously restrained himself from all immoral  indulgences, the
nervous system, and even the mind itself, has sometimes suffered
in a very distressing degree.  One or two examples of this we have
already noticed under ecphronia  Mania, or madness;* and it is
hardly worth while to dwell further upon the subject.  The natural
cure  is a suitable marriage  wherever  this can be accomplished:
but unless the union be of this character, it will often be attempted
in vain. Professor Frank of Vienna, in his System of Medical Polity,
relates the case of a lady of his acquaintance, of a warm and amorous
constitution,  who was unfortunately married to a very debilitated
and impotent man; and who, although  she often betrayed unawares,
• Vol. III. p. 66. 
 86                     GENETICA.             LCL. V—OK. 11.

 by her  looks and gestures, the secret fire that consumed her, yet
 from a  strong moral principle resisted  all criminal gratification.
 After a long struggle her health  at last gave  way: a slow fever
 seized her, and released her from all sufferings.
   The salacity of a debauched life, or lechery produced and
 confirmed by habit, can only be cured by a total  change of habit:
 which is a discipline fhat the established debauchee has rarely the
 courage to attempt. Exercise, change of place and pursuits, cooling
 laxatives,and a less stimulant diet than he will commonly be found
 accustomed  to, may assist them in the attempt: but in general the
 mind is  as corrupt as the body, and the case is hopeless.   He perse-
 veres, however, at his peril, for with  increasing weakness, he will
 at  length sink into all the miserable train  of symptoms which
 characterize that species of marasmus, which is usually expressed
 by the name of tabes dorsalis, and which we  have  described al-
 ready.*
                        g;    "      t

                        SPECIES II.

                 LAGNESIS  FUROR.

                  lUgtifuoug JlBaimeg^

 appetency unbridled, and breaking the hounds of  modest
  demeanour and conversation : morbid agitation of body
  AND MIND.

 Most of the causes of the preceding species are causes of the pre-
 sent, though it shows itself less  frequently at the age of puberty. It
 is in fact very nearly related to the species salacitas, though the
 local irritation is more violent, and the mind participates more gene-
 rally and in a very different manner.  Under the  first, the patient
 has a sufficiency of self-command  to conduct himself at all times
 with decorum and not to offend the laws and usages of public morals ;
and, if, as is rather the case, however, the mind  should at length
 become affected, it is rather by a transfer of the morbid irritation
 than an extension of it, so that patients thus afflicted very generally
 lose the  venereal erethism, and show no reference to it in the train
 of their maniacal ideas.  In lascivious  madness, on the contrary,
 this last symptom continues in its utmost turgency, all self-command
 is broken down, the judgment is overpowered, the  imagination en-
 kindled and predominant, and the patient is hurried forward by the
 concupiscent fury like the brute creation in the season of heat, re-
 gardless equally of all company and all moral feeling.  As it occurs
 in males it is the satyriasis furens of Cullen : as it occurs in females
 it is the nymphomania furibunda of Sauvages.
' Vol. II. p. 4 8. 
GE. III.—SP. II.]      SEXUAL FUNCTION.
87
  The pulse is quick, the breathing short, the patient is sleepless,
thirsty, and loathes his food ;  the urine is evacuated with difficulty,
and there is a continual fever.  In women the disease is often con-
nected with an hysterical temperament, and even commences with a
semblance of melancholy ;* and I once had an instance of it, from
local irritation, shbrtly after child-birth.  The  child having sud-
denly died, and  there being no more demand for a flow  of milk,
the fluid  was repelled from the breasts with two  little caution, and
the uterine region, from the debility it was  yet labouring  under,
became the seat  of a transferred irritation.   Among females  the
disease is strikingly marked by the movements of the body and  the
salacious appearance of the countenance, and even the language that
proceeds from the lips.   There is often, indeed, at first some  de-
gree of melancholy, with  frequent sighings; but the eyes  roll in
wanton glances,  the  cheeks  are  flushed,  the bosom heaves,  and
every  gesture exhibits the lurking desire, and is enkindled  by  the
distressing flame that burns within.
   In some cases it has unquestionably proceeded from the perpetual
friction of an enormous clitoris, making an approach, from its erec-
tion, to  what Galen calls a female priapism.  Biichner, Schurig,t
and Zacutes LusitanusJ gives numerous examples of this:  and Bar-
tholin has the case of a Venetian woman of pleasure, whose  clitoris
was rendered bony by frequent  use, and  consequently became a
source of constant irritation.
   In hot climates this kind of enlargement and elongation is by no
means uncommon, and, as it becomes a source of uncleanliness, as
well as  of undue excitement, circumcision or a reduction of the
clitoris to its proper size, has been often performed with advantage.
The same operation has been proposed for the case  before us, and,
in some instances, it has succeeded completely. " A young woman,"
 says M. Richerand, " was so violently affected with this disease, as
to have recourse to masturbation, which was always accompanied
with profuse emissions; and which she repeated so frequently as to
reduce herself to the last stage of marasmus.  Though sensible of
the danger of her situation, she was not possessed of self-command
 enough  to  resist the orgastic urgency.  Her parents took her to
 Professor Dubois, who,  upon the authority of Levret, proposed an
 amputation of the clitoris, which was readily assented to.  The or-
 gan was removed by a single stroke of the bistoury, and all  hemor-
 rhage prevented by an application  of the  cautery.  The  wound
 healed easily, and the patient obtained a radical cure  of her  dis-
 tressing affection.§
   Where the cause cannot be easily ascertained we must employ a
* Del'm9, Advers. Fascic. I.
  Belol, furor uterinus, Melancholicus Effectus, Paris, 1621.
| Gynaxolog, p. 2. 17.
t Prax. Admir  Lib. II. Obs. 91.
§ Richerand, Nosograpbie Chirurgicale, &c 
88
CENETICA.
[CL. V— OK. II.
general plan ot cure.   If there be plethora or  constitutional full-
ness, venesection  should never be omitted; and, in most cases,
cooling laxatives, a spare diet, with acid fruits and vegetables, cold
battling, local and general, will be found useful.  Nitre, by atten-
uating the crasis of the blood, and diminishing its impetus, has often
proved beneficial; and to this may be added conium, aconite and
other narcotics.  Camphor, which acts upon another principle, is a
favourite medicine with many, and is also well worth a trial.
  From the infuriate state of the mind in most cases of this malady,
Vogel has arranged both satyriasis and nymphomania as species of
mania.  But this is incorrect; the fury of the mind is merely symp-
tomatic.  Parr, on the contrary, has ranked, under  lagnesis,  to
which,  with  great perversion,  he applies the  term hallucinatio,
erotomania or love-sickness, more properly a variety of empathe-
ma desiderii, and  which, in the present, and most other systems, is,
therefore, regarded as a mental malady.
  Love-sickness, however, may sometimes be an occasional or ex-
citing cause, and  its symptoms may be united with the complaint,
and  even add to the general  effect, of which the History of the
Academy of Sciences affords an instance :* but in itself, it is, as we
have already shown, altogether  a disease of a different kind, and
even nature; and where it becomes  blended  with  concupiscent
fury, it must be from a concurrence of some of the special causes of
the latter, either general or local, which we have just pointed out.
  In males the disease has led to quite as much exhaustion as  in
females: Bartholin gives an example of a hundred  pollutions daily.
                      GENUS  IV.

                      AGENESIA.

                     IB ale ^tevilitp.

               INABILITY TO  BEGET OFFSPRING.

The generic term is a compound from a, negative and yttoftxi, •' to
beget," and will be found to comprehend the three following spe-
cies, derived from impotency  of power or energy; an imperfect
emission where the power is adequate; or an incongruity in the
copulative influences or fluids upon each other.
     1. AGENESIA IMPOTENS.       MALE IMPOTENCY.
     2.--------DYSSPERMIA.     SEMINAL MIS-EMISSION.
     S. ——----INCONGRUA.      COPULATIVE INCONGRUITY.
• Ann. 1764. p. 26. 
GE. IV—SI'. I.]        SEXUAL FUNCTION.                  89

  Among  plants  we sometimes meet with a like generative dis-
ability; occasionally from  imperfectly formed  styles or stigmas,
stamens or anthers; sometimes from a suppression of farina, and
sometimes  from a total destitution of seeds: which last defect  is
common to bromelia Jlnunas ; musaparadisiaca, or Banyan ; arto-
carpus incisa or bread-fruit tree ; and berberis vulgaris or common
berberry.



                        SPECIES I.

              AGENESIA IMPOTENS.

                     IE ale Simpotencp*

    IMPERFECTION OR  ABOLITION OF GENERATIVE  POWER.

The species before us is, perhaps, more  generally called by the
nosologists  anaphrodisia, though  this last term has  been used  in
very different senses ; sometimes importing a want of desire, some-
times inability, sometimes  both;  and sometimes only a particular
kind of inability resulting from atony alone.  The third species has
never, hitherto,  so far as the author knows, been introduced into
any  nosological  arrangement,  although the reader will probably
find, as he proceeds, sufficient ground for its admission.  And even
the first and second, closely as  they are connected by nature, have
rarely, if ever,  been  introduced before  under the same common
division, but been regarded as distinct genera belonging to distant
orders or even classes, and  arranged with diseases that have little
or no relation to them, of which  numerous examples are given  in
the volume of Nosology.
  Impotency in males may proceed from two very distinct causes,
showing themselves in very different ways, and laying a foundation
for the following varieties :

     x Atonica.                        Atonic impotency.
    b  Organica.                       Organic impotency.

  In the first  of these there  is a  direct imbecility, or  want  of
tone ;  produced chiefly by  excess  of indulgence, long-continued
gleet, or a paralytic affection of the generative organs.  It has also
been occasioned by a violent contusion on the loins, or a fall on the
nates.*
  Under the two last cases a cure is often effected by time, and lo-
cal tonics  and  stimulants, especially cold-bathing: and the  same
                 * Hildan. Cent. VI, Obs. 59.
VOL. IV.                     M 
90
GENETIC A.
[CL. V—OR. IT.
 process will frequently succeed where the  weakness  has followed
 upon a chronic gleet:  in which we may also employ  the course of
 remedies which  have  already been recommended for this  com-
 plaint.*
   Where the impotency results from a paresis or a paralysis of the
 local nerves, or  has been brought on by a life of debauchery, the
 case  is  nearly  hopeless.  We have heard much of aphrodisiacs,
 but there is none on which we  can  depend  in effects of this kind.
 Wine, which  is  the ordinary stimulant in the case before us,  will
 rarely succeed even  in a single instance, and where it has done so,
 it has increased the debility afterwards.  It is, in truth, one of the
 most common causes of the disease itself.
   Cantharides have  often been employed,  but. in  the present  day
 they are deservedly  distrusted, and flourish rather in  proverbs than
 in practice.  Their effect, as a  local stimulant, shows itself rather
 on the bladder and prostate gland than on the testes, and as a gene-
 ral irritant in increasing the heat and  action of the whole system,
 in which the  testes  may,  perhaps, sometimes have participated.
 " They are," says Dr.  Cullen, " a stimulant and heating substance,
 and I have had  occasion to  know them, taken in large  quantity as
 an aphrodisiac, to have excited violent pains in the stomach, and a
 feverish  state over the whole body."f
   Many  of the  verticil late plants, as mint and  penny-royal,  have
been tried in a  concentrated state for the  same  purpose, but  with
 different, and even opposite  effects, in the  hands of different prac-
 titioners. To the present hour they are supposed by many to sti-
mulate the uterus specifically,  while  they take off the venereal
 appetency in males.   Upon sober  and impartial trials,  however,
 they seem to be equally guiltless  of both :  and  may as readily be
relinquished for such purposes  as the  nests of  the Java swallow,
 which  are purchased at a high price as a powerful incentive,  and
 form an extensive article of  commerce  in the East.
   The best asphrodisiacs are warm and general  tonics,  as the sti-
 mulant bitters, and the metallic  salts, especially the  preparations of
 iron.   Ginseng, as an  aromatic bitter,  has  a just claim to a further
 trial  than it seems hitherto to have received.  In China it has for
age>  been in high esteem, not only as a general restorative and ro-
borant, but particularly in seminal debilities. Dr. Cullen appears to
have thrown it out of practice by telling us that he knew "a gentle-
man  a little advanced  in life, who chewed  a quantity of this  root
every day for several years, but who acknowledged that he never
found his venereal faculties  in the least improved by it."  This is
no doubt true, but the  merits of a medicine are not to be decided
by a  single experiment of so very loose a kind.
  Local irritants, in  many cases,  have undoubtedly been of use, as
 blisters,  caustics, and setons.   Electricity is said to have been  still
• Art. Nat. Cur. Vol. V. Ohs. 59.
f Mat. Med. Vol. II. p. 563. 
GE. IV.—SP. I.]       SEXUAL FUNCTION.
91
more extensively serviceable : and friction with ammoniated oil or
spirits, or any other rubefacient is fairly entitled to a trial.  Sting-
ing with nettle-leaves (urtica urens) was, atone time, a popular re-
medy, and flagellation of the loins* or nates,f or both, still more so.
The principle is the same, and we  hence account for the success
which is said to have attended all these in particular cases.
  In organic impotency, forming our second variety, the chance
of success is generally hopeless.  This proceeds from a misforma-
tion or misorganization of the parts, either natural or accidental: as
an amputated, injured, or enormous penis, or a defect or destitution
of the testes,  lJ later  introduces brevity  or exility of the penist,
among the causes, but these evils are generally overcome by habit.
An incurvated, retracted,  or otherwise distorted form is also men-
tioned  by many writers, but these seem rather  to belong to the
ensuing species.  An unaccommodating  bulk  of the organ seems
to have been no uncommon cause.§  Shenck gives an instance of
this kind in  which the bulk was produced by the monstrosity of a
double  penis;[] and Albinus relates  a  case of  divorce  obtained
against a husband from inability to enter the vagina ob penem inor-
wem.f  A similar litigation with divorce is recorded by Plater.**
                        SPECIES II.

             AGENESIA DYSSPERMIA.

                  &eminal IHigemiggtoiL

         IMPERFECT EMISSION OF THE SEMINAL FLUID.

This is the dyspermatismus, or, as it is usually but incorrectly spelt,
dy-spermatismus.  The termination  is varied,  not  merely on ac-
count of greater brevity and simplicity, but in conformity with the
parallel Greek  compounds, polyspermia, gymnospermia, aspermia,
terms well  known  to  every botanist, and the two former of which
are elegantly introduced into the  Linnean vocabulary
  * Meibom. de Flagrorum usu in re Venerea.
  t Riedlin, Linn. Med. 1696. p. 6.
  t Observ. Libr. I.  pp. 249, 250.
  § Schurig. Gynxcolog. p. 226.
    Wadel, Pathol.  Sect. Ill- p. 11.
  || Ol'serv. Lib. IV. N. 2. 8,
  K Dissert, de Inspect ione corpora, forensis, in causis matrimonialibus fall*-
cibus et dubiis. Hall. 1740.
  *• Observ. Lib. I. p. 250, 
92
GENETIC A.
[CL. V.—OU. II.
  Imperfection or defect of emission proceeds from numerous cau-
ses, accompanied with some change of symptoms as appertaining
to each, and hence laying a foundation for the following varieties :

« Entonica.                   The imperfectemissionproceeding
  Entonic misemission.           from super-erection or priapism.
S Epileptica.                  Rendered imperfect by the incur-
  Epileptic misemission.          sion of an epileptic spasm pro-
                                duced by sexual excitement dur-
                                ing the intercourse.
/ Anticipans.                 The discharge ejected hastily pre-
  Anticipating misemissions.     maturely and withoutdue adjust-
                                ment.
^ Cunctans.                    The  discharge  unduly  retarded
  Retarding misemission.         from hebetude of the genital or-
                                gans: and hence not accomplish-
                                ed  till  the orgasm, on the part
                                 of the female, has subsided.
e Refluens.                     The  discharge thrown  back into
  Refluent misemission.           the vesiculse seminales or the
                                 bladder, before it reaches the
                                 extremity of the penis.

  Of the first, or entonic variety, examples are by  no means un-
common.  Dr. Cockburn gives an instance in a young noble Vene-
tian, who, though married to a fine and healthy young lady, had no
seminal emission in the act  of union  notwithstanding there was a
vigorous erection, whilst he could discharge very  freely in his
dreams.*   He was greatly afflicted, as were also his family, by such
a misfortune; and as no remedy could be devised at home, the Ve-
netian ambassadors resident at the different  courts of Europe were
requested to consult the  most eminent physicians in  their various
quarters.  The case came in this  manner  under the  notice of Dr.
Cockburn, who, hitting  accurately upon the  cause of the retention,
and ascribing it to the violence  of the  erection, or rather to the
plethora of the  vessels  of the penis, whose distention produced a
temporary imperforation of the urethra, so  that the  powers which
threw out the semen could  not overcome the resistance, an effect
 which probably did not occur in  dreaming,  advised purgative me-
 dicines and a slender diet, which soon produced the desired issue.f
   I remember, many years  ago, a healthy young couple who con-
 tinued without offspring for seven or eight years after marriage, at
 which period the  lady, for  the first  time, became pregnant, and
 continued to add to her family every year till she had six or seven
 children ; and in professional conversation with the  father, he has
 clearly made it  appear to me that the cause  of sterility, during the
• See a similar case in Marcel. Donat. Lib. IV. Cap. 18,
f Edin. Med. Ep. I. p. 270. 
GE. IV— SP. II.]
SEXUAL FUNCTION.
93
above period, was the morbid entony we are now discussing. Time,
that,  by degrees,  broke the vigour of the  encounter,  effected  at
length a radical cure, and gave him an offspring he had  almost de-
spaired of.  Mr. J. Hunter recommends opium in this case, as the
best allayer of the undue stimulus.
  The second variety,  or misemission  from the incursion of  an
epileptic fit, it is not  difficult to account  for.  Persons who are
predisposed to epilepsy,  are,  for the most part, of a highly irrita-
ble  habit; and wherever the predisposition  exists, any accidental
excitement, as we have already shown in discussing this affection,*
is sufficient to produce a fresh paroxysm : and hence it is seldom
more likely to  occur than from the perculsion  of a  sexual em-
brace.  Even  death itself has sometimes ensued in consequence  of
the violence of the venerea^paroxysm.
  Examples of epilepsy from  this cause, as  collected in the public
medical records, are numerous.   Among men,  one of the most  fa-
mous instances is that of the celebrated Hunnish chief Attila.f Mor-
gagnif. and Sinbaldus§ have given examples  among women.
  Hence a  life of  matrimony had better be relinguished by those
 who are thus afflicted, as well on their own accounts, as on that of
their descendants.  And  where  marriage is actually effected, sex-
ual commerce should be sedulously abstained  from at the periods
in which the disease is accustomed to recur, or during  the contin-
uance of those signs by which a paroxysm is usually preceded.
  The third and fourth varieties, or anticipating and retard-
ing  misemission, are  put  together  by Plouquet  under the name
of ejaculatio intempestiva,\\ and are equally  entitled to this charac-
ter  : while the former is, by Schenck, denominated ejaculatio pre-
matura.^
  The anticipating or premature variety evinces  great  nervous  ir-
ritability in a delicate or relaxed habit: the plethora of the first  or
entonic variety  would produce  the best and most effectual cure;
but as this is rarely to be  accomplished in a  constitution of this
kind, tonics, a  plain but nutricious diet, especially light suppers,
and, more especially still, a bidet of cold water before  retiring  to
bed, form the  most effectual means of  subduing this precession  of
generative power.   In some cases,  the afflux has  been so quick  as
to take place even before the vagina has been fairly entered.
  The fourth or retarding variety forms a perfect contrast to
the preceding.   It imports a sluggishness either of constitution  or
of local erethism, in consequence of which the. seminal flow does not
* Vol. III. Syspasia, Epilepsia, p. 358.
f Norelli. Amalth. Med. Hist. p. 161.
t De sed. et Caus. Morb. Ep. XXVI. Art. 13.
§ Geneanthropia, p. 794.
[| Init. Biblioth. Tom. iv. p. 61. 4to. Tubing, 1795.
' Observ. Lib. IV. Obs. 46. 
 «j4,                      GENETICA.             L^L. V.—OK. IL

 take place till the orgasms of the female has subsided, and fatigue,
 perhaps disgust has  succeeded to desire.  Here too, general tonics
 and local stimulants offer the fairest  chance of success;  and  both
 sting-nettles*  and flagellations,! as in some cases of organic impo-
 tency, are said to have worked wonders.  The variety is generally
 described under the name of bradyspermatismus.
  The refluent variety is chiefly introduced upon the authority
 of M. Petit,f whose  description has been copied by Sauvages.  k* It
 consists," he tells us, "in a reflux of the semen into the bladder
 or vesiculse seminales, on account of the narrowness of the urethra,
 in consequence  of  which there is no semination during the inter-
 union, and the semen is afterwards discharged  with the urine.
  This narrowness  is common to those who have suffered from fre-
 quent bIeuorrhceas,and have hence contracted strictures or scirrhous
 indurations in  the course of  the urethral passage, or have the  pas-
 sage blocked up with indurated mucus.  Deidier gives a case not
 very unlike, consisting  of a patient  who laboured under  a fistula
 opening from  the vesiculse  seminales into the rectum : in  conse-
quence of which, though sound in every other respect, whenever
 he embraced his  wife scarcely any of the semen escaped  from the
penis, nearly the whole passing into the intestine, intermixed  with
a small quantity of urine ; and hence  his marriage was sterile.§
  In all these cases  the cure  of the impotency must  depend upon a
 cure of the local  cause of constriction.  The dyspermatismus,  ure~
thralis, nodosus and mucosus of Sauvages and Cullen, who has co-
pied from him, are  all  resolvable in this variety, as proceeding
from like causes, and producing a  like effect.
                       SPECIES III.

             AGENESIA INCONGRUA.

                 Copulative 3mongruttp»

THE SEMINAL FLUID INACCORDANT IN ITS CONSTITUENT PRINCI-
  PLES, WITH THE CONSTITUTIONAL DEMAND OF THE RESPECTIVE
  FEMALE.

All the species of this genus are closely connected; yet it is only
the first two that  have hitherto been noticed by  nosologists j nor
is  there any preceding  system that I am aware  of, under which
* Eph. Nat. Cur. Dec. II. Ann. V. App.p. 55.
■j- Meibom, and Ueidlin, loc. citat.
i Memoirs de l'Academie de Chirurgie, I. p. 434.
% Tom. HI. Consult. I. 
 GE. IV.—SP. in.]      SEXUAL FUNCTION.                   n*

 even  these two have beeiTintroduced  into  the  same subdivision.
 In almost every instance, indeed, they  have  been regarded as dis-
 tinct  genera  belonging to distant orders or even classes, and ar-
 ranged with diseases that have little or no relation to them.  Thus,
 in Sauvages impotentia, by him  called anaphrodisia, occurs in the
 second order  of his sixth class, united with such diseases as "loss of
 thirst'" and "desire of eating;" while dvsspermia, ordyssperma-
 tismus is carried forward to the third order of his ninth class.  In
 Cullen these  diseases occur, indeed, in  the same  class, a very im-
 proper one, that of locales, but under different orders of this class;
 impotentia being arranged under the second order,  with the mor-
 bid cravings of the alimentary  canal, and some of those of the mind,
 as nostalgia;  and dysspermia being placed  under the fifth  order,
 entitled  epischeses or suppression.
   The present species is, for the first time,  so far as the author
 knows, introduced into a nosological system ; and is derived  from
 personal  observation in full accordance with the scattered remarks
 of several other writers and practitioners. The principle upon which
 the species is  found belongs,  strictly,  to the general  doctrine  of
 conception, and has been  already explained in  the Physiological
 Proem to the  present class.  It will hence be  sufficient to  throw
 out a few additional hints for the purpose of bringing the principle
 more immediately home to the disease  before us, and supporting
 the propriety  of its introduction into the general register.
   Every  one  must have  noticed occasional  instances in  which a
 husband  and  wife, apparently in sound health and  vigour of  life,
 have  no  increase  while  together; either of whom, nevertheless,
 upon the  death of the other, has become the parent  of a numerous
 family; and both of whom,  in  one or two curious instances of di-
 vorce, upon a second marriage.  In various instances, indeed, the
 latent cause of sterility,  whatever it consist in, seems gradually to
 diminish, and  the pair that for years was childless, is at length
 endowed  with a progeny.   In all this there seems to be an incon-
 gruity, inaccordancy, or want of  adaptation  in the  constituent
 principles of the seminal fluid of the male to the sexual organization
 of the respective  female; or, upon the hypothesis of  the epigenesi?,
 which  we have already illustrated, to the seminal fluid of the fe
 male.  Writers,  strictly medical, have not often adverted to  this
 subject, though it is appealed to,  and for the most  part with appro-
 bation, by physiologists of all ages and countries.  Sauvages, how-
 ever, evidently alludes to and admits such a cause in his definition
 of dysspermatismus serosus, which is as follows  : " Ejaculatio seminis
 aquosioris, adeoque ad genesim inepti, quae species  est frequentis-
 simum sterilitatis virilis principium."  He illustrates his definition
 by a case which occurred to Haguenot and Chaptal, who attributed
it to the cause in question, and refers for other examples to Etmuller.
 Cullen expresses himself doubtfully upon this species, " De dvssper
 matismo seroso Sauvagesii," says  he, " mini non satis constat." Yet
 his own  gonorrhoea laxorum, in the present  system spermorrho?:i 
yfj                      GENETIC A.             [CL.  \ .—Oil. ll.

afonica,  and which  he explains " humor plerumque  pellucidus,
sine penis erectione, sed cum libidine, in vigilante, ex urethra fluit,"
makes so near an approach to it, that  the physiologist who admits
the one can find little difficulty iu admitting the other. The resem-
blance is, indeed, close and striking ; in the latter disease the indi-
vidual labouring under it, emits involuntarily, and without  coition,
or even erectimi, but  with a libidinous sensation, a pellucid fluid,
apparently of a seminal character, affirmed positively  by Sauvages,
from whom  Cullen derives his species,  and to whom he refers,  to
be an " effluxus seminis ;" while, in the former, the same dilute
and effete semen, with difficult,  and  imperfect erection, is poured
forth during coition.
  In like manner, Forestus speaks of a  proper gonorrhoea, or invo-
luntary emission of seminal fluid, produced ex aquositate,* from too
watery a condition of the secretion : Timseus, of the  same disease
occasioned ex semine acrirf by a secretion of an acrimonious semen :
and  Hornung, of hysterics occasioned in married  women who are
sterile from an " immissio frigidi seminis ^"f. an expression adopted
from, or at  least employed  by, BalIonius,§   and supported  by
Schurig,|| and Ab Heer.^f
  The explanation, however,  now  offered, takes a more compre-
hensive view of the subject, by supposing that the seminal fluid may
be secreted, not merely in a state of morbid diluteness, but, under
various modifications, even in a state of health, of such a condition
as to render it inadequate to the purposes of generation in female
idiosyncrasies of certain kinds, while it may be perfectly adequate
in those of other kinds.  In agricultural language it supposes that
the respective seed may not be adapted to the  respective soil, how-
ever sound in itself.   So, Parr tells us, on another occasion that,
" In some instances the semen itself seems defective in its essential
qualities."**
  Here again, the mode of treatment must be  regulated by a close
attention to the nature of the cause.  In most  cases, whatever will
tend to invigorate the system generally will best tend to cure the
sterility: as a generous diet,  exercise, the cold-bath,  and particu-
larly the use of  the bidet or local cold-bath.   With these  may be
combined the warm and stimulant resins and balsams, as guiacum,
turpentine, copaiba;  and theoxydes of iron, zinc, and silver.
  Abstinence by consent, for many months, has, however, proved a
 * Lib. XXVI.  Obs. 12.
 | Cas. p. 188.
 $ Cista. p. 487.
 § Opp. I. p. 120.
 || Spermatologia, p. 21.
 T Observ. Rar. N.  10.
** Dis. Art. Anaphrodisia. 
GE. IV.—SP. in.] '       SEXUAL FUNCTION.
97
more frequent remedy than any other,  and especially where the
intercourse has  been so incessantly  repeated as to break down the
staminal strength :  and hence the separation produced by a voyage
to India has often proved successful.
                       GENUS  V.


                       APHOKIA.

            female §>terilitp*   2i5arrernie0gt

             INABILITY TO CONCEIVE OFFSPRING.

Aphoria («#a£tat) " sterilitas" " infecunditas"  from « negative,
p££« " fero," " pario," is the term in common use. among the Greek
writers.  It is singular that the morbid condition it imports has no
distinct place in any of our most esteemed nosologists.  It may
possibly be intended  under  the anaphrodisia of several of them,
though in none of them has the genus any one species, that expressly
applies to female barrenness.
  The proper species belonging to it are the following:

1. APHORIA IMPOTENS.      BARRENNESS OF IMPOTENCY.
2. -------- PARAMENICA.    BARRENNESS OF MISMENSTRUATION.
5. -------- IMPERCITA.     BARRENNESS OF IRRESPONDENCE.
4.--------INCONGRUA.     BARRENNESS OF INCONGRUITY.
                        SPECIES I.

               APHORIA IMPOTENS.

               3i5arrenne00 of  Jmpotewp.

      IMPERFECTION OR ABOLITION OF CONCEPTIVE POWER.

This species runs precisely parallel with  the same disease in males
already described under  agenesia impotens, and consequently
offers us the two following varieties  :

         « Atonica.               Atonic barrenness.
         C Organica.              Organic barrenness.

I n atonic barrenness there is a direct imbecility or want of tone.
  VOL. IT.                    N 
98
GENETICA.
[CL. V—OR. II
rather thau a want of desire : and the ordinary causes are a life of
intemperance of any kind, and especially of intemperate indulgence
in sexual pleasures, a chronic leucorrhcea, or paralvtic affection of
the generative organs.  It has also been occasioned by violent con-
tusions in the loins, or the hypogastric region, and by  over-exertion
in walking.
   The plan of treatment is to be the same as already laid  down
under atonic sterility or impotency in males, yet it is seldom that
any treatment has afforded  success under this variety.
   Organic barrenness is produced by some structural hindrance
or defect, whether natural or accidental. And this may be of various
kinds : for the vagina may be imperforate, and  prohibit not only all
intermission of semen, but an entrance of the penis itself.   The
ovaria may be defective, or even altogether wanting, or not duly
developed, or destitute of ovula; or the fimbria  may be defective,
and incapable of grasping the uterus ;  or the Fallopian tube may be
obstructed, or impervious,  or wanting : in all  which  cases barren-
ness must necessarily ensue.  In the case of an impervious vagina,
however, unless  there be a total occlusion, conception will  some-
times  follow:  for it  has  occurred  where the  passage has been so
narrow as  not to admit the penis ;  and occasionally  indeed,  when
with the same impediment,  a rigid and unbroken  hymen has offered
an additional obstacle, of which  the medical records  contain abun-
 dant examples.   Ruyset gives us a singular case  of a hymen found
 unbroken at the time  of labour.
   In all these instances the hymen  seems to have been placed high
 up in the passage, so as to  allow the penis to obtain a curtailed en-
 trance,  and  to produce its shock ;  when the  occlusion not  being
 complete, a part of the semen has passed through the aperture, and
 effected its ordinary result.
   These, however, are rare instances: for the  impediment before
 us is, in common cases, a sufficient bar not only to conception, but to
 copulation.  The author was lately  consulted by a very amiable
 young couple in  an instance of  this kind,  to  whom  the want of a
 family was felt as a very grievous affliction. The hymen had a small
 aperture, but was tense and firm, and the ordinary force of an em-
 brace was not sufficient to break it.  He explained the nature of the
 operation to be performed, and added that he had no  doubt of a suc-
 cessful  issue.  The  lady  was reluctant  to submit  herself to the
 hands of a surgeon, and hence with  equal courage and judgment be-
 came her own operator.  The impediment was completely removed,
 and she has since had several children.
    In a few instances, however,  this will not answer, for there is a
 natural narrowness  of stricture, sometimes  found  in the vagina,
 which  cannot be overcome, at least  without  a  severer  operation
 than most women could be induced  to submit to :  that I mean of lay-
 ing it open through the whole length of the contraction.  A sponge
 tent, however, gradually enlarged, has sometimes succeeded.  Surig 
«.iE. V.—SP. 11.]        SEXUAL FUNCTION.
99
gives an account of a dissolution of marriage in consequence of an
impediment of this kind.*
                       SPECIES II.

             APHORIA PARAMENICA.

           Barrenness erf ^iBigmengtruatiom

CATAMENIAL  discharge morbidly retained, secreted with
               DIFFICULTY, OR IN PROFUSION.

It is not always necessary to  impregnation that a female should
menstruate : for we have already observed! that a retention ot men-
ses, or rather a want of menstruation, is not always a disease ; but
only where symptoms occur which indicate a  disordered state of
some part or other of the body, and which experience teaches us
is apt to arise in consequence of such retention.  In some cases,
there is great torpitude or sluggishness in the growth or develop-
ment, or proper erethism of the ovaries,  and menstruation is de-
layed on this account,  and in a few rare instances we have remarked
that  it has occurred for the first time after sixty years of age.  It
may  hence easily  happen, and we shall presently have occasion to
show that it often has done so, that a woman becomes married  who
has  never been subject to  this periodical flux: and although it
is  little to be expected that she  should breed till the sexual organs
are in a condition to elaborate this secretion, yet if such condition
take  place after marriage, impregnation may instantly succeed and
prohibit or postpone the efflux which would otherwise take placet
  But where there is a manifest retention of  the catamenial flux
producing the general symptoms  of disorder which we noticed when
describing this disease, it is rarely that conception takes place,
in  consequence of the morbid condition of the organs that form its
seat.
  For the same reason it seldom occurs where  the periodical  flow
is accompanied with great and spasmodic pain,  is small in quantity,
and often deteriorated in quality.  And, if during any intermediate
term, conception accidentally commence, the very next paroxysm of
distressing pain puts a total end to all hope by separating the germ
fvoin the uterus.
* Gynaxolog. p. 223.
j Vol- IV. Paramenia obstructionis, p. 33.
■  Class V. Order III. Carpotica, Introductory remarks. 
100
8ENETICA.
CI.. V.~OK. II.
  But there must be a healthy degree of tone and energy  in the
conceptive organs, as well as of ease and quiet, in order that they
should prove  fruitful: and hence, wherever the menstrual flux  is
more frequently repeated than in its natural  course,  or is thrown
forth, even at its proper time, in great profusion,  and, as is gene-
rally the case, intermixed  with genuine blood, there is as little
chance of conception as in difficult menstruation.   The organs are
too debilitated for the new process; and not unfrequently there  is
as little desire as there is elasticity.
  Having thus pointed  out the general causes and physiology  of
barrenness  when a result of mismenstruation, it will be obvious that
the cure must depend upon a cure of the  particular kind of morbid
affection that operates at the time and lays a foundation for the dis-
ease, of all which we have already treated under the  different spe-
cies of the genus paramenia, and need not repeat what is there
laid down.
                       SPECIES III.

              APHORIA  IMPERCITA.

              liBamnnegg of Hrrespon&ence,

SERILITY PRODUCED BY PERSONAL AVERSION OR WANT OF APPE-
                            TENCY.

It is not perhaps altogether impossible, that impregnation  should
take place in the case of a  rape, or where there is a great  repug-
nancy on the part of the female, for there may be so high  a  tone
of constitutional orgasm as to be beyond the control of the individual
who is thus forced, and not to be repressed even by a virtuous recoil,
and a sense of horror at the time.  But this is a possible rather than
an actual case, and though the  remark may be sufficient to suspend
a charge of  criminality, the infamy can only be completely wiped
away by collateral circumstances.
  In ordinary instances, rude, brutal force is never found to succeed
against  the  consent of the violated  person.   And for the same
reason,  wherever there is a personal aversion, a coldness, or reserve,
instead  of an appetency and  pleasure,  an irrespondence in the
feelings of the female to those  of the male, we have  as little reason
to hope for a parturient issue.   There must be an  orgastic shock,
or perculsion sufficient to shoot off an ovulum from its bed, and to
urge the fine and irritable fimbria of the Fallopian tube to lay hold
of the uterus and grasp it tight, by which alone a communication can
be  opened between this last  organ and the ovarium, or the seed
cannot  reach  home  to  its proper soil,  and  produce a harvest. 
UE. V—SP. III.]        SEXUAL FUNCTION.                  JOi

So observes the first didactic poet of ancient Rome, addressing
himself to the Generative Power, in the language not of the voluj
tuary but of the physiologist:

           — per maria,  ac monteis, floviosque rapaceis
        Frundiferasque domos avium, camposque virenteis,
        Omnibus incctiens blandum per pectora amorem,
        Ecficis, ut cupidk generatim secla propagent.*

        So through the seas, the mountains, and the floods,
        The verdant meads, and woodlands fill'd with song,
        Spuru'd bt desiue each palpitating tribe
        Hastes, at thy shrine, to plant the future race.

  The  cause  is  clear, and the effect certain, but it is a disease
immedicable by the  healing  art,  and can only  be attack?'! by a
kind, assiduous, and winning attention, which, however sli^uted at
first, will imperceptibly work into the cold and stony heart, as the
drops of rain work into the pavement.  It should  teach  rv  how-
ever, the folly of  forming family connexions and endeavour;--Z, to
keep up a family name, where the feelings of affection are not  rn~
cased on both sides.
                        SPECIES  IV.

               APHORIA INCONGRUA.

               15arrennej50 of Incongruity

THE CONCEPTIVE POWER  INACCORDANT WITH THE CONST!"'  .HT
  PRINCIPLES OF THE SEMINAL FLUID RECEIVED ON THE PART OV
  THE MALE.

This species runs precisely parallel with the third under the pre-
ceding genus agenesia incongrua, and the physiological and thera-
peutic remarks there offered will equally apply to the present place.
* DeRer. Nat. 1.17. 
Jijv                     t.ENEIICA.           "CL. \ .—OR. II.


                      GENUS  YI.

                     jEDOPTOSIS.

                    genital ^rolapge,

PROTRUSION OF ONE OR MORE OF THE GENITAL ORGANS, OR OF EX-
  CRESCENCES ISSUING FROM THEM, INTO THE  GENITAL PASSAGE ;
  IMPAIRING OR OBSTRUCTING ITS COURSE.

iEDOPTosis is a compound term from uidoiov, " inguen," pi. ut^otet
"pudenda,'' whence ctifas "pudor,'" and ?i-r<»<r<« " lapsus."  In like
mariner Sauvages and Sagar use iEdopsophia, applying the term to
the  meatus urinarius, as well as to the uterus.  Sauvages, however,
expresses the present disease, but less correctly, by hysteroptosis,
for this, with strict propriety,  can denote only  one of the species
that fall within its range, namely displacement of the uterus.
  The genus embraces the five following species :

  -EDOPTOSIS UTERI.        FALLING DOWN OF THE WOMB.
  ----------VAGIN'iE.        PROLAPSE OF THE VAGINA.
  ----------VESICE.        PROLAPSE OF THE BLADDER.
4.----------COMPLICATA.    COMPLICATED GENITAL  PROLAPSE.
■*>-----------POLVPOSA.      GENITAL EXCRESCENCE.
                       SPECIES I.

                yEDOPTOSIS UTERI.

              falling ooton of t&e OTomb,

        PROTRUSION OF THE UTERUS INTO THE VAGINA.

This may take place in several ways, and hence offers the following
varieties :

      a. Simplex.          Simple descent of the womb.
      £ Retroversa.        Retroverted womb.
      y Inversa.           Inverted womb.

  In the first variety, or that consisting of a simple descent of the
uterus, the organ retains its proper posture and figure.  Different
names  are  frequently given to different degrees of this variety. 
GE. YI—SP. I.]
SEXUAL FUNCTION.
103
If the  descent be only to the middle of the vagina,  it is  called
relaxatio uteri ; if to the labise, procidentia ; if lower than the
labia?,  prolapsus.  The distinction is  of trifling importance ; the
causes are the same in all, which are those of debility  or violence.
The disease is hence most common to women who have had  nume-
rous families; but is occasionally met with in virgins after straining,
using violent exercise in dancing, or  running, and hence sometimes
in girls  of a very early age.   Professor Monro gives  an example
of its occurring in an infant of not more than three years old, pre-
ceded by a regular menstruation, or more probably a discharge  of
blood, every  three weeks or month,  from the vagina, accompanied
with considerable pain in the belly,  loins, and  thighs.  The case
was too long neglected as being supposed of little importance ; and
the uterus, which at  first appeared  to be  a  very small body just
peeping out of the vagina, descended lower and lower, continually
increasing in size, till at length it  became as big as a hand-ball,
and entirely  blocked up  the passage  of the pudendum.  At this
time the sanguineous discharge had  ceased its  returns; but a con-
siderable secretion of leucorrhcea supervened.  The uterus  seems
at  last to have been strangulated, gangrene  ensued, and was soon
succeeded by death.*
   The disease first shows itself by what is called a bearing down of
the womb, which is a slight  descent produced by a relaxed state of
its  ligaments, and its  own  weight when in  an upright position.
There is, at this time, an uneasy sensation in the loins,  as well as in
the inguinal  regions,  often extending to  the labia, and  particularly
in walking or standing.  There is also an augmented flow  of the
natural  mucous secretion in  consequence of the local irritation,
which  by  degrees  becomes  acrimonious,  and excoriates the sur-
rounding parts, and is accompanied  with an obstinate leucorrhcea.
The stomach  sympathises with the morbid state  of the womb, the
appetite fails, the bowels  become irregular and flatulent, and the
animal spirits are dejected.
  In attempting a cure we must first restore the prolapsed organ to
its  proper position, and then retain it there, by a support introduced
into the  vagina, which should be continued till  the ligaments of the
womb have recovered their proper tone.  Various pessaries have
been invented for this purpose, but that  made of the caoutchouc  01
elastic gum, with a ligature  to withdraw it at option, appears to be
one of the most commodious.  Astringent injections, as a solution oi
alum or sulphate of z.inc,  or even of cold-water, will generally  be
found useful; as will  also spuuging the body  with cold-water, or
 using a  hip-bath  of sea-water.   New and rough port-wine, diluted
 with an equal quantity of cold-water, has proved one  of the  most
valuable injections to which  the author has ever had recourse.
   Dr. Berchelmann  in a foreign journal, has  recommended a far
bolder and more decisive cure, derived from the rash, but successful
- Edin. Med. Essays, Vol. III. Art, XVII. p. 28?. 
104
GENETIC A.
[CL.  V—OK. II.
practice of a woman upon herself.  This courageous sufferer having
lon»; laboured under a prolapse of the womb, and tried every method
in vain, tired out with  the continuance of her complaint, cut into
the depending substance of the womb with  a common kitchen-
knife.   A considerable hemorrhage ensued; after which, the ves-
sels collapsing, the organs gradually contracted, and ascended into
its proper site ; and she was radically cured of the disease.  Having
boastt"! (if her success, the writer  informs  us  that many  other
women in  the neighbourhood, afflicted with  the same  complaint,
applied for uer assistance, and derived a like  cure  from the  same
operation.*
  In cases where the  prolapse depends upon  a loose and  relaxed
condition of the uterus, it is highly probable that this bold practice
may often be found to succeed, but it must be useless where the
relaxation is seated in  the ligaments: and the  knife,  if employed
at all,  should be applied to an extirpation of the entire organ, which
has lately taken place with success in  various cases.
  In the i.etroverted womb, the fundus falls down, and becomes
the lower part, sometimes from  a morbid weight and enlargement,
but more  usually from a neglected  distension of the  bladder be-
tween  the third  and fourth  month of pregnancy, at which period
the fundus is just heavy enough to fall forward, whenever the cer-
vix is pressed  upon and elevated by such distension; though after
this period the cervix itself is too heavy to be affected by the  blad-
der in this way,  and the entire uterus too much enlarged to fall
down in any way.  The bladder,  in  this  case, must be carefully
evacuated, and kept evacuated by a free use of the catheter, which
will give the uterus an  opportunity of righting  itself.   But if this
should not take place  in two or three days, the  obstetric practi-
tioner  should endeavour to restore the organ to its proper position
by introducing the fingers of one  hand into the vagina and two
fingers of the other hand into the rectum.
  The womb  is  inverted when  at the same time that it is dis-
placed or  has fallen  down, it  is turned  inside out.   This mis-
chievous condition is most commonly  produced by unskilfully and
violently pulling away  the placenta after delivery : and is only to be
remedied by a restoration of the  uterus to its proper state before  it
contracts, without which  perpetual barrenness must  necessarily
ensue, and the patient be subject for life to a difficulty of walking
leucorrhoea, ulceration, and the chance of a scirrhus or cancer.
  *  Acta Philosophico-Mcdica Soc. Acad. Scient. Princ. Hassiacx 4to. Giessx
Cattorum. 
Gf.. VI.—Sl\ II.]
SEXUAL FUNCTION.
105
                       SPECIES II.

               iEDOPTOSIS  VAGINAE.

                ^tolap0e of tSe Vagina*

PROTRUSION OF THE UPPER PART OF THE VAGINA INTO THE LOWER.

This, like the descent of the uterus, may, according to the degree
of the disease, be a relaxation, procidence, prolapse, or complete
inversion of the organ.  Under all which modifications it has a
considerable resemblance to a prolapse of the anus.  It appears in
the form of a fleshy substance protruding at the back part of the
vulva, with an opening in the centre or on one side.  At first it is
soft, but by continued exposure and irritation, it becomes inflamed,
indurated and ulcerated.  The urethra is  necessarily turned out of
its course : and if the catheter be required it should  be employed
with its point directed  backwards   and  downwards.  Its ordinary
causes are those of a prolapse  of the womb, and it is to be treated
by a like plan of astringent injections and general tonics.  Pregnancy
commonly  performs the best cure :  and where this fails, Dr. Ber-
chelmann, from the success which has accompanied incision in the
case of prolapsed  uteri,  has  recommended scarification,  which
appears  well worthy of trial,  though the author has not known it
put into practice.
                       SPECIES III.

               iEDOPTOSIS VESICA.

                prolapse of tlje Blaoimr*

   l'ROTRUSION OF THE BLADDER INTO THE URINARY PASSAGE.

Tins species  is introduced chiefly upon the authority of Sauvages,
who "fives  us two modifications  or varieties of it; one in  which
there is a protrusion of. the inner or nervous membrane, in conse-
quence of its  separating from the  general substance of the blad-
der, visible in  the  meatus urinarius, of the size of a  hen's egg,
subdiaphonous  and  filled  with  urine'; and the  other in  which
there is a  protrusion  of the inner membrane of the neck of the
bladder into  the same passage,   lie gives a case of  the former
variety  from  Noc!. who met  with it in a virgin, who was  from the
   VOL. IV.                    0 
£06                   GENETICA.             [CL. V.—OU. II.
first peculiarly troubled with a retention of urine, accompanied with
frequent convulsive movements.  She soon fell a sacrifice to it, and
it was on dissection that the nature of the tunic was clearly proved.
M. de Sauvages queries  whether on  a  recurrence  of this case it
would  be most advisable to make an opening into the protruding
sac, or to extirpate it altogether.
  The second variety he tells us is chiefly found anions; women who
have borne many children, or have been injured by  blows  or other
violence on the lower belly.  The protruding cyst produced by  an
inversion of the membrane, drops down into the urinary passage to
about the length of the little finger, and is sufficiently conspicuous
between the labia.  Solingen, who met with a case of this kind,
returned  it by a probe, armed at the upper end with  a  piece of
sponge moistened with an astringent lotion ;  and afterwards endea •
roured to retain it in its proper position by a bandage.
                       SPECIES IV.

           iEDOPTOSIS COMPL1CATA.

            Complicates  (genital prolapse,

Protrusion of different  organs  complicated  with  each
                           OTHER.

From the connexion of the uterus and the vagina with the bladder,
a prolapse of either of the two former is often complicated  with
that of the latter, giving us the two following varieties :
* Utero-vesicalis.               Prolapse  of the uterus dragging
  Utero-vesical Prolapse.          the bladder along with it.
S Vagino-vesicalis.              Prolapse  of the vagina dragging
  Vagino-vesical Prolapse.         the bladder along with it.
  Under either of these conditions the bladder, being deprived of
the expulsory aid of the abdominal muscles, in consequence  of its
dropping below their action, is incapable of contracting itself suffi-
ciently to evacuate the water it contains : and hence the patient is
obliged to squeeze it with her hands or between her thighs.
  The causes and mode of treatment have  been already described
under the  two preceding species.  The present is the hysteroptosi-;
composita of Sauvages* 
Gl.. VI—SP.V.]
SEXUAL FUNCTION.
107
                        SPECIES V.

              ^DOPTOSIS  POLYPOSA.

                    dDenital (fcvceegcence.

 :'OLYPUS OR  OTHER CARUNCULAR  EXCRESCENCE IN  THE  COURSE
                   OF THE GENITAL AVENUE.

 This is the  polypus uteri, and polypus vagina? of  authors: but,
 strictly speaking, they are less polypi than polypous concretions,
 since the proper polypus is the fleshy excrescence of the nostrils,
 as already observed in the first volume.*
   The excrescences  before us issue both from the uterus and the
 vagina, and hence form two distinct modifications as follow:

 x Uteri.                      issuing with a slender root mostly
   Polypus of the womb.         from the fundus of the uterus, and
                               more or less elongating into the
                               vagina.
 o  Vaginae.                    Issuing from the sides of the vagina
   Polypus of the vagina.         broad and bulbous.
   The latter excrescences in an incipient  state, and particularly
 when loose and  flabby, are sometimes dispersed  by stimulant and
 astringent applications, or a hard compress of sponge or any other
 elastic material: and, if this cannot be accomplished,  they must be
 destroyed by excision or caustics.  It is rarely that they have a neck
 narrow  enough for the application of a ligature.
  Polypous excrescences  of the womb, are, however, a disease of
 much greater severity; since the  stomach  suffers, in most cases,
from  sympathy, and  consequently  the general health, producing
all the symptoms we have already noticed under jedoptosis uteri :
which last is not unfrequently a result, if the excrescence be of
long continuance, and of considerable weight and magnitude.
  They are of all sizes, and  of various degrees of hardness, from
that of a soft  and yielding sponge  to that of firm and substantial
leather.  Though they commonly  grow  from the fundus of the
uterus, they have sometimes been  found to sprout from its sides,
and even its cervix, shooting down to different depths of the vagina,
and occupying it more or less completely according to their extent.
They are generally round in shape and compact in structure, inter-
sected by membranes, running in different directions.   Sometimes,
however, they are oblong, in which case they  usually consist of a
loose  irregular texture with numerous interstitial cavities.  Dr.
" vol. I. p. 313. 
40g                    GENETIC A.             [GL. V.-OR. II.

Baillie has given  various examples of this diseased production  in
his tables of Morbid Anatomy.*
  They have been attempted to be removed  in different ways, as
by caustics, excision, laceration, and ligature.  The last, however,
is  the only method unaccompanied with  danger or uncertainty.
Yet even this can rarely be had recourse to while the excrescence
continues in the womb; and hence, the usual method is to deter the
operation till, from its increase  of size and weight, it has descended
into the vagina,  when the removal cannot be attempted  too soon.
They  have sometimes dropped  off spontaneously, the peduncle
having probably decayed or shrivelled away.
* See especially Facie, c. IX. Plate IV. 1. 
                        CLASS  V.


                      GENETIC A



                        ORDER  III.

                      CARPOTICA.

          SDigeageg affecting tge Impregnation*

 The ordinal term carpotica, is derived  from napvcs, " fructus,'-
 whence mtpTrvn^, " fruitio."
   [n the Physiological Proem to the present Class, we have taken
 a brief survey of the laws and general process of generation so far
 as we are acquainted with them.  Impregnation constitutes a part,
 and the most important part, of this wonderful economy, and, from
 the changes that the body undergoes during its action, it can never
 be  surprising that it  should often give rise  to  various diseases.
 These diseases  maybe arranged under four  genera;  including,
 those which occur during the progress of pregnancy : those  which
 occur during the  progress of labour ; conceptions  misplaced : and
 spurious attempts at conception ;  the whole of which may be thus
 expressed :

  f.  PARACYESIS.                   MORBID PREGNANCY.
 II.  PARODYNIA.                    MORBID LABOUR.
 III. ECCYESIS.                      EXTRA-UTERINE FETATION.
 IV. PSEUDOCYESIS.                  SPURIOUS PREGNANCY.

  In the  preceding  Physiological  Proem, we  have shown that, in
 order for impregnation to take place, it is necessary the semen of
 the male  should pass  from the vagina to  the one or other of the
 ovaries by means of the Fallopian tubes which lay hold of the uterus
 by their very fine and sensible fimbriae, or fringed extremities, with
 a sort of  spastic grasp  during the high-wrought shock of the em-
 brace, and thus alone open a path-way for the semen to travel in.
  The two ovaries are not merely intended to supply the place of
 each other, in the event of one being wanting or defective, but,
like the testes in men, they seem to  increase the extent of the pro-
ductive power, and enable a female to bear a larger offspring than
 she would do, if she were possessed of one ovary alone.  Mr.  John 
no
(.EMETIC A.
[CL. V.—OR. III.
 Hunter has put  this to the test by comparing the number of young
 produced by a perfect sow with those of a sow spayed of one ovary,
 both of the same farrow,  and impregnated by a boar of the same
 farrow also.  The spayed  sow continued to breed for four years,
-during  which period she  had eight  farrows  producing a  total of
 seventy-six young.  The  perfect sow continued to  breed  for six
 years ;  during the first four of  which she  also had  eight  farrows
 producing  a total of eighty-seven  young:  and during the two
 ensuing years she had five more farrows producing a total of seventy-
 five young, in addition to those of the first four years.*  So that, if
 we may judge from this single experiment, the use of two ovaries,
 in equal health and activity, enables an animal to breed both more
 numerously, and for a longer period of time, than the possession of
 one alone.
  Among women, however, the extent of fecundation does not seem
 to be much interfered with by the defect of a single  ovarium, or its
 means of communication with the uterus, according to a paper of
 Dr. Granville read before the Royal Society, Apil  16, 1813, con-
 taining the case  of a female  whose uterus was found after death to
 have had but one set of the lateral appendages, and, consequently,
 a connexion with but one ovarium, and who, nevertheless, had been
the mother of eleven children, several of each sex, with twins on
 one occasion.
  After impregnation has  taken place, the membranes produced in
the uterus form a complete septum, and, consequently, a bar to the
ascent of any subsequent flow of semen, so as to prohibit the pos-
sibility of two or more successive impregnations co-existing in any
part of the uterus  during the  period of a determined gravidity.
Children, indeed, have been  born  within a few  weeks, or even
months, of  each other, and hence a colour has been given to the
hypothesis that they may be conceived at different periods of a com-
mon parturition, and such births have, in consequence, been distin-
guished by the name of superfetations; but we shall have occasion
hereafter, when  treating of  a plurality of  children, to show that
fetuses thus born in succession, however they may vary in size or
maturity, are real twins, conceived at one and the same time, from
the descent of a plurality of ovula into  the uterus, instead of a single
one, and that the difference of size or  maturity depends upon some
unknown cause in the dead or puny  fetus,  which  has killed it 01
prevented its keeping pace with the other.
  Women  are in general capable of breeding as soon as they begin
to menstruate, which is the ordinary proof that the organs of con-
ception are fully developed and perfected : and since this discharge,
as we have remarked in  the Proem  just referred to, commences
sometimes in very early life, and particularly in hot climates, where
it has occurred in  girls of not more than nine years of age, so we
have instances of conception and pregnancy having commenced as
'  Animal Economy, p. 157
T 
CL. V.—OR. Ill]      SEXUAL FUNCTION.                   Hi

early.   Baron Haller* and professor Schmidt,f concur in examples
of pregnancy at nine years old:  and the medical records  confirm
these singular histories by numerous instances of a like kind.I
   Yet, though menstruation is the  ordinary proof that the  concep-
tive powers have acquired a sufficient  finish and vigour for their
proper function, menstruation itself is not absolutely necessary for
impregnation. As there are circumstances that hurry on this secre-
tion before its ordinary term of appearance, there are  others that
delay it, insomuch that some women  pass through a long life with-
out  menstruating at all, while others only begin after reaching an
adult age, and  others a«;ain not till the  period in  which it usually
ceases.   Now,  it may happen that  a  woman whose peculiar habit
produces a peculiar retardation of menstruation, may  marry before
this secretion takes place for the first time; and, as  we have just
observed that she  is able to breed as  soon as ever she is  able  to
menstruate, the former process may anticipate the latter, and post-
pone it till the  term of pregnancy has been completed.  " A young
woman,"  says  Sir  Everard Home, " was married before  she was
seventeen, and, although she had never menstruated,  became preg-
nant; four months after her delivery she became pregnant a second
time, and four months after the second delivery she was a third
time pregnant, but miscarried ; after this  she  menstruated for the
first time, and continued to do so for several  periods, and again be-
came pregnant.''§
   There is much difference of opinion as to the period of pregnancy
in the human female ; for while other animals seem to  observe great
punctuality upon this subject, we  meet  with  so many and such
considerable varieties in women, that legislators, as well as physi-
cians, have not agreed in assigning a common term.  Hippocrates
rules it that we should  admit  the possibility of  a child being born
at ten months, but not later, which is the common ternitassigned in
the  book  of the Apocrypha entitled  Wisdom of Solomon ;|| while
Haller gives references  to women  who are said  to have gone  not
only ten but eleven, twelve, thirteen, and even  fourteen  months ;
most of which,  however, are of a suspicious kind.  Twelve  months,
nevertheless, is a term allowed by  many physicians, as what may
take place under peculiar weakness or delicacy of health ;"  and yet
it is most probable that in all these the mother is mistaken as to the
* Vide Blumenbach, Bibl. I. p. 558.
f Act. Helvet. IV. 162.
* Eph. Nat. Cur. Dec. III. Ann. II. Obs. 172,
:» Phil. Trans. 1817, p. 258.
I! Chap. VII. 2.
* Buchner, Miscell. 1727, p. 170.
  Enguin, Journ. de Med. Tom. LXT.
  Brambilla, Abbandl.  der Joseph. Acad. Band. I. p. 103.
  Telmout de St. Journ. de Med. Tom. XXVII.
  Ploucquet, Von den physichcn  Erfordernifsen fie: F.rbfahitjhe-i  do.
    Kinder, p. 69. Treb. 
113
GENETIC A.
[CL. V.—OK. III.
proper time  of her  conception,  and imagines  herself  to  have
commenced pregnancy for  some weeks  or even months before it
actually takes place.   The  state of menstruation affords  no full
proof; for  as conception may occur without its appearance,  so it
may continue for many months or even during the whole term of
pregnancy, though most commonly in a smaller quantity than usual.
There is a singular case in the Histoire de I'Academie des Sciences,
of a living child born after what is said to have been three years ot
pregnancy.'  Few reports of this kind are worth attending to, or
entitled to any kind of explanation :  but it has sometimes happened,
and probably did so in this last case that a woman conceits  herself
to be in a state of pregnancy, and has various  symptoms that
simulate it. for a twelvemonth or considerably more than a twelve-
month, and  particularly towards the  cessation  of  the  catamenia,
instances of  which we  shall  have  occasion to notice under the
fourth genus  of the present order, entitled  pseudocyesis or spu-
rious  pregnancy : and if, alter such a simulation continued  for a
year or two, the woaian should fall  into a state of real  pregnancy,
she may persuade herself at the close of the process that she has
been pregnant for the  whole of this time.
  Uy the code Napoleon,  the  legitimacy of a child  born three
hundred days after a dissolution  of marriage may be questioned.
In our own country the law is to this hour in an unsettled state ;
and much nicety of argument has frequently taken place ; of which
an example was afforded in the  famous question of  the  Banbury
peerage, upon a new raised distinction  of access and  generative
access.  There can be no doubt, however,  that a considerable dif-
ference in duration may ensue from the state of the mother's health :
for as the fetus receives its nourishment from the mother, there is
a probability that various deviations from  health  may retard the
maturity of*the fetus.   And it is probably on this  account that
different legislators have  assigned different periods of legitimacy ;
one of the shortest of which is that determined upon by  the faculty
ofLeipsic,  who have been  complaisant  enough to decide, that a
child  born five  months  and eight  days  after the return of the
husband, may be considered as legitimate; and that a fetus at five
months is often a perfect and healthy child.
  In the ordinary calculation of our own  country, the  allowed term
does not essentially differ from that in the code Napoleon, for it
extends to  nine calendar months or forty weeks:  but  as  there i*
often much difficulty in determining the exact day between any two
periods of menstruation in  which semination has taken  effect, it is
usual  to count the  forty weeks  from the  middle of the interval
before it ceases ; or,  in other words,  to  give a date  of forty-two
weeks from the last appearance of the menses :  anil at the  expira-
tion of this  term, within a few days before or after, the labour may
confidently be expected.
* Hist, de I'Academie des Sciences, 1753, p. 206. 
GL\ I.j
SEXUAL FUNCTION.
113
   In the progress of pregnancy the figure of the uterus, as well as
 its  position,  changes considerably.   Before the end of the third
 month it has a tendency to dip towards the pelvis, at which period
 it may be felt to ascend : during the seventh month it forms a line
 with the navel; in the eighth month  it ascends  still higher,  reach-
 ing  mid-way between this organ and the sternum ;  and in the ninth
 it almost touches the ensiform  cartilage; at the close of which, as
 though overwhelmed by its own bulk, it begins again  to descend,
 and shortly afterwards, from the irritation produced by the  weight
 of the child, or, more probably,  from the simple law of instinct, it
 becomes attacked with a series of spasmodic contractions extending
 to the surrounding organs, which constitute the  pains of labour,
 gradually increase in strength,  enlarge the mouth of the organ, and
 protrude the child into the world.
   In natural pregnancy, a strong hearty woman surfers little consi-
 dering the great change which  many of the most important  organs
 of both the thorax and abdomen are sustaining; and in  natural
 labour, though the returning  pains  are violent for several  hours,
 there is little or no  danger.   But  numerous unforeseen circum-
 stances may arise from the constitution of the mother, the shape
 of the pelvis, the figure or position  of the child, to produce diffi-
 culty, danger, and even death.
   In describing the diseases  which appertain to the whole of this
 period, it is not the author's design to do more than to take a gene-
 ral pathological survey, so as to communicate that kind of  know-
 ledge upon the subject  which every  practitioner of the healino-art
 should be acquainted with, even though he may not engage in the
 obstetric branch of his profession.  The minuter and more practi-
 cal parts, and especially those which relate to the application of
 instruments  and the  mechanical means  of assistance, must be
sought for in  books and lectures expressly  appropriated to this
purpose,  with  which it is not his intention to interfere.
                        GENUS I.

                     PAKACYESIS.

                   IBoiiitti pregnantp*

1"HE TROGRESS OF PREGNANCY DISTURBED OR ENDANGERED BY THE
        SUPERVENTION OF GENERAL OR LOCAL DISORDER.

The generic term is derived from 5r«f«s," male," and xuyris, "gra-
viditas."  The genus will conveniently embrace the three following
species, according as the general system, or organs distinct from
VOL. IV.
P 
114
GENETICA
[CL. V—OH. ni
those immediatelv concerned, are disturbed ;  as the sexual organs
themselves are disturbed ; or as the fruit itself is disturbed and ex-
tended prematurely:

1. PARAOYESIS IRRITATIVA.  CONSTITUTIONAL DERANGEMENT OF
                              PREGNANCY.
2. ._________ UTERINA.    LOCAL DERANGEMENT OF PREGNANCY.
3. .           ABORTUS.   MISCARRIAGE. ABORTION.
                       SPECIES  I.

           PARACYESIS IRRITATIVA.

     Constitutional  SDerangement of pregnane?*

 PREGNANCY  EXCITING DISTRESS OR DISTURBANCE IN OTHER OR-
    GANS OR FUNCTIONS THAN THOSE PRIMARILY CONCERNED.

The new condition of the womb operates upon the whole or differ-
ent parts of the system in various ways   We have frequently had
occasion to observe that there is no organ whatever which exercises
a  more extensive control over the entire fabric than the uterus,
with the exception of the stomach, and  hence many  parts are  af-
fected  by sympathy during its  new  action, and particularly the
brain and the whole of the nervous function.  But its change  of
shape,  bulk,  and position,  operates mechanically on  other organs
and frequently produces serious mischief by pressure or irritation ;
these organs are chiefly the stomach itself, the lungs,  the intestinal
canal,  and the veins of the legs.   And  hence  the evils resulting
from these causes, may be contemplated under the  following va-
rieties :
•', Systatica.


£ Dyspeptica.

v Dyspnoica.

2* Alvina.


t Varicosa.
Accompanied with faintings, palpitations,
  convulsions, or other direct affections
  of the nervous system.
Accompanied with indigestion, sickness,
  and head ache.
Accompanied with difficult breathing and
  occasionally a cough.
Accompanied with derangement of the
  alvine canal, as costiveness, diarrhoea,
  or hemorrhoids.
Accompanied  with  venous dilatation of
  the lower extremities.
  That the nervous system should  often suffer severely and in va-
rious ways during pregnancy, will not appear singular to those who 
    <^E. l._SP. I.]          SEXUAL FUNCTION.                HQ

    have  attended to the remarks we have already made concerning the
    close chain of sympathy  that prevails  between the brain and the
    sexual organs,  from the time of the first development of the latter
'   to their becoming torpid and superannuated on the cessation of the
    catamenia.   But in delicate  habits, in  which  these nervous affec-
    tions chiefly occur,  there is another cause, which  is even  more
    powerful than the preceding ; and that is the demand of an addition-
    al supply of sensorial power in support of  the new process, and,
    consequently, an additional excitement and exhaustion of the senso-
    riuin, persevered in without intermission, and increasing from day
    to day.  This excitement and exhaustion necessarily produce weak-
    ness ; and of course an irregularity in the flow, and particularly in
    the alternating pauses, of the sensorial  current; hereby predispos-
    ing alike to palpitation of the heart, clonic spasms, and convulsions,
    according to the  law of  physiology  laid  down under the genus
    clonus,* to which the reader may turn at his leisure.   Fainting,
    as has also been previously  shown under  the genus syncope,! is
    dependent upon the same deficiency of action, rendered more com-
    plete, or more protracted  in duration.
      Palpitation, in the case before us, is rarely attended  with dan-
    ger, but is often a most distressing symptom. It returns irregularly
    in the course of the day or night, but particularly after a meal, and
    very frequently on first lying down in bed.  In the capricious state
    of the nervous  system at this time, its return after meals does not
    seem  to be so much dependent upon the nature of the food as  upon
    the state of the stomach at the moment; it has recurred after a light
    and plain dinner, and been quiet after a more stimulant dinner; and
   then for a few days has been most severe after the  latter, and  least
   so after  the former; for a short time the digestion has gone on tran-
   quilly under  both,  and then again excited palpitation, and perhaps
   in an  equal degree  under both : nor has a total abstinence from so-
   lid animal food afforded any relief.  The pulsatory action is some-
   times  confined to the heart, sometimes alternates  with the cceliac
   or some other arterial trunk in the abdomen, and  sometimes with
   the temporal arteries.   While writing this  sheet, the author is oc-
   casionally consulted  by a  lady now in her sixth month,  who has
   been most grievously afflicted with  this affection from the time  of
   her  beginning to breed, and who  will probably be subject to it till
   her confinement.   None of the antispasmodics afford much  if any
   relief; camphor, in large doses, is found  the best  palliative; the
   narcotics have all been tried in vain : opium maddens the head and
   throws out a most distressing  lichenous  rash.  The  paroxysmg
   usually continue from  two to six or eight hours.  Other irritations
   produce it as well as those of the stomach, and especially  any sud-
   den emotion of the mind.
     Syncope or fainting occurs during any period of  pregnancy, but
* Vol. III. p. 265.
T Vol. III. p. 337- 
116
GENETICA.
[CL. V.—OR. HI.
 chiefly in the stage of the first three months, and especially about
 the time  of quickening.  After this period the general  frame ac-
 quires a habit of accommodation to the  change that has taken place,
 and is less easily affected.  It is ordinarily produced by  more than
 usual exertion, exposure to heat or any  sudden excitement of the
 mind.  It is sometimes of short duration, and the patient does not
 lose her recollection ; but in other instances it continues for an hour
 or upwards.   A  recumbent position, pungent volatiles,  sprinkling
 the face with cold water, and a free exposure to air, with a mode-
 rate use of cordials,  offer the speediest  means  of recovery.   The
 extremities, however, should be  kept warm, and the friction ot  a
 warm hand applied to the feet.
  One of  the worst ailments that ever accompanies the process of
 gestation  is that of convulsions.  They may occur at any period of
 this  process, and their  exciting  causes  are  not always manifest.
 The predisposing causes are general  weakness or irritability of the
 nervous system, a constitutional tendency to  epilepsy, or any other
 clonic spasm, and entonic  plethora.  In all  these cases there is a
 double danger; for we  have to dread apoplexy from the  rupture of
blood-vessels in the head; and abortion or premature  labour  from
 an extension of  the  spasmodic action to the  uterus.  No  time,
therefore, is to be lost, and the remedial process must be as active
 as it is instant.
  Bleeding must be had recourse to immediately, as well in the ato-
nic as in the entonic form of the disease.  In the first, indeed, it is
 of itself an evil,  for it  will  add to  the general weakness ; but as
there is already, or, by a repetition of the fit, will unquestionably be,
a considerable determination to the  head,  and more especially as
the vessels in an atonic  and  relaxed frame yield easily as well to
 anastomosis as to rupture, it will be a far greater evil to omit it.
 The  quantity of blood,  however, that  it may be advisable to ab-
 stract, must be determined by the concomitant symptoms so far as
they relate to the  head.   Generally speaking, in weakly habits, the
head is only affected secondarily, or by sympathy with the irritation
of the uterus, where convulsions make their appearance ; and hence
 bleeding,  in such cases, is to be employed  rather as a prophylactic
than as an antidote : and it may be sufficient to confine ourselves to
the  operation of cupping ; at the  same  time opening the bowels by
 a sufficient repetition of some laxative.  After this opium must be
 chiefly trusted to, if the spasms still  continue :  and, on their subsi-
dence, or in their  interval, the metallic  tonics should be introduced
 with the warmer bitters.
  Where, however, the constitution  is  robust, and the convulsions
 have been preceded, as  is often the fact in this case,  by a tensive
 or even heavy pain in the head, vertigo, illusory corruscations be-
fore  the eyes, or  illusory sounds  in the ears, the encephalon  is it-
 self the immediate seat  of disease, and the  bleeding even in  the
 first instance should be followed up to fainting, or at least till twenty
 ounces are drawn away, which it will frequently be necessary to 
ce. i.—sp. i.]
SEXUAL FUNCTION.
117
 repeat within twenty-four hours afterwards ; and, if the practition-
 er be a skilful operator, it will be better to abstract the blood from
 the jugular vein, as the  good effect will be sooner felt.  The hair
 should be shaved from the head and ice-water or other frigid lotions
 be applied, and very frequently renewed.   The bowels must at the
 same time be purged vigorously, and dilute  farinaceous  food con-
 stitute  the whole of the diet.   Opium should  be abstained from, at
 least till the general strength  is reduced  to an atonic  state, when
 if the paroxysms should still return, it  may be had recourse  to in
 conjunction with antimonial powder or some other relaxant.
   When, in despite of all this treatment, apoplexy has takeu place,
 and is  followed by a palsy of a particular organ, or of  an entire
 side, it will often be  found that the paralytic affection will often
 continue through the whole course of the pregnancy, and entirely
 disappear  afterwards.
   Sickness, heart-burn, and other symptoms of indigestion are
 still more  common  affections  than  those of the nervous system we
 have first noticed.  These are chiefly troublesome in the commence-
 ment of pregnancy, and evidently prove that they  proceed not from
 any machanical pressure, either director indirect, against the coats
 of the stomach, but from  mere sympathy with the  new and irritable
 state of the uterus : for, as  the novelty of this state wears away
 and  the stomach  becomes accustomed to it, the sickness and other
 dyspeptic symptoms subside gradually, and are rarely troublesome
 even when in the latter months of pregnancy the uterus  has swol-
 len to its utmost extent, from  a length  of  three inches  to that of
 twelve, and has risen nearly as high as the sternum.
   The head-ache,  which occurs a» a dyspeptic symptom, is  of a
 very different kind  from that we have just  noticed, and is  rarely re-
 lieved by very copious bleedings, though the  whole of these symp-
 toms  are occasionally mitigated by a loss of eight or nine  ounces of
 blood from the  arm, or the application of leeches  to the epigastric
 region as  recommended  by  Dr. Sims,  and M. Lorentz.  Cloths
 wetted with laudanum and applied to the pit of the stomach  have
 also  been found  serviceable in various  cases: but the most effica-
 cious means consist in the employment  of gentle laxatives, and a
 very light diet, to which may be added the use of the aerated alka-
line  waters or saline draughts, in a  state of effervescence.
  The fluid  discharged  from the   stomach on these occasions is
 usually limpid, thin, and watery : but where there is much  straining
 a little bile is thrown up at the same time.  It is rarely  that  this
 kind of vomiting produces any serious evil; though when it  has
 become very obstinate, as well as very severe, it has sometimes en-
 dangered a miscarriage.   The other symptoms of dyspepsy usually
 cease with  this and  are rather disquieting than sources of any de-
gree of alarm.  They may often be palliated by some of the means
already recommended under limosis,cardialgia,* and dyspepsia.!
* Vol. I. p. 86.
t Vol. I. p. 105. 
118
GENRTICA.
[CL. V—OR. Ill
  The chief symptoms of dyspnea that become troublesome during
pregnancy are occasional fits of spasmodic anhelation.  These are
mostly common to those, whose respiratory organs are naturally
weak, or who are predisposed to hysteria.   The paroxysms are of
short duration and usually yield with ease to the warmer sedatives
and  antispasmodics.  A clry and troublesome cough, however, is
sometimes combined  with this  state of the chest,  that, if violent,
endangers abortion,  and has occasionally produced it.   Bleeding
will  here also be advisable as the first step in the curative process.
Eight ounces of blood  will suffice, but the depletion must be repeat-
ed at distinct intervals if the cough should continue unabated. Gentle
laxatives should succeed to the bleeding and be persevered  in as
the bowels may require.  And to these may be added the mucilagi-
nous demulcents already recommended  in idiopathic cough, united
with such  doses of hyoscyamus, conium, or opium as are found best
to agree with the state of the constitution.*   There is little danger,
however,  of this cough  terminating in consumption however trou-
blesome and  obstinate it may be in itself, for it is rarely that two
superadded actions go forward in the constitution at  the same time :
and  hence, as we already have had occasion to observe, whenever
pregnancy takes place  in a patient  labouring under phthisis, the
progress of  the latter disease is arrested, till  tlie new process has
run its course.!
  Derangements of the  alvine  canal  under some  modifica-
tion  or other, accompany most cases of pregnancy,  are often  very
distressing, and by their irritation sometimes hasten  on labour pains
before their time.
  These affections are  of two very opposite kinds.  In  some in-
stances the  intestines participate in  the  irritability  of the uterus,
the peristaltic action is  morbidly increased, and there is a trouble-
some diarrhoea.  In others the larger intestines appear  to be ren-
dered torpid partly by the share of sensorial power  which is taken
from them in support of the new action, and partly by the pressure
of the expanding uterus on  their coats.  In both cases piles  are a
frequent attendant, but  particularly in the last.
  The diarrhoea varies in different individuals from a  looser flow
of proper  feces to a muculent secretion, or a dejection of dark co-
loured offensive stools,  accompanied with a foul tongue and loss of
appetite.  The first modification  requires no remedy, and may be
safely left to itself.  The second and third import a morbid action
of the excretories of the intestines, and  are best relieved  by  small
and  repeated doses  of rhubarb with two  grains of ipecacuan to
each,}: and afterwards  by infusions of cascarilla, orange-peel, or any
other light aromatic bitter.
  The costiveness must be caicfully guarded against by such ape-
* Vol. 1. p. 346. 352.
f Vol. II. p. 505.
t Burns, Principles of Midwifery, p. 154 
GE.I.  SP. I.]         SEXUAL FUNCTION.                 H9

rients, as are found upon trial to agree best with the bowels. Where
acidity in the  stomach is suspected, magnesia may be employed,
and will often prove sufficient: but where this does not exist,  the
senna electuary, Epsom salts, or castor oil, will be found to answer
much better.  The piles  will usually  disappear as soon as  the
bowels are restored to a current state : and, if not, they should be
treated according to  the plan already laid down under proctica
marisca.*
  Varicose dilatations of the veins of the lower extremities are
a frequent, though not often a very troublesome accompaniment of
pregnancy.  They are chiefly  found in women  whose occupation
obliges them to  be much on their  feet.  Where the affected veins
are first perceived to enlarge, the  varicose knots may  generally be
prevented by exchanging  the accustomed erect position for a re-
cumbent one, and using the legs but little.  Where the varices are
actually formed,  the legs  may be  supported with a bandage drawn
only with such  moderate  pressure as to afford sustentation; for if
carried beyond this we shall  only endanger a worse congestion in
some other  part  not equally  guarded against.   For  the rest the
reader may  turn  to  exangia varix, in a preceding part of  this
work.!
                       SPECIES II.

             PARACYESIS UTERINA.

           IlocaS SDcrangement of $3regnamp.

 PREGNANCY disturbed or  endangered by some  DISEASED At
                   fection of the uterus.

  In the progress of this work, we have seen that on the commence-
ment and through the course of impregnation the periodical secre-
tion of the uterus is suspended : that the organ gradually enlarges
from its ordinary size till, in the  ninth month,  it measures ten 01
twelve inches  from top to bottom, and that, in the course of this
enlargement, it changes its position according to a law that is  never
departed from in a state of  health.
  In a state of morbid action, however, or from some  accidental in-
jury, the uterus does not always maintain  its proper position,  nor
abstain from throwing forth  not only its ordinary and  natural secre-
tions,  but other fluids of a  morbid character; and hence becomes
» Vol. T. p. 233.
+ Vol. II. p. 598. 
 f 20                 OENETJCA.                 |OL. V.—OH. III.

subject to several varieties of affection of which it may be sufficient
 to notice the following :

 a. Retroversa.          Retroversion of the uterus.
 o Leucorrhoica.         The uterus  secreting,  or exciting in the
                          vagina a secretion of, leucorrhcea, so as
                          to produce debility.
 y Catamenica.           The catamenia continuing to recur.
3 Hsemorrhagica.        Accompanied with hemorrhage.

  A retroversion of the utehus  may be produced in various
ways, though it is seldom found except in pregnancy,  and between
the third and fourth month of this state.  This organ, notwithstand-
ing its appendages of broad and round ligaments,  is still left pendu-
lous in the hypogastrium : and hence,  if the fundus or broad and
upper part happen, by a scirrhous induration, or pregnancy, or any
other means,  to acquire a certain bulk and weight, and if at the same
time the cervix, or lower and  narrow  part,  be pushed on one side
by any accidental force, as that of  the bladder when distended, the
broad and upper part will tumble  downward, while the narrower
part ascends  and takes its place.   It  is this which constitutes a re-
troverted uterus ; but as it occasionally occurs under other states
than that of pregnancy, we  have treated of it already, under the
genus jedoptosis uteri, where we have stated the mode of treat-
ment to be adopted in the case before  us
  Leucorrhcea is a result of the increased action excited in  every
part of the uterus,  or of the upper part of  the vagina which is in-
flamed by continuous  sympathy.   We  have already observed that
the mucous discharge denominated  leucorrhcea, or whites, appears
to be secreted from the lower part of the  uterus,  and the  upper
part of the latter organ :* and hence  any excitement operation on
the fundus of the womb  may be easily conceived under a particular
condition of  the cervix of the uterus  and tlv vagina, or of the sys-
tem generally, capable of producing this secretion  in  considerable
abundance.
  When  treating of leucorrhcea as an idiopathic affection we re-
marked that where the discharge is  excessive it produces considera-
ble debility of the system generally,  and of the sexual and lumbar
region more particularly :  and that when it  becomes chronic, it of-
ten degenerates into an  acrimonious condition and  occasions great
disquiet by excoriating the cuticle to a considerable extent.
  Both these evils are consequent  upon its  occurrence in pregnan-
cy, and the first has, occasionally,  threatened abortion.  They are
to be relieved by the remedial process already  pointed out under
the genus leucorrhea  in the first order of the present class.!
  A continuance of the catamenial discharge at the  regular
* Vol. IV. Class V. Ord. J. Gen. II.
t Vol. IV. p. 51. 
iiE. l.—SP. II.]       SEXUAL FUNCTION.
121
periods, is also, in many cases of delicate habits, a source of great
weakness and discomfort, and sometimes endangers miscarriage or
premature labour: in all which instances it ought to be checked by
a recumbent  position, and particularly a little  before the time in
which  it may be expected, and by the other means already enume-
rated under paramenia superflua in the present class.*  It has
sometimes continued, however, in strongand vigorous habits through
the  whole period  of  pregnancy  without any serious  mischief ;t
though, even  here,  it has  usually been found to produce general
debility, and many troublesome dyspeptic symptoms.
   HemmanJ and  several  other  writers give cases of women who
have never menstruated except when in a state of pregnancy : such
is  the  degree of  irrilation which the secretories of the uterus, in
some instances, demand, in order to be roused into a due perform-
ance of their  function.  So, some persons can only see on a full ex-
posure to a meridian light,§ and others can only hear when the
tympanum is irritated  by the noise of  a drum or  of  a carriage,
sufficient to deafen all  the world around them.U
   Hemorrhage from the uterus is sometimes connected with this
irregular  return  of  the periodical  discharge, as we have already
observed it is not unfrequently in an  unimpregnated state  of the
organ.  In both cases this is usually a consequence of great general
debility, and it is hence the more alarming in any period of partu-
rition, as  risking the loss of the uterine fruit.   In the  delicacy of
habit we are  now contemplating,  bleeding would only add to the
debility or predisponeut  cause : and we  must content ourselves
with the plan already recommended under atonic hemorrhage of
the uterus in  a prior class and volume.^  Where the discharge has
been induced by external violence, or a  sudden  emotion  of the
mind,  venesection will be the best remedy  we can  have recourse
to, and afterwards thirty or five and thirty drops of laudanum in a.
saline  draught with two or three grains of ipecacuan.
* Vol. IV. p. 44.
■j- Hagedorn, Cent. II. Obs. 94.
i Medicinisch-Chirurgche Aufaaze.  Berl. 1778.
  Hopfergartner, iiber menfchliche Entwiklungen. p. 71. Sturtg. 1792.
§ Vol. III. Paropsis noctifuga. p. 138.
|| Vol  III. Paracusis perversa, p. 138.
% Vol. II. Class III. Ord. IV. pp. 469, 470.
VOL. IV.
Q 
122
t.ENETICA-
[CL. V.—OK. HI.
                      SPECIES  III.

            PARACYESIS ABORTUS.


                Miscarriage*  abortion*

  premature exclusion of a dead fetus from the uterus.

We have stated in  the  introductory  remarks to the present order
that the usual term of pregnancy i> forty weeks, or nine calendar
months.  Within this period, however, the  fetus may be morbidly
expelled at any time. If the  exclusion take place within six weeks
after conception it is usually called miscarriage; if between six
weeks  and  six months, abortion ;  if during any part of the last
three  months before the  completion of the natural term, prema-
ture labour.  Among some writers, however, abortion and mis-
carriage are  used synonymously and both are made to express  an
exclusion of the fetus at"any time before the commencement of the
seventh month. At seven months the fetus will often live. It has been
born alive, in a few rare instances, at four months ;* and has as
rarely  continued alive when born between five and six months.f
  The process of  gestation  may be checked,  however, from  its
earliest period : for  many of the causes of abortion, which can ope-
rate afterwards, may operate throughout the entire term, and hence
a miscarriage occurs not unfrequently within  three weeks after
impregnation,  or before the ovum has  descended into the  uterus.
In this case the pains very much  resemble those of  difficult men-
struation; and with a considerable discharge of clotted or coagu-
lated blood the tunica decidua passes away alone, having also some
resemblance to that imperfect form  of  it which we  have already
noticed as being produced in some cases of difficult menstruation,
but exhibiting a more  completely membranous structure.   And
here the ovulum escapes unperceived at some subsequent period,
and is probably decomposed and incapable of being traced.
  In subsequent periods of pregnancy abortion consists of two parts
or stages, the separation of the ovum from the fundus of the womb,
and its expulsion  from the  mouth.  Sometimes these take place
very nearly simultaneously, but sometimes  several  days or even
weeks intervene ;  so that the process of abortion may considerably
vary in its duration, and become  exceedingly tedious.   In  several
cases  I have known the ovum remain undischarged for upwards of
six  weeks, and, in one  case, for three months aftei  its separation,
and consequently  after the death of the fetus, comparing  its size
and appearance with the ascertained term of gestation.
 ________________■____________________
      * A. Reyes, Campus Elys.  Qusest. 90. p. 1164.
      r Brouzet, sur l'Education medicinale des Enfans. I. p. 37. 
UE. I. —SP. HI.]        SEXUAL  FUNCTION.
123
  Through the whole of this period there is an occasional discharge
from the vagina, and often temporary disquietudes, and even con-
tractile pains in the uterus.  But both are of a very different kind
from those which occur antecedently to the separation of the ovum.
The first pains are usually sharp and expulsory, with a free dis-
charge of clothing  arterial blood ; sometimes, indeed, in an alarm-
ing, though rarely  a dangerous profusion; in  the last they are dull
and heavy, and the discharge is smaller in quantity, dark and fetid.
We may also judge of the detachment of the ovum, and consequently
the death of the fetus, by the cessation of those sympathetic symp-
toms which have hitherto  connected  the stomach and the  mammae
with the  action of the  uterus, as the morning sickness,  and the
increasing plumpness of the breasts,  which, not unfrequently, are
so stimulated as to secrete already a small quantity of milk. On the
separation of the ovum from the fundus ol the uterus all these dis-
appear;  the stomach may  be dyspeptic, but without the usual sick-
ness, and the breasts become more ttian ordinarily flaccid.
  The ovum, when at  length discharged, comes away  very differ-
ently in  different  cases.   Sometimes the whole ovum  is  expelled
at once; but more generally it is discharged in detached parts, the
fetus  first escaping with the  liquor  amnii,  or descending with  its
own proportion of the placenta,  the maternal proportion following
some hours, or even days, afterwards. And, where there are twins,
one of the fetuses, naked or surrounded with its membranes, is
usually expelled alone, and the other not till an interval of several
hours, or even a day or two: the discharge of blood ceasing, and
the patient appearing to be in a state of recovery : so that it is diffi-
cult to  determine  whether or not there are twins in cases  of early
abortion.
  The causes of abortion  are very numerous ;  and some  of them
are rather to be conjectured, than  fully ascertained.  They may
depend upon  the ovum itself, upon the   uterus itself, or upon the
uterus as affected  by the  nature of  the  maternal constitution, or
accidental lesions.
  " The  imperfections observable in  ova,"  remarks Dr. Denman,
"are of different kinds, and found occasionally in every part; and
there is usually  a  consent between  the fetus and the shell of the
ovum, as the  placental  part and  membranes may be called, but not
always.  For examples have occurred in which the  fetus has died
before  the termination of the   third month, yet the shell, being
healthy, has increased to a certain size,  has remained till the expi-
ration of the  ninth month and then been expelled, according to the
genius and constitution of the uterus, though frequently it has been
Found to have undergone great changes, as,  for instance,  in many
cases of hydatids."*
  " It is remarkable,'' says the same author, " that women who are
in the habit of miscarrying, go on in a very promising way  to a cer-
tain time, and then miscarry, not once,  but for a number of times,
* Practice of Midwifery, Edit. 5. p. 508. 8vo. 
124
GENETICA.
[CL.  V.—OR.  III.
in spite of all the methods that can be contrived, and all the methods
that can be given : so that, besides the force of habit, there is some-
times reason to suspect that the uterus is incapable of distending
oeyond such size,  before it assumes its  disposition to act. and that
it cannot be quieted till it  has excluded the ovum.   What  1 am
about to say, will  not, 1 hope,  be construed  as  giving a license to
irregularity of conduct, which  may often  be  justly assigned as the
immediate  cause of abortion, or lead to the negligent  use of those
means that are likely to  prevent it.   But from the examination of
many ova after their  expulsion, it  has  appeared that  their longer
retention could not have  produced  any advantage,  the fetus being
decayed, or having ceased  to  grow long before it was expelled.
Or the ovum has been in such a state as to become wholly unfit for
the purpose it was assigned  to answer :  so that if we could believe
there was a distinct intelligence existing in every pa'-t of the body,
we  should  say it was concluded in council that this ovum can never
come to perfection and shall be expelled."*
  The causes of abortion of a constitutional or accidental kind are
more obvious.  They  may be internal and depend upon a relaxed
or debilitated state of the system  generally, and consequently of
the uterus  as a part of it; or external,  and depend on adventitious
circumstances. Violent pressure, as  that of tight stays, by preventing
the uterus  from duly  enlarging, is an obvious cause, as is also that
of a sudden shock by  a fall, or  a blow on the abdomen : violent ex-
ertion of every kind is a cause not less obvious, as that of immoderate
exercise in dancing, riding,  or even walking; lifting heavy weights :
great straining to  evacuate the  feces, or too frequent evacuations
from a powerful  purgative.  Violent excitement of the passions, as
of terror, anxiety, sorrow or joy. Violent excitement of the external
senses by objects  of disgust—whether of sight, sound, taste, or even
smell; or whatever else tends  to disturb or check the circulation
suddenly, and hereby to produce fainting, will often prove a cause of
abortion.   And when once  this affection has been  produced, the
organs with difficulty  recover their elasticity, and  it is extremely
apt to recur upon the  slightest causes.   Plater gives us an account
of fourteen miscarriages  in  succession ;f  Werlhoff, of five within
two years;!; and Werloschnig, of not less than eight in a single year.§
Wolfius relates the history  of  a woman, who,  in the whole course
of her life,  suffered twenty-two distinct abortions :|| and Schultz,
that of another, who,  in spite of every remedy, miscarried twenty-
three times, and  uniformly in  the third month, probably from an
indisposition in the uterus to  become distended further, as suwo-ested
* Denman, ubi supr£. p. 508.
-}- Observationes, Lib. II. p. 467.
* Opp. III.p. 718.
^ De Ourationibus Vernoautumn, p. 496.
![ Lection. Memorab. p. 413. 
GE. I.—SP. III.]       SEXUAL FUNCTION.                   1§9

in similar cases  by Dr. Dentuan in the  passage just quoted from
him. .                               •
  Another, and a very frequent cause, is plethora, and this, whether
it be from entony or atony.  "The uterus," observes Mr. Burns,
" being a large vascular organ,  is obedient to the laws of vascular
action, whilst the  ovum is more influenced by those regulating new
formed parts; with this difference, however, that new formed  parts
or tumours are united firmly to the part from which they grow by all
kinds of vessels,  and  generally by fibrous or cellular substance)
whilst the ovum is connected to  the uterus only by very tender and
fragile arteries and veins.  If, therefore, more  blood be sent to the
maternal part of the ovum than it can easily receive, and circulate
and  act under, a  rupture of the vessels  will  take place,  and an
extravasation  and consequent  separation  be  produced :  or even
where no  rupture is  occasioned-, the action of the ovum may be so
oppressed  and disordered as to unfit it for continuing the  process
of gestation."*
   Now in atonic plethora, or that commonly existing in high and
fashionable life, among those who use little exercise, live luxurious-
ly,  and sleep in soft warm beds, although the action that accom-
panies the pressure is  feeble  compared with what occurs in the op-
posite state, the vessels themselves are feeble also, and their mouths
arid tunics are exceedingly apt  to  give way to even a slight  im-
petus : and hence plethora becomes a frequent cause of abortion  in
women of a delicate habit and unrestrained indulgence.
   Among the  robust and the vigorous, however, its mode of opera-
tion is still more obvious and direct. An  increased flow of blood  is
here forced urgently on  the uterus, which  participates  irresistibly
in the vehemence of the  action ; so  that if the vessels do  not sud-
denly give way, and hemorrhage instantly occur, the patient feels
a tensive weight  in the region of the uterus, and  shooting pains
about the  pelvis.  " This cause," observes Mr. Burns, " is especial-
ly apt to operate in those who are  newly married, and  who  are  of
a salacious disposition, as the action of the uterus is thus much in-
creased, and the  existence of plethora rendered doubly dangerous.
 In these cases, whenever the menses have become obstructed, all
 causes  tending to increase the circulation must be avoided, and
 often a temporary separation from the husband is  indispensable."!
   The general treatment of abortion consists of two intentions, that
 of preventing it when  it threatens ; and that of safely  leading the
 patient  through it when there is little doubt that it has taken place.
   The  chief symptoms  menacing  abortion are transitory pains  in
 the back or hypogastric  region, or  a sudden hemorrhage from the
 vagina.  In all these cases the first step to be taken is a recumbent
 position, and when the patient is once placed in this state  we should
 deliberately  examine  into the  nature of the cause.   If  there  be
* Principles of Midwifery, 3d Edit. 8vo. p. 191.
f Burns, ut supra, p. 192. 
12tf
GENETICA.
[CL. V.—OK. III.
 symptoms of plethora,  or oppression, if an  accident, or a sudden
 emotion of the mind, or  severe exercise, as  of dancing, riding, or
 even walking, have produced  them by disturbing  the  equilibrium
 of the circulating system, blood should  be  immediately taken from
 the  arm, and  ail  irritation removed from  the bowels by a gentle
 laxative or injection.   In plethora, indeed, we may go beyond this,
 and empty the  bowels more  freely: yet  even  here  our object
 should be to reduce without weakening.  In every instance, except
 where plethora prevails,  after  abstracting  blood, the next best
 remedy is  a full dose  of opium consisting of thirty Or forty drops
 of laudanum, or more if the symptoms be  urgent,  and repeated
 every three or four hours till the object is obtained.*   And where
 the system is so feeble or emaciated that  bleeding is  countcrinili-
 cated, we must  content  ourselves with giving sulphuric  acid with
 small doses of digitalis, unless, indeed, there be much tendency to
 sinking at  the stomach, and, in this case, we must limit our practice
 to the mineral acid and opium, and  gently relieving the bowels.
   By this plan the pains originating from incidental  causes are often
 checked, and the partial  separation of the ovum that has commenced
 is put a stop  to.   But  the remedial  process  is  thus  far merely
 begun : the patient, for some weeks, must be peculiarly attentive
 to her diet,  which should be  light and sparing, and if exercise of
 any  kind be allowed, it should  be that of swinging, or  of any easy
 carriage.   Cold bathing,  and especially cold sea-bathing, is of great
 importance ; and where these cannot conveniently be had, a cold hip
 or shower-bath may be employed in their stead ; and if there should
 still  be the  slighest  issue of blood from the  vagina,  injections  of
 cold water, or of a solution of alum, or sulphate of zinc, should be
 thrown up  the passage two or three  times a day : or an  icicle or  a
 snow ball be employed as a pessary.
   If the habit be peculiarly vigorous and  robust,  stimulants and
 softness of bed-clothes must be  carefully avoided, and  the downy
 couch be exchanged for a hard mattress. But if the  constitution be
 delicate and emaciated,  two  or three  glasses of wine  may be al-
 lowed daily, and a course of angustura, columbo,  or some  other
 bitter tonic should be entered upon.  In either  case, however, it is
 absolutely  necessary  that sexual connexion should  be abstained
 from for ten days or a fortnight.
   It has of late been very much the custom  to confine  women of a
very delicate  frame,  and especially after  they have once miscar-
 ried, to a recumbent position  from the first symptom of conception
 through the whole term of gestation.   In a  few cases this may be  a
 right and advantageous practice, but in  the  present day it is em-
ployed far too  indiscriminately.  Among the causes of abortion we
 have just enumerated there ate many it can never touch, as where
 the ovum itself is at fault, or there is a natural  indisposition in the
 uterus to expand beyond a certain  diameter.  In  this  last case, if
* Aaskow. Act. Soc. Med, Hafn. Tom. I. 
  GE. I.—SP. III.]        SEXUAL FUNCTION.                  4«r-

  we could be  sure of it, a  tepid hip-bath  employed every evening
  about the time the abortion is expected would be a far more likely
  means of preventing it: for we should act here as in ail other affec-
  tions where our object is to relax  and take off  tension, in  which
  states we uniformly  employ warmth and moisture, commonly, in-
  deed, a  bread  and  water  poultice.  And hence, in  the instance
  before us, one of the best applications  we could  have recourse  to
  would be a broad swathe of flannel  moistened with warm water and
  applied  round  the loins  and lower belly every  night on going to
  bed, surrounded externally with a dry swathe of  folded linen.  This
  should be worn through  the whole  night, and continued  for a  fort-
  night about the time we have reason to expect a periodical  return
  of abortion from the  cause now alluded to.
   1 was lately requested to join in  consultation with an obstetric
 physician upon the state  of a young married lady  of  a highly  ner-
 vous and irritable frame united with great energy and  activity  both
 of mind and  body,  who  had  hitherto  miscarried  about  the third
 month of gestation, by braving all risks, taking walks of many miles
 at a stretch, or riding on horseback for half the day at a time.  She
  was now once more in the family way, and had just commenced the
  discipline ot only quitting her bed for the sofa to which she was
  carried, and  on which she was  ordered to repose  with  her head
 quite  flat and in a line with her body, and without moving her arms
 otherwise than to feed herself: and to continue  in this motionless
 state for  the ensuing eight months.   Without entering into the im-
 mediate cause of her former  miscarriages, I ventured  to express
 my doubts whether so sudden  and  extreme  a  change  would not
 rather hurry  on than prevent abortion, by accumulating such  a
 degree of sensorial power as should  produce an  insupportable dys-
 phoria  or restlessness, which would peculiarly  vent  itself on the
 organ of greatest irritation.   But I  recommended that all exertion
 of body and mind should be moderated, that the diet should be plain,
 the hours regular, that the position should be generally recumbent,
 and strictly so for a fortnight about  the time in which abortion
 might be expected.   It  was overruled, however, to persevere in
 the plan already adopted from the  moment, and  every  sedentary
 relief and amusement that could be devised was  put in requisition
 to support the patient's spirits.   She went on well for a week, but
 at the end of this period became irritable, fatigued, and dispirited ;
 and miscarried at about six weeks from conception, instead of ad-
 vancing to three months as she had hitherto done.
  Even in the case  of a delicate and relaxed frame, and of a mind
 that has no objection to confinement, it  is well worth consideration
 whether  the ordinary means  of augmenting the general strength
 and elasticity by such tonics as are  found best  to agree with  the
system, and such exercises as may be  taken without fatigue; par-
ticularly any of those kinds of motion which the Greeks denominat-
ed seora, as swinging or sailing, riding in a palanquin,  or  in a car-
riage with a sofa-bed or  hammock, which, as we observed on a 
 128                     GENET1CA.             |CL. V—OU. 111.

former occasion** instead of exhausting, tranquillize and prove se-
dative, retard the pulse, produce sleep, and calm the irregularities
of every  irritable organ,—may not be far more likely to carry the
patient forward than a life of unchanging indolence, and undisturbed
rest, which cannot fail to add to the general  weakness, how much
soever the  posture it inculcates may favour the quiet of the uterus
itself.
   We have thus far supposed that there is a mere danger  of abor-
tion, and that the symptoms are capable of being suppressed.  But
if the pains, instead  of being local and  irregular, should  have be-
come regular and contractile before medical assistance is sought
for, or should have extended round the body, and been accompanied
with strong expulsory efforts, and  particularly  if, in conjunction
with those, there  should  have been a considerable degree of he-
morrhage, our preventive plan will be in  vain, a  separation has un-
questionably taken place,  and to check the descent of the detached
ovum would  be useless if not mischievous.   Even though the pains
should have ceased we can give no encouragement, for such a ces-
sation only affords a stronger proof that the effect is concluded.
  If the discharge continue but in small quantity, it is best to let it
take its course ; to confine the patient to a bed lightly covered with
clothing, and give her five and twenty or thirty drops of laudanum.
Bleeding is often had recourse to with a  view of effecting a revul-
sion : it is uncalled for, however, and may do mischief by augment-
ing the weakness.
  But the practitioner often arrives when the discharge is in great
abundance  and amounts to a flooding;  and the patient is faint and
sinking, and appears ready to expire.
  To the inexperienced these symptoms are truly alarming,  and,
in a  few  instances, sudden death appears to  have ensued from the
exhaustion  that accompanies them.  But  these are very uncommon
cases, for it rarely happens that the patient does not recover in an
hour or  two  from  the deliquium : and even  the syncope itself is
one of the most effectual means of putting a check to the discharge
by the sudden interruption it gives to all vascular action.  Cold,
both external and  internal,  is here of the utmost importance; the
bed-curtains should be undrawn, the windows thrown open, and a
sheet alone flung over the  patient; while linen wrung out  in  cold
water, or ice-water should  be applied to the lower parts of the body
and renewed as its temperature becomes  warm :  holding the appli-
cation, however, as soon as the hemorrhage ceases.
  Injections should, in this case, be desisted from  ; for the formation
of clots of blood around the bleeding vessels  should be encouraged
as much  as possible, instead of being  washed  away.  And for this
reason it is now a  common practice to plug the  vagina as  tight as
possible with sponge or  folds of linen,  or  what  is better, a silk
" Marasmus Phthisis, Vol. II. p. 519. 
  GE. I—SP. III.]        SEXUAL FUNCTION.                  ^g

  handkerchief, smeared over with oil that they  may be introduced
  trie more easily, and afterwards to  confine the  plug with a T ban-
  dage.  I ins plan has been long recommended by Dr.  Hamilton,
  and has been extensively followed with considerable success. Here,
  also. Dr. Hamilton prescribes large doses of opium as an auxiliary,
  beginning with five  grains, and continuing it  in doses of three
  grams every three hours, till the hemorrhage has entirely  ceased.
  Opium, however, is given with most advantage where the flooding
  takes place after the expulsion of the ovum; for if this have not
  occurred its advantage may be questioned, since it has a direct ten-
  dency to interrupt that muscular contraction without which  the
  ovum cannot be expelled.  And it should be farther observed that
  where opium  is had recourse  to  in  such large doses as  are above
  produced,  it must not be dropped suddenly, for  the most mischiev-
  ous consequences would  ensue ; but must be continued in doses gra-
  dually diminishing till it can at length be omitted with prudence.
    It the flooding occur alter the  sixth  or seventh month, and  the
  debility be extreme, the  hand  should be introduced into the uterus
  as soon as its mouth is sufficiently dilated, and the child turned and
  Drought away.   And if, before this time, a considerable degree  of
  irritation be kept up in the womb from  a retention  of the fetus or
  any considerable part of  the ovum after its separation, one or two
  lingers should also  be  introduced for the purpose of hookin* hold
  ot  what remains, and bring it away at once.  Such a retention is
  often exceedingly distressing,  the dead parts continuing to drop
  away in membranous or filmy patches for several weeks intermix-
 ed with a bloody and offensive  mucus.  And not unfrequently some
 danger of a typhus fever is incurred from the corrupt state  of the
 unexpelled  mass.  In this case,  the strength must be  supported
 with a nutricious d et, a liberal allowance of wine, and the use of the
 warm bitters,  with  mineral acids.  It is also of great importance
 that the uterus itself be well  and frequently washed  with stimulant
 and antiseptic  injections,  as a solution of alum or sulphate of zinc,
 a decoction of cinchona or pomegranate bark, a solution of myrrh
 or benzoin, or,  what is better than any of them,  negus made with
 rough port wine.  The  injection must not be wasted in the vagina,
 but pass directly into the uterus; and, on this account, the syrino-e
 must be armed with a pipe made for the purpose and of sufficient
 length.
  The application of cold then, plugging  the vagina,  opium, and
 perfect quiet, and, where the pulse is  full,  venesection, are the
 chief remedies  to be employed in abortions,  or threatenings  of"
 abortion, accompanied with profuse hemorrhage; and where these
 do not succeed, and especially after the  sixth month, immediate de-
 livery  should be  resorted  to.  The process, however, of applying
 cold >hould not be continued longer than  the hemorrhage demands;
for  cold  itself, when in  > vtreme, is  one of  the  most powerful
sources of sensorial exhaustion we are acquainted with. And hence,
where fie system is constitutionally weak, and particularly where
  VOL. IV.                    ]l 
130
GENETICA.
[CL. V.—OR.   .
it has been weakened by recurrence of the same discharge it may
be a question  well  worth weighing whether any thing below  a
moderately cool temperature be allowable even on the first attack ?
as also whether the application of warm clothes to the stomach and
extremities might not be  of more advantage ?  for unless the extre-
mities of the ruptured vessels possess  some degree of power they
cannot possibly contract, and the flow of blood must continue.  And
it is in these cases that benefit has sometimes been found by a still
wider departure from the ordinary rules of practice, and the allow-
ance of a little cold negus.  So that the utmost degree of judgment
is necessary on this occasion, not only how far to carry the estab-
lished plan, but on peculiar emergences how  far to  deviate  from,
and even oppose it.
   We have said that the hemorrhage  which  takes place in abor-
tions, however profuse, is rarely accompanied with serious effects.
This, however, must be limited to the first  time of their  taking
place: for if they recur frequently in the course of a single gesta-
tion, or form a habit of recurrence in subsequent pregnancies, the
blood, from such frequent discharges, loses its proper crasis; the
strength of the constitution is broken down :  the sensorial fluid is
secreted in less abundance, perhaps in less energy: and all the func-
tions of the system are of consequence  performed with a consider-
able degree of  langour.  The increasing sensorial weakness  pro-
duces increasing irritability : and hence slighter external impres-
sions occasion severer mischief and the patient becomes subject to
frequent  fits of hysteria, and other spasmodic affections.  Nor is
this all:  for the stomach  cannot digest its  food, the intestines are
sluggish, the bile is irregularly secreted, the heart acts feebly ; and
the whole of this miserable train of symptoms is apt to terminate
in dropsy.
                       GKNUS  II.

                      PARODYN1A.

                     IBorbto !Labom\

THE PROGRESS OF LABOUR DISTURBED OR ENDANGERED BY IRRE-
    GULARITY OF SYMPTOMS, PRESENTATION OR STRUCTURE.

The generic term is a Greek compound from ?r«f*, male, and «^<»
or aS'n , <»«s, "dolor paturientis." All the different species of vivi-
parous  animals have  a  term of uterogestation  peculiar  to them-
selves,  and to which they  adhere  with  a  wonderful  precision.
Among women we have already said that this term i* forty weeks,
being nine calendar or ten lunar months. Occasionally the expulso- 
GE. II.]
SEXUAL FUNCTION.
131
ry process commences a little within this period, and occasionally
extends a little beyond it: but, upon the whole, it is so true to this
exact time as clearly to show it to be under the influence of some
particular  agency, though the nature of such  agency has never
been satisfactorily pointed out.  Sometimes the  weight of the child
has been supposed to force it downwards at this  precise period, and
sometimes  the uterus has been supposed to  contract, from its ina-
bility of expanding any farther, and hence from  an  irritable excite-
ment produced by the pressure of the growing fetus.  By other phy-
siologists it has been prescribed in the increasing activity of the child,
and the uneasiness occasioned by its movements.   But it is a suffi-
cient answer to all these hypothesis to remark that  a like  punctua-
lity is  observed whether the child be small or large, alive  or dead;
unless, indeed, the death took place at a premature period of the
pregnancy  : for " No fact,"  says Dr. Denman, " i3 more incontes-
tably proved than that a dead child, even though  it may have be-
come putrid, is commonly born after a labour as regular and natural
in every  part of  the process as a living one :"* and hence we can
only resolve it into the ordinary law of instinct or of nature, like
that which regulates the term of menstruation, or assert still more
intelligibly with  Avicenna  that,  "at the  appointed  time labour
comes on by the command of God."
  In natural labour, which consists  in a gradual  enlargement of the
mouth of the womb, and the diameter of  the  vagina, so as to suffer
the child to pass  away when urged from above by a repetition of
expulsatory contractions of the uterus and all the surrounding mus-
cles, there  is little or no danger, however painful or distressing  to
the mother.  These contractions, or labour-pains, continue  with a
greater or  less irregularity of interval and  recurrence from  two
hours to  twelve,  the  process rarely terminating sooner than the
former period, or later than  the latter:  the  ordinary  term being
about six hours.
  But unhappily labours do not always proceed in a natural course;
for sometimes there is a feebleness  or irregularity in the muscular
action that greatly retards their progress ; or a derangement of some
remote organ that sympathizes with the actual state of the uterus,
and produces the same effect; or the mouth of the  uterus itself is
peculiarly rigid and unyielding :  or  the natural presentation of the
child's head may be exchanged for some other position ; or the ma-
ternal pelvis may be misshapen, and not afford convenient room
for the descent of the child ; or there may be a plurality of children ;
or even after the birth of the child the placenta may  not follow with
its ordinary regularity, or an alarming hemorrhage may supersede :
each of which conditions becomes a distinct species of disease in
the progress of morbid labour, and  the whole of which may be ar-
ranged as follow:
* Pract. of Midwifery, 8vo. Edit. 5. p. 255. 
U2
GENETICA.
|CL.  V—OU.  III-
1. TARODYNIA ATONICA.        ATONIC  LABOUR.
              IMPLASTICA.     UNPLIANT LABOUR.
              SYMPATHETICA.  COMFLI0A»ED LABOUR-
              PERVERSA.      PRETERNATURAL  PRESENTATION.

                                 CROSS-BIRTH.
              AMORPHICA.     IMPRACTICABLE LABOUR.
              PLURALIS.       MULTIPLICVTE LABOUR.
             SECUNDARIA.     SEQUENTIAL LABOUR.
                        SPECIES  I.

              PARODYNIA ATONICA.

                      atonic  Labour,

LABOUR PROTRACTED BY GENERAL OR LOCAL DEBILITY, OR HEB-
                      ETUDE OF ACTION.

It often happens in various affections of the system that a general
law is incapable of being carried into effect with promptness and
punctuality from  weakness or  indolence  of  the  organs that are
chiefly concerned in its execution.  Thus, when vaccine or variolous
fluid  is properly  inserted  under the cuticle,  it remains there in
many cases for several days beyond its proper period, in a dormant
state  from inirritability or indolence in the cutaneous absorbents :
and, in the case of small-pox, even where the fluid has been receiv-
ed into the system, whether naturally  or by  inoculation, and has
excited febrile action, this action is, in many instances, very consi-
derably augmented from a like indolence or inirritability of the secer-
nents of the skin  which do not  throw  off the morbid matter suffi-
ciently on the surface.
   A  like want of harmonious  action very frequently  occurs in
parturition.   The full time has expired—the  uterus  feels uneasy,
and the uneasiness is communicated to the adjoining organs, and
there are  occasional  pains in the back or  in  the lower belly, but
 either  from a weakness, or hebitude, or both, in the  uterus itself,
 or in the muscles that are to co-operate with it in expelling the
 child,  the pains are not effective and the labour makes little  pro-
 gress.
   It  often happens, also,  in debilitated  habits that while in some
 part of its progress the labour advances kindly and even rapidly,
 the little strength the patient possesses is worn out, and her pains
suddenly cease ; or, what is worse, still continue, but without their
 expulsory or effective power, and, consequently, do  nothing more
 than  tease her, and add to the weakness.  This exhaustion will
5.
6. 
GE. II.—SP.  I.]
SEXUAL FUNCTION.
133
sometimes occur soon after the commencement of the labour, or in
its first stage, before the os uteri has dilated and  while the water is
slowly accumulating over it;  but in this stage it is more likely to
occur  if the membranes should have  prematurely given way, and
the water have been already evaculated.  Yet it occurs  also,  occa-
sionally, towards the close even of the last stage, and when the
head of the child has completely cleared itself of the uteius, and is
so broadly resting  on the perinseum that a single effective  pain or
two would be sufficient to send it without any  assistance into the
world.
  In the greater number of these cases, to wait  with a quiet com-
mand of mind,  and soothe the patient's desponding spirits  by a
thousand little insinuating attentions, and a confident issurance that
she will do well at last,  is the best if not the only duty to be per-
formed.   A stimulant injection, however, of dissolved soap or mu-
riate of soda will often re^jxcite the  contractions where they flag,
or change the nature of the pains where they are ineffective. After
this it is often  useful  to  give thirty or five  and  thirty  drops of
laudanum, and to let the patient remain perfectly quiet.  It is not
certain in whit  way the hndanum may act, for it sometimes proves
a local stimulant, and sometimes a  general sedative, but in either
way it will be serviceable and nearly equally  so : for it will either
shorten  the labour by  re-exciting and  invigorating the  pains, or
increase the general strength by producing sleep and quiet.
  If the pulse should be quick and feeble with languor and a sense
of taiutness at the  stomach,   a  little mulled  wine or  some other
cordial may be allowed.   If  the mouth of the  womb  be lax  and
dilatable, and the  water  have accumulated largely and  protrude
upon  it as in a bag, advantage is  often gained by  breaking the
membranes and evacualing  the fluid, for a new action is  hereby
given to the uterus, and while it contracts with more force it meets
with less resistance, and its mouth is more rapidly expanded,   liut
unless the labour should have advanced to this stage, the  membranes
should never be interfered with ; for their plasticity,  and the gradual
increase and  pressure of their protruding sac  against the edges of
the os  uteri, form  the easiest and surest means of  enlarging it,
whilst the retention of the fluid in  this early  stage of parturition
lubricates the inner surface of the womb, and tends  to keep off
heat and irritation.
  For  the same reason, if the mouth of the womb  be narrow and
have hitherto scarcely given way, the application of the finger can
be of no advantage.  Every attempt to dilate it  must be in vain, and
only produce irritation, and an increased thickening in  the edges :
but if  it have opened to a diameter of two inches, and be  at  the
same time  soft and expansile, advantage should be taken  of the
pains to dilate it by  the introduction of one or two fingers still  fur-
ther, which should only, however, co-operate with the pains,  and be
employed while  they are acting; and by these conjoint  means  the 
13i
GENETICA.
[ CL. V.—OK. Ilf.
head of the child sometimes passes rapidly and completely out of
the uterus into the vagina, or outer mouth as it is called on these
occasions.
   We  have said that it is  sometimes apt  to lodge here in conse-
quence of the patient's exhaustion, and an utter cessation of all
pains, or of all that are of any avail.  She should  again therefore
be suffered to rest, and, if faint, be again recruited  with some cor-
dial support.   Generally speaking, tune alone is here wanting, and
the practitioner must consent to wait: and it will  be better lor him
to retire  from his patient and to wait at a little  distance.  But if
several hours  should pass away without any return of expulsory
efforts, if there should be frequent or continual pains without any
benefit, if the patient's strength should sink, her pulse become weak
and frequent, if the mind should show unsteadiness, and there be a
tendency to syncope, and if. at the same  time, the  head be lying
clear on the perinaeum, the vectis or forct-ps should be had recourse
to, and the woman be delivered by artificial means.  This situation
forms a  general warrant:  but for the  peculiar circumstances in
which  such  or any other instruments  should  be employed,  the
manner of employing them and the nature  of the instruments them-
selves, the reader must consult such books  as are expressly written
upon the subject, and  should sedulously attend  the lectures and
the introductory  practice which are so usefully offered to him in
this metropolis.
                       SPECIES II.


            PARODYN1A  IMPLASTICA.


                    dnpliant  ILabour.

LABOUR DELAYED OR INJURED FROM IMPLASTICITY OR UNKINDLY
               DILATATION OF THE SOFT PARTS.

The tediousness  and difficulty of the preceding species  of labour
proceed chiefly  from atony or hebetude of the system generally, or
of the instrumental organs particularly.   But it often happens that
the  parts dilate  and the labour proceeds as slowly from an  implas-
ticity, or rigid  resistance  to the  expansion and  expulsory efforts
which should take place, according to the  law  of nature, at the
fulness of time  which we are now  supposing to  be accomplished,
and which is sometimes productive of other evils  than  that of pro-
tracted suffering, offering us indeed the four following  varieties :— 
GE. 11.—SP.  II.]         SEXUAL FUNCTION.                13j
* Rigiditatis.           The delay confined to a simple rigidity of
                          the uterus or outer mouth.
£ Prolapsa.             Accompanied with prolapse.
y Hsemorrhagica.       Accompanied with hemorrhage.
^ Lacerans.            Accompanied with laceration of the uterus
                          or perinseum.

  Rigidity of the uterus may extend to the entire organ, or be
limited to the  cervix, or os uteri as it is called after the cervix has
lost its natural form, and partakes of the sphseroidal shape of the
fundus.   Where  the  former occurs the practitioner  uwets  with
severe pains  in the loins, shooting  round to the lower bidly and
producing great contractile efforts'of the muscles surrounding the
uterus, so as to throw the patient from the violence of her exertions
into a profuse  perspiration, and induce  the attendants to believe
that the labour is advancing with great speed, while the practitioner
himself finds, on  examination, that there is no progress whatever;
that the uterus itself does not unite in the expulsory force, the
fluid of the amnios does not accumulate over the os uteri, nor the
head  of the child bear down upon it.
  In  other cases, he finds that the general organ of the  uterus does
participate in  the common action, and force the head of  the  child
downward,  but that  the  mouth of the  womb does  not dilate or
become thinner in consequence hereof;  appearing on the contrary,
in some cases,  from a peculiar tenderness and irritation, to grow
thicker and tenser, and more intractable.
  And  he not unfrequently finds  even  where both the body  and
mouth of the womb are sufficiently pliable and co-operative with the
common  intention, and the head  of the child has become easily
cleared of this organ, that a like rigidity and implasticity exist in
the os externum, and that the  child having readily worked its way
thus far, is fast locked from this circumstance, and cannot get  any
further.
  In all cases of this kind the same means of relaxation should be
resorted to as in an irritable or inflammatory tenseness and rigidity
of other organs.  Blood should be freely abstracted, active purga
fives  be given by  the mouth,  and copious  emollient injections be
administered  without much aperient virtue, so that they may for
9ome  time remain  in the  rectum and act as a fomentation.  And
here also it may be advantageous  to apply round  the loins  and
lower belly, a broad swathe of flannel wrung out in hot water, and
to encircle it  with an equally broad band of folded linen, in the
manner already recommended in paramenia difficilis.
  In  several cases of rigidity, if no means be adopted to subdue the
tension,  the protrusive  force of the surrounding muscles is some-
times so considerable that, as it cannot expel the child  by itself,  it
goes  far to expel the child and the uterus conjointly, the latter
being thrust downward into the outward passage and its mouth pro-
jecting out of the vulva, thus constituting a parturient pkolapsp 
130
UENETICA.
[CL. v.—OK. in
   While the uterus is thus forcibly descending, the attendant should
 support it, or the head of the child, with two  fingers : if the pro-
 lapse be complete, the uterus should be  returned  into  the proper
 place as quickly as possible; and if this cannot be done, the child
 must be turned, and delivery take place as speedily as may be.
   In the violence of this struggle, it sometimes happens moreover,
 and particularly where the  water  has  escaped,  that some ot  the
 vessels give v/ay, or the placenta is  partly detached, and there is
 the additional evil of a profuse hemorrhage to contend with.
   If this occur in the commencement of labour, venesection should
 generally be had recourse to, the patient be kept  cool  and  quiet,
 and take thirty  drops of laudanum.  If the labour have advanced
 and is advancing rapidly, and the hemorrhage not be very consider-
 able, we may safely trust to nature to complete the process before
 any serious mischief ensues.  But if the patient be debilitated, or
 much exhausted, or the labour advance  slowly, the woman should
 be delivered by turning the child, or having recourse  to the forceps
 according to the progress  of the labour, and the position of  the
 child at the time.
   But there is a far worse evil than any of these, which results from
 the implasticity we ar<" now considering: and  that  is  a rupture or
 laceration either of the vagina or of the uterus.
  The causes of laceration are said to be numerous,  and it often
occurs suddenly and without any known cause : but if we examine
into their general nature, we  shall find that except, in  the case of
brutal force or want of skill, they are almost always dependent on
a certain degree of implasticity  in the part of  the  lacerated  organ
 which prevents it from yielding  with  the uniformity  of the other
parts, or, from a peculiar degree of irritability  that renders it more
liable to irregular action or spasm : though there can be no question
that in  a very few instances the  laceration has commenced from a
cut produced by  an occasional sharpness of  the edge of the ilium.
"Those women," observes Mr. Burns," are  most liable to rupture
of the uterus who are very  irritable, and subject to  cramp; or who
have the pelvis contracted, or its brim very sharp, or who have the
os uteri very rigid, or any part of the womb  indurated.  Schulzius
relates a case where it was  produced  by scirrhus  of  the  fundus ;
and Friedius one where it was owing to a carneo-cartilaginous state
of the os uteri."*
  Laceration of the fundus of the womb may take place during any
part of the labour when the pains are violent, and  the walls of the
organ do not act in unison in every part; but the  mischief more
 commonly commences  in the cervix, when  the head, or the shoul-
ders, or any other part, is passing through, and the whole of its cir-
 cumference  does not yield equally.   Where the  accident  occurs
 in the vagina or perinjemn,it must necessarily  take place after the
 head  has descended from  the womb,  and  is pressing upon the
* Principles of Midwifery, 8vo. 3d. edit. p. 361. 
GE. II.—SP. II]
SEXUAL FUNCTION.
137
substance of these organs that, like the lacerating os uteri, does not
yield equally in every point.    •
  In most cases of an implastic rigidity, whether in the body of the
uterus itself, or in its cervix, or in the os externum, there is a con-
siderable degree of local irritation, and, in very many of them, of firm
and vigorous action.  The  parts arc not only rigid, but dry, and hot,
and tender,  and the pulse is generally full, with restlessness, and a
heated skin.  And hence  venesection is imperatively  called for
from an  early  period of the labour;  and there are few cases in
which the uterus has  not acted afterwards with more freedom,  and
ils mouth been rendered laxer, softer, and more compilable.   In all
such cases, also, an emollient injection several times repeated, will
considerably co-operate in taking off the tension, and insreasing the
expansibility.   Here opium should be avoided, but  general relax-
ants, as antimony  and ipecacuan,  given  in the neutral effervescing
draught, may add  to  the gener.il  benefit.  The operator must  be
abstinent till the parts have yielded, and the tension and irritation
subsided, for  before this, every application of the fingers will only
increase the morbid tendency.
   The only case in which  the use of opium is here  to be justified,
is where, from the violence of  the contractile pains, a considerable
and  an  alarming  hemorrhage  has ensued, and  the  state of the os
uteri will not allow of the introduction of the hand for the purpose
of turning and delivering immediately.  In this instance, after ve-
nesection and  a due administration of emollient and  aperient injec-
tions, our last dependence  must be upon a powerful opiate  for the
purpose of allaying the irritation and taking off the pains.
  And if the force of the expulsory power thrust down the uterus
so as to give danger of producing  a prolapse,  the practitioner must
support the organ during the recurrence of the pains, by introducing
two fingers into the vagina for this  purpose, and the patient must be
kept in a recumbent position without moving from it; and must be
instructed to avoid as much as  possible every ex.-ulsory or bearing-
down exertion, while the  pain  is upon her.   If the uterus have
actually protruded into the vagina, a reduction must be instantly
attempted;  and if this cannot be done, no time  should be  lost in
passing the band  through the cervix, as soon as, without force, it
can be sufficiently dilated for this purpose, and delivering the child
by turning.
  Laceration generally takes place suddenly, though, in irritable
habits, cramps or  other spasmodic affections  are often previously
complained  of in different parts of the body.  Mr. Burns has well
described the  symptoms that succeed-: " Wlien this accident does
happen, the woman feels something give way within her, and usually
suffers at that time an increase of pain.  The presentation disappears
more or less speedily, unless the head have fully entered the  pelvis,
or the uterus contract spasmodically on part of the child, as happen-
  Vol. IV.—S 
138
OENETICA,
|CL. V.—OR. III.
 ed in Bechling's patient.*   The pains go off as soon as the child
 passes  through the rent into the%bdomen : or if the presentation
 be fixed in the pelvis, they become irregular and gradually decline.
 The passage of the child into the abdominal cavity is attended with
 a sensation of strong motion of the belly, and is sometimes produc-
 tive of  convulsions."!
   It is not necessary to make a distinction between the parts in
 which the laceration takes  place:  for whether  it be in the fundus
 or cervix of the  womb, or in the vagina, except where, as just ob-
 served, the position  is fixed in the pelvis, the part presented in-
 stantly disappears,  and  the child  slips imperceptibly through the
 chasm into the hollow of the abdomen, sometimes with  a hemor-
 rhage that threatens life instantly, but sometimes with little or even
 no hemorrhage whatever.
   This accident will not unfrequently occur towards the close of a
 labour that promises fair.   It is not many  years ago, when the pre-
 sent author, at that  time engaged in this branch of the profession,
 was requested with all speed to attend, in consultation, upon  a lady
 in Wigmore Street, who was then  under the hands of a practitioner
 of considerable skill  and eminence.  She had  for about eight hours
 been in labour of her first child, herself about thirty-eight years of
 age,  had  had natural pains, and been cheered throughout with the
 prospect of doing well, and even more rapidly than usual under the
 circumstances of the case.   In fact the head had completly cleared
 the os uteri and was resting on the perinaeum, and the  obstetric
 practitioner was flattering  himself that in a quarter of an hour at
 the farthest, he should be released from his confinement, when he
 was surprised by a sudden retreat of the child during a pain which
 he expected would  have afforded her great  relief,  accompanied
 with an alarming flooding: and it was in this emergency the author
 of this work was requested to attend.  On examination, it was ascer-
 tained that a large laceration had taken place in the uterus  com-
 mencing at the cervix and apparently on the passing of the shoulders,
 but why any part of  it should have torn at this time rather than
 antecedently there were no means of determining. It is usual, under
 these circumstances, to follow up the child with the hand  through
 the rupture into the  abdomen, and to endeavour to lay hold of the
 feet,  and  withdraw it by turning.   The hemorrhage had  alarmed
 the practitioner, and this had not been attempted;  and  at  the time
 of the author's arrival, which was about an hour and a half after-
 wards, the attempt was too late, for the pulse  was rapidly sinking,
 the breathing  interrupted,  and  the countenance ghastly, yet the
 patient had not  totally lost her self-possession,  and being informed-
 of her situation, begged earnestly to be let alone, and to be suffered
to die in quiet.
  Where  there is little or no hemorrhage, the  life usually conti-
• Haller, Disput. torn. III. p. 477.
f Burns, ut supra, p. 362. 
GE. II.—SP. II.]
SEXUAL FUNCTION.
139
nues much longer whether the child be extracted or not; mostly
about twenty-four hours ;  though in some cases considerably longer
still.  Dr. Garthshore attended a patient who lived till the twenty-
sixth day, and the Copenhagen Transactions* contain the case of a
woman, who after being delivered, lingered for three months:  and
a few marvellous histories are given in the public collections, of a
natural healing of the uterus while the child continued as a foreign
and extra-fetal  substance  in the cavity of the abdomen for many
years.   Haller has reported a case  in which it continued in  this
state for nine years;!  and  others relate examples of its remaining
for sixteen,^ and even twenty-six years,§ or through the entire term
of the mother's natural life.
  The only rational hope of  saving both the mother and the child
is by following up the latter  through the rupture, and delivering it
by the feet: but where this  cannot  be done from the smallness of
the dilatation of the  os uteri, or from  a  violent  contraction of the
uterus between the os uteri and the rent, we have nothing to pro-
pose but to leave the event to nature, or  to extract the child by the
Cesarian operation.   We have just seen  that in a few rare instances
the vis  Medicatrix Naturae, or instinctive tendency to  health  has
succeeded in healing the  wound and restoring the patient with the
fetus still inhabiting the belly.  But this result is so little to be ex-
pected that an incision into the cavity of the abdomen has not un-
frequently been tried, and in some  instances unquestionably with
success.||
                       species in.

          PARODYNIA  SYMPATHETICA.

                   (Eomjrtfratrti Safcour.

LABOUR  RETARDED OR  HARASSED BY SYMPATHETIC DERANGEMENT
             OF SOME REMOTE ORGAN OR FUNCTION.

We have often had occasion to observe that, with the exception of
the stomach, there is no organ that holds such numerous ramifica-
tions of  sympathy with  other  organs as the womb: and we hence
• Tom. II. p. 326.
t Mem, de Paris. 1773.
* Eph. N»t. Cur. Dec. I. Ann. VIII. Obs. 12.
§ Id. Dec. II. Ann. VIII. Obs. 134.
|) ProgrSs de la Medicine, 1698. 12mo.
  Abbandlung der Konigl. Schwed. Acad. 1774.
  Hist, de l'Aca<J. Royale des Sciences, 1714. p. 29.1716, p. 32. 
140
GENETICA.
[CL. V.—OK. 111.
find the progress of parturition  disturbed, and what would other-
wise be a  natural, converted into a morbid labour by the interfer-
ence of various other parts of the body or the faculties which  ap-
pertain to them.  The whole family of varieties which issue from
this  source are extremely numerous: but the three following  are
the chief:

« Pathematica.                 Accompanied with terror or other
                                 mental emotion.
£ Syncopalis.                   Accompanied with fainting.
y Convulsiva.                  Accompanied with convulsions.

  In the pathematic variety, the joint emotions which are usually
operative upon a  patient's mind, and especially on the first labour,
are bashfulncss on the presence of her medical attendant, and ap-
prehension for her own safety.   There is not a practitioner in the
world but must have had numerous instances of a total suspension
of pains on his first  making his  appearance in the chamber.   And
in some cases the pains have been completely driven away for four
and twenty hours, or even o longer term.
  There is nothing extraordinary in this, for two powerful morbid
actions are seldom  found to proceed in the animal frame simulta-
neously ; and hence pregnancy is well known to put by phthisis, and
the severest pain of  a decayed tooth to yield to the dread of having
it extracted, while the patient is  on  his way to the operator's house.
  It is hence of great importance that the  bespoken attendant
should familiarize himself to his patient before his assistance is re-
quired, and endeavour to obtain her entire confidence: and  it is
better, when he is first ushered int,o  her presence, in his professional
capacity,  that  he should bay little upon the subject  of his visit,
direct  the conversation to some other topic of general  interest, and
then withdraw till he is wanted.  And if the idea alone of his ap-
proach be peculiarly harassing, it is best for him to be in a remote
part of the house in readiness, and not to  see bis  patient till  her
pains  have  taken so strong  a bold as to be beyond the control of
the fancy.
   If her apprehensions, however,  be very active, and if there be
any particular ground for them it is most reasonable to enter can-
didly on the question, and to afford her all  the consolation that can
be administered.
   Syncope in labour proceeds  commonly from a peculiar partici-
pation of the  stomach in the irritation of  the womb, and is hence
often connected with a  sense of nausea,  or  with vomiting.  Occa-
sionally it occurs also from the exhaustion produced by the violence
of the pains; and particularly in relaxed and  debilitated habits, in
which case the fainting fits sometimes follow up each other in very
rapid  succession, and require very close attention on the part of the
practitioner and  the patient's friends.
   The usual  remedies should here be had recourse to in the first. 
GE. II.—SP. III.]
SEXUAL FUNCTION.
141
instance:  pungent volatilcs should be  applied to the nostrils, the
patient be in a recumbent position, with the curtains undrawn, and,
unless the season of year prohibit, with the windows open ; the
face, and especially the forehead and temples, should be sprinkled
with cold  water or ether; and  the usual volatile fetids, aromatics,
and terebinthinates, as camphor, should be given by the mouth : and
to these, if necessary,  and ; articularly where the pulse is feeble
and fluttering, should be added a glass or two of Madeira, or any
other cordial wine, with twenty drops of laudanum.
  If this plan should not answer, and especially  if the fainting fits
should increase in duration and approximation  to each other, the
patient must be delivered by the process of turning as soon as ever
the os uteri is sufficiently dilated to let  the hand piss without force.
  One of the worst and most alarming  of the associated symptoms
in labour, is that of convulsions, and these are often connected
■with fainting-fits  and alternate with each other.   We have already
glanced at them  generally under syspasia convulsio,* but  must
dwell a little more at large upon the present modification.
   Convulsions  may occur during any period of gestation, but we
are now to consider them  as  an accompaniment of labour and as
interrupting its  progress.  Their proximate cause is a peculiar ir-
ritation of the nervous  system as participating  in the irritation of
the womb: and hence it is obvious that the radical and specific cure
is a termination of the labour.
   We cannot always trace the link of this peculiar influence of the
womb upon the nervous system : though, where there is a predis-
position to clonic spasm of any kind, we can readily account for its
excitement, and  may be under less apprehension than  where it
occurs without any such tendency.  The occasional causes of faint-
ing are the occasional causes  of convulsions; and hence  they are
apt to follow, and particularly in delicate or debilitated  constitu-
tions, on the fatigue and exhaustion of violent and protracted pains,
great depression of the animal spirits, and  profuse hemorrhage.
Sometimes, however, they occur where^none  of  these are present,
and where the patient  is of a  strong plethoric habit of body, and
especially if it be her first time of pregnancy : and are accompanied
with, or even preceded by a  sense of  dizziness and oppression in
the head,  ringing in the ears,  or imperfect vision : the plethora it-
self thus forming the occasional cause.
   The attendant symptoms are peculiarly violent, sometimes re-
sembling  those of hysteria, sometimes  those of epilepsy, but more
vehement than in either of these.   Nothing can restrain the spastic
force of a woman when in parturient convulsions, whatever be her
natural weakness.  The distortion of the countenance is more hide-
ous than the most extravagant imagination can conceive : and the
rapidity with which the eyes open and  shut,  the  sudden  twirlings
of the mouth, the foam that collects about the lips, the  peculiar
• Vol. III. p. 346. 
142
GENETIC A.
[CL. V.~OR. III.
 hiss that issues from them, the  stertor, the insensibility, and the
 jactitating struggle of the limbs, form a picture of agony that can-
 not be beheld without horror.
   The exciting cause is the irritable state of the womb; and, what-
 ever be  the predisponent  or occasional cause, whether a debilitated
 and mobile condition of the  nervous system, or a robust and entonic
 fulness of the blood-vessels, it is obvious that such violence of action
 cannot take place under any circumstances without endangering a
 rupture  of the vessels in  the bead, and consequently all  the mis-
 chiefs of apoplexy.  It is  against this, indeed, that all practitioners,
 how much soever they may  disagree upon  other points,  most cor-
 dially  endeavour to guard, though it rarely happens that effusion in
 the brain, and  some of its results, do  not take place in spite of all
 their exertions.
   The first step is to open a vein and  bleed copiously, from a large
 orifice, till the patient faints:  and if the operator be expert, the
 best vein to make choice of  is the jugular: the hair should be im-
 mediately removed from the  head, and lotions of cold water, pound-
 ed ice, or the  freezing  mixture,  produced by  dissolving three or
 four different sorts of neutral salts in water at the same time, be
 applied all over it by wetted  napkins, changed for others as soon as
 they acquire  the least degree of warmth.   At the same time a pur-
 gative injection should  be thrown up the rectum,  and  five or six
 grains of calomel be given by the mouth with a draught of sulphate
 of magnesia in infusion of senna.  The paroxysms must, if possible,
 be put a  stop to, the fatal effects they threaten must be anticipated,
"and not a moment is to be lost.
   This is the general plan; and it is to  be pursued under all circum-
 stances, though its extent, and particularly in regard to blood-letting,
 must be  regulated by the strength  and energy of the patient.  The
 local mode of treatment seems to be somewhat less decided.
   It may happen that at the attack of the fits, the os uteri is merely
 beginning to  open, or that it  is of  the diameter of a crown piece,
 but peculiarly rigid and undilatable.  There are practitioners who,
 in this case confine themselves to the depleting plan, and only wait
for the advance of the labour:  but in the state of  the uterus we
 are now  contemplating, they may have to wait for some hours be-
 fore the  labour is so  far advanced as to render them capable of
 affording any manual  assistance whatever, while the fits are, per-
 haps, recurring every quarter of an  hour, and threatening fatal
 mischief to \he brain.  And  in this case I cannot but warmly ap-
 prove of the  bolder, or rather  the more judicious  advice of Dr.
 Bland, who, after a due degree of depletion, recommends a full dose
of opium, for 'he purpose of allaying  the nervous irritation  gene-
rally, and particularly that of the uterus, which  is the punctum
saliens of the whole.   A few hours rest may set all to rights, if no
vessel have thus far given way in the head :  for when the next tide
of pains returns, it will commence under very different circumstan-
ces in consequence of the reducent course of medicine that has been 
ge. II.—SP. 111.]
SEXUAL FUNCTION.
143
pursued:  and it will  rarely be found that  the whole body of the
uterus is not rendered more lax and plastic,  and consequently its
cervix, and even the os externum, more yielding  and dilatable.
  But this is not the common course which the uterus takes under
these circumstances ;  for, in by far the greater number of cases, the
whole of this organ, the cervix as well as the fundus, is so exhaust-
ed in the general contest, as to be more than ordinarily relaxed and
flaccid, and  dilatable with  considerable ease:  insomuch  that if
the muscular power of the system were now concentrated in a com-
mon expulsory effort,  as in natural labours, the whole process would
terminate in a few minutes.  But unfortunately this muscular exer-
tion, instead of being concentrated, is distracted and erratic,  and
wandering over all the muscles and organs of the system,  produc-
ing general mischief instead of local benefit: so that whatever pains
there may be they are of far less use than in a state of harmonious
action.   This may be easily ascertained by introducing the hand on
a return of the paroxysm, when  the  uterus will  be found to con-
tract, indeed, but with a tremulous undetermined sort of force, per-
fectly different from what it does at any other time.
   The necessary practice in this case should seem to be obvious
and without doubt: the medical attendant seems imperatively called
upon to introduce  his hand into the os uteri, as  soon as it is suffi-
ciently open for him to do so without force, to  break the membranes
if not broken already, lay hold of the  child's  feet, deliver by turn-
ing, and thus put an  end to the convulsions at  once,  and, conse-
quently to the  fatal effects which seemed to  await the mother as
well as the child.
   Such was the practice recommended by Mauriceau, upwards of
a century since : La convulsion, says he, fait  souvent perir la mere
etl'enfant, silafemme«!'estfias firom/itementsecouruefiar /'accouche-
ment, qui est le meilleur remede, qu'on puisse apporter a Tune et
a l'autre.*  This recommendation was adopted   generally, and in
our own country successively  by Smellie, W. Hunter, and Lowder.
And although, in circumstances of so much danger, it was not and
could not be always successful, yet it was supposed, and  with  rea-
son, to be the means of saving the life as well of the mother as of
the child, in very numerous instances in which that of one or of both
would otherwise have unquestionably perished.   Some forty years
after the publications of M. Mauriceau's work, Professor Roederer of
 Goettingen called  this practice in question, and recommended that
 the patient be left to  the natural course of the labour :f and we are
 told by Dr. Denman  that in our own  country Dr. Ross, toward the
 close of last century, "wasthe first person of late years,  who had
 courage  to declare his doubt of the propriety of  speedy delivery in
 all cases of puerperal convulsions. The observation," continues Dr.
 Denman,"on which these doubts were founded,  was merely practi-
• Traits des Maladies des Feir.mes grosses.  Tom. I. 23. 4to. Paris, IT?:
f; Elementa Artis Obstetricjr, Aph. 679. Gnet, 1769. Sv.i. 
144
GENETICA.
[CL. V.—OR. III.
 cal, and the event of very many cases has since confirmed the jus-
 tice of his observation, both with respect to mothers and children.""
   The sweeping extent of this censure seems to show that the prac-
 tice has often been had recourse to  indiscriminately, and without a
 correct  limitation.  And the apparent occurrence of Dr. Denman
 in Dr. Ross's opinion, together with  the undecided manner in which
 he treats of the question in  his subsequent pages, has raised up
 amongst the most celebrated  obstetric physicians of our own day
 various  advocates for leaving in general  to nature the  case of la-
 bour accompanied with convulsions, or at least till the natural efforts
 of the mother are found completely  to fail; and in this last case, as
 the child's head may be supposed to have cleared the uterus, to
 have recourse to the perforator or the forceps, according to the na-
 ture of the position.
   The chief grounds for this proposed delay, as far as I have been
 able to collect them, are, that the introduction of the hand into the
 os internum, in the irritable state of the organ we are now contem-
plating,  is more calculated to renew the convulsions than to  put an
 end to them : that a repetition of them after due depiction has been
 employed is not so dangerous as is generally apprehended, and
 consequently that immediate delivery is  by no means  essential to
 the patient's safety: and lastly,  that we are not sure of  putting an
 end  to the convulsions, even after delivery is effected ; since it is
 well known that they  have occasionally continued, and  sometimes
 have not commenced till the process of labour has been long com-
 pleted.
   In reply to this, it  may  be  observed, that if a repetition of the
 convulsive fits be not so dangerous as is commonly apprehended,  a
 practitioner should feci less reluctance in introducing the hand even
 though he were sure of exciting a single fit by so  doing:  and the
 more so as this single fit might perhaps be the means of terminating
 the whole, and, consequently, would be a risk bought at a cheap rate.
 At the same time it should be observed that  general  experience
 does not seem to justify the remark that a cautious and scientific use
 of the  hand, where the mouth of the womb is sufficiently  dilated, be-
 comes a necessary or  even a frequent excitement of fresh parox-
 vsins; and the prediction of such an  effect is therefore without suf-
 ficient foundation.   And if there be a considerable chance, as seems
 to be admitted, that instrumental assistance will be lcquisite at last,
 and that the forceps, or what, in the probability of the child's being
 still a live is ten times  worse, the perforator must be called into ac-
 tion, how much more humane is it, as well as  scientific, to employ
 instrumental aid at first, and thus save the pain and the peril of per-
 haps many hours of suffering—and particularly when the soft, and
 supple, and plastic instrument of the hand, may supercede the use
 of the ruder, and rougher, and less manageable tools of  art.
   But the most important part of the question is as to the actual de-
* Practice of Midwifery, p. 586. 8vo. 3. edit. 1816. 
GE. II.—SP. III.]
SEXUAL FUNCTION.
445
gree of danger which is induced by convulsions ;  and to determine
this, nothing more seems necessary than to put the whole upon the
footing of an impending apoplexy. It is possible that no effusion in
the brain may have taken place at the time when  the depleting plan
has been carried  into execution, but  if the paroxysms should still
recur, surely few men can look at the violence of the struggle which
they induce, at the bloated and distended state of the vessels of the
face and of the temples,  at  the force with which  the current of
blood is determined to the head, at the stertor and comatose state
of the patient during the continuance of the fit, without feeling the
greatest alarm  at every return.  And that he does not  feel in vain
is clear, because in various  instances the insensibility continues
after the paroxysm is over, accompanies her through the  remain-
der of her labour, and is the harbinger of her death.
   Regarding puerperal convulsions  then as a case of impending
apoplexy produced  by an exciting cause which  it is often in our
power to remove, it should seem to follow as a necessary and in-
conlestible result, that in this,  as in every other case in which the
same disease is threatened, our first and unwearied attempt should
be to remove  such  cause  as  far as it may be in our  power, and
whenever it is so-
   It is not long since that the present  author's opinion was  request-
ed upon a case of this very kind; but it was by the connexions of
the patient who had already fallen a victim to her sufferings.  She
had been attacked with natural  labour-pains and was  attended by a
female, who, alarmed by the  sudden  incursion of a convulsion-fit,
sent immediately for male assistance.   The practitioner  arrived,
and a consultation was soon  held with  several  others: the os uteri
is admitted to have been at this time  open to the size of a crown-
piece, soft, lubricous, and dilatable.   The depleting and refrigerant
plan was,  however, confided in alone, and the  labour was  suffered
to take its course.   Expulsory pains followed at  intervals,  but the
convulsions  followed also, and  became more frequent and more ag-
gravated : in about  six hours from the  time of  venesection, the
patient  became permanently  insensible,  and  as  the  child's head,
completely cleared of the uterus, had now descended into  the pel-
vis, it  was  determined to deliver her by the forceps,  which was
applied accordingly ;  and in about an hour afterwards a dead child
was brought into  the  world, whose  appearance sufficiently proved
that it had not been dead long.
   The source of irritation  had now ceased, and with it the convul-
sions, but the patient continued comatose still: yet even this effect
went off in seven hours afterwards, and she revived, and gave con-
siderable hopes of recovery.   On the second day,  however, in con-
sequence of the accession of milk-fever,  the convulsions returned|
immediately followed with stertor and insensibility, and on the ensu-
ing day she died apoplectic
 .  To reason from  a single.instance, whether successful or unsuc-
cessful, is often to reason wrong.'  Yet it is" difficult  to avoid con-
  Vor.. IV.—T 
14b
GENET1CA.
[CL. V.—OR. Ill
jecturing that if immediate delivery had here taken place as soon
as the sanguiferous system had been duly emptied, and when the
state of the uterus was  so favourable for a trial, two lives  might
have been spared, both of which were lost  under the course pur-
sued.  It is true the fits returned with the milk-fever, but had the
brain been less injured, there would have been far less danger of
such return.  The cases of Dr. Smellie and of Dr. Perfect concur
in justifying such a conjecture; and the following passage of Mr.
Burns should be committed to memory by every student, and every
practitioner.  " But this is not all," adverting to the necessity of a
free depletion, " for the patient is suffering from a disease connect-
ed with the state of the uterus, and the state is got rid of by  termi-
nating the labour.  Even when  convulsions take place very early
in labour,  the os uteri is generally opened to a certain degree, and
the detraction of blood which has been resorted to  on the first at-
tack of the disease, renders the os uteri usually lax and dilatable.
In this case, although we have no  distinct labour pains, we must
introduce  the hand,  and slowly dilate it, and deliver the child.   I
entirely agree with those who are  against forcibly  opening  th e os
uteri: but I also agree with those who advise the  woman to be de-
livered as soon as we can possibly do  it  without violence.   There-
is, I am convinced, no  rule of  practice more plain or beneficial.
Delivery does not, indeed, always save the patient, or even prevent
the recurrence  of the  fits, but it  does  not thence follow that it
ought not to be adopted."*
                       SPECIES IV.

              PARODYNIA PERVERSA.

                        (HrroisjMnrtft.

LABOUR impeded by preternatural presentation of the FETl/S
                      OR ITS MEMBRANES.

In the ordinary course of gestation the fetus is rolled up into  as
small a compass as possible, with  the breast;uppermost,  and the
head dependent, the legs incuryated and the arms folded :  the pla-
centa rises from some  part of the fundus, and the umbilical  cord
hangs at perfect ease in loose folds,  or is sometimes turned loosely
round the body: thus forming an ellipse whose longer axis corres-
ponds to the longer axis of the uterus.   Why the head rather than
the breast, or indeed any other part of the fetus should so uniformly
  ■■ *.   »-----------------------———------------------.-------------____________________«»_
         • Principlei of Midwifery, p. 359. 3d edit. 8vo. 1811. 
GE. II.—SP. IV.]
SEXUAL FUNCTION.
147
constitute the point of presentation, we know not, excepting that
it is by far the most commodious point for delivery:  and we can
hence only  resolve it into one of those striking laws  of nature
which are ever aiming at  accomplishing the  best ends by the best
means, and  afford an unvarying and  unequivocal proof of design
united with benevolence and power.
  Here,  however, as in every other part of the animal economy,
we  meet  with occasional deviations from the ordinary course of na<-
ture, and deviations which are  always productive of evil.  For it
sometimes happens, from incidental causes that are totally conceal-
ed from us,  that some other part of the child is lowermost or pre-
sents itself instead of the head: or that the placenta rises in an un-
favourable part of the womb, or that  the navel-string  hangs down
below the head and is constantly in danger of being strangled as the
child passes through the sharp  bones  of the pelvis: and hence we
have the  following varieties of morbid condition offering themselves
to us under  the present species:

« Faciei.                  Presentation of the face.
• Natium.                 Presentation of the breech.
y Pedis.                    Presentation of one or both feet.
^Brachialis.               Presentation of one or both arms.
e Transversalis.            Presentation of the shoulder.
£ Funis prolapsi.            Prolapsed navel-string.
v Placentae.                 Presentation of the placenta.
  As it is by no means the object of the present work to instruct in
the manual or artificial operations of the obstetric art, the author
must limit himself to pointing out the different morbid  conditions
in which  such operations will be  found necessary.  Their nature,
mode of  accomplishment, and effective instruments, are only to be
learnt by works written professedly on this subject, or, which is in-
finitely better,  by an attendance  on lectures, and such initiatory
practice as the obstetric schools afford.  A few general or inciden-
tal  remarks are all that the author can undertake to add to the
above table of morbid presentations.
  There  is no mode of  determining  what may be the  presentation
of a child before  the commencement of labour, and  even at that
time it is most prudent for a practitioner to speak with some hesi-
tation on the subject till the membranes have actually  broken, and
the position  is fully decided.   For though the real presentation is
often sufficiently ascertainable through the membranes themselves,
and particularly on the natural descent of the head, yet it has occa-
sionally happened that, on the breaking of the membranes, the head
has receded and the shoulder or some other  part taken its place ;
and there are  cases  in which the opposite and more  fortunate
change has  occurred of a recession of a presenting shoulder and a
descent of the head in its stead.*
• Joerg, Hist. Part. p. 90.
 Burns, ut »upra, p. 292. 
148
GENETIC A.
[CL. V—OR. I1L
   There is hence no foundation for those apprehensions which  are
often entertained by pregnant women respecting the misposition of
the child drawn from some peculiar symptom or feeling which  she
has never been conscious of on former times, as a singularity in  the
shape of the abdomen, a sense of  the  child's  rising  suddenly to-
wards the stomach, or a numb or painful uneasiness in one leg more
than in another.   These, and hundreds of other anomalous  sensa-
tions have occurred in cases where the presentation has at last been
found natural, and the labour has proved highly favourable; while
on the contrary it is very rarely, when a cross birth is detected, that
it has been  particularly apprehended  by any procursive tokens
whatever.  And the mind of the timid  may hence be  comforted in
the midst of  all  the peculiarities on which they are accustomed to
hang with daily alarm.
   It will rarely be found necessary to have recourse to any mecha-
nical  instrument in any of the varieties we have  enumerated above :
and in some of them, as the breech and foot presentations,  the  ex-
pulsory powers of nature alone are found sufficient,  at least till  the
head descends into the pelvis :  at which time  it will be found  ne-
cessary, whenever the arms lie over the head, to introduce a finger
or two and gently draw  them down.
   Where the face presents, or any other part of the head than  the
vertex, it was formerly the custom to deliver by  turning, but a
skilful practitioner of the present day is commonly able, by a dex-
trous pressure of one or two fingers against  particular parts of  the
head, and particularly,  if attempted in an early stage of labour, to
give the organ a right direction  without introducing the hand.
   On the presentation, however, of a shoulder or  of one or both arms,
it will be expedient to turn  as soon as possible;  or, in other words,
as soon as .he mouth of the womb is sufficiently  dilated for this pur-
pose.  It is singular that, while under the old practice, delivery by
the feet was often  endeavoured in face-cases, attempts were made
in arm and shoulder-cases to bring  down the head and reduce the
labour to a natural course.  This it seems has been done, and may
be done,  but with so much fatigue and  exhaustion to the patient as
to run the risk of  incapacitating her for any subsequent efforts, if
she do even  not fall a sacrifice to a flooding as in a case related  by
Dr. Smellie.   It is to the successful exertions of Pare and Mauri-
ceau  that the better practice of the  present day has obtained a
triumph over all Europe.  Yet, in justice to the obstetric  practi-
tioners of ancient Greece, it should be  observed, that  the  modern
method is little more than a revival of their own which unaccountably
sunk into disfavour ;  for we are  told by jElius, that Philomeles dis-
covered the  method, at that lime in common use, of turning and
delivering  children  by the feet  in  all unnatural  presentations.
Where, however, the child is small or  of premature birth,  it may
sometimes be taken away without  changing the presentation :  for
the obstetric  writers abound in examples of delivery effected under 
GE. II—SP. IV]
SEXUAL FUNCTION.
149
such circumstances by pulling down the arm and drawing the bead
into the vagina.*
  It  sometimes happens that the shoulder is so far advanced into
the pelvis before the arrival of the practitioner, or from the vehe-
ment force of the uterus,  that it is impossible to raise or move the
child by the utmost power of the operator :  and the state  of the
case seems to  leave the woman without any hope of relief. At
this very moment, however, and by these very  means  the wise and
benevolent law  of instinct or of nature  is interposing to the relief
that is  despaired of.   This wonderful process,  though occasionally
noticed by earlier writers, and  foremost of all perhaps by Schoen-
hcider, in the Copenhagen Transactions,t was first fully illusirated
and explained by  Dr. Denman, who distinguished it by the name of
a spontaneous evolution.   His explanation  is best given in his
own words: "As  to the manner in which this evolution takes place,
I presume that  after the long continued action of the uterus, the body
of the child  is brought into such a compacted state,  as to receive
the full force of every returning action.  The body in its doubled
state being too large to  pass through  the pelvis, and  the  uterus
pressing  upon its  inferior  extremities, which  are the  only parts
capable  of being  moved,  the  latter are forced gradually lower,
making room as they are pressed down, for the reception of some
other part into the cavity of the uterus which they have evacuated,
till,  the body turning as  it  were upon its own axis, the breech of
the child is expelled, as  in an original presentation  of that part:
and consequently  is delivered  by nature at the  time  she  least ex-
pected it."  Dr. J. Hamilton, however, has justly observed that
this evolution  can  only take place where the action of the uterus
can produce no exertion on the presenting part,  or where that part
is so shaped that it cannot be wedged in the pelvis: and he might
have added where  the woman is in full strength and  the  uterus is
capable of exercising a strong expulsory power.   And hence, it is
a chance that  should never be trusted to or suffered to interfere
with the common practice of delivering by the feet wherever this
can be accomplished.
   In all the above cases  it  is a general rule and one of great im-
portance,  to suffer the  water of the amnios to accumulate towards
the neck  of the womb as largely as possible, and to leave the mem-
branes unbroken as long as may be.
   A presentation of the funis is another difficulty often of conside-
 rable moment  in the progress of labour: for it is obvious that by a
 check to the pulsation, either actually taking place or being greatly
 endangered in every pain by the violent pressure of the head or of
 any other part  against the mouth of the uterus, or afterwards against
• Gardner, Med. Comment. Vol. V. 307.
 Bandelocque, Sect. 1530.
 Burns, ut supra, 303.
J Act. Havn. torn. II. Art. XXIII. 
150
GENETICA.
[CL. V.—OR. III.
the sides of the pelvis, and consequently against the funis itself, the
life of the child is in imminent hazard, and without the exercise  of
considerable skill, may inevitably be lost.   If it be possible to return
the prolapsed part of the  funis round the head  as it is descending,
or to hook it against the  band or some other part so as to keep it
Clear of pressure, this ought to be done by all means.  But if this
be possible the child must be turned, as soon as turning be practi-
cable from the dilated state of the os internum : or if the head should
have reached the pelvis before the accident takes place, the  labour
must be accelerated by the patient's using her utmost  efforts dur-
ing every pain;  and, if she be too much  exhausted for  concentrat-
ing her strength, it must  be quickened by  the use of the forceps.
But  if the pulsation in  the chord have already ceased, and we have
hereby a proof  that the child is dead already,  the labour is to be
suffered to take its natural course.
  It sometimes happens, however, that after the child is turned and
the head does not follow the body so speedily as  could be wished
from  the patient's being  greatly exhausted—and the  same  fre-
quently occurs in breech  cases,  in consequence of the  protracted
length of the labour in this presentation—there is still a considera-
ble danger to the navel string, from its pressure between the child's
head  and the pelvis.   This should be remedied as much as possible
by giving the funis full play between the pains.  But it frequently
occurs in spite  of the utmost caution, that the pulsation is sus-
spended, and the child  is born in a state of asphyxy, and apparently
lifeless.
  The common  practice  in this case  is  to tie  the navel string as
quickly as possible, remove the child from the mother to the warmth
of the fire-place, and endeavour to stimulate the lungs into action
by breathing forcibly into  the mouth while the nostrils are closed.
Friction with a warm hand, and with a conjoint aid of some pungent
volatile is at the  same time applied actively to the chest; and if this
do not succeed the nostrils  are attempted to be roused with ammonia,
or the fauces with a tea-spoonful of brandy and hot water, to  excite
sneezing or coughing.   All this is well;  but there is a  great and,
I am afraid, not unfrequently a  fatal  error in  thus separating the
navel string  and removing the child from  the  mother.   While  it
continues united it has two chances of recovery, that of the  action
of the lungs and that of the re-action of the umbilical artery.  By
removing it  from the mother we allow it but one chance, and that,
in my opinion, the feeblest.  The  expansion of the lungs  is alto-
gether a new  process, and, like other new processes,  does not
always take  place with great promptness,  even where the child  is
in full life and vigour, and  the umbilical artery in regular pulsation;
for it is  sometimes half a minute or double this  time before the
child begins to cry, which  is the first proof of its respiring. But the
flow  of the  blood through the  umbilical artery is an  established
habit, and like all other habits, has a powerful tendency to recur  if
we give it time and favour; and must derive an additional tendency. 
GE. II.—SP. IV.]       SEXUAL FUNCTION.
151
from the stimulus of the posterior placental vessels which are still
pulsating and operating with a vis a tergo.   Of the various cases of
asphyxy on birth which I have witnessed, by far the greater num-
ber have proved fatal when treated in the former way, and success-
ful when treated in the latter: and the explanation here given will
readily account for the difference.
  The placenta itself may, also, form a preternatural presentation,
and add much to the difficulty, and the danger of labour.  We have
said that this rises ordinarily from some part of the fundus of the
uterus, though it may originate from its sides, or from some other
quarter, for there is no quarter of the womb which may not become
its source.   Hence it occasionally takes its rise more or less  over
the mouth of the womb; and while this part of the womb continues
quiescent, it produces no more inconvenience there than any where
else.  But the moment labour commences, or even, in the latter
months of parturition, when any cause whatever irritates the mouth
of the womb, and  in any degree puts it upon  the stretch, some of
the placental vessels must necessarily become ruptured and a he-
morrhage ensue.   So long as this is small in quantity, and does not
frequently return, it will be sufficient to enjoin quiet, a recumbent
position, and that the bed be not heated with a profusion of blankets.
But if the hemorrhage be considerable, whether before the full time
of labour, or on its accession or in any part of it, there is no perfect
safety but in delivery, and hereby giving the ruptured vessels an
opportunity of closing their mouths.  The difficulty is less than a
young practitioner might at first  expect:  for he may be sure,  from
the hemorrhage itself,  that the os uteri is both  dilated and dilatable,
for if this did not give way neither  would the vessels which  pro-
duce  the hemorrhage.
                       SPECIES  V.

             PARODYNIA AMORPHICA.

                  RmpracttcaWe JUimur,

LABOUR IMPEDED BY MIS-CONFIGURATION OF THE FETUS, OR, OF THK
                      MATERNAL PELVIS.

In natural labour the size of the head  is adapted to the diameter o?
the pelvis it has to pass through: in  some children, indeed, tie
head is rather larger  than in others, or has a difference of shape;
and we  meet with a like difference in  the area of the pelvis: and
these circumstances may prolong the labour, though the expulsory
powers of the mother will ultimately triumpth  over the resistance.
  But it unfortunately happens that the head is sometimes so en 
152
GENETLCA.
tCL. V.—OK. III.
larged by monstrosity of structure, hydrops capitis, or some other
disease, or that the maternal pelvis is so deformed in its make, that
the child cannot pass through the  passage, and delivery becomes
altogether impracticable.
  There is,  however,  an intermediate state between the natural
size of the pelvis with a head of a natural size applied to it, and
that of absolute impracticability from the utter inaccordance of the
head to the opening; in which,  though the most  violent and  best
directed pains of the mother may not be sufficient to produce ex-
pulsion, this object may be effected by ihe assistance of instruments
co-operating  with  the natural efforts.
  What  space of pelvis is absolutely necessary to enable a living
child, at its full time, to pass through it, has not been  very accu-
rately settled  by obstetric writers, some maintaining that  this cannot
take place where the conjugate diameter is less than two inches and
a half, though it may till we reach this degree of narrowness; and
others that it cannot take effect under three inches. The difference
in the size of the head in different  children on their birth,  and  of
the thickness of the soft parts within the pelvis in different women
may easily account for this variation in the rule laid down.   It is
clear, however, from the acknowledgment  of both parties,  that if
the dimensions of the pelvis be  much under three inches, delivery
cannot be accomplished without the loss of the child: and it is also
clear that if the head be  much enlarged beyond  the natural  size
from any cause whatever, it cannot pass even through the ordinary
dimensions, thus giving  us the two  following sources or varieties
of difficult labour from an amorphous cause.
«. A fetu.          The fetus deformed by a preternatural magni-
                     tude of head, or some other morbid protube-
                     rance.
2 Pelvica.          The pelvis contracted in its diameter by natural
                     deformity, or subsequent disease or injury.
  It is by no means easy to determine what is the actual measure-
ment of the hollow of the pelvis in a living woman, and particularly
during the time of labour : and hence, how useful soever it may be
to be acquainted with what ought to be its precise capacity as taken
under other circumstances, the judgment must chiefly determine as
to the practicability or impracticability of the passage from a calm
attention to the individual case at the time, and particularly where
the difficulty  proceeds from the form of the child rather than from
that of the mother. If, in  well weighing the  circumstances, the
question remain doubtful, the patient should be allowed  to proceed
with her natural exertions alone,  or such  only in addition as the
hands may be able to afford, till the  strength is considerably ex-
hausted,  and  the mind  participates  in the depression of the body.
And if at this time, as will probably be the case, the head has de-
scended so low as  to be in contact  with the perinacum,  and an ear
can be felt, it would be imprudent to delay any longer assisting he?
with the vectis or the forceps. 
UE. 11.—SP. V.i
SKXUAL FUNCTION.
153
   But the case may not be doubtful,  and the passage may be so
 much contracted as to render all attempts to accomplish the deli-
 very by the hands,  or  the ordinary instruments, totally ineffectual
 from the first.   In this situation other means must be resorted to,
 or the mother and the  child must both perish, worn out by fatigue
 and perhaps rendered gangrenous in the points of contact from
 irritation and inflammation.
   The means that present themselves to the practitioner on this
 occasion are the three  following:  He may reduce the head of the
 child by the crotchet  or perforator.   He may, in a small degree,
 enlarge the diameter of the  pelvis by dividing the symphysis pubis.
 Or, he may make a section through the abdomen into the uterus.
  The first of these methods is designed to save the mother by a
 voluntary sacrifice of the child.  The two last give a chance to the
 child, but at an imminent hazard of the mother.
   Where the difficulty proceeds from a morbid enlargement of the
 child's  head, the question as to which of these three methods of
 treatment  should be adopted,  ought  not to  admit of a moment's
 debate.  The child is, perhaps, dead already, or, if  not, it is not
 likely that it would long survive the deformity it labours  under, or
 live so as to render life a blessing: and the life  of a sound woman
 must not be risked, and still less sacrificed, for the chance of saving
 an unsound child.  The head,  therefore,  ought  to be diminished,
 and consequently the perforator to be  had recourse to.
  But there are instances of a deformity of the pelvis so  consider-
 able as that the perforator cannot be employed  to any advantage: for
 how much soever the cranium may have been broken down, there
 may not be breadth enough  to extract the child  in any way.  And
this will always be the  case where the range of the pelvis is under
an inch and a half from the pubis to the sacrum, or on either side.
Dr. Osborn asserts that he once succeeded in removing a child by
means of the crotchet, in a case  where the widest side of the pelvis
was only an inch and three quarters broad, and not more  than two
inches long:* which is a capacity so narrow as to  throw some doubt
upon the accuracy of the measurement in the  minds of many prac-
titioners,t and certainly so narrow as  to form an unparalleled case
in the annals of the obstetric art.
  In situations, therefore, of  this kind, some other plan  must be
pursued even to save the  life of the  mother; and the only plans
that can even be  thought of, are that of dividing the symphysis of
the pubis, and that of the Cesarean section.
  Towards the latter months  of pregnancy there  seems to be a dis-
position in the bones of the pelvis  to separate at their symphysis,
insomuch that some pregnant women  are sensible of a motion at
the junction of  the bones, especially at that of the  ossa pubis.J
         •  Osborn's Essays, p. 203.
         f  Burn's Princ. of Midwifery, p. 351.
         +  Denmaa. Pract. of Midwiferv, p. 46. 446.
Vol. IV.—U 
154
GUNETICA.
[CL. V.—OR. 1H«
This has been known to anatomists for some centuries, and  about
seventy years ago,foi;the first time, gave rise to a question whether
advantage might not be taken of this  tendency in cases of pelvic
contractions, to enlarge the space by dividing the ossa pubis at their
symphysis, and thus  obtain the same end as is  answered by the
Cesarean  section,  with a considerable diminution of risk.   The
operation seems first of all to have been proposed by M. Louis, of
the French Academy of Surgery, to Professor Camper of Groningen,
who tried it first on a dead female body, and found it would afford
space, and next on a living pig, which for  some days afterwards,
was incapable either of walking or standing, but in a few weeks per-
fectly recovered.   He was then desirous of trying it upon a young
woman condemned to death  at Groningen, but did not succeed in
his request.   Not long afterwards, however, it was performed with
complete success by M. Sigault of Paris, upon the wife of a soldier
who had  hitherto  borne  four children, each of  which, from the
mother's misformation, was  obliged  to be extracted piece-meal.
The section of the cartilage connecting the ossa pubis enabled the
bones to be separated, according to his account, by a chasm of two
inches and a half; and yielded a free passage to the child in four
mmutes and a  half.   The wife, with  her husband and child, a few
weeks afterwards, presented themselves  to  the  members of the
faculty assembled in their hall.   The patient  walked  steadily, and
•was  found to  be  perfectly recovered.*  Mr. Le Roy, who was
requested to attend on the occasion, tells us that the same operation
■was afterwards performed by two other practitioners, on two other
women, and in both cases with an equally happy termination.   He
also observes, that although in an unimpregnated state, the bones
of the  pelvis cannot  be made to separate  upon a division of the
symphysis to a space of more than an inch, which would be insuffi-
cient for the purpose proposed, the additional softness and flaccidity
which  take place during pregnancy, as well in the bones and car-
tilages as in the muscles is so considerable, that a separation of two
inches and a half may be easily effected in  labour, and was effected
in the above cases, while the  same bistoury that divided the soft
parts, easily also divided the  cartilage.f  In various other parts of
the Continent, and especially at Mons and in Holland, it has been
repeated with  complete emancipation both to the child and mother.
Dr. J.  H.  Myers, who witnessed it at Paris, speaks of it  in the
highest terms of commendation.  He says that the length of the
incision does not exceed three inches, and that the whole operation
is over in less than five minutes: while in the Cesarean operation
the wound is  necessarily more than nine  inches  long, the uterus
is divided, and the  surrounding viscera are uncovered.  " I have
seen," says  Dr. Myers,  "the operation twice performed in this
  •  Med. Comm. Edin. Vol. V. p. 214.
  t  Recherches Historiques et  Partiques sur la Section de la Sympbyse du
Pubis, &c. Paris. 8vo. 1778. 
GE. II.—SP. V.]         SEXUAL FUNCTION.                  155

capital with every possible success.  The last patient, while I am
writing, is in the room, coming to show herself in justice to her
operator.  It is only eighteen  days since the operation was perform-
ed, and  she is in perfect health, and by no means injured by it."*
   The operation, however, has been  decried, and, in some instan-
ces,  has certainly  failed;  but there appears  to be some doubt
whether, in  several of these cases at least, if not in all, it was con-
ducted with a sufficient degree of dexterity and skill: for when we
are told by one operator that, after the division of the symphysis, be
could not effect an opening of much more than a finger's breadth,
and by another, that the utmost extent of the hiatus was not more
than  an  inch and a half, and compare these remarks with the fol-
lowing assertion of Dr. Myers upon  this very point, it is difficult
to come to any other  conclusion.  "The moment," says he, "the
division is made, there is an  enlargement of the pelvis, I venture
to say, to any extent desired; the last I saw was three inches, ac-
curately measured by an instrument called fielvimetre, contrived by
Mr. Trainel."   To which we may add that M. de Lambon perform-
ed the operation twice on the same patient; in the first instance,
without injury to the  mother, and in  the  second, with  success to
both mother and child !f
   After these decisive facts in its favour, to which the reader may add
others from the volume of Nosology, I cannot but conceive that the
prejudice against it, in our own country, has been  carried  too far.
One experiment alone has been made amongst ourselves, and that
with an unsuccessful  issue.   But the chief opposition to it seems to
have proceeded from the discountenance of Dr. Denman, added to
certain experiments made in  relation to it by Dr. William Hunter,
which do not seem to have  been conducted  under  circumstances
that can fairly call in  question the  truth  of the preceding stater
ments.
   "Immediately," says Dr.  Denman, "after the accounts of the
operation were  brought into  this  country, wishing, as a matter of
duty, to understand the ground of the subject, I had a conference
with  the late Mr. John  Hunter, in which we considered its first
principle, its safety ; and after the most serious consideration it was
agreed that, if the utility could be proved, there appeared from the
structure of the parts, or from the injury they were likely to sustain
by the mere section of the symphysis, no sufficient objection  against
performing  it.  Of its real  utility  it was, however, impossible to
decide before many experiments bad been made on the dead body,
to ascertain  the degree of enlargement of the capacity of the pelvis,
well-formed or distorted, which would be  thereby obtained.   Such
experiments were soon  made: and their result published by the
late Dr. Hunter; and these  proved, on the whole, that in extreme
or great degrees of  distortion of the pelvis, the advantage to be
* Edin. Med. Comment. Vol. VII. p. 453.
r Leake's Practical Observations on the acute Diseases of Women, 8vo. 
15b
GExNETlCA.
[CL. V.—OK. HI.
gained was wholly insufficient to allow the head of the child to pass
without lessening its bulk : and in small degrees of distortion that
the operation was unnecessary,  such cases  admitting  of  relief by
less desperate methods.  They  proved, moreover, that irreparable
injury would be done by attempts to increase the  common advan-
tages gained by the section of the symphysis by straining  or tear-
ing asunder the ligaments which  connect the ossa innominata to
the sacrum, and to the  soft  parts contained in the pelvis,  particu-
larly to the bladder."*
  Now it did not  require these experiments to prote that this ope-
ration, or almost any other, would become mischievous if unskil-
fully performed, but surely it was something too much to endeavour
to set aside the facts and  results known to have taken place in very
numerous instances in the living body, and  to call in  question the
veracity of those who made them, and those who witnessed them,
by facts and results made merely on the dead body,  without one
single experiment on the body while alive and in the  peculiar cir-
cumstances under which  alone it is  admitted that  the  facts and re-
sults contended for  could possibly take place.
  Upon the whole it is allowed in  the passage just quoted, as the
concurrent opinion of Dr. Denman himself, Mr. John  Hunter, and
apparently Dr.  William Hunter, and this too after " the  most se-
rious consideration,"—that " there appears  from the  structure of
the parts or from  the injury they are likely to sustain,  by the mere
section of the symphysis  no sufficient objection against performing
the operation."  That  it will answer in every degree of a con-
tracted pelvis was never asserted  by its  most sanguine advocates,
but only in cases  where the constriction  was somewhat too consi-
derable to  allow  of the  extraction  of the  child by the  forceps.
And lastly, it is, after all  admitted by Dr.  Denman himself, that
where the life of a child is  of more  than ordinary importance from
public or other considerations,  and  the  mother  who  is in labour
with it possesses a pelvis so deformed and contracted, that it cannot
pass through the passage in its present state, " there the section of
the symphysis of the ossa pubis might be proposed and performed,
—being less horrid to the woman than the Cesarean operation, and
instead of adding  to the danger, giving some chance of preserving
the life of the child."t
  It is perfectly clear however, that, be  the advantages of dividing
the symphysis  what they may, when the pelvis is under certain
states of deformity,  it is an operation that can never be of any avail
where the passage is so  narrow that the child cannot be brought
away piece-meal even by  the use of the perforator.  And in such
circumstances the only alternative is to leave the patient to nature,
in the slender and desperate hope  that  the pains may gradually
Wear away  as the  parts become  habituated lo the irritation, and the
child, as in many  cases of extra-uterine  fetation, be thrown out in
* Denman's Practice, &c. 447.
f Denman, ut supr. 449. 
GE. II.—SP. V.]       SEXUAL FUNCTION.                   15?

detached fragments by an abscess ; or to have recourse to what has
been called the Cesarean operation, and deliver by  making a sec-
tion into the uterus through the abdomen.
   The love of offspring, or a sense of duty, has been so prevalent
in some women as to induce them to submit to this severe trial in
cases where the pelvis has by no means been  so straitened as we
are now contemplating.  And these motives not being confined to
any particular age, the operation is of considerable antiquity, and is
particularly noticed by the elder Pliny, who tells us  that the  elder
Scipio Africanus, and the first of the Cesars were brought into the
world in this manner, and adds, that the name of Cesar was hence
derived, "a caso matris utero."*  In recent times, one of the ear-
liest cases in which it was submitted to was that  of the wife of a
cattle-gelder at Siegen-hausen in Germany, in the beginning of the
sixteenth century. The child, it seems, was from its  size, supposed
to be incapable of being expelled in the natural way, and the ope-
ration was  performed by the cattle-gelder himself.   Barehin, in his
Appendix  to Rousset,  who was a warm supporter of the practice,
and wrote  in favour of it in 1581, tells us that this woman did
well,  and  bore  several  children afterwards in the natural  way.
There are  a few other instances related of its having been executed
by lay hands, and with equal success : particularly one performed
in Ireland  by an  uninstructed midwife whose  instrument was a
razor.   The case is related by Mr. Duncan Stewart, in the Edin-
burgh Medical Essays,!  who saw the woman a few  days after the
operation.   She was well in  about a month.  Among regular prac-
titioners, however, it has  been generally opposed on account of its
very doubtful result, from the time of Pare and Guillemeau, who
warmly resisted its employment.  Dr. Hull not long since made a
collection of all the cases in which the operation had been peformed
both at home and  abroad, and calculated them at 231, of which 139,
being considerably more than half, had  proved  successful.J   The
German collections, indeed,  give  various examples  of its having
been repeated several times on the same person: and M.  Trestan
narrates the extraordinary history of one woman who had submitted
to it not fewer than seven times.§   One of the latest examples is,
I  believe, the case furnished by Dr.  Locker of Zurich, and pub-
lished in a late volume of the Transactions of the Medico-Chirur-
gical Society : in  which the mother and child were  both  happily
preserved.!!
   Under this view of the subject it is singular to observe the gene*
ral fatality,  at least to the  mother, with which the Cesarean section
• Hist. Nat. Lib. VII. cap. is.
f Vol. V. p. 360.
t Translation of M. Bandeloque's Memoir, p. 231
§ Journ. de Medicine, lorn. XXXVI. p. 69.
J Vol. IX. p. 11. 
158
GENETIC A.
[CL. V—OR. Hi
has been followed in our own country.   " There are, I think," says
Mr. Burns, " histories of twenty cases where this operation has been
performed in Britain : out of these only one woman has been saved,
but ten children have been preserved."*
   At Edinburgh, Mr Hamilton remarks,!  that  it had been per-
formed five  times at the date of his publication :  and that in no in-
stance had the patient the good  fortune to survive it many days. Of
the last case he was an eye witness, and it was only resorted to after
every other  means had proved ineffectual; the child was saved,but
the mother survived only six  and twenty hours.   This  ingenious
writer enters wrh great pertinence into the question to what cause
so general a failure is to be ascribed.  And  while he admits that
nervous or uterine irritation from cutting, internal hemorrhage, or
an extravasation into the cavity of the abdomen may each have an
influence ; he is disposed to think that its unsuccess is principally
to be imputed to the effect which access of air is well known to have
on viscera exposed and in a state  of irritation.  Dr. Monro repeat-
edly found that,  in making even a large  aperture  by incision into
the abdomen of animals, if the wound be quickly  closed the animal
readily recovers : but that, if the viscera  be exposed for only a few
minutes to the air, severe pains and fatal  convulsions ensue.  And
hence  Mr. Hamilton most warmly exhorts that, in performing the
Cesarean operation, the bowels be denuded as little as possible, and
the wound be closed with the utmost expedition.
  This answer,  however, is hardly satisfactory :  and I am rathef
inclined to think that the comparative  want of  success at home is
owing  to the greater reluctance in performing  the operation  than
seems  to be manifested in France and Germany, in consequence of
which  it is rarely determined  upon till the woman is too far ex-
hausted, and has an insufficiency of vigour to enable the wounded
parts to assume  a healing condition. In most of the cases recorded,
there does not seem to have been  any deficiency of skill; and  par-
ticularly in that which occurred about five and thirty years since,
and was attented by Mr. John Hunter and Dr. Ford,! and hence the
unfavourable issue must be resolved into some other cause.
  It is happy for the world, and peculiarly  so for those  who arc
possessed  of a contracted pelvis, and in many cases without knowing
it till they are in labour, that a far safer, and less  painful  operation
may be had recourse to, where the deformity is known in due time,
I mean that of a premature delivery.  " A great number of in-
stances have occurred," says Dr. Denman, "of women so formed
that it  was not possible for them to bring forth a living child at the
termination  of nine  months, who have, in my own practice, been
blessed with living children by the accidental coming on of labour,
when they were only seven months advanced in their pregnancy, or
* Princip. ut supr. p. 348.
f Elements of the Practice of Midwifery, 8vo,
t Denman, ut supr. p. 463.        S 
GE. II.—SP. V.]        SEXUAL FUNCTION.
159
several weeks before their due time. But the first account of any ar-
tificial method of bringing on premature labour was given to me by
Dr. C. Kelly.  He informed me that about the year 1756, there was
a consultation of the most eminent men at that time in London to
consider of the moral rectitude of, and advantages which might be
expected from, this practice ;  which met with their general ap-
probation.  The first case in which it  was deemed necessary and
proper fell under the care of the late Dr. Macaulay, and it termi-
nated successfully.  The patient was the wife of a linen-draper in
the Strand.  Dr. Kelly informed me that he himself had practised
it;  and among other instances, mentioned that he had performed
this  operation three times upon the same woman,  and twice the
children  had been born living.
  " A lady of rank," continues the same writer, " who had  been
married  many years, was soon after her marriage  delivered of a
living child in the beginning of the  eighth month of her pregnancy.
She had  afterwards four children at the full time, all of which were,
after very difficult labours, born dead.  She applied in her next
pregnancy to Dr. Savage, whom I  met in consultation.   By some
accounts she had received she was prepared for this operation, to
which she submitted with great resolution.  The membranes were
according ruptured, and the waters discharged, early in the eighth
month of her pregnancy.  On the following day she had  a rigor,
succeeded by heat and other symptoms of fever which very much
alarmed  us for the event. On the third day, however, the pains of
labour came on,  and she was, after a short time, delivered, to the
great comfort and satisfaction of herself and friends, of a small but
perfectly healthy child, which is at  this time nearly of the same size
it would  have been had it been born at the full period of utero-ges-
tation ; and it has lived to the state of manhood.  In a subsequent
pregnancy the same method was pursued, but  whether the child
was  of larger size, or  the pelvis  was  become  smaller, whether
there was any mistake  in the reckoning, or whether the child fell
into any  untoward position, I  could not discover, but it was still-
born, though the labour did not continue longer than six hours. Yet
in a third trial the child was born living and healthy, and she re-
covered without  any unusual inconvenience or trouble."*
  It is only necessary  to add, that  the time in which labour-pains
will come on after thus rupturing the membranes and discharging
the waters, is uncertain, and appears to  depend much on the irrita-
bility of the uterus.  It is sometimes delayed, as in the first trial in
die case  just noticed, for three days, but the labour has sometimes,
also, been found  to commence within a few hours.
* Epist. App. ad Strauss de fortu. Mussipont. p. 298. 
 JbO                     GENET1CA.           [CL. V.—OR. Ill



                       SPECIES VI.

              PARODYMA  PLURALIS.

                   3&ult(j)Urate Uabont.

       LABOUR COMPLICATED BY A  PLURALITY OF CHILDREN.

 The fertility of women seems to depend upon various circumstan-
 ces, partly, perhaps, the extent or  resources of the  ovaria, partly
 constitutional warmth of orgasm, and partly the  adaptation of the
 male semen to the organization of the respective female.  Eisen-
 menger gives us the history of a  woman  who produced fifty-one
 children :* and sometimes the fertility seems to pass from genera-
 tion to generation, in both sexes, though it must be  always liable
 to some variation from the constitution  of the family that is mar-
 ried into.  I have in my own family, at the time of writing, a young
 female servant whose mother bore  twenty-three  children,  and
 brought them  up  with so  much success, that at the time of her
 mother's death she was the youngest of  nineteen then living : and
 her eldest brother has fourteen children at  present,  all  of whom I
 believe are in health.
   But  while some women produce thus rapidly in single succes-
 sion, there are others that are multiparient, and bring forth occa-
 sionally two or even three at a time, more than one ovum being
 detached by the orgastic shock.  Three  at a time is  not common :
 I have met with but one instance of it in which the children were
 all alive and likely to live;  and one instance only occurred to Dr.
 Denman in the course of upwards of thirty year's practice. Four
 have occasionally but very rarely been brought  forth together, and
 there are a few wonderful stories of five,  but which rest on no well-
authenticated testimony.
   Twins are mostly produced at  a common birth, but, owing to the
 incidental  death of one of them while the other continues to  live,
 there is sometimes a material difference  in the time of their expul-
 sion, and consequently therefore in their  bulk or degree of maturi-
 ty, giving  us the two following varieties :
 <* Congruens.                  Of equal or nearly equal growth,
  Congruous twinning.            and  produced  at a  common
                                birth.
£  Incongruens.                Of unequal growth, and produced
   Incongruous twinning.          at different births.

  In congruous twinning, or ordinary twin cases, in which there is
• Epist. App. ad Strauss de foctu. Mussipont. p. 228. 
 UE. If.—SP.V1.)         SEXUAL FUNCTION.                 161

 no great disparity of size between the two, on the birth of the one,
 it can be  pretty easily ascertained that another is still in the womb
 by applying the hand to the abdomen ; for  the limbs, and, if the
 child be alive, its movements, may generally be felt very distinctly,
 except, indeed, when  an  ascites is  present, and  the practitioner
 must then have recourse to other tokens.
   There are no precise signs by which a woman or  her attendant
 can determine  whether she be pregnant of twins or not.  Inequali-
 ties  in the prominence of the  abdomen, peculiarities of internal
 sensation or motion, slowness in the progress of a labour, have been
 advanced as signs ; but they  belong as frequently to  the uniparient
 as to the multiparient, and hence are not entitled to attention.
   The claim to priority of birth  in a twin case is dependent, not on
 superiority of strength, or any  other endowment, but on a closet-
 proximity to the mouth of the uterus alone, and, consequently, on
 a greater convenience of position.  Though  when, on the birth of
 twins, one is found small and emaciated, and the other plump and
 strong, we  have some ground for apprehending that the vigorous
 child has absorbed the greater part of the nutriment  afforded by
 the mother, as  we find not unfrequently in  plants shooting from the
 same spot of earth.
   The general rules that govern in  morbid labour of individual
 children, govern equally in morbid  labour  of twins.   The second
 child is usually delivered with comparatively few pains  and little
 inconvenience, as the parts  have been  sufficiently dilated  by the
 passage of the first; and, although there is commonly some interval
 between the termination of the one and the commencement of the
 other struggle, it is not often  that this interval exceeds half an hour
 or an hour.  It has, indeed,  in  a few instances extended to whole
 days;  in one instance to ten,* and in another to seventeen days.t
 But these are very uncommon cases : and as mischief may possibly
 happen to the womb, and to  the system at large from a long pro-
 traction of uterine irritation, it  is now the practice to deliver the
 second child by art, after having waited four or five hours in vain
 for a return of expulsory exertions.
  In incongruous twinning we meet in different cases with every
 possible diversity  in  perfection of form, and term  of expulsion
 between the co-offspring.  Nor is this to be wondered  at in cither
 respect.   We have already seen  that a single fetus  may die during
 any period of parturition from a variety of  causes: and hence we
 may readily conjecture that one of the twins may die at any period,
 while the  other still  thrives and  remains  unaffected.  This twin
 may remain_ in  the womb, and both  be expelled together  at  the
full time.   But it may happen, also, from the peculiar irritation of
the uterus generally, or the peculiar position of" the dead fetus near
the cervix, that this organ may be so  far stimulated by the  death,
    • Hist, de l'Acad. des Sciences, 1751, p. 107.
    f De Boset in Verhendelingren van Harlem, XII. App. No. 6.
Vol. IV.—X 
162                      GENETICA.           [CL. V.—Oil. HI.

and corrupt state of the fetal course and ils membranes, as to expel
it from the body, while the living child receives no injury, and con-
tinues to thrive, and is maturely delivered at its proper time.
  In the latter case, where the dead fetus has been discharged in
the second or third  month of  pregnancy, the mother, not knowing
herself to have  been pregnant with  twins, has been erroneously
conceived, on  the arrival of the second birth, to have produced a
perfect child within the short  term  of six or seven months.
  In the former case, or that in which the dead fetus remains quiet
in the womb through the remaining  term  of pregnancy, and both
are discharged  at a common birth, an  opinion equally erroneous
was formerly entertained in order  to account for the apparent dif-
ference of the two in growth and size : for it was supposed that the
dead  and  puny, and apparently premature  fetus, was  conceived
some months subsequently to the  perfect  and vigorous child, and
hence had not time  to reach it in  size and perfection :  and  to this
supposed  subsequent conception was given the name of superfe-
tation.
  We have reason to believe that such a process does occasionally
take place in some  quadrupeds whose wombs are so formed as to
allow of it: but we have already observed in the Preliminary Proem
to the present Class, as also in the introductory observations to the
present Order,  that, in women, from  the moment of  conception, an
efflorescent membrane is formed  which  lines the whole cavity of
the uterus, and acts as a septum to the ascent of any subsequent tide
of male semen; not to say further that the os uteri itself is so plug-
ged up by the secretion of a viscid mucus  at the time as to prevent
any communication  between this organ and the vagina till the period
of pregnancy is completed.   And  hence the doctrine of superfeta-
tion in women has deservedly sunk into general disrepute.*
   The cases of this kind, and formerly ascribed to  this cause, are
by no means uncommon.  Dr. Maton has given a very decided one
in the Medical Transactions, containing the history of a lady de-
livered at Palermo of a male child in November 1807, and again,
scarcely three  months  afterwards, in  February 1808, of another
male infant, " completely formed."t  The proportion or powers of
the first child  are not sufficiently noticed: but we are told that
both  were born alive ;  that the elder died when  nine days old
" without any apparent cause ;" and that the younger died also, but
 after a longer term.
   In Henchel we have an account of a minutej and  a mature fetus
 born at the same time:  and  in the  Transactions of the Medico-
 Chirurgical Society, a similar account by Mr.  Chapman, with the
 exception of the time, which varied considerably : the dead and mi-
 nute fetus, apparently not more than three or four months old, hav-
* Waldschmied, Dissert, de Superfcetatione falso practens a Hanb. 1727.
f Vol. IV. Art. XII.
t Neue Medicinische und Chirurgische Anmerkungen, B. II. 
uE. II.—SP. VI.]       SEXUAL FUNCTION.                 163

ing in this case been born in October 1816, and the twin,  a  full-
grown child, not till December, just two months afterwards.*
  In this last instance, however, there  can be no doubt that the
aborted fetus had remained quiet in the  uterus for some months af-
ter his death before it was expelled ; which, in truth, is the only way
of reconciling its apparent age and size  of not more than three or
four months at the time of its expulsion/with the full time, or  nine
months of the mother, completed only two months afterwards.
  Nor is a quiet and undisturbing continuance in the  uterus after
the death of the fetus by any means  uncommon, whether the off-
spring be single or double.  We have already given  examples of
an interval  of ten, and even seventeen days, in the case,  of twins
born equally of full size.  But  where the growth has  been discre-
pant, and the dead fetus has remained behind  unsuspected, it has
sometimes been several months before expulsion has taken place.
Ruyset gives a case in which it was delayed a twelvemonth, after
the apparent term of its death, and even then discharged  without
corruption :t and some of the  foreign collections  have  instances
that more than double this time.!
  The present author  was lately engaged in consultation upon the
case of a lady in Bedford  Row, who had miscarried of a fetus under
three months old, which  there  was every  reason to believe  died
four months antecedently  ; as at that time the  mother  had been at-
tacked with a flooding and rigors, had had various subsequent  ute-
rine hemorrhages, and had  never  been  able to quit a recumbent
position without producing some return of the bleeding.
                      SPECIES  VII.

            PARODYNIA  SECUNDARIA.

                    «Sr quenttal aafcour.

    DISEASED ACTION, OR DISTURBANCE SUCCEEDING DELIVERY.

In ordinary child-birth the pains of labour may be said to cease with
the expulsion of the fetus: since though sequential, or after-pains,
as they are ordinarily called, are not uncommon for a day or two,
and are useful in expelling the placenta and its membranes, and a
few large coagula of blood that  have formed in  the  uterus, these
* Vol. IX. p. 195.
f Thesaur. omnium max.
* Nene Samml. Wahrnekmungen." Band. IV. p. 241. 
164
GENETICA.
[CL. V.—OR. Ill
last are neither violent nor by any means frequent.  It sometimes
happens, however, that there is almost as much  trouble, and  as
much pain, and as much danger after the birth of the  child as an-
tecedently, so that the labour itself may be fairly said to be pro-
tracted into this secondary stage, which offers the following varie-
ties of morbid affection :
    a.  Retentiva.             Retention of the secundines.
    £  Dolorosa.              Violent after-pains.
    y  Hemorrhagica.        Violent hemorrhage or flooding.
    $  Lochialis.              Profuse lochial discharge.
  In about ten minutes or a quarter of an  hour after  the birth of
the child  the uterus  recovers its  action, and again exerts itself,
though  with  less force, and  consequently  slighter pain,  to  expel
what is commonly called the after birth, consisting of the  placenta
and  its membranes ;  which in common cases are  easily separated
and thrown off from the sides of the organ.  The instinctive or re-
medial  power of nature is just as competent of itself to do this as
to expel the child; but, as unquestionable benefit is found from as-
sisting in the expulsion in the latter case, a like  degree of benefit
is also found  in the former; and the practitioner, by taking hold of
the funis, and gently pulling it during the action of a pain, will, in
most cases, be sure of expediting the passage of the placenta, with-
out running the least  risk of rudely tearing it from the sides of the
uterus, and exciting a hemorrhage.
  It will sometimes however be found that the funis, instead of
being fully inserted at its upper extremity into the body of the pla-
centa,  originates alone from a few of its  vessels, and that from an
incautious tug it gives way, and is drawn  down by itself, leaving
the placenta  behind;  and  consequently putting it entirely out of
the practitioner's power to render any collateral assistance.
  It also happens, not unfrequently, from the general exhaustion of
the system, or the local exhaustion and torpitude of the uterus, that
no expulsory pains of any kind follow at the ordinary time, or even
for a long period afterwards, and consequently that the placenta is
still lying unseparated in the uterus.
  On a trial instituted by Dr. W. Hunter  and Dr. Sandys in the
Middlesex Hospital, it was found in one  case, that the  placenta left
to the  action of the uterus alone, was not rejected till  twenty-four
hours after delivery:  and as no ill  consequences followed on this
experiment, it became soon afterwards a practice with  many in this
metropolis, as it had  long before been  with still more  on the Con-
tinent, to pay no attention to the placenta, and to leave it to take its
course.  Great mischief, however, has been, in many  cases, found
to ensue from this kind of quietism : for, where there is great ex-
haustion, a sufficiency of natural exerjtion does not in numerous in-
stances return for three or four days afterwards, and sometimes even
longer: while the placenta, by remaining in  the uterus, keeps up
a febrile irritation, and, what is infinitely worse, by being in many
instances partly though not wholly  detached, and  rendered a dead 
C.E. II.—SP. VII.]       SEXUAL FUNCTION.
165
as well as a foreign substance, the detached part putrifies, and pro-
duces a fetor through the whole atmosphere of the chamber, suffi-
cient of itself to render the patient sick, and faint, and feverish, if
it do not occasion a genuine typhus.
   I  was lately requested to attend in consultation  upon a case
of this kind.  The patient had had a very difficult labour, and
after two or three days of severe suffering was delivered by the use
of the crotchet.  She  was afterwards  for a long time in  a state of
syncope, and the placenta was  suffered to remain without any at-
tempt to remove it. She had no expulsory pains for three days, but
very great soreness and some degree of laceration in the soft parts,
with such  a torpitude  of the bladder that the water was obliged to
be drawn off daily.  In about eight and forty hours, she  had a hot
dry  skin, brown furred tongue, with a quick small pulse, and slight
delirium, and occasional  shiverings.   It was in this state I was
requested  to see her.  The room,  which was small, was insupport-
able from its stench, notwithstanding all the  pains  taken to main-
tain cleanliness, and  to  cover the  fetor by  pungent odours.   I
 strenuously advised that the placenta should be instantly removed,
 but  was answered that gangrene was already begun, the patient
 would certainly die, and as certainly  sink under the very attempt
 to bring it away, so that the operator would fall under the charge
of having killed her.   My reply was, that she would assuredly die
if it were not removed, but I  was not so certain that she would if
 it were; that in my judgment  the fetor rather proceeded from the
 placenta itself than from the ichorous discharge about the vagina,
 and gave a token of a  very extensive separation, though the patient
 wanted  power to  expel it from her body.   And I could  not avoid
adding that if none of the gentlemen present (we made four in all)
would venture upon the task, I would take the risk upon  myself,
though I had long declined the practice, and give  the patient this
only chance of a recovery.   This  declaration inspirited  the rest:
the operation was determined  upon, the placenta, as I  suspected,
 was found nearly separated throughout, and half advanced into the
vagina, and was removed without difficulty. By the use of cinchona
 and the mineral acids, with a  nutritive regimen,  the patient gra-
 dually recovered, and  is now in a state of perfect health.
   The modern practice, therefore, of not trusting the placenta to
 the  mere powers of nature, when those powers are  exhausted  or
 inoperative, is  founded upon a principle of the soundest observa-
 tion.  Four or five hours is the utmost time  now usually allowed,
 and if it  be retained  beyond  this period, the operator interferes,
 brings it away by the  funis, if the uterus will hereby become suf-
 ficiently stimulated, and if not, or the funis be  broken,  by cau-
 tiously introducing his hand into the  uterus, and  peeling the pla-
 centa gradually from its walls  by  the action of his fingers.
   If the uterus, instead of contracting at all  at its fundus, should
 contract irregularly and  transversely so as to form what has been
 called  an hour-glass contraction, the removel  of the  placenta
should take place before this time. 
106
GKNET1CA.
[CL. V.—OR. HI
    In some irritable habits it is sometimes found, on the contrary,
  that after-pains, instead  of ceasing  gradually, continue almost
  without ceasing, and with nearly as great violence as the pains of
  labour itself; and this for many hours  after the extraction of the
  placenta.
    If such after-pains follow close upon the labour, they proceed
  from  a morbid irritation and spasmodic tendency  of the uterus
  alone; and the best remedy is an anodyne liniment applied to the
  abdomen,  with an active dose of laudanum, which last must be re-
  peated as  soon as the first dose has lost its effect, the bowels in the
  mean while being kept regularly  open.  If such violent pains do
  not take place till some hours after the evacuation of the placenta,
  or even the next day, it is iiighly  probable that some large cake of
 coagulated blood has formed in the uterus, and become a source of
 irritation.   This may often be hooked out by a finger or  two intro-
 duced for  such purpose, and the organ be rendered easy: if not, an
 opiate will here be as necessary as in the preceding case.
   Haemorrhage or flooding after delivery is  another evil which
 the practitioner in the obstetric art is not unfrequently called upon
 to combat.  This is sometimes produced by pulling too forcibly at
 the umbilical cord, and separating the placenta from the walls of
 the uterus before its vessels have  sufficiently contracted : but  the
 most common cause is  an  exhausted state  of the uterine vessels
 themselves, and a consequent inability to contract their mouths; so
 that the blood flows  through them  without resistance.
   The uterus is, at this time, so stored  with blood of its  own, that
 a prodigious rush will often flow from it  without producing syncope
 or any serious evil upon the general  system: for it is only till it
 has lost its own proper supply, and begins to draw upon the corpo-
 real vessels for a recruit, that any alarming impression is perceived.
 Yet from the first moment the attendant should be on his guard, and
 should have recourse to the means already laid down under flood-
 ing occurring in the  latter months  of pregnancy.*  From the very
 open state  in the present case of the mouths of all the uterine ves-
 sels that have anastomosed with  the vagina, the flooding is here,
 however, upon some occasions, far more profuse and dangerous
 than at any other period, so  that a woman has sometimes been car-
 ried off in the course of ten minutes, with a sudden faintness, sinking
 of the pulse, and wildness of the eyes that is most heart-rending.
 And, in such a situation, as the living powers are failing apace, and
 must be supported at all adventures, while cold and astringent appli-
 cations are  still applied to the affected region, we must have recourse
 to the warmest, the most active, and most diffusible cordials, as Ma-
 deira wine or brandy  itself in an undiluted state: and if we succeed
in rousing the frame  from its deadly apathy, we must drop them  by
  • Vol. IV. p. 121. Gen. I. Spec. II. Paracyesis uterina hemorrhagica;  and
compare with Vol. II. pp. 468,469. 
GE. II.—SP. VII.)    e  SEXUAL FUNCTION.                  167

degrees, or exchange them for food of a rich and nutritive, but les9
stimulant description.
   When the discharge of blood from the uterus ceases, it is suc-
ceeded by a fluid of a different appearance which is commonly called
lochia (A«#/«,) a term employed by Dioscorides in the sense of
secundae, or the materials evacuated by a lying-in woman after the
birth of the child.  The nature of this discharge does not seem to
have been very fully explained by pathologists. The numerous and
expanded blood-vessels of the uterus contract gradually, and par-
 ticularly in their mouths or outlets; by which means the fluid they
 contain, and which is not entirely evacuated by the vagina, is thrown
 back on the  system with so much moderation as to produce no seri-
 ous evil, and its  stimulus is chiefly directed to the breasts.  As the
 mouths of these vessels progressively collapse,  the finer part of the
 blood only, or at least with not more than  a small proportion of the
 red particles issues from them, and in smaller abundance, and hence
 the discharge appears less in quantity and of a more diluted redness.
 By intermixing  with the oxygene of the air, which has a free ad-
 mission to the sexual organs, this red, as in the case of venous blood,
 assumes a purple or Modena hue: and as  this hue becomes blended
 with the yellowish tinge of the serum, it  necessarily changes to
 greenish, which is the  colour of the lochial discharge before its ces-
 sation.
    While this discharge issues in a due  proportion  to  the demand
 of the idiosyncrasy, for the quantity differs considerably in different
 women, there is little fever or irritation, and we have  no ill conse-
 quences to apprehend : but the mouths of these vessels may be irri-
 tated by various causes, as catching cold, violent emotions  of the
 mind, the use of too stimulant a diet, or the want of a sympathetic
 action in the breasts ; and the  result, under different circumstances,
 is of a directly opposite kind.  If there be no spasm hereby induced
 on the mouths of the closing vessels, they will throw forth a morbid
 superabundance of serous fluid, without  running,  perhaps, into a
 hemorrhage, or  opening sufficiently to discharge red blood, and the
 patient will become greatly exhausted and weakened, have a sense
 of a prolapse of the uterus, and be particularly dispirited in her mind.
 If, on the contrary,  which is more  frequently the case, the mouths
 of the uterine vessels become  suddenly and spasmodically closed in
  consequence of the superinduced irritation, there will be a total and
  abrupt suppression  of the lochia, a sense  of great weight and  pain
  will be perceived in the uterus and the whole region of the pubes, a
  considerable degree of fever will ensue, and the patient will be in
  danger of a puerperal typhus.
    These are the  evils which result from a disturbance of the ba-
  lance of the lochial discharge.  In attempting to remedy them the
  exciting cause should,  in the first place, be removed as far as this
  is capable of being accomplished.  After which, in the former  case,
  the strength is  to be sustained by unirritant tonics,  astringents, and
  a plain  nutritive  diet: and in the latter, the  spasmodic pain, and 
168
GENETIC A.
[CL. V.—OU. HI.
heat, and other febrile symptoms, are to be subdued by antispasmo-
dics and relaxants, particularly camphor, with small doses of ipe-
cacuan or antimony.  The neutral salts have also in this case proved
serviceable, which have the farther advantage of opening and  cool-
ing the bowels.   It will likewise be found highly useful to foment
the abdomen with flannels wrung out in hot water, or, which is far
better, to bind a flannel swathe wrung out in hot water in the same
manner round the whole of the abdomen and the back, and to en-
circle it with a band of folded linen to  prevent it from wetting the
sheets, and to let it remain on like a cataplasm, till it becomes dry
by evaporation.
                      GENUS 111.


                    E C  C Y E S  I  S.

                 Extrauterine jFetatiou.

IMPERFECT FETATION IN SOME ORGA,V EXTERIOR TO THE UTERUS.

We have shown in the Physiological Proem to the  present class,
that the sexual fluid of the male passes,  at the time of the embrace
or soon afterwards into the uterus, and from the uterus into the
Fallopian tube, or even the ovarium, where it impregnates an ovu-
lum detached from its proper niche by the force of the orgastic per-
culsion.  It sometimes happens, however, that the Fallopian tubes,
or the openings  from the uterus leading into them, are so impacted
with fat or  some other material, or so straitened in their diameter,
that the detached and impregnated ovum is incapable of obtaining a
passage into the cavity of the uterus, and is arrested  in its course:
in which case it must either remain in the tube itself, into which
it has thus far proceeded, or drop, at the origin of the fimbriae, into
the  hollow of the abdomen.   And it has also sometimes occurred,
that the ovulum or vesicle that has been detached in the ovariuiji
has been incapable of making its way out of the ovarium itself, and
has become impregnated in its original seat without a possibility of
stirring farther.
  In all these cases, the progress of impregnation still goes forward,
though in an imperfect manner, and with an imperfect development
of organs, and we are hence, furnished with the three following dis-
tinct species of extra-uterine gestation.
     1. eccyesis ovaria.          ovarian exfetation.
    2. ----------tubal1s.        tubal exfetation.
    3.  ■         abdominalis.   abdominal exfetation. 
CE. III.]
SEXUAL  FUNCTION.
169
   It is a very remarkable fact, that the uterus still sympathises in
every one of these species  with the imprisoned  and impregnated
ovum, in whatever part of the body it may happen to be lodged, pro-
duces ordinarily the same efflorescent membrane or decidua, which
we have already observed it secretes in the commencement of lit ro-
gestation for the reception of the ovum upon its arrival in ti e ute-
rus, enlarges its capacity and thickens its walls as though the fetus
were really present in its interior; exhibits the same symptoms and
excites the same caprices of the stomach as those by which utero-
gestation is usually distinguished: and, at the expiration cf the
regular period of nine months, and sometimes, as in ordinary preg-
nancy, even before this,  is attacked with spasmodic or expulsory
pains  which often continue  for some hours, and seldom  altogether
subside till the organized and extra-uterine substance loses its living
power, and becomes of the nature of a foreign material to the organs
by which it is surrounded.  After which menstruation again returns
regularly, as it has hitherto  been suspended.
   The extra-uterine ovum, in the mean while, endowed  in conse-
quence of its impregnation with aprinciple of life, continues to grow,
whatever be the place of its  aberration, in some instances becomes
surrounded with an imperfect kind of placenta, develops the general
structure of its kind, and exhibits an organized compages of bones,
membranes, vessels, viscera and limbs ; the whole figure being more
or less perfect according to circumstances that lie beyond  our power
of penetration.
   After the death of the extra-uterine fetus, the uterus, and conse-
quently the general frame, frequently becomes quiet;  and the bulky
substance enveloped in a covering of coagulable lymph, remains for
years, or perhaps through the whole of  life, with no other inconve-
nience than that of a heavy weight and  tumour in the  part in which
the dead fetus is lodged.  But, in many  instances, like  any other
intrusive or foreign material, it produces  great irritation, which is
succeeded by the  ordinary process of ulcerative inflammation, and
an opening is hereby made into the intestines, or the vagina, or ex-
ternally through the integuments of the abdomen,  and the indisso-
luble parts of  the fetus are discharged piece-meal; sometimes the
patient sinking during the tedious process under the exhaustion of a
hectic, but more generally evincing strength enough to sustain the
progressive expulsion, and at length restored to the enjoyment of
former health.
   Vol. IV.—Y 
470
GENETIC A.
[CL. V.—OR. III.
                        SPECIES I.


                 ECCYESIS OVARIA.

                   <©bm*Can Krtetatfou.

 IEPERFECT FETATION OCCURRING IN THE RIGHT OR LEFT OVARIUM.

The physiology and general pathology have been already given so
much at large in the paragraphs immediately preceding, that it is
only necessary to observe  further that  this form  of extra-uterine
fetation is very common as well as very distressing.  Vater relates
a singular case  of this kind producing  a  general intumescence  of
the abdomen on the  right side, the right ovarium being the seat  of
the disease, that continued with little variation  through a period  of
three years and a half, with an equal degree of distress and danger
to the patient:*  and other instances are adverted to in the volume
of Nosology.
  It is in this organ more especially  that rudimental  attempts  at
fetal organization, the mere sports of nature, are frequently found
produced without impregnation, or any contact with the  male sex,
and sometimes in very young subjects.
  One of the most singular cases of this kind is that communicated
by Dr. Baillie to the Royal Society in the year 1788.f  The young
subject of the case was not more than twelve or thirteen years old,
with an infantine uterus and perfect hymen: and the fetation con-
sisted of a suetty substance, hair and the rudiments of four teeth.
  The same kind of formative ludibra are found,  also, in  mature
life in  women of  the most correct lives,  and whose chastity has
never  been  impeached, of which we have an  instance  in a late
volume of the  Transactions  of  the  Medico Chirurgical Society.
The subject, an unmarried female, was about thirty years of age,
at the  time of  her death,  which  took place after a long series  of
suffering, accompanied with great pain in  the region of the bladder,
and a considerable swelling of the abdomen.   On examining the
body, a large tuft of hair of about the size of a hen's egg was found
inclosed in a tumour of the left ovarium, surrounded with a fluid
of the  thickness of cream.  In the bladder was traced a similar tuft
of hair surrounded with a like fluid, which distended and plugged
up the organ .J
   Such rudiments  of organized  form  have  been resolved by the
disciples of Buffon into the peculiar activity of his molecules organi-
ques, concerning which we have already spoken in the Physiological

  • Dissert, de Graviditate apparente ex tumore ovarii dextri enormi, &c.
  | Phil. Trans  1789.
  i Vol. ix. p. 427. 
GE. III.—SP. I.]        SEXUAL FUNCTION.
171
 Proem to the present class, thronging with a more than ordinary
 proportion in the region or organ in which the  preternatural pro-
 ductions have been found to exist; and by still  later physiologists
 into a salacious temperament in the individuals  who have been the
 subject of them, and who are still further said, as we have also re-
 marked in the  same Proem, to have a  power  when this orgastic
 erethism is at its utmost heat, as about the period of menstruation,
 of irritating and even inflaming the ovaria, and occasionally even of
 detaching one or more ova  and  putting them into  a like state of
 irregular action.  And where cases occur in infants they  are  as-
 cribed to the same cause operating on a constitution diseased by a
 morbid precocity.*
  The first of these explanations it is hardly worth while to combat
 in the present day,  and  particularly in  the  present place, after
 having already  illustrated,  in  the Proem above referred to,  the
 feebleness of its first principles.  And with respect to the second it
 is sufficient to observe that  the very same attempts at fetation  are
 sometimes made and carried quite as far  towards completion, in
 organs that cannot be suspected of any salacious sensation, and even
 in males as well as in females.  Thus, Dr. Huxham gives a case in
 which the rudiments of an embryo were found in a tumour seated
 near the anus of a child ;t and Mr. Young a still  more extraordina-
 ry one, yet a case well known, I suppose, to nearly all the medical
 practitioners  of the metropolis from personal inspection, of a large
 protuberant cyst, containing a nucleus of  fetal rudiments found in
 the abdomen  of a male infant about fifteen months old.  The child
 died after a tedious and painful illness. The body was opened, and
 the cyst examined : " The substance it contained," says Mr .Young
"had unequivocally the shape and  characters of a human fetus:"
for a particular description of which the  reader  must  turn to  the
account itself.f
  Upon this subject we can only say that all such abortive attempts
are monstrosities; and that all monstrosities, are not confined to any-
particular age, as that of fetal life, or to any particular organ. They
run occasionally through  every  part of the frame, and  every part
of the life, and appear in the  form of cysts, and  excrescences, and
polypi,  and ossifications, and a thousand  other  morbid deviations
from the ordinary mark of nature, though  they are most frequently
found in the first months of  impregnation, unquestionably because
the excited organs are, at that period, more capable than  at any
other, of being moulded, by accidental circumstances, into anoma-
lous shapes, and of preserving life under almost every kind of mis-
construction and deformity.
  In extra-uterine fetation of whatever kind, or wherever situated,
the art of medicine can do but little.   If the tumour be free from
  • Vol. IV. Proeotia feminina, Ovd. I. Gen. II. Spec. II. of the present class,
p. 81.
  f Phil. Trans. Vol. XLV. 1748. p. 325.
  * Medico-Chir. Trans. Vol. I. p. 241. 
172                       GENETICA.           [CL. V.—OR. Hi

pain, and the general system not essentially disturbed by it, nothing
should be attempted whatever.  And if, in a case of irritation and
ulcerative inflammation, nature herself seems to point out one par-
ticular part for the opening of the abscess  rather than another, it
will almost always be far better merely to watch her footsteps, and
assist her intention than to attempt a cure or removal of the cyst in
any other way: for we had long ago an opportunity of observing,
when treating of inflammation generally, that,  " it is a  wise and
benevolent law of Providence, and affords un incontrovertible proof
of an instinctive remedial  power, that inflammation, wherever seat-
ed, is always  more violent  on the side of the inflamed point nearest
the surface, and shows a constant tendency to work its way exter-
nally  rather than internally;"* or, in other words, in that  direction
in which the  most salutary end can be obtained with the least essen-
tial mischief.  And hence, though it may often be found advisable
to enlarge an opening made externally by the effort of nature alone,
it will generally be injurious to deviate from the spot thus instinc-
tively marked out, and make an opening elsewhere.
   The cyst has sometimes laid dormant, or without producing much
disturbance, for many years, and then, from some accidental cause,
has become irritated, inflamed, and produced a large abscess :  the
ovarium, in the progress of the inflammation, forming an  adhesion
to the  integuments  of the abdomen, and thus at length  breaking
externally ; mostly  in the course of the linea alba, often near the
navel, but sometimes towards the groin.  In a few instances, how-
ever, the inflammatory action has travelled in some other direction,
and sought some other outlet: so that the ovarium has formed an
adhesion with the vagina, or the  larger intestines, and ultimately
opened into them, and the bones and other indissoluble parts of the
fetus have been thrown forth in fragments from the vagina or the
anus. Zrcutus Lusitanus gives a case in which the bones of an im-
pregnated  ovarium were discharged  piece-meal  by the anus after
the impregnation had continued for twelve years :t and Bartholin
another of much larger duration, in which the exit was formed in
the hypochondrium after the fetus had been imprisoned for not less
than eighteen years.
   In a few instances, however, the extra-uterine substance has been
removed by art without waiting for the formation of an abscess. A
successful operation of this kind is related in the  Histoire  de I'Aca-
demie Royale, after a gestation of twenty-seven months,  the child
being  extracted by an incision  into the abdomen.f   M. Tristen
gives a similar example,  attended with a like favourable issue :§
and in the Edinburgh Medical Commentaries we have an account
of the vagina being laid open for the same purposed
* Vol. II. p. 161.
■J- De Praxi admiranda. Lib. II. Obs. 157.
$ Hist, de l'Acad. des Sciences, 1714. p. 29. 1716. p. 52.
§ Observ. Chirurg. Leid. 1743. 4to.
|| Smith, Vol.V. p. 337, 
GE. III.—SP. II.]
SEXUAL FUNCTION.
173
                       SPECIES II.

                ECCYESIS TUBALIS.

                    <ZFut>al mutation.

     IMPERFECT FETATION OCCURRING IN THE FALLOPIAN TUBE.

Diemerbroek has observed that this is the most common cause un-
der which extra-uterine gestation shows itself,* and it is at the same
time the most dangerous.   There is in truth less room for disten-
tion here than in any of the other cavities in which the exiled ovum
may happen to lodge : and hence the overstretched tube has occa-
sionally bursted, and  the patient has soon fallen a sacrifice to the
irritation and fever produced by so large a rent: while, if this have
not taken place from the mischief done to the tube, it has followed
nearly as soon from the morbid excitement and inflammation pro-
duced in the abdomen in consequence of the sudden entrance of so
large a foreign body into its cavity.  Dr. Middleton, however, has
described a singular case  of a woman who carried a fetus for six-
teen years, in one of the Fallopian tubes, with so little disturbance to
the general health of the system, that at this period she became
pregnant in the regular way, and appears to have passed through
her pregnancy with  a favourable issue.t  The general pathology
and mode of treatment run  parallel  with those of the preceding
species.
                      SPECIES III.


             ECCYESIS ABDOMINALIS.

                 <3Iifflomtnal ZStfrtsttou.

 IMPERFECT FETATION OCCURRING IN THE CAVITY OF THE ABDOMEN.

An extra-uterine fetus may be deposited in the cavity of the abdo-
men by bursting through the walls of the ovarium or Fallopian tube
after it has been produced there, or by an accidental drop of the
impregnated ovum from the extremity or fringe of the tube in its
way to the uterus.   In the two former instances there is danger of
great and fatal inflammation, not less from the rent produced in the

              • Opera omnia Anatomica, p. 135.
              f Phil. Trans. Vol. XLVUI.  1744, 1745. 
174
GENET1CA.
!CL. V.—OR'. Hi.
organ just quitted by the fetus, than from the irritation which so
large a foreign body cannot fail to produce on the organs on which
it presses.  In the last instance, on the contrary, the substance, on
its first entrance, is so minute, and its growth so gradual, that the
contiguous organs suffer little or  no irritation except from some ac-
cidental excitement, till atlength, indeed, the magnitude of the fetus
may alone be a sufficient cause of morbid action, and lay a founda-
tion for the most serious consequences.
  In the introductory remarks to the present genus, we observed,
that, in almost all cases of extra-uterine fetation, the moment the
ovum becomes impregnated the womb regularly sympathises in the
action, produces a tunica decidua, enlarges, ceases  to menstruate,
mimics the entire process of utero-gestation, and,  at the expiration
of nine months, is attacked with regular labour pains.   After these
have continued for some hours they gradually  cease : and what is
still  more remarkable, the ex-fetus,  which, till this moment, is en-
dowed with life, and  continues to grow, how  imperfect soever its
form, dies, as though  strangled in its imprisonment; and by becom-
ing a dead substance, becomes, at the same time, a substance ob-
noxious to the living organs around it, which have hitherto suffered
little inconvenience from its proximity ;  often excites irritation and
an abscess, and from such abscess, as we have already observed, is
thrown forth piece-meal.
  The  following history, which is highly curious in  itself, forms a
striking illustration of the  whole of these remarks.  It is published
by Dr. Bell of Dublin,  from a full knowledge of the entire  facts:
A young woman, aged twenty one, after being married fifteen months
had the usual signs of pregnancy, and at the expiration of her rec-
koning was attacked  with  regular labour pains which  were very
violent for some days, when they gradually left her.   But the abdo-
men  still continued to enlarge, while the strength  of the patient as
gradually  failed, and  she was reduced to the utmost  state of amaci-
ation.  Eight or nine months from the cessation of her labour-pains
she discharged a  considerable quantity  of fluid from a small aper-
ture  at the navel, along with which were perceived some  fleshy
fibres and pieces of bone.  It was proposed to follow up this indica-
tion of nature, and make an opening into the abdomen at  this very
point, large enough to remove the fetus supposed to be lodged  there.
This was  accomplished  by  an incision running two inches above
and the same  length below the navel, when the bones of two full
grown  fetuses were  extracted, for little beside bones at that time
remained. No hemorrhage ensued, and the patient  recovered her
health so  speedily as to be able to menstruate in about three months.
After three months more she was prevailed upon  again to cohabit
with her husband, became pregnant, had a natural labour, and bore
several children in succession.*
  •  History of a case in which two Fetuses tbat had been carried near twenty-
one  months, were successfully extracted from the abdomen by incision, fcc. 
4iE. HI.—SP. III.]
SEXUAL FUNCTION.
175
  In this case it is clear that the sensations of the uterus during the
development of the twin ex-fetuses, were those of mere sympathy;
as it is also that they ceased to grow, and became dead and irritat-
ing substances after the common term of utero-gestation, or on the
cessation of the labour-pains.
  This is the usual course, but in some cases the irritation the dead
substance excites is less violent, and instead of an  ulcerative, an
adhesive inflammation is produced, and coaguable lymph is thrown
forth, which by the law of nature, is gradually transformed into a
soft and membranous material that becomes a sheath or nidus for
the dead fetus, and prevents it from exciting any further irritation.
And in this manner an abdominal ex fetus  has sometimes  been
borne for a considerable number  of years, or  even  to the end  of
life, without any serious mischief.   In the volume  of Nosology I
have referred to various proofs of its having, in this  way lain quiet
for twenty-two, twenty-six, and even forty-six years.
   Putrefaction, under these circumstances, does not take place, for
the imbedded substance is shut out from the chief auxiliary to putre-
faction, which is air : but a change of some other kind is generally
found to prevail, though with some diversity, according to the acci-
dental circumstances that accompany it.   And hence the fetus,  on
opening the cyst, after the death of the mother, or on its own ex-
traction antecedently, has  been  found sometimes concerted into
adipocire,  or a suetty or cetaceous material,* making a near ap-
proach to it; sometimes into a leathery or cartilaginous structure ;t
and sometimes into an osseous or almost stony mass,  which has
been distinguished by the  name of osteopedion or lithopoedion.J -
   Under these circumstances, also, the bulk and weight of the fetus
has considerably varied;  for,  the  fluids having evaporated, it has
often been found light and shrivelled, yet, when loaded with osseous
matter, it  has been peculiarly heavy.   In a structure of somewhat
more than ordinary completion Krohn found the weight amount to
four pounds and a half.
   For medical treatment there is little scope, and this little has
 been already touched upon under the first species.§
• Wagner, Nov. Act. Liter. Maris. Balth. 1699.
f Phil. Trans. Various examples, passim.
i Abhandl. der Josephin. Acad. Band. I.
  Eyson, Diss, de Foetu lapidescente. Groning. 1661.
 % Foetfls extra uterum historia. Lond. 1791. Gott. Ann. 1791. 
170
LKNETICA.
[CL. V.—OR.HI.
                      GENUS IV.

                   PSEUDOCYESIS.

                  Salmons Pregnane^.

 SYMPTOMS OF PREGNANCY WITHOUT IMPREGNATION: CHIEFLY OC-
        CURRING ON THE CESSATION OF THE CATAMENIA.

 In the preceding genus we beheld the uterus excited to action, and
 mimicking the progress of pregnancy, though without any preten-
 sions to it, in consequence.of itsjassociation with some extra-uterine
 impregnation.  In the present genus there is no proper impregna-
tion any where, but a mere irrtiation derived  from the^lodgement
of some morbid and unorganized substance, which excites a train of
feelings, and not unfrequently a change of action, easily recalled
from the force of habit.  It is on this last account  that virgins are
rarely, if ever liable to this affection. Such at least is the  general
 opinion, which appears to be  well founded; •* And no case," says
 Mr. Burns, " that I have met with contradicts  the supposition."
  This train of  feeling and change of action seem also, at times,
 excited by a peculiar kind of irritability of the uterus itself, even
 where there is no substance whatever in its own or any other cavity
 that can become a stimulus:  and we are hence put into possession
 of the two following distinct species :

    1. PSEUDOCYESIS MOLARIS.         MOLE.
    2. ———■ •------INDIANS.         FALSE CONCEPTION.
                       SPECIES I.

             PSEUDOCYESIS  MOLARIS.

                          moit.

IKE UTERUS IRRITATED HY A COAGULUM  OF BLOOD OR OTHER SE-
  CRETION LODGED  IN  ITS  CAVITY, OFTEN ASSUMING A FIBROUS
  APPEARANCE.

A coagulum of blood thrown into the womb by a relaxation of the
mouth of the menstrual excernents, or remaining there as a sequel
of miscarriage or labour, is perhaps the most common cause of this
morbid action and sensation.  It was long ago thus explained by Mr. 
GE. IV.—SP. 1.3       SEXUAL FUNCTION.
177
 Hewson—"from the blood's being without motion in the cavity of
 the uterus ;" and consequently coagulating: "and hence," conti-
 nues he, " the origin of those large clots which sometimes come
 from the cavity:  and which, when  more condensed by the oozing
 out of the serum, and of the red globules, assume a flesh-like ap-
  earance, and have been called moles."*   The concretion, indeed,
  as become sometimes so close and indurated  as to  resemble  the
 consolidation of a  stone ; and hence Mr. Bromfield describes a mole
 expelled  from the uterus as consisting of a stony mass of the size
 of a child's head.t   And Hancroft has related a similar case.J
   Living blood, however, has a  strong tendency at all times, and
 especially when aided by rest and the warmth of the body, to fabri-
 cate vessels and assume a membranous structure.  "I have reason
 to believe," says Mr. J.  Hunter, "that the coagulum has the power,
 under necessary circumstances, to form vessels  in and of itself: for
 although not  organic, it  is still of a peculiar  form, structure or ar-
' rangement.  I think I have  been  able to inject  what  1 suspected to
 be the  beginning of a vascular formation in the coagulum when it
 could not derive any vessels from the surrounding parts "§  It is
 probably on  this account that we sometimes  find  the discharged
 mass or mole  evincing something of a fibrous or membranous appear-
 ance, and mimicing the structure of an organized substance.
   Fragments of a placenta, or of its membranes, have also some-
 times  remained  unexpelled  from the  uterus, and  have  become
 blended  with coagula of blood,|| and probably of blood aiming, as
 above, at a vascular development, and hence the mole has  been of
 a still more complicated character,  and  has  often puzzled practi-
 tioners of great judgment and experience.
   And occasionally hydatids have  found  the  means of forming a
 nidus in  some one of the sulci of the womb, and by swelling into a
 considerable tumour or various clusters of tumours, have very con-
 siderably added to the enlargement.^!
   Many  writers  have described, by the  name  of moles, the frag-
 ments of a fetus which  have long remained in  the uterus after its
 death, and have sometimes been surrounded with an adscititious in-
 volucrum.or some part of its placenta or membranes, but so changed
 by some  subsequent chemical or animal operation, as to have little
 resemblance  to  their original structure.  These, however, are ra-
 ther miscarriages, or remnants of miscarriages, than  moles.  They
 manifestly bespeak an impregnation and organic growth in the pro-
 per organ, but, owing to  torpitude or some other diseased condition
• Inquiries, &c. Part. I. p. 27.
f Observ. II. p. 156.
i Diss, de Molu, occasione molx osseze in vetula inventa. Goet. 1746.
§ On Blood, &c. p. 92. 4to. Edit. 1794.
D Uuysch, Thesaurus, III. VI.
H Eph. Nat. Our. Dec. II. Ann. II. 157. Ann. VIII. 50. et alibi.
  Morgagni, De Sed. et Caus. Morb. Ep. XI.VI1I. 12, &c.
I
Vol. IV.—Z 
178
GENETICA.
[CL. V—OR. I1-.
of the womb, were not expelled at the period of the death of the
fetus.  We have already observed, in treating of miscarriage, pa-
racyesis abortus, and  more particularly still under  paracyesis
tluralis, that such retention, and almost to an unlimited period,
is by no means uncommon, and have illustrated  the  remark by
numerous examples.
  Simulating pregnancy, from molar concretions, assumes in many
cases so  much of the character of genuine impregnation  as to be
distinguished with considerable difficulty.  In general, however,
the abdominal swelling increases in the spurious kind far more ra-
pidly than  in the  real for  the  first  three  months ; after which
it keeps nearly at a stand :  the  tumour, moreover, is considerably
more equable, the  breasts are  flat  and do not participate in  the
action, and there  is no  sense  of  quickening.  There is  almost
always a  retention  of the menses.
  If wo suspect the disease, the state of the uterus should be exa-
mined, and it will often be in the examiner's power to ascertain the
fact, and by a skilful introduction  of the finger to hook  down a part
of the mass through the cervix, and hence, by a little dexterity, to
remove the whole; but he should be careful not to break the mole
into fragments.
  Moles, wholly or in fractions, are thrown out by the action of the
uterus at different periods :  often at three months; more frequently
by something like  a regular  accession of labour-pains, at nine: but
they occasionally remain much longer: in a case of Reidlin's, for
three years;1  and in one described by Zuingen for not less than-
seventeen. t
                       SPECIES II.

              PSEUDOCYESIS  INANIS

                    jFalse (tonttption.

THE  UTERUS  VOID OF INTERNAL SUBSTANCE; AND  IRRITATED Br
               SOME UNKNOWN MORBID ACTION.

There are two periods during the active  power of the womb in
which it is peculiarly irritable; and these are not. at the commence-
ment, and at the  final termination of the  catamenial flux.  And
hence it sometimes happens at the last period, from some unknown
excitement,  though generally, perhaps, the  increased erethism
• Lin. Med. 1695. p. 297.
f Theatrum vitsc humana, p. 331, 357. 
€E. IV.—-SP. II.3        SEXUAL FUNCTION.                  179

which, in consequence of such irritation, accompanies the conjuga
embrace, that it becomes sensible of feelings and communicates
them to the stomach, not unlike what it has formerly sustained in an
early age of impregnation ; and, a catenation of actions having thus
commenced, every link in the chain that  accompanied the  whole
range of former pregnancies is passed through, and as accurately
imitated, as if there were a real foundation for it.
  This illusory feeling, however, sometimes dies away gradually at
the end of three months, but more usually runs on to the end of the
ninth, when there is occasionally a feeble attempt at labour-pains,
but they come to nothing,  and\the farce is gradually, and  in a few
instances suddenly concluded by a rapid diminution of the abdomi-
nal swelling and a return of the uterus to its proper size.
  The distinctive signs which indicate real  from spurious pregnancy
under the  last species, and  which  we  have already noticed, are
equally applicable to the present, and the practitioner should avail
himself of them. 
 
CLASS VI. 
           CLASS VI.

        ECCRITICA.

  DISEASES OF THE EXCERNENT FUNCTION.

ORDER I.
         MESOTICA.
            AFFECTING THE PARENCHYMA.

      II.
         CATOTICA.
            AFFECTING INTERNAL SURFACES.

     HI.
         ACROTICA.
            AFFECTING THE EXTERNAL SURFACE. 
CLASS  VI.
PHYSIOLOGICAL  PROEM.
The structure of the solid parts of the body consists of three dis-
tinct substances—a fibrous, a parenchymatous, and a cellular  or
web-like.  The fibrous is chiefly to be traced in the bony, muscular,
and membranous parts; the parenchyma, a term first employed  by
Erasistratus, and, as we shall  show hereafter, in a very different
sense from that in which it is used at present, in what are commonly
called visceral organs;  and the cellular in both.   The cellular is,
in truth, as it was first denominated by Bordeu, a mucous web ;* and
while it serves the purpose of giving support to the vessels and
nerves of  the fibrous parts,  of separating them  from each other
where necessary,  and where necessary of connecting them; it is
the repository or receptacle of the gelatinous material, which con-
stitutes the general substance of the  parenchymatous parts, and has
peculiar qualities superadded to it according to the nature of the
organ which it embodies, and the peculiarity of the texture which
runs through it:  whence the structure of the liver differs from that
of the pancreas, the structure of the pancreas from that of the kid-
neys: and the structure of the lungs, or of the  placenta, from  all
the rest.
   All these parts are perpetually wearing out by their own action—
the most firm and  solid  as well as the most spongy and attenuate.
They are  supplied with  new materials from the general current of
the blood, and have their waste and recrement carried off by a cor-
respondent  process.
   It is obvious that, for this purpose, there must be two distinct sets
or systems of vessels:  one  by which the d"Ue  recruit is provided,
and the other by  which the refuse  or  rejected part is removed.
These vessels are, in common language, denominated secretories
and absorbents.   They bear the same relation to each other as the
arteries and veins : the action which commences with the former is
carried forward into the latter:  and we may further observe, that
while the secretories originate from the arteries, the  absorbents
* Reeherches su.r le Tissu muqueux ou organe cellulaire.  Paris, 1767. 
 184                PHYSIOLOGICAL PROEM.            [CL. VI.

 terminate in the veins.  The general  function sustained by these
 two sets or systems of vessels is, in the present work, denominated
 eccritical or excernent: the health of this function consists in
 the balance of power maintained between their respective vessels:
 and its diseases in the disturbance of such balance.   There may be
 undue secretion  with healthy absorption ; undue  absorption with
 healthy secretion :  or there may be undue or morbid absorption
 and secretion  at the same time.
   The refuse  matter, however, or that which is no longer fit for use,
 is not all wasted: nor in reality any of that which falls within the
 province of the absorbents.  Nature is a judicious economist, and
 divides the eliminated materials  into two parts—one consisting of
 those fluids which, by an intimate  union with the newly formed
 chyle, and a fresh subaction in the lungs, may once more be adapted
 for the  purposes of general  circulation ; and the  other of those
 which no elaboration can revive,  and whose longer retention  in the
 body would  be mischievous.  It  is  the province of the  absorbent
 system to take the charge of the  whole of the  first office;  to collect
 the effete matter from every quarter, and to  pour it, by  means of
innumerable channels that are perpetually uniting, into the thoracic
duct, which forwards it progressively to the heart.  The really waste
and intractable matter, instead of disturbing the action of the  absor-
bents, is at once thrown out of the general system by the mouths of
the secernents themselves, as in the case of insensible perspiration;
or, where such a perpetual efflux would be inconvenient, is deposit-
ed in separate reservoirs, and suffered to accumulate, till  the indi-
vidual has a commodious opportunity of evacuating  them,  as in the
case of the urine and the feces.
   Thus far we see into the general economy :  but when we come to
examine minutely into the nature of either of these  sets of vessels,
we find that there is much yet to be learned both as to their struc-
ture, and the means by which  they operate.  The subject is of great
 importance, and may perhaps be best considered under the  three
following divisions:

     I.  THE  GENERAL NATURE  OF THE SECERNENT SYSTEM.
   II.  THE  GENERAL NATURE  OF  THE ABSORBENT SYSTEM.
   III.  THE GENERAL EFFECTS PRODUCED BY THE ACTION OF THESE
         TWO SYSTEMS ON EACH OTHER.

   I. It was  at one time the common doctrine  among physiologists,
as well chemical as mechanical, that all the vast variety of animal
productions  which are traced in the different secretory organs, whe-
ther wax, or tears, or milk, or bile, or saliva, were formerly contain-
ed in the circulating mass ;  and that the only  office  of these organs
was  to separate  them respectively from the other  materials that
entered into the  very complex crasis of the blood ; whence, indeed,
the name of secernents or  secretories, wnich  mean  nothing
 more than separating powers. This action was by the chemists sup- 
CL. VI.]
PHYSIOLOGICAL PROEM.
185
posed to depend  on peculiar attractions,  or the play of affinities
which was the explanation advanced by some;  or on peculiar fer-
ments, conveyed by the blood to the secernent organ, or pre-exist-
ing in it, which was the opinion of others.  The mechanical phy-
siologists, on the contrary, ascribed the separation to the peculiar
figure or diameter of the secretory vessels, which, by their make,
were only fined to receive  particles  of a given form, as  prisms
where  the vessels were  triangular, and  cubes where  they  were
square.   Such was the explanation of Des Cartes: while Boerhaave,
not essentially wandering from  the same view,  supposed the more
attenuate secretions to depend upon vessels of a finer bore, and the
more viscid  upon those of a larger diameter.
  Modern chemistry, however,  has  completely  exploded all these
and many other hypotheses founded upon the same common princi-
ple, by proving that most of the secerned materials are not formally
existent  in  the  blood, and, consequently, that it is not, strictly
speaking, by an  act of separation, but of  new arrangement  or re-
composition that they are produced outof its elements.  And hence,
physiologists have been led  to a critical inquiry into the fabric of
the secerning organ, but  hitherto without much satisfaction.  In
its simplest state it seems, as far as it can be traced, to consist of
nothing more than single  vessels possessing a  capillary orifice, as
in the Schneidtrian membrane.  In a somewhat more  compound
form we find this orifice opening into a follicle,  or minute cavity of
an elliptic shape; and, in a still more complicated make, we  meet
with a glandular apparatus more or less  glomerate, consisting of a
congeries of secernent vessels,  with or without  follicles, and occa-
sionally accompanied  with a basin or reservoir for a safe deposit ot
the secreted or elaborated matter against the time of its being want-
ed, of which the gall-bladder furnishes us with a well-known exam-
ple.  But in none of these instances are  we able to discover any
peculiar effect produced by this complication of machinery beyond
that of affording the means of  accumulation: for large as is the
organ of the liver it is in the penicilli, or the pori biliarii alone that
the bile is formed and completely elaborated:  the liver is a vast
bundle or combination of these, and hence affords an opportunity
for a free formation of bile in a collective  state, but it has not been
ascertained that it affords any thing more.  And although in the gall-
bladder we find this fluid a little varied  after its deposit, and ren-
dered thicker, yellower, and bitterer, the  change is nothing more
than what must necessarily follow from absorption, or the removal
of a part of  the finer particles of the bile. The conglomerate glands
of the mammse offer us the same results, for the milk here secreted
is as perfect milk  in every separate lactiferous tube, as when it flows
in an accumulated form from the nipple.  And hence, follicles them-
selves may be nothing more than minute reservoirs for the convenient
accumulation of such fluids as are deposited in them till they are re-
quired for use.   Mucus and sebum are inspissated by retention, but
they rarely undergo any other change.   We are obliged; therefore,
   Vol. IV.—A a 
 186                PHYSIOLOGICAL PROEM.            ICL. \ I

 to conclude with Sir Everard Home, that " the organs of secretion
 are principally made up of arteries and veins; but there is nothing
 in the different modes in which these vessels ramify that can in any
 way account for the changes  in the blood, out of which secretions
 arise."*
   These organs, however, are largely supplied with twigs of small
 nerves;  and it has been an idea long  entertained  by physiologists
 that secretion is chiefly effected through their instrumentality.   Sir
 Everard  Home, in  his paper inserted in the volume of the Philoso-
 phical Transactions just referred to, has " observed  that in fishes
 which are capable of secreting the electric fluid the nerves connect-
 ed with the electrical organs exceed those that go to all the other
 parts of  the fish, in the proportion of twenty to one :"t and in con-
 firmation of this view of the subject, it may be remarked that there
 are no parts of the body more manifestly affected, and few so much
 so, as the secretory organs,  by mental emotion.  The whole sur-
 face of the skin is sometimes bedewed with drops of sweat and even
 of blood by a sudden  paroxysm of  agony of mind;  grief fills the
 eyes with tears: fear is well  known to be a powerful stimulant to
 the kidneys, and very generally to  the alvine canal; anger gives
 an additional flow, perhaps an additional acrimony, to  the bile; and,
 if urged to violence, renders  the  saliva poisonous, as  we  have
 already observed under the  genus LYSSA:f.and  disappointed hope
 destroys  the digestion, and turns the secreted fluids of the stomach
 acid.
  All this should seem to prove that the secretory organs are chiefly
influenced  by the sensorial system; yet Haller has  long  ago ob-
served that  the larger branches of the nerves seldom enter into
them, and seem purposely to avoid them:§ the secernent glands
have little sensibility ; and  the secretions of plants,  which have no
nervous system, are as abundant, and diversified, and  as wonderful
in every  respect, as those of  animals.
  The means,  therefore, by which the very extensive and import-
ant economy of secretion is effected, seem hitherto, in a  very
 considerable degree, to have  eluded  all investigation.   We behold,
nevertheless, the important work proceeding before us, and are in
 some degree acquainted with its machinery.
  The most simple, and at the same time, perhaps, the most copi-
ous of the fluids, which are in this manner separated from the blood,
is that discharged by  very minute secernent vessels, supposed to be
terminal or exhalant arteries, which open into all  the cavities  of
the body, and pour forth a fine, breathing  vapour,  or halitus, as it
is called, which keeps their surfaces moist, and makes motion easy
—an effluvium which must  have been noticed by every one who
* Phil. Trans. 1809, p. 387.
f Id. p. 386.
* Vol. 111. p. 232.
§ Pbysiolog. torn. IX. passim. 
<^L. VI.]
PHYSIOLOGICAL PROEM.
187
has ever attended the cutting up of a bullock in a slaughter-house.
We have formerly had occasion to observe that arteries terminate
in two ways—in minute veins—and in exhalant vessels.  The for-
mer termination can often  be  followed up by injections and occa-
sonally traced by  the microscope;  but no microscopic experiment
has hitherto enabled the anatomist to discover the orifices of the
exhalant branches of arteries.  Their existence, however, is proved,
as Mr. Cruickshank has observed, by their  sometimes, and espe-
cially  when enlarged in diameter  or acted  upon by a more  than
ordinary vis  a  tergo, pouring forth blo«d  instead of  vapour,  of
which we have  a striking instance  in bloody sweat; as also in the
menstrual flux, which though not blood itself, proceeds,  as Dr.
Hunter  has sufficiently shown, from the mouths of the exhalant
arteries of the  uterus, periodically altered  in their diameter and
secernent power.
   II.  The  fluid thus thrown forth to lubricate internal surfaces,
would necessarily accumulate and become  inconvenient,  if there
were not a correspondent set of vessels perpetually at work  to carry
off the surplus.   But such a set of vessels is  every where distribut-
ed over the entire range of the body, as well within as  without, to
answer  this express purpose :  and they are hence called absor-
bents ; and from the limpidity of their contained fluid, lymphatics.
   Their course has been progressively followed up and developed
from  the time  of Asellius,* who, in the year 1622, "reaped the
first laurels in this  field by his discovery of those vessels on the
mesentery  which, from their  carrying a milk-white fluid, he de-
nominated  lacteals,"t  and  whose researches were confirmed and
extended by the  valuable works  of Pecquet,  Rudbeck,  Jollyffe,
Bartholine, Glisson, Nuck, and Ruysch, till  by the concurrent and
finishing demonstrations of Hoffman and Mekel, and more especially
of our own illustrious countrymen Hewson,  the elder Monro, both
the Hunters, and Cruickshank, the  whole of this curious and elabo-
rate economy was completely explained and illustrated towards the
close of the preceding century, and the opposition of Baron Haller
was abandoned.
   The vessels of the absorbent system anastomose more frequently
than either the veins  or the arteries; for it is a general law of
nature that the smaller the vessels of every kind the  more freely
they communicate and unite with  each  other.  We can no more
trace  their orifices, excepting, indeed, those of the lacteals,  than we
can the  orifices of the exhalants ; but we can trace  their united
branches from an early function, and can follow them up singly, or
in the confederated form of conglobate glands, till, with the excep-
tion of a few that enter the right subclavian vein, they all terminate
in the common trunk of the thoracic duct; which, as we have for-
merly observed, receives also the tributary stream of the anasto-
• Epistola ad Haller.
f Hewson, Of the Lymphatic System, p. 2, 
18b
PHYSIOLOGICAL PROEM.
|CL VI.
mosing lacteals or the absorbents which drink up the subactcd food
from the alvine canal, whose orifices are capable of being traced—
and pours the whole of this complicated fluid, steadily and slowly
by means of a valve placed for this purpose at its opening, into  the
subclavian vein of the left side.
  By this contrivance  there is a prodigious saving  of animalized
fluids, which, however they may differ from each  other in  several
properties, are far more  easily reducible to genuine blood, than
new and unassimilated matter obtained from without.
  Yet, this is not all:  for many of the secretions, whose surplus is
thus thrown back upon the system, essentially  contribute to its
greater vigour and perfection.   We have a striking example of this
in absorbed semen, which, as observed on  a late  occasion,* gives
force and firmness to the voice, and changes the downy hair of the
cheeks into a bristly beard : insomuch that those who are castrated
in early  life  are  uniformly deprived of these peculiar features of
manhood.   The  absorption of the  surplus  matter secreted by the
ovaria at the same age of puberty produces an equal influence upon
the mammary glands, and finishes the character of the female sex,
as the preceding absorption completes that of the male.  So, absorp-
tion of fat from  the colon, where,  in  the  opinion of Sir Everard
Home, it is formed in great  abundance, carries on the growth of
the body in youth.t
  Absorbents accompany every part of the general frame so closely,
and with so much minuteness of structure, that Mr. Cruickshank has
proved them to exist very numerously in the coats of small arteries
and veins, and suspects them to be  attendants on the vasa vasorum,
and equally to enter into their  fabric.   Wherever they exist  they
are peculiarly distinguished  by their very  numerous valves,  with
which they are enriched  far more  than any other sets of  vessels
whatever.   " A lymphatic valve is a semicircular  membrane, or
rather of a parabolic shape, attached to the  inside  of the lymphatic
vessels by its circular edge, having its straight edge, corresponding
to the diameter,  loose or floating in the cavity: in consequence of
 this contrivance  fluids passing in one direction make the valve lie
close  to the  side of the vessel, and leave the passage free; but
attempting to pass in the opposite direction, raise  the valve from
 the side of the vessel, and push its loose edge towards the centre
 of  the cavity. But, as this would shut up little more than  one half
 of  the cavity, the valves  are disposed in pairs exactly opposite to
 each other, by which means the whole cavity is accurately closed."$
   The distance at which  the pairs of valves lie varies exceedingly.
 The intervals are often equal and measure an eighth or a sixteenth
part of an inch. Yet the interval is at times  much  greater. " I have
 seen a lymphatic vessel," says Mr. Cruickshank, " run six inches
* Vol. IV. p. 11. Phys. Proem, supra.
f Vol. I. p. 13 of the present work, as also Phil. Trans. 1813, p. 157.
f Cruickshank, Anut, of Absorb, Vessels, p. 66. 2d Edit. 
CL. VI.]
PHISI0L0G1CAL PROEM.
189
without a single valve  appearing in  its cavity.  Sometimes the
trunks are more crowded with valves than the branches, and some-
times I have seen the reverse of this.''*
  In the absorbents, also, we meet  with glands;  their form is mostly
oval, one end being turned to the  thoracic duct and the other from
it:  but  we are in the  same  kind of uncertainty concerning their
use, and, in some measure,  concerning their organization,  as  in
respect to those of the secernent system.  The vessel that conveys
a fluid to one of these glands is called a vas inferens, and that which
conveys it away a vas efferena.  The vasa inferentia, or  those that
enter a gland, are sometimes numerous; they have been detected
as amounting to fifteen or twenty; and  are sometimes thrice  or
oftener as many.   They are always, however, more numerous than
the vasa efferentia, or those which  carry on the fluid towards the
thoracic duct.  The last are consequently, for the most  part, of a
larger diameter, and sometimes consist of a single vessel alone.  It
is conceived by many physiologists that the conglobate mass which
forms the gland consists of nothing more than convolutions of the'
vasa inferentia; whilst others as strenuously contend that they are
a congeries of cells or acini totally distinct from the absorbent ves-
sels that enter into them.   Whatever their structure may be, they
seem to the present author to be powerfully auxiliary to  the valves
by abating the back force they are  unquestionably called at  times
to encounter from some morbid action,  and  there is reason to be-
lieve  that in this way, like the conglomerate glands of the secer-
nents, they become basins or receptacles.
  As in the case of the secernents,  we are also unacquainted with
the means by which the absorbents act.   This, in both instances, is
said to be a vis a tergo,—a term which  gives us little information
in either instance, and  is peculiarly difficult of comprehension  in
the latter.  In their most composite state they possess a very low
degree of sensibility, and are but little supplied with branches from
the larger trunks of nerves.
  Abstruse, however, as the process of absorption is to us at present,
we have sufficient proofs of the fact.  Of six pints of warm  water
injected into the abdomen of a living dog not more than four ounces
remained at the expiration of six  hours.  The water accumulated
in dropsy of the brain, and deposited in the ventricles, we have
every reason to believe is often absorbed from the cavities; for the
symptoms of the disease have been sometimes marked, and after
having made their appearance, and been skilfully followed up  by
remedies, have entirely vanished: and  the  water in dropsy of the
chest, and even at times in ascites, has been as effectually removed.
  It has been doubted by some physiologists whether there be any
absorbent vessels that open on the surface of the body: yet a mul-
titude of facts seem sufficiently to establish the positive side of this
• Loc. citat. 
1D0
PHYSIOLOGICAL PROEM
[CL. VI.
 question, though it is not fluids of every kind that can be carried
 from the skin into the circulating system, and hence their power is
 by no means universal.  Sailors who, when in great thirst, put on
 shirts wetted with saltwater, find considerable relief to this distress-
 ing sensation.   Dr. Simpson, of  St. Andrews, relates  the case of
 a rapid decrease of  the water in which the legs of a phrenitic patient
 were  bathed:  and De Haen  finding that his dropsical patients filled
 equally fast whether  they were permitted to drink liquids  or not,
 did not hesitate  to assert that they must absorb  from the atmo-
 sphere.   Spirits and many volatile irritants seem to be absorbed
 more  rapidly than water, and there can be no doubt that warmth and
 friction are two of the means by which the power of absorption is
 augmented.  " A patient of mine," says Mr.  Cruickshank, " with a
 stricture in the oesophagus, received nothing, either solid or liquid,
 into the stomach for two months: he was exceedingly thirsty, and
 complained of  making no water.   I ordered him the warm-bath for
 an hour, morning and evening, for a month : his  thirst vanished,
 and he made water in the same manner as when he used to drink
by the mouth, and when the fluid descended readily into the sto-
mach."*  The aliment of nutritive clysters seems, in like manner,
 to be often received  into the system, and it  is said, though upon
more  questionable  grounds, that  cinchona, in decoction, has also
 been absorbed  both from the intestines  and the skin.
  Narcotic fluids rarely enter to any considerable extent, and never
 so as to do mischief, respecting which, therefore, the power of  the
 cutaneous absorbents is very limited: and there are few poisonous
 liquids, with the exception of the venereal, that  may not be  ap-
 plied with safety to a sound skin.
  This double process of secretion and absorption was supposed by
 the ancients to be performed, not by two distinct sets of vessels
 expressly formed for the purpose, but by the peculiar construction
 of the arteries, or the veins, or of both.  These are sometimes re-
 presented as being porous, and hence, as letting  loose contained
 fluids by  transudation, and imbibing extraneous fluids  by capillary
 attraction.  There is, in fact, something extremely plausible in this
 view of the subject, which,  in respect to dead animal matter, is al-
 lowed to  be true, even in our own day.   For, it is well known that
 a bladder filled with blood and suspended in the air, from a cause
 wc shall presently advert to,  is  readily permeated with oxygene
 gass, so as to transform the  deep Modena hue of the surface of  the
 blood that touches the bladder into a bright scarlet: and thin fluids
 injected into the blood-vessels of  a dead body transude very gene-
 rally; insomuch  that glue dissolved in water and  thrown  into the
 coronary veins, will permeate  into the cavity of the pericardium,
 and by jellying even assume its figure.   And hence it is that bile is
 often found, after death, to pass through the tunics of the gall blad-
 der and tinge the transverse  aorta of the colon, the duodenum or the

                • Anat. of the Absorb. V«ssels, p. 108. 
CL. VI.]
PHYSIOLOGICAL PROEM.
191
 pylorus with a brown, yellow, or green hue, according to its colour
 at the time.
   The doctrine of porosity or transudation, was hence very gene-
 rally supported till the time of Mr. Hewson, by physiologists of the
 first reputation. Boyle, hence, speaks, as Mr. Cruickshank has just-
 ly observed, of the fiorositas animalium, and wonders that this pro-
 perty should fiave escaped the attention of Lord Bacon.  Even Dr.
 Hunter and Professor Mekel believed it in respect to certain fluids,
 or certain parts of the body.  The experiments of Hewson, J. Hun-
 ter, and Cruickshank, have, however, sufficiently shown that, while
 vessels in losing life,  lose the property of confining their fluids,
 they possess this  property most accurately so long as the principle
 of life continues to actuate them.
   There is, moreover, another method by which the ancients some-
 times accounted for the inhalation and exhalation of fluids, making
 a much nearer approach to the modern doctrine, and that is by the
 mouths of vessels ; still, however, regarding these vessels as arte-
 ries or veins, and particularly the latter.   " The soft parts of the
 body," observes  Hippocrates, " attract matter to themselves both
 from within,  and from without; a proof ihat the whole body ex-
 hales and inhales."  Upon which passage Galen has the following
 comment: "For as the veins, by mouths placed in the skin, throw
 out whatever is redundant of vapour or smoke, so they receive by
 the same  mouths no small quantity from the surrounding air : and
 this is what Hippocrates means when he says that the whole body
 exhales and inhales."
   This hypothesis of the absorption of veins, without the interfer-
 ence of lymphatics, has  been  revived within the last eight or ten
 years by M. Magendie, and M. Flandrin, of Paris, who have made
 an appeal to experiments which appear highly plausible, and arc
 entitled to a critical examination.
  The doctrines  hereby attempted  to be established,  are, indeed,
 varied in some degree from those of  the Greek schools ; and are
 more complex.  In few words, they may be thus expressed : that
 the only general absorbents are the veins;—that the  lacteals mere-
 ly absorb  the food;—that the lymphatics have no absorbent  power
 whatever;—and  that the villi in the different portions of the intes-
 tinal canal are formed in part by venous twigs which absorb  all the
 fluids in the intestines,  with the exception of  the chyle, which last
 is absorbed by the lacteals, and finds its way into the blood through
 the thoracic duct; and that these fluids are carried to the heart and
 lungs directly through the venae portse whose function it is minute-
 ly to subdivide and mix with  the  blood  the fluids thus absorbed,
 which subdivision and  intermixture is necessary to prevent their
 proving detrimental.
  M. Magendie further supposes that the cuticle has no power of
 absorption in a sound state, either by veins or  lymphatics; but that
 if abraded or strongly urged by the pressure of minute substances
that enter into its perspirable pores, the mouths of its minute veins
are thus rendered absorbent. 
192                PHYSIOLOGICAL PROEM.            [CL. VI

  He supposes the function of the lymphatics to consist in convey-
ing the finer lymph of the blood directly to the heart, as the veins
convey the grosser and purple part: and that they rise, as the veins,
from terminal arteries.
  Proper  lymph, in the  system of M. Magendie, is that opaline,
rose-coloured,  sometimes madder-red, fluid  which is obtained by
puncturing the lymphatic or the thoracic duct after a long fast.
It is every where similar  to itself;  and hence differs from the fluid
of cavities which is perpetually varying.  He  supposes the mistake
of confounding the two to proceed from a want of attention to this
fact.
  One of the chief reasons urged for regarding veins as absorbents,
is, that membranes which absorb actively have,  in his opinion, no
demonstrable lymphatics, as the arachnoid.   But, according to Bi-
chat, such membranes have no more demonstrable veins than lym-
phatics; veins are seen to creep on them, but  never to enter.
  The two principal experiments on which M. Magendie seems to
rely in proof that the veins, and not the lymphatics, are absorbents,
are the following :—First, M. Delille  and himself  separated the
thigh from the body of a dog that bad been previously rendered in-
sensible by opium.  They left the limb attached by nothing but the
crural artery and vein.   These  vessels were isolated by the most
cautious dissection  to an extent of nearly three inches, and their
cellular coat was removed lest  it might conceal some lymphatic
vessels.  Two grains of the upas  tiente were then forcibly thrust
into the dog's paw.   The effect of this poison was quite as imme-
diate and intense as if the thigh  had not been separated from the
body: it operated before  the fourth minute, and the animal  was
dead before  the tenth.   In the  second experiment a small  barrel
of a quill was introduced  into the crural artery and the vessel fixed
upon  it by two  ligatures.  The artery was immediately  cut all
round between the two ligatures.  The same process took place
with respect to the crural vein.  Yet the  poison introduced  into
the paw produced its effect in the same manner and as speedily. By
compressing the crural vein  between the  fingers at the moment
the action of the poison began to be developed, this  action speedi-
ly ceased: it re-appeared when the vein was left free, and once
more ceased if the vein were again compressed.
  The experiments are very  striking, and, on a cursory view, may
be supposed to carry conviction with them:  but the confidence of
those  who have studiously followed the concurrent experiments,
and the clear and cautious deductions of our distinguished country-
men, Hewson, both the Hunters, and Cruickshank, will not so easily
be shaken.
  We have  already observed that lymphatic absorbents, in the opi-
nion of the  last of these  writers, probably in the opinion of all of
them, enter as fully into the  tunics of  veins and arteries, and even
into those of the vasa vasorum, as into any other part of the ani-
mal frame:  and hence there  can be no difficulty in conceiving that 
CL. VI.]
PHYSIOLOGICAL PROEM.
195
the poison employed in these experiments  might accompany the
veins by means of their lymphatics.   We also observed that while
the lymphatics anastomose, or run into each other more frequently
than any other set of vessels, their valves, which alone  prevent a
retrograde course, and direct the  contained fluid towards the tho-
racic duct, are occasionally placed at a considerable distance  from
each other, in some instances not less than six inches, and that this
length of  interval occurs in  the  minute twigs as well as in the
trunks.  And hence, admitting that, in the veins that were cut or
isolated in M. Magendie's experiments, such a vacuity of valves in-
cidentally existed, there is also no difficulty  in conceiving by what
course the poisons that have already entered into their lymphatics
from  without should, in consequence of this frequency of anasto-
mosis and destitution of valves, be stimulated to a retrograde course
by the violence made use of, and be thrown  into the current of the
blood from within, by the mouths of those  lymphatics that enter
into the tunics of the veins; and particularly as the separated ves-
sels were only isolated to a distance of less than three inches, while
the lymphatics are occasionally void of valves to double this dis-
tance.
  In some cases we have reason to believe that the lymphatics that
enter into the tunics of the lacteals, which M. Magendie admits to
be a system of absorbents altogether  distinct  from the veins, are
equally destitute of valves in certain parts or directions, and com-
municate by anastomosis  some portion of the chyle  and any sub-
stance contained in it to the interior of the adjoining veins, and con-
sequently to the blood itself: for the  experiments of Sir Everard
Home upon rhubarb introduced into the stomach of an animal, after
the thoracic duct has been secured by a double ligature, show that
this substance, and consequently others as well, is capable of travel-
ling from the stomach into the urinary  bladder, notwithstanding thi6
impediment.   In the singular experiments made with prussiate of
potash by  Dr. Wollaston and Dr. Marcet,  the blood which  was
drawn from the arm during the interval of the introduction of this
substance into the stomach, and its detection in the urine, did not,
indeed, on being  tested,  discover the smallest trace of the prus-
siate, though it was so  obvious in  the fluid of the urinary bladder.
The difficulty of accounting for this is considerable, but may, per-
haps, be explained by the very diffused state  of the prussiate in the
entire mass of the blood, and its greater  concentration when se-
creted by the kidneys:  by which the same test which was applied
in vain in the former instance, completely succeeded in the latter.
  There is, however, another mode of accounting for  the result of
M. Magendie's experiments, without abandoning the well-establish-
ed doctrine of absorption by the lymphatic system.   It is a remark
which ought never to be lost sight of, that experiments made upon
animals in a state either of great pain or of great debility can  give
us, by their result, no full proof of the line of conduct pursued by
nature in a state of health.  In the dead animal body the  valves of
  Vol. IV—B b 
194
PHYSIOLOGICAL PROEM.
[CL. VI.
the lymphatic vessels very generally lose all elasticity and power
of resistance, and transmit fluids in every direction; whence, in all
probability, that porosity or transudation,  which we have  already
observed, as manifest occasionally in the stomach and intestines, and
in various other organs, on the use of anatomical injections.  And
hence there can be little doubt, that as an organ makes an approach
to the same state  of insensibility and  irritability,  by the severe if
not fatal wounds inflicted on it in the course of such experiments
as are here alluded to, the valves of its lymphatic vessels make an
approach also to the same  state of flaccidity,  and  allow the fluids,
whose course they should resist, to pass in any direction.
   This  altered condition of many parts of the lymphatics in the
dead body, was sufficiently shown by Mr. Cruickshank, in a course of
numerous experiments made at Dr. Hunter's Museum, in the spring
of 1773.  The organs chiefly injected were the kidney, liver, and
lungs of adult human subjects.  In one case he pushed his injection
from the artery to  the pelvis and ureter without any rupture of the
vessels.  In another he injected the pelvis and ureter from the vein,
which he thought succeeded better than from the artery.  In three
different kidneys he injected from the uterus the tubuli uriniferi
for a considerable  length along the mammillae ; and in one case a
number of the  veins on the external surface of the kidney were
evidently  filled  with  the injection.  In all these experiments, the
colouring matter of the injection was vermillion.  In numerous in-
stances  he filled the lymphatics of the lungs and liver with quick-
silver ;  and  from the  lymphatics of the liver he was able, twice  in
the adult, and once in the fetus, to fill the  thoracic  duct itself.*
   Dr. Mekelf had already shown the same facts by a similar train
of experiments, instituted  only a year or two before, and the con-
clusion  he drew from them is in perfect coincidence with  the ex-
planation now offered.  Dr. Mekel's experiments  consisted in in-
jecting mercury with great care, but considerable force, into various
lymphatics, and minute secreting cavities; and he found that a di-
rect communication took place between such cavities and lympha-
tics, and the veins  in immediate connexion  with them: and  hence,
he contended, that the lymphatics  and the veins are both of them
absorbents under particular  circumstances ; the lymphatics  acting
ordinarily, and forming the  usual channel  for carrying off secreted
fluids;  and the  veins acting extraordinarily, and  supplying the
place of the  lymphatics where these are in a sute of morbid torfii-
tude or  debility,  or the cavity is overloaded.   He traced this com-
munication particularly in the breasts, in the liver, and  in the blad-
der: and he thus accounts for the ready passage which  bile finds
into the blood, when  the ductus  choledochus is obstructed, as in
  •  Edin. Med. Com I. p. 430.
  f  Nova Experimenta et Observations de fibribus venarum et vasorum lym-
phaticorum in  ductus, visceraque corporis humani, ejusdemque rtructur*
militate. 8vo. 
CL. VI.]
PHYSIOLOGICAL PROEM.
195
juandice; and the urinous fluid which is often thrown forth from
the axillae and other organs upon a suppression of the  natural se-
cretion.
   It follows, therefore, that the experiments of M. Magendie, al-
lowing them to be precisely narrated,  are capable of explanation
without abruptly overthrowing the  established  doctrines of  pre-
ceding physiologists in the same line of pursuit: and we have still
ample reason for believing that the economy of secretion and ab-
sorption is effected by two systems of vessels distinct  from veins
and arteries, and  in a state of health continually holding a balance
with each other.
   III. In different periods of life, many of the secretions vary  con-
siderably in  their sensible properties,  or relative quantity.  Thus
the bile of the fetus is sweet, and  only acquires a  bitter  taste after
birth.   In infancy perspiration flows more profusely than during
manhood ; and the testes which secrete nothing before  the age of.
puberty, at this time acquire activity, and again lose their power in
old age.
   There are also many of the secernent organs that, in  case of ne-
cessity, become  a substitute for each other.   Thus the perspirable
matter of the skin, when supprest by a sudden chill or any other
cause, is often discharged by the  kidneys:  the catamenia by the
lungs ; and the serum accumulated in dropsies by the intestines.
   The secretions are moreover very much affected and increased
by any violent commotion of the system generally. In hysteria the
flow of  urine is  greatly augmented, while  the absorption of  bile
seems diminished; <*nd hence the discharge is nearly colourless. la
violent agitation   of the mind, we  have already observed that the
juices of the stomach become acid;  and sometimes the secer-
nents of the skin, and sometimes those of  the  larger  intestines,
are stimulated into increased action; whence colloquative perspi-
ration, looseness, or both.  The  heat and commotion of a fever
will sometimes produce the same effect and sometimes a contrary;
the skin being dry,  parched and pricking.   And  occasionally the
dryness has been  so considerable as to produce a sudden separation
of the cuticle from the cutis ; of which Mr. Gooch relates a singu-
lar instance in a  patient who for several years, had once  or twice a
year an attack of fever accompanied  with a peculiar itching of the
skin, and particularly of the hands and wrists, that ended in a total
separation of the  cuticle from these parts : insomuch that it could
easily be turned off from the wrist down to the fingers' ends so as to
form a kind of cuticular  glove.*   The same distinguished writer
gives as singular an  instance of the effects of  solar  heat upon
the  skin of  another  patient, who had no  sooner  exposed him-
self to  the  direct rays of the sun, than his skin  began  to be
affected with a sense  of tickling,  became violently  hot, as  stiff as
leather, and  as red as vermillion.f  In this case we  have an instance
* Medical and Chirurgical Observations, 8ve,
t Op. Citat. 
196
I'HiSiOLOGlCAL PROEM.
[CL. VI
  of highly excited action in the cutaneous excerncntsof both kinds,
  and of the formation of new blood-vessels under the cuticle ;  the
  more attenuate part of the fluid secreted being rapidly carried off,
  and hence, the cutaneous integument converted into a coriaceous
  substance.
    There are some parts of the body that waste and become renew-
  ed far more rapidly than others; the fat than the muscles; the mus-
  cles than the bones;  and probably the bones than the skin; for the
  dye of the madder-root with which the bones  become coloured
  when this root has for  sometime formed a part of the daily food of
  an animal, is carried off far  sooner than the coloured lines of char-
  coal powder, ashes, soot, and the juices of  various plants, when
 introduced into the substance of the skin by puncturing or tattooing
 it, a practice common  among our sailors; and still more so,  and
 carried to a far greater degree of perfection, among the inhabitants
 of the South-sea Islands.
   It has been said, indeed,* that the disappearance of the madder-
 colour from the bones, affords no proof that the phosphate of lime
 in which it was seated has itself been carried off at the same time;
 because the serum of the blood is found  to have a stronger affinity
 for madder than the phosphate coloured by it; and hence will gra-
 dually attract and remove it, when the animal is no longer fed with
 the coloured food.  The  experiment,  however,  upon which this
 latter opinion is grounded, has not been hitherto conducted in such
 a manner as to be directly applicable to the question ; and if it had
 been, it would afford no proof that a perpetual, though, in that case,
 a slower change than the madder would exhibit, is not taking place
 in the  bones:  nor are we driven to the effects of madder dye upon
 their solid substance as the only foundation for this opinion ; for
 there is scarcely a bone in the animal  system which does not as-
 sume a different shape at one period of life compared with  that at
 another period : a  remark that peculiarly  applies  to the flat bones
 of the skeleton, and forms the chief cause of that wonderful change
 which  the lower jaw experiences as the individual advances from
 middle of life  to old age, and which often gives a different character
 to the entire face.f
   It is from this mysterious  power of reproduction appertaining to
 every part of  the system, that we are so  often able to renew the
 substance and function of parts that have been  wasted by fevers or
 atrophy, or abruptly destroyed or lopped off by  accident.
   In the progress of this general economy, every organ and part of
 the body secretes for itself the nutriment it requires, from the com-
 mon pabulum of the blood which is conveyed to it, or from  secre-
tions which have already  been obtained from the blood, and deposit-
ed in surrounding cavities, as fat, gelatin,  and  lymph.  And it is

         • Bernouilli, Diss, de Nutritione, Groning. 1669. 4to.
        t Gibson, Manchester Memoirs, Vol. I. 533. 
CL. VI.]
PHYSIOLOGICAL PROEM.
197
 probable that the several organs of secretion, like the eye, the ear,
 and the other distinct organs of sense, are peculiarly affected by
 peculiar stimulants and excited to some diversity of sensation.
   In Germany, this idea has been pursued so far as in some hypo-
 theses, and particularly that of M. Hubner,* to lay a foundation for
 the doctrine of a sixth sense, to which, as we observed on a former
 occasion,t has been given the name of selbstgefiihl or gemeingefuhl,
 "self-feeling," or  "general-feeling."  The sensations, however,
 we are at present alluding to, are not so much general on those of
 the whole self, as particular or limited to  the organs in which they
 originate : and seem rather to be a result of different modifications
 of the fluid that causes the common sense of touch, than produced
 by distinct sensorial secretions.  In most parts of the system these
 modifications are so inconsiderable as to  elude  our notice, but in
 others we have the fullest proof of such an effect;  for we see the
 stomach evincing a sense of hunger, the fauces of thirst, the geni-
 tal organs of  venereal orgasm.  And in  like manner we find the
 bladder stimulated  by cantharides, and the intestinal canal by pur-
 gatives ; and we may hence conjecture that every other part of the
 system, where any  kind of secretion is going forwards, is endowed
 with a like  peculiarity of irritability and sensibility, though not
 sufficiently keen to attract our attention.
   It is hence we meet with that  surprising variety of secretions
 which are furnished  not only by different, but even by the  same
 animal in different  parts of the body.   Hence sugar is secreted by
 the stomach and sometimes by  the kidneys ; sulphur by the brain;
 wax by the ears ; lime by the salivary glands, the secretories of the
 bones, and, in a state  of disease, by the lungs, the kidneys, the arte-
 ries, and the exhalants of the skin : milk by the breasts; semen by
 the testes; the menstrual fluid by the uterus ; urine by the kidneys;
 bile by the liver; muriate of soda by the secernents of almost every
 organ ;  and sweat from every part of the surface.
   Hence some animals, as the bee, secrete honey ;  others, as the
 coccus ilicis, a  large  store  of wax ; others, as the viper and scor-
 pion, gum, which is the vehicle of their poison : others thread, as
 the spider, and some species of slug; and many silk, as the silk-worm
 and the pinna, or nacre ; whence  Reamur denominates  the  pinna
 the sea-silk-worm:  it is common to some of the Italian coasts, and
 its silky beard or byssus is worked at Palermo into very beautiful
 silk stuffs.  There are great numbers of worms, insects, and fishes
 that secrete a very pure, and some of them a very strong phospho-
rescent light, so as,  in some regions, to enkindle the sea, and in
others the sky, into  a bright blaze at night.  Many animals secrete
air ; man himself seems to do so under certain circumstances, but
fishes of various kinds more largely, as those furnished with air-
* Comment, de Cxnesthesi, 1794.
t Vol. HI. Physiol. Proem, p. 12. 
198
PHYSIOLOGICAL PROEM.
[CL. VI.
bladders, which they fill or exhaust at pleasure, and the sepia or
cuttle-fish, with numerous other sea-worms : and by this power they
raise or sink themselves as they  have occasion.  The  cuttle-fish
secretes also a natural ink, which it evacuates when pursued by an
enemy, and thus converts it into an instrument  of defence : for by
blackening the water all around, it obtains a sufficient concealment
and easily effects its escape.  Other animals, and these also chiefly
fishes, secrete a very large portion of electric matter, so as to con-
vert their bodies into a powerful battery.  The  torpedo-ray  was
well-known to the  Romans to possess this  extraordinary power :
and the gymnotus electricus (electric eel,) has since been discovered
to possess it in a much larger proportion.   The genus tetradon in
one species secretes an electric fluid,  in another an  irritating fluid
that stings the hand that touches it, and in a  third a poisonous mat-
ter diffused through the whole of its flesh.
   From  the same cause we meet with as great  and innumerable a
variety of secretions among plants, as camphors, gums, balsams,
resins :  and, as in animals, we often meet with very different secre-
tions, in  very different parts of the same plant.  Thus the mimosa
nilotica secerns from its roots a fluid as offensive as that of assofce-
tida ;  in the sap of its stem an astringent acid; its glands give forth
gum arabic ; and its flower an odour of a very grateful fragrance.
   This  subject is  highly  interesting, and  might be extended to
volumes, but we are already digressing too far.  There is no part
of the body in which the process of secretion is not going forward ;
we trace it,  and consequently the  fabric  which gave rise to it, in
the parenchyma or intermediate substance of organs, in their inter-
nal surfaces and outlets, and on the external  surface of  tbe entire
frame :  thus forming three divisions of prominent distinction,both
in respect to locality  and  to the  diseases which  relate  to them.
It is on these divisions, that the orders of the  present class arc
founded. 
    CLASS  VI.

ECCRITICA.
                        ORDER I.

                      MESOTICA.

           ©tseases affecttns tHe $arenchgma.

pravity in the quantity or quality of the intermediate or
  connecting substance of organs;  without  inflammation,
  fever, or other derangement of the general health.

The classic termECCRiTiCA is a derivative from ouce^o, " secerno,"
" exhaurio," " to secern or strain off," " to drain or exhaust," and
is preferred  by the author to any other derivative which wia, its
primitive, affords, as equally applicable to the two systems of vessels
that enter into the general and important economy illustrated in the
preceding Proem.  The ordinal term mesotica is derived from
n«<rof, "medius;"  for which parenchymatica  might  have been
substituted, but that there are two objections to the use of the latter:
the first is, that -xxex is here  employed in a different sense from its
general signification in the system before  us,  which  is that  of
" male," or " perperam,"—instead of fieror fiernitus, its real mean-
ing in  parenchyma; and, consequently,  the double signification
would  trench upon that simplicity and uniformity which it is the
direct object of the present nomenclature to maintain. The second
objection is, that the term parenchyma (7rxgty%vf*.x) is formed upon
a false hypothesis,  invented by Erasistratus, who first employed the
term, and held that the common mass or interior substance of a
viscus  is produced by concreted blood,  strained off through the
pores of the blood-vessels which  enter into its general structure or
membranes.
  The order embraces the five following genera:

         I. POLYSARCIA.           CORPULENCY.
        II. EMPHYMA.             TUMOUR.
       III. PAROSTIA.              MIS-OSSIFICATION.
       IV. CYRTOSIS.               CONTORTION OF THE BONES.
        V. OSTHEXIA.              9STHEXY. 
:00                     ECCRITICA.             [CL.V1.-0K. I.



                       GENUS 1.

                     POLYSARCIA.

                       (Eoqmlencs.

FIRM AND UNWIELDY BULKINESS OF THE BODY OR ITS MEMBERS, FROM
              AN ENLARGMENT OF NATURAL PARTS.

Polysarcia, from TuXuTx^oi, "carnosus," "carne abundans," im-
ports bulkiness from any morbid increase of natural parts, whether
fleshy or adipose : and the present genus is co-extensive with this
latitude of interpretation.  In medical history, however, we know
of no morbid increase of this kind except from an accumulation ot
fat; and hence the genus is at present limited to a single species, as
follows:

             1. ADIPOSA.               OBESITY.
                      SPECIES  I.

              POLYSARCIA ADIPOSA.



    BULKINESS FROM A SUPERABUNDANT ACCUMULATION OF FAT.

This species admits of two varieties.   For it may be

x Generalis.                 Extending over the body and limbs.
  General obesity.
£ Splanchnica.               Confined to the organs or integu-
  Splanchnic obesity.           ments of the trunk.

  In man and other animals fat is collected in the follicles of the
cellular membrane, accumulated in  the groin,  axilla, omentum,
around the kidneys, and the blood-vessels.  It is likewise secreted
on the surface of the skin, which it protects from acrid substances,
and where it sometimes secretes, often  from want of cleanliness,
or being intermixed with hardened mucus, in the shape of minute
worms, forming the varus fiunctatua, or maggot-pimple of the third
Order of the present Class.  When the perspiration becomes pro-
fuse, in consequence of hard walking or other exercise, a certain
portion of animal oil is dissolved in this fluidj which makes the chief 
<SE.T.—SP.I.]        EXCERNENT FUNCTION.
201
perhaps the only difference between the matter of perspiration and
that of sweat.   Fat is, hence, accumulated by diminished perspira-
tion ; as it is also by  the nature of the aliments  fed on, and from
idiosyncrasy.  It is the basis of steatomatous tumours, and contains
the sebacic acid which acts readily on  many metals, as lead, copper,
and iron.
  In many fishes, as the salmon and herring, it is diffused over the
whole body, as though the body were steeped in it. In other genera
of fishes,  as the ray,  it is found in the liver alone-   In  some  few,
as the whale, it appears in the form offtakes, and is called blubber,
which sometimes amounts to the enormous quantity of three tons
in an individual.
  Fat is a bad conductor of heat; and hence, one of its uses  is that
of keeping the body warm; on which account those who are in-
cumbered with fat  perspire with  but  a small  quantity of exercise,
and are almost always too hot.  We  may hence  also see why the
warmth of the body is  retained  by oiling the surface,  or wearing
oiled skin  over it.  Fat  is also of considerable  use  in  lubricating
the solids, and facilitating their movements;  in preventing  exces-
sive sensibility ; while by equally distending the skin, it coniributes,
when not in excess, to the  beauty  of the person.  In cases of ex-
treme hunger, or of  abstinence from food, fat is re-absorbed and
carried to the blood-vessels; and from an experiment of Dr. Siark,*
it appears to be more capable of supplying the waste of the body
than any sort of ordinary food.  And  hence, there is much  proba-
bility in  the conjecture of Lyonet that  insects, destitute of  blood,
derive their chief nourishment from the fat in  which they abound.f
  With the exception, however, of the earth of the bones, it is the
least animalized of all the substances that  enter into the composi-
tion of the animal frame.  Chemically examined pure fat contains
no azote,  which is the peculiar characteristic  of animalization; it
has also little oxygene, consisting chiefly, indeed, of hydrogene and
carbone.  " I do not consider," says Mr. John Hunter, "either the
fat or the earth of bones, as a  part of the animal: they are not ani-
mal matter: they have no action within  themselves:  they have not
the principle of life."! It i6 of late formation in the fetus : scarcely
any trace of its existence is discoverable before the fifth month from
conception.
  The mode of  its production is still  a matter  of controversy.  By
some it has been supposed to be secreted  by  peculiar  glands, by
others merely to transude from exhalant arteries of a  peculiar kind.
Sir Everard Home  has lately started  another hypothesis,  which is
at least highly ingenious and plausibly supported.  He has attempt-
ed to prove that the fat of animals  is  produced in the larger intes-
tines, (especially the colon,) out of the recrement of the food and
• Hewson, II. p. 151.
f Tr. Anat. de la chenille qui rouge le bois de saule, pp. 428. 483, et seq.
* On Blood, p. 440.
Vol. IV.—C c 
202
ECCRITICA,
[GL. VI.—OR. I
 the  bile, and afterwards conveyed into the system generally by
 channels yet undiscovered to contribute towards the common growth
 of the system, especially in early life.*   And some arguments in
 favour of this opinion may be drawn from the nature of that species
 of enterolithus, to which in the present system is given the name
 of scybalum  and from the observations with which it has been illus-
 trated, f
  In  general obesity, or the variety of adipose polysarcia immedi-
 ately before us, the bulk of the body has sometimes  been enormous.
 It has amounted to five hundred, and nearly six hundred pounds in
 many instances.   Bright, of Maldon, weighed seven  hundred  and
 twenty-eight  pounds; Lambert of Leicester, seven  hundred  and
 thirty-nine pounds a little before his death, which was in the fortieth
 year of his age.  The German journals give us examples of men
 who weighed eight hundred pounds.  Yet the Philosophical Trans-
 actions  furnish perhaps a still  more extraordinary example of  this
 disease  in a  girl  that weighed two hundred and fifty-six  pounds,
 though only four years old.f
  Where a powerful adipose diathesis prevails, fat is often  produc-
 ed whatever be the food  fed upon.  Ale and porter drank to excess,
 are, perhaps, the most ordinary means;  Akermann gives proof of
 the same effect  from spirits :§ and in  the  Ephemera of  Natural
 Curiosities is the case of an individual  who generated fat faster,
 and in larger quantities,  upon bread than upon a meat diet.U  Indo-
 lence and indulgence in sleep seem necessary,  however,  in every
 instance.
  In these cases the animal oil  is  sometimes secreted and deposited
 in the cellular membrane almost as rapidly as water in anasarca :
 on which account obesity has by some writers been called, and cor-
rectly enough, a dropsy of fat. It is, in fact, under particular circum-
 stances, the soonest formed  and deposited, and the soonest absorbed
 of all the animal secretions.  For its formation, however,  ease of
 body and mind are indispensable, and perhaps  a slight increase in
 the flow of sensorial power  beyond the common standard, or what
 has hitherto  been the standard of an individual.  It is on this  ac-
 count those are apt to become  fat who suddenly relinquish  a  habit
of hard  exercise either of body or mind  for  a life of  quiet enjoy-
ment, provided the change be not sufficient to interfere with  the
 general  health.  And for the same reason, as we have already ob-
 served, animals which are castrated, and females that do not breed,
or who have just ceased to breed, grow fat and corpulent with equal
 ease; the sensorial power intended for the use of the sexual organs,
 and to be expended  at  a particular outlet,  being  hereby  thrown

          • Phil. Trans, for 1813. p. 158. and 1816. p. 301.
          f Vol. I. p. 191.
          * N. 185.
          % Baldinger N. Mag. B. VI. p. 489.
          | Dec. III. Ann. VII. VIII. p. 138. 
6E. I.—SP. I.]
EXCERNENT FUNCTION.
203
back upon  the  system generally, and transferred to the adipose
secernents.  And hence, also, the cause of that increase of bulk
which most persons experience about the middle of life,  when the
muscles  have attained their utmost  firmness,  the  stature its full
height, and the sexual economy its perfection, there is a less de-
mand for the ordinary supply of sensorial power than has hitherto
been made,  and the surplus is expended in broadening and round-
ing the general  frame by filling up the cells of the adipose mem-
brane with animal oil, instead of elongating it.
  For all this, however,  there must be an ease of body  and mind
approaching to cheerfulness; on which account plumpness,  and
cheerfulness,  or good humour,  are commonly associated in our
ideas: for pain and anxiety, that wear away the  corporeal substance
generally, make their first inroad on the animal oil, and empty the
cells of the adipose  membrane before  they produce any manifest
effect on the muscular fibres, or, as these are  collectively termed,
the flesh ; upon which subject we have already touched in discuss-
ing several of the species of  the genus marasmus.*
  Hence the fat becomes absorbed or carried off, as it is secerned
and deposited more readily than any other animal substance.  By
sweating, horse-riding, and  a spare diet, a Newmarket jockey has
not unfrequently reduced himself a stone and  a half in a week or
ten days :f  and a plump widow has, by weeping, become a skeleton
in a month or  two.
  A moderate increase in the secretion  of animal oil rather adds to
the facility of motion, and improves the beauty of the person.  But
if it  much  exceed, the play of these different organs upon each
other is impeded, the pulse is oppressed, the breathing laborious,
there is an  accumulation of blood in the head, a general tendency
to drowsiness, and a perpetual danger of apoplexy.
  In splanchnic obesity, the encumbered  viscera are  more or
less buried in  beds of fat, and usually accompanied with  scirrhous
affections; making an approach to some species or other of para-
bysma, as described in the first Class and second Order of the present
system.^  We have observed that general obesity may be regarded
as a dropsy of animal oil instead of a dropsy of water.  And, as the
latter disease is sometimes universal and runs through the whole
of the cellular  substance,  and at others local, and confined to parti-
cular cavities,  the former also exhibits  both these  modifications;
and in the variety before us,  is confined to individual organs.
  It most generally overloads the omentum, and gives that project-
ing rotundity to the abdomen which is vulgarly distinguished by the
name of pot-bellt, and is well described by Prince Henry in his
• Vol. II. p. 494.
t Code of Health, by Sir John Sinclair, &c.
t Vol. I. p. 273. 
2(H                       ECCKITICA.            [CL. VI.—OK.

address to Falstaft', as " huge hill of flesh,"*—" a globe of sinful
continents."f
  Animal oil is more apt to accumulate in the abdominal  viscera
than on the surface, and hence while these organs always participate
in a general obesity,  it is not to be wondered at that  they should
sometimes be loaded  alone.  As it has  been stated that freedom
from pain is necessary to its  accumulation, it may, perhaps, be a
matter of surprise that scirrhosities  should be a concomitant. But
this morbid condition 'akes place so  slowly as to  produce little or
no local disquiet;  while the  small degree of increased irritability
that accompanies their formation, for a reason already assigned,
tends rather to promote the morbid deposit than to prevent it.
  In attempting a  cure of the general  disease, the first step is  to
avoid all the common and more obvious causes as much as possible.
Hence, as a life of indolence and indulgence in eating and drinking
is highly  contributory to obesity, the  remedial treatment should
consist in  the use of severe, regular, and habitual exercise, a hard
bed, little -deep, and dry and scanty  food, derived from vegetables
alone, except where, from  a singularity of constitution, farinaceous
food is found to be a chief source of obesity.  And where these are
insufficient, we may have recourse to  frequent venesection, and such
medicines as freely evacuate the fluids whether by the bowels  or
the skin. And, for the same reason, sialagogues, as chewed tobacco,!
and mercury, have occasionally been used with success.§
  Generally speaking, however, the  diet  and regimen just recom-
mended, with a spare allowance of water,, will be sufficient  to bring
down the  highest degree of adipose  corpulency.  Of  this we have
a striking example in the history of Mr. Wood, the noted miller of
Billericay in E->sex.   Born of intemperate parents, he was accus-
tomed to indulge himself in  excessive  eating, drinking,  and indo-
lence, till, in the forty-fourth year of bis age,  he became unwieldy
from his bulk, was almost suffocated, laboured under very ill health
from indigestion, and was subject to fits of gout and epilepsy.  For-
tunately a friend pointed out to him  the Life of Cornaro:  and he
instantly determined to take Cornaro  for his model, and if necessary
to surpass his abridgments.  With great  prudence,  however, he
made  his change  from a highly superfluous  to a very spare diet
gradually : first diminishing his ale to a pint a day, and using a much
smaller portion of animal food ; till, at length, finding the plan work
wonders as well in his renewed vigour of mind as of body, he limited
himself to a diet of simple  pudding made of sea biscuit, flour, and
skimmed milk, of which he  allowed himself a pound and a half about
four or five o'clock in the morning for  his breakfast, and the same
• Henry IV. Part I  Act II.
f Id. Pari II. Act II.
* Borelli, Cent. II Obs. 11
§Barholin. Act.  Mafn. 1. Obs 74.
  Bonet, Sepulchr.Lib.il. Sect.ii. Obs. 36. Appx. 
'..E. I.—SP. 1.J       EXCERNENT FUNCTION.               205

tmantity at noon for his dinner.  Besides this he took nothing either
of solids or fluids, for he had at length brought himself to abstain,
even from water; and found  himself easier without it.   He went
to bed about eight or nine o'clock, rarely slept for more than five
or six hours,  and hence rose usually at one or two in the morning,
and employed himself in laborious exercise of some kind or other,
till the time of his breakfast.  And  by this  regimen he reduced
himself to the condition of a middle s;zed man of firm flesh, well
coloured complexion and sound  health.*   A  like plan,  or rather
something approaching it, the present author once recommended
to Mr. Lambert of Leicester, on  being consulted concerning  the
state of his health.  But either he had not courage enough to enter
upon  it, or did not choose  to relinquish  the profit obtained by
making a show of himself in this metropolis.   He made his choice,
but it was a fatal one,  for he fell a sacrifice to it in less than  three
years afterwards.
   The local disease is for the most part far less manageable:  but
it has sometimes yielded to a steady perseverance in the above plan,
in connexion with active  purgatives, and the application of mercu-
rial ointment to the vicinity of the organ affected; or a free  use of
calomel in the form of pills.
                      GENUS II.

                     EMPHYMA

                         humour.

SLOMERATION in the substance of organs from the production
  OF NEW AND ADSCITITIOUS  MATTER :  SENSATION DULL, GROWTH
  SLUGGISH.

Phyma, in  the present system, is limited to cutaneous tumours
accompanied with inflammation, as already explained in Class III.
Order Il.f   Emphyma  imports, in contradistinction to phyma, a
tumour originating below the integuments, and accompanied with
inflammation, at least in its  commencement:  while  ecphyma in
Order  III. of the present Class, imports, in contradiction to both,
mere superficial extuberances, confined to the  integuments alone.
The term glomeration, or "heaping into a ball," in the generic de-
finition, is preferred to the more common  terms protuberance or
extuberance, because some tumours or emphymata lie so deeply
seated  below the integuments as  to produce no prominence what-
ever, and are only discoverable by the touch.
• Med. Trans. Vol. II. Art. XVII.
t Vol. II, p. 190, 
206
ECCRITICA.          [CL. VI.-OR. I.
  The species of this Order, and much of their general character
and arrangement, are taken with a few variations from Mr. Aber-
nethy's valuable Tract on Tumours.
  The subject, indeed, though of a mixed description, is commonly
regarded as appertaining rather to the province of surgery than of
medicine, from the tendency which most tumours seated on or near
the surface have to  open externally, or to call for some  manual
operation.  In a general system of the healing  art,  however, it is
necessary to notice them,  though it is not the author's intention to
dwell upon them at length : but rather to refer the reader, from the
few hints he is about to pursue, to Mr. Abernethy's work, as  the
best comment upon them which he can consult.
  The species embraced by the genus phyma are the following:

     1. emphyma sarcoma.        sarcomatous tumour.
     2.------encystis.        encysted tumour. wen.
     3.  ■ ■       exostosis.      bonytumoup.
                       SPECIES I.

               EMPHYMA SARCOMA.

                 Sarcomatous STumour.

     TUMOUR IMMOVABLE ;  FLESHY AND FIRM TO THE TOUCH.

The varieties of this species, modified in respect to structure and
situation, are very numerous.   The following, distinguished by the
former quality, are chiefly worthy of notice:

« Carnosum.              Vascular throughout: texture simple:
  Fleshy tumour.             when bulky mapped on the surface
                            with arborescent veins.  Found over
                            the body and limbs generally.
£ Adiposum.              Suetty throughout:  inclosed in a thin
  Adipose tumour.           capsule of condensed cellular  sub-
                            stance : connected by minute vessels.
                            Found  chiefly in the fore and back
                            part of  the trunk.
y Pancreaticum.          Tumour in irregular masses; connect-
  Pancreatic tumour.         ed by a loose fibrous substance, like
                            the irregular masses of the pancreas.
                            Found  occasionally in  the cellular
                            substance, but more usually in con-
                            voluted glands: chiefly in the female
                            breast. 
CE. II.—SP. I.]      EXCERNENT FUNCTION.                207
^ Cellulosum.
  Cystose tumour.
    Derbyshire-neck.
Scirrhosum.
 Scirrhous tumour.
^Mammarium.
  Mammary tumour.
jj Tuberculosum.
  Tuberculous tumour.
                           Tumour cellulose or cystose:   cells
                             oval, currant-sized or grape-sized,
                             containingaserousfluid; sometimes
                             caseous. Found generally, but most-
                             ly, in the thyroid gland, testis, and
                             ovarium.
                           Hard, rigid,  vascular,  infarction of
                             grandular follicles ; indolent, insen-
                             tient, glabrous; sometimes shrink-
                             ing and becoming more indurated.
                             Found in glandular structures, chief-
                             ly those of the secernent system.
                           Tumour of the colour,  and assuming
                             the texture of the mammary gland :
                             dense and whitish : sometimes softer
                             and brownish : often producing, on
                             extirpation, a malignant ulcer with
                             indurated edges.   Found in various
                             parts of the body and limbs.
                           Formed of firm, round, and clustering
                             tubercles ; pea-sized or bean-sized;
                             yellowish  or  brownish-red;  when
                             large, disposed to ulcerate, and pro-
                             duce a painful, malignant, andofien
                             fatal sore.  Found chiefly in the lym-
                             phatic glands of  the neck :   often
                             simultaneously in other glands and
                             organs.
                           Of a pulpy consistence and brain-like
                             appearance ;  whitish ;  sometimes
                             reddish-brown; when large, apt to
                             ulcerate, and produce a sloughing,
                             bleeding,  and  highly dangerous
                             sore.   Found  in  different parts;
                             chiefly in the testes: at times pro-
                             pagating itself along the absorbent
                             vessels to adjoining organs.

  All these grow occasionally to an enormous size, particularly the
sarcomatous, the  adipose, and the scirrhous.  They are  all  pro-
duced by some  increased action or irritation  in the part in which
they occur, the cause of which it  is rarely in  our power to ascer-
tain.  In general,  they commence slowly and imperceptibly,  au_d
are seldom  accompanied with  much  pain whatever be  the ex-
tent of their growth.   They  are all more or less organized  through
the whole of their structure, by which they are particularly distin-
guished from those of the next species: and it is highly probable
that most of the irritating causes which produce any one, produce
all the  rest, the modification depending on the difference of site,
« Medullare.
  Medullary  tumour. 
20&                     ECCRITICA.             [CL. VI.—OR. I.

hadit, idiosyncrasy, or local misaffection.   In their formation, how-
ever, there seems to be a greater tendency to inflammation, and
especially adhesive inflammation in the fleshy tumour, or proper
sarcoma, than in any of the rest; and, from the more perfect elabora-
tion of its fabric, there is no other  form  that maintains  itself so
firmly, oris removed, excepting by excision, with so much difficul-
ty.   The origin  of the  adipose may, in some degree, be understood
from the remark we have offered  under  the last genus, and parti-
cularly under its second variety.
  The scirrhous tumour, when irritated, has a general tendency to
run into a cancerous ulcer; for which it is  not  always  easy  to ac-
count, excepting where there happens to be an hereditary taint in
the blood : for neither the tumour nor its ordinary result, as we ob-
served when treating of carcinus, is by any means confined to a
glandular or to any particular structure, though the secernent glands
constitute us most common seat.   In Mr. Aherneihy's Treatise, the
place of the scirrhous tumour, however, is occupied by another to
which he gives the name of carcinoma, which, in the  present sys-
tem, is regarded as a modification of the scirrhous, degenerated, and
ulcerated mostly by a cancerous diathesis; and in such  case  apper-
taining 10 carcinus, already described  in  the  fourth  order  of the
third class ;* or  where no such diathesis  is present,  belong ingto
the same class and order under the genus  and  species  ulcus viti-

  The scirrhous tumour  is, in  fact, the most important  of the
whole tribe, not only as leading, under peculiar circumstances, and
in particular  habits, to the  most fatal  result, but as being  more
common to every organ than any  other variety whatever; and, in a
few instances, common to almost  every organ collectively or at the
same timet.
  The other varieties are looser and more  spongy, and contain far
less of living power : in consequence of which  they are more easily
disposed to ulcerate, and, when in this condition, often spread and
become sordid and malignant from debility alone.
  We have said that the tumours of this  species will sometimes
grow to a vast and preposterous bulk. This is particularly the case
with the first variety or fleshy sarcoma, and more especially when
it seats itself  in  the scrotum, forming  the saroocele, or hernia
carnosa of authors.   Negroes  are particularly  subject  to this
affection, and in  one instance the tumour weighed fifty pounds.§  It
is said that among them the disease is more common to the right
testicle than to the left.  Stoll, however, ha6 asserted  directly the
contrary so far as relates to Europeans, and his remarks are sup-
ported by  the observations of  Pfeffinger  and  Friedius.  He has
• Vol. II. p. 534.
f Vol. II. p. 616.
$ Henggen, Museum der Heilkunde, Band. II. p. lit.
f Schotte, Phil. Trans. Vol. LXX11I. 1783. 
c;e. ii.—sp. i.]
EXCERNENT FUNCTION.
209
moreover generalized his assertion by contending that the  left
ovary of women as well as the left testicle of men is more subject
to diseases of all kinds than the right.*
  The adipose tumour is also frequently of a very large magni-
tude.  Mr.  Abernethy gives an instance of one on the  thigh that
weighed fifteen pounds after extirpation,! and M. Leske of another
of the weight of nineteen pounds dissected from the face4  In  the
Journal de Medicine, is an  account of a  third, that weighed not
less than forty-two pounds.§
  The bulk of the scirrhous tumour, however, and especially when
seated on the  breast, has often equalled and sometimes  exceeded
the largest of these.  M. Leske, indeed, gives a case, in which a
tumour of this kind was amputated from the breast, of  the enor-
mous weight of sixty-four pounds, that had been  increasing for
years, and was at last  so oppressive as to endanger the patient's
life.H
  The most unsightly, however, of the whole is the sarcoma cellu-
/o«um,whenit fixes on the thyriod gland, in which situation it is often
called Botium, Bronchocele, or Goitre  ; and, in our own vernacular
language, Derbyshire neck, fromavulgar idea of considerable an-
tiquity, that the inhabitants of this county are more subject to it
than  those of other districts.  The cells are here very numerous,
the fluid often viscid, and sometimes gelatinous;  so that, when the
tumour bursts, as it  occasionally does,  spontaneously, the contained
fluid is apt to drain  away very  slowly, and has  ulcerated with a
large sloughy surface without having half evacuated its contents.
   Most of these may be frequently repressed or resolved if disco-
vered and attended to  in their origin.   The fleshy,  which always
commences with some degree of inflammatory action, should be vi-
gorously attacked with leeches, repeated as often as may be neces-
sary, and afterwards with astringents  or alterants,  as  the  dilute
solution of the superacetate of lead, for the former purpose, and the
mercurial emplaster for  the latter.  An issue or  seton in the vici-
nity will also frequently assist by producing a transfer of action.  If
this plan does not succeed the tumour  should be extirpated by the
knife without loss  of time, or allowing it to acquire any consider-
able bulk.
   The scirrhous tumour is usually indicative  of weak,  instead of
entonic, action in  the organ  in  which  it maks its  appearance,  in
consequence of which the lymphatics absorb only the more attenu-
ate part of the secerned fluids, and leave the grosser, which thicken
and  harden in the parenchyma.   There is  little irritation at first,
but as the distention and obduration  increase,  the part  becomes
stimulated, and, as we have already observed in a scrofulous can-
   • Nov. Act. Physico-Med. Acad. Nat. Cur. torn. IV. Norim.
   f On Tumours, p. 31.8vo. 1814.
   $ Auserlesene Abhandlungen, &c. Leipzig, 1774, 8vo.
   § Tom. XX. p. 551.              B Op. citat.
Vol. IV.—D d 
210
ECCRITICA.
[CL. VI.—OR. 1
cerous diathesis is apt to call the latent seminium into action, when
the hardened  tumour degenerates into a foul ulcer.   In an early
stage they have yielded  to local irritants, which have a tendency to
excite an increased action, and of a new kind, and hence the ad-
vantage of mercurial applications, or emplasters of the gum-resins:
and particularly the emplaster of ammoniac with quicksilver, which
unites the  two, and is an admirable preparation.  Where, indeed,
the irritation is already considerable, the more direct of these sti-
mulants must be abstained from, and the inirritants and narcotics
may be had recourse to  with more advantage, as the preparations
of lead,  acids of almost every kind, and cataplasms of hemlock,
henbane, belladonna, or potato-leaves.   But  here  also the  best
and most effectual relief is to be had in extirpation, and the actual
cautery,  as employed by  M. Maunoir,* will often be found more
effectual and even produce less pain than the knife.
   Many of these varieties of tumours, on their first appearance, may
be repelled by stimulant applications in conjunction with a steady
pressure wherever this can be  applied: for, with the exception of
the first,  there is little tendency  to inflammation in any of them, and,
in the greater number,  a decided weakness of the  living power.
They are often, indeed,  connected with  constitutional debility, and
hence appear  simultaneously in different parts of the body.   Ex-
tirpation in this  case is useless; at least till the general frame is
invigorated by a tonic regimen and course of medicines.  And even
then, from the peculiar seat or size of the tumour, it will not always
be found advisable.
   This is particularly true in that variety of the cystous sarcoma
which is denominated  bronchocele, goitre, or  derbyshire-
neck ; and which usually proceeds from an enlargement of the thy-
roid gland.  It is mostly found in females, and in its commencement
the patient and her friends always turn a deaf ear to the use of the
knife, under a hope that it may yield to a course of external and
internal  medicine: nor is the  tumour, indeed, at all times suffi-
ciently defined from  the  first for any effective use of chirurgical
means.  It originates without pain or any discoloration of the skin,
and presents a general  prominence on  the fore part of the neck,
that rises so gradually as to be at  first almost without an outline.
As the prominence increases, it becomes harder and  somewhat
irregular, commonly with a partial feeling of fluctuation, though, in
some instances, the tumour appears to be firm throughout.   The
skin grows yellowish, and  the oppressed veins of the neck become
varicose; the respiration is sometimes rendered difficult, and from
the same cause the patient is troubled with head-aches.  The ex-
pediency of removing the tumour is, at this time, highly question-
able, and every  day  increases the  difficulty from the growing
diameter of its arteries, and their proximity to the carotids.
*  See Vol. II. p. 617. 
GE. II.—SP. I.]       EXCERNENT FUNCTION.               211

  The internal substance and structure of this  tumour differs ex-
ceedingly in  different cases.  It has sometimes been found steato-
matous throughout, but more generally, as we have already observ-
ed, consists of a fluid varying  in  viscidity, and in the number of
cells or capsules in which it is locked up.  It commonly first shows
itself in girls who  have reached  the age of puberty, though it fre-
quently commences at a later period; and is  an ordinary symptom
of cretinism,  as we shall notice when treating of that disease in the
course of the present order.
  Here also we have deficient living power in  the organ affected,
and very  generally in the entire constitution;  for it usually appears
in girls of relaxed and  flaccid fibres, in many cases  partly debili-
tated by growth, and partly by a larger flow of catamenia than the
general tone  of the system can sustain without  yielding.   On this
account we may see why cretinism  should be a  cause.
  Stimulants and tonics have hence been found generally useful, as
have also repeated and long continued friction  with the hand over
the area of the tumour, alone or  in conjunction  with ammoniacal or
terebinthinate irritants, chiefly solutions of camphor in spirits.  For
a reason  that does not seem hitherto to have been sufficiently ex-
plained, in this kind of tumour,  as  in those of scrofula, the  most
successful stimulants are the alkalies : and of these the ammoniacal
were at one time believed to be far more so than any of the  rest;
and hence the patient was limited altogether to a course of burnt
sponge or burnt hartshorn, and at one time to burnt toads.  There
does not  seem, however, to be any particular reason for this predi-
lection, and hence, in the  present day, the subcarbonate of ammo-
nia, or the carbonate of soda, have been pretty generally allowed to
supply the place of all  the  other preparations of this kind, as the
most convenient form in which the  alkali can be given.  It is also
recommended to be applied externally, in the form of  sea-water, or
the  bibulous  sea-plants, as  already described in the  treatment of
scrofula:*  the whole of the remedial process  for which may be
adopted as the fittest line of conduct on the present occasion:  both
diseases being chiefly seated in the  glandular parts of the animal
frame, and accompanied  with  great indolence in the lymphatic
system.
  The tumour has sometimes  been cured spontaneously ; an in-
stance  of which occurred not long ago to the present author, in a
young  lady who had for six or seven years been  successively under
the care of all the most skilful physicians and surgeons of this me-
tropolis, and who had, nevertheless,  the mortification of finding the
protuberance grow much larger, and  more  unsightly in spite of
frictions, and  blisters, and setons, and mercury  in every form, and
the  alkalies, and hemlock,  and hyosciamus, employed jointly or al-
ternately, and in almost every proportion through the whole of this
period.   The distended skin at length gave way in various places.
* Vol. II. p. 530. 
21£
ECCRIT1CA.
[CL. VI.—OR.
and a thin fluid issued from the foramina.  This natural discharge
was  encouraged, and  the  sac by degrees exhausting itself^ the
tumour as gradually diminished, and at length completely disap-
peared.
                        SPECIES II.

                EMPHYMA  ENCYSTIS.

                SSncgstetr arumottr.  QWen.

    tumour moveable; pulpy; often elastic to the touch

A very small change in the power or mode of action of a secernent
vessel will often produce a very considerable change in the nature
of the fluid which it secretes.   Of this we have a clear proof in the
thin and acrid lymph  poured forth from the mucous membrane of
the nostrils in a catarrh, and the bland and viscid discharge which
lubricates this cavity in a state of health ; limpid  and mucilaginous
at first, but  gradually hardening into a horny substance.  So the
lungs, which, when sound, secrete a mild, when in a morbid condi-
tion, throw out a tenacious phlegm, a watery, or  whey-like sanies,
or a muculent pus.  And we may hence easily account for the great
diversity of  materials found in the species of tumour before us,
which is peculiarly  distinguished by being surrounded with a pro-
per cyst, and hence rendered moveable to the  touch.
   To follow up the subdivision through the whole of the varieties it
offers, would be almost endless. The following are  chiefly worthy
of notice:

x Steatoma.         Encysted extuberance, containing a fatty 01
   Steatome.           suetty substance, apparently  secreted  from
   Adipose Wen.      the internal surface of the cyst.  Found over
                     most parts of the  body, and varying in size
                     from that of a kidney bean to that of a pump-
                     kin.
£  Atheroma.       Encysted extuberance, containing a mealy or
   Atherome.         curd-like substance, sometimes intermixed
   Mealy Wen.       with harder corpuscles: apparently secreted
                     as the last.  Found  of different sizes over
                     most parts of the body.
y  Melliceris.       Encysted extuberance,  containing a honey-like
  Honied  Wen.       fluid.  Found of different sizes over  most
                     parts of the body.
^ Ganglion.         Encysted extuberance, containing a colourless
  Ganglion.           fluid: the extuberance fixed upon a tendon 
GE. II.—SP.II.]       EXCERNENT FUNCTION.
f Testudo.        Encysted extuberance containing a fluid readily
   Horny wen.       hardening into horn  or nail ; and especially
                     when protuded externally upon an ulceration
                     of the surrounding integuments.

   Most of these are supposed by Sir Astley Cooper to be nothing
more at first than obstructed and enlarged  cutaneous follicles : the
sebaceous matter accumulating in the hollow of the follicle, which
is lined with cuticle, and expanding it often to a considerable extent
by pressure, in consequence of the mouth of the  follicle becoming
plugged up or entirely  closed.   Where  it is  plugged  up the
obstructed mouth is generally visible by a black dot, which is car-
bonized  sebacious matter.  This being picked  off, or otherwise
removed, a  probe may often be easily forced down into the  cavity,
and the whole of the confined material be squeezed  out by pressing
the sides of the tumour, even when of some inches in diameter, and
this with little pain and no inflammation.* Such Sir Astley regards
as the general history of common encysted tumour seated  on the
surface   But they  will necessarily  vary  in their structure and
contents from  a multiplicity of adventitious  circumstances, and
perhaps also from idiosyncrasy
   The steatomc grows  to a larger size than any of the rest.   Rho-
dius gives a case in which it weighed  sixty pounds :t and it has
been dissected of the weight of twenty six  pounds from the 'sca-
pula!.
   The ganglion is introduced into the present list from the paritv
of its nature; and in so doing the author has only followed the
example of Mr.  Sharp.  " The ganglion of the  tendon," says he,
"is an encysted tumour of the meliceris  kind; but its fluid is
generally iike the white of an egg.  When it is small, it sometimes
disperses of itself.  Pressure and sudden blows do also remove it,
but for the most part it  continues unless it can be extirpated."§ It
is mostly produced by hard labour, or straining a tendon ; and hence
is peculiarly common to the wrists  of washing-women.   In many
instances, however, its exciting cause is unknown : and  in some
cases it appears to be connected with the constitution.  It is singu-
lar that it should sometimes disappear, as it seems to do,  during
pregnancy, and return afterwards.  Plater records a case of this
kind in the ham, and Bartholine, in the Copenhagen Transactions.
another on the wrist.
  The horny cyst is described by Vogel under the  name of testudo,
here adopted. Mr. Abernethy has glanced  at it in his treatise, and
Sir Everard Home has  more fully described and  illustrated it in
his cases of horny excrescences on the human body, inserted in the
* Surgical Esssays. By A. Cooper and II. Travers. Part II. 1819.
f Observ. Med. Cent. III. Patav. 1657. 8vo.
$ Fabr. Hildan. Cent. III. Obs. 63.
§ Surgery, chap. xxv. p. 1. 
:i4
LL CRITIC A.
[CLVI.—Olt. i
Philosophical Transactions:  a subject, however, which wc shall
have occasion to return to when treating of lepidosis icthyiasis,
in the third order of the present class.
  I have stated that the ganglion is sometimes connected with  the
habit or constitution, and the remark  may be applied to several
of the  other varieties.  They have  hence  been found scattered
over the  whoh body ;*  and in one instance appear to have been
connate and he. ^ditary.t In these cases they will sometimes yield
to a general  treatment  or  a  change of regimen.  Richter  gives
examples of the cure of the steatome, one of the most difficult to be
operated  upon by internal means, by emetics ;| and Kaltschmid, by
a diet of great abstinence ;$ by which plan, we have already observed,
that adipose corpulency is commonly  capable of being removed,
und hence not unreasonably advised when there is a  tendency to
the formation of adipose tumours.
  Electricity, and particularly that of the voltaic trough, seems to
have been serviceable in removing many tumours belonging to this
and the last species; and having omitted it in its proper place, we
may here observe that Dr. Eason of Dublin has given  an instance
in which  a hard scirrhous tumour was  removed from the breast of
a woman who was struck to the floor, and for some time deprived
of the use of her limbs by a stroke of lightning.  It was observed
to be much softer almost immediately after the accident, and in a
short time totally disappeared, though  it had for a long time  re-
sisted the power of every application that could be thought of.||
  For the rest the writers on practical  surgery must be consulted,
and especially Mr. Sharp's excellent Treatise, and Mr.  Abernethy's
work already referred to.



                       SPECIES III.

               EMPHYMA EXOSTOSIS.

                      Bong £umour.

tumour  inelastic, often immovable; hard and bony to  th*.
                           TOUCH.

Thkse consist of calculous  or bony matter; and are sometimes
  * O'Donnel, Lond. Med. Journ. VI. p. 33.
  T Vogel, Briefen an Haller I. Hundest.
  i Ciur. Bibl. Band. V.
  § Pr. de Steatomate fame curato.          j
   Comp. Girard, Lepiologie : ou Traits de3 Tumeurs connues sur le nom
'ies Loupes.  Paris, 1775
  i Edin. Med. Comm. IV. p. 84. 
GE. 11.—SP. IH.J    EXCERNENT Ft NOTION.                gl5

seated immovably on a bone, sometimes immovably  on the perios-
teum, sometimes pendulously in a joint, sometimes either moveably
or immovably in  some fleshy part of the body, thus  constituting
the four following varieties :

* Ostea.                     Immovable;  protuberant;  seated
  Osteous Tumour.             on the substance of a bone.
£ Periostea.                  Immovable ;  protuberant; from  a
  Node.                        bony enlargement of the perios-
                               teum.
y Pendula.                   Bony  tumour hanging pendulous
  Pendulous Exostosis.         into  a joint.
*~ Exotica.                   Bony tumour moveable or immova-
  Exotic Exostosis.             able, seated in some fleshy part of
                               the body.

  Lime is one of the substances most easily secreted in the body of
all animals.   How far it may be formed in the body we shall  have
occasion to notice under the genus osthexia, formed the  fifth of
the present  order.  We  behold it at an early period of fetal life,
and, in old age, when every other secretion has diminished or failed
altogether, we are perpetually meeting with-examples of a morbid
augmentation of this in the coats of the blood-vessels, the bladder,
the brain, and various other  organs, afflicting the closing years of
life with  a variety of troublesome, and  not  unfrequently  highly
painful disorders.
  The first variety is found in most of the bones of the body,
but chiefly perhaps in the bones of the cranium :  where they are
sometimes excrescent, and composed of bony  spicula resembling
crystallizations : sometimes  exquisitely hard  and glabrous, analo-
gous to ivory ;* no doubt from their being composed of phosphate
in a greater measure than  carbonate of lime.
  According to their structure, Sir Astley Cooper has subdivided
these tumours into cartilaginous  and  fungous; and according to
their seat  into periosteal, when they commence between the exter-
nal surface of the bone, and the internal surface of the periosteum ;
and medullary, when they commence in the medullary membrane
and cancellated fabric of the bone.t
  This periosteal subdivision includes the second variety of the
present species: which is chiefly found as a symptom in lues, and
is commonly described under the name of nodes. In some instances
it has occurred as a sequel of acute rheumatism. And in both cases
its treatment must depend upon the nature of  the disease to which
it appertains, and must form a part of the general plan, as we have
already observed when discussing these maladies.
   The third and fourth variety  are chiefly derived from Mr.

           • Baillie, Morb. Anat. Fascie. X. Pi. I. Fig. 1. '2.
           t Surgical Essays, Treatise on Exostosis. 
216
ECCRITICA.
[CL. VI—OH. I.
Abernethy's classification. The difference of their form and mode
of union with the adjoining parts, depends chiefly upon the differ-
ence of their scat.  " A woman," says Mr. Abcrnethy, " was admit-
ted in St.  Bartholomews Hospital with a hard  tumour in the ham.
It was about four inches in length and three in breadth.   She had
also a tumour in the front of the thigh a little above the patella, of
lesser size and hardness.   The  tumour on the ham by its pressure
on the nerves and vessels bad greatly benumbed the sensibility and
obstructed the circulation of the leg, so that it was very edematous.
As it appeared impossible  to remove this tumour, and as its origin
and connections were unknown, amputation  was  resolved on.   On
examining the amputated limb,  the tumour  in the ham could only
be  divided by a saw ; several slices were taken  out  of it by this
means and appeared to consist of coagulable and vascular substance,
in the interstices of which a great deal of bony matter was deposit-
ed. The remainder of the tumour was  macerated and dried, and
it appeared to be formed of an irregular and compact deposition of
the earth of bone.  The  tumour on the front of the thigh was of
the same nature with that in the ham :  but containing so little lime
that it could be cut with a knife.  The  thigh-bone was not at all
diseased."*
  Of the general nature of the exotic variety we shall have to treat
under osthexia infarciens,  of which perhaps it is only a modi-
fication.
  These in all instances are cases  for surgical rather than medi-
cal treatment, and are  seldom to be cured  except by extirpation,
and, when  this cannot be done, and the tumour is  seated on a limbj
by amputation.





                      GENUS III.

                     PAROSTIA.

                     fWfs=nssttfcatfou.

HONES CNTKMPERED in their substance, and incapable of afford-
                  ing THEIR PROPER SUPPORT.

Parostia is a compound from nx^x, " perperam" and «TTeov, « os
ossis."  The genus is new, but sufficiently called  for.   It includes
two species connected by the common character of an inaccordant
secretion of some one of the constituent principles of the bony ma-
* Surgical Observations, Classification of Tumours, p. 102. 
GE. III.—SP. I.J      EXCEKNENT FUNCTION.
217
terial, in consequence of which the substance is rendered too brit-
tle, and apt to break on slight concussions, or other movements, or
too soft, and equally apt to bend.  These species are as follows:

1. PAROSTIA FRAGILIS.          FRAGILITY OF THE BONES.
£• ————— FLEXILIS.           FLEXIBILITY OF THE BONES



                        SPECIES  I.

                PAROSTIA FRAGILIS.

                 jFrafitlttg of  the Bones.

SUBSTANCE OF THE  BONES BRITTLE AND APT TO BREAK ON SLIGHT
             EXERTIONS WITH LITTLE OR No PAIN.

Bone, shell, cartilage and membrane,  in their nascent stage are all
the same substance, and originate from the coagulable lymph of the
blood, which produces both gelatine and albumen, probably as be-
ing possessed of a smaller or larger proportion of oxygene.   Mem-
brane is gelatine with a small proportion of albumen  to give  it a
certain degree  of firmness: cartilagp is membrane with a  larger
proportion of albumen to give it a still greater degree of firmness ;
and shell and bone are cartilage, hardened and rendered solid by
the insertion of lime into their  interior: in the case of shell, the
lime being intermixed with a small proportion of phosphoric, and a
much larger proportion of carbonic acid;  and in the case of bone,
with a small  proportion of carbonic, and  a much larger of phos-
phoric acid.  It is hence obvious that if the earthy and the animal
parts do not bear  a proper relation  to each other, the bone must be
improperly tempered, and unadapted to its office : that if the earthy
or calcareous part be deficient, its substance must be soft and yield-
ing ; and that if the  animal part  be  deficient, or  the calcareous part
in excess, it must loose its cohesive power, become brittle and apt
to break.
   It is the second of these  morbid  states that forms the proximate
cause of  the species before us, as the first forms the  cause  of the
ensuing species.
   Parostia fragilis is the fragilitas ossium, or fragile vitreum of
authors, and is most frequently found as an attendant upon advanced
age.  It is, also, occasionally to be met with as  a symptom in lues,
struma, porphyra, and general intemperance ; and has been known
as a sequel of small-pox.  In most of these diseases the blood be-
comes attenuate, and the coagulable lymph loses much of its visci-'
dity.  In old age the diameter of the blood-vessels becomes con-
tracted, all the secretions aru separated less freelv, and particular^
   Vol. IV.—E » 
218
ECCHIT1CA.
[CL. VI.—OR.
 that of animal oil; and the grossest of them, and hence, particular-
 ly the earthy  corpuscles, are less freely absorbed, and consequently
 accumulate.   We are, therefore, at no loss to account for the in-
 creased hardness and fragility of the bones under these circumstan-
 ces;  nor for their tendency to break upon slight and sudden move-
 ments.  The  author was once present at a church in which a lady
 nearly seventy years old, in good general health, broke both the
 thigh bones in merely kneeling down ; and  on being taken hold  of
 to be carried away, had an os  humeri also broken without any vio-
 lence and  with little pain.  It was in the winter season, and the
 cold might have added to the constitutional rigidity.   From the ge-
 neral inirritability of the system no  fever  of  importance ensued,
 and, under the influence of a warm bed, and a diluent but somewhat
 cordial regimen, the  bones  united in  a  few  weeks.   Mr. Gooch
 relates a similar case of  fracture occasioned by a violent fit  of
 coughing.*
  The common cause seems to consist in a general inirritability  of
 the system, and atorpitudeof the absorbent powers, which, by car-
 rying off only the finer and more attenuate particles, and suffering
 the grosser and particularly the earthy to accumulate, overcharge
 the bones with this material.
  Hence the best remedy  is to be  found in a plan of warm tonics
 that may supply the system with something of the stimulus it stands
 in need of, and in a  free use-of acids whether mineral or vegetable,
 that by their  tendency to  dissolve calcareous  earths, may at least
 diminish its introduction into the chyliferous vessels in  the process
 of digestion, if they do not  reach  the  assimilating vessels of the
 bones and lessen the separation or elaboration at the extremity of
 the nutritive chain.
  Of the mineral acids the sulphuric will generally be found pre-
 ferable ; it seldom gripes or nauseates, and almost always promotes
 the action of the stomach when weak or indolent. It is hence, also,
 an excellenttonic.and maybe persevered in longer than any of the
 rest   The muriatic agrees in most cases  with the stomach,  but not
 with the bowels, which always become  more  relaxed during its
 use than where the other  acids are employed.  It  is  on  this ac-
 count, however, peculiarly adapted to cases of habitual constipation.
 The nitric acid, in a few idiosyncrasies, has proved a very  power-
ful tonic, as well as solvent of animal earth; but in many cases it
 disagrees with the  stomach, and produces flatulency, eructation,
 and other symptoms  of indigestion.  Where these cannot  be em-
ployed, we  must have recourse to the vegetable acids, and especially
the citric, or tartaric, the last either in its pure form or in  that of
cream of tartar.  Lemons and oranges may  also be taken copious-
ly, and the carbonic acid, combined with water by means of Nooth's
 apparatus.
• Observations, &c. Appendix. 
wE. HI.—SP. II.]     EXCEUNENT FUNCTION.                319
                        SPECIES II.


                PAROSTIA  FLEXILIS.

                 iFIep'tfltts of the  iJoncs.

SUBSTANCE OF THE  BONE SOFT AND APT TO BEND AND BECOME
    CROOKED ON SLIGHT EXERTIONS WITH LITTLE OR NO PAIN.

This  is  the  mollifies  ossium of authors,  formerly denominated
spina  vintosa, from its being first noticed on  the spine, and accom-
panied with protuberances which were supposed to proceed from
inflation.
  Its  physiology has been given under the preceding species, with
which it is connected in the relation of contrast.  As fragility of
the bones proceeds from an access of osseous earth, flexibility pro-
ceeds from a deficiency of one or  more of the elements which con-
stitute it. This deficiency may proceed from  two causes, each
producing some peculiarity of symptoms, which we shall presently
illustrate  by examples.  For first, there may be too small a  secre-
tion or elaboration of calcareous  phosphate  to allow a sufficient
compactness to the bones ; and secondly, there may be an adequate
separation of the calcareous  earth but  a  deficiency of the phospho-
ric  acid which, we  have  already observed, is necessary to give it
fixation ; in consequence of which it is often  carried back in a loose
state of the circulation, and  discharged as a  recrement by the kid-
neys or some other emunctory.
  The disease is sometimes  idiopathic, and occurs sometimes as  a
symptom of porphyra, diabetes, and some forms of colic.  In  direct
opposition to the preceding species, moreover, it is commonly found
in the earlier rather than in  the later periods of life, and has been
observed in infancy.  It has occasionally been detected in quadru-
peds,  and  of the stoutest kinds, as the ox and the lion.  It is  some-
times general, and sometimes  confined to particular bones.
  The cause is commonly obscure : it  appears frequently to consist
in a morbid state of the digestive  organs, but is seated, perhaps, as
often  at  the  other  extremity  of  the great  chain of the nutritive
powers, in the assimilating or secernent vessels, where it must ne-
cessarily elude all detection.   In the museum of Professor Proskas-
ka  of Vienna, is a preparation  of an adult who died of this disease,
in which all the vertebrae are glued into  one  mass, the sacrum  be-
ing scarcely distinguishable, and the ribs bent inward, and marked
by  the impression of the arms, which  the patient was in the  habit
of pressing forcibly against his sides.  The  whole  skeleton  is  ex-
tremely light.  This last/act  is always the case from  the absence 
220
ECCR1TICA.
LCL. VI.—OK. f
of so large a portion of animal earth.  An analysis, by Dr. Bostock,
of the vertebr .  of an adult female  who died of the  species before
us, indicated that the earthy matter was only one eighth part of the
weight of the bone, instead of amounting to more  than  half, which
Dr. Bostock intimates to  be its proper  proportion in a  state of
health.*
  A singular case of this disease is given by Dr.  Hosty, of Paris,
in the Philosophical Transactions.t  The patient, a married  wo-
man, between thirty and forty years of age, was attacked by it gra-
dually, after several lyings-in and  two  falls on the side, which gave
her great pain over all her body but fractured no  bone.  The first
decided symptom was an incurvation of one of the fingers, accom-
panied with a very considerable discharge  of  bony or calcareous
earth by the urine,  which was loaded with  it,  and gave a  copious
deposit.  The incurvation  by degrees  extended to all the limbs, so
that the feet were at length bent upwards nearly to the head, but
without muscular contraction or fracture.  The calcareous matter
at length ceased to  flow  towards  the  bladder, and  seems  to have
been transferred to  the salivary glands, from which  was discharged
a flux of dark discoloured spittle.   All the  functions  of the  body
were in a state of great disorder; she had, at times, a very consider-
able degree of fever, which was, at one period, accompanied with
head-ache, delirium, and subsultus tendinum.   She  died in about a
twelvemonth from the commencement of the disease:  and^all  the
bones, on  being examined, were  found soft,  and  supple, though
some of them, as the ribs, were still in some degree friable.  The
scalpel, with very  little force, ran through the hardest of them.
Nothing extraordinary was found in the thoracic or  abdominal vis-
cera, but the right hemisphere of the brain appeared to be one third
larger than the left.
  In (his case, the disease  evidently commenced in the bones them-
selves, and seems to have proceeded  from a  want of phosphoric
acid to give compactness to  the calcareous earth:  for  that there
was a sufficiency of this earth is clear, from its being found loose in
the fluids, and thrown out as a recrement by the urine and saliva till
the whole  was removed, and nothing  of the  bones remained  but
their cartilaginous or membranous fabric.  In a similar case related,
in a work of considerable value, by Mr. Thompson, this tendency to
the discharge of the absorbed and loose earth of the softened bones
at the emunctories of the body was still more  considerable.   The
urine, we are told, for the first two years of the  patient's illness,
deposited generally a  whitish sediment, which, upon evaporation,
became like mortar ; and, on one or two occasions, he voided a  few
jagged calculi.  After this period the calcareous discharge ceased,
the bones having no more earth in  their  composition, as was suffi-
* Transactions of the Medico-Chirurg. Soc. Vol IV T>. 42
f Vol. XLV1II. year 1753. 
GE. III.—SP. II.]      EXCERNENT FUNCTION.
221
ciently ascertained on the patient's death, which, however, did not
occur till nine years from the commencement of the malady.*
  In some cases there seems to be but little deficiency of phospho-
ric acid, while there is an evident want of earthy matter: for we
meet with no calcareous discharge by any of the munctories, while
the union which takes place between whatever portion of the earth
is conveyed to the bones, and the phosphoric acid which is secreted
at the same time, renders them in some degree friable, though weak,
and hence as liable to fracture on slight exertions as in the prece-
ding species.
  A case of this kind is at this moment under the joint care of the
author and Mr,  . l*wship.  The patient is a lady, hitherto in good
health, of about eight and twenty: both the thigh-bones were broken
without any violence  about a twelvemonth ago,  and all the other
bones  showed  a strong tendency to softness and compressibility.
There was great general  debility in all the functions, with a feeble
and quickened pulse.  By perfect quiet, a recumbent posture on a
hard and level couch, and the steady use of a tonic regimen and
diet, she is now evidently recovering.   Her general health is im-
proved, the extremities of both bones appear to be united and buried
in an irregular mass of callus  that has clustered around them : and
it is probable that in a few months  she may be able to be removed
by an easy conveyance to the sea coast.
   A somewhat similar case, but of greater severity, communicated
by Sir John Pringle to the Royal Society, is contained in its forty-
eighth volume.t  The patient was an unmarried female servant  of
good character.  A parostic  diathesis  seems, from some cause  or
other, to have existed, and to have been brought into action by a
tedious and troublesome chlorosis.   One of the legs first gave way
and snapped as she was walking from the bed to her chair, and soon
afterwards both the thigh bones from a little exertion.   From this
time her general health  suffered, her habit became cachectic, and
there being an increasing inability to a supply of compact calcare-
ous earth, all the bones became soft and pliable, and bent in  every
 direction without breaking, while those which were brokeh  ne* r
 united.  Her head, however, throughout, was scarcely affected, and
 her mental faculties continued clear to the last.  She died  in less
 than nine months from the commencement of the disease: and  on
 examining her body all the bones were capable of being cut through
 without turning the edge of the knife.
   In one or two of the preceding cases mercury was employed, and
 carried to the extent of producing salivation, yet without any benefit
 whatever.  It is not easy, indeed, to conceive what benefit could  be
 expected from  such a  plan.   The deficiency of one  or all the
 constituents of perfect and  healthy earth of bones, is evidently
  * Medical Observations and Inquiries by a Society of I'hysicians in London,
Vol. V. 8vo.
  f Phil. Trans, year 1753. 
222
ECCMT1CA.
[CL. VI.—OR. 1.
dependent upon local or general debility, though we cannot always
discover the cause of this debility, nor the peculiar circumstances
connected with it which give  rise to this rather than any other ef-
fect of diminished energy.  And hence, the only line of treatment
we can engage in with any hope of success is that of perfect quiet,
and a recumbent posture to prevent distortion and fracture, a plain
but nutritive, and somewhat generous diet, and a course  of tonic
medicines.  In the case of the lady just adverted to, and who is now
in a train of recovery, the medicines chiefly employed were various
preparations of cinchona and iron, chiefly the pilular ferri composi-
te, with an allowance of ale instead of wine with ))«r dinner.
                       GENUS IV.


                       CYRTOSIS.


                Ctontortfon of  the Wontu.

HEAD BULKY, ESPECIALLY  ANTERIORLY:  STATURE  SHORT, AND IN-
         CURVATED ; FLESH FLABBY, PALE AND WRINKLED.

The term cyrtosis is derived from the Greek xveros, " curvus, in-
curvus, gibbosus," and among the  ancients, particularly imported
recurvation  of  the spine, or posterior crookedness,  as lordosis
(Aof£w<r<s), imported procuration of the head and shoulders or ante-
rior  crookedness.  It  has, in recent times, more generally been
written oyrtonosos, literally " morbus incurvus ;" but  the term
•ore?, or morbus, is pleonastic in a system of nosology, and hence,
cyrtosis is preferable.
  T'he genus is intended to include two specific diseases which have
a close connection in many of their  most prominent symptoms, and
especially in the sponginess and incurvation of the bones, and  in
the withered appearance of the flesh,  insomuch that the second is,
by some, regarded  as  only a modification of the first; but which,
however, are peculiarly distinguished from each other by the dif-
ferent state of the mental powers.—These are:—

         1. cyrtosis rachia.               rickets.
         2.-------cretinismus.           cretinism, 
GE. IV.—Sp. I.]
EXCERNENT FUNCTION.
22S
                        SPECIES I.

                CYRTOSIS  RHACHIA.

                          lifcfccts,

OHIEFLY AFFECTING THE  LIMBS AND BODY: SPINE CROOKED J RIB9
  DEPRESSED ; ARTICULAR EPIPHYSES ENLARGED AND SPONGY ', BELLY
  TUMID j MENTAL FACULTIES CLEAR, OFTEN PREMATURE.

There is some doubt about  the origin of both the  vernacular
names.  Cretinism on its first discovery was, by many writers,
supposed to be produced  by an habitual  use of water impregnated
with chalk or  creta, in the low Swiss valleys where it was earliest
traced: and  it  is commonly supposed  that the specific name is
derived from this opinion.
  The English word rickets, is usually written in technical lan-
guage, rhachitis; a name first given to it by Glisson, and said to be
derived from pxxis (rhachis,) the spine in consequence of the dis-
tortion and  curvature of this organ, occasioned by its  being no
longer able to bear the weight of the head and upper extremities.
As  this malady, however, was first observed in England, and par-
ticularly in the western counties, and was provincially denominated
rickets, before it attracted the attention of medical writers; it is
more probable that rickets is  derived from the Saxon ricg or rick
"a heap or hump," and particularly as  applied to the back, which
also it denotes in a second sense; so that ricked or ricket is literally,
in its full  import, "hump-backed."   It is from this root we derive
hay-rick, " a heap  of hay," and not, as  Dr. Johnson  has  given it,
from " reek," to smoke.   Rachitis might, however, be a word suf-
ficiently good  for the present purpose, were it not for its termina-
tion ; itis, in the medical technology of modern times,  implying
visceral inflammation,  and being limited, by a sort of common con-
sent, to the  numerous species of  disease arranged in the present
method under the genus empresma, Class III. Ord.  II. which we
have considered already ;* and on  this account it is that, in the spe-
eies before us, rachitis is exchanged for rhachia.
  If this disease were known to  the Greeks, we should expect to
find it, not indeed under the specific term rhachia, but the generic
term cyrtosis; for while neither rhachia nor rhachitis is to be traced
among the Greek  writers in the sense of diseased action, the lat-
ter is common to them in the signification already ascribed to it.
  There  is much  reason for believing, however, that both rickets
and cretinism are comparatively of modern date : and  it is a singu-
lar circumstance that both these  species should have been first
* Vol. II. p. 212. 
224
ECCRITICA.
[CL. VI.—OH. li
 noticed, and apparently have made their first appearance coetane
 ously.  The earliest account wc have of rickets is that published
 by Glisson as it occurred in England in the middle of the seventeenth
 century; the first account of cretinism is that of  Plater, who met
 with it about the same time in Carinthia and the Valais.  The dis-
 ease is also common in Navarre, and in many of the valleys of the
 Pyrenees, particularly that  of Luchen; and it has been  observed
 by Sir George Staunton as far off as  Chinese Tartary, in a part of
 the country much resembling Switzerland and  Savoy in its Alpine
 appearance.  There are some writers, however, who have endea-
 voured to trace both species of this genus up to the Greeks and Ro-
 mans.   Thus Zeviani contends that rickets, if  not cretinism, is to
 be discovered in  the Roman names of Vari and Volgi, as also in
 several passages  ridiculing  deformity, in Thersites, the supposed
 iEsop of Greece, as well as in other authors; * but all such remarks
 are too general;  he cannot produce a single passage from the me-
 dical writers of antiquity, clearly characterizing the peculiar  de-
 formities before us.  De Haen has attempted to trace the same dis-
 ease in the works of Hippocrates, but has failed;  and hence it is
generally ad nitted in the present day, and has been so from the time
of Glisson himself, supported by the concurrent opinions of Bate,
Regemorter, Van Swieten, and Trinka, that both rickets  and
 cretinism are of the recent date  we have just assigned to them.
  The enlargement of the thyroid gland called goitre, or broncho-
 cele, is the most striking feature in the unsightly aspect of a cretin;
but this, as Dr. Reeve has observed, is not a constant attendant;  nor
is  there any necessary connexion between  goitre and cretinism,
 notwithstanding the assertions and ingenious reasoning of Fodere.
 Cretinism is frequently observed without any affection of the thy-
 roid gland, and this gland, on the contrary,  is often very much  en-
 larged without the slightest degree of that affection of the intellec-
 tual faculties by which cretinism is particularly marked.t
   Cretinism, in  many  of its symptoms, though not in all, may be
 regarded as a most severe and complicated modification of rickets;
 and the pathology of both is closely connected with that of atrophy,
 .ts we  endeavoured to explain it in its proper place.J
   In  order that  the various parts of the body should thrive and
 enlarge in the infancy  of life, it is necessary  not only that there
 be a due supply of nutritious food, but that  the entire chain of  the
 nutritive  organs, from  the  digestive to the assimilating powers,
 should be in a state of sound health, and capable of fulfilling their
 respective functions.   In  several of the varieties of atrophy this is
 not the case.   In one or  two of them we have reason to believe
 that the digestive  process is  imperfect,  and  that the disease is
 chiefly seated in the chylific viscera.   In others that  proper nutri-
• Delia cura di Hambini, attacati della Hhachitide.  Cap. II. p. IS,
{• Storr, Alpenreise Vorbereitung, p. 55.
t Vol. 11. p. 475.   Marasmus atrophia. 
liE. IV.—SP. I.]      EXCERNENT FUNCTION.
225
 ment, though duly introduced into the blood, is not duly elaborated
 from it and converted into the structure of the different parts whose
 waste it is  to supply ; and, consequently, that  the disease is chiefly
 seated in the assimilating powers.  And, in treating of atrophy, we
 observed that the one extremity of the nutritive chain so closely
 harmonizes with the other, that let the disease commence at which
 end soever it may, the opposite is affected by sympathy.   We also
 observed that the different divisions of secernents are not all equal-
 ly under the influence of a  morbid torpitude  ; since  occasionally
 those that secrete the animal oil cease to act long before any of the
 rest; whence emaciation occurs, and in many instances continues
 for some time, as a solitary symptom : and the individual falls away
 in plumpness without being sensible of any other failing.
   In rickets the nutritive organs are disturbed  generally through
 the whole length of the  chain ; but the chief failure  is in a due
 supply of bony earth or the  phosphoric  acid that should combine
 with it.   The evident intention of this kind of supply is to enable
 the bones to expand and acquire maturity while growing, and to
 uphold their strength and firmness afterwards.  And so long as they
 obtain a sufficient  supply and the waste earth  of the  bones is pro-
 portionably carried off by the absorbents, so long this  part of the
 animal economy continues perfect: but, with the exception of the
 fat or animal oil, there is, perhaps no secretion that is so liable to
 have its proper  balance disturbed, whether by excess or deficiency,
 by a morbid condition of the digestive or of the assimilating  pow-
 ers, as that of bony or calcareous earth.
   A deficient formation then, or elaboration, of bony earth consti-
 tutes the proximate cause of both rickets aud  cretinism.   The re-
 mote or exciting cause it is not always in our  power to ascertain :
 yet in numerous, perhaps most instances, we are capable of  trac-
 ing them to a want of pure air, and a warm and dry  atmosphere,
 nutritious food, regular exercise, cleanliness, and the  concomitant
 evils attendant upon a state of poverty; and hence, it  is chiefly iii
 the hovels of the poor, the destitute, and the profligate, that  both
 diseases are met with;  while the severity of the symptoms is  very
 generally in proportion to the extent or multiplication of these con-
 current causes.
   But there are other diseases that result from the evils  we are
 now contemplating as well as rickets or cretinism, such as atrophy,
 scrofula, scurvy, and typhous fevers: ami hence, there must be
 some predisponent cause operating in the present instance, and
 calling rickets into action rather than any one of the  rest.  Such
 cause we do not seem always able  to trace, but there is reason to be-
 lieve that it is sometimes dependent upon an hereditary taint of an
 idiopathic nature, sometimes upon  a  scrofulous or venereal de-
 pravation in the constitution of the father or the  mother.  Such, also,
 is the opinion of Dr. Cullen.   " This disease," says he, " may be
justly considered as proceeding from parents: for it often appears in
 a great number of the same family; and my observation leads me to
   Vol. IV.—F f 
226
EcenmcA.
[CL. VI.—Olt.1.
judge that it originates more frequently from mothers than from
fathers.   So far as I can refer the disease  of the  children  to  the
state of the parents, it has appeared to me most commonly to arise
from some weakness, and pretty frequently from a scrofulous habit
in the mother."—" I must remark, however," continues Dr. Cullen,
" that  in  many cases I have not been  able to discern the condition
of the  parents to which I could refer it."*
  Rickets seldom appears earlier than the ninth month of infancy,
and not often later than the second year ; being preceded, according
to Dr. Strack, by a paleness  and swelling of the countenance, and a
yellow, sulphur  hue in that part of the cheeks which  should natu-
rally be red.t   In some instances it seems to have originated later;
in every stage, indeed, of a child's growth, till the bones  have  ac-
quired their full size and firmness ;J and it is said to have occurred
even after this.   But in  these late appearances we are generally
capable of tracing.the disease to some local  injury, which acts as
an  exciting cause, and, for the most part, unites it with parostia
flexilis.
  Rhachia, in its ordinary course, commences imperceptibly  and
advances slowly: the body becomes gradually emaciated,  the flesh
flaccid, and the  cheeks wan or sallow, with a slight degree of tume-
faction.   As the flesh diminishes in bulk, the head is found to in-
crease, the sutures gape, and the forehead grows prominent.  The
spine bends and  is incapable of supporting the weight it has to car-
ry : the ribs and sternum partake of the distortion, the former lose
their convexity, and the latter projects into a ridge.
  The same deficiency of bony earth runs  through the entire ske-
leton, and affects not only those parts that are composed chiefly of
lime and phosphoric acid, as the flat bones and the middle  of  the
long bones, but  the extreme knobs or epiphyses, in which lime is
combined as largely with carbonic as with phosphoric acid.  And
hence, the joints are loose and spongy, and in swelling keep pace
with the head.  In many instances the lime appears to be elabo-
rated but without its correspondent acids, and consequently, with-
out compactness, and to no purpose:  for we can occasionally trace
it loose  in  the  urine, in  which it forms  a calcareous deposit, as
though carried off from the blood as a recrement.
   All  the assimilating powers participate in the debility in a great-
er or less degree: the process of dentition is slow and imperfect,
and, while the cellular membrane is without animal oil, the muscu-
lar fibres are tabid, without  energy, and almost inirritable. It does
not seem, however, that the  secretion of sensorial power is so much
interfered with as the other secretions of the system.  Some part,
indeed, of what should be sent over the frame at  large, appears to

  •  Pract. of Phys. Vol. IV. Hook II. Ch. IV. \ MDCCXXII.
  t Act.  Philosophico-Medico Soc. Acad.  Princ. Hassix, &c.  4to.  Giessse.
Cathorum.
  $  Thomasin, Journ. de Med. torn. XLIII. p. 222. 
GE. IV.—SP. I.]     EXCEKNENT FUNCTION.
227
be concentrated in the sensorium: so that its equipoise is disturbed,
but the general average is not perhaps much diminished.   And we
are hence able to account for the curious and interesting fact that
while the body is generally failing, the mind in many instances ad-
vances in its faculties, in so much that a very slight recapitulation
of the names of those who have been  pre-eminently gifted  with
mental talents in every age and nation, and have immortalized them-
selves as poets, philosophers, and even leaders in the field, will put
before the eye of those who have not much attended to this subject,
a far greater  proportion  of the hump-backed, and  the ricketty,
than they may hitherto have had any conception of. We had occa-
sion to make a  like remark  when treating of scrofula,  and the
same fact occurs almost as strikingly in hectic fever.  The  progress
of the mind does  not necessarily depend upon the general  progress
of the body:  in the ordinary course of things the one  runs parallel
with  the  other; but, in  the great field of pathology, where this
course is departed from, we are perpetually called to behold proofs
that these powers are by no means one and indivisable, and that,
even before the hour of death, the spirit gives token of an advance
towards  perfection, while the body  in its general crasisis imbecile,
or,  perhaps, sinking gradually into ruins.
  At the commencement of rickets there is rarely any degree of
fever, but, as the disease advances, irritability, as in  scrofula, suc-
ceeds to inirritability, and a hectic  is produced. Or it may happen
that the  sensorium at last participates in a greater degree with the
disease  of the rest of the frame, and the mind itself becomes en-
feebled,  and torpid, or fatuous.
  In  the treatment of rickets, the eye should be  directed to the
two following intentions : that of strengthening the system, general-
ly:  and that of facilitating a supply of phosphate of lime to the or-
gans that form the chief seat of disease.
  For the former purpose, a pure, dry, and temperate atmosphere,
a  wholesome and  somewhat  generous  diet,  regular exercise, of
such kind as can be indulged in with the least inconvenience, clean-
liness, and cold-bathing are of essential importance, and have  often
worked a cure alone.  And it is possibly owing to a more general
conviction of the advantage of such a  regimen in the present en-
lightened age, that rickets is a complaint far less common now than
it was a  century  or even half a century ago.
  A tonic plan of medicines, however, ought to be interposed, and
will effectually co-operate with a tonic regimen. As in infancy we
can employ  those remedies only which are neither very bulky nor
very disgustful, we should, for the  purpose immediately before us,
make choice of the metallic salts.   Mr. Boyle is said to have em-
ployed, long ago, with very great success, some kind of ens veneris;
and various preparations of copper have since been  made use of,
and been highly extolled  for their  virtues in  the present disease
especially by Benevoli, and Buchner. Dr. Cullen, however, is per-
suaded that the ens veneris of Boyle was a preparation not of cop- 
22B
ECCIUTICA.
[CL. VI.—OK. I-
per, but of iron, in fact theflores martiales of the old dispensatories,
and there is no doubt that this conjecture is right.  From the ge-
neral irritability of the system, iron, indeed, seems to be more ad-
visable on the present  occasion than any  other metal.  And its
stimulant  property is  a  recommendation to its use, rather than a
dissuasive.
   If the appetite fail, which is not common, and the stomach evince
acidity and other dyspeptic symptoms, an occasional emetic will be
highly serviceable.   The bowels must be kept open with rhubarb,
or  neutral salts ;  and, if the abdomen be tumid, or there be any
other symptoms of an affection of the mesenteric glands, mercury
in small doses may be advantageously had recourse to, and combin-
ed  with the tonic plan.
   The means of carrying into execution the second intention, or
that of producing a direct supply of osseous matter, is accompanied
with  more difficulty, nor is it certain that we are in possession of
any remedy whatever by which  this can be accomplished, though
it has often been attempted.
   Bone may be regarded as a cancellated fabric  of gluten whose
cells are filled  up with the earth of lime and a combination of car-
bonic and  phosphoric  acid, of which the  former bears  the larger
proportion. In all cases of rhachia, there  seems to be a deficiency
of these acids, but particularly of the phosphoric, and, in many cases,
a deficiency of the earth as  well as of the acids.
   Acids, however, of every kind, when in  excess, have a tendency
to dissolve calcareous  earth instead  of concreting it  into a  solid
mass: and hence  one  of the most effectual means of preventing
that tendency to the separation or production of a morbid super-
abundance of calcareous earth in osthexia and lithia, is a free
use of acids as a solvent.
   A hint has been  taken from this effect, and as the disease before
us is of an opposite kind, and evinces a deficiency of lime, and es-
pecially of phosphate of lime, instead of an excess, it has been in-
geniously proposed to  pursue an opposite practice, and to  have
recourse  to a free use of  alkalies and alkalescent earths, especially
lime united with phosphoric acid, with a view of obtaining the de-
ficient materials.   Baron Haller  and  De Haen employed, for this
purpose,  prepared oyster-shells ;  but these consist of lime with car-
bonic acid, and do not, therefore, offer a proper supply for the basis
of bones.   M.  Bonhomme has of late improved upon this practice
by substituting the  phosphate of lime, or  the powder of bones
for its carbonate, and uniting it in equal parts with  phosphate of
soda: of which compound the dose is a scruple for an infant given
twice a day.   And he  recommends  that the body should also be
bathed morning and  niglit with an alkaline  solution, consisting of
half an ounce of common potass  in a pound of spring water. Abil-
gaard has carried the alkaline plans still farther, and has employed 
GE. IV.—SP. I.]      EXCERNENT FUNCTION.
2£9
 the fixed alkali internally.*   And, as acidity of the stomach in in-
 fants seems to be one cause of the disease, and a  principal cause,
 as conjectured by Cappelf and Zeviani,} where the digestion is evi-
 dently at fault, we may, in such circumstances, reasonably  expect
 benefit from alkaline preparations or magnesia.
 .  How  far any preparation  of lime  introduced  into the stomach
 may  be  able  to find its  way without decomposition,  through the
 sanguiferous system to the assimilating vessels, and be secerned in
 the parts affected, has not been  exactly  determined.   Vauquelin
 made various  experiments upon fowls, to  decide the question, and
 M. Bonhomme has since attempted others.  To  themselves these
 experiments appeared satisfactory ; but they are  open to some ob-
jections  which have not been entirely removed.  Yet we see every
 day, in a thousand instances, with what facility substances, of almost
 every kind, introduced into the  stomach, are diffused with little
 other change than that of minute division over every part of the
 system.   Emetics do not act till  they reach the circulating system:
 the colouring matter of the madder-root is conveyed to and tinges
 the most solid  bones: prussiate  of potash, turpentine and various
 other balsams enter without change into the  bladder.  It is hence
 that rape-seed communicates an intolerable taste to hares that feed
 upon it, and that the flesh of sheep feeding upon wormwood ac-
 quires the bitter flavour of this plant.  So, the buck-thorn gives a
 cathartic property to the flesh of  thrushes that have swallowed it,
 and scammony to goat's milk.  Partridges that have feasted harm-
lessly on hellebore, often occasion sickness when employed as food ;
and when oxen have grazed in a pasture abounding with alliaceous
plants the beef they produce possesses the same  taste and  smell.
And hence, phosphate of lime  may, in like manner, be  conveyed
from the stomach to the secernents of the bones,  and  reach them
without chemical decomposition.
  As rachiais peculiarly distinguished by a great inirritability and
want  of  action, rubefacients and  other cutaneous  stimulants have
often been employed, and proved serviceable, as well from the fric-
tion  that accompanies their use   as  their own actuating  power.
These have sometimes been so far heightened as  purposely  to ex-
cite some degree of fever, with a  view of carrying off the disease
by this means,  as dyspepsy,  cephalaea, and chronic rheumatism
have often been carried off by  a smart attack of a tertian intermit-
tent.   We are told that a practice of this  kind prevails very gene-
rally in the Western Isles, and is productive of great success.  The
heating oil of the skate-fish is  rubbed  every evening first upon the
wrists and ankles of the patient,  which raises a  fever of several
hour's duration :  and  when the inunction upon these parts has lost
  •  Collect. Soc. Med. Havn. I. Art. I.
  f  Versuch einen vollerstandigen Abhandlung iiber die Englische krankheit,
&c.
  * Delia cura di Bambini, attacati della Rhachitide. Cap. II. p. 80. 
230
ECCRITICA.
[CL.VL—OR.I.
its effect, it is then applied, in like manner, to the knees and el-
bows ;  and afterwards, in like manner, to the spine; so that a cer-
tain degree of pyrexy may be daily maintained.  And when friction,
on all these, organs, is found to fail, as fail it will by degrees; a flan-
nel shirt dipped in the oil is finally had recourse to, and worn en the
body, which produces a higher degree of fever than has yet existed;
and* continues to be worn, after fresh illinations, till a  cure is ob-
tained, which is said to be certain, and usually in a short time.
   Many ingenious devices have been executed by surgical instru-
ment makers for giving support to the limbs that seem mostly to
suffer,  and for removing the weight of  the  body from one part to
another.  In  infancy, however, all  these are of little avail,  and
where  the disease pervades the entire  skeleton, they  will  always
do as much mischief as good, by aiding  one  part at the expense of
another.  The best mechanical instruments are a hard incompres-
sible couch, and a level floor on which the infant may lie at full
length, and stretch his limbs as he pleases.   The couch should be
made light and moveable, so that he may be carried upon it in  the
open air for exercise.   Moderate warmth is of great service, but a
downy bed that gives way to the pressure  of the body and sinks
into unequal  hollows cannot fail to increase the incurvation.
                    "  SPECIES II.


             CYRTOSIS CRETINISMUS.


                        Gtrettutsm.

UHIEFLY AFFECTING THE HEAD AND NECK; COUNTENANCE VACANT AND
  STUPID ; MENTAL FACULTIES FEEBLE OR IDIOTIC : SENSIBILITY OB-
  TUSE ;  MOSTLY WITH ENLARGEMENT OF THE THYROID GLAND.


Cretinism makes a very close approach to rickets in its general
symptoms.  It differs principally in  the tendency  to  the peculiar
enlargement of the thyroid gland, which, in France, is denominated
goitre, and with us, Derbyshire-neck, and  in the mental imbecility
which accompanies it from the first.
  In treating of rhachitis we observed, that, while all the functions
of the general frame are here in a state of great debility, with the
exception of the  mental, these last exhibited, in many instances,
a precocity  and a vigour rarely found in firm health.  And we
endeavoured to account for it by supposing that the flow of sensorial
fluid instead  of being in deficiency,  like all the other secretions,
is only disturbed  in its balance; and that much of the  proportion 
GE. IV.—SP. 11.]      EXCERNENT FUNCTION.
231
of this, which should be distributed among the motory fibres of the
frame, and prevent that inirritability and  muscular inertness by
which rickets is so peculiarly distinguished, is transferred under a
different modification to the sensorium, and gives to the mental fa-
culties a more than ordinary degree of quickness.
   In cretinism the organ of the brain seems to follow the fate of the
rest of the body, and, in many cases, even to take the lead, so that
the chief imbecility is to be found in this region.   For the peculiar
symptom  of goitre it is not so easy to account.   We know so lit-
tle of the purpose, and even of the fabric  of this gland, as to be inca-
pable of  assigning its use in the  animal economy, and hence, it is
not much to be wondered at that its peculiar tendency to associate,
in the present disease, with the morbid condition of the bones and
of the intellect, should not hitherto have been ascertained. It does
not always, however,  accompany  the other symptoms, though it is,
for the most part, an associate.
   We have already observed that cretinism  was first distinctly-
noticed and described by Plater about the middle of the seventeenth
century, as occurring among the poor in Carinthiaand the Valais;
and that it was afterwards found  in a still severer degree in other
vallies of Switzerland and the Alps generally ; as it has since been
detected in very distant regions where the country exhibits a simi-
larity of features, as among a miserable race calfed Caggets, inha-
biting the hollows of the Pyrenees, whose district and history have
been given us by M.  Raymond, and as far off as Chinese Tartary,
where it is represented as existing by Sir George Staunton.
   On the first discovery of cretinism it was ascribed by some to the
use of snow-water, and by others to the use of water impregnated
with calcareous earth: both  which opinions are  entirely without
foundation.  The first  is sufficiently disproved by observing that
persons born in places contiguous to the glaciers, and who  drink
no other water than  what flows from the melting of ice and snow,
are not subject to the disorder; and contrarywise, that the disorder
is observed in places where snow is unknown.  The second is con-
tradicted by the fact that the common  waters of Switzerland, in-
stead of being impregnated with  calcareous matter, excel those of
most other countries  in Europe in purity and flavour.  " There  is
not," observes Dr. Reeve, " a village, nor a valley, but what is en-
livened by rivulets, or streams gushing from the rocks. The water
usually drunk at La Batia and Martigny is from the river Dranse,
which  flows  from the glacier of St. Bernard, and  falls  into  the
Rhone ;  it is remarkably free from earthy matter, and well tasted.
At Berne the water  is extremely pure, yet,  as  Haller  remarks,
swellings of  the  throat are not uncommon in both  sexes, though
cretinism is rare.
   As comfortable and genial warmth forms one of the best auxiliaries
in attempting the cure of both cretinism and rickets, there can be
no doubt that the chill of snow-water, if taken as such, must consi-
derably add to the general debility of the  system when  labouring 
■252
ECCRITICA.
[CL. VI.—OR. I.
 under either of these diseases, though there  seems no reason for
 supposing that it would originate either.  It is not difficult  to
 explain why water impregnated with calcareous earth should have
 been regarded as a cause : for in cretinism, as in rhachia, the cal-
 careous earth designed by nature for building up the bones, is often
 separated and floats loose in various fluids of the  body for want of
 a sufficiency of phosphoric acid to convert it  into a phosphate  ot
 lime, and give it  solidity.  And as it is, in  consequence hereof,
 pretty freely discharged by the urine,  it seems to have given rise
 to the opinion  that such  calcareous earth was introduced into the
 system with the common  beverage of the lakes or rivers, and pro-
 duced the morbid symptoms.
   M. de Saussure has assigned a far more probable, and  unques-
 tionably the real cause of the disease in referring  us to a few other
 physical features of the Alpine districts in which it makes its ap-
 pearance chiefly.  The vallies, he tells us, are surrounded by very
 high mountains, sheltered from currents of fresh  air, and exposed
 to the direct, and, what  is worse, the reflected  rays of the sun.
 They are marshy, and the atmosphere is  hence humid, close, and
 oppressive.   And when to these chorographical causes we add the
 domestic ones, which are also well known to prevail very generally
 among the poor of these regions, such as meagre, innutritious food,
 indolence and uncleanliness, with  a predisposition to  the disease
 from an hereditary taint of many generations,  we can  sufficiently
 account for  the prevalence of cretinism in such places,  and for the
 most humiliating characters it is ever found to assume.
   The general symptoms of cretinism are those of rhachia; but the
disease shows itself earlier, often at birth, and not  unfrequently
before this period, apparently commencing with the procreation of
the fetus, and affording the most evident proofs of ancestral conta-
mination.  The child, if not deformed and cachectic at birth, soon
becomes so;  the body is stinted in its growth, and the organs in their
development; the abdomen swells, the skin is  wrinkled, the mus-
cles are loose and  flabby, the throat is covered with a monstrous
prominence, the complexion wan, and the countenance  vacant and
6tupid.  The cranium bulges out to an enormous size, and particu-
larly towards the  occiput, for it is  sometimes depressed on the
crown, and at the temples; insomuch that to a front view the  head,
in some cases, appears even diminutive.  The blunted sensibility of
these wretched beings renders them indifferent to the action of cold
and heat, and even to blows or wounds.   "They  are, generally,"
observes M. Pinel, "both deaf and dumb.  The strongest and most
pungent odours scarcely affect them.  I  know a Cretin who devours
raw onions and even charcoal with great avidity.  A striking proof
of the coarseness and imperfect development of the organ of taste.
Their organs of sight and feeling are equally limited in their ope-
ration.  Of  moral affections they seem  wholly destitute; discover-
ing no signs of gratitude  for kindness  shown to them, nor attach-
ment to their nearest relations. 
GE. IV.—SP. H.]    EXCERNENT FUNCTION.
233
  The medical treatment, if medicine can ever be of any avail,
should be conducted upon the principles and consists of the process
laid down under the preceding species.
                        GENUS  V.

                     OSTHEXIA.



SOFT PARTS MORE OR LESS INDURATED BY  A SUPERFLUOUS SECRE-
             TION AND DEPOSIT OF OSSIFIC  MATTER.

Osthexia is derived from oe-r«^?,  " osseous or bony,"  and fffs,
" habitus or habit,"—" ossific diathesis  or indiosyncrasy."  This
morbid  affection, though repeatedly alluded to and  described by
miscellaneous writers,  have seldom been attended to in nosological
arrangements.   It does  not occur in  Dr. Cullen's Classification ;
but he alludes to it in his " Catalogue of Omitted Diseases" as one
of those which he thinks ought not to have been omitted.
  We have had  various occasions for remarking that as the calca-
reous earth, which gives compactness and solidity to the skeleton of
the animal frame, becomes waste, and is consequently absorbed and
carried off, it is necessary that there should be an equal and regular
supply of the same  material.  This is  partly obtained from the
lime which enters, in some proportion or other, into  almost every
kind of  nutriment on which we feed: but it seems to be obtained
also, and perhaps in a larger proportion, by some chemical elabora-
tion out of the constituent principles of the blood itself: for a healthy
animal  of any kind  appears  to supply itself with  the  requisite
quantity of bony earth whatever be the nature of its food, and though
the soil  on which it  is grown contains no lime whatever, as is the
case in several of the Polynesian islands, and throughout the whole
of New South Wales, on the hither side of the Blue  Mountains.
  In  several  of the • preceding  genera  we have  seen that this
material is produced or secreted  in deficiency:  in the species
appertaining to the present genus, it is,  on the contrary, produced
or secreted in excess :  and deposited, sometimes in  single organs
for which it is not naturally  intended, and  sometimes throughout
the system at large, occasionally in the parenchyma or general sub-
stance of  organs, and occasionally in the membranes or tunics by
which they are covered and protected, or in the vessels by which
they are furnished with their proper stores.
  We see much of this irregularity in old  age, the  cause of which
we have already endeavoured  to explain.   The excernent vessels
  Vol.  IV.—G  g 
234
ECCUITICA,
LCL. VI.—OH. r.
of both  sets, absorbents  and secretories, partake of the common
debility and torpitude of this advanced period.   There is hence, in
all probability, a smaller quantity of lime, as of every other secerned
material, formed at this period than in the earlier and more vigor-
ous stages: but  however small the quantity, it is carried off, on
account of the grossness of its corpuscles, less freely by the debilitat-
ed absorbents than the finer and more attenute fluids, and is hence
apt to stagnate first in the bones themselves, which, as we have al-
ready observed, are hereby rendered unduly impacted and brittle,
and next in the lymphatics of every part of the system, and espe-
cially those that enter into the tunics of the  sanguiferous  vessels,
which are hereby  often rendered rigid or even ossific.
  This  is a  natural  consequence of the debility of advancing
years.   But we not unfrequently meet with a like effect in the
earlier stages of life, and in persons of the fullest and most vigorous
health, in which case  there can be no question that the lime thus
profusely and eratically deposited is  produced and secreted in
excess, and consequently by a state of  action the very reverse of
that we  have thus far contemplated.
  The mischief thus originating—as it appears  in the parenchyma,
and in the membranes or vessels of organs, and thus lays a founda-
tion for  two very distinct trains of symptoms,—may be contemplat-
ed under the two following species :

1. OSTHEXIA INFARCIENS.       PARENCHYMATOUS OSTHEXY.
1. ■         IMPLEXA.         VASCULAR OSTHEXY.
                       SPECIES I.

              OSTHEXIA  INFARCIENS.

                ^arnicujnuatous <©sthCKL>.

OSSIFIC MATTER DEPOSITED IN NODULES OR AMORPHOUS MASSES, lie
                THE PARENCHYMA OF ORGANS.

The most common organs in which calculous concretions are found,
are the kidneys and the bladder; but, as in these they form detach-
ed and unconnected balls, and are intimately united with local symp-
toms or a  morbid state of these organs and constitute only one of
various kinds of concretions, it will be most convenient to consider
them when treating of the particular diseases to which they give
rise, or of which they are prominent symptoms.
  The organ  in whose interior  fabric the present concretions are
most usually found, seems to be the pineal gland ; of which almost
all the medical and physiological  journals, as well domestic as 
CE. V.—SP. 1.]       EXCERNENT FUNCTION.
235»
foreign, give  numerous  examples, as do likewise Diemerbroek,
De Graafj Schrader, and other monographists.   In this gland they
have also been found in other animals than man, chiefly those of the
deer kind.
  Such deposits are also frequently found in various other parts of
the substance  of the  brain ; in the lungs :* in the substance of the
heart, in one instance weighing two ounces ;t in the thymus gland ;%
in the  thyroid ;§ in the  parotid ;]J the  sublingual, and most other
glands ;T in the deltoid and most other muscles : nor is there an or-
gan in which it has not been traced on different occasions.   Paulli-
ni records one instance of an ossified penis, and in the Ephemera
of Natural Curiosities, we meet with another.**
  The general pathology we have already  given:  the symptoms
and effects vary to infinity.  Most of the above cases seem to have
occurred after the meridian of life ; and in many instances to have
been connected with atonic gout, which, by adding to the debility
ef advancing age, adds to its tendency to form such deposits.
                        SPECIES II.

                OSTHEXIA IMPLEXA.

                     ©ascular ©sthrics.

• SSIFIC MATTER DEPOSITED IN CONCENTRIC LAYERS IN THE TUNICS
  OF VESSELS OR  MEMBRANES, RENDERING THEM RIGID  AND UN-
  IMPRESSIBLE.

All the vessels and membranes as well as the more massy or com-
plicated organs of the body, are subject to deposits of phosphate or
carbonate of lime, from the  causes  already pointed  out: some of
which are those of weak and others of entonic action j  the former
operating upon the debilitated and the aged, the latter upon the
young and vigorous, who labour under a peculiar diathesis or pre-
disposition to the formation of bony earth.  The chief modifications
appertaining to this species may  be contemplated under the follow-
ing varieties:
• Ba'dlie, Morb. Anat. Fasc. II. Pi. 6.
f Burnet, Thesaur. Med. Pract. III. 254.
t Act. Med. Berol. torn. I. Dec. iii. 28.
§ Contuli, De Lapid. &c.
|| Plater, Observ. Lib. III. 707.
1 Haller, Pr. de. induratis corp. hum. partibus Goett. 1753.
  Pranser, Diss, de induratione corp. in specie ossiuno. Leips.
*• Dec. II-Ann. V. 
S36
ECCMTICA.
[CL. VI—OR. I.
* Arterialis.                   Ossification of the aorta or other
  Arterial osthexy.                large arteries.
£ Membranacea.               Ossification of  membranous  or
  Membranous osthexy.            connecting parts.
y Complicata.                  Ossification  of  different  parts
  Complicated osthexy.            simultaneously.

  Where the deposit takes place in the aorta, it is rarely confined
to this artery alone, but spreads to some parts of the heart, and,
perhaps, of the pulmonary,  or some  other large artery as well.
Dr. Baillie gives an instance in which a considerable portion of the
right ventricle and right auricle of the heart were affected at the
same time ;* and Morgagni another in which the ossification extend-
ed to  the valves, and this too without having produced in the patient
either palpitation or dyspnoea.t  So wonderfully is  the instinctive
or remedial power of nature capable, in various instances, of ac-
commodating the general system to morbid changes.
  We have other examples of the trunk of the aorta being wholly
ossified4 and in one case so rigidly, both in its ascending  and de-
scending branches, as to compel the sufferer to maintain an erect
position.§
  The most troublesome of the membranous ossifications are those
of the pleura, of which an example is  given by Dr. Baillie in his
Morbid Anatomy :|| though the trachea affords at times severe and
even fatal examples of this affection,^ in consequenee of the stric-
ture which is hereby occasionally  produced., Mr. Chester gives a
singular case of a spread  of this disease over the thoracic duct, the
ileum, and other abdominal viscera.
  Yet, in the structure of the arteries, ossification  is  found more
frequently than in any other organ with the exception of  the pineal
gland :  the cause of which seems to have been first glanced at  by
Dr. Hunter, and was afterwards followed up with much patient in-
vestigation and accuracy of research by Mr. Cruickshank.   The for-
mer used to send round at his lectures a preparation of the patella,
in which he demonstrated that the ossification of that bone began in
the arteries running through the centre of the cartilage  which, in
young subjects, supplies the place of a bony patella.  Mr.  Cruick-
shank, on prosecuting the subject, discovered that all other bones os-
sify in  the same manner, and  made preparations in proof of this
fact; distinctly showing that the ossification of bones is not only be-
gun, but carried on and completed by the ossification of their ar-
teries :  and consequently, that the arteries have a natural tendency

                 *  Morb. Anat. Ease. V. PI. 2.
                t De Sed. et Cause, h p. XXIII. 11.
                 t Buckner, Miscel. 17^7, p. 305.
                 §  Guattani, De Aneurism, &c.
                 H Fascic. II. PI  I.
                 1  Kirkring, Specileg. Anat. Obs. 27. 
GE. V.—SP. II.]       EXCERNENT FUNCTION.
237
to become ossific above  that of all other part3 of the system what-
ever.
  One of the most extensive appearances of this habit acting mor-
bidly on the tunics of vessels, is related by Dr. Heberden* in the
Medical Transactions,  in the case of a very old man who at last
died suddenly, as well indeed he  might, since almost the only vis-
cus that was found on examination to be in a healthy state was the
liver.   The internal carotid and basilary arteries with many of their
 firimary branches were ossified.  Through the  substance of the
 ungs, which  firmly adhered to their walls, were scattered  small
calculous tumours.  In the  heart, the valves of the left auriculo-
ventrical opening were  particularly ossified, those of the aorta com-
pletely so, and small depositions  of bony matter were found in the
tendinous portions of the carnese columnae.  The coronary artery
was ossified  through its whole extent.   The descending thoracic
and abdominal aorta, with all their primary branches, were convert-
ed  into cylinders of bone, as were the external and internal iliacs.
It is not necessary to pursue the description into the morbid ap-
pearances of almost every other  organ: and I shall only observe
farther, that though the  substance of the brain was healthy, the ven-
tricles contained about  eight ounces  of water.   And  yet with all
this extent of diseased structure,  the patient appeared almost to the
last to be of a sound constitution and free from  the usual infirmities
of advanced age, with the exception  of an habitual deafness; and
attained upwards of fourscore years  of age before he died.
   Where this diathesis prevails very decidedly, it sometimes con-
verts not merely the vessels but  the whole  of the tendons and the
muscles into rigid bones, and renders the entire frame as stiff and
immovable as the trunk of a tree. There is a striking illustration
of this remark in a case communicated to the Royal Society by Dr.
Henry of Enniskillen.t   The patient was a day labourer who had
enjoyed good health till the time of his being attacked with this dis-
ease.  It commenced with a pain and swelling in the right wrist,
which gradually assumed a bony hardness, and  extended up the
course of the muscles as high as the elbow, the  whole of which
were converted  into a bony hardness, and were of double their natu-
ral size. The left wrist and arm followed the fate of the right: and
the line of ossification next shot down to the extremities of the fin-
gers on both sides, and  afterwards up to the shoulders, so that the
joints were completely ancylosed, and the man was pinioned. At
the time of communicating this history, the same ossific mischief
had attacked the right ankle  with a  like  degree of pain, swelling,
and bony induration up the course of the muscles; in which state
the man was discharged from the  hospital as incurable, after saliva-
tion had been tried to no purpose.
   Salivation has, indeed, often been tried,  probably from its suc-
• Med. Trans. Vol. V. Art. XIII.
t Phil, Trans. Vol. LI. yew 1759. 
'238
EtCttlTlCA.
tCL. VI.—OR. 1
 cess in removing venereal nodes, but it does not seem to have been
 of much more avail in any instance than in the present.
   We have  pointed out  two opposite  causes,  or rather states of
 body, in which a tendency to ossification chiefly shows itself.  One
 is that of general debility, and the other of an entonic action in the
 assimilating organs which are chiefly  concerned in the fabrication
 or separation of lime: and in laying down any plan for relief, it
 seems necessary to attend to this distinction.   Where debility be-
 comes a predisponent of morbid ossification, it is  mostly a result
 or concomitant of old age,  a scrofulous diathesis or atonic gout:
 and in all these cases warmth, a generous diet, and tonic course of
 medicines will  form the most reasonable curative plan that  can be
 pursued; and that which will tend most effectually to stimulate the
 absorbents, and prevent that retardation of bony earth in the lym-
 phatics and vasa vasorum, on which we have already shown the dis-
 ease to depend in this modification of it.
  On the contrary, where it occurs in the middle and vigour  of life,
 and we have  reason to believe in the existence of too much  action
 in vessels which we cannot  very accurately follow up, a reducent
plan will be far more likely to prove successful. We should bleed
 and move the bowels freely, and restrain the patient to a low diet
 with a copious  allowance of diluent drinks.
  •And in both cases with a view of dissolving, as far as we are
 able, the calcareous matter that  may morbidly exist  in the system
 already, or be on  the point of entering into it, we should prescribe
a free use of the mineral or vegetable acids, as already recommend-
 ed under vAuosiiKfragilis. 
     CLASS VI.

ECCRITICA.
                      ORDER II.


                   CATOTICA.


         39tseases attecttnjj Xuternal Surfaces.

PRAVITY OF THE FLUIDS, OR EMUNOTORIES THAT OPEN INTO THE
              INTERNAL SURFACES OF ORGANS.

Catotica is derived from xxru,  "infra," whence xxrurepes and
*«t»t*t«5, "inferior," and  "infimus."  The order includes four
genera as follows, some of which will be found of extensive range:

         I. HYDROPS.         DROPSY.
        II. EMPHYSEMA.      INFLATION.  WIND DROPSJ.
        III. PARUItlA.         MISMICTURITION.
        IV. LITHIA.           URINARY CALCULUS.
                      GENUS  I.

                    HYDROPS.

                        29rojftg.

PALE, INDOLENT, AND INELASTIC DISTENTION OF THE BODY, OR IIS
  MEMBERS, FROM ACCUMULATION OF A WATERY FLUID IN NATU-
  RAL CAVITIES.

Hydrops is a Greek term (wfya-^) importing  an accumulation of
water: and in nosology there is no genus of disease that has been
more awkwardly handled.  The term hydrops does not occur in
Sauvages, Linneus, or Sagar, and only once in Vogel  in the com- 
240
ECCR1TICA.
[CL. VI.—OR. II.
pound hydrops scroti.  Linneus connects anasarca and ascites, its
chief species, with  tympanites, polysarcia, or corpulency and gra-
viditas or pregnancy, into one ordinal division, which he names
tumidosi, and of which these constitute distinct genera.  Sagar ar-
ranges all the same under the ordinal division cachexia.   Vogel
pursues the same plan with the omission of graviditas or pregnancy,
which  he does not  choose  to regard as a cachexy. Sauvages em-
ploys the term hydropes, but only in  connexion with partiales, in
order to restrain it  to local dropsies:  so  that with him ascites is a
hydrops, but  anasarca  is not a hydrops,  and does not even belong
to the  same order;  it is an intumescentia, under which, as in the
arrangement  of Linneus, it is united with corpulency, and preg-
nancy; while hydrops thoracis is an anhelatio, and occurs in a dis-
tinct place and volume.
  Dr. Cullen has certainly, and very considerably, improved upon
his predecessors in this range of diseases. After Sauvages he takes
intum esc entire for the name of his order; but divides it into the
four  sections of adiposae, flatuosse, aquosse vel hydropes, and solidae,
while under the third section (the aquosse vel hydropes) he intro-
duces all the  family of dropsies,  whether general or local, instead
of sending them with those who preceded him, to different quar-
ters.  It would, however, have been a much greater improvement,
and  have  added to the simplicity he aimed  at, to have employed
hydrops as a  generic, instead of hydropes as a tribual or family
term.  It is to Boerhaave  we are indebted for the first use  of hy-
drops as employed  in the  present method; and  he has been fol-
lowed by Dr. Macbride and Dr. Young with a just appreciation of
his correctness.
  The species of this genus, which extend over the body generally
or almost all  the different parts of it, are the following:

1. HYDROPS CELLULARIS.        CELLULAR DROPSY.
2.--------CAPITIS.            DROPSY OF THE HEAD.
3. -------- SPIN^E.              -------------- SPINE.
4. -------- THORACIS.           -------------- CHEST.
5. -------- ABDOMINIS.                       - BELLY.
6. ———— OVARII.                     .------OVARY.
7. ——--- TUBALIS.            -------------- FALLOPIAN TUBE.
8. ■        UTERI.--------------WOMB.
9. ■------— SCROTI.             ----_____ SCROTUM.

  Before we  enter upon a distinct view  of the history and treat-
ment of these several species, it may be convenient to give a glance
at the general pathological principles which apply to the whole.
  All  dropsies proceed from similar  causes,  which, as they  are
general or local, produce a general or local disease. The common
predisponent  cause  is debility.    The remote  causes are very nu-
merous, and most of them apply to every form  under which the
disease makes its appearance j for the accumulation of watery fluid 
  GK. 1-1              EXCEHNENT FUNCTION.                041

  which constitutes the most prominent symptom of the malady, may
  be  produced by a profuse  halitus  from the  terminal arteries occa-
  sioning 100 large a supply of that fine lubricating fluid which, as we
  have  obrerved in the Physiological Proem to the present Class,
  flows from the surface of all internal organs, and enables them to
  play with ease and  without attrition upon  each other; it  mav be
  produced by a torpid or  inactive condition of the correspondent
  absorbents occasioning too small a removal of this fluid, when it
  has answered its purpose and is become waste matter; or it may be
  produced by each of these diseased conditions of both sets of ves-
  sels, operating at the same time; and it is to this double deviation
  from healthy action that Dr. Cullen applies the name of an hydropic
  diathesis.
   Want of action on the part of the absorbents is, in every instance,
  the. result of debility. Profuse exhalation on the part of the secern-
  ents or terminal arteries, in most cases, proceeds from  a like cause,
  for  it takes  place from a relaxed state of these vessels, which open
  their mouths too widely, and suffer the serum or other aqueous fluid
  to escape with  too much freedom.
   Dropsy is, in most instances, therefore, a disease of debility; and,
 if we minutely attend to the  histories  of those  who are suffering
 from this disease, we shall generally find that they have for some
 time antecedently, been labouring under debility either general or
 local: that they are  weakened  by protracted  fevers; or languishing
 under the effects of an unkindly lying-in ; that they have unstrung
 their frames by a long exposure to  a cold and moist atmosphere; or
 have worn themselves out by hard  labour; or, which is  still worse,
 by hard eating  and drinking; or that they are suffering from habi-
 tual dyspepsy or some other malady of the stomach or chylopoetic
 organs, especially the liver, which  destroys  or deranges the  diges-
 tive process, and hence lays a foundation for atrophy.  And for the
 same reason, innutritious or indigestible  food is a frequent  cause
 of some species of this disease :* as  is  also great loss of  blood
 from any organ, and especially when such discharge becomes peri-
 odical.
   Where the digestive organs are in  a very morbid state dropsy
 may take place as a result of general debility;  but it more commonly
 occurs from  that peculiar  sympathy which  prevails so strikingly
 between the two ends of the extensive chain of the nutritive,  or, in
 other words, the digestive and  assimilating powers, which we had
 occasion to explain when treating of marasmus :t the inertness and
 relaxation of the excernent vessels being, in this case, produced by
 the torpitude of the  chylopoetic viscera; and the usual forms of
dropsy being those of the  cellular membrane or  of the abdomen.
Hence a  single  indulgence  in large draughts of cold drmks, and
especially of cold water when  the system is  generally  heated and.
             * Obererzgfebiirgisches Journ, IV. St.
             t Vol. II. p. 475. 48S.
Vol. IV.—H h 
^42                       ECCIUTICA.         [CL. VI.—Oil. 1!

exhausted has occasionally proved sufficient to produce dropsy in
one of those forms; of which we have a striking example in the army
of Charles V. during his expedition against Tunis, the greater part
of it, as we are told by De Haen, having fallen into this disease in
consequence of having freely quenched their thirst with cold water
in the midst of great fatigue and perspiration.*
  A like sympathy not unfrequently takes place between several
other organs and the mouths of the excernents : as the skin and the
uterus: the former as loaded with an extension of the  same termi-
nal vessels, and the latter as maintaining an influence over almost
every part of the  frame.  It was  partly perhaps from sympathy
with the skin, and as participating in the chill and consequent col-
lapse of its capillaries  produced by the coldness of the beverage,
that the excernent system became affected in the extensive dropsy
just ailuded to in the army of Charles V.  And we frequently per-
ceive a similar effect on a sudden suppression or  repulsion of cuta-
neous eruptions, the mouths of the excernent vessels opening into
internal cavities partaking of the torpitude of the cutaneous capil-
laries.  The sympathetic influence exercised over the same vessels
by a morbid state of the uterus is not less manifest; for in chloro-
sis  the abdomen  becomes tumid, and the lower limbs  edematous;
and, on the cessation of the catamenia, cellular or abdominal dropsy
are by no means uncommon.
  Such are the general causes of cellular dropsy as well proximate
as  predisponent.  But there are a few other causes  which  it is
necessary to enumerate  as acting occasionally, though the effects
produced by some of them can hardly be called dropsy in  the pro-
per and idiopathic sense of the term.
   In the first place, the absorbents are supposed by some  patholo-
gists, as M. Mezlert and Dr. Darwin, to be at times affected with a
retrograde action, and hence to pour forth into various cavities of
the body a considerable mass of fluid instead of imbibing and car-
rying it off.  Next, the exhalants of an organ, though themselves
in a state of health, may throw forth an undue proportion of fluid in
consequence of some stimulus applied to them. The most common
stimulus to which they are exposed is distention, and that by a re-
tardation of the blood  in the veins, and a consequent accumulation
in  the arteries.  This retardation or interruption of the flow of
 venous blood may arise from diseases of the right ventricle of the
 heart or its valves ; from various affections of the  lungs  or  their
 surrounding muscles;  from an upright posture continued without
 intermission for many  days and nights, as is often  the case in month-
 ly  nurses; from a gravid uterus, whence the edematous ankles of
 pregnant women ; from scirrhous or other obstructions in the liver
 or spleen; from polypous concretions in the veins, aneurisms in the
• Kat. Med. Part V. 38, 39.
t Von der Wassersuchl. 
CE. I.]
EXCERNENT FUNCTION.
243
arteries, or steatomatous or other hard tumours in the vicinity "of the
larger arterial trunks.
  In some  cases inflammation succeeds to distention, and the quan-
tity of fluid poured forth is still more considerable.  It is from this
double source of stimulus, distention and inflammatory action, that
the ventricles of the brain  become filled in meningic cephalitis, and
the cavity of the pericardium occasionally in carditis.
  Thirdly, the aqueous fluid of a cavity may be unduly augmented,
and consequently dropsy ensue, from a rupture of the thoracic duct,
or of a large branch  of the lacteal vessels.  These, however,  are
not common causes ; the lymphatics of the kidneys, may, perhaps,
most frequently have produced the disease  when ruptured  by acci-
dent or idiopatic affection  in the case  of renal  isclrury; during
which the watery parts of the blood that should pass off by the kid-
neys have been thrown back into the system, and lodged in some
cavity.   And it is probable that when dropsy follows upon long ex-
posure to a cold, damp atmosphere, it h produced, in  some instan-
ces in the same manner; the fluid that should pass off by the exha-
Jants  of the skin, but which cannot in consequence of having lost
their power; being, in like manner thrown back into the blood and
transferred to and accumulated in improper channels.
  Fourthly, the skin is said, at times, to be in a condition to absorb
moisture too freely from the atmosphere:* the stomach is  said, as
in the case of dipsosis avens,  to demand too large a quantity of
liquids  to quench its insatiable thirst;!  and the blood  is said to be
in a state of preternatural tenuity from saline acrimony ;% and each
of these conditions it is affirmed has occasionally proved a source
of dropsy.  The first of these unquestionably occurs at times during
dropsy, and all of them may have operated as causes: but preter-
natural  tenuity of blood, adequate to and producing such an effect is
very uncommon from any cause; and the remedial power of nature
is at no loss for means to carry off a superabundance of fluidity in-
troduced by  any means into the  system, provided  the  excernent
function itself be not diseased.
  From this diversity of causes we may  reasonably expect  that the
dropsical  fluid discharged  upon  tapping should  exhibit different
properties, not only in different organs, but in different cases in the
same organ.  And hence,  it is sometimes found nearly as thin as
water, incapable of coagulating when exposed to heat, which only
renders it turbid ; while, at other times, it  flows in a ropy state,
and accords, upon exposure to heat,  with the natural  serum of the
blood.  A  similar discrepancy is discoverable in its colour or some
* Erastus, Disp. IV. p. 206.
  De Haen, Rat. Med. F. IV. p. 125. seq.
f lluchner, Misccll. 1730. p. 888.
  Mondschien, p 12.
* Galen, de Lymph Caus. Lib. III. Cap. 8\
  Van Swieten ad Sect. 1229. 
244
ECCRITICA.
[CL. VI.—OR. II.
other condition ; for it has sometimes been found black and fetid/
bloody, sanious, milky,t greeny yellowish, or peculiarly acrid.§ In
some instances it has resembled the glairy ichor of sores in a  lan-
guid constitution or degenerated habit; and  according to Guathani
and Steidele it has at times appeared oily.||  It has been occasionally
so urinous or ammoniacal as to turn syrup of red poppies green :^f
and, according to Dr.  M Lacklan, has sometimes contained so much
soda  as by the  addition of sulphuric  acid  to  produce Glauber's
salt** with little or no trouble.
   From the nature of the  fluid itself, therefore, we  have  a clear
proof that the  causes of dropsy must be different in different cases.
In augmented secretion, impeded absorption, or the rupture  of a
lymphatic vessel, the accumulated fluid should contain nothing more
than the ordinary constituents of the halitus that naturally moistens
the cavity into which  it is discharged.   A relaxed state of  the ex-
halants may admit particles of greater bulk, and even red blood :
in which case  the  fluid may  differ  both  in  viscidity and  colour.
While, on the  other hand, morbid collections of  water must proceed
from  a cause of a very different nature ; probably from the exhalant
arteries being  themselves so altered by disease as  to  change  the
properties of the fluid which passes through  them:  or the  general
mass of blood  being so attenuate or otherwise vitiated  as to affect
the secretion.   In  the last case, dropsy is not  a primary disease,
but the consequence of some other, generally, perhaps, of a morbid
liver, spleen, or lungs.tf
                        SPECIES  I.

              HYDROPS  CELLULARIS.

                     Cellular Bropsg.

COLD AND DIFFUSIVE INTUMESCENCE OF THE SKIN, PITTING  BENEATH
                 THE PRESSURE OF THE FINGER.

This  species includes three varieties, as  it is general  to the eel-
* Galeazzi, in Com. Bonon. torn. VI.
I Willis, Pharmaceutice Ratibnalis.
  Med. Com. of Edinb. Vol V.
$ Hucker, Com. Lib. Nor. 1736.
§ Du Verney, Memoirs de Paris, 1701. p. 193.
|] Guat. De Aneurismatibus.  Steid. Chirurg. Beobacht B. I.
U De Haen, llat Med. P. XI. p. 214.
** Med. Coram. Edinb IX. II.
ft Hewson Descript. of the Lymph. Syst. Ch. XII. 
GE. I.—SP. L]       EXCERNENT FUNCTION.                0.4 j

lular membrane, limited to the limbs, or accompanied with a com-
bination of very peculiar symptoms, and especially severe, and in
most cases fatal, dyspnoea:
« Generalis.                    Extending  through the cellular
  General dropsy.                membrane of the whole body.
£ Artuum.                     Limited to the cellular membrane
  Edema.                        of the limbs, chiefly of the feet
                                 and ankles;  and mostly appear-
                                 ing in the evening.
y Dyspnoica.                   Edematous swelling  of the  feet,
  Dyspnetic. Dropsy,             stiffness  and numbness of the
                                 joints ; the swelling rapidly as-
                                 cending to the belly, with severe
                                 and  mostly fatal dyspnoea.
  It is under the first of these varieties that cellular dropsy usually
appears as an  idiopathic affection.  Where the  intumescence is
confined to the limbs, it is usually a symptom  or  result of  some
other affection, as chlorosis,  suppressed catamenia, or any other
habitual discharge; a disordered state of the habit  produced by a
cessation  of the catamenial flux ; repelled eruptions; or the  weak-
ness incident upon protracted fevers, or any other exhausting ma-
lady.
  The third variety is  introduced upon the authority of Mr. W.
Hunter, and taken from his Essay, published at Bengal in  1804.
The disease appeared with great frequency among the Lascars in
the Company's service in 1801.   Its attack was sudden and  its
progress so rapid that it frequently destroyed  the  patient in two
days.   From the description it does not seem to have been connected
with  a scorbutic diathesis:  and  Mr. Hunter  ascribed it to the
concurrent causes of breathing an impure atmosphere, suppressed
perspiration, want of exercise, and a previous life of intemperance.
All  or  any of  these may have been auxiliaries, but the exciting
cause does not 6eem to have been  detected.
   The  second and third varieties, however, may be  regarded as the
opening and concluding stages of cellular  dropsy ; for  before the
disease becomes general, it  ordinarily shows  itself in the  lower
limbs, and in its closing scene the respiration is peculiarly difficult,
 and forms one of its most distressing symptoms.
   General or local debility is its predisposing  cause, ordinarily
 brought on by hard labour, intemperance, innutritious food,  fevers
 of various kinds, exhausting discharges, or some morbid enlarge-
 ment of the visceral or thoracic organs that impedes the circulation
 of the blood, and produces congestion and distention.
   The disease is hence common to all ages,  though most frequently
 found in  advanced life; the  edema  of  the  feet and  ankles, with
 which symptoms it opens, appears at first only in the evening, and
 yields  to the  recumbent position  of  the  night.   By  degrees  it
 becomes more permanent and ascends higher, till not only the thighs 
246                      ECCRIT1CA.            [CL. VI.—OR. II.

and hips, but the body at large is affected, the face and eye-lids are
surcharged and bloated, and the  complexion, instead  of the ruddy
hue of health, is sallow and waxy.  A general inactivity pervades
all  the organs, and consequently all their respective functions. The
pulse is slow, often oppressed, and always inelastic : the bowels arc
costive, the urine for the most part small  in  quantity, and conse-
quently of a deeper hue than usual: the respiration is troublesome
and wheezy, and accompanied with a cough that brings up a little
dilute mucus which affords no relief to the  sense of weight and
oppression.  The  appetite fails, the  muscles become weak and
flaccid, and the general  frame emaciated.  Exertion of every kind
is a fatigue, and the mind,  partaking of the hebetude of the  body,
engages in study with reluctance, and is overpowered with drowsi-
ness and stupor.
  An unquenchable thirst is a common symptom ;  and where this
is the case the general irritation  that is connected with it sometimes
excites a perpetual  feverishness  that adds greatly to the general
debility.   In some parts the skin gives  way  more readily than in
others, and the confined fluid accumulates in bags.  At other times
the cuticle cracks, or  its pores become an  outlet for the  escape of
the fluid, which  trickles down in a perpetual  ooze.  The difficulty
'of breathing increases partly  from the everloaded state of the lungs,
and partly from the growing weakness of the muscles of respiration :
the pulse becomes  feebler and more irregular, slight clonic spasms
occasionally ensue, and  death puts a termination  to the series of
suffering.   Yet  the progress is  slow, and the  disease sometimes
continues for many years.
  In  attempting a cure  of cellular dropsy, and indeed of dropsy in
general, for it will be convenient to concentrate the treatment, we
should first direct  our attention  to the  nature of its  cause with a
view  of palliating or removing it.  We are next to unload the sys-
tem of the  weight that oppresses it.  And lastly to re-establish the
frame in health and vigour.
  Simple edema, or swelling of  the extremities is often, as we have
already observed, a symptom or  result of some other complaint, as
chlorosis or pregnancy,  or some  other cause of distention.  In  the
two last cases it may be  palliated by bleeding, a recumbent position,
and other means adapted to take off the pressure.  In chlorosis  it
can only be relieved by a cure of the  primary affection.  In like
manner, general dropsy may  be dependent upon a  habit of intem-
perance, or a sedentary life,  or innutritious food, or an obstinate fit
of  jaundice; and  till these  are corrected no medicinal plan for
evacuating the accumulated water can be of any avail.  For, if we
could even succeed in  carrying it off, it would  again  collect, so
long as the occasional cause continues to operate.
  The occasional cause, however, may no longer exist, as where it
has been produced by a fever or an exanthem that has  at length
ceased though it has left the constitution an entire wreck.  Or it
may  exist  and be  itself incurable, as  where it proceeds from a 
GE. I.—SP. I.]       EXCERNENT FUNCTION.                247

scirrhous induration or some other obstruction of one of the larger
viscera of the thorax or abdomen : and in this case our object should
be to remove with  all  speed the mischievous effects, and palliate
the  organic cause,  as  far as we are able, according to its peculiar
nature, so that it may  be less operative hereafter.
   A removal of the accmulated fluid from the cellular membrane
generally has been  attempted by internal  and external means, as
hydragogues of various kinds, and scarification or  other cutaneous
drains.
   The hydragogues or expellents of water, embrace medicines of
all kinds that act powerfully on any of the excretories, though the
term has sometimes  been  limited to those  that  operate on  the
excretories of  the  intestines alone.   And it becomes us therefore
to contemplate them  under the  character of purgatives, emetics,
diaphoretics, and diuretics.
   The purgatives that have been had  recourse to are of two kinds,
 those of general use, and those that have been supposed to act with
 some specific  or peculiar virtue  in  the removal  of the dropsical
 fluid.
    Among  the first  we  may rank calomel, colocynth, gamboge,
 scammony, jalap,  and several other species of convolvulus, as the
 greater  white  bind-weed (convolvulus Sepium, Linn.): the turbeth
 plant (c. Turpethum, Linn.): and thebrassicamarina, as it is called
 in the dispensatories (c. Soldanella, Linn.) These may be employ-
 ed as drastic purgatives almost indiscriminately, and their compara-
 tive merit will depend upon their comparative effect, for one will
 often be found to agree best with one  constitution  and another with
 another.  We need not here except calomel, unless indeed, where
 given for the purpose of resolving visceral infarctions; since in any
 other case it can only be employed in reference to its influence upon
 the excretories generally, and particularly those of the intestinal
 canal.
    The  purgatives that  have been  supposed  to  operate  with a
 specific effect in dropsies are almost innumerable.  We must con-
 tent ourselves with taking a glance at the following, grana Tiglia,
 or bastard ricinus; elaterium; elder,  and dwarf elder; black helle-
 bore ; senega ; and crystals of tartar.
    The  croton Tiglium, or bastard ricinus, affording the grana
  Tiglia  of the pharmacopoeias,  is an acrid  and  powerful  drastic
  in all its parts, roots, seeds, and expressed oil.  The  oil is of the
  same character as the oil of castor, but a severer and more acrimo-
  nious purge; insomuch, indeed, that a single drop prepared from the
  dry seeds is often a sufficient dose; while a larger quantity proves
  cathartic when rubbed on the navel.  In India the seeds themselves
  have long been given as a hydragogue;  two being sufficient for a
  robuster constitution; one for a weaklier; and four proving  some-
  times fatal.
     From the uncertainty and violence of the action of this plant,
  the elaterium or inspissated juice of the wild cucumber, is a far 
i>48
ECCRITICA.
[CL. VI.—OR. H.
preferable medicine.  Elaterium, however, has been objected to as
unduly stimulant; and both Hoffman and Lister observe that its ef-
fect in increasing  the pulse is perceivable  even in the extremities
of the fingers.  It is on this account that it seems chiefly to have
been neglected by Dr. Cullen ; who admits that he never tried it by
itself, or otherwise than in the proportion of a grain or two in com-
position with other purgatives. And it is hence, also, that attempts
have been made  to obtain a milder cathartic from the roots of the
plant by infusion in  wine or water,* than from the dried fecula of
the juice, which  is the part ordinarily employed.  Admitting the
stimulant power here objected to, it  would only become still  more
serviceable in cold and indolent cases from local or general atony;
but even in irritable habits in cellular dropsy, I have found it highly
serviceable in  a  simple and uncombined state, produced, as it ulti-
mately appeared, and especially in one instance, from a thicken-
ing of the walls of the heart, in a young lady of only thirteen years
of age. It is  best administered in doses of from half a grain or a
grain to two grains, repeated every two or three hours for five
or six times in succession  according to the  extent of its  action.
Evacuation by the alvine canal  is the most eftectual of  any; nor
can we depend upon any other evacuation unless this  is combined
with it.
  The elder tree, and dwarf elder (Sambucus nigra, and s. Ebulus)
have been in high estimation as hydragogues by many practitioners.
Every part of both the plants has been used; but the liber or inner
bark of the first, and the rob or inspissated juice of the berries of
the last have been  chiefly confided in.  Dr. Boerhaave asserts that
the expressed juice of the former, given from  a drachm to half an
ounce at a dose, is the most valuable of all the medicines of this
class, where the viscera are sound ;  and that it so powerfully dis-
solves the crasis of the different fluids, and excites such abundant
discharges, that, the patient is ready to faint from sudden inanition.
Dr. Sydenham confirms this statement, asserts that it operates both
upwards and downwards, and in no less degree by urine, and adds,
that in his hands  it has proved succcessful in a multitude of hydropic
eases.t  Br. Brocklesby preferred the interior bark of the dwarf
elder,}: as Sydenham and Boerhaave did that of the black, or  com-
mon elder.  Dr. Cullen seems to have been prejudiced against both,
though he admits that he never tried either, notwithstanding that
he had often thought of doing so :§ and it is chiefly, perhaps,  from
his unfavourable opinion of their virtues, that they may seem in
our own day to  have sunk into an almost total disuse.  Chesneau
employed indifferently the seeds, and their expressed oil, the root
* Bondluc, Hist, de l'Acad. Royal de Sciences de Pari$.
f Opp. p. 627,768.
j Qiconom. and Med. Observ. p. 278.
 Mit. Med. Vol. I. p. 534. 
GE. I.—SP. I.]
EXCERNENT FUNCTION.
249
 and the inspissated juice of the  root:  though he preferred the s.
 Ebulus to the s. nigra.*
   The tnelampodium, or black hellebore, was  at one time a favour-
 ite cathartic in dropsies, and has the testimony of high authorities
 for having  very  generally proved  efficacious and salutary.  The
 ancients found the plant which they employed under this name so
 severe in its purgative  qualities, that  they were obliged to use it
 with great caution; but we have reason to believe that the black
 hellebore  of the present day is a different production, as it is mild-
 er in its effects than the hellebore of Dioscorides, and different in
 some of its external characters.  Its root was the part selected, and
 the fibres  of the roots, or their cortical  part rather than  the inter-
 nal.  These were employed  either in a watery infusion or extract.
 Mondscheint preferred on all occasions  the  latter; Quarin  used
 either indifferently.^   Bacher invented a  pill which was  once in
 very high  reputation, and sold under his own name all over Europe,
 for the cure  of dropsy, in  which an extract of this root, obtained,
 in the first instance, by spirit, formed the chief  ingredient; the
 others being preparations of myrrh  and carduus benedictus. These
 pills were said to produce a copious evacuation both by stool and
 urine; and by this combined effect  to carry off the disease.   They
 have however had their day, and are gone by, apparently with too
 little consideration upon the subject: for the experiments of Daig-
 nau and De Home, and especially the successful trials in the French
 Military Hospitals, as related by M. Richard,§  to say nothing of Dr.
 Bacher himself, do not  seem to have excited sufficient  attention.
 In our own country, since the days of Dr. Mead,  the black helle-
 bore has been limited to the list of emmenagogues, and even in this
 view is rarely employed  at present.  Whether  this plant prove pur-
 gative, as  has been asserted, when  applied to  the body externally
 in the form of fomentations or cataplasms, like the croton, I have
 never tried. Ferrara,  employed as  hydragogues, the black  and
 white hellebore indiscriminately.
  The  seneka or senega (polygala Senega, Linn.) was another me-
 dicine much in use about a century ago, and reputed to be of very
 great importance in dropsy, from its combined action upon the  kid-
 neys and intestines, and, indeed, all the excretories.  It reached
 Europe from America, where it had  been  iminemoriallv employed
 by the  Seneka Indians, from whom it derives  its specific name, as
 an antidote against the bite of the  rattle-snake.   The root of the
plant is the  part chiefly, if not entirely, trusted to, and this is given
in powder, decoction, or infusion. M. Bouvart found it highly ser-
viceable as a hydragogue, but observes  that, notwithstanding  this
  • Lib. III. Cap. iii. Obs. 8.
  \ Von der Wassersucht, &c.
  \ Animadversiones, &c.
  § Recueil des Observations de Medicine des Hospitaux Militaires, 8cc. torn.
II. 4to.  Paris.
  Vol. IV.—I i 
250
ECCKITICA
|CL. VI.—OR. II.
effect, it does not of itself carry oft" the induration or enlargement
of infarcted viscera, and ought to be combined with other means.
It was very generally employed by Dr., afterwards Sir Francis Mil-
man, in  the Middlesex Hospital, and has again found a place in the
Materia Medica of the London College. There are unquestionable
instances of its efficacy in the removal of dropsy  when it has been
carried so far as to operate both by the bowels and the kidneys.  It
has, however, often failed ; and, as Dr. Cullen observes, is a nause-
ous medicine which the stomach does  not easily bear in a quantity
requisite for success.
   A far more  agreeable, if not more  effectual  medicine in the
case of dropsy, is the super-tartrate of potass, in vernacular lan-
guage the cream or crystals  of tartar.  In small quantities and very
largely diluted  with water,  or some farinaceous fluid, it quenches
the thirst most -pleasantly,  and, at the same  time, in most cases,
proves powerfully diuretic.  But it is as a purgative we are to con-
template it at present: and to give it this effect it must be taken in
a much  larger  quantity,  never less than an ounce  at a  dose, and
often considerably above this weight.   Thus administered it proves
powerfully cathartic, and excites the action of the absorbents  in
every part of the  system far more effectually than is done by the
influence of any entirely neutral salts.   " I need hardly say," ob-
serves Dr. Cullen, " that upon this operation of exciting the absorb-
ents, is chiefly founded the late  frequent use of  the crystals of
tartar in the cure of dropsy."*   Dr.  Cullen, in this passage appa-
rently alludes  to  the  practice of his  friend Dr. Home,  who was
peculiarly  friendly to its  use,  and  in his Clinical  Experiments
relates  twenty cases  in  which he tried it, and completed a radical
cure in fourteen of them, no relapse occurring notwithstanding the
frequency  of such regressions.   The practice, however, is of much
earlier date than Dr.  Cullen seems to imagine; for Hildanus repre-
sents the physicians of his day as at length flying to it as their sheet
anchor, and deriving from it no common  benefit.t   On the Conti-
nent it has generally, but  very unnecessarily, been united  with
 other and  nu>re active materials, as jalap, gamboge, or some  of the
 neutral salts,  chiefly  vitriolated tartar, or common sea-salt; the
 latter in the proportion of from three to eight drachms of each daily,
 largely diluted with some common drink.J
    Another powerful  source of evacuation that has often been had
 recourse  to  far the cure of dropsy, is emetics:  and, though little
 in use  in  the  present day, they have weighty testimonies in their
 favour among earlier physicians.  Their mode of action has a resem-
 blance to that of the drastic purgatives; for, by exciting the sto-
 mach to a greater degree of secretion, they excite the system gene-
 rally; and, in tact, far more extensively and more  powerfully than

               * Mat. Med. 11. 513. 4to. Edit.
               f Cent IV. Obs. 42.
                Medicinisches VVochenblatt, 1781. N.  40. 
GE. I.—SP. I.]       EXCEliNENT FUNCTION.                251

can be accomplished by mere purgatives, in some degree from the
greater labour exerted  in the act of vomiting, but chiefly from the
closer sympathy which the stomach exercises over every other part
of the system than the  alvine canal, or, perhaps, an y othe  organ,
can pretend to.  In cases of great debility, however, it must be ob-
vious that such exertion would be too considerable, and.would only add
to the  general weakness; and it is on this account chiefly that the
practice has been of late years very much discontinued in our own
country.  It is in consequence of this extensive sympathy of the sto-
mach  with every part of the  system that emetics have often proved
peculiarly serviceable in various local dropsies, especially that of the
scrotum when limited to the vaginal sheath, and that of the ovarium,
when discovered in an early stage. And from this cause, in combina-
tion with powerful muscular pressure, they have  often acted with
prompt and peculiar efficacy on ascites or dropsy of the abdomen ;
while  Withering,  Percival,   and many  of  the  foreign journals*
abound with cases of the cure of ascites by a spontaneous vomiting.
   Diaphoretics have  also  been  resorted to  as  very actively pro-
moting the evacuation of morbid fluids ; and many instances are
related by Bartholet,t Quarin,f and others, of the complete success
of perspiration when spontaneously excited.   Tissot  tells us that
it was by this means Count  Ostermann was  cured, a very copious
sweat having suddenly burst forth from his feet, which continued
for a long time without intermission.
   In the Medical Transactions there is  a very interesting case  of
an equal cure effected  by the same means, in a letter from Mr.
Mudge to Sir George Baker.  The form of the disease was, indeed,
an ascites,  but it will be  more convenient to  notice it here,  while
discussing the treatment of dropsy generally, than'reserve it for the
place  to which it  more immediately belongs.  The  patient, a fe-
male of about forty years old, had laboured under the disease for
twenty years : the abdomen  was  so extremely hard as well as en-
larged, that it was doubtful  whether the complaint was not a para-
bysma complicatum, or physcony of various abdominal organs, and
tapping was not thought advisable.  She was extremely emaciat-
ed ; had a quick, small pulse, and insatiable thirst;  voided little
urine, breathed with difficulty, and could not lie down in  her bed
for fear of suffocation.  For  an accidental rheumatism in her limbs
she had four doses  of  Dover's powder prescribed for her, of two
scruples in each dose, one dose of which she was to take  every
night.  The first dose relieved the pain in her limbs, but did nothing
more.  An hour or two  after  taking the second dose on the ensuing
night she began to void urine in large quantities, which she con-
tinued to do through the whole night, and as fast as she discharged
• Sammlung Medicinischen Wahrnemungen, B. VIII. p. 220.
  N. Sammlung, &c. B. VIII. p. 114.
  Schulz. Schwed. Abhundlungen, B. XXI. p. 102.
f Apud. Bonet. Polyalth. IV. 47.
i Animadversiones, &c. 
252
ECCR1TICA.
[CL. VI.—OK. II,
the water her belly softened and sunk.  The third dose completed
the evacuation ; and "thus," observes Mr. Mudge, " was this formi-
dable ascites, which had subsisted near  twenty years, by a fortu-
nate accident carried off in eight and forty hours."  The cure, too,
was radical:  for the constitution  wholly recovered  itself, and the
patient was restored to permanent health.
   We may observe from this case that the viscera  are  not  neces-
sarily injured  by being surrounded or even pressed  upon by a very
large accumulation of  water for  almost any length  of time.   It
should be noticed, also, in connection  with  this  remark, that the
patient before us was  not  much more than  in the  middle of life,
even at the date of her cure : at which period we  have more reason
to hope for a retention of constitutional health in the midst of a
chronic and severe local disease, than at a later  age.   And there
can be no question that sudorifics will be  found more generally
successful in establishing a harmony of  action between the surface
and the kidneys, and produce less relaxation of the system at this
than at a more advanced term of life.
   But except where there is  such  a  concurrence of favourable
points, sudorifics can be but little relied upon in  the  treatment  of
dropsy, and are rather of use as auxiliaries than as radical remedies.
They are also open to the same objection as emetics : they are apt,
as Buchner has well observed, to do mischief by relaxing and debi-
litating ;* and instances are  not wanting in  which  they have very
seriously augmented the evil.t
   Diuretics are a far more valuable class of medicines, and there
are few of them that operate by the kidneys alone ; the intestines,
the lungs, and oftentimes the whole surface of the body, internal as
well as external, usually participating in their action.
   Of diuretics, the most powerful, if not the most useful, is fox-glove.
It was in high estimation with Dr.  Withering, and Dr. Darwin
regards it almost as a specific in dropsies of every kind ; though he
admits that it does not succeed so certainly in evacuating the fluid
from the abdomen, as from the thorax and limbs.  The preparation
usually  employed by the latter was a decoction of the  fresh green
leaves, which, as the plant is  a biennial, may be procured at  all
 seasons of the year.  Of these he boiled four ounces in two pints of
water till only one pint remained ; and added two ounces of vinous
 spirit after the decoction was strained off.   Half an  ounce  of this
 decoction constituted an  ordinary dose, which was given early in
 the morning and repeated every hour from  three to  eight or nine
 doses, or till  sickness or some other disagreeable sensation was
 induced.  In the hands of Sir George Baker, even when used in  the
 form recommended by Dr.  Darwin, its success was occasionally
 very doubtful; while in some cases it was highly injurious,  without
* Diss, de diversa Hydropi Medendi Methodo. Hal. 1766
f Piso, de Morb. ex serosa Coll. Obs. 1. 
GE. I.—SP. I.]       EXCERNENT FUNCTION.
253
the slightest benefit whatever.*  Even where it acts very power-
fully as a diuretic, and carries off five or six quarts of water a day,
it often excites such incessant nausea, sinking, giddiness and dim-
ness of sight, and such a retardation and intermission of the pulse,
that the increased evacuation by no means compensates for the in-
creased debility.   And by a repetition it is often found to lose even
its diuretic effects.
  In the powder made into pills it seems  to operate with an equal
uncertainty. It has sometimes produced a radical cure without any
superinduced mischief: but in other cases it  has been almost or
altogether inert.  Sir George Baker gives  an instance of this inert-
ness both in the decoction and in pills. In a trial with  the former,
the dose  was six drachms every hour for five successive hours during
two days, through the whole of which it had not the least efficacy,
not even exciting nausea.  In a trial with the latter, three pills, con-
taining a grain of the powder in each, were given twice a day for
several days  in succession.  They gave  no relief whatever ;  nor
produced any other effect than giddiness and dimness of sight.
   It is not wonderful, therefore, that the fortune of fox-glove should
have been various: that at one time it should  have been esteemed
a powerful remedy, and at another time been  rejected  as  a plant
iota substantia venenosa.  Its roots have been tried as well as its
leaves;  and apparently with effects as variable but less active.  It
seems to have been first introduced into the London Pharmacopoeia
in 1721—folia, flores, semen; was discarded in the ensuing edition
of 1746, and has since been restored in its folia alone: having en-
countered a like alternation of favour and proscription in the Edin-
burgh  College.  It is greatly to be  wished that some mode or  ma-
nagement could be  contrived, by which  its power of promoting
absorption might be exerted without the usual accompaniment of its
depressive effects.   When  recommended so strenuously by sach
characters as  Dr. Darwin, and  more  particularly Dr.  Withering,
from  a large  number of successful cases, it is a medicine which
ought  not lightly to be  rejected from  practice, and should rather
stimulate our industry to a separation of its medicinal from its
mischievous qualities.  Upon  the  whole, the singular fact first
noticed by Dr. Withering seems to be sufficiently established, that
in all its forms it is less injurious to weakly and delicate habits than
to those of firmer and tenser fibres.f
   The most useful of the diuretic class of medicines is the siliquose
 and alliaceous tribes; particularly the latter, comprising leeks,
 onions,  garlic, and  especially the  squill.  The last is always a
 valuable and important article, and Sydenham asserts that he  has
 cured dropsies by this alone.   It has the  great advantage of acting
 generally on the secernent system, and consequently of stimulating
 the excretories of the alvine canal as  well as those of the kidneys.
* Medical Transactions, Vol. III. Art. XVII.
t Essay on Digitalis, p. 189. 
254
ECCIUT1CA.
[CL. VI.—OR. II.
It sometimes, indeed, proves a powerful purgative by itself;  but is
always an able associate with any of the cathartics just enumerated.
It may be given  in any form, yet its disgusting taste points out that
of pills as the least incommodious.
   When intended to act by the kidneys alone, Dr. Cullen advises
that it should be combined with a neutral salt; or, if a mercurial
adjunct be preferred, with a solution of corrosive sublimate,  which
seems to urge its course to the kidneys quicker and more completely
than any other preparation of mercury.*  It may, also, be observed
that the dried squill answers better as a diuretic than the  fresh;
the latter, as being more acrimonious, usually stimulating the sto-
mach into an increased excitement, which throws it off by stool or
vomiting, too soon for it to enter into the circulating system.
   The colchicum autumnale, or meadow-saffron, ranks  next, per-
haps, in point of power as a diuretic, and is much entitled to atten-
tion.  It is to the enterprising spirit ofDr. Stoerck that we are chiefly
indebted for a knowledge of the virtues of this plant, whose expe-
riments were made principally on his own person. The fresh roots,
which is the part he  preferred, are highly acrid and stimulating; a
single grain wrapped in a crumb of bread and taken into the sto-
mach, excites a burning heat and pain, both in  the stomach and
bowels,  strangury, tenesmus,  thirst, and  total  loss  of appetite.
And even while  cutting the  roots, the  acrid vapour that escapes,
irritates the nostrils and  fauces; and  the substance  held in the
fingers,  or applied to the tip of the tongue, so completely exhausts
the sensorial power,  that  a numbness or turpitude is produced  in
either organ, and continues for a long time afterwards. According
to Stoerck's experiments, this acrimony is best corrected by infu-
sion in vinegar;  to which he afterwards added twice the quantity of
honey .t  In the form of an acetum, and of the strength he proposed,
it is given as a preparation in  the  extant London Pharmacopoeia,
while most  of the  other colleges  have preferred his oxymel.
Stoerck used it under both forms, but perhaps the best preparation
is the wine,  as recommended by Sir Everard Home in cases of gout,
depurated from all sediment, as  already  noticed under the latter
disease.  Stoerck began with a drachm of this twice a-day, and gra-
dually increased  it to an ounce or upwards.  Hautesierk asserts that
it is less efficacious than the oxymel  of squills.J
  The other diuretics, in common use,  are of  less importance ;
though many of them may be found serviceable auxiliaries as they
may easily enter into the  dietetic regimen. These are the sal diure-
ticus, or acetate of potash, which very slightly answers to its name,
unless given in a  quantity sufficient to act at the  same time  as an
aperient; nitrous ether; juniper berries, broom-leaves,and, which
is far better, broom ashes; or either of  the fixed alkalies; and the
• Mat. Med. Vol. II. Part II. Ch. xxi.
f Libellus de Radice Colehice aulumnali. Vindob. 1763. 8vo.
* Recueil. II. 
GE. I.—SP. I.]        EXCERNENT FUNCTION.
255
green lettuce, lactuca virosa, strongly recommended by Dr. Collin
of Vienna, but as far as it has been tried in this country far beyond
its  merits.  Dr. Collin, however, asserts that out of twenty-four
dropsical patients he cured by this medicine all but one.
  To this class of remedies we have yet to add dandelion (Leonto-
don taraxacum, Linn.) and tobacco.   The former of these  was at
one time supposed to act so powerfully and specifically on the kid-
neys as to obtain the name of lectiminga ; and is said by some  writers
to have effected  a cure  in ascites after every other medicine  had
failed.  It is truly wonderful to see  how very little of this virtue
it retains in the  present day, so as to be scarcely worthy of atten-
tion : while with respect to tobacco, notwithstanding the strenuous
recommendation of Dr. Fowler, it is liable to many of the objections
already stated against fox-glove.
  The gratiola officinalis, or  hedge-hyssop, was  once extensively
employed, both in a recent state of its leaves and in their extract,
and, like many other simples, it appears to have been injudiciously
banished from the Materia Medica.  In  both forms it  is a power-
ful diuretic, and often a sudorific; and in the quantity of half a  drachm
of the dry herb, or a drachm of infusion, whether in wine or in water,
it becomes an active emetic and purgative.   It is said to have been
peculiarly useful in dropsies consequent upon parabysma, or infarc-
tion of the abdominal viscera; and in such cases seems still entitled
to our attention.  As a strong bitter,  it may, like the lactuca virosa,
which is also a strong bitter, possess some degree of tonic power,
in connection with its  diuretic tendency.   The bitter, however, is
of a disagreeable and nauseating kind, which it is not easy to  cor-
rect.
  The external means of evacuating the fluid of cellular dropsy
are blisters, setons, or issues, punctures, and scarification. The last
is as  much less troublesome as it is  usually most effectual.  It is,
however, commonly postponed to too late a period, under  an idea
that sloughing wounds may be produced by the operation, difficult of
cure, and tending to gangrene. In blistering this  has often happen-
ed, but in scarifying the fear  is unfounded, while any degree of
vital  energy remains:  and it should never be forgotten that the
longer this simple operation is delayed, the more  the danger, what-
ever it may be, is increased.   I have never experienced the slight-
est inconvenience from the practice; and have rarely tried  it with-
out some advantage; seldom indeed without very great benefit. The
wound should be limited to a small crucial incision, resembling the
letter T on the outside of each knee, as the most dependent organ,
a little below the joint. The cut thus  shaped, and very slightly pene-
trating into the  cellular membrane will not easily close, and conse-
quently the discharge will continue without interruption. In a young
lady about twelve years of age, whom the author lately attended appa-
rently labouring under an affection of the liver, but whose enormous
bulk of body as well as of limbs, prevented all accuracy of examina-
tion, a common jack-towel applied to each leg after the incision was 
256
ECCR1TICA.
[CI .  VI.—OR. II.
made, was completely wetted through, and obliged to be changed
every three or four hours, for as many days.  She was also purged
with small and frequently repeated  doses of elaterium: and the
quantity of fluid hereby drawn off at the same time by the intestines
is scarcely credible.   The whole system was  evacuated in about a
week; and the entire figure re-acquired as much elegance of shape
and elasticity, as  before the attack. She was of a lively disposition
and fond of dancing; in which exercise she engaged with as  much
energy and vivacity as ever. Nearly  a twelvemonth afterwards the
disease returned : but the same  means were not successful.   The
breathing  was now affected, and there was great palpitation of the
heart; so  frequent and distressing indeed as to render her incapa-
ble of sleeping for a moment unless  in an upright position.   The
patient in a few weeks fell a victim to the disorder; and on examin-
ing the body, the  liver and lungs were found perfectly sound : but
the heart was enlarged to nearly double its natural size, and parti-
cularly on the right side.
  During  the progress of hydropic  accumulation there  is  great
dryness of the tongue, and, as already observed, an almost intolera-
ble thirst.  And the question has often been agitated, whether under
these circumstances  the patient's strong desire to drink should be
gratified.   In a state of health it is  well known,  that whatever be
the quantity of fluid  thrown into the blood it remains there  but a
short time, and passes off by the kidneys, so that the balance is  easily
restored :  and hence.it is obvious that one  of the most powerful, as
well  as one of the simplest diuretics  in such a state, is a large por-
tion of diluent drink. But dropsy is a state very far removed from
that of health ; and in many cases a  state in which there is a pecu-
liar irritability in the secernents of a particular cavity, or of the
cellular membrane generally, which detracts the aqueous fluid of
the blood from  its other constituents, and  pours it fourth into the
cavity of the morbid organ.   And hence it has been very generally
concluded that the greater the quantity of fluid taken into the sys-
tem, the  greater  will be the dropsical accumulation: and conse-
quently that a rigid abstinence from  drinking is of imperative ne-
cessity.
  Sir Francis Milinan, however, has very satisfactorily shown, that
if this discipline be rigidly enforced, a much greater mischief will
follow than by perhaps the utmost latitude of indulgence.   For, in
the first place, whatever solid food is  given, unless a due proportion
of diluent drink be allowed, it will remain in an hydropic patient,
a hard, dry, and indigested mass in  the stomach,  and only add  a
second disease  to a  first.  And next, without diluting fluids, the
power of the most active diuretics will remain dormant: or rather
they will irritate  and excite pyrexy instead of taking their proper
course to the kidneys.  And,  once more, as the thirst and general
irritation and pyrectic symptoms increase, the surface of the body,
harsh, heated, and acrid, will imbibe a much larger quantity of fluid
from the atmosphere than the patient is asking for his stomach; for it 
GE. T.—SP. I.]
EXCERNENT FUNCTION.
25?
has been sufficiently proved, that, under the most  resolute deter-
mination not to drink, a hundred pounds of fluid have in this man-
ner been absorbed by the inhalants of the skin, and introduced into
the system in a few days, and the patient has become  bulkier to
such an extent in spite of his abstinence.
  Even in a state of health or where no dropsy exists we are in all
probability perpetually absorbing moisture by the lymphatics of the
skin.   Professor Home found himself heavier  in the morning than
he was just before  he went to bed in the preceding evening, though
he had been perspiring all night, and had received nothing either by
the mouth or in any other sensible way.  " That the surface of the
skin," says Mr. Cruickshank, "absorbs fluids  that come in contact
with it, I have not the least doubt.  A patient of mine, with a stric-
ture in the oesophagus, received nothing either solid or liquid into
the stomach for two months : he was exceedingly thirsty, and com-
plained of making no water.  I ordered him the warm-bath  for an
hour,  morning and evening, for a month: his thirst vanished, and he
made water in the same manner as when  he used to drink by the
mouth, and when the fluid descended readily into the stomach."*
  Under these circumstances,  therefore, our first object should be
to determine by measurement whether the quantity of fluid dis-
charged by the bladder holds a fair balance with that which  is re-
ceived by the mouth: and if we find this to be  a fact, and so long as
it continues to be a fact, we may  fearlessly indulge the patient in
drinking whatever diluents he may please, and to whatever extent.
In some cases, indeed, water alone, when drunk in large abundance,
has proved a most powerful diuretic, and has carried off the dis-
ease without  any other assistance, of which a striking instance oc-
curs in Panarolus;f  and hence Pouteauf occasionally advised it in
the place of all other aliment whatever: as  does also Sir George
Baker, in a valuable article upon this subject in the Medical Trans-
actions,^ in  which he forcibly illustrates the advantage of a free
use of diluent drinks, by various cases transmitted to him, in which
it operated a radical cure, not only without the assistance of any
other  remedy, but, in one or two  instances, after every medicine
that could be thought of, had been tried to no purpose.
  But the fluid discharged from the kidneys may not be equal, nor
indeed bear any proportion to what is introduced into the mouth, and
we may thus have a manifest proof that a considerable quantity  of
the latter is drained  off into the morbid cavity.    Still we mast not
entirely interdict the use of ordinary diluents, nor suffer the patient
to be tormented  with a continued and feverish  thirst.  If simple
diluent drinks will not pass  to the kidneys of  themselves, it will
then be our duty to combine them  with some of the  saline or aci-
• Anat. of Absorb. Vessels, p. 108. 4to. 1790.
t Pentec. II. Obs. 24.
* OZuvres Posthumes I.
§ Vol. II. Art. xvii.
Vol. IV.—K k 
25S
ECCRITICA
fCL. Vt.—OR. II
 dulous diuretics, we have already noticed, which  have a  peculiar
 tendency to this organ ; and we shall generally find,  that in  this
 state  of union they will accompany the diuretic  ingredients, and
 take the desired  course.  Of these, one of the most  effectual, as
 well as the most pleasant, is creme of tartar; and hence this ought
 to form a part of the ordinary beverage  in all extensive dropsies,
 and especially *he cellular and abdominal.  Any  of the vegetable
 acids, however, may be employed for the same purpose : as may also
 rennet-whey and butter-milk, and the more acid their taste the bet-
 ter will they answer their end.  A decoction of sorrel-leaves makes
 also a pleasant diet drink for an hydropic patient;  as does likewise
 an  aqueous infusion of sage-leaves with lemon-juice : both sweeten-
 ed to the taste.   Small stale table-beer, and weak cyder, or  cyder
 intermixed  with water, may in  like manner be allowed, with little
 regard to measure.   And it was by the  one or  other of  these that
 most of the cures just referred  to, as related by Sir George Baker,
 were effected.   In one instance the cyder was new, yet it proved
 equally salutary under the heaviest prognostics.   The patient was
 in his  fiftieth year; his legs and thighs had increased  to such  a
 magnitude that the cuticle crackled in various  places; he  was ex-
 tremely emaciated, and so enfeebled as not to  be  able to quit his
 bed, or return to it without assistance.  His thirst was extreme, his
 desire for new cyder inextinguishable, and his case being regarded
 as desperate it was allowed him mixed  with water.  He drank it
 most greedily, seldom in a less quantity than five  or six  quarts a-
 day ; and by this indulgence discharged sixteen or eighteen quarts
 of urine every twenty-four hours till the water was totally drained
 off;  and he  obtained a radical cure without any other means what-
 ever.  Even ardent spirits, if largely diluted, and joined with a por-
 tion  of vegetable acid, have been found to stimulate the  kidneys;
 and  in the  opinion of Dr. Cullen may make a part of the ordinary
 drink.*  And it is chiefly owing to the tendency which the  neutral
 salts have to the kidneys, as their proper emunctory, and the sym-
 pathy which the  secernents of these  organs maintain with those of
 all others, that the cure of dropsy has sometimes been  effected by
 large draughts of sea-water alone;  though sometimes this has also
 acted  upon  the bowels, and produced the same  salutary result, by
 exciting a very copious diarrhoea, of which a striking  example is
 given by Zacutus Lusitanus.f
  It should  never, however, be  forgotten,  that dropsy is  a disease
 of debility, and that the plan of evacuating will rarely of itself effect
 a cure; and  never, perhaps, except in recent cases, and where little
inroad has been made upon the constitution.  In all other cases it
 should be regarded as a preparatory step alone ;  a mere palliative ;
and an evil in itself; though an evil of a less kind to surmount  an
evil of a greater.  And it is for want of due attention to this  fact,
» Mat. Med, II, 549.
t Prax. Hist. Lib. VIII. Obs. 53. 
GE. I.—SP. I.]
EXCERNENT FUNCTION.
259
that the plan of evacuating, and particularly by drastic purgatives,
has by many practitioners been carried to a dangerous and even a
fatal extreme.   Every purgative that does not diminish the general
bulk, adds to the general disease by increasing the debility : and if
upon a very few trials the plan be not found to answer this salutary
purpose it cannot too soon be desisted from.
  The radical cure must, after all, depend  upon invigorating  the
constitution, or the organs particularly affected : for even a total
removal of the water affords nothing  more than a palliative and
present relief
  Such an intention may often, indeed, be combined  with that of
evacuating the fluid ; and hence Mondschein with great reason ad-
vises us to employ bitters with diuretics,* as Martius does with
purgatives.t
  Bitters, indeed, where the debility does not  depend upon visce-
ral obitructionsi form one of the most efficacious tonics we can em-
ploy.  They are peculiarly adapted to that general loss of elastici-
ty in the whole system and that laxity of the exhalants which consti-
tutes the hydropic diathesis. " It has been alleged," says Dr. Cul-
len, " that bitters sometimes act as diuretics. And as the matter of
them appears  to be often carried to the kidneys, and to change the
State of the urine, so it is possible that in some cases they  may in-
crease the secretion: but in  many trials we have  never found their
operation  in this way to be manifest, or at least to be any ways con-
siderable. . In one situation, however, it may have appeared to be
so.   When in dropsy bitters moderate that exhalation into the ca-
vities which forms the disease,  there must necessarily be a greater
proportion of serum carried to  the kidneys: and thereby bitters
may, without increasing the action  of the kidneys, seem to increase
the  secretion of urine."|
  To bitters have been added the warmer balsamics and aromatics,
and by many physicians  the metallic oxydes; chiefly the different
preparations of copper; though  Willis, Boerhaave, Bonet, and Dig-
by,  have occasionally preferred those of  silver. Iron has generally
been  abstained from  as too heating, though recommended  by
Grieve,§ Richard,H and Rhumelius U
  Where  the disease is evidently dependent upon some visceral ob-
struction, mercury offers a fairer chance of success than any other
metal; and in this case has often been pushed to salivation with the
most salutary  result.   Du Verney employed it to this extent in an
ascitic patient, whom at the  same time he tapped ; and by this dou-
• Mondschein, p. 82.
f Martius, Obs 54.
* Mat Med. II. p. 58.
$ Med. Com. Edinb. IX. II. 75.
II Journ. de Med. XXIX. 140.
t Medic. Spagyr. tripart. p. 168, 
£60
ECCR1TICA.
[CL. VI.—OR. II.
ble plan eftected a cure ; allowing a regimen of wine and stimulant
meals during the process.*  And Rahn assures us, that in one case,
the disease, though it several times recurred, was in every instance
put to flight  by a  ptyalism excited by mercurial inunction.t But
where the system is in a state of great general  debility, such a so-
lution of the fluids will only add to the weakness and increase the
disease.  Small doses of calomel steadily persisted in will be here
our safest course, with a nutritious and generous diet of flesh-meat
two or  even  three times  a day; shell fish; eggs;  spice, and the
acrid vegetables, as celery, water-cresses, raw  red  cabbage shred
fine, and eaten as sallad.
  I have dwelt the longer on this species  because the  general ob-
servations which it  suggests, as well in respect to  its causes and
history as to its  mode of treatment, apply in a very considerable
degree to all the rest; concerning which we shall now have little
more to do than to enumerate them and point out their distinctive
characters.
                       SPECIES II.

                 HYDROPS  CAPITIS.

        ©roausji of the ?H|eatt.  Skater in the Heatr.

EDEMATOUS INTUMESCENCE OF THE HEAD: THE SUTURES OF THE
                       SCULI. GAPING.

This disease has been strangely confounded by nosologists and prac-
tical writers with that inflammation  of the brain which apparently
commences in its substance or lower part, and, producing effusion
into the ventricles, distends them, and thus unites the symptoms of
fever and great  irritability with those of  heaviness, and at length
of stupor.  The accumulation of fluid is  here only an effect, and
follows upon inflammation of the brain as in any other part, and is
only to be removed by removing the inflammation.  It is ordinarily
denominated, however, acute or internal  hydrocephalus ;  but Dr.
Cullen has correctly distinguished it from  proper hydrocephalus or
dropsy of the head, by placing it in a different part of his classifica-
tion, and assigning it a different name.  In his view it is an apo-
plexy, and  he has hence called it apoplexia hydrocephalica.   In the
present work it  occurs  under the name of cephalitis profunda,
and in treating of it as a cephalitis the author has submitted hit-
reasons for  not regarding it as an apoplectic affection.
• Mem. de Paris, 1703, p. 174.
f Medic. Briefwechsel B. I. 365. 
GE. I.—SP. II.]
EXCERNENT FUNCTION.
261
   The disease before us is  common to children.  A few singular
cases are, indeed, recorded of its commencing in adult age,* and
producing an enlargement of the scull by a morbid  separation of
the sutures, but these are very rare.   That it does, however, occur
without such separation and enlargement, and that too occasionally
in every period of  life, has been proved by a multitude of exami-
nations after death, that have shown the ventricles of the brain dis-
tended with fluid, and producing a considerable pressure upon the
brain.   Yet where no such  enlargement of the scull takes place, we
may sometimes strongly suspect the disease from the symptoms,
but cannot during the life of a patient speak with certainty upon
the subject.
  Dropsy of the head, like that of every other organ, is a  disease
of debility, and as we have already observed in the introductory re-
marks to the present genus, may proceed from a relaxed condition
of the secernents  of the brain, a torpitude of its absorbents, or
from both.  The causes of this morbid state we are  rarely able to
ascertain: yet in some families there seems to be a  peculiar pre-
disposition to it, since it occurs in many of the  children  born in
succession : and it may sometimes be connected with a scrof lous
diathesis.
   The immediate seat of the dropsy varies considerably : for some-
times the fluid accumulates between the bones of the cranium and
the dura mater; sometimes between  the  dura mater  or the other
membranes and the  brain, and sometimes in the ventricles or con-
volutions of the organ.   With the deficiency of tone there is also
not unfrequently some deficiency of structure or substance : and it
is in consequence of this that the fluid, when morbidly secreted or
collected in one part, spreads without resistance to another. A de-
ficiency of structure or substance is sometimes found in the brain
itself and sometimes in the cranium.  If it occur in  the former a
path may be immediately opened  for the morbid fluid, accumulated
in the ventricles or in any other interior part, to reach the mem-
branes and distend the scull: and if in the latter, it may even pass
beyond the scull, and separate and distend the integuments.   I have
seen instances of large perforations produced in  different parts of
the bones by a morbid absorption of the bony earth, as though the
trephine had been  repeatedly applied, and  this too in adult age :
ana in some instances there has been a total absence of the calvaria.t
Generally  speaking, there  is some  deficiency of bony earth, as
though it were impossible for this secretion to keep pace with the
enlargement of the cranium : and hence the bones of the cranium
have occasionally been so thin as to be pellucid and transmit the
light of a candle, of which Van Swieten gives an instance^ from
* Hildan. Cent. HI. Obs. 17. 19.
t Act. Hefvet. I. 1.
'  Comment, in Hydrop. Sect. 12J" 
263
ECCRIT1CA.
[CL VI.—OR. II.
 Betbeder;' or have  had their place supplied by a membrane co-
 vering the entire range of the sinciput, an example of which will
 be found  in Vesalius.t
   The dropsical fluid is also said by many writers of high authority
 to originate in some cases between the integuments and the  bone,
 and  to be confined to this quarter : and hence, the disease has been
 divided into external and internal dropsy of the head.   It is  possi-
 ble,  indeed, as Van Swieten has justly observed, that  since  water
 may be collected in  the cellular membrane of the whole body, such
 an accumulation may take place in the integuments of the  head4
 But  the pretended cases are so rare that Van Swieten  himself, Pe-
 tit^ and  many other writers of  high credit, nave doubted whether
 such a form of the disease has ever actually occurred.   Yet, should
 it occasionally take place, there can, I think, be no  question <hat it
 ought rather to be regarded as  a  variety of anasarca  or cellular
 dropsy, than hydrocephalus or dropsy of the head, properly so call-
 ed.  Celsus has  been quoted upon the  occasion  as  confirming the
 existence  of this external modification, and applying to it the name
 of hydrocephalus :  but this is to misund< rstand him  egregiously.
 In the passage referred to he is speaking of internal diseases of the
 head  alone, of cephalaea, and  other  aches produced  by wine, or
 indigestion, by cold, or heat, or the rays of the sun, sometimes ac-
 companied with fever, and sometimes without;  sometimes  affect-
 ing the whole  of its interior, and sometimes only a  part:—"modo
 in toto capite, modo in parte."  And he then adds, " praeter haec
 etiamnum invenitur  genus, quod potest longum esse: ubi humor
 cutem inflat, eaque itumescit, et, prementi digito, cedit: ufyoxt<px\av
Grseci appellant."||  It is manifest, therefore, that the  hydrocepha-
lus here noticed, like the other diseases with which it is associated,
is an internal  affection of the head: and this idea  is still  farther'
confirmed by the treatment which  he shortly afterwards proceeds
to prescribe for it.
  It is hence highly probable that the cases which have been called!
external dropsies of the head, have consisted of internal accumula-
tions spreading to and distending the integuments through channel*
that  were not ascertained, and  on this account not supposed, to
 exist.
  Were the distinctions of external and internal dropsy of the head
necessary  to be preserved, it would be far more  accurate to  limit
the former to those modes of the disease in which the water is con-
fined between  the calvaria and the membranes,  and the latter to-
those in which it originates in the cavities of the brain  : but as we
• Histoire de PHydrocephale de Be^le, p. 35.
t De Corp. human, fabrica. lib. I. cap. 5.
t Comment, loc. citat. 1718.
% Academ. des Sciences, Mem. p. 121.
'i De Median. Lib. IV. cap. II. 
«E. I.—SP. II.)     EXCERNENT FUNCTION.                  265

can rarely, if ever, determine  the  limits of the  collection by the
symptoms, it is a distinction which cannot be supported, and would
often lead  us into  error.
   Hydrops capitis frequently commences in the fetus, and some-
times renders the head so large as to retard the labour, and greatly
harass the delivery.   Blanchard gives a case in which four pounds
of water were  evacuated from  the  head  of a fetus after its birth.
At other times it does not show itself till some months, or even two
or three year*, after birth.  In most cases the whole head  enlarges
gradually by a gradual separation of the sutures ; but in a few cases
the first symptom has been a  small, elastic tumour on the upper
part of the head, produced by an inequality  of the dura mater, and
its yielding more readily at the part that presents, than in any other
quarter.   This tumour sometimes  grows to a size as large as the
head  itself.  It is seldom,  however, that the walls of the tumour
burst; for  the  uniform pressure  to which they are exposed, has a
tendency to thicken and harden them. And hence, as the resistance
increases,  the  sutures give way generally, and  the tumour  fre-
quently disappears and is lost in the general swell.
  The brain often exhibits,  as we have already observed, some mis-
formation or defect, which of itself may constitute a remote cause:
but the proximate  cause  is a debility of the local secernments, ab->
sorbents, or both.  If the  debility be  confined to these, or the defect
in structure do not interfere with  the proper development of the
mental or corporeal powers  of the sensorium, the infant may  live
and even thrive in every other part, while the water continues to
accumulate  and the head to  become more monstrous, and  even in-
supportable from its own weight: for, provided the pressure  ap-
plied be very gradual, and unaccompanied with inflammation, the
brain, like the stomach and  intestines in  dropsy of  the belly, may
be drowned in water for even twenty or thirty years without serious
mischief. Michaelis relates the case of a patient twenty-nine years
old, whose  appetite and memory were good, and the pupils of the
eyes natural, though the disease had continued from birth.*  And
in treating  of vascular osthexy I  had occasion to notice, from  Dr.
Heberden, the history of a patient who, with about eight ounces of
water in  the ventricles of the brain, as appeared on opening him,
—and which there was good reason  for believing had existed there
for many years,—and with scarcely an organ free from disease in
his whole body, with the exception  of the brain itself, which wan
found healthy in its substance, was enabled to attain the good  old
age of upwards of fourscore years with an apparently sound con
stitution, and free from all the usual infirmities of advancing years,
saving the inconvenience of  an habitual deafness.
  But the torpitude or imbecility of the excernent vessels may ex-
tend to the other parts of the brain, and to parts that are immedi
ately connected with the mental faculties; or the defects of structure
• Medical Communications, Vol. I. Art. XXV, 
264                       ECCRITICA.            [CL.VI.—Olt.U.

that are so often combined with dropsy of the head may extend to
the same : and in such cases the hearing, sight, or speech may be
affected : there may be loss of memory or stupidity, vertigo, epi-
lepsy, or convulsion fits.   The brain has sometimes been found in
a spongy or fungous state;* or otherwise disorganized :t and some-
times tense and slender with nerves like mucus.J The fluid, more-
over may accumulate with rapidity, instead  of slowly, as soon as
the exciting cause, whatever it maybe, is in opet"Slion, and the sud-
denness of the pressure may impede the action of the sanguiferous
vessels; and  we shall then perceive symptoms of  compression, as
a heavy pain in the head,  stupor, occasional vomiting, quick pulse,
and  other febrile concomitants, a perpetual flow of tears from the
eyes, or of mucus from the nostrils.  And hence it is that dropsy
of the head is so frequently a symptom or a sequel  of inflammation
of the brain,  and particularly of parenchymatic inflammation.
  Yet  even here we have, sometimes, striking and most singular
proofs, that the remedial power of  nature is  interfering either to
obtain a cure, or to render  the disease compatible with life, and with
the general faculties of the sensorium.  There is an interesting il-
lustration of this remark  in a case, related by Dr. Donald Monro,
in the Medical Transactions. It is that of a child which at the age
of a year and a half, was brought into St. George's Hospital with a
head much enlarged  from  the disease before us.  She was feverish
and had a slight stupor.   The complaint was peculiarly obstinate,
and resisted  the use of purges, blisters, issues, bandages, and other
remedies.  The enlargement proceeded and became chronic, though
the fever and stupor gradually diminished and  at length ceased;
yet the head continued to enlarge  and  kept an equal  proportion
with the child's growth :  so that when in her eighth year, it mea-
sured two feet four inches round, which is nearly a foot more than
it ought to have done, and the forehead alone was halt the entire
length of the face, or four inches out of eight, which is double the
proportion it ought to have held,—yet the child was at this time as
lively and  sensible as most children of her age, and had a  strong
and  peculiarly retentive memory.  It was long before she could
walk, on account of the vast weight of head  she had to carry, and
the difficulty of preserving a balance ; but at  length she learned to
walk also with tolerable ease.§
   In the following case the efforts of the remedial power were less
successful: but it is peculiarly worthy of notice, as much from the
lateness of the age in which the disease commenced, and the sutures
were separated, as from  the natural  struggle there seems to have
been to obtain a triumph over it.   It  is related by Dr. Baillie, in
another volume of the same valuable work.  The patient was a
• Conrad, Diss, de Hydrocephalo. Argent. 1778.
f Bonet, Sepulchr. Lib. I. Sect. XVI. Obs. 9.
+ Buttner Beschreibung des innern Wasserkopfs, &c. Konigs. 1773,
§ Medical Transactions, Vol. II. p. 359. 
GE. I.—SP. II.]      EXCERNENT FUNCTION.               265

boy, not less than seven years of age when he first became affected.
The pupils, from an early stage, were considerably dilated, and the
pulse was somewhat irregular; he complained of pain towards the
back of his  head, and  was often  in a state of stupor.  His under-
standing, however,  was clear, and his  sight very little  impaired
almost to the last.   He had  twice intervals of great promise, for a
few weeks, with considerable  abatement of all the symptoms, and
an appearance of doing well.  But in both instances he  relapsed,
and at the  distance of ten months from the  commencement, fell
under daily attacks of convulsion  fits. It is remarkable that, though
his intellect continued  unimpaired, the frontal and  parietal bones,
from the force of the accumulated fluid in every  direction,  were
separated from each other, to a distance of from half to three quar-
ters of an inch, notwithstanding that they had been firmly united at
their respective sutures before the commencement of the disease.
Nearly a pint of water was  found in the ventricles upon  examina-
tion.
  "We have observed, that in many cases the bones of the scull be-
come peculiarly thin and  pellucid, or are  altogether deprived of
their calcareous earth, and  reduced to cartilages.   But where the
instinctive or remedial power of nature, which is always labouring
to restore morbid parts to a state of health, or to enable them in
their altered condition to  fulfil their proper functions, has succeed-
ed in rendering the diseased brain still  capable of exercising  some
of its faculties, a supply of phosphate of lime, is, in various instan-
ces, also provided for  the bony membrane;  which not only re-as-
sumes its ordinary firmness, but has sometimes exhibited  a density
far beyond  the usual proportion and commensurate with  the  mag-
nitude of the scull; while the cervical vertebrae have been equally
strengthened for the purpose of bearing so enormous a load.  Hil-
danus gives a case of this kind in a youth eighteen years  old, who
had laboured under a dropsy of the head from his third year.  The
scull was of an immense magnitude.(immensse magnitudinis) as well
as peculiarly hard and solid.  The patient spoke distinctly, but his
mind was not equal to his articulation, and he suffered greatly from
violent epileptic attacks.*  " If sculls of this kind," says the Ba-
ron Van Swieten, " should be disinhumed in their burial-ground by
posterity, there would  certainly not be wanting persons who would
ascribe them to some gigantic  family.  If,  indeed,  the calvaria
should be dug up entire, the error may  be corrected, by observing
the size of the upper jaw-bones, which would be found of the  ordi-
nary proportion: but if the  bones should be separated and single,
there could be no appeal to  this distinctive mark.t
   The disease is always dangerous from the difficulty of determin-
ing its extent, and  what degree of cerebral disorganization may ac-
company it. Where, however, it is limited to a weak condition of the
         • Observ. Chirurg. Cent. HI. Obs. XIX. p. 199.
         f Comment, torn. IV. Sect. 1217. p. 123,
Vol. IV.—L 1 
266                      ECCRITICA.            [CL. VI.—OR. II.

excernents of the brain it is often remedial and admits of a radical
cure.   But where, on the contrary, no  favourable  impression can
be made upon it, the general frame  partakes by degrees of the de-
bility, the vital powers flag, the limbs become emaciated, and death
ensues at an uncertain period : or the patient survives, a miserable
spectacle to the world and burden to himself;  rarely reaching old
age, but sometimes enduring life for twenty or even  thirty years*
before he is released from his sufferings.  On  opening the  head
twelve or fifteen pints of fluid  have  often been  evacuated ; and oc-
casionally not less than twenty-four or twenty-five pints,f which have
the singular property  of not jellying even on exposure to heat.J
  The water has sometimes been found lodged in a cyst, and in a
few instances the cerebrum itself has formed a sack for containing
it.  Morgagni asserts that the disease is more common to girls than
to boys.§  I  do not know that the remark has been confirmed  by
any collateral authority.
  The cure, as in the preceding species, must be attempted  by
evacuating the water by internal or external means, and by giving
tone to the debilitated organs.
  Drastic purges can  rarely, in this form of the disease, be carried
to such an extent as to be of essential  service, on  account of
the early period of life in which  it commonly shows itself.  For
the same reason diaphoretics have not been generally recommend-
ed, or often  found  serviceable when  ventured upon.  Diuretics
have been more frequently had recourse to;  and particularly the
digitalis.  Dr. Withering was favourable to its use, but it has com-
monly, as in other forms  of dropsy, proved more injurious than
beneficial.
  The best internal medicine  is calomel, in small doses, in union
with some carminative, for the purpose of keeping up the action of
the stomach, a healthy state of which is of great importance.  The
calomel, however, should  be  employed rather as a stimulant or
tonic,  so  as  to excite the mouths of the torpid vessels to a return
of healthy action, than as a purgative, or with  a view of producing
salivation; except, indeed, where symptoms of inflammation are
present, in which case it cannot be given too freely as already ob
served under parenchymal  cephalitis.||   Where the disease has
been unaccompanied with inflammatory symptoms, but nevertheless
has been attended with a feverish irritation, and great heaviness,
as well as considerable enlargement of the  head, the author has
found half a grain of calomel, given three times a day, in the  man-
• Van Swieten, Comment, loc. citat.
f Bonet, Sepulchr. Lib. I. Sec. XVI. Obs. I,
  Eph. Nat. Cur. Dec. HI. Ann. I. Obs. 10.
t Hewson, on Lymph. Syst. Fart II. p. 193.
§ De Sed et Cause. Mor. Ep. XII. Art. 6.
I Vol. II. p. 224. 
ce. i.~sp. n.]
EXCERNENT  FUNCTION.
267
ner above proposed, and continued three times a day for a month,
of essential service :  and particularljtain a case that occurred to
him, many years ago, of a little boy who was four years old when
the disease first appeared;  which, howe^r, had made its attack so
insidiously as to escape the observation of the parents till  the in-
creased bulk of the head attracted their notice,  which was soon af-
terwards succeeded by the symptoms just adverted to.  The com-
plaint had increased, the symptoms were more aggravated, and the
scull, within six months, had become as large as that of an adult,
when the mercurial process was commenced, accompanied  with a
free fomentation of the head with the solution of the acetate of am-
monia, and an occasional use of purgatives.  In  ten days there was
an evident improvement:  the child was less languid, and  feverish,
and showed less  desire to rest his head perpetually on  a chair.
The scull no longer augmented ; the mental faculties, which began
to discover hebetude, regained vigour, and the patient, now in  his
twentieth year, is an under-graduate in one of our universities, ex-
hibiting a  development  of talents  that has already obtained  for
him  various prizes,  and gives a  promise of considerable success
hereafter.   The bulk of  his head  is at this moment very little
larger than it was at six years of age : a curious fact in pathology,
though by  no  means uncommon : since where the disease forms
space enough for a perfect growth of the brain,  the calvaria ceases
to expand, and  the head  becomes once more proportioned  to the
rest of the body.
  The external means employed  for  diminishing  the contained
fluid have consisted in local stimulants, as different preparations
of ammonia, blisters, and cauteries, and puncturing the integu-
ments.
  All local stimulants have a chance of being useful  where the dis-
ease is  seated  near the surface, or between the  membranes and
the cranium, for they tend to excite the absorbents to an increased
degree of tone and action, and consequently to a diminution of the
general mass.   But they do not seem to have much effect when the
fluid issues from the  convolutions or ventricles of the brain.  Blis-
tering the whole of the sinciput has unquestionably been found ser-
viceable, and is perhaps  the most effectual external stimulant we
can employ.
  The water has also been evacuated in many instances, with full
success by a lancet:  and, where the sutures gape very wide, and
the integuments are considerably distended, this remedy ought al-
ways to  be tried.   The  brain, however, like  every other organ,
when it has been long accustomed to the stimulus of pressure, can-
not suddenly lose such a stimulus without a total  loss of  energy;
and hence, as it is necessary in many cases of dropsy of the belly,
to stop as soon  as we have drawn off a certain portion of water, m
order to avoid faintness, it is found equally necessary to evacuate
the water  from the  brain  with caution and by separate stages j
for where the whole has been discharged at once, the sensorial ex- 
268                      ECCRIT1CA.            [CL. VI.—OR. II.

haustion has been so complete as to produce deliquium and sudden
death.  Hence six or eigh*ounces are as much as it may be  pru-
dent to let loose at a time in an infant of three or four years of age;
when the orifice should bf covered with a piece of adhesive plaster,
and an interval of a day or two be allowed. The operation, indeed,
is very far from  succeeding in every  instance : for in some cases
there is so much internal disease or even disorganization, that suc-
cess is not  to be  obtained by any means.  And  next, a fresh tide
of water will  not unfrequently accumulate, and  the head become
as much distended as before.   Still, however, the  attempt should
be made, and  even repeated and repeated  again  if a fresh flow of
fluid should demand it:  for the disease has occasionally been found
to yield  to a second or third evacuation, where  it has triumphed
over the first.
  Dr.  Vose of Liverpool, has published an instructive case of this
kind in the  ninth  volume of the Medico-Chirurgical Transactions.
The patient was seven months old, and the head  between two and
three times  its natural size  when the operation was first performed.
On this occasion a couching needle was made use of, and the ori-
fice was closed when three ounces and five drachms of fluid were
evacuated: about  an equal quantity was conjectured to dribble from
the orifice after the operation, at which time the  infant became ex-
tremely faint, and the integuments of  the head had shrivelled  into
the shajfe of a pendulous bag.   He revived, however, with the aid
of a little cordial  medicine  ; and, the water accumulating afresh, a
second operation  was performed by a history about six weeks af-
ter, when eight ounces of fluid were drawn off with little constitu-
tional disturbance ;  which was succeeded only nine days later  by a
third operation, that yielded, by the introduction of a grooved direc-
tor, twelve ounces, without  any interference with the general health
whatever.   A copious and  vicarious discharge of serum from the
rectum took place shortly after the third puncture of the integu-
ments, which  was succeeded by some degree of deliquium ; but
from this also, the patient soon recovered ; the head gradually di-
minished in  size,  and a complete cure  was at length effected.
  Formey,* Pitschel.t and several other writers have recommend-
ed compression, with  a view of stimulating the torpid  mouths of
the absorbents to  a resumption of their proper action. Butno com-
pression can be made on these, whatever they may consist in  (for
absorbents have not hitherto been detected in the  brain) without
compressing, at the same time, parts that are injured by pressure
already.  Advantage, however, may be taken of the recommenda-
tion after the  brain has been evacuated; and a  proper  compress
about the shrivelled head, may be  of  as  much use in preventing
deliquium,  and perhaps, by its excitement, in stimulating the  tor-
• Ad. Riverii, Observ. Medic. Cent. V.
f Anat. and Chir. Anmerk.  Dresd. 1784. 
GE. I.—SP. II.]       EXCEKNENT FUNCTION.
269
pid vessels to a return of their proper function, as it is well known
to be of when applied around* the  abdomen after the use of the
trocar.
                       SPECIES III.

                   HYDROPS SPINjE.

                    ISrojras of tfte Spfnc.

SOFT, FLUCTUATING EXTUBERANCE ON THE SPINE ; GAPING VERTEBRAE.

This is the spina bifida of authors, so called from the double chan-
nel which is often produced by it through a considerable length of
the vertebral column : a natural channel for the spinal marrow, and
a morbid channel running in a parallel line, and equally descending
from the brain, and filled  with the fluid  which constitutes the dis-
ease.
  It is sometimes  local, but in most instances is connected  with  a
morbid state of the brain,  and  directly communicates with  it.  In
this  last form it may be regarded  as a compound dropsy of this or*
gan, the accumulating water working its way down towards the fo-
ramen ovale in consequence of its dependent position, or a deficien-
cy in the substance of the brain in this  quarter, instead of up to-
wards the fontanel.  In both cases the surrounding dura mater gives
way, and, in the last, forms a sinus, which, as it descends, winds it-
self through any accidental opening that may exist in or between
the bones of the vertebrae, and distends  the  superincumbent inte-
guments into the same kind of tumour that we have already noticed
as sometimes existing on the crown  of the head, when the  fluid is
pressed in an upper direction.
  Dropsy of the spine is mostly congenital, and consequently a dis-
ease of fetal life; in many instances, however, the tumour does not
show itself till some weeks, or even months  after  the birth  of the
child.  The degree of danger must depend upon the structural de-
fect, or other mischief that exists in the  brain, or the substance of
the spinal marrow.  It has sometimes appeared as a  local affection
in adult age, and has admitted of a cure; but, from its usually oc-
curring in the earliest and  feeblest stage of life, and often before the
sensorium is fully developed, so as, indeed to prevent its develop-1
ment in a perfect  form, it is rarely  remediable.  We observed in
the last species, that the bones of the cranium  are often found im-
perfect: and it is hence not to be wondered at that the bones of the
vertebrae should  exhibit a like imperfection in the present, and  al-
low a protrusion externally.  Fieliz gives a case in which the whole 
.270                      ECCRITICA.             [CL.VI.-0R.1L

of the spinous processes were deficient, and  the  dropsy extended
through the entire length of the spirte.*
  The integuments  are here thinner and  more disposed to Durst
than in the head, and hence, if the tumour be left to its natural
course, it commonly continues to enlarge till  it bursts; while, it it
be opened, the child, in most cases, dies from exhaustion and deli-
quium, as in dropsy of the head, provided the water be evacuated
entirely ; and if it be discharged gradually, an inflammation ot the
spinal marrow is apt to ensue, which proves as fatal.  Hence there
is much reason in the advice  of Mr. Warner  merely to support the
tumour, but not to touch it otherwise, and, in the mean while, to
see how  far we can give the  remedial power  of nature an opportu-
nity of exerting itself by invigorating the  frame generally.   Some-
thing, however, beyond support  may be safely ventured upon,  for a
gentle compression may be tried with propriety, and if found to do
no mischief, it should be  gradually increased.  If the disease ex-
tend to the ventricles it  will probably be of little use, but  if it be
local.it may ultimately prove successful.
   This form of dropsy is  mostly fatal; but there  are a few cases on
record of a successful termination upon the employment of different
methods.  Thus, Heister, who in  his day also recommended  com-
pression, gives an example of its  having radically yielded  to this
plan, in union with spirituous liniments ;t and Fantoni,$ and Heil-
mann,§  describe, each of them, an instance of a  perfect cure  upon
opening and evacuating the cavity.  In  all  which instances, how-
ever, it seems probable that there  was no such communication with
 the brain, or  that  the brain, or spinal marrow, was less affected
 than they ordinarily appear to be.
   A few singular cases have occurred of young persons protracting
 a miserable existence under  this disease to the age of adolescence.
 Martini mentions a youth who lived till  eleven years old; and Ar-
 crel notices others who survived till seventeen,||  but with paralytic
 sphincters of the anus and bladder.

              * In Richter, Chir. Bibl. Band. IX. p. 185.
              f Wahrnehmung. B. II.
              $ In Pacchioni Animadvers. cit.
                Morgagni De Sed. et Caus.
              ^ Prodrom.  Act. Havn. p. 136.
               | Schwed. Abhandl. B. X. p. 291. seq. 
OK. I.—SP. IV.]     EXCERNENT FUNCTION.
                       SPECIES IV.


                HYDROPS THORACIS.

                   Erojisg of the (Eiiest,

^ense of oppression in the chest ; dyspncea on exercise, or. de-
  cumbiture; livid countenance; urine red and spare; pulsk
  irregular; edematous extremities; palpitation, and start-
  ings during sleep.

This is the hydrothorax of authors; and the secreted fluid, in direct
opposition to that of hydrocephalus,  commonly,  perhaps  always,
jellies upon exposure to heat.
  Sauvages, who ha3 made this disease a genus, gives a considera-
ble number of species under it, derived from the particular part or
cavity of the thorax which is occupied, or the peculiar nature of the
effusion; as hydrops mediastini, pleurae, pericardii,  hydatidosus;
to which he might have added pulmonalis, as the water is, perhaps,
sometimes effused into  the cellular texture of the lungs.  But as
these can never, with  any degree of certainty,  be  distinguished
from each other till after death, and as such distinction could make
no essential difference in the mode of treatment, it is unnecessary
to notice  them,  and is scarcely consistent with an arrangement
founded upon symptoms alone. Those who are desirous of examin-
ing into the curious, and often contradictory signs by which these
several forms of pectoral  dropsy have been attempted to be discri-
minated by various writers, may turn with  advantage  to Sir L.
Maclean's work upon the subject, where he will find them selected
with much patient study, and accompanied  with many judicious
remarks.* In the present place it may be sufficient to observe  that
the disease is, in fact, sometimes limited to any one of those parts,
and sometimes extends  to several of them : and that when it occurs
as a consequence of cellular dropsy, it is in a greater or less degree
common to the whole.
  The complaint originates with little or no observation, and  con-
tinues its course imperceptibly; there is at length found to be some
difficulty of breathing, particularly on exertion or motion of  any
kind, or when the body is in a recumbent position, usually accom-
panied with a dry and troublesome cough, and  an edema of the
ankles towards the evening.  Then follow, in quick succession, the
symptoms enumerated  in the  definition, several  of which I have
drawn directly from my friend  Sir L. Maclean's very  accurate
arrangement of them. The difficulty of breathing becomes, at length,
  • Inquiry into the Nature, Causej, and Cure of Hydrothorax, p. 52,70. 8vo.
1810. 
 272                      ECCRITICA.           [CL. VI.—OR. II.

 peculiarly distressing, and the patient can obtain no rest but in an
 erect posture ; while even in this condition he often starts suddenly
 in his sleep, calls vehemently for the windows to be opened, and
 feels in danger of suffocation.  His eyes stare about in great anxi-
 ety, the livid hue of his cheeks is intermixed with a deadly paleness,
 his pulse is weak and irregular, and as soon as the constrictive
 spasm of the chest is over, he relapses  into a state of drowsiness
 and insensibility. By applying the hand to the sides and using a
 slight degree of percussion, we shall sometimes be able to trace a
 slight degree of fluctuation.
  The disease, contrary to the preceding species, is mostly to be
 found in advanced life, and its duration chiefly depends upon the
 strength and habit of the patient at  the time of its incursion.  It is
 hence, in some cases, of long continuance, while in others the pa-
 tient is suddenly cut off, during one of the violent spasms,  which at
 length attack him as  well awake as  in the midst of sleep.
  The causes are those of dropsy in general, upon which  we have
already enlarged, acting  more immediately upon the organs of the
chest, and inducing some organic affection of the heart, lungs, or
the larger arteries.  We also  frequently find, upon dissection, that
the disease has been produced or considerably augmented by a num-
ber of hydatids (taenia hydatis, Linn.) some of which appear to be
floating loosely in the effused  fluid, and others to adhere to particu-
lar  parts of the internal surface of the pleura, constituting the hy-
drothorax hydatidosus of Sauvages.  They consist of spherical vesi-
cles containing a watery fluid, whose circular membrane is pos-
sessed  of a  living power and  a peculiar organization that enables
them to attach themselves to the internal surface of a cavity, and
to suck up the more attenuate and limpid humours from  the neigh-
bouring parts.
  The only  decisive  symptom in this diseas- is the fluctuation of
water in the chest, whenever it can be ascertained;  for several of
the other signs are often  wanting, or, in a separate, state, are to be
found in other complaints of the chest as well as in  dropsy, more
particularly in asthma and empyema.  And hence, in determining
the presence of this  disorder, we are to  look for them  conjointly,
and not to  depend upon any one when  alone.  Even when asso-
ciated, we are sometimes  in obscurity:  and the difficulty  of indi-
cating  the disease by any set of symptoms has been sufficiently
pointed out by De Haen ;* while Lentin.t Stoerckf and Rufus§ have
given instances of its existence without  any symptoms whatever:
and Morgagni with few or none||.  Bonet observes that dyspnoea^
* Rat. Med. P. v. p. 97.
■j- In Blumenbach Biblioth. III.
i Ann. Med. II. p. 266.
§ Ad River. Observ. Med.
R De Sed. et Caus. Morb. Ep. XVI. Art. 2. 4. 6. 8. 11.
* Ep. cit. Art. 28. 30. 
GE. I.—SP. IV.]       EXCERNENT FUNCTION.
273
is not an indication common to all cases,* ami Morgagni, that start-
ings during sleep or on waking, do not always accompany the dis-
ease, and may certainly exist without it. Hoffmann and Baglivi have
given as an additional symptom, intumescence and torpitude of the
left hand and arm ;  but even this affection, or the  more  ordinary
one of laborious respiration, has existed without water in the chest.
De Rueff relates a singular case  in a man who was attacked with
most of the symptoms jointly, at the  age of about sixty, and  was
supposed to be in the last stage of  this disease.  He recovered by
an ordinary course of  medicine, and died at the age of eighty with
his chest perfectly sound to the last.t
  The general principles to be attended to in the mode of treatment,
are the same as have already been laid down under hydrops cellula-
ris: for, as  already observed, the causes are similar, and only varied
by an accidental deposition of the morbid fluid in the chest, in con-
sequence of a peculiar debility in the  thoracic viscera, or of so:ne
organic misaffection.  The squill is here a more valuable medicine
than in most other species; as, independently of its diuretic virtue,
it affords great relief to the dry and teasing cough, and  in some
degree, perhaps, to the pressure of the fluid itself,  by exciting  the
excretories of the  lungs  to an increased discharge  of mucus.
Digitalis, as in other species  of the  same genus, is  a doubtful
remedy; its diuretic effects are considerable, but, however cautious-
ly administered, it too often sinks the pulse, and diminishes the vital
energy generally ; and is particularly distressing from its producing
nausea,  and  endangering  deliquium ; results which  ought more
especially to be guarded against in  dropsy  of the chest, as it is, in
most cases, not merely a disease of debility but of enfeebled age.
Sir L. Maclean is  a firm friend  to its use in  almost  every case:
but even he is obliged to  admit that the state of the pulse, the
stomach, the bowels, and the sensorial function, should  be  atten-
tively observed by every one who prescribe* *<•   And under  the
following provision,  which  he immediacy lays down, there can be
no difficulty in consenting t« ^pfoy it.  " If these be carefully
watched, and  the m^idne withdrawn as soon as any of them are
materially offered, I hesitate not to affirm that  no serious  inconve-
nience will ever ensue from it,  and  that it may be administered
with as much  safety as any of the  more  active medicines in daily
use. "J
  Blisters  are, in many cases, of considerable avail; they act more
directly, and therefore  more rapidly and  effectually than in most
other modes of dropsy, and should  be among the first remedies we
have recourse to.
   The strong symptoms of congestion under which the heart seems,
in some instances, to labour, has occasionally induced practitioners
       • Sepulchr. Lib. II. Sect. I Obs. 72. 84.
       f Nov. \ct. Acad. Nat. Cur. torn. IV. 4to. Norimb.
       * Inquiry into the Nature, &c. of Hydrothorax, p. 171
Vol. IV.—M m 
274
ECCRITICA.
[CL. VI.—OR. II.
to try the effect of venesection; and there are cases in which-it has
unquestionably been found  serviceable : as that more  especially
related by Dr. Home, in which he employed it seven times in the
course of eighteen  days,  and hereby produced a  cure.*   I am
induced to think, however, that in this instance the dropsy  was an
effect of the obstruction under which the heart laboured, rather than
that the obstruction was an effect of the dropsy.  And in all instances
of this kind no practice can be more prudent.  But when the drop-
sy is  primary and indiopathic, all such  obstructions will be more
safely and even more effectually relieved by a quick and  drastic
purge than by venesection.
  Opium is a medicine that seems peculiarly adapted to many of the
symptoms : but by itself it succeeds very rarely, heating the skin
and exciting stupor  rather than refreshing sleep.  When  mixed,
however, with the squill pill, or with small doses of ipecacuan, and,
if the  bowels be confined, with  two or  three grains of calomel, it
often succeeds in charming the spasmodic struggle of the night, and
obtaining for the patient a few hours of  pleasant oblivion.
  Besides blisters as external revellents, setons and caustics have
sometimes been made use  of, and especially in the  arms or legs.
Baglivi preferred the cautery and applied it to the latter.t ZacutU9
Lusitanus to both, and employed it in connexion with diuretics and
tonic»4   t
   Tapping is another external  mean  of  evacuating the  water.
The practice  is of ancient date, and is described by most of the
Greek writers. To avoid the effect of a  dangerous deliquium from
a sudden removal  of the pressure, Hippocrates allowed, in many
instances, thirteen days before  the  fluid was  entirely  drawn off.
And to prevent the inconvenience resulting from a collapse of the
integuments, and the necessity of a fresh opening, or the retention
of a canula in. the orifice  through the whole of this period, he ad-
vised that a small perforation  should be made in one of the ribs,
and that the trocar shouW pnter  through this foramen.§
   There are two very powerful ohjpctions, however, to the use  of
the trochar.   The first is  common to most Jrnpsies, and consists in
its offering, in most  instances, nothing more than  a  palliative.
The second is peculiar to the present species, and consists in the
uncertainty of drawing off any water whatever, from the obscurity
or complicated nature of the complaint, upon which we have touch-
ed already.  If the fluid be lodged in the pericardium, the duplica-
tureof the mediastinum or the cellular texture of the lungs.it is ob-
vious that the operation must be  to no purpose.  And  yet, with the
rare exception of a palpable fluctuation in  the chest, we have no set
 of symptoms that will certainly discriminate these different forms of
• Clinical Experiments, p. 346.
f Opp. p. 103.
* Prax. Admir. Lib. I. Obs. 112.
$ ITi{< tflroc vtiav, Lib. LUI. p. 544. 
GE. I—SP. IV.]      EXCERNENT FUNCTION.
275
the disease.  It must be also equally in vain if the fluid be confined
in a cyst, as has occasionally proved a fact, unless the operator
should have the good fortune to pierce the cyst by accident.  Andj
in a few instances, again, the fluid, which has at all times a striking
tendency to  become inspissated, has been  found so viscid as not to
flow : of which Saviard has given us a striking example.*
  A considerable pause is necessary, therefore,  before  tapping is
decided upon : nor ought it ever to be employed till the ordinary
internal  means have been tried to  no purpose.  But where these
have been tried and without avail ; and  more especially where we
have reason to ascribe the  disease to local debility or  some local
obstruction rather than to a general  decline of the  constitution ;
and more especially still, where we have the satisfaction of ascer-
taining a fluctuation, or  of  noticing, as has sometimes occurred,
that the ribs bulge out on the  affected side, the operation may  be
ventured upon, and will often be found serviceable.  The ordinary
place for introducing the instrument is between the fourth and fifth
of the false ribs : about four fingers breadth from the  spine.  Du
Verney,  however, recommends between the second  and third of
the false ribs:  and, in different cases, there may be reason for even
a greater latitude than this.
  On the Continent the operation of tapping is far more frequently
tried than in our own  country:  and the German Miscellanies are
full of cases of a successful event.   In the volume of Nosology I
have given an account of many of these; in several  of which the
quantity of water evacuated  appears to have been  very considerable.
Thus, in one instance, a hundred and fifty pounds were  discharged
at a single time: in others between four and five hundred pounds
by  different  tappings  within the year: and in  a  single example
nearly seven thousand pints in eighty operations, during a period of
twenty-five years through which the patient laboured under this
complaint;  having hereby prolonged  a miserable existence, which
doubtless would have terminated without it much earlier, but which,
perhaps,  was hardly worth prolonging at such an expense.  In the
Berlin Medical Transactions there is a case of a cure  effected  by
an  accidental wound made into the thorax, by which the whole of
the water escaped at once.t
  In a few rare instances we have reason to believe that the dis-
ease has ceased spontaneously, judging  from the trifling remedies
that were employed at the  time : as, for  example, the  specific  ot
eighteen ounces of daudelion-juice taken  daily, which, according
to Hautesierk, succeeded radically in one patient; or  the use  ot
small doses  of squills alone, which, in th< hands of Tissot, was
equally fortunate in another.
• Recueil d'Observationes Chirurgiques, &c. Farif, 1784,
f Act. Med. Berol. Vol. X. Pec. I. p. 44. 
27&                     ECCRITICA.            t^L- VI.—OR. II.
                       SPECIES V.

               HYDROPS ABDOMINIS.

                   Bropsg of the Bells.

TENSE, HEAVY, AND EQUABLE INTUMESCENCE OF THE WHOLE BELLY J
  DISTINCTLY FLUCTUATING 1 O 1 HE  HAND  UPoN A SLIGHT STROKE
  BEING GIVEN  TO THE OITOSITE SIDE.

This is the ascites of nosologists.   It is sometimes  a result of ge-
neral debility, operating chiefly on the exhalants that open on the
internal surface of the  sack of the peritonaeum  and the abdominal
muscles: sometimes occasioned by  local  debility,  or some  other
disease of one  or more of the abdominal organs, considerably in-
faicted and enlarged, and sometimes a metastasis or secondary dis-
ease produced  by repelled gout, exanthems, or other  cutaneous
eruptions:  examples of all which  are to be found  in Morgagni,*
and  offer the three following varieties, which may not unfrequently
be applied to the preceding species :
x Atonica.                       Preceded  by general debility
  Atonic dropsy of the belly.         of the constitution.
C Parabysmica.                  Preceded  by or  accompanied
  Parabysmic dropsy of the belly,     with oppilation or  indurated
                                   enlargement  of one or more
                                   of the abdominal viscera.
y Metastatica.                    From repelled gout, exanthems,
  Metastatic dropsy of the belly.     or other cutaneous  eruptions.
  In the first variety, the fluid is found in the cavity of the ab-
domen, or between the peritonaeum and the abdominal muscles. It
is produced by any of  the causes of general debility, operating on
an hydropic diathesis ; and is frequently a result of scurvy, or va-
rious fevers.
   In the second variety, the organ most  commonly affected is the
liver, which is occasionally loaded with hydatids, and has  sometimes
 weighed twelve pounds.  The gall-bladder is often  proportionally
 enlarged and turgid, and has occasionally been found with an oblite-
 rated meatus, full of a coffee-like fluid, and together with its con-
 tents  has weighed upwards of ten pounds. The accumulation has
 also sometimes been discovered in  the omentum,! or sides of the
 intestines.^  In this second variety the disease is often denominated
* De Sed. et Caus Morb. Kp. XXXVIII. Art. 49
f De Haen, Kat. Med. P. IV. p. 95.
  Senberlich, i'r. de Hydrops omenti saccato. Pr. 1752,
t Frank, in Commentation. Goetting, VU. 74, 
QE. I.—SP. V.J      EXCERNENT FUNCTION.
2/7
an encysted dropsy; a term, however, which will quite as well apply
to dropsies of the ovaria, the Fallopian tube, and even the uterus
and scrotum, as to that of the liver.
  In the thikd variety the fluid is  commonly deposited in the
cavity of the  abdomen;  and is  far more easily removed than in
either of the others ; often yielding, indeed, to a few drastic purges
alone : except where, as sometimes happens  in  metastatic dropsy
from repelled gout,  the constitution has been broken down by a long
succession of previous paroxysms.
  Under the veil of dropsy, pregnancy has often  been  purposely
disguised : and  sometimes, on  the contrary, where pregnancy has
been ardently wished for and has actually taken place, it has been
mistaken for a case of ascites :  while, in a few instances, both have
co-existed:  Mauriceau, indeed, mentions a case of pregnancy  re-
curring a second time along with dropsy :* and in  an hydropic dia-
thesis there is a general tendency to the latter whenever the former
makes its appearance ; for the exhalants of the abdomen  are easily
thrown into a morbid condition, and the pressure of the  uterus, as
it enlarges, weakens and torpefies their action.  If dropsy occur at
a period of life  when the catamenia are on the  point of naturally
taking  their leave, and where the patient has been  married  for
many years without ever having been impregnated, it is not always
easy, from the collateral signs, to  distinguish between the two.   A
lady under these circumstances was a few years ago attended for
several  months by  three or  four of the most celebrated  physicians
of this metropolis, one of whom was a practitioner in midwifery,
and concurred with the rest in affirming that her disease was an en-
cysted dropsy of the abdomen.   She was in consequence put under
a very active series of different evacuants ; a fresh plan being had
recourse to as soon  as a preceding had failed ; and  was successively
purged, blistered, salivated, treated with  powerful  diuretics, and
the warm-bath, but equally to  no purpose: for the swelling stil!
increased and became firmer; the face and the general form were
emaciated,  the breathing  was  laborious,  the  discharge of urine
small, and the appetite intractable ; till at length these threatening
symptoms were followed by a succession of sudden and  excruciat-
ing pains, that by the domestics, who  were not prepared for their
appearance, were supposed to be the forerunners of a speedy disso-
lution, but which fortunately terminated before the arrival of a single
 medical attendant, in giving birth to an infant that, like its mother,
 had wonderfully withstood the whole  of the  preceding medical
 warfare without injury.
   In all common cases, the best means we can take to guard against
 deception, are to inquire into the  state of the menses, of the mam-
 mae, and of the swelling itself.   If the menses continue  regular,  if
 the mammae appear flat or shrivelled with  a  contracted  and light-
• Traitc des Maladies des Femmes grosses. II. p. 59. 204. 
 2T&                      ECCK1TICA.            [CL. VI.-OH.H

 coloured areola j and if the intumescence fluctuate to a tap of the
 fingers, there can be no doubt of its being a case of dropsy : but if,
 on the  contrary, the  mammae appear plump and globular with a
 broad and deep-coloured areola;  if we  can learn, which  in cases
 where pregnancy is wished to be concealed, we often  cannot do,
 that the catamenia have for some time been obstructed ; and if the
 swelling appear uniformly hard and  solid, and more especially
 if it be seated  chiefly just above the symphysis of the pubes, or,
 provided it be higher, if it be round, and circumscribed—though
 we may occasionally err, there can be little or no doubt,  in  most
 instances, of the existence of pregnancy.  The most difficult of all
 cases is that in which dropsy and pregnancy take place simultane-
 ously.   It is a most distressing combination for the patient; and can
 only be treated with palliatives till the time of child-birth.
  The ordinary causes of dropsy of the abdomen are those of cel-
 lular dropsy, of  which we have treated  at considerable length al-
 ready, and to which the reader may therefore refer himself: the
 only difference being, as in dropsy of the chest, that the excernents
 of these cavities are, from particular circumstances, more  open at
 the time to the influence of whatever may happen to be the cause
 than the excernents of the cellular membrane, or of any other  part
of the system.  From the extent, however, of the abdominal region,
and the connexion of  its cavity with so  many large and important
viscera, and especially with the liver, we can be at no  loss in ac-
counting for amore frequent appearance of dropsy under this species
than under any other.
  The general symptoms, moreover, are those of cellular dropsy.
The appetite flags, there is the same aversion to motion and  slug-
gishness when engaged in it,  the same intolerable thirst, dryness of
the skin, and diminution of all the natural discharges.  The pecu-
 liar symptoms, as distinct  from cellular dropsy, are the  gradual
 swelling of the belly, and, as  a consequence of this, a dry, irritable
 cough and difficulty of respiration.
  It is often as difficult to  determine whether the water be seated
 in the cavity of the  abdomen  or in  the liver, omentum,  or  any
 other cyst, as in making a like distinction in dropsy  of the chest.
 But, generally speaking, if we have  previously had reason  to  sus-
 pect a diseased condition of any of these organs, if the abdominal
 swelling be local or unequal,  and the constitution do not seem to
 enter readily into the morbid action, and the remaining functions
 retain  a healthy vigour, we may suspect  the dropsy to be of the
 encysted form.   While, on the contrary, if the animal frame evince*
 general weakness, if the limbs be edematous, the appetite fail, and
 the secretions be concurrently small and restricted, there is  good
 reason for believing that the fluid is effused into the  cavity of the
 peritonaeum.
  The treatment of ascites, as to its general  principles and plan,
 must be the same as that already  laid down for anasarca or cellular
 dropsy: but here, instead of  evacuating the water by scarification, 
GE. I.—SP. V.]     EXCEKNENT FUNCTION.
279
 we can often very advantageously, and more easily than in any of
 the preceding species, draw it off at once by tapping.  Where in-
 deed, thed ropsy is of the encysted kind, our efforts will often prove
 in vain;  for we  may either miss the proper viscus, or the fluid
 lodged in the  separate vesicles of a vast aggregation of hydatids
 amounting sometimes to seven, eight, or nine thousand at a time *
 cannot be set free.   But where it lies in the peritoneal sac alone,
 or on the  outside  of this sac alone, we can often afford very great
 relief by this simple process, and sometimes  an effectual cure?  It
 ought, therefore, by no means to  be delayed, as it often is, till the
 debility from being local has become general, nor can the operation
 be too soon performed after a fluctuation is distinctly felt, and the
 swelling  from its  bulk  has become  troublesome to the breathing
 and interferes with the night's rest.   Nor should we be deterred if
 the first evacuation do not  fully succeed.  On the contrary, if the
 general strength seem to augment for some time after the operation,
 the appetite to improve, and the  usual symptoms of the disease to
 diminish,  we may take  courage from our first success, and augur
 still more favourably from a second or even a third attempt if it
 should be necessary.  Various cases have fallen to the lot of the
 author in  which a radical cure has only been completed in this man-
 ner: nor are instances wanting in which the patient has only reco-
 yerered after the twelfth time of  operating.   Hautesierk gives an
 instance of cure after sixty tappings within two years and a half, in
 conjunction with a steady use of aperients and tonics :t and Martin,
 in the Swedish Transactions, relates another instance of an infant
 of  four years old  restored after a  second use  of the trocar, in con-
 junction with a like course  of medicines.
  Internal evacuants, therefore, as far as the strength will allow,
 and tonic restoratives generally, should be called to our aid throu«Hi
 the entire  process of cure, as already recommended under hydrops
 cellularis.  The thirst, which is often unconquerable, and the most
 distressing of all the symptoms, may be allayed, as  we have already
 pointed out, by a  free use of subacid  drinks, the desire for which
 is by no means to be repressed, as  the absorbents of the skin are
 always stimulated by the irritation of an ungratifled  desire to im-
 bibe far more  fluid  from the atmosphere than any indulgence in
 drinking can amount to: as ordinary food, the alliaceous plants,
 which give an agreeable excitement to the stomach, and at the same
 time quicken the action of the kidneys, will be found highly useful:
 and asparagus, which in an inferior degree answers the last of these
 purposes,  may make a pleasant change in its season.
  After all, it  must be confessed  that tapping is often employed
without radical success, for the disease, under all its modifications,
is too often incurable. Yet even in the worst of cases it has its ad-
vantage as a palliative ; and it is no small consolation to be able to

                  * Commerc. Nor.  1731. p. 271.
                  f Kecucil, II. 
280                      ECCRITICA.            [CL. VI.-OH. II.

procure temporary ease and comfort in the long  progress  of a
chronic but fatal disease.
  The quantity evacuated by the operation of tapping has, in some
instances, been enormous.   It has often amounted to eight gallons
at a time, and Dr. Stoerck gives an instance of twelve gallons and
a half.*  Guattani relates a case in which  thirty pints of an oily
fluid  were, in  like  manner, evacuated by  a single  paracentesis.
This disease was produced by an aneurismal  affection.t and it shows
great irregularity of action  in the absorbent system :  for while the
absorbents of the peritonaeal sac were in the  utmost degree dull aud
torpid,  those of the  surface were in a like degree irritable, and
drunk up  all the animal oil from the cellular membrane, as well as
all the  moisture they came  in  contact with  from the atmosphere.
The  operation  has frequently  been repeated forty  or  fifty  times
upon  the same patient; and sometimes much oftener. In the Edin-
burgh Medical  Communications is a case in which it occurred nine-
ty-eighty times within three years.:):  And in a foreign Journal of
repute is another case in which the operation was repeated a hun-
dred  and forty-three times,  though the total quantity evacuated is
not given.§  Dr. Scott of Harwich performed the operation  twen-
ty-four  times in only fifteen months, and drew off a hundred and
sixteen gallons in the whole.||
  Occasionally, both abdominal and  cellular dropsy have been car-
ried  off by a spontaneous flow of water from some organ or other.
In the latter species most frequently by a natural fontanel in some
one of the extremities, as the hand, foot, or  scrotum.^!  In the for-
mer   by a spontaneous rupture of  the protuberant umbilicus, of
which the  instances in the  medical  records are very numerous:**
And  hence many operators, taking  a hint  from this spontaneous
mode of cure, have preferred making an incision into the umbilicus
with  a lancet to the  use of  the trocar.  Paullini relates a singular
mode of operation, and which, though it completely succeeded, is
not likely to  be had recourse to  very often.   The  patient  not
submitting to the use of the trocar, had the  good  fortune  to  be
gored in the belly by a bull; the opening proved effectual, and  he
recovered .tt
   There are also a few instances of a subsidence of the accumula-
* Ann. Med. I. p. 149.
•J- De Aneurismatibus.
* Vol. IV. p. 378.
§ N. Samml. Med. Wahrnemungen. B HI. p. 94.
|| Edinb. Med. Comment. Vol. VI. p. 441.
i Riedlin, Linn. Med. 1696. p. 258.
  Schenck, Lib. III. Sect. II. Obs. 136. ex. Hollerio. Obs. 140, 141.
** Desportes, Hist, de Malad. de St  Dominiques, II. 122.
   Schenck, Lib. Ill Sect. II. Obs. 147.
   Forestus, Lib. XIX. Obs. 33.
ft Cent. II. Obs. 10. 
GE. I.—SP. V.]
EXCERNENT FUNCTION,
381
upon a spontaneous efflux of some other kind;  especially of
i, and chiefly from the hemorrhoidal vessels.*
                        SPECIES  VI.


                   HYDROPS OVARII.

                   Biopsy of the <£toar».

 HEAVY INTUMESCENCE OF THE ILIAC REGION ON ONE OR BOTH SIDES :
   GRADUALLY SPREADINft OVER THE BELLY; WITH OBSCURE FLUCTU-
   ATION.

 There is the  same difficulty in distinguishing this disease from
 pregnancy as in dropsy of the belly: and consequently the same
 mistakes  have occasionally been made.  Th^ere is also quite as much
 difficulty  in distinguishing it from the parabysmic variety of abdomi-
 nal dropsy, especially when the liver is the organ enlarged and filled
 with hydatids.  Yet in this last case, the confusion is of less conse-
 quence, as the general mode of treatment will not essentially vary.
 Pregnancy, when it first alters the shape, produces an enlargement
 immediately over the pubes, which progressively ascends, and when
 it reaches the umbilicus assumes a definite boundary. In the atonic
 or common variety of abdominal dropsy, the swelling of the belly
 is general and undefined from the first. And in dropsy of the ovarr
 or ovaries, it commences laterally, on one or both  sides, ac^raj
 ing as one or both ovaries are affected.  And it is hence of the ut-
 most importance to attend to the patient's own statemep^of the ori-
 gin of the disease and the progressive increase of the swelling.  It
is generally moveable when the patient is laid on ber back; and as
 the orifice of the uterus moves also with the motfon of the tumour,
 by passing the finger up  the vagina, we may thu9 obtain another
 distinctive symptom.  Where there are several cysts in the ovary,
 we may perceive irregularities in the external Jamour resembling,
 to the touch, those of scirrhus.
  This disease is sometimes found in pregn?*it women, but far more
 commonly in the unimpregnated *nd th? barren.  It is also met
 with in the young and those wb* regularly menstruate, as well as in
those whose term of menstruation Us just ceased.   The accumu-
 lation of fluid is often hf^e also *ery considerable.  Morand drew
off four hundred and twenty-seven pints, within ten months ;t and
Martineau four  hup^red and ninety-five within  a year:  and from
          * Saviard, Observ. Chir. Engalenus, p, 150.
          f Mem. de l'Acad. de Chir. II. 448.
Vol. IV.—N n 
282
ECCRITICA.
[CL. VI.—OR. II.
the same patient six thousand six hundred and thirty-one pints by
eighty punctures within twenty-five years.'
  The disease commences, and indeed often continues for years,
without much affection of the  general health ;  yet it is insidious,
and the constitution at length suffers and falls a prey  to it.
  Internal medicines have been rarely found efficacious, and when
tried must consist of those already noticed in the treatment of cel-
lular dropsy. Tapping affords the same ease as in abdominal dropsy,
and the operation is  to  be performed  in the same manner.   I had
lately a lady under my care for six or seven years, who reqmed
the operation to be performed at first every six months, afterwards
every three months, and at length every month or six weeks.  She
rose from it extremely refreshed, and in good spirits;  and often on
the same evening joined a party of friends, and was sometimes pre-
sent at a musical entertainment.  In about six years, however, her
health completely gave way, and she sunk under the disease.
  So  little,  however, is the general health interfered with for the
first year or two,  that the patient occasionally  becomes pregnant,
while the accumulation continues to increase, and often produces a
living offspring.  Sir I4. Maclean,  has given  an  interesting case of
this kind, in which there was not only an extensive dropsy, but an
abscess of the ovary, and a discharge of pus as well as of water on
tapping, which was performed five times during a single pregnancy.
The patient passed easily through  her labour, but died within five
months afterwards upon a burstingof the abscess into the peritonaeal
sac.  On examining the body, two pints of " a thick, brown, well
digested pus were found to have escaped into the cavity of the ab-
domen, and three pints more  in  the ovarian sac.  The opening
>*as large enough to admit of three fingers ; and the external sur-
 facfc of both the  large  and small intestines  was found  inflamed,
 andyebgjmg in  some places on gangrene."  This my learned friend
 ascribes t^he  influence of the pus that had escaped and was in
 contact with Mjem :t but as this is said to have been "well digested
 pus," the inflammation  is,  I think, more probably to be attributed
 to sympathy withXhe lacerated ovarium in its actual state of irrita-
 tion from so Hrge a vent, and so much larger an inflamed surface in
 its interior.
   The fluid is in Vhis species also, sometimes lodged in a cyst, oc-
 casionally in manyVysts, or perhaps  hydatids, and  there is great
 difficulty in ascertain!^ its cxact situation, and consequently in
 puncturing it.   A  distinguished and  skilful friend of the author's
 not long since made  an attempt ox a lady, who had been affected
 with the disease  for some years; yet unfortunately not a drop of
 serum ensued, but instead of it a pint oNjlood.  The swelling of
 the abdomen has since  increased to an enoruous size: internal me-
 dicines have proved  of little  avail, and she h»s not consented to
• Phil. Trans. 1784. p. 471.
t Enquiry into the Nature, &c. of Hydrothorax. Appx. p. 1. 8vo. 1810. 
<3E. I.—SP. VI.]     EXCERNENT FUNCTION.
283
another trial of the trocar.   It was probably from an equal want of
success that Tozzetti long since declared the operation to be of no
avail ;* and that Morgagni denounced it not only as useless but mis-
chievous.t   A more radical mode has been proposed, but so far as I
know only proposed, that of extirpating the ovarium ;  which, how-
ever, for various reasons ist  not  likely to be brought into practice;
De Haen regards such an operation as doubtful,§ and Morgagni as-
serts it to be impossible.!! Dr. Perceval relates a case of cure  pro-
duced  by vomiting. 1   Port-wine has been injected after evacuating
the water, but a general inflammation is apt to succeed, and some-
times death.**
                       SPECIES VII.


                  HYDROPS TUBALIS.


              39roj)sg of the jFallopfau &uto.

Heavy elongated intumescence of the iliac region, spreading
          transversely ; with obscure fluctuation.

This species is not common.  Dr. Baillie, however, among others,
has particularly noticed and described it in his morbid anatomy, in
a case referred to in the volume of Nosology.  Its mode  of treat-
ment is that of dropsy of the ovary.  Tapping may be attempted,
but as the water lies frequently in the hydatid-vesicles or distinct
sacs, success is doubtful.
  The quantity collected is for the most part  larger than in the
ovarium.  Munnik mentions a  case in which  the  distended tube
contained a hundred and ten pints of fluid ;tt Harder one in which
the fluid measured a hundred and forty pints ;JJ and  Cypriani an-
other that afforded a hundred and fifty pints at a single tapping^
* Osservazioni, &c.
f De Sed. et Caus. Morb. Ep. XXXVIJI. Art. 68, 69.
* N. Act. Nat. Cur. Vol. V. Obs. 49.
§ Rat. Med. P. IV. c. iii. § 3.
|| De Sed. et Caus. Morb. Ep. XXXVIII. Art. 69, 7«.
% Ep. II. p. 156.                            ./''tit <:  jyii
•» Denman, Introduct. to the Pract. of Midwifery^* IIL Sect All.
|f Apud Manget.                      y
it Apiar. Obs. 87,88.                 /    ,    ...  .. ,m
6§ Epistola historiam exhibens fcetus hj^"' ex Tubaexcisi Leid. 1700. 
284                      ECCR1TICA.             [CL. VI —Oli. II.
Weiss describes a case of complicated dropsy distending both the
ovarium and the Fallopian tube.*
  The causes, and progress as well as general mode of treatment
are those of dropsy of the ovary.   Its chief distinctive symptom is
the elongated line which the swelling assumes and the direction it
takes towards the iliac region  on the one side or on the other.
                      SPECIES  VIII.

                HYDROPS  UTERI.

                   Brnjjsg  of the S&omb.

HEAVY, CIRCUMSCRIBED  PROTUBERANCE IN  THE  HYPOGASTRICS!,
  WITH OBSCURE FLUCTUATION ; PROGRESSIVELY ENLARGING, WITH-
  OUT ISCHU11Y, OR PREGNANCY; MOUTH OF THE WOMB THIN AND
  YIELDING TO THE TOUCH.

Sauvages makes not less than seven species of this disease, which
he calls hydrometra, and which with him occurs as a genus.  The
distinctions, however, are of too little account to call for such sub-
division ; and one or two of the species  is doubtful: particularly
the hydrometra gravidarum, or dropsy of the womb during preg-
nancy.  Dr. Cullen regards it as altogether unfounded, and hence
makes the symptom of citra graviditatem a pathognomic character
of the complaint.
  The disease is rarely to be met with in the cavity of the uterus,
and when this is the case the orifice is perfectly closed.   It is much
more frequently to be found in a particular cyst, or the walls of an
hydatid, or a cluster of hydatids, or between  the tunics  of the or-
gan.  Carron ascribes it in various cases to a debility of the uterus
produced by a chronic leucorrhcea.t  Other writers to the stimulus
of  pent-up, coagulated blood, sometimes assuming an encysted
structure.$  It is for the most part the result of a scirrhous or some
*ther morbid change  in  the  organ, producing  debility  and occa-
sionally fever.   A  membranous or cellular dropsy is the variety
most -ommonly assumed, in which the uterus is sometimes distend-
ed to au enormous size, and  the  abdomen  seems to be labouring
under an fer,asarca.
    The watei>wnen jn ^ne  cavjty of the uterus, may often be  eva-
 cuated by  a can.|a introduced into the mouth of the organ ; and if
 this should be prev,nte(j  by a scirrhUS) cicatrix, or tubercle lying
 over its mouth, a rup.,re of  the sac in which the fluid is i0(ige3

   • Abhandl. einer ungewohnlM,en Krankheit, &c Rastadt. 1785.
   t In Blegny, Zodiac, 1781.
   * Act. Nat. Cur. Vol. VII. Obs. 61. 
CE. I.—SP. VIII.]     EXCERNENT FUNCTION.               285

may sometimes be produced by a violent shock of electricity passed
through the hypogastric region, hard exercise or emetics.
  A sudden fall has often had the same effect.  Tozzetti relates a
case of cellular dropsy of the womb which extended down the thigh
and leg on one side ; and disappeared by a spontaneous discharge
of the water from the cuticle of* the leg affected.*
  The uterus has also been  said to be sometimes  affected with
dropsy in consequence of a conveyance of the  water accumulated
in die cavity of the abdomen in dropsy of the belly, into the uterine
cavity  by means of the fringy termination  of the  Fallopian  tubes.
Of this cause, however, there does not appear to be any satifactory
proof.  " Yet I  must confess," says  Dr. Denman, " I  have seen
some cases of water collected, and repeatedly discharged from the
uterus in the state of child-bed, which I was unable to explain on
any other principle."!
  The internal treatment is that  of the  preceding species.
                        SPECIES  IX.

               HYDROPS   SCROTI

                  Bropsg of tfte Scrotum.

SOFT, TRANSPARENT, PYRIFORM  INTUMESCENCE OF THE SCROTCM ',
           PROGRESSIVELY ENLARGING, WITHOUT PAIN.

This is the hydrocele of Heister, and other writers : and offers the
two following varieties :

x Vaginalis.                   The fluid contained in  the tunica
  Vaginal dropsy of the          vaginalis or surrounding sheath
    scrotum.                    of the  testis.
Z Cellularis.                   The fluid contained in the cellular
  Cellular dropsy of the          membrane of the scrotum.
    scrotum.

  The ordinary causes of the first variety are organic atony, and
organic violence, as a contusion, and perhaps repelled buboes. Van
der Harr asserts that it occurs more frequently on the left than on
the right side;± and Jonston that it is never  found on  the latter.^
Delattre describes a case of congenital affection.||
• Osservazioni, Mediche, J'irenz. 1752.
f Introduct. to the l'ract. of Midwifery, Ch. III. Sect. IX.
t Waarneeminge.
§ IV. 72.
(1 Journ. de Med. torn. XXXII. 
■ '28tf
EccnrncA.
[CL.  VI.—oh. u.
   The second variety takes easily the pressure of the finger, and is
 mostly an accompaniment of general cellular dropsy, or a prelude
 to it.   If it be an idiopathic affection it may be removed by scari-
 fication.
   The vaginal dropsy of the scrotum is the proper disease, and is
 elastic to the  touch.  It sometimes takes place with great rapidity,
 and sometimes very slowly. The tunic is, in some cases, extremely
 distended, and the whole scrotum rendered  transparent, so that a
 candle may be seen through its contents.
   On the Malabar coast, Kcempfer asserts, that the disease is ende-
 mic ;* and the scrotum has been sometimes  found  to weigh sixty
 pound s.t
   In recent cases, emetics have appeared peculiarly serviceable:
 and astringents and  stimulants may be tried in the form of cata-
 plasms or  fomentations; as vinegar, with or without a  solution of
 muriate of ammonia,  or neutralized  with volatile alkali.  Though
 where there is much pain leeches should be previously applied.  If
 this do not succeed the sac must be  opened, and the fluid be eva-
 cuated by  a lancet or the  trocar.  But the water soon re-accumu-
 lates, and the same palliative  must usually be had recourse to three
 or four times a-year.  Van Swieten mentions the case of  a dignified
 ecclesiastic who was obliged to have the operation performed every
 three months for twenty years in succession.!  And I had lately a
 patient who submitted to  it as often, for many years of the latter
 part of his  life, though he did not live  so long as Van Swieten's
 patient.
  The only radical cure we are acquainted with is that of obliterat-
 ing the cavity, by  exciting an  inflammation in the vaginal  and
 albugineous tunics, or in the latter alone.  By the first  of these
 operations  the two tunics  adhere together,  and the cavity being
 destroyed, there can be no subsequent accumulation. Thus inflam-
 mation may be excited by a seton, a caustic, the introduction of an
 irritating fluid by means of a syringe, as brandy, diluted spirits of
 wine, or a  solution of corrosive sublimate; or by incision.  This
 was the ordinary plan pursued till of late years, and the  particular
 modes of carrying it into effect were  equally countenanced by sur-
geons of reputation.
  For the latter and simpler process, or that  which consists in con-
 fining  the  inflammation to the  tunica  albuginea,  we  have been
chiefly indebted of late years to Mr. Ramsden, and Mr. Kinder
 Wood.  The last, after evacuating the fluid, draws forward with a
 small hook " that portion of the tunica vaginalis presenting at the
 external opening, and cuts it  away with a pair of" scissors, imme-
 diately closing the external  opening with adhesive plaster.  By
 which  means a moderate inflammation  of the  membrane will be
• Amccnitat. Exotic.
f Memoires de Paris, 1711. p. 30.
t Comment, ad § 252. 
ViE. 1—SP. IX.]      EXCERNENT FUNCTION.                 287

insured, and I  am led to hope,"  says the ingenious writer,  " that
the success  will be frequent."* In effect, Mr. Wood gives various
instances of complete success. The piece snipped off is very small,
and very little  inconvenience is suffered. The inflammation under
this mode of operating is so inconsiderable as to be confined to the
tunica vaginalis alone, and consequently the cavity between the
two tunics is not obliterated as is obvious by the testis being still
able to roll  to a considerable extent within the scrotum.  This
plan, therefore, is best adapted for dropsies of recent standing, and
where the sack is not much thickened and indurated.  In old and
obdurate  cases it will mostly be  found  necessary to carry the in-
flammation  so  far as  to obliterate the cavity.
   Mr. Wood does not seem to be aware that Mr. John Douglas em-
ployed a similar remedy as a radical cure in the cellular dropsy of
the scrotum, and recommended it in his Treatise on Hydrocele,
published in this metropolis in 1755.   Celsus appears also to have
glanced at the  same in both kinds of dropsy.t
   In a case  on  which  the author was consulted some few years ago,
the patient, a gentleman far advanced in life, and who had been re-
gularly tapped about once in three months for  five  or  six years
antecedently, found a considerable hemorrhage ensue shortly after
the last operation, but which yielded on immersing the scrotum into
water chilled  to  the freezing point.  The hemorrhage, however,
returned within two days, and the scrotum was again as much dis-
tended,  though manifestly with  blood,  as  before  the trocar had
been applied.  It was clear that  a pretty large artery had been ac-
cidentally wounded, or that the internal parts were in a very mor-
bid condition.  To ascertain the real fact, and put a stop to the dis-
charge, the  scrotal and vaginal tunics were immediately laid open
from the top to the  bottom, and a pretty strong pressure made
between the testicle and the side of  the latter tunic  with folds of
lint, which  effectually restrained the hemorrhage, without the ne-
cessity of pausing to  take up any vessel.  On examining the organ
more  closely on the  ensuing day, a foul and  spongy ulcer was
detected  on the tunica albuginea, from which the hemorrhage had
proceeded : by a course of warm digestive dressing, however, both
the wound and the ulcer healed, and a radical cure of the  dropsy
was completely accomplished4
   The clitoris has sometimes been found affected witli  the  second
 or cellular variety, and acquired  a considerable size.  The earliest
 writer who  seems to  have noticed this sort of dropsy is  Aetius ;§
 and it has since been described  or adverted to  bv Van Swieten,||
  * Trans, of the Medico-Chir. Soc. Vol. IX. 49.
  f De Medicin. Lib. VII. cap. 21.
  t See, for a case somewhat similar, Edin. Med Ess. II. Art. XIV. by Mr.
Jamieson.
  § Tetrab. IV. Serm. II. c. 22. Serm. IV. c. 100.
  | Comment, ad. § 1227. 
288                      ECCRITICA.            [CL. VI.—OR. II.

Saviard,* Menoury.t and various others under the name of hydro-
cele muliebris or fceminina.




                       GENUS It.

                   EMPHYSEMA.

                 Xttflatfou.  a^tnfcuTojJSg.

ELASTIC AND SONOROUS DISTENTION OF  THE BODY OR US MEMBERS
  FROM AIR ACCUMULATED IN NATURAL CAVITIES, IN WHICH IT IS
  NOT COMMONLY PRESENT.

The  term emphysema is derived from  t/*. or ev and Qvo-xu  " inflo"
" flatu distendo." It has often been made a question by what means
the air is obtained in various cavities, in which it is found in great
abundance; for we cannot always trace its introduction from without,
nor ascribe it to a putrefactive process.  Fantoni found air seated
between the tunics of the gall-bladder, and Hildanus in the muscles.
" In one instance,"  observes Mr. J. Hunter, " I have discovered air
in an abscess which  could not have  been received from  the external
air;  nor could it  have  arisen from  putrefaction."J   The  case is
singular and well entitled to attention, but too long to be copied.
From this and various other circumstances, Mr. Hunter conceived
the opinion that air is often secreted by animal organs, or separated
from the juices conveyed to them :  and he appeals, in confirmation
of this opinion, to the experiments of Dr. Iugenhouz upon vege-
tables. I have not had an opportunity of reading these experiments,
but that such a sort  of secretion exists in plants must be obvious to
every one who carefully examines the inflated legume of the differ-
ent species of bladder-senna, (colutea,) and the capsules of several
other shrubs quite as common in our gardens, and which can only
become inflated by a  separation  or secretion of  air  from  the
surrounding vessels. Yet an appeal to a variety of curious facts in
the economy of numerous animals will perhaps answer the purpose
much better, as leading us more directly to the point.   The sepia
officinalis, or cuttle-fish, and the argonauta Nautilus, the ordinary
parasitic inhabitants of which—for we do not know the animal that
rears the  shell—has a very near resemblance to the cuttle-fish, and
as suspected by Rafinesque, and since  determined by  Cranch, is a
species of ocythoe,§ introduce air at option into the'numerous cells
* Nouveau Recueil, &c.
f Journ. de Med. 1790.
* Anim. Econ. p. 207.
* Phil. Trans. 1817, p. 293. 
 GE. n.]              EXCERNENT FUNCTION.               g89

 of the back-bone,  and thus render themselves specifically lighter
 whenever they wish to ascend from the depths of the sea to the
 surface;  and, in like manner, exhaust the back-bone of its air, and
 thus render themselves specifically heavier whenever they wish to
 descend.   All fishes possessing a  sound or air-bladder are equally
 capable of supplying  this organ with air, first for the purpose of
 balancing themselves, and next, apparently, for that of raising them-
 selves towards the  surface.  In all these cases the air, thus intro-
 duced and accumulated, appears to be a direct secretion: at least
 we cannot otherwise account for its presence, as  we can  easily do
 in the bones of birds whose cells are filled with air; for we can here
 trace an immediate communication with the air cells of the lungs.
   Mr. Bauer has lately shown that a gass is constantly shooting forth
 in small bubbles from the roots of plants into the  slimy papulae by
 which they are surrounded ;  and that it is by this means that the
 slimy matter becomes elongated, is rendered vascular, and convert-
 ed into hair or down.  Mr. Brande has  also shown thatgass, meaning
 hereby carbonic acid gass, exists in a  considerable quantity in the
 blood while circulating in the arteries and veins, and is very largely
 poured forth from blood placed, while warm,  under the receiver of
 an air-pump, so as to give an appearance of effervescence.  He
 calculates that two cubic inches are extricated from every ounce of
 blood thus experimented upon, the venous and arterial blood con-
 taining an equal proportion.   And Sir Everard Home, has hence
 ingeniously conjectured that it is by the escape of bubbles of this
 gass through the serum, in cases of coagulated blood, that  new ves-
 sels are formed, as  also that granulations are produced in pus;  from
 which it appears that the same gass escapes with equal freedom.
   These results of Mr. Brande, upon  the same subject, are in per-
 fect accordance with the well known experiments of Dr. Hales and
 Baron Haller, which of late years  appear to  have been  too  much
 neglected, if not discredited.  The former asserts that in  distilling
 blood, a thirty-third part of the whole proved to be air; and the
 latter confirms the  assertion ; " utique," says  he, " fere trigesima
 tertia pars totius sanguinis verus est aer." From all which we may
 reasonably conjecture that the body of air found in many cases, of
 perhaps all the species of emphysema, is produced, like other fluids
 found in different cavities of the animal frame, by a process of se-
 cretion.  These species are three,  and are as follow:

     1. emphysema  cellulare.     cellular inflation.
     2. -------_—  abdominis.     tympany.
     3. ---:------■  uteri.         inflation of  the womb.

  There are probably  many others—but these are the only ones
which have been hitherto distinctly pointed out.
  Vol. IV.—0 o 
290
ECCRIT1CA.
[CL. VI.—OR. If
                        SPECIES I.


            EMPHYSEMA CELLULARE.

                    (Ecilular Xuflatfon.

TENSE, GLABROUS, DIFFUSIVE INTUMESCENCE OF THE SKIN, CRACKLING
             BENEATH THE PRESSURE OF THE FINGER.

This is the pneumatosis of Sauvages and Cullen, and consists in a
distention of the cellular membrane by air instead of by water,  as
in hydrops  cellularis or anasarca.   The distention is sometimes
limited to particular parts of the body, and sometimes extends over
the entire frame.
  From the remarks we have just offered on the probable separa-
tion or secretion of air from the blood,  this  disease may originate
from various causes, and exhibit itself under various modifications;
but the two following are the only extensive forms under which it
has hitherto been traced :
x A vulnere thoracis.           From a wound in the chest, with
  Traumatic Emphysema.        sense of suffocation.
C A veneno.                   From fish-poison or other venom ;
  Empoisoned Emphysema.      with extensive  signs  of gan-
                                grene and putrescency.
  For the first of these varieties there is no great difficulty in
accounting.  If a wound so far  penetrate the chest as to enter any
part  of the lungs, and divide some of  the larger  branches of the
bronchiae, the inspired air, instead of being confined to its proper
channels, will rush immediately into the chest and fill up its whole
cavity ; as it will also into the cellular membrane of the lungs, from
which it will find a passage into the cellular membrane of the en-
tire body, and produce an universal inflation.
  This  last effect is highly troublesome and distressing: but the
first is productive of the utmost alarm.  The lungs compressed  on
every side by the extravasated air, are incapable of expansion : and
there is consequently an instantaneous danger of suffocation.  The
patient labours for breath with all his might, and labours but to lit-
tle purpose ; his cheeks are lived, his senses  soon become stupefied,
and, without speedy relief, death must inevitably ensue.  The dis-
tress is moreover sometimes aggravated by the excitement of a
cough, in the fits of which, if any considerable blood-vessels have
been burst, blood is expectorated along  with the rejected mucus.
   Mr. Kelly, in the Edinburgh Medical Commentaries, has given a
very singular case of this affection from another  cause, which  we
will presently explain.  The patient, almost fifty-seven years of age, 
GE. II.—SP. I.]      EXCERNENT FUNCTION.
291
had long laboured under a chronic cough and difficulty of breathing.
The emphysema began to appear  on the second day after a most
violent fit of coughing, laborious respiration and  r ain in the side.
It soon covered the whole right side to the scrotum which was also
much inflated, producing a crackling  sound upon pressure ;  and,
gradually widening its course, by the  fourth day it extended  over
the whole body.  It was at first conceived that air had entered from
without into the cellular membrane by means of some wound in the
side; but no such injury or any  other channel of communication
could be discovered.  The symptoms, however, were so pressing
that it was at length determined, under the advice of Dr. Munro, to
afford an escape for the air, by an opening into the cavity of the chest.
The pleura was in consequence tapped ; when  upon withdrawing
the perforator, such a blast oi wind issued through the canula, as
to blow  out a lighted candle three or four times successively.  The
patient immediately became easy, and free from oppression, and his
pulse fell from above a  hundred strokes in  a minute to ninety.
Punctures were at the same time made into the cellular membrane,
in different parts of the body, and from these also the  imprisoned
air puffed out upon pressure but  not otherwise.  The  patient re-
covered gradually, and in about three  weeks ate and slept as well
as he had done at any time for thirty years before.  For nearly a
twelvemonth he continued to enjoy a good state of health ; but about
the close of this period was again attacked  with a cough, a pain in
the chest, and a difficulty of breathing; a hectic fever followed, and
he died  in about six  weeks.   On  opening  the  thorax, Mr. Kelly
tells us, that he found the lungs "in a  very putrid, diseased state,
with some tubercles on the external surface of the right lobe; there
was  extensive adhesion to the pleura, particularly at the  place
where the pain had been felt most keenly before the perforation;
and, on making an incision into the right lobe, an abscess was dis-
covered  which contained about four ounces of fetid purulent mat-
ter."*  We are hence, I think, led to  conjecture that the emphy-
sema was in this case produced by the  bursting of a former abscess
in the right lobe of the lungs, accompanied with a rupture of one or
more of  the bronchial vessels, in  consequence of which the same
effect followed as if a  wound had been  inflicted  from without.
   Where it is necessary  to evacuate the air from the cavity of the
chest, by an artificial  opening, the operator cannot do better than
follow the example of Mr. Hewson, who employed a scalpel, and in-
troduced it into the fore-part of the thorax, either on the right or left
side; but between the fifth and sixth  ribs in the former  case, be-
cause here the integuments are thin; and between the seventh and
eighth, or the eighth  and tenth in the latter, for the  purpose of
avoiding the pericardium.
   The inflation which follows so suddenly and so extensively in the
• Edinb. Med. Comment. Vol. II. p. 427. 
292
ECCRITICA.
[CL. VI.—OR. H.
second variety, or upon the introduction of fish-poison, or that of
several  species of the mushroom or numerous other edible  venoms
into the stomach, it is not so easy to account for.  In most of the
cases there is so violent and general a disturbance of every function,
as to produce extreme and instantaneous debility ; all  the  precur-
sors of  putrescency are present, and  speedy dissolution  is threat-
ened.  Every part of the body  is swollen and inflated, particularly
the stomach  and intestines, the vapour of  which, when  examined
after death, is found to consist of a fetid and a putrid gass : a black-
ish and greenish froth is discharged from the mouth; clonic or teta-
nic spasms play  wildly over all the  muscles ; the chest labours with
Suffocation, the brain is stupefied, and broad, livid or gangrenous
spots spread  over the body ; and on dissection are found  still more
freely, and of larger diameter, on the surface of most of the thoracic
and visceral organs
   If, then, in a state of undisturbed organization, many parts of the
body have  a power of secreting or  separating air  from the blood,
as we have endeavoured to show in the introductory remarks to the
present genus, how much more readily may we suppose such a se-
paration to take  place  in proportion  as the organs approach that
precise  state  in which the gasses of the blood extricate themselves
spontaneously from its other constituents.  And it may be added,
that this explanation is confirmed by our perceiving that the most
effectual remedies against all such inflations are the most powerful
antiseptics we can employ : as acids,  alcohol, and  the aromatics.
   In a few words, we never cease to  find a  free extrication of air
whenever the body or any part of it is  running rapidly into a state
of putrefaction :  and hence another cause of cellular emphysema^
and a cause that is perpetually occurring to us in gangrene.




                        SPECIES  II.

             EMPHYSEMA ABDOMINIS.

                         &$mvant>.

TENSE, LIGHT, AND EQUABLE INTUMESCENCE OF THE BELLY; DIS-
         TINCTLY RESONANT TO A STROKE OF THE HAND.

This disease is the tympanites of authors, so called from the drum-
like sound  which is given on striking the belly with the hand.
   There have been many occasions of observing that the  Greek
termination itis or ites, is, for the sake of simplicity and perspicuity,
confined, in the present system, to  the different species of a single
genus of diseases, that  of empresma,  of which we have treated al- 
6E. II.—SP. 11.]      EXCERNENT FUNCTION.
293
ready :» and hence, as well as for other reasons sufficiently obvious,
the specific term before us has been selected in its stead.
  Tympanites, however, is by most writers applied  principally to
an enormous collection or evolution of air in some part or other of
the alvine canal, constituting the tympanites intestinalis of Sauvages:
and it is to this disease alone that Dr. Cullen confines his attention]
when treating of the subject in  his First Lines.  This flatulent dis-
tention  he ascribes to an atony of the muscular fibres of the intes-
tines, accompanied with a spasmodic constriction in parts of the
canal ;  by which means the passage of the  air is, in some places,
interrupted.   In this view of the case, however, tympanv, instead
of being entitled to the rank of a distinct genus, is nothing more
than a symptom or sequel of some other  enteric affection, as  dys-
pepsy, colic,  worms, or hysteria: and hence the remedies'applica-
ble to these  are what Dr. Cullen recommends for  tvmpanites__
namely, avoiding flatulent food, laxatives, and tonics."
   Mr. John Hunter seems to have conceived that a tympany of the
stomach or intestines may exist as an  idiopathic complaint.   "1 am
inclined," says he, "to believe  that the stomach has  a power of
forming air and letting it loose from the blood by a  kind of secre-
tion.  We cannot, however, bring any absolute proof of this taking
place in the stomach, as it may in all cases be referred  to a defect
in digestion;  but we have instances  of its  being found  in  other
cavities where no secondary cause can be assigned."!  He alludes
chiefly to an  extrication of air in the  uterus, which  we shall  have
occasion to notice in our next species.
   In concurrence with these remarks  it may, also, be observed, that
some persons are said'to have  a power of producing  ventricular
distentions voluntarily, which it is difficult to account for except by
a voluntary power  of secreting air for this purpose, or forcing it
down the oesophagus, which will be still less readily allowed.  Mor-
gagnij and other writers have  hence treated of this form of the
disease, as  well as of that in which  the  flatus is lodged in  the
peritonaeal sac : while others have contended that this is the  only
form, and that a peritonaeal tympany  has  no real existence.§
   If an  idiopathic tympany of the stomach should ever be decidedly
ascertained, its cure must be attempted by the remedies for flatus
of any other  kind : but at present the only disease  we can fairly
contemplate  as entitled to the name of tympanites, or emphysema
abdominis, notwithstanding the incredulity of some practitioners, is
that in  which the resonant swelling of the belly is produced by air
collected in  the sac of the  peritonaeum.  It is unquestionably a
rare disease, though we must contend, in  the language of Dr.  Cul-

        *  Vol. II. Cl. III. Ord. II. Gen. VII. p. 212.
        t On  the Animal Kconom.  p. 206 4to. 1792.
        t  De  Sed. et Caus. Morb. Ep. XXXVIII Art. 23.
          Collect. Soc. Med. Ilavn. II. p. 73.
        §  Litre, Mem. de l'Acad. des Sciences, 1713, p. 235, 
294
ECCR1T1CA.
[CL. VI.—OH. H.
len, that, " from several dissections it is unquestionable that such
a disease has sometimes truly occurred :" nor can we suppose such
accurate and cautious pathologists  as  Heister,* Lieutaud.t  and
Bell.J  who have respectively given examples  of it, to  have been
successively deceived upon the subject.   Admitting it be produced
by secretion, its occasional causes  are  still very obscure.  It has
been said to follow upon jaundice, and  morbid affections of other
abdominal visera, upon debility produced by fever ;  upon hysteria,
violent passions or other emotions of the mind; and  probably all
these may have operated in different cases.
  The ordinary natural cure seems to consist in an escape of the
air  from the umbilicus by an outlet produced  by  an abscess or
ulceration of this protuberant organ, or a sudden and fortunate rup-
ture f)f its integuments.  Morgagni and  several later writers§ give
us well authenticated cases of an occurrence of the first of these,
and Stoerck of both.||  We are thus led by nature herself to try the
effects  of tapping, or making  an artificial opening into  the cavity of
th.- abdomen in the case of wind-dropsy, as well as in that of water-
dropsy :  aiid here, from the protruded state  of the  umbilicus, the
lancet  may conveniently be  introduced  at this point.  The belly-
should, at the time of the operation, be well  swathed with a broad
girth, which may be  tightened at option, and should  be kept as tight
as the  patient can bear it, as  well for the purpose of general support
as for that of expelling the air within, and preventing the entrance
of air from without.
  Van  Swieten  dissuaded his pupils from this operation ;%  and
Cembalusier,** and a few others have since asserted thatit does not
answer.  Uut in most of these cases we have reason  to believe that
the seat of the disease was mistaken, and that the flatulency existed
in the intestinal canal  rather than in the peritonaeal  sac.
  Antecedently,  however, to the operation of the paracentesis, we
may try the effect of sending shocks of the electric aura through
the abdomen.   Cold fomentations, moreover, or even pounded  ice
rnay be applied externally, and gelid drinks, reduced nearly to the
freezing point, be swallowed  copiously at the same time.  This plan
is said  to have answered occasionally.tt   And it is  obvious that  a
tonic regimen,  with free exercise,  and particularly equitation,
and, where it  can be had recourse to, sea-bathing, should be enter-
ed upon as soon as the tympany is dispersed.
* Wahrnehmungen. I. Art. 15.
f Hist. Anat. V.'p. 432.
t On Ulcers and Tumours. Vol. IT.
§ Guisard, Practique de Chirurgie. torn. I. p. 134.
H Ann. Med. II. p. 190. 193, 194.
1 Ad Sect. 1251.
•* Pneumatopathol. p 503.
  Dusseau, Journ. de Med. 1779.
ff Theden, N. Bemerkungen und Erfahrungen, II. p. 251; 
GE. 11.—SP. II.}     EXCERNENT FUNCTION.                 0,95

  There  is a singular case of flatulent distention inserted in the
Edinburgh Medical Essays, by '■ rofessor Monro, which is called a
tympany, but does not seem to have been exterior to the intestinal
canal; and hence, if  a tympany at all, must have been produced by
a secretion of air into the stomach or bowels, as conjectured by Mr.
J. Hunter.  The patient was  a young woman aged  twenty-two.
The inflation continued  for at least three months, the belly being
sometimes so extremely  distended as to endanger its bursting, and
sometimes considerably  detumefied, at which last period  a variety
of unequal and protuberant balls were felt all over the abdomen,
and seemed to indicate so many intestinal constrictions.   The pa-
tient's appetite continued good, she was very costive, and menstruat-
ed  only at intervals of several months. She was at length attacked
with borborygmi, and a  day or two afterwards had such explosions
of  wind  «v» xxi xx-tu, that none of the other patients would remain
in  the same room, and  hardly on the same floor with her.  From
this time she recovered  gradually.*
                         SPECIES  III.

                  EMPHYSEMA  UTERI.

                    Xnflatfou of the V&wfo.

   LIGHT, TENSE, CIRCUMSCRIBED PROTUBERANCE IN  THE HYPOGAS-
     THIUM ; OBSCURELY SONOROUS ; WIND OCCASIONALLY DISCHARG-
     ED THROUGH THE MOUTH OF THE UTERUS.

   This is the physometra of Sauvages and later nosologists.  Like
   the last species, it is by no means a frequent complaint, and not
   easy to be accounted for except upon the principle of a  secretion
   of air : and hence the existence of this species as well as of the last
•  has been denied by several writers who do not happen to have met
   with examples of it.  The description given of it is somewhat ob-
   scure in most of the pathologists, but there seems, upon the whole,
   sufficient  reason for admitting it into the list of morbid affections.
   "It has been said," observes Dr. Denman, " that wind maybe col-
   lected and retained in the cavity of the uterus till itis distended in
   such a manner as to resemble pregnancy, and to produce its usual
   symptoms ; and that by a sudden eruption of the wind, the tumefac-
   tion of the abdomen has been removed, and the patient immediately
   reduced to her proper size. Of this complaint I have never seen an
   example: but many cases have occurred to me of temporary explo-
* Edin. Med. Essays. Vol. I. Art. XXXI. 
296
ECCRIT1CA.
[CL. vi.—on. ir.
 sions of wind from the uterus which there was no power of restrain-
 ing."*
   The uterus is one of those organs referred to under our last spe-
 cies, as supposed by Mr. John Hunter to have a power  of secret-
 ing or separating air from the blood : and, as he has examined the
 subject with critical attention in  direct reference  to  the present
 complaint, his remarks  are particularly entitled to our  attention.
 " I have been informed," says he,  " of persons who have had  air in
 the uterus or vagina without having been sensible of it but by it*
 escaping from them without  their being able to prevent it: and
 who, from this circumstance,  have been kept in constant alarm lest
 it should make a noise in its passage, having no power to retard it
 as when it is contained  in the rectum.  The fact being so extraor-
 dinary made me somewhat incredulous; but rendered me more in-
 quisitive in the hope of being enabled to ascertain and account for
 it: and those of whom  I have  been led to inquire, have  always
 made the natural distinction between air passing  from the vagina
 and by the anus: that from the anus they feel and can retain, but
 that in the vagina they cannot; nor are they aware of it till it pass-
 es.  A woman, whom I attended with Sir John  Pringle, informed
 tis  of this fact, but mentioned it  only as a  disagreeable thing.  I
 was anxious  to determine  if there were any communication be-
 tween the vagina and  rectum, and  was allowed to examine, but dis-
 covered nothing uncommon  in the structure of  these parts.   She
 died sometime after; and being permitted to open the body, I found
 no disease either in the vagina or the  uterus.   Since that time I
 have had opportunities of inquiring of a number of women concern-
 ing this circumstance, and by three or four have been informed of
 the same fact, with all the circumstances above mentioned."t
  The only difficulty in the  case  is the means  by which air  can
 thus become  accumulated in the cavity of the uterus ; for admitting
 this fact, of which there  can no longer, I should think, be any doubt,
 we  can easily conceive a distention to the utmost power of the or-
 gan  in consequence of an obstruction of the mouth of the womb
 from spasm,  a coagulum of blood, or any other viscid  material.
 And hence, in all the cases of this disease which have descended to
us,  we find such a closure described as existing whenever the organ
 has been examined.  Thus, in the instance  related by Eisenmen-
 ger,J we are told that  the uterus was completely impervious;  and
 a like account is given of a similar instance  recorded in the Ephe-
mera of Natural Curiosities. Palfin§ gives a case in which the ob-
struction proceeded from an hydatid cyst that had fixed at the mouth
of the uterus, and  Fernelius|| another in which the obstruction,
  * Introduction to the Practice of Midwifery, Chap. III. Sect .X.
  f Animal Economy, p. 406, 4to. 1792.
  * Collect. Historia foetus Mussi-pontani, &c.
  % Description des parties de  la femme qui servant a la generation.  JLeid-.
1708.
  B Patholog. Lib. IV. Cap. XV. 
CK. II.—SP. III.]
EXCERNENT FUNCTION.
297
and  consequently the inflation, returned periodically.  Dr. Den-
man intimates  that this  affection is sometimes accompanied with
spasmodic pains, resembling those of labour; and the same remark
will  apply to dropsy of the womb which  so  much  resembles it.
The fact is that the uterus, when once enlarged by whatever means,
and stimulated, has a natural tendency to run into a series of expul-
sory exertions in order to free itself from its burden, and to excite
all the surrounding muscles into the same trainof action; and hence,
natural  labour, false conception, uterine dropsy and inflation pro-
duce the same effect, though perhaps, in different degrees.
  Emphysemas, like dropsies, are, in all cases, disorders of debi-
lity; and hence the mode of treatment in the disease before us is
obvious.  As an occasional discharge of wind from the vagina affords
temporary ease, we should take a hint from this effect: and endea-
vour, first,  to evacuate the confined air entirely, by a canula in-
troduced into the os tincae; and secondly, to invigorate the weak-
ened organ by the  use of some tonic injection, as a solution of cate-
rhu, alum,  white vitriol,  or diluted port wine.
                       GENUS  III.


                        PARURIA.

                      SWCsmictttrttfon.

          MORBID SECRETION OR DISCHARGE OF URINE.

The term paruria is a Greek derivation from nx^x, perperam, and
ovetu, " mingo."   The genus is intended  to include the ischuria,
dysuria, pyuria, enuresis, diabetes, and several other divisions and
subdivisions of authors, which, like the different species of the pre-
ceding genus, lie scattered in most of the nosologies through widely
different parts of  the general arrangement.  Thus, in Cullen, dia-
betes occurs in the second  class of his system ; enuresis in the
fourth order of his fourth class; and ischuria, and dysuria, in the
fifth order of the same class.   All these, however, form a natural
group; and  several of them have  characters scarcely  diversified
enough for distinct species, instead of forming distinct genera.
Dysuria might have been employed instead of paruria, as a gene-
ric term for the whole; but as  it has  been usually limited to the
third species in the present arrangement, it has been thought better
to propose a new  term than to run the risk of confusion by retain-
ing the old term in a new sense.
  The species that justly belong to the present genus appear to be
the following:
  Vol. IV—P p 
298
ECCR1T1CA.
[CL. VI.—OR. II.
    1. PARURIA INOPS.                DESTITUTION OF URINE.
    2.--------RETENTIONIS.         STOPPAGE OF URINE.
    3. -------- STILLATITIA.          STRANGURY.
    4.--------MELLITA.              SACCHARINE URINE.
    5.--------INCONTINENS.         INCONTINENCE OF URINE.
    6.--------INCOCTA.              UNASSIMILATED URINE.
    7.--------ERRATICA.            ERRATIC URINE.

  From this  group of family diseases we may  perceive that the
urine  is sometimes deranged in its quantity, sometimes in its qua-
lity, and sometimes in its outlet: and that in its quality it is derang-
ed in  two ways, by being made a medium for foreign materials, and
by being  imperfectly elaborated.  The most important principle
which it seems  to carry off from the constitution is the urea or that
of the uric acid :  and it has been ingeniously remarked by M. Be-
rard, in his Analysis of Animal Substances, "That as this is the
most  azotised of all the animal principles,  the  secretion  of urine
appears to have for its object a separation of the excess of azote from
the blood, as  respiration separates from it the excess of carbone."
                        SPECIES  I.

                PARURIA  INOPS.

                   Bestftutfon of Wivint.

URINE UNSECRETED BY THE KIDNEYS:  NO DESIRE TO MAKE W'ATEM,
  NOR SENSE OP FULNESS IN ANY PART OF THE URINARY TRACK.

A deficient secretion of urine is often a result of renal inflamma-
tion, in  which case, however, there is necessarily a considerable
degree of pain and tenderness in the lumbar region.  But the pre-
sent species  occurs occasionally as an idiopathic affection, some-
times followed rapidly by great danger to the general fabric, some-
times assuming a chronic form, and running on for a considerable
period of time without danger, and sometimes existing as  a consti-
tutional affection coeval with the birth of the individual.
  Dr. Parr relates a case that occurred in his own practice in which
no urine was apparently secreted for six weeks,* and Haller gives
a similar case that lasted twenty-two weeks.t In the Philosophical
Transactions^: we meet with various  instances of a similar  defi-
ciency ; among the most singular of which is the case of a youth of
• Diet, in verb. Ischuria.
f Bibl. Med. Pr. II. p. 200.
* Vol. XXVIU. year 1783. 
«E. III.—SP. I.]      EXCERNENT FUNCTION.
299
 seventeen years of age<lescribed by Dr. Richardson, who had nev?r
 made water from his birth, nor had felt the least uneasiness on this
 account, being healthy, vigorous, and active.
   Let it not be supposed, however, that so important a recrement
 as the urine is, can have  its constituent principles remain behind,
 and load the blood without danger.  The outlet at Which  these are
 separated and discharged is not  always manifest, and  hence they
 sometimes appear not to be separated and discharged at all; though
 if the state of the patient be critically examined into by an accurate
 pathologist, the vicarious channel  will  generally be  detected, and
 most of the cases that must at present  range under the species be-
 fore us,  would be transferred to that  of paruria erratica.
   The two most common emunctories that supply the place of the
 kidneys are the skin and  the bowels.   In Dr. Parr's case, he states
 that there was no vicarious evacuation, except a profuse sweat for
 a day or two, and he adds that there was no suspicion of imposture,
 as  the patient was in a hospital  and  constantly watched.  But we
 have no account of the state of the bowels.  In Dr.  Richardson's
 case of a natural destitution of urine, the patient is admitted to have
 laboured under an habitual diarrhoea, though the little  uneasiness,
 and the  discharge of the urinary elements is very correctly ascribed
 to the intestinal flux.
   The effects that result  from a retention of the urinary  elements
 in the system, are a loss of energy and a growing torpitude in every
 function, proving that the sensorium  is directly debilitated, and
 rendered incapable of secreting its  proper fluid.  It is, hence, to be
 expected that the brain should evince  torpitude  in a greater  de-
 gree than any other organ, and become  oppressed and comatose, as
 though in a state of apoplexy.  Nor is  it difficult to account for
 these effects, since they naturally follow from having the blood sur-
 charged  with that excess of azote which, as we have just observed,
 it appears to be the office  of the urine to carry off.  The  destruc-
 tive powers of azotic gass to animal life  is known to every one, as is
 also its further power of increasing the  coagulability of the blood.
  I do not know, however, that the great and  pressing danger of
 having the constituent principles  of the  urine thrown back into the
 blood,  have been distinctly pointed  out by any physician before the
 appearance of Sir Henry Halford's valuable article in a late volume
 of the Medical Transactions, which contains the following  interest-
 ing case: " A very corpulent, robust farmer, of about fifty-five years
 of age, was seized with a  rigor which induced him to  send for his
 apothecary.   He had not made water, it appeared, for twenty-four
 hours: but there was no pain, no sense of weight in the loins,  no
 distention in  any part of the abdomen, and therefore no  alarm was
 taken till the following morning, when it was thought proper to as-
 certain whether there was any water in the  bladder, by the intro-
 duction of the catheter ; and none was found.   I was  then called,
and another inquiry was made, some few hours afterwards, by one 
300
ECCK1TICA.
[CL. VI.— OR. II.
of the most experienced surgeons in London, whether the bladder
contained any urine or not, when it appeared clearly that there was
none.  The patient sat up in bed and conversed as usual, complain-
ing of some nausea, but of nothing material in his own view ; and I
remember that his friends expressed their surprise that so much
importance should be attached to so little apparent illness.   The
patient's pulse was somewhat slower than usual, and sometimes he
was heavy and oppressed.  I ventured to state that if we should
not succeed in making the kidneys act, the patient would soon be-
come comatose,  and would  probably die the following night; for
this was  the  course  of the  malady in  every other instance which
I had seen.   It  happened so; he died in thirty hours after this,  in
a state of stupefaction."*
  To this short history, Sir Henry has added the following remarks,
which are of  too much importance  to be  omitted.  " All the pa-
tients who have fallen under my care were fat  corpulent  men be-
tween fifty and sixty years of age : and in three of them there was
observed  a strong urinous  smell  in the  perspiration twenty-four
hours before death ;" evidently proving that in these cases the in-
stinctive or remedial power of nature, aided by the constitutional
vigour of the  respective patients, was endeavouring to convert the
exhalants of the skin into a substitute for the palsied kidneys, but
was not able  completely to succeed.
   In attempting a cure of paruria inops we ought, in the first in-
stance, whatever be its cause, to take a hint from the light of na-
ture which is  thus thrown upon us: and, as the excretories of the
skin and of the kidneys are so perpetually assisting each  other  in
almost every  way, excite the former by active diaphoretics to  take
upon themselves for a time the office  of the latter, and  carry  off
the urea that should be discharged by the kidneys.
   We should next endeavour to restore the kidneys to their natural
action by gentle stimulants or diuretics, as the aliaceous  and sili-
quose  plants, especially horse-radish and  mustard,  the  aromatic
resins and balsams, especially those of turpentine, copaiba, and the
 essential oil  of juniper.  Digitalis is of little avail, and in idiopathic
 diseases of the kidneys does not often exhibit a diuretic effect.  If
 given at all it should be in conjunction with tincture of lytta, or the
 spirit  of nitric ether.
    Stimulants may, at the same time, be applied externally, as the
 hot-bath, or strokes of the electric or voltaic fluid  passed through
 the loins ; to which may succeed rubefacients and blisters.
    In the mean  while the alvine canal  should be gently excited  by
 neutral  salts; and juniper-tea, broom-tea, or  imperial, may alter-
 nately form the common drink.   Th« juice of the birch-tree (be-
 tula alba) will often, however, prove a better diuretic than any of
 these.   It is  easily obtained by wounding the trunk, and when fresh
 is a sweetish and limpid fluid, in its concrete state affording a brown
• Med, Trans. Vol. VI. p. 410. 
•iE. III.—SP. I.J
EXCERNENT FUNCTION.
iwl
ish manna. It has the advantage of being slightly aperient as well
as powerfully diuretic.   From its stimulating the intestines it was
at one time supposed to be a good vermifuge, and to have various
other properties  of which, in  the present day, we know nothing:
whence  it has unjustly fallen  into discredit even for properties to
which it has a fair claim.
                       SPECIES  II.

              PARURIA RETENTIONS.

                    Stoppage of WLvinc.

wRINE totally  obstructed in  its flow: with a  sense of
  WEIGHT OR UNEASINESS IN SOME PART OF THE URINARY TRACK.

This is the ischuria of many writers, and though, like the preced-
ing species, it is  equally without a flow of urine, it differs  very
widely from  it in other circumstances.  In paruria inops the ex-
cretories of the kidneys are inactive, and, consequently, no urine is
produced.  In the species before  us the secernents possess an ade-
quate power,  but the secretion is obstructed in its passage.   And,
as it may be obstructed in different organs and in numerous ways
in each organ, we have the following varieties:

«c Renal is.             Pain  and  sense of weight in the region of
  Renal stoppage of    the kidneys, without  any  swelling  in
     urine.              the hypogastrium.
£ Ureterica.          With pain or sense of weight in the re-
  Ureteric stoppage     gion of  the ureters.
     of urine.
v Vesicalis.          With protuberance in  the hypogastrium;
  Vesical stoppage      frequent desire to make  water;  and pain
     of urine.           at the neck of the bladder.
^ Urethralis.          With  protuberance  in  the hypogastrium;
   Urethral stoppage     frequent desire to  make  water; and a
     of urine.           sense  of obstruction  in  the  urethra, re-
                       sisting the introduction of a catheter.

   Obstruction of urine may take place in the kidneys  from a
variety  of causes: as spasm, calculous concretions, inflammation or
abscess; and the tumour or swelling which occurs in any of these
states, may be so  considerable as to prevent the fluid from flowing
into the pelvis of  the kidneys as it becomes secreted by the tubules,
or out of the pelvis when it has collected there.
   The kidneys, however, lie so deep, and from their minuteness 
302
ECCU1TICA.
[CL. VI—OR. II.
 are so completely buried in the loins, that the intumescence which
 produces the obstruction is often imperceptible  to the eye, or even
 to the touch.   At times, however, the  organ becomes wonderfully
 augmented  as the process of inflammation proceeds.  Cabrolius
 gives  us the history of a purulent kidney that weighed fourteen
 pounds.*  And where the enlargement  is accompanied with but
 little inflammation, proceeds gradually, and does not enter into a
 suppurative state, the organ not unfrequently becomes much more
 enormous, and has sometimes been found to weigh from thirty-five
 to forty pounds.t
  In this condition there is no difficulty in conceiving  a total ob-
 struction to the flow of the urine even when elaborated in sufficient
 abundance.   But the kidney, on  the contrary, sometimes wastes
 away,  instead  of enlarges, and this so  much as to become  a shri-
 velled  sack, and not exceed a drachm in weight; and as the  ,k-^
 of the kidney contracts with its body, the organ at its extreme point
 is sometimes found imperforate: and hence how small soever  may
 be the  quantity of fluid which in this morbid condition may be se-
 parated from the  blood, none  whatever can pass into  the ureter;
 and if both the kidneys  concur in the  same emaciation, this  also
 must form as effectual a cause of the disease before us as any other.
  When the stoppage of urine exists  in the ureters, the causes
 may be as numerous and nearly of the same kind as when the kid-
 neys are at fault: for here also we occasionally meet with calculous
 concretions, inflammations, and spasms : to which we may add  gru-
 mous blood, viscid mucus, and a closed orifice in consequence of
 ulceration.
  Vesical retention of urine is produced  by inflammation,
 pressure upon the neck of the bladder, irritation, or paresis. Pres-
 sure of the neck of the bladder may be  occasioned by distention of
 the rectum from scybala, or  other enterolithic concretions, flatus,
 inflammation, or piles ; or by distention of the vagina from inflam-
 mation, or a lodgement of the menstrual flux in consequence of an
 imperforate hymen.  Irritation  may be excited  by a calculus, or
 too long a voluntary retention of urine, as often happens  on our
 being so closely impacted in large assemblies or public courts, or so
 powerfully arrested by the interests or  eloquence of a subject  dis-
 cussed in such places, that we cannot consent to  retire  so soon as
 we ought: whence the  spincter of the bladder from  being volun-
 tarily,  becomes at length spasmodically constricted, and the urine
 cannot escape.  It sometimes happens, under the last circumstance,
 that from the pressure of the urine against the sides of the bladder,
 the absorbents are stimulated to an increased degree of action, and
a considerable portion of the surplus is  thus carried back into the
vessels, and perhaps thrown off by perspiration, so that we are able
to remain for a very long term  of time after the bladder has be-
 come painful from over-distention.
• Cabrol. Observ. p. 28.
t Commerc. Liter. Nor. 1731. p. 32.1737. p. 326. 
CE. HI.—SP. II.)     EXCERNENT FUNCTION.
303
   A tony'or paralysis of the bladder, by which its propulsive power
is destroyed, is a frequent cause; whence, as Saviard has observed,
it is often met with in paraplegia :* and as Morand remarks, on in-
juries to the  spine.f  And hence, I have  occasionally found it an
attendant upon severe and long protracted attacks of lumbar rheu-
matism :| as most practitioners have probably done on injuries to
the kidneys,  ureters, urethra, prostate gland, or penis.   It is said,
moreover, to be a  result of repelled  eruptions  of various kinds,
chiefly of scabies§ and scalled head ;|| but it has not occurred to me
from these causes : though I  have not witnessed it in infancy from
the irritation of teething where dentition has been attended with
difficulty.
   In urethral retention of urine, the causes do not essentially
vary from those already noticed; such as inflammation, the lodge-
ment of a calculus; viscid mucus ; and grumous blood.   To which
are to be added, the ligature of a strangulating phimosis; irritation
from a blennorrhoea or clap; strictures;  an ulceration of the ure-
thra producing an opening into the scrotum, or rendering the canal
altogether imperforate.
   There is  always danger, from a retention of urine when  it has
continued so long as to distend and prove painful to  the bladder:
and the danger is of two kinds, first, that of an inflammation of the
distressed organ,  and next, that of resorption, and a refluence  of
the urea, and other constituent parts of the  urine, as noticed under
the preceding species.
   The retention, however, has occasionally continued for a consi-
derable period without mischief.  It has lasted from  a  week to a
fortnight.If   Marcellus Donatus gives a case of six months  stand-
ing ;** and Paullini another of habitual retention.tt But in all these
an observant practitioner will perceive the two  following accom-
paniments:  firstly, a constitutional or superinduced  hebetude of
the muscular coat of the bladder so as to  indispose it to inflamma-
tion ;  and secondly, a resorption of the urinary fluid  and its evacu-
ation by some vicarious channel, as already remarked under paruria
inops.   We  have there stated that the two most commonly substi-
tuted outlets  are  the excretories  of the  bowels and of the  skin.
Dr. Percival gives an instance of the latter in which  the perspira-
ble matter was so much supersaturated with the ammoniacal salt  of
* Observ. Chirurgiques.
f Vermichte Schriften, B. II.
i See also Snowden, in the London Medical Journal.
§ Morgagni, de Sed. et Caus Morb.  Ep. XLI. Art. 4.
H Nov. Act. Nat. Cur. Vol. V. Art. 68.
TJ Eph. Nat. Cur passim.
  Cornar. Obs. N. 21.
•• Lib. IV. cap. 27, 28.
ft Cent. II. Obs. 26. 
MM
ECCIUT1CA.
[CL. VI.—UU. II
the refluent urine, as to chrystallize on the surface of the body, and
this to such an extent that the skin was covered all  over with a
white saline powder.*   Sometimes it has been thrown out from the
stomach intermixed with blood, in the form of hgematemesis ;t and
sometimes from the nostrils with the same intermixture in the form
of an epistaxis.J  And where the absorbents of the bladder  have
been too torpid for action, it has  regurgitated through the ureters
of these organs instead of by these of the former.§
   The quantity retained, and afterwards discharged, or found in
the bladder on dissection, has often been very considerable.  It has
occasionally amounted to eight or nine pints; and there is a case
given by M. Vilde in the Journal de Medicine, in which it equalled
sixteen pints.
   In all the varieties  thus pointed out the mode of management
must be regulated by the cause  as far as we are able to ascertain it.
   If we have reason to believe the  suppression is strictly renal
from the symptoms just adverted  to, and particularly from ascer-
taining that there is no water in the bladder or ureters, in  most
cases,  whether it proceeds from inflammation or stone, we shall do
right to employ relaxants, and mild aperients : and where the pain
is violent, venesection succeeded by anodynes.  But it  sometimes
happens that the  obstruction is produced by a parabysmic enlarge-
ment or coacervation of the  substance of the kidney without inflam-
mation.  If this should occur in both kidneys at the same  time,
which  is rarely the case, we have little  chance of success by any
plan that can be laid down.  If it be confined to one, the sound kid-
ney will  often  become a substitute for the diseased, and perform
double duty; and we may here attempt a resolution of the enlarge-
ment by minute doses of mercury continued for some weeks, unless
salivation should ensue, and render it necessary to intermit our
practice.   A mercurial plaster  with ammoniacum should also be
worn constantly over the region of the affected organ.
   The same plan must be pursued if we have reason to suspect the
obstruction is confined to the ureters.   The passage of  a calculus
is the  chief cause of this variety of retained  urine: and indepen-
dently of the sense of pain and weight in the region of the ureters
which an impacted  calculus produces, we have  commonly also a
feeling of  numbness  in either leg, and  a retraction of one of the
testicles in men, as the calculus  in  its passage  presses upon the
nerves which descend from the spermatic vessels. Opium and fttax-
ants are here the chief, if not the only means, we can rationally em-
ploy ; though the ononis spicata, or rest-harrow of our fields, is said,
both in the form of powder and of decoction, to be useful in this and
* Edin. Med. Comm. Vol. V. 437.
f Act. Nat Cur. HI. Obs. 6.
* Eph. Nat. Cur. Dec. II. Ann. IV. Obs. 63.
S Petit Traits, &c. CEuvres Posthumes. torn. III. p. 2. 
he. in.—sp. ii.]
EXCERNENT FUNCTION.
;i0o
 various other diseases  of  the bladder,  accompanied with severe
 pain : on which account it holds a place in the Materia Medica of
 Bergius.   The asplenium Ceterach and athamanta Oreoselinum, or
 mountain-parsley, weref ormerly in vogue for the same purpose, but
 seem to be of feeble efficacy.  Tlie  seeds  of the athamanta cre-
 tensis, or wild carrot, had a wider and better founded fame, both as
 a diuretic and lithontriptic.  Dr. Cullen employed them for the lat-
 ter purpose but without success.  The suppression is seldom total;
 for the opposite ureter  is rarely so much affected by sympathy as
 to be spasmodically contracted, and equatly to oppose  the  flow of
 the urine.
   The most rnrnmon variety of this disease is that of vesical reten-
 tion, or a retention of the water in the bladder. This is usually pro-
 duced by inflammation or  spasm, by which the sphincter  of the
 bladder becomes contracted, and rigidly closed. The inflammation is
 to be relieved by the ordinary means ; and, in addition  to these, by
 anodyne clysters, and fomentations, a warm bath, warm liniments,
 and blisters to the perinaeum. Spasm  is excited by various causes:
 a stone in the bladder will do if, an ulcer about the neck of the blad-
 der Will do it, as will also too long a  voluntary retention of urine.
 Spasm is, for the most part, to be treated, and will, in  most cases,
 be subdued, by the method just proposed for inflammation ; to which
 we may add camphor  and opium by the mouth, and bladders of
 warm  water applied  to the pubes and perinaeum, or, which is
 better, the warm-bath itself. Camphor has the double advantage of
 being a sedative as well as an active diuretic;  but combined with
 opium, we obtain a much more powerful medicine than either affords
 when employed singly.  If the  retention proceed  from  Spanish
 flies, camphor alone will often answer: though in this case it is far
 Better to  combine with it mucilaginous diluents, as gum Arabic
 dissolved  in barley Water.   Several of the terebinthinate oils have,
 also, been employed  with  great  advantage, as the oil of juniper;
 the balsamum carpathicum,  as it was  called  by C. Ab Hortis, who
 first introduced it into  practice,  and  recommended  it  for  a mul-
 titude of other complaints as well; concerning which there was at
 one time a great secret, but which is,  in fact, nothing more than aa
 essential oil, very carefully  distilled  from the  fresh cones of the
 trees which yield the common turpentine; and  the balsamum hun-
 garicum, which is an exudation from the tops of thepinussilvestris,
 and proves sudorific as well  as diuretic. Another remedy, of early
 origin, and which has preserved its reputation to our own day,  is
 the dandelion, the leontodon  Taraxacum of Linneus.   It was at
 one time regarded as  a panacea, and prescribed  for almost every
 disease by which the system is invaded,  as gout, jaundice, hypo-
 chondrias,  dropsy, consumption,  parabysmus of every species, as
well as gravel and other diseases of the bladder:  and was equally
employed in its roots, stalks, and leaves. It is now chiefly used as
a deobstruent.; but it possesses, unquestionably,  diuretic powers,
and hence, indeed, its vulgar name of piss-a-bed.
  Vol. IV—Qq 
306
ECCK1TICA.
[CL. VI.—OR. IT
  If the joint use of these means  should fail, the water must be
evacuated by the introduction of a bougie or catheter, though the
irritation is sometimes increased by the use of these instruments ;
and the spasm or the thickening at  the prostate or about the neck
of the bladder is so considerable, as to prevent an introduction of
even the smallest of them.  In this case, if the inflammation in-
crease, and the distress be alarming, nothing remains but to punc-
ture the bladder, either above the pubes, in the perinaeum, laterally,
or posteriorly through the rectum, for the operation has been  per-
formed in all these ways, and each has had its  advocates.
  The urethral retention, as already pointed out, arises also from
inflammation, which is to be treated in the ordinary way ; or from
a calculus or a stricture ; both which are best removed by the  ap-
plication of a bougie.  In the last case the bougie, if it pass with-
out much pain, should be continued daily,  and progressively en-
larged in its size.  It has often  been employed with a tip of lunar
or alkaline caustic: and in many instances with perfect success:
but very great caution is requisite in the use of a caustic bougie;
and even in  the hands of the most skilful it has sometimes proved
highly mischievous.  When a simple bougie  is employed, Ferrand*
advises, that if the water do not now immediately, it should be re-
introduced and left in the urethra; and I have myself advised such
a retention of the bougie catheter through an entire night with con-
siderable advantage;  for the water which would not flow at first
has gradually trickled, and given some relief to the over distended
bladder,  which has hereby progressively recovered its tone  and
propulsive power; so that the water, before morning, has been pro-
pelled in a stream.  But this is a plan only to be pursued  where
the organ has too little instead of too much irritability, and conse •
quently where there is no danger of inflammation.
                       SPECIES III.

              PARURIA  STILLATITfA.

                        Stranflurg.

         painful and stillatitious emission of URINE.

This is the dysuria of Sauvages and later writers. In the preceding
species there is an entire stoppage of the urine; in the present it
flows, but with pain and by drops.  Several of the causes are those
of paruria retentionis; but others are peculiar to the species itself;
* Blegny Zod. Ann. 1681. 
GE. III.—SP. III.]     EXCERNENT FUNCTION.
307
and as they are accompanied with some diversity in the symptoms.
they lay a foundation for the following varieties:

      *c Spasmodica.           Spasmodic strangury.
      0 Ardens.               Scalding strangury.
      y Callosa.               Callous strangury.
      ^ Mucosa.               Mucous strangury.
      t Helminthica.          Vermiculous strangury.
      £ Polyposa.             Polypose strangury.
  The first variety is characterized by a spasmodic constriction
of the sphincter, or some other part of the urinary canal, catenat-
ing with spasmodic action in some  adjoining part. The spasmo-
dic actions of which this variety is a concomitant are chiefly those
of hysteria,  colic, and spasm in the kidneys.  It is hence a secon-
dary affection, and the cure must depend on curing the diseases
which have  occasioned it.   Opium  and the digitalis will often af-
ford speedy relief when given in combination.
  In the  second variety  there is also a spasmodic constriction.
but of a different kind, and  making it more of a primary affection;
whence Sauvages and others have distinguished it by the name of
dysuria primaria.  It is excited by an external or internal use of
various  stimulants, as acrid foods, or cantharides taken internally;
and is accompanied with a  sense of scalding as the urine  is dis-
charged.
  This  is also a frequent result of blisters: and  to avoid it in this
case the patient should be always advised to drink freely of warm
diluents in a mucilaginous form.  Gum-arabic, marsh-mallows root,
the jelly of the orchis or salep, infusion of quince-seed, lint-seed, or
decoction of oatmeal or barley may be employed with equal advan-
tage ;  for they do not essentially differ, and the only preference i?
to be given to that which affords the largest proportion of mucilage.
  Formerly the winter cherry (physalis  Alkekengi, Linn.) was  in
much repute, and was supposed to  produce speedy relief.* It is
unquestionably sedative and  diuretic, and possesses these properties
without heating or irritating:  and seems to be worthy of farther
trial.  As a sedative, indeed, Hoffman employed it in haemoptysis;
and as a diuretic it has been still more generally  made use of in
dropsy.   About five or six cherries, or an ounce of the juice, forms
a dose;  the pericarp is bitter, yet the fruit within possesses but little
of this property, and has an  acidulous and not unpleasant taste.
  Camphor  has also been employed with great advantage for the
same purpose, and acts on the same  double principle  of being a
diuretic and a sedative.  It is often found to act in the same manner
when applied externally, and even when intermixed with the blister
plaster itself, as though in some constitutions it possesses a specific
influence over the bladder:  upon which  subject  Dr. Percival has
penned  the following  note  in his  Commentary to the  volume  of
* Manardus, Epirt. Libr. XIII. N. IS. 
308                      ECCRITICA.             (CL. VI.-OW. W

Nosology; " In three  instances blisters sprinkled with camphor
were repeatedly applied without strangury, and as uniformly, when
the camphor was omitted with the concurrence of that symptom.
I will not say that in all constitutions,  camphor will obviate stran-
gury ;  nor in all constitutions  will cantharides  without camphor
produce it."
  It will commonly be found useful, and sometimes absolutely ne-
cessary, in this variety, from whatever cause  produced, to employ
neutral aperients: and with them the means just recommended in
cases of cantharides will rarely fail to succeed in most other cases
If not, the practitioner should have recourse to a decisive dose of
opium.
  Strangury is also occasioned by a callous thickening of the
membrane of the urethra producing a permanent stricture.   Some
interesting examples of this may be seen in Dr.  Baillie's Plates of
Morbid Anatomy.*
  We  have already had occasion to observe that the most common
situation of a stricture  is in its  bulb or  the prostate gland that lies
immediately above,t though it may take place in any other part.  A
stricture of this kind "consists," says  Dr. Baillie, "of an approxi-
mation, for a short extent, of the sides of the canal to each other.
Sometimes there is a mere line of approximation, and not uncom-
monly  the sides of the urethra  approach to each other from some
considerable length, as, for instance, nearly an inch.  The surface
of the urethra at the stricture is often sound, but not unfrequently if;
is more or less  thickened."   It is this  thickening  which produces
the variety of strangury before us.  The sides of the urethra have
sometimes approximated so nearly by its increase that the stricture
will only allow a bristle to pass through it:  and hence ulcers are
occasionally formed in the prostate gland, and fistulae  in the  peri-
naeum: and the cavity of  the prostate is enlarged from distention,
in consequence of the  accumulation of urine behind the ulcer; of
all which Dr. Baillie has also given examples.
   When the prostate, or urethra, is highly irritable, palliation only
can be resorted to; but where the thickening  is recent, and there i?
little irritation, a skilful use of a bougie will sometimes afford tem-
porary relief; after which, by gradually employing those of larger
diameter, the stricture will often give  way and the canal widen so
as to allow the water to flow with considerable comfort.  I have at
this moment a  patient under my care, who was so grievously afflict-
ed with this variety of strangury about six years ago, from two dis-
tinct strictures, as never to make  water otherwise than by drops :
the smallest cat-gut bougie could with  difficulty be made to pass
through the thickened  parts ; and he was entirely debarred  from
going into company.   By gradually accustoming himself to bougies
of increasing diameter he can now bear  the introduction  of a
• Fascic. VIII. PI. IV. V.
f Vol. IV. Blenorrhcea luodes, p. 58. 
GE. Ill—SP. HI.]   EXCERNENT FUNCTION.
S09
moderately sized one with ease ; the water flows freely, though in
a small stream, and he is able to go into company and travel with-
out inconvenience.   He still finds it necessary, however, that the
bougie should occasionally be continued, and it is introduced into
the urethra every week or fortnight.
  In the variety which we have called mucous strangury, the urine
is intermixed with a secretion of acrimonious mucus, of a whitish or
greenish hue, which is frequently a sequel of gout, lues, orblennor-
rhcea.  It is often, however, produced by cold, and in this last case
forms the  catarrhus vesicae of various authors : so denominated from
its being conceived that the bladder and urethra are affected in the
same manner as the nostrils in a. coryza. The constriction therefore
depends upon an excoriated or irritable state of the urethra, or neck
of the  bladder.  And hence the warm-bath, or sitting in a bidet of
warm-water, is often of considerable service.  Warm and diluent
injections have also frequently been found, as well as diluent and
demulcent drinks, of great advantage.  If this  variety continue
long it is apt to produce an obstinate and very narrow structure, of
which  ulceration and fistulae in perinaeo are frequent results.
   Strangury is also sometimes accompanied with  a discharge of
worms of a  peculiar kind,  and  proceeds from the irritation they
excite.  Of  this we have various instances in the Ephemerides of
Natural Curiosities,* in some of which the worms were found in
the bladder  after death, and  in others discharged by the urethra
during life.  They are described as of different forms in different
cases,  sometimes resembling the larves of insects : sometimes  dis
tinctly cucurbitinous, of the fasciola,  fluke, or gourd kind.  Dr.
Barry  of Dublin has given us the case  of a solitary worm discharg-
ed by the urethra of a man aged fifty,  " above an  inch in length, of
the thickness of the smallest sort of eel, and not unlike it in shape,
ending in a sharp pointed tail."   It was dead, but did not seem to
have been dead long.  The  patient had for several years been in
the habit of  discharging urine mixed with blood, but unaccompani-
ed with pain either in the bladder or urethra. During the whole of
this time  he  had been feverish;  and  gradually lost his appetite,
found his strength decay, and had become turbid and hectic; from
all which he  speedily recovered as soon as this cause of irritation
was removed.t
   We have also an example of a like vermicule, highly gregarious,
and of much longer  dimensions  in an interesting  paper of Mr.
Lawrence, inserted in the second volume of the Medico-Chirurgi-
cal Transactions.  The patient was a female aged twenty-four, and
had long laboured under a severe  irritation of the bladder,  which
was ascribed to a calculus.   She at length discharged three or four
worms of  a  non-descript kind, and continued to discharge more
  • Dec. I. Ann. IX. X. Oba. 113.  Dec. II. Ann. I. Obs. 104. Ann. VI. Obs.
31. Dec. III. Ann. I. Obs. 82. Ann. II. Obs. 203.
  t Edin. Med. Ess. Vol. V. Part. II. Art. LXXII. p. 239 
310
ECCR1T1CA.
[CL. VI.—OR. 11.
 especially when their removal was  aided by injections into the
 bladder, or the catheter had remained in the urethra for the night.
 The evacuation of these animals continued for at least a twelve-
 month.  Twenty-two were once passed at a time ; and the whole
 number could not be less than from  eight hundred to a thousand.
 A  smaller  kind was occasionally  evacuated.   The larger were
 usually four to six inches in length; one of them  measured eight.
 For the most part they were discharged dead.
   The subject is obscure, but it may be observed that  the  ova of
 worms, and  even worms themselves, are occasionally found in many
 animal fluids, and have been especially detected in the blood-ves-
 sels, where they have been  hatched into grubs or vermicules, for
 the most part of an undecided  character; though some, observed in
 the mesenteric arteries of asses, have been referred to the  genus
 strongylus.*  Dr. Barry supposes his isolated worm to have travel-
 led in the form of an ovum as far as to the extremity of an exhaling
 artery opening into the bladder; to have found, in this place, apro-
  fier nidus and  nourishment for  the purpose of being hatched  into a
  arve or grub,  and of growing to the  size it had  assumed  when
 thrown out of the urethra;  and, in consequence of this progressive
 growth and the proportional dilatation of the vessel in which it was
 lodged, he accounts for the discharge of blood without pain.   If a
 worm reach the bladder alive and full of eggs, we have no difficulty
 in accounting for a succession of progenies.
   Strangury is  also sometimes  produced in consequence of the
 bladder or urethra, or both, being obstructed by the formation of a
 polypous excrescence,  which has occasionally shot down to the
 external extremity.
   Dr. Baillie's Morbid Anatomy furnishes several examples of this
 variety; which, in most  cases,  is only to be radically cured by an
 extirpation of the substance which produces the obstruction,! wher-
 ever it can be laid hold of.  When small, however, and in the form
 of caruncles, these  excrescences have sometimes separated spon-
 taneously, and been thrown out by the urethra with very great re-
 lief to the sufferer, and have  been followed by a perfect cure.J
  Upon this variety my venerable friend Dr. Percival has added
 the following note in his manuscript Commentary on the Nosology,
 from which the present work  has been so often enriched: " It might
 not be amiss  to insist on a case which sometimes  deceives young
 practitioners: ischuria cum stranguria. A copious draining of urine
 took place for several days in a patient with a swelled belly. Death
 supervening, the bladder was found distended to an enormous bulk,
 and  the parietes of the abdomen wasted.  Two excrescences near
the neck of the bladder internally had almost closed its outlet, and
 interfered with the action of  the sphincter."

               • Hodgson on the Diseases of Arteries.
               f Fascir. IX. P). HI.
               * Fabric. Hildan. Cent. IV. Obs. LIU.
                Art. Nat. Cur. Vol. I. Obs. Xllh 
CE. III.—SP. IV.]     EXCERNENT FUNCTION.
311
                      SPECIES  IV.

                 PARURIA  MELLITA.

                    Saccharine ©trine.

urine discharged freely, for the most part profusely; of a
  violet smell and sweet taste j  with great thirst, and ge-
  neral debility.

This is the diabetes, diabetes Anglicus, or diabetes mellitus of au-
thors ; from hetCvrvf, importing " a siphon," or rather from foxCxiia,
"transeo." Diabetes, among the Greek and Roman, and, indeed,
among modern physicians till the time of  Willis, imported  simply
a flux of urine, either crude or aqueous, for no distinction was made
between the two,  and both were named indifferently diabetes, dip-
sacus, from the accompanying thirst, urinary diarrhoea, urinal dropsy,
and  hyderus (ihpt)  or  water-flux.*  The writers among the an-
cients  who seem chiefly  to have noticed it are Galen, Aretaeus, and
Trallian ; and the reader who is desirous of knowing what they say,
and is not in possession  of the original authors, may turn  to Dr.
Latham's Treatise upon the disease,! who has translated the whole
with very great clearness and fidelity.  The form  of diabetes, to
which we are now directing^our attention, Galen describes as hav-
ing a  resemblance  to lientery, from  the rapidity with which the
solids and fluids of the  body seem to be  converted  into a  crude
and liquid mass, and hurried forward to the kidneys ; and to canine
appetite, from the voracity and thirst which are its peculiar  symp-
toms.   He  supposes a high degree of appetency  or irritation to
exist  in the substance of the kidneys, in consequence of which it
attracts the matter of urine with great  vehemence from  the vena
cava; and  an equal degree of atony and relaxation to exist  in its
orifices or pores, so that the same matter  flows  off unchanged  as
9oon as it reaches them.J
  This general view of the subject was adopted with a few additions*
by Aretaeus, and without any  by  Trallian ; and seems to have de-
scended with little variation, as we have just observed, till the time
of Willis,  who first called the attention of practitioners to the curi-
ous and important fact that the urine of diabetic patients, seemed
in many cases, to contain a saccharine principle.   These  cases,
however, were not, at that time, duly distinguished, and hence,  in
Sauvages, who was well acquainted with Willis's discovery, diabetes
  •  Galen, de Crisibus, Lib. I. Cap. XII.
  f Facts and Opinions concerning Diabetes, 8vo. 1811.
  $  De Loc. Affect. Lib. VI, Cap. iii. iv., compared with De Crisibus, Lib. I.
Cap. xii. 
 312                     ECCRITICA.             [CL. VI.—OK. H.

 signifies equally an immoderate  flux of urine from hysteria, gout,
 fever, spirituous potation, as well as urine  combined  with saccha-
 rine matter: though the only relation which the last has to the rest
 is that of its being usually secreted in a preternatural quantity : but
 as even this last quality, though mostly, is not always the case, it
 should be  distinguished by some other name than that of diabetes, .
 and form a distinct division : or, if the name of diabetes be applied
 to it, it should be given to it exclusively.   Dr. Young, who retains
 the. name in the latter sense, and employs it as that of a  genus, justly
 allows but one species to the genus, the diabetes millitus of Cullen,
 and describes the diabetes insipidus under the genus and species of
 hyperuresis aquosus.   There is great doubt whether this last ever
 exists  as an idiopathic affection.  Cullen himself,  indeed, candidly
 expresses the  uncertainty of his mind upon the subject:  " Almost
 all the cases of diabetes of late times," he observes, " exhibit saccha-
 rine urine, ita ut dubium sit, an alia diabetis idiopathicse etperma-
 nentis species revera detur."   If such be found it will probably be
 nothing more  than  a variety of the next species in  the present ar-
 rangement, paruria  incontinens :* while the honeyed  diabetes
 or saccharine  urine ought to be studied as a distinct affection.
  The pathology of this disease is still involved in  a  considerable
 degree of obscurity: for though anatomy has pointed out a  few
 morbid changes that exists more or less  extensively  in the urinary
 or digestive organs, and chemistry has sufficiently explained to us
 the morbid character of the discharge, they have thrown less light
 upon its origin than could be wished for, and  have hitherto led to
 no satisfactory  opinion  upon the subject.  Even the seat of the
 disorder is, to the present hour, a point of controversy;  and as its
 seat, together with the nature  of its  cause, can only be  collected
 from its symptoms, we will first  lay down its general  history, and
 afterwards glance at a few of the leading hypotheses  which have
 been started in respect to its pathology.
  Saccharine  or honeyed paruria is rarely, though  sometimes,!
 found in  early life, but is often a sequel to  a life of  intemperance,
 on which account it is occasionally connected with a morbid state
 of the liver.   It makes its approach insidiously, and often arises to
 a considerable degree, and exists for some weeks,  without  being
 particularly attended to.  If the urinary  symptoms take the lead, it
 is without the patient's noticing them, for the first morbid change
 he is sensible of is in the stomach.  At  this time, to  adopt  the
 description of  Dr. Latham, " It  is attended,  for the most part, with
 a very voracious appetite, and  with an  insatiable thirst; with a
 dry, harsh  skin; and clammy, not parched, but sometimes reddish
 tongue ; and with a frequent excretion  of very white saliva,  not
inspissated, but yet scarcely fluid.  As the  disease proceeds, it is
 accompanied often with a hay-like scent or  odour issuing from  the
• Spec.V.
t Latham's Facts and Opinions, p. 176. 
GE. HI—SP. IV.]     EXCERNENT FUNCTION.                313

body, with a similar sort of halitus exhaling from the lungs, and
with a state of mind dubious and forgetful: the patient being dis-
satisfied,  fretful, and distrusting, ever  anxious indeed for  relief,
but wavering and unsteady in the means advised for the purpose of
procuring it."*
  In  the  mean time the  kidneys discharge a fluid usually very
limpid and  large  in quantity, though  sometimes slightly  tinged
with green, like a diluted mixture of honey and water, and possess-
ing a  saccharine taste more or less powerful.  The pulse varies in
different  individuals, but, for  the most  part,  is quicker than in
health ; and not  unfrequently there is  a  sense of weight or even
acute pain in the loins occasionally spreading to the hypochondria,
a symptom which  Aretseus notices as one of the earliest  that  ap-
pears ; the uneasiness extending still lower, till, as ti e same  writer
remarks,  a  sympathetic smarting is felt at the extremity  of the
penis whenever the patient makes water*
  The  flesh wastes  rapidly;  and, as the emaciation advances,
** cramps,"  says Dr. Latham, "or spasms of the extremities some-
times supervene, the pulse is more quick and feeble, and the saliva
more glutinous."   And when the strength is almost exhausted in
a still more advanced stage of  the  disease, the  lower  extremities
often become edematous, and the skin cold and damp:  the diabetic
discharge is then frequently much diminished, and is  sometimes
even found to become more urinous for a few hours  before death
closes the distressing scene.
  A pulmonic  affection occasionally accompanies or precedes the
attack; Dr. Bardsley, indeed, affirms that he does  not recollect a
case that  was entirely free from this symptom.   And it is probably
on this account, as also from the feverish  state  of the pulse, which
by some writers has been supposed to partake of a hectic character,
that by M.M, Nicolas  and Gueudeville the disease has been deno-
minated Phthisurie sucreej  The state  of the bowels is extremely
variable,  though  there  is  commonly a troublesome costiveness;
sometimes, indeed, so much so, that the feces are peculiarly hard-
ened and  scybalous: which is well described by a patient of Dr.
Latham's, in a letter of consultation ; " the heat of my body," says
he, " I suppose arises from a most determined costiveness  that I
cannot find means to conquer, and which  occasions me great pain
and misery, frequently feeling an inclination without the ability of
discharging: and when, after  much difficulty, the excrement is
ejected, it has almost the solidity of lead.":}: In  a few instances the
disease seems to be connected with family predisposition.  Mr.
Storer has noticed  a case  of this kind  in his communication with
  • Facts and opinions concerning Diabetes, &c p. 1.
  f Ke"cherches et Experiences Medicates et Chimiques sur la Diabete sucree,
<ju la Phthisie sucrle 8vo. Paris, 1803.
  i Facts and Opinions, &c. p. 185.
  Voi. IV.—Rr 
J14
ECCKI11CA.
[CL. VI.—OR.H,
 Dr. Rollo;  and M. Isenflamm has given the history of seven chil-
 dren of the same parents who fell victims to it in succession.*
   The real  nature of the fluid evacuated has been very sufficiently
 determined both in our own country and on the continent, by chemists
 of the first authority, who have concurrently ascertainedthat, whilst
 it is destitute of its  proper  animal  salt, it is loaded with the new
 ingredient of saccharine matter.
   Dr.  Dobson, from a pound of urine collected an  ounce  of sac-
 charine substance ; and  Mr. Cruickshank, from thirty-six  ounces
 troy, obtained, in like manner, by evaporation, not less than three
 ounces and  a quarter: which, from the quantity discharged by the
 patient, would have amounted to  not less than twenty-nine  ounces
 every twenty-four hours.  Chevreul  has shown that by concentrat-
 ing this morbid urine and setting it  aside we may obtain a deposit
 of sugar in  a crystallized state.
   The absence of animal salts has been ascertained not less satis-
 factorily.   M.M. Nicolas and Gueudeville showed, by  a  series of
 experiments in 1802,  that the saccharineviirine contains  no urea,
 nor uric or benzoic acid ; that the phosphoric salts exist in  a  very
 small proportion: and that in consequence  of its sugar it will enter
into the vinous and acetous fermentation, and yield an alcohol of a
disagreeable odour.t   The same  results have since  been  obtained
by M.M. Dupuytren and Thenard by experiments still more satis-
factory.  They also  found an  albuminous  substance in the urine
which is always discharged in a sensible form when the  disease be-
gins to take a favourable change, and is the constant harbinger of a
return  of the proper animal salts ; for after having appeared for a
little while it gradually diminishes and yields its place to  the  urea
and uric acid.  In an excellent paper of Dr. Henry's, inserted  in
the Transactions of  the  Medico-Chiurgical  Society,^ he appears
to have arrived at many of the  same  conclusions though by a some-
 what different process.
   Dissection has also been had recourse to for collateral  informa-
 tion on this complicated malady: but its researches have been less
 successful than those  of  the  chemists.  The only  organ in  which
any morbid  structure  has been  clearly  ascertained is  the  kidneys.
 Mr. Cruickshank affirms generally that the arteries of the kidneys
are, on these occasions, preternaturally enlarged, particularly those
of the  cryptx or minute glands which  secrete the urine. "§   And
this state of inflammation or morbid activity is confirmed by Dr.
Baillie in his " Account of a  case of  diabetes, with an examination
of the  appearances after death,"|| in which he tells us  that "The
  * Versuct einiger practicher Anmerkungen iiber die Eingeweide, &c. Er-
lang, 1784.
  f Hecherches et Experiences, ut supra chat.
  i Transact, of Medico-Chhurg. Soc. Vol. X.
  § On the Lacteals and Lymphatics, p. 69.
  I! Transactions of a Society for the Improvement of Medical and Chirurgical
Knowledge, &c. 
GE. III.—SP. IV.)     EXCERNENT FUNCTION.
315
veins upon the surface were much fuller of blood than usual, put-
ting on an arborescent appearance.   When the substance of both
kidneys was cut into it was observed to be every where much more
crowded with  blood-vessels than in a natural  state, so as, in some
parts, to approach to the appearance of inflammation.   Both kid-
neys had the same degree of firmness to the touch as when healthy:
but I think were hardly so firm as kidneys usually are, the vessels
of which are so much  filled with blood.  It is difficult to  speak
very accurately about nice differences in  degrees of sensation un-
less  they can be brought into immediate comparison. Avery small
quantity of a whitish fluid, a good deal resembling pus, was squeez-
ed out from one or two infundibula in both kidneys, but there was
no appearance of ulceration in either.
  These premises, taken conjointly or separately, according to the
light in which  they may  be  viewed  by different persons, open  an
abundant field for speculation concerning the nature of the malady:
and  hence, an infinity of hypotheses have been offered, of which the
following are the chief:

  I. The disease is dependent upon a morbid action of the stomach,
or some of the chylifacient viscera,  which necessarily, therefore,
constitute its seat.
  II. The disease is dependent upon a dyscrasy orintemperament
of the blood, produced by a morbid action of the assimilating pow-
ers.
  III. The  disease is dependent upon a retrograde motion  of the
lacteals, and is consequently seated in the lacteal  vessels.
  IV. The disease is dependent upon a morbid condition of the
kidneys, and seated in these organs.

  I.  The first of these hypotheses,  though not the most ancient,
has been by far the most commonly received, and  is, perhaps, the
most prevalent in the present day. It is derived from observing the
increased action which exists in the stomach, and probably also in
the collatitious viscera, in conjunction with the  untempered fluid
which is discharged by the kidneys, whose morbid crasis is refer-
red to these organs.  But even here there has been much difficulty
in determining which of the digestive viscera is principally at fault.
Dr. Mead having remarked that the disease is frequently  to  be
traced amongst those who have lived intemperately, and particular-
ly who have indulged in an excess of spirits and other  fermented
liquors, ascribed it to the liver, and  the  idea was very generally
received in his day.  Dr. Rollo has since, and certainly with more
plausibility, fixed the seat of the disease in the stomach, and confin-
ed it to this organ: conceiving it to consist "in an increased action
and  secretion  with a vitiation of the gastric fluid, and probably too
active a state of the lacteal absorbents:—while  the kidneys, and
other parts of  the system, as the head and skin, are only affected
secondarily."
  According to this hypothesis the  blood is formed imperfectly 
81&
ECCRITICA.
[CL. VI.—OR. II.
from the first, and the morbid change of animal salts for sugar is the
work of the stomach or its auxiliary organs, which are immediately
influenced by it.   It is  a strong if not a fatal  objection to  this
view of the subject, that  the blood before it reaches the kidneys, is
found, upon the most accurate experiments to which it has hitherto
been submitted, " to  contain the salts of the blood, but no trace
whatever of sugar."  The  experiments 1 allude to  are those of
Dr.  \Yollaston,and Dr. Marcet, detailed in the Philosophical Trans-
actions.*   Prior experiments had, indeed, been  made  under the
superintendence of Dr. Rollo, which induced those engaged in them
to conjecture that some small portion of sugar might exist in the
blood ; but these trials led to no definite conclusion, and did not
sat'sfy the experimenters themselves.  The  results  of Wollaston
have since been confirmed by other experiments of Nicolas, Sorg,
Thenard, and Bostock.
   II. The second hypothesis, or that which regards the disease as
dependent upon a dyscrasy or intemperament of the blood, produc-
ed by a morbid action of  the assimilating powers, is of parallel date
with the preceding, and has had the successive support of many of
the ablest and most distinguished pathologists from its origin to our
pwn day.  It was first started by Dr. Willis and immediately fol-
lowed upon his discovery of the saccharine  property of diabetic
urine, who thus expresses his opinion of the seat and nature of the
disease, in his treatise upon this malady :—"  Diabetes is rather an
immediate affection of the blood than  of the kidneys, and thence de-
rives its origin ; for the mass of the  blood becomes,  so to speak,
melted down, and is too copiously dissolved intoastateof serosity:
which is sufficiently manifest from the prodigious increase of the
quantity of urine  which   cannot arise from any  other cause than
from this solution and waste of blood."  He admits, however, that
the orifices of the kidneys are at this time peculiarly relaxed  and
patulous, in consequence of which the untempered fluid passes off
with greater ease and rapidity.
  This hypothesis of Willis was readily embraced  by his  distin-
guished cotemporary  Sydenham, who fortified himself in the same
by observing, that those who have long laboured under an intermit-
tent, and have been unskilfully treated, and especially old persons,
sometimes fall into  a  diabetes, from a crude or debilitated condition
of the blood.  And hence he tells us in his letter to Dr. Brady, Re-
gius Professor of Physic in the University of Cambridge, that " the
curative indication must  be completely directed towards the invi-
gorating and strengthening  the  blood, as  well  as restraining the
preternatural flux of urine."
  Thus advanced and advocated by two of the brightest luminaries
that have ever enlightened the  medical world, it  cannot be a mat-
ter  of  surprise that this opinion should have been extensively
adopted.  In  truth it was espoused on the continent as well as at
• Vol. CI. 1811. p. 96. 
G£. III.—SP. IV.]     EXCERNENT FUNCTION.
317
 home, and, in  1784, gave birth to  M. Place's able dissertation at
 Gbrtingen :* and continued to be the prevailing opinion till the ap-
 pearance of Dr. Rollo'swork, to which we have just adverted; and
 even since the appearance  of this work, it has oeen still warmly
 and ably maintained by Dr. Latham, who, while  he pays all the
 homage to Dr. Rollo's labours  and abilities to which they are enti-
 tled, and scrupulously adopts the general principles of his practice,
 opposes his doctrine of a morbid condition of the stomach.t which!
 as well as the kidneys,t he believes to be perfectly  sound in its ac-
 tion. " I must take leave," says Dr. Latham, " to differ in opinion
 most materially from Dr. Rollo, who seems to  consider this most
 enormous appetite as such an evil in diabetes, as to endeavour, by
 every possible means, to repress  it, having founded  his theory
 principally on the idea that on this action of the stomach depends
 the evolution of sugar, with the whole train  of consequent symp-
 toms:  whereas, I consider the appetite, however great  it may be,
 and which I would never check by medicines, as a natural sensation!
 calling into its full exercise that organ through  which the constant
 waste of the body must be directly supplied, and without which the
 patient must soon inevitably perish : and I look upon the more mo-
 derate appetite which takes place usually in a few days after a strict
 conformity to animal diet,, as the surest sign of convalescence, in-
 asmuch as I hold it in proof that the blood being thereby rendered
 firmer in its crasis, there is  less disposition in  it to  be decomposed,
 and,  consequently, (as  is the fact) that there must  soon be a dimi-
 nished  discharge of  nutritious  matter from the kidneys."
   An opinion promulgated and maintained in  succession by autho-
 rities so high,  and names so deservedly dear  to the healing art,
 ought not to be lightly  called in question: but  it is as difficult to
 reconcile the present notion as the preceding with the existence of
 the ordinary salts and the  non-existence of sugar  in the blood of
 diabetic patients. Dr. Latham, however, has argued the point with
 great and elaborate ingenuity, and has endeavoured to  show, by a
 train  of reasoning which is  worthy of attention, that the sugar, in
 respect to its elements, may exist in the blood,  though the substance
 itself be not discoverable in it, being " so weakly and loosely oxyge-
 nated as to be again  readily evolved by the secretory action of the
 kidneys, not from any fault in the kidneys themselves, but from the
 regular and natural exercise of their function, in separating from
 the imperfect  blood such  matters as are not properly combined
 with it."§                                    v  v  j
  III.  \ bold and plausible  effort was made, between forty and fifty
years ago, to get rid of the stumbling-block of the absence of sugar
  • Dis. de Vera Diabetis caussa in defectu assimilationis quxrenda.  Goett
1784.
  f Facts and observations, &c. p. 230.
  * id. p. no.                                               %
  § Ut supra, p. 97. 
318
ECCRHTCA.
[CL. VI.—OR. If.
 from the blood by showing that, provided it were once  formed by
 the digestive organs, there is no necessity for its travelling in this
 direction. This hypothesis was brought forward  by that very acute
 and  ingenious  physiologist, Mr. Charles  Darwin, in  an essay pre-
 sented to the JEsculapian Society of Edinburgh, in 1778, that ob-
 tained from him an unanimous grant of the prize-medal for the year:
 an honour dearly earned, as almost immediately afterwards, he fell
 a martyr to  his indefatigable pursuits, while on  the verge of gra-
 duating.  In this essay he endeavoured to  account for  the disease
 of saccharine urine by a retrograde motion  of the lymphatics of the
 kidneys.  Having endeavoured to establish  the general principle of
 a retrograde  lymphatic action, he proceeds  to remark, that all the
 branches of the lymphatic system have  a  certain sympathy  with
 each other, insomucii that when one branch is  stimulated into any
 unusual motion, some other branch has its motions either increased,
 or decreased, or  inverted, at  the  same time: thus,  when  a  man
 drinks a moderate quantity  of vinous spirit, the  whole system acts
 with more energy by concert with  the stomach  and  intestines, as
 is  seen from the glow on  the skin, and the increase of strength
 and activity: but when, says he, a greater  quantity of this inebri-
 ating material is drunk, at the same time that the  lacteals are quick-
 ened  in their power of absorbing  it, the urinary branches of the
 absorbents which  are connected with the  lacteals by many anasto-
 moses, have  their motions inverted, and a large  quantity of pale,
 unanimalized urine is hereby discharged.  Where, continues Mr.
 Darwin, this ingurgitation of too much vinous  spirit  occurs often,
 the urinary branches of absorbents at length gain a habit of invert-
 ing their motions whenever the lacteals are much stimulated :  and
 the whole or a great part of the chyle,  is thus carried to the blad-
 der without  entering  the circulation, and the body becomes ema-
 ciated :  while the urine is necessarily  sweet and of the colour of
 whey.  And  on this account Mr. Darwin proposed to denominate
 the species before us a chyliferous  diabetes.
  This hypothesis, for, ingenious as it is,  it has never been entitled
 to a  higher character, became at one time  also very popular, and
 was supported by the talents of the celebrated author of Zoonomia,
 the father of  its ingenious inventor.   A few singular facts which
 have  occurred  since the decease of both these  writers, seem  at
 first  sight to give  it a little colourable support:  such as the rapid
 passage of certain substances from the stomach to the bladder ap-
 parently, according to the experiments of Dr. Wollaston and Dr.
 Marcet, without their taking the course of the circulation:  and M.
 Magendie's experiments upon the lymphatic system, and the doctrine
 he has founded upon them.   These,  however,  the author  has  ex-
 amined with some attention in the  I hysiological Proem to the pre-
 sent  Class, and has endeavoured to reconcile them with the ascer-
 tained and admitted structure and laws of the animal frame: so that
they can add but  little to the speculation before us  And in truth,
how much soever it  may have  been caught up hastily  by  men  of 
GE. III.—SP. IV.]    EXCERNENT FUNCTION.                319

warm imagination, or those who are fond of novelty, the  soberer
physiologists have never been made converts to it.  " In the dia-
betes," says Mr. Cruickshank,  "it has been supposed that the chyle
flows retrograde from the thoracic duct into the lymphatics of th©
kidney, from them into the cryptae, so into the tubuli uriniferi, thence
into the infundibula, pelvis, ureter, and so into the bladder.  This
opinion is mere supposition, depending on no experiments.  And,
besides that all such opinions should be rejected, why should  the
chyle flow retrograde into the lymphatics of the kidney and not in
the lacteals themselves ? and why are not the feces fraught with a
similar fluid as well  as the urine ? the arteries of  the kidneys are,
on these  occasions, preternaturally enlarged, particularly those of
the cryptae or minute glands which secrete the urine.   And it is
in nitely more probable that the fluid of the diabetes arises from
some remarkable change in the vessels usually secreting the urine,
than from any imaginary  retrograde  motion of the chyle  through
the lymphatics of the kidneys."*  Even Dr.  Wollaston prefers a
state  of  doubt concerning the course pursued  by the above-men-
tioned substances to an adoption of this conjecture, notwithstanding
the ready solution it offers to his  experiments  " With respect,"
says he,  "to Dr. Darwin's conception of a retrograde action of the
absorbents, it is so strongly opposed by the known structure of that
system of vessels, that I believe few persons will admit it to be in
any degree probable."!
   IV.  We come now to the fourth hypothesis to which the disease
before us has given rise, and which places it in the kidneys.  These
form, indeed, the most ostensible  seat, and  hence, as  we have  al-
ready seen, they were the  first suspected, and  were  supposed  by
the Greek writers to be in  a state of great relaxation  and debility,
and hence also of great irritability.  To this irritability was ascrib-
ed their morbid .activity, and the accumulation of blood with which
they were overloaded : while their weakened and relaxed condition
allowed the serous  or more  liquid parts of  the blood  to  pass  off
through the patulous mouths of the excretories without  restraint
or change, and consequently,  in  a  crude and  inelaborated form,
like the food in a lientery.
   Such was the explanation of Galen:  and of all  the hypotheses
before us there is no one  that  seems to  be  so fully confirmed, as
well by the symptoms of the disease during its progress, as by the
appearances it offers upon dissection.  The anatomists have hence
generally adopted this  opinion,  which  is to  be found in  Bonet.J
Ruysch§ and  Cruickshank ;|| and  in proof that it has of late been
gaining additional ground among physicians and medical practition-
• On the Lacteals and Lvmpatics, p. 69.
t Phil. Trans ut supra. 1811. p. 105.
* Sepulchr. Lib. III. Sect XXVI. Obs. I.
§ Observ. Anat. Chir. N. 13.
!! On the Lacteals and Lymphatic  p. 69 
620
ECCKITICA.
[CL. VI.—OR. II
 ers in general, as well on the Continent as in our own cou- try, it
 may be sufficient to refer to the writings of Richter, the  works of
 M.M. Nicolas and Gueudeville,  and M.M.  Dupuytren and  The-
 nard, already quoted from,  and the communications of Mr.  Watt,
 Dr. Henry, and  still more lately, of  Dr. Satterly; several of
 whom, however, conceive the stomach  or  some other chylifactive
 organ to be affected at the  same time  secondarily or sympatheti-
 cally.
   By far the greater number of these writers regard the irritation
 of the  kidneys as  connected with inflammation :  though several of
 them ascribe it to a spasm.   They  seem to reason from  the pain
 found occasionally in the region of the loins, and the limpidity and
 enormous quantity of the fluid that is  discharged, which in  their
 opinion is analogous to that evacuated in hysteria or  hypochondri-
 as ; such was the opinion of Camerarius upwards of a century ago,*
 and of Richter and Gueudeville in our own day: "la phthisune,"
 says the  last,  for  under  this name  he  describes saccharine urine,
 "est une consomption entretenue per une  deviation  spasmodique
 et continuelle des sues nutritifs non animalises  sur  l'organe uri-
 naire."t
   There seems after all but little to support this doctrine, and yet
 it was adopted by  Cullen, and that  so completely as to induce him
 to arrange diabetes in his Class Neuroses, and Order Spasmi, im-
 mediately before hysteria, and hydrophobia.   His reason for doing so
 is- contained in the following passage in his First Lines : " As hard-
 ly any secretion can be increased without  an increased action of
 the vessels concerned in it,  and as some instances of this disease
 are attended with affections  manifestly spasmodic, I have had no
 doubt of arranging the diabetes under the order of spasmi."J  A
 more unsatisfactory reason  has, perhaps, never  been offered, nor
 does the  author himself seem satisfied  with it, for we find him,
 shortly afterwards, not indeed, like M. Gueudeville, uniting it with
 another cause to give it potency, but abandoning it for this auxiliary
 cause, which seems to be adopted exclusively: for he adds within a
 few aphorisms, " I think  it probable that, in most cases, the  proxi«
 mate cause is some fault  in the assimilatory powers, or  those em-
 ployed in converting alimentary matter into the  proper animal
 Buids."§
  But admitting the kidneys to be in a morbid and highly irritable
 state, which is the oldest, and apparently the best  supported doc-
 trine upon the subject, and that this state is connected with an in-
flammatory action of a peculiar kind, what necessity  is there for
 supposing an idiopathic  affection of any other  part, whether the
stomach or the nerves, the chylifacient or the assimilating powers ?
And why may not every other derangement that marks the progress

  *  Diss, de Diabete Hypochondriacorum periodico, Tuli. 1696.
  f Recherches et Experiences Medicates, &c. 8vo. Paris, 1803.
  * Pract. of Phys. Aph. MDrV.
  § Pract. Phys. Aph. MDXII. 
GE. HI.—SP. IV.]    EXCERNENT FUNCTION.
321
of the disease be regarded as consequent upon the renal mischief?
I ask the question with all the deference that is due to the distin-
guished authorities that have passed in review before us, the value
of whose writings, and the extent of whose talents no man is more
sensible of than myself: but I ask it also, after having studiously at-
tended to the nature of these derangements both in theory and in
all the practice which has fallen to my own lot, and with a strong
disposition to believe that the whole can be traced and resolved in-
to this single and original source, and  consequently that diabetes
is a far less complicated  disease than has hitherto been imagined.
  That an  inordinate excitement of the kidneys is capable of aug-
menting the urinary  secretion,  whatever be the cause of such ex-
citement, is obvious to  every one who has attended to the stimulant
effects of spirits drunk to excess, hysteria, and several other irregu-
lar actions of the nervous system, and the whole tribe of diuretics.
  In all  these cases, however, the excitement is only secondary,
and follows upon a previous affection of some other organ or part
of the system.   But in the disease before us, we are contemplating
a primary excitement,  a morbid action originating and seated in the
kidneys themselves.   And  surely when we reflect upon the pro-
digious quantity of serum the excretories of the cellular membrane
are capable of separating and carrying off from the blood in cellular
dropsy, and those of the more limited  range  of the pleura  or the
peritoneum, in dropsy  of the chest or of the belly, there can be no
difficulty in conceiving that the emunctory of the kidneys, whose
function, when in health consists in eliminating a very large portion
of the more attenuate parts of the blood, should, when in astate of
morbid and increased action, be capable of secreting quite as pro-
digious an  excess of fluid as is found secreted  in any kind of dropsy
whatever.   And hence, from a  morbid irritation of the kidneys
alone, we may, I think, satisfactorily account for the largest quantity
of water that is ever discharged  in  the disease before us, and see
with what peculiar force it was denominated  by the Greeks, hvde-
kus (ufopos,) or water-flux, as also hydrops matellaeorurinal dkopsy.
  This analogy will be still more obvious fr.om our following up
the common forms of  dropsy to their ordinary  consequences, and
comparing them with the consequences of diabetes. As the watery
parts of  the blood in cellular or abdominal dropsy are drawn off
with great rapidity and profusion  to a single organ, every other
organ becomes necessarily desiccated and  exhausted ; the  skin is
harsh and dry, the muscles lean and rigid, the blood-vessels collaps-
ed, the bowels costive, and the adipose cells emptied of their oil.
Every part of the  system is faint, and languishes  for a supply, and
hence that intolerable  thirst which oppresses the fauces and  sto-
mach, and urges them by an increased  action to satisfy the general
demand.   This is a  necessary effect of so  profuse a  depletion, be
the cause what it  may: and we have reason, therefore, to augur a
priori that  such an  effect must follow in this  form of the Greek
hyderus, or water-flux. That it does follow we have already seen;
 v Voi. IV.—S s 
322
ECCRITICA.
[CL. VI—OR. 11.
and we are hence led almost insensibly to adopt, in its fullest lati-
tude, the correct doctrine of Dr. Latham, that "the increased ap
petite in this last  disease, however great it may be, is a natural
sensation,  calling into its full exercise that organ through  which
the constant waste of the body must be directly supplied, and with-
out which  the patient must soon inevitably perish."*
   From a morbid excitement then, a weak and irritable inflamma-
tion, if I may be allowed the expression, of the kidneys alone, we
are able to account, not only for all the local symptoms of an enor-
mous flux of water, lumbar, or hypochondriac pains, and occasion-
ally fulness, and the post-orbit appearances of distended or "preter-
naturally  enlarged  arteries," as observed  by  Mr. Cruickshank,
" blood-vessels more crowded than in  a natural state, so as in some
parts to approach to the  appearance of inflammation," as observed
by Dr.  Baillie, "ossified arteries," as observed by Mr. Gooch, and
" a glutinous infarction of the parenchyma of the kidneys,"  as ob-
served  in  other cases by Plenciz ;t but also for the constitutional
symptoms  of a dry, harsh, and heated skin, general emaciation, and
sense of exhaustion, depression of animal spirits, great thirst and
voracious appetite. In dropsy, indeed, the appetite is not uniformly
voracious,  nor is it always so  in diabetes: but that inanition  of al-
most every kind has a tendency to produce this system, where the
tone of the stomach is not interfered with or has re-established it-
self, is  manifest from its occurring so commonly after severe fa-
tigue, long fasting, protracted fever, or any other exhausting state
of body.  And hence the very existence of the symptom in diabetes
is a direct proof that the action of the stomach, instead  of  being
morbid, is  perfectly sound, though inordinately excited.
   But the  grand question, it may, perhaps, be said, still remains
untouched.  How are we to account for that crude, fused, or dis-
solved state of the blood, which  appears  so conspicuously in dia-
betes, and  which reduces it from an animalized to a vegetable era-
sis? Now upon this point, let us fairly put to ourselves this previ-
ous question : Does such a state of the blood appear at all ? and is
it in fact reduced or changed in any respect from its anamalized
character antecedently to its arrival at the morbid organ of the kid-
neys?  So far as we have been able to obtain information from che-
mical experiments, the blood of a diabetic patient continues in full
possession  of its anamalized qualities,  and evinces no approach to-
wards those of vegetable fluids:  and so far as we can judge from its
being drawn from the arm during life, instead of evincing a thin, dis-
solved,  and colourless state, it discovers that very condition which
we should anticipate as a natural consequence of a very copious ab-
straction of its serous or  more liquid, principles.  For we are told,
without a dissentient voice, by those who  have drawn blood freely
and repeatedly during the disease, that it has the general appear-
* Practical treatise, 8cc. I. p. 417.
t Acta et Observations Med. p. 153. 
,GE. III.—SP. IV.]
EXCERNENT FUNCTION.
323
ance of the treacle; thicker than natural from the drain of its finer
parts, and darker from a closer approximation of its red corpuscles;
little capable of coagulability from its loss of coagulable lymph, and
hence not separating by rest into a proper scrum and crassament.
And we are  told farther that  wherever venesection has been ser-
viceable, and the renal flux has  diminished, the latter instantly
assumes a greater disposition to coagulate, and loses the darkness
of its hue.
  The grand reason, after all, for supposing that this change from
an animalized to a vegetable, or rather from an uric to an oxalic
character, takes place in the blood itself, is from the difficulty of
conceiving how it can take place in the kidneys: the difficulty of
explaining how an organ whose common function is to secern alka-
lies, and an acid strictly animal, should be brought to secern an acid
directly vegetable.  But,  in the first place,  is the difficulty one
which is diminished by  transferring this wonderful change of action
to the assimilating powers, or to the stomach, or to any other organ ?
For let us lay the fault wherever we will, we are still involved  in
the dilemma of supposing, that an animal structure whose healthy
function consists in  the formation of ammonia, has its action  so
perverted by the disease before us, as to produce sugar in its stead.
And hence, by enlisting the assimilating powers into service upon
the present occasion, we only gain two  levers instead of one.  We
place the globe upon the elephant instead of upon the tortoise, but
we have still to inquire what it is that supports the latter.
  There are, however,  if I mistake  not, various pathological and
physiological facts perpetually occurring before your eyes, which if
properly applied, may at least reconcile us to this supposed anomaly,
if they do not explain its nature: a very few of which I will briefly
advert to.
  We  see a tendency in most animal organs to produce sugar un-
der particular  circumstances,  whatever be  the character of their
ordinary secretion; and this both in cases of health, where we have
no ground for supposing an imperfectly animalized fluid; and  in
cases of disease where such a change may perhaps be contended for
and supported : and we  see this also, and equally, under an animal
and under a vegetable  diet; in some instances, indeed,  most  so
where the former predominates.  No one, if he did not know the
fact, would predict that  the breast of a healthy woman, which forms
no sugar at any other time, would become  a saccharine fountain
immediately after child-birth: and  still less so that an animal diet,
or a mixed  diet of animal and vegetable food, would  produce a
larger abundance than a vegetable diet alone : and least  of all, that
woman's milk produced by animal food would yield more sugar in
a given quantity than ass's, goat's, sheep's, or cow's; and less case-
ous matter than any of these quadrupeds,*  though  this last is the

  • Experimens des M. M.  Stirpriaan, Liviscius, et De Bondt, in  Mem. de la
Socicte de Med. a Paris. 1788. 
324                      ECCRITICA.           [CL.VI.—OR. II..

only matter of a strictly animalized quality which milk of any kind
Contains.
  This, however, is a natural process.  Yet under the action of a
morbid  influence sugar is  often  produced in other  organs,  while
what should be sugar in the mammae is changed to some other sub-
stance.   Under the  genus Ptyalismus, we have observed, that  the
saliva is sometimes so  impregnated with  a saccharine principle as
to acquire the name of p.  mellitus:* it is indeed by some  authors
represented as  having the sweetness of honey.  Pus,  under various
circumstances,  evinces a sweetish taste, and  hence the occasional
sweetness of the sputum in consumptive  patients.   So in fevers of
various  kinds, as we have already had several occasions to observe,
and particularly in hectic  fever, the sweat throws forth a vapour
strongly impregnated with  acetous acid.   Even the ceramen some-
times both smells and tastes sweet; a fact noticed  by Hippocrates,
who at the same time remarks that it is a fatal symptom.
  As an animal product it might be reasonable to expect that  the
gastric juice would be alkaline,  and it is so in some animals :  yet
those who have  paid but little attention to animal chemistry will
be surprised to learn that while it is for the most part neutral in ani-
mals that feed jointly on flesh and vegetables, it is alkaline in  rumi-
nating and graminivorous animals, or those that feed on grass, and
acid in carnivorous animals, as the falcon, hawk and heron. Upon
which poinfs the experiments of Brugnatelli,t coincide with those
of Carminati and Macquart.
  It is unnecessary to  pursue these illustrations any further. Can-
didly reflected  upon they cannot  fail, I think, to diminish in a con-
siderable degree, the repugnance which the mind  at first feels in
admitting a secretion of su^ar by  an organ, whose common function
is so inaccordant with  such a production : and consequently they
co-operate in leading us to the conclusion which  it has been  the
design of these remarks to arrive at, that paruria mellita, or diabetes,
is a disease seated in the kidneys alone, and dependent upon a  pe-
culiar irritability or inflammation of the renal organ.
  Of the predisposing or occasional causes of this this disease, how-
ever, we are still involved inconsiderable darkness; with the excep-
tion that whate\er debilitates the system seems at  times to become
a predisponent, and only requires some  peculiar local excitement
to give birth to the disease, without which it is in vain to expect that
it should take place.  Hence it occurs to us, in some instances, as
a consequence of old age, in others of a  constitution broken down
by intemperance or other illicit gratifications; in others again of a
diseased liver,  or diseased lungs,J of atonic  gout, or suppressed
eruptions; ami particularly of chronic carbuncles, or ill-conditioned
  * Vol. 1. p. 55.
  f Saggio d'un Analisa Chcmica di Succi gastrici.
   Vide Crell, Heitrag zu dem Chem. Annal. 1787.
  $ See Case in Latham's Tracts, &c. p. 142, as also the remarks already quot.
ed from Dr. Bardsley. 
GE. HI.—SP IV.]     EXCERNENT FUNCTION.                325

sores approaching to their  nature, and showing like  themselves  a
considerable degree of constitutional debility.
  I am greatly obliged to Dr. Latham for calling my attention to
this last fact while drawing up the present  history of the  disease,
and for referring me in support of his own opinion upon this sub-
ject to the following passage  in Cheselden: "There is sometimes
a large kind of boil or  carbuncle in  the  membrane,  which first
makes a large  slough  and a number of small holes through  the
skin,  which in time mortifies and casts off, but the longer the slough
is suffered to remain the more it discharges, and the more advan-
tage to the patient:  at the latter end of which case the matter has
a bloody  tincture, and a bilious smell, exactly like what comes
from  ulcers in the liver ; and both these cases are attended  with
SWEET URINE as in DIABETES."*
  In  concurrence with this remark of Cheselden, Dr.  Latham in-
forms me in a letter as follows : " I have a patient at this moment,
whose diabetes was  first observed after a  long  confinement  from
carbuncle : he is upwards o.  seventy, and is moreover afflicted  ith
a mucous discharge  from the internal coats of the bladder "  Not
dissimilar to which, is the  following case, which is well worthy  of
notice, and occurs among the earliest, in Dr. Latham's treatise on
this disease.  " About the year 1789 there was a most remarkable
,case  of diabetes in  St. Bartholomew's hospital, under the imme-
diate  care of the late greatly to be lamented Dr. David Pitcairn.
The patient's history of  himself was this: that a rat  had bitten him
between the finger and thumb, that his  arm had swelled violently,
and that boils and abscesses  had formed, not only in that arm but in
other parts of the body : that his health from that time had decay-
ed, and emaciation followed. His urine had then the true diabetic
character both  in quantity and quality : the saccharine part was  in
very  great proportion, constantly oozing through the common earth-
en pot over the glazing, and affording an infinity of pure saccha-
rine crystals, adhering like hoar-frost to the outside  of the utensil,
and which were  collected by myself and  by every  medical pupil
daily, in great abundance."t
   How far the grand agent  in this change of renal  action, admit-
ting the disease to be seated in the kidneys, is to be ascribed to a
 change in the quality or intensity of the nervous power transmitted
to it, or, as the chemists call it, in the state of the animal electri-
 city of the organ, to which power Dr. Wollaston has referred the
 production and distinction of all the secretions, 1 am not prepared  to
 say: but the subject ought not to be concluded without noticing this
 conjecture, which at the same time imports, on the part  of those
 who  hold it, an admission of the general  principle of the disease
 which I have endeavoured to support.  " Since," says Dr. Wollas-
 ton,  " we have become  acquainted with the surprising chemical
" Anatomy, 8vo. p. 139.
f Facts and opinions, p. 134. 
 326                      ECCRITICA.           [CL. VI.—OR. Ii.

 effect  of the lowest state of  electricity, I  have been inclined to
 hope that we  might from that source derive  some explanation of
 such phenomena.  But though I have referred secretion in general
 to the  agency of the electric power with which  the nerves appear
 to be induced, and am thereby reconciled to the secretion of acid urine
from blood that is known to be alkaline, which, before that time,
 seemed highly paradoxical, and although the  transfer of the prus-
 siate of potash, of  sugar, or of other substances  may equally be ef-
 fected by the same power as acting cause, still the channel through
 which  they are conveye'd remains to be discovered by direct expe-
 riment."*
   While such  is the diversity of opinions  which  have been  held
 concerning the pathology of honeyed paruria it cannot be a matter
 of much surprise that the proposed plans of treatment should also
 exhibit a very great discrepancy.
   On a first glance, indeed, and without keeping the grounds of
 these distinct opinions in view, nothing can be more discordant or
 chaotic than the remedial process proposed by  different individuals.
 Tonics, cardiacs, astringents, and the fullest indulgence of the vora-
 cious appetite  in meals of animal food, with  a total prohibition of
 vegetable nutriment on the one side, and emetics,  diaphoretics,
 and venesections to deliquium, and  again and again repeated, on
 the  other: while  opium in  large doses takes a middle 'stand, as
 though equally offering a truce to the patient  and  the practitioner.
   It is easy,  however,  to redeem the therapeusia of the present
 day from the charge of inconsistency  and  confusion, to  which at
 first sight it may possibly lie open.   Different views of the disease
 have led to different intentions : but so long as their intentions have
 been clearly adhered to, how  much  soever  they may vary in their
 respective courses, they are free from the imputation of absurdity.
 These intentions have been chiefly the following:
   I. To invigorate the debilitated organs whether  local or general,
 and to give firmness and coagulability to the blood.
   This was the object of all the Greek physicians, and it regulated
 the  practice  to a Very late period  in the history of the  disease.
 " The vital intention," says Dr. Willis, " is performed by an incras-
 sating and moderately cooling diet; by refreshing cordials, and by
 proper and seasonable hypnotics."  Hence agglutinants of all kinds
 were called into use, as tragacanth, gum arabic, and the albumen of
 eggs ;  and these were united with astringents, as rhubarb, cinnamon,
 and lime-water, with or without an anodyne draught at evening as
 might be thought prudent. Sydenham carried  the tonic and cardiac
 part of this plan considerably further than Willis :  for while the lat-
 ter  chiefly limited his patients to milk or a farinaceous diet, the for-
 mer allowed them  an animal  diet, with  a vinous beverage.  " Let
 the patient," says he,J" eat food of easy digestion, such as veal, mut-
• Phil. Trans. 1811. p. 105. 
GE. III.—SP. IV.]    EXCERNENT FUNCTION.                 32:

ton, and the like, and abstain from all sorts of fruit and garden-stuff,
and at all his meals drink Spanish wine."
  This plan continued in force with  little variation, except as to
the proportionate allowance of animal and vegetable food, till with-
in the last thirty years.  The chief tonic medicines being the warm
gums, or resins, astringents and bitters.  Alum and alum-whey ap-
pear to have been in particular estimation with most practitioners.
They  were especially recommended by Dr. Dover and Dr. Brock-
lesby in our own country, and Dr. Herz* on  the Continent.  Dr.
Brisbane and Dr. Oostendyk,t on the contrary, assert, that in their
hands they were of no use whatever.   Sir Clifton Wintringham ap-
plied alum dissolved in vinegar, as a lotion, to  the loins.  The other
astringents that have been chiefly had recourse  to are  lin.e-water,
as noticed already, chalybeate waters, kino and catechu in tincture,
powder, and decoction; none of which, however, seem to have
been eminently serviceable.   While  cantharides, as a local astrin-
gent,  has been exposed to a very extensive range of experiment
both at home and abroad.  Dr. Morgan gave  it in the tincture, Dr.
Herz in the form of powder, and both esteemed it  salutary.  Dr.
Bribsane tried it in the first of  these ways, giving from twenty to
thirty drops twice a-day : but appears to have been as dissatisfied
with cantharides as with alum, and declares that all astringents are
hurtful, as Amatus Lusitanusi  asserted long  before, that  they are
of no use.
   II. A second intention of pathologists, in the present  disease, has
been that of adding to the deficient animal salts, and resisting the
secretion of sugar, by confining the patient to a course of diet and
medicines calculated to yield the former, and to counteract the lat-
ter.
   This intention  may have been  indirectly acted upon  by some
part of the process  we have just noticed, and  particularly by the
dietetic plan of Sydenham: but it is to Dr. Rollo that the medical
world is immediately indebted for its full illustration, and the means
of carrying it directly into effect, which consists in  enforcing upon
the patient an entire abstinence  from every species of vegetable
matter, and  consequently limiting  him to a  diet of animal food
alone : some form of hepatized ammonia being employed as an auxi-
liary in the  mean time.   Narcotics, as under the preceding inten-
tion, are also occasionally prescribed by Dr. Rollo : and, in accord-
ance with his doctrine that the  stomach is the chief seat of morbid
action, and that  the thirst and  voracity are indications of such
action, the aid of an emetic is occasionally called in to allay the
high-wrought excitement.
   From this last part of Dr. Rollo's curative method Dr. Latham
appears to dissent upon the ground, and in the present author's opi-

      • Sell Neuc Beitrage. I. 124.
      f Samml. auserl. Abhandl. fur. Pract. aerzte. 13. T. 179.
      i Cent. V. Cur. 33. 
328
ECCRIT1CA.
[CL. VI.—Oil. II
 nion a correct ground, that the increased action of the stomach pro-
 ceeds from a sound instead of from a morbid appetency : but to the
 injunction of an exclusive use of animal f.od, and a total abstinence
 from fermented and  fermentable liquors, he  accedes, with a  lull
 conviction of its importance, and without permitting the* smallest
 deviation.  And as Dr. Rollo, with a view of completing the inten-
 tion of supplying the readiest means for a recruit of the deficient
 animal salts, prescribed  hepatized  ammonia as an  auxiliary, Dr.
 Latham for the  same purpose, prescribes phosphoric acid,  having
 observed in various cases of the disease an evident deficiency in the
 supply of phosphate of lime ; whence, indeed, the destruction  that
 is occasionally met with  of the fangs  of the  teeth  together with
 their alveolar processes.
   Some severe remarks,  which I am at  a loss to account for, have
 occasionally  been thrown upon  this last  recommendation since
 the publication of Dr. Latham's very candid and ingenious  work.
 The idea is in perfect accordance  with his own view of the gene-
 ral nature of the disease : and, in  every view of it,  is  more likely
 to be of service, than Dr. Rollo's hepatized ammonia, or, perhaps,
 than alkalies of any kind.  For while, like the last, it has been sug-
 gested  upon the principles of supplying to the kidneys the deficient
 materials upon which they are to work, it has a  claim to attention
 as a very valuable tonic  and  astringent, even by those  who may
 abjure this principle as incorrect, and particularly by the advocates
 for the mineral acids.  1 ought not indeed, while upon this subject,
 to conceal  the following  paragraph of a letter in direct allusion to
 it, addressed to me by Dr. Latham, so lately as May 26 of the cur-
 rent year, in which he communicates with much candour, his pre-
 sent opinion upon  the general line of practice he thus undertook to
recommend to the public, little less than twelve years ago.   " The
 experience," says he, " which 1 have had in diabetes  since the pub-
 lication of my observations on that disease, does not  excite, in any
degree, a wish to alter the opinions which I  had then formed con-
 cerning it: and  I  am more and more convinced that although my
theory may be wrong, the practice has been successful.   As  to the
theory about the phosphoric acid, I cannot help thinking that there
is more in it than I ever suspected ; be that however as it may, 1
 urge my patients to persevere in its use, and am certain that it may
 do something more than produce a mitigation of the thirst,  which
 circumstance of itself would be sufficient to  maintain it as a reme-
 dy even if it went no further in effecting a cure."
   III.  Some of the indications of the disease, however, have given
 rise to a much bolder intention.  We have already seen that, from
 a few of its symptoms, and the appearances discoverable on dissec-
 tion, there is reason to  apprehend  an irritable and  inflammatory
 state of the kidneys;  and it has hence been attempted to cut short
 the complaint, and, so to speak, to strangle  this condition  at  its
 birth, by copious and repeated bleedings.   Le  Fevre appears to
 have adopted and acted upon this principle almost as early as the 
C.E. III.-/-SP.IV.}
EXCERNENT FUNCTION.
329
beginning of the preceding century:* but he does not seem to have
obtained any considerable number of converts to his opinion; and
it is to Dr. Watt of Glasgow that we are principally indebted for
whatever advantages may have resulted from  this mode of practice
in our own day; and particularly for trusting  to it mainly or exclu-
sively, and carrying it to a very formidable extent.  The plan pur-
sued by Dr. Watt,  has since been pursued by Dr. Satterley, and
the  success obtained by the former has apparently been more than
equalled by the latter, in the course  of various trials, of which a
very interesting account is detailed in  a late volume of the Medical
Transactions.!  These trials embrace four distinct cases, the first
of which  is given  most at length.   The  patient was thirty-two
years of age : and had been in a state of  progressive debility for
nearly six months, brought on in the  first instance, as  was appre-
hended, by his  having drunk copiously of  cold water when over-
heated.  He fell under Dr. Satterley's  care in  consequence of being
taken to the Middlesex  Hospital; the  symptoms  were strongly
marked, and the disease unequivocal: the pulse was quick, small,
and  hard.  Fourteen ounces  of blood were taken from the arm  on
the day after his  admission, which was Feb. 19, 1808 :  he was put
upon a  meat diet, with an allowance of drink sufficient to allay,
though not to satiate, his distressing thirst. The abstraction of blood
appearing to afford  relief, eighteen ounces more were taken from
him  the next day, the 20th; twenty ounces more on  the  23d ; the
same quantity on  the 25th; and eighteen ounces successively on the
28th, on March the  3d, and March  11th : making a total  of a hun-
dred and twenty-six ounc.es in twenty days. On the day and night
of admission, he  had evacuated  sixteen quarts  of urine ; after the
first use of the lancet, the quantity was reduced to eleven  quarts in
twenty-four hours ; after the  second, to six quarts; after  the third
it varied from five to seven quarts; after the fourth, it stood at six;
after the fifth, it  varied from five to  six ;  after the  sixth, it sunk
below five; and at the time of the seventh,  was calculated at three,
and had sometimes  been not more than two: at which time his mor-
bid  thirst had entirely left him, he was in tolerably good health, and
increased in strength and size.   In consequence of some pneumo-
nic  symptoms,  he was afterwards blooded  once or twice, and de-
tained in the hospital for a long period of time, though the term is
not stated.  He was, however, at length discharged cured, and was
found several years afterwards to have kept free from any return
of the complaint.
  The regimen  and accompanying course of medicines are not very
accurately stated. He seems to have been  limited to a diet of ani-
mal  food ; to have used alternately as  a part of his beverage, alum-
whey and lime-water; to have taken occasionally calomel, and cas-
tor-oil, and for  a  part, if not the whole period, a grain  of calomel
              * Opera, p. 134.  Verunt. 1737. 4to.
              t Vol. V. Art. I.
Vol. IV.—T t 
350
ECCR1TICA.
[CL. VI.—OH. il
and a dose of compound powder of ipecacuan every night, the quan-
tities of which are not given.  But it was the depleting plan that
was altogether depended upon, and no very minute attention was
paid to any thing else.
  The two  next cases  admitted of easier cure under the same
treatment.  The patients were both males.  The fourth case breaks
off incompletely, for, in consequence of a removal of the patient, the
termination  was not  known.
  In each of these there was the local symptom of great pain in the
loins, which in the first is described as having been " always severe
but at times excessively acute."  Here  also  the  testicles were
occasionally retracted ; and in one of two female cases there was a
distressing itching in the pudendum :  so that  there is reason to
conclude that these instances were accompanied with a more than
ordinary degree of irritability or inflammation.   " This," says Dr.
Satterley, " is the extent of my experience respecting bleeding in
diabetes : an experience that fully warrants my asserting the safety,
and  I think the efficacy of the practice, in some  species  of this
complaint."
  IV. It has, however, been thought possible by other practitioners,
to subdue the  irritation whether  local or general, and which  is
often strikingly  conspicuous, by powerful narcotics repeated in
quick succession; and thus to*<5btain a cure without that increase
of debility which, in many cases, must necessarily ensue upon an
active plan of depletion—and this has constituted a fourth intention.
  Anodynes, though of no great potency, were occasionally admi-
nistered by Willis and Sydenham ; and their benefit was expressly
insisted upon by Buckwald.K  The ordinary form has been that of
Dover's powder, thus aiming at  a diaphoretic as well as a sedative
effect: and in  this form it has  sometimes been found successful,
particularly in a case published by Dr. M'Cormick in the Edinburgh
Medical Commentaries :t but I  am not aware that  narcotics alone
have been relied upon, or their effects completely ascertained  be-
fore the late experiments of Dr. P. Warren, an interesting statement
of which he has communicated in the same work that contains Dr.
 Satterley's practice in venesection.^   These experiments embrace
 the progress of two cases that occurred under Dr. Warren's care
 in  St. George's  Hospital.  In the first he directed his attention,
 like Dr. M'Cormick, to opium,in conjunction with some relaxant;
 and  hence made choice of  the compound powder of  ipecacuan.
 So far as the present cases go,  however,  they prove very satisfac-
 torily that whatever benefit is derivable from the use of this valu-
 able medicine, depends far more upon its sedative than its sudo-
 rific power.  Dr. Warren, indeed, seems rather to have found the
 latter a, clog upon his exertions, as he could not carry the opium
* Dissert, de lliabetis curatione> 8tc.
f Vol IX. Art. II. p. 56.
t Vide supra. 
GE. III.—SP. TV.)     EXCERNENT FUNCTION.                331

far enough to produce a permanent effect on account of the nausea
or vomiting occasioned by the ipecacuan, from  which symptoms no
benefit whatever appeared to be derived.  In his first  case, there-
fore, he soon trusted himself to opium alone, and persevered in the
same practice through the second.
   These patients also were in the prime or middle of life: the one
aged twenty-two, the other thirty-eight: and both had been declin-
ing for some months antecedently to their applying to St. Georges'
Hospital for relief.   The first  seems to  have  been worn  down by
the fatigue of journeying, and was consiberably  disorded, before
the attack of diabetes, in his stomach and bowels.  When received
into the hospital, however, with this last complaint upon him, he
had a considerable pain in his back and loins.  Of the origin of the
second case no account is given.   To ascertain whether an animal
diet would succeed  by itself,  or  whether it be  of any collateral
advantage, the patients were sometimes restricted to animal food
alone, to opium alone, and to opium with a mixed  diet of animal
and vegetable food.   It  appears to me, from  the tables, that the
animal regimen was of advantage, but  certainly not alone capable
of effecting a cure, for  in every instance the quantity of urine in-
creased and became sweeter, whatever the diet employed, as soon
as the opium was diminished.   Dr. Warren, however, is inclined to
think that it was of no avail whatever; and, consequently, the second
patient had no restriction upon his food, whether animal or vegetable.
The  quantity of opium given  was considerable.  When Dover's
powder was employed it was gradually increased from a scruple to
a drachm  twice a-day.   And when opium was  employed alone, or
with kino, with  which it was for a short time mixed,  but without
any perceptible advantage, it was augmented from four grains to
six grains and a half twice a-day in one patient:  and to five grains
four times a-day in the other.  It is singular that  the opium seldom
produced  constipation.  Few other medicines were employed.*
  The disease in both cases was as decided as in  the  preceding,
treated  by venesection:  but the flow of urine was much  less, the
maximum  in the one patient being only fifteen, and in the other only
eight pints in the twenty-four hours: and the cure occupied a much
longer period of time ; running on to nearly four months in the first
instance, and to more than six in the second.
   The sum of the whole appears to be,  that paruria mellita attacks
persons of very different ages, constitutions, and habits, and  hence,
indifferent cases, demands a different mode of treatment:  and that
the morbid* action is seated in the kidneys:  with the irritable, and,
often, inflammatory,  state of which all the parts of the system more
or less sympathize.  It appears that under a diet of animal food
strictly adhered to, the  tendency to an  excessive secretion,  and
particularly to a secretion of saccharine matter, is much less than
under any other kind of regimen, though, from idiosyncrasy or some
• Med. Transact, Vol, IV. Art. XVI. p. 188. 
332,
ECCH1T1CA.
[CL. VI.—OR. II.
other cause, this rule occasionally admits of exceptions. It appears-
also that the irritation is in some instances capable of being allayed,
and at length completely subdued  by a perseverance  in copious
doses of opium, probably by an  exhaustion of the general excita-
bility; and in others by a free use of the  lancet, leading  more ra-
pidly to a like effect.   The skin, through  the progress of this com-
plaint, does not seem  to  catenate in the  action of the kidneys so
much as in many others, except in a few individuals;  and hence
diaphoretics are rarely of advantage.  As the  irritability  of the
affected organ is connected with debility and relaxation, tonics are
frequently found serviceable,and particularly the astringents; those
nii'stly so, that are conveyed to the  kidneys with the least degree of
decomposition.  And hence the advantage that  has been  so olten
found to result from a  use of lime water, alum-whey, and many of
the mineral  springs.   The  mineral  acids  are, on  this  account, a
medicine of very great importance, and ih some instances have been
found to effect  a cure alone ; of which Mr.  Earnest has given a
striking proof in a professional journal of reputation.*   Their seda-
tive virtue is nearly  equal to their  tonic,  and they surpass every
other remedy in their power of quenching the distressing symptom
of intolerable thirst.   Cinchona and various other bitters have been
tried, but have rarely  proved  successful.   Some benefit has occa-
sionally been derived from irritants applied to the loins, and espe-
cially from caustics ; but these have also failed.
  How advantageous soever the plan of sanguineous depletion may
be found occasionally,  it is clear that it cannot be  had recourse to
generally, for the present disease, is, for the most part, th .ugh by
no means always, a result of advanced years and of a debilitated
constitution.  Under such circumstances, indeed,  it has uniformly
occurred to  the present writer, in the few instances  he has been
called upon to superintend it, in which, while the  thirst was intense,
the appetite by no means kept pace with it, and was sometimes found
to fail completely.  Where, on the  contrary, the constitution does
not seem seriously affected, and the soundness and, indeed, vigour
of the stomach and collatitious viscera  are sufficiently proved by
the perpetual desire of food to supply the waste that is taking place,
a free use of the lancet may probably be allowed  as offering what
may be called a royal road to the  object of our wishes:  but  the
practice should, I think, be limited to this state of the animal frame;
since, while this favourable condition of  the digestive organs re-
mains,  whatever be the  prostration of strength  induced by  the
lancet, it will soon be  recovered from.
  By what means an animal  diet effects the beneficial change that
so generally follows from its use, has never, that  I know of, been
distinctly pointed out: but there is  a fact of  a very singular kind
that has lately  been  discovered in animal chemistry  which  is, I
think, capable  of throwing a  considerable light upon the subject.
* Medical Journal, Vol. XIII. 
GE. HI.—SP. IV.]    EXCERNENT FUNCTION.               333

  In healthy urine, the predominant principle is that of uric acid, in
diabetic, that of saccharine or oxalic. The uric acid, indeed, exists
so largely in sound urine as to be always in  excess, as we  shall
have occasion to observe under lithia or urinary calculus.  It
is not only a strictly animal acid, but till of late years was supposed
to exist in no other urine than that of man; though it has  since
been found, but in a  smaller  proportion, in the urine  of various
other animals. Whatever then  has a tendency to reverse the nature
of the acid secretion in the disease before us, to produce uric instead
of oxalic acid, and in this respect to restore to the urine its natural
principle,  must  go far towards a cure of the disease, as well  by
taking off from  the kidneys a source of irritation, and  hereby di-
minishing the quantity of the secretion, as by contributing to the
soundness .of the urine itself.   Now the physiological fact I refer
to is, that animal food has a direct tendency to induce this effect:
for Dr. Wollaston has satisfactorily ascertained that a greater quan-
tity of uric  acid is produced in the dung of birds in proportion as
they feed  on animal food : and he has hence ingeniously suggested,
that where there  is an opposite tendency in the system to that we
are now contemplating, a tendency to the, secretion of an excess of
uric acid, as in  the formation of uric calculi and gouty concretions,
this evil may possibly be  obviated by a vegetable diet.
                        SPECIES V.

             PARURIA  INCONTINENT

                  Kntonttneuce  of WLvint.

FREQUENT OR PERPETUAL DISCHARGE OF URINE, WITH DIFFICULTY
                      OF RETAINING IT.

This is the enuresis of most of the nosologists, and admits of four
varieties from diversity of cause and mode of treatment, with often
a slight diversity in some of the symptoms.

a. Acris.                      From a peculiar acrimony in  the
  Acrimonious incontinence     fluid secreted.
    of urine.
£ Irritata.                   From  a peculiar irritation  in some
  Irritative incontinence of      part of the urinary channel.
    urine.
y Atonica.                   From atony of  the  sphincter  of
  Atonic incontinence of        the bladder.
    urine.
^ Aquosa.                    From  superabundant  secretion:
  Flux of aqueous urine.        the fluid limpid and dilute. 
S34
EfcCRITICA.
[CL.VJ.—OR.II
  In the first variety, proceeding from  a peculiar acrimony of
the secreted fluid, the cause and effect are mostly temporary; as
too large a portion of spirits combined with certain essential oils,
as that of the juniper-berry.  Diluents and cooling laxatives offer
the best cure.
  In the second variety, the irritation usually proceeds from sand
or gravel, or some foreign  substance, as hairs, accidentally intro-
duced into the urethra.  We  have some accounts, however, of a
discharge of hairs, in such quantities that it is not possible to ascribe
the affection to an accidental cause; and  we should  rather, per-
haps, resolve them into  a preternatural growth of hair in the blad-
der itself, an idea the more tenable as we shall have to observe, iu
due time, that  calculi  of the bladder have occasionally been dis-
charged or found  after death surmounted with down.  In this case
the disease may be regarded as a species of trichosis, under which
name  it is described by Goelicke,* as it is  under that of trichiasis
by Scultetus.t  But at present we are in want of decisive informa-
tion upon the subject.   If the last view be  correct, filling the blad-
der with inject:ons of lime-water or any other depilatory liquid of
as much acrimony as the.bladder will bear without injuring its in-
ternal and mucous surface, will be the best mode of cure.
  Frequently, however, the irritation  is that of simple  debility :
and hence, tonics  and stimulants, as the terebinthinates or even  the
tincture of cantharides, may be  employed internally with success,
while  externally we prescribe blisters to the perinaeum, or the cold
water of a bidet.  Pressure  is also of great  service in many instan-
ces.  In the sixth volume of the Medico-Chirurgical Transactions,
Mr. Hyslop gives a case of nine years' standing, in  which a cure
was effected in three days by binding a bougie tightly to the urethra
through its course by  means of adhesive plaster.   And Mr. Burns
gives another case, in the same volume, in  which great benefit was
derived  from a  similar plan:  which is also in many instances
equally adapted to the next variety.
  In incontinence of urine from an atony of the sphincter of  the
bladder, the same means may be had recourse to, though with less
hope of success.
  Stoll  recommends  the use of an  acetum armoracium, which,
from combining a stimulant with a tonic and astringent power, may
possibly be  found serviceable, and is certainly worthy  of trial.}:
Small shocks of electricity passed from the pubes to the perinaeum
*eem also to have succeeded in a few cases.
  As  the perpetual  dribbling of the  urine in this, and even   the
preceding variety, is  always troublesome,  and often produces  ex-
coriation, the patient  will  find  it very convenient to be provided
with a light urinary receptacle.  This, for  males, may consist of a
* Dissert, de Trichosi. Frankf. 1724.
f Trichiasis admiranda, seu Morbus Pilarus, &c. Norib. 1658.
* Praelect. p. 287. 
GE. 111.—SP. V.j      EXCERNENT  FUNCTION.               335

small bag of oiled-silk worn as a glove for the penis, with a small
piece of sponge placed in it as an absorbent.   The simplest contri-
vance for females  is a larger piece of soft sponge loosely attached
to the pudendum.
   The fourth variety, or flux of aqueous urine, is often a nervous
affection, as in hysteria, or hypochondrias ; but  it more generally
proceeds from a relaxation of the mouths  of  the cryptse or tubuli
unnifen, which  in  consequence suffer a much larger quantity of
fluid, and with too little elaboration, to pass through them than they
should do.                                                    J
   In treating of paruria mellita, we observed  that  antecedently to
the discovery of the singular secretion of sugar in the genuine form
of this disease, the term diabetes,  by which it was commonly ex-
pressed, imported  any  extraordinary  or  profuse flow of  urine,
whether watery  or saccharine :  whence the term was made  to em-
brace at least two affections of the kidneys of very different kinds:
as a simple relaxation of the mouths of the  urinary tubules from
debility ; and  vehement excitement and a morbid change of action ;
the former expressed by diabetes  insipidus, and  the latter by d.
tnellitus.   The variety we  are  now contemplating constitutes the
first of these; as the second  runs parallel  with the preceding spe-
cies.  It is the urina aquosa* of Galen, which was also by himself,
as well  as the Greek writers in general,  blended with the urina
mellita,  from their not having been acquainted with the difference of
their constituent principles, and of the state  of the kidneys in the
one case and in the other ;  and  hence both were  equally described
by them under the names  of hyderus  or  water-flux, and hydrops
matellae or urinal dropsy.
   As this variety, like the preceding, is dependent on a debilitated
state of the organ, it should be attacked with the  same remedies,
and particularly with astringent tonics and stimulants both local and
general.   Blisters applied to the loins  will be found often useful, as
may also tincture of cantharides in doses of from twenty drops to
half a drachm  or even a drachm.   The warm  and resinous balsams
will moreover frequently afford aid, as turpentine and  balsam  of
copaiva, or the essential oil of juniper.
  The quantity  discharged under this variety of the disease has
occasionally been enormous : amounting to from thirty to forty pints
a-day and sometimes more, for one, two pr even three months with-
out intermission; a variety of examples of which  are offered in the
volume  of Nosology.  Fonseca mentions  a case of  two hundred
pints evacuated daily, but for what term of time is uncertain.t
* De Crisibus, Lib. I. Cap. XII.
f De Naturs Artisque Miraculis, p. 538. 
336
ECCRITICA.
[CL. VL—Olt. II
                       SPECIES VI.


                  PARURIA INCOCTA.

                  ^uassfrnflatctr  Wivint.

 URINE IMPREGNATED WITH FLUIDS TAKEN INTO THE STOMACH, AM)
                  EXCRETED WITHOUT CHANGE.

 The  Greek pathologists evidently allude to this  morbid state of
 the urinary organs in comparing some varieties of their diabetes,
 or urinary diarrhoea, to  a  lientery or  laevitas intestinorum,  under
 which last the food is described by them as evacuated in a crude
 and undigested state, with very little alteration from the condition
 in which it was introduced into the stomach.
  The experiments of Sir Everard Home, and those of Dr. Wollas-
 ton, and Dr. Marcet, both contained in the Philosophical Transac-
 tions  for the year 1811,  show that rhubarb and prussiate of potash,
 may pass from the stomach into the bladder, without undergoing
 any decomposition; and, in these cases, apparently without taking
 the course  of the blood-vessels.   By what other path it  is possible
 for them to have travelled is to this moment a subject of mere con-
jecture, upon which, however, the author has offered a few hints
 in the Physiological Proem to the present class.   Oil of almonds
 has frequently  reached  the bladder with an  equal destitution of
 change and has been discharged in the form of oil by the urethra :*
 and oil of turpentine and juniper pass off in the same manner daily.
 Actuarius mentions a discharge of urine of a blue colour, in a boy
who had taken a bitter pill designed for  another patient, but does
not state the  materials.   Urine containing a sediment resembling
Prussian blue was discharged copiously by a patient in a low fever
about three days before his death : it afterwards became greenish,
and possessed a strong ammoniacal smell.  Another case is related
by the same author of a  discharge of  blue urine in a  woman of
 sixty, without mischief.  We do not know, however, that either of
these  two last cases were connected with any thing introduced into
the stomach, and the blue or dark-coloured matter consisted proba-
bly of extravasated and  venous blood,  intermixed with the yellow
or other tinge of the urine.
  Copious  diluents, mucilaginous or farinaceous, will  at all times
afford the best means of  deterging the kidneys of any  such untem-
pered materials as  those  we are now contemplating; and if the co-
lour should appear to proceed from  a  rupture  of blood-vessels in
* Kachotoni, Comment. Bonom. torn. II. Pait. 1. 
GE. III.—SP. VII.]     EXCERNENT FUNCTION.
337
the same organs, the affection will become a variety of hematuria,
and should be treated accordingly.*
                       SPECIES  VII.

                PARURIA ERRATICA.

                      Erratic 2£rtue.

         URINE DISCHARGED AT SOME FOREIGN OUTLET.

Under the preceding species, we have seen that certain substances
introduced into the stomach, will  find their way unchanged to the
kidneys.  The present species presents to us a singularity of a dif-
ferent and almost opposite kind, by showing us that'rhe urine itself,
in a certain condition of the organ that secretes it, or of the system
generally, may travel from the kidneys  to other regions in a form
equally unchanged.  We  know nothing of the means by which all
this is accomplished, but we can sometimes avail ourselves of the
fact itself, by employing a variety of medicines, which, in conse-
quence of their being able, in this manner, to arrive at a definite
organ without being decomposed in the general current of the blood,
are supposed to have a specific influence upon such quarter, and
have often been denominated specifics for such an effect; as cantha-
rides in respect to the bladder, demulcents in respect to the lungs,
and cinchona in respect to the irritable fibre.
  This disease has often been described under the name of uropla-
nia, which is nothing more  than a Greek compound for "erratic
urine" as it is here denominated, but it has seldom been introduced
into nosological arrangements.  The  cases, however, are so nume-
rous and distinct, in writers of great authority, that it ought not to
be rejected.   In most instances it is not a vicarious discharge; or,
in other words, a secretion of a different kind compensating for a
destitution of urine, but a  discharge of an urinous fluid apparently
absorbed after its secretion  by the kidneys, and conveyed to the
outlet  from  which it issues by a path or under a  protection that
has hitherto never been explained.  We sometimes meet with it
while there  is a free  secretion of urine by the kidneys, and a free
passage by the bladder and urethra, in which case alone it can  be
called  a disease. On other occasions we find it, as already observed
under  paruria inops, performing a remedial part, and travelling in
the new direction to  carry off recrementory matter that cannot be
                    • See Vol. II. p. 468,
Vol. IV.—U u 
338
ECCRITICA.          [CL. VI.-OR. II.
discharged at its proper outlet, nor retained in the blood without
mischief.
  It lias in different persons been evacuated by the salivary glands,
the skinpat the navel, and by a fistulous opening into the perinaeum.
  The volume of Nosology gives a reference to cases and authori-
ties illustrating each of these forms of discharge : and  others are
probably to be met with in other writings.
                       GENUS  IV.


                         LITHIA.

                    8Xrfuarg ©^Icultts.

MORBID SECRETION  OR ACCUMULATION OF CALCULOUS MATTER IS
                     INTERNAL CAVITIES.

Lithia is a Greek term  from *.i6o$, whence mQixm " calculo laboro."
It has often  been written  lithiasis,  which  is here exchanged for
lithia, since iasis, in the present arrangement, is limited, as a ter-
mination, to words indicating diseases affecting  the skin or cuticle,
and that for reasons which will be explained presently.
  The name of lithus or lithiasis, as used by Aretaeus and Aure-
lianus, and that of caculus or sabulum, as employed by Celsus and
Pliny, sufficiently evince the  elementary principles  of which the
Greeks and Romans conceived urinary calculi to consist.  The mis-
take is not to be wondered  at when we reflect, that it was  not till
about thirty years ago that these principles were detected  with  any
degree of accuracy; and that we are indebted  to the minute  and
elaborate experiments of Fourcroy and Vauquelin for an analysis
that till their time,  though  successively pursued by Hales, Boyle,
Boerhaave, and Slare, had been left in  a very unsatisfactory state ;
and  which even since this period  has required  the further  correc-
tions of  Wollaston, Marcet, Cruickshank, Berzelius, Brande, and
various other animal chemists, to produce all the success  we could
desire.   So generally was the belief that the calculi of the bladder
were formed in the same manner and consisted of the same mate-
rials as the stones of the mineral kingdom, that Dr. Shirley  pub-
lished a  learned book as late  as  1671, which is now become ex-
tremely  scarce, entitled "Of the causes of stones in the  greater
world in order to  find out the causes and cure of the stones in man."
   The urinary  secretion in  a state of health is one of the most com-
pound fluids  in  the animal system : and consists of various  acids and
alkalies, the former, however, bearing a preponderancv,  with  a
certain proportion of calcareous  earth ; and other materials which 
GE. IV]
EXCERNENT FUNCTION.
339
 it is not necessary to dwell  upon  at present.  The acid first dis-
 covered in it was the phosphoric, which was traced by Brandt and
 Kunckle, whence the experiments of Boyle from which he obtained
 phosphorus.  The important discovery of  uric acid was reserv-
 ed for Scheele, who  detected it in 1776:  as he did also benzoic
 acid, chiefly confined to the urine of children.   Proust  has  since
 proved that it contains also carbonic acid, and a peculiar resin like
 that of bile ; and other acids, in smaller proportion, have more lately
 been ascertained by Thenard and Berzelius.  Hence the calcare-
 ous earth that is separated by the kidneys, as  we have had  occa-
 sion to observe that it is also by  most other organs of the body in a
 state of health or of disease, is productive of numerous compounds,
 as carbonate of lime, phosphate of lime, oxalate of  lime :  together
 with compounds still more complicated by  an intermixture of the
 lime with  the urinary alkalies.  But as, in a state of health, the
 urine is always found to contain  calcareous earth under some form
 or other, in a morbid state it is always found to contain magncsian
 earth more or less united  with the other materials, both  acid and
 alkaline.   In many cases,  moreover, the natural acids or the natural
 alkalies are secreted in excess, in others in deficiency.  And from
 all these circumstances it is easy to conceive  that a very  great
 variety of concretions, or  calculi may at times take place either in
 the kidneys or in the bladder.  How far these varieties extend, has,
 perhaps, not fully been determined to the present day, but the num-
 ber which  has been detected  and analyzed is now very considerable,
 and has been  increasing ever since Dr. Wollaston's valuable essay
 on this subject, which appeared in the  Philosophical Transactions
 for the year  1797,  and laid a  foundation  for  the  arrangement.
 Among those  which  have been subsequently ascertained, a few, and
 especially the cystic  oxyde,  has  been  discovered by himself; and
 the whole are thus enumerated by Dr. Marcet in a still later pro-
 duction of highly distinguished merit.*  1   Lithic  calculus, com-
 posed chiefly of lithic or uric acid.  2. Earth-bone  calculus,  con-
 sisting chiefly of phosphate of lime.   3.  Jimmoniaco-magnesian
phosphate or calculus, in which this triple salt  obviously prevails.
 4. Fusible calculus, consisting of a mixture of the two former.  5.
 Mulberry calculus, or oxalate of lime.   6. Cystic calculus, consist-
 ing of the substance called by Dr. Wollaston cystic oxyde.  7. Alter-
 nating calculus, or a concretion composed of two or more different:
 species arranged in  alternate layers.   8. Compound calculus, the
 ingredients of which are so intimately mixed as not to be separable
 without chemical analysis.   9.  Calculus from the Prostate gland, of
 a peculiar kind, and consisting, according to Dr. Wollaston, " of
 phosphate of lime not distinctly stratified, and tinged by the secre-
 tion of the prostate  gland."   The two  not hitherto described  are,
 10. Xanthic oxyde, making an approach to the cystic calculus, but
  • Essay on the Chemical History and Medical Treatment of Calculous Dis-
orders, 
340                      ECCKIT1CA.           [CL. VI.—OH. U.
giving, which that docs not, a bright lemon residuum on evaporat-
ing its nitric solution.  And 11. Fibrinous calculus, so called from
its possessing properties exactly similar to those of the fibrina of
the blood, and no doubt formed by a deposit from this fluid.
  Of these a few only are  commonly found in the  kidneys, though
most of those which are found  in the kidneys are found also in the
bladder, and in reality constitute the common nuclei of the calcu-
lous concretions of this last organ  ; the augmentation resulting from
other constituent principles of the urine, gradually  separating, and
encrusting them as they lie in  the bladder in an undisturbed state.
  The symptoms, moreover, of renal  and vesical calculi differ as
widely as their component parts, and hence point out the necessity
of subdividing the genus into the two following species :

     1.  LITHIA  RENALIS.           RENAL CALCULUS.
     2.  ------ VESICALIS.         VESICAL CALCULUS^
                        SPECIES 1.

                   LITHIA RENALIS.

                      ilnwl <£aIculu*L

 PAIN IN THE LOINS, SHOOTING DOWN  TOWARDS  THE  TESTES  O-KT
   THIGHS, INCREASED ON EXERCISE; URINE OFTEN DEPOSITING A
   SABULOUS SEDIMENT.

 The calculous matter of the kidneys sometimes passes off in minute
 and imperceptible grains with the urine, which are only noticed by
 their concreting or christallizing about the sides of the vessel that
 receives it;  and  sometimes collects and forms very troublesome
 spherules or nodules in the substance or pelvis of the kidneys: thus
 offering the two following varieties:

•« Arenosa.                   Pain slight, and unfrequent: free
   Urinary sand.                  discharge of sabulous  granules.
 £ Calculosa.                  Pain mostly severe and constant:
   Urinary gravel.                sabulous  discharge  small  and
                                 seldom or never: calculus vary-
                                 ing in size, often large and  ob-
                                 structing the pelvis or ureter of
                                 the kidney.

   Urinary sand, or the sabulous matter deposited on the sides or
 bottom of a receiving vessel, is of two kinds, white and red : and it 
UE. IV.—SP. I.]
EXCERNENT FUNCTION.
341
is of great importance to distinguish the one from the other as they
proceed from very different causes, and require a different, and, in-
deed opposite mode of treatment.   Mr.  Brande has published  an
excellent treatise upon this subject in his Quarterly Journal; and in
the remarks about to be offered upon this species, I shall avail my-
self in no small degree of the benefit of his labours, in connexion
with those of Dr. Marcet, to  which I have already referred.
  The urine, in a healthy state, is always an acid secretion, and it
is the excess of its acid that holds the earthy salts in solution.  If,
from any cause, it be deprived  of this excess, or, in other words^
the secretion of its acid be morbidly diminished, the earthy  parts
are no longer held in solution, and a tendency to form a white sand
or calcareous  deposit immediately commences.   And that this
is the real source of its production is manifest from the simple ex-
periment of mixing a little alkali with recently voided urine; for
the alkali has no sooner exercised its affinity for  the acid than the-
urine throws down a white powder. And hence a like deuosit will
not unfrequently take place upon  using magnesia too freely.
  A knowledge  of the cause of this modification of urinary sand
puts us at once  into an easy mode of curing it, a mode however
which was first pointed out to the world by Dr. Wollaston.   It
consists in introducing into the system some other acid  as a substi-
tute for that which is wanting to the kidneys.  All the  acids seem
to answer this purpose, but as the sulphuric usually sits easier on
the stomach than any other of the mineral acids it is entitled to a
preference; and the more so on account of its superior tonic powers,
and consequently its better adaptation to the chylifactive organs, a
debility of which is  no unfrequent cause of the  complaint.   The
vegetable acids, nevertheless, may be interposed with  the sulphu-
ric, or, where the stomach is  very delicate, entirely supersede their
use.  Of these the citric is the pleasantest and can be  persevered
in for the longest period of time, especially in the case of children.
The tartaric, nowever, and especially in the form of cream of tar-
tar, has the advantage of gently operating upon the  bowels, which
is always a beneficial effect.   Carbonic acid, whether taken in the
form  of effervescing saline draughts, or simply dissolved in water
by means of Nooth's apparatus, will also be found  a useful and plea-
sant auxiliary.  The general diet should be of the  same description,
and be as largely as possible intermixed with  salads, acids, fruits,
and especially oranges. Malt liquor should be  abstained from; and,
if the habit of the patient require that he should continue the use
of wine, Champagne or claret  should be preferred  to Madeira  or
port.
  It is possible, however, that this modification may be a result of
too large a secretion of calcareous earth, instead of too small a
secretion of acid; yet the effect being  the same, the same mode  of
treatment will be advisable.
  But the acid may be in excess instead of in deficiency, or, which
is nearly the same thing, the  natural secretion of calcareous earth 
342
ECCKITICA
[CL. VI.—OH. II.
 may ifself be deficient, while the acid retains its usual measure :
 andf in this case the acid itself has a tendency to form a deposit by
 crystallizing into  minute and red spiculae,—and  hence the  modifi-
 cation of red sand that is so frequently found coating the sides and
 bottoms of chamber-utensils.
   This, like the preceding, is sometimes voided in a concrete or
 crystallized state, or the urine may be voided clear and the depo-
 sit not take place till some hours afterwards.  The last is  ordina-
 rily the result of some temporary cause, and is of no importance, as
 it disappears with the cause that produces it.   The first is of more
 serious consideration, as it indicates a lithic diathesis that may lead
 to a formation of large and mischievous calculi, and is a pretty cer-
 tain harbinger of the variety we shall have to notice under the name
 of gravel.
   As acids form  the best preventive and cure  in the  preceding
 case, alkalies present an equal, or nearly equal remedy in the pre-
 sent, with the exception that the tendency to  produce urinary red
 sand is more likely to run into a habit, and is hence less easily ex-
 tirpated, than that to produce white.
   It has, in fact, been long known that concrete uric acid is  soluble
 in the caustic fixed alkalies, and these were, in consequence here-
 of, the earliest forms of alkali adverted to  for this deposit.   But it
 has since been ascertained that the alkaline carbonates and sub-car-
 bonates are equally effectual.  And, as the latter are far less apt to
■disagree with the  stomach than  the former, they have very gene-
 rally taken their place.  Of the  alkalies and alkaline carbonates
 soda has commonly been found to answer the purpose best.   It is,
 indeed, chiefly eftectual in its  pure state, but it is most convenient
 to use it in a milder form; and of all the forms it offers that of so-
 da-water is the pleasantest, and may be persevered in for the longest
 period of time. Nevertheless, there are some constitutions in which
 potash and its carbonate prove more effectual than  soda, a  remark
 for which we are indebted  to  Sir Gilbert  Blane, who, on this
 account, has occasionally given it the preference, and for the sake
 of rendering it more palatable has sometimes partly saturated it
 with lemon-juice or citric acid; and where there has been severe or
 protracted pain, producing considerable irritation, iias  united it
 with opium.* A drachm of the carbonate of either of the fixed alka-
 lies will form  a  moderate dose for an  adult, and  may be repeated
 two or three times a day, taken during the effervescence produced
 by the addition of half an ounce  of lemon-juice to  the menstruum,
 which may consist of two ounces of water sweetened with honey.
   Ammonia and its  sub-carbonate have been had recourse to, and
 with  great advantage, where  symptoms  of indigestion have been
 brought on by the  fixed alkalies; and particularly in cases in which
 red gravel is connected with gout, and  the two diseases show a dis-
 position to alternate.
  * Transactions of a Society for improving Medical and Chirurgical Know-
ledge, Vol. UI. p. 358. 
GE. IV—SP. I.]     EXCERNENT FUNCTION.
343
   Magnesia is also of considerable use, as has been lately shown by
Mr. Brande in two excellent papers upon this subject, published in
the Philosophical Transactions.* Taken  in free and frequent doses
it has often succeeded in checking the tendency to a formatipn of
sand and gravel, and has kept many individuals free from this com-
plaint for very long periodsof time,  who have been constitutionally
predisposed to it.  Nevertheless, it is not calculated to supersede
the use of the alkalies, but may be  employed as a convenient ad-
junct, or supply their place for a time, when the patient has become
tired of using them.
   There is some doubt as to  the manner in which the acids em-
ployed to correct a secretion of  white sand, and the alkalies tliat of
red, fulfil their object: whether  indirectly by a peculiar action on
the chylifacient organs so as to render the fresh supply of nutriment
more easily disposed  to yield an acid in  the one case, and lessleasi-
ly in the other; or directly by passing unchanged along the current
of the blood  and arriving  at the kidneys in their  proper firms.
There is a difficulty attending both these views; but as  uric acid,
though  soluble in the caustic  alkalies, is  found not to  be solu-
ble in their carbonates and sub-carbonates, the benefit of alkaline
medicines does  not seem referable  to their  solvent powers.  And
hence it is, on the whole, more probable that both acids and alkalies
  roduce an indirect influence on the kidneys, as we have already
  ad occasion  to observe  that animal food does in saccharine wine,
by a peculiar  influence on the chylifacient viscera, or the nutritive
materials during their subaction.
   There is also another class of medicines which have long jtood
the test, and been proved to possess a truly remedial power  ti all
urinary concretions of the kind  before us—I mean astringents. So
considerable is their efficacy that De Heucher ascribes to theai an
expulsory power, in his treatise entitled " Calculus per astringtntia
pellendus."   Their real mode of action  has probably been  pointed
out by Dr. Cullen in  a passage in which  he has anticipated much of
the reasoning of the present day concerning the benefit of alkalies.
and has hereby given  an additional proof of the strength of his judg-
ment. Speaking of the leaves of  the uva ursi, he says that this medi-
cine, "Not only from the experiments of the late De Haen, but also
from my own, I have found to be often powerful in relieving the
symptoms of  calculus.  This plant is manifestly a powerful astrin-
gent: and in  what manner this and other astringents are useful in
the cases mentioned may be difficult to explain: but I shall offer a
conjecture upon the subject.  Their powerful attraction of acid we
have mentioned above, and that thereby  they may be useful in cal-
culous cases is rendered probable by this, that the medicines which
of late have been found the most powerful in relieving the symptoms
of calculus are a variety of alkalies, which are known to do  this
I
* Phil. Trans. Year 1810, p. 136, 1813, p. 213. 
344
ECCRITICA.
[CL. VI— OH. II.
 without their acting at all in dissolving the stone."*  Their virtue
 as a stomachic  tonic ought also to be taken into consideration as
 well as their absorbent power.
   Tee second variety of the lithic concretion we are now con-
 templating, and which, from its tendency to form larger masses is
 usually denominated gravel, is of far greater importance than the
 preceding, from the actual pain that is suffered in most cases, and
 the canger  there always exists  of the conversion of such nodules
 into :alculi  of the bladder.
   Of  the eleven classes of urinary calculi enumerated by Dr. Mar.
 cet, ihere are rarely more than three that are found passing through
 the ratural  passage of the kidneys, though others are traced occa-
 siondly as  imbedded in the  pelvis  or substance of the kidneys.
 These three are the uric, oxalic, and cystic:  and of these the two
 last £re very rare productions in comparison with the first.  " Out
 of fifiy-eight cases of kidney calculi," says Mr. Brande, " fifty-one
 were uric, six oxalic, and one cystic."  The phosphates seem never
 to coicrete  so as to form calculi in the kidneys, for which it seems
 difficilt to assign a reason.
   Tie uric calculi, as voided immediafely from the kidneys, are of
 a yel owish  or reddish-brown colour, somewhat hard, and soluble in
 caustic potash.   They exhale the smell  of burnt horn  before  the
 blowpipe, and  when heated  with nitric acid, produce the peculiar
 red om pound which Dr. Prout has called rosacic acid.  The oxalic
 calculi vary considerably in appearance.  They  are generally of a
 grayish-brown  colour, and made up of numerous small cohering
 spheiules, and  have sometimes  a  polished surface and resemble
 hemp-seeds.  They are easily recognised by their insolubility in di-
 lute muriatic acid :  and  by swelling up under the blow-pipe, and
 burn ng into a white ash consisting of pure lime.  The  cystic cal-
 culi nave a yellowish colour, and a crystallized  appearance; they
 are soluble in dilute muriactic acid, and in diluted solution of pot-
 ash. Dr. Wollaston has remarked, that when heated in the  flame of
 a lamp, spirit, or by the blow pipe, they  exhale a peculiar fetid smell
 by which they may readily be characterized.!
   The usual symptoms by which this variety is marked are those
 of pressure and irritation : as a fixed pain in the region of the affect-
 ed kidney, with a numbness of the thigh on the same side, the pain
 alternating with a  sense of  weight.  The pain is sometimes very
 acute  and accompanied with nausea and  deliquium, proving that
the calculus  has entered  the  ureter, and  is working its  way down
into the bladder, after which the  pain ceases till it reaches the ure-
thra, or by  remaining in the bladder, it becomes incrusted with
other materials, and  forms a vesicular calculus.   During the whole
of the passage from the kidneys the urine is usually high coloured,
and deposits a reddish or reddish-brown sediment, occasionally not
• Mat. Med. Part II  Chap. I. p. 13.
f Brande, Journal, &c. Vol. VIII. p. 67. 
GE. IV.-—SF. I.]      EXCERNENT FUNCTION.
345
 unlike the grounds of coffee, and evidently giving proof of the lace-
 ration of blood-vessels by the angular points of the calculus.  It is a
 very singular fact, and has been properly noticed by Dr. Heberden,
 that during the most violent pain at any time  endured from this
 cause there is rarely an  acceleration of the pulse : in the same man-
 ner as the torture sustained by the passage of a gall-stone through
 the gall-ducts produces  as little effect  upon it.  If, however, the
 flow of the urine be obstructed by the calculus, as sometimes hap-
 pens,  the ordinary constitutional symptoms take place which cha-
 racterize that  affection, as a  general  sense of uneasiness,  heat,
 thirst, a quickened pulse, and  other pyrectic concomitants,  sick-
 ness at the  stomach, costiveness,  sleepless nights, and  at length
 coma,  intermitting pulse, convulsions, and death : and all this
 even where the pain or weight in the loins  is  not  peculiarly dis-
 tressing.
   We have  often had occasion to  observe that where a morbid
 change takes place in an organ very gradually; it may proceed to
 almost any extent without any acute suffering on the part of the
 patient, and sometimes without any suffering whatever.   The same
 fact not unfrequently occurs in the disease before us, of which a re-
 markable instance is related by Dr. Marcet, in  a patient who died
 of a dropsy in the chest, without having  made any complaint of the
 state  of his urinary organs, though one of his kidneys  was found,
 on dissection, to be distended by a large collection of calculi.
   The proximate cause of the  formation of uric  calculi  we  have
 already shown to be an excess of uric acid ;  that of the oxalic and
 cystic is not quite so obvious—a point, however, of less importance
 from the  infrequency of their  occurrence.  The predisposing and
 occasional causes of all of them are too often involved in obscurity.
 In many persons there is  an hereditary tendency to this complaint;
 general indolence or a  sedentary life becomes a predisponent  in
 others ; too large an indulgence in fermented liquors, and the luxu-
 ries of the table generally, forms a predisponent in a third class;
 but the chief cause of this kind we are acquainted withisa want of
 constitutional vigour, and especially in the digestive organs ; and
 hence  the periods of  life in  which  this  disease occurs most fre-
 quently are from infancy to the age of puberty, and in declining
 years:  while it is rarely found during the busy  and  restless  term.
 of mature virility.
   The process of treatment must,  for the  most part, be derived
 from these causes.  As a preventive of that modification of calculus
 which is by far the most  frequent, we have already advised the use
 of alkalies and  alkaline  carbonates.  Where the digestive organs
 are weak the diet should be light but generous; warm  add bitter
 tonics will always be found serviceable ; the bowels should never be
 suffered to become costive, and should occasionally be stimulated
by brisk purgatives, which tend equally  to remove acidities  from
the stomach,  and to stimulate the kidneys to a more healthy action.
  Vol. IV—X k 
346                      ECCRITICA.           [CL. VI.—OR. II.

Indolence and a sedative life must give way to exercise, and espe-
cially equitation, which is by far the best kind of exercise  for  the
present purpose, and whatever will tend to promote an increased
determination towards the surface, and a frequent glow on the skin
will  prove a valuable auxiliary ; for the skin itself becomes, in this
affection, though rarely in paruria  mellita, an  outlet, for the dis-
charge of a redundancy of acid, as may be observed by the simple
experiment of tyeing a piece of  paper stained  with litmus about
the neck; which even in a state of common  health, will often  be
changed to a red colour by  the  acid thrown off in the ordinary
course of perspiration.
   Of the mischievous effects of a luxurious diet, and the advantage
of abstinence M. Magendie  has given a very striking example in
the case of a merchant of one of the Hanseatic towns, who was
habitually afflicted with the  complaint  before us.   " In the  year
1814, this gentleman," he  tells us, " was possessed of a considerable
fortune, lived in an-appropriate style, and kept a very good table, of
which he himself made no very sparing use.   He was at this time
troubled with the  gravel.   Some political measure unexpectedly
took place which caused him the  loss of his  whole  fortune,  and
obliged him to take refuge in England, where he passed  nearly a
year in a state bordering upon extreme distress, which obliged him
to submit to numberless privations ; but his gravel disappeared. By
 degrees he succeeded in re-establishing his affairs ;  he resumed his
 old  habits, and the gravel very shortly began to return.  A second
 reverse occasioned him once  more  the loss of  all he had acquired.
 He  went to France almost without the means of subsistence, when
 his  diet being in proportion to his exhausted  resources, the gravel
 again a second time vanished. Again his industry  restored him to
 comfortable circumstances;  again he indulged in the pleasures of
 the  table, and had to pay the tax of his old complaint."*
   It may at first sight appear a singular fact, but the  remarks just
 offered will tend to explain  it, that mariners are rarely subject to
 stone or gravel.  Mr. Hutchison has  published  a valuable article
 upon this subject in one of the volumes of the Medico-Chirurgical
 Transactions,! from which it appears that out of ninety-six thousand
 six  hundred and ninety-seven patients admitted in the course of
 sixteen years into the three grand coast hospitals of Plymouth,
 Haslar, and Deal, not more than eight had laboured  under either
 species of lithia.   Whence  it appears that the occupation, diet,
 activity and regimen of a maritime life are the best  preservatives
 against all such affections: such as an animal aliment largely combin-
 ed  with the alkaline stimulus of muriate of soda; a  farinaceous, for
 the most part, instead of any other vegetable diet; great exercise, and
 that free exhalation from the skin at night which is so well known
  •  Hecherches Physiologiques et Medicales sur les Causes, les Symptomes
et la Traitment de la Gravelle. 8vo. Paris, 1818.
  f  Trans, of the Medico-Chirurg. Soc. Vol. IX.. 
GE. IV.—SP. I.]      EXCERNENT FUNCTION.
34f
to take place among the sailors in the royal navy, in consequence of
their being compelled to sleep closely together.  And, as the disease
appears to be equally uncommon in tropical climates, we have here
an easy explanation of the cause of its infrequency.  In our own
country it appears from the tables of the Norwich hospital  to be
more frequent in Norfolk than in any other county of the same po-
pulation
  It only remains to be observed, that during the paroxysm of pain
produced by the passage of a calculus through the ureter, our chief
object should be to allay the irritation and  mitigate the distress.
The warm-bath is here a very valuable  remedy, friction on the
loins with rubefacient irritants combined with narcotics often afford
relief: but the present author has found most benefit from a flannel -
swathe wrung out in hot water and folded about the loins ;  being
suffered to remain there for hours, wrapped round, to confine the
moisture, with an outer swathe  of  calico or linen.   If these  do not
answer, opium, and in free doses, must be had recourse to.
                       SPECIES II.

                  LITHIA VESICALIS.

                   Stone in the Blazer.

 FREQUENT DESIRE OF MAKING WATER, WITH A DIFFICULTY OF DIS-
   CHARGE; PENIS RIGID,  WITH ACUTE PAIN AT THE GLANS : SONO-
   ROUS RESISTANCE TO THE SOUND WHEN SEARCHING THE BLADDER.

 The substances, vulgarly  called stones in the bladder, are, for the
 most part, of a very composite structure.  They originate firm a
 nucleus which may consist of any  morbid or foreign material tnat
 can accidentaly obtain an  entrance and a lodgment in the bladder;
 the body of the calculus being formed out of such constituent  parts
 of the urine as are most easily detached and attracted: which gra-
 dually encrust around it, and concrete into a mass for the most part
 far too large to pass through the urethra.
   The most common of these nuclei is a kidney-calculus itself, and
 consequently a crystallized spherule or nodule of uric  acid;  and
 where the acid is habitually in excess, the coating of the vesicular
 calculus may consist of this alone or chiefly: but from the great
 variety of materials, as earths, alkalies, and other acids besides uric,
 and sometimes blood and mucus, which enter into the composition
 of the urine at this time, it  is not often that a calculus of the bladder
 is a crystallization of uric  acid alone.
   In the introductory remarks upon the present genus we observed
that the different kinds of calculi discovered in the human bladder 
348
ECCRITICA.
[CL.  VI.—OR.  II
had been treated  of by Dr.  Wollaston, as far  as they were then
known, in a very masterly essay upon this subject, published in the
Philosophical Transactions for the year 1797: he has since enume-
rated them as follows:
  1. Uric acid calculus.
  2. Fusible, triple, or ammonio-magnesian phosphate.
  3. Bone-earth calculus, or phosphate of lime.
  4. Mulberry calculus,  or  oxalate of lime.
  5. Cystic oxyde.

  The cystic  oxyde is not contained in the article above referred to,
as not having been discovered at the time : but it has since been
detected by the same excellent chemist, and named as above.
  We have also observed that various other calculous masses have
still more lately been  ascertained by the analyses of other experi-
menters, and that the whole number, as arranged  by Dr. Marcet,
am-, unts, in the present day  to  eleven or  twelve.  Their  names
we have already given, nor  is it worth while, in a work devoted to
practical medicine, to notice them any further, as they are rarely
to be met with in comparison with the  five arranged above, and
when met with will not call for any essential difference in the mode
of treatment.
   In effect they have been found equally different in composition,
form, size and colour; from the weight of half a drachm to  that of
several pounds ; purple,  jasper-hued, red, brown,  crystaline, cine-
ritious, versicoloured: in one or two instances covered with down,*
aparently  produced from the surface of  the bladder, from  which,
as  we  have already  had to observe, hairs are occasionally dis-
charged with the urine.t  They have also been found solid, perfo-
rated, hollow, compact, crumbling, glabrous, rough,  and spinous,^
and, in a few instances, combined with iron.§
   They seem sometimes  to  form  very  rapidly : and where  the
patient has already discharged one  or two, and the urethra has in
consequence become more than ordinarily dilated, they occasionally
pass off in great numbers in a short space of time. We have hence,
in different professional  journals and transactions,  accounts of a
hundred and  twenty voided in the course of three days ;[| two
thousand in the course of two years ;f and three hundred of a pretty
 large size within the same term.**  The largest discharged in this
 manner,  which has ever occurred  to me in reading, weighed five
 * Blegny, Zodiac. Ann. IV. Febr. Obs. 4.
 f Gen. Ill  Spec. V. part, in cont.
 * Bartholin. Act. Hafn. torn. II. Obs. 85,
 % Act. Erudit. Leips. 1627. p. 332.
  Dotseus, Ep. ad Waldschmidt. p. 253.
 i Epli. Nat Cur Dec. 111. Ann. V. VI. p. 99.
 1 Griidlichi r Bericht, von Blatterstein,
•• Hddan. Fabric. Cent. I. Obs. 89. 
CE. IV.—SP II.]     EXCERNENT FUNCTION.
349
ounces.  Dr. Huxham describes one instance of such a fact ;* and
another is given in a distinguished foreign miscellany.t  By females
they have often been discharged of the weight of two ounces and a
half; and my excellent friend Dr. Yellowly mentions a calculus of
nearly three ounces and a half;% in one case we  are told of a stone
thus evacuated that weighed twelve ounces.§
  The general  character of the uric  calculus has been given al-
ready.  Its texture when formed in the bladder is commonly lami-
nated ; and, when, cut into halves, a distinct nucleus of uric acid is
almost always perceptible.  Its exterior is generally smoother than
that of other calculi, except the calculus of bone-earth, or phosphate
of lime.||
  The appearance of the second or fusible calculus is generally
white, and often resembles chalk in its texture.  Strongly heated
before the blow-pipe this substance evolves ammonia, and  readily
fuses ; whence  the name assigned to it. It often breaks into layers,
and exhibits a glittering appearance when broken.
  The third division, consisting of the bone-earth calculus, or
phosphate  of lime  unmixed with any  other substance, has a pale
brown, smooth surface; and when sawn through is found of a lami-
nated texture  and easily separates into concentric crusts.  This
calculus is peculiarly difficult of fusion.
  The fourth  division,  embracing the  mulberry calculus, or
oxalate of  lime, is  of a rough and tuberculated exterior, and of a
deep reddish brown or mulberry  colour, probably produced by a
mixture  of blood  that has escaped  from some  lacerated  vessel,
whence the name assigned to  it.  The nucleus is generally oxalic,
and of renal origin ; but it is sometimes uric. It is also frequently
enveloped by the fusible calculus.
  The fifth, or cystic calculus, has a crystalline appearance, but
of a peculiar greasy lustre, and is somewhat tough  when cut.   Its
colour is a pale fawn bordering upon straw-yellow. It is very rarely
to be met with.
  Such are the calculi which are principally found in the bladder;
and we  may  readily conceive with what facility they are  formed
there, when an accidental tendency is given to their formation by
a lodgment of any thing that may serve as a nucleus, by noticing the
deposits  of phosphates of lime and other materials that are perpe-
tually encrusting every substance over which a current of urine is
frequently passing; as the public drains  in our streets, which are
daily exhibiting them in regular crystals.
  The ordinary causes of renal calculi are necessarily those of ve-
sical calculi, but any local injury or infirmity, which prevents the
• Huxh. Vol. IIL p. 42.
f Sammlung. Med. Wahrnemung. Band. VIII. p. 258.
* Trans, of the Medico-Chir. Soc. Vol. VI.
§ Eph. Nat. Cur. Dec. II. Ann. V Obs. 71.
4 Brande's Journal, Vol. VIII. p. 207. 
350
ECCRITICA.
[CL. VI.—OR. II.
 urine from passing  oft' freely from  the  bladder, accelerates their
 formation and enlargement, not only by the confinement it causes,
 but by the decomposition which rest soon produces, in which case
 it becomes ammoniacal, and a larger portion of the phosphates will
 be precipitated.  And hence, an obstruction in the urethra of any
 kind, but particularly a diseased prostate becomes a frequent aux-
 iliary, and sometimes even a primary cause of the formation of a
 stone without any mischief in the kidneys, or any disordered secre-
 tion of urine.*  "The bladder," says Sir Everard  Home,  "never
 being completely emptied, the dregs of the urine, if I may be al-
 lowed the expression, being never  evacuated, a calculus formed
 on a nucleus of the ammoniaco-magnesian  phosphate and mucus is
 produced,  when it would not have Deen produced under  other cir-
 cumstances.  This species of stone, or a stone upon  such a nucleus,
 can onlv be produced where the bladder is unable to empty itself.
 It may therefore be  arranged among the  consequences of the en-
 largement of the middle lobe of the prostate gland."t
   It does not appear  from the experiments or observations of Dr.
 Marcet, that a difference in the waters of different places is much,
 if at all concerned in the production of calculous disorders: nor
 have we any satisfactory evidence of their being more prevalent in
 cider than  in other countries, notwithstanding  the general  opinion
 that they are so.  But we  are yet in want of sufficient data upon
 this subject to speak with  much decision.
  As the disease of stone in the  bladder is very generally a sequel
 of calculi in the kidneys, the symptoms indicative of the preceding
 species form, in most instances, the first symptoms of the present.
 Yet, occasionally, from causes we have just pointed out, the  concre-
 tion  commences in the bladder, and  the  symptoms of an affected
 kidney are not experienced.  One of the first  signs of a stone in
the bladder is an uneasy sensation at the point of the urethra, occur-
ring in conjunction with a discharge  of urine that deposits red or
white sand, or after having occasionally voided small calculi  or frag-
ments of a larger. This pain is sympathetic, and proceeds from the
irritation of the prostate or the neck of the bladder, agreeably to a
law of nature we have often found it necessary to recur to, which
ordains that the extremities of nerves which enter into the fabric of
an organ, and particularly of mucous canals, should possess a keener
 reciprocity of feeling than any intermediate part, and consequently
participate with more acuteness in any diseased action.   This un-
 easy sensation at the point of the urethra, is at first only perceived
 on using any violent or jolting exercise; or in a frequent desire to
 »ake water, which is often voided by drops or in small quantities,
 or, if in a  stream, the current stops  suddenly while the patient  i>
 still conscious that the bladder is not fully emptied, and has  still
 an inclination to evacuate more, but  without a power  of  doing so.
• Brande's Journal, &c. Vol. Vlll. p. 210.
f On the Diseases of the Prostate Gland, Vol. I. p. 40. 
GE. IV.—Sp. II.]     EXCERNENT FUNCTION.
351
As the stone increases in size there is also a dull pain about the neck
of the bladder, the rectum partakes of the irritation, and produces a
troublesome tenesmus, or frequent desire to go to stool. Where the
pain is trifling the urine  is often limpid, as the saline or earthy
materials from their confinement in the bladder arrange themselves
around the growing calculus, and enlarge it by a new coating; but
where the irritation is considerable, there  is often  a mucous sedi-
ment in the water, and sometimes a discolouration from  blood.
The region of uneasiness extends its boundary, the stomach partici-
pates in the disquiet, sleepless nights ensue, with pyrexy, anxiety,
and dejection of spirits:  all which symptoms are increased by exer-
cise of every kind and particularly by equitation.  Several of these
signs may indicate a  primary disease of the prostate or neck of the
bladder, but the  occasional discharge of  calculous fragments o^
deposit  of urine  loaded with uric  acid or phosphate  of lime, are
sufficiently pathognomic.  It is usual, however, in all such cases, to
examine the bladder  by a sound, which commonly puts the question
beyond all dispute: though if the calculus be lodged in  a peculiar
 sac or the  fasciculi  of the bladder,  or lurk behind some  morbid
 enlargement  of the  prostate  gland, the sound  may not detect  it,
 and the experimenter may deceive himself and  the patient in re-
 spect to the nature of the disease.
   The treatment of  this disease offers two indications, a palliative
 and a radical.
   The palliative may be applied to relieve the actual symptoms,
 and to prevent a  further enlargement of the calculus.
   The  symptoms  vary  greatly in  different cases :  partly, indeed,
 from the size of the  calculus itself, but quite as much from the con-
 stitutional irritability of the bladder and the particular  quarter of
 it in which it is seated.   In a few persons, the bladder has possess-
 ed so little morbid excitement that stones of considerable magnitude
 have been found in this organ after death  without having produced
 any very serious inconvenience during life.   If the calculus be irti-
 mediately seated on the neck  of the bladder, itis, however, almost
 impossible for the most impassive  not to  suffer severely at times.
 But the stone has sometimes found a fortunate lodgment between
 the muscular fascicles of the bladder, where it has become imbedded
  as in a pouch, and a train of morbid symptoms, which have antece-
  dently shown themselves, have gradually disappeared in proportion
  as this change has been affected.
    Mr. Nourse showed to the Royal Society the bladder of a man in
  which not less than  six sacs or bags were in this manner produced
  by a protrusion of the internal coat of the bladder through the mus-
  cular, and which  contained altogether nine stones.*  The stones
  are sometimes fixed so  firmly that it is impossible to separate them
  by the forceps in performing the operation  of lithotomy,  without
  tearing the bladder  or cutting one side of the sac ; which last me«
* Mem. 4<52. Sect. 3. 
352
ECCRfTICA.
[CL. VI.—OR. H.
 thod M. Garangeot informs us he once tried with success.  In seve-
 ral other cases, however, that he has  described, the vessels of the
 bladder had spread luxuriantly over the stone, and apparently grown
 into it;  and the extraction was  followed by a mortal hemorrhage.*
 Generally speaking, calculi, when seated in pouches of this  kind,
 continue without much disturbance for years, and sometimes for the
 whole  of a man's natural life, of  which Dr. Marcet has given various
 striking examples in his  treatise.
   Art  cannot scoop out such convenient receptacles, but it may do
 something to allay the irritability of the bladder when severely ex-
 cited, and  in this manner palliate the  distressing pain that is often
 endured.   This may frequently be accomplished by the warm-bath ;
 by rubefacients  impregnated  with opium applied to the  region of
 the pubes,  and in the course of the perinaeum ; by cooling aperients
 and  a steady use of sedatives, and particularly of conium.  If these
 do not answer we must have  recourse to opium, which  will  often
 succeed  best  and with least inconvenience to  the constitution, if
 introduced into the anus in the form of a suppository.
   Our  next intention should be  to  prevent,  as far as possible, an
 augmentation of the  calculus already  existing in the bladder.
   In order to accomplish this, it will  be necessary to inform  our-
 selves of its chemical constituents, for otherwise  any method we
 may propose will probably do harm.   From  the remarks already
 made, it  is obvious that the chief constituent principles of the cal-
 culi  in  the  bladder, like  those in the kidneys, are uric acid and
bone-earth, or phosphate  of lime.  If  the former predominate the
urine will often throw down a precipitate or incrustation of red sand];
if the latter, of white sand ; and in the former  case, as there is an
excess  of uric acid, our remedial forces must be derived from the
alkalies and alkaline preparations to which we have already advert-
ed under the preceding species : in the latter case, as there is, in
 all probability, a deficiency of acid, we must have recourse to an
 opposite mode of treatment, and  employ the  mineral and vegetable
acids, with a diet chiefly composed of vegetables, as recommended
above under renal calculus.
  But the calculus may consist of both, for it may exhibit, and often
does, a nucleus of crystallized uric acid with laminae of phosphate
of lime, magnesia, or some other substance :  or, by carrying either
of the above processes to an extreme,  we may convert one morbid
action into another.   For if, by the use of alkalies, we diminish too
much the secretion of uric acid,  we may let loose the calcareous
 earth, which, in a healthy proportion,  it always holds  in solution,
 and hereby increase the vesical calculus by supplying  it  with  this
material; while, on the contrary, by an undue  use of acids where
 these are required to a certain extent, we may obtain a secretion
 of uric acid in a morbid excess, and augment the stone in the blad-
 der by  a  crystallization of an opposite kind.   Hence a very consi-
* Mem. de l'Acad. de Chirurg. torn. I. 
 OE. IV.—SP. II.]     EXCERNENT FUNCTION.                353

 derable degree of skill and caution is requisite in the mode of treat-
 ment, and the character of the urine should be watched perpetually.
 Nor, where the calculus is of a still more composite kind, can either
 of these plans be attended with all the success they seem to ensure,
 so that the augmentation will  sometimes  be found to proceed  in
 spite of the best directed efforts.
  From the success that  has  attended the  use  of the colchicum
 autumnale in many cases of gout, and the tendency there is in many
 cases of this disease to form calculi in the joints, Mr. Brande has
 ingeniously thrown out the idea of trying the virtue of the  colchi-
 cum in the disease  before  us,  and hints that he has  received from
 one quarter a very flattering account of its success, though not suffi-
 ciently precise for publication. If the reasoning pursued in examin-
 ing the powers and effects of the colchicum in that part  of the
 present work which is allotted to the  history of gout,  be correct,
 we can have little hope of any permanent advantage from  its use
 in respect to the  lithic concretions before us.  It has there appear-
 ed  that the colchicum does not act as a preventive but as an anti-
 dote, during the prevalence of a paroxysm. Nor does  it act in
 this last way in all paroxysms, but chiefly, if not  solely, in those
 of the regular form of gout, in  which the general state of the con-
 stitution is  sound and vigorous, while in atonic gout it seems from
 the violence of its effects, not  unfrequently to add to  the  evil.
 Yet it is in this last modification of gout that calculi are only found
 to concrete in the joints : the deposit rarely, if ever, taking place,
 till the constitution has been seriously  shaken  by  a  series  of at-
 tacks, evidencing, as in the case  of similar deposits in the coats of
 the vessels and the parenchyma of various organs in  old people, a
 general torpitude and  debility  of the excernent system.  Upon
 which subject the reader may turn to the genus osthexia* in a pre-
 ceding order of the present Class.
  There is something perhaps more plausible in the remedial regi-
 men proposed by M. Magendie, who, on reflecting  that azote is an
 essential constituent of urea and  uric acid, advises that the patient
 be  confined to food that possesses no sensible portion of azote,  as
 sugar, gum, oil-olive, butter, and a  vegetable diet generally :f thus
 treating it with a  dietetic course directly the reverse of what is now
 generally  proposed for paruria  mellita, or diabetes.
  From the whole that has been advanced not only under the pre-
 sent genus, but also under much of the  preceding, itis obvious that
 the soundness of  the urine keeps pace, in a considerable degree,
 with the soundness of the  stomach and its auxiliary organs,  and is
 dependent upon them : and hence in calculous concretions of every
 kind it is of the utmost importance that the chylifacient viscera,
and the whole course of the intestinal canal, should be kept in  as
healthy a  state  as possible.
   • Supra, p. 233.
   f Hecherches Pbysioloeiques et Medicales, &c. ut supra.
Vox, IV.—Y y 
354
ECCK1T1CA.
[CL. VI.—OR. H.
  Astringents and bitters offer to us the best remedies  for  this
purpose.  From the supposed absorbent power of the former, Dr.
Cullen, as we have already seen,  ascribes  to them much of the pe-
culiar  benefit resulting from the use of alkalies and magnesia, in-
dependently of their decided virtue as a tonic : nor ought we, while
upon this subject, to overlook the advantage which, in calculi of uric
acid at least, the same distinguished writer asserts that he derived
from the use of soap, which  he ascribes entirely  to its correcting
acidity in stomach ;* thus acting the same part as magnesia,  and
in many cases with greater potency.
  If such be the difficulty of preventing a calculus already formed
in the  bladder from enlarging, we may readily see how hopeless
must be every attempt at dissolving the matter that has already be-
come crystallized or concreted.   Calculi of uric acid  will dissolve
in caustic alkalies, but in no  alkalies of less power: nor can those
of the phosphates be acted upon by acids  of any kind, except in a
state far too concentrated for medical use.  " These considerations,"
says Mr. Brande, " independently of more urgent reasons, show
the futility of attempting the  solution of a stone of the bladder by
the injection of acid and alkaline solutions.   In  respect to the al-
kalies, if sufficiently strong to act upon the uric crust of the calcu-
lus, they would certainly injure the coats of the bladder: they would
also become inactive by combination with the acids of the urine:
and they would form a dangerous precipitate from the same cause.
The acids, even when very largely diluted, and qualified with opi-
um, always  excite great irritation.  They cannot,  therefore, be
applied strong enough  to dissolve any appreciable portion of the
stone,  and  the uric nucleus always remains as an ultimate obstacle
to success."f  The greatest impediment  of all,  however, consits
in the  difficulty of ascertaining the nature of the surface of the stone
that is to be acted upon, and the  diversity of substances of which
its various laminae very frequently consist: insomuch that had we
glas-.e* that could give us an  insight into the bladder and unfold
to  us  the  nature of the first layer, and could  we  even  remove
tins superficial crust by a solvent of one  kind, we should be per-
petually meeting with  other  crusts that would  require  other li-
thontriptics, while the  very   means we employ  to dissolve them,
by decomposing the principles of the urine, would build up fresh
layers faster than we could hope to destroy those that have already
concreted.
   In truth, if we examine the most  famous lithontriptics that have
had their day, we shall find that by far the greater number of them
were calculated to deceive either their own inventors, or the public,
jy a palliative rather than a  solvent power.   Some of them  were
oleaginous or mucilaginous ;  others, that  contained a considerable
portion  of  alkali,  contained  also some narcotic  preparation:
* Mat  Med. Part. II. Chap. X. p. 402.
f Journal, Vol. VIII. p. 215. 
«E. IV.—SP. II]     EXCERNENT FUNCTION,
355
 while a third sort seem to have acted by a diluent power alone, in
 consequence  of being taken into  the stomach or injected into the
 bladder in a  very large quantity; and by these means  all had a
 tendency to appease the irritation. Even Mrs. Stephen's rude and
 operose  preparations which  exercised so much of the  analytical
 skill of Dr. Hales, and Dr.  Hartley, and Dr. Lobb, and Dr. Jurin,
 and many other celebrated characters of their day, were combined
 with opium when the patient was  in pain, and with aperients when
 he  was costive ;  and through their entire use, with an abstinence
 from port wines and other fermented liquors, salt meats, and heat-
 ing condiments, and with rest and a reclined position instead of ex-
 ercise ; and with these auxiliaries there is no great difficulty in sup-
 posing she might often succeed in allaying a painful  fit of  stone
 or irritation of the bladder, whatever may be the talismanic virtue
 of her egg-shells, and pounded snails, and  best Alicant  soap, and
 cresses, and burdock, and parsley, and fennel, and hips,  and haws,
 and the twenty or thirty other materials that held a seat in the ge-
 neral council.*
   How far filling the bladder with sedative or demulcent  injections
 may succeed  in diminishing irritation and alleviating pain, has not
 perhaps been sufficiently tried : but from the supposed success of
 many of the old lithontriptics employed in this way, and whose vir-
 tue can be ascribed to no other cause, it is a practice worth adven-
 turing upon in the present age of physiological experiments. When,
 however, there is much disease of the prostate or bulb of the  ure-
 thra, the attempt should be desisted from, but wherever  the sound
 can  enter  without much pain, we  need not be afraid of increasing
 the irritation. This operation is of very ancient date, and of equally
 extensive range, as appears from  a brief account, published  in a
 professional journal of considerable merit, of the manner in which
 it is performed in the present era, and has been from time imme-
 morial in the  dominions of Muscat, beyond the mountains of So-
 hair in Arabia.  The instrument employed  is a catheter of gold,
 made long enough to pass directly into the bladder, so as to avoid
 injuring any part of the urethra with such solvent as might be had
 recourse to.   The usual form it  appears, and I notice  it for the
 purpose of confirming the remarks 1 have made upon the nature of
 such lithontriptics as have been most in vogue in every age, con-
 sisted of a weak ley of alkali or alkaline ashes, united with a cer-
 tain proportion of mutton suet and opium.t   And  when we are
 gravely told that this preparation never fails to dissolve the stone,
 we are at no loss to settle the  account upon this subject, and can
 trace the  real cause  of whatever degree of ease may have been
 derived from such an  injection, and can allow that even the alkali
 itself, if not in too concentrated a state, may have been of occasional
 advantage.

  * See a full account of them in the Edin. Med. Essays, Vol. V. Part II. Art,
LXIX.
  f Edin. Med. Comm. Vol. III. p. 334. 
356
ECCRITICA.
(CL. VI.—OR. If.
  When, however, all these  means of relief fail, and the general
health is worn out by a long succession of pain and anxiety, no-
thing remains but the operation of extraction.   The shortness and
expansibility of the  urethra  in women, which allows, as we have
already seen, a passage for calculi of a considerable calibre to pass
naturally, has suggested an idea of the possibility of introducing a
stone forceps into the female bladder so as to supply the place of
lithotomy.   The first hint of this kind that has occurred to me, is
to be found in the Gallicinium Medico-practicum of Gockel, pub-
lished in Ulm, in 1700. It was afterwards taken up, perhaps, origi-
nally started, by Mr. Bloorafield, who ingeniously advised that the
urethra should, for this purpose, be dilated by forcing water through
the gut of a fowl introduced into the urethra as an expansile canuia.
Mr. Thomas has since, by the use of a sponge-tent gradually en-
larged  for the purpose, succeeded  in introducing his finger into
the bladder,  and bringing  away an ivory ear-pick which had been
incautiously used as  a catheter, and had slipped into  the cavity of
this organ.*
  This, however, is a method that never can be applied to males,
nor even successfully to females,  except where the calculus is com-
paratively of small dimensions, or the meatus is so far dilated by
the passage of former calculi as to render  it unnecessary.   In all
other cases lithotomy offers the only means of removing the indis-
soluble  stone from the bladder; and for the  various modes in which
this is performed, the reader  must consult the writers on practical
surgery.
  Calculi thus extracted have been found of all weights and bulks.
a stone from a quarter of a pound to half a pound may, perhaps, be
regarded as the ordinary average: but they have sometimes grown
to a much larger size, and have still been safely extracted.   The
largest  for which lithotomy seems at any time to have been per-
formed  in this country, weighed forty-four ounces, and was sixteen
inches in length.   The operation was performed by Mr. Cline, but
the  stone could not be brought away, and the patient died a few
days after.t  In a foreign  journal of high reputation, we have an
account of a calculus found in the bladder after death, that weigh-
ed four pound and a half, or seventy-two ounces, and seems to have
filled nearly the whole of its  cavity4
* Transactions of the Medico-Chir. Soc. Vol. I. p. 124
f Phil. Trans, year 1809.
t Bresl. Sammlung. Band. II. 1724. 434. II, 
      CLASS VI.

ECCRITICA.
                        ORDER III.


                      ACROTICA.

         Efseases affecting the Eternal Surface.

 GRAVITY OF THE FLUIDS OR EMUNCTORIES THAT OPEN ON THE EXTER*
   NAL SURFACE ; WITHOUT FEVER, OR OTHER INTERNAL AFFECTION,
   AS A NECESSARY ACCOMPANIMENT.

 Acrotica is a Greek term, from xxfos, " summus," whence xx^otta-
 vtos,  "summitas," "cacumen."  The excretories of the skin form
 a most important outlet of the system, and although the fluid they
 secrete, is, in a state of health, less  complicated than that of the
 kidneys, under a variety of circumstances it becomes more so.  It
 is to this quarter that all the deleterious or poisonous ferments pro-
 duced by eruptive fevers are directed by the remedial power of
 nature, as that in which they  can be thrown off with least evil
 to the constitution.  By the close sympathy which the surface of
 the body holds with the stomach,  the heart, the lungs, and the kid-
 neys, its excretories are almost perpetually varying in their action,
 and still more so from their direct exposure  to the changeable state
 of the atmosphere : in consequence of which they are one moment
 chilled,  torpid, and  collapsed, and perhaps the  next violently
 excited and irritated: now  dry and  contracted,  now relaxed and
 streaming with moisture ; now  secreting their natural  fluid alone,
 and now charged with acrimonies of every kind, acid, alkaline, and
 saburral: and sometimes with a load of gluten or calcareous earth
 that hardens into horn or shell.
  But the mouths of the cutaneous exhalants are in their own na-
 ture peculiarly delicate and tender; and hence the necessity of their
 being covered by the epithelium  of a fine cuticle, which defends
them in a considerable degree from the rudeness of external im- 
358
ECCRITICA.          [CL.VL—OR. IH.
pressions or irritants with which the air is  impregnated. This de-
fence, however, they frequently lose; often from external violence,
and often also from the acrimony or roughness of the materials that
are thus transmitted to them, and which excoriate as effectually as
friction, a keen, frosty north-east wind, or the direct rays of a tro-
pical  sun.   And at times the  absorbents of the skin are torpid or
weak in their action ; and the finer parts only of the fluids that are
secerned are imbibed and carried off, while the grosser parts remain
and accumulate in the  cutaneous follicles, and become acrimonious
from  decomposition.   And hence  a  great variety of  superficial
eruptions, papulous, pustulous, and  ichorous, squammose, or furfu-
raceous. And not unfrequently there is a constitutional  irritability
of the skin which not only renders it peculiarly liable to be excited
by small causes in every  part, but to sympathise  in the  morbid
action through its whole extent in whatever part it may commence :
and hence the spread of eruptions to a greater or less extent, some-
times, indeed, over the entire surface.
   From these sources of affection a variety of complaints must ne-
cessarily take their rise, none of them perhaps fatal to life, but
many of them  peculiarly troublesome and obstinate.   They  may
be arranged under the following genera:

         I. EPHIDR0SIS.          MORID SWEAT.
        II. EXANTHESIS.         CUTANEOUS BLUSH.
       III. EXORMIA.           PAPULOUS-SKIN.
       IV. LEPIDOSIS.           SCALE-SKIN.
        V. ECPHLYSIS.          BLAINS.
       VI. ECPYESIS.           SCALL.  TETTER.
      VII. MALIS.               PUTANEOUS  VERMINATION.
      VIII.  ECPHYMA.            CUTANEOUS  EXCRESCENCE.
       IX. TRICHOSIS.          MORBID HAIR.
        X. EP1CHROSIS.          MACULAR SKIN.

   Most of these genera contain numerous species, many of which,
though by no means all,  form a part of Dr. Willan's arrangement,
and have been described by himself or my late excellent friend Dr.
Bateman, of whose  labours I shall avail myself as far as they may
answer the present purpose. 
6E. I.]
EXCERNENT FUNCTION.
359
                       GENUS I.

                    EPHIDROSIS.

                      plortOr  Stocat.

     PRETERNATURAL SECRETION OF CUTANEOUS PERSPIRATION.

Ephidrosi (eQtfyacrti) is a Greek term for "sudor " The matter of
sweat and that of insensible perspiration are nearly the same ; the
former consisting of the latter with a small intermixture of animal
oil. It is affirmed by some writers that there are persons who never
perspire.  This demands ample proof; for experience teaches us
that all warm-blooded animals either perspire by the skin, or have
some vicarious evacuation that supplies its place, as in the case of
the dog kind, in which an increased  discharge  of saliva  seems to
answer the purpose ; though in violent agony, I have known a New-
foundland dog thrown into a sweat that has drenched the  whole of
his thick and wavy hair.   In cold-blooded animals we sometimes
find partial secretions, as in the lizards, the exudation from  some
of which, particularly the  lacerta Geitja of the Cape of Good Hope,
is highly acrid;  and as it touches the hand and feet of man  occa-
sionally produces dangerous gangrenes.  Generally speaking, how-
ever, cold-blooded animals secrete but a small quantity of fluid from
the surface, and  consequently suffer but little exhaustion or  dimi-
nution of weight, and  an live long without nourishment:  and it is
hence probable  that, among mankind, those who throw  off but a
small quantity of halitus  may exist upon a  very  spare supply of
food,  which may afford a solution  to many of the wonderful stories
of fasting persons, most of whom seem to have passed sedentary
and inactive lives, recorded in the scientific journals of  different
countries, a subject we have already discussed :* for the matter of
insensible perspiration is calculated, upon an average, as being daily
equal in weight to half the food introduced into the stomach in the
course of the day.  Thus if a man of good health and middle age,
weighing about 146 pounds avoirdupois, eat and drink at the rate
of fifty-six ounces in twenty-four hours, he will commonly  be found
to lose about twenty-eight ounces within the same period by in-
sensible perspiration: sixteen ounces during the two-thirds of this
period allotted to wakefulness, and  twelve  ounces during the re-
maining third allotted to sleep.
   It sometimes happens that this  evacuation is secreted in excess,
and becomes sensible, so as to render the whole, or various parts of
the body, and especially the palms of the hands, covered with mois-
• Vol. T. Class. I. Ord. I. Limosis expers, p. 76. 
360
ECCRITICA.           [CL. Vl.-Ott. Ill
ture, without any misaffection of the system.  It is to this species
that the term ephidrosis has been usually applied and limited by
nosologists.   Sauvages, however, has employed it in a wider signi-
fication, so as to include various  other species, and perhaps cor-
rectly ; though Cullen inclines to regard all but the first as merely
symptomatic of some other complaint.
  The following appear to be those which are chiefly entitled to1»
specific rank:

     1. EPHIDROSIS PROFUSA.         PROFUSE SWEAT.
    g. —---------- CRUENTA.         BLOODY SWEAT.
    3.-----------PARTIALIS.         PARTIAL SWEAT.
    4# ______._____DISCOLOR.         COLOURED SWEAT.
    5, ___________ OLENS.            SCENTED SWLAT.
    6.-----------ARENOSA*         SANDY SWEAT.
                       SPECIES I.

               EPHIDROSIS  PROFUSA.

                     iirofuse Stocat.

        CUTANEOUS PERSPIRATION SECRETED PROFUSEL1.

This is commonly a result of relaxed fibres : the mouths of the cu-
taneous exhalants being too loose and patulous, and the perspirable
fluid flowing forth copiously and rapidly upon very slight exertions,
sometimes without any exertion at all; as we have already seen
the urine flows in paruria aquosa, and the serum in various species
of dropsy.
  There is here, generally speaking, less solution of animal oil than
in perspiration produced by exercise or hard labour :* but from the
drain that is perpetually taking place, no animal oil accumulates, and
the frame  is usually slender.  Corpulent  persons also perspire
much, but this is altogether from a different cause, being that of
the weight they have to carry, and  the labour with which breathing
and every other function is performed in consequence of  the gene-
ral oppression of the system. Here also an extenuation of the frame
Would  soon follow, but that from  the peculiar diathesis which so
readily predisposes to the  formation of fat the  supply is  always
equal to, and for the most part continues to exceed the waste, un-
less a more than ordinary course of exertion be engaged in.
   In persons of relaxed fibres, but whose general health is sound,
I have frequently perceived that there is no particular liability to
* Biishner, Die. de Sudore colliquative. Hal. 1757. 
GE. I.—SP. I]      EXCEKNENT FUNCTION.
361
catch cold, notwithstanding this tendency to perspiration, and have
very often seen it suddenly checked  without any evil: such is  the
wonderful effect of an established habit.   But the moment the ge-
neral health suffers, or the  system becomes seriously weakened by
its continuance, the sweat is apt to become colliquative, and to ter-
minate in a tabes or decline.*
  Tulpius gives a case of its continuing for seven years.f  Astrin-
gents of  all kinds have been tried, but with variable effects.  Dr.
Percival  relied chiefly  on bark; De  Haen  employed  the white
aganc.J and in the Journal  de Medicine,§ the same medicine is re-
commended under the name of fungus laricis ; it is the boletus la*
ricis of the present day.   It was  given in the form of troches and
pills.   Cold  sea-bathing, and  the mineral acids, with temperate
exercise, light animal food, and the use of  a hair mattress instead
of a down bed at night, have proved successful on many occasions,
and form the best plan we can adopt.
                        SPECIES  II.

               EPHIDROSIS CRUENTA.

                       ftlootrs Sfocat.

       CUTANEOUS PERSPIRATION INTERMIXED WITH BLOOD.

This species has not been very commonly described by nosologists 5.
but the cases of idiopathic affection are so numerous and so clearly
marked by other writers, that it ought not to  be passed over.||
  We have noticed a sympathetic and vicarious affection of this kind
under the genus mismenstruation,! and have there observed that
the cutaneous  exhalants, in such instances,  become  enlarged in
their diameter, and suffer red blood, or a fluid  of the appearance of
red blood, to pass through them.  In cases of extreme debility from
other causes, as in the last and fatal stage of atonic fevers, or in sea
or land scurvy,** blood has been known to flow from the cutaneous
exhalants in like manner, evidently from weakness, and a relaxation
©f their extremities, in connexion perhaps with a thinner or more
            * See Vol II p. 474.
            f Lib. HI. Cap. 42.
            * Rat. Med. P.  XII. Cap. vi. § 6.
            § Tom. XLVII.
            II Ploucq. Init. VII. 316.
            1 Vol. Ill p 45.
            ** N. Act. Nat. Cur. Vol. IV. Obs. 41,
               Bresl. Samml. 1725. I p. 183.
Vol. IV.—Z z 
362
ECCK1TICA.
[CL. VI.—OR. in.
dissolved  state of the  blood  itself.  None of these, however, are
idopathic  affections.  When  the discharge shows itself as a pri-
mary disease, the cause has generally been some violent commotion
of the nervous system forcing the red panicles into the cutaneous
excretories, rather than a simple influx from a relaxed state of their
fibres.   And hence it has taken place occasionally during coition ;*
sometimes during vehement terror; and  not unfrequently during
the agony of hanging or the torture.t  It is  said also to have oc-
curred in some instances in new-born infants,! probably from  the
additional force given to the circulation, in consequence of a full
inflation of the lungs accompanied with violent crying.
                       SPECIES III.

              EPHIDROSIS  PARTIALIS

                      partial .Storat.

CV IANEOUS PERSPIRATION LIMITED TO A PARTICULAR PART OR ORGAN'

There are some persons who rarely perspire, others who perspire
far more freely from  one organ than another, as the head, or the
feet, or the body.  Such abnormities rather predispose to morbid
affections, than are morbid affections themselves.  Sauvages, in il-
lustration  of the  present species, quotes a case from  Hartmann, of
a woman who was never capable of being thrown into a sweat either
by nature  or art  in any part of her body except when she was preg-
nant, at which time she perspired  on the left side alone.§  Schmidt
has noticed a like anomaly.W
  In this last case it is probable that the kidneys became a substi-
tute  for the action  of the cutaneous exhalants, as we see they do on
various occasions, as when their mouths become collapsed from the
chilly spasm that shoots over them on plunging into a cold bath, or
in a  fit of hysterics.
  The sweat thus discharged from a partial outlet, is  frequently
fetid, as under the fifth species of the present genus ; and where it
is constitutional, it is often repelled with great danger to some more
important organ.
* Paullini, Cent. III. Obs. 46.
  Eph. Nat. Dec. II. Ann. VI. Appx. pp. 4. 45.55.
\ Bartholinus, Kpist. I. p. 718.
\ Eph. Nat. Cur. Dec. II. Ann. X. Obs. 65.
§ Hartmanni, De Sudore unius lateris, 4to. 1740
H Collect. Acad. Vol. III. p. 577. 
GE. ?.—SP. IV.]      EXCERNENT FUNCTION.
3$5
                       SPECIES IV.

              EPHIDROSIS DISCOLOR.

                     (Eolouretr Stoeat.

   CUTANEOUS PERSPIRATION POSSESSING A DEPRAVED TINGE,

sweat is often tinged with a deeper  yellow than is  natural to  i
from a resorption of bile into the bloodvessels :  and, as we hav e
already seen, it is sometimes intermixed with blood, from violence'
or a relaxed state of the cutaneous exhalants.  And where these,
or causes like these, co-operate, we can  readily account for the
various colours it has sometimes exhibited, as green, black, blue,
saffron, or ruby:  examples  of  all which are referred to in the
volume of Nosology.   We see, indeed, the whole of these hues,
produced  daily under the cuticle, from the extravasation of blood,
according as the effused fluid is more or less impregnated with the
colouring  matter of the blood, and the finer and more limpid parts
are first absorbed and carried off. It is possible, also, that in some
of the cases referred to,  the stain  may have been  produced by
inhaling a vapour impregnated with metallic corpuscles, or some
other  pigment;  and especially when working  in  metallurgical
trades or quicksilver mines.



                       SPECIES V.

                EPHIDROSIS  OLENS

                     Scentetr Stoeat.

   CUTANEOUS PERSPIRATION POSSESSING A DEPRAVED SMELL

The varieties that have been chiefly noticed are those of a sulphu-
reous scent; of a sour scent; of a rank or fetid scent; of a violet,*
and of a  musky scent.t  The rank or fetid scent  is sometimes
partial; being only evacuated from particular organs, as the feet
and axilla. De Monteaux, however,  has found the same  thrown off
generally  :% and, as a symptom in atonic fevers, it must  have been


           • Paullini, Cent. I. Obs. 21.
             Eph. Nat. Cur. Dec. II. Ann. V. Appx. p. 9.
           t Id. Dec. III. Ann. IX. X. Obs. 96.
           $ Maladies de Femmes, torn. II,. 
£64
ECCIUTICA
[CL. VI.—OH. Ill
 witnessed by most practitioners, as also in several sordid cutaneous
 eruptions.  In fevers, moreover, we frequently meet with a secre
 ti >n of sour, perspiration, which, in a few instances, has had  the
 pungency of vinegar.   When  such smells accompany diseases,
 they usually cease on the cessation of the disease which gives rise
 to them.  Where they are habitual, they often depend upon amor-
 bid state of the stomach, or of the cutaneous  excretories ; and, will
 often yield to a course of aperients or alterants, a frequent use of
 the warm, and, when the constitution will allow, of the cold bath,
 and such exercise as shall  call  forth a copious discharge  of per-
 spirable matter, and free the cutaneous follicles, or orifices, of what-
 ever olid materials may lurk there.
   Many  of these,  however, are often dependent upon the diet or
 manner of life.   Thus, the food  of garlic yields a perspiration pos-
 sessing a garlic smell: that of peas, a leguminous smell, which is the
 cause  of this peculiar odour among the inhabitants of Greenland:
 and acids a smell of acidity.  Among glass-blowers, from the large
 quantity of sea-salt  that enters into the materials of their manufac-
 ture, the sweat is sometimes so highly impregnated, that the salt
 they  employ  and imbibe  by the skin  and  lungs, has been seen
 to collect in crystals upon their faces.   A musky scent is not often
 thrown forth from the human body, but  it is perhaps the most com-
 mon of all odours that escape from the skin of other animals.  We
 discover  it  in many of the ape kind, and especially the simia
 Jacchus ; still more  profusely in the opossum, and  occasionally in
 hedge-hogs, hares, serpents, and crocodiles.   The  odour of civet
 is the production of the  civet-cat alone; the viverra Zibetha,  and
 viverra Civetta of Linneus, though we meet with faint traces of it
 in some varieties of the domestic cat.  Among  insects,  however,
 such odours are considerably more common, and by far the  greater
 number of them  are of an agreeable kind, and of very high excel-
 lence;  for  the musk scent of  the cerambix moschulus, the apis
fragrans, and the tipula moschiferu,  is much more delicate than
 that of the musk  quadrupeds :  while the cerambix suaveolens, and
 several species of the ichneumon, yield the sweetest perfume of the
 rose; and the petiolated sphex, a balsamic ether, highly fragrant, but
 peculiar to itself.
/ 
GE. I.—SP. VI.]      EXCERNENT FUNCTION.                365
                       SPECIES  VI.


              EPHIDROSIS  ARENOSA.


                      San&g Stoeat

CUTANEOUS  PERSPIRATION CONTAINING  A DISCHARGE OF SANDY OR
                 OTHER GRANULAR MOLECULES.

As the odorous particles of both animal and  vegetable food are
sometimes absorbed by the lacteals and  impregnate the matter of
perspiration, so at times are the more solid  particles  of the mate-
rials employed in handicraft  trades absorbed by the lungs,  and
equally thrown forth upon  the surface.   This, as observed under
the last species, is particularly the case with  glass-blowers, upon
whose  forehead and arms salt is often seen to collect and crystal-
lize  in great abundance, from the  quantity of  this  material which
they employ in the manufacture of glass, and its diffusion through
the heated atmosphere  of the workshop in minute and impercepti-
ble particles.
  But  a reddish sandy  material is occasionally found to concrete on
the surface of the body under other circumstances, and which  can-
not be  charged to any material volatilized in the course of business.
Bartholin, Schurig,* Mollenbroek,tand  various other writers, have
given instances of this  kind of crystallization, which seems to  con-
sist in  an excess of free uric acid, translated from the kidneys to the
skin by an idiopathic sympathy, and forming red sand on the  sur-
face, as it probably would otherwise have done in the bladder or the
urinal.  It is possible,  indeed, that a man may hereby escape from
the fabrication of an urinary calculus, or stone  in the bladder: and
were such a transfer at all times in our power, we should  gladly
avail ourselves of it in  many cases  of a lithic diathesis, and employ
it as a  preventive of urinary concretions.  When the sand is trou-
blesome from the  quantity collected, the alkaline and other medi-
cines recommended under lithia renalis\ will easily remove it.§
* Litholog. p. 235.
f De Vasis, Cap. XIII.
% Hist. Anat. Cent. I. 34,
i Supra, p. 346. 
366
ECCR1T1CA
[CL. VI.—OR. III.
                     GENUS  11.

                 EXANTHESIS

                   (Cutaneous iSlttsh-

S1MFLE, CUTANEOUS, ROSE-COLOURED EFFLORESCENCE, IN CIRCUM-
       SCRIBED PLOTS, WITH LITTLE OR NO ELEVATION.

Exanthesis is a Greek compound from t\ " extra" and «»0f« " flo-
reo," superficial or cutaneous efflorescence, in contradistinction to
enanthesis, in Class III. Order IV., ash-fever or " efflorescence
springing from within."
  This genus affords but one known species,  the specific name for
which is taken from Dr. Willan:

    1. exanthesis roseola.             rose-rash.
                      SPECIES I.

             EXANTHESIS ROSEOLA.

                      ftosotflush.

efflorescence in blushing patches, gradually deepening to
  a rose colour, m >stly circular, or oval j often alternate-
  ly fading and reviving; sometimes with a colourless um-
  bo ; chiefly on the cheeks, neck, or arms.

Roseola was sometimes employed by the older writers, though in a
very loose sense, to signify scarlet-fever,  measles, and one or two
other exanthems that were often confounded ; but as it is now no
longer used for these it may stand well enough as a name for the
present  species, which Fuller has described as a flushing all over
the body like fine crimson, which is void of danger, and " rather a
ludicrous spectacle than an ill symptom.""
  As a symptom, this rash is frequently met with in various mala-
dies.  Thus in the dentition of infancy it appears on  the cheeks;
in the inoculated  cow-pox, around the vesicle; in dyspepsy, and
various fevers,  in different parts of the body, constituting varieties,
several of which, by Dr. AVillan, are named according to the disease
* Exanthematologia, p. 128.
 Bateman's Synops. 95. 
 «E. II—SP. I.]      EXCERNENT FUNCTION.                s6f

 they accompany, Roseola infantilis, R. variolosa, R. vaccina, and R
 miharis : but which, as mere symptoms of other disorders, are to
 be sought for in the diseases of which they occasionally form a part
  m In the spring and autumn it often appears to be idiopathic esne-
 cialfy m irritable constitutions.  The occasional causes are fatiaue
 sudden alterations  of heat  and  cold, or the drinking of very cold
 water after violent exercise. Dr. Willan mentions one instance of
 its occurring  after sleeping in  a damp  bed.  It has sometimes
 been mistaken for an eruption of the measles, and still oftener, for
 that of a mild rosalia or scarlet fever, of  which last error the same
 author gives an example in a child that  was extensively affected
 with it,  about midsummer,  for  several years in  succession  and
 whose attendant physician  informed the  parents that the scarlet
 tever had recurred in their child  seven  times; and hence  one
 reason why the same was formerly applied to all these.
   The attack is sometimes preceded, during the heat of summer
 by a slight febrile indisposition.  It appears first on  the face and
 neck,  and, in  the course  of a day or two, is distributed over the rest
 ot the body.  The  eruption  spreads  in small patches, of  various
 figures, but usually larger than those of measles, often as large as a
 shilling, at first of a brightish red, and soon settled into the deeper
 hue  of the damask rose.  It sometimes assumes an annular form
 and  appears over the body in rose-coloured rings, with central areas
 or umbos, of the usual colour of the skin : the rings  being at first
 small,  but gradually dilating to the diameter of half an inch.
  This rash is troublesome, but of little importance otherwise.  In
the medical treatment of it, the state of the stomach and bowels
should be particularly inquired  into, and, for the most part, will
be found to require  correction. Acidulated drinks, with occasional
and gentle laxatives, generally remove the disease, unless it be con-
nected with any  constitutional or visceral affection, when it some-
times proves very obstinate,  and  can  only be cured by curing the
primary malady.                                         &
                      GENUS III.

                       EXORMIA

                     iiajmlous Sfcur.

mall acuminated elevations of the cuticle; not containing
 a fluid, nor tending to suppuration ; commonly terminat-
 ing in scurf.
For the acuminated elevation of the cuticle, which the Latins call
papula, the Greeks h*d two synonymous terms,  ecthyma, («%»*) 
a6&
ECCR1TICA.
[CL. VI.—OR. III.
 and exormia f*f»^*'«)  The first was used most frequently in this
 sense; but as this has, by some unaccountable means, been employed
 very generally to import a very different  eruption, a crop of large
 pustulous, rather than of small  solid pimples, forming a species of
 ecpyksis, or the sixth genus of the present order, I have chosen the
 second term for the present purpose.
   The common terminating diminutive,  (ula or ilia) is probably
 derived from the Greek «5a»? (ule or ile,) " materia," " materies"—
 of the matter, make, or nature of; "thus papula or papilla," of the
 matter or nature  of pappus ; " lupula," of the matter or nature of
 the lupus; "pustula," of  the  matter or nature  of pus ; and so of
 many others.
   Papula and  pustula, which  by Sauvages are degraded into mere
 symptoms of diseases, and  not allowed to constitute diseases  of
 themselves,  are raised to  the rank of genera, by Celsus, Linneus,
 and Sagar, and, under a plural form, (papulae and pustulse,) to that
 of orders by Willan.  In the present system, exormia and ecphlysis,
 intended to  supply  their place, are employed as generic terms, and
 run parallel  with those of papulse and pustulae by Willan, which are
 not essentially connected  with internal disease ;  and are only made
 use of, instead of papula and pustula, first, as being more immedi-
 ately Greek, and  next, in order to prevent confusion from  the  va-
 riety of senses, assigned  to the latter terms, by different writers.
 Exormia and ecphlysis, therefore, as distinct genera, under the pre-
 sent arrangement, import  eruptions of pimples or pustules, in their
 simplest state, affecting the cuticle, or, at the utmost, the superficial
 integument alone, and consequently without fever, or other internal
 complaint, as a necessary or essential symptom ; although some part
 or other of the system may occasionally  catenate or  sympathize
 with the efflorescence.  It is difficult,  indeed, to draw a  line  of
 separation, and perhaps  impossible to  draw it  exactly, between
 efflorescences,  strictly cutaneous and strictly  constitutional, fro in;
 the numerous examples we meet with, of the one description com-
bining with, or passing into, the other.  But a  like difficulty belongs
 to every other branch  of physiology, in the widest sense of the term,
 as well as to nosology; and all we can  do, in any division of the
science, is to  lay down the boundary, with  a9  much  nicety and
caution as possible,  and to correct it, as corrections may afterwards
be called for.
  The species which belong to this genus, or which, in other words,
are characterized by  a papulous skin, not necessarily  connected
 with an  internal affection, are the following:

     1. EXORMIA STROPHULUS.       GUM-RASH.
     2. ■---------LICHEN.           LICHENOUS RASH.
     S. ---------PRURIGO.         PRURIGINOUS RASH.
     4.  ■----    MILIUM.           MILLET-RASH. 
 C»K. III.—SP. I.]     EXCERNENT FUNCTION.                369


                        SPECIES  I.

              EXORMIA  STROPHULUS.

                        Qfttm-ltasfi.

 ERUPTION OF RED PIMPLES IN EARLY INFANCY, CHIEFLY ABOUT THE
   FACE, NECK, AND ARMS, SURROUNDED BY A REDDISH  HALO ;  OR
   INTERRUPTED BY IRREGULAR  PLOTS OF CUTANEOUS BLUSH.

 Dr. Willan has observed, that the colloquial name of Red-gum,
 applied to the common form of this disease, is a corruption of Red-
 gown, under which the disease was known in former times, and by
 which it still continues to be called in various districts ; as though
 supposed, from its variegated plots of red upon a pale  ground, to
 resemble a piece of red printed linen.  In effect, it is written Red-
 gown in most of the old dictionaries : in Littleton's aslale as 1684,
 and I believe to the present day.  The varieties in Willan are the
 following, whose descriptions are large and somewhat loose. We
 may extract  from  them,  however, the subjoined distinctions of
 character;

 a.  Intertinctus.              Pimples bright red ; distinct; inter-
   Red-gum.    .              mixed with stigmata, and red patch-
                              es ; sometimes spreading over the
                              body.
 £ Albidus.                   Pimples  minute, hard, whitish ; sur-
   White-gum.                 rounded by a reddish halo.
 y  Confertus.               Pimples red, of different sizes, crowd-
   Tooth-rash.                 ing or in clusters ; the larger sur-
                              rounded by a red halo; occasionally
                              succeeded by a red crop.
 I* Volaticus.                 Pimples deep-red, in circular patches.
   Wild-fire-rash.               or clusters; clusters sometimes soli-
                              tary on each arm  or cheek;  more
                              generally flying from part to part.
 e Candidus.                 Pimples large, glabrous, shining; of a
   Pallid gum-rash.             lighter hue than the  skin : without
                             halo or blush.

   Generally speaking, none of these varieties are of serious import-
 ance ; and all of them being consistent with a healthy state of all
 the functions of the body, they require but little attention from me-
 dical practitioners.  Several  of them  are  occasionally connected
with acidity or some other morbid symptom of the stomach and
bowels,  and, hence, particular attention should be paid to the primae
viae.  The  system,  also, suffers generally, in many cases, if the
  Vol. IV.—3 A 
370
ECCHITICA.
|CL. VI.—OH.III.
 efflorescence be suddenly driven inwards by exposure to currents of
 cold air, or by the use of cold-bathing.  Both these, therefore, should
 be avoided while the efflorescence continues; and if such an accident
 should occur,  the infant  should be immediately plunged into a
 warm-bath, which commonly succeeds in reproducing the eruption,
 when the constitutional illness ceases.*  In every variety, indeed,
 the  nurse should be directed to keep the child's skin clean, and to
 promote an equable perspiration by daily ablutions with tepid water,
 which are useful in most cutaneous disorders ; and will be found in
 other respects of material  importance to the health of children.
   In the tooth-rash, strophulus  coifertus, there is no difficulty in
 tracing the  ordinary cause.  Yet this also has often  been ascribed
 to a'state of indigestion, or some feverish complaint in the mother or
 nurse.  " 1 have, however," says Dr. Willan, " frequently seen the
 eruption, where no such cause for it was  evident.   It  may  with
 more propriety be ranked among the numerous symptoms of irrita-
 tion, arising from the inflamed and painful state of the gums in denti-
 tion, since it always occurs during the process, and disappears soon
 after the first teeth have cut through the gums."   It may, however,
 like the red-gum, s. intertinctus, be occasionally connected  with a
 "weak and irritable state of the bowels: though the tender and  deli-
 cate state of the  skin, and  the strong determination of blood to the
 surface, which  evidently takes place in early infancy, and is the
 common proximate cause of the red-gum, is probably the common
 remote cause of the tooth-rash.
   The tooth-rash is the severest  form in which strophulus shows
 itself. Instead of being confined to the face and bre'ast, it oftentimes
 spreads widely over the  body, though it appears chiefly, in a diffused
 state, on the fore-arm.   Dr. Willan notices a very  obstinate and
 painful modification of this disorder which sometimes  takes place  on
 the lower extremities.   " The papulae spread from  the calves  of
 the leg6 to the thighs, nates, loins, and round the body, as high  as
 the navel;  being very numerous and close  together, they produce
 a continuous redness over all the parts above mentioned.  The cu-
 ticle presently  becomes shrivelled,  cracks  in various places, and
finally separates from the skin in large  pieces."   It  has some re-
semblance to the intertrigo, which however may be  distinguished
by having an  uniform  red, shining surface without papulae, and
being limited to  the nates and thighs.
   In like manner, those children are most liable to the scrophulus
volaticus or wild-fire rash, who have a fair and irritable skin, though
this also occasionally catenates with  a morbid state of the stomach
and bowels.   It  appears sometimes as early as between the  third
and sixth month,  but more  frequently later.
  This last is the erythema volaticura of Sauvages, the aestus vola-
ticus of many earlier writers : whence the French  name of feu vo-
lage.   All these terms have,  however, been  often  used in a very
* Bronzet, sur l'Education des Enfans, p. 187. 
Cfc. ffi.-SP. 1.1
EXCERNENT  FUNCTION.
371
indefinite sense, and  hence, also, applied to one or two species of
porrigo, and especially porrigo  Crustacea, or crusta lactea.*   And
hence, Dr. Armstrong has described this last disease as a strophulus
or tooth-rash.f
  The strophulus  albidus,  and strophulus candidus, are  the two
slightest  varieties  of this  species  of indisposition.  The first is
chiefly limited to the  face,  neck, and breast, and often continues in
the form of numerous, hard, whitish specks for a long time, which?
on the removal  of their tops do  not discharge any fluid, though it is
probable they were originally formed by a deposition of fluid, which
afterwards concreted  under the cuticle.  The  pimples in the scro-
 Shulus candidus are larger  and  diffused over a wider space :  often
 istributed over the loins, shoulders, and upper part of the arms;
though it  is rarely that they descend lower.  Several of the varie-
ties occasionally co-exist and run into each other, particularly the
first two.t.
                         SPECIES II.

                  EXORMIA  LICHEN

                      afcftrnous Hash.

 ERUPTION DIFFUSE ', PIMPLES RED J TROUBLESOME SENSE  OF TING-
                       LING OR PRICKING.

Lichen (Ae<%»}v •««) is a term common to the Greek phytologists as
well as the Greek pathologists.  By the former it is applied to that
extensive genus of the algae, or rather to many of its species, which
still retain  the  name of lichen  in the Linnean  system: and it is
conjectured by Pliny that the physicians applied  the same name to
the species of disease before us, from the resemblance it  produces
on the surface of the body  to many of the spotty and  minutely
tubercular lichens, which are found wild upon stones, walls, and the
bark of trees or shrubs.  Gorraeus, however, gives two other origins
of the term ; one of which he does not approve, from the eruption
being supposed to be cured  by its being  licked with the human
tongue ;  and the other to which he inclines from its creeping in a
lambent  or tongue-like form, over  different parts of the body.
The derivation in both these cases being /£<#*> "  lambo,"  " lingo."
   It is a far more troublesome  rash than the preceding; from  the
severest modifications of which, however, it chiefly differs by  the
* Astruc, De Morb. Infant, p. 44.'
f On the Diseases of Children, p. 34.
* Underwood, on the Diseases of Children, Vol. I. passim. 
372
ECCRITICA.
[CL. VI.—OH. Ill
intolerable tingling or
characterizes it.  The
* Simplex.
  Simple Lichen.
j3 Pilaris.
  Hair-Lichen.
v Circumscriptus.
  Clustering Lichen.
S~ Lividus.
  Livid Lichen.
t Tropicus.
  Summer-rash.
  Prickly-heat.
£ Ferus.
  Wild Lichen.
sj Urticosus.
  Nettle-Lichen.
pricking which accompanies, and peculiarly
following are its chief varieties :
        General  irritation ; sometimes a
           few febrile  symptoms  at  the
           commencement;  tingling  ag-
           gravated during the night pim-
           ples  scattered  over the body;
           which fade and desquammate in
           about a week.
        Pimples  limited  to  the roots  of
           the  hair ;  desquammate  after
           ten days ;  often alternating with
           complaints of the head  or sto-
           mach.
        Pimples  in clusters  or patches of
           irregular   forms,  appearing  in
           succession over the  trunk and
           limbs ; sometimes  coalescing :
           and  occasionally  reviving  in
           successive crops, and  persever-
           ing for six or eight weeks.
        Pimples  dark-red or livid ; chiefly
           scattered  over the extremities ;
           desquammation at uncertain pe-
           riods, succeeded by fresh crops,
           often  persevering  for  several
           months
        Pimples bright red, size of a  small
           pin's head;  heat, itching, and
           needle-like pricking; sometimes
           suddenly disappearing, and pro-
           ducing sickness or other inter-
           nal affection ; relieved by the re-
           turn of a fresh crop.
        Pimples  in  clusters or patches,
           surrounded by a red halo ;  the
           cuticle growing gradually harsh,
           thickened, and  chappy  i  often
           preceded by general irritation.
        Pimples  very minute, slightly ele-
           vated, reddish: intolerable itch-
           ing, especially at night; irregu-
           larly subsiding,  and  reappear-
           ing ; chiefly  spotting the limbs ;
           occasionally spreading over the
           body   with   gnat-bite-shaped
           wheals; from  the violence  of
           the  irritation, at times  accom- 
GE. III.—SP. II.]      EXCERNENT FUNCTION.                373

                                panied with vesicles or blisters,
                                and  succeeded by  an extensive
                                exfoliation of the cuticle.

  Under this  species, as  under the  last, we may observe that all
the varieties are,-in their purest state, simple affections of the skin ;
though occasionally, probably from peculiarity of habit, or some ac-
cidental disorder of the digestive function, connected with the state
of the constitution, or of the stomach or bowels. Dr. Willan, indeed,
makes it a part of his specific character, that lichen is " connected
with internal disorder:"  but his description is at variance with his
definition; for, with respect to the first variety, or simple lichen,
he expressly asserts,* that it " sometimes appears suddenly without
any manifest disorder of  the constitution ;" while in regard to the
tropical lichen or  prickly heat,  one of the  severest  modifications
under which the disease appears, he states, and with apparent ap-
probation, from Winterbottom, Hillary, Clark, and Cleghorn, that
it is considered as salutary;  that even " a vivid  eruption of the
prickly heat is a proof that the person affected with it is in a good
state of  health ;"—that " its appearance on the skin  of persons in
a state of convalescence  from fevers, &c.  is always a favourable
sign, indicating the return of health and vigour ;"t that " it seldom
causes any sickness or disorder except the troublesome itching and
pricking:" + that "it is notattended with any febrile commotion whilst
it continues out ;"§ and that " it is  looked upon as a sign of healthy
and, indeed, while it continues fresh on the skin, no inconvenience
arises from it except a frequent itching."||  And in  like manner,
Dr. Heberden observes that some patients  have found  themselves
well on the appearance of the eruption, but troubled with pains of
the head and stomach during the time of its spread ; but by far the
greater number  experience no other evil  from it besides the in-
tolerable anguish produced by the itching, which sometimes makes
them fall away by breaking their rest, and  is often so tormenting
as to make them  almost  weary of  their lives.  Most of these re-
marks apply equally to the urticose variety, one of its severest
forms, as I shall  have occasion  to observe presently.
   The simple lichen shows itself first  of all by an appearance of
distinct red papulae about the cheeks and chin, or on the arms, with
but little inflammation round their base ; in the course of three or
four days the eruption spreads  diffusely over the  neck, body, and
lower extremities, attended with an unpleasant sensation of tingling,
which is sometimes aggravated during the night.   In  about a week
the colour of  the eruption fades, and the cuticle separates in scurf
• Willan, p. 39.
| Id. p. 35, from Winterbottom.
i Id. p. 59, from Miliary.
§ Id. p. 61, from Clark.
II Id. p. 63. from Cleghorn. 
374
LCCR1T1CA.
LCE. VI.—OR. Ill,
 All the surface of the body, indeed, remains scurfy for a long time,
 but particularly the flexures of the joints.   The duration of the
 complaint varies ; and hence, in  different  cases, a term of from
 fourteen to thirty days intervenes between the eruption and a reno-
 vation of the cuticle.  " The eruption sometimes appears suddenly
 without any manifest disorder of the constitution :"*  and some-
 times there is  a febrile state, or rather a state  of irritation at the
 beginning of the disorder, though  "seldom considerable enough to
 confine the patient to  the house"!—and which is  relieved by the
 appearance of  the eruption.  It has occasionally been mistaken for
 measles or scarlatina : but its  progress, and indeed  the general
 nature of its symptoms from the first, are sufficiently marked to dis-
 tinguish it from either of  these.
   The causes are not distinctly pointed out by any of  the writers,
 and it is singular that they should  have been passed by both by
 Willan and Bateman.  So far as I have seen, this and all the va-
 rieties depend upon a peculiar irritability of the skin as its remote
 cause, and some accidental stimulus as its exciting cause. The ir-
 ritability of the skin is sometimes constitutional, in which case the
 patient is subject to frequent returns of the complaint;  but it has
 occasionallybeen introduced by various internal and external sources
 of irritation : as a diet too luxurious or too meagre ; the debility
 occasioned by a protracted chronic disease, or an exacerbated state
 of the mind; an improper use of mercury, or of other preparations
 that have disagreed  either with the stomach, or the  chylifacient
 viscera.   Under  any of which circumstances, a slight occasional
 cause is sufficient for the purpose, as exposure to the burning rays
 of a summer sun, a sudden chill on  the surface, cold  water drunk
 during great heat or perspiration, a dose of  opium or any other
narcoctic  or substance that  disagrees  with the stomach or the
idiosyncrasy.  Dr. Heberden has suggested  another cause, as per-
 haps operating in various  cases, and inquires  whether it may not
be produced by some irritant floating in the atmosphere, of so fine
 a structure as to be invisible to the naked eye, as the down of va-
 rious plants or insects; and he particularly alludes to the delicate
hairs of the dolichos pruriens, or cowhage, as occasioning the dis-
ease in the West Indies, from their attacking the skin  in this man
ner imperceptibly.  But since general ablutions  afford  little or no
relief, and all medicated lotions are even more ineffectual; and as
we can often trace it to other causes in our own country, and are
at no loss for a different cause in the West Indies, the present can
hardly be allowed to be the ordinary cause, though it may become
an occasional excitement.
   The remedial process should consist in  keeping the bowels cool
and free by neutral salts ; a mixed diet of vegetables, ripe fruits,
• Willan, ut supra, p. 39.
t Id. p. 37. 
UK. III.—SP. II.]
EXCERNENT FUNCTION.
375
especially of the acescent kind, as oranges and lemons, and fresh
animal food; with an abstinence from fermented liquors, a light and
cool dress, an open exposure to pure air, and an occasional use of
the tepid-bath.  The mineral acids have sometimes proved service-
able, but not always ; and the red or black hydrargyrus sulphuratus,
has been thought useful by many.  Where the system is evidently
in an impoverished state from previous sickness,  innutritive food,
or any mesenteric affection, bark, the mineral acids, or the metallic
tonics, afford a reasonable hope of relief, and especially such prepa-
rations of iron as may sit easy on the stomach.
  The  hair lichen,  and  clustering  lichen,  differ  from the
preceding in little more than a difference of station or  of  form.
Their causes or mode of treatment run parallel, and it is not need-
ful to enlarge on them farther.
  The livid lichen is evidently  connected with a weak and debi-
litated habit.  Its papulae are often interspersed with petecchiae ;
sometimes,  indeed, with purple patches or vibices, and manifest a
state of constitution  bordering on that of scurvy or porphyra. Here
the diet, regimen, and medical treatment, should be altogether tonic  ,
and cordial, and may be taken from the plan already proposed for
this last malady.*
   The tropical lichen,  or prickly heat, is a disease of high
antiquity, and is equally described by the Greek and Arabian writers.
The latter denominate it eshera, which is the plural of sheri, lite-
rally papulae, and hence the papula, or papulous disorder,  by
way of  emphasis.   And  this  term,  softened  or  corrupted  into
essera, has been adopted and employed as the name of the disease
bymany European writers of great reputation, as Bartholin, Hillary,
and Plouquet.  The term, however,  has sometimes  been  used
both in the East and among Europeans in a looser sense, so as oc-
casionally, but most improperly, to embrace urticaria, and some
other febrile rashes as well.
  The symptoms of  the disease I shall give  in the  words of my
valued friend Dr. James Johnson, whose excellent work on the In-
fluence of Tropical Climates, I lament that I was not in possession
of so early in the progress  of the present  undertaking as  I could
wish to have been.   Dr. Johnson delineates the disease as he has
felt it, and as, in recollection, he seems almost to feel it still, and
hence his description flows
             Warm from the heart and faithful to its fires.
"From mosquittoes," says he, "cock-roaches, ants, and the nume-
rous other tribes of depredators on our personal property, we have
some defence by night, and in general, a respite by  day ;  but this
unwelcome guest assails us at all, and particularly the most unsea-
sonable  hours.  Many a time  have I been  forced to spring from
table and abandon the repast, which I had scarcely touched, to writhe
* Vol. II. p. 582. 
37b
ECCR1TICA.
[CL.  VI.—OR. Ill
 about in the open air, for a quarter of an hour: and  often  have I
 returned to the charge with no better  success, against my ignoble
 opponent!  The  night affords no asylum.   For some weeks after
 arriving in India, I seldom could obtain more than an hour's sleep
 at one time, before 1 was compelled  to quit my couch, with no
 small precipitation, and if there was any water at hand,  to sluice it
 over me, for the  purpose of  allaying the inexpressible  irritation!
 But this was productive of temporary relief only ; and,  what was
 worse, a more violent paroxysm frequently succeeded.
   " The sensations arising from prickly heat are perfectly inde-
 scribable ;  being  compounded of pricking,  itching,  tingling, and
 many other feelings, for which there is no appropriate appellation.
   " Itis usually,  but not invariably, accompanied by an eruption ot
vivid  red pimples, not larger in general than a pin's head, which
 spread over the breast, arms, thighs, neck, and occasionally along
 the forehead, close to the  hair.  This eruption often disappears, in
 a great measure,  when we are sitting quiet, and the skin is cool ;
 but no sooner do  we use any exercise that brings out perspiration,
 or swallow any warm or stimulating  fluid, such as tea, soup, or
wine, than the pimples become elevated, so as to be   distinctly
 seen, and but too sensibly felt!
  " Prickly heat, being merely a symptom, not a cause of good
health, its disappearance has been erroneously accused of produc-
ing much mischief; hence the early writers  on tropical diseases,
harping on the old string  of * humoral pathology,' speak very  se-
riously of the danger of repelling, and the advantage of 'encourag-
ing the eruption,  by taking small warm liquors, as tea, coffees, wine
whey, broth, and  nourishing meats.'
  " Indeed, I never saw it even repelled by a cold bath ; and in
my own case, as  well  as in many others, it rather seemed to aggra-
vate the eruption  and disagreeable sensations, especially during the
glow  which succeeded the immersion.  It  certainly  disappears
suddenly sometimes on the accession of other diseases, but I never
had reason  to suppose, that its disappearance occasioned  them.  I
have tried lime juice, hair powder, and a variety of external appli-
cations, with little or no benefit.  In short, the only means which I
ever saw productive of any good effect in mitigating its violence,
till the  constitution got  assimilated to the  climate,  were—light
clothing—temperance in eating and drinking—avoiding all exer-
cise in the  heat of the day—open bowels—and last, not least, a de-
termined resolution to resist with stoical apathy its first  attacks."
  The wild lichen, or lichen ferus, is particularly noticed by Cel-
sus under the name of agria, as applied to it by the Greeks from the
violence with which  it rages.  It  occurs in  him after a brief de-
scription of a variety of papula of a milder kind, which Willan sup-
poses, and with some reason, to be the clustering.   " Altera autem
est, quam'Ayjiav Graeciappellant: in qua similiter quidem, sed ma-
gis cutis exasperatur,  exulceraturque, ac vehementius etroditur, et
rubet, et interdum inter pilosremittit. Quae minos rotunda est; difli 
CK. I1I.—SP. II.]
EXCERNKNT FUNCTION.
377
 alius sanescit:  nisi sublata est, in impetiginem vertitur."*  This
 variety, however, in its general range, its vehemence, and protract-
 ed duration, approaches nearer to the nettle-lichen than  to anv
 other : yet the pimples are larger,  more clustered, and  more apt to
 run into a pustular inflammation, so as often to produce cutaneous
 exulcerations and black scabs ; and hence the remark of Celsus, that
 it is  disposed to  terminate in an impetigo, or, as others have it, in
 psora or lepra.
   The urticose or nettle-lichen is, perhaps, the most distressing
 form of all the varieties, if we except the tropical: and, like the tro-
 pical, notwithstanding its violence, it is often totally independentof
 any constitutional affection.  I can distinctly say, from various cases
 that  have occurred  to  me, that even  where the patient  has been
 worked up to such a degree of madness as to force him against his
 ovyn  will into a perpetual scratching,  which  greatly exasperates it,
 still  the constitution has remained unaffected, the pulse regular, the
 appetite good.and the head clear.  In most of the cases, the author
 alludes to, however, there was  an established or idiopathic irrita-
 bility of the system, and especially of  the skin ; and in one or two of
 them it was unfortunate that opium, under every form and in every
 quantity, always increased the irritability ; while no other narcotic
 was of any avail.  I freely confess that I have been more perplexed
 with  this obstinate and intractable variety, which has in some cases,
 irregularly subsided for a few days or weeks, and then  re-appeared
 with  more violence than  ever, than I  have been with  almost any
 other complaint that has ever occurred to me.  A tepid bath  and es-
 pecially of sea-water has sometimes been serviceable, but I have often
 found even this fail; and have uniformly observed  the bath mis-
 chievous when made hot; for the skin  will not bear stimulation.
  From the alterant apozems of sarsaparilla, elm-bark, juniper-tops,
 and snake-root, no benefit has accrued;  and  as little  from sulphur,'
 sulphurated quick-silver, nitre, the mineral acids, and the mineral
 oxydes and salts.   I once tried the arsenic solution, but the stomach
 would not bear it.  Sea-bathing, however, in connexion with sea-air,
 has rarely failed ; and I am hence in the habit of prescribing it to a
 delicate young lady who has been several times most grievously
 afflicted with this distressing malady,  as soon as it re-appears; as
 well from the known inefficacy of every other remedy,  a  long list
 of which she has  tried with  great resolution, as from  the  benefit
 which this has almost uniformly produced.
  I have said that the wild lichen, in its severity and duration, offers
 a near resemblance to this.   The former, however, is more  apt to
 run into a  pustular  inflammation, though in the nettle-lichen we
 sometimes find a  few of the vessels filled with a straw-coloured
 fluid,  but  which  are not permanent.  There is also a greater
tendency to some constitutional  affection in  the wild than  in the
nettle-modification, and particularly to a sickness or some other
              * De Medicina, Lib. V. Cap. XXVIII.
Vol.  IV.—3 B 
378
ECCR1TICA
[CL. VI— OR. II
disorder of the stomach upon repulsion by cold.  Under the nettle-
lichen the patient seldom finds the stomach or any other organ give
way, and will endure exposure to a sharp current of air, with a full
feeling of refreshment, without any danger of subsequent mischief.
  There is a singular modification of this disease described in a
letter from Dr. Monsey, of Chelsea College,  to Dr. Heberden, in
which the cause was exposure of the  skin to  a bright sun in the
open air.   The patient was a man thirty years of age, of a  thin,
spare habit;  and his skin,  as soon as the solar rays fell upon it,
became instantly almost as thick as leather, and as red as vermillion,
with an  intolerable itching: the whole  of which abated about a
quarter of an hour after he went into the shade. Dr. Monsey adds,
that this was not owing to the heat of the sun,  for  the sun in winter
affected him full as much, if not more, and the heat of  the fire had
not such an effect.  He was, in consequence, thrown into a state of
" confinement for near ten  years.  It may not  be amiss," continues
Dr. Monsey, "to mention one particular, which is, that one hot day,
having a mind to try if he were at all benefited by his immersions,"
(he seems to  have used a salt-bath under cover, for many weeks)
" he undressed himself and went into the sea,  in the middle of the
day : but he paid very dearly for the experiment, the heat diffusing
itself so violently over his whole body by the time he  had put on
his clothes, that his eye-sight began to fail, and he was compelled
to lie  down upon the ground  to  save himself from  falling.   The
moment he lay down the faintness went off; upon this he got up,
but instantly  found  himself in the former condition :  he, therefore,
lay  down, and immediately recovered.   He continued  alternately
getting up and lying down  till the disorder began  to be exhausted,
which was in about  half an hour, and so gradually went off.   He
had frequently been obliged to use the same practice at other times,
when  he was  attacked with this disorder."
  That this case is to be regarded as a peculiar form of the present
species, the extraordinary irritation and intolerable  itching of the
skin seem to vouch for sufficiently.  It discovers,  however, a cuta-
neous excitement of an idiopathic and  most singular  kind :  and,
keeping this idea in mind, it is not difficult to  account for the ten-
dency to deliquium related in the latter part of the account.   The
patient, it seems, could endure cold bathing under cover, or in the
shade, and was not rendered faint by the re-active glow  that ensued
upon his quitting the water; but when to this  re-active glow was
united, in consequence of his bathing in the open air  and in the
middle of the day, the  pungent heat of the sun, he was incapable
of enduring both, till, by a certain length of exposure to this con-
joint stimulus, the cutaneous nerves became torpid, which it seems
they did in about half  an hour; when  the affection, we are told,
"gradually went oft*."
  A daily exposure to the  same exhausting power  would in all
probability, soon have  rendered the torpitude habitual, or at least
have reduced the cutaneous sensibility to its proper balance, which, 
GE. III.—SP. II.]
EXCERNENT FUNCTION.
379
after all, forms the real cure in the West Indies, and in most of the
chronic cases of our own country.  This, however, does not seem
to have been thought of: but, after having tried a long list of dif-
ferent series of medicines, in hospital and in private practice, to no
purpose, the patient was at length fortunate enough, when under
the care of Dr. Monsey, to be put, as a forlorn hope, upon a brisk
course of calomel, of which he took five grains, every night, with a
purge of rhubarb or cathartic extract, the ensuing morning, for
nearly a fortnight in succession; and having thus transferred  the mor-
bid irritability of the skin to the intestinal canal, the disease left him.
                       SPECIES HI.

                 EXORMIA  PRURIGO.

                    $rurfflf nous Mauh.

 eruption diffuse : PIMPLES nearly of the colour of the cuti-
   cle; WHEN  ABRADED BY SCRATCHING, OOZING A  FLUID THAT
   CONCRETES INTO MINUTE BLACK SCABS; INTOLERABLE ITCHING
   INCREASED BY SUDDEN EXPOSURE TO HEAT.

 In the symptoms of a papular eruption, and an intolerable itchin°-,
 this species bears an approach towards the preceding:  but it differs
 from it, essentially, in the colour of the papulae, and in the nature
 of the itching, which is often far more simple; and, when combined
 with a sense of stinging, gives a feeling peculiar to itself, like that
of a nest of ants creeping over the body, and stinging at the same
time.
  It offers the  three following  varieties,  the last of which chiefly
differs from the second in being more inveterate :

« Mitis.                      Pimples soft  and smooth : itching
  Mild Prurigo.                at times subsiding;  chiefly com-
                               mon to the  young, and  in spring
                               time.
£ Formicans.                Pimples varying  from  larger  to
  Eminet-prurigo.               more obscure than in  the  last;
                               itching incessant,  and accom-
                               panied with a sense  of pricking
                               or stinging, or of the  creeping
                               of ants over the body; duration,
                               from two months to two or three
                              years, with  occasional but short
                               intermissions j chiefly common to
                               adults. 
380                     ECCRITICA.             [CL. VI.—OR. HI.
                                Pimples  mostly larger than  in
                                  either of the above, sometimes
                                  indistinct, giving the surface a
                                  shining and granulated appear-
                                  ance; itching incessant: com-
                                  mon to  advanced years, and
                                  nearly inveterate.

  In all the varieties the itching differs in its extent: being some-
times limited to a part only of the body, and sometimes  spreading
over the entire frame.*  Courmette relates a  case in which it
alternated  from side to side :t  and, in many instances,  it appears
periodically.  Hence, in Willan, we have not only an account of
the three preceding varieties, but of several others,  which  chiefly,
if not entirely, differ from them, in being  limited to  particular
parts; as  prurigo podicis, p.  praeputii, p. urethrali6, p. pubis, p.
pudendi muliebris.
  A common cause of this species, in all its varieties, though by no
means the  only cause, is want of proper cleanliness of the skin and
of apparel; and hence it is found most frequently in the hovels of
the poor, the squalid, and the miserable.  Yet,  as it is not always
found under these circumstances, even where there is the grossest
uncleanliness,  some  other cause, jointly operating in  such situa-
tions, some idiopathic condition of the skin, by which  the sordes
thus collected, and obstructing the mouths  of the cutaneous exha-
lants, becomes an active irritant, must be admitted.  One of these
conditions  appears to be, a skin  peculiarly delicate and sensible,
which is mostly to be found in early life; and another, a skin pecu-
liarly dry  and scurfy, which is a common condition of old  age ; on
which account repelled perspiration is correctly set down as a cause
by Riedlin. Even in the cleanliest habits, these  peculiarities of the
skiu often become causes of themselves, and of a more intractable
kind than  mere sordes, as they are far more difficult of removal. A
diet of fish alone has sometimes excited such a habit:  and an  ha-
bitual addiction to spirituous drinks, whether, wine, ale,  or alcohol,
produces also, in many persons,  a like sensibility of the  surface,
and lays a foundation for the disease, in its most obstinate form.
   Where  the rash continues long and becomes  pertinacious,  the
 papulae form minute exulcerations, degenerating, in the first variety,
 into a species of contagious itch, and, in the second, into a running
 scall;  which last,  in  the  third or  inveterate  variety,  sometimes
 forms nests for various parasitic insects,:]: and especially for several
 species of the acarus and pediculus,  to which Dr. Willan  adds the
 pulex.  In treating of intestinal animalcules, we had occasion to
 observe that "they appear from the luxuriance  of their  haunts and
* Sitonus, Tr. 34, Loescher.
f Journ. Med. torn. LXXXV.
t Sommer, Diss, de affectibus pruriginosis Senfim.
  Loescher, Diss, de pruritu senili totius corporis.  Witeb. 1723.
y Senilis.
  Inveterate prurigo. 
CE. III.—SP. III.]     EXCERNENT FUNCTION.
381
repasts, to be, in various instances, peculiarly enlarged and altered
from the structure they exhibit out of the body ; whence'a difficul-
ty in determining, in many cases, the exact external species to which
a larve, worm, or animalcule found within the body may belong."*
This remark applies with peculiar force to  the  parasites  detected
in the  disease before us, some of which grow to such an enormous
size, and with such altered characters, from rioting on so plentiful a
supply of juice, that it is by no means easy to recognize them. Dr.
Willan describes an insect of this kind found in great abundance
on the body of a patient suffering under the inveterate  prurigo,
which  he at first took for a pediculus, though from the nimbleness
of its motions, as  well as from other characters, be at length ascer-
tained it to be a pulix, not described by Linneus : more probably,
from the causes just stated, so altered in its form, as not  to be ea-
sily referred to the species to which it really belongs.
  Thorough and regular ablution and cleanliness are here, there-
fore, peculiarly necessary, and these will often succeed alone, espe-
cially in the first  variety.  If they should not, sulphur and the sul-
phureous waters, as that of  Harrowgate, taken  internally and ap-
plied to the  skin  itself, have sometimes been  found  serviceable.
Fossile alkali combined with sulphur, and taken  internally with in-
fusion of sassafras or juniper drops, is peculiarly recommended by
Dr. Willan.  If the constitution have suffered from a meagre diet,
or be  otherwise exhausted, general  tonics and nutritive food must
necessarily form a part of the plan.
   In many cases, however, of the second variety, and in still more
of the third, this pertinacious and distressing complaint bids defi-
ance to all the forms of medicine, or the ingenuity of man: and I
cannot adduce a stronger illustration of this remark, than  by refer-
ring to an attack which it has lately made on one of the  brightest
ornaments of medical science in  our own  day, whose friendship
allows me to give the present reference to himself.  It is now con-
siderably more than a year and a half since he was first visited with
this formicative, but colourless rash, which  affected  the entire sur-
face, but chiefly  the legs : and he has since tried every mean that
the resources of  his own mind or the skill of his  medical friends
could  suggest, yet for the most part without any thing beyond a
palliative or  temporary  relief.  The tepid bath produced more
harm than good, though several times repeated :  Harrowgate water,
 internally and externally had recourse to, has been of as little avail:
acids  and  alkalies, separate or conjoined, in whatever way made
 use of, have failed equally:  nor have purgatives or diaphoretics or
 any of the alterative diet drinks, or the alterative  metallic prepa-
rations answered better.  The coldest spring water employed as a
bath or lotion, and free doses of opium as a sedative, are the only
medicines from which he has at any time derived any decided re-
lief, and these have constantly afforded it for a short time.  In the
* Vol. I. Helminthia erratica. p. 208, 
S8£
ECCR1TICA.
LCL. VI.  OR. lit.
 middle of the coldest nights of last winter, and the still colder nights
 of the winter before, he was  repeatedly obliged to  rise and  have
 recourse to sponging with cold water, often  when on the point of
 freezing.   The opium he  has taken never effected  real sleep, nor
 abated the complaint, but generally threw him into a quiet kind of
 a revery, which produced all the refreshment of sleep :  and to ob-
 tain this happy aphelxia, or abstraction of mind, he has been  com-
 pelled to use the opium in large doses, often to an extent  of ten
 grains every twenty-four hours, for weeks together, and rarely in
 less quantity than five or six grains a day and night for many months
 in succession.   The change operated on the general habit by this
 peculiar sensibility of the skin is not a little singular; for first, in
 the midst of the distraction produced by so perpetual a harassment,
 and the necessary restlessness of nights, neither his animal  spirits
 nor his appetite have in any degree flagged, but, upon the whole,
 rather increased in energy, and his pulse has held true to its  pro-
 per standard.  And next, though opium was  wont to disagree  with
 him in various ways antecedently, it has proved  a cordial  to him
 through the whole of his tedious affection, without a  single unkind-
 ly concomitant, and has never rendered  his bowels constipated.
 From the  long continued excess  of action there was at length an
 evident deficiency in the restorative power of the skin : for two ex-
 coriations  arising from  the eruption, degenerated into  sloughing
 ulcers.  At the present period, forming a distance of  nineteen or
 twenty months from the first attack, he is apparently getting well;
 the skin, which has been so long in a state of  excitement, is loosing
 its morbid sensibility, and becoming torpid:  he has rarely occasion
 to  have  recourse to cold ablutions, but dares not trust himself
 through the day without a dose of opium, as an exhilarant,  though
 the quantity is considerably reduced. He has also, for  many months,
 been taking the bark and soda as a general tonic.   Perhaps the
 most instructive part of  this case is the great advantage and  safety
of the external application of cold water, as a refrigerant and tonic
in cutaneous eruptions accompanied with intolerable heat and  irri-
 tation.  And it is possible that  half the wells, which  in times of
superstition were dedicated to some favourite saint, and still retain
his proper name, derived their virtue from this quality rather than
from any chemical ingredient they contain, which has often as little
to do with the cure as the special  interposition of the preternatural
 patron. 
GE. m.—SP. IV.]     EXCERNENT FUNCTION.
                      SPECIES IV.

                 EXORMIA MILIUM.

                      mnitumuh.

PIMPLES VERT MINUTE ; TUBERCULAR; CONFINED TO THE FACE J DIS-
  TINCT; milk-white; hard; glabhous; resembling millet
  SEEDS.

This species is taken from Plenck, who denominates it grutum sive
milium.  It is a very common form of simple pimple,  or exormia,
and must have been seen repeatedly by every one, though, with the
exception of Plenck, I do not know that it has hitherto been  de-
scribed by any nosologists.  It has a near resemblance to the white-
gum of children, as  described by Dr. Underwood, the strophulus
albidus of Willan, and the present system.  But the pimples in the
milium are totally unattended with any kind of inflammatory halo
or surrounding redness:  and are  wholly insensible.  They  are
sometimes solitary, but more frequently gregarious.  It is a blemish
of small importance, and rarely requires medical interposition : but
as it proceeds from a torpid state of the  cutaneous excretories, or
rather of their mouths or extremities, which are balled up by hard-
ened mucus, stimulant and tonic applications have often been found
serviceable,  as  lotions of  brandy,  spirit of  wine, or tincture of
myrrh, or a solution of sulphate of zinc with a little brandy added
to it.
  When this species becomes inflamed it lays a foundation for a
varus or stone-pock, which we have already described under  the
order of inflammations, in the third class of the present system.*
                      GENUS IV.

                    LEPIDOSIS.

                       Scale=Sfefn.

EFFLORESCENCE OF SCALES OVER DIFFERENT PARTS OF THE  BODY,
               OFTEN THICKENING INTO CRUSTS.

Lepidosis is a derivative from Xt*ii-hs, " squamma."  The Greek
is preferred to  the Latin term, in concurrence with the general
* Vol. II. p. 196. 
:M
ECCRIT1CA.
[CL. VI.—OR. HI.
rule adopted in the present  system in regard to the names  of the
classes, orders, and genera.  The genus includes those diseases
which consist in an exfoliation of the cuticle in scales or crusts  of
different thickness, and with a more or less defined outline, injmany
cases owing to a  morbid state  or secretion of the rete mucosum
or adipose layer of  the part immediately beneath, which is some-
times too dry, or  deficient in quantity;  sometimes perhaps  absent
altogether;  sometimes  charged with a material that changes  its
natural  colour; and sometimes loaded with an enormous abundance
of a glutinous fluid, occasionally combined with a calcareous earth.
In the severer cases the true skin  participates in the change.
  As this colorific substance, forming the intermediate of the three
lamellae that constitute the cutaneous integument, is  only a little
lighter in hue than the true skin among Europeans, it is not often
that we  have an opportunity in  this part of  the world of noticing
the changes  effected upon it by  different diseases : but as among ne-
groes it  contains the black pigment by which  they are distinguished,
such changes are  very obvious and frequent: for the individual  is
sometimes hereby, as we shall  see presently, rendered pye-balled,
or spotted black and. white, and there are instances in which the
whole of this substance, or rather of its colouring  part, being car-
ried off  by a fever, a black man has suddenly been transformed into
a white.
  Changes of this kind often occur without  any separation  of the
cuticle  from the cutis, but if the fever be  violent  such separation
takes place over the entire body, and the  cuticle is thrown off  in
the shape of scurf, or scales, or a  continuous sheath.   And  some-
times the desquammation from  a hand has been so perfect that the
sheath has formed an entire glove.  The same effect has followed
occasionally from other causes than fever,  as on an improper use  of
arsenic* or other  mineral poisons, on beiiig bitten by a viper,f and
sometimes on a  severe fright.}   There are various  instances in
which the nails have been exfoliated with the cuticle,§ and  others
in which the hair has followed  the same  course.   Sometimes, in-
deed, a  habit of recurrence has been established and the whole has
been thrown off and renewed at regular periods,||  in one instance
once a month.^
   In the genus before us the exfoliations are of a more limited
kind, and in some instances very  minute and  comparatively insig-
nificant. In the  severer forms, however, the true skin participates
in the morbid action,  and the result is far more troublesome.
• De Haen, Rat. Med. Part. x. Cap. II.
f Eph. Nat. Cur. Dec. I. Ann. IV. V. Obs. 38.
■$ Act. Nat. Cur. Vol. VII. Obs. 43.
$ Eph. Nat. Cur. Dec. III. An. II. Obs. 124.
i Cooch, Phil. Trans. 1769.
« Eph. Nat. Cur. Dec. HI. Ann. I. Obs, 13i. 
Gi\iV.—SP. I.]      EXCERNENT FUNCTION.               585

  The species it presents to us are the following:

1. lepidosis  pityriasis.            d.andriff.
2. ---——■  lepriasis.             leprosy.
3.-------psoriasis.             Cdryscall.
                                  / scaly tetter.
ICTHYIASIS.             FISH-SKIN.
                        SPECIES  I.

               LEPIDOSIS  PITYRIASIS.

                          SSatttrvCff.

PATCHES OF FINE BRANNY SCALES EXFOLIATING WITHOUT CUTICU-
                       LAR TENDERNESS.

This species is the slightest of the whole: its varieties are as fol-
low :

«e Capitis.                     Scales minute  and delicate : con-
  Dandriff of the head.           fined to the head; easily sepa-
                                rable.   Chiefly common to  in-
                                fancy and advanced years.
/S Rubra.                      Scaliness common to the body  ge-
  Red dandriff.                 nerally ;  preceded  by redness,
                                roughness, and scurfiness of the
                                surface.
y Versicolor.                  Scaliness in diffuse  maps of irre-
  Motley dandriff.               gular outline,  and  diverse  co-
                                lours, chiefly brown and yellow ;
                                for  the most part  confined to
                                the  trunk.

  Pityriasis is a term common to the Greek  Physicians, who con-
cur in describing it, to adopt the words of Paulus of .<Egina, as " the
separation of slight furfura matters (iriiv$»$m  t^/mctuv,) from the
surface of the head, or other parts of the body without ulceration."
The same character is given by the Arabian writers, and especially
by Avicenna and Ali Ahbas.  But several writers, both Greek and
Arabian, who have thus described it generally,  limit its extent to
the head, which is the ordinary seat of  the porrigo or scabby scall,
characterized by ulceration, and a purulent discharge,  covered  by
minute scabs : and hence in some writers, pityriasis  has been con-
founded with porrigo, or, in other words, the dry  and branny scale
with the  pustular scab; which, however, there is no difficulty in
accounting  for, since the first variety, whose seat is also in the head,
has a tendency, if neglected, and the minute and scurfy scales grow
  Vol. IV.—3 C 
58h
ECCRITICA.
ICL. VI.—OR. III.
thicker and broader, and crustaceous, to degenerate into porriginou
pustules.
  The first variety, or Qandriff of the head, when it attacks  in-
fants, exhibits minute scales, and when it appears in advanced age,
scales of larger diameter.   It shows itself at the upper edge of the
forehead and temples as a slight whitish scurf, set in the form of a
horse-shoe ;  on other parts of the head there are  also cuticular  ex-
foliations, somewhat  larger, flat  and seinipellucid.   Sometimes,
however, they cover nearly the whole of  the hairy scalp, imbricate
in position,  or with an overlap, as in tiling.
  Little attention is necessary to this complaint beyond that of clean-
liness, and frequent ablution; where, however, the hairy scalp is
attacked it is better to shave the head, when the scales may be re-
moved by a  careful use of soap and warm water, or by an alkaline
lotion.  This is the more expedient because the scales in this situa-
tion are often intermixed with sordes, and pustules containing an
acrimonious lymph are formed under the incrustations ; and in this
way pityriasis, as we have already observed, may, and occasionally
does, degenerate into porrigo.
  The second variety, or red dandriff, sometimes affects the gene-
ral health in a perceptible degree from the suppression which takes
place in the perspiration, and the consequent dryness, stiffness, and
soreness of  the skin ; and the general itching which hence ensues,
is often productive of much restlessness  and languor.   This, which
is the severest  modification of the disease, appears  chiefly at an
advanced period of life, though itis not limited to old age.  A tepid
bath of sea-water is, perhaps, the most useful application, as serving
to soften the skin, and produce a gentle diapnoe.  With this external
remedy Dr.  Willan advises we should unite the compound decoction
of sarsaparilla, and antimonials, which operate towards a like  ef-
fect.  The  tinctura hellebori ni^ri in email doses has also  some-
times been  found useful : anJ, where the irritability of the skin  is
not very great,  Dr. Eateman was  in the  habit of using a gently re-
stringent lotion or ointment, consisting of the superacetate of lead
with a certain proportion of borax or alum.
   The variegated or motley dandkiff,  pityriasis versicolor, often
branches out over the arms, back, breast, or abdomen, but rarely in
the face, like many foliaceous lichens growing on  the bark of trees ;
and sometimes, where the discoloration is not continuous, suggests
 the idea of a map of continents, islands, and peninsulas, distributed
 over the skin.
   We have a more distinct proof of a morbid condition of the rete
 mucosum, or adipose colorific layer of the skin  in this than in any
 other affection belonging to the entire genus. The morbid  action,
 indeed, seems confined to this quarter and consists in the secretion
 of a tarnished pigment, though possibly, in some instances, it may
 be only discoloured by a mixture with a small portion of extrava-
 sated blood.  And were it not for the  furfuraceous scales which
 determine  its real nature, this affection would belong to the genus 
GE. IV.—SP. 1.]      EXCERNENT FUNCTION.               387

epiciihosis  of the present order.  There is no elevation ; and the
staining rarely extends over the  whole body.  Dr. Willan tells us
that it seldom appears over the sternum or along the spine of the
back.  I had lately a patient, however, in a gentleman about forty
years old, who was suddenly attacked with a discoloration and bran-
ny  efflorescence of this kind,  which extended directly across the
spine oyer the loins, and very nearly girded the body. It continued
upon him for about  three  years  without any  constitutional indis-
position, or even local disquietude, except a slight occasional itch-
ing, and then went  away as suddenly as it made  its appearance.
The hue was a fawn-colour : and as  the patient was anxious to lose
it, he tried acids, alkalies, and other detergents of various kinds,
but without any  effect whatever.  This  variety of dandriff  gene-
rally continues for  many months, and not unfrequently, as in the
present case, for several years.  Being altogether harmless,  it re-
quires no medical treatment.
  The pityriasis nigra of Willan, referred  to by Bateman, but only
glanced at by either of them, so far as I have seen it, is  rather a
modification of the  genus epichrosis, and species Pcecilia,  under
which  it will be noticed.   It is a cuticular discoloration, but with-
out cuticular exfoliation.
                        SPECIES II.

                LEPROSIS  LEPRIASIS,

                          aejirnsg.

 This genus constitutes the vitiligo of Celsus. The term lepriasis
is a derivative from Xt^pti " scaber, vel asper, ex squammulis dece-
dentibus; with a termination appropriated by  a sort of common
consent, to the squammose tribe of diseases.*  Lepra, which is the
more common term, is derived from the same root: but lepriasis is
preferred to lepra as a more general term, and hence better calcu-
lated to comprise the  general varieties of this species so generally
described or referred  to by the  Greek and  Oriental writers, but
whose descriptions, not very definite when first written, at least
with a few exceptions, have been rendered altogether indefinite and
incongruous in modern times, from a misunderstanding  or  confu-
sion of the names under which-the descriptions are given.
  The embarrassment which Dr. Bateman felt upon  this subject,
when writing on the  genus elephantiasis,  and which has been
noticed already,t he was equally sensible of when he came to lepra,
• See the author's volume of Nosology.  Prelim. Diss. p. 51.
f Vol. H. p. 567. 
388
&CCKTTICA.
[CL. VI.—OR. Ill
and the researches of Dr. Willan gave him little or no assistance.
I could not then find time to render him the aid he stood in need of,
but I have since directed my attention to the subject, and will now
give the reader its results as briefly as possible.
  In the admirable and  exact description of the cutaneous efflores-
cences and desquammations, to which the Hebrew tribes were sub-
ject on their quitting Egypt, and which they seem to have derived
from the Egyptians, drawn up by Moses, and forming a part of the
Levitical law,* there are three that distinctly belong to the present
species, all of  them distinguished by the  name of berat (mm)
or " bright  spot;"  one called boak  (pm)  which also imports
brightness, butin a subordinate degree, being " a dull-white berus,"
not contagious, or, in other words, not rendering a person unclean,
or making it  necessary  for him to be  confined ;  and  two  called
tsorai (njTW) " venom or malignity :"  the one a berat  lebena  or
" bright-white berat,"t and the other a berat cecha, " dark or dusky
berat,"% spreading in the skin ; both of which are contagious, or, in
other words, render the person affected with it unclean, and exclude
him from society.§
  The Arabic and Greek writers have in fact taken notice of and
described all these, but  with so much confusion of terms and symp-
toms, from causes I will presently point  out, that without  thus
turning back to the primary source it is difficult to unravel  them
or understand what they mean.
  The boak, or slighter and uncontaminating berat, is still denomi-
nated by the same name  among the Arabians, boak, and  is the Xt^x
AA^os or "dull-white leprosy" of the  Greeks: while  the bright-
white and dusky berats of the Hebrews, which the latter distinguish-
ed on account of their malignity by the name of ru/ijf (tsorat,) are
still called among  the Arabians by the Hebrew generic term with a
very slight alteration ; for the berat lebena (rmS mm) or bright-
white berat of the  Hebrew tongue, is the beras bejus of the Arabic,
and the berat cecha (nm mm) or dusky berat,  its beras asved:
the former  of these two constituting the Xe^x  Atvxy or  " bright-
white"  leprosy of the Greeks, and the latter their  Xtx^x  f«A»j
" dusky or nigrescent leprosy."
  So far the whole seems to run in perfect harmony ; but as many
of the Arabians, in process of time, used boak and beras indiscrimi-
nately, the different species of the disease  as well as their qualities
became immediately confounded, and we are told sometimes  that
leprosy is,  and at  other times that it is not unclean or  contagious.
And what increased the confusion is, that  the Arabians employed
• Levit. Cap. XIII.
f Id. Cap. XIII. 38, 39.
* Id. V. 3.
I Id. V. 6.  8. 
GE. IV.—SP. II.]      EXCEKNENT FUNCTION.
389
also another term of still wider import than either of these, being,
kuba or kouba, which imported scaly eruptions of every kind, run-
ning not merely parallel with the entire genus lepidosis before us,
but something beyond,  so as to include the humid as well as the dry
scall ; and consequently diseases of very different qualities and  de-
grees of malignancy, contagious and  uncontagious, cuticular and
ulcerative. It is a term peculiarly common to the writings of Avi-
cenna  and Serapion.  And as kouba, or with  the  article  alkouba
was also frequently applied to all  the species of beras or leprosy,
the real characters of the latter were rendered doubly doubtful and
intricate. And hence a very obvious source of confusion upon this
subject originating among the Arabians.
   But while the Arabian writers borrowed two terms appropriated
to the disease before us from the Hebrew tongue, beras and boak, and
employed both of them in a loose and indefinite manner, the Greeks
themselves borrowed one and employed it  still more indetermi-
nately : for from the Hebrew njnx (tsorat) they obtained ther -^m^x
 (psora)—as our own language  has since the word  sore.  Tsorat,
 as we have already seen, is restrained by the Hebrew legislator to
 the two forms of betas or leprosy which were  contagious or ren-
 dered a man unclean : and as the Greeks introduced this term into
 their own  tongue it would have been better to  have restrained it to
 the same import, and to have used psora as the translation of tsorat.
 But the Greeks had the word  lepra already by them, as significa-
 tive of the same disease generally or  a synonym of berat or beras;
 and hence instead of psora they employed lepra, which is the word
 made use  of in the Greek, as well  as in the Latin versions.  As
 lepra, however, is a generic term and runs  parallel  with berat, so
 as to include the boak or uncontaminating, as well  as the  conta-
 minating forms of the  disease, the clearness, if not the entire sense,
 of the Hebrew is greatly diminished in  the Greek version. When
 we are told by Moses, in the language of the Hebrew bible, that the
 priest shall examine the berat, or bright  spot, accurately, and if  it
 have the specific marks, it is a tsorat, (which the berat is not ne-
 cessarily,) we readily understand what  he means.   But when he
 tells us in the language of the Greek bible, that the priest shall look
 at the berat or rnXxvym (which is itself necessarily a lepra)  and  if
 it have the specific marks  it is a lepra, the meaning, to say the
 least of it, is obscure  and doubtful.  It  is probable, however,  that
 psora, when first  introduced into the Greek tongue, imported the
 very same idea as in the Hebrew: but it soon gave way to the older
 term of lepra, and having thus lost its primative and restricted sig-
 nification, it seems to  have wandered in search  of a meaning,  and
 had at different times, and by different persons, various meanings
 attributed to  it; being sometimes used to  express scaly eruptions
 generally, sometimes the scales of leprosy ; but at last and with a
 pretty common assent the  far slighter efflorescence of scaly tetters
 or scalls,  denominated in the Levitical c«de saphai (nnao):  and 
390
ECCUITICA.
[CL. VI.—-OR. in
 by the Latins scabies or impetigo sicca: constituting the psoriasis,
 or ensuing species of the present classification.   So that whilst in
 Hebrew, or under its primitive  sense, tsorat or  psora denoted  the
 most malignant form of lepidosis, in Greek or under its secondary
 sense, it denoted one of the mildest forms of the  same.  And hence,
 another source of confusion upon the subject before us originating
 among the Greek writers, as the preceding originated among  the
 Arabian.
   And when to these two  sources of perplexity we add that  the
 Greek term lepra was, from a  cause I have formerly explained,
 employed equally to express elephantiasis, we shall easily be able to
 account for the indefinite and incoherent descriptions of all these
 diseases which are given by many of the Greek and Arabian writers,
 and  the inaccuracy with which the symptoms of one specific disease
 are run into another.   Actuarius endeavoured to throw something
 of order into the midst of this confusion by contemplating all these
 maladies, in conjunction with lichen, as different forms of a com-
 mon genus, and dividing them into four separate species : " A less
violent disease," says  he, "than elephantiasis, is lepra; lepra  is,
 however, more violent than psora, and psora than the lichenes. But
 lepra penetrates deep, forms circular eruptions and certain funguses
 or deliquescences of flesh  (tivxs  trwrrfeis  <rxgxo<;)  and throws  oft'
 scales from which also it derives  its name: while psora is more
 superficial, assumes indeterminate  shapes, and only casts off furfu-
raceous corpuscles.   A roughness and itching of the skin is com-
mon to both."*  And to the same  effect Paulus oOLgina.
  The real fact is, that the two last are nearly connected in nature,
and in the present work follow in immediate succession, while both
are widely remote from the  first;  and though it is possible they
have occasionally terminated in it, are by no means naturally con-
nected with it, or form a necessary harbinger.
  Lepra or lepriasis, in Celsus occurs under the  name  of vitiligo,
and like the berat of the Hebrew  legislator, is made to include three
modifications : the ordinary forms of it, indeed, that have descend-
ed to us, though delineated with  much error and  incongruity. The
description of Celsus is drawn up with peculiar accuracy and con-
cinnity, and makes the  nearest approach to  that of Moses of any I
 am acquainted with : and by uniting them and combining a few well
 ascertained symptoms from other authors, we shall be able to obtain
 a pretty clear insight into the genuine  characters of these  modifi-
 cations, freed from the extraneous  concomitants that have so often
 bewildered us.
» Actuar. De Meth. Medend. II. 11.
And compare Paul JEgin. IV. 2.
Serapion JBreviar. Tr. V. Cap. IV.
Avicenn. lib. I. iii. 1. 
GE. IV.  SP. II.]      EXCERNENT FUNCTION.
391
*ip
« Albida.               Scales glabrous, dull-white, circular and
  Boak (pna). Hebr.       definite ;  preceded  by  reddish and
  Boak.  Arab.           glossy  elevations  of the skin;  sur-
  Alphos. ('Ax<pei) Auct.   rounded by  a dry,  red, and slightly
    Gr.  Cels.            elevated  border:   scattered;  some-
  Common or dull-white   times confluent; irregularly exfoliat-
    leprosy.              ing and reproduced :  rarely  found  on
                          the face : not contagious.
£ Nigricans.            Scales  glabrous, dusky or livid, without
  Berat cecha; Hebr.     central  depression,  patches  increas-
  (nro mm)              ing in  size ;  scattered,  or  confluent
  Beras asved, Arab.      Contagious.
  Melas (MeA*s) Auct.
    Gr.  Cels.                                               "
  Dusky or black leprosy.
y Candida.             Scales on an elevated base glossy-white,
  Berat lebena. Hebr.     with a  deep central  depression ;  en-
  (rm1? mm)             circled with  a red  border; patches
  Beras bejas.  Arab.     increasing  in  size:  hairs on  the
  Leuce (Aevxjj) Auct.     patches white or hoary; diffused over
     Gr.  Cels.           the body.  Contagious.
  Bright-white leprosy.

  All these, at least in their origin, are strictly cutaneous affec-
tions :  though we shall presently have to observe that the last two
when they become inveterate, sometimes seem to affect ther habit;
and it is hence possible that the first may do so in a long course of
time  if neglected.
  It  is on this account that the boak, common or dull-white le-
prosy has been regarded as in every instance a  constitutional ma-
lady  by many writers of recent times ;  but it was not so regarded
either by the best Greek and Arabian  physicians, who  also duly
distinguished it from elephantiasis and other complaints with which
it has been confounded by later writers ; nor is  it so regarded by
Dr. Willan, who ascribes it chiefly to cold, moisture, and the accu-
mulation of sordes  on the skin, especially in persons  of a slow
pulse, languid circulation, and a harsh dry, and impermeable cuti-
cle :  or whose diet is meagre and  precarious.   It is hence found
chiefly in this metropolis among bakers and bricklayers' labourers:
coal-heavers, dust-men, laboratory-men,  and others  who  work
among dry, powdery substances, and are rarely sufficiently atten-
tive to cleanliness of person.
   In the common, and perhaps, in all the varieties, the scaly patches,
 commence  where the bone is  nearest to the surface, as  along the
 skin  about the elbow, and upon the ulna in the fore arm,  on the
scalp, and  along the spine, os ilium, and shoulder-blad^.  They
rarely appear on the calf of the leg, on the fleshy part of the arms,
or  within the flexures of the joints.   Both sides of the<%ody are
usually affected at the same time and in the same manner; but, con- 
392
ECCKITICA.         fCL. VI.—OR. IIL
 trary to the erysipelatous erythema and some other maladies of the
 skin, the parts first affected do not run through their action and heal
 as other parts become diseased, but continue  with little alteration,
 till, from medical application or the natural vigour of the constitu-
 tion, returning health commences ; when all the patches assume  a
 like favourable appearance at the  same time, those nearest the ex-
 tremities, and where the disease, perhaps, first showed itself, going
 off somewhat later than the rest.  The scaly incrustations  some-
 times extend to the scalp, and a little encroach on  the forehead and
 temples; but  it is very rarely that they spread to the cheeks, chin,
 hose, or eyebrows.  The eruption is seldom attended with pain or
 uneasiness of any kind, except a slight degree of itching when the
 patient is warm in bed, or of tingling on a sudden change of tem-
 perature in the atmosphere.
   We have said that this variety is strictly a  cutaneous eruption,
 and rarely, if ever, affects the constitution.  It is in consequence,
 regarded as of but little importance in  the Levitical code,  which
 contemplates it as not penetrating below the skin of the flesh, and
 not demanding a separation from society.  " If a man or a woman,"
 says the Jewish law, "have in the skin of their flesh a berat, a  white
 berat, then the priest (who after the manner of the Egyptians united
 the character of a physician  with his own,) shall  look ; and, behold,
 if the berat in  the skin of the flesh be dull, it is a boak growing in
 the skin: he is clean."* Not essentially different Celsus, "the viti-
 ligo,  though it brings no danger, is, nevertheless, offensive, and
 springs  from a bad habit of body.  The dull-white and  the dusky
 forms in many persons  spring up and  disappear at uncertain  pe-
 riods.   The bright-white when it  has once made its attack,  does
 not so easily quit its hold.  The cure of the two  former is not diffi-
 cult; the last scarcely ever heals."t
   We may hence distinctly affirm that the variety of the dull-white
 or common leprosy, is not contagious:  and had it  been so among
 the Jews, Moses would  have condemned the patient to a quarantine
under this form, as well as under the two ensuing.  Dr. Willan, in-
deed, yielding to  the general opinion upon this subject, derived
from a proper  want of discriminating one form of the disease  from
another, inclines to believe that it may occasionally become in time
 so interwoven  with the habit as to be propagable, but  still rejects
the idea of its  being contagious.  In reality, although in most coun-
tries where  leprosy is a common malady, places  of separate  resi-
dence arc usually allotted to those who are affected with it under
whatever modification it may appear, this has rather been from an
 erroneous interpretation of the Jewish law, and an ignorance of the
 exceptions that are introduced into it.  The lepers of Haha, a pro-
vince in the Barbary states,  though banished from  the towns, are
 seen in,parties of ten or twenty together, infesting the roads, and

      VLevit. Cap. XIII. 38, 39.
       f De Medicina. Lib. v. Cap. XXVIII. Sect. 19. 
liE. IV.—SP. II.]     EXCERNENT FUNCTION.
39S
  approach travellers to beg charity.   In Morocco they are confined
  to  a separate  quarter, or banished to the outside of the walls.
  They are, according  to Mr.  Jackson, but  little disfigured  by the
  disease, except in the loss of their eye-brows, which  the females
  endeavour to supply by the  use of lead-ore; while they give an
  additional colour to their complexion by the assistance of al akken
  or rouge.
   In like  manner, Niebuhr  asserts that  one of  the  species of
  leprosy to which the Arabs are subject, is by them still called Boak;
  but that it is neither contagious nor fatal.   Upon which remark his
  annotator, M. Forskal adds, "the Arabs, call a sort of leprosy in
  which various  spots are  scattered over the body, Behaq ;  which is
  without doubt  the same  as is named pm (bohak or behaq) in Lev.
  xiii.  They believe it to  be so far from contagious that one may lie
  with the person affected without danger.—On May 15,1763," says
  he,  "I saw, at Mokha,  a Jew who had the  leprosy bohak.  The
  spots are of unequal size : they do not appear glossy; they are but
  little raised above the  skin, and do not change the colour of the hair:
  the spots are of a dull-white inclining to red."*
   The nigrescent leprosy, forming a second variety, is impro-
  perly called black, though it  was So named by the Greeks.  The
 colour, as repeatedly  described  by the Jewish legislator, is rather
 obscure, darkling, or dusky.  The"term is nro (cecha), whence the
 Latin caecus :  and it immediately imports  obfuscous, or  overcast
 with shade or smoke.  The character in Celsus is in perfect accord-
 ance with this, as he explains  to us that ^a«?, or niger, in its appli-
 cation to this variety,  imports " umbrae  similis," " shade like," or
 " shadowed."   The hue  is tolerably represented in  Dr. Willan's
 plate, but better in Dr. Bateman's, in which it has been retouched.
 The  natural colour of the hair, which in  Egypt and Palestine is
 black, is not changed, as we are repeatedly told in the Hebrew code,
 nor is there any depression in the dusky spot; while the  patches,
 instead of keeping stationary to their first size, are  perpetually en-
 larging their  boundary.  The  patient labouring under this form
 was  pronounced unclean by the Hebrew priest or physician, and
 thereby  sentenced to  a separation  from his  family and friends :
 and  hence there is no  doubt of  its having proved contagious.
 Though  a much severer malady than the common leprosy, it is far
 less  so  than  the leuce, or third variety: and on this  account is
 described more briefly in  the Hebrew canon.   In our own  quarter
 of the world the exfoliated surface in the nigrescent or dusky
 leprosy remains longer without  new scales, discharges lymph, often
 intermixed with Mood, and is very sore.  When it covers the scalp
 it is  particularly troublesome.   With us it is chiefly found among
soldiers, sailors, sculler-men, stage-coachmen, brewers'  labourers,
and others, whose occupations  are attended with much fatigue, and
  * Reisebeschreibung nach Arabien und andern unliegeden Landern. Band.
L Kopenhag. 4to. 1774.
  Vol. IV.—3 D 
394
EGCRITICA.
[CL. VI.—OR. 11,
expose them to cold and damp, and to a precarious or  improper
mode of diet.   For the same reason, women habituated to poor liv-
ing, and constant hard labour, are also liable to this form of the dis-
ease. In consequence of the increased excitement and irritability of
the skin in the hot and sandy regions of Egypt and Palestine, there
is, however, a far greater predisposition to leprosy of all kinds, than
in the cooler temperature of Europe.  And hence,  under the next
variety, we shall have occasion to  observe, from the  Levitical
account, that all of them were apt to follow upon various cracks, or
blotches, inflammations or even contusions of the skin.
  The bright-white leprosy, is by far the most serious and obsti-
nate of all the forms which the disease assumes.  The  pathognomic
characters dwelt upon by the Hebrew legislator in deciding it are,
" a glossy-white and spreading scale upon an elevated base, the
elevation depressed in the middle but without a change of colour,
the black hair  on the patches, which is the  natural colour of the
hair in Palestine, participating in the whiteness, and the patches
themselves perpetually widening  their outline."  Several of these
characters taken separately belong to other lesions or blemishes of
the skin  as  well, and therefore none of them  were  to be taken
alone: and it was only when the whole of them concurred, that the
Jewish priest, in his capacity of  physician, was to  pronounce the
disease a tsorat (n^nx) or  malignant leprosy. We  have said that
in lepriasis, the rete mucosum, or colorific adipose layer of the skin,
is peculiarly affected, and we have here a still more distinct proof
of this assertion  in the change of the hair, the colour of which is
derived from this material. This  change is produced by the barter
of a black for a white colouring  material, probably a  phosphate of
lime, which giyes also the  bright glossy colour, not hoary or  dull,
to the 6caly patches; and which, in ichthyiasis, forming the fourth
species in the present genus, we shall find is occasionally deposited
on the surface in prodigious abundance.
  Common as this form of leprosy was among the Hebrews, during
and subsequent to their residence in  Egypt,  we have  no reason to
believe it  was  a family complaint, or even  known amongst them
antecedently ; and there is hence little doubt, notwithstanding the
confident assertions of Manetho to the contrary, that they received
the infection from the Egyptians instead of communicating it to
them. Their subjugated  and distressed state, however, and the
peculiar nature  of their employment, must have rendered them very
liable to this as well  as to various  other blemishes and misaffections
of the skin; in the production of which there are no  causes more
active or powerful than a depressed state of body or mind,  hard
labour under a burning sun, body constantly covered  with the
excoriating dust of brick-fields, and an impoverished diet: to all of
which the  Israelites were exposed  whilst  under the Egyptian
bondage.
  It appears also from the Mosaic account, that in consequence of
these hardships, there was, even after they had left Egypt, a general 
GUE. IV.—SP. n.)     EXCERNENT FUNCTION,
3^
predisposition to the tsorat or contagious forms of leprosy, so that
it often occurred as a consequence of various other cutaneous affec-
tions;  sometimes  appearing as a  berat lebena (run1? mm,)  or
bright-white leprosy,  and sometimes as a  berat  cecha  (nm n ^m,)
dusky leprosy,  according to  the peculiar habit or idiosyncrasy.
The cutaneous blemishes or blains which had a tendency to termi-
nate in leprosy, and which  were  consequently  watched  with a
suspicious eye from the first, are stated by Moses to have been the
following:
1.  Saat (n*w).*

2.  Saphat (nnflD).t

3.  Netek (pru).i


4.  Berat (nnm).§


5.  Boak (pna).ll


6.  Nega (jm).H
7.  Shechin  (pnt?).**

8.  Mecutash (tyx roaaj.tt
Herpes, or tetter,  «v\i, Sept.  an
  irritated cicatrix.
Psoriasis, or dry scall.—Dry  sa-
  hafata.  Arab.
Porrigo, or humid  scall.  Porrigo.
  Lat.  vers.  Jun.  et  Tremel
 , Moist sahafata.  Arab.
Leuce,  bright-white  scale:  the
  critical sign  of  contagious  le-
  prosy.
Alphos,  dull-white  scale :   the
  critical  sign  of uncontagious
  leprosy.
Ictus, blow or  bruise; a<pv, Sept.
Furunculus, or boil,  as in Job,
  ii. 7.
Anthrax,  or carbuncle: literally
  " a fiery inflammation."
  On the appearance of any one of these affections upon a person
he was  immediately  brought before  the priest for  examination.
If the priest perceived  that in connexion with such blemish there
Were the distinctive signs of a tsorat or contagious leprosy,  as  a
bright glossy and squammose surface, with a depression in the  mid-
dle, and white hairs, the person was immediately declared unclean,
and is supposed to have been sent out of the  camp to a lazaretto
provided for the purpose.   If the priest had  any doubt upon the
 * Levit. cap. xiii. 2, 10,19, 43
 f Id. v. 2, 6, 7, 8.
 * Id. v. 30, 31.
 § Id. v. 2, et sxpe alibi.
 II Id. v. 39.
 1 Id. v. 29, 42.
»• Id. v. 18.
tf Id. t. 24, 
39b
EC CHI IIC A.
[cuvi.-ou.ir.
subject, the nerson was put under domestic  confinement for seven
days, when he was examined a second time; and if in the course of
the preceding week the eruption  had  subsided and  discovered no
tendency to the above distinctive characters, he was discharged at
once.  But if the eruption were stationary, and the result  still
doubtful, he was put under confinement for  seven days  more: at
the expiration of which, on a third examination, the nature of the
disease always sufficiently disclosed itself; and he was either  sen-
tenced to a  permanent separation  from the community,  or  pro-
nounced  clean, and set at liberty.
  These doubtful cases, as we have just noticed, sometimes super-
induced the bright-white, and sometimes the dusky  leprosy, appa-
rently according to the particular constitution of the skin, or of the
habit generally.  And we are further told  that there were  two
ways in which the disease, and particularly the severest or bright-
white form of it, terminated ;—a favourable and  an unfavourable.
If it spread  over the entire frame without producing  any  ulcera-
tion, it lost its contagious power by degrees ; or, in other words,
run through its course and exhausted  itself.   In which case, there
being no longer any fear of further evil either  to  the individual
himself or to the  community,  the patient was declared clean by
the priest, while the dry scales were yet upon him, and restored
to society.*  If, on the contrary, the patches should ulcerate, and
quick or fungous flesh ('n "isy;)),t  spring up in  them, the priest
was at once to pronounce it an inveterate leprosy ;i. a temporary
confinement was declared to be totally unnecessary, and he was re-
garded as unclean for life. The  accuracy with which  this  second
termination is described, is fully confirmed by the passage  quoted
already, but for another purpose from Actuarius,  and it is  curious
to observe how closely they coincide. "The lepra," says the latter,
speaking of it in its worst form,  "penetrates deep, forms circular
eruptions and certain fungusses ordeliquescences of flesh."  But we
meet with nothing in the Mosaic account that approximates it to ele-
phantiasis : nothing of a thick, rugose, livid tuburculate, and parti-
cularly an insensible skin : nothing of fierce and staring  eyes, hoarse
and nasal voice, or of a general falling off of the hair.  And hence we
have additional proof that these maladies were distinct, and uncon-
nected. The malignant state of the disease, however, is still general-
ly called after the Greek misnomer elephantiasis: and the two mala-
dies in consequence hereof are to this hour confounded in the Greek
islands, and even as far north as Iceland, the ultima  Thule to which
the  literature of the Greeks  has  travelled :  but we have sufficient
proof in  all these cases, from some of the best travellers of  the pre-
sent day, that the disease thus described is not the tubercular or thick-
legged elephantiasis, but the above malignant form of genuine le-
prosy.  Thus, Mr. Jowett, in his very interesting " Christian Re

                    • Levit. cap.  xiii. v. 12, 13.
                    f Id. v. 10, 14, 15.
                    t Id. v. 11. 
GE. IV.—SP. H.)     EXCERNENT FUNCTION.
397
searches in the Mediterranean," in describing the beautiful, but now,
from its political reverses, most pitiable island of Haivali or Kydonia,
near Scio, " a little farther on is the hospital for  lepers: it was
founded by a leper.   Elephantiasis is  no uncommon disorder in
these parts;  its effects are very offensive. I saw poor men and wo-
men with their fingers or legs literally wearing or wasting away:"*
—forming a character directly opposite to what occurs  in proper
elephantiasis ; where the limbs, though they continue to crack, con-
tinue to thicken  enormously, even to the moment of separation.
Dr. Henderson, on the contrary,  while describing the real elephan-
tiasis in Iceland, calls it the  Jewish leprosy, and  offers a sort of
apology for Moses, that he " has not noticed the very striking anaes-
thesia, or insensibility of the skin,"t which, continues he, " is an
inseparable attendant  on the genuine elephantiasis."  The direct
answer is, that Moses delineates a different disorder, and one in
which no  such symptoms exist.
  As leprosy, except in  its less common and contagious modifica-
tions, has always been accounted a blemish rather than a serious dis-
ease in the East, the art of medicine has rarely, in that quarter, been
gravely directed towards it, save in  the use of the oxyde of arsenic,
which is  by far the  most efficacious  of every remedy that has
hitherto been tried in any quarter.   I have already had occasion to
notice the preparation and proportion of this mineral, employed from
time  immemorial,  in treating of elephantiasis, for which disease,
also, it is in common use : and the  reader may turn to the passage
at his leisure.   But, with the  exception  of arsenic, the remedies
proposed  by the Asiatics are trifling and little worthy of notice.
  In  Europe  the mode of treatment has, indeed, been far  more
complicated, but I am afraid not much more skilful or successful:
consisting, till of late years, of preparations quite as insignificant as
any that occur in the Arabian writers, and often highly injurious by
their  stimulating property.  Of the insignificant, the simplicity of
modern practice has banished by far the greater number; and it is
now, perhaps, hardly known to the  general, or even to the medical
botanist, that meadow scabious, and  several other species of the same
genus were so denominated from their  being  supposed,  when em-
ployed as a wash, in the form of decoction, to possess an almost spe-
cific virtue against leprosy, itch, and almost  every other  kind of
foul and scabious erurtion.
  Warm bathing, simple or medicated; and this frequently repeated,
is advantageous to all the varieties ; for it tends to remove the
scales, soften the skin, and excite perspiration.  In the nigrescent
leprosy, which proceeds  chiefly from poor diet, in connexion  with
sordes,  the bath should be of pure  fresh water, and the remainder
* Christian Researches in the Mediterranean, p. 65, 8vo.l822.
| Iceland ? or the Journal of a residence in that Island. 
398
ECCRITICA.
[CL. VI.—Oft. III.
 of the cure will generally, in such cases, depend upon a better re-
 gimen, and general tonics.  In the otner varieties, when they occur
 among ourselves, the sulphureous waters of Harrowgate, Croft, and
 Moffat, whether applied externally or internally, seem frequently
 to prove more efficacious.  As  external applications, most benefit
 appears to be derived from the tar-ointment, as employed by Dr.
 Willis, and a dilute solution of sublimate, or the unguentum hy-
 drargyri nitrati, as recommended by Dr. Willan   These medicinei
 should be applied to the skin, and the former of them be well  rub-
 bed in upon the parts affected every night, and carefully washed off
 the next morning with warm  water, or a slight alkaline lotion.
  As internal medicines, the most useful seem to have been the sola-
 num Dulcamara, and ledum palustre, in decoction or infusion.  Dr.
 Crichton strongly recommends the former, and speaks in high terms
 of its success.  I have  not been so fortunate in the trials  I have
 given it. The ledum, in Sweden,* and, indeed, over most parts of
 the north of Europe, as high up as Kamschatka, has long maintained
 a very popular character, and the form  of using it  is given by
 Odhelsus, in the  Stockholm  Transactions for  1774.  Infuse  four
 ounces of the ledum in a quart of hot water; strain off when cold;
 the dose from half a pint to a quart daily.
  The  bark of the  ulmus campestris  or  elm-tree, has also been
 warmly recommended by various  writers, for this as well as nume-
 rous other cutaneous eruptions ; and in connexion with more active
medicines, appears to have been of some use, but it is feeble in its
 effect when trusted to alone.  Its form is that of a decoction,  two
 ounces  to  a quart  of water: the dose half a pint morning  and
 evening.!
  The cenanthe crocata, or hemlock drop-wort, is another plant that
has been recommended in obstinate and habitual cases of this kind ;
and there are unquestionable examples of its having produced a
beneficial effect.  Dr. Pulteney has especially noticed  its  success
in a letter to Sir William Watson.  The herb, however, is one of
the most violent poisons we possess in our fields, and when mistaken
for wild celery,  water-parsnip, or various other herbs, has  fre-
 quently proved fatal a  few hours after being  swallowed, exciting
 convulsions, giddiness,  lock-jaw, violent  heat in the  throat ana
 stomach, and sometimes sickness, and purging: and  where  the
patient has been fortunate enough to recover, it has often been with
a loss of his nails and hair.   Goats, however, eat it with impunity,
though it is injurious to  most other quadrupeds.  As a medicine, it
is given in  the form of an infusion of the leaves : though sometimes
the juice of the roots has taken the place  of  the  leaves.   Three
tea-spoonfuls of the juice is an ordinary dose, which is repeated
every morning.

  ■ Linnaeus, Diss, de Ledo palustri.  Upsal, 1775.
  Abhandl. der Konigl. Schwed. Academie der  Wissenchaffien, Band. XI!
p. 194.
  t Medieal Transactions, Vol, II, p, 203, 
GE. IV.—SP. II]    EXCERNENT FUNCTION.
399
  But by far the most active and salutary medicine for every form
of leprosy, in Europe as well as in Asia, is  arsenic.  I have al-
ready adverted to its common use in the latter quarter, and at home,
in the form of the College solution, it has often been found to suc-
ceed, when every other medicine has been  abandoned in despair.
The ordinary dose is five minims twice or even three times a-day,
increased as the stomach will allow.
                       SPECIES III.

                LEPIDOSIS  PSORIASIS.

                        53rg Scall.

 PATCHES OF ROUGH, AMORPHOUS SCALES; CONTINUOUS, OR OF IN-
          DETERMINATE outline; skin often chappy.

 Psoriasis is a derivation of -d^*, "scabies, asperitas," with a ter-
 minal ins, as in the preceding species.  The primary term i^*, or
 psora, was used  in very different  senses among the Greek writers
 from a cause 1  have already explained under lepriasis, where it has
 been shown that the real radical is the Hebrew term yvt (tsora,)
 " to smite malignantly, or with a disease," whence njnx (tsorat,)
 imports the leprosy in a malignant or contagious form, but not in an
 uncontagious.  The lexicographers not hitting upon the proper ori-
gin of ifsafx, have supposed  it to be derived  from -^xa (psao,) which
means, however, unfortunately " tergo, detergo," " to cleanse, pu-
rify, or  deterge,"—instead of " to pollute:" but as one  way of
cleansing is by  scraping, and, as persons  labouring  under psora
scrape or scratch the skin on account of its itching, the difficulty
is supposed to be hereby solved, and psora is allowed to import de-
rivatively, what, upon this explanation, it opposes radically.
  The actual origin of the term, however,  is of little importance.
It was mostly employed by the  Greek writers, and has  been very
generally so in  modern times to  import a  dry scall  or scale, for
the terms are univocal, the Saxon sceala or scala being the origin
of the former, and denoting  the latter, of a rough surface and an
indeterminite outline, as expressed in the specific definition.
  Psoriasis, as thus interpreted, is the dry Sahafati of the Arabian
writers, the nn2D Saphat of the Levitical code, as already explain-
ed ; the Arabic being derived from the Hebrew root.  It embraces
the following varieties:

* Guttata.                     Drop-like,  but  with   irregula;
  Guttated dry scall.             margin,  In  children contagiou? 
400                      ECCHITICA.           [CL. Vl.—OR. III.
/3 Gyrata.                      Scaly patches  in serpentine or
  Gyrated dry scall.             tortuous stripes. Found chiefly
                                on the  back, sometimes on the
                                face.
y Diffusa.                      Patches  diffuse,  with  a  ragged,
  Spreading dry sea 1.            chopped, irritable surface: sense
                                of burning  and itching  when
                                warm :  skin gradually thicken-
                                ed and furrowed, with a pow-
                                dery scurf in the fissures.  Ex-
                                tends over the face and scalp.
^ Inveterata.                  Patches continuous over the whole
  Inveterate dry scall.           surface; readily falling off and
                                reproducible  with painful, dif-
                                fuse excoriations.  Extend  to
                                the nails and toes, which  be-
                                come  convex  and thickened.
                                Found chiefly in old persons.
t Localis,                     Stationary and limited to particu-
  Local dry scall.                lar organs.

  In the first or guttated variety, the patches very seldom ex-
tend to the size of a sixpence ; and are distinguished from those of
leprosy by  having neither an elevated margin nor an elliptic or cir-
cular form, often spreading angularly, and sometimes running into
small  serpentine  processes.  The  eruption commences  in  the
spring, mostly on the limbs, and appears afterwards distributed over
the body, sometimes over the face. It subsides by degrees towards
the autumn, and sometimes reappears on the spring ensuing.
  In  children, probably from the  greater sensibility of their skin,
this variety of scall spreads often with great rapidity, and  is scat-
tered over the entire body in two or three days.
  The second or  gyrated variety runs in  a migratory  course,
and appears the shape of earth worms or leeches when incurvated,
with slender vermiform appendages.  Not unfrequently the two ends
meet, and give the scall an annulated figure, like a ring-worm, par-
ticularly about the upper part  of the shoulders or on the neck,  in
which  case they are sometimes confounded with  shingles or  some
other modification of herpes.
  The spreading scall commences commonly on the face or tem-
ples, as the first of the preceding does on the extremities, and the
second on the back. It is sometimes confined to a single patch, which
nevertheless, is occasionally to be seen in  some other part, as the
wrist, the elbow-joint, breast, or calf  of the leg.   It is often obsti-
nate and of long duration, and has been known to  continue  for a
long series  of  years : in which case, however, there is usually an
aggravation or extension of it at the vernal periods. It is at times
preceded by some constitutional affection; and at  times seems to
produce the same.  When limited to the back of the hand this, like 
GE. IV.—SP. Ill]     EXCERNENT FUNCTION.
401
 some other forms of lepidosis, is vulgarly called the Baker's Itch.
 On the hands and arms, and sometimes on the face and neck, it is
 peculiarly troublesome to  washer-women ; probably from the irri-
 tation of the soap they are continually making use'of.
   The  inveteracy  of the  fourth  variety  seems principally to
 spring from the general torpitude and want of power in the class of
 persons whom  it chiefly attacks, which is those who are  in the de-
 cline of life.  Itis accompanied with painful excoriations, in many
 instances occasioned by the pressure of some parts of  the clothing
 against the sores, or by the attrition of  contiguous surfaces, as of
 the nates, groins, thighs, and scrotum.  At an advanced period of
 the disease, the cuticle is often still more extensively destroyed;
 and the extremities, the back and nates have been seen excoriated
 at  the same time, with a very profuse discharge of thin lymph from
 the surface: after which the discharge itself thickens,  from  an  ab-
 sorption of the finer parts, and forms a dry, harsh, and almost horny
 cuticle,  which progressively separates in  large  pieces.   At first,
 this variety intermits in the summer, but  at  length becomes per-
 manent and intractable.
   The local variety is  found chiefly on the lips, eye-lids, pre-
 puce, scrotum, and inside of the hands.   It  is peculiarly common
 to  shoemakers, and artificers in metallic trades, as braziers, tinmen,
 and silversmiths; probably from filth and  the irritation of the sub-
 stances they make  use of.
   The dry scall, under one or other of the above forms, is one of
 the most frequent cutaneous diseases in this kingdom,  and the first
 variety, guttated or drop-scall, psoriasis guttata,  is sometimes con-
 tagious in irritable skins, and especially among children.  Several
 of these  modifications are also found, occasionally, as symptoms or
 sequels of lues, particularly the first three ;  but are in every instance
 distinguishable by the livid or chocolate hue  of the scales.
   As cutaneous sordes, in connexion with  a peculiarity in the con-
 stitution of the skin, and especially in connexion  with  a meagre
 diet, indolence, and  want  of exercise, appears to be  the general
 cause of this as well as of many other, perhaps most other, simple
 cutaneous eruptions, the first principles of a curative intention must
 consist in washing and softening the skin by warm bathing,  regu-
 larly persevered in;  and in improving the  diet, and exciting to a
 life of more activity.  Beyond this the common treatment of pso-
 riasis should be, with little exception, that  of  lepriasis: and hence
 the sulphureous waters of Harrowgate, Croft,  Sharpmore, Brough-
 ton, Wrigglesworth, and other places, used both externally and in-
 ternally, will succeed better than common spring or  river-water.
 Chalybeate medicines, and particularly chalybeate  waters, have been
 powerfully recommended by Dr. Willis and many others; but, ex-
 cepting where the disease is combined with a languid  circulation,
 as  in the inveterate form, and demands excitement, these do not
 appear to be  of any certain efficacy.  Bleeding and the repetition
of purgatives are of no avail, though a common practice with many,
  Vol. IV.—3  E 
402
ECCBIT1CA.
[CL.VI.—OR.III.
and founded  also on the authority of Dr. Willis.  " Strong mercu
rial preparations," observes Dr. Willan, " are of no advantage, but
eventually rather aggravate the complaint."  Nor do the fresh juices
of the  alterant plants, scurvy-grass, succory, fumitory, or  sharp-
pointed dock, appear to be of any material benel't.
   \ gentle purgative should open the course of medical treatment;
to which should succeed an internal use of the  fixed alkalies with
precipitated sulphur, and decoctions of elm-root,  sarsaparilla, sassa-
fras, mezereon, or dulcamara; and where the  skin is very dry an
antimonial at night, or five grains of Plummer's  pill, the compound
subinuriate mercurial pill of the London College.  Yet, here, as in
the preceding species, the most effectual remedy, in obstinate cases,
is the arsenic solution, with an abstinence from  fruits, acids, and
fermented liquors : under which plan, in conjunction with the above
reeimen, most of the ordinary cases will be found to  disappear in
about three weeks or a month.




                       SPECIES IV.

               LEPIDOSIS ICTHYIASIS.

                        iFtsli-Sfttu.

1HICK,  INDURATED  INCRUSTATION  ENCASING  THE  SKIN  TO  A
       GREATER OR LESS  EXTENT ; SCALINESS IMPERFECT.

The specific term  is derived from i%0t>« " piscis" with the terminal
adjunct of the preceding species.  The word is commonly written,
but less correctly ichthyosis,  since as I have already observed the
suffix iasis is  by general consent applied to all species appertaining
to the genus or tribe of diseases before us.
   In treating of the genus parostia,* as well as in various other
places, I have had occasion  to observe that the calcareous earth which
the assimilating  powers of the animal  frame elaborate  from the
materials of the food or of the blood, for the use of the  bones, to
give them increased size and  solidity in adolescence, and to main-
tain their firmness in mature  life, is, in many  cases, secreted irre-
gularly; sometimes in excess, sometimes in deficiency, and some-
times imperfectly, or without a due proportion of phosphoric acid,
and other constituents ; while, on the other hand, in the advance of
old age, although the secretion may not be much disturbed as to its
quantity or quality, in the process of carrying off the waste matter
the finer parts alone are removed in consequence of the debility of
the absorbents, and the bones become brittle and easily broken.
• Vol. IV. p. 216. 
GE. IV.—SP. IV.]    EXCERNENT FUNCTION.               403

  In the genus lithia we have seen that one of the outlets for the
discharge of the waste  calcareous earth is the kidneys: and that
when these are supplied with an excess of earth, or a quantity be-
yond what the uric acid will hold in solution, it is apt to subside,
accumulate, and concrete, and consequently to form calculi.
  We have also seen, under paruria erratica, as well as under
lithia,  that the excretories of the skin become at times an outlet
of the same kind for the  removal of calcareous earth, whence the
calcareous deposits in gout, and the calcareous scurf which is often
accumulating on the head of those who perspire much.
  In the disease before us  the  cutaneous  excretories throw forth
such an excess of this earthy material that it  often encases the en-
tire body like  a shell;  and the cutis, the rete mucosum, and the
cuticule being equally impregnated  with it, the order of the tegu-
mental laminae is destroyed, and the whole forms a common mass
of bony or horny corium, generally scaly or  imbricate, according
as the calcareous earth is deposited with a larger or smaller pro-
portion  of gluten, in many instances of enormous thickness, and
sometimes giving rise to sprouts or branches  of a very grotesque
appearance:  thus offering  to us numerous varieties,  of which the
following are the chief:

x Simplex.                  The  incrustation  forming a  harsh
  Simple Fish-skin..            papulated  or  warty  rind ; hue
                               dusky; subjacent muscles  flexi-
                               ble.   Sometimes covering the
                               whole body except the head and
                               face, palms   of  the  bauds, and
                               soles of the feet.
/3 Cornea.                    The  incrustation forming a  rigid,
  Horny Fish-skin.             horny,  imbricated  rind;   hue
                               brown or yellow ; subjacent mus-
                               cles inflexible.   Sometimes co-
                               vering  the  entire  body, includ-
                               ing the face and tongue.
y Cornigera.                 The  incrustation accompanie with
  Cornigerous Fish-skin.        horn-like,   incurvated    sprout-
                               ings;   sometimes  periodically
                               shed anxl  reproduced.

  This  indurated incrustation  commences  with a change in the
papillae of the cutis ; which are elongated and enlarged into roundish
cones or tubercles, often void of sensation.  Some of the scaly pa-
pillae have a short, narrow neck, and broad irregular  tops.  Some-
times the scales are  flat and  large, and imbricate or placed like
tiling, or the scales on the back of fishes, one overlapping another.
They also differ  considerably in colour in different instances, and
are  blackish, brown, or white.   The  skin, to  a very considerable
extent,  has sometimes  been found  thickened  into a  stout, tough 
404
EC CRITIC A.
[CL. VI.—OR.III.
leather.  In a singular enlargement of the lower extremity produc-
ed by a puerperal sparganosis, Mr. Chevalier found the thickness of
the corium in some parts near a quarter of an inch ; which, on being
cut into, presented the same grained appearance that is observable
in a section of the hides of the larger quadrupeds.  Below the co-
riaceous skin the  adipose membrane exhibited  an equal increase
of substance, and in front of the tibia was not less than an inch and
a half  thick.  Mr. Machin gives a very extraordinary case of icthy-
iasis of the same kind, originating, indeed, from  a different and un-
known cause, which covered the whole body with the exception of
the head and face, the palms of the hands, and the soles of the feet.
The entire skin formed a dusky, ragged, thick case, which did  not
bleed when cut into or scarified, was callous and insensible, and was
shed annually like the crust of a lobster, about  autumn, at which
time it usually acquired the thickness  of three-fourths of an inch,
and was thrust off by the sprouting of a new skin beneath.*  This
man married, and had a family of six children, all of whom possess-
ed the same ragged covering as himself.   The  father was  twice
salivated for the complaint, and threw  off the casing each time, as
did one of the children during the small-pox; but the disease soon
returned on both  of them.  In the  Transactions of the Medico-
Chirurgical Society there is a case in which the face alone was ex-
empted from the fish-scale covering.!
  There is a  remarkable passage in the Lettres  Edifiantes et Cu-
rieuses, of the Jesuits,  which  intimates that this disease is by no
means  uncommon among the inhabitants of  Paraguay ; the words,
which have been quoted by M. Buffon and Dr. Willan, are as  fol-
lows: " II regne parmi eux une maladie extraordinaire:  e'est une
espece de Lepre, qui  leur couvre tout de  corps, et y forme une
croute  semblable a des ecaiiles de poisson :  cette incommodite ne
leur cause aucune douleur, ni meme aucun autre derangement dans
la sante."| There  is perhaps no part of the  world where  we should
sooner expect to meet  with this, and indeed various other species
of squammose or  leprous affections of the skin, considering  the
sultry heat of the atmosphere, the rankness of the perspiration that
issues from the bodies of the natives, and their  deficiency in per-
sonal cleanliness ; yet I do not know that the same account has been
given by any other travellers, and have looked in vain over Estalla
and Dobrizhoffer:  nor does this particular incrustation of the skin
seem to be prevalent in other inland countries exposed to the same
excitements, though most of them exhibit squammose disorders of
the surface of some kind or other.
  In our own country it often shows itself locally and is  restricted
to a single limb, as an  arm, leg, or  soles of the feet, and  it  has
• Phil. Trans. Nu. 424.
t Trans. Medico-Chir. Soc. Vol. IX. p. 52.
t Recueil de Lettres, &,c. XXV. p. 122. 
t*E. IV.—bP. IV.]    EXCERNENT FUNCTION.
403
sometimes fixed on a cheek, an interesting figure of which is given
in Dr. Bateman's Delineations.
  Examples of the cornigerous variety, or that in which the incrus-
tation is accompanied with a sprouting of horns or horn-shaped pro-
jections, are by no means uncommon.  Sir Everard Home has given
two cases in  the Philosophical Transactions that occurred within
his own knowledge.   The patients were women about  the  middle
of life or rather later : one had four horns,  and the other a single
horn.  Each of them  grew from a cyst  which formed  gradually,
and at last opened spontaneously and discharged " a thick gritty
fluid."*  The foreign journals are full of similar accounts, in some,
of which the horns are of considerable length, mostly  growing upon
the head, though in a few instances on the back.t In  the  British
Museum is shown us, as a curiosity, a horn of this kind eleven inches
long, and two and a half in circumference at the base.   It is said to
have issued from a wen that formed  in the head of a woman, and to
have reached its full length in four years.
   When these are single they rather perhaps belong to the genus
ecphyma, and  particularly the species verruca and clavus ; but they
are very frequently connected with a dry furfuraceous orscaly skin,
often oozing a calcareous material.  A very singular example of thi>>
complex modification occurred a few years  ago in  a Leicester-
shire heifer, which was  publicly exhibited, and of which the au-
thor presented a description and a drawing to the Royal Society.
The whole of the skin was covered with a thick, dry, chalky scurf,
often producing an itching; and whenever the skin was scratched,
a calcareous fluid oozed  from it that soon hardened, and put forth
corneous, recurvating excrescences, frequently divaricating, and as-
suming sometimes a  leafy, sometimes a horn-shaped appearance.
The back was covered with them ; over the forehead and below the
dew-lap they hung in some hundreds ; many as large as natural horns
and rattling  together whenever the animal  moved.  The heifer
was otherwise  in good health, and secreted the same chalky fluid
whatever food  it was fed upon.
   Medicine has hitherto been found  of  but little avail  under  any
form of this aft'ection.  Dr. Willan advises to immerse the incrusted
part in water,  and to pick off'the scales with the finger nails, while
thus soaked.   Dr. Bateman recommends that the bath should be
of sulphureous waters, and the scales rubbed off with a flannel or
rough cloth.   But both admit that their methods produce  only a
partial cure : that the skin does not recover its proper texture, and
that the eruption will probably recur.  Dr. Bateman further recom-
mends, as having been  actually serviceable,  pills made of pitch
hardened by flour or any other farinaceous substance, which makes
* Phil. Trans. Vol. LXXXI. 95.
f Eph. Nat. Cur. Dec. 1. Ann. I. Obs. 30.
  See also Hist, de la Societe Rovale de la Medicine, 1776, p, 316, 
406                      ECCRITICA.          [CL. VI.—OH. HI
the cuticle crack  and fall off, as he tells us, without the aid of ex-
ternal means, and leaves a sound skin  underneath.  Where there
is an evident excess of calcareous earth the most efficacious remedy
is probably to be found in a free use of  acids, and especially the
mineral acids, as in white urinary sand,* to which this disease bears
a  near  resemblance.   The arsenic solution,  however, is  worth
trying, but I have no documents of its effects.
                        GENUS  V.

                     ECPHLYSIS.

                            Mams.

ORBICULAR ELEVATIONS OF THE CUTICLE CONTAINING A WATERY
                            FLUID.

Ecphlysis, (" Ex<pxvtris, from  txtpxv^u, "ebullio," " efferveo,"  "to
boil or bubble up or over,") imports  " vesicular  eruption confined
in its action to the surface ;" as emphlysis, which we have long since
described,t is " vesicular eruption essentially connected with in-
ternal and  febrile affection."   The term is intended to include all
those utricles, or minute bladders of the cuticle containing a watery
fluid, and not necessarily connected with internal disease, whether
bullae or vesiculae, between which Dr.  Willan has  made  but little
difference in  his definitions,  except in respect to size ; and  which
were equally denominated by the Greek physicians phlyctaenae a
term derived from the same source.  And  hence the species  that
fairly appertain to this genus, appear to be the following:

1. ECPHLYSIS POMPHOLYX.       WATER-BLEBS.
2.----■      HERPES.           TETTEH
3.---------RHYPIA.           SORDID BLAIN.
4. ----——  ECZEMA.          HEAT-ERUPTION.
• Supra, p. 340.
f Vol. II. p. 386. 
GE. V.—SIM.]      EXCERNENT FUNCTION.                407


                        SPECIES  I.

             ECPHLYSIS  POMPHOLYX.

                       ffia?ater=J3lcfcs.

ERUPTION  OF  BLEBS,  CONTAINING  A RKDDISH, TRANSPARENT
  FLUID; MOSTLY DISTINCT; BREAKING AND HEALING WI'I HOUT
  SCALE OR CRUST.

Pompholyx or pomphus, was used among the  Greek writers in the
same  sense as pemphix, of which  we have treated already,* and
equally imported a bladdery  tumour of the skin, distended with a
fluid :  the  Latins denominated  it bulla, of which our own term
water bleb is an apt and exact representative.   Pemphix, in the
modern use of the term, is necessarily accompanied with fever, and
hence under the present arrangement is an emi>hlysis as pompho-
lyx, being without fever or other constitutional affection necessarily
connected  with it, is an ecphlysis. The latter is hence denominat-
ed Pemphigus apyretos by Plenck, and Pemphigus sine pyrexia by
Sauvages.  It has, however,  been properly separated from pemphi-
gus by Dr  Willan, who has arranged  it as it stands in the present
work.   It offers the four following varieties :
a Benignus.                 Blebs  pea-sized,  or filbert-sized;
  Mild water-blebs.            appearing successively  on vari-
                              ous parts  of the body;  bursting
                              in three or four  days, and heal-
                              ing readily.
/3 Diutinus.                 Blebs gradually growing from small
  Lingering water-blebs.       vesicles to the size of walnuts ;
                              yellowish: often spreading in suc-
                              cession over the whole body, and
                              interior of the mouth; occasion-
                              ally  reproduced, and forming an
                              excoriated surface with ulcera-
                              tion.  Often preceded by languor,
                              or other general indisposition for
                              several  weeks.  Duration  from
                              two to four or five days.
7 Quotidianus.              Blebs with a dark red base, appear-
   Quotidian water-blebs.       ing at night and dissappearing in
                              the morning, or appearing in the
                              morning  and   disappearing  at
                              night. Found chiefly on the hands
                              and legs.
* Vol. II. 402.  Emphlysis Pemphigus. 
408
ECCUITICA.
[CL. \I.—OR. III.
 } Solitarius.                 Bleb solitary ; but reproductive in
  Solitary water-bleb.          an adjoining part; very large, and
                               containing   a   tea-cup-full   of
                               lymph. Preceded by tingling: of-
                               ten accompanied with languor.
  The third, or quotidian  variety, is  here  introduced  upon  th*
 authority of Sauvages, for it does not occur in Willan, who seems
 to have overlooked it: and hence  it is  not  noticed by  Bateman.
 Sauvages, from  the  time of its more  usual  appearance,  calls it
 epinyctis; but as Vandermonde has given a case of an opposite
 kind, in which the bulla showed itself daily and  subsided nightly,
 this name will not properly apply.
  Under  whatever  form,  however, the pompholyx appears, its
 causes seem to be debility and irritability either general or confined
 to the cutaneous  exhalants.  The  benign variety has hence been
 found in infancy during teething and bowel complaints,  and occa-
 sionally immediately alter vaccination. The quotidian has evidently
 succeeded to great anxiety, fatigue, watching, and  low diet.   It
 appears also chiefly in persons of advanced age, or who have been
unduly addicted to spirituous liquors.   It is by far the most severe
 of all the forms of the disease, as being painful as well as tedious.
 The  other varieties are to be referred to like  causes.
  In early or middle life, Peruvian bark given freely, with an im-
proved diet, where  necessary, has formed the most  successful
remedy.   In old age, softening the skin, and gently exciting the
cutaneous exhalants, has been equally useful: but while the bark
is less serviceable in old age, warm bathing has proved rather inju-
rious in earlier life.
                       SPECIES II.


                ECPHLYSIS HERPES.

                          better.

ERUPTION OF VESICLES IN SMALL, DISTINCT CLUSTERS; WITH A RED
  MARGIN; AT FIRST PELLUCID, AFTERWADS OPAKE : ACCOMPANIED
  WITH ITCHING OR TINGLING;  BONCRETING INTO SCABS: DURA-
  TION FROM FOURTEEN TO TWENTY-ONE  DAYS.

Herpes from i%ru, "serpo," "repo," has been used in very different
senses by different writers, being sometimes restricted  to one or
two of the modifications of the present classification, and by others
extended so widely as to include both the preceding and the ensu-
ing genus—or, in other words, cutaneous eruptions, dry, vesicular, 
OE. V.~SP. II.]
EXCERNENT FUNCTION.
409
 and postular, and in this latitudinarian sense of the term it is em-
 ployed by Mr. B. Bell, who gives us a herpes farinosus, and postu-
 losus, as well as a herpes miliaris and  exedens.
    In the present arrangement the term is  limited  to minute and
 clustering cutaneous vesicular eruptions alone, which forms a clear
 and distinctive indication.  The fluid  contained in the vesicles is
 for the most part highly acrimonious and excoriating; and hence
 the terms ^o-/« and ^t«5 (darsis and  dartus) "excoriatio and ex-
 coriatus," have  been applied to it: from which the French have
 derived their popular name for it of dartre, which, by an easy cor-
 ruption, has been changed in our own tongue into tetter.
   The following are the varieties which seem fairly to belong to it:

 * Miliaris.            Vesicles millet sized ;  pellucid ; clusters
   Miliary tetter.        commencing  at an  indeterminate part
                         of the surface and progressively strewed
                         over the body ; succeeded by fresh crops.
 p Exedens.            Vesicles hard;  of the size and  origin of
   Erosive tetter.        the last; clusters thronged ; fluid dense,
                         yellow  or reddish; hot,  acrid, corrod-
                         ing the subjacent skin,  and  spreading
                         in serpentine trails.
 y Zoster.             Vesicles pearl-sized; the  clusters spread-
   Shingles,              ing round the body like a  girdle; at
                         times  confluent.   Occasionally preced-
                         ed by general irritation or other  consti-
                         tutional affection.
 } Circinatus.          Vesicles with a reddish  base,  uniting in
   Ring-worm.           rings,  the area  of the   rings slightly
                         discoloured;   often  followed   by fresh
                         crops.
 *  Iris.                Vesicles uniting in small rings, surround-
   Rain-bow-worm.       ed by four concentric rings of different
                        hues; vesicular and prominent.  Usually
                        found about the hands or instep.
   The first, or miliary variety, is the herpes  miliaris  of Hip-
 pocrates and Hoffman, the h. phlyctenodes of Bateman.   The cause
 of the peculiar irritability of the skin that excites this affection is
 very obscure.  The lymph  contained in the vesicles is sometimes
 brownish,  and for  the space  of two or three days, other clusters
 successively  arise near the former. The  eruption commences in any
 part of the body. The enclosed lymph sometimes becomes  milky or
 opake in the  course of ten or twelve days, from an absorption of its
 finer parts ; and about the fourth day the inflammation around the
 vesicles assumes a duller red hue, while the minute utricles break
and  discharge their fluid, or dry into scales, which fall off and leave
a considerable degree of inflammation below, that still continues to
exude fresh matter, which also forms into cakes, and falls off like
  Vol. IV.—3 F 
410
ECCRITICA.
[CL. VI —OR. HI.
 that which preceded.  The itching is always  very troublesome:
 and the matter discharged from the vesicles is so tough and viscid,
 that every thing applied in the way of dressing adheres very closely
 and is removed with great trouble and uneasiness.
   To the second, or  erosive variety, the Greeks gave the name
 of ^jjs ea-Stofuvos, or herpes esthiomenos, of which the Latin herpes
 exedens is a mere translation.  The herpes esthiomenos, however,
 has hitherto been much misunderstood, and been held of a far  se-
 verer character than it really possesses, in consequence of an error
 that has long since crept into the text of Celsus, and been propa-
 gated in the  common editions, in which he is made to say that the
 livid and fetid  ulcer which the Greeks called  Sti'tapx, sometimes
 degenerates into a herpes esthiomenos, or exedens, "eating herpes;"
 as though the herpes exedens  formed  the worst and most gangren-
 ous stage of  this ulcer.  In the volume of Nosology I have exam-
 ined this passage critically, and have  shown that for herpes esthio-
jmenos we ought to read QxyeS'xtvx, "the ulcer called phagedasna,"
 as it  is properly given in the corrected text of the variorum edi-
 tion,  which settles the dispute at once, and clears Celsus from the
 absurdity wiiich has been  ascribed to him of converting a  cutane-
 ous vesicular affection into a deep  spreading  ulcer  of a  cancer-
 pus  character.  Celsus, therefore, in reality  makes no  mention
 whatever of the herpes exedens or esthiomenos; and  it is to other
 writers we must turn for its  character.   Galen has  described  it
 very accurately : and in the volume of Nosology I have copied and
 translated Galen's description, as it occurs in different parts of his
 writings.  The definition giyen of it above, is certainly taken from
 his representation.   The ulcerative ring-worm of Dr. Bateman is,
 perhaps, a modification of this variety: it is of tedious and difficult
 cure, but is limited to hot climates.
   Where this variety is connected, as it is sometimes found to  be,
 with the state of the constitution, and particularly of the stomach,
 and the patches are accompanied with a sensation or actual burn-
 ing or scalding, so as to resemble a more papulated form of measles,
 like the measles of this modification they are denominated nirles in
 some parts of Scotland.
   The third variety, herpes zoster, is the zona ignea of many
 writers, both which terms imply a belt or girdle, and  are evidently
 given to the eruption from its ordinary seat and course as surround-
 ing the body.  The Latin word of these is cingulum,  and from cin-
 guium our own shingles has been derived in a corrupt way.
   A slight constitutional  affection sometimes precedes the  appear-
 ance of this form,  as sickness and head-ache, but by  no means ge-
 nerally : for in most instances the first symptoms are those of heat,
 itching and tingling in some  part of  the trunk, which, when exa-
 mined, is found to be studded with small red patches of an irregular
 shape, at a little distance from each other, upon each of which  nu-
 merous  minute elevations are seen  clustering together.  These,
 when accurately inspected, are found to be distinctly vesicular; 
GE. V.-SP. II.)
EXCERNENT FUNCTION.
411
 in the course of twenty-four hours they enlarge to the size of small
 pearls, are perfectly transparent, and  filled  with a limpid flu d.
 The clusters are  of various diameter, from one  to  two,  or even
 three inches, and are surrounded by a narrow red margin, in con-
 sequence of the extension of the inflamed base a little beyond the
 congregated vesicles.   During three or four days other clusters
 continue to arise in succession, and with considerable regularity,
 that is nearly in a line with the first, extending always towards the
 spine at one extremity, and towards the  sternum  or linea  alba at
 the other ; most commonly passing round the waist like half a sash,
 but sometimes, like  a sword-belt, across the shoulder.    As  the
 patches  which first appear subside, the vesicles become  partially
 confluent,  and assume a livid or blackish hue, and terminate in thin
 dark scabs, the walls of the  utricles beir - thickened by the exsic-
 cation of the grosser parts of the containeu fluid.  The scabs  fall
 off about the twelfth or fourteenth day, when tne exposed  surface
 of the skin appears red and tender ; and, where the ulceration and
 discharge  have been considerable, is pmed with  numerous cica-     \
 trices.   The complaint is generally of little importance, but is some-      ^
 times accompanied, especially on the decline of the eruption, with
 an intense deep-seated pain in the chest, which is not easily allayed
 by medicine.   By some authors, as Hoffman and Platner, it is said
 to be occasionally malignant and dangerous, and Languis alludes to
 two cases in noblemen that terminated fatally.*  The disorder, how-
 ever, seems in these instances to have been of a different kind from
 shingles, and to have depended upon a morbid state  of the consti-
 tution.
   This affection is found most frequently in the summer and autumn,
 when the skin is most irritable from increased action, and in persons
 of a particular diathesis, disposed to herpes rather than to any other
 form of scaly  eruption.  Under these circumstances slight exciting
 causes wHl produce it, as  exposure to cold after  violent  exercise
 with great heat; cold cucurbitaceous vegetables, or other substances
 that disagree "with the stomach ; inebriety ; or even a sudden parox-
 ysm of passion or other strong mental emotion, of which Schwarz
 tells us that he had seen  not less than  three  cases.t  It  is more
 common to early than to later life, being found principally between
 twelve and twenty-five years of age.  It  has sometimes appeared
 critical  in bowel-complaints, or pulmonic affections.^  It does not
 seem to  be contagious, though asserted  to be so by some writers.
 " In the course of my attendance," says Dr. Bateman,  " at the Pub-
lic Dispensary during eleven  years, between thirty and forty cases
 of shingles have occurred, none of which  were traced to a  conta-
gious origin, or occasioned the disease in other individuals."
• Epist. Med. p. 110.
f Diss, de Zona serpiginosa. Hal. 1745.
f Bateman on Cutaneous Diseases, p. 227. 8vo. 1813. 
412
ECCRITICA,
[CL. VI.—ou. in.
  The ring-worm is a still slighter variety of herpes than shin-
gles, both with respect to disquieting symptoms, and range of the
disease.   Here the vesicles are restricted to the circumference of
the herpetic patch,  thus forming  an annular  outline; the central
area, however, in some degree participating in the inflammation,
becomes roughish and of a dull red colour, and throws off an exfo-
liation as the vesicles decline, leaving a red and tender surface be-
neath.  The process is completed in about a week : but a fresh
crop of herpetic circles freely spring up in the neighbourhood, or
in some other part of the body ; and, as such crops are occasionally
repeated many times in succession,  the course of the disease is not
unfrequently protracted through a long period, and  migrates over
the entire surface from face to foot.   Yet no  other  inconvenience
attends  it than a disquieting itching and tingling in the patches.
It is found most frequently in children, and though deemed conta-
gious, affords no real ground for such an opinion.  It has, indeed,
been traced in some  instances, in  several children of the same
school or  family at  the same  time; but perhaps only where  the
same occasional cause, whatever  that may be, has  been operating
upon all of them : while in most instances, the examples have con-
sisted in single patients who have not been debarred  communica-
tion or even sleeping with their school-fellows, or other branches of
a family.
  The rain-bow worm, or tetter, is of rare occurrence, and was by
Dr. Willan at first mistaken  for  an exanthem, in  consequence of
his  having only seen it in its earliest stage : on  which  account in
the first edition of his Table of Classification he called it a rain-bow
rash.  The error  has been corrected by Dr. Bateman, to whom we
are indebted for the first accurate description  of it.  Its usual seat
is on the back of the hands, or the palms and fingers, sometimes on
the instep.  The  patches are very small, and  at their full size do
not exceed that of a sixpence.  Its  first appearance is that of an
efflorescence, but by degrees the concentric  and iridescent rings
become  distinctly formed and vesiculated, and even the area par-
takes of the vesication and becomes an umbo.  The utricles  are
distended in about nine days, they continue stationary for two days
more, and then gradually decline, and disappear a week afterwards.
The central vesicle  is of  a yellowish-white colour;  the innermost
ring of  a  dark or brownish-red ; the second of nearly the central
tint;  the third, which is narrower than the rest, is dark-red;  the
fourth, or outermost, which does  not appear till the seventh, eighth,
or ninth day, is of a light-red hue, and is gradually lost in the ordi-
nary colour of the skin.
  This  variety has only been seen in young persons, and  is uncon-
nected with any constitutional affection.  Its exciting cause is not
known: though it has occasionally followed a severe  catarrhal affec-
tion, accompanied with hoarseness. It has also  occasionally recurred
several times in the  same person,  always occupying the same part?
and going through its course in the same periods of time. 
GE. V.—SP. II.}     EXCERNENT FUNCTION.
413
  The local ring-worm is accompanied with a considerable sense
of heat and itching or tingling irritation in the region in which it
Originates.  That of the lip, renders the adjoining parts hard, and
tumid, and  painful,  and especially the angle of the mouth;  the
form  is usually  semicircular;  and though  the  herpes  does  not
spread to any considerable distance, it is  sometimes found  at the
same  time within the mouth, forming imperfect rings on the tonsils
and uvula, and producing an herpetic sore throat.  It usually ap-
pears, however, as a symptom or sequel of some disease of the ab-
dominal viscera, and sometimes  proves critical to them.  It  termi-
nates, as  in other cases, in ten or fifteen days in dark thick  scabs,
which form over a red and  tender new cuticle.
  The local ring-worm of the prepuce is apt to be mistaken at first
for a  chancre, and still more so,  if, under the influence of this mis-
take,  it be treated with irritants, for the base will then become
much more thickened and inflamed, and the natural course  of the
vesicles will be interrupted. If the eruption be left alone, it will
prove itself in about twenty-four hours by  the enlargement and dis-
tinct  form of the vesicles, and their assuming an annular line. They
die away after having run  their course, as in the other  varieties.
The exciting cause of this is not known.  It has been ascribed,
however, by Mr.  Pearson, to a previous use of mercury.  Like
several of the other modifications it has a tendency to recur, after
it has once  shown itself.
   No internal use of medicine is necessary in the treatment  of any
of  the varieties of herpes, except where the constitution becomes
affected from the irritation ; and in such case, a gentle purgative or
two should be administered at first, and  a plan of tonics be  laid
down afterwards, the diet being simple and plain.
   External  applications are almost of as little avail, for the erup-
tion must have time to run through its course, and if this be inter-
rupted we shall certainly prolong the period, and add to the irrita-
tion.   Stimulating ointments and lotions were in use formerly, but
they  have now been judiciously laid aside, as only tending to ex-
acerbate the affection.  Where from the viscosity of the discharged
fluid  the  vesicles are apt  to adhere  to  the clothes or whatever
covering they come in contact  with, they may be covered with a
layer of cetaceous cerate of lint; but a layer of  lint alone will be
 most useful in the local variety  of the prepuce, as even oleaginous
applications are apt to irritate the disease when in that quarter. 
4J4                      ECCRITICA.           [CL.VI.~OR.IW.


                       SPECIES III.

                 ECPHLYSIS RHYPIA.

                       Sortrfif Main.

ERUPTION OF BROAD, FLATTISH, DISTINCT VESICLES: BASE SLIGHT-
  LY INFLAMED ; KLUID SANIOUS J  SCABS THIN AND  SUPERFICIAL :
  EASILY RUBBED OFF AND REPRODUCED.

For a distinct arrangement of this species in medical classification,
we are altogether indebted to Dr. Bateman, who has  denominated
it rupia,  from fWo«, "sordes," as indicative of the ill smell and sor-
did condition of the diseased  parts ;  and  in  his delineations has
given two very excellent and instructive coloured plates of  its ap-
pearance under different modifications.  'Twos, however, with its'
aspirate and  the  ordinary power of the v should be rendered, in
Latin characters, rhypia, as now given, and only altered for the sake
of greater correctness.
  The species offers three  varieties as  follows :

x Simplex.                 Scab  flat; livid  or blackish ;  shape
  Simple sordid  blain.        circular.
j8 Prominens.              Scab  elevated,  conical, and  black-
  Limpet-shelled blain.       ish; shape limpet-shelled.
y Escharotica.              Sanious  discharge  erosive, produc-
  Erosive blain.               ing gangrenous eschars.

  The vesicles under this species  never become confluent: theii
progress  is  slow, and  leads,lto an ill-conditional discharge,  which
concretes into thin, superficial,  and chocolate-coloured scabs, of
the distinctive characters  noticed above.   When the ulcers under
the scab, in the  two first  varieties, heal, they still  leave the sur-
face of a livid or blackish  colour, as if from a pigment in the rete
mucosum.  The  second variety, assumes the direct form and swell
of a small limpet-shell, with its open part downwards, but its colour
is much darker.*
  All the modes of this eruption are connected with a debilitated,
and hence frequently with a cachetic state of the system, and the
first is  sometimes accompanied with  symptoms resembling those
produced by a morbific poison.  They occasionally make a near
approach to  the  ecthymata.t but differ in the form, shape, and
size of the vesicle, and in the colour and consistence of the contained
* Bateman, ut supra, p. 237.
f Seethe ensuing Genu*,Species III, Ecpyesis, Ecthyma. 
6E. V—SP. III.]     EXCERNENT FUNCTION.
415
fluid, as consisting of flattened muddy blains, and forming larger
and more circular scabs.
  The escharotic variety affects only infants and young children
when reduced by bad diet and nursing, or some severe disease, as
the small-pox.   The vesicles are generally found on the loins,
thighs, and other extremities,  and appear to contain a  corrosive
sanies:  some of which frequently terminate in gangrenous eschars,
which leave deep indentations.
  The disease is only to be combated by supporting the system.
and restoring it to a state of vigour by means of good, light, nutri-
tious diet,  and the use of alterative "and tonic  medicines, as the
compound pill of the submuriate of mercury, bark, columbo,  and
sarsaparilla.
                        SPECIES IV.

                 ECPHYSIS ECZEMA.

                      ffytat HSvuption.

 ERUPTION OF  MINUTE,  ACUMINATED  VESICLES,  DISTINCT, BUT
   CLOSELY CROWDING ON EACH OTHER; PKLLUCID OR MILKY J WITH
   TROUBLESOME ITCHING OR TINGLING ; TKRMINATING IN THIN
   SCALES OR SCABS;  OCCASIONALLY SURROUNDED BY A BLUSHING
   HALO.

 Eczema, from ex^ea, " efferveo," is the hidroa of Sauvages and Vo-
 gel : it is common to all countries in the summer, and has been
 described in  all ages.  Its  proximate  cause  is irritation in con-
 sequence of exposure to the direct rays  of the sun, or to air heated
 to a high  temperature, or violent exercise.  Hence it chiefly affects
 those parts that are most exposed to this influence,  as the face,
 neck, and fore  arms in women, but particularly the back of the
 hands and fingers, the latter being sometimes so tumefied that the
 rings cannot be drawn off.  The blushing halo by  which they are
 surrounded is popularly called a heat spot.  In men of a sanguine
 temperament, and  who use violent exercise in hot weather, these
 vesicles  are intermixed  in  various places with minute pustules
 possessing a hard, circular base, the phylzacium of Willan, or with
 hard and painful tubercles, which appear in  succession, and rise
 to the size of small boils, and suppurate very  slowly, though with-
 out a central core. The vesicles are apt to be confounded with two
 other eruptions of very different kinds, miliaria, while it spreads
 widely over the body,  and scabies,  when fixed chiefly about the
wrists, the ball of the thumbs,  and the  fingers.  It is, however,
 distinguishable  from the former by being accompanied with fever 
416
ECCRITICA.          [CL. VI—OR. Hi.
 or any other constitutional derangement; and  from the latter by
 the pellucidity and acumination of the vesicles, the closeness and
 uniformity of their distribution, and the absence of surrounding in-
 flammation, or subsequent ulceration.  The sensation, moreover, to
 which it gives rise, is that of a smarting or tingling rather than of
 itching.
  The eruption is irregularly successive, and has no  determinate
 period of decline, which very much depends upon  the irritability
 of the skin itself.  Generally, however, it runs its course in two or
 three weeks, and subsides slowly and almost imperceptibly.  But
 where the skin is highly irritable it will sometimes continue till the
 weather grows cool in  the autumn, and  consequently for two or
 even three months.
  Medicine,  external or internal, seems to accomplish  but little.
 The re-action of a cold bath, in most cases, increases the irritation:
 and hence a tepid bath is most serviceable.  Astringent lotions add
 equally to the irritability, as do unguents of all kinds. Washing the
 parts with mild or Windsor soap and tepid water, I have found most
 effectual—when, in a few days, the skin will bear  a soap of a coarser
 kind  with  still  more advantage.   Where the  irritability of  the
 skin is connected with that of the general frame, the mineral acids,
 and other astringent tonics, have proved decidedly beneficial.
  The eczema empetiginodes of Dr. Bateman, is an eczema set down
on an impetiginous habit of the skin, and is hence a mixed com-
plaint.  His  eczema rubrum or mercuriale has already been  de-
scribed as an  erythema.*
                       GENUS  VI.

                       ECPYESIS.

                       i^umttf Stall.

ERUPTION OF SMALL PUSTULES DISTINCT OR CONFLUENT; HARDEN-
                 ING INTO CRUSTULAR PLATES.

Ecpyesis is a Greek term from ixirvu, " suppuro."  It is here used
in contradistinction to empyesis already employedtto import deep-
seated suppurations ; and consequently is intended to describe pus-
tular eruptions simply cutaneous, or not necessarily connected with
internal affection, as opposed to those which result from an internal
cause.  The genus, therefore, embraces the pustulae of Dr. Willan,
• Erythema vesiculare. Vol. II. p. 210.
f Vol. II. p. 411. Class 111. Ord. II. 
t-E. VI.]
EXCERNENT FUNCTION.
417
 }vhich he has correctly defined " elevations of the cuticle with an
 inflamed base containing pus."
   The old English term for ecpyesis or pustula in this sense of the
 Word, is scall, from the Saxon scala or sceala, not essentially differ-
 ent from the medical sense of scale.  The scall was of two kinds,
 dry and moist:  both  which are clearly referred to in the Levitical
 law that governed in  the  matter  of plague.  The former is there
 denominated  r.HSD (saphat,) as  we have  already observed  when
 treating of lepra, and the latter,  or the  eruption  before us  pnj
 (netek.)*  The Arabians, like our own ancestors, denominated both
 these by  a common  name (sahafata) from (sahaf,)  squammx, or
 lather from  the  Hebrew nri3D (saphat) :  distinguishing  the  one
 from the other, like our ancestors also, by the adjuncts dry and  hu-
 mid : so  that the sahafata of the  Arabians is a direct synonym of
 the old English or Saxon scale.   In our established version the He-
 brew pro (netek,) which imports  the eruption before us or humid
 scall, is by mistake rendered dry scall, which as remarked above is
 a nnso (saphat).   The expletive dry does not occur in the original,
 and that pro (netek,) denotes humid scall  rather than dry scall, is
 clear from the explanation contained in the bible-context, in which
 it is represented  as a scall  seated on the hair or beard, and affecting
 its strength and colour, forming so thick a crust or scab that its re-
 moval by shaving cannot be accomplished, or ought  not to be  at-
 tempted.  It is distinctly, therefore, a porrigo or scabby scall, and
 is thus actually rendered in the Latin version of Treinellius and  Ju-
 nius, forming one of the species  of the present genus;  and seems
 to be one of the two modifications of it, which, in our own language,
 are denominated  honeycomb-scall, and scalled head.  &^xva-^ut, by
 which netek is rendered in  the Septuagint, is literally crust, a very
 significant term in common use to express the peculiar nature of
 the scab that hardens on the porriginous sore.  Tetter, a  corrup-
 tion from the French  dartre, or the Greek  J«£Te«, has of late years
 been used synonymously with scall, and has almost supplanted  it:
 but the proper meaning of dartre, or tetter, is herpes, to which, in
 this work, it is confined, an excoriating eruption of a vesicular or
 ichorous kind.
  The species that belong to this genus are the following:__

       1.  ECPVESIS IMPETIGO.       RUNNING SCALL.
       2.  ■--------PORHIGO.        SCABBY SCALL.
       3.--------ECTHYMA.       PAPULOUS SCALL.
       4.------— SCABIES.         ITCH.

  All these specific terms have been very loosely employed, and in
 very different significations by most writers.  They are here limit-
ed to the definite senses assigned them by Dr. Willan; and, with the
Vol. IV.—3 G
* Leviticus, xiii. ZO, 31. 
418
ECCKITICA.
[CL. VI.—OR. Ut.
exception of ecthyma, by Celsus, whom Willan has followed.  Ec-
thyma does not occur in  Celsus, though it is found in Galen, but
in a sense somewhat different from its use in modern times, as will
he further noticed hereafter.
                       SPECIES I.

               ECPYESIS  IMPETIGO.

                     liunmnij --Scall.

PUSTULES CLUSTERING, YELLOW, ITCHING J TERMINATING IN A YEL-
        LOW SCALY CRUST, INTERSECTED WITH CRACKS.

The specific term is a derivative from impeto " to infest," and the
following are the varieties the species offers us :
                            Clusters loose; irregularly scat-
                              tered
                              mities;
x Sparsa.
  Scattered humid scall
chiefly over  the  extre-
often succeeded by fresh
/B Herpetica.
  Herpetic Scall.
y Erythematica.
  Erythematic Scall.
Laminosa.
Laminated Scall.
Exedens.
Erosive scall.
Localis.
Local, humid scall.
  crops.
Clusters  circular,  crowded  with
  pustules, intermixed with  vesi-
  cles ; often with exterior  con-
  centric rings surrounding the in-
  terior area  as it heals: itching
  accompanied  with  heat  and
  smarting.  Chiefly in the hands
  and wrists.
Pustules scattered;  preceded by
  erythmatic  blush and  intumes-
  cence ; often by febrile or other
  constitutional affection.  Chiefly
  in the face, neck and chest.
 Pustules confluent; chiefly in the
   extremities ; the aggregate scabs
   forming  a  thick,  rough,  and
   rigid casing around the affect-
   ed limb, so as to  impede its
   motion; a  thin  ichor  exsuding
   from the numerous cracks.
 The purulent discharge corroding
    the skin and cellular membrane.
 Confined to a particular part; most-
    ly the hands or fingers; and pro-
   duced by external stimulants, as
    sugar or lime. 
HE. VI.—SP. I.]       EXCERNENT FUNCTION.
419
   The differences are sufficiently clear from these definitions.  The
 first varietv or scattered humid scall  has  sometimes been con-
 founded with varieties of porrigo  and  scabies, constituting two
 subsequent species of the present genus.  It differs from porrigo,
 however, in having the purulent discharge  succeeded by an ichor-
 ous humour soon after the eruption has shown itself, and in the
 possession of a thinner and less extensive  scab.   It differs  from
 scabies in its more  copious exsudation of ichor, when the  latter  is
 secreted, in the magnitude and slower progress of the utricles, and
 in the sensation of heat and smarting, rather than of itching which
 accompanies  it.   And differs from both in being uncontagious.
   The erythematic form commences with  the ordinary signs  of
 an erysipelas, as  a redness and puffy swelling of  the upper part  of
 the face with an edema of the eye-lids; and the irritation is some-
 times accompanied  with  some degree of pyrexy  for two  or  three
 days.   But a critical  eye will easily  perceive that instead of the
 smooth polish of the erysipelas there is a slight inequality on the
 surface as if it were obscurely papulated, and in a day or two the
 disease will show its true character by the  formation  of numerous
 psydracious pustules over the inflamed and humid skin, instead  of
 the large irregular bullae of the erysipelas. The pustules are form-
 ed with a sense  of  heat, smarting and itching, and, as they break,
 they discharge a  hot and acrid  fluid,  which adds to the irritation
 and excoriation of  the surface.  In this  painful condition the face
 or other part remains for ten days or a fortnight, when the dis-
 charge  begins to diminish, and to concrete  into  thin yellowish
 scabs.  Fresh pustules, however, arise in the neighbourhood, and
 the disease runs on from one to  two or three months, according  to
 the irritability of the skin and its tendency to be affected by con-
 tinuous sympathy.  It has sometimes perambulated the.entire sur-
 face from  head  to  foot:  during the whole  of which course the
 constitution is scarcely disturbed, or in any way affected.
   The  laminated  humid scall is  sometimes  conjoined in the
 lower limbs with cellular dropsy, and produces severe  ulceration :
 and its  casing or incrustation occasionally extends to the fingers
 and toes, and destroys the nails,  being  succeded by nails of an
 imperfect fabrication, thick, notched,  and irregular.
   The erosive form is rare, and highly intractable.   It commences
 on the side of the chest or trunk of the body, and gradually extends
 itself.   The pustules are here intermixed with vesicles, the fluid  is
 peculiarly acrid and erosive, and the skin and cellular texture are
 slowly, but deeply and extensively destroyed, with Very great pain
 and irritation :  insomuch that the disease is said by some, though
 with little foundation, to  be of a cancerous nature.
   The local form  is chiefly produced by the use of irritant ma-
 terials,  constantly applied to the parts affected, which  are chiefly
 the hands, as sugar among  the  labourers in grocery warehouses,
and lime among bricklayers. Whence this variety has been  vul-
garly called Grocer's Itch, or Bricklayer's Itch.  According to the 
420
ECCRITICA.
ICL.VI.-OR. Ill
peculiar character of the skin the eruption is sometimes vesicular,
and belongs to the preceding genus, being a modification  of ecze-
ma ;  but more generally pustulous, and appertains to the genus
before us.  In neither instance does it seem to be contagious.
   Most of the  causes  enumerated  under lepriasis,  and many
of the species of ecphlysis, operate in the  present  species, as ge-
neral debility or relaxation, with a skin peculiarly  irritable ; poor
diet; filth ; fatigue ; and local stimulants.   And hence, where the
constitution seems to  catenate with the disease, the same general
remedies have  been  found  successful; as the alkalies, sulphur
taken freely, Plummcr's pill, the alterative decoctions or infusions
of dulcamara, ledum  palustre, juniper-tops, sarsaparilla, and  me-
zereon ; together with a frequent use of warm bathing for th& pur-
pose of purifying and  softening the skin.  In connexion with these
we should have recourse to such external applications as may best
tend to diminish the irritability of the  cutaneous vessels and give
tone to their  action.  The most useful of these are the  metallic
oxydes, with  the exception of those of lead  which  are rarely use-
ful, at least  if employed alone:  and  are often found injurious.
About ten grains of sublimate dissolved in a pint of distilled water,
with a small  proportion  of muriated  ammonia, will   frequently
prove a valuable remedy.   Or the oxyde of zinc may be applied in
the form of  an  ointment, which I have often  found  serviceable
prepared in the manner  already noticed under the species prurigo.
Lime-water is also recommended by many writers, and has proved
useful as a stimulant  astringent; as have  also solutions of alum,
and sulphate  of zinc,  and sulphuret of potash; the old liver of sul-
phur ; but 1 have found  them less useful than the zinc ointment.
   The acrid oil contained in the shell of the cashew-nut has often
been employed with great advantage in some of these varieties, and
especially where the disease is decidedly local, and  a local change
of action is the grand  desideratum.  In many cases, however, the
skin is too irritable for stimulants of any kind, and will only bear
warm water,  or a decoction  of  mallows, poppy-heads, or digitalis:
after which the excoriated surface may be illined with cream or an
emulsion of almonds.   In general, nevertheless, astringent stimu-
lants agree far better  with  this  affection than with  herpes.  The
burning and maddening pain in the erosive scall can rarely be al-
leviated but by opium.  The Harrowgate waters are generally re-
commended,  and in many instanes have certainly been found use-
ful. 
GE. VI.—SP. H.]
EXCERNENT FUNCTION.
421
SPECIES  II.
ECPYESIS  PORRIGO.

      Scatoji Scall.
PUSTULES STRAW COLOURED ;  CONCRETING INTO SCALES OR YEL-
                         LOW SCABS.

This is the porrigo of Celsus and  Willan, from porrigo " to
spread about;"  and the tinea of Sauvages and most of the nosolo-
gists.  It offers the following varieties :
« Crustacea.
  Milky Scall.
•i Galeata.
  Scalled-head.
-/ Favosa.
  Honey-comb scall.
£ Lupinosa.
  Lupine scall.
r Furfuracea.
  Furfuraceous scail.

£ Circinata.
  Ring-worm scall.
 Pustules commencing on the cheeks or
   forehead in patches . scabs often con-
   fluent,  covering the whole face with
   a  continuous  incrustation.   Found
   chiefly in  infants during  the period of
   lactation.
 Pustules commencing on  the scalp in
   distinct, often distant patches; gradu-
   ally spreading till  the  whole head is
   covered as with a helmet; cuticle be-
   low  the scabs,  red,  shining, dotted
   with papillous apertures,  ooxing fresh
   matter; roots of the  hair destroyed.
   Contagious.   Found chiefly in children
   during dentition.
 Pustules  common  to  the  head, trunk,
   and extremities; pea-sized; flattened
   at  the top ; in clusters, often uniting;
   discharge fetid;  scabs honey-combed,
   the cells filled with fluid.  Found both
   in eariy and  adult age.
 Pustules minute in small patches, mostly
   commencing  on  the scalp; patches
   terminating in dry, delving scabs re-
   sembling lupine seeds ; the interstices
   often covered  with a thin, whitish, ex-
   foliating incrustation.  Found chiefly
   in early life.
Pustules very minute, with  little fluid;
   seated  on  the scalp: terminating in
   scurfy  scales.  Found chiefly in adults.
Clusters  of very minute pustules seated
  on the  scalp in circular plots  of bald-
  ness with a brown or reddish, and some^ 
422
ECCRITICA.
[CL.V1.—OR. III.
                          what furfuraceous base. Found chiefly
                          in children.

  The first variety is the  crusta lactea of numerous authors,
the tinea lactea of Sauvages, so called from the milky or rather the
creamy appearance  and consistency of the discharge, whence the
French name of croute de lait, and our own of milky scall.  It is
almost exclusively a disease of infancy, at which  period the  skin of
the head is peculiarly tender and delicate.  It commences ordina-
rily on the forehead and cheeks in an eruption of numerous, minute
and yellowish-white pustules,  which are crowded together upon a
red surface, and break and discharge a viscid fluid that concretes
into thin yellowish scabs.   A.s the  pustular patches spread the dis-
charge is renewed, and continues to be thrown forth from beneath
the scabs increasing their thickness and extent till the forehead, and
sometimes the cheeks and entire face become covered as with a cap;
the eye-lids and nose alone remaining  free from the  incrustation.
The quantity of the discharge  varies considerably, so that in some
instances the scabs are nearly dry.  As they fall off and cease to
be renewed, a red and tender  cuticle is exposed to view, like that
in impetigo, but without a tendency to crack into fissures. Smaller
patches are occasionally formed about the neck and breast, and even
on the extremities, and the disease runs on for several weeks, some-
times several months: during  which the  constitution suffers but
little except  from a troublesome itching  which  sometimes inter-
feres with the rest, and destroys the digestion.   And, where the
last takes place, a foundation  is immediately laid  for general  de-
bility, and  especially for torpitude  and  enlargement of the mesen-
teric glands. In many instances, the irruption returns at irregular
intervals, after  having appeared to take  its leave ; apparently re-
produced by cutting additional teeth, or some other irritation, Dr.
Strack affirms that, when the disease  is   about to terminate, the
urine acquires the smell of that voided by cats ;  and that,  where
there  is no tendency to this change of odour, the disease is  gener-
ally of long continuance.   It is singular that notwithstanding the
extensive disfigurement and sometimes  depth of the ulcerations, no
permanent scar or deformity is hereby produced.
  The second variety, or scalled head, originates generally in
the scalp, and consists of pustules somewhat larger, and loaded with
a still more viscid material than the first.  The pustules are circular
in form, with a  flatfish and irregular edge.  They sometimes com-
mence on the cheeks but where the face  is affected the ordinary
course is from the scalp towards the cheeks by the line of the ears.
They are usually accompanied  with a considerable degree of itch-
in^, and harass  children from  six months to four  or five years of
a<*e.  The  disease is rarely found in adults.  From the quantity
of the discharge the hair is matted together, the scabs become con-
siderably thickened, the ulceration spreads into the integuments,
and the indurated patches seem, in  some  cases, to be fixed upon a 
GE. VI.—SP. II.]      EXCERNENT FUNCTION.                423

quagmire of offensive fluid.  The lymphatic system, if not in a
state of debility before the appearance of the eruption,  soon be-
comes affected and exhibits marks  of irritation, but whether  from
general debility or absorbed acrimony it  is difficult to say.  The
glands on the side of the neck  enlarge and  harden,  exhibiting at
first a chain of small  tumours lying close  under the skin ;  after
which  some of them inflame, the integuments become discoloured,
and a slow and painful suppuration ensues.  The ears unite in the
inflammation, and  from behind them, or even from their interior, a
considerable quantity of the same viscous and fetid fluid is  poured
forth.  In some cases the submaxillary and parotid glands catenate
in the inflammatory action.  The fluid is peculiarly acrimonious,
and consequently  whatever part of the body it lights upon acciden-
tally  becomes  affected by its  influence.  Hence the arms  and
breasts of nurses evince frequently the same complaint, and other
domestics receive  the disease by contagion.  Its duration is uncer-
tain, but it is more manageable than the preceding species ; and if
not maintained by the irritation  of teething or any other excitement,
it may be conquered in a few weeks.
   The honey-comb  scall, or third variety, differs very little  from
the preceding, except in the seat of the patches, and in an increased
size and thickness of the scab,  which is  often cellular and honey-
combed.  And as  pustules of this form have been called favi,  from
their resemblance to honey-combs, this variety of the disease, from
the time of Ali Abbas to the present, has  been distinguished by the
name  of tinea favosa, scabies favosa, or porrigo favosa.   By Dr.
Bateman it is united with the  preceding variety.  The  colour of
the scab is yellowish or greenish, and semi-transparent, its  surface
highly irregular, and  indented, and its consistency softish.  The
pustules are  found on the face,  trunk and extremities.  The irri-
tation they produce excites the little sufferer  to be  perpetually
picking and scratching them about the edges, by which means the
skin is kept sore and the ulceration extended. This is particularly
the case about the heels and  roots of the toes,  the extremities of
which last are sometimes ulcerated, while the pustules even creep
under the nails.  The odour from this and the preceding variety is
not only most rank and  offensive  to the smell, but occasionally
inflames the eyes of nurses and others who are officially surrounded
by its vapour.
   The lupine variety, is peculiarly characterized by the dryness
of its scabs which are formed upon small clusters of minute pustules,
the finer part of whose fluid is rapidly  absorbed, so that the part
remaining concretes, and  shows in the central indentations of its
surface a white scaly powder.  The size of the  scab is that of a
sixpence :  it is found in the head,  and in other  parts, but when in
other parts than the head, it is often much smaller in diameter, and
sometimes does not exceed two lines. It is liable to increase if
neglected, and is usually tedious and of long duration.
   The FURFURACEousorBRANNYscAii makes astill nearer approach 
424
ECCRITICA.
[CL. VI.—OR. III.
to the tribe of lepidosis, and is often mistaken for  a pityriasis, or
lepriasis, particularly where  it appears in the scalp, which is its
most common seat.  It commences,  however, if  its  course  be
watched, with an eruption of minute pustules, which nevertheless
possess a very small quantity of fluid, so that the whole is soon
absorbed, and the excoriation  or ulceration is but slight.   It is  apt
to be renewed, is attended with a considerable degree of itching,
and some soreness of the scalp, the hair partially falls off, becomes
thin, less strong in its texture, and somewhat lighter in  its colour :
none of which symptoms occur in any species of the true  scaly erup-
tion.  The glands of the neck moreover are occasionally swelled
and painful.
  The ring-worm scall has been known and described under dif-
ferent names, from the Greek writers to our own day.   It consists
of  clusters  of very minute pustules  forming circular plots of a
brown or reddish hue.   There  is sometimes only a single  plot;
and the  pustules are so small as to elude all notice unless very
closely examined, though a papular roughness is obvious to every
one.  The exudation is small, yet if neglected it concretes into
thin  scabs sometimes irregularly tipped  with green, while  the
plots expand in diameter, and become confluent.    The hair  is in-
jured from the first attack; appearing thinner and lighter in colour,
and breaking off short;  in  progress of time the roots are affected
and the plots are quite bald, and,  as they  spread  into each other,
and baldness extends over the whole head, and nothing remains but
a narrow  border ol hair forming  the outline  of the  scalp.  It is
chiefly confined to children, and  since the multiplication of large
boarding schools and manufactories, in  which last they are employ-
ed  with too little attention to their health, it has  been strikingly
common in our own country : and from its contagious property has
been propogated with great rapidity.  It sometimes spreads from
the head  over the forehead  and neck.       „
  Porrigo, therefore, is a disease which appears  under different
modifications of ulceration, from sores of some depth oozing a thick
fetid pus, and covered with a broad, scaly scab, to  eruptions  so
minute as to require the aid of a glass, being covered with fine fur-
furacious exfoliations, and discharging a thin purulent ichor, mani-
fested rather by its effects than its presence.
  The predisposing  cause  is in every instance irritability of the
cutaneous exhalants; and as we find this irritability much greater
in infancy than in mature life, the different varieties of porrigo are
chiefly confined to this season.  The exciting causes are filth, or
want of cleanliness, bad nursing, innutritious diet, want of pure air,
and whatever else has a tendency to weaken the system generally,
and irritate the skin locally.   And we  may hence see why some of
the varieties are found occasionally as sequels on lues, or on those
who have debilitated their constitutions by high living, and espe-
cially by an immoderate use of spirits. 
. VI—SP. II.]    EXCERNENT FUNCTION.
425
  in iZ Z*     T that ma7* ^erhaPs a11 these varieties may,
  em  «nd        .'    ^T^ With the Sene,al state of the s/s!
  tnn;e        su+cl^ase  the restorative diet-drinks and alterative
  tomes enumerated under the genus ecphlysis will often be equally
  advantageous here.  Sulphur  and the vegetable alkanes havl a  o

  thl l^orTa-TT'^ eSpeda11^ Sma11 ^-s of "calomel! or
  the black or red oxyd of mercury.   And if there be much general

  hToscvamis'^h ^ ^^ t0 Unite theSe with th« ~«
  voZ/fTcutJ  PanSJ+°r heart'S ease (vio,a tricolor) ™ in high
  before u. Sir  T erUPtlonigenerally, and particularly for thole
 howeven 'int   f  ,G T^ a"d sev™teenth centuries.  It fell,
 the rW „? * dl.Sr,ePUteVbUt  WaS fevived b^ Dr« Strack, Awards
 Srtlti « 11   ^ ^thcentury, ™ consequence of his prize dis-
 serjation delivered at Leyden, in 1779, in  which he speaks warmly
 pL LSUCC6SS m ^  thG 11SeaSeS b^ng5"? to the present and thi
 handful SfT'f  u  emPlo/inS this h^b Dr  Strack directs that a
 handful of the fresh  or half a drachm of the dried leaves, be boiled

 ™hi*l ■  P*   h  milk t0 ,G StraUled for use> and fo™ a single dose,
 lulltLl  t re.Pra.ted m,°rnin» and evenir)g-  He ass^ts that
 nhlv Li ,fr^K,§ht+dayS,the e,'UPtion ««»% increases consider-
 tJo*l  thatt/!ePaierit's urine acquires the  cat-like smell we

 rXn if6"?7- tlUiCd t0: but that' Where tlle medicine  has bee*
 llvfnM*1"  i? S   SC^?r SCUrf beSins t« fall off in large  scales,
 leaving the skin clear.   The  remedy is to  be persisted in till the
 skin has resumed its natural appearance, and the urine its natural
 odour.  Dr. fetrack also recommends,  as an internal remedy, which
 we  should  little have expected, a decoction of  the leaves  of the
 iussilago Farfara or coltsfoot, which I should scarcely have noticed
 were it not that this medicine was also esteemed useful by Dr. Cul-
 len, as we  had formerly occasion to observe, in sores dependent
 upon a scrophulous habit, many of which he tells us he has seen heal-
 ed  under its  employment both in extract and decoction.t  As to
 the viola tricolor, Baldinger, who seems also to have tried it, and

 Zrt ^fJu^u^V aSSei'tS that {t is of inferior valu* to sul-
 phury and Selle  that if given in small doses it is useless,  and if
 m larger that it does more harm than good §
  There is some difficulty in determining upon the external appli-
 cations.  Generally speaking, the skin under all the modifications
 of this species bears astringent and even stimulant remedies  well,
 "W ™'thout obstinacy to their use : but in a few instances we
meet with the contrary, and aggravate the pustules, and extend their

  • De Crusta  Lactea Infantum  Francf. 1779
    See also Commen. Lips. Vol. XXVII. p.  170.

  t M^dfp^^Sfp^v^r0"1- Mezser-Vermichte Scrifte"' Bn-

  J SsSSche *erzte ix-p-nr-
  Vol. IV—3 H                                 , 
426
ECCRITICA.
[CL. M.—OIL HI
range by the slightest irritants.  The most irritable varieties arc
the honey-comb, where it occurs at the extremities of the joints,
as about the toes and heel and behind the ears, and the furfuraceous.
The last, however, will  usually bear a lotion of mild soap and wa-
ter, and afterwards equal  parts of starch and calamine reduced to
a  very  fine powder, and  dusted over the patches.  The honey-
combed scall often requires  sedative fomentations and cataplasms
at first, but will afterwards allow an  application of the zinc oint-
ment, or even that of the  nitric oxyde of mercury diluted with an
equal part  of calamine cerate.  Dr. Willan was  attached to  the
coculus Indicus  in cases of this sort,  which he prescribed  in the
proportion  of two drachms of the powdered berry to an ounce  ot
lard.  In common, however, we may employ a bolder practice and
use pretty  actively alkaline or acid lotions, or solutions of zinc, or
warm resinous ointments of pitch or gum elemi.  All that is want-
ing is the excitement of a new and healthier action, which the cu-
taneous vessels for the most part receive with but little trouble ; and
this, with a punctilious attention to cleanliness, is in most cases
sufficient to ensure a cure.
  With  the sulphur  ointment, or, which  is better, sulphur  and
cream, I have often  succeeded in curing very virulent  attacks of
the porrigo favosa that have covered the whole of the face, and
matted the  beard into a most disgusting spectacle.
  In the external treatment of porrigo galeata, or scalled-head, one
of the most effectual applications is a modification of Banyer's un-
guntum  ad  scabiem, for in its original form it is both too  irritant
and too  astringent as well  as very unscientifically compounded. I
was first induced to try this preparation from the recommendatiou
of my excellent  and learned friend Dr. Farr ; it has since been re-
commended by Professor Hamilton, and more lately by Dr. Bate-
man.  Each has  altered its composition in a slight degree, and the
following form, which is more simple  than any of the  rest, is  that
which 1  have been in the habit of  employing with  great  success
for many years.  To a powder consisting of two drachms of calomel
and an  ounce of exsiccated alum and  cerusse, and six drachms of
Venice turpentine and an  ounce and  a half of spermaceti cerate.
The hair is first to be cut off as close as may be, for shaving is often
impossible ; the  scalp is then to be  slowly and carefully  washed
with soap and water, and, where there  is very little irritation, with
soft  soap as being  more stimulant, in  preferance  to hard ; the
washing to be repeated night and morning, and the scalp to be well
dried afterwards. The ointment is to  be applied after the washing
every night, and is to be well rubbed all over the head.   It may be
washed  off in the morning; and, when the scalp is made dry, instead
of applying it through the  day, the head may be thoroughly powder-
ed with  nicely levigated starch contained  in a fine linen or cambric
bag.  The  scabs  and incrustations will hereby become desiccated,
and often brittle, for the ointment alone will diminish, and at length
utterly suppress  the  morbid  secretion.  And in this  state they 
<*E.  VI.—SP. II.]      EXCERNENT FUNCTION.                42/

should be gently picked or combed off, one after another as they
grow loose and become detached at the edges.
   In the last variety the ring-worm porrigo, or alopecia porriginosa
of Sauvages, though the appearance is  far less disgusting, and un-
accompanied with smell of any kind,  the bulbs of the hair seem
more affected than in any of the preceding.  And hence this, which
is one of the most common modifications of the disease, and, as we
have already observed, has been peculiarly frequent of late years,
has been found one of the most obstinate.   It has ordinarily made
its appearance among children at school, but is not  confined either
to schools or to childhood ; for I  have at thi&noment a medical
friend under my care, troubled with the same complaint, whose age
is about forty.
  The disease appears to be seated under the cuticle in the mouths
of the secernents of the rete mucosum, which secrete a material  of
a different colour from what is natural and healthy, and hence give
a brown or reddish hue to the entire patch.   This material affords
no nutriment to the bulbs of the hair, and seems sometimes  to be
acrimonious: whence  the  hair,  like  the  rete mucosum  itself,
changes its colour ; and, with the change  of colour, becomes thin-
ner and weaker, and  breaks off short  at  the base  of  the cuticle,
sometimes at the roots below.
   The acrimony of the secretion occasionally produces  a morbid
sensibility in the minute vessels  of the part affected, so that the
patient can hardly bear the patch to be pressed upon or the comb
to pass over it; yet this is not a common effect, for irritants may
usually be employed from the first.
   Where this morbid sensibility exists  we must endeavour to short-
en its stage, for it will at length pass  off naturally, by tepid and
sedative fomentations, as of poppy-heads, or digitalis:  and  after-
wards have recourse to depilatories, without which we  can do no-
thing, for we cannot otherwise penetrate to a sufficient depth ; and
hence the more active they are, the more radical will be  their ef-
fects.  Different preparations of mercury have for this purpose
been chiefly employed, and mostly a solution of sublimate.   The
other metallic acids have been tartar emetic, sulphate of zinc, sul-
phate of iron, aerugo or the green oxyde  of  copper,  and even
arse: ic :  while practitioners of a more timid character have  con-
fined themselves  to  the pitch-plaster, balsam  of sulphur, or de-
coctions  of tobacco, hemlock,  or the viola tri-color.
   In slight cases most of these  applications will  be found  suffi-
cient; but, in severe and obstinate  cases, none of them.   And
hence, in every case,  I have for many years confined myself to a
solution of the nitrate of silver in the proportion of  from  six to ten
grains to an ounce of distilled water,  according to  the age  of the
patient, or the irritability of his  cuticle; and with this application
I have never failed.  It destroys the  hair to its roots, gives  tone
to the morbid vessels, and changes their action.  It often excites
a slight vesication or soreness on the surface, and it is in most in-
stances necessary to push it to this point. 
428
ECCRITICA.           [CL. VI.—OR. III.
  Where porrigo is of long standing, and has become chronic, the
irritation must be lessened gradually, and a steady use of alterants
is  absolutely necessary;  especially in  the  varieties accompanied
with a considerable discharge, for many writers of authority, as
Pelargus,* Sennert,t Stolid and Morgagni,§  have given examples
of epilepsy, apoplexy, and  even  death  itself following upon  a
sudden  retrocession of  the  eruption.   In the  Berlin Medical
Transactions there is a case or two of amaurosis produced by  a
metastasis of this disease. II
                       SPECIES III.


                ECPYESIS ECTHYMA.

                     3$Wulou* Scall.

pustules large; distinct; distant; sparingly scattered; seat-
  ed ON A HARD, ELEVATED RED BASE ;  TERMINATING  IN  THICK,
  HARD, GREENISH, OR DARK-COLOURED SCABS.

Ecthyma from exQvetv, " to rage, or break forth with fury," was
used by the Greek writers synonymously  with exormia, in the sense
of papula: to which effect Galen " apertum est  ab exSveiv quod est
t%oe[txv} id est erumpere, derivatum esse ex6vftx<n, id est Papulus,
nomen in iis quae sponte' extuberant in cute."Tf   I  have observed,
however, under exormia,**  forming Genus III.  of  the present
Order, that ecthyma has of late years been limited by the nosolo-
gists, and especially by Willan, Young, and Bateman, to the sper
cies before us, probably on account of its  more papulated  form,
and there seems no reason for deviating from arrangement.
  The following are its chief varieties:

a Vulgare.                   Base bright-red ; eruption complet-
  Common papulous scall.       ed with  a single crop.   Duration
                               about fourteen days.
j8 Infantile.                   Base bright-red ;  eruption recurrent
  Infantile papulous scall.       in several successive crops,  each
                               more extensive than the preced-


          * Mediciniscbe Jahrgange. I. P. 1. p. 50.
          f Paral. ad L.  V. Med. Prac. 4. 2.
          i Praelect. p. 48.
          § De Sed. et Caus. Morb. Ep. Iv. Art. 3.
          || Dec. I. Vol. VII. p. 7. II. Vol. VI. p. 28.
          1 In Hippocr. Lib. III. Sect. 51.
          " Supra, p. 367. 
GE. VI.—SP. III.]     EXCERNENT FUNCTION.
429
                               ing.   Found  chiefly in  weakly
                               infants during the period of lac-
                               tation.   Duration two or  three
                               months.
                             Base dark-red,  elevated;  pustules
                               larger, and  more freely scatter-
                               ed, discharging a bloody or curdly
                               sanies.—Found chiefly in advanc-
                               ed age.   During several  weeks,
                               sometimes months.

   This last is the melasma of Linneus, Vogel, and Plenck.  They
 are all diseases of debility, local or general; and hence, whether
 they occur in infancy, adult life, or age, are to be cured by general
 tonics, pure air, and exercise, tepid bathing, and preparations gently
 stimulating applied externally in the form of lotions, ointments, or
 powders.  None of them are contagious, and in this as well as in
 their approaching more nearly to a papulous or broad  pimply cha-
 racter,  especially that of the  small-pox, they differ essentially from
 the preceding.   Nutritious food alone, with pure air  and regular
 exercise, are often sufficient for a cure.  But as this  species is
 manifestly dependent upon a debilitated or cachectic  state of the
 constitution, it is often connected with those other symptoms which
 appertain to such a condition, as a tumid belly, diarrhoea, and gene-
 ral emaciation in infants ; and dyspepsy and scirrhous parabysmata,
 or enlargements of the abdominal viscera, in adults. Dr  Bateman
 has given a very excellent coloured print of what he calls a cachec-
 tic, or fourth variety,  in his Delineations, in which the scabby pus-
 tules are thickly scattered over the limbs, mimicking very closely in
 size and number an ordinary appearance of discrete small-pox at the
 time of its scabbing.  It is, however, distinctly a symptomatic affec-
tion, or  rather a sequel, of some long or chronic disease  of an  ex-
hausting nature, and always disappears in the train of its  cure.
                        SPECIES  IV.

                 ECPYESIS SCABIES.

                            Xttfu

ERUPTION OF MINUTE PIMPLES, PUSTULAR, VESICULAR, PAPULAR, IN-
  TERMIXED OR ALTERNATING ; INTOLERABLE ITCHING ; TERMINAT-
  ING IN SCABS.  FOUND CHIEFLY BETWEEN THE FINGERS OR IN THE
  FLEXURES OF THE JOINTS ; CONTAGIOUS.

This disease is peculiarly complex;  but the specific  characters
y Luridum.
  Lurid papuldus scall. 
430
ECCRITICA.
[CL. VI.—OR. III.
now given  embrace
varieties, and which

« Papularis.
  Rank itch.
p Vesicularis.
  Watery itch*
                   the  modifications which  constitute its chief
                   are as follows :
                                                 V
                          Eruption of miliary,  aggregate pim-
                           ples;  with a papular, slightly in-
                           flamed  base,  and vesicular apex;
                           pustules scantily interspersed;  tips,
                           when abraded by scratching, covered
                           with a minute, globular brown scab.
                         Eruption of larger and  more  perfect
                           vesicles, filled  with  a transparent
                           fluid, with  an uninflamed base ; in-
                           termixed  with pustules;  at times
                           coalescing,   and  forming   scabby
                           blotches.
                         Eruption of distinct, prominent yellow
                           pustules,  with a slightly inflamed
                           base;  occasionally  coalescing,  and
                           forming irregular  blotches,  with a
                           hard, dry, tenacious scab.
                         Eruption complicated of pustular, ve-
                           sicular, and  papular  pimples co-ex-
                           isting ; spreading  widely  over  the
                           body;  occasionally  invading  the
                           face:   sometimes   confluent   and
                           blotchy
                          Eruption chiefly  of  rank, numerous
                           pustules,   with  a   hard,  inflamed
                           base, rendering the skin rough, and
                           brownish ;  itching extreme ; abrasion
                           unlimited from excessive scratching.
                           Produced  by handling  mangy  ani
                           mals.

  That all these affections are not distinct species of a common ge-
nus, but mere varieties of a single species, is manifest from the fact
that in different individuals, or under different conditions of the skin,
every variety, even the mangy itch itself, will produce every other
variety, while all of them in same instances co-exist, and  are de-
stroyed by the same means.  The above English names for the first
three are those in common br vulgar use, and it would be difficult
to find names more appropriate.   The pocky itch is so denominated
from the resemblance of the pustules to minute small-pox, and not
from any supposed connexion with syphilis.  It gives the largest
pimples of all the modifications, as well as the most purulent, but it
has never the hard base of either the small-pox or the ecthyma or
papulous scall we have just noticed, nor has it the hard raised bor-
der or round imbedded scab of the last, and hence is easily distin-
guished from both.  The two former varieties are  far  more readily
y Purulenta.
  Pocky itch.
$ Complicata.
  Complicated itch.
e Exotica.
  Mangy itch. 
GK. VI.—SP. IV.]     EXCERNENT FUNCTION.
431
 confounded with some varieties of prurigo and of lichen, and espe-
 cially in consequence of the black dots on the tips of the papulse,
 and the long red lines common to all  as produced  by scratching
 But they are distinguished by the greater simplicity of the itchin*
 sensation,  which, however intolerable, is not combined  with ting-
 ling or formication : and by their being highly contagious which the
 others are  not.  Yet from their general resemblance, all these have,
 by many writers, been confounded, and by others who were fully
 sensible of their distinction, been incorrectly described under scabies
 or psora  as a common name.
   As a primary disease, itch is, in every instance the result of per-
 sonal uncleanliness, and an accumulation of sordes upon the skin*
 though the most cleanly are capable of receiving it by contact: and
 it always  appears most readily were  close air, meagre  diet, and
 little exercise  are companions of personal  filth ; for here, as we
 have already had frequent occasions of observing, the skin is more
 irritable,  and  more easily  acted  upon  by any morbid  cause.
 Like many other animal secretions the fluid hereby generated is
 contagious: and, on close intercourse, but not otherwise, and chiefly
 in the warmth of a common bed, or of a bed that has been slept in
 before by a person affected with  the  disease, is capable, of com-
 munication.  Where the cutaneous irritation hereby produced is
 general to  the surface,  and has been  suffered to remain without
 check, or with little  attention, for a long time, a sudden suppression
 of the irritation by a speedy cure, like the sudden suppression of a
 long standing ulcer or issue is often attended with some severe in-
 ternal affection; in one instance, indeed, related by Wantner, it was
 succeded by mania.  And  in camps, and prisons, where the con-
 stitution  has been debilitated by confined air, and innutritious diet,
 the eruption has sometimes been known to assume a malignant cha-
 racter : of  which Ballinger gives us an example,  the whole surface
 of the body, in  the instances to which he refers, having exhibited a
 sordid tesselation ef crusts, excoriations, and  broad livid  spots,
 with an indurated base accompanied with fever at night and severe
head-ache.
  Whenever an organ is weakened in its action it is extremely apt
to become a nidus for worms or insects of some kind or other to bur-
row in.   Hence the numerous varieties of helininthia or invermi-
nation in debility of the stomach or other digestive organs; and
hence the lodgement, as we have already observed, of the grubs of
a minute insect, probably a species of pulex, in one or two of the
varieties of prurigo: and hence again in gangrenous ulcers, and espe-
cially in  warm climates, the appearance almost  every morniug  of
innumerable grubs or maggots, of which we have frequent exam-
ples in the  wounds inflicted on  the backs of the negro-slaves in the
West Indies by severe  flogging.  A similar deposit of eggs, appa-
rently of the genus acarus or tick, is sometimes found in itch pus-
tules, or in  the immediate vicinity  of them   And hence itch 
4Sj2
ECCRITICA.
[CL. VI.—OH. HI.
has, by Wichmann, and many other writers  of great intelligence,
been ascribed solely to  this cause :* while others who have sought
for the appearance of the grub hereby produced, but in vain,  have
peremptorily denied  the existence of such a fact in any case.t The
statement now given constitutes, however, the actual history, and
readily reconciles these conflicting opinions.   Such insects are not
always  to  be traced, but they may  be  seen occasionally: and
wherever they appear, they are not a cause but a consequence of
the diseas,e.
   There are  few complaints that have been treated  with  so  many
remedies, and none  with  so  many pretended specifics.   Sulphur,
zinc, acids of all kinds, bay-berries, white hellebore, arsenic, alum,
muriate and other preparations of quicksilver, alkali, tobacco and
tar, have all been used externally in the form of  lotions  or oint-
ments, and sulphur and sulphuric acid have been given  internally,
and been strongly recommended both in Germany and in  our own
country for their success.  Sulphuric  acid was  first used  in the
Prussian army, in 1756, by Dr. Colthenius, chief physician; after
which Professor Schroeder of Gottingen, employed it very freely
and asserted  that he never failed herewith to cure the itch, in four-
teen days at farthest.:):
   Dr Linckius, in the  Nova Acta Naturae Curiosorum,  gives an
account of an  epidemic itch  which  raged very generally around
Nuremberg about the middle of the last century,  and  resisted all
the usual means of sulphur, lead, turpentine, arsenic, mercury, hu-
man and animal urine, chalybeate waters, lime-water, and drastic
purgatives, and only yielded to diuretics urged to such an  extent as
to irritate the urethra with a considerable degree of pain.   The
medicine he employed was a sub-nitrate of pot-ash, obtained by de-
flagrating common  nitre  with  charcoal.   The  first hint of this
practice he  received from a treatise  of Mauchart.   The  urine
hereby excreted was  very fetid, and threw down a copious sedi-
ment^
   It is very possible that  all of these have been successful under
peculiar degrees and modifications  of the  complaint.  For the itch
is not  difficult to cure, and seems only  to  require an  applica-
tion that will excite a new and more healthy  action in the cutane-
ous vessels.  The simplest and most certain cure is to be  obtained
by the  sulphur ointment, of which that  of  the  London  College
gives as good and as simple a form as any.  On the Continent they
usually combine with the sulphur an  equal quantity of  powered
  * Wichmann, Aetiologie der Kraze. Hanov. 1786. Rochard, Journ. de Med.
torn. XLI. p. 26.
  ■J- Sagar, Haldinger. N. Maga. B. XI. p. 484.
    Hartmann, Diss. Quxstiones super Wichmanni JEtiologia, Scabiei. Fr. 1789.
  $ See Dr. Helonich's Dissertatio de Olei Vitriolis usii, &c. Hall. 1762.
  § Therapeia Scabiei epidemics per Diuresin, &c.  Nov. At. Nat. Cur*
torn. IV. 
GE. VI.—SP. IV.]     EXCERNENT FUNCTION.
45$
bay-berries, and of sulphate  of zinc, which is mixed up into  an
ointment with linseed or olive oil.   This form was first proposed
by Jasser, and under the name of unguentum Jasserianum has main-
tained an unrivalled character for the last half century.*  The of-
fensive smell  of the sulphur, whether in the simple ointment or
Jasser's compound preparation, is very much diminished by adding
to the materials a  few  drops of the essence of burgamot and as
much rose-water as the powders will absorb before they are mixed
with the animal or vegetable  oil.
  These are the safest and most effectual applications, and should
be employed wherever practicable.  But where there is an imprac-
ticability the most elegant mode of treatment is  to be obtained by
a mercurial lotion  made by dissolving a drachm of muriated quick-
silver in half a pint of water, and adding two drachms of crude sal
ammoniac, and half an ounce  »f nitre.  The hands are to be washed
with this solution night and morning, and a little of it is to be ap-
plied with a clean  sponge to the pustules in other parts.
   About eight and forty hours steady use of the lotion or the sul-
phur ointment, will generally be found sufficient to effect a cure:
after which  the  person should be  well cleansed and rinsed with
warm watter : and it will tend much to expedite and ensure the cure
if the body be in  like manner exposed to a warm-bath before  the
curative process is entered upon, as much of the  contagious matter
and impacted sordes will hereby be removed, and the ointment or
lotion will have a  chance of taking a greater effect.   Where the
constitution has been influenced, aperient and alterative medicines
will also be necessary, and ought not to be neglected.
   In India a pleasant and easy cure is said to be effected by wear-
ing linen that has  been dipped in juice expressed from the agreea-
ble fruit  of the bilimbi tree (averhoa Bilimbi. Linn.) which has
also the reputation of  being  an antidote in many other cutaneous
disorders: but I  cannot speak of its effects from  any personal
knowledge.
   How far scabies, may, under any circumstances, cease naturally
I cannot say : we  are  informed, however, by Bennet, that a case
which had resisted all remedies was cured by a phthisical expec-
toration which continued for a month.t
  * Schmucher, Vermischte-chirurgische  Scriften, Band. III. p. 18S, Frank.
1783.8vo.
  -j- Young, On Consumptive Diseases, p. 171.

  Vol.  IV.—3 I 
434                      ECCRITICA.           [CL. VI.—OB. HTv
                      GENUS VII.


                          MALIS.


                 (gutaneous Wevminatim.

      THE CUTICLE OR SKIN  INFESTED WITH  ANIMALCULES.

Malis and maliasmus (/***<?, jaxXixo-jms) are Greek nouns importing
cutaneous vermination. In the present system the genus is design-
ed to include both the malis and phthiriasis of Sauvages and several
other writers which  are very unnecessarily divided.  Common as
this disease  is to man, it is still more so  to animals of perhaps
every other class  and description, from  the  monkey to the  fish-
tribes, and from those to the lowest worms.  All of them are in-
fested with  parasitic  and minute living creatures on their skins,
shells, or scales, which afford them an asylum, and  for the most
part supply them with nutriment.  Yet the same  affection is  still
more  common to plants; which are not only infested with parasitic
plants but with parasitic animals as well.   The volume of Nosolo-
gy contains  many curious examples of this kind which the reader
may turn to at his leisure.
  These external parasites, whether  animal or vegetable, by our
old botonical writers, were significantly called dodders, from a term
which has lately, but improperly been restrained to  a  particular
tribe or genus of plants to which Linneus has given the name of
cuscusa, a parasite found very extensively on the nettles and the
wild thyme of our own wastes: but which formerly was applied to
external parasitic  plants  of all kinds ; and  hence Dryden in his
Fables  speaks  of  doddered  oaks, and in his Eneid of doddered
laurels :

                  Near the hearth a laurel grew
           Doddered with age, whose boughs encompass round
           The household gods, and shade the holy ground.

   Dodders are, therefore,  parasites generally, and as strictly apply
to those which constitute the present genus as to any  that infest
the vegetable world.
   Generally speaking, vermination is a proof of weakness, whether
in animals or in plants; and hence the  weaker the  plant or the
animal  the more  subject are they to  be  attacked, and the more
readily to be infested.
   A few instances may possibly be adduced of plants and animals in
perfect health being  thus haunted, but they do not oppose the gene-
ral rule.  The remote cause of this disease, however, is most com-
monly filth:  for filth debilitates thccutaneous vessels in every in 
GE. ML—SP. I.]     EXCERNENT FUNCTION.
435
stance, by obstructing the pores of the exhalants and confining the
perspirable matter till it becomes acrimonious.
  The animalcules that infest mankind are the following;  which
will constitute so many species:
 1.
 2.
 3.
 4.
 5.
6.
MALIS PEDICULI.
----- PULICIS.
----- ACARI.
1      FILARI.S.
------ C2STRI.
——— GORDII.
LOUSINESS.
FLEA-BITE.

TIOK-BITE.
GUINEA-WORM.
GADFLY-BITE.
HAIR-WORM.
     SPECIES  I.

MALIS  PEDICULI.

      HLottmnrsg.
CUTICLE INFESTED  WITH LIOE, DEPOSITING THEIR NITS OR EGGS
     AT THE ROOTS OF THE HAIR ; TROUBLESOME ITCHING.

The insects  of this name that  trouble our own race are  the two
following:

« Pedeculi humani.       Infestment of the common louse, chiefly
  Common louse.          inhabiting the  head of uncleanly chil-
                          dren, where  it  produces  a   greasy
                          scurf or  other, filth;  and sometimes
                          exulceration and porrigo : occasional-
                          ly migrates over the body.
|3 Pediculi pubis.         Infestment of the morpio or crab-louse;
  Crab-louse              found chiefly on  the groins and eye-
                          brows of uncleanly men :  itching  ex-
                          treme, without ulceration.

  The common pediculus is too well known torendor any particu-
lar description necessary.   Leewenhoeck, who cautiously watched
them, by wayof experiment,  on his own  person,  affirms that  the
male is furnished at the extremity of the abdomen, with a sting, and
that  it is this sting which  produces the usual irritation, the suction
of the broboscis hardly seeming to produce any irksome sensation
on the skin of the hand.  The male is  readily distinguished from
the female by having the tail or tip of the abdomen rounded, which
in the female is forked or  bifid.  The animal is produced from a
small oval egg, vulgarly called a nit, which is agglutinated by its
smaller end to the hair on which it is deposited.   From this egg 
43ti
ECCHITICA.
[CL. VI.—OB. Ill
proceeds the insect complete in all its parts, and differing only from
the parent animal in its size.   To determine the time of pregnancy
and proportion of increase, this indefatigable physiologist took two
females and placed them in a black silk stocking, which he wore
day and night, that they might have the full benefit of feeding upon
him.  He found that in six days each laid fifty eggs without ex-
hausting its store, and that in twenty-four days the young were
capable of laying eggs  themselves : and,  carrying on the calcula-
tion, he estimates tnat the two females conjointly, might produce
eighteen thousand in two months.
  The largest animals  of this kind were discovered by Linneus in
the warm caverns of Falhum in Sweeden.  It has been observed,
however, by many entomologists, that those which conceal  them-
selves  in clothes, forming the pediculus  vestimentorum, are, in
some respects, a different animal from the lice of the  hair, or p.
capitis. Dr. Willan remarks that the latter lay single nits on the hairs
of the head, and do not spontaneously quit the scalp or its natural
covering.  The  former are  large,  flat, and whitish, and seldom
appear on  the head, but reside on the trunk of the body, on  the
limbs and on the clothes.  Their nits are conglomerate, and usually
deposited in the folds of the linen or in other articles of dress.
  The pediculls pubis is distinguished by the cheliform structure
of its legs, whence its  name of crab-louse ; its antennas consists of
five articulations.   Its excrement stains the linen and appears like
diluted blood.  It is a frequent case of local prurigo ; for these ani-
mals burrow in the skin, and, being almost unknown among decent
persons, may remain a long time unsuspected, since  even an ex-
amination  for the purpose  will scarcely detect them.  They are
chiefly discoverable by their nits, which  may be seen attached to
the basis of the hairs,  the insects themselves appearing only like
discolourations of the skin.
   All these are bred among the inhabitants of sordid dwellings, jails,
and workhouses, or who are habitually uncleanly.  Monkeys, the
Hottentots, and some tribes of negroes are said to eat them.  The
cutaneous  secretion is sometimes so  changed by disease, that it
becomes offensive to them, and they quit the person who is labour-
ing under it;  various infectious fevers  seem to produce this result.
   It is affirmed by  some writers that  the  pediculus  capitis  or
humanus, has been found  useful in epilepsies, diseases of the head,
and in scrofula, and that the worst .consequences has  arisen from
drying the little ulcerations they produce.  In Russia and other
parts of the Continent, where this kind of uncleanliness is, perhaps,
less attended to than in our own country, all this may have occurred;
for we  have already had occasion to observe, that any cutaneous
irritation, whether from scabies, porrigo, or any other excitement,
maintained till it has become habitual,  should be suppressed gradu-
ally, or we shall endanger a transfer of the morbid action to a part
of  far more importance.  Upon the whole, however, such remarks
are only apologies for filth and indolence, as we are in no want of 
CE. VII—SP. I.]     EXCERNENT FUNCTION.               A^7

much more effectual cutaneous irritants, where such means are
called for, than can be obtained from so disgusting a source.
  The most  fatal  poisons to all  these vermin  are the mercurial
oxydes,staphisacre,menispermum,rue, opium, angelica, and laurel;
sattron, pepper, sedum, lycopodium, pinguicula, tobacco,  and the
seeds of veratrum.  Cleanliness itself, however, is a sufficient an-
tidote and a sure prophylactic.  The  pediculus pubis is best de-
stroyed by calomel mixed with starch  powder, and applied  by a
                        SPECIES II.

                    MALIS PULICIS.

                          jFlea=Stte.

 CUTICLE INFESTED WITH FLEAS ; OFTEN PENETRATING THE CUTIS
   WITH THEIR BRISTLY PROBOSCIS, AND EXCITING PUNGENT PAIN ;
   EGGS DEPOSITED ON OR UNDER THE CUTICLE.

 This species offers us the two following varieties :
 * Pediculi irritanis.              Infestment of the common flea,
   Common flea.                    with a proboscis shorter than
                                   the body;  eggs deposited on
                                   the roots of the hair, and on
                                   flannel.
 " Pediculi penetrantis,          Infestment  of  the  chigoe  or
   Chiggre.                         chiggre, a  West Indian flea,
                                   with a proboscis as long as the
                                   body; often'penetrating deep-
                                   ly into the skin, and lodging
                                   its  eggs  under the  cuticle,
                                   particularly of the feet; pro-
                                   ducing malignant, occasional-
                                   ly fatal ulcers.
   The common flea infests not mankind only, but quadrupeds and
birds of all kinds.  It  is probable that it has many  varieties, but
these have not been ascertained by entomologists.  Contrary to the
economy of the pediculus, the flea undergoes all  the changes of the
metamorphosing tribes of the insects, being produced from an egg,
which gives rise to a minute vermicle or larve, that is transformed
into  a chrysalis, and finishes in a winged animal.  The eggs, in the
summer months, take six days before they  are hatched, the larve
the same period before  it becomes a chrysalis, the chrysalis twelve
days before it assumes its perfect form : so that  the entire process
is  completed in a little more than three weeks in the summer 
 438                     ECCRITICA.          [CL. VI.—OR. 111.

 though a longer period of time is consumed in the colder months.
 It obtains its nourishment from the juices of the animal it infests,
 by driving its sharp proboscis under the cuticle.
  The chigoe  or chiggre is thus excellently described by Catesby.
 " It is a very small flea found only in warm climates. It is a very
 troublesome insect, especially to negroes and others that go bare-
 foot and are slovenly.  They penetrate the skin, under which they
 lay a bunch or  bag of eggs, which swell to the bigness of a small
 pea or tare, and give great pain till taken  out: to perform which
 great care is required for fear of breaking the bag which endangers
 mortification and the loss of a leg, and sometimes life itself. This
insect, in its natural size, is not above a fourth part so big as the
 common flea.  The egg is so  small as to be scarcely discerned  by
the naked eye."
  As these animalcules are fostered like the pediculus by filth and
laziness, they are best destroyed by vigilance and cleanliness: and
in the mean time most of the poisons recommended in the  former
case will prove  effectual in the latter.
                       SPECIES III.

                     MALIS  ACARI.

                         2Ffcfe=Mtc.

UCTICLE infested with the tick;  itching harassing, often
                    WITH SMARTING PAIN.

The tick insect offers us the following varieties :
<x. Acari domestici.             "Observed on the head in consi-
  Domestic tick.                 derable numbers."  This is not
                                a  common  variety,  but   Dr.
                                Young  has an example, and  I
                                have introduced the variety up-
                                on his authority and in his words.
0 Acari Scabiei.               Infestment of the itch-tick;  bur-
  Itch-tick.                      rowing under the cuticle in or
                                near the pustules or vesicles of
                                the scabs in those affected.
y Acari autumnalis.            Infestmentof the harvest bug, less
  Harvest bug.                  in size than the common mite ;
                                inflicting its bite in the autumn,
                                and firmly adhering to the skin;
                                itching  intolerable, succeeded
                                by glossy wheals. 
QE. VII.—SP. III.]   EXCERNENT FUNCTION.
439
   The acarus is a very numerous genus of very minute insects in-
cluding, besides those enumerated  above, a multitude of other spe-
cies well known to every one, as a. Ricinus, or dog-tick, a. Siro]or
mite, a. dysenteriae, or dysentery tick, of which we have' spoken'al-
ready .*                                              r
   The  first in the above  varieties is  probably the a. Leucurus of
Linneus, with a testaceous exterior found frequently in the neigh-
bourhood of gangrenous sores, and  dead bodies.   The  second a.
scabiei or exulcerans, for  though enumerated as two by Linneus*
they are the same animal, is white with reddish legs.  It burrows*
not in, but near the  exulcerations of the itch, as already observed
under scabies, as also in the neighbourhood of other exulcerations,
and  adds considerably to their irritation.   The  harvest-bug is a
globular ovate-red insect,  with an abdomen bristly behind.   From
the glossy  wheals which its bite produces  it has  sometimes been
called WHEAL-WORM.
   The wounds inflicted by vermin of  this kind are to be avoided
by avoiding their haunts ;  or a tepid bath when we have been ex-
posed to them.  Where the punctures have taken  place they are
easiest relieved by a lotion composed of equal parts of the aroma-
tic spirit of  ammonia and water, which I  have often  found also
highly serviceable in the bite of an animal that does not, indeed,
harbour in the cuticle or on the skin, though he is as troublesome
by his sudden and predacious sallies, I mean the gnat and the mus-
queto fly.
                        SPECIES IV.


                    MALIS  FILARIjE.

                      <3fttCnea=3iarorm.

 SKIN IFESTED WITH THE GUINEA-WORM; WINDING AND TURNING
   UNDER THE CUTICLE, FOR THE MOST PART, OF THE NAKED FEET
   OF WEST INDIAN SLAVES; SEVERE  ITCHING, OFTEN SUCCEEDED
   BY INFLAMMATION AND FEVER.

This worm is found chiefly in both the Indies, most frequently in
the morning dew; often twelve feet long, not thicker than a horse-
hair.   It should be drawn out  with great caution, by means of  a
piece of silk tied round its head; for if, by being to much strained,
the animal break, the part remaining under the skin will  grow with
redoubled vigour, and often occasion a fatal inflammation.
• Vol. II. p. 307. 
440
ECCRITICA.
[CL. VI.—OR. HI
   This animal is the irk Medini  of Avicenna, and the Arabians,
literally, vermis Medinensis, but which has, by some means or other,
been by most writers corruptly translated nervus, or vena Medi-
nenis.
   The Guinea-worm was well known  to the Greek writers, who,
according to  Pliny, denominated it fexxoirix, (dracontia,) whence
the name of dracunculus which is frequently applied to it.  Aetius
and Agatharcides have both given an account of this worm, as ha?
also Paulus of ^Egina.
   The inflammation  produced by this animal commences with  an
itching in the part affected without acute  pain.  The part swells
and inflames, and at length resembles a furunculus or boil, in hard-
ness, and when on the point of breaking, in vehement pain.   Soon
after the  tumour has burst, the head of the worm may be  seen
peeping from the  bottom of the sore, when  it is to be  cautiously
laid hold of as already described.   Sir James M'Gregor informs us
that the native  practitioners are far more expert in  extracting it
than Europeans:  and that after a nice feel with  their fingers  for
the body of the worm they make an incision, as nearly as they can
judge,  through  its middle, and by nicely tying a piece of silk to
each end curl out both at the same time.  Mr. Hutcheson gives an
account of his having extracted one that measured  three yards and
a half in length.*
                       SPECIES V.

                    MALIS (ESTRI

                       Gtau^flg mu.

SKIN INFESTED WITH THE LARVES OF THE  GAD-FLY ; V3HIEFLY BUM
   ROWING IN THE SCHNEIDERIAN MEMBRANE OF THE NOSTRILS.

This complaint is more common to  quadrupeds than to mankind
especially to sheep, horses, and black cattle; the insect depositing
its eggs in different parts of the bodies of these animals, and hence
producing painful tumours, occasionally succeeded by  death, from
the violence of the inflammation. We sometimes, however, and in
the West Indies not unfrequently, find the eggs of this insect de-
posited in the interior  membrane of the human nostrils ; acciden-
tally inhaled with the air, or lodged by a sudden ascent of the in-
sect itself.  Mr. Kilgour of Jamaica, gives a  striking example of
this, though he does not indicate the insect.  The patient was re*
* Edin. Med. Essays, Vol. V. Fart. II. p. 309. 
GE. VII.—SP. V.]    EXCERNENT FUNCTION.
44-1
duced almost to a state of madness before the appearance of a single
larve ascertained the real  nature of the  disease.   The  cure  was
effected [,:j an injection of tobacco decoction.   Two hundred were
discharged in ten days.*
                         SPECIES VI.

                      MALIS  GORDII.




  SKIN INFESTED "WITH THE HAIR WORM ; CHIEFY INSINUATING ITSELF
    UNDER THE CUTICLE OF THE BACK,OR LIMBS OF INFANTS ; PRODUC-
    ING PRICKING PAINS, EMACIATION, AT TIMES CONVULSIONS.

  This is the morbus pilaris of  Horst, the  malis a crinonibus of Et-
  muller and Sauvages.
    The nature of the disease is still involved in some uncertainty,
 -the fibrils thrown forth from the  surface  of the skin accompanied
  with the symptoms above described, are by some authors supposed
  to be a morbid production of real hairs ;  but the greater number,
  and among the rest Ambrose Pare, ascribe to them a distinct livino-
  principle.
    The disease is uncommon ;  but upon the whole it seems to be
 often  produced  by a species of the gordius or hair worm; some of
 which are well known to infest other animals in like manner; and
 especially the cyprinus alburnus or bleak, which,  at the time, ap-
 pears  to be in great agony.
   Hoffman tells  us that the children of Misnia are much infested
 with worms of this kind,  which he describes as resembling black
 hairs lodged under the skin : and  which, by a perpetual irritation,
 so  emaciate them that they become little more than living skeletons.
 When the skin is warm they appear, but while cold they keep bu-
 ried under its cover.
   A similar disease is said by M. Bassignet to have been peculiar,
 in 1776, to the town of Seyne  and its neighbourhood, and to have
 made its attack upon almost all the new-born children.   In Seyne it
 was at that time  called cees, a  corruption  of ceddes, a  provincial
 term for a bristle.  It appeared from the first twelve hours till the
 end of the first month after birth, rarely later than the last period.
 The symptoms were a violent itching, and  general erethism  so as
 to prevent  sleep; hoarseness, a diminution of the voice, and an
inability of sucking.   Friction with the hand over the body proved
* History of a ease in which worms in the nose were removed, &c. 8yo. 1782
Vol. IV.—3 K 
4*2
ECCRl ncA.
[CL. VI—OR. III.
a certain cure, and brought forth a kind  of dark  rough filaments
resembling hair, often  not more than  the twelfth of an inch in
length', in some cases furnished with a minute bulb at the extremity.*
  A decoction of the cocculus Indicus is serviceable in this and in
most of the preceding species : but perhaps the most determinate
cure for the whole, is to be found in the civadilla, supposed to be a
species  of the veratrum, which I have already recommended in
many cases.  No insect or vermin of any kind is capable of resist-
ing or living under the  pungent and acrid aroma of its seeds when
reduced to powder, which it is only necessary to sprinkle over the
linen or bed-clothes that are thus infested.  The powder, indeed,
is a powerful errhine ; and when tasted affects the  tongue with the
pungency of needles, and  excites a severe and protracted ptyalism.
On  account of this acrid  and penetrating power it ought not to be
used where the surface  of the body is exulcerated.   In porrigo, or
scabby scall, it  has  even proved fatal:  and hence it is omitted
in Rosenstein's third edition of his work " On the Diseases of Chil-
dren," though recommended in the two preceding.
                     GENUS VIII.


                       ECPHYMA.

                 (Cutaneous ISpcresceuce.

SUPERFICIAL, PERMANENT, INDOLENT EXTUBEHANCE ; MOSTLY CIR-
                        CUMSCRIBED.

Eophyma is a Greek "term from txQvu " educo,  egero," in contra-
distinction both to phyma " an inflammatory tumour," and emphyma
" a tumour without inflammation originating  below the integu-
ments."  Extubeiances similar to those belonging to  this genus
are frequently found in the rinds of fruits, as apples and  oranges,
and form a peculiar character in some  species of melon ; none of
which are produced by insects, nor are we acquainted with the im-
mediate cause.
  The species of this genus are the four following:

      1. ECPHYMA  CARUNCULA.         CARUNCLE.
      2.--------VERRUCA.           WART.
      3.------— CLAVUS.            CORN.
      4.--------CALLUS.             CALLUS.
* Hist, de h Societe Royale, &c. Ann. 1776. 
 «E. VIII.—SP. I.]    EXCERNENT FUNCTION.               443


                        SPECIES I.


               ECPHYMA CARUNCULA.

                         (Earuncle.

 SOFT, FLESHY, OFTEN PENDULOUS, EXCRESCENCES OF THE COMMON
                        INTEGUMENT.

 This species is found over the surface generally and occasionally,
 as a sequel of lues, about the arms and sexual organs.
  From its shape or position it often obtains a particular name, as
ficus, when fig or raisin-shaped; encanthis, when seated  on the
 canthus or angle of the eye.
  These excrescences on their first formation seem to  be produc-
 tions of the  cuticle alone ; but by gradually thickening  and  a fresh
 vascularity they come at length to be connected with the skin  it-
 self, and in some instances, even to proceed to the depth  of the
 subjacent muscles.   They are of very  different degrees of hard-
 ness : being in some instances not much firmer than the parts with
 which they are connected : whilst in others they are found to ac-
 quire the obduracy of a rigid schirrus.  Their colour also is  very
 various: in some cases they are of a pale  white, and in others of
 different shades of red.   In some instances they are single and in
 others gregarious.  In many cases they are not larger than ordi-
 nary warts,  but in others they are much broader and thicker.
  Where they are neither painful nor  unsightly there can be no
 reason for attacking  them, but in other cases they should be re-
 moved.   Those of a soft consistency may be often  destroyed  by
 rubbing them frequently  with a piece of  crude  sal ammoniac,  or
 washing them with a strong solution of that salt.  Savin powder is
 a still more  effectual  escharotic.   Pressure alone will  also some-
 times succeed when it can be fairly applied.  But if none of these
 answer, recourse must be had to lunar caustic or the scalpel 
444
ECCRITICA.          [CL. VI.-OR. Ill
                        SPECIES II.

                ECPHYMA VERRUCA.

                           OTart.

 ilKM, HARD,  ACRID,  INSENSIBLE EXTUBERANCE OF  THE  COMMON
         INTEGUMENT ; FOUND CHIEFLY ON THE HANDS.

 Warts are small sarcomata that offer the following varieties :
 x Simplex.               Simple and distinct:  sessile or pensile
  Simple Wart.
 (3 Lobosa.                Full of lobes and fissures.
  Lobed Wart.
 y Confluens.             In coalescing clusters.
  Confluent Wart.
  All these rise, like the caruncle, from the  cuticle at first,  and
 gradually become connected with the cutis by being  supplied with
 minute arteries that rarely extend far into its substance, as the sur-
 face, when of any bulk, is hard, ragged, and insensible.   The ex-
 treme sensibility of the base of a wart rendres its connexion with a
 subcutaneous nerve highly probable.
  It is destroyed by ligature,  the knife, escharotics, or powerful
 astringents.  Many of our common pungent plants  are employed
 by the vulgar for the same purpose, and in various instances answer
 sufficiently.  One of the most frequent is the celendine or chelido-
 nium majus, whose yellow acrid juice is applied  to the excrescence
 daily or occasionally till it disappears.   The pyroligenous acid,
 however obtained, answers the same purpose, as does  the meloe
proscarabaeus, the liquor potasse or ammoniae, mineral acids, mu-
 riated ammonia.  In Sweden they are destroyed  by the  gryllus
 verrucivorus, or wart-eating grasshopper,  with  green wings spot-
 ted with brown.  The common people catch it  for  this purpose ;
 and it is said to operate by biting off the excrescence, and dis-
 charging a corrosive liquor on the wound.  They often disappear
 spontaneously, and hence lay a foundation for being charmed away. 
CE. VIII.—SP. III.]   EXCERNENT FUNCTION.
                      SPECIES III.


                 ECPHYMA CLATUS.

                          ©ornsf.

ROUNDISH, HORNY, CUTANEOUS EXTUBERANCE WITH A CENTRAL NU-
  CLEUS, SENSIBLE AT  ITS  BASE : FOUND CHIEFLY ON THE TOES
  FROM THE PRESSURE OF TIGHT SHOES.

Corns originate in the same manner as caruncles and warts.  They
are sometimes spontaneous,  and gregarious,  spreading over  the
whole head and body ; and sometimes rise to a considerable height,
and assume a horny appearance. In the  last case the  tubercle
makes a near approach to some of the species of the genus lepido-
sis, especially 1. Icthyiasis cornea, and cornigera.  In the ninth vo-
lume of the Transactions of Natural Curiosities, is a case of an an-
nual fall by a spontaneous suppuration.
  The cure consists in cutting or paring  the  excrescence down
nearly to its  roots ; and then applying some warm resinous, or other
stimulating preparation, as the juice of squills, house-leek, or pur-
lane, or the compound Galbanum or ammoniac emplaster.
                       SPECIES IV.

                 ECPHYMA  CALLUS.

                          ©alius.

 CALLUS EXTUBERANT THICKENING OF THE  CUTICLE ; INSENSIBLE
                       TO THE TOUCH.

 This species is found chiefly on the palms of the hands and soles of
 the feet as a consequence of hard labour.  Among those who accus-
 tom themselves to long journeys over the burning sands of Egypt
 some have had their feet as indurated with a thick callus as an ox's
 hoof, so as to bear shoeing with  iron: and  in Siam such persons
 have been known to walk with their naked feet on red-hot iron
bars.
  This  species is produced also by a  frequent exposure  of the
hands or feet to hot water, or to mineral  acids.  The cuticle of the
feet has been rendered so thick and insensible by the use of sul-
phuric acid as to endure fire  without pain. The acid is  hence 
446
ECCRITICA.
[CL. VI.—OH. Ill
commonly employed by professed fire-walkers, and fire-eaters, the
interior of the mouth being hardened and scared in the same way
as the soles  of the feet.
  In the Medical Museum is a singular case of this complaint as it
occured in a young man, the cuticle of whose hands was so thick-
ened and indurated as to render them of no use.   He was by trade
a dyer; and the disease was gradually brought on by cleaning brass
wire,  with a fluid consisting of sulphuric acid, tartar, and alum.
His fingers were so rigid from the callosity of the cuticle, that on a
forcible endeavour to straighten them,  blood started  from every
pore.   As the disease was chiefly ascribed to the use of the  acid,
the patient was ordered to apply to his hands an emollient liniment
consisting of equal parts of olive-oil and aqua-kali.   After two days,
one half the  alkali was omitted, and the yolk of  two eggs added.
By means of this application  the hardened cuticle began to peel
off; and  a new  flexible one  to  appear  beneath; he acquired  the
use of  his fingers by degrees,  and in about two  months the  cure
was perfected.
                       GENUS  IX.


                     TRICHOSIS,

                       3*lorhftr f^atr.

        MORBID ORGANIZATION OR DEFICIENCY OF HAIR.

Trichosis {r^tyfixris) " pilare malum," is a term of Actuarius, and
other Greek writers, from 0g<|  " pilus."   Trichiasis is the  more
common appellation; but it has often been used in a somewhat dif-
ferent and more limited sense.  The terms athrix and distrix, which
express two of the species under this genus, are evidently from the
same root.
  Hair may be regarded as a  vegetation from the surface  of the
body; it rises from a bulbous root  of an  oval  form which fixes in
the cuticle or rete  mucosum, and  seems  sometimes to  shoot into
the cutis.   The separate hairs are  spiral and hollow, furnished
with vessels, and knotted at certain  distances like  some sorts of
grass, and in some cases send out branches at their  knot9.  Their
roots or bulbs are found  over the whole surface of the body, though
they only vegetate  in particular  parts,  for which is not easy to
assign  a reason.  The hairs in  the stems of the roots are nourish-
ed by the  gluten -ot  its base, and as  this  is more copious or more
fluid the  stem  is more succulent:  when a  smaller quantity or 
GE. IX.]
EX'IERNENT FUNCTION.
447
more dense, the hair is dry, crisp, and soon falls of: when not car-
ried to the extremities, the stems or hairs become brittle, or split.
The rete mucosum furnishes the hair with its colour; and as this
colour, together with the nutritive mucus of the hair, diminishes,
and is at length altogether suppressed in old  age,  we see one rea-
son why the hair becomes gray, and perishes.
  As hairs, at least in  a state of  health, have no more nerves than
the filaments of vegetables,  it is probable that the circulation is
carried on in them in the  same manner as in plants.  By combing
we  free the fluid from those obstructions which must necessarily
be produced by their being bent in all directions : and hereby pro-
mote a circulation through the bulb, and relieve  the  head  from
accumulations :  for though the vessels of the bulb  are small they
are numerous.*  And  we are hence enabled to account for the re-
lief and refreshment which is often felt by a patient after the ope-
ration  of combing.   Long hair has  been in all ages esteemed  an
ornament.  There is no  question, however, that it requires more
nutriment for its support than short hair;  and  some physiologists
have gone so far as to doubt whether it may not hereby be injurious
to the  general health, as productive of debility.  But there seems
no real ground for such a belief, as a healthy system, like the roots
or trunk of a healthy tree, will always be able without inconvenience
to furnish sustenance  enough for its  branchy foilage.   Dr. Parr,
however,  affirms, that suddenly cutting of long hair has to his
knowledge been injurious and attended with every appearance of
plethora:  while very thick  hair  may occasionally weaken by the
undue warmth and perspiration it occasions.
  According to the experiments of Vauquelin, read to the institute
in 1808, human hair is not soluble in boiling water, but,  when ex-
posed  to a greater temperature  in Pappin's digester, it dissolves
readily. From  a solution of black hair,  a black matter was depo-
sited,  which  proved to be an oil of the  consistence of bitumen,
together with iron and sulphur.   And as the hair of some persons
has a smell approaching to that of sulphur, and especially those who
have red hair, we are no longer at a loss  to account for this.  The
same excellent chemist found that alcohol extracts from black hair
a whitish, and a grayish-green oil, the last of which  separates as
the alcohol evaporates.  It  is  probable, therefore, that  the black
matter is gummy or albuminous ; the white we  are told resembles
cetaceum in appearance though it differs in chemical affinity.  Red
hair affords the white matter, and instead of the grayish-green oil,
an  oil  as red as  blood.  White hair contains phosphate of magnesia,
affording us another proof of the greater facility with which calca-
reous matter is  either  formed or let loose in old age than in any
other period  of life ;t and its oil is nearly colourless.  When hair
» Parr. Med. Diet. Art. Pilus.
| Vol. IV. p. 215. 
448
ECCRITICA.          [CL. VI.—OR. 111.
becomes suddenly white  from terror, Vauquelin thinks  it may be
owing to a sudden extrication of some acid, as the oxymuriatic acid
is found to whiten black hair; but it is suggested by Parr, that this
may more probably be owing to an absorption of the oil of the hair
by its sulphur, as in the operation of whitening wollen cloths.
  These remarks will assist  us in comprehending something of
the nature of the following species of diseases which are included
in the genus before us :

    1. TRICHOSIS SETOSA.           BRISTLY  HAIR.
    2.----------PLICA.             MATTED  HAIR.
    3. ——-----HIRSUTIES.        EXTRANEOUS HAIR.
    4.----------DISTRIX.          FORKY HAIR.
    5.----------POLIOSIS.          GRAY  HAIR.
    6. -----     ' ATHRIX.           BALDNESS.
    7.----------AREA.             AREATED HAIR.
    8.----------DECOLOR.         DISCOLOURED HAIR,
                        SPECIES  I.

                TRICHOSIS  SETOSIA.


        HAIRS OF THE BODY THICK, RIGID, AND BRISTLY,

This is the hystriacis or porcupine hair of Plenck. It is in fact a
stiff corpulency of hair produced by a gross or exuberant nutriment,
and  has been  sometimes limited to the head, sometimas to  other
organs, and sometimes common to the body. The remarks already
offered will sufficiently account for its production.
  In  the fifth  volume of the Philosophical Transactions, we have
an extraordinary example of hair of this kind being thrown off and
renewed every  autumn/ like the horns of the  deer, and various
other quadrupeds.  The affection was also hereditary, for five sons
exhibited the same morbid state of the  hair.*
* See algo Samml. Med. Wahrnemung. Band. IV. p. 249. 
GE. IX.—SP. II.]     EXCERNENT FUNCTION.               449


                        SPECIES II.

                  TRICHOSIS  PLICA.



MAIRS  VASCULARLY  THICKENED?  INEXTBICABLY  HARLED AND
   MATTED BY THE SECRETION OF A GLUTINOUS FLUID FROM THEIR
   ROOTS.

This disease affords a sufficient proof by itself, if other proofs were
wanting, of the vascularity of the hairs.  Vauquelin ascribes it to
a superfluous excretion of the fluid that nourishes them, but there
must be something more  than this : there must be also an intumes-
cence or dilatation of the vascular tunic of the hairs,  since their
capacity is always augmented, and in some cases  so much  so as to
permit the ascent of red  blood : in consequence of which they bleed
when divided by the scissors.
   Most authors ascribe it to uncleanliness,  which is no doubt the
ordinary exciting cause, though  there seem to be others of equal
efficiency.  It  is also very generally affirmed to be contagious, and
I had hence added this character to  the disease  in the volume of
Nosology.  But as Dr. Kerckhoffs strenuously maintains the con-
trary after a very minute attention to the complaint in Poland itself,
and  more especially after having in vain endeavoured to inoculate
first himself and then two children, from the  matter issuing from
the bulbs of hair pulled for this  purpose from a boy who was  suf-
fering from it in the most loathsome manner, I have here withdrawn
from the symptom.
   Dr. Kerckhoffs reduces plica  to a much simpler principle than
it has hitherto been described under, and strips it of many of the
most formidable features by which it has been characterized ; par-
ticularly its connection with hectic fever or  any idiophatic affection
of the brain.*   He regards it as  a mere result of the custom com-
mon among the lowest classes of the Polonese, of letting the hair
grow to an immense length, of never combing, or in any other way
cleaning it, and of constantly covering the head with a thick wool-
len bonnet or leathern cap.  And hence, says he, while the rich
are in general exempt from the disease, it is commonly to  be met
with among the poor alone, who  wallow in  filth and misery, and
particularly among the  Jews, who are proverbially negligent of
their persons.   He contends, in  consequence, that it  is no more
endemic to Poland than to any other country : and that  nothing
more is necessary to effect a  cure than general  cleanliness, and
excision of the  matted hair.
  *  Observations Medicales, Par. Jos. Rom. Louis Kerckhoffs, Medicine de
l'Armee, &c.  See Med. Trans. Vol. VI. Art. III.
  Vol. IV.—3 L 
450
ECCRITICA.          [CL. VI.—OR. 111.
  The first person he saw labouring under this disease, and he
gives the case as a general  specimen, was  a  boy from fifteen to
eighteen years old, in a miserably poor  village in the neighbour-
hood of Posen : most offensively filthy,  lying in a dark hole,  and
stinking (puant) beside the beasts.  He had black hair, very long, very
coarse, and braided into thick plaits of  a twelvemonth's standing.
His head was covered with grease, his brain was  greatly affected,
and he was complaining of terrible head-aches.  The medical prac-
titioner that attended him opposed the removal  of the hair from a
vulgar belief that the  common outlet of morbid  humours being thus
cut off, such humours would flow rapidly to the brain and  produce
apoplexy or some other cerebral affection.  At  length he consent-
ed that after a brisk purge the process of cutting  the hair should
commence, but only to be proceeded in by degrees.   The length
of two fingers was therefore  first removed ; and this  producing no
mischief, it was again shortened to the same extent two days after-
wards :  and in this manner the whole was cut off in  about twenty
days.  After this the  patient was allowed  to comb his head a little
and wash it with milk; a few bitters and  other  tonics were pre-
scribed for him, and he was very shortly restored to perfect health.
  Admitting Dr  Kerckhoffs' explanation of this disease to be cor-
rect, it is somewhat singular that the same  explanation  has  never
hitherto been given by the most intelligent and most celebrated
Polish, or even German.physicians : as it is also  that the disease
should be unknown in other countries where  the hair is, in like
manner, suffered to grow without cutting, and where as little  at-
tention is paid to cleanliness.
  Hence Sinapius* and numerous other writers deny  uncleanliness
to be the only, or even the  ordinary cause.  They contend for a
predisposition in the  habit, and affirm that under  such  predisposi-
tion any local accident, and a variety of affections in remote organs,
may become  exciting  causes.  In the Ephemera of Natural  Curi-
osities is a case in which  it seems to  have been produced by a
wound in the head.t   Vehr relates another in which it followed, to-
gether with jaundice, upon  a suppression of catamenia for three
inonth§4  It is also occasionally a sequel of several of the varieties
of psoriasis.
   Cutting off the hair, however, though generally supposed  to ex-
asperate the  disease,  or to  lead to some secondary evil, does  not
appear to produce these effects ; and hence Vicat recommends the
use of the scissors whenever the hairs bleed.§   It is far better with
Dr. Kerckhoffs to use them beforehand.
   Though the disease has been usually confined to the hair  of the
• Paradoxa Med.
f Dec. II. Ann. II Obs. 1.
t Diss. Iceterus fuscus cum Plica Polonica, 8tc. Fr. 1708.
§ Memoire sur la l'lique Polonoise Lausanne, 1775. 
GE. IX.—SP. 1L]     EXCERNENT FUNCTION.
451
scalp, it has  occasionally appeared in other quarters,  as in the
beard, the cuticle, and even the pudendum :  authorities for  which
are quoted in the volume of Nosology.
  From the great afllux of fluids, and even of blood  to the head,
during this disease, it is often accompanied with hemicrania, or
some other cephalalgic affection.
                       SPECIES III.


               TRICHOSIS HIRSUTIES.


                     SSptvaneous IHafr.

 GROWTH OF HAIR IN EXTRANEOUS FARTS, OR SUPERFLUOUS GROWTH
                       IN PARTS COMMON.

 The most frequent example of this misaffection is that of bearded
 women.   In a few instances the female beard has even been brist-
 ly, thus uniting the present with a preceding species.   Hippocrates
 ascribed hirsuties under this  form to a deficient menstruation,*
 whence it is occasionally met with in young women.  This  cause
 is admitted generally in modern practice; but one of the most strik-
 ing cases in a young woman, that has ever occurred to the present
 author, was  accompanied with  an habitual paramenia  superflua,
 under which the patient at length sunk at about forty years of age.
   In like manner a beard has sometimes been found on boys,t and
in a  few instances on infants.^
   Hair has often also sprouted forth from organs  whence it does
 not grow naturally ; which, however, in most instances, can be ac-
 counted for without any great difficulty by bearing in mind  a re-
mark offered in the opening of the present genus,  I  mean that
 " the roots or bulbs of hairs are  found  over the entire surface of
the body,  though  they only vegetate in particular parts."   Yet
Amatus Lusitanus has given us an example to which this explana-
tion will not apply, for in this the exotic hairs grew on the tongue,§
as the  feathers  of the toucan grow naturally.  Criniti and  Bose
found the heart covered in the same manner.||
* Epidem. Lib. VI. Sect. 7.
  Schurig, Parthenologia, p. 185. Dresd. 1729, 4to.
| Paullini, Cent. III. Obs. 64.
* Eph. Nat. Cur. Dec. II. Ann. IV. Obs. 163. Ap. 203.
§ Cent. VI. Cur. 65.
,|) Pr. Hist, de Anitomenis Messenii hirsuto corde, Paris. 1525".
  Pr. Sistens historiam cordis villosi, Leips. 1771. 
452
ECCRITICA.
[CL. VI.—OR. in,
  Of organized animal  substances hair, however, seems to be ori-
ginated more easily than any  other : and this to without having,
at least in many cases, any apparent bulb or root to shoot from. Wc
had lately occasion when treating  of paruria stillatitia, to no-
tice their discharge from the  bladder as constituting  one  of the
causes of  this  complaint.  So in  malis gordii*  they have been
apparently solicited by friction, from different parts of the body of
an infant with  seeming  relief to his distress.  And under the genus
eccyesis,! numerous examples have been given of  their formation
in various internal organs.   It is on this account the hair and beard
are said by writers of graver authority occasionally to grow for some
time after the death of  every other part of  the body ; of which ex
amples may be found in Heister,}: and Camerarius.§
                       SPECIES  IV.

                 TRICHOSIS DISTRIX.



hairs of the scalp weak, slender, and splitting at their ex-
                          tremities.

This is a common affection, and depends upon a deficiency in the
supply of proper nutriment from  the bulb or root of the hair, in
consequence of which the upper part of the tube becomes arid and
brittle, and splits into minute filaments, as already explained in the
introductory remarks to the present genus.   Its cure is to  be ac-
complished by cutting the hair short, and stimulating the roots by-
irritant pomatums, unguents, or oils.
* Vol. IV. p. 441.
f Vol. IV. p. 168.
i Heist. Compend. Anat.
§ Camerar, Memorab. Cent. VI. p. 47. 
GE. IX.—SP V.J    EXCERNENT FUNCTION.                453
                        SPECIES V.


                TRICHOSIS POLIOSIS.



            hairs  prematurely gray or  hoary.

 The  specific term  poliosis  is  a Greek derivative from ttcXo;,
 " candidus," " canus"—" white or hoary."
  The general  principle of  this diseased appearance has been ex-
plained in the introductory remarks to  the present  genus.   The
colour of the hair is derived from the rete mucosum, which secretes
a very compound material for this purpose, a part of the occasional
 ingredients of which are iron,  sulphur, lime, a grayish-green, and a
 blood-red oil. In the silvery white or glossy hairof young persons,
 the nutritive matter is, perhaps, the rete mucosum in its purest and
 most uncoloured state. Gray hair is produced in two ways. In one
 there is no colouring material  whatever, except apparently a small
 portion of the sulphur ; and in this case the hair is directly hoary,
 or of  a yellowish or rusty white.   In other circumstances the rete
 mucosum or nutriment of the  hair, from causes already  explained
 under the  genus parostia, is loaded with calcarious matter, but
 deficient in its  proper oil; and hence the hair is somewhat whiter,
 but of a dead hue, harsher, and coarser, very brittle, and apt to fait
 off from the roots.
  White hair, probably produced by the former of  these means, has
 been found occasionally in every stage of life : and Schenck gives a
 case in which it appeared on birth.*  It has sometimes been trans-
 mitted hereditarily :t and in one or two instances, seems to have
 taken place from terror,} the spasm of the capillaries of the  skin
 extending to the bulbs of the hair, which no longer communicated
 a supply of the ordinary pigment.   It has for the  same reason fol-
lowed upon an obstinate cephal3ea,§ and is said to have occurred
 after  death.H
  • Lib. I. Obs. 3. ex Stuckio.
  t Eph. Nat. Cur. Dec. 11. Ann. I. Obs. 69.
  ICamerar. Memor. Cent. II. N. 14. Doute, Ergo Canities a timore, Paris*
1757.
  § Journ. des Sgavans, 1684.
  8 Eph. Nat. Cur. Dec. II. Ann. 1. Obs. 69. 
454                      ECCRITICA.            [CL. VI.—OR. III.
                        SPECIES  VI.

                  TRICHOSIS ATHRIX.

                          iSaltmesjs.

                decay and  fall of the  HAin.

 The general principle of this defect has been so fully detailed under
 the preceding species, and in the introductory remarks to the pre-
 sent genus, that it is not necessary to add any thing further.
   This affection of the hair is the alopecia of Sauvages and  other
 modern nosologists, but not that of Celsus and  Galen, which is a
 variety of the next species.  Alopecia is a  Greek term derived
 from *Aa>T>)| "vulpes," a fox, this animal being supposed to lose its
 hair and become bald  sooner than any other quadruped.   The Ara-
 bian writers  named it from  the same source daus-saleb, literally
 "morbia-vulpis."  The species  admit of the following  varieties:
 *  Simplex.                 Hairs of the scalp  of a natural hue;
   Bald-head.                  gradually dying at the  bulbs, or
                              loosened by a relaxation of the cu-
                              taneous texture.
 £  Calvities.                 Hairs gray or hoary: baldness chief-
   Bald-crovvn.                ly on the crown of the head ; and
                             confined to the head.  Mostly com-
                             mon to advanced age.
y  Barbae.                  Decay and fall of the beard.
   Bald-beard.
   The first variety is the defluvium capillorum of Sennert. What-
ever tends to give an established relaxation and want of tone to the
cutaneous vessels becomes a cause of this affection: and itis hence
a frequent sequel upon fevers of various kinds.  It is also found as
a symptom in tabes, phthisis, porrigo, and impetigo.
   General tonics and cold bathing form the most promising treat-
ment where it is an  idiopathic affection : and where it is a seconda-
ry complaint it must follow the fortune of the disorder that gives
rise to it.
   The second variety proceeds from a cause precisely opposite to
the preceding.  Here the cutaneous secernents, instead of being too
loose and relaxed  are too dry and rigid: there is little nutriment
afforded to the roots or bulbs of the hair, whence  they become arid
and brittle, particularly at the extreme point of the head or crown,
and are perpetually breaking off at their origin.   The cause of the
whiteness or hoariness of the hair has been explained under the
preceding species.  Other causes than that of old age are noticed 
QE. IX.—SP. VI.]     EXCERNENT FUNCTION.               455

by pathologists, and have no doubt a foundation; as terror, which
has sometimes operated very rapidly, insolation or exposure of the
head to thj < ays of the sun, unlimited sexual indulgence,* cephalaea,
and worcos.f
  Ti.-.s affection is far more common to males than  to females; it
is asserted  by many writers that it never occurs in  eunuchs,} and
by Schenck that it never takes place  in any persons before the use
of sexual copulation; and hence ought not to exist in bachelors;
and, provided the remark be well founded, on  which I  cannot
speak from my own knowledge, might be employed as a test of
their continence.
  The most promising remedies are to be sought for in an  exter-
nal application of warm animal oils, and oily aromatic essences, as
lavender-water.
  Baldness of the beard  is not a common defect: but examples of
it are referred to in the volume of Nosology.
                       SPECIES VII.


                  TRICHOSIS AREA.

                      ^rratctr *G§afr.

PATCHES OF BALDNESS WITHOUT DECAY OR CHANGE OF COLOUR IN
  THE SURROUNDING HAIR ; EXPOSED PLOTS OF THE SCALP  GLA-
  BROUS, WHITE AND SHINING; SOMETIMES SPREADING AND COALES-
  CING, RENDERING THE BALDNESS «XTENSIVE.

This species is taken entirely from Celsus,  who gives two varie-
ties of it almost in the following words :

* DifiTuens.                   Bald  plots  of  an indeterminate
  Diffluent areated hair.           figure ; existing  in  the  beard
                                 as  well as in the  scalp : ob-
                                 stinate  of cure.  Common  to
                                 all  ages.
<3 Serpens.                    Baldness  commencing at the oc-
  Serpentine areated hair.         ciput, and winding in a line
                                not  exceeding  two  fingers'
                                 breadth,  to  each  ear, some-


       * Gilibert. Adversus Pract. Prin.
         Merlet. Diss. Ergo a Salacitate Calvities. Paris. 1662.
       f Paulini Lanx Sat. Dec. IV. Obs. 9.
       t De Moor, Diss, in Hipp. App. VI. 28. L. B. 1736.
         Schenck. L. I. Obs. 10. 
4j6
ECCRITICA.
[CL. VI.—OR. III.
                                   times to the forehead : often
                                   terminating  spontaneously.
                                   Chiefly limited to children.
  The first variety forms the true alopecia of the Greeks, of which
I have spoken already, and is so denominated by Celsus, Galen, and
other Greek and Roman writers.  The second is called  by them
ophiasis from e<z>/s,  a serpent, in consequence of the serpentine di-
rection in which the disease trails round the head.
  Dr.  Bateman has described this species under the name of porri-
go delcalvans, while he admits that the surface of the scalp offers no
porriginous or other eruption whatever, but " within these arese is
smooth, shining, and remarkably white." " It is probable, however,
he adds, though not ascertained, that there may be an eruption  of
minute achores  about,  the roots of the  hair, in the first instance,
which are not peimanent, and do not discharge any fluid."   It must
be obvious to every one  that this fall of the hair has no connexion
whatever with porrigo ;  depending upon a partial operation of the
causes that we have already noticed as giving rise to  the  two pre-
ceding species of poliosis and athrix.
  A frequent siiaving  of the entire scalp, with affusion of cold wa-
ter, unci the use  of stimulant liniments, as a solution of two drachms
of the oil of mace  in three or four  ounces of  alcohol, will some-
times be found to produce a fresh crop of hair :  though,  in most
instances, all applications are equally unavailable.
                      SPECIES  VIII.

               TRICHOSIS  DECOLOR.

                    ^(scoloureu' $?air.

         HAIR OF THE HEAD OF A PRETERNATURAL HUE.

As the hair receives its tint from the pigment communicated to the
bulbs by the rete mucosum, whatever varies the character or colour
of this material, will vary also the colour of the hair.  Some of
the causes of such variation we shall  have  to notice under the en-
suing genus; but there are others which are not so easily explain-
ed.  From the rete mucosum, we have already seen that the  hair
obtains iron and sulphur, as also the blood-red oil which is procured
by digestion from the  red hair,  which forms a third constituent,
since it does not seem  from the experiments  of Vauquelin,  that
this  is a  result of the iron.  The grayish-green oil which this ex-
cellent chemist has been also able to extract from black and other 
GE. IX.—SP. VIII.]   EXCERNENT FUNCTION.
457
 dark kinds of hair is another distinct principle; and, from an  ex-
 cess or deficiency, or a peculiar combination of the colorific con-
 stituents, we are able to account for some of the extraordinary hues
 which the hair is occasionally found to exhibit, though others seem
 to elude all explanation.  The  chief varieties they display are the
 following:

 * Caerulea.                       Of a blue colour.*
 P Denigrata.                     Changed from another colour to
                                    a black.f
 y Vindis.                        Of a green  colour.  Of  which
                                    we have  had very numerous
                                    examples.^
 * Variegata.                      Spotted, like the hair of a leo-
                                    pard^ Of this the examples
                                    are more common than of any
                                    of the preceding varieties.

   Many of these singular hues are said to have followed upon some
 natural colour of the hair : and,  in some instances, suddenly.   This
 is particularly the case with the second variety; or that in which
 the hair has abruptly become black, which  seems to have occurred
 as a result of fever, of exsiccation, and of  terror.   Schurig gives a
 case in which the beard, as well as the hair, was transformed from
 a white to a black.||
   We have observed, under the  fifth species, that one of the causes
 of white or  rather  hoary hair,  is a dry shrivelled  or obstructed
 state of its bulbs  by which the colorific matter is no longer commu-
 nicated. And it is possible, that as both terror and fevers, and many
 other violent commotions, have sometimes proved a cure for palsy,
 they may occasionally produce a like sudden effect upon the minute
 vessels of the bulbs of the hair, remove  their obstruction,  or  arm
them with new power, and thus  re-en^ble  them to  throw up into
the tubes of the colourless hair the proper pigment.


       • Paulini, Cent. I. Obs. 93.
       f Paulini, Cent. III. Obs. 59.
       * Bartholin. Hist. Anat. Paulin. Cent. I. Obs. 93,
       § Eph. Nat. Cur. Dec. III. Ann* Obs. 184.
       H Schurig. Spermatos.
Vol.  IV.—3 M 
458                     ECCRITICA            [CL. VI. OB. HI.
                      GENUS  X.

                   EPICHROSIS.

                     Macular Sittn.

            SIMPLE DISCOLORATION OF THE SURFACE.

Epichrosis (tvij^aa-is,) is a term common  to the Greek writers,
and employed to express a coloured or spotted surface of any kind.
The genus is new, but it seems called for. Like the last it consists
of blemishes, many  of  which  cannot always  either be cured or
even palliated ; but, as all these are morbid affections, the nosolo-
gical system that suffers them to pass without notice is imperfect.
Many of them, however, are not of serious consequence.
  The following are  the species that belong  to it:

      1.  epichrosis leucasmus.        veal skin.
      2.  ■--------spilus.            mole.
      S.  ——----   LENTICULA.        freckles.
      4.--------EPHELIS.           sun-burn.
      5.     ■        AURIGO.            ORANGE-SKIN.
6.
PtECILIA.           PYE-BALLED SKIN.
7-  '    ---*  ALPHOSIS.          ALBINO-SKIN.
                       SPECIES  I.

             EPICHROSIS  LEUCASMUS.

                       WtaUS&in.

WHITE, GLABROUS,  SHINING,  PERMANENT  SPOTS, PRECEDED  BY
  WHITE TRANSITORY ELEVATIONS  OR TUBERCLES OF THE SAME
  SIZE J OFTEN  COALESCING  AND  CREEPING  IN  A SERPENTINE
  DIRECTION; THE  SUPER-INCUMBENT HAIRS  FALLING OFF AND
  NEVER RESPROUTING.

This is the vitiligo, or veal-skin of Willan, so called from the veal-
like appearance which these spots produce on the general colour of
the surface.   It is common to the different parts of the body, but
chiefly found above the face, neck, and ears.  The term leucasmus
(Xttxxa-fMs,) importing whiteness, is  merely employed  instead of
vitiligo to avoid confusion, as Dr. Willan has used vitiligo in a sense
different from that of Celsus, or of any one who preceded  him. 
GE. X—SP. II.]     EXCERNENT FUNCTION.
459
  The size of these spots vary considerably, from that of a large
pin s head to that of a shilling or half-a-crown.  The blank and
morbid whiteness remains through life, and seems to show that the
patches are no longer possessed of red  blood-vessels, and that the
white hue of  the rete mucosum alone is  visible in their respective
areas, exhibiting a pure white, only differing  from that of death in
being glossy from the action of living principle.
                         SPECIES II.

                  EPICHROSIS  SPILUS.



  BROWN, PERMANENT, CIRCULAR PATCH ;  SOLITARY ;  SOMETIMES
    SLIGHTLY ELEVATED,  AND CRESTED WITH A TUFT OF *IAIR.

  The specific  term, from <rmXo$ "macula," has been long in  use.
  The blemish is common, but unimportant.
    We have had much of late to observe concerning the rete  mu-
  cosum, and in the ensuing species shall have again to refer to this
  material.   We have already remarked  that it is a substance which
  forms the second or middle of three laminae that constitute the
  external integument.  It is improperly called either rete or muco-
  sum, for it is neither a net-work, nor a mucous  material, being in
 effect nothing  more than  an adipose  secretion of  a peculiar kind,
 which, when black, has a considerable resemblance to the grease
 that is interposed between the axles and wheels of our carriages.
   It is the common pigment or colouring principle of the skin,
 and hence differs very considerably in hue, as is sufficiently obvious
 in the respective individuals of  the same country, but still more so
 in those of remote regions; giving a  white or fair hue to the in-
 habitants of the south side of the Caucasus and their probable  de-
 scendants  the great body of  Europeans, a black  to the negroes of
 Africa, an  olive hue to  the Mongo-Tartar race,  a brown to  the
 islanders of Australasia, and a red to the native tribes of North
 America.
   In temperate climates, and in  its purest state, itis a clear glossy
 white, and when reddened under a delicate  cuticule, by the minute
 and innumerable arteries, that are distributed over the surface of
 the body, it gives that rich but dainty tone  of colour which consti-
 tutes beauty of complexion.
   It sometimes happens, however, that persons who are perfectly
 fair in their general  complexion, from an equal  diffusion  of this
 substance in its utmost purity, have a few small spots of a  lighter
or deeper brown in  the face, limbs, or body, from an occasional
dash of brown in the rete  mucosum, produced  by causes which it 
460
ECCRITICA.
LCL. VI.—OR.l
 is impossible to unravel: and which, as we shall show presently,in
 other persons extends over the entire surface, and is consequently
 intermixed with the whole of the secretion: and  it is this occa-
 sional dash that constitutes a spilus or mole.  In treating of tri-
 chosis we observe that  chemical analysis has proved that the hair,
 and consequently the rete mucosum which supplies it with pigment,
 is possessed of a certain portion of iron ; and it is possible that a
 concentration of this mineral substance in the coloured part may
 constitute  the colorific material.  Be this as it  may, we perceive,
 wherever these coloured spots exist, there is a greater tendency to
 increased action than elsewhere ;  and hence, we often find a slight
 elevation, and increased closeness of structure, and not unfrequent-
 ly an enlargement of the natural down into a tuft of hairs.
  If this reasoning be correct, alkaline lotions, (and all soaps are of
 this character though not sufficiently strong for the present purpose,)
 should form the best cosmetics.  But the spots are rarely remove-
 able by any means, and the less they are tampered with the better.
  These  differ essentially from naevi  or genuine mother-marks,
 inasmuch as the latter are produced by a distention  of the minute
 blood-vessels of the  skin, so that those which should contain only
 colourless blood, admit the red particles, and hereby exhibit stains
 of different shapes and ranges, and of different shades of crimson or
 purple, according to the quantity of red blood that is hereby suffered
 to enter,  or the nature of the  vessels that are distended.



                        SPC1ES  III.

             EPICHROSIS LENTICULA.

                         jFredtlcs.

 uutiole stigmatised with yellowish-brown dots, resembling'
    minute lentil seeds; gregarious} often transitory.

 Lenticula is more generally  written in modern times lentigo ; it
is here given as it occurs in Celsus. The root is the Latin term lens
a lentil-seed.  The Greek word for which is <pxxix; and this, with-
out a diminutive termination, was also applied to the same blemish,
 when the spots were of a larger size.
  Its causes are various : most commonly it is produced by an ex-
posure to the rays of the sun; but it frequently arises without any
such exposure, and is sometimes transmitted hereditarily.
  The mode by which the colorific rays of the sun operate in the
production of this effect we shall explain under ephelis or sun-burn,
forming the next species. WTherethe remote cause is constitutional
it is probably a result of  the same colorific material as that to which 
GE. X.—SP.  III.]    EXCERNENT FUNCTION.                461

we have just referred spilus or mole, existing in the rete mucosum,
and operating more diffusively,  though in  much smaller patches.
How it comes to pass that this middle layer of the exterior integu-
ment should at any time be thus interruptedly charged with a co-
loured pigment so as to form the freckled  appearance which  con-
stitutes the present cuticular blemish, is not so easy to say, but that
it has a remarkable tendency to do  so is obvious, not only from the
present and  preceding species, but still more so from the very strik-
ing and singular patch-work which constitutes epichrosis pceci-
lia or the sixth species of the genus before us: where we shall be
again under  the necessity of thouching upon the subject.
  Freckles most frequently are found on persons of fair  complex-
ions and red hair; and as we have  already observed, that this hue
of the  hair is  produced  by a peculiar pigment derived  from  the
rete mucosum, which gives rise to a blood-red oil that ascends into
the hair-tubes, we have an additional reason  for ascribing the brown,
or reddish-brown freckles of the skin to  a  superabundance of the
same pigment in the same adipose layer.
  Freckles are often transitory.  They occur in many instances in
great abundance in pregnant women, and disappear after lying-in,
sometimes, indeed, in the  latter months of pregnancy.  Riedlin
affirms, but  upon what authority I  know not, that they are a fore-
sign of a female offspring.*
  Cosmetics are of less avail in this than in  the ensuing species, but
those we shall have there occasion to notice may be tried under the
species before us.
                        SPECIES IV.

               EPICHROSIS EPHELIS.

                         Sunburn.
CUTICLE TAWNEY BY EXPOSURE TO THE  SUN : OFTEN SPOTTED WITH
   DARK  FRECKLES, CONFLUENT OR CORYMBOSE; DISAPPEARING  IN
   THE WINTER.
Ephelis (ttpuXis,) is a term of Celsus as  well as the name appropri-
ated to the preceding species ; and its real meaning is " sun-burn"
or " sun-spot"—'■ vitium faciei solisustione."  In Celsus, however,
the term is used in a much wider sense, and applied to blemishes
which  have no connexion with sun-burning.  It is here  restrained
to its proper signification.
   The sun in hot climates, or very hot summer seasons, has a ten-
dency  to affect the colour of the skin in a two-fold manner.  First
by a direct affinity of its colorific rays,  or those  of light, with the
oxygene of the animal surface, and particularly with that of the rete
mucosum, in consequence of which a considerable part of the oxy-
* Lin. Med. 1695. p. 393. 
 4G2                      ECCRITICA,          [CL. VI.—OR. HI.

 gene is detached and flies off, and the carbonate and hydrogene, with
 which it was united, being freed from its constraint, enter into  a
 new combination, and form a more or less perfect charcoal, accord-
 ing to the proportion in which they combine.  And, secondly, by
 the indirect influence  with which the colorific  rays  of the sun, or
 those of heat, produce upon  the liver and excite it to a more abun-
 dant secretion  of bile,  possessing a deeper hue, and  which is more
 copiously resorbed into the system.  That a certain proportion of
 bile is resorbed at all times is clear from the colour  of  the urine
 and the stain which the perspirable fluid gives  to clean linen: and
 that this proportion is  greater in hot summers than in cold winters,
 and particularly in intertropical climates, is well known to every
 one who has attended to the subject.
   These then are  the ordinary causes of that effusive brown stain
 of  the  skin which we denominate  sun-burn.   But  whether the
 deeper  spots or freckles, which so often accompany  a sun-burnt
 skin be owing to an equal action of either of these causes, and par-
 ticularly of the first upon the rete  mucosum, or to an extrication
 of  any  colouring matter, as of iron, for example,  existing in the
 rote mucosum itself, and unequally distributed, is beyond our power
 to determine.   Either cause is sufficient to produce such an effect,
 though perhaps  the real cause is the latter: and  we have already
 seen that  in the distribution of this  adipose layer over the surface,
 and its  connexion with the cuticle and the cutis, there is a frequent
 obstruction  to a free flow of whatever colouring material may exist
 in it. which is in consequence accumulated in spots or patches in-
 stead  of being equally diffused.
  As sun-burn is chiefly occasioned by an inordinate separation of
 oxygene from the other constituent principles of the rete mucosum
 with which it was united, the most rational cosmetics, in this case,
 are those which  have a tendency to bleach the skin, by containing
 a considerable proportion of some vegetable or mineral acid. Hom-
 ber^'s cosmetic, which has long been in vogue on the Continent, is
 a ddute solution of oxymuriate  of  mercury with a mixture of ox-
 gall,  llartmann's, which has also been in high estimation, consists
 of a simple distillation  of arum-root in water.   This  forms a very
 pungent lotion, and its object is to dilute or  wash out the brown
 pigment by exciting an increased flow of perspirable fluid towards
the surface, and to carry off a part of it by an increased  action of
the cutaneous absorbents. Spirit of lavender or any of the essential
oils dissolved in alcohol may be employed for the same purpose:
 and some  have used a diluted eau de luce which  is also useful as an
alkaline irritant.   In Schroeder's Pharmacopoeia there is a prepa-
 ration for  the same purpose which we  should little expect, and the
virtues of>vhich are not very likely to be tried in the present day:
it is entitled aqua stercoris humani: but in former times dung of all
kinds  was a standard article in almost every Materia Medica, and
there are few diseases for which  it was not  recommended by some
 practitioners ; occasionally, indeed  internally as well as externally.
 The general intention  was  that  of obtaining  a very pungent vola: 
GE. X.—SP. V.]      EXCEKNENT FUNCTION.                4G3

tile alkali;  but this we are able to do at present by far leSs offen-
sive means.
  When  the  hands are deeply discoloured they may often be
bleached by exposing them to the fumes of sulphur.
  In  drupaceous fruits, and  especially those of a fine cuticle, as
apples,  we sometimes meet with spots and  miscolorations of the
same character as moles, freckles, and sun-burn; the causes of which
we do not always know, though we  can sometimes trace them to
small  punctures in the cutis by birds and insects.
                         SPECIES V.

                 EPICHROSIS AURIGO.             ,♦



 CUTICLE SAFFRON-COLOURED, WITHOUT APPARENT AFFECTION OF THE
   LIVER, OR ITS APPENDAGES J COLOUR DIFFUSED OVER THE ENTIRE
   SURFACE: TRANSIENT :  CHIEFLY IN NEW-BORN INFANTS.

 This orange hue of infants, and which is occasionally to be met with
 in later periods appears, as Dr. Cullen observes, to depend eitheron
 bile, not as in the usual  manner excreted, but received into the
 blood-vessels and effused  under the cuticle, or on a peculiar yellow-
 ness of the serum of the  blood distinct  from any connexion with
 bile.*  Sauvages has rightly  distinguished between this disease, as
 a mere cutaneous affection, and proper jaundice.  In him it occurs
 under the  name of ephelis lutea, an  improper name, however, as
 the affection is not an ephelis or sun-burn; while  the  jaundice of
 infancy he calls aurigo neophytorurn, which ought rather to be icte-
 rus neophytorum.
   It may in general be remarked, that while the sclerotic tunic of
 the eyes as well as the skin is tinged with yellow  in  the genuine
 jaundice of infants, the former retains its proper whiteness in aurigo.
 Whence the serum derives the yellow hue it  so  strikingly evinces
 on some occasions,  except from the bile, it is difficult to determine.
 That a certain proportion  of bile exists constantly in the blood in a
 healthy state is manifest, as we have already observed from the co-
 lour of the urine, and the tinge  given to linen  by the matter of
 insensible perspiration; and that this proportion varies in different
 climates, and different seasons of  the year, without producing genu-
 ine jaundice, we have observed also.  And hence, infants  under
 particular circumstances, may be  subject  to a like increase with a
like absence of icteritious symptoms. But what those circumstances
are, do  not seem to  be clearly known.  We see  nevertheless that
whatever rouses the system  generally, and the excretories pecu-
» Synops. Nosol. Med. Gen.XCI. 5. 
4G4
ECCRITICA.
[CL. VI.—OR. III.
liarly, readily takes off the saffron dye :  and hence it often yields
T.o a few brisk purges, and still more rapidly to an emetic.
                         SPECIES  IV.

                 EPICHROSIS  P(ECILIA.

                      $se=BaUetr Slkin.

  CUTICLE MARBLED GENERALLY, WITH ALTERNATE PLOTS OR PATCHES
                      OF BLACK AND WHITE.

  Poecilia (7TotxtXix) isa term of Isocrates,from 5re/*<Aes, " versicolor"
  " nictus diversis coloribus;"  whence Paecile the  porch or picture-
  gsmery of the Stoics at Athens.   The  species is new to nosological
  classification; but the  morbid affection has been long known  to
  physiologists, and ought to have  had  a niche in the  catalogue of
  diseases before now.
   This affection is chiefly found among negroes from  an  irregular
  secretion or distribution of the pigment which gives  the black hue
 to the rete mucosum.   In Albinoes, as we  shall have occasion  to
 observe presently, this pigment is entirely withheld, and the matter
 of the rete mucosum seems to be otherwise affected; in the species
 before us it is only irregularly or interruptedly distributed.
   What the cause  of this interrupted  distribution consists in  we
 know not; but in several of the preceding species of  the present
 genus, and particularly in moles and freckles, we perceive a striking
 tendency to such an effect; and if we turn our attention to the ani-
 mal and vegetable  world around us, we shall observe it springing
 before us in a thousand  different ways, and giving rise to an infinite
 diversity of the nicest and most elegant cutaneous tapestry. It is in
 truth, as the author has  already remarked in the volume of Nosolo-
 gy, to the partial secretion or  distribution  of this natural  pigment
 that we  are  indebted  for all the variegated  and beautiful hues
 evinced by different kinds of animals and plants.   It is this which
 gives us the fine red or violet that tinges the nose and  hind-quarters
 of some baboons, and the exquisite silver that whitens the  belly of
 the dolphin, and other  cetaceous fishes.  In the toes  and tarsal
 membrane of ravens and turkeys, it is frequently black : in common.
 hens and peacocks, gray: blue in the titmouse, green in the water
 hen, yellow in the eagle, orange in the  stork, and red in some spe-
 cies of the scolopax.  It affords that sprightly  intermixture of co-
 lours which besprinkle the skin of the frog and salamander.  But it
 is for the gay and glittering scales of the fishes, the splendid metal-
 lic shells of beetles, the gaudy eye spots that  bedrop the wings of
 the butter-fly, and the infinitely diversified hues of the flower-garden
 that nature reserves the utmost force of this  ever-varying pigment,
and sports with it in her happiest caprices.
  In some cases, a diversified  colour of the skin appears to be he-
reditary among  mankind.  Blumenbach  gives an example of a 
«5E. X—SP. VI]      EXCERNENT FUNCTION.
46,5
 Tartar-tribe, whose skin was generally spotted like  the  leopard's.*
 Individuals thus motley coloured are commonly called pye-balled
 negroes,  or are said to have pye-balled skin.
   The Medico-Physical Society of New York, has lately published
 a case communicated by Dr. Emery Bissel, in which a man of the
 Brotherton tribe of Indians, ninety years of age, had been gradually
 becoming white for the last thirty years of his life.  The first ap-
 pearance  of this change was a small while patch near the pit of the
 stomach,  soon after  an  attack of acute rheumatism; which was
 shortly accompanied with other white spots in the vicinity that
 enlarged and  at length intermixed.   And the spread of the  white
 hue continuing to range over the whole Dody, the original  colour
 was only visible,  at the time of writing, on the forehead, and fore-
 part of the face and neck, with a few small patches on the arm. The
 skin, as it become white, was of a fine clear tint, and had nothing of
 the dull earthy appearance, or the livid hue observed in albinoes.
 Whence it should seem that not merely the black or dark coloured
 pigment had been absorbed and  carried off, but that a fair, whitish,
 and glossy rete  mucosum, like  that secreted under the cuticle in
 white men,  had taken its place.f
   This extraordinary change, however, is sometimes produced far
 more rapidly: for in the American States  a black man has in a few
 instances  had  the whole of the colouring pigment carried off in the
 course of a severe fever, and has risen from his bed completely
 transformed into a white man.   Biichner,  on the contrary, relates
 the case of a white man who, on recovery  from a like disorder, had
 his face tinged with a black hue, doubtless from a morbid secretion
 of a pigment the skin had never before elaborated.
  A course of nitrate of silver, continued internally for some weeks,
has often produced a deep tawny and uniform discoloration of the
 skin approaching to  a black, being deepest in  the parts most ex-
posed to the light.  Fourcroy, Butini, Reimarus,  and many other
writers, have given cases of this change;  and Dr. Roget has lately
published another instance in  the Transactions of the Medico-
 Chirurgical Society.
  Plenck asserts that he once saw a man with a green face, the right
 side of his body black, and the left yellow, produced by a previous
 disease: and Dr. Bateman  informs us,  " that subsequent to the pe-
 riod of his publication, Dr Willan had observed a variety of pity-
 riases in children born in India and brought to this country, which
 commenced in a partially papulated state of the skin, and termi-
 nated in  a  black discoloration with  slightly furfuraceous exfolia-
 tions. It sometimes affected half a limb, as the arm or leg; some-
 times the  fingers or toes."J
         * De Generis Hum. varietate nativa.
         f Journ. of Science and Arts, No. XII. p. 379
         * Cutaneous Diseases, p. 48.
Vol.  IV.—3 N 
466
ECCRITICA.
[CL. VI—Oil. Ill-
                      SPECIES VII.

              EPICHROSIS  ALPHOSIS.

                       gtltnno=<SftM.

CUTICLE DULL WHITE : PUPILS ROSY : SIGHT WEAK, AND STRONGEST ft*
                         THE SHADE.

This species occurs not among negroes only, as commonly sup-
posed,  but among the inhabitants of Europe as well, and affords us
the two following varieties:
x vEthiopica.               Hair white  and  woolly: irids  white.
  Negro albino.              Found among  negroes.
0 Europea.                Hair flaxen and silky.  Found among
  European albino.           Europeans and other white nations.
  The first of these varieties is by far the most striking, on account
of the  greater change in the colour of the skin,  and the peculiar
contrast it forms with the general cast of the  negro-features.
  The name of albino was first employed by the Portuguese, and
applied to such Moors as were born white, or  rather whoconiinued
so from the time of birth, for the children of negroes  have little
discoloration on birth, nor for several weeks  afterwards, and who,
on account of this morbid hue, were  regarded  as monsters : and
the term has since passed into our own  and most other languages
of the  world.  In  these persons, however, there were other pecu-
liarities observed besides the hue of the skin, for their hair, in all
its natural quarters, was equally white, the iris of the eyes white,
and the pupil rose-coloured.   This whiteness of the surface, how-
ever,  is not the clear and glossy tint of the uncoloured parts of the
European frame in a healthy state, but of a dead  or pallid cast,
something like that of leprous scales.   The  eyes, in consequence
of the deficiency of their natural pigment, are so weak that the in-
dividuals can hardly see any object in the day,  or bear the rays of
the sun; though under the milder light of the moon, they see with
great accuracy, and run through the deepest shades of their  forests
with as much ease and activity as other persons do in the brightest
daylight.  They are also said to be less robust than other  men;
and to sleep through the day and go abroad at night: both which
last facts are easily accounted  for, for the weakness of their sight,
and the discomfort of the sun-beams to their eyes.
   It was at one time a  subject of inquiry whether  these persons
were  a distinct variety of the human race, or merely instances of
an occasional  aberration from the ordinary laws  that govern  the
human fabric : and the former opinion derived some support from
its being found that male and female albinoes, who not unfrequently
intermarried, being rejected by the rest of the world, produced an
offspring with  the same imperfections as their own. 
L.E. X—SP. VII.]      EXCEHNENT FUNCTION.
467
   The question, however, has long been sufficiently set  at rest,
 since albino children have been found produced in  most parts of
 the world,  and  from parents of all  tribes and colours, black and
 olive-hued, and red and tawny :  and, since the subject has been
 more closely attended to, from white parents or inhabitants of Eu-
 rope, as well as black or copper-coloured Africans.
   It is the appearance  of the characteristic albino-signs in Eu-
 ropean children, that  constitutes  the second  of the two  varieties
 before us.   These signs are a  dull or unglossy white diffused over
 the body, with white or flaxen hair,  white  irids  and red pupils.
 The disease is rare, but we have had at least  eleven examples de-
 scribed by different authoritic s to the present time.  Two by de
 Saussure, four  by Buzzi,  one  by Helvetius,  one by Maupertius,
 and three by Dr. Traill.  It is  singular that  all these  are males;
 and still more so that the  female offspring  of the  same  ft males
 were, without an exception, destitute of the albino degenctacy.
 The three described by Dr. Traill were part of a family of six. the
 daughters of which were in every respect unaffected.  How far this
 disorder is  in Europe capable of being  produced hereditarily as
 abroad  is not known;  nor, indeed, does  there yvt appear to have
 been an opportunity of forming an intermarriage between  a male
 and a female of  this kind,  as not a single female has yet been dis-
 covered possessing the imperfective formation.
   The same delicacy of constitution that distinguishes the foreign
 or  negro albino, distinguishes the  European, of which  we may
 form an estimate from Dr. Traill's account of one of the three we
 have already alluded to.  " The oldest of these albinoes," says he
 " is nine years of age, of a delicate constitution, slender, but well
 formed  both in  person and in  features:  his  appetite  has always
 been bad: he frequently complains of  a dull pain in  his forehead :
 his skin is  exceedingly fair; his hair flaxen and soft;  his  cheeks
 have very little of the rose  in  them.  The iris and pupil of his
 eyes are of  a bright-red colour,  reflecting in some  situations an
 opaline  tinge.   He cannot endure  the strong light of  the sun.
 When desired to look up, his eye-lids  are in constant motion, and
 he is incapable of fixing his eyes steadily on any object as is observ-
 ed in those labouring under some kinds of slight ophthalmia, but in
 him is  unaccompanied by tears.   His mother says that his tears
 never flow in the coldest weather, but when vexed  they are shed
 abundantly.   He goes to  school, but generally retires to the dark-
 est part of  it to  read his lesson.—His disposition is very gentle;
 lie is not deficient  in  intellect.   His whole appearance is  so re-
 markable that some years ago a person attempted to steal him, and
 would have succeeded in dragging  him away, had not his cries
brought him assistance."*
   The  disease  consists altogether in a defective secretion of the
rete mucosum, which is not only without the colouring constituent
* Nicholson's Journ. Nat. Phil. Feb. 1868. 
468                      ECCRITICA.           [CL. VI.—OR. HI.

principles that naturally belong to it,  and particularly its power of
affording a black pigment, but seems  to be also untempered or im-
perfectly elaborated in other respects, judging from  the  dullness
or deadiuss of the white hue it gives to the surface of the body,
instead of the life and glossiness  it diffuses in a slate of perfect
health.  That this cutaneous layer is  not  altogether wanting is
clear, since in such case  the red vascularity of the cutis would be
conspicuous through  the  delicate tiansparent  cuticle, in  albinoes
peculiarly delicate, and tinge the  surface with a red instead of a
white colour.
  It  is to this imperfection  in the secretion or elaboration of the
rete mucosum that the delicacy or feebleness of the general frame
is in all probability to be ascribed, though we may be at some loss
in  determining how such  an effect is produced by such  a cause.
That the flaxen hue of the hair, and  the whiteness of the irids is
derived from the  same source, admits, however, of no doubt, and
the opinion long ago expressed by  Professor  Blumenbach,* that the
red culour of the pupils  in the two adult albinoes, whom he had
examined at Chamouni, was equally owing to the want of the usual
black pigment, hat since hern confirmed by M. Buzzi of Milan,
who  has had an opportunity of dissecting an albino, and has proved
that the pigmentum nigrum of the choroid coat, and also  that por-
tion of it which  lies behind  the iris, and is called  uvea,  were to-
tally wanting.f
  We have  observed,  under the preceding species, that  other
animals are  as richly supplied with a rete mucosum  as  mankind,
and that they are indebted to it  for their respective colours :  and,
as there can be no reason  why they may not at  times endure a like
deficiency, we have reason to expect  a priori that they may occa-
sionally exhibit proofs of the same complaint.   In accordance with
this  reasoning, M. Blumenbach has traced  this affection  in many
tribes, and  especially in white dogs, owls,  and rabbits :  and Dr.
Traill has  lately observed a case  of the same  disease in  a young
sparrow which he accidentally shot.  This seems  to have been a
perfect albino, with red  eyes, pale reddish  beak and neck, snow-
white plumage,  of a satin gloss on the  head, neck, wing coverts,
and  back.   The nest from which it issued contained another young
sparrow of the common colour; and  when the  albino bird quitted
the nest, which it was seen to do a few  days before it was  shot, it
was instantly attacked by  fifty or sixty common  swallows,  and
obliged to take refuge in a tree t.
  * Med. Bibl. II. 5>7.
  •j- Dissertazione storico-anatomica sopra una varieta particolare de nomini
biauchi, &c. Milan,  1784.
  Le Cat, Traite de la Couleur de la peau humaine.
  * Edin. Phil. Journ. No. IV. p. 390. 
469
GENERAL INDEX.
        The Numerals indicate the Volume; the Figures the Page.

The Classes and Orders are distinguished by Small Capitals; and the Genera
                              by Italics.
A.
 Abortion, iv. 122
 Abscess, how distinguished from Apo-
   stem, ii. 163
          of the breast, ii. 187
 Absence of mind, iii. 108
 Abstraction of mind, iii. Ill
 Absorbent system, physiology of, iv.
   187
           whether veins are absorb-
   ents, iv 191
           general effects  from the
   union of this and the secernent sys-
   tem, iv. 195
 Absorption in cataract, iii.  151
 Acari malis, iv  438
 Aearus dysenteriae, ii. 3)4
        cutaneous, iv. 438
 Acid bath, i  257
     formic, in indigestion,  i. 116
     uric, produced more   copiously
   from  animal than vegetable food, iv.
   333
     oxalic, predominant principle in
   diabetic urine,  iv. 332
 Acidum abietis, i. 348
 Acoroides resinifera of New Holland,
   i.  113
 Acrotica, iv. 357
 Acrotism, iii. 260
 Acrotismus, iii. ib.
 &doptosis, iv. 102
           .vaginae,  iv. 105
           vesicae, iv. ib.
           uteri, iv. 102
           complicata,  iv. 108
           polyposa, 107
 iEsTHETicA, iii  133
 jEstus volacitus,  iv. 370
iEthusa  Cynapium, or fool's parsley,
  i.  141
After-pains in labour, iv. 165
  Agallochum, or lign-abes, i. 113
  Agenesia, iv. 88.
           impotens, iv.89
           dys-spermia, iv. 91
           incongrua, iv. 94
  Agria, iv.376
  Jigryprda, iii. 308
           excitata, iii. ib.
           pertsesa, iii. 310
  Ague, ii. 65
        quotidian, ii, 68
        tertian, ii. 70
        quartan, ii. 71
        irregular, ii. 72
        complicated, ii. 73
        has raged   in  high grounds,
   while low have escaped, ii. 77
        treatment of, ii. 78
 Ague-cake, i. 279
 Air, average of inspired, in a minute
   i. 301
                expired, i. 301. 304
   whether secreted by organs, iv. 286
 Albino-skin,  iv. 466
 Algor, iii. 187
 Alimentary canal, i. 2
      .          comparative length
   of, i. 4                         .
                 Diseases or, i. 9
 Alkekengi, or winter-cherry, iv. 307
 Alopecia, iv. 427. 456
 Alphabets, why they differin different
   languages,  i. 335
          mostly derived  from the
   Phenician,  i. ib.
             Devanagari,  and some
  others not,  i. 336
Alphos, iv. 391, 392
Alphosis,  iv. 466
Alusia,  iii. 93
       elatio, iii. 94
       hypochondrias, iii. 99
Alysmus, iii. 314 
470
GENERAL  INDEX.
Alyssum, iii. 252
Amaurosis, iii. 154
           varieties, iii. ib.
Ambition, ungovernable,  iii. 83
Ammoniaco-magnesan  phosphate of
  the bladder, iv. 339
Amnesia, hi. 124.126
Anal hemorrhage, ii. 466. 468
Anaphrodisia, iv 89
Anas cygnus, i. 294
    olor, i.  ib.
Anasarca, iv. 245
         serosa, ii. 319
Anemone pratensis,  iii. 146
Anetns, ii. 65
        quotidianus, ii. 68
        tertianus, ii. 70
        quartanus, ii. 71
        erraticus, ii. 72
        complicatus, ii. 73
        treatment of, ii. 78
Aneurisma,  ii. 592
           varieties, ii. 593
Anger, ungovernable,  iii. 84
Angelica, i. 215, 216
Angina polyposa, ii. 234
Anhelation, i. 362
Animals,  lower  orders,  propagable
  both by offsets and seeds, iv. 6
Animation suspended, iii. 367
Anthracia, ii. 424
          pestis, ii. 426
           rubula, il 445
Anthrax, ii.  193
Antigua fever, compared with Bulam,
  ii. 103
Antimony, glass of,  cerated,  ii. 310
Antipathia,  antipathy, iii. 315
            sensilis, iii. ib.
            insensilis,  iii. 316
Anxiety, ungovernable, iii. 88
         corporeal, iii. 312
Aphis humuli, i. 197
Aphtha, ii. 390
Aphrodisiacs, of little avail, iv. 90
Aphonia, i.  318
         ehnguium, i. 319
         atonica, i. 322
         surdorum, i. 324
 Aphoria, iv. 97
         impotens, iv. 97
          paramenica, iv. 99
         impercita, iv. 100
          incongrua, iv. 101
 Aphis, iv.7
 Aphelxia, iii. 107
          socors, iii. 108
          intenta, iii. Ill
          otiosa, iii. 112
 Appetite, morbid, i. 71
Appetite, canine,  i. 72
         depraved, i. 80
Apochysis, iii. 148
Apostema, aposteme, ii. 163
          how differs from abscess, ii.
  164
          commune, ii. 164
          psoaticum, ii. 175
          hepatis, ii. 176
          Empyema, ii. 178
          Vomica, ii  181
Apoplexia, apoplexy, iii. 394
           entonic,  iii. 402,  403
           atonic, iii. 404
           sanguine, iii. 401
           serous, iii. ib.
Aqua regia bath,  i. 257
     obscura, iii. 149
     serena, iii.  ib.
Arctium Lappa, ii. 590
Ardor, iii. 187
Area, iv.455
Areca oleracea, i. 3. 211. 217
      Malabar Nut, i. 106
Arnica, i. 157
        montana, iii. 432
Arqua,  iii. 149
Arsenic, in intermittents, ii.  86
         in rheumatism, ii. 335
         in consumption, ii. 510
         in cancer, ii. 544
         in nerve-ache, iii. 195
         in rabies, iii. 251
         in chorea, iii. 296
         in epilepsy, iii. 364
         in leprosy, iv. 399
Artemisia santonica, i. 215
Arteries and veins, ii. 7
Arthrocace,  ii. 620
Arthrosia, ii. 324
          acuta,  ii. 326
          chronica, ii. 332
          Podagra, ii. 335
          Hydarthrus, ii. 358
Arthritis, ii. 324
Articular inflammation, ii. 325
Arum in hemicrania, iii. 328
Ascaris lambricoides, i. 200
        vermicularis, iv. 10
Asclepias, gigantea, ii. 572
Ascites, iv. 276
Aspalathus canariensis, i. 93
Asphyxia, iii. 367
           varieties of, iii. 368
           how related to  acrotismus,
   iii. 260
Asphyxy, iii. 367
 Asplenium ceteracb, as a diuretic, iv.
   305
Aithfna, i. 370 
GENERAL  INDEX.
471
Asthma, siccum, i. 375
        humidum, i. 378
        nervous, i. 375
Athamanta oreoselinum,  as a diuretic,
  iv. 305
           Meum, iv. 40
           cretensis, iv. 305
Atheroma, iv. 212
Atmosphere contaminated with febrile
  matter, sometimes affects birds, ii.
  48
Atriplex foetida, iii. 349
Atrophia, atrophy, ii. 475
Aura epileptica, iii. 360
     podagrica, ii. 348
Aurigo, iv. 463
Aurum fulminans,  ii. 378
Avarice, ungovernable, iii. 83
Azote necessary to animal nutriment,
  i. 3
B.
Bacher's pill,  iv. 249
Baker's itch, iv. 401
Baldness, iv. 448. 454
Balfour,  his  hypothesis of  sol-lunar
  influence, ii. 56
Ballismus, iii. 297
Balsamum carpathicum, iv. 305
          hungaricum, iv. ib.
Banana, i. 3
Barbadoes-leg, ii. 320
Barbiers,  iii. 303
Bark, Peruvian, history of, ii. 81
Barrenness, iv. 97
           of impotency,  iv. ib.
           of mis-menstruation, iv. 99
           of irrespondence, iv. 100
           of incongruity, iv. 101
Bastard-pox,  ii. 563
Beating,  sense of, in the ears, iii. 169
Bee, economy of, iv. 7
Beet, i. 3
Beetle, larves of, intestinal, i. 204
       grubs intestinal, i. ib.
Bella donna in cataract, iii. 153
              amaurosis, iii. 155
Belly-ache, i. 120
      dropsy of,  iv. 276
Benat-allil (Arab.)  ii. 385
Beras (leprosy,) iv. 388. 391. 395
Berat (leprosy,) iv. 388. 391
Beriberia, Beribery,  iii. 303
           origin of the name, iii. ib.
Bex,  i. 342
     humida, i. 344
     sicca, 349
     convidsivav 354
Bezoar      Jj lg6
Bezoardus,  3
            spurious, i. 187
Bichat,  his hypothesis concerning the
  mind, iii.  28
Bildungstrieb, iv. 18
Bile, use of, i. 244
Bilious remittent fevers, Ii. 91. 93. 104
Bimariy kodek  (Pers.) iv. 79
Birds, singing,  vocal avenue, i. 294
      imitative, i. 295
Bismuth, oxyde of,  in indigestion, i.
  110
Black disease, i. 362
      leprosy,  ii. 570
      vomit, i. 266—ii. 102
      water, i  84
Bladder, prolapse of, iv. 102
         vermicules discharged from.
  iv. 309
         stone in, iv. 347
         inflammation of, ii. 269
Bladder-bougies,  i. 238
Bladdery fever, ii. 402—iv. 309
Blains,  iv. 406. 414
Blear-eye,  ii. 288
Blebs, water, iv. 407
Blenorrhcea, iv. 55
            simplex, iv. 56
            luodes, iv. ib.
            chronica, iv. 62
Blood, Ijow affected by inspiration,
  300
       modena hue of, how produced.
  i. 301
       scarlet hue, how produced, i
  ib.305
       intrinsic properties  of,  ii. 21
       moving powers of, ii. 11
       sulphur of, ii. 22
       iron of, ii. ib. 23
       colouring matter of, ii. 23
       red particles of, ii. 24
       transmits mental and corporeal
  taints to  subsequent generations, ii,
  26
       why supposed to be alive, ii,
  ib.
Bloody flux, ii. 300
Blow-fly, larves of, intestinal, i.  307
Blue-boy, ii. 602
Blushing, cause of, ii. S
Blush inflammatory, ii. 200
Boak (common leprosy,) iv. 388. 391.
  393
Boerhaave, his doctrine of fevers, ii. 30
Boil, ii. 192
Boletus laricis, iv. 361
Bombus, iii. 169 
472
GENERAL  INDEX.
 Bones,  contortion of the,  iv. 222
 Bonus Henricus, i. 257
 Borborygmus, i. 89
 Botium, iv. 209
 Botts intestinal, i. 203
 Bowels, inflammation of, ii. 256
 Brain-fever,  ii. 215. 219
 Brain, inflammation of, ii. 214
       nature  of,  ramifications  and
   substitutes, iii. 6
       of man compared with animals,
   iii. 10
       generally  admitted to be
   gland, iii. 21
 Bread-fruit tree, i. 3
 Bread-nut, i. ib.
 Breast-pang, suffocative,  i. 393
             acute, i. 394
             chronic, i.  400
 Breeze or gadfly larves,  i. 204
 Breslaw remittent fever, ii. 110
 Bright  spot leprous  of the Hebrews,
   what, iv. 388
 Broken-wind, i. 370
Bronchial polypus,  ii. 237
Bronchitis, ii. 233
Bronchocele,  iv.209
Bronchus, ii. 290
Brosimum alicastrum, i. 3
Brown, his doctrine of fevers, ii. 30
Brown-study,  iii. 108. 112
Bubo, ii.  188
Bubukle, ii. 197
Buccal  pouch in  monkeys and other
   animals, i. 4
 Bucnemia, ii. 316
          sparganosis, ii. 317
          tropica,  ii. 320
 Bulam fever,  ii. 99
       its relation  to the Antigua fe-
   ver and others, ii. 103
 Bulge-water tree, i. 211
 Burdock, ii. 590
 Bursa 3?abricii in birds, i. 5
C.
Cabbage-tree, i. 3. 211
Cachexies, ii. 450
Caddy-fly larves, intestinal,  i. 207
Cadmia of Gaubius, iii. 295
Cajeput-tree, i. 57
Calcareous earth, formed or secreted
  by all animals, i.  164
Calculus renal, iv. 340
         vesical, iv. 340. 347
         intestinal,  i.  188
         urinary, iv. 338
         its various kinds, iv. 339.348
Caligo, iii. 146
ICallus, iv. 445
 Calor mordicans in typhus, ii. 129
 Calvities, iv. 454
 Camphor,  its sedative power against
   the irritation of the bladder by can-
   tharides, iv. 307
 Cancer, ii. 533
         common, ii. 534
         whether contagious, ii. 536
         ascribed to vermicles, ii. 537
         in various parts, ii. 539
 Cannabis sativa, i. 256
 Capsicum,  in indigestion, i.  IIS
 Carbuncle,  ii. 193
            escar,  ii. 194
 Carbuncle berry, ii. ib.
 Carbuncied face, ii. 197
 Carcinus, ii. 5j3
          Vulgaris, ii.  534
 Cardamine pratensis, ii 245. 351
           the sisymbrium of Diosco-
   rides, iii  351
 Cardiogmus, ii 593
 Carditis, ii. 248
 Caries,  ii.  612
        of the spine, ii. 614
 Carminatives, i.  91
 Carnevaletto delle donne, of Baglivi.
  iii. 290
 Carpotica, iv. 109
 Caruncula, caruncle, iv. 443
 Cams,  iii 366
        Asphyxia,  iii. 367
        Ecstasis, iii. 382
        Catalepsia,  iii. 385
        Lethargus,  iii.  390
        Apoplexia, hi.  394
        Paralysis, iii. 414
 Caryophyllata, i. 237
 Casmunar,  in indigestion, i. 113
 Catacausis, ii. 576
            ebriosa, ii. 577
 Catalepsia,  catalepsy, iii. 385
 Catamenia,  origin and progress, iv. 32
 Cataphora,  iii. 591
 Cataract, iii. 148
 Catarracta,  iii. 148
            varieties, iii. 149
 Catarrh, ii. 299
 Catarrhus,  ii. ib.
           communis, ii. 291
           epidemicus,  ii. 293
           caninus, ii. 296
           vesicae, iv. 309
 Catechu, i. 238
 Catoche, what, iii. 388
 Catochus, what. iii. 384 388
         how connected  with  teta-
   nus, iii.  221
 C atoxic a,  iv. 238 
GENERAL INDEX.
473
 ttattu schiragaam. vermifuge, i. 219
  Cauma,  ii. X17
          its varieties, ii. 121
 Causus,  or burning remittent, ii. 108
 Cellular substance of organs, iv. 183
 Ckjtotica, iv. 29
  Cephahea, iii. 318
           gravans, iii. ib.
           intensa,  iii. 320
           Hemicrania, iii. 323
           pulsatilis, iii. 324
           nauseosa, iii. 325
 Cephalitis, ii. 214
           meningica, ii. 219
           profunda,  ii. 222
 Cerchnus, i.  317
 Cesarean operation in labour, iv. 156
 Cevadilla, i. 211
 Chaerophyllum sylvestre, i. 237
 Chalasis, ii. 526
 Chamomile, in indigestion, i. 115
 Chancres, ii. 549
 Charcoal powder, its use  in  indiges
   tion, i. 109
 Chenopodium anthelminticum, i. 215
               vulvaria, iii. 349
 Cherry-laurel, i. 256
 Chervil,  i. 237
 Chest,  dropsy of, iv. 271
 Chicken-pox,  ii. 400
 Child-bed fever, ii.  148
 Chilblain, ii. 210
 Chiggoe, Chiggre, iv. 437
 Chivalry, iii. 94
 Chlorine, iii 253
 Chlorosis,  iv.  74
          atonica, iv. 78
          entonica, iv. 76
 Chocolate, butter of,  i. 237. 353
 Choke-damp, iii. 368. 376
 Xoxui, i. 167
 Xoah, i. 167
 Cholera, i. 167
         biliosa,  i. 168
         flatulenta, i. 171
         spasmodica, i. 172
         epidemic, i. 171
 Cholelithus, i.'268
            quiescens, i. 270
            means, i. 271
 Chorea,  iii. 289
 Chronic rheumatism, ii. 332
 Chyle, its nature, i. 6
       how produced,  i. 150
 Cbylifaction, process of, i. 9
 Chyme, i. 102
 Chymifaction, process of, i. 6
 Cicuta virosa, i. 141
Cinchona, history of, ii. 8\
 Cinetica, iii.  202
  Vol. IV.—3 O
 Circumligatura,  ii. 189
 Clap, iv. 56
 CLASS I. Piioem i, 1
            Order i. i. 17
            Ohd. ii. i. 243
         H. Proem i. 291
            Ord  i. i. 309
            Obd. ii. i. 342
       III. Proem ii. 5
            Ori». i. ii. 27
                 ii. ii. 154
                iii. ii. 363
                iv. ii. 450 j
        IV. Proem iii. 5
            Ord. i. Hi  41
                 ii. iii. 133
                 iii. iii. 202
                 iv. iii. 307
         V. Proem iv. 5
            Ord. i. iv. 30
                 ii. iv. 74
                iii. iv. 109
       VI. Proem iv. 183
            Obd. i. iv. 199
                 ii. iv. 239
                iii. iv. 357
 Clavus,  iv. 445
 Climacteric disease, ii. 480
 Climacterics,  Greek what, ii. 480
 Cloaca in birds, i. 5
 Clonic Spasm, iii. 265
 Clonus, iii. 265
        pathology of, iii. 265
        Singultus, iii. 268
        Sternutatio,  iii. 270
        Palpitatio, iii. 272
        Nictitatio, iii. 281
        Subsultus, iii. 283
        Pandiculatio,  iii. 284
 Clutterbuck, his doctrine of fever, ii.
  30
 Cobalt in consumption, ii. 510
 Coffee, its use in asthma, i. 481
                 sick  head-ache, iii.
  330
 Colchicum autumnale, how far a spe-
  cific in gout, ii. 356
                           useful in
  dropsy, iv. 254
 Cold, general feeling of what, iii. 187
      in the head, ii. 224
 CtELIACA, i. 17
 Colic, i. 120
      ofPoitou, 127
 CoUca,  i. 120
        cibaria, i. 135
        constipata, i. 144
       constricta, i. 145
        flatulenta, i.  142
Collatitious organs of digestion, i, 5 
474                       GENERAL INDEX.
Colon, valve of, i. 4
Coltsfoot in scrofula,  ii. 532
Coma vigil, iii. 392
Comatose spasm, see Spasm.
Combustibility of the body, ii. 576
Concoction, ancient docU*ine of,  ii. 31
Concretion, intestinal, i. 185
Conessi bark, ii. 315
Congestion, marks of, in typhus, ii. 133
Constipation, i. 148
Consumption, ii 494
              varieties, ii. 495
              how  far  affected  by
  agues, ii. 525
Contagion, what, ii  43
           impure atmosphere neces
  sary to its spread,  ii. 51
           laws of, ii. 5-
           and miasm, identity of, ii.
  296
Contortion of the bones, iv. 222
Convulsio, convulsion, iii. 345
           varieties of, iii. 346
           puerperal, iv.  138
Copaiva, balsam of, i. 164. 237
Coprostasis, i. 147
            constipata, i.  148
            obstipata, i. 151
Corns, iv. 445
Cornea opake,  iii. i46
Corpora lutea,  what,  iv. 11
Corpulency, iv. ^00
Coryza, i. o09
        entonica,  i. 310
        atonica, i. 312
        how related to catarrh, ii. 290
Costiveness, i. 147
Couching the eye, iii. 151
Cough, i. 342
        of old age, i. 344
        hooping or convulsive, i. 354
Country-sickness,  iii. 86
Cowhage,  i. 214
Cow-pox, ii.  394
          its varieties, ii. 396
          whether produced by grease
  in the horse's heel, ii. 399
Crab-louse, iv. 456
Crack-brained wit, iv. 94.  96
Cramp, iii. 211
Crampus,  iii. ib.
Craziness, iii. 42
Credulity, iii. 124.128
Crepitus, i. 89
Cretinism, iv. 231
           its relation with rickets, iv
  223
Crimping of cod-fish, iii. 23
Crinones,  iv. 441
Crisis, febrile doctrine of,  ii. 54
Crisis, of Hippocrates,  ii. 55
       referred to the heavenly bo-
  dies, ii. 56
Cross-birth, iv. 146
Crotophium, iii. 260
Crotophus,  iii. ib.
Croton Tiglium as a hydragogue, iv.
  247
Croup, ii. 233
       acute, ii  ib.
       chronic, ii. 237
Crusta lactea, iv. 422
Cubebs, iv. 60
Cucumber-suppositories, i. 238
Cullen,'his doctrine of fever, ii. 3fe)
Cutaneous vermination, iv. 434
Cyania,  ii.  601
Cycas circinalis, i. 3
Cyrtosis, iv.  222
         Rhachia, iv.223
         Cretinismus, iv. 230
Cystic oxyde or calculus, of the blad-
  der, iv. 339
Cystitis, ii. 269
D.
Dal fil (Arab.), ii.  320.568
Dance of St. Vitus, or St. Guy, iii. 289
Dandelion, i 256
           iv. 305
Dandriff, iv. 385
Dans saleb  (Arab.) iv. 454
Dartus darsis,  iv. 409
Darwin,  E. his doctrine of fevers, ii.
  30
Day-mare,  i. 391
    sight,  iii.  137
Deaf-dumbness, i. 324
                 speech  maintained
  and how, i.  325
Decay of nature, ii. 480
Decline, ii. 487
Defluxion, ii. 290. 335
Delirium ferox,  ii. 219
         mite, ii. 219
Delivery premature, its advantages at
  times, iv. 158
         origin of the practice, iv. 159
Demulcents, their nature  and  how
  they act, i. 352
Dentition,  economy of,  i. 19
Dentrifices, i. 36
Depression in cataract, iii. 151
Derbyshire-neck, iv. 207. 209, 210
Despair, iii. 89
Despondency, iii. 89
Destitution of urine, iv.2
Devonshire colic, i. 127
Diabetes, iv. 311 
GENERAL INDEX.
475
Diabetes, aquosus, iv. 312
          insipidus, iv. 312.  355
          melitus,  iv. 511, 312
          different hypotheses  to ac-
  count for its symptoms, iv. 315
Diabetes, sugar secreted  by various
organs as well  in  a state of health   fever, ii. 301
Dumas, his hypothesis concerning the
  mind, in. 28
Dumbness, i. 318
           elingual, 319
Dysenteria, ii. 300
           how far  connected with
   as of sickness,  iv. 324
 Diarrhoea, i. 152
           fusa, i. 153
           biliosa, i. 154
           mucosa, i. 156
           chylosa, i. 157
           Lienteria,  i. 159
           serosa, i. 160
           tubularis, i. 162
           gypsata, i. 164
           urinary, iv. 311
 Diary fever, ii. 58
 Dictamnus albus,  i. 215
 Digitalis, how far useful in phthisis, ii.
   519
          in  dropsy, iv. 253  273
 Digestion, process of, i. 6
           hypothesis concerning, i. 8
 Digestive Function, i.  1
          Organs, i.  1
 Dinus,  iii. 330
 Diplopia, iii. 144
 Dipsacus, iv. 311
 Dipsosis,  i. 67
          avens, i. 69
          expers, i. 70
Dirt-eaters of West Indies, i. 82
 Distemper of dogs, ii. 295
Division of the  symphysis of the  ossa
  pubis in impracticable labour, iv. 153
Dizziness, iii. 330
Dodders,  iv  434
Dolichos pruriens, i. 214
Doronicum Pardalianches, i. 157
Dotage, iii. 130, 131
Dracunculus,  iv. 440
Drivelling, i. 57
Drop serene, iii. 154
Dropsy, iv. 238
        cellular, iv. 244
        of the head, iv. 260
              spine, iv. 269
              chest, iv. 271
              belly, iv. 277
              ovary, iv. 281
              fallopian tube, iv. 283
              womb, iv. 284
              scrotum, iv. 285
              head (acute)  ii. 215.
            or contagion,  ii. 302
            simplex, ii. 303
            pyrectica,  ii. 307
 Dysenteric fever, ii. 307
 Dysentery, ii. 300
 Dyspepsia, i. 100
            phthysis, i. 104
 Dysphagia, i. 58
            atonica, i. 62
            constricta,  i. 59
            globosa,  i.  63
            uvulosa, i. 64
            linguosa, i. 65
 Dysphagy, i. 58
 Dysphonia,  i. 326
            susurrans, i. 327
            puberum, i. 329
            immodulata, i. 331
Dysphoria, iii. 312
           simplex,  iii  313
           anxietas,  iii. 314
Dyspnoea, i. 362
          chronica, i. 364
          exacerbans, i. 368
Dys-spermia, iv. 91
             varieties,  iv. 92
Dtsthetica, ii. 450
  217
        urinal, iv. oil
Drowning, death from, iii. 371
Dry gangrene, ii. 610
 Ear-ache,  ii. 224
 Earthbone calculus of the bladder, iv,
   339
 Ecchymoma lymphatica, ii. 317
 Eccritica, iv. 199
 Eccyesis, iv. 168
         ovaria, iv. 170
         tubalis, iv. 173
         abdominalis, iv. 173
 Ecphlysis, iv. 406
          Pompholyx, iv. 407
          Herpes, iv. 408
          Rhypia, iv. 414
         Eczema, iv. 415
 Ecphronia,  iii  42
           Melancholia, "iii. 56
           Mania, iii. 64
 Ecphyma, iv 442
         Caruncula, iv. 443
         Verruca, iv. 444
         Clavus, iv. 445
         Callus, iy. 445
Ecpycsis, iy. 416 
476
GENERAL INDEX,
Ecpyesis, Impetigo, iv. 418
         Porrigo, iv. 420
         Ecthyma, iv. 428
         Scabies, iv. 429
Ecstasis, Ecstacy, iii. 382
Ecthyma, iv. 428
Ectropium, ii. 288
Eczema, iv. 415
Edematous inflammation, ii. 203
Effluvium, human, ii. 42. 51
           marsh, ii. 42
Elatio,  iii. 94
Elephantia,  ii. 567, 568
Elephantiasis, ii.  566—iv. 390. 396
              Arabica, ii. 570
              Italica, ii. 573
              Asturiensis,  ii. 575
 Elephant-leg, ii.  320
              how  differs  from  ele-
   phantiasis of the  Greeks, ii. 320
 Elephant-shin,  ii. 566
 Elephas, ii. 966. 568
 Elf-sidenne, i  388
 Ellis, his hypothesis of respiration, i
   381—ii. 12
 Emaciation, ii. 472
 Emansio mensium,  iv. 31
 Empassioned excitement,  iii. 79
             depression, iii. 85
 Empathema, iii.  77
             entonicum, iii. 79
             entonicum,  laetitiae,  phi
   lautiae, superbiae gloriae famis,  ira
   cundiac,  zelotypis, iii. 79
            atonicum, iii. 85
                      varieties, iii. ib.
            inane, iii. 92
  Emphlysis,  ii. 386
             Miliaria, ii. 386
            Aphtha, ii  390
            Vaccinia, ii. 394
             Varicella, ii  400
             Pemphigus, ii. 402
             Erysipelas, ii.  406
  Emphyma, iv. 205
             Sarcoma, iv. 206
             Encystis, iv. 212
             Exostosis, iv. 214
  Emphysema, iv. 288
              cellulare, iv. 290
              abdominis, iv. 292
              uteri, iv. 295
   Empresma, ii. 212
             Cephalitis, ii. 214
             Otitis,  ii. 224
             Parotitis, ii. 225
             Paristh mitis, ii. 227
             Laryngitis, ii. 231
             Bronchitis, ii. 233
             Pneumonitis,  ii* 237
Empresma, Pleuritis, ii. £'\£
           Carditis, ii. 248
           Peritonitis,  ii. 249
           Gastritis, ii. 252
           Enteritis, ii. 256
           Hepatitis, ii. 260
           Splenitis, ii. 267
           Nephritis, ii 286
           Cystitis, h  269
           Hysteritis,  ii. 270
           Orchitis, ii. 272
 Emprosthotonos, iii. 221
 Empyesis, ii. 411
           Variola, ii. 411
 Emrods, i. 233
 Enanthesis, ii. 366
           Rosalia, ii. 3661
           Rubeola, ii. 379
           Urticaria, ii. 384
 Encanthis, iv. 443
 Encystis, iv. 212
 Enecia, ii. 116
         Cauma, ii  117
         Typhus, ii. 123
         Synochus,  ii.  145
 English melancholy, iii. 102
         mercury, i. 237
 Entasia, ii. 207
          Priapismus, iii. 207
          Loxia, ii. 208
          articularis, iii. 210
          Systremma,  iii. 211
          Trismus,  iii. 213
          Tetanus, iii.  220
          Lyssa, iii. 228
          acrotismus, iii. 260
  Ehterica, i. 17
  Enteritis, ii. 256
           adhaesiva, ii. 256
           erythematica, ii. 259
  Enterolithus, i. 274
             Bezoardus, i. 276
             Calculus, i. 278
              Scybalum, i. 283
  Enuresis, iv. 333
  Epanetus, ii. 91
           mitis, ii.ib.
           malignus, ii. 93
           Hectica, ii. 112
            Causus, ii. 108
            asthemcus, ii. 110
            flavus, ii. 98
  Ephelis, iv. 461
  Ephemera,  ii. 58
             mitis, ii. 59
             acuta,  ii.  61
             sudatoria, ii. 62
  Ephialtes, i. 388
            vigdantium, i. 391
            nocturnus* i.392 
GENERAL  INDEX.
477
 »>hidrosis, iv. 359
             profusa, iv. 360
             cruenta, iv. 361
             partialis, iv. 362
             discolor, iv. 363
             olens,  iv 363
             arenosa, iv. 365
 Epian, ii. 446
 Epichrosis, iv. 458
           Leucasmus, iv. 458
           Spilus,  iv. 459
           Lenticula, iv. 460
           Ephelis, iv. 461
           Aurigo, iv.  463
           Poecilia, iv. 464
           Alphosis, iv. 466
 Epigenesis, theory of,  iv.  13
 Epilepsia,  Epilepsy, iii. 356
           varieties of, iii. 357
 Epinyctis, iv. 408
 Epistaxis (nasal haemorrhage,) ii. 460.
  468
 Ergot, iv.  40
 Erosion of the skin, ii.  211
 Eructatio,  Eructation, i. 89
 Eruptive fevers, ii. 363
 Erysipelas,  ii. 406
            cedematosum, ii. 409
            gangraenosum,  ii.  409
            pestilens, ii. 428
Erysipelatous inflammation, ii. 204
 Erythema, ii. 200
          cedematosum, ii. 203
          erysipelatosum, ii. 204
           gangraenosum, ii. 206
           vesiculate, ii. 207
          Pernio,  ii. 210
          Intertrigo, ii. 211
           why ulcerative  rather than
  phlegmonous, ii. 202
          mercuriale,  ii. 210
           volaticum, iv. 370
Essera, or Eshera,  iv. 375
Esophagus,  i. 4
Esthiomenos, iv. 410
Everted eye-lid, ii. 289
Evolution spontaneous  in labour, iv.
  150
 Exangia, ii. 592
         Aneurisma, ii. 592
         Varix,  ii. 598
         Cyania, ii. 601
 BXANTHEMATICA, ii. 363
 Exanthem,  ii. 363
            rash, ii. 366
            ichorous, ii. 386
            pustulous, ii. 411
            carbuncular, ii. 424
 Exahthisi*, iv. 366
             Roseola, iy, 366
Excernent system, physiology of, iv.
  183
Excitability of Brown, what, ii. 39
Excoecaria Agallochum, i. 113
Excrescence,  cutaneous, iv. 442
Excrescence  genital,  iv. 102
Exfeiation, iv. 168
           ovarian, iv. 170
           tubal, iv. 173
           abdominal, iv. 173
Exormia, iv.  367
          Strophulus, iv. 369
          Lichen,  iv.  371
          Prurigo, iv. 379
          Milium,  iv.  383
          how distinguished from Eer
  thyma,  iv. 367
Exostosis,  iv. 214
Expectorants, i. 346
              in what way they act,
  i. 346                   J   '
Extra-uterine Fetation, iv.  168.  See
  Exfetation
Eye-lids, twinkling of the, iii. 281
F.
 Fainting, iii. 339
          from various odours, iii. 339
 Fainting-fit, iii. 341
 Falling-sickness, iii. 356
 Falling down of the womb, iv. 102
 False inspiration,  iii. 94. 96
 False conception,  iv. 178
 Fanaticism, iii. 94. 98'
 Fasciola,  i. 202. 210—iv. 6
 Fasting long, or chronic, i. 77
        woman of Tetbury, i. 79
 Fat, formed from bile,  i. 13—iv. 201
 Fatuity,  iii. 123
         imbecility, iii. 124
         irrationality, iii. 130
 Febrifuges possess some property not
   yet ascertained, ii. 89
 Febris lenta nervosa, ii. 127
       dysenterica, or nova, of Sydens
   ham, ii. 302
        rubra of Heberden, ii. 367
 Felon, ii. 199
 Fern, male, i. 217
 Fetation extra-uterine,  iv. 168.    See
   Exfetation
 Fetus  has been  born alive at four
   months, iv. 122
       may live at seven, iv.  122
 Feu volage, iv. 370
 Fevers, ii. 27
        difficulty  of defining, ii. 27
        genera in the  present work
I ii.28 
478
GENERAL INDEX.
Fevers,  proeguminal  cause, what, ii.lFlux, bloody, ii. 300
  29
        procatarctic, ii. 29
        exciting cause,  ii. 29
        proximate, ii. 29
        remote,  ii. 42
        chief hypothesis of, ii. 30
        by what agents  excited or in-
  fluenced, ii. 46
         diary,  ii. 58
         sweating, ii.  62
         intermittent, ii. 65
         remittent, ii. 91
         yellow, ii.  98
         Bulam, ii. 99
         paludal, ii. 99
         seasoning,  ii. 99
         jungle, ii.  99
         ardent, ii.  108
         continued, ii. 116
         inflammatory,  ii 117
         imputrid continent, ii. 117
                  continued, ii. 117
         sanguineous continued, ii. 117
         hysterical,  ii. 127
         nervous, ii. 127
         putrid, malignant, jail, camp,
  hospital, ii. 129
         synochal, ii. 145
         puerperal, or child-bed, ii. 148
         peritoneal, ii 148
         eruptive, ii. 365
         miliary, ii. 386
         bladdery,  ii. 402
Fibrinous calculus of the bladder, iv
  340
Fibre,  nervous, iii. 8. 21
       irritable, iii. 20
Fibrous substance of organs, iv. 183
Ficus,  iv. 443
Fidgets, iii. 313
Fievre matellotte, ii. 99
Filaria, iv. 439
Filix mas, i. 217
Fish-skin, iv. 402
Flavours, how influenced at different
  times, and  under different circum
  stances, iii. 180
Flatulency, i. 89
Flatus,  i. ib.
Flea-bite, iv. 437
Flesh-fly, larves of, intestinal, i. 207
Flexibility of the bones,  iv. 219
Flooding, iv. 128. 164
Fluids,  sexual diseases affecting the,
  iv. 29
Fluke-worm, i. 202—iv. 6
             found in the liver, i. 275
Fluttering of the heart, iii. 272
Flux, i.  152
       of aqutous urine, iv. 333
 Food, small quantity often demanded.,
   i. 78
       water sufficient  food for some
   animals, i. 78
       air sufficient, i. 71
 Fool's parsley, i 141
 Folly, ni. 130
 Forgetfulness, iii. 124, 125
               singular examples  of,
   iii. 127
 Fragile vitreum,'iv. 217
 Fragilitasossium, iv.2l7
 Fragility of the bones, iv. 217
 Frambcesia, ii. 445
 Fraxinella,  i. 21.5
 Freckles, iv. 460
 Fret, ii  211
 Frogs, singular procreation of,  iv. 9
 Frost-bite, ii. 210. 607
 Fundament, tailing down  of, ~) .  „.«
            prolapse of,     5 "'
 Fungi, a common  cause of surfeit,  i.
   141
       springing up  nightly in  ga.n-
  grenous limbs, i. 199
 Fungus haematodes,  ii. 618
 Furunculus, ii. 192
Fusible calculus of the bladder,  iv. 339
Gadfly larves, i. 204—iv. 440
Galactia, iv. 66
          praematura,  iv. 67
          defectiva, iv.  69
          depravata,  iv. 71
          erratica,  iv.72
        .  virorum, iv. 73
Gallantry romantic, iii. 94
Gall-bladder,  wanting  in  many ani-
  mals, i. 245
Le  Gallois,  his experiments, iii. 24
Gall-stone, i. 268
           passing of, i. 271
Ganglion, iv. 212
Ganglions of the brain, what, iii. 12
Gangr&na, ii 603
           sphacelus, ii. 604
           ustilaginea, ii. 608
           necrosis, ii. 610
           caries, ii. 612
Gangrenous inflammation, ii. 206
Garden-lettuce,  ii. 242
Gasses,  inhalation of, i  385
Gastric juice, discovery of, i.  9
             quantity of, i. 9
             quality of,  i. 9
             other powers, i. 9,10 
GENERAL  INDEX.
■479
Gastritis, ii. 252
         adhaesiva, ii. 256
         erythematica, ii. 259
Generative fnnction, iv. 5
                    machinery of the,
  iv. 6
theses of, iv. 15
Gums, scurvy of, i. 47
Gutta seu Junctarum dolor, ii. 335
      obscura,  iii. 149
      serena, iii.  149
Gymnastic medicine, ii. 520—iii. 297

                 H.
                  process of, iv. 6
                  different   hypo-
                                  i'Hjematica,  ii. 27
                  difficulties    ac-i Haemoptysis, ii. 462. 468
companying the  subject of genera- Haematemesis, ii. 464. 468
the
    tion, iv. 18. 20
  Genetica, iv. 29
  Geoffroya,  i  211
  Geum urbanum, i. 160
  Ginseng, whether an aphrodisiac, iv
    90
  Glanders in horses,  ii. 297—iv. 58
  Glaucedo, iii. 147
  Glaucosis, iii. 147
  Gleet,  iv. 62
  Glottis,  i. 291
          air how rendered sonorous in,
    i. 292
          capable  of  supplying
    tongue's place, i. 296
  Gluttony, i. 72
  Goggle-eye,  iii. 160
  Goggles, iii  160
  Goitre,  iv. 209
  Gonorrhoea, iv.  55
  Gordius, intestinal, L 205
          cuticular, iv. 441
 Gout, ii. 335
       origin of term, ii. 335
       its varieties, 337
       how far refrigerants may be em
   ployed, ii 344, -45 347
       reputed specifics, 352
       compression and percussion, ii
   357
 Granulation, ii. 169
 Grasshopper, wart-eating, iv. 444
 Gratiola officinalis, iv.255
 Gravedo of Celsus, ii. 291
 Gray hair, iv. 448. 453
 Great pox, h.  549
 Green-sickness,  iv. 74
 Grief, ungovernable, iii. 89
 Grocer's Itch,  iv. 419
 Grog-blossoms, ii. 198
 Groundsel, its  use in sickness of the
  stomach, i. 99. 280
Gryllus verrucivorus, its power  in de-
  stroying warts, iv. 444
Guinea-worm,  iv. 439
Gum, yellow, of New Holland, i. 113
              of infants, i. 261
Gum-boil, ii. 184
Gums, excrescent, i. 47
  Haenruturia, ii. 464. 468
  H<emorrhagia, ii. 456
               entonica, ii. 457
               atonica,  467
  Hair-worm, intestinal,  i. 205
             cutaneous, iv. 441
  Hair, morbid, iv. 446
       matted or plaited, iv. 449
       gray, iv. 453
       bristly, iv 448
  Hallucination, iii 93
  Hanging, death from, iii 371
  Hardness of hearing, iii. 165
  Hare-brained passion, iii. 92
  Harmattan, ii. 45
  Harvest-bug, iv. 438
  Head, dropsy of, iv. 260
 Head-ache, iii. 318
            stupid, iii. ib.
            chronic, iii  320
            sick, iii. 325
            throbbing, iii. 324
            spasmodic,  iii. 325
 Hearing, how far it exists in  different
   animals,  iii. 15
 Hearing, morbid, iii. 162
         acute, iii. 164
         hardness of, iii. 165
         perverse, iii 166
         double, iii. 168
         illusory, iii. 163
         varieties of, iii. 169
 Heart, organization of, ii. 6
       how far it may leap for joy, ii. 7
       fluttering of,  iii. z72
       throbbing  of,  iii.  272
       burn, i.  83
      ache ungovernable, ii. 98
Heat, general feeling of, how produc*
  ed, iii. 187
Heat-eruption, iv. 415, 416
Hectic fever, ii. 112
Hectica,  ii.  112
Hedge-hyssop, iv. 255
Helix hortensis, iv. 6
Hellebore, how far a specific in gout,
  ii. 356
           black, as a hydragogue, iv. 
480
GENERAL  INDEX.
Hemeralopia, iii. 135
Hermicrania,  iii. 323
Helminthia, i.  195
           alyi, i. 200
           erratica, i. 205
           podicis,  i. 203
Hemiplegia, iii. 418
Hemorrhage, ii. 456
            entonic or active, ii. 457
            varieties  of entonic, ii.
  457
            atonic,  ii. 467
            varieties,  ii. 468
Hemorrhoides, i. 233
Hemp seeds,  in jaundice, i. 256
Hen-blindness, iii. 139
Hepatitis, ii. 260
          acuta, ii 260
          chronica, ii. 265
Herb bennet,  i. 160
Hermaphrodites, iv. 6
Hernia humoralis, ii. 272
       carnosa,  iv. 208
Herpes, iv. 408
Hesitation in speech, i. 332
Hiccough, iii. 268
Hirsuties, iv. 451
Hirudo viridis, iv. 6
Hirudo sanguisuga, intestinal, i, 208
Hives, ii. 400
Hoffmann, his doctrine of fevers, ii. 30
Holy fire, ii. 209
Home-sickness,  iii. 86
Honey-dew, what, i. 197
Hooping-cough, i. 354
Hordeolum, ii. 191
Horns,  never grow after  castration,
  iv. 13
Horse hair-worm, intestinal, i. 205
Horse-leech,  intestinal, i. 208
Hour-glass contraction of the womb,
  iv. 165
Human Understanding, Locke's Essay
  on, examined and eulogized, iii. 33
                    analysis of, iii. 34
Humoral opacity of the eye, iii. 147
Hunger, sensation  of, how accounted
  for, i. 67
Hydarthrus,  ii. 358
Hyderus (diabetes), iv. 311. 335
Hydra, iv. 6
Hydrargyria, i. 51—ii.  210
Hydrocele, iv. 285
Hydrometra, iv. 284
 Hydrophobia, iii. 228
               without rabies, iii. 229
 Hydrops, iv. 239
         cellularis, iv. 244
         capitis, iv.260
         spinae, iv. 269
Hydrops, thoracis,  iv. 271
         abdominis, iv. 276
         ovarii, iv. 281
         tubalis, iv. 283
         uteri, iv.  284
         scroti, iv. 285
         matellae, iv. 335
Hyoid bone, i. 291
Hypochondrias, iii. 99
               its varieties, iii. 106
Hypochondriasm,  iii. 99
                  its varieties, iii. 101
Hypochyma, iii. 149
Hypochysis, iii.  149
Hysteria, iii. 352
         foeminia, iii. 352
         masculina,  iii. 35 3
Hysterics, iii. 352
Hysteritis,  ii. 270
           simplex, ii. 270
           puerperarum, ii. 271

               I& J.

Jaundice, yellow,  i. 244
         biliary, i. 247
         gall-stone, i. 251
         spasmodic,  i. 251
         of infants, i. 261
         black, i. 262, 263
         green, i. 262, 263
Iceland  liver-wort, ii. 517
Icterus,  i. 244
        choloeus, i. 247
        cholohthicus, i. 251
        spasmodicus,  i. 251
        hepaticus, i. 259
        infantum,  i. 261
Icthyiasis, Icthyosis,  iv. 402
Ideas, what, iii. 34
      of sensation, iii. 34
         reflection, iii. 35
      objective and subjective, iii. 35
      complex, iii. 35
      association of,  iii. 37
Idiotism, iii. 130, 131
Ignis sacer of Celsus, ii. 208
Jealousy, ungovernable, iii. 84
Jimmerat (Arab.)  ii. 436
Ileac passion, i. 121
Ileus, i  121
Illusion, iii. 93
Imbecility, m ental, iii. 124
Impetigo, iv. 418
Impostume in the  head,  ii. 184
Impotency, male,  iv. 89
           barrenness of, iv. 97
Impregnation,  Diseases   affecting
   the,  iy, 109
                physiology of, iv. 109 
GENERAL  INDEX.
481
   Inability to beget offspring, iv. 88
           to conceive offspring, iv. 97
           species of, iv. 88
   Incarnation,  ii. 169
   Incongruity, copulative, iv. 94
   Inconstancy, iii. 129
   Incontinence of urine, iv. 333
  Incubus, i. 388
  Indian-pink, i.  219
  Indigestion,  i. 100
  Inflammation, general, of Fordyce, ii.

               edematous, ii. 203
               erysipelatous, ii. 204
               gangrenous, ii. 206
               vesicular,  ii. 207
               of the brain, ii. 214
                      throat, ii  227
                      kidneys, ii. 268
                      larynx, ii. 231
                      lungs, ii. 239
                      pleura, ii. 245
                     heart, ii.  248
                     stomach, ii. 252
                     bowels, ii. 256
                     Kver, ii. 260
                     spleen, ii.  267
                     bladder, ii. 269
                     womb, ii. 270
                     testicles, ii. 272
                     eyes, ii. 273
                     iris, ii. 278
               articular, ii. 324
 Inflammations, iii. 153
               pathology of, ii 154
               proximate cause of, ii,
   154
               remote causes of, ii. 158
               healthy, ii. 158
               unhealthy, ii. 158
               adhesive, ii. 159
               ulcerative, ii. 159
               always tend to the sur
   face, ii. 161
               resolution of, what, ii
   162
               suppurative, ii. 159.165
                           process of,
   ii. 166
Inflammatory fever,  ii.  \\7
                    its varieties, ii. 121
             blush, ii. 200
Inflation,  iv.288
          cellular, iv. 290
          tympanic, iv. 292
          of the *omb, iv. 295
Influenza,  ii.  293
           its order of recurrence, ii
   299
Insanity, iii. 42
   Vol.  IV.—3  P
  Insanity, pathology of,  iii. 44
           proximate cause, iii. 52
           whether more  common  to
    England than  other countries, iii.
    54
           whether an increasing mala-
    dy, iii. 55
  Inoculation for cow-pox, ii. 396
                small-pox,  ii. 421
                for plague, ii. 432
  Insensibility of touch,  iii. 189
     .    .                  complicated
    with insensibility of  other  senses.
    iii. 189
  Inspiration, false, iii. 94
  Instinct, what, ii. 26
  Intellect,  diseases  affectins  the,
    iii. 41
  Intellectual principle,  iii. 25
  Intermarriages  between  near  rela-
    tions,  wisdom  of restraints divine
    and human upon, iv. 26
  Intermittent Fever, ii. 65
                   quotidian, ii. 68
                   tertian, ii. 70
                   irregular, ii. 72
                   complicated, ii. 73
                   treatment of, ii. 77
 Intestines,  organs of, i. 4
 Introsusception, i. 123
 Invermination,  i. 195
 Ionthus, ii. 195
         Varus, ii. 196
         corymbifer, ii. 197
 Joy, ungovernable, iii. 80
 Iris, inflammation of, ii. 278
     (herpes,) iv 412
 Irk Medini (Guinea worm,) iv. 439
 Irrationality, iii. 130
 Ischuria, iv. 301
 Itch, iv. 429
      baker's, iv 401
      complicated,  iv. 430
      grocer's, iv.  419
      pocky, iv. 4S0
      rank,  iv. ib.
     watery,  iv. ib.
     mangy, iv. ib.
 Itch-tick, iv.438
 Judam (Arab.),  ii. 568
 Juzam (Arab.), ii. ib.

                 K.

Kibe, ii. 210
Kidneys, inflammation of, ii. 268
Kin-cough, or kind-cough, i. 354
King's evil, ii. 527
Knife-eaters, i. 82
KOIAIA, i. 17 
482
GENERAL INDEX.
Kouba or kuba (Arab ), iv. 389
Krummholzohl, vermifuge, i. 213
Labour,  morbid, iv. 130
         atonic, iv. 132
         unpliant, iv. 134
                  varieties of,  iv. 135
         complicated, iv. 139
         perverse, iv 146
                  varieties of, iy. 147
         impracticable,  iv. 151
         multiplicate, iv. 160
         sequential,  iv. 163
         premature, iv. 122
         show, iv 53
Lacerta aquatica, intestinal, i  208
Lachrymose ophthalmy,  ii. 275
Lacteals, organ of, i. 6
Lagnesis, iv  82
         Salactitas, iv. 83
         Furor, iv. 86
Lallatio, i. 338
Lambdacismus,  i. ib.
Land-scurvy, ii. 581
Lappa,  ii. 590
Laryngic suffocation, i. 360
Laryngitis, ii. 231
Laryngysmus, i. 360
              stridulus,  i. 360
Larynx, i. 291
         of birds, i.  293
         stridulous constriction of,  i
  360
Lascivious madness,  iv. 86
Laughing, how produced,  . 300
Lauro-cerasus,  see Prunus
Lawrence,  his hypothesis  concerning
  life and a living principle,  iii. 30
Lax, i.  152
Lead, subacetate of in hemorrhages,
  ii. 470
Leech,  intestinal, i. 205
Leg,  tumid puerperal, ii. 317
            of West Indies, ii.  320
Leipopsychia, iii. 337
Lenticula, iv. 460
Lentor  of the blood, what, ii. 32
Leodonton Taraxacum,  i. 256
                       iv. 305
Leontiasis, ii. 569
Lepidosis, iv o83
          Pityriasis, iv. 385
         Lepriasis, iv  387
          Psoriasis,  iv. 399
         Icthyiasis, iv. 402
Lepriasis, iv. 387
Leprosy, iv. ib.
Leprosy, Asturian, ii. ST1
         black, ii. 570
         dull-white, iv. 341
         dusky, iv. 391
         nigrescent,  iv. 391. 393
         bright-white,  iv. 391.  394
Lethargus.Jij. S90
Lethargy, >
          varieties of, iii. 391
Leucasmus,  iv. 458
Leuce, iv. 391
Leucorrhcea, iv. 48
           communis,  iv. 49
           Nabothi,  iv. 53
           senescentium, iv. 54
Libellula or dragon-fly, singular posi-
  tion of sexual organs, iv. 10
Lichen (in botany) caninus, iii.  248
       terrestris cinereus, iii. 248
       in pathology, iv. 371
Lientery, i.  159
Life, various  hypotheses concerning,
  iii. 27
     weariness of, iii. 103
Lign-aloes in indigestion,  i. 113
Limosis, i. 71
        arens,  i. 72
        Cardialgia, i. 83
        Dyspepsia, i. 100
         Emesis, i. 94
        expers, i. 76
        Flatus, i. 89
        Pica, i. 80
Lippitude, ii. 288
Lippitudo, ii. 288
Lisping,  i. 340
Lithia, iv. 388
       renalis, iv. 340
       vesicalis, iv. 347
Lithiasis, iv. 338
Lithic calculus,  iv. 339
Lithontriptics, iv. 354
               Stephens's, iv. 355
Lithopoedion, iv. 175
Lithotomy, iv. 356
Lithus,  iv. 338
Liver,  organ of, i. 5
       how  affected by summer heat,
  i. 155
       use of, i. 244
       found in most animals of every
  rank, i. 244
       inflammation of,  ii. 260
Living principle,  various hypotheses
  concerning, iii. 28
Loathing, i. 96
Lobelia syphilitica, ii. 557
Lochial discharge profuse, iv. 164. 167
Locked jaw, iii. 213
             varieties, iii. 215 
GENERAL  INDEX.
483
 Locke, tribute to his Essay on Human
   Understanding, iii. 33
 Lodgement of matter in the chest, ii.
   178
 Long-sight, iii. 140
 Looseness, i. 152
 Lopezia  Mexicana,  or  lopez-root.
   160
 Love, ungovernable, iii. 86
 Love-sickness, iii. ib.
 Lousiness, iv. 485
 Loxia, iii. 208
 Lowness of spirits, iii. 99
                   its varieties, iii. 101
 Ludibria fauni, i. 392
 Lues, ii. 547
      Syphilis,  ii. 549
      syphilodes, ii. 563
      history of, ii. 549
      Ostiacks  said to be insusceptive
   of, i. 556
 Lullaby-speech,  i. 338
Lumbago, ii. 326. 331
Lumbricus cucurbitinus, i. 209
Luna fixata,  iii. 295
Lungs, structure of,  i. 297
Lupus, ii. 620
Lust, iv. 82
Lyssa, iii.  228
       canina,  iii. 235. 238
       felina, iii. 235, 236
M.
Macular-skin, iv. 458
Madness, iii 64
          varieties, iii. 64
          lascivious, iv. 86
Madwort, iii. 252
Magendie, his  hypothesis concerning
  the living principle, iii 28
                      of the  absorb
  ent system,  iv. 191
           his  azotic  regimen of,  in
  calculus, iv. 353
Maggots, intestinal,  i. 207
Magnesia,
          its use in indigestion, i. 108
Malabar nut, i. 106
Malaria of the Campagna, ii. 90
Mai de la Rosa, ii. 367. 576
Mai de  Siam, ii. 99
    del Sole, ii. 574
Maliasmus, iv. 434
Malis, iv. ib.
      pediculi, iv. 435
      pulicis, iv. 487;
      acari, iv. 438
      filiaris, iv. 439
 Malis, gordii, iv. 441
        oestri, iv. 440
 Malleatio, iii. 292
 Malum pilare, iv. 446
 Mama-pian, ii. 448
 Manducation, i. 5
 Mange, iv.
 Mania, iii.  64
        varieties, iii. 64
        the illusion often unconnected
   with the cause of the disease, iii. 69
 Mania,  most easily  cured  when pro-
   duced by  accidental causes, iii. 70
        heat and cold in the cure ap-
   plied at the same time, iii 74
        attendance  on  religious ser-
   vices, how far advisable, ni. 74
        moral treatment of, iii. 74
 Manie sans delire, iii. 92
 Marasmus, ii.  472
           Atrophia, ii. 475
           climactericus, ii. 480
           Tabes, ii. 487
           Phthisis,  ii. 494
 Marcus, his  doctrines of  fever,  ii. 30
 Mare's milk  as a vermifuge, i. 219
 Marsh effluvium, ii. 42
                 principles, ii.  46
                 laws of, ii. 52
 Masques a louchette, iii.  160
 Materialism,  hypotheses in support of,
   iii. £8
 Matter, lodgement of in the chest, ii.
   178
        of the world, its essence not
   known, iii. 26
        whether extension  be  a dis-
   tinct  property, iii.  26
        whether solidity, iii. ib.
 Maw-worm, i. 203
 Meal-bark, i. 3
 Measles, ii. 379
         black, ii. 379
 Medicine gymnastic, ii. 520
         pneumatic,  ii. 521
Megrim, iii. 323
Melxna, i. 262
        cholcea, i. 263
        cruenta, i. 266
Melaleuca Leucodendron, i. 57
Melampodium, iv. 249
Melanaema, iii. 567
Melancholia,  iii 56
             its varieties,  iii. 56
Melancholy, iii. ib.
            how distinguished path*
  gnomically from mania, iii. 58
            why mistaken at times fat
  hypochondrism,  iii, 58 
484
GENERAL  INDEX.
Melancholy, exciting causes, iii. 59
            tendency to violence and
  abusive language accounted for, iii.
  62
Melas, iv. 391
Melasma, iv. 429
Melliceris, iv. 212
Memory, retention of,  how  differs
  from quickness, iii. 126
          failure of, iii. 126
Menorrhagia,  iv. 43
Menstruation obstructed, iv.  31
                        by retention,
  iv. 31
                        by  suppres-
  sion, iv. 35
             laborious, iv. 36
             superfluous, iv. 43
             vicarious, iv. 45
             irregular  cessation  of,
  iv, 46
Mental extravagance, iii. 94
Mephytic suffocation, iii. 376
Merganser,  i. 294
Mergus,  i. ib.
Mesotica, iv. 199
Metamorphosia, iii. 144
Miasm, febrile, what,  ii. 43
       laws of, ii. 52
       powers of in typhus, ii. 124
       identity with contagion, ii. 296
Mildew mortification, ii. 608
Miliary fever, ii. 386
Milium,  iv.  383
Milk, artificial, ii. 516
Milks, analysis of in difi'erent animals,
  ii. 516
Milk-teeth,  i. 21
Milk-flow, premature, iv. 67
          deficient, iv 69
          depraved, iv. 71
           erratic, iv. 72
          in males, iv. 73
Millepes, i. 255
Millet-rash,  iv. 383
Mind, its nature but little known, iii. 25
      whether in its essence material
  or immaterial, iii. 25
      real character  deducible from
  natural and revealed evidence, but
  its essence not known, iii. 27
      by what means  it  maintains an
  intercourse  with  the  surrounding
  world, iii. 31
      various  hvpotheses  examined,
  iii. 32
      the difficulty felt by Locke,  iii.
  33
      its faculties  to  itself  what or-
  gans are to the body, iii. 37
Mind, feelings of, iii. 38
      subject to diseases  as  well as
  the body, iii. 38
Misanthropy, iii.  103
Miscarriage, iv. 122
Misemiss on, seminal, iv. 91
Misenunciation, i. 334
Mislactation, iv.  66
Mismenstruation,  iv. 29
                 barrenness of, iv. 99
Mismicturition, iv. 297
               See Paruria
Misossification, iv. 216
               fragile, iv. 217
               flexile,  iv. 219
Mole uterine, iv. 176
     cutaneous,  iv. 459
Mollities ossium,  iv. 219
Monorrchids,  whether natural, iv. 10
Morbus niger, i.  262
        comi'.ialis, iii. 356
        pilaris, iv. 441
        puerorum, iv  79
Moria,  iii. 123
        imbecilis, iii. 124
        demens,  iii.  130
Mordekie, Mordechie (Arab.), i. 174
Morpio, iv.
Mort de chien (cholera,) i. 174
Mortification,  ii. 604
Moss, Iceland, i. 353
Mountain-parsley as  a diuretic, iv. 305
Mouthwatering,  i. 51
Mulberry  calculus of the  bladder, iv.
  359
Mumps, ii. 225
Mungo  radix, iii. 246
Musca,  larves of, intestinal,  i. 207
        carnaria,  i. 207
        vomitoria, i. 207
Muscles,  diseases affecting the, iii.
  202
          fibres of, iii. 7
          in mass, iii. 202
          voluntary  and  involuntary,
  iii. 204
          See muscular fibres
Muscular  fibres,  what and  how pro-
  duced,  iii. 7
          contraction, laws of, iii. 203
          See Muscles
Musk in rabies, iii. 249
      artificial, how  prepared, i. 357
Myrrh in hectic fever, ii.  116

                 N.

Nausea, i. 96
Necrosis,  ii. 610
Necrosis ustilaginea, ii. 608 
GENERAL  INDEX.
485
 Negroes,  pye-balled  or  spotted, iv
   464,465
 Nephritis, ii. 269
 Nerium antidysentericum, ii. 315
 Nerve-ache,  iii. 192
             of the face, iii. 193
                   foot, iii. 192. 198
                   breast, iii. 192 200
 Nerves, number and general charac-
   ter, iii. 8
 Nerves, whether solid chords or hoi
   low cylinders, iii. 18
 Nervous function,  its extent and im-
   portance,  iii. 5
         fluid, hi  21
               both  sensific  and mo
   tory,  iii. 22
 Netek (Hebrew) Scall, iv. 395
 Nettle-lichen, iv. 372. 377
      rash,  ii. 384
 JYeuralgia, iii. 192
           faciei, iii. 193
                  mistaken for tooth
   ache, i. 38
           pedis, iii. 192. 198
           mammae,  iii. 192.  200
 Neurotica,  iii.  41
 Nictitatio, iii. 281
 Night-mare,  i. 392
 Night pollution, iii. 114
Night-sight,  iii. 135
Nirles,  iv.
Nisus formativus, what, iv. 18
Noli me tangere, ii. 619
Numbness, iii. 189
Nutmeg, hypnotic quality of,  i. 92
                             iii. 311
 Nux vomica, i. 88.  114
             in  intermittents, ii. 87
                dysentery, ii. 313
                palsy, iii. 432
Nictalopia, iii. 135. 137
Nymphaea Nelumbo, ii. 559
Nymphomania furibunda, iv. 86. 88

                 O.

 Obesity, iv.  200
         general, iv. ib.
         splanchnic,  iv. 203
 Oblivion, iii. 125
 Obstipation,  i. 151
 Ocular spectres, iii. 144
 Odontia, i. 17
         dentitionis, i.  18
         dolorosa,  i.  27
         stuporis, i. 39
         deformis,  i.  41
         edsatubj  u 43
 Odontio, incrustans, i. 45
         excrescens, i.'47
Oestrus, (larves of, or) bots, intestinal,
  i. 203
        cuticular, iv. 440
Oil,  train,  in chronic  rheumatism, ii,
'  334
Oleum templinum,  i. 213
       jecoris aselli, ii.  334
Olives, singular mode  of rearing, i. 7
Omentum,  organ of, i. 13
Oneirodynia, Iii. 114
Ononis spicata, as a diuretic, iv. 304
Opacity, humoral,  iii.  147
Ophiasis, iv  456
Ophiorrhiza Mungos, hi. 246
Ophthalmia, ii. 273
            Taraxis,  ii.  275
            iridis,  ii. 278
            purulenta, ii. 280
            glutinosa, ii. 287
            chronica,  ii. 429
            metastatica,  ii. 283
            epidemica, ii,  280
            gonorrhoea, ii. 284
            catarrhalis,  ii. ib.
            intermittens, ii. 284
            Lippitudo, ii. 288
Ophthalmy, ii. 273
            lachrymose,  ii. 275
            purulent,  ii. 280
            of infants, ii. 284
            Egyptian, ii. 280
            epidemic, ii. 280
            glutinous, ii. 287
Opisthonia, iii 211
Opisthotonos, iii. 211. 221
Orange-skin, iv. 463
Orban, his practice of using acids in
  consumption,  ii. 513
Orchitis, ii.
Organic molecules,  what, iv. 16
Orgasm, diseases affecting the, iv. 74'
Orgastic A, iv. ib.
Ormskirk medicine, iii. 251
Ornithorhynchus paradoxus, or platy-
  pus, i. 5
Orthopnoea, i. 363
Osmundia regalis, i. 217
Osteopocdion, iv. 175
Osthexia, Osthexy,  iv. 233
         infarciens, iv. 234
         implexa,  iv.  235
         varieties,  iv. 236
Otaheite, vowel-softness  of many pas-
  sages  in  this and  other savage
  tongues,  i. 339
Ova, human, iv. 14
Oyaria, human, iy,  ib. 
486
GENERAL INDEX.
Painter's cholic, i. 127
Palpitatio, iii. 272
           cordis, iii. ib.
           arteriosa, iii. 275
           complicata, iii. 278
Palpitation, iii. 272
            in  the epigastric region,
  ui.277
Palsy, iii. 414
       varieties, iii. 417
       shaking,  iii. 297
Pandiculatio, Pandiculation, iii. 284
Papula, iv. 367
Papulous skin,  iv.  ib.
Parabysma, i- 273
            hepaticum,  i. 274
            complicatum, i. 288
            intestinale,  i. 285
            mesentericum, i. 282
            omentale, i. 287
            pancreaticum,  i. 281
            splenicum, i. 279
Paracentesis in dropsy of the chest, of
  early origin, iv.  274
Paracusis,  iii. 162
           acris, iii. 164
           obtusa, iii. 165
           perversa, iii. 166
           duplicata, iii. 168
           illusoria, iii.  ib.
                    varieties, iii. 169
           Surditas, ,iii.  169
Paracyesis, iv. 113
            irritativa, iv. 114
            uterina, iv.  119
            Abortus, iv. 122
Parageusis, iii.  178
            acuta, iii. 181
            obtusa, iii. 180.182
            expers, iii. ib. 183
Paralysis, iii. 414
          varieties of, iii. 417
          whether likely to be  bene-
  fited by tertian  ague,  iii. 435
Paramenia, iv. 29
            obstructions, iv. 31
            difficilis, iv. 36
            superflua, iv. 43
            erroris, iv.  45
            cessatonis, iv. 46
            Paraphimosis, ii. 189
Paraplegia, iii. 417. 422
Par apsis, iii. 183
          acris,  iii. 184
          expers, iii. 189
          illusoria, iii. 190
Parenchyma of  organs, iy.  183
Parenchtma, diseases apfecting the-
  iv. 199  .
Paristhmitis, ii. 227
             varieties, ii. 227
Parodynia, iv.  130
           atonica, iv. 132
           implastica, iv, 134
           sympathetica, iv.  139
           perversa, iv.  146
           amorphica,  iv. 151
           pluralis,  iv. 160
           secundaria, iv. 163
Paroniria, iii. 114
           ambulans,  iii, 115, 116
           loquens, iii. 115.  118
           salax, iii. 115.119
Paronychia, ii.  199
Paropsis, iii. 134
          lucifuga, iii. 135
          noctifuga, iii. 137
          longinqua, iii.  140
          propinqua,  iii. 141
          lateralis, iii.  142
          illusoria, iii.  143
          Caligo,  iii. 146
          Glaucosis, iii. 147
          Catarracta, iii  148
          Synizesis, iii 152
          Amaurosis,  iii. 154
          Staphyloma, iii. 158
          Strabismus, iii. 160
Parosmis, iii. 172
          acris, hi. ib.
          obtusa,  iii. 176
          expers,  iii. 177
Parostia, iv. 216
          fragilis, iv. -17
          flexilis, iv. 219
Parotid phlegmon, ii. 185
Parotitis, ii.  225
Paruria, iv.  297
         inops, iv. 298
         retentionis, iv. 301
         stillatitia, iv. 306
         mellita, iv  311
         incontinens, iv. 333
         incocta, iv  356
         erratica, iv. 337
Passio bovina, iv.
Passion ungovernable, iii. 77
Passions of the mind, as  Uable to dis-
  ease,  as its intellectual  faculties, iii.
  77
Pearl-ash,  in indigestion, i. 110

^•Mii. 573
Pellagra, 5
Pemphigus, ii. 402
Peripneumonia, ii. 239
Peripneumony, ii, 239 
GENERAL INDEX.
487
   Peripneumony,  varieties, ii. 239
   Peritoneal fever, ii. 148
   Peritoneum,  inflammation  of, ii. 249
   Peritonitis, ii. 249
              propria, ii. 250
              omentalis, ii. 251
              mesenterica, ii. 251
   Pernio, ii. 210
   Pestis, ii. 426
         varieties, ii. 426
   Phacia, iv. 460
   Phalaena pinguinalis, larves of, intesti-
    nal, i. 207
  Phasianus,  mot-mot, i 294
  Pheasant, mot-mot, i. 294
  Philautia,  iii. 82
  Phimosis, ii 189
  Phimotic phlegmon, ii. 189
  Phlegmasia:,  ii. 153
  Phlegmatia dolens, ii. 317
  Phlegmone, Phlegmon, ii.  182
             Parulis, ii. 184
             communis, ii. 183
             auris, ii. 184
             parotidea, ii 185
             mammae, ii. 187
             Bubo, ii. 188
             phimotica, ii. 189
  Phlogistica, ii. 153
  Phlogotica, ii. 153
  Phlyctaenae, ii. 209
 Phlysis, ii. 198
•Phosica, i  310
 Phosphorus in typhus, ii. 143
               gout, ii. 350
 Phrenica, iii. 41
 Phrensy, ii. 219
 Phryganea grandis,  larves of, intesti
   nal,  i. 207
 Phthiriasis, iv.  434
 Phthisis, ii. 494
         varieties,  ii. 495
         dyspeptic, ii. ib.
 Phyma, ii.  190
        Hordeolum, ii. 191
        Furunculus, ii. 192
        Sycosis, ii. 192
        Anthrax, ii. 193
Physalis Alkekengi,  or winter-cherry,
   iv. 307
Physometra, iv. 295
Pian, ii. 445
Piles, i 233
Pin of the eye,  iii. 146. 155
Pin-eye, iii. 146. 155
Placenta, retention of, iv. 164
Plague, ii. 426
        varieties, ii. 426
        of Athens, ii. 427. 429
        of London, ii. 429
  [Plague, of Morocco, ii. 431
           of British army in Egypt, ii.

           inoculation for, ii. 432
           exposure  to,  diminishes its
    power, ii. 440
          influenced by state of the at-
    mosphere, ii. 441
  Platalea Leucorodia (spoon-bill,) i. 294
  Plethora, ii. 451
           entonica or sanguine, ii. 453
           atonica or serous,  ii. 454
  Pleuralgia, i. 401
             acuta,  i. 402
             chronica, iv. 403
  Pleurisy, ii. 245
           spurious, ii. 331
  Pleuritis, ii. 245
           vera, ii. 245
           mediastina, ii. 247
           diaphragmatica, ii. 247
  Pleurosthotonus, iii. 221
  Plica, iv. 449
  Pneumatic medicine, ii. 521
  Pneumatica, i. 309
  Pneumatosis, iv. 290
  Pneumonica, i. 342
  Pneumonitis, ii. 239
              vera, ii. 239
              maligna, ii. 243
              notha, ii. 244
 Podagra, ii. 335
           its varieties, ii. 337
 Poecilia,  iv. 464
 Poison of viper as an antilyssic, iii.'259
 Poliosis,  iv. 453
 Polyglottus, mocking-bird, i. 295
 Polypus, i. 313
         elasticus, i. 314
         coriaceus,  i. ib.
         uteri, iv. 107
         vaginae, iv. ib.
Polysarcia, iv. 200
           adiposa, iv. ib.
Pompholyx, Pomphus, iv. 407
Pontine marshes, insalubrity of, ii.  90
Porphyra, ii. 578
           simplex, ii. 580
           haemorrhagica,  ii. 581
           nautica, ii. 585
Porrigo, iv. 421, 422
 Portland powder, ii. 352
 Pose,  ii. 335
 Power, nervous, iii. 21
                 sensific and motific,
   iii. 22
                 motific, or irritation
   of a lower description than sensific,
  iii. 23
Pox, ii. 549 
488
GENERAL INDEX.
Pox, bastard, ii. 563
Precocity, genital,  iv. 79
Pregnancy, morbid, iv. 113
                  from constitutional
  derangement, i. 114
                  from   local   de-
  rangement, iv. 119
                  from  miscarriage
ii. 122

iv. Ill
proper  period  of,
                  utmost  extent  al-
  lowed, iv. 112
Premature delivery, its advantages at
  times, iv. 158
Priapus, iii. 207
Pricking, general feeling of, iii. 186
Prickly-heat, iv. 372. 375
Pride ungovernable,  iii. 82
Proctica, i. 220
          simplex, i. 220
          spasmodica, i. 221
          callosa,  i 227
          Exania,  i. 240
          Marisca, i 233
          Tenesmus, i. 232
Praotica, iv. 79
          foeminia,  iv. 81
          masculina,  iv. 80
Prolapse, genital, iv.  102
          of the bladder, iv. 105
                vagina, iv. 105
                womb, iv. 102
Protuberant eye,  iii. 158
Prunus Lauro-cerasus,  i. 394
                       in fevers, ii. 87
Prurigo, iv. 379
Pruritus, iii. 186
Prussic acid, i. 278
Psellismus, i. 332
           Ilambalia, i. 332
            Blxsitas,  i.334
Pseudocyesis, iv. 176
              molaris,  iv 176
               inanis, iv. 178
 Psoas abscess, ii.  175
 Psora, iv. 389. 399
 Psoriasis, iv. 399
 Psorophthalmia, ii. 287
 Ptyalism, i. 49
 Ptyalismus, i.  ib.
             acutus, i. 50
             chronicus, i. 57
             iners, i. 57
 Pubis symphysis  ossa, division of, in
    impracticable labour, iv. 153
 Puerperal fever,  ii.  148
                  epidemic, ii. 148
                  contagious, ii. 149
            mania, iii. 65
Puerperal convulsions, iii. o4r*
Pulex (Daphnia,) iv. 7
      (Monoculus,) iv. ib.
Pulex, iv.
Pulsatilla nigricans, iii. 146
Pulse, doctrine of,  ii. 16
Pulse, why different in different ages,
   i. 9
       standard in adult life, ii.  16
                 infancy, ii. 17
                 advanced life, ii. 17
       different kinds  of,  ii. 19
       of Solano, ii. 20
       of Bordeu, ii. 20
Pulselessness, iii. 260
Pulvis, antilyssus, iii. 249
       Cobbii, iii.  251
Pupil, closed, iii. 132
       double, iii. 153
       five-fold, iii. ib.
Purpura (Miliaria,) ii.  386
Purulent ophthalmy, ii. 280
Pus, a secretion, ii. 167,  168
     Hewson's view, ii. 167
     Hunter's, ii. 168.171
     use of, ii. 170.173
Push, ii. 183
Pye-balled skin, iv. 464
Pyrectica, ii. 27
                 Q.

Quartan  ague, ii. 71
         double,  73
         treble,  ib.
         duplicate, 74
         triplicate, ib.
Quas, Russian, ii. 591
Quinsy,  ii. 227
         varieties, ii. ib.
         nervous, i. 63

                 R.

 Rabid blood,  as an  antilyssic,  iii. 252
 Rabies, iii. 228
        canine, iii. 235.238
        feline, iii. 235, 236
 Rainbow worm,  iv. 412
 Raphania,  iii. 300
 Raptus nervorum,  iii. 211
 Rush exanthem, ii. 366
      rose, iv. ib.
      gum, iv. 369
      lichenous,  iv. 371
      pallid,  iv. 371
      pruriginous,  iv. 379
      millet,  iv.  383
      rainbow, iv.
      tooth,  iv.  369, 370 
GENERAL  INDEX.
489
 Rash, wildfire, iv. 369,  370
 Rattling in the throat, i  316
 Rectum, stricture of, spasmodic, i. 221
                     callous,  i. 227
 Red-gum,  iv. 369
 Remittent fever, ii. 91
          mild, ii. 91
          malignant, ii.  93
          autumnal, ii. 94
          yellow,  ii. 98
          burning,  ii. 108
         asthentic,  ii. 110
         of  Breslaw, ii. ib.
Renal calculus, iv. 340
Respiration, effect of, on the  blood, i.
  300
Rubeola, ii. 366
Rubia tincorum, iv. 39
Rubula, ii. 445
Rubus Chamaemorus, ii  590
Rumbling of the bowels, i. 89
Rumination, instances of in man, i. 94
thinning at the nose, i. 309
Rye, spurred, iv. 40
Saat(Hebr.), iv.395
Sahafata (Arab.) Scall, iv. 399
Salacitas, ~) .
Salacity,\> IV-8o
                        |Saliva, analysis of, i. 49
Ellis's hypothesis, i. 301  Salivation, i. 50
quantity of air  expired Salmon, fecundity of, iv. 9
   and inspired  in, i. 304
 Rest-harrow as  a diuretic, iv. ib.
 Restlessness, iii. 312
 Retching,  i. 96
 Retension  of the menses, iv. 31
                 secundines,  iv. 164
 Revery,  iii.  107
         of mind, iii. 108
         abstraction of mind, iii. 107.
   Ill
         brown-study, iii. 107.112
 Rachialgia, i. 127
 Rachitis, iv. 223
         origin of the name,  iv. ib.
 Rheuma, how used formerly, ii. 335
 Rheumatism, acute, ii. 326
             whether  co-exists with
   gout,  ii. 325
             articular, iii. 326
             lumbar, ii. 330
             of the hip-joint, ii. ib
             pleura,  ii.  331
             chronic, ii. 332
 Rhonchus,  i. 316
           stertor, i. ib.
           Cerchnus, i. 317
 Rhus vernix, i. 358—iii. 432
      toxicodendrum, iii. 42
Rhypia,  iv. 414
 Richerand, his hypothesis concerning
   a living principle, iii.  28
Rickets, iv. 223
Ringing in the ears, iii.  169
Ring-worm,  iv.  409. 412
             scall,  iv. 421.424
Rosalia,  ii. 366
Rose-rash,  iv. ib.
Rose-wood, i. 93
Roseola, iv. 366
Rosy-drop, ii. 197
Rot in sheep, cause of, i. 210
Rotacismus, i. 338
   Vol. IV.—3  Q
Sambucus Ebulus, iv. 248
          nigra, iv. 248
Sancti Viti chorea, iii. 289
Sand,  urinary, iv. 340
               white, iv. 341
               urinary  red, iv. 342
Sanguiferous  system,  machinery  ofj
  ii. 5
                      moving powers
  of, ii. 11
                      fluids of, iii. 21
Santonica, i. 215
Saphat (Hebr.) Scall, iv. 389. 395. 399
Sarocele, iv. 208
Satyriasis furens, iv. 86
Scabies, iv. 429, 430
Scabiosa Indica, i. 211
Scale-skin,  iv. 384
Scall,  dry, iv. 399
       humid,  iv. 416
       scabby, iv. 421
       milky, iv. 422
       honey-comb, iv. 423
Scalled head,  iv. 422
Scandix cerefolium,  i. 237
Scarab aeus,  (beetle-grubs)  intestinal,
  i. 203
Scarlatina, ii.  366
Scarlet-fever,  ii ib.
              with sore throat, ii. 368.
  371
Scelotyrbe,  iii. 290. 297
Scented odours issuing from the bodies
  of animals, iv. 364
Sciatica, ii. 331
Scotodinus, iii.»334
Scotoma, iii. 334. 236
Scott's acid bath," in jaundice, i. 257
                    lues, ii.  558
Scrophula, ii. 525
Scurvy, ii. 578
        l*»d, ii. 581 
490
GENERAL  INDEX.
J>197
Scurvy, petecchial, ii. 580
        sea, ii. 585
Scybalum, i. 191
Sea-bear, i.3
    calf, i. 3
    sickness how produced, i. 99
    worms,  feed harmlessly on cop
  per-bottomed ships, i. 139
Seasoning fever of hot climates, ii.  100
Secale cornutum, or spurred rye, i. 141
Secernent Ststem,  diseases of,  iv
  184
Secretions, furnished by different  ani-
  mals, and often the  same animal in
  different parts, iv. 197
          sugar              "*
          sulphur
          lime
          milk
          urine
          bile
          honey
          wax
          silk
          phosphorescent light
          air
          electricity
           furnished by plants  S-198
           equally diversified
 Secundines, retention of, iv. 164
 Self-conceit, ungovernable, iii. 82
 Seminal fluid, how secreted, iv. 10
              powerful  influence  of,
   on the animal economy, iv. 12
        flux, iv. 64
              entonic, iv. 64
              atonic,  iv. 65
        misemission, iv. 91
 Senega, iv. 249
 Seneka-root, i. 384
 Sensation, diseases  affecting  the,
   iii. 133
 Sensation and motion, principle of, iii
   19
                      whether a com-
   mon power, or from  distinct sources,
   iii. 22
 Senses, external, in different animals,
   iii. 13
         whether any animal possesses
   more than five, iii. 17
 Sensorial  powers, diseases affect
   ing jointly, ii. 307
 Sentimentalism, iii. 94
 Sefpigo, iv
 Seta equina, intestinal,  i. 205
 Seville Orange Tree,  iii. 2£5
 Sex and features, h«w accounted for,
   iv. 14. 17
Shaking palsy, iii. 297
Shark, procreation of, iv. 8
Shingles,  iv. 409, 410
Short breath,  i  364
Sibbens, or Sivens, ii  564
Sick head-ache,  iii. 325
Sickness of the stomach, i. 94
Sighing, how produced, i. 300
Sight, in different animals, ii.
Sight, morbid, iii. 154
       night, iii. 135
       day,  iii. 137
       long, in.  140
            of age,  iii. 141
       short, iii. 141
       skew, iii. 142
       false, iii.  143
Silliness,  hi. 130
Silver, nitrate of, in epilepsy,  iii. 365
        power of producing a dark co-
  lour on the skin,  iii. 365
Simarouba, ii. 315
Singing-birds, vocal avenue of, i. 294
                    bull-finch, i. 294
i.294
nightingale, i. ib.
thrush,  i. 294
tuneful manakin,

mocking-bird,  1.
    295
Singultus, iii. 268
Sisymbrium,  iii. 351
Skin papulous, iv. 367
Slaughter-houses,  exhalation  of,  in
  consumption,  ii. 522
Slavering, i. 57
Sleeplessness, iii. 308
Sleep-disturbance, iii. 114
                 sleep-walking,   iii.
  116
                 sleep-talking,   iii.
  115.117
                 night-pollution,  iii.
  115
Small-pox, ii. 411
           varieties, ii. 417
Smell, morbid, iii. 172
       acrid, iii. ib.
       sex,  age, and  other qualities
  discoverable by it, iii. 174
       obtuse, iii. 176
       want of, iii.  177
       illusory, whence, iii. 333
       how  far  it  exists in different
  animals, iii. 14
Snaffles, ii. 296
Snad, procreation of,  iv. 10
Sneezing,  iii. 270
Snivelling, i. 311
Sexual fluids, diseases affecting, iv. 29 Snuff-taking, why injurious, i. 106 
GENERAL  INDEX.
491
Snuffles, ii. 296
Snuffling, i. 311
Soap, i. 256
Soins, ii. 591
Sol-lunar influence, Balfour's hypothe-
  sis of, ii. 56
Solid parts of organs,  of what com-
  posed, iv.  183
Solvents, biliary, i. 273
Somnambulism, iii. 116
Sore-throat, ii. 227
            ulcerated  or malignant,
  ii. 228
Soreness,  general feeling of, iii. 184
Sounds, vocal, i 337
        guttural,  i. 340
        nasal, i. 338
        lingual, i. ib.
        dental, i. 340
        labial, i. 337. 339
        imaginary in the ears, iii. 169
Sparganosis,  ii. 317
Spasm, doctrine of, as applicable  to
  fevers, ii. 33
Spasm, constrictive, iii. 207
                  its species,  iii. 207
       clonic, iii. 265
              its species, iii. 267
       vynclonic, iii. 287
              its species, iii. ib.
       comatose, iii. 342
              its species, iii. 342
Spawn, or hard roe, what, iv.  8
Speech, how produced,  i. 292
        inability of,  i. 318
        may be produced  without a
  tongue, i. 319
Speechlessness, i. 318
Sperm, or soft roe, what, iv.  8
Spermorrhcea,  iv. 64
Spider, discharged from the anus, i.
  208
Spigelia, i. 211.219
Spignel,  iv. 40
Spilosis, iv. 459
Spilus, iv. 459
Spina ventosa, what,  ii.  614
Spine, dropsy of,  iv 269
Spirit of animation, of Darwin, ii.  39
Spitting of blood, ii. 462
Splanchnica, i. 243
Spleen, office not known, i. 13
        not found below the  class  of
  fishes, i. 13
         iii. 103
Splenalgia, ii. 267
Splenitis, ii. ib.
Spoon-bill, i. 294
Spurred-rye,  i. 141
  r            iv. 40
Spurzheim, his hypothesis  upon the
  nature of the mind, iii. 29
Squalus, procreatiou of, iv. 8
Squinting, iii. 160
           varieties, iii. 161
St. Anthony's fire, ii. 406
                  varieties, ii. 407
St. Guy, Dance de, iii. 289
St. Vitus's Dance, iii. 89
Stahl, his doctrine of fevers, ii. 30
Stammering, i. 332
Staphyloma,  iii. 158
             varieties, iii. ib.
Stays, tight, their mischievous effects,
  i. 404
Sterility, male, iv.  88
        female, iv. 97
Sternalgia, i. 393
           ambulantium, i. 394
           chronica,  i. 400
Sternutatio, iii. 270
Stertor, i. 316
Stiff-joint, muscular,  iii. 210
                     its  varieties, hi.
  210
Stitch,  i  402
Stomach, organ of, i. 4
          omnivorous power of, i. 3
          self-digesting power of, i. 11
          seat of universal  sympathy,
  i. 14
          inflammation of,  ii. 252
Stone in the bladder, iv. 347
Stone-pock,  ii. 196
Stoppage of urine, iv. 301
Strabismus, iii. 160
Stramonium, iii. 249
Strangury, iv.  306
            spasmodic, iv. 307
            scalding, iv. ib.
            callous, iv. 308
            vermiculous,  iv.309
            polypous, iv. 310
            mucous, iv. 309
Stricture of the rectum, spasmodic,  i.
  221
Strophulus, iv. 369
Struma, ii. 525
        vulgaris, ii. 527
Studium inane, iii. 112
Stupidity, iii. 124              ,
Sturgeon, mode of procreation, iv. 9
Stuttering, i. 332
Sty, ii.  191
Subsultus, iii. 283
Sudor anglicus, ii. 62
Suffocatio stridula, ii. 233
Suffocation from  asphyxy, iii. 368
           from  hanging  or  drown-
  ing, iii. 368 
492
GENERAL INDEX.
 Suffocation, mephytic, iii. 376
             electrical, iii. 379
             from severe cold, iii. 380
 Suffusio, iii. 149
          scintillans, iii. 143
          reticularis, iii. 143
 Sugar in saccharine urine, thepropor
   tion, iv. 314
 Summer-rash, iv. 372. 375
 Sun-burn, iv  461
 Superannuation, iii 130, 131
 Superfetation, iv. 162
 Suppression of the menses, iv. 35
 Suppurative inflammation, ii. 165
 Surditas, iii. 169
 Surfaces, intkr>al, diseases affect
   ing, iv. 239
 Surface, extkhval, diseases affect-
   ing the,  iv. 357
 Surfeit,  i. 135
 Suspended  animation, iii. 367
 Susurrus, iii. 169
 Sweat, morbid, iv. 359
               profuse, iv. 360
               bloody, iv. 361
               partial, iv. 362
               coloured, iv. 363
               scented, iv. ib.
               sandy, iv. 365
 Swan, dumb, i. 294
       musical,  i. 294
 Sweating-fever, ii. 62
                whether Englishmen
   only subject to it, ii. 64
 Sweet-spittle, i. 55  59
 Swimming of ihe head, iii. 336
 Swine-pox,  ii. 400
 Swooning, iii. >57
           varieties,  iii. 339
 Sycosis,  ii. 192              '
 Sympathies   and   antipathies,  how
   formed in the mind, iii. 37
 Synclonus, iii. 287
          Tremor, iii. 287
          Chorea, iii. 289
          Ballismus, iii. 297
          Raphania, iii. 300
          Beriberia, iii. 303
 Syncope,  iii. 336
         simplex, iii. 337
                 varieties, iii. 339
         recurrens, iii. 341
Synizesis, iii. 152
Synocha,  ii. 118
Syaoxhal fever,  ii.  145
Synochus, ii. 145
          its varieties, ii.  146
Syrigmus, iii.  169
Syspasia, iii. 342
          Convulsio, iii. 345
 Syspasia, Hysteria,  iii. 352
          Epilepsia, iii. 356
 Systatica, iii. 307
 Systremma, iii. 211

                 T.

 Tabes, ii. 487
        varieties, ii. 487
        dorsalis, ii. 490
 Tabor or Talbor, his  early use of the
   bark in agues,  ii. 84
 Taedium vitae, iii. 103
 Taenia Solium,  i 200
       vulgaris, i ib.
       generation of, iv. 10
 Tarantismus, iii. 290
 Tar, fumigation with,  ii. 521
 I'ar-water, useful in indigestion,  i. 1Q9
 Taraxacum, i. 256
            iv. 305
 Taraxis, ii 275
 Taste, how far it  exists  in  different
   animals, iii. 14. 178
 Taste, morbid, iii. 178
              acute, iii. 181
              obtuse,  iii. 180. 182
              want of, iii.  180. 183
              illusory, whence, iii. 333
 ['eats in the mare, inguinal, iv. 10
Teeth, tartar of,  i. 45
        transplantation of,  i. 43
        whether an  extraneous body,
  i. 32
        whether injured by sugar, i. 34
        pretended, reproduced by jug-
  glers, i.  27
        carious, i. 30
        deformity of, i. 41
Teething,  i. 18
           in adults,  i. 25
           in old age,  i. ib.
Tenderness, general external feeling
  of, how produced, iii. 184
Teneritudo, iii. 184
Tenesmus, i. 232
Tertian ague,  ii. 184
        double,  }
        triple,    sii. 73
        duplicate, j
Testes, diminish in the winter in many
  animals,  iv. 10
        where seated in the cock, iv.
  ib.
Testudo, iv. 213
 Tetanus, iii. 221
         anticus,  iii. 221
         dorsalis, iii. 221, 222
         lateralis, iii.  221
         erectus, iii. 221. 223 
GENERAL  INDEX.
493
  Tetter, iv. 408
  Therioma, iv. 410
  Thirst,  morbid, i. 67
          immoderate, i. 69
          sensation of,  how  accounted
    for, i. 67
  Thirstlessness, i. 70
  Throbbing of the arteries, iii. 275
  „,,               heart, iii.  272
  Thrush, ii 390
          its varieties, ii. 390
  Tic,  meaning of the term, iii. 194. 213
       doloureux, iii. 193
  Tick-bite,  iv.438
  Tiglium seeds as a hydragogue, iv. 247
  Tinea, iv.  422, 423
  Toads,  suckling in cancer, ii. 545
  Tongue,  speech not  necessarily de-
    pendent upon it, i. 542
  Tonquin powder, iii. 251
  Tooth,  derangement of, i. 17
         wise,  i. 25
  Tooth-ache, i. 27
  Tooth-edge, i. 39
  Toothlessness, i. 43
  Torpor, iii. 366
  Touch, morbid, iii. 183
                acute sense of, iii. 184
                insensibility of, iii. 189
                illusory, iii. 190
 Trance, hi. 385
 Transudation  in dead animal matter.
   iv. 190
 Trembling, iii. 287
 Tremor,  iii 287
 Trichechus Dvdong, i. 3
 Trichoma,  iv.
 Trichocephalus, i. 200
 Trichosis, iv. 446
          setosa, iv. 448
          Plica, iv. 449
          Hirsuties, iv. 451
          distrix, iv. 452
          Poliosis,  iv. 453
          athrix, iv. 454
          Area, iv. 455
          decolor, iv. 456
          Tripudatio, iii. 297
Trismus (entasia) iii. 213
         varieties,  iii. 215
         maxillaris, iii. 193
         dolorificus, iii. 193
Triton palustris, intestinal, i. 208
Tsorat of the Jews, what, iy. 388, 389.
  394.399
Tubba, ii. 447
Tubercle,  ii. 190
Tumid-leg, puerperal, ii. 317
            of West Indies, ii. 320
Tumour, iv. 205
 Tumour, sarcomatous, iv. 206
          fleshy,  iv. ib.
          adipose, iv. ib.
          pancreatic, iv. ib.
          cellulose, iv. 207
          cystose, iv. ib.
          scirrhous, iv. 207, 208
          mammary, iv. 207
          tuberculous,  iv. ib.
         medullary, iv. ib.
         encysted, iv. 212
         steatomatous,  iv. ib.
         atheromatous, iv. ib;
         honied, iv. ib.
         ganglionic, iv. ib.
         horny, iv. 213
         bony, iv. 214
         osteous, iv. 215
         periosteous, iv. ib.
         pendulous, iv. ib.
         exotic,  iv. ib.
 Turgescence visceral, i. 273
 Tussis, i. 342
 Twinkling of the eye-lids,  iii. 281
 Twinning, congruous, iv.  160
           incongruous, iv. 161
 Twins, iv. 160
 Twitchingsof the tendons, iii. 283
 Tympanites, iv. 292
 Tympany, iv. ib.
           whether ever an idiopathic
  affection, iv. 293
 Typhomania, ii. 219—iii. 392
Typhus, how far approximates  yellow
  fever, ii. 50. 124
        described, ii.  123
        causes, ii. 124
        how becomes contagious,  ii.
  124                      b
        extent and intensity of conta-
  gion, ii. 125
        mild, ii.  127
        malignant or putrid,  ii. 128
        specific properties of its mi-
  asm, ii.  124. 132
        septic power, distinct from its
  debilitating,  ii.  132
        copious  bleeding,  how  far
  advisable, ii. 134
U&, V.,
Vaccinia,  ii*. 394
          its varieties, ii. 395
Vagina, prolapse of, iv. 102
Vapours,  iii 101
Variola, ii. 411
Varix,  ii.  598
Varus, ii.  196 
494
GENERAL INDEX.
Vegetation promoted by animal  de-
  jections, i. 8
Veins and arteries,  ii. 7
Vena Medinenses, iv. 440
Venereal disease, ii. 547
Ventriloquism, what, i. 295
Vermifuges,  211
Vermis Medinensis, iv. 440
Vermination, cutaneous, iv. 434
Vertigo,  iii. 331
         origin of,  iii. 332
Verruca, iv 444
Vesiculae seminales, iv. 11
         differ in different animals, iv.
  11
Vesicular inflammation, ii. 207
         fever,  ii. 402
         its varieties, ii. ib.
Viper, poison of, as an antilyssic, iii.
  259
Vis insita, iii. 20
    nervea, hi. ib.
    a tergo, hypothesis of, ii. 13
Viscus quernus, iii. 351
Vitiligo,  iv. 387
 Ulcer, ii. 615
       depraved, ii. 616
       callous, ii. ib.
       fungous,  ii. ib.
       cancerous, ii. ib.
       sinuous, ii. 618
       carious, ii. 620
 Ulcus,n- 615
       incamans, n. oIj
       vitiosum, ii. 616
       ainuosum, ii. 617
       tuberculosum, ii. 619
       cariosum, ii. 620
 Vocal avenue, i. 291
 Voice, how produced, i. 292
       imitative, seat of, i.295
       whispering, i. 3i7
       of puberty, i. 329
       rough, i. 331
       harsh, i. ib.
       nasal, i.  ib.
       squeaking,  i. ib.
       whizzing, i. ib.
       guttural, i. ib.
       palatine, or through the  nose,
   i.331
       immelodious, i. ib.
  Vomica, ii. 181
          occult, ii- ib.
          open, ii. ib.
  Vomiting and purging, i. 167
           of blood,  ii. 464
           i. 96
  Vomito prieto, ii. 99
  Vomituritio, i. 96
jVomitus, i. 96
Voracity, i. 72
luric calculus, iv. 344
Urinal dropsy, iv. 311. 335
Urinary  calculus, iv.  338
Urinary sand, iv. 340
         gravel,  iv. 340. 344'
Urine, earths, salts,  and other pirinci-
  ples of, iv. 339
       bloody, ii. 464
       destitution of, iv. 298
       stoppage of, iv. 301
       saccharine, iv. 311
       honeyed, iv. ib.
       incontinence of, iv. 333
       unassimilated, iv. 336
       erratic, iv. 337
Uroplania,  iv. 337
Urticaria, ii. 384
Uteri procidentia, iv. 103
      prolapsus, iv. ib.
      relaxatio, iv. ib.
 Uterine  hemorrhage, ii. 465. 468
                 W.

Wakefulness, iii. 308
             irritative, iii. 308
             chronic, iii. 310
Walrus, i.3
Wart, iv. 444
Water in the head,  iv. 260
Water-blebs, iv. 407
Water-flux, iv. 311
Water-brash, i. 84
Water-pox, ii. 400
Water-hemlock, i. 141
Web of the eye, iii. 146
Weeping,  how produced, i. 300
Wen, iv. 212
      adipose,  iv. ib.
      honied, iv. ib.
      horny, iv. 213
Wheal worm, iv. 439
Whelk, ii. 195
White-gum, iv.  369. 371
White-swelling, ii. 358
Whites, iv. 48
Whitlow, ii. 199
Whizzing in the ears,  iii. 169
Wild carrot, as  a diuretic, iv. 305
Wind-cholera, i. 171
      cholic, i.  142
      dropsy, iv. 288
 Winking,  iii. 281
 Winter-cherry,  iv. 307
 Wit, how  it may exist without judg-
   ment, and hence in insanity, hi. 57
      crack-brained,  iii. 94. 96
 Witlessness, iii. 130 
GENERAL INDEX.
495
Womb, inflammation of, ii. 270
        falling down of, iv. 102
        retroverted, iv. 104
Worm-grass, i. 219
Worm, goose-foot,  i. 215
Wormwood, i. 114
Worms, intestinal, their abihty to re-
  sist digestion,  i. 11
                various   species,  i
  195
                long round, i. 200
                     thread,  i.  200,
  201
                     tape, i. 201
                broad tape, i. 202
                maw,  i. 203
                erratic, i. 205
         hepatic, i. 275
         vesical, iv. 309
Worm-seed, i. 211
Wry-neck, iii. 208
X.
Xanthic oxyde of the bladder, iv. 339
Y.
Yam, i. 3
Yawning, iii. 286
Yaws, iii. 445
Yellow fever, how far approaches ty-
  phus, ii. 50
             description of, ii. 98
                Z.

Zaruthan,  ii. 543
Zona, iv. 410
      ignea, iv. ib.
Zoster, iv. 409, 410
END  OF VOL.  IV. 
 
 
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