ZOONOMIA;
OR,
The Laws of Organic Life.
PART SECOND.
Br ERASMUS DARWIN, M. D.
A NEW EDITION;
WITH
An Introductory Address,
AND
A SHORT APPENDIX,
BY CHARLES CALDWELL, M. D.
FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA,
MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY,
&c. &c.
VOL. I.
PHILADELPHIA;
PRINTED BY T. DOBSON, AT THE STONE HOUSE
NO. 41, SOUTH SECOND STREET.
1797.



ZOONOMIA;
OR,
The Laws of Organic Life.
PART II.
CONTAINING
A CATALOGUE OF DISEASES
DISTRIBUTED INTO
NATURAL CLASSES ACCORDING TO THEIR
PROXIMATE CAUSES,
WITH THEIR
SUBSEQUENT ORDERS, GENERA, AND SPECIES,
AND WITH
THEIR METHODS OF CURE.
Hæc, ut potero, explicabo; nec tamen, quasi Pythius Apollo, certa
ut sint et fixa, quæ dixero; sed ut Homunculus unus e multis
probabiliora conjecturâ sequens.
CIC. TUSC. DISP. l. I. 9. 	



INTRODUCTORY ADDRESS.
To the Country and Village Practitioners
of Medicine in the United States of
America,
GENTLEMEN,
ALLOW me to invite your attention,
and to solicit your extensive and respectable patronage,
to the following interesting and important publication.
You are here presented with a neat, and I flatter
myself I may add, a correct Philadelphia edition of
the Second Part of a late medical work, entitled
ZOONOMIA. The entire body of the work, con-
sidered in its collective result, is indeed an ingenious
and an able exposition of certain principles and laws,
by which organized bodies are governed, while suscep-
tible of the diversified motions of life. The Second
Part, which now steps forward a candidate for your
attention, embraces an elucidation of the theory of
diseases, together with the application of appropriate
remedies, and is therefore more immediately subser-
vient to the practice of the healing art.
An attempt to advance the celebrity of the subse-
quent sheets, or to add to the real weight of the mul-
tifarious matter they contain, is by no means the pur-
pose for which I now lift my pen. I mean not to
a3 figure

vi INTRODUCTORY ADDRESS.
figure in the language of studied panegyric, nor to
trumpet the work in accents of extravagant and un-
conditional praise. My only aim is to intimate, in
general terms, something of its character and merit—
my only wish, to "speak of it as it is." Here, gen-
tlemen, permit me to observe, that although the name
of its illustrious author be alone sufficient to secure to
it at least a temporary, and perhaps an extensive, cur-
rency, yet a general diffusion of the knowledge of its
practical utility will constitute the best basis for its
permanent reputation.
"Multum in parvo," is an antiquated motto, very
strikingly characteristic of the following work. For
although it be somewhat voluminous in itself, yet from
its comprehensive manner, and condensed style of com-
position, it is truly contracted when viewed in relation
to the immensity of the matter it contains. In the
subsequent pages are the public presented, in detail, with
an entire System of the Theory and Practice of Medi-
cine, accompanied by a short but general Treatise on
Materia Medica, corresponding in principle to the Pa-
thological system premised. The work, with respect
to its great outlines, is conceived with strength and
ingenuity; while its subordinate parts are finished with
a nice and masterly hand. Though evidently a work
of much labour and study, it appears notwithstanding
to be the result of accurate and profound observation,
rather than of extensive and diversified reading. It is
in most parts characterized by a boldness, and perhaps
I may add, an originality of thought; but is seldom,
very 	

INTROCUCTORY ADDRESS. vii
very seldom, emblazoned by the "purpurei panni" of
learning. The author appears to have had in view a
detailed and faithful delineation of what he conceived
to be the permanent truths of nature; not a splendid
collection of the variable and often contradictory spe-
culations and opinions of men.
The work must notwithstanding be acknowledged
to be indeed uncommonly rich, with respect both to
primary principles and doctrinal combinations. The
immensity and variety of matter it condenses into a
narrow compass, declare it to be the production of a
mind possessing an entire command of most, if not all,
the modern discoveries relative to the science and
practice of the healing art. Thus without intruding
on the reader's time by lengthy quotations, or inter-
rupting his attention by a multiplicity of references, it
presents him, in a new style and under a new arrange-
ment, with most of the practical truths which other
medical writings contain. In a word, it may be con-
sidered as a vast lens of prime construction and power,
collecting to a luminous point the scattered and appa-
rently diverging rays, which fall at present on the ex-
panding atmosphere of medical science.
Though several distinguished philosophers have con-
tended for perfectibility, as an essential attribute of
the nature of man, yet none, I believe, have ventured
to allege, that man has hitherto attained to the point
of consummate perfection. His humiliating deficiency
is particularly striking in his very limited advance-
ment in the acquisition of physical science. Even
a4 Darwin 

viii INTRODUCTORY ADDRESS.
Darwin himself is unable to boast an entire command
of the laws of Nature, which he so much loves, and
to which his name and memory will ever be so dear.
In the following publication there exist speculations
and opinions not a few, which evidence the work to
be the result of the labours of an ingenious, yet falli-
ble man. Were we disposed to analyse, and examine
it with a spirit of rigid and critical severity, we might
find considerable ground for exception to our author's
nosological classification, or general arrangement of
diseases. In his specific divisions, his attempt at un-
common minuteness and particularity would seem to
have led him to be sometimes disagreeably tedious,
and to have, perhaps too justly, subjected him to the
general charge of complexity in his system. Thus,
for instance, many of those diseases to which he has,
in his nomenclature assigned the name, and in his sys-
tem the character and importance of distinct species,
might without impropriety be considered as nothing
more than mere varieties, or different forms of the
same original affection. But we have reason to felici-
tate ourselves that few, if any, existing evils are of an
aspect so dark, or of a nature so unmixed and bitter,
as not to be lightened by the dawn, and rendered at
least tolerable by the influence of some necessarily con-
comitant good. Let this be our consolation in the
case before us. For while we lament that our author's
minuteness and prolixity of division have, in a great
measure, prevented us from being able to grasp, at a
single view, the aggregate of his nosological nomen-
clature,								

INTRODUCTORY ADDRESS. ix
clature, we must notwithstanding derive pleasure from
reflecting, that these very properties which we were
at first inclined to censure, afford us an opportunity
of collecting, more in detail, his observations and opi-
nions relative to the diseases of the system of man.
The work, gentlemen, is now before you, and
solicits your earnest and candid attention. It is a work
of interesting and important facts, of ingenious com-
binations, and of fair and logical deductions. Be not
reluctant to examine it with care, to eviscerate it with
avidity, for it indeed contains a hidden treasure. In
it you will be presented with an abundant and most
delicious repast, on which your appetites will not, I
am confident, be easily cloyed. I had almost called
it the book of Nature, and invited you to "explore
the wondrous work." But I may, at least, be per-
mitted to recommend it as a page in nature's stupen-
dous volume, containing facts which no future time
shall change, and exhibiting many principles and laws
which no daring opponent will ever be able to inva-
lidate or destroy. Although I do not hesitate to de-
clare, thus publicly, my dissent in many particulars,
from the speculations and opinions of our ingenious
author; yet, considering the work in its collective
merit, I cannot help pronouncing it a splendid and
towering monument of genius, destined long to survive
its illustrious builder, and perhaps finally to triumph
over the revolutions and ravages of time! Full on the
front of this monument shall the name of Darwin
blaze in gold, when that of the Ptolemies shall have
been 

x INTRODUCTORY ADDRESS.
been long since dashed by the indignant soot of time
from those huge and unmeaning piles of folly, which
their pride and ambition vainly prompted them to
rear!
The following publication I hold as highly interest-
ing and important in a peculiar point of view, in
which it will be but very seldom considered by the
generality of readers. It demonstrates, in a manner
the most pleasing and satisfactory, what an immensity
of good may result to society at large, and of same to
an individual character, from an assiduous and well
directed application of talents, even amidst the nume-
rous and distracting avocations of a most troublesome
and laborious profession. Doctor Darwin has been,
throughout the greater part of his life, nothing more
than a country, or at best a village practitioner of me-
dicine. According to the most accurate information I
have been able to receive on this subject, his field of
practice has been at all times extensive, while the
principal portion of the harvest has been for the most
part his own. Your own personal experience, gen-
tlemen, will therefore most forcibly impress on your
minds, how arduous must have been his duties, how
excessive his fatigues, how numerous, how urgent,
how distracting his calls! Yet amidst a ceaseless com-
bat with such avowed and formidable foes to accuracy
of observation, extent of inquiry, and solidity of
thought, what have, or rather what have not, the
talents and exertions of Darwin effected? To say only
that they have raised him to a level with the first phy-
sicians

INTRODUCTORY ADDRESS. xi
sicians whom the world has yet beheld, would indeed
bear the semblance of an attempt to be-little him by
a sordid penury of praise! His need of fame should
far exceed such narrow limits. For to pass in silence
over the work immediately before us a work of such
deep and varied physical research, as apparently to
require years of unmolested leisure for its final accom-
plishment; his pen has given birth to a philosophical
poem, sufficient alone to immortalize his country and
his age! A poem which combines, in a manner supe-
rior perhaps to what the world has ever witnessed be-
fore, the researches and decisions of the understanding,
with the sportings and flights of the imagination; the
tranquil lights of philosophy with the bolder beauties
of poesy and song! In this oblation to the Muses has
our illustrious bard delivered to the world a brilliant
and precious memorial of his talents and his industry,
which shall not cease to attract the attention, and
command the united applause of posterity, while the
love of genius and merit shall retain its seat in the
bosom of man, while literary taste shall be able to
preserve its existence, or the richest beauties of nature
continue to be understood or admired!
Permit me, gentlemen, with pleasure to look for-
ward to the time when, under similar circumstances,
equal effects will result from a happy coincidence of
equal talents and attention on this side the Atlantic.
Such an event is doubtless far within the ken of hope,
and even within the narrower sphere of rational pro-
bability. Such an event will, I am confident, yet oc-
cur.									

xii INTRODUCTORY ADDRESS.
cur. The auspicious period we are not indeed fur-
nished with forecast sufficient to descry. From the
rapid and general diffusion of physical science through-
out our country, and from the growing taste for the
beauties of literature acquiring such depth of root in
the American mind, we are however encouraged, at
least to flatter ourselves, that it is not deeply buried
in the ever-teeming matrix of time. Nor am I dis-
posed to search for the future Darwin of America
with such strength of anticipation in any other place,
as in some of the secondary towns or even villages of
our common country. For trust me, gentlemen, the
opportunities which you possess for your advancement
in the true and unperverted science of nature, are
less, much less, inauspicious than you are yourselves at
first view willing to admit. That you are indeed beset
by numerous literary and social wants, and subjected
to the uniform pressure of many cumbrous evils of
situation, is incontestably true; but doubtless it is
equally true, that you at the same time enjoy several
important advantages peculiar to yourselves.
What though you be removed from the accents of
the learned, the eloquent, and once-beloved professor's
voice, and situated far without the circulating sphere
of voluminous and well-selected libraries? Can you
not listen to the clearer voice of daily occurring facts?
Can you not consult the purer book of nature, ever
unfolded to your view? Can you not acquire the pre-
cious art of extracting, from such abundant sources,
the sweets of virgin truth, uncontaminated by the gall 
of

INTRODUCTORY ADDRESS. xiii
of poisonous error? By the study of books you are too
often made acquainted with nothing more than the
speculative opinions of men; while the study of na-
ture will never fail to introduce you into the favourite
walks, and thus unveil to you the inestimable secrets,
of science. Though not so heavily fraught with learn-
ing as those who enjoy a more ready and constant
access to literary societies, to academical lectures, and
to public libraries, you may notwithstanding possess a
superior share of useful and practical truth.
Universities and subordinate institutions of instruc-
tion are doubtless necessary to the advancement, and
peculiarly essential to the general diffusion of the
science of nature. In my opinion of the importance,
and in my good wishes for the prosperity of such in-
stitutions, I will be pardoned when I declare, that I
hold myself second to no one. But it is a truth,
the purest sterling coin is not without alloy 
Schools of medicine have been long denominated
the repositories, and considered as in some measure the
perpetuators of antiquated and obsolete opinions.
Though the charge has been doubtless by far too
pointed and general, yet it is, perhaps, a circumstance
to be lamented, that it has not been altogether desti-
tute of foundation. I mean not a shadow of disrespect
to the medical schools of America. Far, very far
from it I am too sensible of the advantages, I flatter
myself, I have already derived, and which I am sure
I am even now daily deriving, from one of them,
not to feel towards it obligations of filial gratitude 
not 

xiv INTRODUCTORY ADDRESS.
not to venerate it as my alma mater in the science of
medicine. Yet perhaps, even on this side the At-
lantic, such institutions may be somewhat influential
in propagating and in perpetuating physical principles
and opinions not wholly unexceptionable.
By being situated, gentlemen, beyond the more im-
mediate and authoritative influence of these public
seminaries, you are in a great measure liberated from
the trammels and prejudices in which they are so apt
to involve the unripened minds of youth. Like the
uncaged birds of your forests, your genius may take
wing, and range at large for food or pastime, through
the fair and unlimited commons of nature. Your
notes, though few, wild, and simple, must be original,
bold, and sweetly melodious. Thus supported by
your own strength of mind, unawed by the sanctity
of prescribed opinion, and unblinded by attachment
to distinguished names, you are at liberty to make
truth alone the object of your researches, and to
depend principally on experiment and observation as
your surest means for its final attainment. You are
enlisted under the banner of no ambitious and inter-
ested leader, and are therefore urged by no propensity
to distort facts and torture principles for the temporary
establishment of a favourite system. In such a situa-
tion as this the giant mind of Darwin grew and ripen-
ed In such a situation was materials for the follow-
ing work collected, digested, and ultimately arranged
 And in such a situation may some of you, gentle-
men, whom I have now the honour of addressing
at 

INTRODUCTORY ADDRESS. xv
at a distance, yet issue forth the future Darwins of
the Western World!
Had our illustrious author been more intimately
connected with the medical teachers of London and
of Edinburgh, his writings would, no doubt, have
been more deeply tinctured by opinions and principles
which those gentlemen so industriously inculcate and
so ably defend. His works might have thus, indeed,
appeared more learned and voluminous, but would
have been much less ingenious, original, and bold.
To his insulated situation, at a distance from the pub-
lic schools of the kingdom, may be attributed, in a great
measure, the many tone and conscious independence
of his mind. In this detached situation we may view
him in the light of his own teacher and guide, for he
has at all times experimented, observed, and thought
for himself. Such are the happy effects of his inde-
fatigable researches, that in the science of the princi-
ples and laws of living bodies, and in the knowledge
of the general nature and treatment of diseases, he
appears to have far outstepped his national co-tempo-
raries, and may be justly accounted the boast of the
British isle, no less in the real philosophy of medicine,
than in the brilliant imagery, the polished elegance,
and the bold sublimity of song. Long may he yet con-
tinue the unrivalled pride of his country! and may he
experience in the splendid evening of his life, a ple-
nitude of that health and happiness he has so ably
contributed to confer upon others!
1 I cannot, 

xvi INTRODUCTORY ADDRESS.
I cannot, gentlemen, conclude this introductory
address without expressing a desire to be favoured
with your observations and remarks, either through a
public or private channel, as well on the original text,
as on the short Appendix I have taken the liberty of
subjoining to the following sheets.
With sincere wishes for your individual success and
happiness in life, and with sentiments of earnest solici-
tude for the interest and advancement of our common
profession, I have the honour to be,
GENTLEMEN,
Your most obedient,
And very humble servant,
CH. CALDWELL.
PHILADELPHIA,
January 10th, 1797. 
N. B. I flatter myself no apology will be required by
Dr. Darwin, or by the public at large, for the
liberty I have taken of correcting occasional errors
which had gained admission into the London press,
owing, I presume, to the Work having been origi-
nally printed at a distance from the eye and exami-
nation of the author.
C. C. 

PREFACE.
ALL diseases originate in the exuberance, defi-
ciency, or retrograde action, of the faculties of
the sensorium, as their proximate cause; and
consist in the disordered motions of the fibres of
the body, as the proximate effect of the exertions
of those disordered faculties.
The sensorium possesses four distinct powers,
or faculties, which are occasionally exerted, and
produce all the motions of the fibrous parts of
the body; these are the faculties of producing
fibrous motions in consequence of irritation
which is excited by external bodies; in conse-
quence of sensation which is excited by pleasure
or pain; in consequence of volition which is ex-
cited by desire or aversion; and in consequence
of association which is excited by other fibrous
motions. We are hence supplied with four na-
tural classes of diseases derived from their proxi-
mate causes; which we shall term those of irri-
tation, those of sensation, those of volition, and
those of association.
In the subsequent classification of diseases I
have not adhered to the methods of any of those,
who have preceded me; the principal of whom
b is 

xviii PREFACE.
are the great names of Sauvages and Cullen;
but have nevertheless availed myself, as much as
I could, of their definitions and distinctions.
The essential characteristic of a disease consists
in its proximate cause, as is well observed by
Dr. Cullen, in his Nosologia Methodica, T. ii.
Prolegom. p. xxix. Similitudo quidem morbo-
rum in similitudine causæ eorum proximæ, qua-
liscunque sit, reverâ consist. I have taken the
proximate cause for the classic character. The
characters of the orders are taken from the ex-
cess, or deficiency, or retrograde action, or other
properties of the proximate cause. The genus
is generally derived from the proximate effect.
And the species generally from the locality of
the disease in the system.
Many species in this system are termed genera
in the systems of other writers; and the species
of those writers are in consequence here termed
varieties. Thus in Dr. Cullen's Nosologia the
variola or small-pox is termed a genus, and the
distinct and confluent kinds are termed species.
But as the infection from the distinct kind fre-
quently produces the confluent kind, and that of
the confluent kind frequently produces the dis-
tinct; it would seem more analogous to botanical
arrangement, which these nosologists profess to
imitate, to call the distinct and confluent small-
pox varieties than species. Because the species
of plants in botanical systems propagate others
similar to themselves; which does not uniformly
occur in such vegetable productions as are termed
varieties.
In									

PREFACE. xix
In some other genera of nosologists the species
have no analogy to each other, either in respect
to their proximate cause, or to their proximate
effect, though they may be somewhat similar in
less essential properties; thus the thin and saline
discharge from the nostrils on going into the
cold air of a frosty morning, which is owing to
the deficient action of the absorbent vessels of
the nostrils, is one species; and the viscid mucus
discharged from the secerning vessels of the same
membrane, when inflamed, is another species of
the same genus, Catarrhus. Which bear no ana-
logy either in respect to their immediate cause or
to their immediate effect.
The uses of the method here offered to the
public of classing diseases according to their
proximate causes are, first, more distinctly to un-
derstand their nature by comparing their essential
properties. Secondly, to facilitate the knowledge
of the methods of cure; since in natural classi-
fication of diseases the species of each genus, and
indeed the genera of each order, a few perhaps
excepted, require the same general medical treat-
ment. And lastly, to discover the nature and
the name of any disease previously unknown to
the physician; which I am persuaded will be
more readily and more certainly done by this
natural system, than by the artificial classifications
already published.
The common names of diseases are not well
adapted to any kind of classification, and least of
all to this from their proximate causes. Some
of their names in common language are taken
b2 from 

xx PREFACE.
from the remote cause, as worms, stone of the
bladder; others from the remote effect, as diar-
rhœa, salivation, hydrocephalus; others from
some accidental symptoms of the disease, as tooth-
ach, head-ach, heart-burn; in which the pain
is only a concomitant circumstance of the excess
or deficiency of fibrous actions, and not the cause
of them. Others again are taken from the de-
formity occasioned in consequence of the unna-
tural fibrous motions, which constitute diseases,
as tumours, eruptions, extenuations; all these
therefore improperly give names to diseases;
and some difficulty is thus occasioned to the rea-
der in endeavouring to discover to what class
such disorders belong.
Another difficulty attending the names of dis-
eases are, that one name frequently includes more
than one disease, either existing at the same time
or in succession. Thus the pain of the bowels
from worms is caused by the increased action of
the membrane from the stimulus of those ani-
mals; but the convulsions, which sometimes suc-
ceed these pains in children, are caused by the
consequent volition, and belong to another class.
To discover under what class any disease
should be arranged, we must first investigate
the proximate cause; thus the pain of the
tooth-ach is not the cause of any diseased mo-
tions, but the effect; the tooth-ach therefore
does not belong to the class of Sensation. As
the pain is caused by increased or decreased
action of the membranes of the tooth, and these
actions are owing to the increase or decrease of
irritation, 

PREFACE. xxi
irritation, the disease is to be placed in the class
of Irritation.
To discover the order it must be inquired,
whether the pain be owing to increased or de-
fective motion of the pained membrane; which
is known by the concomitant heat or coldness of
the part. In tooth-ach without inflammation
there are generally a coldness attends the cheek
in its vicinity; as may be perceived by the hand
of the patient himself, compared with the oppo-
site cheek. Hence odontalgia is found to belong
to the order of decreased irritation. The genus
and species must be found by inspecting the
synopsis of the second order of the Class of Irri-
tation. See Class I. 2. 4. 12.
This may be further elucidated by considering
the natural operation of parturition; the pain
is occasioned by the increased action or disten-
sion of the vessels of the uterus, in consequence
of the stimulus of the fetus; and is therefore
caused by increased irritation; but the action of
the abdominal muscles in its exclusion are caused
by the pain, and belong to the class of increased
sensation. See Class II. 1. 1. 12. Hence the
difficulty of determining, under what class of
diseases parturition should be arranged, consists
in there being two kinds of diseased actions
comprehended under one word; which have
each their different proximate cause.
In Sect. XXXIX. 8. 4. and in Class II.
I. I. I. we have endeavoured to give names to
four links of animal causation, which conveni- 
ently

xxii PREFACE.
ently apply to the classification of diseases; thus
in common nictitation, or winking with the eyes
without our attention to it, the increased irrita-
tion is the proximate cause; the stimulus of the
air on the dry cornea is the remote cause; the
closing of the eyelid is the proximate effect;
and the diffusion of tears over the eye-ball is the
remote effect. In some cases two more links of
causation may be introduced; one of them may
be termed the pre-remote cause; as the warmth
or motion of the atmosphere, which causes
greater exhalation from the cornea. And the
other the post-remote effect; as the renewed pel-
lucidity of the cornea; and thus six links of cau-
sation may be expressed in words.
But if amid these remote links of animal cau-
sation any of the four powers or faculties of the
sensorium be introduced, the reasoning is not
just according to the method here proposed; for
these powers of the sensorium are always the
proximate causes of the contractions of animal
fibres; and therefore in true language cannot be
termed their remote causes. From this criterion
it may always be determined, whether more dis-
eases than one is comprehended under one
name; a circumstance which has much impeded
the investigation of the causes, and cures of dis-
eases.
Thus the term fever, is generally given to a
collection of morbid symptoms; which are in-
deed so many distinct diseases, that sometimes
appear together, and sometimes separately; hence
it
2

PREFACE. xxiii
it has no determinate meaning, except it signifies
simply a quick pulse, which continues for some
hours; in which  it is here used.
In naming diseases I have endeavoured to
avoid the affectation of making new compound
Greek words, where others equally expressive
could be procured: as a short periphrasis is easier
to be understood, and less burthensome to the
memory.
In the Methodus Medendi, which is marked
by M. M. at the end of many of the species of
diseases, the words incitantia, sorbentia, torpentia,
&c. refers to the subsequent articles of the Ma-
teria Medica, explaining the operations of me-
dicines.
The remote causes of many diseases, their pe-
riods, and many circumstances concerning them,
are treated of in the preceding volume; the de-
scriptions of many of them, which I have omit-
ted for the sake of brevity, may be seen in the
Nosologia Methodica of Sauvages, and in the
Synopsis Nosologiæ of Dr. Cullen, and in the
authors to which they refer.
In this arduous undertaking the author solicits
the candour of the critical reader; as he cannot
but foresee, that many errors will be discovered,
many additional species will require to be in-
serted; and others to be transplanted, or erased.
If he could expend another forty years in the
practice of medicine, he makes no doubt, but
that he could bring this work nearer perfection,
and thence render it more worthy the attention
of 

xxiv PREFACE.
of philosophers.  As it is, he is induced to
hope, that some advantages will be derived from
it to the science of medicine, and consequent
utility to the public, and leaves the completion
of his plan to the industry of future genera-
tions.
DERBY, Jan. 1. 1796. 	

ZOONOMIA
OR,
THE LAWS OF
ORGANIC LIFE.
PART II.
By ERASMUS DARWIN, M. D. F. R. S.
AUTHOR OF THE BOTANIC GARDEN.
Principiò cœlum, ac terras, camposque liquentes,
Lucentemque globum lunæ, titaniaque astra,
Spiritus intùs alit, totamque infusa per artus
Mens agitat molem, et magno se corpore miscet.
VIRG. Æn. vi.							
Earth, on whose lap a thousand nations tread,
And Ocean, brooding his prolific bed,
Night's changeful orb, blue pole, and silvery zones,
Where other worlds encircle other suns,
One Mind inhabits, one diffusive Soul
Wields the large limbs, and mingles with the whole. 







ZOONOMIA.
PART II.
CLASSES OF DISEASES.
I. DISEASES OF IRRITATION.
II. DISEASES OF SENSATION.
III. DISEASES OF VOLITION.
IV. DISEASES OF ASSOCIATION.
B
THE 

2 DISEASES [CLASS I.
THE ORDERS AND GENERA OF THE FIRST CLASS
OF DISEASES.
CLASS I.
DISEASES OF IRRITATION.
ORDO I.
Increased Irritation.
GENERA.
1. With increased actions of the sanguiferous system.
2. With increased actions of the secerning system.
3. With increased actions of the absorbent system.
4. With increased actions of other cavities and mem-
branes.
5. With increased actions of the organs of .
ORDO II.
Decreased Irritation.
GENERA.
1. With decreased actions of the sanguiferous system.
2. With decreased actions of the secerning system.
3. With decreased actions of the absorbent system.
4. With decreased actions of other cavities and mem-
branes.
5. With decreased actions of the organs of .
ORDO 

CLASS I. 1. 1.] OF IRRITATION. 3
ORDO III.
Retrograde Irritative Motions.
GENERA.
1. Of the alimentary canal.
2. Of the absorbent system.
3. Of the sanguiferous system.
THE ORDERS, GENERA, AND SPECIES, OF THE
FIRST CLASS OF DISEASES.
CLASS I.
DISEASES OF IRRITATION.
ORDO I.
Increased Irritation.
GENUS I.
With increased Actions of the Sanguiferous System.
SPECIES.
1. Febris irritativa. Irritative fever.
2. Ebrietas. Drunkenness.
3. Hamorrhagia arteriosa. Arterial hæmorrhage.
4. Hæmoptoe arteriosa. Spitting of arterial blood.
5. Hæmorrhagia narium. Bleeding from the nose.
B2 GENUS 

4 DISEASES [CLASS I. 1. 2.
GENUS II.
With increased Actions of the Secerning System.
SPECIES.
1. Color febrilis.Febrile heat.
2. Ruber febrilis.Febrile redness.
3. Sudor calidus. Warm sweat.
Sudor febrilis.Sweat in fevers.
a labore.from exercise.
ab igne.from fire.
a medicamentis. from medicines.
4. Urina uberior colorata. Copious coloured urine.
5. Diarrhœa calida.Warm diarrhœa.
febrilis. from fever.	
crapulosa.from indigestion.
infantum. from infants.
6. Salivatio calida.  salivation.
7. Catarrhus calidus. catarrh.
8. Expectoratio calida. expectoration.
9. Exsudatio pone aures. Discharge behind the ears.
10. Gonorrhœa calida. Warm gonorrhœa.
11. Fluor albus calidus. fluor albus.
12. Hœmorrhois alba. White piles.
13. Serum e vesicatorio. Discharge from a blister.
14. Perspiratio fœtida.Fetid perspiration.
15. Crines novi. New hairs.
GENUS

Class I. 1. 4.] OF IRRITATION. 5
GENUS III.
With increased Actions of the Absorbent System.
SPECIES.
1. Lingua arida. Dry tongue.
2. Fauces aridœ. Dry throat.
3. Nares aridi.  Dry nostrils.
4. Expectoratio solida. Solid expectoration.
5. Constipatio alvi. Costiveness.
6. Cutis arida.  Dry skin.
7. Urina parcior colorata.Diminished coloured urine.
8. Calculus felleus et icterus. Gall-stone and jaundice.
9. renis.  Stone of the kidney.
10.vesicœ. Stone of the bladder.
11 arthriticus. Gout-stone.
12. Rheumatismus chronicus.  Chronic rheumatism.
13. Cicatrix vulnerum.  Healing of ulcers.
14. Corneœ obfuscatio.  Scar on the cornea.
GENUS IV.
With increased Actions of other Cavities and Membranes.
SPECIES.
1. Nictitatio irritativa. Irritative nictitation.
2. Deglutitio irritativa. Irritative deglutition.
3. Respiratio et tussis.  Respiration and cough.
4. Exclusio bilis.Exclusion of the bile.
5. Dentitio.Toothing.
6. Priapismus. Priapism.
7. Distentio mamularum. Distension of the nipples.
B3 8. Descensus 

6 DISEASES [CLASS I. 1. 5.	
8. Descensus uteri. Descent of the uterus.
9. Prolapsus ani. Descent of the rectum.
10. Lumbricus.Round worm.
11. Tænia. Tape-worm.
12. Ascarides.Thread-worm.
13. Dracunculus. Guinea-worm.
14. Morpiones. Crab-lice.
15. Pediculi. Lice.
GENUS V.	
With increased Actions of the Organs of .
SPECIES.	
1. Visus acrior. Acuter sight.
1. Auditus acrior.	hearing.
3. Olfaclus acrior.	smell.
4. Gustus acrior. taste.
5. Taclus acrior. touch.
6. Sensus caloris acrior.  sense of heat.
7. extensionis acrior.  of extension.
8. Titillatio. Tickling.
9. Pruritus. Itching.
10. Dolor urens. Smarting.
xi, Consternatio. Surprise.
ORDO 

CLASS I. 2. 3.] OF IRRITATION. 7
ORDO II.
Decreased Irritation.
GENUS I.
With decreased Actions of the Sanguiferous System.
SPECIES.
1. Febris inirritativa. Inirritative fever.
2. Paresis inirritativa. - debility.
3. Somnus interruptus. Interrupted sleep.
4. Syncope. Fainting.
5. Hœmorrhagia venosa. Venous hemorrhage.
6. Hœmorrhois cruenta. Bleeding piles.
7. Hœmorrhagia renum. - from the kidneys.
8. - hepatis. - from the liver.
9. Hœmoptoe venosa. Spitting of venous blood.
10. Palpitatio cordis. Palpitation of the heart.
11. Menorrhagia. Exuberant menstruation.
12. Dysmenorrhagia. Deficient menstruation.
13. Lochia nimia. Too great lochia.
14. Abortio spontanea. Spontaneous abortion.
15. Scorbutus. Scurvy.
16. Vibices. Extravasations of blood.
17. Petechiœ. Purple spots.
GENUS II.
With decreased Actions of the Secerning System.
SPECIES.
1. Frigus febrile. Coldness in fevers.
- chronicum. - permanent.
B4 2. Pallor 

8 DISEASES [CLASS I. 2. 3.
2. Pallor fugitivus.Paleness fugitive.
- permanens. - permanent.
3. Pus parcius. Diminished pus.
4. Mucus parcior. Diminished mucus.
5. Urina parcior pallida. Pale diminished urine. 
6. Torpor hepaticus. Torpor of the liver.
7. Torpor pancreatis. Torpor of the pancreas.
8. Torpor renis. Torpor of the kidney.
9. Punctæ mucosæ vultus. Mucous spots on the face.
10. Maculæ cutis fulvæ. Tawny blots on the skin.
11. Canities. Grey hairs.
12. Callus. Callus.
13. Cataracta. Cataract.
14. lnnutritio ossium. Innutrition of the bones.
15. Rachitis. Rickets.
16. Spina distortio. Distortion of the spine.
17. Claudicatio coxaria. Lameness of the hip.
18. Spina protuberans. Protuberant spine.
19. Spina bifida. Divided spine.
30. Defectus palati. Defect of the palate.
GENUS III.
With decreased Actions of the Absorbent System.
SPECIES.
1. Mucus faucium frigidus. Cold mucus from the throat.
2. Sudor frigidus. - sweat.
3. Catarrhus frigidus. - catarrh.
4. Expectoratio frigida. - expectoration.
5. Urina uberior pallida. Copious pale urine.
6. Diarrhœa 

CLASS I. 2. 3.] OF IRRITATION. 9
6. Diarrhœa frigida. Cold diarrhœa.
7. Fluor albus frigidus. - fluor albus.
8. Gonorrhœa frigida. - gonorrhœa.
9. Hepatis tumor. Swelling of the liver.
10. Chlorosis. Green sickness.
11. Hydrocele. Dropsy of the vagina testis.
12. Hydrocephalus internus. - of the brain. 
13. Ascites. - of the belly.
14. Hydrothorax. - of the chest.
15. Hydrops ovarii. - of the ovary.
16. Anasarca pulmonum. - of the lungs.
17. Obesitas. Corpulency.
18. Splenis tumor. Swelling of the spleen.
19. Genu tumour albus. White swelling of the knee.
20. Bronchocele. Swelled throat.
21. Scrophula. King's evil.
22. Schirrus. Schirrus.
23. - recti. - of the rectum.
24. - urethræ. - of the urethra.
25. - æsophagi. - of the throat.
26. Lacteorum inirritabili- 
tas.
Inirritability of the lacteals. 
27. Lymphaticorum inirita- 
bilitatis. 
Inirritability of the lym-
phatics.
GENUS

10 DISEASES [CLASS I. 2. 4.
GENUS IV.
With decreased actions of other Cavities and Membranes.
SPECIES.
I. Sitis calida. Thirst warm.
- frigida. - cold.
2. Esuries. Hunger.
3. Nausea sicca. Dry nausea.
4. Ægritudo ventriculi. Sickness of stomach.
5. Cardialgia. Heart-burn.
6. Arthritis ventriculi. Gout of the stomach.
7. Colica flatulenta. Flatulent colic.
8. Colica saturnina. Colic from lead.
9. Tympanitis. Tympany.
10. Hypochondriasis. Hypochondriacism.
11. Cepbalæa frigida. Cold head-ach.
12. Odontalgia. Tooth-ach.
13. Otalgia. Ear-ach.
14. Pleurodyne chronica. Chronical pain of the side.
15. Sciatica frigida. Cold sciatica.
16. Lumbago frigida. - lumbago.
17. Hysteralgia frigida. - pain of the uterus.
18. Proclalgia frigida. - pain of the rectum.
19. Vesicæ felleæ inirritibili- 
tas et icterus. 
Inirritability of the gall- 
bladder and jaundice.
GENUS

Class I. 1. 2.] OF IRRITATION. 11
GENUS V.
With decreased Actions of the Organs of Sense.
SPECIES.
1. Stultitia inirritabilis. Folly from inirritability. 
2. Visus imminutus. Impaired vision.
3. Muscæ volitantes. Dark moving specks.
4. Strabismus. Squinting.
5. Amaurosis. Palsy of the optic nerve.
6. Auditus imminutus. Impaired hearing. 
7. Olfactus imminutus. - smell.
8. Gustus imminutus. - taste. 
9. Taclus imminutus. - touch.
10. Stupor. Stupor.
ORDO III.
Retrograde Irritative Motions.
GENUS I.
Of the Alimentary Canal.
SPECIES.
1. Ruminatio. Chewing the cud.
2. Ructus. Eructation.
3. Apepsia. Indigestion, water-qualm.
4. Vomitus. Vomiting.
5. Cholera. Cholera.
6. Ileus. Iliac passion.
7. Globus hystericus. Hysteric strangulation.
8. Vomendi conamen inane. Vain efforts to vomit.
9. Barborigmus.

12 DISEASES [CLASS I. 2. 1.
9. Borborigmus. Gurgling of the bowels.
10. Hysteria. Hysteric disease.
11. Hydrophobia. Dread of water.
GENUS II.
Of the Absorbent System.
SPECIES.
1. Catarrhus lymphaticus. Lymphatic catarrh.
2. Salivatio lymphatica. Lymphatic salivation.
3. Nausea bumida. Moist nausea,
4. Diarrhœa lymphatica.Lymphatic flux.
5. Diarrhoea chylifera.Flux of chyle.
6. Diabœtes.Diabetes.
7. Sudor lymphaticus. Lymphatic sweat.
8. Sudor asthmaticus. Astmatic sweat.
9. Translatio puris.Translation of matter.
10. - lactis. - of milk.
11. - urinæ. - of urine.
GENUS III.
Of the Sanguiferous System.
SPECIES.
1. Capillarium motus re- Retrograde motion of the
trogressus.capillaries.
2. Palpitatio cordis. Palpitation of the heart.
3. Anhelatio spasmodica. Spasmodic panting.
CLASS 

CLASS I. 1. 1.] OF IRRITATION.
CLASS I.
DISEASE OF IRRITATION.
ORDO I.
Increased Irritation.
GENUS I.
With increased Actions of the Sanguiferous System.
THE irritability of the whole, or of part, of our sys-
tem is perpetually changing; these vicissitudes of irri-
tability and of inirritability are believed to depend on
the accumulation or exhaustion of the sensorial power,
as their proximate cause; and on the difference of the
present stimulus, and of that which we had previously
been accustomed to, as their remote cause. Thus a
smaller degree of heat produces pain and inflammation
in our hands, after they have been for a time immer-
sed in snow; which is owing to the accumulation of 
sensorial power in the moving fibres of the cutaneous
vessels during their previous quiescence, when they
were benumbed with cold. And we feel ourselves
cold in the usual temperature of the atmosphere on
coming out of a warm room; which is owing to the
exhaustion of sensorial power in the moving fibres of
the vessels of the skin by their previous increased ac-
tivity, into which they were excited by unusual heat.
Hence the cold sits of fever are the occasion of the
succeeding hot ones; and the hot fits contribute to
occasion

14 DISEASES [CLASS I. 1. 1.
occasion in their turn the succeeding cold ones. And
though the increase of stimulus, as of heat, exercise,
or distention, will produce an increased action of the
stimulated fibres; in the same manner as it is pro-
duced by the increased irritability which was occa-
sioned by a previous defect of stimulus; yet as the
excesses of irritation from the stimulus of external
things are more easily avoided than the deficiencies of
it; the diseases of this country, except those which
are the consequences of drunkenness, or of immode-
rate exercise, more frequently begin with torpor than
with orgasm; that is, with inactivity of some parts, or
of the whole of the system, and consequent coldness,
than with increased activity, and consequent heat.
If the hot fit be the consequence of the cold one,
it may be asked if they are proportionate to each
other: it is probable that they are, where no part is
destroyed by the cold fit, as in mortification or death.
But we have no measure to distinguish this, except
the time of their duration; whereas the extent of the
torpor over a greater or less part of the system, which
occasions the cold fit; or of the exertion which occa-
sions the hot one; as well as the degree of such tor-
por or exertion, are perhaps more material than the
time of their duration. Besides this some muscles are
less liable to accumulate sensorial power during their
torpor, than others, as the locomotive muscles com-
pared with the capillary arteries; on all which ac-
counts a long cold sit may often be followed by a
short hot one.
SPECIES.

CLASS I. 1. 1.] OF IRRITATION. 15
SPECIES.
1. Febris irritativa. Irritative fever. This is the
synocha of some writers: it is attended with strong
pulse without inflammation; and in this circumstance
differs from the febris inirritativa of Class I. 2. 1. 1.
which is attended with weak pulse without inflamma-
tion. The increased frequency of the pulsation of
the heart and arteries constitutes fever; during the
cold fit these pulsations are always weak, as the ener-
gy of action is then decreased throughout the whole
system; and therefore the general arterial strength
cannot be determined by the touch, till the cold part
of the paroxysm ceases. This determination is some-
times attended with difficulty; as strong and weak
are only comparative degrees of the greater or less re-
sistance of the pulsation of the artery to the compres-
sion of the finger. But the greater or less frequency
of the pulsations affords a collateral evidence in those
cases, where the degree of strength is not very distin-
guishable, which may assist our judgment concerning
it. Since a moderately strong pulse, when the pa-
tient is in a recumbent posture, and not hurried in
mind, seldom exceeds 120 strokes in a minute; where-
as a weak one often exceeds 130 in a recumbent pos-
ture, and 150 in an erect one, in those fevers, which
are termed nervous or putrid. See Sect. XII. 1. 4.
The increased frequency of the pulsation of the
heart and arteries, as it is occasioned either by excess
or defect of stimulus, or of sensorial power, exists both
in

16 DISEASES [CLASS I. 1. 1.
in the cold and hot fits of fever; but when the cold fit
ceases, and the pulse becomes strong and full as well as
quick, in consequence of the increased irritability of
the heart and arteries, it constitutes the irritative fe-
ver, or synocha. It is attended with considerable heat
during the paroxysm, and generally terminates in a
quarter of a lunation, without any disturbance of the
faculties of the mind. See Class IV. 1. 1. 8.
M. M. Venesection. Emetics. Cathartics. Cool
the patient in the hot fit, and warm him in the cold
one. Rest. Torpentia.
2. Ebrietas. Drunkenness. By the stimulus of
wine or opium the whole arterial system, as well as
every other part of the moving system, is excited into
increased action. All the secretions, and with them
the production of sensorial power itself in the brain,
seem to be for a time increased, with an additional
quantity of heat, and of pleasurable sensation. See
Sect. XXI. on this subject. This explains, why at
the commencement of the warm paroxysm of some
fevers the patient is in greater spirits, or vivacity;
because, as in drunkenness, the irritative motions are
all increased, and a greater production of sensation is
the consequence, which when in a certain degree, is
pleasurable, as in the diurnal fever of weak people.
Sect. XXXVI. 3. 1.
3. Hæmorrhagia arteriosa. Arterial hæmorrhage.
Bleeding with a quick, strong, and full pulse. The
2 hæmorrhages 

CLASS I. 1. 1.] OF IRRITATION. 17
hæmorrhages from the lungs, and from the nose, are
the most frequent of these; but it sometimes happens,
that a small artery but half divided, or the puncture
of a leech, will continue to bleed pertinaciously.
M. M. Venesection. Cathartic with calomel. Di-
vide the wounded artery. Bind sponge on the punc-
ture. If coffee or charcoal internally- If air with
less oxygen-
4. Hæmoptoe arteriosa. Spitting of arterial blood.
Blood spit up from the lungs is florid, because it has
just been exposed to the influence of the air in its pas-
sage through the extremities of the pulmonary ar-
tery; it is frothy, from the admixture of air with it
in the bronchia. The patients frequently vomit at
the same time from the disagreeable titillation of blood
about the fauces; and are thence liable to believe,
that the blood is rejected from the stomach.
Sometimes an hæmoptoe for several successive days
returns in gouty persons without danger, and seems
to supply the place of the gouty paroxysms. Is not
the liver always diseased previous to the hæmoptoe,
as in several other hæmorrhages- See Class I. a. 1. 9.
M. M. Venesection, a purge, a blister, diluents,
torpentia; and afterwards sorbentia, as the bark, the
acid of vitriol, and opium. An emetic is said to stop
a pulmonary hæmorrhage, which it may effect, as
sickness decreases the circulation, as is very evident
in the great sickness sometimes produced by too large
a dose of digitalis purpurea.
C Dr 

18 DISEASES [CLASS I. 1. 1.
Dr. Rush says, a table spoonful or two of common
salt is successful in hæmoptoe; this may be owing to
its stimulating the absorbent systems, both the lym-
phatic, and the venous. Should the patient respire
air with less oxygen- or be made sick by whirling
round in a chair suspended by a rope- One immersion
in cold water, or a sudden sprinkling all over with
cold water, would probably stop a pulmonary hæmor-
rhage. See Sect. XXVII. I.
5. Hæmorrhagia narium. Epistaxis. Bleeding at
the nose in elderly subjects most frequently attends
those, whose livers are enlarged or inflamed by the
too frequent use of fermented liquors.
In boys it occurs perhaps simply from redundancy
of blood; and in young girls sometimes precedes the
approach of the catamenia; and then it shews a dis-
position contrary to chlorosis; which arises from a de-
ficiency of red blood.
M. M. It is stopped by plunging the head into
cold water, with powdered salt hastily dissolved in it;
or sometimes by lint strewed over with wheat flour
put up the nostrils; or by a solution of steel in bran-
dy applied to the vessel by means of lint. The cure
in other respects as in hæmoptoe; when the bleeding
recurs at certain periods, after venesection, and eva-
cuation by calomel, and a blister, the bark and steel
must be given, as in intermittent fevers. See Section
XXVII. 1.
ORDO 

CLASS I. 1. 2.] OF IRRITATION. 19
ORDO I.
Increased Irritation.
GENUS II.
With increased Actions of the Secerning System.
THESE are always attended with increase of partial
or of general heat; for the secreted fluids are not sim-
ply separated from the blood, but are new combina-
tions; as they did not previously exist as such in the
blood vessels. But all new combinations give out
heat chemically; hence the origin of animal heat,
which is always increased in proportion to the secre-
tion of the part affected, or to the general quantity of
the secretions. Nevertheless there is reason to be-
lieve, that as we have a purposely to distinguish
the presence of greater or less quantities of heat, as
mentioned in Sect. XIV. 6. so we may have certain
minute glands for the secretion of this fluid, as the
brain is believed to secrete the sensorial power, which
would more easily account for the instantaneous pro-
duction of the blush of shame, and of anger. This
subject deserves further investigation.
SPECIES.
1. Calor febrilis. The heat in fevers arises from
the increase of some secretion, either of the natural
fluids, as in irritative fevers; or of new fluids, as in
infectious fevers; or of new vessels, as in inflammatory
fevers. The pain of heat is a consequence of the in-
C2 creased 

20 DISEASES [CLASS I. 1. 2.
creased extension or contraction of the fibres exposed
to so great a stimulus. See CLASS I. 1. 5. 6.
2. Rubor febrilis. Febrile redness. When the
cold fit of fever terminates, and the pulsations of the
heart and arteries become strong as well as quick
from the increase of their irritability after their late
quiescence, the blood is impelled forwards into the
fine extremities of the arteries, and the anastomozing
capillaries, quicker than the extremities of the veins
can absorb and return it to the heart. Hence the
pulse at the wrist becomes full, as well as quick and
strong, and the skin glows with arterial blood, and the
veins become empty and less visible.
In elderly people the force of the heart and arte-
ries become less, while the absorbent power of the
veins remain the same; whence the capillary vessels
part with the blood, as soon as it is received, and the
skin in consequence becomes paler; it is also probable,
that in more advanced life some of the finer branches
of the arteries coalesce, and become impervious, and
thus add to the opacity of the skin.
3. Sudor calidus. Warm sweat may be divided
into four varieties, according to their remote causes.
First, the perspirable matter is secreted in as great
quantity during the hot fit of fever, as towards the
end of it, when the sweat is seen upon the skin. But
during the hot fit the cutaneous absorbents act also
with increased energy, and the exhalation is likewise
increased 

Class I. 1. 2.] OF IRRITATION. 21
increased by the greater heat of the skin; and hence
it does not appear in drops on the surface, but is in
part reabsorbed, and in part dissipated in the atmo-
sphere. But as the mouths of the cutaneous absor-
bents are exposed to the cool air or bedclothes; whilst
those of the capillary glands, which secrete the per-
spirable matter, are exposed to the warmth of the cir-
culating blood; the former, as soon as the fever-fit
begins to decline, lose their increased action first; and
hence the absorption of the sweat is diminished, whilst
the increased secretion of it continues for some hours
afterwards, which occasions it to stand in drops upon
the skin.
As the skin becomes cooler, the evaporation of the
perspirable matter becomes less, as well as the absorp-
tion of it. And hence the dissipation of aqueous fluid
from the body, and the consequent thirst, are per-
haps greater during the hot fit, than during the sub-
sequent sweat. For the sweats do not occur, accord-
ing to Dr. Alexander's experiments, till the skin is
cooled from 112 to 108 degrees of heat; that is, till
the paroxysm begins to decline. From this it ap-
pears, that the sweats are not critical to the hot fit,
any more than the hot fit can be called critical to the
cold one; but simply, that they are the natural con-
sequence of the decline of the hot fit, commencing
with the decreased action of the absorbent system, and
the decreased evaporation from the skin. And from
hence it may be concluded, that a fever-fit is not in
general an effort of nature to restore health, as Sy-
denham considered it, but a necessary consequence of
C3 the 

22 DISEASES [CLASS I. 1. 2.
the previous torpor; and that the causes of fevers
would be less detrimental, if the fever itself could be
prevented from existing; as appears in the cool treat-
ment of the small-pox.
It must be noted that the profuse sweats on the skin
are more frequent at the decline of fever-fits than the
copious urine, or loose stools, which are mentioned be-
low; as the cutaneous absorbents, being exposed to
the cool air, lose their increased action sooner than the
urinary or intestinal absorbents; which open into the
warm cavities of the bladder and intestines; but which
are nevertheless often affected by their sympathy with
the cutaneous absorbents. Hence few fevers termi-
nate without a moisture of the skin; whence arose
the fatal practice of forcing sweats by the external
warmth of air or bedclothes in fevers; for external
warmth increases the action of the cutaneous capilla-
ries more than that of the other secerning vessels;
because the latter are habituated to 98 degrees of
heat, the internal warmth of the body; whereas the
cutaneous capillaries being nearer the surface are ha-
bitually kept cooler by the contact of the external
air. Sweats thus produced by heat in confined rooms
are still more detrimental; as the air becomes then
not only deprived of a part of its oxygene by fre-
quent respiration, but is loaded with animal effluvia
as well as with moisture, till it can receive no more;
and in consequence, while the cutaneous secretion
stands upon the skin in drops for want of exhalation,
the lungs are exposed to an insalubrious atmosphere.
I do

CLASS I. 1. 2.] OF IRRITATION. 23
I do not deny, that sweating may be so managed as
to be serviceable in preventing the return of the cold
paroxysm of fevers; like the warm bath, or any other
permanent stimulus, as wine, or opium, or the bark.
For this purpose it should be continued till past the
time of the expected cold fit, supported by moderate
doses of wine-whey, with spirit of hartshorn, and mo-
derate degrees of warmth. Its salutary effect, when
thus managed, was probably one cause of its having
been so much attended to; and the fetid smell, which
when profuse is liable to accompany it, gave occasion
to the belief, that the supposed material cause of the
disease was thus eliminated from the circulation.
When too great external heat is applied, the system
is weakened by excess of action, and the torpor which
causes the cold paroxysm recurs sooner and more vio-
lently. For though some stimuli, as of opium and
alcohol, at the same time that they exhaust the senso-
rial power by promoting increase of fibrous action,
may also increase the production or secretion of it in
the brain, yet experience teaches us, that the exhaus-
tion far out-balances the increased production, as is
evinced by the general debility, which succeeds in-
toxication.
In respect to the fetor attending copious continued
sweats, it is owing to the animalized part of this fluid
being kept in that degree of warmth, which most fa-
vours putrefaction, and not suffered to exhale into the
atmosphere. Broth, or other animal mucus, kept in
similar circumstances, would in the same time acquire
C4 a putrid 

24 DISEASES [CLASS I. 1. 2.
a putrid smell; yet has this error frequently produced
miliary eruptions, and increased every kind of inflam-
matory or sensitive fever.
The ease, which the patient experiences during
sweating, if it be not produced by much external heat,
is similar to that of the warm bath; which by its sti-
mulus applied to the cutaneous vessels, which are ge-
nerally cooler than the internal parts of the system,
excites them into greater action; and pleasurable sen-
sation is the consequence of these increased actions of
the vessels of the skin. From considering all these
circumstances, it appears that it is not the evacuation
by sweats, but the continued stimulus, which causes
and supports those sweats, which is serviceable in pre-
venting the returns of fever-fits. And that sweats too
long continued, or induced by too great stimulus of
warmth, clothes, or medicines, greatly injure the pa-
tient by increasing inflammation, or by exhausting the
sensorial power. See Class I. 1. 2. 14.
Secondly, The sweats produced by exercise or labour
are of the warm kind; as they originate from the in-
creased action of the capillaries of the skin, owing to
their being more powerfully stimulated by the greater
velocity of the blood, and by a greater quantity of
it passing through them in a given time. For the
blood during violent exercise is carried forwards by
the action of the muscles faster in the arteries, than it
can be taken up by the veins; as appears by the red-
ness of the skin. And from the consequent sweats, it
is evinced, that the secretory vessels of the skin du-
ring 

CLASS I. 1. 2.] OF IRRITATION. 25
ring exercise pour out the perspirable matter faster,
than the mouths of the absorbent vessels can drink it
up. Which mouths are not exposed to the increased
muscular action, or to the stimulus of the increased
velocity and quantity of the blood, but to the cool
air.
Thirdly, The increased secretion of perspirable mat-
ter occasioned by the stimulus of external heat be-
longs likewise to this place; as it is caused by the in-
creased motions of the capillary vessels; which thus
separate from the blood more perspirable matter, than
the mouths of their correspondent absorbent vessels
can take up; though these also are stimulated by ex-
ternal heat into more energetic action. If the air be
stationary, as in a small room, or bed with closed cur-
tains, the sweat stands in drops on the skin for want
of a quicker exhalation proportioned to the quicker
secretion.
A fourth variety of warm perspiration is that occa-
sioned by stimulating drugs, of which opium and alco-
hol is the most powerful; and next to these the
spices, volatile alkali, and neutral salts, especially sea
salt; that much of the aqueous part of the blood is
dissipated by the use of these drugs, is evinced by the
great thirst, which occurs a few hours after the use
of them. See Art. III. 2. 12. and Art. III. 2. 1.
We may from hence understand, that the increase
of this secretion of perspirable matter by artificial
means, must be followed by debility and emaciation.
When this is done by taking much salt, or salted meat,
the 

26 DISEASES [CLASS I. 1. 2.
the sea-scurvy is produced; which consists in the inir-
ritability of the bibulous terminations of the veins
arising from the capillaries; see Class I. 2. 1. 14.
The scrophula, or inirritability of the lymphatic
glands, seems also to be occasionally induced by an
excess in eating salt added to food of bad nourish-
ment. See Class I. 2. 3. 21. If an excess of perspi-
ration is induced by warm or stimulant clothing, as by
wearing flannel in contact with the skin in the summer
months, a perpetual febricula is excited, both by the
preventing the access of cool air to the skin, and by
perpetually goading it by the numerous and hard
points of the ends of the wool; which when applied
to the tender skins of young children, frequently
produce the red gum, as it is called; and in grown
people, either an erysipelas, or a miliary eruption,
attended with fever. See Class II. 1. 3. 12.
Shirts made of cotton or calico stimulate the skin
too much by the points of the fibres, though less
than flannel; whence cotton handkerchiefs make the
nose sore by frequent use. The fibres of cotton are,
I suppose, ten times shorter than those of flax, and
the number of points in consequence twenty times
the number; and though the manufacturers singe
their calicoes on a red-hot iron cylinder, yet I have
more than once seen an erysipelas induced or increa-
sed by the stimulus of calico, as well as of flannel.
The increase of perspiration by heat either of
clothes, or of fire, contributes much to emaciate the
body; as is well known to jockeys; who, when they
are

CLASS I. 1. 2.] OF IRRITATION. 27
are a stone or two too heavy for riding, find the
quickest way to lessen their weight is by sweating
themselves between blankets in a warm room; but
this likewise is a practice by no means to be recom-
mended, as it weakens the system by the excess of
so general a stimulus, brings on a premature old age,
and shortens the span of life; as may be further
deduced from the quick maturity, and shortness of
the lives, of the inhabitants of Hindostan, and other
tropical climates.
M. Buffon made a curious experiment to shew this
circumstance. He took a numerous brood of the but-
terflies of silkworms, some hundreds of which left
their eggs on the same day and hour; these he divi-
ded into two parcels; and placing one parcel in the
south window, and the other in the north window of
his house, he observed, that those in the colder situa-
tion lived many days longer than those in the warmer
one. From these observations it appears, that the
wearing of flannel clothing next the skin, which is
now so much in fashion, however useful it may be in
the winter to those, who have cold extremities, bad
digestions, or habitual coughs, must greatly debilitate
them, if worn in the warm months, producing fevers,
eruptions, and premature old age. See Sect. XXXVII.
5. Class I. 1. 2. 14. Art. III. 2. 1.
4. Urina uberior colorata. Copious coloured urine.
Towards the end of fever-fits a large quantity of high
coloured urine is voided, the kidneys continuing to act
strongly,

28 DISEASES [CLASS I. 1. 2.
strongly, after the increased action of the absorbents
of the bladder is somewhat diminished. If the absorb-
ents continue also to act strongly, the urine is higher
coloured, and so loaded as to deposit, when cool, an
earthy sediment, erroneously thought to be the mate-
rial cause of the disease; but is simply owing to the
secretion of the kidneys being great from their in-
creased action; and the thinner parts of it being ab-
sorbed by the increased action of the lymphatics,
which are spread very thick on the neck of the blad-
der; for the urine, as well as perhaps all the other
secreted fluids, is produced from the kidneys in a very
dilute state; as appears in those, who from the stimu-
lus of a stone, or other cause, evacuate their urine
too frequently; which is then pale from its not having
remained in the bladder long enough for the more
aqueous part to have been reabsorbed. The general
use of this urinary absorption to the animal œconomy
is evinced from the urinary bladders of fish, which
would otherwise be unnecessary. High coloured urine
in large quantity shews only, that the secreting vessels
of the kidneys, and the absorbents of the bladder,
have acted with greater energy. When there is much
earthy sediment, it shews, that the absorbents have
acted proportionally stronger, and have consequently
left the urine in a less dilute state. In this urine the
transparent sediment or cloud is mucous; the opake
sediment is probably coagulable lymph from the blood
changed by an animal or chemical process. The float-
ing scum is oil. The angular concretions to the sides
of

CLASS I. 1. 2.] OF IRRITATION. 29
of the pot, formed as the urine cools, is microcosmic
salt. Does the adhesive blue matter on the sides of
the glass, or the blue circle on it at the edge of the
upper surface of the urine, consist of Prussian blue-
5. Diarrhœa calida. Warm diarrhœa. This spe-
cies may be divided into three varieties deduced from
their remote causes, under the names of diarrhœa fe-
brilis, diarrhœa crapuloso, and diarrhœa infantum.
The febrile diarrhœa appears at the end of fever-fits,
and is erroneously called critical, like the copious
urine, and the sweats; whereas it arises from the in-
creased action of those secerning organs, which pour
their fluids into the intestinal canal (as the liver,
pancreas, and mucous glands), continuing longer than
the increased action of the intestinal absorbents. In
this diarrhœa there is no appearance of curdled chyle
in the stools, as occurs in cholera. I. 3. 1. 5.
The diarrhœa crapulosa, or diarrhœa from indiges-
tion, occurs when too great a quantity of food or li-
quid has been taken; which not being completely di-
gested, stimulates the intestines like any other extra-
neous acrid material; and thus produces an increase
of the secretions into them of mucus, pancreatic juice,
and bile. When the contents of the bowels are still
more stimulant, as when drastic purges, or very pu-
trescent diet, have been taken, a cholera is induced.
See Sect. XXIX. 4.
The diarrhœa infantum, or diarrhœa of infants, is
generally owing to too great acidity in their bowels.
Milk

30 DISEASES [CLASS I. 1. 2.
Milk is found curdled in the stomachs of all animals,
old as well as young, and even of carnivorous ones,
as of hawks. (Spallanzani.) And it is the gastric
juice of the calf, which is employed to curdle milk in
the process of making cheese. Milk is the natural
food for children, and must curdle in their stomachs
previous to digestion; and as this curdling of the milk
destroys a part of the acid juices of the stomach, there
is no reason for discontinuing the use of it, though it
is occasionally ejected in a curdled state. A child of
a week old, which had been taken from the breast of
its dying mother, and had by some uncommon error
been suffered to take no food but water-gruel, be-
came sick and griped in twenty-four hours, and was
convulsed on the second day, and died on the third!
When all young quadrupeds, as well as children, have
this natural food of milk prepared for them, the ana-
logy is so strong in favour of its salubrity, that a per-
son should have powerful testimony indeed of its disa-
greeing, before he advises the discontinuance of the
use of it to young children in health, and much more
so in sickness. The farmers lose many of their calves,
which are brought up by gruel, or gruel and old
milk; and among the poor children of Derby, who
are thus fed, hundreds are starved into the scrophula,
and either perish, or live in a state of wretched debility.
When young children are brought up without a
breast, they should for the first two months have no
food but new milk; since the addition of any kind of
bread or flour is liable to ferment, and produce too
much

CLASS I. 1. 2.] OF IRRITATION. 31
much acidity; as appears by the consequent diarrhœa
with green dejections and gripes; the colour is owing
to a mixture of acid with the natural quantity of bile,
and the pain to its stimulus. And they should never
be fed as they lie upon their backs, as in that posture
they are necessitated to swallow all that is put into
their mouths; but when they are fed, as they are sit-
ting up, or raised up, when they have had enough,
they can permit the rest to run out of their mouths.
This circumstance is of great importance to the health
of those children, who are reared by the spoon, since
if too much food is given them, indigestion, and
gripes, and diarrhœa, is the consequence; and if too
little, they become emaciated; and of this exact quan-
tity their own palates judge the best.
M. M. In this last case of the diarrhœa of children,
the food should be new milk, which by curdling de-
stroys part of the acid, which coagulates it. Chalk
about four grains every six hours, with one drop of
spirit of hartshorn, and half a drop of laudanum. But
a blister about the size of a shilling is of the greatest
service by restoring the power of digestion. See Ar-
ticle III. 2. 1. in the subsequent Materia Medica.
6. Salivatio calida. Warm salivation. Increased
secretion of saliva. This may be effected either by
stimulating the mouth of the gland by mercury taken
internally; or by stimulating the excretory duct of the
gland by pyrethrum, or tobacco; or simply by the
movement of the muscles, which lie over the gland,
as

32 DISEASES [CLASS I. 1. 2.
as in masticating any tasteless substance, as a lock of
wool, or mastic.
In about the middle of nervous fevers a great spitting
of saliva sometimes occurs, which has been thought cri-
tical; but as it continues sometimes two or even three
weeks without the relief of the patient, it may be
concluded to arise from some accidental circumstance,
perhaps not unsimilar to the hysteric ptyalisms men-
tioned in Class I. 3. 2. 2. See Sect. XXIV.
M. M. Cool air, diluents, warm bath, evacuations.
7. Catarrhus calidus. Warm catarrh. Consists in
an increased secretion of mucus from the nostrils with-
out inflammation. This disease, which is called a cold
in the head, is frequently produced by cold air acting
for some time on the membranes, which line the nos-
trils, as it passes to the lungs in respiration. Whence
a torpor of the action of the mucous glands is first
introduced, as in I. 2. 3. 3. and an orgasm or increased
action succeeds in consequence. Afterwards this or-
gasm and torpor are liable to alternate with each
other for some time like the cold and hot fits of ague,
attended with deficient or exuberant secretion of mu-
cus in the nostrils.
At other times it arises from reverse sympathy with
some extensive parts of the skin, which have been ex-
posed too long to cold, as of the head, or feet. In
consequence of the torpor of these cutaneous capilla-
ries those of the mucous membrane of the nostrils act
with greater energy by reverse sympathy; and thence
I secrete

CLASS I. 1.2.] OF IRRITATION. 33
secrete more mucus from the blood. At the same
time the absorbents, acting also with greater energy
by their reverse sympathy with those of some distant
part of the skin, absorb the thinner parts of the mucus
more hastily; whence the mucus is both thicker and
in greater quantity. Other curious circumstances at-
tend this disease; the membrane becomes at times so
thickened by its increased action in secreting the mu-
cus, that the patient cannot breathe through his nos-
trils. In this situation if he warms his whole skin
suddenly by fire or bed-clothes, or by drinking warm
tea, the increased action of the membrane ceases by
its reverse sympathy with the skin; or by the retrac-
tion of the sensorial power to other parts of the sys-
tem; and the patient can breathe again through the
nostrils. The same sometimes occurs for a time on
going into the cold air by the deduction of heat from
the mucous membrane, and its consequent inactivity
or torpor. Similar to this when the face and breast
have been very hot and red, previous to the eruption
of the small-pox by inoculation, and that even when
exposed to cool air, I have observed the feet have
been cold; till on covering them with warm flannel,
as the feet have become warm, the face has cooled.
See Sect. XXXV. 1. 3. Class II. 1. 3. 5. IV. 2. 2. 10.
IV. I. 1. 5.
M. M. Evacuations, abstinence, oil externally on
the nose, warm diluent fluids, warm shoes, warm night-
cap.
D 8. Expec- 

34 DISEASES [CLASS I. 1. 2.
8. Expectoratio calida. Warm expectoration con-
sists of the increased secretion of mucus from the mem-
brane, which lines the bronchiæ, or air-cells of the
lungs, without inflammation. This increased mucus is
ejected by the action of coughing, and is called a cold,
and resembles the catarrh of the preceding article;
with which it is frequently combined.
M. M. Inhale the steam of warm water, evacua-
tions, warm bath, afterwards opium, sorbentia.
9. Exsudatio pone aures. A discharge behind the
ears. This chiefly affects children, and is a morbid se-
cretion; as appears from its fetor; for if it was owing
to defect of absorption, it would be saline, and not
fetid; if a morbid action has continued a consider-
able time, it should not be stopped too suddenly; since
in that case some other morbid action is liable to suc-
ceed in its stead. Thus children are believed to have
had cholics, or even convulsions, consequent to the too
sudden healing of these morbid effusions behind their
ears. The rationale of this is to be explained from a
medical fact, which I have frequently observed; and
that is, that a blister on the back greatly strengthens
the power of digestion, and removes the heart-burn in
adults, and green stools in children. The stimulus of
the blister produces sensation in the vessels of the skin;
with this additional sensorial power these vessels act
more strongly; and with these the vessels of the in-
ternal membranes of the stomach and bowels act with
greater energy from their direct sympathy with them.
Now

CLASS I. 1. 2.] OF IRRITATION. 35
Now the acrid discharge behind the ears of children
produces sensation on that part of the skin, and so far
acts as a small blister. When this is suddenly stopped,
a debility of the digestive power of the stomach suc-
ceeds from the want of this accustomed stimulus, with
flatulency, green stools, gripes, and sometimes conse-
quent convulsions. See Class II. 1. 5. 6. and II.
1. 4. 6.
M. M. If the matter be absorbed, and produces
swelling of the lymphatics of the neck, it should be
cured as soon as possible by dusting the part with
white lead, cerussa, in very fine powder; and to pre-
vent any ill consequence an issue should be kept for
about a month in the arm; or a purgative medicine
should be taken every other day for three or four
times, which should consist of a grain of calomel, and
three or four grains of rhubarb, and as much chalk.
If there be no appearance of absorption, it is better
only to keep the parts clean by washing them with
warm water morning and evening; or putting fuller's
earth on them; especially till the time of toothing is
past. The tinea, or scald head, and a leprous erup-
tion, which often appears behind the ears, are differ-
ent diseases.
10. Gonorrhœa calida. Warm gleet. Increased
discharge of mucus from the urethra or prostate gland
without venereal desire, or venereal infection. See
Class I. 2. 3. 8.
D2 M. M. Can- 

36 DISEASES [CLASS I. 1. 2.
M. M. Cantharides, balsams, rhubarb, blister is
perinæum, cold bath, injections of metallic salts, flan-
nel shirt, change of the form of the accustomed chair
or saddle of the patient.
11. Fluor alius calidus. Warm fluor albus. In-
creased secretion of mucus in the vagina or uterus
without venereal desire or venereal infection. It is
distinguished from the fluor albus frigidus by the in-
creased of warmth in the part, and by the great-
er opacity or spissitude of the material discharged; as
the thinner parts are reabsorbed by the increased ac-
tion of the absorbents, along with the saline part,
whence no smarting or excoriation attends it.
M. M. Mucilage, as isinglass, hartshorn jelly, gum
arable. Ten grains of rhubarb every night. Callico
or flannel shift, opium, balsams. See Class I. 2. 3. 7.
12. Hæmorrhois alba. White piles. An increased
discharge of mucus from the rectum frequently mista-
ken for matter; is said to continue a few weeks, and
recur like the bleeding piles; and to obey lunar in-
fluence. See Class I. 2. 1. 6.
M. M. Abstinence from vinous spirit. Balsam of
copaiba. Spice swallowed in large fragments, as ten
or fifteen black pepper-corns cut in half, and taken
after dinner and supper. Ward's paste, consisting of
black pepper and the powdered root of Helenium
Enula
13. Serum 

CLASS I. 1. 2.] OF IRRITATION. 37
13. Serum e vesicatorio. Discharge from a blister.
The excretory ducts of glands terminate in mem-
branes, and are endued with great irritability, and ma-
ny of them with sensibility; the latter perhaps in con-
sequence of their facility of being excitable into great
action; instances of this are the terminations of the
gall-duct in the duodenum, and of the salivary and la-
chrymal glands in the mouth and eye; which produce
a greater secretion of their adapted fluids, when the
ends of their excretory ducts are stimulated.
The external skin consists of the excretory ducts of
the capillaries, with the mouths of the absorbents;
when these are stimulated by the application of can-
tharides, or by a slice of the fresh root of bryonia alba
bound on it, the capillary glands pour an increased
quantity of fluid upon the skin by their increased
action; and the absorbent vessels imbibe a greater
quantity of the more fluid and saline part of it;
whence a thick mucous or serous fluid is deposited be-
tween the skin and cuticle.
14. Perspiratio fœtida. Fetid perspiration. The
uses of the perspirable matter are to keep the skin
soft and pliant, for the purposes of its easier flexibi-
lity during the activity of our limbs in locomotion,
and for the preservation of the accuracy of the 
of touch, which is diffused under the whole surface
of it to guard us against the injuries of external bo-
dies; in the same manner as the secretion of tears is
designed to preserve the cornea of the eye moist, and
D3 in 

38 DISEASES [CLASS I. 1. 2.
in consequence transparent; yet has this cutaneous
mucus been believed by many to be an excrement;
and I know not how many fanciful theories have
been built on its supposed obstruction. Such as the
origin of catarrhs, coughs, inflammations, erysipelas,
and herpes.
To all these it may be sufficient to answer, that the
ancient Grecians oiled themselves all over; that some
nations have painted themselves all over, as the Picts
of this island; that the Hottentots smear themselves
all over with grease. And lastly, that many of our
own heads at this day are covered with the flour of
wheat and the fat of hogs, according to the tyranny
of a filthy and wasteful fashion, and all this without
inconvenience. To this must be added the strict ana-
logy between the use of the perspirable matter and
the mucous fluids, which are poured for similar pur-
poses upon all the internal membranes of the body;
and besides its being in its natural state inodorous;
which is not so with the other excretions of feces, or
of urine.
In some constitutions the perspirable matter of the
lungs acquire a disagreeable odour; in others the axil-
la, and in others the feet, emit disgustful effluvia; like
the secretions of those glands, which have been called
odoriferæ; as those, which contain the castor in the
beaver, and those within the rectum of dogs, the mu-
cus of which has been supposed to guard them against
the great costiveness, which they are liable to in hot
summers; and which has been thought to occasion
canine

CLASS I. 1. 2.] OF IRRITATION. 39.
canine madness, but which, like their white excre-
ment, is more probably owing to the deficient secre-
tion of bile. Whether these odoriferous particles at-
tend the perspirable matter in consequence of the in-
creased action of the capillary glands, and can pro-
perly be called excrementitious; that is, whether any
thing is eliminated, which could be hurtful if retain-
ed; or whether they may only contain some of the
essential oil of the animal; like the smell, which ad-
heres to one's hand on stroking the hides of some
dogs; or like the effluvia, which is left upon the
ground, from the feet of men and other creatures;
and is perceptible by the nicer organs of the dogs,
which hunt them, may admit of doubt.
M. M. Wash the parts twice a day with soap and
water; with lime water; cover the feet with oiled
silk socks, which must we washed night and morning.
Cover them with charcoal recently made red hot, and
beaten into fine powder and sifted, as soon as cold,
and kept well corked in a bottle, to be washed off,
and renewed twice a day. Internally rhubarb grains
vi. or viii. every night, so as to procure a stool or two
extraordinary every day, and thus by increasing one
evacuation to decrease another. Cool dress, diluting
liquids?
15. Crines novi. New hairs. The black points
on the faces of some people consist of mucus, which is
become viscid, and which adheres in the excretory
ducts of the glands of the skin; as described in Class
D4 I. 2. 2. 9.

40 DISEASES [CLASS I. 1. 2.
I. 2. 2. 9. and which maybe pressed out by the fin-
gers, and resembles little worms. Similar to this
would seem the fabrication of silk, and of cobweb by
the silk worm and spider; which is a secreted matter
pressed through holes, which are the excretory ducts
of glands. And it is probable, that the production
of hair on many parts of the body, and at different
periods of life, may be effected by a similar process;
and more especially as every hair may be considered
as a slender flexible horn, and is an appendage of the
skin. See Sect. XXXIX. 3. 2. Now as there is a
sensitive sympathy between the glands, which secrete
the semen, and the throat, as appears in the mumps;
see Hydrophobia, Class IV. 1. 2. 7. and Parotitis,
Class IV. 1. 2. 19. the growth of the beard at pu-
berty seems to be caused by the greater action of the
cutaneous glands about the chin and pubes in conse-
quence of their sympathy with those of the testes.
But this does not occur to the female sex at their time
of puberty, because the sensitive sympathy in them
seems to exist between the submaxillary glands, and
the pectoral ones; which secrete the milk, and afford
pleasure both by that secretion, and by the erection
of the mamulæ, or nipples; and by delivering the
milk into the mouth of the child; this sensitive sym-
pathy of the pectoral and submaxillary glands in wo-
men are also observable in the Parotitis, or mumps, as
above referred to.
When hairs grow on the face or arms so as to be
disagreeable, they may be thus readily removed with-
out

CLASS I. 1. 2.] OF IRRITATION. 41
out pain or any ill consequence. Warm the ends of
a pair of nippers or forceps, and stick on them a little
rosin, or burgundy pitch; by these means each single
hair may be taken fast hold of; and if it be then
plucked off slowly, it gives pain; but if plucked off
suddenly, it gives no pain at all; because the vis iner-
tiæ of the part of the skin, to which it adheres, is not
overcome; and it is not in consequence separated from
the cellular membrane under it. Some of the hairs
may return, which are thus plucked off, or others may
be induced to grow near them; but in a little time
they may be thus safely destroyed; which is much to
be preferred to the method said to be used in Tur-
key to eradicate hair; such as a mixture of orpiment
and quick lime; or of liver of sulphur in solution;
which injure the skin, if they are not very nicely ma-
naged; and the hair is liable to grow again as after
shaving; or to become white, if the roots of it have
been much inflamed by the causticity of the applica-
tion. See Class I. 2. 2. 11. on grey hairs.
ORDO 

42 DISEASES [CLASS I. 1. 3.
ORDO I.
Increased Irritation.
GENUS III.
With increased Actions of the Absorbent System.
THESE are not attended with so great increase of
heat as in the former genus, because the fluids pro-
bably undergo less chemical change in the glands of
the absorbent system; nor are the glands of the ab-
sorbent vessels so numerous or so extensive as those
of the secerning ones. Yet that some heat is pro-
duced by the increased action of the absorbents ap-
pears from the greater general warmth of the skin
and extremities of feeble patients after the exhibition
of the Peruvian bark, and other medicines of the ar-
ticle Sorbentia.
SPECIES.
1. Lingua arida. Dry tongue occurs in those fe-
vers, where the expired air is warmer than natural;
and happens to all those, who sleep with their mouths
open; the currents of air in respiration increasing the
evaporation. There is also a dryness in the mouth
from the increased action of the absorbent vessels,
when a sloe or a crab-apple is masticated; and after
the perspiration has been much increased by eating
salt or spice, or after other copious secretions; as
after drunkenness, cathartics, or fever fits, the mucus
of the mouth becomes viscid, and in small quantity,
from

CLASS I. 1. 3.] OF IRRITATION. 43
from the increased absorption, adhering to the tongue
like a white slough. In the diabetes, where the
thirst is very great, this slough adheres more pertina-
ciously, and becomes black or brown, being coloured
after a few days by our aliment or drink. The inspis-
sated mucus on the tongue of those, who sleep with
their mouths open, is sometimes reddened as if mixed
with blood, and sometimes a little blood follows the
expuition of it from the fauces owing to its great ad-
hesion. When this mucus adheres long to the pa-
pillæ of the tongue, the saliva, which it contains in
its interstices, like a sponge, is liable to become pu-
trid, and to acquire a bitter taste, like other putrid
animal substances; which is generally mistaken for an
indication of the presence of bile.
M. M. Warm subacid liquids. See Class I. 2. 5. 8.
2. Fauces aridœ. Dry throat. The expuition of
a frothy mucus with great and perpetual hawking
occurs in hydrophobia, and is very distressing to the
patient; which may be owing to the increased irri-
tability or sensibility of the upper part of the œso-
phagus, which will not permit any fluid to rest on it.
It affects some people after intoxication, when the
lungs remain slightly inflamed, and by the greater
heat of the air in expiration the mucus becomes too
hastily evaporated, and is expectorated with difficulty
in the state of white froth.
I knew a person, who for twenty years always
waked with his tongue and throat quite dry; so that
he

44 DISEASES [CLASS I. 1. 3.
he was necessitated to take a spoonful of water, as
soon as he awoke; otherwise a little blood always
followed the forcible expuition of the indurated mu-
cus from, his fauces. See Class II. 1. 3. 17.
M. M. Steel-springs fixed to the night-cap so as
to suspend the lower jaw and keep it closed; or
springs of elastic gum. Or a pot of water suspend-
ed over the bed, with a piece of list, or woollen
cloth, depending from it, and held in the mouth;
which will act like a syphon, and slowly supply mois-
ture, or barley water should be frequently syringed
into the mouth of the patient.
3. Nares aridi. Dry nostrils with the mucus har-
dening upon their internal surface, so as to cover
them with a kind of skin or scale, owing to the in-
creased action of the absorbents of this membrane;
or to the too great dryness of the air, which passes
into the lungs; or too great heat of it in its expi-
ration.
When air is so dry as to lose its transparency;
as when a tremulous motion of it can be seen over
corn fields in a hot summer's day; or when a dry
mist, or want of transparency of the air, is visible
in very hot weather; the of smell is at the
same time imperfect from the dryness of the mem-
brane, beneath which it is spread.
4. Expecloratio solida. Solid expectoration. The
mucus of the lungs becomes hardened by the increa-
sed

CLASS I. 1. 3.] OF IRRITATION. 45
sed absorption, so that it adheres and forms a kind of
lining in the air-cells, and is sometimes spit up in the
form of branching vessels, which are called polypi of
the lungs. See Transact. of the College, London.
There is a rattling or wheezing of the breath, but it
is not at first attended with inflammation.
The Cynanche trachealis, or Croup, of Dr. Cullen,
or Angina polyposa of Michaelis, if they differ from
the peripneumony of infants, seem to belong to this
genus. When the difficulty of respiration is great,
venesection is immediately necessary, and then an eme-
tic, and a blister. And the child should be kept nearly
upright in bed as much as may be. See Tonsillitis,
Class II. 1. 3. 3.
M. M. Diluents, emetics, essence of antimony, fœ-
tid gums, onions, warm bath for half an hour every
day for a month. Inhaling the steam of water, with
or without volatile alkali. Soap.
5. Constipatio alvi. Costiveness from increased ac-
tion of the intestinal absorbents. The feces are har-
dened in lumps called scybala; which are sometimes
obliged to be extracted from the rectum with a kind
of marrow spoon. This is said to have happened
from the patient having taken much rust of iron.
The mucus is also hardened so as to line the intes-
tines, and to come away in skins, rolled up as they
pass along, so as to resemble worms, for which they
are frequently mistaken; and sometimes it is evacua-
ted in still larger pieces, so as to counterfeit the form
of

46 DISEASES [CLASS I. 1. 3.
of the intestines, and has been mistaken for a por-
tion of them. Balls of this kind, nearly as heavy as
marble, and considerably hard, from two inches to
five in diameter, are frequently found in the bowels
of horses. Similar balls found in goats have been
called Bezoar.
M. M. Cathartics, diluents, fruit, oil, soap, sul-
phur, warm bath. Sprinkling with cold water, cool
clothing. See Class I. 2. 4. 18.
6. Cutis arida. Dry Skin. This dry skin is not
attended with coldness as in the beginning of fever-
fits. Where this cutaneous absorption is great, and
the secreted material upon it viscid, as on the hairy
scalp, the skin becomes covered with hardened mucus;
which adheres so as not to be easily removed, as the
scurf on the head; but is not attended with inflamma-
tion like the Tinea, or Lepra. The moisture, which
appears on the skin beneath resinous or oily plasters,
or which is seen to adhere to such plasters, is owing
to their preventing the exhalation of the perspirable
matter, and not to their increasing the production of
it, as some have idly imagined.
M. M. Warm bathing, oil externally, oil-skin
gloves, resinous plasters. Wax.
7. Urina parca colorata. Diminished urine, which
is high coloured, and deposits an earthy sediment,
when cold, is owing to the great action of the urinary
absorbents. See Class I. 1. 2. 4. In some dropsies
the

CLASS I. 1. 3.] OF IRRITATION. 47
the cutaneous absorbents are paralytic, as well as
those opening into the cellular membrane; and hence,
no moisture being acquired from the atmosphere, or
from the cellular membrane, great thirst is excited;
and great absorption from all parts, where the ab-
sorbents are still capable of action. Hence the urine is
in very small quantity, and of deep colour, with copi-
ous sediment; and the kidneys are erroneously blamed
for not doing their office; stimulant diuretic medi-
cines are given in vain; and very frequently the un-
happy patient is restrained from quenching his thirst,
and dies a martyr to false theory.
M. M. Diluent liquids, and warm bathing, are the
natural cure of this symptom; but it generally at-
tends those dropsies, which are seldom curable; as
they are owing to a paralysis both of the cutaneous
and cellular lymphatics.
8. Calculus felleus. Gall-stone. From the too
hasty absorption of the thinner parts of the bile, the
remainder is left too viscid, and crystallizes into
lumps; which, if too large to pass, obstruct the duc-
tus choledochus, producing pain at the pit of the sto-
mach, and jaundice. When the indurated bile is not
harder than a boiled pea, it may pass through the
bile-duct with difficulty by changing its form; and
thus gives those pains, which have been called spasms
of the stomach; and yet these viscid lumps of bile may
afterwards dissolve, and not be visible among the fe-
ces.
In

48 DISEASES [CLASS I. 1. 3.
In two instances I have seen from thirty to fifty
gall-stones voided after taking an oil vomit as below.
They were about the size of peas, and distinguishable
when dry by their being inflammable like bad wax,
when put into the flame of a candle. For other causes
of jaundice, see Class I. 2. 4. 19.
M. M. Diluents, daily warm bathing. Ether mix-
ed with yolk of egg and water. Unboiled acrid ve-
getables, as lettuce, cabbage, mustard, and cresses.
When in violent pain, four ounces of oil of olives, or
of almonds, should be swallowed; and as much more
in a quarter of an hour, whether it stays or not.
The patient should lie on the circumference of a large
barrel, first on one side, and then on the other. Elec-
tric shocks through the gall-duct. Factitious Selter
water made by dissolving one dram of Sal Soda in a
pint of water; to half a pint of which made luke-
warm add ten drops of marine acid; to be drank as
soon as mixed, twice a day for some months. Opium
must be used to quiet the pain, if the oil does not
succeed, as two grains, and another grain in half an
hour if necessary. See Class IV. 2. 2. 4.
9. Calculus renis. Stone of the kidney. The pain
in the loins and along the course of the ureter from a
stone is attended with retraction of the testicle in men,
and numbness on the inside of the thigh in women.
It is distinguished from the lumbago or sciatica, as
these latter are seldom attended with vomiting, and
have pain on the outside of the thigh, sometimes quite
4 down

CLASS I. 1. 3.] OF IRRITATION. 49
down to the ankle or heel. See Herpes and Ne-
phritis.
Where the absorption of the thinner parts of the
secretion takes place too hastily in the kidneys, the
hardened mucus, and consequent calculous concre-
tions, sometimes totally stop up the tubuli uriniferi;
and no urine is secreted. Of this many die, who
have drank much vinous spirit, and some of them
recover by voiding a quantity of white mucus, like
chalk and water; and others by voiding a great
quantity of sand, or small calculi. This hardened
mucus frequently becomes the nucleus of a stone in
the bladder. The salts of the urine, called micro-
cosmic salt, are often mistaken for gravel, but are
distinguishable both by their angles of crystallization,
their adhesion to the sides or bottom of the pot,
and by their not being formed till the urine cools.
Whereas the particles of gravel are generally with-
out angles, and always drop to the bottom of the
vessel, immediately as the water is voided.
Though the proximate cause of the formation of
the calculous concretions of the kidneys, and of chalk-
stones in the gout, and of the insoluble concretions of
coagulable lymph, which are found on membranes,
which have been inflamed in peripneumony, or rheu-
matism, consists in the too great action of the absorb-
ent vessels of those parts; yet the remote cause in
these cases are probably owing to the inflammation of
the membranes; which at that time are believed to
secrete a material more liable to coagulate or concrete,
E than 

50 DISEASES [CLASS I. 1. 3.
than they would otherwise produce by increased ac-
tion alone without the production of new vessels,
which constitutes inflammation. As defined in Class
II. 1. 2.
The fluids secreted from the mucous membranes of
animals are of various kinds and consistencies. Hair,
silk, scales, horns, finger-nails, are owing to natural
processes. Gall-stones, stones found in the intestines
of horses, scurf of the skin in leprosy, stones of the
kidneys and bladder, the callus from the inflamed pe-
riosteum, which unites broken bones, the calcareous
cement, which repairs the injured shells of snails, the
calcareous crust on the eggs of birds, the annually re-
newed shells of crabs, are all instances of productions
from mucous membranes, afterwards indurated by ab-
sorption of their thinner parts.
All these concretions contain phosphoric acid, mu-
cus, and calcareous earth in different proportions;
and are probably so far analogous in respect to their
component parts as well as their mode of formation.
Some calcareous earth has been discovered after pu-
trefaction in the coagulable lymph of animals. For-
dyce's Elements of Practice. A little calcareous earth
was detected by Scheel or Bergman in the calculus of
the bladder with much phosphoric acid, and a great
quantity of phosphoric acid is shewn to exist in oyster-
shells by their becoming luminous on exposing them
a while to the sun's light after calcination; as in the
experiments of Wilson. Botanic Garden, P. 1. Canto
I. l. 182, note. The exchange of which phosphoric
acid

CLASS I. 1. 3.] OF IRRITATION. 51
acid for carbonic acid, or fixed air, converts shells into
limestone, producing mountains of marble, or calcare-
ous strata.
Now as the hard lumps of calcareous matter, term-
ed crabs' eyes, which are found in the stomachs of
those animals previous to the annual renewal of their
shells, are redissolved, probably by their gastric acid,
and again deposited for that purpose; may it not be
concluded, that the stone of the bladder might be dis-
solved by the gastric juice of fish of prey, as of crabs,
or pikes; or of voracious young birds, as young
rooks or hawks, or even of calves? Could not these
experiments be tried by collecting the gastric juice by
putting bits of sponge down the throats of young
crows, and retracting them by a string in the manner
of Spallanzani? or putting pieces of calculus down
the throat of a living crow, or pike, and observing if
they become digested? and lastly, could not gastric
juice, if it should appear to be a solvent, be injected
and born in the bladder without injury by means of
catheters of elastic resin, or caoutchouc?
M. M. Diluents. Cool dress. Frequent change
of posture. Frequent horizontal rest in the day.
Bathe the loins every morning with a sponge and cold
water. Aerated alkaline water internally. Absti-
nence from all fermented or spirituous liquors. What-
ever increases perspiration injures these patients, as it
dissipates the aqueous particles, which ought to dilute
the urine. When the constitution begins to produce
gravel, it may I believe be certainly prevented by a
E2 total 

52 DISEASES [CLASS I. 1. 3.
total abstinence from fermented or spirituous liquors;
by drinking much aqueous fluids; as toast and wa-
ter, tea, milk and water, lemonade; and lastly by
thin clothing, and sleeping on a hardish bed, that the
patient may not lie too long on one side. See Class
IV. 2. 2. 2. There is reason to believe, that the
daily use of opium contributes to produce gravel in the
kidneys by increasing absorption, when they are in-
flamed; in the same manner as is done by fermented
or spirituous liquor. See Class I. 3. 2. 11.
When the kidneys are so obstructed with gravel,
that no urine passes into the bladder; which is known
by the external appearance of the lower part of the
abdomen, which, when the bladder is full, seems as
if contracted by a cord between the navel and the
bladder; and by the tension on the region of the
bladder distinguishable by the touch; or by the intro-
duction of the catheter; the following methods of
cure are frequently successful. Venesection to six or
eight ounces, ten grains of calomel, and an infusion of
senna with salts and oil, every three hours, till stools
are procured. Then an emetic. After the patient
has been thus evacuated, a blister on the loins, should
be used; and from ten to twenty electric shocks should
be passed through the kidneys, as large as can he ea-
sily borne, once or twice a day. Along with this
method the warm bath should be used for an hour
once or twice a day. After repeated evacuations a
clyster, consisting of two drams of turpentine dissolved
by yolk of egg, and sixty drops of tincture of opium,
should

CLASS I. 1. 3.] OF IRRITATION. 53
should be used at night, and repeated, with cathartic
medicines interposed, every night, or alternate nights.
Aerated solution of alkali should be taken internally,
and balsam of copaiva, three or four times a day.
Some of these patients recover after having made no
water for nine or ten days.
If a stone sticks in the ureter with incessant vomit-
ing, ten grains of calomel must be given in small pills
as above; and some hours afterwards infusion of senna
and salts and oil, if it can be made to stay on the sto-
mach. And after the purge has operated four or
five times, an opiate is to be given, if the pain con-
tinues, consisting of two grains of opium. If this does
not succeed, ten or twenty electric shocks through the
kidneys should be tried, and the purgative repeated,
and afterwards the opiate. The patient should be fre-
quently put into the warm bath for an hour at a time.
Eighty or an hundred drops of laudanum given in a
clyster, with two drams of turpentine, is to be pre-
ferred to the two grains given by the stomach as
above, when the pain and vomiting are very urgent.
10. Calculus vesicæ. Stone of the bladder. The
nucleus, or kernel, of these concretions is always
formed in the kidney, as above described; and pas-
sing down the ureter into the bladder, is there per-
petually increased by the mucus and salts secreted
from the arterial system, or by the mucus of the blad-
der, disposed in concentric strata. The stones sound
in the bowels of horses are also formed on a nucleus,
E3 and 

54 DISEASES [CLASS I. 1.3.
and consist of concentric spheres; as appears in saw-
ing them through the middle. But as these are form-
ed by the indurated mucus of the intestines alone
without the urinary salts, it is probable a difference
would be found on their analysis.
As the stones of the bladder are of various degrees
of hardness, and probably differ from each other in
the proportions at least of their component parts;
when a patient, who labours under this afflicting dis-
ease, voids any small bits of gravel; these should be
kept in warm solutions of caustic alkali, or of mild
alkali well aerated; and if they dissolve in these solu-
tions, it would afford greater hopes, that that which
remains in the bladder, might be affected by these
medicines taken by the stomach, or injected into the
bladder.
To prevent the increase of a stone in the bladder
much diluent drink should be taken; as half a pint of
water warmed to about eighty degrees, three or four
times a day: which will not only prevent the growth
of it, by preventing any microcosmic salts from being
precipitated from the urine, and by keeping the mu-
cus suspended in it; but will also diminish the stone
already formed, by softening and washing away its
surface. To this must be added cool dress, and cool
bed-clothes, as directed above in the calculus renis.
When the stone is pushed against or into the neck
of the bladder, great pain is produced; this may
sometimes be relieved by the introduction of a bou-
gie to push the stone back into the fundus of the blad-
der

CLASS I. 1. 3.] OF IRRITATION. 55
der. Sometimes by change of posture, or by an opi-
ate either taken into the stomach, or by a clyster.
A dram of sal soda, or of salt of tartar, dissolved in
a pint of water, and well saturated with carbonic acid
(fixed air), by means of Dr. Nooth's glass-apparatus,
and drank every day, or twice a day, is the most effi-
cacious internal medicine yet discovered, which can
be easily taken without any general injury to the con-
stitution. An aerated alkaline water of this kind is
sold under the name of factitious Seltzer water, by J.
Schweppe, at N° 8, King's Street, Holborn, Lon-
don; which I am told is better prepared than can be
easily done in the usual glass-vessels, probably by em-
ploying a greater pressure in wooden ones.
Lythotomy is the last recourse. Will the gastric
juice of animals dissolve calculi- Will fermenting ve-
getable juices, as sweet-wort, or sugar and water in
the act of fermentation with yest, dissolve any kind
of animal concretions-
11. Calculus arthriticus. Gout-stones are formed
on inflamed membranes, like those of the kidneys
above described, by the too hasty absorption of the
thinner and saline parts of the mucus. Similar con-
cretions have been produced in the lungs, and even
in the pericardium; and it is probable, that the ossi-
fication, as it is called, of the minute arteries, which
is said to attend old age, and to precede some mor-
tifications of the extremities, may be a process of
this kind. 
E4 As

56 DISEASES [CLASS I. 1. 3.
As gout-stones lie near the surface, it is probable,
that ether, frequently applied in their early state,
might render them so liquid as to permit their re-
absorption; which the stimulus of the ether might
at the same time encourage.
12. Rheumatismus chronicus. Chronic rheumatism.
After the acute rheumatism some inspissated mucus,
or material similar to chalk-stones of the gout, which
was secreted on the inflamed membrane, is probably
left, owing to the too hasty absorption of the thin-
ner and saline part of it; and by lying on the fas-
cia, which covers some of the muscles, pains them,
when they move and rub against it, like any extra-
neous material.
The pain of the shoulder, which attends inflamma-
tions of the upper membrane of the liver, and the
pains of the arms, which attend asthma dolorificum,
or dropsy of the pericardium, are distinguished from
the chronic rheumatism, as in the latter the pain
only occurs on moving the affected muscles.
M. M. Warm bath, cold bath, bandage of em-
plastrum de minio put on tight, so as to compress
the part. Cover the part with flannel. With oiled
silk. Rub it with common oil frequently. With
ether. A blister. A warmer climate. Venesection.
A grain of calomel and a grain of opium for ten
successive nights. The Peruvian bark.
13. Cicatrix vulnerum. The fear after wounds.
In the healing of ulcers the matter is first thickened
by

CLASS I. 1. 3.] OF IRRITATION. 57
by increasing the absorption in them; and then lessen-
ed, till all the matter is absorbed, which is brought
by the arteries, instead of being deposited in the ulcer.
M. M. This is promoted by bandage, by the sor-
bentia externally, as powder of bark, white lead;
solution of sugar of lead. And by the sorbentia in-
ternally after evacuations. See Sect. XXXIII. 3. 2.
In those ulcers, which are made by the contact of
external fire, the violent action of the fibres, which
occasions the pain, is liable to continue, after the ex-
ternal heat is withdrawn. This should be relieved by
external cold, as of snow, salt and water recently mix-
ed, ether, or spirits of wine suffered to evaporate on
the part.
The cicatrix of an ulcer generally proceeds from
the edges of it; but in large ones frequently from
the middle, or commences in several places at the
same time; which probably contributes to the uneven-
ness of large scars.
14. Corneæ obfuscatio. Opacity of the cornea.
There are few people, who have passed the middle of
life, who have not at some time suffered some slight
scratches or injuries of the cornea, which by not heal-
ing with a perfectly smooth surface, occasion some re-
fractions of light, which may be conveniently seen in
the following manner: fill a tea-saucer with cream
and tea, or with milk, and holding it to your lips, as
if going to drink it, the imperfections of the cornea
will appear like lines or blotches on the surface of the
fluid,

58 DISEASES [CLASS I. 1. 3.
fluid, with a less white appearance than that surface.
Those blemishes of the eye are distinguished from the
muscæ volitantes described in Class I. 2. 5. 3. by their
being invariably seen at any time, when you look for
them.
Ulcers may frequently be seen on the cornea after
ophthalmy, like little pits or indentations beneath the
surface of it: in this case no external application
should be used, left the scar should be left uneven;
but the cure should be confined to the internal use of
thirty grains of bark twice a day, and from five to
ten drops of laudanum at night, with five grains of
rhubarb, if necessary.
After ulcers of the cornea, which have been large,
the inequalities and opacity of the cicatrix obscures
the sight; in this case could not a small piece of the
cornea be cut out by a kind of trephine about the
size of a thick bristle, or a small crow-quill, and would
it not heal with a transparent scar- This experiment
is worth trying, and might be done by a piece of hol-
low steel wire with a sharp edge, through which
might be introduced a pointed steel screw; the screw
to be introduced through the opake cornea to hold it
it up, and press it against the cutting edge of the hol-
low wire or cylinder; if the scar should heal without
losing its transparency, many blind people might be
made to see tolerably well by this slight and not pain-
ful operation. An experiment I wish strongly to re-
commend to some ingenious surgeon or oculist.
ORDO 

CLASS I. 1. 4.] OF IRRITATION. 59
ORDO I.
Increased Irritation.
GENUS IV.
With increased Actions of other Cavities and Membranes.
SPECIES.
1. Nictitatio irritativa. Winking of the eyes is
performed every minute without our attention, for the
purpose of cleaning and moistening the eye-ball; as
further spoken of in Class II. 1. 1. 8. When the
cornea becomes too dry, it becomes at the same time
less transparent; which is owing to the pores of it be-
ing then too large, so that the particles of light are
refracted by the edges of each pore, instead of passing
through it; in the same manner as light is refracted
by passing near the edge of a knife. When these
pores are filled with water, the cornea becomes again
transparent. This want of transparency of the cor-
nea is visible sometimes in dying people, owing to their
inirritability, and consequent neglect of nictitation.
The increase of transparency by filling the pores
with fluid is seen by soaking white paper in oil;
which from an opake body becomes very transpa-
rent, and accounts for a curious atmospheric phe-
nomenon; when there exists a dry mist in a morning
so as to render distant objects less distinct, it is a
sign of a dry day; when distant objects are seen
very

60 DISEASES [CLASS I. 1. 4.
very distinct, it is a sign of rain. See Botan. Garden,
Part I. add. note xxv. The particles of air are pro-
bably larger than those of water, as water will pass
through leather and paper, which will confine air;
hence when the atmosphere is much deprived of moi-
sture, the pores of the dry air are so large, that the
rays of light are refracted by their edges instead of
passing through them. But when as much moisture
is added as can be perfectly dissolved, the air becomes
transparent; and opake again, when a part of this
moisture collects into small spherules previous to its
precipitation. This also accounts for the want of
transparency of the air, which is seen in tremulous mo-
tions over corn-fields on hot summer-days, or over
brick-kilns, after the flame is extinguished, while the
furnacc still remains hot.
2. Deglutitio irritativa. The deglutition of our sa-
liva is performed frequently without our attention,
and is then an irritative action in consequence of the
stimulus of it in the mouth. Or perhaps sometimes
for the purpose of diffusing a part of it over the dry
membranes of the fauces and pharynx; in the same
manner as tears are diffused over the cornea of the
eye by the act of nictitation to clean or moisten it.
3. Respiratio et Tussis irritativa. In the acts of re-
spiration and of coughing there is an increased motion
of the air-cells of the lungs owing to some stimulating
cause, as described above in Class I. 1. 2. 8. and I.
1. 3. 4.

CLASS I. 1. 4.] OF IRRITATION. 61
1. 3. 4. and which are frequently performed without
our attention or consciousness, and are then irritative
actions; and thus differ from those described in Class
II. 1. 1. 2. and 5. To these increased actions of the
air-cells are superadded those of the intercostal muscles
and diaphragm by irritative association. When any
unnatural stimulus acts so violently on the organs of
respiration as to induce pain, the sensorial power of
sensation becomes added to that of irritation, and in-
flammation of the membranes of them is a general con-
sequence.
4. Exclusio bilis. The exclusion of the bile from
the gall-bladder, and its derivation into the duodenum,
is an irritative action in consequence of the stimulus of
the aliment on the extremity of the biliary duct, which
terminates in the intestine. The increased secretion
of tears is occasioned in a similar manner by any sti-
mulating material in the eyes; which affects the ex-
cretory ducts of the lacrymal glands. A pain of the
external membrane of the eye sometimes attends any
unusual stimulus of it, then the sensorial power of sen-
sation becomes added to that of irritation, and a su-
perficial inflammation is induced.
5. Dentitio. Toothing. The pain of toothing
often begins much earlier than is suspected; and is
liable to produce convulsions; which are sometimes
relieved, when the gum swells, and becomes inflamed;
at other times a diarrhœa supervenes, which is gene-
rally

62 DISEASES [CLASS I. 1. 4.
rally esteemed a favourable circumstance, and seems to
prevent the convulsions by supplying another means of
relieving the pain of dentition by irritative exertion;
and a consequent temporary exhaustion of sensorial
power. See Class I. 1. 2. 5. Sect. XXXV. 2. 1.
The convulsions from toothing generally commence
long before the appearance of the teeth; but as the
two middle incisors of the lower jaw generally appear
first, and then those of the upper, it is advisable to
lance the gums over these longitudinally in respect to
the jaw-bones, and quite down to the periosteum, and
through it.
As the convulsions attending the commencement of
toothing are not only dangerous to life in their greatest
degree, but are liable to induce stupor or insensibility
by their continuance even in a less degree, the most
efficacious means should be used to cure them.
M. M. Lance the gum of the expected teeth quite
through the periosteum longitudinally. Venesection
by the lancet or by two or three leeches. One grain
of calomel as a purge. Tincture of jalap, five or six
drops in water every three hours till it purges, to be
repeated daily. After evacuations a small blister on
the back or behind the ears. And lastly, two or
three drops of laudanum according to the age of the
child. Warm bath. See Class III. 1. 1. 5. and 6.
6. Priapismus chronicus. I have seen two cases,
where an erection of the penis, as hard as horn, con-
tinued two or three weeks without any venereal de-
sires,

CLASS I. 1. 4.] OF IRRITATION. 63
sires, but not without some pain; the easiest attitude
of the patients was lying upon their backs with their
knees up. At length the corpus cavernosum urethræ
became soft, and in another day or two the whole sub-
sided. In one of them a bougie was introduced,
hoping to remove some bit of gravel from the caput
gallinaginis, camphor, warm bathing, opium, lime-
water, cold aspersion, bleeding in the veins of the pe-
nis, were tried in vain. One of them had been a free
drinker, had much gutta rosacea on his face, and died
suddenly a few months after his recovery from this
complaint. Was it a paralysis of the terminations of
the veins, which absorb the blood from the tumid pe-
nis- or from the stimulus of indurated semen in the
seminal vessels- In the latter case some venereal de-
sires should have attended. Class III. 1. 2. 16.
The priapismus, which occurs to vigorous people in
the morning before they awake, has been called the
signum salutis, or banner of health, and is occasioned
by the increase of our irritability or sensibility during
sleep, as explained in Sect. XVIII. 15.
7. Distentio mamularum. The distention of the nip-
ples of lactescent women are at first owing to the sti-
mulus of the milk. See Sect. XIV. 8. and Sect.
XVI. 5. See Class II. 1. 7. 10.
8. Descensus uteri. This is a very frequent com-
plaint after bad labours, the fundus uteri becomes
inverted and descends like the prolapsus ani.
M. M. All

64 DISEASES [CLASS I. 1. 4.
M. M. All the usual pessaries are very inconve-
nient and ineffectual. A piece of soft sponge about
two inches diameter introduced into the vagina gives
great ease to these patients, and supports the uterus;
it should have a string put through it to retract it
by.
There are also pessaries now made of elastic gum,
which are said to be easily worn, and to be conve-
nient, from their having a perforation in their centre.
9. Prolapsus ani. The lower part of the rectum
becomes inverted, and descends after every stool chiefly
in children; and thus stimulates the sphincter ani like
any other extraneous body.
M. M. It should be dusted over with very fine
powder of gum sandarach, and then replaced. Astrin-
gent fomentations; as an infusion of oak-bark, or a
slight solution of alum. Horizontal rest frequently
in the day.
10. Lumbricus. Round worm. The round worm
is suspected in children when the belly is tumid, and
the countenance bloated and pale, with swelling of
the upper lip. The generation of these worms is
promoted by the too dilute state of the bile, as is
evident in the fleuke-worm found in the biliary ducts
and substance of the liver in sheep; and in water-
rats, in the livers of which last animals they were
lately detected in large numbers by Dr. Capelle.
Transactions of the College at Philadelphia, v. 1.
2 Now

CLASS I. 1. 4.] OF IRRITATION. 65
Now as the dilute state of the bile depends on the
deficiency of the absorption of its thinner parts, it
appears, that the tumid belly, and bloated counte-
nance, and swelled upper lip, are a concomitant cir-
cumstance attending the general inactivity of the ab-
sorbent system; which is therefore to be esteemed the
remote cause of the generation of worms.
The simplicity of the structure of worms probably
enables them to exist in more various temperatures of
heat; and their being endued with life prevents them
from being destroyed by digestion in the stomach, pro-
bably in the same manner as the powers of life pre-
vent the fermentation and putrefaction of the stomach
itself. Hence I conclude, that worms are originally
taken into our alimentary canal from without; as I
believe similar worms of all kinds are to be found out
of the body.
M. M. The round worm is destroyed by a cathar-
tic with four or six grains of calomel; and afterwards
by giving six or eight grains of filings of iron twice a
day for a fortnight. See Hepatis tumor, Class I.
2. 3. 9. As worms are liable to come away in fevers,
whether of the hectic or putrid kind, could they be
removed by purulent matter, or rotten egg, or putrid
flesh, since in those fevers from the enfeebled action of
the intestines the fæces become highly putrid-
11. Tania. Tape-worm consists of a chain of ani-
mals extending from the stomach to the anus. See
Sect. XXXIX. 2. 3. It frequently exists in cats, rats,
and geese, and probably in many other animals.
F The 

66 DISEASES [CLASS I. 1. 4.
The worms of this genus possess a wonderful power
of retaining life. Two of them, which were voided
by a pointer dog in consequence of violent purgatives,
each of which were several feet in length, had boiling
water poured on them in a bason; which seemed not
much to inconvenience them. When the water was
cool, they were taken out and put into gin or whiskey
of the strongest kind, in which their life and activity
continued unimpaired; and they were at length killed
by adding to the spirit a quantity of corrosive subli-
mate. Medic. Comment. for 1791, p. 370.
The tape-worm is cured by an amalgama of tin and
quicksilver, such as is used on the back of looking-
glasses; an ounce should be taken every two hours,
till a pound is taken; and then a brisk cathartic of
Glauber's salt two ounces, and common salts one
ounce, dissolved in two wine pints of water, half a
pint to be taken every hour till it purges. The worm
extends from the stomach to the anus, and the amal-
gama tears it from the intestine by mechanical pres-
sure, acting upon it the whole way. Electric shocks
through the duodenum greatly assists the operation.
Large doses of tin in powder. Iron filings in large
doses. The powder of fern-root seems to be of no
use, as recommended by M. Noufflier.
12. Ascarides. Thread-worms. These worms are
said to be more frequent in some parts of this king-
dom than in others, as near the fens of Lincolnshire.
Do they escape from the body and become flies, like
the bott-worm in horses? Do they crawl from one
child

CLASS I. 1. 4.] OF IRRITATION. 67
child to another in the same bed? Are they acquired
from flies or worms, which are seen in putrid neces-
sary houses, as these worms as well as the tape-worms,
are probably acquired from without? this may ac-
count for their re-appearance a few weeks or months
after they have been destroyed; or can this happen
from the eggs or parts of them remaining?
Ascarides appear to be of two kinds, the common
small ones like a thread; which has a very sharp head,
as appears in the microscope; and which is so tender,
that the cold air soon renders it motionless; and a
larger kind above an inch long, and nearly as thick as
a very small crow-quill, and which is very hard in re-
spect to its texture, and very tenacious of life. One of
these last was brought to me, and was immediately
immersed in a strong solution of sugar of lead, and lived
in it a very long time without apparent inconvenience.
M. M. Ascarides are said to be weakened by
twenty grains of cinnabar and five of rhubarb taken
every night, but not to be cured by this process.
As these worms are found only in the rectum, variety
of clysters have been recommended. I was informed
of a case, where solutions of mercurial ointment were
used as a clyster every night for a month without
success. Clysters of Harrowgate water are recom-
mended, either of the natural, or of the factitious,
as described below, which might have a greater pro-
portion of liver of sulphur in it. As the cold air
soon destroys them, after they are voided, could cly-
sters of iced water be used with advantage? or of
F2 spirit

68 DISEASES [CLASS I. 1. 4.
spirit of wine and water? or of ether and water?
Might not a piece of candle, about an inch long, or
two such pieces, smeared with mercurial ointment, and
introduced into the anus at night, or twice a day, be
effectual by compressing their nidus, as well as by the
poison of the mercury.
The clysters should be large in quantity, that they
may pass high in the rectum, as two drams of to-
bacco boiled a minute in a pint of water. Or per-
haps what might be still more efficacious and less
inconvenient, the smoke of tobacco injected by a pro-
per apparatus every night, or alternate nights, for
six or eight weeks. This was long since recommend-
ed, I think by Mr. Turner of Liverpool; and the
reason it has not succeeded, I believe to have been
owing to the imperfections of the joints of the com-
mon apparatus for injecting the smoke of tobacco,
so that it did not pass into the intestine, though it
was supposed to do so, as I once observed. The
smoke should be received from the apparatus into a
large bladder; and it may then be certainly injected
like the common clyster with sufficient force; other-
wise oiled leathers should be nicely put round the
joints of the machine; and a wet cloth round the
injecting pipe to prevent the return of the smoke by
the sides of it. Clysters of carbonated hydrogen
gas, or of other factitious airs, might be tried.
Harrowgate water taken into the stomach, so as to
induce six or seven stools every morning, for four or
six weeks, is perhaps the most efficacious method in
common

CLASS I. 1. 4. OF IRRITATION. 69
common use. A factitious Harrowgate water may be
made probably of greater efficacy than the natural, by
dissolving one ounce of marine salt, (called bay salt)
and half an ounce of magnesia Glauber's salt, (called
Epsom salt, or bitter purging salt) in twenty-eight
ounces of water. A quarter or half a pint of this is
to be taken every hour, or two hours in the morning,
till it operates, with a tea-spoonful of a solution of
liver of sulphur, which is to be made by putting an
ounce of hepar sulphuris into half a pint of water. See
Class IV. 1. 2. 9.
13. Dracunculus. A thin worm brought from the
coast of Guinea. It is found in the interstices of the
muscles, and is many yards long; it makes a small ul-
cer; which is cured by extracting an inch of the worm
a day, and wrapping the extracted part slowly round
a bit of tobacco pipe till next day, so as not to break
it. I have twice seen long worms, like a thick horse-
hair, in water in July in this country, which appeared
hard and jointed.
14. Morpiones. Crab-lice. The excrement of
this animal stains the linen, and appears like diluted
blood.
M. M. Spirit of wine. Mercurial ointment, shaving
the part. Oil destroys other insects, if they be quite
covered with it, as the ticks on dogs, and would pro-
bably therefore destroy these. Its manner of opera-
tion is by stopping up or filling their spiracula, or
F3 breathing

70 DISEASES CLASS I. 1. 5.
breathing pores; a few drops of oil poured on a wasp,
so as to cover it, destroys it in a few seconds.
15. Pediculi. Lice. There is said to be a dis-
ease, in which these animals are propagated in inde-
structible numbers, so as to destroy the patient.
M. M. Cleanliness, mercurial ointment, stavis acria
in powder, or the tincture of it in spirit of wine. Spi-
rit of wine alone? Bath of oil?
ORDO I.
Increased Irritation.
GENUS V.
With increased Actions of the Organs of Sense.
SPECIES.
1. Visus acrior. Acuter sight. There have been
instances of people, who could see better in the gloom
of the evening, than in the stronger light of the day;
like owls, and bats, and many quadrupeds, and flying
insects. When the eye is inflamed, great, light be-
comes eminently painful, owing to the increased irri-
tative motions of the retina, and the consequent in-
creased sensation. Thus when the eye is dazzled with
sudden light, the pain is not owing to the motion of
the iris; for it is the contraction of the iris, which
relieves the pain from sudden light; but to the too
violent

CLASS I. 1. 5.] OF IRRITATION. 71
violent contractions of the moving fibres, which con-
stitute the extremities of the optic nerve.
2. Auditus acrior. The irritative ideas of hearing
are so increased in energy as to excite our attention.
This happens in some diseases of the epileptic kind,
and in some fevers. Hence the whispering of the
currents of air in a room, the respiration of the com-
pany, and noises before unperceived, become trouble-
some; and founds louder than usual, or unexpected,
produce starting, and convulsions.
M. M. Put oil of almonds into the ears. Stop the
meatus auditorius with cotton wool. Set the feet of
the patient's bed on cushions, or suspend it by cords
from the ceiling.
3. Olfactus acrior. The irritative ideas of smell
from the increased action of the olfactive nerve excite
our attention. Hence common odours are disagree-
able; and are perceived from variety of objects, which
were before thought inodorous. These are commonly
believed to be hallucinations of the sense.
M. M. Snuff starch up the nostrils.
4. Gustus acrior. The irritative ideas of taste, as
of our own saliva, and even of the atmospheric air,
excite our attention; and common tastes are disagree-
ably strong.
M. M. Water. Mucilage. Vegetable acids. Scrape
the tongue clean. Rub it with a sage-leaf and vinegar.
F4 5. Tactus

72 DISEASES [CLASS I. 1. 5.
5. Tactus acrior. The irritative ideas of the nerves
of touch excite our attention: hence our own pres-
sure on the parts, we rest upon, becomes uneasy, with
universal soreness.
M. M. Soft feather-bed. Combed wool put under
the patients, which rolls under them as they turn, and
thus prevents their friction against the sheets. Draw-
ers of soft leather. Plasters of create with calamy.
6. Sensus caloris acrior. Acuter sense of heat oc-
curs in some diseases, and that even when the percep-
tible heat does not appear greater than natural to the
hand of another person. See Class I. 1. 2. See
Sect. XIV. 8. All the above increased actions of our
organs of sense separately or jointly accompany some
fevers, and some epileptic diseases; the patients com-
plaining of the perception of the least light, noises in
their ears, bad smells in the room, and bad tastes in
their mouths, with soreness, numbness, and other un-
easy feels, and with disagreeable sensations of general
or partial heat.
7. Sensus extensionis acrior. Acuter sense of exten-
sion. The sense of extension was spoken of in Sect.
XIV. 7. and XXXII. 4. The defect of distention in
the arterial system is accompanied with faintness; and
its excess with sensations of fulness, or weight, or
pressure. This however refers only to the vascular
muscles, which are distended by their appropriated
fluids; but the longitudinal muscles are also affected
by

CLASS I. 1. 5.] OF IRRITATION. 73
by different quantities of extension, and become vio-
lently painful by the excess of it.
These pains of muscles and of membranes are gene-
rally divided into acute and dull pains. The former
are generally owing to increase of extension, as in
pricking the skin with a needle; and the latter gene-
rally to defect of extension, as in cold head-aches; but
if the edge of a knife, or point of a pin, be gradually
pressed against the fibres of muscles or membranes,
there would seem to be three states or stages of this
extension of the fibres; which have acquired names
according to the degree or kind of sensation produced
by the extension of them; these are 1. titillation or
tickling. 2. itching, and the 3. smarting; as described
below. See Sect. XIV. 9.
8. Titillatio. Tickling is a pleasurable pain of the
sense of extension above mentioned, and therefore ex-
cites laughter; as described in Sect. XXXIV. 1. 4.
The tickling of the nostrils, which precedes the efforts
of sneezing, is owing to the increased irritation occa-
sioned by external stimulus; and is attended with a
pleasurable sensation in consequence of the increased
action of the part. When this action is exerted in a
greater degree, the sensation becomes painful, and the
convulsion of sneezing ensues; as the pain in tick-
ling the soles of the feet of children is relieved by
laughter.
A lady after a bruise on her nose by a fall was af-
fected with incessant sneezing, and relieved by snuf-
fing

74 DISEASES [CLASS I. 1. 5.
fing starch up her nostrils. Perpetual sneezings in the
measles, and in catarrhs from cold, are owing to the
stimulus of the saline part of the mucous effusion on
the membrane of the nostrils. See Class II. 1. 1. 2.
9. Pruritus. Itching seems to be a greater de-
gree of titillation, and to be owing to the stimulus
of some acrid material, as the matter of the itch;
or of the herpes on the scrotum, and about the
anus; or from those universal eruptions, which at-
tend some elderly people, who have drank much vi-
nous spirit. It occurs also, when inflammations are
declining, as in the healing of blisters, or in the cure
of ophthalmia, as the action of the vessels is yet so
great as to produce sensation; which, like the titil-
lations that occasion laughter, is perpetually changing
from pleasure to pain.
When the natural efforts of scratching do not re-
lieve the pain of itching, it sometimes increases so as
to induce convulsions and madness. As in the furor
uterinus, and satyriasis, and in the sphincter ani and
scrotum. See Class II. 1. 4. 14. IV. 2. 2. 6.
M. M. Warm bath. Fomentation. Alcohol ex-
ternally. Poultice. Oiled silk. Mercurial ointments
on small surfaces at once. See Class II. 1. 4. 12.
Solutions of lead on small surfaces at once.
10. Dolor urens. Smarting follows the edge of a
knife in making a wound, and seems to be owing
to the distention of a part of a fibre, till it breaks.
A smart-

CLASS I. 1. 5.] OF IRRITATION. 75
A smarting of the skin is liable to affect the scars
left by herpes or shingles; and the callous parts of
the bottoms of the feet; and around the bases of
corns on the toes; and frequently extends after sci-
atica along the outside of the thigh, and of the leg,
and part of the foot. All these may be owing to
the stimulus of extension, by blood or serum being
forced into vessels nearly coalesced.
M. M. Emplastrum de minio put like a bandage
on the part. Warm fomentation. Oil and camphor
rubbed on the part. Oil-silk covering. A blister
on the part. Ether, or alcohol, suffered to evapo-
rate on the part.
11. Consternatio. Surprise. As our eyes acquaint
us at the same time with less than half of the ob-
jects, which surround us, we have learned to con-
fide much in the organ of hearing to warn us of
approaching dangers. Hence it happens, that if any
sound strikes us, which we cannot immediately ac-
count for, our fears are instantly alarmed. Thus in
great debility of body, the loud clapping of a door,
or the fall of a fire-shovel, produces alarm, and some-
times even convulsions; the same occurs from unex-
pected sights, and in the dark from unexpected ob-
jects of touch.
In these cases the irritability is less than natural,
though it is erroneously supposed to be greater; and
the mind is busied in exciting a train of ideas inat-
tentive to external objects; when this train of ideas
is

76 DISEASES [CLASS I. 1. 5.
is dissevered by any unexpected stimulus, surprise is
excited; as explained in Sect. XVII. 3. 7. and XVIII.
17. then as the sensibility in these cases is greater,
fear becomes superadded to the surprise; and con-
vulsions in consequence of the pain of fear. See Sect.
XIX. 2.
The proximate cause of surprise is the increased
irritation induced by some violent stimulus, which
dissevers our usual trains of ideas; but in diseases of
inirritability the frequent starting or surprise from
sounds not uncommon, but rather louder than usual,
as the clapping of a door, shews, that the attention
of the patient to a train of sensitive ideas was pre-
viously stronger than natural, and indicates an inci-
pient delirium; which is therefore worth attending
to in febrile diseases.
ORDO 

CLASS I. 2. 1.] OF IRRITATION. 77
ORDO II.
Decreased Irritation.
GENUS I.
With decreased Action of the Sanguiferous System.
THE reader should be here apprised, that the words
strength and debility, when applied to animal motions,
may properly express the quantity of resistance such
motions may overcome; but that, when they are ap-
plied to mean the susceptibility or insusceptibility of
animal fibres to motion, they become metaphorical
terms; as in Sect. XII. 2. 1. and would be better ex-
pressed by the words activity and inactivity.
There are three sources of animal inactivity; first,
the defect of the natural quantity of stimulus on those
fibres, which have been accustomed to perpetual stimu-
lus; as the arterial and secerning systems. When their
accustomed stimulus is for a while intermitted, as when
snow is applied to the skin of the hands, an accumula-
tion of sensorial power is produced; and then a degree
of stimulus, as of heat, somewhat greater than that at
present applied, though much less than the natural
quantity, excites the vessels of the skin into violent
action. We must observe, that a deficiency of stimu-
lus in those fibres, which are not subject to perpetual
stimulus, as the locomotive muscles, is not succeeded
by accumulation of sensorial power; these therefore
are more liable to become permanently inactive after
a diminution of stimulus; as in strokes of the palsy,
this may be called inactivity from defect of stimulus.
2. A

78 DISEASES [CLASS I. 2. 1.
2. A second source of animal inactivity exists, when
the sensorial power in any part of the system has
been previously exhausted by violent stimuli; as the
eyes after long exposure to great light; or the sto-
mach, to repeated spirituous potation; this may be
termed inactivity from exhaustion of sensorial power.
See Sect. XII. 2. 1.
3. But there is a third source of inactivity owing to
the deficient production of sensorial power in the
brain; and hence stimuli stronger than natural are re-
quired to produce the accustomed motions of the ar-
terial system; in this case there is no accumulation of
sensorial power produced; as in the inactivity owing
to defect of stimulus; nor any previous exhaustion of
it, as in the inactivity owing to excess of stimulus.
This third kind of inactivity causes many of the
diseases of this genus; which are therefore in general
to be remedied by such medicines as promote a greater
production of sensorial power in the brain; as the
incitantia, consisting of wine, beer, and opium, in small
repeated quantities; and secondly of such as simply
stimulate the arterial and glandular system into their
natural actions; as small repeated blisters, spices, and
essential oils. And lastly the sorbentia, which contri-
bute to supply the more permanent strength of the
system, by promoting the absorption of nourishment
from the stomach, and intestines; and of the super-
fluous fluid, which attends the secretions.
SPECIES 

CLASS I. 2. 1] OF IRRITATION. 79
SPECIES.
1. Febris inirritativa. Inirritative fever. This is
the typhus mitior, or nervous fever of some writers;
it is attended with weak pulse without inflammation,
or symptoms of putridity, as they have been called.
When the production of sensorial power in the brain
is less than usual, the pulse becomes quick as well as
weak; and the heart sometimes trembles like the
limbs of old age, or of enfeebled drunkards; and
when this force of the contractions of the heart and
arteries are diminished, the blood is pushed on with less
energy, as well as in less quantity, and thence its sti-
mulus on their sides is diminished in a duplicate ratio.
In compressions of the brain, as in apoplexy, the pulse
becomes slower and fuller; for in that disease, as in
natural sleep, the irritative motions of the heart and
arteries are not diminished, volition alone is suspended
or destroyed.
If the absorption of the terminations of the veins
is not equally impaired with the force of the heart
and arteries, the blood is taken up by the veins the
instant it arrives at their extremities; the capillary
vessels are left empty, and there is less resistance to
the current of the blood from the arteries; hence the
pulse becomes empty, as well as weak and quick; the
veins of the skin are fuller than the arteries of it;
and its appearance becomes pale, bluish, and shrunk.
See Class II. 1. 3. 1.
When 

80 DISEASES [CLASS I. 2. 1
When this pulse persists many hours, it constitutes
the febris inirritativa, or typhus, or nervous fever, of
some writers; it is attended with little heat, the urine
is generally of a natural colour, though in less quan-
tity; with great prostration of strength, and much dis-
turbance of the faculties of the mind. Its immediate
cause seems to be a deficient secretion of the sensorial
power from the inaction of the brain; hence almost
the whole of the sensorial power is expended in the
performance of the motions necessary to life, and little
of it can be spared for the voluntary actions of the
locomotive muscles, or organs of sense, see Class I.
2. 5. 3. Its more remote cause may be from a para-
lysis or death of some other part of the body; as of
the spleen, when a tumour is felt on the left side, as
in some intermittents; or of the kidneys, when the
urine continues pale and in small quantity. Does the
revivescence of these affected parts, or their torpor,
recurring at intervals, form the paroxysms of these
fevers? and their permanent revivescence establish the
cure? See Class IV. 2. 1. 19.
M. M. Wine and opium in small quantities repeated
every three hours alternately; small repeated blisters;
warm but fresh air; sorbentia; nutrientia; transfusion
of blood. Small electric shocks passed through the
brain in all directions. Oxygene air?
2. Paresis inirritativa. Inirritative debility. A
defective action of the irritative motions without in-
crease of the frequency of the pulse. It continues 
4 three

CLASS I. 2. 1.] OF IRRITATION. 81
three or four weeks like a fever, and then either ter-
minates in health, or the patient sinks into one kind
of apoplexy, and perishes. Many symptoms, which
attend inirritative fevers, accompany this disease, as
cold hands and feet at periodic times, scurf on the
tongue, want of appetite, muddy urine, with pains of
the head, and sometimes vertigo, and vomiting.
This disease differs from the inirritative fever by
the pulse not being more frequent than in health.
The want of appetite and of digestion is a principal
symptom, and probably is the cause of the universal
debility, which may be occasioned by the want of
nourishment. The vertigo is a symptom of inirrita-
bility, as shewn in Class IV. 1. 2. 6. the muddy urine
is owing to increased absorption from the bladder in
consequence of the diminished cutaneous and cellular
absorption, as in anasarca, explained in Sect. XXIX.
5. 1. and is therefore a consequence of the inirrita-
bility of that part of the system; the foul tongue is
owing to an increased absorption of the thinner part
of the mucus in consequence of the general deficiency
of fluid, which should be absorbed by the skin and
stomach. The sickness is owing to decreased action
of the stomach, which is probably the primary disease,
and is connected with the vertigo.
M. M. An emetic. Calomel, grains iv. once or
twice. Then a blister. Peruvian bark. Valerian.
Columbo. Steel. Opium and wine in small quanti-
ties, repeated alternately every three hours. Small
electric percussions through the stomach.
G 3. Somnus

82 DISEASES [CLASS I. 2. 1.
3. Somnus interruptus. Interrupted sleep. In some
fevers, where the inirritability is very great, when
the patient falls asleep, the pulse in a few minutes be-
comes irregular, and the patient awakes in great dis-
order, and fear of dying, refusing to sleep again from
the terror of this uneasy sensation. In this extreme
debility there is reason to believe, that some volun-
tary power during our waking hours is employed to
aid the irritative stimuli in carrying on the circulation
of the blood through the lungs; in the same manner
as we use voluntary exertions, when we listen to weak
sounds, or wish to view an object by a small light; in
sleep volition is suspended, and the deficient irritation
alone is not sufficient to carry on the pulmonary cir-
culation. This explanation seems the most probable
one, because in cases of apoplexy the irritative motions
of the arterial system do not seem to be impaired, nor
in common sleep. See Incubus III. 2. 1. 13.
M. M. Opium in very small doses, as three drops
of laudanum. A person should watch the patient,
and awaken him frequently; or he should measure
the time between slumber and slumber by a stop-watch,
and awaken the patient a little before he would
otherwise awake; or he should keep his finger on the
pulse, and should forcibly awaken him, as soon as it
becomes irregular, before the disorder of the circula-
tion becomes so great as to disturb him. See Class I.
2. 1. 9. and Sect. XXVII. 2.
4. Syncope.

CLASS I. 2. 1.] OF IRRITATION. 83
4. Syncope. Fainting consists in the decreased action
of the arterial system; which is sometimes occasioned
by defect of the stimulus of distention, as after vene-
section, or tapping for the dropsy. At other times it
arises from great emotions of the mind, as in sudden
joy or grief. In these cases the whole sensorial power
is exerted on these interesting ideas, and becomes ex-
hausted. Thus during great surprise or fear the heart
stops for a time, and then proceeds with throbbing
and agitation: and sometimes the vital motions be-
come so deranged, as never to recover their natural
successive action; as when children have been fright-
ened into convulsions. See Sect. XII. 7. 1.
Miss -, a young lady of Stafford, in travelling
in a chaise was so affected by seeing the fall of a horse
and postilion, in going down a hill, though the car-
riage was not overturned, that she fainted away, and
then became convulsed, and never spoke afterwards;
though she lived about three days in successive con-
vulsions and stupor.
5. Hæmorrhagia venosa. A bleeding from the ca-
pillaries arising from defect of venous absorption, as
in some of those fevers commonly termed putrid.
When the blood stagnates in the cellular membrane,
it produces petechiæ from this torpor or paralysis of
the absorbent mouths of the veins. It must be ob-
served, that those people who have diseased livers, are
more liable to this kind of hæmorrhages, as well as to
the hæmorrhagia arteriosa; the former, because pa-
G2 tients

84 DISEASES [Class I. 2. 1.
tients with diseased livers are more subject to paralytic
complaints in general, as to hemiplegia, and to dropsy,
which is a paralysis of the lymphatics; and the latter
is probably owing to the delay of the circulation in
the vena porta by the torpor of this hepatic vessel,
when the liver is not much enlarged; and to its pres-
sure on the vena cava, when it is much enlarged.
M. M. Vitriolic acid, opium, steel, bark. Sponge
bound on the part. Steel dissolved in spirit of wine
externally. Flour.
6. Hæmorrhois cruenta. In the bleeding piles the
capillary vessels of the rectum become distended and
painful from the defect of the venous absorption of
the part, and at length burst; or the mucous glands
are so dilated as to give a passage to the blood; it is
said to observe lunar periods.
M. M. Venesection, poultices, cathartics, spice,
cold bath, and sorbentia. External compression by
applying lint, sponge, or cotton. Internal compres-
sion by applying a bit of candle smeared with mercu-
rial ointment. Strangulate the tumid piles with a silk
string. Cut them off. See Class I. 2. 3. 22.
Mrs.- had for twelve or fifteen years, at inter-
vals of a year or less, a bleeding from the rectum
without pain; which however stopped spontaneously
after she became weakened, or by the use of injec-
tions of brandy and water. Lately the bleeding con-
tinued above two months, in the quantity of many
ounces a day, till she became pale and feeble to an
alarming

Class I. 2. 1.] OF IRRITATION. 85
alarming degree. Injections of solutions of lead, of
bark and salt of steel, and of turpentine, with some
internal astringents, and opiates, were used in vain.
An injection of the smoke of tobacco, with ten grains
of opium mixed with the tobacco, was used, but with-
out effect the two first times on account of the imper-
fection of the machine; on the third time it produced
great sickness, and vertigo, and nearly a fainting fit;
from which time the blood entirely stopped. Was
this owing to a fungous excrescence in the rectum;
or to a blood-vessel being burst from the difficulty of
the blood passing through the vena porta from some
hepatic obstruction, and which had continued to bleed
so long- Was it stopped at last by the fainting fit-
or by the stimulus of the tobacco-
7. Hæmorrhagia renum. Hæmorrhage from the
kidneys, when attended with no pain, is owing to de-
fect of venous absorption in the kidney. When at-
tended with pain on motion, it is owing to a bit of
gravel in the ureter or pelvis of the kidney; which is
a much more frequent disease than the former. See
Sect. XXVII. 1.
M. M. 1. Venesection in small quantity, calomel,
bark, steel, an opiate; cold immersion up to the na-
vel, the upper part of the body being kept cloathed.
Neville-Holt water. 2. Alkalized water aerated.
Much diluent liquids. Cool dress. Cool bed-room.
Cows are much subject to bloody urine, called four
water by the farmers; in this disease about sixty
G3 grains

86 DISEASES [Class I. 2. 1.
grains of opium with or without as much rust of iron,
given twice a day, in a ball mixed with flour and wa-
ter, or dissolved in warm water, or warm ale, is, I
believe, an efficacious remedy, to which however
should be added about two quarts of barley or oats
twice a day, and a cover at night, if the weather be
cold.
8. Hæmorrhagia Hepatis. Hæmorrhage from the
liver. It sometimes happens in those, who have the
gutta rosea, or paralytic affections owing to diseased
livers induced by the potation of fermented liquors,
that a great discharge of black viscid blood occasion-
ally comes away by stool, and sometimes by vomiting:
this the ancients called Melancholia, black bile. If it
was bile, a small quantity of it would become yel-
low or green on dilution with warm water, which was
not the case in one experiment which I tried; it must
remain some time in the intestines from its black co-
lour, when it passes downwards, and probably comes
from the bile-ducts, and is often a fatal symptom.
When it is evacuated by vomiting it is less dangerous,
because it shews greater remaining irritability of the
intestinal canal, and is sometimes salutary to those who
have diseased livers.
M. M. An emetic. Rhubarb, steel, wine, bark.
9. Hæmoptoe venosa. Venous hæmoptoe frequently
attends the beginning of the hereditary consumptions
of dark-eyed people; and in others, whose lungs have
too

Class I. 2. 1.] OF IRRITATION. 87
too little irritability. These spittings of blood are ge-
nerally in very small quantity, as a tea-spoonful; and
return at first periodically, as about once a month;
and are less dangerous in the female than in the male
sex; as in the former they are often relieved by the
natural periods of the menses. Many of these pati-
ents are attacked with this pulmonary hæmorrhage in
their first sleep; because in feeble people the power
of volition is necessary, besides that of irritation, to
carry on respiration perfectly; but, as volition is
suspended during sleep, a part of the blood is delayed
in the vessels of the lungs, and in consequence effused,
and the patient awakes from the disagreeable sensa-
tion. See Class I. 2. 1. 3. II. 1. 6. 6. III. 2. 1. 10.
M. M. Wake the patient every two or three hours
by an alarum clock. Give half a grain of opium at
going to bed, or twice a day. Onions, garlic, slight
chalybeates. Issues. Leeches applied once a fort-
night or month to the hemorrhoidal veins to produce
a new habit. Emetics after each period of hæmoptoe,
to promote expectoration, and dislodge any effused
blood, which might by remaining in the lungs pro-
duce ulcers by its putridity. A hard bed, to prevent
too sound sleep. A periodical emetic or cathartic
once a fortnight.
10. Palpitatio cordis. The palpitation of the heart
frequently attends the hæmoptoe above mentioned;
and consists in an ineffectual exertion of the heart to
push forwards its contents in due time, and with due
G4 force.

88 DISEASES [Class I. 2. 1.
force. The remote cause is frequently some impedi-
ment to the general circulation; as the torpor of the
capillaries in cold paroxysms of fever, or great adhe-
sions of the lungs. At other times it arises from the
debility of the action of the heart owing to the defi-
cient sensorial power of irritation or of association, as
at the approach of death.
In both these cases of weak exertion the heart feels
large to the touch, as it does not completely empty
itself at each contraction; and on that account con-
tracts more frequently, as described in Sect. XXXII.
2. 2. Another kind of palpitation may sometimes
arise from the retrograde motions of the heart, as in
fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.
11. Menorrhagia. Continued flow of the catame-
nia. The monthly effusion of blood from the uterus
or vagina is owing to a torpor of the veins of those
membranes in consequence of the defect of venereal
stimulus; and in this respect resembles the mucus dis-
charged in the periodical venereal orgasm of the fe-
male quadrupeds, which are secluded from the males.
The menorrhagia, or continued flow of this discharge,
is owing to a continued defect of the venous absorp-
tion of the membranes of the uterus or vagina. See
Class IV. 2. 4. 7.
M. M. Venesection in small quantity. A cathar-
tic. Then opium, a grain every night. Steel. Bark.
A blister. Topical aspersion with cold water, or cold
vinegar.
12. Dys-

Class I. 2. 1.] OF IRRITATION. 89
12. Dysmenorrhagia. A difficulty of menstruation
attended with pain. In this complaint the torpor of
the uterine vessels, which precedes menstruation, is by
sympathy accompanied with a torpor of the lumbar
membranes, and consequent pain; and frequently
with cold extremities, and general debility. The small
quantity and difficulty of the discharge is owing to
arterial inactivity, as in chlorosis. Whence it hap-
pens, that chalybeate medicines are of efficacy both
to stop or prevent too great menstruation, and to
promote or increase deficient menstruation; as the for-
mer is owing to inirritability of the veins, and the
latter of the arteries of the uterus. See Article IV.
2. 6. in the Materia Medica.
M. M. Opium, steel, pediluvium. Warm bath.
13. Lochia nimia. Too great discharge after de-
livery. In that unnatural practice of some hasty ac-
coucheurs of introducing the hand into the uterus im-
mediately after the delivery of the child, and forcibly
bringing away the placenta, it frequently happens,
that a part of it is left behind; and the uterus, not
having power to exclude so small a portion of it, is
prevented from complete contraction, and a great hæ-
morrhage ensues. In this circumstance a bandage
with a thick compress on the lower part of the belly,
by appressing the sides of the uterus on the remain-
ing part of the placenta, is likely to check the hæ-
morrhage, like the application of a pledget of any
soft substance on a bleeding vessel.
In	

90 DISEASES [Class I. 2. 1.
In other cases the lochia continues too long, or in
too great quantity, owing to the deficiency of venous
absorption.
M. M. Aa enema. An opiate. A blister. Slight
chalybeates. Peruvian bark. Clothes dipped in cold
vinegar, and applied externally. Bandages on the
limbs to keep more blood in them for a time have
been recommended.
14. Abortio spontanea. Some delicate ladies are
perpetually liable to spontaneous abortion, before the
third, or after the seventh, month of gestation. From
some of these patients I have learnt, that they have
awakened with a slight degree of difficult respira-
tion, so as to induce them to rise hastily up in bed;
and have hence suspected, that this was a tendency
to a kind of asthma, owing to a deficient absorption
of blood in the extremities of the pulmonary or
bronchial veins; and have concluded from thence,
that there was generally a deficiency of venous ab-
sorption; and that this was the occasion of their fre-
quent abortion. Which is further countenanced,
where a great sanguinary discharge precedes or fol-
lows the exclusion of the fetus.
M. M. Opium, bark, chalybeates in small quan-
tity. Change to a warmer climate. I have directed
with success in four cases half a grain of opium twice
a day for a fortnight, and then a whole grain twice
a day during the whole gestation. One of these pa-
tients took bellies twenty grains of Peruvian bark
for

CLASS I. 2. 1.] OF IRRITATION. 91
for several weeks. By these means being exactly
and regularly persisted in, a new habit became esta-
blished, and the usual miscarriages were prevented.
Miscarriages more frequently happen from eruptive
fevers, and from rheumatic ones, than from other
inflammatory diseases. I saw a most violent pleurisy
and hepatitis cured by repeated venesection about a
week or ten days before parturition; yet another
lady whom I attended, miscarried at the end of the
chicken pox, with which her children were at the
same time affected. Miscarriages towards the termi-
nation of the small pox are very frequent, yet there
have been a few instances of children, who have been
born with the eruption on them. The blood in the
small pox will not inoculate that disease, if taken be-
fore the commencement of the secondary fever; as
shewn in Sect. XXXIII. 2. 10. because the conta-
gious matter is not yet formed, but after it has been
oxygenated through the cuticle in the pustules, it be-
comes contagious; and if it be then absorbed, as in
the secondary fever, the blood of the mother may
become contagious, and infect the child. The same
mode of reasoning is applicable to the chicken pox.
See Class IV. 3. 1. 7.
15. Scorbutus. Sea-scurvy is caused by salt diet,
the perpetual stimulus of which debilitates the venous
and absorbent systems. Hence the blood is imper-
fectly taken up by the veins from the capillaries,
whence brown and black spots appear upon the skin
without

92 DISEASES [CLASS I. 2. 1.
without fever. The limbs become livid and edema-
tous, and lastly ulcers are produced from deficient
absorption. See Sect. XXXIII. 3. 2. and Class II.
I. 4. 13. For an account of the scurvy of the lungs,
see Sect. XXVII. 2.
M. M. Fresh animal and vegetable food. Infusion
of malt. New beer. Sugar. Wine. Steel. Bark.
Sorbentia. Opium-
16. Vibices. Extravasations of blood become black
from their being secluded from the air. The extra-
vasation of blood in bruises, or in some fevers, or
after death in some patients, especially in the parts
which were exposed to pressure, is owing to the fine
terminations of the veins having been mechanically
compressed so as to prevent their absorbing the blood
from the capillaries, or to their inactivity from dis-
ease. The blood when extravasated undergoes a che-
mical change before it is sufficiently fluid to be taken
up by the lymphatic absorbents, and in that process
changes its colour to green and then yellow.
17. Petechiæ. Purple spots. These attend fevers
with great venous inirritability, and are probably
formed by the inability of a single termination of a
vein, whence the corresponding capillary becomes rup-
tured, and effuses the blood into the cellular mem-
brane round the inert termination of the vein. This
is generally esteemed a sign of the putrid state of the
blood, or that state contrary to the inflammatory one.
As

CLASS I. 2. 1.] OF IRRITATION. 93
As it attends some inflammatory diseases which are
attended with great inirritability, as in the confluent
small pox. But it also attends the scurvy, where no
fever exists, and it therefore simply announces the
inactivity of the terminations of some veins; and is
thence indeed a bad symptom in fevers, as a mark
of approaching inactivity of the whole sanguiferous
system, or death. The blue colour of some children's
arms or faces in very cold weather is owing in like
manner to the torpor of the absorbent terminations
of the veins, whence the blood is accumulated in
them, and sometimes bursts them.
ORDO II.
Decreased Irritation.
GENUS II.
Decreased Action of the Secerning System.
THESE are always attended with decrease of par-
tial, or of general heat; for as the heat of animal
bodies is the consequence of their various secretions,
and is perpetually passing away into the ambient air,
or other bodies in contact with them; when these
secretions become diminished, or cease, the heat of
the part or of the whole is soon diminished, or ceases
along with them.
SPECIES. 

94 DISEASES [CLASS I. 2. 2.
SPECIES.
1. Frigus febrile. Febrile coldness. There is rea-
son to believe, that the beginning of many fever-fits
originates in the quiescence of some part of the ab-
sorbent system, especially where they have been owing
to external cold; but that, where the coldness of the
body is not owing to a diminution of external heat, it
arises from the inaction of some part of the secerning
system. Hence some parts of the body are hot whilst
other parts are cold; which I suppose gave occasion to
error in Martyn's Experiments; where he says, that the
body is as hot in the cold paroxysms of fevers as at
other times.
After the sensorial power has been much diminished
by great preceding activity of the system, as by long
continued external heat, or violent exercise, a sudden
exposure to much cold produces a torpor both greater
in degree and over a greater portion of the system,
by subtracting their accustomed stimulus from parts
already much deprived of their irritability. Dr.
Franklin in a letter to M. Duberge, the French trans-
lator of his works, mentions an instance of four young
men, who bathed in a cold spring after a day's har-
vest work; of whom two died on the spot, a third on
the next morning, and the other survived with diffi-
culty. Hence it would appear, that those, who have
to travel in intensely cold weather, will sooner perish,
who have previously heated themselves much with
drams, than those who have only the stimulus of na-
tural

CLASS I. 2. 2.] OF IRRITATION. 95
tural food; of which I have heard one well attested
instance. See Article VII. 2. 3. Class III. 2. 1. 17.
Frigus chronicum. Permanent coldness. Coldness
of the extremities, without fever, with dry pale skin,
is a symptom of general debility, owing to the de-
creased action of the arterial system, and of the ca-
pillary vessels; whence the perspirable matter is se-
creted in less quantity, and in consequence the skin
is less warm. This coldness is observable at the ex-
tremities of the limbs, ears, and nose, more than in
any other parts: as a larger surface is here exposed
to the contact of the air, or clothes, and thence the
heat is more hastily carried away.
The pain, which accompanies the coldness of the
skin, is owing to the deficient exertion of the sub-
cutaneous vessels, and probably to the accumulation
of sensorial power in the extremities of their nerves.
See Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I.
2. 4. 1.
M. M. A blister. Incitantia, nutrientia, sorbentia.
Exercise. Clothes. Fire. Joy. Anger.
2. Pallor fugitivus. The fugitive paleness, which
accompanies the coldness of the extremities, is owing
to a less quantity of blood passing through the capil-
laries of the skin in a given time; where the absorb-
ent power of the veins is at the same time much dimi-
nished, a part of the blood lingers at their junction
with the capillary arteries, and a bluish tinge is mixed
with

96 DISEASES [CLASS I. 2. 2.
with the paleness; as is seen in the loose skin under
the eye-lids, and is always a mark of temporary debi-
lity. See Class II. 1. 4. 4. Where the paleness of
the skin is owing to the deficiency of red globules in
the blood, it is joined with a yellowish tinge; which
is the colour of the serum, with which the blood then
abounds, as in chlorosis, and in torpor or paralysis of
the liver, and is often mistaken for a superabundance
of bile.
A permanent paleness of the skin is owing to the
coalescence of the minute arteries, as in old age. See
Class I. 2. 2. 9. There is another source of paleness
from the increased absorption of the terminations of
the veins, as when vinegar is applied to the lips. See
Sect. XXVII. 1. and another from the retrograde mo-
tions of the capillaries and fine extremities of the arte-
ries. See Class II. 3. 1. 1.
M. M. A blister, nutrientia, incitantia, exercise,
oxygene gas.
3. Pus parcius. Diminished pus. Dryness of ul-
cers. In the cold fits of fever all the secretions are
diminished, whether natural or artificial, as their quan-
tity depends on the actions of the glands or capilla-
ries, which then share in the universal inaction of the
system. Hence the dryness of issues and blisters in
great debility, and before the approach of death, is
owing to deficient secretion, and not to increased ab-
sorption.
I M. M. Opium,

CLASS I. 2. 2.] OF IRRITATION. 97
M. M. Opium, wine in very small quantities, Peru-
vian bark.
4. Mucus parcior. Diminished mucus. Dryness of
the mouth and nostrils. This also occurs in the cold
fits of intermittents. In these cases I have also found
the tongue cold to the touch of the finger, and the
breath to the back of one's hand, when opposed to
it, which are very inauspicious symptoms, and gene-
rally fatal. In fevers with inirritability it is generally
esteemed a good symptom, when the nostrils and
tongue become moist after having been previously dry;
as it shews an increased action of the mucous glands of
those membranes, which were before torpid. And the
contrary to this is the facies Hippocratica, or counte-
nance so well described by Hippocrates, which is pale,
cold, and shrunk; all which are owing to the inacti-
vity of the secerning vessels, the paleness from there
being less red blood passing through the capillaries,
the coldness of the skin from there being less secretion
of perspirable matter, and the shrunk appearance from
there being less mucus secreted into the cells of the
cellular membrane. See Class IV. 2. 4. 11.
M. M. Blisters. Incitantia.
5. Urina parcior pallida. Paucity of pale urine, as
in the cold fits of intermittents; it appears in some
nervous fevers throughout the whole disease, and
seems to proceed from a palsy of the kidneys; which
probably was the cause of the fever, as the fever
H sometimes

98 DISEASES [CLASS I. 2. 2.
sometimes ceases, when that symptom is removed:
hence the straw-coloured urine in this fever is so far
salutary, as it shews the unimpaired action of the
kidneys.
M. M. Balsams, essential oil, asparagus, rhubarb, a
blister. Cantharides internally.
6. Torpor hepaticus. Paucity of bile from a partial
inaction of the liver; hence the bombycinous colour
of the skin, grey stools, urine not yellow, indigestion,
debility, followed by tympany, dropsy, and death.
This paralysis or inirritability of the liver often de-
stroys those who have been long habituated to much
fermented liquor, and have suddenly omitted the use
of it. It also destroys plumbers, and house-painters,
and in them seems a substitute for the colica saturnina.
See Sect. XXX.
M. M. Aloe and calomel, then the bark, and cha-
lybeates. Mercurial ointment rubbed on the region
of the liver. Rhubarb, three or four grains, with
opium half a grain to a grain twice a day. Equita-
tion, warm bath for half an hour every day.
7. Torpor Pancreatis. Torpor of the pancreas. I
saw what I conjectured to be a tumour of the pan-
creas with indigestion, and which terminated in the
death of the patient. He had been for many years a
great consumer of tobacco, insomuch that he chewed
that noxious drug all the morning, and smoaked it all
the afternoon. As the secretion from the pancreas re-
sembles

CLASS I. 2. 2.] OF IRRITATION. 99
sembles saliva in its general appearance, and probably
in its office of assisting digestion, by preventing the
fermentation of the aliment; as would appear by the
experiments of Pringle and Macbride; there is reason
to suspect, that a sympathy may exist between the sa-
livary and pancreatic glands; and that the perpetual
stimulus of the former by tobacco might in process of
time injure the latter. See Tobacco, Article III. 2. 2.
8. Torpor renis. Inirritability or paralysis of the
kidneys is probably frequently mistaken for gravel in
them. Several, who have lived rather intemperately
in respect to fermented or spirituous liquors, become
suddenly seized about the age of sixty, or later, with
a total stoppage of urine; though they have previously
had no symptoms of gravel. In these cases there is
no water in the bladder; as is known by the intro-
duction of the catheter, of which those made of elastic
gum is said to be preferable to metallic ones; or it
may generally be known by the shape of the abdo-
men, either by the eye or hand. Bougies and cathe-
ters of elastic gum are sold at N° 37, Red Lion-street,
Holborn, London.
M. M. Electric shocks, warm bath. Emetics. See
calculus renis, Class I. 1. 3. 9. When no gravel
has been previously observed, and the patient has
been, a wine-drinker rather than an ale-drinker, the
case is generally owing to inirritability of the tubuli
urmiferi, and is frequently fatal. See Class I. 2. 4.
20.
H2 9. Punctæ

100 DISEASES [CLASS I. 2. 2.
9. Punctæ mucosæ vultûs. Mucous spots on the face.
These are owing to the inactivity of the excretory
ducts of the mucous glands; the thinner part of this
secretion exhales, and the remainder becomes inspis-
sated, and lodges in the duct; the extremity of which
becomes black by exposure to the air.
M. M. They may be pressed out by the finger-
nails. Warm water. Ether frequently applied. Blis-
ter on the part-
10. Maculæ cutis fulvæ. Morphew or freckles.
Tawny blotches on the skin of the face and arms of
elderly people, and frequently on their legs after slight
erysipelas. The freckles on the face of younger peo-
ple, who have red hair, seem to be a similar pro-
duction, and seem all to be caused by the coalescence
of the minute arteries or capillaries of the part. In
a scar after a wound the integument is only opake;
but in these blotches, which are called morphew and
freckles, the small vessels seem to have become in-
active with some of the serum of the blood stagnating
in them, from whence their colour. See Class III.
1. 2. 12.
M. M. Warm bathing. A blister on the part-
11. Canities. Grey hair. In the injection of the
vessels of animals for the purposes of anatomical pre-
parations, the colour of the injected fluid will not
pass into many very minute vessels; which neverthe-
less uncoloured water, or spirits, or quicksilver will
permeate.

CLASS I. 2. 2.] OF IRRITATION. 101
permeate. The same occurs in the filtration of some
coloured fluids through paper, or very fine sand,
where the colouring matter is not perfectly dissolved,
but only diffused through the liquid. This has led
some to imagine, that the cause of the whiteness of
the hair in elderly people may arise from the dimi-
nution, or greater tenuity, of the glandular vessels,
which secrete the mucus, which hardens into hair;
and that the same difference of the tenuity of the
secerning vessels may possibly make the difference of
colour of the silk from different silk-worms, which is
of all shades from yellow to white.
But as the secreted fluids are not the consequence
of mechanical filtration, but of animal selection; we
must look out for another cause, which must be found
in the decreasing activity of the glands, as we advance
in life; and which affects many of our other secre-
tions as well as that of the mucus, which forms the
hair. Hence grey hairs are produced on the faces of
horses by whatever injures the glands at their roots,
as by corrosive blisters; and frequently on the human
subject by external injuries on the head; and some-
times by fevers. And as the grey colour of hair con-
sists in its want of transparency, like water converted
into snow; there is reason to suppose, that a defect of
secreted moisture simply may be the cause of this kind
of opacity, as explained in Cataracta, Class I. 2. 2. 13.
M. M. Whatever prevents the inirritability and in-
sensibility of the system, that is, whatever prevents the
approach of old age, will so far counteract the pro-
H3 duction

102 DISEASES [CLASS I. 2. 2.
duction of grey hairs, which is a symptom of it. For
this purpose in people, who are not corpulent, and
perhaps in those who are so, the warm bath twice or
thrice a week is particularly serviceable. See Sect.
XXXIX. 5. 1. on the colours of animals, and Class
I. 1. 2. 15.
12. Callus. The callous skin on the hands and
feet of laborious people is owing to the extreme ves-
sels coalescing from the perpetual pressure they are
exposed to.
As we advance in life, the finer arteries lose their
power of action, and their sides grow together; hence
the paleness of the skins of elderly people, and the
loss of that bloom, which is owing to the numerous
fine arteries, and the transparency of the skin, that
encloses them.
M. M. Warm bath. Paring the thick skin with
a knife. Smoothing it with a pumice stone. Cover
the part with oiled silk to prevent the evaporation
of the perspirable matter, and thus to keep it moist.
13. Cataracla is an opacity of the crystalline lens
of the eye. It is a disease of light-coloured eyes, as
the gutta serena is of dark ones. On cutting off with
scissors the cornea of a calf's eye, and holding it in
the palm of one's hand, so as to gain a proper light,
the artery, which supplies nutriment to the crystalline
humour, is easily and beautifully seen; as it rises from
the

CLASS I. 2. 2.] OF IRRITATION. 103
the centre of the optic nerve through the vitreous
humour to the crystalline. It is this point, where the
artery enters the eye through the cineritious part of
the optic nerve (which is in part near the middle of
the nerve,) which is without sensibility to light; as is
shewn by fixing three papers, each of them about half
an inch in diameter, against a wall about a foot distant
from each other, about the height of the eye; and
then looking at the middle one, with one eye, and re-
treating till you lose sight of one of the external pa-
pers. Now as the animal grows older, the artery be-
comes less visible, and perhaps carries only a transpa-
rent fluid, and at length in some subjects I suppose
ceases to be pervious; then it follows, that the cry-
stalline lens, losing some fluid, and gaming none, be-
comes dry, and in consequence opake; for the same
reason, that wet or oiled paper is more transparent
than when it is dry, as explained in Class I. 1. 4. 1.
The want of moisture in the cornea of old people,
when the exhalation becomes greater than the supply,
is the cause of its want of transparency; and which
like the crystalline gains rather a milky opacity. The
same analogy may be used to explain the whiteness of
the hair of old people, which loses its pellucidity along
with its moisture. See Class I. 2. 2. 11.
M. M. Small electric shocks through the eye. A
quarter of a grain of corrosive sublimate of mercury
dissolved in brandy, or taken in a pill, twice a day for
six weeks. Couching by depression, or by extraction.
The former of these operations is much to be prefer-
H4 red

104 DISEASES [CLASS I. 2. 2.
red to the latter, though the latter is at this time so
fashionable, that a surgeon is almost compelled to use
it, lest he should not be thought an expert operator,
For depressing the cataract is attended with no pain,
no danger, no confinement, and may be as readily re-
peated, if the crystalline should rise again to the centre
of the eye. The extraction of the cataract is attended
with considerable pain, with long confinement, gene-
rally with fever, always with inflammation, and fre-
quently with irreparable injury to the iris, and conse-
quent danger to the whole eye. Yet has this opera-
tion of extraction been trumpeted into universal fa-
shion for no other reason but because it is difficult to
perform, and therefore keeps the business in the hands
of a few empirics, who receive larger rewards, re-
gardless of the hazard, which is encountered by the
flattered patient.
A friend of mine returned yesterday from London
after an absence of many weeks; he had a cataract in
a proper state for the operation, and in spite of my
earnest exhortation to the contrary, was prevailed up-
on to have it extracted rather than depressed. He
was confined to his bed three weeks after the opera-
tion, and is now returned with the iris adhering on
one side so as to make an oblong aperture; and which
is nearly, if not totally, without contraction, and thus
greatly impedes the little vision, which he possesses.
Whereas I saw some patients couched by depression
many years ago by a then celebrated empiric, Che-
valier Taylor, who were not confined above a day or 
two,

CLASS I. 2. 2.] OF IRRITATION. 105
two, that the eye might gradually be accustomed to
light, and who saw as well as by extraction, perhaps
better, without either pain, or inflammation, or any
hazard of losing the eye.
As the inflammation of the iris is probably owing
to forcing the crystalline through the aperture of it in
the operation of extracting it, could it not be done
more safely by making the opening behind the iris and
ciliary process into the vitreous humour- but the ope-
ration would still be more painful, more dangerous,
and not more useful than that by depressing it.
14. Innutritio ossium. Innutrition of the bones. Not
only the blood effused in vibices and petechiæ, or from
bruises, as well as the blood and new vessels in in-
flamed parts, are reabsorbed by the increased action
of the lymphatics; but the harder materials, which
constitute the fangs of the first set of teeth, and the
ends of exfoliating bones, and sometimes the matter
of chalk-stones in the gout, the coagulable lymph,
which is deposited on the lungs, or on the muscles
after inflammation of those parts, and which frequent-
ly produces difficulty of breathing, and the pains of
chronic rheumatism, and lastly the earthy part of the
living bones are dissolved and absorbed by the increased
actions of this system of vessels. See Sect. XXXIII.
3. 1.
The earthy part of bones in this disease of the innu-
trition of them seems to suffer a solution, and reab-
sorption; while the secerning vessels do not supply a
sufficient

106 DISEASES [CLASS I. 2. 2.
sufficient quantity of calcareous earth and phosphoric
acid, which constitute the substance of bones. As
calcareous earth abounds every where, is the want of
phosphoric acid the remote cause? One cause of this
malady is given in the Philosophic Transactions, where
the patient had been accustomed to drink large quan-
tities of vinegar. Two cases are described by Mr.
Gouch. In one case, which I saw, a considerable
quantity of calcareous earth, and afterwards of bone
ashes, and of decoction of madder, and also of subli-
mate of mercury, were given without effect. All the
bones became soft, many of them broke, and the pa-
tient seemed to die from the want of being able to
distend her chest owing to the softness of the ribs.
M. M. Salt of urine, called sal microcosmicum,
phosphorated soda. Calcined hartshorn. Bone-ashes.
Hard or petrifying water, as that of Matlock, or such
as is found in all limestone or marly countries. The
calcareous earth in these waters might possibly be
carried to the bones, as madder is known to colour
them. Warm bath. Volatile or fixed alkali as a
lotion on the spine, or essential oils.
The innutrition of the bones is often first to be per-
ceived by the difficulty of breathing and palpitation of
the heart on walking a little faster than usual, which
I suppose is owing to the softness of the ends of the
ribs adjoining to the sternum; on which account they
do not perfectly distend the chest, when they are raised
by the pectoral and intercostal muscles with greater
force than usual. After this the spine becomes curved
both

CLASS I. 2. 2.] OF IRRITATION. 107
both by the softness of its vertebræ, and for the pur-
pose of making room for the disturbed heart. See
Species 16 of this genus.
As these patients are pale and weak, there would
seem to be a deficiency of oxygene in their blood, and
in consequence a deficiency of phosphoric acid; which
is probably produced by oxygene in the act of res-
piration.
Mr. Bonhome in the Chemical Annals, August,
1793, supposes the rickets to arise from the prevalence
of vegetable or acetous acid, which is known to soften
bones out of the body. Mr. Dettaen seems to have
espoused a similar opinion, and both of them in con-
sequence give alkalies and testacea. If this theory
was just, the soft bones of such patients should shew
evident marks of such acidity after death; which I
believe has not been observed. Nor is it analogous
to other animal facts, that nutritious fluids secreted
by the finest vessels of the body should be so little ani-
malized, as to retain acetous or vegetable acidity.
The success attending the following case in so short
a time as a fortnight I ascribed principally to the use
of the warm bath; in which the patient continued for
full half an hour every night, in the degree of heat,
which was most grateful to her sensation, which might
be I suppose about 94. Miss -, about ten years
of age, and very tall and thin, has laboured under
palpitation of her heart, and difficult breathing on
the least exercise, with occasional violent dry cough,
for a year or more, with dry lips, little appetite
either

108 DISEASES [CLASS I. 2. 2.
either for food or drink, and dry skin, with cold ex-
tremities. She has at times been occasionally worse,
and been relieved in some degree by the bark. She
began to bend forwards, and to lift up her shoulders.
The former seemed owing to a beginning curvature
of the spine, the latter was probably caused to facili-
tate her difficult respiration.
M. M. She used the warm bath, as above related;
which by its warmth might increase the irritability of
the smallest series of vessels, and by supplying more
moisture to the blood might probably tend to carry
further the materials, which form calcareous or bony
particles, or to convey them in more dilute solution.
She took twice a day twenty grains of extract of bark,
twenty grains of soda phosphorata, and ten grains of
chalk, and ten of calcined hartshorn mixed into a
powder with ten drops of laudanum; with flesh food
both to dinner and supper; and port wine and water
instead of the small beer, she had been accustomed to;
she lay on a sofa frequently in a day, and occasionally
used a neck-swing.
15. Rachitis. Rickets. The head is large, pro-
tuberant chiefly on the forepart. The smaller joints
are swelled; the ribs depressed; the belly tumid,
with other parts emaciated. This disease from the
innutrition or softness of the bones arose about two
centuries ago; seems to have been half a century in
an increasing or spreading state; continued about half
a century at its height, or greatest diffusion; and is 
and

CLASS I. 2. 2.] OF IRRITATION. 109
now nearly vanished: which gives reason to hope,
that the small-pox, measles, and venereal disease,
which are all of modern production, and have already
become milder, may in process of time vanish from
the earth, and perhaps be succeeded by new ones!
See the preceding species.
16. Spinæ distortio. Distortion of the spine is ano-
ther disease originating from the innutrition or soft-
ness of the bones. I once saw a child about six years
old with palpitation of heart, and quickness of respi-
ration, which began to have a curvature of the spine;
I then doubted, whether the palpitation and quick
respiration were the cause or consequence of the cur-
vature of the spine; suspecting either that nature had
bent the spine outwards to give room to the enlarged
heart; or that the malformation of the chest had com-
pressed and impeded the movements of the heart. But
a few weeks ago on attending a young lady about ten
years old, whose spine had lately begun to be distort-
ed, with very great difficulty and quickness of respi-
ration, and alarming palpitation of the heart, I con-
vinced myself, that the palpitation and difficult res-
piration were the effect of the change of the cavity of
the chest from the distortion of the spine; and that
the whole was therefore a disease of the innutrition or
softness of the bones.
For on directing her to lie down much in the day,
and to take the bark, the distortion became less, and
the palpitation and quick respiration became less at
the

110 DISEASES [CLASS I. 2. 2.
the same time. After this observation a neck-swing
was directed, and she took the bark, madder, and
bone-ashes; and she continues to amend both in her
shape and health.
Delicate young ladies are very liable to become
awry at many boarding schools. This is occasioned
principally by their being obliged too long to preserve
an erect attitude, by sitting on forms many hours to-
gether. To prevent this the school-seats should have
either backs, on which they may occasionally rest
themselves; or desks before them, on which they
may occasionally lean. This is a thing of greater con-
sequence than may appear to those, who have not at-
tended to it.
When the least tendency to become awry is ob-
served, they should be advised to lie down on a bed
or sofa for an hour in the middle of the day for many
months; which generally prevents the increase of this
deformity by taking off for a time the pressure on the
spine of the back, and it at the same time tends to
make them grow taller. Young persons, when nicely
measured, are found to be half an inch higher in a
morning than at night; as is well known to those, who
inlist very young men for soldiers. This is owing to
the cartilages between the bones of the back becom-
ing compressed by the weight of the head and shoul-
ders on them during the day. It is the same pressure
which produces curvatures and distortions of the
spine in growing children, where the bones are softer
than usual; and which may thus be relieved by an
horizontal

CLASS I. 2. 2.] OF IRRITATION. 111
horizontal posture for an hour in the middle of the
day, or by being frequently allowed to lean on a chair,
or to play on the ground on a carpet.
Young ladies should also be directed, where two
sleep in a bed, to change every night, or every week,
their sides of the bed; which will prevent their ten-
dency to sleep always on the same side; which is not
only liable to produce crookedness, but also to occasion
diseases by the internal parts being so long kept in uni-
form contact as to grow together. For the same rea-
son they should not be allowed to sit always on the
same side of the fire or window, because they will then
be inclined too frequently to bend themselves to one
side.
Another great cause of injury to the shape of young
ladies are from the pressure of stays, or other tight
bandages, which at the same time cause other diseases
by changing the form or situation of the internal parts.
If a hard part of the stays, even a knot of the thread,
with which they are sewed together, is pressed hard
upon one side more than the other, the child bends
from the side most painful, and thus occasions a cur-
vature of the spine. To counteract this effect such
stays, as have fewest hard parts, and especially such
as can be daily or weekly turned, are preferable to
others.
Where frequent lying down on a sofa in the day-
time, and swinging frequently for a short time by the
hands or head, with loose dress, do not relieve a be-
ginning distortion of the back; recourse may be had 
to

112 DISEASES [CLASS I. 2. 2.
to a chair with stuffed moveable arms for the purpose of
suspending the weight of the body by cushions under the
arm-pits, like resting on crutches, or like the leading
strings of infants. From the top of the back of the
same chair a curved steel bar may also project to sus-
pend the body occasionally, or in part by the head,
like the swing above mentioned. The use of this chair
is more efficacious in straightening the spine, than
simply lying down horizontally; as it not only takes
off the pressure of the head and shoulders from the
spine, but at the same time the inferior parts of the
body contribute to draw the spine straight by their
weight; or lastly, recourse may be had to a spinal
machine first described in the Memoires of the academy
of surgery in Paris, Vol. III. p. 600, by M. Le
Vacher, and since made by Mr. Jones, at N° 6,
North-street, Tottenham-court Road, London, which
suspends the head, and places the weight of it on the
hips. This machine is capable of improvement by
joints in the bar at the back of it, to permit the body
to bend forwards without diminishing the extension of
the spine.
The objections to this machine of M. Vacher, which
is made by Mr. Jones, are first, that it is worn in the
day-time, and has a very unsightly appearance. Mr.
Jones has endeavoured to remedy this, by taking away
the curved bar over the head, and substituting in its
place a forked bar, rising up behind each ear, with
webs fastened to it, which pass under the chin and
occiput. But this is not an improvement, but a de-
I terioration 

CLASS I. 2. 2.] OF IRRITATIOM. 113
terioration of M. Vacher's machine, as it prevents the
head from turning with facility to either side. Another
objection is, that its being worn, when the muscles of
the back are in action, it is rather calculated to pre-
vent the curvature of the spine from becoming greater,
than to extend the spine, and diminish is curvature.
For this latter purpose I have made a steel bow,
as described in the annexed plate, which receives the
head longitudinally from the forehead to the occiput;
having a fork furnished with a web to sustain the
chin, and another to sustain the occiput. The summit
of the bow is fixed by a swivel to the board going
behind the head of the bed above the pillow. The
bed is to be inclined from the head to the feet about
twelve or sixteen inches. Hence the patient would
be constantly sliding down during sleep, unless sup-
ported by this bow, with webbed forks, covered also
with fur, placed beneath the chin, and beneath the
occiput. There are also proper webs lined with fur
for the hands to take hold of occasionally, and also to
go under the arms. By these means I should hope
great advantage from gradually extending the spine
during the inactivity of the muscles of the back; and
that it may be done without disturbing the sleep of
the patient, and if this should happen, the bow is
made to open by a joint at the summit of it, so as to
be instantly disengaged from the neck by the hand of
the wearer. This bow I have not yet had oppor-
tunity to make use of, but it may be had from Mr.
Harrison, whitesmith, Bridge-gate, Derby.
I It					

114 DISEASES [CLASS I. 2. 2.
It will be from hence easily perceived, that all other
methods of confining or directing the growth of young
people should be used with great skill; such as back-
boards, or bandages, or stocks for the feet; and
that their application should not be continued too long
at a time, left worse consequences should ensue, than
the deformity they were designed to remove. To this
may be added, that the stiff erect attitude taught by
some modern dancing masters does not contribute to
the grace of person, but rather militates against it; as
is well seen in one of the prints in Hogarth's Analysis
of Beauty; and is exemplified by the easy grace of
some of the antient statues, as of the Venus de Medici,
and the Antinous, and in the works of some modern
artists, as in a beautiful print of Hebe feeding an
Eagle, painted by Hamilton, and engraved by Egin-
ton, and many of the figures of Angelica Kauffmam.
Where the bone of one of the vertebræ of the back
has been swelled on both sides of it, so as to become
protuberant, issues near the swelled part have been
found of great service, as mentioned in Species 18 of
this genus. This has induced me to propose in cur-
vatures of the spine, to put an issue on the outside of
the curve, where it could be certainly ascertained, as
the bones on the convex side of the curve must be en-
larged; in one case I thought this of service, and re-
commend the further trial of it.
In the tendency to curvature of the spine, whatever
strengthens the general constitution is of service; as
the use of the cold bath in the summer months. This
however

CLASS I. 2. 2.] OF IRRITATION. 115
however requires some restriction both in respect to
the degree of coldness of the bath, the time of continu-
ing in it, and the season of the year. Common springs,
which are of forty-eight degrees of heat, are too cold
for tender constitutions, whether of children or adults,
and frequently do them great and irreparable injury.
The coldness of river water in the summer months,
which is about sixty-eight degrees, or that of Matlock,
which is about sixty-eight, or of Buxton, which is
eighty-two, are much to be preferred. The time of
continuing in the bath should be but a minute or two,
or not so long as to occasion a trembling of the limbs
from cold. In respect to the season of the year, deli-
cate children should certainly only bathe in the sum-
mer months; as the going frequently into the cold
air in winter will answer all the purposes of the cold
bath.
17. Claudicatio coxaria. Lameness of the hip.
A nodding of the thigh-bone is said to be produced in
feeble children by the softness of the neck or upper
part of that bone beneath the cartilage; which is na-
turally bent, and in this disease bends more down-
wards, or nods, by the pressure of the body; and
thus renders one leg apparently shorter than the other.
In other cases the end of the bone is protruded out
of its socket, by inflammation or enlargement of the
cartilages or ligaments of the joint, so that it rests on
some part of the edge of the acetabulum, which in
time becomes filled up. When the legs are straight,
I2 as

116 DISEASES [CLASS I. 2. 2.
as in standing erect, there is no verticillary motion in
the knee-joint; all the motion then in turning out the
toes further than nature designed, must be obtained
by straining in some degree this head of the thigh-
bone, or the acetabulum, or cavity, in which it
moves. This has induced me to believe, that this mis-
fortune of the nodding of the head by the bone, or
partial dislocation of it, by which one leg becomes
shorter than the other, is sometimes occasioned by
making very young children stand in what are called
stocks; that is with their heels together, and their
toes quite out. Whence the socket of the thigh-bone
becomes inflamed and painful, or the neck of the bone
is bent downward and outwards.
In this case there is no expectation of recovering
the straightness of the end of the bone; but these
patients are liable to another misfortune, that is, to
acquire afterwards a distortion of the spine; for as
one leg is shorter than the other, they sink on that
side, and in consequence bend the upper part of their
bodies, as their shoulders, the contrary way, to ba-
lance themselves; and then again the neck is bent
back again towards the lame side, to preserve the head
perpendicular; and thus the figure becomes quite
distorted like the letter S, owing originally to the de-
ficiency of the length of one limb. The only way to
prevent this curvature of the spine is for the child to
wear a high-heeled shoe or patten on the lame foot,
so as to support that side on the same level with the
other, and thus to prevent a greater deformity.
I have 

CLASS I. 2. 2.] OF IRRITATION. 117
I have this day seen a young lady about twelve,
who does not limp or waddle in walking; but never-
theless, when she stands or sits, she sinks down towards
her right side, and turns out that toe more than the
other. Hence, both as she sits and stands, she bends
her body to the right; whence her head would hang
a little over her right shoulder: but to replace this
perpendicularly, she lifts up her left shoulder and con-
tracts the muscles on that side of the neck; which are
therefore become thicker and stronger by their con-
tinued action; but there is not yet any very percep-
tible distortion of the spine.
As her right toe is turned outward rather more than
natural, this shews the disease to be in the hip-joint;
because, when the limb is stretched out, the toe can-
not turn horizontally in the least without moving the
end of the thigh-bone; although when the knee is
bent, the toe can be turned through one third or half
of a circle by the rotation of the tibia and fibula of
the leg rounds each other. Hence if children are set
in stocks with their heels touching each other as they
sit, and are then made to rise up, till they stand erect,
the socket or head of the thigh-bone becomes injured,
especially in those children, whose bones are soft; and
a shortness of that limb succeeds either by the bending
of the neck of the thigh-bone, or by its getting out
of the acetabulum; and a consequent rising of one
shoulder, and a curvature of the spine is produced
from so distant a cause.
I3 M. M. An

118 DISEASES [CLASS I. 2. 2.
M. M. An elastic cushion made of curled hair
should be placed under the affected hip, whenever she
fits; or should be fitted to the part by means of
drawers, so that she cannot avoid sitting on it. A
neck-swing, and lying down in the day, should be oc-
casionally used to prevent or remove any curvature of
the spine. The rest as in Species 13 and 15 of this
genus.
18. Spina protuberans. Protuberant spine. One
of the bones of the spine swells, and rises above the
rest. This is not an uncommon disease, and belongs
to the innutrition of the bones, as the bone must be-
come soft before it swells; which softness is owing to
defect of the secretion of phosphorated calcareous
earth. The swelling of the bone compresses a part of
the brain, called the spinal marrow, within the cavity
of the back-bones; and in consequence the lower
limbs become paralytic, attended sometimes with diffi-
culty of emptying the bladder and rectum.
M. M. Issues put on each side of the prominent
bone is of great effect, I suppose, by their stimulus;
which excites into action more of the sensorial powers
of irritation and sensation, and thus gives greater ac-
tivity to the vascular system in their vicinity. The
methods recommended in distortion of the spine are
also to be attended to.
19. Spina bifida. Divided spine, called also Hy-
drorachitis, as well as the Hydrocephalus externus,
are

CLASS I. 2. 2.] OF IRRITATION. 119
are probably owing in part to a defect of ossification
of the spine and cranium; and that the collection of
fluid beneath them may originate from the general
debility of the system; which affects both the secer-
ning, and absorbent vessels.
A curious circumstance, which is affirmed to attend
the spina bifida, is, that on compressing the tumor
with the hand gently, the whole brain becomes affect-
ed, and the patient falls asleep. I suppose the same
must happen on compressing the hydrocephalus exter-
nus? See Sect. XVIII. 20.
20. Ossis palati defectus. A defect of the bone of
the palate, which frequently accompanies a division
of the upper lip, occurs before nativity; and is owing
to the deficient action of the secerning system, from
whence the extremities are not completed. From a
similar cause I have seen the point of the tongue de-
ficient, and one joint of the two least fingers, and of
the two least toes, in the same infant; who was
otherwise a fine girl. See Sect. XXXIX. 4. 4.
The operation for the hare-lip is described by many
surgical writers; but there is a person in London,
who makes very ingenious artificial palates; which
prevents that defect of speech, which attends this
malformation. This factitious palate consists of a thin
plate of silver of the shape and form of the roof of
the mouth; from the front edge to the back edge of
this silver plate four or five holes are made in a
straight fine large enough for a needle to pass through
I4 them;

120 DISEASES [CLASS I. 2. 3.
them; on the back of it is then sewed a piece of
sponge; which when expanded with moisture is nearly
as large as the silver plate. This sponge is slipped
through the division of the bone of the palate, so as
to lie above it, while the silver plate covers the aper-
ture beneath, and is suspended by the expanding
sponge. This is removed every night and washed,
and returned into its place in the morning; on this
account it is convenient to have five or six of them,
for the sake of cleanliness. I have been more parti-
cular in describing this invention, as I do not know
the name, or place of residence, of the maker.
ORDO II.
Decreased Irritation.
GENUS III.
The decreased Action of the Absorbent System.
SOME decrease of heat attends these diseases,
though in a less degree than those of the last genus,
because the absorbent system of glands do not gene-
rate so much heat in their healthy state of action as
the secerning system of glands, as explained in Class
I. 1. 3.
SPECIES.
1. Mucus faucium frigidus. Cold mucus from the
throat. Much mucus, of rather a saline taste, and
less

CLASS I. 2. 3.] OF IRRITATION. 121
less inspissated than usual, is evacuated from the fauces
by hawking, owing to the deficient absorption of the
thinner parts of it. This becomes a habit in some
elderly people, who are continually spitting it out of
their mouths; and has probably been brought on by
taking snuff, or smoking tobacco; which by fre-
quently stimulating the fauces have at length rendered
the absorbent vessels less excitable by the natural sti-
mulus of the saline part of the secretion, which ought
to be reabsorbed, as soon as secreted.
M. M. A few grains of powder of bark frequently
put into the mouth, and gradually diffused over the
fauces. A gargle of barley water.
2. Sudor frigidus. The cold dampness of the hands
of some people is caused by the deficient absorption
of perspirable matter; the clammy or viscid feel of
it is owing to the mucous part being left upon the
skin. The coldness is produced both by the decreased
action of the absorbent system, and by the evapora-
tion of a greater quantity of the perspirable matter
into the air, which ought to have been absorbed.
M. M. Wash the hands in lime water, or with a
small quantity of volatile alkali in water.
3. Catarrhus frigidus. The thin discharge from
the nostrils in cold weather. The absorbent vessels
become torpid by the diminution of external heat,
sooner than the secerning ones, which are longer kept
warm by the circulating blood, from which they select
the

122 DISEASES [CLASS I. 2. 3.
the fluid they secrete; whereas the absorbent vessels
of the nostrils drink up their fluids, namely the thin
and saline part of the mucus, after it has been cooled
by the atmosphere. Hence the absorbents ceasing to
act, and the secerning vessels continuing some time
longer to pour out the mucus, a copious thin dis-
charge is produced, which trickles down the nostrils
in cold weather. This discharge is so acrid as to
inflame the upper lip; which is owing to the neu-
tral salts, with which it abounds, not being reabsorb-
ed; so the tears in the fistula lacrymalis inflame the
cheek. See Class I. 1. 2. 7.
4. Expectoratio frigida. Cold expectoration. Where
the pulmonary absorption is deficient, an habitual
cough is produced, and a frequent expectoration of
thin saline mucus; as is often seen in old enfeebled
people. Though the stimulus of the saline fluid,
which attends all secretions, is not sufficient to excite
the languid absorbent vessels to imbibe it; yet this
saline part, together with the increased quantity of
the whole of the secreted mucus, stimulates the
branches of the bronchia, so as to induce an almost
incessant cough to discharge it from the lungs. A
single grain of opium, or any other stimulant drug,
as a wine-posset with spirit of hartshorn, will cure
this cold cough, and the cold catarrh of the pre-
ceding article, like a charm, by stimulating the torpid
mouths of the absorbents into action. Which has
given rise to an indiscriminate and frequently perni-
cious

CLASS I. 2. 3.] OF IRRITATION. 123
cious use of the warm regimen in coughs and ca-
tarrhs of the warm or inflammatory kind, to the
great injury of many.
M. M. Half a grain of opium night and morning
promotes the absorption of the more fluid and saline
parts, and in consequence thickens the mucus, and
abates its acrimony. Warm diluent drink, wine
whey, with volatile alkali.
5. Urina uberior pallida. On being exposed naked
to cold air, or sprinkled with cold water, a quantity
of pale urine is soon discharged; for the absorbents
of the bladder become torpid by their sympathy with
those of the skin; which are rendered quiescent by
the diminution of external heat; but the kidneys con-
tinue to secrete the urine, and as no part of it is ab-
sorbed, it becomes copious and pale. This happens
from a similar cause in cold fits of agues; and in less
degree to many debilitated constitutions, whose ex-
tremities are generally cold and pale. The great quan-
tity of limpid water in hysteric cases, and in diabætes,
belongs to Class I. 3. 1. 10. I. 3. 2. 6.
M. M. Tincture of cantharides, opium, alum, sor-
bentia. Flannel shirt in cold weather. Animal food.
Beer. Wine. Friction. Exercise. Fire.
6. Diarrhœa frigida. Liquid stools are produced
by exposing the body naked to cold air, or sprinkling
it with cold water, for the same reason as the last ar-
ticle.
But

124 DISEASES [CLASS I. 2. 3.
But this disease is sometimes of a dangerous nature;
the intestinal absorption being so impaired, that the
aliment is said to come away undiminished in quantity,
and almost unchanged by the powers of digestion, and
is then called lientery.
The mucus of the rectum sometimes comes away
like pellucid hartshorn jelly, and liquefies by heat like
that, towards the end of inirritative fevers, which is
owing to the thinner part of the mucus not being ab-
sorbed, and thus resembles the catarrh of some old
people.
M. M. Opium, campeachy wood, armenian bole.
Blister. Flannel shirt in cold weather. Clysters with
opium. Friction on the bowels morning and night.
Equitation twice a day.
7. Fluor albus frigidus. Cold fluor albus. In weak
constitutions, where this discharge is pellucid and thin,
it must proceed from want of absorption of the mu-
cous membrane of the vagina, or uterus, and not
from an increased secretion. This I suspect to be the
most frequent kind of fluor albus; the former one de-
scribed at Class I. 1. 2. 11. attends menstruation, or
is a discharge instead of it, and thus resembles the ve-
nereal orgasm of female quadrupeds. The discharge
in this latter kind being more saline, is liable to exco-
riate the part, and thus produce smarting in making
water; in its great degree it is difficult to cure.
M. M. Increase the evacuation by stool and by per-
spiration, by taking rhubarb every night, about six
or

CLASS I. 2. 3.] OF IRRITATION. 125
or ten grains with one grain of opium for some
months. Flannel shirt in winter. Balsam copaiva.
Gum kino, bitters, chalybeates, friction over the
whole skin with flannel morning and night. Partial
cold bath, by sprinkling the loins and thighs, or
sponging them with cold water. Mucilage, as isin-
glass boiled in milk; blancmange, hartshorn jelly, are
recommended by some. Tincture of cantharides some-
times seems of service given from ten to twenty drops
or more, three or four times a day. A large blister
of burgundy pitch and armenian bole, so as to cover
the loins and lower part of the belly, is said to have
sometimes succeeded by increasing absorption by its
compression in the manner of a bandage. A solution
of metallic salts, as white vitriol, sixty grains to a pint;
or an infusion of oak-bark may be injected into the
vagina. Cold bath.
8. Gonorrhœa frigida. Cold gleet. Where the
gleet is thin and pellucid, it must arise from the want
of absorption of the membranes of the urethra, rather
than from an increased secretion from them. This I
suppose to be a more common disease than that men-
tioned at Class I. 1. 2. 10.
M. M. Metallic injections, partial cold bath, inter-
nal method as in the fluor albus above described.
Balsam of copaiva. Tincture of cantharides.
9. Hepatis tumor. The liver becomes enlarged
from defect of the absorption of mucus from its cells, 
as

126 DISEASES [CLASS I. 2. 3.
as in anasarca, especially in feeble children; at the
same time less bile is secreted from the torpid circula-
tion in the vena portæ. And as the absorbents, which
resume the thinner parts of the bile from the gall-
bladder and hepatic ducts, are also torpid or quiescent,
the bile is more dilute, as well as in less quantity.
From the obstruction of the passage of the blood
through the compressed vena porta these patients have
tumid bellies, and pale bloated countenances; their
paleness is probably owing to the deficiency of the
quantity of red globules in the blood in consequence
of the inert state of the bile.
These symptoms in children are generally attended
with worms, the dilute bile and the weak digestion
not destroying them. In sheep I have seen fleuke-
worms in the gall-ducts themselves among the dilute
bile; which gall-ducts they eat through, and then
produce ulcers, and the hectic fever, called the rot.
See Class I. 1. 4. 10. and Article IV. 2. 6.
M. M. After a calomel purge, crude iron-filings
are specific in this disease in children, and the worms
are destroyed by the returning acrimony and quantity
of the bile. A blister on the region of the liver.
Sorbentia, as worm-seed, santonicum. Columbo.
Bark.
10. Chlorosis. When the defect of the due action
of both the absorbent and secerning vessels of the liver
affects women, and is attended with obstruction of the
catamenia, it is called chlorosis; and is cured by the
exhibition

CLASS I. 2. 3.] OF IRRITATION. 127
exhibition of steel, which restores by its specific stimu-
lus the absorbent power of the liver; and the men-
struation, which was obstructed in consequence of de-
bility, recurs.
Indigestion, owing to torpor of the stomach, and a
consequent too great acidity of its contents, attends this
disease; whence a desire of eating chalk, or marl.
Sometimes a great quantity of pale urine is discharged
in a morning, which is owing to the inaction of the ab-
sorbents, which are distributed on the neck of the
bladder, during sleep. The swelling of the ankles,
which frequently attends chlorosis, is another effect of
deficient action of the absorbent system; and the pale
countenance is occasioned by the deficient quantity of
red globules of blood, caused by the deficient quantity
or acrimony of the bile, and consequent weakness of
the circulation. The pulse is so quick in some cases
of chlorosis, that, when attended with an accidental
cough, it may be mistaken for pulmonary consumption.
This quick pulse is owing to the debility of the heart
from the want of stimulus occasioned by the deficiency
of the quantity, and acrimony of the blood.
M. M. Steel. Bitters. Constant moderate exer-
cise. Friction with flannel all over the body and limbs
night and morning. Rhubarb five grains, opium half
a grain, every night. Flesh diet, with small beer, or
wine and water. The disease continues some months,
but at length subsides by the treatment above de-
scribed. A bath of about eighty degrees, as Buxton
Bath, is of service; a colder bath may do great injury.
11. Hydro-

128 DISEASES [CLASS I. 2. 3.
11. Hydrocele. Dropsy of the vagina testis. Drop-
sies have been divided into the incysted and the dif-
fused, meaning those of the cellular membrane, the
cells of which communicate with each other like a
sponge, and those of any other cavity of the body.
The collections of mucous fluids in the various cells
and cavities of the body arise from the torpor of the
absorbent vessels of those parts. It is probable, that
in dropsies attended with great thirst the cutaneous
absorbents become paralytic first; and then from the
great thirst, which is thus occasioned by the want of
atmospheric moisture, the absorption of the fat ensues;
as in fevers attended with great thirst, the fat is
quickly taken up. See Obesitas I. 2. 3. 16. Some
have believed, that the cellular and adipose mem-
branes are different ones; as no fat is ever deposited
in the eye-lids or scrotum, both which places are very
liable to be distended with the mucilaginous fluid of
the anasarca, and with air in Emphysema. Sometimes
a gradual absorption of the accumulated fluid takes
place, and the thinner parts being taken up, there re-
mains a more viscid fluid, or almost a solid in the part,
as in some swelled legs, which cannot easily be in-
dented by the pressure of the finger, and are called
scorbutic. Sometimes the paralysis of the absorbents
is completely removed, and the whole is again taken
up into the circulation.
The Hydrocele is known by a tumor of the scro-
tum, which is without pain, gradually produced, with
fluctuation, and a degree of pellucidity, when a candle
4 is 					

CLASS I. 2. 3.] OF IRRITATION. 129
is held behind it; it is the most simple incysted drop-
sy, as it is not in general complicated with other dis-
eases, as ascites with schirrous liver, and hydrocepha-
lus internus, with general debility. The cure of this
disease is effected by different ways; it consists in dis-
charging the water by an external aperture; and by
so far inflaming the cyst and testicle, that they after-
wards grow together, and thus prevent in future any
secretion or effusion of mucus; the disease is thus
cured, not by the revivescence of the absorbent power
of the lymphatics, but by the prevention of secretion
by the adhesion of the vagina to the testis. This I
believe is performed with less pain, and is more cer-
tainly manageable by tapping, or discharging the fluid
by means of a trocar, and after the evacuation of it to
fill the cyst with a mixture of wine and water for a few
minutes till the necessary degree of stimulus is pro-
duced, and then to withdraw it; as recommended by
Mr. Earle. See also Medical Commentaries by Dr.
Duncan, for 1793.
12. Hydrocephalus internus, or dropsy of the ventri-
cles of the brain, is fatal to many children, and some
adults. When this disease is less in quantity, it pro-
bably produces a fever, termed a nervous fever, and
which is sometimes called a worm fever, according to
the opinion of Dr. Gilchrist, in the Scots Medical
essays. This fever is attended with great inirritability,
as appears from the dilated pupils of the eyes, in
which it corresponds with the dropsy of the brain.
K And

130 DISEASES [CLASS I. 2. 3.
And the latter disease has its paroxysms of quick
pulse, and in that respect corresponds with other fevers
with inirritability.
The hydrocephalus internus is distinguished from
apoplexy by its being attended with fever, and from
nervous fever by the paroxysms being very irregular,
with perfect intermissions many times in a day. In
nervous fever the pain of the head generally affects
the middle of the forehead; in hydrocephalus inter-
nus it is generally on one side of the head. One of
the earliest criterions are the patient being uneasy on
raising his head from the pillow, and wishing to lie
down again immediately; which I suppose is owing to
the pressure of the water on the larger trunks of the
blood-vessels entering the cavity being more intolera-
ble than on the smaller one; for if the larger trunks
are compressed, it must inconvenience the branches
also; but if some of the small branches are compressed
only, the trunks are not so immediately incommoded.
Blisters on the head, and mercurial ointment exter-
nally, with calomel internally, are principally recom-
mended in this fatal disease. When the patient can-
not bear to be raised up in bed without great unea-
siness, it is a bad symptom. So I believe is deafness,
which is commonly mistaken for stupor. See Class. I.
2. 5. 6. And when the dilatation of the pupil of
either eye, or the squinting is very apparent, or the
pupils of both eyes much dilated, it is generally fatal.
As by stimulating one branch of lymphatics into in-
verted motion, another branch is liable to absorb its
fluid

CLASS I. 2. 3.] OF IRRITATION. 131
fluid more hastily; suppose strong errhines, as common
tobacco snuff to children, or one grain of turpeth mi-
neral, (Hydrargyrus vitriolatus), mixed with ten or
fifteen grains of sugar, was gradually blown up the
nostrils? See Class I. 3. 2. 1. I have tried common
snuff upon two children in this disease; one could not
be made to sneeze, and the other was too near death
to receive advantage. When the mercurial prepara-
tions have produced salivation, I believe they may
have been of service, but I doubt their good effect
otherwise. In one child I tried the tincture of Digi-
talis; but it was given with too timid a hand, and
too late in the disease, to determine its effects. See
Sect, XXIX. 5. 9.
As all the above remedies generally fail of success,
I think frequent, almost hourly, shocks of electricity
from very small charges might be passed through the
head in all directions with probability of good event.
And the use of the trephine, where the affected side
can be distinguished. See Strabismus, Class I. 2. 5. 4.
When one eye is affected, does the disease exist in the
ventricule of that side?
13. Ascites. The dropsy of the cavity of the ab-
domen is known by a tense swelling of the belly;
which does not sound on being struck like the tym-
pany; and in which a fluctuation can be readily
perceived by applying one hand expanded on one side,
and striking the tumour on the other.
K2 Effusion

132 DISEASES [CLASS I. 2. 3.
Effusions of water into large cavities, as into that
of the abdomen or thorax, or into the ventricules
of the brain or pericardium, are more difficult to be
reabsorbed, than the effusion of fluids into the cel-
lular membrane; because one part of this extensive
sponge-like system of cells, which connects all the
solid parts of the body, may have its power of ab-
sorption impaired, at the same time that some other
part of it may still retain that power, or perhaps
possess it in an increased degree; and as all these
cells communicate with each other, the fluid, which
abounds in one part of it, can be transferred to an-
other, and thus be reabsorbed into the circulation.
In the ascites, cream of tartar has sometimes been
attended with success; a dram or two drams are given
every hour in a morning till it operates, and is to
be repeated for several days; but the operation of
tapping is generally applied to at last. Dr. Sims, in
the Memoirs of the Medical Society of London, Vol.
III. has lately proposed, what he believes to be a
more successful method of performing this operation,
by making a puncture with a lancet in the scar of the
navel, and leaving it to discharge itself gradually for
several days, without introducing a canula, which he
thinks injurious both on account of the too sudden
emission of the fluid, and the danger of wounding
or stimulating the viscera. This operation I have
twice known performed with less inconvenience, and
I believe with more benefit to the patient, than the
common method.
After

CLASS I. 2. 3.] OF IRRITATION. 133
After the patient has been tapped, some have tried
injections into the cavity of the abdomen, but hitherto I
believe with ill event. Nor are experiments of this kind
very promising of success. First because the patients
are generally much debilitated, most frequently by
spirituous potation, and have generally a disease of
the liver, or of other viscera. And secondly, because
the quantity of inflammation, necessary to prevent
future secretion of mucus into the cavity of the ab-
domen, by uniting the peritoneum with the intestines
or mesentery, as happens in the cure of the hydrocele,
would I suppose generally destroy the patient, either
immediately, or by the consequence of such adhesions.
This however is not the case in respect to the
dropsy of the ovarium, or in the hydrocele.
14. Hydrops thoracis. The dropsy of the chest
commences with loss of flesh, cold extremities, pale
countenance, high coloured urine in small quantity,
and general debility, like many other dropsies. The
patient next complains of numbness in the arms, espe-
cially when elevated, with pain and difficulty of swal-
lowing, and an absolute impossibility of lying down
for a few minutes, or with sudden starting from sleep,
with great difficulty of breathing and palpitation of
his heart.
The numbness of the arms is probably owing more
frequently to the increased action of the pectoral mus-
cles in respiration, whence they are less at liberty to
perform other offices, than to the connexion of nerves
mentioned in Sect. XXIX. 5. 2. The difficulty of
K3 swallowing

134 DISEASES [CLASS I. 2. 3.
swallowing is owing to the compression of the œsopha-
gus by the lymph in the chest; and the impossibility
of breathing in an horizontal posture originates from
this, that if any parts of the lungs must be render-
ed useless, the inability of the extremities of them
must be less inconvenient to respiration; since if the
upper parts or larger trunks of the air-vessels should
be rendered useless by the compression of the accu-
mulated lymph, the air could not gain admittance to
the other parts, and the animal must immediately
perish.
If the pericardium is the principal seat of the dis-
ease, the pulse is quick and irregular. If only the
cavity of the thorax is hydropic, the pulse is not quick
nor irregular.
If one fide is more affected than the other, the pa-
tient leans most that way, and has more numbness in
that arm.
The hydrops thoracis is distinguished from the ana-
sarca pulmonum, as the patient in the former cannot
lie down half a minute; in the latter the difficulty of
breathing, which occasions him to rise up, comes on
more gradually; as the transition of the lymph in
the cellular membranes from one part to another of
it is slower, than that of the effused lymph in the
cavity of the chest.
The hydrops thoracis is often complicated with fits
of convulsive breathing; and then it products a dis-
ease for the time very similar to the common periodic
asthma, which is perhaps owing to a temporary ana-
sarca

CLASS I. 2. 3.] OF IRRITATION. 135
sarca of the lungs; or to an impaired venous absorp-
tion in them. These exacerbations of difficult breath-
ing are attended with cold extremities, cold breath,
cold tongue, upright posture with the mouth open,
and a desire of cold air, and a quick, weak, intermit-
tent pulse, and contracted hands.
These exacerbations recur sometimes every two or
three hours, and are relieved by opium, a grain every
hour for two or three doses, with ether about a dram
in cold water; and seem to be a convulsion of the
muscles of respiration induced by the pain of the
dyspnœa. As in Class III. 1. 1. 9.
M. M. A grain of dried squill, and a quarter of a
grain of blue vitriol every hour for six or eight hours,
unless it vomits or purge. A grain of opium. Blisters,
Calomel three grains every third day, with infusion
of senna. Bark. Chalybeates. Puncture in the side.
Can the fluctuation in the chest be heard by apply-
ing the ear to the side, as Hippocrates asserts- Can
it be felt by the hand or by the patient before the
disease is too great to admit of cure by the paracen-
tesis- Does this dropsy of the chest often come on
after peripneumony- Is it ever cured by making the
patient sick by tincture of digitalis- Could it be
cured, if on one side only, by the operation of punc-
ture between the ribs, and afterwards by inflaming
the cavity by the admission of air for a time, like
the cure of the hydrocele; the pleura afterwards
adhering wholly to that lobe of the lungs, so as to
prevent any future effusion of mucus-
K3 15. Hydrops

136 DISEASES [CLASS I. 2. 3.
15. Hydrops ovarii. Dropsy of the ovary is another
incysted dropsy, which seldom admits of cure. It is
distinguished from ascites by the tumour and pain,
especially at the beginning, occupying one side, and
the fluctuation being less distinctly perceptible. When
it happens to young subjects it is less liable to be mis-
taken for ascites. It affects women of all ages, either
married or virgins; and is produced by cold, fear,
hunger, bad food, and other debilitating causes. I
saw an elegant young lady, who was shortly to have
been married to a sensible man, with great prospect of
happiness; who, on being overturned in a chaise in
the night, and obliged to walk two or three miles in
wet, cold, and darkness, became much indisposed,
and gradually afflicted with a swelling and pain on one
side of the abdomen; which terminated in a dropsy
of the ovary, and destroyed her in two or three years.
Another young woman I recollect seeing, who was
about seventeen, and being of the very inferior class
of people, seemed to have been much weakened by
the hardship of a cold floor, and little or no bed, with
bad food; and who to these evils had to bear the un-
ceasing obloquy of her neighbours, and the persecution
of parish officers.
The following is abstracted from a letter of my
friend Mr. Power, surgeon, at Bosworth in Leicester-
shire, on examining the body of an elderly lady who
died of this disease, March 29, 1793. " On open-
ing the abdomen I found a large cyst attached to the
left ovarium by an elastic neck as thick as the little
finger,

CLASS I. 2. 3.] OF IRRITATION. 137
finger, and so callous as not to admit of being sepa-
rated by scissors without considerable difficulty. The
substance of the cyst had an appearance much resem-
bling the gravid uterus near the full period of gesta-
tion, and was as thick. It had no attachment to the
peritoneum, or any of the viscera, except by the hard
callous neck I have mentioned; so that the blood must
with difficulty have been circulated through it for
some time. Its texture was extremely tender, being
easily perforated with the finger, was of a livid red
colour, and evidently in a sphacelated state. It con-
tained about two gallons of a fluid of the colour of
port wine, without any greater tenacity. It has fal-
len to my lot to have opened two other patients,
whose deaths were occasioned by incysted dropsy of
the ovarium. In one of these the ovarium was much
enlarged with eight or ten cysts on its surface, but
there was no adhesion formed by any of the cysts to
any other part; nor had the ovarium formed any ad-
hesion with the peritoneum, though in a very diseased
state. In the other the disease was more simple, being
only one cyst, without any attachment but to the
ovarium.
"As the ovarium is a part not necessary to life,
and dropsies of this kind are so generally fatal in the
end, I think I shall be induced, notwithstanding the
hazard attending wounds, which penetrate the cavity
of the abdomen, to propose the extirpation of the
diseased part in the first case, which occurs to me, in
which I can with precision say, that the ovarium is
the

138 DISEASES [CLASS I. 2. 3.
the seat of the disease, and the patient in other re-
spects tolerably healthy; as the cavity of the abdo-
men is often opened in other cases without bad con-
sequences."
An argument, which might further countenance
the operation thus proposed by Mr. Power, might be
taken from the disease frequently affecting young per-
sons; from its being generally in these subjects local
and primary; and not like the ascites, produced or
accompanied with other diseased viscera; and lastly,
as it is performed in adult quadrupeds, as old sows,
with safety, though by awkward operators.
16. Anasarca pulmonum. The dropsy of the cel-
lular membrane of the lungs is usually connected with
that of the other parts of the system. As the cells of
the whole cellular membrane communicates with each
other, the mucaginous fluid, which remains in any
part of it for want of due absorption, sinks down to
the most depending cells; hence the legs swell, though
the cause of the disease, the deficiency of absorption,
may be in other parts of the system. The lungs how-
ever are an exception to this, since they are suspend-
ed in the cavity of the thorax, and have in conse-
quence a depending part of their own.
The anasarca of the lungs is known by the difficulty
of respiration accompanied with swelled legs, and
with a very irregular pulse. This last circumstance
has generally been ascribed to a dropsy at the same
time existing in the pericardium, but is more probably
I owing

CLASS I. 2. 3.] OF IRRITATION. 139
owing to the difficult passage of the blood through
the lungs; because I found on dissection, in one in-
stance, that the most irregular pulse, which I ever at-
tended to, was owing to very extensive adhesions of
the lungs; insomuch that one lobe intirely adhered
to the pleura; and secondly, because this kind of
dropsy of the lungs is so certainly removed for a time
along with the anasarca of the limbs by the use of
digitalis.
This medicine, as well as emetic tartar, or squill,
when given so as to produce sickness, or nausea, or
perhaps even without producing either in any per-
ceptible degree, by affecting the lymphatics of the
stomach, so as either to invert their motion, or to
weaken them, increases by reverse sympathy the ac-
tion, and consequent absorbent power of these lym-
phatics, which open into the cellular membrane. But
as those medicines seldom succeed in producing an ab-
sorption of those fluids, which stagnate in the larger
cavities of the body, as in the abdomen, or chest, and
do generally succeed in this difficulty of breathing
with irregular pulse above described, I conclude that
it is not owing to an effusion of lymph into the pericar-
dium, but simply to an anasarca of the lungs.
M. M. Digitalis. See Art. V. 2. 1. Tobacco.
Squill. Emetic tartar (antimonium tartarizatum).
Then Sorbentia. Chalybeates. Opium half a grain
twice a day. Raisin wine and water, or other wine
and water, is preferred to the spirit and water, which
these patients have generally been accustomed to.
The

140 DISEASES [CLASS I. 2. 3.
The usual cause of anasarca is from a diseased liver,
and hence it most frequently attends those, who
have drank much fermented or spirituous liquors; but
I suspect that there is another cause of anasarca, which
originates from the brain; and which is more cer-
tainly fatal than that, which originates from a dis-
eased liver. These patients, where the anasarca ori-
ginates from, or commences in, the brain, have not
other symptoms of diseased liver; have less difficulty
of breathing at the beginning; and hold themselves
more upright in their chair, and in walking. In this
kind of dropsy I suspect the digitalis has less or no
effect; as it particularly increases the absorption from
the lungs.
17. Obesitas. Corpulency may be called an ana-
sarca or dropsy of fat, since it must be owing to an
analogous cause; that is, to the deficient absorption
of fat compared to the quantity secreted into the cells
which contain it. See Class II. 1. 1. 4.
The method of getting free from too much fat
without any injury to the constitution, consists, first,
in putting on a proper bandage on the belly, so that,
it can be tightened or relaxed with ease, as a tightish
under waistcoat, with a double row of buttons. This
is to compress the bowels and increase their absorp-
tion, and it thus removes one principal cause of cor-
pulency, which is the looseness of the skin. Secondly,
he should omit one entire meal, as supper; by this
long abstinence from food the absorbent system will
act

CLASS I. 2. 3.] OF IRRITATION. 141
act on the mucus and fat with greater energy. Thirdly,
he should drink as little as he can with ease to his
sensations; since, if the absorbents of the stomach
and bowels supply the blood with much, or perhaps
too much, aqueous fluid, the absorbents of the cel-
lular membrane will act with less energy. Fourthly,
he should use much salt or salted meat, which will
increase the perspiration and make him thirsty; and
if he bears this thirst, the absorption of his fat will be
greatly increased, as appears in fevers and dropsies
with thirst; this I believe to be more efficacious than
soap. Fifthly, he may use aerated alkaline water for
his drink, which may be supposed to render the fat
more fluid,-or he may take soap in large quantities,
which will be decomposed in the stomach. Sixthly,
short rest, and constant exercise.
18. Splenis tumor. Swellings of the spleen, or in
its vicinity, are frequently perceived by the hand in
intermittents, which are called Ague-cakes, and seem
owing to a deficiency of absorption in the affected
part.
Mr. Y-, a young man about twenty-five years
of age, who lived intemperately, was seized with an
obstinate intermittent, which had become a continued
fever with strong pulse, attended with daily remission.
A large hard tumour on the left side, on the region 
of the spleen, but extending much more downward,
was so distinctly perceptible, that one seemed to get
one's fingers under the edge of it, much like the feel
of

142 DISEASES [CLASS I. 2. 3.
of the brawn or shield on a boar's shoulder. He was
repeatedly bled, and purged with calomel, had an
emetic, and a blister on the part, without diminishing
the tumour; after some time he took the Peruvian
bark, and slight doses of chalybeates, and thus be-
came free from the fever, and went to Bath for seve-
ral weeks, but the tumour remained. This tumour
I examined every four or five years for above thirty
years. His countenance was pale, and towards the
end of his life he suffered much from ulcers on his legs,
and died about sixty, of general debility; like many
others, who live intemperately in respect to the ingur-
gitation of fermented or spirituous liquors.
As this tumour commenced in the cold fit of an in-
termittent fever, and was not attended with pain, and
continued so long without endangering his life, there
is reason to believe it was simply occasioned by de-
ficient absorption, and not by more energetic action of
the vessels which constitute the spleen. See Class II.
1. 2. 13.
M. M. Venesection. Emetic, cathartic with calo-
mel; then sorbentia, chalybeates, Peruvian bark.
19. Genu tumor albus. White swelling of the knee,
is owing to deficient absorption of the lymphatics of
the membranes including the joint, or capsular liga-
ments, and sometimes perhaps of the gland which
secretes the synovia; and the ends of the bones are
probably affected in consequence.
I saw 

CLASS I. 2. 3.] OF IRRITATION. 143
I saw an instance, where a caustic had been ap-
plied by an empiric on a large white swelling of the
knee, and was told, that a fluid had been discharged
from the joint, which became anchylosed, and healed
without loss of the limb.
M. M. Repeated blisters on the part early in the
disease is said to cure it by promoting absorption;
saturnine solutions externally are recommended. Bark,
animal charcoal, as burnt sponge, opium in small doses.
Friction with the hand.
20. Bronchocele. Swelled throat. An enlargement
of the thyroid glands, said to be frequent in moun-
tainous countries, where river water is drank, which
has its source from dissolving snows. This idea is a
very ancient one, but perhaps not on that account to
be the more depended upon, as authors copy one
another. Tumidum guttur quis miratur in alpibus, seems
to have been a proverb in the time of Juvenal. The
inferior people of Derby are much subject to this dis-
ease, but whether more so than other populous towns,
I can not determine; certain it is, that they chiefly
drink the water of the Derwent, which arises in a
mountainous country, and is very frequently blacken-
ed as it passes through the morasses near its source;
and is generally of a darker colour, and attended with
a whiter foam, than the Trent, into which it falls;
the greater quantity and whiteness of its froth I sup-
pose may be owing to the viscidity communicated to
it by the colouring matter. The lower parts of the
town

144 DISEASES [CLASS I. 2. 3.
town of Derby might be easily supplied with spring
water from St. Alkmonds's well; or the whole of it
from the abundant springs near Bowbridge: the wa-
ter from which might be conveyed to the town in
hollow bricks, or clay-pipes, at no very great ex-
pence, and might be received into frequent reservoirs
with pumps to them; or laid into the houses.
M. M. Twenty grains of burnt sponge with ten of
nitre made with mucilage into lozenges, and permitted
to dissolve slowly under the tongue twice a day, is as-
serted to cure in a few months; perhaps other animal
charcoal, as candle-snuffs, might do the same.
I have directed in the early state of this disease a
mixture of common salt and water to be held in the
mouth, particularly under the tongue, for a few mi-
nutes, four or six times a day for many weeks, which
has sometimes succeeded, the salt and water are then
spit out again, or in part swallowed. Externally vi-
negar of squills has been applied, or a mercurial
plaster, or fomentations of acetated ammoniac; or
ether. Some empirics have applied caustics on the
bronchocele, and sometimes, I have been told, with
success; which should certainly be used where there
is danger of suffocation from the bulk of it. One
case I saw, and one I was well informed of, where
the bronchocele was cured by burnt sponge, and a
hectic fever supervened with colliquative sweats; but
I do not know the final event of either of them.
De Haen affirms the cure of bronchocele to be
effected by flowers of zinc, calcined egg-shells and,
scarlet

CLASS I. 2. 3.] OF IRRITATION. 145
scarlet cloth burnt together in a close crucible, which
was tried with success, as he assured me, by a late
lamented physician, my friend, Dr. Small of Birming-
ham; who to the cultivation of modern sciences added
the integrity of ancient manners; who in clearness of
head, and benevolence of heart, had few equals, per-
haps no superiors.
21. Scrophula. King's evil is known by tumours
of the lymphatic glands, particularly of the neck. The
upper lip, and division of the nostrils is swelled, with
a florid countenance, a smooth skin, and a tumid ab-
domen. Cullen. The absorbed fluids in their course
to the veins in the scrophula are arrested in the lym-
phatic or conglobate glands; which swell, and after
a great length of time, inflame and suppurate. Mate-
rials of a peculiar kind, as the variolous and venereal
matter, when absorbed in a wound, produce this tor-
por, and consequent inflammation of those lymphatic
glands, where they first arrive, as in the axilla and
groin. There is reason to suspect, that the tonsils fre-
quently become inflamed, and suppurate from the mat-
ter absorbed from carious teeth; and I saw a young
lady, who had both the axillary glands swelled, and
which suppurated; which was believed to have been
caused by her wearing a pair of new green gloves for
one day, when she had perspired much, and was much
exhausted and fatigued by walking; the gloves were
probably dyed in a solution of verditer.
L These

146 DISEASES [CLASS I. 2. 3.
These indolent tumours of the lymphatic glands,
which constitute the scrophula, originate from the in-
irritability of those glands; which therefore sooner fall
into torpor after having been stimulated too violently
by some poisonous material; as the muscles of enfee-
bled people sooner become fatigued, and cease to act,
when exerted, than those of stronger ones. On the
same account these scrophulous glands are much longer
in acquiring increase of motion, after having been sti-
mulated into inactivity, and either remain years in a
state of indolence, or suppurate with difficulty, and
sometimes only partially.
The difference between scrophulous tumours, and
those before described, consists in this; that in those
either glands of different kinds were diseased, or the
mouths only of the lymphatic glands were become tor-
pid; whereas in scrophula the conglobate glands them-
selves become tumid, and generally suppurate after a
great length of time, when they acquire new sensibi-
lity. See Sect. XXXIX. 4. 5.
These indolent tumours may be brought to suppu-
rate sometimes by passing electric shocks through
them every day for two or three weeks, as I have
witnessed. It is probable, that the alternate applica-
tion of snow or iced water to them, till they become
painfully cold, and then of warm flannel or warm wa-
ter, frequently repeated, might restore their irritability
by accumulation of sensorial power; and thence either
facilitate their dispersion, or occasion them to suppurate.
See Class II. 1. 4. 13.
This

CLASS I. 2. 3.] OF IRRITATION. 147
This disease is very frequent amongst the children
of the poor in large towns, who are in general ill
fed, ill lodged, and ill clothed; and who are further
weakened by eating much salt with their scanty meal
of insipid vegetable food, which is seldom of better
quality than water gruel, with a little coarse bread in
it. See diarrhœa of infants, Class I. 1. 2. 5. Scro-
phulous ulcers are difficult to heal, which is owing
to the deficiency of absorption on their pale and flabby
surfaces, and to the general iniritability of the system.
See Class I. 1. 3. 13.
M. M. Plentiful diet of flesh-meat and vegetables
with small-beer. Opium, from a quarter of a grain
to half a grain twice a day. Sorbentia. Tincture of
digitalis, thirty drops twice a day. Externally sea
bathing, or bathing in salt and water, one pound to
three gallons, made warm. The application of Peru-
vian bark in fine powder, seven parts, and white lead,
(cerussa) in fine powder one part, mixed together and
applied on the ulcers in dry powder, by means of
lint and a bandage, to be renewed every day. Or
very fine powder of calamy alone, lapis calaminaris.
If powder of manganese-
22. Schirrus. After the absorbent veins of a gland
cease to perform their office, if the secerning arteries
of it continue to act some time longer, the fluids are
pushed forwards, and Stagnate in the receptacles or
capillary vessels of the gland; and the thinner part of
them only being resumed by the absorbent system of
L2 the

148 DISEASES [CLASS I. 2. 3.
the gland, a hard tumour gradually succeeds; which
continues like a lifeless macs, till from come accidental
violence it gains sensibility, and produces cancer, or
suppurates. Of this kind are the schirrous glands of
the breasts, of the lungs, of the mesentery, and the
scophulous tumours about the neck and the bron-
chocele.
Another seat of schirrus is in the membraneous parts
of the system, as of the rectum intestinum, the urethra,
the gula or throat; and of this kind is the verruca or
wart, and the clavus pedum, or corns on the toes. A
wen sometimes arises on the back of the neck, and
sometimes between the shoulders; and by distend-
ing the tendinous fascia produces great and perpetual
pain.
M. M. Mercurial ointment. Cover the part with
oiled silk. Extirpation. Electric shocks through the
tumour. An issue into the substance of the wen.
Opium. Ether externally.
23. Schirrus recti intestini. Schirrus of the rectum.
A schirrus frequently affects a canal, and by contract-
ing its diameter becomes a painful and deplorable dis-
ease. The canals thus obstructed are the rectum, the
urethra, the throat, the gall-ducts, and probably the
excretory ducts of the lymphatics, and of other glands.
The schirrus of the rectum is known by the patient
having pain in the part, and being only able to part
with liquid feces, and by the introduction of the finger;
the swelled part of the intestine is sometimes protruded
downwards, 

CLASS I. 2. 3.] OF IRRITATION. 149
downwards, and hangs, like a valve, smooth and hard
to the touch, with an aperture in the centre of it.
See a paper on this subject by J. Sherwin. Memoirs
of a London Medical Society, Vol. II. p. 9.
M. M. To take but little solid food. Aperient
medicines. Introduce a candle smeared with mercu-
rial ointment. Sponge-tent. Clysters with forty
drops of laudanum. Introduce a leathern canula, or
gut, and then either a wooden maundril, or blow
it up with air, so as to distend the contracted part as
much as the patient can bear. Or spread mercurial
plaster on thick soft leather, and roll it up with the
plaster outwards to any thickness and length, which
can be easily introduced and worn; or two or three
such pieces may be introduced after each other. The
same may be used to compress bleeding internal piles.
See Class I. 2. 1. 6.
24. Schirrus urethræ. Schirrus of the urethra.
The passage becomes contracted by the thickened
membrane, and the urine is forced through with great
difficulty, and is thence liable to distend the canal be-
hind the stricture; till at length an aperture is made,
and the urine forces its way into the cellular mem-
brane, making large sinuses. This situation sometimes
continues many months, or even years, and so much
matter is evacuated after making water, or at the
same time, by the action of the muscles in the vicinity
of the sinuses, that it has been mistaken for an in-
creased secretion from the bladder, and has been erro-
L3 neously 

150 DISEASES [CLASS I. 2. 3.
neously termed a catarrh of the bladder. See a paper
by Dr. R. W. Darwin in the Medical Memoirs.
M. M. Distend the part gradually by catgut bou-
gies, which by their compression will at the same time
diminish the thickness of the membrane, or by bougies
of elastic gum, or of horn boiled soft. The patient
should gain the habit of making water slowly, which
is a matter of the utmost consequence, as it prevents
the distention, and consequent rupture, of that part
of the urethra, which is between the stricture and the
neck of the bladder.
When there occurs an external ulcer in the peri-
næum, and the urine is in part discharged that way,
the disease can not be mistaken. Otherwise from the
quantity of matter, it is generally supposed to come
from the bladder, or prostate gland; and the urine,
which escapes from the ruptured urethra, mines its
way amongst the muscles and membranes, and the pa-
tient dies tabid, owing to the want of an external ori-
fice to discharge the matter. See Class II, 1. 4. 11.
25. Schirrus œsophagi. A schirrus of the throat
contracts the passage so as to render the swallowing of
solids impracticable, and of liquids difficult. It affects
patients of all ages, but is probably most frequently
produced by swallowing hard angular substances, when
people have lost their teeth; by which this membrane
is over distended, or torn, or otherwise injured.
M. M. Put milk into a bladder tied to a canula
or catheter; introduce it past the stricture, and press
it

CLASS I. 2. 3.] OF IRRITATION 151
it into the stomach. Distend the stricture gradually
by a sponge-tent fastened to the end of whalebone,
or by a plug of wax, or a spermaceti candle, about
two inches long; which might be introduced, and
left there with a string only fixed to it to hang out
of the mouth, to keep it in its place, and to retract
it by occasionally; for which purpose the string must
be put through a catheter or hollow probang, when
it is to be retracted. Or lastly introduce a gut fixed
to a pipe; and then distend it by blowing wind into
it. The swallowing a bullet with a string put through
it, to retract it on the exhibition of an emetic, has
also been proposed. Externally mercurial ointment
has been much recommended. Poultice. Oiled silk.
Clysters of broth. Warm bath of broth. Transfu-
sion of blood into a vein three or four ounces a day?
See Class III. 1. 1. 15.
I directed a young woman about twenty-two years
of age, to be fed with new milk put into a bladder,
which was tied to a catheter, and introduced beyond
the stricture in her throat; after a few days her spirits
sunk, and she refused to use it further, and died.
Above thirty years ago I proposed to an old gentle-
man, whose throat was entirely impervious, to supply
him with a few ounces of blood daily from an ass,
or from the human animal, who is still more patient
and tractable, in the following manner. To fix a sil-
ver pipe about an inch long to each extremity of a
chicken's gut, the part between the two silver ends to
be measured by filling it with warm water; to put
one end into the vein of a person hired for that pur-
L4 pose					

152 DISEASES [CLASS I. 2. 3.
pose, so as to receive the blood returning from the ex-
tremity; and when the gut was quite full, and the
blood running through the other silver end, to intro-
duce that end into the vein of the patient upwards to-
wards the heart, so as to admit no air along with the
blood. And lastly, to support the gut and silver ends
on a water plate, filled with water of ninety-eight de-
grees of heat, and to measure how many ounces of
blood was introduced by passing the finger, so as to
compress the gut, from the receiving pipe to the de-
livering pipe; and thence to determine how many
gut-fulls were given from the healthy person to the
patient. See Class IV. 2. 4. 11. L. Mr. - con-
sidered a day on this proposal, and then another day,
and at length answered, that "he now found himself
near the house of death; and that if he could return,
he was now too old to have much enjoyment of life;
and therefore he wished rather to proceed to the end
of that journey, which he was now so near, and which
he must at all events soon go, than return for so short
a time." He lived but a few days afterwards, and
seemed quite careless and easy about the matter.
26. Lacteorum inirritabilitas. Inirritability of the
lacteals are described in Sect. XXVIII. under the name
of paralysis of the lacteals; but as the word paralysis
has generally been applied to the disobedience of the
muscles to the power of volition, the name is here
changed to inirritability of the lacteals, as more cha-
racteristic of the disease.
27. Lym- 

CLASS I. 2. 4.] OF IRRITATION. 153
27. Lymphaticorum inirritabilitas. The inirritability
of the cellular and cutaneous lymphatics is described
in Sect. XXIX. 5. 1. and in Class I. 2. 3. 16. The
inirritability of the cutaneous lymphatics generally ac-
companies anasarca, and is the cause of the great thirst
in that malady. At the same time the cellular lym-
phatics act with greater energy, owing to the greater
derivation of sensorial power to them in consequence
of the less expenditure of it by the cutaneous ones;
and hence they absorb the fat, and mucus, and also
the thinner parts of the urine. Whence the great
emaciation of the body, the muddy sediment, and the
small quantity of water in this kind of dropsy.
ORDO II.
Decreased Irritation.
GENUS IV.
With decreased Actions of other Cavities and Membranes.
MANY of the diseases of this genus are attended
with pain, and with cold extremities, both which cease
on the exhibition of wine or opium; which shews,
that they originate from deficient action of the affected
organ. These pains are called nervous or spasmodic,
are not attended with fever, but are frequently suc-
ceeded by convulsions and madness; both which be-
long

154 DISEASES [CLASS I. 2. 4.
long to the class of volition. Some of them return at
periods, and when these can be ascertained, a much less
quantity of opium will prevent them, than is necessary
to cure them, when they are begun; as the vessels
are then torpid and inirritable from the want of sen-
sorial power, till by their inaction it becomes again
accumulated.
Our organs of sense properly so called are not liable
to pain from the absence of their appropriated stimuli,
as from darkness or silence; but the other senses,
which may be more properly called appetites, as those
by which we perceive heat, hunger, thirst, lust, want
of fresh air, are affected with pain from the defect or
absence of their accustomed stimuli, as well as with
pleasure by the possession of them; it is probable that
some of our glands, whose sense or appetite requires
or receives something from the circulating blood, as
the pancreas, liver, testes, prostate gland, may be
affected with aching or pain, when they cannot ac-
quire their appropriated fluid.
Wherever this defect of stimulus occurs, a torpor
or inaction of the organ ensues, as in the capillaries of
the skin, when exposed to cold; and in the glands,
which secrete the gastric juice, when we are hungry.
This torpor however, and concomitant pain, which is
at first owing to defect of stimulus, is afterwards in-
duced by other associations or catenations, and consti-
tutes the beginning of ague fits.
It must be further observed, that in the diseases of
pain without fever, the pain is frequently not felt in
the

CLASS I. 2. 4.] OF IRRITATION. 155
the part where the cause of the disease resides; but is
induced by sympathy with a distant part, whose irri-
tability or sensibility is greater or less than its own.
Thus a stone at the neck of the bladder, if its stimulus
is not very great, only induces the pain of strangury
at the glans penis. If its stimulus be greater, it then
induces pain at the neck of the bladder. The concre-
tions of bile, which are protruded into the neck of
the gall-bladder, when the disease is not very great,
produce pain at the other extremity of the bile-duct,
which enters the duodenum immediately under the pit
of the stomach; but, when the disease is great from
the largeness of the bile-stone, the pain is felt in the
region of the liver at the neck of the gall-bladder.
It appears from hence, that the pains enumerated
in this genus are consequences of the inactivity of the
organ; and, as they do not occasion other diseases,
should be classed according to their proximate cause,
which is defective irritation; there are nevertheless
other pains from defect of stimulus, which produce
convulsions, and belong to Class III. I. 1.; and others,
which produce pains of some distant part by associa-
tion, and belong to Class IV. 2. 2.
SPECIES.
1. Sitis. Thirst. The senses of thirst and of hun-
ger seem to have this connection, that the former is
situated at the upper end, and the latter at the lower
end of the same canal. One about the pharinx,
where the œsophagus opens into the mouth, and the
other

156 DISEASES [CLASS I. 2. 4.
other about the cardia ventriculi, where it opens into
the stomach. The extremities of other canals have
been shewn to possess correspondent sensibilities, or
irritabilities, as the two ends of the urethra, and of
the common gall-duct. See IV. 2. 2. 2. and 4.
The membrane of the upper end of the gullet
becomes torpid, and consequently painful, when there
is a deficiency of aqueous fluid in the general sys-
tem; it then wants its proper stimulus. In the same
manner a want of the stimulus of more solid mate-
rials at the other end of the canal, which terminates
in the stomach, produces hunger; as mentioned in
Sect. XIV. 8. The proximate causes of both of them
therefore consist in deficient irritation, when they are
considered as pains; because these pains are in con-
sequence of the inactivity of the organ, according to
the fifth law of animal causation. Sect. IV. 5. But
when they are considered as desires, namely of liquid
or solid aliment, their proximate cause consists in the
pain of them, according to the sixth law of animal
causation. So the proximate cause of the pain of
coldness is the inactivity of the organ, and perhaps
the consequent accumulation of sensorial power in it;
but the pain itself, or the consequent volition, is the
proximate cause of the shuddering and gnashing the
teeth in cold fits of intermittent fevers. See Class
I. 2. 2. 1.
Thirst may be divided into two varieties alluding
to the remote cause of each, and may be termed
sitis calida, or warm thirst, and sitis frigida, or cold
thirst.

CLASS I. 2. 4.] OF IRRITATION. 157
thirst. The remote cause of the former arises from
the dissipation of the aqueous parts of our fluids by
the increased secretion of perspirable matter, or other
evacuations. And hence it occurs in hot fits of fe-
ver, and after taking much wine, opium, spice, salt,
or other drugs of the Art. incitantia or secernentia.
The thirst, which occurs about three hours after eat-
ing a couple of red herrings, to a person unaccus-
tomed to salted meat, is of this kind; the increased
action of the cutaneous vessels dissipates so much of
our fluids by insensible perspiration, as to require
above two quarts of water to restore the fluidity of
the blood, and to wash the salt out of the system.
See Art. III. 2. 1.
M. M. Cold water. Vegetable acids. Warm bath.
The remote cause of sitis frigida, or cold thirst,
is owing to the inaction of the cutaneous, pulmo-
nary, urinary, and cellular absorbents; whence the
blood is deprived of the great supply of moisture,
which it ought to receive from the atmosphere, and
from the cells of the cellular membrane, and from
other cysts; this cause of thirst exists in dropsies, and
in the cold fits of intermittents. The desire of fluids,
like that of solids, is liable to acquire periods, and
may therefore readily become diseased by indulgence
in liquids grateful to the palate.
Of diseased thirst, the most common is either owing
to defect of the action of the numerous absorbent
vessels on the neck of the bladder, in which the pa-
tient

158 DISEASES [CLASS I. 2. 4.
tient makes much paleish water; or to the defective
absorption of the skin and lungs, in which the pa-
tient makes but little water, and that high-coloured,
and with sediment. In both the tongue and lips are
liable to become very dry. The former in its greatest
degree attends diabetes, and the latter anasarca.
M. M. Warm water, warm wine, warm bath.
Opium. Cold bath. Iced water. Lemonade. Cyder.
2. Esuries. Hunger has been fancifully ascribed
to the sides of the stomach rubbing against each
other, and to the increased acidity of the gastric juice
corroding the coats of it. If either of these were
the cause of hunger, inflammation must occur, when
they had continued some time; but, on the contrary,
coldness and not heat are attendant on hunger; which
evinces, that like thirst it is owing to the inactivity
of the membrane, which is the seat of it; while the
abundant nerves about the cardia ventriculi, and the
pain of hunger being felt in that part, gives great
reason to conclude, that it is there situated.
The sense of hunger as well as of thirst is liable to
acquire habits in respect to the times of its return-
ing painfulness, as well as in respect to the quantity
required to satiate its appetency, and hence may be-
come diseased by indulgence, as well as by want of
its appropriate stimulus. Those who have been ac-
customed to distend their stomach by large quanti-
ties of animal and vegetable food, and much potation,
find a want of distension, when the stomach is empty,
which

CLASS I. 2. 4.] OF IRRITATION. 159
which occasions faintness, and is mistaken for hunger,
but which does not appear to be the same sensation.
I was well informed, that a woman near Lichfield,
who eat much animal and vegetable food for a wager,
affirmed, that since distending her stomach so much,
she had never felt herself satisfied with food; and had
in general taken twice as much at a meal, as she had
been accustomed to, before she eats so much for a
wager.
3. Nausea sicca. Dry nausea. Consists in a quies-
cence or torpor of the mucous or salivary glands, and
precedes their inverted motions, described in nausea
humida, Class I. 3. 2. 3. In the same manner as
sickness of the stomach is a quiescence of that organ
preceding the action of vomiting, as explained in Sect.
XXXV. 1. 3. This is sometimes induced by disa-
greeable drugs held in the mouth, at other times of
disgustful ideas, and at other times by the association
of these actions with those of the stomach; and thus
according to its different proximate causes may belong
to this, or to the second, or to the fourth class of
diseases. 
M. M. Lemonade. Tasteful food. A blister. Warm
bath.
4. Ægritudo ventriculi. Sickness of stomach is pro-
duced by the quiescence or inactivity of that organ,
as is explained in Sect. XXXV. 1.3. It consists in
the state between the usual peristaltic motions of that
organ

160 DISEASES [CLASS I. 2. 4.
organ, in the digestion of our aliment, and the retro-
grade motions of it in vomiting; for it is evident, that
the direct motions of it from the cardia to the pylorus
must stop, before those in a contrary direction can
commence. This sickness, like the nausea above de-
scribed, is sometimes produced by disgustful ideas, as
when natty objects are seen, and nasty stories related,
as well as by the exhaustion of the sensorial power by
the stimulus of some emetic drugs, and by the defect
of the production of it, as in enfeebled drunkards.
Sickness may likewise consist in the retrograde mo-
tions of the lymphatics of the stomach, which regur-
gitate into it the chyle or lymph, which they have
lately absorbed, as in Class I. 3. 2. 3. It is probable,
that these two kinds of sickness may be different sen-
sations, though they have acquired but one name; as
one of them attends hunger, and the other repletion;
though either of them may possibly be induced by
association with nauseous ideas.
M. M. A blister on the back. An emetic. Opium.
Crude mercury. Covering the head in bed. See
Sect. XXV. 16. Class IV. 1. 1. 2. and 3.
5. Cardialgia. Heartburn originates from the in-
activity of the stomach, whence the aliment, instead
of being subdued by digestion, and converted into
chyle, runs into fermentation, producing acetous acid.
Sometimes the gastric juice itself becomes so acid as to
give pain to the upper orifice of the stomach; these
acid contents of the stomach, on falling on a marble
4 hearth,

CLASS I. 2. 4.] OF IRRITATION. 161
hearth, have been seen to produce an effervescence
on it. The pain of heat at the upper end of the gul-
let, when any air is brought up from the fermenting
contents of the stomach, is to be ascribed to the sym-
pathy between these two extremities of the œsophagus
rather than to the pungency of the carbonic gas, or
fixed air; as the sensation in swallowing that kind of
air in water is of a different kind. See Class I. 3. 4.
3. and IV. 2. 2. 5.
M. M. This disease arising from indigestion is often
very pertinacious, and afflicting; and attended with
emaciation of the body from wants of sufficient chyle.
As the saliva swallowed along with our food prevents
its fermentation, as appears by the experiments of
Pringle and Macbride, some find considerable relief by
chewing parched wheat, or mastic, or a lock of wool,
frequently in a day, when the pain occurs, and by
swallowing the saliva thus effused; a temporary relief
is often obtained from antiacids, as aerated alkaline
water, Seltzer water, calcareous earths, alkaline
salts made into pills with soap, soap alone, tin, milk,
bitters. More permanent use may be had from such
drugs as check fermentation, as acid of vitriol; but
still more permanent relief from such things as invi-
gorate the digestion, as a blister on the back; a due
quantity of vinous spirit and water taken regularly.
Steel. Temperance. A sleep after dinner. A waist-
coat made so tight as slightly to compress the bowels
and stomach. A flannel shirt in winter, not in sum-
mer. A less quantity of potation of all kinds. Ten
M black 

162 DISEASES [CLASS I. 2. 4.
black pepper-corns swallowed after dinner. Half a
grain of opium twice a day, or a grain. The food
should consist of such things as do not easily ferment,
as flesh, shell-fish, sea-biscuit, toasted cheese. I have
seen toasted cheese brought up from the stomach 24
hours after it had been swallowed, without apparently
having undergone any chemical change. See Class II.
1. 3. 17. and IV. 1. 2. 13.
6. Arthritis Ventriculi. Sickness of the stomach in
gouty cases are frequently a consequence of the torpor
or inflammation of the liver, and then it continues
many days or weeks. But when the patient is seized
with great pain at the stomach with the sensation of
coldness, which they have called an ice-bolt, this is a
primary affection of the stomach, and destroys the
patient in a few hours, owing to the torpor or in-
action of that viscus so important to life.
This primary gout of the stomach, as it is a torpor
of that viscus, is attended with sensation of coldness,
and with real defect of heat, in that part, and may
thence be distinguished from the pain occasioned by
the passage of a gall-stone into the duodenum, as well
as by the weak pulse, and cold extremities; to which
must be added, that it affects those only, who have
been long afflicted with the gout, and much debilitated
by its numerous attacks.
M. M. Opium. Vinous spirit. Volatile alkali.
Spice. Warmth applied externally to the stomach by
hot cloths or fomentation.
7. Colica

CLASS I. 2. 4.] OF IRRITATION. 163
7. Colica flatulenta. The flatulent colic arises from
the too great distention of the bowels by air, and con-
sequent pain. The cause of this disease is the inactivity
or want of sufficiently powerful contraction of the
coats of the bowels to carry forwards the gas given up
by the fermenting aliment. It is without fever, and
generally attended with cold extremities.
It is distinguished, first, from the pain occasioned
by the passage of a gall-stone, as that is felt at the pit
of the stomach, and this nearer the navel. Secondly,
it is distinguished from the colica saturnina, or colic
from lead, as that arising from the torpor of the liver,
or of some other viscus, is attended with greater cold-
ness, and with an aching pain; whereas the flatulent
colic being owing to distention of the muscles of the
bowels, the pain is more acute, and the coldness less.
Thirdly, it is distinguished from inflammation of the
bowels, or ileus, as perpetual vomiting and fever at-
tend this. Fourthly, it is distinguished from cholera,
because that is accompanied with both vomiting and
diarrhœa. And lastly, from the colica epileptica, or
hysteric colic, as that is liable to alternate with con-
vulsion, and sometimes with insanity; and returns by
periods.
M. M. Spirit of wine and warm water, one spoon-
ful of each. Opium one grain. Spice. Volatile al-
kali. Warm fomentation externally. Rhubarb.
8. Colica saturnina. Colic from lead. The pain is
felt about the navel, is rather of an aching than acute
M2 kind 

164 DISEASES [CLASS I. 2. 4.
kind at first, which increases after meals, and gra-
dually becomes more permanent and more acute. It
terminates in paralysis, frequently of the muscles of
the arm, so that the hand hangs down, when the arm
is extended horizontally. It is not attended with
fever, or increase of heat. The seat of the disease is
not well ascertained, it probably affects some part of
the liver, as a pale bluish countenance and deficiency
of bile sometimes attends or succeeds it, with conse-
quent anasarca; but it seems to be caused immediately
by a torpor of the intestine, whether this be a pri-
mary or secondary affection, as appears from the con-
stipation of the bowels, which attends it; and is al-
ways produced in consequence of the great stimulus
of lead previously used either internally for a length
of time, or externally on a large surface.
A delicate young girl, daughter of a dairy farmer,
who kept his milk in leaden cysterns, used to wipe
off the cream from the edges of the lead with her
finger; and frequently, as she was fond of cream,
licked it from her finger. She was seized with the sa-
turnine colic, and semi-paralytic wrists, and sunk from
general debility.
A feeble woman about 40 years of age sprained her
ankle, and bruised her leg and thigh; and applied by
ill advice a solution of lead over the whole limb, as
a fomentation and poultice for about a fortnight. She
was then seized with the colica saturnina, lost the use
of her wrists, and gradually sunk under a general de-
bility.
M. M. First

CLASS I. 2. 4.] OF IRRITATION. 165
M. M. First opium one or two grains, then a ca-
thartic of senna, jalap, and oil, as soon as the pain
is relieved. Oleum ricini. Alum. Oil of almonds.
A blister on the navel. Warm bath. The stimulus
of the opium, by restoring to the bowel its natural
irritability in this case of painful torpor, assists the
action of the cathartic.
9. Tympanitis. Tympany consists in an elastic
tumor of the abdomen, which founds on being struck.
It is generally attended with costiveness and emacia-
tion. In one kind the air is said to exist in the
bowels, in which case the tumor is less equal, and
becomes less tense and painful on the evacuation of
air. In the other kind the air exists in the cavity of
the abdomen, and sometimes is in a few days ex-
changed for water, and the tympany becomes an
ascites.
Air may be distinguished in the stomach of many
people by the sound on striking it with the fingers,
and comparing the found with that of a similar per-
cussion on other parts of the bowels; but towards the
end of fevers, and especially in the puerperal fever, a
distention of the abdomen by air is generally a fatal
symptom, though the ease, and often cheerfulness, of
the patient vainly flatters the attendants.
M. M. In the former case a clyster-pipe unarmed
may be introduced, and left some time in the rectum,
to take off the resistance of the sphincter, and thus dis-
charge the air, as it is produced from the fermenting
M3 or 

166 DISEASES [CLASS I. 2. 4.
or putrefying aliment. For this purpose, in a disease
somewhat similar in horses, a perforation is made into
the rectum on one side of the sphincter; through
which fistula the air, which is produced in such great
excess from the quantity of vegetable food which they
take, when their digestions are impaired, is perpe-
tually evacuated. In both cases also, balsams, essen-
tial oil, spice, bandage on the abdomen, and, to pre-
vent the fermentation of the aliment, acid of vitriol,
saliva. See Class I. 2. 4. 5.
10. Hypochondriasis. The hypochondriac disease
consists in indigestion and consequent flatulency, with
anxiety or want of pleasurable sensation. When the
action of the stomach and bowels is impaired, much
gas becomes generated by the fermenting or putres-
cent aliment, and to this indigestion is catenated lan-
guor, coldness of the skin, and fear. For when the
extremities are cold for too long a time in some weak
constitutions, indigestion is produced by direct sym-
pathy of the skin and the stomach, with consequent
heart-burn, and flatulency. The same occurs if the
skin be made cold by fear, as in riding over dange-
rous roads in winter, and hence conversely fear is
produced by indigestion or torpor of the stomach by
association.
This disease is confounded with the fear of death,
which is an insanity, and therefore of a totally different
nature. It is also confounded with the hysteric dis-
ease, which consists in the retrograde motions of the
alimentary

CLASS I. 2. 4.] OF IRRITATION. 167
alimentary canal, and of some parts of the absorbent
system.
The hypochondriasis, like chlorosis, is sometimes
attended with very quick pulse; which the patient
seems to bear so easily in these two maladies, that if
an accidental cough attends them, they may be mis-
taken for pulmonary consumption; which is not
owing primarily to the debility of the heart, but to
its direct sympathy with the actions of the stomach.
M. M. Blister. A plaster on the abdomen of Bur-
gundy pitch. Opium a grain twice a day. Rhubarb
six grains every night. Bark. Steel. Spice. Bath-
water. Siesta, or sleep after dinner. Uniform hours
of meals. No liquor stronger than small beer, or
wine and water. Gentle exercise on horseback in
the open air uniformly persisted in. See Cardialgia,
I. 2. 4. 5.
11. Cephalæa. Head-ach frequently attends the
cold paroxysm of intermittents; afflicts inebriates the
day after intoxication; and many people who remain
too long in the cold bath. In all which cases there is
a general inaction of the whole system, and as these
membranes about the head have been more exposed
to the variations of heat and cold of the atmosphere,
they are more liable to become affected so far as to
produce sensation, than other membranes; which are
usually covered either with clothes, or with muscles,
as mentioned in Sect. XXXIII. 2. 10.
M4 The 

168 DISEASES [CLASS I. 2. 4.
The promptitude of the membranes about the scalp
to sympathize with those of other parts of the system
is so great, that this cephalæa without fever, or quick-
ness of pulse, is more frequently a secondary than a
primary disease, and then belongs to Class IV. 1. 2.
11. The hemicrania, or partial head-ach, I believe
to be almost always, a disease from association; though
it is not impossible, but a person may take cold on
one side of the head only. As some people by sit-
ting always on the same side of the fire in winter are
liable to render one side more tender than the other,
and in consequence more subject to pains, which have
been erroneously termed rheumatic. See Class IV.
2. 1. 7. & 8.
M. M. The method of cure consists in rendering
the habit more robust, by gentle constant exercise in
the open air, flesh diet, small beer at meals with one
glass of wine, regular hours of rest and rising, and of
meals. The cloathing about the head should be
warmer during sleep than in the day; because at that
time people are more liable to take cold; that is, the
membranous parts of it are more liable to become
torpid. As explained in Sect. XVIII. 15. In re-
spect to medicine, two drams of valerian root in pow-
der three or four times a day are recommended by
Fordyce. The bark. Steel in moderate quantities.
An emetic. A blister. Opium, half a grain twice
a day. Decayed teeth should be extracted, par-
ticularly such as either ache, or are useless. Cold
bath between 60 and 70 degrees of heat. Warm
bath

CLASS I. 2. 4.] OF IRRITATION. 169
bath of 94 or 98 degrees every day for half an
hour during a month. See Class IV. 2. 2. 7.
and 8.
A solution of arsenic, about the sixteenth part of a
grain, is reported to have great effect in this disease.
It should be taken thrice a day, if it produces no grip-
ing or sickness, for two or three weeks. A medicine
of this kind is sold under the name of tasteless ague-
drops; but a more certain method of ascertaining the
quantity is delivered in the subsequent materia medica,
Art. IV. 2. 6.
12. Odontalgia. Tooth-ach. The pain has been
erroneously supposed, where there is no inflammation,
to be owing to some acrid matter from a carious tooth
stimulating the membrane of the alveolar process into
violent action and consequent pain; but the effect
seems to have been mistaken for the cause, and the
decay of the tooth to have been occasioned by the
torpor and consequent pain of the diseased mem-
brane.
First, because the pain precedes the decay of the
tooth in regard to time, and is liable to recur, fre-
quently for years, without certainly being succeeded
at last by a carious tooth, as I have repeatedly ob-
served.
Secondly, because any stimulant drug, as pyre-
thrum, or oil of cloves, applied to the tooth, or ether
applied externally to the cheek, so far from increasing
the pain, as they would do if the pained membrane,
already

170 DISEASES [CLASS I. 2. 4.
already acted too strongly, that they frequently give
immediate relief like a charm.
And thirdly, because the torpor, or deficient action
of the membrane, which includes the diseased tooth,
occasions the motions of the membranes most connect-
ed with it, as those of the cheek and temples, to act
with less than their natural energy; and hence a cold-
ness of the cheek is perceived easily by the hand of
the patient, comparing it with the other cheek; and
the pain of the hemicrania is often produced in the
temple of the affected side.
This coldness of the cheek in common tooth-ach
evinces, that the pain is not then caused by inflamma-
tion; because in all inflammations so much heat is pro-
duced in the secretions of new vessels and fluids, as to
give heat to the parts in vicinity. And hence, as soon
as the gum swells and inflames along with the cheek,
heat is produced, and the pain ceases, owing to the
increased exertions of the torpid membrane, excited
by the activity of the sensorial power of sensation;
which previously existed in its passive state in the
painful torpid membrane. See Odontitis, Class II.
1. 4. 7. and IV. 2. 2. 8.
M. M. If the painful tooth be found, venesection.
Then a cathartic. Afterwards two grains of opium.
Camphor and opium, one grain of each held in the
mouth; or a drop or two of oil of cloves put on the
painful tooth. Ether. If the tooth has a small hole
in it, it should be widened within by an instrument,
and then stopped with leaf-gold, or leaf-lead; but
should

CLASS I. 2. 4.] OF IRRITATION. 171
should be extracted, if much decayed. It is probable
that half a small drop of a strong solution of arsenic,
put carefully into the hollow of a decayed aching
tooth, would destroy the nerve without giving any
additional pain; but this experiment requires great
caution, left any of the solution should touch the
tongue or gums.
Much cold or much heat are equally injurious to
the teeth, which are endued with a fine sensation
of this universal fluid. The best method of preserving
them is by the daily use of a brush, which is not very
hard, with warm water and fine charcoal dust. A
lump of charcoal should be put a second time into the
fire till it is red hot, as soon as it becomes cool the
external ashes should be blown off, and it should
be immediately reduced to fine powder in a mortar,
and kept close stopped in a phial. It takes away the
bad smell from decayed teeth, by washing the mouth
with this powder diffused in water immediately. The
putrid smell of decaying stumps of teeth may be de-
stroyed for a time by washing the mouth with a weak
solution of alum in water. If the calcareous crust
upon the teeth adheres very firmly, a fine powder of
pumice-stone may be used occasionally, or a tooth in-
strument.
Acid of sea-salt, much diluted, may be used; but
this very rarely, and with the greatest caution, as in
cleaning sea-shells. When the gums are spongy,
they should be frequently pricked with a lancet.
Should black spots in teeth be cut out? Does the
enamel

172 DISEASES [CLASS I. 2. 4.
enamel grow again when it has been perforated or
abraded?
13. Otalgia. Ear-ach sometimes continues many
days without apparent inflammation, and is then fre-
quently removed by filling the ear with laudanum, or
with ether; or even with warm oil, or warm water.
See Class II. 1. 4. 8. This pain of the ear, like
hemicrania, is frequently the consequence of associa-
tion with a diseased tooth; in that case the ether
should be applied to the cheek over the suspected
tooth, or a grain of opium and as much camphor mixed
together and applied to the suspected tooth. In this
case the otalgia belongs to the fourth class of diseases.
14. Pleurodyne chronica. Chronical pain of the side.
Pains of the membranous parts, which are not attend-
ed with fever, have acquired the general name of
rheumatic; which should, nevertheless, be restricted
to those pains which exist only when the parts are in
motion, and which have been left after inflammation
of them; as described in Class I. 1. 3. 12. The pain
of the side here mentioned affects many ladies, and,
may possibly have been owing to the pressure of tight
stays, which has weakened the action of the vessels
composing some membranous part, as, like the cold
head-ach, it is attended with present debility; in one
patient, a boy about ten years old, it was attended
with daily convulsions, and was supposed to have ori-
ginated from worms. The disease is very frequent,
and

CLASS I. 2. 4.] OF IRRITATION. 173
and generally withstands the use of blister on 
part; but in some cases I have known it removed by
electric shocks repeated every day for a fortnight
through the affected side.
Pains of the side may be sometimes occasioned by
the adhesion of the lungs to the pleura, after an in-
flammation of them; or to the adhesion of some ab-
dominal viscera to their cavity, or to each other;
which also are more liable to affect ladies from the un-
natural and ungraceful pressure of tight stays, or by
sitting or lying too long in one posture. But in these
cases the pain should be more of the smarting, than of
the dull kind.
M. M. Ether. A blister. A plaster of Burgundy
pitch. An issue or seton on the part. Electric shocks.
Friction on the part with oil and camphor. Loose
dress. Frequent change of posture both in the day
and night. Internally opium, valerian, bark.
15. Sciatica frigida. Cold sciatica. The pain along
the course of the sciatic nerve, from the hip quite
down to the top of the foot, when it is not attended with
fever, is improperly termed either rheumatism or gout;
as it occurs without inflammation, is attended with
pain when the limb is at rest; and as the pain attends
the course of the nerve, and not the course of the
muscles, or of the fascia, which contains them. The
theory of Cotunnius, who believed it to be a dropsy
of the sheath of the nerve, which was compressed by
the accumulated fluid, has not been confirmed by dis-
section.

174 DISEASES [CLASS I. 2. 4.
section. The disease seems to consist of a torpor of
this sheath of the nerve, and the pain seems to be in
consequence of this torpor. See Class II. 1. 2. 13.
M. M. Venesection. A cathartic. And then one
grain of calomel and one of opium every night for
ten successive nights. And a blister, at the same time,
a little above the knee-joint on the outside of the
thigh, where the sciatic nerve is not so deep seated.
Warm bath. Cold bath. Cover the limb with oiled
silk, or with a plaster-bandage of emplastrum de minio.
16. Lumbago frigida. Cold lumbago. When no
fever or inflammation attends this pain of the loins,
and the pain exists without motion, it belongs to this
genus of diseases, and resembles the pain of the loins,
in the cold fit of ague. As these membranes are ex-
tensive, and more easily fall into quiescence, either by
sympathy, or when they are primarily affected, this
disease becomes very afflicting, and of great pertina-
city. See Class II. 1. 2. 17.
M. M. Venesection. A cathartic. Issues on the
loins. Adhesive plaster on the loins. Blister on the
os sacrum. Warm bath. Cold bath. Remove to a
warmer climate in the winter. Loose dress about the
waist. Friction daily with oil and camphor.
17. Hysteralgia frigida. Cold pain of the uterus
preceding or accompanying menstruation. It is attend-
ed with cold extremities, want of appetite, and other
marks of general debility.
M. M.

CLASS I. 2. 4.] OF IRRITATION. 175
M. M. A clyster of half a pint of gruel, and 30
drops of laudanum; or a grain of opium and six grains
of rhubarb every night. To sit over warm water, or
go into a warm bath.
18. Proctalgia frigida. Cold pain at the bottom
of the rectum previous to the tumour of the piles,
which sometimes extends by sympathy to the loins; it
seems to be similar to the pain at the beginning of
menstruation, and is owing to the torpor or inirritabi-
lity of the extremity of the alimentary canal, or to the
obstruction of the blood in its passage through the
liver, when that viscus is affected, and its consequent
delay in the veins of the rectum, occasioning tumours
of them, and dull sensations of pain.
M. M. Calomel. A cathartic. Spice. Clyster,
with 30 drops of laudanum. Sitting over warm water.
If chalybeates after evacuation- See Class I. 2. 3. 23.
and I. 2. 1. 6.
19. Vesicæ felleæ inirritabilitas. The inirritability
of the gall-bladder probably occasions one kind of
icterus, or jaundice; which is owing to whatever ob-
structs the passage of bile into the duodenum. The
jaundice of aged people, and which attends some fevers,
is believed to be most frequently caused by an irrita-
tive palsy of the gall-bladder; on which account the
bile is not pressed from the cyst by its contraction, as
in a paralysis of the urinary bladder.
A thick- 

176 DISEASES [CLASS I. 2. 4.
A thickening of the coats of the common bile-duct
by inflammation or increased action of their vessels so
as to prevent the passage of the bile into the intestine,
in the same manner as the membrane, which lines the
nostrils, becomes thickened in catarrh so as to prevent
the passage of air through them, is probably another
frequent cause of jaundice, especially of children; and
generally ceases in about a fortnight, like a common
catarrh, without the aid of medicine; which has given
rise to the character, which charms have obtained in
some countries for curing the jaundice of young
people.
The spisstude of the bile is another cause of jaun-
dice, as mentioned in Class I. 1. 3. 8. This also
in children is a disease of little danger, as the gall
ducts are distendible, and will the easier admit of the
exclusion of gall-stones; but becomes a more serious
disease in proportion to the age of the patient, and
his habits of life in respect to spirituous potation.
A fourth cause of jaundice is the compression of the
bile-duct by the enlargement of an inflamed or schir-
rous liver; this attends those who have drank much
spirituous liquor, and is generally succeeded by dropsy
and death.
M. M. Repeated emetics. Mild cathartics. Warm
bath. Electricity. Bitters. Then steel, which, when
the pain and inflammation are removed by evacuations,
acts like a charm in removing the remainder of the in-
flammation, and by promoting the absorption of the
new vessels or fluids; like the application of any acrid
eye-

CLASS I. 2. 4.] OF IRRITATION. 177
eye-water at the end of ophthalmia; and thus the
thickened coats of the bile-duct become reduced, or
the enlargement of the liver lessened, and a free pas-
sage is again opened for the bile into the intestine.
Ether with yolk of egg is recommended, as having a
tendency to dissolve inspissated bile. And a decoction
of madder is recommended for the same purpose; be-
cause the bile of animals, whose food was mixed with
madder, was found always in a dilute state. Aerated
alkaline water, or Seltzer water. Raw cabbage, and
other acrid vegetables, as water-cresses, mustard.
Horses are said to be subject to inspissated bile, with
yellow eyes, in the winter season, and to get well as
soon as they feed on the spring grass.
The largest bile-stone I have seen was from a lady,
who had parted with it some years before, and who
had abstained above ten years from all kinds of vege-
table diet to prevent, as she supposed, a colic of her
stomach, which was probably a pain of the biliary
duct; on resuming the use of some vegetable diet, she
recovered a better state of health, and formed no new
bilious concretions.
A strong aerated alkaline water is sold by J.
Schweppe, No. 8, King's-street. Holborn. See Class
I. 1. 3. 10.
20. Pelvis renalis inirritabilitas. Inirritability of
the pelvis of the kidney. When the nucleus of a
stone, whether it be inspissated mucus, or other mat-
ter, is formed in the extremity of any of the tubuli
N uriniferi,

178 DISEASES [CLASS I. 2. 5.
uriniferi, and being detached from thence falls into
the pelvis of the kidney, it is liable to lodge there
from the want of due irritability of the membrane;
and in that situation increases by new appositions of in-
durated animal matter in the same manner as the stone
of the bladder. This is the general cause of hæmor-
rhage from the kidney; and of obtuse pain in it on
exercise; or of acute pain, when the stone advances
into the ureter. See Class I. 1. 3. 9.
ORDO II.
Decreased Irritation.
GENUS V.
Decreased Action of the Organs of Sense.
SPECIES.
1. Stultitia inirritabilis. Folly from inirritability.
Dulness of perception. When the motions of the
fibrous extremities of the nerves of sense are too weak
to excite sensation with sufficient quickness and vigour.
The irritative ideas are nevertheless performed, though
perhaps in a feeble manner, as such people do not run
against a post, or walk into a well. There are three
other kinds of folly; that from deficient sensation,
from deficient volition, and from deficient association,
as will be mentioned in their places. In delirium, re-
verie, and sleep, the power of perception is abolished
from other causes.
2. Visus

CLASS I. 2. 5.] OF IRRITATION. 179
2. Visus imminutus. Diminished vision. In our ap-
proach to old age our vision becomes imperfect, not only
from the form of the cornea, which becomes less con-
vex, and from its decreased transparency mentioned in
Class I. 2. 3. 26.; but also from the decreased irri-
tability of the optic nerve. Thus, in the inirritative
or nervous fever, the pupil of the eye becomes dilated;
which in this, as well as in the dropsy of the brain,
is generally a fatal-symptom. A part of the cornea
as well as a part of the albuginea in these fevers is
frequently seen during sleep; which is owing to the
inirritability of the retina to light, or to the general
paresis of muscular action, and in consequence to the
less contraction of the sphincter of the eye, if it may
be so called, at that time.
There have been instances of some, who could not
distinguish certain colours; and yet whose eyes, in
other respects, were not imperfect. Philos. Transact.
Which seems to have been owing to the want of irri-
tability, or the inaptitude to action, of some classes of
fibres which compose the retina. Other permanent
defects depend on the diseased state of the external
organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11.
3. Muscæ volitantes. Dark spots appearing before
the eyes, and changing their apparent place with the
motions of the eyes, are owing to a temporary defect
of irritability of those parts of the retina, which have
been lately exposed to more luminous objects than the
other parts of it, as explained in Sect. XL. 2. Hence
N2 dark 

180 DISEASES [CLASS I. 2. 5.
dark spots are seen on the bed-clothes by patients,
when the optic nerve is become less irritable, as in fe-
vers with great debility; and the patients are perpe-
tually trying to pick them off with their fingers to dis-
cover what they are; for these parts of the retina of
weak people are sooner exhausted by the stimulus of
bright colours, and are longer in regaining their irri-
tability.
Other kinds of ocular spectra, as the coloured ones,
are also more liable to remain in the eyes of people
debilitated by fevers, and to produce various halluci-
nations of sight. For after the contraction of a mus-
cle, the fibres of it continue in the last situation, till
some antagonist muscles are exerted to retract them
whence, when any one is much exhausted by exercise,
or by want of sleep, or in fevers, it is easier to let the
fibres of the retina remain in their last situation, after
having been stimulated into contraction, than to exert
any antagonist fibres to replace them.
As the optic nerves at their entrance into the eyes
are each of them as thick as a crow-quill, it appears
that a great quantity of sensorial power is expended
during the day in the perpetual activity of our sense
of vision, besides that used in the motions of the eye-
balls and eye-lids; as much I suppose as is expended
in the motions of our arms, which are supplied with
nerves of about the same diameters. From hence we
may conclude, that the light should be kept from pa-
tients in fevers with debility, to prevent the unneces-
sary exhaustion of the sensorial power. And that on
the

CLASS I. 2. 5.] OF IRRITATION. 181
the same account their rooms should be kept silent as
well as dark; that they should be at rest in an hori-
zontal posture; and be cooled by a blast of cool air,
or by washing them with cold water, whenever their
skins are warmer than natural.
4. Strabismus. Squinting is generally owing to one
eye being less perfect than the other; on which ac-
count the patient endeavours to hide the worst eye in
the shadow of the nose, that his vision by the other
may not be confused. Calves, which have an hyda-
tide with insects enclosed in it in the frontal sinus on
one side, turn towards the affected side; because the
vision on that side, by the pressure of the hydatide,
becomes less perfect; and the disease being recent, the
animal turns round, expecting to get a more distinct
view of objects.
In the hydrocephalus internus, where both eyes are
not become insensible, the patient squints with only one
eye, and views objects with the other, as in common
strabismus. In this case it may be known on which
side the disease exists, and that it does not exist on
both sides of the brain; in such circumstances, as the
patients I believe never recover as they are now treat-
ed, might it not be adviseable to perforate the cra-
mum over the ventricle of the affected side? which
might at least give room and stimulus to the affected
part of the brain?
M. M. If the squinting has not been confirmed by
long habit, and one eye be not much worse than the
N3 other, 

182 DISEASES [CLASS I. 2. 5.
other, a piece of gauze stretched on a circle of whale-
bone, to cover the best eye in such a manner as to re-
duce the distinctness of vision of this eye to a similar
degree of imperfection with the other, should be worn
some hours every day. Or the better eye should be
totally darkened by a tin cup covered with black silk
for some hours daily, by which means the better eye
will be gradually weakened by the want of use, and
the worse eye will be gradually strengthened by using
it. Covering an inflamed eye in children for weeks
together, is very liable to produce squinting, for the
same reason.
5. Amaurosis. Gutta serena. Is a blindness from
the inirritability of the optic nerve. It is generally
esteemed a palsy of the nerve, but should rather be
deemed the death of it, as paralysis has generally been
applied to a deprivation only of voluntary power.
This is a disease of dark eyes only, as the cataract is
a disease of light eyes only. At the commencement
of this disease, very minute electric shocks should be
repeatedly passed through the eyes; such as may be
produced by putting one edge of a piece of silver the
size of a half-crown piece beneath the tongue, and
one edge of a piece of zinc of a similar size between
the upper lip and the gum, and then repeatedly
bringing their exterior edges into contact, by which
means very small electric sparks become visible in the
eyes. See additional note at the end of the first vo-
lume, p. 567. and Sect, XIV. 5.
M. M. Mi-

CLASS I. 2. 5.] OF IRRITATION. 183
M. M. Minute electric shocks. A grain of opium,
and a quarter of a grain of corrosive sublimate of
mercury, twice a day for four or six weeks. Blis-
ter on the crown of the head.
6. Auditus imminutus. Diminished hearing. Deaf-
ness is a frequent symptom in those inflammatory or
sensitive fevers with debility, which are generally
called putrid; it attends the general stupor in those
fevers, and is rather esteemed a salutary sign, as du-
ring this stupor there is less expenditure of sensorial
power.
In fevers of debility without inflammation, called
nervous fevers, I suspect deafness to be a bad symp-
tom, arising like the dilated pupil from a partial pa-
ralysis of the nerve of sense. See Class IV. 2. 1. 15.
Nervous fevers are supposed by Dr. Gilchrist to
originate from a congestion of serum or water in some
part of the brain, as many of the symptoms are so
similar to those of hydrocephalus internus, in which
a fluid is accumulated in the ventricules of the brain;
on this idea the inactivity of the optic or auditory
nerves in these fevers may arise from the compression
of the effused fluid; while the torpor attending pu-
trid fever may depend on the meninges of the brain
being thickened by inflammation, and thus compres-
sing it; now the new vessels, or the blood, which
thickens inflamed parts, is more frequently reabsorb-
ed, than the effused fluid from a cavity; and hence the
stupor in one case is less dangerous than in the other.
N4 In 

184 DISEASES [CLASS I. 2. 5.
In inflammatory or sensitive fevers with debility,
deafness may sometimes arise from a greater secretion
and absorption of the ear-wax, which is very similar
to the bile, and is liable to fill the meatus audito-
rius, when it is too viscid, as bile obstructs the gall-
ducts.
M. M. In deafness without fever Dr. Darwin ap-
plied a cupping-glass on the ear with good effect,
as described in Phil. Trans. Vol. LXIV. p. 348. Oil,
ether, laudanum, dropped into the ears.
7. Olfactus imminutus. Inactivity of the sense of
smell. From our habits of trusting to the art of cook-
ery, and not examining our food by the smell as other
animals do, our sense of smell is less perfect than
theirs. See Sect. XVI. 5. Class IV. 2. 1. 16.
M. M. Mild errhines.
8. Gustus imminutus. Want of taste is very com-
mon in fevers, owing frequently to the dryness or
scurf of the tongue, or external organ of that sense,
rather than to any injury of the nerves of taste. See
Class I. 1. 3. 1. IV. 2. 1. 16.
M. M. Warm subacid liquids taken frequently.
9. Tactus imminutus. Numbness is frequently com-
plained of in fevers, and in epilepsy, and the touch is
sometimes impaired by the dryness of the cuticle of
the fingers. See Class IV. 2. 1. 16.
When 

CLASS I. 2. 5.] OF IRRITATION. 185
When the sense of touch is impaired by the com-
pression of the nerve, as in sitting long with one thigh
crossed over the other, the limb appears larger, when
we touch it with our hands, which is to be ascribed
to the indistinctness of the sensation of touch, and
may be explained in the same manner as the apparent
largeness of objects seen through a mist. In this last
case the minute parts of an object, as suppose of a
distant boy, are seen less distinctly, and therefore we
instantly conceive them to be further from the eye,
and in consequence that the whole subtends a larger
angle, and thus we believe the boy to be a man. So
when any one's fingers are pressed on a benumbed
limb, the sensation produced is less than it should be,
judging from visible circumstances; we therefore con-
ceive, that something intervened between the object
and the sense, for it is felt as if a blanket was put be-
tween them; and that not being visibly the case, we
judge that the limb is swelled.
The sense of touch is also liable to be deceived from
the acquired habits of one part of it acting in the
vicinity of another part of it. Thus if the middle fin-
ger be crossed over either of the fingers next to it,
and a nut be felt by the two ends of the fingers so
crossed at the same time, the nut appears as if it was
two nuts. And lastly, the sense of touch is liable to
be deceived by preconceived ideas; which we believe
to be excited by external objects, even when we are
awake. It has happened to me more than once, and
I suppose to most others, to have put my hands into
an

186 DISEASES [CLASS I. 2. 5.
an empty bason standing in an obscure comer of a
room to wash them, which I believed to contain cold
water, and have instantly perceived a sensation of
warmth, contrary to that which I expected to have felt.
In some paralytic affections, and in cold fits of ague,
the sensation of touch has been much impaired, and
yet that of heat has remained. See Sect. XIV. 6.
M. M. Friction alone, or with camphorated oil,
warm bath. Ether. Volatile alkali and water. In-
ternally spice, salt. Incitantia. Secernentia.
10. Stupor. The stupor, which occurs in fevers
with debility, is generally esteemed a favourable symp-
tom; which may arise from the less expenditure of
sensorial power already existing in the brain and
nerves, as mentioned in species 6 of this genus. But
if we suppose, that there is a continued production of
sensorial power, or an accumulation of it in the torpid
parts of the system, which is not improbable, because
such a production of it continues during sleep, to which
stupor is much allied, there is still further reason for
believing it to be a favourable symptom in inirritable
fevers; and that much injury is often done by blisters
and other powerful stimuli to remove the stupor. See
Sect. XII. 7. 8. and XXXIII. 1. 4.
Dr. Blane in his Croonian Lecture on muscular mo-
tion for 1788, among many other ingenious observa-
tions and deductions, relates a curious experiment on
salmon, and other fish, and which he repeated upon
eels similar event.
"If

CLASS I. 2. 5.] OF IRRITATION. 187
"If a fish, immediately upon being taken out of
the water, is stunned by a violent blow on the head,
or by having the head crushed, the irritability and
sweetness of the muscles will be preserved much
longer, than if it had been allowed to die with the
organs of sense entire. This is so well known to fish-
ermen, that they put it in practice, in order to make
them longer susceptible of the operation called crimp-
ing. A salmon is one of the fish least tenacious of life,
insomuch, that it will lose all signs of life in less than
half an hour after it is taken out of the water, if
suffered to die without any farther injury; but if, im-
mediately after being caught, it receives a violent
blow on the head, the muscles will shew visible irrita-
bility for more than twelve hours afterwards."
Dr. Blane afterwards well remarks, that "in those
disorders in which the exercise of the senses is in a
great measure destroyed, or suspended, as in the hy-
drocephalus, and apoplectic palsy, it happens not un-
commonly, that the appetite and digestion are better
than in health."
ORDO 

188 DISEASES [CLASS I. 3. 1.
ORDO III.
GENUS I.
Of the Alimentary Canal.
THE retrograde motions of our system originate
either from defect of stimulus, or from defect of irrita-
bility. Thus sickness is often induced by hunger,
which is a want of stimulus; and from ipecacuanha,
in which last case it would seem, that the sickness was
induced after the violence of the stimulus was abated,
and the consequent torpor had succeeded. Hence
spice, opium, or food relieves sickness.
The globus hystericus, salivation, diabætes, and
other inversions of motion attending hysteric parox-
ysms, seem to depend on the want of irritability of
those parts of the body, because they are attended
with cold extremities, and general debility, and are
relieved by wine, opium, steel, and flesh diet; that is,
by any additional stimulus.
When the longitudinal muscles are fatigued by long
action, or are habitually weaker than natural, the an-
tagonist muscles replace the limb by stretching it in a
contrary direction; and as these muscles have had
their actions associated in synchronous tribes, their
actions cease together. But as the hollow muscles pro-
pel the fluids, which they contain, by motions asso-
ciated in trains; when one ring is fatigued from its
too great debility, and brought into retrograde action;
the

CLASS I. 3. 1.] OF IRRITATION. 189
the next ring, and the next, from its association in
train falls into retrograde action. Which continue so
long as they are excited to act, like the tremors of the
hands of infirm people, so long as they endeavour to
act. Now as these hollow muscles are perpetually
stimulated, these retrograde actions do not cease as the
tremors of the longitudinal muscles, which are gene-
rally excited only by volition. Whence the retro-
grade motions of hollow muscles depend on two cir-
cumstances, in which they differ from the longitudinal
muscles, namely, their motions being associated in
trains, and their being subject to perpetual stimulus.
For further elucidation of the cause of this curious
source of diseases, see Sect. XXIX. 11. 5.
The fluids disgorged by the retrograde motions of
the various vascular muscles may be distinguished, 1.
From those, which are produced by secretion, by their
not being attended by increase of heat, which always
accompanies increased secretion. 2. They may be
distinguished from those fluids, which are the conse-
quence of deficient absorption, by their not possessing
the saline acrimony, which those fluids possess; which
inflames the skin or other membranes on which they
fall; and which have a saline taste to the tongue. 3.
They may be distinguished from those fluids, which
are the consequence both of increased secretion and
absorption, as these are attended with increase of
warmth, and are inspissated by the abstraction of their
aqueous parts. 4. Where chyle, or milk, are found
in the feces or urine, or when other fluids, as matter,
are

190 DISEASES [CLASS I. 3. 1.
are translated from one part of the system to another,
they have been the product of retrograde action of
lymphatic or other canals. As explained in Sect.
XXIX. 8.
SPECIES.
1. Ruminatio. In the rumination of horned cattle
the retrograde motions of the œsophagus are visible to
the eye, as they bring up the softened grass from their
first stomach. The vegetable aliment in the first
stomach of cattle, which have filled themselves too full
of young clover, is liable to run into fermentation,
and distend the stomach, so as to preclude its exit,
and frequently to destroy the animal. To discharge
this air the farmers frequently make an opening into
the stomach of the animal with success. I was inform-
ed, I believe by the late Dr. Whytt of Edinburgh,
that of twenty cows in this situation two had died,
and that he directed a pint of gin or whisky, mixed
with an equal quantity of water, to be given to the
other eighteen; all of which eructed immense quan-
tities of air, and recovered.
There are histories of ruminating men, and who
have taken pleasure in the act of chewing their food a
second time. Philos. Transact.
2. Ructus. Eructation. An inverted motion of the
stomach excluding through its upper valve an elastic
vapour generated by the fermentation of the aliment;
which proceeds so hastily, that the digestive power
does

CLASS I. 3. 1.] OF IRRITATION. 191
does not subdue it. This is sometimes acquired
by habit, so that some people can eruct when they
please, and as long as they please; and there is gas
enough generated to supply them for this purpose;
for by Dr. Hale's experiments, an apple, and many
other kinds of aliment, give up above six hundred
times their own bulk of an elastic gas in fermentation.
When people voluntarily eject the fixable air from
their stomachs, the fermentation of the aliment pro-
ceeds the faster; for stopping the vessels, which con-
tain new wines, retards their fermentation, and open-
ing them again accelerates it; hence where the di-
gestion is impaired, and the stomach somewhat dis-
tended with air, it is better to restrain than to encou-
rage eructations, except the quantity makes it neces-
sary. When wine is confined in bottles the fermen-
tation still proceeds slowly even for years, till all the
sugar is converted into spirit; but in the process of
digestion, the saccharine part is absorbed in the form
of chyle by the bibulous mouths of the numerous
lacteals, before it has time to run into the vinous fer-
mentation.
3. Apepsia. Indigestion. Water-qualm. A few
mouthfuls of the aliment are rejected at a time for
some hours after meals. When the aliment has had
time to ferment, and become acid, it produces car-
dialgia, or heart-burn. This disease is perhaps gene-
rally left after a slight inflammation of the stomach,
called a surfeit, occasioned by drinking cold liquors,
or

192 DISEASES [CLASS I. 3. 1.
or eating cold vegetables, when heated with exercise.
This inflammation of the stomach is frequently, I be-
lieve, at its commencement removed by a critical
eruption on the face, which differs in its appearance
as well as in its cause from the gutta rosea of drun-
kards, as the skin round the base of each eruption
is less inflamed. See Class II. 1. 4. 7. This disease
differs from Cardialgia, Class I. 2. 4. 5. in its being
not uniformly attended with pain of the cardia ven-
triculi, and from its retrograde motions of a part of
the stomach about the upper orifice of it. In the same
manner as hysteria differs from hypochondriasis; the
one consisting in the weakness and indigestion of the
same portions of the alimentary canal, and the other
in the inverted motions of some parts of it. This
apepsia or water-qualm continues many years, even to
old age; Mr. G - of Lichfield suffered under this
disease from his infancy; and, as he grew old, found
relief only from repeated doses of opium.
M. M. A blister, rhubarb, a grain of opium twice
a day. Soap, iron-powder. Tin-powder.
4. Vomitus. An inverted order of the motions of
the stomach and œsophagus with their absorbent ves-
sels, by which their contents are evacuated. In the
act of vomiting less sensorial powder is employed than
in the usual peristaltic motion of the stomach, as ex-
plained in Sect. XXXV. 1. 3. Whence after the
operation of an emetic the digestion becomes stronger
by an accumulation of sensorial power during its de-
4 creased

CLASS I. 3. 1.] OF IRRITATION. 193
creased action. This decreased action of the stomach
may be either induced by want of stimulus, as in the
sickness which attends hunger; or it may be induced
by temporary want of irritability, as in cold fits of
fever; or from habitual want of irritability, as the
vomiting of enfeebled drunkards. Or lastly, by ha-
ving been previously too violently stimulated by an
emetic drug, as by ipecacuanha.
M. M. A blister. An emetic. Opium. Warmth
of a bed, covering the face for a while with the bed-
clothes. Crude mercury. A poultice with opium or
theriaca externally.
5. Cholera. When not only the stomach, as in the
last article, but also the duodenum, and ilium, as low
as the valve of the colon, have their motions invert-
ed; and great quantities of bile are thus poured into
the stomach; while at the same time some branches of
the lacteals become retrograde, and disgorge their con-
tents into the upper part of the alimentary canal; and
other branches of them disgorge their contents into the
lower parts of it beneath the valve of the colon; a vomit-
ing and purging commence together, which is called cho-
lera, as it is supposed to have its origin from increased
secretion of bile; but I suppose more frequently arises
from putrid food, or poisonous drugs, as in the case
narrated in Sect. XXV. 13. where other circumstances
of this disease are explained. See Class II. 1.2. 11.
The cramps of the legs, which are liable to attend
cholera, are explained in Class III. 1. 1. 14.
O 6. Ileus.

194 DISEASES [CLASS I. 3. 1.
6. Ileus. Consists in the inverted motions of the
whole intestinal canal, from the mouth to the anus;
and of the lacteals and absorbents which arise from it.
In this pitiable disease, through the valve of the colon,
through the pylorus, the cardia, and the pharinx,
are ejected, first, the contents of the stomach and in-
testines, with the excrement and even clysters them-
selves; then the fluid from the lacteals, which is now
poured into the intestines by their retrograde motions,
is thrown up by the mouth; and, lastly, every fluid,
which is absorbed by the other lymphatic branches,
from the cellular membrane, the skin, the bladder,
and all other cavities of the body; and which is then
poured into the stomach or intestines by the retro-
grade motions of the lacteals; all which supply that
amazing quantity of fluid, which is in this disease con-
tinually ejected by vomiting. See Sect. XXV. 15. for
a further explanation of this disease.
M. M. Copious venesection. Twenty grains of
calomel in small pills, or one grain of aloe every hour
till stools are procured. Blisters. Warm bath. Crude
mercury. Clyster of ice-water. Smear the skin all
over with grease, as mentioned in Sect. XXV. 15.
As this malady is occasioned sometimes by an in-
trosusception of a part of the intestine into another
part of it, especially in children, could holding them
up by their heels for a second or two of time be of
service after venesection? Or the exhibition of crude
quicksilver two ounces every half hour, till a pound
is taken, be particularly serviceable in this circum-
stance?

CLASS I. 3. 1.] OF IRRITATION. 195
stance- Or could half a pound, or a pound, of crude
mercury be injected as a clyster, the patient being
elevated by the knees and thighs so as to have his
head and shoulders much lower than his bottom, or
even for a short time held up by the heels- Could
this also be of advantage in strangulated hernia-
Where the disease is owing to strangulated hernia, the
part should be sprinkled with cold water, or iced water,
or salt and water recently mixed, or moistened with
ether. In cases of strangulated hernia, could acupuncture,
or puncture with a capillary trocar, be used with safety
and advantage to give exit to air contained in the
strangulated bowel- Or to stimulate it into action-
It is not uncommon for bashful men to conceal their
being afflicted with a small hernia, which is the cause
of their death; this circumstance should therefore
always be enquired into. Is the seat or cause of the
ileus always below the valve of the colon, and that of
the cholera above it- See Class II. 1. 2. 11.
7. Globus hystericus. Hysteric suffocation is the per-
ception of a globe rolling round in the abdomen, and
ascending to the stomach and throat, and there in-
ducing strangulation. It consists of an ineffectual in-
version of the motions of the œsophagus, and other
parts of the alimentary canal; nothing being rejected
from the stomach.
M. M. Tincture of castor. Tinct. of opium of
each 15 drops. See Hysteria, Class I. 3. 1. 9.
O2 8. Vomendi 

196 DISEASES [CLASS I. 3. 1.
8. Vomendi conamen inane. An ineffectual effort to
vomit. It frequently occurs, when the stomach it
empty, and in some cases continues many hours; but
as the lymphatics of the stomach are not inverted at
the same time, there is no supply of materials to be
ejected; it is sometimes a symptom of hysteria, but
more frequently attends irregular epilepsies or re-
veries; which however may be distinguished by their
violence of exertion, for the exertions of hysteric mo-
tions are feeble, as they are caused by debility; but
those of epilepsies, as they are used to relieve pain, are
of the most violent kind; insomuch that those who
have once seen these ineffectual efforts to vomit in
some epilepsies, can never again mistake them for
symptoms of hysteria. See a case in Sect. XIX. 2.
M. M. Blister. Opium. Crude mercury.
9. Borborigmus. A gurgling of the bowels pro-
ceeds from a partial inversion of the peristaltic motions
of them, by which the gas is brought into a superior
part of the bowel, and bubbles through the descend-
ing fluid, like air rushing into a bottle as the water
is poured out of it. This is sometimes a distressing
symptom of the debility of the bowels joined with a
partial inversion of their motions. I attended a young
lady about sixteen, who was in other respects feeble,
whose bowels almost incessantly made a gurgling noise
so loud as to be heard at a considerable distance, and
to attract the notice of all who were near her. As
this noise never ceased a minute together for many
hours

CLASS I. 3. 1.] OF IRRITATION. 197
hours in a day, it could not be produced by the uni-
form descent of water, and ascent of air through it,
but there must have been alternately a retrograde
movement of a part of the bowel, which must again
have pushed up the water above the air; or which
might raise a part of the bowel, in which the fluid
was lodged, alternately above and below another
portion of it; which might readily happen in some of
the curvatures of the smaller intestines, the air in
which might be moved backward and forward like the
air-bubble in a glass-level.
M. M. Essential oil. Ten corns of black pepper
swallowed whole after dinner, that its effect might be
flower and more permanent; a small pipe occasionally
introduced into the rectum to facilitate the escape of
the air. Crude mercury. See Class I. 2. 4. 9.
10. Hysteria. The three last articles, together
with the lymphatic diabætes, are the most common
symptoms of the hysteric disease; to which sometimes
is added the lymphatic salivation, and sits of syncope,
or convulsion, with palpitation of the heart (which
probably consists of retrograde motions of it), and a
great fear of dying. Which last circumstance distin-
guishes these convulsions from the epileptic ones with
greater certainty than any other single symptom. The
pale copious urine, cold skin, palpitation, and trem-
bling, are the symptoms excited by great fear. Hence
in hysteric diseases, when these symptoms occur, the
fear, which has been usually associated with them,
O3 recurs 

198 DISEASES [CLASS I. 3. 1.
recurs at the same time, as in hypochondriasis, Class
I. 2. 4. 10. See Sect XVI. 8. 1.
The convulsions which sometimes attend the hysteric
disease, are exertions to relieve pain, either of some
torpid, or of some retrograde organ; and in this re-
spect they resemble epileptic convulsions, except that
they are seldom so violent as entirely to produce in-
sensibility to external stimuli; for these weaker pains
cease before the total exhaustion of sensorial power is
produced, and the patient sinks into imperfect syn-
cope; whereas the true epilepsy generally terminates
in temporary apoplexy, with perfect insensibility to
external objects. These convulsions are less to be
dreaded than the epileptic ones, as they do not ori-
ginate from so permanent a cause.
The great discharge of pale urine in this disease
is owing to the inverted motions of the lymphatics,
which arise about the neck of the bladder, as de-
scribed in Sect. XXIX. 4. 5. And the lymphatic
salivation arises from the inverted motions of the sali-
tary lymphatics.
Hysteria is distinguished from hypochondriasis, as in
the latter there are no retrograde motions of the ali-
mentary canal, but simply a debility or inirritability
of it, with distention and flatulency. It is distinguish-
ed from apepsia and cardialgia by there being nothing
ejected from the stomach by the retrograde motions of
it, or of the œsophagus.
M. M. Opium. Camphor. Asafœtida. Castor, with
sinapisms externally; to which must be added a clyster
of

CLASS I. 3. 1.] OF IRRITATION. 199
of cold water, or iced water; which according to
Mons. Pomme, relieves these hysteric symptoms in-
stantaneously like a charm; which it may effect by
checking the inverted motions of the intestinal canal
by the torpor occasioned by cold; or one end of the
intestinal canal may become strengthened, and regain
its peristaltic motion by reverse sympathy, when the
other end is rendered torpid by ice-water. (Pomme
des Affections Vaporeuses, p. 25.) These remove the
present symptoms; and bark, steel, exercise, coldish
bath, prevent their returns. See Art. VI. 2. 1.
11. Hydrophobia. Dread of water occasioned by the
bite of a mad dog, is a violent inversion of the motions of
the œsophagus on the contact or even approach of water
or other fluids. The pharinx seems to have acquired
the sensibility of the larinx in this disease, and is as
impatient to reject any fluid, which gets into it. Is not
the cardia ventriculi the seat of this disease- As in
cardialgia the pain is often felt in the pharinx, when
the acid material stimulates the other end of the canal,
which terminates in the stomach. As this fatal disease
resembles tetanus, or locked jaw, in its tendency to
convulsion from a distant wound, and affects some
other parts by association, it is treated of in Class III.
1. 1. 15. and IV. 2. 1. 7.
O4 ORDO

200 DISEASES [CLASS I. 3. 2.
ORDO III.
Retrograde Irritative Motions.
GENUS II.
Of the Absorbent System.
SPECIES.
1. Catarrhus lymphaticus. Lymphatic catarrh. A
periodical defluxion of a thin fluid from the nostrils,
for a few hours, occasioned by the retrograde motions
of their lymphatics; which may probably be supplied
with fluid by the increased absorption of some other
lymphatic branches in their vicinity. It is distinguish-
ed from that mucous discharge, which happens in
frosty weather from decreased absorption, because it is
less salt to the taste; and from an increased secretion
of mucus, because it is neither so viscid, nor is attend-
ed with heat of the part. This complaint is liable
to recur at diurnal periods, like an intermittent fever,
for weeks and months together, with great sneezing
and very copious discharge for an hour or two.
I have seen two of these cases, both of which oc-
curred in delicate women, and seemed an appendage
to other hysteric symptoms; whence I concluded,
that the discharge was occasioned by the inverted mo-
tions of the lymphatics of the nostrils, like the pale
urine in hysteric cases; and that they might receive
this fluid from some other branches of lymphatic vessels
opening into the frontal or maxillary cavities in their
vicinity. Could

CLASS I. 3. 2.] OF IRRITATION. 201
Could such a discharge be produced by strong er-
rhines, and excite an absorption of the congestion of
lymph in the dropsy of the brain-
2. Salivatio lymphatica. Lymphatic salivation. A
copious expuition of a pellucid insipid fluid, occasioned
by the retrograde motions of the lymphatics of the
mouth. It is sometimes periodical, and often attends
the hysteric disease, and nervous fevers; but is not
accompanied with a saline taste, or with heat of the
mouth, or nausea.
3. Nausea humida. Moist nausea consists in a dis-
charge of fluid, owing to the retrograde motions of
the lymphatics about the fauces, without increase of
heat, or saline taste, together with some retrograde
motions of the fauces or pharinx; along with this
nausea a sickness generally precedes the act of vomit-
ing; which may consist of a similar discharge of mucus
or chyle into the stomach by the retrograde motions
of the lymphatics or lacteals, which open into it. See
Class I. 2. 4. 3. and I. 2. 4. 4.
M. M. Subacid liquids. Wine. Opium. A blister.
4. Diarrhœa lymphatica. Lymphatic diarrhœa. A
quantity of mucus and lymph are poured into the in-
testines by the inverted motions of the intestinal lym-
phatics. The feces are less fetid and more liquid;
and it sometimes portends the commencement of a di-
abetes, or dropsy, or their temporary relief. This
lymphatic

202 DISEASES [CLASS I. 3. 2.
lymphatic diarrhœa sometimes becomes chronical, in
which the atmospheric moisture, absorbed by the cu-
taneous and pulmonary lymphatics, is poured into the
intestines by the retrograde motions of the lacteals. See
Section XXIX. 4. 6. where some cases of this kind
are related.
5. Diarrhœa chylifera, cæliaca. Chyliferous diarrhœa.
The chyle drank up by the lacteals of the upper in-
testines are poured into the lower ones by the retrograde
motions of their lacteals, and appears in the dejections.
This circumstance occurs at the beginning of diarrhœa
crapulosa, where the patient has taken and digested
more aliment than the system can conveniently receive,
and thus eliminates a part of it; as appears when
there is curdled chyle in some of the dejections. See
Sect. XXIX. 4. 7. It differs from the lymphatic
diarrhœa, as the chyliferous diabætes differs from the
aqueous and mucaginous diabætes.
6. Diabætes. By the retrograde motions of the
urinary lymphatics, an immense quantity of fluid is
poured into the bladder. It is either termed chyli-
ferous, or aqueous, or mucaginous, from the nature
of the fluid brought into the bladder; and is either
a temporary disease, as in hysteric women, in the
beginning of intoxication, in worm cases, or in those
exposed to cold damp air, or to great fear, or anxi-
ety, or in the commencement of some dropsies; or
it becomes chronical.
When

CLASS I. 3. 2.] OF IRRITATION. 203
When the urinary lymphatics invert their motions,
and pour their refluent contents into the bladder,
some other branch of the absorbent system acts with
greater energy to supply this fluid. If it is the in-
testinal branch, the chyliferous diabetes is produced:
if it is the cutaneous or pulmonary branch, the aque-.
ous diabætes is produced: and if the cellular or cys-
tic branches, the mucaginous diabetes. In the two
last the urine is pellucid, and contains no sugar.
In dropsies the fluid is sometimes absorbed, and
poured into the bladder by the retrograde motions
of the urinary lymphatics, as during the exhibition of
digitalis. In the beginning of the dropsies of infirm
gouty patients, I have frequently observed, that they
make a large quantity of water for one night, which
relieves them for several days. In these cases the
patient previously feels a fulness about the precordia,
with difficult respiration, and symptoms similar to those
of hysteria. Perhaps a previous defect of absorption
takes place in some part of the body in those hysteric
cases, which are relieved by a copious discharge of
pale urine. See Diabætes explained at large, Section
XXIX. 4.
A discharge of blood sometimes attends the dia-
bætes, which was occasionally a symptom of that dis-
ease in Mr. Brindley, the great navigable canal maker
in this country. Which may be accounted for by
the communication of a lymphatic branch with the
gastric branch of the vena portarum, as discovered
by J. F. Meckel. See Section XXVII. 2.
M. M. Alum.

204 DISEASES [CLASS I. 3. 2.
M. M. Alum. Earth of Alum. Cantharides. Calo-
mel. Bark. Steel. Rosin. Opium. See Sect.
XXIX. 4.
7. Sudor lymphaticus. Profuse sweats from the in-
verted motions of the cutaneous lymphatics, as in
some fainting fits, and at the approach of death;
and as perhaps in the sudor anglicanus. See Sect.
XXIX. 5. These sweats are glutinous to the touch,
and without increased heat of the skin; if the part
is not covered, the skin becomes cold from the eva-
poration of the fluid. These sweats without heat
sometimes occur in the act of vomiting, as in Sect.
XXV. 9. and are probably the cause of the cold
sweaty hands of some people. As mentioned in Sect.
XXIX. 4. 9. in the case of R. Davis, which he cured
by frequent application of lime. Though it is pos-
sible, that cold sweaty hands may also arise from the
want of due absorption of the perspirable matter ef-
fused on them, and that the coldness may be owing
to the greater evaporation in consequence.
The acid sweats described by Dr. Dobson, which
he observed in a diabetic patient, and ascribes to the
chyle effused on the skin, must be ascribed to the
retrograde action of the cutaneous lymphatics. See
Sect. XXIX. 6.
8. Sudor asthmaticus. The cold sweats in this dis-
ease only cover the head, arms, and breast, and are
frequently exceedingly profuse. These sweats are
owing

CLASS I. 3. 2.] OF IRRITATION. 205
owing to the inverted motions of the cutaneous lym-
phatics of the upper part of the body, and at the
same time the increased absorption of the pulmonary
absorbents: hence these sweats when profuse relieve
the present fit of asthma. There is no other way to
account for sweats appearing on the upper parts of
the body only, but by the fluid having been absorbed
by the lymphatic branch of the lungs, and effused on
the skin by the retrograde movements of the cutane-
ous lymphatics; which join those of the lungs before
they enter into the venous circulation. For if they
were occasioned, as generally supposed, by the diffi-
culty of the circulation of the blood through the lungs,
the whole skin must be equally affected, both of the
upper and lower parts of the body; for whatever
could obstruct the circulation in the upper part of the
venous system, must equally obstruct it in the lower
part of it. See Sect. XXIX. 6. In the convulsive
asthma these sweats do not occur; hence they may be
distinguished; and might be called the hydropic
asthma, and the epileptic asthma.
9. Translatio puris. Translation of matter from
one part of the system to another can only be explain-
ed from its being absorbed by one branch of the lym-
phatic system, and deposited in a distant part by the
retrograde motions of another branch; as mentioned
Sect. XXIX. 7. 1. It is curious, that these transla-
tions of matter are attended generally, I believe, with
cold fits; for less heat is produced during the retro-
grade

206 DISEASES [CLASS I. 3. 2.
grade action of this part of the system, as no secretion
in the lymphatic glands, of the affected branches can
exist at the same time. Do any ineffectual retrograde
motions occasion the cold fits of agues? The time
when the gout of the liver ceases, and the gout in the
foot commences, is attended with a cold fit, as I have
observed in two instances, which is difficult to explain
without supposing the new vessels, or the matter pro-
duced on the inflamed liver, to be absorbed, and either
eliminated by some retrograde motion, or carried to
the newly inflamed part? See Class IV. 1. 2. 15.
10. Translatio laclis. Translation of milk to the
bowels in puerperal fevers can only be explained by
the milk being absorbed by the pectoral branch of
lymphatics, and carried to the bowels by the retro-
grade motions of the intestinal lymphatics or lacteals.
See many instances of this in Sect. XXIX. 7. 4.
11. Translatio urina. Translation of urine. There
is a curious case related in the Transactions of the Col-
lege of Physicians at Philadelphia, Vol. I. p. 96. of a
girl, who labouring under an iscuria vomited her urine
for many months; which could not be distinguished
from that which was at other times drawn off by the
catheter. After having taken much opium, she seems
at length to have formed gravel, some of which was
frequently brought up by vomiting. Dr. Senter
ascribes this to the retrograde motions of the lympha-
tics of the stomach, and the increased ones of those of
4 the 

CLASS I. 3. 2.] OF IRRITATION. 207
the bladder, and refers to those of Sect. XXIX. of
this work; which section was first published in 1780;
and to Macquire's Dictionary of Chemistry, Art.
Urine.
The patient above described sometimes had a dis-
charge of urine by the navel, and at other times by
the rectum, and sometimes by urinous sweats.
ORDO III.
Retrograde Irritative Motions.
GENUS III.
Of the Sanguiferous System.
SPECIES.
1. Capillarium motus retrogressus. In microscopic
experiments it is usual to see globules of blood regur-
gitate from the capillary vessels again and again, be-
fore they pass through them; and not only the mouths
of the veins, which arise from these capillaries, are
frequently seen by microscopes to regurgitate some
particles of blood during the struggles of the animal;
but a retrograde motion of the blood in the veins of
these animals, from the very heart to the extremities
of the limbs, is observable by intervals during the dis-
tresses of the dying creature. Haller, Elem. Phys.
T. i. p. 216. See Section XXIX. 3. 8.
2. Palpitatio

208 DISEASES [CLASS I. 3. 3.
1. Palpitatio cordis. May not the ineffectual and
weak unequal motions of the heart in hysteric cases be
ascribed to the retrograde motions of it, which continue
for a short time, or terminate in syncope? See Class
IV. 3. 1. 6.
3. Anbelatio spasmodica. In some asthmas may not
the difficulty of respiration arises from the inverted
action of the finer branches of the bronchia, or of the
pulmonary artery or vein, like those of the capillaries
above described in No. I. of this genus?
THE 

CLASS II.] OF IRRITATION. 209
THE ORDERS AND GENERA OF THE SECOND CLASS
OF DISEASES.
CLASS II.
DISEASES OF SENSATION.
ORDO I.
Increased Sensation.
GENERA.
1. With increased action of the muscles.
2. With the production of new vessels by internal
membranes or glands with fever.
3. With the production of new vessels by external
membranes or glands with fever.
4. With the production of new vessels by internal
membranes or glands without fever.
5. With the production of new vessels by external
membranes or glands without fever.
6. With fever consequent to the production of new
vessels or fluids.
7. With increased action of the organs of sense.
ORDO II.
Decreased Sensation.
GENERA.
1. With decreased actions of the general system.
2. With decreased actions of particular organs.
P ORDO

210 DISEASES [CLASS II.
ORDO III.
Retrograde Sensitive Motions.
GENERA.
1. Of the arterial system.
2. Of the absorbent system.
3. Of the excretory ducts.
THE ORDERS, GENERA, AND SPECIES, OF THE
SECOND CLASS OF DISEASES.
CLASS II.
DISEASES OF SENSATION.
ORDO I.
Increased Sensation.
GENUS I.
With Increased Action of the Muscles.
SPECIES.
1. Deglutitio. Deglutition.
2. Respiratio. Respiration.
3. Sternutatio. Sneezing.
4. Anhelitus. Panting.
5. Tussis ebriorum. Cough of inebriates.
6. Singultus. Hiccough.
7. Singultus.

CLASS II. 1. 2.] OF SENSATION. 211
 7. Asthhma humorale. Humoral asthma.
 8. Nictitatio sensitiva. Winking from pain.
 9. Oscitatio et pandiculatio. Yawning and stretching.
10. Tenesmus. Tenesmus.
11. Stranguria. Strangury.
12. Parturitio. Parturition.
GENUS II.
With the Production of new Vessels by internal Membranes
or Glands, with Fever.
SPECIES.
 1. Febris sensitiva irritata. Sensitive irritated fever.
 2. Ophthalmia interna. Inflammation of the eye.
 3. Phrenitis. of the brain.
 4. Peripneumonia. of the lungs.
 trachealis. the croup.
 5. Pleuritis. of the pleura.
 6. Diaphragmitis. of the dia-
phragm.
 7. Carditis. of the heart.
 8. Peritonitis. of the perito-
neum.
 9. Mesenteritis. of the mesen-
tery.
10. Gastritis. of the sto-
mach.
11. Enteritis. of the bowels.
12. Hepatitis. of the liver.
13. Splenitis. of the spleen.
P2 14. Nephritis.

212 DISEASES [CLASS II. 1. 3.
14. Nephritis. Inflammation of the kidney.
15. Cystitis. - of the blad-
der.						
16. Hysteritis. - of the womb.
17. Lumbago sensitiva. - of the loins.
18. Ischias. - of the pelvis.
19. Paronychia interna. - beneath the
nails.
GENUS III.
With the Production of new Vessels by external Membranes
or Glands, with Fever.
SPECIES.
1. Febris sensitiva inirri- Sensitive inirritated fever.
tata.
2. Erysipelas irritatum. Erysipelas irritated.
- inirritatum. - inirritated.
- sensitivum - sensitive.
3. Tonsillitis interna. Angina internal.
- superficialis. - superficial.
- inrritata. - inirritated.
4. Parotitis suppurans. Mumps suppurative.
- mutabilis. - mutable.
- felina. - of cats.
5. Catarrhus sensitivus. Cattarrh inflammatory.
6. - contagiosus. - contagious.
- equinus et ca- - among horses and
ninus. dogs.
7. Peripneumonia superfi- 
cialis.
Superficial peripneumony.
8. Per-

CLASS II. 1. 3.] OF SENSATION. 213
8. Pertussis. Chin-Cough.
9. Variola discreta. Small-pox distinct.
- confluens. - confluent.
- inoculata. - inoculated.
10. Rubeola irritata. Measles irritated.
- inirritata. - inirritated.
11. Scarlatina mitis. Scarlet fever mild.
- maligna. - malignant.
12. Miliaria sudatoria. Miliary fever sudatory.
- irritata. - irritated.
- inirritata. - inirritated.
13. Pestis. Plague.
- vaccina. - of horned cattle.
14. Pemphigus. Bladdery fever.
15. Varicella. Chicken-pox.
16. Urticaria. Nettle rash.
17. Aptha sensitiva. Thrush sensitive.
- irritata. - irritated.
- inirritata. - inirritated.
18. Dysenteria. Bloody flux.
19. Gastritis superficialis. Superficial inflammation of
 the stomach.
20. Enteritis superficialis. - of
 the bowels.
P3 GENUS

214 DISEASES [CLASS II. 1. 4.
GENUS IV.
With the Production of new Vessels by internal Membranes
or Glands, without Fever.
SPECIES.
1. Ophthalmia superficialis. Ophthalmy superficial.
- lymphatica. - lymphatic.
- equina. - of horses.
2. Pterigion. Eye-wing.
3. Tarsitis palpebrarum. Red eyelids.
4. Hordeolum. Stye.
5. Paronychia superficialis. Whitlow.
6. Gutta rosea hepatica. Pimpled face hepatic.
- stomatica. - stomatic.
- hereditaria. - hereditary.
7. Odontitis. Inflamed tooth.
8. Otitis. - ear.
9. Fistula lacrymalis. Fistula lacrymalis.
10. Fistula in ano. Fistula in ano.
11. Hepatitis chronica. Chronical hepatitis.
12. Scrophula suppurans. Suppurating scrophula.
13. Scorbutus suppurans. Suppurating scurvy.
14. Schirrus suppurans. Suppurating schirrus.
15. Carcinoma. Cancer.
16. Arthrocele. Swelling of the joints.
17. Arthropuosis. Suppuration of the joints.
18. Caries ossium. Caries of the bones.
GENUS 

CLASS II. 1. 6.] OF SENSATION. 215
GENUS V.
With the Production of new Vessels by external Membranes
or Glands, without Fever.
SPECIES.
1. Gonorrhœa venerea. Clap.
2. Syphilis. Venereal disease.
3. Lepra. Leprosy.
4. Elephantiasis. Elephantiasis.
5. Frambœsia. Framboesia.
6. Psora. Itch.
7. Psora ebriorum. Itch of drunkards.
8. Herpes. Herpes.
9. Zona ignea. Shingles.
10. Annulus repens. Ring-worm.
11. Tinea capitis. Scald-head.
12. Crusta lactea. Milk-crust.
13. Trichoma. Plica polonica.
GENUS VI.
With Fever consequent to the Production of new Vessels
or Fluids.
SPECIES.
1. Febris sensitiva. Sensitive fever.
2. = a pure clauso. Fever from concealed mat-
ter.
3. - a vomica. - from vomica.
4. - ab empyemate. - from empyema.
5. - mesenterica. - mesenteric.
P4 6. Febris 

216 DISEASES [CLASS II. 1. 7.
6. Febris a pure aerato. Fever from aerated matter.
7. - a phthisi. - from consumption.
8. - scrophulosa. - scrophulous.
9. - ischiadica. - from ischias.
10. - arthropuodica. - from joint-evil.
11. - a pure contagioso. - from contagious mat-
ter.
12. - variolosa secunda - secondary of small-
ria. pox.
13. - carcinomatosa. - cancerous.
14. - venerea. - venereal.
15. - a sanie contagiosa. - from contagious sa-
nies.
16. - puerpera. - puerperal.
17. - a sphacelo. - from sphacelus.
GENUS VII.
With increased Action of the Organs of Sense.
SPECIES.
1. Delirium febrile. Delirium of fevers.
2. - maniacale. - maniacal
3. - ebrietatis. - of drunkenness.
4. Somnium. Dreams.
5. Hallucinatio visus. Deception of sight.
6. - auditus - of hearing.
7. Rubor a calore. Blush from heat.
8. - jucunditalis. - from joy.
9. Priapismus amatorius. Amorous priapism.
10. Distentio mamularum. Distention of the nipples.
ORDO

CLASS II. 2. 2.] OF SENSATION. 217
ORDO II.
Decreased Sensation.
GENUS I.
With Decreased Action of the general System.
SPECIES.
1. Stultitia insensibilis. Folly from insensibility.
2. Tadium vitæ. Irksomeness of life.
3. Paresis sensitiva. Sensitive debility.
GENUS II.
With decreased Actions of particular Organs.
SPECIES.
1. Anorexia. Want of appetite.
2. Adipsia. Want of thirst.
3. Impotentia. Impotence.
4. Sterilitas. Barrenness.
5. Insensibilitas artuum. Insensibility of the limbs.
6. Dysuria insensitiva. Insensibility of the bladder.
7. Accumulatio alvina. Accumulation of feces.
ORDO 

218 DISEASES [CLASS II. 3. 1.
ORDO III.
Retrograde Sensitive Motions.
GENUS I.
Of Excretory Ducts.
SPECIES.
 Motus retrogressus. Retrograde motion.
1. - ureterum. - of the ureters,
2. - urethræ. - of the urethra.
3. - duclus choledoci. - of the bile-duct.
CLASS 

CLASS II. 1. 1.] OF SENSATION. 219
CLASS II.
DISEASES OF SENSATION.
ORDO I.
Increased Sensation.
GENUS I.
With increased Action of the Muscles.
THE actions belonging to this genus are those which
are immediately excited by the sensations of pain or
pleasure, but which are neither followed by inflamma-
tion, nor by convulsion. The former of which be-
long to the subsequent genera of this order, and the
latter to the class of voluntary motions.
The criterion between the actions, which are the
immediate consequence of painful sensation, and con-
vulsive actions properly so called, consists in the former
having a tendency to dislodge the stimulating cause,
which induces the painful sensation; and the latter
being exerted for the purpose of expending the senso-
rial power, and thus dulling or destroying the general
sensation of the system. See Class III. 1.
There is a degree of heat produced in the affected
part by these sensitive actions without inflammation,
but in much less quantity than when attended by in-
flammation; as in the latter there is a production of
new vessels. See Sect. XXXIII. 2. 3.
Some 

220 DISEASES [CLASS II. 1. 1.
Some of the species of this genus cannot properly
be termed diseases in their natural state, but become
so by their defect or excess, and are here inserted to
facilitate the explanation of the others.
SPECIES.
1. Deglutitio. Swallowing our food is immediately
caused by the pleasurable sensation occasioned by its
stimulus on the palate or fauces, and is acquired long
before the nativity of the animal. Afterwards the
pain of hunger previously produces the various volun-
tary exertions to procure the proper material, but the
actions of masticating and of swallowing it are effected
by the sensorial power of sensation; which appears by
their not being always controllable by the will, as
when children in vain attempt to swallow nauseous
drugs. See Class IV. 1. 3. 1. The masticated food
stimulates the palate, which is an organ of sense, into
so much action, as to produce agreeable sensation;
and the muscles subservient to deglutition are brought
into action by the sensation thus produced. The
pleasurable sensation is the proximate cause; the
action of the fibres of the extremities of the nerves of
taste is the remote cause; the sensorial power of irrita-
tion exciting these fibres of the nerves of taste into in-
creased action is the pre-remote cause; the action of
the muscles of deglutition is the proximate effect; the
pushing the food into the stomach is the remote effect;
and the nutrition of the body is the post-remote effect.
Though 

CLASS II. 1. 1.] OF SENSATION 221
Though the muscles subservient to deglutition have
their actions previously associated, so as to be excited
into synchronous tribes or successive trains, either by
volition, as when we swallow a disagreeable drug; or
by sensation, as when we swallow agreeable food; or
by irritation, as when we inattentively swallow our
saliva; yet do all those three kinds of deglutition be-
long to the respective classes of volition, sensation, and
irritation; because the first links of these tribes or
trains of muscular action are excited by those sensorial
powers, and the associated links, which accompany or
succeed them, are excited by the combined powers
either of volition, or of sensation, or of irritation,
along with that of association.
2. Respiratio. Respiration is immediately caused
by the sensorial power of sensation in consequence of
the baneful want of vital air; and not from the accu-
mulation of blood in the lungs, as that might be car-
ried on by inhaling azote alone, without the oxyge-
nous part of the atmosphere. The action of respira-
tion is thus similar to that of swallowing our food to
appease the pain of hunger; but the lungs being sur-
rounded with air, their proper pabulum, no interme-
diate voluntary exertions are required, as in hunger,
to obtain and prepare the wanted material.
Respiration is similar to slow combustion; the ox-
ygenous part of the atmosphere is received through
the moist membranes, which line the air-cells of the
lungs, and uniting with the inflammable part of the
blood generates an acid, probably the phosphoric
acid

222 DISEASES [CLASS II. 1. 1.
acid; a portion of carbonic acid is likewise produced
in this process; as appears by repeatedly breathing
over lime-water, which then becomes turbid. See
Botanic Garden, P. I. Canto I. l. 401. note.
3. Sternutatio. Sneezing consists of muscular actions
produced by the sensorial faculty of sensation; and is
an effort to dislodge, by means of air forcibly impelled
through the nostrils, some material; which stimulates
the membrane, which lines them, into too great action,
and might thence injure the sense of smell which is
diffused on it.
In this operation the too great action of the vessels
of the membrane of the nostrils is the remote cause;
the sensation thence induced is the proximate cause;
and the muscular actions are the proximate effect.
This action of sneezing frequently precedes common
respiration in new-born children, but I believe not
always; as like the latter it cannot have been previ-
ously acquired in the uterus.
It is produced in some people by sudden light, as
by looking up at the sky in a morning, when they
come out of a gloomy bed-chamber. It then becomes
an associate action, and belongs to Class IV. 1. 2. 2.
M. M. When it is exerted to excess it may be
cured by snuffing starch up the nostrils. See Class I.
1. 2. 13.
4. Anhelitus. Painting. The quick and laborious
breathing of running people, who are not accustomed
to violent exercise, is occasioned by the too great con-
flux

CLASS II. 1. 1.] OF SENSATION. 223
flux of blood to the lungs. As the sanguiferous sys-
tern, as well as the absorbent system, is furnished in
many parts of its course with valves, which in general
prevent the retrograde movement of their contained
fluids; and as all these vessels, in some part of their
course, lie in contact with the muscles, which are
brought into action in running, it follows that the
blood must be accelerated by the intermitted swelling
of the bellies of the muscles moving over them.
The difficulty of breathing, with which very fat
people are immediately affected on exercise, is owing
to the pressure of the accumulated fat on the veins,
arteries, and lymphatics; and which, by distending
the skin, occasions it to act as a tight bandage on the
whole surface of the body. Hence when the muscles
are excited into quicker action, the progress of the
blood in the veins, and of the lymph and chyle in the
absorbent system, is urged on with much greater force,
as under an artificial bandage on a limb, explained in
Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence
the circulation is instantly quickened to a great degree,
and the difficulty of breathing is the consequence of a
more rapid circulation through the lungs. The in-
creased secretion of the perspirable matter is another
consequence of this rapid circulation; fat people, when
at rest, are believed to perspire less than others, which
may be gathered from their generally having more
liquid stools, more and paler urine, and to their fre-
quently taking less food than many thin people; and
lastly, from the perspiration of fat people being gene-
rally

224 DISEASES [CLASS II. 1. 1.
rally more inodorous than that of lean ones; but
when corpulent people are put in motion, the sweat
stands in drops on their skins, and they "lard the
ground" as they run. The increase of heat of cor-
pulent people on exercise, is another consequence of
their more rapid circulation, and greater secretion.
See Class I. 2. 3. 17.
Other causes of difficult or quick respiration will be
treated of under Asthma, Pertussis, Peripneumony,
Tonsillitis.
5. Tussis ebriorum. Sensitive cough is an exertion
of the muscles used in expiration excited into more
violent action by the sensorial power of sensation, in
consequence of something which too powerfully stimu-
lates the lungs. As the saline part of the secreted
mucus, when the absorption of it is impeded; or the
too great viscidity of it, when the absorption is in-
creased; or the too great quantity of the mucus, when
the secretion is increased; or the inflammation of the
membranes of the lungs; it is an effort to dislodge
any of these extraneous materials.
Of this kind is the cough which attends free-
drinkers after a debauch; it consists of many short ef-
forts to cough, with a frequent expuition of half a
tea-spoonful of frothy mucus, and is attended with
considerable thirst. The thirst is occasioned by the
previous dissipation of the aqueous parts of the blood
by sensible or insensible perspiration; which was pro-
duced by the increased action of the cutaneous and
4 pulmonary

CLASS II. 1. 1.] OF SENSATION. 225
pulmonary capillaries during the stimulus of the wine.
In consequence of this an increased absorption com-
mences to replace this moisture, and the skin and
mouth become dry, and the pulmonary mucus be-
comes inspissated; which stimulates the bronchia, and
is raised into froth by the successive currents of air in
evacuating it. This production of froth is called by
some free-drinkers "spitting sixpences" after a de-
bauch. This subsequent thirst, dry mouth, and viscid
expectoration in some people succeeds the slightest de-
gree of intoxication, of which it may be esteemed a
criterion. See Class IV. 2. 1. 8.
As coughs are not always attended with pain, the
muscular actions, which produce them, are sometimes
excited by the sensorial faculty of irritation, as in Class
I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs
are also sometimes convulsive, as in Class III. 1. 1. 10.
and sometimes sympathetic, as Class IV. 2. 1. 7.
M. M. Venesection, when the cough is attended
with inflammation. Mucilages. Opium. Torpentia.
Blister.
6. Singultus. Hiccough is an exertion of the mus-
cles used in inspiration excited into more violent action
by the sensorial power of sensation, in consequence of
something which too powerfully stimulates the cardia
ventriculi, or upper orifice of the stomach. As when
solid food is too hastily taken without sufficient dilu-
tion. And is an effort to dislodge that offensive
material, and push it to some less sensible part of
Q the

226 DISEASES [CLASS II. 1. 1.
the stomach, or into the middle of the contained
aliment.
At the end of fatal fevers it may arise from the
acrimony of the undigested aliment, or from a part of
the stomach being already dead, and by its weight or
coldness affecting the surviving part with disagreeable
sensation. The pain about the upper orifice of the
stomach is the proximate cause, the too great or too
little action of the fibres of this part of the stomach
is the remote cause, the action of the muscles used in
inspiration is the proximate effect, and the repercussion
of the offending material is the remote effect.
Hiccough is sometimes sympathetic, occasioned by
the pain of gravel in the kidney or ureter, as in Class
IV. 1. 1. 7. and is sometimes a symptom of epilepsy
or reverie, as in Sect. XIX. 2.
M. M. Oil of cinnamon from one drop gradually
increased to ten, on sugar, or on chalk. Opium.
Blister. Emetic.
7. Asthma humorale. The humoral asthma pro-
bably consists in a temporary anasarca of the lungs,
which may be owing to a temporary defect of lym-
phatic absorption. Its cause is nevertheless at present
very obscure, since a temporary deficiency of venous
absorption, at the extremities of the pulmonary or
bronchial veins, might occasion a similar difficulty of
respiration. See Abortio, Class I. 2. 1. 14. Or it
might be supposed, that the lymph effused into the
cavity of the chest might, by some additional heat
during

CLASS II. 1. 1.] OF SENSATION. 227
during sleep, acquire an aerial form, and thus compress
the lungs; and on this circumstance the relief, which
these patients receive from cold air, would be readily
accounted for.
The paroxysms attack the patient in his first sleep,
when the circulation through the lungs in weak peo-
ple wants the assistance of the voluntary power. Class
I. 2. 1. 3. And hence the absorbents of the lungs
are less able to fulfil the whole of their duty. And
part of the thin mucus, which is secreted into the air
cells, remains there unabsorbed, and occasions the dif-
ficult respiration, which awakes the patient. And the
violent exertions of the muscles of respiration, which
succeed, are excited by the pain of suffocation, for the
purpose of pushing forwards the blood through the
compressed capillaries, and to promote the absorption
of the effused lymph.
In this the humoral differs from the convulsive
asthma, treated of in Class III. 1. 1. 10. as in that
there is probably no accumulated fluid to be absorbed;
and the violent respiration is only an exertion for the
purpose of relieving pain, either in the lungs or in
some distant part, as in other convulsions, or epilepsy;
and in this respect the fits of humoral and convulsive
asthma essentially differ from each other, contrary to
the opinion expressed without sufficient consideration
in Sect. XVIII. 15.
The patients in the paroxysms both of humoral and
convulsive asthma find relief from cold air, as they ge-
nerally rise out of bed, and open the window, and
Q2 put 

228 DISEASES [CLASS II. 1. 1.
put out their heads; for the lungs are not sensible to
cold, and the sense of suffocation is somewhat relieved
by there being more oxygen contained in a given
quantity of cold fresh air, than in the warm confined
air of a close bed-chamber.
I have seen humoral asthma terminate in confirmed
anasarca, and destroy the patient, who had been an
excessive drinker of spirituous potation. And M. Sa-
vage asserts, that this disease frequently terminates in
diabætes; which seems to shew, that it is a temporary
dropsy relieved by a great flow of urine. Add to this,
that these paroxysms of the asthma are themselves re-
lieved by profuse sweats of the upper parts of the
body, as explained in Class I. 3. 2. 8. which would
countenance the idea of their being occasioned by con-
gestions of lymph in the lungs.
The congestion of lymph in the lungs from the de-
fective absorption of it is probably the remote cause
of humoral asthma; but the pain of suffocation is the
immediate cause of the violent exertions in the pa-
roxysms. And whether this congestion of lymph in
the air-cells of the lungs increases during our sleep,
as above suggested, or not; the pain of suffocation
will be more and more distressing after some hours of
sleep, as the sensibility to internal stimuli increases
during that time, as described in Sect. XVIII. 15.
For the same reason many epileptic fits, and paroxysms
of the gout, occur during sleep.
In two gouty cases, complicated with jaundice, and
pain, and sickness, the patients had each of them a
shivering

CLASS II. 1. 1.] OF SENSATION. 229
shivering fit, like the commencement of an ague, to
the great alarm of their friends; both which com-
menced in the night, I suppose during their sleep; and
the consequence was a cessation of the jaundice, and
pain about the stomach, and sickness; and instead of
that the gout appeared in their extremities. In these
cases I conjecture, that there was a metastasis not only
of the diseased action from the membranes of the liver
to those of the foot; but that some of the new vessels,
or new fluids, which were previously produced in the
inflamed liver, were translated to the feet during the
cold fit, by the increased absorption of the hepatic
lymphatics, and by the retrograde motions of those of
the affected limbs.
This I think resembles in some respects a fit of hu-
moral asthma, where stronger motions of the absor-
bent vessels of the lungs are excited, and retrograde
ones of the correspondent cutaneous lymphatics;
whence the violent sweats of the upper parts of the
body only are produced; and for a time the patient
becomes relieved by the metastasis and elimination of
the offending material by sensitive exertion. For a
further account of this intricate subject sees Class III.
1. 1. 10.
M. M. To relieve the paroxysm a tea-spoonful of
ether may be given mixed with water, with 10 drops
of laudanum, to be repeated three or four times.
Venesection. An emetic. A blister. Afterwards the
Peruvian bark, with a grain of opium at night, and
two or three of aloes. A flannel shirt in winter, but
not in summer. Issues. Digitalis? 
Q3 In

230 DISEASES [CLASS II. 1. 1.
In this species of asthma, there is great reason to
believe, that the respiration of an atmosphere, with
an increased proportion of oxygen, will prove of great
advantage; some well-observed and well-attested cases
of which are published by Dr. Beddoes; as this purer
air invigorates the circulation, and the whole system
in consequence, perhaps not only by its stimulus, but
by its supplying the material from which the sensorial
power is extracted or fabricated. In spasmodic asthma,
on the contrary, Dr. Ferriar has found undoubted
benefit from an atmosphere mixed with hydrogen. See
Sect. XVIII. 15. and Class III. 1. 1. 10.
8. Niclitatio sensitiva. Winking of the eyes is per-
formed every minute, without our attention, for the
purpose of diffusing the tears over them, which are
poured into the eye a little above the external corner
of it, and which are afterwards absorbed by the
lacrymal points above and below the internal corner
of it. When this operation is performed without our
attention, it is caused by the faculty of irritation, and
belongs to Class I. 1. 4. 1. but when it is produced
by a stronger stimulus of any extraneous material in
the eye, so as to cause pain, the violent and frequent
nictitation is caused by the faculty of sensation.
This disease is sometimes produced by the introver-
sion of the edge of the lower eyelid, which bends the
points of the hairs of the eyelash upon the ball of the
eye, which perpetually stimulate it into painful sen-
sation. This introversion of the eyelid is generally
owing to a tumor of the cellular membrane below the 
edge

CLASS II. 1. 1.] OF SENSATION. 231
edge of the eyelid, and though a very troublesome
complaint may often be cured by the following simple
means. A little common plaster spread on thin linen,
about a quarter of an inch long, must be rolled up so
as to be about the size of a crow-quill, this must be
applied immediately below the eyelash on the outside
of the eye; and must be kept on by another plaster
over it. This will then act as a slight compression on
the tumor under the eyelash, and will prevent the
hairs from touching the eye-ball. In a week or two
the compression will diminish the tumor it lies over,
and cure this painful deformity.
9. Ofcitatio et pandiculatio. Yawning and stretching
of the limbs is produced either by a long inactivity of
the muscles now brought into action, as sometimes
happens after sleep, or after listening a long time to
a dull narrative; or it is produced by a too long con-
tinued action of the antagonist muscles. In the former
case there is an accumulation of sensorial power during
the quiescence of the muscles now brought into action;
which probably constitutes the pain or wearisomeness
of a continued attitude. In the latter case there is an
exhaustion of sensorial power in the muscles, which
have lately been acting violently, and a consequent
accumulation in the muscles, which are antagonists to
them, and which were at rest.
These involuntary motions are often seen in para-
lytic limbs, which are at the same time completely dis-
obedient to the will; and are frequently observable in
Q4 very

232 DISEASES [CLASS II. 1. 1.
very young children; and from thence we may con-
dude, that these motions are learnt before nativity; as
puppies are seen to open their mouths before the mem-
branes are broken. See Sect. XVI. 2.
Where these motions are observed in limbs other-
wise paralytic, it is an indication that electric shocks
may be employed with advantage, as the excitability
of the limb by irritation is not extinct, though it be
disobedient both to volition and sensation.
10. Tenesmus consists in violent and frequent in-
effectual efforts to discharge the contents of the rec-
tum, owing to pain of the sphincter. The pain is
produced by indurated feces, or by some acrid mate-
rial, as the acidity of indigested aliment; and the ef-
forts are attended with mucus from the pained mem-
brane. The feces must sometimes be taken away by
the end of a marrow-spoon, as cathartics and even
clyster will pass without removing them. It is some-
times caused by sympathy with the urethra, when
there is a stone at the neck of the bladder. See Class
II. 2. 2. 7. and IV. 1. 2. 8.
M. M. Fomentation, an enema with mucilage and
laudanum.
The common exclusion of the feces from the rectum
is a process similar to this, except that the muscles of
the sphincter ani, and those of the abdomen, which
act along with them by the combined powers of sen-
sation and association, are in tenesmus excited by pain-
ful sensation, and in the latter by a sensation, which
may

CLASS II. 1. 1.] OF SENSATION. 233
may in some instances be almost called pleasurable,
as relieving us from a painful one in the exclusion of
the feces.
11. Stranguria. Strangury consists in painful ef-
forts to discharge the contents of the urinary bladder.
It is generally owing to a stone in the sphincter of the
bladder; or to the inflammation of the neck of it oc-
casioned by cantharides. It is sometimes caused by
sympathy with the piles; and then is liable in women
to occasion convulsions, from the violence of the pain
without inflammation. See Class IV. 2. 2. 2. and 3.
M. M. Fomentation, clyster with oil and lauda-
num, push the stone back with a bougie; if from
cantharides give half a pint of warm water every
ten minutes. Mucilage of gum arabic and traga-
canth.
The natural evacuation of the urine is a process
similar to this, except that the muscular fibres of the
bladder, and the muscles of the abdomen, which act
in concert with them by the combined powers of sen-
sation and of association, are, in the former case of
strangury, excited into action by painful sensation;
and in the latter by a sensation, which may almost
be termed pleasurable, as it relieves us from a pre-
vious uneasy one.
The ejectio seminis is another process in some re-
spects similar to strangury, as belonging to the same
sensible canal of the urethra, and by exciting into
action the accelerator muscles; but in the strangury
these

234 DISEASES [CLASS II. 1. 1.
these muscles are excited into action by painful sen-
sation, and in the ejection of the semen by pleasurable
sensation.
12. Parturitio. Parturition is not a disease, it is
a natural process, but is more frequently unfortunate
in high life than amongst the middle class of females;
which may be owing partly to fear, with which the
priests of LUCINS are liable to inspire the ladies of
fashion to induce them to lie in in town; and partly
to the bad air of London, to which they purposely
resort.
There are however other causes, which render
parturition more dangerous to the ladies of high life;
such as their greater general debility from neglect of
energetic exercise, their inexperience of the variations
of cold and heat, and their seclusion from fresh air.
To which must be added, that great source of the
destruction of female grace and beauty, as well as of
female health, the tight stays, and other bandages,
with which they are generally tortured in their early
years by the active folly of their friends, which by
displacing many of the viscera impedes their actions,
and by compressing them together produces adhesions
of one part to another, and affects even the form and
aperture of the bones of the pelvis, through which
the nascent child must be protruded.
As parturition is a natural, not a morbid process,
no medicine should be given, where there is no ap-
pearance of disease. The absurd custom of giving a
powerful

CLASS II. 1. 1.] OF SENSATION. 235
powerful opiate without indication to all women, as
soon as they are delivered, is, I make no doubt, fre-
quently attended with injurious, and sometimes with
fatal consequences. See Class II. 1. 2. 16.
Another thing very injurious to the child, is the
tying and cutting the navel-string too soon; which
should always be left till the child has not only repeat-
edly breathed, but till all pulsation in the cord ceases.
As otherwise the child is much weaker than it ought
to be; a part of the blood being left in the placenta,
which ought to have been in the child; and at the
same time the placenta does not so naturally collapse,
and withdraw itself from the sides of the uterus, and
is not therefore removed with so much safety and cer-
tainty. The folly of giving rue or rhubarb to new-
born children, and the danger of feeding them with
gruel instead of milk, is spoken of in Class I. 1. 2. 5.
and II. 1. 2. 16.
ORDO 

236 DISEASES [CLASS II. 1. 2.
ORDO I.
Increased Sensation.
GENUS II.
With the Production of new Vessels by internal Membranes
or Glands, with Fever.
In the first class of diseases two kinds of fevers were
described, one from excess, and the other from defect
of irritation; and were in consequence termed irri-
tative, and inirritative fevers. In this second class of
diseases another kind of fever occurs, which is caused
by excess of sensation, and termed in consequence Sen-
sitive Fever. But there is no fever from defect of
sensation, because the circulation is carried on in health
without our consciousness, that is, without any sen-
sation attending it.
But as excess of sensation may exist with excess or
defect of irritation, two other kinds of fever arise
from a combination of sensitive fever with the irrita-
tive, and inirritative ones. Making five kinds in all.
1. Irritative fever, described in Class I. 1. 1. 1.
2. Inirritative fever. Class I. 2. 1. 1.
3. Sensitive fever. Class II. 1. 6. 1.
4. Sensitive irritated fever. Class II. 1. 2. 1.
5. Sensitive inirritated fever. Class II. 1. 3. 1.
As the sensitive irritated fever attends all the dis-
eases enumerated under the genus about to be de-
scribed,

CLASS II. 1. 2.] OF SENSATION. 237
scribed, it is placed at the head of it. And as the
sensitive inirritated fever accompanies the greatest
number of the species enumerated under the third
genus of this order, it is placed at the head of them.
And as the sensitive fever attends the diseases of the
sixth genus, it is placed at the head of them. But as
every febrile paroxysm consists of disordered tribes or
trains of associated motions, it may be doubted, whe-
ther they ought not all to have been placed in the
fourth class, amongst the diseases of association. See
Class IV. 2. 4. 11.
All the subsequent species of this genus are attended
with sensitive irritated fever; there are nevertheless
some superficial inflammations, which affect the same
situations without much fever, as the scrophulous oph-
thalmy and spurious peripneumony, which belong to
other genera.
Inflammation is uniformly attended with the pro-
duction or secretion of new fibres constituting new
vessels; this therefore may be esteemed its essential
character, or the criterion of its existence. The ex-
tension of the old vessels seems rather a consequence
than a cause of the germination, or pullulation, of
these new ones; for the old vessels may be enlarged,
and excited with unusual energy, without any pro-
duction of new ones, as in the blush of shame or of
anger.
When these new vessels are formed, if they are not
reabsorbed into the circulation, they secrete a new
fluid called purulent matter; which generally opens
itself

238 DISEASES [CLASS II. 1. 2.
itself a passage on the external skin, and produces an
ulcer, which either gradually heals, or spreads, and
is the cause of hectic fever; or they secrete contagious
matter, which has the property of exciting the same
kind of inflammation, and of producing the same kind
of contagious matter, when inserted by inoculation
into the skin of other persons. These contagious
matters form ulcers, which either heal spontaneously,
or by art; or continue to spread, and destroy the pa-
tient, by other kinds of hectic fever.
In this genus there is an increase of the sensorial
power of irritation as well as of sensation; whence
great arterial energy is produced, and the pulse be-
comes strong and full, as well as quick; and the coats
of the arteries feel hard under the finger, being them-
selves thickened and distended by inflammation. The
blood drawn, especially at the second bleeding, is
covered with a tough size; which is probably the mu-
cus from the inflamed internal surface of the arteries,
increased in quantity, and more coagulable than in its
natural state; the thinner part being more perfectly
absorbed by the increased action of the inflamed ab-
sorbents. See Sect. XXXIII. 2. 2. This is rendered
more probable, because the hard feel of the pulse, and
the abundance of coagulable lymph commence, exist,
and cease together.
Great heat is produced from the new chemical
combinations arising in the secretion of new fibres,
and great pain from the distention of old ones, or
from their increased action. The increased quantity
of

CLASS II. 1. 2.] OF SENSATION. 239
of sensation from a topical inflammation or phlegmon
is the immediate cause of the febris sensitiva irritata,
or inflammatory fever; as when it arises from the
pain of pleurisy, or paronychia; but generally an ir-
ritative fever precedes this topical inflammation,
which occurs during the hot sit of it; and then the
irritative fever is changed into a sensitive irritated
fever, by the additional cause of the sensorial power of
sensation besides that of irritation.
SPECIES.
1. Febris sensitiva irritata. Sensitive irritated fever,
or inflammatory fever. Phlegmasia. A strong full
pulse, with inflammation of the coats of the arteries,
constitutes this disease. It originates from some to-
pical inflammation, which, if the fever is not sub-
dued, terminates in suppuration; and differs from
irritative fever in respect to the painful sensation
which accompanies it. For as pleasurable sensation is
the cause of the growth of the new vessels, and dis-
tention of the old ones, in the natural enlargement
of the body during our infancy; so a painful sensation
is the cause of the unnatural production of new vessels,
and enlargement of old ones in inflammatory dis-
eases.
When matter is thus formed in any internal viscus,
or in the cellular membrane, as in the lungs or liver;
so long as this abscess remains without admission of air,
this inflammatory fever is liable to continue, receiving
only temporary relief by bleeding or emetics, or ca-
thartics;

240 DISEASES [CLASS II. 1. 2.
thartics; till the patient, after a month, or two, or
three, expires. But, if air be admitted to these in-
ternal abscesses, this kind of fever is changed into a
hectic fever in a single day. It also sometimes hap-
pens, that when the abscess remains unopened to the
air, if the matter has become putrid, that hectic fever
supervenes, with colliquative sweats, or diarrhœa;
the matter in both cases is sometimes absorbed, and
the sides of the abscess grow together again without
an external aperture. See Class II. 1. 4. 1. and 2.
Another termination of inflammation is in gangrene,
but this belongs to the inflammation of the external
skin; as the production of purulent matter belongs to
inflammation of the internal or mucous membranes.
Thus when the external skin is the seat of inflamma-
tion, as in erythema, or erysipelas, and produces sen-
sitive irritated fever, no collection of purulent matter
can be formed; but a material oozes out, and lies
upon the surface, like that in the confluent small-pox,
and the cuticle at length peels off, or gangrene super-
venes. It must be noted, that these kinds of inflam-
mation can exist together; and some parts of the cel-
lular membrane may suppurate at the same time that
the external skin is affected with erythema, or ery-
sipelas.
M. M. Venesection. Cathartics. Diluents. Cool
air. Torpentia. Cold Bath- See Sect. XII. 6.
The increased arterial action in this sensitive irritated
fever is not simply owing to the increased irritability
of the arterial system, or to the stimulus of the disten-
4 tion

CLASS II. 1. 2.] OF SENSATION. 241
tion of the vessels, but also to the increased acrimony
or pungency of the blood; which has now so far
changed its nature as to become more fluid, more
dense, and to be loaded with coagulable lymph. Hence
it becomes necessary not only to lessen the quantity of
blood by venesection and by cathartics, but also to
dilute its acrimony, or pungency, by the introduction
of aqueous and mucilaginous fluids, such as barley
water, cream and water, sugar and water, weak
broths; to which may be added so much of some ve-
getable essential oil, as may render them grateful to
the stomach, and thus promote their absorption, as by
infusing parsley or celery and turnips in the broth;
or by balm, mint, or sage teas.
The following species of this genus only distinguish
the situation of the part previously inflamed, and
which is the remote cause of the sensitive irritated, or
inflammatory fever, which attends it.
2. Opthalmia interna. Inflammation of the eye is
attended with the production of new vessels, which
spread over the tunica adjunctiva, and over the cor-
nea; these new vessels are easily seen, as they lie on
a white ground, and give ocular demonstration of their
production in inflammation. When this inflammation
of the cornea suppurates, it is liable to leave little
ulcers, which may be seen beneath the surface in the
form of little excavations; and as these heal, they are
liable to be covered with an opake scar. This scar,
in some months or years, is liable to wear away, and
R become 

242 DISEASES [CLASS II. 1. 2.
become transparent, without the assistance of any po-
lishing powder, as of very finely levigated glass, as
some have recommended. But when the cornea is
affected through all its thickness, the return of its
transparency becomes hopeless. See Class I. 1. 1. 3. 14.
In violent degrees of opthalmy the internal parts,
as the retina, optic artery, iris, ciliary process, become
inflamed, as well as the external ones; hence the least
light admitted to the eye occasions intolerable pain.
This curious circumstance cannot be owing to the
action of light on the inflamed vessels of the cornea;
it therefore shews, that the extremity of the optic
nerve or retina is also rendered more exquisitely sen-
sible to light, by partaking of the inflammation; and
I have been told, that red colours are in these cases
sometimes painfully perceived even in perfect dark-
ness. This shews that the retina is excited into mo-
tion by the stimulus of light; and that, when it is in-
flamed, these motions give great pain, like those of
other inflamed parts, as the muscles, or membranes.
And secondly, that the ideas of colours consist in the
motions of the retina; which ideas occasion pain, when
the extremity of the moving nerve is inflamed.
M. M. Venesection. Cathartics. Diluents. Tor-
pentia. Frequently moisten the eye with cold water
by means of a rag. Cool airy room. Darkness.
When the inflammation begins to decline, white vi-
triol gr. vi. in an ounce of water is more efficacious
to moisten the eye than solutions of lead. Tincture
of opium diluted. New vessels from the inflamed
tunica

CLASS II. 1. 2.] OF SENSATION. 243
tunica adnata frequently spread like a fly's wing upon
the transparent cornea, which is then called Pterigium.
To stop the growth of this, the principal vessels should
be cut through with a lancet. When the inflamma-
tion begins to decline, after due evacuation any stimu-
lating material put into the eye increases the absorp-
tion, which soon removes the new red vessels; which
has given rise to a hundred famous eye-waters, and
eye-doctors; if these stimulating materials are used too
soon, the inflammation is increased by them. See
Sect. XXXII. 2. 10.
There is another opthalmia, which attends weak
children, and is generally esteemed a symptom of
scrophula, as described in Class II. 1. 5. 3. and ano-
ther, which is of venereal origin, mentioned in Class
II. 1. 5. 2. both which may be termed opthalmia su-
perficialis.
3. Phrenitis. Inflammation of the brain is attended
with intolerance of light and sound; which shews,
that the extremities of the nerves of those senses are
at the same time inflamed; it is also attended with
great pain of the head, with watchfulness, and furious
delirium. The violent efforts, these patients are said
sometimes to exert, are owing to the increased secre-
tion of sensorial power in the brain; as all other in-
flamed glands have a greater circulation of blood pas-
sing through them, and a greater secretion in conse-
quence of their peculiar fluids, as in the hepatitis much
more bile is generated.
R2 M. M. Vene-

244 DISEASES [CLASS II. 1. 2.
M. M. Venesection. Cathartics. Torpentia. Fo-
ment the head with cold water for hours together.
Or with warm water. Cool airy room. Afterwards
cupping on the occiput. Leeches to the temples.
When the patient is weakened a blister on the head,
and after further exhaustion five or six drops of tinc-
ture of opium.
4. Peripneumonia. Inflammation of the lungs. The
pulse is not always hard, sometimes soft; which is
probably owing to a degree of sickness or inaction of
the stomach; with dull pain of the chest; respiration;
constantly difficult, sometimes with erect posture; the
face bloated and purplish; cough generally with moist
expectoration, often stained with blood.
When the difficulty of respiration is very great, the
patient is not able to cough; in this situation, after
copious bleeding, the cough is liable to return, and is
so far a favourable symptom, as it shews some abate-
ment of the inflammation.
A peripneumony frequency occurs in the chin-
cough, and destroys the patient, except immediate
recourse be had to the lancet, or to four or five
leeches; when blood cannot be otherwise taken.
The peripneumony is very fatal to young children,
especially as I believe it is frequently mistaken for a
spasmodic asthma, or for the croup, or cynanche tra-
chealis of Cullen. Both which, however, when they
occur, require immediate venesection by the lancet or
by leeches, as well as the perineumony.
The

CLASS II. 1. 2.] OF SENSATION. 245
The croup is an inflammation of the upper part
and the peripneumony of the lower part of the same
organ, viz. the trachea or wind-pipe. See Class I.
1. 3. 4. But as the inflammation is seldom I suppose
confined to the upper part of the trachea only, but
exists at the same time in other parts of the lungs,
and as no inflammation of the tonsils is generally per-
ceptible, the uncouth name of cynanche trachealis
should be changed for peripneumonia trachealis. The
method of cure consists in immediate and repeated
bleeding. A vomit. A grain of calomel or other
mild cathartic. Bathing in subtepid water, and in
breathing over the steam of warm water, with or with-
out a little vinegar in it. And lastly, by keeping the
child raised high in bed.
Inflammation of the lungs is also liable to occur in
the measles, and must be attacked by venesection at
any time of the disease; otherwise either a present
death, or an incurable consumption, is the conse-
quence.
The peripneumony is frequently combined with in-
flammation of the pleura, and sometimes with that of
the diaphragm; either of these may generally be dis-
tinguished, not only by the pain which attends inflam-
mation of these membranes, but by inspecting the
naked chest, and observing whether the patient
breathes more by elevating the ribs, or by depressing
the diaphragm.
A crisis happens in children about the sixth day
with much pale urine, which must be waited for after
R3 evacuations

246 DISEASES [CLASS II. 1. 2.
evacuations have been used, as far as can be done
with safety; in this situation the warm bath twice a
day, and small blisters repeatedly in succession, are of
peculiar service.
After the termination of peripneumony a collection
of coagulable lymph is frequently left in the cavity of
the chest unabsorbed; or a common anasarca of the
lungs occurs from the present inaction of the absorb-
ent vessels, which had previously been excited too
violently. This difficulty of breathing is cured or
relieved by the exhibition of digitalis. See Art. IV.
2. 8.
M. M. The lancet is the anchor of hope in this
disease; which must be repeated four or five times,
or as often as the fever and difficulty of breathing in-
crease, which is generally in the evening; antimonials,
diluents, repeated small blisters about the chest, muci-
lage, pediluvium, warm bath. Is a decoction of seneka-
root of use? Do not neutral salts increase the ten-
dency to cough by their stimulus, as they increase the
heat of urine in gonorrhœa? Children in every kind
of difficult breathing, from whatever cause, should be
kept as upright in bed as may be, and continually
watched; since, if they slip down, they are liable to
be immediately suffocated. After the patient is greatly
debilitated, so that no further evacuation can be ad-
mitted, and the difficult breathing and cough continue,
I have given four or five drops of tincture of opium,
that is, about a quarter of a grain of solid opium,
with great advantage, send I believe in several cases I
have

CLASS II. 1. 2.] OF SENSATION. 247
have saved the patient. A greater quantity of opium
in this state of debility cannot be used without hazard-
ing the life of the person. This small quantity of an
opiate should be given about six in the evening, or
before the access of the evening paroxysm, and re-
peated three or four nights, or longer.
There is a peripneumony with weak pulse, which
may be termed peripneumonia inirritata, as described
in Sect. XXVII. 2. which belongs to this place. See
also Superficial Peripneumony, Class II. 1. 3. 7.
5. Pleuritis. Pleurisy. Inflammation of the pleura,
with hard pulse, pain chiefly of the side, pungent,
particularly increased during inspiration; lying on ei-
ther side uneasy, the cough very painful, dry at the
beginning, afterwards moist, often bloody.
One cause of pleurisy is probably a previous ad-
hesion of the lungs to a part of the pleura, which
envelopes them. This in many cases has been pro-
duced in infancy, by suffering children to lie too long
on one side. Or by placing them uniformly on one
side of a fire, or window, to which they will be
liable always to bend themselves.
When matter is produced during peripneumony or
pleurisy in one side of the chest, so long as it is a
concealed vomica, the fever continues, if the disease
be great, for many weeks, and even months; and
requires occasional venesection, till the patient sinks
under the inflammatory or sensitive irritated fever.
But if air be admitted, by a part of the abscess open-
R4 ing

248 DISEASES [CLASS II. 1. 2.
ing itself a way into the air-vessels of the lungs, a
hectic fever, with colliquative sweats or diarrhœa, su-
pervenes, and frequently destroys the patient; or the
abscess heals, the lungs adhering to the pleura.
M. M. The lancet must be used copiously, and re-
peated as often as the pain and difficult respiration
increase. A blister on the pained part. Antimonial
preparations. Diluents. Cool air. Do neutral salts
increase the tendency to cough- Pediluvium or semi-
cupium frequently repeated.
6. Diaphragmitis. Inflammation of the diaphragm.
Pain round the lower ribs as if girt with a cord. Dif-
ficult respiration performed only by elevating the ribs
and in an erect posture. The corners of the mouth
frequently retracted into a disagreeable smile, called
risus Sardonicus.
Those animals, which are furnished with clavicles,
or collar-bones, not only use their foremost feet as
bands, as men, monkies, cats, mice, squirrels, &c.
but elevate their ribs in respiration as well as depress
the diaphragm for the purpose of enlarging the cavity
of the chest. Hence an inflammation of the diaphragm
is sudden death to those animals, as horses and dogs,
which can only breathe by depressing the diaphragm;
and is I suppose the cause of the sudden death of
horses that are overworked; whereas, in the human
animal, when the diaphragm is inflamed, so as to ren-
der its motions impossible from the pain they occasion,
respiration can be carried on, though in a less perfect
manner,

CLASS II. 1. 2.] OF SENSATION. 249
manner, by the intercostal muscles in the elevation of
the ribs. In pleurisy the ribs are kept motionless,
and the respiration is performed by the diaphragm, as
may be readily seen on inspecting the naked chest, and
which is generally a bad symptom; in the diaphrag-
mitis the ribs are alternately elevated, and depressed,
but the lower part of the belly is not seen to move.
M. M. As in pleurisy and peripneumony. When
the patient becomes delirious, and smiles disagreeably
by intervals, and is become so weak, that evacuations
by the lancet could be used no further, and I have
almost despaired of my patient, I have found in two
or three instances, that about five or six drops of
tinct. thebaic. given an hour before the evening exa-
cerbation, has had the happiest effect, and cured the
patient in this case, as well as in common peripneu-
mony; it must be repeated two or three evenings, see
Class II. 1. 2. 4. as the exacerbation of the fever and
difficult respiration and delirium generally increase to-
wards night.
The stimulus of this small quantity of opium on a
patient previously so much debilitated, acts by in-
creasing the exertion of the absorbent vessels, in the
same manner as a solution of opium, or any other
stimulant, put on an inflamed eye after the vessels are
previously emptied by evacuations, stimulates the ab-
sorbent system, so as to cause the remaining new ves-
sels to be immediately reabsorbed. Which same sti-
mulants would have increased the inflammation, if
they had been applied before the evacuations. See
Class

250 DISEASES [CLASS II. 1. 2.
Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the
sanguiferous system is full of blood, the absorbents
cannot act so powerfully, as the progress of their con-
tents are opposed by the previous fulness of the blood-
vessels; whence stimulants in that case increase the
action of the secerning system more than of the ab-
sorbent one; but after copious evacuation this resist-
ance to the progress of the absorbed fluids is removed;
and when stimulants are then applied, they increase
the action of the absorbent system more than that of
the secerning one. Hence opium given in the com-
mencement of inflammatory diseases destroys the pa-
tient; and cures them, if given in very small doses at
the end of inflammatory diseases.
7. Carditis. Inflammation of the heart is attended
with unequal intermitting pulse, palpitation, pain in
the middle of the sternum, and constant vomiting. It
cannot certainly be distinguished from peripneumony,
and is perhaps always combined with it.
8. Peritonitis. Inflammation of the peritoneum is
known by pain all over the abdomen, which is in-
creased on erecting the body. It has probably most
frequently a rheumatic origin. See Class II. 1. 2. 17.
9. Mesenteritis. Inflammation of the mesentery is
attended with pains like colic, and with curdled or
chyle-like stools. It is a very frequent and dangerous
disease, as the production of matter more readily takes
place

CLASS II. 1. 2.] OF SENSATION. 251
place in it than in any other viscus. The consequence
of which, after a hard labour, is probably the puer-
peral fever, and in scrophulous habits a fatal purulent
fever, or hopeless consumption.
M. M. Venesection. Warm bath. Emollient clysters.
10. Gastritis. In inflammation of the stomach the
pulse is generally soft, probably occasioned by the
sickness which attends it. The pain and heat of the
stomach is increased by whatever is swallowed, with
immediate rejection of it. Hiccough.
This disease may be occasioned by acrid or indigesti-
ble matters taken into the stomach, which may che-
mically or mechanically injure its interior coat. There
is however a slighter species of inflammation of this
viscus, and perhaps of all others, which is unattended
by much fever; and which is sometimes induced by
drinking cold water, or eating cold insipid food, as
raw turnips, when the person has been much heated
and fatigued by exercise. For when the sensorial
power has been diminished by great exertion, and the
stomach has become less irritable by having been pre-
viously stimulated by much heat, it sooner becomes
quiescent by the application of cold. In consequence
of this slight inflammation of the stomach an eruption
of the face frequently ensues by the sensitive associa-
tion of this viscus with the skin, which is called a sur-
feit. See Class IV. 1. 2. 13. and II. 1. 4. 6. and II.
1. 3. 19.
M. M. Vene- 

252 DISEASES [CLASS II. 1. 2.
M. M. Venesection. Warm bath. Blister. Ano-
dyne clysters. Almond soap. See Class II. 1. 3. 17.
11. Enteritis. Inflammation of the bowels is often
attended with soft pulse, probably owing to the con-
comitant sickness; which prevents sometimes the early
use of the lancet, to the destruction of the patient.
At other times it is attended with strong and full
pulse like other inflammations of internal membranes.
Can the seat of the disease being higher or lower in
the intestinal canal, that is, above or below the valve
of the colon, produce this difference of pulse by the
greater sympathy of one part of the bowels with the
stomach than another- In enteritis with strong pulse
the pain is great about the navel, with vomiting, and
the greatest difficulty in procuring a stool. In the
other, the pain and fever are less, without vomiting,
and with diarrhœa. Whence it appears, that the en-
teritis with hard quick pulse differs from Ileus, de-
scribed in Class I. 3. 1. 6. only in the existence of
fever in the former and not the latter, the other symp-
toms generally corresponding; and, secondly, that the
enteritis with softer quick pulse, differs from the cho-
lera described in Class I. 3. 1. 5. only in the existence
of fever in the former, and not the latter, the other
symptoms being in general similar. See Class II.
1. 3. 20.
Inflammation of the bowels sometimes is owing to
extraneous indigestible substances, as plum-stones,
especially of the damasin, which has sharp ends. Some-
times

CLASS II. 1. 2.] OF SENSATION. 253
times to an introsusception of one part of the in-
testine into another, and very frequently to a stran-
gulated hernia or rupture. In respect to the first, I
knew an instance where a damasin stone, after a long
period of time, found its way out of the body near
the groin. I knew another child, who vomited some
damasin stones, which had lain for near twenty hours,
and given great pain about the navel, by the exhibi-
tion of an emetic given in repeated doses for about
an hour. The swallowing of plum-stones in large
quantities, and even of cherry-stones, is annually fa-
tal to many children. In respect to the introsuscep-
tion and hernia, see Ileus, Class I. 3. 1. 6.
M. M. Repeated venesection. Calomel from ten to
twenty grains given in small pills as in Ileus; these
means used early in the disease generally succeed.
After these evacuations a blister contributes to stop
the vomiting. Warm bath. Crude mercury. Aloes
one grain-pill every hour will frequently stay in the
stomach. Glauber's salt dissolved in pepper-mint wa-
ter given by repeated spoonfuls.
When the patient is much reduced, opium in very
small doses may be given, as a quarter of a grain, as
recommended in pleurisy. If the pain suddenly ceases,
and the patient continues to vomit up whatever is
given him, it is generally fatal; as it indicates, that
a mortification of the bowel is already formed. Some
authors have advised to join cathartic medicines with
an opiate in inflammation of the bowels, as recom-
mended in colica saturnina. This may succeed in
slighter

254 DISEASES [CLASS II. 1. 2.
slighter cases, but is a dangerous practice in general;
since, if the obstruction be not removed by the eva-
cuation, the stimulus of the opium is liable to increase
the action of the vessels, and produce mortification
of the bowel, as I think I have seen more than once.
12. Hepatitis. Inflammation of the liver is attend-
ed with strong quick pulse; tension and pain of the
right side; often pungent as in pleurisy; oftener dull.
A pain is said to affect the clavicle, and top of the
right shoulder; with difficulty in lying on the left side;
difficult respiration; dry cough; vomiting; hiccough.
There is another hepatitis mentioned by authors,
in which the fever, and other symptoms, are wanting,
or are less violent; as described in Class II. 1. 4. 11.
and which is probably sometimes relieved by erup-
tions of the face; as in those who are habituated to
the intemperate use of fermented liquors.
M. M. Hepatic inflammation is very liable to ter-
minate in suppuration, and the patient is destroyed
by the continuance of a fever with sizy blood, but
without night-sweats, or diarrhœa, as in other un-
opened abscesses. Whence copious and repeated ve-
nesection is required early in the disease, with repeat-
ed, doses of calomel, and cathartics. Warm bath.
Towards the end of the disease small doses of opium
before the evening paroxysms, and lastly the Peruvian
bark, and chalybeate wine, at first in small doses, as
20 drops twice a day, and afterwards, if necessary, in
larger. See Art. IV. 2. 6.
Mrs.

CLASS II. 1. 2.] OF SENSATION. 255
Mrs. C. a lady in the last month of her pregnancy,
was seized with violent hepatitis, with symptoms both
of peripneumony and of pleurisy, for it seldom hap-
pens in violent inflammations, that one viscus alone is
affected; she wanted then about a fortnight of her
delivery, and after frequent venesection, with gentle
cathartics, with fomentation or warm bath, she reco-
vered and was safely delivered, and both herself and
child did well. Rheumatic and eruptive fevers are
more liable to induce abortion.
13. Splenitis. Inflammation of the spleen commences
with tension, heat, and tumour of the left side, and
with pain, which is increased by pressure. A case
is described in Class I. 2. 3. 18. where a tumid spleen,
attended with fever, terminated in schirrus of that
viscus.
14. Nephritis. Inflammation of the kidney seems
to be of two kinds; each of them attended with dif-
ferent symptoms, and different modes of termination.
One of them I suppose to be an inflammation of the
external membrane of the kidney, arising from gene-
ral causes of inflammation, and accompanied with pain
in the loins without vomiting; and the other to consist
in an inflammation of the interior parts of the kidney,
occasioned by the stimulus of gravel in the pelvis of
it, which is attended with perpetual vomiting, with
pain along the course of the ureter, and retraction of
the testis on that side, or numbness of the thigh.
The

256 DISEASES [CLASS II. 1. 2.
The former of these kinds of nephritis is distin-
guished from lumbago by its situation being more ex-
actly on the region of the kidney, and by its not be-
ing extended beyond that part; after three or four
days I believe this inflammation is liable to change
place; and that a herpes or erysipelas, called zona,
or shingles, breaks out about the loins in its stead;
at other times it is cured by a cathartic with calo-
mel, with or without previous venesection.
The other kind of nephritis, or inflammation of
the interior part of the kidney, generally arises from
the pain occasioned by the stimulus of a stone enter-
ing the ureter from the pelvis of the kidney; and
which ceases when the stone is protruded forwards
into the bladder; or when it is returned into the
pelvis of the kidney by the retrograde action of the
ureter. The kidney is nevertheless inflamed more fre-
quently, though in a less degree, from other causes;
especially from the intemperate ingurgitation of ale,
or other fermented or spirituous liquors. This less
degree of inflammation is the cause of gravel, as that
before mentioned is the effect of it. The mucus se-
creted to lubricate the internal surface of the urinife-
rous tubes of the kidney become secreted in greater
quantity, when these vessels are inflamed; and, as
the correspondent absorbent vessels act more energe-
tically at the same time, the absorption of its more
fluid parts are more powerfully affected; on both these
accounts the mucus becomes both changed in qua-
lity and more indurated. And in this manner stones
1 are

CLASS II. 1. 2.] OF SENSATION. 257
are produced on almost every mucous membrane of
the body; as in the lungs, bowels, and even in the
pericardium, as some writers have affirmed. See
Class I. 1. 3. 9.
M. M. Venesection. Ten grains of calomel given
in small pills. Then infusion of senna with oil. Warm
bath. Then opium a grain and half. See Class
I. 1. 3. 9. for a further account of the method of
cure.
15. Cystitis. Inflammation of the bladder is at-
tended with tumor and pain of the lower part of the
belly; with difficult and painful micturition; and te-
nesmus. It generally is produced by the existence of
a large stone in the bladder, when in a great degree;
or is produced by common causes, when in a slighter
degree.
The stone in the bladder is generally formed in the
kidney, and passing down the ureter into the bladder
becomes there gradually increased in size; and this
most frequently by the apposition of concentric spheres,
as may be seen by sawing some of the harder calculi
through the middle, and polishing one surface. These
new concretions superinduced on the nucleus, which
descended from the kidney, as described in Class I. 1.
3. 9. and in the preceding article of this genus, is
not owing to the microcosmic salt, which is often
seen to adhere to the sides of chamber-pots, as
this is soluble in warm water, but to the mucus of
the bladder, as it rolls along the internal surface of it.
S Now

258 DISEASES [CLASS II. 1. 2.
Now when the bladder is slightly inflamed, this mucus
of its internal surface is secreted in greater quantity,
and is more indurated by the absorption of its more
liquid part at the instant of secretion, as explained in
Class I. 1. 3. 9. and II. 1. 2. 14. and thus the sti-
mulus and pain of a stone in the bladder contributes
to its enlargement by inflaming the interior coat of it.
M. M. Venesection. Warm bath. Diluents. Ano-
dyne clysters. See Class I. 1. 3. 9.
16. Hysteritis. Inflammation of the womb is ac-
companied with heat, tension, tumor, and pain of
the lower belly. The os uteri painful to the touch.
Vomiting. This disease is generally produced by im-
proper management in the delivery of pregnant wo-
men. I know an unfortunate case, where the pla-
centa was left till the next day; and then an unskilful
accoucheur introduced his hand, and forcibly tore it
away; the consequence was a most violent inflamma-
tory fever, with hard throbbing pulse, great pain,
very sizy blood, and the death of the patient. Some
accoucheurs have had a practice of introducing their
hand into the uterus immediately after the birth of
the child, to take away the placenta; which they
said was to save time. Many women I believe have
been victims to this unnatural practice.
Others have received injury, where inflammation
has been beginning, by the universal practice of giv-
ing a large dose of opium immediately on delivery,
without any indication of its propriety; which, though
a proper

CLASS II. 1. 2.] OF SENSATION. 259
a proper and useful medicine, where the patient is
too feeble, when given in a small dose, as 10 drops
of tincture of opium, or half a grain of solid opium,
must do a proportionate injury, when it is given im-
properly; and as delivery is a natural process, it is
certainly more wise to give no medicines, except there
be some morbid symptom, which requires it; and
which has only been introduced into custom by the
ill-employed activity of the Priests or Priestesses of
LUCINA; like the concomitant nonsense of cram-
ming rue or rhubarb into the mouth of the unfor-
tunate young stranger, who is thus soon made to ex-
perience the evils of life. See Class II. 1. 1. 12.
and I. 1. 2. 5. Just so some over-wise beldames force
young ducks and turkeys, as soon as they are hatched,
to swallow a pepper-corn.
M. M. Venesection repeatedly; diluents; fomen-
tation; the patient should be frequently raised up in
bed for a short time, to give opportunity of discharge
to the putrid lochia; mucilaginous clysters. See Fe-
bris Puerpera.
17. Lumbago sensitiva. Sensitive Lumbago. When
the extensive membranes, or ligaments, which cover
the muscles of the back are torpid, as in the cold
paroxysm of ague, they are attended with pain ill
consequence of the inaction of the vessels, which com-
pose them. When this inaction continues without a
consequent renewal or increase of activity, the disease
becomes chronical, and forms the lumbago frigida,
S2 or

260 DISEASES [CLASS II. 1. 2.
or irritativa, described in Class I. 2. 4. 16. But
when this cold fit or torpor of these membranes, or
ligaments or muscles of the back, is succeeded by a
hot fit, and consequent inflammation, a violent inflam-
matory fever, with great pain, occurs, preventing the
erect posture of the body; and the affected part is
liable to suppurate, in which case a very dangerous
ulcer is formed, and a part of one of the vertebræ
is generally found carious, and the patient sinks after
a long time under the hectic fever occasioned by the
aerated or oxygenated matter.
This disease bears no greater analogy to rheumatism
than the inflammation of the pleura, or any other
membranous inflammation; and has therefore un-
justly been arranged under that name. It is distin-
guished from nephritis, as it is seldom attended with
vomiting, I suppose never, except the ureter happens
to be inflamed at the same time.
The pain sometimes extends on the outside of the
thigh from the hip to the ankle, heel, or toes, and is
then called sciatica; and has been thought to consist
in an inflammation of the theca, or covering of the
sciatic nerve, as the pain sometimes so exactly attends
the principal branches of that nerve. See Class I. 2.
4. 15. 16.
M. M. Venesection repeatedly; calomel; gentle
cathartics; diluents; warm bath; poultice on the
back, consisting of camomile flowers, turpentine,
soap, and opium; a burgundy-pitch plaster. A de-
bility of the inferior limbs from the torpor of the
muscles,

CLASS II. 1. 2.] OF SENSATION. 261
muscles, which had previously been too much excited,
frequently occurs at the end of this disease; in this
case electricity, and issues on each side of the lumbar
vertebræ, are recommended. See Class I. 2. 4. 16.
18. Ischias. The Ischias consists of inflammatory
fever, with great pain about the pelvis, the os coc-
cigis, and the heads of the thigh bones, preventing
the patient from walking or standing erect, with in-
crease of pain on going to stool. This malady, as
well as the preceding, has been ascribed to rheuma-
tism; with which it seems to bear no greater analogy,
than the inflammations of any other membranes.
The patients are left feeble, and sometimes lame
after this disease; which is also sometimes accompanied
with great flow of urine, owing to the defective ab-
sorption of its aqueous parts; and with consequent
thirst occasioned by the want of so much fluid being
returned into the circulation; a lodgment of feces in
the rectum sometimes occurs after this complaint from
the lessened sensibility of it. See Class I. 2. 4. 15.
M. M. Venesection; gentle cathartics; diluents;
fomentation; poultice with camomile flowers, turpen-
tine, soap, and opium; afterwards the bark. See
Class I. 1. 3. 5.
When this inflammation terminates in suppuration
the matter generally can be felt to fluctuate in the
groin, or near the top of the thigh. In this circum-
stance, my friend Mr. Bent, Surgeon near Newcastle
in Staffordshire, proposes to tap the abscess by means of
S3 a trocar,

262 DISEASES [CLASS II. 1. 2.
a trocar, and thus as often as necessary to discharge
the matter without admitting the air. Might a weak
injection of wine and water, as in the hydrocele, be
used with great caution to inflame the walls of the
abscess, and cause them to unite? See Class II.
1. 6. 9.
19. Paronychia interna. Inflammation beneath the
finger-nail. The pain occasioned by the inflammatory
action and tumor of parts bound down between the
nail on one side and the bone on the other, neither of
which will yield, is said to occasion so much pain as
to produce immediate delirium, and even death, ex-
cept the parts are divided by a deep incision; which
must pass quite through the periosteum, as the inflam-
mation is said generally to exist beneath it. This dis-
ease is thus resembled by the process of toothing in
young children; where an extraneous body lodged
beneath the periosteum induces pain and fever, and
sometimes delirium, and requires to be set at liberty
by the lancet.
ORDO 

CLASS II. 1. 3.] OF SENSATION. 263
ORDO I.
Increased Sensation.
GENUS III.
With the Production of new Vessels by external Mem-
branes or Glands, with Fever.
The diseases of this genus are perhaps all produc-
tive of contagious matter; or which becomes so by
its exposure to the air, either through the cuticle, or
by immediate contact with it; such are the matters of
the small-pox and measles. The purulent matter,
formed on parts covered from the air by thicker mem-
branes or muscles, as in the preceding genus, does
not induce fever, and cannot therefore be called con-
tagious; but it acquires this property of producing
fever in a few hours, after the abscess has been open-
ed, so as to admit the air to its surface, and may then
be said to consist of contagious miasmata. This kind
of contagious matter only induces fever, but does not
produce other matter with properties similar to its
own; and in this respect it differs from the conta-
gious miasmata of small-pox or measles, but resembles
those which have their origin in crowded jails; for
these produce fever only, which frequently destroys
the patient; but do not produce other matters similar
to themselves; as appears from none of those, who
died of the jail-fever, caught at the famous black as-
sizes at Oxford, at the beginning of this century,
having infected their physicians or attendants.
S4 If

264 DISEASES [CLASS II. 1. 3.
If indeed the matter has continued so long as to
become putrid, and thus to have given out air from
a part of it, it acquires the power of producing fever;
in the same manner as if the ulcer had been opened,
and exposed to the common air; instances of which
are not unfrequent. And from these circumstances
it seems probable, that the matters secreted by the
new vessels formed in all kinds of phlegmons, or pus-
tules, are not contagious, till they have acquired some-
thing from the atmosphere, or from the gas produced
by putrefaction; which will account for some pheno-
mena in the lues venerea, cancer, and of other con-
tagious secretions on the skin without fever, to be
mentioned hereafter. See Class II. 1. 4. 14.
The theory of contagion has been perplexed by
comparing it with fermenting liquors; but the con-
tagious material is shewn in Section XXXIII. to be
produced like other secreted matters by certain ani-
mal motions of the terminations of the vessels. Hence
a new kind of gland is formed at the terminations of
the vessels in the eruptions of the small-pox; the ani-
mal motions of which produce from the blood vario-
lous matter; as other glands produce bile or saliva.
Now if some of this matter is introduced beneath the
cuticle of a healthy person, or enters the circulation,
and excites the extremities of the blood-vessels into
those kinds of diseased motions, by which it was itself
produced, either by irritation or association, these dis-
eased motions of the extremities of the vessels will pro-
duce other similar contagious matter. See Sect.
XXXIII.

CLASS II. 1. 3.] OF SENSATION. 265
XXXIII. 2. 5. and 9. Hence contagion seems to be
propagated two ways; one, by the stimulus of con-
tagious matter applied to the part, which by an un-
known law of nature excites the stimulated vessels to
produce a similar matter; as in venereal ulcers, which
thus continue to spread; or as when variolous mat-
ter is inserted beneath the cuticle; or when it is sup-
posed to be absorbed, and diffused over the body
mixed with the blood, and applied in that manner to
the cutaneous glands. The other way, by which con-
tagion seems to be diffused, is by some distant parts
sympathizing or imitating the motions of the part first
affected; as the stomach and skin in the eruptions of
the inoculated small-pox, or in the bite of a mad dog;
as treated of in Sect. XXII. 3. 3.
In some of the diseases of this genus the pulse is
strong, full, and hard, constituting the sensitive irri-
tated fever, as described in the preceding genus; as
in one kind of erysipelas, which requires repeated
venesection. In others the arterial action is sometimes
moderate, so as to constitute the sensitive fever, as
in the inoculated small-pox; where the action of the
arteries are neither increased by the sensorial power of
irritation, as in the sensitive irritated fever; nor de-
creased by the defect of that power, as in the sensitive
inirritated fever. But in the greatest number of the
diseases of this genus the arterial action is greatly
diminished in respect to strength, and consequently
the frequency of pulsation is proportionally increased,
as explained in Sect. XXXII. 2. 1. Which is owing
to the deficiency of the sensorial power of irritation
joined

266 DISEASES [CLASS II. 1. 3.
joined with the increase of that of sensation, and thus
constitutes the sensitive inirritated fever; as in Scarla-
tina with gangrenous tonsils.
From this great debility of the action of the arte-
ries, there appears to be less of the coagulable lymph
or mucus secreted on their internal surfaces; whence
there is not only a defect of that buff or size upon
the blood, which is seen on the surface of that, which
is drawn in the sensitive irritated fever; but the blood,
as it cools, when it has been drawn into a bason,
scarcely coagulates; and is said to be dissolved, and
is by some supposed to be in a state of actual putre-
faction. See Sect. XXXIII. 1. 3. where the truth
of this idea is controverted. But in the fevers of both
this genus and the preceding one great heat are pro-
duced from the chemical combinations in the secre-
tions of new vessels and fluids, and pain or uneasiness
from the distention of the old ones; till towards the
termination of the disease sensation ceases, as well as
irritation, with the mortification of the affected parts,
and the death of the patient.
Dysenteria, as well as tonsillitis and aphtha, are
enumerated amongst the diseases of external mem-
branes, because they are exposed either to the at-
mospheric air, which is breathed, and swallowed with
our food and saliva; or they are exposed to the in-
flammable air, or hydrogen, which is generated in the
intestines; both which contribute to produce or pro-
mote the contagious quality of these fluids; as men-
tioned in Class II. 1. 5.
It 

CLASS II. 1. 3.] OF SENSATION. 267
It is not speaking accurate language, if we say, that
in the diseases of this genus the fever is contagious;
since it is the material produced by the external mem-
branes, which is contagious, after it has been ex-
posed to air; while the fever is the consequence of
this contagious matter, and not the cause of it. As
appears from the inoculated small-pox, in which the
fever does not commence, till after suppuration has
taken place in the inoculated arm, and from the dis-
eases of the fifth genus of this order, where con-
tagion exists without fever. See Class II. 1. 5. and
II. 1. 3. 18.
SPECIES.
1. Febris sensitiva inirritata. Sensitive inirritated
fever. Typhus gravior. Putrid malignant fever.
Jail fever. The immediate cause of this disease is the
increase of the sensorial power of sensation, joined with
the decrease of the sensorial power of irritation; that
is, it consists in the febris sensitiva joined with the
febris inirritativa of Class I. 2. 1. 1. as the febris sen-
sitiva irritata of the preceding genus consists of the
febris sensitiva joined with the febris irritativa of Class
I. 1. 1. 1. In both which the word irritata, and in-
irritata, are designed to express more or less irritation
than the natural quantity; and the same when applied
to some of the diseases of this genus.
This fever is frequently accompanied with topical
inflammation, which is liable, if the arterial strength
is not supported, to end in sphacelus; and as morti-
fied

268 DISEASES [CLASS II. 1. 3.
fied parts, such as sloughs of the throat, if they ad-
here to living parts, soon become putrid from the
warmth and moisture of their situation; these fevers
have been termed putrid, and have been thought to
owe their cause to what is only their consequence.
In hot climates this fever is frequently induced by the
exhalations of stagnating lakes or marshes, which
abound with animal substances; but which in colder
countries produce fevers with debility only, as the
quartan ague, without inflammation.
The sensitive inirritated, or malignant fever, is also
frequently produced by the putrid exhalations and
stagnant air in prisons; but perhaps most frequently
by contact or near approach of the persons, who have
resided in them. These causes of malignant fevers
contributed to produce, and to support for a while,
the septic and antiseptic theory of them; see Sect.
XXXIII. 1. 3. The vibices or bruises, and petechiæ
or purples, were believed to be owing to the dissolved
state of the blood by its incipient putrefaction; but
hydrostatical experiments have been made, which shew
the sizy blood of the patient in sensitive irritated or
inflammatory fever, with strong pulse, is more fluid,
while it is warm, than this uncoagulable blood taken
in this sensitive inirritated, or malignant fever; from
whence it is inferred, that these petechiæ, and vibices,
are owing to the deficient power of absorption in the
terminations of the veins. See Class I. 2. 1. 5.
This sensitive inirritated fever, or typhus gravior,
is distinguished from the inirritative fever, or typhus
mitior,

CLASS II. 1. 3.] OF SENSATION. 269
mitior, in the early stages of it, by the colour of the
skin; which in the latter is paler, with less heat,
owing to the less violent action of the capillaries; in
this it is higher coloured, and hotter, from the greater
energy of the capillary action in the production of
new vessels. In the more advanced state petechiæ,
and the production of contagious matter from inflamed
membranes, as the aphthæ of the mouth, or ulcers of
the throat, distinguishes this fever from the former.
Delirium, and dilated pupils of the eyes, are more
frequent in nervous fevers; and stupor with deafness
more frequent attendants on malignant fevers. See
Class I. 2. 5. 6.
There is another criterion discernible by the touch
of an experienced finger; and that is, the coat of the
artery in inflammatory fevers, both these attended
with strength of pulsation, and those with weak pulsa-
tion, feels harder, or more like a cord; for the coats
of the arteries in these fevers are themselves inflamed,
and are consequently turgid with blood, and thence
are less easily compressed, though their pulsations are
nevertheless weak: when the artery is large or full
with an inflamed coat, it is called hard; and when
small or empty with an inflamed coat, it is called sharp,
by many writers.
M. M. The indications of cure consist, 1. In pro-
curing a regurgitation of any offensive material, which
may be lodged in the long mouths of the lacteals or
lymphatics, or in their tumid glands. 2. To excite
the system into necessary action by the repeated exhi-
bition

270 DISEASES [CLASS II. 1. 3.
bition of nutrientia, sorbentia, and incitantia; and to
preserve the due evacuation of the bowels. 3. To
prevent any unnecessary expenditure of sensorial power.
4. To prevent the formation of ulcers, or to promote
the absorption in them, for the purpose of healing
them.
1. One ounce of wine of ipecacuanha, or about ten
grains of the powder, should be given as an emetic.
After a few hours three or four grains of calomel
should be given in a little mucilage, or conserve.
Where something swallowed into the stomach is the
cause of the fever, it is liable to be arrested by the lym-
phatic glands, as the matter of the small-pox inoculated
in the arm is liable to be stopped by the axillary lym-
phatic gland; in this situation it may continue a day
or two, or longer, and may be regurgitated during
the operation of an emetic or cathartic into the sto-
mach or bowel, as evidently happens on the exhibi-
tion of calomel, as explained in Sect. XXIX. 7. 2.
For this reason an emetic and cathartic, with venesec-
tion, if indicated by the hardness and fulness of the
pulse, will very frequently remove fevers, if exhibited
on the first, second, or even third day.
2. Wine and opium, in small doses repeated fre-
quently, but so that not the least degree of intoxica-
tion follows, for in that case a greater degree of de-
bility is produced from the expenditure of sensorial
power in unnecessary motions. Many weak patients
have been thus stimulated to death. See Sect. XII.
7. 8. The Peruvian bark should be given also in re-
peated

CLASS II. 1. 3.] OF SENSATION 271
peated doses in such quantity only as may strengthen
digestion, not impede it. For these purposes two
ounces of wine, or of ale, or cyder, should be given
every six hours; and two ounces of decoction of bark,
with two drachms of the tincture of bark, and six
drops of tincture of opium, should be given also every
six hours alternately; that is, each of them four times
in twenty-four hours. As much rhubarb as may in-
duce a daily evacuation, should be given to remove
the colluvies of indigested materials from the bowels;
which might otherwise increase the distress of the pa-
tient by the air it gives out in putrefaction, or by pro-
ducing a diarrhœa by its acrimony; the putridity of
the evacuations are in consequence of the total inability
of the digestive powers; and their delay in the intes-
tines, to the inactivity of that canal in respect to its
peristaltic motions.
The quantities of wine or beer and opium, and
bark, above mentioned, may be increased by degrees,
if the patient seems refreshed by them; and if the
pulse becomes slower on their exhibition; but this
with caution, as I have seen irrecoverable mischief
done by greater quantities both of opium, wine, and
bark, in this kind of fever; in which their use is to
strengthen the digestion of the weak patient, rather
than to stop the paroxysms of fever; but when they
are administered in intermittents, much larger quan-
tities are necessary.
The stimulus of small blisters applied in succession,
one every three or four days, when the patient be-
comes

272 DISEASES [CLASS II. 1. 3.
comes weak, is of great service by strengthening
digestion, and by preventing the coldness of the ex-
tremities, owing to the sympathy of the skin with
the stomach, and of one part of the skin with ano-
ther.
In respect to nutriment, the patient should be sup-
plied with wine and water, with toasted bread, and
sugar or spice in it; or with sago with wine; fresh
broth with turnips, celery, parsley; fruit; new milk.
Tea with cream and sugar; bread pudding, with le-
mon juice and sugar; chicken, fish, or whatever is
grateful to the palate of the sick person, in small
quantity repeated frequently; with small beer, cyder
and water, or wine and water, for drink, which may
be acidulated with acid of vitriol in small quantities.
3. All unnecessary motions are to be checked, or
prevented. Hence horizontal posture, obscure room,
silence, cool air. All the parts of the skin, which
feel too hot to the hand, should be exposed to a
current of cool air, or bathed with cold water, whe-
ther there are eruptions on it or not. Wash the
patient twice a day with cold vinegar and water, or
cold salt and water, or cold water alone, by means
of a sponge. If some parts are too cold, as the ex-
tremities, while other parts are too hot, as the face
or breast, cover the cold parts with flannel, and cool
the hot parts by a current of cool air, or bathing
them as above.
4. For the healing of ulcers, if in the mouth, so-
lution of alum in water about 40 grains to an ounce,
4 or

CLASS II. 1. 3.] OF SENSATION. 273
or of blue vitriol in water, one grain or two to an
ounce may be used to touch them with three or four
times a day. Of these perhaps a solution of alum
is to be preferred, as it instantly takes away the
stench from ulcers I suppose by combining with the
volatile alkali which attends it. For this purpose a
solution of alum of an ounce to a pint of water should
be frequently injected by means of a syringe into the
mouth. If there are ulcers on the external skin, fine
powder of bark seven parts, and cerussa in fine pow-
der one part, should be mixed, and applied dry on
the sore, and kept on by lint, and a bandage.
As sloughs in the mouth are frequently produced
by the previous dryness of the membranes, which
line it, this dryness should be prevented by frequently
moistening them, which may be effected by injection
with a syringe, or by a moist sponge, or lastly in the
following manner. Place a glass of wine and water,
or of milk and sugar, on a table by the bed-side, a
little above the level of the mouth of the patient;
then, having previously moistened a long piece of nar-
row listing, or cloth, or flannel, with the same liquor,
leave one end of it in the glass, and introduce the
other into the mouth of the patient; which will thus
be supplied with a constant oozing of the fluid through
the cloth, which acts as a capillary syphon.
The viscid phlegm, which adheres to the tongue,
should be coagulated by some austere acid, as by le-
mon juice evaporated to half its quantity, or by crab
juice; and then it may be scraped off by a knife,
T or

274 DISEASES [CLASS II. 1. 3.
or rubbed off by flannel, or a sage leaf dipped in vi-
negar, or in salt and water.
2. Erysipelas, St. Anthony's fire, may be divided
into three kinds, which differ in their method of cure,
the irritated, the inirritated, and the sensitive erysipelas.
Erysipelas irritatum is attended with increase of ir-
ritation besides increase of sensation; that is, with
strong, hard, and full pulse, which requires frequent
venesection, like other inflammations with arterial
strength. It is distinguished from the phlegmonic in-
flammations of the last genus by its situation on the
external habit, and by the redness, heat, and tumour
not being distinctly circumscribed; so that the eye or
finger cannot exactly trace the extent of them.
When the external skin is the seat of inflammation,
and produces sensitive irritated fever, no collection of
matter is formed, as when a phlegmon is situated in
the cellular membrane beneath the skin; but the cu-
ticle rises as beneath a blister-plaster, and becomes
ruptured; and a yellow material oozes out, and be-
comes inspissated, and lies upon its surface; as is seen
in this kind of erysipelas, and in the confluent small-
pox; or if the new vessels are reabsorbed the cuticle
peels off in scales. This difference of the termination
of erysipelatous and phlegmonic inflammation seems to
be owing in part to the less distensibility of the cuticle
than of the cellular membrane, and in part to the
ready exhalation of the thinner parts of the secreted
fluids through its pores.
This

CLASS II. 1. 3.] OF SENSATION. 275
This erysipelas is generally preceded by a fever for
two or three days before the eruption, which is liable
to appear in some places, as it declines in others; and
seems frequently to arise from a previous scratch or
injury of the skin; and is attended sometimes with in-
flammation of the cellular membrane beneath the
skin; whence a real phlegmon and collection of mat-
ter becomes joined to the erysipelas, and either occa-
sions or increases the irritated fever, which attends it.
There is a greater sympathy between the external
skin and the meninges of the brain, than between the
cellular membrane and those meninges; whence ery-
sipelas is more liable to be preceded or attended, or
succeeded, by delirium than internal phlegmons. I
except the mumps, or parotitis, described below;
which is properly an external gland, as its excretory
duct opens into the air. When pain of the head or
delirium precedes the cutaneous eruption of the face,
there is some reason to believe, that the primary dis-
ease is a torpor of the meninges of the brain; and
that the succeeding violent action is transferred to the
skin of the face by sensitive association; and that a
similar sympathy occurs between some internal mem-
branes and the skin over them, when erysipelas ap-
pears on other parts of the body. If this circum-
stance should be supported by further evidence, this
disease should be removed into Class IV. along with
the rheumatism and gout. See Class IV. 1. 2. 17.
This supposed retropulsion of erysipelas on the brain
from the frequent appearance of delirium, has pre-
T2 vented

276 DISEASES [CLASS II. 1. 3.
vented the free use of the lancet early in this disease
to the destruction of many; as it has prevented the
subduing of the general inflammation, and thus has in
the end produced the particular one on the brain. Mr.
B-, a delicate gentleman about sixty, had an ery-
sipelas beginning near one ear, and extending by de-
grees over the whole head, with hard, full, and strong
pulse; blood was taken from him four or five times in
considerable quantity, with gentle cathartics, with ca-
lomel, diluents, and cool air, and he recovered with-
out any signs of delirium, or inflammation of the me-
ninges of the brain. Mr. W-, a strong corpulent
man of inferior life, had erysipelas over his whole
head, with strong hard pulse: he was not evacuated
early in the disease through the timidity of his apo-
thecary, and died delirious. Mrs. F-had erysi-
pelas on the face, without either strong or weak pulse;
that is, with sensitive fever alone, without superabun-
dance or deficiency of irritation; and recovered with-
out any but natural evacuations. From these three
cases of erysipelas on the head it appears, that the
evacuations by the lancet must be used with courage,
where the degree of inflammation requires it; but not
where this degree of inflammation is small, nor in the
erysipelas attended with inirritation, as described be-
low.
M. M. Venesection repeated according to the de-
gree of inflammation. An emetic. Calomel three
grains every other night. Cool air. Diluents, eme-
tic tartar in small doses, as a quarter of a grain
every

CLASS II. 1. 3.] OF SENSATION. 277
every six hours. Tea, weak broth, gruel, lemonade,
neutral salts. See Sect. XII. 6.
Such external applications as carry away the heat
of the skin may be of service, as cold water, cold
flour, snow, ether. Because these applications impede
the exertions of the secerning vessels, which are now
in too great action; but any applications of the stimu-
lant kind, as solutions of lead, iron, copper, or of
alum, used early in the disease, must be injurious; as
they stimulate the secerning vessels, as well as the ab-
sorbent vessels, into greater action; exactly as occurs
when stimulant eye-waters are used too soon in oph-
thalmy. See Class II. 1. 2. 2. But as the cuticle
peels off in this case after the inflammation ceases, it
differs from ophthalmy; and stimulant applications
are not indicated at all, except where symptoms of
gangrene appears. For as a new cuticle is formed
under the old one, as under a blister, the serous fluid
between them is a defence to the new cuticle, and
should dry into a scab by exhalation rather than be re-
absorbed. Hence we see how greasy or oily applica-
tions, and even how moist ones, are injurious in erysi-
pelas; because they prevent the exhalations of the
serous effusion between the old and new cuticle, and
thus retard the formation of the latter.
Erysipelas inirritatum differs from the former in its
being attended with weak pulse, and other symptoms
of sensitive inirritated fever. The feet and legs are
particularly liable to this erysipelas, which precedes or
attends the sphacelus or mortification of those parts.
T3 A great

278 DISEASES [CLASS II. 1. 3.
A great and long coldness first affects the limb, and
the erysipelas on the skin seems to occur in conse-
quence of the previous torpor of the interior mem-
branes. As this generally attends old age, it becomes
more dangerous in proportion to the age, and also to
the habitual intemperance of the patient in respect to
the use of fermented or spirituous liquor.
When the former kind, or irritated erysipelas, con-
tinues long, the patient becomes so weakened as to be
liable to all the symptoms of this inirritated erysipelas;
especially where the meninges of the brain are prima-
rily affected. As in that case, after two or three ef-
forts have been made to remove the returning periods
of torpor of the meninges to the external skin, those
meninges become inflamed themselves, and the patient
sinks under the disease; in a manner similar to that
in old gouty patients, where the torpor of the liver
or stomach is relieved by association of the inflamma-
tion of the membranes of the feet, and then of other
joints, and lastly the power of association ceasing to
act, but the excess of sensation continuing, the liver or
stomach remains torpid, or become themselves in-
flamed, and the patient is destroyed.
M. M. Where there exists a beginning gangrene
of the extremities, the Peruvian bark, and wine, and
opium, are to be given in large quantities; so as to
strengthen the patient, but not to intoxicate, or to
impede his digestion of aliment, as mentioned in the
first species of this genus. Class II. 1. 2. 1. But
where the brain is inflamed or oppressed, which is
known

CLASS II. 1. 3.] OF SENSATION. 279
known either by delirium, with quick pulse; or by
stupor, and slow respiration with slow pulse; other
means must be applied. Such as, first, a fomentation
on the head with warm water, with or without
aromatic herbs, or salt in it, should be continued for
an hour or two at a time, and frequently repeated.
A blister may also be applied on the head, and the
fomentation nevertheless occasionally repeated. Inter-
nally very gentle stimulants, as camphor one grain or
two in infusion of valerian. Wine and water or small
beer, weak broth. An enema. Six grains of rhubarb
and one of calomel. Afterwards five drops of tincture
of opium, which may be repeated every six hours,
if it seems of service. Might the head be bathed
for a minute with cold water? or with ether? or
vinegar?
Erysipelas sensitivum is a third species, differing only
in the kind of fever which attends it, which is simply
inflammatory, or sensitive, without either excess of
iritation, as in the first variety; or the defect of ir-
ritation, as in the second variety: all these kinds of
erysipelas are liable to return by periods in some peo-
ple, who have passed the middle of life, as at periods
of a lunation, or two lunations, or at the equinoxes.
When these periods of erysipelas happen to women,
they seem to supply the place of the receding cata-
menia; when to men, I have sometimes believed them
to be associated with a torpor of the liver; as they
generally occur in those who have drank vinous spirit
excessively, though not opprobriously; and that hence
T4 they

280 DISEASES [CLASS II. 1. 3.
they supply the place of periodical piles, or gout, or
gutta rosea.
M. M. As the fever requires no management, the
disease takes its progress safely, like a moderate pa-
roxysm of the gout; but in this case, as in some of
the former, the erysipelas does not appear to be a
primary disease, and should perhaps be removed to
the Class of Association.
3. Tonsillitis. Inflammation of the tonsils. The un-
couth term Cynanche has been used for diseases so
dissimilar, that I have divided them into Tonsillitis
and Parotitis; and hope to be excused for adding a
Greek termination to a Latin word, as one of those
languages may justly be considered as a dialect of the
other. By tonsillitis the inflammation of the tonsils
is principally to be understood; but as all inflamma-
tions generally spread further than the part first af-
fected; so, when the summit of the windpipe is also
much inflamed, it may be termed tonsillitis trachealis,
or croup. See Class I. 1. 3. 4. and II. 1. 2. 4.; and
when the summit of the gullet is much inflamed along
with the tonsil, it may be called tonsillitis pharyngea,
as described in Dr. Cullen's Nosologia, Genus X. p.
92. The inflammation of the tonsils may be divided
into three kinds, which require different methods of
cure.
Tonsillitis interna. Inflammation of the Internal
tonsil. When the swelling is so considerable as to
produce difficulty of breathing, the size of the tonsil
should be diminished by cutting it with a proper
lancet,

CLASS II. 1. 3.] OF SENSATION. 281
lancet, which may either give exit to the matter it
contains, or may make it less by discharging a part
of the blood. This kind of angina is frequently at-
tended with irritated fever besides the sensitive one,
which accompanies all inflammation, and sometimes
requires venesection. An emetic should be given
early in the disease, as by its inducing the retrograde
action of the vessels about the fauces during the nausea
it occasions, it may eliminate the very cause of the
inflammation; which may have been taken up by the
absorbents, and still continue in the mouths of the
lymphatics or their glands. The patient should then
be induced to swallow some aperient liquid, an infu-
sion of senna, so as to induce three or four evacua-
tions. Gargles of all kinds are rather hurtful, as
the action of using them is liable to give pain to the
inflamed parts; but the patients find great relief
from frequently holding warm water in their mouths,
and putting it out again, or by syringing warm water
into the mouth, as this acts like a warm bath or
fomentation to the inflamed part. Lastly, some mild
stimulant, as a weak solution of salt and water, or
of white vitriol and water, may be used to wash
the fauces with in the decline of the disease, to expe-
dite the absorption of the new vessels, if necessary,
as recommended in ophthalmy.
Tonsillitis superficialis. Inflammation of the surface
of the tonsils. As the tonsils and parts in their vici-
nity are covered with a membrane, which, though
exposed to currents of air, is nevertheless constantly
kept

282 DISEASES [CLASS II. 1. 3.
kept moist by mucus and saliva, and is liable to
diseases of its surface like other mucous membranes,
as well as to suppuration of the internal substance of
the gland; the inflammation of its surface is succeed-
ed by small elevated pustules with matter in them,
which soon disappears, and the parts either readily
heal, or ulcers covered with sloughs are left on the
surface.
This disease is generally attended with only sensi-
tive fever, and therefore is of no danger, and may
be distinguished with great certainty from the danger-
ous inflammation or gangrene of the tonsils at the
height of the small-pox, or scarlet fever, by its not
being attended with other symptoms of those diseases.
One emetic and a gentle cathartic is generally suffi-
cient; and the frequent swallowing of weak broth,
or gruel, both without salt in them, relieves the pa-
tient, and absolves the cure. When these tumours
of the tonsils frequently return I have sometimes sus-
pected them to originate from the absorption of putrid
matter from decaying teeth. See Class I. 2. 3. 21.
and II. 2. 2. 1.
Tonsillitis inirritata. Inflammation of the tonsils
with sensitive inirritated fever is a symptom only of con-
tagious fever, whether attended with scarlet eruption,
or with confluent small-pox, or otherwise. The matter
of contagion is generally diffused, not dissolved in the
air; and as this is breathed over the mucaginous
surface of the tonsils, the contagious atoms are liable
to be arrested by the tonsil; which therefore becomes
the

CLASS II. 1. 3.] OF SENSATION. 283
the nest of the future disease, like the inflamed circle
round the inoculated puncture of the arm in suppo-
sititious small-pox. This swelling is liable to suffocate
the patient in small-pox, and to become gangrenous
in scarlet fever, and some other contagious fevers,
which have been received in this manner. The ex-
istence of inflammation of the tonsil previous to the
scarlet eruption, as the arm inflames in the inoculated
small-pox, and suppurates before the variolous erup-
tion, should be a criterion of the scarlet fever being
taken in this manner.
M. M. All the means which strengthen the patient,
as in the sensitive inirritated fever, Class II. 1. 2. 1.
As it is liable to continue a whole lunation or more,
great attention should be used to nourish the patient
with acidulous and vinous panada, broth with vege-
tables boiled in it, sugar, cream, beer; all which
given frequently will contribute much to moisten,
clean, and heal the ulcuscles, or sloughs, of the throat;
warm water and wine, or acid of lemon, should be
frequently applied to the tonsils by means of a syringe,
or by means of a capillary syphon, as described in
Class II. 1. 2. 1. A slight solution of blue vitriol, as
two grains to an ounce, or a solution of sugar of lead
of about six grains to an ounce, may be of service;
especially the latter, applied to the edges of the sloughs,
drop by drop by means of a small glass tube, or small
crow-quill with the end cut off, or by a camel's-hair
pencil or sponge; to the end of either of which a
drop will conveniently hang by capillary attraction;
as

284 DISEASES [CLASS II. 1. 3.
as solutions of lead evidently impede the progress of
erysipelas on the exterior skin, when it is attended
with seeble pulse. Yet a solution of alum injected
frequently by a syringe is perhaps to be preferred, as
it immediately removes the fetor of the breath, which
must much injure the patient by its being perpetually
received into the lungs by respiration.
4. Parotitis. Mumps, or branks, is a contagious
inflammation of the parotis and maxillary glands, and
has generally been classed under the word Cynanche
or Angina, to which it bears no analogy. It divides
itself into two kinds, which differ in the degree of
fever which attends them, and in the method of cure.
Parotitis suppurans. The suppurating mumps is to
be distinguished by the acuteness of the pain, and the
sensitive, irritated, or inflammatory fever, which at-
tends it.
M. M. Venesection. Cathartic with calomel three
or four grains repeatedly. Cool air, diluents. This
antiphlogistic treatment is to be continued no longer
than is necessary to relieve the violence of the pain,
as the disease is attended with contagion, and must
run through a certain time, like other severs with
contagion.
Parotitis mutabilis. Mutable parotitis. A sensitive
fever only, or a sensitive irritated fever, generally
attends this kind. And when the tumor of the parotis
and maxillary glands subsides, a new swelling occurs
in some distant part of the system; as happens to the
hands

CLASS II. 1. 3.] OF SENSATION. 285
hands and feet, at the commencement of the secon-
dary fever of the small-pox, when the tumor of the
face subsides. This new swelling in the parotitis mu-
tabilis is liable to affect the testes in men, and form a
painful tumor, which should be prevented from sup-
puration by very cautious means, if the violence of the
pain threaten such a termination; as by bathing the
part with coldish water for a time, venesection, a ca-
thartic; or by a blister on the perinæum, or scrotum,
or a poultice.
When women are affected with this complaint, after
the swelling of the parotis and maxillary glands sub-
sides, a tumor with pain is liable to affect their breasts;
which, however, I have never seen terminate in sup-
puration.
On the retrocession of the tumor of the testes above
described, and I suppose of that of the breasts in
women, a delirium of the calm kind is very liable to
occur; which in some cases has been the first symp-
tom which has alarmed the friends of the patient;
and it has thence been difficult to discover the cause
of it without much inquiry; the previous symptoms
having been so slight as not to have occasioned any
complaints. In this delirium, if the pulse will bear
it, venesection should be used, and three or four
grains of calomel, with fomentation of the head with
warm water for an hour together every three or four
hours.
Though this disease generally terminates favourably,
considering the numbers attacked by it, when it is
epidemic,

286 DISEASES [CLASS II. 1. 3.
epidemic, yet it is dangerous at other times in every
part of its progress. Sometimes the parotis or maxillary
glands suppurate, producing ulcers which are difficult
to cure, and frequently destroy the patient, where there
was a previous scrophulous tendency. The testis in
men are also liable to suppurate with great pain, long
confinement, and much danger; and lastly the affection
of the brain is fatal to many.
Mr. W. W. had a swelled throat, which after a
few days subsided. He became delirious or stupid,
in which state he was dying when I saw him; and
his friends ascribed his death to a coup de soleil, which
he was said to have received some months before,
when he was abroad.
Mr. A. B. had a swelling of the throat, which
after a few days subsided. When I saw him he had
great stupor, with slow breathing, and partial delirium.
On fomenting his head with warm water for an hour
these symptoms of stupor were greatly lessened, and
his oppressed breathing gradually ceased, and he reco-
vered in one day.
Mr. C. D. I found walking about the house in a
calm delirium without stupor; and not without much
inquiry of his friends could get the previous history
of the disease; which had been attended with paro-
titis, and swelled testis, previous to the delirium. A
few ounces of blood were taken away, a gentle
cathartic was directed, and his head fomented with
warm water for an hour, with a small blister on the
back, and he recovered in two or three days.
Mr.

CLASS II. 1. 3.] OF SENSATION. 287
Mr. D. D. came down from London in the coach
alone, so that no previous history could be obtained.
He was walking about the house in a calm delirium,
but could give no sensible answers to any thing which
was proposed to him. His pulse was weak and quick.
Cordials, a blister, the bark, were in vain exhibited,
and he died in two or three days.
Mr. F. F. came from London in the same manner
in the coach. He was mildly delirious with consider-
able stupor, and moderate pulse, and could give no ac-
count of himself. He continued in a kind of cataleptic
stupor, so that he would remain for hours in any pos-
ture he was placed, either in his chair, or in bed;
and did not attempt to speak for about a fortnight;
and then gradually recovered. These two last cases
are not related as being certainly owing to parotitis
but as they might probably have that origin.
The parotitis suppurans, or mumps with irritated
fever, is at times epidemic among cats, and may be
called parotitis felina; as I have reason to believe from
the swellings under the jaws, which frequently suppu-
rate, and are very fatal to those animals. In the vil-
lage of Haywood, in Staffordshire, I remember a
whole breed of Persian cats, with long white hair,
was destroyed by this malady, along with almost all
the common cats of the neighbourhood; and as the
parotitis or mumps had not long before prevailed
amongst human beings in that part of the country,
I recollect being inclined to believe, that the cats re-
ceived the infection from mankind; though in all
other

288 DISEASES [CLASS II. 1. 3.
other contagious diseases, except the rabies canina can
be so called, no different genera of animals naturally
communicate infection to each other; and I am in-
formed, that vain efforts have been made to commu-
nicate the small-pox and measles to some quadrupeds
by inoculation. A disease of the head and neck de-
stroyed almost all the cats in Westphalia. Savage,
Nosol. Class X. Art. 30. 8.
5. Catarrhus sensitivus consists of an inflammation
of the membrane, which lines the nostrils and fauces.
It is attended with sensitive fever alone, and is cured
by the steam of warm water externally, and by dilu-
ents internally, with moderate venesection and gentle
cathartics. This may be termed catarrhus sensitivus,
to distinguish it from the catarrhus contagiosus, and is
in common language called a violent cold in the head;
it differs from the catarrhus calidus, or warm catarrh,
of Class I. 1. 2. 7. in the production of new vessels,
or inflammation of the membrane, and the consequent
more purulent appearance of the discharge.
Rancedo catarrhalis, or catarrhal hoarseness, is a
frequent symptom of this disease, and is occasioned by
the pain or soreness which attends the thickened and
inflamed membranes of the larynx; which prevents
the muscles of vocallity from sufficiently contracting
the aperture of it. It ceases with the inflammation,
or may be relieved by the steam of warm water alone,
or of water and vinegar, or of water and ether. See
Paralytic Hoarseness, Class III. 2. 1. 4.
1 6. Catarrhus

CLASS II. 1. 3.] OF SENSATION. 289
6. Catarrhus contagiosus. This malady attacks so
many at the same time, and spreads gradually over so
great an extent of country, that there can be no
doubt but that it is disseminated by the atmosphere.
In the year 1782 the sun was for many weeks ob-
scured by a dry fog, and appeared red as through a
common mist. The material, which thus rendered the
air muddy, probably caused the epidemic catarrh,
which prevailed in that year, and which began far in
the north, and extended itself over all Europe. See
Botanic Garden, Vol. II. note on Chunda, and Vol. I.
Canto IV. line 294, note; and was supposed to have
been thrown out of a volcano, which much displaced
the country of Iceland.
In many instances there was reason to believe, that
this disease became contagious, as well as epidemic;
that is, that one person might receive it from another,
as well as by the general unsalutary influence of the
atmosphere. This is difficult to comprehend, but may
be conceived by considering the increase of contagious
matter in the small-pox. In that disease one particle
of contagious matter stimulates the skin of the arm in
inoculation into morbid action so as to produce a
thousand particles similar to itself; the same thing oc-
curs in catarrh, a few deleterious atoms stimulate the
mucous membrane of the nostrils into morbid actions,
which produce a thousand other particles similar to
themselves. These contagious particles diffused in
the air must have consisted of animal matter, other-
wise how could an animal body by being stimulated
U by

290 DISEASES [CLASS II. 1. 3.
by them produce similar particles- Could they then
have had a volcanic origin, or must they not rather
have been blown from putrid marshes full of animal
matter- But the greatest part of the solid earth has
been made from animal and vegetable recrements,
which may be dispersed by volcanoes.-Future disco-
veries must answer these questions.
As the sensitive fever attending these epidemic ca-
tarrhs are seldom either much irritated or inirritated,
venesection is not always either clearly indicated or
forbid; but as those who have died of these catarrhs
have generally had inflamed livers, with consequent
suppuration in them, venesection is advisable, wherever
the cough and fever are greater than common, so as
to render the use of the lancet in the least dubious.
And in some cases a second bleeding was necessary,
and a mild cathartic or two with four grains of calo-
mel; with mucilaginous subacid diluents; and warm
steam occasionally to alleviate the cough, finished the
cure.
The catarrhus contagiosus is a frequent disease
amongst horses and dogs; it seems first to be dissemi-
nated amongst these animals by miasmata diffused in
the atmosphere, because so many of them receive it at
the same time; and afterwards to be communicable
from one horse or dog to another by contagion, as
above described. These epidemic or contagious ca-
tarrhs more frequently occur amongst dogs and horses
than amongst men; which is probably owing to the
greater extension and sensibility of the mucous mem-
brane,

CLASS II. 1. 3.] OF SENSATION. 291
brane, which covers the organ of smell, and is dif-
fused over their wide nostrils, and their large maxillary
and frontal cavities. And to this circumstance may
be ascribed the greater fatality of it to these animals.
In respect to horses, I suspect the fever at the be-
ginning to be of the sensitive, irritated, or inflammatory
kind, because there is so great a discharge of purulent
mucus; and that therefore they will bear once bleed-
ing early in the disease; and also one mild purgative,
consisting of about half an ounce of aloe, and as much
white hard soap, mixed together. They should be
turned out to grass both day and night for the benefit
of pure air, unless the weather be too cold (and in
that case they should be kept in an open airy stable,
without being tied), that they may hang down their
heads to facilitate the discharge of the mucus from their
nostrils. Grass should be offered them, or other fresh
vegetables, as carrots and potatoes, with mashes of
malt, or of oats, and with plenty of fresh warm or
cold water frequently in a day. When symptoms of
debility appear, which may be known by the coldness
of the ears or other extremities, or when sloughs can
be seen on the membrane which lines the nostrils, a
drink consisting of a pint of ale with half an ounce of
tincture of opium in it, given every six hours, is likely
to be of great utility.
In dogs I believe the catarrh is generally joined
with symptoms of debility early in the disease. These
animals should be permitted to go about in the open
air, and should have constant access to fresh water.
U2 The

292 DISEASES [CLASS II. 1. 3.
The use of being as much as may be in the air is
evident, because all the air which they breathe passes
twice over the putrid sloughs of the mortified parts
of the membrane which lines the nostrils, and the
maxillary and frontal cavities; that is, both during
inspiration and expiration; and must therefore be
loaded with contagious particles. Fresh new milk,
and fresh broth, should be given them very frequently,
and they should be suffered to go amongst the grass,
which they sometimes eat for the purpose of an emetic;
and if possible should have access to a running stream
of water. As the contagious mucus of the nostrils,
both of these animals and of horses, generally drops
into the water they attempt to drink. Bits of raw
flesh, if the dog will eat them, are preferred to cooked
meat; and from five to ten drops of tincture of opium
may be given with advantage, when symptoms of de-
bility are evident, according to the size of the dog,
every six hours. If sloughs can be seen in the nostrils,
they should be moistened twice a day, both in horses
and dogs, with a solution of sugar of lead, or of alum,
by means of a sponge fixed on a bit of whale bone,
or by a syringe. The lotion may be made by dis-
solving half an ounce of sugar of lead in a pint of
water.
Ancient philosophers seem to have believed, that
the contagious miasmata in their warm climates affected
horses and dogs previous to mankind. If those con-
tagious particles were supposed to be diffused amongst
the heavy inflammable air, or carbonated hydrogen, of
putrid

CLASS II. 1. 3.] OF SENSATION. 293
putrid marshes, as these animals hold their heads down
lower to the ground, they may be supposed to have
received them sooner than men. And though men
and quadrupeds might receive a disease from the same
source of marsh-putrefaction, they might not after-
wards be able to infect each other, though they might
infect other animals of the same genus; as the new
contagious matter generated in their own bodies might
not be precisely similar to that received; as happened
in the jail-fever at Oxford, where those who took the
contagion and died, did not infect others.
On mules and dogs the infection first began,
And, last, the vengeful arrows fix'd on man.
Pope's Homer's Iliad, I.
7. Peripneumonia superficialis. The superficial or
spurious peripneumony consists in an inflammation of
the membrane, which lines the bronchia, and bears
the same analogy to the true peripneumony, as the
inflammations of other membranes do to that of the
parenchyma, or substantial parts of the viscus, which
they surround. It affects elderly people, and fre-
quently occasions their death; and exists at the end
of the true peripneumony, or along with it; when the
lancet has not been used sufficiently to cure by reab-
sorbing the inflamed parts, or what is termed by re-
solution.
M. M. Diluents, mucilage, antimonials, warmish
air constantly changed, venesection once, perhaps
twice, if the pulse will bear it. Oily volatile draughts.
U3 Balsams?

294 DISEASES [CLASS II. 1. 3.
Balsams? Neutral salts increase the tendency to
cough. Blisters in succession about the chest. Warm
bath. Mild purgatives. Very weak chicken broth
without salt in it. Boiled onions. One grain of calo-
mel every night for a week. From five drops to ten
of tincture of opium at six every night, when the pa-
tient becomes weak. Digitalis? See Class II. 1. 6. 7.
8. Pertussis. Tussis convulsiva. Chin-cough re-
sembles peripneumonia superficialis in its consisting in
an inflammation of the membrane which lines the air
vessels of the lungs; but differs in the circumstance of
its being contagious; and is on that account of very
long duration; as the whole of the lungs are probably
not infected at the same time, but the contagious in-
flammation continues gradually to creep on the mem-
brane. It may in this respect be compared to the
ulcers in the pulmonary consumption; but it differs
in this, that in chin-cough some branches of the
bronchia heal, as others become inflamed.
This complaint is not usually classed amongst febrile
disorders, but a sensitive fever may generally be per-
ceived to attend it during some part of the day, espe-
cially in weak patients. And a peripneumony very
frequently supervenes, and destroys great numbers
of children, except the lancet or four or six leeches
be immediately and repeatedly used. When the child
has permanent difficulty of breathing, which continues
between the coughing fits: unless blood be taken
from it, it dies in two, three, or four days of the
inflammation

CLASS II. 1. 3.] OF SENSATION. 295
inflammation of the lungs. During this permanent
difficulty of breathing the whooping-cough abates, or
quite ceases, and returns again after once or twice
bleeding; which is then a good symptom, as the child
now possessing the power to cough shews the difficulty
of breathing to be abated. I dwell longer upon this,
because many lose their lives from the difficulty there
is in bleeding young children; where the apothecary
is old or clumsy, or is not furnished with a very sharp
and fine-pointed lancet. In this distressing situation
the application of four leeches to one of the child's
legs, the wounds made by which should continue to
bleed an hour or two, is a succedaneum; and saves
the patient, if repeated once or twice according to the
difficulty of the respiration.
The chin-cough seems to resemble the gonorrhœa
venerea in several circumstances. They are both re-
ceived by infection, are both diseases of the mucous
membrane, are both generally cured in four or six
weeks without medicine. If ulcers in the cellular
membrane under the mucous membrane occur, they
are of a phagedenic kind, and destroy the patient in
both diseases, if no medicine be administered.
Hence the cure should be similar in both these dis-
eases; first general evacuations and diluents, then,
after a week or two, I have believed the following
pills of great advantage. The dose for a child of
about three years old was one sixth part of a grain
of calomel, one sixth part of a grain of opium, and
two grains of rhubarb, to be taken twice a day.
U4 The

296 DISEASES [CLASS II. 1. 3.
The opium promotes absorption from the mucous
membrane, and hence contributes to heal it. The
mercury prevents ulcers from being formed under the
mucous membrane, or cures them, as in the lues
venerea; and the rhubarb is necessary to keep the
bowels open.
M. M. Antimonial vomits frequently repeated.
Mild cathartics. Cool air. Tincture of cantharides,
or repeated blisters; afterwards opiates in small doses,
and the bark. Warm bath frequently used. The
steam of warm water with a little vinegar in it may be
inhaled twice a day. Could the breathing of carbonic
acid gas mixed with atmospheric air be of service?
Copious venesection, when a difficulty of breathing
continues between the fits of coughing; otherwise the
cough and the expectoration cease, and the patient is
destroyed. Ulcers of the lungs sometimes supervene,
and the phthisis pulmonalis in a few weeks termi-
nates in death. Where the cough continues after
some weeks without much of the whooping, and a sen-
sitive fever daily supervenes, so as to resemble hectic
fever from ulcers of the lungs; change of air for a
week or fortnight acts as a charm, and restores the
patient beyond the hopes of the physician.
Young children should lie with their heads and
shoulders raised; and should be constantly watched
day and night; that when the cough occurs, they
may be held up easily, so as to stand upon their feet
bending a little forward; or nicely supported in that
posture which they seem to put themselves into. A
bow

CLASS II. 1. 3.] OF SENSATION. 297
bow of whalebone, about the size of the bow of a
key, is very useful to extract the phlegm out of the
mouths of infants at the time of their coughing;
as an handkerchief, if applied at the time of their
quick inspirations after long holding their breath, is
dangerous, and may suffocate the patient in an instant,
as I believe has sometimes happened.
9. Variola discreta. The small-pox is well divided
by Sydenham into distinct and confluent. The for-
mer consists of distinct pustules, which appear on
the fourth day of the fever, are circumscribed and
turgid; the fever ceasing when the eruption is com-
plete. Headach, pain in the loins, vomiting fre-
quently, and convulsive fits sometimes, precede the
eruption.
The distinct small-pox is attended with sensitive
fever only, when very mild, as in most inoculated
patients; or with sensitive irritated fever, when the
disease is greater: the danger in this kind of small-
pox is owing either to the tumor and soreness of the
throat about the height, or eighth day of the erup-
tion; or to the violence of the secondary fever. For,
first, as the natural disease is generally taken by par-
ticles of the dust of the contagious matter dried and
floating in the air, these are liable to be arrested by
the mucus about the throat and tonsils in their passage
to the lungs, or to the stomach, when they are pre-
viously mixed with saliva in the mouth. Hence the
throat inflames like the arm in inoculated patients;
and

293 DISEASES [CLASS II. 1. 3.
and this increasing, as the disease advances, destroys
the patient about the height.
Secondly, all those upon the face and head come
out about the same time, namely, about one day
before those on the hands, and two before those in
the trunk; and thence, when the head is very full,
a danger arises from the secondary fever, which is a
purulent, not a variolous fever; for as the matter
from all these of the face and head is reabsorbed at
the same time, the patient is destroyed by the vio-
lence of this purulent fever; which in the distinct
small-pox can only be abated by venesection and ca-
thartics; but in the confluent small-pox requires cor-
dials and opiates, as it is attended with arterial
debility. See Sect. XXXV. 1. and XXXIII. 2. 10.
When the pustules on the face recede, the face
swells; and when those of the hands recede, the hands
swell; and the same of the feet in succession. These
swellings seem to be owing to the absorption of variolous
matter, which by its stimulus excites the cutaneous
vessels to secrete more lymph, or serum, or mucus,
exactly as happens by the stimulus of a blister. Now,
as a blister sometimes produces strangury many hours
after it has risen; it is plain, that a part of the can-
tharides are absorbed, and carried to the neck of the
bladder; whether it enters the circulation, or is
carried thither by retrograde movements of the urinary
branch of lymphatics; and by parity of reasoning the
variolous matter is absorbed, and swells the face and
hands by its stimulus.
Variola

CLASS II. 1. 3.] OF SENSATION. 299
Variola confluens. The confluent small-pox consists
of numerous pustules, which appear on the third day
of the fever, flow together, are irregularly circum-
scribed, flaccid, and little elevated; the fever conti-
nuing after the eruption is complete; convulsions do
not precede this kind of small-pox, and are so far to
be esteemed a favourable symptom.
The confluent small-pox is attended with sensitive
inirritated fever, or inflammation with arterial debility;
whence the danger of this disease is owing to the
general tendency to gangrene, with petechiæ, or pur-
ple spots, and hæmorrhages; besides the two sources
of danger from the tumor of the throat about the
height, or eleventh day of the eruption, and the
purulent fever after that time; which are generally
much more to be dreaded in this than in the distinct
small-pox described above.
M. M. The method of treatment must vary with
the degree and kind of fever. Venesection may be
used in the distinct small-pox early in the disease,
according to the strength or hardness of the pulse;
and perhaps on the first day of the confluent small-
pox, and even of the plague, before the sensorial
power is exhausted by the violence of the arterial
action- Cold air, and even washing or bathing in
cold water, is a powerful means in perhaps all erup-
tive diseases attended with fever; as the quantity of
eruption depends on the quantity of the fever, and
the activity of the cutaneous vessels; which may be
judged of by the heat produced on the skin; and
which

300 DISEASES. [CLASS II. 1. 3.
which latter is immediately abated by exposure to ex-
ternal cold. Mercurial purges, as three grains of
calomel repeated every day during the eruptive fever,
so as to induce three or four stools, contribute to abate
inflammation; and is believed by some to have a spe-
cific effect on the variolous, as it is supposed to have
on the venereal contagion.
It has been said, that opening the pock and taking
out the matter has not abated the secondary fever;
but as I had conceived, that the pits, or marks left
after the small-pox, were owing to the acrimony of
the matter beneath the hard scabs, which not being
able to exhale eroded the skin, and produced ulcers,
I directed the faces of two patients in the confluent
small-pox to be covered with cerate early in the dis-
ease, which was daily renewed; and I was induced to
think, that they had much less of the secondary fever,
and were so little marked, that one of them, who
was a young lady, almost entirely preserved her
beauty. Perhaps mercurial plasters, or cerates, made
without turpentine in them, might have been more
efficacious in preventing the marks, and especially if
applied early in the disease, even on the first day of
the eruption, and renewed daily. For it appears from
the experiments of Van Woensel, that calomel or sub-
limate corrosive, triturated with variolous matter,
incapacitates it from giving, the disease by inocula-
tion. Calomel or sublimate given as an alterative
for ten days before inoculation, and till the eruptive
fever commences, is said with certainty to render the
disease

CLASS II. 1. 3.] OF SENSATION. 301
disease mild by the same author. Exper. on Mercury
by Van Woensel, translated by Dr. Fowle, Salisbury.
Variola inoculata. The world is much indebted to
the great discoverer of the good effects of inoculation,
whose name is unknown; and our own country to
Lady Wortley Montague for its introduction into this
part of Europe. By inserting the variolous contagion
into the arm, it is not received by the tonsils, as ge-
nerally happens, I suppose, in the natural small-pox;
whence there is no dangerous swelling of the throat,
and as the pustules are generally few and distinct,
there is seldom any secondary fever; whence those
two sources of danger are precluded; hence when the
throat in inoculated small-pox is much inflamed and
swelled, there is reason to believe, that the disease
had been previously taken by the tonsils in the natural
way.-Which also, I suppose, has generally happened,
where the confluent kind of small-pox has occurred on
inoculation.
I have known two instances, and have heard of
others, where the natural small-pox began fourteen
days after the contagion had been received; one of
these instances were of a countryman, who went to a
market town many miles from his home, where he
saw a person in the small-pox, and on returning the
fever commenced that day fortnight: the other was of
a child, whom the ignorant mother carried to another
child ill of the small-pox, on purpose to communicate
the disease to it; and the variolous fever began on the
fourteenth day from that time. So that in both these
cases

302 DISEASES [CLASS II. 1. 3.
cases fever commenced in half a lunation after the con-
tagion was received. In the inoculated small-pox the
fever generally commences on the seventh day, or after
a quarter of a lunation; and on this circumstance
probably depends on the greater mildness of the latter.
The reason of which is difficult to comprehend; but
supposing the facts to be generally as above related, the
flower progress of the contagion indicates a greater
inirritability of the system, and in consequence a ten-
dency to malignant rather than to inflammatory fever.
This difference of the time between the reception of
the infection and the fever in the natural and artificial
small-pox may nevertheless depend on its being inserted
into a different series of vessels; or to some unknown
effect of lunar periods. It is a subject of great curiosity,
and deserves further investigation.
When the inoculated small-pox is given under all
the most favourable circumstances I believe less than
one in a thousand miscarry, which may be ascribed to
some unavoidable accident, such as the patient having
previously received the infection, or being about to be
ill of some other disease. Those which have lately
miscarried under inoculation, as far as has come to my
knowledge, have been chiefly children at the breast;
for in these the habit of living in the air has been
confirmed by so short a time, that it is much easier
destroyed, than when these habits of life have been
established by more frequent repetition. See Sect.
XVII. 3. Thus it appears from the bills of mortality
kept in the great cities of London, Paris, and Vienna,
that

CLASS II. 1. 3.] OF SENSATION. 303
that out of every thousand children above three hun-
dred and fifty die under two years old. (Kirkpatrick
on Inoculation.) Whence a strong reason against our
hazarding inoculation before that age is passed, espe-
cially in crowded towns; except where the vicinity of
the natural contagion renders it necessary, or the con-
venience of inoculating a whole family at a time; as
it then becomes better to venture the less favourable
circumstances of the age of the patient, or the chance
of the pain from toothing, than to risk the infection in
the natural way.
The most favourable method consists in, first, for a
week before inoculation, restraining the patients from
all kinds of fermented or spirituous liquor, and from
animal food; and by giving them from one grain to
three or four of calomel every other day for three
times. But if the patients be in any the least danger
of taking the natural infection, the inoculation had
better be immediately performed, and this abstinence
then began; and two or three gentle purges with
calomel should be given, one immediately, and on
alternate days. These cathartics should not induce
more than two or three stools. I have seen two in-
stances of a confluent small-pox in inoculation follow-
ing a violent purging induced by too large a dose of
calomel.
Secondly, the matter used for inoculation should be
in a small quantity, and warm, and fluid. Hence it is
best when it can be recently taken from a patient in
the disease; or otherwise it may be diluted with part
of

304 DISEASES [CLASS II. 1. 3.
of a drop of warm water, since its fluidity is likely to
occasion its immediate absorption; and the wound
should be made as small and superficial as possible, as
otherwise ulcers have been supposed sometimes to en-
sue with subaxillary abscesses. Add to this, that the
making two punctures either on the same, or one on
each arm, secures the success of the operation in re-
spect to communicating the infection.
Thirdly, at the time of the fever or eruption the
application of cool air to those parts of the skin, which
are too warm, or appear red, or are covered with
what is termed a rash, should be used freely, as well
as during the whole disease. And at the same time,
if the feet or hands are colder than natural, these
should be covered with flannel. See Class IV.
2. 2. 10.
10. Rubeola irritata, morbilli. The measles com-
mence with sneezing, red eyes, dry hoarse cough, and
is attended with sensitive irritated fever. On the
fourth day, or a little later, small thick eruptions ap-
pear, scarcely eminent above the skin, and, after three
days, changing into very small branny scales.
As the contagious material of the small-pox may be
supposed to be diffused in the air like a fine dry pow-
der, and mixing with the saliva in the mouth to infect
the tonsils in its passage to the stomach; so the con-
tagious material of the measles may be supposed to be
more completely dissolved in the air, and thus to im-
part its poison to the membrane of the nostrils, which
4 covers

CLASS II. 1. 3.] OF SENSATION. 305
covers the sense of smell; whence a catarrh with
sneezing ushers in the fever; the termination of the
nasal duct of the lacrymal sac is subject to the same
stimulus and inflammation, and affects by sympathy
the lacrymal glands, occasioning a great flow of tears.
See Sect. XVI. 8. And the redness of the eye and
eyelids are produced in consequence of the tears being
in so great quantity, that the saline part of them is
not entirely reabsorbed. See Sect. XXIV. 2. 8.
The contagion of the measles, if it be taken a suf-
ficient time before inoculation, so that the eruption
may commence before the variolous fever comes on,
stops the progress of the small-pox in the inoculated
wound, and delays it till the measle-fever has finished
its career. See Sect. XXXIII. 2. 9.
The measles are usually attended with inflamma-
tory fever with strong pulse, and bear the lancet in
every stage of the disease. In the early periods of
it, venesection renders the fever and cough less; and,
if any symptoms of peripneumony occur, is repeat-
edly necessary; and at the decline of the disease, if
a cough be left after the eruption has ceased, and
the subsequent branny scales are falling off, venesec-
tion should be immediately used; which prevents the
danger of consumption. At this time also change of
air is of material consequence, and often removes the
cough like a charm, as mentioned in a similar situa-
tion at the end of the chin-cough.
Rubeola inirritata. Measles with inirritated fever,
or with weak pulse, has been spoken of by some wri-
X ters.

306 DISEASES [CLASS II. 1. 3.
ters. See London Med. Observ. Vol. IV. Art. XI.
It has also been said to have been attended with sore
throat. Edinb. Essays, Vol. V. Art. II. Could the
scarlet fever has been mistaken for the measles? or
might one of them have succeeded the other, as in the
measles and small-pox mentioned in Sect. XXXIII.
2. 9.?
From what has been said, it is probable that inocu-
lation might disarm the measles as much as the small-
pox, by preventing the catarrh and frequent pulmo-
nary inflammation, which attends this disease; both
of which are probably the consequence of the imme-
diate application of the contagious miasmata to these
membranes. Some attempts have been made, but a
difficulty seems to arise in giving the disease; the
blood, I conjecture, would not infect, nor the tears;
perhaps the mucous discharge from the nostrils might
succeed; or a drop of warm water put on the erup-
tions, and scraped off again with the edge of a lancet;
or if the branny scales were collected, and moistened
with a little warm water? Further experiments on
this subject would be worthy the public attention.
11. Scarlatina mitis. The scarlet fever exists with
all degrees of virulence, from a flea-bite to the plague.
The infectious material of this disease, like that of the
small-pox, I suppose to be diffused, not dissolved, in
the air; on which account I suspect, that it requires
a much nearer approach to the sick, for a well per-
son to receive the infection, than in the measles; the
contagion

CLASS II. 1. 3.] OF SENSATION. 307
contagion of which I believe to be more volatile, or
diffusible in the atmosphere. But as the contagious
miasmata of small-pox and scarlet fever are supposed
to be more fixed, they may remain for a longer time
in clothes or furniture; as a thread dipped in vario-
lous matter has given the disease by inoculation after
having been exposed many days to the air, and after
having been kept many months in a phial. This also
accounts for the slow or sporadic progress of the scar- 
let fever, as it infects others at but a very small dis-
tance from the sick; and does not produce a quantity
of pus-like matter, like the small-pox, which can ad-
here to the clothes of the attendants, and when dried
is liable to be shook off in the form of powder, and
thus propagate the infection.
This contagious powder of the small-pox, and of
the scarlet fever, becomes mixed with saliva in the
mouth, and is thus carried to the tonsils, the mucus
of which arrests some particles of this deleterious ma-
terial; while other parts of it are carried into the
stomach, and are probably decomposed by the power
of digestion; as seems to happen to the venom of
the viper, when taken into the stomach. Our per-
ception of bad tastes in our mouths, at the same
time that we perceive disagreeable odours to our nos-
trils, when we inhale very bad air, occasions us to
spit out our saliva; and thus, in some instances, to
preserve ourselves from infection. This has been sup-
posed to originate from the sympathy between the
organs of taste and smell; but any one who goes into
X2 a sick

308 DISEASES [CLASS II. 1. 3.
a sick room close shut up, or into a crowded assembly-
room, or tea-room, which is not sufficiently ventilated,
may easily mix the bad air with the saliva on his
tongue so as to taste it; as I have myself frequently
attended to.
Hence it appears that these heavy infectious matters
are more liable to mix with the saliva, and inflame the
tonsils, and that either before or at the commencement
of the fever; and this is what generally happens in
the scarlet fever, always I suppose in the malignant
kind, and very frequently in the mild kind. But as
this infection may be taken by other means, as by the
skin, it also happens in the most mild kind, that there
is no inflammation of the tonsils at all; in the same
manner as there is generally no inflammation of the
tonsils in the inoculated small-pox.
In the mild scarlatina on the fourth day of the fever
the face swells a little, at the same time a florid red-
ness appears on various parts of the skin, in large
blotches, at length coalescing, and after three days
changing into branny scales.
M. M. Cool air. Fruit. Lemonade. Milk and
water.
Scarlatina maligna. The malignant scarlet fever
begins with inflamed tonsils; which are succeeded by
dark drab-coloured sloughs three or five lines in dia-
meter, flat, or beneath the surrounding surface; and
which conceal beneath them spreading gangrenous
ulcers. The swellings of the tonsils are sensible to the
eye 

CLASS II. 1. 3.] OF SENSATION. 309
eye and touch externally, and have an elastic rather
than an œdematous feel, like parts in the vicinity of
gangrenes. The pulse is very quick and weak, with
delirium, and the patient generally dies in a few days;
or if he recovers, it is by slow degrees, and attended
with anasarca.
M. M. A vomit once. Wine. Beer. Cyder.
Opium. Bark, in small repeated doses. Small, suc-
cessive blisters, if the extremities are cooler than natu-
ral. Cool air on the hot parts of the skin, the cool
extremities being at the same time covered. Iced
lemonade. Broth. Custards. Milk. Jellies. Bread
pudding. Chicken. Touch the ulcers with a dry
sponge to absorb the contagious matter, and then with
a sponge filled with vinegar, with or without sugar of
lead dissolved in it, about six grains to an ounce; or
with a very little blue vitriol dissolved in it, as a grain
to an ounce; but nothing so instantaneously corrects
the putrid smell of ulcers as a solution of alum, about
half an ounce to a pint of water, which should be a
little warmish, and injected into the fauces gently by
means of a syringe. These should be repeated fre-
quently in a day, if it can be done easily, and without
fatigue to the child. A little powder of bark taken
frequently into the mouth, as a grain or two, that it
may mix with the saliva, and thus frequently stimulate
the dying tonsils. Could a warm bath made of de-
coction of bark, or a cold fomentation with it, be of
service? Could oxygene gas mixed with common air
stimulate the languid system? Small electric shocks
X3 through

310 DISEASES [CLASS II. 1. 3.
through the tonsils every hour? ether frequently ap-
plied externally to the swelled tonsils?
As this disease is attended with the greatest degree
of debility, and as stimulant medicines, if given in
quantity, so as to produce more than natural warmth,
contribute to expend the already too much exhausted
sensorial power; it appears, that there is nothing so
necessary to be nicely attended to, as to prevent any
unnecessary motions of the system; this is best accom-
plished by the application of cold to those parts of
the skin, which are in the least too hot. And se-
condly, that the exhibition of the bark in such quan-
tity, as not to oppress the stomach and injure diges-
tion, is next to be attended to, as not being liable to
increase the actions of the system beyond their natural
quantity; and that opium and wine should be given
with the greatest caution, in very small repeated quan-
tity, and so managed as to prevent, if possible, the
cold fits of fever; which probably occur twice in 25
hours, obeying the lunations like the tides, as men-
tioned in Sect. XXXII. 6, that is, I suppose, the cold
periods, and consequent exacerbations of fever, in this
malignant scarlatina, occur twice in a lunar day;
which is about ten minutes less than 25 hours; so
that if the commencement of one cold fit be marked,
the commencement of the next may be expected, if
not disturbed by the exhibition of wine or opium, or
the application of blisters, to occur in about twelve
hours and a half from the commencement of the for-
mer; or if not prevented by large doses of the bark.
No

CLASS II. 1. 3.] OF SENSATION. 311
No one could do an act more beneficial to society,
or glorious to himself, than by teaching mankind how
to inoculate this fatal disease; and thus to deprive it
of its malignity. Matter might be taken from the
ulcers in the throat, which would probably convey
the contagion. Or warm water might be put on the
eruption, and scraped off again by the edge of a lan-
cet. These experiments could be attended with no
danger, and should be tried for the public benefit,
and the honour of medical science.
12. Miliaria. Miliary fever. An eruption pro-
duced by the warmth, and more particularly by the
stimulus of the points of the wool in flannel or blan-
kets applied to the skin, has been frequently observed;
which, by cool dress, and bed-clothes without flan-
nel, has soon ceased. See Class I. 1. 2. This,
which may be called miliaria sudatoria, has been con-
founded with other miliary fevers, and has made the
existence of the latter doubted. Two kinds of erup-
tions I have seen formerly attended with fever, but
did not sufficiently mark their progress, which I con-
ceived to be miliary eruptions, one with arterial
strength, or with sensitive irritated fever, and the
other with arterial debility, or with sensitive inirritated
fever.
In the former of these, or miliaria irritata, the
eruptions were distinct and larger than the small-pox,
and the fever was not subdued without two or three
venesections, and repeated cathartics with calomel.
X4 The

312 DISEASES [CLASS II. 1. 3.
The latter, or miliaria inirritata, was attended with
great arterial debility; and during the course of the
fever pellucid points appeared within the skin, par-
ticularly on the soft parts of the fingers. And, in one
patient, whom I esteemed near her end, I well recol-
lect to have observed round pellucid globules; like
what are often seen on vines in hot-houses; no larger
than the smallest pins' heads, adhere to her neck and
bosom; which were hard to the touch, but were easily
rubbed off. These diseases, if they are allied, do not
differ more than the kinds of small-pox; but require
many further observations.
The eruption so often seen on children in the cradle,
and called by the nurses red-gum; and which is at-
tended with some degree of fever, I suspect to be pro-
duced by too great warmth, and the contact of flannel
next their tender skins, like the miliaria sudatoria;
and like that requires cool air, cool clothes, and linen
next their skin.
13. Pestis. The plague, like other diseases of this
class, seems to be sometimes mild, and sometimes ma-
lignant; according to the testimony of different wri-
ters. It is said to be attended with inflammation,
with the greatest arterial debility, and to be very con-
tagious, attended at an uncertain time of the fever
with buboes and carbuncles. Some authors affirm,
that the contagion of the plague may be repeatedly
received, so as to produce the disease; but as this
is contrary to the general analogy of all contagious
diseases,

CLASS II. 1. 3.] OF SENSATION. 313
diseases, which are attended with fever, and which
cure themselves spontaneously; there is reason to sus-
pect, that where it has been supposed to have been
repeatedly received, that some other fever with arte-
rial debility has been mistaken for it, as has probably
universally been the case, when the small-pox has been
said to have been twice experienced.
M. M. Venesection has been recommended by some
writers on the first day, where the inflammation was
supposed to be attended with sufficient arterial strength,
which might perhaps sometimes happen, as the bubo
seems to be a suppuration; but the carbuncle, or an-
thrax, is a gangrene of the part, and shews the greatest
debility of circulation. Whence all the means before
enumerated in this genus of diseases to support the
powers of life are to be administered. Currents of
cold air, cold water, ice, externally on the hot parts
of the skin.
The methods of preventing the spreading of this
disease have been much canvassed, and seem to consist
in preventing all congregations of the people, as in
churches, or play-houses; and to remove the sick into
tents on some airy common by the side of a river, and
supply them with fresh food, both animal and vege-
table, with beer and wine in proper quantities, and to
encourage those who can, daily to wash both their
clothes and themselves.
The pestis vaccina, or disease amongst the cows,
which afflicted this island about half a century ago,
seems to have been a contagious fever with great ar-
terial

314 DISEASES [CLASS II. 1. 3.
terial debility; as in some of them in the latter stage
of the disease, an emphysema could often be felt in
some parts, which evinced a considerable progress of
gangrene beneath the skin. In the sensitive inirritated
fevers of these animals, I suppose about sixty grains
of opium, with two ounces of extract of oak-bark,
every six hours, would supply them with an efficacious
medicine; to which might be added thirty grains of
vitriol of iron, if any tendency to bloody urine should
appear, to which this animal is liable. The method
of preventing the infection from spreading, if it should
ever again gain access to this island, would be imme-
diately to obtain an order from government to prevent
any cattle from being removed, which were found
within five miles of the place supposed to be infected,
for a few days; till the certainty of the existence of
the pestilence could be ascertained, by a committee of
medical people. As soon as this was ascertained, all
the cattle within five miles of the place should be im-
mediately slaughtered, and consumed within the cir-
cumscribed district; and their hides put into lime-water
before proper inspectors.
14. Pemphigus is a contagious disease attended with
bladdery eruptions appearing on the second or third
day, as large as filberts, which remain many days, and
then effuse a thin ichor. It seems to be either of a
mild kind with sensitive fever only, of which I have
seen two instances, or with irritated, or with inirri-
tated fever, as appears from the observations of M.
Salabert.

CLASS II. 1. 3.] OF SENSATION. 315
Salabert. See Medical Comment, by Dr. Duncan,
Decad. II. Vol. VI.
15. Varicella. Chicken-pox is accompanied with
sensitive fever, pustules break out after a mild fever
like the small-pox, seldom suppurate, and generally
terminate in scales without scars. I once saw a lady,
who miscarried during this disease, though all her
children had it as slightly as usual. It sometimes
leaves scars or marks on the skin. This disease has
been mistaken for the small-pox, and inoculated for
it; and then the small pox has been supposed to hap-
pen twice to the same person. See Trans. of the Col-
lege, London. It is probable that the pemphigus and
urticaria, as well as this disease, have formerly been
diseases of more danger; which the habit of innume-
rable generations may have rendered mild, and will in
process of time annihilates. In the same manner as
the small-pox, the venereal disease, and rickets, seem
to become milder or less in quantity every half cen-
tury. While at the same time it is not improbable,
that other new diseases may arise, and for a season
thin mankind!
16. Urticaria. Nettle-rash begins with mild sen-
sitive fever, which is sometimes scarcely perceptible.
Hence this eruption has been thought of two sorts,
one with and the other without fever. On the second
day red spots, like parts stung with nettles, are seen;
which almost vanish during the day, and recur in the
evening

316 DISEASES [CLASS II. 1. 3.
evening with the fever, succeeded in a few days by
very minute scales. See Trans. of the College, Lon-
don.
17. Aphtha. Thrush. It has been doubted, whether
aphtha or thrush, which consists of ulcers in the mouth,
should be enumerated amongst febrile diseases; and
whether these ulcers are always symptomatic, or the
consequence rather than the cause of the fevers which
attend them. The tongue becomes rather swelled;
its colour and that of the fauces purplish; sloughs or
ulcers appear first on the throat and edges of the
tongue, and at length over the whole mouth. These
sloughs are whitish, sometimes distinct, often coalescing,
and remain an uncertain time. Cullen. I shall con-
cisely mention four cases of aphtha, but do not pretend
to determine whether they were all of them sympto-
matic or original diseases.
Aphtha sensitiva. A lady during pregnancy was
frequently seized with ulcers on her tongue and cheeks,
or other parts of the mouth, without much apparent
fever; which continued two or three weeks, and
returned almost every month. The thrush in the
mouths of young children seems to be a similar disease.
These ulcers resemble those produced in the sea-scurvy,
and have probably for their cause an increased action
of the secerning system from increased sensation, with
a decreased action of the absorbent system from de-
creased irritation. See Class I. 2. 1. 14.
M. M. So- 

CLASS II. 1. 3.] OF SENSATION. 317
M. M. Solutions of alum, of blue vitriol. Powder
of bark taken frequently into the mouth in very small
quantity. See Class II. 1. 3. 1.
Aphtha irritata. Inflammatory aphtha. A case of
this kind is related under the title of suppurative
rheumatism. Class IV. 2. 1. 16.
Aphtha inirritata. Sloughs or ulcers of the mouth,
attended with sensitive fever with great arterial debi-
lity. They seem to spread downwards from the throat
into the stomach, and probably through the whole
intestinal canal, beginning their course with cardialgia,
and terminating it with tenesmus; and might perhaps
be called an erysipelas of this mucous membrane.
M. M. Cool air. A small blister on the back.
Bark. Wine. Opium in small repeated quantities.
Soap neutralizes the gastric acid without effervescence,
and thus relieves the pain of cardialgia, where the
stomach is affected. Milk also destroys a part of this
acid. Infusion of sage leaves two ounces, almond soap
from five grains to ten, with sugar and cream, is gene-
rally both agreeable and useful to these patients. See
I. 2. 4. 5.
Where the stomach may be supposed to be exco-
riated by poisons containing acid, as sublimate of mer-
cury or arsenic; or if it be otherwise inflamed, or
very sensible to the stimulus of the gastric acid; or
where it abounds with acid of any kind, as in cardi-
algia; the exhibition of soap is perhaps a preferable
manner of giving alkali than any other, as it decom-
poses in the stomach without effervescence; while the
caustic alkali is too acrid to be administered in such
cases,

318 DISEASES [CLASS II. 1. 3.
cases, and the mild alkali produces carbonic gas. If
a drop of acid of vitriol be put on cap paper, it will
be long before it destroys the paper; but if a drop
of mild alkali be added, a sudden effervescence arises,
and the paper is instantly destroyed by the escape of
the fixed air; in the same manner as lumps of solid
lime is broken into powder by the escape of the steam
produced from the water, which is poured on them.
This shows why a succession of acid and of alkaline
caustics sooner destroys a part, than either of them
applied separately.
18. Dysenteria. Bloody-flux is attended with sensi-
tive fever generally with arterial debility; with frequent
mucous or bloody stools; which contain contagious
matter produced by the membranes of the intestines;
the alimentary excrement being nevertheless retained;
with griping pains and tenesmus. 
M. M. Emetics, Antimonials, Peruvian bark. Opium
and calomel of each a grain every night. Bolus arme-
niæ. Earth of alum. Chalk. Calcined hartshorn.
Mucilage. Bee's wax mixt with yolk of egg. Cera-
ted glass of Antimony. Warm bath. Flannel cloath-
ing next to the skin. Large clysters with opium. With
ipecacuanha, with smoke of tobacco- Two dysenteric
patients in the same ward of the infirmary at Edinburgh
quarrelled and whipped each other with horsewhips a
long time, and were both much better after it, owing
perhaps to the exertion of so much of the sensorial
power of volition; which, like real insanity, added
excitement to the whole system.
The

CLASS II. 1. 3.] OF SENSATION. 319
The prevention of this contagion must consist prin-
cipally in ventilation and cleanliness; hence the patients
should be removed into cottages distant from each
other, or into tents; and their fæces buried as soon
as may be; or conveyed into a running stream; and
themselves should be washed with cold or warm water
after every evacuation. For the contagious matter
consists in the mucous or purulent discharge from the
membrane which lines the intestines; and not from
the febrile perspiration, or breath of the patients.
For the fever is only the consequence and not the
cause of contagion; as appears from Genus the Fifth
of this Order, where contagion exists without fever.
19. Gastritis superficialis. Superficial inflammation
of the stomach. An erysipelatous inflammation of
the stomach is mentioned by Dr. Cullen from his own
observations; which is distinguished from the inflam-
matory gastritis by less pain and fever, and by an
erysipelatous redness about the fauces. Does this
disease belongs to aphtha-
20. Enteritis superficialis. Superficial inflammation
of the bowels is also mentioned by Dr. Cullen from
his own observation under the name of enteritis ery-
rhematica; and is said to be attended with less pain
and fever, without vomiting, and with diarrhœa. May
not this disease be referred to aphtha, or to dysentery-
ORDO

320 DISEASES [CLASS II. 1. 4.
ORDO I.
Increased Sensation.
GENUS IV.
With the Production of new Vessels by internal Membranes
or Glands, without Fever.
WHERE, inflammation is produced in a small part,
which has not great natural sensibility, the additional
sensation does not produce an increased action of the
arterial system; that is, the associated motions which
are employed in the circulation of the blood, those for
instance of the heart, arteries, glands, capillaries, and
their correspondent veins, are not thrown into increased
action by so small an addition of the sensorial power
of sensation. But when parts, which naturally possess
more sensibility, become inflamed, the quantity of the
sensorial power of sensation becomes so much increased,
as to affect the associated motions belonging to the
circulation, occasioning them to proceed with greater
frequency; that is, a fever is induced. This is well
exemplified in the internal and superficial paronychia,
one of which is attended with great pain and fever,
and the other with little pain and no fever. See Class
II. 1. 2. 19. and II. 1. 4. 5.
From hence it appears, that the sensitive fever is an
accidental consequence of the topical phlegmon, or
inflammation, and not a cause of it; that it is often
injurious, but never salutary; and should therefore
always be extinguished, as soon as may be, either by
I the

CLASS II. 1. 4.] OF SENSATION. 321
the lancet and cathartics, and diluents, and cold air,
when it is of the irritated kind; or by the bark,
opium, cool air, and nutrientia, when it is of the
inirritated kind.
SPECIES.
1. Ophthalmia superficialis. As the membranes,
which cover the eye, are excluded from the air about
one third part of the twenty-four hours; and are moi-
stened by perpetual nictitation during the other sixteen;
they may be considered as internal membranes; and
from the analogy of their inflammation to that of other
internal membranes, it is arranged under this genus;
whilst the tonsillitis is esteemed an inflammation of an
external membrane, because currents of air are per-
petually passing both day and night over the fauces.
The superficial ophthalmy has generally been es-
teemed a symptom of scrophula, when it recurs fre-
quently in young persons; but is probably only a
concomitant of that disease, as a symptom of general
debility; ramifications of new red vessels, and of
enlarged old ones, are spread over the white part of
the eye; and it is attended with less heat, les pain,
and less intolerance of light than the ophthalmia in-
terna, described in Class II. 1. 2. 2. It occurs in
those of feeble circulation, especially children of a
scrophulous tendency, and seems to arise from a pre-
vious torpor of the vessels of the tunica albuginea
from their being exposed to cold air; and from this
torpor being more liable to occur in habits, which
Y are

322 DISEASES [CLASS II. 1. 4.
are naturally inirritable; and therefore more readily
fall into quiescence by a smaller deduction of the
stimulus of heat, than would affect stronger or more
irritable habits; the consequence of this torpor is
increased action, which produces pain in the eye,
and that induces inflammation by the acquisition of the
additional sensorial power of sensation.
Ophthalmia lymphatica is a kind of anasarca of the
tunica adnata; in this the vessels over the sclerotica,
or white part of the eye, rise considerably above the
cornea, which they surround, are less red than in the
ophthalmia superficialis, and appear to be swelled by
an accumulation of lymph rather than of blood; it is
probably owing to the temporary obstruction of a
branch of the lymphatic system.
M. M. If the pain be great, venesection by leeches
on the temple, or cutting the temporal artery, and
one purge with three or four grains of calomel should
be premised. Then the Peruvian bark twice a day.
Opium from a quarter to half a grain twice a day for
some weeks. Bathe the eye frequently with cold
water alone, or with cold water, to a pint of which
is added half an ounce of salt. White vitriol six grains
dissolved in one ounce of water; a drop or two to be
put between the eyelids twice a day. Take very
small electric sparks from the eyes every day for a
fortnight. Bathe the whose head with salt and water
made warm every night for some months. Send such
children to a school near the sea for the convenience
of sea-bathing for many months annually; such schools
are to be found in or near Liverpool.
When

CLASS II. 1. 4.] OF SENSATION. 323
When a child is afflicted with an inflamed eye of
this kind, he should always sit with his back to the
window or candle; but it is generally not necessary
to cover it, or if the uneasy sensation of light makes
this proper, the cover should stand off from the eye,
so as not much to exclude the cool air from it. As
covering an eye unnecessarily is liable to make that
eye weaker than the other, from its not being suffici-
ently used, and thence to produce a squinting for
ever afterwards.
Nevertheless, when the pain is great, a poultice
must be applied to keep the eyes moist, or a piece of
oiled silk bound lightly over them. Or thus, boil an
egg till it is hard, cut it longitudinally into two hemis-
pheres, take out the yolk, sew the backs of the two hol-
low hemispheres of the white to a ribbon, and bind
them over the eyes every night on going to bed;
which, if nicely fitted on, will keep the eyes moist with-
out any disagreeable pressure. See Class I. 1. 3. 14.
Ophthalmia equina. An inflammation of this kind
is liable to affect the eyes of horses; one cause of
which is owing to a silly custom of cutting the hair
out of horses' ears; by which they are not only lia-
ble to take cold at the ear, but grass seeds are liable
to fall into their ears from the high racks in stables;
and in both cases the eye becomes inflamed by sym-
pathy. I once directed the temporal artery of a horse
to be opened, who had frequent returns of an in-
flamed eye; and I believed it was of essential service
to him; it is probable that the artery was afterwards
Y2 contracted

324 DISEASES [CLASS II. 1. 4.
contracted in the wounded part, and that thence less
blood was derived to the eye: the hæmorrhage was
stopped by two persons alternately keeping their fin-
gers on the orifice, and afterwards by a long bandage
of broad tape.
2. Pterigion. Eye-wing. A spot of inflammation
sometimes begins on the inside of the lower eyelid,
or on the tunica albuginca, and spreads an intertex-
ture of red vessels from it, as from a center, which
extend on the white part of the eye, and have the
appearance of the wing of a fly, from whence its name.
M. M. Cut the ramifications of vessels again and
again with the point of a lancet close to the centre of
inflammation.
3. Tarsitis palpebrarum. Inflammation of the edges
of the eyelids. This is a disease of the glands, which
produce the hairs of the eyelashes, and is frequently
the cause of their falling off. After this inflammation
a hard scar-like ridge is left on the edge of the eyelid,
which scratches and inflames the eyeball, and becomes
a very troublesome disease.
The Turkish ladies are said to colour the edge of
the eyelash with crude antimony in very fine powder,
which not only gives lustre to the eye, as a diamond
set on a black foil, but may prevent extraneous light
from being reflected from these edges into the eye,
and thus serve the purpose of the black feathers about
the eyes of swans, described in Sect. XXXIX. 5. 1.
and

CLASS II. 1. 4.] OF SENSATION. 325
and may also prevent the edges of the eyelids from
being inflamed by the frequent stimulus of tears on
them. Black lead in fine powder might be better for
all these purposes than antimony, and might be put
on with a camel's hair brush.
M. M. Mercurial ointment smeared at night on the
edges of the eyelids. Burnt alum sixty grains, hog's
grease half an ounce, well rubbed into an ointment
to be smeared on them in the night. Cold water
frequently in the day. See Class II. 1. 1. 8.
4. Hordeolum. Stye. This inflammation begins
either on or near the edges of the eyelids, or in the
loose skin of them, and is sometimes very slow either
in coming to suppuration or in dispersing. The skin
beneath the lower eyelid is the most frequent seat of
this tumor, which sometimes never suppurates at all,
but becomes an incysted tumor: for as this skin is
very loose for the purpose of admitting great motion
to the eyelid, the absorbent power of the veins seems
particularly weak in this part; whence when any per-
son is weakened by fatigue or otherwise, a darker
shade of colour is seen beneath the eyes; which is
owing to a less energetic action of the absorbent ter-
minations of the veins, whence the currents of dark
or venous blood are delayed in them. This dark shade
beneath the eyes, when it is permanent, is a symptom
of habitual debility, or inirritability of the circulating
system. See Class I. 2. 2. 2.
M. M. Smear the tumors with mercurial ointment,
Y3 moisten

326 DISEASES [CLASS II. 1. 4.
moisten them frequently with ether. To promote
their suppuration they may be wounded with a lancet,
or slit down the middle, or they may be cut out. A
caustic leaves a large scar.
Paronychia superficialis. Whitlow. An inflamma-
tion about the roots of the nail beneath the skin,
which suppurates without fever, and sometimes de-
stroys the nail; which is however gradually repro-
duced. This kind of abscess, though not itself dan-
gerous, has given opportunity for the inoculation of
venereal matter in the hands of accoucheurs, and of
putrid matter from the dissection of diseased bodies;
and has thus been the cause of disease and death.
When putrid matter has been thus absorbed from a
dead body, a livid line from the finger to the swelled
gland in the axilla is said to be visible; which shews
the inflammation of the absorbent vessel along its whole
course to the lymphatic gland; and death has gene-
rally been the consequence.
M. M. In the common paronychia a poultice is
generally sufficient. In the absorption of putrid matter
rub the whole hand and arm with mercurial ointment
three or four times a day, or perpetually. Could
the swelled axillary gland be effected? In the ab-
sorption of venereal matter the usual methods of cure
in syphilis must be administered, as in Class II. 1. 5. 1.
6. Gutta rosea. The rosy drop on the face is of
three kinds. First, the gutta rosea hepatica, or the
red

CLASS II. 1. 4.] OF SENSATION. 327
red pimples on the faces of drunkards, which are
probably a kind of crisis, or vicarious inflammation,
which succeeds, or prevents, a torpor of the mem-
branes of the liver. This and the succeeding species
properly belong to Class IV. 1. 2. 14.
Secondly, the pimpled face in consequence of drink-
ing cold water, or eating cold turnips, or other insipid
food, when much heated with exercise; which pro-
bably arises from the sympathy between the skin of
the face and the stomach; and may be called the
gutta rosea stomatica. Which is distinguished from
the former by the habits of the patient in respect to
drinking; by the colour of the eruptions being less
deep; and by the patient continuing generally to be
troubled with some degree of apepsia. See Class I.
3. 1. 3. I knew a lady, who had long been afflicted
with pain about the region of the stomach; and, on
drinking half a pint of vinegar, as a medicine, she
had a breaking out commenced on her face; which
remained, and she became free from the pain about
the stomach. Was this a stomachic, or an hepatic
disease?
Thirdly, there is a red face, which consists of
smaller pimples than those above mentioned; and
which is less liable to suppurate; and which seems to
be hereditary, or at least has no apparent cause like
those above mentioned; which may be termed gutta
rosea hereditaria, or puncta rosea.
Mrs. S. had a pimpled face, which I believe arose
from potation of ale. She applied alum in a poultice
Y4 to

328 DISEASES [CLASS II. 1. 4.
to it, and had soon a paralytic stroke, which dis-
abled her on one side, and terminated in her death.
Mrs. L. had a red pimpled face, which seemed to
have been derived from her mother, who had pro-
bably acquired it by vinous potation; she applied a
quack remedy to it, which I believe was a solution of
lead, and was seized with epileptic fits, which termi-
nated in palsy, and destroyed her. This shews the
danger of using white paint on the face, which is
called bismuth, but is in reality white lead or
cerussa.
Mr. Y-had acquired the gutta rosea on his
nose, and applied a saturnine solution on it for a few
nights, and was then seized with paralysis on one side
of his face; which however he gradually recovered,
and has since acquired the gutta rosea on other parts
of his face.
These fatal effects were probably caused by the dis-
agreeable sensation of an inflamed liver, which used
before to be relieved by the sympathetic action and
consequent inflammation of the skin of the face, which
was now prevented by the stronger stimulus of the
application of calx of lead. The manner in which
disagreeable sensations induce epilepsy and palsy is
treated of in Class III. In some cases where habitual
discharges, or eruptions, or ulcers are stopped, a
torpor of the system may follow, owing to the want
of the accustomed quantity of sensation or irritation.
See Class I. 1. 2. 9. and II. 1. 5. 6. In both these
situations some other stimulus should be used to supply
the

CLASS II. 1. 4.] OF SENSATION. 329
the place of that which is taken away; which may
either be perpetual, as an issue; or periodical, as a
cathartic repeated once a fortnight or month.
Miss W. an elegant young lady of about twenty,
applied a mercurial lotion to her face, which was co-
vered with very small red points; which seemed to
have been not acquired by any known or avoidable
means; she was seized with inflammation of her liver,
and after repeated bleeding and cathartics recovered,
and in a few weeks the eruption appeared as before.
M. M. Five grains of calomel once a month, with
a cathartic, five grains of rhubarb and a quarter of a
grain of emetic tartar every night for many weeks.
With this preparation mercurial plasters, made with-
out turpentine, and applied every night, and taken off
every morning, will sometimes succeed, and may be
used with safety. But blistering the face all over the
eruption, beginning with a part, succeeds better than
any other means, as I have more than once experien-
ced.-Something like this is mentioned in the Letters
of Lady Mary Wortley Montague, who blistered her
face with balsam of Mecca.
Mrs. F. had for many years had a disagreeably
looking eruption on her chin, after a cathartic with
calomel, she was advised to blister her whole chin; on
the healing of the blister a few eruptions again ap-
peared, which ceased on the application of a second
blister. She took rhubarb five grains, and emetic tar-
tar a quarter of a grain every night for many weeks.
Miss

330 DISEASES [CLASS II. 1. 4.
Miss L. a young lady about eighteen, had tried
variety of advice for pimples over the greatest part of
her face in vain. She took the above medicines in-
ternally, and blistered her face by degrees all over
and became quite beautiful. A spot or two now and
then appeared, and on this account she frequently
slept with parts of her face covered with mercurial
plaster, made without turpentine, which was held on
by a pasteboard mask, and taken off in the mornings;
if any part of the plaster adhered, a little butter or oil
destroyed the adhesion.
7. Odontitis. Inflammatory tooth-ach is occasioned
by inflammation of the membranes of the tooth, or a
caries of the bone itself. The gum sometimes suppu-
rates, otherwise a swelling of the cheek succeeds by
association, and thus the violence of the pain in the
membranes of the tooth are relieved, and frequently
cured; and when this happens the disease properly
belongs to Class IV. as it so far resembles the transla-
tions of morbid actions in the gout and rheumatism.
At other times the tooth dies without caries, espe-
cially in people about sixty years of age, or before;
and then it stimulates its involving membrane, like any
other extraneous substance. The membrane then be-
comes inflamed and thickened, occasioning some pain,
and the tooth rises upwards above the rest, and is
gradually pushed out whole and undecayed; on its
rising up a pus-like mucus is seen discharged from the
gum, which surrounds it; and the gum seems to have
left

CLASS II. 1. 4.] OF SENSATION. 331
left the tooth, as the fangs or roots of it are in part
naked.
M. M. Where the tooth is sound it can only be
saved by evacuations by venesection, and a cathartic;
and after its operation two grains of opium, a blister
may also be used behind the ear, and ether applied to
the cheek externally. In slighter cases two grains of
opium with or without as much camphor may be held
in the mouth, and suffered to dissolve near the affected
tooth, and be gradually swallowed. See Class I.
2. 4. 12. Odontalgia may be distinguished from otitis
by the application of cold water to the affected tooth;
for as the pain of common tooth-ach is owing to tor-
por, whatever decreases stimulus adds to the torpor
and consequent pain; whereas the pain of an inflamed
tooth being caused by the increased action of the
membranes of it is in some measure alleviated by the
application of cold.
8. Otitis. Inflammation and consequent suppuration
of some membranes of the internal ear frequently
occur in children, who sleep in cold rooms, or near
a cold wall, without a night-cap. If the bones are
affected, they come out in a long process of time,
and the child remains deaf of that ear. But in this
case there is generally a fever attends this inflam-
mation; and it then belongs to another genus.
M. M. A warmer night-cap. Warmish water
should be gently syringed into the ear to keep it
clean twice a day; and if it does not heal in a week,
a little

332 DISEASES [CLASS II. 1. 4.
a little spirit of wine should be added; first about
a fourth part, and it should be gradually increased
to half rectified spirit and half water: if it continues
long to discharge matter with a very putrid smell,
the bones are injured, and will in time find their
exit, during which time the ear should be kept clean
by filling it with a weaker mixture of spirit of wine
and water; or a solution of alum in water; which
may be poured into the ear, as the head is inclined,
and shook out again by turning the head, two or
three times, morning and evening. See Class II.
1. 4. 10.
9. Fistula lacrymalis. The lacrymal sac, with its
puncta lacrymalia and nasal duct, are liable to be de-
stroyed by suppuration without fever; the tears then
run over the eye-lids, and inflame the edges of them,
and the cheeks, by their perpetual moisture, and saline
acrimony.
M. M. By a nice surgical operation a new aperture
is to be made from the internal corner of the eye into
the nostril, and a silver tube introduced, which sup-
plies the defect by admitting the tears to pass again
into the nostril. See Melanges de Chirurgie par M.
Pouteau; who thinks he has improved this operation.
10. Fistula in ano. A mucous discharge from the
anus, called by some white piles, or matter from a
suppurated pile, has been mistaken for the matter
from a concealed fistula. A bit of cotton wool ap-
plied

CLASS II. 1. 4.] OF SENSATION. 333
plied to the fundament to receive the matter, and re-
newed twice a day for a week or two, should always
be used before examination with the probe. The
probe of an unskillful empyric sometimes does more
harm in the loose cellular membrane of these parts
than the original ulcer, by making a fistula he did not
find. The cure of a fistula in ano of those, who have
been much addicted to drinking spirituous liquor, or
who have a tendency to pulmonary consumption, is
frequently of dangerous consequence, and is succeeded
by ulcers of the lungs, and death.
M. M. Ward's paste, or twenty black pepper-corns
taken after each meal twice a day; the pepper-corns
should be cut each into two or three pieces. The
late Dr. Monro of Edinburgh asserted in his lectures,
that he had known a fistula in ano cured by injecting
first a mixture of rectified spirit of wine and water;
and by gradually increasing the strength of it, till the
patient could bear rectified spirit alone; by the daily
use of which at length the sides of the fistula became
callous, and ceased to discharge, though the cavity
was left. A French surgeon has lately affirmed, that
a wire of lead put in at the external opening of the
ulcer, and brought through the rectum, and twisted
together, will gradually wear itself through the gut,
and thus effect a cure without much pain. The ends
of the leaden wire must be twilled more and more as
it becomes loose. Or, lastly, it must be laid open by
the knife.
11. Fistula 

334 DISEASES [CLASS II. 1. 4.
11. Fistula urethræ. Where a stricture of the
urethra exists, from whatever cause, the patient, in
forcing the stream of urine through the stricture, dis-
tends the urethra behind it; which after a time is
liable to burst, and to become perforated; and some
of the urine is pushed into the cellular membrane,
occasioning fistulas, which sometimes have large sur-
faces producing much matter, which is pressed out at
the time of making water, and has been mistaken for
a catarrh of the bladder; these fistulas sometimes ac-
quire an external opening in the perinæum, and part
of the urine is discharged that way.
Can this matter be distinguished from mucus of the
bladder by the criterion delivered in Class II. 1. 6. 6-
M. M. The perpetual use of bougies, either of cat-
gut or of caoutchouc. The latter may be had at No.
37, Red-lion street, Holborn, London. The former
are easily made, by moistening the catgut, and keep-
ing it stretched till dry, and then rounding one end
with a penknife. The use of a warm bath every day
for near an hour, at the heat of 94 or 96 degrees,
for two or three months, I knew to be uncommonly
successful in one case; the extensive fistulas com-
pletely healing. The patient should introduce a bou-
gie always before he makes water, and endeavour to
make it as slowly as possible. See Class I. 2. 3. 24.
12. Hepatitis chronica. Chronical inflammation of
the liver. A collection of matter in the liver has fre-
quently been found on dissection, which was not sus-
pected

CLASS II. 1. 4.] OF SENSATION. 335
pected in the living subject. Though there may have
been no certain signs of such a collection of matter,
owing to the insensibility of the internal parts of this
viscus; which has thus neither been attended with
pain, nor induced any fever; yet there may be in
some cases reason to suspect the existence of such an
abscess; either from a sense of fulness in the right hy-
pochondre, or from transient pains sometimes felt
there, or from pain on pressure, or from lying on the
left side, and sometimes from a degree of sensitive
fever attending it.
Dr. Saunders suspects the acute hepatitis to exist in
the inflammation of the hepatic artery, and the chro-
nical one in that of the vena portarum. Treatise on
the Liver. Robinson. London. 
13. Scrophula suppurans. Suppurating scrophula.
The indolent tumors of the lymphatic glands are
liable, after a long time, to regain their sensibility;
and then, owing to their former torpor, an increased
action of the vessels, beyond what is natural, with
inflammation, is the consequence of their new life,
and suppuration succeeds. This cure of scrophula
generally happens about puberty, when a new energy
pervades the whole system, and unfolds the glands
and organs of reproduction.
M. M. See Class I. 2. 3. 21. Where scrophu-
lous ulcers about the neck are difficult to heal, Dr.
Beddoes was informed, in Ireland, that an empyric
had had some success by inflaming them by an ap-
plication	

336 DISEASES [CLASS II. 1. 4.
plication of wood sorrel, oxalis acetosella, the leaves
of which are bruised in a mortar, and applied on the
ulcers for two or three days, and then some more
lenient application is used.
A poor boy, about twelve years old, had a large
scrophulous ulcer on one side of the chest beneath
the clavicle, and another under his jaw; he was
directed, about three weeks ago, to procure a pound
of dry oak-bark from the tanners, and to reduce it
to fine powder, and to add to it one ounce of white
lead in fine powder, and to cover the ulcers daily
with it, keeping it on by brown paper and a ban-
dage. He came to me a few minutes ago, to shew
me that both the ulcers are quite healed. The con-
stant application of linen rags, moistened with a solu-
tion of an ounce of sugar of lead in a pint of wa-
ter, I think I have seen equally efficacious.
14. Scorbutus suppurans. In the sea-scurvy there
exists an inactivity of venous absorption, whence
vibices and petechiæ, and sometimes ulcers. As the
column of blood pressing on the origins of the veins
of the lower extremities, when the body is erect,
opposes the ascent of the blood in them, they are
more frequently liable to become enlarged, and to
produce varices, or vibices, or, lastly, ulcers about
the legs, than on the upper parts of the body. The
exposure to cold is believed to be another cause of
ulcers on the extremities; as happens to many of the
poor in winter at Lisbon, who sleep in the open air,
I without

CLASS II. 1. 4.] OF SENSATION. 337
without stockings, on the steps of their churches or
palaces. See Class I. 2. 1. 15.
M. M. A bandage spread with plaster to cover
the whole limb tight. Rags dipped in a solution of
sugar of lead. A warm flannel stocking or roller.
White lead and oak bark, both in fine powder. Ho-
rizontal rest.
14. Schirrus suppurans. When a schirrus affects
any gland of no great extent or sensibility, it is, after
a long period of time, liable to suppurate without in-
ducing fever, like the indolent tumors of the conglo-
bate or lymphatic glands above mentioned; whence
collections of matter are often found after death both
in men and other animals; as in the liver of swine,
which have been fed with the grounds of fermented
mixtures in the distilleries. Another termination of
schirrus is in cancer, as described below. See Class
I. 2. 3. 22.
16. Carcinoma. Cancer. When a schirrous tumor
regains its sensibility by nature, or by any accidental
hurt, new vessels shoot amongst the yet insensible parts
of it, and a new secretion takes place of a very in-
jurious material. This cancerous matter is absorbed,
and induces swelling of the neighbouring lymphatic
glands; which also become schirrous, and afterwards
cancerous.
This cancerous matter does not seem to acquire its
malignant or contagious quality, till the cancer be-
Z comes

338 DISEASES [CLASS II. 1. 4.
comes an open ulcer; and the matter secreted in it is
thus exposed to the air. Then it evidently becomes
contagious, because it not only produces hectic fever,
like common matter in ulcers open to the air; but it
also, as it becomes absorbed, swells the lymphatic
glands in its vicinity; as those of the axilla, when the
open cancer is on the breast. See Class II. 1. 3.
Hence exsection before the cancer is open is gene-
rally a cure; but after the matter has been exposed
to the air, it is seldom of service; as the neighbouring
lymphatic glands are already infected. I have ob-
served some of these patients after the operation to
have had diseased livers, which might either have previ-
ously existed, or have been produced by the fear or
anxiety attending the operation.
Erosion with arsenic, after the cancer is become an
open ulcer, has generally no better effect than exsec-
tion, but has been successful before ulceration. The
best manner of using arsenic, is by mixing one grain
with a dram of lapis calaminaris, and strewing on the
cancer some of the powder every day, till the whole
is destroyed.
Cancers on the face are said to arise from the peri-
osteum, and that unless this be destroyed by the knife,
or by caustics, the cancer certainly recurs. After the
cancer becomes an open ulcer of some extent, a puru-
lent fever supervenes, as from other open ulcers, and
gradually destroys the patient. See Class II. 1. 6. 13.
Two very interesting cases have been lately pub-
lished by Dr. Ewart, of Bath, in which carbonic acid 
gas,

CLASS II. 1. 4.] OF SENSATION. 339
gas, or fixed air, was kept constantly in contact with
the open cancerous ulcers of the breast; which then
healed like other common ulcers. This is rather to
be ascribed to the exclusion of oxygen, than to any
specific virtue in the carbonic acid. As in common
ulcers the matter does not induce hectic fever, till it
has been exposed to the air, and then probably united
with oxygen.
The manner of applying the fixed air, is by in-
cluding the cancer in one half or hemisphere of a
large bladder; the edges are made to adhere to the
skin by adhesive plaster, or perhaps a mixture of one
part of honey with about twenty parts of carpenter's
glue might better suit some tender skins. The bladder
is then kept constantly filled with carbonic acid gas,
by means of a pipe in the neck of it; and the matter
let out at a small aperture beneath.
17. Arthrocele. Swelling of the joints seems to have
its remote cause in the softness of the bones, for they
could not swell unless they were previously softened,
see Class I. 2. 2. 12. The epiphyses, or ends of the
bones, being naturally of a looser texture, are most
liable to this disease, and perhaps the cartilages and
capsular ligaments may also become inflamed and
swelled along with the heads of the bones. This
malady is liable to distort the fingers and knees, and
is usually called gout or rheumatism; the former of
which is liable to disable the fingers by chalk-stones,
and thence to have somewhat a similar appearance.
Z2 But

340 DISEASES [CLASS II. 1. 4.
But the arthrocele, or swelling of the joints, affects
people who have not been intemperate in the use of
fermented or spirituous liquors; or who have not
previously had a regular gout in their feet; and in
both these circumstances differs from the gout. Nor
does it accord with the inflammatory rheumatism, as
it is not attended with fever, and because the tumors
of the joints never entirely subside. The pain or
sensibility, which the bones acquire, when they are
inflamed, may be owing to the new vessels, which
shoot in them in their soft state, as well as to the
distention of the old ones.
M. M. Half a grain of opium twice a day, gra-
dually increased to a grain, but not further, for many
months. Thirty grains of powder of bark twice a
day for many months. Ten grains of bone-ashes, or
calcined hartshorn, twice a day, with decoction of
madder? Soda phosphorata?
18. Arthropuosis. Joint-evil. This differs from the
former, as that never suppurates; these ulcers of the
joints are generally esteemed to arise from scrophula;
but as scrophula is a disease of the lymphatic or
absorbent system, and this consists in the suppuration
of the membranes, or glands, or cartilages about
the joints, there does not seem a sufficient analogy to
authorize their arrangement under the same name.
The white swelling of the knee, when it suppurates,
comes under this species, with variety of other ulcers
attended with carious bones.
19. Caries

CLASS II. 1. 5.] OF SENSATION. 341
19. Caries ossium. A caries of the bones may be
termed a suppuration of them; it differs from the
above, as it generally is occasioned by some external
injury, as in decaying teeth; or by venereal virus, as
in nodes on the tibia; or by other matter derived to
the bone in malignant fevers; and is not confined to
the ends of them.
The separation of the dead bone from the living is
a work of some time. See Sect. XXXIII. 3. 1.
ORDO I.
Increased Sensation.
GENUS V.
With the Production of new Vessels by external Mem-
branes or Glands, without Fever.
THE ulcers, or eruptions, which are formed on the
external skin, or on the mouth or throat, or on the
air-cells of the lungs, or on the intestines, all of
which are more or less exposed to the contact of the
atmospheric air, which we breathe, and which in
some proportion we swallow with our food and saliva;
or to the contact of the inflammable air, or hydrogen,
which is set at liberty by the putrefying aliment in
the intestines, or by putrefying matter in large ab-
scesses; all of them produce contagious matter;
which, on being inoculated into the skin of another
person, will produce fever, or a similar disease.
Z3 In

342 DISEASES [CLASS II. 1. 5.
In some cases even the matter formed beneath the
skin becomes in some degree contagious, at least so
much so as to produce fever of the hectic or malignant
kind, as soon as it has pierced through the skin,
and has thus gained access to some kind of air; as the
fresh pus of a common abscess; or the putrid pus of
an abscess, which has been long confined; or of can-
cerous ulcers.
From this analogy there is reason to suspect, that
the matter of all contagious diseases, whether with or
without fever, is not infectious till it has acquired
something from the air; which, by oxygenating the
secreted matter, may probably produce a new acid.
And secondly, that in hectic fever a part of the
purulent matter is absorbed; or acts on the surface of
the ulcer; as variolous matter affects the inoculated
part of the arm. And that hectic fever is therefore
caused by the matter of an open ulcer; and not by
the sensation in the ulcer independent of the aerated
pus, which lies on it. Which may account for the
venereal matter from buboes not giving the infection,
according to the experiments of the late Mr. Hunter,
and for some other phenomena of contagion. Sec
Variola discreta, Class II. 1. 3. 9.
SPECIES.
1. Gonorrhœa venerea. A pus-like contagious ma-
terial discharged from the urethra after impure coha-
bitation, with smarting or heat on making water;
which begins at the external extremity of the urethra,
to							

CLASS II. 1. 5.] OF SENSATION. 343
to which the contagious matter is applied, and where
it has access to the air.
M. M. In this state of the venereal disease once
venesection, with mild cathartics of senna and manna,
with mucilage, as almond emulsion, and gum arabic,
taken for two or three weeks, absolve the cure. Is
camphor of use to relieve the ardor urinæ- Do bal-
sams increase or lessen the heat of urine- Neutral
salts certainly increase the smarting in making water,
by increasing the acrimony of the urine.
Can the discharge from the urethra be soon stopped
by saturnine injections, or mercurial ones, or with
solution of blue vitriol, at first very dilute, and gra-
dually made stronger- And at the same time left the
syphilis, or general disease, should supervene, the
patient might take a quarter of a grain of corrosive
sublimate of mercury twice a day, as directed below-
2. Syphilis. Venereal disease. The contagion shews
itself in ulcers on the part first inoculated, as chancres;
ulcers on the tonsils succeed, with eruption on the
skin, especially about the roots of the hair; after-
wards on other parts of the skin, terminating in dry
scabs; and lastly, with pain and swelling of the
bones.
The corona veneris, or crown of Venus, consists of
the eruptions at the roots of the hair appearing most
round the forehead; which is occasioned by this part
being more exposed to the air; which we observed,
at the beginning of this genus, either produces or
Z4 increases

344 DISEASES [CLASS II. 1. 5.
increases the virulence of contagious matter. But it is
difficult to conceive from this history, why the throat
should be first affected; as it cannot be supposed, that
the disease is so often taken by the saliva, like the
small-pox, though this may sometimes occur, perhaps
very often. The connection between the genitals in
men and the throat, is treated of in Class IV. 1. 2. 7.
Hydrophobia.
M. M. A quarter of a grain of corrosive sublimate
of mercury, taken thrice a day for five or six weeks,
made into a pill with bread-crumbs, or dissolved in a
spoonful of brandy and water, is a very efficacious and
almost certain cure. When it does not succeed, it is
owing either to the drug being bad, or to its having
precipitated from the brandy, or from its being spoiled
in the pill by long keeping. Opium contributes much
to expedite the cure both of the simple gonorrhœa, and
of venereal ulcers, by increasing absorption both from
the mucous membrane, and from the surface of
ulcers.
3. Lepra. Leprosy. Leprosy of the Greeks. The
skin is rough with white branny scales, which are full
of chinks; often moist beneath, and itching. The scales
on the head or arms of some drinking people are a
disease of this kind. The perspirable matter designed
for the purpose of lubricating the external skin is
secreted in this disease in a too viscid state, owing to
the inflammation of the subcutaneous vessels; and, as
the absorbents act too strongly at the same time, a
viscid

CLASS II. 1. 5.] OF SENSATION. 345
viscid mucus is left adhering to the surface of the
skin.
In the leprosy of the Jews, described in the thir-
teenth and fourteenth chapters of Leviticus, the de-
pression of the sore beneath the surface of the skin,
and the hairs in it becoming white, seem to have been
the principal circumstances, which the priest was
directed to attend to for the purpose of ascertaining
the disease.
M. M. Essence of antimony from 20 drops to 100
twice or thrice a day, with half a pint of decoction of
elm-bark; or tincture of cantharides from 20 to 60
drops four times a day; or sublimate of mercury,
with much diluting fluid. Acid of vitriol? Perhaps
the cure chiefly depends on much dilution with water,
from two to four pints a day, in which elm-bark, or
pine-buds, or juniper-tops, may be boiled. Bath or
Buxton water drank in large quantities. Warm bath.
Oil-skin bound on the part to confine the perspirable
matter. Ointment of tar and suet; or poultice for
two or three days, and then cerate with lapis calami-
naris. Diet of raisins and bread. Abstinence from
wine, beer, and all spirits.
4. Elephantiasis. Leprosy of the Arabs. A con-
tagious disease; the skin is thickened, wrinkled, rough,
unctuous, destitute of hair, without any sensation of
touch in the extremities of the limbs; the face de-
formed with tubercles; the voice hoarse, and with a
nasal tone. Cullen.
5. Framboesia.

346 DISEASES [CLASS II. 1. 5.
5. Framboesia. Yaws is said to be contagious and
hereditary. It principally affects the negroes in the
West Indies. Edinb. Essays, Vol. VI.
6. Psory. Itch. A contagious prurient eruption.
There are two kinds of itch, that which appears
between the fingers, and under the joints of the knees
and elbows; and that which seldom is seen in these
places, but all over the other parts of the body. The
latter is seldom thought to be the itch, as it does not
easily infect even a bedfellow, and resists the usual
means of cure by brimstone.
If the itch be cured too hastily by rubbing mercu-
rial or arsenical preparations over the whole body,
or on too great a part of it, many bad symptoms
are produced; as weakness of digestion, with pale
bloated countenance, and tendency to dropsy. I have
twice seen St. Vitus's dance occur from the use of a
mercurial girdle; and once a swelled liver. I have
also seen a swelled spleen and swelled legs from the
external use of arsenic in the cure of the itch. And
very numerous and large phlegmons commonly succeed
the too hasty cure of it by other means.
There does not appear a strict analogy between the
hasty cure of the itch, and the retrocession of the
pustules is the secondary fever of the small-pox; be-
cause in that the absorption of the matter is evinced
by the swelling of the face and hands, as the pustules
recede, as explained in Class II. 1. 3. 9. Variola
discreta. And a fever is produced by this absorption;
neither of which happen, when the pustules of the
itch are destroyed by mercury or arsenic.
Nor

CLASS II. 1. 5.] OF SENSATION. 347
Nor can these inconveniencies, which occur on the
too hasty cure of the itch, he explained by those which
follow the cure of some kinds of gutta rosea, Class II.
1. 4. 6. as in those the eruptions on the face were an
associated disease with inflammation of the liver or
stomach, which they were accustomed to relieve;
whereas the itch is not known to have had any pre-
vious catenation with other diseases.
In the itch there exists not only great irritation in
the production of the pustules, but great sensation is
caused by their acrimony afterwards; insomuch that
the pain of itching, without the interrupted smarting
occasioned by scratching, would be intolerable. This
great excitement of the two sensorial powers of irri-
tation and sensation are so great, when the pustules are
diffused over the whole surface of the body, that a
torpor succeeds the sudden ceasing of it; which affects
those parts of the system, which were most catenated
with the new motions of the skin, as the stomach,
whence indigestion and flatulency; or which are ge-
nerally most liable to fall into torpor, as the numerous
glands, which form the liver. Whence the diseases
consequent to the hasty cure of the itch are diseases
of debility, as tumid viscera, œdematous swellings,
and St. Vitus's dance, which is a debility of associa-
tion. In the same manner indigestion, with green
evacuations, are said to follow an injudicious applica-
tion of cerussa to stop too hastily the exsudation behind
the ears of children, Class I. 1. 2. 9. And dropsies
are liable to succeed the cure of old ulcers of the legs,
which have long stimulated the system.
M. M.

348 DISEASES [CLASS II. 1. 5.
M. M. The size of a large pea, of an ointment
consisting of one part of white precipitate of mercury
to six parts of hogs' lard well triturated together, to
be rubbed on a part of the body every night, and
washed off with soap and water next morning, till
every part is cleared; with lac sulphuris twenty grains
to be taken every morning inwardly. Warm saline
bath, with white vitriol in it. Flowers of sulphur
mixed with thick gruel, with hogs fat. With either
of which the body may be smeared all over.
7. Psora ebriorum. Elderly people, who have been
much addicted to spirituous drinks, as beer, wine,
or alcohol, are liable to an eruption all over their
bodies; which is attended with very afflicting itching,
and which they probably propagate from one part of
their bodies to another with their own nails by scratch-
ing themselves. I saw fatal effects in one such patient
by a too extensive use of a solution of lead; the
eruption disappeared, he became dropsical, and died;
I suppose from the too suddenly ceasing of the great
stimulus caused by the eruptions over the whole skin,
as in the preceding article.
M. M. The patient should gradually accustom him-
self to half his usual quantity of vinous potation.
The warm bath, with one pound of salt to every three
gallons. Mercurial ointments on small parts of the
skin at a time. A grain of opium at night instead
of the usual potation of wine or beer.
8. Herpes.

CLASS II. 1. 5.] OF SENSATION. 349
8. Herpes. Herpes consists of gregarious spreading
excoriations, which are succeeded by branny scales
or scabs. In this disease there appears to be a deficient
absorption of the subcutaneous mucus, as well as in-
flammation and increased secretion of it. For the fluid
not only excoriates the parts in its vicinity by its acri-
mony, but is very saline to the taste, as some of
these patients have assured me; I believe this kind of
eruption, as well as the tinea, and perhaps all other
cutaneous eruption, is liable to be inoculated in other
parts of the body by the finger-nails of the patients in
scratching themselves.
It is liable to affect the hands, and to return at
distant periods; and is probably a secondary disease
as well as the zona ignea, or shingles, described
below.
M. M. Poultice the eruption with bread and milk,
or raw carrots grated, for two or three whole days,
to dilute or receive the discharged fluid, and abate the
inflammation; then cover the parts with fresh cerate
mixed with lapis calaminaris. On the parts not ex-
coriated mercurial ointment, made of one part of white
calx of mercury and six of hogs' fat. Internally, after
venesection, gentle repeated cathartics. Lastly, the
bark. Acid of vitriol. Bolus Armeniæ, or testacia.
Antimonials. Decoction of interior bark of elm.
9. Zona ignea. Shingles. This eruption has been
thought a species of herpes by some writers, and by
others a species of erysipelas. Yellow or livid vesicles
appear,

350 DISEASES [CLASS II. 1. 5.
appear, producing a corrosive ichor, which is some-
times attended with a degree of fever. It is said to
infest sometimes the thorax and ribs, but its most
general situation is on the small of the back, over
one kidney, extending forward over the course of one
of the ureters.
There is reason to suspect, that this also is a secon-
dary or sympathetic disease, as well as the preceding
one; but future observations are required, before it
can be removed to the fourth class, or diseases of as-
sociation. In three patients I have been induced to be-
lieve, that the eruption on the loins was a translation
of inflammation from the external membrane of the
kidney to the skin. They had, for a day or two
before the appearance of the eruption, complained of
a dull pain on the region of one kidney, but without
vomiting; by which it was distinguished from nephritis
interna, or gravel; and without pain down the out-
side of the thigh, by which it was distinguished from
sciatica. In other situations the shingles may sympathize
with other internal membranes, as in a case published
by Dr. Russel (De Tabe Glandulari), where the
retrocession of the shingles was succeeded by a serious
dyspnœa.
M. M. Venesection, if the pulse is strong. Calomel
three or four grains, very mild repeated cathartics.
Poultice for a few days, then cerate of lapis calami-
naris, as in herpes. A grain of emetic tartar dissolved
in a pint of water, and taken so as to empty the sto-
mach and intestines, is said much to hasten the cure;
compresses

CLASS II. 1. 5.] OF SENSATION. 351
compresses soaked in a Saturnine solution are recom-
mended externally on the eruption; and cerate where
there are ulcerations. Desanet's Surgical Journal,
Vol. II. p. 378. If this be a vicarious disease, it should
continue half a lunation; left, on its ceasing, the bad
habits of motion of the primary disease should not have
been so perfectly dissevered, but that they may recur.
10. Annulus repens. Ring-warm. A prurient erup-
tion formed in a circle, affecting children, and would
seem to be the work of insects, according to the theory
of Linnæus, who ascribes the itch and dysentery to
microscopic animalcula. These animalcula are pro-
bably the effect, and not the cause, of these eruptions;
as they are to be seen in all putrescent animal fluids.
The annular propagation of the ring-worm, and its
continuing to enlarge its periphery, is well accounted
for by the acrimony of the ichor or saline fluid erod-
ing the skin in its vicinity.
M. M. Cover the eruption daily with ink. With
white mercurial ointment, as described above in
herpes. With solution of white vitriol ten grains to
an ounce. These metallic calves stimulate the absor-
bents into stronger action, whence the fluid has its
saline part re-absorbed, and that before it has access
to the air, which probably adds to its acrimony by
oxygenating it, and thus producing a new acid.
11. Tinea. Scald head. This contagious eruption
affects the roots of the hair, and is generally most
2 virulent

352 DISEASES [CLASS II. 1. 5.
virulent around the edges of the hair on the back part
of the head; as the corona veneris appears most on
the edges of the hair on the forepart of the head;
for in these parts the eruption about the roots of the
hair is most exposed to the external air, by which its
acrimony or noxious quality is increased.
The absorption of the matter thus oxygenated
swells the lymphatics of the neck by its stimulus, oc-
casioning many little hard lumps beneath the seat of
the eruption; when this happens, the sooner it is cured
the better, left the larger lymphatics of the neck should
become affected.
M. M. The art of curing these eruptions consists,
first, in abating the inflammation, and consequent
secretion of a noxious material. Secondly, to prevent
its access to the air, which so much increases its acri-
mony. And thirdly, to promote the absorption of it,
before it has been exposed to the air; for these pur-
poses venesection once, and gentle cathartics, which
promote absorption by emptying the blood-vessels.
Next poultices and fomentations, with warm water,
abate inflammation by diluting the saline acrimony of
the secreted fluid, and abating the painful sensation.
Afterwards cerate joined with some metallic calx, as of
zinc or lead, or solution of lead, mercury, or copper,
or iron, which may stimulate the absorbent system into
stronger action.
Cover the shaved head with tar and suet, and a
bladder; this, by keeping the air from the secreted
fluid, much contributes to its mildness, and the stimulus
of

CLASS II. 1. 5.] OF SENSATION. 353
of the tar increases its absorption. See the three pre-
ceding species of this genus.
12. Crusta lactea. Milk-crust is a milder disease
than tinea, affecting the face as well as the hairy scalp
of very young children. It is not infectious, nor liable
to swell the lymphatics in its vicinity like the tinea.
M. M. Cover the eruption with cerate made with
lapis calaminaris, to be renewed every day. Mix one
grain of emetic tartar with forty grains of chalk, and
divide into eight papers, one to be taken twice a day,
or with magnesia alba, if stools are wanted. The
child should be kept cool and much in the air.
13. Trichoma. Plica polonica. A contagious dis-
ease, in which the hair is said to become alive and
bleed, forming inextricable knots or plaits of great
length, like the fabled head of Medusa, with intole-
rable pain, so as to confine the sufferer on his bed for
years.
Aa ORDO

354 DISEASES [CLASS II. 1. 6.
ORDO I.
Increased Sensation.
GENUS VI.
With Fever consequent to the Production of new Vessels
or Fluids.
SPECIES.
1. Febris sensitiva. Sensitive fever, when unmixed
with either irritative or inirritative fever, may be dis-
tinguished from either of them by the less comparative
diminution of muscular strength; or in other words,
from its being attended with less diminution of the
sensorial power of irritation. An example of unmixed
sensitive fever may generally be taken from the pulmo-
nary consumption; in this disease patients are seen to
walk about with ease, and to do all the common
offices of life for weeks, and even months, with a
pulse of 120 strokes in a minute; while in other
fevers, whether irritated or inirritated, with a pulse of
this frequency, the patient generally lies upon the
bed, and exerts no muscular efforts without difficulty.
The cause of this curious phenomenon is thus to be
understood; in the sensitive fever a new sensorial
power, viz. that of sensation, is superadded to that of
irritation; which in other fevers alone carries on the
increased circulation. Whence the power of irritation
is not much more exhausted than in health; and those
muscular motions, which are produced in consequence
of

CLASS II. 1. 6.] OF SENSATION. 355
of it, as those which are exerted in keeping the body
upright in walking, riding, and in the performance of
many customary actions, are little impaired. For an
account of the irritated sensitive fever, see Class II.
1.2. 1.; for the inirritated sensitive fever, Class II.
1. 3. 1. IV. 2. 4. 11.
2. Febris a pure clauso. Fever from inclosed matter
is generally of the irritated sensitive kind, and con-
tinues for many weeks, and even months, after the
abscess is formed; but is distinguished from the fever
from aerated matter in open ulcers, because there are
seldom any night-sweats, or colliquative diarrhœa in
this, as in the latter. The pulse is also harder, and
requires occasional venesection, and cathartics, to abate
the inflammatory fever; which is liable to increase
again every three or four days, till at length, unless
the matter has an exit, it destroys the patient. In
this fever the matter, not having been exposed to the
air, has not acquired oxygenation; in which a new
acid, or some other noxious property, is produced;
which acts like contagion on the constitution inducing
fever-fits, called hectic fever, which terminate with
sweats or diarrhœa; whereas the matter in the closed
abscess is either not absorbed, or does not so affect the
circulation as to produce diurnal or hectic fever-fits;
but the stimulus of the abscess excites so much sensa-
tion as to induce perpetual pyrexia, or inflammatory
fever, without such marked remissions. Nevertheless
there sometimes is no fever produced, when the mat-
Aa2. ter

356 DISEASES [CLASS II. 1. 6.
ter is lodged in a part of little sensibility, as in the
liver; yet a white pus-like sediment in those cases
exists I believe generally in the urine, with occasional
wandering pains about the region of the liver or chest.
3. Vomica. An abscess in the lungs is sometimes
produced after peripneumony, the cough and shortness
of breath continue in less degree, with difficulty in
lying on the well side, and with sensitive irritated
fever, as explained in the preceding article.
The occasional increase of fever, with hard pulse
and sizy blood, in these patients, is probably owing to
the inflammation of the walls of the vomica; as it is
attended with difficulty of breathing, and requires ve-
nesection. Mr. B-, a child about seven years old,
lived about five weeks in this situation, with a pulse
from 150 to 170 in a minute, without sweats, or diar-
rhœa, or sediment in his water, except mucus occa-
sionally; and took sufficient nourishment during the
whole time. The blood taken was always covered
with a strong cupped size, and on his death three or
four pints of matter were found in one side of the
chest; which had probably, but lately, been effused
from a vomica. This child was frequently induced to
swing, both in a reciprocating and in a rotatory swing,
without any apparent absorption of matter; in both
these swings he expressed pleasure, and did not appear
to be vertiginous.
M. M. Repeated emetics. Digitalis- Perseverance
in rotatory swinging. See Class II. 1. 6. 7.
Mr.

CLASS II. 1. 6.] OF SENSATION. 357
Mr. I. had laboured some months under a vomica
after a peripneumony, he was at length taken with a
catarrh, which was in some degree endemic in March
1795, which occasioned him to sneeze much, during
which a copious hæmorrhage from the lungs occurred,
and he spit up at the same time half a pint of very
fetid matter, and recovered. Hence errhines may be
occasionally used with advantage.
4. Empyema. When the matter from an abscess in
the lungs finds its way into the cavity of the chest, it
is called an empyema. A servant man, after a violent
peripneumony, was seized with symptoms of empyema,
and it was determined, after some time, to perform
the operation; this was explained to him, and the
usual means were employed by his friends to encou-
rage him, "by advising him not to be afraid." By
which good advice he conceived so much fear, that he
ran away early next morning, and returned in about a
week quite well. Did the great fear promote the ab-
sorption of the matter, like the sickness occasioned by
digitalis- Fear renders the external skin pale; by this
continued decrease of the action of the absorbents of
the skin might not those of the lungs be excited into
greater activity- and thus produce increased pulmonary
absorption by reverse sympathy, as it produces pale
urine, and even stools, by direct sympathy-
M. M. Digitalis-
5. Febris Mesenterica. Fever from matter formed
in the mesentery is probably more frequent than is
Aa3 suspected.

358 DISEASES [CLASS II. 1. 6.
suspected. It commences with pain in the bowels,
with irritated sensitive fever; and continues many
weeks, and even months, requiring occasional venesec-
tion, and mild cathartics; till at length the continu-
ance of the pyrexia, or inflammatory fever, destroys
the patient. This is an affection of the lymphatic
glands, and properly belongs to scrophula; but as the
matter is not exposed to the air, no hectic fever, pro-
perly so called, is induced.
6. Febris a pure aerato. Fever from aerated mat-
ter. A great collection of matter often continues a
long time, and is sometimes totally absorbed, even
from venereal buboes, without producing any disorder
in the arterial system. At length, if it becomes pu-
trid by its delay, and one part of the matter thus
becomes aerated by the air given out by the other
part; or if the ulcer has been opened, so that any
part of it has been exposed to the air for but one day,
a hectic fever is produced. Whence the utility arises
of opening large abscesses by setons, as in that case
little or no hectic fever is induced; because the mat-
ter is squeezed out by the side of the spongy threads
of cotton, and little or no air is admitted; or by tap-
ping the abscess with a trocar, as mentioned in ischias,
Class II. 1. 2. 18.
In this fever the pulse is about 120 in a minute,
and its access is generally in an evening, and some-
times about noon also, with sweats or purging to-
wards morning, or urine with pus-like sediment;
and the patients bear this fever better than any other
with

CLASS II. 1. 6.] OF SENSATION. 359
with so quick a pulse; and lastly, when all the matter
from a concealed ulcer is absorbed, or when an open
ulcer is healed, the hectic fever ceases. Here the ab-
sorbed matter is supposed to produce the fever, and
the diarrhœa, sweats, or copious muddy urine, to be
simply the consequence of increased secretion, and not
to consist of the purulent matter, which was supposed
to be absorbed from the ulcer. See Sudor calidus,
Class I. 1. 2. 3.
The action of the air on ulcers, as we have already
shewn, increases the acrimony of the purulent matter,
and even converts it into a weaker kind of contagious
matter; that is, to a material inducing fever. This
was ascribed to the union of the azotic part of the
atmosphere with the effused pus in Sect. XXVIII. 2.
but by contemplating more numerous facts and ana-
logies, I am now induced to believe, that it is by the
union of oxygen with it; first, because oxygen so
greedily unites with other animal substances, as the
blood, that it will pass through a moist bladder to
combine with it, according to the experiment of Dr.
Priestley. Secondly, because the poisons of venomous
creatures are supposed to be acids of different kinds,
and are probably formed by the contact of air after
their secretion. And lastly, because the contagious
matter from other ulcers, as in itch, or small-pox, are
formed on external membranes, and are probably
combinations of animal matter and oxygen, producing
other new acids; but further experiments must deter-
mine this question.
Aa4 It

360 DISEASES [CLASS II. 1. 6.
It was thought a subject of consequence by the
Æsculapian Society at Edinburgh, to find a criterion
which should distinguish pus from mucus, for the pur-
pose of more certainly discovering the presence of
ulcers in pulmonary diseases, or in the urinary pas-
sages. For this purpose that society offered their first
gold medal, which was conferred on the late Mr.
Charles Darwin, in the year 1778, for his experiments
on this subject. From which he deduces the follow-
ing conclusions:
"1. Pus and mucus are both soluble in the vitri-
olic acid, though in very different proportions, pus
being much the less soluble.
"2. The addition of water to either of these com-
pounds decomposes it; the mucus thus separated,
either swims on the mixture, or forms large flocci
in it; whereas the pus falls to the bottom, and forms
on agitation a uniform turbid mixture.
"3. Pus is diffusible through a diluted vitriolic acid,
though mucus is not; the same occurs with water,
or a solution of sea salt.
"4. Nitrous acid dissolves both pus and mucus;
water added to the solution of pus produces a pre-
cipitate; and the fluid above becomes clear and green;
while water and the solution of mucus form a dirty
coloured fluid.
"5. Alkaline lixivium dissolves (though sometimes
with difficulty) mucus, and generally pus.
"6. Water precipitates pus from such a solution,
but does not mucus.
"7. Where

CLASS II. 1. 6.] OF SENSATION 361
"7. Where alkaline lixivium does not dissolve pus,
it still distinguishes it from mucus; as it then prevents
its diffusion through water.
"8. Coagulable lymph is neither soluble in diluted
nor concentrated vitriolic acid.
"9. Water produces no change on a solution of se-
rum in alkaline lixivium, until after long standing,
and then only a very slight sediment appears.
"10. Corrosive sublimate coagulates mucus, but does
not pus.
"From the above experiments it appears, that strong
vitriolic acid and water, diluted vitriolic acid, and
caustic alkaline lixivium and water will serve to dis-
tinguish pus from mucus; that the vitriolic acid can
separate it from coagulable lymph, and alkaline lix-
ivium from serum.
"And hence, when a person has any expectorated
material, the composition of which he wishes to ascer-
tain, let him dissolve it in vitriolic acid, and in caustic
alkaline lixivium; and then add pure water to both
solutions: and if there is a fair precipitation in each,
he may be assured that some pus is present. If in
neither a precipitation occurs, it is a certain test, that
the material is entirely mucus. If the material cannot
be made to dissolve in alkaline lixivium by time and
trituration, we have also reason to believe that it is pus."
Experiments on Pus and Mucus. Cadell. London.
7. Phthisis pulmonalis. In pulmonary consumption
the fever is generally supposed to be the consequence
of

362 DISEASES [CLASS II. 1. 6.
of the stimulus of absorbed matter circulating in the
blood-vessels, and not simply of its stimulus on their
extremities in the surface of the ulcers; as mentioned
in Class II. 1. 5. and Class II. 1. 3. 9. The ulcers
are probably sometimes occasioned by the putrid
acrimony of effused blood remaining in the air-cells
of the lungs after an hæmoptoe. See Class I. 2. 1.
9. The remote cause of consumption is ingeniously
ascribed by Dr. Beddoes to the hyper-oxygenation of
the blood, as mentioned Section XXVIII. 2.
As the patients liable to consumption are of the
inirritable temperament, as appears by the large pupils
of their eyes; there is reason to believe, that the
hæmoptoe is immediately occasioned by the deficient
absorption of the blood at the extremities of the
bronchial vein; and that one difficulty of healing the
ulcers is occasioned by the deficient absorption of the
fluids effused into them. See Sect. XXX. 1. and 2.
The difficulty of healing pulmonary ulcers may be
owing, as its remote cause, to the incessant motion of
all the parts of the lungs; whence no scab, or indu-
rated mucus, can be formed so as to adhere on them.
Whence these naked ulcers are perpetually exposed to
the action of the air on their surfaces, converting their
mild purulent matter into a contagious ichor; which not
only prevents them from healing, but by its action on
their circumferences, like the matter of itch or tinea,
contributes to spread them wider. See the preceding
article and Sect. XXXIII. 2. 7. where the pulmonary
phthisis is supposed to be infectious.
This

CLASS II. 1. 6.] OF SENSATION. 363
This acidifying principle is found in all the metallic
calces, as in lapis calaminaris, which is a calciform
ore of zinc; and in cerussa, which is a calx of lead;
two materials which are powerful in healing excoria-
tions, and ulcers in a short time by their external
application. How then does it happen, that the
oxygen in the atmosphere should prevent pulmonary
ulcers from healing, and even induce them to spread
wider; and yet in its combination with metals, it
should facilitate their healing? The healing of ulcers
consists in promoting the absorption of the fluids effused
into them, as treated of in Section XXXIII. 3. 2.
Oxygen in combination with metals, when applied in
certain quantity, produces this effect by its stimulus;
and the metallic oxydes not being decomposed by their
contact with animal matter, no new acid, or contagious
material, is produced. So that the combined oxygen,
when applied to an ulcer, simply I suppose promotes
absorption in it, like the application of other materials
of the articles sorbentia or incitantia, if applied exter-
nally; as opium, bark, alum. But in the pulmonary
ulcers, which cannot protect themselves from the air
by forming a scab, the uncombined oxygen of the
atmosphere unites with the purulent matter, converting
it into a contagious ichor; which by infection, not by
erosion, enlarges the ulcers, as in the itch or tinea;
which might hence, according to Dr. Beddoes's inge-
nious theory of consumption, be induced to heal, if
exposed to an atmosphere deprived of a part of its
oxygen. This I hope future experiments will confirm,
and

364 DISEASES [CLASS II. 1. 6.
and that the pneumatic medicine will alleviate the
evils of mankind in many other, as well as in this
most fatal malady.
M. M. First, the respiration of air lowered by an
additional quantity of azote, or mixed with some
proportion of hydrogen, or of carbonic acid air, may
be tried; as described in a late publication of Dr.
Beddoes on the medicinal use of factitious airs. John-
son, London. Or lastly, by breathing a mixture of
one tenth part of hydro-carbonate mixed with common
air, according to the discovery of Mr. Watt, which
has a double advantage in these cases, of diluting the
oxygen of the atmospheric air, and inducing sickness,
which increases pulmonary absorption, as mentioned
below. An atmosphere diluted with fixed air (car-
bonic acid) might be readily procured by setting tubs
of new wort, or fermenting beer, in the parlour and
lodging-room of the patient. For it is not acids
floating in the air, but the oxygen or acidifying prin-
ciple, which injures or enlarges pulmonary ulcers by
combining with the purulent matter.
Another easy method of adding carbonic acid gas
to the air of a room, would be by means of an appa-
ratus invented by Mr. Watt, and sold by Bolton and
Watt at Birmingham, as described in Dr. Beddoes'
Treatise on Pneumatic Medicine. Johnson, London.
It consists of an iron pot, with an arm projecting, and
a method of letting water drop by slow degrees on
chalk, which is to be put into the iron pot, and
exposed to a moderate degree of heat over a com-
mon

CLASS II. 1. 6.] OF SENSATION. 365
mon fire. By occasionally adding more and more
chalk, carbonic acid gas might be carried through a
tin pipe from the arm of the iron pot to any part of
the room near the patient, or from an adjoining room.
In the same manner a diffusion of solution of flowers
of zinc might be produced and breathed by the
patient, and would be likely much to contribute to
the healing of pulmonary ulcers; as observed by Mr.
Watt. See the treatise above mentioned.
Breathing over the vapour of caustic volatile alkali
might easily be managed for many hours in a day;
which might neutralize the acid poison formed on
pulmonary ulcers by the contact of oxygen, and thus
prevent its deleterious quality, as other acids become
less caustic, when they are formed into neutral salts
with alkalis. The volatile salt should be put into a
tin canister, with two pipes like horns from the top
of it, one to suck the air from, and the other to
admit it.
Secondly, the external ulcers in scrophulous habits
are pale and flabby, and naturally disinclined to heal,
the deposition of fluids in them being greater than
the absorption; these ulcers have their appearance
immediately changed by the external application of
metallic calxes, and the medicines of the article Sor-
bentia, such as cerussa and the bark in fine powder,
see Class I. 2. 3. 21. and are generally healed in a
short time by these means. Induced by these obser-
vations, I wished to try the external application of
such powders to ulcers in the lungs, and constructed
a box

366 DISEASES [CLASS II. 1. 6.
a box with a circulating brush in it, as described in
the annexed plate; into this box two ounces of fine
powder of Peruvian bark were put, and two drams
of cerussa in fine powder; on whirling the central
brush, part of this was raised into a cloud of powder,
and the patient, applying his mouth to one of the tin
pipes rising out of the box, inhaled this powder
twice a day into his lungs. I observed it did not
produce any cough or uneasiness. This patient was
in the last stage of consumption, and was soon tired
of the experiment, nor have I had such patients as I
wished for the repetition of it. Perhaps a fine powder
of manganese, or of the flowers of zinc, or of lapis
calaminaris, might be thus applied to ulcers of the
lungs with greater advantage? Perhaps air impreg-
nated with flowers of zinc in their most comminuted
state, might be a better way of applying this powder
to the lungs, as discovered by Mr. Watt. See Dr.
Beddoes on Pneumatic Medicine. Johnson.
Thirdly, as the healing of an ulcer consists in pro-
ducing a tendency to absorption on its surface greater
than the deposition on it; see Sect. XXXIII. 3. 2.
other modes of increasing pulmonary absorption, which
are perhaps more manageable than the preceding
ones, may be had recourse to; such as by producing
frequent nausea or sickness. See Sect. XXIX. 5. 1.
and Art. IV. 2. The great and sudden absorption
of fluid from the lungs in the anasarca pulmonum
by the sickness induced by the exhibition of digitalis,
astonishes those who have not before attended to it,
by

CLASS II. 1. 6.] OF SENSATION. 367
by emptying the swelled limbs, and removing the
difficulty of breathing in a few hours.
The most manageable method of using digitalis is
by making a saturated tincture of it, by infusing two
ounces of the powder of the leaves in a mixture of
four ounces of rectified spirit of wine, and four ounces
of water. Of this from 30 to 60 drops, or upwards,
from a two-ounce phial, are to be taken twice in the
morning part of the day, and to be so managed as
not to induce violent sickness. If sickness nevertheless
comes on, the patient must for a day or two omit
the medicine; and then begin it again in reduced
doses.
Mr.-, a young man about twenty, with dark
eyes, and large pupils, who had every symptom of
pulmonary ulcers, I believed to have been cured by
digitalis, and published the case in the Transactions
of the College, Vol. III. But about two years
afterwards I heard that he relapsed and died. Mr.
L-, a corpulent man, who had for some weeks
laboured under a cough with great expectoration, with
quick pulse, and difficulty of breathing, soon recovered
by the use of digitalis taken twice a day; and though
this case might probably be a peripneumonia notha, or
catarrh, it is here related as shewing the power of
pulmonary absorption excited by the use of this
drug.
Another method of inducing sickness, and pulmo-
nary absorption in consequence, is by sailing on the
sea; by which many consumptive patients have been
said

368 DISEASES [CLASS II. 1. 6.
said to have received their cure; which has been
erroneously ascribed to sea-air, instead of sea-sickness;
whence many have been sent to breathe the sea-air
on the coasts, who might have done better in higher
Situations, where the air probably contains less oxygen
gas, which is the heaviest part of it. See a Letter
from Dr. T. C. below.
A third method of inducing sickness, and conse-
quent pulmonary absorption, is by the vertigo occa-
sioned by swinging; which has lately been introduced
into practice by Dr. Smith, (Essay on Pulmonary
Consumption), who observed that by swinging the
hectic pulse became slower, which is explained in
Class IV. 2. 1. 10. The usual way of reciprocating
swinging, like the oscillations of a pendulum, pro-
duces a degree of vertigo in those, who are unused
to it; but to give it greater effect, the patient should
be placed in a chair suspended from the ceiling by
two parallel cords in contact with each other, the
chair should then be forcibly revolved 20 or 40 times
one way, and suffered to return spontaneously; which
induces a degree of sickness in most adult people,
and is well worthy an exact and pertinacious trial,
for an hour or two, three or four times a day for a
month.
The common means of promoting absorption in
ulcers, and of thickening the matter in consequence,
by taking the bark and opium internally, or by metallic
salts, as of mercury, steel, zinc, and copper, in small
quantities, have been repeatedly used in pulmonary
4 consumption;

CLASS II. 1. 6.] OF SENSATION. 369
consumption; and may have relieved some of the
symptoms. As mercury cures venereal ulcers, and as
pulmonary ulcers resemble them in their not having
a disposition to heal, and in their tendency to enlarge
themselves, there were hopes, from analogy, that it
might have succeeded. Would a solution of gold in
aqua regia be worth trying- When vinegar is applied
to the lips, it renders them instantly pale, by pro-
moting the venous absorption; if the whole skin was
moistened with warmish vinegar, would this promote
venous absorption in the lungs by their sympathy with
the skin- The very abstemious diet on milk and ve-
getables alone is frequently injurious. Flesh-meat once
a day, with small wine and water, or small beer, is
preferable. Half a grain of opium twice a day, or a
grain, I believe to be of great use at the commence-
ment of the disease, as appears from the subsequent
case.
Miss-, a delicate young lady, of a consumptive
family, when she was about eighteen, had frequent
cough, with quick pulse, a pain of her side, and the
general appearances of a beginning consumption. She
took about five drops of laudanum twice a day in a
saline draught, which was increased gradually to ten.
In a few weeks she recovered, was afterwards mar-
ried, bore three or four children, and then became
consumptive and died.
The following case of hereditary consumption is re-
lated by a physician of great ability and very extensive
practice; and, as it is his own case, abounds with
Bb much

370 DISEASES CLASS II. 1. 6.]
much nice observation and useful knowledge; and, as
it has been attended with a favourable event, may
give consolation to many, who are in a similar situa-
tion; and shews that Sydenham's recommendation of
riding as a cure for consumption is not so totally inef-
fectual, as is now commonly believed.
"J. C. aged 27, with black hair, and a ruddy
complexion, was subject to cough from the age of pu-
berty, and occasionally to spitting of blood. His ma-
ternal grandfather died of consumption under thirty
years of age, and his mother fell a victim to this dis-
ease, with which she had long been threatened, in her
43d year, and immediately after she ceased to have
children. In the severe winter of 1783-4, he was
much afflicted with cough; and being exposed to in-
tense cold, in the month of February he was seized
with peripneumony. The disease was violent and
dangerous, and after repeated bleedings as well as
blisterings, which he supported with difficulty, in
about six weeks he was able to leave his bed. At
this time the cough was severe, and the expectoration
difficult. A fixed pain remained on the left side,
where an issue was inserted; regular hectic came on
every day about an hour after noon, and every night
heat and restlessness took place, succeeded towards
morning by general perspiration.
"The patient, having formerly been subject to ague,
was struck with the resemblance of the febrile parox-
ysm, with what he had experienced under that disease,
and was willing to flatter himself it might be of the
same

CLASS II. 1. 6.] OF SENSATION. 371
same nature. He therefore took bark in the interval
of fever, but with an increase of his cough, and this
requiring venesection, the blood was found highly in-
flammatory. The vast quantity of blood which he
had lost from time to time, produced a disposition to
fainting, when he resumed the upright posture, and
he was therefore obliged to remain almost constantly
in a recumbent position. Attempting to ride out in a
carriage, he was surprised to find that he could sit up-
right for a considerable time, while in motion, without
inconvenience, though, on stopping the carriage, the
disposition to fainting returned.
"At this time, having prolonged his ride beyond the
usual length, he one day got into an uneven road at
the usual period of the recurrence of the hectic pa-
roxysms, and that day he missed it altogether. This
circumstance led him to ride out daily in a carriage at
the time the febrile accession might be expected, and
sometimes by this means it was prevented, sometimes
deferred, and almost always mitigated.
"This experience determined him to undertake a
journey of some length, and Bristol being, as is usual
in such cases, recommended, he set out on the 19th
of April, and arrived there on the 2d of May. During
the greater part of this journey (of 175 miles) his
cough was severe, and being obliged to be bled three
different times on the road, he was no longer able to
sit upright, but at very short intervals, and was
obliged to lie at length in the diagonal of a coach.
The hectic paroxysms were not interrupted during the
B2 journey,

372 DISEASES [CLASS II. 1. 6.
journey, but they were irregular and indistinct, and
the salutary effects of exercise, or rather of gestation,
were impressed on the patient's mind.
"At Bristol he stayed a month, but reaped no bene-
fit. The weather was dry and the roads dusty; the
water insipid and inert. He attempted to ride on
horseback on the downs, but was not able to bear
the fatigue for a distance of more than a hundred
yards. The necessity of frequent bleedings kept down
his strength, and his hectic paroxysms continued,
though less severe. At this time, suspecting that his
cough was irritated by the west-winds bearing the va-
pour from the sea, he resolved to try the effects of an
inland situation, and set off for Matlock in Derbyshire.
"During the journey he did not find the improve-
ment he expected, but the nightly perspirations began
to diminish; and the extraordinary fatigue he expe-
rienced proceeded evidently from his travelling in a
post-chaise, where he could not indulge in a recumbent
position. The weather at Bristol had been hot, and
the earth arid and dusty. At Matlock, during the
month of June 1784, there was almost a perpetual
drizzle, the soil was wet, and the air moist and cold.
Here, however, the patient's cough began to abate,
and at intervals he found an opportunity of riding
more or less on horseback. From two or three hun-
dred yards at a time, he got to ride a mile without
stopping; and at length he was able to sit on horse-
back during a ride from Mason's bath to the village
of Matlock along the Derwent, and round on the op-
posite

CLASS II. 1. 6.] OF SENSATION. 373
posite banks, by the works of Mr. Arkwright, back
to the house whence he started, a distance of five
miles. On dismounting, however, he was seized with
deliquium, and soon after the strength he had reco-
vered was lost by an attack of the hæmorrhoids of
the most painful kind, and requiring much loss of
blood from the parts affected.
"On reflection, it appeared that the only benefit
received by the patient was during motion, and con-
tinued motion could better be obtained in the course
of a journey than during his residence at any particular
place. This, and other circumstances of a private but
painful nature, determined him to set out from Mat-
lock on a journey to Scotland. The weather was
now much improved, and during the journey he re-
cruited his strength. Though as yet he could not sit
upright at rest for half an hour together without a
disposition to giddiness, dimness of sight, and deli-
quium, he was able to sit upright under the motion of
a post-chaise during a journey of from 40 to 70 miles
daily, and his appetite began to improve. Still his
cough continued, and his hectic flushings, though the
chills were much abated and very irregular.
"The salutary effects of motion being now more
striking than ever, he purchased a horse admirably
adapted to a valetudinarian in Dumfriesshire, and be-
ing now able to sit on horseback for an hour together,
he rode out several times a day. He fixed his resi-
dence for a few weeks at Moffat, a village at the foot
of the mountains whence the Tweed, the Clyde, and
Bb3 the

374 DISEASES [CLASS II. 1. 6.
the Annan, descend in different directions; a situation
inland, dry, and healthy, and elevated about three
hundred feet above the surface of the sea. Here his
strength recovered daily, and he began to eat animal
food, which for several months before he had not
tasted. Persevering in exercise on horseback, he gra-
dually increased the length of his rides, according to
his strength, from four to twenty miles a day; and
returning on horseback to Lancashire by the lakes of
Cumberland, he arrived at Liverpool on the first of
September, having rode the last day of his journey
40 miles.
"The two inferences of most importance to be drawn
from this narrative, are, first, the extraordinary benefit
derived from gestation in a carriage, and still more
the mixture of gestation and exercise on horseback, in
arresting or mitigating the hectic paroxysm; and se-
condly, that in the florid consumption, as Dr. Beddoes
terms it, an elevated and inland air is in certain cir-
cumstances peculiarly salutary; while an atmosphere
loaded with the spray of the sea is irritating and nox-
ious. The benefit derived in this case from exercise
on horseback, may lead us to doubt whether Syden-
ham's praise of this remedy be as much exaggerated
as it has of late been supposed. Since the publication
of Dr. C. Smyth on the effects of swinging in lower-
ing the pulse in the hectic paroxysm, the subject of this
narrative has repeated his experiments in a great va-
riety of cases, and has confirmed them. He has also
repeatedly seen the hectic paroxysm prevented, or cut
short,

CLASS II. 1. 6.] OF SENSATION. 375
short, by external ablution of the naked body with
tepid water.
"So much was his power of digestion impaired or
vitiated by the immense evacuations, and the long
continued debility he underwent, that after the cough
was removed, and indeed for several years after the
period mentioned, he never could eat animal food
without heat and flushing, with frequent pulse and
extreme drowsiness. If this drowsiness was encou-
raged, the fever ran high, and he awoke from dis-
turbed sleep, wearied and depressed. If it was reso-
lutely resisted by gentle exercise, it went off in about
an hour, as well as the increased frequency of the
pulse. This agitation was however such as to inca-
pacitate him during the afternoon for study of any
kind. The same effects did not follow a meal of milk
and vegetables, but under this diet his strength did
not recruit; whereas after the use of animal food it
recovered rapidly, notwithstanding the inconvenience
already mentioned. For this inconvenience he at last
found a remedy in the use of coffee immediately after
dinner, recommended to him by his friend Dr. Perci-
val. At first this remedy operated like a charm, but
by frequent use, and indeed by abuse, it no longer
possesses its original efficacy.
"Dr. Falconer, in his Dissertation on the Influence of
the Passions and Affections of the Mind on Health and
Disease, supposes that the cheerfulness which attends
hectic fever, the ever-springing hope, which brightens
the gloom of the consumptive patient, increases the
Bb4 diseased

376 DISEASES [CLASS II. 1. 6.
diseased actions, and hastens his doom. And hence
he is led to enquire, whether the influence of fear
might not be substituted in such cases to that of hope
with advantage to the patient? This question I shall
not presume to answer, but it leads me to say some-
thing of the state of the mind in the case just re-
lated.
"The patient, being a physician, was not ignorant
of his danger, which some melancholy circumstances
served to impress on his mind. It has already been
mentioned, that his mother and grandfather died of
this disease. It may be added, that in the year pre-
ceding that on which he himself was attacked, a sister
of his was carried off by consumption in her 17th
year; that in the same winter in which he fell ill,
two other sisters were seized with the same fatal disor-
der, to which one of them fell a victim during his
residence at Bristol, and that the hope of bidding a
last adieu to the other was the immediate cause of his
journey to Scotland, a hope which, alas! was indulged
in vain. The day on which he reached the end of his
journey, her remains were committed to the dust! It
may be conjectured from these circumstances, that
whatever benefit may be derived from the apprehension
of death, must in this case have been obtained. The
expectation of this issue was indeed for some time so
fixed that it ceased to produce much agitation; in
conformity to that general law of our nature, by
which almost all men submit with composure to a fate
that is foreseen, and that appears inevitable. As how-
ever

CLASS II. 1. 6.] OF SENSATION. 377
ever the progress of disease and debility seemed to be
arrested, the hope and the love of life revived, and
produced, from time to time, the observations and the
exertions already mentioned.
"Wine and beer were rigorously abstained from
during six months of the above history; and all the
blood which was taken was even to the last buffy."
Feb. 3, 1795.
8. Febris scrophulosa. The hectic fever occasioned
by ulcers of the lymphatic glands, when exposed to
the air, does not differ from that attending pulmonary
consumption, being accompanied with night-sweats and
occasional diarrhœa.
M. M. The bark. Opium internally. Externally
cerussa and bark in fine powder. Bandage. Sea-
bathing. See Class I. 2. 3. 21. and II. 1. 4. 12.
9. Febris ischiadica. A hectic fever from an open
ulcer between the muscles of the pelvis, which differs
not from the preceding. If the matter in this situation
lodges till part of it, I suppose, becomes putrid, and
aerates the other part; or till it becomes absorbed
from some other circumstance; a similar hectic fever is
produced, with night-sweats, or diarrhœa.
Mrs.-, after a lying in, had pain on one side
of her loins, which extended to the internal part of
the thigh on the same side. No fluctuation of matter
could be felt; she became hectic with copious night
sweats, and occasional diarrhœa, for four or five
weeks;

378 DISEASES [CLASS II. 1. 6.
weeks; and recovered by, I suppose, the total ab-
sorption of the matter, and the reunion of the walls
of the abscess. See Class II. 1. 2. 18.
10. Febris Arthropuodica. Fever from the matter
of diseased joints. Does the matter from suppurating
bones, which generally has a very putrid smell, pro-
duce hectic fever, or typhus? See Class II. 1. 4. 16.
11. Febris a pure contagioso. Fever from contagious
pus. When the contagious matters have been pro-
duced on the external habit, and in process of time
become absorbed, a fever is produced in consequence
of this reabsorption; which differs with the previous
irritability or inirritability, as well as with the sensibi-
lity of the patient.
12. Febris variolosa secundaria. Secondary fever
of small-pox. In the distinct small-pox the fever is
of the sensitive irritated or inflammatory kind; in the
confluent small-pox it is of the sensitive inirritated
kind, or typhus gravior. In both of them the swelling
of the face, when the matter there begins to be ab-
sorbed, and of the hands, when the matter there begins
to be absorbed, shew, that it stimulates the capillary
vessels or glands, occasioning an increased secretion
greater than the absorbents can take up, like the
action of the cantharides in a blister; now as the ap-
plication of a blister on the skin frequently occasions
the strangury, which shews, that some part of the
cantharides

CLASS II. 1. 6.] OF SENSATION. 379
cantharides is absorbed; there is reason to conclude,
that a part of the matter of small-pox is absorbed, and
thus produces the secondary fever. See Class II. 1.
3. 9. And not simply by its stimulus on the surface
of the ulcers beneath the scabs. The exudation of a
yellow fluid from beneath the confluent eruptions on
the face before the height is spoken of in Class II.
1. 3. 2.
The material thus absorbed in the secondary fever
of small-pox differs from that of open ulcers, as it is
only aerated through the elevated cuticle; and se-
condly, because there is not a constant supply of fresh
matter, when that already in the pustules is exhausted,
either by absorption, or by evaporation, or by its
induration into a scab. Might not the covering the
face assiduously and exactly with plasters, as with ce-
rate of calamy, or with minimum plaster, by precluding
the air from the pustules, prevent their contracting a
contagious, or acescent, or fever-producing power?
and the secondary fever be thus prevented entirely.
If the matter in those pustules on the face in the con-
fluent small-pox were thus prevented from oxygenation,
it is highly probable, both from this theory, and from
the facts before mentioned, that the matter would not
erode the skin beneath them, and by these means no
marks or scars would succeed.
13. Febris carcinomatosa. Fever from the matter
of cancer. In a late publication the pain is said to be
relieved, and the fever cured, and the cancer eradi-
cated,

380 DISEASES [CLASS II. 1. 6.
cated, by the application of carbonic acid gas, or fixed
air. See Class II. 1. 4. 16.
14. Febris venerea. From the absorption of the
matter from venereal ulcers and Suppurating bones.
See Syphilis, II. 1. 5. 2.
M. M. Any mercurial calx. Sarsaparilla? Me-
zereon?
15. Febris a sanie putrida. Fever from putrid
sanies. When parts of the body are destroyed by
external violence, as a bruise, or by mortification, a
putrefaction soon succeeds; as they are kept in that
degree of warmth and moisture by their adhesion to
the living parts of the body, which most forwards that
process. Thus the sloughs of mortified parts of the
tonsils give fetor to the breath in some fevers; the
matter from putrefying teeth, or other suppurating
bones, is particularly offensive; and even the scurf,
which adheres to the tongue, frequently acquires a
bitter taste from its incipient putridity. This material
differs from those before mentioned, as its deleterious
property depends on a chemical rather than an animal
process.
16. Febris puerpera. Puerperal fever. It appears
from some late dissections, which have been published,
of those women who have died of the puerperal fever,
that matter has been formed in the omentum, and
found in the cavity of the abdomen, with some
blood

CLASS II. 1. 6.] OF SENSATION. 381
blood or sanies. These parts are supposed to have
been injured by the exertions accompanying labour;
and as matter in this viscus may have been produced
without much pain, this disease is not attended with
arterial strength and hard full pulse like the inflamma-
tion of the uterus; and as the fever is of the inirrita-
tive or typhus kind, there is reason to believe, that the
previous exhaustion of the patient during labour may
contribute to its production; as well as the absorption
of a material not purulent but putrid; which is formed
by the delay of extravasated or dead matter produced
by the bruises of the omentum, or other viscera, in
the efforts of parturition, rather than by purulent
matter, the consequence of suppuration. The pulse
is generally about 120 when in bed and in the morn-
ing; and is increased to 134, or more, when the
patient sits up, or in the evening paroxysm. The
pulse of all very weak patients increases in frequency
when they sit up; because the expenditure of sensorial
power necessary to preserve an erect posture deducts so
much from their general strength; and hence the pulse
becomes weaker, and in consequence quicker. See
Sect. XII. 1. 4.
In this fever time must be allowed for the absorption
of the matter. Very large and repeated quantities of
the bark, by preventing sufficient food from being
taken, as bread, and wine, and water, I have thought
has much injured the patient; for the bark is not here
given as in intermittent fevers to prevent the paroxysm,
but simply to strengthen the patient by increasing the
power

382 DISEASES [CLASS II. 1. 6.
power of digestion. About two ounces of decoction
of bark, with four drops of laudanum, and a dram
of sweet spirit of vitriol, once in six hours, and a glass
of wine between those times, with panada, or other
food, I have thought of most advantage, with a small
blister occasionally.
Where not only the stomach but also the bowels
are much distended with air, so as to found on striking
them with the fingers, the case is always dangerous,
generally hopeless; which is more so in proportion
to the quickness of the pulse. Where the bowels
are distended two drops of oil of cinnamon should
be given in the panada three or four times a day.
17. Febris a sphacelo. Fever from mortification.
This fever from absorption of putrid matter is of
the inirritative or typhus kind. See the preceding
article.
M. M. Opium and the bark are frequently given in
too great quantity, so as to induce consequent debility,
and to oppress the power of digestion.
ORDO 

CLASS II. 1. 7.] OF SENSATION. 383
ORDO I.
Increased Sensation.
GENUS VII.
With increased Action of the Organs of Sense.
SPECIES.
1. Delirium febrile. Paraphrosyne. The ideas in
delirium consist of those excited by the sensation of
pleasure or pain, which precedes them, and the trains
of other ideas associated with these, and not of those
excited by external irritations or by voluntary exer-
tion. Hence the patients do not know the room which
they inhabit, or the people who surround them; nor
have they any voluntary exertion, where the delirium
is complete; so that their efforts in walking about a
room or rising from their bed are unsteady, and pro-
duced by their catenations with the immediate affec-
tions of pleasure or pain. See Section XXXIII. 1. 4.
By the above circumstances it is distinguished from
madness, in which the patients well know the per-
sons of their acquaintance, and the place where they
are; and perform all the voluntary actions with stea-
diness and determination. See Sect. XXXIV. 2. 2.
Delirium is sometimes less complete, and then a
new face and louder voice stimulate the patient to
attend to them for a few moments; and then they
relapse again into perfect delirium. At other times
a delirium affects but one sense, and the person thinks
he

384 DISEASES [CLASS II. 1. 7.
he sees things which do not exist; and is at the same
time sensible to the questions which are asked him,
and to the taste of the food which is offered to him.
This partial delirium is termed an hallucination of
the disordered organ; and may probably arise from
the origin of one nerve of sense being more liable to
inflammation than the others; that is, an exuberance
of the sensorial power of sensation may effect it; which
is therefore thrown into action by slighter sensitive
catenations, without being obedient to external stimu-
lus, or to the power of volition.
The perpetual flow of ideas in delirium is owing to
the same circumstance, as of those in our dreams;
namely, to the defect or paralysis of the voluntary
power; as in hemiplagia, when one side of the body
is paralytic, and thus expends less of the sensorial
power, the limbs on the other side are in constant mo-
tion from the exuberance of it. Whence less sensorial
power is exhausted in delirium, than at other times,
as well as in sleep; and hence in fevers with great
debility, it is perhaps, as well as the stupor, rather a
favourable circumstance; and when removed by nu-
merous blisters, the death of the patient often follows
the recovery of his understanding. See Class I. 2. 5. 6.
and I. 2. 5. 10.
Delirium in diseases from inirritability is sometimes
preceded by a propensity to surprise. See Class I.
1. 5. 12.
M. M. Fomentations of the shaved head for an
hour repeatedly. A blister on the head. Rising from
I bed.

CLASS II. 1. 7.] OF SENSATION. 385
bed. Wine and opium, and sometimes venesection in
small quantity by cupping, if the strength of the arte-
rial system will allow it.
2. Delirium maniacale. Maniacal delirium. There
is another kind of delirium, described in Sect. XXXIII.
1. 4. which has the increase of pleasurable or painful
sensation for its cause, without any diminution of the
other sensorial powers; but as this excites the patient
to the exertion of voluntary actions, for the purpose
of obtaining the object of his pleasurable ideas, or
avoiding the object of his painful ones, such as perpe-
tual prayer, when it is of the religious kind, it be-
longs to the insanities described in Class III. 1. 2. 1.
and is more properly termed hallucinatio maniacalis.
3. Delirium ebrietatis. The drunken delirium is in
nothing different from the delirium attending fevers
except in its cause, as from alcohol, or other poisons.
When it is attended with an apoplectic stupor, the
pulse is generally low; and venesection I believe some-
times destroys those, who would otherwise have reco-
vered in a few hours.
M. M. Diluting liquids. An emetic.
4. Somnium. Dreams constitute the most complete
kind of delirium. As in these no external irritations
are attended to, and the power of volition is entirely
suspended; so that the sensations of pleasure and pain,
with their associations, alone excite the endless trains
Cc of

386 DISEASES [CLASS II. 1. 7.
of our sleeping ideas; as explained in Sect. XVIII. on
sleep.
5. Hallucinatio visús. Deception of sight. These
visual hallucinations are perpetual in our dreams; and
sometimes precede general delirium in fevers; and
sometimes belong to reverie, and to insanity. See
Class III. 1. 2. 1. and 2. and must be treated accord-
ingly.
Other kinds of visual hallucinations occur by moon-
light; when objects are not seen so distinctly as to
produce the usual ideas associated with them, but ap-
pear to us exactly as they are seen. Thus the trunk
of a tree appears a flat surface, instead of a cylinder
as by day, and we are deceived and alarmed by seeing
things as they really are seen. See Berkley on Vision.
6. Hallucinatio auditús. Auricular deception fre-
quently occurs in dreams, and sometimes precedes ge-
neral delirium in fevers; and sometimes belongs to
vertigo, and to reverie, and to insanity. See Sect.
XX. 7. and Class III. 1. 2. 1. and 2.
7. Rubor a colore. The blush from heat is occa-
sioned by the increased action of the cutaneous vessels
in consequence of the increased sensation of heat. See
Class I. 1. 2. 1. and 3.
8. Rubor jucunditatis. The blush of joy is owing
to the increased action of the capillary arteries, along
with

CLASS II. 1. 7.] OF SENSATION. 387
with that of every moving vessel in the body, from
the increase of pleasurable sensation.
9. Priapismus amatorius. Amatorial priapism. The
blood is poured into the cells of the corpora cavernosa
much faster than it can be reabsorbed by the vena
penis, owing in this case to the pleasurable sensation
of love increasing the arterial action. See Class I.
1. 4. 6.
10. Distentio mamularum. The teats of female
animals, when they give sick, become rigid and erect-
ed, in the same manner as in the last article, from
the pleasurable sensation of the love of the mother to
her offspring. Whence the teat may properly be
called an organ of sense. The nipples of men do the
same when rubbed with the hand. See Class I.
1. 4. 7.
Cc2 ORDO

388 DISEASES [CLASS II. 2. 1.
ORDO II.
Decreased Sensation.
GENUS I.
Of the General System.
SPECIES.
1. Stultitia insensibilis. Folly from insensibility.
The pleasure or pain generated in the system is not
sufficient to promote the usual activity either of the
sensual or muscular fibres.
2. Tædium vitæ. Ennui. Irksomeness of life.
The pain of laziness has been thought by some philo-
sophers to be that principle of action, which has ex-
cited all our industry, and distinguished mankind from
the brutes of the field. It is certain that, where the
ennui exists, it is relieved by the exertions of our
minds or bodies, as all other painful sensations are re-
lieved; but it depends much upon our early habits,
whether we become patient of laziness, or inclined to
activity, during the remainder of our lives, as other
animals do not appear to be affected with this malady;
which is perhaps less owing to deficiency of pleasurable
sensation, than to the superabundancy of voluntary
power, which occasions pain in the muscles by its ac-
cumulation; as appears from the perpetual motions of
a squirrel confined in a cage.
3. Paresis sensitiva. Weakness of the whole system
from insensibility.
ORDO

CLASS II. 2. 1.] OF SENSATION. 389
ORDO II.
Decreased Sensation.
GENUS II.
Of Particular Organs.
SPECIES.
1. Anorexia. Want of appetite. Some elderly
people, and those debilitated by fermented liquors,
are liable to lose their appetite for animal food; which
is probably in part owing to the deficiency of gastric
acid, as well as to the general decay of the system:
elderly people will go on years without animal food;
but inebriates soon sink, when their digestion becomes
so far impaired. Want of appetite is sometimes pro-
duced by the putrid matter from many decaying teeth
being perpetually mixed with the saliva, and thence
affecting the organ of taste, and greatly injuring the
digestion.
M. M. Fine charcoal powder diffused in warm wa-
ter held in the mouth frequently in a day, as in Class
I. 1. 4. 4. or solution of alum in water. Extract the
decayed teeth. An emetic. A blister. Chalybeates.
Vitriolic acid. Bile of an ox inspissated, and made
into pills; 20 grains to be taken before dinner and
supper. Opium half a grain twice a day.
All the strength we possess is ultimately derived
from the food, which we are able to digest; whence
a total debility of the system frequently follows the
Cc3 want 

390 DISEASES [CLASS II. 2. 2.
want of appetite, and of the power of digestion.
Some young ladies I have observed to fall into this
general debility, so as but just to be able to walk
about; which I have sometimes ascribed to their volun-
tary fasting, when they believed themselves too plump;
and who have thus lost both their health and beauty
by too great abstinence, which could never be restored.
I have seen other cases of what may be termed
anorexia epileptica, in which a total loss of appetite,
and of the power of digestion, suddenly occurred
along with epileptic fits. Miss B. a girl about
eighteen, apparently very healthy, and rather plump,
was seized with fits, which were at first called hyste-
rical; they occurred at the end of menstruation, and
returned very frequently with total loss of appetite.
She was relieved by venesection, blisters, and opiates;
her strength diminished, and after some returns of the
fits, she took to her bed, and has survived 15 or 20
years; she has in general eaten half a potatoe a day,
and seldom speaks, but retains her senses, and had
many years occasional returns of convulsion. I have
seen two similar cases, where the anorexia, or want
of appetite, was in less degree; and but just so much
food could be digested, as supplied them with sufficient
strength to keep from the bed or sofa for half the
day. As well as I can recollect, all these patients
were attended with weak pulse, and cold pale skin;
and received benefit by opium, from a quarter of a
grain to a grain four times a day. See Class III. 1.
1. 7. and III. 1. 2. 1. and III. 1. 2. 20.
2. Adipsia.

CLASS II. 2. 2.] OF SENSATION. 391
2. Adipsia. Want of thirst. Several of the inferior
people, as farmers wives, have a habit of not drink-
ing with their dinner at all, or only take a spoon-
ful or two of ale after it. I have frequently ob-
served these to labour under bad digestion, and de-
bility in consequence; which I have ascribed to the
too great stimulus of solid food undiluted, destroy-
ing in process of time the irritability of the sto-
mach.
3. Impotentia (agenesia). Impotency much seldomer
happens to the male sex than sterility to the female
sex. Sometimes a temporary impotence occurs from
bashfulness, or the interference of some voluntary
exertion in the production of an effect, which should
be performed alone by pleasurable sensation.
One, who was soon to be married to a lady of
superior condition to his own, expressed fear of not
succeeding on the wedding night; he was advised to
take a grain of opium before he went to bed, and
to accustom himself to sleep with a woman previously,
but not to enjoy her, to take off his bashfulness;
which succeeded to his wish.
M. M. Chalybeates. Opium. Bark. Tincture of
cantharides.
4. Sterilitas. Barrenness. One of the ancient me-
dical writers asserts that the female sex become preg-
nant with most certainty at or near the time of
menstruation. This is not improbable, since these
Cc4 monthly

392 DISEASES [CLASS II. 2. 2.
monthly periods seem to resemble the monthly vene-
real orgasm of some female quadrupeds, which be-
come pregnant at those times only; and hence the
computation of pregnancy is not often erroneous,
though taken from the last menstruation. See Section
XXXVI. 2. 3.
M. M. Opium a grain every night. Chalybeates
in very small doses. Bark. Sea-bathing.
5. Insensibilitas artuum. As in some paralytic limbs.
A great insensibility sometimes accompanies the torpor
of the skin in cold fits of agues. Some parts have
retained the sense of heat, but not the sense of touch.
See Sect. XVI. 6.
M. M. Friction with flannel. A blister. Warmth.
6. Dysuria insensitiva. Insensibility of the bladder.
A difficulty or total inability to make water attends
some fevers with great debility, owing to the insensi-
bility or inirritability of the bladder. This is a dan-
gerous but not always a fatal symptom.
M. M. Draw off the water with a catheter. Assist
the patient in the exclusion of it by compressing the
lower parts of the abdomen with the hands. Wine
two ounces. Peruvian bark one dram in decoction,
every three hours alternately. Balsam of copaiva.
Oil of almonds, with as much camphor as can be
dissolved in it, applied as a liniment rubbed on the
region of the bladder and perinæum, and repeat-
ed every four hours, was used in this disease with
I success	

CLASS II. 2. 2.] OF SENSATION. 393
success by Mr. Latham. Med. Comment. 1791, p.
213.
7. Accumulatio alvina. An accumulation of feces
in the rectum, occasioned by the torpor, or insensi-
bility, of that bowel. But as liquids pass by these
accumulations, it differs from the constipatio alvi,
which is owing to too great absorption of the alimen-
tary canal.
Old milk, and especially when boiled, is liable to
induce this kind of costiveness in some grown persons;
which is probably owing to their not possessing sufficient
gastric acid to curdle and digest it; for as both these
processes require gastric acid, it follows, that a greater
quantity of it is necessary, than in the digestion of
other ailments, which do not previously require being
curdled. This ill digested milk not sufficiently stimu-
lating the rectum, remains till it becomes a too solid
mass. On this account milk seldom agrees with those,
who are subject to piles, by inducing costiveness and
large stools.
M. M. Extract the hardened scybala by means of
a marrow-spoon; or by a piece of wire, or of whale-
bone bent into a bow, and introduced. Injections of
oil. Castor oil, or oil of almonds, taken by the mouth.
A large clyster of smoke of tobacco. Six grains of
rhubarb taken every night for many months. Aloes.
An endeavour to establish a habit of evacuation at a
certain hour daily. See Class I. 1. 3. 5.
ORDO

394 DISEASES [CLASS II. 3. 1.
ORDO III.
Retrograde Sensitive Motions.
GENUS I.
Of Excretory Ducts.
THE retrograde action of the œsophagus in rumi-
nating animals, when they bring up the food from
their first stomach for the purpose of a second masti-
cation of it, may probably be caused by agreeable
sensation: similar to that which induces them to
swallow it both before and after this second mastica-
tion; and then this retrograde action properly belongs
to this place, and is erroneously put at the head of
the order of irritative retrograde motions. Class I. 3.
1. 1.
SPECIES.
1. Ureterum motus retrogressus. When a stone has
advanced into the ureter from the pelvis of the kidney,
it is sometimes liable to be returned by the retrograde
motion of that canal, and the patient obtains fallacious
ease, till the stone is again pushed into the ureter.
2. Urethræ motus retrogressus. There have been
instances of bougies being carried up the urethra
into the bladder most probably by an inverted motion
of this canal; for which some have undergone an
operation similar to that for the extraction of a stone.
A case is related in some medical publication, in
which

CLASS II. 3. 1.] OF SENSATION. 395
which a catgut bougie was carried into the bladder,
and after remaining many weeks, was voided piece-
meal in a semi-dissolved state. Another case is related
of a French officer, who used a leaden bougie; which
at length found its way into the bladder, and was,
by injecting crude mercury, amalgamated and voided.
In the same manner the infection from a simple
gonorrhœa is probably carried further along the course
of the urethra; and small stones frequently descend
some way into the urethra, and are again carried up
into the bladder by the inverted action of this canal.
3. Ductus choledochi motus retrogressus. The concre-
tions of bile, called gall-stones, frequently enter the
bile-duct, and give violent pain for some hours; and
return again into the gall-bladder, by the retrograde
action of this duct. May not oil be carried up this
duct, when a gall-stone gives great pain, by its retro-
grade spasmodic action- See Class I. 1. 3. 8.
M. M. Opium a grain and half.
THE

396 DISEASES [CLASS III.
THE ORDERS AND GENERA OF THE THIRD CLASS
OF DISEASES.
CLASS III.
DISEASES OF VOLITION.
ORDO I.
Increased Volition.
GENERA.
1. With increased actions of the muscles.
2. With increased actions of the organs of sense.
ORDO II.
Decreased Volition.
GENERA.
1. With decreased actions of the muscles.
2. With decreased actions of the organs of sense.
THE 

CLASS III. 1. 1.] OF VOLITION. 397
THE ORDERS, GENERA, AND SPECIES, OF THE
THIRD CLASS OF DISEASES.
CLASS III.
DISEASES OF VOLITION.
ORDO I.
Increased Volition.
GENUS I.
With Increased Actions of the Muscles.
SPECIES.
1. Factitatio. Restlessness.
2. Tremor febrilis. Febrile trembling.
3. Clamor. Screaming.
4. Risus. Laughter.
5. Convulsio. Convulsion.
debilis. weak. 
6. dolorifica. painful. 
7. Epilepsia. Epilepsy.
8. dolorifica. painful.
9. Somnambulismus. Sleep-walking.
10. Asthma convulsivum. Asthma convulsive.
11. dolorificum. painful.
12. Stridor dentium. Gnashing of the teeth.
13. Tetanus trismus. Cramp of the jaw.
14. dolorificus. painful.
15. Hydrophobia. Dread of water.
GENUS

398 DISEASES [CLASS III. 1. 2.
GENUS II.
With increased Actions of the Organs of Sense.
SPECIES.
1. Mania mutabilis. Mutable madness.
2. Studium inane. Reverie.
3. Vigilia. Watchfulness.
4. Erotomania. Sentimental love.
5. Amor sui. Vanity.
6. Nostalgia. Desire of home.
7. Spes religiosa. Superstitious hope.
8. Superbia stemmatis. Pride of family.
9. Ambitio. Ambition.
10. Maror. Grief.
11. Tædium vitæ. Irksomeness of life.
12. Desiderium pulchritudi- Loss of beauty.
nis.
13. Pauperlatis timor. Fear of poverty.
14. Lethi timor. of death.
15. Orci timor. of hell. 
16. Satyriasis. Lust.
17. Ira. Anger.
18. Rabies. Rage.
19. Citta. Depraved appetite.
20. Cacositia. Aversion to food.
21. Syphilis imaginaria. Imaginary pox.
22. Psora imaginaria. itch.
23. Tabes imaginaria. tabes.
24. Sympathia aliena. Pity.
25. Educatio heroica. Heroic education.
ORDO

CLASS III. 2. 1.] OF VOLITION. 399
ORDO II.
Decreased Volition.
GENUS I.
With decreased Actions of the Muscles.
SPECIES.
1. Lassitudo. Fatigue.
2. Vacillatio senilis. See-saw of old age.
3. Tremor senilis. Tremor of old age.
4. Brachiorum paralysis. Palsy of the arms.
5. Raucedo paralytica. Paralytic hoarseness.
6. Vesicæ urinariæ paraly- Palsy of the bladder.
sis.
7. Recli paralysis. Palsy of the rectum.
8. Paresis voluntaria. Voluntary debility.
9. Catalepsis. Catalepsy.
10. Hemiplegia. Palsy of one side.
11. Paraplegia. Palsy of the lower limbs.
12. Somnus. Sleep.
13. Incubus. Night-mare.
14. Lethargus. Lethargy.
15. Syncope epileptica. Epileptic fainting.
16. Apoplexia. Apoplexy.
17. Mors a frigore. Death from cold.
GENUS

400 DISEASES [CLASS III. 2. 2.
GENUS II.
With decreased Actions of the Organs of Sense.
SPECIES.
1. Recollectionis jactura. Loss of recollection.
2. Siultitia voluntaria. Voluntary folly.
3. Credulitas. Credulity.
CLASS

CLASS III. 1. 1.] OF VOLITION. 401
CLASS III.
DISEASES OF VOLITION.
ORDO I.
IncreaSed Volition.
GENUS I.
Increased Actions of the Muscles.
WE now step forward to consider the diseases of
volition, that superior faculty of the sensorium, which
gives us the power of reason, and by its facility of
action distinguishes mankind from brute animals; which
has effected all that is great in the world, and super-
imposed the works of art on the situations of nature.
Pain is introduced into the system either by excess
or defect of the action of the part. (Sect. IV. 5.)
Both which circumstances seem to originate from the
accumulation of sensorial power in the affected organ.
Thus when the skin is exposed to great cold, the
activity of the cutaneous vessels is diminished, and in
consequence an accumulation of sensorial power obtains
in them, because they are usually excited into incessant
motion by the stimulus of heat, as explained in Sect.
XII. 5. 2. Contrarywise, when the vessels of the skin
are exposed to great heat, an excess of sensorial power
is also produced in them, which is derived thither
by the increase of stimulus above what is natural.
This accounts for the relief which is received in all
kinds of pain by any violent extertions of our muscles
Dd or

402 DISEASES [CLASS III. 1. 1.
or organs of sense; which may thus be in part as-
cribed to the exhaustion of the sensorial power by such
exertions. But this relief is in many cases so instan-
taneous, that it seems nevertheless probable, that it is
also in part owing to the different manner of progres-
sion of the two sensorial powers of sensation and voli-
tion; one of them commencing at some extremity of
the sensorium, and being propagated towards the cen-
tral parts of it; and the other commencing in the
central parts of the sensorium, and being propagated
towards the extremities of it; as mentioned in Sect.
XI. 2. 1.
These violent voluntary exertions of our muscles or
ideas to relieve the sensation of pain constitute convul-
sions and madness; and are distinguished from the
muscular actions owing to increased sensation, as in
sneezing, or coughing, or parturition, or ejectio se-
minis, because they do not contribute to dislodge the
cause, but only to prevent the sensation of it. In two
cases of parturition, both of young women with their
first child, I have seen general convulsions occur from
excess of voluntary exertion, as above described, in-
stead of the actions of particular muscles, which ought
to have been excited by sensation for the exclusion of
the fetus. They both became insensible, and died
after some hours; from one of them the fetus was
extracted in vain. I have heard also of general con-
vulsions being excited instead of the actions of the mus-
culi accelerators in the ejectio seminis, which termi-
nated fatally. See Class III. 1. 1. 7.
These		

CLASS III. 1. 1.] OF VOLITION. 403
These violent exertions are most frequently excited
in consequence of those pains, which originate from
defect of the action of the part. See Sect. XXXIV.
1. and 3. The pains from excess and defect of the
action of the part are distinguishable from each other
by the former being attended with increase of heat in
the pained part, or of the whole body; while the
latter not only exist without increase of heat in the
pained part, but are generally attended with coldness
of the extremities of the body.
As soon as these violent actions of our muscular or
sensual fibres for the purpose of relieving pain cease to
be exerted, the pain recurs; whence the reciprocal
contraction and relaxation of the muscles in convulsion,
and the intervals of madness. Otherwise these violent
exertions continue, till so great a part of the sensorial
power is exhausted, that no more of it is excitable by
the faculty of volition; and a temporary apoplexy
succeeds, with snoring as in profound sleep; which so
generally terminates epileptic fits.
When these voluntary exertions become so connect-
ed with certain disagreeable sensations, or with irri-
tations, that the effort of the will cannot restrain
them, they can no longer in common language be
termed voluntary; but nevertheless belong to this
class, as they are produced by excess of volition, and
may still not improperly be called depraved voluntary
actions. See Sect. XXXIV. 1. where many motions
in common language termed involuntary are shewn to
depend on excess of volition.
Dd2 When

404 DISEASES [CLASS III. 1. 1.
When these exertions from excess of volition, which
in common language are termed involuntary motions,
either of mind or body, are perpetually exerted in
weak constitutions, the pulse becomes quick; which
is occasioned by the too great expenditure of the sen-
sorial power in these unceasing modes of activity. In
the same manner as in very weak people in fevers, the
pulse sometimes increases in frequency to 140 strokes
in a minute, when the patients stand up or endeavour
to walk; and subsides to 110, when they lie down
again in their beds. Whence it appears, that when
a very quick pulse accompanies convulsion or insanity,
it simply indicates the weakness of the patient; that is,
that the expenditure of sensorial power is too great
for the supply of it. But if the strength of the pa-
tient is not previously exhausted, the exertions of the
muscles are attended with temporary increase of circu-
lation, the reciprocal swellings and elongations of their
bellies push forwards the arterial blood, and promote
the absorption of the venous blood; whence a tempo-
rary increase of secretion and of heat, and a stronger
pulse.
SPECIES.
1. Factitatio. Restlessness. There is one kind of
restlessness attending fevers, which consists in a fre-
quent change of posture to relieve the uneasiness of the
pressure of one part of the body upon another, when
the sensibility of the system, or of some parts of it, is
increased by inflammation, as in the lumbago; which
may

CLASS III. 1. 1.] OF VOLITION. 405
may sometimes be distinguished in its early stage by
the incessant desire of the patient to turn himself in bed.
But there is another restlessness, which approaches
towards writhing or contortions of the body, which is
a voluntary effort to relieve pain; and may be esteemed
a slighter kind of convulsion, not totally unrestrainable
by opposite or counter-acting volitions.
M. M. A blister. Opium. Warm bath.
2. Tremor febrilis. Reciprocal convulsions of the
subcutaneous muscles, originating from the pain of
the sense of heat, owing to defect of its usual stimulus,
and consequent accumulation of sensorial power in it.
The actual deficiency of heat may exist in one part of
the body, and the pain of cold be felt most vividly in
some other part, associated with it by sensitive sym-
pathy. So a chillness down the back is first attended
to in ague-fits, though the disease perhaps commences
with the torpor and consequent coldness of some inter-
nal viscus. But in whatever part of the system the
defect of heat exists, or the sensation of it, the con-
vulsions of the subcutaneous muscles exerted to relieve
it are very general; and, if the pain is still greater, a
chattering of the teeth is added, the more suddenly to
exhaust the sensorial power, and because the teeth are
very sensible to cold.
These convulsive motions are nevertheless restrain-
able by violent voluntary counteraction; and as their
intervals are owing to the pain of cold being for a
time relieved by their exertions, they may be compared
Dd3 to

406 DISEASES [CLASS III. 1. 1.
to laughter, except that there is no interval of pleasure
preceding each moment of pain in this as in the latter.
M. M. See I. 2. 2. 1.
3. Clamor. Screaming from pain. The talkative
animals, as dogs, and swine, and children, scream
most, when they are in pain, and even from fear; as
they have used this kind of exertion from their birth
most frequently and most forcibly; and can therefore
sooner exhaust the accumulation of sensorial power in
the affected muscular or sensual organs by this mode of
exertions; as described in Sect. XXXIV. 1. 3. This
facility of relieving pain by screaming is the source of
laughter, as explained below.
4. Risus. The pleasurable sensations, which occa-
sion laughter, are perpetually passing into the bounds
of pain; for pleasure and pain are often produced by
different degrees of the same stimulus; as warmth,
light, aromatic or volatile odours, become painful by
their excess; and the tickling on the soles of the feet
in children is a painful sensation at the very time it
produces laughter. When the pleasurable ideas,
which excite us to laugh, pass into pain, we use some
exertion, as a scream, to relieve the pain, but soon
stop it again, as we are unwilling to lose the pleasure;
and thus we repeatedly begin to scream, and stop
again, alternately. So that in laughing there are three
stages, first of pleasure, then pain, then an exertion
to relieve that pain. See Sect. XXXIV. 1. 3.
Every

CLASS III. 1. 1.] OF VOLITION. 407
Every one has been in a situation, where some
ludicrous circumstances has excited him to laugh; and
at the same time a sense of decorum has forbid the ex-
ertion of these interrupted screams; and then the pain
has become so violent, as to occasion him to use some
other great action, as biting his tongue, and pinching
himself, in lieu of the reiterated screams which consti-
tute laughter.
5. Convulsio. Convulsion. When the pains from
defect or excess of motion are more distressing than
those already described, and are not relievable by such
partial exertions, as in screaming, or laughter, more
general convulsions occur; which vary perhaps ac-
cording to the situation of the pained part, or to some
previous associations formed by the early habits of
life. When these convulsive motions bend the body
forwards, they are termed emprosthotonoi; when
they bend it backward, they are termed opisthotonoi.
They frequently succeed each other, but the opistho-
tonoi are generally more violent; as the muscles,
which erect the body, and keep it erect, are naturally
in more constant and more forcible action than their
antagonists.
The causes of convulsion are very numerous, as
from toothing in children, from worms or acidity in
their bowels, from eruption of the distinct small-pox,
and lastly, from breathing too long the air of an un-
ventilated bed-room. Sir G. Baker, in the Trans-
actions of the College, described this disease, and de-
Dd4 tected

408 DISEASES [CLASS III. 1. 1.
tected its cause; where many children in an orphan 
house were crowded together in one chamber without
a chimney, and were almost all of them affected with
convulsion; in the hospital at Dublin, many died of
convulsions before the real cause was understood.
See Dr. Beddoes's Guide to Self-preservation. In a
large family, which I attended, where many female
servants slept in one room, which they had contrived
to render inaccessible to every blast of air; I saw four
who were thus seized with convulsions, and who were
believed to have been affected by sympathy from the
first who fell ill. They were removed into more airy
apartments, but were some weeks before they all re-
gained their perfect health.
Convulsion is distinguished from epilepsy, as the pa-
tient does not intirely lose all perception during the
paroxysm. Which only shews, that a less exhaustion
of sensorial power renders tolerable the pains which
cause convulsion, than those which cause epilepsy.
The hysteric convulsions are distinguished from those,
owing to other causes, by the presence of the expec-
tation of death, which precedes and succeeds them,
and generally by a flow of pale urine; these convul-
sions do not constantly attend the hysteric disease, but
are occasionally superinduced by the disagreeable sen-
sation arising from the torpor or inversion of a part of
the alimentary canal. Whence the convulsion of
laughter is frequently sufficient to restrain these hysteric
pains, which accounts for the fits of laughter fre-
quently attendant on this disease.
M. M. To

CLASS III. 1. 1.] OF VOLITION. 409
M. M. To remove the peculiar pain which excites
the convulsions. Venesection. An emetic. A ca-
thartic with calomel. Warm-bath. Opium in large
quantities, beginning with smaller ones. Mercurial
frictions. Electricity. Cold-bath in the paroxysm;
or cold aspersion. See Memoirs of Med. Society, Lon.
V. 3. p. 147. a paper by Dr. Currie.
Convulsio debilis. The convulsions of dying animals,
as of those which are bleeding to death in the slaugh-
ter-house, are an effort to relieve painful sensation,
either of the wound which occasions their death, or of
faintness from want of due distention of the blood-ves-
sels. Similar to this in a less degree is the subsultus
tendinum, or starting of the tendons, in fevers with
debility; these actions of the muscles are too weak to
move the limb, but the belly of the acting muscles is
seen to swell, and the tendon to be stretched. These
weak convulsions, as they are occasioned by the dis-
agreeable sensation of faintness from inanition, are
symptoms of great general debility, and thence fre-
quently precede the general convulsions of the act of
dying. See a case of convulsion of a muscle of the
arm, and of the fore-arm, without moving the bones
to which they were attached, Sect. XVII. 1. 8. See
twitchings of the face, Class IV. 3. 2. 2.
6. Convulsio dolorisica. Raphania. Painful con-
vulsion. In this disease the muscles of the arms and
legs are exerted to relieve the pains left after the rheu-
matism in young and delicate people; it recurs once or
twice

410 DISEASES [CLASS III. 1. 1.
twice a day, and has been mistaken for the chorea, or
St. Vitus's dance; but differs from it, as the undue
motions in that disease only occur, when the patient
endeavours to exert the natural ones; are not attended
with pain; and cease, when he lies down without
trying to move: the chorea, or dance of St. Vitus, is
often introduced by the itch, this by the rheumatism.
It has also been improperly called nervous rheuma-
tism; but is distinguished from rheumatism, as the
pains recur by periods once or twice a day; whereas
in the chronic rheumatism they only occur on moving
the affected muscles. And by the warmth of a bed
the pains of the chronic rheumatism are increased, as
the muscles or membranes then become more sensible
to the stimulus of the extraneous mucaginous material
deposited under them. Whereas the pains of the ra-
phania, or painful convulsions, commence with cold-
ness of the part, or of the extremities. See Rheumatis-
mus chronicus, Class I. 1. 3. 12.
The pains which accompany the contractions of the
muscles in this disease, seem to arise from the too great
violence of those contractions, as happens in the cramp
of the calf of the leg; from which they differ in those
being fixed, and these being reiterated contractions.
Thus these convulsions are generally of the lower
limbs, and recur at periodical times from some uneasy
sensation from defect of action, like other periodic
diseases; and the convulsions of the limbs relieve the
original uneasy painful sensation, and then produce a
greater pain from their own too vehement contrac-
tions. There is however another way of accounting
for

CLASS III. 1. 1.] OF VOLITION. 411
for these pains, when they succeed the acute rheuma-
tism; and that is by the coagulable lymph, which
may be left still unabsorbed on the membranes; and
which may be in too small quantity to affect them
with pain in common muscular exertions, but may
produce great pain, when the bellies of the muscles
swell to a larger bulk in violent action.
M. M. Venesection. Calomel. Opium. Bark.
One grain of calomel and one of opium for ten suc-
cessive nights. A bandage spread with emplastrum de
minio put tight on the affected part.
7. Epilepsia is originally induced, like other convul-
sions, by a voluntary exertion to relieve some pain.
This pain is most frequently about the pit of the sto-
mach, or termination of the bile-duct; and in some
cases the torpor of the stomach, which probably occa-
sioned the epileptic fits, remains afterwards, and pro-
duces a chronical anorexia; of which a case is related
in Class II. 2. 2. 1. There are instances of its begin-
ning in the heel, of which a case is published by Dr.
Short, in the Med. Essays, Edinb. I once saw a
child about ten years old, who frequently fell down
in convulsions, as she was running about in play; on
examination a wart was found on one ancle, which
was ragged and inflamed; which was directed to be
cut off, and the fits never recurred.
When epilepsy first commences, the patients are
liable to utter one scream before they fall down;
afterwards the convulsions so immediately follow the
pain,

412 DISEASES [CLASS III. 1. 1.
pain, which occasions them, that the patient does not
recollect or seem sensible of the preceding pain. Thus
in laughter, when it is not excessive, a person is not
conscious of the pain, which so often recurs, and causes
the successive screams or exertions of laughter, which
give a temporary relief to it.
Epileptic fits frequently recur in sleep from the in-
crease of sensibility at that time, explained in Sect.
XVIII. 14. In two such cases, both of young women,
one grain of opium given at night, and continued many
months, had success; in one of them the opium was
omitted twice at different times, and the fit recurred
on both the nights. In the more violent case, de-
scribed in Sect. XVIII. 15. opium had no effect.
Epileptic fits generally commence with setting the
teeth, by which means the tongue is frequently wound-
ed; and with rolling the eye-balls in every kind of
direction; for the muscles which suspend the jaw, as
well as those which move the eyes, are in perpetual
motion during our waking hours; and yet continue
subservient to volition; hence their more facile and
forcible actions for the purpose of relieving pain by
the exhaustion of sensorial power. See Sect. XXXIV.
1. 4.
Epileptic convulsions are not attended with the fear
of death, as in the hysteric disease, and the urine is of
a straw colour. However it must be noted, that the
disagreeable sensations in hysteric diseases sometimes
are the cause of true epileptic convulsions, of syncope,
and of madness.
The

CLASS III. 1. 1.] OF VOLITION. 413
The pain, which occasions some fits of epilepsy, is
felt for a time in a distant part of the system, as in a
toe or heel; and is said by the patient gradually to
ascend to the head, before the general convulsions
commence. This ascending sensation has been called
aura epileptica, and is said to have been prevented
from affecting the head by a tight bandage round the
limb. In this malady the pain, probably of some tor-
pid membrane, or diseased tendon, is at first only so
great as to induce slight spasms of the muscular fibres,
in its vicinity; which slight spasms cease on the numb-
ness introduced by a tight bandage; when no bandage
is applied, the pain gradually increases, till generally
convulsions are exerted to relieve it. The course of
a lymphatic, as when poisonous matter is absorbed;
or of a nerve, as in the sciatica, may, by the sympathy
existing between their extremities and origins, give
an idea of the ascent of an aura or vapour.
In difficult parturition it sometimes happens, that
general convulsions are excited to relieve the pain of
labour, instead of the exertions of those muscles of the
abdomen and diaphragm, which ought to forward the
exclusion of the child. See Class III. 1. 1. That is,
instead of the particular muscular actions, which ought
to be excited by sensation to remove the offending
cause, general convulsions are produced by the power
of volition, which still the pain, as in common epilepsy,
without removing the cause; and, as the parturition
is not thus promoted, the convulsions continue, till
the sensorial power is totally exhausted, that is, till
death.

414 DISEASES [CLASS III. 1. 1.
death. In patients afflicted with epilepsy from other
causes, I have seen the most violent convulsions recur
frequently during pregnancy without miscarriage, as
they did not tend to forward the exclusion of the fetus.
M. M. Venesection. A large dose of opium. De-
livery.
The later in life epileptic fits are first experienced,
the more dangerous they may be esteemed in general;
as in these cases the cause has generally been acquired
by the habits of the patient, or by the decay of some
part, and is thus probably in an increasing state.
Whereas in children the changes in the system, as they
advance to puberty, sometimes remove the cause. So
in toothing, fits of convulsion with stupor frequently
occur, and cease when the tooth advances; but this
is not to be expected in advanced life. Sir -,
about sixty years of age, had only three teeth left in
his upper jaw, a canine tooth, and one on each side
of it. He was seized with epileptic fits, with pain
commencing in these teeth. He was urged to have
them extracted, which he delayed too long, till the fits
were become habitual, and then had them extracted
in vain, and in a few months sunk under the disease.
Mr. F-, who had lived intemperately, and had
been occasionally affected with the gout, was suddenly
seized with epileptic fits; the convulsions were suc-
ceeded by apoplectic snoring; from which he was, in
about 20 minutes, disturbed by fresh convulsions, and
had continued in this situation above four-and-twenty
hours. About eight ounces of blood were then taken
from

CLASS III. 1. 1.] OF VOLITION. 415
from him; and after having observed, that the apo-
plectic's torpor continued about 20 minutes, I directed
him to be forcibly raised up in bed, after he had thus
lain about fifteen minutes, to gain an interval between
the termination of the sleep, and the renovation of
convulsion. In this interval he was induced to swal-
low forty drops of laudanum. Twenty more were
given him in the same manner in about half an hour,
both which evidently shortened the convulsion fits,
and the consequent stupor; he then took thirty more
drops, which for the present removed the fits. He
became rather insane the next day, and after about
three more days lost the insanity, and recovered his
usual state of health.
The case mentioned in Sect. XXVII. 2. where the
patient was left after epileptic fits with a suffusion
of blood beneath the tunica adjunctiva of the eye, was
in almost every respect similar to the preceding, and
submitted to the same treatment. Both of them suf-
fered frequent relapses, which were relieved by the
same means, and at length perished, I believe, by the
epileptic fits.
In those patients, who have not been subject to epi-
lepsy before they have arrived to about forty years of
age, and who have been intemperate in respect to spiri-
tuous potation, I have been induced to believe, that
the fits were occasioned by the pain of a diseased
liver; and this became more probable in one of the
above subjects, who had used means to repel eruptions
on the face; and thus by some stimulant application
4 had

416 DISEASES [CLASS III. 1. 1.
had prevented an inflammation taking place on the
skin of the face instead of on some part of the liver.
Secondly, as in these cases insanity had repeatedly oc-
curred, which could not be traced from an hereditary
source; there is reason to believe, that this as well as
the epileptic convulsions were caused by spirituous po-
tation; and that this therefore is the original source
both of epilepsy and of insanity in those families,
which are afflicted with them. This idea however
brings some consolation with it; as it may be inferred,
that in a few sober generations these diseases may be
eradicated, which otherwise destroy the family.
M. M. Venesection. Opium. Bark. Steel. Ar-
senic. Opium one grain twice a day for years toge-
ther. See the preceding article.
8. Epilepsia dolorifica. Painful epilepsy. In the
common epilepsy the convulsions are immediately in-
duced, as soon as the disagreeable sensation, which
causes them, commences; but in this the pain conti-
nues long with cold extremities, gradually increasing
for two or three hours, till at length convulsions or
madness come on; which terminate the daily parox-
ysm, and cease themselves in a little time afterwards.
This disease sometimes originates from a pain about
the lower edge of the liver, sometimes in the temple,
and sometimes in the pudendum; it recurs daily for
five or six weeks, and then ceases for several months.
The pain is owing to defect of action, that is, to the
accumulation of sensorial power in the part, which
probably

CLASS III. 1. 1.] OF VOLITION. 417
probably sympathizes with some other part, as ex-
plained in Sect. XXXV. 2. XII. 5. 3. and Class II.
1. 1. 11. and IV. 2. 2. 3.
It is the most painful malady that human nature is
liable to!-See Sect. XXXIV. 1. 4.
Mrs. C- was seized every day about the same
hour with violent pain on the right side of her bowels
about the situation of the lower edge of the liver,
without fever, which increased for an hour or two,
till it became totally intolerable. After violent scream-
ing she fell into convulsions, which terminated some-
times in fainting, with or without stertor, as in com-
mon epilepsy; at other times a temporary insanity
supervened; which continued about half an hour,
and the fit ceased. These paroxysms had returned
daily for two or three weeks, and were at length
removed by large doses of opium, like the fits of
reverie or somnambulation. About half an hour be-
fore the expected return of the fit three or four
grains of opium were exhibited, and then tincture of
opium was given in warm brandy and water about
20 or 30 drops every half hour, till the eyes became
somewhat inflamed, and the nose began to itch, and
by the sharp movements of the patient, or quick
speech, an evident intoxication appeared; and then
it generally happened that the pain ceased. But the
effects of this large dose of opium was succeeded by
perpetual sickness and efforts to vomit, with great
general debility all the succeeding day.
Ee The

418 DISEASES [CLASS III. 1. 1.
The rationale of this temporary cure from the ex-
hibition of opium and vinous spirit depends on the
great expenditure of sensorial power in the increased
actions of all the irritative motions, by the stimulus
of such large quantities of opium and vinous spirit;
together with the production of much sensation, and
many movements of the organs of sense or ideas in
consequence of that sensation; and lastly, even the
motions of the arterial system become accelerated by
this degree of intoxication, all which soon exhausted
so much sensorial power as to relieve the pain; which
would otherwise have caused convulsions or insanity,
which are other means of expending sensorial power.
The general debility on the succeeding day, and the
particular debility of the stomach, attended in con-
sequence with sickness and frequent efforts to vomit,
were occasioned by the system having previously been
so strongly stimulated, and those parts in particular
on which the opium and wine more immediately acted.
This sickness continued so many hours as to break
the catenation of motions, which had daily repro-
duced the paroxysm; and thus it generally happened,
that the whole disease ceased for some weeks or
months from one great intoxication, a circumstance
not easily to be explained on any other theory.
The excess or defect of motion in any part of the
system occasions the production of pain in that part,
as in Sect. XII. 1. 6. This defect or excess of fibrous
action is generally induced by excess or defect of the
stimulus of objects external to the moving organ. But
there

CLASS III. 1. 1.] OF VOLITION. 419
there is another source of excessive fibrous action, and
consequent pain, which is from excess of volition,
which is liable to affect those muscles, that have weak
antagonists; as those which support the under jaw,
and close the mouth in biting, and those of the calf
of the leg; which are thus liable to fixed or painful
contractions, as in trismus, or locked jaw, and in the
cramp of the calf of the leg; and perhaps in some
colics, as in that of Japan: these pains, from contrac-
tion arising from excess of volition in the part from
the want of the counteraction of antagonist muscles,
may give occasional cause to epileptic fits, and may
be relieved in the same way, either by exciting irri-
tative and sensitive motions by the stimulus of opium
and wine; or by convulsions or insanity, as described
above, which are only different methods of exhausting
the general quantity of sensorial power.
Considering the great resemblance between this
kind of painful epilepsy and the colic of Japan, as
described by Kemfer; and that that disease was said
to be cured by acupuncture, or the prick of a needle;
I directed some very thin steel needles to be made about
three inches long, and of such a temper, that they
would bend double rather than break; and wrapped
wax thread over about half an inch of the blunt end
for a handle. One of these needles, when the pain
occurred, was pushed about an inch into the painful
part, and the pain instantly ceased; but I was not
certain, whether the fear of the patient, or the stimulus
of the puncture, occasioned the cessation of pain; and
Ee2 as

420 DISEASES [CLASS III. 1. 1.
as the paroxysm had continued some weeks, and was
then declining, the experiment was not tried again.
The disease is said to be very frequent in Japan, and
its seat to be in the bowels, and that the acupuncture
eliminates the air, which is supposed to distend the
bowel. But though the aperture thus made is too
small to admit of the education of air; yet as the
stimulus of so small a puncture may either excite a
torpid part into action, or cause a spasmodic one to
cease to act; and lastly, as no injury could be likely
to ensue from so small a perforation, I should be
inclined at some future time to give this a fairer trial
in similar circumstances.
Another thing worth trial at the commencement of
this deplorable disease would be electricity, by passing
strong shocks through the painful part; which, whether
the pain was owing to the inaction of that part, or of
some other membrane associated with it, might stimu-
late them into exertion; or into inactivity, if owing
to fixed painful contraction.
And lastly, the cold bath, or aspersions with cold
water on the affected part, according to the method
of Dr. Currie in the memoirs of a Med. Soc. London,
V. iii. p. 147, might produce great effect at the
commencement of the pain. Nevertheless opium duly
administered, so as to precede the expected paroxysm,
and in such doses, given by degrees, as to induce
intoxication, is principally to be depended upon in
this deplorable malady. To which should be added,
that if venesection can be previously performed, even
to

CLASS III. 1. 1.] OF VOLITION. 421
to but few ounces, the effect of the opium is much
more certain; and still more so, if there be time to
premise a brisk cathartic, or even an emetic. The
effect of increased stimulus is so much greater after
previous defect of stimulus; and this is still of greater
advantage where the cause of the disease happens to
consist in a material, which can be absorbed. See
Art. IV. 2. 8.
M. M. Venesection. An emetic. A cathartic.
Warm bath. Opium a grain every half hour. Wine.
Spirit of wine. If the patient becomes intoxicated
by the above means, the fit ceases, and violent vomit-
ings and debility succeed on the subsequent day, and
prevent a return. Blisters or sinapisms on the small
of the leg, taken off when they give much pain, are
of use in slighter convulsions. Acupuncture. Elec-
tricity. Aspersion with cold water on the painful
part.
9. Somnambulismus. Sleep-walking is a part of
reverie, or studium inane, described in Sect. XIX.
In this malady the patients have only the general
appearance of being asleep in respect to their inatten-
tion to the stimulus of external objects, but, like the
epilepsies above described, it consists in voluntary
exertions to relieve pain. The muscles are subservient
to the will, as appears by the patient's walking about,
and sometimes doing the common offices of life. The
ideas of the mind also are obedient to the will,
because their discourse is consistent, though they
Ee3 answer

422 DISEASES [CLASS III. 1. 1.
answer imaginary questions. The irritative ideas of
external objects continue in this malady, because the
patients do not run against the furniture of the room;
and when they apply their volition to their organs of
sense, they become sensible of the objects they attend
to, but not otherwise, as general sensation is destroyed
by the violence of their voluntary exertions. At the
same time the sensations of pleasure in consequence of
ideas excited by volition are vividly experienced, and
other ideas seem to be excited by these pleasurable
sensations, as appears in the case of Master A. Sect.
XXXIV. 3. 1. where a history of a hunting scene
was voluntarily recalled, with all the pleasurable ideas
which attended it. In melancholy madness the patient
is employed in voluntarily exciting one idea, with
those which are connected with it by voluntary asso-
ciations only, but not so violently as to exclude the
stimuli of external objects. In reverie variety of ideas
are occasionally excited by volition, and those which
are connected with them either by sensitive or voluntary
associations, and that so violently as to exclude the
stimuli of external objects. These two situations of
our sensual motions, or ideas, resemble convulsion and
epilepsy; as in the former the stimulus of external
objects is still perceived, but not in the latter. Whence
this disease, so far from being connected with sleep,
though it has by universal mistake acquired its name
from it, arises from excess of volition, and not from
a suspension of it; and though, like other kinds of
epilepsy, it often attacks the patients in their sleep,
yet

CLASS III. 1. 1.] OF VOLITION. 423
yet those two, whom I saw, were more frequently
seized with it while awake, the sleep-walking being
a part of the reverie. See Sect. XIX. and XXXIV.
3. and Class II. 1. 7. 4. and III. 1. 2. 18.
M. M. Opium in large doses before the expected
paroxysm.
10. Asthma convulsivum. The fits of convulsive
asthma return at periods, and are attended with cold
extremities, and so far resemble the access of an
intermittent fever; but, as the lungs are not sensible
to the pain of cold, a shivering does not succeed, but
instead of it violent efforts of respiration; which have
no tendency, as in the humoral asthma, to dislodge
any offending material, but only to relieve the pain
by exertion, like the shuddering in the beginning of
ague-fits, as explained Class III. 1. 1. 2.
The insensibility of the lungs to cold is observable
on going into frosty air from a warm room; the
hands and face become painfully cold, but no such
sensation is excited in the lungs; which is another
argument in favour of the existence of a peculiar set
of nerves for the purpose of perceiving the universal
fluid matter of heat, in which all things are immersed.
See Sect. XIV. 6. Yet are the lungs nevertheless
very sensible to the deficiency of oxygen in the
atmosphere, as all people experience, when they go
into a room crowded with company and candles, and
complain, that it is so close, they can scarcely breathe;
and the same in some hot days in summer.
Ee4 There

424 DISEASES [CLASS III. 1. 1.
There are two diseases, which bear the name of
asthma. The first is the torpor or inability of the
minute vessels of the lungs, consisting of the termina-
tions of the pulmonary and bronchial arteries and
veins, and their attendant lymphatics; in this circum-
stance it resembles the difficulty of breathing, which
attends cold bathing. If this continues long, a con-
gestion of fluid in the air-cells succeeds, as the absorb-
ent actions cease completely before the secerning
ones; as explained in Class I. 1. 2. 3. And the
coldness, which attends the inaction of these vessels,
prevents the usual quantity of exhalation. Some fits
cease before this congestion takes place, and in them
no violent sweating nor any expulsion of phlegm
occurs. This is the humoral asthma, described at
Class II. 1. 1. 7.
The second kind of asthma consists in the convulsive
actions in consequence of the disagreeable sensations
thus induced; which in some fits of asthma are very
great, as appears in the violent efforts to raise the
ribs, and to depress the diaphragm, by lifting the
shoulders. These, so long as they contribute to
remove the cause of the disease, are not properly
convulsions, but exertions immediately caused by sen-
sation; but in this kind of asthma they are only
efforts to relieve pain, and are frequently preceded by
other epileptic convulsions.
These two kinds of asthmas have so many reem-
bling features, and are so frequently intermixed, that
it often require great attention to distinguish them;
but

CLASS III. 1. 1.] OF VOLITION. 425
but as one of them is allied to anasarca, and the
other to epilepsy, we shall acquire a clearer idea of
them by comparing them with those disorders. A
criterion of the humoral or hydropic asthma is, that
it is relieved by copious sweats about the head and
breast, which are to be ascribed to the sensitive exer-
tions of the pulmonary vessels to relieve the pain
occasioned by the anasarcous congestion in the air
cells; and which is effected by the increased absorption
of the mucus, and its elimination by the retrograde
action of those lymphatics of the skin, whose branches
communicate with the pulmonary ones; and which
partial sweats do not easily admit of any other expla-
nation. See Class I. 3. 2. 8. Another criterion of it
is, that it is generally attended with swelled legs, or
other symptoms of anasarca. A criterion of the con-
vulsive asthma may be had from the absence of these
cold clammy sweats of the upper part of the body only,
and from the patient having occasionally been subject to
convulsions of the limbs, as in the common epilepsy.
It may thus frequently happen, that in the humoral
asthma some exertions of the lungs may occur, which
may not contribute to discharge the anasarcous lymph,
but may be efforts simply to relieve pain; besides
those efforts, which produce the increased absorption
and elimination of it; and thus we have a bodily
disease resembling in this circumstance the reverie, in
which both sensitive and voluntary motions are at the
same lime, or in succession, excited for the purpose of
relieving pain.
It

426 DISEASES [CLASS III. 1. 1.
It may likewise sometimes happen, that the dis-
agreeable sensation, occasioned by the congestion of
lymph in the air-cells in the humoral or hydropic
asthma, may induce voluntary convulsions of the respi-
ratory organs only to relieve the pain, without any
sensitive actions of the pulmonary absorbents to absorb
and eliminate the congestion of serous fluid; and thus
the same cause may occasionally induce either the
humoral or convulsive asthma.
The humoral asthma has but one remote cause,
which is the torpor of the pulmonary vessels, like
that which occurs on going into the cold bath; or
the want of absorption of the pulmonary lympha-
tics to take up the lymph effused into the air-cell.
Whereas the convulsive asthma, like other convulsions,
or epilepsies, may be occasioned by pain in almost
any remote part of the system. But in some of the
adult patients in this disease, as in many epilepsies, I
have suspected the remote cause to be a pain of the
liver, or of the biliary ducts.
The asthmas, which have been induced in conse-
quence of the recess of eruptions, especially of the
leprous kind, countenance this opinion. One lady I
knew, who for many years laboured under an asthma,
which ceased on her being afflicted with pain, swelling,
and distortion of some of her large joints, which were
esteemed gouty, but perhaps erroneously. And a
young man, whom I saw yesterday, was seized with
asthma on the retrocession, or ceasing of eruptions
on his face.
The

CLASS III. 1. 1.] OF VOLITION. 427
The convulsive asthma, as well as the hydropic, are
more liable to return in hot weather; which may be
occasioned by the less quantity of oxygen existing in a
given quantity of warm air, than of cold, which can
be taken into the lungs at one inspiration. They are
both most liable to occur after the first sleep, which is
therefore a general criterion of asthma. The cause of
this is explained in Sect. XVIII. 15. and applies to
both of them, as our sensibility to internal uneasy
sensation increases during sleep.
When children are gaining teeth, long before they
appear, the pain of the gums often induces convul-
sions. This pain is relieved in some by sobbing and
screaming; but in others a laborious respiration is ex-
erted to relieve the pain; and this constitutes the true
asthma convulsivum. In other children again general
convulsions, or epileptic paroxysms, are induced for
this purpose; which, like other epilepsies, become
established by habit, and recur before the irritation
has time to produce the painful sensation, which ori-
ginally caused them.
The asthma convulsivum is also sometimes induced
by worms, or by acidity in the stomachs of children,
and by other painful sensations in adults; in whom it
is generally called nervous asthma, and is often joined
with other epileptic symptoms.
This asthma is distinguished from the peripneumo-
ny, and from the croup, by the presence of fever in
the two latter. It is distinguished from the humoral
asthma, as in that the patients are more liable to run
to

428 DISEASES [CLASS III. 1. 1.
to the cold air for relief, are more subject to cold
extremities, and experience the returns of it more
frequently after their first sleep. It is distinguished
from the hydrops thoracis, as that has no intervals,
and the patient sits constantly upright, and the breath
is colder; and, where the pericardium is affected, the
pulse is quick and unequal. See Hydrops Thoracis,
I. 2. 3. 14.
M. M. Venesection once. A cathartic with calomel
once. Opium. Asafœtida. Warm bath. If the
cause can be detected, as in toothing or worms, it
should be removed. As this species of asthma is so liable
to recur during sleep, like epileptic fits, as mentioned
in Section XVIII. 15. there was reason to believe,
that the respiration of an atmosphere mixed with hy-
drogen, or any other innocuous air, which might di-
lute the oxygen, would be useful in preventing the pa-
roxysms by decreasing the sensibility of the system.
This, I am informed by Dr. Beddoes, has been used
with decided success by Dr. Ferriar. See Class II.
1. 1. 7.
11. Asthma dolorificum. Angina pectoris. The
painful asthma was first described by Dr. Heberden
in the Transactions of the College; its principal symp-
toms consist in a pain about the middle of the sternum,
or rather lower, on every increase of pulmonary or
muscular exertion, as in walking faster than usual,
or going quick up a hill, or even up stairs; with
great difficulty of breathing, so as to occasion the
patient

CLASS III. 1. 1.] OF VOLITION. 429
patient instantly to stop. A pain in the arms about
the insertion of the tendon of the pectoral muscle
generally attends, and a desire of resting by hanging
on a door or branch of a tree by the arms is some-
times observed. Which is explained in Class I. 2. 3.
14. and in Sect. XXIX. 5. 2.
These patients generally die suddenly; and on
examining the thorax no certain cause, or seat, of the
disease has been detected; some have supposed the
valves of the arteries, or of the heart, were imper-
fect; and others that the accumulation of fat about
this viscus or the lungs obstructed their due actions;
but other observations do not accord with these sup-
positions.
Mr. W —————, an elderly gentleman, was seized
with asthma during the hot part of last summer; he
always waked from his first sleep with difficult respi-
ration, and pain in the middle of his sternum, and
after about an hour was enabled to sleep again. As
this had returned for about a fortnight, it appeared to
me to be an asthma complicated with the disease,
which Dr. Heberden has called angina pectoris. It
was treated by venesection, a cathartic, and then by
a grain of opium given at going to bed, with ether
and tincture of opium when the pain or asthma re-
curred, and lastly with the bark, but was several
days before it was perfectly subdued.
This led me to conceive, that in this painful asthma
the diaphragm, as well as the other muscles of respi-
ration, was thrown into convulsive action, and that
the

430 DISEASES [CLASS III. 1. 1.
the fibres of this muscle not having proper antagonists,
a painful fixed spasm of it, like that of the muscles
in the calf of the leg in the cramp, might be the
cause of death in the angina pectoris, which I have
thence arranged under the name of painful asthma,
and leave for further investigation.
From the history of the case of the late much la-
mented John Hunter, and from the appearances after
death, the case seems to have been of this kind, com-
plicated with vertigo and consequent affection of the
stomach. The remote cause seems to have arisen from
ossifications of the coronary arteries; and the imme-
diate cause of his death from fixed spasm of the heart.
Other histories and dissections are still required to put
this matter out of doubt; as it is possible, that either
a fixed spasm of the diaphragm, or of the heart,
which are both furnished with but weak antagonists,
may occasion sudden death; and these may constitute
two distinct diseases.
Four patients I have now in my recollection, all of
whom I believed to labour under the angina pectoris
in a great degree; which have all recovered, and have
continued well three or four years by the use, as I
believe, of issues on the inside of each thigh; which
were at first large enough to contain two pieces each,
and afterwards but one. They took besides some
slight antimonial medicine for a while, and were re-
duced to half the quantity or strength of their usual
potation of fermented liquor.
The

CLASS III. 1. 1.] OF VOLITION. 431
The use of femoral issues in angina pectoris was first
recommended by Dr. Macbride, physician at Dublin,
Med. Observ. & Enquir. Vol. VI. And I was fur-
ther induced to make trial of them, not only because
the means which I had before used were inadequate,
but from the ill effect I once observed upon the lungs,
which succeeded the cure of a small fore beneath the
knee; and argued conversely, that issues in the lower
limbs might assist a difficult respiration.
Mrs. L-, about fifty, had a small sore place
about the size of half a pea on the inside of the leg a
little below the knee. It had discharged a pellucid
fluid, which she called a ley-water, daily for fourteen
years, with a great deal of pain; on which account
she applied to a surgeon, who, by means of bandage
and a saturnine application, soon healed the sore, un-
heedful of the consequences. In less than two months
after this I saw her with great difficulty of breath-
ing, which with universal anasarca soon destroyed her.
The theory of the double effect of issues, as above
related, one in relieving by their presence the asthma
dolorificum, and the other in producing by its cure an
anasarca of the lungs, is not easy to explain. Some
similar effects from cutaneous eruptions and from blis-
ters are mentioned in Class I. 1. 2. 9. In these cases
it seems probable, that the pain occasioned by issues,
and perhaps the absorption of a small quantity of
aerated purulent matter, stimulate the whole system
into greater energy of action, and thus prevent the
torpor which is the beginning of so many diseases.
In confirmation of this effect of pain on the system, I
remember

432 DISEASES [CLASS III. 1. 1.
remember the case of a lady of an ingenious and active
mind, who, for many of the latter years of her life,
was perpetually subject to great pains of her head
from decaying teeth. When all her teeth were gone,
she became quite low spirited, and melancholy in the
popular sense of that word, and after a year or two
became universally dropsical and died.
M. M. Issues in the thighs. Five grains of rhu-
barb, and one sixth of a grain of emetic tartar every
night for some months, with or without half a grain
of opium. No stronger liquor than small beer, or
wine diluted with twice its quantity of water. Since
I wrote the above I have seen two cases of hydrops
thoracis, attended with pain in the left arm, so as to
be mistaken for asthma dolorificum, in which femo-
ral issues, though applied early in the disease, had no
effect.
12. Stridor dentium. The clattering of the teeth
on going into cold water, or in the beginning of ague-
fits, is an exertion along with the tremblings of the
skin to relieve the pain of cold. The teeth and skin
being more sensible to cold than the more internal
parts, and more exposed to it, is the reason that the
muscles, which serve them, are thrown into exertion
from the pain of cold rather than those of respiration,
as in screaming from more acute pain. Thus the
poet,
Put but your toes into cold water,
Your correspondent teeth will clatter.
PRIOR.
I IN
4.

CLASS III. 1. 1.] OF VOLITION. 433
In more acute pains the jaws are gnashed together
with great vehemence, insomuch that sometimes the
teeth are said to have been broken by the force. See
Sect. XXXIV. 1.3. In these cases something should
be offered to the patients to bite, as a towel, other-
wise they are liable to tear their own arms, or to
bite their attendants, as I have witnessed in the pain-
ful epilepsy.
13. Tetanus trismus. Cramp. The tetanus consists
of a fixed spasm of almost all the muscles of the body;
but the trismus, or locked jaw, is the most frequent
disease of this kind. It is generally believed to arise
from sympathy with an injured tendon. In one case
where it occurred in consequence of a broken ancle
from a fall from a horse, it was preceded by evident
hydrophobia. Amputation was advised, but not sub-
mitted to; two wounds were laid into one with scis-
sors, but the patient died about the seventh day from
the accident. In this case the wounded tendon, like
the wounds from the bite of a mad dog, did not pro-
duce the hydrophobia, and then the locked jaw, till
several days after the accident.
I twice witnessed the locked jaw from a pain be-
neath the sternum, about the part where it is com-
plained of in painful asthma, or angina pectoris, in the
same lady at some years distance of time. The last
time it had continued two days, and she wrote her
mind, or expressed herself by signs. On observing a
broken tooth, which made a small aperture into her
Ff mouth,

434 DISEASES [CLASS III. 1. 1.
mouth, I rolled up five grains of opium like a worm
about an inch long, and introducing it over the broken
tooth, pushed it onward by means of a small crow-
quill; as it dissolved I observed she swallowed her saliva,
and in less than half an hour, she opened her mouth
and converted as usual.
Men are taught to be ashamed of screaming from pain
in their early years; hence they are prone to exert the
muscles of the jaws instead, which they have learnt to ex-
ert frequently and violently from their infancy; whence
the locked jaw. This and the following spasm have no
alternate relaxations, like the preceding ones; which is
perhaps owing, first, to the weakness of their antagonist
muscles, those which elevate the jaw being very strong
for the purpose of biting and masticating hard sub-
stances, and for supporting the under jaw, with very
weak antagonist muscles; and secondly, to their not
giving sufficient relief even for a moment to the pain,
or its preceding irritation, which excited them.
M. M. Opium in very large quantities. Mercurial
ointment used extensively. Electricity. Cold bath.
Dilate the wound, and fill it with lint moistened with
spirit of turpentine; which inflames the wound, and
cures or prevents the convulsions. See a case, Trans-
act. of American Society, Vol. II. p. 227.
Wine in large quantities in one case was more suc-
cessful than opium; it probably inflames more, which
in this disease is desirable. Between two or three ounces
of bark, and from a quart to three pints of wine a
day, succeeded better than opium. Ib.
14. Tetanus

CLASS III. 1. 1.] OF VOLITION. 435
14. Tetanus dolorificus. Painful cramp. This kind
of spasm most frequently attacks the calf of the leg,
or muscles of the toes; it often precedes paroxysms of
gout, and appears towards the end of violent diar-
rhœa, and from indigestion, or from acid diet. In
these cases it seems to sympathize with the bowels,
but is also frequently produced by the pain of external
cold, and to the too great previous extension of the
muscles, whence some people get the cramp in the ex-
tensor muscles of the toes after walking down hill,
and of those of the calf of the leg after walking up a
sleep eminence. For the reason why these cramps
commence in sleep, see Sect. XVIII. 15.
The muscle in this disease contracts itself to relieve
some smaller pain, either from irritation or association,
and then falls into great pain itself, from the too great
action of its own fibres. Hence any muscle, by being
too vehemently exerted, falls into cramp, as in swim-
ming too forcibly in water, which is painfully cold;
and a secondary pain is then induced by the too vio-
lent contraction of the muscle; though the pain,
which was the cause of the contraction, ceases. Which
accounts for the continuance of the contraction, and
distinguishes this disease from other convulsions, which
are relaxed and exerted alternately. Hence whatever
may be the cause of the primary pain, which occasions
the cramp of the calf of the leg, the secondary one is
relievable by standing up, and thus by the weight of
the body on the toes forcibly extending the contracted
muscles. For the cause, which induces these muscles
Ff2 of

436 DISEASES [CLASS III. 1. 1.
of the calf of the leg to fall into more violent contrac-
tion than other spasmodic muscles, proceeds from the
weakness of their antagonist muscles; as they are ge-
nerally extended again after action by the weight of
the body on the balls of the toes. See the preceding
article.
M. M. Rub the legs with camphor dissolved in oil,
and let the patient wear stockings in bed. If a foot-
board be put at the bed's feet, and the bed be so
inclined, that he will rest a little with his toes against
the foot-board, that pressure is said to prevent the
undue contractions of the musculi gastrocnemii, which
constitute the calf of the leg. In gouty patients, or
where the bowels are affected with acidity, half a
grain of opium, and six grains of rhubarb, and six of
chalk, every night. Flesh-meat to supper. A little
very weak warm spirit and water may be taken for
present relief, when these cramps are very troublesome
to weak or gouty patients.
15. Hydrophobia. Dread of water generally at-
tending canine madness. I was witness to a case,
where this disease preceded the locked jaw from a
wound in the ancle, occasioned by a fall from a horse;
as mentioned in the preceding article. It came on
about the sixth day after the accident; when the
patient attempted to swallow fluids, he became con-
vulsed all over from the pain of this attempt, and
spirted them out of his mouth with violence. It is
also said to happen in some hysterical cases. Hence
it

CLASS III. 1. 1.] OF VOLITION. 437
it seems rather the immediate consequence of a pained
tendon, than of a contagious poison. And is so far
analogous to tetanus, according with the opinions of
Doctor Rush and Doctor Percival.
In other respects, as it is produced by the saliva
of an enraged animal instilled into a wound, it would
seem analogous to the poison of venomous animals.
And from the manner of its access so long after the
bite, and of its termination in a short time, it would
seem to resemble the progress of contagious fevers.
See Sect. XXII. 3. 3.
If the patient was bitten in a part, which could be
totally cut away, as a finger, even after the hydro-
phobia appears, it is probable it might cure it; as I
suspect the cause still remains in the wounded tendon,
and not in a diffused infection tainting the blood.
Hence there are generally uneasy sensations, as cold
or numbness, in the old cicatrix, before the hydro-
phobia commences. See a case in Medical Commu-
nications, Vol. II. p. 190.
If the diseased tendon could be inflamed without
cutting it out, as by cupping, or caustic, or blister
after cupping, and this in the old wound long since
healed, after the hydrophobia commences, might pre-
vent the spasms about the throat. As inflaming the
teeth by the use of mercury is of use in some kinds
of hemicrania. Put spirit of turpentine on the wound,
wash it well. See Class I. 3. 1. 11. IV. 1. 2. 7.
M. M. Wine, musk, oil, internally. Opium, mer-
curial ointment, used extensively. Mercurial fumiga-
Ff3 tion.

438 DISEASES [CLASS III. 1. 1.
tion. Turpeth mineral. To salivate the patient as
soon as possible. Exsection or a caustic on the scar,
even after the appearance of hydrophobia. Put a
tight bandage on the limb above the scar of the old
wound to benumb the pained tendon, however long
the wound may have been healed. Could a hollow
catheter of elastic gum, caoutchouc, be introduced into
the œsophagus by the mouth or nostril, and liquid
nourishment be thus conveyed into the stomach- See
Desault's Journal, Case I. where, in an ulcer of the
mouth, such a catheter was introduced by the nostril,
and kept in the œsophagus for a month, by which
means the patient was nourished and preserved.
It is recommended by Dr. Bardsley to give oil inter-
nally by a similar method contrived by Mr. John
Hunter. He covered a probang with the skin of a
small eel, or the gut of a lamb or cat. It was tied up
at one end above and below the sponge, and a slit
made above the upper ligature; to the other end of
the eel-skin or gut was fixed a bladder and pipe. The
probang thus covered was introduced into the stomach,
and the liquid food or medicine was put into the blad-
der and squeezed down through the eel-skin. Mem.
of Society at Manchester. See Class I. 2. 3. 25.
Dr. Bardsley has endeavoured to prove, that dogs
never experience the hydrophobia, or canine madness,
without having been previously bitten or infected;
and secondly, that the disease in this species of animal
always shews itself in five or six weeks; and concludes
from hence, that this dreadful malady might be anni-
hilated

CLASS III. 1. 2.] OF VOLITION. 439
hilated by making all the dogs in Great Britain per-
form a kind of quarantine, by shutting them up for a
certain number of weeks. Though the disease from
the bite of the mad dog is perhaps more analogous to
those from the wounds inflicted by venomous animals
than to those from other contagious matter, yet these
observations are well worthy further attention; which
the author promises.
ORDO I.
Increased Volition.
GENUS II.
With increased Actions of the Organs of Sense.
IN every species of madness there is a peculiar idea
either of desire or aversion, which is perpetually ex-
cited in the mind with all its connections. In some
constitutions this is connected with pleasurable ideas
without the exertion of much muscular action, in
others it produces violent muscular action to gain or
avoid the object of it, in others it is attended with
despair and inaction. Mania is the general word for
the two former of these, and melancholia for the lat-
ter; but the species of them are as numerous as the
desires and aversions of mankind.
In the present age the pleasurable insanities are
most frequently induced by superstitious hopes of
heaven, by sentimental love, and by personal vanity.
Ff4 The

440 DISEASES [CLASS III. 1. 2.
The furious insanities by pride, anger, revenge, sus-
picion. And the melancholy ones by fear of poverty,
fear of death, and fear of hell; with innumerable
others.
Quicquid agunt homines, votum, timor, ira, voluptas,
Gaudia, discursus, nostri est sarrago libelli.
JUVEN. I. 85.
This idea, however, which induces madness or me-
lancholy, is generally untrue; that is, the object is a
mistaken fact. As when a patient is persuaded he has
the itch, or venereal disease, of which he has no
symptom, and becomes mad from the pain this idea
occasions. So that the object of madness is generally
a delirious idea, and thence cannot be conquered by
reason; because it continues to be excited by painful
sensation, which is a stronger stimulus than volition.
Most frequently pain of body is the cause of convul-
sion, which is often however exchanged for madness;
and a painful delirious idea is most frequently the
cause of madness originally, but sometimes of convul-
sion. Thus I have seen a young lady become con-
vulsed from a fright, and die in a few days; and a
temporary madness frequently terminates the parox-
ysms of the epilepsia dolorifica, and an insanity of
greater permanence is frequently induced by the pains
or bruises of parturition.
Where the patient is debilitated a quick pulse some-
times attends insane people, which is nevertheless
generally only a symptom of the debility, owing to
the too great expenditure of sensorial power; or of
the

CLASS III. 1. 2.] OF VOLITION. 441
the paucity of its production, as in inirritative, or in
sensitive inirritated fever. See III. 1. 1.
But nevertheless where the quick pulse is perma-
nent, it shews the presence of fever; and as the mad-
ness then generally arises from the disagreeable sensa-
tions attending the fever, it is so far a good symptom;
because when the fever is cured, or ceases spontane-
ously, the insanity most frequently vanishes at the same
time.
The stimulus of so much volition supports insane
people under variety of hardships, and contributes to
the cure of diseases from debility, as sometimes occurs
towards the end of fevers. See Sect. XXXIV. 2. 5.
And, on the same account, they bear large doses of
medicines to procure any operation on them; as
emetics, and cathartics, which, before they produce
their effect in inverting the motions of the stomach in
vomiting, or of the absorbents of the bowels in purg-
ing, must first weaken the natural actions of those
organs, as shown in Sect. XXXV. 1. 13.
From these considerations it appears, that the in-
dications of cure must consist in removing the cause
of the pain, whether it arises from a delirious idea,
or from a real fact, or from bodily disease; or se-
condly, if this cannot be done, by relieving the pain
in consequence of such idea or disease. The first is
sometimes effected by presenting frequently in a day
contrary ideas to shew the fallacy, or the too great
estimation, of the painful ideas. 2dly. By change of
place, and thus presenting the stimulus of new objects,
as

442 DISEASES [CLASS III. 1. 2.
as a long journey. 3dly. By producing forgetfulness
of the idea or object, which causes their pain; by re-
moving all things which recall it to their minds; and
avoiding all conversation on similar subjects. For I
suppose no disease of the mind is so perfectly cured by
other means as by forgetfulness.
Secondly, the pain in consequence of the ideas or
bodily diseases above described is to be removed, first,
by evacuations, as venesection, emetics, and cathar-
tics; and then by large doses of opium, or by the
vertigo occasioned by a circulating swing, or by a sea-
voyage, which, as they affect the organs of sense as
well as evacuate the stomach, may contribute to an-
swer both indications of cure.
Where maniacs are outrageous, there can be no
doubt but coercion is necessary; which may be done
by means of a strait waistcoat; which disarms
them without hurting them; and by tying a handker-
chief round their ancles to prevent their escape. In
others there can be no doubt, but that confinement
retards rather than promotes their cure; which is for-
warded by change of ideas in consequence of change
of place and of objects, as by travelling or sailing.
The circumstances which render confinement ne-
cessary, are first, if the lunatic is liable to injure
others, which must be judged of by the outrage he
has already committed. 2dly. If he is likely to in-
jure himself; this also must be judged of by the des-
pondency of his mind, if such exists. 3dly. If he can-
not take care of his affairs. Where none of these cir-
cumstances

CLASS III. 1. 2.] OF VOLITION. 443
cumstances exist, there should be no confinement.
For though the mistaken idea continues to exist, yet
if no actions are produced in consequence of it, the
patient cannot be called insane, he can only be termed
delirious. If every one, who possesses mistaken ideas,
or who puts false estimates on things, was liable to
confinement, I know not who of my readers might
not tremble at the sight of a madhouse!
The most convenient distribution of insanities will be
into general, as mania mutabilis, studium inane, and
vigilia; and into partial insanities. These last again
may be subdivided into desires and aversions, many
of which are succeeded by pleasurable or painful ideas,
by fury or dejection, according to the degree or
violence of their exertions. Hence the analogy be-
tween the insanities of the mind, and the convulsions
of the muscles described in the preceding genus, is
curiously exact. The convulsions without stupor, are
either just sufficient to obliterate the pain, which oc-
casions them; or are succeeded by greater pain, as in
the convulsio dolorifica. So the exertions in the
mania mutabilis are either just sufficient to allay the
pain which occasions them, and the patient dwells
comparatively in a quiet state; or those exertions ex-
cite painful ideas, which are succeeded by furious dis-
courses, or outrageous actions. The studium inane,
or reverie, resembles epilepsy, in which there is no
sensibility to the stimuli of external objects. Vigilia,
or watchfulness, may be compared to the general
writhing of the body; which is just a sufficient exer-
tion

444 DISEASES [CLASS III. 1. 2.
tion to relieve the pain which occasions it. Eroto-
mania may be compared to trismus, or other muscular
fixed spasm, without much subsequent pain; and
mæror to cramp of the muscles of the leg, or other
fixed spasm with subsequent pain. All these coinci-
dences contribute to shew, as explained in Sect. III. 5,
that our ideas are motions of the immediate organs
of sense obeying the same laws as our muscular
motions.
The violence of action accompanying insanity de-
pends much on the education of the person; those
who have been proudly educated with unrestrained
passions, are liable to greater fury; and those, whose
education has been humble, to greater despondency.
Where the delirious idea, above described, produces
pleasurable sensations, as in personal vanity or reli-
gious enthusiasm; it is almost a pity to snatch them
from their fool's paradise, and reduce them again to
the common lot of humanity; lest they should com-
plain of their cure, like the patient described in
Horace,
- Pol! me occidistis, amici,
Nen servastis, ait, cui sic extorta voluptas,
Et demptus per vim mentis gratissimus error!
The disposition to insanity, as well as to convulsion,
is believed to be hereditary; and in consequence to
be induced in those families from slighter causes than
in others. Convulsions have been shewn to have
been most frequently induced by pains owing to defect
of stimulus, as the shuddering from cold, and not
from

CLASS III. 1. 2.] OF VOLITION. 445
from pains from excess of stimulus, which are gene-
rally succeeded by inflammation. But insanities are
on the contrary generally induced by pains from ex-
cess of stimulus, as from the too violent actions of
our ideas, as in common anger, which is an insanity
of short duration; for insanities generally, though
not always, arise from pains of the organs of sense;
but convulsions generally, though not always, from
pains of the membranes or glands. And it has been
previously explained, that though the membranes and
glands, as the stomach and skin, receive great pain
from want of stimulus; yet that the organs of sense,
as the eye and ear, receive no pain from defect of
stimulus.
Hence it follows, that the constitutions most liable
to convulsion, are those which most readily become
torpid in some part of the system, that is, which pos-
sess less irritability; and that those most liable to in-
sanity, are such as have excess of sensibility; and
lastly, that these two circumstances generally exist is
the same constitution; as explained in Sect. XXXI. 2.
on Temperaments. These observations explain why
epilepsy and insanity frequently succeed or reciprocate
with each other, and why inirritable habits, as scro-
phulous ones, are liable to insanity, of which I have
known some instances.
In many cases however there is no appearance of
the disposition to epilepsy or insanity of the parent
being transmitted to the progeny. First, where the
insanity has arisen from some violent disappointment,
and

446 DISEASES [CLASS III. 1. 2.
and not from intemperance in the use of spirituous
liquors. Secondly, where the parent has acquired
the insanity or epilepsy by habits of intoxication after
the procreation of his children. Which habits I sup-
pose to be the general cause of the disposition to in-
sanity in this country. See Class III. 1. 1. 7.
As the disposition to gout, dropsy, epilepsy, and
insanity, appears to be produced by the intemperate
use of spirituous potation, and is in all of them here-
ditary; it seems probable, that this disposition gradu-
ally increases from generation to generation, in those
families which continue for many generations to be
intemperate in this respect; till at length these diseases
are produced; that is, the irritability of the system
gradually is decreased by this powerful stimulus, and
the sensibility at the same time increased, as explained
in Sect. XXXI. 1. and 2. This disposition is com-
municated to the progeny, and becomes still increased,
if the same stimulus be continued, and so on by a
third and fourth generation; which accounts for the
appearance of epilepsy in the children of some fami-
lies, where it was never known before to have existed,
and could not be ascribed to their own intemperance.
A parity of reasoning shews, that a few sober genera-
tions may gradually in the same manner restore a due
degree of irritability to the family, and decrease the
excess of sensibility.
From hence it would appear probable, that scro-
phula and dropsy are diseases from inirritability;
but that in epilepsy and insanity an excess of sen-
sibility

CLASS III. 1. 2.] OF VOLITION. 447
sibility is added, and the two faulty temperaments
are thus conjoined.
SPECIES.
1. Mania mutabilis. Mutable madness. Where
the patients are liable to mistake ideas of sensation for
those from irritation, that is, imaginations for reali-
ties, if cured of one source of insanity, they are liable
in a few months to find another source in some new
mistaken or imaginary idea, and to act from this new
idea. The idea belongs to delirium, when it is an
imaginary or mistaken one; but it is the voluntary
actions exerted in consequence of this mistaken idea,
which constitute insanity.
In this disease the patient is liable carefully to con-
ceal the object of his desire or aversion. But a con-
stant inordinate suspicion of all people, and a careless-
ness of cleanliness, and of decency, are generally con-
comitants of madness. Their designs cannot be coun-
teracted, till you can investigate the delirious idea or
object of their insanity; but as they are generally
timid, they are therefore less to be dreaded.
Z. Z. called a young girl, one of his maid-servants,
into the parlour, and, with cocked pistols in his
hands, ordered her to strip herself naked; he then
inspected her with some attention, and dismissed her
untouched. Then he stripped two of his male ser-
vants in the same manner, to the great terror of the
neighbourhood. After he was secured, with much
difficulty he was persuaded to tell me, that he had got
the 

448 DISEASES [CLASS III. 1. 2.
the itch, and had examined some of his servants to
find out from whom he had received it; though at
the same time there was not a spot to be seen on his
hands, or other parts. The outrages in consequence
of this false idea were in some measure to be ascribed
to the pride occasioned by unrestrained education,
affluent wealth, and dignified family.
Madness is sometimes produced by bodily pain,
particularly I believe of a diseased liver, like convul-
sion and epilepsy; at other times it is caused by very
painful ideas occasioned by external circumstances, as
of grief or disappointment; but the most frequent
cause of insanity arises from the pain of some imaginary
or mistaken idea; which may be termed hallucinatio
maniacalis. This hallucination of one of the senses is
often produced in an instant, and generally becomes
gradually weakened in process of time, by the perpe-
tual stimulus of external objects, or by the successions
of other catenations of ideas, or by the operations of
medicines; and when the maniacal hallucination ceases,
or is forgotten, the violent exertions cease, which
were in consequence of it, and the disease is cured.
Mr. —————, a clergyman, about forty years of age,
who was rather a weak man, happened to be drinking
wine in jocular company, and by accident swallowed
a part of the seal of a letter, which he had just then
received; one of his companions seeing him alarmed,
cried out in humour, "It will seal your bowels up."
He became melancholy from that instant, and in a day
or two refused to swallow any kind of nourishment.
4 On

CLASS III. 1. 2.] OF VOLITION. 449
On being pressed to give a reason for this refusal, he
answered, he knew nothing would pass through him.
A cathartic was given, which produced a great many
evacuations, but he still persisted, that nothing passed
through him; and though he was frightened into tak-
ing a little broth once or twice by threats, yet he soon
ceased intirely to swallow any thing, and died in con-
sequence of this insane idea.
Miss —————, a sensible and ingenious lady, about
thirty, said she had seen an angel; who told her,
that she need not eat, though all others were under
the necessity of supporting their earthly existence by
food. After fruitless persuasions to take food, she
starved herself to death.——It was proposed to send an
angel of an higher order to tell her, that now she
must begin to eat and drink again; but it was not
put into execution.
Mrs. —————, a lady between forty and fifty years of
age, imagined that she heard a voice say to her one
day, as she was at her toilet, "Repent, or you will
"be damned." From that moment she became me-
lancholy, and this hallucination affected her in greater
or less degree for about two years; she then recovered
perfectly, and is now a cheerful old woman.
Mrs. —————, a farmer's wife, going up stairs to
dress, found the curtains of her bed drawn, and on
undrawing them, she believed that she saw the corps
of her sister, who was then ill at the distance of
twenty miles, and became from that time insane; and
as her sister died about the time, she could not be
Gg produced

450 DISEASES [CLASS III. 1. 2.
produced to counteract the insane hallucination, but
she perfectly recovered in a few months.
Mrs. —————, a most elegant, beautiful, and accom-
plished lady, about twenty-two years of age, had
been married about two months to an elegant, po-
lished, and affluent young man, and it was well known
to be a love-match, on both sides. She suddenly be-
came melancholy, and yet not to so great a degree,
but that she could command herself to do the honours
of her table with grace and apparent ease. After
many days intreaty, she at length told me, that she
thought her marrying her husband had made him un-
happy; and that this idea she could not efface from
her mind day or night. I withstood her being con-
fined, as some had advised, and proposed a sea-voyage
to her, with expectation that the sickness, as well as
change of objects, might remove the insane halluci-
nation, by introducing other energetic ideas; this
was not complied with, but she travelled about Eng-
land with her friends and her husband for many
months, and at length perfectly recovered, and is
now I am informed in health and spirits.
These cases are related to shew the utility of en-
deavouring to investigate the maniacal idea, or hallu-
cination; as it may not only acquaint us with the
probable designs of the patient, from whence may
be deduced the necessity of confinement; but also may
some time lead to the most effectual plan of cure.
I received good information of the truth of the
following case, which was published a few years
ago

CLASS III. 1. 2.] OF VOLITION. 451
ago in the newspapers. A young farmer in War-
wickshire, finding his hedges broke, and the sticks
carried away during a frosty season, determined
to watch for the thief. He lay many cold hours
under a hay-stack, and at length an old woman, like
a witch in a play, approached, and began to pull up
the hedge; he waited till she had tied up her bottle
of sticks, and was carrying them off, that he might
convict her of the theft, and then springing from his
concealment, he seized his prey with violent threats.
After some altercation, in which her load was left
upon the ground, she kneeled upon her bottle of
sticks, and raising her arms to heaven beneath the
bright moon then at the full, spoke to the farmer al-
ready shivering with cold, "Heaven grant, that
thou never mayest know again the blessing to be
warm." He complained of cold all the next day,
and wore an upper coat, and in a few days another,
and in a fortnight took to his bed, always saying
nothing made him warm, he covered himself with
very many blankets, and had a sieve over his face, as
he lay; and from this one insane idea he kept his bed
above twenty years for fear of the cold air, till at
length he died.
M. M. As mania arises from pain either of our
muscles or organs of sense, the arts of relieving pain
must constitute the method of cure. See Sect. XXXIV.
3. 4. Venesection. Vomits of from five grains to
ten of emetic tartar, repeated every third morning for
three or four times; with solution of gum-ammoniac,
Gg2 and

452 DISEASES [CLASS III. 1. 2.
and soluble tartar, so as to purge gently every day.
Afterwards warm bath for two or three hours a day
Opium in large doses. Bark. Steel.
Dr. Binns gave two scruples (40 grains) of solid
opium at a dose, and twenty grains four hours after-
wards; which restored the patient. Dr. Brandreth
gave 400 drops of laudanum to a maniac in the great-
est possible furor, and in a few hours he became calm
and rational. Med. Comment. for 1791, p. 384.
Prognostic.
The temporary quick pulse attending some ma-
niacal cases is simply a symptom of debility, and is the
consequence of too great exertions; but a permanent
quick pulse shews the presence of fever, and is fre-
quently a salutary sign; because, if the life of the
patient be safe, when the fever ceases, the insanity
generally vanishes along with it, as mentioned above.
In this case the kind of fever must direct the method
of curing the insanity; which must consist of moderate
evacuations and diluents, if the pulse be strong; or by
nutrientia, bark, and small doses of opium, if the
pulse be weak.
Where the cause is of a temporary nature, as in
puerperal insanity, there is reason to hope, that the
disease will cease, when the bruises, or other painful
sensations attending this state, are removed. In these
cases the child should be brought frequently to the
mother, and applied to her breast, if she will suffer
it, and this whether she at first attends to it or not; 
as

CLASS III. 1. 2.] OF VOLITION. 453
as by a few trials it frequently excites the storgè, or
maternal affection, and removes the insanity, as I have
witnessed.
When the madness is occasioned by pain of the
teeth, which I believe is no uncommon case, these
must be extracted; and the cure follows the extinction
of the pain. There is however some difficulty in
detecting the delinquent tooth in this case, as in hemi-
crania, unless by its apparent decay, or by some pre-
vious information of its pain having been complained
of; because the pain of the tooth ceases, as soon as
the exertions of insanity commence.
When a person becomes insane, who has a family
of small children to solicit his attention, the prognostic
is very unfavourable; as it shews the maniacal hallu-
cination to be more powerful than those ideas which
generally interest us the most.
2. Studium inane. Reverie consists of violent vo-
luntary exertions of ideas to relieve pain, with all
the trains or tribes connected with them by sensations
or associations. It frequently alternates with epileptic
convulsions; with which it corresponds, in respect to
the insensibility of the mind to the stimuli of external
objects, in the same manner as madness corresponds with
common convulsion, in the patient's possessing at the
same time a sensibility of the stimuli of external
objects.
Some have been reported to have been involved
in reverie so perfectly, as not to have been disturbed
Gg3 by

454 DISEASES [CLASS III. 1. 2.
by the discharge of a cannon; and others to have been
insensible to torture, as the martyrs for religious opi-
nions; but these seem more properly to belong to par-
ticular insanities than to reverie, like nostalgia and
erotomania.
Reverie is distinguished from madness as described
above; and from delirium, because the trains of
ideas are kept consistent by the power of volition, as
the person reasons and deliberates in it. Somnambu-
lismus is a part of reverie, the latter consisting in the
exertions of the locomotive muscles, and the former of
the exertions of the organs of sense; see Class I. 1. 1.
9. and Sect. XIX. both which are mixed, or alter-
nate with each other, for the purpose of relieving
pain.
When the patients in reverie exert their volition on
their organs of sense, they can occasionally perceive
the stimuli of external objects, as explained in Sect.
XIX. And in this case it resembles sometimes an
hallucination of the senses, as there is a mixture of
fact and imagination in their discourse; but may be
thus distinguished: hallucinations of the senses are
allied to delirium, and are attended generally with
quick pulse, and other symptoms of great debility;
but reverie is without fever, and generally alternates
with convulsions; and so much intuitive analogy (see
Sect. XVII. 3. 7.) is retained in its paroxysms,
as to preserve a consistency in the trains of ideas.
Miss G —————, whose case is related in Sect. III. 5.
8. said, as I once sat by her, "My head is fallen off,
see

CLASS III. 1. 2.] OF VOLITION. 455
see it is rolled to that corner of the room, and the
little black dog is nibbling the nose off." On my
walking to the place which she looked at, and re-
turning, and assuring her that her nose was unhurt,
she became pacified, though I was doubtful whether
she attended to me. See Class III. 1. 1. 9. and Class
III. 1. 2. 2.
M. M. Large doses of opium given before the
expected paroxysm, as in epilepsia dolorifica, Class
III. 1.1. 8.
The hallucinatio studiosa, or false ideas in reverie,
differ from maniacal hallucinations above described,
as no insane exertions succeed, and in the patients
whom I have seen they have always been totally for-
gotten, when the paroxysm was over.
Master —————, a school-boy about twelve years old,
after he came out of a convulsion fit and sat up in bed,
said to me, "Don't you see my father standing at
the feet of the bed, he is come a long way on foot to
see me." I answered, no: "What colour is his
coat-" He replied, "A drab colour." "And
what buttons-" " Metal ones," he answered, and
added, "how sadly his legs are swelled." In a few
minutes he said, with apparent surprise, "He is
gone," and returned to his perfect mind. Other cases
are related in Sect. XIX. and XXXIV. 3. and in Class
III. 1. 2. 2. with further observations on this kind of
hallucination; which however is not the cause of re-
verie, but constitutes a part of it, the cause being
generally some uneasy sensation of the body.
Gg4 3. Vigilia

456 DISEASES [CLASS III. 1. 2.
3. Vigilia. Watchfulness consists in the unceasing
exertion of volition; which is generally caused by
some degree of pain either of mind or of body, or
from defect of the usual quantity of pleasurable sensa-
tion; hence if those, who are accustomed to wine at
night, take tea instead, they cannot sleep. The same
happens from want of solid food for supper, to those
who are accustomed to use it; as in these cases there
is pain or defect of pleasure in the stomach.
Sometimes the anxiety about sleeping, that is the
desire to sleep, prevents sleep; which consists in an
abolition of desire or will. This may so far be com-
pared to the impediment of speech described in Sect.
XVII. 1. 10. as the interference of the will prevents
the effect desired.
Another source of watchfulness may be from the
too great secretion of sensorial power in the brain, as
in phrenzy, and as sometimes happens from the ex-
hibition of opium, and of wine; if the exhaustion of
sensorial power by the general actions of the system
occasioned by the stimulus of these drugs can be
supposed to be less than the increased secretion
of it.
M. M. 1. Solid food to supper. Wine. Opium.
Warm bath. 2. The patient should be told that his
want of sleep is of no consequence to his health. 3.
Venesection by cupping. Abstinence from wine. 4.
A blister by stimulating the skin, and rhubarb by
stimulating the bowels, will sometimes induce sleep.
Exercise. An uniform sound, as of a pausing drop
of

CLASS III. 1. 2.] OF VOLITION 457
of water, or the murmur of bees. Other means are
described in Sect. XVIII. 20.
4. Erotomania. Sentimental love. Described in
its excess by romance-writers and poets. As the ob-
ject of love is beauty, and as our perception of beauty
consists in a recognition by the sense of vision of those
objects, which have before inspired our love, by the
pleasure they have afforded to many of our senses
(Sect. XVI. 6.); and as brute animals have less accu-
racy of their sense of vision than mankind (ib.); we
see the reason why this kind of love is not frequently
observable in the brute creation, except perhaps in
some married birds, or in the affection of the mother
to her offspring. Men, who have not had leisure to
cultivate their taste for visible objects, and who have
not read the works of poets and romance-writers, are
less liable to sentimental love; and as ladies are edu-
cated rather with an idea of being chosen, than of
choosing; there are many men, and more women,
who have not much of this insanity; and are therefore
more easily induced to marry for convenience or in-
terest, or from the flattery of one sex to the other.
In its fortunate gratification sentimental love is sup-
posed to supply the purest source of human felicity;
and from the suddenness with which many of those
patients, described in Species I. of this genus, were
seized with the maniacal hallucination, there is reason
to believe, that the most violent sentimental love
may be acquired in a moment of time, as repre-
sented

458 DISEASES [CLASS III. 1. 2.
sented by Shakespeare in the beginning of his Romeo
and Juliet.
Some have endeavoured to make a distinction be-
tween beauty and grace, and have made them as it
were rivals for the possession of the human heart; but
grace may be defined beauty in action; for a sleeping
beauty cannot be called graceful in whatever attitude
she may recline; the muscles must be in action to
produce a graceful attitude, and the limbs to produce
a graceful motion. But though the object of love is
beauty, yet the idea is nevertheless much enhanced
by the imagination of the lover; which appears from
this curious circumstance, that the lady of his passion
seldom appears so beautiful to the lover after a few
months separation, as his ideas had painted her in his
absence; and there is, on that account, always a
little disappointment felt for a minute at their next
interview from this hallucination of his ideas.
This passion of love produces reverie in its first state,
which exertion alleviates the pain of it, and by the
assistance of hope converts it into pleasure. Then the
lover seeks solitude, lest this agreeable reverie should
be interrupted by external stimuli, as described by
Virgil.
Tantum inter densas, umbrosa cacumina, fagos
Asiidue veniebat, ibi hæc incondita solus
Montibus et sylvis studio jactabat inani.
When the pain of love is so great, as not to be re-
lieved by the exertions of reverie, as above described;
as when it is misplaced on an object, of which the
lover

CLASS III. 1. 2.] OF VOLITION. 459
lover cannot possess himself; it may still be counter-
acted or conquered by the stoic philosophy, which
strips all things of their ornaments, and inculcates
"nil admirari." Of which lessons may be found in
the meditations of Marcus Antoninus. The maniacal
idea is said in some lovers to have been weakened by
the action of other very energetic ideas; such as have
been occasioned by the death of his favourite child,
or by the burning of his house, or by his being ship-
wrecked. In those cases the violence of the new idea
for a while expends so much sensorial power as to
prevent the exertion of the maniacal one; and new
catenations succeed. On this theory the lover's leap,
so celebrated by poets, might effect a cure, if the pa-
tient escaped with life.
The third stage of this disease I suppose is irreme-
diable; when a lover has previously been much en-
couraged, and at length meets with neglect or disdain;
the maniacal idea is so painful as not to be for a mo-
ment relievable by the exertions of reverie, but is
instantly followed by furious or melancholy insanity;
and suicide, or revenge, have frequently been the con-
sequence. As was lately exemplified in Mr. Hack-
man, who shot Miss Ray in the lobby of the play-
house. So the poet describes the passion of Dido,
- Moriamur inulta?-
At moriamur, ait,-sie, sie, javat ire sub umbras!
The story of Meda seems to have been contrived
by Ovid, who was a good judge of the subject, to re-
present the savage madness occasioned by ill-requited
love. Thus the poet,
Earth

460 DISEASES [CLASS III. 1. 2.
Earth has no rage like love to hatred turn'd,
Nor hell a fury like a woman scorn'd.
DRYDEN.
5. Amor sui. Vanity consists of an agreeable reve-
rie, and is well ridiculed in the story of Narcissus,
who so long contemplated his own beautiful image in
the water, that he died from neglect of taking sus-
tenance. I once saw a handsome young man, who
had been so much flattered by his parents, that his
vanity rose so near to insanity, that one might discern
by his perpetual attention to himself, and the difficulty
with which he arranged his conversation, that the idea
of himself intruded itself at every comma or pause of
his discourse. In this degree vanity must afford great
pleasure to the possessor; and when it exists within
moderate bounds, may contribute much to the happi-
ness of social life.
My friend Mr. ———— once complained to me, that
he was much troubled with bashfulness in company,
and believed that it arose from his want of personal
vanity; on this account he determined on a journey
to Paris, when Paris was the centre of politeness; he
there learnt to dress, to dance, and to move his hands
gracefully in conversation; and returned a most con-
summate coxcomb. But after a very few years he
relapsed into rusticity of dress and manners.
M. M. The cure of vanity may be attempted by
excess of flattery, which will at length appear ridicu-
lous, or by its familiarity will cease to be desired. I
remember to have heard a story of a nobleman in the
court

CLASS III. 1. 2.] OF VOLITION. 461
court of France, when France had a court, who was
so disagreeably vain in conversation, that the king was
pleased to direct his cure, which was thus performed.
Two gentlemen were directed always to attend him,
one was to stand behind his chair, and the other at a
respectful distance before him; whenever his lordship
began to speak, one of them always pronounced,
"Lord Gallimaufre is going to say the best thing in
the world." And, as soon as his lordship had done
speaking, the other attendant pronounced, "Lord
Gallimaufre has spoken the best thing in the world."
Till in a few weeks this noble lord was so disgusted
with praise that he ceased to be vain; and his majesty
dismissed his keepers.
6. Nostalgia. Maladie de Paris. Calenture. An
unconquerable desire of returning to one's native
country, frequent in long voyages, in which the pa-
tients become so insane as to throw themselves into
the sea, mistaking it for green fields or meadows. The
Swiss are said to be particularly liable to this disease,
and when taken into foreign service frequently to de-
sert from this cause, and especially after hearing or
singing a particular tune, which was used in their vil-
lage dances, in their native country, on which account
the playing or singing this tune was forbid by the pu-
nishment of death. Zwingerus.
Dear is that shed, to which his soul conforms,
And dear that hill, which lists him to the storms.
GOLDSMITH.
7. Spes

462 DISEASES [CLASS III. 1. 2.
7. Spes religiosa. Superstitious hope. This mania-
cal hallucination in its milder state produces, like sen-
timental love, an agreeable reverie; but when joined
with works of supererogation, it has occasioned many
enormities. In India devotees consign themselves by
vows to most painful and unceasing tortures, such as
holding up their hands, till they cannot retract them; 
hanging up by hooks put into the thick skin over
their shoulders, sitting upon sharp points, and other
self torments. While in our part of the globe fasting
and mortification, as flagellation, has been believed to
please a merciful deity! The serenity, with which
many have suffered cruel martyrdoms, is to be ascribed
to this powerful reverie.
Mr. —————, a clergyman, formerly of this neighbour-
hood, began to bruise and wound himself for the sake
of religious mortification, and passed much time in
prayer, and continued whole nights alone in the
church. As he had a wife and family of small chil-
dren, I believed the case to be incurable; as otherwise
the affection and employment in his family connections
would have opposed the beginning of this insanity.
He was taken to a madhouse without effect, and after
he returned home, continued to beat and bruise him-
self, and by this kind of mortification, and by some-
times long fasting, he at length became emaciated and
died. I once told him in conversation, that "God
was a merciful being, and could not delight in cruelty,
but that I supposed he worshipped the devil." He
was struck with this idea, and promised me not to
beat

CLASS III. 1. 2.] OF VOLITION. 463
beat himself for three days, and I believe kept his
word for one day. If this idea had been frequently
forced on his mind, it might probably have been of
service.
When these works of supererogation have been of
a public nature, what cruelties, murders, massacres,
has not this insanity introduced into the world!——A
commander, who had been very active in leading and
encouraging the bloody deeds of St. Bartholomew's
day at Paris, on confessing his sins to a worthy eccle-
siastic on his death-bed, was asked, "Have you no-
thing to say about St. Bartholomew -" "On that
day," he replied, "God Almighty was obliged to
me!"——The fear of hell is another insanity, which
will be spoken of below.
8. Superbia stemmatis. Pride of family has fre-
quently formed a maniacal hallucination, which in its
mild state has consisted in agreeable reverie, but when
it has been so painful as to demand homage from
others, it has frequently induced insane exertions.
This insanity seems to have existed in the flourishing
state of Rome, as now all over Germany, and is at-
tacked by Juvenal with great severity, a small part of
which I shall here give as a method of cure. Sat. 8.
Say, what avails the pedigree, that brings
Thy boasted line from heroes or from kings;
Though many a mighty lord, in parchment roll'd,
Name after name, thy coxcomb hands unfold;
Though wreathed patriots crowd thy marble halls,
Or steel clad warriors frown along the walls;
While

464 DISEASES [CLASS III. 1. 2.
While on broad canvas in the gilded frame
All virtues flourish, and all glories flame?-
Say,-if ere noon with idiot laugh you lie
Wallowing in wine, or cog the dubious die,
Or act unashamed, by each indignant bust,
The midnight orgies of promiscuous lust!-
Go, lead mankind to Virtue's holy shrine,
With morals mend them, and with arts refine,
Or list, with golden characters unsurl'd,
The flag of peace, and still a warring world!-
-So shall with pious hands immortal Fame
Wreathe all her laurels round thy honour'd name,
High o'er thy tomb, with chissel bold engrave,
"THE TRULY NOBLE ARE THE GOOD AND BRAVE."
9. Ambitio. Inordinate desire of fame. A care-
lessness about the opinions of others is said by Xeno-
phon to be the source of impudence; certainly a pro-
per regard for what others think of us frequently
incites us to virtuous actions, and deters us from vici-
ous ones; and increases our happiness by enlarging
our sphere of sympathy, and by flattering our vanity.
Abstract what others feel, what others think,
All pleasures sicken, and all glories seen.
POPE.
When this reverie of ambition excites to conquer
nations, or to enslave them, it has been the source of
innumerable wars, and the occasion of a great devasta-
tion of mankind. Casar is reported to have boasted,
that he had destroyed three millions of his enemies,
and one million of his friends.
4 The

CLASS III. 1. 2.] OF VOLITION. 465
The works of Homer are supposed to have done
great injury to mankind by inspiring the love of mili-
tary glory. Alexander was said to sleep with them
always on his pillow. How like a mad butcher amid
a flock of sheep appears the hero of the Iliad, in the
following fine lines of Mr. Pope, which conclude the
twentieth book.
His fiery coursers, as the chariot rolls,
Tread down whole ranks, and crush out heroes' souls;
Dash'd from their hoofs, as o'er the dead they fly,
Black bloody drops the smoaking chariot dye;——
The spiky wheels through heaps of carnage tore,
And thick the groaning axles dropp'd with gore;
High o'er the scene of death ACHILES stood,
All grim with dust, all horrible with blood;
Yet still insatiate, still with rage on flame,
Such is the lust of never dying fame!
The cure must be taken from moral writers.
Woolaston says, Cæsar conquered Pompey; that is,
a man whose name consisted of the letters C. æ. s. a. r.
conquered a long time ago a man, whose name con-
sisted of the letters P. o. m. p. e. y. and that this is
all that remains of either of them. Juvenal also
attacks this mode of insanity, Sat X. 166.
——I, demens, et sævas curre per alpes,
Ut pueris placeas, et declamatio fias!
Which is thus translated by Dr. Johnson,
And lest a name, at which the world grew pale,
To point a moral, or adorn a tale!
Hh 10. Mæror.

466 DISEASES [CLASS III. 1. 2.
l0. Mæror. Grief. A perpetual voluntary con-
templation of all the circumstances of some great loss,
as of a favourite child. In general the painful ideas
gradually decrease in energy, and at length the recol-
lection becomes more tender and less painful. The
letter of Sulpicius to Cicero on the loss of his daugh-
ter is ingenious. The example of David on the loss
of his child is heroic.
A widow lady was left in narrow circumstances
with a boy and a girl, two beautiful and lively chil-
dren, the one six and the other seven years of age;
as her circumstances allowed her to keep but one
maid-servant, these two children were the sole atten-
tion, employment, and consolation of her life; she fed
them, dressed them, slept with them, and taught them
herself; they were both snatched from her by the
gangrenous sore throat in one week: so that she lost
at once all that employed her, as well as all that was
dear to her. For the first three or four days after
their death, when any friend visited her, she sat up-
right, with her eyes wide open, without shedding
tears, and affected to speak of indifferent things.
Afterwards she began to weep much, and for some
weeks talked to her friends of nothing else but her
dear children. But did not for many years, even to
her dying hour, get quite over a gloom, which was
left upon her countenance.
In violent grief, when tears flow, it is esteemed a
good symptom; because then the actions caused by
sensitive association take the place of those caused by
volition;

CLASS III. 1. 2.] OF VOLITION. 467
volition; that is, they prevent the voluntary exer-
tions of ideas, or muscular actions, which constitute
insanity.
The sobbing sighing attendant upon grief are
not convulsive movements, they are occasioned by the
sensorial power being so expended on the painful
ideas, and their connections, that the person neglects
to breathe for a time, and then a violent sigh or sob
is necessary to carry on the blood, which oppresses
the pulmonary vessels, which is then performed by
deep or quick inspirations, and laborious expirations.
Sometimes nevertheless the breath is probably for a
while voluntarily held, as an effort to relieve pain.
The paleness and ill health occasioned by long grief is
spoken of in Class IV. 2. 1. 9.
The melioration of grief by time, and its being at
length even attended with pleasure, depends on our
retaining a distinct idea of the lost object, and for-
getting for a time the idea of the loss of it. This
pleasure of grief is beautifully described by Akenside,
Pleasures of Imagination, Book II. l. 680.
Ask the faithful youth,
Why the cold urn of her, whom long he loved,
So often fills his arms; so often draws
His lonely footsteps at the silent hour
To pay the mournful tribute of his tears?
Oh! he will tell thee, that the wealth of worlds
Should ne'er seduce his bosom to forego
That sacred hour; when, stealing from the noise
Of care and envy, sweet remembrance soothes
With Virtue's kindest looks his aching breast,
And turns his tears to rapture.
Hh2 M. M. Con-

468 DISEASES [CLASS III. 1. 2.
M. M. Consolation is best supplied by the Christian
doctrine of a happy immortality. In the pagan re-
ligion the power of dying was the great consolation
in irremediable distress. Seneca says, "no one need
be unhappy unless by his own fault." And the
author of Telemachus begins his work by saying,
that Calypso could not console herself for the loss of
Ulysses, and found herself unhappy in being immortal.
In the first hours of grief the methods of consolation
used by uncle Toby, in Tristram Shandy, is probably
the best; "he sat down in an arm chair by the bed
of his distressed friend, and said nothing."
11. Tædium vitæ. The inanity of sublunary things
has afforded a theme to philosophers, moralists, and
divines, from the earliest records of antiquity; "Vanity
of vanities!" says the preacher, "all is vanity!" Nor
is there any one, I suppose, who has passed the
meridian of life, who has not at some moments felt
the nihility of all things.
Weariness of life in its moderate degree has been
esteemed a motive to action by some philosophers.
See Sect. XXXIV. 2. 3. But in those men, who
have run through the usual amusements of life early
in respect to their age; and who have not industry
or ability to cultivate those sciences, which afford a
perpetual fund of novelty, and of consequent enter-
tainment, are liable to become tired of life, as they
suppose there is nothing new to be found in it, that
can afford them pleasure; like Alexander who is said
to

CLASS III. 1. 2.] OF VOLITION. 469
to have shed tears, because he had not another world
to conquer.
Mr. -, a gentleman about fifty, of polished
manners, who in a few months afterwards destroyed
himself, said to me one day, "a ride out in the
morning, and a warm parlour and a pack of cards in
the afternoon, is all that life affords." He was per-
suaded to have an issue on the top of his head, as
he complained of a dull head-ach, which being un-
skillfully managed, destroyed the pericranium to the
size of an inch in diameter; during the time this
took in healing, he was indignant about it, and
endured life, but soon afterwards shot himself.
Mr. -, a gentleman of Gray's Inn, some years
ago was prevailed upon by his friends to dismiss a
mistress, by whom he had a child, but who was so
great a termagant and scold, that she was believed to
use him very ill, and even to beat him. He became
melancholy in two days from the want of his usual
stimulus to action, and cut his throat on the third so
completely, that he died immediately.
Mr. Anson, the brother of the late Lord Anson,
related to me the following anecdote of the death of
Lord Sc-. His Lordship sent to see Mr. Anson
on the Monday preceding his death, and said, "You
are the only friend I value in the world, I determined
therefore to acquaint you, that I am tired of the
insipidity of life, and intend to-morrow to leave it."
Mr. Anson said, after much conversation, that he
was obliged to leave town till Friday, and added,
Hh3 "As

470 DISEASES [CLASS III. 1. 2.
"As you profess a friendship for me, do me this last
favour, I entreat you, live till I return." Lord
Sc- believed this to be a pious artifice to gain
time, but nevertheless agreed, if he should return by
four o'clock on that day. Mr. Anson did not return
till five, and found, by the countenances of the
domestics, that the deed was done. He went into
his chamber and found the corpse of his friend leaning
over the arm of a great chair, with the pistol on the
ground by him, the ball of which had been discharged
into the roof of his mouth, and passed into his brain.
Mr. - and Mr. -, two young men, heirs
to considerable fortunes, shot themselves at the age
of four or five and twenty, without their friends
being able to conjecture any cause for those rash
actions. One of them I had long known to express
himself with dissatisfaction of the world; at eighteen
years of age he complained, that he could not en-
tertain himself; he tried to study the law at Cam-
bridge, and afterwards went abroad for a year or
two by my advice; but returned dissatisfied with all
things. As he had had an eruption for some years
on a part of his face, which he probably endeavoured
to remove by external applications; I was induced
to ascribe his perpetual ennui to the pain or dis-
agreeable sensation of a diseased liver. The other
young gentleman shot himself in his bed-room, and
I was informed that there was found written on a
scrap of paper on his table. "I am impotent, and
therefore not fit to live." From whence there was
reason

CLASS III. 1. 2.] OF VOLITION. 471
reason to conclude, that this was the hallucinatio
maniacalis, the delirious idea, which caused him to
destroy himself. The case therefore belongs to mania
mutabilis, and not to tædium vitæ.
M. M. Some restraint in exhausting the usual plea-
sures of the world early in life. The agreeable cares
of a matrimonial life. The cultivation of science, as
of chemistry, natural philosophy, natural history,
which supplies an inexhaustible source of pleasurable
novelty, and relieves ennui by the exertions it oc-
casions.
In many of these cases, where irksomeness of life
has been the ostensible cause of suicide, there has pro-
bably existed a maniacal hallucination, a painful idea,
which the patient has concealed even to his dying
hour; except where the mania has evidently arisen
from hereditary or acquired disease of the membra-
nous or glandular parts of the system.
12. Pulchritudinis desiderium. The loss of beauty,
either by disease, as by the small-pox, or by age, as
life advances, is sometimes painfully felt by ladies,
who have been much flattered on account of it. There
is a curious case of this kind related in Le Sage's
Bachelor of Salamanca, which is too nicely described
to be totally imaginary.
In this situation some ladies apply to what are ter-
med cosmetics under various names, which crowd the
newspapers. Of these the white has destroyed the
health of thousands; a calx, or magistery, of bismuth
is supposed to be sold in the shops for this purpose;
Hh4 but

472 DISEASES [CLASS III. 1. 2.
but it is either, I am informed, in part or entirely
white lead or cerussa. The pernicious effects of the
external use of those saturnine applications are spoken
of in gutta rosea, Class II. 1. 4. 6. The real calx of
bismuth would probably have the same ill effect. As
the red paint is prepared from cochineal, which is an
animal body, less if any injury arises from its use, as it
only lies on the skin like other filth.
The tan of the skin occasioned by the sun may be
removed by lemon juice evaporated by the fire to half
its original quantity, or by diluted marine acid; which
cleans the cuticle, by eroding its surface, but requires
much caution in the application; the marine acid must
be diluted with water, and when put upon the hand
or face, after a second of time, as soon as the tan dis-
appears, the part must be washed with a wet towel
and much warm water. Freckles lie too deep for this
operation, nor are they in general removable by a
blister, as I once experienced. See Class I. 2. 2. 9.
It is probable, that those materials which stain silk,
or ivory, might be used to stain the cuticle, or hair,
permanently; as they are all animal substances. But
I do not know, that any trials of this kind have been
made on the skin. I endeavoured in vain to whiten
the back of my hand by marine acid oxygenated by
manganese, which so instantly whitens cotton.
The cure therefore must be sought from moral
writers, and the cultivation of the graces of the mind,
which are frequently a more valuable possession than
celebrated beauty.
13. Pau- 

CLASS III. 1. 2.] OF VOLITION. 473
13. Paupertatis timor. The fear of poverty is one
kind of avarice; it is liable to affect people who have
left off a profitable and active business; as they are
thus deprived of their usual exertions, and are liable
to observe the daily expenditure of money, without
calculating the source from whence it flows. It is
also liable to occur with a sudden and unexpected in-
crease of fortune. Mr. ————, a surgeon, about fifty
years of age, who was always rather of a parsimonious
disposition, had a large house, with a fortune of forty
thousand pounds, left him by a distant relation; and in
a few weeks became insane from the fear of poverty,
lamenting that he should die in a jail or workhouse.
He had left off a laborious country business, and the
daily perception of profit in his books; he also now
saw greater expences going forwards in his new house,
than he had been accustomed to observe, and did not
so distinctly see the source of supply; which seems to
have occasioned the maniacal hallucination.——This idea
of approaching poverty is a very frequent and very
painful disease, so as to have induced many to become
suicides, who were in good circumstances; more per-
haps than any other maniacal hallucination, except
the fear of hell.
The covetousness of age is more liable to affect
single men, than those who have families; though an
accumulation of wealth would seem to be more desira-
ble to the latter. But an old man in the former situ-
ation, has no personal connections to induce him to
open his purse; and having lost the friends of his
youth,

474 DISEASES [CLASS III. 1. 2.
youth, and not easily acquiring new ones, feels him-
self alone in the world; feels himself unprotected, as
his strength declines, and is thus led to depend for
assistance on money, and on that account wishes to
accumulate it. Whereas the father of a family has
not only those connections, which demand the fre-
quent expenditure of money, but feels a consolation
in the friendship of his children, when age may ren-
der their good offices necessary to him.
M. M. I have been well informed of a medical per-
son in good circumstances in London, who always
carries an account of his affairs, as debtor and credi-
tor, in his pocket-book; and looks over it frequently
in a day, when this disease returns upon him; and
thus, by counteracting the maniacal hallucination,
wisely prevents the increase of his insanity. Another
medical person, in London, is said to have cured him-
self of this disease by studying mathematics with great
attention; which exertions of the mind relieved the
pain of the maniacal hallucination.
Many moral writers have stigmatised this insanity;
the covetous, they say, commit crimes and mortify
themselves without hopes of reward; and thus be-
come miserable both in this world and the next. Thus
Juvenal:
Cum furor haud dubius, cum sit manifesta phrenitis,
Ut locuples moriaris, egenti vivere fato!
The covetous man thought he gave good advice to
the spendthrift, when he said, "Live like me," who
well answered him,
" Like

CLASS III. 1. 2.] OF VOLITION. 475
-" Like you, Sir John?
" That I can do, when all I have is gone!"
POPE.
14. Lethi timor. The fear of death perpetually
employs the thoughts of these patients; hence they
are devising new medicines, and applying to phy-
sicians and quacks without number. It is confounded
with hypochondriasis, Class I. 2. 3. 9. in popular con-
versation, but is in reality an insanity.
A young gentleman, whom I advised to go abroad
as a cure for this disease, assured me, that during the
three years he was in Italy and France he never passed
a quarter of an hour without fearing he should die.
But has now for above twenty years experienced the
contrary.
The sufferers under this malady are generally at
once discoverable by their telling you, amidst an un-
connected description of their complaints, that they
are nevertheless not afraid of dying. They are also
easily led to complain of pains in almost any part of
the body, and are thus soon discovered.
M. M. As the maniacal hallucination has generally
arisen in early infancy from some dreadful account of
the struggles and pain of dying, I have sometimes ob-
served, that these patients have received great con-
solation from the instances I have related to them of
people dying without pain. Some of these, which I
think curious, I shall concisely relate, as a part of the
method of cure,
Mr. -,

476 DISEASES [CLASS III. 1. 2.
Mr. -, an elderly gentleman, had sent for me
one whole day before I could attend him; on my ar-
rival he said he was glad to see me, but that he was
now quite well, except that he was weak, but had
had a pain in his bowels the day before. He then
lay in bed with his legs cold up to the knees, his
hands and arms cold, and his pulse scarcely discernible,
and died in about six hours. Mr. -, another gen-
tleman about sixty, lay in the act of dying, with dif-
ficult respiration like groaning, but in a kind of stupor
or coma vigil, and every ten or twelve minutes, while
I sat by him, he waked, looked up, and said, "who
is it groans so, I am sure there is somebody dying in
the room," and then sunk again into a kind of sleep.
From these two cases there appeared to be no pain
in the act of dying, which may afford consolation to
all, but particularly to those who are afflicted with the
fear of death.
15. Orci timor. The fear of hell. Many theatric
preachers among the Methodists successfully inspire
this terror, and live comfortably upon the folly of
their hearers. In this kind of madness the poor pa-
tients frequently commit suicide; although they be-
lieve they run headlong into the hell, which they
dread! Such is the power of oratory, and such the
debility of the human understanding!
Those, who suffer under this insanity, are gene-
rally the most innocent and harmless people; who are
then liable to accuse themselves of the greatest ima-
ginary

CLASS III. 1. 2.] OF VOLITION. 477
ginary crimes, and have so much intellectual cowardice,
that they dare not reason about those things, which
they are directed by their priests to believe, however
contradictory to human a prehension, or derogatory
to the great Creator of all things. The maniacal
hallucination at length becomes so painful, that the
poor insane flies from life to become free from it.
M. M. Where the intellectual cowardice is great,
the voice of reason is ineffectual; but that of ridicule
may save many from those mad-making doctors;
though it is too weak to cure those, who are already
hallucinated. Foot's Farces are recommended for
this purpose.
16. Satyriasis. An ungovernable desire of venereal
indulgence. The remote cause is probably the stimulus
of the semen; whence the phallus becomes distended
with blood by the arterial propulsion of it being more
strongly excited than the correspondent venous absorp-
tion. At the same time a new sense is produced in
the other termination of the urethra; which, like
itching, requires some exterior friction to facilitate the
removal of the cause of the maniacal actions, which
may probably be increased in those cases by some asso-
ciated hallucinations of ideas. It differs from priapis-
mus chronicus in the desire of its appropriated object,
which is not experienced in the latter, Class I. 1. 4. 6.
and from the priapismus amatorius, Class II. 1. 7. 9.
in the maniacal actions in consequence of desire. The
furor uterinus, or nymphomania, is a similar disease.
M. M. Vene-

478 DISEASES [CLASS III. 1. 2.
M. M. Venesection. Cathartics. Torpentia. Mar-
riage.
17. Ira. Anger is caused by the pain of offended
pride. We are not angry at breaking a bone, but
become quite insane from the smallest stroke of a whip
from an inferior. Ira furor brevis. Anger is not
only itself a temporary madness, but is a frequent at-
tendant on other insanities, and as, whenever it ap-
pears, it distinguishes insanity from delirium, it is ge-
nerally a good sign in fevers with debility.
An injury voluntarily inflicted on us by others ex-
cites our exertions of self-defence or of revenge against
the perpetrator of it; but anger does not succeed in
any great degree unless our pride is offended; this
idea is the maniacal hallucination, the pain of which
sometimes produces such violent and general exertions
of our muscles and ideas, as to disappoint the revenge
we meditate, and vainly to exhaust our sensorial
power. Hence angry people, if not further excited
by disagreeable language, are liable in an hour or two
to become humble, and sorry for their violence, and
willing to make greater concessions than required.
M. M. Be silent, when you feel yourself angry.
Never use loud oaths, violent upbraidings, or strong
expressions of countenance, or gesticulations of the
arms, or clenched fists; as these by their former asso-
ciations with anger will contribute to increase it. I
have been told of a sergeant or corporal, who began
moderately to cane his soldiers, when they were awk-
ward

CLASS III. 1. 2.] OF VOLITION. 479
ward in their exercise, but being addicted to swearing
and coarse language, he used soon to enrage himself
by his own expressions of anger, till toward the end
he was liable to beat the delinquents unmercifully.
18. Rabies. Rage. A desire of biting others,
most frequently attendant on canine madness. Ani-
mals in great pain, as in the colica saturnina, are
said to bite the ground they lie upon, and even their
own flesh. I have seen patients bite the attendants,
and even their own arms, in the epilepsia dolorifica.
It seems to be an exertion to relieve pain, as ex-
plained in Sect. XXXIV. 1. 3. The dread of water
in hydrophobia is occasioned by the repeated painful
attempts to swallow it, and is therefore not an essen-
tial or original part of the disease called canine mad-
ness. See Class III. 1. 1. 15.
There is a mania reported to exist in some parts
of the east, in which a man is said to run a muck;
and these furious maniacs are believed to have in-
duced their calamity by unlucky gaming, and after-
wards by taking large quantities of opium; whence
the pain of despair is joined with the energy of
drunkenness; they are then said to sally forth into
the most populous streets, and to wound and slay all
they meet, till they receive their own death, which
they desire to procure without the greater guilt, as
they suppose of suicide.
M. M. When there appears a tendency to bite in
the painful epilepsy, the end of a rolled-up towel,
or

480 DISEASES [CLASS III. 1. 2.
or a wedge of soft wood, should be put into the
mouth of the patient. As a bullet is said sometimes
to be given to a soldier, who is to be severely flog-
ged, that he may by biting it better bear his pu-
nishment.
19. Citta. A desire to swallow indigestible sub-
stances. I once saw a young lady, about ten years
of age, who filled her stomach with the earth out of a
flower-pot, and vomited it up with small-stones, bits of
wood, and wings of infects amongst it. She had the
bombycinous complexion, and looked like a chlorotic
patient, though so young; this generally proceeds
from an acid in the stomach.
M. M. A vomit. Magnesia alba. Armenian bole.
Rhubarb. Bark. Steel. A blister. See Class I.
2. 4. 5.
20. Cacositia. Aversion to food. This may arise,
without disease of the stomach, from connecting nau-
seous ideas to our usual food, as by calling a ham a
hog's a—————. This madness is much inculcated by
the stoic philosophy. See Antoninus' Meditations.
See two cases of patients who refused to take nourish-
ment. Class III. 1. 2. 1.
Aversions to peculiar kinds of food are thus formed
early in life by association of some maniacal hallucina-
tion with them. I remember a child, who on tasting
the gristle of sturgeon, asked what gristle was- And
being told it was like the division of a man's nose, re-
2 ceived

CLASS III. 1. 2.] OF VOLITION. 481
ceived an ideal hallucination; and for twenty years
afterwards could not be persuaded to taste sturgeon.
The great fear or aversion, which some people ex-
perience at the sight of spiders, toads, crickets, and
the like, have generally had a similar origin.
M. M. Associate agreeable ideas with those which
disgust; as call a spider ingenious, a frog clean and
innocent; and repress all expressions of disgust by the
countenance, as such expressions contribute to pre-
serve, or even to increase, the energy of the ideas
associated with them; as mentioned above in Species
17. Ira.
21. Syphilis imaginaria. The fear that they are
infected with the venereal disease, when they have
only deserved it, is a very common insanity amongst
modest young men; and is not to be cured without
applying artfully to the mind; a little mercury must
be given, and hopes of a cure added weekly and gra-
dually by interview or correspondence for six or eight
weeks. Many of these patients have been repeatedly
salivated without curing the mind!
22. Psora imaginaria. I have twice seen an ima-
ginary itch, and twice an imaginary diabætes, where
there was not the least vestige of either of those dis-
eases, and once an imaginary deafness, where the pa-
tient heard perfectly well. In all these cases the hal-
lucinated idea is so powerfully excited, that it is not
to be changed suddenly by ocular sensation, or reason.
Ii Yet

482 DISEASES [CLASS III. 1. 2.
Yet great perseverance in the frequently presenting
contrary ideas will sometimes slowly remove this hal-
lucination, or in a great length of time oblivion, or
forgetfulness, performs a cure, by other means in
vain attempted.
23. Tabes imaginaria. This imaginary disease, or
hallucination, is caused by the supposed too great
frequency of parting with the semen, and had long
imposed upon the physician as well as the patient,
till Mr. John Hunter first endeavoured to shew, that
in general the morbid effects of this pollution was in
the imagination; and that those were only liable to
those effects in general, who had been terrified by
the villainous books, which pretend to prevent or to
cure it, but which were purposely written to vend some
quack medicine. Most of those unhappy patients,
whom I have seen, had evidently great impression of
fear and self-condemnation on their minds, and might
be led to make contradictory complaints in almost any
part of the body, and if their confessions could be
depended on, had not used this pollution to any
great excess.
M. M. 1. Assure them if the loss of the semen hap-
pens but twice a week, it will not injure them. 2.
Marry them. The last is a certain cure; whether the
disease be real or imaginary. Cold partial bath, and
astringent medicines frequently taken, only the
mind to the disease, or to the delinquency; and
thence increase the imaginary effects and the real cause,
if

CLASS III. 1. 2.] OF VOLITION. 483
if such exists. Mr. ———— destroyed himself to get free
from the pain of fear of the supposed ill consequences of
self-pollution, without any other apparent disease; whose
parents I had in vain advised to marry him, if possible.
24. Sympathia aliena. Pity. Our sympathy with
the pleasures and pains of others distinguishes men
from other animals; and is probably the foundation
of what is termed our moral sense; and the source of
all our virtues. See Sect. XXII. 3. 3. When our
sympathy with those miseries of mankind, which we
cannot alleviate, rises to excess, the mind becomes its
own tormenter; and we add to the aggregate sum of
human misery, which we ought to labour to diminish;
as in the following eloquent lamentation from Aken-
side's Pleasures of Imagination, Book II. 1. 200.
Dark,
As midnight storms, the scene of human things
Appear'd before me; deserts, burning sands,
Where the parch'd adder dies; the frozen south;
And desolation blasting all the west
With rapine and with murder. Tyrant power
Here sits enthroned in blood; the baleful charms
Of superstition there insect the skies,
And turn the sun to horror. Gracious Heaven!
What is the life of man? Or cannot these,
Not these portents thy awful will suffice?
That, propagated thus beyond their scope,
They rise to act their cruelties anew
In my afflicted bosom, thus decreed
The universal sensitive of pain,
The wretched heir of evils not its own!
Ii2 A poet

484 DISEASES [CLASS III. 1. 2.
A poet of antiquity, whose name I do not recol-
lect, is said to have written a book describing the
miseries of the world, and to have destroyed himself
at the conclusion of his task. This sympathy, with
all sensitive beings, has been carried so far by some
individuals, and even by whole tribes, as the Gen-
toos, as not only to restrain them from killing animals
for their support, but even to induce them to permit
infects to prey upon their bodies. Such is however
the condition of mortality, that the first law of nature
is, "Eat or be eaten." We cannot long exist with-
out the destruction of other animal or vegetable
beings, either in their mature or their embryon state.
Unless the fruits, which surround the seeds of some
vegetables, or the honey stolen from them by the bee,
may be said to be an exception to this assertion. See
Botanic Garden, P. I. Cant. I. l. 278. Note. Hence,
from the necessity of our nature, we may be supposed
to have a right to kill those creatures, which we want
to eat, or which want to eat us. But to destroy even
insects wantonly shews an unreflecting mind or a de-
praved heart.
Nevertheless mankind may be well divided into the
selfish and the social; that is, into those whole plea-
sures arise from gratifying their appetites, and those
whose pleasures arise from their sympathizing with
others. And according to the prevalence of these oppo-
sing propensities we value or dislike the possessor of them.
In conducting the education of young people, it is
a nice matter to inspire them with so much benevolent
sympathy, 

CLASS III. 1. 2.] OF VOLITION. 485
sympathy, or compassion, as may render them good
and amiable; and yet not so much as to make them
unhappy at the sight of incurable distress. We should
endeavour to make them alive to sympathize with all
remediable evils, and at the same time to arm them
with fortitude to bear the sight of such irremediable
evils, as the accidents of life must frequently present
before their eyes. About this I have treated more at
large in a plan for the conduct of a boarding school
for ladies, which I intend to publish in the course of
the next year.
25. Educatio heroica. From the kinds and degrees
of insanities already enumerated, the reader will pro-
bably recollect many more from his own observation;
he will perceive that all extraordinary exertions of vo-
luntary action in consequence of some false idea or hal-
lucination, which strongly affects us, may philosophi-
cally, though not popularly, be termed an insanity;
he will then be liable to divide these voluntary exer-
tions into disagreeable, pernicious, detestable, or into
meritorious, delectable, and even amiable, insanities.
And will lastly be induced to conceive, that a good
education consists in the art of producing such happy
hallucinations of ideas, as may be followed by such
voluntary exertions, as may be termed meritorious or
amiable insanities.
The old man of the mountain in Syria, who go-
verned a small nation of people called Assastines, is
recorded thus to have educated those of his army who 
were

486 DISEASES [Class III. 1. 2.
were designed to assassinate the princes with whom he
was at war. A young man of natural activity was
chosen for the purpose, and thrown into a deep sleep
by opium mixed with his food; he was then carried
into a garden made to represent the paradise of Maho-
met, with flowers of great beauty and fragrance,
fruits of delicious flavor, and beautiful houries beckon-
ing him into the shades. After a while, on being a
second time stupefied with opium, the young enthusiast
was reconveyed to his apartment; and on the next
day was assured by a priest, that he was designed for
some great exploit, and that by obeying the com-
mands of their prince, immortal happiness awaited
him.
Hence it is easy to collect how the first impressions
made on us by accidental circumstances in our infancy
continue through life to bias our affections, or mislead
our judgments. One of my acquaintance can trace the
origin of his own energies of action from some such re-
mote sources; which justifies the observation of M.
Rousseau, that the seeds of future virtues or vices are
oftener sown by the mother, than the tutor.
END OF VOL. I. OF PART II.